胸腔闭式引流吸引压力与并发症相关性观察

目的：观察胸腔闭式引流吸引压力与并发症有无相关性。方法：将70例开放性特发性气胸作闭式引流持续负压吸引的病人随机分两组。治疗组吸引压力-8cmH2O，对照组-14cmH2O。比较不同吸引压力并发症的发生。结果：治疗组并发症发生少于对照组。结论：-8cmH2O吸引压力较适用于特发性气胸闭式引流吸引。     

Tension in a double loop tendon anterior cruciate graft during a simulated open chain knee extension exercise.

Concerns exist regarding the tension developed in a reconstructed anterior cruciate ligament (ACL) during open chain knee extension exercises used to rehabilitate the knee. Therefore, the primary objective was to measure tension in an ACL graft during a simulated open chain knee extension exercise as a function of ankle weight. A secondary objective was to determine whether the graft tension was reduced with relatively high stiffness fixation. The open chain exercise was simulated in seven cadaveric specimens in which the ACL had been reconstructed with double loop tendon grafts. Graft tension was measured at 15 degrees of flexion as the effective ankle weight was increased from 22.5 to 67.5 and then to 112.5 N for three different fixation stiffnesses (25, 125, and 225 N/mm). The initial tension was set to restore the 225 N anterior limit of motion to that of the intact knee at 30 degrees of flexion. Increasing the ankle weight caused the graft tension to increase significantly (p<0.0001), but the increase with the highest ankle weight was only 62 N on average. Increasing the fixation stiffness caused the graft tension to decrease significantly (p<0.0001) because the initial tension decreased by 107 N as the fixation stiffness increased. Because the graft tension with the highest ankle weight was limited to 112 N on average, high stiffness fixation methods, which are also resistant to lengthening in the region of the fixation, may reduce the risk of graft construct lengthening during open chain knee extension exercises.     

Effect of prolonged unweighting of human skeletal muscle on neuromotor force control

The purpose of this study was to determine the effect of 4 weeks of unilateral lower limb suspension (ULLS) on the fluctuations in motor output and the associated physiological changes. Subjects (n = 17) performed steady isometric plantarflexion (PF) and knee extension (KE) tasks, and KE shortening and lengthening contractions (intensity = 25% maximum). Spinal excitability of the soleus muscle was assessed via the H-reflex, muscle cross-sectional area (CSA) via MRI, along with EMG activity during the PF tasks. Following ULLS, isometric force fluctuations increased ∼12% for the PF, and 22% for the KE (P < 0.05), with no difference in the pattern of PF muscle activation (P = 0.46). The unsteadiness of lengthening KE contractions increased 25% following ULLS (P = 0.03), while KE steadiness during shortening contractions was not altered (P = 0.98). Significant correlations were observed between the percent changes in PF isometric force fluctuations and H-reflex (r = 0.49, P = 0.04), and between the PF isometric force fluctuations and PF CSA (r = −0.61, P < 0.01). These findings suggest the effects of unweighting on neuromotor performance are muscle group and contraction type dependent, and that the disuse-paradigm altering muscle CSA and spinal excitability may serve to mediate the associated loss of steadiness. Data for this project were collected in the Musculoskeletal Research Laboratory at Syracuse University.     

Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention

Clinical guidelines for instituting pharmacotherapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), specifically lipid management and aspirin, have long been based on absolute risk. However, lipid management in the current era remains challenging to both patients and clinicians in the setting of somewhat discordant recommendations from various organizations. All guidelines endorse the use of statins for primary prevention for those at sufficient absolute risk, and treatment recommendations are generally “risk-based” rather than exclusively targeting specific low-density lipoprotein cholesterol levels. Nonetheless, guidelines differ in relation to the risk threshold for initiation and the intensity of statin treatment. The key concept of the clinician-patient risk discussion introduced in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines is a process that addresses the potential for ASCVD risk reduction with statin treatment, potential for adverse treatment effects, patient preferences, encouragement of heart-healthy lifestyle, and management of other risk factors. However, operationalizing the clinician-patient risk discussion requires effective communication of the most accurate and personalized risk information. In this article, we review our treatment approach for the appropriate use of coronary artery calcium testing in the intermediate-risk patient to guide shared decision making. The decision to initiate or intensify statin therapy may be uncertain across a broad range of estimated 10-year ASCVD risk of 5% to 20%, and coronary artery calcium testing can reclassify risk upward or downward in approximately 50% of this group to inform the risk discussion. We conclude with 2 case-based examples of uncertain risk and uncertain statin therapeutic benefit to illustrate execution of the clinician-patient risk discussion.     

戊二醛气雾消毒剂对飞机机舱消毒的实验观察

在飞机机舱内以２％强化中性戊二醛气雾剂进行消毒，当用药量为１１０ｍｇ／ｍ３作用３０分钟，可杀灭纸片上人工污染的繁殖体试验菌９９．９％以上；对机舱内空气与表面自然菌可杀灭９０％以上。试验表明，该消毒液对物品无明显腐蚀作用。     

Mandibular position influence on pilots’ postural balance analyzed under dynamic conditions

Objective: The aim of this study is to evaluate the influence of the mandibular position on the postural stability in a sample of civilian and military pilots.

Methods: Twenty military pilots (males, mean age 35.15 ± 3.14 years) and 17 civilian pilots (males, mean 34.91 ± 2.15 years) were enrolled in this study and underwent a Sensory Organization Test (SOT) using the EquiTest® (NeuroCom International Inc., Clackamas, OR, USA) computerized dynamic posturography. The composite parameter was recorded and analyzed.

Results: The equilibrium score (ES) recorded in centric occlusion is slightly higher than the ES recorded in mandibular rest position; civilian pilots showed ESs slightly higher than military pilots. The two-way ANOVA analysis shows these differences are not statistically significant.

Discussion: The findings of this study seem to suggest that the composite parameter of the SOT is not sensitive in analyzing the influence of the stomatognathic system on the postural balance of civilian and military pilots.     

A Multicenter Randomized Controlled Trial Comparing Two Bowel Cleansing Regimens for Colonoscopy After Failed Bowel Preparation

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Report of the NIH Task Force on Research Standards for Chronic Low Back Pain

Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting “responder analyses” in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.PerspectiveA task force was convened by the NIH Pain Consortium with the goal of developing research standards for chronic low back pain. The results included recommendations for definitions, a minimum dataset, reporting outcomes, and future research. Greater consistency in reporting should facilitate comparisons among studies and the development of phenotypes.