神经根沉降征对经皮椎间孔镜治疗腰椎间盘突出症术后价值研究

目的:通过对比神经根沉降征阳性患者与阴性患者在经皮椎间孔镜下治疗术后的临床效果差异,进一步探讨神经根沉降征对于经皮椎间孔镜治疗腰椎间盘突出症患者术后价值的预测;方法:回顾性研究2017年6月-2018年10月于课题组所在单位的经皮椎间孔镜治疗腰突症的患者80例,对神经根沉降征阳性组与神经根沉降征阴性组的术后VAS评分,改良Macnab疗效评分,ODI评分进行统计学分析;结果:2组患者术后的VAS评分,改良Macnab疗效评分,ODI评分均较术前明显改善,但神经根沉降征阳性组术后疗效明显优于神经根沉降征阴性组;结论:神经根沉降征可作为经皮椎间孔镜治疗腰突症患者的术后疗效预测的评价标准之一。     

经皮椎间孔镜技术治疗老年高位脱垂游离型腰椎间盘突出症

目的探讨经皮椎间孔镜技术治疗老年高位脱垂游离型腰椎间盘突出症的临床疗效。方法对11例老年高位脱垂游离型腰椎间盘突出症患者采用经皮椎间孔镜技术治疗。应用VAS评分、Oswestry功能障碍指数及改良Macnab疗效评定标准对患者术前及术后第1天,3、6个月的治疗效果进行评价。结果患者手术时间为40~85(62±17)min,术后患者腰腿痛症状即刻缓解。术后第1天,3、6个月VAS评分,术后第3、6个月ODI指数均明显低于术前(均P<0.05);根据改良Macnab标准,优良率为90.91%。术后未发生下肢麻木、椎间盘炎、血管损伤、硬脊膜破裂及肠管损伤等并发症。结论经皮椎间孔镜技术治疗老年高位脱垂游离型腰椎间盘突出症患者近期内疗效确切、手术风险小及并发症少。     

经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的临床效果

目的探讨经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的临床意义。方法选取2016年8月～2017年8月我院骨科收治的46例腰椎间盘突出症患者。随机数字表法分为研究组和对照组各23例。研究组应用经皮椎间孔镜TESSYS技术治疗,对照组应用椎间盘系统技术治疗。评价及对比两组治疗后关节优良情况、各项围手术期指标、术后疼痛程度(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会评分(JOA)。结果研究组优良率显著高于对照组(P0.05);研究组各项围手术期指标均明显优于对照组(P0.05);治疗后,研究组VAS评分、ODI评分均低于对照组(P0.05),JOA评分显著高于对照组(P0.05)。结论应用经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症,优势显著,可改善患者关节疼痛、关节障碍等症状,同时具有创伤小、出血少、恢复快的优势。     

经皮椎间孔镜治疗老年腰椎间盘突出症47例效果观察及护理

目的:探讨经皮椎间孔镜治疗老年腰椎间盘突出症(LDH)的临床效果及护理方法。方法:对47例老年LDH患者经皮椎间孔镜治疗,并给予精心围术期护理,比较治疗前后疼痛视觉模拟评分(VAS)及Oswestry功能障碍评定(ODI)指数,观察临床效果。结果:本组患者治疗前后VAS评分及ODI指数比较差异有统计学意义(P0.05),治疗优良率为89.36%。结论:经皮椎间孔镜治疗老年LDH患者疗效显著,而及时、有效的围术期护理对提高手术疗效具有重要意义。     

