Metacarpal Joint Research Articles

Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (≥2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p = 0.008) and grip strength (15 vs. 21 kg p = 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

Digital Salvage by Transposing Adjacent Ray Components

Background: Ballistic hand injuries often devastate bone and soft tissue and may ultimately require debridement of critical structures. Long-term hand function is frequently compromised as a result of distorted anatomy. Careful assessment at the time of injury affords the opportunity to critically appraise the anatomy and creatively design a reconstructive strategy. Methods: Herein we describe 2 cases of gunshot injuries to the hand that resulted in devastation to adjacent yet opposing metacarpal and phalangeal joint surfaces. Our reconstructive strategy aimed to maximize hand function by preserving undamaged tissue and transposing adjacent ray components. Results: In both instances, our patients’ reconstructive surgeries resulted in acceptable cosmesis and improved functional outcome relative to more traditional approaches to these ballistic injuries. Conclusions: Our experience shows that a creative appraisal of devastating hand injuries allows for unique reconstructive strategies. Our cases further demonstrate the utility of transposing adjacent ray components to reconstruct digital mobility and hand function.

Focal Vibration Alters Human Digital Sensory Nerve Action Potentials: A Pilot Study

Introduction We studied the impact of vibratory stimulation on the electrophysiological features of digital sensory nerve action potential (SNAP). Methods The antidromic digit 3 SNAP was recorded in 19 healthy adults before, during, and after applying a vibration to either 3rd or 5th metacarpal phalangeal joint (MCPJ) at 60 Hz and amplitude of 2 mm. 100% supramaximal stimulus intensity was performed in 5 subjects (randomly selected from the 19 subjects) where the SNAP sizes were recorded. Results The amplitude of digit 3 SNAP declined to 58.9 ± 8.6% when a vibration was applied to MCPJ digit 3. These impacts did not change by increasing the electrical stimulus intensity. The SNAP regained its baseline value immediately after the cessation of vibration stimulation. The magnitude of size reduction of digit 3 SNAP was less when vibration was moved to from MCPJ of digit 3 to MCPJ of digit 5. Discussion. The marked drop of the SNAP size during vibratory stimulation reflects the decreased responsiveness of Aβ afferents to electrical stimulation, which deserve further investigation in the study of focal vibration in neurorehabilitation.

Characterization of the reproductive behaviour of the roan antelope (Hippotragus equinus)

Little information exists on the sexual behaviours of the roan antelope (Hippotragus equinus; E. Geoffroy Saint-Hilaire, 1803), a species listed vulnerable in southern Africa. To fill this gap, two adult males and 13 adult females from two captive breeding herds, at Lapalala Wilderness, South Africa, were observed three times per day from September 2017 to July 2018. Pre-categorised behaviours exhibited by males and females were recorded and their frequencies quantified. Fifteen pre-defined behaviours were recorded in males with precopulatory behaviours being the most recurrent. Overall, 181 courtships and 73 complete mounts (copulations) were recorded for the two mating periods observed; each mount lasted between 3 and 4 s. In females, eight pre-defined behaviours were observed and homosexual mounts were observed for the first time in females of this species and indeed within the Hippotragini tribe. Receptivity lasted for between 24 and 72 h, with prominent behaviours being copulation, flehmen and urination. Besides hiding, moving away or lying-out, non-receptive females fell on their metacarpal joints when approached by a male, a behaviour not yet reported in hippotragine species. This study showed that courtship is the most prominent component of male mating behaviour and that receptivity in females may vary between 1 and 3 days.

Revisiting Gillies' "Cocked Hat" Reconstruction for Thumb Reconstruction.

A technique for reconstructing a thumb following amputation through the metacarpal phalangeal joint is described. This technique was first described by Gillies and involves bony augmentation with iliac crest bone graft to lengthen the first ray and a random pattern flap to cover and provide durable sensate soft tissue coverage. As opposed to more commonly performed procedures, this technique does not involve microsurgery or any specialized equipment. There are several limitations to this technique, but it remains a good option where resources do not allow more modern reconstructive procedures. We present our use of the technique, which was performed at a forward operating base for a coalition service member.

