Umbrales auditivos en pacientes con enfermedad de Méniere manejados con corticoides transtimpánicos

Introducción: Pese a que el uso de corticoides transtimpánicos en pacientes con enfermedad de Méniere es habitual en muchos centros, la evidencia respecto de su efecto sobre los umbrales auditivos es aún controversial. Objetivo: Estudiar los umbrales auditivos de pacientes con enfermedad de Méniere que recibieron corticoides transtimpánicos en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile. Material y Método: Estudio retrospectivo de pacientes con enfermedad de Méniere que consultaron entre los años 2015 y 2021. Se estudiaron los umbrales auditivos, antes y después de 3 inyecciones de dexametasona transtimpánica. Resultados: Se obtuvieron datos completos de 27 pacientes. Al comparar el promedio tonal puro antes y después del tratamiento, no se observaron diferencias significativas. A nivel individual, la variación de cambio de los umbrales auditivos con dexametasona se correlaciona en forma significativa con los umbrales auditivos previos a las inyecciones y con el tiempo transcurrido desde la última inyección, pero no con la edad. Conclusión: La terapia con dexametasona transtimpánica en pacientes con enfermedad de Méniere no altera los umbrales auditivos. Sin embargo, se requieren más estudios, para comprobar, si existe un efecto transitorio en los umbrales auditivos de los primeros días posterior al procedimiento.

Introduction: Although transtympanic corticosteroids are proposed in Méniere's disease patients refractory to standard medical therapy, the evidence regarding the effect of transtympanic corticosteroids on hearing thresholds is still controversial. Aim: To study the hearing thresholds of patients with Méniere's disease who were administrated with transtympanic corticosteroids at the Otorhinolaryngology Service of the University of Chile's Clinical Hospital. Material and Method: Retrospective study of Méniere's disease patients who consulted between 2015 and 2021. Demographic variables and hearing thresholds were studied before and after three transtympanic injections of dexamethasone. Results: A total of 27 patients were studied. There were non-significant differences in pure-tone hearing threshold averages before and after the injections. Individual variation in hearing thresholds correlates significantly with the pre-injection hearing thresholds and the period since the last injection, but not with age. Conclusion: Transtympanic dexamethasone therapy in patients with Meniere's disease does not alter hearing thresholds. However, more studies are needed to verify whether there is a transitory effect on hearing thresholds in the first days after the procedure.

Exploratory Study on Quantitative Diagnostic of Dampness Syndrome of Colorectal Adenoma / 中医杂志

ObjectiveTo preliminarily establish and verify the quantitative diagnosis method of dampness syndrome of colorectal adenoma， so as to provide evidence for the diagnosis of colorectal adenoma syndrome. MethodsThis study included 334 patients with colorectal adenoma， who were grouped into 200 in the training group and 134 in the validation group by clinical visits chronologically. According to the data from the four examinations of traditional Chinese medicine， patients in training group were subgrouped into dampness syndrome subgroup and non-dampness syndrome subgroup. After eliminating items with response rate less than 3%， the factors showed statistical difference in frequency between the subgroups were screened as diagnostic items. The diagnostic items were assigned scores using the conditional probability formula conversion method， and the diagnostic thresholds and grading criteria were determined by the maximum likelihood discriminant method， so as to establish the quantitative criteria preliminarily. Retrospective and prospective tests were conducted respectively on patients in training group and validation group， including the sensitivity， specificity， accuracy， positive likelihood ratio and other indexes， to evaluate the quantitative criteria. ResultsThe training group included 176 participants as dampness syndrome subgroup and 24 participants as non-dampness syndrome subgroup， who applied 40 diagnostic items， and 19 related factors were identified as significant differences. After assigning the scores in turn， the quantitative diagnostic threshold was determined as 45， and the quantitative diagnostic criteria for colorectal adenoma with dampness syndrome were as follows： greasy coating （7 scores）， thick coating （8 scores）， heaviness of head （9 scores）， heaviness of whole body （6 scores）， heaviness of limbs （6 scores）， sticky and greasy stool （6 scores）， sticky and greasy mouth （10 scores）， obesity （6 scores）， sleepiness （12 scores）， laziness （13 scores）， epigastric fullness （8 scores）， abdominal distension and pain （11 scores）， lumbar and knee aches and heaviness （8 scores）， joint and muscle aches and pains （9 scores）， loose stools （12 scores）， fetid mouth odor （15 scores）， slippery pulse （8 scores）， overabundance of eye secretion （7 scores）， and large touge （10 scores）. Grading criteria： 45 ≤ points ＜ 61 as mild， 61 ≤ points ≤ 104 as moderate， points ＞ 104 as severe. In the test retrospective of the training group involving 200 patients， the sensitivity， specificity， accuracy， and positive likelihood ratio were 86.36%， 95.83%， 87.50%， and 20.73 respectively； In the test prospective of the verification group involving 134 patients， the sensitivity， specificity， accuracy， and positive likelihood ratio were 76.64%%， 96.30%， 80.60%， and 20.69， respectively. ConclusionIt is effective to diagnose and identify the dampness syndrome of colorectal adenoma by preliminarily establish a quantitative diagnostic method with a combined model of disease and evidence， and the method may provide support for future related studies.

