4th Digit Research Articles

Photocopies Yield Lower Digit Ratios (2D:4D) Than Direct Finger Measurements

The ratio between 2nd and 4th digit length (2D:4D) may be a negative correlate of prenatal testosterone. This possibility has led to a number of studies of 2D:4D and its relationship with sexual orientation and other sex-dependent traits. At first, 2D:4D ratio was calculated from measurements made directly on the fingers but recently a number of studies have used measurements from photocopies of the hands. Here, we compared finger lengths (2D, 3D, 4D, and 5D) and ratios obtained from these two measurement techniques. Our sample consisted of 30 homosexual men and 50 men and 70 women who were not selected for their sexual orientation. We found evidence that (1)2D:4D from photocopies tended to be lower than that from direct measurements, (2) there were differences in finger lengths such that 2D from photocopies tended to be shorter or equal in length to direct measurements, while 4D from photocopies tended to be longer or equal in length to direct measurements, (3) the sex differences in 2D:4D tended to be stronger for photocopy measurements, and (4) the pattern for length differences across 2D to 5D appeared to be different for homosexual men compared to men and women recruited without regard to sexual orientation. We conclude that there are differences in digit ratios obtained from photocopies and direct measurements, and these differences arise from length differences recorded from the different protocols. Therefore, 2D:4D ratios obtained from photocopies and direct measurements should not be combined within one study nor should they be used together in comparative studies. We suggest that finger length differences between the two techniques could result from the shapes of fat-pads at the tips of the fingers and these may be dependent on sex and sexual orientation.

Hand Numbness in a Soccer Player

HISTORY This is a 20 year-old male college soccer defenseman who developed hand numbness and weakness after an elbow injury during a soccer game. During the first half of the game he was kicked in the medial aspect of the left elbow and then fell to the ground. He does not remember the exact mechanism of injury. He initially felt numbness throughout the left 4th and 5th digits and was removed from play. He went back in for the second half and completed the game. He presented to the sports medicine clinic three days later at which time the numbness in the 4th and 5th digits remained unchanged. He denied numbness in the forearm as well as neurogenic pain. In addition he complained of weakness in the left 4th and fifth digits. Most notably he was not able to move his left 5th digit normally. He had been taking ibuprofen intermittently. PHYSICAL EXAMINATION Upon presentation in the sports medicine clinic three days later he had a mild to moderate deformity of the 4th and 5th digits of the left hand which included extension at the MCP joints and flexion of the PIP joints. There was no tenderness to palpation. There was decreased sensation to light touch and hyperesthesia to pinprick in the following distribution: dorsal and ventral aspect of the 4th and 5th digits, dorsal and ventral aspects of the medial palm and dorsal aspect of the forearm. Manual motor testing showed 4/5 strength with abduction of the 5th digit and 4th and 5th digit DIP flexion. Froments sign was positive. DIFFERENTIAL DIAGNOSIS Ulnar neuropathy Median neuropathy Brachial plexopathy Cervical radiculopathy TESTS AND RESULTS None FINAL WORKING DIAGNOSIS Traumatic ulnar neuropathy TREATMENT AND OUTCOMES The preservation of motor strength and hyperesthesia to pinprick were felt to be indicators of an incomplete injury and a likely good prognosis. Treatment included Vioxx 50mg PO QD to reduce swelling in the area of the ulnar groove along with splinting of the involved digits to reduce clawing in the 4th and 5th digits. With this treatment numbness and weakness resolved within two weeks and the claw deformity resolved by 3 weeks.

