[Teaching basic life support maneuvers in students of a training cycle, is the quality of the maneuvers maintained over time?] / Enseñanza de las maniobras de soporte vital básico en alumnos de un ciclo formativo, ¿se mantiene la calidad de las maniobras en el tiempo?

OBJECTIVE: To evaluate the quality of basic life support after a standardized training process and study their short-term evolution. MATERIALS AND METHODS: Experimental study with students from the training cycles of Higher Technician in Physical Conditioning and Higher Technician in Teaching and Socio-Sports Animation of the Colegio de la Trinidad from Córdoba. An initial evaluation is carried out, an evaluation of 15 days after training and another 30 days later; consisting of an evaluation by a theoretical test, and a practical evaluation of 2min of CPR. For the development of practical evaluations, we used the Resusci Anne® QCPR simulator. The main outcome variable is the global percentage of CPR obtained using the SimPad SkillReporter®. RESULTS: We study 45 students, 71.1% of them male. Statistically significant differences are observed in the total theoretical score of the initial evaluation and the 15 days evaluation (7.81 vs. 6.82 points; P<.0001), and between the 15-day and 30-day evaluation (6.82 vs. 7.66 points; P<.0001); and in the overall percentage of CPR between the initial evaluation and the 15-day evaluation (27 vs. 49 points; P=.008) and between the initial evaluation and the 30 days evaluation (27 vs. 6.15 points; P<.0001). CONCLUSIONS: The CPR quality improves after training, being close to the quality standards established by the ERC.

Treatment of complex proximal interphalangeal joint fractures using a new dynamic external fixator: 15 cases.

The management of proximal interphalangeal joint fractures of the fingers is difficult. Dynamic traction splinting systems are cumbersome and the Suzuki fixator does not prevent secondary fracture displacement. Fifteen cases were treated with a new dynamic external fixator with distraction, the Ligamentotaxor. In two cases, additional fixation was required with a screw. After 10 months, grip strength scored 85.7% compared with the contralateral hand, flexion achieved 76.3 degrees and the extension deficit was 19.6 degrees . The visual analogical scale pain level (VAS) was 1.9 and the Quick DASH score totalled 16.9. Revision treatment was needed for sepsis for one patient. A case of secondary fracture displacement was corrected in the outpatient clinic. Consolidation was achieved in all cases. In conclusion, despite imperfect outcomes for these complex fractures, we believe that the Ligamentotaxor technique is useful.

Enseñanza de las maniobras de soporte vital básico en alumnos de un ciclo formativo, ¿se mantiene la calidad de las maniobras en el tiempo? / Teaching basic life support maneuvers in students of a training cycle, is the quality of the maneuvers maintained over time?

Objetivo Evaluar la calidad de las maniobras de soporte vital básico tras un proceso formativo normalizado y estudiar su evolución a corto plazo. Materiales y métodos Estudio experimental con alumnos de los ciclos formativos de Técnico Superior en Acondicionamiento Físico y Técnico Superior en Enseñanza y Animación Sociodeportiva del Colegio de la Trinidad de Córdoba. Se realiza una evaluación inicial, una evaluación 15 días tras la formación y otra a los 30 días, que constan de una evaluación mediante un test teórico y una evaluación práctica de 2min de RCP. Para el desarrollo de las evaluaciones prácticas, se utiliza el simulador Resusci Anne® QCPR. Se considera como variable principal el porcentaje global de RCP obtenido mediante SimPad SkillReporter®. Resultados Se estudia una muestra de 45 alumnos, 71,1% varones. Se observan diferencias estadísticamente significativas entre la puntuación teórica total de la evaluación inicial y la de los 15 días (7,81 vs. 6,82 puntos; p<0,0001) y entre la evaluación de los 15 días y la de los 30 días (6,82 vs. 7,66 puntos; p<0,0001), y en el porcentaje global de RCP entre la evaluación inicial y la de los 15 días (27 vs. 49 puntos; p=0,008) y entre la evaluación inicial y la evaluación a los 30 días (27 vs. 6,15 puntos; p<0,0001). Conclusiones La calidad de la maniobra de RCP mejora a corto plazo tras la formación, siendo cercana a los estándares de calidad establecidos por la ERC (AU)

