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991.
Bionka M. Huisstede Saskia Gladdines Manon S. Randsdorp Bart W. Koes 《Archives of physical medicine and rehabilitation》2018,99(8):1635-1649.e21
Objectives
To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.Data Sources
Cochrane Library, Physiotherapy Evidence Database, PubMed, Embase, and CINAHL were searched to identify relevant systematic reviews and randomized controlled trials (RCTs).Data Selection
Two reviewers independently applied the inclusion criteria to select potential studies.Data Extraction
Two reviewers independently extracted the data and assessed the methodologic quality.Data Synthesis
A best-evidence synthesis was performed to summarize the results. Two reviews (trigger finger and De Quervain disease) and 37 randomized controlled trials (RCTs) (trigger finger: n=8; Dupuytren disease: n=14, and De Quervain disease: n=15) were included. The trials reported on oral medication (Dupuytren disease), physiotherapy (De Quervain disease), injections and surgical treatment (trigger finger, Dupuytren disease, and De Quervain disease), and other conservative (De Qervain disease) and postsurgical treatment (Dupuytren disease). Moderate evidence was found for the effect of corticosteroid injection on the very short term for trigger finger, De Quervain disease, and for injections with collagenase (30d) when looking at all joints, and no evidence was found when looking at the PIP joint for Dupuytren disease. A thumb splint as additive to a corticosteroid injection seems to be effective (moderate evidence) for De Quervain disease (short term and midterm). For Dupuytren disease, use of a corticosteroid injection within a percutaneous needle aponeurotomy in the midterm and tamoxifen versus a placebo before or after a fasciectomy seems to promising (moderate evidence). We also found moderate evidence for splinting after Dupuytren surgery in the short term.Conclusions
In recent years, more and more RCTs have been conducted to study treatment of the aforementioned hand disorders. However, more high-quality RCTs are still needed to further stimulate evidence-based practice for patients with trigger finger, Dupuytren disease, and De Quervain disease. 相似文献992.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651
Objective
To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.Design
Multicenter prospective cohort study.Setting
Institutions for physical therapy and rehabilitation.Participants
Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.Interventions
Not applicable.Main Outcome Measures
Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.Results
Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).Conclusions
PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. 相似文献993.
Carolyn E. Schwartz Brian Stucky Carly S. Rivers Vanessa K. Noonan Joel A. Finkelstein 《Archives of physical medicine and rehabilitation》2018,99(8):1599-1608.e1
Objective
To investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.Design
Prospective cohort study observed at 1, 2, and 5 years post-SCI.Setting
Specialized SCI centers.Participants
Sample included 1125, 760, and 219 participants at 1, 2, and 5 years post-SCI (N = 2104). The study sample was 79% men; 39% were motor/sensory complete (mean age, 44.6±18.3y).Interventions
Not applicable.Main Outcome Measures
Patient-reported outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 and the Life Satisfaction-11 Questionnaire. Participant latent variable scores were adjusted for (1) potential attrition bias and (2) propensity scores reflecting risk of worse outcomes. The Oort structural equation modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response shifts over follow-up.Results
The study data comprised the time after FIM scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response shift effects, Physical showed small true change improvements at 2- and 5-year follow-up, despite FIM stability.Conclusions
We detected recalibration and reconceptualization response shift effects in 1- to 5-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable. 相似文献994.
目的：探讨应用趾腓侧皮瓣修饰性再造拇指指腹缺损的手术方法及操作技巧。方法：2009年1月至2014年1月,对22例22指拇指指腹缺损的患者,应用同侧趾腓侧皮瓣游离移植修饰性再造拇指指腹缺损,其中采用趾-指动脉和趾-指静脉吻合18例,跖背动脉-桡动脉深支和跖背静脉-手背静脉吻合4例,神经修复均为指-趾神经吻合,供区皮肤缺损采用同侧腹股沟全厚皮片游离移植。结果：术后22例趾腓侧皮瓣游离移植均获成功,伤口一期愈合,无皮瓣坏死。随访6～12个月（平均7．6个月）,皮瓣外形逼真,罗纹清晰,出汗、感觉恢复良好,两点分辨觉3．0～6．0 mm,平均4．2 mm。供区植皮完全成活,足部外形及功能无明显影响。结论：趾腓侧皮瓣是修饰性再造拇指指腹缺损的首选皮瓣,再造拇指指腹外形及功能接近正常。 相似文献
995.
