Repetitive strain injury

Pain in the forearm is relatively common in the community. In the workplace forearm pain is associated with work involving frequent repetition, high forces, and prolonged abnormal postures. Nevertheless, other factors are involved in the presentation and the continuation of the pain. Notable among these factors are psychosocial issues and the workplace environment-the attitude to workers and their welfare, the physical conditions, and design of the job. Primary prevention may be effective but active surveillance is important with early intervention and an active management approach. Physical treatments have not been extensively evaluated. In the established case, management should be multidisciplinary, addressing physical aspects of the job but also addressing the "yellow, blue, and black flags" which should be viewed as obstacles to recovery. For the worker "on sick" a dialogue should be established between the worker, the primary care physician, and the workplace. Return to work should be encouraged and facilitated by medical interventions and light duty options. Rehabilitation programmes may be of use in chronic cases.     

Repetitive strain injuries

The semimechanized and repetitive nature of industry, the greater use of keyboards, and the need to boost production during an economic recession have led to a huge increase in repetitive strain injuries. The types of injury, their diagnosis and their treatment are discussed.     

Repetition strain injury: a review of current understanding

"Repetition strain injury" (RSI) is a controversial condition and has become a major occupational health problem in Australia. It seems to be a disorder that is consequent to the introduction of new technology without due concern for human performance. The introduction of mechanized and partly automated processes apparently has made physical workloads lighter but has resulted in an increased regularity of physical movement with workloads that frequently are concentrated locally. Mechanization and automation have also produced an increased rate of work. A combination of several factors, each of which in itself is seemingly tolerable, may lead to this occupational hazard. Physical, psychological and ergonomic aspects may contribute to the condition but there are no useful diagnostic investigations. The pathology is unknown. Management of the condition requires carefully supervised treatment of the patient and his or her environment. The prevention of RSI necessitates improved organizational and ergonomic control in the work environment. Fundamental research into its causes, natural history and pathophysiology is essential for the development of scientifically based preventive strategies and patient therapy.     

Epidemiological aspects of "repetition strain injury" in Telecom Australia

An epidemic of "repetition strain injury" ("RSI") in Telecom Australia is described. In the years 1981-1985, there have been 3976 reports of "RSI". The occupation that was most affected was that of telephonist, with 1886 reports and a rate of 343 per 1000 keyboard staff members over five years; among other occupations that were affected were clerical workers (1421 reports; rate, 284 per 1000 keyboard staff members); telegraphists (17 reports; rate, 34 per 1000 staff members); and process workers (235 reports; rate, 116 per 1000 staff members). Women accounted for 3330 (83%) of all reports; in the telephonist group, 27% of female and 20% of male staff members were affected (P less than 0.001); for women, younger staff members were more affected. There was a significant difference among states in the prevalence of "RSI" in telephonists. There was a high morbidity, and 644 (16%) subjects were affected for more than 26 weeks; the cost-effectiveness of treatment and rehabilitation varied appreciably among state administrations. The costs of the epidemic exceed $15 million, including $1.8 million in medical costs. Reasons for the rise and decline of the epidemic are discussed.     

重复异位妊娠的保守治疗

目的：探讨重复异位妊娠保守治疗法。方法：22例非破裂重复异位妊娠均采用MTX静脉化疗，其中5例加用米非司酮治疗。结果：22例重复异位妊娠保守治疗全部成功，其中15例一个疗程MTX化疗血β－HCG下降至正常，2例两个疗程MTX化疗痊愈，5例第2个疗程联合米非司酮治疗成功。结论：采用MTX静脉化疗或联合米非司酮治疗重复异位妊娠是简单易行的方法。     

肺应力和应变在肺损伤家猪机械通气中的作用

目的 研究不同平台压参数设置下,急性肺损伤(acute lung injury, ALI)家猪的跨肺压(transpulmonary pressure)等呼吸力学参数,明确平台压30cmH₂O能否全面准确反应ARDS呼吸力学情况。方法 将6只健康家猪麻醉、进行外科手术后,按照以下不同实验状态进行机械通气: A组平台压＜30cmH₂O、B组平台压＞30cmH₂O伴腹内高压(intra-abdominal hypertension, IAH)。观察不同分组通气参数设置下,肺应力、平台压等呼吸力学标。结果呼吸力学: A组肺应力为(15.07±1.47)cmH₂O高于 B组(10.92±1.28)cmH₂O;B组胸壁弹性阻力与呼吸系统弹性阻力之比(Ecw/Ers)为(0.36±0.06)高于A组(0.24±0.05);B组肺顺应性(Cdyn)为(13.38±2.79)ml/cmH₂O,明显高于A组(10.26±1.18)ml/cmH₂O ;差异均有统计学意义(P<0.01)。B组胸壁顺应性(Ccw)为(43.12±8.00)ml/cmH₂O,低于A组(63.28±36.71)ml/cmH₂O,差异均有统计学意义(P<0.01)。结论 单纯以平台压30cmH₂O作为机械通气的标准,不能准确地反映ARDS患者肺部的呼吸力学。腹内高压时,需要更高的平台压来改善氧合状况。肺应力和应变是真正反应ARDS肺呼吸力学的指标,将肺应力和应变理论引入临床,有利于为ARDS患者制定更加安全、合理的通气策略。     

Repetitive pseudoseizures incorrectly managed as status epilepticus.

