Anatomic relationship of the radial nerve to the elbow joint: Clinical implications of safe pin placement

The percutaneous placement of lateral distal humeral pins risks injury to the radial nerve. We aimed to provide a reliable and safe parameter for the insertion of lateral distal humeral pins. A secondary aim of this study was to investigate the effect of pin/screw placement in the intended zone of fixation at the lateral distal humerus. We dissected 70 fresh cadaveric upper limbs and the radial nerve was identified and its course followed into the anterior compartment. The point where the radial nerve crosses humerus in mid lateral plane was identified and the distance between this point and lateral epicondyle was measured, as was the maximum trans‐epicondylar distance, along with the olecranon fossa height. Statistical analysis was performed using the Pearson correlation coefficient. The average trans‐epicondylar distance was measured at 62 ± 6 mm (range 52–78 mm), and the average lateral radial nerve height was 102 ± 10 mm (range 75–129 mm). The ratio of the lateral nerve height to the trans‐epicondylar distance was an average of 1.7 ± 0.2 (range 1.4–2.0). The Pearson correlation coefficient between the lateral nerve height and the trans‐epicondylar distance was r = 0.95. A relative dimension, the trans‐epicondylar distance is both reliable and easily accessible to the operating surgeon. The absolute safe zone for pin entry into the lateral distal humerus is that area lying within the caudad 70% of a line, equivalent in length to the patient's own trans‐epicondylar distance, when projected proximally from the lateral epicondyle. Clin. Anat. 22:684–688, 2009. © 2009 Wiley‐Liss, Inc.     

A Comparison of the Assay Sensitivity of Average and Worst Pain Intensity in Pharmacologic Trials: An ACTTION Systematic Review and Meta-Analysis

Identifying methods to improve assay sensitivity in randomized clinical trials (RCTs) may facilitate the discovery of efficacious pain treatments. RCTs evaluating pain treatments typically use average pain intensity (API) or worst pain intensity (WPI) as the primary efficacy outcome. However, little evidence is available comparing the assay sensitivity of these 2 measures. In this systematic review and meta-analysis, we comprehensively reviewed all low back pain, osteoarthritis pain, fibromyalgia, diabetic peripheral neuropathy pain, and postherpetic neuralgia RCTs that used a parallel group design. Eligibility required: 1) primary RCT report published between 1980 and 2016, 2) comparing 1 or more active, efficacious pharmacologic pain treatment(s) with placebo, and 3) providing data on the standardized effect size (SES) for API as well as WPI for all treatment arms. Twenty-seven active versus placebo comparisons were identified in 23 eligible articles. Using a random-effects meta-analysis, API SES and WPI SES did not differ significantly (difference?=??.021, 95% confidence interval = ?.047 to .004, P?=?.12). The findings indicate that, depending on the objectives of the study, either API or WPI could be used as a primary outcome measure in clinical trials for the chronic pain conditions included in this analysis.

Effectiveness of Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease With Different Degrees of Static Lung Hyperinflation

Objective

To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).

阑尾炎、老年性白内障及剖宫产单病种成本测算

目的核算阑尾炎、老年性白内障及剖宫产病种的平均成本,为实行单病种付费提供数据支持。方法统计分析2012年及2013年某三级综合医院阑尾炎、老年性白内障及剖宫产相关病例,运用收入直接计入法、支出配比法及占床日数成本分摊法等核算此三病种平均成本。结果 2012年阑尾炎、老年性白内障及剖宫产三病种的平均成本分别为7445.78元、7127.11元及6637.46元,2013年此三病种平均成本分别为7578.44元、7439.97元、及6868.31元。结论核算出单病种成本能使医院管理者掌握单病种费用的盈亏状况,为医保部门指导给付费用奠定基础,为以后实施DRGs预付模式创造有利条件。     

