深层肌肉刺激联合本体感觉神经肌肉促进疗法治疗颞下颌关节紊乱病的疗效观察

目的观察深层肌肉刺激联合本体感觉神经肌肉促进技术治疗颞下颌关节紊乱病的疗效。 方法采用随机数字表法将52例颞下颌关节紊乱病（TMD）患者分为观察组及对照组,对照组患者给予常规物理因子治疗及本体感觉神经肌肉促进治疗（PNF）,观察组患者在上述干预基础上辅以深层肌肉刺激治疗（DMS）。于治疗前、治疗3周后分别观察2组患者疼痛视觉模拟评分(VAS)及Fricton颞下颌关节紊乱指数改善情况。 结果治疗后2组患者疼痛VAS评分均较治疗前显著降低（P<0.05）,且治疗后观察组疼痛VAS评分［（2.18±0.98）分］较对照组［（3.43±1.03）分］显著降低（P<0.05）。治疗后观察组患者颞下颌关节功能障碍指数（DI）、肌肉压痛指数（PI）、颞下颌关节紊乱指数（CMI）［分别为（0.424±0.067）、（0.032±0.017）和（0.129±0.034）］均较治疗前及对照组显著降低（P<0.05）;对照组患者治疗后DI指数（0.581±0.098）、CMI指数（0.172±0.051）均较治疗前显著降低（P<0.05）,但PI指数治疗前、后差异无统计学意义（P>0.05）。 结论深层肌肉刺激联合本体感觉神经肌肉促进技术治疗颞下颌关节紊乱病具有协同疗效,能进一步缓解患者疼痛,提高颞下颌关节功能,该联合疗法值得临床推广、应用。     

温经通络推拿联合艾灸对腰椎间盘突出症患者疼痛程度及腰椎功能的影响

目的 探讨温经通络推拿联合艾灸对腰椎间盘突出症（LDH）患者疼痛程度及腰椎功能的影响。方法 择取2020年7月-2021年7月于我院就诊的73例LDH患者,按单盲法将其分成对照组（n=37）、观察组（n=36）。对照组予温经通络推拿干预,于此基础上,观察组合用艾灸干预。对比两组疼痛程度[视觉模拟评分法（VAS）]、腰椎功能[Oswestry功能障碍指数（ODI）]、日常生活能力[日常生活能力评分量表（ADL）]。结果 干预4周后,两组VAS评分均较干预前低,且较对照组,观察组VAS评分更低,有统计学差异（P＜0.05）;干预4周后,两组ODI评分均较干预前低,且较对照组,观察组ODI评分更低,有统计学差异（P＜0.05）;干预4周后,两组ADL评分均增高,且较对照组,观察组ADL评分更高,有统计学差异（P＜0.05）。结论 温经通络推拿联合艾灸可减轻LDH患者疼痛,改善腰椎功能,提升日常生活能力。     

基于姿势解密技术的手法治疗对下交叉综合征的临床疗效

目的 观察基于姿势解密技术的手法治疗对下交叉综合征的临床疗效。 方法 选取下交叉综合征患者33例,按随机数字表法分为观察组17例和对照组16例。观察组患者给予基于姿势解密技术的手法治疗,对照组则给予本体感觉神经肌肉促进法（PNF）治疗,2组患者均每周治疗1次,每次治疗20 min,连续治疗4周。于治疗前、治疗1周后、治疗4周后、治疗结束１个月后（随访时）,采用视觉模拟评分（VAS）、Oswestry功能障碍评分（ODI）分别评估2组患者的疼痛程度和腰椎功能;于治疗前、治疗1周后、治疗4周后,测量2组患者的手指指地距离;于治疗前、治疗4周后,测量2组患者骨盆前倾角度（ASIS-PSIS）、骶骨倾斜角度（SS）、腰椎曲度指数（LCI）和表面肌电腰背肌伸屈比（FRR）。 结果 治疗1周后和治疗4周后,2组患者的VAS评分、ODI评分和手指指地距离均显著小于组内治疗前（P<0.05）,且观察组治疗1周后和治疗4周后的手指指地距离均显著小于对照组同时间点,治疗4周后的VAS评分和ODI评分均显著低于对照组同时间点,差异均有统计学意义（P<0.05）。随访时,2组患者的VAS评分和ODI均显著低于组内治疗前,观察组随访时的VAS评分和ODI评分均显著低于对照组随访时,差异均有统计学意义（P<0.05）。治疗4周后,2组患者的骨盆前倾角度、骶骨倾斜角度和腰椎曲度指数与组内治疗前比较,差异均有统计学意义（P<0.05）。治疗4周后,2组患者两侧的表面肌电腰背肌FRR与组内治疗前比较,差异均有统计学意义（P<0.05）,且观察组治疗4周后左、右两侧的表面肌电腰背肌FRR分别为（13.27±5.48）和（14.54±4.90）,改善均显著高于对照组治疗4周后,差异均有统计学意义（P<0.05）。 结论 基于姿势解密技术的手法治疗不仅可以显著改善下交叉综合征患者的骨盆前倾角度、腰椎前凸症状和腰椎活动度,还具有缓解腰痛、放松腰背部肌肉的作用。     

