Hand surgery & rehabilitation最新文献

{"title":"Chronic exertional compartment syndrome in the forearm: Ultrasound-guided surgical technique.","authors":"Jean Michel Cognet, Jean Baptiste Facon, Alexandre Faure, Olivier Mares","doi":"10.1016/j.hansur.2025.102094","DOIUrl":"10.1016/j.hansur.2025.102094","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic exertional compartment syndrome of the forearm is most commonly associated with exercise. It presents as cramping after a few minutes of activity, requiring cessation of exercise. We describe an ultrasound-guided surgical technique for the treatment of forearm chronic exertional compartment syndrome.</p><p><strong>Anatomy and pathophysiology: </strong>The forearm consists of three compartments: the anterior, lateral, and dorsal compartments. These compartments are formed by the muscles of the forearm and are surrounded by a fibroelastic membrane composed of connective tissue. Repetitive activity in the forearm leads to an increase in muscle volume within a non-extensible compartment. This increase in pressure causes pain and cramping, forcing the individual to stop the activity. Diagnosis is based on measurement of intramuscular compartment pressures.</p><p><strong>Surgical technique: </strong>Surgical treatment involves performing a fasciotomy. This can be done through an incision along the length of the forearm or through a minimally invasive approach using endoscopic or ultrasound guidance. The ultrasound-guided technique uses two small entry points and a specialized knife. No post-operative immobilization is required, allowing patients to quickly resume their activities.</p><p><strong>Discussion: </strong>Chronic exertional compartment syndrome of the forearm is a condition that is particularly common among motorcyclists. Diagnosis is based on a combination of a suggestive clinical presentation and pathological intramuscular pressure. Treatment may be conservative or surgical (fasciotomy). Fasciotomy can be performed using an open approach or a minimally invasive ultrasound-guided technique. Published studies on ultrasound-guided treatment report excellent results with a rapid return to sports activities after surgery.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102094"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided release of carpal tunnel syndrome - Anterograde technique.","authors":"Carla Ricardo Nunes, Olivier Marès, Vincent Martinel","doi":"10.1016/j.hansur.2025.102091","DOIUrl":"10.1016/j.hansur.2025.102091","url":null,"abstract":"<p><p>Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost. Ultrasound-guided carpal tunnel release is indicated in moderate and severe carpal tunnel syndrome persisting after conservative treatment. A preoperative ultrasound scan is recommended to evaluate anatomy. Recurrent carpal tunnel syndrome, secondary carpal tunnel syndrome and anatomic variants compromising the safety of transverse carpal ligament division are contraindications. The procedure is performed under local anesthesia without tourniquet. The entry point is a short transverse incision proximal to the wrist crease. The transverse carpal ligament is divided anterogradely, using a dedicated blade under ultrasound control, making sure no nerves, tendons or blood vessels are injured. The final step is to check that the division is complete. Early return to use of the hand is permitted. Reports of similar techniques demonstrated early symptomatic relieve, favorable patient-reported outcome measures from within 1 week after surgery to 2 years' follow-up, with early return to normal daily activity and work. The complications rate is low: many series showed no complications. Comparative studies between ultrasound-guided carpal tunnel release and the mini-open technique reported similar or greater and quicker symptom relief, less scar pain and better strength. Final functional results tend to be similar.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102091"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial nerve at Frohse's arcade: a new technique of release under total ultrasound guidance. First experience.","authors":"Olivier Marès, Javier Ferreira, Sarah Pradel, Vincent Martinel, Camillo Chaves, Thomas Apard","doi":"10.1016/j.hansur.2025.102089","DOIUrl":"10.1016/j.hansur.2025.102089","url":null,"abstract":"<p><p>Radial nerve compression at the arcade of Frohse is a rare but significant condition that typically presents with pain primarily after exertion and at night on the dorsal side of the forearm, more distally than tennis elbow pain, and weakness of the wrist extensors and the long fingers and thumb extensors. Traditional treatment often involves open surgery, resulting