Pediatric Physiotherapeutic Approach for Guillain-Barre Syndrome Associated With Dengue Fever: A Case Report.

Guillain-Barre syndrome (GBS) is a peripheral nerve system (PNS) inflammatory disorder characterized by sudden, acute, symmetrical, generally ascending limb weakness with diminished or absent deep tendon reflexes, upper- and lower-extremity paresthesias, and sensory complaints. GBS is caused by an aberrant immunological response to an infection, which causes peripheral nerve damage. Dengue virus has been linked to a number of neurological diseases, including GBS. In the current case report, an eight-year-old child was taken to the hospital with dengue fever and lower limb paralysis. Physiotherapy methods focused on muscle strength and functional activity. The major goal of this case study was to assess functional tasks and enhance the patient's reaction to physical treatment. We find that the patient's response to strength and functional tasks was excellent in the early phases of recovery.

Tratamiento simultáneo secuencial con ultrasonidos focalizados de alta intensidad, láser de CO2 fraccionado y plasma rico en plaquetas para rejuvenecimiento facial en fototipos altos / Sequential simultaneous treatment with high-intensity focused ultrasound, fractional CO2 laser and platelet-rich plasma for facial rejuvenation in dark phototypes

Introducción y objetivo: La combinación de técnicas mínimamente invasivas es muy frecuente para tratar el envejecimiento de la piel. El objetivo de este ensayo es evaluar un protocolo de tratamiento intensivo para rejuvenecimiento facial en una sesión única, combinada y secuencial, empleando ultrasonidos focalizados de alta intensidad (HIFU), láser de CO2 fraccionado y plasma rico en plaquetas (PRP) autólogo. Material y método: Ensayo piloto para evaluar la eficacia y seguridad del tratamiento combinado en una muestra seleccionada de 15 pacientes (fototipos III-V) con signos evidentes de envejecimiento facial. La eficacia fue evaluada de forma enmascarada por 2 expertos independientes mediante comparación de fotografías antes del tratamiento y 3 meses después. Las variables analizadas (grado de dolor, laxitud, rejuvenecimiento global y satisfacción) se cuantificaron mediante escalas ordinales cuantitativas o cualitativas. La seguridad se evaluó mediante anotaciones de seguimiento en las historias clínicas. Resultados: Obtuvimos mejorías significativas en la reducción de la laxitud en los tercios superior, medio e inferior de la cara (p=0.026, p=0.011, p=0.003). En la escala de mejoría estética global, según los evaluadores expertos, 14 participantes (93%) se consideraron “mejorados” o “muy mejorados”. Todos los pacientes reconocieron algún tipo de mejoría, 9 indicaron estar “muy satisfechos”, 3 “satisfechos” y 3 “moderadamente satisfechos”. El tratamiento fue doloroso, pero suficientemente tolerado por la mayoría de pacientes. No aparecieron efectos adversos inesperados ni complicaciones importantes, con buena recuperación postoperatoria. En general los pacientes se reincorporaron a sus actividades laborales 10 días después del tratamiento. Conclusiones: El perfil de eficacia/seguridad del método ensayado ha sido muy favorable en la serie investigada. (AU)

Background and objective: The combination of minimally invasive techniques is very common to treat aging skin. The objective of this trial is to evaluate an intensive treatment protocol for facial rejuvenation, in a single, combined and sequential session, using high intensity focused ultrasound (HIFU), fractional CO2 laser and autologous platelet rich plasma (PRP). Methods: Pilot trial to evaluate the efficacy and safety of the combined treatment in a selected sample of 15 patients (phototypes III-V) with evident signs of facial aging. Efficacy was assessed blinded by 2 independent experts by comparing photographs before treatment and 3 months later. The variables analyzed (degree of pain, laxity, global rejuvenation and satisfaction) were quantified using ordinal quantitative or qualitative scales. Safety is assessed by follow-up notes in medical records. Results: Significant improvements in laxity reduction were achieved in the upper, middle, and lower thirds of the face (p=0.026, p=0.011, p=0.003). On the scale of global aesthetic improvement, according to the expert evaluators, 14 participants (93%) consider themselves "improved" or "very improved". All patients recognized some kind of improvement, 9 indicated being "very satisfied", 3 "satisfied" and 3 "moderately satisfied". The treatment was painful, but sufficiently tolerated by the majority of patients. There were no unexpected side effects or major complications, with good postoperative recovery. In general, the patients returned to their work activities 10 days after treatment. Conclusions: The efficacy/safety profile of the tested method has been very favorable in the series investigated. (AU)

"Huoling Shengji granule" for amyotrophic lateral sclerosis: protocol for a multicenter, randomized, double-blind, riluzole parallel controlled clinical trial.

