Flexor Side Research Articles

A Printable Magnetic-Responsive Iron Oxide Nanoparticle (ION)-Gelatin Methacryloyl (GelMA) Ink for Soft Bioactuator/Robot Applications.

The features or actuation behaviors of nature's creatures provide concepts for the development of biomimetic soft bioactuators/robots with stimuli-responsive capabilities, design convenience, and environmental adaptivity in various fields. Mimosa pudica is a mechanically responsive plant that can convert pressure to the motion of leaves. When the leaves receive pressure, the occurrence of asymmetric turgor in the extensor and flexor sides of the pulvinus from redistributing the water in the pulvinus causes the bending of the pulvinus. Inspired by the actuation of Mimosa pudica, designing soft bioactuators can convert external stimulations to driving forces for the actuation of constructs which has been receiving increased attention and has potential applications in many fields. 4D printing technology has emerged as a new strategy for creating versatile soft bioactuators/robots by integrating printing technologies with stimuli-responsive materials. In this study, we developed a hybrid ink by combining gelatin methacryloyl (GelMA) polymers with iron oxide nanoparticles (IONs). This hybrid ION-GelMA ink exhibits tunable rheology, controllable mechanical properties, magnetic-responsive behaviors, and printability by integrating the internal metal ion-polymeric chain interactions and photo-crosslinking chemistries. This design offers the inks a dual crosslink mechanism combining the advantages of photocrosslinking and ionic crosslinking to rapidly form the construct within 60 s of UV exposure time. In addition, the magnetic-responsive actuation of ION-GelMA constructs can be regulated by different ION concentrations (0-10%). Furthermore, we used the ION-GelMA inks to fabricate a Mimosa pudica-like soft bioactuator through a mold casting method and a direct-ink-writing (DIW) printing technology. Obviously, the pinnule leaf structure of printed constructs presents a continuous reversible shape transformation in an air phase without any liquid as a medium, which can mimic the motion characteristics of natural creatures. At the same time, compared to the model casting process, the DIW printed bioactuators show a more refined and biomimetic transformation shape that closely resembles the movement of the pinnule leaf of Mimosa pudica in response to stimulation. Overall, this study indicates the proof of concept and the potential prospect of magnetic-responsive ION-GelMA inks for the rapid prototyping of biomimetic soft bioactuators/robots with untethered non-contact magneto-actuations.

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Cross‐finger flap as ultima ratio for the reconstruction of defects of the finger flexor sides

Hyperspectral Imaging to Study Dynamic Skin Perfusion after Injection of Articaine-4% with and without Epinephrine-Clinical Implications on Local Vasoconstriction.

This study aimed to investigate the dynamic skin perfusion via hyperspectral imaging (HSI) after application of Articaine-4% ± epinephrine as well as epinephrine only. After the subcutaneous injection of (A100) Articaine-4% with epinephrine 1:100,000, (A200) Articaine-4% with epinephrine 1:200,000, (Aw/o) Articaine-4% without epinephrine, and (EPI200) epinephrine 1:200,000, into the flexor side of the forearm in a split-arm design, dynamic skin perfusion measurement was performed over 120 min by determining tissue oxygen saturation (StO2) using HSI. After injection, all groups experienced a reactive hyperaemia. With A200, it took about three min for StO2 to drop below baseline. For Aw/o and EPI200, perfusion reduction when compared to baseline was seen at 30 min with vasoconstriction >120 min. A100 caused vasodilation with hyperaemia >60 min. After three minutes, the perfusion pattern differed significantly (p < 0.001) between all groups except Aw/o and EPI200. The vasoactive effect of epinephrine-containing local anaesthetics can be visualised and dynamically quantified via StO2 using HSI. Aw/o + epinephrine 1:100,000 and 1:200,000 leads to perfusion reduction and tissue ischaemia after 30 min, which lasts over 120 min with no significant difference between both formulations. When using Aw/o containing epinephrine in terms of haemostasis for surgical procedures, a prolonged waiting time before incision of 30 or more min can be recommended.

