Effect of Different Neurodynamic Mobilization Techniques on Knee Extension Range of Motion in the Slump Position

Abstract

Mobilization of the nervous system has emerged as a significant adjunct to the treatment of musculoskeletal injuries. Clinical studies have shown that neurogenic symptoms can be resolved by treatment techniques directed at restoring normal neural biomechanics and physiology. Two alternate mobilization techniques have been proposed: the slider and tensioner techniques. A search of the literature revealed no peer-reviewed studies comparing the effects of these two treatment techniques, although a number of studies have investigated these techniques in isolation and found them to have positive effects on range of motion and other outcome measures. The aim of this study was to investigate the effects of these two techniques on knee range of motion of normal subjects (30 females [mean age 21.4+/?1.2 years, range 19-24]) in the slump position. Knee flexion angle of the right leg was measured using a universal 360° goniometer while in a fully slumped position, prior to and after the application of the respective mobilization technique. The tensioner technique brought about a significant decrease in knee flexion angle (P=0.003) with a mean percentage change of 14.7+/?11.8%(3.4+/?2.5°). The slider technique brought about a significant decrease in knee flexion angle (P<0.001) with a mean percentage change of 19.9+/?15%(4.3+/?2.6°). There was a non-significant between-group difference for the effect of the two techniques on range of motion (P=0.075). The findings of this study indicate that in normal female subjects, both the tensioner and slider techniques have a positive and significant effect on improving knee extension range of motion in the slump position. This could decrease the sensitivity of the sciatic nerve and the neuromeningeal structures to mechanical load. The clinical significance of changes of this magnitude on neural tissue and of these techniques in a symptomatic population requires further investigation.     

Changes in Gastrin and Serum Pepsinogens in Monitoring of Helicobacter pylori Response to Therapy

The aims of this study in 50 patients with H.pylori infection and duodenal ulcer were to examine theeffect of eradication therapy on the serum levels ofgastrin, pepsinogen I, and pepsinogen II and to investigate whether monitoring of the serumchanges in these peptides after treatment could predictpatient outcome. H. pylori status was assessed at entryand one and six months after therapy by culturing and microscopic analysis of the gastric mucosaand by [¹⁴C]urea breath test. Significantdecreases were observed in the serum levels of gastrin(–11.4 ± 3%), pepsinogen I (–28.9± 4%), and pepsinogen II (–40.4 ±3%) in the 45 patients whose infection was eradicated,but not in the patients without eradication. Serumvalues of these peptides were unchanged in an additionalgroup of 10 patients that only received omeprazol, none of whom had H. pylorieradicated. The best cutoff point of the percentage ofeach peptide to predict patient outcome was 10% forgastrin and pepsinogen I, and 15% for pepsinogen II. Apepsinogen II decrease >15% resulted in the best markerof H. pylori clearance, accurately identifying patientoutcome 86.6% of the time, whereas the diagnosticaccuracy of gastrin and pepsinogen I was 61.7% and76.6%, respectively. Significant correlations werefound between the bacterial load assessed by histologywith the serum concentrations of pepsinogen I and II andwith the urease activity as measured by the amount of ¹⁴CO₂ excreted. Inconclusion, eradication of H. pylori infection isfollowed by a significant drop in serum levels ofgastrin, pepsinogen I, and pepsinogen II. Changes in thelatter are the most uniform and may be used as an indirect tool to predicttreatment outcome.     

两种自动血沉仪与经典魏氏法检测红细胞沉降率的结果比较

目的:应用两种自动血沉仪检测红细胞沉降率(ESR)并与经典魏氏法进行比较,评价各自方法的准确性.方法:随机抽取门诊患者94人,同时采集三份标本,分别应用TEST1自动血沉仪、DRAGONMED2010自动血沉仪及经典魏氏法同时检测ESR,对数据进行统计学分析与比较.结果:TEST1自动血沉仪、DRAGONMED 2010自动血沉仪检测ESR的结果分别与经典魏氏法比较,结果差异均无显著性(P＞0.05);但在血沉结果分段比较时低值(ESR≤20mm/h)结果差异均有显著性(P＜0.05).前两者方法具有良好的相关性(r=0.951,Y=0.932X 2.318).后两者方法同样有良好的相关性(r=0.978,Y=0.882X 2.272).结论:两种自动血沉仪检测ESR的结果与经典魏氏法相比较都有良好的相关性和准确性,但TEST1法相对于DRAGONMED 2010自动血沉仪法,它是一种更加快速、优点更加显著的检测ESR的新方法,值得临床推广应用;两种仪器方法在血沉低值与经典魏氏法结果上有差异,但对于临床实际应用来说无医学决定性意义.     