Application of the monofilament cutaneous threshold test in assessing impaired touch sensation caused by central nervous system injury / 中华物理医学与康复杂志

Objective:To test the utility of monofilament cutaneous threshold testing among patients with impaired touch sensation caused by central nervous system injury.Methods:Thirty stroke survivors and 30 patients with spinal cord injury were recruited. Monofilament threshold testing and cotton wool tests were performed on the bilateral forehead, face, palms and dorsum of feet among the stroke survivors. Among those with a spinal cord injury both tests were performed on each side of the L 4, L 5 and S 1 vertebrae. One week later, all were retested. Intra-class correlation coefficients (ICCs) were used to quantify the test-retest reliability of the tests. Kappa values were calculated to determine the degree of agreement between them. Stepwise multiple linear regressions were evaluated to examine the relationship between touch perception thresholds and age, height, gender, type of injury and injured site. Results:①The ICC for the monofilament test was between 0.74 and 0.95, higher than that of the cotton wool test (ICC: 0.60 to 0.83). ②The kappa value between the monofilament and cotton wool tests was 0.550, indicating good agreement. ③The types of injury and injured sites were independent correlates of the touch perception thresholds, but there was no significant correlation between the touch perception thresholds and age, height, gender or group.Conclusions:The monofilament cutaneous threshold test has good test-retest reliability, better than the cotton wool test. Therefore, it may be useful as a tool for assessing impaired touch sensation caused by central nervous system injury.

Luces y sombras en la predicción de coledocolitiasis: oportunidades para la investigación futura / Lights and shadows in predicting choledocholithiasis: Opportunities for future research

Resumen La coledocolitiasis secundaria es una entidad de alta prevalencia que involucra desafíos de diagnóstico y tratamiento; asimismo, genera un elevado uso de recursos y costo económico. Existen múltiples vacíos de conocimiento con respecto a los modelos de predicción clínica para el diagnóstico, estratificación en grupos de riesgo y manejo de pacientes con coledocolitiasis secundaria. Los principales vacíos recaen sobre su rendimiento diagnóstico, variables incluidas y umbrales de riesgo, así como sobre su costo-efectividad para el uso de recursos no invasivos e invasivos, y aplicación en grupos poblacionales especiales. Este artículo ahonda estos vacíos de conocimiento y propone una agenda que puede orientar la investigación futura.

Abstract Secondary choledocholithiasis is a disease of high prevalence that involves diagnostic and treatment challenges; it implies a high use of resources and economic costs. There are significant knowledge gaps related to clinical prediction models, risk group classification, and patient treatment in secondary choledocholithiasis cases. Those gaps include diagnostic performance, variables, and risk thresholds, as well as cost-effectiveness for the use of non-invasive and invasive resources, and their application in special population groups. This study analyzes those knowledge gaps and outlines a guideline that could lead future research.

Características Psicomotoras e Sensoriais de crianças com Transtorno do Espectro Autista (TEA) em atendimento terapêutico ocupacional / Características psicomotoras y sensoriales de niños con trastorno del espectro autístico (TEA) en atención de Terapia Ocupacional / Psychomotoral and sensory characteristics of children with autistic spectrum disorder (tea) in occupational therapeutic care

Atualmente o autismo tem sido classificado como Transtorno do Espectro Autista (TEA), podendo apresentar como critério diagnóstico os atrasos no desenvolvimento psicomotor e alterações sensoriais, além das características típicas. Objetivo: Identificar as características psicomotoras e sensoriais de crianças com diagnóstico de TEA atendidas no setor de Terapia Ocupacional na Unidade Saúde Escola da Universidade Federal de São Carlos (USE-UFSCar). Método: Trata-se de uma pesquisa exploratória e descritiva, de abordagem quantitativa. Participaram nove crianças de quatro a dez anos de idade com diagnóstico de TEA, e seus responsáveis. Os instrumentos utilizados para coleta de dados foram um Questionário de dados gerais da criança; Perfil sensorial e Bateria Psicomotora. A coleta dos dados ocorreu na própria Unidade,sendo que os dados dos instrumentos padronizados foram analisados a partir das instruções pré-existentes, e os dados do Questionário de forma descritiva. Resultados: Identificou-se que as crianças participantes apresentam déficits psicomotores nos seguintes aspectos: noção do corpo, estruturação espaço-tempo, praxia global e fina. Em relação ao sistema sensorial, as alterações identificadas no presente estudo foram na audição, sistema vestibular e multissensorial, constante procura sensorial, inatenção e na motricidade fina. Conclusão: Aponta-se para a importância de maiores investimentos nesse campo, uma vez que pode favorecer as intervenções voltadas a esse público.

