Surgical treatment of proximal interphalangeal joint stress fracture in a climber.

Proximal interphalangeal joint stress fractures commonly occur as epiphyseal line injuries in teenage climbers; however, fractures with closed epiphyseal lines are rare. Poor outcomes are more common if treatment is delayed. We report the case of a 16-year-old climber who underwent delayed surgical treatment for a fracture with a closed epiphyseal line, with a favorable outcome. There was 20 ° extension lag at the proximal interphalangeal joint and a fracture on the dorsal aspect of the base of the metaphyseal bone, with osteosclerosis at the fracture site. The fracture site was refreshed and internal fixation was performed using the tension-band wiring technique. At 3 months postoperatively, there was no pain, extension had improved, and bone union was achieved. This case illustrates the effectiveness of surgery in achieving favorable outcomes for delayed proximal interphalangeal joint stress fractures in climbers with epiphyseal line closure. LEVEL OF EVIDENCE: V.

Shoulder-assist exoskeleton effects on balance and muscle activity during a block-laying task on a simulated mast climber.

Interest in utilizing exoskeletons to mitigate the risks of musculoskeletal disorders (MSDs) among construction workers is growing, spurred by encouraging results in other industries. However, it is crucial to carefully examine their impact on workers' stability and balance before implementation. In this study, seven male participants lifted a 35-lb cinder block from a production table to a simulated wall at two heights-elbow and shoulder levels-using three different exoskeleton models on an unstable platform, where their balance and shoulder muscle activity were assessed. Balance-related parameters, included mean distance (MDIST), total excursion (EXCUR), and mean velocity (VEL) of the center of pressure, were derived from force plate data. Muscle activity in six shoulder and upper arm muscles was estimated using electromyography (EMG) data. The results indicated that wearing two of the exoskeletons significantly increased both total and medio-lateral (ML) MDIST compared to not wearing an exoskeleton. Wearing one of the exoskeletons significantly increased total and ML VEL and ML EXCUR. Although lifting level did not have a significant impact on the balance parameters, it did affect the muscle activity in most of the measured muscles. Moreover, only one exoskeleton significantly reduced the activity in a particular shoulder muscle compared to no exoskeleton use. In conclusion, the evaluated shoulder-assist exoskeletons showed limited benefits for preventing upper extremity MSDs and may negatively affect whole-body balance during a block-laying task on an unstable platform. These findings underscore the importance of comprehensive evaluations of balance and effectiveness prior to adopting exoskeletons in construction.

A Rare Case of a Medial Peritalar Dislocation on a Rock Climber.

Introduction: Peritalar dislocations are rare and account for only 1% of all traumatic foot injuries. The talonavicular and the subtalar joints are dislocated; the tibiotalar and calcaneocuboid joints remain intact. Associated injuries are not uncommon. Sports related peritalar dislocations have been reported. However, there are no cases reported on rock climbers. Case Report: We report the case of a healthy 38-year-old patient, seen after a climbing accident against the wall. He presented a severe varus deformity of the hindfoot and an ankle hematoma and the talar head was palpable laterally against the skin. The radiological assessment showed a medial peritalar dislocation of the left foot. The dislocation was successfully closed reduced in the emergency room under sedation using axial traction and external translation maneuver. Non-operative treatment with cast immobilization and non-weight-bearing was performed for 6 weeks. At 6 months, the patient walked physiologically, without limping. He returned climbing and the subtalar joint did not show any stiffness. Conclusion: An understanding of the mechanism of injury is necessary to attempt a closed reduction which should be performed as quickly as possible to avoid skin necrosis. An open reduction might be necessary. After reduction, a complete radiological assessment is necessary to exclude associated fractures. The direction of the dislocation, the energy of the accident, the timing of the reduction, as well as the joint's stability after reduction have a direct impact on the clinical and functional outcomes.

Negative phototropism of the shoots helps temperate liana Hedera helix L. to locate host trees under habitat conditions.

