Do interoception and attending to the upper limbs affect body ownership and body representation in the grasp illusion?

Passively grasping an unseen artificial finger induces ownership over this finger and an illusory coming together of one’s index fingers: a grasp illusion. Here we determine how interoceptive ability and attending to the upper limbs influence this illusion. Participants passively grasped an unseen artificial finger with their left index finger and thumb for 3 min while their right index finger, located 12 cm below, was lightly clamped. Experiment 1 (n = 30) investigated whether the strength of the grasp illusion (perceived index finger spacing and perceived ownership) is related to a person’s level of interoceptive accuracy (modified heartbeat counting task) and sensibility (Noticing subscale of the Multidimensional Assessment of Interoceptive Awareness). Experiment 2 (n = 30) investigated the effect of providing verbal or tactile cues to guide participants’ attention to their upper limbs. On their own, neither interoceptive accuracy and sensibility or verbal and tactile cueing had an effect on the grasp illusion. However, verbal cueing increased the strength of the grasp illusion in individuals with lower interoceptive ability. Across the observed range of interoceptive accuracy and sensibility, verbal cueing decreased perceived index spacing by 5.6 cm [1.91 to 9.38] (mean [95%CI]), and perceived ownership by ∼3 points on a 7-point Likert scale (slope -0.93 [-1.72 to -0.15]). Thus, attending to the upper limbs via verbal cues increases the strength of the grasp illusion in a way that is inversely proportional to a person’s level of interoceptive accuracy and sensibility.

Neural Coding of Vibration Intensity

Vibrotactile feedback technology has become widely used in human–computer interaction due to its low cost, wearability, and expressiveness. Although neuroimaging studies have investigated neural processes associated with different types of vibrotactile feedback, encoding vibration intensity in the brain remains largely unknown. The aim of this study is to investigate neural processes associated with vibration intensity using electroencephalography. Twenty-nine healthy participants (aged 18–40 years, nine females) experienced vibrotactile feedback at the distal phalanx of the left index finger with three vibration intensity conditions: no vibration, low-intensity vibration (1.56 g), and high-intensity vibration (2.26 g). The alpha and beta band event-related desynchronization (ERD) as well as P2 and P3 event-related potential components for each of the three vibration intensity conditions are obtained. Results demonstrate that the ERD in the alpha band in the contralateral somatosensory and motor cortex areas is significantly associated with the vibration intensity. The average power spectral density (PSD) of the peak period of the ERD (400–600 ms) is significantly stronger for the high- and low-vibration intensity conditions compared to the no vibration condition. Furthermore, the average PSD of the ERD rebound (700–2,000 ms) is significantly maintained for the high-vibration intensity compared to low-intensity and no vibration conditions. Beta ERD signals the presence of vibration. These findings inform the development of quantitative measurements for vibration intensities based on neural signals.

Fingertip Necrosis due to Chemical Burn from Glacial Acetic Acid: A Case Report

Glacial acetic acid is a high-purity acetic acid that is mainly used as a solvent in chemical production and for various purposes in the food and pharmaceutical industries. It is safe enough to be used for chemical peeling when diluted, and has been used in folk remedies for warts, athlete’s foot, and eczema. Indeed, such conditions are the most common reason for exposure to glacial acetic acid. In the present report, we describe the case of a 10-year-old girl who presented with pain and necrosis of the distal phalanx of her left index finger. Two days prior, her fingers had been wrapped overnight with a paste of flour mixed with glacial acetic acid to treat warts. We irrigated the affected area with normal saline, applied a mupirocin ointment, and administered prostaglandin E1. However, the necrosis progressed rapidly. After 10 days, the girl’s fingertip was amputated, and a hypothenar free flap was performed. The case represents a severe chemical burn resulting from the misuse of glacial acetic acid, requiring surgical treatment.

