Diagnostic sensitivity of electrophysiology and ultrasonography in ulnar neuropathies of different severity

ObjectiveTo assess the diagnostic performance of electrophysiology and nerve ultrasound in ulnar neuropathies of varying clinical severity in 135 consecutive patients.MethodsClinical severity of ulnar neuropathy was graded on a 4 point scale from very mild (symptoms only) to severe (marked atrophy of intrinsic hand muscles). Sensitivity and localization ability of electrophysiology and nerve ultrasound were assessed for each point of the scale.ResultsUltrasound had higher sensitivity than electrophysiology in clinically very mild (20% and 3% for ultrasound and electrophysiology, respectively) and mild (62% and 47% for ultrasound and electrophysiology, respectively) neuropathies, had greater localizing ability in axonal ulnar neuropathies, and identified nerve hypermobility.Ultrasound nerve cross-sectional area had strong positive correlation with both clinical and electrophysiological severity scores, but with significant overlap across the severity groups.ConclusionThe diagnostic work-up of ulnar neuropathies was improved by using both electrophysiology and ultrasound at all levels of clinical severity. Ultrasound increased the diagnostic yield in very mild and mild neuropathies, localized all the ulnar neuropathies with abnormal non-localizing electrophysiology and identified nerve hypermobility.SignificanceThis is the first detailed analysis of the diagnostic performance of electrophysiology and ultrasound in ulnar neuropathies of varying severity.     

基于数据挖掘方法的椎动脉型颈椎病用药规律研究

目的:运用中医传承辅助平台分析椎动脉型颈椎病中药处方的用药规律。方法:通过中国知网、重庆维普、万方数据库中收集2010年1月—2014年12月治疗椎动脉型颈椎病的中药处方,采用关联规则算法、复杂系统熵聚类等无监督数据挖掘方法,分析处方中各种药物的使用频次、性味归经、药物之间的关联规则及核心药物组合。结果:对筛选出的118个中药处方进行分析,确定其常用药物频次,发现常用药物关联规则共57个,核心组合30个。结论:椎动脉型颈椎病常用的药物以活血化瘀药、温经通络药和祛风止眩药为主,四气分布以温、平、凉为主,五味分布以甘、辛、苦为主,主要归于肝、脾、心经,使用频次较高的药味为川芎、葛根、当归、天麻、丹参等。     

建立用生色底物法研究重组水蛭素在大鼠血浆中的药动学

目的:建立用生色底物法(chromogenic substrate assay,CSA)测定大鼠血浆中重组水蛭素(re-combinant hirudin,rH)含量的方法,并用该法研究rH在大鼠血浆中的药动学。方法:以TGPApNA(tosyl-gly-cyl-polyl-arginine-para-nitraniline)为底物,凝血酶(thrombin,Th)能水解TGPApNA释放出对-硝基苯胺(para-nitraniline,pNA),pNA在405nm处有特异性吸收,通过测定反应体系中未被rH中和的Th量,间接测定rH的活性。结果:CSA法能有效地测定大鼠血浆中rH的含量;rH的浓度在3.125~40 ng.mL-1范围内呈线性关系;日间和日内精密度相对标准偏差均符合要求。应用上述方法测定大鼠iv 2.0 mg.kg-1的rH后不同时间的血药浓度,结果表明该药符合二室模型一级动力学过程。结论:用生色底物法测定大鼠血浆中rH具有准确、可靠、重现性好的特点,可用于rH药动学的研究。     

旋牵手法对椎动脉型颈椎病即时效应观察

目的　观察旋牵手法治疗椎动脉型颈椎病 (CSA)的效果。方法　对 12 0例患者采用旋牵手法治疗后 ,即时经颅多普勒超声 (TCD)检查左右两侧椎动脉 (VA)、基底动脉 (BA)的收缩峰期血流速度 (Vpeak)、舒张末期血流速度 (Vm in)、搏动指数 (PI)、阻力指数 (RI)值 ,并作治疗前后对比观察 ,进行统计学处理。结果　左、右两侧 VA、BA的 Vpeak、Vmin值经治疗后明显加快 ,恢复或接近正常范围 ,而 PI及 RI值明显下降。结论　旋牵手法能改善椎动脉型颈椎病脑部血供 ,从而达到治疗目的     

止眩颗粒对瘀血阻络复制的家兔CSA模型TCD的影响

目的:探讨止眩颗粒对家兔椎动脉型颈椎病(CSA)模型TCD的影响及作用机理。方法:采用瘀血阻络的方法在家兔左侧颈夹肌及头夹肌内注入瘀血9ml,造成局部气血运行受阻,椎动脉供血不足,复制CSA模型。胃肠灌注止眩颗粒、西比灵,通过经颅骨多普勒(TCD)观察药物对模型的影响及作用。结果:止眩颗粒组、西比灵组基底动脉(BA)收缩期血液速度(PEAK)较CSA模型组2周明显增快,有显著性差异;与模型组4周比较,有极显著性差异。止眩颗粒组BA的平均血液速度(MEAN)、舒张期血液速度(DIAS)与模型组4周比较,有极显著性差异。止眩颗粒组LVA、RVA的PEAK、DIAS、MEAN较模型组2周、4周明显增快,有显著或极显著性差异。西比灵LVA的PEAK、DIAS与模型组2周比较,RVA的DIAS、MEAN与模型组2周、4周比较,明显增快,有显著性差异。止眩颗粒组BA的MEAN、LVA的PEAK较西比灵组明显增快,有显著性或极显著性差异。结论:止眩颗粒是通过扩张家兔BA、LVA、RVA,解除血管痉挛,增加血流速度,显著改善脑循环来发挥疗效的,在对家兔TCD的改善上优于西比灵。     

