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.

Intravascular papillary endothelial hyperplasia (masson tumor) of the right wrist: A case report and literature review.

Intravascular papillary endothelial hyperplasia (IPEH), also called masson tumor which is a benign vascular tumor named after Pierre Masson, the French pathologist who originally described it in 1923, terming it "hémangioendothéliome végétant intravasculaire." It is characterized by a reactive proliferation of endothelial cells associated with thrombosis. Ultrasound and MRI are the main imaging examinations, but the diagnosis of IPEH was confirmed by biopsy pathology and immunohistochemistry. It is generally accepted that surgical excision is the first choice of treatment. In this report, we report a case of Masson tumor arising in the right wrist.

Acute Compression of the Anterior Interosseous Nerve After a Proximal Both-Bone Forearm Fracture: A Case Report.

Anterior interosseous nerve (AIN) syndrome is a rare condition characterized by isolated weakness in the flexor pollicis longus (FPL) muscle, sometimes accompanied by weakness in the index flexor digitorum profundus (FDP) muscle. In this clinical case report, an 18-year-old male presented with a right proximal both-bone forearm fracture that was sustained while playing soccer, with subsequent development of AIN palsy, without sensory deficits or progressive pain. Preoperative imaging was performed, showing a proximal third radius and mid-shaft ulna fracture. Given the progressive presentation of an acute AIN palsy, the patient was indicated for urgent operative intervention. During exploration and decompression of the AIN within the pronator tunnel, the nerve was found to be in continuity but was compressed by a large hematoma and the distal radial shaft. The patient recovered full median nerve function by his six-week postoperative examination and by his final follow-up recovered full range of motion with painless return to full activities. In proximal or mid-shaft both-bone forearm fractures, a careful neurovascular exam is essential, as uncommon conditions like anterior interosseous syndrome (AIS) can present without obvious sensory deficits or pain. Potential etiology for traumatic AIN compression includes significant fracture displacement, soft tissue injury, active extravasation on advanced imaging, and/or clinical concern for compressive hematoma. Patients presenting with FPL and/or index FDP weakness in the absence of sensory deficits or pain on passive stretch may benefit from dedicated surgical exploration and decompression of the AIN to prevent irreversible nerve damage.

Theoretical proposal for restoration of hand motor function based on plasticity of motor-cortical interhemispheric interaction and its developmental rule.

After stroke, the poorer recovery of motor function of upper extremities compared to other body parts is a longstanding problem. Based on our recent functional MRI evidence on healthy volunteers, this perspective paper proposes systematic hand motor rehabilitation utilizing the plasticity of interhemispheric interaction between motor cortices and following its developmental rule. We first discuss the effectiveness of proprioceptive intervention on the paralyzed (immobile) hand synchronized with voluntary movement of the intact hand to induce muscle activity in the paretic hand. In healthy participants, we show that this bilateral proprioceptive-motor coupling intervention activates the bilateral motor cortices (= bilaterally active mode), facilitates interhemispheric motor-cortical functional connectivity, and augments muscle activity of the passively-moved hand. Next, we propose training both hands to perform different movements, which would be effective for stroke patients who becomes able to manage to move the paretic hand. This bilaterally different movement training may guide the motor cortices into left-right independent mode to improve interhemispheric inhibition and hand dexterity, because we have shown in healthy older adults that this training reactivates motor-cortical interhemispheric inhibition (= left-right independent mode) declined with age, and can improve hand dexterity. Transition of both motor cortices from the bilaterally active mode to the left-right independent mode is a developmental rule of hand motor function and a common feature of motor function recovery after stroke. Hence, incorporating the brain's inherent capacity for spontaneous recovery and adhering to developmental principles may be crucial considerations in designing effective rehabilitation strategies.

Assessing the Metabolic and Physical Effects of Combined DPP4 and SGLT2 Inhibitor Therapy in Patients with Type-2 Diabetes Mellitus: An Observational Prospective Pilot Study.

Introduction: This study aimed to assess the efficacy of combined administration of dipeptidyl peptide-4 (DPP4) and sodium-glucose cotransporter-2 (SGLT2) inhibitors on metabolic disorders and their preferable and complementary effects. Methods: The effectiveness of a 24-week intervention on metabolic parameters (including glucose profile), physical functions (grip strength and calf circumference), and health-related quality of life (HR-QOL) was analyzed using the International Physical Activity Questionnaire and Geriatric Depression Scale 5. A total of 39 patients with type-2 diabetes mellitus (T2DM) treated with the combination of DPP4 and SGLT2 inhibitors were included in this multicenter pilot study. Results: Combination therapy significantly reduced the HbA1c level (median [interquartile range]) after 24 weeks (pretreatment: 7.7% [7.3-8.2] vs. posttreatment: 7.1% [6.6-7.9], P < 0.001). The grip strength significantly increased after 24 weeks (1.7 ± 2.7 kg, P < 0.001), while the mean calf circumference and body mass index significantly decreased. In particular, administration of the SGLT2 inhibitor significantly increased total physical activity in participants aged ≥65 years (P = 0.003), while psychological QOL did not significantly improve. Conclusions: Combination therapy with DPP4 and SGLT2 inhibitors decreased HbA1c levels and improved physical function in patients with T2DM. This study confirmed the effectiveness of combination therapy for metabolic disorders and suggested its beneficial and complementary effects. Therefore, advances in treatment plans to achieve further improvements in glucose profiles using DPP4 and SGLT2 inhibitors are recommended to enhance the QOL of patients with T2DM. Clinical trial number: University Hospital Medical Information Network Center: UMIN000045375.

