Temporal changes in cortical activation during conditioned pain modulation (CPM), a LORETA study

For most healthy subjects, both subjective pain ratings and pain-evoked potentials are attenuated under conditioned pain modulation (CPM; formerly termed diffuse noxious inhibitory controls, or DNIC). Although essentially spinal-bulbar, this inhibition is under cortical control. This is the first study to observe temporal as well as spatial changes in cortical activations under CPM. Specifically, we aimed to investigate the interplay of areas involved in the perception and processing of pain and those involved in controlling descending inhibition. We examined brief consecutive poststimulus time windows of 50 ms using a method of source-localization from pain evoked potentials, sLORETA. This enabled determination of dynamic changes in localized cortical generators evoked by phasic noxious heat stimuli to the left volar forearm in healthy young males, with and without conditioning hot-water pain to the right hand. We found a CPM effect characterized by an initial increased activation in the orbitofrontal cortex (OFC) and amygdala at 250-300 ms poststimulus, which was correlated with the extent of psychophysical pain reduction. This was followed by reduced activations in the primary and secondary somatosensory cortices, supplementary motor area, posterior insula, and anterior cingulate cortex from 400 ms poststimulus. Our findings show that the prefrontal pain-controlling areas of OFC and amygdala increase their activity in parallel with subjective pain reduction under CPM, and that this increased activity occurs prior to reductions in activations of the pain sensory areas. In conclusion, achieving pain inhibition by the CPM process seems to be under control of the OFC and the amygdala.     

CPM机在下肢骨折患者术后膝关节功能恢复中的应用及效果观察

目的:采用CPM机对下肢骨折患者术后进行膝关节功能恢复,探讨其疗效。方法:95例患者随机分为两组,对照组采用一般常规治疗和护理,观察组在此基础上增加CPM机功能锻炼,比较两组治疗效果。结果:观察组48例全部进入结果分析,对照组47例,1例脱落;观察组总有效率81.3%,对照组总有效率65.2%,两组优良率差异有统计学意义(Ridit z=10.953,P=0.000)。结论:下肢骨折患者术后利用CPM机进行膝关节功能恢复,能减少关节僵硬,促进膝关节功良好恢复。     

Increased placental trophoblast inclusions in placenta accreta

IntroductionTrophoblast inclusions (TIs) are often found in placentas of genetically abnormal gestations. Although best documented in placentas from molar pregnancies and chromosomal aneuploidy, TIs are also associated with more subtle genetic abnormalities, and possibly autism. Less than 3% of non-aneuploid, non-accreta placentas have TIs. We hypothesize that placental genetics may play a role in the development of placenta accreta and aim to study TIs as a potential surrogate indicator of abnormal placental genetics.MethodsForty cases of placenta accreta in the third trimester were identified in a search of the medical records at one institution. Forty two third trimester control placentas were identified by a review of consecutively received single gestation placentas with no known genetic abnormalities and no diagnosis of placenta accreta.ResultsForty percent of cases with placenta accreta demonstrated TIs compared to 2.4% of controls. More invasive placenta accretas (increta and percreta) were more likely to demonstrate TIs than accreta (47% versus 20%). Prior cesarean delivery was more likely in accreta patients than controls (67% versus 9.5%).DiscussionPlacenta accreta is thought to be the result of damage to the endometrium predisposing to abnormal decidualization and invasive trophoblast growth into the myometrium. However, the etiology of accreta is incompletely understood with accreta frequently occurring in women without predisposing factors and failing to occur in predisposed patients.ConclusionThis study has shown that TIs are present at increased rates in cases of PA. Further studies are needed to discern what underlying pathogenic mechanisms are in common between abnormal placentation and the formation of TIs.     

CPM在膝关节置换术后功能锻炼中的应用体会

目的探讨在全膝关节置换术后采用下肢关节康复器（CPM）辅助膝关节功能锻炼的治疗疗效。方法评价28例患者行全膝关节置换术后辅助持续被动活动治疗的实施效果。结果 CPM较传统方法可提高膝关节活动度、痛苦小、患者易于接受、膝关节功能优良率达90%以上。结论采用CPM机辅助持续被动活动,同时配合主动活动,可减轻患者负性情绪、降低应激反应,提高机体抵抗力、减少并发症,对患者的身体状态和功能改善起到积极作用。     

CPM在预防膝关节术后关节僵硬中的应用和护理

70年代初,著名骨科医师SaLter提出持续被动活动理论（Continuous Passive Motion．CPM）,对于骨折患者出现膝关节僵硬的治疗起到了重要作用。CPM通过对膝关节持续被动的屈伸进行关似活动的训练改善关节的活动度,促进早口康复。2007—20091年我科对81例膝部骨折术后病人早期进行CPM治疗,有效地改善了患者膝关节僵硬的出现,提高了生活质量。     

中药熏洗、中药离子导入加CPM综合治疗膝关节功能障碍24例疗效观察

目的:观察中药熏洗、离子导入配合CPM治疗膝关节功能障碍的疗效.方法:将48例膝部骨折术后膝关节功能障碍的患者随机分为治疗组和对照组各24例,治疗组以中药熏洗、离子导入配合CPM进行治疗,对照组用单独CPM进行治疗,以膝关节活动范围、疼痛程度及肿胀为指标进行临床观察,治疗1周后评价疗效.结果:膝关节活动范围、疼痛程度及...     

