Botulinum toxin in post-stroke patients: stiffness modifications and clinical implications

Abstract.Objective: To objectively quantify stiffness and clinical changes in the upper limb of poststroke patients following botulinum toxin (BT) injection.Methods: Eighteen consecutive chronic post-stroke spastic patients were injected Botulinum toxin A in the forearm flexor spastic muscles. Spasticity was clinically evaluated with the Ashworth scale. Stiffness was measured with indices (passive stiffness index (ISI) and total stiffness index (TSI) obtained by mechanical wrist displacements induced by a torque motor,which could also provide the stretch reflex threshold speed (SRTS) from flexor muscles. Functional status was measured with the Barthel index and a specific hand ability scale, pain with a visual analogue scale (VAS). The ranges of voluntary wrist extension (EROM) and flexion (FROM) and wrist isometric extension and flexion (IE—IF) strength were also calculated.Results: IE and EROM significantly increased, being respectively p < 0.01 and p < 0.05; also SRTS was augmented (p < 0.001),while TSI showed lower values (p < 0.001); the Ashworth score decreased at least one point.Hand function for selected tasks improved in 50% of patients, the Barthel index only in 4 (22 %), forearm pain was completely relieved in 3 patients (17 %).Conclusions: BT can be considered a valid therapeutic tool in all spastic patients, because of immediate advantages: reduction of muscle hypertonia, pain relief, improvement in selected motor performances.     

Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh

BACKGROUND: The development of intra-abdominal adhesions, bowel obstruction, and enterocutaneous fistulas are potentially severe complications related to the intraperitoneal placement of prosthetic biomaterials. The purpose of this study was to determine the natural history of adhesion formation to polypropylene mesh and two types of polytetrafluoroethylene (ePTFE) mesh when placed intraperitoneally in a rabbit model that simulates laparoscopic ventral hernia repair. MATERIALS AND METHODS: Thirty New Zealand white rabbits were used for this study. A 10-cm midline incision was performed for intra-abdominal access and a 2 cm x 2 cm piece of mesh (n = 60) was sewn to an intact peritoneum on each side of the midline. Two types of ePTFE mesh (Dual Mesh and modified Dual Mesh, W.L. Gore & Assoc., Flagstaff, AZ) and polypropylene mesh were compared. The rate of adhesion formation was evaluated by direct visualization using microlaparoscopy (2-mm endoscope/trocar) at 7 days, 3 weeks, 9 weeks, and 16 weeks after mesh implantation. Adhesions to the prosthetic mesh were scored for extent (%) using the Modified Diamond Scale (0 = 0%, 1 50%). At necropsy the mesh was excised en bloc with the anterior abdominal wall for histological evaluation of mesothelial layer growth. RESULTS: The mean adhesion score for the polypropylene mesh was significantly greater (P < 0.05) than Dual Mesh at 9 weeks and 16 weeks and modified Dual Mesh at 7 days, 9 weeks, and 16 weeks. Fifty-five percent (n = 11) of the polypropylene mesh had adhesions to small intestine or omentum at necropsy compared to 30% (n = 6) of the Dual Mesh and 20% (n = 4) of the modified Dual Mesh. There was a significantly greater percentage (P < 0.003) of ePTFE mesh mesothelialized at explant (modified Dual Mesh 44.2%; Dual Mesh 55.8%) compared to the polypropylene mesh (12.9%). CONCLUSIONS: Serial microlaparoscopic evaluation of intraperitoneally implanted polypropylene mesh and ePTFE mesh in a rabbit model revealed a progression of adhesions to polypropylene mesh over a 16 week period. The pore size of mesh is critical in the development and maintenance of abdominal adhesions and tissue ingrowth. The macroporous polypropylene mesh promoted adhesion formation, while the microporous nature of the visceral side of the ePTFE served as a barrier to adhesions.     

Management of vaginal erosion of polypropylene mesh slings

PURPOSE: The SPARC (American Medical Systems, Minneapolis, Minnesota) polypropylene sling has recently been introduced as an alternative delivery system to TVT (Ethicon, New Brunswick, New Jersey) tension-free vaginal tape for placement of a tension-free mid urethral sling. Erosion must always be considered a risk of synthetic materials. We present 4 cases of vaginal erosion of polypropylene mesh placed with this system and the successful conservative management done. MATERIALS AND METHODS: A total of 90 patients received a SPARC polypropylene pubovaginal sling at our institution between October 1, 2001 and October 1, 2002. During followup 3 of our patients and 1 patient with tension-free vaginal tape who was referred from elsewhere presented with vaginal exposure of the mesh. RESULTS: Two patients described persistent vaginal discharge 6 weeks postoperatively, including 1 who complained primarily of partner discomfort during sexual intercourse. Two patients were completely asymptomatic and mesh erosion was discovered at routine physical examination 6 weeks postoperatively. Pelvic examination demonstrated vaginal exposure of the mesh in all cases. Each patient was observed conservatively and 3 months postoperatively all 4 had complete spontaneous epithelialization over the mesh. None had stress incontinence, urgency or urge incontinence, all emptied the bladder to completion and all patients were completely satisfied with the procedure. CONCLUSIONS: The recent literature suggests that polypropylene mesh erosion should be treated with complete removal of the sling material. We present 4 cases of vaginal erosion of polypropylene slings that were managed conservatively with observation and resulted in complete spontaneous healing. Sling preservation with continued patient continence and satisfaction is a feasible option in those with vaginal exposure of polypropylene mesh.     

