Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion:A case report and review of literature

BACKGROUND Thumb replantation following complete traumatic avulsion requires complex techniques to restore function,especially in cases of avulsion at the level of the metacarpophalangeal joint(MCP I)and avulsion of the flexor pollicis longus(FPL)at the musculotendinous junction.Possible treatments include direct tendon suture or tendon transfer,most commonly from the ring finger.To optimize function and avoid donor finger complications,we performed thumb replantation with flexion restoration using brachioradialis(BR)tendon transfer with palmaris longus(PL)tendon graft.CASE SUMMARY A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail.The patient presented with skin and bone avulsion at the MCP I,avulsion of the FPL tendon at the musculotendinous junction(zone 5),avulsion of the extensor pollicis longus tendon(zone T3),and avulsion of the thumb’s collateral arteries and nerves.The patient was treated with two stage thumb repair.The first intervention consisted of thumb replantation with MCP I arthrodesis,resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis.The second intervention consisted of PL tendon graft and BR tendon transfer.Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°,grip strength of 45 kg,key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.CONCLUSION Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Quantitative trait loci identification reveals zinc finger protein CONSTANS-LIKE 4 as the key candidate gene of stigma color in watermelon(Citrullus lanatus)

Stigma color is a critical agronomic trait in watermelon that plays an important role in pollination.However,there are few reports on the regulation of stigma color in watermelon.In this study,a genetic analysis of the F2 population derived from ZXG1553(P1,with orange stigma)and W1-17(P2,with yellow stigma)indicated that stigma color is a quantitative trait and the orange stigma is recessive compared with the yellow stigma.Bulk segregant analysis sequencing(BSA-seq)revealed a 3.75 Mb segment on chromosome 6 that is related to stigma color.Also,a major stable effective QTL Clqsc6.1(QTL stigma color)was detected in two years between cleaved amplified polymorphic sequencing(CAPS)markers Chr06_8338913 and Chr06_9344593 spanning a~1.01 Mb interval that harbors 51 annotated genes.Cla97C06G117020(annotated as zinc finger protein CONSTANS-LIKE 4)was identified as the best candidate gene for the stigma color trait through RNA-seq,quantitative real-time PCR(qRT-PCR),and gene structure alignment analysis among the natural watermelon panel.The expression level of Cla97C06G117020 in the orange stigma accession was lower than in the yellow stigma accessions with a significant difference.A nonsynonymous SNP site of the Cla97C06G117020 coding region that causes amino acid variation was related to the stigma color variation among nine watermelon accessions according to their re-sequencing data.Stigma color formation is often related to carotenoids,and we also found that the expression trend of ClCHYB(annotated asβ-carotene hydroxylase)in the carotenoid metabolic pathway was consistent with Cla97C06G117020,and it was expressed in low amounts in the orange stigma accession.These data indicated that Cla97C06G117020 and ClCHYB may interact to form the stigma color.This study provides a theoretical basis for gene fine mapping and mechanisms for the regulation of stigma color in watermelon.

Zinc finger protein 296 promotes hepatocellular carcinoma progression via intervening interaction between macrophages and B cells

Objective:Hepatocellular carcinoma(HCC)is a prevalent malignancy with poor survival.Different cell types in the tumor microenvironment participate in the tumorigenesis and progression of HCC.This study aimed to analyze the immune microenvironment of HCC and its relationship with clinical outcomes.Methods:We analyzed HCC RNA-seq for cell type identification and prognosis by estimating relative subsets of RNA transcripts using CIBERSORTx.The interaction between B cells and macrophages in HCC was analyzed using a Hepa1-6 orthotopic transplantation mouse model and flow cytometry.The effect of Zinc finger protein 296(ZNF296)on the interaction of B cells and macrophages was verified using human HCC tissues analyzed through western blot,quantitative real-time polymerase chain reaction(qPCR),and multiplex immunofluorescence.A comparative analysis of immune cells associated with HCC prognosis was performed using RNA-seq data from The Cancer Genome Atlas(TCGA),bulk multimodal data,and single-cell transcriptomic data from existing HCC single-cell transcriptomic data employing the Single Cell Inferred Site Specific Omics Resource for Tumor Microenvironments(SCISSOR).Results:Liver hepatocellular carcinoma(LIHC)RNA-seq analysis of TCGA showed that high eosinophil infiltration promoted HCC progression.The proportion of B cells correlated with that of macrophages(r=−0.24)and affected the infiltration and programmed death ligand 1(PD-L1)expression of macrophages in HCC.ZNF296 may participate in the interaction between B cells and macrophages to accelerate the HCC progression by regulating PAFAH1B3 and H2AFX.Moreover,ZNF296 expression positively correlated with LAG3(r=0.27)and CTLA4(r=0.31)expression levels.Among the immune cell phenotypes related to survival and death identified by SCISSOR analysis,T cells correlated with an excellent prognosis of HCC.The normal function of liver and dendritic cells was also associated with a good prognosis in HCC.Conclusions:This study analyzed the interaction of the immune microenvironment with HCC prognosis,identifying ZNF296 as a promising diagnostic and therapeutic target for HCC.

Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis

BACKGROUND Primary thumb carpometacarpal(CMC)osteoarthritis is one of the most common conditions encountered by hand surgeons.Of the vast number of operations that have been proposed,none have demonstrated results significantly superior to trapeziectomy alone.AIM The purpose of our study was to determine why surgeons opt for their technique in treating CMC arthritis.METHODS A cross-sectional survey of active members of the American Society for Surgery of the Hand was conducted to evaluate the reasons behind their preferred technique in the treatment of isolated thumb CMC arthritis.Surgeons were contacted by email once and provided with a link to a de-identified survey consisting of 5 treatment questions and 5 demographic questions.RESULTS Of 950 responses were received.40.5%of surgeons preferred trapeziectomy+ligament reconstruction tendon interposition(LRTI),followed by trapeziectomy+suspensionplasty(28.2%),suture button suspension(5.9%),trapeziectomy alone(4.6%),prosthetic arthroplasty(3.2%),arthrodesis(1.1%),and other(6.6%).Proponents of trapeziectomy+LRTI cited familiarity(73.2%),exposure during fellowship(48.8%)and less proximal migration(60%)to be the main reasons affecting their decision.Surgeons who preferred trapeziectomy+suspensionplasty most reported simplicity(74.9%),fewer complications(45.3%),less proximal migration(43.8%),and avoidance of autogenous tissue harvest(42.7%).Advocates of suture button suspension cited avoidance of autogenous tissue harvest(80.4%),shorter immobilization(76.8%),and quicker recovery(73.2%)with their technique.Advocates of trapeziectomy alone cited simplicity(97.7%),fewer complications(86.4%),and avoidance of autogenous tissue harvest(59.1%).In their comments,45%of surgeons choosing trapeziectomy alone cited evidence as an additional rationale.Advocates of prosthetic arthroplasty cited improved pinch strength(83.3%)and improved range of motion(63.3%),while those preferring arthrodesis cited better pinch strength(90%)and frequently in their comments,durability.Of the surgeons who preferred a technique other than LRTI,41.8%reported they had tried LRTI in the past,citing complexity of the procedure,flexor carpi radialis harvest,and longer operative time as reasons for moving on.CONCLUSION Our study provides an update on current treatment trends and offers new insight into the reasons behind surgeons'decision making in the management of thumb carpometacarpal osteoarthritis.Despite strong Level 1 evidence supporting the use of trapeziectomy alone,our findings demonstrate that most surgeons continue to supplement trapeziectomy with other techniques such as LRTI or suspensionplasty.Several factors including familiarity,personal experience(Level 4 evidence),and comfort may be more influential than Level 1 evidence in determining the techniques in a surgeon's armamentarium.Further prospective studies are needed to determine the optimal technique for surgical management of Eaton stages II-IV CMC arthritis and how these studies will affect surgeons’choice.

