Search Results (117)

Text entry remains a bottleneck for productivity-oriented Virtual Reality (VR), especially in scenarios where optical hand tracking is unstable because of self-occlusion, poor lighting, or out-of-view interaction. We present SlideRing, a dual-thumb wearable text-entry method that senses thumb-to-finger micro-gestures with two miniature Inertial Measurement Units (IMUs). SlideRing defines a 30-command interaction space from two hands, three target fingers, and five gesture types, then maps these commands to a full alphabetic keyboard through two complementary strategies: an ergonomic layout optimized for low movement cost and a QWERTY-compatible layout optimized for learnability. To decode subtle inertial signals, we design a dual-stream recognition model with a Statistical Feature Encoder, a Temporal Feature Encoder, and a context-aware gating module for joint finger–action classification. In offline evaluation, the model reaches 96.5% target-finger accuracy and 94.2% action-type accuracy. In a five-day text-entry study, the ergonomic layout improves from 7.43 to 15.75 words per minute (WPM), while the QWERTY-compatible layout improves from 10.55 to 15.25 WPM. The ergonomic layout reduces physical demand, whereas the QWERTY-compatible layout lowers initial mental load. These results suggest that IMU-based thumb-to-finger input has the potential to provide robust, low-visual-demand text entry for constrained VR environments. Full article

Objective: To quantify and map bone mineral density (BMD) at the bases of human finger phalanges using computed tomography (CT) with a calibration phantom and to compare BMD both between and within digits. Methods: Ten cadaveric hands (H1 to H10) were CT scanned with a Model 3 CT Calibration Phantom (Mindways). All data were processed in the Horos software (Version 4.0.0) and the regions of interest (ROIs) at each phalangeal base were delineated. Hounsfield Units (HU) were converted to BMD (mg/cm³) per the phantom framework. Descriptive statistics and repeated-measures ANOVA analyses were performed for each digit and corresponding phalangeal level (proximal, middle, distal). Inter-digital comparisons were performed at corresponding phalanx levels and intra-digital variations were analyzed within digits across phalangeal levels. Results: Mean BMD varied across digits and phalangeal levels. At the proximal phalanx base, the thumb and index fingers exhibited the highest values, whereas at the middle phalanx base the middle and ring fingers demonstrated the highest mean BMD values. At the distal phalanx base, the little finger demonstrated the highest BMD value, while the lowest value was observed at the distal phalanx of the index finger. Intra-digital analysis revealed distinct distribution patterns: BMD decreased distally in the thumb and index fingers, peaked at the middle phalanx in the middle and ring fingers, and was highest distally in the little finger. Repeated-measures ANOVA demonstrated statistically significant intra-digital differences in the thumb and index fingers, whereas no statistically significant inter-digital differences were observed across corresponding phalangeal levels. Conclusions: CT-based, phantom-calibrated BMD mapping at the bases of the phalanges demonstrates substantial intra-digital variability and descriptive inter-digital differences. These site-specific findings may provide additional information relevant to implant selection and preoperative planning for fixation in phalangeal fractures and tendon- or ligament-to-bone insertion injuries in hand surgery. Full article

Meta-analysis is a statistical tool commonly used within systematic reviews to synthesize quantitative evidence, but individual studies with atypical results or disproportionate influence can materially affect pooled estimates, heterogeneity estimates, and the conclusions drawn from evidence syntheses. Conventional outlier and influence diagnostics for meta-analysis are useful, but their interpretation often relies on asymptotic reference values or informal rules of thumb, which may be inadequate when the number of studies is limited or heterogeneity is substantial. We introduce boutliers, an R package that implements bootstrap-calibrated outlier detection and influence diagnostics for fixed-effect and random-effects meta-analysis. The package provides leave-one-study-out diagnostics based on Studentized deleted residuals, relative changes in the variance of the pooled effect estimator, and relative changes in the between-study variance, together with a likelihood-ratio diagnostic based on a mean-shifted model. For each diagnostic measure, bootstrap reference distributions, critical values, and p-values are provided to support quantitative interpretation of influential studies. We describe the statistical framework, implementation, and practical use of the package and illustrate its application using a real published meta-analysis dataset on spinal manipulative therapy for chronic low back pain. The boutliers package provides accessible tools for incorporating uncertainty-calibrated influence diagnostics into routine meta-analytic practice. Full article