八段锦联合物理疗法治疗慢性腰痛的疗效观察

目的：观察八段锦联合物理疗法治疗慢性腰痛的临床疗效及对竖脊肌表面肌电信号的影响。方法：将84例慢性腰痛患者随机分为观察组和对照组各42例。对照组采用常规物理治疗，观察组在对照组基础上行八段锦训练，共治疗4周。分别于治疗前、治疗后和随访6个月时记录2组患者疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），表面肌电仪分别采集腰部前屈、后伸及最大屈曲状态下竖脊肌平均肌电值信号并计算屈曲-放松比（FRR）。结果：治疗4周后，2组患者VAS评分及ODI值均较治疗前显著降低（均P<0.01），屈曲与后伸过程中平均肌电值（FLEXAEMG、EXEAEMG）及相应FRR值均显著升高（均P<0.01），最大屈曲状态肌电值（MVFAEMG）显著降低（P<0.01），且观察组优于对照组（P<0.05）；随访6个月时，对照组VAS评分及ODI值较治疗后均升高（均P<0.05），FLEXAEMG、EXEAEMG、FRR降低（P<0.05），MVFAEMG升高（P<0.05）；观察组VAS评分及ODI值与治疗后比较无显著性差异，FLEXAEMG、EXEAEMG、FRR降低（均P<0.05），MVFAEMG升高（P<0.05），组间比较，观察组均优于对照组（均P<0.05）。结论：八段锦训练能够有效缓解慢性腰痛的临床症状且远期疗效更佳，这可能与八段锦训练提高竖脊肌收缩和放松能力并增强腰椎稳定性有关。     

低频电针联合推拿对慢性腰痛患者疼痛及功能的短期影响

目的：观察低频电针联合推拿对慢性腰痛(CLBP)患者疼痛及功能的短期效果。方法：将招募的40位CLBP患者按照随机数字表法分为实验组（n=20例）和对照组（n=20例）。实验组采用低频电针结合推拿进行干预治疗,而对照组则单独给予电针处理,每周两次,治疗共持续2周。对两组患者分别于治疗前后进行疼痛（NRS评分）、功能障碍（ODI评分）评估,并于治疗结束后进行治疗效果评价,比较两组的疗效差异。结果：两组患者治疗后的NRS、ODI评分较治疗前均有明显降低（P<0.01）;同时,实验组治疗后的NRS评分[(1.79±1.23) VS (2.62±1.12)]和ODI评分[(16.47 7.41) VS (23.90 8.09)]均明显低于对照组(均P<0.05);且实验组治疗的总有效率明显高于对照组(95% VS 70%,P<0.05)。结论：低频电针与推拿联合应用,可提高对CLBP患者疼痛和功能障碍的短期的治疗效果。     

腰神经后支射频与阻滞对腰椎压缩骨折疼痛效果比较

目的比较腰神经后支射频消融与神经阻滞治疗老年腰椎压缩骨折疼痛近期、远期效果和安全性。方法将老年骨质疏松性腰椎压缩骨折病人60例分为两组,各30例。观察组给予腰神经后支射频治疗,对照组给予腰神经后支神经阻滞治疗,分别于治疗前1d及治疗后1d、5d、3个月、6个月,对病人行总体疼痛视觉模拟（VAS）评分和OSWESTRY功能障碍指数问卷（ODI）评分。结果与治疗前相比,观察组治疗后各时间点VAS评分及ODI评分均明显下降,差异有显著性（F=23.770、414.821,q=9.969～46.117,P〈0.01）;对照组术后1、5dVAS评分及ODI评分明显下降,差异有显著性（F=21.004、354.325,q=5.064～40.039,P〈0.05）。与对照组比较,观察组术后1、5dVAS评分及ODI评分差异无显著性（P〉0.05）,术后3、6个月VAS评分及ODI评分明显下降,差异有显著性（t=4.814～26.612,P〈0.05）。结论腰神经后支射频治疗老年腰椎压缩骨折疼痛的远期疗效明显优于神经阻滞治疗。     

