Can muscle weakness and disability influence the relationship between pain catastrophizing and pain worsening in patients with knee osteoarthritis? A cross-sectional study

ObjectiveTo verify if the relationship between pain catastrophizing and pain worsening would be mediated by muscle weakness and disability in patients with symptomatic knee osteoarthritis.MethodsThis was a cross-sectional study in a hospital out-patient setting. Convenience sampling was used with a total of 50 participants with symptomatic knee osteoarthritis. Pain and the activities of daily livings (ADL) were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale. Pain catastrophizing was assessed using the Coping Strategy Questionnaire (CSQ) subscale. Muscle strength of knee extension and 30-s chair stand test (30CST) were also assessed. Path analysis was performed to test the hypothetical model. Goodness of fit of models were assessed by using statistical parameters such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).ResultsThe chi-square values were not significant (chi-square = 0.283, p = 0.594), and the indices of goodness of fit were high, implying a valid model (GFI = 1.000; AGFI = 0.997; CFI = 1.000; RMSEA = 0.000). Pain was influenced significantly by muscle strength and ADL; muscle strength was influenced significantly by ADL via 30CST; ADL was influenced by pain catastrophizing.ConclusionThe relationship between pain catastrophizing with pain worsening are mediated by muscle weakness and disability.     

Lumbar Spinal Cord Stimulation Can Improve Muscle Strength and Gait Independently of the Analgesic Effect: A Case Report

Spinal cord stimulation (SCS) is widely used for pain relief in patients with failed back surgery syndrome (FBSS), and muscle weakness is a common finding in patients with chronic pain. We present here a single case report of a 47‐year‐old woman, who, after SCS for FBSS, had continuous improvement in lower leg muscle strength and gait, but only transient and minimal pain relief. To the authors’ knowledge, this is only the second published case report of significant improvement in “motor” function, independent of the analgesic effect following SCS in FBSS. If SCS, in fact, does improve muscle strength, new strategies for the management of patients with chronic pain might be opened up. Further studies are needed to verify this hypothesis.     

双向线性能量和负压控制及不旋转核技术在晶状体悬韧带脆弱的白内障超声乳化手术中的应用

目的探讨双向线性能量和负压控制及不旋转核技术在晶状体悬韧带脆弱的白内障超声乳化手术中应用的临床效果。方法对220例(233只眼)悬韧带脆弱的白内障患者,应用双向线性能量和负压控制系统的高负压低能量技术结合不旋转核超声乳化法行白内障超声乳化联合人工晶体植入术。记录术中能量和相对能量复合参数以及并发症发生的情况,同时观察术后早期(1周内)和晚期(9～26个月)的矫正视力以及并发症发生情况。结果术后视力有明显提高。术前即存在轻度晶状体脱位(悬韧带断离范围小于1/4圆周)的15只眼中3只眼术中发生悬韧带断离范围轻度扩大(扩大范围小于1/8圆周);其它手术前未发现晶状体脱位的218只眼中2只眼术中发生局限性(小于1/8圆周)悬韧带断离。术后早期角膜一过性轻度水肿35只眼,15.2%;前房少量出血5只眼,2.1%;轻微虹膜炎45只眼,19.3%;瞳孔欠圆16只眼,6.9%。术后晚期前囊膜混浊122只眼,52.4%;前囊口收缩综合症5只眼,2.1%;后囊膜混浊76只眼,32.6%;人工晶体移位13只眼,5.6%;视网膜脱离3只眼,1.3%。结论利用双向线性能量和负压控制系统的高负压低能量技术结合不旋转核超声乳化法能最大程度地减少对晶状体悬韧带的旋转力和牵拉力,同时还降低了超声能量对悬韧带的冲击力,可最大限度地避免悬韧带的离断。     

老年ICU-AW患者超声测得四肢骨骼肌厚度与MRC评分相关性及对预后的预测ROC曲线分析

目的 探讨老年重症加强护理病房(intensive care unit, ICU)获得性肌无力(ICU-acquiredweakness, ICU-AW)患者超声测得四肢骨骼肌厚度与英国医学研究委员会(medical research council, MRC)量表评分相关性,并绘制受试者工作特征(receiver operating characteristic, ROC)曲线评价其对预后的预测价值。方法 选取我院老年ICU-AW患者60例作为研究组,另选取同期老年ICU接受机械通气无ICU-AW患者60例作为对照组,比较2组超声测得四肢骨骼肌厚度、MRC评分,分析四肢骨骼肌厚度与MRC评分的相关性,比较不同预后患者临床资料、四肢骨骼肌厚度、MRC评分,分析四肢骨骼肌厚度、MRC评分与老年ICU-AW患者预后的关系及预测预后的价值。结果 研究组肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度及MRC评分低于对照组(P<0.05);老年ICU-AW患者肱二头肌、桡侧腕屈肌、股四头肌、胫前屈肌厚度与MRC评分呈正相关(P<0.05);病死患者28 d时机械通气天数高于生存患者,肱...     

