Effects of bulk tank milk, waste milk, and pasteurized waste milk on the nutrient utilization, gastrointestinal tract development, and antimicrobial resistance to Escherichia coli in pre-weaned dairy calves.

This study aimed to assess the impact of bulk tank milk (BTM), waste milk (WM), and pasteurized waste milk (PWM) on nutrient digestibility, ruminal and cecal fermentation, gastrointestinal tract (GIT) development, and antimicrobial resistance of fecal Escherichia coli from dairy calves at 2 periods (30 and 60 d of age). Calves were grouped according to body weight, serum protein levels, and breed composition. Three treatments were included: BTM (n = 21), WM from cows under antibiotic treatment (n = 21), and PWM (waste milk submitted to high-temperature, short-time pasteurization; n = 21). A total of 63 calves were used, of which: 18 animals (n = 6 per treatment) evaluated in the period of 4 - 30 d and 45 (n = 15 per treatment) from 4 - 60 d. During the experimental period, a daily intake of 6 L of milk was divided into 2 equal meals, with ad libitum access to water and starter. Milk and feed intakes were recorded daily. Apparent total-tract digestibility and nitrogen balance were conducted from 25 to 29 d of age (n = 6) and from 53 to 57 d of age (n = 15). Animals were euthanized at 30 ± 1 and 60 ± 1 d of age for the assessment of ruminal and cecal fermentation and GIT development. Antimicrobial susceptibility testing was conducted at 1, 30, and 60 d of age (n = 15/treatment). Statistical analysis utilized a linear mixed-effects model for continuous outcomes and generalized linear models for single measurements (R software). Treatments WM and PWM had lower rumen pH, higher ruminal acetate concentration, larger reticulorumen and liver, and a higher prevalence of fecal-resistant E. coli compared with BTM at both 30 and 60 d. Up to 60 d, both BTM and WM treatments exhibited higher digestibility of ether extract and gross energy compared with the PWM, whereas WM and PWM treatments showed increased nitrogen intake and retention compared with the BTM. These findings suggest that pasteurization of waste milk negatively affects nutrient digestibility and calf performance, while also impacting rumen development. Additionally, the use of milk containing antibiotic residue leads to the selection of resistant E. coli in the GIT over time.

Multiple regression analysis of factors influencing dominant hand grip strength in an adult Malaysian population.

Grip strength is an important measure used to monitor the progression of a condition, and to evaluate outcomes of treatment. We assessed how various physical and social factors predict normal grip strength in an adult Malaysian population of mixed Asian ethnicity (254 men, 246 women). Grip strength was recorded using the Jamar dynamometer. The mean grip strength for the dominant hand was 29.8 kg for men and 17.6 kg for women. Multiple regression analysis demonstrated that the dominant hand grip strength was positively associated with height and body mass index, and negatively associated with age for both sexes. Dominant hand grip strength was related to work status for men (p < 0.05) but not for women. However, there was no difference in grip strength among ethnic groups.

Mechanical contribution of the fibula to torsion stiffness in the lower extremity.

The role of the fibula in rotational stability of the lower extremity, taking into account the intact knee joint and tibia, to the best of our knowledge, has not been investigated. A cadaver study was designed to determine the torque transfer down the lower extremity, with and without the fibula. Six fresh, frozen human cadaver legs were used. The knee joint was left intact and the foot disarticulated. An external rotation up to 5 degrees , coupled with axial compression, was applied to the femur passing through the knee joint in extension and down the lower extremity to the fixed distal end, where torque (N m) was measured via a load cell. Each specimen was further tested with the fibula, cut 4 cm from the distal end, and finally with the entire fibula disarticulated at the proximal end and removed. To achieve 5 degrees rotation, torques reached 1.82 N m (SD, 0.66 N m). When the fibula was cut, the torque reduced a small yet significant amount of 5%. With the entire fibula removed, the torque reduction was significant and more pronounced at 11%. The fibula provided a small yet significant role in torsion stability. From this study, where the biomechanical characteristics of the fibula is explicated, it is hoped that this information will have use in further understanding the biomechanical role of the fibula, especially, in relation to the altered mechanics associated with lower limb pathology involving a deficient fibula.

No corrosion of 304 stainless steel implant after 40 years of service.