Actualmente, el autismo se ha clasificado como trastorno del espectro autista (TEA), y puede presentarse como criterio de diagnóstico de retrasos en el desarrollo psicomotor y cambios sensoriales, además de las características típicas. Objetivo: identificar las características psicomotoras y sensoriales de los niños diagnosticados con TEA tratados en el sector de terapia ocupacional en la Unidad de la Escuela de Salud de la Universidad Federal de São Carlos (USE-UFSCar). Método: Esta es una investigación exploratoria y descriptiva, con un enfoque cuantitativo. Participaron nueve niños de cuatro a diez años diagnosticados con TEA y sus padres. Los instrumentos utilizados para la recopilación de datos fueron un cuestionario de datos generales del niño; Perfil sensorial y batería psicomotora. La recopilación de datos tuvo lugar en la propia Unidad, y los datos de los instrumentos estandarizados se analizaron utilizando instrucciones preexistentes y los datos del Cuestionario de manera descriptiva. Resultados: Se identificó que los niños participantes tienen déficits psicomotores en los siguientes aspectos: noción del cuerpo, estructuración espacio-tiempo, praxis global y fina. Con respecto al sistema sensorial, los cambios identificados en el presente estudio fueron en el sistema auditivo, vestibular y multisensorial, búsqueda sensorial constante, falta de atención y en el motricidad fina. Conclusión: señala la importancia de mayores inversiones en este campo, ya que puede favorecer intervenciones dirigidas a esta audiencia.

Currently, autism has been classified as Autism Spectrum Disorder (ASD), and may present as a diagnostic criterion delays in psychomotor development and sensory changes, in addition to the typical characteristics. Objective: To identify the psychomotor and sensory profile of children diagnosed with ASD. Method: This is a survey study, exploratory and descriptive, with a qualitative and quantitative approach. Nine children from four to ten years old diagnosed with a diagnosis of ASD participated, linked to the School Health Unit (uSE)­UFSCar and their guardians. The instruments used for data collection were a questionnaire of general data of the child; Sensory profile and Psychomotor Battery. Data collection took place at the Unit itself, and data from standardized instruments were analyzed based on pre-existing instructions, and data from the Questionnaire were analyzed descriptively. Results: Children with ASD have psychomotor deficits in the following aspects: body notion, space-time structuring, global and global and fine praxis. Regarding the sensory system, the changes identified were in hearing, vestibular and multisensory system, constant sensory search, inattention and fine motor. Conclusion: It points to the importance of greater investments in this field, since it can favor interventions aimed at this audience.

Caracterización neurofisiológica de la función de fibra pequeña en mujeres heterocigotas con enfermedad de Fabry / Neurophysiologic characterization of small fiber function in heterozigous women with Fabry disease

RESUMEN INTRODUCCIÓN: La enfermedad de Fabry (EF) es una enfermedad genética, causada por el déficit de la enzima alfa galactosidasa A (α-Gal A), lo que provoca la acumulación de glicoesfingolípidos en los tejidos. Sus manifestaciones clínicas son variables. Estudios en mujeres heterocigotas reportan la existencia de dolor neuropático como manifestación de neuropatía de fibra pequeña. OBJETIVO: Determinar la presencia de neuropatía de fibra pequeña en mujeres heterocigotas para la EF, mediante la prueba cuantitativa sensorial. MATERIALES Y MÉTODOS: Se evaluaron 33 mujeres heterocigotas para EF y 33 mujeres sanas, con características demográficas similares. A todas se les aplicó la prueba cuantitativa sensorial (Quantitative Sensory Testing por medio de la detección de umbrales de frío (Colà Detection Threshold), calor (Warm Detection Threshold), dolor inducido por calor (Heat-pain Detection Thresholds) y vibración (Vibratory Detection Threshold) en los miembros superior e inferior, utilizando un sistema asistido por computador versión IV (CASE IV, WR Medical Electronics Co., Stillwater, MN). Adicionalmente, al grupo de mujeres heterocigotas para EF, se le evaluó la percepción subjetiva de dolor neuropàtico mediante el cuestionario de síntomas sensitivos neuropáticos positivos (Positive Neuropathic Sensory Symptom). Los resultados de la prueba cuantitativa sensorial se compararon entre los grupos. También se estableció la correlación entre la prueba cuantitativa sensorial y los resultados del cuestionario de síntomas sensitivos neuropáticos positivos. RESULTADOS: Se encontró una diferencia estadísticamente significativa en las pruebas de vibración (p = 0,008), calor (p = 0,017) y dolor inducido por calor (p = 0,04) en el miembro inferior en las mujeres heterocigotas para EF, comparado con el grupo control. Se encontró una correlación inversa estadísticamente significativa entre la intensidad del dolor quemante y el dolor inducido por calor en el miembro inferior (p = 0,018, r = -0,48) y entre la intensidad del dolor al ser rozado o tocado y el dolor inducido por calor en el miembro inferior (p = 0,006, r = -0,49). CONCLUSIÓN: En las mujeres heterocigotas para EF, las pruebas objetivas para establecer la presencia de neuropatía de fibra pequeña son anormales en miembros inferiores y se correlacionan con los síntomas sensitivos.

