Exposure to gallium arsenide nanoparticles in a research facility: a case study using molecular beam epitaxy.

We evaluated GaAs nanoparticle-concentrations in the air and on skin and surfaces in a research facility that produces thin films, and to monitored As in the urine of exposed worker. The survey was over a working week using a multi-level approach. Airborne personal monitoring was implemented using a miniature diffusion size classifier (DiSCMini) and IOM sampler. Environmental monitoring was conducted using the SKC Sioutas Cascade Impactor to evaluate dimensions and nature of particles collected. Surfaces contamination were assessed analyzing As and Ga in ghost wipes. Skin contamination was monitored using tape strips. As and Ga were analyzed in urines collected every day at the beginning and end of the shift. The greatest airborne exposure occurred during the cutting operations of the GaAs Sample (88883 np/cm3). The highest levels of contamination were found inside the hood (As max = 1418 ng/cm2) and on the laboratory floor (As max = 251 ng/cm2). The average concentration on the worker's skin at the end of the work shift (3.36 ng/cm2) was more than 14 times higher than before the start of the shift. In weekly urinary biomonitoring an average As concentration of 19.5 µg/L, which was above the Società Italiana Valori di Riferimento (SIVR) reference limit for the non-occupational population (2.0 - 15 µg/L), but below the ACGIH limit (30 µg/L). Overall, airborne monitoring, surface sampling, skin sampling, and biomonitoring of worker confirmed the exposure to As of workers. Systematic cleaning operations, hood implementation and correct PPE management are needed to improve worker protection.

Investigation Into the Effects of Intra-Articular Steroid on Post-Traumatic Osteoarthritis in Distal Radius Fractures: A Randomized Controlled Pilot Study.

PURPOSE: The aim of this prospective, randomized, controlled, double-blinded pilot study was to determine the rates of post-traumatic osteoarthritis and assess joint space width in the presence or absence of a single intra-articular injection of corticosteroid after an acute, intra-articular distal radius fracture (DRF). METHODS: Forty patients received a single, intra-articular, radiocarpal joint injection of 4 mg of dexamethasone (DEX) (n = 19) or normal saline placebo (n = 21) within 2 weeks of a surgically or nonsurgically treated intra-articular DRF. The primary outcome measure was minimum radiocarpal joint space width (mJSW) on noncontrast computed tomography scans at 2 years postinjection. Secondary outcomes were obtained at 3 months, 6 months, 1 year, and 2 years postinjection and included Disabilities of the Arm, Shoulder, and Hand; Michigan Hand Questionnaire; Patient-Rated Wrist Evaluation; wrist range of motion; and grip strength. RESULTS: At 2-year follow-up, there was no difference in mean mJSW between the DEX group (2.2 mm; standard deviation, 0.6; range, 1.4-3.2) and the placebo group (2.3 mm; standard deviation, 0.7; range, 0.9-3.9). Further, there were no differences in any secondary outcome measures at any postinjection follow-up interval. CONCLUSIONS: Radiocarpal joint injection of corticosteroid within 2 weeks of an intra-articular DRF does not appear to affect the development of post-traumatic osteoarthritis within 2 years follow-up in a small pilot cohort. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

What Plastic Surgeons Should Know about Small-Joint Arthroplasty: Is This for Your Practice?

SUMMARY: This article reviews the state of the art for arthroplasty of the metacarpophalangeal and proximal interphalangeal joints. Arthritis that affects these joints can result in significant pain and compromised function. The authors review indications for arthroplasty for each joint, types of implants to consider, technical considerations, patient expectations, and outcomes and complications.

State-of-the-art Review on the Antiparasitic Activity of Benzimidazolebased Derivatives: Facing Malaria, Leishmaniasis, and Trypanosomiasis.

Protozoan parasites represent a significant risk for public health worldwide, afflicting particularly people in more vulnerable categories and cause large morbidity and heavy economic impact. Traditional drugs are limited by their toxicity, low efficacy, route of administration, and cost, reflecting their low priority in global health management. Moreover, the drug resistance phenomenon threatens the positive therapy outcome. This scenario claims the need of addressing more adequate therapies. Among the diverse strategies implemented, the medicinal chemistry efforts have also focused their attention on the benzimidazole nucleus as a promising pharmacophore for the generation of new drug candidates. Hence, the present review provides a global insight into recent progress in benzimidazole-based derivatives drug discovery against important protozoan diseases, such as malaria, leishmaniasis and trypanosomiasis. The more relevant chemical features and structure-activity relationship studies of these molecules are discussed for the purpose of paving the way towards the development of more viable drugs for the treatment of these parasitic infections.