椎间孔镜治疗脱出型腰椎间盘突出症疗效分析

目的:探讨椎间孔镜技术治疗脱出型腰椎间盘突出症的临床疗效。方法:选择自2009年11月至2011年5月在我院应用椎间孔镜技术治疗的脱出型腰椎间盘突出症、并且随访资料完整的患者19例;随访时间6月~22月,平均随访13月。比较术前、术后即刻、1周、3月、6月、12月、22月的日本骨科协会评估治疗分数(Japanese orthopaedic association,JOA)、视觉模拟评分(visualanalogue scale,VAS)、MacNab评分及疼痛功能指数评分(Oswestry,2.0版本),分析临床疗效。结果:19例患者术后JOA评分较术前明显升高,术后VAS和Oswestry评分较术前明显降低,MacNab评分优良率为84.21%,重复测量数据的Bonferroni法检验有统计学意义(P<0.01)。结论:椎间孔镜技术是治疗脱出型腰椎间盘突出症的有效方法。     

椎间孔镜治疗腰椎间盘突出症50例疗效观察

目的探讨应用椎间孔镜治疗腰椎间盘突出症的临床疗效。方法 50例腰椎间盘突出症患者,均行椎间孔镜下腰椎间突出摘除术,采用视觉模拟评分(visual analogue scale,VAS)及改良MacNab标准评价疗效。结果 50例均在椎间孔镜下完成手术,术后1周、3个月VAS评分[(1.0±0.6)、(0.6±0.2)分]较术前[(5.9±0.5)分]明显降低(P0.01);疗效优30例,良15例,可3例,差2例,治疗优良率为90%。结论椎间孔镜下微创治疗腰椎间盘突出症疗效确切。     

maxMorespine椎间孔镜治疗老年腰椎间盘突出症的临床效果

目的探讨maxMorespine椎间孔镜治疗老年腰椎间盘突出症的临床效果。方法将100例老年腰椎间盘突出症患者按治疗方法不同分为2组:对照组50例给予椎板间开窗髓核摘除术治疗,观察组50例给予经皮maxMorespine椎间孔镜椎间盘切除术治疗。比较2组手术临床指标(包括手术时间、术中出血量、卧床时间、住院时间、间盘切除量及咬骨体积等)及术前术后VAS疼痛评分与ODI功能障碍指数改善情况、术后并发症发生情况与临床疗效等。结果观察组术中出血量、卧床时间、住院时间、间盘切除量及咬骨体积均明显低于对照组(P<0.05);2组术后VAS疼痛评分及ODI功能障碍指数均较术前明显降低(P<0.05),2组术后VAS疼痛评分及ODI功能障碍指数比较差异无统计学意义(P>0.05);观察组术后并发症发生率明显低于对照组患者(P<0.05),临床疗效优良率明显高于对照组(88.0%比76.0%,P<0.05)。结论经皮maxMorespine椎间孔镜治疗老年腰椎间盘突出症临床疗效显著,创伤小,并发症发生率低。 更多还原     

镜下磨钻辅助的可视化椎间孔成形治疗腰椎间盘突出症的临床应用

目的探讨镜下磨钻辅助的可视化椎间孔成形治疗腰椎间盘突出症的临床疗效。方法 36例行镜下磨钻辅助的可视化椎间孔成形患者为可视化组,33例行TESSYS成形患者为对照组。比较两组透视次数、手术时间,术前、术后采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、改良MacNab标准等评价临床疗效。结果可视化组透视次数、手术时间低于对照组(P0.05)。两组术前、术后和末次随访VAS评分、ODI指数比较,差异无统计学意义(P0.05)。依据改良MacNab标准,末次随访时,两组优良率比较,差异无统计学意义(P0.05)。结论镜下磨钻辅助下的经皮内镜椎间孔成形治疗腰椎间盘突出症较传统TESSYS技术具有放射暴露少、操作安全、学习曲线平缓的优点,且可获得与TESSYS技术相当的临床效果。     

