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Objective To explore the validity of proximal medial gastrocnemius release (PMGR) for treating unilateral chronic plantar fasciitis.Methods The prospective study was conducted.From January 2018 to July 2018,56 patients who were diagnosed chronic plantar fasciitis in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,were enrolled and divided into study group (n =28) and control group(n =28) according to different therapies.Fifty-six patients were enrolled including 33 males and 23 females,the age was (48.1 ±6.2) years (range,43.9-57.1 years).The patients in study group were treated with PMGR for unilateral chronic plantar fasciitis.Meanwhile,the patients in control group were treated by shock wave therapy,one extracorporeal shock wave therapy was accepted every 3 days,each impact 2 000 times,a total of five times.Visual analogue scale (VAS),the American orthopaedic foot and ankle hindfoot scale (AOFAS) and dorsal extension range of ankle joint of all patients before treatment and 3 months after treatment were recorded and compared.All the patients were outpatient followed for (3.9 ± 0.7) months until October 2018,the pain and function of feet were recorded.Measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD).The data were statistically analyzed by t test between two groups.Count data were analyzed by chi-square test between two groups.Results In study group,preoperative VAS,AOFAS and dorsal extension angleof ankle joint were (6.9 ± 0.8) scores,(48.4 ± 2.8) scores and (10.8 ± 3.9) °,while 3 months after treatment VAS,AOFAS and dorsal extension angleof ankle joint were (2.1 ± 1.0) scores,(82.8 ± 3.6) scores and (21.9 ± 4.8)°.The difference between pre-operation and 3 months after treatment of study group was significant(P ＜ 0.05).In control group,VAS,AOFAS and dorsal extension angle of ankle joint were (6.1 ± 0.7) scores,(49.1 ± 2.8) scores and (11.8 ± 3.6) ° before treatment,while VAS,AOFAS and dorsal extension range of ankle joint were (3.8 ± 1.2) scores,(56.0 ± 3.6) scores and (12.2 ± 3.2) ° at 3 months after treatment.There were significant differences in VAS between pre-treatment and 3 months after treatment (P ＜ 0.05).There were no significant differences in AOFAS and dorsal extension angleof ankle joint between pre-treatment and 3 months after treatment (P ＞ 0.05).At 3 months after treatment,there were significant differences in VAS,AOFAS and dorsal extension angle of ankle joint between two groups(P ＜ 0.05),and the outcome of study gronp was better than the control group.Conclusions PMGR can not only relief pain of foot but also improve ankle function.This is an effective surgical treatment for unilateral chronic plantar fasciitis.
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Guided by Chinese medicine culture,the strengthening of the cultural self-confidence of Chinese medicine is the cornerstone of the personnel training majoring in Chinese material medica.With the rapid development of modern medicine,the personnel training of the undergraduate students majoring in Chinese material medica in the universities of western medicine is facing several problems,such as lack of cultural identity,lack of professional confidence,unsteadiness of professional thinking,and changes of employment direction.For these problems,based on the main line "Solidify the cultural foundation of Chinese medicine,strengthen the self-confidence of Chinese material medica",our school selected the Chinese medicine cultural traveling,social practices and Chinese medicine employment guidance curriculum as the starting points,and carried out various of lively and vivid activities,which had positive impacts on the learning enthusiasm and professional love of the undergraduate students majoring in Chinese material medica.
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Objectives To discuss the diagnosis and treatment of patellar plica under arthroscopy.Methods A retrospective survey was performed in 75 cases with patellar plicas under arthroscopy from Jun.2008 to June.2012.All patients were admitted by the clinic.All the patients diagnosised by arthroscopy and clinical evidence, and cuted off under arthroscopy.After the operation, patients were followed-up in the clinic and by telephone for 12 to 60 months, according to the knee joint Lysholm scoring system to assess curative effect.Results All the patients with successful operation, the operation time was 15-25 minutes.All cases after the operation without complications such as infection, quicker recovery of joint function.After 12 to 60 months, 70 patients were followed up, the knee joint Lysholm excellent score was 92.9％.Conclusions Inferior patellar plica under is a type of knee joint synovial plica syndrome, the arthroscopic surgery can determine diagnosis and do effective treatment.
