Worse Preoperative Pain and Higher Activity Levels Predict Patient Choice of Formal Physical Therapy After Primary Anterior Total Hip Arthroplasty

BackgroundThe purpose of this randomized controlled trial is (1) to compare the efficacy of supervised formal physical therapy (PT) and self-directed home exercises and (2) to identify independent predictors of transitioning from self-directed home exercises to supervised formal PT following total hip arthroplasty (THA) via an anterior approach.MethodsAfter Institutional Review Board approval, 147 patients undergoing primary unilateral THA through anterior approach were enrolled and randomized to receive either clinic or home-based PT. Surveys with Hip Disability Osteoarthritis Outcome Scores (HOOS) and Short Form-12 Health Survey scores for both groups were obtained before surgery and at 6, 14, and 24 weeks after surgery. Patients had the option to transition into the other study group at their 6-week follow-up visit.ResultsOf the 147 patients enrolled, final analysis included scores for 136 patients. Forty-two (63.6%) of the 66 patients randomized to the supervised formal PT group crossed over to self-directed home exercise group and 12 (17.1%) of the 70 patients randomized to the self-directed home exercise group crossed over to supervised formal PT group. There were no significant (P > .05) differences between groups at all time points for the overall HOOS and Short Form-12 Health Survey. Subjects with worse preoperative pain scores (P = .005) and higher HOOS preoperative activity of daily living scores (P = .015) were more likely to transition from the home exercise group to formal PT group.ConclusionThere were no significant outcome score differences between subjects undergoing supervised formal PT and self-directed home exercises. However, patients reporting worse preoperative pain and higher preoperative activity levels may prefer supervised formal PT compared to self-directed home exercises after undergoing primary anterior THA.     

Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center

(Headache 2010;50:1576‐1586) Background.— The impact of migraine on patients’ daily life has been evaluated in several studies. The relationship between disability and health‐related quality of life (HRQoL) in patients with migraine, however, has not been systematically evaluated. Objective.— To assess the impact of migraine on patients’ HRQoL and disability patterns and to describe the relationship between disability and HRQoL in patients with migraine attending a specialty Italian headache center according to the biopsychosocial model of disability endorsed by the International Classification of Functioning, Disability and Health. Methods.— In this observational study, adult patients with migraine were consecutively recruited. Disability was measured with the MIDAS (Migraine Disability Assessment) and the WHO‐DAS II (World Health Organization Disability Assessment Schedule), HRQoL with the SF‐36 (Medical Outcome Survey 36‐item Short‐Form Health Survey). Spearman's rank correlation between MIDAS score, SF‐36 and WHO‐DAS II scales was performed to evaluate the relationships between quality of life and disability. The impact of migraine on disability and HRQoL was assessed by comparing WHO‐DAS II and SF‐36 scores against Italian normative values, and by evaluating the different disability and HRQoL profiles in patients with different severity of migraine, defined according to migraine frequency and pain intensity. Results.— A total of 102 patients with migraine (87 females) were enrolled. Mild to moderate correlations were reported between WHO‐DAS II and SF‐36's PCS (r = ?0.67, P < .01) and MCS (r = ?0.36, P < .05) scales; MIDAS score correlations to SF‐36's PCS (r = ?0.44, P < .01) and MCS (not significant) were lower than WHO‐DAS II summary score. The correlation between MIDAS score and the WHO‐DAS II summary score was mild (r = ?0.36, P < .05). The majority of HRQoL and disability scales (with the exception of SF‐36's Physical Functioning, and WHO‐DAS II Getting along with people scales) scored significantly lower than normative values. A trend towards worsening of both HRQoL and disability, consistent with increasing migraine severity, was reported (Mann‐Whitney's U = 119.5 for MIDAS; U = 113.0 for WHO‐DAS II summary score, both with P < .01; U = 152.9 for PCS; U = 171.0 for MCS, both with P < .05) Conclusions.— In migraineurs attending an Italian specialty headache clinic, disability scores were worse and HRQoL scores lower than those of the general population, and worsened consistently with increased migraine severity. Measures of HRQoL and disability evaluate different psychosocial aspects of migraine and researchers should continue to employ them in public health and clinical research on migraine. They provide information on a poorly recognized part of migraine's burden, where economic impact is minimal but there are important effects on patients’ daily lives in terms of interpersonal relationships, perceived quality of life and emotional status.     

Sternal wall pressure comparable to leaning during CPR impacts intrathoracic pressure and haemodynamics in anaesthetized children during cardiac catheterization

Aim

Force due to leaning during cardiopulmonary resuscitation (CPR) negatively affects haemodynamics and intrathoracic airway pressures (ITP) in animal models and adults, but has not been studied in children. We sought to characterize the effects of sternal force (SF) comparable to leaning force on haemodynamics and ITP in anaesthetized children.

Methods

Children (6 months to 8 yrs) presenting for routine haemodynamic cardiac catheterization with anaesthesia and mechanical ventilation >6 months after cardiac transplant were studied. Haemodynamics and ITP were measured before and during incremental increases in SF of 10% and 20% body weight.

