红花化瘀汤熏洗治疗膝关节镜术后康复效果及对患者疼痛和膝关节功能的影响

目的:探讨红花化瘀汤熏洗在膝关节镜术后康复中的临床效果及对患者疼痛和膝关节功能的影响。方法:选择膝关节镜手术患者104例为研究对象,随机数字表分为对照组和观察组各52例。对照组术后给予常规方法治疗,观察组在对照组基础上联合红花化瘀汤熏洗治疗。治疗8周后,比较两组治疗效果、VAS评分、膝关节功能及炎症因子。结果:两组术后2周、4周、6周及8周膝关节肿胀度均小于术前(P<0.05);但观察组术后以上时间点膝关节肿胀度小于对照组(P<0.05);且观察组术后以上时间点VAS评分低于对照组(P<0.05);观察组术后8周疼痛、功能、活动度、畸形、肌力和稳定性评分高于对照组(P<0.05);观察组治疗后8周NO和IL-1β水平低于对照组(P<0.05),TGF-1β水平高于对照组(P<0.05)。结论:红花化瘀汤熏洗用于膝关节镜术后康复中能改善患者膝关节肿胀程度,减轻患者疼痛,提高患者膝关节功能,可降低炎症因子水平。     

Measurement of dyspnea: word labeled visual analog scale vs. verbal ordinal scale

We previously used a verbal ordinal rating scale to measure dyspnea. That scale was easy for subjects to use and the words provided consistency in ratings. We have recently developed a word labeled visual analog scale (LVAS) with labels placed by the subjects, retaining the advantages of a verbal scale while offering a continuous scale that generates parametric data. In a retrospective meta-analysis of data from 43 subjects, individuals differed little in their placement of words on the 100 mm LVAS (mean+/-S.D. for slight=20+/-2.5 mm, moderate=50+/-5 mm and severe=80+/-6 mm) and ratings were distributed uniformly along the scale. A significant stimulus-response correlation was obtained for both the LVAS (r(2)=0.98) and for the verbal ordinal scale (Spearman r=0.94). The resolution of the two scales differed only slightly. With meaningful verbal anchors, well-defined end-points, and clear instructions about the specific sensation to be rated, both scales provide valid measures of dyspnea.     

生长抑素受体介导的靶向放疗在消化系统肿瘤治疗中的研究进展

生长抑素受体介导靶向放疗是建立在对生长抑素、生长抑素类似物及其受体的研究基础之上.目前已经证实生长抑素类似物有良好的抗肿瘤效应,应用放射性核素标记生长抑素类似物与消化系统肿瘤高表达的生长抑素受体特异性和选择性结合以达到两者共同抗肿瘤作用的方法,具有重要的应用前景.本文就生长抑素受体介导的靶向放疗在消化系统肿瘤治疗方面的研究进展作一综述.     

Capillary muscle

The contraction of a muscle generates a force that decreases when increasing the contraction velocity. This “hyperbolic” force–velocity relationship has been known since the seminal work of A. V. Hill in 1938 [Hill AV (1938) Proc R Soc Lond B Biol Sci 126(843):136–195]. Hill’s heuristic equation is still used, and the sliding-filament theory for the sarcomere [Huxley H, Hanson J (1954) Nature 173(4412):973–976; Huxley AF, Niedergerke R (1954) Nature 173(4412):971–973] suggested how its different parameters can be related to the molecular origin of the force generator [Huxley AF (1957) Prog Biophys Biophys Chem 7:255–318; Deshcherevskiĭ VI (1968) Biofizika 13(5):928–935]. Here, we develop a capillary analog of the sarcomere obeying Hill’s equation and discuss its analogy with muscles.From 1487 to 1516, Leonardo da Vinci planned to write a treatise on human anatomy. The book never appeared, but many drawings and writings have been conserved, mainly at the royal collection at Windsor (1):

After a demonstration of all of the parts of the limbs of man and other animals you will represent the proper method of action of these limbs, that is, in rising after lying down, in moving, running and jumping in various attitudes, in lifting and carrying heavy weights, in throwing things to a distance and in swimming and in every act you will show which limbs and which muscles are the causes of the said actions and especially in the play of the arms. (2, 3)

