Clinical and cost-effectiveness of individualised (early) patient-directed rehabilitation versus standard rehabilitation after surgical repair of the rotator cuff of the shoulder: protocol for a multicentre, randomised controlled trial with integrated Quintet Recruitment Intervention (RaCeR 2).

INTRODUCTION: Despite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal outcomes. Our aim is to assess whether individualised (early) patient-directed rehabilitation results in less shoulder pain and disability at 12 weeks after surgical repair of full-thickness tears of the rotator cuff compared with current standard (delayed) rehabilitation. METHODS AND ANALYSIS: The rehabilitation after rotator cuff repair (RaCeR 2) study is a pragmatic multicentre, open-label, randomised controlled trial with internal pilot phase. It has a parallel group design with 1:1 allocation ratio, full health economic evaluation and quintet recruitment intervention. Adults awaiting arthroscopic surgical repair of a full-thickness tear are eligible to participate. On completion of surgery, 638 participants will be randomised. The intervention (individualised early patient-directed rehabilitation) includes advice to the patient to remove their sling as soon as they feel able, gradually begin using their arm as they feel able and a specific exercise programme. Sling removal and movement is progressed by the patient over time according to agreed goals and within their own pain and tolerance. The comparator (standard rehabilitation) includes advice to the patient to wear the sling for at least 4 weeks and only to remove while eating, washing, dressing or performing specific exercises. Progression is according to specific timeframes rather than as the patient feels able. The primary outcome measure is the Shoulder Pain and Disability Index total score at 12-week postrandomisation. The trial timeline is 56 months in total, from September 2022. TRIAL REGISTRATION NUMBER: ISRCTN11499185.

Distal Biceps and Triceps Injuries.

BACKGROUND: Rupture of the distal biceps and triceps tendons are relatively uncommon injuries typically occurring in middle-aged males as a result of eccentric loading of the tendon. METHODS: A literature search was performed and the authors' personal experiences reported. RESULTS: This review discusses the diagnosis, indications and guidelines for management of these injuries and provides a description of the authors' preferred operative techniques. CONCLUSION: Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.

Conservative management versus open reduction and internal fixation for mid-shaft clavicle fractures in adults--the Clavicle Trial: study protocol for a multicentre randomized controlled trial.

BACKGROUND: Clavicle fractures account for around 4% of all fractures and up to 44% of fractures of the shoulder girdle. Fractures of the middle third (or mid-shaft) account for approximately 80% of all clavicle fractures. Management of this group of fractures is often challenging and the outcome can be unsatisfactory. In particular it is not clear whether surgery produces better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform our decision. METHODS/DESIGN: We aim to undertake a multicentre randomised controlled trial evaluating the effectiveness and safety of conservative management versus open reduction and internal fixation for displaced mid-shaft clavicle fractures in adults. Surgical treatment will be performed using the Acumed clavicle fixation system. Conservative management will consist of immobilisation in a sling at the side in internal rotation for 6 weeks or until clinical or radiological union. We aim to recruit 300 patients. These patients will be followed-up for at least 9 months. The primary endpoint will be the rate of non-union at 3 months following treatment. Secondary endpoints will be limb function measured using the Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score at 3 and 9 months post-operatively. DISCUSSION: This article presents the protocol for a multicentre randomised controlled trial. It gives extensive details of, and the basis for, the chosen methods, and describes the key measures taken to avoid bias and to ensure validity. TRIAL REGISTRATION: United Kingdom Clinical Research Network ID: 8665. The date of registration of the trial is 07/09/2006. The date the first patient was recruited is 18/12/2007.

Anterior shoulder dislocation.

INTRODUCTION: Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS: We have discussed this condition with our colleagues and performed a Medline search ('anterior shoulder dislocation') of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS: Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS: Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae.

Reduced band gap dithieno[3,2-b:2',3'-d]pyrroles: new n-type organic materials via unexpected reactivity.

