Murray Valley encephalitis in an adult traveller complicated by long-term flaccid paralysis: case report and review of the literature

Murray Valley encephalitis (MVE) virus, a mosquito-borne flavivirus, is the most common cause of viral encephalitis in the tropical 'Top End' of northern Australia. Clinical encephalitis due to MVE virus has a mortality rate of approximately 30%, with a similar proportion of patients being left with significant neurological deficits. We report the case of a 25-year-old man from the UK who acquired MVE while travelling through northern Australia. He required prolonged admission to the Intensive Care Unit and several years later remains partly ventilator-dependent, with flaccid quadriparesis. To our knowledge, this is the first reported case of MVE virus-induced flaccid paralysis in an adult in northern Australia, although it is well described in children. Paralysis was thought to be due to anterior horn cell involvement in the spinal cord and extensive bilateral thalamic destruction, both of which are well recognised complications of infection with MVE virus. Cases of flaccid paralysis with similar pathology have been described following infection with the related flavivirus Japanese encephalitis virus as well as more recently with West Nile virus. Our case highlights the potential severity of flavivirus-induced encephalitis and the importance of avoiding mosquito bites while travelling through endemic areas.     

基于强证据支持的治疗周围性面瘫疗效的研究

目的通过对针灸治疗周围性面瘫的临床文献进行收集、分析,对疗效研究文献质量采用改良的Jadad量表评价,以筛选出高质量文献增加研究结果可信度,同时使用针灸证据推荐级别的划分标准,明确证据级别,指导临床应用。方法全面检索文献,纳入文献均为随机对照试验(RCT),采用RevMan5.0软件对痊愈率等疗效评价指标行Meta分析。结果根据2012年面瘫指南,共纳入高质量研究4项,进行Meta分析,显示目前现有的高质量文献证明针灸对照激素在治疗周围性面瘫的临床痊愈率方面具有疗效优势[RR合并=1.60,95%CI(1.29,1.98),P0.0001]。结论现有高质量文献强证据支持针灸在治疗周围性面瘫的临床痊愈率方面优于激素,针灸治疗周围性面神经麻痹,值得临床广泛推广与应用。     

CO2 laser cordectomy for bilateral vocal-cord paralysis

Bilateral vocal-cord paralysis usually causes dyspnoea with inspiratory stridor. Most patients have a fairly satisfactory voice. The purpose of this paper is to present the results of a series of 24 patients with bilateral vocal-cord paralysis treated by CO₂ laser cordectomy during 1978–86. Breathing improved in 19 patients. In most of the patients, however, the voice worsened. If further surgery is necessary this can easily be performed. In appropriate patients the CO₂ laser is an ideal surgical tool for the performance of a cordectomy in patients with bilateral vocal-cord paralysis.     

Osteoporosis after spinal cord injury.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.     

早期神经移位移植治疗产瘫

目的：报告早期神经移位移植治疗产瘫的方法和疗效。方法：１９９５年５月～１９９６年８月，对１２例出生后３个月无肌力恢复的产瘫患儿进行手术治疗，上干不全损伤神经瘤形成者８例，上干完全断裂或根性撕脱４例，采用４种神经移位移植术修复上干。用Ｍａｌｅｔ评分评价疗效。结果：术后随访１６～２８个月，平均２０．８个月，肩肘功能完全恢复３例，达ＭａｌｅｔⅣ级６例，优良率７５％，膈神经移位优良率８３．３％，副神经移位优良率６６．７％。结论：早期神经移位移植治疗产瘫可获得满意疗效     

自体MSC-NSCs治疗小儿急性播散性脑脊髓炎后瘫痪1例

目的观察自体骨髓间充质干细胞转化神经干细胞移植对急性播散性脑脊髓炎后下肢瘫痪的治疗效果。方法采集自体骨髓分离间充质干细胞体外培养增殖后诱导为神经干细胞后移植给患儿。结果患儿下肢的功能明显恢复。结论自体骨髓间充质干细胞转化神经干细胞移植是急性播散性脑脊髓炎后下肢瘫痪的有效方法。     

肝移植术后膈肌麻痹的监测与处理

目的 总结肝移植术后膈肌麻痹致严重肺部并发症的监测与处理经验.方法 回顾性分析中山大学附属孙逸仙纪念医院2001年2月至2007年3月60例成人肝移植患者资料,探讨术后右侧膈肌麻痹所致严重呼吸道并发症的病理生理变化、临床过程及处理对策.结果 在60例肝移植患者中,有40例术后发生呼吸系统并发症,其中5例为膈肌麻痹所致.5例术后均因严重的膈肌麻痹导致反常呼吸,呼吸机支持时间延长,4例患者实施了气管切开.呼吸机支持期间同时合并发生细菌性肺炎和真菌性肺炎5例、肺不张4例、急性呼吸窘迫综合征4例、肝肺综合征4例、肺间质水肿3例.除1例于术后第31天死于急性呼吸窘迫综合征和多器官衰竭外,其余4例均治愈出院.结论 严密监测呼吸功能及正确使用呼吸机等综合治疗是肝移植术后的重要环节.如果怀疑膈神经功能不全,应延长呼吸机支持时间并早期果断实施气管切开.

