[Sustainability in occupational dermatology : Starting points, challenges, and potentials for sustainable care of work-related skin diseases]. / Nachhaltigkeit in der Berufsdermatologie : Ansatzpunkte, Herausforderungen und Potenziale für eine nachhaltige(re) Versorgung beruflich Hauterkrankter.

Sustainability is becoming increasingly important in healthcare and has moved into focus at various levels. This article aims to provide an overview of guiding principles, concepts, and target systems of sustainability and to transfer these to occupational dermatology. Current and future starting points are outlined for various levels, e.g., politics, research, industry, and patient care, in order to link sustainability and occupational dermatology in a structured and systematic way and to transform the structures of patient care in occupational dermatology care towards sustainability. Using the specific example of protective gloves, which is a pivotal personal protective measure to prevent work-related hand eczema, starting points, potentials, and challenges are analyzed and specific possibilities and perspectives for more ecologically sustainable action are presented.

The pathologies of migrants who travel by boat documented on imaging.

The migration phenomenon is increasingly common worldwide. It is essential for radiologists to be aware of the endemic diseases of the migrant's country as well as the characteristics of the journey to be able to understand and interpret radiological findings when admitted to our centre. This article aims to use imaging from our centre to describe the most common pathologies that migrant patients present with after long journeys by boat.

Incidence of hand-foot syndrome with protein kinase inhibitors in advanced hepatocellular carcinoma patients who received atezolizumab-bevacizumab combination.

INTRODUCTION: Treatment of advanced HepatoCellular Carcinoma (HCC) is based on first-line (L1) combination of atezolizumab and high-dose (HD) bevacizumab while second-line (L2) refers one antiangiogenic protein kinase inhibitors (aaPKI). This prolonged antiangiogenic pressure let us to observe an increasing occurrence of Hand-Foot Syndromes (HFS) in patients receiving aaPKI after HD bevacizumab combination. This study reports observations and discussions about the evidence and hypothesis that could be made. METHODS: Patients who received the L1 combination from September 1st 2020 to December 31st 2022 to identify L2 aaPKI. Demographic, biological, oncological data and occurrence of HFS were collected. In addition were collected the number of L1 combination cycles, type of aaPKI, and delay between last L1 cycle and L2 initiation. This study had a purely exploratory purpose, so no statistical analysis was planned. RESULTS: 17 patients received an aaPKI after the L1 HD bevacizumab combination with a median time of 26 days from last L1 cycle to L2 start. Five patients experienced HFS including grade 3 (n = 2) with sorafenib and cabozantinib. The HFS occurred with a median delay of 23 days (IQR: 21-28) from aaPKI start. Three patients experienced aaPKI-related dose-limiting toxicity. CONCLUSIONS: Proportion of patients experienced HFS in our cohort did not differ from pivotal trials data and the sample size do not allow to conclude. Hypotheses include timing of aaPKI start in HCC treatment, vascular toxicity at aaPKI start after HD bevacizumab discontinuation instead combination, patient-related outcome for a better understanding of these aaPKI-related HFS post HD bevacizumab.

Usefulness of Hand-assisted Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis in the Era of Laparoscopic Surgery - A Single-center Observational Study.

Objectives: Hand-assisted laparoscopic surgery (HALS) combines the benefits of laparoscopic surgery with the tactile feedback from open surgery. In the current era of laparoscopic surgery, the significance of HALS as a technical transition has diminished. This study clarified the usefulness of HALS in restorative proctocolectomy (RPC) for ulcerative colitis (UC) in the era of laparoscopic surgery. Methods: The 212 patients who underwent RPC with ileal pouch-anal anastomosis between 2007 and 2023 were included in this study. The patients were divided into three groups, open surgery (OS), HALS, and conventional laparoscopic surgery (LAP), and their characteristics, surgical outcomes, surgical complications, and functional outcomes were compared. Results: The number of surgical techniques was OS in 21 cases, HALS in 184 cases, and LAP in 7 cases. The number of surgeons was two for OS and HALS, and four for LAP, with OS and HALS having fewer surgeons than LAP. The length of the skin incision was 13, 7, and 3 cm for OS, HALS, and LAP, respectively, and the operation times was 250, 286, and 576 minutes for OS, HALS, and LAP, respectively, with LAP having the longest operation time. The postoperative complications and function did not differ markedly among the three groups. Conclusions: In RPC for UC, HALS involved fewer surgeons and a shorter operative time than LAP. Even in the era of laparoscopic surgery, HALS remains a useful option, especially when a shorter operation time is required or when the number of available surgeons is insufficient.

