Pathologic laughter and crying in ALS: a search for their origin

Spells of laughter and crying are well known in patients with amyotrophic lateral sclerosis (ALS). Since ALS occurs mostly in older age groups, this brings up the possibility that aging changes in the brain could play a causative role in the origin of such spells. To rule out or at least reduce the complicating factor of aging, a study was made of the incidence of pathologic laughter and crying in patients whose motor neuron disease had started before the age of 45 years. The data were collected from 73 such individuals, all with confirmed ALS. All told, 36 had experienced episodes of pathologic laughter and/or crying. Of these, 20 had bouts of both laughter and crying. 9 bouts of crying alone and 7 spells of laughter alone. Nearly all with such emotional spells had developed bulbar involvement with the illness. The youngest patient with spells was 31 when his illness began and 35 when he started to have bouts of crying.     

Delayed pain response after lumbar discography

Summary The delayed onset of symptomatic pain following lumbar discography (with no immediate pain response) is described in six patients, five with a minimum 2-year follow-up. It is usually seen in patients with nearly normal disc morphology who have incomplete or discrete annular tears that are not filled at the time of injection. Later (2–12 h in this study), dye leakage occurs through these lesions, thereby precipitating the discogenic pain This phenomenon may be missed and is probably more common than previously believed due to early discharge from the hospital, the patient expecting discomfort after the invasive study (hence no complaint is made), and the clinician being unaware of this delayed symptom, thereby not asking about it in follow-up. Close patient questioning regarding a delayed onset of symptomatic pain after discography is, therefore, an essential element in diagnostic information following this study.     

Trehalose protects against ocular surface disorders in experimental murine dry eye through suppression of apoptosis

The disaccharide trehalose is a key element involved in anhydrobiosis (the capability of surviving almost complete dehydration) in many organisms. Its presence also confers resistance to desiccation and high osmolarity in bacterial and human cells by protecting proteins and membranes from denaturation. The present study used a novel murine dry eye model induced by controlled low-humidity air velocity to determine whether topically applied trehalose could heal ocular surface epithelial disorders caused by ocular surface desiccation. In addition, the efficacy of 87.6 mM trehalose eyedrops was compared with that of 20% serum, the efficacy of which has been well documented. Mice ocular surface epithelial disorders were induced by exposure of murine eyes to continuous controlled low-humidity air velocity in an intelligently controlled environmental system (ICES) for 21 days, which accelerated the tear evaporation. The mice were then randomized into three groups: the control group received PBS (0.01M) treatment; a second group received 87.6 mM trehalose eyedrops treatment; and the third group received mice serum eyedrops treatment. Each treatment was administered as a 10 μl dose every 6 h for 14 days. The resultant changes in corneal barrier function and histopathologic examination of cornea and conjunctiva were analyzed and the level of apoptosis on the ocular surface was assessed using active caspase-3. After 14 days of treatment, the corneal fluorescein staining area, the ruffling and desquamating cells on the apical corneal epithelium, as well as the apoptotic cells on ocular surface epithelium had significantly reduced in eyes treated with trehalose compared with those treated with serum and PBS. In contrast, after 14 days of treatment, improvements in the thickness of the corneal epithelium, the squamous metaplasia in conjunctival epithelium and the number of goblet cells of the conjunctiva were less marked in eyes treated with trehalose compared with serum. These results demonstrated that trehalose could improve the appearance of ocular surface epithelial disorders due to desiccation through suppression of apoptosis. Trehalose produces some of the same responses as serum upon topical application and can maintain corneal health.     