Background: There is still a large demand for effective treatments to delay disease deterioration in amyotrophic lateral sclerosis (ALS). Typical symptoms of ALS are considered "flaccidity syndrome" in traditional Chinese medicine (TCM). Huoling Shengji Granule (HLSJ) is a TCM formula used to treat flaccidity syndrome. Results of preclinical tests and a previous clinical study support HLSJ as a novel drug for ALS patients. This trial proposed to examine whether a 48-week course of HLSJ is effective and safe for ALS patients diagnosed with the Chinese medicine syndrome of spleen qi insufficiency and kidney yang deficiency. Methods and analysis: In this phase II, multicenter, randomized, double-blind, riluzole parallel-controlled, superiority-design study, eligible participants had the equal opportunity to be assigned to receive either HLSJ or riluzole randomly. Eleven specialized ALS centers in Mainland China will recruit 144 patients for this trial. The primary and secondary outcomes included the change in the ALSFRS-R score and the Rasch-Built Overall Amyotrophic Lateral Sclerosis Disability Scale (ROADS) from baseline to Week 48. Discussion: Here, we endeavored to evaluate TCM for ALS using a standard evidence-based approach for the first time. In addition, the ROADS, a self-report linear-weighted questionnaire, was selected as a secondary outcome measure. We expect to offer a new reference for the outcome evaluation of ALS trials.Clinical trial registration:http://www.Chictr.org.cn, identifier ChiCTR2100044085.

Four Patterns of Canine Wei Syndrome Treated with Traditional Chinese Medicine.

Atrophy and weakness of the limbs is a common condition in animals, especially dogs. It typically presents with flaccidity and weakness of the limbs, especially the hind legs, muscle atrophy, and the inability to walk. In Traditional Chinese Medicine (TCM) and Traditional Chinese Veterinary Medicine (TCVM), this is known as wei syndrome (WS). According to TCM, the etiology of WS can be (1) lung heat and fluid consumption; (2) insufficiency of the liver and kidneys; (3) dampness-heat invasion; (4) damage to the spleen and stomach, which are also the patterns of WS. This report aims to provide an alternative option for the treatment of canine paralysis. Four dogs with different WS patterns were treated with acupuncture, moxibustion, and Chinese herbs based on the guidelines of the TCM literature. Three patients recovered normal functioning. The fourth patient could walk normally after 2 weeks of treatment, but his hind limbs became weak again 3 months later. Weekly acupuncture treatment was resumed until his death 18 months later. TCM application of acupuncture, moxibustion, and Chinese herbs can be an effective treatment for canine WS. It is hoped that this case report will broaden the treatment options of other veterinarians when patients present with this condition.

Comparative effects of fractional radiofrequency and microneedling on the genitalia of postmenopausal women: Histological and clinical changes.

OBJECTIVES: The authors aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. METHODS: Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. The authors evaluated before and after treatment using the Vaginal Laxity Questionnaire (VLQ), EuroQol Five-Dimensional (EQ-5D) questionnaire, and the Blatt and Kupperman Menopausal Index (BKMI). Additionally, the authors performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). RESULTS: In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p = 0.01). Similarly, the data changes of the G2 group proved to be significant (p = 0.001) across the same time interval. In comparing the groups, VLQ values were not different (p > 0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p < 0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p < 0.05). CONCLUSIONS: The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodeling.

Effect of Extracorporeal Shock Waves on Induced Neocollagenesis of Integumentary Tissue.

