Nonoperative Treatment of Dupuytren's Contracture: The Use of Ultrasound Imaging to Assess Efficacy.

Objective: We have used ultrasound imaging technology to objectively demonstrate changes in the degree and quality of diseased fascia in patients with Dupuytren's disease treated nonoperatively with therapeutic splinting and tissue mobilization. Materials and Methods: Measurement of active proximal interphalangeal and metacarpophalangeal joint extension along with ultrasound elastography imaging of the fascia was performed prior to, and 6 months after, the initiation of therapy. Results: Improvement in active joint extension over the course of therapy was associated with a consistent decrease in the radiologic dimensions of the diseased fascia in combination with qualitative changes in its composition. Conclusion: The use of a simple orthosis and soft tissue mobilization techniques have a quantifiable effect on the degree of deformity and the quantity and quality of contracted fascia in Dupuytren's disease, and would appear to have a role in the management of mild to moderate presentations of the disease when enzymatic or surgical interventions may not be practical.

Opioid receptor expressing neurons of the central amygdala gate behavioral effects of ketamine in mice.

Ketamine has anesthetic, analgesic, and antidepressant properties which may involve multiple neuromodulatory systems. In humans, the opioid receptor (OR) antagonist naltrexone blocks the antidepressant effect of ketamine. It is unclear whether naltrexone blocks a direct effect of ketamine at ORs, or whether normal functioning of the OR system is required to realize the full antidepressant effects of treatment. In mice, the effect of ketamine on locomotion, but not analgesia or the forced swim test, was sensitive to naltrexone and was therefore used as a behavioral readout to localize the effect of naltrexone in the brain. We performed whole-brain imaging of cFos expression in ketamine-treated mice, pretreated with naltrexone or vehicle, and identified the central amygdala (CeA) as the area with greatest difference in cFos intensity. CeA neurons expressing both µOR (MOR) and PKCµ were strongly activated by naltrexone but not ketamine, and selectively interrupting MOR function in the CeA either pharmacologically or genetically blocked the locomotor effects of ketamine. These data suggest that MORs expressed in CeA neurons gate behavioral effects of ketamine but are not direct targets of ketamine.

Assessment, patient selection, and rehabilitation of nerve transfers.

Peripheral nerve injuries are common and can have a devastating effect on physical, psychological, and socioeconomic wellbeing. Peripheral nerve transfers have become the standard of care for many types of peripheral nerve injury due to their superior outcomes relative to conventional techniques. As the indications for, and use of, nerve transfers expand, the importance of pre-operative assessment and post-operative optimization increases. There are two principal advantages of nerve transfers: (1) their ability to shorten the time to reinnervation of muscles undergoing denervation because of peripheral nerve injury; and (2) their specificity in ensuring proximal motor and sensory axons are directed towards appropriate motor and sensory targets. Compared to conventional nerve grafting, nerve transfers offer opportunities to reinnervate muscles affected by cervical spinal cord injury and to augment natural reinnervation potential for very proximal injuries. This article provides a narrative review of the current scientific knowledge and clinical understanding of nerve transfers including peripheral nerve injury assessment and pre- and post-operative electrodiagnostic testing, adjuvant therapies, and post-operative rehabilitation for optimizing nerve transfer outcomes.

Aberrant splicing exonizes C9ORF72 repeat expansion in ALS/FTD.

A nucleotide repeat expansion (NRE) in the first annotated intron of the C9ORF72 gene is the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). While C9 NRE-containing RNAs can be translated into several toxic dipeptide repeat proteins, how an intronic NRE can assess the translation machinery in the cytoplasm remains unclear. By capturing and sequencing NRE-containing RNAs from patient-derived cells, we found that C9 NRE was exonized by the usage of downstream 5' splice sites and exported from the nucleus in a variety of spliced mRNA isoforms. C9ORF72 aberrant splicing was substantially elevated in both C9 NRE+ motor neurons and human brain tissues. Furthermore, NREs above the pathological threshold were sufficient to activate cryptic splice sites in reporter mRNAs. In summary, our results revealed a crucial and potentially widespread role of repeat-induced aberrant splicing in the biogenesis, localization, and translation of NRE-containing RNAs.

The hand diagram: A novel outcome measure following supercharged end-to-side anterior interosseous nerve to ulnar nerve transfer in severe compressive ulnar neuropathy.

