Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent appr...Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.展开更多
Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients w...Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.展开更多
The advent of CRISPR-Cas has revolutionized precise gene editing.While pioneering CRISPR nucleases like Cas9 and Cas12 generate targeted DNA double-strand breaks(DSB)for knockout or homology-directed repair,next gener...The advent of CRISPR-Cas has revolutionized precise gene editing.While pioneering CRISPR nucleases like Cas9 and Cas12 generate targeted DNA double-strand breaks(DSB)for knockout or homology-directed repair,next generation CRISPR technologies enable gene editing without DNA DSB.Base editors directly convert bases,prime editors make diverse alterations,and dead Cas-regulator fusions allow nuanced control of gene expression,avoiding potentially risks like translocations.Meanwhile,the discovery of diminutive Cas12 orthologs and Obligate Mobile Element-Guided Activity(OMEGA)nucleases has overcome cargo limitations of adeno-associated viral vectors,expanding prospects for in vivo therapeutic delivery.Here,we review the ever-evolving landscape of cutting-edge gene editing tools,focusing on miniature Cas12 orthologs and OMEGA effectors amenable to single AAV packaging.We also summarize CRISPR therapies delivered using AAV vectors,discuss challenges such as efficiency and specificity,and look to the future of this transformative field of in vivo gene editing enabled by AAV vectors delivery.展开更多
In recent years,e-scooters have been introduced in many European cities.In several places we have witnessed a rapid uptake of this new mode of transport mainly as a result of public sharing schemes.A number of inciden...In recent years,e-scooters have been introduced in many European cities.In several places we have witnessed a rapid uptake of this new mode of transport mainly as a result of public sharing schemes.A number of incidents,injuries and even fatalities have given rise to questions regarding the safety of these vehicles.These questions are being researched mainly using official crash data and data specifying injuries and hospital treatment.Until now,the research has focused on investigating typical injury patterns and estimating risk levels.Very little is known about exactly where conflicts and crashes occur.Knowledge of hazard hotspots is crucial when investigating risk levels and improving safety for all road users.Hence,this paper develops an approach to investigating locations with potentially dangerous interactions within the active mobility system in the city of Berlin.The approach consists of explorative expert interviews,an online poll,and quantitative analyses.For the latter we combine three datasets.First,we research crash hotspots using official data.Second,we use data based on acceleration sensors from cyclists'smartphones to find locations of sudden movements.Third,we use trip data from the operators of escooter sharing systems.The information gathered is used in a conclusive expert workshop to identify hazard hotspots.Results show that many of the conflicts with pedestrians are caused by parked escooters.Second,e-scooter trips are concentrated in the inner city and along specific routes.In moving traffic,various data sources are used to identify hotspots at intersections and in areas between intersections.The present research lays the foundation for important further studies to investigate interactions at hotspots in detail by determining nine specific locations in the city of Berlin.展开更多
文摘Background:Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture.Although early passive mobilization limits rupture,it often compromises the functional recovery.Recent approaches favor early active mobilization with strong,multi-stranded core sutures to enhance outcomes.This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting.Methods:In this prospective study,143 tendons from 30 patients who underwent surgery were followed up.The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture,providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs,thereby reducing operative time without increasing bulk.Early active mobilization was initiated on postoperative day 2.The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group,which enabled real-time guidance and compliance monitoring.The outcomes were measured in terms of total active motion,grip strength,pinch strength,time to return to work,postoperative pain,and complications.Results:Of the 30 patients,28(93.3%)had fair-to-excellent outcomes,whereas only 2(6.7%)had poor outcomes.Most patients(93.3%)returned to work within 12 weeks postoperatively.Four(13.3%)patients had complications,such as wound infection and skin necrosis.The patients showed significant changes in grip strength(45.2%)and pinch strength(70.7%)between weeks 8 and 12.No tendon ruptures were observed.Conclusion:The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization,which began on the second day after surgery,resulting in fair-to-excellent outcomes.It supports digitally supervised physiotherapy through app-based monitoring,enhancing patient compliance,and reducing reliance on in-person therapy sessions.This combination led to excellent functional recovery with minimal complications.
