Dupuytren Disease Surgical Treatment: A Randomized Clinical Trial Comparing Partial Fasciectomy by Bruner Approach Versus Zetaplasty.

BACKGROUND: Dupuytren is a fibroproliferative pathology leading to contracture of the palmar fascia. Several approaches have been described for the surgical treatment with partial fasciectomy with few comparisons in literature. Our purpose is to compare the functional outcomes between the partial fasciectomy performed by Bruner type incision and zetaplasty incision. METHODS: The method used was a randomized clinical trial including adult patients of both sexes with surgical indication for Dupuytren disease presented to a reference center. Patients were randomly and consecutively allocated in the groups 1:1. We recorded the Disabilities of the Arm, Shoulder, and Hand (DASH) score; range of motion for active and passive extension of the metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints; visual analog scale for pain; and complications. RESULTS: In all, 62 patients were included, with 48 patients reaching the minimum follow-up of 6 months with 63 operated fingers. In the Bruner approach group, we obtained a correction of the active and passive extension of the MP of 28° and of the PIP of 23°. In the zetaplasty group, correction of MP was 30° for active and passive, and 18° for active extension and 16° for passive extension of the PIP. The reduction in the DASH score was 10 points in the Bruner group and 22 points in the zetaplasty group. There was no statistically significant effect of the type of treatment on preoperative and postoperative differences in any of the parameters evaluated. CONCLUSIONS: There were no statistically significant differences between the 2 techniques for self-reported functional outcomes or objective measures of physical examination.

Zone 1 and 2 flexor tendon repair via a longitudinal incision crossing the volar distal interphalangeal joint: functional and cosmetic outcomes.

INTRODUCTION: The primary aim of this study was to present patient-reported functional outcomes after zone 1 and 2 flexor tendon repair using a novel longitudinal volar approach crossing the distal interphalangeal joint (DIPJ) perpendicularly. The secondary aims were to investigate the cosmetic outcomes, satisfaction and complication rates associated with this technique. METHODS: Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases. RESULTS: The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair. CONCLUSIONS: Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.

A novel approach to the proximal interphalangeal joint: The volar oblique incision - a retrospective cohort study.

BACKGROUND: The surgical approach to the volar structures in the digits must be designed to provide adequate exposure of tendons, vessels and nerves but also in a way that prevents flexion contracture of the digit as the scar contracts. This is traditionally done using a zigzag 'Bruner' incision, first described by Dr Julian M Bruner in 1967. In this paper, we describe an alternative approach, the Volar Oblique incision, and present a single institutional cohort of patients who have undergone procedures beginning with this approach. METHODS: A retrospective cohort study was performed on eight cases that involved a Bruner incision and eight similar cases that involved a volar oblique incision. Charts were reviewed for demographic data. Patients were asked to return to clinic postoperatively for scar assessment using the Patient and Observer Scar Assessment Scale (POSAS), where lower scores correspond to more favourable scar characteristics. The average follow-up period was 22 months. While in clinic, standard joint measurements were taken to assess for any proximal interphalangeal joint contracture. Demographics and questionnaire data were analysed using the Mann-Whitney U test for non-parametric data and quantitative joint measurements were analysed using Student's t-test. RESULTS: There was no difference in flexion contracture between the two groups. The POSAS patient score for scar irregularity was lower in the volar oblique group compared to the Bruner group, but there was no difference in any of the other subcategories, the total patient score, nor the overall patient opinion. The total POSAS observer score was lower in the volar oblique group compared to the Bruner group, with lower scores in the scar thickness, observed relief and observed pliability subcategories as well as the overall observer opinion. CONCLUSION: The volar oblique incision appears to be satisfactory alternative to the classic Bruner incision in hand surgery that requires volar exposure of the digits. Future studies are needed to assess the validity of these findings on a larger scale. LAY SUMMARY: There are various types of incisions that surgeons use when they operate on fingers. When choosing an incision, it is important that the incision provides good exposure to the deeper structures but does not form a tight scar that limits movement of the finger (contracture).A commonly used incision for the palmar side of the finger is the zig-zag or 'Bruner' incision. Some people, however, find this zig-zag scar unappealing. We started using a single diagonal incision, which we have called the volar oblique, instead of the zig-zag Bruner for access to the middle joint of the finger. We wanted to describe the volar oblique technique and then compare the quality of these two scars and also assess if one limits movement of the finger more than the other.Our research found no differences in finger contracture between groups. We did, however, find that patients reported scar irregularity more favourably in the volar oblique group and that surgeons rated scar thickness, relief (roughness) and pliability of the volar oblique scar higher than that of the zig-zag Bruner scar.This research presents a novel surgical technique and compares its results with respect to scar quality and finger contracture to the more traditional zig-zag Bruner approach.

The complete chloroplast genome of Ilex 'Emily Bruner', Ilex cornuta 'Burfordii' × Ilex latifolia (Aquifoliaceae).