in significant scarring. This study introduces a novel percutaneous radial nerve release technique under complete ultrasound guidance and highlights its efficacy and safety. The procedure involves identifying the entry point, lateral of the radial nerve, allowing for targeted release of the superficial fascia surrounding the supinator muscle without damaging nearby vascular or nerve structures. A cadaveric study was performed on ten fresh-frozen specimens to validate the entry point and route, which successfully demonstrated complete fascial release without complications. Preliminary clinical results from five patients showed complete resolution of symptoms associated with radial tunnel syndrome with no reported complications. The technique results in a significantly smaller incision (<1 cm) compared to traditional methods (up to 10 cm) and can be performed under WALANT anesthesia, making it suitable for the outpatient setting. This approach offers a minimally invasive alternative for patients with isolated posterior interosseous nerve compression and highlights the importance of ultrasound guidance in achieving optimal results. Because the technique requires a learning curve, it is recommended for surgeons with experience in ultrasound-guided procedures.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102089"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De Quervain's disease: Ultrasound-guided release.","authors":"Francisco Javier Ferreira Villanova, Vincent Martinel, Olivier Marès","doi":"10.1016/j.hansur.2025.102087","DOIUrl":"https://doi.org/10.1016/j.hansur.2025.102087","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the outcomes of a novel antegrade, ultrasound-guided release of the first extensor tendon compartment for treating De Quervain's disease.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study of 34 patients who underwent ultrasound-guided release of the first extensor compartment for clinically diagnosed De Quervain's disease between June 2022 and December 2023. Inclusion criteria included age >18 years and failure of conservative treatment (e.g., NSAIDs, physiotherapy, and steroid injection) for more than six weeks. Exclusion criteria were prior trigger thumb surgery and documented allergy to local anesthetics. Outcomes were assessed using pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and complication rates.</p><p><strong>Results: </strong>The mean VAS for pain improved from 7.4 to 1.1, and the QuickDASH score improved from 55 to 9.4 at the final follow-up. We recorded three minor complications and no major complications.</p><p><strong>Conclusion: </strong>Ultrasound-guided surgical release of the first extensor compartment for De Quervain's disease is a minimally invasive, technologically advanced, and effective treatment option.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102087"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided trigger thumb release.","authors":"Francisco Javier Ferreira Villanova, Vincent Martinel, Olivier Marès","doi":"10.1016/j.hansur.2025.102084","DOIUrl":"10.1016/j.hansur.2025.102084","url":null,"abstract":"<p><p>The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb. We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged >18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates. The mean age of the patients was 37.8 years (range: 27-72). Based on Green's classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications. Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure. Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102084"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterograde ultrasound guided lacertus fibrosus release at the elbow under WALANT - Technical note.","authors":"Carla Ricardo Nunes, Vincent Martinel, Olivier Marès","doi":"10.1016/j.hansur.2025.102086","DOIUrl":"10.1016/j.hansur.2025.102086","url":null,"abstract":"<p><p>Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release. The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT. We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine. The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division. The patient returns to full activity within days to a week after surgery. Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102086"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided trigger finger release with a minimally invasive knife: A retrospective analysis of 297 releases.","authors":"Michiel Cromheecke, Sebastiaan Bogaert, Mathieu Dejonghe, Pieter-Bastiaan De Keyzer, Olivier Mares, Jean Goubau, Jean-Michiel Cognet","doi":"10.1016/j.hansur.2025.102081","DOIUrl":"10.1016/j.hansur.2025.102081","url":null,"abstract":"<p><p>Trigger finger, or stenosing tenovaginitis, is a common condition characterized by impaired flexor tendon sliding due to thickening of the A1 pulley. While open surgical release remains the gold standard for the treatment of persistent trigger finger, there is increasing interest in minimally invasive ultrasound-guided techniques to improve precision and outcomes. The purpose of this study is to evaluate the outcomes, safety, and complications associated with ultrasound-guided trigger finger release using a minimally invasive surgical knife. We performed a retrospective analysis of 297 trigger finger releases performed on 238 patients between April 2021 and December 2023. All procedures were performed on the long fingers, excluding the thumb, using ultrasound guidance under WALANT or regional anesthesia. Patients were evaluated at 6 weeks and 3 months postoperatively for symptom resolution, complications, and functional recovery. The procedure achieved a 100% success rate for complete release of the A1 pulley with no major complications or iatrogenic damage such as tendon or neurovascular injury. Minor complications, such as temporary postoperative loss of motion or localized pain, occurred in 33 cases (11.1%) and all resolved with conservative management by the three-month follow-up. Importantly, only one procedure required conversion to open surgery due to intraoperative uncertainty, where full release was confirmed. Ultrasound-guided minimally invasive trigger finger release is a safe and effective technique. It provides precise release with a low risk of complications or iatrogenic damage. As ultrasound technology advances and availability increases, this technique has the potential to become a reliable and patient-friendly alternative to classic open methods.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102081"},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transverse ultrasound-guided fasciotomy in lateral epicondylitis.","authors":"Vincent Martinel, Franck Lapègue, Aymeric Andre, Olivier Marès","doi":"10.1016/j.hansur.2024.102075","DOIUrl":"10.1016/j.hansur.2024.102075","url":null,"abstract":"<p><p>Lateral epicondylitis is a very common form of tendinosis that may heal spontaneously. Diagnosis is mainly clinical. Treatment is usually non-operative. However, if conservative treatment fails, open or arthroscopic tenotomy of the epicondylar muscles may be an option. Ultrasound-guided percutaneous tenotomy may now be performed on the common epicondylar tendon close to the enthesis, with a success rate close to that of conventional surgery. For several years now, we have used a slightly different technique, involving ultrasound-guided fasciotomy of the extensor digitorum communis and extensor carpi radialis brevis muscles at the level of the radiohumeral joint. It may be performed under local anesthesia in the office. Ultrasound-guided hydro-dissection of the fascia is essential to facilitate the procedure and easily visualize the various anatomical structures. Fasciotomy can be performed with an ophthalmology scalpel, surgical knife or curved needle. This procedure is similar to arthroscopic techniques, but is significantly less expensive and with lower carbon footprint. It is safe and effective when a surgeon with experience in ultrasound-guided procedures performs it.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102075"},"PeriodicalIF":0.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided percutaneous release of the ulnar nerve at the elbow.","authors":"Olivier Marès, Javier Ferreira, Berenice Moutinot, Vincent Martinel, Pascal Kouyoumdjian, Thomas Apard","doi":"10.1016/j.hansur.2024.102071","DOIUrl":"10.1016/j.hansur.2024.102071","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment of ulnar tunnel syndrome is controversial, with no consensus on the ideal procedure. Nevertheless, in-situ decompression seems to provide faster recovery with less morbidity than neurolysis-transposition. The aim of this retrospective study was to validate a new percutaneous technique using ultrasonography.</p><p><strong>Methods: </strong>A retrospective 2-center study included 40 patients with McGowan stage 1 or 2 ulnar nerve entrapment at the elbow treated by a new limited ultrasound-guided percutaneous technique. Patients with McGowan stage 3, osteoarthritis at the elbow or instability were excluded. The study endpoint was clinical success of the percutaneous technique using ultrasonography for release of ulnar nerve entrapment at the elbow. The secondary endpoint was time to recovery.