Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized,noninferiority trial

Study DesignThis is a noninferior, single-blind, randomized controlled trial.IntroductionJoint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred.Purpose of the StudyThe purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM).MethodsParticipants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal.ResultsSixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: −3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: −2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: −3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse.ConclusionAn educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise.     

Exploration of shear wave elastography measures of the iliotibial band during different tasks in pain-free runners

ObjectivesTo determine whether shear wave velocity (SWV) of the iliotibial band (ITB): i) increases with active and passive static tasks, and a dynamic task, ii) differs between ITB regions, iii) changes after exposure to running. Additionally, it aimed to determine the between-day reliability.DesignCase series & test-retest.SettingHuman movement unit laboratory.ParticipantsFifteen runners.Main outcome measuresSWV was measured unilaterally in three regions of the ITB (proximal, middle and distal), during six tasks: rest and contraction (pre- and post-running), modified Ober test, standing, pelvic drop, and weight shift.ResultsCompared to rest, SWV was higher during contraction and Ober test in the distal and middle regions, and higher for the middle region in standing and pelvic drop. No differences were found between regions. A tendency of decreased SWV was observed after running. Compared to the start of the dynamic task, SWV was greater at the end of the movement. Reliability was moderate-to-good for the middle region in the standing tasks (ICCs = 0.68 to 0.84).ConclusionSVW of the ITB was higher under passive or active tension. Comparisons between tasks/regions need to be considered in light of the small sample size and poor repeatability of some regions/conditions.     

高脂饮食对自发性高血压大鼠中心动脉弹性的影响及鱼油的干预作用

目的观察高饱和脂肪酸及富含鱼油(n-3多不饱和脂肪酸)饮食对自发性高血压大鼠(SHR)大动脉弹性的影响。方法选择8周龄雄性SHR 30只,适应性喂养至14周龄后,按体重随机分为3组,每组10只,分别给予普通饲料、高脂饲料、高脂加鱼油饲料,持续喂养至36周龄,共干预22周。同龄对照大鼠(WKY)30只同前分组。干预后测定血压、体重、血浆游离脂肪酸谱、生化指标,喂养结束后,应用组织多普勒超声法测定中心动脉脉搏波传导速度(APWV),应用组织化学和免疫组织化学法测定中心动脉管壁的病理改变和基质金属蛋白酶9(MMP-9)的表达水平。结果 SHR高脂饮食组血压较普食组和高脂加鱼油组升高(160.5±5.5 mm Hg比153.1±1.0mm Hg、155.1±6.7 mm Hg,P0.01);HE染色显示高脂饮食组动脉管壁中膜横截面积(MCSA)较普食组增加(35500±8536μm2比28348±3956μm2,P0.05),高脂加鱼油组胸主动脉MCSA较高脂饮食组减小(16865±7235μm2,P0.05)。WKY大鼠MCSA无明显变化。SHR大鼠高脂饮食组主动脉弹力纤维占中膜面积百分比较普食组减少(21.1%±2.3%比30.7%±2.3%,P0.05),高脂加鱼油组较高脂饮食组升高(34.5%±4.1%,P0.05)。SHR大鼠高脂饮食组中心动脉APWV较普食组增加,而高脂加鱼油组APWV较高脂饮食组减小(P0.05)。SHR大鼠高脂饮食组的主动脉壁中MMP-9表达较普食组、高脂加鱼油组升高。结论高饱和脂肪酸饮食具有刺激SHR大鼠大动脉血管壁增厚、上调MMP-9在动脉壁表达及增加动脉僵硬度的作用,而富含n-3多不饱和脂肪酸的饮食可能通过逆转这一作用发挥预防及控制血压的作用。     

Biomechanical Remodeling of the Chronically Obstructed Guinea Pig Small Intestine

Small intestinal obstruction is a frequently encountered clinical problem. To understand the mechanisms behind obstruction and the clinical consequences, data are needed on the relation between the morphologic and biomechanical remodeling that takes place in the intestinal wall during chronic obstruction. We sought to determine the effect of partial obstruction on mechanical and morphologic properties of the guinea pig small intestine. Partial obstruction was created surgically in 2 groups of animals living for 2 and 4 weeks. Controls were sham operated and lived for 4 weeks. A combined impedance planimetry–high-frequency ultrasound system was designed to measure the luminal cross-sectional area and wall thickness. These measures were used to compute the circumferential stress and strain of the excised intestinal segments. The incremental elastic modulus was obtained by using nonlinear fitting of the stress–strain curve. Histologic analysis and the measurements of total wall collagen were also performed. The luminal cross-sectional area, wall thickness, and elastic modulus in circumferential direction increased in a time-dependent manner proximal to the obstruction site (P < 0.01), whereas no differences in these parameters were found distal to the obstruction site (P > 0.25). The circumferential stress–strain curves of the proximal segments in 2- and 4-week groups shifted to the left, indicating the intestinal wall became stiffer. Histologic examination revealed a massive increase in the thickness of the muscle layer especially the circular smooth muscle layer (P < 0.05). The collagen content proximal to the obstruction site was significantly larger in the partially obstructed animals compared to controls (P < 0.05). No difference was found distal to the obstruction site. Strong correlation was found between the collagen content and the elastic modulus at stress levels of 70 kPa stress (P < 0.01) and 10 kPa (P < 0.05) proximal to the obstruction site suggesting that the alteration of collagen has great impact on the mechanical remodeling. The morphologic and biomechanical remodeling likely influence the function of the intestine affected by partial obstructed intestine.     