A pilot study of 17 wrist-cutting suicide injuries in single institution: perspectives from a hand surgeon

BackgroundSelf-cutting is a special type of emergency in hand surgery. Despite its low mortality rate, it is clinically significant because there is a possibility of permanent disability and repeated suicide attempts are likely to occur. Therefore, we aim to understand the characteristics of self-inflicted wrist injuries and share the perspectives from a hand surgeon in order to inform those who face these patients primarily in the emergency room.MethodsWe reviewed 17 patients with self-inflicted wrist injuries who were referred to the Department of Hand surgery from the Emergency Medicine Department from 2013 to 2017. We investigated the differences in demographic features (age, gender, psychological diagnosis, alcohol consumption, prior suicide attempts) and clinical features (injury side, injury pattern, anatomical structures, distance from wrist crease).ResultsAmong the patients, 4 were female and 13 were male. 70.6% of patients (12/17) had injuries on the left wrist and 94.1% of patients (16/17) had injuries on the flexor side. The average distance from the wrist crease to the injured site was 3.43 cm and 90.5% (19/21) of total injuries had an average distance of was less than 5 cm. The most frequently injured structures were palmaris longus tendon (58.5%, 10/17). 52.9% (9/17) of patients, among which 6 of the 8 patients with deep injuries and 3 of the 9 patients with superficial injuries, had a history of a psychiatric disorder.ConclusionsWe conclude that a male with a previously diagnosed psychiatric disorder has a higher chance of inflicting a deeper injury. In addition, self-cutting injuries are highly predictable because most of these injuries occur on the flexor side of the left wrist and are limited to a distance of 5 cm from the wrist crease. In terms of the implements used in self-inflicted injuries, we can predict the type of damage to some degree depending on the type of implement used. In view of these characteristics, more appropriate evaluation can be implemented in the emergency room and those who deal with these patients primarily can cope more effectively for better long-term results.

Free Flow-through Anterolateral Thigh Flaps for Wrist High-tension Electrical Burns: A Retrospective Case Series

ObjectiveThe objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns. MethodsWe collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits. ResultsThe injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up. ConclusionTreating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.

Histological investigation of picosecond laser-toning and fractional laser therapy

Rejuvenation therapy using picosecond pulse laser and picosecond pulsed fractional therapy with a fractional lens have been performed with clinical effects evaluated. However, no histological analysis of effects on photoaged skin exists. In this study, influence of laser-toning and fractional therapy using picosecond pulse laser on photoaging was histologically investigated. The flexor side forearm of a male, age 61, with photoaging was divided into three 20 cm2 areas and irradiated with approximately 400 shots of 10-Hz laser, 8 mm spot size, and nine passes at an output of 0.7, 0.9, and 1.1 J/cm2 using picosecond laser-toning therapy six times, every two weeks. Two weeks post final irradiation, 2 mm punch biopsies were taken from the irradiation fields. Fractional therapy using Micro Lens Array (MLA) attached picosecond fractional therapy was applied to the medial crural skin with marked photoaging of a male, age 63. Irradiation was applied at 0.5 and 0.7 J/cm2 through two passes, with 3 mm punch biopsies taken from each irradiation field immediately after and again two months post-irradiation. Samples were subjected to hematoxylin and eosin (HE) and Elastica van Gieson staining and compared. In the picosecond laser-toning therapy sample, photoaging-induced dermis reconstruction occurred. The picosecond fractional therapy sample showed both epidermis and dermis reconstruction, with intrinsic aging and photoaging improvements. Recovery of dermal and epidermal age related atrophy by picosecond laser-toning and picosecond fractional therapy was histologically confirmed. Picosecond fractional therapy demonstrated superior improvement.

Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration

BackgroundPrevious studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI).MethodsTwenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4–5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups.ResultsThere were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05).ConclusionsThere was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine.Trial registration numberClinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.

Cross-correlation analysis of isometric contraction for mechanomyography signals on forearm muscle

This study examines the cross-correlation coefficient of Mechanomyography (MMG) signals recorded from Palmaris Longus (PL), Flexor Digitorum Superficialis (FDS), Extensor Digitorum (ED) and Extensor Carpi Ulnaris (ECU) of forearm muscles during isometric muscle action. Nine healthy participants using dominant hand (mean±SD: age=24.78±1.79 year) volunteered in this study to perform submaximal to maximal (25%, 50%, 75% and 100%) isometric muscle actions with maximal voluntary contraction force of hand exercise gestures (grip strength supinated, grip strength pronated, finger flexion and pinch grip). During each isometric contraction, four-separated VMG sensor (TSD250A)-sensitive accelerometer type was used to record MMG signals on flexor and extensor side of forearm muscles. Maximum crosscorrelation coefficients at zero time lags were analyzed between flexor (PL & FDS) and extensor (ED & ECU) sides for each subject and force level to determine which sides show high level of association during isometric muscle action of forearm with different hand exercise gestures. The results showed maximum cross-correlation coefficients that range from Rxy = 0.801 – 0.943 for all hand exercise gestures performed. In addition, from the results obtained between flexor and extensor side indicates that the maximum range of cross-correlation coefficient for extensor side muscle groups were slightly higher than the flexor side muscle groups.

Strain Index Values in the Ultrasonographic Evaluation of Psoriasis

Objective: Psoriasis is a widespread, chronic, recurrent, inflammatory disease of the skin which affects men and women equally. Elastography is a novel technique which uses the elasticity of the lesion. The aim of this study is to determine the elastographic findings of dermal psoriasis. This is the first study to evaluate SI in psoriasis patients and SI is helpful to evaluate psoriasis patients. We suggest that determining cut-off SI values for normal and dermal psoriasis can be helpful in the early diagnosis and follow-up of psoriasis patients. Materials and Methods: This prospective study included a total of 21 (10 females, 11 males) healthy volunteers and 32 (17 females, 15 males) psoriasis patients between 2015 and 2016. An Aplio 500 ultrasound device (Toshiba Medical Systems Corp., Otawara, Japan) and a 5-13 MHz linear transducer were used for ultrasonographic and ultrasound elastographic examinations. The measurements were made from the flexor sides of upper and lower extremities. At least three measurements were performed for each lesion and strain index (SI) values were recorded Results: The median SI values of healthy volunteers and psoriasis were 1.25 (0.16-8.00) (interquartile range (IR) 1.50) and 2.73 (0.43-13.32) (IR 3.39), respectively, indicating a significant difference between the groups (p: 0.001). Conclusion: Our study results showed that the SI values of the dermis in psoriasis patients were significantly higher than those of healthy volunteers. We suggest that determining cut-off SI values for normal and dermal psoriasis can be helpful in the early diagnosis and follow-up of psoriasis patients. Advances in Knowledge: Due to the literature search, this is the first study to evaluate SI in psoriasis patients and SI is helpful to evaluate psoriasis patients.

Immunohistochemical distribution of Ki67 in epidermis of thick glabrous skin of human digits.

The glabrous skin on the flexor sides of hands and feet, compared to other integument regions, has thicker epidermis and more complex pattern of epidermal ridges, wherefore in microscopy is denominated as thick skin. The epidermis of this skin type has individually unique and permanent superficial patterns, called dermatoglyphics, which are maintained byregenerative potential of deep epidermal rete ridges,that interdigitate with adjacent dermis. Using light microscopy, we analyzed cadavericbig toes thick skin samples, described histology of deep epidermal ridges (intermediate, limiting, and transverse), andquantitatively evidenced their pattern of proliferation by immunohistochemicalassessment of Ki67. Immunohistochemical distribution of Ki67 was confined to basal and suprabasal layers, with pattern of distribution specific for intermediate, limiting and transverse ridges that gradually transform within epidermal height. Deep epidermal ridges, interdigitating with dermal papillae, participate in construction of intricate epidermal base, whose possible role in epidermal regeneration was also discussed. Having a prominent morphology, thistype of epidermisoffers the best morphological insight in complexities of skin organization, and its understanding could challenge and improve currently accepted models of epidermal organization.