Background: Hand Hygiene (HH) plays a crucial role in preventing Hospital-Acquired Infections (HAIs), yet compliance and technique often remain inadequate. To our knowledge, this study is among the first large-scale Semmelweis Scanner-based evaluations of hand hygiene technique among both medical and non-medical students in Uzbekistan and the wider Central Asian region. Methods: A cross-sectional study was conducted between March 2024 and July 2025 at the Tashkent Medical Academy and the Tashkent State Technical University, resulting in 4191 data scans and 16,764 pictures analyzed. Hand surface coverage was evaluated using the Semmelweis digital monitoring system, which provides image-based feedback on insufficiently covered areas. Adequate performance was defined as achieving at least 95% hand surface coverage. Results: The findings showed that only 43.4% of hand hygiene measurements achieved the ≥95% hand coverage threshold, while 56.6% showed incomplete coverage. The sixth WHO-recommended step, i.e., rotational rubbing of the thumb and fingertips was identified as the most frequently missed moment. Significant variation was observed across faculties and departments, with bachelors achieving the highest success (n = 1012, 51.8%) and Ph.D. students reaching the lowest (18.4%). Conclusions: Hand hygiene technique among students in Uzbekistan is highly variable and frequently inadequate when evaluated using scanner-based digital assessment. The findings suggest that incomplete hand surface coverage, rather than the absence of sanitization attempts, is the principal challenge. Digital hand hygiene monitoring systems can provide an effective complementary tool for technique-focused education and can support infection prevention practices in both medical and non-medical training environments. Full article

Stray-current corrosion from DC-electrified railways drives premature failure of buried metallic infrastructure (pipelines, foundations, tunnel reinforcement), causing resource waste, repair-driven carbon emissions and service disruptions that undermine the sustainability of urban transit corridors. Conventional impressed-current cathodic protection (ICCP) design relies on uniform-anode rules of thumb or closed commercial codes that cannot quantify the trade-off between protection uniformity, energy use and hardware cost. We present an open MATLAB framework that couples a custom 3D finite element method (FEM) solver with multi-objective particle swarm optimisation (MOPSO) and minimises three competing objectives simultaneously: total impressed current, RMS deviation from the protection target, and number of active anodes. A laboratory-calibrated coupling factor ($\mathrm{CF}=1.98$, consistent with the image-method prediction of 2 for a highly conductive pipe inclusion) absorbs the pipe–soil interface kinetics into a single direct FEM solve, and a pre-computed Green’s-function basis accelerates each MOPSO evaluation by more than two orders of magnitude. The solver is validated against an instrumented prototype with RMSE $=14.9$ mV across ten Cu/CuSO₄ saturated reference electrode (CSE) measurements, and applied to a 500 m DC traction line. At an identical total current of 20.30 A across five anodes, the optimised design achieves an RMSE of 86.6 mV against the $-850$ mV NACE target, whereas a conventional uniform layout produces severe over-protection (RMSE $=1107$ mV)—a twelve-fold reduction. The framework is recommended as a transparent, reproducible engineering tool that simultaneously extends pipeline service life and reduces rectifier energy demand, supporting UN Sustainable Development Goals 9 and 11 for sustainable urban-rail infrastructure. Full article

As robotics prehension systems and virtual reality applications are in constant evolution, the need for high-fidelity haptic interaction increases. This helps ensure and enhance user immersion and handling precision. While commercial haptic interfaces offer high performance, their prohibitive cost limits their widespread adoption in general-purpose robotics. Furthermore, many low-cost solutions suffer from limited transparency, where the operator constantly fights the friction of the actuator even during free motion. This article presents the design and development of an innovative, cost-effective master–slave robotic system aimed at democratizing efficient haptic feedback devices. The solution is intended for remote manipulation of objects with a maximum mass of 1 kg, while limiting the gripping force to 50 N, thus ensuring the integrity of objects being manipulated. The device includes a master haptic module in the form of a clamp that reproduces the thumb–index–middle finger gripping motion performed by the user. The system relies on a custom haptic interface measuring the angular position of the master gripper, which is transmitted in real time to the slave gripper, so as to adjust the position of the clamp accordingly, thus optimizing the grasping control loop. As soon as an object is detected, using a force sensor integrated into the slave gripper, the master motor renders a resistive force, preventing the user from closing the haptic module. The other part of the system is the slave mechanical gripper with three fingers, each with three phalanges based on human anatomy, allowing the clamp to mechanically conform to irregular object geometries with a single actuator. The last but not least innovative aspect lies in the implementation of a current sensor, which provides the haptic feedback. The force applied by the user is reproduced by the slave gripper using current sensors, eliminating the need for expensive force-torque sensors while maintaining a responsive feedback loop. Full article

