The neurophysiological evaluation in 60 patients with Kennedy disease / 中华神经科杂志

Objective:To study the neurophysiological features of Kennedy disease (KD) and to figure out the function of the nervous system.Methods:Subjects were recruited from the outpatient and the ward of Peking University Third Hospital from November 2010 to November 2022. Sixty patients with KD (29 patients with KD alone, 31 KD cases with the complication of diabetes mellitus) and 60 patients with diabetic polyneuropathy (DPN) were included in this study. Electrophysiological tests were performed in all subjects, including electromyogram, nerve conduction study, somaosensory evoked potential (SEP), contact heat evoked potential (CHEP) and triple stimulation technique (TST). Student′s t-tests were conducted to compare differences intra or inter groups of nerve conduction velocity and action potential of nerve conduction study, latency and interphase of SEP, initial peak latency of CHEP and other parameters. Results:Compared with the normative value, the amplitude of the sensory nerve action potential (SNAP) declined by 30%-80% in KD patients [median nerve (0.7±0.4) μV, ulnar nerve (0.8±0.3) μV, sural nerve (1.8±0.1) μV], the amplitude of the median and ulnar nerves was lower than the sural nerves ( t=2.43, P=0.010; t=2.40, P=0.010). The conduction time of peripheral segments of SEP and CHEP was prolonged by 115%-130%, while that of the central segments was prolonged by 104%-115% in SEP. TST test/TST control declined by 40%-60% in 17 patients with KD. The amplitude of SNAP declined by 30%-50% in patients with DPN [median nerve (2.9±0.5) μV, ulnar nerve (2.6±0.6) μV, sural nerve (1.6±0.2) μV], the amplitude of the sural nerves was lower than the median and ulnar nerves ( t=2.52, P=0.006; t=2.47, P=0.007). The conduction time of peripheral segments of SEP and CHEP was prolonged by 75%-112%, while that of the central segments was normal in both SEP and CHEP in DPN patients. Compared with DPN patients, the upper limb SNAP amplitude was lower in KD patients with the complication of diabetes mellitus [median nerve (0.7±0.3) μV, t=3.18, P=0.001; ulnar nerve (0.8±0.4) μV, t=3.20, P=0.001]. Conclusions:Sensory nerve is involved in patients with KD, including the large fiber and the small one. The central segments was abnormal in the deep sensory pathway, and the pyramid tract may be involved besides the anterior horn cell.

Practical application of "dual-element and three-step" vocational college education model based on the modern apprenticeship / 中华医学教育探索杂志

This research implements the "dual-element and three-step" education model based on the modern apprenticeship system for rural medical students, establishes a complete teacher management system through the joint enrollment of schools and teaching hospitals, and strengthens the professional cognition stage, professional learning stage and professional practice stage. It has certain effects on promoting students' good sense of professional identity and responsibility, enhancing learning initiative and professional vocational ability, and cultivating skilled and service-oriented medical talents with "six-in-one" post competences in rural areas.

Application of muscle ultrasound in amyotrophic lateral sclerosis / 中华神经科杂志

Amyotrophic lateral sclerosis (ALS) is one of the fatal neurodegenerative diseases. Muscle ultrasound can be used in ALS to make early diagnosis, strengthen disease management and differentiate other neuromuscular diseases from it. In ALS patients, morphological changes such as muscle atrophy, increased echo intensity and fasciculation can be detected by muscle ultrasound which is helpful in assessing respiratory and swallowing functions as well. High frequency ultrasound has the clinical value in the diagnosis, monitoring and prognosis evaluation of ALS patients.

Rare variants of HSPB1 are probably associated with amyotrophic lateral sclerosis / 南方医科大学学报

OBJECTIVE@#To explore the association between rare HSPB1 variants and amyotrophic lateral sclerosis (ALS).@*METHODS@#We performed next-generation sequencing for 166 Chinese ALS patients to screen for possible pathogenic rare variants of HSPB1. The control individuals were obtained from 1000 Genome Project and an in-house whole-exome sequencing database. The Sequence Kernel Association Test (SKAT) and the SKAT-optimal test (SKAT-O) were used to identify the association between rare HSPB1 variants and ALS.@*RESULTS@#We identified 3 possible pathogenic rare variants of HSPB1 (all were missenses), including c.379C>T (p.R127W), c.446A>C (p.D149A) and c.451A>C (p.T151P). Compared with 1000 Genome Project, SKAT p=3.61×10@*CONCLUSIONS@#Rare variants of HSPB1 are probably associated with the pathogenesis of ALS.

