Wrist Motion Research Articles

Research on the difference of stroke characteristics and stroke effect between different stroke duration of table tennis players

This study aimed to explore the differences in joint kinematic characteristics and stroke effect between fast and slow strokes of table tennis players. Thirty-four table tennis players were randomly selected as participants for this experiment. A high-speed infrared motion capture system was used to collect kinematic data of the right-side upper and lower limb joints during strokes. Simultaneously, a high-speed camera was used to measure the stroke effect. According to the duration of a stroke, the stroke data were classified into two types: fast-stroke and slow-stroke using a two-step clustering algorithm. The duration of the three phases of fast-stroke was shorter, with faster ball speed and stronger spin. Compared with slow-stroke, fast-stroke exhibited shorter displacements in the three lower limb joints and faster linear velocities in the three upper limb joints. In addition, the motion angles of the knee and ankle joints were smaller, while the angles of the hip, shoulder, and elbow joints were larger, with higher angular velocities. Increasing the extension speed of the lower limbs, the flexion speed of the elbow joints, and the wrist movement speed can achieve fast strokes, enhancing ball speed and spin. Small and quick hip joint movement can effectively transfer energy to the upper limbs, increasing the movement speed of the elbow and wrist joints, thus improving the ball speed and spin of the stroke.

Application of distal radius coronal bone structure matching in the treatment of distal radius fractures

To investigate the clinical effect of coronal bone structure matching(CBSM)in the treatment of distal radius fracture. A total of 39 cases of distal radius fracture between Jannary 2018 and Jannary 2022 were included in this study. Among them there were 22 males and 17 females with an average age of (48.9±16.3) years old, ranged from 22 to 65 years old. All patients were treated with open reduction and internal fixation with plates. Based on the measurement of CBSM value on the X-ray film the next day after surgery. All patients were divided into matched group and mismatched group according to the coronal bone structure matching in the normal range or not. There were 27 patients in the matched group, including 15 males and 12 females, the age ranged from 22 to 64 years old with an average of (48.0±16.2) years old. AO classification of fracture was C1 in 6 cases and C2 in 21 cases;the operation time ranged from 1 to 6 days after injury;9 cases were complicated with ulnar styloid process fracture. There were 12 patients in the mismatched group, including 7 males and 5 females;the age ranged from 22 to 65 years old with an average of (48.8±15.8) years old. AO classification of fracture was C1 in 4 cases and C2 in 8 cases;the time from injury to operation ranged from 1 to 5 days;4 cases were complicated with ulnar styloid process fracture. The X-ray films were used to evaluate fracture healing, humeral height, ulnar angle and palm tilt angle at 3 months after operation. The range of wrist motion(pronation, supination, palmar inclination and dorsiflexion), function outcomes(Gartland-Werley score) and pain levels (visual analogue scale, VAS) were compared between the two groups at the last follow-up. The average follow-up time of 39 patients were(9.5±4.3)months, ranged from 6 to 14 months. All patients healed in one stage without postoperative infection, fracture nonunion and fracture displacement occurred. Compared with match group at the last follow-up, the VAS in the mismatch group was increased[(2.5±1.3)points vs (1.6±1.0)points], the wrist pronation were decreased[(70.5±12.6)° vs (80.5±9.4)°], with statistically significant difference(P<0.05). There was no significant difference in the range of motion(supination, palmar inclination, dorsiflexion)and excellent good rate between the two groups at last follow-up after operation (P>0.05). Wrist dysfunction, limited pronation, and wrist pain may occur when the postoperative matching degree of the distal radius fracture is not within the normal range.

A Rapid Adaptation Approach for Dynamic Air-Writing Recognition Using Wearable Wristbands with Self-Supervised Contrastive Learning

HighlightsUtilizing self-supervised learning, the proposed wearable wristband with a four-channel sensing array and wireless transmission module is developed for tracking air-writing and dynamic gestures.The model can learn prior features from unlabeled signals of random wrist movements, significantly reducing the dependency on extensive labeled data for training.The wristband system rapidly adapts to multiple scenarios after fine-tuning using few-shot data, enhancing user interaction through natural and intuitive communication.

