Middle Fingertip Research Articles

Structural And Functional State Of Various Zones Of Skin Microcirculation In Men With Isolated Diastolic Hypertension

The objective of our study was to assess the structural and functional characteristics of various skin microcirculation zones in men with newly diagnosed isolated diastolic hypertension (IDH). Material and Methods — Our study sample included 275 men (aged 30 to 60 years) subjected to the comprehensive medical examination, which included blood tests, videocapillaroscopy (VCS) on the left ring finger, laser Doppler flowmetry (LDF) in the skin of the middle finger tip and forearm at rest, functional tests and photoplethysmography (PPG) on the left forefinger, determination of flow-mediated vasodilation of the brachial artery, echocardiography, ultrasound imaging of extracranial and femoral arteries, and also 24-hour ambulatory blood pressure monitoring (ABPM). According to the ABPM data, an isolated increase in diastolic blood pressure (BP) was noted in 83 subjects who formed the IDH group. The control group (CG) consisted of 90 men with normal BP. Results — VCS and LDF revealed no significant differences between the groups at the scale of capillaries and precapillary arterioles. According to PPG, IDH subjects had significantly higher values of reflection index vs. the CG (35.6% vs. 30.4%, p=0.0013) and lower values of ejection duration (310.5 ms and 319.5 ms, p=0.0159), respectively. Conclusion — The greatest contribution to peripheral vascular resistance in men with IDH most likely comes from large muscle arterioles, in which neurogenic regulation of vascular tone prevails.

Contribution of external reference frame to tactile localization.

The purpose of the present study was to elucidate whether an external reference frame contributes to tactile localization in blindfolded healthy humans. In a session, the right forearm was passively moved until the elbow finally reached to the target angle, and participants reached the left index finger to the right middle fingertip. The locus of the right middle fingertip indicated by the participants deviated in the direction of the elbow extension when vibration was provided to the biceps brachii muscle during the passive movement. This finding indicates that proprioception contributes to the identification of the spatial coordinate of the specific body part in an external reference frame. In another session, the tactile stimulus was provided to the dorsal of the right hand during the passive movement, and the participants reached the left index finger to the spatial locus at which the tactile stimulus was provided. Vibration to the biceps brachii muscle did not change the perceived locus of the tactile stimulus indicated by the left index finger. This finding indicates that an external reference frame does not contribute to tactile localization during the passive movement. Humans may estimate the spatial coordinate of the tactile stimulus based on the time between the movement onset and the time at which the tactile stimulus is provided.

Cure of Fingertip Necrosis after Median Nerve Block Application in Two Cases of Definite and Probable Systemic Sclerosis.

One patient with systemic sclerosis with index fingertip necrosis and another with probable systemic sclerosis with index and middle fingertip impending necrosis were successfully treated with ultrasound-guided median nerve block application on the affected side. The nailfold temperatures of the affected fingers measured using thermography were below 25°C. Immediately after application, the temperature increased substantially. After repeated applications, the mean basal temperature on the affected side increased by 3.6°C in Case 1 and by 5.9°C in Case 2. Peripheral nerve block can be a basic treatment for fingertip necrosis. The thermographical observation of the extent and region in which the temperature increased is novel.

The thermal sensation threshold and its reliability induced by the exposure to 28 GHz millimeter-wave.

The application of 28 GHz millimeter-wave is prevalent owing to the global spread of fifth-generation wireless communication systems. Its thermal effect is a dominant factor which potentially causes pain and tissue damage to the body parts exposed to the millimeter waves. However, the threshold of this thermal sensation, that is, the degree of change in skin temperature from the baseline at which the first subjective response to the thermal effects of the millimeter waves occurs, remains unclear. Here, we investigated the thermal sensation threshold and assessed its reliability when exposed to millimeter waves. Twenty healthy adults were exposed to 28 GHz millimeter-wave on their left middle fingertip at five levels of antenna input power: 0.2, 1.1, 1.6, 2.1, and 3.4 W (incident power density: 27-399 mW/cm2). This measurement session was repeated twice on the same day to evaluate the threshold reliability. The intraclass correlation coefficient (ICC) and Bland-Altman analysis were used as proxies for the relative and absolute reliability, respectively. The number of participants who perceived a sensation during the two sessions at each exposure level was also counted as the perception rate. Mean thermal sensation thresholds were within 0.9°C-1.0°C for the 126-399 mW/cm2 conditions, while that was 0.2°C for the 27 mW/cm2 condition. The ICCs for the threshold at 27 and 126 mW/cm2 were interpreted as poor and fair, respectively, while those at higher exposure levels were moderate to substantial. Apart from a proportional bias in the 191 mW/cm2 condition, there was no fixed bias. All participants perceived a thermal sensation at 399 mW/cm2 in both sessions, and the perception rate gradually decreased with lower exposure levels. Importantly, two-thirds of the participants answered that they felt a thermal sensation in both or one of the sessions at 27 mW/cm2, despite the low-temperature increase. These results suggest that the thermal sensation threshold is around 1.0°C, consistent across exposure levels, while its reliability increases with higher exposure levels. Furthermore, the perception of thermal sensation may be inherently ambiguous owing to the nature of human perception.

