Automated measurement of proprioception following stroke

Background.?Proprioception provides feedback which is essential for adequate motor control. Despite having detrimental functional implications, the assessment of proprioception deficits in current clinical practice is mostly qualitative and inadequate for diagnosis and longitudinal monitoring of subtle impairments and their effect on motor function.

Purpose.?To evaluate a novel quantitative approach to the assessment of proprioception deficits in stroke patients.

Method.?We designed and implemented an automated protocol where a magnetic motion tracking system and a sensor attached to each of the patient's hands, enables registration of trajectories in 3D coordinates. In this protocol the patient's affected and healthy hands are placed respectively below and above a square board. With vision blocked, the subject's affected hand is passively moved to one of four locations, and then the patient is instructed to actively position the healthy hand directly above his/her perceived location of the affected hand. The positional difference between the two hands is automatically recorded by the system. This procedure is repeated several times and the magnitude and direction of errors are used to quantify the proprioception deficit. The data for this pilot study was collected in a sample of 22 stroke patients and an age-matched group of neurologically intact subjects.

Results.?Stroke patients had significantly higher mean distance error compared with the control group (average values of 7.9 and 5.3 cm, respectively), and showed higher instability (variance) in repeated performance (average values of the standard deviation of errors 3.4 and 1.8 cm, respectively). Significant correlation was found between the mean distance error and the results of semi-quantitative clinical tests of proprioception.

Conclusion.?The system provides a reliable quantitative measure of upper limb proprioception, offering considerable advantage over the traditional means applied in the clinic.     

Endoscopic diagnosis and treatment of inlet patch: Justification,techniques, and results

Esophageal gastric inlet patches (EGIPs) comprise an island of heterotopic gastric columnar epithelium in the cervical esophagus with a reported prevalence of up to 10%. Usually the diagnosis is made by chance in the course of an upper gastrointestinal endoscopy. After histopathologic examination EGIPs can be classified as oxyntic (mucosal glands contain parietal cells), mucoid type (mucosa is composed solely of glands with mucous cells), or mixed type (presence of both: glands with parietal cells and glands of mucous cells). Despite their overall low incidence of clinically relevant conditions, EGIPs seem to be a significant entity. Few individuals with EGIPs report symptoms of globus sensations, dysphagia, hoarseness, or chronic cough that are often misinterpreted as an atypical manifestation of gastroesophageal reflux disease. It is known that these symptoms significantly compromise the patients' quality of life. Therefore, therapy should be initiated. However, proton pump inhibitors' response seems to be poor in these patients. We were able to show that an interventional ablative endoscopic therapy by argon plasma coagulation can be a safe and effective procedure. However, further researches are required to better understand the clinical significance of EGIPs and their association to symptoms.     

关于功能性消化不良患者胃感觉功能与早饱症状的关系

目的 了解功能性消化不良(functional dyspepsia,FD)患者的胃感觉功能与早饱症状的关系.方法 将48例功能性消化不良患者按照是否存在早饱症状分为早饱组和非早饱组,其中早饱组24例(男女各12例),非早饱组24例(男女各12例).运用饮水负荷试验测定胃感觉功能,并与20例对照组的胃感觉功能进行比较.刚出现上腹部饱足感时的饮水量为初次饱足阈值,受试者出现完全饱足或因上腹部症状不能继续饮水时的饮水量即最大饱足阈值.结果 功能性消化不良患者初次饱足阈值和最大饱足阈值均较对照组显著降低(433±60.2)ml比(503±32.45)ml,P＜0.01和(784±90.8)ml比(1030±84.8)ml,P＜0.01);功能性消化不良患者早饱组和非早饱组间初次饱足阈值和最大饱足阈值比较无明显差别(430±61.7)ml比(437±59.6)ml,P＞0.05和(779±95.1)ml比(788±87.9)ml,P＞0.05).50%的功能性消化不良患者初次饱足阈值降低,75%的患者最大饱足阈值降低.结论 部分功能性消化不良患者确实在胃感觉过敏,功能性消化不良患者胃感觉功能与早饱症状之间无明显关系.     