BACKGROUND: With advances in the surgical management for severe ulnar neuropathy with the introduction of the super charged-end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfer, a simple and reliable outcome measure is required. There is currently not "one" standardized outcome measure used to represent and compare results. PURPOSE: To present the abduction hand diagram as a "novel", reproducible, and simple outcome measure for patients with severe ulnar neuropathy. STUDY DESIGN: Retrospective case series. METHODS: Nine patients with severe entrapment/compressive ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative abduction tracings, Medical Research Grade (MRC) muscle strength, key pinch strength, Disability of the Hand Arm and Shoulder (DASH) score, and crossed finger test. Electrodiagnostic data included change in compound muscle action potentials (CMAP) amplitude of the first dorsal interosseous (FDI), and abductor digiti minimi (ADM). Summary statistics were used for demographic and clinical data. RESULTS: Average follow-up was 22.8 ± 9.3 months. At 18-months of follow up, 44% had ADM MRC grade 3 strength or higher, mean key pinch strength improved to 72 ± 19.3%, and mean DASH was 33 ± 28.7. There was a mean increase of 16.7 ± 9.1 mm and 31.5 ± 12 mm in total and summed hand abduction tracing measurements respectively. CONCLUSIONS: Hand abduction tracings are a quantitative outcome measure to follow recovery over time for intrinsic hand function and can be used in patients with severe ulnar neuropathy following surgical intervention.

An orexigenic subnetwork within the human hippocampus.

Only recently have more specific circuit-probing techniques become available to inform previous reports implicating the rodent hippocampus in orexigenic appetitive processing1-4. This function has been reported to be mediated at least in part by lateral hypothalamic inputs, including those involving orexigenic lateral hypothalamic neuropeptides, such as melanin-concentrating hormone5,6. This circuit, however, remains elusive in humans. Here we combine tractography, intracranial electrophysiology, cortico-subcortical evoked potentials, and brain-clearing 3D histology to identify an orexigenic circuit involving the lateral hypothalamus and converging in a hippocampal subregion. We found that low-frequency power is modulated by sweet-fat food cues, and this modulation was specific to the dorsolateral hippocampus. Structural and functional analyses of this circuit in a human cohort exhibiting dysregulated eating behaviour revealed connectivity that was inversely related to body mass index. Collectively, this multimodal approach describes an orexigenic subnetwork within the human hippocampus implicated in obesity and related eating disorders.

Profile and costs of dengue hospitalizations in Southeast Pará from the SUS perspective (2000-2015) / Perfil e custos das internações por dengue no Sudeste do Pará na perspectiva do SUS (2000-2015) / Perfil y costos de las hospitalizaciones por dengue en el Sudeste de Pará en la perspectiva del SUS (2000-2015)

Background and objectives: Considering the little evidence associated with dengue hospitalizations, their public expenditures in Southeast Pará and its relevance to the public health in Brazil, this study aims to demonstrate the records of hospitalizations and expenses associated with this arbovirus between 2000 and 2015 from the perspective of the Unified Health System (SUS). Methods: This is a descriptive research that sought to assess the records and expenses (USD) of hospitalization caused by dengue (SUS code: 74500457, 74300440, 0303010010) and severe dengue (SUS code: 74300628, 74500627, 0303010029), as well as their associated deaths (CID: A90 and A91), respectively, from the SIH/SUS and SIM/SUS from 2000 to 2015 for all 39 municipalities in the southeast of Pará. Results: A total of 1206 deaths, 22,860 individuals with dengue and 306 with severe dengue underwent services in the SUS between 2000 and 2015, representing 23,166 hospitalizations (23,613: dengue and 313: severe dengue), in which Bom Jesus do Tocantins and Goianésia do Pará represent the municipalities with the highest number of hospitalizations associated with dengue. Conclusion: It is possible to verify the relevance of continuing efforts to combat and fight dengue in southeastern Pará. It reinforces the need to conduct studies that contribute to a better understanding of the distribution of hospitalizations and deaths in the different municipalities of the state of Pará, as well as reflections on the epidemiological and economic scenario for the implementation of a rational and efficient decision-making process.(AU)