Closed Sagittal Band Injury from a Low-Energy Impact: A Case Report.

Author(s): Lin, Jonathan; Chen, Johnathan | Abstract: The sagittal band is a sheet of connective tissue that provides lateral stability to the extensor digitorum tendon at the metacarpal joint. It is one of the three components of the dorsal extensor hood. Rupture of the one of the sagittal bands can lead to contralateral subluxation or dislocation of the extensor tendon. Closed sagittal band injury is commonly termed ‘boxer knuckle’ as it has been historically described in professional boxers who have sustained trauma to their closed fists. This injury is also associated with inflammatory conditions, such as rheumatoid arthritis. In this case report, we present a 64-year-old female with no known history of rheumatoid arthritis who sustained a closed sagittal band injury from shifting position in her bed. Ultrasonography and MRI are useful in the evaluation of a sagittal band injury. Using dynamic ultrasound imaging, the extensor tendon subluxation can be visualized with metacarpophalangeal (MCP) flexion, confirming the diagnosis of sagittal band injury.

Anatomical Variations of the Extrinsic Musculature of Thumb

Anatomical variations are commonly encountered during human cadaver dissections. Some of these variations are never discovered unless there is an underlying injury that requires attention. For conceivable clinical and rehabilitation treatments, anatomical modifications may have implications on function therefore it is imperative to report them. This case series depicts the anatomical inconsistency in the muscles and tendons of the extrinsic musculature of the thumb in three human specimens. During a cadaver dissection in physical therapy anatomy course, various anatomical variations were found in three human cadaveric specimens. Cadaver 1 exhibited a new muscle with a split tendon near the distal posterolateral radius. The author uncovered the supplementary muscle between the Extensor Pollicis Longus (EPL) and Extensor Pollicis Brevis muscles. Cadaver 2 had two other extrinsic tendons inserted at the thumb. The Extensor Digitorum provided an extra tendon to the pollicis; a similar insertion as the EPL was recognised. In cadaver 3 an extra muscle belly was observed within the tendon of the abductor pollicis longus. The other muscle variation was near the distolateral attachment at the base of the first metacarpal joint, between the abductor pollicis brevis and extensor carpi radialis muscles. Understanding the diverse anatomical arrangements could prove beneficial for surgeons and those involved in rehabilitating upper extremities. A detailed understanding of the forearm structural anatomy and anomalies is essential to comprehend the function and movements when lesions affect the normal biomechanics within teaching and clinical environments.

Predicting metacarpal length using paired ratios with bilateral X-ray films.

Introduction:When the metacarpal bones sustain severe osseous injury requiring reconstruction, functional recovery relies on the precise distribution of tension throughout full range of motion. While the small scale of hand structures compounds the effects of altering normal anatomy, literature lacks consensus recommendations for the acceptable degree of length alteration and/or appropriate methods of length estimation in reconstructive procedures. Length asymmetry has been reported in human metacarpal bones; however, studies assessing this phenomenon in living subjects with attention to functional implications or length prediction are lacking.Methods:Hand X-rays were obtained for 34 patients aged 25–80 without history of metacarpal trauma, joint degeneration, or pathologic bone metabolism. A scaled bivariate model predicted metacarpal length using an ipsilateral paired metacarpal and matching contralateral ratio: Estimate_Dx_R = Median_Dy_R * (Median_Dx_L/Median_Dy_L). A second set of predictions used the contralateral metacarpal as a control. Pearson correlation coefficients, paired t-tests, and chi-square tests evaluated the symmetry between bilateral metacarpal lengths and paired metacarpal ratios as well as the accuracy of each predictive method.Results:The contralateral control and target metacarpal differed significantly in digits 1, 2, 3, and 5. No significant difference in matched metacarpal ratios of the right and left hands was found. For all digits except 5D, bivariate model predictions generated were more strongly correlated with actual target length. Chi-square tests did not detect a significant difference in predictive value of the two models.Conclusion:The scaled bivariate model we describe may be useful and economic in generating accurate length estimates of metacarpals for reconstructive procedures.

