COVID-19-Related Risk Factors for Developing Occupational Contact Dermatitis Along With Its Incidence, Prevention, and Management: A Systematic Review.

Occupational contact dermatitis (OCD) is an eczematous local inflammatory skin irritation caused by repeated use of hand sanitizer and other chemical substances. Occupational irritant contact dermatitis (OICD) and occupational allergic contact dermatitis (OACD) are the two variants of CD that cannot be identified clinically. Hand dermatitis (HD) is typically assessed as a clinical consequence because it affects the hands most frequently at work as per epidemiological studies on OCD. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards were followed when conducting this umbrella review. We used the search terms "Occupational Contact Dermatitis AND COVID-19" to search for the most pertinent papers in full text on the databases PubMed/MedLine, ScienceDirect, and PubMed Central (PMC). Additionally, the reference section of the papers was used to find more articles. A total of 11,646 results were found, and eight papers remained after applying the inclusion criteria (full-text papers, English language, studies published in the previous 10 years, involving humans, and only systematic reviews). After completing the title and abstract screening, we obtained five papers. Next, the full-text screening and AMSTAR quality check were completed, yielding the same five papers. After searching ScienceDirect, five papers that met the inclusion criteria were included, and six papers were selected from the references, yielding a total of 11 papers. The causes of occupational dermatitis from protective face masks are discussed in this review. We anticipate an increase in the incidence of occupational dermatitis linked to face mask use given that a large segment of healthcare workers (HCWs) wear protective face masks. To understand the prevalence and available therapies for mask-related occupational dermatitis, further well-designed research is required.

The state of hand rub dispensers in healthcare settings - a multicenter assessment in 19 German healthcare facilities.

BACKGROUND: Hand hygiene is one of the most important hygiene measures to prevent healthcare-associated infections. Well-functioning hand rub dispensers are the foundation of hand hygiene but are often overlooked in research. As the point of origin for hand hygiene, dispensers not only promote compliance through ease of use, but also strongly influence the amount of hand rub used per disinfection. This work investigates how dispenser types and conditions affect dispensed volumes and usability. METHODS: Data from 5,014 wall-mounted or point-of-care dispensers was collected from 19 German healthcare facilities during installation of an electronic hand hygiene monitoring system, including dispenser type and dispensed hand rub volumes. Of these dispensers, 56.2% were metal dispensers, and the majority (89.5%) were wall-mounted. For one hospital, 946 wall-mounted dispensers were analyzed in detail regarding pump material, damages, functionality, cleanliness, and filling levels. RESULTS: Dispensed volumes varied across and within dispenser types, ranging from 0.4 mL to 4.4 mL per full actuation, with the largest volumes generally dispensed by plastic dispensers with a preset of 1.0 to 3.0 mL per actuation. In general, most dispensers dispense more hand rub per full actuation than specified by the manufacturer. When different types of dispensers are used within a healthcare facility, vastly different volumes can be dispensed, making reliable and reproducible disinfection difficult for healthcare workers. In the detailed analysis of 946 dispensers, 27.1% had cosmetic defects, reduced performance, or were unusable, with empty disinfectant being the most common reason. Only 19.7% of working dispensers delivered their maximum volume on the first full actuation. CONCLUSION: Even though several studies addressed the variability in dispensed volumes of hand hygiene dispensers, studies dealing with dispenser types and functionality are lacking, promoting the common but false assumption that different dispensers may be equivalent and interchangeable. Variability in dispensed volumes, coupled with frequent dispenser defects and maintenance issues, can be a major barrier to hand hygiene compliance. To support healthcare workers, more attention should be paid to 'dispenser compliance', selecting dispensers with similar volume ranges and proper maintenance.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013-2021.

PURPOSE: This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021. METHODS: Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. RESULTS: From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. CONCLUSIONS: There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. CLINICAL RELEVANCE: With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Range of Motion Following Flexor Tendon Repair: Comparing Active Flexion and Extension With Passive Flexion Using Rubber Bands Followed by Active Extension.

