Use of botulinum toxin in complex regional pain syndrome in the hand

This is the first report of the use of botulinum toxin injected into the hand to treat complex regional pain syndrome (CRPS). Botulinum toxin has been shown to improve pain in Raynaud's syndrome, carpal tunnel syndrome, and CRPS of the lower limb. Botulinum toxin has also been shown to act on pain neurotransmitters directly. A 40-year-old man was referred to us with bilateral CRPS after falling onto his hands. Fifty units of Botox® were injected into the carpal tunnel and 50 units around the digital neurovascular bundles of the left non-dominant hand. Hand assessments were performed before injection, and weekly for 6 weeks post-injection. The dominant hand acted as a control. A steady improvement of power grip strength in the left hand was shown. Power in his left hand was greater than the right, despite him being right handed. Total active movement did not change significantly. He felt the injection was beneficial. Botulinum toxin may have improved the signs and symptoms of CRPS in the hand due to its combined effect on the vascular and nervous systems. Botulinum toxin may block the self-perpetuation cycle of pain and sympathetic stimulation by blocking neurotransmitters and warrants further studies on CRPS.     

Frequency‐specific disruptions of neuronal oscillations reveal aberrant auditory processing in schizophrenia

Individuals with schizophrenia exhibit abnormalities in evoked brain responses in oddball paradigms. These could result from (a) insufficient salience‐related cortical signaling (P300), (b) insufficient suppression of irrelevant aspects of the auditory environment, or (c) excessive neural noise. We tested whether disruption of ongoing auditory steady‐state responses at predetermined frequencies informed which of these issues contribute to auditory stimulus relevance processing abnormalities in schizophrenia. Magnetoencephalography data were collected for 15 schizophrenia and 15 healthy subjects during an auditory oddball paradigm (25% targets; 1‐s interstimulus interval). Auditory stimuli (pure tones: 1 kHz standards, 2 kHz targets) were administered during four continuous background (auditory steady‐state) stimulation conditions: (1) no stimulation, (2) 24 Hz, (3) 40 Hz, and (4) 88 Hz. The modulation of the auditory steady‐state response (aSSR) and the evoked responses to the transient stimuli were quantified and compared across groups. In comparison to healthy participants, the schizophrenia group showed greater disruption of the ongoing aSSR by targets regardless of steady‐state frequency, and reduced amplitude of both M100 and M300 event‐related field components. During the no‐stimulation condition, schizophrenia patients showed accentuation of left hemisphere 40 Hz response to both standard and target stimuli, indicating an effort to enhance local stimulus processing. Together, these findings suggest abnormalities in auditory stimulus relevance processing in schizophrenia patients stem from insufficient amplification of salient stimuli.     

Transmission of Brucellosis from Elk to Cattle and Bison,Greater Yellowstone Area,USA, 2002–2012

Bovine brucellosis has been nearly eliminated from livestock in the United States. Bison and elk in the Greater Yellowstone Area remain reservoirs for the disease. During 1990–2002, no known cases occurred in Greater Yellowstone Area livestock. Since then, 17 transmission events from wildlife to livestock have been investigated.     

Epithelioid sarcoma‐like (pseudomyogenic) hemangioendothelioma,clinically mimicking dermatofibroma,diagnosed by skin biopsy in a 30‐year‐old man

Epithelioid sarcoma‐like (pseudomyogenic) hemangioendothelioma (ESHE) represents a rare soft tissue and bone tumor that typically presents as nodule(s) in the distal extremities of young adults. The nodules traverse several tissue planes simultaneously and can involve the dermis, subcutis, skeletal muscle and bone. ESHE shares clinical and microscopic features with epithelioid sarcoma (ES), and, accordingly, is commonly misdiagnosed as ES. However, unlike ES, which has a poor prognosis, ESHE commonly follows an indolent course. Herein, we report a case of ESHE diagnosed by skin biopsy that clinically mimicked a dermatofibroma. We also provide clinical photographs of the lesions in various stages of development, representing information that has not been previously published, to our knowledge.     

Adults in All Body Mass Index Categories Underestimate Daily Energy Requirements

ObjectiveTo compare the difference between self-reported and calculated daily energy requirements of adults within different body mass index (BMI) categories.MethodsAdults (n = 978) self-reported daily energy requirements, demographic information, and height, weight, age, and physical activity level (PAL) to calculate total energy expenditure.ResultsThe main effects of BMI, gender, PAL, and dieting status on the difference between self-reported and calculated energy requirements for weight maintenance were significant (P < .05); age, race/ethnicity, level of education, and being in a health-related field had no effect. Individuals across all BMI categories underestimated their energy requirements, but obese individuals underestimated to the greatest degree. Males, current dieters, and those who reported a low-active or active PAL underestimated to the greatest extent in each category.Conclusions and ImplicationsThere is a lack of basic nutrition knowledge about personal energy needs in individuals across all BMI categories regardless of age, race/ethnicity, level of education, or work/training in a health-related field.     

Early Impacts of a Healthy Food Distribution Program on the Availability and Price of Fresh Fruits and Vegetables in Small Retail Venues in Los Angeles

Healthy food distribution programs that allow small retailers to purchase fresh fruits and vegetables at wholesale prices may increase the profitability of selling produce. While promising, little is known about how these programs affect the availability of fresh fruits and vegetables in underserved communities. This study examined the impacts of a healthy food distribution program in Los Angeles County over its first year of operation (August 2015–2016). Assessment methods included: (1) a brief survey examining the characteristics, purchasing habits, and attitudes of stores entering the program; (2) longitudinal tracking of sales data examining changes in the volume and variety of fruits and vegetables distributed through the program; and (3) the collection of comparison price data from wholesale market databases and local grocery stores. Seventeen stores participated in the program over the study period. One-fourth of survey respondents reported no recent experience selling produce. Analysis of sales data showed that, on average, the total volume of produce distributed through the program increased by six pounds per week over the study period (95% confidence limit: 4.50, 7.50); trends varied by store and produce type. Produce prices offered through the program approximated those at wholesale markets, and were lower than prices at full-service grocers. Results suggest that healthy food distribution programs may reduce certain supply-side barriers to offering fresh produce in small retail venues. While promising, more work is needed to understand the impacts of such programs on in-store environments and consumer behaviors.