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Once the deformities of rheumatoid arthritis of the hand begin to develop, conservative management will not prevent their further development. The ulnar drift of the fingers can be improved considerably by a surgical operation, especially if performed early. Experience has shown that an operation performed during the active stage of the disease does not cause exacerbation of symptoms. The results of operations have been encouraging with regard to return of function, decrease in pain and improved appearance of the hand.     

The effectiveness of the superiorly based pharyngeal flap in relation to the type of palatal defect and timing of the operation

A 10-year review of 39 patients who underwent a superiorly based pharyngeal flap for severe velopharyngeal insufficiency was performed. The effectiveness of the operation, as scored by standardized preoperative and postoperative evaluations, was related to age at operation, type of defect, and duration of velopharyngeal inadequacy. There was no statistical difference between those who were under the age of 6 years (100 percent were improved) at the time of the operation versus those 6 years and older (74 percent improved). Likewise, there was no difference between those patients who received an early flap (92 percent were improved) versus those who received a flap 2 or more years after initial palatorrhaphy (90 percent were improved). The type of palatal defect also was not a significant factor, and none of the patients exhibited a postoperative decrease in function (p less than or equal to 0.001). The operation offered reliable salvage of velopharyngeal competency regardless of the above-mentioned factors.     

Quorum-based synchronization protocols for multimedia replicas

Multiple replicas of multimedia objects are distributed to peers in overlay networks. In quorum-based (QB) protocols, every replica may not be up-to-date and the up-to-date replica can be found in the version counter. Multimedia objects are characterized in terms of not only data structure but also quality of service (QoS) parameters like frame rate. A transaction reads a parameter of a replica while there is a type of read operation to read a whole state of a replica. Each parameter of a replica is changed through a write operation. Thus, the data structure and QoS parameters of a replica are independently manipulated. In the multimedia quorum-based (MQB) protocol, multiple replicas of a multimedia object are synchronized based on the newness precedent relation. An object is an encapsulation of data and abstract operations for manipulating the data. There are enriching and impoverishing types of write operations. Some data is added to a replica in an enriching operation. On the other hand, some data in a replica is removed in an impoverishing operation. In order to reduce the overhead to write every replica in a quorum, we take an approach that the state of each replica is not always updated. If a transaction issues an enriching write operation, every replica in the write quorum is updated in the same way as the QB protocol. On the other hand, if an impoverishing write operation is issued, every replica is not updated in the quorum. Impoverishing operations are just recorded in replicas. On receipt of a read operation to read a whole state, impoverishing operations recorded are performed on a replica. The MQB protocol is evaluated in terms of the processing overhead of replicas. We show that the processing overhead of each replica can be reduced in the MQB protocol.     

THE TREATMENT OF ACUTE INFECTIONS OF THE HAND

Acute infections of the hand are serious and frequently arise from a trivial wound which has been neglected or improperly treated. Accurate diagnosis, prompt institution of treatment, and early restoration of function are essential for successful treatment. Results in the treatment of acute infections of the hand are greatly improved by the rigid practice of a method of operation which recognizes fundamental surgical principles.     

Initially alloperfused autograft: an experimental study with rat groin free flap

The purpose of this experimental study was to investigate the effects of alloperfusion on autografts. The authors designed an experimental model to study flap viability during and after alloperfusion. They performed 23 free groin flap transfers on 46 rats. The flap was transferred as an autograft; however, the anastomosis was performed as an allograft procedure. After the operation, animals were held together on a table for observation. The rats were randomly divided into two groups depending on whether or not a steroid was given. They were fed by hand. At the end of the various waiting periods, the pedicles were divided, and animals were separated from each other. The survival of the flap and the animal was observed. No flaps survived in the untreated group. Seven flaps in the steroid-treated group that had their connections cut before 140 hours also did not survive. Five flaps that had their pedicles cut after 140 hours survived. Results are presented and discussed.     

Parkinsonism—Evaluation and Treatment of Movement Disorders

Patients with movement disorders from parkinsonism were treated with thalamotomy performed by stereotactic surgical procedure. In order to determine with any degree of objectivity the results of these lesions, an accelerometer was used to record hand tremor and various mechanical tests were carried out that included self-care activities to evaluate impairment of function. On the basis of these tests, patients were selected for surgical operation, their condition before and after operation was evaluated, and a program for their rehabilitation was drafted.     