目的:探讨颞肌切除辅助标准大骨瓣开颅治疗特重型颅脑损伤的可行性及安全性。方法:将31位特重型颅脑损伤的患者随机分为研究组及对照组,研究组16例患者行颞肌切除辅助标准大骨瓣开颅血肿清除减压术,对照组15例患者只行标准大骨瓣开颅血肿清除减压术,对两组患者进行为期3个月的随访,观察比较疗效及并发症的发生率。结果:研究组疗效明显优于对照组,差异有统计学意义(P<0.05)。研究组和对照组出现的不良反应发生率分别为43.8%和46.7%,差异无统计学意义(P>0.05)。结论:颞肌切除辅助标准大骨瓣开颅术疗效优于标准大骨瓣开颅术疗效。 相似文献
996.
目的：探讨髋关节X线片测量指标与脑瘫患儿髋关节发育的相关性,评价其在该类疾病所致髋关节半脱位中的价值与作用。方法回顾性分析2012年5月—2014年5月在我中心检查治疗的60名脑瘫患儿骨盆平片中的120个髋关节,测量其骨结构的X线指标,包括：髋臼指数（acetabular index,AI）、股骨头偏移百分比（migrarion percentage,MP）、颈干角（neck-shaft angle,NSA）。结果 AI （21.05±3.83）°、MP （18.05±13.74）%、NSA（150.54±8.41）°。结论大部分脑瘫患儿存在髋关节骨骼发育异常,并导致髋关节半脱位改变。股骨头偏移百分比测量可以较客观地反映髋关节半脱位情况及其严重程度,具有较高的临床实用价值。 相似文献
997.
Trent Peng Adriana Pérez Kelley Pettee Gabriel 《Journal of manipulative and physiological therapeutics》2018,41(4):294-303
Objective
The purpose of this study was to explore the association between obesity (via body mass index [BMI]) and presence of low back pain (LBP) in a representative sample of US adults, aged ≥18 years.Methods
This cross-sectional study used data from 32 060 respondents to the 2015 National Health Interview Survey. Body mass index (kg/m2) was calculated using reported height and weight and expressed as normal weight (<25 kg/m2), overweight (25 to <30 kg/m2), or obese (≥30 kg/m2); 3-month prevalence of reported LBP was the targeted outcome. Weighted univariate and multivariable logistic regression (adjusting for age, sex, race/ethnicity, education, and leisure-time physical activity) were performed. Interaction by sex and race/ethnicity was also explored.Results
Findings suggest a statistically significant association between BMI categories and LBP. The adjusted odds ratios (95% confidence interval) of LBP in overweight and obese participants were higher than those in normal weight participants: 1.21 (1.11-1.32) and 1.55 (1.44-1.67), respectively. Both sex and race/ethnicity statistically significantly modified the association between BMI and LBP. Compared with normal weight white men (reference), odds ratios (95% confidence interval) of LBP were higher among obese white men, obese white women, and obese nonwhite women (1.28 [1.10, 1.48], 1.58 [1.36, 1.84], and 1.36 [1.16, 1.60], respectively), and lower in overweight, nonwhite men, and normal weight nonwhite men and women (0.80 [0.68, 0.94], 0.62 [0.51, 0.76], and 0.73 [0.61, 0.87], respectively).Conclusion
Overweight and obesity were associated with increased odds of LBP. However, the measures of associations varied in magnitude and direction by race and sex groups. 相似文献998.