Results

20 subjects (5.4 ± 1.7 yrs of age and 18.3 ± 3.3 kg) were studied. Mean right atrial pressure (6.5 ± 2.6 at baseline vs. 7.7 ± 2.6 at 10% SF vs. 8.6 ± 2.7 mmHg at 20% SF), mean pulmonary capillary wedge pressure (10.2 ± 2.9 at baseline vs. 11 ± 3.3 at 10% SF vs. 11.8 ± 3.4 mmHg at 20% SF) and ITP (16.3 ± 3.2 at baseline vs. 17.9 ± 3.9 at 10% SF vs. 19.5 ± 4 cm H₂O) all increased significantly with incremental SF (p < 0.001 for all). Aortic systolic pressure (85 ± 10 mmHg at baseline vs. 83 ± 10 mmHg at 10% SF vs. 82 ± 10 mmHg at 20% SF, p = 0.014) and coronary perfusion pressure (42 ± 7 mmHg at baseline vs. 39 ± 7 mmHg at 10% SF vs. 38 ± 7 mmHg at 20% SF, p < 0.001) both decreased significantly with incremental SF.

Conclusions

In asymptomatic, anaesthetized children after cardiac transplantation, sternal forces comparable to leaning previously reported to occur during CPR elevate ITP and right atrial pressure and decrease coronary perfusion pressure. These haemodynamic effects may be clinically important during CPR and warrant further study.     

Living with osteoarthritis: patient expenditures,health status,and social impact

Objective

To determine “out‐of‐pocket” expenditures related to osteoarthritis (OA) and to explore whether demographic details, health status scores (Medical Outcomes Study 36‐item Short Form [SF‐36] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), or perception of social effect were expenditure determinants.

Methods

A prospective cohort study of community‐dwelling subjects with OA completed 4 consecutive 3‐month cost diaries. In addition, subjects completed the SF‐36 and WOMAC at baseline and at 12 months. Social impact at baseline was collected. Four groups categorized by age and sex were compared. Patients undergoing joint replacement were excluded.

Results

Differences in health status were defined more by age than by sex, especially for physical function. The costs to the patients were high, particularly for women, who spent more on medications and special equipment. Women also reported receiving more assistance from family and friends. Higher disease‐related expenditures were associated with greater pain levels, poorer social function and mental health, and longer duration of disease. Significant independent predictors of total patient expenditures related to OA were being female and having joint stiffness.

Conclusion

Despite having heavily subsidized health care and access to the Pharmaceutical Benefits Scheme, out‐of‐pocket costs for patients with OA in Australia are considerable. Higher expenditures for patients with OA are related to more advanced disease, especially for women.

     

SF、LDH和γ-GT检测在乳腺癌诊断治疗中的临床应用价值

目的探讨血清铁蛋白(SF)、乳酸脱氢酶(LDH)和γ-谷氨酰转肽酶(γ-GT)检测在临床乳腺癌诊断及治疗疗效判断中的应用价值。方法收集2010年2月至2013年8月乳腺癌患者42例,乳腺良性肿瘤患者57例和正常健康女性85例,分别用化学发光免疫法测定SF,用生化速率法测定LDH和γ-GT的含量,并对所测数据进行分组比较分析。结果乳腺癌血清中SF、LDH和γ-GT含量显著高于乳腺良性肿瘤患者和正常健康女性,两组差异有显著性(P0.01);SF、LDH和γ-GT含量随乳腺癌临床分期的增加而显著增加,随手术或治疗效果好转而迅速下降,复发时再次增高;SF、LDH和γ-GT对乳腺癌诊断的敏感度分别为64.9%、81.2%和87.5%。结论 SF、LDH和γ-GT含量检测对乳腺癌临床诊断有一定的参考价值,特别对乳腺癌治疗效果的判断有极为重要的临床应用价值。     

4项联合检测对骨髓增生异常综合征与巨幼细胞贫血鉴别诊断的临床意义

目的探讨铁蛋白(SF)、平均红细胞体积(MCV)、乳酸脱氢酶(LDH)及铁染色联合检测对骨髓增生异常综合征(MDS)与巨幼细胞贫血(MeA)鉴别诊断的临床意义。方法选取临床确诊的39例MeA和32例MDS的初诊患者;35例骨髓象大致正常者为健康对照组。严格按照番禺区中心医院的标准操作规程进行操作,测定血清LDH、血清SF、全血MCV值及骨髓铁染色。两组之间比较采用t检验;多组间比较采用方差分析,两两比较采用q检验。结果 MDS组和MeA组的SF、MCV、LDH及内外铁和健康对照组差异均有统计学意义(P<0.05);MDS组环形铁粒幼细胞明显增高。结论联合检测SF、MCV、LDH及铁染色对鉴别诊断MDS和MeA具有重要的临床意义。     

The hepatitis delta virus RNA genome interacts with eEF1A1, p54, hnRNP-L, GAPDH and ASF/SF2

Because of its extremely limited coding capacity, the hepatitis delta virus (HDV) takes over cellular machineries for its replication and propagation. Despite the functional importance of host factors in both HDV biology and pathogenicity, little is known about proteins that associate with its RNA genome. Here, we report the identification of several host proteins interacting with an RNA corresponding to the right terminal stem-loop domain of HDV genomic RNA, using mass spectrometry on a UV crosslinked ribonucleoprotein complex, RNA affinity chromatography, and screening of a library of purified RNA-binding proteins. Co-immunoprecipitation was used to confirm the interactions of eEF1A1, p54^nrb, hnRNP-L, GAPDH and ASF/SF2 with the right terminal stem-loop domain of HDV genomic RNA in vitro, and with both polarities of HDV RNA within HeLa cells. Our discovery that HDV RNA associates with RNA-processing pathways and translation machinery during its replication provides new insights into HDV biology and its pathogenicity.