Functional results of excisional arthroplasty for the rheumatoid hand

Two types of assessment were used in our evaluation of the long-term results of excisional MCP arthroplasty in the rheumatoid hand: a standard surgeon-patient assessment, and a functional test model applied to 17 rheumatoid hands before and after operation.The surgeon-patient overall assessment at the time of follow-up indicated satisfaction with the results in 15 of 17 hands, whereas the occupational therapists'' objective functional testing indicated a less positive end result — improvement in 6 of the 17 hands and worsening in 8.The discrepancy need not negate the validity of either finding but would suggest that factors other than function as measured give patient satisfaction. These include such features as pain relief, ability to put on gloves again and improved appearance.     

SURGICAL TREATMENT OF INFANTILE HYDROCEPHALUS

The operation of endoscopic coagulation of the choroid plexuses for the relief of infantile hydrocephalus is now 18 years old. Nearly a hundred cases have been reported and the indications and procedure are well standardized. Several patients have grown up apparently normally from the earliest series of operations.In a recent series of 20 operations performed on ten patients in the past ten years, there have been no deaths attributable to the procedure. The operation has substantially decreased the pressure in all cases, and has brought it within normal limits in all cases in which it was performed before the head became grossly enlarged.The mentality has improved following relief of pressure in all cases. When the operation was performed before deterioration began, the results were uniformly excellent.     

同种异体骨切割设备夹持装置的设计

根据对骨植入材料的力学分析，从仿生学原理入手，建立六自由度的手夹持结构的力学模型，设计了骨切割设备夹持手机械结构。它能适应不规则形状骨材料的加工，满足临床对不同规格产品的需求，可提高操作的安全性、骨料的利用率。     

Laparoscopic abdominal cysts fenestration using harmonic scalpel

The use of ultrasonically activated scalpel for tissue cutting and coagulation is a potential replacement for electrosurgery, which can be related to different complications. Its working principle is to transform the electric power into the mechanical longitudinal movement of the working part of the instrument, by a piezoelectric transducer situated in the hand piece. Between October 2000 and June 2004, six patients with abdominal cysts were treated by laparoscopy, using the harmonic scalpel. The average age was 40.8 (ranging from 15-60) years. Laparoscopic abdominal cyst fenestration was performed in five patients, and laparoscopic cholecystectomy and abdominal cyst fenestration were done in one patient during the same operation. The average duration of the operation was 40 (ranging from 25-70) minutes and hospital stay was 2.8 (ranging from 1-5) days. Laparoscopic abdominal cyst fenestration using the harmonic scalpel is a safe and successful operation, with good results including all the advantages of the minimally invasive surgery.     

A Hungarian twin study on hand clasping, arm folding and tongue curling

A twin study was performed in adult Hungarian monozygotic and dizygotic pairs for hand clasping, arm folding and tongue curling. Genetic background of these traits could not be confirmed, although there appears to be a positive correlation between hand clasping type and handedness.     

Cardiovascular and sympatho-adrenal responses to static handgrip performed with one and two hands

12 healthy men aged 21-25 years performed, in the sitting position, a sustained handgrip at 25% of their maximum voluntary contraction, first with each hand separately and then with both hands simultaneously. Heart rate (HR), systolic blood pressure (SBP), stroke volume (determined reographically) and plasma catecholamine concentration were measured during each handgrip test. The HR and SBP increased consistently during each handgrip test while stroke volume decreased by approximately 20% of the initial value. Cardiac output did not change significantly. There were no significant differences in the magnitude and dynamics of the cardiovascular responses between the tests with one and with both hands. Plasma noradrenaline and adrenaline levels showed similar elevations in response to handgrip performed with the right hand and with both hands, while during the exercise performed with the left hand the increase in the plasma catecholamine concentration was less pronounced. It was concluded that: (1) during sustained handgrip, performed in the sitting position by young healthy subjects, the stroke volume markedly decreases and cardiac output does not change significantly in spite of the increased HR; (2) the cardiovascular and sympatho-adrenal responses to static handgrip do not depend on the mass of contracting muscle when the same relative tension is developed.     