Lianas employ a variety of searching mechanisms to find support; however, it is not clear to what extent environmental signals are used to help direct the search. Several adventitious root climbers have been shown to bend away from light and grow toward darker areas or objects, in one case including actual tree trunks. In the literature, this negative phototropism (NP) has also been informally and inconsistently reported from a temperate root climber Hedera helix L. (common ivy). In this study, rigorous laboratory tests have confirmed the occurrence of NP in both seedlings and prostrate shoots of H. helix. Furthermore, a field experiment with potted ivy seedlings placed around tree trunks demonstrated their ability to remotely locate trees. This finding was corroborated by a survey of growth directions in wild-growing prostrate ivy shoots in two woodland habitats. An additional outdoor experiment showed that the ability to locate support is expressed in shade but supressed by full sun conditions. These results show that H. helix uses NP to locate support and indicate that this ability is a component of the species' shade escape strategy.

A Rare Case of an Isolated Neglected Subcutaneous Rupture of the Flexor Digitorum Superficialis in a Climber: Successful Surgical Treatment and Review of the Literature.

Isolated neglected subcutaneous rupture of the flexor digitorum superficialis (FDS) in zone III of the hand is a rare injury that is distinct from subcutaneous rupture of the deep flexor tendons in the fingers. While a few cases have been reported in the literature, the pathophysiology of this injury remains poorly understood. In this article, we present a case study of a climber who experienced an isolated subcutaneous rupture of the FDS following a sports accident. The patient's diagnosis was initially delayed due to an unclear clinical presentation. However, surgical intervention was successfully performed, resulting in positive clinical outcomes at the one-month follow-up. This case highlights the importance of considering isolated subcutaneous rupture of the FDS as a potential injury in climbers and other individuals who engage in high-impact sports.

From dark to darkness, negative phototropism influences the support-tree location of the massive woody climber Hydrangea serratifolia (Hydrangeaceae) in a Chilean temperate rainforest.

Climbing plants rely on suitable support to provide the light conditions they require in the canopy. Negative phototropism is a directional search behavior proposed to detect a support-tree, which indicates growth or movement away from light, based on light attenuation. In a Chilean temperate rainforest, we addressed whether the massive woody climber Hydrangea serratifolia (H. et A.) F. Phil (Hydrangeaceae) presents a support-tree location pattern influenced by light availability. We analyzed direction and light received in two groups of juvenile shoots: searching shoots (SS), with plagiotropic (creeping) growth vs. ascending shoots (AS), with orthotropic growth. We found that, in accordance with light attenuation, SS and AS used directional orientation to search and then ascend host trees. The light available to H. serratifolia searching shoots was less than that of the general forest understory; the directional orientation in both groups showed a significant deviation from a random distribution, with no circular statistical difference between them. Circular-linear regression indicated a relationship between directional orientations and light availability. Negative phototropism encodes the light environment's heterogeneous spatial and temporal information, guiding the shoot apex to the most shaded part of the support-tree base, the climbing start point.

An Updated Checklist of the Genus Capparis L. (Capparaceae) in Vietnam, including a New Species from Hon Tre Island.

The Indochinese Peninsula is a main center of speciation of Capparis, but the taxonomic treatment of the genus is still critical in this area. With regard to Vietnam, a discordant number of species was recorded by different authors during the last century, whereas various new species have been recently described. An updated checklist of the intrageneric taxa occurring in the country is here presented, including a new species from the island of Hon Tre, Khanh Hoa Province. The genus comprises in Vietnam 37 species, 9 subspecies and 3 varieties, all belonging to Capparis sect. Monostichocalyx. The study area, with 10 endemic species, is confirmed as one of the hotspots of the genus. Three lectotypes are also selected. The new species here described and illustrated, C. oxycarpa, is related to C. pranensis, differing in the few-flowered subumbels, narrower sepals, smaller petals, longer filaments and smaller, apiculate fruit; its affinities with related taxa and conservation status are discussed, and data on its ecology and phenology are given.

Removing climbers more than doubles tree growth and biomass in degraded tropical forests.

