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Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. To systematically review the efficacy of the acellular nerve allograft, its difference from the gold standard (the nerve autograft) and to discuss its possible indications. PubMed, Embase and Web of Science were systematically searched until the 4th of January 2022. Original peer reviewed paper that presented 1) distinctive data; 2) a clear comparison between not immunologically processed acellular allografts and autologous nerve transfers; 3) was performed in laboratory animals of all species and sex. Meta analyses and subgroup analyses (for graft length and species) were conducted for muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count diameter, tetanic contraction and amplitude using a Random effects model. Subgroup analyses were conducted on graft length and species. Fifty articles were included in this review and all were included in the meta-analyses. An acellular allograft resulted in a significantly lower muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count and smaller diameter, tetanic contraction compared to an autologous nerve graft. No difference was found in amplitude between acellular allografts and autologous nerve transfers. Post hoc subgroup analyses of graft length showed a significant reduced muscle weight in long grafts versus small and medium length grafts. All included studies showed a large variance in methodological design. Our review shows that the included studies, investigating the use of acellular allografts, showed a large variance in methodological design and are as a consequence difficult to compare. Nevertheless, our results indicate that treating a nerve gap with an allograft results in an inferior nerve recovery compared to an autograft in seven out of eight outcomes assessed in experimental animals. In addition, based on our preliminary post hoc subgroup analyses we suggest that when an allograft is being used an allograft in short and medium (0-1cm, > 1-2cm) nerve gaps is preferred over an allograft in long (> 2cm) nerve gaps.

Since the Second World War there has been considerable growth in the importance of non-manufacturing based forms of production to the performance of many Western economies. Many countries have seen increased contributions being made by industries such as the media, entertainment and artistic sectors. Gathering together a leading international, multi disciplinary team of researchers, this informative book presents cutting-edge perspectives on how these industries function, their place in the new economy and how they can be harnessed for urban and regional economic and social development. Allen J. Scott is Professor of Policy studies and Geography at the University of California, Los Angeles and Dominic is Associate Professor in the Department of Social and Economic Geography, Uppsala University, Sweden. Part 1: Introduction 1. A Prelude to Cultural Industries and the Production of Culture Part 2: Setting the Scene 2. Mapping the Cultural Industries: Regionalization; The Example of South East England 3. Cities, Culture and 'Transitional' Economies: Developing Cultural Industries in St. Petersburg 4. Putting E-Commerce In Its Place: Reflections on the Impact of the Internet on Cultural Industries Part 3: Creativity, Cities, and Places 5. Creativity, Fashion, and Market Behaviour 6. The Designer in the City and the City in the Designer 7. Creative Resources of the Japanese Video Game Industry 8. Making a Living in London's Small Scale Creative Sector Part 4: Clustering Processes in Cultural Industries 9. Toward a Multidimensional Conception of Clusters: The Case of the Leipzig Media Industry, Germany 10. Manufacturing Culture in Birmingham's Jewellery Quarter 11. Beyond 'Clusters': Towards a 'Critical Political Economy' of Networks in the Film and Television Industies Part 5: Peripheral Regions and Global Markets 12. Minature Painting, Cultural Economy and Territorial Dynamics in Rajasthan, India 13. Profiting from Creativity? The Music Industry in Stockholm, Sweden and Kingston, Jamaica 14. Cultural Industry Production in Remote Places: Indigenous Popular Music in Australia

ObjectiveTo identify what outcomes have been assessed in traumatic brachial plexus injury (TBPI) research to inform the development of a core outcome set for TBPI.DesignSystematic review.MethodMedline (OVID), EMBASE, CINAHL and AMED were systematically searched for studies evaluating the clinical effectiveness of interventions in adult TBPIs from January 2013 to September 2018 updated in May 2021. Two authors independently screened papers. Outcome reporting bias was assessed. All outcomes were extracted verbatim from studies. Patient-reported outcomes or performance outcome measures were extracted directly from the instrument. Variation in outcome reporting was determined by assessing the number of unique outcomes reported across all included studies. Outcomes were categorised into domains using a prespecified taxonomy.ResultsVerbatim outcomes (n=1491) were extracted from 138 studies including 32 questionnaires. Unique outcomes (n=157) were structured into 4 core areas and 11 domains. Outcomes within the musculoskeletal domain were measured in 86% of studies, physical functioning in 25%, emotional functioning in 25% and adverse events in 33%. We identified 63 different methods for measuring muscle strength, 16 studies for range of movement and 63 studies did not define how they measured movement. More than two-thirds of the outcomes were incompletely reported in prospective studies.ConclusionThis review of outcome reporting in TBPI research demonstrated an impairment focus and heterogeneity. A core outcome set would ensure standardised and relevant outcomes are reported to facilitate future systematic review and meta-analysis.PROSPERO registration numberCRD42018109843.

IntroductionTraumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty per cent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the National Health Service and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer term outcomes and those focused on quality of life. This project aims to produce a core outcome set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care.Methods and analysisThis mixed-methods project will be conducted in two phases. In phase 1 a long list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2, the outcomes identified across the systematic review, and the interviews will be included in a three-round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS.Ethics and disseminationThe use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval.Trial registration numbersCRD42018109843.

