The Christchurch earthquake stroke incidence study

We examined the impact of major earthquakes on acute stroke admissions by a retrospective review of stroke admissions in the 6 weeks following the 4 September 2010 and 22 February 2011 earthquakes. The control period was the corresponding 6 weeks in the previous year. In the 6 weeks following the September 2010 earthquake there were 97 acute stroke admissions, with 79 (81.4%) ischaemic infarctions. This was similar to the 2009 control period which had 104 acute stroke admissions, of whom 80 (76.9%) had ischaemic infarction. In the 6 weeks following the February 2011 earthquake, there were 71 stroke admissions, and 61 (79.2%) were ischaemic infarction. This was less than the 96 strokes (72 [75%] ischaemic infarction) in the corresponding control period. None of the comparisons were statistically significant. There was also no difference in the rate of cardioembolic infarction from atrial fibrillation between the study periods. Patients admitted during the February 2011 earthquake period were less likely to be discharged directly home when compared to the control period (31.2% versus 46.9%, p = 0.036). There was no observable trend in the number of weekly stroke admissions between the 2 weeks leading to and 6 weeks following the earthquakes. Our results suggest that severe psychological stress from earthquakes did not influence the subsequent short term risk of acute stroke, but the severity of the earthquake in February 2011 and associated civil structural damages may have influenced the pattern of discharge for stroke patients.     

产后盆腔肌筋膜疼痛两种综合治疗疗效比较

 目的 比较经阴道触发点与手法按摩分别联合经皮神经电刺激治疗产后盆腔肌筋膜疼痛(myofascial pelvic pain,MFPP)的效果。方法 选取2018- 05至 2019-11医院顺产后6~9周的产妇,根据MFPP诊断标准纳入509例患者,随机分为观察组(257例)和对照组(252例),观察组采用经阴道触发点联合经皮骶3神经电刺激治疗,对照组采用经皮电刺激联合按摩治疗。记录患者治疗前、治疗后痛觉评分,统计治疗有效率。结果 两组患者治疗1个月后VAS评分、性交痛程度均较治疗前明显降低,差异有统计学意义(P＜0.05)。治疗1个月后,两组VAS评分、性交痛程度差异无统计学意义;治疗后观察组盆底肌力明显高于对照组,差异有统计学意义(P＜0.05);观察组总有效率99.22%明显优于对照组的94.05%,差异有统计学意义(P＜0.01)。结论 经阴道触发点联合经皮骶3神经电刺激治疗产后MFPP患者效果显著,且操作简便、安全可靠。     

Sonography-guided trigger point injections in abdominal myofascial pain syndrome

Even though chronic abdominal pain is 1 of the most common reasons for hospital visits, diagnostic testing is often time-consuming and treatment is inadequate. Abdominal myofascial pain syndrome (AMPS) is usually not included as a differential diagnosis, but it should be considered in cases of chronic abdominal pain. The purpose of this study was to investigate the clinical characteristics of AMPS and to assess the effect of sonography-guided trigger point injections (TPI).A total of 100 patients with AMPS from 2012 to 2018 were retrospectively evaluated for clinical characteristics and TPI effects. AMPS was diagnosed using Srinivasan and Greenbaum''s criteria, and the TPIs were performed at intervals of 2 to 4 weeks. The Visual Analog Scale (VAS) ratio was calculated by subtracting the final VAS from the initial VAS score and dividing it by the initial VAS score after injections, and the patients were divided into 4 groups: non-responders, mild, moderate, and good responders.The median duration of pain was 12 months, and the median number of hospital visits before TPI was 2. Of the 100 patients, 66 (66%) were categorized as good responders, 11 (11%) as moderate responders, 7 (6.9%) as mild responders, and 16 (15.7%) as non-responders. When the initial and final VAS scores were compared, the sonography-guided injections were found to be effective in alleviating pain (P < .001). Moreover, patients who received the injections 2 or more times tended to have more significant pain reduction than those who received a single injection (P < .001).Patients with AMPS suffer from long-term pain and undergo many hospital visits and diagnostic tests. TPI with lidocaine can be an effective and safe treatment for patients with chronic AMPS.     

