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  • 1.
    Carlstedt, Thomas
    et al.
    Royal National Orthopaedic Hospital.
    Hultgren, Tomas
    Karolinska Institute.
    Nyman, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences.
    Hansson, Thomas
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Cortical activity and hand function restoration in a patient after spinal cord surgery2009In: NATURE REVIEWS NEUROLOGY, ISSN 1759-4758, Vol. 5, no 10, 571-574 p.Article in journal (Refereed)
    Abstract [en]

    Background. Following a motorcycle accident, a 9-year-old boy experienced a complete right-sided ( dominant) arm and hand paralysis with total sensory loss, Horner syndrome and severe constant pain. This study assessed the long-term outcome of spinal cord surgery undertaken on the patient, focusing on the restored hand function and related cortical activity. The study follows on from previous reports on the same patient. Investigations. Clinical functional and electrophysiological examinations. Functional MRI of cortical activity. Diagnosis. Complete brachial plexus (C5-T1) avulsion from the spinal cord. Management. Spinal cord surgery to restore motor trajectories.

  • 2.
    Fornander, Lotta
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Norrköping. Karolinska Institute, Sweden.
    Brismar, Tom
    Karolinska Institute, Sweden.
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences.
    Wikstroem, Heidi
    Helsinki University Hospital, Finland.
    Cortical plasticity in patients with median nerve lesions studied with MEG2016In: Somatosensory & motor research, ISSN 0899-0220, E-ISSN 1369-1651, Vol. 33, no 3-4, 178-185 p.Article in journal (Refereed)
    Abstract [en]

    We have previously shown age- and time-dependent effects on brain activity in the primary somatosensory cortex (SI), in a functional magnetic resonance imaging (fMRI) study of patients with median nerve injury. Whereas fMRI measures the hemodynamic changes in response to increased neural activity, magnetoencephalography (MEG) offers a more concise way of examining the evoked response, with superior temporal resolution. We therefore wanted to combine these imaging techniques to gain additional knowledge of the plasticity processes in response to median nerve injury. Nine patients with median nerve trauma at the wrist were examined with MEG. The N1 and P1 responses at stimulation of the injured median nerve at the wrist were lower in amplitude compared to the healthy side (pamp;lt;.04). Ulnar nerve stimulation of the injured hand resulted in larger N1 amplitude (pamp;lt;.04). The amplitude and latency of the response did not correlate with the sensory discrimination ability. There was no correlation between N1 amplitude and size of cortical activation in fMRI. There was no significant difference in N1 latency between the injured and healthy median nerve. N1 latency correlated positively with age in both the median and ulnar nerve, and in both the injured and the healthy hand (pamp;lt;.02 or pamp;lt;.001). It is concluded that conduction failure in the injured segment of the median nerve decreases the amplitude of the MEG response. Disinhibition of neighboring cortical areas may explain the increased MEG response amplitude to ulnar nerve stimulation. This can be interpreted as a sign of brain plasticity.

  • 3.
    Fornander, Lotta
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Norrköping. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nyman, Torbjörn
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences.
    Brismar, Tom
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Inter-hemispheric plasticity in patients with median nerve injury2016In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 628, 59-66 p.Article in journal (Refereed)
    Abstract [en]

    Peripheral nerve injuries result in reorganization within the contralateral hemisphere. Furthermore, recent animal and human studies have suggested that the plastic changes in response to peripheral nerve injury also include several areas of the ipsilateral hemisphere. The objective of this study was to map the inter-hemispheric plasticity in response to median nerve injury, to investigate normal differences in contra- and ipsilateral activation, and to study the impact of event-related or blocked functional magnetic resonance imaging (fMRI) design on ipsilateral activation. Four patients with median nerve injury at the wrist (injured and epineurally sutured amp;gt;2 years earlier) and ten healthy volunteers were included. 3T fMRI was used to map the hemodynamic response to brain activity during tactile stimulation of the fingers, and a laterality index (LI) was calculated. Stimulation of Digits II-III of the injured hand resulted in a reduction in contralateral activation in the somatosensory area SI. Patients had a lower LI (0.21 +/- 0.15) compared to healthy controls (0.60 +/- 0.26) indicating greater ipsilateral activation of the primary somatosensory cortex. The spatial dispersion of the coordinates for areas SI and SII was larger in the ipsilateral than in the contralateral hemisphere in the healthy controls, and was increased in the contralateral hemisphere of the patients compared to the healthy controls. There was no difference in LI between the event-related and blocked paradigms. In conclusion, patients with median nerve injury have increased ipsilateral SI area activation, and spatially more dispersed contralateral SI activation during tactile stimulation of their injured hand. In normal subjects ipsilateral activation has larger spatial distribution than the contralateral. Previous findings in patients performed with the blocked fMRI paradigm were confirmed. The increase in ipsilateral SI activation may be due to an interhemispheric disinhibition associated with changes in the afferent signal inflow to the contralateral primary somatosensory cortex.

