Articles de revues : « Distal Advice »

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Jones, Gareth T., Gary J. Macfarlane, Karen Walker-Bone, Kim Burton, Peter Heine, Candida McCabe, Paul McNamee et al. « Maintained physical activity and physiotherapy in the management of distal arm pain : a randomised controlled trial ». RMD Open 5, n^o 1 (mars 2019) : e000810. http://dx.doi.org/10.1136/rmdopen-2018-000810.

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ObjectivesThe epidemiology of distal arm pain and back pain are similar. However, management differs considerably: for back pain, rest is discouraged, whereas patients with distal arm pain are commonly advised to rest and referred to physiotherapy. We hypothesised that remaining active would reduce long-term disability and that fast-track physiotherapy would be superior to physiotherapy after time on a waiting list.MethodsAdults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6–8 weeks); advice to rest while awaiting physiotherapy, or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26 weeks was greater among the active advice group, compared with those advised to rest and/or among those receiving immediate versus usually timed physiotherapy.Results538 of 1663 patients invited between February 2012 and February 2014 were randomised (active=178; rest=182; immediate physiotherapy=178). 81% provided primary outcome data, and complete recovery was reported by 60 (44%), 46 (32%) and 53 (35%). Those advised to rest experienced a lower probability of recovery (OR: 0.54; 95% CI 0.32 to 0.90) versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 95% CI 0.39 to 1.07).ConclusionsAmong patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26-week functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared with physiotherapy delivered after 6–8 weeks waiting time. These findings question current guidance for the management of distal arm pain.

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Coughlin, Tim, Alan R. Norrish, Brigitte E. Scammell, Paul A. Matthews, Jessica Nightingale et Ben J. Ollivere. « Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures : a randomized controlled trial of effectiveness ». Bone & ; Joint Journal 103-B, n^o 6 (1 juin 2021) : 1033–39. http://dx.doi.org/10.1302/0301-620x.103b.bjj-2020-2026.r1.

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Aims Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Methods Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. Results A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). Conclusion Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy. Cite this article: Bone Joint J 2021;103-B(6):1033–1039.

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Fu, Guangliang, Arnold Heemink, Sha Lu, Arjo Segers, Konradin Weber et Hai-Xiang Lin. « Model-based aviation advice on distal volcanic ash clouds by assimilating aircraft in situ measurements ». Atmospheric Chemistry and Physics 16, n^o 14 (26 juillet 2016) : 9189–200. http://dx.doi.org/10.5194/acp-16-9189-2016.

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Abstract. The forecast accuracy of distal volcanic ash clouds is important for providing valid aviation advice during volcanic ash eruption. However, because the distal part of volcanic ash plume is far from the volcano, the influence of eruption information on this part becomes rather indirect and uncertain, resulting in inaccurate volcanic ash forecasts in these distal areas. In our approach, we use real-life aircraft in situ observations, measured in the northwestern part of Germany during the 2010 Eyjafjallajökull eruption, in an ensemble-based data assimilation system combined with a volcanic ash transport model to investigate the potential improvement on the forecast accuracy with regard to the distal volcanic ash plume. We show that the error of the analyzed volcanic ash state can be significantly reduced through assimilating real-life in situ measurements. After a continuous assimilation, it is shown that the aviation advice for Germany, the Netherlands and Luxembourg can be significantly improved. We suggest that with suitable aircrafts measuring once per day across the distal volcanic ash plume, the description and prediction of volcanic ash clouds in these areas can be greatly improved.

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Loisel, F., M. Bourgeois, T. Rondot, J. Nallet, M. Boeckstins, S. Rochet, G. Leclerc, L. Obert et D. Lepage. « Treatment goals for distal radius fractures in 2018 : recommendations and practical advice ». European Journal of Orthopaedic Surgery & ; Traumatology 28, n^o 8 (16 avril 2018) : 1465–68. http://dx.doi.org/10.1007/s00590-018-2196-9.

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Vielitz, Arne. « Radiusfraktur : schneller beweglich mit zusätzlicher Mobilisation mit Bewegung ». manuelletherapie 24, n^o 05 (décembre 2020) : 216. http://dx.doi.org/10.1055/a-1266-4680.

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Reid SA, Andersen JM, Vicenzino B. Adding Mobilisation with Movement to Exercise and Advice Hastens the Improvement in Range, Pain and Function after Non-Operative Cast Immobilisation for Distal Radius Fracture: a Multicentre, Randomised Trial. J Physiother 2020; 66: 105–112. doi:10.1016/j.jphys.2020.03.010

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Santosa, Agus. « Distal Hypospadias, Treated or Untreated ? : A Case Report ». Journal Of Nursing Practice 4, n^o 1 (31 octobre 2020) : 1–7. http://dx.doi.org/10.30994/jnp.v4i1.100.

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Background: Treatment for distal hypospadias is a controversy among the experts. Some argue that it does not require any surgery if it does not interfere with the patient's urinary and sexuality. Purpose: This study aimed to determine whether patients with distal hypospadias need treated or untreated.Methods: The method used is a case study. Participants in this study is a 10-year-old male with distal hypospadias—location of the study in Purwokerto city, Banyumas district, Central Java. Participants were interviewed and physically examined by a doctor and nurse. The results of interviews and physical examinations are recorded and analyzed based on a literature review to determine the decision, treatment, or untreated. Results: A 10-year-old patient with hypospadias and the pediatric urologist do not give surgery advice, because the urethral opening is still close to the glans penis, and there are no symptoms of urinary dysfunction. Conclusion: Patients with distal hypospadias may be untreated as long as they do not interfere with urinary function

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Bruder, Andrea M., Nora Shields, Karen J. Dodd, Raphael Hau et Nicholas F. Taylor. « A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture : a multi-centre, randomised trial ». Journal of Physiotherapy 62, n^o 3 (juillet 2016) : 145–52. http://dx.doi.org/10.1016/j.jphys.2016.05.011.

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Wachs, Sebastian, Juan Manuel Machimbarrena, Michelle F. Wright, Manuel Gámez-Guadix, Soeun Yang, Ruthaychonnee Sittichai, Ritu Singh et al. « Associations between Coping Strategies and Cyberhate Involvement : Evidence from Adolescents across Three World Regions ». International Journal of Environmental Research and Public Health 19, n^o 11 (31 mai 2022) : 6749. http://dx.doi.org/10.3390/ijerph19116749.

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Cyberhate represents a risk to adolescents’ development and peaceful coexistence in democratic societies. Yet, not much is known about the relationship between adolescents’ ability to cope with cyberhate and their cyberhate involvement. To fill current gaps in the literature and inform the development of media education programs, the present study investigated various coping strategies in a hypothetical cyberhate scenario as correlates for being cyberhate victims, perpetrators, and both victim–perpetrators. The sample consisted of 6829 adolescents aged 12–18 years old (Mage = 14.93, SD = 1.64; girls: 50.4%, boys: 48.9%, and 0.7% did not indicate their gender) from Asia, Europe, and North America. Results showed that adolescents who endorsed distal advice or endorsed technical coping showed a lower likelihood to be victims, perpetrators, or victim–perpetrators. In contrast, if adolescents felt helpless or endorsed retaliation to cope with cyberhate, they showed higher odds of being involved in cyberhate as victims, perpetrators, or victim–perpetrators. Finally, adolescents who endorsed close support as a coping strategy showed a lower likelihood to be victim–perpetrators, and adolescents who endorsed assertive coping showed higher odds of being victims. In conclusion, the results confirm the importance of addressing adolescents’ ability to deal with cyberhate to develop more tailored prevention approaches. More specifically, such initiatives should focus on adolescents who feel helpless or feel inclined to retaliate. In addition, adolescents should be educated to practice distal advice and technical coping when experiencing cyberhate. Implications for the design and instruction of evidence-based cyberhate prevention (e.g., online educational games, virtual learning environments) will be discussed.

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Kay, Sandra, Margaret McMahon et Kathy Stiller. « An advice and exercise program has some benefits over natural recovery after distal radius fracture : a randomised trial ». Australian Journal of Physiotherapy 54, n^o 4 (2008) : 253–59. http://dx.doi.org/10.1016/s0004-9514(08)70004-7.

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GOLDWIRTH, M., et D. R. A. GOODWIN. « The “Plastic Bag Syndrome” ». Journal of Hand Surgery 24, n^o 1 (février 1999) : 116–17. http://dx.doi.org/10.1016/s0266-7681(99)90059-1.

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We report a condition we call the “plastic bag syndrome” in which pressure on the neurovascular bundles causes temporary ischaemia in the distal part of the finger together with a neuropraxia of the digital nerves. Although in most cases the discomfort or numbness is fleeting, requires no medical assistance and is readily forgotten, in some instances the symptoms are such that medical advice is sought. Since the injury can lead to permanent damage and subsequent limitation in the use of the finger, we believe that the public should be advised to take simple precautions to prevent it from happening.

