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Roles of individual EF-hands in the activation of m-calpain by calcium.

m-Calpain is a heterodimeric, cytosolic, thiol protease, which is activated by Ca(2+)-binding to EF-hands in the C-terminal domains of both subunits. There are four potential Ca(2+)-binding EF-hands in each subunit, but their relative affinities for Ca(2+) are not known. In the present study mutations were made in both subunits to reduce the Ca(2+)-binding affinity at one or more EF-hands in one or both subunits. X-ray crystallography of some of the mutated small subunits showed that Ca(2+) did not bind to the mutated EF-hands, but that its binding at other sites was not affected. The structures of the mutant small subunits in the presence of Ca(2+) were otherwise identical to that of the Ca(2+)-bound wild-type small subunit. In the whole enzyme the wild-type macroscopic Ca(2+) requirement (K(d)) was approx. 350 microM. The mutations did not affect the maximum specific activity of the enzyme, but caused increases in K(d), which were characteristic of each site. All the EF-hands could be mutated in various combinations without loss of activity, but preservation of at least one wild-type EF-hand 3 sequence was required to maintain K(d) values lower than 1 mM. The results suggest that all the EF-hands can contribute co-operatively to calpain activation, but that EF-hand 3, in both subunits, has the highest intrinsic affinity for Ca(2+) and provides the major driving force for conformational change.

Animals↗

Alcohol-free instant hand sanitizer reduces elementary school illness absenteeism.

UNLABELLED: BACKGROUND AND HYPOTHESES: A substantial percentage of school absenteeism among children is related to transmissible infection. Rates of transmission can be reduced by hand washing with soap and water, but such washing occurs infrequently. This study tested whether an alcohol-free instant hand sanitizer (CleanHands) could reduce illness absenteeism in school-age children. METHODS: A 10-week, open-label, crossover study was performed on 420 elementary school-age children (ages 5-12). Students were given a brief orientation immediately prior to the start of the study on the relationship of germs, illness, and hand washing. Each student in the treatment group then received the test product in individual bottles, with instructions to apply one to two sprays to the hands after coming into the classroom, before eating, and after using the restroom, in addition to their normal hand washing with soap and water. The control group was instructed to continue hand washing as normal with non-medicated soap. After 4 weeks of treatment and a 2-week wash-out period, the control and experimental groups were reversed. Data gathered on absenteeism were classified as gastrointestinal or respiratory related and normalized for nonillness-related absenteeism and school holidays. RESULTS: Compared to the hand washing-only control group, students using CleanHands were found to have 41.9% fewer illness-related absence days, representing a 28.9% and a 49.7% drop in gastrointestinal- and respiratory-related illnesses, respectively. Likewise, absence incidence decreased by 31.7%, consisting of a 44.2% and 50.2% decrease in incidence of gastrointestinal- and respiratory-related illnesses, respectively. No adverse events were reported during the study. CONCLUSIONS: Daily use of the instant hand sanitizer was associated with significantly lower rates of illness-related absenteeism.

Absenteeism↗

A cross sectional study of the association between sex, smoking, and other lifestyle factors and osteoarthritis of the hand.

OBJECTIVE: To describe the association between sex, smoking, physical activity, occupation, and previous digit fracture and hand osteoarthritis (OA). METHODS: Cross sectional study of 522 subjects from 101 Tasmanian families (348 women, 174 men). Hand OA was assessed by 2 observers using the OARSI atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal joints as well as a score for Heberden's nodes based on hand photography. A structured questionnaire collected information regarding physical activity, sport participation, occupation, and smoking history. RESULTS: Women had a higher prevalence of hand OA and the increase with age was significantly higher for women at all sites (all p < 0.05). Ever smoking was associated with less frequent (OR 0.59, 95% CI 0.38, 0.92) and less severe Heberden's nodes (beta -0.60, 95% CI -1.03, -0.17), but not radiological disease. Recall of occupation, physical activity, and sport participation between the ages of 20 and 40 years had no association with the prevalence or severity of hand OA, while self-reported digital fracture was significantly associated with more common (OR 2.42, 95% CI 1.22, 4.83) and severe DIP joint disease (beta +3.92, 95% CI +1.50, +6.36). No factors were associated with carpometacarpal disease. CONCLUSION: In this sample, women had a higher prevalence of hand OA at all sites as well as greater severity and a steeper age gradient (implying higher incidence rates). Smoking may decrease the risk of Heberden's nodes while having no effect on radiological hand OA, suggesting a differential effect possibly at the time of disease onset. With the exception of digital fracture, these data do not support a causal role for occupation or activity in earlier life with regard to hand OA.

