Treatment of myogenic temporomandibular disorder: a prospective randomized clinical trial,comparing a mechanical stretching device (TheraBite®) with standard physical therapy exercise

Aims:

To compare in a randomized controlled clinical trial (RCT) the application of the TheraBite® (TB) Jaw Motion Rehabilitation System with a standard physical therapy (PT) exercise regimen for the treatment of myogenic temporomandibular disorder (TMD).

Methodology:

Myogenic TMD patients were randomized for the use of the TB device or for standard PT. Mandibular function was assessed with the mandibular function impairment questionnaire (MFIQ). Pain was evaluated using a visual analog scale, and maximum inter-incisor (mouth) opening (MIO) was measured using the disposable TB range of motion scale.

Results:

Of the 96 patients randomized (46 TB, 50 standard PT exercises), 38 actually started with the TB device and 41 with the standard PT exercises. After six-week follow-up, patients using the TB device reported a significantly greater functional improvement (MFIQ score) than the patients receiving regular PT exercises (P?=?0·0050). At 6 weeks, no significant differences in pain, and active or passive MIO were found between the two groups. At 3 months, patients in both treatment groups did equally well, and showed a significant improvement in all parameters assessed.

Conclusions:

This RCT on myogenic TMD treatment, comparing standard PT with passive jaw mobilization using the TheraBite Jaw Motion Rehabilitation System®, shows that both treatment modalities are equally effective in relieving myogenic TMD symptoms, but that the use of the TB device has the benefit of achieving a significantly greater functional improvement within the first week of treatment.     

Different changes in contractile and histochemical properties of reinnervated and regenerated slow soleus muscles of the guinea-pig

Summary The changes in contraction time (CT) and histochemical muscle fibre pattern are compared with respect to ATPase activity of the slow soleus muscle of the guinea-pig during regeneration in free grafts and reinnervation after nerve interruption. Interruption of the nerve by crushing at birth results first in prolongation of CT which later returns to normal (control) values. A homogeneous fibre pattern is established related to the homogeneity of the motor units constituting the muscle. In the regenerating muscle CT and muscle fibre pattern of the graft repeat the changes during postnatal development, i.e. CT shows progressive prolongation accompanied by transformation of a heterogeneous (fibres of high and low ATPase activity) to a homogeneous (fibres of low activity only) fibre pattern. However, the regenerating muscle also shows an initial phase with slow CT. Thus the changes in reinnervation and regeneration of the muscle after birth differ, the reinnervated muscle revealing only prolongation, the regenerated muscle a temporary shortening followed by prolongation, i.e. a biphasic development of CT.     

Carbon monoxide contributes to the constipating effects of granisetron in rat colon