Dominantly inherited tubular aggregate myopathy.

We report an unusual familial myopathy characterized morphologically by the presence of large tubular aggregates in all fibre types. Two patients, a father and daughter, presented with slowly progressive proximal weakness, limitation of eye movement, and Achilles tendon contractures. Serum creatine kinase was 5-10 times normal. Light microscopy revealed type I fibre predominance. Basophilic accumulations, which stained intensely with the NADH-TR reaction, were present in both fibre types. Electron microscopy revealed that these consisted of tightly packed parallel tubular arrays. These varied somewhat in their ultrastructural appearance and were classified accordingly as type I, II, and III tubular structures. The tubular aggregates appear to be derived from the sarcoplasmic reticulum. This report further supports the evidence of a distinct clinico-pathological entity of genetic origin.     

酚妥拉明佐治慢支感染并心衰的护理

目的　探讨慢支感染并心衰的有效治疗和护理方法。方法　采用酚受拉明 2 0mg加入 5%的液2 50ml内静脉点滴。结果　治疗组纠正心衰时间 18.2 6± 2 .12小时 ,对照组纠正心衰时间 2 2 .71± 1.98小时 ,两组比较P <0 .0 1。结论　治疗组经系统治疗和护理 ,纠正心衰时间 ,明显优于对照组。     

Acute quadriparesis in an asthmatic treated with atracurium

An 18-yr-old male asthmatic was paralyzed with atracurium for a period of seven days to facilitate mechanical pulmonary ventilation. After withdrawal of the muscle relaxant, train-of-four neuromuscular monitoring demonstrated rapid recovery of normal function. Three days later he developed acute quadriparesis without respiratory compromise. Electrophysiological studies showed normal conduction velocities, low compound muscle action potential amplitudes and evidence of denervation. Most cases of post-ventilatory weakness in the ICU involve the use of vecuronium and pancuronium. It has been suggested that the steroid nucleus in these muscle relaxants may be responsible. Our patient developed generalised weakness after treatment with atracurium, a benzylisoquinolinium muscle relaxant. Thus, it appears that the steroid nucleus of vecuronium and pancuronium is not essential in causing post-ventilatory weakness.     

System weaknesses as contributing causes of accidents in health care.

OBJECTIVE: Accidents in health care, resulting in injury or death to the patient, are a matter of considerable concern. The aim of this study is to examine whether system weaknesses can contribute to these accidents, and if so, how. DESIGN: Eight consecutive accidents reported to the Health Authority in Sweden were analysed using MTO (Man-Technique-Organization) analysis. SETTING: Emergency care hospitals in Sweden. RESULTS: All cases that involved the system supported the assumption that system weaknesses are a contributing factor to accidents. In this study two types of latent failure could be identified: process control latent failures and interactional latent failures. The time span from activation of process control latent failures to operator error was very short, and the study demonstrates the simple relationship between situational factors and operator errors. Interactional latent failures exert system influence in a more indistinct manner. Latent failures, as seen in this study, act not only by creating opportunities for operator errors but also by hindering error detection in the time window available. Safety barriers, which might have prevented the accidents, could be proposed in seven out of eight cases. CONCLUSION: System weaknesses seem to play an important role in accident evolution. Consequently, certain measures can be suggested in order to improve patient safety: (i) sufficient resources should be allocated for research and development at both medical schools and hospitals in order to establish competence and procedures for systematic analyses of processes; and (ii) authorities handling accident cases should have adequate competence in system analysis.     

集合不足型外斜视外直肌斜向后徙

目的　评价集合不足型外斜视外直肌斜向后徙的效果。方法　研究组 2 2例 ,对照组 8例 ,看近斜视角大于看远斜视角至少 15PD ,研究组 2 2例行外直肌斜向后徙术 ,对照组 8例行标准的外直肌后徙术。结果　研究组 18/2 2术后看近外斜度≤ 10PD ,2 2 /2 2术后看远外斜度≤ 10PD ,看近看远外斜角平均差值由术前 2 5± 8 11PD减少到术后 5 2 3± 4 0 3PD。对照组仅 3 /8术后看近外斜度≤10PD ,6/8术后看远外斜度≤ 10PD。结论　集合不足型外斜视外直肌斜向后徙术效果优于标准的外直肌后徙术。