The influence of the digital pulse wave reference point on the pulse transit time measurement and variability

By measuring pulse wave velocity (PWV) via an arterial route, one can determine the stiffness of the artery. The duration between the ECG R-wave climax and a reference point on the digital pulse wave (DPW) in the same cardiac cycle must be determined in order to determine the pulse transit time (PTT). The time it takes for a pulse wave to travel from the heart to a peripheral artery location is known as the PTT. To find out the best reference point on the DPW that is associated with the least beat-beat coefficient of variation (CV) of PWV. The study was carried out on 10 healthy young males aged 19 years. A two-minute recording of the left middle fingertip DPW signals (through piezoelectric Finger Pulse Transducer) and lead II ECG (through three surface electrodes) were carried out. PTT was calculated as follows: from the climax of the electrocardiogram R wave to the onset (foot) of the DPW (PTT1); from the apex to the onset points of the DPW at 10% of its amplitude (PTT2); and from the apex to the onset points of the DPW at 50% of its amplitude (PTT3). PTT1, PTT, and PTT3 were measured on each volunteer and on the same cardiac cycles.

Vascular stiffness in cold pressor test hyper-reactors

Abstract Background: The cold pressor test (CPT) is a sympathoexcitatory manoeuvre to measure cardiovascular hyperactivity which may be a sign of future hypertension development. Aims and Objectives: To evaluate the vascular stiffness background among healthy CPT hyper-reactor (H-R) males and age and gender-matched normo-reactors (N-R). Methods: The study was carried out in 34 healthy young males aged 19 years old. Five minutes of recordings of left middle fingertip digital pulse wave (DPW) signals (through a piezoelectric finger pulse transducer) were registered. This was followed by the application of a cold pressor. Blood pressure (BP) and heart rate (HR) during CPT were recorded, and the individuals were divided into N-Rs and H-Rs. Vascular stiffness indices like pulse wave velocity (PWV), B/A wave ratio, pulse rising time (PRT, or crest), large artery stiffness index (SI), and pulse width (PW) were compared between H-Rs and N-Rs. Results: No significant differences were observed between the two groups across all studied parameters. Conclusion: The results suggest there was no difference in the vascular stiffness background between CPT H-R and N-R individuals.

Associations among serum VEGF and CGRP levels with the peripheral vascular blood flow of the skin of the hands in women with Fibromyalgia

BackgroundFibromyalgia (FM) is a long-term condition of unknown physiopathology, whose hallmark symptoms are diffuse musculoskeletal chronic pain and fatigue. ObjectivesWe aimed to analyze the associations among serum vascular endothelial growth factor (VEGF) and calcitonin gene-related peptide (CGRP) levels with the peripheral temperature of the skin of both hands and the core body temperature in patients with FM and healthy controls. MethodsWe conducted a case-control observational study with fifty-three women diagnosed with FM and twenty-four healthy women. VEGF and CGRP levels were spectrophotometrically analyzed in serum by enzyme-linked immunosorbent assay. We used an infrared thermography camera to assess the peripheral temperature of the skin of the dorsal thumb, index, middle, ring, and pinkie fingertips and dorsal centre as well as the palm thumb, index, middle, ring, and pinkie fingertips, palm centre and thenar and hypothenar eminences of both hands and an infrared thermographic scanner to record the tympanic membrane and axillary temperature. ResultsLinear regression analysis adjusting for age, menopause status, and body mass index showed that serum VEGF levels were positively associated with the maximum (β = 65.942, 95% CI [4.100,127.784], p = 0.037), minimum (β = 59.216, 95% CI [1.455,116.976], p = 0.045), and mean (β = 66.923, 95% CI [3.142,130.705], p = 0.040) temperature of the thenar eminence of the non-dominant hand, as well as with the maximum temperature of the hypothenar eminence of the non-dominant hand (β = 63.607, 95% CI [3.468,123.747], p = 0.039) in women diagnosed with FM. ConclusionsMild associations were observed between serum VEGF levels and the peripheral temperature of the skin in hand areas in patients with FM; therefore, it is not possible to establish a clear relationship between this vasoactive molecule and vasodilation of the hands in these patients.

