目的 观察体外冲击波治疗髌腱末端病的效果。 方法 2006年1月－2010年12月67例髌腱末端病患者全部采用非手术治疗，其中38例采用体外冲击波治疗，11例采用手法按摩疗法，5例采用体外擦药酒、药膏，4例注射醋酸泼尼松龙加普鲁卡因，9例采用针灸疗法。观察体外冲击波治疗与其他非手术疗法之间的效果有无差异。 结果 经相同疗程治疗后，采用体外冲击波治疗者显效25例，有效10例，效果不明显3例；采用其他非手术疗法者显效9例，有效12例，效果不明显8例；两组治疗结果差异有统计学意义（Z=?2.966，P=0.003）。 结论 应用体外冲击波治疗髌腱末端病方法简便，操作安全，疗效显著，较其他非手术治疗方法有明显的优势。但对运动员患者应用此方法时，应与训练安排紧密结合起来，才能收到最大的效果。Objective To explore the therapeutic effect of extracorporeal shock wave therapy (ESWT) on patellar tendinopathy (PT). Methods A total of 67 cases who were diagnosed with PT between January 2006 and December 2010 were selected. All of the patients were treated with conservative treatment, including ESWT in 38, massage therapy in 11, ointment in 5, injection with prednisolon acetate and procaine in 4, and acupuncture in 9. The therapeutic effects of ESWT and other treatment were observed and compared. Results After the same treatment duration, the therapeutic effect was excellent in 65.79%, good in 26.32%, and fair in 7.89%, respectively in patients who had undergone ESWT; while the result was excellent in 31.03%, good in 41.38%, and fair in 27.59% , respectively in the patients who had received the other conservative treatments. The difference was significant (Z=?2.966, P=0.003). Conclusions ESWT is easy, safe, and effective for PT. It has more distinct advantages than other conservative treatments. However, it’s better to combine the treatment with training plans when the patients are athletes.
Objective To compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar fracture. Methods A retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups (P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an average of 46.1 years. The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The reduction quality was evaluated by Ovadia deals radiographic score, and the ankle function and pain were evaluated by VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion. Results Mason 2B Pilon subtype: There was no significant difference in operation time, intraoperative blood loss, postoperative hospital stay, and follow-up time between the two groups (P>0.05). The radiological evaluation of Ovadia deals in group A was significantly worse than that in group B (P<0.05). The VAS score in the two groups significantly improved at each time point after operation, and the VAS score and AOFAS score further improved with the extension of time after operation, and the differences were significant (P<0.05). Except that the AOFAS score of group A was significantly lower than that of group B at last follow-up (P<0.05), there was no significant difference in VAS score and AOFAS score between the two groups at other time points (P>0.05). At last follow-up, the ankle range of motion in group A was significantly less than that in group B (P<0.05). There was no significant difference in the incidence of sural nerve injury, deep tissue infection, limitation of toe movement, and traumatic ankle arthritis between the two groups (P>0.05). Mason 2B avulsion subtype: The operation time was (119.47±20.61) minutes and the intraoperative blood loss was 50 (35, 55) mL. Seventeen patients were followed up 13-25 months, with an average of 18 months. The Ovadia deals score was excellent in 10 cases, good in 6 cases, and poor in 1 case at 1 week after operation, and the excellent and good rate was 94.1%. All fractures healed in 8-18 weeks with an average of 12.35 weeks. There were 1 case of sural nerve injury and 3 cases of traumatic ankle arthritis after operation. No deep tissue infection or limitation of toe movement occurred. The VAS score decreased significantly and AOFAS score increased significantly with time, and the differences were significant between different time points before and after operation (P<0.05). The ankle range of motion at last follow-up was (56.71±2.47)°. ConclusionCompared with the posterolateral approach, the combined approach is a better choice for the treatment of Mason 2B Pilon subtype. If the posteromedial bone block does not affect the reduction of the medial malleolus, the posterolateral approach can achieve good effectiveness for Mason 2B avulsion subtype.
With the development of rehabilitation medicine being promoted as a national strategy, the rehabilitation medicine has developed rapidly in China, and the number of rehabilitation medicine departments in tertiary general hospitals has increased greatly. However, the discipline development faces some problems, such as unreasonable physical condition setting, nonstandard clinical path of rehabilitation technology, inaccurate discipline positioning, loopholes in safety management, inadequate rehabilitation quality control, and imperfect talent construction system. This paper attempts to discuss the strategic thinking of the development of rehabilitation medicine from six dimensions: foundation, technology, system, safety, quality control, and talents, so as to provide a reference for discipline builders.
