正清风痛宁联合柳氮磺吡啶治疗类风湿关节炎的疗效观察

目的 观察正清风痛宁和柳氮磺吡啶联合治疗类风湿关节炎（RA）短期疗效和药物不良反应。方法 活动期RA患者72例，随机分为两组：治疗组38例，口服正清风痛宁和柳氮磺吡啶：对照组34例，口服甲氨蝶呤和柳氮磺吡啶。结果 治疗组治疗第6周总有效率（81．6％）与对照组（52．9％）比较差异有显著性（P〈0．01）；治疗组24周总有效率（94．7％）与对照组（91．2％）比较差异无显著性（P〉0．05）；不艮反应发生率治疗组（7．9％）与对照组（29．4％）比较差异有显著性（P〈0．05）。治疗组和对照组均明显减轻了关节肿胀、疼痛，改善了关节功能，降低了炎性指标（P〈0．05或P〈0．01）。结论 正清风痛宁联合柳氯磺吡啶治疗RA不仅具有抗炎镇痛、调节免疫反应的作用，且起效快、安全性高。     

类风湿关节炎运动干预疗法的研究进展

类风湿关节炎（rheumatoid arthritis，RA），是一种病因不明的自身免疫性疾病，在我国其发病率为0．32％～0．36％。多见于女性，主要表现为对称性、慢性、进行性关节炎，最终导致关节畸形和功能丧失。传统的治疗方法中强调卧床休息和关节制动。现在越来越多的研究表明：对RA患者进行运动干预能够有效防止关节功能下降，预防畸形，促进功能恢复，并对患者心理起到正性作用，提高其生活质量。最近美国风湿病学会公布的RA治疗原则中，把运动疗法列入该病的主要治疗方法，现综述如下。     

蚂蚁粉食疗法对类风湿性关节炎关节功能康复的疗效观察及免疫学机制探讨

类风湿关节炎（RA）是一种常见的自身免疫病，本病以关节的进行性损伤和功能障碍为主要特征，患者可因关节功能障碍而影响生活和劳动。类风湿灵等多种以蚂蚁为主药的中成药，用于治疗RA均有一定的疗效。若能明确蚂蚁在RA治疗过程中对关节功能改善的疗效及其疗效发挥的免疫学机制，将有助于更好地应用蚂蚁来进行RA的康复治疗。１对象与方法实验组为１６５例RA患者，年龄３４～６７岁，平均５１．４３岁，其中关节功能为甲级者１６例，乙级者２７例，丙级者８２例，丁级者４０例。患者符合ARA诊断标准，关节功能分级如下：甲级，关节活…     

类风湿关节炎患者社区康复护理效果观察

目的探讨类风湿关节炎（RA）患者社区康复护理的效果。方法将符合纳入标准的120例类风湿关节炎患者,按就近方便实施干预原则分为观察组和对照组各60例。对照组实施传统的家庭休养,定期门诊随访;观察组在此基础上,采用社区家庭康复护理模式干预。观察两组患者关节功能及实验室指标差异,并比较两组患者的康复效果。结果观察组患者关节功能明显改善,ESR及CRP实验指标差异均有统计学意义（P〈0.05）。结论社区家庭护理干预模式,可充分发挥家庭和社区对RA患者社区康复治疗的积极作用,指导患者规范化治疗与康复锻炼,改善关节功能。     

类风湿关节炎患者自我管理模式应用效果

目的探讨自我管理模式在类风湿关节炎(RA)患者中的应用效果。方法采取自我管理项目(CDSMP)使患者对疾病进行自我管理,评估患者12周及24周的健康状况、总体功能、疾病活动性指标、关节肿痛与压痛数、关节疼痛评分。结果患者进行自我管理的12周、24周的健康状况评估问卷、患者总体功能分级表、疾病活动性指标、关节肿痛与压痛数、关节疼痛评分差异有统计学意义(P0.05)。结论将自我管理模式应用于RA患者中,有利于患者缓解和减少并发症、延缓和恢复关节功能、提高社会活动能力及提高生活质量。     