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Ruzanov, D. Yu, E. I. Davidovskaya, T. V. Baranouskaya, T. T. Shebusheva, I. V. Buynevich, L. V. Aleshkevich et V. E. Gavrilenko. « PHENOTYPES AND STATES OF UNCONTROLLED BRONCHIAL ASTHMA ». Health and Ecology Issues, n^o 2 (28 juin 2016) : 34–38. http://dx.doi.org/10.51523/2708-6011.2016-13-2-7.

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Aim: analyzing the causes of the uncontrolled course of bronchial asthma (BA) to reveal the states and phenotypes influencing the efficiency of therapy. Material and methods. 762 patients seeking medical advice or referred for specialized pulmonogical aid have been comprehensively examined. Results. We have defined the prevalence of different phenotypes and states of asthma and the risk for the uncontrolled course of BA. Conclusion. Patients with chronically severe distal and unstable BA detect the highest risk for the uncontrolled course in the absence of compliance, in irrational therapy, asthma-COPD overlap syndrome, decompensated chronic severe pathology and critical mistakes in the application of dosage aerosol inhalators.

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Saxena, Pradeep, Swastik Bhardwaj, Tarun Sutrave et Ankit Lalchandani. « A rare case of malignant pancreatic non-functional neuroendocrine tumor presenting as huge abdominal lump ». International Surgery Journal 9, n^o 5 (26 avril 2022) : 1094. http://dx.doi.org/10.18203/2349-2902.isj20221164.

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We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor (PNET) in a young female. The tumor occupied the whole abdomen and pelvis and was clinically masqueraded as an ovarian tumor. Imaging with contrast enhanced CT scan and magnetic resonance imaging of the abdomen aided in preoperative diagnosis of origin of the tumor from the pancreas. Distal pancreatectomy with splenectomy and left hemicolectomy was done. Primary colocolic anastomosis was done for reconstruction. Postop course was uneventful, and patient was discharged with advice to undergo adjuvant chemotherapy. Surgical excision of large size locally advanced non-functional PNET should be done with curative intention/ to treat symptoms and improve patient survival

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Saxena, Pradeep, Swastik Bhardwaj, Tarun Sutrave et Ankit Lalchandani. « A rare case of malignant pancreatic non-functional neuroendocrine tumor presenting as huge abdominal lump ». International Surgery Journal 9, n^o 5 (26 avril 2022) : 1094. http://dx.doi.org/10.18203/2349-2902.isj20221164.

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We present a case of an exceptionally large size non-functioning pancreatic neuroendocrine tumor (PNET) in a young female. The tumor occupied the whole abdomen and pelvis and was clinically masqueraded as an ovarian tumor. Imaging with contrast enhanced CT scan and magnetic resonance imaging of the abdomen aided in preoperative diagnosis of origin of the tumor from the pancreas. Distal pancreatectomy with splenectomy and left hemicolectomy was done. Primary colocolic anastomosis was done for reconstruction. Postop course was uneventful, and patient was discharged with advice to undergo adjuvant chemotherapy. Surgical excision of large size locally advanced non-functional PNET should be done with curative intention/ to treat symptoms and improve patient survival

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Langerhuizen, David W. G., Stein J. Janssen, Joost T. P. Kortlever, David Ring, Gino M. M. J. Kerkhoffs, Ruurd L. Jaarsma et Job N. Doornberg. « Factors Associated with a Recommendation for Operative Treatment for Fracture of the Distal Radius ». Journal of Wrist Surgery 10, n^o 04 (11 mars 2021) : 316–21. http://dx.doi.org/10.1055/s-0041-1725962.

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Abstract Background Evidence suggests that there is substantial and unexplained surgeon-to-surgeon variation in recommendation of operative treatment for fractures of the distal radius. We studied (1) what factors are associated with recommendation for operative treatment of a fracture of the distal radius and (2) which factors are rated as the most influential on recommendation of operative treatment. Methods One-hundred thirty-one upper extremity and fracture surgeons evaluated 20 fictitious patient scenarios with randomly assigned factors (e.g., personal, clinical, and radiologic factors) for patients with a fracture of the distal radius. They addressed the following questions: (1) Do you recommend operative treatment for this patient (yes/no)? We determined the influence of each factor on this recommendation using random forest algorithms. Also, participants rated the influence of each factor—excluding age and sex— on a scale from 0 (not at all important) to 10 (extremely important). Results Random forest algorithms determined that age and angulation were having the most influence on recommendation for operative treatment of a fracture of the distal radius. Angulation on the lateral radiograph and presence or absence of lunate subluxation were rated as having the greatest influence and smoking status and stress levels the lowest influence on advice to patients. Conclusions The observation that—other than age—personal factors have limited influence on surgeon recommendations for surgery may reflect how surgeon cognitive biases, personal preferences, different perspectives, and incentives may contribute to variations in care. Future research can determine whether decision aids—those that use patient-specific probabilities based on predictive analytics in particular—might help match patient treatment choices to what matters most to them, in part by helping to neutralize the influence of common misconceptions as well as surgeon bias and incentives. Level of Evidence There is no level of evidence for the study.

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Hutchison, Anne-Marie, Owen Bodger, Rhys Whelan, I. Dougie Russell, Wing Man, Paul Williams et Andrew Bebbington. « Functional outcome and patient satisfaction with a ‘self-care’ protocol for minimally displaced distal radius fractures ». Bone & ; Joint Open 3, n^o 9 (1 septembre 2022) : 726–32. http://dx.doi.org/10.1302/2633-1462.39.bjo-2022-0077.r1.

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Aims We introduced a self-care pathway for minimally displaced distal radius fractures, which involved the patient being discharged from a Virtual Fracture Clinic (VFC) without a physical review and being provided with written instructions on how to remove their own cast or splint at home, plus advice on exercises and return to function. Methods All patients managed via this protocol between March and October 2020 were contacted by a medical secretary at a minimum of six months post-injury. The patients were asked to complete the Patient-Rated Wrist Evaluation (PRWE), a satisfaction questionnaire, advise if they had required surgery and/or contacted any health professional, and were also asked for any recommendations on how to improve the service. A review with a hand surgeon was organized if required, and a cost analysis was also conducted. Results Overall 71/101 patients completed the telephone consultation; no patients required surgery, and the mean and median PRWE scores were 23.9/100 (SD 24.9) and 17.0/100 (interquartile range (IQR) 0 to 40), respectively. Mean patient satisfaction with treatment was 34.3/40 (SD 9.2), and 65 patients (92%) were satisfied or highly satisfied. In total there were 16 contact calls, 12 requests for a consultant review, no formal complaints, and 15 minor adjustment suggestions to improve patient experience. A relationship was found between intra-articular injuries and lower patient satisfaction scores (p = 0.025), however no relationship was found between PRWE scores and the nature of the fracture. Also, no relationship was found between the type of immobilization and the functional outcome or patient satisfaction. Cost analysis of the self-care pathway V traditional pathway showed a cost savings of over £13,500 per year with the new self-care model compared to the traditional model. Conclusion Our study supports a VFC self-care pathway for patients with minimally displaced distal radius fractures. The pathway provides a good level of patient satisfaction and function. To improve the service, we will make minor amendments to our patient information sheet. Cite this article: Bone Jt Open 2022;3(9):726–732.

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Ballhause, Tobias M., Roland Gessler, Matthias H. Priemel, Karl-Heinz Frosch et Carsten W. Schlickewei. « Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta ». Case Reports in Orthopedics 2020 (13 juillet 2020) : 1–7. http://dx.doi.org/10.1155/2020/8887644.

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Introduction. Osteogenesis imperfecta (OI) is the term for a heterogenic group of conatal diseases that affect the bone formation. Eight different OI types are known. Patients with types III and IV frequently suffer from fractures without adequate trauma. The literature gives plenty advice for fracture treatment in pediatric OI patients, but there is less for adults, and no recommendations can be found for geriatric OI patients. Case Presentation. We report on an 83-year-old male who suffered from OI type IV. He was able to walk with an individually adapted gait orthosis. In an accident, the patient sustained a distal, multifragment, femoral shaft fracture. The fracture was openly reduced and fixated with a retrograde inserted elastic stable intramedullary nail (ESIN). Three months later, the patient was capable of walking without crutches. Due to another accident, he sustained a peri-implant refracture without failure of the ESIN. We immobilized the leg, and it achieved bony healing without reosteosynthesis. Eleven weeks later, he was again able to mobilize himself with full weight bearing. Discussion. We present a unique case of osteosynthesis in a distal, multifragment, femoral shaft fracture in a geriatric OI patient. No recommendations for the treatment of mature patients with OI can be found in the literature. We present our treatment concept and technique of osteosynthesis with an ESIN. Despite another accident with a peri-implant refracture, sufficient bony healing occurred, which allowed the patient to freely mobilize himself again.