PURPOSE: This study aimed to compare the outcome in terms of range of motion between early active flexion and extension (early active motion, [EAM]) and passive flexion using rubber bands followed by active extension (sometimes referred to as a Kleinert regimen) after flexor tendon repair in zones 1 and 2. METHODS: Data were collected from the Swedish national health care registry for hand surgery (HAKIR). Rehabilitation regimens were decided by the preference of each caregiver. At 3 months, 828 digits (656 EAM and 172 passive flexion) and at 12 months, 448 digits (373 EAM and 75 passive flexion) were available for analysis. Thumbs were analyzed separately. RESULTS: No notable difference in total active motion was found between the groups at 12 months of follow-up. CONCLUSIONS: This large registry study supports the hypothesis that EAM rehabilitation may not lead to better range of motion long-term than passive motion protocols. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children's upper limb motor skills, a randomized controlled trial.

PURPOSE: This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. MATERIALS AND METHODS: Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. RESULTS: Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. CONCLUSIONS: This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions.Incorporating occupational therapy tasks on a vertical surface may increase the control of proximal muscles and ease graphomotor performance.Working on a vertical surface can make activities fun for children and make challenging tasks, like writing, more interesting.Working on a vertical surface during rehabilitation sessions can particularly help children with unilateral cerebral palsy to further develop essential fine, visual, and gross motor skills more than training on horizontal surfaces.

Software Integrated Personalized Biosensing Device for Serum Creatinine Detection Based on Boron doped MXene Nanohybrid.

In recent years, an increase in the number of chronic kidney disease (CKD) cases has led to a global health burden majorly affecting underdeveloped and developing nations. A key biomarker for assessing the kidneys' normal functioning is creatinine, which is filtered out from the blood by the kidney. Thus, timely and specific detection of creatinine becomes necessary for diagnosis and subsequent treatment of CKD. Hence, in this study, we have tried to develop a field-deployable, software-integrated immunosensor for the detection of creatinine in a serum sample. The immunosensor was developed by incorporating gold nanoparticles, boron doped MXene, polyaniline, and anticreatinine antibody using an appropriate bioconjugation reaction. The developed sensor was able to detect creatinine in a linear dynamic range of 10 nM to 0.1 M with a limit of detection of 1.72 (±0.07) nM. The sensor was integrated with an indigenously developed software named "CretCheck" which simplifies the process of data analysis. The software integrated personalized biosensing device was used to find the creatinine concentrations directly from the obtained analytical signals. The developed immunosensor with the integrated software can also be implemented directly in primary health care facilities for creatinine detection in the future.

Association Between Relative Grip Strength, Insulin Resistance, and Nonalcoholic Fatty Liver Disease Among Middle-Aged and Older Adults: A Prospective Cohort Study.

Introduction: This study aims to investigate the combined association between insulin resistance (IR) levels, relative grip strength (RGS), and the incidence of nonalcoholic fatty liver disease (NAFLD), stratified by sex, using longitudinal data. Methods: The study included 1702 adult participants aged 51-88 years who completed surveys in both 2013-2014 and during a subsequent follow-up in 2019-2020. NAFLD was assessed using the hepatic steatosis index, and RGS was measured using the JAMA-5030J1 equipment (SAEHAN, Korea). To assess the interaction between RGS and IR levels and their impact on NAFLD risk, we employed a proportional hazards Cox regression model. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated for NAFLD incidence. Results: After adjusting for various confounding variables, we observed a significant decrease in NAFLD risk in the middle RGS group (HR = 0.70, 95% CI = 0.53-0.93) and high RGS group (HR = 0.31, 95% CI = 0.22-0.44) compared to the low RGS group. In addition, significant sex differences were noted in the relationship between IR, RGS levels, and NAFLD incidence across different groups. Conclusions: This study highlights that higher RGS levels are independently associated with a reduced risk of developing NAFLD. Notably, RGS emerges as a predictive indicator for assessing NAFLD risk.

A Study of Functional Outcome and Assessment of Role of Proximal Humerus Internal Locking System (Philos) Plating in Elderly Population with Proximal Humerus Fracture: A Case Series.