Leveraging wearable sensors and machine learning for posture-based detection of carpal tunnel syndrome

Abstract Carpal tunnel is associated with long-term use of the wrist and hand for various activities such as typing, welding, or poor working postures. Carpal Tunnel Syndrome (CTS) may cause severe pain and discomfort in the hand and wrist, and in some circumstances, surgery becomes inevitable. The objective of this study is to prevent typing postures, which can be ascertained as predisposing subjects to CTS development. The data used in this study is an array of wrist wearable sensors to capture flexion, extension, and bending of fingers while using a keyboard or mouse. Machine learning is employed on the data in order to identify risk factors indicative of a high probability of CTS. The analyzed models are linear regression, Support Vector Machine, Random Forest, Multilayer Perceptron, Convolution Neural Network, and Long Short Term Memory. The conditions for assessing the performance of the data models include RMS error, coefficients of determination, and mean absolute percentage error. In this research, I conducted an exploratory data analysis (EDA) to gain an initial understanding of the dataset. Following the exploratory phase, I applied feature extraction techniques, specifically Principal Component Analysis (PCA). As put forward for the proposed research, the strategies to prevent risky occupations have broad potential at the present time, especially in the case of CTS when preventing repetitive wrist movements.

Silver oxide integrated ionic polymer composite for wearable sensing and water purification

Integrating metal nanoparticles (NPs) with ionic polymer blends/composites showed immense interest for their potential in wearable sensors, soft robotic arms, flexible man-machine interfaces of biomedical devices, and water purification applications. However, conventional NPs attached ionic polymer composites exhibit limitations such as low sensitivity (ΔR/R), low total dissolved solids (TDS) reduction, and low phosphate (PO4-P) removal rate. Herein, ionic polymer composites (IPCs) using flower-shaped silver oxide (Ag2O) attached Poly (vinylidene fluoride) (PVDF)/ polyvinylpyrrolidone (PVP)/ionic liquid (IL) were designed and developed for wearable sensing and water purification. The IPCs demonstrated remarkably high ΔR/R values of 50, 10, and 3.5 corresponding to the wrist movement of 50°, finger movement of 180°, and chin movements respectively. The Ag2O-based IPC recorded a significant reduction of TDS from sewage water from 3405 ppm to 1035 ppm, elevated the dissolved oxygen (DO) levels in the sewage water from 1.2 mg/l to 6.8 mg/l, and removed approximately 87.38 % phosphate from sewage water. Due to the uniform distribution of Ag2O within pores of IPC, it demonstrated enhanced performance for wearable and wastewater treatment applications.

Improving manual dexterity using ergonomic wearable glove in patients with multiple sclerosis: A quasi-randomized clinical trial

One main problem faced by people with multiple sclerosis (PwMS) is upper limb dysfunction, which can occur in the first decade of the disease and with the highest prevalence of disability in the progressive type of the disease. Then, PwMS may benefit from personalised and intensive treatment as provided by robotic devices. These innovative devices have increasingly been brought into the neurorehabilitation field, due to their ability to provide repetitive and task-oriented training. In this quasi-randomized study, we aim to evaluate the effects of robotic-assisted hand training, using the Hand TutorTM device, on hand functionality, active RoM, and manual dexterity, compared to conventional rehabilitation in PwMS. We enrolled 30 MS patients, who received 20 training sessions, each lasting 45 min with robotic-assisted hand training with Hand Tutor (n 15, experimental group) or conventional rehabilitation therapy (n 15, control group). All patients were evaluated at pre- and post-intervention with clinical scales for upper limb functionality (DASH, BBT, NHPT, and MI). In addition, only patients in the experimental group received an objective kinematic analysis of the hand and wrist movements, delivered by the Hand Tutor glove, both pre- and post-intervention. We found that PwMS in both groups statistically improved their upper limb functions, however the experimental group achieved better results in terms of manual dexterity. This promising rehabilitation training with Hand Tutor glove led to positive effects on upper limbs motor outcomes and kinematic parameters in patients with MS.

