Clinical application of adult olfactory bulb ensheathing glia for nervous system repair

The ability of adult olfactory bulb ensheathing glia (OB-OEG) to promote histological and functional neural repair has been broadly documented. Pre-clinical studies show that beneficial effects of adult OB-OEG are repeatable in the same type of spinal cord injury initially tested, in other spinal cord and CNS injury models, in different species and after the administration of these cells in different forms (either alone or in combination with other cells, drugs, products or devices). These studies demonstrate the reproducibility, robustness, fundamental nature and relevance of the findings. Therefore, the use of adult OB-OEG for spinal cord injury repair meets the scientific criteria established by the International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) for the translation to human application.Because there is so much heterogeneity in the way adult OEG is administered, each of these different OEG-based therapies must be individually categorized to determine whether they fulfill the requisites dictated by the consolidated regulatory body to be considered or not as a medicine. In the case they do, in Europe, they shall be subjected to the Regulatory European Framework for Advanced Therapy Medicinal Products and the European Clinical Trials Directive (Directives 2001/20/EC and 2009/120/EC). After a deep analysis of the European Regulation we have concluded that grafts consisting of suspensions of purified adult OEG, to be used for the promotion of axonal regeneration in the CNS, do not comply with the definition of Medicinal Product provided by the European Medicines Agency. In contrast, experimental therapies using OEG in combination with other cell types, drugs, products or devices, or genetically-modified OEG fall under the definitions of Medicinal Product. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.     

经筋刺法治疗难治性周围性面神经麻痹临床观察

目的 研究以石学敏教授＂经筋、皮部＂理论为指导的经筋刺法对难治性周围性面神经麻痹患者面部功能的改善作用.方法 将20例难治性周围性面神经麻痹的患者随机分为两组,治疗组与对照组各10例.对照组予普通针刺治疗,治疗组予经筋刺法治疗.治疗前及治疗后采用House-Brackmann分级量表进行评价分级,并比较两组患者临床疗效.结果 治疗组总有效率（90.0%）均优于对照组（80.0%）,两组比较,差异有统计学意义（P＜0.05）.治疗组House-Brackmann分级量评分的改善优于对照组.结论 以石学敏教授＂经筋、皮部＂理论为指导的经筋刺法对难治性周围性面神经麻痹面部功能具有良好的改善作用.     

某市2006～2011年急性弛缓性麻痹病例的监测系统评价

目的了解周口市急性弛缓性麻痹(AFP)发病情况,探讨消灭脊灰后AFP监测工作措施。方法对周口市2006~2011年AFP病例监测资料进行流行病学分析,并对AFP病例监测系统进行评价。结果 2006~2011年全市共报告AFP病例353例,未发现脊灰野病毒引起的病例。病例分布在全市10个县(区),发病以0～4岁儿童为主,占77.34%;男性发病多于女性,男女比例2.84∶l;所有监测病例经河南省专家诊断组诊断均为排除脊灰病例,格林巴利综合征最多,占36.26%。自2006年起,15岁以下儿童非脊灰AFP病例报告发病率均>l/10万,各项主要监测指标均达到了卫生部规定的80%的要求。结论周口市AFP监测系统运转正常,系统报告敏感、及时、准确,监测报告质量不断提高,但仍有一些问题有待进一步改进。     

喉返神经麻痹的CT表现

目的 分析喉返神经麻痹的CT表现，探讨其解剖和病理形态变化基础，提高对其影像学表现的认识。方法 搜集2001至2003年经临床诊断的喉返神经麻痹患者32例，回顾性分析CT资料。所有患者均行全颈部CT增强扫描，范围从舌骨水平到上胸部水平，层厚及间隔均为5mm。结果 喉返神经麻痹后，CT检查可出现一系列相应表现：杓会厌皱襞、杓状软骨及环杓关节前内侧移位，同侧梨状窝扩张、松弛27例（84．4％）；喉室扩大16例（50．0％）；声带不对称且固定11例（34．4％）等。结论 喉返神经支配除环甲肌以外的所有喉内肌，其麻痹后所支配的肌肉群可以发生去神经性萎缩。CT扫描可以有效地显示其相应改变，同时有助于明确麻痹原因。     

银杏叶提取物金纳多治疗外伤性眼外肌麻痹

目的 观察银杏叶提取物金纳多对外伤性眼外肌麻痹的治疗效果.方法 68例（74眼）外伤性眼外肌麻痹分为两组,观察组应用金纳多注射液治疗,对照组给予传统的营养神经药物治疗,观察症状、体征改善的情况,比较两组的疗效.结果 观察组治愈率和有效率均明显高于对照组（x2=14.51,9.86,P＜0.05）.结论 应用金纳多注射液治疗外伤性眼外肌麻痹,提高了治愈率.     