Huge areas of tropical forests are degraded, reducing their biodiversity, carbon, and timber value. The recovery of these degraded forests can be significantly inhibited by climbing plants such as lianas. Removal of super-abundant climbers thus represents a restoration action with huge potential for application across the tropics. While experimental studies largely report positive impacts of climber removal on tree growth and biomass accumulation, the efficacy of climber removal varies widely, with high uncertainty as to where and how to apply the technique. Using meta-analytic techniques, we synthesize results from 26 studies to quantify the efficacy of climber removal for promoting tree growth and biomass accumulation. We find that climber removal increases tree growth by 156% and biomass accumulation by 209% compared to untreated forest, and that efficacy remains for at least 19 years. Extrapolating from these results, climber removal could sequester an additional 32 Gigatons of CO2 over 10 years, at low cost, across regrowth, and production forests. Our analysis also revealed that climber removal studies are concentrated in the Neotropics (N = 22), relative to Africa (N = 2) and Asia (N = 2), preventing our study from assessing the influence of region on removal efficacy. While we found some evidence that enhancement of tree growth and AGB accumulation varies across disturbance context and removal method, but not across climate, the number and geographical distribution of studies limits the strength of these conclusions. Climber removal could contribute significantly to reducing global carbon emissions and enhancing the timber and biomass stocks of degraded forests, ultimately protecting them from conversion. However, we urgently need to assess the efficacy of removal outside the Neotropics, and consider the potential negative consequences of climber removal under drought conditions and for biodiversity.

Pulley Rupture in Rock Climber after Collagenase Treatment for Dupuytren Contracture.

Pulley injuries and Dupuytren disease are quite common in rock climbing. We report a rock climber who was treated for a Dupuytren contracture with collagenase injection therapy. Two months later, he developed a traumatic pulley injury during climbing and was treated with a ring orthosis. However, the finger contracture deteriorated and both a recurrent pulley rupture and a second pulley rupture were diagnosed. We were unable to find any reports on the use of collagenase in rock climbers with Dupuytren disease. We report a case of pulley rupture in a rock climber, treated for Dupuytren contracture in the treated and an adjacent finger, 2 months after the injection of collagenase. Level of Evidence: Level V (Therapeutic).

Higher water and nutrient use efficiencies in savanna than in rainforest lianas result in no difference in photosynthesis.

Differences in traits between lianas and trees in tropical forests have been studied extensively; however, few have compared the ecological strategies of lianas from different habitats. Here, we measured 25 leaf and stem traits concerning leaf anatomy, morphology, physiology and stem hydraulics for 17 liana species from a tropical seasonal rainforest and for 19 liana species from a valley savanna in south-west China. We found that savanna lianas had higher vessel density, wood density and lower hydraulically weighted vessel diameter and theoretical hydraulic conductivity than tropical seasonal rainforest lianas. Compared with tropical seasonal rainforest lianas, savanna lianas also showed higher leaf dry matter content, carbon isotope composition (δ13C), photosynthetic water use efficiency, ratio of nitrogen to phosphorus, photosynthetic phosphorus use efficiency and lower leaf size, stomatal conductance and nitrogen, phosphorus and potassium concentrations. Interestingly, no differences in light-saturated photosynthetic rate were found between savanna and tropical seasonal rainforest lianas either on mass or area basis. This is probably due to the higher water and nutrient use efficiencies of savanna lianas. A principal component analysis revealed that savanna and tropical seasonal rainforest lianas were significantly separated along the first axis, which was strongly associated with acquisitive or conservative resource use strategy. Leaf and stem functional traits were coordinated across lianas, but the coordination or trade-off was stronger in the savanna than in the tropical seasonal rainforest. In conclusion, a relatively conservative (slow) strategy concerning water and nutrient use may benefit the savanna lianas, while higher nutrient and water use efficiencies allow them to maintain similar photosynthesis as tropical seasonal rainforest species. Our results clearly showed divergences in functional traits between lianas from savanna and tropical seasonal rainforest, suggesting that enhanced water and nutrient use efficiencies might contribute to the distribution of lianas in savanna ecosystems.

Occupational safety and health in traditional date palm works.