A case report of a severe neonatal systemic vasculitis on the first day of life

Background Neonatal systemic vasculitis syndromes have been reported in infants born to mothers with systemic lupus erythematosus, Sjögren’s syndrome, Behҫet’s disease, cutaneous polyarteritis nodosa and anti-neutrophil cytoplasmic antibody-associated vasculitides. Here we report a novel association of a case of new-onset maternal seronegative inflammatory arthritis associated with a transient systemic vasculitis in a neonate. Case presentation In the first 24 h of life, a preterm Caucasian baby boy was noted to have blue discoloration to all four extremities. Despite antibiotics, fresh frozen plasma and anticoagulation, the discoloration remained, particularly in the left index finger. This was associated with fever and a maximum C-reactive protein (CRP) of 148 mg/L. Intravenous immunoglobulin (IVIG) was given with short-term improvement. Initial echocardiogram showed enlarged coronary arteries with normalization on repeat 1 week later. Clinical signs and symptoms responded to high dose oral steroid administration. MRI angiography (MRA) of the body and heart showed tortuosity of arteries in the upper and lower extremities with gadolinium uptake, suggestive of vasculitis. Autoantibody profile negative. Genetic panel for hereditary autoinflammatory diseases was negative as was whole exome sequencing performed on the trio. The baby was weaned off steroids by 5 months of age. A small distal autoamputation of the left index finger occurred. He was born to a 28-year-old woman who developed new onset severe symmetrical polyarthritis at 8 weeks gestation. This was presumed a reactive arthritis secondary to a dental infection. Infectious work up and autoantibodies were negative. She was treated with high dose prednisone for the remainder of her pregnancy. The mother was weaned off prednisone, treated with hydroxychloroquine for 8 months post-partum and remains in remission. A repeat MRA done at 1 year old showed mild residual tortuosities of the arteries in the forearms. The remainder of the medium and large vessels were within normal limits with no gadolinium enhancement to suggest active disease. The child is now 4 years old with normal growth and development. Conclusion This is a unique case of new-onset seronegative presumed reactive arthritis in a mother with the rare development of a successfully treated medium vessel vasculitis in an infant.

The Finger Ring: Need for Regular Removal and Replacement

We present two cases of finger ring impaction. Both patients tried to remove it in rural hospitals before presenting to the burns and plastic unit of the University of Calabar Teaching Hospital. The male had the ring on the left index finger while the female had it on the left ring finger. The rings were removed by the use of circumferential cutaneous tissue infiltration (ring block) with plain lignocaine, strip of esmarch bandage exanguination of the finger, lubrication with K-Y jelly and then extraction.

Association between gestational period and obesity in children with the use of dermatoglyphic traits: A preliminary study

Events occurring during the gestational period can influence the development of diseases and conditions such as obesity. This study aimed to analyze the association between events occurring in the gestational period and the occurrence of obesity in children based on dermatoglyphic traits. The sample comprised 73 children born in 2009, living in Palhoça, Santa Catarina (SC), Brazil, regularly enrolled in public and private schools in that municipality and who are participants of an ongoing major cohort study project called Coorte Brasil Sul. The results show predictive traits of obesity when comparing BMI and fingerprint groups. Obese male group, presented the figure Ulnar Loop (UL) in the right hand (MDT1) thumb and greater number of ridges in the (MDSQL1) right thumb the greater the BMI; likewise, the older the woman getting pregnant the greater the number of ridges that the child presented in the (MESQL2) left index finger and (MESQL1) right thumb. The results obtained infer the presence of predictive traits of BMI ranges and a possible association between the dermatoglyphic traits of children with obesity and late pregnancy women.

A Silent Closed Rupture of the Flexor Digitorum Profundus on the Index Finger: An Unsolved Mystery

We report the case of a patient who fully recovered from a closed flexor tendon rupture through a two-stage flexor tendon reconstruction using silicone rods, despite a considerable delay in treatment. A 17-year-old male patient visited our clinic with a sudden inability to flex his left index finger, although there were no signs of injury. Magnetic resonance imaging revealed an extensive rupture of the flexor digitorum profundus from the base of the distal phalanx to the proximal phalangeal joint of his left hand. After a two-stage tendon graft operation was performed, the patient regained full flexion of the index finger and was able to hold a fist without any limitations in range of motion. Complete rupture of tendons usually accompanies history of trauma or underlying tendon pathology. In our case, however, the tendon rupture occurred silently with no obvious underlying causes. It is important to recognize the signs to evaluate the underlying structures for appropriate management and treatment. Even with considerable delay, the patient may regain full function of the tendon.