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BACKGROUND: Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of interleukin-6mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function. OBJECTIVE: To observe the changes of interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy after high epidural anesthesia treatment. DESIGN: A case-controlled analysis. PARTICIPANTS: Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventianal treatment group. High epidural anesthesia group consisted of 22patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females,who received physical examination at the same period. INTERVENTIONS: Patients with dilated cardiomyopathy were treated with high epidural anesthesia and conventional method, whereas those in conventional treatment group were treated with conventional method only.Elbow venous blood of 3 Ml was sampled from all patients on empty stomach in the morning before treatment and after 4-week treatment. The level of serum interleukin-6 and soluble interleukin-2 receptor was measured with enzyme-linked immunoadsorbent assay. MAIN OUTCOME MEASURES: The level of serum interleukin-6 and soluble interleukin-2 receptor of patients in eachgroup. RESULTS: Blood samples of the 56 subjects were qualified and entered the final analysis.①The level of serum interleukin-6 was higher in dilated car diomyopathy group (13.9ng/L) than in healthy control group (11.22 ng/L) (z= -3.072, P ＜ 0.05). ② The level of serum interleukin-6 in high epidural anesthesia group was obviously decreased aftertreatment (11.42 ng/L) as compared with that before treatment (20.42ng/L) (z =2.582 9, P ＜ 0.05).The le vel of serum interleukin-6 in conventional treatment group was similar before and after treatmant(12.16 ng/L and 12.80 mg/L, z = -1.89,P ＞ 0.05). The difference of interleukin-6 level in high epidural anesthesiagroup (-2.04 ng/L)was obviously higher than that in conventional treat ment group (0.28 ng/L) (P ＜ 0.01) before and after treatment.③The level of serum soluble interleukin-2 receptor was higher in dilated car diomyopathy group[(1 306.17±1.46)ng/L]than in healthy control group [(1078.95±1.23) ng/L] (t =2.51, P ＜ 0.05). ④ The level of soluble intedeukin-2 receptor in high epidural anesthesia group was decreased after treatment [(1 086.68±1.34)ng/L]as compared with thatbeforetreatment [(1 328.01±1.51) ng/L], (t =2.145, P ＜ 0.05). The level of soluble interleukin-2 receptor in conventional treatment group was similar before and after treatment [(1 473.33±1.66) ng/L and (1 331.07±1.52) ng/L,t=-1.06, P ＞ 0.05]. CONCLUSION:The level of serum interleukin-6 and soluble inter leukin-2 receptor is significantly decreased after high epidural anesthesia, suggesting that high epidural anesthesia can regulate cytokines better than conventional treatment.The regulation of high epidural anesthesia is related to inhibition of sympathetic nervous system and humoral-im mune system.
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<p><b>OBJECTIVE</b>To investigate the effects of thoracic epidural blockade (TEB) on plasma fibrinogen (FIB) levels.</p><p><b>METHODS</b>Thirty cases of dilated cardiomyopathy (DCM) were selected randomly into a TEB group and a control group. TEB patients were subjected to a persistent TEB (T1 - 5), and injected with 0.5% lidocaine 3 - 5 ml every two or four hours for four weeks in addition to routine medicine, while patients in the control group were given routine medicine only. Plasma concentrations of FIB were measured using the micro-capillary assay. Doppler echocardiography was performed before and after the treatment.</p><p><b>RESULTS</b>Plasma concentrations of FIB in two groups were greater than the normal value before the treatment. There was a significant decrease of plasma concentrations of FIB in the TEB group after the treatment (4.2 +/- 1.3 g/L vs 3.6 +/- 0.9 g/L, P < 0.05), but there was no significant change in the control group (4.2 +/- 1.2 g/L vs 4.3 +/- 1.9 g/L, P > 0.05). After four weeks of treatment, the left ventricular end diastolic diameters (LVEDD) of TEB patients were reduced (72 +/- 10 mm vs 69 +/- 10 mm, P < 0.05) and the left ventricular ejection fraction (LVEF) of TEB patients increased significantly (33% +/- 13% vs 44% +/- 14%, P < 0.05). In contrast, LVEDD (73 +/- 11 mm vs 73 +/- 12 mm, P > 0.05) and LVEF (32% +/- 14% vs 33% +/- 12%, P > 0.05) did not change significantly in the control group.</p><p><b>CONCLUSIONS</b>The results suggest that plasma FIB levels in patients with DCM were decreased by performing a TEB, in addition to a reduction of the enlarged cardiac cavity and an improvement in cardiac systolic dysfunction. TEB might contribute to lowering the occurrence of thrombus and thromboembolism in patients with DCM. TEB might be a promising therapeutic method to improve the prognosis of DCM patients.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Anesthesia, Epidural , Autonomic Nerve Block , Cardiomyopathy, Dilated , Blood , Therapeutics , FibrinogenABSTRACT