住院病人空间分布函数研究

目的:研究住院病人空间分布以及住院病人距离衰减系数,了解居民医疗服务获得的地理可及性现状,为区域卫生规划提供决策依据。方法:随机抽取23家医疗机构住院病人,利用地理信息系统计算病人到就诊医疗机构的距离以及相应的住院病人概率,进行多种曲线模型拟合,根据决定系数和模拟图形选择适宜的模型,得出相应的距离衰减系数。结果:指数曲线模型在二级医疗机构中拟合效果较好,乘幂曲线模型在三级医疗机构中拟合效果较好。指数曲线模型中二级综合医疗机构、二级专科医疗机构住院病人距离衰减系数均值分别为0.51、0.50。乘幂曲线模型中三级综合医疗机构、三级专科医疗机构住院病人距离衰减系数均值分别为0.84、0.53。结论:二级医疗机构住院病人概率随距离衰减的趋势快于三级医疗机构,综合医疗机构住院病人概率随距离衰减的趋势快于专科医疗机构。在区域卫生规划中计算卫生资源配置水平时,对于不同级别、类别的医疗机构应采用不同的距离衰减系数。     

Effectiveness of high-flow nasal cannula on pulmonary rehabilitation in subjects with chronic respiratory failure

BackgroundThe effects of exercise training using both high fraction of inspired oxygen (F_IO₂) and high flow oxygen delivered through a high-flow nasal cannula (HFNC) on exercise capacity in patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) are unknown.MethodsIn this randomized study, 32 patients with CRF receiving LTOT were assigned to undergo 4 weeks of exercise training on a cycle ergometer using an HFNC (flow: 50 L/min) with a F_IO₂ of 1.0 (HFNC group; n = 16) or ordinary supplemental oxygen via a nasal cannula (flow: 6 L/min) (oxygen group; n = 16). A 6-min walking test and a constant-load test were performed before and after 4 weeks of exercise training.ResultsFollowing 4 weeks of exercise training, change in the 6-min walking distance was significantly greater in the HFNC than in the oxygen group (55.2 ± 69.6 m vs. −0.5 ± 87.3 m; p = 0.04). However, there was no significant difference between the two groups in the degree of improvement in the duration of the constant-load exercise test after exercise training.ConclusionsConsidering the effect on daily activities (e.g., walking), exercise training using both high F_IO₂ and high flow through an HFNC is a potentially superior exercise training modality for patients with CRF receiving LTOT.Clinical Trial Registration — http://www.clinicaltrials.gov. Unique identifier: NCT02804243     

阿托伐他汀联合米力农治疗慢性心力衰竭的临床研究

目的探讨阿托伐他汀钙联合米力农注射液治疗慢性心力衰竭的临床疗效。方法选取2018年12月—2019年12月于河南省人民医院进行治疗的慢性心力衰竭患者93例,随机分为对照组(46例)和治疗组(47例)。对照组iv米力农注射液,首次采用50μg/kg负荷剂量静脉推注10 min,随后以0.25～0.50μg/(kg·min)静脉匀速泵入,连续使用72 h;治疗组患者则在对照组基础上口服阿托伐他汀钙片,10 mg/次,2次/d。两组均连续治疗1周。观察两组的临床疗效,比较两组治疗前后临床症状评分、6 min步行距离、心功能指标及血清去甲肾上腺素、细胞间黏附分子-1(ICAM-1)、超敏C反应蛋白(hs-CRP)、醛固酮(ALD)、脑自然肽氨基端前体蛋白(NT-proBNP)、心肌肌钙蛋白I(cTnI)水平。结果治疗后,对照组临床总有效率78.26%明显低于治疗组93.62%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者临床症状评分显著降低,但6 min步行距离显著升高(P0.05);且治疗后治疗组临床症状评分和6 min步行距离相较于对照组改善更为显著(P0.05)。治疗后,两组患者心功能指标左心室射血分数(LVEE)、左心室收缩末内径(LVESD)、左心室收缩末期容积(LVESV)均较治疗前明显改善(P0.05);且治疗后治疗组心功能相关指标相较于对照组改善更为显著(P0.05)。治疗后,两组患者血清去甲肾上腺素、ICAM-1、hs-CRP、ALD、NT-proBNP、cTnI水平均较治疗前明显降低(P0.05);且治疗后治疗组这些相关血清生化指标显著低于对照组(P0.05)。结论阿托伐他汀钙联合米力农注射液治疗慢性心力衰竭疗效确切,能显著改善患者临床症状及心功能指标,可改善患者相关血清生化指标,具有一定的临床推广应用价值。