Total Wrist Arthroplasty: An International Perspective.

Concerns about implant durability and technical difficulty continue to make total wrist arthroplasties a specialized procedure with a narrow scope of indications. As a result, more routinely performed total or partial wrist arthrodesis continues to maintain popularity over arthroplasty. However, wrist motion preservation is undoubtedly preferable for patients and current literature is trending to more favorable outcomes for total wrist arthroplasties. In the setting of the evolving role of wrist arthroplasties in clinical practice, it is important to focus on providing hand surgeons a practical approach to incorporating total wrist arthroplasty into the treatment toolbox available to them when treating patients with painful wrist arthritis.

Top No-Nonsense Tips: The Dos and Don'ts of Managing Flexor Tendon Injuries.

Flexor tendon injury surgical repairs can be challenging for surgeons, where the timing of surgery and precision of repair matter the most. The latest evidence and basic science discoveries in flexor tendon management are provided. It is important to review how wide-awake local anesthesia no tourniquet surgery has been a paradigm shift in surgical management and pearls learned from incorporating this into practice.

Primary Arthrodesis of Non-thumb Metacarpophalangeal Joints of the Hand: Clinical and Patient-Reported Outcomes.

BACKGROUND: Metacarpophalangeal (MCP) joint arthritis is common secondary to a variety of inflammatory, degenerative, and traumatic causes. Although MCP arthroplasty is more common for the second to fifth digits, primary arthrodesis can be used for high-demand patients with arthritis or unsalvageable fractures of the MCP joint. There has been limited recent studies on the outcomes of these patients. METHODS: A retrospective review of 38 fingers in 27 patients with primary arthrodesis from 1990 to 2020 was conducted. The major outcomes were complications, reoperations, radiographic union, and time to union. Patient-reported outcomes including the Michigan Hand Outcomes Questionnaire and a questionnaire specific to the operative MCP joint were collected. RESULTS: Rate of radiographic union was 84% including revisions. The average time to union was 3.6 months. Rates of complications, reoperation, and amputation were 26%, 16%, and 7%, respectively. Arthrodesis as part of emergent trauma reconstruction was significantly more likely to result in reoperation (50% vs 7%) and complication (63% vs 17%) than chronic arthritis. Patient-reported outcomes were fair to good with improvement in pain (79%), function (66%), and appearance (40%). Sixty-six percent (66%) of patients were satisfied with their surgery, and 73% would repeat the surgery. CONCLUSION: Arthrodesis for unsalvageable MCP fractures was associated with higher rates of reoperation and complication than inflammatory or degenerative arthritis. Excluding emergent trauma, MCP fusion was reliable with a reoperation rate of 7% and a modest complication rate of 17%. Patients rated reasonable levels of satisfaction and willingness to repeat the procedure despite complications.

Educating Youth to Civic Engagement for Social Justice: Evaluation of a Secondary School Project.

The positive effects of youth civic engagement can be felt both at the individual level (e.g., better emotional regulation, a greater sense of empowerment) and at the community level (e.g., a greater likelihood of participation in civic and political activities). They may also be a protective factor for at-risk youth in the short and long term and a valuable element for positive identity development in general. The purpose of this longitudinal study was to assess the impact of an educational intervention implemented in secondary schools to promote youth civic engagement (N = 508 at Time 1, N = 116 at Time 2). The study is divided into two parts: first, it examines the changes stimulated by the project, and second, it uses a path analysis model to explain the intention to participate. Results show that after participation, hostile and benevolent sexism, classic and modern ethnic prejudice, and social dominance orientation decreased, while trust in institutions increased. In addition, the path analysis showed that policy control, social trust, and civic engagement increased the intention of civic engagement at time T1. Despite some limitations, this study may provide useful guidance for those designing and implementing civic education interventions for young people.

Managing Difficult Problems in Small Joint Arthroplasty: Challenges, Complications, and Revisions.