A Novel Mutation in SOST Gene Causes Sclerosteosis

Background: Sclerostin is a SOST gene product that inhibits osteoblasts activity and prevents excessive bone formation by antagonizing Wnt signaling pathway. Sclerosteosis has been linked to the loss of function mutation in SOST gene. It is a rare autosomal recessive disorder characterized by craniotubular hyperostosis leading to gigantism, cranial nerves entrapment, and fatal cerebellar herniation. Objectives To report a novel mutation of SOST gene in a patient with sclerosteosis. Clinical Case: A 25-year-old female was referred to the endocrine clinic for suspected GH excess. The patient noted the onset of headache, progressive bilateral blurred vision and hearing disturbance, irregular menses, and generalized arthralgia; at the age of 23 years. Subsequently, she observed a progressive increase in the size of shoes and hands, proptosis, and protrusion of the chin. She was the second of seven siblings from non-consanguineous parents with normal antenatal and neonatal history except for syndactyly. All family members were phenotypically normal except for a sister with similar physical appearance who had cranial decompression 20 years back. MRI pituitary was done initially due the suspicion of pituitary adenoma and it revealed an enlarged sella turcica with normal pituitary gland. Surprisingly, the MRI showed diffuse osseous thickening with narrowing of skull base foramina, narrowing of optic and internal auditory canals, secondary compression of cerebral parenchyma and bilateral cerebellar tonsillar herniation. Further image revealed extremely increased bone mass density with Z-score values of +12, generalized increase cortical thickness, vertebral end plates sclerosis, and deformed left index finger. Biochemical and endocrine tests revealed normal GH, IGF -1, TSH, prolactin, short Synacthen test, FSH, LH, estradiol, calcium, phosphorus, PTH and alkaline phosphatase. Due to progressive worsening of vision with compressive optic neuropathy, optic nerve fenestration with decompression hemicraniotomy was performed. Sclerosteosis was suspected due to the predominant craniotubular hyperostosis with syndactyly. There was no definite therapy. Management aimed at relieving symptoms and preventing complications, so she was commenced on calcitriol and prednisolone to suppress the osteoclasts. Genomic sequencing of the SOST was performed. We identified a novel deletion mutation in SOST gene (c.387delG, p.D131fs*) which disrupts the sclerostin function causing sclerosteosis in this patient. Conclusion: We describe a novel mutation in the SOST gene in a patient with sclerosteosis in Saudi Arabia, that has not been previously described. Closing the gap between the genomic knowledge and clinical applications will add the benefit of success in development of targeted therapies in such a fatal disease.

A case report of a severe neonatal systemic vasculitis on the first day of life

BACKGROUND: Transmission of autoantibodies across the placenta has been associated with neonatal cutaneous vasculitis and lupus syndromes. Here we report a novel association of a case of new-onset maternal seronegative inflammatory arthritis associated with a transient systemic vasculitis in a neonate. CASE PRESENTATION: In the first 24 hours of life, a preterm baby boy was noted to have blue discoloration to all four extremities. A workup for sepsis and thrombosis were negative. Despite antibiotics, fresh frozen plasma and anticoagulation, the discoloration remained, particularly in the left index finger. This was associated with fever and a maximum C-reactive protein (CRP) of 148 mg/L. Two doses of intravenous immunoglobulin (IVIG) were given with short-term improvement. Echocardiogram was normal. The fever, elevated CRP and finger discoloration responded to high dose steroid administration. MRI angiography (MRA) of body and heart showed tortuosity of arteries in the upper and lower extremities with gadolinium uptake, suggestive of vasculitis. Autoantibody profile negative. Genetic panel for hereditary autoinflammatory diseases was negative as was as whole exome sequencing performed on the trio. The baby was weaned off steroids by 5 months of age. A small distal autoamputation of the left index finger occurred. He was born to a 28-year-old woman who developed new onset severe symmetrical polyarthritis at 8 weeks gestation. It was presumed this was reactive arthritis secondary to a dental infection. Infectious work up and autoantibodies were negative. She was treated with high dose prednisone for the remainder of her pregnancy. The mother was weaned off prednisone and treated with hydroxychloroquine for 8 months post-partum and remains in remission. A repeat MRA done at 1 year old showed mild residual tortuosities of the arteries in the forearms. The remainder of the medium and large vessels were within normal limits with no gadolinium enhancement to suggest active disease. The child is now 4 years old with normal growth and development. CONCLUSION: This is a unique case of new-onset seronegative presumed reactive arthritis in a mother with the rare development of a successfully treated medium vessel vasculitis in an infant.

Respiration, heartbeat, and conscious tactile perception

Cardiac activity has been shown to interact with conscious tactile perception: Detecting near-threshold tactile stimuli is more likely during diastole than systole and heart slowing is more pronounced for detected compared to undetected stimuli. Here, we investigated how cardiac cycle effects on conscious tactile perception relate to respiration given the natural coupling of these two dominant body rhythms. Forty-one healthy participants had to report conscious perception of weak electrical pulses applied to the left index finger (yes/no) and confidence about their yes/no-decision (unconfident/confident) while electrocardiography (ECG), respiratory activity (chest circumference), and finger pulse oximetry were recorded. We confirmed the previous findings of higher tactile detection rate during diastole and unimodal distribution of hits in diastole, more specifically, we found this only when participants were confident about their detection decision. Lowest tactile detection rate occurred 250-300 ms after the R-peak corresponding to pulse-wave onsets in the finger. Inspiration was locked to tactile stimulation, and this was more consistent in hits than misses. Respiratory cycles accompanying misses were longer as compared to hits and correct rejections. Cardiac cycle effects on conscious tactile perception interact with decision confidence and coincide with pulse-wave arrival, which suggests the involvement of higher cognitive processing in this phenomenon possibly related to predictive coding. The more consistent phase-locking of inspiration with stimulus onsets for hits than misses is in line with previous reports of phase-locked inspiration to cognitive task onsets which were interpreted as tuning the sensory system for incoming information.