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1.
目的:探讨癌痛管理信息平台在癌症疼痛病人院外疼痛控制和随访中的应用效果。方法:采用随机数字表法将2019年5月—2020年5月收治的118例癌症疼痛病人分为对照组和观察组各59例,对照组采用常规干预,观察组采用癌痛管理信息平台干预,干预1个月。比较两组干预前后疼痛程度、不良情绪、生活质量变化及随访满意度。结果:观察组病人干预1个月后疼痛程度低于对照组(P<0.05);观察组病人干预1个月后焦虑、抑郁评分均低于对照组(P<0.05);观察组病人干预1个月后生理状况、情绪状态、功能状况、社交能力与家庭情况评分均高于对照组(P<0.05);观察组病人随访满意度高于对照组(P<0.05)。结论:癌痛管理信息平台应用于癌痛病人院外疼痛控制和随访可有效减轻其疼痛程度,同时改善不良情绪及生活质量,提高随访满意度。  相似文献   
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BackgroundIn shoulder arthroplasty, bone resorption around the stem can lead to stem loosening and makes surgery difficult at the time of revision. Proximal bone resorption after reverse shoulder arthroplasty can cause instability because of a decrease of deltoid wrapping effect. As factors of the stem itself, such as stem coating, shape, length, and use of bone cement, may also affect bone resorption, a single-stem model should be used to compare bone resorptions between different pathologies and surgical procedures. However, to date, a few reports have compared these differences in detail using a single-stem model. Therefore, we investigated the prevalence and location of humeral bone resorption in a single-stem model.MethodsThe study included 100 shoulders that underwent anatomical total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with a single uncemented humeral stem from 2008 to 2018. The patients were 31 men and 69 women. The mean age at surgery was 72.9 years (range, 41-86 years). The patients were divided into three groups: especially, 25, 61, and 14 shoulders received TSA for primary osteoarthritis without rotator cuff tears (TSA group), HHR using an anatomical head with rotator cuff repair for cuff tear arthropathy (CTA) (HHR group), and HHR using a CTA head without rotator cuff repair (CTA group), respectively. Patients were monitored for a mean of 56 months (range, 12-98 months). The location of bone resorption was divided into seven zones as follows: zone 1, greater tuberosity; zone 2, lateral diaphysis; zone 3, lateral diaphysis beyond the deltoid tuberosity; zone 4, tip of the stem; zone 5, medial diaphysis beyond the deltoid tuberosity; zone 6, medial diaphysis; and zone 7, calcar region. The degree of bone resorption was classified from grade 0 to 4.ResultsBone resorption of grade 3 or higher was significantly more frequent at the greater tuberosity in the HHR and CTA groups (P < .001 and P < .001, respectively) than that in the TSA group. Grade 4 bone resorption was significantly more frequent in the CTA than that in the TSA and HHR groups in zone 1 (P = .016 and P = .041, respectively).ConclusionThe state of attachment of the rotator cuff to the greater tuberosity might affect bone resorption at the greater tuberosity, such as the greater tuberosity after shoulder arthroplasty. In cases of shoulder arthroplasty for arthropathy with rotator cuff tear, performing rotator cuff repair might prevent bone resorption.Level of evidenceLevel IV; Prognosis Study  相似文献   
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《Orthopaedics and Trauma》2022,36(3):166-174
Shoulder replacement surgery has become the gold standard treatment for end-stage glenohumeral arthropathies in patients who are fit for surgical treatment. The options include anatomic total shoulder replacement, reverse total shoulder replacement and humeral hemiarthroplasty procedures. Whilst for some patients and some indications there is little debate, decision-making for older patients with osteoarthritis remains one of the hot topics in shoulder surgery. In this article we will explore the treatment options, outcomes, and controversies.  相似文献   
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目的 探讨益气活血通络方对糖尿病神经病理性疼痛(diabetic neuropathic pain,DNP)的影响及其作用机制。方法 高脂喂养大鼠4周后,35 mg/kg链脲佐菌素(streptozotocin,STZ)腹腔注射复制2型糖尿病大鼠模型,通过观测大鼠机械痛阈和热缩足反应时间作为判定DNP模型复制成功的标准。将DNP大鼠随机分为模型组,益气活血通络方高、中、低剂量组和阳性对照组(甲钴胺),另设空白对照组。Western blot法和免疫荧光双标检测脊髓中补体受体- 3的单克隆抗体(monoclonal antibody of complement receptor type 3,OX42)和P2X7(purinergic 2X7)的表达水平;ELISA法检测血清肿瘤坏死因子- α(tumor necrosis factor- α,TNF- α)、白细胞介素- 1β(interleukin- 1β,IL- 1β)和趋化因子配体3(CC- chemokine ligand 3,CCL3)水平。结果 益气活血通络方干预后,DNP大鼠的机械痛阈和热缩足反应时间均得到显著的改善;大鼠血清TNF- α、IL- 1β和CCL3水平显著降低(P<0.05);脊髓组织中OX42和P2X7表达水平均显著降低(P<0.05)。结论 益气活血通络方对DNP大鼠具有显著的治疗作用,其作用机制可能是通过抑制脊髓小胶质细胞活性,调节P2X7的表达,从而减轻神经炎症反应。  相似文献   
7.