Justificativa e objetivos: Considerando as poucas evidências associadas às internações por dengue, seus gastos públicos no Sudeste do Pará e sua relevância para a saúde pública no Brasil, este estudo tem como objetivo demonstrar os registros de internações e gastos associados a esta arbovirose entre 2000 e 2015 a partir da perspectiva do Sistema Único de Saúde (SUS). Métodos: Trata-se de uma pesquisa descritiva que buscou avaliar os registros e gastos (USD) de internação por dengue (código SUS: 74500457, 74300440, 0303010010) e dengue grave (código SUS: 74300628, 74500627, 0303010029), bem como seus óbitos associados (CID: A90 e A91), respectivamente, do SIH/SUS e SIM/SUS de 2000 a 2015 para todos os 39 municípios do sudeste paraense. Resultados: Um total de 1.206 óbitos, 22.860 indivíduos com dengue e 306 com dengue grave foram atendidos no SUS entre 2000 e 2015, representando 23.166 internações (23.613: dengue e 313: dengue grave), nas quais Bom Jesus do Tocantins e Goianésia do O Pará representa os municípios com maior número de internações associadas à dengue. Conclusão: É possível verificar a relevância da continuidade dos esforços de combate e combate à dengue no sudeste paraense. Reforça a necessidade da realização de estudos que contribuam para um melhor entendimento da distribuição das internações e óbitos nos diferentes municípios do estado do Pará, bem como reflexões sobre o cenário epidemiológico e econômico para a implementação de um processo decisório racional e eficiente. Fazendo processo.(AU)

Justificación y objetivos: Considerando la poca evidencia asociada a las hospitalizaciones por dengue, sus gastos públicos en el Sudeste de Pará y su relevancia para la salud pública en Brasil, este estudio tiene como objetivo demostrar los registros de hospitalizaciones y gastos asociados a este arbovirus entre 2000 y 2015 a partir de la perspectiva del Sistema Único de Salud (SUS). Métodos: Se trata de una investigación descriptiva que buscó evaluar los registros y gastos (USD) de hospitalización por dengue (código SUS: 74500457, 74300440, 0303010010) y dengue grave (código SUS: 74300628, 74500627, 0303010029), así como sus muertes asociadas (CID: A90 y A91), respectivamente, del SIH/SUS y SIM/SUS de 2000 a 2015 para los 39 municipios del sureste de Pará. Resultados: Un total de 1206 muertes, 22.860 personas con dengue y 306 con dengue grave fueron atendidos en el SUS entre 2000 y 2015, lo que representa 23.166 hospitalizaciones (23.613: dengue y 313: dengue grave), en las que Bom Jesus do Tocantins y Goianésia hacen Pará representan los municipios con mayor número de hospitalizaciones asociadas al dengue. Conclusión: Es posible verificar la relevancia de continuar los esfuerzos para combatir y luchar contra el dengue en el sureste de Pará. Refuerza la necesidad de realizar estudios que contribuyan a una mejor comprensión de la distribución de hospitalizaciones y muertes en los diferentes municipios del estado de Pará, así como reflexiones sobre el escenario epidemiológico y económico para la implementación de una decisión racional y eficiente. proceso de fabricación.(AU)

Rehabilitation Following Nerve Transfer Surgery.

Nerve transfer surgery is an important new addition to the treatment paradigm following nerve trauma. The following rehabilitation plan has been developed over the past 15 years, in an interdisciplinary, tertiary peripheral nerve program at the "Roth|McFarlane Hand and Upper Limb Centre." This center evaluates more than 400 patients with complex nerve injuries annually and has been routinely using nerve transfers since 2005. The described rehabilitation program includes input from patients, therapists, physiatrists, and surgeons and has evolved based on experience and updated science. The plan is comprised of phases which are practical, reproducible and will serve as a framework to allow other peripheral nerve programs to adapt and improve the "Roth|McFarlane Hand and Upper Limb Centre" paradigm to enhance patient outcomes.

Alternative Noninvasive Treatment of Unstable Extra-articular Proximal and Middle Phalangeal Fractures: A Static Linear Traction Orthosis Design.

Extra-articular unstable proximal and middle phalanx fractures are typically managed with surgical means with common complications of tendon tethering, stiffness, and secondary hand dysfunction. As a result, alternative conservative measures are being explored. The use of static linear traction through the application of an orthosis allows for fracture reduction and anatomic healing, with successful range of motion outcomes.

