The Role of Surgery to Relieve Symptomatic Cutaneous T-Cell Lymphoma Refractory to Medical Treatments.

Background: Though mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL), it has no curative treatment. The aim of current topical and systemic treatment is centered around relieving symptoms and optimizing disease-free time. The use of surgical management to achieve the same goals of symptomatic reduction is not well described in the current literature. Methods: We present a case of refractory MF that failed chemotherapy, radiotherapy, and UV light therapy. Despite medical management, the tumor burden progressed to significant compression neuropathy of the ulnar and median nerves. Results: To reduce tumor burden and attempt to provide symptomatic relief, a surgical plan was developed to include radical resection of the tumor of the left upper extremity (LUE) with release of the cubital tunnel, carpal tunnel, Guyon canal, and coverage with split-thickness skin graft. The patient reported decreased symptomatology interfering with her daily activities and, overall, a better quality of life postoperatively. Conclusion: Surgical intervention, in addition to established medical standards of care, for symptomatic relief of compression neuropathy from tumor mass effect for refractory CTCL should be considered to achieve quality of life goals for patients.

The Evolution of Hand Injuries at a State's Only Level I Trauma Center: A Look From the 1980s Through the Global Pandemic.

BACKGROUND: The purpose of this study is to evaluate any changes to hand trauma in the past three decades and through the COVID-19 pandemic. We hypothesized that improved consumer safety regulations, changes in access to care, and the impact of a global pandemic, among other variables, have significantly influenced the mechanisms and treatment of hand injuries between the 1980s, 2010s (pre-COVID-19), and 2020s (post-COVID-19). METHODS: A retrospective single-center review was performed at the only level I trauma center in Mississippi, identifying all hand trauma consultations between 2012-2019 and 2020-2021, compared to aggregated data from 1989. RESULTS: Car accidents, gunshots, saw injuries, door injuries, and falls increased in 2012-2019 and 2020-2021 compared to 1989, whereas knife injuries, glass injuries, industrial injuries, and burns decreased. Crush injuries, de-gloving injuries, and lacerations with irregular edges were increased in recent cohorts, corresponding with increased amputations and tissue loss. Skin and subcutaneous injuries decreased in modern cohorts, corresponding with a decreased ability for primary skin repair and the need for more flaps. Additionally, while hospitalizations have increased, patients have improved follow-up. CONCLUSIONS: The nature of hand trauma has changed significantly over the past three decades. Increased numbers of cars and greater access to firearms might have led to increased rates of high-energy trauma, whereas burn and industrial injuries have decreased, potentially secondary to improved safety efforts. Despite increased overall hand trauma, time to treatment and follow-up have improved. Through this study, we can be more cognizant of the evolution of hand trauma in the modern era. This can allow improved access to care and further refine management to optimize functionality for hand injuries.

Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique.

Background: Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. Methods: In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0-10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Results: Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (-1.8 versus -1.8; P = 0.96), BCTQ-FSS (-1.0 versus -1.0; P = 0.75), numeric pain scale (-3.9 versus -3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. Conclusions: CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.

Universality of Hair as a Nucleant: Exploring the Effects of Surface Chemistry and Topography.

The ability to control crystal nucleation through the simple addition of a nucleating agent (nucleant) is desirable for a huge range of applications. However, effective nucleating agents are known for only a small number of systems, and many questions remain about the mechanisms by which they operate. Here, we explore the features that make an effective nucleant and demonstrate that the biological material hair-which naturally possesses a chemically and topographically complex surface structure-has excellent potential as an effective nucleating agent. Crystallization of poorly soluble compounds in the presence of hairs from a range of mammals shows that nucleation preferentially occurs at the cuticle step edges, while a novel microdroplet-based methodology was used to quantify the nucleating activities of different hairs. This showed that the activities of the hairs can be tuned over a wide range using chemical treatments. Analysis of the hair structure and composition using atomic force microscopy, scanning ion conductance microscopy, and X-ray photoelectron spectroscopy demonstrates that surface chemistry, surface topography, and surface charge all act in combination to create effective nucleation sites. This work therefore contributes to our understanding of heterogeneous nucleating agents and shows that surface topography as well as surface chemistry can be used in the design or selection of universal nucleating agents.

Plastic Surgery: Beware the Candle Burning at Both Ends.