Background: Obesity became a worldwide public health problem and its treatment presents a strict relationship with skin flaccidity, for which the development of non-invasive therapies is an emerging field. Objective: This study aims to evaluate the physiological response of the skin tissue of individuals with obesity with flaccidity to the physiological stimulus of shockwave therapy (ESWT). Methods: This is a comparative intervention study based on histological and immunohistochemical analyses of a set of samples of skin tissue of women with Grade II obesity who achieved a 10 percent preoperative weight loss before bariatric surgery and complaints of skin flaccidity, subjected to the ESWT treatment. A total of seven sessions were carried out in the abdominal region on the left side, and the collateral side was used as control; the biological material was collected at the moment of the bariatric surgery. Hematoxylin and Eosin, Masson's trichrome, Picrosirius Red and the markers for immunohistochemical were used for the morphological evaluation. Results: Fourteen women were included in the research. The results demonstrated that the tissue which underwent the ESWT intervention presented significant increases of fibroblast cells (p<0.0001) and collagen fibers Type I and II (p<0.0002). In the significant expressions of the markers FGF1, FGF2, FGFR1 were identified in the exposed side (p<0.0002, 0.0017, <0.0001, respectively) as well as a significantly higher expression of Ki67 marker of cell proliferation (p<0.0002). Conclusion: ESWT was associated with a significant increase of cell proliferation and collagen expression in flaccid skin of individuals who achieved weight loss before bariatric surgery.

Comparative effects of fractional radiofrequency and microneedling on the genitalia of postmenopausal women: Histological and clinical changes

Abstract Objectives: The authors aimed to evaluate clinical and histological changes induced by Fractional Radiofrequency (FRF) and microneedling in vulvar tissue. Methods: Thirty postmenopausal women were randomly divided into G1 (FRF) and G2 (microneedling) groups. Sub-ablative FRF was executed using disposable fractionated electrodes with an intensity of 8 mJ. Microneedling was performed using a derma roller system. The authors evaluated before and after treatment using the Vaginal Laxity Questionnaire (VLQ), EuroQol Five-Dimensional (EQ-5D) questionnaire, and the Blatt and Kupperman Menopausal Index (BKMI). Additionally, the authors performed biopsies of the labia majora for histological analysis pre- and post-treatment. Data were expressed as mean (± standard deviation). A paired t-test was used for intra-group comparison (pre- and post-treatment), with an independent t-test used to compare intergroup data (both pre- and post-treatment). Results: In the G1 group, the VLQ values showed differences compared to the pre-treatment values with the data obtained 60 days after the beginning of the sessions (p = 0.01). Similarly, the data changes of the G2 group proved to be significant (p = 0.001) across the same time interval. In comparing the groups, VLQ values were not different (p > 0.05). Regarding histological analysis, FRF demonstrated improvement concerning the number of fibroblasts, blood vessels, and fatty degeneration (p < 0.05) compared to the control. Additionally, FRF and microneedling samples showed higher type III collagen and vimentin expression in the immunohistochemical analysis (p < 0.05). Conclusions: The therapies were found to be effective in treating the flaccidity of the female external genitalia. Additionally, histological changes were observed after interventions suggesting collagen remodeling.

Ocular hypotonia following pulmonary endarterectomy.

Significant fluid removal and negative fluid balance is typical of the management of patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. In this study, we describe severe ocular hypotonia as an unusual clinical sign in a 72-year-old man immediately following pulmonary endarterectomy. Complete resolution occurred with fluid resuscitation overnight and no residual visual disturbance was reported.

Lateral Skin-Platysma Displacement: A New Approach to Neck Rejuvenation Through a Lateral Approach.

Lateral skin-platysma displacement is a new technique for neck rejuvenation based on composite platysma-cutaneous flaps repositioned laterally through cable sutures. This technique skews the anatomy of the muscle, displacing it in a more lateral position and decreases the risk of paramedian bands recurrence. Traction applied to the midbody of the myocutaneous flaps is more effective in treating anterior excess skin than traction applied to the lateral platysma borders. The advantages of Lateral skin-platysma displacement are limited neck undermining, absence of submental scar, shorter operating time, faster patient recovery, satisfactory results, and an easier approach to submandibular gland reduction.