Introduction: The purpose of the study was to assess the functional outcome of proximal humerus fractures (2 part, 3 part, and 4 part) managed with a proximal humerus internal locking system (PHILOS). Materials and Methods: This retrospective study included 27 cases of proximal humerus fractures managed surgically between February 2021 and February 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER classification was used to categorize the fractures. Functional assessment was done using Constant Murley's shoulder score and disabilities of the arm, shoulder, and hand. Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results: The mean age was 55.63 ± 10.37 years. Of the total 27 cases of proximal humerus fractures, functional outcome was excellent (score 85-100) in 3.70% (n = 1) cases, good (score 71-85) in 81.49% (n = 22) cases, moderate (score 56-70) in 14.81% (n = 4), and poor (score 0-55) in none of the (n = 0) cases. In 92.60% of cases, follow-up showed no complications. Varus collapse and subacromial impingement, both occurring in 3.70% (n = 1) of the subjects, were noted in this study. Conclusion: Based on the findings of this retrospective study, it can be opined that PHILOS plating appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilization, and excellent functional outcomes as observed in this study. In addition, very few post-operative complication rates again support our conclusion.

Assessing Public-Reported Perceptions of Low-Risk Hand Surgery Provided in the Office Versus an Ambulatory Surgery Center: Survey Study.

Purpose: There is growing evidence for the safety of wide-awake, office-based, low-risk hand surgery. However, there is limited insight into patient receptiveness to these procedures. Here, we evaluate the public perceptions and degree of tolerance of low-risk, office-based hand surgery. Methods: A prospective study was performed using a 26-question, paid survey via a clinically validated, public, online marketplace. Participants were divided based on (pre-education) perceptions of in-office hand surgery into three cohorts as follows: in-office surgery (IOS), no in-office surgery, or no preference (NP). Educational material was then presented comparing three surgical settings and anesthetic types. Then, participants selected their setting/anesthetic preferences for the following four procedures: trigger finger release, cyst excision, carpal tunnel release, and distal radius fracture. Statistical analyses with unpaired t tests and chi-square tests were performed. P < .05 was significant. Results: There were 509 respondents-266 in the IOS group, 104 in the no in-office surgery group, and 139 in the NP group. Previous outpatient surgery was most frequent in the IOS cohort. In-office surgery and NP cohorts were more likely to believe that surgical procedures could be performed in the clinic setting. The remaining demographics were similar across cohorts. After reviewing the education graphic, 50 of the 139 in the NP group switched to prefer IOS. For procedure-specific questioning, 40.6% (207/509) were amenable to in-office trigger finger release and 58.3% (297/509) for cyst excision, unlike more invasive procedures (carpal tunnel release: 25.6% (130/509); distal radius fracture: 9.8% (50/509). The most influential factors determining surgical location were comfort during the procedure and total encounter time. The IOS group favored location to be at the surgeon's discretion more than the no in-office surgery group. Conclusions: In-office, low-risk, hand surgery appears desirable to select patients. If presented with the option for in-office trigger finger release or cyst excision, approximately 40.6% (207/509) and 58.3% (297/509), respectively, may be amenable to IOS. Type of study/level of evidence: Prospective IB.

Xylazine-Associated Wounds of the Upper Extremity: Evaluation and Algorithmic Surgical Strategy.

The coadministration of xylazine, a veterinary tranquilizer, with illicit fentanyl has led to severe soft tissue injuries, ranging from superficial irritation to deep tissue necrosis and even bone involvement, because of multifactorial tissue toxicity. Despite its non-opioid nature, xylazine enhances and prolongs the euphoric effects of fentanyl, exacerbating the potential for abuse. The pathogenesis of the tissue damage from xylazine is multifactorial but most akin to a burn from local tissue injury. With illicit opioids increasingly adulterated with xylazine, particularly in urban areas like Philadelphia, the prevalence of associated wounds, especially in the upper extremities, is anticipated to rise. Managing these wounds demands a multidisciplinary approach, with hand surgeons and reconstructive surgeons playing a central role. This review summarizes the historical context, pharmacodynamics, initial evaluation, wound categorization, algorithmic treatment, and expected outcomes of xylazine-associated wounds.

Postoperative Pathologies of the Hand Following Shoulder Surgery.