Restoration of Five Digit Hand in Type III B & C Thumb Hypoplasia-A Game Changer in Surgical Management.

Background Hypoplasia of thumb is the second common congenital difference of the thumb, next only to duplication. It may occur as an isolated hand difference or as a part of radial longitudinal deficiency. In approximately 60% of these children, the radius shows hypoplasia. The incidence of thumb hypoplasia is one in 100,000 live births. In 50% of these children, the other hand will also have similar deficiency, although variable in severity. Hypoplasia of thumb has been classified into five major categories, according to the increasing severity of hypoplasia. Type III hypoplasia of thumb is characterized by skeletal hypoplasia involving the first metacarpal and carpometacarpal joint, absent intrinsic muscles and rudimentary extrinsic muscles. It was further subclassified into types A, B & C. Type III B, described by Manske and McCarroll, involves extensive deficiency of extrinsic and intrinsic musculature with aplasia of the metacarpal base. Type III C, described by Buck-Gramcko, has hypoplastic metacarpal head. Methods It is widely believed that reconstruction of Type III B & C hypoplastic thumb will not be functionally useful, and they are often included in the indications for pollicization in thumb hypoplasia. In India, we frequently come across parents, who are not willing to remove the hypoplastic digit. This forced us to find out a way to reconstruct the hypoplastic thumb into a functionally useful digit. We describe our surgical technique of reconstruction of hypoplastic thumbs and our experience in utilization of the technique in five children with Type III B & C hypoplasia of thumb. Carpometacarpal joint of thumb was reconstructed and stabilized with a toe phalangeal transfer in the first stage and an opponensplasty was done in the second stage to improve movement. Results In all the five operated children, our surgical technique yielded a stable thumb which was functional. The donor site morbidity was acceptable. The parents were satisfied with the appearance and functional improvement. Conclusion Surgical reconstruction of hypoplastic thumbs of Type III B & C is possible, and conversion of these poorly developed remnants into a useful digit by our surgical technique is a gamechanger in the management of thumb hypoplasia.

The Use of Cadaveric Meniscus for Joint Resurfacing of the Wrist and Hand

HYPOTHESIS: Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate joint arthrodesis or mechanical arthroplasty. Cadaveric meniscus has long been used for large joint resurfacing,1,2 but its application to smaller joints of the hand is less well understood. In severely arthritic thumb and finger joints, we propose the use of cadaveric meniscus for joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function. METHODS: Thirty-six patients with osteoarthritis of the CMC, MCP, or PIP joints underwent joint resurfacing with cadaveric meniscus. Patient demographics and operative information were recorded. Postoperative Disability of the Shoulder, Arm and Hand scores, Wong-Baker pain scale score, grip strength, and pinch strength were compared to preoperative scores at 6 weeks and 6 months. RESULTS: Twenty-one females and 15 males, with mean age of 56.7 years (42–73), underwent a total 43 joint reconstructions. Reconstructive sites included thumb carpometacarpal joint (n = 21), thumb metacarpal joint (n = 2), thumb interphalangeal joint (n = 2), digit metacarpal joint (n = 3), and digit proximal interphalangeal joint (n = 2). Mean Disability of the Shoulder, Arm and Hand score decreased from an average of 39.2 (16–91) to 22.7 (3–55) at 6 months and pain scale scores decreased from an average of 6.5 (4–10) to 1.6 (0–4). Grip strength increased from 38.7 (3–84) to 44.5 (8–94) and pinch increased from 10.3 (1–19) to 10.7 (2–20). There were no complications related to the meniscus, and no patients required revision surgery. CONCLUSION: In this series of 42 joint reconstructions, we demonstrate the successful use of cadaver meniscus in hand joint arthroplasty to reduce subjective pain and disability scores, as well as to improve objective strength measures, including grip and pinch strength. Our early results suggest that cadaveric meniscus for small joint arthroplasty represents a viable joint salvage option or adjunct to preserve pain-free motion and avoid total joint arthrodesis. REFERENCES: 1. Rosso F, Bisicchia S, Bonasia DE, et al. Meniscal allograft transplantation: a systematic review. Am J Sports Med. 2015;43:998–1007. 2. Kang RW, Lattermann C, Cole BJ. Allograft meniscus transplantation: background, indications, techniques, and outcomes. J Knee Surg. 2006;19:220–230.