Construction of effective reproduction number of infectious disease individuals based on spatiotemporal discriminant search model: take hand-foot-mouth disease as an example.

OBJECTIVE: In order to facilitate the tracing of infectious diseases in a small area and to effectively carry out disease control and epidemiological investigations, this research proposes a novel spatiotemporal model to estimate effective reproduction number(Re)for infectious diseases, based on the fundamental concept of contact tracing. METHODS: This study utilizes the incidence of hand, foot, and mouth disease (HFMD) among children in Bishan District, Chongqing, China from 2015 to 2019. The study incorporates the epidemiological characteristics of HFMD and aims to construct a Spatiotemporal Correlation Discrimination of HFMD. Utilizing ARC ENGINE and C# programming for the creation of a spatio-temporal database dedicated to HFMD to facilitate data collection and analysis. The scientific validity of the proposed method was verified by comparing the effective reproduction number obtained by the traditional SEIR model. RESULTS: We have ascertained the optimal search radius for the spatiotemporal search model to be 1.5 km. Upon analyzing the resulting Re values, which range from 1.14 to 4.75, we observe a skewed distribution pattern from 2015 to 2019. The median and quartile Re value recorded is 2.42 (1.98, 2.72). Except for 2018, the similarity coefficient r of the years 2015, 2016, 2017, and 2019 were all close to 1, and p <0.05 in the comparison of the two models, indicating that the Re values obtained by using the search model and the traditional SEIR model are correlated and closely related. The results exhibited similarity between the Re curves of both models and the epidemiological characteristics of HFMD. Finally, we illustrated the regional distribution of Re values obtained by the search model at various time intervals on Geographic Information System (GIS) maps which highlighted variations in the incidence of diseases across different communities, neighborhoods, and even smaller areas. CONCLUSION: The model comprehensively considers both temporal variation and spatial heterogeneity in disease transmission and accounts for each individual's distinct time of onset and spatial location. This proposed method differs significantly from existing mathematical models used for estimating Re in that it is founded on reasonable scientific assumptions and computer algorithms programming that take into account real-world spatiotemporal factors. It is particularly well-suited for estimating the Re of infectious diseases in relatively stable mobile populations within small geographical areas.

Segmentary exclusion syndrome in hand traumatology - definition, rehabilitation and orthosis.

BACKGROUND: Segmentary exclusion syndrome is a motor behavior consisting in non-use or underuse of a limb or limb segment following local inflammation, most often of traumatic origin, primarily affecting the fingers and hand. It can be associated with somatosensory disorder, limitation of range of motion, and pain. PURPOSE OF THE STUDY: The objective of this article is to further describe segmentary exclusion syndrome, and to present practical rehabilitation techniques and strategies focused on prevention, assessment and treatment.

Graft Choice for Managing Scaphoid Non-union: Umbrella Review.

INTRODUCTION: Since the introduction of the non-vascularized bone graft by Matti and Russe, followed by vascularized grafts and more recently by free vascularized bone grafts, the choice of technique in scaphoid non-union has been controversial. The purpose of the present study was to address the following questions in an umbrella review: Do union rates differ between techniques? Are there any indications for superiority of one technique over another? METHODS: An umbrella review conducted during September 2023 month included systematic reviews and meta-analyses. The primary criterion was mean union rate according to technique. The secondary criterion was indication according to type of non-union. The PubMed, Cochrane, and MEDLINE databases were searched using a predefined methodology according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA version 2020). The quality of the systematic reviews included was evaluated by the "Assessing the Methodological Quality of Systematic Reviews" instrument (AMSTAR 2). RESULTS: Nine studies (systematic reviews or meta-analyses) were included. Quality ranged between low and high. A Table was constructed to summarize the qualitative findings of each article. There was no significant difference in union rates between vascularized and non-vascularized bone grafts in 8 of the 9 studies: vascularized bone graft, 84-92%; non-vascularized bone graft, 80-88%. One study found higher union rates with vascularized bone graft (RR 1.1; 95% CI 1.0-1.2; P = 0.02), but no significant difference in functional results. However, vascularized bone graft was more effective in case of avascular necrosis of the proximal pole (74-88% union for vascularized bone graft vs. 47 - 62 % for non-vascularized bone graft) and in revision cases, while non-vascularized bone graft showed fewer failures in case of humpback deformity and/or dorsal intercalated segment instability (IRR 0.7 ± 0.09; P = 0.01). CONCLUSIONS: This umbrella review provides an overview for management of scaphoid non-union. There were no significant global differences between techniques. Thus, various factors need to be considered when selecting the appropriate technique.

