Left Atrial Fibroelastoma as a Cause of Stroke: A Case Report.

Cardiac papillary fibroelastoma is a benign and rare primary tumor of the heart that is most frequently located in the aortic or the mitral valves. Papillary fibroelastoma arising from the left atrium is exceedingly rare, comprising less than 7% of all cardiac papillary fibroelastomas. Tumors in this location could be a source of cardioembolic stroke, often in the anterior circulation of the cerebrum. A 66-year-old female presenting with right hemiparesis, central facial palsy, homonymous hemianopia, and dysarthria received intravenous thrombolysis for stroke without apparent improvement. Magnetic resonance imaging of the brain revealed ischemic infarction in the territories of the left middle and posterior cerebral arteries. A tumor with a maximal diameter of 2.3 cm was disclosed during workup for possible cardioembolic stroke with transthoracic echocardiography and computed tomography of the heart. The clinical course was complicated by stroke-in-evolution and hemorrhagic transformation. The patient underwent left atrial tumor excision and left atrium appendage closure. In-patient stroke rehabilitation programs were also initiated after the conditions stabilized. No clinically significant complications developed after the operation. Neurological functions improved and the patient was able to perform most basic daily living activities with some assistance. An exhaustive search for the cause of cardioembolic stroke is paramount, as management strategies may differ from patients with thrombotic stroke.

Effect of a Novel Perturbation-Based Pinch Task Training on Sensorimotor Performance of Upper Extremity for Patients With Chronic Stroke: A Pilot Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system. DESIGN: A single-blinded randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Patients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study. INTERVENTIONS: In addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks. MAIN OUTCOME MEASURES: The scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up. RESULTS: There were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P<.001) and coordination (P=.01) component of the FMA score. CONCLUSIONS: This study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.

Chloroquine inhibits human retina pigmented epithelial cell growth and microtubule nucleation by downregulating p150glued.

Chloroquine (CQ) is an antimalaria drug that has been used in clinical practice for several decades. One serious complication of CQ treatment is the macular retinopathy caused by the disruption of the retinal pigmented epithelium, leading to vision loss. Little is known about how CQ affects retinal pigmented epithelium. In this study, we found that cell proliferation was reduced by CQ treatment in time and dose-dependent manners. No obvious cell death was detected; however, what was observed instead was G0/G1 arrest during which primary cilium started to grow in the presence of CQ. Pharmacological inhibition of primary cilium formation led to a reduction of cell viability suggesting that CQ-induced primary cilium protected cells from death. In addition to cell growth, with the CQ treatment the retina pigmented epithelium (RPE) cells less flattened with the spindle-like protrusion. When checking the microtubule networks, the microtubule nucleation activity was disrupted in the presence of CQ. The level of p150 glued , the largest subunit of dynactin, was reduced in CQ-treated RPE1 cells, and depletion of p150 glued resulted in a phenotype reminiscent of CQ-treated cells. Thus, CQ treatment reduced the expression of p150 glued , leading to reduced S phase entry and defective microtubule nucleation.

Effects of the Surface Texture and Weight of a Pinch Apparatus on the Reliability and Validity of a Hand Sensorimotor Control Assessment.

OBJECTIVES: To investigate the reliability and validity of a modified pinch apparatus devised with 3 surface textures and 2 different weights for clinical application. DESIGN: Case-controlled study. SETTING: A university hospital. PARTICIPANTS: The participants (N=32) included carpal tunnel syndrome (CTS) patients (n=16) with 20 sensory neuropathy hands, and an equal number of age-sex matched volunteers without CTS, as well as young volunteers without CTS (n=16 with 20 hands) used to analyze both the testing validity and reliability of the modified device. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Semmes-Weinstein monofilament (SWM) and two-point discrimination (2PD) tests were conducted, and the force ratio between the FPpeak (peak pinch force during lifting phase) and FLmax (maximum load force at maximum upward acceleration onset) detected from a pinch-holding-up activity (PHUA) under various testing conditions was obtained. RESULTS: The range of the intraclass correlation coefficient of this pinch device was 0.369-0.952. The CTS patients exhibited poorer force modulation ability according to the inertial change in a dynamic lifting task when compared to the controls under all testing conditions (P<.001). The area under the receiver operating characteristic force ratio curve was 0.841, revealing high accuracy of the test for diagnosing CTS neuropathic hands under the testing condition in which the 125-g coarse texture device was used. In addition, the weight factor was shown to have significant effects on the sensitivity and accuracy of the PHUA assessment. CONCLUSIONS: This study showed that the PHUA test via the modified pinch apparatus is a sensitive tool that can be used in clinical practice for detecting neuropathic CTS hands. In addition, changing the weight of the pinch device has a significant effect on the sensitivity and accuracy of the PHUA assessment.