Effectiveness of Regional Nerve Blocks Versus Local Anesthetic Infiltration for Elective Hand and Wrist Surgery.

BACKGROUND: Pain relief by different methods in elective hand and wrist surgery is pivotal for patients undergoing elective wrist and hand surgery. AIM: To evaluate the effectiveness and duration of peripheral nerve block versus local surgical site anesthetic infiltration among patients undergoing elective wrist and hand surgery. SUBJECTS AND METHODS: This study was carried out in the Orthopaedic Department of Duhok Emergency Teaching Hospital, Duhok, Kurdistan region, Iraq. All patients who attended the Orthopaedic Department (total number=496) for elective hand and wrist surgery between November 2021 and November 2022 were included in the study, but only 300 patients completed the study protocol after the exclusion of 196 patients. Three methods of nerve block were used for postoperative pain relief. The degree and duration of pain relief were assessed. RESULTS: Patients who underwent ultrasound-guided nerve block had more duration of pain relief when compared to those patients who underwent local surgical site anesthetic infiltration and anatomical landmark nerve block (p<0.01), while patients who underwent local surgical site anesthetic infiltration had better pain relief when compared to those patients who underwent ultrasound-guided nerve block and anatomical landmark nerve block (p<0.01 for the group experiencing mild pain and p=0.12 for the group experiencing moderate pain and p<0.01 for the group experiencing severe pain). CONCLUSION: Ultrasound-guided nerve block is better for a longer duration of pain relief postoperatively than local surgical site anesthetic infiltration, while local surgical site anesthetic infiltration more effectively controls the severity of pain following elective hand and wrist surgery.

Evaluation of comfort gloves made of semipermeable and textile materials in patients with hand dermatoses: Results of a controlled multicenter intervention study (ProTection II).

BACKGROUND: Comfort gloves are used in the management of hand dermatoses. OBJECTIVES: To compare the acceptance and tolerability of comfort gloves made of different materials in patients with hand dermatoses and their effects on skin lesions. METHODS: In a prospective multicenter study, 284 patients with hand dermatoses were invited to wear either a cotton glove (COT) or a semipermeable Sympatex glove underneath a cotton glove (SYM/COT) for two subsequent phases of 19 consecutive nights each. A total of 88 controls were asked not to wear any comfort gloves overnight. The severity of skin lesions over time was examined. Questionnaires were used to assess health-related quality of life (HRQoL) and acceptance and tolerability of the gloves. RESULTS: The hand dermatoses improved in all groups. No substantial intergroup differences regarding severity and HRQoL were observed. SYM/COT received better ratings regarding climate conditions and tactility while COT showed superiority in fit, wearing comfort, and practicality. CONCLUSIONS: We confirmed that SYM/COT and COT are well tolerated and accepted suggesting that SYM/COT is a good alternative for COT as comfort gloves in patients with hand dermatoses. Individual requirements, needs, and preferences may direct the material choice.

Molecular Evolutionary Dynamics of Coxsackievirus A6 Causing Hand, Foot, and Mouth Disease From 2021 to 2023 in China: Genomic Epidemiology Study.

