New and Simple Test of Nerve Function in Hand

A simple objective test of innervation and regeneration of sensory nerves in the hand by immersion in warm water is described. The test results are shown to correpond to operation findings.     

Patterns in Cortical Connectivity for Determining Outcomes in Hand Function after Subcortical Stroke

Background and Purpose

Previous studies have noted changes in resting-state functional connectivity during motor recovery following stroke. However, these studies always uncover various patterns of motor recovery. Moreover, subgroups of stroke patients with different outcomes in hand function have rarely been studied.

Materials and Methods

We selected 24 patients who had a subcortical stroke in the left motor pathway and displayed only motor deficits. The patients were divided into two subgroups: completely paralyzed hands (CPH) (12 patients) and partially paralyzed hands (PPH) (12 patients). Twenty-four healthy controls (HC) were also recruited. We performed functional connectivity analysis in both the ipsilesional and contralesional primary motor cortex (M1) to explore the differences in the patterns between each pair of the three diagnostic groups.

Results

Compared with the HC, the PPH group displays reduced connectivity of both the ipsilesional and contralesional M1 with bilateral prefrontal gyrus and contralesional cerebellum posterior lobe. The connectivity of both the ipsilesional and contralesional M1 with contralateral primary sensorimotor cortex was reduced in the CPH group. Additionally, the connectivity of the ipsilesional M1 with contralesional postcentral gyrus, superior parietal lobule and ipsilesional inferior parietal lobule was reduced in the CPH group compared with the PPH group. Moreover, the connectivity of these regions was positively correlated with the Fugl-Meyer Assessment scores (hand+wrist) across all stroke patients.

Conclusions

Patterns in cortical connectivity may serve as a potential biomarker for the neural substratum associated with outcomes in hand function after subcortical stroke.     

Hand Function is Altered in Individuals with a History of Illicit Stimulant Use

Use of illicit stimulant drugs such as methamphetamine, cocaine, and ecstasy are a significant worldwide problem. However, little is known about the effect of these drugs on movement. The aim of the current study was to investigate hand function in adults with a history of illicit stimulant use. We hypothesized that prior use of illicit stimulant drugs is associated with abnormal manipulation of objects. The study involved 22 subjects with a history of illicit stimulant use (aged 29±8 yrs; time since last use: 1.8±4.0 yrs) and two control groups comprising 27 non-drug users (aged 25±8 yrs) and 17 cannabis users with no history of stimulant use (aged 22±5 yrs). Each subject completed screening tests (neuropsychological assessment, medical history questionnaire, lifetime drug history questionnaire, and urine drug screen) prior to gripping and lifting a light-weight object with the dominant right hand. Horizontal grip force, vertical lift force, acceleration, and first dorsal interosseus electromyographic (EMG) activity were recorded during three trials. In trial one, peak grip force was significantly greater in the stimulant group (12.8±3.9 N) than in the control groups (non-drug: 10.3±4.6 N; cannabis: 9.4±2.9 N, P<0.022). However, peak grip force did not differ between groups in trials two and three. The results suggest that individuals with a history of stimulant use overestimate the grip force required to manipulate a novel object but, are able to adapt grip force in subsequent lifts. The results suggest that movement dysfunction may be an unrecognized consequence of illicit stimulant use.     

Evaluation of Two Methods of Determining the Efficacies of Two Alcohol-Based Hand Rubs for Surgical Hand Antisepsis

The antimicrobial efficacies of preparations for surgical hand antisepsis can be determined according to a European standard (prEN 12791 [EN]) and a U.S. standard (tentative final monograph for health care antiseptic drug products [TFM]). The U.S. method differs in the product application mode (hands and lower forearms, versus hands only in EN), the number of applications (11 over 5 days, versus a single application in EN), the sampling times (0, 3, and 6 h after application, versus 0 and 3 h in EN), the sampling methods (glove juice versus fingertip sampling in EN), and the outcome requirements (absolute bacterial reduction factor [RF], versus noninferiority to reference treatment in EN). We have studied the efficacies of two hand rubs according to both methods. One hand rub was based on 80% ethanol and applied for 2 min, and the other one was based on 45% propan-2-ol, 30% propan-1-ol, and 0.2% mecetronium etilsulfate and applied for 1.5 min. The ethanol-based hand rub was equally effective as the 3-min reference disinfection of prEN 12791 in both the immediate (RFs, 2.97 ± 0.89 versus 2.92 ± 1.03, respectively) and sustained (RFs, 2.20 ± 1.07 versus 2.47 ± 1.25, respectively) effects. According to TFM, the immediate effects were 2.99 log₁₀ (day 1), 3.00 log₁₀ (day 2), and 3.43 log₁₀ (day 5), and bacterial counts were still below baseline after 6 h. The propanol-based hand rub was even more effective than the reference disinfection of prEN 12791 in both the immediate (RFs, 2.35 ± 0.99 versus 1.86 ± 0.87, respectively) and sustained (RFs, 2.17 ± 1.00 versus 1.50 ± 1.26, respectively) effects. According to TFM, the immediate effects were 2.82 log₁₀ (day 1), 3.29 log₁₀ (day 2), and 3.25 log₁₀ (day 5), and bacterial counts were still below baseline after 6 h. Some formulations have been reported to meet the efficacy requirements of one of the methods but not those of the other. That is why we conclude that, despite our results, meeting the efficacy requirements of one test method does not allow the claim that the requirements of the other test method are also met.     

PXL01 in Sodium Hyaluronate for Improvement of Hand Recovery after Flexor Tendon Repair Surgery: Randomized Controlled Trial

Background

Postoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery.

Methods

This prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery.

Results

The most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p = 0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p = 0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p = 0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p = 0.021; PPAS: 76% vs. 35%, p = 0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p = 0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture.

Conclusions

Treatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the most efficient dose and health economic benefits.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01022242","term_id":"NCT01022242"}}NCT01022242; EU Clinical Trials 2009-012703-25.     

颈动脉支架置入术改善认知功能

目的:观察颈动脉狭窄患者支架置入术时其认知功能的影响及简易精神评估量表(MMSE)与蒙特利尔认知评估北京版(MoCA)有无相关性。方法:收集124例颈动脉支架置入患者,在支架置入前及置入后1、3、6月分别应用简易精神评估量表(MMSE)、蒙特利尔认知评估北京版(MoCA)、P300检测患者认知功能的变化,同时对患者卒中有无复发进行登记,所有患者意识清楚,能配合完成上述检查。结果:所有患者安全、成功的置入颈动脉支架,无相关并发症出现;支架置入前颈动脉的狭窄率为(84±8.6)%,支架置入以后颈动脉狭窄率为(4.8±3.8)%,狭窄率较术前明显狭窄:支架置入前患者的MMSE、MoCA及P300潜伏期分别为21±3.1、14±3.6 ms,在治疗后随访的1、3及6个月,MMSE、MoCA明显提高而P300明显缩短;MMSE与MocA呈正相关;在随访期内患者无有症状的卒中复发。结论:颈动脉狭窄是导致认知功能障碍的原因之一,颈动脉支架置入可以改善患者认知功能障碍。