Locking of the metacarpophalangeal joint: A comprehensive review of the literature.

Locked metacarpophalangeal joint is an uncommon phenomenon with many possible etiologies. Diagnosis can be difficult because of the many more common pathologies (trigger finger, sagittal band lesion, etc.) that can lead to a clinical picture that may resemble the locked metacarpophalangeal joint. Once the differential diagnoses have been eliminated, the etiology of this blockage must be determined and the surgical procedure must be oriented. The origin of the problem is often difficult to determine, especially since standard imaging tests are often not very informative. Several clinical forms are possible, with blockages in extension or flexion, but which will have a disabling functional impact on the overall function of the hand. Currently, there is no gold standard for the management of this condition. In this study, we performed a review of the literature in order to better understand the different possible etiologies but also to analyze the different diagnostic and therapeutic management. LEVEL OF EVIDENCE: IV.

Functional connectivity during cognitive control in children with autism spectrum disorder: an independent component analysis.

Restrictive and repetitive behavior in autism may be related to deficits in cognitive control. Here, we aimed to assess functional connectivity during a cognitive control task and compare brain network activity and connectivity in children with autism spectrum disorders (ASD) and typically developing children using a multivariate data-driven approach. 19 high-functioning boys with ASD and 19 age-matched typically developing boys were included in this study. Functional magnetic resonance imaging was performed at 3T during the performance of a cognitive control task (go/no-go paradigm). Functional networks were identified using independent component analysis. Network activity and connectivity was compared between groups and correlated with clinical measures of rigid behavior using multivariate analysis of covariance. We found no differences between the groups in task performance or in network activity. Power analysis indicated that, if this were a real difference, it would require nearly 800 subjects to show group differences in network activity using this paradigm. Neither were there correlations between network activity and rigid behavior. Our data do not provide support for the presence of deficits in cognitive control in children with ASD, or the functional networks supporting this ability.

Rational dosages of nutrients have a prolonged effect on learning disabilities.

CONTEXT: Reports that administration of nutrients has increased the academic performance of learning-disabled children exist in the literature. OBJECTIVE: To document the effects of nutrients on learning-disabled children in a controlled study. DESIGN: A randomized, double-blind, placebo-controlled crossover trial, which followed 1 year of open-label nutrients. Children who improved in the open-label trial were eligible to enter the controlled phase of the study. SETTING: Subjects were enrolled from the general community through advertisements. PATIENTS OR OTHER PARTICIPANTS: Twenty children met the criteria for being learning disabled. INTERVENTION: Each child was tried out on some (but not necessarily all) of the B vitamins and minerals used in this study. These were administered semi-blinded for the first year; double-blinded in crossover rotations during the second year; and open-label in the ensuing years. MAIN OUTCOME MEASURES: At various time points, school-certified psychologists administered psychoeducational tests. School report cards were evaluated at baseline and for all subsequent periods. RESULTS: Twenty learning-disabled children entered the study, but 1 dropped out because of nausea. The remaining 19 children showed significant academic and behavioral improvements within a few weeks or months of open-label treatment with nutrient supplements. Some children gained 3 to 5 years in reading comprehension within the first year of treatment; and all children in special education classes became mainstreamed, and their grades rose significantly. Twelve of the children completed the 1-year double-blind phase, after which approximately half of the children chose to remain on the nutrients for at least 2 additional years. For those who discontinued, it took at least 1 year to begin to see the first indications of decline in academic performance, and another year for their grades to drop significantly. In contrast, for children who remained on nutrients, the gains continued the upward trend; at the end of year 4, the difference in scores between the 2 groups had reached statistical significance (P < .01). CONCLUSION: The overall results of this study tentatively support the concept that learning disabilities may in some cases be a nutrient-responsive disorder.