Ilex 'Emily Bruner' is an important economic plant with ornamental and ecological functions in southeastern China. In this study, we characterized the complete chloroplast (cp) genome sequence of 'Emily Bruner' to investigate its phylogenetic relationship. The entire cp genome of 'Emily Bruner' was 157,216 bp in length with 37.68% overall GC content, including a large single-copy (LSC) region of 86,721 bp and a small single-copy (SSC) region of 18,427 bp, which were separated by a pair of inverted repeats (IRs) of 52,068 bp. The cp genome contained 135 genes, including 90 protein-coding genes, 37 tRNA genes, and 8 rRNA genes. Phylogenetic analysis based on whole cp genome sequences showed that 'Emily Bruner' is closest to I. cornuta species.

A Different Conversation: Psychological Research and the Problem of Self in Autism.

Observations about peculiarities in the autistic population concerning type and frequency of references to subjective states, and lack of perspective taking, have been on the whole referred to as the paradox of the autistic self, i.e. a co-presence of ego-centeredness and weak self-referentiality (Lombardo & Baron Cohen 2010). Prevalent approaches in autism ascribe these peculiarities to high order disfunctions caused by neurological factors, such as defective self-encoding processes. Two narratives told by an adult man with Asperger during counselling are examined with Conversation Analysis; the analysis identifies features that may lead to descriptions like the paradox of autistic self, but also reveals competences related to perspective-taking and narrative construction. Drawing on Bruner's narrative theory, as well on recent interactional research on autism and the psychology of self, it is suggested that a relatively limited practice with narrative co-construction might be at the origin of the peculiarities observed. A socio-developmental approach to the understanding of autism not only can provide explanations compatible with first and second person accounts of life with autism, but can also open new paths for researching ways of self-construction that are less reliant on social interaction. The article finally challenges assumptions in psychological research about the ability of humans to access their internal states, and discusses how such assumptions can deter understanding of atypical populations.

Revisiting Bruner's Legacy from the Perspective of Historical Materialism.

The book Jerome S. Bruner beyond 100: cultivating possibilities (2015) is a celebration and a continuing development of Jerome S. Bruner's contribution in psychology. As a review of this book, this article aims to commemorate Bruner's legacy by developing it further. The main content of the book is summarized into four issues: culture and language, narrative and folk psychology, dilemmas and shared dilemmas, subjectivity and intersubjectivity. Hegel's contribution to 'social reality' and Karl Marx's historical materialism are introduced to discuss the relation between the individual and his world, which is fundamental in Bruner's psychological inquiry and also a key question underlying the four issues. In the horizon of the ontological revolution launched by historical materialism, the difference between sensuous consciousness and pure consciousness and the dynamic process of social discourse interweaving sensuous consciousness and ideology is discussed and revisited. By integrating nature and society on the dimension of historicity, historical materialism can inspire psychology to understand the historical construction of human existence.

Contemporary Dialogues between Rorty's Pragmatism and Cultural Psychology: a Reading of Jerome S. Bruner beyond 100.

The book Jerome S. Bruner beyond 100: Cultivating Possibilities immerses the reader in an epistemic, historical, and affective portrait delivered by authors from various fields and distinct perspectives on Bruner's work, in celebration of his hundredth birthday. If, on the one hand, it is possible to say that Bruner's life story intertwines with the history of Psychology itself, on the other hand, it is possible to recognise the author as a great ironist, according to Rorty's perspective, in his way of approaching the transformation process in psychological science. The present paper constructs a pragmatics dialogue with Bruner's Cultural Psychology discussing contemporary Western society in its way of understanding cultural diversity and communality citizenship. In times of media customisation and the fluid and agile environment of virtual communities, bubbles have become arenas for the reification of beliefs and meanings based on validation by peers and not by the dialectical, transformative tension towards their possible opposites. The present discussion builds up a reflection concerning possible affective-semiotics process in contemporary culture, highlighting Bruner's grammar on intersubjectivity and narrative interpretation of reality on the basis of Rorty's pragmatics-ethical philosophy.

Memory, Emotion, and Intersubjectivity: beyond the Information Given, and beyond the Individual Mind.

This commentary reflects on papers assembled for a special issue about the impact of Bruner's idea of "beyond the information given." The assembled papers are examined in relation to three cross-cutting issues that they illustrate: 1) processes of reflection in autobiographical recollection; 2) links between meaning and emotion; and 3) the idea of going beyond the individual mind as well as beyond the given information.

Bruner and Beyond: a Commentary.

The philosophy of Bruner transcends traditional boundaries in the study of the human mind with a new kind of psychology, one that frees the thinking mind from its opposition to feelings and also from the limitations of being considered an 'inside-the-head' phenomenon. It is with active engagement with the outside world that a child develops its understanding. In this engagement with the outside world, the developmental construction of thought is actively created through the use of symbols. The cultural context, images, and languages a person experiences are thus considered to be formative in thinking. Opposing the notion of readiness, Bruner believed children to be capable of complex thought, and the dynamics of these developments were guided by meaning-making. The significance of meaning in Psychology was resurrected in his writing. Furthermore, the notion of narrative as constructive in facilitating the organisation and management of mental processes is invaluable. In this article, we bring a commentary on two articles, one that relates to the study of scaffolding of emotion regulation by parents of adolescents and the other on the narrative understanding of selfhood of individuals with autism.