OBJECTIVE: Date palm is mostly cultivated in Western Asia and North Africa and is the main wealth for the people of these regions. Traditional date palm crown access via manual climbing, as the main activity in date fruit production, suffers from occupational hazards. Mitigation of these problems through interventions or new designs initially needs to complete knowledge of safety and health aspects and relationships between them and characters of date palm climbers. This study provided detailed information about this concern. METHODS: A questionnaire consisting of personal, operational, safety, satisfaction, financial and ergonomic demographics was used for data collection. 117 climbers participated in the study. Nonparametric correlations using Spearman's coefficient and logistic regressions investigated the linkage between characters obtained by the questionnaire. RESULTS: The annual mortality rate of falls from height was calculated by 3.4 per one thousand men. Fall was a major challenge in traditional date palm crown access and its rate was highly greater in comparison with the estimation of International Labor Office (ILO) about fatal agricultural injuries. Safety and health condition was the main contributing factor in the status of date palm climbing and was significantly linked to job satisfaction. Safety risk-taking and non-awareness of technology had a significant linkage with together (r = - 0.195, p = 0.035). Safety risk-taking, also, had significant correlations with discomfort in back (r = - 0.201, p = 0.030). Regressions showed heavier climbers (> 75 kg) were expected about 4.3 (1/0.230) times than more lightweight ones to have an upper leg discomfort with high severity relative to low severity (p = 0.018). CONCLUSION: Obesity, senescence, and awareness of technology as three personal characteristics of climbers need to be addressed. Future strategies are required to improve the safety condition of climbing and manage the workforces as well as governmental decision making to address the financial aspects of climbers for sustainable date production and reduction in reasons causing unemployment. Considering current status and modification of the present tool and equipment is recommended.

Multi-objective database queries in combined knapsack and set covering problem domains.

Database queries are one of the most important functions of a relational database. Users are interested in viewing a variety of data representations, and this may vary based on database purpose and the nature of the stored data. The Air Force Institute of Technology has approximately 100 data logs which will be converted to the standardized Scorpion Data Model format. A relational database is designed to house this data and its associated sensor and non-sensor metadata. Deterministic polynomial-time queries were used to test the performance of this schema against two other schemas, with databases of 100 and 1000 logs of repeated data and randomized metadata. Of these approaches, the one that had the best performance was chosen as AFIT's database solution, and now more complex and useful queries need to be developed to enable filter research. To this end, consider the combined Multi-Objective Knapsack/Set Covering Database Query. Algorithms which address The Set Covering Problem or Knapsack Problem could be used individually to achieve useful results, but together they could offer additional power to a potential user. This paper explores the NP-Hard problem domain of the Multi-Objective KP/SCP, proposes Genetic and Hill Climber algorithms, implements these algorithms using Java, populates their data structures using SQL queries from two test databases, and finally compares how these algorithms perform.

Grip Force Measurement as a Complement to High-Resolution Ultrasound in the Diagnosis and Follow-Up of A2 and A4 Finger Pulley Injuries.

The ability of finger flexors to generate force has been studied in relation to climbing performance. However, not much attention has been paid to the decrease in finger grip force in relation to annular pulley injuries. The purpose of the present study was to determine if an injured annular pulley implies a finger flexor force decrease, as well as its relation to clinical and sonographic changes. We performed an observational study in 39 rock climbers with A2 or A4 pulley injuries to the 3rd or 4th fingers. The variables considered were pain upon palpation, ultrasound tendon-bone distance, and finger grip strength decrease. Three rock climbing grip types were considered: the one finger crimp, open crimp, and close crimp. Injured rock climbers presented a decrease in finger grip strength compared to non-injured controls when performing a one finger crimp (p < 0.001). There exists a significant correlation between a tendon-bone distance at the level of the injured pulley and a decreased finger grip strength measured by performing a one finger crimp (p = 0.006). A decrease in finger grip strength could be considered in the diagnostic and follow-up process of A2 and A4 pulley injuries to the 3rd and 4th fingers.

Phylogeography of Schisandra chinensis (Magnoliaceae) Reveal Multiple Refugia With Ample Gene Flow in Northeast China.

