手法联合核心稳定训练治疗老年非特异性腰痛临床研究

目的:观察手法联合核心稳定训练治疗老年非特异性腰痛的临床疗效。方法:124例随机分为研究组和对照组各62例。两组均行手法治疗,观察组加用核心稳定训练治疗。结果:治疗后两组VAS、ODI评分均较治疗前改善(P<0.01),观察组改善程度优于对照组(P<0.01)。治疗后两组闭眼单脚站立时间、闭目原地踏步时间均较治疗前延长(P<0.01),观察组延长程度大于对照组(P<0.05)。结论:手法可以瞬间纠正腰椎“骨错缝、筋出槽”,恢复力学平衡。配合核心稳定性训练,使筋强骨健,维持腰椎稳定,疗效较好且安全。     

Prospective Evaluation of an Extended 21-Core Biopsy Scheme as Initial Prostate Cancer Diagnostic Strategy

Background

The debate on the optimal number of prostate biopsy core samples that should be taken as an initial strategy is open.

Objective

To prospectively evaluate the diagnostic yield of a 21-core biopsy protocol as an initial strategy for prostate cancer (PCa) detection.

Design, setting, and participants

During 10 yr, 2753 consecutive patients underwent a 21-core biopsy scheme for their first set of biopsy specimens.

Intervention

All patients underwent a standardized 21-core protocol with cores mapped for location.

Outcome measurements and statistical analysis

The PCa detection rate of each biopsy scheme (6, 12, or 21 cores) was compared using a McNemar test. Predictive factors of the diagnostic yield achieved by a 21-core scheme were studied using logistic regression analyses.

Results and limitations

PCa detection rates using 6 sextant biopsies, 12 cores, and 21 cores were 32.5%, 40.4%, and 43.3%, respectively. The 12-core procedure improved the cancer detection rate by 19.4% (p = 0.004), and the 21-biopsy scheme improved the rate by 6.7% overall (p < 0.001). The six far lateral cores were the most efficient in terms of detection rate. The diagnostic yield of the 21-core protocol was >10% in prostates with volume >70 ml, in men with a prostate-specific antigen level < 4 ng/ml, with a prostate-specific antigen density (PSAD) <0.20 ng/ml per gram. A PSAD <0.20 ng/ml per gram was the strongest independent predictive factor of the diagnostic yield offered by the 21-core scheme (p < 0.001). The 21-core protocol significantly increased the rate of PCa eligible for active surveillance (62.5% vs 48.4%; p = 0.036) than those detected by a 12-core scheme without statistically increasing the rate of insignificant PCa (p = 0.503).

Conclusions

A 21-core biopsy scheme improves significantly the PCa detection rate compared with a 12-core protocol. We identified a cut-off PSAD (0.20 ng/ml per gram) below which an extended 21-core scheme might be systematically proposed to significantly improve the overall detection rate without increasing the rate of detected insignificant PCa.     

The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

Inclusion of fenofibrate in a series of mesoporous silicas using microwave irradiation

A selection of porous silicas were combined with a model drug using a recently developed, controlled microwave heating process to determine if the application of microwave irradiation could enhance subsequent drug release. Five mesoporous silica types were investigated (core shell, core shell rehydrox, SBA-15, silica gel, SYLOID®) and, for comparison, one non-porous silica (stober). These were formulated using a tailored microwave heating method at drug/excipient ratios of 1:1, 1:3 and 1:5. In addition, all experiments were performed both in the presence and absence of water, used as a fluidising media to aid interaction between drug and support, and compared with results obtained using more traditional heating methods. All formulations were then characterised using differential scanning calorimetry (DSC), powder X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transformation infrared spectroscopy (FT-IR). Pharmaceutical performance was investigated using in vitro drug release studies. A significant enhancement in the release profile of fenofibrate was observed for formulations prepared using microwave heating in the absence of water for five of the six silica based formulations. Of all the formulations analysed, the greatest extent of drug release within the experimental 30 min was the 1:5 core shell rehydrox achieving a total of 86.6 ± 2.8%. The non-porous (stober) particles did not exhibit an increased release of the drug under any experimental conditions studied. This anomaly is thought to be a result of the comparatively small surface area of the silica particles, thus preventing the adsorption of drug molecules.     

Novel co-axial prilling technique for the development of core–shell particles as delayed drug delivery systems

In this study, biocompatible double layered beads consisting of pectin core and alginate shell were prepared through a single step manufacturing process based on prilling apparatus equipped with co-axial nozzles. The core was loaded with piroxicam (PRX) as model non-steroidal anti-inflammatory drug (NSAID). Morphology, size distribution and shape of the double layered beads varied depending on the operative conditions and polymer concentrations. Co-axial nozzles size, applied vibration frequency, gelling conditions and, mainly, polymers mass ratio were identified as critical variables. Particularly, the relative viscosity of polymeric feed solutions inside the nozzle was the key parameter to obtain homogeneous and well-formed coated particles. The produced beads were investigated for the release kinetic in different media. Once PRX was encapsulated within the pectin core, a controlled release pattern was observed. Particularly, beads produced with 4:1 core/shell ratio (F4) released less than 30% of PRX in simulated gastric fluid (SGF) while total liberation of the drug was achieved during the next 3 h in simulated intestinal fluid (SIF). More interesting, F4 tested in SIF was able to release drug in a delayed and sustained manner at established time points (2h_8.2%, 3h_32.2%, 4h_70.1% and 5h_about 100%). Based on the above results, co-axial prilling approach is expected to provide success in manufacturing systems with delayed drug release profiles. Such systems may be potentially useful in targeting diseases which are affected by the circadian rhythm, such as chronic inflammation.     

核心肌力训练对脑卒中后平衡和日常生活活动能力的影响

目的探讨核心肌力训练对脑卒中偏瘫患者平衡功能和日常生活活动能力(activities of daily living,ADL)的影响。方法研究对象为2013年5月—2014年2月住院治疗的脑卒中患者42例,采用随机数字表法将患者分为对照组和治疗组各21例。对照组进行常规偏瘫康复治疗,治疗组在常规治疗基础上增加核心肌力训练。治疗前、治疗4周后采用平衡测试仪评定患者重心移动轨迹长度及重心移动范围,应用改良巴氏指数(modified barthel index,MBI)评分对患者ADL进行评定。计量资料采用t检验,P0.05为差异有统计学意义。结果治疗4周后治疗组的重心移动轨迹及重心移动范围[(375.70±110.63)mm、(698.39±521.72)mm2]较对照组[(451.12±121.98)mm、(1 129.0±640.18)mm2]均显著减少(P0.05),MBI评分[(69.70±17.90)分]较对照组[(58.86±16.76)分]显著增加(P0.05)。结论核心肌力训练配合常规康复综合治疗更有效改善脑卒中偏瘫患者的平衡功能和ADL。     

PDCA循环在医疗核心制度落实中的应用

医疗质量与医疗安全是医院的根本,落实医疗核心制度是医院确保质量与安全的关键.在Plan阶段,加强医务人员培训,强化核心制度落实意识;在Do阶段,完善质量管理组织体系,确保核心制度严格执行;在Check阶段,建立督查机制,实施监管;在Action阶段,加强反馈与干预,持续改进.PDCA循环的应用确保了医疗核心制度的落实.     

Ⅹ Ⅹ Ⅳ European Stroke Conference

<正>Time:May 12-15,2015Venue:Vienna,AustriaEmail:m.g.hennerici@eurostroke.euWebsite:http://www.eurostroke.eu/On behalf of the European Stroke Conference(ESC)Programme Committee it is my pleasure to invite you all to theⅩⅩⅣ