BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of t...BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.展开更多
BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results sig...BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.展开更多
[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic t...[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.展开更多
Main Objective: To determine the prevalence of thumb sucking habits amongst children at the KNUST Basic School. Methodology: This study was quantitative and descriptive with the design being a cross-sectional type. Th...Main Objective: To determine the prevalence of thumb sucking habits amongst children at the KNUST Basic School. Methodology: This study was quantitative and descriptive with the design being a cross-sectional type. The data was obtained from KNUST Basic School with a sample size of 200. Data was obtained through questionnaires and clinical examination. Results: Out of the 200 children studied, 19 (9.5%) were identified as thumb suckers, with a majority being females (13, 68.42%) and the rest being males (6, 31.58%). Most of the thumb suckers (47.37%) engaged in the habit due to hunger. The clinical manifestations observed among the thumb suckers included Class I malocclusion (94.7%), high arched palate (89.5%), anterior open bite (4), increased overjet (3, 15.8%), proclined maxillary incisors (4, 22.2%), linguoversion of mandibular incisors (1, 5.6%), unilateral posterior crossbite (2, 10.5%), speech changes (7, 41.2%), thinner thumb (7, 36.8%), elongated thumb (9, 47.4%), and callus formation on the thumb (2, 10.5%). Conclusion: Thumb sucking is a common oral habit which stimulates the growth of the orofacial complex from ages 0 to 3 years. The habit of thumb sucking is usually outgrown by age 3 but beyond this age, it turns out as a deleterious habit which has to be seen as such and measures put in place to stop thumb sucking.展开更多
Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, whi...Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.展开更多
AIM To explore the induction effects and mechanism of Solanum lyratum Thumb(ST) on human hepatocellularcarcinoma SMMC-7721 cells through the mitochondrial pathway.METHODS The experiments were conducted on three groups...AIM To explore the induction effects and mechanism of Solanum lyratum Thumb(ST) on human hepatocellularcarcinoma SMMC-7721 cells through the mitochondrial pathway.METHODS The experiments were conducted on three groups: an experimental group (with ST ethanol extracts' concentration being 2.5, 5 and 10 mg/L), a negative control group (with only nutrient solution, 0 mg/L ST ethanol extracts), and a positive control group (2.5 mg/L DDP). The inhibition rate of cell proliferation was checked by using the methyl thiazolyl tetrazolium method, and cell apoptosis was tested by TUNEL method. Furthermore, RT-PCR was used to examine m RNA expression of Fas, Fas L, caspase-8, caspase-3, p53 and Bcl-2 genes.RESULTS Compared with the negative control group, the inhibition and apoptosis rates of the experimental group with different concentrations of ST extracts on human hepatocellular carcinoma SMMC-7721 cells significantly increased(P<0.05). Besides, the m RNA expression of Fas L and Bcl-2 significantly decreased(P<0.05) while the m RNA expression of Fas, caspase-8, caspase-3 and p53 increased significantly. When compared with the positive control group, the experimental groups with 5 mg/L ST ethanol extracts showed effects similar to the positive control group.CONCLUSION ST ethanol extracts induced the apoptosis of hepatocellular carcinoma SMMC-7721 cells through up-regulated Fas, caspase-8, caspse-3 and p53, and down-regulated Fas L and Bcl-2 in the mitochondrial pathway.展开更多
Objective： To explore the effects of Houttuynia Cordata Thumb （HCT 鱼腥草 Yu Xing Cao） on expression of transforming growth factor-β1 （TGF-β1） and bone morphogenetic protein-7 （BMP-7） in the renal tissues of ...Objective： To explore the effects of Houttuynia Cordata Thumb （HCT 鱼腥草 Yu Xing Cao） on expression of transforming growth factor-β1 （TGF-β1） and bone morphogenetic protein-7 （BMP-7） in the renal tissues of diabetic rats. Methods： The diabetic rats induced by intravenous injection of streptozotocin（STZ） were randomly divided into a model group, a HCT group and a lotensin group, with normal rats designated as the controls. 8 weeks later, the ratio of kidney weight to body weight, the glomerular area, the excretion of β 2-microglobin （β2-MG） in 24-hr urine, the albumin excretion in 24-hr urine, and creatinine clearance rate （CCR） were investigated. The expression of TGF- β 1, BMP-7 and collagen I in the renal tissues was observed with the immunohistochemical method and by the semi-quantitative assay. Results： The overgrowth of glomerulus, the excretion of β 2-MG in 24-hr urine, the albumin excretion rate in 24-hr urine and CCR in the HCT group significantly reduced （P〈0.05）, and the expression of TGF-β1 and collagen I significantly decreased （P〈0.05）, but BMP-7 significantly increased （P〈0.05） in the HCT group as compared with those in the model group, with no significant difference as compared with the lotensin group （P〉0.05）. Conclusion： HCT has a protective effect on the renal tissues in diabetic rats, which is probably correlated with the decrease of the expression of TGF-β1 and collagen I and with the increase of the expression of BMP-7 in the renal tissues.展开更多
In order to reveal the photosynthetic characteristics of C. trichotomum responses to drought, salt and water-logging stresses, one-year-old potted seedlings were taken as materials, and the several stresses including ...In order to reveal the photosynthetic characteristics of C. trichotomum responses to drought, salt and water-logging stresses, one-year-old potted seedlings were taken as materials, and the several stresses including natural drought, submergence stress, water-logging and different salt treatments （0.2%, 0.4%, 0.6% and 0.8% NaCl） were carried out on August 15, 2012. The morphological and photosynthetic characteristics were observed and determined. The results showed that adverse enviromental stress had a significant effect on the morphological changes and photosynthetic characteristics of C. trichotomum. On the 14th day after natural drought, the leaves wilted and could not recovery at night, and 60% of the seedlings could recover after re-watering. From the 7th day to the 10th day after submergence stress treatment, the 2nd and the 3rd leaves at the base of 60% seedling turned yellow and the lenticels were observed. At the early stage of water-logging stress, white lenticels appeared at the base of seedlings, and the leaves wilted, chlorina and fallen off on the 8th day. A large number of leaves fallen off under 0.6% NaCl or more salt stress, and even the whole plant died. The chlorophyll content, net photosynthetic rate （Pn） and transpiration rate （Tr） decreased gradually with the stress process, such as 8 days after natural drought, less than 0.4% salt stress and water-logging stress, but the changes were not significant compared with those of the control. With the increase of the stress intensity and the prolonged time, the changes of photosynthetic index were significant. All the results indicated that C. trichotomum had a certain degree of tolerance to drought, water and salt, but it was not suitable for living, in water-logging condition for a long time.展开更多
[Objectives]To optimize the extraction process of total flavonoids of Zhuang medicine Clerodendrum japonicum(Thumb.)Sweet and establish a method for its extraction and content determination.[Methods]The total flavonoi...[Objectives]To optimize the extraction process of total flavonoids of Zhuang medicine Clerodendrum japonicum(Thumb.)Sweet and establish a method for its extraction and content determination.[Methods]The total flavonoids of C.japonicum were extracted by reflux extraction method.Through a single factor experiment,the effects of extraction method,extraction solvent concentration,extraction volume and extraction time on the total flavonoids content of medicinal materials were investigated to select the optimal extraction process of the total flavonoids of C.japonicum.[Results]The optimal extraction process of the total flavonoids of C.japonicum was 75%ethanol,1∶20 solid-to-liquid ratio,and 50 min reflux extraction time.[Conclusions]This method can effectively determine the content of total flavonoids in C.japonicum and provide a certain scientific basis for the study of the quality standard of this Zhuang medicine.This method has high reproducibility.It is stable and feasible in extraction of total flavonoids from Zhuang medicine C.japonicum.展开更多
Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after sur...Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.展开更多
Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to t...Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field.Hence,a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.Methods:Based on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department,we subdivided thumb hypoplasia according to the variables of morphological characteristics,anatomical structures,functional status,the relationship between thumb deformity and hand deformity,the relationship between congenital hand deformity syndrome and thumb hypoplasia,and the selection of treatment methods.Results:A total of 10 types were presented,which were elucidated with nomenclatures as well as pathological feature and symptoms.Conclusion:This modified system may shed additional light on the classification of congenital thumb anomalies,which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.展开更多
BACKGROUND Thumb polydactyly is one of the most common congenital hand deformities,and the Bilhaut-Cloquet procedure or a modified one is often used.However,controversy remains over the rare instances in which both th...BACKGROUND Thumb polydactyly is one of the most common congenital hand deformities,and the Bilhaut-Cloquet procedure or a modified one is often used.However,controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.AIM To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.METHODS From January 2014 to December 2020,15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center.The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance.Subjective parents’evaluations and functional outcomes(ALURRA and TATA criteria)were obtained.The alignment deviation,instability,range of motion(percent of opposite thumb)of the interphalangeal and metacarpophalangeal joints,and the aesthetic aspects,including circumference,length,nail size,and nail deformity,were used to assess the clinical outcomes.RESULTS The average age of patients at the time of surgery was 13 mo,and the mean final follow-up occurred at 42 mo.An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs.An unstable interphalangeal joint occurred in one thumb.The flexion-extension arc at the metacarpophalangeal joint was good,while that at the interphalangeal joint was poor.Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs.The mean ALURRA score was 21.8(range:20-24),and the Tada score was 6.9(range:5-8).Compared with the non-operated side,the length of the operated thumb was approximately 95%,the girth was 89%,and the nail width was 82.9%.The mean ranges of motion were 62.1%of that of the unaffected thumb in the interphalangeal joint and 78.3%in the metacarpophalangeal joint.CONCLUSION Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure.Defects of the preserved thumb,such as the skin,nail,and bone,can be effectively restored using the complex tissue flap.展开更多
in the paper the results of reconstruction of thumb and first matacarpus of 10 cases are reported. All the 10 transplantations were successful and revealed fine recovery of function and appearance.It was considered th...in the paper the results of reconstruction of thumb and first matacarpus of 10 cases are reported. All the 10 transplantations were successful and revealed fine recovery of function and appearance.It was considered that the method of simultaneous removal of the second toe and metatarsus,first web space of the foot and the dorsal pedis flap for reconstruction of thumb and metacarpus to be superior to traditional methods in many aspects.Revascularization by anastomosis between the dorsalis pedis artery and the proximal end of the radial artery and that between the first plantar metatarsal artery and the distal end of the radial artery is effective to overcome ischemia of transplants because of variation of the first dorsal metatarsal artery.展开更多
Objective: Nalebuff’s type I deformity of the rheumatoid thumb, which is the most common thumb deformity with rheumatoid arthritis, can be classified into three stages according to the range of motion of the thumb. H...Objective: Nalebuff’s type I deformity of the rheumatoid thumb, which is the most common thumb deformity with rheumatoid arthritis, can be classified into three stages according to the range of motion of the thumb. However, a functional assessment for each stage has never been undertaken. Methods: The ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were evaluated to determine Nalebuff’s clinical stage, and both the Modified Kapandji Index (MKI) and the simple test for evaluating hand function (STEF) were used to evaluate hand function in 32 rheumatoid arthritis patients with type I deformity. We assessed hand function in each stage, and examined the relationship between the three clinical stages and dysfunction of the hand. Results: The scores for both MKI and STEF were significantly reduced in parallel with advancing stage of thumb deformity. Conclusion: Nalebuff’s staging system is also useful for reflecting the level of thumb function.展开更多
文摘BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.
文摘BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.
文摘[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.
文摘Main Objective: To determine the prevalence of thumb sucking habits amongst children at the KNUST Basic School. Methodology: This study was quantitative and descriptive with the design being a cross-sectional type. The data was obtained from KNUST Basic School with a sample size of 200. Data was obtained through questionnaires and clinical examination. Results: Out of the 200 children studied, 19 (9.5%) were identified as thumb suckers, with a majority being females (13, 68.42%) and the rest being males (6, 31.58%). Most of the thumb suckers (47.37%) engaged in the habit due to hunger. The clinical manifestations observed among the thumb suckers included Class I malocclusion (94.7%), high arched palate (89.5%), anterior open bite (4), increased overjet (3, 15.8%), proclined maxillary incisors (4, 22.2%), linguoversion of mandibular incisors (1, 5.6%), unilateral posterior crossbite (2, 10.5%), speech changes (7, 41.2%), thinner thumb (7, 36.8%), elongated thumb (9, 47.4%), and callus formation on the thumb (2, 10.5%). Conclusion: Thumb sucking is a common oral habit which stimulates the growth of the orofacial complex from ages 0 to 3 years. The habit of thumb sucking is usually outgrown by age 3 but beyond this age, it turns out as a deleterious habit which has to be seen as such and measures put in place to stop thumb sucking.
文摘Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.
基金the Guangxi Key Disciplines(Pathogen Biology)[2013]16,Key Laboratory Cultivation Base of Universities in Guangxi(Guangxi Education Research[2014]6)the Science and Technology Research Projects of Universities in Guangxi in 2014,No.YB2014307+1 种基金the Guangxi Natural Science Fund Project,No.2013GXNSFAA019249,No.2014GXNSFBA118148the Scientific Research Project of The Department of Education of Guangxi Zhuang Autonomous Region,No.200810LX327
文摘AIM To explore the induction effects and mechanism of Solanum lyratum Thumb(ST) on human hepatocellularcarcinoma SMMC-7721 cells through the mitochondrial pathway.METHODS The experiments were conducted on three groups: an experimental group (with ST ethanol extracts' concentration being 2.5, 5 and 10 mg/L), a negative control group (with only nutrient solution, 0 mg/L ST ethanol extracts), and a positive control group (2.5 mg/L DDP). The inhibition rate of cell proliferation was checked by using the methyl thiazolyl tetrazolium method, and cell apoptosis was tested by TUNEL method. Furthermore, RT-PCR was used to examine m RNA expression of Fas, Fas L, caspase-8, caspase-3, p53 and Bcl-2 genes.RESULTS Compared with the negative control group, the inhibition and apoptosis rates of the experimental group with different concentrations of ST extracts on human hepatocellular carcinoma SMMC-7721 cells significantly increased(P<0.05). Besides, the m RNA expression of Fas L and Bcl-2 significantly decreased(P<0.05) while the m RNA expression of Fas, caspase-8, caspase-3 and p53 increased significantly. When compared with the positive control group, the experimental groups with 5 mg/L ST ethanol extracts showed effects similar to the positive control group.CONCLUSION ST ethanol extracts induced the apoptosis of hepatocellular carcinoma SMMC-7721 cells through up-regulated Fas, caspase-8, caspse-3 and p53, and down-regulated Fas L and Bcl-2 in the mitochondrial pathway.
基金Supported by the grant of National Natural Science Foundation of China(3047225).
文摘Objective： To explore the effects of Houttuynia Cordata Thumb （HCT 鱼腥草 Yu Xing Cao） on expression of transforming growth factor-β1 （TGF-β1） and bone morphogenetic protein-7 （BMP-7） in the renal tissues of diabetic rats. Methods： The diabetic rats induced by intravenous injection of streptozotocin（STZ） were randomly divided into a model group, a HCT group and a lotensin group, with normal rats designated as the controls. 8 weeks later, the ratio of kidney weight to body weight, the glomerular area, the excretion of β 2-microglobin （β2-MG） in 24-hr urine, the albumin excretion in 24-hr urine, and creatinine clearance rate （CCR） were investigated. The expression of TGF- β 1, BMP-7 and collagen I in the renal tissues was observed with the immunohistochemical method and by the semi-quantitative assay. Results： The overgrowth of glomerulus, the excretion of β 2-MG in 24-hr urine, the albumin excretion rate in 24-hr urine and CCR in the HCT group significantly reduced （P〈0.05）, and the expression of TGF-β1 and collagen I significantly decreased （P〈0.05）, but BMP-7 significantly increased （P〈0.05） in the HCT group as compared with those in the model group, with no significant difference as compared with the lotensin group （P〉0.05）. Conclusion： HCT has a protective effect on the renal tissues in diabetic rats, which is probably correlated with the decrease of the expression of TGF-β1 and collagen I and with the increase of the expression of BMP-7 in the renal tissues.
基金Supported by the Major Scientific Research Projects of the 12th Five-year National Public welfare Industry(201104002-6)
文摘In order to reveal the photosynthetic characteristics of C. trichotomum responses to drought, salt and water-logging stresses, one-year-old potted seedlings were taken as materials, and the several stresses including natural drought, submergence stress, water-logging and different salt treatments （0.2%, 0.4%, 0.6% and 0.8% NaCl） were carried out on August 15, 2012. The morphological and photosynthetic characteristics were observed and determined. The results showed that adverse enviromental stress had a significant effect on the morphological changes and photosynthetic characteristics of C. trichotomum. On the 14th day after natural drought, the leaves wilted and could not recovery at night, and 60% of the seedlings could recover after re-watering. From the 7th day to the 10th day after submergence stress treatment, the 2nd and the 3rd leaves at the base of 60% seedling turned yellow and the lenticels were observed. At the early stage of water-logging stress, white lenticels appeared at the base of seedlings, and the leaves wilted, chlorina and fallen off on the 8th day. A large number of leaves fallen off under 0.6% NaCl or more salt stress, and even the whole plant died. The chlorophyll content, net photosynthetic rate （Pn） and transpiration rate （Tr） decreased gradually with the stress process, such as 8 days after natural drought, less than 0.4% salt stress and water-logging stress, but the changes were not significant compared with those of the control. With the increase of the stress intensity and the prolonged time, the changes of photosynthetic index were significant. All the results indicated that C. trichotomum had a certain degree of tolerance to drought, water and salt, but it was not suitable for living, in water-logging condition for a long time.
基金National Natural Science Foundation of China(81660659)Natural Science Foundation Project of Guangxi(2019GXNSF AA245090&2018GXNSFAA050141)+2 种基金Open Research Project of Guangxi Key Laboratory of Basic Research in Traditional Chinese Medicine(KJT1701205)Systematic Research Program of Chinese Medicine(Zhuang Medicine),a Key Discipline with Advantages and Characteristics in Guangxi:Research on the Production Process and Quality Control Method of Heyin CapsuleProgram of Scientific Research Third-level Laboratory"Chinese(Zhuang)Medicine Chemical and Quality Analysis Laboratory"of State Administration of Traditional Chinese Medicine(Guo Zhong Yi Yao Fa 2009[21])。
文摘[Objectives]To optimize the extraction process of total flavonoids of Zhuang medicine Clerodendrum japonicum(Thumb.)Sweet and establish a method for its extraction and content determination.[Methods]The total flavonoids of C.japonicum were extracted by reflux extraction method.Through a single factor experiment,the effects of extraction method,extraction solvent concentration,extraction volume and extraction time on the total flavonoids content of medicinal materials were investigated to select the optimal extraction process of the total flavonoids of C.japonicum.[Results]The optimal extraction process of the total flavonoids of C.japonicum was 75%ethanol,1∶20 solid-to-liquid ratio,and 50 min reflux extraction time.[Conclusions]This method can effectively determine the content of total flavonoids in C.japonicum and provide a certain scientific basis for the study of the quality standard of this Zhuang medicine.This method has high reproducibility.It is stable and feasible in extraction of total flavonoids from Zhuang medicine C.japonicum.