SUMMARY INTRODUCTION: Fabry disease is a genetic condition caused by alpha-galactosidase A deficiency triggering glycosphingolipid accumulation in tissues. Clinical manifestations are variable. Studies in heterozigous females report the existence of neuropathic pain as manifestation of small fiber neuropathy. OBJECTIVE: To determine presence of small fiber neuropathy in heterozigous females with Fabry disease through Quantitative Sensory Testing (QST). MATERIALS AND METHODS: 33 heterozigous females with fabry disease and 33 healthy females with similar demographic characteristics were evaluated. QST was performed to every female evaluating Cold detection Threshold (CDT), Warm Detection Threshold (WDT), Heat-pain Detection Threshold (HPDT) and Vibratory Detection Threshold (VDT) in upper and lower limbs through Computer Assisted Sensory Examination software (CASE IV, WR Medical Electronics Co., Stillwater, MN). Subjective perception of neuropathic pain was measured through Positive Neuropathic Sensory Symptom questionnaire (P-NSS) in heterozigous females with Fabry disease. QST results were compared between groups. Correlations between QST and P-NSS were established. RESULTS: Statistically significant differences were observed in VDT (p= 0,008), WDT (p= 0,017) and HPDT (p= 0,04) in lower limbs of heterozigous females with Fabry disease compared with control group. Negative correlation was found among burning pain intensity and HPDT at lower limbs (p= 0,018, r= -0,48) and among pain intensity to light touch and HPDT in lower limbs (p= 0,006, r=-0,49). CONCLUSIONS: Objective tests to establish presence of small fiber neuropathy in heterozigous females with Fabry disease are abnormal at lower limbs and correlate with sensory symptoms.

Transfusion practices in cirrhotic patients at a tertiary liver care center from Northern India

Abstract Introduction: Transfusion in cirrhotic patients remains a challenge due to the absence of evidence-based guidelines. Our study aimed to determine the indication of transfusion and the associated transfusion thresholds in cirrhotic patients. Methods: This retrospective observational study was conducted in the Department of Transfusion Medicine at a tertiary care liver center from October 2018 to March 2019. The blood bank and patient records of cirrhotic patients admitted during the study period were retrieved and analyzed to determine the current transfusion practice. Results: A total of 992 cirrhotic patients were included in the study. Blood components were transfused to 402 (40.5%) patients. Sixty-nine (17.2%) patients were transfused to control/treat active bleeding, while 333 (82.8%) were transfused prophylactically. Packed red blood cells (65.4%) was the most commonly transfused blood component, followed by fresh frozen plasma (35.6%), among patients receiving transfusions (therapeutic & prophylactic). The mean pre-transfusion thresholds for: (i) packed red blood cell transfusion: hemoglobin less than 7 g/dL; (ii) fresh frozen plasma transfusion: international normalized ratio over 2.6; (iii) platelet concentrate transfusion: platelet count less than 40,700/µL, and; (iv) cryoprecipitate transfusion: fibrinogen less than 110 mg/dL. The average length of stay of the study population was 5 days (3-9. Conclusion: To conclude, 40.5% of our hospitalized cirrhotic patients were transfused, with the majority of the transfusions being prophylactic (82.8%). Separate guidelines are required for this patient population, as these patients have an altered hemostasis which responds differently to the transfusion of blood components.