Effects of alcohol on autonomic responses and thermal sensation during cold exposure in humans

We investigated the effects of alcohol on thermoregulatory responses and thermal sensations during cold exposure in humans. Eight healthy men (mean age 22.3 ± 0.7 year) participated in this study. Experiments were conducted twice for each subject at a room temperature of 18°C. After a 30-min resting period, the subject drank either 15% alcohol at a dose of 0.36 g/kg body weight (alcohol session) or an equal volume of distilled water (control session), and remained in a sitting position for another 60 min. Mean skin temperature continued to decrease and was similar in control and alcohol sessions. Metabolic rate was lower in the alcohol session, but the difference did not affect core temperature, which decreased in a similar manner in both alcohol and control sessions (from 36.9 ± 0.1°C to 36.6 ± 0.1°C). Whole body sensations of cold and thermal discomfort became successively stronger in the control session, whereas these sensations were both greatly diminished after drinking alcohol. In a previous study we performed in the heat, using a similar protocol, alcohol produced a definite, coordinated effect on all autonomic and sentient heat loss effectors. In the current study in the cold, as compared to responses in the heat, alcohol intake was followed by lesser alterations in autonomic effector responses, but increased changes in sensations of temperature and thermal discomfort. Overall, our results indicate that although alcohol influences thermoregulation in the cold as well as in the heat, detailed aspects of the influence are quite different.     

脑深部电刺激术与毁损术治疗双侧帕金森病的疗效对照研究

目的:探讨双侧丘脑底核(STN)脑深部电刺激术(DBS)和分期双侧丘脑和(或)苍白球毁损术治疗双侧帕金森病(PD)的疗效比较。方法:2001年至2005年在该科接受双侧STN-DBS患者29例为DBS组,分期双侧丘脑或苍白球毁损术患者59例为毁损组,采用统一的PD评定量表(UPDRS),在“关”状态下对患者的日常生活活动(ADL)及运动功能进行评分(双侧DBS及第2次毁损术术前及术后1个月),计算其差值及改善率,并对并发症进行观察及评价。结果:DBS组患者ADL差值为15.93±3.98,改善率为(57.9±9.5)%,运动功能差值为29.45±5.17,改善率为(62.8±9.0)%,并发症1例。毁损组患者ADL差值为12.17±4.050,改善率为(53.8±1.2)%,运动功能差值为22.80±5.59,改善率为(59.8±1.0)%,长期及短暂并发症14例。两者术后1个月ADL及运动的UPDRS评分较术前均明显减少(P0.05),并发症比较(P=0.017)有显著性差异。结论:两种治疗方法在改善患者的临床症状方面疗效均较好,但STN-DBS减少了并发症的发生,是值得推广的治疗方法。     

The role of mucosal receptors in the nasal sensation of airflow

50 subjects were admitted into a randomized double-blind placebo controlled cross-over trial with 4% lignocaine as the active drug and normal saline as the placebo. Each subject had 2 ml of solution sprayed into each nasal cavity and all subjects had both sprays but on different occasions. The order in which the sprays were administered was randomized. The subjective sensation of nasal airflow was measured using a visual anologue scale before and after the spray. These measurements were made under conditions of the same airflow rate, which was monitored throughout the experiment using a reprogrammed NR6 rhinomanometer. Objective nasal patency was measured as peak nasal inspiratory flow rate. It was found that the nasal sensation of airflow decreased slightly after both lignocaine (difference between medians 5.0; 95% confidence interval —2.91 to 6.11) and normal saline (difference between medians 6.0; 95% confidence interval — 1.02 to 7.21). Nonparametric analysis of variance showed this difference to be non-significant (P = 0.73). In addition there was no significant change in objective nasal patency. The results suggest that nerve endings in the nasal mucosa play no part in sensing nasal airflow during respiration.     

