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The addition of aromatase inhibitors has improved cancer-related outcomes in postmenopausal patients with estrogen receptor-positive breast cancer. However, aromatase inhibitor can be associated with a constellation of adverse musculoskeletal effects that comprises bone loss, arthralgia, myalgia, and tendinopathy. This medication complication, known as aromatase inhibitor-associated musculoskeletal syndrome, can limit treatment tolerability in many patients because of the high prevalence of aromatase inhibitor-associated musculoskeletal syndrome among those on aromatase inhibitor. The hand and wrist are the most affected joints in aromatase inhibitor-associated musculoskeletal syndrome, with patients presenting with symmetric arthralgia, stiffness, and tendinopathy. Radioulnar joint subluxation with extensor tendon tear has not been previously reported in patients with aromatase inhibitor-associated musculoskeletal syndrome. This is a case report of a 72-yr-old breast cancer survivor on an aromatase inhibitor presenting with chronic dominant wrist pain, weakness, and 5th digit finger drop. An extensor digitorum minimi tendon tear and radioulnar instability were identified using diagnostic musculoskeletal ultrasonography. This case illustrates the utility of in-office ultrasonography combined with dynamic examination for the often underrecognized pathology associated with aromatase inhibitor-associated musculoskeletal syndrome in breast cancer survivors. [ABSTRACT FROM AUTHOR]

Background: The inability to extend the fingers at the metacarpophalangeal and interphalangeal joints leads to finger drop. While wrist drop and foot drop are well recognized, the causes of finger drop are poorly understood., Aims: This study describes the clinical, electrodiagnostic (EDX), and ultrasound (US) features in patients with finger drop., Materials and Methods: This is a retrospective study of 87 patients presenting with finger drop and referred for EDX studies during the past 10 years. We analyzed the clinical picture, EDX data, and US findings. The patients were categorized into global (all five digits) or partial (limited to 1-4 digits) finger drop., Results: Fifty-six (64%) patients had global finger drop, while 31 (36%) had partial finger drop. The frequent cause of finger drop was Parsonage-Turner syndrome (PTS) (29 [33%]), followed by trauma (23 [26%]), cervical radiculopathy (16 [18%]), extensor tendon rupture (four [4%]), and compression/entrapment (two [2%]). In 13 (15%) patients, no cause was identified. A total of 13/16 (81%) patients with cervical radiculopathy and four of the patients with tendon rupture had partial finger drop, while 52/64 (81%) with posterior interosseous nerve (PIN) neuropathy had global finger drop. Of the 16 patients who experienced cervical radiculopathy as the cause of the finger drop, 15 patients had C7 and C8 radiculopathy and one patient had C7 radiculopathy. EDX studies of patients with PTS revealed partial axon loss in 18 (62%) patients, conduction block in eight (28%), and total axon loss in four (14%). Enlarged fascicles were observed by US in 40% of patients with PTS. EDX studies of patients who sustained iatrogenic nerve injury causing finger drop demonstrated total axon loss in six (46%) patients, partial axon loss in four (31%), demyelination in two (15%), and conduction block in two (15%)., Conclusions: PIN neuropathy is the most common cause of finger drop, however, lesser-known causes such as cervical radiculopathy and extensor tendon rupture should also be considered. Global finger drop is suggestive of PIN neuropathy, while partial finger drop occurs more often in cervical radiculopathy and tendon rupture. EDX and US studies provide valuable information for localizing the lesion site and may reveal the cause of the finger drop., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Shields et al.)

