Results of Abductor Pollicis Longus Suspension Ligamentoplasty for Treatment of Advanced First Carpometacarpal Arthritis

Background

Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty.

Methods

The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs.

Results

The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71° preoperatively to 82° postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously.

Conclusions

The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.     

Temporal dissociation of salience and prediction error responses to appetitive and aversive taste

The feedback‐related negativity (FRN), a frontocentral ERP occurring 200–350 ms after emotionally valued outcomes, has been posited as the neural correlate of reward prediction error, a key component of associative learning. Recent evidence challenged this interpretation and has led to the suggestion that this ERP expresses salience instead. Here, we distinguish between utility prediction error and salience by delivering or withholding hedonistically matched appetitive and aversive tastes, and measure ERPs to cues signaling each taste. We observed a typical FRN (computed as the loss‐minus‐gain difference wave) to appetitive taste, but a reverse FRN to aversive taste. When tested axiomatically, frontocentral ERPs showed a salience response across tastes, with a particularly early response to outcome delivery, supporting recent propositions of a fast, unsigned, and unspecific response to salient stimuli. ERPs also expressed aversive prediction error peaking at 285 ms, which conformed to the logic of an axiomatic model of prediction error. With stimuli that most resemble those used in animal models, we did not detect any frontocentral ERP signal for utility prediction error, in contrast with dominant views of the functional role of the FRN ERP. We link the animal and human literature and present a challenge for current perspectives on associative learning research using ERPs.     

Psychopathic traits are differentially associated with efficiency of neural communication

Recent advances in the application of graph theory made it possible to quantify the efficiency of communication within a neural network, going beyond traditional connectivity methods that only identify the degree to which neural regions are connected. Psychopathic traits, namely, interpersonal‐affective and impulsive‐antisocial traits, have been linked to widespread and distinct disruptions in neural connectivity. The efficiency of neural communication for individuals high on these psychopathic traits, though, is unknown. In the present study, resting‐state EEG was used to generate a connectivity matrix (i.e., weighted phase lag index) for multiple frequency bands. These connectivity matrices were examined using minimum spanning tree analysis, a graph theory approach that allows for the examination of neural efficiency, and regressed on Self‐Report Psychopathy‐Short Form scores (n = 158, unselected community sample). Results indicated that individuals with higher interpersonal‐affective traits had significantly less efficient communication within alpha1 (i.e., long‐range neural communication) and gamma (i.e., short‐range neural communication) frequency bands. Conversely, individuals with higher impulsive‐antisocial traits had more efficient communication within these same frequency bands. Overall, elevated psychopathic traits were related to alterations in the basic efficiency of neural communication. Moreover, this unique application of graph analysis provides a new avenue for inquiry into the mechanisms underlying the chronic and severe behavior of individuals with psychopathic traits.     

Protein tyrosine phosphatase conjugated with a novel transdermal delivery peptide,astrotactin 1–derived peptide recombinant protein tyrosine phosphatase (AP-rPTP), alleviates both atopic dermatitis–like and psoriasis-like dermatitis

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EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H₁‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.