2004-2010年郑州市金水区急性弛缓性麻痹病例流行病学分析与监测系统评价

目的通过分析郑州市金水区急性弛缓性麻痹(AFP)病例的流行病学特征及监测系统敏感性,巩固和维持无脊髓灰质炎(脊灰)状态,指导本区消灭脊灰工作。方法应用中国免疫规划监测信息管理系统软件对数据进行统计分析。结果 2004一2010年共报告AFP病例698例,其中本地病例58例,年报告发病率为3.67/10万～11.62/10万,5岁以下儿童占发病数的96.55%,有17.24%的儿童未全程免疫或免疫史不详;无脊灰病毒野毒株检出和脊髓灰质炎病例报告。结论 AFP发病趋于小年龄化,易感人群依然存在,病例及时就诊率低,应广泛开展家长课堂和社区健康教育,提高家长的免疫接种意识和及时就诊率,同时加强查漏补种和强化免疫工作,提高疫苗免疫覆盖率。     

针灸联合康复训练对早期偏瘫患者恢复下肢运动功能的效果观察

目的：探讨针灸联合康复训练对早期偏瘫患者恢复下肢运动功能的效果。方法：选择本院2009年9月~2011年3月收治的脑卒中偏瘫患者120例,随机分为研究组与对照组各60例,研究组患者在常规治疗的基础上给予针灸治疗及康复训练;对照组给予常规治疗。用Bmnnstmm分期、Fugl—Meyer（FMA）积分法及FCA综合功能评定法,评价患者治疗1、3个月时下肢体运动功能。结果：治疗1、3个月后研究组患者下肢Bmnnstmm分期、FMA积分、FCA行走功能评分均较综合治疗前明显改善,差异有统计学意义（P〈0.05）,且研究组各指标明显优于对照组,两组差异有统计学意义（P〈0.05）。结论：针灸联合康复训练对早期偏瘫患者下肢运动功能的恢复有较好疗效,值得应用。     

Ciliary neurotrophic factor is not required for terminal sprouting and compensatory reinnervation of neuromuscular synapses: re-evaluation of CNTF null mice

Loss of synaptic activity or innervation induces sprouting of intact motor nerve terminals that adds or restores nerve-muscle connectivity. Ciliary neurotrophic factor (CNTF) and terminal Schwann cells (tSCs) have been implicated as molecular and cellular mediators of the compensatory process. We wondered if the previously reported lack of terminal sprouting in CNTF null mice was due to abnormal reactivity of tSCs. To this end, we examined nerve terminal and tSC responses in CNTF null mice using experimental systems that elicited extensive sprouting in wildtype mice. Contrary to the previous report, we found that motor nerve terminals in the null mice sprout extensively in response to major sprouting-stimuli such as exogenously applied CNTF per se, botulinum toxin-elicited paralysis, and partial denervation by L4 spinal root transection. In addition, the number, length and growth patterns of terminal sprouts, and the extent of reinnervation by terminal or nodal sprouts, were similar in wildtype and null mice. tSCs in the null mice were also reactive to the sprouting-stimuli, elaborating cellular processes that accompanied terminal sprouts or guided reinnervation of denervated muscle fibers. Lastly, CNTF was absent in quiescent tSCs in intact, wildtype muscles and little if any was detected in reactive tSCs in denervated muscles. Thus, CNTF is not required for induction of nerve terminal sprouting, for reactivation of tSCs, and for compensatory reinnervation after nerve injury. We interpret these results to support the notion that compensatory sprouting in adult muscles is induced primarily by contact-mediated mechanisms, rather than by diffusible factors.     

Differential skeletal muscle gene expression after upper or lower motor neuron transection

Causes of disuse atrophy include loss of upper motor neurons, which occurs in spinal cord injury (SCI) or lower motor neurons (denervation). Whereas denervation quickly results in muscle fibrillations, SCI causes delayed onset of muscle spasticity. To compare the influence of denervation or SCI on muscle atrophy and atrophy-related gene expression, male rats had transection of either the spinal cord or sciatic nerve and were sacrificed 3, 7, or 14 days later. Rates of atrophy increased gradually over the first week after denervation and then were constant. In contrast, atrophy after SCI peaked at 1 week, then declined sharply. The greater atrophy after SCI compared to denervation was preceded by high levels of ubiquitin ligase genes, MAFbx and MuRF1, which then also markedly declined. After denervation, however, expression of these genes remained elevated at lower levels throughout the 2-week time course. Interestingly, expression of the muscle growth factor, IGF-1 was increased at 3 days after denervation when fibrillation also peaks compared to SCI. Expression of IGF-1R, GADD45, myogenin, and Runx1 were also initially increased after denervation or SCI, with later declines in expression levels which correlated less well with rates of atrophy. Thus, there were significant time-dependent differences in muscle atrophy and MAFbx, MuRF1, and IGF-1 expression following SCI or denervation which may result from distinct temporal patterns of spontaneous muscle contractile activity due to injury to upper versus lower motor neurons.     

