Reliability of 3 methods for assessing shoulder strength

The reliability of tests for isometric strength of the shoulder joint in symptomatic subjects has yet to be established. For this purpose, interrater and intrarater agreement trials were undertaken to ascertain the reliability of manual muscle tests, a handheld dynamometer, and a spring-scale dynamometer for 5 different shoulder movements in symptomatic subjects. Intraclass correlation coefficients were calculated from a random-effects model. All movements tested with the handheld dynamometer demonstrated excellent reliability for the interrater trial (rho = 0.79-0.92). Excellent reliability was also demonstrated for elevation, external rotation, and internal rotation for the intrarater trial (rho = 0.79-0.96). For the interrater trial, measurement of the lift-off maneuver with the handheld dynamometer was significantly more reliable than with manual muscle tests (P =.002). In summary, the handheld dynamometer was the most reliable and discriminatory means for assessing strength of the rotator cuff in symptomatic subjects.     

无创评估容量反应性的临床应用进展

容量评估与干预是围术期患者安全管理的一项重要因素,可以影响患者最终转归。无创评估容量反应性具有简便、快速、创伤小、患者更易配合等特点,是进行个体化液体治疗的基础,近些年临床应用广泛。本文从基于心肺交互作用的评估指标、基于容量负荷的评估方法两方面对常用的无创评估容量反应性的方法进行阐述,为临床应用提供参考。     

Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease

BACKGROUND: Bronchodilator reversibility testing is recommended in all patients with chronic obstructive pulmonary disease (COPD) but does not predict improvements in breathlessness or exercise performance. Two alternative ways of assessing lung mechanics-measurement of end expiratory lung volume (EELV) using the inspiratory capacity manoeuvre and application of negative expiratory pressure (NEP) during tidal breathing to detect tidal airflow limitation-do relate to the degree of breathlessness in COPD. Their usefulness as end points in bronchodilator reversibility testing has not been examined. METHODS: We studied 20 patients with clinically stable COPD (mean age 69.9 (1.5) years, 15 men, forced expiratory volume in one second (FEV(1)) 29.5 (1.6)% predicted) with tidal flow limitation as assessed by their maximum flow-volume loop. Spirometric parameters, slow vital capacity (SVC), inspiratory capacity (IC), and NEP were measured seated, before and after nebulised saline, and at intervals after 5 mg nebulised salbutamol and 500 microg nebulised ipratropium bromide. The patients attended twice and the treatment order was randomised. RESULTS: Mean FEV(1), FVC, SVC, and IC were unchanged after saline but the degree of tidal flow limitation varied. FEV(1) improved significantly after salbutamol and ipratropium (0.11 (0.02) l and 0.09 (0.02) l, respectively) as did the other lung volumes with further significant increases after the combination. Tidal volume and mean expiratory flow increased significantly after all bronchodilators but breathlessness fell significantly only after the combination treatment. The initial NEP score was unrelated to subsequent changes in lung volume. CONCLUSIONS: NEP is not an appropriate measurement of acute bronchodilator responsiveness. Changes in IC were significantly larger than those in FEV(1) and may be more easily detected. However, our data showed no evidence for separation of "reversible" and "irreversible" groups whatever outcome measure was adopted.     

Different methods for anatomical targeting

AIM: Several procedures are used in the different neurosurgical centers in order to perform stereotactic surgery for movement disorders. At the moment no procedure can really be considered superior to the other. We contribute with our experience of targeting method. METHODS: Ten patients were selected, in accordance to the guidelines for the treatment of Parkinson disease, and operated by several methods including pallidotomy, bilateral insertion of chronic deep brain electrodes within the internal pallidum and in the subthalamic nucleus (18 procedures). Interventions: in each patient an MR scan was performed the day before surgery. Scans were performed axially parallel to the intercommissural line. The operating day a contrast CT scan was performed under stereotactic conditions. Measures: after digitalization of the MRI images, it was possible to visualize the surgical target and to relate it to parenchimal and vascular anatomic structures readable at the CT examination. The CT scan obtained was confronted with the MR previously performed, the geometrical relation between the different parenchimal and vascular structures and the selected targets were obtained. Stereotactic coordinates were obtained on the CT examination. RESULTS: It was possible to calculate the position of the subthalamic nucleus and of the internal pallidum on the CT scan, not only relating to the intercommissural line, but considering also the neurovascular structures displayed both on the MRI and the CT scans. CONCLUSION: The technique that our group presents consist in an integration between information derived from the CT and the MR techniques, so that we can benefit from the advantages of both methods and overcome the disadvantages.     

