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Introduction: Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures. Methods: A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating (“skin-to-skin”) times. Results: A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 – 20.75) vs. OPF (36 minutes, IQR = 31.55 – 44; p < 0.001). Conclusion: Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations. Level of Evidence: Retrospective Comparative Study III

Abstract Human height is strongly influenced by genetics but the contribution of modifiable epigenetic factors is under-explored, particularly in low and middle-income countries (LMIC). We investigate links between blood DNA methylation and child height in four LMIC cohorts (n = 1927) and identify a robust association at three CpGs in the suppressor of cytokine signaling 3 (SOCS3) gene which replicates in a high-income country cohort (n = 879). SOCS3 methylation (SOCS3m)—height associations are independent of genetic effects. Mendelian randomization analysis confirms a causal effect of SOCS3m on height. In longitudinal analysis, SOCS3m explains a maximum 9.5% of height variance in mid-childhood while the variance explained by height polygenic risk score increases from birth to 21 years. Children’s SOCS3m is associated with prenatal maternal folate and socio-economic status. In-vitro characterization confirms a regulatory effect of SOCS3m on gene expression. Our findings suggest epigenetic modifications may play an important role in driving child height in LMIC.

During the COVID-19 pandemic, many children from limited-literacy communities in India did not receive information regarding COVID-19 safety due to the sudden shutdown of schools. Many parents from these communities could not afford virtual learning and lacked the ability to educate the children themselves. In July 2021, the research team developed comic, coloring, and activity books to provide children with fun, yet readable, educational materials. We consulted with teachers to simplify the language and understand the popularity of different cartoon characters. Between August 2021 and January 2022, our community health partners distributed the books to two age groups, ages 6–10 (n = 116, mean age 8.72) and 11–14 (n = 81, mean age 12.05). We conducted surveys with the children during and a week after distribution to assess any change in their knowledge about COVID-19 safety. The average age of children in this study was 10.09 (SD = 2.01) years. All resided in underresourced urban communities with low literacy rates and limited education. All questions were answered more correctly in the postsurvey, with the social distancing question having the greatest and most statistically significant increase (33.6%, p < 0.0001). The average increase in knowledge among children aged 6–10 (16.9%) was greater, though not statistically significantly so, than the average increase among children aged 11–14 (4.7%). These results indicate that child-friendly books can increase health education for children ages 6–14 in low-literacy populations. Additionally, the mechanism of the program is fit to be used in other low-resource populations globally.

IntroductionIn the past, various techniques have been used to improve motor imagery (MI), such as immersive virtual-reality (VR) and kinesthetic rehearsal. While electroencephalography (EEG) has been used to study the differences in brain activity between VR-based action observation and kinesthetic motor imagery (KMI), there has been no investigation into their combined effect. Prior research has demonstrated that VR-based action observation can enhance MI by providing both visual information and embodiment, which is the perception of oneself as part of the observed entity. Additionally, KMI has been found to produce similar brain activity to physically performing a task. Therefore, we hypothesized that utilizing VR to offer an immersive visual scenario for action observation while participants performed kinesthetic motor imagery would significantly improve cortical activity related to MI.MethodsIn this study, 15 participants (9 male, 6 female) performed kinesthetic motor imagery of three hand tasks (drinking, wrist flexion-extension, and grabbing) both with and without VR-based action observation.ResultsOur results indicate that combining VR-based action observation with KMI enhances brain rhythmic patterns and provides better task differentiation compared to KMI without action observation.DiscussionThese findings suggest that using VR-based action observation alongside kinesthetic motor imagery can improve motor imagery performance.