Background: The original Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) is a simple assessment tool but does not account for individual differences in hand starting position and fails to provide information on limb asymmetries. The purpose of the study is to evaluate the test–retest reliability of a new single-arm CKCUEST as well as the reliability of the limb symmetry index (LSI). This version normalizes the test based on the participant’s arm length and allows for the assessment of limb symmetry since it is performed one arm at a time. Methods: Twelve healthy young adults provided both verbal and written consent to participate. Participants were excluded if they had sustained an injury in the past three months requiring medical attention and/or resulting in decreased activity for more than three days. Testing was conducted in the push-up position with participants’ thumbs placed parallel and at a distance equal to the length of their dominant arm (measured from the acromion to the tip of the middle finger), and feet positioned shoulder-width apart. Participants were instructed to keep the testing hand stable on the floor while the opposite hand reached across the body to touch the stationary hand and then return to the starting position marked with athletic tape. The goal was to complete as many touches as possible in 15 s, with each touch counted only if the participant touched the stationary hand, returned to the starting position, and maintained the shoulder-width stance. The average number of touches from the three trials was used for analysis. Intraclass Correlation Coefficients (ICC_(3,1)) were computed to determine test–retest reliability. Results: Test–retest reliability of the single-arm CKCUEST individual tests was good to excellent. The ICC_(3,1) was 0.88 (95% CI: 0.74–0.95) for all tests, 0.89 (95% CI: 0.66–0.96) for the dominant arm, and 0.93 (95% CI: 0.78–0.98) for the non-dominant arm. In contrast, the reliability of the Limb Symmetry Index (LSI) was questionable, showing substantial variability with an ICC_(3,1) of 0.53 (95% CI: −0.03–0.83) between Day 1 and Day 2, despite similar mean values (Day 1: 93.6 ± 8.46; Day 2: 94.8 ± 5.77). The Kappa coefficient suggested a substantial level of agreement for the direction of the asymmetry (preferred limb) (Kappa coefficient = 0.62). Conclusions: The new single-arm CKCUEST, which personalizes the hand starting position and measures limb symmetry, demonstrates high reliability among healthy young adults. Full article

Accurate and accessible motor function quantification is important for monitoring the movement disorders’ progression. Manual muscle testing models and wearable sensors can be costly or reduce degrees of freedom. Artificial intelligence, especially human pose estimation (PE), offers promising alternatives. This work aims to compare the accuracy of a 2D PE tool for the Finger Tapping Test (FTT) with a 3D infrared motion capture system (MoCap). PE tracked three anatomical landmarks (wrist, thumb, index finger), while reflective markers were placed at corresponding locations on both tools to measure wrist-centered angles. Different trials of slow and rapid FTT sessions were statistically analyzed by rank correlation analysis, Friedman, Bland–Altman, and Kruskal–Wallis to assess agreement and repeatability. PE and MoCap measurements showed no significant differences (p > 0.05), with high reliability (ICC 0.87–0.91), low variability (CV 6–8.6%), and negligible effect size. Bland–Altman slopes indicated minor amplitude-dependent bias, while RMSE (2.92–4.48°) and MAPE (6.38–8.22%) errors occurred in slow and rapid conditions. These results demonstrate that 2D PE provides a reliable, accessible, and low-cost alternative for quantifying finger movement. The findings suggest that PE can serve as an assistive method for monitoring motor function. Future studies can be population-level studies with patients with neurological disorders. Full article