Lidocaine and Monoethylglycinexylidide Serum Determinations to Analyze Liver Function of Cirrhotic Patients After Oral Administration

Our aim was to compare standard liver functiontests (serum bilirubin, serum albumin and prothrombinconcentration), with lidocaine andmonoethylglycinexylidide pharmacokinetic parameters,after oral lidocaine administration, to assess hepatic function ofcirrhotic individuals. Twenty-one consecutive cirrhoticpatients, nine consecutive acute hepatitis patients, andnine healthy individuals received oral lidocaine. Lidocaine and monoethylglycinexylidide serumconcentrations were determined by the TDx system.Cirrhotic patients had higher lidocaine and lowermonoethylglycinexylidide serum concentrations anddifferences in its pharmacokinetic variables, compared tocontrol and hepatitis groups (P < 0.05). Sensitivityof lidocaine serum determinations (100%) was greaterthan sensitivity of serum bilirubin (57%), serum albumin (62%), and prothrombin concentrations(43%) and monoethylglycinexylidide serum concentrations(57%) in differentiating cirrhotic individuals fromcontrols. In conclusion, after oral administration, lidocaine and monoethylglycinexylididepharmacokinetic parameters are significantly altered incirrhotic patients compared to normal and acutehepatitis subjects. Lidocaine pharmacokinetic parameterswould be better than those ofmonoethylglycinexylidide and standard liver functiontests in the evaluation of liver function of cirrhoticpatients.     

Polymer composition and acidification effects on the swelling and mechanical properties of poly(acrylamide-co-acrylic acid) superporous hydrogels

Poly(acrylamide-co-acrylic acid) (poly(AM-co-AA)) superporous hydrogels (SPHs) were synthesized and the acidification effects on the swelling and mechanical properties were studied. Gelation exotherms were measured to determine the optimum introduction time for adding a blowing agent. The gelation kinetics decreased with increasing the AA concentration. The maximum equilibrium swelling was observed around an AA weight fraction of 0.4, but the compressive strength decreased monotonically with increasing the AA concentration. Poly(AM-co-AA) SPHs were much less swollen in acidic solution than in distilled water of pH 6.7. The swelling ratio decreased with increasing acidity (decreasing pH). Reduction of water absorption content by acidification led to considerable increase in the mechanical strength.     

ALIFAX TEST1血沉仪临床适用性评估

目的评估魏氏替代法ALIFAX TEST1血沉仪(以下简称TEST1血沉仪)的临床适用性。方法收集2019年1-2月南京医科大学第一附属医院风湿免疫科、血液科和骨科患者红细胞沉降率(ESR)检测标本各30例,分别使用TEST1血沉仪和魏氏法进行测定分析。对血细胞比容(HCT)<35%的标本魏氏法检测结果经Fabry公式校正后再与TEST1血沉仪检测结果进行相关性比较。统计分析2017年6-12月(用魏氏改良法Monitor100血沉仪检测)与2018年同期(用魏氏替代法TEST1血沉仪)上述3个科室住院患者ESR检测的异常率。结果上述3个科室TEST1血沉仪与魏氏法两种方法测定结果具有相关性,要Fabry公式校正后,风湿免疫科(r=0.9574,P<0.01)和骨科(r=0.9451,P<0.01)优于血液科(r=0.8765,P<0.01)。对于HCT<35%的标本,TEST1血沉仪检测结果与魏氏法相关性降低(r=0.8781,P<0.01);当HCT明显低于正常范围(<25%)时TEST1血沉仪检测结果与魏氏法则无相关性(r=0.5838,P>0.05)。TEST1血沉仪与Monitor100血沉仪同期检测ESR相比,风湿免疫科患者差异无统计学意义(P>0.05),血液科和骨科患者TEST1血沉仪检测的ESR低于Monitor100血沉仪(血液科:χ^2=76.35,P<0.001;骨科:χ^2=17.93,P<0.001)。结论TEST1血沉仪基本适用于风湿免疫科、血液科和骨科标本的检测。对于贫血患者而言,TEST1血沉仪受HCT影响比魏氏法小,但重度贫血(HCT<25%)患者宜选用魏氏法,且结果需按照Fabry公式进行校正。     

Immunological Testing for Occult Blood in Patients with Acute Infectious Diarrhea (Can It Improve the Specificity of the Guaiac Test?)

