The underlying cause of diabetic neuropathy remains unclear,although pathological studies have suggested an ischaemic basis related to microangiopathy, possibly mediated through effects on the energy-dependent Na+/K+p...The underlying cause of diabetic neuropathy remains unclear,although pathological studies have suggested an ischaemic basis related to microangiopathy, possibly mediated through effects on the energy-dependent Na+/K+pump. To investigat e the pathophysiology of diabetic neuropathy, axonal excitability techniques wer e undertaken in 20 diabetic patients with neuropathy severity graded through a c ombination of quantitative sensory testing (QST) using a vibratory stimulus, ass essment of symptom severity using the Total Neuropathy Symptom Score (T-NSS) an d measurement of glycosylated haemoglobin as a marker of disease control. To ass ess axonal excitability,compound muscle action potentials were recorded at rest from abductor pollicis brevis following stimulation of the median nerve, and sti mulus-response behaviour, threshold electrotonus,a current-threshold relationship and the recovery of excitability were recorded in each patient. All patients had established neuropathy,with abnormalities of T-NSS present in all patients and QST abnormalities present in 65%. Compared w ith controls,diabetic neuropathy patients had significant reduction in maximal C MAP amplitude (P < 0.0005), accompanied by a‘fanning in’of threshold electroto nus. In addition, the strength-duration time constant was decreased in diabetic neuropathy patients and recovery cycles were altered with reductions in refract oriness,the duration of the relative refractory period, superexcitability and su bexcitability. It is proposed that while the changes in threshold electrotonus w ith supportive findings in the currentthreshold relationship are consistent with axonal depolarization,possibly mediated by a decrease in Na +/K+pump activity , the alterations in the recovery cycle of excitability could be explained on th e basis of a smaller action potential, reflecting a limitation on the nodal driv ing current imposed by a reduction in Na+conductances.展开更多
Objective: To investigate a revision of the Trauma and Injury Severity Score (TRISS) weight coefficients in order to overcome the inference from foreign coefficients on Chinese trauma scoring. Methods: The data of ...Objective: To investigate a revision of the Trauma and Injury Severity Score (TRISS) weight coefficients in order to overcome the inference from foreign coefficients on Chinese trauma scoring. Methods: The data of 1 297 Chinese trauma patients were studied for trauma scoring with the Revised Trauma Score Injury Severity Score TRISS (RTS ISS TRISS) system to get a serial of new weight coefficients through analyzing a multivariation logical regression between the outcome and the injury severity. Results: ISS was higher but the Age Score and probability of survival (Ps) of the death group were lower than those of the survival group. New values of RTS ISS Age coefficients differed from the Major Trauma Outcome Study (MTOS) ones, through which the constant b 0 decreased its negative value, and ISS weight b 2 increased its negative value, but RTS weight b 1 and age weight b 3 changed with the trauma types. MTOSs values and new values of weight coefficients were used on 1 297 patients for prognosis by calculating Ps. The accuracy of new values ( 90.13 %) was a little higher than that of MTOSs (89.5%), with a promotion in specialization but a loss in sensitivity. Conclusions: A revision of TRISSs weight coefficients is either necessary or feasible. To achieve this purpose, a Chinese trauma database with large capacity is recommended.展开更多
文摘The underlying cause of diabetic neuropathy remains unclear,although pathological studies have suggested an ischaemic basis related to microangiopathy, possibly mediated through effects on the energy-dependent Na+/K+pump. To investigat e the pathophysiology of diabetic neuropathy, axonal excitability techniques wer e undertaken in 20 diabetic patients with neuropathy severity graded through a c ombination of quantitative sensory testing (QST) using a vibratory stimulus, ass essment of symptom severity using the Total Neuropathy Symptom Score (T-NSS) an d measurement of glycosylated haemoglobin as a marker of disease control. To ass ess axonal excitability,compound muscle action potentials were recorded at rest from abductor pollicis brevis following stimulation of the median nerve, and sti mulus-response behaviour, threshold electrotonus,a current-threshold relationship and the recovery of excitability were recorded in each patient. All patients had established neuropathy,with abnormalities of T-NSS present in all patients and QST abnormalities present in 65%. Compared w ith controls,diabetic neuropathy patients had significant reduction in maximal C MAP amplitude (P < 0.0005), accompanied by a‘fanning in’of threshold electroto nus. In addition, the strength-duration time constant was decreased in diabetic neuropathy patients and recovery cycles were altered with reductions in refract oriness,the duration of the relative refractory period, superexcitability and su bexcitability. It is proposed that while the changes in threshold electrotonus w ith supportive findings in the currentthreshold relationship are consistent with axonal depolarization,possibly mediated by a decrease in Na +/K+pump activity , the alterations in the recovery cycle of excitability could be explained on th e basis of a smaller action potential, reflecting a limitation on the nodal driv ing current imposed by a reduction in Na+conductances.
文摘Objective: To investigate a revision of the Trauma and Injury Severity Score (TRISS) weight coefficients in order to overcome the inference from foreign coefficients on Chinese trauma scoring. Methods: The data of 1 297 Chinese trauma patients were studied for trauma scoring with the Revised Trauma Score Injury Severity Score TRISS (RTS ISS TRISS) system to get a serial of new weight coefficients through analyzing a multivariation logical regression between the outcome and the injury severity. Results: ISS was higher but the Age Score and probability of survival (Ps) of the death group were lower than those of the survival group. New values of RTS ISS Age coefficients differed from the Major Trauma Outcome Study (MTOS) ones, through which the constant b 0 decreased its negative value, and ISS weight b 2 increased its negative value, but RTS weight b 1 and age weight b 3 changed with the trauma types. MTOSs values and new values of weight coefficients were used on 1 297 patients for prognosis by calculating Ps. The accuracy of new values ( 90.13 %) was a little higher than that of MTOSs (89.5%), with a promotion in specialization but a loss in sensitivity. Conclusions: A revision of TRISSs weight coefficients is either necessary or feasible. To achieve this purpose, a Chinese trauma database with large capacity is recommended.
