Morpho-Physiological and Biochemical Responses of Field Pea Genotypes under Terminal Heat Stress.

Field pea is one of the important short-duration cool season pulse crops which contributes significantly towards food and nutritional security. Two heat-susceptible (HS) and two heat-tolerant (HT) genotypes were selected from the previous study for further characterization. A significant variation was observed for morpho-physiological traits studied. Principal component analysis explained that first two principal components, i.e., PC1 and PC2 showed 76.5% of the total variance in optimal condition, whereas 91.2% of the total variance was covered by the first two PCs in heat stress environment. The seed yield per plant determined significant and positive association with superoxide dismutase and number of seeds per pod under optimal conditions, whereas under heat stress condition, it was positively associated with number of effective pods per plant, biological yield per plant, proline, pod length, number of seeds per pod, superoxide dismutase, and peroxidase. The significant reduction was noticed in the susceptible genotypes, whereas tolerant genotypes showed stable and non-significant reduction in chlorophyll content. Further, minimum cell damage and higher hydrogen peroxide production was noticed in the susceptible genotypes. In addition, the biochemical characterization of HS and HT genotypes revealed that the higher expression of peroxidase, superoxide dismutase, and catalase modulates the tolerant responses in HT genotypes. These genotypes were further used in developing heat-tolerant field pea genotypes.

A Systematic Review of the Outcomes of Flexor Tenolysis in Zones 2-5.

Background: Although numerous surgical techniques have been described and deployed, flexor tenolysis remains one of the most challenging procedures in hand surgery and there is no standardised way of recording the outcomes. The aim of this study is to systematically review the evidence supporting current concepts and outcomes in flexor tenolysis. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline and EMBASE databases were searched for articles published in English using the keyword search terms 'flexor' or 'tendon' and 'tenolysis' or 'tenoarthrolysis'. A total of 555 articles were listed and further screening provided fourteen studies remaining for final inclusion. The parameters for data extraction included number of digits operated on, age of the patients, initial injury mechanism requiring flexor tenolysis, outcome assessment method, follow-up period, results and complications. The primary outcome was postoperative active range of motion. Results: 556 digits were included across all studies and the age of patients ranged between 1 and 75 years. Eleven out of fourteen of the articles used the Strickland criteria to report their outcomes. Other outcome measures used were total active motion (TAM), Buck-Gramcko and pulp-to-palm distance. In the studies which used the Strickland criteria, the average percentage of outcomes reported as 'good' or 'excellent' was 68% with a range between 45% and 91%. Three other studies used Buck-Gramcko, TAM and pulp-to-palm distance outcome reporting and achieved 72% 'good' or 'excellent', 84% improvement and 30% able to touch distal palm crease respectively. Conclusions: Although the literature contains a limited number of observational studies, the current evidence shows that 68% of well-selected patients who undergo flexor tenolysis achieve a good or excellent outcome as measured by the Strickland criteria. Level of Evidence: Level III (Therapeutic).

Genome-Wide Analysis of Late Embryogenesis Abundant Protein Gene Family in Vigna Species and Expression of VrLEA Encoding Genes in Vigna glabrescens Reveal Its Role in Heat Tolerance.

Late embryogenesis abundant (LEA) proteins are identified in many crops for their response and role in adaptation to various abiotic stresses, such as drought, salinity, and temperature. The LEA genes have been studied systematically in several crops but not in Vigna crops. In this study, we reported the first comprehensive analysis of the LEA gene family in three legume species, namely, mung bean (Vigna radiata), adzuki bean (Vigna angularis), and cowpea (Vigna unguiculata), and the cross-species expression of VrLEA genes in a wild tetraploid species, Vigna glabrescens. A total of 201 LEA genes from three Vigna crops were identified harboring the LEA conserved motif. Among these 55, 64, and 82 LEA genes were identified in mung bean, adzuki bean, and cowpea genomes, respectively. These LEA genes were grouped into eight different classes. Our analysis revealed that the cowpea genome comprised all eight classes of LEA genes, whereas the LEA-6 class was absent in the mung bean genome. Similarly, LEA-5 and LEA-6 were absent in the adzuki bean genome. The analysis of LEA genes provides an insight into their structural and functional diversity in the Vigna genome. The genes, such as VrLEA-2, VrLEA-40, VrLEA-47, and VrLEA-55, were significantly upregulated in the heat-tolerant genotype under stress conditions indicating the basis of heat tolerance. The successful amplification and expression of VrLEA genes in V. glabrescens indicated the utility of the developed markers in mung bean improvement. The results of this study increase our understanding of LEA genes and provide robust candidate genes for future functional investigations and a basis for improving heat stress tolerance in Vigna crops.

