肩胸关节运动训练对肩袖损伤术后肩关节功能的影响

目的:观察肩胛胸壁关节运动训练治疗肩袖损伤术后肩关节功能障碍的疗效,探讨其对肩关节功能障碍的影响。方法:选择肩袖损伤术后患者40例,随机分为观察组和对照组各20例。2组均按照常规肩袖损伤术后康复治疗方案进行治疗,观察组在此基础上增加肩胛胸壁关节运动训练,疗程12周。治疗前及治疗6周和12周后采用Constant-Murley肩关节功能评分量表(CMS)、目测类比评分法(VAS)及肩关节活动范围进行评估。结果:治疗6及12周后,2组CMS评分较治疗前明显提高(P<0.05),观察组除力量测试评分外其他项目评分均更高于对照组(P<0.05);2组患者VAS及关节活动范围较治疗前均有明显改善(P<0.05),观察组VAS评分及肩关节前屈角度改善更优于对照组(P<0.05)。治疗12周后,2组日常活动、活动范围及CMS总分3个方面较治疗6周后明显提高(P<0.05),观察组CMS总分及各分项分均更高于对照组(P<0.05);2组VAS及关节活动范围均较治疗6周后明显增加,且观察组更优于对照组(P<0.05)。结论:常规综合康复治疗方法及增加肩胛胸壁关节运动训练在治疗肩袖损伤术后肩关节功能障碍中均有明显疗效,但增加肩胛胸壁关节运动训练后在改善肩关节功能方面治疗效果更佳。     

体外冲击波治疗肩袖损伤术后肩关节功能障碍的临床研究

目的:肩部触发点体外冲击波联合康复训练治疗肩袖损伤术后的效果分析。方法:于我院收治的肩袖损伤术后患者中抽取80例，以随机数字表法分为对照组和观察组各40例，对照组采用康复训练，观察组采用肩部触发点体外冲击波联合康复训练，对比2组治疗前后Constant-Murley肩关节功能评分量表(CMS)、加州大学肩关节评分(UCLASS)评分和关节活动范围(ROM)、疼痛情况(VAS)、患者满意度和临床疗效等。结果:治疗后，2组CMS评分、UCLASS评分及肩关节ROM均较治疗前明显提高(P<0.05),且观察组治疗后CMS各项评分均明显高于对照组(P<0.05),UCLASS中疼痛、功能、肩关节屈曲角度以及满意度等评分均明高于对照组(P<0.05);观察组治疗后ROM各项评分均明显高于对照组(P<0.05);2组VAS评分均较治疗前明显下降(P<0.05),且观察组治疗后VAS评分均明显低于对照组(P<0.05);观察组满意度及治疗优良率均显著高于对照组(P<0.05)。结论:对肩袖损伤患者，采用肩部触发点体外冲击波联合康复训练效果显著，可明显改善患者...     

超声引导下封闭注射治疗肩袖损伤的疗效观察

目的观察超声引导下封闭注射治疗肩袖损伤患者的疗效。方法采用随机数字表法将66例肩袖损伤患者分为观察组及对照组, 每组33例。2组患者均给予常规康复干预, 包括超短波治疗及肩关节功能训练, 观察组患者在此基础上辅以超声引导下封闭注射治疗, 对照组患者则针对肩部压痛点进行徒手封闭注射治疗。于治疗前、治疗2周及4周后分别采用疼痛视觉模拟评分法(VAS)、Constant-Murley肩关节功能评分(CMS)对2组患者肩部疼痛、关节功能恢复情况进行评定, 同时采用通用量角器测量患者肩关节前屈、外展及后伸范围。于治疗4周后对2组患者进行临床疗效评定。结果治疗2周、4周后2组患者疼痛VAS评分、CMS评分及肩关节活动度均较治疗前明显改善(P<0.05), 并且上述时间点观察组患者疼痛VAS评分、CMS评分、肩关节活动度以及治疗4周后总有效率(93.9%)亦显著优于对照组水平(P<0.05)。结论超声引导下封闭注射治疗能在短期内显著缓解肩袖损伤患者关节疼痛, 改善关节功能及生活质量, 其疗效明显优于局部痛点徒手封闭注射治疗。     

