Objective:To investigate clinical and neuroimaging features of enterovirus71(EV71) related acute flaccid paralysis in patients with hand-fool-mouth disease.Methods:Nine patients with acute flaccid paralysis met the cr...Objective:To investigate clinical and neuroimaging features of enterovirus71(EV71) related acute flaccid paralysis in patients with hand-fool-mouth disease.Methods:Nine patients with acute flaccid paralysis met the criterion of EV71 induced hand-foot-mouth disease underwent spinal and brain MR imaging from May 2008 to Sep 2012.Results:One extremity flaccid was found in four cases(3 with lower limb,1 with upper limb),two limbs flaccid in three cases(2 with lower limbs,1 with upper limbs),and four limbs flaccid in two cases.Spinal MRI studies showed lesion with high signal in T2-weighted images(T2WI) and low signal T1-weighted images(T1WI) in the spinal cord of all nine cases,and the lesions were mainly in bilateral and unilateral anterior hom of cervical spinal cord and spinal cord below thoracic 9(T9) level.In addition,the midbrain,pons, and medulla,which were involved in 3 cases with brainstem encephalitis,demonstrated abnormal signal.Moreover,spinal cord contrast MRI studies showed mild enhancement in corresponding anterior hom of the involved side,and strong enhancement in its ventral root.Conclusions: EV71 related acute flaccid paralysis in patients with hand-foot-mouth disease mainly affected the anterior hom regions and ventral root of cervical spinal cord and spinal cord below T9 level. MR imaging could efficiendy show the characteristic pattern and extent of the lesions which correlated well with the clinical features.展开更多
In this article,one proved case of flaccid tongue treated by Guan’s tongue acupuncture was introduced by the three-step method of"puncture,prick,and swallowing".This case was an elderly female patient with ...In this article,one proved case of flaccid tongue treated by Guan’s tongue acupuncture was introduced by the three-step method of"puncture,prick,and swallowing".This case was an elderly female patient with Parkinson disease,which had the main clinical symptoms of flaccid and weak tongue,and speech and swallowing disorder,and was diagnosed as flaccid tongue(deficiency of the both qi and blood,and deficiency syndrome of liver and kidney).The patient received diagnosis and treatment based on an overall analysis of its dialectical characteristics,using the five acupoints of Heart,Jīnjīn(金津EX-HN12),Yùyè(玉液EX-HN13),Tongue root acupoint 1,and Tongue root acupoint 2 in total.First,the four acupoints of EX-HN12,EX-HN13,Tongue root acupoint 1,and Tongue root acupoint 2 were punctured successively,and then using the reinforcing method,the Heart on the tongue surface was pricked.Finally,the patient was advised to make a slow swallowing action.Through tongue acupuncture therapy for 6 times,the patient’s speech and swallowing function was improved,which achieved a satisfactory therapeutic effects.展开更多
BACKGROUND Acute flaccid paralysis(AFP)and neurogenic respiratory failure rarely occur in children.At the end of 2018,some children with such symptoms were admitted to our hospital.In this study,we aimed to assess two...BACKGROUND Acute flaccid paralysis(AFP)and neurogenic respiratory failure rarely occur in children.At the end of 2018,some children with such symptoms were admitted to our hospital.In this study,we aimed to assess two children with AFP and neurogenic respiratory failure associated with enterovirus D68(EV-D68).CASE SUMMARY Two children admitted to our hospital presented with symptoms and imaging results different from those of acute disseminated encephalomyelitis and hand,foot,and mouth disease.Their main symptoms were AFP and neurogenic respiratory failure.Magnetic resonance imaging showed severe inflammatory injury mainly to the anterior horn cells of the spinal cord.Blood and cerebrospinal fluid samples were collected to assess for pathogens,including bacteria,tuberculosis,cryptococcus,herpes virus,and coxsackie virus,and the results were negative.At the beginning,the two cases were not assessed for EV-D68 in the nasopharyngeal,blood,and cerebrospinal fluid specimens.About 2 mo later,EVD68 was detected in the stool sample of one of the cases.The symptom of AFP was caused by injury to the anterior horn cells at levels C5-L5 of the spinal cord,while neurogenic respiratory failure was at levels C3-C5.CONCLUSION We should pay attention to the detection and diagnosis of EV-D68 and make efforts to develop antivirus drugs and vaccines.展开更多