Assessing Joint Hypermobility in Preschool-Aged Children

To provide a revision of the Beighton score adapted for children younger than the age of 5years, to apply the revised version in a cohort of preschool age children, and to verify the reliability of the revised version in a cohort of preschool children with genetic syndromes associated with hypermobility. The revised Beighton score was applied in a population of preschool children to evaluate joint hypermobility in 5 parts of the body, bilaterally (passive dorsiflexion of the fifth finger; passive hyperextension of the elbow; passive hyperextension of the knee; passive apposition of the thumb to the flexor side of the forearm; passive dorsiflexion of the ankle joint). The frequency distribution of the total scores was calculated with a range between 0 and10. A total of 284 healthy preschool children (146 boys and 138 girls) and 26 preschool children with genetic disorders (15 boys and 11 girls) were assessed. Mean age was 33.6±12.7months. A score ≤4 was found in more than 90% of the whole cohort; therefore, a cut-off score >4 was used to identify hypermobility. Twenty-two of the 284 (7%) healthy children and 23 of the 26 children (89%) with genetic syndromes associated with hypermobility had a score >4. The joints reporting a greater incidence of hypermobility were "apposition of the thumb to the forearm" and "passive dorsiflexion of the ankle," in 34% and 22% respectively. No differences related to sex or age were observed. The revised version of the Beighton score can be used to define generalized hypermobility for children up to 5years of age and to assess and follow-up longitudinally patients with isolated hypermobility or those in whom the laxity is associated with other clinical features.

The Ulnar Nerve After Surgical Transposition: Can Sonography Define the Reason of Persisting Neuropathy?

Ulnar nerve neuropathy is mainly caused by compression at the level of the cubital tunnel. Two main approaches are currently known for the surgical treatment of this condition: decompression of the nerve in its usual position or transposition to the ulnar flexor side. This study was performed to define the usefulness of ultrasound in patients with persisting symptoms after ulnar nerve transposition. We present the data of 8 subjects with persisting symptoms after nerve transposition due to compressive neuropathy. The cross-section areas (CSA) and texture changes were recorded. Each ulnar nerve was divided into 6 segments - 3 segments at the proximal pass and 3 segments at the distal pass through the subcutaneous fascia. Texture changes were recorded in 4.6 (76.7 %) ± 1.2 and outer nerve sheath blurring in mean 4.1 (68.3 %) ± 1.1 of the segments. Caliber changes were found in the course of the nerve based on the 6 segments: A mean CSA of 7.45 mm² ± 2.24 was found proximal to the upper fascial passage (PUF), a mean CSA of 11.96 mm² ± 3.61 at the upper fascial passage (UF), a mean CSA of 11.49 mm² ± 8.16 distal to the upper fascial passage (DUF), a mean CSA of 10.84 mm² ± 4.73 proximal to the lower fascial passage (PLF), a mean CSA of 12.12 mm² ± 5 at the lower fascial passage (LF), and a mean CSA of 7.89 mm² ± 3.42 distal to the lower fascial passage (DLF). All transposed nerves presented relevant kinks at the UF, 6 nerves presented relevant kinks at the LF. In cases of secondary ulnar neuropathy after nerve transposition, ultrasound can reliably assess the actual "situation" of the nerve and thus at least ease the decision for secondary surgery.

