Peri-ventricular grey stimulation versus motor cortex stimulation for post stroke neuropathic pain.

Central post stroke pain is often difficult to manage satisfactorily with conventional treatment modalities for pain. In the last decade functional neurosurgery has offered hope with motor cortex stimulation achieving significant alleviation of pain in some patients. Unfortunately this has led to the neglect of chronic stimulation of deep grey matter as another modality of treating this condition. In this article we present our experience with motor cortex stimulation and that with deep grey matter stimulation in patients with post stroke pain. We argue that both modalities have a significant role and that what is required are better methods of identifying particular patients who are more likely to respond to one or the other.     

The Stiff Elbow

Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus, its prevention is of paramount importance. When this approach fails, non-operative followed by operative treatment modalities should be pursued. Upon initial presentation in those who have minimal contractures of 6-month duration or less, static and dynamic splinting, serial casting, continuous passive motion, occupational/physical therapy, and manipulation are non-operative treatment modalities that may be attempted. A stiff elbow that is refractory to non-operative management can be treated surgically, either arthroscopically or open, to eliminate soft tissue or bony blocks to motion. In the future, efforts to prevent and treat elbow stiffness may target the basic science mechanisms involved. Our purpose was to review the etiologies, classification, evaluation, prevention, operative, and non-operative treatment of the stiff elbow.     

Polymerization of human prion peptide HuPrP 106–126 to amyloid in nucleic acid solution

Summary.  The human prion peptide PrP106–126 polymerizes in the presence of DNA both in its circular and linearized forms under solution conditions where the peptide alone does not polymerize. The polymerization process has been monitored by the increase in the fluorescence of anilino naphthalene sulfonic dye which detects the availability of the hydrophobic surface(s) in the aggregate as a consequence of polymerization. The polymerization is a nucleation dependent phenomenon as is evidenced from an existence of a lag period before the onset of the polymerization and a strong dependence of the polymerization on the prion peptide concentrations. The reaction is dependent on the pH as seen from rapid polymerization at pH 5 compared to the reaction at neutral pH where no polymerization is observed after a relatively long period of incubation. The polymer has been characterized as amyloid by using new absorbing and emitting species resulting from the interaction of the polymer with the amyloid specific fluorescent dye, Thioflavine S. This is probably the first demonstration that an endogenous macromolecule can influence the polymerization of a prion peptide. We have previously shown that there is a conformational change in the nucleic acid as a consequence of this interaction. This prion peptide is considered as a model to understand prion diseases as is evidenced from its toxicity towards primary brain cells in culture. The peptide encompasses one of the important amyloidogenic regions of the normal cellular prion protein. Demonstration of nucleic acid induced polymerization of the normal and scrapie prion isoforms accompanying a change in the nucleic acid conformation can establish a possible role of nucleic acid in prion disease. Received January 8, 1997 Accepted March 4, 1998     

术前左室射血分数及短缩分数对冠状动脉旁路术后恶性心律失常的预测价值

为了评价冠状动脉旁路术 (CABG)术前左室射血分数 (LVEF)及左室短缩分数 (LVFS)对术后室性心律失常 (VA)预测的准确性 ,采用术前及术后 2周心脏彩超EF、FS值 (面积长轴法 )、心室晚电位 (VLP)、心肌酶、持续心电监测的方法 ,对我院 1 5 0例行CABG术的患者进行分析。结果 :1 )术前心肌梗死 (MI)、室壁瘤、VA及VLP阳性患者EF、FS值明显减低 ;2 )术前左心功能不全 (LVD)患者术后EF、FS值明显改善 ;3 )术前LVD、VA、VLP阳性及室壁瘤患者术后VA发生率明显高于其他患者。提示 :1 )面积长轴法EF、FS值是反映左心功能的敏感指标 ;2 )术前LVD患者术后短期左心功能明显好转 ,获益最大 ;3 )非LVD患者术后因心肌顿抑导致近期心功能暂时下降 ;4 )EF≤ 4 0 %和(或 )FS≤ 2 4 %是预测术后VA的独立指标 ,FS较EF更能准确地反映心脏收缩功能 ;5 )LVD、VLP、室壁瘤等综合指标分析有助于提高对术后VA预期的敏感性、特异性和准确性