Sensibility Evaluation Battery for the Peripheral Nerve Injured Hand

Traditional sensibility evaluation tools are rendered subjective by stimulus application variables and the gross nature of result interpretations. The literature reveals no single test which will adequately evaluate both sensory acuity and functional use of that acuity following nerve laceration injuries affecting the hand. A selection of sensibility evaluation tools presently available are reviewed. Based on the theories presented in the literature, a battery of assessment tools is proposed for sensibility evaluation of the nerve-injured hand. It is suggested that these systematically evaluate each of the nerve fibre and receptor systems in the hand, and provide an indication of functional sensibility of the hand — an individual's ability to use sensory information for grasp and manipulative functions of the hand without the use of vision.     

Sensory processing relates to attachment to childhood comfort objects of college students

The author tested the hypothesis that attachment to comfort objects is based on the sensory processing characteristics of the individual. Fifty-two undergraduate students with and without a childhood comfort object reported sensory responses and performed a tactile threshold task. Those with a comfort object described their object and rated their attachment to it. Participants with a strong attachment liked the texture of their comfort object and sleeping with it. Smell sensitivity in childhood, seeking out tactile stimulation as children, and tactile threshold predicted the intensity of object attachment. Participants with comfort objects showed a higher tactile threshold and reported seeking out more tactile stimulation as children than participants without a comfort object did. These findings suggest that children with an object attachment seek out more sensory stimulation through touch, which in turn is soothing. Results support growing research linking sensory processing to psychological functioning.     

神经生长因子在周围神经损伤再生的作用及临床应用

神经生长因子（nerve growth factor,NGF）对神经系统的正常分化、发育、成熟、维持功能和存活、损伤修复等均具有重要的生物学作用。近年来,随着科学家对NGF的进一步研究,其机制被逐步阐明,并应用于临床。在此,就NG对周围神经损伤的作用及及临床应用作一综述。     

20名手传振动作业工人的神经肌电图分析

目的探讨手传振动对作业工人周围神经的损害情况。方法对20名从事手传振动作业工人和30名无接触职业危害的健康成人进行神经肌电图检查分析。结果①MCV检测结果显示正中神经运动传导远端潜伏期延长（占85．0％）、MCV减慢（占35．0％）（P〈0．01）;②SCV捡测结果显示正中神经SCV减慢（占40．0％）、尺神经SCV减慢（占30．0％）（P〈0．01）;③肌电图检查结果表现为小力收缩时多相电位增多（占42．5％）及安静时出现纤颤电位（占15．0％）（P〈0．05或P〈0．01）。结论振动对作业工人周围神经损伤明显,神经肌电图检查最早表现为正中神经运动传导远端潜伏期延长,随着损伤加重,进一步出现神经传导速度减慢,运动和感觉同时受累。     

Hyperactivity with Tactile Defensiveness as a Phobia

Conceptualizing some cases of hyperkinesis (those with tactile defensiveness) as tactile phobias provides the rationale for two unconventional management approaches modeled on the two most popular behavioral treatments of phobia: systematic desensitization and implosion. Both methods are adapted to a nonverbal level, befitting the age of the afflicted children and the nature of the problem. The first method uses the sensory integration techniques developed by Ayres to desensitize the child to touch systematically and gradually. The other method, developed by Henderson and Dahlin, uses restraint and intense tactile stimulation implosively to break through the fear and hyperactive resistance.     

神经干细胞移植的方法选择及其在脊髓损伤中的应用

脊髓损伤是一种创伤性中枢神经系疾病,常伴有脊髓损伤平面以下感觉、运动、自主神经功能丧失,常导致患者终身残疾,且并发症较多,甚至死亡。至今尚无有效的治疗方法从根本上修复已损伤的脊髓功能。神经干细胞具有自我更新、增殖和多向分化等潜能,其移植后可向神经元分化并替代已坏死的神经元,形成新的突触,重建神经通路促进脊髓功能的修复,为脊髓损伤患者的康复带来曙光。近年来许多科学家对神经干细胞进行基因修饰,基因调控,或联合其他细胞、生物材料以及改变移植时间、途径等多方面进行深入研究,来提高移植效率,虽然取得了长足的进展,但仍存在一些不足之处尚待进一步完善,如神经干细胞移植的途径、时机、次数的相关标准,移植细胞的免疫排斥、长期存活、定向分化,神经干细胞的来源及伦理,移植的安全性等。本文拟对神经干细胞移植方法,移植时间,移植途径进行综述,并对神经干细胞移植所存在的问题及应用前景进行展望。     