  • 4.
    Fornander, Lotta
    et al.
    Karolinska Institute.
    Nyman, Torbjörn
    Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Anaesthesiology and Intensive Care VHN.
    Hansson, Thomas
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Ragnehed, Mattias
    Linköping University, Department of Medicine and Health Sciences, Radiology . Linköping University, Faculty of Health Sciences.
    Brismar, Tom
    Karolinska Institute.
    Age- and time-dependent effects on functional outcome and cortical activation pattern in patients with median nerve injury: a functional magnetic resonance imaging study Clinical article2010In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 113, no 1, 122-128 p.Article in journal (Refereed)
    Abstract [en]

    Object. The authors conducted a study to determine age- and time-dependent effects on the functional outcome after median nerve injury and repair and how such effects are related to changes in the pattern of cortical activation in response to tactile stimulation of the injured hand. Methods. The authors studied 11 patients with complete unilateral median nerve injury at the wrist repaired with epineural suture. In addition, 8 patients who were reported on in a previous study were included in the statistical analysis. In the entire study cohort, the mean age at injury was 23.3 +/- 13.4 years (range 7-57 years) and the time after injury ranged from 1 to 11 years. Sensory perception was measured with the static 2-point discrimination test and monofilaments. Functional MR imaging was conducted during tactile stimulation (brush strokes) of Digits II-III and IV-V of both hands, respectively. Results. Tactile sensation was diminished in the median territory in all patients. The strongest predictor of 2-point discrimination was age at injury (p less than 0.0048), and when this was accounted for in the regression analysis, the other age- and time-dependent predictors had no effect. The activation ratios (injured/healthy hand) for Digit II-III and Digit IV-V stimulation were positively correlated (rho 0.59, p less than 0.011). The activation ratio for Digit II-III stimulation correlated weakly with time after injury (p less than 0.041). The activation ratio of Digits IV-V correlated weakly with both age at injury (p less than 0.048) and time after injury (p less than 0.033), but no predictor reached significance in the regression model. The mean ratio of ipsi- and contralateral hemisphere activation after stimulation of the injured hand was 0.55, which was not significantly different from the corresponding ratio of the healthy hand (0.66). Conclusions. Following a median nerve injury (1-11 years after injury) there may be an initial increase in the volume of the cortical representation, which subsequently declines during the restoration phase. These dynamic changes may involve both median and ulnar nerve cortical representation, because both showed negative correlation with time after injury. These findings are in agreement with animal studies showing that cortical plasticity is an important mechanism for functional recovery after peripheral nerve injury and repair.

  • 5.
    Hansson, Thomas
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Peripheral and central effects of nerve regeneration: Experimental and clinical studies2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A nerve injury in the hand often results in profound abnmmalities in sensory perception despite careful alignment and microsurgical repair in order to facilitate accurate nerve regeneration. The present experimental and clinical studies were undertaken in an attempt to functionally evaluate peripheral and central effects of nerve regeneration.

    In the experimental studies the rat foot was used as a model for the human hand. Three months after neurotomy and repair a flUlctional evaluation was performed of regenerated and misrouted polymodal nociceptor C-fibers and low-threshold mechanoreceptive axons by mechanical stimulation on the foot and electrical recordings proximal to the lesion and by Evans blue albumin extravasation.

    It was found that 1) functional regeneration of misrouted axons related to polymodal nociceptive units and low-threshold mechanoreceptive units is more efficient in hairy skin of the rat foot whereas only misrouted polymodal nociceptor C-fibers recover function in glabrous skin, 2) following epineural suture and repair with a silicone tube after sciatic neurotomy there is similar effect on the regeneration of polymodal C-fibers after three months, and 3) functional regeneration of C-fibers is more successful in 3-month-old than in new-born rats.

    In the clinical studies the functional effects of median nerve injury and regeneration were evaluated by two-point discrimination test, electroneurography, somatosensory evoked potentials and functional magnetic resonance imaging (IMRI). A method oftMRI during tactile stimulation was developed, and the normal cortical activation during stimulation was studied in 12 healthy volunteers.

    The effects of nerve injury were studied in 6 injured adult men 15-55 months after median nerve injury and repair. It was found that 1) the 2-point discrimination was > 15 mm, 2) the nerve conduction velocity and signal amplitude were decreased in the severed nerve segment, but the cortical evoked response was normal at nerve stimulation proximal to the lesion, 3) tactile stimulation of the glabrous skin of the hand in healthy volunteers caused bilateral cortical activation (fMRI) in the primary somatosensory cortex, 4) a loss of sensory discrimination in the hand after median nerve injury was associated with a normal or even elevated activation (fMRI) in the somatosensory cortex during tactile stimulation of the digit IT-m.