Interaction between the premotor processes of eye and hand movements: Possible mechanism underlying eye–hand coordination

Interaction between the execution process of eye movement and that of hand movement must be indispensable for eye–hand coordination. The present study investigated corticospinal excitability in the hand muscles during the premotor processes of eye and/or hand movement to elucidate interaction between these processes. Healthy humans performed a precued reaction task of eye and/or finger movement and motor-evoked potentials in the hand muscles were evoked in the reaction time. Leftward eye movement suppressed corticospinal excitability in the right abductor digiti minimi muscle only when little finger abduction was simultaneously executed. Corticospinal excitability in the first dorsal interosseous muscle was not suppressed by eye movement regardless of whether or not it was accompanied by finger movement. Suppression of corticospinal excitability in the hand muscles induced by eye movement in the premotor period depends on the direction of eye movement, the muscle tested, and the premotor process of the tested muscle. The suppression may reflect interaction between the motor process of eye movement and that of hand movement particularly active during eye–hand coordination tasks during which both processes proceed.     

Functional Corticospinal Projections from Human Supplementary Motor Area Revealed by Corticomuscular Coherence during Precise Grip Force Control

The purpose of the present study was to investigate whether corticospinal projections from human supplementary motor area (SMA) are functional during precise force control with the precision grip (thumb-index opposition). Since beta band corticomuscular coherence (CMC) is well-accepted to reflect efferent corticospinal transmission, we analyzed the beta band CMC obtained with simultaneous recording of electroencephalographic (EEG) and electromyographic (EMG) signals. Subjects performed a bimanual precise visuomotor force tracking task by applying isometric low grip forces with their right hand precision grip on a custom device with strain gauges. Concurrently, they held the device with their left hand precision grip, producing similar grip forces but without any precision constraints, to relieve the right hand. Some subjects also participated in a unimanual control condition in which they performed the task with only the right hand precision grip while the device was held by a mechanical grip. We analyzed whole scalp topographies of beta band CMC between 64 EEG channels and 4 EMG intrinsic hand muscles, 2 for each hand. To compare the different topographies, we performed non-parametric statistical tests based on spatio-spectral clustering. For the right hand, we obtained significant beta band CMC over the contralateral M1 region as well as over the SMA region during static force contraction periods. For the left hand, however, beta band CMC was only found over the contralateral M1. By comparing unimanual and bimanual conditions for right hand muscles, no significant difference was found on beta band CMC over M1 and SMA. We conclude that the beta band CMC found over SMA for right hand muscles results from the precision constraints and not from the bimanual aspect of the task. The result of the present study strongly suggests that the corticospinal projections from human SMA become functional when high precision force control is required.     

Cell proliferation in the mouse parotid gland after unilateral parotidectomy.

Unilateral parotidectomy with or without total submandibulectomy has been used to induce cell proliferation in mouse parotid gland. Maximum DNA synthesis and mitosis were recorded four and five days after the operation. The double operation increased the proliferative response. Such proliferative stimulii was not accompanied by secretion and was sex independent. On the other hand, the response decreased with age. RNA and protein synthesis inhibitors showed that the stimulation of DNA synthesis depends on early protein synthesis, which seems to be synthesized on a preexisting template.     

Influence of pollination systems on fruit set and fruit quality in kiwifruit (Actinidia deliciosa)

Kiwifruit (Actinidia deliciosa (Chev.) Liang and Ferguson) is a dioecious species highly pollination dependent, since fruit size is directly correlated with seed number. To evaluate the best pollination system for this species a study of two natural and two artificial pollination systems was carried out and their effect on fruit set and fruit quality was determined. While anemophilous pollination produced few and small fruits, that were not commercially acceptable, high fruit set percentages and good quality fruits were obtained when insects participated in the pollination process. Artificial pollination, performed as hand pollination, improved yield quantity and quality. When environmental conditions impair insect activity this method can be an useful agricultural practice in order to assure a good yield.     

Results of Parks operation for faecal incontinence after anal sphincter injury.