Genetic diversity of VAR2CSA ID1-DBL2Xb in worldwide Plasmodium falciparum populations: Impact on vaccine design for placental malaria

In placental malaria (PM), sequestration of infected erythrocytes in the placenta is mediated by an interaction between VAR2CSA, a Plasmodium falciparum protein expressed on erythrocytes, and chondroitin sulfate A (CSA) on syncytiotrophoblasts. Recent works have identified ID1-DBL2Xb as the minimal CSA-binding region within VAR2CSA able to induce strong protective immunity, making it the leading candidate for the development of a vaccine against PM. Assessing the existence of population differences in the distribution of ID1-DBL2Xb polymorphisms is of paramount importance to determine whether geographic diversity must be considered when designing a candidate vaccine based on this fragment. In this study, we examined patterns of sequence variation of ID1-DBL2Xb in a large collection of P. falciparum field isolates (n = 247) from different malaria-endemic areas, including Africa (Benin, Senegal, Cameroon and Madagascar), Asia (Cambodia), Oceania (Papua New Guinea), and Latin America (Peru). Detection of variants and estimation of their allele frequencies were performed using next-generation sequencing of DNA pools. A considerable amount of variation was detected along the whole gene segment, suggesting that several allelic variants may need to be included in a candidate vaccine to achieve broad population coverage. However, most sequence variants were common and extensively shared among worldwide parasite populations, demonstrating long term persistence of those polymorphisms, probably maintained through balancing selection. Therefore, a vaccine mixture including such stable antigen variants will be putatively applicable and efficacious in all world regions where malaria occurs. Despite similarity in ID1-DBL2Xb allele repertoire across geographic areas, several peaks of strong population differentiation were observed at specific polymorphic loci, pointing out putative targets of humoral immunity subject to positive immune selection.     

小针刀结合推拿手法治疗CSA的临床疗效观察

目的探求小针刀结合推拿手法治疗CSA的临床疗效。方法 400例CSA患者随机分成A（药物治疗组）、B（小针刀治疗组）、C（推拿手法治疗组）、D（小针刀结合推拿手法治疗组）4个组,对400例患者在小针刀治疗前、后分别进行临床疗效及疗程对比观察。结果 A组治疗总有效率65.9%;B组总有效率74.6%;C组总有效率80.3%;D组总有效率95.9%。A、B、C、D 4组平均时间分别为2.80周、2.08周、1.95周、1.74周。结论小针刀结合推拿手法治疗对椎动脉型颈椎病有明确的治疗作用,且与单纯药物治疗组、小针刀治疗组、推拿治疗组相比,其疗效更强,疗程最短。     

Comparison of functional assays used in the clinical development of a placental malaria vaccine

BackgroundMalaria in pregnancy is associated with significant morbidity in pregnant women and their offspring. Plasmodium falciparum infected erythrocytes (IE) express VAR2CSA that mediates binding to chondroitin sulphate A (CSA) in the placenta. Two VAR2CSA-based vaccines for placental malaria are in clinical development. The purpose of this study was to evaluate the robustness and comparability of binding inhibition assays used in the clinical development of placental malaria vaccines.MethodsThe ability of sera from animals immunised with different VAR2CSA constructs to inhibit IE binding to CSA was investigated in three in vitro assays using 96-well plates, petri dishes, capillary flow and an ex vivo placental perfusion assay.ResultsThe inter-assay variation was not uniform between assays and ranged from above ten-fold in the flow assay to two-fold in the perfusion assay. The intra-assay variation was highest in the petri dish assay. A positive correlation between IE binding avidity and the level of binding after antibody inhibition in the petri dish assay indicate that high avidity IE binding is more difficult to inhibit. The highest binding inhibition sensitivity was found in the 96-well and petri dish assays compared to the flow and perfusion assays where binding inhibition required higher antibody titers.ConclusionsThe inhibitory capacity of antibodies is not easily translated between assays and the high sensitivity of the 96-well and petri dish assays stresses the need for comparing serial dilutions of serum. Furthermore, IE binding avidity must be in the same range when comparing data from different days. There was an overall concordance in the capacity of antibody-mediated inhibition, when comparing the in vitro assays with the perfusion assay, which more closely represents in vivo conditions. Importantly the ID1-ID2a protein in a liposomal formulation, currently in a phase I trial, effectively induced antibodies that inhibited IE adhesion in placental tissue.     

A Before and After Analysis of Health Care Utilization by Patients Enrolled in Opioid Controlled Substance Agreements for Chronic Noncancer Pain

Objective

To evaluate the impact of opioid controlled substance agreements (CSAs) enrollment on health care utilization.