The relationship between transverse plane leg rotation and transverse plane motion at the knee and hip during normal walking

The purpose of this study was to test the clinical hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with those of the transverse plane motion at the knee and hip. Twenty subjects underwent kinematic assessment during walking at 108 steps/minute. The transverse plane rotation of the leg relative to the foot was used to indicate rearfoot complex pronation and supination. Taking into account errors inherent in kinematic assessment involving skin mounted markers, it is unlikely that a correlation exists between the range of internal leg rotation during the contact phase and the total range of transverse plane leg rotation during gait and the corresponding values for the transverse plane motion at the knee and hip. Correlation tests were performed to assess the temporal characteristics of the motions at the joints that showed that there was no correlation between the transverse plane motion in the rearfoot complex, knee and hip. Thus the hypothesis that the magnitude and temporal characteristics of rearfoot complex motion are closely correlated with the transverse plane motion at the knee and hip was rejected.     

新型4通道单电源低功耗程控接口脑电放大器的研制

本脑电放大器针对现有同类电路缺点进行改进，采用了最新一代高性能模拟与混合信号集成电路芯片，优化了电路结构并通过精细的电路工艺措施实现了噪声电压1．9μVp-p、共模抑制比100dB、输入阻抗80MΩ、基线漂移小、单电源5V供电和工作电流小于10mA等电路指标，并实现了增益控制和滤波控制的数字化接口。1年的应用表明该放大器安全省电、体积小、结构简单、性能稳定，非常适合作为便携式智能型脑电图仪器的前端。     

Pancreatic Exocrine Insufficiency in Intraductal Papillary Mucinous Carcinoma Presenting with Leg Edema Treated with Pancreatic Exocrine Replacement Therapy

An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool. Computed tomography showed pleural effusion, ascites, and cystic lesions in the pancreatic head and mural nodules within the cysts. Pancreatic juice cytology revealed adenocarcinoma. The diagnosis was pancreatic exocrine insufficiency caused by intraductal papillary mucinous carcinoma. The patient did not wish to undergo surgery. Therefore, diuretics, component nutrients, and pancreatic exocrine replacement therapy using pancrelipase were initiated. After starting treatment, her leg edema, pleural effusion, and ascites disappeared, and her activities of daily living improved markedly.     

Modelling the cost-utility of bio‑electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK

ABSTRACT

Objective: To estimate the cost-utility of bio-electric stimulation therapy (Posifect^*) compared to standard care in elderly patients with chronic, non-healing wounds of > 6 months duration, from the perspective of the National Health Service (NHS) in the UK.

Methods: Clinical and resource use data from a 16 week clinical evaluation of bio-electric stimulation therapy among patients who had recalcitrant wounds were combined with utility data obtained from a standard gamble analysis to construct a 16 week Markov model. The model considers the decision by a clinician to continue with a patient's previous care plan or treat with bio-electric stimulation therapy. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the cost-utility of bio-electric stimulation therapy compared to standard care to be estimated. The acquisition cost of Posifect had not been decided at the time of performing this study. Hence, the base case analysis used a cost of £50 per dressing.

Results: 33% of all wounds are expected to heal within 16 weeks after the start of bio-electric stimulation therapy. Consequently, using bio-electric stimulation therapy is expected to lead to a 51% decrease in the number of domiciliary clinician visits, from 4.7 to 2.3 per week. The model also showed that using bio-electric stimulation therapy instead of patients’ standard care is expected to reduce the NHS cost of managing them by 16% from £2287 (95% CI: £1838; £2735) to £1921 (95% CI: £1609; £2233) and result in a health gain of 0.023 QALYs over 16 weeks. Hence, bio-electric stimulation therapy was found to be a dominant treatment. Sensitivity analyses demonstrated that the cost-utility of using bio-electric stimulation therapy relative to standard care is very sensitive to the acquisition cost of the therapy, the acquisition cost of patients’ drugs and the number of clinician visits and less sensitive to utility values and the acquisition cost of other dressings.

Conclusion: Within the limitations of the model, bio-electric stimulation therapy is expected to afford the NHS a cost-effective dressing compared to standard care in the management of chronic non-healing wounds of > 6 months duration. Bio-electric stimulation therapy's acquisition cost is expected to be offset by a reduction in the requirement for domiciliary clinician visits, leading to a release of NHS resources for use elsewhere in the system, thereby generating an increase in NHS efficiency.     