慢性正己烷中毒后周围神经损害迁延不愈2例报道

目的 报道并讨论2例慢性正己烷中毒后周围神经损害迁延不愈的病例,提高对中毒后周围神经损害的认识水平。 方法 收集病例资料,分析其特点,查阅相关文献。 结果 2例病例周围神经损害迁延不愈,且以自主神经和感觉神经损害为主,要考虑发生或合并了少见的周围神经疾病,如自主神经和感觉神经节病变。 结论 对于正己烷中毒后周围神经损害迁延不愈的病例,应考虑合并其他周围神经疾病的可能;正己烷中毒是否会导致自主神经和感觉神经节病变,值得关注。     

Subclinical cervico-spino-bulbar effects of lead: a study of short-latency somatosensory evoked potentials in workers exposed to lead, zinc, and copper

Subclinical central and peripheral nervous system dysfunction among lead-exposed workers was studied by measuring short-latency somatosensory evoked potentials (SSEP) and maximal motor and sensory nerve conduction velocities (MCV and SCV) following stimulation of the median nerve at the wrist. The examinations were conducted in 20 gun-metal foundry workers exposed to lead, zinc, copper, and tin, with blood lead (BPb) concentrations of 16 to 64 micrograms/dl (mean, 42 micrograms/dl). The interpeak latency of SSEP in the cervico-spino-bulbar region [N9(Erb)-N13 latency] was significantly prolonged, and the MCV and SCV in the forearm were significantly slowed. Multiple regression analysis revealed that the yield of urinary lead following challenge with calcium disodium ethylenediamine tetraacetate (CaEDTA) and packed red blood cell volume were the major factors associated with the prolongation of SSEP latency in the cervico-spino-bulbar region. Similarly, the interpeak latency in the upper central nervous system (N13-N20 latency) was inversely related to the zinc concentration in erythrocytes; latency up to the Erb's point [N9(Erb) latency], which reflects conduction time in a long pathway of the sensory median nerve, was inversely related to urinary zinc level; the MCV and SCV in the palm were positively related to erythrocyte zinc concentration and plasma copper concentration, respectively. These findings suggest that the subclinical neurophysiological effects of lead occur not only in peripheral nerves but also in the central nervous system. It appears that zinc antagonizes the central and peripheral neurologic dysfunction caused by lead; similarly, copper antagonizes the peripheral sensory nerve dysfunction.     

Multicriteria decision analysis methods with 1000Minds for developing systemic sclerosis classification criteria

ObjectivesClassification criteria for systemic sclerosis (SSc) are being developed. The objectives were to develop an instrument for collating case data and evaluate its sensibility; use forced-choice methods to reduce and weight criteria; and explore agreement among experts on the probability that cases were classified as SSc.Study Design and SettingA standardized instrument was tested for sensibility. The instrument was applied to 20 cases covering a range of probabilities that each had SSc. Experts rank ordered cases from highest to lowest probability; reduced and weighted the criteria using forced-choice methods; and reranked the cases. Consistency in rankings was evaluated using intraclass correlation coefficients (ICCs).ResultsExperts endorsed clarity (83%), comprehensibility (100%), face and content validity (100%). Criteria were weighted (points): finger skin thickening (14–22), fingertip lesions (9–21), friction rubs (21), finger flexion contractures (16), pulmonary fibrosis (14), SSc-related antibodies (15), Raynaud phenomenon (13), calcinosis (12), pulmonary hypertension (11), renal crisis (11), telangiectasia (10), abnormal nailfold capillaries (10), esophageal dilation (7), and puffy fingers (5). The ICC across experts was 0.73 [95% confidence interval (CI): 0.58, 0.86] and improved to 0.80 (95% CI: 0.68, 0.90).ConclusionsUsing a sensible instrument and forced-choice methods, the number of criteria were reduced by 39% (range, 23–14) and weighted. Our methods reflect the rigors of measurement science and serve as a template for developing classification criteria.     

Philosophic reflections on the meaning of touch in nurse–patient interactions

In this paper I examine the meaning of physical touch as it occurs in the nurse–patient interaction. There are two aspects of the nurse–patient relationship that are found in most nurse–patient interactions which together have profound implications for nurses as practitioners and as individual human persons. The first is the clinical intimacy of the nurse–patient relationship where nurses touch, rub, smooth, clean, dress and otherwise physically interact with patients. The other is the existential crisis, the possibility of loss, suffering and death that lurks at the horizon of most, if not all, healthcare encounters. Edmund Husserl, Merleau‐Ponty and more recently Robert Sokolowski argue that tactile sensations and resultant perceptions are fundamental to all sensory perception. Further, they argue that tactile sensation is fundamental for the ongoing constitution of ‘my’ self as a person and for the development and exercise of human intersubjectivity. If tactile interaction is crucial to the development of our very selves as persons and a significant aspect of our interaction with patients includes direct or observed tactile sensations and if further these sensations occur around the context of existential crises for our patients, then nurse's very selves as persons are being challenged by these interactions. Here, then I examine the philosophical argument for the role of tactile sensations in our human development and briefly look at contemporary neurophysiologic research that supports this philosophical account. I then suggest ways such physical intimacy can lead to a strengthening or weakening of the person of the nurse and the nursing interaction and end with some thoughts about ways to support nurses in these activities.     

