Palmar Surface Research Articles

Age‐related changes in the control mechanisms for vasomotion in the microcirculation

Ageing causes deterioration in function and structure of the skin microcirculation which has been reported to reflect similar deterioration in the microcirculation of other organs. The deterioration in function has been shown to reduce the total microvascular blood flow. The objective of our study was to determine the extent to which the three main control mechanisms of cutaneous microcirculation i.e., myogenic, neurogenic, and metabolic (endothelium dependent and non‐endothelium dependent) are affected by ageing. We used young (approximately 2 weeks old, n=10) and older (approximately 12 weeks old, n=10) Sprague‐Dawley rats. The animals were sedated, their body temperature maintained at 35 – 37oC with a heating blanket and Laser‐Doppler Flowmetry recorded from the palmar surface of the forepaw. Perfusion analysis was used to estimate the microvascular blood flow within a selected region of the palm, whilst the spectral composition of flowmotion was analyzed with Continuous Wavelet Transform using the Morlet mother wavelet. We used the following published frequency bands for rats for the spectral analysis of the microcirculation: myogenic (0.20 – 0.70 Hz), neurogenic (0.08 – 0.20 Hz), and metabolic control (0.01 – 0.08 Hz). Statistical significance was examined with one‐tailed, two‐sample t‐Test. The weights (in grams) of the young and older rats were 114±6 and 542±11 (mean±SEM). The skin perfusion for the young and older rats were 377±31 and 189±18 (perfusion units) respectively; the difference was significant with p<0.01. The mean amplitudes of the wavelet components for myogenic, neurogenic, and metabolic microvascular control for the young rats were 56.8, 71.6 and, 105.4 respectively, whilst those for the older rats were 30.4, 48.2, and 63.3; the decreases in the values for the older rats were significant (p<0.05). The study demonstrates that aging causes significant impairment of all the three major control mechanisms that influence cutaneous microcirculation. The results provide an approach to investigate interventions that may affect specific control mechanisms of the microcirculation.

Potential Influence of Skin Hydration and Transepidermal Water Loss on the Dermal Transfer and Loading of Elemental Metallic Lead.

The factors influencing transfer of chemicals or other contaminants to and from the surface of the skin are often poorly understood. Previous research has indicated that environmental conditions, skin hydration, and repeated contacts may all influence the quantity of dermal transfer. The aim of this analysis was to evaluate the influence of skin hydration and condition on quantitative chemical transfer in a series of systematic measurements using human subjects for 5 and 10 repeated contacts. Elemental metallic lead was used as the exemplar test substance for the measurements collected. Skin hydration index (HI) was assessed using a corneometer and skin condition and barrier function were measured using an open-chamber transepidermal water loss (TEWL) instrument. Results indicated that for the palmar surface of the index finger where sampling was conducted, the relative hydration level of the skin was higher for males (n = 6) versus females (n = 4) (mean HI = 4.0 for females; mean HI = 5.5 for males) but this difference was not statistically significant. Overall, the skin hydration level was not significantly associated with dermal loading for either the 5 contact scenario (Pearson correlation = 0.27; R2 = 0.07; P = 0.45) or the 10 contact scenario (Pearson correlation = 0.26; R2 = 0.07; P = 0.47). When the results were stratified by higher versus lower hydration levels (HI = 1-5 versus HI = 5-10), for the higher hydration levels (HI = 5-10; mean HI = 7), there was a moderately positive association between skin hydration and loading, but this was not statistically significant for either the 5 contact scenario (Pearson correlation = 0.75; R2 = 0.56; P = 0.15) or the 10 contact scenario (Pearson correlation = 0.6; R2 = 0.36; P = 0.28). No clear relationship was observed between the lower hydration levels (HI = 1-5) and dermal loading. For the palmar index finger, there was a negative correlation between the TEWL measurements and both the 5 contact (Pearson correlation = -0.45; R2 = 0.2; P = 0.19) and 10 contact (Pearson correlation = -0.3; R2 = 0.09; P = 0.4) scenarios, but this was not statistically significant. The results of this study are consistent with the limited results of other analyses, which have suggested that there may be nuances with respect to the effects of skin hydration on the quantitative dermal transfer to and from the skin, although additional data are needed to better understand these potential differences.