调神针刺法治疗不安腿综合征临床观察

目的:观察调神针刺法治疗不安腿综合征及其伴发睡眠障碍、焦虑情绪的临床疗效,为调神法在临床上的应用提供理论依据。方法:将60例患者随机分为观察组和对照组,每组30例。对照组予常规针刺治疗,穴取足三里、阳陵泉、悬钟等下肢局部腧穴;观察组在对照组取穴基础上加用百会、神庭、本神。两组均每日治疗1次,每周6d,1周为一疗程,连续治疗3个疗程。观察两组患者治疗前后国际不安腿综合征评定量表(IRLS)、匹兹堡睡眠质量指数(PSQI)和汉密尔顿焦虑量表(HAMA)评分变化。结果:治疗后两组患者IRLS评分、PSQI和HAMA总评分均较治疗前下降(P<0.05),且观察组治疗后各评分改善均优于对照组(P<0.05)。结论:在常规针刺基础上,调神针刺法可明显减轻不安腿综合征患者的下肢不适感,改善其睡眠障碍和焦虑情绪,疗效优于单纯常规针刺。     

Development and Visualization Improvement for the Rapid Detection of Decapod Iridescent Virus 1 (DIV1) in Penaeus vannamei Based on an Isothermal Recombinase Polymerase Amplification Assay

Viral diseases have seriously restricted the healthy development of aquaculture, and decapod iridescent virus 1 (DIV1) has led to heavy losses in the global shrimp aquaculture industry. Due to the lack of effective treatment, early detection and regular monitoring are the most effective ways to avoid infection with DIV1. In this study, a novel real-time quantitative recombinase polymerase amplification (qRPA) assay and its instrument-free visualization improvement were described for the rapid detection of DIV1. Optimum primer pairs, suitable reaction temperatures, and probe concentrations of a DIV1-qRPA assay were screened to determine optimal reaction conditions. Then, its ability to detect DIV1 was evaluated and compared with real-time quantitative polymerase chain reactions (qPCRs). The sensitivity tests demonstrated that the limit of detection (LOD) of the DIV1-qRPA assay was 1.0 copies μL⁻¹. Additionally, the presentation of the detection results was improved with SYBR Green I, and the LOD of the DIV1-RPA-SYBR Green I assay was 1.0 × 10³ copies μL⁻¹. Both the DIV1-qRPA and DIV1-RPA-SYBR Green I assays could be performed at 42 °C within 20 min and without cross-reactivity with the following: white spot syndrome virus (WSSV), Vibrio parahaemolyticus associated with acute hepatopancreatic necrosis disease (V_pAHPND), Enterocytozoon hepatopenaei (EHP), and infectious hypodermal and hematopoietic necrosis virus (IHHNV). In conclusion, this approach yields rapid, straightforward, and simple DIV1 diagnoses, making it potentially valuable as a reliable tool for the detection and prevention of DIV1, especially where there is a paucity of laboratory equipment.     

尿毒症继发不安腿综合征73例临床表现分析

目的 了解尿毒症继发不安腿综合征患者患病率、严重程度、危险因素、具体不适部位及临床表现.方法 以2015年3～7月于首都医科大学附属北京友谊医院、北京第六医院、北京中兴医院、首都医科大学附属北京朝阳医院血液净化中心尿毒症持续性血液透析患者186例为研究对象,进行横断面研究,采用床旁问卷形式,以国际不安腿综合征研究小组(...     

A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting

Leg ulcers are costly to the NHS, and they have a significant impact on patients'' physical, social, and psychological well‐being. Compression therapy is traditionally the “gold‐standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub‐bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold‐standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.     

Effects of compression bandaging on leg pulsatile blood flow

Leg external compression bandaging is the mainstay of venous ulcer treat-ment, yet little is known about the impact of therapeutic compression levels on arterial haemodynamics. In this study, the effect of foot-to-knee, four-layer compression bandaging on below-knee arterial pulsatile blood flow was assessed by nuclear magnetic resonance flowmetry. In 14 healthy supine subjects, bilateral flow measurements at five below-knee sites without compression, and after compressing one leg to an average malleolar sub-bandage pressure of 40·7±4·0 mmHg, revealed a potentially important new phenomenon. The forefoot-to-knee compression bandaging caused a highly significant (P<0·001) increase in the bandaged leg pulsatile blood flow owing to increases in both peak flow and pulse width. It is hypothesized that arteriolar vasodilatation, induced either myogenically by reduced transmural pressure or by vasodilatory substance release triggered by increased venous shear stress, produce the observed compression-related phenomenon. Whatever the mechanism(s), the finding of a compression-associated pulsatile flow increase suggests a previously undiscovered arterial linkage, which may play a role in the well-documented beneficial effects of compression bandaging in venous ulcer treatment. A possible impact of the arterial flow–pulse increase is speculated to effect venous ulcer outcome via a decrease in leucocyte effects in the distal microvasculature, as a consequence of the more vigorous haemodynamic state.