Tactile Perception of Right Middle Fingertip Suppresses Excitability of Motor Cortex Supplying Right First Dorsal Interosseous Muscle

The present study examined whether tactile perception of the fingertip modulates excitability of the motor cortex supplying the intrinsic hand muscle and whether this modulation is specific to the fingertip stimulated and the muscle and hand tested. Tactile stimulation was given to one of the five fingertips in the left or right hand, and transcranial magnetic stimulation eliciting motor evoked potential in the first dorsal interosseous muscle (FDI) or abductor digiti minimi was given 200 ms after the onset of tactile stimulation. The corticospinal excitability of the FDI at rest was suppressed by the tactile stimulation of the right middle fingertip, but such suppression was absent for the other fingers stimulated and for the other muscle or hand tested. The persistence and amplitude of the F-wave was not significantly influenced by tactile stimulation of the fingertip in the right hand. These findings indicate that tactile perception of the right middle fingertip suppresses excitability of the motor cortex supplying the right FDI at rest. The suppression of corticospinal excitability was absent during tonic contraction of the right FDI, indicating that the motor execution process interrupts the tactile perception-induced suppression of motor cortical excitability supplying the right FDI. These findings are in line with a view that the tactile perception of the right middle finger induces surround inhibition of the motor cortex supplying the prime mover of the finger neighboring the stimulated finger.

Impact Vibration Source Localization in Two-Dimensional Space Around Hand.

This article investigated the localization ability of an impulse vibration source outside the body in two-dimensional space. We tested whether humans can recognize the direction or distance of an impulse vibration source when using their hand to detect spatiotemporal vibrotactile information provided by the propagated vibrational wave from the source. Specifically, we had users put their hands on a silicone rubber sheet in several postures. We asked users to indicate the position of the vibration source when a location on the sheet was indented. Experimental results suggested that the direction of the impact vibration source can be recognized to some extent, although recognition accuracy depends on hand posture and the position of the vibration source. The best results were achieved when the fingers and palm were grounded and a vibration source was presented around the middle fingertip, and the directional recognition error in this case was 6 °. In contrast, results suggest it is difficult to accurately recognize the distance of the vibration. The results of this study suggest a new possibility for directional display where vibrotactile actuators are embedded at a distance from the user's hand.

Novel device vs manual examinations for the measurement of cervical dilation in labor: a randomized controlled trial

Cervical dilation and changes in cervical dilation inform the management of labor, including decisions to admit a patient to the hospital, augment labor, or perform a cesarean delivery. Practitioners routinely measure cervical dilation subjectively using 2 fingers on manual examination; however, agreement of ≤1 cm between 2 observers has been reported as 60% to 91% previously in laboring women. To evaluate the agreement among different providers' examinations using DilaCheck (interexaminer agreement) compared with interexaminer agreement between 2 manual examinations for cervical dilation of women in labor. Women admitted in labor to a labor and delivery service were randomized to receive 2 cervical examinations from trained providers, using either a novel device (DilaCheck) or the standard manual examination. This randomized controlled trial compares a novel device with the standard method of manual examination for the measurement of cervical dilation. The novel device consisted of a string measuring tape suspended between 2 soft plastic rings worn on the index and middle fingertips. Interobserver agreement, defined as the agreement (exact, ≤1 cm [primary outcome], or ≤2 cm) in the numeric cervical dilation measurement obtained by 2 different examiners, was compared between the 2 groups. A total of 42 women in labor were randomized, 21 to the novel device and 21 to the standard manual examination groups. The 2 device examinations agreed in 19% of cases, whereas manual examinations agreed exactly in 42.9% of cases (P=.10). Interobserver agreement of ≤1 cm was 61.9% vs 95.2%, respectively (P=.008). Interobserver agreement of ≤2 cm was 90.5% vs 100%, respectively (P=.15). Most interobserver disagreement was seen at 5 to 7 cm of cervical dilation. A novel device, DilaCheck, intended for a more objective cervical assessment of women in labor did not improve interobserver agreement; in fact, it decreased it. Standard cervical dilation examinations result in poor interexaminer exact agreement, usually at best 50% or less. Clinical management should be based on clinical differences of >1 cm because, in general, 90% of cervical examinations will agree within 1 cm of each other. Given the importance of dilation measurements in the management of labor, continued innovation in this field would benefit women in labor and the providers caring for them; however, the puzzle remains unsolved.