Background: Acute Flaccid Paralysis (AFP) was adopted by World Health Organization (WHO) in 1988 as a key pillar used in monitoring progress towards the global polio eradication initiative. High quality AFP surveillan...Background: Acute Flaccid Paralysis (AFP) was adopted by World Health Organization (WHO) in 1988 as a key pillar used in monitoring progress towards the global polio eradication initiative. High quality AFP surveillance is essential to support this global initiative. We applied recently developed case verification methods for the quantitative evaluation of AFP cases reported to the surveillance systems to evaluate the quality of AFP reports in Akwa Ibom State, Nigeria. Objectives: The aim of this study is to identify the demographic, clinical and epidemiological attributes and quality of acute flaccid paralysis surveillance. Methods: All AFP cases reported in children 0 - 14 years during January 2006 to December 2012 were investigated and verified by WHO surveillance officers, using standard questionnaire. Two stool samples 24 - 48 hours apart from a total of 1184 AFP cases were collected within 14 days of onset of paralysis with the prior oral/verbal informed consent and transported to the national polio laboratory under reverse cold chain. Result: In all, 885/1184 representing 75% of the AFP cases reported were verified by WHO officers in the period under review. Overall, 534/885 (60.3%) of AFP cases had more than >3 doses of Oral Polio Vaccine (OPV), while 196/885 (22.2%) received 3 dose of OPV and 128/885 (14.5%) received between 1 - 2 doses of OPV. It was interesting that 27/885 (3%) never received OPV before. Overall, 743/885 (84.0%) were reported within ≤14 days of paralysis onset, while 142/885 (16%) were reported after ≥14 days of paralysis onset. In total, 797/885 (90.1%) of cases were found to have fever at the onset of paralysis;paralysis was found to be asymmetric in 805/885 (91%). Wasting or diminished muscle tone was observed in 34.0% of cases verified, while deep tendon reflexes were good (normal) in 79% of cases. Gullain-Barre syndrome was observed in 50.9% of the reported cases followed by injection neuritis (25.0%) and transverse myelitis (2.0%). However, other causes recorded 22.1%. The legs (90.2%) are the parts of the body mostly affected, while arm recorded 9.8% of the AFP cases reported and verified. Conclusions: The result of this study indicates that the characterization of AFP cases reported to the surveillance network could provide better understanding of age, and sex distribution, common clinical causes of AFP and impact of distance to health facilities on the health seeking behaviours of AFP cases.展开更多
Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especiall...Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especially acupuncture therapy has achieved certain effects for the treatment of post-stroke flaccid paralysis.Acupuncture treatment can promote the recovery of nerve conduction,increase muscle strength and improve joint flexibility,and correct abnormal movement patterns of limbs.Acupuncture combined with rehabilitation training will be the focus for the treatment of post-stroke flaccid paralysis.In this review,the combination of different acupuncture therapies with modern rehabilitation for the treatment of post-stroke flaccid paralysis has been summarized in order to effectively promote the recovery of motor function and significantly improve their life quality.展开更多
Objective: This study focuses on the reverse cold chain system of stool sample management from cases reported to the AFP surveillance system between 2010 and 2015. Through the distribution of their NPEV isolation rate...Objective: This study focuses on the reverse cold chain system of stool sample management from cases reported to the AFP surveillance system between 2010 and 2015. Through the distribution of their NPEV isolation rates, we identify lapses in the reverse cold chain management and provide recommendations that should help improve the reverse cold chain system and the AFP surveillance system in general as Nigeria once again matches towards a polio free certification. Methods: A descriptive retrospective study was conducted using AFP surveillance data routinely collected between January 2010 and December 2015 by the Disease Surveillance and Notification Officers (DSNOs) in Nigeria and the WHO accredited Polio Laboratories. All AFP cases reported to the Disease Surveillance network during this period from all the states were included in the study. EPIINFO—veritable customized software was used to run queries on the access database and obtain the specific data sets required. Results: A total of 52,879 AFP cases were reported from 2010-2015, in which 7288 non-polio enteroviruses were isolated. NPEV isolation rate ranged from 10.8% in the southeast to 20.3% in the northeast with the states in the northern geopolitical zones having higher NPEV rates in comparison to the states in the southern geopolitical zones. The WHO Polio laboratory in Ibadan serves twenty-seven states in the country;the average non-polio AFP rate among states served by this laboratory is 11.7% from a total of 4012 AFP cases recorded. The WHO Polio laboratory in Maiduguri recorded 3276 with an average non-polio AFP rate of 19.2%. Conclusion: Though the country’s NPEV isolation rate remain slightly higher above the 10% recommended by WHO, steps should be taken to enhance the reverse cold-chain system particularly in the southern states. This would increase confidence in the AFP surveillance system in Nigeria as she proceeds once again towards complete polio eradication and meeting certification standards.展开更多