A Touch-Observation and Task-Based Mirror Therapy Protocol to Improve Sensorimotor Control and Functional Capability of Hands for Patients With Peripheral Nerve Injury.

IMPORTANCE: To develop a practical program in the early phase after nerve repair for more rapid return of function. OBJECTIVE: To investigate the effects of touch-observation and task-based mirror therapy on the sensorimotor outcomes of patients with nerve repair. DESIGN: An assessor-blinded study with a randomized controlled design. SETTING: University hospital. PARTICIPANTS: We recruited 12 patients with median or ulnar nerve repair between the level of midpalm and elbow referred by the plastic surgeons. INTERVENTION: The patients were randomized into touch-observation and task-based mirror therapy or control groups, and both groups received training for 12 wk. OUTCOMES AND MEASURES: The Semmes-Weinstein monofilament (SWM) test, two-point discrimination test, Purdue Pegboard Test (PPT), Minnesota Manual Dexterity Test (MMDT), and pinch-holding-up activity test were assessed at pretreatment, immediately after treatment, and 12 wk after the last treatment. RESULTS: The experimental group showed greater improvements in the results of the pinch-holding-up activity test and the PPT Unilateral Pin Insertion, Bilateral Pin Insertion, and Assembly subtests. However, change on the SWM test revealed no significant difference between the two groups. CONCLUSIONS AND RELEVANCE: Touch-observation and task-based mirror therapy is an effective but low-cost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury.

Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.

BACKGROUND/AIM: Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors. METHODS: Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference. RESULTS: There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment. CONCLUSIONS: RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03847103.

7-hydroxy-staurosporine, UCN-01, induces DNA damage response, and autophagy in human osteosarcoma U2-OS cells.

Human osteosarcoma (bone cancer) is a highly malignant and the most prevalent bone tumor affecting children. Despite recent advances in the understanding of the molecular mechanism by which anticancer drugs kill osteosarcoma or block its growth, however, the mortality rate has declined only modestly. Thus, a new therapeutic approach is needed to be established. 7-hydroxystaurosporine, UCN-01, abrogates the G2 checkpoint thus enhancing the cytotoxicity of chemotherapeutic agents. In addition, it has been evaluated in clinical trials as a single antineoplastic agent in treating several cancers. However, the effects of UCN-01 on treating bone cancer has never been tested. In this study, we found that UCN-01 induced cell cycle arrest and apoptosis in the human osteosarcoma, U2-OS cells. In addition, the migration ability was also reduced, suggesting UCN-01 inhibited cell growth and migration. When U2-OS cells were treated with UCN-01, DNA damage response was triggered. The ataxia telangiectasia mutated (ATM) and the non-canonical downstream effector, ERK, was activated by UCN-01. In addition, depletion of ATM or inhibition of ERK deteriorated the cell viability in UCN-01-treated U2-OS cells. Furthermore, UCN-01 induced autophagy activation for protecting cells from apoptosis. Thus, UCN-01 might function as a single antineoplastic agent in treating human osteosarcoma.

Comparison Between Steroid and 2 Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized, Double-Blind, Active Drug-Controlled Pilot Study.

OBJECTIVE: To compare the effects of 2 different injection sites of low doses of botulinum toxin type A with steroid in treating lateral epicondylalgia. DESIGN: Double-blind, randomized, active drug-controlled trial. SETTING: Tertiary medical center. PARTICIPANTS: Patients with lateral epicondylalgia for >6 months were recruited from a hospital-based outpatient population (N=26). A total of 66 patients were approached, and 40 were excluded. No participant withdrew because of adverse effects. INTERVENTIONS: Patients were randomly assigned into 3 groups: (1) botulinum toxin epic group (n=8), who received 20U of botulinum toxin injection into the lateral epicondyle; (2) botulinum toxin tend group (n=7), who received 20U of botulinum toxin injected into tender points of muscles; and (3) steroid group (n=11), who received 40mg of triamcinolone acetonide injected into the lateral epicondyle. MAIN OUTCOME MEASURES: A visual analog scale, a dynamometer, and the Patient-Rated Tennis Elbow Evaluation were used to evaluate the perception of pain, maximal grip strength, and functional status, respectively. Outcome measures were assessed before intervention and at 4, 8, 12, and 16 weeks after treatment. The primary outcome measure was a visual analog scale. RESULTS: At 4 weeks after injection, the steroid group was superior to the botulinum toxin tend group in improvement on the visual analog scale (P=.006), grip strength (P=.03), and Patient-Rated Tennis Elbow Evaluation (P=.02). However, these differences were not observed at the 8-, 12-, and 16-week follow-up assessments. There was no significant difference between the steroid and botulinum toxin epic groups. CONCLUSIONS: Injections with botulinum toxin and steroid effectively reduced pain and improved upper limb function in patients with lateral epicondylalgia for at least 16 weeks. The onset of effect was earlier in the steroid and botulinum toxin epic groups than in the botulinum toxin tend group.