仰卧旋转扳法联合电针治疗腰椎间盘突出症的临床效果观察

目的 研究仰卧旋转扳法联合电针治疗腰椎间盘突出症的临床效果。方法 选取2017 年11 月～2019 年11 月浙江中医药大学附属第三医院收治的腰椎间盘突出症患者为研究对象,采用随机分组法将纳入标准的腰椎间盘突出症患者104 例分为观察组与对照组,每组各52 例,对照组采用仰卧旋转扳法,观察组在对照组的治疗基础上加用电针治疗。比较两组治疗后的总有效率、SF-McGill 疼痛评分、ODI 评分、SOD 与α1-AGP 指标。结果 治疗后观察组治疗总有效率为96.2%,高于对照组的75.0%;观察组PRI、VAS、PPI 的评分较对照组显著下降,SOD 指标较对照组显著升高,α1-AGP 较对照组显著下降,差异均有统计学意义（P＜0.05）。结论 仰卧旋转扳法联合电针治疗腰椎间盘突出症能提高临床效果,值得推广。     

尖端扭转型室性心动过速的快速识别和治疗

目的:分析快速识别和治疗尖端扭转性室性心动过速（Tdp）的方法及疗效。方法:对36例Tdp的临床资料、心电图特征及治疗情况进行分析。结果:先天性长QT间期综合征（LQTS）伴发Tdp者3例,获得性长QT间期致Tdp（LQTT）者29例,伴有极短联律间期的Tdp4例。先天性LQTS治疗的重点是使用β受体阻滞剂;获得性LQTT治疗的重点是去除病因,增快心率,纠正心室复极异质性;伴极短联律间期的Tdp治疗的重点是使用钙拮抗剂。结论:尽快获取病史和诱发因素,详细甄别心电图和针对性治疗,对Tdp的快速识别和及时处理具有重要意义。     

利用Oracle触发器实现临床用药目录分级提示

目的:为了避免医保超范围不合理用药,提高临床医生的工作效率,防范医患矛盾,维护医保定点医疗机构的经济效益,利用Oracle触发器实现临床用药目录分级提示.方法:改造军卫数据库“ordadm”、“doctor orders insert”触发器,利用Oracle触发器自动执行代码块,校验当前患者费别对应的用药目录,及时提示当前药物医嘱的使用级别,协助临床医师合理用药.结果:该触发器可以对临床用药医嘱进行实时监控,分级提示受限用药,发挥了及时杜绝的功效,使合理用药工作更具科学性、主动性.结论:该触发器自适应性强,适用于任何安装军卫系统的医疗卫生机构,有利于丰富和完善军卫系统的功能.     

Characteristics and Impact of Life Turning Points for Older Adults

This research examines the characteristics of turning points, events considered as being significant in one’s life. One hundred and forty-nine turning points, as reported by 53 older adults were investigated. They were characterized according to: age at occurrence of turning point, domain, specific or thematic nature, and areas of functioning on which the turning point had an impact. Compared to men, women reported significantly more turning points related to the health domain. Turning points were distributed through the life span, with some concentration at midlife. Family was the sphere most influenced by turning points. The different domains of turning points corresponded to the specific spheres of impact. Turning points were more often related to discrete events than to a series of events clustered under a theme. Identity and social role processes appear most influential in leading older adults to identify particular life circumstances as turning points in their lives.

Optimal medical therapy is a proven option for chronic stable angina

The authors of the meta-analysis of a percutaneous coronary intervention (PCI)-based invasive strategy for improving prognosis for the treatment of angina conclude that a pooling of data from various studies can be sufficiently powered to evaluate the impact of PCI on long-term mortality. However, most randomized coronary artery patient trials have insufficient power to detect significant differences in hard end points. Randomized trials in patients with chronic stable angina enroll few patients who are over age 65 years, have depressed ventricular function, have clinical instability, or who have undergone previous coronary artery bypass grafting (CABG) or PCI. "Medical therapy" today no longer means the absence of PCI, but rather the presence of intensive, evidence-based pharmacologic intervention. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial randomized 2,287 patients to optimal medical therapy alone or optimal medical therapy plus PCI. Optimal medical therapy consisted of antiplatelet therapy, anti-ischemic therapy, and aggressive lipid and blood pressure control. Based on the strength of the evidence, the author of this commentary recommends more-aggressive medical therapy for patients with moderate-to-severe angina, and PCI or CABG for many patients in whom symptoms persist. Optimal medical therapy is a proven option for chronic stable angina.