Biomechanical approaches applied to the lower and upper limb for the measurement of spasticity: A systematic review of the literature

Purpose: To review and characterise biomechanical approaches for the measurement of spasticity as one component of the upper motor neurone syndrome. Method: Systematic literature searches based on defined constructs and a four-step review process of approaches used or described to measure spasticity, its association with function or associated phenomena. Most approaches were limited to individual joints and therefore, to reflect this trend, references were grouped according to which body joint(s) were investigated or whether it addressed a functional activity. For each joint, references were further sub-divided into the types of measurement method described. Results: A database of 335 references was established for the review process. The knee, ankle and elbow joints were the most popular, perhaps reflecting the assumption that they are mono-planar in movement and therefore simpler to assess. Seven measurement methods were identified: five involving passive movement (manual, controlled displacement, controlled torque, gravitational and tendon tap) and two involving active movement (voluntary and functional). Generally, the equipment described was in an experimental stage and there was a lack of information on system properties, such as accuracy or reliability. Patient testing was either by cohort or case studies. The review also conveyed the myriad of interpretations of the concept of spasticity. Conclusions: Though biomechanical approaches provide quantitative data, the review highlighted several limitations that have prevented them being established as an appropriate method for clinical application to measure spasticity.     

Handling of risk-bearing drugs during pregnancy

The drug use of nearly 2,000 pregnant women was evaluated at the level of the individual patient for the drugs belonging to the Australian risk categories B3, C and D. The pattern of changes in the use of these drugs is studied in terms of women who discontinue (d), continue (c) or begin (b) using the drug during pregnancy. The ratios d/(c+b) and d/b were the highest for the drugs belonging to the high-risk groups and the lowest for drugs from the low-risk categories. This suggests a congruence between theoretical knowledge and daily practice. Patients who had already been using a drug for a long time before pregnancy, more frequently continued using that drug than patients who had been using the drug only incidentally before. The described daily dose for the riskful drugs was approximately 20% lower in patients who started to use a drug during pregnancy compared to those who continued drug use. The data from this analysis indicate that the prescribing physician is generally aware of the possible risks of drug use during pregnancy. The d/(b+c) and d/b ratios are shown to be a good measure of prescribing behaviour in relation to pregnancy and can be used to compare knowledge of theory and daily practice.     

前列腺癌及前列腺上皮内瘤13号染色体等位基因杂合性缺失分析

目的　探讨原发性前列腺癌及高级别前列腺上皮内肿瘤 (PIN) 13号染色体等位基因杂合性缺失 (LOH)及其意义。　方法　经显微切割技术获取前列腺癌及PIN标本各 10例。提取DNA ,采用PCR及微卫星多态性技术 ,对 13号染色体上 14个微卫星标志位点LOH进行检测。　结果　 10例原发性前列腺癌中 7例 13号染色体上至少有一个位点检测到LOH。 13q14及 13q12～ 13为两个高频LOH区。 10例PIN中 13号染色体的 14个位点均未检测到LOH。　结论　前列腺癌中存在 13号染色体的高频LOH区 ,乳腺癌易感基因 (BRCA2 )、视网膜母细胞瘤基因 (RB1)及位于附近的肿瘤抑制基因可能与前列腺癌的发生发展有关     

The workload of GPs: consultations of patients with psychological and somatic problems compared

BACKGROUND: GPs report that patients' psychosocial problems play a part in 20% of all consultations. GPs state that these consultations are more time-consuming and the perceived burden on the GP is higher. AIM: To investigate whether GPs' workload in consultations is related to psychological or social problems of patients. DESIGN OF STUDY: A cross-sectional national survey in general practice, conducted in the Netherlands from 2000-2002. SETTING: One hundred and four general practices in the Netherlands. METHOD: Videotaped consultations (n = 1392) of a representative sample of 142 GPs were used. Consultations were categorised in three groups: consultations with a diagnosis in the International Classification of Primary Care chapter P 'psychological' or Z 'social' (n = 138), a somatic diagnosis but with a psychological background according to the GP (n = 309), or a somatic diagnosis and background (n = 945). Workload measures were consultation length, number of diagnoses and GPs' assessment of sufficiency of patient time. RESULTS: Consultations in which patients' mental health problems play a part (as a diagnosis or in the background) take more time and involve more diagnoses, and the GP is more heavily burdened with feelings of insufficiency of patient time. In consultations with a somatic diagnosis but psychological background, GPs more often experienced a lack of time compared to consultations with a psychological or social diagnosis. CONCLUSION: Consultations in which the GP notices psychosocial problems make heavier demands on the GP's workload than other consultations. Patients' somatic problems that have a psychological background induce the highest perceived burden on the GP.     