目的探讨多元化联合教学模式在超声引导下疼痛介入治疗教学中的应用效果。方法选择2018年1月至2020年12月在北京大学第三医院疼痛科进修的30名医师作为研究对象,将其分为对照组与观察组;对照组采用常规教学模式;观察组采用多元化联合教学模式,比较两组医师技能考核成绩、教学质量评分和满意度评分。结果观察组医师技能考核成绩优良率为93.3%,高于对照组的73.3%(P<0.05);观察组医师对基础理论知识掌握、临床思维能力的提高、学习兴趣的激发、疾病诊治能力的提高4个方面的评分均高于对照组(P<0.01)。结论多元化联合教学模式可促进超声引导下疼痛介入治疗技能的提高,有利于提高学员的综合临床能力。  相似文献   
8.
《Journal of endodontics》2022,48(1):102-108
IntroductionThe first outbreak of coronavirus disease 2019 (COVID-19) in the United States resulted in a nationwide closure of dental offices that created an oral health crisis. The aim of this observational study was to analyze and compare the characteristics of patients who visited 2 private endodontics offices from March 16 to May 31, 2020, compared with the same period in 2019.MethodsDemographic, diagnostic, and procedural data of 1520 (693 in 2020 and 827 in 2019) patient visits were collected. Bivariate and multiple logistic regression analyses were used to assess the impact of the COVID-19 outbreak on patient-related variables.ResultsBivariate analyses showed that the number of patient visits decreased in April and May 2020 (P < .0001). In 2020, patients’ self-reported pain level was higher, they were more frequently diagnosed with pulp necrosis and acute apical abscess, and they received more incisions for drainage (P < .05). Multiple logistic regression analyses showed that the COVID-19 outbreak was associated with less visits for older patients (>49.5 years) (odds ratio [OR] = 0.720; 95% confidence interval [CI], 0.573–0.906), more patients with kidney diseases (OR = 2.690; 95% CI, 1.143–6.331), higher levels of pain on percussion (OR = 2.277; 95% CI, 1.718–3.016), less cases with previously initiated treatment (OR = 0.242; 95% CI, 0.080–0.731), less periapical diagnoses of asymptomatic apical periodontitis (OR = 0.510; 95% CI, 0.306–0.849), and a higher number of nonsurgical root canal treatments (OR = 2.073; 95% CI, 1.397–3.074) and apicoectomies (OR = 2.799; 95% CI, 1.367-5.729).ConclusionsThese findings show that the public health burden of endodontic infections was more intense during the initial outbreak of COVID-19.  相似文献   
9.
《Journal of endodontics》2022,48(11):1407-1413
IntroductionInformation on the type of vesicular glutamate transporter (VGLUT) that is expressed in the Piezo2-positive (Piezo2+) neurons in the trigeminal ganglion (TG) and on the type of Piezo2+ axons and their distribution in the dental pulp is important for understanding dental pain elicited by mechanical stimuli and developing new therapeutic strategies.MethodsWe examined the expression of Piezo2 and its coexpression with VGLUT1 and VGLUT2 in rat TG, the sensory root, and human dental pulp using light and electron microscopic immunohistochemistry and quantitative analysis.ResultsVGLUT1 and VGLUT2 were expressed in the TG neurons. Piezo2 was expressed in axons of all types but primarily in small myelinated (Aδ) axons in the sensory root. In the dental pulp, Piezo2 was expressed densely in the numerous axons that form a plexus in the peripheral pulp. Piezo2+ axons in the peripheral pulp were mostly unmyelinated, and Piezo2 immunoreactivity was often concentrated near the axolemma, suggesting that it may represent functional receptors.ConclusionsThese findings suggest that VGLUT1 and VGLUT2 are involved in the glutamate signaling in Piezo2+ neurons, Piezo2 may be primarily activated by noxious mechanical stimuli, and Piezo2-mediated dental mechanotransduction may be primarily elicited in the peripheral pulp.  相似文献   
10.
椎间盘源性腰痛是慢性腰痛的常见类型,是导致残疾的首要原因之一,给社会带来了巨大的经济负担。由于椎间盘解剖结构的特殊性,目前关于椎间盘源性腰痛的具体机制尚不清楚,其诊断及治疗尚未达成统一共识。国内外对于椎间盘源性腰痛的治疗主要包括保守治疗及外科手术治疗,治疗的目的是缓解临床症状,而不是从根本上逆转椎间盘退变。近年来生物治疗开始兴起,为椎间盘源性腰痛的治疗提供了新的方向,但国内关于生物治疗的相关研究报道较少。本文就椎间盘源性腰痛的诊断及治疗进展作一综述,以期为临床提供相关参考。  相似文献   
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