Football players with long standing hip and groin pain display deficits in functional task performance

Objectivesi) Compare functional task performance between football players with and without hip/groin pain. ii) Explore the relationship, and sex-specific effects, between functional tasks and the Copenhagen Hip and Groin Outcome Score (HAGOS) in players with hip/groin pain.DesignCross-sectional.SettingLaboratory.Participants183 (38 women) football players with a self-reported history of >6months of non-time-loss hip/groin pain and a positive flexion-adduction-internal rotation test, and 61 (14 women) asymptomatic players.Main outcomeParticipants completed the hop-for-distance (HFD), one leg rise (OLR), side bridge (SB) endurance, and HAGOS. Study aims were assessed using linear models, controlling for body mass index and age, incorporating sex-specific interaction terms.ResultsPlayers with hip/groin pain could not hop as far (adjusted mean difference: -9 cm, 95% CI: -15 cm to -2cm, P=0.012) and completed fewer OLR repetitions (adjusted mean difference −7, 95% confidence interval −11 to −3 repetitions, P=0.001) compared to asymptomatic players. Symptomatic women, but not symptomatic men, with worse HAGOS scores had lower SB endurance. Independent of sex, football players with worse HAGOS scores could not hop as far and completed fewer OLR repetitions.ConclusionFootball players with hip/groin pain demonstrated deficits in HFD and OLR with the performance of these tasks associated with their HAGOS results. The study identifies potential impairments that can be targeted as a component of rehabilitation programs for football players with hip/groin pain.     

Chest pain on questionnaire and prediction of major ischaemic heart disease events in men

Objective To examine the prediction of major ischaemic heartdisease events by questionnaire-assessed chest pain and othersymptoms. Design Population-based prospective study. Subjects 7735 randomly selected men, aged 40–59 yearsat entry. Methods Symptoms and history of diagnosed ischaemic heart diseasewere ascertained by administered questionnaire at baseline.Follow-up was for an average of 14·7 years, for firstmajor ischaemic heart disease event. Results During follow-up, 969 men had a major ischaemic heartdisease event. ‘Definite’ angina (chest pain fulfillingall WHO criteria) and ‘possible’ angina (exertionalchest pain without all other WHO criteria) were associated withsimilar ischaemic heart disease outcome, and a single combinedangina category was used. In the whole cohort, the relativerisks (95% CI) of a major ischaemic heart disease event were2·03 (1·61, 2·57) for angina only, 2·13(1·72, 2·63) for possible myocardial infarctiononly and 4·50 (3·57, 5·66) for angina pluspossible myocardial infarction, compared to no chest pain. Therelative risk for recall of an ischaemic heart disease diagnosiswas 3·98 (3·36, 4·71). Only 33% of menwith angina or possible myocardial infarction symptoms recalleda previous ischaemic heart disease diagnosis. In men withoutrecall of an ischaemic heart disease diagnosis (in whom 82%of events during follow-up occurred), chest pain symptoms remainedpredictive of major ischaemic heart disease events with relativerisks (95% CI) of 1·69 (1·27, 2·24) forangina only, 1·49 (1·12, 1·97) for possiblemyocardial infarction only and 2·55 (1·44, 4·53)for angina plus possible myocardial infarction. ‘Otherchest pain’ increased risk of a major ischaemic heartdisease event by 1·19 (1·01, 1·40) comparedto no chest pain. Symptoms of breathlessness or calf pain onwalking increased ischaemic heart disease risk in men with ‘otherchest pain’ and in men without chest pain, but had nofurther effect on ischaemic heart disease risk in men with symptomsof angina or possible myocardial infarction. Conclusions In defining angina by chest pain questionnaire,the exertional component is the crucial criterion. When usingquestionnaire-assessed symptoms to determine ischaemic heartdisease risk, information on previous ischaemic heart diseasediagnoses should be taken into account. The majority of menwith angina or possible myocardial infarction symptoms do nothave a diagnosis of ischaemic heart disease, but they remainat significantly increased risk of a major ischaemic heart diseaseevent. The value of breathlessness and calf pain on walkingin stratifying ischaemic heart disease risk is restricted tomen with ‘other chest pain’ or no chest pain.     