深层肌肉刺激治疗足底筋膜炎的疗效观察

目的 观察深层肌肉刺激（DMS）治疗足底筋膜炎的临床疗效。 方法 采用随机数字表法将56例足底筋膜炎患者分为观察组及对照组,每组28例。2组患者均给予传统康复干预(包括足底按摩手法及超声波治疗),观察组还同时辅以DMS治疗。每周治疗5 d,连续治疗4周。于治疗前、治疗4周后分别采用疼痛视觉模拟评分法（VAS）、足底超声检查及改良Barthel指数(MBI)评价患者疼痛、足底筋膜厚度及日常生活活动（ADL）能力改善情况。 结果 治疗后2组患者疼痛VAS评分、足底筋膜厚度及MBI评分均较治疗前明显改善（P<0.05）;并且观察组治疗后疼痛VAS评分［（2.9±1.9）分］、足底筋膜厚度［（2.84±0.71）mm］及MBI评分［（74.9±9.2）分］亦显著优于对照组水平（P<0.05）。 结论 DMS治疗足底筋膜炎的疗效明显优于传统康复干预,能进一步缓解疼痛,促进患部炎症水肿消散及生活质量提高,该疗法值得临床推广、应用。     

腰椎核心稳定性训练结合电针治疗慢性非特异性腰痛的疗效观察

目的：观察腰椎核心稳定性训练结合电针治疗慢性非特异性腰痛（CNLBP）的临床疗效。方法：CNLBP患者64例随机分为2组各32例,对照组给予电针治疗,观察组在此基础上增加腰椎核心稳定性训练。治疗前后采用Oswestry功能障碍指数(ODI)和视觉模拟评分法(VAS)对2组疼痛程度和功能水平进行评价。结果：治疗1个月后,2组ODI及VAS评分均较治疗前明显下降（P<0.05）;随访1个月后,观察组ODI及VAS评分与治疗1个月后比较差异无统计学意义,对照组ODI及VAS评分与治疗1个月后比较明显升高（P<0.05）;观察组治疗后各时间点ODI及VAS评分均更低于对照组（P<0.05）。结论：腰椎核心稳定性训练结合电针治疗慢性非特异性腰痛疗效优于单纯电针治疗,且短期内不易复发。     

温经通络推拿联合艾灸改善腰椎间盘突出症患者疼痛程度及腰椎功能的作用

目的 探讨温经通络推拿联合艾灸改善腰椎间盘突出症（LDH）患者疼痛程度及腰椎功能的效果。方法 便利选择2020年7月至2021年7月在江西中医药大学附属医院就诊的73例LDH患者，按随机数字表法将其分为对照组（n=37）与观察组（n=36）。对照组予以温经通络推拿，观察组在此基础上联合艾灸干预。干预4周后，分别采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）及日常生活能力（ADL）评分量表进行评估，比较两组患者的疼痛程度、腰椎功能及日常生活能力。结果 干预4周后，观察组和对照组患者的VAS评分分别为（2.11±0.68）分与（11.51±3.26）分，ODI评分分别为（3.69±1.18）分与（16.22±4.45）分，均低于干预前；且观察组评分低于对照组，差异均有统计学意义（P<0.05）。干预4周后，观察组ADL评分[（78.25±7.37）分]高于干预前[（49.38±4.54）分]及对照组同期[（66.84±6.61）分]，差异均有统计学意义（P<0.05）。结论 温经通络推拿联合艾灸可有效减轻LDH患者疼痛，改善其腰椎功能，提升日常生活能力。     

针灸与推拿治疗梨状肌综合征临床研究

目的:探讨针灸与推拿治疗梨状肌综合征临床疗效。方法:将30例梨状肌综合征病例随机分成针灸组和推拿组,观察两组病例治疗前后疼痛VAS评分、即时止痛效果和两组患者临床疗效。结果:两组治疗前后自身疼痛VSA评分比较,差异均有统计学意义(均P<0.01);两组治疗后VSA评分比较,差异有统计学意义(P<0.05);针灸组即时显效率为86.67%,推拿组为46.67%,针灸组的即时显效率明显高于推拿组;针灸组治愈率为33.33%,推拿组为20.00%,针灸组的治愈率高于推拿组,针灸组有效率100.00%,推拿组为93.33%,针灸组的有效率高于推拿组。结论:针灸与推拿治疗梨状肌综合征均有明显临床疗效,但针灸的镇痛效果优于推拿。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.