Pseudoseizures should be considered in the differential diagnosis of intractable seizures. Incorrect diagnosis may result in incorrect management, with the patient unnecessarily exposed to side effects of drugs. The authors report on three patients who presented with uncontrolled seizures originally diagnosed and managed as status epilepticus. Electroencephalography performed during provoked attacks led to a diagnosis of pseudoseizures. Psychiatric assessment revealed psychologic disorders. The patients received supportive therapy, and the pseudoseizures stopped.     

重复神经电刺激在重症肌无力中的临床应用研究

目的　探讨重复神经电刺激 (RNS)对重症肌无力 (MG)的临床应用价值。方法　对 3 0例MG患者的面神经、副神经、腋神经、尺神经分别用低频 (3Hz、5Hz)和高频 (10Hz、15Hz、2 0Hz)超强电流进行RNS检查 ,共检查 12 0条神经。所检神经对应的肌肉疲劳后 ,再以上述频率和电流重复进行RNS检查。结果　低频刺激阳性为 5 6.67% (17/ 3 0 ) ,高频刺激阳性为 2 6.67% (8/ 3 0 ) ,两者比较差异有高度显著性 (P <0 .0 0 1)。 10 0 %RNS阳性患者在低频刺激时即可获得阳性结果。疲劳前的RNS阳性率为 5 6.67% (17/ 3 0 ) ,疲劳后为 83 .3 3 % (2 5 / 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。疲劳后按 4块肌肉统计RNS阳性率为 86.67% (2 6/ 3 0 ) ,而按 3块肌肉统计阳性率为 60 .0 0 % (18/ 3 0 ) ,两者比较差异有显著性 (P <0 .0 5 )。结论　低频RNS检查在MG疾病诊断中具有重要的价值 ,对MG患者的临床分型和指导治疗具有重要意义 ,受检神经所支配的肌肉疲劳后和增加检查的神经数目能提高RNS阳性率。     

重复经颅磁刺激治疗失眠研究进展

【摘要】 重复经颅磁刺激（rTMS）是基于经颅磁刺激发展而来的一项新的神经电生理技术，它利用电磁感应原理，非侵入性地刺激大脑皮层，从而改变刺激部位及与其存在解剖连接部位的皮层兴奋性。本文就重复经颅磁刺激治疗失眠的刺激技术参数进行综述。     

RNS技术在重症肌无力的应用

目的研究重复神经刺激技术(RNS)对重症肌无力(MG)疾病的诊断价值。方法分别对我院诊治的36例MG患的面神经、腋神经及尺神经进行RNS检查,共检查108条神经。结果108条神经中RNS阳性率为60．2％(65条),其中以腋神经对应的三角肌阳性率最高,为77．8％(28／36),尺神经对应的小指展肌阳性率最低,为41．7％(15／36)。同一患有一条或多条神经RNS阳性的病例数为总例数的86．1％(31／36)。所有RNS阳性的MG患在低频刺激即可获得阳性结果,最佳刺激频率为3～5Hz。结论对MG患同时进行腋神经、面神经和尺神经的重频刺激,可提高RNS的阳性率。     

小鼠急性重复缺氧后心脏匀浆中出现的一种新物质

对小鼠进行急性重复性缺氧 ,并测定未缺氧小鼠及缺氧小鼠心脏匀浆高效液相色谱图。发现小鼠缺氧后 ,心脏匀浆中出现一种新物质 ,且随小鼠缺氧耐受的增加 ,该物质的生成量增大。提示 :该物质是与缺氧密切相关的物质 ,可能是一种能抵抗缺氧、增强耐受的物质抗缺氧因子 ,也可能是机体在抵抗缺氧过程中产生的代谢产物。     

成人反复上呼吸道感染缓解期的症候学研究

目的:研究成人反复上呼吸道感染缓解期的中医证候学特点.方法:收集主诉反复上呼吸道感染的门诊病例,对其中医症候学和基础疾病进行描述性分析.结果:成人反复上呼吸道感染缓解期常见症状为乏力、畏风畏寒、不耐寒热,舌淡、苔薄白、脉细和虚较多见,肺、脾、肾三脏气虚证为常见证型.结论:对于成人反复上呼吸道感染的防治,不但要注意补益肺气,还应注意补益脾肾.