Central and peripheral nervous system effects of hand-arm vibrating tool operation. A study of brainstem auditory-evoked potential and peripheral nerve conduction

To examine the effects of hand-arm vibrating tool operation on the central and peripheral nervous system, the brainstem auditory-evoked potential (BAEP), median nerve conduction velocity and hearing level were measured in twelve chain saw operators (6 operators had a history of white finger attack) and in eight brush saw operators (none had a history of the attack). Control subjects, matched to each chain saw and brush saw operator by sex and age, were selected randomly from healthy adults without otitis, deafness and tinnitus. The I-V interpeak latency (conduction from cochlear nerve to brainstem) and V peak latency of BAEP were significantly prolonged in chain saw operators; the I-V interpeak latency was significantly correlated with working years in brush saw operators. The median nerve conduction velocity was significantly slowed in both chain saw and brush saw operators. Moderate hearing loss was observed in the two groups. It is suggested that vibrating tool operation, i.e. the combined stressors of local vibration, noise, climate and heavy work, affected not only the peripheral nervous system but also the brainstem portion of the auditory pathway; the brainstem effect, if any, is less advanced than the peripheral nervous system effect of local vibration.     

Central and peripheral nervous system effects of hand-arm vibrating tool operation

Summary To examine the effects of hand-arm vibrating tool operation on the central and peripheral nervous system, the brainstem auditory-evoked potential (BAEP), median nerve conduction velocity and hearing level were measured in twelve chain saw operators (6 operators had a history of white finger attack) and in eight brush saw operators (none had a history of the attack). Control subjects, matched to each chain saw and brush saw operator by sex and age, were selected randomly from healthy adults without otitis, deafness and tinnitus. The I–V interpeak latency (conduction from cochlear nerve to brainstem) and V peak latency of BAEP were significantly prolonged in chain saw operators; the I–V interpeak latency was significantly correlated with working years in brush saw operators. The median nerve conduction velocity was significantly slowed in both chain saw and brush saw operators. Moderate hearing loss was observed in the two groups. It is suggested that vibrating tool operation, i. e. the combined stressors of local vibration, noise, climate and heavy work, affected not only the peripheral nervous system but also the brainstem portion of the auditory pathway; the brainstem effect, if any, is less advanced than the peripheral nervous system effect of local vibration.     

Leprosy diagnosis: a device for testing the thermal sensibility of skin lesions in the field

A handy device for testing the thermal sensibility of skin lesions has been developed and field tested in various centres in Africa and India. The instrument performed satisfactorily and its use made testing for thermal sensibility in the field practicable and straightforward. Analysis of the results of testing 260 persons, most of whom exhibited a few lesions that were characteristic of early leprosy, showed that the rate of diagnosis of sensory impairment of such skin lesions, and hence the diagnosis of leprosy, would be about 15-25% more if thermal sensibility testing using this device were added to the other tests of sensibility routinely carried out in the field. Regular use of the device in the field would help to bring more leprosy patients under treatment than at present.     

微小RNA在新生儿缺血缺氧性脑病中的表达

微小RNA(miRNA)是一类高度保守的内源性小分子RNA。miRNA主要通过选择性结合mRNA调控基因表达。目前研究结果表明，中枢神经系统存在大量miRNA，并参与神经细胞的正常生长、发育，以及组织损伤修复、肿瘤发生、神经退行性变等多种病理、生理过程。笔者拟就新生儿缺血缺氧性脑病(HIE) miRNA谱系的最新研究进展进行阐述，探讨其miRNA特异性表达，对新生儿HIE诊断和预后判断的意义，旨在为该病的相关诊治研究提供参考。     

A stem cell ... is stem cell?

We are used to associate stem cells with renewable tissues such as blood, gut and skin. But some cells in the adult central nervous system have the capacity to generate new neurons and glial cells as well and as such, they are considered to be neural stem cell. Yet their ability to generate neurons and glia, and their presence in the central nervous system throughout life, suggests new, intriguing possibilities for recovery and repair after damage to the central nervous system--and unexpectedly, the regeneration of blood tissues. After transplantation into irradiated hosts, neural stem cells were found to produce a variety of blood cell types including myeloid and lymphoid cells as well as early hematopoietic cells. Therefore, the developmental potential of stem cells is not restricted to the differentiated elements of the tissue in which they reside. Multipotential stem cells can persist in an undifferentiated state, and depending on specific environmental conditions function as a stem cell for many different tissues.     