Outcomes and Early Recurrence Following Enzymatic (Collagenase) Treatment of Moderate and Severe Dupuytren Contractures.

PURPOSE: We offer collagenase Clostridium histolyticum (CCH) injections to all patients with a Dupuytren contracture and a palpable cord. We assessed whether more severe contractures respond less well or recur more frequently. METHODS: From a database of 502 CCH injections, 386 (77%) had a complete dataset with minimum 1-year face-to-face follow-up. Contracture severity was assessed using the Tubiana system: grade 1 (27%), grade 2 (49%), grade 3 (19%), and grade 4 (5%). Patients received a single intralesional injection of 0.58 mg CCH followed by manipulation. Finger position was measured at 6 to 12 weeks, 6 months, and 1 year. Failure to break the cord, skin tears, and any adverse events were noted. Recurrence was defined as a failure to maintain any prior correction to within 20°. RESULTS: There were 17 failures (4%) and 6 allergic reactions (1%). We found 31% corrected completely, with approximately half remaining corrected at 1 year. We achieved 43° (95% confidence interval, 40°-46°) correction of combined deformity, with 11° (95% confidence interval, 9°-13°) correction attrition over 1 year. Sixteen percent of treated digits experienced a recurrence with no difference between Tubiana grades, and one-third chose further treatment. Following treatment, Tubiana grade 1 contractures improved by 78% in comparison with higher grade contractures (55%-67% relative correction). By 1 year, all grades had a similar mean 46% relative correction. A complete correction was seen in 61% of grade 1 contractures, with more severe contractures less likely to correct completely (9%-24%). A 31% skin tear rate had no impact on outcome, recurrence, or long-term morbidity. CONCLUSIONS: CCH may treat any Dupuytren cord regardless of severity. Although contracture may recur, few patients pursue further treatment within 1 year. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The management of acute fracture dislocations of proximal interphalangeal joints: a systematic review.

LEVEL OF EVIDENCE: III.

FDP Avulsion Injury Due to Enchondroma: A Unique Surgical Approach.

Flexor Digitorum Profundus avulsion injury associated with an enchondroma at the level of the distal phalanx is extremely rare. There have been few cases reported to date and most have been surgically managed using a screw and/or Bunnell pull-out wire technique with or without bone grafting. We describe the first case using a simple interosseus fixation technique for the reattachment of FDP tendon without bone grafting. The patient made an excellent post-operative recovery. This technique is a simple, effective, patient-friendly and internalised solution which, in addition, may prevent the need for bone grafting.

A 15-year mystery resolved: a large bone-boring glomus tumor mistaken as dermatitis.

Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love's pin test and Hildreth's test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.

Brachial plexus impingement secondary to implantable cardioverter defibrillator: A case report.

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel's sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

The management of chronic non-arthritic scapholunate dissociation: a systematic review.

A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965-2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all interventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (+19%; n = 45) and worsened in tenodesis (-6%; n = 45). Grip strength was better in capsulodesis (+31%; n = 64 versus + 11%; n = 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to heterogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regarding the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised. LEVEL OF EVIDENCE: II.

Apert syndrome: A consensus on the management of Apert hands.