经皮椎间孔镜技术治疗极外侧型腰椎间盘突出症观察

目的观察经皮椎间孔镜技术治疗极外侧型腰椎间盘突出症的临床疗效。方法选取2013年9月～2015年2月我院收治的26例极外侧型腰椎间盘突出症患者,均予以经皮椎间孔镜手术治疗。术后随访2年以上,对手术前后腰、腿痛VAS评分进行比较,并于术后2年进行疗效评定。结果 26例患者均顺利完成手术,无一例发生术中神经根或硬膜损伤等并发症。手术时间63～102(平均73.6)min;住院时间4～7(平均5.1d)。术后即时和不同随访时间,腰、腿痛的VAS评分均较术前显著下降(P<0.05)。术后随访2年时,采用改良MacNab疗效评价,中26例、优16例、良7例、可1例、差2例,总优良率为88.5%。结论极外侧型腰椎间盘突出症行经皮椎间孔镜技术治疗,可取得良好的近期疗效。     

经皮椎间孔镜联合胶原酶治疗脱出型腰椎间盘突出症的疗效

目的评价经皮椎间孔镜联合胶原酶治疗脱出型腰椎间盘突出症临床疗效。方法选择单间隙脱出型腰椎间盘突出症患者51例,随机分为单纯椎间孔镜组和联合胶原酶组。用视觉模拟评分法(VAS)及Mac Nab标准评价比较两组治疗效果。结果两组患者手术后的VAS评分与术前比较差异有显著性(P0.05),两组术后3 d的VAS评分比较差异有显著性(P0.05),两组术后6和12个月的VAS评分差异有显著性(P0.05)。按照改良Mac Nab疗效评定标准,联合胶原酶组治疗后12个月的优秀率为75%,与椎间孔镜组比较差异有显著性(P0.05)。结论经皮椎间孔镜联合胶原酶和单纯经皮椎间孔镜治疗脱出型腰椎间盘突出症均有效果,但前者的远期疗效更可靠。     

Psychometric assessment of the German version of the Questionnaire about the Process of Recovery

Personal recovery is important for mental health services and service users; moreover, valid and reliable assessment instruments are necessary for measuring personal recovery. Therefore, this study aimed to evaluate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. The study was conducted using a cross-sectional design with a convenience sample. The questionnaire was completed by 200 patients of outpatient services of two psychiatric hospitals in Switzerland. A confirmatory factor analysis was conducted to validate the unidimensional factor structure of the German version of the Questionnaire about the Process of Recovery. Cronbach's alpha was calculated to assess the internal consistency. The results showed an overall acceptable model fit (χ² = 134.188, df = 90, P = 0.002; RMSEA = 0.050, 90% CI: 0.031–0.067; CFI = 0.937; TLI = 0.927) and excellent internal consistency (Cronbach's α = 0.91). These results are consistent with those of studies that have examined the Questionnaire about the Process of Recovery in other languages. This study provides preliminary evidence that the German version of the Questionnaire about the Process of Recovery is a reliable assessment instrument for measuring personal recovery among people with mental illness experiences. However, it is necessary to conduct further psychometric tests to verify the validity and reliability of the instrument. The German version of the Questionnaire about the Process of Recovery can be applied to both research and clinical practice, especially as a means of facilitating communication during the planning and evaluation of treatment goals.     

Causes and consequences of the deficiencies of the lower limbs in the Republic of Guinea

Purpose: According to the last general census of 1996, the deficiency of lower limbs is the main cause of handicap in the Republic of Guinea. The objective of this study that took place in 2008 in Conakry is to analyze the main causes of this phenomenon, as well as to understand the reasons of their increase within the Guinean capital. Method: Our survey covered 244 Guineans out of which 170 men and 74 women were living in Conakry, aged between 10 and 68 years old (±12,6). Results: The main causes of the deficiencies are the poliomyelitis after-effects (40%), as well as other risk factors such as the road accidents and the failure of the health system. Whatever the nature of the deficiencies, their compensation is mainly based on the technical supports such as tricycles and wheelchairs. However, they are distributed in a random way and without any medical follow-up. Conclusion: The orthopedic care in the Republic of Guinea is insufficient and inadequate. Hence, certain individuals who need it the most do not receive it. This type of care is not always helpful and sometimes harmful to the health of the disabled persons.