Progress in improving the properties of dissolving pulp by enzymes / 生物工程学报

Dissolving pulp consists of high purity cellulose and is widely used to as raw materials for the production of regenerated cellulose fiber, cellulose ester and cellulose ether. The characteristic of dissolving pulp affects greatly the production and processing performance of subsequent products. The α-cellulose content, hemicellulose content, pulp viscosity, ash, transition metal ion content, fiber morphology, molecular weight distribution of cellulose and the reactivity are the important properties. Because of its green, mild and high efficiency, the application of enzymes in improving the properties of dissolving pulp has a promising application prospect and has been researched significantly. In this review, the main properties of dissolving pulp are presented first, followed by a recommendation of the enzymes to improve these properties. The application and current research of cellulase and xylanase in improving the properties of dissolving pulp are emphasized. The main problems and the future research areas in improving the properties of dissolving pulp by enzymes are revealed. Finally, the technology prospects in this field are proposed.

Biochemical analysis between common type and critical type of COVID-19 and clinical value of neutrophil/lymphocyte ratio / 南方医科大学学报

OBJECTIVE@#To identify the key biochemical indicators that affect the clinical type and outcomes of COVID-19 patients and explore the application of neutrophil/lymphocyte ratio (NLR) in COVID-19.@*METHODS@#Ninety-three patients with confirmed diagnosis of COVID-19 admitted in Ezhou Central Hospital from February to April in 2020 were analyzed. Among them, 43 patients were selected from Intensive Care Unit (ICU) with the diagnosis of critical type of COVID-19, and 50 cases of common type were selected from the Department of Respiratory Medicine. The baseline data, blood routine test and biochemical indexes of the patients were collected on the first day of admission. NLRs of the patients were calculated, and COX survival analysis according to the NLR 4-category method was performed. The patients' outcomes were analyzed with receiver operating curves (ROCs). The patients were divided into two groups according to NLR cutoff value for comparison of the biochemical indexes. Based on the patients' outcomes, NLR cutoff value classification and clinical classification, multiple binary logistics regression was performed to screen the key variables and explore their significance in COVID-19.@*RESULTS@#The NLR four-category method was not applicable for prognostic evaluation of the patients. The cut-off value of NLR for predict the prognosis of COVID-19 was 11.26, with a sensitivity of 0.903 and a specificity of 0.839; the laboratory indicators of the patients with NLR < 11.26 were similar to those in patients of the common type; the indicators were also similar between patients with NLR≥11.26 and those with critical type COVID-19. NLR, WBC, NEUT, PCT, DD, BUN, TNI, BNP, and LDH had significant effects on the clinical classification and outcome of the patients ( < 0.05); Cr, Ca, PH, and Lac had greater impact on the outcome of the patients ( < 0.05), while Na, PCO had greater impact on the clinical classification of the patients ( < 0.05).@*CONCLUSIONS@#NLR can be used as an important reference for clinical classification, prognostic assessment, and biochemical abnormalities of COVID-19. Patients of critical type more frequently have bacterial infection with more serious inflammatory reactions, severer heart, lung and kidney damages, and much higher levels of DD and LDH than those of the common type. NLR, NEUT, DD, TNI, BNP, LDH, Ca, PCT, PH, and Lac have obvious influence on the prognosis of COVID-19 and should be observed dynamically.

Biochemical analysis between common type and critical type of COVID-19 and clinical value of neutrophil/lymphocyte ratio / 浙江大学学报·医学版