HAND INJURY

HISTORY: A 15 year old H.S. football quarterback sustained a right thumb injury while throwing a pass. His hand hit a defender’s chest during follow through, jamming his thumb. He noted swelling and bruising over thenar eminence and his 2nd MCP joint. This resulted in limited ROM of the right thumb especially of abduction and opposition. PHYSICAL EXAMINATION: Examination of the right hand showed edema along the 1st MCP joint, thenar eminence with ecchymosis in 1st webspace extending into 2nd MCP joint. Skin was intact. Thumb was well vascularized. No tenderness over 2nd metacarpal or 2nd MCP joint. Thumb opposition and 1st MCP flexion and extension less than 20° were limited by edema and pain, IP ROM was within functional limits. Tenderness over ulnar aspect of 1st MCP joint . Pain and tenderness present during MCP extension with mild laxity with UCL stressing. Laxity at the CMC joint with some dorsal subluxation, reducible. Tenderness proximal to trapezium. Contralateral side thumb revealed also some laxity at the CMC. DIFFERENTIAL DIAGNOSIS: 1. Fracture of the right 1st Metacarpal bone 2. Fracture of the right thumb proximal phalanx 3. Fracture of the wrist bones 4. Right 1st MCP joint UCL sprain TEST AND RESULTS: X-rays of the right hand 3V: No bony or soft tissue abnormalities. MRI right hand ordered to rule out occult fracture(s), ligament tears : 1. Nondisplaced fracture of the trapezium. Diffuse bone marrow contusion in the 1st metacarpal with small avulsion fragment of the radial metacarpal at RCL attachment 2. Bone contusion of the distal dorsal capitate 3. Moderate grade sprain of UCL and RCL at the thumb MCP joint with partial tearing of proximal RCL at the avulsion fragment. 4. Diffuse low grade muscle strain with superimposed partial musculotendinous tear of flexor pollicis brevis muscle. TREATMENT AND OUTCOMES: 1. Wrist and thumb immobilization in Custom thumb spica splint to enable graduated ROM as tolerated and Occupational Therapy 2. Restriction from all contact sports for 6 weeks 3. Consultation with Hand Orthopedist to evaluate for surgical necessity determined patient to be appropriate for conservative treatment. Patient seen in Sports Medicine Clinic 39 days after initial injury. Returned to sports after 6 weeks of immobilization with thumb/wrist taped . Patient denied pain with activity.

Trapeziectomy and Abductor Pollicis Longus Suspensionplasty Combined with Extensor Pollicis Brevis Tenodesis for Management of Thumb Basal Joint Osteoarthritis and Metacarpophalangeal Hyperextension

Metacarpal joint hyperextension is common cause of postoperative dissatisfaction after trapeziectomy in the management of basal thumb osteoarthritis. The senior author uses this technique to address this biomechanical problem at the time of trapeziectomy.