Somatotopic Arrangement of the Human Primary Somatosensory Cortex Derived From Functional Magnetic Resonance Imaging.

Functional magnetic resonance imaging (fMRI) was used to estimate neuronal activity in the primary somatosensory cortex of six participants undergoing cutaneous tactile stimulation on skin areas spread across the entire body. Differences between the accepted somatotopic maps derived from Penfield's work and those generated by this fMRI study were sought, including representational transpositions or replications across the cortex. MR-safe pneumatic devices mimicking the action of a Wartenberg wheel supplied touch stimuli in eight areas. Seven were on the left side of the body: foot, lower, and upper leg, trunk beneath ribcage, anterior forearm, middle fingertip, and neck above the collarbone. The eighth area was the glabella. Activation magnitude was estimated as the maximum cross-correlation coefficient at a certain phase shift between ideal time series and measured blood oxygen level dependent (BOLD) time courses on the cortical surface. Maximally correlated clusters associated with each cutaneous area were calculated, and cortical magnification factors were estimated. Activity correlated to lower limb stimulation was observed in the paracentral lobule and superomedial postcentral region. Correlations to upper extremity stimulation were observed in the postcentral area adjacent to the motor hand knob. Activity correlated to trunk, face and neck stimulation was localized in the superomedial one-third of the postcentral region, which differed from Penfield's cortical homunculus.

Somatosensory evoked potentials that index lateral inhibition are modulated according to the mode of perceptual processing: comparing or combining multi-digit tactile motion

ABSTRACT Many perceptual studies focus on the brain’s capacity to discriminate between stimuli. However, our normal experience of the world also involves integrating multiple stimuli into a single perceptual event. Neural mechanisms such as lateral inhibition are believed to enhance local differences between sensory inputs from nearby regions of the receptor surface. However, this mechanism would seem dysfunctional when sensory inputs need to be combined rather than contrasted. Here, we investigated whether the brain can strategically regulate the strength of suppressive interactions that underlie lateral inhibition between finger representations in human somatosensory processing. To do this, we compared sensory processing between conditions that required either comparing or combining information. We delivered two simultaneous tactile motion trajectories to index and middle fingertips of the right hand. Participants had to either compare the directions of the two stimuli, or to combine them to form their average direction. To reveal preparatory tuning of somatosensory cortex, we used an established event-related potential design to measure the interaction between cortical representations evoked by digital nerve shocks immediately before each tactile stimulus. Consistent with previous studies, we found a clear suppression between cortical activations when participants were instructed to compare the tactile motion directions. Importantly, this suppression was significantly reduced when participants had to combine the same stimuli. These findings suggest that the brain can strategically switch between a comparative and a combinative mode of somatosensory processing, according to the perceptual goal, by preparatorily adjusting the strength of a process akin to lateral inhibition.

Wearable Laser Doppler Flowmetry Sensor: A Feasibility Study with Smoker and Non-Smoker Volunteers.

Novel, non-invasive wearable laser Doppler flowmetry (LDF) devices measure real-time blood circulation of the left middle fingertip and the topside of the wrist of the left hand. The LDF signals are simultaneously recorded for fingertip and wrist. The amplitude of blood flow signals and wavelet analysis of the signal are used for the analysis of blood perfusion parameters. The aim of this pilot study is to validate the accuracy of blood circulation measurements recorded by one such non-invasive wearable LDF device for healthy young non-smokers and smokers. This study reveals a higher level of blood perfusion in the non-smoker group compared to the smoker group and vice-versa for the variation of pulse frequency. This result can be useful to assess the sensitivity of the wearable LDF sensor in determining the effect of nicotine for smokers as compared to non-smokers and also the blood microcirculation in smokers with different pathologies.