Objective To evaluate the quality of basic life support after a standardized training process and study their short-term evolution. Materials and methods Experimental study with students from the training cycles of Higher Technician in Physical Conditioning and Higher Technician in Teaching and Socio-Sports Animation of the Colegio de la Trinidad from Córdoba. An initial evaluation is carried out, an evaluation of 15 days after training and another 30 days later; consisting of an evaluation by a theoretical test, and a practical evaluation of 2min of CPR. For the development of practical evaluations, we used the Resusci Anne® QCPR simulator. The main outcome variable is the global percentage of CPR obtained using the SimPad SkillReporter®. Results We study 45 students, 71.1% of them male. Statistically significant differences are observed in the total theoretical score of the initial evaluation and the 15 days evaluation (7.81 vs. 6.82 points; P<.0001), and between the 15-day and 30-day evaluation (6.82 vs. 7.66 points; P<.0001); and in the overall percentage of CPR between the initial evaluation and the 15-day evaluation (27 vs. 49 points; P=.008) and between the initial evaluation and the 30 days evaluation (27 vs. 6.15 points; P<.0001). Conclusions The CPR quality improves after training, being close to the quality standards established by the ERC (AU)

Experience of using the bioresorbable copolyester poly(DL-lactide-ε-caprolactone) nerve conduit guide Neurolac™ for nerve repair in peripheral nerve defects: report on a series of 28 lesions.

Synthetic nerve guides are occasionally used to repair nerve defects. The aim of the present work was to analyse the results of Neurolac™ use in a series of 23 patients. We operated on 28 nerve lesions located on various sites: arm (n = 1), elbow (n = 5), forearm (n = 4), wrist (n = 2), palm (n = 5), fingers (n = 11). Defects averaged 11.03 mm and were repaired using Neurolac™. After an average of 21.9 months' follow up (3-45 months), subjective criteria (pain, cold intolerance, Quick DASH) and objective criteria (strength, Weber and Semmes-Weinstein sensitivity tests) were compared with the contralateral side. Average pain score was 2.17/10. Cold intolerance was reported in fifteen cases. Quick DASH averaged 35.37/100. Grip strength averaged 64.62% of the contralateral side. As regards sensitivity, the difference between the two sides was 18.89 on Weber's test, and 46.92 on Semmes-Weinstein. Defect size did not affect the outcomes. We observed eight complications the most serious being two fistulizations of the Neurolac™ device close to a joint and one neuroma. Neurolac™ presents some advantages (resorption, semi-permeability, emergency use, tenseless repair) like other synthetic guides used for nerve regeneration and its transparency constitutes an added benefit. However, some difficulty in its handling and its expensiveness represent real disadvantages. Our results are not in favour of its use in repairing hand nerve defects.

Locking plates for fixation of extra-articular fractures of the first metacarpal base: a series of 15 cases.

Extra-articular fractures of the first metacarpal base may lead to retraction of the first web and weakness of the pinch. Conventional surgery (K-wire or non-locking plates) needs six weeks of immobilization. Our goal was to achieve the reduction of such fractures using locking mini-plates to allow early mobilization. Our series included 15 patients, with an average age of 35 years, operated on for an extra-articular fracture of the first metacarpal base. All patients underwent surgery with variable angle locking mini-plates. In 10 patients, we used a double-row plate and for the other five patients T-shaped plates. Fractures were immobilized for two weeks. Outcome evaluation consisted in the assessment of subjective criteria (pain, quick-DASH), objective criteria (Kapandji score, Jamar®, pinch®), screening for complications, time off work and radiological consolidation. Follow-up time was 10 months. Pain averaged 2.2/10 and quick-DASH 17.4. Kapandji score was 90%, grip strength 95.5% and pinch strength 88.6% of the contralateral hand. Three secondary displacements occurred with T-plates. Mean time off work was seven weeks. Radiological consolidation was detected at four to six weeks. Our results seem to indicate that locking T-plates do not provide sufficient strength to allow early mobilization. The direct cost of locking plates is high but this must be weighed against the reduced indirect costs when calculating the cost effectiveness of this type of management. Double-row locking plates offer a valuable therapeutic alternative since they allow stable fixation and early mobilization of the thumb, which may outweigh their high cost.