When exposed to 0.9% NaCl type 304 stainless steel undergoes severe pitting corrosion within a matter of days. However, a Sherman plate fabricated from type 304 stainless steel remained inside a patient's arm for almost 40 years without any visible indications of corrosion. Given the previous understanding of the pathological environments this was considered quite remarkable. It is proposed that the low dissolved oxygen levels found in human-body fluids makes the long-term in vivo environment much more benign than would be anticipated from in vitro experiments. Furthermore, it is proposed that previous cases of localized pitting corrosion on stainless steel implants most likely arose due to the development of short-term aggressive conditions due to pathological changes in the surrounding tissue as a result of the trauma of the implant procedure. In the present case the Sherman plate was sufficiently small that the surrounding tissue was not aggravated sufficiently to lead to the development of such an environment aggressive. The conclusion that surgical implants are at most risk during the first few weeks of service implies that short-term corrosion protection methods, such as coatings, may be more effective than previously thought.

Esthetic prostheses in minor and major upper limb amputations.

In summary, the impact and value of esthetic prostheses on amputee rehabilitation and their long-term use were demonstrated in this study to have no correlation with the severity of injury and level of amputation. All patients with traumatic amputation should be given equal opportunity to receive prostheses if the service is readily available. Whether use of prostheses is temporary or long-term, they help patients cope with the traumatic life experience of limb loss.

Optimum tensioning position for extensor indicis to extensor pollicis longus transfer.

This study evaluates various wrist and thumb positions for tensioning the extensor indicis proprius when transferred to the extensor pollicis longus tendon to determine which positions provide optimum passive range of flexion and extension of the thumb. In five adult cadaver upper limbs, transfer of the extensor indicis proprius to the extensor pollicis longus was simulated. The limbs were fixed with the elbow in 90 degrees flexion and the forearm and wrist in neutral. Surface bone markers were digitized to determine the thumb and wrist positions in three-dimensional space and their intersegmental joint angles. Twelve combinations of thumb (the interphalangeal and metacarpophalangeal joints) and wrist positions for tensioning were tested. A fixed tension of 80 N was applied to the tendon ends for each of the tensioning positions and during the transfer to ensure that the tendon remained taut. A wrist tenodesis effect was used subsequently to assess the passive range of thumb motion as an indicator of the outcome of the transfer. The results showed that the better tensioning position was with the thumb fully extended and the wrist in neutral. In six patients in whom an extensor indicis proprius to extensor pollicis longus transfer was done, the tendons were tensioned with the thumb in full extension and the wrist in neutral. A prospective review and functional assessment at an average of 18.6 months' followup was done. No significant differences between the surgically treated and normal thumbs were seen for the Jebsen Taylor, 9-peg, and grip and pinch strength tests. The study suggests that in an extensor indicis proprius to extensor pollicis longus transfer, tensioning of the tendons with the thumb in full extension and the wrist in neutral gives good thumb flexion and extension range.

The long head of the triceps brachii as a free functioning muscle transfer.

This anatomic study investigates the possibility of using the long head of the triceps brachii muscle as a free functioning muscle transfer for the upper limb. It has been reported that the long head is not difficult to harvest and that its loss does not create significant donor-site morbidity. The muscle was studied in 23 fresh frozen upper limbs. The long head in all 23 specimens had a constant and proximal vascular pedicle from the profunda brachii artery and vein. The mean pedicle was long (4 cm) and had large-caliber vessels (diameter, 3-mm artery and 4-mm vein). Angiograms were carried out in five specimens and dye perfusion studies in six specimens. A single branch from the radial nerve of at least 7 cm in length innervated the muscle. Muscle architecture was studied in 12 specimens and revealed that the long head of the triceps is better suited for forearm reconstruction than either the gracilis or the latissimus dorsi muscles. The mean physiologic cross-sectional area (8.36 cm(2)) and fiber length (10.8 cm on the superficial surface and 8.2 cm on the deep surface) of the long head match more closely those of the flexor digitorum profundus and the extensor digitorum communis, the muscles most commonly replaced.

The microvasculature of the nail bed, nail matrix, and nail fold of a normal human fingertip.

The organization of the microvasculature of the dorsal human fingertip based on a vascular corrosion cast was examined using a stereoscopic microscope. The variations of the superficial capillary network of the 3 specialized areas of skin of the dorsal fingertip (the nail bed, the nail matrix, and the nail fold) are described. In the nail bed numerous capillary loops were observed arising from a deeper regular arrangement of sagittally aligned, parallel rows of vessels. The size and direction of inclination of the capillary loops varied, getting longer and more inclined to the nail bed distally, with the longest capillary loops seen at the hyponychium. There were no capillary loops at the nail matrix region, but there was a single, layered, rectangular plexus of capillaries in the plane of the nail matrix. This extended distally to sagittally stretched coils of vessels that straightened out as the nail matrix enters the nail bed region. At the edge of the proximal nail fold the capillary loops looked like fine bristles and were approximately 3 times shorter than those found on the nail bed and hyponychium. This study provides a baseline for future work in understanding the changes in the microvasculature of the dorsal fingertip due to injury or pathology.