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Mehershahi, Shehriyar, Haider Ghazanfar, Shoaib Ashraf, Danial H. Shaikh et Harish Patel. « Colitis Induced by Colon-Cleansing Agent ». Case Reports in Gastroenterology 15, n^o 2 (8 juillet 2021) : 621–25. http://dx.doi.org/10.1159/000514440.

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Constipation is one of the most common functional gastrointestinal disorders and affects 20% of the general population. Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract that affects the large intestine and is characterized by chronic abdominal pain and altered bowel habits. We report a case of a 35-year-old African American man with a past medical history of IBS who presented to the clinic with a chief complaint of abdominal pain and bloody diarrhea for 1 week. The patient stated that he used a colon-cleansing agent because of persistent constipation. Computed tomography scan of the patient’s abdomen and pelvis with contrast was performed which showed diffuse contiguous segmental mural thickening and nodularity seen along the distal transverse, descending, and sigmoid colon. Colonoscopy showed moderate diffuse inflammation characterized by altered vascularity, erythema, and granularity from the rectum to the descending colon, and localized mild inflammation characterized by erythema was found at the ileocecal valve. The patient’s clinical condition improved with symptomatic management over 10 days. Patients with IBS should be advised to restrain from using a colon-cleansing agent without advice from their primary doctor as it can lead to various complications.

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Reid, Susan A., Josef M. Andersen et Bill Vicenzino. « Adding mobilisation with movement to exercise and advice hastens the improvement in range, pain and function after non-operative cast immobilisation for distal radius fracture : a multicentre, randomised trial ». Journal of Physiotherapy 66, n^o 2 (avril 2020) : 105–12. http://dx.doi.org/10.1016/j.jphys.2020.03.010.

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Tsao, Wen-Yu. « Building the long bridge between visitors and customers through online general reviews ». Online Information Review 43, n^o 2 (8 avril 2019) : 201–18. http://dx.doi.org/10.1108/oir-01-2016-0028.

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Purpose Many reviews on the internet are contributed their time to evaluate which are largely transparent generally; however, How are these information valuable and useful to visitors before making a purchasing decision? As the reason, there is a need to understand the distal path of visitors concern. The purpose of this paper is to evaluate the effects of both perceived useful and valuable motivations on visitors’ willingness to buy in the distal paths. Design/methodology/approach Web questionnaire survey. Findings Visitors’ confirmation was the beginning to impact the intention to buy through only one distal path, perceived value (PV) and satisfaction. Research limitations/implications Even though the author tried his best to design and implement thoughtfully for this research, there are still some limitations. First, the results could be influenced by self-selection bias. The sample of respondents surveyed in this study consisted of young adults (58.90 percent were between the ages 21 and 25 years old), the majority of whom (54.79 percent) were students. Therefore, in the context of this study, the visitors surveyed were young and able to easily access information online. The phenomenon has been, proved by Hsu (2013), found, it still needs to explore further. Second, perceived usefulness did not have a significant impact on satisfaction which consistent with Tao et al. (2009) result. The data represent the response’ feeling for now; it needs to be explored further. Third, it would also be worthwhile to investigate any obstacles, such as believable (Cheung et al., 2012) that might reduce the intentions to buy of visitors. Finally, recommendations and promotions have also been found to influence visitors’ further purchasing behavior, such as extra buy (Tsao, 2013). These phenomena are worth investigating in future research. Practical implications To inspire visitors, information of reviews can be posted by offering positive or negative suggestions (e.g. good or bad experience); managers should improve their products or services from the suggestions of reviews and need to consider the distinctive influences of various aspects of reviews when promoting products and devising e-marketing strategies. Marketers should recruit and filter reviews to write positive suggestions of their own products or service. IS practitioners should post the reviews might need to provide more detailed information (e.g. the reasons of like or dislike). The posted information from reviews should be accurate, particularly aiming at visitors who are motivated by reviews’ suggestions. All proposed measures are particularly important for visitors with sufficient reviews effects. Greater transparency of reviews might be achieved by more explicit reviews information (e.g. via like or dislike statements). Social implications The result provides a basis to generate concrete advice for owners about reviews concern to enhance visitors’ PV. It seems sensible to pursue two strategies: first, enhance the visitors’ PV to trigger motivation forward, and second, inspire the visitors to progress smoothly in the visiting stage. Originality/value The results of the expectation-confirmation theory applied to reviews recommendations how important to employ for enterprises. These reviews were either directly given by experienced users or at least validated with their help to visitors. Therefore, the value is building the distal bridge between visitors and customers through online general reviews.

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Lopez, Valeria, Gaston Slullitel, Cristian Ortiz, Emilio Wagner, Gustavo Norberto Pinton et Victoria Alvarez. « Muscular Vein Thrombosis Previous to Immobilization in Acute Tendo Achilles Rupture ». Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000267.

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Category: Ankle Introduction/Purpose: Thromboembolic complications during lower-limb immobilization after Achilles tendon ruptures are common. Both operative and nonoperative treatments of Achilles rupture include a period of immobilization which is a well- documented risk factor for distal vein thrombosis. Curiously, there is a gap in literature linking the diagnosis of thromboembolic events to the Achilles rupture previous to the inmobilization. The term DTV refers to the anterior/posterior tibial or the peroneal veins, i.e. those that correspond to arterial structures and comprise the profound vein system. Although still with little agreement, the role of muscular vein thrombosis or isolated gastrocnemius or soleus vein thrombosis are gaining relevance within the current published data, despite there is no report of it association with tendo Achilles rupture before or after the initiation of treatment. Methods: Case report: Five consecutive patients with a diagnosis of traumatic Achilles rupture were evaluated. All patients sustained non traumatic injuries. One of the patients was a heavy smoker, and two of them had BMI over 25. We routinely execute an ultrasound to locate the rupture site and at the same time color ultrasound Doppler was performed by an expert in vascular echography, before the initiation of treatment. In all cases a thrombosis of the calf muscle veins was found. Surgical treatment was not advice in any of the patients and definitive treatment was conservative. Results: Calf muscle veins are deep veins in the distal lower extremity that are nonpaired and not associated with named tibial arteries. These veins make up a complex venous system of the musculature of the posterior leg and include the soleal and gastrocnemius veins that run as sinusoids within the muscles of the same name. The soleal sinusoids may drain into the midperoneal or posterior tibial veins, whereas the gastrocnemius sinusoids may empty directly into the popliteal vein. Although the real incidence of MVT is extremely variable, in patients presenting with symptoms and signs suspicious for distal vein thrombosis, muscular veins have been shown to be the most common location for thrombosis with 23% to 41% of all patients. Conclusion: Our group of patients was diagnosed before immobilization was established. One plausible explanation could be that the muscle trauma associated with the tendinous rupture may have some influence in the thrombi generation triggering endothelial dysfunction, or affecting the calf muscle pump creating venous stasis, conditions that favour the VTE appearance. It is our perspective that although not well stablished there is at least a theoretical risk of further propagation to the profound venous system and subsequently to the pulmonary system, and this fact not only conditions the treatment of MVT itself, but also the treatment of the Achilles rupture.

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Stepanyan, Marina Ju, Elena V. Komarova, Nikolay N. Murashkin et Ekaterina I. Alexeeva. « Symptoms of Oesophageal Affection in Children With Scleroderma According to Mano-Impedancemetry : A Case Series ». Pediatric pharmacology 15, n^o 6 (20 février 2019) : 464–69. http://dx.doi.org/10.15690/pf.v15i6.1985.

