Mechanisms of tizanidine action on spasticity

This investigation estimated the mechanisms of tizanidine action on spasticity using a battery of neurophysiological methods. Thirty patients with old post-stroke spastic hemiparesis took part in the investigation. They were treated with tizanidine-mean daily dose 15.8 ± 5.6 mg for a mean of 23.3 ± 4.8 days. A questionnaire for assessment of subjective improvement after treatment used a 5-point scale. For standardization of the neurological examination 5-point scales were used to assess muscle tone, muscle force and tendon reflexes. A battery of neurophysiological methods was used to analyze different mechanisms of spasticity: for alpha motoneuron excitability – the F wave parameters; for presynaptic inhibition – the ratio of H reflex amplitudes before and after vibration of the achilles tendon (Hvibr/Hmax); for common interneuron activity – the flexor reflex parameters. Our results revealed that tizanidine reduces spastically increased muscle tone, but has no influence on muscle force, tendon reflexes, Babinski sign and ankle clonus. Tizanidine is supposed to act by increasing the presynaptic inhibition and decreasing of alpha motoneuron excitability. When spasticity has decreased presynaptic inhibition and increased motoneuron excitability, it is better to treat with tizanidine.     

肌蒂移植术治疗陈旧性脊髓损伤(附56例报告)

作者采用肌蒂移植术治疗胸腰段陈旧性脊髓损伤56例.脊髓功能恢复率提高至Franke 1个等级以上者占76.8%(43/56).本文讨论了肌蒂移植术对陈旧性脊髓损伤的适应证.安徽省宿州市骨伤科医院淮北煤矿基建局医院     

细胞移植治疗心肌梗死的研究与展望

细胞移植是治疗心肌梗死的一种新策略,本文对目前应用于临床研究的骨骼肌卫星细胞移植及骨髓干细胞移植治疗心肌梗死的进展进行综述。上述两种细胞移植均具有来源丰富、无排斥反应的特点,而且通过研究观察表明,上述两种细胞移植后,心脏功能均能得到改善,故具有美好发展前景。但二者亦均具有不足之处和需要解决的问题,还需进一步研究与探索。     

Botulinum toxin injection in patients with hereditary spastic paraparesis

In an open label study, we analyzed the efficacy of botulinum toxin injection at the lower limbs of patients with hereditary spastic paraparesis (HSP). Fifteen patients who showed disabling spasticity with no or poor effect of oral treatment were recruited consecutively. Botulinum toxin was injected (400 U; Botox^®) into the spastic muscles identified by clinical examination (equinus, varus, and pathological hip adduction). Patients were regularly assessed from the first day to the fifth month: spasticity (Ashworth), motor strength, range of movements, Functional Ambulation Categories (FAC), gait parameter, Rivermead Motor Assessment, self-analysis of benefit and satisfaction. We observed a moderate and significant ( P  < 0.05) reduction of ankle plantar flexor and hip adductor spasticity, with a partial increase in the range of the active and passive motion at the ankle and in gait velocity. At an individual level, six of 15 patients showed an increase in gait velocity. The FAC and RMA did not change. Patients often reported partial improvement in foot position and lower limb propulsion, and fair satisfaction. In conclusion, botulinum toxin injection can be effective in HSP patients with relatively ancient spasticity. This technique can be introduced into the therapeutic panel, which also includes physiotherapy, oral treatment and baclofen pump.     

Anomalous flexor digitorum superficialis muscle belly presenting as a mass within the palm

Anomalies of the flexor digitorum superficialis muscle are extremely uncommon and usually present as a painful mass or pseudotumour within the palm. Diagnosis may be difficult because many other soft tissue tumours (lipomas, ganglions, giant cell tumours and hamartomas) may present similarly. Magnetic resonance imaging helps to define the extent and characteristics of this anomalous muscle belly and to distinguish it from a soft tissue sarcoma, whereas plain radiographs are of little value. Three types of flexor digitorum superficialis muscle anomalies have been described, and treatment consists of subtotal or total surgical debulking of the mass if symptoms persist or if the diagnosis is in question. Most patients have complete resolution and full recovery. To date, 20 cases have been reported in the literature, usually involving the right small finger. In the present paper, the case of an anomalous flexor digitorum superficialis muscle in a 17-year-old male patient’s left index finger is reported. Symptoms were relieved following surgical debulking and hand-based occupational therapy.     

肝脏单形性上皮样血管平滑肌脂肪瘤的影像表现

目的提高对肝脏单形性上皮样血管平滑肌脂肪瘤（HMEA）影像表现的认识和诊断准确率。方法对经手术病理证实的4例HMEA进行回顾性分析，讨论影像表现和病理之间的联系。结果4例HMEA中，2例误诊为肝细胞癌，1例误诊为局灶性结节增生，1例诊断正确。影像表现主要为：（1）平扫呈等低或等稍高密度的HMEA2例，强化模式呈“快进慢出”。病理特点足瘤内有丰富的窦隙状薄壁分隔微血管网，无分化成熟的脂肪细胞，1例伴厚壁的血管。（2）平扫呈低密度或低信号的HMEA2例，强化模式呈“快进快出”，中央可见粗大的动脉。病理特点为瘤中央有畸形粗大厚壁的动脉，无脂肪细胞夹杂其间。结论HMEA影像表现与病理结构直接相关，根据影像表现结合临床资料可对该病作出初步诊断，但确诊仍依赖病理组织学检查。     