Arthroscopic interposition arthroplasty of the trapeziometacarpal joint.

PURPOSE: In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy. METHODS: Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging. RESULTS: The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.2° vs. 69.6° for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks. CONCLUSIONS: Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.

Fifth metacarpal neck fracture fixation: Locking plate versus K-wire?

INTRODUCTION: Neck fractures of the fifth metacarpal bone can leave sequelae. Surgery is indicated when the displacement of the head in flexion exceeds 45° and/or rotation is impaired. Among available techniques, non-locking mini-plates have the most drawbacks; recently developed locking plates may, however, challenge the preference for K-wires. HYPOTHESIS: The present study compared results between locking plates and intramedullary K-wires. MATERIAL AND METHODS: The series comprised 38 fifth metacarpal fractures: 18 were managed by locking plate (group I) and 20 by intramedullary K-wire (group II). Results were analyzed on subjective and objective criteria (pain, DASH, strength, mobility, time off work, radiology). RESULTS: No significant differences were found for pain, DASH, strength, time off work or head displacement at last follow-up. Active mobility, however, was significantly greater in the K-wire group, with mean relative metacarpophalangeal flexion 59% of healthy-side values in group I vs. 98% in group II, and mean relative extension 89% in group I vs. 99% in group II. Group I showed six complications (three cases of stiffness, one of head necrosis, two of delayed consolidation) vs. seven in group II (three cases of wire migration, three of neurologic lesion, one of esthetic blemish). DISCUSSION: Locking plates with immediate mobilization paradoxically provided poorer mobility at end of follow-up than intramedullary K-wire with 6 weeks' immobilization. The extra cost of locking plates was thus not justified by results. Intramedullary K-wire nailing remains the reference technique for the management of displaced fracture of the fifth metacarpal neck. LEVEL OF EVIDENCE: Level IV continuous prospective comparative study.

Failure of phospholipid hydroperoxide glutathione peroxidase expression in oligoasthenozoospermia and mutations in the PHGPx gene.

Phospholipid hydroperoxide glutathione peroxidase (PHGPx) is a selenoprotein belonging to the family of glutathione peroxidases. PHGPx has long been considered a major antioxidant that, in cooperation with vitamin E, protects biomembranes. To determine the expression pattern of PHGPx mRNA in human, quantitative RT-polymerase chain reaction (PCR) analyses using RNA from different embryonal and adult tissues were performed. A predominant expression was found in testes. In spermatozoa, PHGPx was found to be localized in the mid-piece of spermatozoa. We studied the relationship between spermatozoa PHGPx expression, mutations in PHGPx gene and human oligoasthenozoospermia, a defect in which both the number and the motility of spermatozoa are significantly below normal. Spermatozoa specimens from 45 infertile males were analysed for fertility-related parameters according to World Health Organisation and were classified as suffering from oligoasthenozoospermia. Two patients (4.44%) showed no expression of PHGPx and in nine patients (20.00%), a reduced expression of the enzyme was observed. DNA sequences of various regions of the PHGPx gene (coding, 5'flanking region and intron 1) from these patients and 58 fertile volunteers were analysed for mutations by PCR amplification and direct sequencing. Sequence data revealed no cause/effect relationship for any of the variants. From these data it can be concluded that oligoasthenozoospermia is associated with a decrease in the level of expression of PHGPx in the spermatozoa of some infertile men (24.44%), but is not linked to mutations in PHGPx gene.