Objective To investigate if diastolic function could be improved by cardiac sympathetic nerve blockade in patients with dilated cardiomyopathy (DCM). Methods Sixty consecutive cases of DCM were randomed into therapeutic group and control group. Patients in therapeutic group were administered thoracic epidural blockade (TEB) (T 1-5 ) with 0.5 % lidocaine intermittent injection every two hours for four weeks, in addition to some routine medicine, while patients in control group were only administered routine treatment. Then the parameters of left ventricular diastolic function were evaluated with Doppler echocardiography before and after four weeks. Results ①All the patients in TEB group felt better within five minutes after injection of lidocaine within local epidural cavity.Their symptoms were relieved more rapidly than those of the drug therapy alone. Some patients with NYHA class Ⅳ could lie down supine in a short time. Exercise tolerance increased in patients with NYHA class Ⅱ to Ⅲ. But symptoms and signs of patients in control group were relieved very slowly, some patients even got worsen. ② Thirteen of thirty in therapeutic group got improvement on diastolic function after treatment. One of thirty in this group deteriorated. In detail, six of fifteen patients with demonstrated improvement of left ventricular diastolic filling changed from having a restrictive filling pattern to having a pseudonormal left ventricular filling pattern. Four of nine patients with a pseudonormal filling pattern changed to have a delayed filling pattern.Three of six patients, left ventricular filling pattern moved from a pseudonormal left ventricular filling pattern to a normal filling pattern. Only one patient acquired a restrictive filling pattern from a pseudonormal filling pattern. In contrast, in control group one of thirty got improvement on diastolic function after treatment. Nine of thirty in this group deteriorated. Individual changes of left ventricular filling pattern showed that only one patient improved from a delayed filling pattern to normal filling pattern, whereas seven patients had a restrictive left ventricular filling pattern developed from a pseudonormal filling pattern and another two patients achieved a pseudonormal filling pattern from delayed filling pattern. Conclusions Diastolic function in patients with DCM was improved significantly by cardiac sympathetic nerve blockade. The approach has beneficial effects on the patients of DCM.
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Objective To explore the mechanism of effects of cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF) and left cardiac cavity size of patients with dilated cardiomyopathy.Method 121 consecutive patients with dilated cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEA group) and control group(c group).In TEA group,5％ lidocaine was injected into thoracic epidural cavity for about 4 to 8 weeks in addition with routine therapy.In c group,only routine therapy was used.We observe the changes of LVEF and left cardiac cavity size before and after treatment in both groups. Result In TEA group,after anesthesia,LVEF was increased from(31.3± 12.8) to(47.3± 21.3),P<0.001;left ventricular end－ diastolic diameter was reduced from(69.1± 7.1)to (65.1± 8.0),P<0.001;left atrial diameter was decreased from(44.0± 6.2)to(39.4± 7.2),P< 0.001. Conclusion Cardiac sympathetic anesthesia can effectively improve the ejection performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.
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Aim To investigate the effect of spinal substance P on the antinociceptive propoties of ketamine. Methods Using behaviors and Fos expression technique,the effects of intrathecal administration (it) of substance P of different dose on the ketamine induced antinociception were observed in the formalin test of mice. Results Compared with NS group, the amount of time that mice spent licking the injected paw was dose-dependently decreased in 20 and 30 mg?kg -1 groups(P