FRAX-based assessment and intervention threshold curves for osteoporosis evaluation in Ecuador / Curvas de intervención y evaluación basadas en FRAX Ecuador

RESUMEN Introducción: La herramienta FRAX ha sido validada y adaptada a diferentes países, cubriendo a casi el 80% de la población mundial, incluido Ecuador, donde fue adaptada en 2009. El objetivo de este estudio fue elaborar curvas de evaluación e intervención basadas en FRAX Ecuador. Métodos: Utilizando el modelo FRAX Ecuador, calculamos la probabilidad de fractura osteoporótica mayor y fractura de cadera femenina sin ningún factor de riesgo y sin la inclusión de DMO. Las probabilidades se calcularon en intervalos de 5 años de 40 a 90 años. Las probabilidades de fractura mayor y de cadera se calcularon en 3 escenarios diferentes: 1. Historia de fractura previa sin la inclusión de DMO, 2. T-Score de -2,5 SD sin otros factores de riesgo clínico, 3. T-Score -1,5 SD sin otros factores de riesgo clínico. Resultados: En mujeres sin factores de riesgo, la probabilidad de fractura osteoporótica mayor aumentó con la edad del 0,4% a los 40 años al 7,3% a los 90 años. La probabilidad de fractura de cadera aumentó con la edad de 0% a los 40 años a 3,6% a los 90 anos. La probabilidad de fractura osteoporótica mayor aumentó en mujeres con un puntaje T de -2,5 SD de 0,9% a los 40 años a 5,5% a los 90 años; con puntaje T de -1,5 DE, de 0,6% a los 40 años a 3,9% a los 90 anos. Conclusión: Los datos muestran la importancia de aplicar herramientas como FRAX, específicas para cada país y también la creación de curvas de evaluación e intervención que permitan discernir según cada paciente la necesidad de utilizar recursos como DXA y tratamientos específicos.

ABSTRACT Introduction: FRAX has been validated and adapted to different countries, covering almost 80% of the world's population, including Ecuador where it was adapted in 2009. The purpose of this study is to elaborate evaluation and intervention curves based on FRAX Ecuador. Methods: Using the FRAX Ecuador model, we calculated the probability of a major osteoporotic fracture and a female hip fracture without any risk factor and without the inclusion of BMD. The probabilities were calculated in 5-year intervals from 40 to 90 years. The probabilities of major fractures and hip fractures were calculated in 3 different scenarios: 1. History of previous fracture without the inclusion of BMD, 2. T score -2.5 SD without other clinical risk factors, 3. T score -1.5 SD without other clinical risk factors. Results: In women without risk factors, the probability of a major osteoporotic fracture increased with age from 0.4% at 40 years to 7.3% at 90 years. The probability of hip fracture increased with age from 0% at 40 years to 3.6% at 90 years. The probability of a major osteoporotic fracture increased in women with a T score of -2.5 SD from 0.9% at 40 years to 5.5% at 90 years; with a T-score of -1.5 SD, from 0.6% at 40 years to 3.9% at 90 years. Conclusion: Data shows the importance of applying tools such as FRAX, specific for each country and also the creation of evaluation and intervention curves that allow discerning according to each patient the need for the use of resources such as DXA and specific treatments.

Evaluation of skin sensitivity in individuals presented with temporomandibular disorder / Avaliação da sensibilidade cutânea em indivíduos com disfunção temporomandibular

ABSTRACT Purpose: to identify the occurrence of a difference in skin sensitivity between analogous points on the face in individuals with temporomandibular disorder. Methods: a total of 60 individuals of both genders, aged 18 to 73 years, participated in the study. People classified with TMD signs and symptoms with the Fonseca Anamnestic Questionnaire were included. The skin sensitivity was evaluated with a Semmes-Weinstein esthesiometer. Sensitivity change was defined in this study as the occurrence of a difference between analogous points on both hemifaces. The localization of the points followed the regional block anatomical description and was confirmed with a neuromuscular electrostimulation device. The collected data were analyzed statistically with a 5% significance level. Results: the occurrence of a difference in sensitivity between the analogous points had a significant association with age group and severity of TMD. However, no association was perceived between sensitivity change and gender. Conclusion: in the population studied, the more severe the temporomandibular disorder, the greater the skin sensitivity change on the face. Also, the older the person, the higher the number of analogous points with a difference in sensitivity.

RESUMO Objetivo: identificar a ocorrência de diferença da sensibilidade cutânea entre pontos análogos da face em indivíduos com disfunção temporomandibular. Métodos: participaram do estudo 60 indivíduos, de ambos os sexos, com idades entre 18 e 73 anos. Foram incluídas pessoas classificadas com sinais e sintomas de DTM pelo Questionário Anamnésico de Fonseca. A avaliação da sensibilidade cutânea ocorreu com o auxílio de um estesiômetro Semmes-Weinstein. Para esse estudo, definiu-se alteração da sensibilidade a ocorrência de diferença entre pontos análogos das duas hemifaces. A localização dos pontos seguiu a descrição anatômica de bloqueio regional e foram confirmados com a utilização do aparelho de eletroestimulação neuromuscular. Foi realizada análise estatística dos dados coletados com nível de significância de 5%. Resultados: a ocorrência de diferença de sensibilidade entre os pontos análogos teve associação significante com as variáveis faixa etária e severidade da disfunção temporomandibular. Contudo, não foi percebida entre a alteração da sensibilidade e o sexo. Conclusão: na população estudada, quanto mais severa a disfunção temporomandibular, maior a alteração de sensibilidade cutânea ao longo da face, assim como, quanto maior a idade, maior a quantidade de pontos análogos com diferença de sensibilidade.