OBJECTIVE@#To identify the key biochemical indicators that affect the clinical type and outcomes of COVID-19 patients and explore the application of neutrophil/lymphocyte ratio (NLR) in COVID-19.@*METHODS@#Ninety-three patients with confirmed diagnosis of COVID-19 admitted in Ezhou Central Hospital from February to April in 2020 were analyzed. Among them, 43 patients were selected from Intensive Care Unit (ICU) with the diagnosis of critical type of COVID-19, and 50 cases of common type were selected from the Department of Respiratory Medicine. The baseline data, blood routine test and biochemical indexes of the patients were collected on the first day of admission. NLRs of the patients were calculated, and COX survival analysis according to the NLR 4-category method was performed. The patients' outcomes were analyzed with receiver operating curves (ROCs). The patients were divided into two groups according to NLR cutoff value for comparison of the biochemical indexes. Based on the patients' outcomes, NLR cutoff value classification and clinical classification, multiple binary logistics regression was performed to screen the key variables and explore their significance in COVID-19.@*RESULTS@#The NLR four-category method was not applicable for prognostic evaluation of the patients. The cut-off value of NLR for predict the prognosis of COVID-19 was 11.26, with a sensitivity of 0.903 and a specificity of 0.839; the laboratory indicators of the patients with NLR < 11.26 were similar to those in patients of the common type; the indicators were also similar between patients with NLR≥11.26 and those with critical type COVID-19. NLR, WBC, NEUT, PCT, DD, BUN, TNI, BNP, and LDH had significant effects on the clinical classification and outcome of the patients ( < 0.05); Cr, Ca, PH, and Lac had greater impact on the outcome of the patients ( < 0.05), while Na, PCO had greater impact on the clinical classification of the patients ( < 0.05).@*CONCLUSIONS@#NLR can be used as an important reference for clinical classification, prognostic assessment, and biochemical abnormalities of COVID-19. Patients of critical type more frequently have bacterial infection with more serious inflammatory reactions, severer heart, lung and kidney damages, and much higher levels of DD and LDH than those of the common type. NLR, NEUT, DD, TNI, BNP, LDH, Ca, PCT, PH, and Lac have obvious influence on the prognosis of COVID-19 and should be observed dynamically.

Assessment of the function of cervical spinal upper motor neuron in patients with frail arm syndrome / 中华神经科杂志

Objective To investigate cervical spinal upper motor neuron (UMN) dysfunction in patients with frail arm syndrome (FAS) by physical examination,triple stimulation technique (TST) and pectoralis tendon reflex tests.Methods Sixty-seven FAS patients,coming from Peking University Third Hospital from June 2013 to June 2016,underwent physical examination and routine electrophysiological tests.The pyramid signs,the results of pectoralis tendon reflex and TST were collected to estimate the function of cervical spinal UMN.Results On the time of diagnosis,weakness of bilateral proximal upper limbs was found in 61 patients,while weakness of unilateral proximal upper limb was found in six patients.There were 25 patients with tendon hyperreflexia,20 patients with tendon hyporeflexia and 22 patients with tendon areflexia.All the patients were pectoral muscle tendon hyperreflexia except one.UMN score of cervical region was 2.0 ± 0.5.Lower motor neuron score of cervical region was 2.0 ± O.2.The amplitude ratio of TSTtest/TSTcontrol was 78.31％ ± 6.52％.The latency and amplitude of quantitative detection of pectoralis tendon reflex was (7.80 ± 1.22) ms and (1.23 ± 0.14) mV,respectively.In the follow-up study,the tendon reflexes and the UMN score declined,the amplitude ratio of TSTtest/TSTcontrol decreased,while the lower motor neuron score increased and the latency of quantitative detection of pectoralis tendon reflex remained almost unchanged.Conclusion The results showed that there was cervical spinal UMN dysfunction in patients with FAS,and the pyramid signs were often concealed by muscle atrophy with progression of the disease.

A clinical and neurophysiologic study of upper motor neuron-dominant amyotrophic lateral sclerosis / 中华神经科杂志

Objective To investigate the clinical and electrophysiological characteristics of upper motor neuron-dominant amyotrophic lateral sclerosis (UMN-D ALS ).Methods The clinical and electrophysiological characteristics were analyzed retrospectively in 76 patients with UMN-D ALS and 19 patients with primary lateral sclerosis (PLS).Electrophysiological study included the examination of median nerve,ulnar nerve,tibial nerve,peroneal nerve and sural nerve except for the electromyogram of bulbar region,cervical region,thoracic region and lumbosacral region.Results The diagnosis in 8 PLS patients were changed to UMN-D ALS after detailed review.In UMN-D ALS patients,there were more females in age group of older than 40 (male:female =1∶1.37) and 32 patients (38.1％) had onset with bulbar dysfunction.UMN-D ALS patients showed electromyograph evidence of denervation at 30 months (median)after onset,and clinical lower motor neuron (LMN) signs 6 months later.Seventy-seven patients (91.6％)developed LMN sign by 4 years from symptom onset.ALS functional rating score-revised changed from 40 ±3 to 32 ±4 in 4 years in U MN-D ALS patients (t =1.83,P ＜ 0.05 ).The amplitude of motor unit action potential (MUAP) on the first interosseus dorsalis was higher (( 1003.7 ± 25.2) μV vs (353.5 ±21.5) μV,t=2.34,P ＜0.05) and the duration of MUAP was longer ((19.8 ±2.3) ms vs (9.6 ±1.3) ms,t =1.85,P ＜0.05 ) in UMN-D ALS patients than in PLS patients.Conclusions UMN-D ALS occurs more in female cases,with more bulbar onset and with faster progression than PLS does.It also presents focal denervation in electromyograph.