A suscetibilidade a doenças de grande impacto econômico põe em risco a viabilidade econômica da bananicultura. A melhor estratégia para controle destas doenças, do ponto de vista econômico e ambiental, é a utilização de cultivares resistentes. Porém, estas devem apresentar, além de boas características de produtividade, um bom sabor e facilidade para manuseio e transporte como requisitos para aceitação do mercado. Portanto, este trabalho visou a avaliar características pós-colheita do genótipo PA42-44 resistente ao mal-do-panamá, sigatoka-amarela e negra, comparando à cultivar 'Prata-Anã', bastante difundida, porém suscetível às doenças citadas. Para tal, bananas de cada um dos genótipos foram colhidas e armazenadas à temperatura de 22 ± 1°C e umidade relativa de 75 ± 5% até atingirem determinado índice de coloração para avaliação. As bananas foram avaliadas nos índices de coloração 2; 3; 4; 5 e 6, segundo a escala de notas de Von Loesecke. As variáveis avaliadas foram: firmeza, pH, acidez titulável (AT), sólidos solúveis (SS), relação SS/AT e despencamento. Também foi verificado qual dos genótipos amadurece mais rapidamente, analisando a modificação da cor das bananas por 12 dias. Finalmente, foi realizada a análise sensorial para os atributos aparência, aceitabilidade, firmeza e doçura de ambos os genótipos. As bananas PA42-44, quando comparadas à 'Prata-Anã', nos mesmos índices de coloração, encontravam-se em processo mais avançado de amadurecimento. Porém, quando avaliadas em função do período de armazenamento, a 'Prata-Anã' amadureceu mais rapidamente. As bananas PA42-44 são menos firmes e bem mais suscetíveis ao despencamento que as bananas 'Prata-Anã'. Já as características sensoriais dos genótipos foram iguais quanto à preferência.The production of bananas will always be threatened by diseases of great economical impact that can unable production. The best strategy to control these diseases, economically and environmentally, is the utilization of resistant materials. However, these must have more than good characteristics of production; they should have attractive flavor and easiness in handling and transportation as requisites for market acceptance. Therefore, the objective of this work was the evaluation of post harvest characteristics of the disease resistant genotype PA 42-44 comparing with the 'Prata-Anã' variety commercially accepted, but susceptible to diseases. For that matter, bananas of each genotype were harvested and stored at 22 ± 1°C temperature and 75 ± 5% relative humidity, until they reached the pre-determined color index for evaluation. The bananas were evaluated at the color indexes of 2, 3, 4, 5 and 6 according to the Von Loesecke scale. The variables analyzed were: firmness, pH, titratable acidity (TA), soluble solids (SS), relation SS/TA and finger detachment. It was also studied maturation period through analysis of color alteration of the bananas for 12 days. Finally, a panel test was done for appearance, acceptability, firmness and sweetness for both genotypes. PA42-44 bananas when compared with 'Prata-Anã' bananas in the same coloration index was more ripe. However, when analyzed in relation to storage period 'Prata-Anã' ripened more rapidly. The PA42-44 bananas are less firm and more susceptible to finger detachment than 'Prata-Anã' bananas. The panel test between the genotypes showed similar taste appreciation.

Green-ripe disorder often occurs when banana fruit (Musa AAA group) ripen at high temperature above 25 °C. In this study, the effect of modified atmosphere package (MAP) + 1-methylcyclopropene (1-MCP) treatment on the shelf-life quality of banana after high temperature storage was studied. The results showed that 300 nL L-1 1-MCP treatment combined with MAP could prevent the occurrence of green-ripe disorder in banana stored at high temperature, reduce ethylene production and respiration, then delay senescence and ripening, and reduce disease incidence and finger drop of fruit. Further analysis showed that the combined treatment decreased the content of reactive oxygen species (ROS) and enhanced the activity of defense-related enzymes and antioxidants. By inhibiting the activity of cell-degrading enzymes, the treatment increased lignin and cellulose content and maintained cell wall integrity. In addition, the treatment regulated the contents of endogenous hormones indole-3-acetic acid and abscisic acid, thus delaying the softening of fruit. This work provides a theoretical foundation for the storage and transportation of banana fruit at high temperature. [Display omitted] • 1-MCP+MAP prevent the occurrence of green-ripen in bananas under high temperature. • 1-MCP+MAP treatment delayed the senescence and ripening of banana fruit. • 1-MCP+MAP treatment reduced the disease incidence and the finger drop of fruit. • 1-MCP+MAP treatment enhanced antioxidant system and defense ability. • 1-MCP+MAP delayed the fruit softening and maintaining the cell wall integrity. [ABSTRACT FROM AUTHOR]