Observation on therapeutic efficacy of heat-sensitive moxibustion plus Western medicine for diabetic peripheral neuropathy / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of heat-sensitive moxibustion plus Western medicine in treating patients with diabetic peripheral neuropathy (DPN). Methods: A total of 70 patients with DPN were divided into an observation group and a control group by sealed envelope method combined with the random number table method, with 35 cases in each group. The control group was treated with routine medicine, and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment in the control group. After 2 courses of treatment, the scores of Toronto clinical scoring system (TCSS) and vibration perception threshold (VPT) in both groups were observed, and the clinical efficacy was compared. Results: During treatment, 3 cases dropped out in the control group and 4 cases in the observation group. After treatment, the total effective rate in the observation group was higher than that in the control group (P<0.05). The scores of TCSS and VPT in both groups decreased after treatment, and the intra-group comparison showed statistical significance (both P<0.05). The scores of TCSS and VPT in the observation group were lower than those in the control group, and the differences were statistically significant (both P<0.05). Conclusion: Heat-sensitive moxibustion plus Western medicine can improve the symptoms in patients with DPN, and has a better curative effect than the Western medicine alone.

Neural thresholds in the diagnosis of diabetic peripheral neuropathy / 中华物理医学与康复杂志

Objective To explore the value of neural thresholds in diagnosing and treating diabetic peripheral neuropathy.Methods A total of 42 type 2 diabetics and 21 healthy counterparts were recruited,and grouped according to the patients' illness duration and level of hemoglobin A1c (HbA1C).The neural thresholds of their median,ulnar and superficial peroneal nerves were measured.Results The neural thresholds increased with the disease's duration.The average neural threshold of those living with the disease for 10 years or more was significantly higher than that with a duration of less than 10 years.The nerve thresholds also increased with the level of hemoglobin A1c(HbA1C),and they were significantly higher in the group with an HbA1C level ≥9 than those in the group with HbA1C＜9.There was a positive linear correlation between the neural threshold of the ulnar and superficial peroneal nerves and the HbA1C level (P＜0.05).However,there was no significant correlation between the neural thresholds of the median nerves and the level of HbA1C (P＞0.05).There was also a positive linear correlation between the neural thresholds of the median,ulnar and superficial peroneal nerves and the duration of the disease (P＜0.01).Conclusion The neural threshold changes with the duration of diabetes and the level of HbA1C.Evaluating the peripheral nerve function of diabetics may have clinical utility.

Analysis on Odorous Components in Different Processed Products of Periplaneta americana by HS-SPME-GC-MS / 中国实验方剂学杂志

Objective:To analyze the odorous components and their contents in raw products, wine-processed products, vinegar-processed products and wheat bran-processed products of Periplaneta americana. Method:Headspace solid-phase microextraction (HS-SPME) was used to extract the volatile components from different processed products, the chemical compositions were analyzed by gas chromatography-mass spectrometry (GC-MS), and the relative contents of each component was calculated by peak area normalization method. Result:A total of 41, 32, 40 and 47 components were respectively identified from raw, wine-processed, vinegar-processed and wheat bran-processed products of P. americana, involving a total of 13 common components. Conclusion:The odorous components in the raw products are mainly derived from aldehydes, alcohols, amines, hydrocarbons and other volatile substances. Odorous components can be reduced effectively and flavoring substances can be increased by wine, vinegar and wheat bran processing. This study provides a scientific basis for the further study of correcting odor of P. americana, it also provides a reference for analysis and correction of odor of animal medicines.

FRAX-based intervention and assessment thresholds in seven Latin American countries

Age-specific intervention and assessment thresholds were developed for seven Latin American countries. The intervention threshold ranged from 1.2% (Ecuador) to 27.5% (Argentina) at the age of 50 and 90 years, respectively. In the Latin American countries, FRAX offers a substantial advance for the detection of subjects at high fracture risk.INTRODUCTION:Intervention thresholds are proposed using the Fracture Risk Assessment (FRAX) tool. We recommended their use to calculate the ten-year probability of fragility fracture (FF) in both, men and women with or without the inclusion of bone mineral density (BMD). The purpose of this study is to compute FRAX-based intervention and BMD assessment thresholds for seven Latin American countries in men and women ≥ 40 years.METHODS:The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF) equivalent to a woman with a prior FF and a body mass index (BMI) equal to 25.0 kg/m2 without BMD or other clinical risk factors. The lower assessment threshold was set at a 10-year probability of a MOF in women with BMI equal to 25.0 kg/m2, no previous fracture and no clinical risk factors. The upper assessment threshold was set at 1.2 times the IT.RESULTS:For the seven LA countries, the age-specific IT varied from 1.5 to 27.5% in Argentina, 3.8 to 25.2% in Brazil, 1.6 up to 20.0% in Chile, 0.6 to 10.2% in Colombia, 0.9 up to 13.6% in Ecuador, 2.6 to 20.0% in Mexico, and 0.7 up to 22.0% in Venezuela at the age of 40 and 90 years, respectively.CONCLUSIONS:In the LA countries, FRAX-based IT offers a substantial advance for the detection of men and women at high fracture risk, particularly in the elderly. The heterogeneity of IT between the LA countries indicates that country-specific FRAX models are appropriate rather than a global LA model (AU)