Reconstruction of the soft tissue defects of hand and wrist with ulnar artery perforator flap-presentation of case series

Reconstruction of soft tissue defect of hand and wrist is a common problem to plastic surgeon. I reconstructed the defect, both dorsal and palmar surface with a perforator-based flap from ulnar artery. The aim of the present study is to evaluate ulnar artery perforator flap in soft tissue defect of hand and wrist. Between January 2018 to February 2021, seven cases of skin defect were reconstructed with a perforator-based flap from ulnar artery, either pedicled or propeller type flap. The study was done at NRS medical college, Kolkata, where I have evaluated the viability of the flap, post-operative complication and patient’s satisfaction. All flaps survived, only in one case there was marginal necrosis that was treated conservatively. There was no post-operative complication, all flaps were doing well in six month and one year and one and half year follow up and patient’s satisfactions were also good. Ulnar artery perforator based fasciocutaneous flap, pedicled or propeller provides a reliable coverage of soft tissue defects of hand as well as wrist.

Unexpected Bullae in a 12-year-old Boy

Unexpected Bullae in a 12-year-old Boy

Two-point discrimination assessment of the upper extremities of healthy young Turkish individuals.

Objectives This study aims to measure the two-point discrimination (TPD) values of the upper extremities of healthy young Turkish individuals. Patients and methods Between March 2016 and June 2016, a total of 60 healthy students (31 males, 29 females; mean age: 22.0±1.7 years; range, 19 to 27 years) were included. Eleven grand upper limb parts which take innervation from the brachial plexus were measured with an esthesiometer. Results The values at the dominant sides were statistically significantly greater than the non-dominant sides at those areas: upper lateral arm (p=0.001), lower lateral arm (p=0.001), mid-posterior arm (p=0.001), mid-lateral forearm (p=0.001), mid-posterior forearm (p=0.012), skin over the first dorsal interossei muscle (p=0.031), and palmar surface of distal phalanx of the thumb (p=0.045). Both dominant and non-dominant lower lateral arm TPD measurement results increased in males compared to females, indicating a statistically significant difference (p=0.005 and p=0.011, respectively). Also, dominant and non-dominant mid-posterior arm measurement scores were found to statistically significantly increase in males compared to females (p=0.019 and p=0.040, respectively). Conclusion Our study results show that laterality, with lower values on the non-dominant side, but not the sex, has an effect on TPD. The findings of this study may be useful in establishing the normative data for TPD in the upper extremity parts of healthy young Turkish individuals.

Drug resistance and phylogenetic grouping of bacteria isolated from visitors' hands in a secondary-care hospital.

Dynamic movement in the hospital environment promotes the transmission of nosocomial pathogens and multidrug resistance mechanisms through the dissemination of organisms that carry genetic determinants. Healthcare workers play an important role in the spread of pathogens; however, the role of visitors in this environment is poorly understood. This study aimed to molecularly identify and examine the antibiotic resistance of the palmar microbiota of patients' companions in a hospital waiting room. Twenty-five palmar surface and interdigital space sample swabs were randomly collected and cultured on blood agar plates, and 19 colonies with different macro- and microscopic characteristics were isolated. The V4 and V6 hypervariable regions of the 16S rRNA gene from each isolate were amplified by PCR and sequenced. Maximum likelihood- and Bayesian inference-based phylogenetic analyses were performed to determine taxonomic relationships. Antibiotic resistance was evaluated by disk diffusion and broth microdilution. Among the isolates, 52.6% were related to Bacillus, 36.8% to Staphylococcus, 5.3% to Enterococcus and 5.3% to Atlantibacter. All of the isolates exhibited ampicillin and penicillin resistance, while 94.7% also exhibited dicloxacillin resistance. Staphylococcus aureus was resistant to penicillins but sensitive to the remaining drugs. Bacteria identified as Bacillus subtilis (MLM14B99), Bacillus pumilus (MLM23B07 and MLM25B06), Staphylococcus epidermidis (MLM24S31 and MLM29S04), and Enterococcus (MLM22E08) showed resistance to at least 46.7% of the antibiotics. To decrease the transmission of pathogenic bacteria with an antibiotic resistance profile, re-evaluation of hand cleaning measures and their application by people who visit hospital centres is needed.