Apart from Leonardo’s attempts, the understanding of muscle contraction has been a long quest since antiquity and the work of Hippocrates of Cos (4). The topological structure of muscles was described in the anatomical studies by Andreas Vesalius in 1543 (5) and the static force generated was quantified in the first biomechanics treatise of Giovanni Borelli in 1680 (Fig. 1A) (6). One realizes the difficulties associated with the understanding of the force generation mechanism by comparing the scale at which the force is used (typically the body scale: 1?m) to the scale at which the force is generated [contraction of the myosin molecule: 10?nm (7)]. Eight orders of magnitude separate the molecular origin of the force from its macroscopic function, namely the motion of organisms. Considering the scales involved, research on muscles has progressed with the development of new techniques, from early microscopy for the micrometer-scale sarcomere (8), to X-ray diffraction (9) and interference microscopy (10) for the actin–myosin sliding structure, and optical tweezers for the study of individual myosin molecules (7).Open in a separate windowFig. 1.(A) Plate of Borelli’s De Motu Animalium. Figure courtesy of ref. 6. (B) Isotonic lever for human subjects [from Wilkie (11)]. A, hand grip attached to cable; B, catch to hold lever up at the end of movement; C, fixed contact; D, lever with moving contact; E, weight. (C) Force–velocity results obtained with two different subjects: red squares, D.W.; black circles, L.M. The solid lines are Eq. 1, with F₀ = 196?N, v_max = b.F₀/a = 7.5?m/s, and F₀/a = 5 for D.W., and F₀ = 200?N, v_max = 7.0?m/s, and F₀/a = 2.1 for L.M. (data from ref. 11).Despite the complexity of the muscular system, the relation between the force F needed to move a given load and the velocity v of the motion is accessible via macroscopic experiments such as the one from Wilkie sketched in Fig. 1B (11). Here, a constant force F = Mg is imposed by the weight E, and one records the maximal speed of contraction, v(F). Decoupling inertial effects from muscle properties, one gets human muscle characteristics as shown in Fig. 1C. The force reaches its maximum F₀ at v = 0, and it vanishes at a maximal speed v = v_max. The evolution between these two limits is captured by an equation proposed by Hill in 1938 (12), (F + a)(v + b) = (F₀ + a)b, which can be written under the hyperbolic form:FF0=1−v/vmax1+(F0/a)v/vmax.[1]This equation is drawn with a solid line in Fig. 1C for two subjects (D.W. and L.M. in ref. 11), using the values F₀ = 196?N, v_max = bF₀/a = 7.5?m/s, and F₀/a = 5 for D.W., and F₀ = 200?N, v_max = 7.0?m/s, and F₀/a = 2.1 for L.M. The isometric tension F₀ defines the force against which the muscle neither shortens nor lengthens, and v_max is the maximal speed reached without load (F = 0). These results illustrate the accuracy of Hill’s equation and the variability of the parameter F₀/a between different subjects. Apart from skeletal human muscles, Hill’s equation (Eq. 1) is found to apply to almost all muscle types and over various species (13).The contractile muscular machinery is made of parallel muscle cells that extend from one tendon to another, which connect to bones. A muscle cell is composed of nuclei and myofibrils, a linear assembly of sarcomeres, the elementary contractile unit. The typical size of sarcomeres is 3 μm, so that their number in myofibril of a 30-cm muscle cell is on the order of 10⁵. A sarcomere itself is made of thin actin filaments connected to thick myosin filaments via myosin heads (Fig. 2 C1 and C2). When a neuron stimulates a muscle cell, an action potential sweeps over the plasma membrane of the muscle cell. The action potential releases internal stores of calcium that flow through the muscle cell and trigger a contraction (C2). Actin and myosin filaments are juxtaposed but cannot interact in the absence of calcium (relaxed-state C1). With calcium, the myosin-binding sites are open on the actin filaments, and ATP makes the myosin motors crawl along the actin, resulting in a contraction of the muscle fiber (C2) (14, 15). The interaction energy increases with the number of cross-bridges, namely with the surface between actin and myosin threads.Open in a separate windowFig. 2.Experimental setup of a capillary muscle and its biological inspiration, the sarcomere. The steel wire is equivalent to the myosin filament that slides in the silicone oil tube, which stands for the actin filament. (A) Position at t = 0, corresponding to relaxed state of the sarcomere (C1). (B) Position at t > 0, corresponding to the contracted state of the sarcomere (C2). (D) Example of capillary contraction obtained with 2r = 1.8?mm, 2R = 5?mm, η = 1 Pa⋅s, γ = 22 mN/m, k = 3.3 μN/m, and x₀ = 7.6?mm.Hill’s equation is a heuristic law and its connection to the sliding-filament model has first been established via adjustable correlations (16) and later via strong theoretical assumptions (17). The purpose of the present article is to build a capillary analog of the sliding-filament model, to record the corresponding force–velocity relationship, and to show how this minimal model system leads to Hill’s equation.     

Percutaneous CT-Guided Cryoablation of the Celiac Plexus: A Retrospective Cohort Comparison with Ethanol

PurposeTo retrospectively analyze and compare the incidence of diarrhea in patients who underwent cryoablation of the celiac plexus for intractable abdominal pain versus ethanol therapy over a 5-year period.Materials and MethodsFrom June 2014 to August 2019, 83 patients were identified who underwent neurolysis of the celiac plexus for management of intractable abdominal pain by using either cryoablation (n = 39 [59% female; age range, 36–79 years old [average, 60 ± 11 years old]) or alcohol (n = 44 [48% female; age range, 29–76 years old [average, 60 ± 12 years old]). Pain scores and reports of procedure-related complications or side effects, with special attention to diarrhea and/or other gastrointestinal symptoms, were collected from follow-up visits at 1 week, 1 month, and 3 months post-intervention and were compared between groups.ResultsThe mean time of follow-up was 17.7 days. Four patients who underwent cryoablation developed gastrointestinal symptoms consisting of 2 cases of nausea and vomiting and 2 cases of diarrhea (5.1%). Twelve patients who underwent ethanol ablation developed gastrointestinal symptoms, including 1 case of nausea, 3 cases of vomiting, and 9 cases of diarrhea (20.5%). There was a significantly higher incidence of both diarrhea (chi-squared likelihood ratio, P = .03) and overall gastrointestinal symptoms (chi-squared likelihood ratio, P = .04) in the ethanol group than in the cryoablation group.ConclusionsCryoablation of the celiac plexus may provide a new treatment option for intractable abdominal pain, and it appears to have a lower incidence of diarrhea and fewer gastrointestinal side effects than ablation using ethanol.