Early Versus Delayed Fourth Ray Amputation With Fifth Ray Transposition for Management of Mutilating Ring Finger Injuries.

PURPOSE: To compare hand function after early versus delayed fourth ray amputation and transposition of the fifth ray in mutilating ring finger injuries. METHODS: We prospectively compared 2 groups of patients who sustained either isolated mutilating ring finger or complex hand injuries between January 2008 and December 2013. The first group (12 patients; 10 male and 2 female) was managed by early (within 14 d) fourth ray amputation with fifth ray transposition, and the second group (13 patients; 9 male and 4 female) was managed similarly but on a delayed basis (after 20 d). The postoperative fifth metacarpophalangeal joint active range of motion was recorded and compared with the preoperative value. Function was evaluated by measuring grip and key pinch strengths, supination and pronation strengths, and hand breadth. All parameters were evaluated by comparing the injured and the noninjured hands. RESULTS: Group 1 patients exhibited superior results to group 2 patients regarding the postoperative grip and key pinch strength and pronation and supination strength in addition to the mean postoperative active range of motion of the transposed ray metacarpophalangeal joint. However, the results were statistically significant regarding only grip and pronation strengths. Postoperative active range of motion of the transposed ray metacarpophalangeal joint was significantly reduced in the cases having preoperative compromise of the transposed digit in group 1. The final subjective cosmetic satisfaction was better in group 1. CONCLUSIONS: Our results support early fourth ray amputation with fifth ray transposition for mutilating ring finger injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Attenuated EAN in TNF-α deficient mice is associated with an altered balance of M1/M2 macrophages.

The role of tumor necrosis factor (TNF)-α and its receptors in neuroautoimmune and neuroinflammatory diseases has been controversial. On the basis of our previous studies, we hereby aimed to further clarify TNF-α's mechanism of action and to explore the potential role of TNF-α receptor (TNFR)1 as a therapeutic target in experimental autoimmune neuritis (EAN). EAN was induced by immunization with P0 peptide 180-199 in TNF-α knockout (KO) mice and anti-TNFR1 antibodies were used to treat EAN. Particularly, the effects of TNF-α deficiency and TNFR1 blockade on macrophage functions were investigated. The onset of EAN in TNF-α KO mice was markedly later than that in wild type (WT) mice. From day 14 post immunization, the clinical signs of TNF-α KO mice were significantly milder than those of their WT counterparts. Further, we showed that the clinical severity of WT mice treated with anti-TNFR1 antibodies was less severe than that of the control WT mice receiving PBS. Nevertheless, no difference with regard to the clinical signs of EAN or inflammatory infiltration in cauda equina was seen between TNF-α KO and WT mice with EAN after blockade of TNFR1. Although TNF-α deficiency did not alter the proliferation of lymphocytes in response to either antigenic or mitogenic stimuli, it down-regulated the production of interleukin (IL)-12 and nitric oxide (NO), and enhanced the production of IL-10 in macrophages. Increased ratio of regulatory T cells (Tregs) and reduced production of interferon (IFN)-γ in cauda equina infiltrating cells, and elevated levels of IgG2b antibodies against P0 peptide 180-199 in sera were found in TNF-α KO mice with EAN. In conclusion, TNF-α deficiency attenuates EAN via altering the M1/M2 balance of macrophages.

Women's perceptions of and experiences with medical student involvement in outpatient obstetric and gynecologic care in the United Arab Emirates.

OBJECTIVE: The purpose of this study was to determine the experiences, satisfaction, and comfort of women with medical student participation in outpatient care during obstetric and gynecology clerkships. STUDY DESIGN: A consecutive sample of 303 women who attended the clinic were interviewed before consultation; a structured questionnaire was used. RESULTS: Two hundred sixty-four women (87.1%) accepted student involvement; 158 women (59.8%) and 173 women (66.5%), respectively, preferred female students or preceptors. Comfort levels were significantly lower with male students or preceptors in all skills that were tested (P <.0001), particularly pelvic examination and the discussion of sexual problems. Acceptance was associated significantly with older age (P <.0001), higher parity (P <.0001), higher education (P =.002), husband's occupation (P =.006), obstetric consultation (P <.0001), previous teaching encounters (P =.0006), recognition of the students' roles (P =.004), and satisfaction with clinical service (P = 0.01). Reasons for nonacceptance (n = 39 women, 12.9%) were concern about privacy during examination (53.8%) or counseling (25.6%) and the extent of the students' involvement (20.5%). CONCLUSION: Most women agreed to participate in the teaching of obstetric and gynecologic skills to medical students.