Biomechanical investigation of load differences on the upper extremities in dynamic hand strikes and isometric hand pushes during assembly tasks

AbstractThis study determines the effects of increasing forces on different musculoskeletal load parameters, such as muscle activity and joint movement, during assembly task‐related dynamic hand strikes and isometric push forces. Fifteen subjects (12 men and 3 women) were instructed to strike and push on a force plate in two selected conditions. In the first condition, the palmar surface of the dominant hand is oriented horizontal to the measuring surface; in the second condition, the body position is maintained, but the hand is turned 90° to allow the use of the ulnar side of the hand (fist strike position). The subjects accomplished four force levels in ascending order (i.e., 150, 250, 350, and 400 N) within the corresponding striking and pushing conditions. The extracted kinematic variables of interest were strike velocity, recoil velocity, force plate contact time, peak vertical reaction force component (force plate), force impulse, muscle activity, and maximum joint ranges of motion during the push or strike process. Differences in the results between pushes and strikes and, under certain circumstances, between fist and palm strikes were identified. Increasing push forces correlate with the muscle activity in the pectoralis and lower arm extensor muscles. The fact that, at push forces > 250 N, the subjects modify and adapt their upper body and arm posture to achieve the required force could reveal an obvious feasibility limit and explain why assembly workers tend to use their hands as a hammer.

Effects of dexamethasone and acetylsalicylic acid on inflammation caused by Complete Freund's adjuvant in the naked mole rat (Heterocephalus glaber)

The naked mole rat (NMR) is a fossorial rodent that has been observed to have a unique nociceptive system in comparison to others. In this study, we explored on characterization of chronic inflammation in the NMR using Complete Freund's adjuvant (CFA) and investigated the effects of dexamethasone and acetylsalicylic acid on the resulting inflammation. The NMRs were injected with 0.1 ml of CFA subcutaneously in the right hind paw, and an equivalent volume of normal saline was injected to the control group. Swelling of the injected right hind limb was observed within 24 h of injection, which involved the tibiotarsal joint, palmar surface and the digits of the injected paw. Swelling persisted for 6 weeks of experimentation and peaked between day 14 and 21. The resulting inflammation affected the mobility, stance and joint rigidity of CFA treated NMRs in comparison to the control group. Treatment of the chronic phase of the inflammation from the 11th day with dexamethasone and acetylsalicylic acid showed no statistical significance in paw circumference compared to the control group, other than on a few, negligible occasions. The present data showed that CFA was able to induce chronic inflammation in the NMR, and the NMR could thus be established as a model for chronic inflammation. There is, however, need for more sensitive parameters to evaluate the effects of anti-inflammatory drugs.

Preoperative Evaluation of Thenar Muscles in Carpal Tunnel Syndrome by Ultrasonography.

This article aims to evaluate the usefulness of ultrasonography for the measurement of thenar muscles in carpal tunnel syndrome (CTS). A total of 85 patients with CTS who had a carpal tunnel release procedure were included in this study. The transducer was applied onto the palmar surface of the hand perpendicularly to the longitudinal axis of the first metacarpal bone. Thenar atrophy was evaluated visually and classified using the visual grading scale. A nerve conduction test was performed and classified according to the electrophysiological severity scale. This technique is more precise than visual evaluation because it is a quantitative assessment.

