Effectiveness of extracorporeal shock wave therapy and kinesio taping in calcific tendinopathy of the shoulder: a randomized controlled trial北大核心CSCD

BACKGROUND AND OBJECTIVE Extracorporeal Shock Wave Therapy (ESWT) is effective in the treatment of calcific tendinopathy of the rotator cuff, eliciting an analgesic/anti-inflammatory action and promoting tissue regeneration. Kinesio taping (KT), another recently-introduced rehabilitative tool, exerts an analgesic and biomechanical action on joints and muscles. ESWT and KT may have a synergic effect when used in combination, but the effectiveness of the association has not been established. METHODS In the experimental group, patients underwent three sessions (once a week for 3 weeks) of ESWT with KT applied at the end of each session. Controls underwent three sessions of ESWT only. All patients were assessed before treatment (T0) and at 1 (T1), 4 (T2) and 12 weeks (T3) after the end of treatment with the following outcome measures: a visual analogue scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Subjective Shoulder Rating Questionnaire (SSRQ), and Oxford Shoulder Score (OSS). RESULTS Both groups showed significant improvement in all outcome measures, but the time course differed between the two groups. At T1 vs. T0, the improvement was significantly better in ESWT+KT than ESWT on VAS (P=0.007), DASH (P<0.0001) and SSRQ (P=0.0001). Successive improvements at T2 vs. T1 and T3 vs. T2 did not differ significantly between the groups. At the end of follow-up, ESWT+KT still showed significantly greater improvement than ESWT on VAS (P=0.02) and SSRQ (P=0.038). CONCLUSION KT associated with ESWT seems to improve the recovery in rotator cuff calcific tendinopathy with a faster therapeutic response compared to ESWT only.     

Successful application of helmet non-invasive ventilation in a parturient with acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is an important cause of morbidity and mortality during pregnancy. The case of a twin pregnant woman in her 28th week who developed infection-related ARDS, undergoing a cesarean section for premature membrane rupture is described. It was performed epidural anaesthesia and helmet non-invasive ventilation (NIV) during the postoperative period. The combination of epidural anesthesia with NIV helped to restore physiological gas-exchange and to prevent common complications associated with a more invasive approach.     

In vitro inhibition of anti-DNA producing cells from systemic lupus erythematosus patients by autologous anti-F(ab')2 antibodies

We have previously documented an inverse relationship between serum levels of anti-F(ab')2 antibodies and disease activity in systemic lupus erythematosus (SLE). The present study focused on the specific in vitro inhibition of anti-DNA producing cells from SLE patients by autologous anti-F(ab')2 antibodies. Peripheral blood lymphocytes (PBL) from eleven inactive SLE patients with no apparent disease activity were cultured in vitro to evaluate anti-DNA antibody secretion. Low levels of synthesis of anti-DNA antibody were detected in 3 of 11 SLE patients using unstimulated PBL; on the contrary, pokeweed mitogen stimulation of cultured cells increased production of anti-DNA in all SLE subjects. Parallel cultures were also performed in the presence of heterologous and autologous anti-F(ab')2 antibodies and results on production of anti-DNA evaluated. Lymphocytes from SLE patients in remission showed inhibition of synthesis of anti-DNA antibodies when autologous anti-F(ab')2 antibodies were added to the cultures, whereas production of anti-tetanus toxoid IgG by the same cells was not significantly altered under the same conditions. These data suggest that a functional anti-idiotypic role may be assigned to anti-F(ab')2 antibodies during clinical remission of SLE.     

The differential reactivity of cells of the melanocytic lineage with four monoclonal antibodies against IFN-gamma inducible molecules.

The reactivity of four monoclonal antibodies (MAbs) directed against IFN-gamma inducible antigens with melanocytic cells was investigated in the course of local and systemic tumor progression of human malignant melanoma. Frozen sections of histologically defined melanocytic tissues at different stages of progression were stained with these MAbs using an indirect immunoperoxidase technique. The reactivity of MAbs Me15/B3 and Me15/F9, directed against two different epitopes of a 90-kDa molecule, was found to correlate with melanoma progression. Indeed, a significantly lower percentage of small than of advanced primary melanomas or metastases stained positively. A differential staining of nevocytic and dysplastic nevi was further observed for these two MAbs, which were also non-reactive with normal skin melanocytes. The reactivity of MAb Me14/D12, which identifies the intercellular adhesion molecule ICAM-1 and MAb Mel14/F12, directed against a 40-kDa molecule, was found to be independent of the Breslow thickness of primary melanomas. Both the latter MAbs stained a high proportion of nevocytic and dysplastic nevi. The co-expression of the surface molecules defined by MAbs Me14/D12, Me15/B3 and Me15/F9 in the course of melanoma progression was also analyzed. The frequency of this co-expression increased according to the Breslow thickness of primary melanomas. In addition, up to 100% of metastases, as opposed to 20% of dysplastic nevi, were found to be simultaneously stained by these three MAbs. It is therefore conceivable that high-risk melanocytic lesions might be identified by the use of a combination of MAbs directed against IFN-gamma regulated antigens.     

Diagnostic imaging and patient database managing systems: The integration of digital information in the experience of an intensive care center

AIM: To present our experience with integrating digital information on Intensive Care Unit patients (clinical data, laboratory findings, imaging, etc) to create electronic patient records. MATERIAL AND METHODS: Using the hospital Intranet, a connection was established between the Local area Network (LAN) of the Intensive Care Unit (ICU) and the Digital Imaging and Communications in Medicine (DICOM(R)) network of the Radiology Department allowing to receive, process and archive digital images locally at the ICU. Using the software RADclient-RADimage, the information received was managed by an electronic patient record system (DIGISTAT by UMS-Unterberger Medical Software, Florence). All the above software runs on Microsoft WindowsNT 4.0 platforms. RESULTS: Images of various kinds and formats (CT, MRI, etc.) pertaining to the ICU patients were semi-automatically handled and filed on a local server acting as a central databank. The images were then included in the electronic patient record and made available to the end user who could view them using either web technologies (hypertexts were automatically generated that could be viewed through the widely available World Wide Web browsers) or specific viewing utilities supplied with DIGISTAT . DISCUSSION AND CONCLUSIONS: For the intensivist, the handling and filing of data on hospitalised or discharged patients for treatment or research purposes involves having to process large amounts of information. Furthermore, in the event of patients being re-admitted to the unit, it is crucial to have ready access to all the information regarding previous hospital stays, including diagnostic images, to avoid the need for time-consuming searches through the hospital s paper-based archives. The possibility to access clinical information and diagnostic images using a single computer programme proved to be useful both for evaluating the patient s conditions immediately after the imaging procedure and for monitoring the patient s progress over time by comparing the different diagnostic images and imaging procedures. This pilot experience could be seen to provide the basic know-how for applying the method in the future Emergency Department of the A. Gemelli Hospital in Rome.