Background: Hand, foot, and mouth disease (HFMD) is a global public health concern, notably within the Asia-Pacific region. Recently, the primary pathogen causing HFMD outbreaks across numerous countries, including China, is coxsackievirus (CV) A6, one of the most prevalent enteroviruses in the world. It is a new variant that has undergone genetic recombination and evolution, which might not only induce modifications in the clinical manifestations of HFMD but also heighten its pathogenicity because of nucleotide mutation accumulation. Objective: The study assessed the epidemiological characteristics of HFMD in China and characterized the molecular epidemiology of the major pathogen (CV-A6) causing HFMD. We attempted to establish the association between disease progression and viral genetic evolution through a molecular epidemiological study. Methods: Surveillance data from the Chinese Center for Disease Control and Prevention from 2021 to 2023 were used to analyze the epidemiological seasons and peaks of HFMD in Henan, China, and capture the results of HFMD pathogen typing. We analyzed the evolutionary characteristics of all full-length CV-A6 sequences in the NCBI database and the isolated sequences in Henan. To characterize the molecular evolution of CV-A6, time-scaled tree and historical population dynamics regarding CV-A6 sequences were estimated. Additionally, we analyzed the isolated strains for mutated or missing amino acid sites compared to the prototype CV-A6 strain. Results: The 2021-2023 epidemic seasons for HFMD in Henan usually lasted from June to August, with peaks around June and July. The monthly case reporting rate during the peak period ranged from 20.7% (4854/23,440) to 35% (12,135/34,706) of the total annual number of cases. Analysis of the pathogen composition of 2850 laboratory-confirmed cases identified 8 enterovirus serotypes, among which CV-A6 accounted for the highest proportion (652/2850, 22.88%). CV-A6 emerged as the major pathogen for HFMD in 2022 (203/732, 27.73%) and 2023 (262/708, 37.01%). We analyzed all CV-A6 full-length sequences in the NCBI database and the evolutionary features of viruses isolated in Henan. In China, the D3 subtype gradually appeared from 2011, and by 2019, all CV-A6 virus strains belonged to the D3 subtype. The VP1 sequences analyzed in Henan showed that its subtypes were consistent with the national subtypes. Furthermore, we analyzed the molecular evolutionary features of CV-A6 using Bayesian phylogeny and found that the most recent common ancestor of CV-A6 D3 dates back to 2006 in China, earlier than the 2011 HFMD outbreak. Moreover, the strains isolated in 2023 had mutations at several amino acid sites compared to the original strain. Conclusions: The CV-A6 virus may have been introduced and circulating covertly within China prior to the large-scale HFMD outbreak. Our laboratory testing data confirmed the fluctuation and periodic patterns of CV-A6 prevalence. Our study provides valuable insights into understanding the evolutionary dynamics of CV-A6.

Science behind children's handwashing: action study of 9- to 10-years-old elementary school students in Japan.

Background: Hand washing instructions for children have been implemented in school education to establish good lifestyle habits. However, repeated hand washing through education from early childhood was common for both teachers and children. If this continues, children might assume they already know how to wash their hands, stop taking handwashing instructions seriously, and become increasingly lax about washing their hands. Purpose: This study aimed to develop a new handwashing education method for children. Methods: We applied the adenosine triphosphate (ATP) test to health education on hand washing in elementary schools. This study was conducted as part of a class for elementary school students in October 2023, in Hokkaido, Japan. The subjects were 157 third-grade (9-10 years old) elementary school students. After excluding absent pupils, 147 were included in the analysis. Results: Both pre- and post-education, ATP values after handwashing were lower than those before handwashing. Following the education, children's handwashing behavior improved, with an increase in the number of point washed and appropriate timing of handwashing. Conclusion: The new handwashing education program utilizing the ATP-test succeeded in promoting handwashing behavior among many children. Visualizing handwashing using ATP values was effective in motivating children.

Reliability and Validity of the Martin Vigorimeter for Grip Strength Measurement in Korean Adults.

Background: Grip strength is important for fine motor skills, and one of the measurement tools for grip strength is the Martin Vigorimeter (MV) dynamometer. Studies on establishing the reliability and validity of the MV in Koreans are limited. We aimed to establish the reliability and validity of the MV for grip strength measurement in healthy Korean adults by comparing it with the Jamar dynamometer, the standard tool used by the American Society of Hand Therapists. Methods: In total, 99 healthy participants (50 men and 49 women) were enrolled. Grip strength was measured using the Jamar dynamometer and MV. Reliability and validity were assessed using the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the measurements of the instruments was analyzed using Pearson's correlation. The effect of hand anthropometry was evaluated, and the conversion equation between the instruments was calculated. Results: MV showed excellent reliability (ICC > 0.90, p < 0.001) and validity with a high correlation (0.7 ≤ r < 0.9) with the Jamar dynamometer. The MDC was acceptable for detecting minimal clinically important differences (< 19.5%) in both instruments (Jamar: 3.4%-6.7%, MV: 3.8% to 6.3%). The grip strength measured using the MV was independent of hand anthropometry, unlike that using the Jamar dynamometer. Conclusions: This study provides insights into the relationship between the Jamar and MV instruments for measuring grip strength in Koreans. The MV is a viable alternative to the Jamar dynamometer in Koreans, offering not only reproducible and reliable measurements of grip strength but also the advantage of being unaffected by variations in hand anthropometry.