Neuro-Musculoskeletal Modeling for Online Estimation of Continuous Wrist Movements from Motor Unit Activities.

Decoding movement intentions from motor unit (MU) activities remains an ongoing challenge, which restricts our comprehension of the intricate transition mechanism from microscopic neural drive to macroscopic movements. This study presents an innovative neuro-musculoskeletal (NMS) model driven by MU activities for online estimation of continuous wrist movements. The proposed model employs a physiological and comprehensive utilization of MU firings and waveforms, thus facilitating the localization of MUs to muscle-tendon units (MTU) as well as the computation of MU-specific neural excitation. Subsequently, the MU-specific neural excitation was integrated to form the MTU-specific neural excitation, which were then inputted into a musculoskeletal model to accomplish the joint angle estimation. To assess the effectiveness of this model, high-density surface electromyography and angular data were collected from the forearms of eight subjects during their performance of wrist flexion-extension task. Two pieces of 8 × 8 electrode arrays and a motion capture system were employed for data acquisition. Following offline model calibration with a global optimization algorithm, online angle estimation results demonstrated a significant superiority of the proposed model over the state-of-the-art NMS models (p < 0.05), yielding the lowest normalized root mean square error (0.10 ± 0.02) and the highest determination coefficient (0.87 ± 0.06). This study provides a novel idea for the decoding of joint movements from MU activities. The research findings hold the potential to advance the development of NMS models towards the control of multiple degrees of freedom, with promising applications in the fields of motor control, biomechanics, and neuro-rehabilitation engineering.

A Study of Exergame System Using Hand Gestures for Wrist Flexibility Improvement for Tenosynovitis Prevention

Currently, as an increasing number of people have been addicted to using cellular phones, smartphone tenosynovitis has become common from long-term use of fingers for their operations. Hand exercise while playing video games, which is called exergame, can be a good solution to provide enjoyable daily exercise opportunities for its prevention, particularly, for young people. In this paper, we implemented a simple exergame system with a hand gesture recognition program made in Python using the Mediapipe library. We designed three sets of hand gestures to control the key operations to play the games as different exercises useful for tenosynovitis prevention. For evaluations, we prepared five video games running on a web browser and asked 10 students from Okayama and Hiroshima Universities, Japan, to play them and answer 10 questions in the questionnaire. Their playing results and System Usability Scale (SUS) scores confirmed the usability of the proposal, although we improved one gesture set to reduce its complexity. Moreover, by measuring the angles for maximum wrist movements, we found that the wrist flexibility was improved by playing the games, which verifies the effectiveness of the proposal.

A Comprehensive Review of Electromyography in Rehabilitation: Detecting Interrupted Wrist and Hand Movements with a Robotic Arm Approach

Electromyography (EMG) is a diagnostic technique that measures the electrical activity generated by skeletal muscles. Utilizing electrodes placed either on the skin (surface EMG) or inserted directly into the muscle(intramuscular EMG), it detects electrical signals produced during muscle contractions. EMG is widely employed in clinical and research settings to assess muscle function, diagnose neuromuscular disorders,and guide rehabilitation therapy. Over the years, EMG has evolved from a basic measurement tool into an essential technology within clinical and research environments, propelled by advances in recording techniques and digital innovations. The integration of wearable technology and artificial intelligence (AI) has significantly expanded its applications, particularly in rehabilitation and sports science. By capturing muscle electrical activity through surface or intramuscular electrodes, EMG benefits from enhanced signal processing that improves accuracy and data analysis. Despite challenges such as signal interference and the complexities of movement patterns—especially in wrist and hand rehabilitation—EMG combined with robotic systems offers real-time feedback for precise and personalized therapy. However, obstacles like cost, complexity, and variability among patients still remain. Future advancements aim to make EMG more accessible and to integrate AI for tailored rehabilitation strategies, alongside improvements in sensors and wireless communication to enhance reliability and performance. This review explores various facets of EMG,from its fundamental principles to its application in detecting disrupted wrist and hand movements through robotic approaches. It provides a comprehensive analysis of EMG’s historical and technological evolution, recent innovations like AI and wearable devices, and its extensive applications in rehabilitation and sports science. Detailed case studies illustrate its effectiveness in areas such as stroke recovery and spinal cord injury rehabilitation. Additionally, the review addresses challenges like technical limitations and patient variability while emphasizing the integration of EMG with robotic systems for personalized therapy. It also discusses the significance of real-time feedback, future enhancements in AI and sensor technology, and the pressing need for more affordable, user-friendly solutions to improve therapeutic outcomes.