Parks operation for faecal incontinence was performed on 97 patients with total loss of anorectal control due to injury. All had sustained complete division of the anal sphincters as a result of trauma, anal surgery, or obstetric tears and either were incontinent or had been given a colostomy. In all patients the divided sphincters were repaired using an overlapping technique; in 93 the repair was protected by a temporary defunctioning stoma. There was no operative mortality. Continence was completely restored in 65 (78%) and improved in a further 11 (13%) of the 83 patients assessed from four to 116 months postoperatively. Minor complications which did not affect the eventual clinical outcome occurred in 23 patients. Factors associated with failure of the operation included breakdown of the repair in the early postoperative period, fistula, and pelvic floor neuropathy. The results show that even after severe injury to the sphincters surgical reconstruction can restore continence in most patients.     

Grasping the Intentions of Others with One's Own Mirror Neuron System

Understanding the intentions of others while watching their actions is a fundamental building block of social behavior. The neural and functional mechanisms underlying this ability are still poorly understood. To investigate these mechanisms we used functional magnetic resonance imaging. Twenty-three subjects watched three kinds of stimuli: grasping hand actions without a context, context only (scenes containing objects), and grasping hand actions performed in two different contexts. In the latter condition the context suggested the intention associated with the grasping action (either drinking or cleaning). Actions embedded in contexts, compared with the other two conditions, yielded a significant signal increase in the posterior part of the inferior frontal gyrus and the adjacent sector of the ventral premotor cortex where hand actions are represented. Thus, premotor mirror neuron areas—areas active during the execution and the observation of an action—previously thought to be involved only in action recognition are actually also involved in understanding the intentions of others. To ascribe an intention is to infer a forthcoming new goal, and this is an operation that the motor system does automatically.     

Grasping the intentions of others with one's own mirror neuron system

Understanding the intentions of others while watching their actions is a fundamental building block of social behavior. The neural and functional mechanisms underlying this ability are still poorly understood. To investigate these mechanisms we used functional magnetic resonance imaging. Twenty-three subjects watched three kinds of stimuli: grasping hand actions without a context, context only (scenes containing objects), and grasping hand actions performed in two different contexts. In the latter condition the context suggested the intention associated with the grasping action (either drinking or cleaning). Actions embedded in contexts, compared with the other two conditions, yielded a significant signal increase in the posterior part of the inferior frontal gyrus and the adjacent sector of the ventral premotor cortex where hand actions are represented. Thus, premotor mirror neuron areas—areas active during the execution and the observation of an action—previously thought to be involved only in action recognition are actually also involved in understanding the intentions of others. To ascribe an intention is to infer a forthcoming new goal, and this is an operation that the motor system does automatically.     

Radiographic analysis of growth in pediatric microsurgical toe-to-hand transfers

Microsurgical toe-to-hand transfers may provide improved hand function in children with absent digits. To date, documentation of the growth potential of these transferred digits has not been performed. This study reviewed the authors' series of pediatric toe-to-hand transfers, with specific attention paid to measuring growth by radiographic analysis. From 1995 to 2000, 23 toe-to-hand transfers were performed in 18 children. Age at time of transfer ranged from 2.8 to 13 years. Indications included constriction band syndrome, transverse deficiency, longitudinal deficiency, traumatic amputation, and vascular malformation. The transfers were successful in 22 of 23 procedures (96 percent success rate). Radiographic analysis of growth was performed using three criteria: (1) appearance of open epiphyseal plates, (2) comparison with preoperative radiographs, and (3) comparison with radiographs of the contralateral control toe. Epiphyseal plates remained open on postoperative radiographs in 27 of 28 phalanges (96 percent) at a mean of 12 months' follow-up (range, 1 to 36 months). The preoperative foot radiographs were compared with serial radiographs of the transferred toe over time. In 10 toe transfers with follow-up greater than 6 months (mean, 21 months), nine patients had increased bony length in the transferred digit. In four patients, radiographs of the toe transfer were compared with radiographs of the corresponding toe on the opposite foot. With a mean follow-up of 29 months, all patients had equal length measurements of the toe transfer with the contralateral toe control. These data provide objective evidence that digital growth potential is preserved in toe-to-hand transfers. Furthermore, this bone growth is comparable with that of the corresponding toe on the contralateral foot. Therefore, microsurgical toe-to-hand transfers may provide children with extra digits that maintain growth and improve hand function.