The effect of radial shockwave on the median nerve pathway in patients with mild-to-moderate carpal tunnel syndrome: a randomized clinical trial

BackgroundThis study aimed to evaluate the short-term effect of radial shockwave on the median nerve pathway as a new model method in patients with mild-to-moderate carpal tunnel syndrome.MethodsIn this randomized clinical trial, 60 patients were randomly allocated into three equal groups. The first group received 1500 shocks on the carpal tunnel, the second group received 1500 shocks on the carpal tunnel and median nerve pathways, and the third group was the control group. In all three groups, patients received conventional physiotherapy for ten sessions. In addition, patients in experimental groups received four sessions of radial shockwave. Pain and paresthesia intensity, sensory and motor distal latency were evaluated as primary outcomes. Boston carpal tunnel Questionnaire scores were evaluated as secondary outcomes. Evaluations were performed at baseline, 1 and 4 weeks after the end of the treatment.ResultsPain and paresthesia intensity and Boston questionnaire score significantly decreased in all three groups, but the greater improvement was noted in shockwave groups. Sensory and motor distal latency were only improved in shockwave groups. In terms of clinical and electrophysiological parameters, two groups of shockwaves showed similar results.ConclusionsRadial shockwave combined with conventional physiotherapy is an effective noninvasive treatment for mild-to-moderate carpal tunnel syndrome that produces greater and longer-lasting results than conventional physiotherapy alone. There were no differences observed between utilizing radial shockwave on the carpal tunnel or median nerve pathways on the palmar surface of the hand, in terms of clinical and electrophysiological measurements.Clinical Trial registration number The study was registered at https://fa.irct.ir/user/trial/49490/view (20200706048028N1) in date of 08/24/2021.

A Virtual Reality Application of the Rubber Hand Illusion Induced by Ultrasonic Mid-air Haptic Stimulation

Ultrasonic mid-air haptic technologies, which provide haptic feedback through airwaves produced using ultrasound, could be employed to investigate the sense of body ownership and immersion in virtual reality (VR) by inducing the virtual hand illusion (VHI). Ultrasonic mid-air haptic perception has solely been investigated for glabrous (hairless) skin, which has higher tactile sensitivity than hairy skin. In contrast, the VHI paradigm typically targets hairy skin without comparisons to glabrous skin. The aim of this article was to investigate illusory body ownership, the applicability of ultrasonic mid-air haptics, and perceived immersion in VR using the VHI. Fifty participants viewed a virtual hand being stroked by a feather synchronously and asynchronously with the ultrasonic stimulation applied to the glabrous skin on the palmar surface and the hairy skin on the dorsal surface of their hands. Questionnaire responses revealed that synchronous stimulation induced a stronger VHI than asynchronous stimulation. In synchronous conditions, the VHI was stronger for palmar stimulation than dorsal stimulation. The ultrasonic stimulation was also perceived as more intense on the palmar surface compared to the dorsal surface. Perceived immersion was not related to illusory body ownership per se but was enhanced by the provision of synchronous stimulation.