Determining the functional sensibility of the hand in patients with peripheral nerve repair: Feasibility of using a novel manual tactile test for monitoring the progression of nerve regeneration.

STUDY DESIGN: Case-controlled cohort study. INTRODUCTION: Sensory function is difficult to observe during nerve regeneration processes. Traditional sensory tests are limited to identifying the level of functioning hand sensation for sensory stimulus is given passively to the cutaneous surface of the hand. PURPOSE OF THE STUDY: To examine the outcome changes in the manual tactile test (MTT), Semmes-Weinstein monofilament (SWM) and 2-point discrimination (2PD) tests for patients with nerve repair and to investigate the concurrent validity of MTT by comparing it with the results of traditional tests. METHODS: Fifteen patients with nerve injury of the upper limbs were recruited, along with 15 matched healthy controls. The MTT, SWM, and 2PD tests were used to examine the sensory status of the subjects. RESULTS: Three subtests (barognosis, roughness differentiation, and stereognosis) in MTT showed that the patients improved with time. A moderate and mild correlation was found between the MTT and 2PD results and between the barognosis and SWM results. CONCLUSIONS: The MTT provides practical and functional perspectives on detecting nerve progression during the courses of degeneration and regeneration. LEVEL OF EVIDENCE: IV.

Manual Tactile Test Predicts Sensorimotor Control Capability of Hands for Patients With Peripheral Nerve Injury.

OBJECTIVES: To comprehend the merits of a Manual Tactile Test (MTT) in assessing hand sensorimotor functions by exploring the relations among 3 subtests along with the precision pinch performances for patients with peripheral nerve injuries (PNIs); and to understand the accuracy of the MTT by constructing the sensitivity and specificity of the test for patients with PNI. DESIGN: Case-control study. SETTING: Hospital and local community. PARTICIPANTS: Patients with PNI (n=28) were recruited along with age-, sex-, and handedness-matched healthy controls (n=28) (N=56). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Semmes-Weinstein monofilament, moving and static 2-point discrimination, roughness differentiation, stereognosis and barognosis subtests of the MTT, and precision pinch performance were used to examine the sensory and sensorimotor status of the hand. RESULTS: The worst results in all sensibility tests were found for the patients with PNI (P<.001) in comparison with the controls. Multiple linear regression analysis showed the MTT was a better indicator for predicting the sensorimotor capacity of hands in the patients with PNI (r(2)=.189, P=.003) than the traditional test (r(2)=.088, P=.051). The results of the receiver operating characteristic curve estimation show that the area under the curve was .968 and .959 for the roughness differentiation and stereognosis subtests, respectively, and .853 for the barognosis subtest, therefore revealing the accuracy of the MTT in assessing sensorimotor status for patients with PNI. CONCLUSIONS: This study indicates that the MTT is highly accurate and a significant predictor of sensorimotor performance in hands of patients with PNI. The MTT could therefore help clinicians obtain a better understanding of the sensorimotor and functional status of the hand with nerve injuries.

Relationship of perceived environmental barriers and disability in community-dwelling elderly in Taiwan--a population-based study.

