Platelet rich plasma compared to dry needling in the treatment of non-insertional Achilles tendinopathy

Objectives: The efficacy of platelet rich plasma in the treatment of Achilles tendinopathy is controversial. Despite positive results observed in open studies, randomized controlled trials failed to show difference against saline or rehabilitation. Aims of this retrospective observational study were to compare the efficacy of platelet-rich plasma and dry needling and to assess possible differences age and sex-related.

Methods: Groups of 46 and 38 patients with non-insertional Achilles tendinopathy were treated with platelet-rich plasma and dry needling (once a week for 3 weeks), respectively. At baseline, 3 and 6 months, pain and function scores and the percentage of satisfactory outcomes were evaluated. Sub-group analyses were performed according to age and sex.

Results: At 3 and 6 months no differences in terms of pain and function between groups were observed, but the percentage of subjects reporting satisfactory results, at 6 months, was higher in platelet rich plasma group. Better results were observed in younger subjects, with a greater reduction of pain, improvement of function, and accordingly of the percentage of positive outcomes. A trend toward better results was also observed in males.

Conclusion: Beneficial effects of platelet rich plasma and dry needling in non-insertional Achilles tendinopathy have been observed only in some subjects, but not in others; platelet rich plasma shows a slight superiority against dry needling, mainly in younger persons; finally, a gender difference in the therapeutic response can be hypothesized.     

Daily family assistance and inflammation among adolescents from Latin American and European backgrounds

To assess the biological impact of time spent helping the family during the teenage years, we examined circulating levels of interleukin-6 (IL-6), soluble interleukin-6 receptor (sIL-6r), and C-reactive protein (CRP) in 64 adolescents (M_age = 17.79 years) from Latin American and European backgrounds. Analyses of nightly diary checklists over 14 days showed that the amount of time spent helping the family in a variety of ways, such as cooking, cleaning, and sibling care, was associated with long-term elevations of sIL-6r and CRP, even after controlling for ethnicity, parental education, BMI, substance use, distress, and frequency of daily family assistance 2 years earlier. However, adolescents who derived a greater sense of role fulfillment from helping the family on a daily basis had lower levels of sIL-6r and CRP as compared to their peers who engaged in the same amount of family assistance. Additional work should explore the family context that drives high levels of assistance among adolescents, as well as the variety of ways adolescents may derive meaning from this activity.     

沿皮浅刺脑缺血大鼠内关及公孙穴：细胞凋亡调控基因和血管活性物质的变化

治疗脑缺血的针刺多是将针刺入肌层及深部组织,从皮肤表层浅刺的治疗研究相对较少。实验以血栓法大鼠大脑中动脉栓塞(MCAO)模型,沿皮浅刺其双侧内关、公孙,发现浅刺和常规针刺均能不同程度改善脑缺血模型大鼠神经功能,提高缺血脑组织抗凋亡基因bcl-2表达,抑制促凋亡基因bax及血清血管活性物质一氧化氮合酶及内皮素1表达,浅刺的调节作用更佳。     

夹脊穴结合局部围针治疗带状疱疹后遗神经痛的Meta分析

背景：临床应用夹脊穴结合局部围针治疗带状疱疹后遗神经痛取得了良好的疗效,但其效果是否优于西药尚不明确。 目的：系统评价夹脊穴结合局部围针治疗带状疱疹后遗神经痛的有效性。 方法：计算机检索中国知网数据库、维普全文期刊数据库、中国生物医学文献数据库、Pubmed医学文献检索服务系统、美国斯坦福大学的Highwire数据库,手工检索南京中医药大学图书馆过刊资料库及相关会议论文集,检索时间为建库至2010-07,收集夹脊穴结合局部围针治疗带状疱疹后遗神经痛的临床随机对照试验,并按照循证医学原则对文献质量进行评价。统计学分析采用RevMan 4.2软件。采用总有效率、临床治愈率、疼痛目测类比评分、临床症状评分等作为结局评价指标。 结果与结论：共纳入13个随机对照试验(共858例)。Meta分析结果显示,夹脊穴结合局部围针治疗带状疱疹后遗神经痛在总有效率[RR=1.26,95%CI(1.19,1.34)]、临床治愈率[RR=1.93,95%CI(1.64,2.27)]、疼痛目测类比评分[WMD=3.13,95%CI(2.38,3.87)]方面明显优于对照组。总有效率分类比较显示,夹脊穴结合围针的效果与物理治疗差异无显著性意义[RR=1.60,95%CI(0.43,6.02)],但明显优于卡马西平[RR=1.45,95%CI(1.22,1.72)]。说明夹脊穴结合局部围针治疗带状疱疹后遗神经痛的疗效优于西药,但尚需要更多高质量的随机双盲对照试验来进一步证实其疗效。     