Cardiovascular effects of agmatine within the rostral ventrolateral medulla are similar to those of clonidine in anesthetized rats

Agmatine was isolated from bovine brain in 1994. It exhibits various functions, as a consequence of which it meets the criteria for an endogenous brain neurotransmitter. However, its physiological action on the cardiovascular system remains unclear. This study was designed to clarify its cardiovascular effects when administered into the rostral ventrolateral medulla （RVLM） in anesthetized and paralyzed rats. Unilateral injection of clonidine （5 nmol） into the RVLM significantly decreased mean arterial pressure （MAP） and heart rate （HR）.     

Information about drugs in family magazines

Family magazines can play an important role in the diffusion of medical information and information regarding drugs to a ‘lay audience’. We describe what kind of drugs are discussed in the family magazines and which information regarding these drugs is given. Furthermore, we look into the information sources for journalists; special attention is paid to the role of the pharmacist: is (s)he recognized by journalists as one of the experts on drugs? Two approaches were used in order to answer the above described research questions: a content analysis of family magazines and indepth interviews of journalists. Gynaecological products as well as drugs for the central nervous system receive much attention in family magazines. The kind of information given about drugs is limited. Only part of the publications pays attention to side-effects. Patients asking questions about drugs in response to publications in family magazines know the name of a drug but are rarely informed about other aspects of the therapy, such as side-effects. In the provision of information physicians and medical specialists play an important role as sources of information for journalists. There is, however, until now no role for the pharmacist as a source of information on drugs in family magazines.     

Molecular phenotype of a human lymphoblastoid cell-line homoplasmic for the np 7445 deafness-associated mitochondrial mutation

We have studied mitochondrial gene expression and metabolic function in a human lymphoblastoid cell-line homoplasmic for the np 7445, deafness- associated mitochondrial DNA mutation. The mutation maps to the 3' termini of the oppositely oriented genes encoding cytochrome oxidase subunit I (COI) and tRNA-ser(UCN). In comparison with control lymphoblastoid cells, we detected a marked depletion (> 60%) of tRNA- ser(UCN). There was, however, no significant impairment of respiratory function, no alteration to the structure or abundance of COI mRNA or its precursors, and no detectable abnormality of mitochondrial protein synthesis. We also found considerable tissue-variation in the abundance of tRNA-ser(UCN). We propose that the tissue-specific phenotype associated with this mutation results from an inherent deficiency in the processing of the mutant pre-tRNA, that becomes limiting for protein synthesis only in a restricted set of cells of the auditory system in which the tRNA is, for other reasons, already at a critically low level.      

Increased risk of squamous cell carcinoma in junctional epidermolysis bullosa

Non-Herlitz junctional epidermolysis bullosa (JEB) is an autosomal recessive genodermatosis characterized by skin fragility and blistering. It is usually caused by mutations in the genes encoding the basement membrane proteins laminin 5 or type XVII collagen. Clinically, impaired wound healing and chronic erosions cause major morbidity in affected patients. Previously it was thought that these individuals, unlike patients with dystrophic EB, did not have an increased risk of developing skin cancer. However, we describe three patients with non-Herlitz JEB (aged 42, 56 and 75 years) who developed cutaneous squamous cell carcinomas (SCCs). The tumours were well-differentiated in two cases, but one patient had multiple primary SCCs that were either well- or moderately differentiated. Most cases of SCC in non-Herlitz JEB described have occurred in those with laminin 5 defects and on the lower limbs. These clinicopathological observations have important implications for the management of patients with this mechanobullous disorder as well as providing further insight into the biology of skin cancer associated with chronic inflammation and scarring.