A queda natural de frutos maduros da bananeira, resultado da separação individual de frutos da coroa da penca, também chamada despencamento, é uma característica indesejável, que pode limitar o lançamento de uma nova cultivar. O fruto destacado da penca tem vida de prateleira reduzida, além de não demonstrar boa aparência aos olhos do consumidor. Os objetivos do presente trabalho foram quantificar a suscetibilidade à queda natural dos frutos de bananeiras de grupos genômicos e ploidias diferentes, e identificar correlações entre a queda natural e diversas características físicas dos frutos. Foram utilizados 37 genótipos de bananeiras. De acordo com análise de variância e teste de Scott-Knott, os resultados evidenciaram a alta resistência ao despencamento dos genótipos pertencentes ao grupo genômico BB (Butuhan, Piraí e BB França), Terra (AAB), Poteau Nain (tipo figo) (ABB) e Thap Maeo (AAB), enquanto Prata-Anã (AAB), Grande Naine (AAA), Ambrósia (AAAA), Ouro (AA) e FHIA 18 (AAAB) obtiveram valores intermediários de resistência ao despencamento. Com relação às bananeiras suscetíveis, destacam-se os híbridos melhorados Pioneira (AAAB), YB42-21 (AAAB), Buccaneer (AAAA) e Calypso (AAAA) e a cultivar Ouro da Mata (AAAB). Verificou-se associação de 74% entre a firmeza do fruto e a resistência ao despencamento. Os estudos de grupos genômicos e ploidias indicaram maior resistência ao despencamento das bananeiras pertencentes ao grupo BB e dos genótipos triplóides ABB e AAB.Natural fruit dropping of ripe bananas in result of individual separation of fruits from the hand crown, is called finger drop, this characteristic is undesirable and would limit the marketing of new cultivars. Fruits that stand out in the hand have a reduced shelf life, and do not present a pleasant appearance for customers. This study was carried out in order to quantify the susceptibility to natural fruit dropping in fruits from different genomic groups and ploidies, and to identify correlations between natural dropping and various physical fruit characteristics. Diploid, triploid e tetraploid banana plants from several genomic groups were used, altogether 37 genotypes. The physical characteristics were used in a variance analysis and the results compared with the Scott-Knott test. Results proved the high resistance against dropping among genotypes that belong to the genomic group BB (Butuhan, Piraí and BB França), Terra (AAB), Poteau Nain (fig type) (ABB) and Thap Maeo (AAB), while Prata-Anã (AAB), Grande Naine (AAA), Ambrósia (AAAA), Ouro (AA) and FHIA 18 (AAAB) presented intermediate values of dropping resistance. Among banana plants with low resistence, the improved hybrids Pioneira (AAAB), YB42-21 (AAAB), Buccaneer (AAAA) and Calypso (AAAA) and the cultivar Ouro da Mata (AAAB) were outstanding. A higher positive correlation between fruit firmness and resistance toward finger drop could be verified. The study of genotype and ploid groups indicated a greater resistance against dropping among banana plants belonging to the BB group and ABB and AAB triploid genotypes.

The objective of this research was to evaluate the effect of CaCl2 application in preharvest and in different doses and times in order to control the natural fruit dropping of banana 'FHIA-18'. The experimental design was in a randomized blocks, in a factorial scheme 3x3+1 control, with three doses of CaCl2 (2, 4 and 6%), three times of application (60, 90 and 120 days) after the bunch emission, with five replicates and one plant per parcel. A linear decrease of dropping resistance and fruit time maturation with increasing doses of CaCl2 was observed. The fruits showed to be more consistent with three applications of CaCl2. The calcium content of the peel and pulp were not significantly changed with the doses and applications of CaCl2, indicating that calcium is not absorbed effectively by the fruits. The application of CaCl2 in preharvest do not reduce the natural fruit dropping in banana 'FHIA-18'. [ABSTRACT FROM AUTHOR]