Vulnerabilidade clínico funcional masculina entre idosos institucionalizados / Male functional clinical vulnerability among institutionalized elderly

Resumo Objetivo: Analisar a vulnerabilidade clínico funcional masculina entre idosos institucionalizados em duas unidades de longa permanência por meio do instrumento Índice de Vulnerabilidade Clínico Funcional (IVCF-20). Metodologia: Trata-se de um estudo transversal e comparativo, no qual se utilizou uma amostra por conveniência em que participaram 31 homens idosos institucionalizados em duas Instituições de Longa Permanência localizadas no município de Marabá-PA, no período de janeiro a maio de 2019. Para a vulnerabilidade, utilizou-se o instrumento IVCF-20 e para a análise estatística foi aplicado o Teste G considerando o nível de significância de p≤0,05. Todos os preceitos éticos em pesquisa foram assegurados. Resultados: Nos grupos predominaram a faixa etária entre 60-74 anos, solteiros, aposentados e com grau de escolaridade baixo. Os idosos institucionalizados apresentavam algumas doenças prévias como Hipertensão Arterial Sistêmica (50%) seguido de Hiperplasia da Próstata (36,8%). Quanto a vulnerabilidade, os grupos apresentaram comprometimento nas atividades de vida diária básicas e instrumentais; na cognição; no humor; na mobilidade no que tange ao alcance e/ou preensão de objetos, na capacidade aeróbica e muscular, durante a marcha e na perda urinária e fecal. Os idosos pertencentes a instituição A apresentaram vulnerabilidade clínica funcional mais comprometida do que idosos pertencentes a instituição B. Conclusão: Os resultados evidenciam alto grau de vulnerabilidade dos idosos institucionalizados ampliando discussões sobre as políticas públicas direcionadas à população idosa masculina.

Resumen Objetivo: Analizar la vulnerabilidad clínica funcional masculina entre adultos mayores institucionalizados en dos unidades de cuidados de largo plazo utilizando el Índice de Vulnerabilidad Clínica Funcional (IVCF-20). Método: Se trata de un estudio transversal y comparativo, se utilizó una muestra de conveniencia, participaron 31 adultos mayores institucionalizados en dos Instituciones de Larga Duración ubicadas en el municipio de Marabá-PA, de enero a mayo de 2019. Para la vulnerabilidad se utilizó el instrumento IVCF-20 y se aplicó la prueba G para el análisis estadístico, considerando el nivel de significancia de p≤0.05. Todos los preceptos éticos en la investigación estaban garantizados. Resultados: Predominó el grupo de edad entre 60-74 años, solteros, jubilados y con bajo nivel educativo. Los adultos mayores institucionalizados tenían algunas enfermedades previas, como la hipertensión arterial sistémica (50 %), seguida de la hiperplasia prostática (36,8%). En cuanto a la vulnerabilidad, los grupos mostraron deterioro en las actividades básicas e instrumentales de la vida diaria, en cognición, de humor, movilidad en términos de alcanzar o agarrar objetos, capacidad aeróbica y muscular durante la marcha y pérdida urinaria y fecal. Los adultos mayores pertenecientes a la institución A tenían una vulnerabilidad clínica funcional más comprometida que los pertenecientes a la institución B. Conclusión: Los resultados muestran un alto grado de vulnerabilidad de los adultos mayores institucionalizados, ampliando las discusiones sobre políticas públicas dirigidas a la población masculina adulta mayor.

Abstract Aim: To analyze functional clinical vulnerability in institutionalized elderly males in two long-term care units using the Functional Clinical Vulnerability Index (IVCF-20). Method: This is a cross-sectional and comparative study. A convenience sample was used, and as a result, 31 senior males in two institutionalized long-term institutions located in the municipality of Marabá-PA from January to May 2019 participated in the study. The IVCF-20 instrument was used to evaluate the vulnerability; a G test was applied for the statistical analysis considering a significance level of p≤0.05. All ethical requirements for research were guaranteed. Results: Among all groups, the age group between 60-74 years old, single, retired, and with a low level of education predominated. Institutionalized older people had some previous diseases such as Systemic Arterial Hypertension (50%) followed by Prostate Hyperplasia (36,8%). As for vulnerability, the groups showed an impairment in basic and instrumental activities of daily living, in cognition, in mood, mobility about reaching and / or grasping objects, aerobic and muscular capacity, gait, and urinary and fecal loss. The elderly belonging to institution A had more compromised functional clinical vulnerability than the elderly belonging to institution B. Conclusion: The results show a high degree vulnerability in institutionalized elderly citizens; discussions about public policies aimed at the elderly male population should expand.