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Background.Currently, scleroderma is a rather rare disease, including among children. Despite the growing interest of investigators in this pathology, the problem of diagnosing oesophageal affection in various forms of systemic sclerosis remains under-investigated since endoscopic data does not provide a complete picture of the oesophageal function. Currently, mano-impedancemetry (MIP) is the leading method in Europe for determining the oesophageal function, including in children with scleroderma; in the Russian Federation, it is used only in adults. Proper and timely evaluation of the oesophageal motility state will allow not only to expand our understanding of the disease pathogenesis but also to determine the efficacy of the initiated therapy and to give practice suggestions in terms of treatment tactics in the early stages of the disease.Our aim wasto determine the possibilities of mano-impedancemetry for diagnosing oesophageal affection in juvenile scleroderma.Patients and Methods.The study included children with juvenile scleroderma taken to the department of rheumatology and dermatology from June to August 2016. To identify oesophageal function disorders, all patients underwent high-resolution manometry in combination with impedancemetry.Results.A decrease in the distal oesophageal contraction amplitude in more than 30% of “wet” swallows was found in 2 of 7 children with juvenile systemic scleroderma and in one of 6 children with juvenile focal scleroderma. All 13 patients had peristaltic waves in the distal oesophagus with an amplitude of <30 mm Hg. They had interrupted peristalsis, in which the peristaltic wave did not go through the entire length of the oesophagus; one of these patients showed a simultaneous contraction with an amplitude of <30 mm Hg. All children (n=13) showed a positive correlation (r= 0.021) between the systemic disease and impaired motility (р=0.021).Conclusion.Despite the clinical and laboratory methods for diagnosing scleroderma, the data of oesophageal mano-impedancemetry is an important criterion, primarily for the differential diagnosis of systemic and focal scleroderma, and assists in the early initiation of therapy for oesophageal motility disorders.Marina Ju. Stepanyan, Ekaterina I. Alexeeva, Elena V. Komarova confirmed the absence of a reportable conflict of interest.Ekaterina I. Alexeeva — receiving research grants from Pfizer, Roche, Centocor, Novartis.Nikolay N. Murashkin — receiving research funding from pharmaceutical companies Jansen, Eli Lilly. Receiving fees for scientific advice from Galderma, Pierre Fabre, Bayer, Astellas, Libriderm.

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Amato, Alexandre Campos Moraes, Ricardo Virgínio dos Santos, Dumitriu Zunino Saucedo et Salvador José de Toledo Arruda Amato. « Machine learning in prediction of individual patient readmissions for elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repair, and femoral-distal arterial bypass ». SAGE Open Medicine 8 (janvier 2020) : 205031212090905. http://dx.doi.org/10.1177/2050312120909057.

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Objective: Early hospital readmissions have been rising and are increasingly used for public reporting and pay-for-performance. The readmission problem is fundamentally different in surgical patients compared with medical patients. There is an opportunity to intervene preoperatively to decrease the risk of readmission postoperatively. Methods: A predictive model of 90-day hospital readmission for patients undergoing elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repair, and femoral-distal arterial bypass was developed using data from the Healthcare Cost and Utilization Project State Inpatient Database for Florida State. The model training followed a nested resampling method with subsampling to increase execution speed and reduce overfitting. The following predictors were used: age, gender, race, median household income, primary expected payer, patient location, admission type, Elixhauser–van Walraven Comorbidity Index, Charlson comorbidity score, main surgical procedure, length of stay, disposition of the patient at discharge, period of the year, hospital volume, and surgeon volume. Results: Our sample comprised data on 246,405 patients, of whom 30.3% were readmitted within 90 days. Readmitted patients were more likely to be admitted via emergency (47.2% vs 30%), included a higher percentage with a Charlson score greater than 3 (35.8% vs 18.7%), had a higher mean van Walraven score (8.32 vs 5.34), and had a higher mean length of hospital stay (6.59 vs 3.51). Endarterectomy was the most common procedure, accounting for 19.9% of all procedures. When predicting 90-day readmission, Shrinkage Discriminant Analysis was the best performing model (area under the curve = 0.68). Important variables for the best predictive model included length of stay in the hospital, comorbidity scores, endarterectomy procedure, and elective admission type. The survival analysis for the time to readmission after the surgical procedures demonstrated that the hazard ratios were higher for subjects who presented Charlson comorbidity score above three (2.29 (2.26, 2.33)), patients transferred to a short-term hospital (2.4 (2.23, 2.59)), home healthcare (1.64 (1.61, 1.68)), other type of facility (2.59 (2.54, 2.63)) or discharged against medical advice (2.06 (1.88, 2.26)), and those with greater length of stay (1.89 (1.86, 1.91)). Conclusion: The model stratifies readmission risk on the basis of vascular procedure type, which suggests that attempts to decrease vascular readmission should focus on emergency procedures. Given the current focus on readmissions and increasing pressure to prevent unplanned readmissions, this score stratifies patients by readmission risk, providing an additional resource to identify and prevent unnecessary readmissions.

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Chong, Syn Yi, et Soo Fan Ang. « The Clinicopathological Features and Staging at Presentation of Gastric Cancer : A Single-Center Retrospective Study ». Asian Journal of Oncology 06, n^o 03 (10 juillet 2020) : 120–26. http://dx.doi.org/10.1055/s-0040-1714307.

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Abstract Introduction Gastric cancer (GC) is the third leading cause of cancer death, with most patients diagnosed at a later stage, with distant metastasis at the time of presentation, contributing to poor prognosis. GC has been associated with nonspecific clinical presentations, which cause a time delay for patients to seek for medical advice. This study aims to identify the clinicopathological features of GC patients and correlate time delay of the diagnosis to the staging of the disease. Materials and Methods This is a single-center retrospective study of GC patients diagnosed from January 2012 to December 2018. All relevant data of GC patient diagnosed during this time period were extracted from the patients’ case notes. Results A total of 69 GC patients were included in this study, with male preponderance and mean age of 62 years old. The top three symptoms presented are dyspepsia or ingestion (47.8%), weight loss (43.5%), and nausea or vomiting (33.3%). The mean time delay was 3.7 months. Patients presented with weight loss have a significantly longer average time delay of 4.88 months. Most tumor lesion was found at the distal stomach (43.5%), while 74.5% tested negative for Helicobacter pylori. Most patients were diagnosed at Stage IV (52.6%) and Stage III (36.8%) of the disease, with poorly differentiated (67.7%) histological features which have poor prognosis. Discussion and Conclusion No evidence of specific symptom or combination of symptoms predicts higher risk of GC. Regardless of the number of symptoms presented or the time delay, most GC patients were diagnosed at later stage of the disease. The study shows the importance of GC screening in Malaysia to ensure early detection, even before a symptom presented.

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Beckett, Frances, Eduardo Rossi, Benjamin Devenish, Claire Witham et Costanza Bonadonna. « Modelling the size distribution of aggregated volcanic ash and implications for operational atmospheric dispersion modelling ». Atmospheric Chemistry and Physics 22, n^o 5 (15 mars 2022) : 3409–31. http://dx.doi.org/10.5194/acp-22-3409-2022.

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Abstract. We have developed an aggregation scheme for use with the Lagrangian atmospheric transport and dispersion model NAME (Numerical Atmospheric Dispersion modelling Environment), which is used by the London Volcanic Ash Advisory Centre (VAAC) to provide advice and guidance on the location of volcanic ash clouds to the aviation industry. The aggregation scheme uses the fixed pivot technique to solve the Smoluchowski coagulation equations to simulate aggregation processes in an eruption column. This represents the first attempt at modelling explicitly the change in the grain size distribution (GSD) of the ash due to aggregation in a model which is used for operational response. To understand the sensitivity of the output aggregated GSD to the model parameters, we conducted a simple parametric study and scaling analysis. We find that the modelled aggregated GSD is sensitive to the density distribution and grain size distribution assigned to the non-aggregated particles at the source. Our ability to accurately forecast the long-range transport of volcanic ash clouds is, therefore, still limited by real-time information on the physical characteristics of the ash. We assess the impact of using the aggregated GSD on model simulations of the 2010 Eyjafjallajökull ash cloud and consider the implications for operational forecasting. Using the time-evolving aggregated GSD at the top of the eruption column to initialize dispersion model simulations had little impact on the modelled extent and mass loadings in the distal ash cloud. Our aggregation scheme does not account for the density of the aggregates; however, if we assume that the aggregates have the same density of single grains of equivalent size, the modelled area of the Eyjafjallajökull ash cloud with high concentrations of ash, significant for aviation, is reduced by ∼ 2 %, 24 h after the start of the release. If we assume that the aggregates have a lower density (500 kg m−3) than the single grains of which they are composed and make up 75 % of the mass in the ash cloud, the extent is 1.1 times larger.

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Casal-Beloy, Isabel, Sara Ramallo Varela, Miriam García-González et Iván Somoza Argibay. « Distal Urethral Advance and Glanduloplasty (DUAGPI) for Distal Hypospadias : A 15 Years Experience ». Archivos Españoles de Urología 75, n^o 5 (2022) : 435. http://dx.doi.org/10.56434/j.arch.esp.urol.20227505.63.

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Madeley, N. Jane, Nnamdi Obi, Chinnasamy Senthil Kumar et Lech Rymaszewski. « Low Risk of Displacement with Early Weight Bearing of the Isolated Weber B Fracture : Results of a New Treatment Protocol ». Foot & ; Ankle Orthopaedics 5, n^o 4 (1 octobre 2020) : 2473011420S0034. http://dx.doi.org/10.1177/2473011420s00341.