PurposeThis study aimed to assess the usability of a virtual reality-assisted sensorimotor activation (VRSMA) apparatus for individual digit rehabilitation. The study had two main objectives: Firstly, to collect preliminary data on the expectations and preferences of patients with carpal tunnel syndrome (CTS) regarding virtual reality (VR) and an apparatus-assisted therapy for their affected digits. Secondly, to evaluate the usability of the VRSMA apparatus that was developed.MethodsThe VRSMA system consists of an apparatus that provides sensory and motor stimulation via a vibratory motor and pressure sensor attached to a button, and a virtual reality-based visual cue provided by texts overlaid on top of a 3D model of a hand. The study involved 10 CTS patients who completed five blocks of VRSMA with their affected hand, with each block corresponding to the five digits. The patients were asked to complete a user expectations questionnaire before experiencing the VRSMA, and a user evaluation questionnaire after completing the VRSMA. Expectations for VRSMA were obtained from the questionnaire results using a House of Quality (HoQ) analysis.ResultsIn the survey for expectations, participants rated certain attributes as important for a rehabilitation device for CTS, with mean ratings above 4 for attributes such as ease of use, ease of understanding, motivation, and improvement of hand function based on clinical evidence. The level of immersion and an interesting rehabilitation regime received lower ratings, with mean ratings above 3.5. The survey evaluating VRSMA showed that the current prototype was overall satisfactory with a mean rating of 3.9 out of 5. Based on the HoQ matrix, the highest priority for development of the VRSMA was to enhance device comfort and usage time. This was followed by the need to perform more clinical studies to provide evidence of the efficacy of the VRSMA. Other technical characteristics, such as VRSMA content and device reliability, had lower priority scores.ConclusionThe current study presents a potential for an individual digit sensorimotor rehabilitation device that is well-liked by CTS patients.

Background and Study Aim: The main purpose behind the study was to establish the challenges in relation to the acquisition of life skills among university student-athletes of Khyber Pakhtunkhwa. The study assessed the extent to which the concern existing resources, facilitators, and trainer attitude influences life skills acquisition among student-athletes. Material and Methods: Descriptive survey research design was followed to obtain desirable results. The target population of this study consisted of all those who participated in different sport at the university level of Khyber Pakhtunkhwa (KP), Pakistan. Amongst them, we selected a representative sample (n=389 fifty 50% of the total population) with the help of a simple random sampling technique. The Statistical Package for Social Sciences (SPSS) version, 24 was used to code and analyse the data. The hypotheses were tested by applying statistical tests like Step-wise regression and independents sample t-test. The significance level of 0.05 was fixed to accept or reject the set hypotheses. Results: Findings of the study indicated that existing resources, facilitators, and trainer/coach attitude significantly influences life skills acquisition among student-athletes (.001, .001 & .000 < .05). The analysed data revealed no significantly difference regarding extent to which specific challenges such as existing resources, facilitators, and trainer attitude influences the acquisition of life skills (.500, .133 & .149 > .05). Conclusions: The findings of the study revealed that all participants have agreed upon the importance of life skills. Therefore, the life skills course might be considered as an integral part of every educational curriculum of Pakistan. It is suggested that a minimum of 2 hours per week may be included in the educational curriculum of each discipline.

Objective: The purpose of this study was to investigate the cortical activity and digit classification performance during tactile imagery (TI) of a vibratory stimulus at the index, middle, and thumb digits within the left hand in healthy individuals. Furthermore, the cortical activities and classification performance of the compound TI were compared with similar compound motor imagery (MI) with the same digits as TI in the same subjects. Methods: Twelve healthy right-handed adults with no history of upper limb injury, musculoskeletal condition, or neurological disorder participated in the study. The study evaluated the event-related desynchronization (ERD) response and brain–computer interface (BCI) classification performance on discriminating between the digits in the left-hand during the imagery of vibrotactile stimuli to either the index, middle, or thumb finger pads for TI and while performing a motor activity with the same digits for MI. A supervised machine learning technique was applied to discriminate between the digits within the same given limb for both imagery conditions. Results: Both TI and MI exhibited similar patterns of ERD in the alpha and beta bands at the index, middle, and thumb digits within the left hand. While TI had significantly lower ERD for all three digits in both bands, the classification performance of TI-based BCI (77.74 ± 6.98%) was found to be similar to the MI-based BCI (78.36 ± 5.38%). Conclusions: The results of this study suggest that compound tactile imagery can be a viable alternative to MI for BCI classification. The study contributes to the growing body of evidence supporting the use of TI in BCI applications, and future research can build on this work to explore the potential of TI-based BCI for motor rehabilitation and the control of external devices.