A study of motor unit number estimation by multiple point stimulation in patients with Hirayama disease / 中华内科杂志

Objective To explore the significance of motor unit number estimation (MUNE) by using multiple point stimulating technique to evaluate patients with Hirayama disease (HD).Methods Multiple point stimulating technique was used to estimate the motor unit number of abductor pollicis brevis and abductor digiti minimi in 35 normal subjects [14-33 years old,mean (20.9 ±4.0) years old,33 men and 2 women]without nerve and muscle disease and 69 patients definitely diagnosed as HD [16-35 years old,mean (21.46 ±6.61 ) years old,67 men and 2 women].The differences between the two groups were examined by Fisher's exact test and t test.Results There were 42 patients with atrophy and 27 patients with normal clinical manifestation of left hand.For right hand there were 54 patients with atrophy and 15 normal.For controls,the MUNE value of left abductor pollicis brevis was 226.97 ± 30.59,while that of right side was 22g.31 ± 25.35.The MUNE value of left abductor digiti minimi was 237.43 ± 30.78,while that of right side was 240.20 ± 37.73.For HD patients,the MUNE of left abductor pollicis brevis and abductor digiti minimi was 145.66 ± 126.10 ( t =5.07,P ＜ 0.01 ) and 102.20 ± 112.67 ( t =9.31,P ＜ 0.01 )respectively,while those of right hand was 149.72 ± 117.80 ( t =5.31,P ＜ 0.01 ) and 64.23 ± 69.27 ( t =16.76,P ＜0.01 ) respectively.MUNE of left abductor digiti minimi in 17 patients that was below 200 among 27 patients with normal clinical manifestation (x2 =9.57,P =0.002).MUNE of right abductor digiti minimi in 12 patients that was below 200 among 15 patients with normal clinical manifestation ( x2 =4.64,P =0.03).Conclusions The differences of MUNE values by multiple point stimulating technique between the normal subjects and the HD patients is significant,which suggests this method is very useful to evaluate HD in the early state.

Target points: a discussion on acupuncture treatment of primary trigeminal neuralgia / 中西医结合学报

In this paper, issues of acupuncture using target points and depth of needling were discussed based on the theory of traditional Chinese medicine acupoints and combined with anatomical and neurological research of Western medicine. The theoretical evidence of acupuncture on nerve foramen and ganglion and the reasons for being nonstandard operating on acupoints were analyzed. This study summarized the method of using acupuncture at Xiaguan (ST7), Cuanzhu (BL2), Sibai (ST2) and Jiachengjiang acupoints to align with the spheno-palatine ganglion and additional nerve foramen (supraorbital, infraorbital and mental foramina) to treat primary trigeminal neuralgia. This study adhered to the Standards for Reporting Interventions in Clinical Trials of Acupuncture and helped in development of study standardization for acupuncture processes. The authors hoped that should help in significantly diminishing risk and improving therapeutic efficacy in clinic.

Triple stimulation technique: normative value of Chinese adults / 中华神经科杂志

Objective To validate the technique and to establish the reference values of triple stimulation technique(TST)in healthy Chinese adults.Methods One hundred healthy subjects were recruited to undergo TST from April 2010 to February 2011 in both abductor digiti minimi.The TST combines transcranial magnetic stimulation(TMS)of the motor cortex with peripheral collision studies.Three stimuli were given,leading to two collisions.A first magnetic stimulus was applied to the scalp overlying the motor cortex.After a delay,an electric stimulus was applied over the ulnar nerve at the wrist.The delay was chosen so that the action potentials descending from the cortex collided with the antidromic action potentials evoked at the wrist,with the collision site at the wrist and above.After another delay,another electrical stimulus was applied to Erb' s point.This delay was chosen so that ascending antidromic action potentials evoked by wrist stimulation collided at or distal to Erb' s point.At the same time,TST test curves were recorded.The TST test curve was compared with a TST control curve in which the first stimulus was applied to Erb' s point and the other two stimulus sites were the same as the test curve.Control stimuli were thus applied successively to Erb' s point,the wrist,Erb' s point.TST quantifies the number of conducting central motor neurons(expressed by the TST amplitude ratio).The values were compared among genders,age groups,arm length and sides respectively.Results The TST amplitude ratio(TSTteat/TSTcontrol)was 85.0％ ± 6.7％.There were no difference among genders,age groups,arm length and sides respectively.The TST amplitude ratio were 85.0％ ± 2.6％ and 85.0％ ± 8.7％,respectively in subjects with arm length 61-70 cm and 71-80 cm.Conclusion TST could be examined precisely and the normative value could be got.