Adult↗

Treatment of hand eczema.

Hand eczema is a common skin disease that tends to become chronic and may interfere with many types of work. Emollients have been shown to be useful in reducing eczema activity and in the primary prevention of hand eczema. Protection of the hands is very important for the prevention of hand eczema and is a fundamental aspect of the treatment of hand eczema. Although topical corticosteroids are the mainstay of treatment, few studies of their rational use, efficacy and side-effects have been conducted. A combination of tacrolimus and topical corticosteroids may reduce the risk of steroid-associated side-effects. Systemic treatment with immunosuppressants such as cyclosporine and methotrexate show promising results, and acitretin may suppress keratotic hand eczema. Botulinum toxin has been used with success in the treatment of dyshidrotic hand eczema. PUVA is effective as a systemic treatment. Bath-PUVA treatment, UVB and Grenz rays can also suppress hand eczema.

Eczema↗

Hand discomfort following heliox chamber dives.

During a series of dry chamber dives using compressed heliox, five attendants and one wet diver experienced eight episodes of hand discomfort, the character of which was atypical of limb pain during decompression sickness. Although immersed for most of the dive, during the compression and decompression phases, the wet diver's hands were out of the water and hence exposed to the helium-containing chamber atmosphere. In all cases, symptoms resolved within a maximum of 48 h. There was no response to hyperbaric oxygen therapy in the three cases that presented before spontaneous resolution. While the attendants wore dry suits to minimize skin absorption of helium, their hands, were exposed to the heliox atmosphere. After the first six cases of hand symptoms, a dry glove assembly was added to prevent helium absorption through the exposed hand. Two cases of hand discomfort occurred following the addition of the dry glove assembly to the dry suit. In both cases, the symptoms were less severe and resolved over a significantly shorter time period. Adoption of the dry gloves resulted in the incidence of hand discomfort among attendants falling from 25% (5/20) to 2.4% (2/84) (p = 0.005). Possible mechanisms of causation of this hand discomfort, thought to be the result of local tissue absorption of helium, are discussed.

Administration, Cutaneous↗

Changes in the cortical map of the hand following postnatal median nerve injury in monkeys: modification of somatotopic aggregates.

Median nerves to the hands of 8-15-d-old marmoset monkeys were transected and precluded from regeneration by ligation. Following periods of 0.4-1.5 years, features of organization in the cortical area 3b hand map were assessed neurophysiologically, and compared to features in normally reared monkeys. Cortical features in monkeys with both histories were similar in certain respects. (1) Receptive field organization was similar in terms of tactile thresholds and receptive field size, continuity, and glabrous-hairy specificity. (2) Somatotopic organization was similar in terms of the continuity of the glabrous representation, and progressions of receptive field shifts across some parts of the hand map. (3) Finally, the overall size of the hand map did not change. In contrast, other cortical features clearly differed following these developmental histories. (1) Neurons at virtually all recording sites in normal hand maps responded to light mechanical stimulation, whereas, following injury, neurons at about 8% of the recording sites responded only to high-intensity stimuli. (2) Somatotopic organization differed in terms of the presence or absence of the representation of skin autonomously innervated by the median nerve, the number and continuity of representations of hairy skin, and the spatial interfacing of representations. (3) Finally, there were differences in the areas and widths of representations of parts of the hand. The overall impression is that there is a correspondence between the cortical features that changed most after injury, and the features that varied most in individual normal monkeys: in both circumstances the most variable features involved properties of spatial patterning across large aggregates of neurons as reflected by the size, shape, continuity, and interfacing of representations. A hypothesis is proposed that suggests that the cortical hand map normally consists of a number of representations that are capable of developing and surviving somewhat autonomously of each other. The features of spatial patterning in the mosaiclike map of these representations are influenced by postnatal availability of inputs from intact hand nerves.

Animals↗

Is "left" always where the thumb is right?: stimulus-response compatibilities as a function of posture and location of the responding hand.