Supinator to posterior interosseous nerve transfer to restore hand opening in brachial plexus and spinal cord injury: a systematic review and individual patient-data meta-analysis.

OBJECTIVE: Cervical spinal cord injury (SCI) and lower trunk brachial plexus injury (BPI) commonly result in hand paralysis. Although restoring hand function is complex and challenging to achieve, regaining volitional hand control drastically enhances functionality for these patients. The authors aimed to systematically review the outcomes of hand-opening function after supinator to posterior interosseous nerve (PIN) transfer. METHODS: A systematic literature review was performed according to the PRISMA guidelines. RESULTS: A total of 16 studies with 88 patients and 119 supinator to PIN transfers were included (87 transfers for SCI and 32 for BPI). In most studies, the time interval from injury to surgery was 6-12 months. Finger extension and thumb extension (Medical Research Council grade ≥ 3/5) recovered in 86.5% (103/119) and 78.1% (93/119) of cases, respectively, over a median follow-up of 19 months. The rates of recovery were similar for the SCI and BPI populations (finger extension, 87.3% in SCI and 84.3% in BPI; thumb extension, 75.8% in SCI and 84.3% in BPI). Type of injury (OR 1.05, 95% CI 0.17-6.4, p = 0.95), time from injury to surgery (OR 1.01, 95% CI 0.8-1.29, p = 0.88), and age (OR 0.97, 95% CI 0.90-1.06, p = 0.60) were not associated with odds of a successful outcome. Duration of follow-up was significantly associated with successful finger extension (OR 1.15, 95% CI 1.01-1.30, p = 0.026). No donor-associated supinator weakness was reported postoperatively given that patients had an intact bicep muscle preoperatively contributing to supination. CONCLUSIONS: Supinator to PIN transfer is a safe and effective procedure that can achieve successful restoration of digital extension in the SCI and BPI population at similar rates. Duration of follow-up was associated with superior outcomes, which was expected.

Firearm Injuries in Young Children: Surgical Resource Utilization and Implications for Prevention.

INTRODUCTION: Pediatric firearm injury prevention research in younger age groups is limited. This study evaluated a large multicenter cohort of younger children with firearm injuries, focusing on injury patterns and surgical resource utilization. METHODS: Children ≤15 y old sustaining firearm injuries between 2016 and 2021 and treated at 10 pediatric trauma centers in Florida were included. Individual cases were reviewed for demographics, shooting details, injury patterns, resource utilization, and outcomes. Patients were grouped by age into preschool (0-5 y), elementary school (6-10 y), middle school (11-13 y), and early high school (14-15 y). Multivariable logistic regression was used to identify predictors of death and critical resource utilization. RESULTS: A total of 489 children (80 preschool, 76 elementary school, 92 middle school, and 241 early high school) met inclusion criteria. Demographics, injury patterns, and resource utilization were similar across age groups. Assault and self-harm increased with age. Self-harm was implicated in 5% of cases but accounted for 18% of deaths. Hand surgery (i.e., below-elbow) procedures were common at 8%. Overall mortality was 10%, but markedly higher for self-harm injuries (47%). On multivariable regression, age and demographics were not predictive of death or critical resource utilization, but self-harm intent was a strong independent risk factor for both. CONCLUSIONS: This study suggests that given the age distribution and disproportionately high impact of self-harm injuries, behavioral health resources should be available to children at the middle school level or earlier. Hand surgery may represent an overlooked but frequently utilized resource to mitigate injury impact and optimize long-term function.

Comparison of AI with and without hand-crafted features to classify Alzheimer's disease in different languages.

