Treatment of fibromyalgia and its symptoms

The main symptoms of fibromyalgia syndrome (FM) are pain, stiffness, subjective weakness and muscle fatigue. Pain in FM usually fluctuates, as well as being ‘deep’ and is always associated with local or generalized tenderness (hyperalgesia and allodynia). The pathogenesis of such peripheral and/or CNS changes in FM is unclear, but peripheral tissue changes, specifically in muscles, have been implicated. Indirect evidence from interventions that attenuate tonic peripheral impulse input in patients with FM suggest that overall FM pain is dependent on nociception. More importantly, FM-associated widespread mechanical hyperalgesia and allodynia can also be improved or abolished by removal of peripheral pain impulse input. In addition, FM patients show evidence of abnormal stress reactivity, including blunting of the hypothalamic–pituitary–adrenal axis and increased autonomic nervous system responsiveness. Thus, therapeutic interventions in FM should target not only pain reductions, but also improvements of peripheral/central sensitization and neuroendocrine/autonomic abnormalities. Despite the complexity of FM, there are pharmacologic and non-pharmacologic interventions that are available that have clinical benefit. Present evidence indicates efficacy of antidepressants, cardiovascular exercise and cognitive behavioral therapy. Based on this evidence, a stepwise program emphasizing education, medications, exercise and cognitive therapy can be recommended.     

基于采购流程的卫生事业单位内部控制探讨

卫生事业单位采购工作内容不仅包括行政事业单位日常办公相关采购项目,还涉及到对基础性卫生科研工作所需仪器设备和技术服务的采购。作为重要依托,规划化的采购业务流程及合规可行的采购管理办法,将为开展相关卫生健康业务工作提供切实保障。从内部控制的角度,将采购业务流程进行精细化分解研究,针对卫生事业单位采购过程中存在的采购专业领域项目准备不足,采购执行管理不力和监督审查制度不健全等问题进行逐一分析,并以某卫生事业单位采购业务为例,提出采用建立采购技术文件确认制度、强化招标参与人员确认机制和制定招标采购纪律监督办法等解决方案,对业务流程中可能产生的采购风险进行有效控制和监管,从而完善采购流程及健全采购内部控制管理。     

Burn intensive care treatment over the last 30 years: Improved survival and shift in case-mix

PurposeMortality in burn intensive care unit (ICU) has been decreasing and treatment appears to be changing. The aims of this study: (1) examine outcome in burn patients, (2) examine changes in ICU indication and (3) explore the influence of a changing case-mix.MethodsRetrospective study in patients admitted to ICU (1987–2016). Four groups were specified: major burns (≥15% TBSA), inhalation injury with small injury (<15% TBSA, inhalation injury), watchful waiting (<15% TBSA, without inhalation injury), tender loving care (patients withheld from treatment). Logistic regression was performed to evaluate the relation between case-mix and outcome.ResultsOverall mortality decreased to 7%. Mortality of major burns decreased by 15%. The major burn group decreased by 36%. The inhalation injury and watchful waiting group increased by 9% and 21%. The percentage of ventilated patients increased by 14% in the major burn group. 40% of patients were ventilated in the watchful waiting group.ConclusionsAfter correction for case-mix, survival improved, mainly in the major burn group. Case-mix shifted towards inhalation injury and watchful waiting. Growth of the watchful waiting group is not necessarily harmful. However, the increase of mechanical ventilation could be. We suggest raising awareness for risks and consequences of mechanical ventilation.     

压痛点推拿治疗神经根型颈椎病疗效观察

目的：观察压痛点强刺激推拿与常规颈部牵引、中频治疗神经根型颈椎病的疗效差异。方法：将60例神经根型颈椎病患者随机分为治疗组和对照组各30例。治疗组采用每隔3日推拿1次,25—30分钟／次的颈肩部软组织压痛点附着处强刺激滑动按压治疗;对照组采用每日1次的颈部间歇牵引20分钟／次,配合中频中强度治疗20分钟／次。结果：治疗组治愈率为60％,总有效率为97％,对照组治愈率为27％,总有效率为70％,两组比较：治愈率和总有效率差异有非常显著或显示性意义（P〈0．01,P〈0．05）。结论：压痛点强刺激推拿治疗神经根型颈椎病有较好疗效。     

Increased Tender Point Counts Before and After Total Hip Arthroplasty Are Associated With Poorer Outcomes But Are Not Individually Predictive