Abstract：

Objective To review our experience in the diagnosis and management of paralysis of the right hemidiaphragm after liver transplantation. Methods 60 adult patients received liver transplantation from February 2001 to March 2007 in Sun Yat-sen Memorial Hospital were retrospectively analyzed. The pathophysiologic changes, clinical progress, and management of serious respiratory complications caused by post-transplant paralysis of the right hemidiaphragm were studied. Results Among 60 patients, 40 developed postoperative respiratory complications, and 5 were due to paralysis of the right hemidiaphragm. The 5 patients presented with paradoxical respiration and the ventilator supporting times were 14, 16, 34, 45, and 60 days, respectively. Tracheostomy was performed in 4. These patients developed pneumonia in 5, atelectasis in 4, acute respiratory distress syndrome (ARDS) in 4, hepatopulmonary syndrome in 4, and pulmonay interstitial edema in 3. Among the 5 patients, 4 patients survived and 1 patient died of ARDS and multiple organs failure 31 days after the transplantation. Conclusions After liver transplantation, strict monitoring of the respiratory function and timely use of a respirator for patients with the paralysis of the hemidiaphragm is very important. For patients with suspicious hemidiaphragm paralysis, tracheostomy should be decisively performed.     

Clinical application of adult olfactory bulb ensheathing glia for nervous system repair

The ability of adult olfactory bulb ensheathing glia (OB-OEG) to promote histological and functional neural repair has been broadly documented. Pre-clinical studies show that beneficial effects of adult OB-OEG are repeatable in the same type of spinal cord injury initially tested, in other spinal cord and CNS injury models, in different species and after the administration of these cells in different forms (either alone or in combination with other cells, drugs, products or devices). These studies demonstrate the reproducibility, robustness, fundamental nature and relevance of the findings. Therefore, the use of adult OB-OEG for spinal cord injury repair meets the scientific criteria established by the International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) for the translation to human application.Because there is so much heterogeneity in the way adult OEG is administered, each of these different OEG-based therapies must be individually categorized to determine whether they fulfill the requisites dictated by the consolidated regulatory body to be considered or not as a medicine. In the case they do, in Europe, they shall be subjected to the Regulatory European Framework for Advanced Therapy Medicinal Products and the European Clinical Trials Directive (Directives 2001/20/EC and 2009/120/EC). After a deep analysis of the European Regulation we have concluded that grafts consisting of suspensions of purified adult OEG, to be used for the promotion of axonal regeneration in the CNS, do not comply with the definition of Medicinal Product provided by the European Medicines Agency. In contrast, experimental therapies using OEG in combination with other cell types, drugs, products or devices, or genetically-modified OEG fall under the definitions of Medicinal Product. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.     

经筋刺法治疗难治性周围性面神经麻痹临床观察

目的 研究以石学敏教授＂经筋、皮部＂理论为指导的经筋刺法对难治性周围性面神经麻痹患者面部功能的改善作用.方法 将20例难治性周围性面神经麻痹的患者随机分为两组,治疗组与对照组各10例.对照组予普通针刺治疗,治疗组予经筋刺法治疗.治疗前及治疗后采用House-Brackmann分级量表进行评价分级,并比较两组患者临床疗效.结果 治疗组总有效率（90.0%）均优于对照组（80.0%）,两组比较,差异有统计学意义（P＜0.05）.治疗组House-Brackmann分级量评分的改善优于对照组.结论 以石学敏教授＂经筋、皮部＂理论为指导的经筋刺法对难治性周围性面神经麻痹面部功能具有良好的改善作用.     

某市2006～2011年急性弛缓性麻痹病例的监测系统评价

目的了解周口市急性弛缓性麻痹(AFP)发病情况,探讨消灭脊灰后AFP监测工作措施。方法对周口市2006~2011年AFP病例监测资料进行流行病学分析,并对AFP病例监测系统进行评价。结果 2006~2011年全市共报告AFP病例353例,未发现脊灰野病毒引起的病例。病例分布在全市10个县(区),发病以0～4岁儿童为主,占77.34%;男性发病多于女性,男女比例2.84∶l;所有监测病例经河南省专家诊断组诊断均为排除脊灰病例,格林巴利综合征最多,占36.26%。自2006年起,15岁以下儿童非脊灰AFP病例报告发病率均>l/10万,各项主要监测指标均达到了卫生部规定的80%的要求。结论周口市AFP监测系统运转正常,系统报告敏感、及时、准确,监测报告质量不断提高,但仍有一些问题有待进一步改进。