Uncommon sublingual ulceration in an infant

Sir, An eight-month-old girl was referred to our department with an extensive lingual ulceration. The parents noted that she had habitually bitten her tongue since the release of her first teeth at the age of six months. She was a poor feeder and did not sleep well because of the painful lingual ulceration. There was no family history of developmental disorders or congenital syndromes. Intraoral examination revealed a deep, circular, and extensive ulceration of the whole ventral surface of the tongue with intermittent bleeding in the tongue (Figs. 1a – c). An examination of the rest of the intraoral mucosa revealed that the lower central incisors had recently erupted. However, there were two other ulcerations of the palmar surface of the second and third fingers caused by nocturnal finger biting. Neurological examination noted a lack of pain sensitivity related to peripheral neuropathy diagnosed as congenital insensitivity to pain. Based on the clinical features and the particular site on the ventral surface of the tongue against the lower central incisors and ulcerative lesions of the fingers due to self-biting, the lesion was diagnosed as Riga–Fede disease. Because of the size of the ulceration, significant pain during feeding led to inadequate nutrient intake associated with permanent sleep disturbances. Radical treatment was chosen and the lower central incisors were extracted. Topical corticosteroids were prescribed to help with healing. The term Riga–Fede disease has been used to describe a traumatic ulceration that has occurred on the ventral surface of the tongue in newborn babies and infants. It is most commonly related to neonatal or natal teeth but may also occur in infants after the eruption of the primary lower incisors [1]. This benign ulceration occurs as a result of repetitive mechanical trauma caused to the oral mucosal surfaces by the teeth and is most commonly located on the ventral surface of the tongue against the teeth [1,2]. Riga–Fede disease may reveal an underlying developmental or neurologic disorder, including congenital insensitivities to pain [3]. The case of our patient was associated with congenital insensitivity to pain. Failure to diagnose may lead to dehydration and inadequate nutrient intake in the infant because of the significant pain during feeding. No biopsy is needed. The diagnosis of Riga–Fede disease is based on clinical characteristics [1,2]. Treatment should focus on eliminating the source of trauma. Conservative treatment is attempted at first by grinding the sharp edges of the teeth and placing composite resin in a dome shape or by placing a protective ring. If conservative treatment fails to heal the wounds, radical treatment may be necessary, such as extraction of the teeth [2,3]. We believe that Riga–Fede disease must be recognized by clinicians to avoid misdiagnosis and delayed treatment.

Antimicrobial Assessment of a Novel Humectant-Hand-Sanitizer against Microbes Transferred To Human Palms from Mobile Phones With/Without Flip Covers

The lack of proper sanitation and hygiene over the years has contributed to a rapid increase in communicable diseases, especially in developing nations like India. This problem warrants investigation of the potential routes responsible for transmitting microbes and infections to an individual. In this study, we have assessed bacterial and fungal load in covered (with flip covers) and uncovered (without flip covers) mobile phones, and the potential transfer of these microbes from phone surfaces to human palm surfaces. The bacterial load (in cfu) in mobile phones with flip covers was 13-fold higher than that of the uncovered phones meanwhile, the fungal load was relatively higher in the uncovered phones. The transfer of bacterial population (in cfu) from the covered mobile phones to the palm surfaces was 14.5-fold higher than that of the uncovered phones. Similarly, fungal transfer was relatively higher from the uncovered phones to the palm surfaces. We further developed a novel alcohol-based Humectant-Hand-Sanitizer (HH-sanitizer) and its sanitization efficiency (in %) was compared with one of the most popular Hygiene products in India, Dettol, against microbes obtained from human palm surfaces (before and after rubbing over mobile phones), and a group of opportunistic pathogens: Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus sp., Bacillus cereus, Listeria monocytogenes, Candida albicans, and Aspergillus sp. The sanitization efficiency (SE %) of the HH-sanitizer on palm surfaces was 98.78±1.82% and 91.27±4.24% against bacterial and fungal isolates respectively, whereas the SE % for the Dettol sanitizer was 94.62% against bacteria and 45.89% against fungi. In vitro antimicrobial assessment against the tested organisms showed the minimum inhibitory concentration of the HH-sanitizer to be 8-fold lower than the Dettol sanitizer. Thus, the HH-sanitizer has the potentiality to be an alternative option. Since bacterial adherence to mobile phones with flip covers and their transfer to human hands was significantly higher and as the common infections, we are prone to are caused more by bacteria than fungus, either way, avoidance of flip covers in phones/laptops/tablets, etc. is recommended to avoid transmittable infections and achieve better hygiene.