Background: Reaction time is an important measure of sensorimotor performance and coordination and has been shown to improve with training. Various training methods have been employed in the past to improve reaction time. Tactile imagery (TI) is a method of mentally simulating a tactile sensation and has been used in brain–computer interface applications. However, it is yet unknown whether TI can have a learning effect and improve reaction time. Objective: The purpose of this study was to investigate the effect of TI on reaction time in healthy participants. Methods: We examined the reaction time to vibratory stimuli before and after a TI training session in an experimental group and compared the change in reaction time post-training with pre-training in the experimental group as well as the reaction time in a control group. A follow-up evaluation of reaction time was also conducted. Results: The results showed that TI training significantly improved reaction time after TI compared with before TI by approximately 25% (pre-TI right-hand mean ± SD: 456.62 ± 124.26 ms, pre-TI left-hand mean ± SD: 448.82 ± 124.50 ms, post-TI right-hand mean ± SD: 340.32 ± 65.59 ms, post-TI left-hand mean ± SD: 335.52 ± 59.01 ms). Furthermore, post-training reaction time showed significant reduction compared with the control group and the improved reaction time had a lasting effect even after four weeks post-training. Conclusion: These findings indicate that TI training may serve as an alternate imagery strategy for improving reaction time without the need for physical practice.

A potential treatment for carpal tunnel syndrome is to biochemically alter the mechanical properties of the transverse carpal ligament (TCL) through Collagenase Clostridium Histolyticum (CCH) injection. The purpose of this study was to determine the time- and dose-dependent effects of CCH injection on TCL elastic modulus and thickness. Nine TCLs were dissected from cadaveric hands for this study. CCH doses of 50U, 100U, 150U, 200U, and 250U were injected into five points on the TCL, respectively. B-mode and shear wave elastography images were taken of each injection point using robot-assisted ultrasound imaging immediately after injection, as well as 2, 4, 6, 8, and 24 hours after injection. TCL thickness and mean shear wave speed were measured for each CCH dose at each time point. CCH doses of 200U and 250U decreased shear wave speed by 18.70% and 30.01% (p

In S. pombe, about 5% of genes are meiosis-specific and accumulate little or no mRNA during vegetative growth. Here we use Affymetrix tiling arrays to characterize transcripts in vegetative and meiotic cells. In vegetative cells, many meiotic genes, especially those induced in mid-meiosis, have abundant antisense transcripts. Disruption of the antisense transcription of three of these mid-meiotic genes allowed vegetative sense transcription. These results suggest that antisense transcription represses sense transcription of meiotic genes in vegetative cells. Although the mechanism(s) of antisense mediated transcription repression need to be further explored, our data indicates that RNAi machinery is not required for repression. Previously, we and others used non-strand specific methods to study splicing regulation of meiotic genes and concluded that 28 mid-meiotic genes are spliced only in meiosis. We now demonstrate that the "unspliced" signal in vegetative cells comes from the antisense RNA, not from unspliced sense RNA, and we argue against the idea that splicing regulates these mid-meiotic genes. Most of these mid-meiotic genes are induced in mid-meiosis by the forkhead transcription factor Mei4. Interestingly, deletion of a different forkhead transcription factor, Fkh2, allows low levels of sense expression of some mid-meiotic genes in vegetative cells. We propose that vegetative expression of mid-meiotic genes is repressed at least two independent ways: antisense transcription and Fkh2 repression.

Background While in adults with sickle cell disease an elevation of tricuspid regurgitation velocity is associated with increased mortality, the importance of this finding in children has not been established. The role of intravascular hemolysis in the development of this complication is controversial.Design and Methods We conducted a prospective, longitudinal, multi-center study of 160 individuals aged 3–20 years with hemoglobin SS, performing baseline and follow-up determinations of clinical markers, six-minute walk distance less than tricuspid regurgitation velocity and E/Etdi ratio by echocardiography.Results At baseline, 14.1% had tricuspid regurgitation velocity of 2.60 m/sec or over, which suggests elevated systolic pulmonary artery pressure, and 7.7% had increased E/Etdi, which suggests elevated left ventricular filling pressure. Over a median of 22 months, baseline elevation in tricuspid regurgitation velocity was associated with an estimated 4.4-fold increase in the odds of a 10% or more decline in age-standardized six-minute-walk distance (P=0.015). During this interval, baseline values above the median for a hemolytic component derived from four markers of hemolysis were associated with a 9.0-fold increase in the odds of the new onset of elevated tricuspid regurgitation velocity (P=0.008) and baseline E/Etdi elevation was associated with an estimated 6.1-fold increase in the odds (P=0.039). In pathway analysis, higher baseline hemolytic component and E/Etdi predicted elevated tricuspid regurgitation velocity at both baseline and follow up, and these elevations in turn predicted decline in six-minute-walk distance.Conclusions Further studies should define the long-term risks of elevated tricuspid regurgitation velocity in childhood and identify potential interventions to prevent increased pulmonary artery pressure and preserve function.