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Category: Trauma; Ankle Introduction/Purpose: Truly isolated Weber B distal fibula fractures are stable injuries that usually recover well following non- operative treatment, however the concern over the possibility of a medial ligament injury, and ankle instability has traditionally lead to regular surveillance in the fracture clinics to exclude delayed talar shift developing. After recent studies suggesting this risk is low we introduced a new functional treatment protocol and present our early results. Methods: 141 consecutive patients presenting acutely with isolated Weber B fractures without talar shift during a 12 months period were included. ED notes and radiographs were reviewed. All patients were splinted in a removable boot, and allowed to fully weight bear up to their comfort levels. Patients without signs of a medial ligament injury were then discharged from follow-up with advice to wear the boot for 6 weeks, an information leaflet and exercise sheet and a helpline number in case of difficulties. If they wanted clinic review this was organised. If signs of a medial ligament injury were documented, or the medial findings were not clear the patient was reviewed with up to date radiographs in the fracture clinic at 4 weeks post-injury. If talar shift developed the patient was to be converted to operative treatment. Olerud and Molander scores were collected between 6 and 12 months post- injury. Results: There were 51 patients without signs of medial ligament injury and of these 23 were discharged according to protocol and 28 patients attended fracture clinic. 89 patients had signs of medial ligament injury or no documented medial findings and of these 65 attended fracture clinic. One discharged patient re-accessed care. Of 93 patients reviewed in the fracture clinic none developed delayed talar shift. One underwent delayed ORIF for ongoing fibula discomfort and the remainder continued with non- operative treatment. 99 (70%) patients provided outcome scores. The mean Olerud and Molander score at a minimum of 6 months follow-up was 87 and the median score was 100. No significant difference was found between treatment arms. The scores were comparable to those in the published literature. Conclusion: We conclude the risk of delayed talar shift is low and satisfactory outcomes can be safely achieved with our functional protocol. Additional tests/imaging to establish the integrity of the medial ligament may be unnecessary.

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Khalilov, I. G. « Unimoment reconstruction of two-storeyed lesions of lower extremity arteries ». Kazan medical journal 80, n^o 3 (2 avril 1999) : 208–11. http://dx.doi.org/10.17816/kazmj66725.

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The comparative characteristic of the results of two basic surgical treatment methods of two-storeyed lesions of lower extremity arteries; proximal reconstruction and simultaneous reconstruction of both storeys is given. It is revealed that atherosclerosis progress in the distal anastomosis region of the aortofemoral shunt as well as in the popliteal artery region and its trifurcation can cause blood circulatior decompensation at remote terms after proxima reconstructions. The unimoment reconstruction makes it possible to exclude in advance from blood circulatior zone the potential hemodynamic barriers in deep femoral artery region, popliteal artery and its trifurcation arising with atherosclerosis developmen at remote terms after the primary operation as well as to decrease the probability of lesion of the dista anastomosis of aortofemoral shunt by neointima hyperplasia.

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Findley, Judith. « Interpretation of distal limb nerve blocks in the horse ». UK-Vet Equine 5, n^o 3 (2 mai 2021) : 104–8. http://dx.doi.org/10.12968/ukve.2021.5.3.104.

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Diagnostic analgesia of the distal limb is frequently performed in equine practice to localise lameness. The specificity of blocks has been widely investigated and it is important that clinicians understand the established blocking patterns and limitations for these blocks in order to correctly advise clients on diagnosis, further imaging and prognosis. This article examines the evidence relating to interpretation of distal limb blocks.

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Rawle, Heather, Paul Holmes, Veronica J. Thomas, Ronwyn Cartwright et Jo Howard. « Neuropsychology and MRI Observational Study In An Adult Sickle Cell Disease Population In South East London ». Blood 116, n^o 21 (19 novembre 2010) : 2642. http://dx.doi.org/10.1182/blood.v116.21.2642.2642.

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Abstract Abstract 2642 We studied 36 patients attending the sickle cell clinic in our large adult population of over 600 patients. These patients presented to the sickle psychology service because they had a past history of a stroke, or presented with concerns about memory. An MRI brain scan and neuropsychological testing (including tests for IQ, processing speed, executive function and memory) were performed on each patient. The data were organised into four groups in terms of severity of MRI abnormalities: normal MRI n=13; silent cerebral infarcts (subcortical punctate small vessel cerebrovascular disease) n= 11; severe infarcts as an adult n=8; and severe infarcts as a child n=4. The majority of patients with a history of stroke had evidence of large vessel infarcts as well as features of deep watershed ischaemia seen in large vessel (distal internal carotid artery) disease. These groups did not differ significantly in terms of gender, phenotype, age and mood. Cognitive impairments were more prevalent in the severe infarct groups but were also found in patients with silent cerebral infarcts and normal MRIs. Executive functioning and processing speed deficits were evident in all groups but were more severe in the silent cerebral infarct and severe infarct groups. Chi-squared tests for trend showed that the following test scores tended to reduce as MRI abnormalities increased: Full-Scale IQ (p=0.016), Processing Speed Index (p=0.015), Trail Making Test A (p=0.014), Trail Making Test B (p=0.018), and FAS Verbal Fluency Test (p=0.006). This suggests that executive functioning, processing speed and full-scale IQ are particularly vulnerable to the effects of MRI abnormalities in this patient population. Although the cognitive impairments were more severe in the groups with abnormal MRIs, there was significant cognitive impairment in some patients with normal MRIs, suggesting that other factors are also causative of cognitive impairments. These factors may include physiological causes such as impaired perfusion, and psychosocial factors such as disruption to education. These results agree with a recent US study (Vichinsky et al, 2010, JAMA, 303, 1823–1831) showing cognitive impairment in patients with normal MRI scans which implies that MRI is not an adequate screening tool to identify patients with cognitive impairment. This study has important clinical implications in terms of how cognitive deficits can affect the effectiveness of patient – health care professional consultations, patients' ability to manage their SCD and adhere to medication and health care advice. It is important therefore to identify patients with SCD who have such cognitive impairments so appropriate support can be offered. Disclosures: No relevant conflicts of interest to declare.

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Freeman, Roy, Jennifer S. Gewandter, Catharina G. Faber, Christopher Gibbons, Simon Haroutounian, Giuseppe Lauria, Todd Levine et al. « Idiopathic distal sensory polyneuropathy ». Neurology 95, n^o 22 (14 octobre 2020) : 1005–14. http://dx.doi.org/10.1212/wnl.0000000000010988.

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ObjectiveTo present standardized diagnostic criteria for idiopathic distal sensory polyneuropathy (iDSP) and its subtypes: idiopathic mixed fiber sensory neuropathy (iMFN), idiopathic small fiber sensory neuropathy (iSFN), and idiopathic large fiber sensory neuropathy (iLFN) for use in research.MethodsThe Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks (ACTTION) public-private partnership with the Food and Drug Administration convened a meeting to develop consensus diagnostic criteria for iMFN, iSFN, and iLFN. After background presentations, a collaborative, iterative approach was used to develop expert consensus for new criteria.ResultsAn iDSP diagnosis requires at least 1 small fiber (SF) or large fiber (LF) symptom, at least 1 SF or LF sign, abnormalities in sensory nerve conduction studies (NCS) or distal intraepidermal nerve fiber density (IENFD), and exclusion of known etiologies. An iMFN diagnosis requires that at least 1 of the above clinical features is SF and 1 clinical feature is LF with abnormalities in sensory NCS or IENFD. Diagnostic criteria for iSFN require at least 1 SF symptom and at least 1 SF sign with abnormal IENFD, normal sensory NCS, and the absence of LF symptoms and signs. Diagnostic criteria for iLFN require at least 1 LF symptom and at least 1 LF sign with normal IENFD, abnormal sensory NCS, and absence of SF symptoms and signs.ConclusionAdoption of these standardized diagnostic criteria will advance research and clinical trials and spur development of novel therapies for iDSPs.

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Farr, Sebastian, Sergio Martínez-Alvarez, Kevin J. Little, Jeffrey Henstenburg, Robin Ristl, Alexandra Stauffer, Francisco Soldado et Dan A. Zlotolow. « The prevalence of Vickers’ ligament in Madelung’s deformity : a retrospective multicentre study of 75 surgical cases ». Journal of Hand Surgery (European Volume) 46, n^o 4 (17 janvier 2021) : 384–90. http://dx.doi.org/10.1177/1753193420981522.

