The optimal management of partial flexor tendon laceration is controversial and remains a clinical challenge. Abnormal tendon gliding (triggering and entrapment) was assessed at the A2 pulley in 40 turkey tendons in three groups: intact, partially divided (palmar or lateral), and trimmed. Testing was of gliding resistance and friction coefficient at 30° and 70° of flexion, loaded with 2 and 4 N. We observed for triggering and entrapment. The changes in gliding properties were compared and analysed using Wilcoxon matched pair testing. A significant difference was found in the change in gliding properties of intact to lacerated and lacerated to trimmed tendons and between tendons that glided normally compared with those exhibiting triggering or entrapment. This suggests that palmar and lateral lacerations which, through clinical examination and visualization, are found to glide normally should be treated with early mobilization. However, partial lacerations that exhibit triggering or entrapment should be trimmed.

BackgroundHistorically, the effect of wine grape shading on flavonoids have investigated the impact of light incidence on proanthocyanidin (PA), flavonol, or anthocyanin concentration. In addition to concentration, the current experiment was designed to look at changes in proanthocyanidin composition, size and tannin activity through ripening. Tannin activity is a methodology for assessing the impact of structure and size on the affinity of tannin towards a hydrophobic surface and is considered to be a proxy for predicted astringency descriptive quality. In 2016 a shade cloth study was imposed on Cabernet Sauvignon on Mt. Veeder, within the larger Napa Valley viticultural area. A control, which was unshaded, and two treatments consisting of 40% and 80% shade were applied at the onset of veraison.ResultsResults showed significant differences in the composition and concentration of anthocyanins throughout ripening. Compositional differences in proanthocyanidin were also observed, where shaded treatments had a significantly higher proportion of galloylated subunits. The molecular mass of the extracted tannin was significantly lower in the unshaded control than in the 80% shade treatment. These factors led to a lower measured tannin activity in extracts from exposed fruit.ConclusionThis work suggests that manipulation of canopy architecture, such as artificial shading, leads to changes in berry pigmentation, tannin composition and activity. These results show that astringency and mouthfeel characteristics of a wine may be altered by vineyard management practices.This article is protected by copyright. All rights reserved.

Background The available literature on the reported patient satisfaction following bilateral staged primary total knee arthroplasty (TKA) is limited. The purpose of our study is to compare patient-reported satisfaction following bilateral non-simultaneous TKA performed in a single unit. Methods We retrospectively analyzed our regional database, the Trent and Wales Arthroplasty Audit Group (TWAAG). Patients who had bilateral staged TKA in the University Hospitals of Leicester, UK, between 1990 and 2007 and had completed a 12-month post-operative questionnaire were included in the study. Results One thousand one patients were included in the study. 824 patients (82.3%) reported being satisfied with both of their primary TKAs. 91% and 88% reported being satisfied with their TKA respectively for the first and second sides. A chi-squared test revealed that the difference in satisfaction rates between the first and second side TKA was statistically significant. 86 patients were pleased with their first side but not pleased/unsure with the second side. On the other hand, 55 patients were pleased with their second side but not pleased/unsure with the first side. This difference was also statistically significant. Conclusion In our study, more patients were pleased following their first side compared to their second side TKA.

Background Fractures through the waist of scaphoid are a common injury, resulting in deformity or nonunion. Recently, a locking plate has been shown to fix deformity or nonunion of scaphoid, with limited observation of functional postoperative outcomes. Objectives We present a case series of 16 patients, with the disabilities of the arm, shoulder, and hand (DASH) score evaluation in primary fixation of scaphoid fractures with humpback deformity (n = 11) and revision open reduction internal fixation (ORIF) for nonunion (n = 5), using the Medartis TriLock 1.5 scaphoid plate and bone grafting. Patients and Methods DASH scores were obtained preoperatively and postoperatively at 3, 6, and 12 (if required) months. Patient demographics, smoking status, employment type, and grip strengths were recorded. Results Thirteen patients attended follow-up. Union was clinically and radiologically assessed with 13 achieving union. The mean preoperative DASH score was 34.0 (n = 16) and at treatment completion (discharge or DNA) was 11.5 (n = 13), with mean reduction of 18.5 (p = 0.03). At treatment completion, mean reduction in DASH score of revision ORIF was 13.7 (p = 0.27; n = 4), compared with 20.7 (p < 0.01; n = 9) in primary fixation with plate. Conclusions Deformity correction, reduction in DASH score, and rate of union make the plate system useful in the management of scaphoid fractures with humpback deformity and revision for nonunion. Level of Evidence This is a Level IV study.

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