体外冲击波治疗肌筋膜疼痛综合征的meta分析

目的:系统评价体外冲击波治疗肌筋膜疼痛综合征的临床效果。方法:检索中外文数据库中关于体外冲击波治疗肌筋膜疼痛综合征(MPS)的临床随机对照研究,对纳入研究进行资料提取和质量评价,采用Rev Man5.2软件进行meta分析。结果:共纳入8篇文献,370例MPS患者。meta分析结果显示:体外冲击波组与激痛点注射组VAS评分差异无显著性意义[MD=-0.35,95%CI(-1.02,0.32),P=0.30]。体外冲击波组较其他治疗组(电针、推拿按摩、牵伸训练)可以更有效地缓解疼痛[MD=-0.78,95%CI(-0.99,-0.58),P0.00001]。体外冲击波组与安慰剂组差异无显著性意义[MD=-1.15,95%CI(-3.18,0.88),P=0.27],但结合森林图中黑色菱形的重心偏移程度可知治疗效果更倾向于体外冲击波组。结论:体外冲击波疗法优于激痛点注射、针灸推拿等方法,可以有效地缓解疼痛,避免不良事件发生。     

健康教育对腰痛干预疗效的系统评价和Meta分析

目的:系统评价健康教育对腰痛患者疼痛、功能性活动及生活质量的临床效果。方法:计算机检索EMBASE、Web of Science、PubMed/Medline、The Cochrane Library、VIP、CNKI和WanFang Data数据库,搜索时限从2009年1月~2019年9月。由两名评价员独立筛选文献、提取数据并评价纳入研究的方法学质量,以RevMan 5.3软件进行Meta分析。结果:最终纳入27个研究,共2701例患者。Meta结果显示与对照组相比:①健康教育联合运动疗法在改善腰痛患者疼痛和功能障碍方面具有显著优势,NPRS评分[MD=-1.78,95%CI(-2.67,-0.89),P<0.01]、RMDQ评分[MD=-4.72,95%CI(-7.70,-0.84),P=0.01];②健康教育联合常规治疗在改善疼痛方面并无显著性差异,VAS评分[MD=-0.49,95%CI(-1.04,0.07),P=0.09],但在改善功能障碍方面具有优势,RMDQ评分[MD=-0.97,95%CI(-1.91,-0.02),P=0.04];③加强健康教育在疼痛改善方面具有优势,VAS评分[MD=-0.52,95%CI(-0.93,-0.11),P=0.01]、NPRS评分[MD=-0.41,95%CI(-0.75,-0.08),P=0.01],在改善功能障碍方面均无优势。所有研究在改善生活质量方面均无优势。结论:运动疗法或常规治疗基础上增加健康教育更有利于腰痛患者疼痛缓解,并能更好的改善因腰痛导致的功能障碍。且加强健康教育可能更加有效。受纳入研究数量和质量的限制,以上述结论尚待更多高质量研究予以验证。     

艾灸治疗肩周炎疼痛的Meta分析

[目的]系统评价艾灸对肩周炎疼痛症状的影响。[方法]计算机检索Cochrane Library、PubMed、EMBase、Web of Science、CNKI、WanFang Data、VIP、CBM,检索建库至2018年2月公开发表的关于艾灸治疗肩周炎疼痛的随机对照试验。按照纳入和排除标准筛选文献,应用偏倚风险评估工具评价纳入研究的质量,提取文献数据并运用RevMan 5.3软件进行Meta分析。[结果]纳入17项研究,共1 916例病人。Meta分析结果显示:在总有效率方面,艾灸与针刺相比[RR=1.19,95%CI=(1.14,1.25),P0.000 01],与电针相比[RR=1.11,95%CI=(1.05,1.17),P0.001],与常规西医相比[RR=1.47,95%CI=(1.10,1.97),P=0.008],疗效较好,差异有统计学意义;与布洛芬缓解胶囊相比,差异无统计学意义[RR=1.13,95%CI=(0.96,1.33),P=0.15]。在视觉模拟评分(Visual Analogue Scale,VAS)方面,艾灸与针刺相比[MD=-0.90,95%CI=(-1.12,-0.68),P0.000 01],与常规西医相比[MD=-1.88,95%CI=(-2.16,-1.60),P0.000 01],疗效较好,差异有统计学意义;与电针相比[MD=-0.32,95%CI=(-0.94,0.29),P=0.31],与体外冲击波相比[MD=0.10,95%CI=(-0.10,0.30)P=0.34],差异无统计学意义;与布洛芬缓解胶囊相比,差异有统计学意义[MD=0.33,95%CI=(0.02,0.64),P=0.04]。[结论]艾灸治疗肩周炎疼痛疗效明显,但由于本次纳入研究质量偏低,以上结论仍需更多大样本、多中心、高质量的随机对照试验予以进一步验证。     