Background: Plastic surgery dates back to 800 BC, where forehead flaps were used to reconstruct noses in India. Today, it is one of the most romanticized fields in medicine. Due to the influence of social media, there has never been a larger spotlight. Ironically, this spotlight brings a narrowed perception of the scope of plastic surgery. This study aimed to assess the scope through the eyes of the average American to identify gaps in knowledge to better represent the field. Methods: A series of questions were developed under survey methodologists and administered by Qualtrics. Responses were gathered, and data were analyzed to assess the public's knowledge of plastic surgery's scope. Results: Two thousand five hundred responses were obtained, balanced across demographics similar to that of the United States. The US population has a poor understanding of the scope of plastic surgery and how to obtain board certification. Conclusions: This survey demonstrates a gap in awareness of plastic surgery as a field and the scope outside aesthetic procedures dramatized by the media. There remains no clear understanding of the qualifications of plastic surgeons or the provider makeup of the field of cosmetic surgery. Subspecialties proved to be overlooked, and knowledge of board certification was sparse. Further effort is needed to educate both the public and patients of the scope of plastic surgery, so that they might seek and gain access to appropriate treatment in the most efficient manner to optimize outcomes regarding the form and function of the body.

Subacute Ulnar Nerve Compression Neuropathy Following Hand Crush Injury in the Setting of Intracanal Accessory Abductor Digiti Minimi: A Double Crush Phenomenon.

Anatomical variations within Guyon's canal such as an accessory abductor digiti minimi are described as causes of ulnar nerve compression. Here we present a unique case of delayed ulnar neuropathy following treatment of left fourth metacarpal base fracture with percutaneous pinning fixation and an uncomplicated two month postoperative course. He returned with new ulnar sensory loss and motor weakness. EMG demonstrated nerve compression with CT identifying an accessory abductor digiti minimi in Guyon's canal. Following Guyon's canal release with partial accessory muscle resection, there was immediate sensory and progressive motor recovery with resolution of clawing. Delayed compression by an accessory abductor digiti minimi following trauma has not been described, suggestive of double-crush phenomenon. The accessory muscle was an asymptomatic variable (first "crush") and with the second "crush" of post-surgical changes resulting in pathological nerve compression. With delayed onset ulnar neuropathy after trauma, surgeons should consider possible accessory structures.

Combined Stabilizing of the Solid-Electrolyte Interphase with Suppression of Graphite Exfoliation via Additive-Solvent Optimization in Li-Ion Batteries.

Propylene carbonate (PC) is a promising solvent for extending the operating temperature range for lithium-ion batteries (LIBs) because of its high dielectric constant and wide temperature range stability. However, PC can cause graphite exfoliation through cointercalation, leading to electrolyte decomposition and subsequent irreversible capacity loss. This work reports the formulation of a ternary electrolyte with the introduction of an inorganic salt additive, potassium hexafluorophosphate (KPF6), to address the aforementioned concerns. We demonstrate the cumulative effect of solvent and additive on delivering multiple performance benefits and safety of the battery. The faster diffusion rate of K + solvation shell decreases the rate of PC decomposition, thereby reducing its cointercalation. Additionally, the optimum concentration of KPF6, i.e., 0.1 M constructs a robust and insoluble LiF-rich electrode/electrolyte interphase, further suppressing graphite exfoliation and Li dendrite formation. The stable cyclability is achieved by enhanced Li + transportation through the LiF-rich interphase, enabling an exfoliation-free and dendrite-free graphite anode in the ternary electrolyte.

Synthesis of Li1.20Mn0.432+Nb0.39O2 disordered rock-salt under reducing conditions for Li-ion batteries.

A Mn2+-Li-Nb disordered rock-salt oxide cathode is prepared by a solid-state reaction under 5% H2/N2, and its electrochemical property shows a high voltage plateau at 4.8 V, with irreversible structural changes in the 1st cycle due to O redox processes; this is supported by powder X-ray diffraction and ex situ laboratory Mn K-edge XANES data.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery.

Background: Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans. Methods: After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant. Results: Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans. Conclusions: This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

Nanoporous YVO4 as a luminescent host for probing molecular encapsulation.

Control of phase separation of VO43- and rare earth precursors in reverse microemulsions afforded ∼35 nm YVO4 nanoparticles with functionalisable ∼7 ± 3 nm nanopores. Doping by Eu3+ allowed luminescent probing of interfacial crystallisation while xylenol orange absorption showed molecular encapsulation in particle cavities. This provides potential multifunctional systems combining UV-Vis-NIR luminescence and (photo)active molecules for optical sensing.

Rapid synthesis of cerium-UiO-66 MOF nanoparticles for photocatalytic dye degradation.

