中西医结合治疗膝关节骨性关节病42例

目的:观察中西医结合治疗膝关节骨性关节病(knee osteoart hilts,KOA)的临床疗效。方法:对2012年6月—2013年4月来本院治疗的42例伴骨量减少的Ⅲ级KOA患者采用控制骨质疏松、中药外洗及外敷→关节镜治疗→玻璃酸钠注射液关节腔注射,改善局部症状治疗→主动、被动屈伸训练及针灸、物理治疗等中西医结合阶段化治疗,观察其临床疗效。采用WOMAC指数作为临床评价指标。结果:42例患者中治愈9例,显效22例,有效10例,无效1例,有效率为97.6%。所有患者治疗后WOMAC指数评分与治疗前比较,差异具有统计学意义(P0.05);治疗6个月与治疗3个月、4个月WOMAC指数评分比较,差异也具有统计学意义(P0.05)。结论:中西医结合阶段化治疗伴估量较少的Ⅲ级KOA具有较好疗效。     

A Review of: “ Handbook of Adaptive Designs in Pharmaceutical and Clinical Development,by A. Pong and S.-C. Chow (Eds.)”

In practice, there exist many disease processes with three ordinal disease classes; for example, in the detection of Alzheimer’s disease (AD) a patient can be classified as healthy (disease-free stage), mild cognitive impairment (early disease stage), or AD (full disease stage). The treatment interventions and effectiveness of such disease processes will depend on the disease stage. Therefore, it is important to develop diagnostic tests with the ability to discriminate between the three disease stages. Measuring the overall ability of diagnostic tests to discriminate between the three classes has been discussed extensively in the literature. However, there has been little proposed on how to select clinically meaningful thresholds for such diagnostic tests, except for a method based on the generalized Youden index by Nakas et al. (2010). In this article, we propose two new criteria for selecting diagnostic thresholds in the three-class setting. The numerical study demonstrated that the proposed methods may provide thresholds with less variability and more balance among the correct classification rates for the three stages. The proposed methods are applied to two real examples: the clinical diagnosis of AD from the Washington University Alzheimer’s Disease Research Center and the detection of liver cancer (LC) using protein segments.     

Psychological Constructs of Activity Readiness in High Functioning Elderly

Abstract

This study examined the relationship of activity readiness with self efficacy, perceived behavioral control, exercise attitudes, self-rated health, and selected demographic variables among high functioning, independent-living elderly. Four hundred seventy-one subjects, ranging in age from 62 to 93 years, were drawn from a popular retirement area and data were gathered through a self-report survey instrument. Subjects residing at no exercising readiness stages held negative self-efficacy, behavioral control, and attitudinal beliefs whereas regular exercisers held positive beliefs toward these constructs. Perceived behavioral control was most indicative of active lifestyle attainment, suggesting intervention strategies designed to initiate and maintain activity in the high functioning elderly focus on control belief cognitions.     

Ankle Fractures: Supination-Eversion Fractures Stage II Primary and Late Results of Operative and Non-Operative Treatment

Sixty-nine patients with stage II supination-eversion fractures of the ankle, 34 treated by operation and 35 treated conservatively, were seen at follow-up after 3–10 years. There was no statistically significant difference between the results of the two methods. However, larger series and perhaps a longer observation time are probably needed to decide whether the displacement of the lateral malleolus as a result of non-operative treatment affords the same possibility of unhindered ankle function as union of the lateral malleolus in the anatomical position obtained by operation.     

Effect of an impaired oral stage on swallowing in patients with Parkinson's disease

We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because patients with PD frequently exhibit an impaired oral stage of swallowing and the tongue movement affects oral and pharyngeal stage. In total, 201 patients with PD (106 men, 95 women; mean age 70·6 ± 8·0 years; median Hoehn‐Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography, and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70·3 ± 7·8 years) with an OTT + 2 standard deviation (0·89 + 2 × 0·46) of 1·81 s, the patients with PD were divided into 167 patients with an OTT < 1·81 s and 34 patients with an OTT ≥ 1·81 s. Swallowing function was compared between the groups and assessed using logistic regression analysis. The following factors were significantly associated with oral stage impairment in both groups: tongue‐to‐palate contact, tongue root‐to‐posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration and onset of swallowing reflex. Logistic regression analysis showed that tongue root‐to‐posterior pharyngeal wall contact, onset of swallowing reflex and aspiration were independent factors. PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD.