Effect of tuberosity repair on functional outcome of reverse shoulder arthroplasty in proximal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#Unsatisfactory results of hemiarthroplasty in Neer's 3- and 4-part proximal humerus fractures in elderly, have led to the shift towards reverse shoulder arthroplasty (RSA). The objective of our study was to repair the tuberosities that are generally overlooked during RSA and observe its impact on the functional outcome and shoulder scores.@*METHODS@#We include elderly patients with acutely displaced or dislocated 3- or 4-part proximal humerus fractures from July 2013 to November 2019 who were treated with RSA along with tuberosity repair by non-absorbable sutures and bone grafting harvested from the humeral head. Open injuries and cases with neuro-muscular involvement of the deltoid muscle were excluded. According to the tuberosity healing on radiographs of the shoulder at 9th postoperative month, the patients were divided into 2 groups, as the group with successful tuberosity repair and the other with failed tuberosity repair. Statistical analysis of the functional outcome and shoulder scores between the 2 groups were done by independent t-test for normally distributed parameters and Mann-Whitney test for the parameters, where data was not normally distributed.@*RESULTS@#Of 41 patients, tuberosity healing was achieved in 28 (68.3%) and failed in 13 (31.7%) cases. Lysis of the tuberosity occurred in 5 patients, tuberosity displacement in 2, and nonunion in 2. Mean age was 70.4 years (range 65 - 79 years) and mean follow-up was 58.7 months (range 18 - 93 months). There were no major complications. Group with successful tuberosity repair showed improvement in mean active range of movements, like anterior elevation (165.1° ± 4.9° vs. 144.6° ± 9.4°, p < 0.000), lateral elevation (158.9° ± 7.2° vs. 138.4° ± 9.6°, p < 0.000), external rotation (30.5° ± 6.9° vs. 35.0° ± 6.3°, p = 0.367), internal rotation (33.7° ± 7.5° vs. 32.6° ± 6.9°, p = 0.671) and in mean shoulder scores including Constant score (70.7 ± 4.1 vs. 55.5 ± 5.7, p < 0.000), American shoulder and elbow surgeons score (90.3 ± 2.4 vs. 69.0 ± 5.7, p < 0.000), disability of arm shoulder and hand score (22.1 ± 2.3 vs. 37.6 ± 2.6, p < 0.000).@*CONCLUSION@#Successful repair and tuberosity healing around the RSA prosthesis is associated with statistically significant improvement in postoperative range of motion, strength and shoulder scores. Standardized repair technique and interposition of cancellous bone grafts, harvested from the humeral head can improve the rate of tuberosity healing.

Balloon-Assistance for the Transcirculation Access of a Remodeling Balloon for Coiling of Wide-Necked Aneurysms: Report of Two Cases / 신경중재치료의학

Balloons are valuable tools in the armamentarium of a neurointerventionist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.

Balloon-Assistance for the Transcirculation Access of a Remodeling Balloon for Coiling of Wide-Necked Aneurysms: Report of Two Cases / 신경중재치료의학

Balloons are valuable tools in the armamentarium of a neurointerventionist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.

Determination of flavonoids, polyphenols and antioxidant activity of Tephrosia purpurea: a seasonal study / 中西医结合学报

<p><b>OBJECTIVE</b>Tephrosia purpurea (Linn) Pers. is widely used in traditional medicine to treat liver disorders, febrile attacks, enlargement and obstruction of liver, spleen, and kidney. In the present study, investigations were carried out to determine the seasonal impact on the content of flavonoid glycosides and on antioxidant activities so as to identify the optimal time of harvesting.</p><p><b>METHODS</b>The plant materials were collected in different seasons during 2013-2014. Air-dried, powdered plant materials were extracted with 95% ethanol and ethanol: water (1:1) by ultrasound-assisted extraction process. Their chemical composition in terms of total polyphenol and flavonoid contents (TPCs and TFCs) was determined using modified colorimetric Folin-Ciocalteu method and aluminum chloride colorimetric assay respectively. To determine the in vitro antioxidant activity, diphenyl-picryl hydrazyl (DPPH) radical-scavenging assay and total antioxidant capacity by phosphomolybdate antioxidant assay were carried out. High-performance liquid chromatography (HPLC)/photo-diode array (PDA) analysis was used to quantify the flavonoid glycosides in the samples collected in different seasons. Correlation studies were also carried out between antioxidant activities and TPCs.</p><p><b>RESULTS</b>The highest TPC and TFC were found to be in the 95% ethanolic extract of the August sample and the lowest in the 50% hydro-alcoholic extract of the plant sample collected in winter season. It was observed that in both the assays used to determine the antioxidant activity, the 95% ethanolic extracts in all the seasons showed a higher activity than their respective 50% hydro-alcoholic extracts with an increase in activity as we go from cold to hot to rainy seasons. Based on correlation analysis, DPPH radical-scavenging activities as well as the spectrophotometrically measured phosphomolybdenum complex were also strongly correlated with TPC of the extracts. The most abundant flavonoid glycoside was quercetin-3-O-rhamnoglucoside in all the seasons. The content of all flavonoids was observed highest in the 95% ethanolic extract of the plant collected in August (TP-3). The 50% hydro-alcoholic extract of the plant collected in December (TP-6) showed the lowest amount of flavonoids and antioxidant activity.</p><p><b>CONCLUSION</b>The findings of this study confirmed that the metabolism and production of flavonoids in T. purpurea are vigorously affected by seasonal factors. Significant differences were observed in the TPC, TFC and flavonoid glycoside composition in the 95% ethanolic as well as 50% hydro-alcoholic extracts of Tpurpurea collected in different seasons. Since the 95% ethanolic extract of the August sample (TP-3), which also happens to be its flowering season, exhibited the highest TPC, TFC and antioxidant activities in both DPPH and phosphomolybdate assays as well as contained the highest content of all flavonoids, it could be recommended as the optimal season of harvesting Tpurpurea with respect to its pharmaceutically important constituents, i.e., flavonoids.</p>

Immediate cardiovascular effects of pranava pranayama in hypertensive patients.

Slow, deep, pranayama - based breathing training has been shown to be effective in reducing blood pressure (BP). The present study was undertaken to determine immediate effects of performing pranava pranayama on cardiovascular parameters in hypertensive patients. 29 hypertensive patients who were on medical treatment and also attending yoga sessions were recruited for the present study. Supine heart rate (HR) and BP were recorded before and after performance of pranava pranayama for five minutes. Post intervention statistical analysis revealed a significant (P<0.05) reduction in systolic pressure (SP) and a more significant (P<0.01) reduction in HR, pulse pressure and double product (Do P). The reduction in rate-pressure product (RPP) was highly significant (P<0.001). Pranava pranayama is effective in reducing HR and SP in hypertensive patients within five minutes of the practice. This may be due to a normalization of autonomic cardiovascular rhythms as a result of increased vagal modulation and/or decreased sympathetic activity and improved baroreflex sensitivity along with an augmentation of endogenous nitric oxide production. Our findings have potential therapeutic applications in day-to-day as well as clinical situations where blood pressure needs to be brought down at the earliest. The significant fall in RPP and Do P signifies a reduction in oxygen consumption and work done by the heart. It is concluded that pranava pranayama, a simple and cost effective technique can be used in the management of hypertensive patients in addition to the regular medical management. Further studies are required to enable a deeper understanding of the mechanisms involved and its usefulness in the long- term management of hypertension.

Effect of six weeks yoga training on weight loss following step test, respiratory pressures, handgrip strength and handgrip endurance in young healthy subjects.

The present study was designed to test whether yoga training of six weeks duration modulates sweating response to dynamic exercise and improves respiratory pressures, handgrip strength and handgrip endurance. Out of 46 healthy subjects (30 males and 16 females, aged 17-20 yr), 23 motivated subjects (15 male and 8 female) were given yoga training and the remaining 23 subjects served as controls. Weight loss following Harvard step test (an index of sweat loss), maximum inspiratory pressure, maximum expiratory pressure, 40 mm endurance, handgrip strength and handgrip endurance were determined before and after the six week study period. In the yoga group, weight loss in response to Harvard step test was 64 +/- 30 g after yoga training as compared to 161 +/- 133 g before the training and the difference was significant (n = 15 male subjects, P < 0.0001). In contrast, weight loss following step test was not significantly different in the control group at the end of the study period. Yoga training produced a marked increase in respiratory pressures and endurance in 40 mm Hg test in both male and female subjects (P < 0.05 for all comparisons). In conclusion, the present study demonstrates attenuation of the sweating response to step test by yoga training. Further, yoga training for a short period of six weeks can produce significant improvements in respiratory muscle strength and endurance.

Acute effect of 30 degrees, 60 degrees and 80 degrees head-down tilt on blood pressure in young healthy human subjects.

There are very few reports on the acute cardiovascular responses to head-down tilt of more than 30 degrees on blood pressure (BP) and heart rate (HR) in human subjects. The aim of the present study was to determine the BP and HR response to five minutes of 30 degrees, 60 degrees and 80 degrees head-down tilt in healthy human subjects. The study was conducted on 20 healthy male volunteers aged 18-20 years. In this study, 30 degrees head-down tilt produced no significant change in BP and HR. With 60 degrees and 80 degrees head-down tilt, there was a significant graded increase in diastolic pressure and a decrease in pulse pressure (P<0.01 for both). This pressor response is most likely due to raised intracranial tension and/or hypoxemia in this condition. The decrease in pulse pressure is possibly due to excessive cardiopulmonary blood volume resulting in a decreased stroke volume. Our study confirms earlier findings that acute 30 degrees head-down tilt produces no significant changes in BP and HR. However, the mechanisms leading to increases in BP that occurred with 60 degrees and 80 degrees acute head-down tilt need to be investigated.

Correlation between body mass index and blood pressure indices, handgrip strength and handgrip endurance in underweight, normal weight and overweight adolescents.

In the present study, we investigated the correlation between body mass index (BMI), blood pressure (BP) indices and indices of physical fitness in apparently healthy subjects aged 14-18 years. We obtained data from 145 (105 males and 40 females) and assessed the correlation between BMI, and heart rate, systolic pressure (SP), diastolic pressure (DP), pulse pressure (PP), mean arterial pressure (MP), rate-pressure product, endurance in the 40 mm Hg test, handgrip strength (HGS), and handgrip endurance. Subjects with BMI <18.5 kg/m2, 18.5-25 kg/m2 and >25 kg/m2 were classed as underweight (65 males and 9 females), normal weight (27 males and 20 females), and overweight (13 males and 11 females) respectively. In view of gender differences in autonomic regulation, data of male and female subjects were analyzed separately. We used analysis of variance to compare differences between the three groups. Correlation between BMI and other indices was tested using Pearson's correlation coefficient. A P value <0.05 was considered statistically significant Both SP and DP were highest in overweight and least in underweight male subjects (P<0.05 for both), whereas in females, differences in DP alone were statistically significant (P<0.05). In underweight male subjects, there was a positive correlation between BMI and SP, DP, PP, MP and HGS (P<0.05 for all). There was a positive correlation between BMI and SP in overweight male subjects (r = 0.5 P = 0.07, n = 13). A positive correlation was observed between BMI and rate-pressure product (r = 0.5, P = 0.45, n = 11) and BMI and HGS (r = 0.6, P = 0.05, n = 11) in overweight females. Our observations indicate that there are gender differences in the correlation between BMI and BP indices especially in underweight and overweight subjects. The observed differences between the three groups and gender differences in correlation between BMI and BP indices may be due to differences in autonomic function and or energy metabolism.

Effect of slow and fast pranayams on reaction time and cardiorespiratory variables.

We planned to undertake a comparative study of the effect of short term (three weeks) training in savitri (slow breathing) and bhastrika (fast breathing) pranayams on respiratory pressures and endurance, reaction time, blood pressure, heart rate, rate-pressure product and double product. Thirty student volunteers were divided into two groups of fifteen each. Group I was given training in savitri pranayam that involves slow, rhythmic, and deep breathing. Group II was given training in bhastrika pranayam, which is bellows-type rapid and deep breathing. Parameters were measured before and after three week training period. Savitri pranayam produced a significant increase in respiratory pressures and respiratory endurance. In both the groups, there was an appreciable but statistically insignificant shortening of reaction time. Heart rate, rate-pressure product and double product decreased in savitri pranayam group but increased significantly in bhastrika group. It is concluded that different types of pranayams produce different physiological responses in normal young volunteers.

Correlation between short-term heart rate variability indices and heart rate, blood pressure indices, pressor reactivity to isometric handgrip in healthy young male subjects.

The purpose of the present study was to determine whether readily measured blood pressure (BP) indices and, responses to autonomic reflex tests could be used as surrogates of short-term heart rate variability (HRV), which is an established marker of autonomic regulation of SA node. Therefore, we examined the correlation between short-term HRV and heart rate (HR), BP indices viz. systolic pressure, diastolic pressure, pulse pressure (PP), and rate-pressure product (RPP), during supine rest and head-up tilt in 17 young healthy normotensive subjects, aged 19.8 +/- 1 yr (mean +/- SD). Three classic autonomic indices viz. Valsalva ratio, HR response to deep breathing and pressor response to isometric handgrip were also determined. We noted two interesting and statistically significant (P < 0.05 in both cases) correlations viz. i) a positive correlation (r = 0.6) between change in RPP during tilt and change in low frequency (LF) RR spectral power expressed in normalized units (LF nu) during tilt, and ii) a negative correlation (r = -0.6) between change in PP during isometric handgrip and LF nu during tilt. The possible physiologic significance of these and other correlations is discussed in this paper. In conclusion, the presence of a statistically significant correlation between RPP, PP and spectral measures of short-term HRV supports a simplistic approach to autonomic assessment, in that, easily measurable BP indices could be used as surrogates of HRV when it is not feasible to determine HRV indices directly. However, the same have to be tested in healthy subjects belonging to various age groups and in patients with conditions known to be associated with autonomic dysregulation.

Modulation of cardiovascular response to exercise by yoga training.

This study reports the effects of yoga training on cardiovascular response to exercise and the time course of recovery after the exercise. Cardiovascular response to exercise was determined by Harvard step test using a platform of 45 cm height. The subjects were asked to step up and down the platform at a rate of 30/min for a total duration of 5 min or until fatigue, whichever was earlier. Heart rate (HR) and blood pressure response to exercise were measured in supine position before exercise and at 1, 2, 3, 4, 5, 7 and 10 minutes after the exercise. Rate-pressure product [RPP = (HR x SP)/100] and double product (Do P = HR x MP), which are indices of work done by the heart were also calculated. Exercise produced a significant increase in HR, systolic pressure, RPP & DoP and a significant decrease in diastolic pressure. After two months of yoga training, exercise-induced changes in these parameters were significantly reduced. It is concluded that after yoga training a given level of exercise leads to a milder cardiovascular response, suggesting better exercise tolerance.

Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers.

BACKGROUND & OBJECTIVES: Practice of breathing exercises like pranayama is known to improve autonomic function by changing sympathetic or parasympathetic activity. Therefore, in the present study the effect of breathing exercises on autonomic functions was performed in young volunteers in the age group of 17-19 yr. METHODS: A total of 60 male undergraduate medical students were randomly divided into two groups: slow breathing group (that practiced slow breathing exercise) and the fast breathing group (that practiced fast breathing exercise). The breathing exercises were practiced for a period of three months. Autonomic function tests were performed before and after the practice of breathing exercises. RESULTS: The increased parasympathetic activity and decreased sympathetic activity were observed in slow breathing group, whereas no significant change in autonomic functions was observed in the fast breathing group. INTERPRETATION & CONCLUSION: The findings of the present study show that regular practice of slow breathing exercise for three months improves autonomic functions, while practice of fast breathing exercise for the same duration does not affect the autonomic functions.

Tilt table testing in the diagnostic evaluation of presyncope and syncope: a case-series report.

Tilt table testing has long been used as a standard tool in the diagnostic evaluation of syncope. However, differences of opinion exist with regard to its utility in the evaluation of patients with only presyncopal attacks. We present the results of drug-free, 70-degree head-up tilt table tests (maximum duration of 45 minutes), conducted between May 2002 and May 2003 in the Department of Physiology at JIPMER. This series consisted of both male and female patients (age 6-79 yr) with presyncope (n = 43), unexplained syncope (n = 43) and asymptomatic healthy volunteers without a history of syncope (n = 14). 28 out of 43 patients with unexplained syncope had a history of recurrent syncope while the remaining 15 had only 1 episode. 2 out of 43 patients (4.6%) with a history of only presyncopal attacks had a positive test (induction of intense presyncope and/or syncope accompanied by hypotension and/or a relative bradycardia). 21 out of 43 patients (49%) with a history of syncope had a positive test. 7 had vasodepressor syncope due to hypotension, 6 had cardioinhibitory syncope characterized by asystole and 10 had a mixed form of the vasovagal syndrome characterized by hypotension as well as bradycardia. 18 out of 28 patients (64%) with recurrent unexplained syncope had a positive test. All fourteen healthy volunteers had a negative test. We conclude that tilt table testing is useful in the diagnostic evaluation of patients with unexplained syncope, especially those with recurrent syncope, but not in the evaluation of patients with presyncope alone.

Modulation of stress induced by isometric handgrip test in hypertensive patients following yogic relaxation training.

13 essential hypertensive patients aged 41 to 60 years were given yoga training for 60 min daily, Monday through Saturday, for a total duration of 4 weeks. Blood pressure and heart rate (HR) were measured with non-invasive semi-automatic blood pressure monitor. Measurements were recorded before the training and at weekly intervals during the 4 week training period. Results of our study show a significant (P<0.001) reduction in resting HR and rate-pressure-product (RPP) after 2 weeks of yoga training. Systolic pressure (SP), diastolic pressure (DP) (P<0.001) and mean pressure (MP) (P<0.05) showed a significant reduction at 3 weeks of training period. After 4 weeks of training, there was further fall in SP, DP, pulse pressure (PP) (P<0.05), MP (P<0.001), HR and RPP. Isometric handgrip test before yoga training produced a significant rise in SP and MP and insignificant rise in DP, HR and RPP. After yoga training, there was a significant rise in all these parameters. Our results show that yoga training optimises the sympathetic response to stressful stimuli like isometric handgrip test and restores the autonomic regulatory reflex mechanisms in hypertensive patients.

Acute effect of Mukh bhastrika (a yogic bellows type breathing) on reaction time.

Reaction time (RT) is an index of the processing ability of central nervous system and a simple means of determining sensory-motor performance. It has been reported that yoga training improves human performance including central neural processing. Earlier studies from our laboratories have shown that yoga training produces a significant decrease in visual reaction time (VRT) and auditory reaction time (ART). The present work was planned to determine if mukh bhastrika (a yogic technique in which breath is actively blasted out in 'whooshes' following a deep inspiration) has any effect on central neural processing by studying its effect on RT. 22 healthy schoolboys who were practising yoga for the past three months were recruited for the present study. VRT and ART were recorded before and after nine rounds of mukh bhastrika. Mukh bhastrika produced a significant (P < 0.01) decrease in VRT as well as ART. A decrease in RT indicates an improved sensory-motor performance and enhanced processing ability of central nervous system. This may be due to greater arousal, faster rate of information processing, improved concentration and/ or an ability to ignore extraneous stimuli. This is of applied value in situations requiring faster reactivity such as sports, machine operation, race driving and specialised surgery. It may also be of value to train mentally retarded children and older sports persons who have prolonged RT.

Byssinosis among male textile workers in Pondicherry: a case-control study.

BACKGROUND: In India, 20 million workers are involved in the manufacturing of textiles. However, there are few epidemiological studies from India that have assessed the magnitude or the risk factors associated with byssinosis. In Pondicherry, textile mills have been in existence for over a century. This case-control study aimed to find the factors associated with the development of byssinosis in textile workers. METHODS: The sample consisted of 761 men above the age of 30 years who had worked for at least 10 years in a textile factory. All the respondents were interviewed by a pretested questionnaire to gather information regarding the symptoms of byssinosis, certain personal characteristics and occupational history. Byssinosis was identified using the classification proposed by the World Health Organization. Two age-matched controls were selected for each case. RESULTS: Univariate analysis of the factors for symptomatic byssinosis showed that dusty worksites, heavy smoking and duration of service > or = 30 years were significant. Logistic regression analysis showed that working in the spinning (odds ratio 6.1) and weaving sections (odds ratio 1.9), heavy smoking (odds ratio 3.9) and > or = 30 years of service (odds ratio 2.0) were independent significant risk factors. CONCLUSION: Efforts to reduce dust levels in the working environment and to discourage smoking among textile workers need to be strengthened to minimize the risk of developing byssinosis.

Effect of pranayam training on cardiac function in normal young volunteers.

Systolic time intervals (STI) are non-invasive and sensitive tests for measuring the ventricular performance. It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions. Keeping this in view, the present study was designed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests (AFT). Twenty four school children were randomly divided into two groups of twelve each. Group I (pranayam group) subjects were given training in nadishuddhi, mukh-bhastrika, pranav and savitri pranayams and practiced the same for 20 minutes daily for a duration of 3 months. Group II (control group) subjects were not given any pranayam training. STI (QS2, LVET and PEP) and AFT (RRIV and QT/QS2) were measured in both the groups at the beginning and again at the end of three months study period. Pranayam training produced an increase in RRIV and a decrease in QT/QS2, suggesting an enhanced parasympathetic and blunted sympathetic activity respectively. QS2, PEP and PEP/LVET increased significantly, whereas LVET was reduced significantly in pranayam group. In contrast, the changes in STI and AFT were much less marked in the control group. Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity. Further studies on a larger sample size may illustrate the underlying mechanism(s) involved in this alteration.