Complications following total wrist replacement: A single-center retrospective review

Background/Purpose: Total wrist replacement (TWR) is an alternative to wrist fusion in advance wrist arthritis with the advantage of preserving the wrist motion. TWR is, however, infrequently performed in Asia-Pacific region. This study aimed to describe our institution's experience in managing complications following TWR. Methods: This study represents a single-center retrospective review of all patients who underwent TWR at the Department of Orthopedics and Traumatology, Prince of Wales Hospital in Hong Kong. The study period spans from 1 January 2004 to 1 March 2023. Recorded demographic parameters include gender, age upon surgery, pathology, types of implants, and follow-up period. Outcomes focused particularly on postoperative complications and need for revision surgery. Results: Twelve TWR from 10 Chinese-Asian patients were reviewed with a mean follow-up duration of 97.4 months. The incidence of complications in our study was as follows: loosening (16.67%), metallosis (8.3%), infection (8.3%), and stiffness (8.3%). One patient required conversion to total wrist arthrodesis due to metallosis and stiffness. Conclusion: TWR offers promising solutions for managing painful arthritic wrists. However, it's crucial to recognize that complications can arise, necessitating further surgical intervention. Surgeons must thoroughly comprehend these risks to provide informed counseling to patients and explore alternative treatment approaches.

Preparation of vascularized forearm dermal fat flap and repairing of donor site

Objective:This study prepared vascularized dermal fat flaps and introduced a local split-thickness skin graft from an in situ cutaneous area cutaneous area to manage forearm flap donor sites and evaluated the esthetic and functional outcomes post-operatively. From July 2020 to June 2023, 13 patients with soft tissue defects in Oral and Maxillary Area were repaired with tvascular forearm dermal fat flap. There were 8 males and 5 females, aged from 42-71 years. The flaps ranged from 8 cm×7 cm to 7 cm×5 cm in size. The donor site defects were covered by local split-thickness skin graft from the in situ skins. The color matching degree, surgical scars, ranges of wrist movement and hand sensations in donor forearms were assessed at 6 months after surgery. Results:The tvascular forearm dermal fat flaps for 15 cases all survived. All the local split-thickness skin grafts transplanted with this technique showed primary healing. The follow-up period for 6 months, Donor site exhibited suitabler color matching and there was not severe complications. Conclusion:The vascularized dermal fat flap provides an alternative to conventional forearm flap harvest, which enables primary donor site closure with reduced rates of delayed donor site healing. The vascularized dermal fat flap is a relatively reliable repair method for soft defects in Oral and Maxillary Area.

Negative emotions reduce sensorimotor cortex activity during proprioceptive modulation of rolandic ∼20HZ beta rhythm in typically developing children and those with neurodevelopmental conditions

BackgroundThe Rolandic ∼20-Hz beta rhythm of the sensorimotor cortex is associated with motor function and perception. However, the modulation of this rhythm by different emotional stimuli is an innovative area of research. AimsThis study aims at investigating the impact of affective pictures (positive, negative, and neutral) on the proprioceptive modulation of the Rolandic ∼20 Hz beta rhythm in typically developing children and children with neurodevelopmental disorders (i.e. cerebral palsy and autism). Methods and proceduresEEG was recorded while participants experienced passive wrist movements during the simultaneous viewing of affective pictures. Time-frequency analysis of the sensorimotor oscillatory activity was performed. Outcomes and resultsOur findings revealed that pictures with negative emotional valence notably diminish event-related synchronization (ERS) amplitude during the perception of hand movement in all groups of children. Conclusions and implicationsThese findings suggest that emotional stimuli, particularly the negative ones, could significantly influence brain's processing of proprioception, adding knowledge to the interaction of common comorbidities, such as sensorimotor disorders and emotional dysregulation, in children with neurodevelopmental disabilities.

