物理治疗创伤后膝关节功能障碍

目的：探讨应用综合物理疗法治疗创伤后膝关节功能障碍的临床疗效。方法：52例创伤后膝关节功能障碍患者均采用水疗、关节活动度及肌力训练等。结果：治疗1个月后52例患者Lysholm膝关节功能及关节活动度评分较治疗前均有明显改善（P〈0.05）。结论：综合性物理治疗手段对创伤后膝关节功能障碍的恢复有积极作用。     

全膝关节置换术后的康复治疗要点与相关研究

康复治疗对人工膝关节置换术后的临床效果至关重要，是术后膝关节功能能够达到预期效果的重要措施。肌力训练、关节活动度训练、本体觉训练及行走步态训练是术后康复治疗最重要的内容。为最大限度地恢复膝关节功能，综合康复训练必不可少，包括各种主动肌力训练增加膝关节伸、屈肌力；早期持续被动膝关节活动度训练增加关节活动度；本体感觉训练改善膝关节的运动控制能力、姿势校正及平衡维持能力；行走步态训练矫正异常行走步态等。     

关节松动术结合BIODEX SYSTEMⅢ治疗膝关节功能障碍的临床研究

目的：观察关节松动术结合BIODEX SYSTEMⅢ治疗膝关节功能障碍的疗效。方法：对47例膝关节功能障碍患者随机分成治疗组26例与对照组21例。治疗组以关节松动术后结合BIODEX SYSTEMⅢ治疗，对照组只进行关节松动术。结果：治疗后两组患者的膝关节屈伸肌肌力及关节活动度（range of motion，ROM）均有明显好转。治疗组优于对照组，具有显著性差异。结论：采用关节松动术结合BIODEX SYSTEMⅢ治疗膝关节功能障碍较之单纯采用关节松动术治疗效果更明显，值得推广。     

等速肌力训练配合氙光低周波治疗膝骨性关节炎的近期效果

目的：研究等速肌力训练配合氙光低周波治疗对膝关节骨关节炎患肌力、疼痛及关节活动度的影响。方法：运用Biodexni等速测试训练系统对31例膝骨关节炎患进行测试，采用等速肌力训练配合氙光低周波治疗，并对治疗前后的测试指标和疼痛评分进行自身配对t检验和等级秩和检验。结果：经过2个疗程(4周)的治疗，患屈伸肌群大多数指标有不同程度提高，疼痛程度明显减轻。结论：等速肌力训练配合氙光低周波治疗对膝关节骨关节炎患肌力及关节活动度近期功能改善效果较好。     

综合康复治疗下肢骨折后膝关节功能障碍的疗效分析

目的观察综合康复治疗膝关节功能障碍的疗效。方法采用早期等长收缩练习,蹬足练习,直腿抬高等以及后期的药物熏洗,肌力训练,关节松动术等。结果综合康复治疗组膝关节活动度明显改善,与对照组相比差异有显著性（P<0.01）。结论综合康复治疗可更好的促进病人膝关节功能障碍的早日康复。     

等速训练改善关节活动度的初步观察

目的：探索等速训练在膝关节功能障碍康复治疗中的作用。方法：31例膝关节功能障碍患者,根据治疗方案分为3组：A组(等速训练,n=11),B组(常规治疗＆等张训练,n=9)和C组(常规治疗＆等速训练,n=11)。结果：A组关节活动度(ROM)扩大(18.3±8.8)°,B组(29.4±15.7)°,C组(55.9±26.1)°。结论：在膝关节功能障碍的康复治疗中速训练有助于扩大关节活动度。     