    List of papers
    1. Functional evaluation of regenerated and misrouted axons to glabrous and hairy skin of the rat hind foot after sciatic neurotomy and suture
    Open this publication in new window or tab >>Functional evaluation of regenerated and misrouted axons to glabrous and hairy skin of the rat hind foot after sciatic neurotomy and suture
    1995 (English)In: Experimental Neurology, ISSN 0014-4886, E-ISSN 1090-2430, Vol. 132, no 1, 99-104 p.Article in journal (Refereed) Published
    Abstract [en]

    The function of misrouted regenerated polymodal nociceptor C-fibers and low-threshold mechanoreceptive axons in the lateral plantar nerve (LPN) and in the foot branch of the superficial peroneal nerve (fSPN) was evaluated 3 months after unilateral sciatic neurotomy and suture. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the neurotomy was cut and tied off. In this way only functional regeneration of misrouted axons was tested in the LPN (or the fSPN). In regenerated animals the glabrous skin area had no functional fSPN-related low-threshold mechanoreceptive axons. However, the hairy fSPN skin area showed function of misrouted LPN-related low-threshold mechanoreceptive axons. In both the glabrous skin domain innervated by the LPN and the hairy skin area supplied by the fSPN, functional regeneration of misrouted polymodal nociceptor C-fibers was found. We conclude that functional regeneration of misrouted axons related to polymodal nociceptive units and low-threshold mechanoreceptive units is more efficient in hairy skin of the rat foot whereas only misrouted polymodal nociceptor C-fibers recover function in glabrous skin.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79479 (URN)10.1016/0014-4886(95)90063-2 (DOI)
    Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
    2. Functional Regeneration of C-Fibries Inside a Silicone Tube After Sciatic Neurotomy in Rats
    Open this publication in new window or tab >>Functional Regeneration of C-Fibries Inside a Silicone Tube After Sciatic Neurotomy in Rats
    1997 (English)In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 31, no 1, 7-11 p.Article in journal (Refereed) Published
    Abstract [en]

    Peripheral nerve lesions are often complicated by difficulties in approximating the nerve tumps without tension. The aim of the present study was to evaluate C-fïbre function after nerve regeneration in rats in which the nerve had been lengthened by leaving a 5 mm gap inside a silicone tube (n = 5). The outcome was compared with nerve regeneration after epineural end-to-end suture (n = 5). The innervated skin territory was defined by Evans blue extravasation after antidromic nerve stimulation. Five rats acted as controls. After three months, there was similar functional reinnervation in both experimental groups, which indicates that silicone tubes may reduce tension over a nerve repair with no adverse effects.

    Keyword
    rat, neurotomy, silicone tube, defect, epineural suture, nociceptors
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79481 (URN)10.3109/02844319709010499 (DOI)
    Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
    3. Inferior functional sensory regeneration after suture of sciatic neurotomy in newborns compared with mature rats
    Open this publication in new window or tab >>Inferior functional sensory regeneration after suture of sciatic neurotomy in newborns compared with mature rats
    1996 (English)In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 17, no 5, 268-271 p.Article in journal (Refereed) Published
    Abstract [en]

    It is generally believed that nerve injuries in children regenerate better than those which occur in adults. However, there are no functional experimental studies that support this belief. This study evaluates the functional regeneration of polymodal C-fibres after nerve regeneration in newborn and mature rats 3 months after unilateral sciatic nerve neurotomy and suture. The distribution of polymodal C-fibres was tested by measuring the Evans blue-stained area in the skin after antidromic nerve stimulation. In the newborn group of regenerated animals showed that functional C-fibres were present in a significantly (P<0.05) smaller area than found in the adult group. We conclude that the functional regeneration of C-fibres is superior in mature rats compared with newborns, 3 months after regeneration.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79482 (URN)10.1002/(SICI)1098-2752(1996)17:5<268::AID-MICR6>3.0.CO;2-F (DOI)
    Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2017-12-07Bibliographically approved
    4. Tactile stimulation of the hand causes bilateral cortical activation: A functional magnetic resonance study in humans
    Open this publication in new window or tab >>Tactile stimulation of the hand causes bilateral cortical activation: A functional magnetic resonance study in humans
    1999 (English)In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 271, no 1, 29-32 p.Article in journal (Refereed) Published
    Abstract [en]

    The purpose of the present study was to assess the somatotopy of the cortical sensory representation of the fingers using a natural tactile stimulation of the glabrous skin. Multislice echoplanar imaging techniques were utilized to investigate blood oxygen level dependent (BOLD) signal changes as a measure of cortical activation. Repetitive sensory stimulation of the glabrous skin of digit II–III and digit IV–V resulted in a multifocal signal increase in a restricted area near the central sulcus in the contralateral hemisphere with a considerable overlap between the activated areas of digit II–III and digit IV–V. In addition, in all subjects tactile stimulation resulted in ipsilateral signal increase near the central sulcus, which was 15–22% of the contralateral effect. Stimulation of digit II–III caused significantly (P<0.05) more activated voxels than digit IV–V in the contralateral hemisphere for both hands and for the left hand in the ipsilateral hemisphere. These findings suggest an ipsilateral activation of the primary somatosensory cortex during a natural tactile stimulation of the digits in humans.