本体感觉训练对肩袖损伤术后关节功能恢复的疗效观察

目的:探讨本体感觉训练对肩袖损伤术后肩关节功能恢复的临床疗效。方法:将50例肩袖损伤关节镜术后患者按随机分组法分为本体感觉训练组(观察组)和常规治疗组(对照组)各25例。2组患者均采用常规康复训练,观察组在此基础上增加本体感觉训练。2组患者于治疗前、治疗4及8周采用Constant-Murley肩关节功能(CMS)评分评定肩关节功能,采用功能独立性测量(FIM)中的"自理能力"评估其独立能力。结果:治疗8周后,2组患者FIM评分均较治疗前明显提高(P0.05),且观察组更高于对照组(P0.05)。治疗4及8周后,2组患者CMS总分及各分项目评分均较治疗前呈逐渐上升趋势(均P0.05);治疗4周后,2组CMS评分中疼痛、外展和肌力比较无显著性差异,日常活动功能、关节活动范围(前屈、外旋、内旋)及CMS总分比较均有显著性差异(均P0.05);治疗8周后,观察组CMS总分及各分项目评分均明显高于对照组(均P0.05)。结论:本体感觉训练结合常规康复训练对肩关节镜术后患者肩关节功能的恢复效果优于常规治疗,可有效改善肩关节功能,值得临床推广。     

关节镜联合小切口修复术治疗肩袖全层损伤的效果

目的 观察关节镜联合小切口修复术治疗肩袖全层损伤的近期效果,并探讨关节镜联合小切口修复术的临床意义。方法 选取2020年1月至2022年4月接受关节镜联合小切口修复术治疗的22例肩袖全层损伤患者为研究对象。比较术前、术后6个月随访时的疼痛视觉模拟评分法（VAS）评分、肩关节主动前屈角度、外旋角度及Constant-Murley、美国加州大学肩关节评分（UCLA）评分。结果 术后6个月随访时,肩袖全层损伤患者的VAS评分低于术前,肩关节主动前屈角度、外旋角度大于术前（P<0.05）。术后6个月随访时,肩袖全层损伤患者的Constant-Murley、UCLA评分高于术前（P<0.05）。结论 关节镜联合小切口修复术治疗肩袖全层损伤的效果显著,可明显降低肩关节疼痛,提高肩关节功能,有助于术后康复。     

上肢康复机器人对脑卒中后肩痛患者的疗效观察

目的：观察上肢康复机器人训练对脑卒中后肩痛(HSP)患者的疼痛、上肢运动功能及肩关节本体感觉的影响。方法：采用随机数字表法将43例HSP患者随机分为对照组(21例)和机器人训练组(22例),对照组仅接受常规康复训练,机器人训练组在对照组的基础上辅以上肢康复机器人训练,均训练4周。于治疗前后进行视觉模拟评分法(VAS)评分、Fugl-Meyer上肢运动功能（FMA-UE)评分及肩关节本体感觉评定(肩关节前屈45°、90°时的角度差绝对值）。结果：2组完成本研究者均为20例。治疗前2组各项指标均差异无统计学意义(P>0.05)。治疗后2组VAS评分均显著降低(P<0.05),且机器人训练组VAS评分显著低于对照组(P<0.05);2组FMA-UE评分均显著提高(P<0.05),且机器人训练组FMA-UE评分显著高于对照组(P<0.05);2组肩关节前屈45°、90°时的角度差绝对值均显著减小(P<0.05),且机器人训练组肩关节前屈45°、90°时的角度差绝对值显著小于对照组(P<0.05)。结论：与常规康复训练比较,常规康复训练辅以上肢康复机器人...     

肩关节镜下肩袖修复术治疗肩袖损伤的临床效果

目的探讨肩关节镜下肩袖修复术治疗肩袖损伤的临床效果。方法将我院2018年2月至2019年2月收治的52例肩袖损伤患者随机分为对照组(26例,开放式肩袖修复术)和观察组(26例,全肩关节镜下肩袖修复术)。比较两组的治疗效果。结果治疗后,两组的肩关节前屈、内旋、外旋活动度及Constant-Muley肩关节评分均增加,数字评估量表(NRS)评分均降低,且观察组显著优于对照组(P<0.05);观察组的治疗优良率显著高于对照组(P<0.05)。结论肩关节镜下肩袖修复术治疗肩袖损伤的临床效果显著,能够有效减轻患者疼痛,加快患者术后肩关节功能的恢复,值得临床推广应用。     