Comparison of multiple point stimulation and incremental stimulation motor unit number estimation in follow-up study of patients with amyotrophic lateral sclerosis / 中华神经科杂志

Objective To compare two common techniques for motor unit number estimation (MUNE), multiple point stimulation(MPS) and incremental stimulation, and determine which is preferable in the follow-up study of patients with amyotrophic lateral sclerosis (ALS).Methods MPS or incremental stimulation MUNE was recorded respectively in 120 ALS patients at baseline and month 3, 6, 9 ,and 12 after study entry.The maximal baseline to negative peak compound muscle action potential (CMAP) amplitude was recorded.For multiple point stimulation, the stimuli sites included the skin of the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow.Individual motor unit responses were obtained by moving thestimulating electrode and isolating threshold responses.Then, with finely graded stimulus intensity at one point, 3 steps in a CMAP were investigated.For incremental stimulation, stimulus intensity was slowlyincreased from subthreshold levels until a small, all-or-none response was evoked.The intensity was slowly increased until the response increased in a quantal fashion.This process was repeated for a total of 10 increments.Single motor unit potential were obtained by subtracting amplitudes of each response from that of the prior response.The values obtained from two methods were compared.Results The value of MUNE declined in the follow-up period.MUNE obtained from MPS was the same as that gained from incremental stimulation at the baseline and the 3rd, 9th, 12th month after study entry, while MUNE obtained in MPS was more than that obtained from incremental stimulation at the 6th month after study entry ( 88 ± 6 and 47 ± 5;t = 1.72, P = 0.04).Conclusions Both MPS and incremental stimulation are certain in the follow-up study of patients with amyotrophic lateral sclerosis.The value of MUNE obtained from two methods might be different in some period.

Evaluation of upper trapezius electromyography in the early diagnosis of amyotrophic lateral sclerosis / 中华神经科杂志

Objective To evaluate the application of upper trapezins muscle electromyography (EMG) in the diagnosis of lower motor neuron damage in bulbar region in amyotrophic lateral sclerosis (ALS). Methods Standard EMG was recorded over upper trapezius muscle in 100 patients with ALS, 80 patients with cervical spondylotic myelopathy (CSM) and 100 normal controls. In groups of ALS and CSM,EMG was also recorded over sternocleidomastoid, rectus abdominis, first dorsal intercostals muscle and tibialis anterior muscles. Among those CSM patients, 43 patients had operations and the EMG on their trapezius muscle was examined at pre-operation and at 3 months post-operation. The parameters of EMG were analyzed between the groups. Results In ALS patients, spontaneous activity in upper trapezius EMG was detected more frequently in patients with disease duration equal to or less than 8 months than the others (21/30(70%) vs 28/70(40%), X~2=7.56, P=0.004). There was no difference in neurogenic EMG changes including abnormal spontaneous potentials and motor unit action petentials (MUAP) between trapezius and sternocleidomastoid in patients with ALS. Significant differences in MUAP were noted between ALS patients((1086.9±152.6)μV, (17.2±6.5) ms,23.6%±3.4%) and controls ((606.7± 82.7)μV,(11.6±1.8) ms,12. 8%±2.2%;q=9.27, 4.57, 4.12, all P<0.01), and between patients with ALS and patients with CSM ((615.7±90.3) μV,(12.1±2.0) ms,13.5%±2.4%,q=8.32,4. 25, 4. 23, all P < 0. 01). Few spontaneous activities in trapezius EMG were detected in post-operation CSM patients. Conclusion EMG in upper trapezius can assist in assessment of clinical and subclinical involvement of bulbar lower motor neurons in patients with ALS, especially at earlier stage.