Purpose: Shoulder arthroscopy and arthroplasty are increasingly common procedures used to address shoulder pathologies. This study sought to evaluate the incidence of hand-related pathologies, including carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS), trigger finger (TF), de Quervain tenosynovitis, and Dupuytren disease following shoulder arthroscopy and arthroplasty procedures. We hypothesized that patients undergoing shoulder surgery would have a higher incidence of hand-related pathologies within 1 year of surgery compared to controls. Methods: This was a retrospective analysis of 12,179 patients who underwent shoulder arthroscopy or arthroplasty surgery that were subsequently diagnosed with CTS, CuTS, TF, de Quervain tenosynovitis, or Dupuytren disease within 1 year after surgery. Relative risk of having associated hand pathologies following shoulder surgery was compared to controls. Results: In total, 10,285 patients underwent shoulder arthroscopy procedures during this period, of whom 815 (7.9%) had an associated hand pathology within 1 year from their shoulder procedure. Arthroscopic surgery was associated with an increased likelihood of having a hand pathology (RR 1.65, 95% CI 1.54-1.76), CTS (RR 1.57, 95% CI 1.42-1.73), CuTS (RR 2.25, 95% CI 1.94-2.61), TF (RR 1.76, 95% CI 1.53-2.03), and Dupuytren disease (RR 2.02, 95% CI 1.54-2.65), but was not associated with a higher likelihood of having de Quervain tenosynovitis. In total, 1,894 patients underwent shoulder arthroplasty procedures during this period, of whom 188 (9.9%) had an associated hand pathology within 1 year. Shoulder arthroplasty was associated with an increased likelihood of having a hand pathology (RR 2.04, 95% CI 1.78-2.34), CTS (RR 2.10, 95% CI 1.72-2.57), CuTS (RR 3.29, 95% CI 2.48-4.39), and TF (RR 1.99, 95% CI 1.47-2.70), but was not associated with an increased likelihood of having de Quervain tenosynovitis or Dupuytren disease. Conclusions: Shoulder arthroscopy and arthroplasty procedures were associated with an increased likelihood of having a CTS, CuTS, or a TF diagnosis made within 1 year of surgery. Only shoulder arthroscopy procedures were associated with a higher likelihood of having Dupuytren disease. Neither shoulder arthroscopy nor arthroplasty procedures were associated with an increased likelihood of a diagnosis of de Quervain tenosynovitis. These associations, however, do not necessarily imply causation, and further investigation is warranted to delineate this relationship. Type of study/level of evidence: Differential Diagnosis/Symptom Prevalence Study Level 3.

Evaluation of Withania somnifera (L.) Dunal (Ashwagandha) on Physical Performance, Biomarkers of Inflammation, and Muscle Status in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Study.

BACKGROUND: Sarcopenia is associated with chronic inflammation, a sedentary lifestyle, and ageing. However, there exists no drug, which is safe and effective for long-term use. Ashwagandha (Withaniasomnifera (L.) Dunal) has the potential to fill this therapeutic gap based on its efficacy and safety profile; hence, the present study was planned to evaluate its effect on inflammatory biomarkers and muscle status in healthy volunteers. METHODOLOGY: A prospective, double-blind, randomized, placebo-controlled clinical study was conducted to evaluate the effects of Ashwagandha extract in healthy volunteers (February 2021 to May 2022) who received either Ashwagandha extract tablets 250 mg or a placebo twice daily for 60 days. The physical performance on a bicycle ergometer, inflammatory/muscle status biomarkers, body composition, reaction time, hemogram, and organ function tests was assessed at baseline, day 30, and day 60. RESULTS: In the Ashwagandha group, there was a statistically significant (p<0.05) improvement in total distance travelled (Ashwagandha 2.85 ± 0.54 km vs placebo 2.16 ± 0.62 km), average speed achieved (Ashwagandha 25.6 ± 5.7 km/hour vs placebo 22.2 ± 5.48 km/hour) on a bicycle ergometer from the baseline visit (V3) to the last visit (V7) as compared to the placebo group. The observations on hand-grip strength, back-leg press, skeletal muscle mass, and VO2 max showed an increasing trend from V3 to V7, whereas the results of the three inflammatory markers (hs-C-reactive protein (CRP) mg/L; IL-6; TNF-alpha ) and the muscle marker (myostatin) revealed a decreasing trend from V3 to V7 in the Ashwagandha group. Ashwagandha extract was found to be safe in healthy volunteers as evidenced by the clinical profile, laboratory investigations, and reaction time test. CONCLUSION: Ashwagandha extract supplementation was safe and effective in enhancing physical performance and strengthening muscle mass and could be a potential candidate for treating sarcopenia.