Different evaluations of the health related quality of life in dialysis patients

BACKGROUND: Sometimes patients on dialysis treatment cannot express their health-related quality of life (HRQoL); and therefore, it is necessary to use the assessment made by their carers. The purpose of this study was to evaluate the agreement between dialysis patients' HRQoL and the assessment made by their carers, and to investigate which variables were associated with the differences found. METHODS: Two hundred and twenty-two pairs of patients and carers were selected from 14 dialysis units. Patients' HRQoL was evaluated by the patients themselves and by their family carer (FAM), nurse (NUR) and physician (PH) using the Karnofsky scale (KS) and the EuroQOL5D (EQ5D) scale. Patients and their family carers answered the Medical Outcome Survey 36-Item Short Form Health Survey (SF-36), and the family carers answered the Zarit burden interview. Physicians scored the patients' comorbidity index and nurses evaluated the Barthel index (BI). RESULTS: The intraclass correlation coefficients (ICC) between the ratings provided by patients and their carers were: KS: 0.80(FAM), 0.76(NUR) and 0.62(PH); EQ5D: 0.42(FAM), 0.48(NUR) and 0.29(PH). The agreement between the EQ5D dimension scores varied from moderate for mobility and self-care to insignificant for pain and anxiety/depression. The variables associated to the size of the differences found were the Zarit burden interview score and the mental component score (MCS) (SF-36) of the carer, the physical component score (PCS) (SF-36), the BI score and patient comorbidity, and the physician's age and experience. CONCLUSIONS: Family carers and health care providers of dialysis patients are reasonably aware of the patient's level of function and well being and can be useful sources of proxy HRQoL information. Nevertheless, discrepancies can occur, depending in part on the different characteristics of patients and their caregivers.     

Criteria and tools for assessing quality of life in palliative care

The concepts of quality of life and palliative care seem at first sight to be inextricably linked. However, it is worth questioning the interest of tools for assessing quality of life in the practice of palliative care. Effectively, these tools can have harmful consequences on the patient and provoke notably a loss of self-esteem.     

Noninvasive methods of assessing inflammation in bronchial asthma

Airway inflammation plays a key role in asthma. Among noninvasive methods as tools to study these inflammatory processes and to monitor airways diseases, the sputum analysis is widely used. As well, the analysis of concentrations of nitric oxide (NO) and the analysis of exhaled breath condensate are alternative methods for assessing the airway inflammation. In addition a treatment strategy directed at normalisation of these noninvasive parameters could led to a better control of the disease.     

New methods for assessing cartilage contact stress after articular fracture

Progress in reducing the incidence and severity of posttraumatic arthritis depends in part on avoiding deleterious stress levels at residual local incongruities. Systematic efforts to elucidate factors adversely influencing cartilage's mechanical environment in turn depend on the availability of suitable modalities to assess intraarticular contact stresses. This has been and remains a challenging biomechanical problem. Technologic approaches used in the past have included mathematical analyses and indwelling physical sensors, each with advantages and limitations. Two emerging, mutually complementary capabilities show promise of dramatically altering the state of the art in this important field. The first of these methodologies, voxel-based contact finite element analysis, provides accurate computational estimates of cartilage stress on a patient-specific basis, and does so while accommodating arbitrarily idiosyncratic patterns of local articular incongruity. The second methodology, instrumentational, involves transient pressure distribution recordings using specially designed piezoresistive array sensors. Operational considerations for both of these new assessment technologies are described, and promising directions for future development are outlined.     

Different anesthesia methods for laparoscopic cholecystectomy

Objectives

The aim of the study was to compare the possibility of performing laparoscopic cholecystectomy using two different anesthesia procedures (spinal anesthesia versus general anesthesia).

Methods

The study included 68 patients with symptoms of cholelithiasis examined in the 309th Hospital of PLA from 2006 to 2009. Patients were randomly selected to undergo laparoscopic cholecystectomy with low tension pneumoperitoneum with CO₂ under general anesthesia (n=33) or spinal anesthesia (n=35). The study used propofol, fentanyl, rocuronium, sevoflurane and tracheal intubation for general anesthesia and hyperbaric 15?mg bupivacaine and 20???g fentanyl were used to achieve a sensorial level of T₃ for spinal anesthesia. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction and cost were compared between both groups.