针灸对脓毒症疗效与安全性的系统评价

目的系统评价针灸治疗脓毒症患者的疗效和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集针灸治疗脓毒症患者的随机对照试验(RCT),检索时限均从建库至2019年10月1日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果纳入20个研究,共1 337例患者。Meta分析结果显示:针灸+常规方法治疗脓毒症患者在28天病死率[RR=0.69,95%CI(0.5,0.96),P=0.03]、治疗后第3天APACHEⅡ评分[MD=-2.4,95%CI(-3.68,-1.12),P=0.0002]、治疗后第7天APACHEⅡ评分[MD=-4.37,95%CI(-6.32,-2.21),P<0.0001]、ICU住院时长[MD=-1.54,95%CI(-2.81,-0.27),P=0.02]、胃肠道功能改善有效率[RR=1.5,95%CI(1.09,2.06),P=0.01]、治疗后第7天PCT浓度[MD=-2.23,95%CI(-3.33,-1.13),P<0.001]和TNF-α浓度[MD=-14.86,95%CI(-23.74,-5.97),P=0.001]方面,与常规治疗组的差异均具有统计学意义。但在治疗后第7天CD8^+记数[MD=1.65,95%CI(-0.32,3.62),P=0.1]方面,二者差异无统计学意义。结论现有有限证据表明,针灸可能是潜在的治疗脓毒症患者的方法之一。受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证。     

经皮穴位电刺激对心率变异性影响的Meta分析

目的 系统评价经皮穴位电刺激（TEAS）对心率变异性（HRV）的影响。方法 计算机检索PubMed、Embase、Ovid MEDLINE、Cochrane Library、CNKI、WanFang Data、VIP和CBM数据库,搜集TEAS影响心率变异性的随机对照试验（RCT）,检索时限均为建库至2023年2月28日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4软件进行Meta分析。结果 共纳入14个RCT,包括719例患者。Meta分析结果显示：TEAS组的SDNN[MD=12.95,95%CI(9.18,16.72),P<0.01]、RMSSD[MD=1.81,95%CI(0.10,3.53),P=0.04]、pNN50[MD=1.75,95%CI(1.02,2.48),P<0.01]、HF[SMD=0.27,95%CI(0.01,0.52),P=0.04]、LF/HF[MD=-0.07,95%CI（-0.12,-0.03）,P<0.01]、ln-LF[MD=0.63,95%CI(0.25,1.01),P<0.0...     

悬吊运动疗法治疗慢性非特异性腰痛疗效的Meta分析

目的探讨悬吊运动疗法治疗慢性非特异性腰痛(CNLBP)的临床疗效。方法计算机检索2007年6月至2017年6月CNKI、维普数据库(VIP)、万方数据库、Pub ed、Web of Science、The Cochrane Library及Embase,搜集悬吊运动疗法治疗CNLBP的随机对照试验(RCT)。对纳入文献进行筛选,资料提取,质量评价和风险评估后,采用Rev Man 5.3软件进行Meta分析。结果共纳入15个RCT,789例患者。悬吊运动疗法在改善视觉模拟量表(VAS)评分[MD=-1.15,95%CI(-1.41,-0.90),Z=8.82,P0.00001]和Oswestry腰痛功能障碍指数评定量表(ODI)评分[MD=-1.29,95%CI(-1.80,-0.78),Z=4.94,P0.00001]方面优于物理治疗;悬吊运动疗法在改善VAS评分[MD=-0.94,95%CI(-1.52,-0.37),Z=3.21,P=0.001]和ODI评分[MD=-5.96,95%CI(-9.41,-2.51),Z=3.38,P=0.0007]优于其他运动疗法,但悬吊运动疗法在改善疼痛数字评分量表(NPRS)评分方面与其他运动疗法无显著性差异[MD=0.35,95%CI(-0.23,0.93),Z=1.19,P=0.23];悬吊运动疗法在改善VAS评分方面与中医疗法无显著性差异[MD=-5.29,95%CI(-20.27,9.70),Z=0.69,P=0.49]。结论悬吊运动疗法在一定程度上可以改善患者疼痛和功能受限。因纳入文献数量有限及质量不高,上述确切结论仍需开展大样本高质量的RCT加以验证。     