Implications for Rehabilitation

• Orthopedic care in the Republic of Guinea is globally ineffective and whatever the nature of the lower limbs deficiencies, rehabilitation is mainly based on technical support such as tricycles and wheelchairs.

• They are usually supplied by private enterprises and are distributed during advertising campaigns in a random way without any medical follow-up.

• In the absence of this, the inappropriate use of wheelchairs and tricycles is not helpful and sometimes harmful to the health and to the autonomy of disabled persons.

     

Dysfunction of the liver affects the sense of smell

Summary BACKGROUND: Cirrhosis of the liver (CL) has been reported to be accompanied by olfactory loss. The aim of the present study was to re-investigate previous work with a special focus on differential olfactory function, the relation between CL etiology and olfactory function, and the correlations between laboratory/psychological parameters and olfactory function. MATERIALS AND METHODS: A total of 45 CL patients participated. Olfactory function was tested using the Sniffin Sticks technique, which provides measures for butanol odor thresholds, odor discrimination and odor identification. Serum levels of zinc and bilirubin were obtained. Psychometric measurements included the trail-making test. RESULTS: The study provided the following major results: (1) Olfactory function was compromised in 76% of CL patients; in addition, the patients ability to identify odors, but not odor thresholds or odor discrimination, was related to the degree of CL. This pattern may be an expression of a stronger effect of CL on the central-nervous processing of odors than on the periphery of the system. (2) Neither etiology of the CL (e.g., alcoholism) nor serum levels of bilirubin and zinc were correlated with olfactory function. However, (3) there was a relation between the results from psychometric function tests and the ability to identify odors. CONCLUSION: Although the reason for olfactory dysfunction in CL is far from clear, future investigations should focus on the hypothesis that endogenous intoxication may lead to a stronger deficit in the central-nervous processing of olfactory information than to peripheral lesions in the olfactory system. In addition, while more specific research is needed, olfactory dysfunction may serve as a subclinical indicator of hepatic encephalopathy.

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Riechstörungen bei Leberzirrhose

Zusammenfassung HINTERGUND: In der Vergangenheit wurde bereits berichtet, dass Leberzirrhose (LZ) Riechstörungen verursachen kann. Ziel dieser Untersuchung war es, diese Ergebnisse zu überprüfen, allerdings mit besonderer Berücksichtigung spezifischer Riechfunktionen, dem Zusammenhang zwischen Ätiologie der Leberzirrhose und der Korrelation zwischen Laborwerten, psychometrischen Parametern und den Ergebnissen der Riechuntersuchungen. MATERIAL UND METHODEN: Insgesamt nahmen 45 Patienten mit Leberzirrhose teil. Die Riechtestung wurde mit den Sniffin Sticks durchgeführt, d. h., die Schwelle für n-Butanol wurde bestimmt, sowie die Fähigkeit, Gerüche zu unterscheiden bzw. zu erkennen. Im Serum wurden die Werte für Bilirubin und Zink bestimmt. Psychometrische Messungen umfassten u. a. den Zahlenverbindungstest. ERGEBNISSE: Die Untersuchung lieferte die folgenden, hauptsächlichen Ergebnisse: (1) die Riechfunktion war bei 76% der Zirrhose-Patienten eingeschränkt; außerdem war die Riechidentifikation, nicht aber Riechschwelle oder Riechdiskrimination bei Zirrhosepatienten mit dem Grad der Zirrhose korreliert. Dieses Muster kann als Zeichen besonders ausgeprägter Beeinträchtigung höherer kognitiver Leistungen durch die Leberzirrhose verstanden werden bei relativ geringerer Beeinträchtigung der olfaktorischen Peripherie. (2) Weder die Ätiologie der Zirrhose (z. B. Alkoholismus) noch die Serumwerte von Bilirubin oder Zink korrelierten mit der Riechfunktion. Allerdings (3) ergab sich ein Zusammenhang zwischen den Ergebnissen der psychometrischen Tests und der Riechidentifikationsleistung. SCHLUSSFOLGERUNGEN: Obwohl die Ursache der Riechstörung bei Leberzirrhose letztlich unklar ist, können künftige Studien davon ausgehen, dass bei Leberzirrhose in Folge der exogenen Intoxikation ein relativ stärkeres Defizit hinsichtlich der zentralnervösen Verarbeitung olfaktorischer Information zu erwarten ist als periphere Läsionen des olfaktorischen Systems.