Independent function in a tendon transfer of the split flexor carpi ulnaris.

This case demonstrates the efficacy of the split flexor carpi ulnaris transfer to restore thumb and finger extension. The humeral and ulnar compartments retained their viability and their function. In addition, they were able to work independently, and the patient has secured two separate functions from one muscle. The versatility and simplicity of this technique give it advantages over more complex reconstructive procedures.

Metamerism in aesthetic prostheses under three standard illuminants--TL84, D65 and F.

This study looks at the effect of metamerism in colour-matching and the assessment of multi-layered silicone rubber finger prostheses. The aim was to identify the choice of illuminants for colour matching the prostheses that would give rise to the least metameric effect between the prostheses and the human skin or the best colour match. The prostheses were prepared and colour matched to a fair-skinned subject under 3 reference illuminants--TL84, D65, F and a combination of illuminants--TL84, D65 and F. The prostheses were then measured for colour using a spectrophotometer based on the CIE indices L*, a*, b* with each prosthesis assessed separately against the subject's index finger under the reference illuminants--TL84, D65 and F. The prostheses were also assessed by a panel of 50 observers and scored according to colour-match. Colour differences between the skin and prosthesis were measured in the illuminant under which the prostheses were prepared and then under the other reference illuminants. A relationship was obtained between the measured mean colour difference, deltaE*, and the mean visual assessment score for each prosthesis. This paper points out the concerns related to the optical phenomenon of metamerism with the colour pigments used. This can affect the colour match of the prosthesis as perceived by the patient. The findings seem to suggest that this metameric colour difference can be minimised if the prosthesis is matched under a combination of lights, which were found to give the best-perceived match.

The effect of storage at -70 degrees C and -150 degrees C on the torsion properties of the canine femur.

This study investigates the effect of storage at -150 degrees C in the vapour phase of liquid nitrogen on the torsion properties of whole intact femurs to be used as allografts. Twenty-five adult dog femurs, stripped of all soft tissue, were used. It has been established that storage at -70 degrees C does not significantly affect the torsion properties of bone. In this study we found no significant difference in structural properties in torsion between the allografts stored at -150 degrees C and -70 degrees C. However, cortical hairline cracks, which were not present before storage, after the bones were stored for 3 months and thawed at 1 degree C/min rate were observed. These cracks fractured longitudinally, and not spirally, when tested to failure and were noted to originate from the vessel foramen. The mean torsion strength of these "damaged" bones was reduced by 48%. We also determined that these hairline cracks occurred during the thawing process at about -42 degrees C. This may suggest an effect of recrystallisation of fluids or water crystals within the "closed" medullary cavity and the foramen, thus increasing the pressure and paying for hairline cracks to propagate from stress risers. No incidence of cortical hairline cracks were observed if the medullary canal was decompressed and the medullary canals washed-out. In tissue banking whole intact bones as allografts, caution should be taken when selecting the freezing and thawing rates for storage as cortical hairline cracks could result and eventually weaken the strength of the allograft.

Split flexor carpi radialis muscle.

A detailed anatomic and intramuscular neural staining study in 22 human and 5 monkey upper limbs revealed that the flexor carpi radialis can be raised on its proximal neurovascular pedicle and that the muscle can be split along its tendon into two independently functioning neuromuscular compartments, each with its own nerve and blood supply. A study of the muscle architecture in the human specimens found the radial compartment to have significantly longer fiber length and a larger physiologic cross-sectional area than the ulnar compartment. Independence of function of each compartment was demonstrated in electrical stimulation studies in six monkeys (Macaca fascicularis), but no significant difference was noted in the peak isometric load between the two compartments (p = 0.68) in the monkey. The extra functioning muscle units become important in local transfers for restoring function in multiple nerve palsies as in Hansen's disease, severe traumatic loss of muscle in crush injuries and compartment syndromes, and after wide resection in infective and neoplastic conditions in the forearm and hand.

The neuromuscular compartments of the flexor carpi ulnaris.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Report on the vascular supply and innervation pattern of the flexor carpi ulnaris. 2. Describe the muscle architecture of the flexor carpi ulnaris, including the physiological cross-sectional area and fiber length. 3. State the uses of the flexor carpi ulnaris both for resurfacing defects in the vicinity of the elbow and in local functional tendon transfers. 4. Understand the principles of splitting skeletal muscles based on neurovascular supply to enhance its utilization in reconstructive procedures. The aim of this study was to describe the intramuscular innervation and vascular supply of the human flexor carpi ulnaris, with confirmation of findings by a similar study in the primate. Two distinct intramuscular nerve branches running parallel to each other, on either side of a central tendon, from the proximal quarter of the muscle belly to its insertion were found. The muscle could then be split into a humeral and an ulnar compartment, each with its own primary nerve branch. Perfusion studies confirmed the adequacy of circulation to the two compartments. In the primate flexor carpi ulnaris, electrical stimulation of the respective branches revealed independent contraction of each compartment. This study provides useful information for enabling the local transfer of the muscle as a whole, both for resurfacing in the vicinity of the elbow and for functional tendon transfers. It will also enable the transfer of the muscle as one or two separate compartments (for resurfacing, in tendon transfers for muscle paralysis, congenital defects, and muscle defects resulting from trauma, and after resections for neoplasm and infection).