Advances in syndrome and treatment of motor neuron disease with traditional Chinese medicine / 中国基层医药

Motor neuron disease(MND) is a group of progressive motor neuron diseases and the pathogenesis is not well defined.The pathologic hallmark of MND is death of lower motor neurons (consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles ) and upper, or corticospinal,motor neurons.The clinical manifestations of MND are mucsle weakness ,muscle atrophy,fasciculations,bulbar paralysis and positive pyramidal signs.Traditional Chinese medicine ( TCM) named MND as flaccidity syndrome.Recently,some scholars have proposed that "MND" can be regarded as an independent research object of TCM.At present,symptomatic supportive treatment is the main treatment for MMD in western medicine ,which can only slow the progress of the disease.TCM treatment for MND has advantages of more effective than western medicine ,fewer adverse reactions and lower price.So TCM can be used as an effective method for combined treatment of MND.This article reviews the research progress of syndrome and treatment of MND with TCM.

Advances in syndrome and treatment of motor neuron disease with traditional Chinese medicine / 中国基层医药

Motor neuron disease(MND) is a group of progressive motor neuron diseases and the pathogenesis is not well defined.The pathologic hallmark of MND is death of lower motor neurons(consisting of anterior horn cells in the spinal cord and their brainstem homologues innervating bulbar muscles) and upper, or corticospinal, motor neurons.The clinical manifestations of MND are mucsle weakness, muscle atrophy, fasciculations, bulbar paralysis and positive pyramidal signs.Traditional Chinese medicine(TCM) named MND as flaccidity syndrome.Recently, some scholars have proposed that "MND" can be regarded as an independent research object of TCM.At present, symptomatic supportive treatment is the main treatment for MMD in western medicine, which can only slow the progress of the disease.TCM treatment for MND has advantages of more effective than western medicine, fewer adverse reactions and lower price.So TCM can be used as an effective method for combined treatment of MND.This article reviews the research progress of syndrome and treatment of MND with TCM.

Blood metabolism study on protection of residual renal function of hemodialysis patients by traditional Chinese medicine Kidney Flaccidity Compound.

In recent years, metabolomics using high-performance liquid chromatography (UPLC) has been used to study the metabolic profiles in plasma, urine, stool and tissue in animal model of chronic kidney disease (CKD). In the previous work, we found that traditional Chinese medicine (TCM) "Kidney Flaccidity Compound" (KFC) based on "kidney flaccidity theory" can improve renal function and quality of life of patients with kidney disease. This study aimed to investigate the metabolic profiles in peripheral blood of hemodialysis patients administrated by KFC for 1.5 and 3 months and explore the potential metabolic mechanism using UPLC. Results showed that 121 metabolites were different between KFC 3-months group and untreated control, of which 75 were significantly upregulated and 46 were significantly downregulated. In the 1.5-months treatment group, there were 365 metabolites, of which 164 were significantly upregulated and 192 downregulated. There were 6 metabolites and 15 metabolites upregulated 3-fold in 3-months and 1.5-months KFC treatment group, respectively. In addition, more than 60 new metabolites were identified in the peripheral blood in KFC treated patients, including two potential diagnostic markers MGDG 30:8 and 2-(hydroxymethyl)-6-[[(1R,4S) -2,2,4-trimethyl-3-oxabicyclo[2.2.2]octan-5-yl]oxy]oxane-3,4,5-triol. The pathway enrichment analysis showed thce differential metabolites mainly enriched in Arginine and proline metabolism, Urea cycle, Tyrosine metabolism, Methionine metabolism, Tricarboxylic acid cycle, and Androgen and estrogen metabolism. The findings are helpful to reveal the mechanism of KFC protects CKD, and to provide a new strategy for recovery renal function in hemodialysis patients.

Criolipólisis plana: efectos sobre el tejido adiposo en el área subumbilical de 38 pacientes. Observaciones clínicas de su aplicación / Cryolipolysis flat: Effects on adipose tissue in the subumbilical area of 38 patients. Clinical observations of its application

Se estudiaron 38 casos de pacientes controladas durante cuatro meses. Se seleccionó el área subumbilical para evaluar la acción clínica y comunicar las observaciones, sobre la aplicación de la criolipólisis plana en la piel y celular subcutáneo, como así también, los efectos adversos y otros no descritos.

We studied 38 cases of patients followed by four months. Only the subumbilical area was taken to evaluate the clinical action and to communicate the observations on the application of flat cryolipolysis in the subcutaneous skin and cellular, as well as the adverse effects and others not described.