内窥镜辅助下乳房聚丙烯酰胺水凝胶取出术

目的探讨内窥镜辅助下取出隆乳术后注射物的整形修复的临床应用与操作要点。方法N2006年1月至2012年10月,应用内窥镜辅助取出聚丙烯酰胺水凝胶注射隆乳术后35例70侧。行双侧腋窝切口或乳晕切口,内窥镜直视下取出注射材料,21例I期放置乳房假体。结果随访1年,术后恢复良好,无明显包块,无包膜挛缩。所有患者术后乳房无明显注射物残留,无血肿及感染。结论采用内窥镜辅助下行注射隆乳术后注射物取出整形修复术,手术在直视下进行,去除注射物较彻底,创伤较小;I期假体置入无明显影响,术后效果好,无明显并发症发生,是值得推广应用的辅助技术。     

L’argatroban,nouvel antithrombotique pour la thrombopénie induite par l’héparine en chirurgie cardiaque de l’adulte : utilisation en chirurgie cardiaque et en réanimation

ObjectivesAlthough heparin-induced thrombocytopemia (HIT) is uncommon, its thromboembolic complications are potentially life-threatening. The low-molecular weight heparins are less responsible of HIT than unfractionated heparin (UFH) but this latter is still indicated in some circumstances such as cardiac surgery. Argatroban, a selective thrombin inhibitor, recently available, has been indicated in HIT treatment. This review presents the main pharmacological characteristics, its indications and uses in the context of cardiac surgery and in intensive care medicine.MethodsReview of the literature in Medline database over the past 15 years using the following keywords: argatroban, cardiac surgery, circulatory assistance, cardiopulmonary bypass.ResultsDespite its short-acting pharmacokinetic, argatroban cannot be recommended during cardiopulmonary bypass. On the contrary, argatroban is indicated in many circumstances in postoperative period of various cardiac surgeries (on-pump, off-pump, circulatory assistance). Nevertheless, after cardiac surgery, doses have to be adapted according to coagulation laboratory testing (ACT), particularly in patients presenting acute organ failure (kidney injury, heart failure, liver failure). This compound has no antagonist and is excluded during severe hepatic failure. The continuous intravenous administration is a drawback.ConclusionArgatroban is a new direct competitive thrombin inhibitor well evaluated as treatment of HIT after cardiac surgery. In HIT management, argatroban is an interesting alternative to lepirudin that is not anymore available and danaparoid because of supply disturbances.     

Psychologist Impairment: What Is It,How Can It Be Prevented,and What Can Be Done to Address It?

Research indicates that psychologists self-report a variety of problems related to their personal and professional functioning, such as depression, substance abuse, and burnout. These difficulties not only lead to psychologist distress, but can also result in impairment and have a negative effect on patient care. This review of the psychologist impairment literature provides information on the historical movement toward colleague assistance, rates of impairment, identifying distress and impairment, intervening with an impaired colleague, barriers to treatment, and preventing impairment. It is suggested that, through education of psychologists and graduate trainees, impairment may be prevented or its effects minimized.     

Device to Provide Intuitive Assistance in Laparoscope Holding

This work proposes a new navigation device which autonomously handles the laparoscope, with a view to reducing latency and adjusting optics in real time. The system designed is an intuitive mechatronic device with three degrees of freedom and a sole active articulation. The device uses the point of insertion as the invariant point for navigation and has a work space that closely resembles an inverted cone.     

探寻我国卫生事业改革的突破口

面对目前的卫生改革困境,提出居高的次均医疗费用是目前的众多矛盾的汇集之处.降低次均医疗费用要着力于医疗费用上涨的微观基础.为此作者提出了医疗机构竞争性获得补偿的理论,切断医院补偿与经营收入的直接联系,不仅可以降低次均医疗费用,转化医疗机构运行机制,还能有助于其他卫生问题的解决.