Objective To summarize the research progress of acute kidney injury after liver transplantation. Method The literatures on acute kidney injury after liver transplantation was collected and reviewed. Results Acute kidney injury after liver transplantation was associated with multiple risk factors. Early prevention and treatment of risk factors in perioperative period was the main measure to reduce acute kidney injury after liver transplantation. Early postoperative diagnosis and timely intervention could reduce the incidence of chronic kidney disease and improve the long-term prognosis of liver transplantation recipients. Conclusion Acute kidney injury is a common complication after liver transplantation which affects prognosis and long-term survival of patients.
To further standardize the clinical diagnosis and treatment behavior of hepatocellular carcinoma, based on evidence-based medical evidence and expert opinion, Chinese Society of Clinical Oncology updated and published guideline of hepatocellular carcinoma. In this paper, the new guideline on the updating of medical treatment strategies for hepatocellular carcinoma was studied.
ObjectiveTo explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.MethodsThis retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.ResultsIn multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.ConclusionThe myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Difference of chronotypes makes influence to cognitive performance of individuals in routine duties. In this paper, 55 subjects with different chronotypes were subjected to continuous sleep deprivation for 30 h by using the constant routine protocol, during which core body temperature was measured continuously, and subjective sleepiness self-rating and the performance of selective attention were measured hourly. The results showed that the phase difference of core body temperature has no significant difference, yet the amplitude and term difference among the three chronotypes are significant. There was an advance in phase between subjective sleepiness self-rating and core body temperature, and the self-rating sleepiness of evening type came the latest, and the self-rating sleepiness of morning type dissipated the fastest. The response time of selective attention showed a 2 h phase delay with subjective sleepiness self-rating. And the analysis of core body temperature showed that the later the chronotype was, the greater the phase delay was. The correct rate of selective attention of different chronotypes were inconsistent with delay of subjective sleepiness self-rating and core body temperature. We provide reference for industry, aviation, military, medical and other fields to make a more scientific scheduling/ shifting based on cognitive performance characteristics of different chronotypes.
ObjectiveTo estimate the level and evolving pattern of peptic ulcer disease (PUD) burden from 1990 to 2019. MethodsThe related data of PUD from 1990 to 2019 were obtained from GBD 2019 database. The corresponding age-standardized rate, annual percentage change, average annual percentage change were calculated and analyzed by Excel and R software. ResultsThe global standardized prevalence of PUD was 99.4/100 000 (95%CI 83.9 to 117.5) in 2019, and decreased from 143.4/100 000 (95%CI 120.5 to 170.2) in 1990. The standardized disability-adjusted disease years (DALYs) rate was 74.4 (95%CI 69.0 to 81.9) in 2019. The estimated annual percentage change (EAPC) from 1990 to 2019 was −3.47% (95%CI −3.58 to −3.37), indicating that the standardized DALYs rate was declining. The prevalence and DALYs of PUD increased with age. The standardized DALYs rate was higher in males than in females in the same age group. Sociodemographic index (SDI) was negatively correlated with the standardized prevalence of PUD (R=−0.45, P<2.2e−16) and the standardized DALYs rate (R=−0.79, P<2.2e−16). ConclusionThe worldwide burden of PUD declined from 1990 to 2019, but the decline had begun to slow or pause in countries with better economic development levels.
ObjectiveTo systematically review the efficacy of pay-for-performance (P4P) for primary care physicians (PCPs). MethodsThe Cochrane Library, Database of Abstracts of Reviews of Effects, EMbase, Web of Science, PubMed, Dissertations and Theses Database, EconLit, CNKI, WanFang Data, IDEAS, and POPLINE were searched to collect studies on the efficacy of P4P for PCPs from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 studies were included. The results of meta-analysis showed that P4P incentives possibly improved child immunization status (RR=1.27, 95%CI 1.19 to 1.36, P<0.001), slightly improved primary care physicians’ prescribing of guideline-recommended antihypertensive medicines compared with existing payment method (RR=1.07, 95%CI 1.02 to 1.12, P=0.006), and improved a mixed outcome measure of service provision and patient health outcomes (RR=1.13, 95%CI 1.04 to 1.23, P=0.004). ConclusionsCurrent evidence shows that P4P possibly increases the quantity of health service provision and improve quality of service provision for targeted populations. The effects of P4P on health outcomes is uncertain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.