正念减压疗法对我国癌症病人焦虑、抑郁水平影响的Meta分析

[目的]通过Meta分析评价正念减压疗法对我国癌症病人焦虑、抑郁情绪的影响。[方法]计算机检索国内有关正念减压疗法应用于癌症病人的随机对照试验研究,经质量评价后,采用RevMan 5.3软件对纳入文献进行Meta分析。[结果]共纳入7项随机对照试验,包括606例病人。Meta分析结果显示:试验组与对照组干预后的焦虑[MD=-5.74,95%CI(-6.44,-5.03),P0.0001]、抑郁[MD=-4.79,95%CI(-6.24,-3.34),P0.0001]比较差异有统计学意义。[结论]正念减压疗法作为一种心理治疗方法应用于我国癌症病人能有效减轻或消除病人焦虑和抑郁的负性情绪,促进病人康复。     

耳穴贴压对胆囊切除患者术后胃肠功能恢复影响的Meta分析

目的 :系统评价耳穴贴压在胆囊切除患者术后胃肠功能恢复中应用的效果。方法 :计算机检索CNKI、CBM、VIP、WANFANG Data、Pub Med、EMBASE、SCI和The Cochrane Library数据库中关于耳穴贴压应用于胆囊切除患者的随机对照试验(RCT)。筛选文献、数据提取、纳入文献的评价均由两名评价者独立进行,核对无误后运用Revman 5.3软件进行数据分析。结果 :最终纳入9篇文献,包括1 060例患者。Meta分析结果显示耳穴贴压在肠鸣音恢复时间[MD=-9.45,95%CI(-13.55,-5.35),P=0.01]、肛门首次排气时间[MD=-11.64,95%CI(-15.63,-7.65),P0.001]、首次进食时间MD=-6.50,95%CI(-6.78,-6.22),P0.001]方面与常规疗法相比时间均缩短。耳穴贴压在降低腹胀发生率[OR=0.18,95%CI(0.11,0.28),P0.001]、恶心呕吐发生率[OR=0.26,95%CI(0.11,0.63),P=0.003]、术后疼痛评分[MD=-1.22,95%CI(-2.37,-0.08),P=0.04]方面均优于常规疗法。结论 :耳穴贴压有助于缩短肠鸣音恢复时间、首次排气时间、首次进食时间,降低腹胀和恶心呕吐的发生率,降低患者术后疼痛评分,但仍需要大样本、高质量的RCT进行验证。     

运动想象疗法对脑卒中患者步行功能影响的Meta分析

目的:通过Meta分析评价运动想象疗法(Motor Imagery,MI)对脑卒中患者步行功能的影响。方法:通过计算机对Cochrane Library、MEDLINE、Web of Science、EMBASE、EBSCO、中国生物医学文献数据库、中国知网、维普数据库、万方数据库中运动想象疗法对脑卒中患者步行功能影响的随机对照试验进行检索,并追溯相关文献的参考文献;2名研究人员独立进行文献筛查、数据的提取,评价并纳入文献,采用Revman5.3软件进行Meta分析。结果:共纳入7篇文献,包括259例研究对象;Meta分析结果显示,与常规康复相比,运动想象疗法有助于提高步幅[MD=9.88,95%CI(0.46,19.30),P=0.04]、Fugl-Meyer运动评分量表下肢部分(FMA-LE)评分[MD=2.24,95%CI(0.90,3.58),P=0.001]、功能性步行功能分级(Functional Ambulation Category Scale,FAC)[MD=0.58,95%CI(0.28,0.88),P0.001],但运动想象疗法不能改善10米最大步行速度[MD=4.24,95%CI(-3.23,11.71),P=0.27]、患侧平均步长[MD=-3.20,95%CI(-10.33,3.93),P=0.38]和健侧平均步长[MD=1.36,95%CI(-3.00,5.71),P=0.54]。结论:运动想象疗法有助于提高步幅、FMA-LE得分和FAC分级,但在10米最大步行速度、患侧平均步长和健侧平均步长方面尚未有明显优势,仍需要多中心、大样本的随机对照研究加以证实。     

盆底肌训练治疗女性盆腔器官脱垂疗效的meta分析

目的:系统评价盆底肌训练治疗女性盆腔器官脱垂的临床疗效。方法:计算机检索CNKI、万方、维普、PUBMED、MEDLINE、OVID等数据库,纳入符合纳入排除标准的随机对照试验,并进行质量评价和数据提取,采用RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献,Meta分析结果显示,盆底肌训练能有效改善盆腔器官脱垂患者的主观感觉(自觉脱垂症状好转)[RR=3.62,95%CI(2.26,5.82),P0.01]、脱垂症状评分[MD=-3.07,95%CI(-3.91,-2.23),P0.01]和POP-Q分度[RR=1.70,95%CI(1.19,2.44),P0.01]。结论:盆底肌训练能有效改善盆腔器官脱垂患者的临床症状,且简单易行,安全可靠,值得进一步推广。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.