Eosinophil cationic protein in tears of normal subjects and patients affected by vernal keratoconjunctivitis

The objectives of this study were to determine: 1) levels of tear eosinophil cationic protein (ECP) in patients with vernal keratoconjunctivitis (VKC); 2) the effect of pharmacologic therapy on ECP release; and 3) the correlation of this mediator with the severity of the disease. Tears were collected from 10 controls and 20 VKC patients before and after therapy for cytologic analysis and ECP measurement by radioimmunoassay. Ocular signs and symptoms were evaluated before tear collection. Mean ECP levels in controls were 7.5 ± 0.4 μg/l, and in VKC patients, 988.3 ± 128 μg/l before therapy ( P <0.001) and 566.3 ± 121 μg/l after therapy ( P <0.005). In dexamethasone (Dex) 0.1%, or cyclosporin A (CsA) 2%, patients (five per group), tear ECP decreased significantly after 7–14 days of treatment. Disodium cromoglycate (DSCG) 4% (five patients) for 14 days did not significantly affect ECP levels. ECP levels were significantly correlated with allergic signs ( P <0.001), symptoms ( P <0.001), and the number of eosinophils in tears (P<0.005). The results of this study suggest that tear ECP levels accurately reflect the clinical status of VKC patients. The measurement of ECP may prove useful not only in the diagnosis and monitoring of allergic disease, but also as an objective parameter for the evaluation of new antiallergic therapies.     

人工泪液氯霉素滴眼液的含量测定和稳定性考察

目的:制定人工泪液氯霉素滴眼液含量测定方法并预测室温存放的有效期.方法:以双波长紫外分光光度法测定氯霉素含量,银量法测定含氯量,采用Q10法预测人工泪液氯霉素滴眼液的有效期.结果:氯霉素浓度在5～40μg·ml-1的范围内与吸收度差值呈良好的线性关系,氯霉素平均回收率为100.77%,RSD为0.37%.人工泪液氯霉素滴眼液在室温25℃下的有效期(t0.9)为9.3个月.结论:含量测定及贮存期预测方法简便、快速、准确可靠,适用于医院制剂的质量控制.     

沙参麦冬汤加减方联合针刺治疗LASIK术后干眼症的疗效观察

目的?观察沙参麦冬汤加减联合针刺治疗准分子激光原位角膜磨镶术（LASIK）术后阴津不足型干眼症临床疗效。方法?依据纳入和排除标准纳入有效病例60例120眼LASIK手术3月后确诊为干眼的患者,随机分为2组,各30例60只眼,对照组单纯使用人工泪液滴眼,治疗组在对照组治疗基础上加服沙参麦冬汤加减方及针刺,15?d为1个疗程,2个疗程后观察角膜荧光素染色情况（FL）情况、泪膜破裂时间（BUT）、泪液分泌试验（SIt）、裸眼视力及干眼自觉症状的改善情况。结果?2组治疗后第15天2组BUT、FL进行比较,差异无统计学意义（P>0.05）;2组SIt情况比较,治疗组优于对照组（P<0.05）。2组治疗后第30天SIt、BUT、FL、裸眼视力及自觉症状的改善治疗组均优于对照组（P<0.05）。治疗组与对照组疗程结束时症状明显改善,总有效率分别为96.8%和86.7%,有显著性差异（P<0.05）。结论?中药配合针刺能有效改善LASIK术后干眼症患者的症状和体征,对治疗LASIK术后干眼症有一定优势。      

Skin tear prevalence in an Australian acute care hospital: A 10‐year analysis

Hospital‐acquired skin tear prevalence is under‐reported; thus, the aim of this study was to analyse skin tear point prevalence and characteristics in a tertiary acute care hospital in Queensland, Australia, over a 10‐year period. All consenting adult inpatients received a full skin inspection and skin tear category, site, cause, treatment, and whether it was documented as hospital‐ or community‐acquired were recorded. Eleven prevalence audits were analysed with a total sample of 3626 patients. An overall pooled prevalence of 8.9% (95% confidence interval [CI] 7.5‐10.4) with an associated hospital‐acquired pooled prevalence of 5.5% (95% CI 4.5‐6.7) was found. In total, 616 skin tears were reported, of which 374 (60.7%) were hospital‐acquired. Over a third of patients (38.7%) had multiple skin tears and most patients (84.8%) with at least one skin tear were aged ≥70 years. The largest proportion of skin tears (40.1%) was those with no skin flap. Of those documented, most were caused by falls or collisions, suggesting combined skin tear and falls prevention strategies may be effective. Over a decade, there was a downward trend in hospital‐acquired skin tear, which is encouraging. Skin tear prevalence is recommended as a measure of care quality with an emphasis on good quality documentation.