The Devil’s in the Details

You have accessThe ASHA LeaderBottom Line1 Feb 2005The Devil’s in the DetailsDiagnosis Coding in the Age of HIPAA Maureen Thompson Maureen Thompson Google Scholar More articles by this author https://doi.org/10.1044/leader.BML.10022005.3 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In This column clarifies current coding requirements for the reporting of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes as required by the Health Insurance Portability and Accountability Act (HIPAA). How does HIPAA relate to diagnostic coding? As required by HIPAA, the U.S. Secretary of Health and Human Services (HHS) published a rule designating ICD-9-CM and its Official ICD-9-CM Guidelines for Coding and Reporting as the approved code set for use in reporting diagnoses. This final rule requires the use of ICD-9-CM and its official coding and reporting guidelines by health plans (including Medicare). Why are reimbursement claims being denied due to HIPAA? Payers require providers to use ICD-9-CM diagnosis codes with the highest degree of accuracy and completeness or the “greatest degree of specificity” as is required by HIPAA. Therefore, a code is invalid-and may result in a denial-if it has not been coded to the full number of digits required for that particular code. What does “greatest degree of specificity” mean? It can mean providing an ICD-9-CM code carried to the 3rd, 4th, or 5th digit. According to Official ICD-9-CM Guidelines for Coding and Reporting, “Diagnosis and procedure codes are to be used at their highest number of digits available.” Specifically, use a three-digit code only if there are no four- or five-digit codes within that code category. Use a four-digit code only if there are no five-digit codes for that category. Use a five-digit code when they exist in a code category For example, if a provider submits a claim with the diagnosis 389.0 (conductive hearing loss), this claim may be rejected because the code category has 5th digit subclassifications. The most appropriate subclassification should be selected, which might be 389.01 (conductive hearing loss, external), 389.02 (conductive hearing loss, tympanic), or 389.03 (conductive hearing loss, middle ear). What happens if fourth or fifth digits are not available for a diagnostic code? When a fourth or fifth digit is not available, do not add fourth or fifth digits to valid three-digit codes (e.g., do not simply add zeroes to valid three-digit codes). The ICD-9-Coding Manual indicates when a fourth or fifth digit is required and offers fifth-digit subclassifications for use with certain categories of codes. For example, if a provider submits a claim with a diagnosis of 299.0 (autistic disorder), which requires a fifth digit, they are instructed to add “0” for current or active state or “1 ” for residual state. May I still use NOS (not otherwise specified) codes? Diagnostic codes that are marked NOS or “unspecified” indicate that there is insufficient information on the medical record to assign a more specific code. Use an NOS code only when you lack the information necessary to code to a more specific subcategory. What if the payer requires fifth-digit coding and there is none? Provide the payer with a copy of the Official ICD-9-CM Guidelines for Coding and Reporting [PDF]. The guidelines explicitly state, “Diagnosis and procedure codes are to be used at their highest number of digits available.” Author Notes Maureen Thompson, is ASHA’s director of private health plans advocacy. Contact her at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 10Issue 2February 2005 Get Permissions Add to your Mendeley library History Published in print: Feb 1, 2005 Metrics Current downloads: 117 Topicsasha-topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2005 American Speech-Language-Hearing AssociationLoading ...

Relationship of inspiratory flow rate and volume on digit tip skin and ulnar artery vasoconstrictor responses in healthy adults

Reflex vasoconstrictive responses are commonly used to assess sympathetic nerve function of the extremities. A regularly used reflex trigger is deep and rapid inspiration. However, little is known about the relationship between respiratory effort and the magnitude of the resultant vasoconstrictor response. This study investigates the association of inspiratory flow rate and volume to the level of vasoconstrictor reflexes in the 4th digit tip skin and the ulnar artery in 12 healthy volunteers (age range 21–65, mean 38.1 years). The effects of Peak Inspiratory Flow (PIF) and Forced Inspiratory Vital Capacity (FIVC) on blood flow were measured at three levels of respiratory effort: low (PIF < 1.0 l/min; FIVC < 1.0 l), medium (PIF = 1.0–1.5 l/min; FIVC = 1.0–1.5 l), and high (PIF > 1.5 l/min; FIVC > 1.5 l) at two separate occasions. Ulnar vasoconstrictor responses showed good correlation with all levels of respiratory effort. Skin digit tip responses showed good correlation at medium and high levels but not at low respiratory effort. Repeatability of both tests was good. Correlation of inspiratory flow rate to vasoconstriction was consistently better than with inspiratory volume. Both digit tip and ulnar vasoconstrictor responses were maximal with greatest respiratory effort.