Reference range for motor unit number estimation by multiple point stimulation / 中华神经科杂志

Objective To examine the technique of multiple point stimulation for motor unit number estimation (MUNE) and to establish the normative value range in Chinese.Methods Surface-recorded motor unit action potentials were measured in 80 healthy subjects.The compound muscle action potential (CMAP) amplitude measured by maximum baseline to negative peak was recorded.The stimuli sites included the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow along median nerve and ulnar nerve.Individual motor unit responses were obtained by adjusting location of the stimulate electrode and isolating threshold responses with distinct morphologies.Then, stimulus intensity was increased gradually to detect single motor unit action potentials (SMUPs).SMUPs were recorded three times.Stimulating was increase again to record another SMUPs set.Total of 12 SMUPs were recorded.Repeat the whole procedure for two times.Results MUNE was 230.0±35.7 in abductor pollieis brevis muscle, and 242.5±30.2 in aductor digiti minimi muscle for multiple point stimulation.Test-retest correlation coefficients and coefficients of variation for mean of two MUNE were 0.88-0.91 and 13.20%-15.24%.Conclusions The multiple point stimulation is a useful and replicable method to asses the MUNE.

The electromyography of rectus abdominis muscle in the diagnosis of polyneuropathy / 中华内科杂志

Objective To assess the value of electromyography (EMG) of rectus abdominis muscle in the diagnosis of polyneuropathy. Methods 109 patients with polyneuropathy were studied. The routine nerve conduction study was done and standard EMG was recorded from rectus abdominis muscle, first dorsal interosseous muscle and tibialis anterior muscle. The parameters studied included spontaneous activity fibrillation potentials (fib) and positive sharp waves (psw); duration, amplitude and percentage of polyphasic wave of motor unit action potential (MUAP) and pattern of recruitment. A group of controls and patients with amyotrophic lateral sclerosis (ALS) were studied at the same time. EMG parameters of rectus abdominis muscles were compared among patients with polyneuropathy, patients with ALS and the controls.Results EMG of rectus abdominis muscle in the patients with polyneuropathy showed neurogenic change.The amplitude of motor unit potential in patients with polyneuropathy(451.67±75.01)μV was higher than that of the controls (373.78±56.46)μV (t=2. 01, P < 0. 04) and lower than that of patients with ALS (537.19±159. 04)μV (t=2. 32, P<0.03). Conclusion EMG of rectus abdominis muscle might be used to find the lesion of intercostal nerve in polyneuropathy.

The study on pain evoked potentials in patients with amyotrophic lateral sclerosis / 中华神经科杂志

Objective To study the features of pain evoked potentials in patients with amyotrophic lateral sclemsis(ALS)and evaluate the pain pathway in these patients.Methods Sixty patients with ALS and 60 controls were set on supine position.The contact heat evoked potential stimulator with a diameter of 27 mm and an area of 573 mm2was used to elicit pain and contact heat evoked potentials(CHEP)in an accelerating speed of 70 ℃/s.Thermal stimuli were given at 54.5 ℃ to three body sites:the dorsum of hand,proximal volar for aml and C7. CHEP was recorded at spots of Cz and Pz.The features of CHEP was observed At the same time,somatosensory evoked potential(SEP)was assesed.Results The figure and latency of CHEP in ALS patients were normal.The latency was:the dorsum of hand:(561.2±28.6)ms; proximal volar forarm:(540.1±39.2)ms;C7:(512.7±31.4)ms.There were no significant differences of latency and SEP between tlle ALS patients and the controls((558.7±30.2),(536.6±23.5), (501.8±26.0)ms,t=4.23,4.51,3.74,P＞0.05).Conclusion Patients with ALS have a normal CHEP,suggesting that the pain pathway in patient with ALS is intact.

Effects of neurotropin on neuropathic pain: a pilot systematic review / 中国新药与临床杂志