Background: Trapeziometacarpal osteoarthritis (TMC OA) is a prevalent degenerative disorder that causes considerable pain and functional limitations, especially in older individuals, whose ideal treatment is still debated in the literature. Various treatments are described to restore a good functional outcome of the thumb; over the past 50 years, biological arthroplasties have been considered the gold standard for treating advanced stages of TMC OA. However, in the last decade, the use of dual mobility cup prostheses has significantly increased, with numerous studies reporting excellent clinical outcomes. In this case report, we show the results of a patient treated on the left hand with suspension arthroplasty and on his right hand with dual mobility arthroplasty in one-stage surgery. The aim of this case report is to directly compare outcomes between trapeziometacarpal prosthesis and suspension arthroplasty performed simultaneously in the same patient. Case Presentation: The present case reports a 71-year-old male patient with bilateral TMC osteoarthritis, referred to our clinic in May 2024. His medical history included hypertension, hypertriglyceridemia, paroxysmal atrial fibrillation, and benign prostatic hyperplasia. On examination, the right hand showed grade 3 osteoarthritis according to the Eaton–Littler classification, with the trapezium maintaining adequate bone stock, making the patient eligible for trapeziometacarpal prosthesis implantation. Conversely, the left hand demonstrated scaphotrapezoid arthritis with a slight reduction in trapezial bone stock, indicating the need for trapeziectomy followed by suspension arthroplasty. Both procedures were performed during the same surgical session by the same experienced hand surgeon using a lateral approach. On the right side, the trapeziometacarpal joint surfaces were resected and replaced with a dual mobility prosthesis, while on the left side, the trapezium was excised, and suspension arthroplasty was performed using a slip of the flexor carpi radialis (FCR) tendon. Methods: The patient underwent simultaneous treatment with a dual mobility trapeziometacarpal prosthesis on the right hand and trapeziectomy with suspension arthroplasty on the left hand. Clinical outcomes (grip and pinch strength, pain, QuickDASH, satisfaction, and range of motion) were evaluated at 1, 3, 6, and 12 months. Paired comparative statistics were applied with significance set at p < 0.05. Results: At all follow-up intervals (1, 3, 6, and 12 months), the hand treated with a trapeziometacarpal prosthesis demonstrated superior grip and pinch strength compared to the hand treated with trapeziectomy and suspension arthroplasty, with the greatest difference observed at 3 months. At 12 months, grip strength increased from 28 kg to 40 kg in the prosthesis-treated hand and from 25 kg to 33 kg in the suspension arthroplasty hand. Paired comparisons were performed at each follow-up interval up to 12 months, confirming a significant difference for grip strength. Pain levels (VAS, Visual Analogue Scale) decreased progressively in both hands, with a more rapid reduction in the hand treated with a trapeziometacarpal prosthesis, reaching statistical significance. QuickDASH scores indicated an earlier return to daily activities in the hand treated with the prosthesis, although this difference was not statistically significant. Patient satisfaction was consistently higher for the hand treated with a trapeziometacarpal prosthesis, with the patient reporting a ‘very satisfied’ rating at all timepoints. Range of motion recovery, assessed through the Kapandji score and measurements of thumb abduction and extension, also favored the hand treated with the prosthesis, with statistically significant differences for abduction and extension, whereas the hand treated with trapeziectomy and suspension arthroplasty demonstrated more gradual improvement over time. Conclusions: This case highlights the functional efficacy of both surgical approaches—biological arthroplasty and trapeziometacarpal prosthesis—in the treatment of TMC osteoarthritis. Both procedures resulted in a good clinical outcome and high patient satisfaction. However, recovery was noticeably faster in the hand treated with a trapeziometacarpal prosthesis, which is consistent with findings previously reported in the literature. These observations suggest that, while both techniques are valid and effective, trapeziometacarpal prosthetic replacement may offer a quicker return to function in appropriately selected patients. Full article

Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, and intraoperative evaluation is subjective. This study aimed to establish objective assessment methods by analyzing the correlations between a novel visual grading system, CT Hounsfield units (HU), and actual bone strength. Materials and Methods: This prospective study included 131 patients undergoing posterior-stabilized TKA. We developed a novel visual grading system (Excellent, Good, Fair, Poor) based on femoral cutting surface characteristics. CT HUs were measured preoperatively by an assisting surgeon in the box bone area. Femoral box specimens underwent indentation testing to determine their actual bone strength. Minimum Required Strength (MRS) was defined at 2.5-fold the patient’s body weight, and Estimated Withstanding Strength (EWS) was determined by scaling first failure load using area ratios. Patients were classified as “cementless suitable” (EWS > MRS) or “cemented mandatory” (EWS < MRS). Correlations were assessed using Spearman’s rank correlation for visual grade and Pearson correlation for Hounsfield units. ROC curve analysis determined diagnostic accuracy. Results: Visual grade exhibited an exceptionally robust relationship to bone strength (Spearman ρ = 0.903, p < 0.01), whereas HU showed substantial correlation (Pearson r = 0.660, p < 0.01, R² = 0.435). Visual grading achieved excellent diagnostic accuracy (AUC = 0.974, sensitivity 95.1%, specificity 95.9%) using “Good” grade as cutoff. HU demonstrated AUC of 0.938 with 92.7% sensitivity and 81.6% specificity at a cutoff value of 65.2. Conclusions: Our novel visual grading system and CT HU demonstrated excellent correlations with actual distal femoral bone strength and outstanding diagnostic performance for identifying cementless TKA candidates. Unlike traditional subjective intraoperative assessments such as the “thumb test”, this system provides objective visual criteria directly correlated with actual bone strength. Preoperative HU screening with intraoperative visual grading can help prevent early failure. Full article

Background/Objectives: The aim of this observational study was to collect hand measurements and anthropometric data in children aged 1–15 years of age to help the design of a pediatric skin electrode for electromyography-based neuromuscular monitoring. Methods: Data collection was performed at the Pediatric Department of the University of Debrecen Medical Centre between 1 December 2019 and 31 January 2021. After gaining written informed consent from the parents or legal representatives and verbal acceptance from age-appropriate (12–35 months) patients, a total of 153 children were enrolled. The following parameters were recorded: demographics (age, sex, weight, height, and hand dominance) and hand size parameters, defined as the distance between the following reference points: the ulnar groove and the midpoint of the hypothenar eminence (A); the midpoint of the hypothenar eminence and the first interphalangeal joint of the 5th finger (B); the ulnar groove and the midpoint of the thenar eminence (C); the midpoint of the thenar eminence and the interphalangeal joint of the thumb (D); the midpoint of the wrist crease and the tip of the third finger; wrist circumference (E); and forearm length. All measurements were made in centimeters (cm). Results: The children were divided into 4 groups (12–23 months, 2–5 years, 6–11 years and 12+ years). The number of children in the groups ranged between 6 and 16. The hand size parameters increased according to the children’s age (A: 4.3 ± 0.4, 5.0 ± 0.7, 6.3 ± 0.6, and 6.9 ± 1.0 cm; B: 3.2 ± 0.4, 4.1 ± 0.7, 5.0 ± 0.6, and 5.9 ± 0.6 cm; C: 3.0 ± 0.3, 3.6 ± 0.7, 4.1 ± 0.6, and 4.9 ± 0.6 cm; D: 4.1 ± 0.4, 4.8 ± 0.8, 6.2 ± 0.8, and 7.2 ± 0.9 cm; E: 10.1 ± 0.6, 12.0 ± 1.1, 15.3 ± 1.3, and 17.7 ± 1.7 cm, respectively, in the four groups, [mean ± SD]). The height of the children showed a closer correlation with hand size parameters (Pearson’s correlation coefficients: 0.702–0.961) than with age (0.665–0.904) or weight (0.675–0.863). The correlation was weaker when data were examined in prespecified age groups. Conclusions: The current pediatric hand size database provides previously unavailable information that was used in one manufacturer’s design, which may help with the future design of pediatric electrodes of electromyography-based neuromuscular monitors; this information may facilitate adoption of quantitative neuromuscular monitoring in routine pediatric anesthesia practice. Full article

Background: Pulse oximetry is a non-invasive method for continuous monitoring of peripheral blood oxygen saturation (SpO₂) to estimate arterial oxygen saturation. Previous studies suggested that SpO₂ measurements show variability depending on the particular finger that is used for measurement. To date, no study has compared all fingers for SpO₂ under hypoxemia and during continuous simultaneous monitoring with randomization of finger sensor placement. Objectives: The aim of this study was to assess the inter-finger variability of SpO₂ values during sequential desaturation and step resaturation. Methods: Forty-three out of forty-five healthy participants (age 23.0 ± 1.8 years, BMI 24.0 ± 4.4 kg·m^–2) completed the experimental assessment with short-term induced hypoxemia by consecutive inhalation of three prepared gas mixtures with reduced oxygen concentrations (14%, 12%, and 10%). SpO₂ was measured continuously with the Masimo Radical-97 (Masimo Corp., Irvine, CA, USA) pulse oximeters. Results: The SpO₂ measured on the thumb was lower than all other fingers by 0.6% to 0.7% SpO₂, a systematic difference that is less than the clinically accepted accuracy of oximeters. No difference in SpO₂ dynamics was found between any of the fingers during step resaturation. Conclusions: A systematic difference in measured SpO₂ exists between the thumb and the other fingers during desaturation, which should be considered at least as well as the impact of the performance of a particular oximeter, sensor placement or anatomical variability. Full article

