Lance-adams syndrome: a report of two cases

Chronic post-hypoxic myoclonus, also known as Lance-Adams syndrome (LAS), is a rare complication of successful cardiopulmanry resuscitation often accompanied by action myoclonus and cerebellar ataxia. It is seen in patients who have undergone a cardiorespiratory arrest, regained consciousness afterwards, and then developed myoclonus days or weeks after the event. Worldwide, 122 cases have been reported in the literature so far, including 1 case of Chinese. Here we report 2 Chinese LAS patients with detailed neuroimagings. Cranial single photon emission computed tomography (SPECT) of patient 1, a 52-year-old woman, showed a mild hypoperfusion in her left temporal lobe, whereas patient 2, a 54-year-old woman, manifested a mild bilateral decrease of glucose metabolism in the frontal lobes and a mild to moderate decrease of the N-acetyl aspartate (NAA) peak in the bilateral hippocampi by cranial [¹⁸F]-fluorodeoxyglucose positron emission tomographic (PET) scan and cranial magnetic resonance spectroscopy (MRS), respectively. We also review the literature on the neuroimaging, pathogenesis, and treatment of LAS. Project supported by the National Natural Science Foundation of China (No. 30600193), the Youth Talent Special Fund of the Health Bureau of Zhejiang Province, China (No. 2004QN012), and the Health Bureau of Zhejiang Province, China (Nos. 2000A114 and 2007A100)     

逍遥散治疗慢性病毒性乙型肝炎(肝郁脾虚证)50例临床观察

目的:观察逍遥散治疗慢性乙型病毒性肝炎的临床疗效。方法:100例慢性乙型病毒性肝炎患者随机分为两组,观察组50例在对照组基础上口服逍遥散,150ml/次,3次/d;对照组50例口服恩替卡韦分散片,0.5mg/次,1次/d。两组患者均治疗3个疗程共12周,观察两组患者治疗前后的临床症状、体征、HBV-DNA、肝功能的变化程度。结果:观察组患者临床疗效总有效率显著高于对照组(98%vs 84%),两组间比较差异有显著性意义(P0.05)。结论:加服逍遥散治疗慢性乙型病毒性肝炎有较好的疗效,值得临床进一步研究应用。     

Reversal of haemodialysis induced hypertriacylgycerolemia by L-carnitine

A 24 week follow-up study on lipid change following maintenance haemodialysis (MHD) in 25 chronic renal failure (CRF) patients revealed significantly raised serum Triacylglycerol (TAG) levels in these cases (P<0.001), while cholesterol and HDL-Cholesterol did not show any significant change, the extent of increase was 10.5±3.6% after 12 weeks and 23.0±5.8% after 24 weeks. Corresponding increase in CRF patients treated conservatively, without haemodialysis, were 3.1±1.2% and 7.2±2.7% at these intervals. Subsequent oral administration of L-Carnitine (5mg/kg body weight twice a day) for three weeks brought about a significant reversal of elevated serum TAG level in MDH group as well as in the conservatively treated group (P≤0.05). It is concluded that the haemodialysis induced Hyper-Triacylglycerolemia of CRF patients is revertible by Carnitine replenishment. Even the concomitant increase in conservatively treated group is revertible by carnitine administration.     

Chronic ankle instability is associated with proprioception deficits: A systematic review and meta-analysis

Background:Acute ankle injury causes damage to joint mechanoreceptors and deafferentation and contributes to proprioception deficits in patients with chronic ankle instability(CAI).We aimed to explore whether deficits of proprioception,including kinesthesia and joint position sense(JPS),exist in patients with CAI when compared with the uninjured contralateral side and healthy people.We hypothesized that proprioception deficits did exist in patients with CAI and that the deficits varied by test methodologies.Methods:The study was a systematic review and meta-analysis.We identified studies that compared kinesthesia or JPS in patients with CAI with the uninjured contralateral side or with healthy controls.Meta-analyses were conducted for the studies with similar test procedures,and narrative syntheses were undertaken for the rest.Results:A total of 7731 studies were identified,of which 30 were included for review.A total of 21 studies were eligible for meta-analysis.Compared with the contralateral side,patients with CAI had ankle kinesthesia deficits in inversion and plantarflexion,with a standardized mean difference(SMD)of 0.41 and 0.92,respectively,and active and passive JPS deficits in inversion(SMD=0.92 and 0.72,respectively).Compared with healthy people,patients with CAI had ankle kinesthesia deficits in inversion and eversion(SMD=0.64 and 0.76,respectively),and active JPS deficits in inversion and eversion(SMD=1.00 and 4.82,respectively).Proprioception deficits in the knee and shoulder of patients with CAI were not statistically significant.Conclusion:Proprioception,including both kinesthesia and JPS,of the injured ankle of patients with CAI was impaired,compared with the uninjured contralateral limbs and healthy people.Proprioception varied depending on different movement directions and test methodologies.The use of more detailed measurements of proprioception and interventions for restoring the deficits are recommended in the clinical management of CAI.     