The anterior interosseous nerve (AIN) end-to-side (ETS) nerve transfer is a relatively recent treatment innovation in managing cubital tunnel syndrome (CuTS). Potential benefits must be balanced against the risks associated with the adoption of an innovative technique, evaluating procedure-specific risks, and considering additional costs in the safe delivery of care. The ETS technique has been proposed as a method of improving intrinsic muscle function in the hand in the setting of ulnar nerve compression at the elbow. The technique is controversial with emerging evidence from retrospective cohort and single-arm interventional studies to support its use. However, there is persisting uncertainty regarding the relative contributions of the decompression, collateral sprouting from intact terminal axons, and neo-innervation from the ETS transfer to any functional recovery. Given this lack of equipoise regarding the efficacy of ETS nerve transfers, a randomised controlled trial is proposed to assess recruitment, protocol compliance, subject retention, and define the sample size for a future multicentre study. This randomised controlled trial (RCT) protocol defines a prospective, single centre study of 20 patients randomised to ulnar nerve decompression with or without ETS nerve transfer, with participant blinding to treatment allocation. Anticipated follow up period is up to 24 months. Data from this study will be used to calculate the sample size for a future multicentre RCT evaluating SETs transfer in CuTS. It would also inform on the willingness of clinicians to randomise their patient given the current uncertainty surrounding this technique and the retention rates anticipated. Should the RCT demonstrate significant functional benefits of combining ETS nerve transfer with decompression, it could shift clinical practice toward using this dual approach, especially in patients with moderate or severe ulnar neuropathy. The findings would likely influence treatment algorithms, optimising patient outcomes, and could also spur further studies into ETS applications in peripheral nerve injuries. ISRCTN ID Number: ISRCTN18379703, Date of Registration: 14th May 2024.

A complication of peripheral nerve injuries, of which there exists limited discourse, is the entrapment of the nerve as it regenerates from the site of injury to its end target, resulting in the arrest of axon regeneration and a consequent reduction of functional recovery. This proof-of-concept paper reports a review of the relevant literature alongside a case series of patients who presented with this phenomenon and who were treated with targeted peripheral nerve decompression. Three cases were identified prospectively. The baseline function was recorded pre-and post-operatively. Recovery was assessed using various tools, including the Medical Research Council (MRC) motor grading, ten-test sensory testing, Tinel's sign progression, a visual analogue scale (VAS) for pain, and the Impact of Hand Nerve Disorders (I-HaND) patient-reported outcome measure (PROM). The first case sustained a brachial plexus injury and received decompression at the pronator fascia, carpal tunnel, cubital tunnel, and Guyon's canal. The second case sustained a sciatic nerve injury and was managed with peroneal and tarsal tunnel decompressions. The final case sustained a suprascapular nerve injury and underwent decompression at the suprascapular ligament. In all these cases, motor function, sensory function, and pain (depending on the nerve's original components) improved following decompression. A literature review revealed seven relevant studies, including four case reports, two cohort studies, and a pre-clinical animal study. These cases, and those identified in our review of the literature, suggest that targeted decompressive surgery can be an appropriate treatment for patients who display signs of stalled neural regeneration. This study adds to the limited evidence of this phenomenon and highlights the challenges in proving the efficacy of decompressive surgery for this specific complication. This study is limited by the number of cases included, the heterogeneity of nerve injuries presented, and its observational nature. There is a clear need for further research into this phenomenon, and the authors are working towards developing a prospective study that will investigate the indications, value, predictors of success, and practicality of decompression surgery for this complication of peripheral nerve injury.

The literature on clusters and cluster building has been rapidly growing both in academic and policy-making circles. Central to this interest and body of work has been the assumption that location in clusters helps firms to exchange, acquire and generate new knowledge. Since knowledge is increasingly believed to be the basis of firm competitiveness clustered firms and industries will outperform others. This paper sets out to examine the evidence for propositions regarding the knowledge-enhancing qualities of clusters by reviewing the literature with the expressed intention of examining whether such claims in fact rest upon rigorous and verifiable empirical findings. In order to do this we extract from the theoretical literature on clusters three hypothetical arguments for the knowledge creating and competitiveness generating power of clusters: knowledge in clusters is created through various forms of local inter-organizational collaborative interaction; knowledge in clusters is created through increased competition and intensified rivalry; knowledge in clusters is created through spillover following from the local mobility and sociability of individuals. The paper goes on to assess and evaluate the number and rigour of empirical cases supporting these types of argument.

This report describes a 53-year-old man who presented, following a motocross injury, with a Mayfield stage 1 perilunate dislocation through a pre-existing asymptomatic scaphoid non-union with a degenerative midcarpal joint. A salvage reconstruction with scaphoid excision and four corner midcarpal arthrodesis resulted in a satisfactory outcome. Follow-up at 6 years demonstrated no instability and no further progression of the osteoarthritis.

ABSTRACT In this paper an attempt is made to measure the cultural industries in a cross-national context. The paper starts with a discussion of the definition and delineation of the term the 'cultural industries'. It is argued that a large range of goods and services may be considered to be cultural industry products and that it is important to place the production and exchange of such products in the context of an industrial systems approach. Following this the concept is operationalised using data on employment and firm activity from Denmark, Finland, Norway and Sweden. Results are presented which suggest that overall growth in both employment and firm numbers has been especially strong in the cultural industries. However, interesting differences between the countries emerged from the data. Thus regional dimensions are then examined resulting in the finding that in all four countries cultural industries have a strong attraction to urban areas but an even stronger propensity to agglomerate. It is suggested that the spatial dynamics observed may be key to the development of the industries' competencies and success. In summary the paper presents results of extensive data analysis that show the cultural industries' important contribution to Scandinavian economies and labour markets.