[Effect of scalp acupuncture stimulation on mood and sleep in children with autism spectrum disorder].

OBJECTIVE: To observe the effects of penetrating technique of scalp acupuncture on emotion, sleep and function development in children of autism spectrum disorder (ASD). METHODS: A total of 60 SAD children aged 3 to 6 years were randomized in a control group (music education rehabilitation,n=30) and an observation group (penetrating technique of scalp acupuncture + music education rehabilitation,n=30). In the two groups, the treatment for 3 months was as 1 course, and 2 courses of treatment were required. Before and after treatment, the changes were observed in childhood autism rating scale (CARS), emotion regulation subscale (ER), children's sleep habits questionnaire (CSHQ) and children autism and psycho-educational profile for autistic and developmentally disabled children (C-PEP-3), separately. RESULTS: Compared with the scores before treatment, CARS score, the score of each subscale of CSHQ, e.g. bedtime resistance, sleep onset delay, irregular sleep duration, sleep anxiety, parasomnias and daytime sleepiness as well as the total score of CSHQ were all reduced in children of two groups (P<0.05); and the score of ER and C-PEP-3 were all increased (P<0.05) after 6 months' treatment. Compared with the control group, ER score was increased in 3 and 6 months after treatment (P<0.05), CARS score was reduced (P<0.05) and C-PEP-3 score was increased obviously (P<0.05) 6 months after treatment in the observation group; but the scores of the subscale for night waking and sleep disordered breathing did not changed noticeably (P > 0.05). CONCLUSION: Penetrating technique of scalp acupuncture improves the emotion and sleep disorder and promotes the function development in ASD children.

Stereoscopic Display of the Peripheral Nerves at the Elbow Region Based on MR Diffusion Tensor Imaging with Multiple Post-Processing Methods.

BACKGROUND: Peripheral nerves at the elbow region are prone to entrapment neuropathies and injuries. To make accurate assessment, clinicians need stereoscopic display of the nerves to observe them at all angles. OBJECTIVES: To obtain a stereoscopic display of the peripheral nerves at the elbow region based on magnetic resonance (MR) diffusion tensor imaging (DTI) data using three post-processing methods of volume rendering (VR), maximum intensity projection (MIP), and fiber tractography, and to evaluate the difference and correlation between them. SUBJECTS AND METHODS: Twenty-four elbows of 12 healthy young volunteers were assessed by 20 encoding diffusion direction MR DTI scans. Images belonging to a single direction (anterior-posterior direction, perpendicular to the nerve) were subjected to VR and MIP reconstruction. All raw DTI data were transferred to the Siemens MR workstation for fiber tractography post-processing. Imaging qualities of fiber tractography and VR/MIP were evaluated by two observers independently based on a custom evaluation scale. RESULTS: Stereoscopic displays of the nerves were obtained in all 24 elbows by VR, MIP, and fiber tractography post-processing methods. The VR/MIP post-processing methods were easier to perform compared to fiber tractography. There was no significant difference among the scores of fiber tracking and VR/MIP reconstruction for single direction. The imaging quality scores of fiber tractography and VR/MIP were significantly correlated based on intraclass correlation coefficient (ICC) analysis (ICC ranged 0.709 - 0.901), which suggested that the scores based on fiber tractography and VR/MIP for the same sample were consistent. Inter- and intraobserver agreements were good to excellent. CONCLUSION: Stereoscopic displays of the peripheral nerves at the elbow region can be achieved by using VR, MIP, and fiber tracking post-processing methods based on raw DTI images. VR and MIP reconstruction could be used as preview tools before fiber tracking to determine whether the raw images are satisfactory.

An intractable case of suspected psoriatic arthritis combined with Dupuytren's disease.

Some cases of psoriatic arthritis (PsA) cannot be explicitly diagnosed, especially when the skin and nail lesions present years after the joint disease or are absent. Autoimmunity may also play a role in the development of Dupuytren's disease. However, the simultaneous presence of PsA and Dupuytren's disease is very rare. We present a patient displaying arthritis in multiple small joints, with bone erosions and bony fusions in all four extremities, combined with Dupuytren's disease. Because of the atypical clinical manifestation, the diagnosis perplexed doctors for decades. Without formal treatment, the disease followed a natural course over time. Reviewing the patient's data, a potential diagnosis of PsA, combined with Dupuytren's disease, was eventually made. After surgery, contractures of palmar and plantar fascia as well the thumb web were released, and the hallux valgus was corrected.

Three-dimensional display of peripheral nerves in the wrist region based on MR diffusion tensor imaging and maximum intensity projection post-processing.

OBJECTIVES: To achieve 3-dimensional (3D) display of peripheral nerves in the wrist region by using maximum intensity projection (MIP) post-processing methods to reconstruct raw images acquired by a diffusion tensor imaging (DTI) scan, and to explore its clinical applications. METHODS: We performed DTI scans in 6 (DTI6) and 25 (DTI25) diffusion directions on 20 wrists of 10 healthy young volunteers, 6 wrists of 5 patients with carpal tunnel syndrome, 6 wrists of 6 patients with nerve lacerations, and one patient with neurofibroma. The MIP post-processing methods employed 2 types of DTI raw images: (1) single-direction and (2) T2-weighted trace. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the median and ulnar nerves were measured at multiple testing sites. Two radiologists used custom evaluation scales to assess the 3D nerve imaging quality independently. RESULTS: In both DTI6 and DTI25, nerves in the wrist region could be displayed clearly by the 2 MIP post-processing methods. The FA and ADC values were not significantly different between DTI6 and DTI25, except for the FA values of the ulnar nerves at the level of pisiform bone (p=0.03). As to the imaging quality of each MIP post-processing method, there were no significant differences between DTI6 and DTI25 (p>0.05). The imaging quality of single-direction MIP post-processing was better than that from T2-weighted traces (p<0.05) because of the higher nerve signal intensity. CONCLUSIONS: Three-dimensional displays of peripheral nerves in the wrist region can be achieved by MIP post-processing for single-direction images and T2-weighted trace images for both DTI6 and DTI25. The FA and ADC values of the median nerves can be accurately measured by using DTI6 data. Adopting 6-direction DTI scan and MIP post-processing is an efficient method for evaluating peripheral nerves.