Background: Grip control is a critical determinant of fencing performance, requiring both stability and precision. Traditional measures of hand strength, such as dynamometry, provide only a global estimate and cannot capture finger-specific load distribution. Yet, upper-extremity overuse syndromes, tendinopathies of the wrist and digital flexors are common in fencers, underscoring the need for more granular assessments that may inform clinical practice, especially in prehension contexts. Methods: This pilot study included eight elite épée fencers from the Polish National Team (age: 23.9 ± 4.9 years; training experience: >10 years) tested using a novel épée handle instrumented with five force-sensitive resistors (FSRs) embedded beneath each finger. Participants performed two 5-s maximal voluntary contractions (MVCs) for each of the three conditions—Pinch (thumb + index), Trio (middle + ring + small), and Whole (all digits). Standard handheld dynamometry was also performed to provide a global reference measure. Results: Maximal grip strength measured with a dynamometer (65.3 ± 11.7 kgf) was substantially higher than finger-specific forces captured with the FSR handle (14.4 ± 4.4 kgf). Isolated Pinch contractions (83.0 ± 29.2 N) were significantly stronger than their integrated contribution within the Whole-hand condition (54.7 ± 16.3 N; Z = 2.52, p = 0.012), whereas Trio forces did not differ significantly (p = 0.263). On average, radial digits (thumb + index) contributed ~39% and ulnar digits (middle, ring, small) ~61% of Whole output, with the thumb and middle finger producing the largest forces. Conclusions: This pilot study demonstrates the feasibility of using an FSR-instrumented épée handle to capture finger-specific grip contributions in elite fencers. Despite limited statistical power (n = 8), the observed effects provide initial quantitative evidence for sport-specific, digit-level assessment, showing potential clinical utility in detecting maladaptive load-transfer mechanisms and informing rehabilitation and injury-prevention programs. Full article

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection. Full article

Background: Large language models (LLMs) such as ChatGPT have evolved rapidly, with notable improvements in coherence, factual accuracy, and contextual relevance. However, their academic and clinical applicability remains under scrutiny. This study evaluates the temporal performance evolution of LLMs by comparing earlier model outputs (GPT-3.5 and GPT-4.0) with ChatGPT-4.5 across three domains: aesthetic surgery counseling, an academic discussion base of thumb arthritis, and a systematic literature review. Methods: We replicated the methodologies of three previously published studies using identical prompts in ChatGPT-4.5. Each output was assessed against its predecessor using a nine-domain Likert-based rubric measuring factual accuracy, completeness, reference quality, clarity, clinical insight, scientific reasoning, bias avoidance, utility, and interactivity. Expert reviewers in plastic and reconstructive surgery independently scored and compared model outputs across versions. Results: ChatGPT-4.5 outperformed earlier versions across all domains. Reference quality improved most significantly (a score increase of +4.5), followed by factual accuracy (+2.5), scientific reasoning (+2.5), and utility (+2.5). In aesthetic surgery counseling, GPT-3.5 produced generic responses lacking clinical detail, whereas ChatGPT-4.5 offered tailored, structured, and psychologically sensitive advice. In academic writing, ChatGPT-4.5 eliminated reference hallucination, correctly applied evidence hierarchies, and demonstrated advanced reasoning. In the literature review, recall remained suboptimal, but precision, citation accuracy, and contextual depth improved substantially. Conclusion: ChatGPT-4.5 represents a major step forward in LLM capability, particularly in generating trustworthy academic and clinical content. While not yet suitable as a standalone decision-making tool, its outputs now support research planning and early-stage manuscript preparation. Persistent limitations include information recall and interpretive flexibility. Continued validation is essential to ensure ethical, effective use in scientific workflows. Full article