Neurovascular supply of the gracilis muscle: a study in the monkey and human.

A comparison of the gross anatomy, extramuscular nerve branches, and intramuscular blood supply of the gracilis muscle showed similar patterns in both monkey and human. The number and pattern of distribution of the extramuscular terminal branches to the muscle were similar. The intramuscular neural pattern demonstrated with the Sihler's staining technique was also similar in both species. In vivo electrical stimulation studies in the monkey revealed that stimulating each extramuscular terminal nerve branch produced a distinct segmental contraction of the muscle. Independent contraction with force generation was observed when the monkey muscle was split into anterior and posterior segments and stimulated through each of the two subdivisions of the main nerve trunk to the muscle. Angiograms verified that circulation was preserved in these two segments.

The effect of the extent of A1 pulley release on the force required to flex the digits. A cadaver study on the thumb, middle and ring fingers.

The A1 pulley was released distally in consecutive stages by 25%, 50%, 75% and 100% of its length. The force required to fully flex the digit at each stage was recorded. The force decreased with more extensive A1 pulley release and this became significant when more than 50% of the pulley was released. These changes were probably due to loss of friction force rather than bowstringing of the tendon.

Fitting a hand-glove prosthesis to enhance the reconstructed mutilated hand.

Microsurgical reconstruction of the severely mutilated hand aimed at improving prehensile functions often does not address the esthetic aspects of the hand. The poor appearance of the reconstructed hand affects its active display and use. A hand-glove prosthesis may be prescribed in this instance to enhance the overall form and function of the mutilated hand. We reviewed 16 cases of mutilating hand injuries in which surgical reconstructions were performed and the patients were subsequently fitted with a hand-glove prosthesis to augment the outcome. An improved appearance was achieved in all patients fitted with the prosthesis. The patients' sense of confidence was also enhanced, which in turn promoted the active and open use of the reconstructed hands. While prescribed primarily to improve the appearance of the reconstructed hands, these prostheses were documented to enhance the physical hand functions in 11 cases by increasing the span of the hand and providing an opposable post and a palmar base for holding and for anchorage. The prosthesis enhanced assistive functions of the reconstructed hands and freed the contralateral normal hand for use in bimanual activities, such as holding a wallet and taking out money, supporting a note pad for writing, and holding a plate at buffet receptions. At the 18-month follow-up visit, 13 (87%) of the patients continued to use their prosthesis. Wear and tear were problems associated with the frequent use of the prosthesis. The expected life span of the prosthesis with daily use ranged from 2 to 3 years. All the patients acknowledged that the prosthesis played a role in their rehabilitation and that it helped them to overcome the initial psychological trauma and to come to terms with their physical loss.

Comparison of the size of plates for fracture fixation with the size of phalanges and metacarpals in cadavers of Asian origin.

The size and volume of plates and screws for fracture fixation of the hand (1.5-mm screws and titanium miniplates, 2.0-mm screws and stainless-steel AO miniplates, and 2.7-mm screws and stainless-steel AO miniplates) were compared against the phalanges and metacarpal bones and the surrounding soft tissue from male cadavers of Asian decent. In the cadaver study, it was first established that the difference between anatomic measurements and radiologic measurements for the interarticular bone length and midshaft width were not significant (p = .09). Second, the volume occupied by the bone showed a close association to interarticular bone length. This finding would suggest that the volume occupied by the bone may be estimated from the radiographs. When the length of the plates was compared to that of the bones, the analysis showed 4-hole and 6-hole 1.5-mm titanium miniplates, and the 4-hole and 6-hole 2.0-mm AO plates were not suitable for the middle phalanx, although only rarely are fractures in the middle phalanx fixed with plates. For the proximal phalanx, only the 4-hole 1.5-mm and 2.0-mm plates were suitable in length. The 6-hole 2.0-mm AO plate was found to be suitable for only the longer proximal phalanx of the middle digit. For the metacarpals, the 5-hole 2.7-mm AO plate was found not to be suitable for the thumb (in length) and the ring digit (in width). The commonly used plates and screws for fracture fixation of the hand may not be suitable in size for groups of people with smaller hand sizes, in particular some Asians and women.