Epidermolysis bullosa (EB) is an inherited disorder characterized by skin blistering from minor trauma. The four classic subtypes are EB simplex, junctional EB, dystrophic EB, and Kindler syndrome. 1 Approximately 500 000 individuals worldwide have EB, 2,3 and all forms are associated with scarring and require a daily wound care regiment: inspection, blister drainage, debridement, ointment application, and dressing changes. [4][5][6][7][8] Patients report experiencing difficulties with performing activities of daily living. 9 Studies have revealed reduced life satisfaction and more caregiver burden among patients with EB. 10 An earlier questionnaire identified psychiatric symptoms in 20 of 25 EB patients. 3 Some previously documented patient concerns include lack of understanding from others and feelings of being different. 11 Patients with EB are similar to patients with other chronic conditions in needing support

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Background: Many stroke survivors experience arm and hand weakness, but there are only limited efficacious options for arm therapy available. Objective: To assess the feasibility of unsupervised home-based use of a virtual reality device (Smart Glove) for hand rehabilitation post stroke. Design: Prospective single-arm study consisting of a 2-week run-in phase with no device use followed by an 8-week intervention period. Setting: Participants were recruited at the Stanford Neuroscience Outpatient Clinic. Participants: Twenty chronic stroke patients with upper extremity impairment. Interventions: Participants were instructed to use the Smart Glove 50 minutes per day, 5 days per week for 8 weeks. Main Outcome Measures: The following outcomes were measured: (1) compliance, (2) patients' impression of the intervention, and (3) efficacy using the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT), and the Stroke Impact Scale (SIS). Results: Of 20 participants, seven (35%) met target compliance of 40 days use, and six (30%) used the device for 20-39 days. Eighty-five percent of participants were satisfied with the therapy, with 80% reporting improvement in hand function. During the run-in phase there were no improvements in hand function. During the intervention, patients improved by a mean of 26.6 AE 48.8 seconds on the JTHFT (P = .03), by 16.1 AE 15.3 points on the hand-domain of the SIS (P < .01) and there was a trend toward improvement on the UE-FM (2.2 AE 5.5 points, P = .10). Conclusions: Unsupervised use of the Smart Glove in the home environment may improve hand/arm function in subacute/chronic stroke patients. A randomized controlled trial is needed to confirm these results.Disclosures: None

Ectopic expression of nerve growth factor (NGF) in transgenic mice leads to site-specific sympathetic sprouting. Smooth muscle cells in the intestines, urinary bladder, and arteries have been shown to express NGF. To address whether enhanced NGF production among these different organ systems stimulates comparable patterns of sympathetic collateral growth, we generated transgenic mice that express NGF under the control of the smooth muscle alpha-actin promoter. In response to elevated levels of NGF protein in the colon, bladder, and arteries/arterioles, sympathetic axons displayed robust sprouting only in the colon and bladder. These data reveal that, unlike most other peripheral tissues, sympathetic efferents in adult mammalian arteries/arterioles do not undergo collateral growth in response to increased levels of smooth muscle-derived NGF.

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