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In a retrospective multicentre study, we aimed to correlate clinical factors and findings on plain radiographs and MRI with the intraoperative presence of Vickers’ ligament in Madelung’s deformity. We screened the records, in which the absence or presence of Vickers’ ligament was affirmatively indicated, of 75 consecutive operated extremities in 58 patients. In 83% a Vickers’ ligament was observed intraoperatively. The whole bone Madelung type (as opposed to the distal type) and a distal radial notch were independent, significant predictors for the presence of the ligament. The correct Vickers detection rate using MRI was 85% of the 27 cases for which MRI was available. Thus, the MRI was a good but not perfectly reliable modality. We conclude that Vickers’ ligament is present in the majority but not all cases with Madelung deformity. We advise that patients with a more severe type of Madelung’s deformity and a distal radial notch should be monitored closely. Level of evidence: IV

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Treifi, Amir, Jessica Cooper et Julian Yates. « Third molars : not so NICE ? risk factors for distal caries in mandibular second molars ». Dental Update 50, n^o 2 (2 février 2023) : 135–40. http://dx.doi.org/10.12968/denu.2023.50.2.135.

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UK guidelines currently advise against the prophylactic removal of mandibular third molars. However, growing evidence shows that asymptomatic impacted mandibular third molars may contribute to the formation of distal caries in mandibular second molars. Patients should be made aware that these guidelines do not necessarily prevent the potential development of decay or loss of mandibular second molars. A retrospective review, over 6 months, analysed the incidence and evaluated the risk for developing caries on the distal aspect of mandibular second molars, in patients referred for assessment of impacted third molars. Distal caries in the mandibular second molar was present in 24.1% of cases. Of these patients, 9% demonstrated caries bilaterally. In those who developed distal caries in the mandibular second molar, 76% of adjacent third molars demonstrated mesio-angular impaction, 91% of third molars were partially erupted, and 95% of third molars were either touching or in close proximity to the ACJ of the second molar tooth. The prophylactic removal or coronectomy of mesio-angluar or horizontally impacted third molars that are partially erupted and closely related to the ACJ of mandibular second molars may result in improved long-term patient outcomes. CPD/Clinical Relevance: The prophylactic removal or coronectomy of certain third molars may result in improved long-term patient outcomes.

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Gurkas, Erdem, Cetin Kursad Akpinar et Emrah Aytac. « ADVANCE : An effective and feasible technique in acute stroke treatment ». Interventional Neuroradiology 23, n^o 2 (13 décembre 2016) : 166–72. http://dx.doi.org/10.1177/1591019916682358.

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Background and purpose Different techniques regarding efficient utilization of thrombectomy devices have been reported. Here, we described a novel technique named ADVANCE that is based on advancing a distal access catheter over the stent retriever. In this study, we aimed to report our initial results with this novel thrombectomy technique. Methods and results Sixty-seven consecutive acute anterior circulation ischemic stroke patients (35 male, 32 female) between January 2015 and January 2016 who were treated by mechanical thrombectomy were included in this prospective study. Patients were classified randomly into two groups: patients treated with either the ADVANCE technique or standard technique. Patients had a mean age of 61.1 ± 12.9 years. The average NIHSS score was 15.8 ± 3.8. In the ADVANCE group, the successful revascularization (mTICI 2b–3) rate was 87.1% and the 90-day good functional outcome rate (mRS 0–2) was 74.1%. The revascularization rate in the ADVANCE group was significantly ( p = 0.005) better than the standard technique group and good functional outcome at 90 days in the ADVANCE group was non-significantly better than the standard technique group ( p = 0.052). Conclusions ADVANCE is the first comparison of this technique to standard stent retriever thrombectomy with a higher rate of revascularization with no emboli to new territory and fewer distal emboli to target territory. This safe and efficient technique needs to be validated in large patient series in new thrombectomy trials.

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Khan, Muhammad Zeb, Mohammad Khalid, Malik Mohammad Awan, Yasin, Muhammad Safdar et Adeel Akram. « Comparison of Intramedullary Interlocking Nailing (IMLNG) and Minimally Invasive Plate Osteosynthesis (MIPO) in Treating Extra Articular Distal Tibial Fractures ». Pakistan Journal of Medical and Health Sciences 16, n^o 7 (30 juillet 2022) : 933–35. http://dx.doi.org/10.53350/pjmhs22167933.

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Background: Due to limited blood flow and sparse soft tissue coverage, treating distal tibia fractures presents a considerable challenge for orthopaedic surgeons. Objective: Our study's objectives were to compare the outcomes of the two treatment modalities of minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) for extraarticular distal tibia fractures. Study Design: Randomized Controlled Trial Place and Duration of the Study: This study was conducted at Department of Orthopedic and Spine Surgery Sughra Shafi Medical Complex, Narowal from March 2021 to March 2022. Material Methods: During A total of 59 patients ( 30 in IMLN group and 29 in MIPO group), both male and female, with AO Type A, b and C distal tibial fractures lasting less than three days and ages ranging from 20 to 60, were enrolled for this research. At the most recent follow-up, clinical and radiological data were assessed. Results: The average duration to union was 21.9 weeks in the IMN group and 19.9 weeks in the MIPO group, and all of the examined patients eventually recovered. In the IMN group, the time to union was substantially greater (p= 0.001). Conclusion: Low operating, union, and hospitalisation times make MIPO advantageous. In order to lessen the morbidity of these patients, we advise using the minimally invasive plate osteosynthesis (MIPO) procedure as the first line of treatment for distal tibia fractures.. Keywords: Distal tibia fracture, minimally invasive plate osteosynthesis, intramedullary nailing,

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Wissner, Erik. « Ablation of atrial fibrillation using the fourth-generation cryoballoon Arctic Front Advance PRO ». Future Cardiology 17, n^o 1 (janvier 2021) : 81–87. http://dx.doi.org/10.2217/fca-2020-0066.

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The cryoballoon (CB) is a popular ablation technology used for pulmonary vein isolation. The fourth-generation CB, Arctic Front Advance PRO features a 40% shorter distal tip but retains the internal design from its second-generation predecessor. The Arctic Front Advance PRO and the second-generation CB demonstrated similar thermodynamic characteristics in a computational model. Several observational and retrospective studies established the acute safety and efficacy of the Arctic Front Advance PRO. Real-time electrical isolation was observed in 75–85% of pulmonary veins targeted with the Arctic Front Advance PRO resulting in shorter fluoroscopy and procedure times.

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Vickerman, Roger. « APPLYING THE DISMAL SCIENCE : WHEN ECONOMISTS GIVE ADVICE TO GOVERNMENTS - Edited by Iain McLean and Colin Jennings ». Public Administration 85, n^o 3 (septembre 2007) : 875–77. http://dx.doi.org/10.1111/j.1467-9299.2007.00673_9.x.

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Saver, Jeffrey L., Rene Chapot, Ronit Agid, Ameer E. Hassan, Ashutosh P. Jadhav, David S. Liebeskind, Kyriakos Lobotesis et al. « Thrombectomy for Distal, Medium Vessel Occlusions ». Stroke 51, n^o 9 (septembre 2020) : 2872–84. http://dx.doi.org/10.1161/strokeaha.120.028956.

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Endovascular thrombectomy (EVT) is well established as a highly effective treatment for acute ischemic stroke (AIS) due to proximal, large vessel occlusions (PLVOs). With iterative further advances in catheter technology, distal, medium vessel occlusions (DMVOs) are now emerging as a promising next potential EVT frontier. This consensus statement integrates recent epidemiological, anatomic, clinical, imaging, and therapeutic research on DMVO-AIS and provides a framework for further studies. DMVOs cause 25% to 40% of AISs, arising as primary thromboemboli and as unintended consequences of EVT performed for PLVOs, including emboli to new territories (ENTs) and emboli to distal territories (EDTs) within the initially compromised arterial field. The 6 distal medium arterial arbors (anterior cerebral artery [ACA], M2–M4 middle cerebral artery [MCA], posterior cerebral artery [PCA], posterior inferior cerebellar artery [PICA], anterior inferior cerebellar artery [AICA], and superior cerebellar artery [SCA]) typically have 25 anatomic segments and give rise to 34 distinct arterial branches nourishing highly differentiated, largely superficial cerebral neuroanatomical regions. DMVOs produce clinical syndromes that are highly heterogenous but frequently disabling. While intravenous fibrinolytics are more effective for distal than proximal occlusions, they fail to recanalize one-half to two-thirds of DMVOs. Early clinical series using recently available, smaller, more navigable stent retriever and thromboaspiration devices suggest EVT for DMVOs is safe, technically efficacious, and potentially clinically beneficial. Collaborative investigations are desirable to enhance imaging recognition of DMVOs; advance device design and technical efficacy; conduct large registry studies using harmonized, common data elements; and complete formal randomized trials, improving treatment of this frequent mechanism of stroke.

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Bleetman, Anthony. « Dismal performance in response to coronavirus : the problem no one wants to discuss – the NHS ». British Journal of Hospital Medicine 81, n^o 8 (2 août 2020) : 1–3. http://dx.doi.org/10.12968/hmed.2020.0438.