In a prospective study, total hip arthroplasty (THA) patients were assessed preoperatively and postoperatively (n = 95) to determine if tender points (TPs) are associated with poor THA outcomes. Patients with high follow-up TP counts had higher visual analog scale (VAS) for pain and sleep, higher follow-up Western Ontario and McMaster Universities Arthritis Index (pain, stiffness, function), lower Health Assessment Questionnaire, Harris Hip, and Short Form 36 (physical functioning, bodily pain, physical component summary) scores. High follow-up TP were associated with increased pain, pain not relieved by surgery, poor function, and poor sleep. Visual analog scale pain and sleep, Short Form 36 (physical functioning, bodily pain), Western Ontario and McMaster Universities Arthritis Index, Health Assessment Questionnaire, and Harris hip scores improved significantly after THA; TP scores did not. Higher preoperative TP were predictive of higher follow-up TP but were poorly predictive of poor outcome measures after surgery in individual patients, suggesting that preoperative TPs are contraindicative for THA.     

Concurrent validation of a pressure pain threshold scale for individuals with myofascial pain syndrome and fibromyalgia

Background: Manual pressure palpation is an examination technique used in the classification of myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there are no validated systems for classifying results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this investigation was to validate a PPTS in individuals diagnosed with MPS and FM. Intra-rater reliability, concurrent validity, minimum cut-off value, and patient responses were evaluated.

Methods: Eighty-four participants who met the inclusion criteria were placed into three groups of 28 (N = 84): MPS, FM, and asymptomatic controls. All participants underwent a two-part testing session using the American College of Rheumatology criteria for classifying FM. Part-1 consisted of manual palpation with a digital pressure sensor for pressure consistency and part 2 consisted of algometry. For each tender point (18 total), participants graded tenderness using the visual analog scale (VAS) while the examiner concurrently graded response using a five-point PPTS.

Results: The PPTS had good intra-rater reliability (ICC ≥ .88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the digital pressure sensor and algometer (ρ ≥ .61). A minimum cut-off value of 2 on the PPTS differentiated participants with MPS and FM from asymptomatic controls.

Discussion: The results provide preliminary evidence validating the PPTS for individuals with MPS and FM. Future research should further study the clinimetric properties of the PPTS with other chronic pain and orthopedic conditions.

Levels of Evidence: 2c.

Clinical Trial Registration: ClinicalTrials.gov registration No. NCT02802202.     

推拿疏通法治疗关节病3则

通过报道笔者在临床中应用＂痛则不通＂理论,对3例以关节疼痛为主症的患者,循经筋分布找到条索状压痛物,施以疏通之法,达到＂通则不痛＂的治疗效果,探讨这一理论在骨关节疾病中的指导作用。     

Effect of Intravenous Lidocaine on Manifestations of Fibromyalgia

Background and Objectives: The objective of our study was to evaluate the effect of intravenous lidocaine on the manifestations of fibromyalgia. Methods: A randomized, double‐blind, comparative study was conducted on 30 patients. All patients received 25 mg amitriptyline. Group 1 (n = 15) received 125 mL of saline; group 2 (n = 15) received 240 mg lidocaine in 125 mL of saline once a week for 4 weeks. The following parameters were evaluated: clinical manifestations before and 4 weeks after treatment; pain intensity on a numerical scale. Results: All patients were female, and the mean age was 44.7 ± 10.5 years in group 1 and 40.9 ± 11.6 years in group 2. No difference in pain intensity or the number of tender points was observed between groups at any time point. Both groups demonstrated a significant decrease in the two parameters after treatment. A significant reduction in sleep disorders, paresthesia, and headache was observed after treatment in the two groups, but there was no significant difference between groups. There was no significant reduction in fatigue, subjective edema or morning stiffness after treatment in either group, without a significant difference between groups. Conclusions: The addition of 240 mg intravenous lidocaine (once a week) to 25 mg amitriptyline for 4 weeks did not modify pain intensity or manifestations in patients with fibromyalgia compared with amitriptyline alone.     

楤木属植物药食兼用嫩芽营养成分分析

五加科木属Ａｒａｌｉａ植物分布亚洲及北美洲,国产２８种。古时我国就以木属嫩芽入药或食用［１］;现在仍用某些木属植物的嫩芽治疗水肿、痢疾、腹泻等症,此外兼作山菜蔬用,已有商品供内销和出口［２～３］。由于该属植物有较高开发价值,现代研究逐渐增多［４...     

国产楤木属药食兼用植物嫩芽的鉴定

目的:研究国产木属药食兼用植物嫩芽的鉴定。方法:形态鉴定及差动热分析法。结果:发现形态鉴定及DTA鉴定特征。结论:仅从形态上难以进行鉴定,但将形态特征与DTA曲线特征结合起来,可进行鉴别并列出检索表。