Effects of methylmercury on the motor and sensory innervation of the rat extensor digitorum longus muscle

This histochemical study examined the effects of chronic methylmercury (MeHg) intoxication on the motor and sensory innervation of extensor digitorum longus muscles. Light microscopic examination of silver-stained axons in the intramuscular nerve bundles of MeHg-treated rats showed Wallerian-like degeneration and a reduction in the number of nerve fibers. Disrupted axons were predominantly sensory because 22.2% of spindle afferents (Ia) and 90.0% of Golgi tendon organ (Ib) sensory fibers were completely degenerated whereas less than 1% of motor endings were totally destroyed. Partial disruption occurred in the cholinesterase and motor terminals of 13.7% of endplates. Our results demonstrated greater vulnerability of sensory nerves than of motor nerves to MeHg-induced degeneration. Thus, the abnormal reflexes, ataxia, and muscle weakness following MeHg poisoning appear related to reduction of proprioceptive feedback from muscles and tendons in addition to the documented lesions in the central nervous system.     

Sensorineural stages of the hand-arm vibration syndrome

Recent work has shown that the vascular signs and neurological symptoms commonly associated with exposure of the hand to vibration may develop independently. A classification for the neurological component of the hand-arm vibration syndrome has been developed for those symptoms dominated by sensory afferent involvement, based on the results of objective tests on 634 hands. The first symptomatic stage (1SN) consists essentially of episodic finger numbness with or without tingling, the second involves, in addition, reduced sensory perception (2SN), while the most severe stage (3SN) focuses on reduced tactile discrimination and/or manipulative dexterity. Consistent implementation of this classification by means of objective tests requires one, or more, precise, quantitative measure of peripheral somatosensory dysfunction, in addition to the traditional neurological tests (fine touch, pain, and temperature). Measurements of tactile function by means of esthesiometry or vibrotactile perception appear suited to this purpose. A procedure for staging individual hands may then be based on combining numerical scores assigned to the results of the traditional neurological tests and, additionally, esthesiometer and/or vibrotactile perception thresholds.     

Effects of lead,zinc and copper absorption on peripheral nerve conduction in metal workers

Summary To examine the antagonistic effects of lead, zinc and copper on the nervous system in man, we measured maximal motor and sensory conduction velocities (MCV and SCV, respectively) in the distal radial and median nerves in 20 gun metal founders with asymptomatically increased absorption of these metals [blood lead concentrations ranged from 16 to 64 g/dl (mean 42)]; and analyzed metal effects on nerve conduction by multiple regression analysis. The MCVs in the radial and median nerves and the SCV in the forearm segment of the median nerve were significantly slowed; indicators of lead absorption (urinary delta-aminolevulinic acid and coproporphyrin) were inversely correlated with the SCV in the radial nerve. The SCVs in the radial nerve and in the hand segment of the median nerve, which were not significantly slowed, were positively related to indicators of copper absorption (plasma or erythrocyte copper). The SCV in the radial nerve was also positively related to the indicator of zinc absorption (plasma zinc); similarly, the MCVs in the radial and median nerves were positively related to the indicators of zinc absorption (erythrocyte or urinary zinc). These findings suggest that copper and zinc antagonize the subclinical effects of lead on peripheral nerve conduction velocities; the conduction velocity in the distal radial nerve is sensitive not only to asymptomatic lead absorption but also to zinc and copper absorption.     

A framework for selecting outcome measures for ambulatory care research

Selecting outcome measures must be considered in the context of the application the researcher has in mind, that is, describing the health of a population, predicting health status, or evaluating health outcomes. Most important, the outcome measure selected must be conceptually defensible--it needs to make sense. A general framework for selecting measures is discussed in the context of five critical characteristics: (1) sensibility, (2) reliability, (3) validity, (4) responsiveness, and (5) burden. A commonsense approach to outcome measurement selection weighs the relative importance of each of these characteristics with the framework and application clearly in mind.     

Promoting neurological recovery following a traumatic peripheral nerve injury

If a peripheral nerve is crushed, or if the nerve is cut and the ends sutured together soon after the lesion (anastomosed), neurological recovery is good. When a length of a peripheral nerve is destroyed, and anastomosis is not possible, the standard surgical repair technique is to graft a length/s of sensory nerve from the patient, into the gap. For gaps <2 cm neurological recovery is moderate, for gaps 2-4 cm recovery is generally poor, and for gaps >4 cm recovery is limited to non-existent. The limited recovery is because sensory nerves act as passive scaffolds for axon regeneration and do not actively promote axon regeneration. However, such grafts remain the "gold standard" for nerve repairs. New techniques are required that induce improved neurological recovery. This paper reviews current clinical and basic research techniques for inducing neurological recovery following traumatic peripheral nerve injuries.