Results

All surgical procedures were completed with the chosen method with the exception of one case, in which spinal anesthesia was converted to general anesthesia. Shoulder pain was significantly less frequent in the spinal anesthesia group (6%) compared with the general anesthesia group (24%). The level of pain at 2, 4, and 6?h after the procedure under spinal anesthesia was significantly lower than that under general anesthesia. At 12?h both groups had the same evaluation in the visual analogue scale. In the spinal anesthesia group all patients recovered 6?h after surgery, while patients in the general anesthesia group spent more time in recovery. All patients were discharged from hospital after 24?h. In the postoperative evaluation all patients were satisfied with the spinal anesthesia and would recommend this procedure, while only 78.9% of patients were very satisfied in the general anesthesia group. The cost of spinal anesthesia was significantly lower than that of general anesthesia.

Conclusions

Laparoscopic cholecystectomy with low pressure pneumoperitoneum with CO₂ can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery and lower cost than general anesthesia.     

A disease-specific questionnaire for assessing quality of life in patients on hemodialysis.

A disease-specific questionnaire was developed for patients receiving chronic hemodialysis by interviewing patients to determine which aspects of their quality of life were adversely affected by their disease. The final questionnaire contained 26 questions in five dimensions (physical symptoms, fatigue, depression, relationships with others, frustration). The questionnaire demonstrated construct validity when compared with the Sickness Impact Profile, time trade-off technique and an exercise stress test. It was reproducible in stable, placebo-treated patients (correlation coefficient 0.85-0.98 for the 5 dimensions). It was more responsive than other measures in detecting an improvement with erythropoietin therapy in a randomized, placebo-controlled trial. This questionnaire should be useful for the assessment of the effect of various interventions upon the quality of life of hemodialysis patients.     

不同方法治疗肱骨干骨折的疗效分析

目的通过对比自锁髓内钉与钢板内固定治疗肱骨干骨折的临床疗效,探讨两种方法在肱骨干骨折中的应用。方法选择2010年1月～2011年6月在笔者所在医院诊治的肱骨干骨折患者60例,随机分为研究组和对照组各30例。研究组采用自锁髓内钉固定治疗,对照组采用钢板内固定治疗,对比观察两组的临床疗效。结果研究组骨折愈合时间比对照组短,再骨折率和医源性桡神经损伤均低于对照组,差异有统计学意义（P〈0.05）,两组肩关节功能评定的优良率比较,差异无统计学意义（P〉0.05）。结论自锁髓内钉固定肱骨干骨折并发症及愈合时间比钢板内固定有优势,而且并不降低肩关节功能的优良率。     

Advanced methods for evaluation of sperm quality

Summary.  Routine semen analysis includes measurements of sperm concentration, motility, and morphology. In our study, three additional tests were evaluated in relation to fertilization rate in an in vitro fertilization program: the freezing and hypo-osmotic swelling tests that evaluate the functional integrity and stability of the sperm membrane under extreme osmotic conditions, and migration sedimentation test that isolates high-quality motile sperm cells. The study was performed on semen delivered by men of couples treated at the In Vitro Fertilization Unit, and men who served as semen donors (fresh or cryopreserved semen). No correlation was found between the sperm fertilization rate, and the decrease in motility percent following the freezing-thawing process. Thus, the freezing test cannot be used to predict semen fertilization capacity. The hypo-osmotic swelling test was applied on semen given by a similar population of men. While the hypo-osmotic swelling test values carried out with fresh semen was found to have good correlation with fertilization, no correlation was found when frozen thawed semen was used. Post-migration sedimentation test sperm characteristics, and especially the recovery rate of the motile sperm, were significantly better in in vitro fertilization cycles with fertilizations. Both the hypo-osmotic swelling test and migration sedimentation test can assist in evaluating semen quality, judged by the fertilization rate in an in vitro fertilization program.     

STD care in the South African private health sector.

