阴道超声在早期宫颈癌及宫颈癌前病变诊断中的应用价值

目的 探讨阴道超声在早期宫颈癌及癌前病变诊断中的临床价值.方法 对临床疑诊的早期宫颈癌和宫颈癌前病变患者分别经阴道超声检查及液基细胞学病理检查和组织活检,再对超声声像图作回顾性分析.结果 对早期宫颈癌、宫颈癌前病变,经阴道超声灵敏度分别为90.9%和83.3%,特异度70.6%和60.O%,漏诊率9.1%和16.7%.结论 阴道超声在早期宫颈癌诊断中起重要辅助作用.     

Diagnosis of cervical and thoracic musculoskeletal spinal pain receptive to mechanical movement strategies: a multicenter observational study

Background: The McKenzie’s Mechanical Diagnosis and Therapy (MDT), which uses a combination of repeated movements and sustained positions to affect signs and symptoms, is commonly used for the conservative evaluation and management of cervical and thoracic spinal conditions.

Objective: Report a consecutive cohort of neck and thoracic pain patients managed using MDT and to record their classifications and physiotherapy management strategies.

Methods: Therapists provided demographic data on themselves and the patients, clinical data on the patients, and Neck Disability Index scores at baseline and final visit.

Results: Sixteen therapists collected data on 138 patients at baseline, of who 120 (87%) were followed up three to five visits later; these were patients with 131 cervical and seven thoracic problems. The therapists and patients are described. Regarding MDT classifications 83% were recorded as cervical and 100% as thoracic Derangement; there was a Directional Preference for extension in 80% of cervical spine patients, and 100% of thoracic spine patients. In addition, 13% of cervical spine patients were classified as OTHER, for which specific classifications were given. Classifications remained stable between initial and discharge sessions in 94% of patients. Neck Disability Index scores reduced from a mean of 24–12 at discharge (P < 0.001).

Conclusions: Routinely collected data can describe both therapists and patients involved, demonstrate the MDT classification clinical utility in terms of prevalence and stability between visits, provide information on the clinical course of this patients’ population, which could help establish treatment efficacy. Randomized controlled trials are needed to test for efficacy.     

Cervical zygapophyseal joints: geometrical parameters and relationship to cervical kinematics

The relationship was examined between the height and slope of the cervical zygapophyseal joints and the patterns of motion of the cervical vertebrae. The height and orientation of the C₃---C₇ superior articular processes were measured in lateral radiographs of 40 normal subjects. The C₄-C₆ facets were oriented at approximately 40° to the vertical, while the C₃ and C₇ facets were more steeply oriented. The heights of the superior articular processes were found to increase at progressively lower vertebral levels. Contrary to published views, the slope of the superior articular facets has no bearing on the pattern of motion of the cervical vertebrae. No relationship was found between slope of the facets and the location of the instantaneous axes of rotation of the cervical vertebrae. In contrast the height of the articular processes was perfectly related to the location of the axes of rotation. Articular height, but not slope, is a major determinant of the patterns of motions of the cervical vertebrae.

This study provides data necessary to confirm or deny the putative roles of the cervical zygapophyseal joints in determining motion of the cervical spine in the sagittal plane.     

Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Preterm Neonates with Birth weight Less than 2000g

Objective:

This study aimed to determine the impact of maternal cervical incompetence (with or without McDonald cerclage) on mortality and morbidity of preterm infant with birth weight <2000g.

Methods:

581 neonates were eligible for this study, 79 with cervical incompetence and 502 without it (control). Incidences of neonatal respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), periventricular leukomalacia (PVL), severe asphyxia, small for gestational age (SGA), early-onset sepsis (EOS), and mortality were compared between the two groups.

Findings:

Mean gestational age was earlier in cervical incompetence group than in control (30.2±2.1 vs 30.7±1.9, P<0.05). Except lower frequency of SGA, there were no significant differences in the incidences of RDS, BPD, ROP, PVL, IVH, NEC, EOS, severe asphyxia and mortality between the two groups. Infants with no cerclage had a higher prevalence of RDS (21/66 vs 9/13, P<0.05) compared to cerclage group due to lower mean gestational age (30.68±2.1 vs 28.6±1.4, P<0.01) and birth weight (1519.5±274.6 vs 1205.8±204.4, P<0.001), and clinical neonatal outcomes of the elective cerclage were similar to emergency cerclage in cervical incompetence groups.

Conclusion:

Maternal cervical incompetence was not associated with postnatal adverse neonatal outcomes. Lower mean gestational age was a major risk associated with higher prevalence of RDS in preterm neonates with no McDonald cerclage, and emergency cerclage did not predict poor clinical neonatal outcomes.     

宫颈癌根治性放疗出现重度慢性放射性直肠炎危险因素调查与护理干预

目的探讨宫颈癌根治性放疗出现重度慢性放射性直肠炎的危险因素,并提出相应的护理干预措施。方法选取我院2017年1月至2019年3月收治的162例宫颈癌根治性放疗患者作为研究对象,其中治疗后出现重度慢性放射性直肠炎(SLRT)患者29例,未出现SLRT患者133例。采用我院设计的危险因素问卷调查表,对引发宫颈癌根治性放疗SLRT的相关因素和危险因素进行单因素和多因素logistic回归分析。结果临床分期、肿瘤大小及平均受照剂量是宫颈癌根治性放疗出现SLRT的危险因素(P<0.05),新辅助化疗是出现SLRT的保护因素(P<0.05),且放疗方式也是出现SLRT的独立因素(P<0.05)。结论宫颈癌根治性放疗出现SLRT与临床分期、肿瘤大小及平均受照剂量等密切相关,医护人员需采取适宜护理干预措施,合理选择放疗方式,尽量减少放射损伤,并辅以有效的化疗手段,提高患者生存率以及生活质量。     