Systemic enhancement of serotonin signaling reverses social deficits in multiple mouse models for ASD.

Autism spectrum disorder (ASD) is a common set of heterogeneous neurodevelopmental disorders resulting from a variety of genetic and environmental risk factors. A core feature of ASD is impairment in prosocial interactions. Current treatment options for individuals diagnosed with ASD are limited, with no current FDA-approved medications that effectively treat its core symptoms. We recently demonstrated that enhanced serotonin (5-HT) activity in the nucleus accumbens (NAc), via optogenetic activation of 5-HTergic inputs or direct infusion of a specific 5-HT1b receptor agonist, reverses social deficits in a genetic mouse model for ASD based on 16p11.2 copy number variation. Furthermore, the recreational drug MDMA, which is currently being evaluated in clinical trials, promotes sociability in mice due to its 5-HT releasing properties in the NAc. Here, we systematically evaluated the ability of MDMA and a selective 5-HT1b receptor agonist to rescue sociability deficits in multiple different mouse models for ASD. We find that MDMA administration enhances sociability in control mice and reverses sociability deficits in all four ASD mouse models examined, whereas administration of a 5-HT1b receptor agonist selectively rescued the sociability deficits in all six mouse models for ASD. These preclinical findings suggest that pharmacological enhancement of 5-HT release or direct 5-HT1b receptor activation may be therapeutically efficacious in ameliorating some of the core sociability deficits present across etiologically distinct presentations of ASD.

Percursos e entraves dos psicanalistas nos hospitais / Paths and obstacles of psychoanalysts in hospitals / Chemins et obstacles des psychanalystes dans les hôpitaux

Os psicanalistas estenderam sua prática para além do consultório, fazendo-se presentes em diversos contextos institucionais. Um desses novos contextos é o hospital. O presente artigo realizou um levantamento de referências bibliográficas que abordam a inserção da prática psicanalítica nos hospitais nos últimos anos. Apresentamos como ocorreu o movimento de expansão da escuta psicanalítica bem como o que a autorizou nesse novo campo. No contexto brasileiro, verificamos a presença de alguns entraves para que essa prática se solidificasse -alguns superados, outros não. Recolhemos os efeitos da sustentação do discurso do analista no hospital e apresentamos uma intervenção clínica realizada nesse contexto.

Paths and obstacles of psychoanalysts in hospitals: Psychoanalysts have extended their practice beyond their cabinet, making themselves present in several institutional contexts. One of these new contexts is the hospital. This paper conducted a survey of the writings that address the inclusion of psychoanalytic practice in hospitals in the past years. We present how the movement to expand psychoanalytic listening took place and what allowed it in this new field. In the Brazilian context, we have verified the presence of certain obstacles to the consolidation of this practice -some have been overcome, others have not. Based on the collected material, we report the results achieved by sustaining the analyst's discourse in the hospital and also present a clinical intervention performed in this same context.

Chemins et obstacles des psychanalystes dans les hôpitaux: Les psychanalystes ont étendu leur pratique au-delà du cabinet, se rendant présents dans des contextes institutionnels divers. L'un de ces nouveaux contextes est l'hôpital. Cet article a réalisé un recueil de références bibliographiques, qui traitent de l'insertion de la pratique psychanalytique dans les hôpitaux au long des dernières années. Nous présentons comment s'est déroulé le mouvement d'expansion de l'écoute psychanalytique ainsi que ce qui l'a autorisé dans ce nouveau champ. Dans le contexte brésilien, nous avons vérifié la présence d' obstacles à la solidification de cette pratique -certains déjà surmontés, d'autres non. D'après la bibliographie recueillie, nous réunissons les effets du discours soutenu par l'analyste à l'hôpital et nous présentons une intervention clinique réalisée dans ce contexte.