Acute flaccid paralysis(AFP)case surveillance is pivotal for the early detection of potential poliovirus,particularly in endemic countries such as Ethiopia.The community-based surveillance system implemented in Ethiop...Acute flaccid paralysis(AFP)case surveillance is pivotal for the early detection of potential poliovirus,particularly in endemic countries such as Ethiopia.The community-based surveillance system implemented in Ethiopia has significantly improved AFP surveillance.However,challenges like delayed detection and disorganized communication persist.This work proposes a simple deep learning model for AFP surveillance,leveraging transfer learning on images collected from Ethiopia's community key informants through mobile phones.The transfer learning approach is implemented using a vision transformer model pretrained on the ImageNet dataset.The proposed model outperformed convolutional neural network-based deep learning models and vision transformer models trained from scratch,achieving superior accuracy,F1-score,precision,recall,and area under the receiver operating characteristic curve(AUC).It emerged as the optimal model,demonstrating the highest average AUC of 0.870±0.01.Statistical analysis confirmed the significant superiority of the proposed model over alternative approaches(P<0.001).By bridging community reporting with health system response,this study offers a scalable solution for enhancing AFP surveillance in low-resource settings.The study is limited in terms of the quality of image data collected,necessitating future work on improving data quality.The establishment of a dedicated platform that facilitates data storage,analysis,and future learning can strengthen data quality.Nonetheless,this work represents a significant step toward leveraging artificial intelligence for community-based AFP surveillance from images,with substantial implications for addressing global health challenges and disease eradication strategies.展开更多
Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved ...Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved by the Food and Drug Administration(FDA)for cosmetic and therapeutic indications in 2002,and its global use has increased substantially.[2]However,some unlicensed botulinum toxin products may cause iatrogenic botulism.[3]Early diagnosis remains challenging owing to non-specific clinical features and the lack of diagnostic biomarkers,often delaying the timely administration of antitoxin.[4]This study reviewed recent cases of botulism in our center and summarized their clinical presentations,symptoms,and outcomes.展开更多
基金funded by the Hainan Natural Science Foundation 310119Haiman Health Institution Project(No 2011-22)
文摘Objective:To investigate clinical and neuroimaging features of enterovirus71(EV71) related acute flaccid paralysis in patients with hand-fool-mouth disease.Methods:Nine patients with acute flaccid paralysis met the criterion of EV71 induced hand-foot-mouth disease underwent spinal and brain MR imaging from May 2008 to Sep 2012.Results:One extremity flaccid was found in four cases(3 with lower limb,1 with upper limb),two limbs flaccid in three cases(2 with lower limbs,1 with upper limbs),and four limbs flaccid in two cases.Spinal MRI studies showed lesion with high signal in T2-weighted images(T2WI) and low signal T1-weighted images(T1WI) in the spinal cord of all nine cases,and the lesions were mainly in bilateral and unilateral anterior hom of cervical spinal cord and spinal cord below thoracic 9(T9) level.In addition,the midbrain,pons, and medulla,which were involved in 3 cases with brainstem encephalitis,demonstrated abnormal signal.Moreover,spinal cord contrast MRI studies showed mild enhancement in corresponding anterior hom of the involved side,and strong enhancement in its ventral root.Conclusions: EV71 related acute flaccid paralysis in patients with hand-foot-mouth disease mainly affected the anterior hom regions and ventral root of cervical spinal cord and spinal cord below T9 level. MR imaging could efficiendy show the characteristic pattern and extent of the lesions which correlated well with the clinical features.
文摘In this article,one proved case of flaccid tongue treated by Guan’s tongue acupuncture was introduced by the three-step method of"puncture,prick,and swallowing".This case was an elderly female patient with Parkinson disease,which had the main clinical symptoms of flaccid and weak tongue,and speech and swallowing disorder,and was diagnosed as flaccid tongue(deficiency of the both qi and blood,and deficiency syndrome of liver and kidney).The patient received diagnosis and treatment based on an overall analysis of its dialectical characteristics,using the five acupoints of Heart,Jīnjīn(金津EX-HN12),Yùyè(玉液EX-HN13),Tongue root acupoint 1,and Tongue root acupoint 2 in total.First,the four acupoints of EX-HN12,EX-HN13,Tongue root acupoint 1,and Tongue root acupoint 2 were punctured successively,and then using the reinforcing method,the Heart on the tongue surface was pricked.Finally,the patient was advised to make a slow swallowing action.Through tongue acupuncture therapy for 6 times,the patient’s speech and swallowing function was improved,which achieved a satisfactory therapeutic effects.