Investigation of the Closed Kinetic Chain Upper Extremity Stability Test in elite canoe/kayak slalom athletes

ObjectiveTo investigate the correlation of arm length with different CKCUEST measures and determine if a modification of the test position (modified-CKCUEST), or normalisation of the CKCUEST (normalised-CKCUEST) score after testing, control for arm length most effectively. Study designQuasi Experimental. SettingBritish Canoe Slalom National Training Centre. ParticipantsThirteen (5 male, 8 female) asymptomatic national squad canoe/kayak slalom athletes were recruited during winter profiling. Main outcome measureThree measures of the CKCUEST were investigated. The CKCUEST, hands 36 inches apart; modified-CKCUEST, hands arm width apart (measured as C7 spinous process to tip of middle finger); and normalised-CKCUEST (measured as CKCUEST score/arm length). ResultsA significant positive correlation was found between arm length and the CKCUEST score (r = 0.807; p = 0.001) and normalised-CKCUEST score (r = 0.654; p = 0.015). No significant correlation was found between the modified-CKCUEST score and arm length (p = 0.745). A statistically significant difference between narrow and wide hand positions, greater than the minimal detectable change, was found (p = 0.000). ConclusionsArm length has a significant impact on CKCUEST score. The modified-CKCUEST score corrected for arm length where the normalised-CKCUEST score did not. Modifying the CKCUEST to individual anthropometrics needs to be performed pre-testing when comparisons are being made between individuals or groups.

Advanced Glycation End Product Accumulation in Subjects with Open-Angle Glaucoma with and without Exfoliation.

Advanced glycation end products (AGEs), which are the products of a non-enzymatic reaction between reducing sugars and other macromolecules, are critical in aging, as well as metabolic and degenerative diseases. To assess the involvement of AGEs in glaucoma, skin autofluorescence (sAF) level, which is a measurement of AGEs’ accumulation, was compared among Japanese patients with glaucoma (316 with primary open-angle glaucoma (PG) and 127 exfoliation syndrome and glaucoma (EG)) and controls (133 nonglaucomatous controls) (mean age 71.6 ± 12.8 years, 254 men and 322 women). The sAF values were estimated from the middle fingertip using a 365 nm light-emitting diode for excitation and detection at 440 nm emission light. The estimated AGE values (arbitrary unit) were 0.56 ± 0.15, 0.56 ± 0.11, and 0.61 ± 0.11 in the control, PG, and EG groups, respectively (p < 0.0001, analysis of variance); and were significantly higher in the EG group than the control (p = 0.0007) and PG (p < 0.0001) groups. After adjustment for various demographic parameters by multivariate analyses, male sex (standard β = 0.23), EG (0.19), and diabetes (0.09) were associated with higher AGE levels; PG (−0.18) and smoking (−0.19) were associated with lower AGE levels. Age, visual acuity, intraocular pressure, glaucoma medications, lens status, and systemic hypertension were not associated with AGEs. The high AGE level in EG suggested that specific oxidation and glycation mechanisms underlie the glaucoma pathogenesis associated with pseudoexfoliation syndrome.

A Cross Sectional Study on Middle Finger Tip Pinch, Ring Finger Tip Pinch, Little Finger Tip Pinch Strengths : The Correlations with Anthropometric Variables in North Indian Population

Introduction: Pinch strength in addition to handgrip strength is considered an important factor in the assessment of proper hand muscle function. Various parameters like nutritional status, physical activities and muscle pathologies can affect the overall gripping capabilities of the fingers .The unique abilities of opposition in human hand is because of the distinct articular surfaces in the miniature bones and intrinsic muscles of the hand. Due to fine neuromuscular coordination and sensory perception in the digits, firm grasping abilities and in the hand pinches have developed. These grasps can be very useful for sensory and motor capabilities of the hand specially in sports like cricket, baseball and volleyball. AIM: To generate data for middle finger tip pinch, ring finger tip pinch, little finger tip pinch strengths and to evaluate their correlations with other anthropometric indices. Materials and Methods: Four hundred and fifty healthy young adult individuals were selected for the study. A pinch gauze was used to measure pinch grip strengths in both the sides. Pearson’s correlation test and independent t-tests were used. SPSS Version 20 was used for statistical analysis. Result: Mean age of the population was 22 years and all the subjects were males. Pinch grip strength in all the pinches were found to be greater in dominant side than non dominant side (p<0.001). There was significant association between middle finger tip pinch and anthropometric indices. No statistically significant correlation of little finger tip pinch with waist circumference, waist to hip ratio and BMI was observed. Conclusion: The analysis provides normative data for pinch grip strengths and their correlation with other anthropometric indices in adult North Indian population.