Locus of control and the long-term effects of parental smoking on mental health.

RATIONALE: Few studies take a life course perspective to explain if exposure to second-hand smoke in childhood influences mental health in adulthood. Importantly, no study provides empirical evidence on the pathways through which exposure to second-hand smoke in childhood influences mental health in adulthood. There is also limited evidence on the factors that moderate the relationship between second-hand smoke exposure and mental health. To inform policy, it is important to explore the pathways through which second-hand smoke influences mental health and understand factors that are likely to moderate this relationship. OBJECTIVES: The objective of this paper is to examine if exposure to parental smoking in childhood influences mental health in adulthood. The study examines general health and smoking status in later life as potential channels and if locus of control (LoC), a personality trait developed in childhood and adolescence, moderates the relationship between exposure to parental smoking in childhood and mental health in adulthood. METHODS: Using 21 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA), the study conducts regression analyses that adjust for the potential effects of confounders and other biases. RESULTS: The results show that exposure to parental smoking in childhood is associated with a decline in mental health in later life, and that general health status and smoking status in adulthood are channels through which exposure to parental smoking in childhood influences mental health in adulthood. Specifically, those who are exposed to parental smoking in childhood tend to have poorer general health and a higher probability of being smokers in adulthood, both of which negatively impact mental health. The findings point to the moderating role of LoC, such that being more internal on LoC dampens the negative effects of exposure to parental smoking on mental health. CONCLUSION: The findings from this study lend support to the need to address the long-term implications of behaviours that are harmful to health. The findings also suggest that LoC has implications for an individual's psychological resilience against the negative effects from exposure to parental smoking in childhood.

Conventional versus Daylight Photodynamic Therapy for Recalcitrant Hand Warts: Efficacy, Safety and Recurrence.

BACKGROUND: Acral warts appear as skin-colored, verrucous, hyperkeratotic papules most located on the dorsal hands, distal fingers, subungual skin, and feet. Conventional photodynamic therapy (C-PDT) has shown a good efficacy and safety profile in patients with viral warts, in both adults and children, with a good cure rate and excellent cosmetic results in front of few and light side effects. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated. OBJECTIVES: to investigate and assess the short- and long-term efficacy of PDT using 10% aminolevulinic acid (ALA) in the treatment of multiple verrucae vulgaris of the hands. The second endpoint was to compare the efficacy and safety of C-PDT versus DL-PDT. MATERIALS AND METHODS: 68 patients (38 males and 30 females) aged between 6 and 80 years, affected by hand warts, were divided into two arms: group A was treated with C-PDT, and group B was treated with DL-PDT. Patients underwent treatments three times at 1-month intervals. The response was assessed 3 months after the last session (W24) and 1 year after the last session (W52) and scored as excellent (75-100% reduction of total wart count), partial (74-25% reduction), and none (< 25% reduction or no response). Any adverse events occurring during or after ALA application or irradiation as well as pain intensity were recorded at each visit. RESULTS: 48 patients (70.6%) achieved excellent response at W24, while 6 patients (8.8%) had a partial response and 14 (20.6%) were resistant to treatment. Patients treated with DL-PDT were less likely to have an excellent response (66.7%) than patients treated with C-PDT (73.7%), although not statistically significant. Among patients with excellent or partial response (n=54), 37% (n=20) had warts relapse at W52. Both treatment modalities were well tolerated, with transient pain as the main side effects. CONCLUSION: PDT is effective in the treatment of verrucae vulgaris of the hands. An overall response rate of 70.6% of excellent response was achieved. While C-PDT showed a trend towards better outcomes, DL-PDT offered a more patient-friendly approach, particularly in terms of comfort and compliance.

Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study.

BACKGROUND: Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis (JIA) with progressive disease course, polyarticular involvement and failure of methotrexate treatment. AIM: To describe features of JIA, associated with wrist arthritis. METHODS: Data from about 753 JIA patients were included in this retrospective cohort study. The clinical and laboratory features of patients with and without wrist involvement were analyzed. RESULTS: Wrist involvement was found in oligoarthritis (5.8%), RF(-)/RF(+) polyarthritis (44.9%/15.0%), enthesitis-related arthritis (17.7%), and systemic (58.6%) JIA categories. Unilateral wrist involvement was typical for oligoarthritis patients, bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories. Wrist arthritis was found to be associated with female sex, a low incidence of uveitis, and more indications of systemic inflammation, including elevated levels of C-reactive protein, erythrocyte sedimentation rate, and platelets, as well as involvement of the cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus arthritis. The number of patients with hip osteoarthritis and hip replacement was also higher. Wrist arthritis was associated with a lower probability of achieving remission [hazard ratio (HR) = 1.3 (95%CI: 1.0-1.7), P = 0.055], and a higher probability of being treated with biologics [HR = 1.7 (95%CI: 1.3-2.10, P = 0.00009)]. CONCLUSION: Wrist arthritis in JIA patients is a marker of a severe disease course, characterized by more intensive inflammation, unfavorable outcomes, and. requiring more intensive treatment with early administration of biologics. Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.

Poroid Hidradenoma: A Rare Finger Lesion.

Poroid hidradenomas are uncommon tumors originating from eccrine sweat glands, often presenting as dermal nodules predominantly composed of cuticular and poroid cell types. They belong to the broader category of poroid neoplasms, which include hidroacanthoma simplex, dermal duct tumor, and eccrine poroma. Despite their rarity, poroid hidradenomas require accurate diagnosis and appropriate management due to potential overlaps in their histological features with other adnexal tumors, including digital papillary adenocarcinoma. We report a case of a 56-year-old female presenting with a nodular lesion on the palmar aspect of her right middle finger, which was excised under local anesthesia. Histopathological examination confirmed the diagnosis of poroid hidradenoma, highlighting the importance of maintaining a high clinical suspicion and precise histological evaluation in managing such an uncommon dermatological condition of the finger.

Network pharmacology and molecular docking approach to elucidate the mechanisms of safflower, phellodendron, scutellaria baicalensis, coptis, and gardenia in hand-foot syndrome.

Background: Safflower, phellodendron, scutellaria baicalensis, coptis, and gardenia (SPSCG) are medicinal plants with a wide range of anti-inflammatory and antioxidant effects. However, the related mechanism of SPSCG against hand-foot syndrome (HFS) has yet to be revealed. Objective: To investigate the mechanisms of SPSCG in the treatment of HFS using the Network Pharmacology. Methods: Active ingredients and targets of SPSCG for HFS were screened by the Chinese Medicine Systems Pharmacology (TCMSP) and Swiss Target Prediction databases. Potential therapeutic targets were collected from the GeneCards and OMIM databases. Subsequently, protein-protein interactions (PPI), Gene Ontology (GO) annotations, and pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG) were performed to investigate the potential mechanism of the SPSCG in HFS. Then, molecular docking and molecular dynamics simulations were performed to predict the binding interactions between the active compound and the core target. Finally, vitro experiments were used to verify the repair effect of key ingredients of SPSCG on cell damage caused by 5-Fluorouracil. Results: Quercetin, kaempferol, ß-sitosterol, and stigmasterol were identified as the major active components of SPSCG. GO analysis showed a total of 1,127 biological processes, 42 terms cellular components, and 57 molecular functions. KEGG analysis showed that the MAPK, TNF, and IL-17 signaling pathways were significantly enriched. The PPI analysis discovered that EGFR, CASP3, AKT1, CCND1, and CTNNB1 shared the highest centrality among all target genes. The experimental results confirmed that these SPSCG active ingredients could treat HFS by reducing inflammation reaction and promoting cell damage repair. Conclusion: SPSCG may alleviate HFS by exerting antioxidative effects and suppressing inflammatory responses.