Influence of periodontal receptors on the jaw-jerk reflex amplitude in man

To study the role of periodontal mechanoreceptors in the modulation of the human jaw-jerk reflex, 60 reflexes were elicited in each of six healthy individuals under three different conditions: (a) with unilateral tooth support on the ipsilateral side; (b) with support on the contralateral side; and (c) with support and local anesthesia of the periodontal tissues on the ipsilateral side. During all conditions, background muscle activity and mandibular displacement were kept as constant as possible. Using on-surface EMG and the amplitude of the first peak of the biphasic jaw-jerk potential as the outcome variable, a condition-dependent reflex amplitude was found for the visually controlled right anterior temporalis muscle. Specifically, the 'ipsilateral support plus anesthesia' condition yielded higher amplitudes than the 'ipsilateral support' condition. Highest amplitudes were found for the 'contralateral support' condition. It was concluded that periodontal mechanoreceptors on the ipsilateral side have an inhibitory effect on the jaw-jerk reflex amplitude in the anterior temporalis muscle.     

穴位注射配合关节拔伸治疗肩周炎临床观察

目的:探讨提高肩周炎疗效的治疗方案.方法:收集160例患者随机分为2组,治疗组80例,对照组80例.治疗组采用穴位注射配合关节拔伸治疗,对照组采用单纯穴位注射治疗.结果:治疗组治愈率65%,对照组治愈率40%,2者差异有显著性意义(P＜0.05).结论:穴位注射配合关节拔伸治疗肩周炎疗效明显优于单纯穴位注射,尤其在改善肩关节活动功能上更优于单纯穴位注射.因此为提高临床疗效,穴位注射必须同关节拔伸治疗有机地结合起来.     

Calculating virtual pitch

A procedure for the schematic and automatic extraction of 'fundamental pitch' from complex tonal signals, such as voiced speech and music, has been developed. While the auditively relevant 'fundamental' of a complex signal cannot be defined in purely mathematical terms, an existent model of virtual-pitch perception turns out to provide a suitable basis. The procedure comprises the formation of determinant spectral pitches (or 'fundamental frequency') from those spectral pitches. The latter deduction is accomplished by a principle of subharmonic matching, for whose realization a simple, universal and efficient algorithm was found. While the calculation may be confined to the determination of 'nominal' virtual pitch, certain typical auditory phenomena, such as the influence of SPL, partial masking and interval stretch, may be accounted for as well, in which case 'true' virtual pitch is obtained. The procedure operates on the frequencies and amplitudes of the signal's spectral components, is suitable for implementation on readily available programmable calculators and other arithmetic computers, and may be used in real-time 'fundamental-pitch' extraction as well. The procedure's performance and its applicability to the research and engineering of auditory communication are illustrated by some examples.     

内关穴双向调节作用考略

[目的]归纳内关穴对多病症的双向调节作用。[方法]采集古代文献,整理出内关穴定位、主治症及相关配穴处方的原文,按病症进行分析归纳。[结果]通过本次文献研究,证明了内关穴对心肺、脾胃、大肠小肠、女子胞宫等脏腑的病症有双向调节作用。[结论]内关穴有多项双向调节作用。     

Stretch reflex variation in the relaxed and the pre-activated quadriceps muscle of normal humans

The stretch reflex to patellar tendon taps was quantified by force measurements at the ankle in 7 normal subjects. In each experiment the stretch reflex was elicited from 14 consecutive stretches by two types of hammers (an ordinary hand-held hammer and a motorized hammer) in the relaxed and the pre-activated quadriceps muscle. The coefficient of variation for the 14 stretch reflexes fell from 54% in the relaxed muscle to 39% in the contracting muscle (p less than 0.05). The stretch reflex varied less between the different levels of active contraction than between the relaxed state and the contracted level (p less than 0.05). The experiment was repeated in all subjects and at all contraction levels. The coefficient of variation of the mean for the two experiments fell non-significantly from a mean value of 27% in the relaxed muscle to 14% in the contracting muscle. The coefficients of variation for the two hammers were almost identical. It is concluded that quantification of the stretch reflex can be made more precisely in the contracting muscle.     

周围神经不同节段扩张延长的实验研究

目的：比较神经不同节段扩张延长与神经移植复神经缺损的效果。方法：将SD大鼠按手术先后分成5组，每组8只大鼠。A组近段扩张，B组远段扩张，C组近远段同时扩张，D组移植，E组为对照组，扩张后分别进行神经修复，术后60－80d作组织学，电生理学，计算机图像分析及腌肠肌肌湿重检测。结果：A，B与C组的坐骨神经约延长30％，各项检测结果均显示以C组的神经生最好，以下依次为A，B，D组。结论：用组织扩张器延长周围神经可修复长段神经缺损，效果优于自体神经移植，神经近，远段同时扩张延长后修复神经缺损的效果优于近段扩张或远段扩张，而近段扩张又优于远段扩张。