OBJECTIVES: To establish the accessibility and quality of sexually transmitted disease (STD) care provided by private general practitioners (GPs) and workplace health services in South Africa. DESIGN: Structured telephone interviews were conducted with a random national sample of 120 GPs and 244 occupational health nurses (OHNs) between May and July 1997. The interview schedules covered indicators of access (including utilisation) and processes (drug treatment, partner management, counselling and condom promotion) of STD care. RESULTS: An estimated 5 million STD-related visits were made to private general practices in 1997. Reported treatment of STDs was assessed for effectiveness using well-established syndromic case management guidelines. Only 28% of GPs reported effective treatment for urethral discharge. This dropped to 14% for genital ulcer and 4% for pelvic inflammatory disease. Fifty-five per cent of the OHNs interviewed indicated that their workplace clinics provided STD care. Nurses provided this care, with or without the support of doctors, in 87% of clinics. Reported urethral discharge and genital ulcer treatment regimens were assessed as effective in 34% and 14% of responses, respectively. CONCLUSIONS: The private sector is a major provider of STD care and is key to national efforts to achieve better STD control, thereby preventing the spread of HIV. However, the results of the research suggest that the poor quality of STD care may be undermining attempts to control these epidemics in our society. Although a complex task, strategies need to be found to improve the quality of care provided within the private sector.     

Statistical epidemiological screening methods assessing certain biochemical markers

The epidemiological studies have shown that it is difficult to define a "normal" value for the serum concentration of some biochemical markers with predictive significance for cardiovascular diseases (CVDs) as follows: total cholesterol (TC), total lipids (TL), triglycerides (TG), glycemia (G), and urea (U). Our study establishes the mean and limit values of the normality for the above mentioned markers, in an adult population from the Ia?i City, using the epidemiological screening method. The employed methodology includes the records of the results of 2788 biochemical determinations during a period of 5 years, in order to assess the state of health of the population, as well the data working up and interpretation by means of the EpiInfo computer program. By testing a series of "normal" limits, the values found with apparent healthy persons (n = 2691) and persons previously diagnosed with diabetes mellitus or CVDs (n = 97) were analyzed in a differentiated way. In the sample of apparent healthy individuals, with the age between 20 and up to 60, the mean values were: 210 mg% for TC; 6.74 g@1000--TL; 125.74 mg%--TG; 0.91 g%--G and 0.34 g%--U. Satisfactory correlations (correlation coefficient-"r") of age with the values of TC (r = 0.38); TG (r = 0.26) and G (r = 0.23) comparatively with U (r = 0.15) or TL (r = 0.14) were noticed. The comparison of the mean values between males and females did not reveal a significant difference (p > 0.05) for any of the assessed constants. The clinical and community studies of the CVD risk assessed in the Ia?i City area will have to be referred to the registered and analyzed values of this epidemiological screening in the interpretation of some biochemical markers data.     

不同方法治疗老年性股骨粗隆间骨折的临床分析

目的 探讨不同方法治疗老年性股骨粗隆问骨折安全有效的内固定方法、临床效果及其临床适应证.方法 对58例老年性股骨粗隆间骨折分别采用股骨近端解剖型锁定钢板固定14例,动力髋螺钉(DHS)固定24例,股骨近端解剖型钢板固定20例,比较3组术中失血量、手术时间、骨质劈裂情况及骨折愈合时间,随访Sanders评分结果和并发症发生情况,并进行临床和统计学分析.结果 术后全部得到随访,随访8个月～3年,平均1.5年,3组术式的优良率分别为92.9%、92%和90%.结论 不同方法治疗老年性股骨粗隆间骨折的临床效果都很满意,但各有其适应证,手术方式应根据骨折类型、年龄、体质因素及患者骨质疏松程度,结合各内固定特点选择最佳治疗方案,对伴有严重骨质疏松的高龄患者适合选用应用解剖型锁定钩板(ALHP)固定,对Evans Ⅰ、Ⅱ型和部分EvansⅢ型适合选用DHS固定,对Ⅳ、Ⅴ型适合选用股骨近端解剖型钢板固定.     

不同麻醉方法用于老年患者纤支镜检查的临床研究

目的 探讨不同麻醉方法用于老年患者纤支镜检查的效果与安全性.方法 将40例需行纤支镜检查的老年患者随机分成无痛纤支镜(S)组和常规纤支镜(C)组两组.每组20例患者.S组采用异丙酚、舒芬太尼麻醉,C组采用2%利多卡因雾化喷喉,分别观察两组检查前、检查中及检查后的脉搏血氧饱和度(pulse oxygen saturation,SpO2)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)变化及副作用.结果 S组麻醉后患者能在无知觉和无痛苦中接受检查,出现呛咳、憋气、及体动等副作用少,血压(blood pressure,BP)、HR变化与C组相比相对稳定,均低于C组(P<0.05).结论 采用异丙酚复合小剂量舒芬太尼麻醉用于老年患者纤支镜检查可充分减轻患者的痛苦,患者无挣扎,手术操作顺利,循环稳定,并发症少,是一种安全而有效的麻醉方法.