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The UK death toll from COVID-19 is currently the fourth worst in the world behind the USA, Brazil and Mexico. Possible reasons include delays in lockdown, the provision of scientific advice to government and the decisions that government made based on the information they were given. When we review our performance and plan for the next public health crisis, we need to be brave enough to dare to challenge the NHS and its advisors.

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Hauck, Erik F., Sabareesh K. Natarajan, David J. Langer, L. Nelson Hopkins, Adnan H. Siddiqui et Elad I. Levy. « Retrograde Trans-Posterior Communicating Artery Snare-Assisted Rescue of Lost Access to a Foreshortened Pipeline Embolization Device : Complication Management ». Operative Neurosurgery 67, suppl_2 (1 décembre 2010) : ons495—ons502. http://dx.doi.org/10.1227/neu.0b013e3181f8530d.

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ABSTRACT BACKGROUND AND IMPORTANCE: The Pipeline embolization device (PED; Covidien Vascular Therapies, Mansfield, Massachusetts) is a promising, yet experimental, vascular reconstruction device for the treatment of complex intracranial aneurysms. We present a PED-related complication and describe a salvage strategy. CLINICAL PRESENTATION: A 64-year-old woman underwent PED-assisted parent vessel reconstruction for her giant cavernous internal carotid artery (ICA) aneurysm. During placement of the first PED, the proximal part of the PED foreshortened and was displaced into the aneurysm sac. Multiple subsequent attempts to recatheterize the PED failed, and, ultimately, distal access through and beyond the PED was lost. Therefore, completion of the Pipeline construct by stacking PEDs for definitive treatment was prevented. Retrograde access of the PED was gained from the distal ICA through a microwire that was advanced from the basilar artery through the posterior communicating artery. The microwire from the distal ICA was grasped with a snare from the proximal ICA and pulled down to the cervical ICA. The opened snare around the microwire was used as a lasso to advance a microcatheter from the cervical ICA through the PED to regain distal access. Five more PEDs were used to achieve complete parent vessel reconstruction and aneurysm obliteration. CONCLUSION: Maintaining distal access is critical until the entire parent vessel is reconstructed, especially when multiple PEDs are required. The salvage technique described may help regain distal access if it is lost during the procedure.

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Vikner, Tomas, Lars Nyberg, Madelene Holmgren, Jan Malm, Anders Eklund et Anders Wåhlin. « Characterizing pulsatility in distal cerebral arteries using 4D flow MRI ». Journal of Cerebral Blood Flow & ; Metabolism 40, n^o 12 (13 novembre 2019) : 2429–40. http://dx.doi.org/10.1177/0271678x19886667.

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Recent reports have suggested that age-related arterial stiffening and excessive cerebral arterial pulsatility cause blood–brain barrier breakdown, brain atrophy and cognitive decline. This has spurred interest in developing non-invasive methods to measure pulsatility in distal vessels, closer to the cerebral microcirculation. Here, we report a method based on four-dimensional (4D) flow MRI to estimate a global composite flow waveform of distal cerebral arteries. The method is based on finding and sampling arterial waveforms from thousands of cross sections in numerous small vessels of the brain, originating from cerebral cortical arteries. We demonstrate agreement with internal and external reference methods and show the ability to capture significant increases in distal cerebral arterial pulsatility as a function of age. The proposed approach can be used to advance our understanding regarding excessive arterial pulsatility as a potential trigger of cognitive decline and dementia.

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Newlin Lew, Kelley, Tracey Arnold, Catherine Cantelmo, Francky Jacque, Hugo Posada-Quintero, Pooja Luthra et Ki H. Chon. « Diabetes Distal Peripheral Neuropathy : Subtypes and Diagnostic and Screening Technologies ». Journal of Diabetes Science and Technology 16, n^o 2 (7 janvier 2022) : 295–320. http://dx.doi.org/10.1177/19322968211035375.

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Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present ( N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.

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Vande Voorde, Kira, Jan Dauwe et Jan Van Oost. « Late Presentation of an Iatrogenic Pseudoaneurysm of the Profunda Femoris Artery following Intramedullary Nailing ». Case Reports in Orthopedics 2018 (23 septembre 2018) : 1–5. http://dx.doi.org/10.1155/2018/8270256.

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Introduction. Hip fractures are one of the most common osteoporotic fractures, and the incidence is expected to increase in the future. Vascular injury of the femoral vessels, although uncommon, is an intermittently reported complication in the treatment of proximal femoral fractures. This may be iatrogenic or less frequently as a result of the fracture itself. The profunda femoris artery is most commonly involved, probably because of its close relationship to the femur in the subtrochanteric region. Case Presentation. We report a well-documented case of pseudoaneurysm of the profunda femoris artery after intramedullary nailing of an intertrochanteric femoral fracture. Arterial damage was due to overpenetration when drilling the distal locking hole. Because of the late presentation, pressure on the medial femoral diaphysis caused severe cortical scalloping. This resulted in an obvious radiographic image rarely reported before. Conclusion. This case report illustrates the uncommon complication of pseudoaneurysm after intramedullary hip nailing. Because of the risk of potentially limb- and life-threatening complications, we advise careful drilling and placement of the distal locking screw. Excessive screw length should be avoided. The injured limb should be returned to the neutral position and lower-limb traction should be reduced before drilling the distal locking hole.

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Hadirca, Laurentiu. « Access to Justice for National Minorities – A Recurrent Theme in the Work of the osce High Commissioner on National Minorities ». International Journal on Minority and Group Rights 24, n^o 2 (18 mai 2017) : 174–94. http://dx.doi.org/10.1163/15718115-02402001.

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This article provides an overview of the work of the osce hcnm on issues of access to justice for national minorities, based on a review of relevant thematic recommendations, country-specific advice, official statements, as well as other activities, projects and engagements of the hcnm. The article analyses how the hcnm’s specific mandate – as a political institution tasked to prevent inter-ethnic conflict, operating primarily through “quiet diplomacy” – has shaped its approach to human and minority rights, and to access to justice issues in particular. The overview shows that throughout the years, access to justice has become a recurrent, if at times tangential, theme for the institution. Overall, the article seeks to distil the general hcnm approach to access to justice issues as it was conveyed through a variety of thematic recommendations and guidelines, specific advice and other relevant engagements, undertaken in the course of the two-and-a-half decades of the institution’s existence.

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Hohol, A. M., A. I. Pankevych, I. A. Kolisnyk, D. S. Machulenko et Ya A. Hohol. « PREDICTION OF VERTICAL IMPACTION OF LOWER WISDOM TOOTH ACCORDING ORTHOPANTOMOGRAPHY OF LOWER JAW ». Ukrainian Dental Almanac, n^o 4 (8 décembre 2021) : 5–10. http://dx.doi.org/10.31718/2409-0255.4.2021.01.

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Topic relevance. The dental surgeon often is left alone with the dilemma: to save or remove the third lower molars. The justification of indications for tooth extraction must have objective criteria. It should be noted that a patient with this problem does not always have the opportunity to receive comprehensive advice from an orthodontist. In view of this, the solution to this problem requires the search for radiological data, which are the most available today and would help to justify treatment tactics for preservation or removal of the tooth. The conditions of tooth preservation in the dentition are most favorable with a slight medio-distal inclination and a vertical position of the third lower molars. However, this does not exclude the possibility of tooth impaction, which is often accompanied by periodic inflammatory phenomena in the tissues adjacent to the tooth and motivates both the patient and the dental surgeon to solve this problem. The aim of our study was to research of radiographic indicators of orthopantomography of the mandible to predict the vertical retention of the third lower molars. Material and methods of research. The platforms of Google Scholar, Research Gate and PubMed are used for research and analysis of the scientific literature on the application of objective criteria of mandibular orthopantomography data in the prediction of vertical impaction of the third lower molars. Impaction of mandibular molars is the result of a number of factors, including heredity, racial characteristics, muscle function, the nature of the food consumed, insufficient growth of the mandible, the size of the retromolar space. The accurately determination the positions of the molars and the size of the retromolar space of the mandible by available methods of X-ray diagnosis (the most common of which is the method of orthopantomography of the jaws) are necessary to prediction of tooth retention. The accuracy of imaging and measurements on orthopantomograms of the jaws was studied by both domestic and foreign authors. The angle of inclination of lower wisdom tooth, the size of the retromolar space of the mandible and the mesiodistal size of the teeth are determined on OPTG of jaws in the vast majority of publications. The age aspect of patients is also important for prediction of tooth impaction. In particular, most researchers state the fact that up to 20 years of life there is a significant probability of changing the position of the teeth during their eruption and therefore it is quite appropriate to wait. To predict the nature of the impaction of the third lower molars, the authors provide indicators of the angle of the tooth, the structure of their roots, the degree of impact and age of the patient. The publication of Maria Mersedes Gallas-Torreira and co-authors, which compared two methods of linear measurements on OPTG – Olive-Basford’s and Olmos ’methods have greatest interest. Both methods can be used to predict of impaction of lower wisdom tooth. However, if the prognostic estimate is based on orthopantomogram data rather than cone-beam computed tomography, the Olmos` method demonstrates a lower error rate and a more plausible prediction. To substantiate the algorithm for predicting the vertical retention of third lower molar in order to improve treatment tactics for the preservation or removal of the tooth which based on the obtained search data and the results of our own clinical observations and it is planned in the future.