Correlation of dermatoglyphics patterns with skeletal malocclusion

Dermatoglyphic Patterns and Skeletal Malocclusion: Dermatoglyphics is the study of the intricate dermal patterns found on the skin of the palmar and plantar surfaces of the hands and feet. The term dermatoglyphics means “skin carving.” He has proven to be of predictive value for both genetic and nongenetic diseases in the medical field. It has been noted that the period of embryonic development for oral and dermal tissues overlaps. Thus, any impact on the development of oral tissues during this period may also represent itself in the dermatoglyphic patterns. Aim: Keeping this in mind, the present study was designed to investigate the correlation between malocclusions and representation in dermatoglyphic patterns. Materials and Methodology: A total of 90 subjects were selected for the study. Thirty cases each of Class I, Class II, and Class III skeletal malocclusions were selected from the age group of 13–18 years of age with permanent molars present. Lateral cephalograms were taken and their dermatoglyphic patterns were recorded by rolling impression technique. The dermatoglyphic data were assessed for different finger ridge patterns and total ridge count (TRC). Results: On comparison of dermatoglyphic patterns between skeletal Class I, II, and III, the skeletal Class I group showed a markedly decreased number of loops and increased TRC. In the skeletal Class II group, we found markedly increased number of loops and markedly decreased TRC. In the skeletal Class III group, we observed a markedly decreased number of arches and increased TRC. Loops were found to be the most predominant pattern in the skeletal Class II and III groups. The mean TRC was found to be increased in the skeletal Class III group, followed by the Class I group and markedly decreased in the skeletal Class II group, which was statistically significant. Conclusion: It is concluded that dermatoglyphics can be used as a screening tool and for the early prediction of skeletal malocclusion at a younger age group. Dermatoglyphics have important practical and clinical implications which can be applied for preventive and interceptive orthodontics among pediatric patients and also for parent counseling.

Determination of drug-resistant bacteria in palmar surface and touchscreen cell phones from bystanders in an urban community

The dynamic microbiota of the human palmar surface (PS) is related to the various hygienic habits of humans and can be transmitted or exchanged upon contact with objects of daily use, such as the indispensable touchscreen cell phone (TCP); this interaction could allow the development of drug-resistant bacteria. The objective was to determine the drug-resistant bacterial contamination between PSs and TCPs in an urban community. Among the total bacterial colonies isolated and molecular and phylogenetically characterized based on the V4-V6 regions of the 16S rRNA gene from PSs and TCPs, the genera present in both types of samples were Staphylococcus (53.3 and 43.5 %, respectively), Bacillus (37.8, 37 %), Atlantibacter (2.2, 10.8 %) and Microbacterium (2.2, 4.3 %). The genera present in only one type of sample were Rothia, Paenibacillus, Escherichia and Micrococcus (2.2 % each). Resistance to penicillins (35.6–93.5 %) and nonsusceptibility to cephalosporins (8.9–37 %) and nitrofurantoin (13.3 and 15.2 %) were observed. The percentage of multidrug antibiotic resistance was 15.4 %. The prevalence of drug-resistant and multidrug-resistant bacteria in PSs and TCPs in the community could give rise to human health problems, and hygiene measures are recommended.

Learning to Combine Local and Global Image Information for Contactless Palmprint Recognition.