AIM To investigate the mechanisms underlying the potential contribution of the heme oxygenase/carbon monoxide(HO/CO) pathway in the constipating effects of granisetron. METHODS For in vivo studies, gastrointestinal motility was evaluated in male rats acutely treated with granisetron [25, 50, 75 μg/kg/subcutaneous(sc)], zinc protoporphyrin IX [Zn PPIX, 50 μg/kg/intraperitoneal(ip)] and hemin(50 μmol/L/kg/ip), alone or in combination. For in vitro studies, the contractile neurogenic response to electrical field stimulation(EFS, 3, 5, 10 Hz, 14 V, 1 ms, pulse trains lasting 10 s), as well as the contractile myogenic response to acetylcholine(ACh, 0.1-100 μmol/L) were evaluated on colon specimens incubated with granisetron(3 μmol/L, 15 min), Zn PPIX(10 μmol/L, 60 min) or CO-releasing molecule-3(CORM-3, 100, 200, 400 μmol/L) alone or in combination. These experiments were performed under co-treatment withor without atropine(3 μmol/L, a muscarinic receptor antagonist) or NG-nitro-L-Arginine(L-NNA, 100 μmol/L, a nitric oxide synthase inhibitor).RESULTS Administration of granisetron(50, 75 μg/kg) in vivo significantly increased the time to first defecation(P = 0.045 vs vehicle-treated rats), clearly suggesting a constipating effect of this drug. Although administration of Zn PPIX or hemin alone had no effect on this gastrointestinal motility parameter, Zn PPIX co-administered with granisetron abolished the granisetron-induced constipation. On the other hand, co-administration of hemin and granisetron did not modify the increased constipation observed under granisetron alone. When administered in vitro, granisetron alone(3 μmol/L) did not significantly modify the colon's contractile response to either EFS or ACh. Incubation with Zn PPIX alone(10 μmol/L) significantly reduced the colon's contractile response to EFS(P = 0.016) but had no effect on contractile response to ACh. Co-administration of Zn PPIX and atropine(3 μmol/L) abolished the Zn PPIX-mediated decrease in contractile response to EFS. Conversely, incubation with CORM-3(400 μmol/L) alone increased both the contractile response to EFS at 10 Hz(10 Hz: 71.02 ± 19.16 vs 116.25 ± 53.70, P = 0.01) and the contractile response to ACh(100 μmol/L)(P = 0.012). Co-administration of atropine abolished the CORM-3-mediated effects on the EFS-mediated response. When granisetron was co-incubated in vitro with ZnP PIX, the ZnP PIX-mediated decrease in colon contractile response to EFS was lost. On the other hand, co-incubation of granisetron and CORM-3(400 μmol/L) further increased the colon's contractile response to EFS(at 5 Hz: P = 0.007; at 10 Hz: P = 0.001) and to ACh(ACh 10 μmol/L: P = 0.001; ACh 100 μmol/L: P = 0.001) elicited by CORM-3 alone. L-NNA co-administered with granisetron and CORM-3 abolished the potentiating effect of CORM-3 on granisetron on both the EFSinduced and ACh-induced contractile response.CONCLUSION Taken together, findings from in vivo and in vitro studies suggest that the HO/CO pathway is involved in the constipating effects of granisetron.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Transmastoid Approach for Resurfacing the Superior Semicircular Canal Dehiscence with a Dumpling Structure

Background:

Superior semicircular canal dehiscence (SSCD) is gradually recognized by otologists in recent years. The patients with SSCD have a syndrome comprising a series of vestibular symptoms and hearing function disorders which can be cured by the operation. In this study, we evaluated the characteristics of patients with SSCD and determined the effectiveness of treating this syndrome by resurfacing the canal via the transmastoid approach using a dumpling structure.

Methods:

Patients with SSCD, confirmed by high-resolution computed tomography and hospitalized at Beijing Tongren Hospital between November 2009 and October 2012, were included in the study. All of the patients underwent the unilateral transmastoid approach for resurfacing the canal, and received regular follow-up after surgery. Data from preoperative medical records and postoperative follow-up were comparatively analyzed to evaluate the effect of surgery.

Results:

In total, 10 patients and 13 ears (three left ears, four right ears, three bilateral ears) were evaluated in the study, which included 7 men and 3 women. Different symptoms and distinctive manifestations of vestibular evoked myogenic potential were found in these patients. After surgery, 4 patients had complete resolution, 5 had partial resolution, and 1 patient, with bilateral SSCD, had aggravation. None of the patients suffered from serious complications such as sensorineural hearing loss, facial paralysis, cerebrospinal fluid leakage, or intracranial hypertension.

Conclusions:

In patients with unilateral SSCD, resurfacing the canal via the transmastoid approach using a dumpling structure is an effective and safe technique. However, more consideration is needed for patients with bilateral SSCD.     

运动单位电位多参数分析在肌原性损害中的诊断价值

目的 :探讨运动单位电位 (MUP)多项参数对肌原性损害的诊断价值。方法 :对 10例肌原性病变患者 ,采用棘波触发平均技术 ,得到股四头肌MUP 2 30个 ,肱二头肌MUP 190个 ,胫骨前肌MUP172个 ,对MUP多项参数进行定量分析 ,并与正常对照进行对比。结果 :各项参数与正常对照相比均有显著意义 (P <0 0 0 1～ 0 0 0 0 1) ,经 5 %可信限和均数 - 2 0标准差界值水平的显著性检验和相关性分析 ,证明时限与面积 /波幅比较大小指数、宽度高度指数和面积具有较高的诊断敏感性。结论 :时限与面积 /波幅比对肌原性损害的诊断作用最敏感 ,大小指数、宽高度指数与面积的诊断作用次之 ,波幅的诊断作用最小     