Microscopic stool examination can distinguishinflammatory from noninflammatory diarrheas. Themodified guaiac test was shown to have good correlationto stool microscopy. In a prospective study we evaluated the diagnostic accuracy of a modified guaiactest (ColoRectal-Test, Roche) and of an immunologicaltest for fecal haemoglobin (Colo-Immun-Test, Roche) inrelation to the diarrheal pathogens identified and compared it with the stool microscopy. In 304patients, clinical presentation, stool microscopy, stoolculture, and modified guaiac test were recorded.Sensitivity of the guaiac test was 69% as compared to 63-67% for the stool microscopy. Specificitycould be improved by 10-15% using an immunological testto exclude false-positive guaiac reactions. A modifiedguaiac test can replace microscopic stool examination to distinguish between inflammatoryand noninflammatory diarrhea. Immunological testing foroccult blood can improve the specificity of the guaiactest, but is too elaborate to serve as a screening test. The modified guaiac test can easily behandled by community health workers and could beimportant in the diagnostic work-up for acute infectiousdiarrhea.     

毛冬青甲素与地高辛对慢性心衰患者运动耐量的短期疗效比较

采用单盲、随机、自身交叉临床试验设计,比较毛冬青甲素与地高辛对8例纽约心脏协会心功能Ⅲ级的慢性充血性心力衰竭患者的运动耐量的影响。口服一周的毛冬毒甲索(120毫克,每日三次)能显著提高运动功量,从3502.17±1832.90焦耳(357±186.84公斤米)到5601.51±3232.10焦耳(57l±329.47公斤米)(P=0.0262)和运动耐量时间从192±79.105秒到260.875±98.835秒(P=0.037)。口服一周地高辛(0.25mg,每日一次)能显著提高运动功量从3938.71±3146.56焦耳(401.5±320.75公斤米)到5612.55±3660.89焦耳(572.125±373.18公斤米)(P=0.018)和运动耐量时间从194.875±107.98秒到263.825±106.755秒(P=0.01);两种药物之间提高运动功量及运动耐量时间无明显差异(P值分别为0.8785及1).结果表明,毛冬青甲索和地高辛有近似的提高运动耐量的作用.     

Chest Pain at Rest in Patients with Coronary Artery Disease (Myocardial Ischemia, Esophageal Dysfunction, or Panic Disorder?)

Severe nonexertional (resting) chest pain may bedue to myocardial ischemia, esophageal dysfunction,psychiatric disorder, or any combination thereof andfrequently poses a difficult diagnostic challenge. Our aim was to investigate causes of chest painin patients with coronary artery disease. Forty-fivepatients with angiographically proven obstructivecoronary lesions and recurrent chest pain at rest were studied; 18 had refractory pain despite cardiactherapy (problem group), and 27 had documentedmyocardial ischemia (control group). Esophagealmanometry, edrophonium provocation, 24-hr pH studies,and psychiatric interview were performed in all patients. Theclinical evolution and the outcome of specific treatmentduring follow-up was used to establish the etiology ofchest pain. Esophageal dysfunction was identified in all problem patients and in 52% of controls,and the esophagus was incriminated as the source of painin 8 (44%) and 5 (18.5%), respectively. After a meanfollow-up of 49 months (range 24-76 months), the cause of chest pain in the problem groupwas identified as panic disorder in 9 patients (50%),gastroesophageal reflux in 6 (33%), esophagealdysmotility in 2 (11%), and gallstone disease in 1 (6%). Of the control patients, 18 (67%) had ischemicpain alone, while 9 had concurrent causes: panicdisorder in 5 (19%) and esophageal dysfunction in 4(15%). Esophageal dysfunction and psychiatricdisturbances are common in patients with coronary arterydisease presenting with resting chest pain, and maycontribute to patients' symptoms.     

Effect of Bariatric Surgery on the Six-Minute Walk Test in Severe Uncomplicated Obesity

Background: The six-minute walk test (6mWT) is a simple index of functional capacity in healthy people, and it has been used to estimate exercise capacity in obese subjects. The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric banding (LAGB) improves the functional capacity in the severely obese on the 6mWT. Methods: A prospective 1-year study was carried out at the Hospital Casoria, Naples, involving 15 consecutive severely obese patients who underwent the 6mWT before and 1 year after LAGB. BMI, walking distance, heart rate, dyspnea, and respiratory function tests were also measured. Patients served as their own controls. Results: 15 patients (all females) were evaluated. Mean BMI decreased from 42.1 (range 39-49) before to 31.9 (range 25-38) postoperatively. The distance walked increased from 475.7 meters (range 380-580) before LAGB to 626.3 meters (range 435-880) 1 year postoperatively (P<0.0001), and the dyspnea score after the 6mWT was significantly reduced postoperatively. All functional variables after the 6mWT showed improvement postoperatively at 1 year study. Conclusion: Weight reduction in the obese increases the functional capacity during walking. The improvements are refected in the patients' own assessment.