Parallel 3-RSR Wrist Rehabilitation Mechanism and Motion Performance Analysis

In order to help patients with wrist injuries to carry out recovery training, a simple and portable parallel 3-RSR wrist rehabilitation mechanism was introduced in order to achieve the expected therapeutic effect. Firstly, the parallel 3-RSR wrist rehabilitation mechanism is described. Taking the parallel mechanism as the research object, the degree of freedom is calculated and the pose is solved by analytical method, which verifies the rationality of the mechanism motion. Then, based on the boundary search method, the reachable workspace of the parallel wrist rehabilitation mechanism is analyzed, and the relevant workspace map is drawn. Finally, considering the reasonable optimization of the structural size of the workspace, the results show that the optimized reachable attitude workspace is significantly larger than the initial workspace. This study provides a theoretical reference for the ontology design of rehabilitation institutions.

Tarans-Scaphoid Lunate Fracture Dislocation: A Case Report of a Rare Injury

Trans-scaphoid lunate dislocation is an uncommon injury but can be devastating, causing loss of wrist joint movement and function, and compromising grip strength. In this report, we present a case of a 48-year-old man with a history of psychiatric disorder who attempted suicide by jumping from the second floor. He sustained a volar lunate dislocation and scaphoid fracture, with migration of the proximal part of the scaphoid to the volar aspect of the forearm. Open surgical reduction was planned through a dorsal approach: first, the lunate was reduced, then the proximal part of the scaphoid was retrieved from the volar aspect of the forearm and anatomically fixed with a 2.5 mm headless screw. The scapholunate relationship was reduced and fixed with two wires through the scapholunate and scaphocapitate joints. The wound was closed in layers, and the wrist joint was immobilized with a dorsal splint for six weeks. Six weeks postoperatively, the K wires were removed, and the patient started physiotherapy. At three months postoperative follow-up, the wrist joint function was good, with good grip strength and a good range of motion. The gold standard treatment option is open reduction and fixation of the fractured bone and stabilization of the carpal bones in anatomical alignment to reduce possible complications such as median nerve compression, chronic carpal instability, chronic wrist pain, loss of grip strength, wrist arthritis, and carpal collapse.

Biomechanical analysis of cadaveric wrists before and after MOTEC wrist arthroplasty using a hexapod robot.

This study compares wrist motion, biomechanical behaviour and radiographic parameters before and after total wrist arthroplasty using a fourth-generation spherical articulation prosthesis. A total of 10 cadaveric specimens were assessed using a hexapod Stewart platform robot. After arthroplasty, there were significant increases in both stiffness and phase angle of wrist motion across all planes of motion assessed. In three specimens, a sudden increase in moment was observed on load/displacement curves. Radiographically, carpal height increased by 14%, and the centre of rotation was displaced 11.1 mm proximally, 4.6 mm dorsally and 3.9 mm radially. This stretched the musculotendinous units, tightening the joint, while increasing the moment arm of the wrist flexors and decreasing the moment arm of the extensors, potentially important in the development of postoperative flexion contractures. Possible alterations in technique and/or implant design are considered to assist surgeons in achieving optimal clinical and survivorship outcomes.

Long-term effectiveness of Ni-Ti memory alloy tripod fixator in treatment of Kienböck disease