    Keyword
    Human, Ipsilateral, Functional magnetic resonance imaging, Sensory, Somatosensory, Tactile, Glabrous, Digits
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25067 (URN)10.1016/S0304-3940(99)00508-X (DOI)9497 (Local ID)9497 (Archive number)9497 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    5. Loss of sensory discrimination after median nerve injury does not decrease activation in the primary somatosensory cortex in fMRI
    Open this publication in new window or tab >>Loss of sensory discrimination after median nerve injury does not decrease activation in the primary somatosensory cortex in fMRI
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to assess functional effects of median nerve injnry and regeneration on the primary somatosensory cortex in adults. Activation in the somatosensory cortex was studied in 6 injured adult men and 12 healthy volunteers with functional magnetic resonance imaging (fMRI) and somatosensory evoked potentials. Examination 15 to 55 months (mean 38 ± 18) after a total transection of the median nerve at the wrist repaired with epineural suture showed a persistent loss of two point discrimination in digit II-III and a decrease in sensory nerve conduction velocity (-29 %) and amplitude (-84 %) in the median nerve segment at the wrist. The cortical somatosensory potential evoked by electrical nerve stimulation proximal to the lesion was normal in latency and amplitude. fMRl performed during tactile stimulation of dig II-III (distal to the lesion) resulted in all patients in activation near the contralateral central sulcus (n=4, two patients and one control were excluded because of movement artifacts). The activated area was increased by 48 %relative to stimulation of the unaffected hand (p<0.05) but not significantly different from controls. It is concluded that a loss of sensory discrimination in the hand following median nerve injury is associated with a normal or even elevated activation in the somatosensory cortex as measured with fMRI during tactile stimulation.

    Keyword
    functional magnetic resonance imaging, nerve injury, plasticity, regeneration, somatosensory
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-79483 (URN)
    Available from: 2012-08-03 Created: 2012-08-03 Last updated: 2012-08-03Bibliographically approved
  • 6.
    Hansson, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Brismar, T
    Loss of sensory discrimination after median nerve injury and activation in the primary somatosensory cortex on functional magnetic resonance imaging2003In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 99, no 1, 100-105 p.Article in journal (Refereed)
    Abstract [en]

    Object. The aim of this study was to assess the effects of median nerve injury and regeneration on neuronal activation in the somatosensory cortex by means of functional magnetic resonance (fMR) imaging and somatosensory evoked potentials (SSEPs). Methods. Ten injured male patients (mean age 26 years) were examined 15 to 58 months after a total transection of the median nerve at the wrist that was repaired with epineural sutures. Two-point discrimination was lost in Digit II-III and sensory nerve conduction displayed decreased velocity (-29%) and amplitude (-84%) in the median nerve at the wrist. The fMR images were obtained during tactile stimulation (gentle strokes) performed separately on the volar surface of either Digit II-III or Digit IV-V (eight patients: two were excluded because of movement artifacts). The SSEPs were obtained using electrical stimulation proximal to the median nerve lesion. Conclusions. Patients with loss of sensory discrimination after median nerve damage and regeneration had larger areas of activation in fMR imaging near the contralateral central sulcus during tactile stimulation of the injured compared with the noninjured hand. The increase relative to the unaffected hand was 43% (p < 0.02) for Digit II-III stimulation and 46% (p < 0.02) for Digit IV-V stimulation. The SSEP data showed normal latency and amplitude. The enlarged area of cortical activation may be the result of reorganization, and it may indicate that larger cortical areas are involved in the discriminatory task after a derangement of the peripheral input.

  • 7.
    Hansson, Thomas
    et al.
    Department of Plastic Surgery, Hand Surgery and Burns and Department of Clinical Neurophysiology, University Hospital, Linköping, Sweden and the Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm, Sweden.
    Brismar, Tom
    Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm, Sweden.
    Loss of sensory discrimination after median nerve injury does not decrease activation in the primary somatosensory cortex in fMRIManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to assess functional effects of median nerve injnry and regeneration on the primary somatosensory cortex in adults. Activation in the somatosensory cortex was studied in 6 injured adult men and 12 healthy volunteers with functional magnetic resonance imaging (fMRI) and somatosensory evoked potentials. Examination 15 to 55 months (mean 38 ± 18) after a total transection of the median nerve at the wrist repaired with epineural suture showed a persistent loss of two point discrimination in digit II-III and a decrease in sensory nerve conduction velocity (-29 %) and amplitude (-84 %) in the median nerve segment at the wrist. The cortical somatosensory potential evoked by electrical nerve stimulation proximal to the lesion was normal in latency and amplitude. fMRl performed during tactile stimulation of dig II-III (distal to the lesion) resulted in all patients in activation near the contralateral central sulcus (n=4, two patients and one control were excluded because of movement artifacts). The activated area was increased by 48 %relative to stimulation of the unaffected hand (p<0.05) but not significantly different from controls. It is concluded that a loss of sensory discrimination in the hand following median nerve injury is associated with a normal or even elevated activation in the somatosensory cortex as measured with fMRI during tactile stimulation.