Analysis of the Effect of Intensive Nursing Care on Improving Sleep Quality During the Perioperative Period of Severed Finger Reimplantation

Objective:To investigate the clinical effect of perioperative intensive nursing on patients who underwent severed finger reimplantation and its influence on sleep quality.Methods:62 patients who underwent severed finger reimplantation between January 2023 and December 2023 were included.They were divided into two groups:the observation group(n=31)and the control group(n=31).The control group received basic nursing interventions,while the observation group received intensive nursing care.The comparison parameters included visual analog pain score(VAS),incidence of vascular crises,length of hospitalization,Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Score(HAM-D),Hamilton Anxiety Score(HAM-A),and patient satisfaction.Results:Postoperative VAS score,incidence of vascular crisis,hospitalization time,PSQI score,and HAM-A and HAM-D scores of the observation group were lower than those of the control group(P<0.05).Meanwhile,the patient satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Perioperative intensive nursing care for patients undergoing severed finger reimplantation demonstrates significant benefits.It reduces postoperative pain,lowers the incidence of vascular crises,shortens hospitalization durations,enhances sleep quality,alleviates negative emotions,and improves nursing satisfaction.These findings underscore the importance and applicability of such care practices.

The Combination of Moberg Flap with V-Y Advancement and Reverse Adipofascial Cross Finger Flap for Coverage of Degloving Injury of the Thumb-Case Report

We report a case of 22 years old male patient who is a worker in a factory and sustained degloving injury of his left thumb in a machine while working. There was loss of the pulp of the thumb extending circumferentially to the dorsal aspect with loss of the skin of the terminal phalanx and part of the proximal phalanx. The nail and germinal matrix were lost with exposure of the bone and extensor pollicis longus tendon insertion. The thumb was totally covered with a combination of two flaps: Moberg flap with V-Y advancement was used to cover most of the volar surface of the thumb and reverse adipofascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Three weeks later this flap was divided and the thumb was mobilized freely. The patient had a full range of movement of the thumb and index finger with few settings of physiotherapy postoperatively. We recommend combining both of these flaps to reconstruct degloving injury of the thumb as they provide near adjacent tissue of similar texture, preserve sensation at the volar aspect of the thumb and also avoid the complications of the distant flaps.

Thumb and Little Finger

A speaker was giving a speech on the difference between man and woman.Hesaid:“Man is like the thumb,and woman is like the little finger…”He stretched his left arm and opened his hand when he was interrupted(被打断)by some great noise,All the women in the hall became angry.

Diagnostic value of methylated branched chain amino acid transaminase 1/IKAROS family zinc finger 1 for colorectal cancer

BACKGROUND The diagnostic value of combined methylated branched chain amino acid transaminase 1(BCAT1)/IKAROS family zinc finger 1(IKZF1)in plasma for colorectal cancer(CRC)has been explored since 2015.Recently,several related studies have published their results and showed its diagnostic efficacy.AIM To analyze the diagnostic value of methylated BCAT1/IKZF1 in plasma for screening and postoperative follow-up of CRC.METHODS The candidate studies were identified by searching the PubMed,Embase,Cochrane Library,CNKI,and Wanfang databases from May 31,2003 to June 1,2023.Sensitivity,specificity,and diagnostic accuracy were calculated by merging ratios or means.RESULTS Twelve eligible studies were included in the analysis,involving 6561 participants.The sensitivity of methylated BCAT1/IKZF1 in plasma for CRC diagnosis was 60%[95%confidence interval(CI)53-67]and specificity was 92%(95%CI:90-94).The positive and negative likelihood ratios were 8.0(95%CI:5.8-11.0)and 0.43(95%CI:0.36-0.52),respectively.Diagnostic odds ratio was 19(95%CI:11-30)and area under the curve was 0.88(95%CI:0.85-0.91).The sensitivity and specificity for CRC screening were 64%(95%CI:59-69)and 92%(95%CI:91-93),respectively.The sensitivity and specificity for recurrence detection during follow-up were 54%CONCLUSION The detection of methylated BCAT1/IKZF1 in plasma,as a non-invasive detection method of circulating tumor DNA,has potential CRC diagnosis,but the clinical application prospect needs to be further explored.