Management of peripheral injuries of the finger

The treatment of acute peripheral finger injuries is part of the daily routine of surgeons in emergency departments. This article presents the most common forms of peripheral finger injuries and the specific diagnostic and therapeutic aspects. The injuries include incision and tear injuries, injuries to the nailbed, distal extensor tendon injuries, severed flexor tendons of the distal joint, bite injuries, high-pressure injection injuries and amputation injuries of the distal phalanx of fingers. For the latter, the form, level and height of the amputation are decisive for therapy. Soft tissue defects on the extensor and flexor side of the finger are also common for emergency surgeons. The basic principles of the initial management of peripheral soft tissue injuries of the hand involve the reconstruction of tendons and nerves and soft tissue coverage. Pathogenic organisms are detectable in more than 80% of bite wounds so that prophylaxis and therapy of infections are of special importance. An adjuvant antibiotic therapy is necessary for infections as well as for high-pressure injection injuries. It is also important for the treating physician to recognize when a hand surgeon must be involved.

A Neonatal Case of Phacomatosis Pigmentovascularis Type IIa.

A 2-day-old male newborn was consulted to our clinic for cutaneous vascular and pigmentary lesions. The pregnancy of his mother and family history were unremarkable. Physical examination showed bilateral nevus flammeus involving the scalp, face, neck, trunk, upper part of the back, scrotum and the flexor sides of arms and thighs. Large, bluish-grey pigmentation was observed on the abdominal area, back, buttocks, legs and the extensor sides of the arms (Figure 1a, b). Laboratory examination, abdominal ultrasound imaging and magnetic resonance imaging of the brain were normal. Systemic involvement was not detected. Phacomatosis pigmentovascularis (PPV) type IIa was diagnosed. FIG. 1. a, b. Bilateral nevus flammeus involving the scalp, face, neck, trunk, scrotum and the flexor sides of arms and thighs (a). Large, bluish-gray pigmentation on the back, buttocks, legs and the extensor sides of arms (b) Phacomatosis pigmentovascularis is a rare disorder characterized by the coexistence of vascular malformations and pigmentary lesions of skin. The first description of the disease was reported by Ota et al. (1), and Hasegawa et al. (2) classified the disease into four types. Nevus flammeus was the constant vascular malformation for all types. The associated pigmentary lesions were nevus pigmentosus et verrucosus in type I, Mongolian spots with or without nevus anemicus in type II, nevus spilus with or without nevus anemicus in type III and both nevus spilus and Mongolian spots with or without nevus anemicus in type IV. Also, each type was classified into two subtypes based on the absence or presence of systemic involvement. Subtype ‘a’ had only oculocutaneous involvement, while ‘b’ had systemic findings (1, 2). Torrelo et al. (3) observed the coexistence of cutis marmorata telangiectatica congenita (CMTC) and Mongolian spots in two cases and reported this association as PPV type V. Happle et al. (1) proposed a new classification and renamed PPV type II as phacomatosis cesioflammea, PPV type III as phacomatosis spilorosea and PPV type V as phacomatosis cesiomarmorata. Other rare associations were called unclassifiable PPV. Type II is the most common form of the disease, with 50% of cases having systemic involvement (1). Sturge-Weber and Klippel-Trenaunay syndromes are the most common disorders associated with PPV (4). Cerebral atrophy, Arnold-Chiarri type I, bilateral deafness, idiopathic facial paralysis, hydro-cephalia, diabetes insipidus, plexiform neurofibroma, delay in psychomotor development, epilepsy, melanosis oculi, iris hamartomas, glaucoma, chronic corneal oedema, prominent vessels in sclera, pigmentary alternations in retina, cataract, leg-length discrepancy, scoliosis, spinal dysraphism, hemihypertrophy, syndactilia, macrocephalia, renal agenesia, renal angiomatosis, hepatosplenomegaly, umbilical hernia, hypoplasia of leg veins, IgA deficiency, hyper IgE syndrome, colonic polyposis, subglottic stenosis, hypoplastic larynx, and multiple granular cell tumours have been reported as isolated cases and are thought to be incidental findings (1, 2). The most common skin manifestation of PPV is nevus flam-meus. Pigmentary lesions include Mongolian spots, nevus of Ota and Ito. Other reported skin disorders are nevus anemicus, nevus spilus, cafe-au-lait spots, generalised vitiligo and congenital triangular alopecia (1). Cutaneous lesions may spontaneously regress with age, but the patients usually require laser therapy for cosmetic problems. Pulsed dye laser has been used for nevus flammeus and Q-switched lasers have been preferred for the treatment of pigmentary lesions (5).