云克配合药物熏蒸治疗类风湿关节炎的护理观察

目的：探讨应用云克（锝[99TC]亚甲基二磷酸盐注射液）结合中药熏蒸治疗类风湿关节炎患者的护理措施及疗效。材料与方法：对36例类风湿关节炎的病人应用云克（锝[99TC]亚甲基二磷酸盐注射液）结合中药熏蒸治疗，总结护理措施及治疗中的注意事项。结果：本组36例，显效24例，占66．67％；有效9例，占25％；无效3例，占8．33％。总有效率91．67％。结论：两种方法相结合对治疗RA临床疗效显著，护士在操作过程中，要注意操作规范，在治疗过程的同时，指导患者进行正确的功能锻炼。     

药浴减轻类风湿关节炎症状的疗效观察

目的 观察药浴对类风湿关节炎（RA）患者关节疼痛、肿胀、功能障碍及关节晨僵的疗效。方法 将120例RA患者随机分为观察组（60例）和对照组（60例）。观察组应用常规药物治疗，同时在风湿免疫常规护理基础上加用药浴。用视觉模拟尺评分法（VAS法）评分比较2组疼痛改善效果并评价两组晨僵的时间、关节肿胀及关节功能障碍的改善。对照组应用常规药物治疗，同时按风湿免疫常规护理。结果 观察组关节疼痛、关节肿胀、关节晨僵时间关节功能障碍较对照组改善，2组比较，有显著性差异（P均〈0．01）。结论 对RA患者在药物治疗的基础上加用药浴能够改善RA症状。     

^99Tc-亚甲基二膦酸盐对类风湿性关节炎患者关节肿痛症状的改善效应

背景：对类风湿关节炎(rheumatoid arthritis，RA)患者关节肿痛的治疗一直是风湿病研究领域的重点问题，临床上迫待需要一种疗效和安全性好的治疗药物。^99Tc-亚甲基二膦酸盐一经用于风湿病治疗，其疗效和安全性即得到普遍关注。设计：以患者为研究对象的前后对照研究。目的：^99Tc-亚甲基二膦酸盐改善RA患者关节功能障碍的特征。单位：一所大学医院风湿免疫科病房。对象：四川大学华西医院风湿科2000-03／2002-03收治的活动期RA住院患者67例，均符合美国风湿病协会1987年制订的RA诊断标准。年龄29—71岁，病程9—78月，其中男11例，女56例。全部病例均排除严重心、肝、肾等功能不全者，活动性胃肠病变者，血液及内分泌系统疾病者，过敏体质，以及孕期或哺乳期妇女。方法：67例RA患者经^99Tc-亚甲基二膦酸盐治疗，对其治疗前后关节肿胀指数，关节压痛指数，握力，晨僵时间，休息痛和血沉，c反应蛋白等临床指标进行比较。疗程结束后进行综合评定，按症状和体征改善程度30％，以上且ESR和CRP有所下降记为有效。同时观察记录副反应出现情况，对资料进行统计分析。结果：67例经^99Tc-亚甲基二膦酸盐治疗后，RA病情明显改善，治疗前后关节肿胀指数，关节压痛指数，晨僵时间，休息痛和血沉，C反应蛋白等各项临床指标改善均有显著性意义(P&;lt;0．05)。该药物临床总有效率81％，副反应发生率小且轻微。结论：^99Tc-亚甲基二膦酸盐可以改善RA患者的关节功能障碍，且安全性较好。     