Static and Dynamic Human Arm/Hand Gesture Capturing and Recognition via Multiinformation Fusion of Flexible Strain Sensors

Human arm/hand gestures capturing and recognition provide an intelligent and convenient way for use in application from human-machine interface (HMI) and human-computer interaction (HCI) to human-robot interaction (HRI). As human gestures constitute a powerful inter-human communication modality, they can be considered as well an intuitive and convenient mean for the communication between human and machines. This paper presents a novel real-time static and dynamic human gesture capturing and recognition method designed using flexible wearable data band/data glove, which are designed based on three/ten stretchable strain sensors respectively. The wearable data bands and data gloves are worn by human arm/hand to ensure that the sensors are accurately attached to the human joints for accurate measurement of joints movements of shoulders joints, elbows joints, wrists joints, metacarpal and proximal joints of fingers. In this work, a new idea of real-time static and dynamic human gesture capturing and recognition is introduced and developed based on the radial basis function neural network (RBFNN). Dynamic time warping (DTW) is used to select dynamic behavior candidates and also to recognize gestures by comparing the observed records with a series of pre-recorded reference data patterns. The solution deals simultaneously with static and dynamic gestures as well as with multiple joints within the interest space. The experimental results of human arm/hand static gestures and dynamic gestures capturing and recognition verify the effectiveness of the proposed methods.

Effectiveness of Physical Therapy Plus TIOBEC® (α-Lipoic Acid + Vitamin B, C, and E) on Complex Regional Pain Syndrome (CRPS): A Small Case Series/Pilot Study

Background: Complex regional pain syndrome (CRPS) is a frequent and devastating complication that occurs after trauma and immobilization and is very frequent after wrist fractures (1% - 37%) and after volar locking plate fixation (3% - 10%). The development of CRPS considerably lengthens the time of recovery after a traumatic injury, causing a great impact on work, social activities and psychological well-being. Objectives: To demonstrate the efficacy of physical therapy and TIOBEC® (a combination of α-lipoic acid and vitamin B, C, and E) in terms of pain amelioration and edema reduction in the management of CRPS in a small series of patients. Methods: Prospective before-and-after study. The protocol of treatment included physical therapy (electromagnetic fields applied to the symptomatic limb [20 Hz-50 Gauss-20 min] followed by manual therapy [assisted, active and resisted mobilization plus manual drainage]) plus oral medication (TIOBEC® 400 mg) prescribed twice a day. Components of TIOBEC® included α-lipoic acid (800 mg), vitamin C (60 mg), niacin (36 mg), vitamin E (10 mg), vitamin B1 (25 mg), vitamin B2 (25 mg), vitamin B6 (9.5 mg), vitamin B12 (25 µg) and folic acid (400 µg). Outcome measures included VAS (visual analog scale) pain scale, reduction of edema at the metacarpal phalangeal joint (hand/foot) and functional evaluation (by Kapandji score) before-and-after treatment. Outcome measures were evaluated at baseline and at mid-term (4 months follow-up period). Results: Five patients (mean [SD] age: 61 [7.9]) who had been diagnosed clinically by neurophysiological sympathetic skin-response, gammagraphy, and radiography were recruited in the study. Mean electrotherapy and manual therapy sessions were 40 ± 27.83. Mean oral medication (TIOBEC®) was 84 ± 13.41 days. Physical therapy and TIOBEC® decreased pain from 6.6 ± 0.54 to 2.8 ± 1.3 (P = 0.001), decreased edema from 12 ± 5.7 mm to 4 ± 4.18 mm (P = 0.035) and improved functional Kapandji score from 6.2 ± 2.77 to 9.4 ± 1.34 (P = 0.029). Neither of the patients stopped oral medication nor reported adverse events. Conclusions: The protocol that includes the electromagnetic field, manual therapy, and TIOBEC® may be safely used in patients with CRPS in an attempt to ameliorate pain, to reduce edema and to improve function. In light of the results of this study, the protocol used might accelerate recovery time. More studies are needed to corroborate the present results observed in this pilot study.

A PRACTICAL TECHNIQUE FOR INTRAOPERATIVE RADIOGRAPHIC ESTIMATION OF ANGLE VALUE IN METACARPOPHALANGEAL JOINT ARTHRODESIS

A functional hand with mobile joints is important for a human being's daily life. Unless stability, strength, and power are needed, arthrodesis of finger metacarpophalangeal(MCP) joint is not chosen. Fusion angle of the MCP joints follows the natural cascade of the hand. To measure the accurate angle, goniometry is counted as the gold standard method; however, many surgeons depend on visual estimation. Overlapping of metacarpal bones and MCP joints make it difficult to estimate the angle visually. A smartphone protractor application and two 21 G green needles may be useful to overcome this difficulty.