Epidermal hydration and skin surface lipids in patients with long-term complications of sulfur mustard poisoning

Background:Despite almost the three decades passed since the chemical attacks of Iraqi's army against the Iranian troops, some veterans are still suffering from long-term complications of sulfur mustard (SM) poisoning, including certain skin complaints specially dryness, burning, and pruritus. We thus aimed to evaluate the skin's water and lipid content in patients with a disability of >25% due to complications of SM poisoning and compare them with a matched control group.Materials and Methods:Sixty-nine male participants were included in this study; 43 SM-exposed patients, and 26 normal controls from their close relatives. The water and lipid content was measured in four different locations: Extensor and flexor sides of forearms and lateral and medial sides of legs by the Corneometer CM 820/Sebumeter SM 810. Collected data was analyzed and P ≤ 0.05 was considered as statistically significant.Results:The mean age of the patients and controls was 49.53 ± 11.34 (ranges: 40-71) and 29.08 ± 8.836 (ranges: 15-49 years), respectively. In the veterans group, the main cutaneous complaint was itching and skin dryness. Cherry angioma, dry skin, and pruritus were significantly more common in the SM-exposed cases than in the controls. (P = 0.01, 0.05, and 0.04, respectively). The moisture and lipid content of all areas were lower in the SM-exposed group, but it was only significant in skin sebum of lateral sides of legs (P = 0.02).Conclusion:Exposure to SM could decrease the function of stratum corneum and lipid production as a barrier, even after several years of its exposure.

Age-related morphometric changes of inner structures of the skin assessed by in vivo reflectance confocal microscopy.

In vivo reflectance confocal microscopy is a useful technique for non-invasive biometry of cutaneous inner structures. In this study, the changes in the inner structures were examined in a wide age range of healthy Japanese using this technique. Skin on the flexor side of the arm and on the face, which represent sun-protected and sun-exposed sites of the skin, respectively, was examined in 52 healthy Japanese subjects aged 6 months-81 years old using a reflectance confocal microscope Vivascope(®) 3000. The size of granular cells increased with age and was larger in the group aged over 50 years than in the young group aged 18-21 years old, at both sites. The size of prickle cells also increased with age in the face but not in the arm. The size of dermal papillae measured at depths of 50 μm (Z = 50 μm) and 80 μm (Z = 80 μm) from the surface decreased with age. The size at Z = 80 μm was smaller in the older group than in the younger group at both sites. However, the mean size of granular cells and dermal papillae was smaller in the face than in the arm. The number of dermal papillae decreased with age in the arm at Z = 50 μm and in the face at Z = 80 μm. Skin aging may be reflected in the size of granular and prickle cells and dermal papillae, and the extent varies in each sun-exposed or sun-protected skin site.

The anti-inflammatory effect of cherry blossom extract (Prunus yedoensis) used in soothing skincare product.