针刀治疗神经根型颈椎病研究概述

神经根型颈椎病在颈部疾患中发病率高,常表现为颈、肩、上肢运动感觉功能障碍,致使中老年人饱受疾患折磨,且该病随着生活、工作方式改变有年轻化发病趋势。西医非手术治疗该病常采取消炎镇痛、缓解神经根水肿等办法,不能有效解除压迫及高应力状态,症状易反复,难以达到患者期望值。而手术治疗风险较大、术后恢复慢且经济负担重,患者接受程度普遍较低。自朱汉章教授1976年创造针刀伊始神经根型颈椎病便是针刀治疗的优势病种。针刀治疗神经根型颈椎病作用机制复杂,在病理生理、临床试验等层面已得到部分阐释。临床操作各有千秋,常表现为进针点定位选择之别。除单纯针刀疗法外,针刀搭配其他治疗方式而衍生出的一系列综合疗法如手法、药物、神经阻滞、针灸等为治疗该病提供了更多选项。经40余年的针刀医学实践阐明,针刀治疗神经根型颈椎病具有独特优势。该文检索中国知网、万方网等数据库有关文献,总结了针刀治疗该病的最新研究进展。现从机理研究、操作方法、方案选择三个方面加以概述,便于为临床提供参考,促进针刀医学的基层推广。     

Acoustic Radiation Force Impulse Imaging for Reactive and Malignant/Metastatic Cervical Lymph Nodes

The aim of this study was to compare lymph node stiffness using acoustic radiation force impulse (ARFI) imaging in patients with cervical lymph node swelling. Forty-two cervical lymph nodes (reactive, n = 22; metastatic, n = 20) from 19 patients (13 men, 6 women; mean age, 63.68 ± 14.9 y; range, 23–85 y) were examined between September 2011 and March 2012. The shear wave velocity (SWV, m/s) of each lymph node was evaluated by ARFI imaging. SWV of reactive lymph nodes was 1.52 ± 0.48 m/s, and that of metastatic/malignant lymph nodes was 2.46 ± 0.75 m/s. A SWV > 1.9 m/s was very useful metastatic lymph node classification, with 95.0% specificity, 81.8% sensitivity and 88.0% overall accuracy. The area under the receiver operating characteristic curve was 0.923 (95% confidence interval, 0.842–1.000). ARFI imaging can be useful in the differentiation of reactive and malignant/metastatic cervical lymph nodes.     

Clinical and radiological assessment of the cervical extensor muscles in people with neck pain. A narrative review

Background: Clinical and radiological investigations of the function and structure of the cervical extensor muscles are increasingly being used in physiotherapy practice.

Objectives: The aim of this review is to investigate the reliability and clinical utility of these tests, to report on normative data and to evaluate the association between the results of these investigations and neck pain.

Major Findings: A range of clinical and radiological tests have been described to assess the function and structure of the cervical extensor muscles. Clinical tests that evaluate cervical muscle strength and endurance can be performed reliably and there is some evidence that performance of these tests is impaired in people with neck pain. There is however, a need for better understanding of what constitutes normal strength and endurance in these muscles and whether abnormal function is a cause or effect of neck pain. Clinical tests of extensor motor control have not been extensively studied. Of the radiological investigations commonly used for evaluation of cervical extensor muscle structure, ultrasound cross-sectional measures have demonstrated acceptable reliability and correlate reasonably well with higher resolution MRI images.

Conclusions: The clinical and radiological tests commonly used to assess cervical extensor muscles generally have acceptable reliability and are mostly well suited within the physiotherapy clinic. Both clinical and radiological tests need further investigation through case-controlled longitudinal studies that explore the relationship between these tests and neck pain.     

叙事医学改善宫颈癌患者心理痛苦及睡眠质量的效果评价

目的:探讨叙事医学改善宫颈癌患者心理痛苦及睡眠质量的效果。方法:选取2019年9月至2020年5月厦门大学附属妇女儿童医院收治的宫颈癌患者60例作为研究对象,按照随机数字表法分为观察组和对照组,每组30例。对照组给予常规心理护理干预,观察组在对照组的基础上,结合叙事医学进行心理护理干预,包括阅读故事、书写心声、诉说与共情倾听等措施,采用自制心理痛苦感受评分量表比较2组患者心理痛苦感受的改善情况,采用匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)比较2组患者干预前后睡眠质量的改善情况,采用远期生命质量评估(Karnofsky Performance Status,KPS)量表比较2组患者干预前后生命质量改善情况。结果:干预后,观察组患者的心理痛苦评分、PSQI评分均显著低于对照组,KPS评分显著高于对照组,观察组心理干预效果优于对照组,2组比较差异均有统计学意义(P<0.05)。结论:叙事医学能有效降低宫颈癌患者的心理痛苦感受,改善患者睡眠质量,提高患者生命质量,是行之有效的心理护理措施,值得临床借鉴。     

Measurement of cervical flexor endurance following whiplash

Aim.?To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations.

Methods.?Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue.

Results.?Inter-rater reliability in whiplash patients was in a range considered ‘almost perfect’ (Intraclass Correlation?=?0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n?=?71) from age and gender matched normals with high effect size (ES?=?1.5).

Conclusions.?These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.