OBJECTIVE: To determine hand-centered coordinate systems for left-right discriminations in representational space, including scenes imagined behind one's head ("backspace"). METHOD: Thirty-two healthy men responded with the index or ring finger of their right (dominant) hand to numbers presented in the center of a screen. These indicated hours on the right or left half of a clock face. A decision "earlier or later than six o'clock?" was required. There were 4 response conditions: (1) pronated and (2) supinated hand in frontspace and (3) pronated and (4) supinated hand in backspace. RESULTS: "Left" and "right" were reliably and differentially associated with the 2 different fingers for all conditions except the pronated hand in backspace (conflict between body-centered and hand-centered reference frames). When backspace trials were analyzed as a function of individual strategies of the localization of the imaginary clockface (ie, around the stimulus number in frontspace versus around the response hand in backspace), it was found that the 2 strategies were associated with opposite right/left assignments. CONCLUSIONS: Together, these results indicate relatively universal left/right assignments to the fingers of a hand held in canonical postures and interindividually variable (but intraindividually consistent) assignments for less canonical postures. The task appears suitable for the quantification of representational neglect, especially in backspace.

Adult↗

Hand gangrene in diabetic patients on chronic dialysis.

To determine whether any potentially reversible variables are related to the development of hand gangrene in diabetic patients on dialysis, the authors compared 15 patients with hand gangrene (group A) to three control groups of diabetics on dialysis: 20 patients with foot gangrene (group B); 31 patients without gangrene of the extremities (group C); and 20 patients without hand arterial calcifications (group D). All patients in groups A-C had medial arterial calcifications of the hands. Group A patients started dialysis at an earlier age (p less than 0.05), were treated for end-stage renal disease (ESRD) for a longer time period (p less than 0.05), and had a lower mean serum albumin concentration during the dialysis period (p less than 0.05) than the patients in the control groups. Hand gangrene also appeared to be associated with the presence of a functioning arterio-venous fistula in the extremity with the gangrene, with loss of function of renal transplant, and with hyperaluminemia. Other variables, including serum parathormone, were not different for the four groups. Logistic regression showed that the following were risk factors for hand gangrene: hypoalbuminemia, long duration of ESRD treatment, hyperphosphatemia, high insulin dose, hypercholesterolemia, and hypoglycemia. In diabetics on dialysis, gangrene develops in hands with medial arterial calcifications, but does not correlate with measures of calcium or phosphorous metabolism. Predictors of hand gangrene include certain potentially reversible clinical and biochemical variables.

Arteriovenous Shunt, Surgical↗

AIDS in the hand patient: the team approach.

Hand surgeons and therapists were faced with a new clinical entity in the 1980s with the emergence of hand and upper extremity infections in patients with AIDS and HIV disease. This entity has become a worldwide epidemic of vast proportions and has proven to be one of the major health concerns of the 1990s. It seems likely that treatment of patients with this devastating disease for hand infections or more routine upper extremity problems will become routine in the future. The reality of surgical treatment and hands-on rehabilitative therapy for patients with a life-threatening infectious disease has been a concern voiced publicly by very few health care professionals, yet discussed quietly among colleagues quite frequently. Our aim must be to provide the highest quality of health care to this group of hand patients, just as we do for all other patients, while at the same time providing the safest possible environment for all members of the health care team. It appears that there is a higher incidence of HIV infection among hand patients than is noted in the general public; therefore, the hand surgeon and medical team should pay particular attention to the rapidly advancing front of new information available regarding care for this challenging group of patients. Hand surgeons and therapists are entering the 1990s armed with a wealth of new and valuable information about HIV disease that has been produced by intensive basic science research and clinical observations accumulated over the last 10 years. The fears generated by the initial misinformation and lack of information concerning modes of transmission of HIV have generally been supplanted by a more rational approach to patient care, fostered by the more accurate scientific information currently becoming available. Unfortunately, the rational approach to the HIV-related political and socioeconomic issues has not yet overtaken the discrimination and stereotyping of the populace stricken with HIV disease. It remains the responsibility of the medical community to continue research efforts aimed at delineating the clinical deficiencies manifested by these patients and determining their effects on treatment regimens for both the unique and commonplace medical and orthopedic problems noted in this patient population.

Acquired Immunodeficiency Syndrome↗

The effects of cold immersion and hand protection on grip strength.

The maximal voluntary grip strength (MVGS) of male volunteers was examined following a series of five intermittent 2 min cold water (5 degrees C) immersions of the unprotected hand or forearm. MVGS changes due to wearing a protective glove were also investigated. The surface electrical activity over the hand flexor muscles was recorded, as was the skin temperature of the hand and forearm. MVGS decreased significantly (p less than 0.01) following hand immersions (16%) and forearm immersion (13%). The majority of these reductions occurred during the first 2-min period of immersion. The effect of wearing a glove after unprotected hand cooling also produced significant (p less than 0.01) MVGS reductions which averaged 14%. These reductions were in addition to those caused by hand cooling. We conclude that both hand and forearm protection are important for the maintenance of hand-grip strength following cold water immersion.