Temperate conifers and broadleaved mixed forests in northeast China are ideal to investigate the genetic consequences of climate changes during the last glacial maximum (LGM), 29 - 16 kya. As previous studies were focused on tree species with long generation time; here, the evolutionary history of Schisandra chinensis, a climber species with a generation time of five years, was investigated using chloroplast DNA (cpDNA), nuclear single copy gene (nSCG), and nuclear single sequence repeats (nSSRs, i.e., microsatellite) markers, along with ecological niche modeling (ENM), which predicted a suitable habitat in Korea Peninsula (KP) during the LGM. Private haplotypes and high genetic diversity of both cpDNA and nSCG were mainly found in KP and Changbai Mt. (CB). Although no significant phylogeographic structure was detected in the cpDNA and nSCG, three nSSRs clusters roughly distributed in west (CB and KP), east (north China), and north (Xiaoxing'an Range, XR) regions were found in Structure analysis. The approximate Bayesian computation analysis showed the west cluster diverged at 35.45 kya, and the other two clusters at 19.85 kya. The genetic diversity calculated for each of the three markers showed no significant correlation with latitude. Genetic differentiation of nSSRs was also not correlated with geographic distance. Migrate analysis estimated extensive gene flow between almost all genetic cluster pairs and BOTTLENECK analysis showed that few populations experienced severe bottlenecks. Overall, results indicate that S. chinensis survived the LGM in situ in multiple refugia, which likely include two macrorefugia (KP and CB) and two microrefugia (XR and north China). Extensive postglacial gene flow among the three nSSRs clusters led to uniformly distributed genetic diversity and low genetic differentiation.

Are hydraulic patterns of lianas different from trees? New insights from Hedera helix.

Lianas form long and flexible but disproportionately narrow stems, and thus require particular strategies to maintain the integrity of xylem water transport and ensure supply to large crown areas. The hydraulic architecture of lianas and the respective within-plant coordination of transport efficiency and safety, and the underlying anatomical variations in xylem, are largely unexplored. We analysed Hedera helix, a liana widespread in European temperate forests, with respect to hydraulic and xylem anatomical variations between the main stem and branches, between juvenile and adult life phases, and along the vertical axis. Main stems were significantly less embolism resistant but exhibited a higher hydraulic conductivity than branches. In branches, the cell turgor loss point of leaves decreased, while the embolism resistance and conductivity of xylem, as well as conduit diameters, increased with height. High water-transport capacities allow ivy to compensate for the small cross-section of stems, while the limited resistance to drought-induced xylem dysfunction of the main stem is probably linked to conservative stomatal regulation. Pronounced differences in xylem anatomy, hydraulic efficiency, and safety between the main stem and branches and along the vertical axis are surprisingly similar to those of self-supporting plants, and indicate that the coordination of carbon and water economies requires similar internal adjustments in tall plants.

Assessing Negative and Positive Phototropism in Lianas.

By the nineteenth century, root climbers and adhesive-tendril climbers were known to exhibit negative phototropism. Negative phototropism is shared by various plant species belonging to many taxonomic families and is considered to be an outcome of parallel evolution. Through negative phototropism, lianas search for supporting hosts; however, compared with positive phototropism, which occurs during germination, there is little research on the properties of negative phototropism. This chapter presents a technique for quantifying negative phototropism in root climbers and adhesive-tendril climbers, which involves casting light on one side of a liana shoot and measuring the coordinates of the shoot tip and the angle of curvature of the entire shoot relative to the gradient of the light conditions.

Long-Term Radiographic Adaptations to Stress of High-Level and Recreational Rock Climbing in Former Adolescent Athletes: An 11-Year Prospective Longitudinal Study.

BACKGROUND: In the past few years, competition climbing has grown in popularity, and younger people are being drawn to the sport. PURPOSE: While radiographic changes in long-term climbers are known, there are little data available on adolescent climbers. The question arises as to whether climbing at high levels at a young age leads to radiographic changes and possibly an early onset of osteoarthritis of the finger joints. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 19 members of the German Junior National Team (GJNT group) and 18 recreational climbers (RC group) were examined clinically and radiographically in 1999. In 2011, these climbers were re-examined (mean follow-up, 11.3 ± 1.2 years). Radiographs were evaluated using a standard protocol, searching for physiological adaptations such as cortical thickness of the middle phalanx and an increased adopted Barnett-Nordin index, as well as for early-onset osteoarthritic changes of the hand. In contrast to the Kellgren-Lawrence scale, subchondral sclerosis was added to the group of physiological, adaptive stress reactions and was not defined as osteoarthritis. Osteoarthritis was defined by a Kellgren-Lawrence grade ≥2. RESULTS: Overall, 15 of 19 (follow-up rate, 78.9%) climbers in the GJNT group and 13 of 18 in the RC group (follow-up rate, 72.2%), with a mean age of 26.8 years, were examined at the 11-year follow-up. Five climbers (33%) in the GJNT group presented with a decreased range of motion for the finger joints, in contrast to only 1 climber (8%) in the RC group. Radiographic stress reactions of the hand were found in 80% of the GJNT group and 46% of the RC group, including cortical hypertrophy (GJNT: 73%; RC: 23%), subchondral sclerosis (GJNT: 80%; RC: 31%), a broadened proximal interphalangeal joint base (GJNT: 67%; RC: 38%), and a broadened distal interphalangeal joint base (GJNT: 53%; RC: 31%). Training intensity in 1999 and body weight in 1999 were significant for the development of radiographic stress reactions in 2011 (P < .05 for both). Signs of early-stage osteoarthritis were seen in 6 climbers: 4 (27%) in the GJNT group and 2 (15%) in the RC group. Significant statistical influences for the development of early-onset osteoarthritis were found for overall total training years (P = .024), use of campus board training in 1999 (P = .033), and climbing level (P = .030). CONCLUSION: One-quarter of climbers who performed at a high level in their youth showed a "mild" form of osteoarthritis (Kellgren-Lawrence grade 2). In analyzing the training regimens of our climbers for longer than 10 years, we conclude that intensive finger training (eg, campus board training) can lead to early-onset osteoarthritis of the hand. We also demonstrate that a high Union Internationale des Associations d'Alpinisme (UIAA) climbing level correlates with the risk for early-onset osteoarthritis of the hand and therefore must be seen as a risk factor for developing early-onset osteoarthritis of the finger joints.