Previous investigations suggested that cherry blossoms could provide valuable bioactive materials. However, few observations regarding the anti-inflammatory effect of cherry blossoms were reported. This study was to explore the anti-inflammatory effect of cherry blossom extract (CBE), which was used as a soothing ingredient in skincare product. In vitro study, the anti-inflammatory effect of CBE on the nitric oxide (NO) inhibition assay in lipopolysaccharide (LPS)-treated RAW 264.7 cells was investigated. In vivo study, 40 volunteers were included in a randomized, single-blinded, placebo-controlled trial. 24-hour-occlusive test chambers were applied on the flexor side of the forearm with 3% sodium lauryl sulphate (SLS). Subsequently, the test areas were treated on 9 subsequent days with a cream containing 3% CBE or a placebo. Evaluation included a visual score and determination of erythema value (E value). In vitro study, 2% CBE reduced NO production by 31.83% compared to the placebo. In the SLS irritant patch test, the visual score and erythema value of CBE were lower than that of the placebo on D5 and D9. Cherry blossom extract shows good anti-inflammatory effect in vitro and in vivo and represents a promising functional ingredient in soothing skincare product by reducing skin inflammation.

Dying Transfixing His Own Heart

A 22-year-old man was found dead in his room, lying on his bed, with a kitchen knife embedded in his thorax. The external examination revealed only 1 deep incised horizontal wound in the third left intercostal space beside the sternum. There were no hesitation marks or defense injuries. On both flexor sides of the wrists, the forearms, and the arms and on the right and the left side of the neck, there were several old transversal cut scars. At the autopsy, once the single-edged knife was removed, and after a median sternotomy, the penetration depth of the stab wound revealed an incision of the left pleura, the pericardium, and the transfixed heart, from the anterior to the posterior side, ending on the seventh thoracic vertebra. Toxicological screening resulted as negative. Death occurred as a result of hemorrhagic shock after deep myocardial injuries. A psychiatric history of paranoid schizophrenia; the old scars, which were marks of previous attempted suicides; and the position of the weapon suggested that it was a suicide caused by a single strong stab wound in the cardiac region. This unusual manner of self-stabbing with a single stab to the heart without hesitation wounds was important to exclude other causes of death.

Ultrasound in hand and wrist: approach for a standardized examination

New very high-frequency ultrasound probes allow highly detailed imaging of superficial structures and thus are especially suitable for examination of the hand. For successful application, specific knowledge and experience as well as standardized examination techniques are required. Based on 11 determined sections of the flexor and extensor side of the hand, the authors present one approach to a standardized ultrasound examination allowing a quick view of all structures. An additional presentation of the most typical traumatic and degenerative disease patterns underlines the potency of this examination technique. With adequate equipment, training and expertise, ultrasound should be regarded as the first-line imaging modality for the assessment of a wide range of pathological conditions affecting the wrist and hand. An exact knowledge of the anatomical relation of the structures to each other gained from ultrasound experience is equally useful for following surgery of the cases.

Morphing structures and signal transduction in Mimosa pudica L. induced by localized thermal stress

Leaf movements in Mimosa pudica, are in response to thermal stress, touch, and light or darkness, appear to be regulated by electrical, hydrodynamical, and chemical signal transduction. The pulvinus of the M. pudica shows elastic properties. We have found that the movements of the petiole, or pinnules, are accompanied by a change of the pulvinus morphing structures. After brief flaming of a pinna, the volume of the lower part of the pulvinus decreases and the volume of the upper part increases due to the redistribution of electrolytes between these parts of the pulvinus; as a result of these changes the petiole falls. During the relaxation of the petiole, the process goes in the opposite direction. Ion and water channel blockers, uncouplers as well as anesthetic agents diethyl ether or chloroform decrease the speed of alert wave propagation along the plant. Brief flaming of a pinna induces bidirectional propagation of electrical signal in pulvini. Transduction of electrical signals along a pulvinus induces generation of an action potential in perpendicular direction between extensor and flexor sides of a pulvinus. Inhibition of signal transduction and mechanical responses in M. pudica by volatile anesthetic agents chloroform or by blockers of voltage gated ion channels shows that the generation and propagation of electrical signals is a primary effect responsible for turgor change and propagation of an excitation. There is an electrical coupling in a pulvinus similar to the electrical synapse in the animal nerves.