丹参改善骨骼肌缺血再灌注损伤的超微结构观察

目的:通过透射电镜观察骨骼肌缺血再灌注损伤过程的病理生理变化探讨丹参的干预作用及机制。方法:采用90只清洁级雄性SD大鼠,6只作为健康对照组,84只行左侧提睾肌主滋养动脉夹闭造模,在缺血2.5 h时,丹参组腹腔注射丹参(42只),对照组注射等剂量的生理盐水(42只),两组分别设缺血再灌注10、20、30、40、50、60、90 min观测点(每个观测点6只)。观测结束后,迅速切取提睾肌,放入电镜固定液。电镜下进行组织形态学观察。结果:健康对照组正常情况下,组成肌原纤维的粗、细2种肌丝沿其长轴排列,每条肌原纤维上均可见明暗相间的带,肌浆内见有较多糖原颗粒及少量内质网、线粒体等细胞器,肌浆网纵向分布于肌原纤维周围,线粒体膜及嵴清晰可见,基质着色深,无肿胀、空泡形成等改变,在肌丝之间分布有较多糖原颗粒;骨骼肌缺血再灌注后10、20、30、40、50、60、90 min的2组各观测点,其病理变化较相似,肌丝模糊、凌乱,部分溶解、消失,甚至完全消失,肌浆网不同程度扩张,线粒体变大变圆,基质变淡,嵴变短变少甚至消失,部分线粒体极度肿胀,呈空泡状。丹参组,其病理变化大体相似,肌纤维均有不同程度恢复。结论:骨骼肌缺血再灌注损伤导致线粒体极度肿胀,肌纤维紊乱。丹参能有效地消除线粒体的水肿,恢复肌纤维,减轻骨骼肌缺血再灌注损伤。     

心脏营养素-1治疗失神经骨骼肌萎缩过程中对正常肌肉组织的影响

目的 探讨应用心脏营养素-1(cardiotrophin-1,CT-1)治疗失神经骨骼肌萎缩的有效剂量和安全剂量,观察不同剂量的CT-1对正常骨骼肌、心肌和血管平滑肌的副作用.方法 取Swiss小鼠80只,随机分成8组,每组分别于胫神经切断术后连续腹腔注射重组小鼠CT-1(rmCT-1)40、60、80、100、120、140、160μg·kg-1·d-1,剩余1组腹腔注射等体积CT-1溶媒,28d后称量失神经侧腓肠肌、正常侧腓肠肌和心脏的湿重;测量胸主动脉平滑肌厚度;检测正常腓肠肌中α-actin和MHC Ⅱa以及心肌中β-MHC的表达、胸主动脉血管平滑肌细胞中α-actin的含量.结果 采用腹腔注射给药,当CT-1用量达到60μg·kg-1·d-1时,开始对失神经骨骼肌产生营养作用,并呈剂量依赖性增强,当给药剂量超过100 μg·kg-1·d-1后,出现对正常骨骼肌、心肌和血管平滑肌的影响.给药剂量达到120μg·kg-1·d-1时,开始促进心肌β-MHCmRNA的表达,增加正常心脏的湿重.当给药剂量达到140μg·kg-1·d-1时,开始促进正常骨骼肌α-actin和MHC Ⅱ amRNA的表达,以及骨骼肌湿重的增加,同时提高了主动脉血管平滑肌α-actin的含量,增加了血管平滑肌的厚度.结论 腹腔注射CT-1防治失神经骨骼肌萎缩的有效剂量为60 μg·kg-1·d-1,最高安全剂量为100 μg·kg-1·d-1.当给药剂量达到120 μg·kg-1·d-1时,开始出现心肌肥厚,当给药剂量达到140 μg·kg-1·d-1时,可导致正常骨骼肌的肥大和血管平滑肌的增厚.     

Abnormal neuromuscular junctions in the lateral rectus muscle of wobbler mice

We have studied the lateral rectus muscles and neuromuscular junctions (NMJs) of abducens motoneurons in wobbler (wr/wr) mutant mice from 26 to 58 days of age. The muscles of wr/wr weighed about 70% of the weight of littermate controls and were composed of fiber types comparable to those of controls, as assayed by succinate dehydrogenase activity. The most obvious difference between wr/wr and control NMJs was a reduction in the length of the postjunctional membrane of wr/wr mice. The mutant muscle endplate membrane was only about 70% (6.58 micron) the length of control muscle regions (9.44 micron). There were no obvious differences at the light microscopic level in the distribution of acetylcholine (ACh) receptors at junctional regions or staining of acetylcholinesterase, as assayed with alpha-bungarotoxin binding or enzyme histochemistry. Indirect immunocytochemical studies using antibodies directed against the subunits of the ACh receptor failed to indicate an abnormal presence of immature receptors clustered at the NMJs of wr/wr mice. Our findings suggest that the formation or maintenance of normal postjunctional folds and the differentiation of receptors at the junctions are under independent control during development. Furthermore, the wobbler mutation may affect muscle cell differentiation as well as neuronal differentiation. This mutant mouse should prove a useful model for study of postjunctional fold formation and function.