Adult↗

[Effect of participation in certain types of sports on the hand bones of adolescents and youth].

The effect of such sports training as boxing, basket-ball and football on the hand skeleton was studied. Roentgenograms of hands in 80 young sportsmen 15--17 years old were examined. Synostosis in the hand bones, in distal portion of the forearm and mineral saturation of the metacarpal bones were studied by the standard method of roentgenodensitometry. It was stated that specific loading on the hand bones as a result of sports training (boxing, basket-ball) produces certain adaptive-compensatory changes in the hand bones development and structure. These changes are manifested as: decreasing rate of synostosis in the distal epiphysis of the forearm and hand bones in young boxers; certain time changes in sinostosis of definite parts of basket-ballers' hand skeleton. Their structural changes are seen as increased mineral saturation in the hand bones (more in boxers and less in basket-ballers) that correspondingly results in their increasing resistivity.

Absorptiometry, Photon↗

[Hand and foot infections in children].

Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estefãnia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. The remaining 16 with hand infection (64%) and 15 with foot infection (29%) were being treated with splint in the position of rest, elevation of the affected limb and endovenous antibiotic therapy. In all abscess cases, surgical drainage was conducted, 16 the of hand and 22 of the foot. There were no sequels in hand infection. In foot infection there was one osteitis of the first metatarsus and a cutaneous fistula.

Adolescent↗

The influence of biodynamic factors on the absorption of vibration energy in the human hand and arm.

A possible basis for risk assessment for hand-transmitted vibration may be to determine the quantity of energy absorbed in the human hand and arm. In the present study the mechanical energy absorption in the hand-arm system has been measured on 10 healthy subjects during exposure to random vibration with constant velocity spectrum. In the study, the influence of various conditions, such as vibration direction (Xh, Yh, Zh), grip force (25-75 N), feed force (20-60 N), frequency weighted acceleration level (3, 6, 9, 12 m/s2) and hand and arm posture (5 flexions, 2 abductions) were studied. The outcome showed that the energy absorption in the human hand and arm depended mainly on the frequency and direction of the vibration stimuli. Higher vibration levels, as well as firmer hand grips and higher feed forces, resulted in a significantly higher absorption. As concerns the hand and arm posture the results show that the flexion had a significant contribution to the vibration absorption but the abduction had no influence on the quantity of absorbed energy. Furthermore, the influence of some of the studied variables had a non-linear effect on the absorption but also differed between different exposure directions. Moreover, it was concluded that the frequency-weighting routine in the international standard ISO 5349 do not reflect the energy absorbing properties of the human hand and arm.

Absorption↗

Hand washing frequency in an emergency department.

Objectives Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one emergency department and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. Design Observational. Setting ED of a 1100-bed tertiary referral, central city, private teaching hospital. Participants Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. Interventions An observer recorded the number of patient contacts and activities for each participant during 3-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. Results Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3% of total contacts (SD, 2.31%). Nurses washed after 58.2% of 146 contacts (SD, 4.1%), residents after 18.6% of 129 contacts (SD, 3.4%), and faculty after 17.2% of 134 contacts (SD, 3.3%). Nurses had a significantly higher hand washing frequency than either faculty (p < 0.0001) or resident physicians (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Cooperative Behavior↗

The consistency, extent, and locations of early-onset changes in cortical nerve dominance aggregates following injury of nerves to primate hands.