Cognitive-Linguistic and Constructivist Mnemonic Triggers in Teaching Based on Jerome Bruner's Thinking.

Effective teachers use mnemonic tools or mnemonic triggers to improve the students' retention of the study material. This article discusses mnemonic triggers from a theoretical viewpoint based on Jerome S. Bruner's writings. Fifty small linguistic-cognitive, constructive-, rhetorical-, and phonological-mnemonic triggers are detected. These triggers may become supporting elements for our memory system when we are "constructing the realities" in a Brunerian sense when we are ordering, differentiating, comparing, and handling information, stories and experiences in our mind. Many of these are small, hidden linguistic elements in speech. This article discusses their usage in the educational talk and textbooks.

Recovery of DNA from latent fingerprint tape lifts archived against matte acetate.

This study was driven by court order to examine methods to remove, extract, and STR-type potential DNA entrapped between latent fingerprint lifting tape and matte acetate that was collected from a 1977 crime scene. Results indicate that recovery of appreciable quantities of DNA is more challenging once adhesive is attached to matte acetate cards and even more difficult when fixed following black powder enhancement. STR amplification of extracts from entrapped fingermarks collected following the dusting/lifting procedure did not produce robust profiles, and extraneous peaks not expressed by print donors were detected for some samples. A hearing was set to argue whether there was DNA remaining to be tested, and if so, whether that DNA could be exculpatory in this postconviction matter. The studies herein provided the basis for the court's decision to not require the testing.

O Estudo da linguagem: Considerações sobre as propostas de Bruner e Skinner / The study of language: Considerations regarding Bruner's and Skinner's proposals

Sabendo-se da importância do desenvolvimento da linguagem para o desenvolvimento global do indivíduo e que teóricos como Jerome Bruner e Burrhus Frederic Skinner trouxeram contribuições relevantes para o estudo da linguagem. Este artigo tem por objetivo contribuir para a compreensão das obras desses autores, no que diz respeito ao desenvolvimento da linguagem, apresentando possíveis pontos de divergência e de convergência entre eles. Para isso, obras clássicas de Bruner e Skinner sobre o desenvolvimento da linguagem são analisadas, assim como alguns artigos que discutem pontos importantes sobre essa temática. Pontos de divergência são encontrados nas teorias de Bruner e Skinner, tais como a diferença nos termos usados por esses autores para se referirem ao que comumente chama-se de linguagem, assim como o fato de dados de observação sistemática serem utilizados por Bruner em sua obra clássica sobre linguagem, característica não encontrada no livro clássico de Skinner sobre comportamento verbal. No entanto, notase, também, pontos de convergência nas obras desses autores, como por exemplo, o aspecto pragmatista da linguagem apontado por ambos, assim como a importância do adulto e da cultura para que a criança desenvolva a linguagem.(AU)

Knowing the importance of language development for the individual's global development and, that academics such as Jerome Bruner and Burrhus Frederic Skinner brought relevant contributions to the language study, the article's objective is to contribute for the comprehension of their works regarding language development, presenting possible convergence and divergence points. Bruner's and Skinner's classical works about language development are analyzed, as well as some articles that discuss important points of the subject. Divergence points are found in Bruner's and Skinner's theories, such as the difference in the terms used by these authors to refer to what is commonly called language, as well as the fact that systematic observation data are used by Bruner in his classical work about language, characteristic not found in Skinner's classical book about verbal behavior. However, convergence points are noticed in the works of these authors, like the language pragmatist aspect indicated by both, as well as adult's and culture's importance for the child to develop language.(AU)

Contributions from gallese's neurophysiology and bruner's psychology to the understanding of social learning / Contribuições da neurofisiologia de Gallese e da psicologia de Bruner para a compreensão da aprendizagem social

The current article makes an articulation between recent findings from neurophysiology such as the mirror neurons and neural plasticity, and others which were originated in psychology in order to achieve a better understanding of human social learning. Several of those recent findings provide support for concepts of psychology such as the relevance of inter-subjectivity, language and culture to psychological development, regarding not only individuals but also the human specie. More specifically, they evidence the role of direct and implicit understanding of others' actions, emotions and feelings in order to understand the development of social relationships. In this sense, relations are drawn between biological and cultural aspects. Gallese and Bruner are the authors taken as references for this reflection.

O artigo propõe algumas articulações que se podem estabelecer entre novos achados da neurofisiologia - no caso, a atuação dos neurônios-espelho e a plasticidade neural - e outros oriundos da psicologia, visando uma melhor compreensão da aprendizagem social. Vários desses achados recentes fornecem apoio para conceitos da psicologia como a importância essencial da intersubjetividade, da linguagem e da cultura para o desenvolvimento psicológico, não só do indivíduo, mas também da espécie humana. Mais especificamente, evidenciam um aspecto até o momento menos considerado no que se refere à cognição social - o papel do entendimento direto e implícito das ações, emoções e sensações para a compreensão do outro, para o estabelecimento e desenvolvimento das relações sociais. Nesse sentido, são traçadas relações entre elementos dos âmbitos biológico e cultural. Gallese e Bruner são os autores tomados como referência para a presente reflexão.