介导植物干旱应答的RING finger类型泛素连接酶的研究进展

干旱是影响植物生长和农作物产量的重要环境因素。泛素连接酶E3是蛋白质泛素化修饰的关键酶之一,对于植物生长发育和干旱胁迫应答具有重要的调控作用。RING finger类型泛素连接酶是其成员最多的一种类型。本文主要概述了植物对干旱胁迫的响应机制及植物中的RING finger类型E3,并详细综述了RING finger类型E3介导植物干旱胁迫应答的研究进展,可以供大家参考。

Prevalence of Thumb Sucking Habits amongst Children at the Knust Basic School

Main Objective: To determine the prevalence of thumb sucking habits amongst children at the KNUST Basic School. Methodology: This study was quantitative and descriptive with the design being a cross-sectional type. The data was obtained from KNUST Basic School with a sample size of 200. Data was obtained through questionnaires and clinical examination. Results: Out of the 200 children studied, 19 (9.5%) were identified as thumb suckers, with a majority being females (13, 68.42%) and the rest being males (6, 31.58%). Most of the thumb suckers (47.37%) engaged in the habit due to hunger. The clinical manifestations observed among the thumb suckers included Class I malocclusion (94.7%), high arched palate (89.5%), anterior open bite (4), increased overjet (3, 15.8%), proclined maxillary incisors (4, 22.2%), linguoversion of mandibular incisors (1, 5.6%), unilateral posterior crossbite (2, 10.5%), speech changes (7, 41.2%), thinner thumb (7, 36.8%), elongated thumb (9, 47.4%), and callus formation on the thumb (2, 10.5%). Conclusion: Thumb sucking is a common oral habit which stimulates the growth of the orofacial complex from ages 0 to 3 years. The habit of thumb sucking is usually outgrown by age 3 but beyond this age, it turns out as a deleterious habit which has to be seen as such and measures put in place to stop thumb sucking.

Nutritional Composition and Anti-Nutrient Levels in Raw and Processed Varieties of Finger Millet Promoted for Nutritional Security

Finger millet (FM) is rich in nutrients such as minerals, vitamins, and amino acids. However, the levels of nutrients and their bioaccessibility depend on the variety, the levels of ant nutrients, the chemical form of nutrients, and the type of processing methods used. The study determined the levels of selected nutrients, anti-nutrients, and bioaccessibility in raw and processed varieties of finger millet being developed by the Kenya Agricultural and Livestock Research Organization (KALRO) in Kenya. Raw finger millet seeds from KALRO Centers in Kenya were processed by malting for 60 hours and roasting at 110°C for 5 minutes as the optimal conditions. Levels of minerals were determined by AAS and AES, anti-nutrients by UV-visible spectrophotometer, proteins by the Pierce kit method, and vitamins by HPLC. The IE4115 and IE3779 showed the highest levels of nutrients and lowest levels of antinutrients hence preferred for processing and bioaccessibility studies. The level (mg/100 g) of selected minerals;K, Cr3+, Mg, Ca, P, Fe, and Zn were found to be highest in the following varieties of the FM;IE3779 (688.519 ± 1.57), IE 4115 (1.29 ± 0.07), IE4115 (294.38 ± 1.93), IE3779 (466.67 ± 4.17), IE4115 (250.92 ± 0.33), KERICHO P (16.98 ± 0.05) and IE4115 (64.10 ± 2.35) respectively. For β-carotene, vitamin B, B2, B3, B6 and B9 the levels were highest in the following varieties of FM;KAKW3 (0.023 ± 0.02), IE4115 (14.85 ± 0.16), IE4115 (12.998 ± 0.04), IE4115 (5.843 ± 0.07), IE3779 (0.06 ± 0.04) and KAKW4 (9.832 ± 0.08). Phytates, tannins, phenols, and oxalates were found to be lowest in the following varieties: IE3779 (14.20 ± 2.90, IE4115 (27.83 ± 0.73), NKFM1 (9.69 ± 0.07) and IE4115 (0.25 ± 0.01). The highest bioaccessibility values reported for K, Mg, Ca, P, Cr3+, Fe, and Zn were 89.53% (malting, IE3779), 49.28% (malting, IE4115), 60.41% (Malting, IE4115), 69.40% (malting, IE4115), 12.9% (malting, IE4115), 59.84% (malting, KAKW3) and 66.89% (roasting, IE3779) respectively (Table 8). For beta carotene, vitamin B1, B2, B3, B6 and B9 the values were 73.33% (malting, p224), 78.84% (malting, IE4115), 78.34 (malting, IE3779), 97.63% (malting, IE4115), 91.64% (malting, IE4115), and 77.52% (roasting, IE4115) (table The result on levels and bioaccessibility showed that IE4115 and IE3779 varieties were more nutritious and therefore should be promoted for nutritional security.