Prenatal diagnosis of trisomy 6 mosaicism

We report on a fetus with multiple congenital anomalies detected at the prenatal ultrasound examination and a trisomy 6 mosaicism in the amniocytes. The pregnancy was interrupted in the 18th gestational week and the autopsy revealed malformations including cleft right hand, arthrogryposis and hypoplasia of the 4th digit of the left hand, syndactylies and overlapping toes, facial dysmorphism with hypertelorism and low-set ears, ventricular septum defect (VSD), intestinal malrotation and scoliosis. Trisomy 6 mosaicism was detected in cultured amniocytes (13.3%), confirmed in umbilical cord fibroblasts (40%) and by fluorescence in situ hybridization on other fetal tissues. Trisomy 6 mosaicism is a very rare finding with only eight cases previously reported to our best knowledge.

Sex and ethnic differences in 2nd to 4th digit ratio of children

Background The ratio between the length of the 2nd or index finger and the 4th or ring finger (2D:4D) differs between the sexes, such that males have lower 2D:4D than females, and shows considerable ethnic differences, with low values found in Black populations. It has been suggested that the sex difference in 2D:4D arises early in development and that finger ratio is a correlate of prenatal testosterone and oestrogen. In children, 2D:4D has been reported to be associated with measures of fetal growth, congenital adrenal hyperplasia, developmental psychopathology, autism and Asperger's syndrome. However, little is known of the patterns of sex and ethnic differences in the 2D:4D ratio of children. Aim To investigate sex and ethnic differences in 2D:4D in Caucasian, Oriental and Black children. Study design Population survey. Method The 2D:4D ratio was measured from photocopies of the right hand of Berber children from Morocco, Uygur and Han children from the North-West province of China, and children from Jamaica. Results There were 798 children in the total sample (90 Berbers, 438 Uygurs, 118 Han, and 152 Jamaicans). The 2D:4D ratio was lower in males than in females and this was significant for the overall sample and for the Uygur, Han and Jamaican samples. There were significant ethnic differences in 2D:4D. The Oriental Han had the highest mean 2D:4D, followed by the Caucasian Berbers and Uygurs, with the lowest mean ratios found in the Afro-Caribbean Jamaicans. The sex and ethnic differences were independent of one another with no significant interaction effect. In the overall sample there were no associations between 2D:4D and age and height. Conclusions In common with adults, the 2D:4D ratio of children shows sex and ethnic differences with low values found in a Black group. There was no overall association between 2D:4D and age and height suggesting that the sex and ethnic differences in 2D:4D appear early and do not show appreciable change with growth.

Dietary Retinoic Acid Induces Hindlimb and Eye Deformities inXenopus laevis

This study investigated the effects of dietary retinoic acid (RA) on frog hindlimb development. Xenopus laevis (African clawed frog) tadpoles were fed a diet supplemented with 0, 1, 10, or 100 microg of RA/g of food for 2 or 5 d at different stages of metamorphosis. Hindlimb deformities were induced in the group fed 100 microg of RA/g of diet for 5 d. Exposures beginning at mid-hindlimb bud development induced bilaterally bent tibiafibula (bony triangles), while exposures later in hindlimb development induced deformities of the feet, including fusion of the 1st and 2nd clawed digits and reduced length of the 4th and 5th digits (due to reduced, missing, or misplaced phalanges). There were also cases of extra phalanges in the 5th digit. The eye was another target of RA exposure. In one experiment, 58% of the tadpoles fed 10 microg of RA/g had a smaller or absent right eye. Additionally, 11% of the tadpoles fed 100 microg of RA/g of diet developed a smaller or absent left eye. Waterborne heavy metals (Zn or Cu) modified RA effects on the hindlimb and eye. Co-exposure to metals and RA resulted in cases of unilateral bony triangles and reduced rates of smaller eyes. There were also cases of extra hindlimb digits in Zn-exposed animals. Dietary RA exposure in tadpoles can cause some deformities that differ from waterborne RA exposures in previous studies. RA also induced deformities that resemble those in affected wild frog populations (bony triangles), although the patterns of other deformities and missing segments (phalanges and metatarsals) are not similar to those documented in the wild.