To investigate the long-term effectiveness of Ni-Ti memory alloy tripod fixator in the treatment of Kienböck disease. The clinical data of 22 patients with Kienböck disease who were treated with Ni-Ti memory alloy tripod fixator between January 2011 and September 2013 and followed up more than 10 years was retrospectively analyzed. There were 14 males and 8 females with an average age of 45 years (range, 20-64 years). The Lichtman staging was stage Ⅲb. According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, there were 6 cases of type B1, 2 cases of type B2, 10 cases of type B3, and 4 cases of type C2. The disease duration ranged from 18 to 50 months, with an average of 30.7 months. The operation time, intraoperative blood loss, and complications were recorded. Wrist height ratio and scapholunate angle were measured by wrist anteroposterior and lateral X-ray films before and after operation. The grip strength of bilateral hands was measured by Jamar dynamometer. The wrist pain was evaluated by visual analogue scale (VAS) score, and the wrist function was evaluated by Mayo score, and the radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion of wrist were measured. The operation time was 45-60 minutes, with an average of 52.21 minutes; the intraoperative blood loss was 50-60 mL, with an average of 58.63 mL. No nerve or blood vessel injury occurred during operation. All patients were followed up 10-13 years (mean, 11.3 years). X-ray films at 3 months after operation showed that the density of lunate bone was lower than that before operation. Satisfactory fusion of the scapho-trapezio-trapezoeid joint was achieved at 3-6 months after operation (mean, 4.5 months), and the wrist height ratio and the scapholunate angle after fusion significantly improved when compared with those before operation ( P<0.05). Wrist pain relieved, scaphoid rotation and dislocation improved, and no radiocarpal joint degeneration was found during follow-up, and no internal fixator loosening, breakage, or lunate bone necrosis occurred. At last follow-up, the wrist radial deviation, ulnar deviation, dorsiflexion, and palmar flexion range of motion, VAS score, and grip strength of the affected side significantly improved when compared with those before operation ( P<0.05); the grip strength of the affected side recovered to 99.00%±1.25% of the healthy side. Mayo score ranged from 72 to 93, with an average of 85; 14 cases were rated as excellent, 5 good, and 3 satisfactory, the excellent and good rate was 86.4%. In the treatment of stage Ⅲb Kienböck's disease, the scapho-trapezio-trapezoeid joint usion using Ni-Ti memory alloy tripod fixator can effectively reduce pain, improve hand function, and prevent further deterioration, and achieve good long-term effectiveness.

Local Transplantation of Mesenchymal Stromal Cells Is Safe and Could Alleviate Kienböck Disease's Complications: A Clinical Trial Study.

Kienböck disease is a rare condition characterized by severe pain and restricted wrist movement. Various palliative methods have been proposed as therapeutic strategies for alleviating symptoms. Mesenchymal stromal cell transplantation has been suggested as an innovative and promising approach due to its potential for inducing regeneration and immunomodulation in the necrotic tissue. This study aims to evaluate the safety of autologous bone marrow derived mesenchymal stromal cells (BM-MSCs) transplantation after core decompression in Kienböck disease. In this phase I of an open-label clinical trial, three patients (one female and two males) with stage 2 Kienböck disease underwent autologous BM-MSCs transplantation following lunate core decompression. The patients were followed up for six months to assess safety as well as secondary clinical outcomes, including pain level, range of motion (ROM), and functional disability. Safety of BM-MSCs injection following the core decompression was evaluated by recording post-treatment complications during the six-month follow-up. No adverse events (AEs) or severe AEs (SAEs) were reported, indicating that BM-MSCs injection after core decompression is a safe intervention. All patients showed a remarkable reduction in visual analog scale (VAS) scores and "Disabilities of the Arm, Shoulder, and Hand" (DASH) questionnaire scores, suggesting the therapeutic potential of this intervention. Moreover, an increase in the ROM indicated that BM-MSCs transplantation can improve wrist functionality. Additionally, radiographic assessments before and after cell infusion demonstrated a reduction in lunate sclerosis after six months of follow-up. The transplantation of autologous BM-MSCs following lunate core decompression seems to be a safe clinical intervention and may lead to pain relief in patients with Kienböck disease. Furthermore, this procedure may help prevent disease progression during the follow-up period (registration number: NCT02646007).

Characterizing upper limb motor dysfunction with temporal and spatial distribution of muscle synergy extracted from high-density surface electromyography.