Acute and chronic effects of aquatic treadmill training on land treadmill running kinematics: A cross-over and single-subject design approach

The aim of this study was to determine if selected kinematic measures (foot strike index [SI], knee contact angle and overstride angle) were different between aquatic treadmill (ATM) and land treadmill (LTM) running, and to determine if these measures were altered during LTM running as a result of 6 weeks of ATM training. Acute effects were tested using 15 competitive distance runners who completed 1 session of running on each treadmill type at 5 different running speeds. Subsequently, three recreational runners completed 6 weeks of ATM training following a single-subject baseline, intervention and withdrawal experiment. Kinematic measures were quantified from digitisation of video. Regardless of speed, SI values during ATM running (61.3 ± 17%) were significantly greater (P = 0.002) than LTM running (42.7 ± 23%). Training on the ATM did not change (pre/post) the SI (26 ± 3.2/27 ± 3.1), knee contact angle (165 ± 0.3/164 ± 0.8) or overstride angle (89 ± 0.4/89 ± 0.1) during LTM running. Although SI values were different between acute ATM and LTM running, 6 weeks of ATM training did not appear to alter LTM running kinematics as evidenced by no change in kinematic values from baseline to post intervention assessments.     

The relationship between childhood emotional abuse and chronic pain among people who inject drugs in Vancouver,Canada

BackgroundPeople who inject drugs (PWID) often contend with chronic pain as a result of illness and trauma, and such pain is known to have significant impacts on mental health, quality of life, and substance use behaviours. Although PWID are also known to have high rates of childhood trauma, little is known about how childhood emotional abuse may be associated with chronic pain in this population.ObjectiveWe undertook this study to explore emotional abuse and chronic pain among PWID.Participants and settingThis study comprised a total of 1459 participants in Vancouver, Canada between June 2014 and November 2016.MethodsWe employed multivariable generalized estimating equations with data derived from two prospective cohort studies of community-recruited PWID to examine the relationship between childhood emotional abuse and chronic pain in the past six months.ResultsAmong eligible participants, 591 (40.5%) reported childhood emotional abuse, and 760 (52.1%) reported chronic pain in the previous six months. In a multivariable analysis, experiencing childhood emotional abuse remained independently associated with chronic pain (adjusted odds ratio: 1.25; 95% confidence interval: 1.01–1.53) after adjustment for a range of socio-demographic and drug use confounders.ConclusionsOur findings suggest that childhood emotional abuse may have lasting relationships with chronic pain among PWID, potentially through established physiological and psychological mechanisms. Current chronic pain treatment may benefit from the evaluation of life course vulnerabilities that may be amenable to earlier interventions. Further, increased availability of effective trauma-informed chronic pain treatment is needed among this vulnerable population.     

Parental chronic illness and child education: Evidence from children in Indonesia

Using two waves (2007, 2014) of Indonesian Family Life Survey data, this paper investigates effects of parental chronic illness on educational attainment of children in Indonesia. Studies on this nonpecuniary cost of adult morbidity are rare in the literature despite its significance in future wellbeing of people in developing countries. This paper is distinguished from existing related studies in that it accounts for the duration of illness in the estimation of the effects. The results show that girls whose father suffers from chronic illness for a longer duration achieve significantly lower educational levels between 2007 and 2014, compared to children of their same age cohort with healthy parents. In contrast, boys are unaffected by the father’s duration of chronic illness. Furthermore, this paper finds no evidence that mother’s duration of chronic illness affects educational attainment of children in Indonesia.     

慢性乙醇中毒患者EMG及NCV检测

目的观察电生理检测对慢性乙醇中毒的诊断价值。方法对32例慢性乙醇中毒患者的临床特征进行分析,并作神经电图（NCV）肌电图（EMG）检测进行分析。结果32例慢性乙醇中毒患者的EMG检查经综合判断提示神经源性损害;MCV异常率为65.6％,≥SCU异常率为83．3％．结论EMG,NCV能反映慢性乙醇中毒引起的周围神经系统的弥漫性损害,为临床提供电生理检测的客观指标。     

Quantitative Assessment of Expression of Lactate Dehydrogenase and its Isoforms 3 and 4 may Serve as Useful Indicators of Progression of Gallbladder Cancer: A Pilot Study

We have studied the expression of lactate dehydrogenase and its isoforms in gall bladder cancer, cholelithiasis and chronic cholecystitis. Quantitative and qualitative assays of lactate dehydrogenase and its various isoforms were carried out in the blood sera of patients and healthy controls along with parallel estimation of various liver function test enzymes. Statistical analysis was done using the software Graph Pad Prism. Significantly high expression of lactate dehydrogenase along with alkaline phosphatase and total bilirubin (P ≤ 0.05) was observed in all the three clinical conditions as compared to controls. LDH showed an increasing trend from stage I to stage IV of GBC indicating a significant positive association with the disease progression. The levels of LDH 3 and 4 isoforms appeared significantly more elevated in GBC than cholelithiasis or chronic cholecystitis. We suggest that a careful estimation of total LDH and its isoforms 3 and 4 alone or along with alkaline phosphatase and total bilirubin during different clinical stages, like chronic cholecystitis, cholelithiasis and GBC, may prove to be a potentially useful biomarker in the prognostic management of gall bladder diseases, specifically GBC.     

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective

Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion.

Methods

Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system.

Results

Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization.

Conclusions

Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.