整体护理对类风湿关节炎腕关节疼痛患者预后的影响

目的:探讨整体护理对类风湿关节炎(RA)腕关节疼痛患者预后的影响。方法:将60例RA腕关节疼痛患者随机分成实验组和对照组各30例,对照组给予RA常规治疗及常规护理,实验组在此基础上给予整体护理。比较两组患者腕关节疼痛评分以及对护理的满意度。结果:实验组治疗2周后腕关节疼痛评分低于对照组(P<0.05);实验组满意度高于对照组(P<0.05)。结论:整体优质护理可有效减轻RA腕关节疼痛患者症状,改善关节功能及预后,提高患者对护理服务的满意度。     

老年股骨颈骨折关节置换术22例围手术期护理

目的：探讨老年股骨颈骨折关节置换术患者围手术期的护理方法。方法：对22例老年股骨颈骨折患者术前进行针对性的心理护理、术前评估、术前指导；术后进行体位护理及生命体征监测、疼痛护理、饮食指导、功能锻炼指导，并加强并发症防治及护理。结果：患者行人工髋关节置换术后，经3—4周住院治疗。均痊愈出院。结论：科学有效的围手术期护理是减少并发症、改善老年患者生活质量及提高手术成功率的重要保证。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.     

Partial medial meniscectomy produces osteoarthritis pain-related behaviour in female C57BL/6 mice

Murine models of osteoarthritis (OA) provide a potentially powerful tool to elucidate mechanisms responsible for OA pain. However, few studies have examined pain behaviours in relevant OA models in mice. We have therefore characterized the time course and pharmacological sensitivities of pain-related behaviours in a model of OA in C57Bl/6 mice induced by partial medial meniscectomy. Progressive degenerative joint damage developed in a time-dependent manner and was first detected 4 weeks after surgery. Pain was assessed by monitoring weight bearing, mechanical hyperalgesia, cold allodynia, mechanical allodynia and vocalisation in response to knee compression for 12 weeks postsurgery. No significant weight-bearing deficits were observed during the course of the study. Significant mechanical allodynia was present in the ipsilateral hind limb from 9 weeks after surgery. Hind limb mechanical hyperalgesia and cold allodynia, and increased vocalisation in response to knee compression developed in the ipsilateral limb in 2 phases. An early phase of hypersensitivities lasted for up to 3 weeks and was reversed by treatment with a nonsteroidal anti-inflammatory drug (NSAID), diclofenac. Pain then resolved for several weeks, followed by a second phase of NSAID-insensitive pain after 7 weeks postsurgery. During this phase, all pain behaviours could be reversed by morphine. In contrast, other analgesic drugs (paracetamol, gabapentin, and tramadol) had selective effects on only 1 or 2 modalities. Pain levels fluctuated during the second phase, with transient periods of reduced pain. At these times, underlying hypersensitivities could be unmasked by administration of naloxone, indicating that reduced pain was due to endogenous opioids.     

Case Report: Delayed Subclavian Vein Injury Secondary to Clavicular Malunion

Background

Fractures of the clavicle are extremely common, representing 2.6–12% of all fractures and 35–44% of all shoulder girdle injuries; 69–82% of these fractures occur in the middle third of the clavicle. Vascular injuries relating to clavicle fracture are usually due to extreme force applied to the clavicle in an acute setting. No other reports of delayed subclavian vein laceration were found on literature search.

Objectives

We present this case to increase awareness among emergency physicians of the potential delayed presentation of this rare condition.

Case Report

A 21-year-old man presented to the Emergency Department with acute swelling of the base of the neck after carrying a heavy load on his left shoulder the night before. He had been recovering from a clavicle fracture for 2 months. Malunion of his left midshaft clavicle fracture led to subclavian vein injury and formation of a large hematoma secondary to reinjury that occurred at work the night before presentation. Computed tomography revealed a 9-cm hematoma at the fracture site. The patient was found to have a subclavian vein injury without evidence of arterial injury or nervous system involvement. The patient was admitted for observation and subsequently discharged without need for surgical intervention.

Conclusion

Subclavian vein laceration is a rare complication of clavicle fracture. Patient education at discharge after conservative management is important due to the risk of vascular complications from malunion and reinjury.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.