     

Transgenic analysis of the BmBLOS2 gene that governs the translucency of the larval integument of the silkworm,Bombyx mori

The larval integument of the silkworm, Bombyx mori, is opaque because urate granules accumulate in the epidermis. Although the biosynthetic pathway of uric acid is well studied, little is known about how uric acid accumulates as urate granules in epidermal cells. In the distinct oily (od) mutant silkworm, the larval integument is translucent because of the inability to construct urate granules. Recently, we have found that the od mutant has a genomic deletion in the B. mori homologue of the human biogenesis of lysosome‐related organelles complex1, subunit 2 (BLOS2) gene (BmBLOS2). Here, we performed a molecular and functional characterization of BmBLOS2. Northern blot analysis showed that BmBLOS2 was ubiquitously expressed in various tissues. We analysed the structure of a newly isolated mutant (od^B) allelic to od and found a premature stop codon in the coding sequence of BmBLOS2 in this new mutation. Moreover, the translucent phenotype was rescued by the germ‐line transformation of the wild‐type BmBLOS2 allele into the od mutant. Our results suggest that BmBLOS2 is responsible for the od mutant phenotype and plays a crucial role in biogenesis of urate granules in the larval epidermis of the silkworm. The relationships amongst Hermansky–Pudlak syndrome (HPS) genes in mammals, granule group genes in Drosophila and translucent mutant genes in B. mori are discussed.     

Comparing the codes of ethics of the six signatory associations of the Mutual Recognition Agreement

Abstract

Purpose: The Agreement for the Mutual Recognition of Professional Association Credentials (MRA) between six national associations provides a mutually negotiated expedited process for applying for certification in speech-language pathology by any of the signatory associations. Although the MRA recognizes common standards in academic and clinical practice and eases the process to have credentials recognized, an interesting concept is that SLPs who have membership in more than one association must adhere to the code of ethics in each association. Thus, as SLPs will need to abide by them the question then becomes, are the codes of ethics in the six national associations comparable?

Method: Using a content analysis procedure, the authors sought to identify similarities between the six codes of ethics.

Result: The results revealed similarities between the six codes in areas such as responsibility to clients, professional conduct and practitioner competence.

Conclusion: The findings should not to be interpreted to imply that one code of ethics was better or more comprehensive than another, as each code of ethics must be understood and interpreted in temporal, situational and local cultural contexts. Rather, the discussion includes a proposal to create a unified document.     

Intra-individual variations in the bifurcation of the radial nerve and the length of the posterior interosseous nerve

Anatomical literature on the radial nerve predominantly features inter-individual variations, with comparatively few studies investigating intra-individual variations. The radial nerve has a complex and variable course, particularly in relation to the location at which the nerve bifurcates to form the superficial branch of the radial nerve and the posterior interosseous nerve. Variations of the radial nerve may change the way the nerve and its branches, their blood supply and nerve transmission respond to forces. This study investigated the presence of intra-individual differences in the bifurcation point of the radial nerve and the length of the posterior interosseous nerve from the bifurcation to the radial tunnel. Eighteen embalmed human cadavers were dissected to reveal the radial nerve. Measurements were taken from the level of the lateral humeral epicondyle to the bifurcation of the radial nerve, and from the bifurcation to the radial tunnel. All cadavers presented with intra-individual variations between the left and right limbs. Significant differences were found between the left and right limbs for the measurement from the lateral humeral epicondyle to the bifurcation (median difference = 18.0 mm; p = 0.016) but not for the measurement from the bifurcation to the radial tunnel (median difference = 7.0 mm; p = 0.396). In conclusion, the location of the radial nerve bifurcation is subject to both intra- and inter-individual variations. Its specific relationship to the lateral humeral epicondyle also varies, occurring both distal and proximal to the level of the epicondyle. Clinical implications of these findings warrant further investigation.     