文摘BACKGROUND Acute flaccid paralysis(AFP)and neurogenic respiratory failure rarely occur in children.At the end of 2018,some children with such symptoms were admitted to our hospital.In this study,we aimed to assess two children with AFP and neurogenic respiratory failure associated with enterovirus D68(EV-D68).CASE SUMMARY Two children admitted to our hospital presented with symptoms and imaging results different from those of acute disseminated encephalomyelitis and hand,foot,and mouth disease.Their main symptoms were AFP and neurogenic respiratory failure.Magnetic resonance imaging showed severe inflammatory injury mainly to the anterior horn cells of the spinal cord.Blood and cerebrospinal fluid samples were collected to assess for pathogens,including bacteria,tuberculosis,cryptococcus,herpes virus,and coxsackie virus,and the results were negative.At the beginning,the two cases were not assessed for EV-D68 in the nasopharyngeal,blood,and cerebrospinal fluid specimens.About 2 mo later,EVD68 was detected in the stool sample of one of the cases.The symptom of AFP was caused by injury to the anterior horn cells at levels C5-L5 of the spinal cord,while neurogenic respiratory failure was at levels C3-C5.CONCLUSION We should pay attention to the detection and diagnosis of EV-D68 and make efforts to develop antivirus drugs and vaccines.
文摘Background: Acute Flaccid Paralysis (AFP) was adopted by World Health Organization (WHO) in 1988 as a key pillar used in monitoring progress towards the global polio eradication initiative. High quality AFP surveillance is essential to support this global initiative. We applied recently developed case verification methods for the quantitative evaluation of AFP cases reported to the surveillance systems to evaluate the quality of AFP reports in Akwa Ibom State, Nigeria. Objectives: The aim of this study is to identify the demographic, clinical and epidemiological attributes and quality of acute flaccid paralysis surveillance. Methods: All AFP cases reported in children 0 - 14 years during January 2006 to December 2012 were investigated and verified by WHO surveillance officers, using standard questionnaire. Two stool samples 24 - 48 hours apart from a total of 1184 AFP cases were collected within 14 days of onset of paralysis with the prior oral/verbal informed consent and transported to the national polio laboratory under reverse cold chain. Result: In all, 885/1184 representing 75% of the AFP cases reported were verified by WHO officers in the period under review. Overall, 534/885 (60.3%) of AFP cases had more than >3 doses of Oral Polio Vaccine (OPV), while 196/885 (22.2%) received 3 dose of OPV and 128/885 (14.5%) received between 1 - 2 doses of OPV. It was interesting that 27/885 (3%) never received OPV before. Overall, 743/885 (84.0%) were reported within ≤14 days of paralysis onset, while 142/885 (16%) were reported after ≥14 days of paralysis onset. In total, 797/885 (90.1%) of cases were found to have fever at the onset of paralysis;paralysis was found to be asymmetric in 805/885 (91%). Wasting or diminished muscle tone was observed in 34.0% of cases verified, while deep tendon reflexes were good (normal) in 79% of cases. Gullain-Barre syndrome was observed in 50.9% of the reported cases followed by injection neuritis (25.0%) and transverse myelitis (2.0%). However, other causes recorded 22.1%. The legs (90.2%) are the parts of the body mostly affected, while arm recorded 9.8% of the AFP cases reported and verified. Conclusions: The result of this study indicates that the characterization of AFP cases reported to the surveillance network could provide better understanding of age, and sex distribution, common clinical causes of AFP and impact of distance to health facilities on the health seeking behaviours of AFP cases.
文摘Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especially acupuncture therapy has achieved certain effects for the treatment of post-stroke flaccid paralysis.Acupuncture treatment can promote the recovery of nerve conduction,increase muscle strength and improve joint flexibility,and correct abnormal movement patterns of limbs.Acupuncture combined with rehabilitation training will be the focus for the treatment of post-stroke flaccid paralysis.In this review,the combination of different acupuncture therapies with modern rehabilitation for the treatment of post-stroke flaccid paralysis has been summarized in order to effectively promote the recovery of motor function and significantly improve their life quality.