Quantitative sensory testing in elderly: longitudinal study / Teste sensitivo quantitativo em idosos: estudo longitudinal

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

RESUMO Objetivo: Avaliar pacientes idosos em um serviço de geriatria, juntamente com as características sensitivas e sua associação com aspectos clínicos. Métodos: Este é um estudo longitudinal descritivo. Foram avaliados 36 sujeitos saudáveis de ambos os sexos. Os seguintes instrumentos e avaliações foram realizados: Avaliação clínica, Mini Exame de Estado Mental (Mini-Mental) e testes sensitivos quantitativos. Resultados: Durante o acompanhamento houve redução do volume corpuscular médio (VCM) em cada avaliação (P < 0,001) e aumento significativo das concentrações de hemoglobina corpuscular média (CHCM) (P < 0,001). Houve aumento dos limiares olfativos (p < 0,001), salgado (p = 0,024), azedo (p = 0,020), amargo (p = 0,001), frio face (p = 0,019), frio mão (p = 0,004), tato face (p < 0,001), tato mão (p = 0.012) e vibração face (p = 0,018). Morbidades prévias foram associadas às alterações de sensibilidade nos indivíduos desta amostra. Conclusão: Este estudo longitudinal sugere que a perda de sensibilidade no envelhecimento pode estar associada à presença de morbidades em idosos.

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

BACKGROUND: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

The optimal gamma passing rate thresholds of IMRT dosimetric verification in the treatment of esophageal cancer / 中华放射医学与防护杂志

Objective To investigate the optimal gamma passing rate of intensity-modulated radiotherapy (IMRT) dosimetric verification in the treatment of esophageal cancer using a three-dimensional dose verification system EDoseTM.Methods Twenty five esophageal cancer patients treated by 7-field IMRT were retrospectively reviewed.Measured dose distribution were reconstructed on CT image and evaluated by gamma analysis and DVH metrics using the EDoseTM system.Plans with DVH metrics dose difference ＜ 5％ or with gamma passing ＞ 90％ under 3％/3 mm criteria were accepted.The optimal gamma passing rate for criteria of 5％/3 mm,3％/3 mm,2％/2 mm were investigated by drawing the receiver operating characteristic (ROC) curves and calculating the Youden Index.The sensitivity and specificity of the these optimal thresholds in the plan verification were also analyzed.Results The optimal thresholds for global gamma indices with 5％/3 mm,3％/3 mm,2％/2 mm were 98.66％,94.84％,78.56％,respectively.In the 90％ common threshold,The sensitivity and specificity for common 90％ threshold and optimal threshold under 3％/3 mm criteria were 0.17 vs.0.85 and t 0.84 vs.0.27,respectively.The sensitivity and specificity were 0.89,0.65 and 0.23,0.47 for optimal thresholds under 5％/3 mm and 2％/2 mm criteria,respectively.Conclusions The sensitivity of optimal threshold gamma passing rate improved significantly compared with the common threshold (90％) at 3％/3 mm criteria.,The sensitivity and the specificity were more balanced at the 2％/2 mm criteria compared with those at 3％/3 mm criteria.

Applications of current perception threshold evaluations in discovering early diabetic peripheral neuropathy / 中国医师杂志

Diabetic neuropathy is one of the common long-term complications of diabetes,which occurs in the peripheral nervous system and the central nervous system,and its most common type is diabetic peripheral neuropathy (DPN).Diabetic peripheral neuropathy can not only cause pain,numbness and limitation of activity in limbs,but also lead to diabetic foot ulcers even amputations due to hypoesthesia and anesthesia,ultimately affects the quality of life of patients with diabetes and increases the mortality.Nearly half of patients with DPN do not have any clinical symptoms,thus the early detection and diagnosis of diabetic peripheral neuropathy are particularly critical.Current perception threshold (CPT) evaluation is considered as a mean of early detection of DPN,which gains more and more attentions because of its non-invasive feature,simple operation and high sensitivity.So far,there is scarcely any article summarizing CPT evaluations' applications in researching the relationships between DPN and its risk factors.This review will discuss the principles and advantages of CPT evaluations,and its relationship with DPN will also be summarized as follows.