BACKGROUND: Detecting and analyzing Alzheimer's disease (AD) in its early stages is a crucial and significant challenge. Speech data from AD patients can aid in diagnosing AD since the speech features have common patterns independent of race and spoken language. However, previous models for diagnosing AD from speech data have often focused on the characteristics of a single language, with no guarantee of scalability to other languages. In this study, we used the same method to extract acoustic features from two language datasets to diagnose AD. METHODS: Using the Korean and English speech datasets, we used ten models capable of real-time AD and healthy control classification, regardless of language type. Four machine learning models were based on hand-crafted features, while the remaining six deep learning models utilized non-explainable features. RESULTS: The highest accuracy achieved by the machine learning models was 0.73 and 0.69 for the Korean and English speech datasets, respectively. The deep learning models' maximum achievable accuracy reached 0.75 and 0.78, with their minimum classification time of 0.01s and 0.02s. These findings reveal the models' robustness regardless of Korean and English and real-time diagnosis of AD through a 30-s voice sample. CONCLUSION: Non-explainable deep learning models that directly acquire voice representations surpassed machine learning models utilizing hand-crafted features in AD diagnosis. In addition, these AI models could confirm the possibility of extending to a language-agnostic AD diagnosis.

Surgical treatment of true arterial aneurysms of the hand: A systematic review.

BACKGROUND: The present study evaluated the clinical features and safety of surgical strategies and treatments for true arterial aneurysms of the hand. METHODS: A systematic search of the PubMed, Embase, Web of Science, Scopus, and CINAHL databases for clinical trials, case series, and case reports investigating true arterial aneurysms of the hand, published over the past 10 years, was performed. The inclusion criterion was surgical excision of arterial aneurysm, followed by arterial revascularization or ligation. Studies addressing pseudoaneurysms, mycotic aneurysms, conservative treatment, or no treatment were excluded. Summary level data regarding study characteristics and outcomes of amputation, neurological symptoms, number of preoperative vascular imaging examinations, and length of hospital stay were extracted. RESULTS: Thirty-nine studies comprising 48 patients (mean [± SD] age, 41.1±22 years [range 0.5-80 years]; 39 [81.25%] male) were included. Thirty (62.5%) patients underwent only 1 preoperative examination and traumatic etiology was observed in 52.1% (n=25). The most prevalent intervention was aneurysm excision, followed by arterial revascularization (n=35 [72.9%]), with no amputations. Neurological symptoms were present in 8 (16.6%) subjects, with no difference between the revascularization and arterial ligation groups (odds ratio [OR] 3.36 [95% confidence interval (CI) 0.37-30.5]). The mean length of hospital stay was 1.44 days (range 0-4 days), with no difference between revascularization and arterial ligation (OR 2.5 [95% CI 0.10-62.6]). CONCLUSION: This review did not find amputation rate outcomes associated with either technique, although similar neurological outcomes were observed. Nevertheless, the retrieved data were limited to those ensuring the safety of both procedures.

Catch the Shift: Ultrasound Diagnosis of Scapholunate Lesion During Watson Test.

Scapholunate ligament lesion is the most common ligament lesion in the wrist. We assessed the reliability of sonography in detecting it during Watson test. Twenty patients with scapholunate ligament lesion confirmed on MRI and intraoperatively were assessed preoperatively between July 2020 and April 2023. Sonography was performed on the scaphoid dorsal subluxation in wrist neutral and during Watson test and compared with the healthy contralateral side. Dorsal subluxation was measured by two independent investigators and intra- and inter-observer reliability were assessed. We found a significant difference between dorsal subluxation of the scaphoid in the healthy (0.89 mm, SD 0.67 mm) compared to the pathological side (1.67 mm, SD 0.95 mm). Reliability was very good and the standard error of measurement was less than 0.4 mm for all measurements. Sonography during Watson test demonstrated high reliability in diagnosing scapholunate lesions. LEVEL OF EVIDENCE: III.

Deep learning-based automated bone age estimation for Saudi patients on hand radiograph images: a retrospective study.