Highlights: [•] Ethylene regulation of finger drop and developmental cues were investigated. [•] As a model, we used green fruit with contrasted ripening rates and ethylene sensitivities. [•] Expression of ethylene signaling and MADS box genes were studied in the control and drop zones. [•] Finger drop sequentially enhanced these genes, with some of them being specific to the process. [•] Besides ethylene, developmental cues might be a key factor regulating finger drop. [Copyright &y& Elsevier]

Background Guillain Barre syndrome (GBS) commonly presents with limb weakness and occasional cranial nerve, respiratory or autonomic involvement. Isolated or predominant bilateral finger drop as presenting feature has never been reported in the pediatric age group. Case A 9 year old boy presented with deformity of both hands for 7 days and leg pain with difficulty in getting up from floor for 3 days. On examination he had bilateral clawing with subtle hip flexor weakness and hyporeflexia. His nerve conduction study revealed motor axonal neuropathy. His serum lead levels and autoimmune markers were within normal limits. His cerebrospinal fluid examination revealed albuminocytological dissociation. He was diagnosed as GBS and was given intravenous immunoglobulin. He improved completely over next 8 weeks. Conclusions GBS is one of the commonest causes of acquired neuropathy in the tropics. In resource limited setting, where electrophysiological facilities may not be available, identification of finger drop sign may help in correct management. [ABSTRACT FROM AUTHOR]

Background: Guillain-Barré syndrome (GBS) is an acute neurological illness affecting the peripheral nervous system causing significant morbidity. The syndrome has been classified electrophysiologically into demyelinating and axonal forms. The clinical features of the axonal variant (acute motor axonal neuropathy-AMAN) are not well characterized, particularly in the Indian context. Objective: To assess the incidence, clinical presentation and disease course of patients with AMAN. Materials and Methods: This is an observational study done at a tertiary referral center in South India. The study period extended from January 2006 to July 2007. All patients with a clinical diagnosis of GBS and satisfying the electrophysiological criteria for AMAN were included. Results: There were 12 cases of AMAN out of a total of 84 cases of GBS. All AMAN patients showed a characteristic pattern of hand weakness predominant weakness of finger extensors with relatively normal power in finger flexors, wrist flexors and extensors. Proximal limb weakness was mild and was present in 85% cases. One patient had cranial nerve palsy and one had hyperreflexia. None of the patients progressed to respiratory failure. Conclusion: AMAN is a distinct subgroup in GBS showing certain distinguishing features, the most notable being predominant weakness of finger extensors. [ABSTRACT FROM AUTHOR]

Few molecular studies have been devoted to the finger drop process that occurs during banana fruit ripening. Recent studies revealed the involvement of changes in the properties of cell wall polysaccharides in the pedicel rupture area. In this study, the expression of cell-wall modifying genes was monitored in peel tissue during post-harvest ripening of Cavendish banana fruit, at median area (control zone) and compared with that in the pedicel rupture area (drop zone). To this end, three pectin methylesterase (PME) and seven xyloglucan endotransglycosylase/hydrolase (XTH) genes were isolated. The accumulation of their mRNAs and those of polygalaturonase, expansin, and pectate lyase genes already isolated from banana were examined. During post-harvest ripening, transcripts of all genes were detected in both zones, but accumulated differentially. MaPME1, MaPG1, and MaXTH4 mRNA levels did not change in either zone. Levels of MaPME3 and MaPG3 mRNAs increased greatly only in the control zone and at the late ripening stages. For other genes, the main molecular changes occurred 1–4 d after ripening induction. MaPME2, MaPEL1, MaPEL2, MaPG4, MaXTH6, MaXTH8, MaXTH9, MaEXP1, MaEXP4, and MaEXP5 accumulated highly in the drop zone, contrary to MaXTH3 and MaXTH5, and MaEXP2 throughout ripening. For MaPG2, MaXET1, and MaXET2 genes, high accumulation in the drop zone was transient. The transcriptional data obtained from all genes examined suggested that finger drop and peel softening involved similar mechanisms. These findings also led to the proposal of a sequence of molecular events leading to finger drop and to suggest some candidates. [ABSTRACT FROM PUBLISHER]

