李冀教授运用木瓜与白芍配伍治疗转筋验案举隅

转筋是以肢体筋脉牵掣拘挛,痛如扭转为主要症状的病症,临床中常以主证或兼证出现。李冀教授认为其病机与胆热痰扰、肝经实火、脾气虚弱、阴津不足、湿热淫筋、营卫不和等有关,病位多在肝、脾两脏。李冀教授在以法遣方治疗转筋的基础上,常配伍木瓜、白芍药对,屡试屡效。现将近5年随诊临五则医案整理分析,以期为临床治疗转筋提供参考。     

Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps

This study in humans tested the hypothesis that nociceptive muscle afferent input facilitates the occurrence of muscle cramps. In 13 healthy adults, muscle cramps were experimentally induced in the foot by stimulating the tibialis posterior nerve at the ankle with 2-s bursts of stimuli separated by 30 s, with stimulation frequency increasing by 2-Hz increments from 10 Hz until the cramp appeared. The minimum stimulation frequency that induced the cramp was defined “cramp frequency threshold”. In 2 days, elicitation of the cramp was performed in the two-feet with and without (baseline condition) injection of hypertonic (painful condition) or isotonic (control condition) saline into the deep midportion of the flexor hallucis brevis muscle, from where surface EMG signals were recorded. The cramp frequency threshold was lower for the painful condition with respect to its baseline (mean ± SE, hypertonic saline: 25.7 ± 2.1 Hz, corresponding baseline: 31.2 ± 2.8 Hz; P < 0.01) while there was no difference between the threshold with isotonic injection with respect to baseline. EMG average rectified value and power spectral frequency were higher during the cramp than immediately before the stimulation that elicited the cramp (pre-cramp: 13.9 ± 1.6 μV and 75.4 ± 3.8 Hz, respectively; post-cramp: 19.9 ± 3.2 μV and 101.6 ± 6.0 Hz; P < 0.05). The results suggest that nociceptive muscle afferent activity induced by injection of hypertonic saline facilitates the generation of electrically elicited muscle cramps.     

Cramp转基因小鼠的构建及鉴定

目的建立系统性表达Cramp转基因模型小鼠,为研究Cramp在衰老中的作用提供模型动物。方法把Cramp cDNA插入系统性表达CMV启动子下游,构建转基因表达载体,显微注射法建立Cramp转基因小鼠。PCR鉴定转基因小鼠的基因型,用RT-PCR和Western blotting方法筛选高表达品系。结果成功构建Cramp cDNA转基因载体,建立了Cramp转基因小鼠,通过RT-PCR和Western blotting方法筛选出3个高表达品系。结论建立了系统表达Cramp转基因小鼠,转入的Cramp基因在骨髓、脾脏、肝脏等组织高表达,为研究Cramp基因在衰老中的作用及机制提供了动物模型。     

Cramp过表达对小鼠骨髓造血干细胞功能的影响

目的 研究Cramp蛋白过表达对小鼠骨髓造血干细胞自我更新和分化能力的影响.方法 应用流式细胞仪分析Cramp过表达转基因小鼠及同龄野生型小鼠的骨髓、脾脏、胸腺等组织器官中各种细胞的比例;分选 骨髓造血干细胞,体外培养,观察其克隆形成能力.结果 与野生型小鼠相比,Cramp过表达转基因小鼠的骨髓、脾脏、胸腺等组织器官中各种细胞的比例、骨髓造血干细胞的克隆形成能力等均无明显变化.结论 本研究中,Cramp过表达转基因小鼠骨髓造血干细胞的分化能力、克隆形成能力无明显变化.     

Cramp基因敲除对小鼠骨髓造血干细胞的影响

目的研究Cramp基因敲除在衰老过程中对小鼠造血干细胞的作用。方法应用流式细胞仪分析3月龄及12月龄Cramp基因敲除小鼠及同窝野生型小鼠的骨髓造血干细胞的比例及不同发育阶段B淋巴细胞的比例。结果与野生型小鼠相比,12月龄Cramp基因敲除小鼠的骨髓长期造血干细胞增多,多潜能造血祖细胞减少;前体B淋巴细胞和未成熟B淋巴细胞减少,成熟B淋巴细胞增多。结论在衰老过程中,Cramp基因敲除对骨髓造血干细胞及B淋巴细胞发育有重要影响。     

How to assess motor impairment in writer's cramp.

Writer's cramp is a task-specific hand dystonia affecting handwriting. Clinical scores such as the Arm Dystonia Disability Scale (ADDS) or Writer's Cramp Rating Scale (WCRS) as well as kinematic analysis of handwriting movements have been used to assess functional impairment in affected patients. In 21 patients with writer's cramp and healthy controls, we analyzed the kinematics of writing and cyclic drawing movements. We rated the severity of dystonia using the ADDS and WCRS and correlated the clinical scores with movement kinematics. Mean stroke frequency was significantly reduced in dystonic patients. Drawing movements showed more frequently a decrease in stroke frequency than handwriting movements. During circle drawing, mean vertical peak velocity was more variable in patients relative to controls, indicating an impaired ability to reproduce the same kinematic pattern over time. An increase in vertical writing pressure was only observed during handwriting but not during circle drawing and may reflect a compensatory effort to stabilize the pencil. Kinematic measures and individual ADDS and WCRS scores did not correlate with each other. The lack of correlation is not surprising as ADDS, WCRS, and kinematic analysis probe different aspects of motor impairment. The ADDS characterizes how dystonia affects a set of fine manual tasks, whereas the WCRS scores the manifestation of dystonia during handwriting. Therefore, the clinical scores and kinematic analysis of handwriting provide complementary insights into motor impairment. Future studies need to address which combination of clinical scores and kinematic measures are most appropriate to quantify impairment in writer's cramp.