  • 8.
    Hansson, Thomas
    et al.
    Department of Clinical Neurophysiology and Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden and Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm Sweden.
    Brismar, Tom
    Department of Clinical Neurophysiology, Karolinska Hospital, Stockholm Sweden.
    Tactile stimulation of the hand causes bilateral cortical activation: A functional magnetic resonance study in humans1999In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 271, no 1, 29-32 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to assess the somatotopy of the cortical sensory representation of the fingers using a natural tactile stimulation of the glabrous skin. Multislice echoplanar imaging techniques were utilized to investigate blood oxygen level dependent (BOLD) signal changes as a measure of cortical activation. Repetitive sensory stimulation of the glabrous skin of digit II–III and digit IV–V resulted in a multifocal signal increase in a restricted area near the central sulcus in the contralateral hemisphere with a considerable overlap between the activated areas of digit II–III and digit IV–V. In addition, in all subjects tactile stimulation resulted in ipsilateral signal increase near the central sulcus, which was 15–22% of the contralateral effect. Stimulation of digit II–III caused significantly (P<0.05) more activated voxels than digit IV–V in the contralateral hemisphere for both hands and for the left hand in the ipsilateral hemisphere. These findings suggest an ipsilateral activation of the primary somatosensory cortex during a natural tactile stimulation of the digits in humans.

  • 9.
    Hansson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Nyman, Torbjörn
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Björkman, Anders
    Malmö University Hospital.
    Lundberg, Peter
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiation Physics. Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Radiation Physics. Östergötlands Läns Landsting, Centre for Medical Imaging, Department of Radiology in Linköping.
    Nylander, Lotta
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Rosén, Birgitta
    Malmö University Hospital.
    Lundborg, Göran
    Malmö University Hospital.
    Sights of touching activates the somatosensory cortex in humans.2009In: Scandinavian journal of plastic and reconstructive surgery and hand surgery / Nordisk plastikkirurgisk forening [and] Nordisk klubb for handkirurgi, ISSN 1651-2073, Vol. 43, no 5, 267-269 p.Article in journal (Refereed)
    Abstract [en]

    We report our observations of cross-modal interactions between sight and touch using functional magnetic resonance imaging (fMRI). Experiments were devised to show that sight and touch are linked in a cross-modal arrangement, and two separate experiments were done in an MRI scanner. In the first, the subject's right hand was stimulated with a brush; in the second, a video sequence was presented to the subject inside the scanner through video goggles in visual three-dimensional stereo, showing one brushstroke every second on a hand in the same manner as the subject had just previously experienced. The result was that both the primary and the secondary somatosensory cortexes were activated in the participants when the hands were touched, and when the subjects saw only a hand being touched in the same manner. The results indicated cross-modal links between sight and touch of the hand in humans.

  • 10.
    Hansson, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Povlsen, Bo
    Functional evaluation of regenerated and misrouted low threshold mechanoreceptors and polymodal nociceptors in the skin of rat hindfeet after crush lesions to the sciatic nerve2005In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 39, no 5, 261-267 p.Article in journal (Refereed)
    Abstract [en]

    Tracer studies on motor axons after nerve crush injuries have indicated that misrouting may occur even when the endoneurium is intact. Misrouting of regenerated polymodal nociceptive C-fibres and low threshold mechanoreceptive axons have been studied functionally in 50 rats three months after unilateral crush lesions to the sciatic nerve. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the lesion was cut and tied off. In this way only functional regeneration of misrouted axons was tested. Misrouted low threshold mechanoreceptive axons and polymodal nociceptor C-fibres were found after regeneration in both glabrous and hairy skin. We conclude that functional misdirection of both myelinated and unmyelinated sensory axons innervating either glabrous or hairy skin can occur after a crush lesion to a peripheral nerve in rats. © 2005 Taylor & Francis.

  • 11.
    Hansson, Thomas
    et al.
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Povlsen, Bo
    Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden and Department of Orthopaedics, St Thomas's Hospital, London, England.
    Functional Regeneration of C-Fibries Inside a Silicone Tube After Sciatic Neurotomy in Rats1997In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 31, no 1, 7-11 p.Article in journal (Refereed)
    Abstract [en]

    Peripheral nerve lesions are often complicated by difficulties in approximating the nerve tumps without tension. The aim of the present study was to evaluate C-fïbre function after nerve regeneration in rats in which the nerve had been lengthened by leaving a 5 mm gap inside a silicone tube (n = 5). The outcome was compared with nerve regeneration after epineural end-to-end suture (n = 5). The innervated skin territory was defined by Evans blue extravasation after antidromic nerve stimulation. Five rats acted as controls. After three months, there was similar functional reinnervation in both experimental groups, which indicates that silicone tubes may reduce tension over a nerve repair with no adverse effects.