BACKGROUND: To identify the relationship between perceived environmental barriers and disability in community-dwelling elderly. METHODS: Cross-sectional study in two community service centers in Tainan. We enrolled 200 community-dwelling residents, aged above 65 years, who had resided in the same community for at least 12 months. Basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were assessed using the Hierarchy of Care Required (HCR). There were 59 participants in BADL disability and 109 in IADL disability. Perceived environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors (CHIEF). We used multinomial logistic regression to examine the relationship of perceived environmental barriers and disability. RESULTS: The presence of perceived environmental barriers was related to BADL disability (OR = 4.39, 95% CI = 1.01-19.11) and IADL disability (IADL with difficulty in 1-2 tasks: OR = 9.93, 95% CI = 3.22-30.56; IADL with difficulty in more than 2 tasks: OR = 8.40, 95% CI = 1.83-38.51). The presence of physically/structurally perceived environmental barriers was related to BADL disability (OR = 4.90, 95% CI = 1.01-23.86) and IADL disability (IADL with difficulty in 1-2 tasks: OR = 4.61, 95% CI = 1.27-16.76; IADL with difficulty in more than 2 tasks: OR = 17.05, 95% CI = 2.82-103.30). CONCLUSIONS: Perceived environmental barriers are related to disability in community-dwelling elderly.

Entrapment neuropathy of common peroneal nerve by fabella: A case report.

BACKGROUND: Neuropathy of the common peroneal nerve caused by compression by a fabella is an extremely rare form of compression neuropathy. Involving both the superficial and deep peroneal nerves, it usually manifests as either impaired sensation from the lower lateral leg to the top of the foot or drop foot, or as a combination of both. CASE SUMMARY: We report the case of a 58-year-old Asian female who presented with inversion of the right foot during the stance phase of gait without sensory complaints related to the lower leg. Electrodiagnostic testing revealed the neuropathy of the common peroneal nerve at the level of the knee, exclusively affecting the muscular branch of the superficial peroneal nerve. A neuromuscular ultrasound disclosed swelling of the right common peroneal nerve just before it crossed over a large fabella as well as atrophy and fatty infiltration of the right peroneus longus and peroneus brevis muscles. Surgical excision of the fabella and neurolysis were performed. Subsequently, the strength of the right foot evertors improved, but the unsteady gait with occasional falls persisted for nine months after the surgery. Therefore, another procedure was performed to transfer the split posterior tibialis tendon to the peroneus brevis in order to correct the gait. CONCLUSION: This is the first case of neuropathy of the common peroneal nerve caused by compression by a fabella affecting exclusively the muscular branch of the superficial peroneal nerve. Clinicians should be aware of this unusual peripheral neuropathy while evaluating and treating patients with gait disturbance.

Botulinum toxin injection for Cockayne syndrome with muscle spasticity over bilateral lower limbs: A case report.

BACKGROUND: Cockayne syndrome (CS) is a rare inherited disease characterized by progressive motor symptoms including muscle weakness, joint contracture, ataxia, and spasticity. Botulinum neurotoxin type A has been used for conditions such as dystonia and spasticity, but it has rarely been used in patients with CS. CASE SUMMARY: We report a 6-year-and-9-mo old girl diagnosed with CS who received an injection of botulinum neurotoxin type A to manage her difficulty with walking. A total dose of 210 units of botulinum neurotoxin type A was administered into the bilateral tibialis posterior and gastrocnemius muscles. To evaluate the treatment effects on spasticity, joint contracture, pain, and ataxia, measurement tools including the Modified Ashworth Scale, the passive range of motion, the Faces Pain Scale-Revised, and the Scale for the Assessment and Rating of Ataxia, were employed. The first week after the injection, the Modified Ashworth Scale score for the plantar flexors and foot invertors improved bilaterally, along with advancements in the passive range of motion of the bilateral ankles and a lower score for the Faces Pain Scale-Revised. These treatment effects persisted to the 8th week post-injection, but returned to baseline values at the 12th week post-injection, except for the pain scale. CONCLUSION: Botulinum toxin injection can thus be considered as a treatment option for lower extremity spasticity, joint contracture, and pain derived from CS.

Effects of enriched branched-chain amino acid supplementation on sarcopenia.

To evaluate the effects of short-term administration of enriched branched-chain amino acids (BCAAs) on subjects with pre-sarcopenia or sarcopenia, our quasi-experimental study enrolled 33 subjects (12 pre-sarcopenia/21 sarcopenia; 6 men/27 women; mean age 66.6 ± 10.3 years) to take one sachet (3.6 g) of enriched BCAA powder twice a day for five weeks followed by a discontinuation period of 12 weeks. We evaluated sarcopenic parameters, including grip strength, 6-meter gait speed, and bioelectrical-impedance-analysis-derived skeletal mass index (SMI), at baseline, 5 weeks, and 17 weeks. We found that both pre-sarcopenic and sarcopenic subjects showed improved SMI, gait speed, and grip strength at 5 weeks. However, all three parameters progressively declined at 17 weeks, especially SMI and grip strength in subjects aged < 65 years and gait speed and grip strength in subjects aged ≥ 65 years. It thus appears that supplementation with enriched BCAAs for 5 weeks correlates with short-term positive effects on sarcopenic parameters but attenuation of those effects following discontinuation for 12 weeks.