In the past few years, there has been a leap from traditional palmprint recognition methodologies, which use handcrafted features, to deep-learning approaches that are able to automatically learn feature representations from the input data. However, the information that is extracted from such deep-learning models typically corresponds to the global image appearance, where only the most discriminative cues from the input image are considered. This characteristic is especially problematic when data is acquired in unconstrained settings, as in the case of contactless palmprint recognition systems, where visual artifacts caused by elastic deformations of the palmar surface are typically present in spatially local parts of the captured images. In this study we address the problem of elastic deformations by introducing a new approach to contactless palmprint recognition based on a novel CNN model, designed as a two-path architecture, where one path processes the input in a holistic manner, while the second path extracts local information from smaller image patches sampled from the input image. As elastic deformations can be assumed to most significantly affect the global appearance, while having a lesser impact on spatially local image areas, the local processing path addresses the issues related to elastic deformations thereby supplementing the information from the global processing path. The model is trained with a learning objective that combines the Additive Angular Margin (ArcFace) Loss and the well-known center loss. By using the proposed model design, the discriminative power of the learned image representation is significantly enhanced compared to standard holistic models, which, as we show in the experimental section, leads to state-of-the-art performance for contactless palmprint recognition. Our approach is tested on two publicly available contactless palmprint datasets—namely, IITD and CASIA—and is demonstrated to perform favorably against state-of-the-art methods from the literature. The source code for the proposed model is made publicly available.

In vivo soft tissue compressive properties of the human hand.

Background/PurposeFalls onto outstretched hands are the second most common sports injury and one of the leading causes of upper extremity injury. Injury risk and severity depends on forces being transmitted through the palmar surface to the upper extremity. Although the magnitude and distribution of forces depend on the soft tissue response of the palm, the in vivo properties of palmar tissue have not been characterized. The purpose of this study was to characterize the large deformation palmar soft tissue properties.MethodsIn vivo dynamic indentations were conducted on 15 young adults (21–29 years) to quantify the soft tissue characteristics of over the trapezium. The effects of loading rate, joint position, tissue thickness and sex on soft tissue responses were assessed.ResultsEnergy absorbed by the soft tissue and peak force were affected by loading rate and joint angle. Energy absorbed was 1.7–2.8 times higher and the peak force was 2–2.75 times higher at high rate loading than quasistatic rates. Males had greater energy absorbed than females but not at all wrist positions. Damping characteristics were the highest in the group with the thickest soft tissue while damping characteristics were the lowest in group with the thinnest soft tissues.ConclusionPalmar tissue response changes with joint position, loading rate, sex, and tissue thickness. Accurately capturing these tissue responses is important for developing effective simulations of fall and injury biomechanics and assessing the effectiveness of injury prevention strategies.

Sentinel Lymph Node Biopsy Positivity in Patients With Acral Lentiginous and Other Subtypes of Cutaneous Melanoma

Acral lentiginous melanoma (ALM) is a rare subtype of malignant melanoma typically occurring on the palmar and plantar surfaces. Although it has distinctive genetic, prognostic, and behavioral characteristics relative to cutaneous melanomas overall, owing to its rarity, treatment is largely guided by data extrapolated from more common subtypes. Although sentinel lymph node (SLN) status has been shown to be a significant prognostic factor for ALM, the independent effect of ALM-subtype disease on the likelihood of SLN positivity and the stage-specific positivity rates for ALM are not well characterized. To evaluate the association of ALM with SLN status as well as to characterize the clinical stage-specific rates of SLN positivity for ALM based on the AJCC Cancer Staging Manual, 8th edition (AJCC-8). The National Cancer Database (NCDB) includes all reportable cases from Commission on Cancer accredited facilities and represents approximately 50% of all newly diagnosed melanoma cases in the US. This retrospective cohort study included cases of AJCC-8 clinical stage I to II melanomas from the NCDB diagnosed from 2012 to 2015. The analysis took place between April 2021 and September 2021. Melanoma histopathologic subtype. Sentinel lymph node status. We identified 60 148 patients with malignant melanomas, 959 of whom had ALM-subtype disease. Among patients in the cohort, 25 550 (42.5%) were women and the mean (SD) age was 64 (16) years. Multivariable logistic regression controlling for demographic and histopathologic characteristics revealed that ALM was independently associated with the highest risk for SLN positivity among included subtypes (vs superficial spreading melanoma: odds ratio, 1.91; 95% CI, 1.59-2.28). Subgroup analysis by AJCC clinical stage demonstrated that ALM was independently associated with the highest risk for SLN positivity for both stage IB and II disease. The rate of SLN positivity for patients with stage IB and II ALM was 18.39% (95% CI, 13.82%-24.03%) and 39.53% (34.98%-44.26%), respectively. In this cohort study ALM was independently associated with SLN positivity and had relatively high positivity rates at clinical stage IB and II. This suggests that SLNB should be encouraged for all patients with clinical stage IB and II ALM, and such patients should receive appropriate counseling about the higher regional metastatic risk of their cancers. Future work with a larger cohort is required to elucidate the risk of SLN positivity for stage IA ALM.