Clinical Observation of Tong Du Wen Yang Needling for Amyotrophic Lateral Sclerosis / 上海针灸杂志

Objective To observe the clinical efficacy of Tong Du Wen Yang (unblocking the Governor Vessel and warming yang) in treating amyotrophic lateral sclerosis (ALS).Method Twenty-eight eligible ALS patients were randomized into two groups by following the visiting sequence. Thirteen patients in the control group were intervened by orally taking Riluzole tablets; 15 cases in the treatment group were by Tong Du Wen Yang needling in addition to oral administration of Riluzole tablets. Before treatment and after 6-month treatment, the therapeutic efficacies were evaluated by using the Chinese medicine syndrome and sign scoring for Wei-flaccidity diseases and Appel function scale.Result After the treatment, the Chinese syndrome and sign scoring scores for Wei-flaccidity dropped in both groups, and the decrease in the treatment group was more significant than that in the control group (P<0.05). The Appel scores dropped in both groups after the treatment, while the decrease in the treatment group was less significant than that in the control group (P<0.05).Conclusion Tong Du Wen Yang needling plus orally taking Riluzole tablets can produce a more significant efficacy than using Western medication alone in treating ALS.

Discussion on Causes and Cure of Pulsus Paradoxus of Flaccidity Syndrome in Lin Zheng Zhi Nan Yi An / 中国中医药信息杂志

The causes of flaccidity syndrome are various. YE Tian-shi's book of Lin Zheng Zhi Nan Yi An combined the causes of flaccidity syndrome, and focused on pulsus paradoxus less qi. On the basis of common treatment methods for flaccidity syndrome, such as clearing heat in lung, treating Yangming and tonifying liver and kidney, this book created the treatment of polsus paradoxus, expanded TCM ideas and methods for treatment of flaccidity syndrome, which made great contributions to TCM treatment for flaccidity syndrome.

A novel ATP1A3 mutation with unique clinical presentation.

Mutations in the ATP1A3 gene are associated with rapid-onset dystonia-parkinsonism (RDP) and alternating hemiplegia of childhood (AHC) as well as RDP/AHC intermediate presentations. Phenotypic diversity is being recognized. In order to identify ATP1A3-related phenotypes not meeting the classical criteria for RDP or AHC we lowered the threshold for mutation analysis in clinical presentations resembling AHC or RDP. A novel heterozygous ATP1A3 missense mutation c.2600G>A (p.Gly867Asp, G867D) was detected in a 15-year-old girl. Her clinical phenotype is partially consistent with an intermediate presentation between alternating hemiplegia of childhood and rapid-onset dystonia-parkinsonism and comprises additional yet unreported features. With onset at 4½ years of age recurrent paroxysmal flaccid hemiplegia alternating in laterality was triggered by watching television or playing computer games. Occlusion of both eyes reliably stopped the plegic attacks with the patient remaining awake. Our observation further widens the phenotypic spectrum associated with ATP1A3 mutations.

Clinical Observation of Electroacupuncture and Acupoint Injection in Treating Common Fibular Nerve Paralysis / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of combined electroacupuncture and nerve growth factor (NGF) injection at acupoints in the treatment of common fibular nerve paralysis and provide evidences for integrative Chinese & western medicine against diabetic peripheral neuropathy (DPN). Methods: Forty subjects were randomized into two groups and NGF injection; and control group was given herbal suffocation, oral Dibazol and compound vitamin B and Mecobalamin Injection. The clinical symptoms and nerve conduction velocity were observed and compared. Results: The cure rate was higher in treatment group than in control group (P<0.05); after treatment, the nerve conduction velocity was improved in both groups (P<0.01), with a significant improvement in treatment group than in control group (P<0.01). Conclusion: Combined electro-acupuncture and NGF injection at acupoints is quite effective in the treatment of common fibular nerve paralysis.

Diagnosis and treatment of two cases of flaccidity syndrome by professor CHEN Jin-liang / 中华中医药杂志

We treated two cases of flaccidity syndrome,one who was suffering obstinate myasthenia gravis was treated by modified Mahuang Fuzi Xixin decoction which is based on warming Yang and replenishing qi,dredging the meridian passage.The other who was suffering lipid storage myopathy was treated by modified Buzhong Yiqi decoction which is based on strengthening spleen and improving digest,ascending the clear and descending the turbid,supplementing qi and nourishing blood, promoting blood circulation to remove meridian obstruction.Both got the obvious improvement.