Objective.To promote the development of objective and comprehensive motion function assessment for patients, based on high-density surface electromyography (HD-sEMG), this study investigates the temporal and spatial variations of neuromuscular activities related to upper limb motor dysfunction.Approach.Patients with unilateral upper limb motor dysfunction and healthy controls were enrolled in the study. HD-sEMG was collected from both arms while they were performing eight hand and wrist movements. Muscle synergies were extracted from the HD-sEMG. Symmetry of bilateral upper limb synergies and synergy differences between motions were proposed as spatial indicators to measure alterations in synergy spatial distribution. Additionally, as a temporal characteristic, the correlation of bilateral upper limb activation coefficient was proposed to describe the coordination control of the central nervous system. All temporal and spatial indicators were compared between patients and healthy subjects.Main results.The patients showed a significant decrease (p< 0.05) in the symmetry of bilateral upper limb synergy spatial distribution and correlation of bilateral upper limb activation coefficient. Patients with motor dysfunction also showed an increase in synergy similarity between motions, indicating altered spatial distribution of muscle synergies.Significance.These findings provide valuable insights into specific patterns associated with motor dysfunction, informing motor function assessment, and guiding targeted interventions and rehabilitation strategies for neurologically disordered patients.

Strong and anti-swelling nanofibrous hydrogel composites inspired by biological tissue for amphibious motion sensors.

Conductive hydrogel-based sensors are increasingly favored for flexible electronics due to their skin-like characteristics. However, conventional hydrogels suffer from significant swelling in humid environments and poor mechanical properties which largely restrict their applications in wearable electronic devices, especially for underwater sensing. Herein, drawing inspiration from the extracellular matrix (ECM) structure, a TPU-PVAc@AgNPs/MXene nanofibrous hydrogel composite (TPAMH) with excellent mechanical robustness and anti-swelling properties is developed. The TPAMH nanofibrous hydrogel composite is created by integrating the silver nanoparticles (AgNPs) and MXene nanosheets into an interwoven network comprising of stiff TPU nanofibers as the fibril scaffold and formic acid-crosslinked PVA hydrogel fibers as the elastic matrix (PVAc). Benefiting from the unique ECM structure, the obtained nanofibrous hydrogel composites exhibit exceptional tensile strength (4.47 MPa), remarkable elongation at break (621%), excellent anti-swelling properties, and high detection sensitivity (maximum gauge factor = 105.02), which are sufficient to monitor body motions in both air and water environments effectively. They can detect large strain movements of fingers, elbows, wrists, and knees, as well as small strain physiological signals such as frown, smile, and pulse beats, with high accuracy. Particularly noteworthy is their ability to accurately identify underwater multidirectional motions and facilitate underwater smart alarms using Morse code.

Could trainees' finger placement at the surgeon's console affect overall outcomes of robotic surgery in radical prostatectomy? A prospective, blinded, robotic simulation pilot study.

Robotic surgery for localized prostate cancer offers a greater range of motion attributed to the EndoWrist instruments. Postoperative outcomes are linked to the quality of vesico-urethral anastomosis. Trainees frequently complain of suturing difficulty in a back-handed fashion. We aimed to analyze wrist motion using the DaVinci simulator. We hypothesized that using the thumb and index finger would allow superior surgical proficiency when compared to the middle finger. After institutional review board approval, we recruited 42 medical students in one academic medical center. Students were randomly assigned to start with their thumb and index finger (1&2) or thumb and middle finger (1&3). Three standardized modules were used with nine metrics calculated, including: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS. Three metrics were found to have differences between the finger placement of 1&3 compared to 1&2. The number of collisions, wound approximation, and penalty score where 1&3 were used had a lower score in each. The number of collisions was 5.7 less in the 1&3 finger placement (p=0.046). This metric was found to have statistically significant differences between finger placement where 1&3 had a lower score compared to 1&2. The wound approximation score was 0.2 points lower when using the 1&3 placement (p=0.075). Lastly, the penalty assigned was 6.5 points lower when using 1&3 (p=0.069). Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes when using 1&2 despite offering a wider range of motion. This may be due to decreased comfort in hand position. Trainees may be able to improve the effectiveness of their vesico-urethral anastomosis during robotic-assisted radical prostatectomy.