Small joint arthroplasty of the hand has been an established means of joint preservation and pain relief for over a half a century. Despite this, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint arthroplasty has not achieved the long-term success seen with hip and knee arthroplasty. Problems following MCP, PIP, and carpometacarpal (CMC) joint arthroplasty can include intraoperative fracture, postoperative dislocation, recurrent pain, limitation of motion, and instability. The hand surgeon needs to be prepared for these problems and their management. This article addresses the management of the most common complications seen following MCP, PIP, and CMC arthroplasty.

Secondary traumatic stress and work ability in death care workers: The moderating role of vicarious posttraumatic growth.

Death care work consists of dealing with traumatic events frequently, if not daily. This type of exposure is considered characteristic of the profession and can lead to significant negative consequences such as secondary traumatic stress. However, sometimes positive changes can occur as a result of experiencing trauma, which is referred to as vicarious posttraumatic growth. The aim of the present study is to investigate the role of vicarious posttraumatic growth (VPTG) in the relationship between secondary traumatic stress (STS) and work ability (WA) in a sample of 231 death care workers in northern Italy. Regression analysis with interaction was performed using PROCESS. The results showed a negative association between STS and WA and a positive association between VPTG and WA. The interaction between STS and VPTG was also statistically significant. The moderating role of VPTG was partially confirmed by the analysis: at low and moderate VPTG levels, the conditional effect was negative and statistically significant, while at high VPTG, STS exposure had no significant and negative effect on WA, as if VPTG had some kind of protective role against STS. These results provide new insights into the role of VPTG in work environments with daily trauma exposure, such as death care.

Safety of Cubital Tunnel Release Under General versus Regional Anesthesia.

Purpose: The aim of this study was to evaluate the occurrence of early (<6 weeks) post-operative complications following ulnar nerve decompressions at the cubital tunnel performed under regional anesthesia compared to those performed under general anesthesia. Methods: In situ ulnar nerve decompressions at the cubital tunnel performed at a single institution from 2012 through 2019 were retrospectively reviewed. Post-operative complications were compared between subjects who underwent the procedure with regional versus general anesthesia. Results: Ninety-one ulnar nerve in situ decompressions were included in the study, which were performed under regional anesthesia in 55 and general anesthesia in 36 cases. The occurrence of post-operative complications was not significantly different between patients who received regional (n = 7) anesthesia and general (n = 8) anesthesia. None of the complications were directly attributed to the type of anesthesia administered. The change in pre- and post-operative McGowan scores were not significantly different between anesthesia groups (p = 0.81). Conclusion: In situ ulnar nerve decompression at the cubital tunnel under regional anesthesia does not result in increased post-operative complications compared to those surgeries performed under general anesthesia. In situ ulnar nerve decompression performed under regional anesthesia is a safe and reliable option for patients who wish to avoid general anesthesia. Level of Evidence: III.

Management of giant cell tumors of the distal radius.

Background: The distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment. Objectives: The purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options. Conclusion: Surgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates.

Small Joint Arthroplasty of the Hand: An Update on Indications, Outcomes, and Complications.

Small joint arthroplasty of the hand is a well-established surgery that can preserve motion and provide reliable pain relief, joint preservation, and improvement in hand function. Soft-tissue integrity is critical in patient and implant selection to avoid postoperative joint instability. Although instability is more common in nonconstrained implants such as pyrocarbon, silicone arthroplasty is associated with high rates of late implant fracture and failure with resultant recurrent deformity and instability. Additional complications such as stiffness, extension lag, and intraoperative fractures may be mitigated by alterations in surgical technique and postoperative rehabilitation protocols. Revision arthroplasty with soft-tissue stabilization procedures have reliable outcomes and can avoid conversion to arthrodesis. This article will review the surgical indications, outcomes of small joint arthroplasty in the hand, and common complications and their management.

Exploring the relationship between performance feedback and medical managers' budgetary performance:The role of managerial self-efficacy.

This study addresses recent calls for more research on the potential intervening role exerted by certain individual variables in the relationship between performance feedback and performance. Specifically, this study selects medical managers' sense of managerial self-efficacy as a potential mediational variable in the feedback-performance relationship. A mediational model examining how the effect of performance feedback on medical managers' budgetary performance is influenced by their sense of managerial self-efficacy was established based on survey data from 60 medical managers working in a hospital. Data analysis was conducted using the partial least squares technique, and the results confirmed the hypothesised relationships. Specifically, performance feedback was positively associated with managerial self-efficacy, and managerial self-efficacy exerted a positive influence on medical managers' budgetary performance. Further, performance feedback was determined not to be directly associated with budgetary performance; however, a full mediating effect of managerial self-efficacy was found. These findings make several contributions to the literature and can help healthcare managers have a better understanding of the consequences and importance of the technical features of performance feedback reports.