Interdigital psoriasis (psoriasis alba): Renewed attention for a neglected disorder

Interdigital psoriasis (psoriasis alba): Renewed attention for a neglected disorder

Wrist anomalies in Turner syndrome compared with Leri-Weill dyschondrosteosis: a new feature in Turner syndrome.

We analysed bone age radiographs in 102 girls with Turner syndrome and compared the findings with 93 control girls and nine girls with Leri-Weill syndrome. Various signs were analysed: radial bowing or Madelung deformity, maximal/minimal height of the radial epiphysis, brachymetacarpia of the 4th digit, carpal and epiphyseal angle, as well as a new sign the distal radio-ulnar physeal disparity. Two values differed significantly between the Turner group and the control group, the first being the epiphyseal angle which has already been reported to be greater in Turner syndrome, and the second being the new sign we have been able to describe. Turner patients had an increased distance between the ulnar and radial metaphysis, or "distal radio-ulnar physeal disparity", the ulnar being shorter. Furthermore, in 27% of cases the medial extremity of the ulnar epiphysis was flattened and passed below the distal extremity of the radius, whose medial part projected over the distal extremity of the ulna, thus reproducing in reverse the characteristic feature of Leri-Weill syndrome. In the growth hormone-treated Turner patients, we found a significant correlation between distal radio-ulnar physeal disparity and growth velocity expressed in cm/year (r = 0.28; P < 0.002) or in SDS/bone age (r = 0.21; P < 0.03) during the first year of treatment. the value of this new sign requires further investigation.

2nd to 4th digit ratios, fetal testosterone and estradiol

Background: The ratio of 2nd to 4th digit length (2D:4D) is sexually dimorphic (mean 2D:4D is lower in males than females) and is thought to be fixed early in development. 2D:4D has been reported to be related to fetal growth, hand preference, autism, Asperger's syndrome, sperm counts, family size, age at myocardial infarction in men and breast cancer in women. There is indirect evidence that 2D:4D is established in utero and is negatively related to prenatal testosterone and positively with prenatal estradiol. However, there are no studies which show direct relationships between fetal testosterone (FT), fetal estradiol (FE) and 2D:4D. Aims: To investigate the relationships between 2D:4D ratios and FT and FE from amniotic fluid. Study design: Cohort study. Subjects: 33 children. Outcome measures: Radioimmunoassays of FT and FE obtained from routine amniocentesis; 2D:4D ratios calculated from 2nd and 4th digit length of the right and left hands at age 2 years. Results: A significant negative association between right 2D:4D ratio and FT/FE ratio, which was independent of sex. Conclusions: These preliminary findings lend support to an association between low 2D:4D and high levels of FT relative to FE, and high 2D:4D with low FT relative to FE.

Compact activation detectors for measuring of absolute neutron yield generated by powerful pulsed plasma installations

A system for measuring of absolute neutron yield and its spatial anisotropy is described. The system was developed in the LPI (Lebedev Physical Institute) and destined for study properties of neutron emission of pulse plasma installations such as Plasma Focus (PF),z-pinches and others. The system consists of transported compact activation detectors and small optically isolated neutron activation counter with 4th digit data output to LCD display. The electronic unit is built on the TTL standard. In power supply of the system the small-size accumulators are used.