The somatosensory cortex of primates contains patch- and bandlike aggregates of neurons that are dominantly activated by cutaneous inputs from the radial, median, and ulnar nerves to the hand. In the present study, the area 3b hand cortex of adult monkeys was mapped immediately before and after combined median and ulnar nerve transection to evaluate the consistency, extent, and location of early post-injury alterations in the deprived median and ulnar nerve cortical bands. Several alterations were observed acutely after injury. (1) The patchlike cortical aggregates of intact radial nerve inputs from the hand underwent a two- to three-fold expansion. This expansion was not related to peripheral changes in the radial nerve skin territory, but was due to rapid central decompression of radial nerve dominance patches. (2) The largest changes involved patches in lateral to central locations of the hand map. (3) The expanded patches occupied cortical zones that were activated by inputs from the digits, palm, and posterior hand prior to injury. These receptive field shifts were initiated within minutes after injury. (4) Receptive fields of neurons within expanded radial nerve patches were normal in size. (5) Besides changes involving radial nerve inputs from the hand, there was a small expansion of forelimb inputs into the preinjury hand cortex; however, the representation of face inputs did not expand into this cortex. (6) Finally, neurons across 50-69% of the hand cortex were unresponsive to tactile stimuli acutely after this injury. These findings indicate that the distribution patterns of nerve dominance aggregates in adult primates begin changing within minutes after nerve injury. Cortical changes involving specific inputs occupy similar extents and locations of cortex, and are arranged in highly consistent patterns, in different individuals. It is suggested that this consistency reflects specific patterns of central sensitization or disinhibition that are triggered by the injury.

Animals↗

[Emergency services for the hand: a necessity].

Every year in France there are 500,000 hand injuries; the number of injuries has remained constant over the last ten years and constitutes one-third of all work-related accidents. At the emergency department for hand surgery from Nancy University Hospital the treatment of hand injuries is the third part of the global activity. There have been significant advancements in the field of hand surgery in the last twenty years due to development of microsurgical techniques which make it possible to revascularize tissue that otherwise would die. Surgeons who treat hand injuries usually have been trained in the fields of orthopedics, traumatology, plastic surgery, and microsurgery. The improved results--attributable to new techniques and early treatment--pointed to the need for organizing emergency services for hand injuries that would operate on a 24-hour basis. In 1979, a group of French surgeons founded the Federation of Emergency Treatment of Hand Injuries that today represents 27 centers in France and 19 others in countries of the European Community. These emergency wards work in conjunction with other centers dealing with emergency service, e.g., the Fire Department, Ambulance service, Industrial Medicine, etc... Over a period of 15 years, the benefits reaped from treating these injuries as true emergencies (less than 6 hours ischemia) based on the principle of Immediate Repair with Early Mobilization (IREM) are both functional and social in nature: in 90% of cases, the patient resumes professional and economic activity and the rate of partial disability is 30% lower than that observed in cases treated in non-specialized centers. Given these results that are acknowledged by all who work in emergency service in general, we think that emergency wards for hand injuries should be an integral part of the overall plan coordinating emergency services in France.

Emergency Medical Services↗

The effect of wrist rest, caffeine, and oral timolol on the hand steadiness of ophthalmologists.

Because hand steadiness is an important aspect of microsurgical technique, hand movement, amplified by a hand-held laser pointer, was measured in 14 ophthalmology trainees on four separate mornings when each had ingested (1) 200mg of caffeine, (2) 12.5mg of timolol (2.5mL of timolol 0.5% ophthalmic solution), (3) a combination of caffeine and the beta-adrenergic blocker, or (4) a placebo. Caffeine increased the resting pulse and hand movement. Although the beta-adrenergic blocker and the combination of caffeine and this drug decreased the resting heart rate from that of placebo, they did not significantly change hand steadiness. However, compared with caffeine alone, the beta-adrenergic blocker-caffeine combination significantly decreased hand movement and the pulse. Resting the wrist significantly steadied hand movements. Hand movement was not correlated with the level of ophthalmology training, the trainee's weight, or their daily caffeine consumption.

Administration, Oral↗

The influence of hand guards on forces and muscle activity during giant swings on the high bar.

To investigate the influence of hand guards on the loads experienced by gymnasts during giant swings on the high bar, forces applied to the bar by each hand and muscle activity of the extrinsic finger flexor and wrist extensor muscle groups were measured in 10 male gymnasts as they completed a minimum of three backward giant swings on the high bar. Measurements were made under four conditions of performance: bare hands, with webbing loops, with doweled hand guards (DHG), and a wind-up swing using DHG. Peak reaction forces at the hands were of the order of 2.2 times body weight (BW) on each hand, and were significantly (P < 0.05) lower when swinging bare-handed, compared with the other three conditions. By contrast, the integrated electromyograms showed that both wrist flexor and extensor muscle activity was unchanged across conditions. These results indicate that the use of hand guards allows greater tensile forces to act across the wrist without a measureable increase in forearm muscle activity. Thus, it is possible that there is extra stress on the ligaments of the wrist or at the epiphyseal plates. In adolescent and preadolescent gymnasts, the additional tension on the distal epiphyses of the radius and ulna may have implications for bone growth.

Adult↗