AIM: To evaluate the efficacy and safety of neurotropin in the treatment of neuropathic pain.METHODS: A systematic literature search was performed in biomedical database including MEDLINE,EMBASE, Cochrane Central Register of Controlled Trials, CBM and CNKI. All studies focused on the clinical controlled trials, especially randomized controlled trials (RCTs) . The outcome measures included efficacy,life quality, cost of the treatment and adverse reactions. Quality assessments of clinical trials were evaluated with Jadad Score. Meta-analysis of included studies was performed with Revman software. RESULTS: Twenty-six clinical trials were included. Jadad Score of 24 trials was less than 3, which indicated the poor quality of the trials. None of the clinical trials evaluated the changes in life quality and cost related to neurotropin treatment.Meta analysis of 11 trials indicated neurotropin was more effective than placebo or blank, and the odds ratio of efficacy was 3.84 [2.68, 5.50] . The combining effect of 6 RCTs showed that neurotropin decreased the pain scores measured by Visual Analog Scale significantly compared with placebo or blank, the weighted mean difference (WMD) was -1.76 [-2.31, -1.21] . The pooled effects of the trials comparing neurotropin with other pain relieving drugs such as earbamazepine or NSAIDs also showed positive effect favored neurotropin.Neurotropin had no more adverse reactions than placebo, carbamazepine or NSAIDs, and the pooled risk difference was -0.01 [-0.04, 0.02] . CONCLUSION: According to present evidence, neurotropin may be effective and safe in the treatment of neuropathic pain. However, the poor quality of the studies decreases the persuasion of the results. Large-scale and well-designed RCTs with enough follow-ups should be carried out to provide further evidence for the use of neurotropin in neuropathie pain.

Diagnostic value of trigemino-cervical reflex on lesion of bulbar region of motor neuron disease / 中国组织工程研究

BACKGROUND: Cervical intumescence is the earliest and easy attacking part of motor neuron disease (MND). With the development of patients'condition, cervical part and medulla oblongata region were involved early,and the trigemino-cervical reflex (TCR) was involved earliest.OBJECTIVE: To establish electromyography of TCR and analyze the value in the diagnosis of MND of the TCR.DESIGN: Case-control study.SETTING: Room of Electrophysiologic Study, Department of Neurology,Third Hospital, Peking University.PARTICIPANTS: Thirty MND patients,mainly amyotrophic lateral sclerosis (ALS) patients and 70 healthy volunteers who were examined at Third Hospital, Peking University from 2002 to 2005. MND patients accorded with the diagnostic standard of Spain El Escorial conference.METHODS: The subjects held the heads slightly raised when lying supine to make the sternocleidomastoid muscles contracted slightly. Electrical stimulation was applied to the infraorbital nerves and latency and amplitude of wave were recorded from the bilateral sternocleidomastoid muscles. The detecting instrument was Keypoint electromyography (EMG).The surface EMG activity was recorded via Ag/AgCl.MAIN OUTCOME MEASURES: Latency of positive wave/ negative wave (P20/N30); square root of the ratio of the amplitudes, that is, value A.RESULTS: Stimulation of the infraorbital nerve on one side of controlled people produced bilateral positive and negative waves. In the MND group,7 patients showed normal (23.3%), 8 patients showed absence of wave (26.7%), 11 patients were delayed in latency (36.7%), and extreme asymmetry of reflection of the two sides was found in 4 patients (13.3%).In the MND group, the latency of positive and negative waves of TCR (P20/N30) was markedly longer than that in the normal control group,and the difference was significant. Square root of the ratio between the amplitudes after and before stimulation (square root of the ratio between peak to peak value and amplitude of wave before stimulation, that was,value A) was lower remarkably than that in the normal control group, and the difference was significant.CONCLUSION: The TCR can be reliably measured. It may help examine the cervical-bulbar lesion and diagnosing motor neuron disease in an early period.

Diagnostic process in 99 cases with amyotrophic lateral sclerosis / 中国康复理论与实践

@#ObjectiveTo explore the factors that delayed the diagnostic process and resulted in misdiagnosis of amyotrophic lateral sclerosis (ALS),in order to look for solution. MethodsThe records of 99 cases with ALS from 1999 to 2003 in our hospital were reviewed retrospectively. Clinical characteristics and diagnostic process on the patients were statistically analyzed.ResultsThe time needed to confirm diagnosis was (13.1±7.5) months. There was a positive correlation between the time when EMG was performed and the time the diagnosis was made. 58.6% of patients were initially misdiagnosed in other hospitals. The most common misdiagnosis was cervical spondylosis. The misdiagnosis more likely occured in the patients of 40-59 years old. The misdiagnosis rate in the patients with initial lower extremities symptoms was higher than that with initial bulbar and upper extremities symptoms. The misdiagnosis more likely occured in patients with early cervical MRI.ConclusionThe major causes of misdiagnosis are unfamiliarity of the physician with the disease,misleading findings or misinterpretation of neuro-radiological or neuro-physiological findings.