Penile sensory thresholds in subtypes of premature ejaculation: Implications of comorbid erectile dysfunction / 亚洲男科学杂志(英文版)

Penile hypersensitivity plays an important role in premature ejaculation (PE), but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction (ED), PE with an intravaginal ejaculation latency time ≤1 min and >1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool (PEDT) score, and the 5-item version of the International Index of Erectile Function (IIEF-5) score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus (median amplitude: 4.92 vs 3.65 μ m, P = 0.02) and the right penile shaft (median amplitude: 3.87 vs 3.30 μ m, P = 0.03), while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group (12 vs 14, P < 0.001). The IIEF-5 and PEDT scores were negatively correlated (r = -0.29, P < 0.001). Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score (20 vs 21, P = 0.02). Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

Investigation on the significance of pressure pain thresholds before and after treatment in female with myofascial chronic pelvic pain / 中国医师进修杂志

Objective To explore the therapeutic effect and clinical significance of pelvic floor rehabilitation technique in female with myofascial chronic pelvic pain (MCPP) by detecting the pressure pain thresholds (PPTs). Methods One hundred healthy female (control group) and 324 female MCPP patients (observation group) from January 2009 to December 2016 were selected. Automatic body surface and vaginal pressure pain detector was applied to detect two groups′PPTs of the 34 spots. The difference of PPTs at each spot was analyzed in two groups. In addition, 51 patients with moderate and severe MCPP were selected to record the changes of PPTs and pain scores before and after the treatment of pelvic floor rehabilitation technique. Results The average PPTs of the abdomen, vulva, pelvic floor and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament in the observation group were significantly lower than those in the control group (P<0.01 or<0.05). The average PPTs of the abdomen, vulva, pelvic floor muscles and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament of 51 MCPP patients after treatment were significantly higher than those before treatment (P<0.01). After treatment, PPTs and pain scores of the pelvic floor muscles, bilateral adnexa uteri, bilateral sacrouterine ligament, bilateral sacral spine ligament and vaginal front and back fornix were negatively correlated (r =- 0.78 to- 0.19, P = 0.01 to 0.04); there was a negative correlation between the PPTs and pain scores of the left and right latissimus dorsi (r=-0.28, P=0.04;r=-0.32, P=0.02). The complete remission rate with the pelvic floor rehabilitation technique in 51 patients with MCPP was 9.8％(5/51), the significant remission rate was 90.2％(46/51), and the total remission rate was 100.0％ (51/51). Conclusions Compared with the normal healthy ones, female with MCPP has lower PPTs in the abdomen, perineum, vagina and pelvic floor. The effect of pelvic floor rehabilitation technique on MCPP is well, which can increase patients′PPTs to reduce pain scores. It is a worthwhile method to treat these diseases.

Estimation of Puretone Thresholds of Sensorineural Hearing Loss Adults Using Auditory Brain Stem Responses to Tone Burst and Tone Burst in Notched Noise / 听力学及言语疾病杂志

Objective Thresholds for auditory brain stem responses (ABRs) to tone burst and tone burst in notched noises of two different intensities were tested in adults with sensorineural hearing loss.The relationship between ABR and puretone thresholds was analyzed to identify an acoustic stimuli with better frequency-specificity.Methods Thirty-eight adults with sensorineural hearing loss (totally 45 ears) were included in the study.Tone burst used to elicit ABRs had 2.5 cycles on the rise and fall and no plateau.Notched noises of two different intensities were used to mask tone burst ipsilaterally when recording ABRs.Those two kinds of notched noises were 25 dB (intensity A) and 15 dB (intensity B) lower than tone burst in intensity respectively.Tone burst ABRs without masking were named tb-ABR,while tone burst ABRs in notched noises of intensity A and B named as amtb-ABR and bmtb-ABR.Thresholds for tb ABR,amtb ABR and bmtb-ABR were tested and analyzed.Results The regression coefficients between puretone thresholds and thresholds for tb-ABR,amtb-ABR and bmtb-ABR of all frequencies were greater than 0.8.The mean differences between ABR and puretone thresholds were all less than 10 dB.Tb-ABR thresholds the were the closest to puretone thresholds at 500 Hz,while bmtb ABR thresholds were the closest at the other three frequencies.Bmtb-ABR thresholds were more close to puretone thresholds in patients with steeply sloping hearing loss.Conclusion Thresholds for all those three ABRs could be used to predict puretone thresholds.In most condition,tb-ABR thresholds were able to estimate puretone thresholds.In some condition,different stimuli could be chosen to elicit ABR at different frequencies.It was reasonable to choose bmtb -ABR for puretone thresholds estimation in patients with steeply sloping hearing loss.