</p><p><strong>Results: </strong>All 40 patients showed clinical improvement, with the resolution of acroparesthesia symptoms. No recurrences were observed at 13 months' follow-up. There were no cases of neurological complications, ulnar nerve instability or infection. Patients were able to return to work rapidly, with an average absence of 3.5 weeks.</p><p><strong>Discussion: </strong>Numerous studies questioned the value of ulnar nerve transposition associated with release in the early stages. No significant difference was found between in-situ decompression and transposition; however, more complications were observed in patients with transposition.</p><p><strong>Conclusion: </strong>Overall, this new ultrasound-guided percutaneous technique for ulnar nerve entrapment was safe. It allowed rapid recovery with effective symptom relief while limiting the risk of complications and time off work.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":" ","pages":"102071"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential CpG methylation at <i>Nnat</i> in the early establishment of beta cell heterogeneity.","authors":"Vanessa Yu, Fiona Yong, Angellica Marta, Sanjay Khadayate, Adrien Osakwe, Supriyo Bhattacharya, Sneha S Varghese, Pauline Chabosseau, Sayed M Tabibi, Keran Chen, Eleni Georgiadou, Nazia Parveen, Mara Suleiman, Zoe Stamoulis, Lorella Marselli, Carmela De Luca, Marta Tesi, Giada Ostinelli, Luis Delgadillo-Silva, Xiwei Wu, Yuki Hatanaka, Alex Montoya, James Elliott, Bhavik Patel, Nikita Demchenko, Chad Whilding, Petra Hajkova, Pavel Shliaha, Holger Kramer, Yusuf Ali, Piero Marchetti, Robert Sladek, Sangeeta Dhawan, Dominic J Withers, Guy A Rutter, Steven J Millership","doi":"10.1101/2023.02.04.527050","DOIUrl":"10.1101/2023.02.04.527050","url":null,"abstract":"<p><strong>Aims/hypothesis: </strong>Beta cells within the pancreatic islet represent a heterogenous population wherein individual sub-groups of cells make distinct contributions to the overall control of insulin secretion. These include a subpopulation of highly-connected 'hub' cells, important for the propagation of intercellular Ca²⁺ waves. Functional subpopulations have also been demonstrated in human beta cells, with an altered subtype distribution apparent in type 2 diabetes. At present, the molecular mechanisms through which beta cell hierarchy is established are poorly understood. Changes at the level of the epigenome provide one such possibility which we explore here by focussing on the imprinted gene neuronatin (<i>Nnat</i>), which is required for normal insulin synthesis and secretion.</p><p><strong>Methods: </strong>Single cell RNA-seq datasets were examined using Seurat 4.0 and ClusterProfiler running under R. Transgenic mice expressing eGFP under the control of the <i>Nnat</i> enhancer/promoter regions were generated for fluorescence-activated cell (FAC) sorting of beta cells and downstream analysis of CpG methylation by bisulphite and RNA sequencing, respectively. Animals deleted for the de novo methyltransferase, DNMT3A from the pancreatic progenitor stage were used to explore control of promoter methylation. Proteomics was performed using affinity purification mass spectrometry and Ca²⁺ dynamics explored by rapid confocal imaging of Cal-520 and Cal-590. Insulin secretion was measured using Homogeneous Time Resolved Fluorescence Imaging.</p><p><strong>Results: </strong><i>Nnat</i> mRNA was differentially expressed in a discrete beta cell population in a developmental stage- and DNA methylation (DNMT3A)-dependent manner. Thus, pseudo-time analysis of embryonic data sets demonstrated the early establishment of <i>Nnat</i>-positive and negative subpopulations during embryogenesis. NNAT expression is also restricted to a subset of beta cells across the human islet that is maintained throughout adult life. NNAT⁺ beta cells also displayed a discrete transcriptome at adult stages, representing a sub-population specialised for insulin production, reminiscent of recently-described \"β_HI\" cells and were diminished in <i>db/db</i> mice. 'Hub' cells were less abundant in the NNAT⁺ population, consistent with epigenetic control of this functional specialization.</p><p><strong>Conclusions/interpretation: </strong>These findings demonstrate that differential DNA methylation at <i>Nnat</i> represents a novel means through which beta cell heterogeneity is established during development. We therefore hypothesise that changes in methylation at this locus may thus contribute to a loss of beta cell hierarchy and connectivity, potentially contributing to defective insulin secretion in some forms of diabetes.</p>","PeriodicalId":94023,"journal":{"name":"Hand surgery & rehabilitation","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10705251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82487063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}