PURPOSE: In pediatric medicine, precise estimation of bone age is essential for skeletal maturity evaluation, growth disorder diagnosis, and therapeutic intervention planning. Conventional techniques for determining bone age depend on radiologists' subjective judgments, which may lead to non-negligible differences in the estimated bone age. This study proposes a deep learning-based model utilizing a fully connected convolutional neural network(CNN) to predict bone age from left-hand radiographs. METHODS: The data set used in this study, consisting of 473 patients, was retrospectively retrieved from the PACS (Picture Achieving and Communication System) of a single institution. We developed a fully connected CNN consisting of four convolutional blocks, three fully connected layers, and a single neuron as output. The model was trained and validated on 80% of the data using the mean-squared error as a cost function to minimize the difference between the predicted and reference bone age values through the Adam optimization algorithm. Data augmentation was applied to the training and validation sets yielded in doubling the data samples. The performance of the trained model was evaluated on a test data set (20%) using various metrics including, the mean absolute error (MAE), median absolute error (MedAE), root-mean-squared error (RMSE), and mean absolute percentage error (MAPE). The code of the developed model for predicting the bone age in this study is available publicly on GitHub at https://github.com/afiosman/deep-learning-based-bone-age-estimation . RESULTS: Experimental results demonstrate the sound capabilities of our model in predicting the bone age on the left-hand radiographs as in the majority of the cases, the predicted bone ages and reference bone ages are nearly close to each other with a calculated MAE of 2.3 [1.9, 2.7; 0.95 confidence level] years, MedAE of 2.1 years, RMAE of 3.0 [1.5, 4.5; 0.95 confidence level] years, and MAPE of 0.29 (29%) on the test data set. CONCLUSION: These findings highlight the usability of estimating the bone age from left-hand radiographs, helping radiologists to verify their own results considering the margin of error on the model. The performance of our proposed model could be improved with additional refining and validation.

Metacarpal Stress Fractures in Athletes: A Systematic Review.

BACKGROUND: Stress fractures in general are common injuries; however, there is limited literature on metacarpal stress fractures in athletes. Our objective is to contribute the first systematic review of metacarpal stress fractures in athletes, with a particular focus on epidemiology, presentation, and outcomes. METHODS: A systematic review regarding metacarpal stress fractures in athletes was performed via PubMed, EMBASE, MedLine, Cochrane, and Web of Science. Inclusion criteria consisted of case reports and case series of metacarpal stress fractures in athletes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS: A total of 11 studies (29 cases) were included. The mean patient age was 17 years, with 12 men and 15 women. The most common sports were tennis and badminton. The most common presentation was pain in the dorsal aspect of the hand related to activity. All patients underwent successful nonoperative management, with mean return to play of 9 weeks. CONCLUSIONS: Metacarpal stress fractures can present with significant pain and impact performance in athletes who perform sports involving repetitive movements of the hand and wrist. Nonoperative treatment, consisting of abstinence from sport until the patient was pain free combined with gradual return to play, was successful for all patients. The addition of proper technique and training load can result in satisfactory return to play. For patients who present with hand pain related to exercise, particularly a young racquet sport player, metacarpal stress fractures are a "can't miss" diagnosis associated with significant functional impairment.

Understanding consumer attitudes towards second-hand robots for the home.

As robot numbers in the home increase, creating a market for second-hand robotic systems is essential to reduce the waste impact of the industry. Via a survey, consumer attitudes of United Kingdom participants towards second-hand robots were investigated; finding that second-hand robots with guarantees have an equal purchasing interest compared to new systems, highlighting the opportunity for manufacturers and retailers to develop certification standards for second-hand robots to move towards a circular economy. Consumer demographics also demonstrated that those most open to the purchase of both new and second-hand systems were women, those aged 18-25 years old, and those who have previously owned a robot for the home. Participants' prior ownership of second-hand electronic devices (such as phones and laptops) did not affect rates of interest for second-hand robotic systems suggesting that the technology is still too new for people to be able to project their experience of current second-hand electronics to that of a robot. Additionally, this research found the robotics industry can consider the potential market for second-hand robots to be more similar to the second-hand smartphone market than to the household electronics market, and lessons learnt from the concerns raised by consumers for other internet-enabled electronic devices are similar to those concerns for second-hand robots. This provides an opportunity for the industry to break down the barriers for a circular economy earlier in the technology maturity process than has been seen for other electronics.