针对人工焊点缺陷识别方法进行研究,提出了一种基于特征聚集度的模糊C均值聚类(FCM)与松弛约束支持向量机(RSVM)联用的分类识别算法。在提取人工焊点特征向量的基础上,算法首先对样本特征数据进行模糊C均值聚类,依据样本隶属度函数计算不同特征的特征聚集度,并由特征聚集度指标改进RSVM算法中的松弛量参数,建立最终的分类器模型。实验结果表明:本文提出的算法建立了泛化能力更强的分类模型,能有效抑制噪声及模糊边界点对分类模型的影响,在人工焊点缺陷识别的应用中获得了满意的识别结果。 相似文献
999.
Comparison of sonographic inferior vena cava and aorta indexes during fluid administered in children
Yun Ang Choi Hyuksool Kwon Jin Hee Lee Jae Yun Jung Yoo Jin Choi 《The American journal of emergency medicine》2018,36(9):1529-1533
Objectives
This prospective, observational study evaluated changes in ultrasound measurements of the inferior vena caval index (IVCI), the aorta diameter/IVC diameter index (Ao/IVCD), and the aorta area/IVC area index (Ao/IVCA) during fluid administration in children requiring intravenous fluid administration.Methods
Children who presented to the pediatric emergency department with symptoms of dehydration were enrolled between May 2015 and February 2016. The maximum diameter of the aorta, from inner wall to inner wall, and the long and short axis diameters of IVC were measured using a convex array transducer in the transverse view. Subsequently, we measured the diameter of the IVC at the subxiphoid area during inspiration and expiration in longitudinal view. We calculated IVCI, Ao/IVCD, and Ao/IVCA during administration of 10 ml/kg and 20 ml/kg normal saline boluses.Results
IVCI and Ao/IVCA significantly changed immediately after administration of initial 10 ml/kg of NS. Ao/IVCA showed significant change during the additional administration of 10 ml/kg (total 20 ml/kg) normal saline boluses (1.43, IQR 1.12–1.86 vs. 1.08, IQR 0.87–1.45, p value < 0.001). No significant changes were observed for IVCI and Ao/IVCD. Ao/IVCA was significantly correlated with the volume of fluid administered. The coefficient between initial and administration of the 10 ml/kg normal saline bolus was ? 0.396 (p value = 0.010), and that between the 10 ml/kg and 20 ml/kg normal saline boluses was ? 0.316 (p value = 0.038).Conclusions
Ao/IVCA showed better correlations with the volume of fluid administered than IVCI and Ao/IVCA. Ao/IVCA might be a promising index for assessing the effects of fluid administration. 相似文献1000.
Stephen A. McNutt Adam C. Weber Bryan R. Costin Milap P. Mehta Craig D. Lewis 《Orbit (Amsterdam, Netherlands)》2015,34(5):268-273
Background: To determine the safety and effectiveness of full thickness eyelid reconstructions using a semicircular rotational flap without reconstructing the posterior lamella.Methods: The charts of all patients undergoing semicircular flap closure of full thickness eyelid defects by one surgeon (JDP) at the Cole Eye Institute between March 2000 and October 2012 were reviewed. Charts were reviewed for patient demographic information, as well as for the size of the defect, the type of flap used, length of follow-up and complications.Results: Fifty eyelids of 50 patients underwent a semicircular flap repair without posterior lamellar reconstruction during the study period, and 41 charts were available for review. Average patient age was 74 years (range, 40–92 years). Average follow-up was 9.8 months (range, 1–84 months). Average defect size was 19.1?mm (range, 14–30?mm, SD 4.6). Complications included pyogenic granuloma (10 patients, 24.4%), exposure keratopathy (7 patients, 17.1%) lagophthalmos (5 patients, 12.2%), ectropion (6 patients, 14.6%), lateral canthal dystopia (2 cases, 4.9%), eyelid notch (2 cases, 4.9%) and trichiasis (4 cases, 9.8%). Two patients underwent subsequent tarsorrhaphy and one patient underwent ectropion repair. There were no cases of wound dehiscence, diplopia or fornix inadequacy, and the recruited aspect of the eyelid healed well in each case. No case required reconstruction of the eyelid margin or fornix.Conclusions: Semicircular flap repair of full thickness eyelid defects without flap or graft repair of the posterior lamella results in an adequate fornix and a low rate of secondary surgery. 相似文献