Role of Hand and Foot Print Dimensions in Stature Identification among Indian Population

Introduction: The four essential factors in Forensic Anthropology, representing in determining personal identification are age, sex, stature and ethnicity. Among this ‘big fours’ of the biological profile, determination of stature is considered as one of the main parameter of personal identification in forensic examinations. Thus, this study will aim to correlate relation between hand and foot measurements with stature of individual. Aim of the study: The study aimed to estimate the relationship between statures of an individual on the basis of hand and foot prints, in Indian populations. Materials and Method: The study group comprised of 100 subjects (age group above 18 years) with normal growth and development. Measurement of height: The measurements of height was made using standard anthropometer by making the subject stand erect on the horizontal plane. The distance of the subject from the ground to the highest point of the vertex in the median sagittal plane was recorded. a) Hand length and Hand breadth: Hand length (HL) was measured from mid-point below radial and ulnar tuberosity to tip of middle finger. Hand breadth (HB) was measured from base of 5th to 2nd metacarpus by drawing the outline of hand on paper. b) Foot length and breadth: The foot length was measured as a direct distance from the most posterior point of back to tip of the Hallux or to tip of the second toe .The foot breadth was measured as the direct distance between the most prominent point on medial side and the most prominent on lateral side. d) Heel Ball Index Measurement The breadth of the foot at ball and at heel (BBAL, BHEL) were measured. The HB Index of the foot was calculated as (BHEL+ BBAL) x 100. Results: Correlation of the various hand and foot parameters showed a regression coefficient range of 0.331-0.377. Among all variables measured, hand length exhibited the highest correlation with stature (r value of 0.377 p-value < 0.003). Further forward stepwise linear regression analysis [Height = 115.426+2.615* Hand length (Left)] established hand length to be the single best predictor of height (r value of 0.377 and standard error of 7.35cms). Conclusion: Thus, the foot length provides highest reliability and accuracy in estimating stature of unknown males and females. Also this study will help to generate population-specific equations using a simple linear regression statistical method.

Anemia prevalence, severity and associated factors among children aged 6\u201371\u2009months in rural Hunan Province, China: a community-based cross-sectional study

BackgroundIn recent 10 years, with the rapid socioeconomic development and the extensive implementation of children nutrition improvement projects, the previous epidemiological data cannot reflect the actual level of anemia among children in China, especially in rural areas. Therefore, this study analyzed the prevalence, severity and associated factors of anemia among children aged 6–71 months in rural Hunan Province.MethodsA community-based cross-sectional study was conducted. Through multistage stratified cluster sampling, 5229 children aged 6 to 71 months and their caregivers were randomly selected from 72 villages across 24 towns in 12 counties from rural Hunan. The demographic characteristics of children and their caregivers, feeding practice, nutritional status of children, caregivers’ anemia-related feeding knowledge, and gestational conditions of mothers were acquired by using a unified questionnaire. Peripheral blood from the left-hand middle fingertip was sampled from each child, and hemoglobin concentration was measured using a HemoCue301 portable hemoglobin analyzer (Sweden). Associated factors analyses involving overall anemia and anemia severities were conducted on multivariate logistic regression models.ResultsThe overall anemia prevalence was 8.8%, and the prevalence of mild, moderate and severe anemia was 6.3, 2.5 and 0.1%, respectively. Children age groups of 6–11 months, 12–23 months and 36–47 months, exclusive breast-feeding within 6 months after birth, and maternal moderate/severe anemia were significantly associated with an increased risk of overall anemia in children. Children age groups of 6–11 months and 12–23 months were significantly associated with an increased risk of mild anemia in children. Children age groups of 6–11 months, 12–23 months and 36–47 months, low caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia were significantly associated with an increased risk of moderate/severe anemia in children. Children who underwent regular physical examination were less likely to have moderate/severe anemia. The common protective factor for overall, mild and moderate/severe anemia in children was high family income.ConclusionsThe anemia status of preschool children in rural Hunan Province was a mild public health problem and associated with children age group, feeding practice, regular physical examination, family income, caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia.