Correlation of gastroesophageal reflux disease symptoms characteristics with long-segment Barrett''s esophagus

Thus far, there has been a paucity of studies that have assessed the value of the different gastroesophageal reflux disease (GERD) symptom characteristics in identifying patients with long-segment Barrett's esophagus versus those with short-segment Barrett's esophagus. To determine if any of the symptom characteristics of GERD correlates with long-segment Barrett's esophagus versus short-segment Barrett's esophagus. Patients seen in our Barrett's clinic were prospectively approached and recruited into the study. All patients underwent an endoscopy, validated GERD symptoms questionnaire and a personal interview. Of the 88 Barrett's esophagus patients enrolled into the study, 47 had short-segment Barrett's esophagus and 41 long-segment Barrett's esophagus. Patients with short-segment Barrett's esophagus reported significantly more daily heartburn symptoms (84.1%) than patients with long-segment Barrett's esophagus (63.2%, P = 0.02). There was a significant difference in reports of severe to very severe dysphagia in patients with long-segment Barrett's esophagus versus those with short-segment Barrett's esophagus (76.9%vs. 38.1%, P = 0.02). Longer duration in years of chest pain was the only symptom characteristic of gastroesophageal reflux disease associated with longer lengths of Barrett's mucosa. Reports of severe or very severe dysphagia were more common in long-segment Barrett's esophagus patients. Only longer duration of chest pain was correlated with longer lengths of Barrett's esophagus.     

抗抑郁药治疗胆囊切除术后慢性疼痛的临床研究

目的　评价路优泰治疗胆囊切除患者慢性疼痛的疗效。方法　将 64例慢性疼痛的胆囊切除患者随机分为抗抑郁剂路优泰组 3 2例和安慰剂组 3 2例 ,治疗 6周 ,应用慢性疼痛评价标准及汉密尔顿抑郁量表 (HAMD ;17项 )于治疗前及治疗第 1、2、4、6周末进行疗效评定。结果　路优泰组的 3 2例中有效率分别为 87.5 %和 84.4% ,而安慰剂组中的有效率分别为 2 8.1%和 3 4.4% ,两组比较差异有显著性 (P <0 .0 1)。结论　路优泰是治疗慢性疼痛的有效药物之一     

脊源性腹痛——8例报告

本文总结了我院1985年～1990年诊治的8例脊源性腹痛及其误诊分析。脊源性腹痛的特点是:①腹痛部位不确切,夜间疼痛尤甚,与体位改变有关。②常有神经根激惹征。③腰背肌紧张比腹肌紧张明显。④伴有其它神经症状和体征。本文所见引起脊源性腹痛的疾病有多发性硬化、脊髓炎、脊髓蛛网膜下腔出血、脊髓蛛网膜炎、多发性神经炎及脊椎骨折。本病易误诊为阑尾炎、泌尿系结石、胆囊炎、胰腺炎、消化性溃疡、神经官能症等。     

Exercise Stress Testing in Patients with Chest Pain and Normal Coronary Arteriography: With Review of the Literature

Eighty of 654 patients studied because of chest pain were found to have normal coronary arteriography. Fifty of these completed submaximal treadmill exercise studies. The purpose of this study was to determine whether treadmill electrocardiography could obviate the need for coronary arteriography in the evalution of patients with undiagnosed chest pain. Of patients studied, 22% had typical angina pectoris, while 78% had atypical chest pain. The resting electrocardiogram was normal in 58% of patients, while 42% showed repolarization abnormalities. Submaximal treadmill testing was normal in 64%, incomplete in 12%, and demonstrated classic ischemic S-T depression in 24%. Our findings of 24% positive studies in patients with normal vessels and 12% incomplete tests suggest that stress electrocardiography may be of limited value in predicting the morphologic state of the coronary arteries in patients with undiagnosed chest pain.     