INTRODUCTION: Apert Syndrome is a congenital condition characterised by primary craniosynostosis, midfacial malformations and complex symmetrical malformations of the hands and feet. The hands demonstrate one of the most complex collections of congenital upper limb deformities, posing a significant challenge for the paediatric hand surgeon. This study examines the extant literature and current practice of the four UK specialist craniofacial units regarding the management of Apert hands in order to provide a basis for guideline development. METHODS: The current literature was reviewed. Survey-type questionnaires were distributed to the four UK specialist craniofacial units and responses analysed. RESULTS: Management of the Apert hand is largely dictated by the degree of malformation present. Although all units aim to achieve a five digit hand, variation in the timing of surgery, operative protocols and mobilisation policies exist. CONCLUSION: The results of this study provide an interesting snapshot of the current management of Apert hands across four UK craniofacial surgery units. The four UK units remain congruent on most areas surrounding the management of Apert hands although some minor inter-unit variation exists. A multidisciplinary approach to management remains fundamental in optimising the regain of function and aesthetically acceptable hands.

Diode laser: In treatment of recurrent verrucous leukoplakia.

Laser first came into light in 1960 and had been used extensively in various fields of medicine. Laser has been experimented in the various dental field, and its utility is being recognized and established well in the dentistry. Lasers are widely used for a number of procedures such as cavity preparation, scaling, and root planning, surgical procedures like excision of soft tissue growths, etc., Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used diode laser for surgical management of a proliferative verrucous leukoplakia (PVL), because of its many advantages over conventional methods. It presents very specific characteristics, mainly a more aggressive biological behavior than other forms of leukoplakia expressed by: A tendency toward multifocality (field cancerization); a high prospect of recurrence; and a high rate of malignant transformation, which can range between 40% and 100% in a follow-up period of 4.4-11.6 years. In this case, we evaluated the advantages of diode laser for the treatment of verrucous leukoplakia, where the results that we obtained were excellent. The patient had come for evaluation till the time of complete healing.

Subscapularis Z-lengthening in children with brachial plexus birth palsy loses efficiency at mid-term follow-up: a retrospective cohort study.

PURPOSE: The aim of this study was to evaluate early and mid-term clinical outcomes after isolated subscapularis Z-lengthening in children with shoulder internal rotation contractures resulting from brachial plexus birth palsy. METHODS: Children with brachial plexus birth palsy treated with subscapularis tendon Z-lengthening from 2001 to 2011 were retrospectively reviewed. Over this period, 31 patients were identified. Primary outcome was improvement in Mallet score after surgery, and secondary outcome measures were active range of motion and Mallet sub-scores. Clinical outcomes were collected at three time intervals: pre-operatively, one-year post-operative and at latest follow-up. RESULTS: After exclusion, 21 patients remained for further analysis. Mean age at surgery was 3.7 years (range, 1.2-8.7), and mean follow-up length was 6.5 years (2.9-9.7). Moderate improvements were found for mean Mallet score, active external rotation, active abduction and hand-to-mouth movement at one year and latest follow-up. However, improvements in active external rotation and Mallet score were not fully maintained at final follow up. CONCLUSION: Isolated subscapularis Z-lengthening is effective at early follow-up, but results are not maintained at mid-term follow-up.

Amniotic constriction bands: a case series and proposed new classification system.

INTRODUCTION: Amniotic constriction bands occur in approximately one in every 15,000 live births and is graded using the Patterson Classification system. METHODS: A case series of all patients with amniotic constriction band that presented to Alder Hey Children's Hospital was compiled between the years 1993 and 2012, data was described and a classification system developed. RESULTS: Thirty seven patients were identified. Of these 17 had amniotic constriction confined to the upper limbs and three of the lower limbs only. Seventeen had both upper and lower limb deformity. Twenty eight children underwent surgical intervention whilst nine to date have not. CONCLUSION: Constriction band of the upper limb was the most common with lower limb bands the least. There is no agreement on the nomenclature of this condition making amalgamation of the literature problematic. A more specific classification of upper limb bands has been suggested which includes anatomical location and depth of band.

Soft tissue stabilization for palmar midcarpal instability using a palmaris longus tendon graft.