Abstract: Commercial ripening of banana fruit occurs at high relative humidity (RH), which prevents browning of damaged skin areas. In experiments with ripening at high RH (94±1%) the individual fruit (fingers) of ‘Sucrier’ (Musa acuminata, AA Group) banana exhibited a high rate of drop. The falling off of the fingers is due to rupture of the peel at the pedicel. In contrast, if the fruit was held at low RH (68±3%) finger drop was absent. Water-soluble pectin in the peel at the rupture area was higher at high RH, indicating increased pectin degradation. However, the activities of polygalacturonase (PG) in the peel at the rupture zone were the same in both treatments. The activity of pectinmethylesterase (PME) was only slightly higher prior to rupture in the high RH treatment, whereas, that of pectate lyase (PL) was considerably higher. The lower rate of pectin degradation at low RH may explain, at least partially, why finger drop is inhibited. The decrease in pectin degradation was not accounted for by the measured PG activity, but could be partially accounted for by the measured PME and PL activities. [Copyright &y& Elsevier]

Abstract: Fruit drop of banana is due to breaking at the junction of the pedicel and pulp, and we found no true abscission zone. The breakage seems therefore due to weakening of the peel. We investigated pectin hydrolysis and some properties at the rupture zone, using ‘Hom Thong’ (Musa acuminata, AAA Group) and ‘Namwa’ (Musa x paradisiaca, ABB Group) fruit, which show massive drop and no drop, respectively. During the period of finger drop, the water content of the peel in ‘Namwa’ was similar to that of ‘Hom Thong’ and thus water content does not account for the high breakage in ‘Hom Thong’. The peel thickness at the rupture area in the two cultivars was not significantly different. During the period of finger drop, the level of water-soluble pectin in the peel at the rupture area of ‘Hom Thong’ was higher than that of ‘Namwa’, indicating pectin degradation. CDTA soluble pectin and insoluble pectin was lower in ‘Hom Thong’, also indicating more pectin breakdown in this cultivar. Polygalacturonase activity in the peel at the rupture area of ‘Hom Thong’ bananas rapidly increased, but not clearly more than in ‘Namwa’ bananas. Pectinesterase activity in the peel at the rupture area of ‘Hom Thong’ was much lower than that of ‘Namwa’ bananas, and thus does not account for the breakage. Pectate lyase in the peel of ‘Hom Thong’ was considerably higher than in that of ‘Namwa’. The present data indicate that the much higher pectate lyase activity in ‘Hom Thong’ might be responsible, at least partially, for the finger drop. [Copyright &y& Elsevier]

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that may trigger Guillain-Barre syndrome (GBS) in selected patients. We describe a case of GBS presenting as marked finger extensor weakness in a 73-year-old woman with COVID-19. Her clinical and electrophysiological findings were consistent with a diagnosis of acute motor axonal neuropathy subtype of GBS with prominent finger dropping. Treatment with intravenous immunoglobulin for 5 days completely resolved her finger extension weakness after 19 months, although other involved extremities recovered earlier at 3 months. This study highlights that COVID-19-associated GBS can present in various forms aside from the classic variant, even in patients without any COVID-19 symptoms. Therefore, it is important to always consider the diagnosis of GBS in patients with COVID-19., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2022 The Korean Academy of Medical Sciences.)

Guillain-Barré Syndrome is an acquired acute autoimmune polyradiculoneuropathy that commonly presents with limb weakness and occasional cranial nerve, respiratory and autonomic involvement. Although the classic description of Guillain-Barré Syndrome is that of a demyelinating neuropathy with ascending weakness, predominant bilateral finger drop as presenting feature has rarely been reported. A characteristic pattern of weakness involving the extensor components of the fingers known as "finger drop sign" has been first described to be specific in acute motor axonal neuropathy form of Guillain-Barré Syndrome in the literature. We report a case of acute motor-sensory axonal neuropathy, which showed characteristic pattern of predominant finger extensor weakness, and provide a summary of all reported cases to date. While previous reports suggested that this is a sign that carries good prognosis, our case report suggested otherwise as the patient succumbed to respiratory and autonomic complications. Further studies are needed to evaluate the clinical significance of this peculiar sign., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.