Current studies on myofascial pain syndrome.

Recent studies have clarified the nature of myofascial trigger points (MTrPs). In an MTrP region, multiple hyperirritable loci can be found. The sensory components of the MTrP locus are sensitized nociceptors that are responsible for pain, referred pain, and local twitch responses. The motor components are dysfunctional endplates that are responsible for taut band formation as a result of excessive acetylcholine (ACh) leakage. The concentrations of pain- and inflammation-related substances are increased in the MTrP region. It has been hypothesized that excessive ACh release, sarcomere shortening, and release of sensitizing substances are three essential features that relate to one another in a positive feedback cycle. This MTrP circuit is the connection among spinal sensory (dorsal horn) neurons responsible for the MTrP phenomena. Recent studies suggest that measurement of biochemicals associated with pain and inflammation in the MTrP region, the sonographic study of MTrPs, and the magnetic resonance elastography for taut band image are potential tools for the diagnosis of MTrPs. Many methods have been used to treat myofascial pain, including laser therapy, shockwave therapy, and botulinum toxin type A injection.

Spinal cord infarction during physical exertion due to polycythemia vera and aortoiliac occlusive disease: A case report.

RATIONALE: Spinal cord infarction is rarely caused by hypercoagulable states. Polycythemia vera (PV) is a myeloproliferative neoplasm that can contribute to thrombotic events due to increased blood viscosity. We report a case of spinal cord infarction due to extensive aortic thrombosis caused by PV. PATIENT CONCERNS: A 56-year-old man presented with acute paraplegia and urinary retention during heavy physical exertion. DIAGNOSES: Imaging studies revealed spinal cord infarction at the T9 to T12 levels and aortoiliac occlusive disease. PV was diagnosed during workup for elevated hemoglobin level INTERVENTIONS:: The patient received intravenous hydration and anticoagulation for spinal cord infarction. PV was managed with phlebotomy and hydroxyurea. Courses of inpatient and outpatient rehabilitation programs were also given. OUTCOMES: The patient became urinary catheter-free 5 months after disease onset, and was able to walk with walker. The American Spinal Injury Association Impairment scale also improved from C at diagnosis to D during last follow-up. LESSONS: Etiologic workup is important for patients with spinal cord infarction to direct specific treatment strategies. Physical exertion may act as a trigger for infarction in patients at risk for thrombotic events, and monitoring of neurologic status during and after periods of exercise is warranted.

Botulinum toxin injection to improve functional independence and to alleviate parenting stress in a child with advanced pantothenate kinase-associated neurodegeneration: A case report and literature review.

RATIONALE: Pantothenate kinase-associated neurodegeneration (PKAN) is a rare autosomal recessive disease. Progressive motor symptoms such as dystonia and spasticity begin in childhood and relentlessly become incapacitating later in life. Treatments including anticholinergics and iron chelation are usually ineffective. Botulinum toxin type A (BoNT-A) is effective for adult patients with dystonia or spasticity. PATIENT CONCERNS: We reported a 10-year-old female patient with advanced PKAN, manifesting as generalized dystonia and spasticity. DIAGNOSIS: The patient was diagnosed with PKAN by a pediatric neurologist. INTERVENTIONS: The patient received BoNT-A injection. OUTCOMES: The effect was obvious at four weeks after the injection, with an improvement of 25% in Barry-Albright Dystonia Scale and 4% in Functional Independence Measure for Children score. Furthermore, there was a 3.8% reduction in Parenting Stress Index Short Form score and 8.3% improvement in Pain and Impact of Disability domain in the score of Cerebral Palsy Quality of Life for Children. LESSONS: BoNT-A injection was effective to improve functional independence and to alleviate stress of caregivers in the patient with advanced PKAN.

Impacts of Sensation, Perception, and Motor Abilities of the Ipsilesional Upper Limb on Hand Functions in Unilateral Stroke: Quantifications From Biomechanical and Functional Perspectives.