Cortical sources of electroencephalographic alpha rhythms related to the anticipation and experience of mirror visual feedback-induced illusion of finger movements.

Mirror visual feedback (MVF) technique consists in placing a mirror in a person's body midline to induce the illusion of bilateral synchronous movements of the limbs during actual unilateral movements. A recent electroencephalographical (EEG) study demonstrated that MVF-induced illusion was related to the event-related desynchronization (ERD) of alpha (8-12 Hz) rhythms (cortical activation) at the central and parietal scalp electrodes ipsilateral to the unilateral right finger movements. In the present study, we re-analyzed those data to localize the cortical sources of alpha ERD during the anticipation and experience of the MVF-induced illusion of index finger movements. To this aim, the exact Low-Resolution Brain Electromagnetic Tomography freeware was used for the estimation of the cortical sources of the alpha ERD. Results showed that as compared to the condition without MVF, the MVF condition was characterized by greater (p < .01, uncorrected) alpha ERD sources in right frontopolar areas during the anticipation of the MVF-induced illusion of left movements. The MVF condition was also characterized by greater (p < .05, corrected) alpha ERD sources in right premotor, primary somatomotor, and posterior inferior parietal areas during both the anticipation and experience of that MVF-induced illusion. These findings suggest that the MVF-induced illusory experience of left finger movements may be due to dynamic changes in alpha ERD in associative, premotor, somatomotor, and visuomotor frontal-parietal areas located in the hemisphere contralateral to the mirrored motor acts.

Calcific Tendinitis of the Proximal Flexor Carpi Radialis in a Throwing Athlete.

Flexor carpi radialis tendinitis is a condition that almost exclusively affects the distal aspect of the tendon where it lies in a tight fibro-osseous tunnel. Tendinitis of the proximal aspect of the tendon at its myotendinous junction is extremely rare. Herein, we present a single case of calcific tendinitis of the flexor carpi radialis tendon at its myotendinous junction in a throwing athlete. Diagnostic challenges and treatments are discussed.

A Comparison of Outcomes following Plate versus Pin Fixation of Metacarpal Shaft and Neck Fractures.

The aim of this study is to compare clinical and radiographic outcomes of open reduction and internal fixation versus closed reduction and percutaneous pinning of metacarpal fractures in relation to anatomic and surgical variables. Methods: Electronic medical records at two institutions were reviewed for patients who underwent surgical intervention for metacarpal fractures. Data were collected from those who underwent reduction and internal fixation with either plates or Kirschner wires (K-wires). Inclusion criteria included minimum postoperative follow-up of 60 days and age 18 years or older. Exclusion criteria included insufficient radiographic data, previously attempted closed reduction with immobilization, pathologic fracture mechanism, history of previous trauma or surgery to the affected bone, and fixation technique other than plate or K-wire. Results: We reviewed data for patients treated over a 22-year time period. Ultimately, 81 metacarpal shaft and neck fractures in 60 patients met inclusion criteria. Among all metacarpal fractures, complications were present in 39 (48.1%) cases. There were no significant associations between complication prevalence and hardware type. Revision surgery was required in 11 (13.6%) patients; there were no significant associations between revision procedures and hardware type. Postoperatively, all patients with imaging data had radiograph follow-up to assess union status. There was no significant association between time to union and hardware type. Conclusions: Outcomes showed no significant difference between plate and pin fixation for metacarpal shaft and neck fractures. These findings suggest that surgeons may have flexibility to decide on the type of operative intervention while considering patient-specific factors, such as the need for early mobilization.

Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected by Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) affecting the metacarpophalangeal (MCP) joint may warrant arthroplasty. The purpose of this study was to investigate implant survivorship, complications, radiographic outcomes, and clinical outcomes in patients undergoing MCP arthroplasty with a pyrocarbon implant to treat RA. METHODS: In all, 124 MCP joint pyrocarbon arthroplasties in 40 patients performed to treat RA were reviewed. Operations were at the index (n = 43, 35%), middle (n = 33, 27%), ring (n = 27, 22%), and small (n = 21, 17%) fingers from 1998 to 2009 in 105 (85%) female and 19 (15%) male joints with a mean age of 54 ± 11 years. Mean postoperative follow-up was 6 ± 3 years. All patients achieved at least 2 years of follow-up. RESULTS: Rates of implant survivorship at 1, 2, 5, and 10 years were 98%, 98%, 90%, and 81%, respectively. Fifteen percent (n = 18) of arthroplasties underwent revision at a mean 5 ± 3 years postoperatively. The overall reoperation rate was 29% (n = 36). Rates of survival from reoperation at 1, 2, 5, and 10 years were 85%, 84%, 76%, and 68%, respectively. Complications occurred in 32% (n = 40). Pain ratings improved postoperatively (P < .01). Arc of motion improved from 37 ± 21 to 43 ± 19 (P = .03). Both appositional and oppositional strength improved after surgery; however, there was no improvement in grip strength (P < .01). CONCLUSIONS: Metacarpophalangeal arthroplasty with a pyrocarbon implant demonstrated reliable improvement in pain and arc of motion in patients with RA. Complication and overall reoperation rates were high, while 1 in 10 undergo revision within 5 years postoperatively.

Outcomes of Surface Replacement Arthroplasty in Metacarpophalangeal Joints Affected by Noninflammatory Arthritis.

BACKGROUND: The purpose of this study was to investigate the outcomes of surface replacement arthroplasty (SRA) for noninflammatory arthritis of the metacarpophalangeal (MCP) joint. METHODS: Records from 20 SRAs performed between 1995 and 2017 in 17 patients with noninflammatory arthritis affecting the MCP joint were retrospectively reviewed. The mean follow up was 6.6 years. RESULTS: Three arthroplasties (15%) underwent 4 revision operations. The 2-, 5-, 10-, and 15-year rates of survival from surface replacement implant revision were 90%, 90%, 79%, and 79%, respectively. Major complications occurring in revised joints included arthrodesis (n = 1) and amputation (n = 1). The overall reoperation rate was 35%. The 2-, 5-, 10-, and 15-year rates of overall reoperation-free survival were 75%, 69%, 60%, and 60%, respectively. CONCLUSIONS: Pain ratings and MCP arc of motion significantly improved following arthroplasty. Metacarpophalangeal SRA for noninflammatory arthritis can improve arc of motion and pain. Revision is uncommon; however, 1 in 3 joints requires reoperation.

Twenty-Year Experience With Primary Distal Radioulnar Joint Arthroplasty From a Single Institution.

PURPOSE: The use of implant arthroplasty in the distal radioulnar joint is increasing. Two main types of implants are commonly used, ulnar head prosthesis (UHP) and hemi or semi-constrained total distal radioulnar joint arthroplasty. The literature consists mainly of small patient series. The purpose of this study was to examine our long-term outcomes of distal radioulnar joint arthroplasty. METHODS: Patient data were collected in a patient registry from 2000 to 2019. The follow-up included radiographic examination, physical examination, Mayo Wrist Scores, pain level, range of motion, and grip strength. Reoperations were recorded. The implants were a semi-constrained prosthesis and a metallic UHP. The mean age at surgery was 50 years. Patient demographics were similar, but the semi-constrained group had a higher preoperative percentage of instability (85 vs 52 percent). The median follow-up time was 30 months for the semi-constrained implants group and 102 months for the UHP group. RESULTS: A total of 53 primary semi-constrained total joint arthroplasties and 102 UHPs were included. The grip strength and Mayo Wrist Score improved for both the implant groups. Pain reduced in 76% of the patients. Supination improved for the semi-constrained total joint arthroplasty group. Lifting capacity was better in the semi-constrained total joint arthroplasty patients. The unadjusted reoperation rate was 23% for the semi-constrained implants group and 34% for the UHP group. Twenty-two implants were bilateral; these had comparable results to unilateral implants. Kaplan-Meier survival curves demonstrated 94% survival rate for the semi-constrained implants group and 87% survival for the UHP group after 5 years. The risk factors associated with reoperation for the combined implant group included younger age at surgery, previous wrist surgery, ulnar shortening, and wrist fusion. CONCLUSIONS: Distal radioulnar joint arthroplasty improved functional outcomes in both the implant groups, but reoperations were frequent. The semi-constrained implants group had better lifting capacity. The bilateral implants had comparable outcomes to the unilateral implants. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.