Mechanisms of Performance Improvements Due to a Leading Teammate During Uphill Cycling.

PURPOSE: To identify the impact of a leading teammate in front of a cyclist on psychological, physiological, biomechanical, and performance parameters during an uphill maximal effort. METHODS: After familiarization, 12 well-trained competitive cyclists completed 2 uphill time trials (UTTs, 2.7 km at 7.4%) in randomized order; that is, 1 performed alone (control condition) and 1 followed a simulated teammate during the entire UTT (leader condition). Performance (UTT time) and mean power output (PO) were recorded for each UTT. For physiological parameters, mean heart rate and postexercise blood lactate concentration were recorded. Psychological parameters (rating of perceived exertion, pleasure, and attentional focus) were collected at the end of each trial. RESULTS: Performance (UTT time) significantly improved by 4.2% (3.1%) in the leader condition, mainly due to drafting decrease of the aerodynamic drag (58% of total performance gains) and higher end spurt (+9.1% [9.1%] of mean PO in the last 10% of the UTT). However, heart rate and postexercise blood lactate concentration were not significantly different between conditions. From a psychological aspect, higher pleasure was observed in the leader condition (+41.1% [51.7%]), but attentional focus was not significantly different. CONCLUSIONS: The presence of a leading teammate during uphill cycling had a strong impact on performance, enabling higher speed for the same mean PO and greater end spurt. These results explain why the best teams competing for the general classification of the most prestigious and contested races like the Grand Tours tend to always protect their leader with teammates during decisive ascents.

MRI sport-specific pulley imaging.

OBJECTIVE: We aim to create a novel MRI methodology that employs sport-specific stress views for imaging finger pulley injuries in the evaluation of post-operative healing effectiveness. The goal is to measure the bone to tendon distance (BTD), which is the current standard for determining pulley injuries. MATERIALS AND METHODS: The athlete was imaged in a crimp-grip stressed position to emulate sport-specific biomechanics. A Gradient Echo technique was modified to maximize the signal to noise ratio and minimize distortion near the bone and tendon, simplifying the determination of the BTD. RESULTS: A stress-crimped hand position is imaged in less than one half-minute to enable diagnostic visualization of a normal proximal phalanx' bone and tendon via measurement of their BTD. CONCLUSION: This novel stress methodology allows for sport-specific imaging, which is ideal for determining functional compromise of the hand's pulley mechanism. Surgical outcomes may be more sensitively compared when using stress views, and these comparisons may then direct optimal repair technique. Future studies will utilize this technique to attempt early-stage detection of pulley injuries prior to complete rupture.

An uncommon localization of black heels in a free climbing instructor.

Black heels, also known as talon noir or calcaneal petechiae, are asymptomatic superficial cutaneous haemorrhages of the feet, mostly seen as post-traumatic lesions in young athletic individuals who practice sports such as tennis, football, or gymnastics. Here, we present a case of black heels in a young male rock climber.