分阶段综合康复训练疗法在肩袖损伤术后应用优势分析

目的 研究分阶段综合康复训练疗法在肩袖损伤术后的应用价值。方法 选取 2022 年 1 月至 2022 年 12 月期间于本院接 受手术治疗的肩袖损伤患者 60 例作为研究对象。采用随机抽签法将患者分为对照组和观察组,每组各 30 例。对照组予以常规 康复训练;观察组予以分阶段综合康复训练。分析对比两组的肩关节疼痛程度、肩关节功能、肩关节活动度、日常生活活动能 力、康复效果以及康复训练满意度。结果 训练后,观察组肩关节功能显著高于对照组（P<0.05）。观察组肩关节前屈及外展 角度均显著高于对照组（P<0.05）。观察组的日常生活活动能力评分显著高于对照组（P<0.05）。结论 肩袖损伤术后予以分 阶段综合康复训练疗法,可促进肩关节功能和活动度,提升日常活动能力。     

超声引导下肩袖三角间隙注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤

目的：观察超声引导下肩袖三角间隙注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤的临床疗效。方法：将部分或全层小撕裂型肩袖损伤患者128例随机分为对照组42例、痛点注射组 43例和超声注射组43例（最终脱失7例）。3组患者均接受常规康复治疗,痛点注射组加行肩关节局部痛点注射,超声注射组加行超声引导下肩袖三角间隙注射。治疗前和治疗3周后对患者进行肩痛程度视觉模拟评分（VAS）、Constant-Murley肩关节评分系统（CMS）各分项评分及功能独立性测量量表（FIM）中的自理能力评定,并比较3组临床治疗的总有效率。结果：治疗3周后,3组患者VAS评分较治疗前比较均明显降低（均P＜0.01）,痛点注射组和超声注射组较对照组评分均更低（均P＜0.05）,且超声注射组更低于痛点注射组（P＜0.05）;3组患者CMS各项评分和FIM的自理能力评分较治疗前均明显提高（均P＜0.01）,痛点注射组和超声注射组较对照组上述评分均更高（均P＜0.05）,且超声注射组更高于痛点注射组（P＜0.05）;痛点注射组和超声注射组临床疗效的总有效率均明显高于对照组（均P＜0.05）,且超声注射组总有效率更高于痛点注射组（P＜0.05）。结论：超声引导下肩袖三角间隙注射结合常规康复技术较痛点注射结合常规康复技术治疗部分及全层小撕裂型肩袖损伤能更好地减轻患者临床症状,改善肩关节功能,提高日常生活自理能力,疗效更好。     

早期康复干预对肩袖损伤患者经手法松解术治疗后功能恢复的影响

目的 观察早期康复干预对肩袖损伤患者(麻醉下)手法松解术后功能恢复的影响。 方法 采用随机数字表法将68例肩袖损伤患者分为观察组及对照组，每组34例。2组患者均给予麻醉下手法松解术（MUA）治疗，对照组术后给予常规康复训练，观察组于术后早期介入系统康复干预，如术后麻醉未清醒阶段实施被动姿势控制训练，完全清醒后指导患者主动活动手指、腕关节及肘关节，后续则根据患者恢复情况逐渐增加弹性球训练、肩关节训练、扩胸运动、肌力训练等。于术前、术后2周、4周时分别采用Constant-Murley肩关节功能评分(CMS)、疼痛视觉模拟评分（VAS）、焦虑自评量表(SAS)及生活质量评分量表(SF-36)对2组患者进行疗效评定。 结果 术后2周、4周时观察组患者肩关节CMS评分［分别为(60.03±5.54)分和(85.94±4.02)分］均显著高于治疗前及同期对照组水平(P＜0.05)；术后2周、4周时观察组SAS评分［分别为(50.26±3.89）分和(43.26±3.89)分］均明显低于治疗前及同期对照组水平(P＜0.05)；术后48 h、术后4周时观察组疼痛VAS评分［分别为(3.14±0.65）分和(0.60±0.62)分］均明显低于治疗前及同期对照组水平(P＜0.05)；术后4周时观察组SF-36评分［（84.59±3.89）分］显著高于治疗前及同期对照组水平(P＜0.05)。 结论 于MUA术后早期介入康复干预能显著改善肩袖损伤患者的肩关节功能，缓解其疼痛程度及焦虑情绪，有助于提高患者日常生活质量。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。