  • 12.
    Hansson, Thomas
    et al.
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Povlsen, Bo
    Department of Plastic Surgery, Hand Surgery and Burns, University Hospital, Linköping, Sweden and Department of Orthopaedics, St Thomas's Hospital, London, England.
    Inferior functional sensory regeneration after suture of sciatic neurotomy in newborns compared with mature rats1996In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 17, no 5, 268-271 p.Article in journal (Refereed)
    Abstract [en]

    It is generally believed that nerve injuries in children regenerate better than those which occur in adults. However, there are no functional experimental studies that support this belief. This study evaluates the functional regeneration of polymodal C-fibres after nerve regeneration in newborn and mature rats 3 months after unilateral sciatic nerve neurotomy and suture. The distribution of polymodal C-fibres was tested by measuring the Evans blue-stained area in the skin after antidromic nerve stimulation. In the newborn group of regenerated animals showed that functional C-fibres were present in a significantly (P<0.05) smaller area than found in the adult group. We conclude that the functional regeneration of C-fibres is superior in mature rats compared with newborns, 3 months after regeneration.

  • 13.
    Jarefors, Erik
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Functional outcome in 17 patients whose mandibles were reconstructed with free fibular flaps2017In: Journal of Plastic Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 51, no 3, 178-181 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The vascularised free fibular flap is considered to be a reliable choice for reconstruction of oromandibular defects, especially after resection of malignant tumours in the area. This study evaluates the functional outcome of this method.

    Method: From January 2001 - May 2014, 37 patients were treated at the University Hospital of Linköping using the free fibular flap. The authors present the results from 17. This study reviewed their records and used the University of Washington Quality-of-Life questionnaire (UW-QoL), the Head and Neck Performance Status Scale (PSS), and interviews to assess their outcome.

    Results and conclusions: Functional evaluation showed a significant decrease in chewing (16 out of 17 patients), appearance (n = 10), salivation (n = 6), sensitivity in the mouth and skin (n = 16), occlusive problems in the mouth (n = 13), and range of mouth opening (n = 12). The remaining domains showed acceptable results, although most of them probably could not compare with the preoperative function. Out of 17 patients, six had to adjust their eating in public significantly, three thought their activity to be considerably restricted and two their recreation to be notably diminished. Common postoperative complications were infections or fistula in the mandible (n = 6), partial or complete rejection of the cutaneous flap (n = 4), and rupture of some of the sutures (n = 3). Nine patients required at least one more operation to repair defects, and six required a new soft tissue flap.

  • 14. Lundborg, Göran
    et al.
    Björkman, Anders
    Hansson, Thomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Nylander, Lotta
    Nyman, Torbjörn
    Rosén, Birgitta
    Artificial sensibility of the hand based on cortical audiotactile interaction: A study using functional magnetic resonance imaging2005In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 39, no 6, 370-372 p.Article in journal (Refereed)
    Abstract [en]

    The capacity of the central nervous system for plastic alterations is the base for our ability to adapt to environmental needs. The crossmodal capacity of the brain makes interaction between senses possible, and deprivation of one sense leads to compensatory changes in other senses. We have recently shown how hearing can substitute for sensation in a transplanted insensitive hand by using a sensor glove equipped with small microphones that pick up the sound of friction, which is elicited by active touch. Here we have used functional magnetic resonance imaging (fMRI) in healthy people to illustrate their capacity for cortical audiotactile interaction with activation of the somatosensory cortex induced by auditory stimuli. The phenomenon occurred only in subjects trained to substitute sensibility by hearing, and no audiotactile interaction was found in untrained subjects. © 2005 Taylor & Francis.

  • 15.
    Povlsen, B
    et al.
    Guys and St Thomas Hospital NHS Trust.
    Belzberg, A
    Johns Hopkins University Hospital.
    Hansson, Thomas
    Linköping University, Department of Biomedicine and Surgery, Division of surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Dorsi, M
    Johns Hopkins University Hospital.
    Treatment for thoracic outlet syndrome2010In: The Cochrane library, ISSN 1465-1858, E-ISSN 1465-1858, no 1, CD007218- p.Article, review/survey (Refereed)
    Abstract [en]