Dislocation of the metacarpophalangeal joint in a female red deer: Case report

The paper presents a post-traumatic anomaly of the metacarpal joint of a front limb of a female red deer, which was the cause of joint dislocation. This anomaly arose due to an incorrect positioning of the limb during movement, especially during fast running, most probably when the frightened animal was escaping from danger. Other mechanical causes cannot be excluded, such as entrapment of the limb in a net fence for crops and forest youngsters, which is commonly used to protect the forest from wild animals. The study showed that the resulting injury had led to secondary degenerative changes and deformities of the lopsided axis of the limb. The result was an incorrect directional orientation of the metacarpal bone and toes, and consequently of the hooves of the third and fourth fingertips. At the same time, the second and fifth toes, residual in this species, became retarded. The joint dislocation led to an incorrect positioning of the hooves during the animal’s movement and, consequently, to their excessive growth. These changes, however, despite their long-standing character, did not affect the animal’s condition, as evidenced by its carcass weight, which was above average for a female deer of this age and in this region of Poland.

The clenched fist syndrome: case report of a clinical rarity of special interest for psychiatrists and hand surgeons

BackgroundThe Clenched Fist Syndrome (CFS) is a type of a psychiatric disorder, in which the patients show flexion finger contractures. Although no organic etiology can be identified, the syndrome in most cases presents with pain and paradoxical stiffness.Case presentationWe, herein, report the case of a 52-year old woman with a 6-month history of progressive hand flexion contracture and intermittent numbness in the first 3 fingers, mimicking carpal tunnel syndrome. On examination, all digits, including the thumb, were held in a tight flexion at the metacarpal and interphalangeal joints. Passive digital extension was painless in all fingers. Physical examination did not reveal any joint tenderness, joint or tendon sheath swelling. X ray was performed and did not show any abnormalities. Neurological examination did not reveal any organic etiology.ConclusionsCFS is believed to be a conversion disorder, i.e. unconsciously motivated and produced, whereas others consider it a factitious disorder, i.e. unconsciously motivated but consciously produced. Surgical treatment is not indicated, as it can worsen the symptoms. The related literature is discussed. We conclude that CFS should always be considered in patients with unexplainable flexion hand contractures, especially in the presence of a positive psychiatric history.

2802. Occupational Exposure to the Ugandan Strain of Zika Virus in a Laboratory Worker in the United States: Clinical Presentation, Viral Persistence, and Antibody Response

BackgroundA laboratory worker suffered an accidental needle stick resulting in infection with the Ugandan strain (MR766) of Zika virus (ZIKV), a strain that has rarely been studied in humans. We report the clinical presentation and outcomes, molecular and serological diagnostic results, and immunological response. A 34-year-old Brazilian-born female laboratory researcher, presented with malaise, skin rash, myalgia and joint pain 10 days after an accidental needle stick while inoculating a mouse with ZIKV-MR766. On physical examination she had bilateral maculopapular rash on the cheeks, and tender effusions at the metacarpal and proximal interphalangeal joints and ankles. Symptoms and signs resolved within 3 weeks. ZIKV infection was confirmed by Nucleic Acid Amplification Test (Lab Corp®) in urine. Serological testing using the ZIKV IgM ELISA test from Lab Corp®, and a confirmatory plaque reduction neutralization test (PRNT) in accordance with the Centers for Disease Control and Prevention (CDC), results were negative.MethodsWhole blood, plasma, urine, saliva, and a vaginal swab were collected from day (D) 14 post exposure (PE) to D104 PE. A novel, antibody competition-based ZIKV diagnostic test (highly specific for ZIKV antibodies) was performed in serum, and detection of ZIKV-MR766 genomic RNA was performed in all body fluids longitudinally.ResultsAntibody response revealed broad IgM response to both ZIKV-Paraiba (strain from the 2015 outbreak) and ZIKV-MR766 during the acute phase of the infection, suggesting cross-reactivity. There was no cross-reactivity against dengue or yellow fever viruses. An IgG response was detected against both ZIKV strains and increased until D104 PE. ZIKV RNA was detected in whole blood, saliva, urine, and the vaginal swab at D14 PE. At D20 PE, virus was only detectable in whole blood at a value of less than 37 copies per mL. At D23 PE, there was no detectable virus. (figure).ConclusionThis case highlights the potential for ZIKV occupational exposure. Findings may be useful for the development of diagnostic tests against ZIKV as we were able to accurately determine time of exposure, presence of virus in body fluids, development of symptoms, and antibody responses after a well-documented infection. Disclosures All authors: No reported disclosures.