An unprecedented synthesis method is used to form a series of Ce-UiO-66-X (X = NH2, OH, H, NO2, COOH) metal-organic frameworks by precipitation from mixed solvents, with instantaneous crystallisation on combining separate solutions of ligands and metal precursors. This allows the first direct synthesis of Ce-UiO-66-OH. Powder X-ray diffraction (PXRD) shows that all materials are pure phase with a broadened profile that indicates nano-scale crystallite domain size. The effect of different functional groups on the benzene-1,4-dicarboxylate linker within the UiO-66 structure has been investigated on degradation of two cationic (methylene blue and rhodamine B) and two anionic (Congo red, and Alizarin red S) dyes under UV and visible light irradiation at room temperature. Analysis of the dye adsorption in the absence of light is accounted for using pseudo-first order kinetics, and the Ce-UiO-66-NH2, Ce-UiO-66-OH, and Ce-UiO-66-H materials display a considerable photocatalytic activity to degrade Alizarin red S and Congo red rapidly between 1 and 3 minutes. The materials show excellent photostability and recyclability under UV and visible light, with no loss of crystallinity seen by PXRD and activity maintained over 5 cycles, with 16 hours photostability for Ce-UiO-66-NH2.

Stable chemical enhancement of passivating nanolayer structures grown by atomic layer deposition on silicon.

Incorporation of carrier-selective passivating contacts is on the critical path for approaching the theoretical power conversion efficiency limit in silicon solar cells. We have used plasma-enhanced atomic layer deposition (ALD) to create ultra-thin films at the single nanometre-scale which can be subsequently chemically enhanced to have properties suitable for high-performance contacts. Negatively charged 1 nm thick HfO2 films exhibit very promising passivation properties - exceeding those of SiO2 and Al2O3 at an equivalent thickness - providing a surface recombination velocity (SRV) of 19 cm s-1 on n-type silicon. Applying an Al2O3 capping layer to form Si/HfO2/Al2O3 stacks gives additional passivation, resulting in an SRV of 3.5 cm s-1. Passivation quality can be further improved via simple immersion in hydrofluoric acid, which results in SRVs < 2 cm s-1 that are stable over time (tested for ∼50 days). Based on corona charging analysis, Kelvin probe measurements and X-ray photoelectron spectroscopy, the chemically induced enhancement is consistent with changes at the dielectric surface and not the Si/dielectric interface, with fluorination of the Al2O3 and underlying HfO2 films occurring after just 5 s HF immersion. Our results show that passivation is enhanced when the oxides are fluorinated. The Al2O3 top layer of the stack can be thinned down by etching, offering a new route for fabrication of ultra-thin highly passivating HfO2-containing nanoscale thin films.

Interfacial Chemistry Effects in the Electrochemical Performance of Silicon Electrodes under Lithium-Ion Battery Conditions.

Understanding the solid electrolyte interphase (SEI) formation and (de)lithiation phenomena at silicon (Si) electrodes is key to improving the performance and lifetime of Si-based lithium-ion batteries. However, these processes remain somewhat elusive, and, in particular, the role of Si surface termination merits further consideration. Here, scanning electrochemical cell microscopy (SECCM) is used in a glovebox, followed by secondary ion mass spectrometry (SIMS) at identical locations to study the local electrochemical behavior and associated SEI formation, comparing Si (100) with a native oxide layer (SiOx /Si) and etched with hydrofluoric acid (HF-Si). HF-Si shows greater spatial electrochemical heterogeneity and inferior lithiation reversibility than SiOx /Si. This is attributed to a weakly passivating SEI and irreversible lithium trapping at the Si surface. Combinatorial screening of charge/discharge cycling by SECCM with co-located SIMS reveals SEI chemistry as a function of depth. While the SEI thickness is relatively independent of the cycle number, the chemistry - particularly in the intermediate layers - depends on the number of cycles, revealing the SEI to be dynamic during cycling. This work serves as a foundation for the use of correlative SECCM/SIMS as a powerful approach to gain fundamental insights on complex battery processes at the nano- and microscales.

Gaining the Upper Hand: Understanding the Causes and Repercussions of Delayed Presentation of Congenital Hand Anomalies.

Congenital upper extremity anomalies are common, with an incidence of 27.2 per 10,000 births.1 This case series highlights patients with delayed presentation of congenital hand anomalies due to breakdowns in referral to pediatric hand surgery. A retrospective review of patients with congenital hand anomalies with delayed presentation to the University of Mississippi Medical Center Congenital Hand Center was performed, and 3 patients were included. Delays in care result from a variety of missteps for patients and parents navigating the health system. In our case series, we observed fear of surgical correction, lack of expected impact to quality of life, and paucity of knowledge of available surgical options by the patient's pediatrician. While all patients underwent successful reconstruction of their congenital hand anomalies, these delays in care resulted in more demanding surgeries and prolonged return to normal hand use. Early referral to pediatric hand surgery for congenital hand anomalies is critical to avoid delays in care and unfavorable post-operative outcomes. Educating primary care physicians of regional surgeon availability, surgical options, ideal reconstruction timelines, and methods to encourage parents to pursue surgical options early for correctable deformities can improve patient outcomes and lessen resultant social consequences in patients with congenital hand anomalies.

Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique.

BACKGROUND: Comparative studies of carpal tunnel release with ultrasound guidance (CTR-US) vs. mini-open CTR (mOCTR) are limited, prompting development of this randomized trial to compare efficacy and safety of these techniques. RESEARCH DESIGN AND METHODS: Patients were randomized (2:1) to CTR-US or mOCTR, treated by experienced hand surgeons (median previous cases: 12 CTR-US; 1000 mOCTR), and followed for 3 months. RESULTS: Among 149 randomized patients, 122 received CTR-US (n = 94) or mOCTR (n = 28). Mean incision length was 6 ± 2 mm in the wrist (CTR-US) vs. 22 ± 7 mm in the palm (mOCTR) (p < 0.001). Median time to return to daily activities (2 vs. 2 days; p = 0.81) and work (3 vs. 4 days; p = 0.61) were similar. Both groups reported statistically significant and clinically important improvements in Boston Carpal Tunnel Questionnaire Symptom Severity and Functional Status Scales, Numeric Pain Scale, and EuroQoL-5 Dimension 5-Level, with no statistical differences between groups. Freedom from wound sensitivity and pain favored CTR-US (61.1% vs. 17.9%; p < 0.001). Adverse event rates were low in each group (2.1% vs. 3.6%; p = 0.55). CONCLUSIONS: The efficacy and safety of CTR-US were comparable to mOCTR despite less previous surgical experience with CTR-US. The choice of CTR technique should be determined by shared decision-making between patient and physician. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT05405218.

Designing mixed-metal electrocatalyst systems for photoelectrochemical dinitrogen activation.

Efficient artificial photosynthesis systems are currently realized as catalyst- and surface-functionalized photovoltaic tandem-and triple-junction devices, enabling photoelectrochemical (PEC) water oxidation while simultaneously recycling CO2 and generating hydrogen as a solar fuel for storable renewable energy. Although PEC systems also bear advantages for the activation of dinitrogen - such as a high system tunability with respect to the electrocatalyst integration and a directly controllable electron flux to the anchoring catalyst through the adjustability of incoming irradiation - only a few PEC devices have been developed and investigated for this purpose. We have developed a series of photoelectrodeposition procedures to deposit mixed-metal electrocatalyst nanostructures directly on the semiconductor surface for light-assisted dinitrogen activation. These electrocatalyst compositions containing Co, Mo and Ru in different atomic ratios follow previously made recommendations of metal compositions for dinitrogen reduction and exhibit different physical properties. XPS studies of the photoelectrode surfaces reveal that our electrocatalyst films are to a large degree nitrogen-free after their fabrication, which is generally difficult to achieve with traditional magnetron sputtering or e-beam evaporation techniques. Initial chronoamperometric measurements of the p-InP photoelectrode coated with the Co-Mo alloy electrocatalyst show higher photocurrent densities in the presence of N2(g) than in the presence of Ar at -0.09 V vs. RHE. Indications of successful dinitrogen activation have also been found in consecutive XPS studies, where both N 1s and Mo 3d spectra reveal evidence of nitrogen-metal interactions.

Silane functionalization of WS2 nanotubes for interaction with poly(lactic acid).

Functionalisation of nanofillers is required for the promotion of strong interfacial interactions with polymers and is essential as a route for the preparation of (nano)composites with superior mechanical properties. Tungsten disulphide nanotubes (WS2 NTs) were functionalized using (3-aminopropyl) triethoxysilane (APTES) for preparation of composites with poly(lactic acid) (PLA). The WS2 NTs : APTES ratios used were 1 : 1, 1 : 2 and 1 : 4 WS2 NTs : APTES. The APTES formed siloxane networks bound to the NTs via surface oxygen and carbon moieties adsorbed on the WS2 NTs surface, detected by X-ray photoelectron spectroscopy (XPS) studies and chemical mapping using energy dispersive X-ray spectroscopy in the scanning transmission electron microscope (STEM-EDS). The successful silane modification of the WS2 NTs was clearly evident with both significant peak shifting by as much as 60 cm-1 for Si-O-Si vibrations (FTIR) and peak broadening of the A1g band in the Raman spectra of the WS2 NTs. The evolution of new bands was also observed and are associated with Si-CH2-CH2 and, symmetric and assymetric -NH3+ deformation modes (FTIR). Further evidence for functionalization was obtained from zeta potential measurements as there was a change in surface charge from negative for pure WS2 NTs to positive for APTES modified WS2 NTs. Additionally, the thermal stability of APTES was shifted to much higher temperatures as it was bound to the WS2 NTs. The APTES modified WS2 NTs were organophilic and readily dispersed in PLA, while presence of the pendant amine and hydroxyl groups resulted in strong interfacial interactions with the polymer matrix. The inclusion of as little as 0.5 wt% WS2 NTs modified with 2.0 wt% APTES resulted in an increase of 600% in both the elongation at break (a measure of ductility) and the tensile toughness relative to neat PLA, without impacting the stiffness or strength of the polymer.