BACKGROUND: The presence of subtle losses in hand dexterity after stroke affects the regaining of independence with regard to activities of daily living. Therefore, awareness of ipsilesional upper extremity (UE) function may be of importance when developing a comprehensive rehabilitation program. However, current hand function tests seem to be unable to identify asymptomatic UE impairments. OBJECTIVES: To assess the motor coordination as well as the sensory perception of an ipsilesional UE using biomechanical analysis of performance-oriented tasks and conducting a Manual Tactile Test (MTT). DESIGN: Case-controlled study. SETTING: A university hospital. PARTICIPANTS: A total of 21 patients with unilateral stroke, along with 21 matched healthy control subjects, were recruited. METHODS: Each participant was requested to perform a pinch-holding-up activity (PHUA) test, object-transport task, and reach-to-grasp task via motion capture, as well as the MTT. MAIN OUTCOME MEASUREMENTS: The kinetic data of the PHUA test, kinematics analysis of functional movements, and time requirement of MTT were analyzed. RESULTS: Patients with ipsilesional UE had an inferior ability to scale and produce pinch force precisely when conducting the PHUA test compared to the healthy controls (P < .05). The movement time was statistically longer and peak velocity was significantly lower (P < .05) in the performance-oriented tasks for the ipsilesional UE patients. The longer time requirement in 3 MTT subtests showed that the ipsilesional UE patients experienced degradation in sensory perception (P < .001). CONCLUSION: Comprehensive sensorimotor assessments based on functional perspectives are valid tools to determine deficits in the sensation-perception-motor system in the ipsilesional UE. Integration of sensorimotor training programs for ipsilesional UE in future neuro-rehabilitation strategies may provide more beneficial effects to regain patients' motor recovery and to promote daily living activity independence than focusing on paretic arm motor training alone. LEVEL OF EVIDENCE: III.

The spinal cord connections of the myofascial trigger spots.

BACKGROUND: Recent electrophysiological studies revealed that endplate noise (EPN) could be specifically recorded from a myofascial trigger point (MTrP) region. EPN has been considered as the focal graded potentials due to excessive acetylcholine release in neuromuscular junction. A recent histological study has demonstrated a free nerve ending at the vicinity of the site, from where EPN could be recorded in an MTrP region. However, the sensory (afferent) and the motor (efferent) connections between an MTrP and the spinal cord still has never been fully studied. AIMS: The aim of this study was to delineate both motor and sensory connections between an MTrP and the spinal cord by applying the stain with horseradish peroxidase (HRP). METHODS: Nine Wistar rats were studied. When the rat was anesthetized, its biceps femoris muscles were exposed for localizing the myofascial trigger spot (MTrS, equivalent to MTrP in human). In one side, a monopolar Teflon-coated, hollow-needle electrode was used for searching EPN in an MTrS region, and then HRP was injected via this hollow-needle electrode into the site where EPN was recorded. HRP was also injected into a normal (non-taut band, non-MTrS) site in the contralateral side to obtain the control data. Two days after HRP injection, the rats were sacrificed and their spinal cords and dorsal root ganglia (DRG) were sectioned for the identification of the sites where neurons were labeled with HRP. RESULTS: The HRP-labeled neurons were found in the ventral horn of the spinal cord and in the DRG over L3, L4, and L5, while most were found in the L5 level. The mean numbers of HRP-labeled neurons in the EPN side looked smaller than that in the control side, but the difference did not reach statistically significant level (P>0.05). The mean values of the diameters of the HRP-labeled neurons in the DRG were not significantly different between the EPN side and the control side (P>0.05). However, HRP-neurons in the ventral horn of the spinal cord in the EPN side showed mild tendency to be smaller than that in the control side. CONCLUSIONS: The spinal cord connections of an MTrS are basically similar to that for a normal tissue region. The motor neurons related to MTrS tended to be smaller in their diameters. The findings in this study further supported the previously proposed hypotheses for the pathogenesis of an MTrP.

Punding following posterior cerebral artery infarction: a case report and literature review.

INTRODUCTION: Punding is a complex stereotyped behavior, characterized by excessiveness, non-goal orientation, and repetitiveness. It is mostly associated with Parkinson's disease, and very few cases in non-Parkinson's disease have been reported. We report a case of punding associated with supratentorial ischemic stroke. CASE PRESENTATION: We present a 70-year-old man with left posterior cerebral artery infarction with quetiapine-induced punding manifesting as repetitive unidirectional body turning. Remission of punding behavior ensued after cessation of quetiapine and administration of clonazepam. CONCLUSION: This case describes the clinical course of quetiapine-induced punding in a patient with left posterior cerebral artery infarction. It suggests clonazepam may serve as a treatment option for poststroke punding.