Design of Anthropomorphic Fingers With Biomimetic Actuation Mechanism

A deep understanding of the movement mechanism of the human fingers is essential for achieving a human-like actuation mechanism for anthropomorphic robotic hands. After carefully analyzing a set of anatomical theories of human fingers, we propose a novel and more reasonable actuation mechanism of the human index finger within the sagittal plane. This actuation mechanism can accomplish independent movement of interphalangeal joints and metacarpal joint. We also consider hyperextension in this new actuation mechanism, which improves the completeness when interpreting the human actuation. We further exploit this actuation mechanism in our robotic finger design, which have accomplished all 33 static and stable grasping postures in the GRASP taxonomy. Videos are available at https://sites.google.com/view/szwd.

Autosomal recessive hypercholesterolemia: Case report

Autosomal recessive hypercholesterolemia (ARH; OMIM #603813) is a very rare monogenic disorder affecting less than 1 in 1000,000 people and is characterized by very high levels of low-density lipoprotein cholesterol (LDL-C), leading to aggressive and premature atherosclerotic cardiovascular disease if left untreated. Lowering of LDL-C is the main target of the treatment. We report on a 29-year-old male patient born in nonconsanguineous Lithuanian family homo(hemi-)zygous for LDLRAP1 gene variant causing ARH. This variant is not present in population databases and, to our knowledge, has not been reported in scientific literature before. The earliest clinical sign, noticed at the age of 5 years, was painful and enlarging nodules on Achilles tendons. At the age of 10 years, xanthomas of the metacarpal joint area on both hands emerged. The first lipid panel was performed at the age of 12 years. In accordance with Dutch Lipid Clinic Network diagnostic criteria for familial hypercholesterolemia (FH), definite FH (type IIA hyperlipoproteinemia) was diagnosed and the treatment with cholestyramine 4 grams per day was initiated. As the patient was 15 years old, direct adsorption of low-density lipoprotein apheresis was started and repeated monthly. At the age of 20 years, along with lipoprotein apheresis, 10 mg of rosuvastatin daily intake was prescribed. At the age of 28 years, the dose of rosuvastatin was increased to 40 mg per day, and 10 mg of ezetimibe daily intake was added. At the age of 28 years, homozygous LDLRAP1 gene variant NM_015627.2:c.488A>C, NP_056442.2:p.(Gln163Pro) causing autosomal recessive hypercholesterolemia was determined by genetic testing. This case report implies that ARH, being an extremely rare disorder, is a severe disease. As there is limited routine testing, including genetic testing, patients suffering from both this disease and FH may remain undiagnosed. Cascade screening and genetic counseling differ for ARH as compared with FH, as the carrier of a pathogenic variant in the LDLRAP1 gene does not have marked total cholesteroland LDL-C elevations. However, genetic testing of the proband and their relatives is essential to evaluate the risk of development of FH and to provide prognosis as well as adequate, timely treatment. To improve the quality of life of patients with FH and prolong their life expectancy, national registries of FH and wider laboratory and genetic testing are undoubtedly necessary. A national FH screening program was set up in Lithuania, which helps to identify, monitor, and treat subjects with FH.