多克隆CNTF抗体对肉毒毒素引起肌麻痹超微结构的影响

目的研究多克隆睫状神经营养因子(c iliary neurotroph ic factor,CNTF)抗体对肉毒毒素(botu linum toxin,BTX)引起的肌麻痹的作用。方法10只新西兰兔,分别在双侧眼外肌肌腹和面部皮下注射A型肉毒毒素(botu linum toxin A,BTXA),注射后第4天在右侧眼外肌和面部皮下注射多克隆CNTF抗体,左侧相同部位注射等量生理盐水作为对照,在注射后14 d,行电镜观察双侧眼外肌和面肌的肌细胞、运动终板及神经纤维的改变。结果注射BTXA后14 d眼外肌和面肌的肌纤维均明显萎缩,线粒体肿胀,肌纤维结构无明显破坏;神经髓鞘板层松散,可见髓样小体,运动终板处可见清亮的兴奋性神经递质小泡增多密集。右侧注射CNTF组可见肌细胞核内移,胞质内线粒体肿胀聚集,肌细胞呈空泡样改变,局部肌丝断裂溶解,变性的肌细胞坏死崩解成细胞碎片;运动终板处也可见大量清亮小泡聚集,神经髓鞘增多。结论注射多克隆CNTF抗体后,与单纯注射BTXA者比较,局部肌细胞结构出现不可逆性破坏,延长了肌肉麻痹恢复时间,提示多克隆CNTF抗体可能延长BTX的肌麻痹作用。     

Four-dimensional sonographic assessment of fetal facial expression early in the third trimester.

OBJECTIVE: To evaluate the characteristic patterns of facial expression in fetuses aged from 28 to 34 weeks using 4-dimensional (4-D) ultrasonography. METHODS: The faces of 10 healthy fetuses aged from 28 to 34 weeks were recorded continuously for 15 min with a 4-D ultrasonographic machine performing up to 25 frames per second. The occurrence rates of blinking, mouthing, yawning, tongue expulsion, smiling, scowling, and sucking were evaluated. RESULTS: Mouthing was the most frequent facial expression (median, 6.5; range, 2-19) whereas the least frequent were scowling (median, 1; range, 0-9) and sucking (median, 1; range, 0-2). Mouthing was evident in all fetuses and significantly more frequent than any other movement (P<.05). Yawning (median, 3; range, 0-6), smiling (median, 2; range, 0-9), and blinking (median, 1.5; range, 0-6) were observed in most cases. Tongue expulsion (median, 1.5; range, 0-5), scowling, and sucking were each observed in 6 cases. CONCLUSION: 4-D sonography provides a means of evaluating fetal facial expression early in the third trimester. It may be a key to predicting fetal brain function and well-being and an important modality in future fetal neurophysiologic research.     

面罩给氧在无痛胃镜检查中的应用

目的:探讨无痛胃镜检查中采用面罩给氧技术的可行性和安全性,并与通过鼻塞管给氧法作比较。方法:60例胃镜检查患者随机分为两组,每组30例。通过面罩给氧为观察组,通过鼻塞管给氧为对照组。全部病例先推注枸橼酸芬太尼0．05 mg,后以丙泊酚2．5 mg／kg作为诱导剂量20～50 s内由静脉内注入,患者意识消失后检测血氧饱和度、血压、心率及操作时间,并对两组进行对比。结果:血氧饱和度在对照组麻醉诱导后至检查结束期间明显降低,与诱导前相比有统计学差异(P<0．05),而观察组无此现象。但两组间在血氧饱和度、操作时间、心率、血压(收缩压和舒张压)方面无显著差异(P>0．05)。结论:辅以面罩给氧进行无痛胃镜检查在维持生命体征指标上优于鼻塞管给氧,使无痛苦胃镜检查更为安全。     

Characteristics of facial nerve palsy during childhood in Japan: frequency of varicella–zoster virus association

BACKGROUND: The aim of this study was to clarify the clinical characteristics of facial nerve palsy and the frequency of varicella-zoster virus association in Japanese children, retrospectively. METHODS: The subjects were 30 facial nerve palsy patients less than 15 years old, treated in the Department of Pediatrics, Kawasaki Medical School Hospital, Okayama, Japan, during the last 10 years. RESULTS: The male/female and right/left ratios were 16/14 and 16/13, respectively. The patients included 21 cases (70%) of Bell's palsy, four cases (13%) due to otitis media, three cases (10%) of Ramsay Hunt syndrome and two cases (7%) due to birth trauma. There were six cases of zoster sine herpete among the Bell's palsy cases. CONCLUSION: Varicella-zoster virus-associated facial palsy was found in nine (36%) of the 25 patients examined. Zoster sine herpete was more frequently encountered in children than adults. Ramsay Hunt syndrome was found in school-age children and zoster sine herpete was often found in preschool children. The period of recovery was fast for facial nerve palsy due to acute otitis media, which occurred within 23 months of age, after myringotomy and administration of antibiotics.     