钙调磷酸酶抑制剂致疼痛综合征的研究进展

钙调磷酸酶抑制剂(CNI)是实体器官移植和造血干细胞移植术后的主要免疫抑制药物。尽管CNI极大的改善了移植患者预后,但该类药物引起的不良反应也经常发生。CNI所致的疼痛综合征(CIPS)是一种罕见的、严重的不良反应,其发生与钙调磷酸酶生理功能的中断有关。患者常表现为双下肢疼痛,严重影响患者运动能力和生活质量,因此,主要对CIPS的流行病学、临床表现、实验室检查、影像学表现、诊断、发病机制及治疗选择进行综述,以期为临床提供参考。     

The effect of GB21 acupressure on pain intensity in the first stage of labor in primiparous women: A randomized controlled trial

IntroductionLabor pain is one of the most intensive pains experienced by women; it results in physical, emotional, and physiological changes in women’s body. The present study aimed to examine the effect of GB21 acupressure on labor pain.DesignIn this randomized clinical trial, 174 primiparous women in their first stage of labor were selected and assigned to three groups: GB21 acupressure group (n = 58), sham group (n = 58), and control group (n = 58).InterventionsThe acupressure and sham groups received routine labor care and acupressure in three different phases of cervical dilations to 3−5 cm, 6−7 cm, and 8−10 cm. The control group received routine care in labor.Main outcome measuresPain severity was measured using a pain scale ruler in three cervical dilations before and after intervention. The collected data were analyzed using the ANOVA, Kruskal–Wallis, paired-t test and Mann–Whitney tests.ResultsPain reduction was significantly higher in GB21 groups compared with sham and control groups (P = 0.001). No statistically significant difference was observed between the three groups in terms of delivery outcomes.ConclusionsIn this study, GB21 acupressure was effective in pain relief during labor, hence recommended as a practical, effective, inexpensive, and accessible method for labor pain management.     

Sagittal spine shape literacy in the general adult population,assessed by a novel,simple graphical tool

[Purpose] The sagittal shape of the spine is associated with back-pain, balance and quality of life. We developed, evaluated and report the responses of a graphical tool to assess sagittal spine shape knowledge (literacy). [Participants and Methods] Two hundred and fifty adults were randomly assigned, in a cross-sectional crossover study, to free-hand draw and select the “ideal” sagittal spine shape. We evaluated the inter and intra-rater reliability and agreement between tests and the sagittal and lordotic spine literacy between the drawing and selection test versions. [Results] Drawing test inter- and intra-rater agreement was 79% and 80% respectively. Drawing vs. selection agreement was 43%. More participants drew than selected the correct spine (30% vs. 21%) (p<0.001) and lumbar lordosis shape (56% vs. 42%) (p<0.001). Test order did not affect spine shape literacy scores. A significantly poorer literacy trend was observed with spine pain presence (p=0.02). [Conclusion] We developed a reliable method to evaluate spine shape literacy and established that only 21% and 42% of our sample demonstrated correct sagittal spine and lordotic spine shape literacy, respectively. The low literacy scores suggests that consideration of including spine shape literacy in health literacy and self-management programs may be warranted, especially in ageing populations.     

Is Pain Assessment of Community-Dwelling Persons With Advanced Dementia by Family and Paid Care Workers Feasible?

ContextThe experience of pain is aggravated among older persons with advanced dementia (OPAD). It is often undetected and therefore untreated because of their limited capacity to identify and report their symptoms. Therefore, it is crucial to improve the pain identification skills of those who know and live with them.ObjectivesTo compare the identification of pain among OPAD between family members and paid care workers and to compare the detection of pain through the use of two common assessment tools.MethodsThis study is a cross-sectional comparison conducted between 82 dyads of informants: the family member of OPAD and the paid care worker, a total of 164 individuals.MeasurementsThe study used two previously validated pain assessment tools for persons suffering from dementia: the Pain Assessment in Noncommunicative Elderly persons tool (PAINE) and Pain Assessment in Advanced Dementia tool (PAINAD), and a general impression question.ResultsBoth family members and paid care workers were able to successfully use both tools. The correlation between family members' ratings and paid care workers' ratings was statistically significant for all the assessments. The correlations between raters were higher when family members lived with the OPAD. The correlations between PAINE and PAINAD scores were moderate and significant, both among family members and paid care workers.ConclusionThis study shows that it is feasible to improve the assessment and identification of pain among OPAD, through the use of validated tools by family members and paid care workers, suggesting the potential to improve quality of care and quality of life of OPAD.