PURPOSE: To report the results of a technique of soft tissue stabilization for palmar midcarpal instability using a palmaris longus graft. METHODS: In patients' symptomatic wrists with palmar midcarpal instability that had failed conservative management, we used a dorsal approach and stabilized the hamate and triquetrum by reconstructing the dorsal triquetrohamate ligament. The palmaris longus tendon graft was fixed with bone anchors. Seven wrists in 6 patients were available for follow-up at a mean of 28 months (range, 17-37 mo). RESULTS: There was an overall meaningful improvement in function (mean preoperative Disabilities of the Arm, Shoulder, and Hand score, 49 preoperatively, 28 postoperatively). There was a significant increase in grip strength from 15 to 21 kg. At final follow-up, 2 patients had moderate pain. The others had mild or no pain. Four patients returned to their previous occupation or activity. Patients retained full pronation and supination. When compared with the normal side, flexion was reduced to 71%, extension to 81%, radial deviation to 90%, and ulnar deviation to 65% of the opposite side. Although the mean results show an improvement, one patient had a poor result with deterioration in Disabilities of the Arm, Shoulder, and Hand score in spite of a clinically stable wrist, and another had clinical evidence of recurrent instability during pregnancy. One patient had residual symptoms from a prominent bone anchor. CONCLUSIONS: Overall, this technique showed good medium-term results in most of our patients. It retained some midcarpal mobility, eliminated clunking in most patients, and provided a noteworthy improvement in grip strength and function. We continue to use this technique for patients with symptomatic midcarpal instability, but it requires further evaluation with larger patient numbers and a longer follow-up to assess its overall value.

Upper blepharoplasty approach to frontozygomatic dermoid cysts.

OBJECTIVES: Dermoid cysts are common periorbital lesions in children. Traditional surgical approaches have included incisions over the mass; above, below, or through the brow; and parallel to the superior orbital rim and the Lynch incision, as well as lateral canthotomy. We aimed to present experience of Alder Hey Children's Hospital on frontozygomatic dermoid removal through a blepharoplasty incision. In this article, we also aimed to review the current literature, describe the operative technique clearly, and offer reasonable explanations for the operative choices made based on our experience of the clinical anatomy and pathology. METHODS: Thirty-four children were operated on (19 girls and 15 boys), aged 1 to 11 years, between 2005 and 2008. The lesions were left sided in 14 patients and right sided in 20 patients. Preoperative computed tomographic/magnetic resonance imaging scan was generally not used, except in cases where the cyst was more than 1 cm away from the brow margin. RESULTS: All cysts were completely excised. At surgery, all cysts were adherent to the periosteum, and 3 were subperiosteal. None extended through the bone into the orbit. The average operating time was 30 minutes. The average follow-up duration was 1 year. The only complications were early mechanical ptosis in 3 children, which completely resolved; the majority had an uneventful postoperative course. There were no recurrences, and in all patients, scar camouflage was described as excellent. CONCLUSIONS: This interesting and extremely effective technique provides excellent scar camouflage with no lid or ocular dysfunction.

Percutaneous ultrasound-guided renal biopsy.

This study was done to assess the safety and efficacy of real-time ultrasound-guided percutaneous renal biopsy (PRB) and to determine the optimal period of observation required as well as to ascertain the risk factors for any ensuing complications. Between 1 st February 2006 and 31 st January 2008, a total of 86 PRBs were performed by the radiologist using an automated biopsy gun with 16-gauge needle at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya. Prior to the procedure coagulation profile was done in all the patients. All patients were kept on strict bed rest for 6-hours post-procedure. Of the 86 renal biopsies performed, 78 patients were referred from Rheumatology Department and 8 were post-kidney transplant recipients. There were 23 males with age ranging from 15 to 56 years and 63 females with age ranging from 16 to 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in only four biopsies. Class I lupus nephritis (LN) was seen in one patient, class II LN in seven patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as either acute tubular necrosis or acute interstitial rejection. The overall complication rate was 5.8% and these complications were observed within 6 hours of biopsy. No late complications were seen. PRB under real-time ultra-sound guidance is a safe and efficacious procedure to establish the histological diagnosis of the renal disease and may be done as an out-patient procedure. A post-biopsy observation time of 6 hours appears to be optimal.