CPM联合玻璃酸钠在膝关节镜术后早期康复中的应用

目的:探讨早期应用下肢关节康复器(CPM)联合关节腔注射玻璃酸钠进行功能锻炼治疗膝关节镜术后的临床疗效及应用价值.方法:总结2009年6月至2010年6月住院按疗程治疗的膝关节镜术后患者120例.将患者按随机化区组设计分为CPM联合透明质酸钠关节内注射治疗组(A组)40例、单纯CPM治疗组(B组)40例和传统的康复方法治疗组(C组)40例.三组在年龄及性别等方面无明星差异.结果:随访1-3个月.A组患者关节活动度均达正常,恢复正常生活时间为19～52d(平均21.6d),B组患者关节活动度也均达正常,恢复正常生活时间为21～56d(平均27.4d),C组40例恢复正常生活时间为29～69d(平均35.6d),A组各项观察指标均有明显改善,与B、C组比较差异有统计学意义(P＜0.05),B组和C组比较差异有统计学意义(P＜0.05).结论:膝关节镜术后早期应用CPM联合关节腔注射玻璃酸钠进行功能锻炼在预后及康复时间上均有明显优势,有利于功能恢复,缩短康复时间,患者术后反应轻,能够减轻术后疼痛,促进软骨修复,改善关节功能,防止关节强值的发生.     

Strategy to confirm the presence of anti-erythropoietin neutralizing antibodies in human serum

Functional cell-based assays are the preferred method to test for the presence of anti-rHuEPO neutralizing antibodies (NAbs). However, due to the unpredictable nature of test serum matrix effects on cell-based assays, confirmatory assays are essential for verifying NAb positive results observed during the course of sample testing. The cell-based assay used for the detection of NAbs described by Wei et al. [1] used 32D-EPOR cells, a murine myeloid cell line transfected with the human EPO receptor (EPOR). The 32D-EPOR cell line responded to either rHuEPO or murine interleukin 3 (mIL-3) with proliferation. NAbs were expected to only inhibit rHuEPO-induced cell proliferation and not mIL-3 induced proliferation. Due to reliance on proliferation, the results from this cell-based assay can be confounded by the presence of non-antibody inhibitory serum factors. This paper describes a strategy for confirming that the inhibition of rHuEPO-induced proliferation in a cell-based assay is only attributable to NAbs. The strategy of antibody depletion uses a resin mixture composed of Protein G Sepharose and Protein L Sepharose (Protein G/L resin) to significantly reduce the concentration of immunoglobulins of IgG, IgM and IgA isotypes from human serum prior to testing in the cell-based assay. If the reduction in immunoglobulins in a serum sample corresponds to a reduction in inhibition of EPO-induced proliferation, it would infer that EPO neutralizing activity is antibody-mediated and not due to non-antibody inhibitory serum factors.     

‘Pain inhibits pain’ mechanisms: Is pain modulation simply due to distraction?

‘Diffuse noxious inhibitory controls’ (DNIC), a form of supraspinal descending endogenous analgesia, requires a noxious conditioning stimulus for pain attenuation. This may be partly dependent on a distraction effect. The term “conditioned pain modulation” (CPM) has recently been introduced to describe the psychophysical paradigm to test DNIC. The present study aimed to determine whether distraction and tonic heat stimulation inhibit pain through the same or different mechanisms by looking at whether there is a similar or even an additive effect on pain attenuation. Test pain was brief heat stimulation applied to the left volar of 34 healthy volunteers. For conditioning, the right hand was immersed in 46.5 °C water. Distraction was provided by three different difficulty levels of continuous cognitive visual tasks. Experimental blocks consisted of test pain: (1) alone; ‘baseline’, (2) with conditioning pain; ‘CPM’, (3) with distraction; ‘distraction’ and (4) with conditioning pain and distraction; ‘combined’. They were randomized and repeated three times and pain intensity and unpleasantness rated. Results showed an overall effect of experimental block on test pain intensity (P = 0.0125). Post-hoc tests revealed a significant reduction in pain intensity ratings under Combined (21.2 ± 2.3; mean ± SEM) compared to CPM alone (16.0 ± 2.3) (P < 0.05). Furthermore, at all levels of distraction there were always a few subjects who were not distracted despite expressing CPM. Based on the additive effect of CPM and distraction on pain inhibition, and the cases of no distraction despite CPM, we suggest that CPM acts independently from distraction.     

综合康复对膝关节功能障碍的影响

目的：探讨综合康复对膝关节功能活动障碍的影响.方法：共选取膝关节功能活动障碍患者138例,随机分为治疗组与对照组,康复组给予关节CPM治疗、关节松动、关节功能锻炼与蜡疗与中频电疗;对照组仅给予未经指导的自我训练.结果：患者经四周治疗后,两组患者膝关节活动范围及膝关节功能均较治疗前明显改善,但治疗组明显优于对照组,（P〈0.05）.结论：综合康复治疗可明显改善膝关节功能障碍患者ROM,促进关节功能进一步恢复.随着交通、建筑施工中意外事故的增加,经常发生外伤所致膝关节内骨折或靠近膝关节部位的骨折,而由此造成的膝关节活动受限甚至关节强直比较常见.若膝关节ROM（range of motio）〈60°,将对患者的日常生活、工作造成较大影响.如何最大程度改善膝关节骨折后功能障碍,提高患者的生活质量,本研究就此进行探讨.