Effects of acute static,ballistic, and PNF stretching exercise on the muscle and tendon tissue properties

The purpose of this study was to investigate the influence of a single static, ballistic, or proprioceptive neuromuscular facilitation (PNF) stretching exercise on the various muscle‐tendon parameters of the lower leg and to detect possible differences in the effects between the methods. Volunteers (n = 122) were randomly divided into static, ballistic, and PNF stretching groups and a control group. Before and after the 4 × 30 s stretching intervention, we determined the maximum dorsiflexion range of motion (RoM) with the corresponding fascicle length and pennation angle of the gastrocnemius medialis. Passive resistive torque (PRT) and maximum voluntary contraction (MVC) were measured with a dynamometer. Observation of muscle‐tendon junction (MTJ) displacement with ultrasound allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate stiffness. Although RoM increased (static: +4.3%, ballistic: +4.5%, PNF: +3.5%), PRT (static: ?11.4%, ballistic: ?11.5%, PNF: ?13,7%), muscle stiffness (static: ?13.1%, ballistic: ?20.3%, PNF: ?20.2%), and muscle‐tendon stiffness (static: ?11.3%, ballistic: ?10.5%, PNF: ?13.7%) decreased significantly in all the stretching groups. Only in the PNF stretching group, the pennation angle in the stretched position (?4.2%) and plantar flexor MVC (?4.6%) decreased significantly. Multivariate analysis showed no clinically relevant difference between the stretching groups. The increase in RoM and the decrease in PRT and muscle‐tendon stiffness could be explained by more compliant muscle tissue following a single static, ballistic, or PNF stretching exercise.     

最大剪切率对颈动脉僵硬度影响的再探讨

目的 分析肾移植前后持续性血透患者颈动脉僵硬度的变化,探讨最大剪切率对颈动脉僵硬度的影响。方法 选取移植肾患者(KTR)患者31例,维持性血透的终末期肾病患者(ESRD)31例,年龄、性别匹配对照组84例。分别测量左右侧颈动脉脉搏波传导速度(PWV)和左右侧颈动脉最大剪切率(SRmax),分析PWV与SRmax的关联关系。结果 ①组间比较：终末期肾病组和移植肾组患者左右侧颈动脉PWV均大于对照组(P＜0.05)；左右侧颈动脉PWV在终末期肾病组和移植肾组间无差异(P＞0.05)。终末期肾病组和移植肾组左侧颈动脉最大剪切率均小于对照组(P＜0.05)。右侧颈动脉最大剪切率在3组间差异无统计学意义(P＞0.05)。②组内比较：在终末期肾病组,右侧颈动脉PWV大于左侧(P＜0.05)；在对照组和KTR组,左右侧颈动脉PWV无差异。在对照组,受试者左侧颈动脉最大剪切率大于右侧(P＜0.05)。在终末期肾病和移植肾组,受试者左、右侧颈动脉最大剪切率无差异(P＞0.05)。③左右侧颈动脉PWV与年龄、收缩压和舒张压呈正相关,与最大剪切率呈线性负相关(P均＜0.05)。结论 颈动脉僵硬度与最大剪切率呈线性负相关,肾移植患者颈动脉僵硬度变化不明显。     

健康飞行员中心动脉反射波增强指数的测定及其临床应用

目的初步观察我军健康现役飞行员中心动脉反射增强指数(augmentation index,AIx)的变化及其影响因素,为招飞及现役飞行员心血管疾病的预防、治疗提供参考。方法采用无创主动脉搏波分析仪(Sphygmocor)对在空军总医院住院、体检、改装的58例现役飞行员中心动脉收缩压(cSBP)及AIx进行定量检测,并随机选择住院体检的63例健康男性人群作为对照组,两组间进行年龄、血压配对比较无差异,并经病史询问无心血管疾病史,体格检查无阳性体征。心电图、X线胸片、肝肾功能、生化全套等检查无异常者。结果两组间临床资料及生化检测指标的比较无统计学差异(P>0.05),健康飞行员组AIx值低于对照组(P<0.05),相关性分析结果表明AIx与年龄呈正相关(飞行员组:r=0.367,P<0.05)。多元逐步回归分析示年龄、cSBP、收缩压、舒张压是健康飞行员AIx的主要影响因素。结论健康飞行员AIx值低于正常健康人,但受年龄、cSBP、收缩压、舒张压影响。AIx值可为招飞及飞行员心血管疾病的预防、治疗提供理论参考。