    Background Thoracic outlet syndrome (TOS) is one of the most controversial clinical entities in medicine. Despite many reports of operative and non-operative interventions, rigorous scientific investigation of this syndrome leading to evidence based management is lacking. Objectives To evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of thoracic outlet syndrome. Search strategy We searched the Cochrane Neuromuscular Disease Group Trials Specialized Register (July 2009), The Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2009), MEDLINE (January 1966 to June 2009), EMBASE (January 1980 to June 2009), CINAHL (January 1981 to June 2009), AMED (January 1985 to June 2009) and reference lists of articles. Selection criteria We selected randomized or quasi-randomized studies in any language of participants with the diagnosis of any type of thoracic outlet syndrome (neurogenic, vascular, and disputed). The primary outcome measure was change in pain rating on a validated visual analog or similar scale at least six months after the intervention. The secondary outcomes were change in muscle strength and adverse effects of the interventions. Data collection and analysis Four authors independently selected the trials to be included and extracted data. The one included study was rated for risk of bias according to the methods recommended in the Cochrane Handbook for Systematic Reviews of Interventions. Main results This review was complicated by a lack of generally accepted criteria for the diagnosis of TOS and had to rely exclusively on the diagnosis of TOS by the investigators in the reviewed studies. There were no studies comparing natural progression with any active intervention. In one trial with a high risk of bias involving 55 participants transaxillary first rib resection decreased pain more than supraclavicular neuroplasty of the brachial plexus. There were no adverse effects in either group. Authors conclusions This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty but no randomized evidence that either is better than no treatment. There is no randomized evidence to support the use of other currently used treatments. There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures and high quality randomized trials that compare the outcome of interventions with no treatment and with each other.

  • 16.
    Povlsen, Bo
    et al.
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Hansson, Thomas
    Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
    Functional evaluation of regenerated and misrouted axons to glabrous and hairy skin of the rat hind foot after sciatic neurotomy and suture1995In: Experimental Neurology, ISSN 0014-4886, E-ISSN 1090-2430, Vol. 132, no 1, 99-104 p.Article in journal (Refereed)
    Abstract [en]

    The function of misrouted regenerated polymodal nociceptor C-fibers and low-threshold mechanoreceptive axons in the lateral plantar nerve (LPN) and in the foot branch of the superficial peroneal nerve (fSPN) was evaluated 3 months after unilateral sciatic neurotomy and suture. Two weeks before evaluation the tibial fascicle (or the peroneal fascicle) above the neurotomy was cut and tied off. In this way only functional regeneration of misrouted axons was tested in the LPN (or the fSPN). In regenerated animals the glabrous skin area had no functional fSPN-related low-threshold mechanoreceptive axons. However, the hairy fSPN skin area showed function of misrouted LPN-related low-threshold mechanoreceptive axons. In both the glabrous skin domain innervated by the LPN and the hairy skin area supplied by the fSPN, functional regeneration of misrouted polymodal nociceptor C-fibers was found. We conclude that functional regeneration of misrouted axons related to polymodal nociceptive units and low-threshold mechanoreceptive units is more efficient in hairy skin of the rat foot whereas only misrouted polymodal nociceptor C-fibers recover function in glabrous skin.

  • 17.
    Povlsen, Bo
    et al.
    London Bridge Hospital, England.
    Hansson, Thomas
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Povlsen, Sebastian D.
    University of Oxford, England.
    Treatment for thoracic outlet syndrome2014In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, Vol. 26, no 11, CD007218- p.Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND:

    Thoracic outlet syndrome (TOS) is one of the most controversial diagnoses in clinical medicine. Despite many reports of operative and non-operative interventions, rigorous scientific investigation of this syndrome leading to evidence-based management is lacking. This is the first update of a review first published in 2010.

    OBJECTIVES:

    To evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of TOS a minimum of six months after the intervention.

    SEARCH METHODS:

    On 23 June 2014 we searched the Cochrane Neuromuscular Disease Group Trials Specialized Register, CENTRAL, The Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL Plus and AMED. We also searched reference lists of the identified trials.

    SELECTION CRITERIA:

    We selected randomized or quasi-randomized studies involving participants with the diagnosis of TOS of any type (neurogenic, vascular, and 'disputed'), without limitations as to language of publication.We accepted studies that examined any intervention aimed at treating TOS.The primary outcome measure was change in pain rating, measured on a validated visual analog or similar scale at least six months after the intervention.The secondary outcomes were change in muscle strength, disability, experiences of paresthesias (numbness and tingling sensations), and adverse effects of the interventions.

    DATA COLLECTION AND ANALYSIS:

    Three authors independently selected the trials to be included and extracted data. Authors rated included studies for risk of bias, according to the methods recommended in the Cochrane Handbook for Systematic Reviews of Interventions.

    MAIN RESULTS:

    This review was complicated by a lack of generally accepted criteria for the diagnosis of TOS and had to rely exclusively on the diagnosis of TOS by the investigators in the reviewed studies. We identified one study comparing natural progression with an active intervention. We found three randomized controlled trials (RCTs), but only two of them had a follow-up of six months or more, which was the minimum required follow-up for inclusion in the review. The first trial that met our requirements involved 55 participants with the 'disputed type' of TOS and compared transaxillary first rib resection (TFRR) with supraclavicular neuroplasty of the brachial plexus (SNBP). The trial had a high risk of bias. TFRR decreased pain more than SNBP. There were no adverse effects in either group. The second trial that met these requirements analyzed 37 people with TOS of any type, comparing treatment with a botulinum toxin (BTX) injection into the scalene muscles with a saline placebo injection. This trial had a low risk of bias. There was no significant effect of treatment with the BTX injection over placebo in terms of pain relief or improvements in disability, but it did significantly improve paresthesias at six months' follow-up. There were no adverse events of the BTX treatment above saline injection.