灸刺足三里治疗难治性面瘫临床观察

目的:观察采用灸刺足三里激发“循经感传”治疗难治性面瘫的临床疗效。方法:60例患者随机分为灸刺足三里组(试验组)、常规治疗组(对照组)各30例,对照组取合谷、太冲、头维等穴,试验组在对照组取穴基础上加灸刺足三里,以患者自觉有温热感沿针体传入穴位深层为度。结果:试验组总有效率为93·3%,明显优于对照组的76·7%(P<0·05);试验组中,有循经感传者的总有效率为100·0%,明显优于无循经感传者的80·0%(P<0·05)。结论:灸刺足三里激发“循经感传”治疗难治性面瘫具有较好疗效,值得推广应用。     

加味半夏厚朴汤治疗颈椎病合并梅核气的疗效观察

目的 :观察加味半夏厚朴汤在治疗颈椎病合并梅核气的临床疗效。方法 :参照国家中医管理局制定的中医病证诊断治疗标准等书 ,对 1996年～ 2 0 0 0年中 1375例中合并梅核气证 352例 ,随机分成两组分别采用半夏厚朴汤合三黄葛根汤与单用三黄葛根汤进行对比观察。结果 :加味半夏厚朴汤与对照组有效率分别为 95.4 %与 78% ,疗程进度治愈率 ,治疗组共 2 52例 ,第 1疗程治愈 189( 75% ) ,第 2疗程 37( 14 .7% ) ,第 3疗程 15例 ( 6% ) ,第 3疗程以上无效 11例 ( 4.3% )。对照组 10 0例 ,第 1疗程 19例 ,第 2疗程 31例 ,第 3疗程 2 8例 ,第 3疗程以上无效 2 2例。两组在治疗过程中有明显的差异 P>0 .0 5。结论 :加味半夏厚朴汤治疗颈椎病合并梅核气证有良好的治疗作用并对疗程有明显的缩短。     

正常人手部神经感觉定量的测定

目的：研究正常人手部定量感觉测试（QSD的阈值及意义。方法：检测230例正常人左手大小鱼际肌的冷觉、温觉、冷痛觉、热痛觉，对其中28例右手做相同测试，对其中21例2周后做重复测试。结果：本组正常人QST测试的重复性较好，左右手QST阈值左右侧之间差异无显著性。各年龄段温度觉阈值存在显著性差异。结论：年龄对定量感觉检查影响显著，应该按年龄段制定正常参考值。定量感觉检查具有可重复性。身体两侧同一部位定量感觉检查具有对称性。     

The electrodiagnostic examination of psychogenic swallowing disorders

The article discusses the usefulness and technique of investigation of suspected psychogenic dysphagia by surface electromyography (sEMG) of deglutition. Thirty-two patients with suspected psychogenic dysphagia (Group 1) and 40 healthy individuals (Group 2) were involved in the study. The timing, amplitude and graphic patterns of activity of the masseter, submental, infrahyoid and trapezius muscles were examined during voluntary single water swallows (“normal”), and continuous drinking of 100 cc of water. The muscle activity in oral, pharyngeal and initial oesophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. Globus hystericus was found in only 14 patients of the Group 1 (43.75%). The main sEMG pattern of psychogenic dysphagia is a lack of any pathologic changes of timing, voltage and graphic patterns of deglutition. In 28% of cases tension of skeletal muscles not involved in deglutition was observed during single swallowing (vs. 0% in controls). Psychogenic/hysteria-conversion dysphagia has no pathologic sEMG patterns associated with deglutition. Skeletal muscle tension during deglutition, being observed in some cases has no connection with the act of swallowing itself. Surface EMG, being non-invasive and non-radiographic, can be used for screening purposes for patients with dysphagia thus avoiding expensive and time-consuming investigation.