文摘Objective: To clarify the indications and to describe the surgical technique and outcomes of surgery involving transfer of the trapezius to the deltoid for the treatment of lesions of the brachial plexus in patients with multidirectional instability in the shoulder. Method: In 17 patients (mean age, 23 years) operated at Sao Vicente de Paulo Hospital and the Institute of Orthopedics and Traumatology of Passo Fundo, Brazil from?1999 to 2009, we performed trapezius transfer to the proximal humerus. In these patients, the mean interval between trauma and surgery was 8 months. Results: Functional improvement and resolution of multidirectional instability of the shoulder were observed in all the patients. No patient showed immediate postoperative complications. The mean active mobility was as follows: 95° flexion, 50° abduction, 45° external rotation, and internal rotation at the level of the first lumbar vertebra (L1). The trapezius muscle strength was classified as grade III, and the UCLA functional outcome was 22 points. The postoperative satisfaction was excellent, and occasional pain and weakness was reported by all the patients. Conclusions: Transfer of the trapezius muscle to the proximal humerus provides better results in patients with a more than 6-month-old lesion. This procedure also preserves passive mobility of the limb, confers shoulder stability, provides active mobility, and prevents osteoarthrosis.
基金supported by National Science and Technology Innovation 2030 Major Program (2021ZD0200900) (H.Y.)the National Natural Science Foundation of China (31925016,82021001) (H.Y.)+4 种基金Basic Frontier Scientific Research Program of Chinese Academy of Sciences From 0 to 1 original innovation project (ZDBS-LY-SM001) (H.Y.)Project of Shanghai Municipal Science and Technology Commission (20MC1920400) (H.Y.)Huida Gene Therapeutics Co.Ltdsupport from Shanghai Center for Brain Science and BrianInspired Technology。
文摘The advent of CRISPR-Cas has revolutionized precise gene editing.While pioneering CRISPR nucleases like Cas9 and Cas12 generate targeted DNA double-strand breaks(DSB)for knockout or homology-directed repair,next generation CRISPR technologies enable gene editing without DNA DSB.Base editors directly convert bases,prime editors make diverse alterations,and dead Cas-regulator fusions allow nuanced control of gene expression,avoiding potentially risks like translocations.Meanwhile,the discovery of diminutive Cas12 orthologs and Obligate Mobile Element-Guided Activity(OMEGA)nucleases has overcome cargo limitations of adeno-associated viral vectors,expanding prospects for in vivo therapeutic delivery.Here,we review the ever-evolving landscape of cutting-edge gene editing tools,focusing on miniature Cas12 orthologs and OMEGA effectors amenable to single AAV packaging.We also summarize CRISPR therapies delivered using AAV vectors,discuss challenges such as efficiency and specificity,and look to the future of this transformative field of in vivo gene editing enabled by AAV vectors delivery.
基金funded by the German Federal Ministry for Digital and Transport using resources from the National Cycling Plan 2020(NRVP)。
文摘In recent years,e-scooters have been introduced in many European cities.In several places we have witnessed a rapid uptake of this new mode of transport mainly as a result of public sharing schemes.A number of incidents,injuries and even fatalities have given rise to questions regarding the safety of these vehicles.These questions are being researched mainly using official crash data and data specifying injuries and hospital treatment.Until now,the research has focused on investigating typical injury patterns and estimating risk levels.Very little is known about exactly where conflicts and crashes occur.Knowledge of hazard hotspots is crucial when investigating risk levels and improving safety for all road users.Hence,this paper develops an approach to investigating locations with potentially dangerous interactions within the active mobility system in the city of Berlin.The approach consists of explorative expert interviews,an online poll,and quantitative analyses.For the latter we combine three datasets.First,we research crash hotspots using official data.Second,we use data based on acceleration sensors from cyclists'smartphones to find locations of sudden movements.Third,we use trip data from the operators of escooter sharing systems.The information gathered is used in a conclusive expert workshop to identify hazard hotspots.Results show that many of the conflicts with pedestrians are caused by parked escooters.Second,e-scooter trips are concentrated in the inner city and along specific routes.In moving traffic,various data sources are used to identify hotspots at intersections and in areas between intersections.The present research lays the foundation for important further studies to investigate interactions at hotspots in detail by determining nine specific locations in the city of Berlin.