Effectiveness of Sensing Gloves-Applied Virtual Reality Education System on Hand Hygiene Practice: A Randomised Controlled Trial.

INTRODUCTION: We developed a virtual reality (VR) education system and evaluated its clinical utility for promoting hand hygiene practices. METHODS: This prospective, two-week, randomised controlled study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024, involved 22 participants (18 medical students and four residents). A fully immersive 360° VR system (VIVE Pro Eye) using a head-mounted display and sensing gloves was used to develop three healthcare tasks in a virtual patient room-Environmental Cleaning, Gauze Exchange, and Urine Collection. After monitoring all participants' baseline usage data of portable hand-rubbing alcohol in the first week, we randomly assigned them into 1:1 groups (VR training and video lecture groups). The primary outcome was differences in hand-rubbed alcohol use before and after intervention. RESULTS: Before the intervention, alcohol use did not significantly differ between both groups. After the intervention, a significant increase in alcohol use was observed in the VR training group (median: 8.2 g vs. 16.2 g; p=0.019) but not in the video lecture group. CONCLUSION: Our immersive 360° VR education system enhanced hand hygiene practices. Infection prevention and control practitioners and digital technology experts must collaborate to advance the development of superior educational devices and content.

The implications of healthcare professionals wearing jewelry on patient care biosafety: observational insights and experimental approaches.

The use of jewelry among healthcare professionals poses a risk of cross contamination due to potential bacterial accumulation and spread. Through a mixed-method design, this study first analyzed the implications of healthcare professionals wearing jewelry on patient care biosafety as well as on the residual bacterial load of hands and rings after hand hygiene. Firstly, an observational prevalence study to verify whether nursing professionals wear personal accessories during healthcare assistance was carried out. Second, an experimental design involving intentional contamination and hygiene of the hands, with and without a ring, was conducted. The bacterial load of both hands and rings was measured by counting colony forming units. The observational study showed that nursing workers frequently wear jewelry during healthcare assistance. Nonetheless, the experimental study did not indicate differences in bacterial contamination between hands with and without a ring, despite the hand hygiene procedure applied. In conclusion, many nursing workers wear jewelry in the workplace. Although hands with and without a ring exhibited similar microbial load, rings appeared as a potential source of bacterial contamination, reinforcing the need to remove jewelry during working hours. Hand hygiene using alcohol, or soap and water significantly decreased the bacterial load on the participants' hands, with handwashing proving to be the most efficient method for removing intentional contamination.

Comparative morphometric analyses of the 2:4 finger ratio and nasal structure in young adults.

The 2:4 finger ratio (2D:4D ratio) refers to the length ratio of the second to the fourth finger of the hand. Studies on the 2D:4D ratio have long established that this ratio tends to be lower in males than in females. Our study aims to investigate the correlation between the 2.4 finger ratio and nasal structure among young adults aged 18-25 through detailed morphometric analysis. The study was conducted on 205 students (Female:127, Male:78) aged between 18 and 25 years studying at Ankara Yildirim Beyazit University Faculty of Medicine. Morphometric measurements of the hand and nose were also measured and recorded by the same researcher. The volunteers were divided into eight groups for age and four groups for BMI. Statistical analysis was performed and p < 0.05 was considered significant. The evaluation revealed significant differences between sexes and the 2D:4D ratio. While no significant relationship was found between age and the 2D:4D ratio, correlations were present with some nasal parameters. A significant relationship was found between the BMI and the right hand 2D:4D ratio (p < 0.05). A positive correlation was observed between the BMI and certain nasal parameters. Furthermore, significant relationships were identified between the 2D:4D ratio and certain nasal parameters (p < 0.05). The data obtained from our study will contribute to the understanding of nasal development, sex determination in forensic medicine, and the diagnosis and treatment of pathologies related to the nose. Additionally, it will assist clinicians involved in planning any nasal operations in describing anatomical points related to this region.

Course of the extensor pollicis longus tendon considering the different functional positions of the wrist and the first ray-an anatomical study.

BACKGROUND: The aim of this anatomical study was to evaluate the course of the extensor pollicis longus (EPL) tendon, its positional relationship to adjacent structures, and the resulting clinical relevance under consideration of various functional positions. MATERIALS AND METHODS: Twenty upper extremities from ten adult human cadavers embalmed using Thiel's method were included in this study. The greatest possible movement/slippage of the EPL tendon, the angle at which the tendon wraps around Lister's tubercle, and its course across the extensor carpi radialis longus and brevis (ECRL and ECRB) were recorded and defined in all functional positions. RESULTS: Our findings demonstrate a high range of motion of the tendon in relation to clinically relevant structures. CONCLUSION: Understanding the anatomical course of the EPL tendon, its potential extent of movement, and its resulting positional changes is essential for the diagnosis and surgical treatment of patients with complaints or injuries in the dorsoradial wrist region.

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.

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.