超声引导下置管持续阻滞星状神经节治疗周围性面神经麻痹的体会

目的评估超声引导下置管持续星状神经节阻滞术治疗周围性面神经麻痹的临床价值。方法周围性面神经麻痹患者12例在超声显像确认颈6横突后,置管于颈6～7横突之间,行持续星状神经节阻滞15d。结果全组均穿刺置管成功,出现霍纳综合征且未见相关并发症,痊愈9例,好转3例。结论在超声引导下置管持续星状神经节阻滞术是一种安全、有效治疗面神经麻痹的方法。     

Guillain-Barré Syndrome in India: population-based validation of the Brighton criteria

Objective

Case definitions of GBS were recently developed in response to the 2009 H1N1 vaccination programme but have undergone limited field testing. We validate the sensitivity of the Brighton Working Group case definitions for Guillain-Barré Syndrome (GBS) using a population-based cohort in India.

Methods

The National Polio Surveillance Unit of India actively collects all cases of acute flaccid paralysis (AFP) in children <15 years old, including cases of GBS. Cases of GBS with available cerebrospinal fluid (CSF) and nerve conduction studies (NCS) results, neurological examination, clinical history, and exclusion of related diagnoses were selected (2002-2003). Relevant data were abstracted and entered into a central database. Sensitivity of the Brighton GBS criteria for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF or NCS, and level 1 which employs both, were calculated.

Results

79 cases of GBS (mean age 6.5 years, range 4.0-14.5; 39% female) met the case definition. GBS cases were ascending (79%), symmetrical (85%), and bilateral (100%); involving lower extremity hypotonia (86%) and weakness (100%), upper extremity hypotonia (62%) and weakness (80%), areflexia/hyporeflexia (88%), respiratory muscles (22%), bulbar muscles (22%), and cranial nerves (13%). Four limbs were involved in 80% of cases. Mean time to maximal weakness was 5.2 days (range 0.5-30 days) with nadir GBS disability scores of 3 (7%), 4 (67%), 5 (15%), 6 (10%), or unclear (1%). CSF (mean time to lumbar puncture 29 days) was normal in 29% with cytoalbuminologic dissociation in 65% (mean protein 105 mg/dL, range 10-1000; mean cell count 11/μL, range 0-220, n = 4 with >50 cells/μL). Significant improvement occurred in 73% whereas death (9%) occurred 6-29 days after sensorimotor symptom onset. The majority of cases (86%) fulfilled Brighton level 3, level 2 (84%), and level 1 (62%) of diagnostic certainty.

Conclusion

The diagnosis of GBS can be made using Brighton Working Group criteria in India with moderate to high sensitivity. Brighton Working Group case definitions are a plausible standard for capturing a majority of cases of GBS in field operations in low income settings during AFP surveillance.     

A new clinical entity in T704M mutation in periodic paralysis

Periodic paralyses (PPs) are a group of rare disorders characterized by episodic, sudden-onset, flaccid paralysis of skeletal muscles usually resulting in complete recovery after the attacks. PPs are caused by abnormal, mostly potassium-sensitive excitability of the muscle tissue. Hypokalemic and hyperkalemic periodic paralysis (HypoKPP and HyperKPP) have been described according to their characteristic phenotypes and the serum potassium level during the attacks of weakness. The T704M mutation on the SCN4A gene is the most common mutation in HyperKPP. Different mutations of the SCN4A gene have also been reported in some cases of HypoKPP. In this study, a large Turkish family carrying the T704M mutation on the SCN4A gene with HypoKPP disease was examined. A similar history was noted in a total of 17 subjects in the pedigree. SCN4A gene of the patients was sequenced with Sanger sequencing. In this study, this mutation was associated with a HypoKKP diagnosis for the first time in the literature. The symptoms of hallucination and diplopia seen in patients had also never been indicated in the literature before. This report expands the phenotypic variability of the T704M mutation, further confirming the lack of genotype-phenotype correlation in SCN4A mutations.     

Anatomic factors affecting the use of ultrasound to predict vocal fold motion: A pilot study

Purpose

Ultrasonography is a well-established modality for visualization of head and neck anatomy. Using ultrasound to detect vocal fold mobility has been described before, but no study has evaluated factors affecting the exam reliability. The aim of the study is to determine anatomic factors influencing the reliability of ultrasound to detect vocal fold motion.Methods and materialsPatients underwent ultrasound evaluation and flexible laryngoscopy to assess vocal fold motion from August 2015 to March 2016. Length, accuracy, and clarity of ultrasound examination were assessed, compared to flexible laryngoscopy. For patients with prior neck CT scan imaging, laryngeal anatomy was independently assessed by a blinded neuroradiologist.

膈神经移位治疗产伤性臂丛神经麻痹对呼吸功能的影响

目的 提高对膈神经移位治疗产瘫术后对呼吸功能影响的认识。方法对６８例产瘫患儿术后呼吸系统变化进行分组分析。结果 膈神经移位组术后摄胸片一侧膈肌均有胎高,透视下随呼吸呈矛盾运动,术后呼吸窘迫、肺炎、肺不张等明显高于非膈神经移位组。按年龄划分小于６个月手术并发症同于６个月以上组,呼吸窘迫均出现在小于３个月的手术组中,结论 膈神经作为移位神经被广泛应用的治疗产瘫手术中,临床上６个月以下取膈神经应慎重,尤