P1688 Rare cause of acute heart failure in patient with scleroderma

Abstract A 32-year old female patient, known to have scleroderma, presented with symptoms of recurrent attacks of palpitations, dyspnea (NYHA class III) &amp; dizziness for 3 days before presentation. No chest pain or syncope. Physical examination at presentation revealed hemodynamic instability (BP: 80/50 mmHg, HR: 200 bpm/ regular thready pulse with fine bilateral basal chest crackles. ECG revealed ventricular tachycardia (figure 1), so electrical cardioversion was immediately done upon which the reverted to multifocal atrial tachycardia with RBBB and restoration of hemodynamics and disappearance of chest crackles. She also had thickening of the fingertips’ skin, amputated tip of the right middle finger with severe associated Raynaud’s phenomenon, skin tightness of both upper and lower limbs, Buccal buckling with limited mouth opening (figure 2 and 3). Renal function and serum electrolytes were normal with elevated troponin I, creatine kinase and CK-MB serum levels. Echocardiogram showed mild concentric LV hypertrophy with normal internal dimensions and severely impaired systolic function (EF∼ 20%) with severe global hypokinesia . The RV was also dilated and impaired (TAPSE∼8 mm). Mild pericardial effusion with no chamber collapse (Figure 4, 5 and 6). Coronary angiography revealed normal epicardial coronaries. Echocardiography one month prior to presentation revealed normal LV dimensions, preserved systolic function and mild diastolic dysfunction with no resting wall motion abnormalities, upper normal RV size with preserved RV systolic function and mild elevation of pulmonary artery systolic pressure. The presence of new acute biventricular failure in the absence of CAD and elevated cardiac biomarkers are highly suggestive of acute myocarditis. Medical therapy included loop diuretics, angiotensin-converting-enzyme inhibitor, beta-blocker and aldosterone receptor antagonist. She was discharged in NYHA I-II, with normal cardiac enzymes and left ventricle ejection fraction of 30% and resolution of the pericardial effusion. Discussion Scleroderma is rarely present with impaired LV contractility but more commonly presented with diastolic dysfunction (in up to 40% of cases) (1,2). This case was presented with acute myopericarditis with severe biventricular systolic dysfunction which is very rare with scleroderma and only mentioned in few case studies, so no consensus on specific treatment. Few patients with myocarditis and scleroderma were treated with immunosuppressants along with diuretics, beta-blockers, and ACE inhibitors with most of them showed improvement clinically with recovery of systolic function after 12 months of follow up (3). We noted improvement of patient symptoms within few days of diuretics, beta-blockers, Aldosterone antagonists and ACE inhibitors. This case had baseline conduction abnormalities (RBBB with multifocal atrial tachycardia) which could be present in up to 20% of cases (4). Abstract P1688 Figure.

Analysis of the impact of age and work experience on palpatory skills of visually impaired and sighted massage therapists

Introduction: Palpation is a basic diagnostic tool. However, difficulties in obtaining unambiguous results make it less reliable. Questions about the reliability of palpation are still valid. The abilities of people who use this type of examination and factors which affect palpation must also be taken into consideration. Aim: Analysis was conducted by means of an experimental study without randomisation. Its aim was to determine the influence of age and work experience on the palpatory skills of massage therapists. Materials and methods: 58 people were studied. They were divided into 2 groups. The first group consisted of 45 massage therapists (students or practitioners). The control group consisted of 13 people with no massage experience. The studied people were subjected to the “hair test”, the “weight test” and the measurement of Static Two-Point Discrimination (STPD) within the thumb-middle fingertips, the thenar and hypothenar. Results: The level of STPD worsens with age in the index and middle fingertips. In the study group, work experience positively influenced the “hair test” and STPD within the thumb and the index finger. In the other tests, the factor of age and work experience did not determine the results. Conclusions: In the research, it is indicated that there are factors affecting palpation skills. However, it is not possible to observe the influence of the analysed factors in each test. This is due to a variety of tests and areas to be measured. Work experience was considered a factor positively affecting palpation skills. Age was considered a factor worsening the tested abilities.