Evaluation of the psychometric properties of the Korean version of the Cultural Competence Assessment

Aim

The 25 item Cultural Competence Assessment assesses the cultural competence of multiple types of healthcare providers. This study aimed to examine the validity and reliability of the Korean version of the questionnaire (KCCA) and to determine the need for changes to improve its validity and reliability.

Methods

Data from 161 hospital nurses were used for the item analysis and to assess the reliability and construct validity of the KCCA before and after the deletion of nine items.

Results

The KCCA did not demonstrate acceptable construct validity and subscale internal reliability. Nine items with high interitem correlations, high modification indices, and relatively lower factor loadings were deleted. The 16 item Modified KCCA showed improved construct validity, convergent and discriminant validity, and reliability.

Conclusion

While further psychometric evaluation of the Modified KCCA should be undertaken with larger samples and diverse professionals, the study's data provide evidence that the Modified KCCA might be a more suitable measure for use among Korean healthcare providers.     

An assessment of the triage performance of the efferent arm of the rapid response system

Objectives

To measure the triage performance of the efferent arm of a rapid response system (RRS) by assessing the 24 h outcome of patients triaged to remain on the ward after rapid response team (RRT) review.

Methods

We performed a retrospective observational study of all consecutive RRS activations between August 2005 and December 2011 in a university-affiliated hospital. Calls involving patients with documented limitations of medical therapy (LOMT) orders were excluded. We determined patients who were triaged to stay on the ward at the end of their first (index) call and analyzed their vital status and location 24 h later. Finally, we reviewed medical charts of patients triaged to remain on the ward and had a cardiac arrest and/or died within 24 h of RRT review.

Results

We studied 8304 RRT calls. We excluded 1794 calls involving patients with LOMT, 2165 that were repeat calls, 20 where data was missing, 650 where patients were immediately transferred to a high dependency (HDU) or an intensive care unit (ICU) and 92 where calls were rapidly upgraded to cardiac arrest calls. Thus, we identified 3583 index calls at the end of which patients were triaged to remain on the ward. Within 24 h, 454 (12.7%) of those had a repeat RRT activation and 378 were transferred to HDU/ICU. 12 (0.3%) suffered a cardiac arrest on the ward. Altogether, 14 (0.4%) patients died within 24 h of the index RRT activation. Of those 6 had LOMT applied after the call, 4 had been admitted to ICU in a further call and 6 (0.2%) patients had unexpected cardiac arrest on the ward.

Conclusions

The rate of unexpected cardiac arrest in the 24 h following RRT activation is very low for patients triaged to stay on the ward. Major triage errors by the RRT appear uncommon.     

On the evaluation of the clinical effects of acupuncture

This paper reviews some of the recent randomised trials on acupuncture published in the literature, with particular reference to the definition of placebo (control), sham acupuncture and real acupuncture. Response rates of 30, 50 and 70% of placebo, sham and real acupuncture respectively, are suggested for the groups of patients studied. The statistical methodology necessary in the design of acupuncture trials, in order to detect differences of this order of magnitude, is discussed. If the postulated response rate had been envisaged at the onset of the trials here reviewed, then the majority of these trials have very low power at a conventional 5% level of significance. It is emphasised that one cannot necessarily conclude from trials which produce statistically non-significant results that acupuncture (when compared with placebo for example) is ineffective. The paper suggests that meaningful comparisons between alternative treatments may be made by using ‘pain free intervals’ with subsequent analysis using life table techniques. Tables are provided for determining appropriate patient numbers.