Spectroscopic Insights into the Influence of Filling Carbon Nanotubes with Atomic Nanowires for Photophysical and Photochemical Applications.

Studying the optical performance of carbon nanotubes (CNTs) filled with guest materials can reveal the fundamental photochemical nature of ultrathin one-dimensional (1D) nanosystems, which are attractive for applications including photocatalysis. Here, we report comprehensive spectroscopic studies of how infiltrated HgTe nanowires (NWs) alter the optical properties of small-diameter (d t < 1 nm) single-walled carbon nanotubes (SWCNTs) in different environments: isolated in solution, suspended in a gelatin matrix, and heavily bundled in network-like thin films. Temperature-dependent Raman and photoluminescence measurements revealed that the HgTe NW filling can alter the stiffness of SWCNTs and therefore modify their vibrational and optical modes. Results from optical absorption and X-ray photoelectron spectroscopy demonstrated that the semiconducting HgTe NWs did not provide substantial charge transfer to or from the SWCNTs. Transient absorption spectroscopy further highlighted that the filling-induced nanotube distortion can alter the temporal evolution of excitons and their transient spectra. In contrast to previous studies on functionalized CNTs, where electronic or chemical doping often drove changes to the optical spectra, we highlight structural distortion as playing an important role.

Discrimination between protein glycoforms using lectin-functionalised gold nanoparticles as signal enhancers.

Glycoforms (and other post-translational modifications) of otherwise identical proteins can indicate pathogenesis/disease state and hence new tools to detect and sense a protein's glycosylation status are essential. Antibody-based assays against specific protein sequences do not typically discriminate between glycoforms. Here we demonstrate a 'sandwich' bio-assay approach, whereby antibodies immobilised onto biolayer interferometry sensors first select proteins, and then the specific glycoform is identified using gold nanoparticles functionalised with lectins which provide signal enhancement. The nanoparticles significantly enhance the signal relative to lectins alone, allowing glycoform specific detection as low as 0.04 µg mL-1 (1.4 nM) in buffer, and crucially there is no need for an enrichment step and all steps can be automated. Proof of concept is demonstrated using prostate specific antigen: a biomarker for prostate cancer, where glycoform analysis could distinguish between cancerous and non-cancerous status, rather than only detecting overall protein concentration.

Differential Pulley Release in Trigger Finger: A Prospective, Randomized Clinical Trial.

BACKGROUND: The palmar aponeurosis or "A0 pulley" may play a role in trigger finger pathology. This study assesses the involvement of the A0 pulley in patients receiving trigger finger release. METHODS: This single-surgeon, prospective, randomized clinical trial was conducted among consenting patients with symptomatic trigger finger. Intraoperative coin toss was used to randomize initial release of either the A0 or A1 pulley. Following release, active flexion and extension of the affected digit were examined. The remaining pulley was then released in sequence, and clinical trigger status was recorded. RESULTS: Thirty fingers from 24 patients were released; 17 fingers received A0 release first, and 13 received A1 release. Following initial A0 release, 8 fingers (47%) demonstrated complete resolution of symptoms, 4 (24%) demonstrated improvement but incomplete resolution of triggering, and 5 (29.4%) demonstrated no improvement. Following initial A1 release, 6 fingers (46%) demonstrated complete resolution, 3 (23%) demonstrated improvement but incomplete resolution of triggering, and 4 (31%) demonstrated no improvement. All patients demonstrated complete resolution after surgical release of both sites. Neither initial A1 release nor initial A0 release was statistically associated with complete, incomplete, or failed symptom resolution. CONCLUSIONS: These data implicate the A0 pulley as the primary cause of 31% to 47% of trigger fingers in our study. Although larger trials are needed to validate these results, our study suggests that release of both A0 and A1 pulleys may offer greater symptom resolution than release of the A1 pulley alone.