Description of the Factors Associated with Trigger Finger in Patients Treated at Petroleos Mexicanos “Pemex”

Background: The trigger finger, also known as stenosing tenosynovitis of the flexor tendon, is a common cause of hand disability;This can result in significant limitations in certain daily living activities. It is possible to treat this condition with conservative or surgical methods. Methods: This is a retrospective, observational, cross-sectional and descriptive study. The source population consisted of all patients with a diagnosis of trigger finger who had been treated in the department of plastic and reconstructive surgery of our institution between 2020 and 2023. The primary objective of this study is to determine the prevalence and characterize the clinical and surgical characteristics of the population affected by trigger finger in our hospital. Results: The total population was 237 patients, of which 165 were women (70%) and 72 men (30%). The most affected hand was the right hand, with a total of 158 patients (67%). In the right hand, the middle finger was the most affected (45%). Of the 237 patients, 80 of them had obesity (34%), 86 had type 2 diabetes mellitus (36%), 95 had systemic arterial hypertension (40%). Open technique was performed in 190 (80%) patients, while percutaneous technique was performed in 47 (20%) of them. Conclusion: The female sex was twice as frequent, and the middle finger and thumb were the most affected. Most of the patients received surgical treatment with open approach and percutaneous approach in 20% of them.

Investigation of Experimental Devices for Finger Active and Passive Tactile Friction Analysis

Complicated tribological behavior occurs when human fingers touch and perceive the surfaces of objects.In this process,people use their exploration style with different conditions,such as contact load,sliding speed,sliding direction,and angle of orientation between fingers and object surface consciously or unconsciously.This work addressed interlaboratory experimental devices for finger active and passive tactile friction analysis,showing two types of finger movement.In active sliding experiment,the participant slid their finger freely against the object surface,requiring the subject to control the motion conditions themselves.For passive sliding experiments,these motion conditions were adjusted by the device.Several analysis parameters,such as contact force,vibration acceleration signals,vibration magnitude,and fingerprint deformation were recorded simultaneously.Noticeable friction differences were observed when comparing active sliding and passive sliding.For passive sliding,stick-slip behavior occurred when sliding in the distal direction,evidenced by observing the friction force and the related deformation of the fingerprint ridges.The employed devices showed good repeatability and high reliability,which enriched the design of the experimental platform and provided guidance to the standardization research in the field of tactile friction.

Considerations for gluten free foods-pearl and finger millet processing and market demand

The market demand for gluten free foods is increasing due to frequent incidences of celiac disease and increasing awareness on consumption of gluten free foods.Millets have become the major constituent of diet as they are gluten-free and also excellent sources of micro and macro nutrients such as vitamins,minerals,dietary fibers and phenolic compounds.Among various millets,the finger millet and the pearl millet are the two most important and common millet varieties grown extensively.Since,they are regarded as the staple foods of the poor and vulnerable populations,development of new products and improvements in their nutritional quality will aid in the general health of these population.Processing of millets and production of variable gluten-free ready-to-eat and nutritional supplements has increased their market value in the recent years.Furthermore,processing can also help in shelf-life extension of the millets with nutritional enrichment,expanding its markets to non-traditional millet consumers.In this context,the present review is aimed to focus on the current processing methods to develop products from the two millet varieties that are gluten free and outline their nutritional benefits.

Biometric Finger Vein Recognition Using Evolutionary Algorithm with Deep Learning

In recent years,the demand for biometric-based human recog-nition methods has drastically increased to meet the privacy and security requirements.Palm prints,palm veins,finger veins,fingerprints,hand veins and other anatomic and behavioral features are utilized in the development of different biometric recognition techniques.Amongst the available biometric recognition techniques,Finger Vein Recognition(FVR)is a general technique that analyzes the patterns of finger veins to authenticate the individuals.Deep Learning(DL)-based techniques have gained immense attention in the recent years,since it accomplishes excellent outcomes in various challenging domains such as computer vision,speech detection and Natural Language Processing(NLP).This technique is a natural fit to overcome the ever-increasing biomet-ric detection problems and cell phone authentication issues in airport security techniques.The current study presents an Automated Biometric Finger Vein Recognition using Evolutionary Algorithm with Deep Learning(ABFVR-EADL)model.The presented ABFVR-EADL model aims to accomplish bio-metric recognition using the patterns of the finger veins.Initially,the presented ABFVR-EADL model employs the histogram equalization technique to pre-process the input images.For feature extraction,the Salp Swarm Algorithm(SSA)with Densely-connected Networks(DenseNet-201)model is exploited,showing the proposed method’s novelty.Finally,the Deep-Stacked Denoising Autoencoder(DSAE)is utilized for biometric recognition.The proposed ABFVR-EADL method was experimentally validated using the benchmark databases,and the outcomes confirmed the productive performance of the proposed ABFVR-EADL model over other DL models.