Investigation of autonomic dysfunction in primary Raynaud’s phenomenon with sympathetic skin response (SSR), R-R interval variation (RRIV) and composite autonomic symptom score (COMPASS)-31

Background: In this study, we aimed to investigate the autonomic dysfunction in patients with primary Raynaud’s phenomenon with using sympathetic skin response (SSR) as a neurophysiologic test, R-R interval variation analysis and composite autonomic symptom score (COMPASS)-31 questionnaire. Methods: Palmar SSR to median nerve electrical stimulation was recorded in 38 patients with 36 healthy age and sex-matched control subjects. The SSR was recorded from the palmar surface of both left and right hands for patients and control groups. The amplitudes and latencies formed as a result of electrical stimulation were calculated and compared between the two groups. Additionally, R-R interval variability was examined during normal breathing, deep breathing, standing up and Valsalva maneuver in both groups. Furthermore, we asked to complete the COMPASS-31 questionnaire, a validated tool to assess symptoms of autonomic dysfunction. And by calculating total COMPASS-31 scores, the relationship between the two groups was investigated. Results: The Raynaud’s phenomenon and control groups were similar in age (37.4 ± 11.6 vs. 34.9 ± 13.0 years), had identical gender ratios and similar body mass index (24.5 ± 6.1 vs. 25.7 ± 4.6%). Palmar SSR to median nerve stimulation of RP patients shows significantly delayed latency (1890 ± 146) (p=0.03). And no difference between amplitudes in comparison to the control group. In the patient and control groups, R-R interval measurements were evaluated during rest and deep breathing, standing up and Valsalva maneuver. When the R-R interval measurements of the patient and control groups at rest and deep breathing were compared, there was no statistically significant difference between the groups. In addition, COMPASS-31 questionnaire scoring system was applied to both groups. The mean COMPASS-31 score was higher in patient group (22.8 ± 13.8), than from healthy controls (8.9 ± 7.8) (p=0.02) Conclusions: Autonomic dysfunction plays a role in the etiology of Raynaud’s phenomenon, due to latency prolongation in the sympathetic skin response and significant difference between COMPASS-31 tests, and these tests can be used in the diagnosis stage of this disease.

The Dermal Ridges as the Infallible Signature of Skin: An Overview.

Our skin is the largest organ and is composed of the dermis and epidermis. The skin surface has lines in the direction of elastic tension. The palmar and plantar skin lines are established before birth in the intrauterine development of the embryo. Dermatoglyphics is the study of epidermal lines on the palmar and plantar surface. It is a branch of biology, anthropology, genetics, and dermatology. Dermatoglyphics are closely associated with genetic factors. These attributes once formed in the womb remain unique and persist throughout the life of an individual unless the dermis is damaged. Digital and palmar dermatoglyphics are represented by fingerprint patterns, atd angle, a, b, c, d triradii, mail line index, etc. Sometimes either due to hereditary reasons, the pressure of intrauterine factors, or external environmental factors, chromosomal aberrations occur in the fetus. These aberrations are reflected in the form of increased angle of atd, variation in pattern frequency or ridge count between a-b triradii (ABRC), presence of unnatural flexion creases, and others in the fingerprints, palmprints, or footprints. These aberrations in dermatoglyphics are useful in studying the genetic abnormalities in ailments, personality disorders, and criminal tendencies.