Postoperative management and rehabilitation after the supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer: A report of 3 cases.

INTRODUCTION: Compressive ulnar neuropathy at the elbow is the second most common compressive neuropathy. Nerve transfers are used for severe ulnar neuropathies as a means of facilitating recovery. Hand therapy and rehabilitation after nerve transfers have not been extensively explored. PURPOSE OF THE STUDY: The aim of this repeated case study was to describe the responses, functional outcome, and neuromuscular health of three participants after the supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer do describe the hand therapy and recovery of 3 cases reflecting different recovery potential mediators, trajectories, and outcomes. STUDY DESIGN: Repeated case study. METHODS: Three participants of similar age (76-80 years) that had severe ulnar neuropathy who underwent surgical treatment including a SETS AIN to ulnar motor nerve surgery were purposively selected from an ongoing clinical trial, based on their response to the surgical and the rehabilitation intervention (large, moderate, and small improvements). Clinical evaluations included measuring range of motion, strength testing, and clinical tests (ie, Egawa's sign) and, subjective assessment of rehabilitation adherence., Quick Disability of Arm, Shoulder and Hand and decomposition-based quantitative electromyography were performed at >23 months to evaluate patients. RESULTS: All the three participants completed the surgical and hand therapy interventions, demonstrating a variable course of recovery and functional outcomes. The Quick Disability of Arm, Shoulder and Hand scores (>23 months) for participants A, B, and C were 68, 30, and 18, respectively. The person with the least improvement had idiopathic Parkinson's disease, dyslipidemia, history of depression, and gout. Comparison across cases suggested that the comorbidities, longer time from neuropathy to the surgical intervention, and psychosocial barriers to exercise and rehabilitation adherence influenced the recovery process. The participants with the best outcomes demonstrated improvements in his lower motor neurons or motor unit counts (109 and 18 motor units in the abductor digiti minimi (ADM) and first dorsal interosseous, respectively) and motor unit stability (39.5% and 37.6% near-fiber jiggle in the ADM and first dorsal interosseous, respectively). The participant with moderate response to the interventions had a motor unit count of 93 for the ADM muscle. We were unable to determine motor unit counts and measurements from the participant with the poorest outcomes due to his physical limitations. CONCLUSIONS: SETS AIN to ulnar motor nerve followed by multimodal hand therapy provides measurable improvements in neurophysiology and function, although engagement in hand therapy and outcomes appear to be mediated by comorbid physical and psychosocial health.

Reverse End-to-Side Anterior Interosseous Nerve-to-Ulnar Motor Transfer for Severe Ulnar Neuropathy.

BACKGROUND: Reverse end-to-side anterior interosseous nerve transfer has been reported to enhance treatment of severe, proximal ulnar neuropathy. The authors report on patients with severe neuropathy treated with ulnar nerve transposition and distal reverse end-to-side anterior interosseous nerve transfer. METHODS: Thirty patients with severe ulnar neuropathy at the elbow were reviewed. Clinical parameters included preoperative and postoperative Medical Research Council muscle strength, clawing, and degree of wasting. Electrodiagnostic data included compound motor action potential and sensory nerve action potential amplitudes. Summary statistics were used for demographic and clinical data. The t test and Wilcoxon signed rank test were used where appropriate. RESULTS: Average follow-up was 18.6 months. Preoperatively, 20 patients had Medical Research Council less than or equal to grade 1 in hand intrinsics, small finger sensory nerve action potentials were absent in all patients except for three, and average compound motor action potentials were severely reduced (absent in nearly 40 percent) confirming severity. All groups had a statistically significant increase in strength. More than three-quarters of patients noted partial or complete resolution of clawing and intrinsic muscle wasting. Seventy-three percent of patients regained Medical Research Council greater than or equal to grade 3 and 47 percent achieved Medical Research Council greater than or equal to grade 4. Mean time to observation of nascent units was 8.5 months, and 77 percent of patients demonstrated an augmentation of motor unit numbers with forearm pronation on needle electromyography CONCLUSION:: Proximal subcutaneous ulnar nerve transposition when combined with reverse end-to-side anterior interosseous nerve-to-ulnar nerve transfer demonstrates significant clinical and electrodiagnostic improvement of intrinsic muscle function. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Distinct neural mechanisms for the prosocial and rewarding properties of MDMA.