Direct addition of tetracyanoethylene to N-(p-hexylphenyl)dithieno[3,2-b:2',3'-d]pyrrole yields not only the aromatic mono- and bis-tricyanovinyl-substituted products but also a quinoidal product with dicyanomethylene groups. The analogous reaction with dithieno[3,2-b:2',3'-d]thiophene yields exclusively the aromatic mono-tricyanovinyl product. The aromatic and quinoidal products possess red-shifted absorptions, increased electron affinities, and favorable pi-stacking motifs in comparison to the unsubstituted oligomers.

Dinitro and quinodimethane derivatives of terthiophene that can be both oxidized and reduced. Crystal structures, spectra, and a method for analyzing quinoid contributions to structure.

Two new oligothiophenes, the dinitro compound 3',4'-dibutyl-5,5' '-dinitro-2,2':5',2' '-terthiophene (1) and the quinodimethane 3',4'-dibutyl-5,5' '-bis(dicyanomethylene)-5,5' '-dihydro-2,2':5',2' '-terthiophene (2), have been synthesized and studied with electrochemistry, UV-vis-NIR-IR spectroscopy, ESR, and X-ray crystallography. These compounds, designed to be both electron and hole carriers, show redox properties that are unusual for oligothiophenes. Cyclic voltammetry and spectroelectrochemistry demonstrated that each compound could be oxidized to a cation radical and reduced to an anion radical and dianion. The spectra of 2 and its three redox partners were analyzed in terms of a limiting structure in which the neutral 2 has orbitals corresponding to those of a substituted-terthiophene dication. Compound 1 crystallizes with the thiophene rings held in an unusual nonplanar, cisoid configuration in face-to-face pi-stacks, with a spacing between molecules of 3.65 A. The C-C bond lengths of the outer nitro-substituted rings have quinoid character. Compound 2 crystallizes with the thiophene rings in a planar, transoid configuration. The molecules are held in pi-stacks formed from pi-dimers with a spacing between molecules of 3.47 and 3.63 A. The C-C bond distances of the thiophene rings of 1 and 2 and other oligomers were analyzed by a principal component analysis. The analysis found that 93% of the structural variance resided in one principal component related to the quinoid structure of the oligothiophene moiety. The analysis reliably demonstrated a quinoid contribution to the structure of 1. This method should be applicable to understanding the structure of other conjugated molecules in which quinoid structures contribute.

Characterization of a cross-reactive electronic nose with vapoluminescent array elements.

A three-channel cross-reactive sensor array based on vapoluminescent platinum(II) double salt materials has been characterized. Two arrays were studied, one consisting of [Pt(CN-cyclododecyl)4][Pt(CN)4] (1), [(phen)Pt(CN-cyclohexyl)2][Pt(CN)4] (2), and [Pt(CN-n-tetradecyl)4][Pt-(CN)4] (3) materials, where phen = 1,10-phenanthroline, and a second array that has compound 3 replaced by the mixed double salt material [(phen)Pt(CN-cyclododecyl)Cl)]2[(phen)Pt(CN-cyclododecyl)2]2[Pt(CN)4]3 (4). Compounds 2, 3 and 4 are characterized here for the first time. Inclusion of solvent vapors into these materials often leads to dramatic shifts in their solid-state absorption and luminescence spectra. In these studies the arrays were exposed to a set of 10 test solvent vapors to determine the ability of each cross-reactive array to give reproducible vapoluminescent spectra characteristic of each solvent vapor. It was discovered that temperature programming between solvent vapor exposures greatly improved the reproducibility of the luminescence spectra obtained. A statistical analysis of three-dimensional resolution factors between pairs of solvent clusters in principal component space supported this assertion. The success of the temperature programming protocol was limited by the thermal stability and the sensitivity to low background water vapor levels of some platinum(II) double salt materials. The ability of the cross-reactive sensor array to differentiate between two different solvent vapors over a large concentration range was also investigated. Acetone and methanol were found to occupy two distinct regions of the three-dimensional principal component space. Detection limits for acetone and methanol were estimated from the principal component analysis as 75 and 6 g/m3, respectively.