In vivo length changes of carpal ligaments of the wrist during dart-throwing motion.

PURPOSE: The dart-throwing motion is an important movement pattern during most wrist actions. The aim of this study was to investigate length changes in the wrist ligaments in different positions of the dart-throw motion in vivo. METHODS: We obtained computed tomography scans of the wrists of 6 volunteers at 5 positions of the wrist during the dart-throw motion: 20° of radial deviation with 60° of extension; 10° of radial deviation with 30° of extension; the neutral position of the carpus; 20° of ulnar deviation with 30° of flexion; and 40° of ulnar deviation with 60° of flexion. We reconstructed the 3-dimensional carpal and distal radioulnar joint structures with customized software and computed changes in length of 8 palmar and dorsal wrist ligaments. RESULTS: From wrist radial deviation with extension to ulnar deviation with flexion, the radioscaphocapitate, long radiolunate, ulnocapitate, and ulnotriquetral ligaments decreased significantly in length but the dorsal radiocarpal ligament and the dorsal intercarpal (DIC) ligament inserting on the trapezoid lengthened significantly; the ulnolunate ligament and the DIC ligament inserting on the scaphoid were shortest in neutral position. CONCLUSIONS: At wrist radial extension, the radioscaphocapitate, long radiolunate, ulnocapitate, and ulnotriquetral ligaments are lengthened and under increased tension. At wrist ulnar flexion, the dorsal radiocarpal ligament and the DIC ligament inserting on the trapezoid are lengthened and under increased tension. The ulnolunate ligament and the DIC ligament inserting on the scaphoid are the shortest and under the least tension in neutral position. These findings will help us understand the biomechanics of the carpus during the dart-throwing motion.

[Measurement of B-lymphocyte stimulator mRNA expression in children with infectious mononucleosis by real-time fluorescence quantitative method].

OBJECTIVE: B cell multiplication plays a key role in infections mononucleosis. The present study was designed to detect the expression of B-lymphocyte stimulator (BLyS) mRNA in peripheral blood using real-time fluorescence quantitative polymerase chain reaction (RFQ-PCR) in children with infectious mononucleosis in order to explore the role of BLys in this disorder. METHODS: Specific primers and TaqMan probes of BLyS were designed, and fluorescence of the PCR products were detected continuously during amplification. According to the standard curves created by plasmid DNA, the expression level of target genes in clinical samples were calculated using Stata Software version 8.0, and the results were presented as the ratio of copies of target gene mRNA to beta2 microglobulin (beta2M) mRNA copies. BLyS mRNA expression in peripheral blood was measured by RFQ-PCR in 18 children with infectious mononucleosis and the results were compared with those measured in 15 healthy controls. RESULTS: The range of target gene mRNA detected by REQ-PCR was from 109 ng/L to 101 ng/L. The coefficient of variation for intra-experimental and inter-experimental reproducibility ranged from 1.88% to 5.89% and 6.32% to 12.34%, respectively. BLyS mRNA expression in peripheral blood in children with infectious mononucleosis were significantly higher than that in controls (1.65+/-0.10 vs 0.56+/-0.08; P < 0.01). CONCLUSIONS: RFQ-PCR has a high sensitivity and reproducibility for the measurement of BLyS mRNA expression. BLyS may be involved in the development of infectious mononucleosis.

Effects of locking area on strength of 2- and 4-strand locking tendon repairs.

PURPOSE: The area of the tendon within the locking suture configuration of the modified Pennington repair is an important determinant of eventual tendon strength. This 2-strand repair's loop configurations encompass a large cross-sectional area of the tendon. Many recently proposed repairs, however, consist of locks in a number of narrow sites on the tendon surface and most are multistranded. It is not clear how the area within the locks affects tendon strength and whether the effects of locking areas change according to the number of repair strands. In this study we investigate the effects of locking area on repair strength of 2- and 4-strand tendon repairs. METHODS: Sixty-five fresh pig flexor tendons were divided equally into 6 groups and were transected completely. They were repaired with 2- or 4-strand techniques. The tendon-suture interface was a circle-locking junction and diameters of the locks were 1, 2, or 3 mm. The tendons were pulled in a tensile testing machine until failure of the repair and the mode of failure, 2-mm gap force, and ultimate strength were measured. RESULTS: In the tendons with either 2- or 4-strand repairs locks with a diameter of 2 or 3 mm had significantly greater gap formation force and ultimate strength than those of 1 mm. The gap formation and ultimate forces were not statistically different between tendons with locks of 2 or 3 mm in diameter. CONCLUSIONS: In both the 2- and 4-strand tendon repairs tested in this study repair strength increased as the diameter of locks of the repair increased from 1 mm to 2 or 3 mm. An increase in the diameter from 2 mm to 3 mm, however, did not increase the gap force and ultimate strength. These findings indicate that the cross-sectional area within the locks affects repair strength when the diameter of the locks is within a certain range (2 mm) and that further enlargement of the locking area does not increase strength.