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Alamgir, MH Mohammad, Md Monowarul Islam, M. Ershadul Haque, M. Nazrul Islam et Abdul Kader. « Treatment of Comminuted Intra-articular Fractures of Distal Radius by External Fixator ». Journal of Current and Advance Medical Research 1, n^o 2 (1 juillet 2014) : 30–34. http://dx.doi.org/10.3329/jcamr.v1i2.20516.

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Background: Treatment of comminuted intra-articular fractures of distal radius by external fixator is an important. Objective: The aim of study was to investigate the usefulness of external fixator as a treatment option for displaced comminuted intra-articular fractures of distal radius. Methodology: This case series was conducted in the Department of orthopaedic Surgery at Shaheed Suhrawardy Medical College& Hospital, Dhaka during the period of November 2011 to July 2013. All the patients having comminuted intra-articular distal radial fractures were being treated with mini uniaxial external fixator under brachial plexus block. The average follow up was performed in about 6 month.Result: A total number of fifteen patients were enrolled for this study. The mean age with SD was 50.21±9.473. Patient outcomes were measured by modified Knirk and Jupiter score and were categorized as satisfactory and unsatisfactory groups. In this study satisfactory outcome was found in 86.0%. All fractures (100.0%) were united nicely. Few complications were encountered. Postoperative osteoarthritis was not found during follow up.Conclusion: The use of external fixator for treating the comminuted intra-articular distal radial fractures produces satisfactory result.DOI: http://dx.doi.org/10.3329/jcamr.v1i2.20516 Journal of Current and Advance Medical Research Vol.1(2) 2014: 30-34

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Singh, Jasmeet, Stacey Q. Wolfe, Rashid M. Janjua, Hirad Hedayat et Christofer Burnette. « Anchor technique : Use of stent retrievers as an anchor to advance thrombectomy catheters in internal carotid artery occlusions ». Interventional Neuroradiology 21, n^o 6 (22 octobre 2015) : 707–9. http://dx.doi.org/10.1177/1591019915609170.

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In three recent cases of acute complete internal artery occlusions, we used stent retriever deployed through the mechanical aspiration/distal access catheters to achieve recanalization. In all cases the stent retriever was used as an anchor and supplemented mechanical thrombectomy. This report describes the technical details of the procedure and presents an alternative plan of action in difficult cases when standard thrombectomy techniques do not work.

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Kono, Kenichi, Hideo Okada et Tomoaki Terada. « A Novel Neck-Sealing Balloon Technique for Distal Access Through a Giant Aneurysm ». Operative Neurosurgery 73, n^o 2 (24 juillet 2013) : onsE302—onsE306. http://dx.doi.org/10.1227/neu.0000000000000011.

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Abstract BACKGROUND AND IMPORTANCE: In endovascular treatment for cerebral aneurysms using balloons, stents, or flow diverters, a microguidewire or microcatheter needs to be navigated distally across the neck of the aneurysm. However, this is sometimes difficult when there is a wide-neck or large aneurysm with a tortuous or atherosclerotic parent vessel. In this case report, we describe a new technique for navigating a microcatheter into a distal vessel. CLINICAL PRESENTATION: An 81-year-old woman presented with trigeminal neuralgia and diplopia due to abducens nerve palsy because of a giant cavernous carotid artery aneurysm. We planned stent-assisted coil embolization of the aneurysm and tried to advance a microcatheter into a distal vessel across the neck of the aneurysm. Although we attempted several previously reported techniques, these were unsuccessful. We then navigated a balloon into the aneurysm, slowly inflated it within the aneurysm, pulled it back gently, and sealed the neck orifice of the aneurysm with the balloon. We easily navigated a microcatheter into the distal vessel. The stent-assisted coil embolization was completed with no complications. CONCLUSION: This novel neck-sealing technique with a balloon for distal access may be useful in cases in which other methods are unsuccessful. In addition, this technique offers the advantages of not producing a loop in the microcatheter within an aneurysm and not requiring retraction of the microcatheter to reduce the loop.

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Jansen, Henrik Løseth, Svein Olaf Dahl et Pål Ringkjøb Nielsen. « An inverse approach to the course of the ‘Little Ice Age’ glacier advance and the following deglaciation at Austerdalsisen, eastern Svartisen, northern Norway ». Holocene 28, n^o 7 (20 avril 2018) : 1041–56. http://dx.doi.org/10.1177/0959683618761539.

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The course of the ‘Little Ice Age’ (LIA) in Scandinavia is characterized by large glacier advances that started at about AD 1300 and culminated at about AD 1750. The end of the LIA is marked as an unprecedented and ongoing glacier retreat that accelerated from the early 20th century. The course of the LIA is here presented based on fluctuations of Austerdalsisen, the largest valley outlet glacier draining the Austre Svartisen (Østisen) ice cap, Nordland, northern Norway. During the LIA glacierization, Austerdalsisen separated into two branches, and relative to the present glacier terminus, a western valley glacier advanced more than 4 km, whereas a SE valley glacier advanced about 3 km. At present, meltwater from Austerdalsisen drains towards SE. If the glacier obtains a critical magnitude, however, most of the meltwater is drained westwards across a higher overflow gap. Based on radiocarbon-dated lake sediments, distal proglacial glaciolacustrine/glaciofluvial sediments and historical observations, the course and chronology of the deglaciation following the LIA glacier maximum at Austerdalsisen are established. Because of high sedimentation rates due to low local bedrock resistance to glacier erosion beneath Austerdalsisen, however, cores from distal glacier-fed lakes covering the entire LIA/Holocene are hard to retrieve. Hence, an inverse approach to reconstruct the entire course of the LIA glacierization at Austerdalsisen is performed by suggesting little input of glacier-meltwater-induced sediments to the SE distal glacier-fed lake Litl Røvatnet, whenever Austerdalsisen rerouted meltwater westwards. If the terminus of Austerdalsisen was near the critical magnitude threshold, regular glacier lake outburst floods (GLOFs) towards SE occurred.

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Giannarini, Gianluca, Martin C. Schumacher, George N. Thalmann, Alain Bitton, Achim Fleischmann et Urs E. Studer. « Elective management of transitional cell carcinoma of the distal ureter : can kidney-sparing surgery be advised ? » BJU International 100, n^o 2 (août 2007) : 264–68. http://dx.doi.org/10.1111/j.1464-410x.2007.06993.x.

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Aksoy, Yusuf, Mehmet Arazi et Sezgin Şimşek. « The Osteosynthesis of Unstable Fractures of the Distal Clavicle with Hook Plate ». Orthopaedic Journal of Sports Medicine 2, n^o 11_suppl3 (1 novembre 2014) : 2325967114S0022. http://dx.doi.org/10.1177/2325967114s00228.

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Objectives: The conservative treatment of unstable fractures of the distal clavicle associated with higher nonunion rates. Although many treatment modalities have been described for these unstable fractures, there isn’t a golden standard one. Although osteosynthesis of the fractures with hook plate known a treatment option its special problems regarded the design of the implant. Aim of the study: To show f effectiveness of the hook plate osteosynthesis in treatment of unstable fractures of the distal clavicle with early removal of the implant to prevent possible complications. Methods: Between July 2011 and September 2013, seven patients with unstable fractures of the distal clavicle were treated with open reduction and internal fixation with hook plate. The mean age of the patients was 36 (range: 21-58) and there were two female and 5 male. Routine plate removal was planned at six months after the index surgery and the patients were informed for this second surgery. All fractures were unilateral and 5 in dominant extremity. Routine follow up were done after two, six and 18 weeks after the index surgery. The healing of the fracture was evaluated with radiological and clinical examinations. The Constant scoring system was used for functional evaluation of the patients. Results: All fractures healed without any mechanical problems related to the plate. The average follow-up of the patients were 22 months (range: 8 - 35). After the complete healing all plates were removed. The mean Constant score was 93 (rang 82 to 98 points) at the final follow up of the patients. Conclusion: The osteosynthesis of the unstable fractures of the distal clavicle with hook plate is seems to be an alternative and effective option for surgical treatment. To prevent implant related mechanical problems, we advise to remove the plate after the healing of the fracture as a routine manner.

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