文摘Objective: This study focuses on the reverse cold chain system of stool sample management from cases reported to the AFP surveillance system between 2010 and 2015. Through the distribution of their NPEV isolation rates, we identify lapses in the reverse cold chain management and provide recommendations that should help improve the reverse cold chain system and the AFP surveillance system in general as Nigeria once again matches towards a polio free certification. Methods: A descriptive retrospective study was conducted using AFP surveillance data routinely collected between January 2010 and December 2015 by the Disease Surveillance and Notification Officers (DSNOs) in Nigeria and the WHO accredited Polio Laboratories. All AFP cases reported to the Disease Surveillance network during this period from all the states were included in the study. EPIINFO—veritable customized software was used to run queries on the access database and obtain the specific data sets required. Results: A total of 52,879 AFP cases were reported from 2010-2015, in which 7288 non-polio enteroviruses were isolated. NPEV isolation rate ranged from 10.8% in the southeast to 20.3% in the northeast with the states in the northern geopolitical zones having higher NPEV rates in comparison to the states in the southern geopolitical zones. The WHO Polio laboratory in Ibadan serves twenty-seven states in the country;the average non-polio AFP rate among states served by this laboratory is 11.7% from a total of 4012 AFP cases recorded. The WHO Polio laboratory in Maiduguri recorded 3276 with an average non-polio AFP rate of 19.2%. Conclusion: Though the country’s NPEV isolation rate remain slightly higher above the 10% recommended by WHO, steps should be taken to enhance the reverse cold-chain system particularly in the southern states. This would increase confidence in the AFP surveillance system in Nigeria as she proceeds once again towards complete polio eradication and meeting certification standards.
基金supported by a fund from the International Development Research Centre(IDRC)(Grant No.109981e001)funded by Canada’s International Development Research Centre(IDRC)(Grant No.109981-001)+3 种基金support from IDRC and UK's Foreign,Commonwealth and Development Office(FCDO)(Grant No.110554-001)support from NSERC Discovery Grant(Grant No.RGPIN-2022-04559)NSERC Discovery Launch Supplement(Grant No:DGECR-2022-00454)New Frontier in Research Fund-Exploratory(Grant No.NFRFE-2021-00879).
文摘Acute flaccid paralysis(AFP)case surveillance is pivotal for the early detection of potential poliovirus,particularly in endemic countries such as Ethiopia.The community-based surveillance system implemented in Ethiopia has significantly improved AFP surveillance.However,challenges like delayed detection and disorganized communication persist.This work proposes a simple deep learning model for AFP surveillance,leveraging transfer learning on images collected from Ethiopia's community key informants through mobile phones.The transfer learning approach is implemented using a vision transformer model pretrained on the ImageNet dataset.The proposed model outperformed convolutional neural network-based deep learning models and vision transformer models trained from scratch,achieving superior accuracy,F1-score,precision,recall,and area under the receiver operating characteristic curve(AUC).It emerged as the optimal model,demonstrating the highest average AUC of 0.870±0.01.Statistical analysis confirmed the significant superiority of the proposed model over alternative approaches(P<0.001).By bridging community reporting with health system response,this study offers a scalable solution for enhancing AFP surveillance in low-resource settings.The study is limited in terms of the quality of image data collected,necessitating future work on improving data quality.The establishment of a dedicated platform that facilitates data storage,analysis,and future learning can strengthen data quality.Nonetheless,this work represents a significant step toward leveraging artificial intelligence for community-based AFP surveillance from images,with substantial implications for addressing global health challenges and disease eradication strategies.
文摘Botulinum toxin,a protein exotoxin secreted by Clostridium botulinum,binds to peripheral nerve terminals,inhibits acetylcholine release,and leads to flaccid muscle paralysis.[1]Botox(onabotulinum toxin A)was approved by the Food and Drug Administration(FDA)for cosmetic and therapeutic indications in 2002,and its global use has increased substantially.[2]However,some unlicensed botulinum toxin products may cause iatrogenic botulism.[3]Early diagnosis remains challenging owing to non-specific clinical features and the lack of diagnostic biomarkers,often delaying the timely administration of antitoxin.[4]This study reviewed recent cases of botulism in our center and summarized their clinical presentations,symptoms,and outcomes.