Epineurial application of TNF elicits an acute mechanical hyperalgesia in the awake rat

Abstract   Tumor necrosis factor alpha (TNF) injected into the sciatic nerve and neutralizing antibodies to its receptor injected around the nerve are respectively associated with inducing and blocking pain behavior beginning 1 to 3 days post-injection. This study examined the acute effects of TNF applied around the nerve trunk on the mechanical threshold (determined with von Frey hairs) and withdrawal latency to radiant heat. TNF (0.9 and 7.7 ng in 90 μL) injected onto the nerve via an indwelling catheter elicited a decrease in mechanical threshold. Following the low dose of TNF, no change in thermal latency was observed; after the 7.7 ng dose, thermal thresholds decreased and returned to baseline multiple times within the 3-hour observation period. Identical doses of TNF injected near, but not on the nerve, 90 ng of TNF injected on the nerve, and vehicle were without effect on either modality. These data indicate that effects of acutely administered TNF to the nerve trunk are capable of producing modality specific pain behavior. These changes may represent a first step in TNF-induced neuropathic pain.     

伴有面转代偿头位的先天性下直肌麻痹临床特征与手术治疗

目的：描述伴有面转代偿头位的先天性单纯下直肌麻痹患者的临床表现,并分析其手术治疗效果。

方法：回顾性分析2014-05/2018-07伴有明显面转代偿头位的先天性下直肌麻痹患者,手术前后患者面转程度的变化借助骨科量角器来检查,垂直、水平斜视度变化通过三棱镜交替遮盖试验来测量,旋转斜视度变化通过眼底对眼球客观旋转状态评估。下直肌缩短术是主要治疗方案。

结果：在15例研究对象中,有13例行下直肌缩短术或者联合上直肌后徙术术后疗效好,下直肌运动不足明显改善,眼球运动协调,以面转为主的代偿头位消失,垂直、水平、旋转斜视得到矫正; 并得出：每缩短1 mm下直肌可矫正1.54±0.93°内旋斜视。而行下斜肌断腱术治疗的垂直斜视度小的患者,面转改善不理想,仍遗留眼球运动不协调。

结论：先天性单纯的下直肌麻痹以面转代偿头位为主,下直肌缩短术治疗效果好,轻度的过矫及欠矫不影响手术疗效。     

Facial transplantation: adding to the reconstructive options after severe facial injury and disease

The ability to reconstruct complex facial injuries is still a considerable challenge despite the development of microsurgical techniques. The reconstructive options for conditions such as panfacial burns are severely limited. The result after multiple surgical procedures in this group is often poor in terms of function and cosmesis. Facial transplantation provides a potential solution, but opinion is currently divided about the extent to which the potential benefits to the quality of life can be justified when weighed against the technical, psychological and immunological risks. This paper reviews the current status of the debate and argues that a rigorous research strategy is the only logical basis for countering the ethical objections to a procedure that offers considerable benefits over existing reconstructive options.     

Changes in social emotion recognition following traumatic frontal lobe injury

Changes in social and emotional behaviour have been consistently observed in patients with traumatic brain injury. These changes are associated with emotion recognition deficits which represent one of the major barriers to a successful familiar and social reintegration. In the present study, 32 patients with traumatic brain injury, involving the frontal lobe, and 41 ageand education-matched healthy controls were analyzed. A Go/No-Go task was designed, where each participant had to recognize faces representing three social emotions (arrogance, guilt and jealousy). Results suggested that ability to recognize two social emotions (arrogance and jealousy) was significantly reduced in patients with traumatic brain injury, indicating frontal lesion can reduce emotion recognition ability. In addition, the analysis of the results for hemispheric lesion location (right, left or bilateral) suggested the bilateral lesion sub-group showed a lower accuracy on all social emotions.     

Williams–Beuren syndrome in diverse populations

Williams–Beuren syndrome (WBS) is a common microdeletion syndrome characterized by a 1.5Mb deletion in 7q11.23. The phenotype of WBS has been well described in populations of European descent with not as much attention given to other ethnicities. In this study, individuals with WBS from diverse populations were assessed clinically and by facial analysis technology. Clinical data and images from 137 individuals with WBS were found in 19 countries with an average age of 11 years and female gender of 45%. The most common clinical phenotype elements were periorbital fullness and intellectual disability which were present in greater than 90% of our cohort. Additionally, 75% or greater of all individuals with WBS had malar flattening, long philtrum, wide mouth, and small jaw. Using facial analysis technology, we compared 286 Asian, African, Caucasian, and Latin American individuals with WBS with 286 gender and age matched controls and found that the accuracy to discriminate between WBS and controls was 0.90 when the entire cohort was evaluated concurrently. The test accuracy of the facial recognition technology increased significantly when the cohort was analyzed by specific ethnic population (P‐value < 0.001 for all comparisons), with accuracies for Caucasian, African, Asian, and Latin American groups of 0.92, 0.96, 0.92, and 0.93, respectively. In summary, we present consistent clinical findings from global populations with WBS and demonstrate how facial analysis technology can support clinicians in making accurate WBS diagnoses.