The extensively abused recreational drug (±)3,4-methylenedioxymethamphetamine (MDMA) has shown promise as an adjunct to psychotherapy for treatment-resistant psychiatric disease. It is unknown, however, whether the mechanisms underlying its prosocial therapeutic effects and abuse potential are distinct. We modeled both the prosocial and nonsocial drug reward of MDMA in mice and investigated the mechanism of these processes using brain region-specific pharmacology, transgenic manipulations, electrophysiology, and in vivo calcium imaging. We demonstrate in mice that MDMA acting at the serotonin transporter within the nucleus accumbens is necessary and sufficient for MDMA's prosocial effect. MDMA's acute rewarding properties, in contrast, require dopaminergic signaling. MDMA's prosocial effect requires 5-HT1b receptor activation and is mimicked by d-fenfluramine, a selective serotonin-releasing compound. By dissociating the mechanisms of MDMA's prosocial effects from its addictive properties, we provide evidence for a conserved neuronal pathway, which can be leveraged to develop novel therapeutics with limited abuse liability.

The Use of Dynamic Assist Orthosis for Muscle Reeducation following Brachial Plexus Injury and Reconstruction.

Therapeutic management of brachial plexus injuries remains complex. The impact of brachial plexus injuries on everyday human functioning should not be underestimated. Early active-assisted range of motion following such injuries may prevent myostatic contractures, minimize muscle atrophy, facilitate muscle fiber recruitment, and enable a faster return to baseline strength levels. The dynamic assist elbow flexion orthosis proposed is designed to provide patients with a graded system for muscle reeducation and function. No clinical data are currently available on the use of this orthosis design; however, this article presents a treatment option based on sound clinical reasoning to facilitate rehabilitation following this devastating injury.

Pathomechanics and Management of Secondary Complications Associated with Tendon Adhesions Following Flexor Tendon Repair in Zone II.

Despite the number of rehabilitation strategies and guidelines developed to maximize the gliding amplitude of repaired tendons, secondary complications, such as decreased range of motion and stiffness associated with tendon adhesions, commonly arise. If left untreated, these early complications may lead to secondary pathomechanical changes resulting in fixed deformities and decreased function. Therefore, an appropriate treatment regimen must not only include strategies to maintain the integrity of the repaired tendon, but must also avoid secondary complications due to reduced gliding amplitude. This review presents a biomechanical analysis of the dynamics of tendon gliding following repair in zone II and rehabilitation strategies to minimize secondary complications related with tendon adhesions.

Sistema de referência e de contrarreferência na rede de atenção aos usuários de drogas: contribuições da análise de redes sociais / Referral and counter-referral system in the care network for drug users: contributions from social network analysis

Resumo O presente artigo analisou o sistema de referência e de contrarreferência de uma rede de atenção aos usuários de drogas a partir da Análise de Redes Sociais (ARS). Trata-se de uma pesquisa de corte transversal realizada no município de Juiz de Fora, em Minas Gerais, com profissionais dos serviços de tratamento aos usuários de drogas. Os dados foram coletados por meio de questionário sobre as relações de referenciamento e de contrarreferenciamento de usuários entre os serviços da rede. Para a análise dos dados a partir da ARS, utilizou-se o software Gephi, extraindo as seguintes métricas: centralidade de grau e centralidade de intermediação. Os resultados indicaram uma maior prevalência de referenciamento em detrimento da contrarreferência, com uma centralização nos serviços especializados, de média e alta complexidade, e nos de urgência/emergência. Espera-se demonstrar as potencialidades da ARS na compreensão de redes organizacionais e influenciar a realização de novas pesquisas que visem compreender as diferentes realidades assistenciais aos usuários de drogas no contexto nacional e internacional.

Abstract This paper analyzed the reference and counter-referral system of a care network for drug users, from Social Network Analysis (SNA). It is a cross-sectional survey conducted in the city of Juiz de Fora, Minas Gerais, with professionals from the drug users’ treatment services. Data was collected through a questionnaire that measured referral and counter-referral relations of drug users between network services. Data from SNA was analyzed using the Gephi software, extracting the following metrics: Degree Centrality and Intermediation Centrality. Results indicated a higher prevalence of referencing rather than counter-referral, with a centralization in specialized, medium and high complexity, and emergency services. It is expected to demonstrate the potential of SNA in the understanding of organizational networks and influence new research that aims to comprehend different care realities for drug users in national and international context.