2nd to 4th digit ratio and a universal mean for prenatal testosterone in homosexual men

Male homosexuals are said to have experienced high prenatal testosterone, and testosterone may have deleterious effects on the immune system. The question of the prenatal androgen status of male homosexuals is therefore of importance. There is evidence that the relative length of the 2nd and 4th digit (2D:4D) is negatively correlated with prenatal testosterone. We review the available literature, and provide further data on 2D:4D in male heterosexuals and homosexuals. Normative values of male mean 2D:4D ratio vary between 0.94 to 1.00 across populations. However, mean 2D:4D ratio is relatively constant among male homosexuals from different populations, with a mean of 0.96 to 0.97. Therefore homosexuals appear to be more androgenised (lower 2D:4D) than heterosexuals in some populations, while in others they appear to be less androgenised (higher 2D:4D) than heterosexuals. Speculations regarding the effect of early sex steroids on the health of male homosexuals should therefore focus on the effects of prenatal testosterone levels associated with 2D:4D ratios of between 0.96 and 0.97.

HNPP due to a novel missense mutation of the PMP22 gene

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant peripheral neuropathy characterized by compressive focal neuropathies and an underlying sensorimotor demyelinative polyneuropathy . 1-3⇓⇓ It is usually caused by a 1.5-Mb deletion of the PMP22 gene (17p11.2), but several point mutations have been reported. We describe a novel missense mutation of the PMP22 gene in a family with HNPP. A 17-year-old girl noted a 2-week history of persistent numbness and tingling of her left 4th and 5th digits and left hand weakness that developed acutely after 1 hour of leaning on her left palm. At age 9 years, she had a 2-month episode of right foot drop and numbness of the right lateral lower leg after sleeping with her legs crossed. On examination, she appeared to have ulnar neuropathy at the wrist (UNW) with mild weakness in the left first dorsal interosseous muscle (FDI) and the abductor digiti minimi, with normal strength in the left …

Are body fluctuating asymmetry and the ratio of 2nd to 4th digit length reliable predictors of semen quality?

Recent attention has been paid to patterns of fluctuating asymmetry (FA) in paired bilateral traits and the extent to which they reflect phenotypic and genetic quality. The FA-fertility hypothesis proposes that FA may be a reliable indicator of ejaculate quality in humans and other animals. The common control by the Hox genes of the differentiation of both the urogenital system and the appendicular skeleton in vertebrates has been proposed as an explanation for the recent finding that FA, and the second to fourth digit ratios (2D:4D) are both associated with semen quality in men. A group of 50 men was evaluated for FA, calculated by the sum of three different body FAs, 2D:4D ratios, and seminal parameters of masturbatory semen samples. Composite FA had a significant effect on semen parameters; the 2D:4D ratios did not predict semen quality. Comparison of our data with previous studies suggests that the putative relationship between semen quality and 2D:4D may have been driven by the inclusion of severely oligozoospermic men within the original subject group. Our sample included men with equally high 2D:4D ratios but who had normal semen. Thus, the 2D:4D ratio may not reliably indicate poor semen quality although FA might.

The ratio of 2nd to 4th digit length: a proxy for transactivation activity of the androgen receptor gene?

The androgen receptor gene (AR) contains a domain which includes a variable number of CAG sequences and alleles with low numbers of CAG repeats show high transactivation activity when complexed with testosterone. The ratio of 2nd and 4th digit length (2D:4D) is negatively correlated with phenotypic effects of testosterone. Low numbers of CAG repeats and low 2D:4D are both associated with high sperm numbers and protection against breast cancer. This suggests that CAG number and 2D:4D are correlated i.e. low CAG number and low 2D:4D indicate high activation of androgen-responsive genes. Findings from AR studies predict that low 2D:4D will be associated with prostate and hepatocellular cancer, urolithiasis, ADHD, ankylosing spondylitis, spontaneous abortion, and polycystic ovaries, while high 2D:4D will be associated with motor neuron diseases and endometrial cancer. Findings from 2D:4D studies predict that short CAG length will be common in autism and Asperger's syndrome, while high numbers of CAG repeats will be found in men who are prone to early myocardial infarction.