等速训练改善关节活动度的初步观察

目的：探索等速训练在膝关节功能障碍康复治疗中的作用。方法：３１例膝关节功能障碍患,根据治疗方案分为３组：Ａ组（等速训练,ｎ＝１１）,Ｂ组（常规治疗＆等张训练,ｎ＝９）和Ｃ组（常规治疗＆等速训练,ｎ＝１１）。结果：Ａ组关节活动度（ＲＯＭ）扩大（１８．３±８．８）°,Ｂ组（２９．４±１５．７）°,Ｃ组（５５．９±２６．１）°。结论：在膝关节功能障碍的康复治疗中,等速训练有助于扩大关节活动度。     

冲击波与超声波疗法治疗创伤后膝关节功能障碍的疗效比较

目的：比较冲击波和超声波治疗创伤后膝关节功能障碍的疗效。方法：60例单侧创伤后膝关节功能障碍患者被随机分成2组,冲击波组和超声波组各30例。2组均给予综合康复治疗（关节松动术、肌力训练和冷疗）。冲击波组增加冲击波治疗,每周2次,共8次。超声波组增加超声波治疗,每天1次,每周5天,共20次。在治疗前、治疗4周后评估患者的疼痛视觉模拟（VAS）评分、膝关节被动关节活动度（ROM）和膝关节功能（HSS）评分。结果：治疗4周后,2组患者VAS评分均较治疗前明显下降（均P＜0.01）,膝关节ROM和HSS评分均较治疗前明显增加（均P＜0.05）;治疗后2组间比较,冲击波组的VAS评分比超声波组明显降低（P＜0.01）,膝关节ROM和HSS评分均较超声波组有明显增加（均P＜0.01）。结论：对于创伤后膝关节功能障碍的患者,冲击波治疗可以比超声波治疗更好地缓解关节疼痛,有效增加膝关节关节活动度和改善膝关节功能。     

骨折后膝关节伸直位僵硬的功能康复

探讨骨折后膝关节伸直位僵硬的功能恢复与康复治疗效果。采用小切口或关节镜下手术及手法松解术，术后第2天开始持续被动活动(continuous pssive motin，CPM)机上行慢速全范围关节活动度功能锻炼，并行肌力训练，1周后进行主动伸、屈膝关节活动，1个月后开始扶拐下地负重行走。分别在术前、术后1个月、术后3个月进行膝关节评分、肌力评定、膝关节活动度测定。术后1个月。70％的患膝关节评分达到优良标准，术后3个月患膝关节评分均达到优良标准。膝关节伸直位僵硬采用小切口或关节镜下手术及手法松解后进行充分的康复治疗对提高肌力，维持关节稳定，恢复膝关节功能有确切疗效。     

人工膝关节置换者康复治疗的特征

目的:分析人工全膝关节置换后康复的影响因素,探讨康复治疗的实施方法.方法:以人工膝关节,置换,康复为检索词,检索中国期刊全文数据库(1999-01/2009-06);以artificial knee joint, athroplasty,rehabilitation为检索词,索PubMed数据库(1999-01/2009-06),文献检索语种限制为中文和英文.以膝关节的活动度,关节功能,肌力,关节稳定性为评价指标.纳入人工膝关节置换后康复治疗的临床研究,排除动物实验.结果:计算机初检得到492篇文献,根据纳入排除标准,对人工膝关节置换后康复的临床研究进行分析.人工全膝关节置换后康复训练的主要内容包括疼痛的处理、关节活动度训练、肌力训练、本体感觉训练及行走功能训练.膝关节活动度是评价人工全膝关节置换疗效的重要指标之一,也是大多数膝评分系统中的一个重要组成部分.患者疼痛症状的改善和是否恢复正常行走功能是观察人工全膝关节置换后疗效的重要指标.肌力训练被认为是置换后康复最重要的部分,尽早进行训练不但可以使患者的膝周肌力尽早得以恢复,还可以促进下肢血液循环,预防深静脉血栓形成.结论:通过康复能尽快恢复患者的肌力、关节活动度和行走能力,同时最大程度控制疼痛.置换后康复活动是否得当,成为直接影响置换效果好坏的重要因素.     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.