电针介入时机对腰多裂肌损伤模型大鼠Foxo1、Myostatin、Myod蛋白表达的影响

目的:观察不同电针介入时机对腰多裂肌损伤大鼠多裂肌叉头蛋白(Foxo1)、肌肉生长抑制素(Myostatin)、成肌分化因子(Myod)蛋白表达的影响。方法:雄性SD大鼠随机分为空白组、模型组、即刻电针组、24 h电针组、48 h电针组,每组8只。以多裂肌肌注0. 5%布比卡因复制腰多裂肌损伤模型。各电针组分别在造模后即刻、24 h、48 h开始电针双侧"委中""肾俞",连续干预7 d。以Western blot检测各组多裂肌Foxo1、Myostatin、Myod蛋白表达水平。结果:与空白组比较,模型组Foxo1、Myod蛋白表达水平显著升高(P 0. 01);与模型组比较,即刻电针组、48 h电针组Foxo1、Myostatin蛋白表达水平降低(P 0. 01,P 0. 05),24 h电针组Foxo1、Myostatin蛋白表达水平显著降低(P 0. 01),Myod蛋白表达水平显著升高(P 0. 01);与24 h电针组比较,即刻电针组Myostatin蛋白表达水平升高(P 0. 05)、Myod蛋白表达水平显著降低(P 0. 01),48 h电针组Foxo1蛋白表达水平显著升高(P 0. 01)、Myod蛋白表达水平显著降低(P 0. 01)。结论:电针促进多裂肌修复的最佳介入时机可能为损伤后24 h。     

转化生长因子-β1在人横纹肌肉瘤肌源性分化中的作用

目的:探讨转化生长因子-β1(TGF-β1)在横纹肌肉瘤肌源性分化中的作用。方法:采用细胞培养、逆转录多聚酶链式反应(RT-PCR)及免疫荧光染色观察TGF-β1对横纹肌肉瘤细胞系RD肌源性分化相关指标的影响,并用免疫组化SP法,检测49例横纹肌肉瘤组织中TGF-β1表达与肌球蛋白重链(MyHC)之间的相关性。结果:TGF-β1可明显抑制RD细胞肌球蛋白重链mRNA和蛋白的表达。用TGF-β1处理RD细胞后,肌球蛋白重链和肌节肌动蛋白(Sarcomeric-Actin)阳性着色细胞数明显下降(P<0.05)。MyoD1的表达在处理前后未见明显差异。横纹肌肉瘤组织中TGF-β1表达与肌球蛋白重链呈明显负相关(P<0.05)。结论:TGF-β1可抑制RD细胞的肌源性分化,这一作用可能不依赖于MyoD1的调节。TGF-β1信号传导通路可能与横纹肌肉瘤的肌源性分化受阻有关。     

Kruppel样因子4过表达对C2C12肌原细胞中热休克蛋白25表达的影响

目的观察Kruppel样因子4过表达对热休克蛋白25表达的影响。方法运用稳定转染pcDNA3.1/myc-His(-)和Kruppel样因子4-pcDNA3.1/myc-His(-)两种细胞株,采用逆转录聚合酶链反应观察Kruppel样因子4在生理状态和热休克反应时对热休克蛋白25 mRNA表达的影响;采用Western blot观察Kruppel样因子4在生理状态和热休克反应时对热休克蛋白25蛋白表达的影响。结果在正常状态下,两种细胞热休克蛋白25 mRNA及蛋白表达水平均较低。生理状态下,热休克恢复1 h及3 h Kruppel样因子4过表达细胞株热休克蛋白25 mRNA表达水平明显高于转空载体细胞;至热休克恢复6 h后两组细胞热休克蛋白25 mRNA表达无明显差异。在生理状态及热休克恢复不同时间后,Kruppel样因子4过表达细胞热休克蛋白25蛋白表达水平均较空载体组明显增加。结论在生理状态下和热休克反应中,Kruppel样因子4过表达均能够促进C2C12肌原细胞中热休克蛋白25高表达。