2nd to 4th Digit Ratio and Offspring Sex Ratio

There is evidence that the ratio of the length of the 2nd and 4th digit (2D:4D) is negatively related to prenatal and adult concentrations of testosterone. It has also been reported that high levels of testosterone at conception in both fathers and mothers are associated with an increased sex ratio (proportion of males at birth). It follows from these observations that low values of 2D:4D may be related to high sex ratio. We present evidence from three populations (English, Spanish and Jamaican) that 2D:4D is negatively related to sex ratio, independent of the sex and ethnicity of the parents.

THE ROLE OF HUMAN-DERIVED FIBRIN SEALANT IN THE REDUCTION OF POSTOPERATIVE FLEXOR TENDON ADHESION FORMATION IN RABBITS

This study assessed the role of a novel fibrin sealant (Vivostat®) in adhesion reduction after flexor tendon surgery. The deep flexor tendons of the 2nd and 4th digits of the left paw of 20 rabbits were exposed and a standard partial injury was performed on each. The rabbits were randomized to either immediate post-injury treatment with Vivostat® or no treatment. In each case active movement of the 2nd digit was prevented while the 4th digit was allowed to move normally. The two groups were assessed at 14 days for adhesion formation with a tensiometer. The right paw acted as the unoperated control. Results showed that there was no significant difference in the force needed to remove the tendon from its sheath when comparing the two Vivostat®-treated groups to the unoperated controls. There was, however, a highly significant difference in this force between the non-Vivostat®-treated groups and the unoperated controls. This suggests a beneficial effect of Vivostat® in reducing post surgical tendon adhesion formation.

Sexual orientation and the 2nd to 4th finger length ratio: evidence for organising effects of sex hormones or developmental instability?

It has been proposed that human sexual orientation is influenced by prenatal sex hormones. Some evidence examining putative somatic markers of prenatal sex hormones supports this assumption. An alternative suggestion has been that homosexuality may be due to general developmental disruptions independent of hormonal effects. This study investigated the ratio of the 2nd to 4th finger digits (the 2D:4D ratio), a measure often ascribed to the organisational actions of prenatal androgens, and the fluctuating asymmetry (FA—a measure of general developmental disruption) of these features, in a sample of 240 healthy, right handed and exclusively heterosexual and homosexual males and females ( N=60 per group). Homosexual males and females showed significantly lower 2D:4D ratios in comparison to heterosexuals, but sexual orientation did not relate to any measures of FA. The evidence may suggest that homosexual males and females have been exposed to non-disruptive, but elevated levels of androgens in utero. However, these data also draw attention to difficulties in the interpretation of results when somatic features are employed as biological markers of prenatal hormonal influences.

The ratio of 2nd to 4th digit length: a proxy for testosterone, and susceptibility to HIV and AIDS?

The incidence of HIV and AIDS is high in sub-Saharan Africa and in male homosexuals. It is suggested that testosterone-mediated immune dysfunction may account for this pattern. The ratio of the length of the 2nd and 4th digit (2D:4D) is negatively related to prenatal and adult testosterone concentrations. There is evidence that black South Africans have lower 2D:4D ratios than most other populations and male homosexuals have lower 2D:4D ratios than male heterosexuals. Men with low 2D:4D ratios may also be more sexually active and/or more fertile than men with high ratio. We suggest that men and women with low 2D:4D are susceptible to HIV infection and AIDS and babies with low 2D:4D ratio susceptible to vertical transmission. Infection rates may therefore be reduced by education and condom supply directed towards low 2D:4D adults.

The 2nd to 4th digit ratio and autism.

The 2nd to 4th digit ratio and autism.