文摘Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.
文摘Background:Congenital thumb deformities account for one-third or more of all cases of congenital hand deformity.However,the current classification schemes of congenital thumb hypoplasia are no longer adequate due to their lack of adaptability to increasing knowledge in the field.Hence,a modified system with the potential to adapt to ongoing advances in knowledge and understanding is desperately needed.Methods:Based on the photographs collected from thousands of cases of congenital deformities of the hand and upper limb over multiple decades in our department,we subdivided thumb hypoplasia according to the variables of morphological characteristics,anatomical structures,functional status,the relationship between thumb deformity and hand deformity,the relationship between congenital hand deformity syndrome and thumb hypoplasia,and the selection of treatment methods.Results:A total of 10 types were presented,which were elucidated with nomenclatures as well as pathological feature and symptoms.Conclusion:This modified system may shed additional light on the classification of congenital thumb anomalies,which will assist in a more effective selection of treatment modalities and offers significant benefits to both patients and practice.
基金the China Scholarship Council,No.201808080126(to Liu FX).
文摘BACKGROUND Thumb polydactyly is one of the most common congenital hand deformities,and the Bilhaut-Cloquet procedure or a modified one is often used.However,controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.AIM To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.METHODS From January 2014 to December 2020,15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center.The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance.Subjective parents’evaluations and functional outcomes(ALURRA and TATA criteria)were obtained.The alignment deviation,instability,range of motion(percent of opposite thumb)of the interphalangeal and metacarpophalangeal joints,and the aesthetic aspects,including circumference,length,nail size,and nail deformity,were used to assess the clinical outcomes.RESULTS The average age of patients at the time of surgery was 13 mo,and the mean final follow-up occurred at 42 mo.An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs.An unstable interphalangeal joint occurred in one thumb.The flexion-extension arc at the metacarpophalangeal joint was good,while that at the interphalangeal joint was poor.Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs.The mean ALURRA score was 21.8(range:20-24),and the Tada score was 6.9(range:5-8).Compared with the non-operated side,the length of the operated thumb was approximately 95%,the girth was 89%,and the nail width was 82.9%.The mean ranges of motion were 62.1%of that of the unaffected thumb in the interphalangeal joint and 78.3%in the metacarpophalangeal joint.CONCLUSION Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure.Defects of the preserved thumb,such as the skin,nail,and bone,can be effectively restored using the complex tissue flap.
文摘in the paper the results of reconstruction of thumb and first matacarpus of 10 cases are reported. All the 10 transplantations were successful and revealed fine recovery of function and appearance.It was considered that the method of simultaneous removal of the second toe and metatarsus,first web space of the foot and the dorsal pedis flap for reconstruction of thumb and metacarpus to be superior to traditional methods in many aspects.Revascularization by anastomosis between the dorsalis pedis artery and the proximal end of the radial artery and that between the first plantar metatarsal artery and the distal end of the radial artery is effective to overcome ischemia of transplants because of variation of the first dorsal metatarsal artery.
文摘Objective: Nalebuff’s type I deformity of the rheumatoid thumb, which is the most common thumb deformity with rheumatoid arthritis, can be classified into three stages according to the range of motion of the thumb. However, a functional assessment for each stage has never been undertaken. Methods: The ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were evaluated to determine Nalebuff’s clinical stage, and both the Modified Kapandji Index (MKI) and the simple test for evaluating hand function (STEF) were used to evaluate hand function in 32 rheumatoid arthritis patients with type I deformity. We assessed hand function in each stage, and examined the relationship between the three clinical stages and dysfunction of the hand. Results: The scores for both MKI and STEF were significantly reduced in parallel with advancing stage of thumb deformity. Conclusion: Nalebuff’s staging system is also useful for reflecting the level of thumb function.