Finger compartment syndrome due to a high-pressure washer injury:A case report

BACKGROUND Although the finger compartment syndrome is not common,it compresses the neurovascular bundles in a limited space and blocks blood flow to the fingers,causing necrosis of the fingertips.Finger fasciotomy through unilateral or bilateral midline release of the finger can achieve decompression of the finger compartment.Herein,we report a case of the compartment syndrome in a finger injury caused by a high-pressure water flow which is commonly used in car washing stations.CASE SUMMARY A 60-year-old man injured his right middle finger while using a high-pressure washer at a car washing station.The patient complained of severe pain in his middle finger and a 0.2 cm punctured open wound on the volar side of the distal phalangeal joint of the middle finger.The fingertip was pale,numb,and characterized by severe swelling and a limited range of motion.Finger radiography showed that there was no fracture in the finger.Digital decompression was performed through finger fasciotomy by bilateral midline incision.On the second day after surgery,the color of the fingertip returned to pink,swelling was resolved,and the range of motion returned to normal.The sensation of the fingertip was completely restored,and the capillary refill test and pinprick test were positive.CONCLUSION The fingertip compartment syndrome can be caused by a high-pressure water flow damage to the fingers when using high-pressure washers at a car washing station.To avoid finger necrosis,rapid diagnosis of the finger compartment syndrome and appropriate digital decompression are essential to better outcome.

Clinical Observation of Self-made Four-step Tendon Regulating Manipulation in the Treatment of 30 Cases of Thumb Stenotic Tenosynovitis

[Objectives] To observe the effectiveness of four-step tendon manipulation in the treatment of thumb stenotic tenosynovitis, under the guidance of "tendon first" theory. [Methods] 30 patients with stenotic tenosynovitis of thumb were treated with four-step tendon manipulation and traditional manipulation respectively, 3 times a week, a total of two weeks. The clinical efficacy, changes of visual analogue scale (VAS) and the recurrence rate after 15 d of follow-up treatment were observed before and after treatment. The differences were statistically significant ( P <0.05). [Results] After treatment, the VAS and the recurrence rate after 15 d of treatment in the observation group were significantly lower than those in the control group ( P <0.05). After treatment, the total effective rate was 73.33% in the control group and 93.33% in the observation group ( P <0.05). [Conclusions] The effect of four-step tendon regulating manipulation in the treatment of thumb stenotic tenosynovitis is ideal. The effect is significantly better than that of traditional Chinese medicine in improving thumb pain and function, which is worthy of clinical promotion.

Multi-Segmental Osteocutaneous Free Fibula Flap for Three-Dimensional Post-Traumatic Thumb and Wrist Reconstruction

Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.

Prognostic role of ring finger and WD repeat domain 3 and immune cell infiltration in hepatocellular carcinoma

We have found that the expression of ring finger and WD repeat domain 3(RFWD3)is significantly higher in unpaired and paired hepatocellular carcinoma(HCC)tissues than in normal tissues.Moreover,this expression has a significant correlation with the infiltration level of 14 immune cell types and when the detected RFWD3 expression levels were grouped as high and low,a prominent difference was revealed for overall survival,disease-specific survival,and progression-free interval.Through statistical analysis(univariate Cox),we were also able to identify RFWD3 as an independent prognostic element for HCC,with RFWD3 having an ability to accurately predict HCC prognosis(area under the curve of 0.863).Finally,we have generated prognostic nomograms for probabilities of 1-,3-and 5-year overall survival in HCC via integrating the factors of age,pathologic stage,alpha-fetoprotein level,and RFWD3 expression.

Triggering,clicking,locking and crepitus of the finger:A comprehensive overview

Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.