Search for alkaloids on callus culture of Passiflora alata

Preliminary work on Passiflora alata leaves failed to detect harmane alkaloids using LC. The aim of this work was to investigate the production of harmane alkaloids through the cell culture of P. alata, inducing its precursor (L-tryptophan). The leaf explants presented satisfactory results after disinfection, and the callus formation was initiated in MS media with adequate quantities of phytohormones. Sixty days after inoculation, calli were inoculated in the optimized semi-solid MS media, with and without the addition of L-tryptophan (50, 100, 200 mg/L) and kept in standard conditions for 90 days. Calli were collected on days 6, 16, 26, 36, and 90, followed by acid-base extraction, and analysed by LC. The results showed an absence of harmane, harmin, harmol, harmalol, and harmaline. With L-tryptophan feeding, two peaks were detected, collected and analysed through positive mode electrospray [ESI(+)-MS] and sequential analysis in tandem ESI(+)-MS/MS. The spectra obtained were very similar, with a repetition of the more intense ions, and consecutive loss of 68 Da units, attributed to the heterocycle pyrazole. It appeared that this transformation was not related to any enzymatic pathway previously described for the plant from L-tryptophan, and the biosynthesis of β-carboline alkaloids in callus culture of P. alata were not observed in this work.

As folhas de varias espécies de Passiflora são utilizadas como ansioliticas e sedativas. Passiflora alata Curtis, Passifloraceae consta em três edições da farmacopéia brasileira, porem não há muitos estudos sobre sua composição química. No passado, enfatizava-se a ação conjunta de alcalóides e flavonóides. Em trabalho anterior, não foi detectada a presença de alcalóides harmanicos através de CLAE. Assim, decidiu-se investigar a produção dos mesmos através de cultivo celular, introduzindo seu precursor metabólico L-triptofano. Os explantes foliares apresentaram resultados satisfatorios para germinação apos assepsia, e a formação de calo foi iniciada em meio MS com quantidades adequadas de fitohormonios, previamente determinadas. Sessenta dias após a inoculação os calos foram repicados para meio semi-solido com e sem L-triptofano (50, 100, 200 mg/L), mantidos por 90 dias em condições padrão. Amostras foram coletadas com 6, 16, 26, 36, e 90 dias, realizada extração acido-base e o extrato analisado por CLAE. Os resultados mostraram a ausência de harmana, harmina, harmol, harmalol e harmalina. Dois picos presentes nas amostras com L-triptofano foram coletados e analisados através de espectrometria de massas, electrospray modo positiva [ESI(+)-MS] e analise em tandem ESI(+)-MS/MS. Os espectros correspondentes foram similares, mostrando a perda consecutiva de 68 Da, atribuídos ao pirazol. Este fato aponta para uma transformação não enzimática, não relacionada a uma biossintese previamente descrita para alcalóides β-carbolínicos.

Upper-extremity disability in essential tremor.

OBJECTIVE: To determine the extent of disability in subjects with essential tremor (ET) using time-based, standardized measures of upper-extremity function. DESIGN: Descriptive case series. SETTING: Motor performance research laboratory. PARTICIPANTS: Thirty subjects with ET (mean age, 58.3+/-13.7 y) and 28 healthy controls (mean age, 58.4+/-12.4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We assessed upper-extremity function using the Box and Block Test, Purdue Pegboard Test (PPT), and Test Evaluant la performance des Membres supérieurs des Personnes Agées (TEMPA). We measured tremor severity with laser displacement sensors. RESULTS: Subjects with ET-type tremor in 1 or both hands performed significantly worse than controls on all unilateral and bilateral tasks (P range, .038-.001) except on the PPT for the dominant side. ET subjects without ET-type tremor in the dominant hand also performed significantly worse than controls on the TEMPA unilateral tasks (P=.043). Performance on the 3 functional measures correlated moderately with tremor severity for the nondominant hand. CONCLUSIONS: Subjects with ET show measurable disability on time-based measures of upper-extremity function. However, our findings are consistent with other reports that tremor severity does not correlate well with disability, especially with regard to the dominant upper extremity.