Substrate metabolism during exercise in the spinal cord injured

The primary aim of the study was to examine substrate metabolism during combined passive and active exercise in individuals with spinal cord injury (SCI). Nine men and women with SCI (mean age 40.6 ± 3.4 years) completed two trials of submaximal exercise 1 week apart. Two maintained a complete injury and seven had an incomplete injury. Level of injury ranged from thoracic (T4–T6 and T10) to cervical (four C5–C6 and three C6–C7 injuries). During two bouts separated by 1 week, subjects completed two 30 min sessions of active lower-body and passive upper-body exercise, during which heart rate (HR) and gas exchange data were continuously assessed. One-way analysis of variance with repeated measures was used to examine differences in all variables over time. Results demonstrated significant increases (P < 0.05) in HR and oxygen uptake (VO₂) from rest to exercise. Respiratory exchange ratio (RER) significantly increased (P < 0.05) during exercise from 0.85 ± 0.02 at rest to 0.95 ± 0.01 at the highest cadence, reflecting increasing reliance on carbohydrate from 50.0 to 83.0% of energy metabolism. Data demonstrate a large reliance on carbohydrate utilization during 30 min of exercise in persons with SCI, with reduced contribution of lipid as exercise intensity was increased. Strategies to reduce carbohydrate utilization and increase lipid oxidation in this population should be addressed.     

Muscle spasticity associated with reduced whole-leg perfusion in persons with spinal cord injury

Abstract

Objective

To determine the association between peripheral blood flow and spasticity in individuals with spinal cord injury (SCI).

Design

A cross-sectional study with measurements of muscle spasticity and whole-limb blood flow in individuals with SCI.

Setting

University of Texas at Austin and Brain & Spine Recovery Center, Austin, TX, USA.

Participants

Eighteen individuals (14 males and 4 females) with SCI were classified into high (N = 7), low (N = 6), and no (N = 5) spasticity groups according to the spasticity levels determined by the modified Ashworth scale scores.

Interventions

Whole-limb blood flow was measured in the femoral and brachial arteries using Doppler ultrasound and was normalized to lean limb mass obtained with dual-energy X-ray absorptiometry.

Outcome measures

Limb blood flow and muscle spasticity.

Results

Age, time post-SCI, and the American Spinal Injury Association impairment scale motor and sensory scores were not different among groups with different muscle spasticity. Femoral artery blood flow normalized to lean leg mass was different (P = 0.001) across the three spasticity groups (high 78.9 ± 16.7, low 98.3 ± 39.8, no 142.5 ± 24.3 ml/minute/kg). Total leg muscle spasticity scores were significantly and negatively correlated with femoral artery blood flow (r = ?0.59, P < 0.01). There was no significant difference in brachial artery blood flow among the groups.

Conclusions

Whole-leg blood flow was lower in individuals with greater spasticity scores. These results suggest that a reduction in lower-limb perfusion may play a role, at least in part, in the pathogenesis leading to muscle spasticity after SCI.     

低钾麻痹诊治的研究进展

低钾麻痹(HP)是一种常见的可逆性的电解质紊乱所致内科急症，深入的病因分析对避免错失治愈时机是非常重要的，电解质及酸碱平衡状况的检查对HP的鉴别诊断提供了有力的证据。作者就导致HP的多种疾病进行综述。     

产瘫后肩关节内旋挛缩畸形的手术治疗

目的：介绍用肩胛下肌起点剥离术及前路松解术，治疗产瘫后肩关节内旋挛缩后遗症的方法及疗效。方法：对３６例经盂肱角测定、肩关节中立位被动外旋及Ｘ线诊断为肩关节内旋挛缩的患儿，采用肩胛下肌起点剥离或止点延长、关节复位及继发性畸形纠正等手术进行治疗。用Ｍａｌｅｔ评分及Ｇｉｌｂｅｒｔ分级两项定量评价系统来评价术前、术后功能。结果：术后随访半年，３２例有效，有效率为８８．８％。年龄愈小疗效愈佳。４例无效者，３例术前无屈肘功能，提示臂丛上干恢复差；１例肩胛下肌止点切断后未作重建。结论：肩胛下肌起点剥离术或前路松解术，是治疗产瘫后肩内旋挛缩的有效方法，疗效与患儿年龄及臂丛上干的恢复程度密切相关     

A simple technique for milking the venom of a small parasitic wasp, Melittobia digitata (Hymenoptera: Eulophidae).

We describe a simple method for obtaining good a quantity of pure venom from a small parasitoid wasp, Melittobia digitata. Crushing the insect's head causes venom to be extruded from the ovipositor that dries rapidly as it is collected onto an insect pin. This technique may be applicable to other parasitic Hymenoptera.     

Scapular deformity in obstetric brachial plexus palsy: a new finding

While most obstetric brachial plexus palsy patients recover arm and hand function, the residual nerve weakness leads to muscle imbalances about the shoulder which may cause bony deformities. In this paper we describe abnormalities in the developing scapula and the glenohumeral joint. We introduce a classification for the deformity which we term Scapular Hypoplasia, Elevation and Rotation. Multiple anatomic parameters were measured in bilateral CT images and three-dimensional CT reconstruction of the shoulder girdle of 30 obstetric brachial plexus palsy patients (age range 10 months-10.6 years). The affected scapulae were found to be hypoplastic by an average of 14% while the ratio of the height to the width of the body of scapula (excluding acromion) were not significantly changed, the acromion was significantly elongated by an average of 19%. These parameters as well as subluxation of the humeral head (average 14%) and downward rotation in the scapular plane were found to correlate with the area of scapula visible over the clavicle. This finding provides a classification tool for diagnosis and objective evaluation of the bony deformity and its severity in obstetric brachial plexus palsy patients.