    AUTHORS' CONCLUSIONS:

    This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty, but no randomized evidence that either is better than no treatment. There is moderate evidence to suggest that treatment with BTX injections yielded no great improvements over placebo injections of saline. There is no evidence from RCTs for the use of other currently used treatments. There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures, and high quality randomized trials that compare the outcome of interventions with no treatment and with each other

  • 18.
    Sommar, Pehr
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences.
    Junker, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences.
    Strandenes, Eivind
    Department of Surgery, Section of Plastic Surgery and Burn Centre, Haukeland University Hospital, Bergen, Norway.
    Ness, Charlotte
    Department of Surgery, Section of Plastic Surgery and Burn Centre, Haukeland University Hospital, Bergen, Norway.
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Johnson, Hans
    Department of Surgery, Section of Plastic Surgery and Burn Centre, Haukeland University Hospital, Bergen, Norway.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    In Vivo Implantation of Osteogenic Induced Human Dermal Fibroblasts in a Fracture ModelManuscript (preprint) (Other academic)
    Abstract [en]

    Fracture healing is a complex event involving cells and growth factors. When healing is impaired it substantially affects quality of life and increases medical costs. To overcome difficulties with impaired bone healing several methods using biomaterials have been tested. Osteogenic biomaterials, which are scaffolds loaded with osteocompetent cells, have been proposed when the defect is large. In this study we wanted to investigate the potential of osteogenic induced human dermal fibroblasts grown on gelatin microcarriers combined with platelet rich plasma (PRP) in a femoral gap surgical model in athymic rats. The gaps were transplanted with one of the following six combinations: 1; NaCl, 2; PRP, 3; microcarriers + PRP, 4; human dermal fibroblasts on microcarriers + PRP, 5; human osteoblasts on microcarriers + PRP, 6; osteogenic induced human dermal fibroblasts on microcarriers + PRP. The gaps were analysed 4 weeks postoperatively with computer tomography, routine histological staining, fluorescence in situ hybridization (FISH) and polyclonal antibodies directed towards osteocalcin and osteonectin. Radiographs taken 4 weeks post surgery did not reveal callus in any of the groups. Gaps transplanted with osteogenic induced human dermal fibroblasts on microcarriers (group 6) contained dense cell clusters with large amounts of extracellular matrix. These cell clusters were not found in the other groups and stained highly positive for osteocalcin and osteonectin. FISH analysis revealed viable human cells in gaps filled with cell-seeded microcarriers confirming survival of transplanted cells. In conclusion osteogenic induced human dermal fibroblasts survive in this new niche and display bonelike structures in the gaps.

  • 19.
    Sommar, Pehr
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Junker, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strandenes, Eivind
    Haukeland Hospital, Norway .
    Ness, Charlotte
    Haukeland Hospital, Norway .
    Hansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Johnson, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Kratz, Gunnar
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL.
    Osteogenically-induced human dermal fibroblasts as a tool to regenerate bone2013In: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, ISSN 2000-656X, E-ISSN 2000-6764, Vol. 47, no 1, 8-13 p.Article in journal (Refereed)
    Abstract [en]

    Engineering of bone tissue could help to overcome the need for extensive reconstruction and associated donor site morbidity, and it has been proposed that osteogenic biomaterials, which are scaffolds that contain osteocompetent cells, could be used to fill large bone defects. This study investigated the potential of osteogenically-induced human dermal fibroblasts cultured on gelatin microcarriers combined with platelet-rich plasma in a model of a femoral defect in athymic rats. Defects were transplanted with one of the following six combinations: 1 = sodium chloride, 2 = platelet-rich plasma, 3 = microcarriers + platelet-rich plasma, 4 = human dermal fibroblasts on microcarriers + platelet-rich plasma, 5 = human osteoblasts on microcarriers + platelet-rich plasma, and 6 = osteogenically induced human dermal fibroblasts on microcarriers + platelet-rich plasma. The femoral defects were assessed 4 weeks postoperatively with computed tomography (CT), routine histological staining, fluorescence in situ hybridisation, and polyclonal antibodies directed towards osteocalcin and osteonectin. Radiographs of all groups taken 4 weeks postoperatively showed unhealed defects. Femoral defects transplanted with osteogenically-induced human dermal fibroblasts on microcarriers (group 6) contained dense clusters of cells with large quantities of extracellular matrix. These clusters were exclusive to this group and stained strongly for osteocalcin and osteonectin. Fluorescence in situ hybridisation showed viable human cells in femoral defects that had been transplanted with microcarriers seeded with cells, which confirmed the survival of implanted cells. In conclusion, osteogenically-induced human dermal fibroblasts survived in this new niche, and bone-like structures were apparent in the defects.

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