Objective: To verify that the TiO2 nanofilm dip-coated by sol-gel can reduce titanium alloy implants (TAI)'s heat production after microwave diathermy (MD). Methods: The effect of 40W and 60W MD on the titanium alloy substrate coated with TiO2 nanofilm (Experimental Group) and the titanium alloy substrate without film (Control Group) were analyzed in vitro and in vivo. Changes in the skeletal muscle around the implant were evaluated in ex vivo by histology. Results: After 20 min of MD, in vitro the temperature rise of the titanium substrate was less in the Experimental Group than in the Control Group (40W: 1.4 degrees C vs. 2.6 degrees C, p < .01, 60W: 2.5 degrees C vs. 3.7 degrees C, p<.01) and in vivo, the temperature rise of the muscle tissue adjacent to TAI was lower in the Experimental Group than in the Control Group (40W: 3.29 degrees C vs. 4.8 degrees C, p < .01, 60W: 4.16 degrees C vs. 6.52 degrees C, p < .01). Skeletal muscle thermal injury can be found in the Control Group but not in the Experimental Group. Conclusion: Sol-gel dip-coated TiO2 nanofilm can reduce the heat production of TAIs under single 40(similar to)60W and continuous 40W MD and protect the muscle tissue adjacent to the implants against thermal injury caused by irradiation. [GRAPHICS] .

Background:Metal implants can produce heat and damage adjacent tissues under microwave irradiation, which makes local metal implants in the body a contraindication for microwave therapy. However, with the wide application of titanium alloy implants which have low permeability and low conductivity, this concept has been challenged. Our team members have confirmed through previous research that continuous low-power microwave irradiation does not cause thermal damage to the surrounding tissues of the titanium alloy. Is there any other way to further increase the dose of microwave irradiation while reducing the heat production of titanium alloy implants? In this study, the effect of TiO2 nanofilm on reducing the heat production of titanium alloy implants in microwave field was verified by animal experiments, and the effect of TiO2 nanofilm on fracture healing was observed.Methods:30 rabbits were selected. In the experiment of temperature measurement, 10 rabbits were randomly divided into experimental group (n = 5) and control group (n = 5), and the contralateral lower limb of the rabbits in experimental group was set as the sham operation group. The right femurs in the experimental group were implanted with Ti6Al4V plates coated with TiO2 nanofilm, and the right femurs in the control group were implanted with common titanium alloy plates without TiO2 nanofilm. The same surgical procedure was used in the sham operation group, but no plate was implanted. The temperature of the deep tissue above the metal implant was measured with an anti-interference thermocouple thermometer during 20 minutes of microwave irradiation. The other 20 rabbits were randomly divided into two groups, experimental group (n = 10) and control group (n = 10). The femoral shaft fracture models were established again. Ti6Al4V plates coated with TiO2 nanofilm and common titanium alloy plates were implanted in the two groups, respectively, and both groups were exposed to continuous microwave irradiation with a power of 40 W or 60 W for 30 days after operation. The fracture healing was evaluated by X-ray at 0 day, 14 days, and 30 days after microwave irradiation, respectively. The animals were sacrificed at 30 days after operation for histopathological assessment.Results:The temperature in the experimental group, control group, and sham operation group increased significantly after 40 W and 60 W microwave irradiation (2.18 ± 0.15°C~6.02 ± 0.38°C). When exposed to 40 W microwave, the temperature rise of the control group was 4.0 ± 0.34°C, which was significantly higher than that of the experimental group 2.82 ± 0.15°C (P < 0.01) and the sham operation group 2.18 ± 0.33°C (P < 0.01). There was no significant difference in temperature rise between the experimental group and the sham operation group (P = 0.21). When exposed to 60 W microwave, the temperature rise of the control group was 6.02 ± 0.38°C, which was significantly higher than that of the experimental group 3.66 ± 0.14°C (P < 0.01) and sham operation group 2.96 ± 0.22°C (P < 0.01), and there was no significant difference between the experimental group and the sham operation group (P = 0.32). X-ray evaluation showed that there was no significant difference in callus maturity between the experimental group and the control group at 14 days (P = 0.554), but there was significant difference in callus maturity between the two groups at 30 days (P = 0.041). The analysis of bone histologic and histomorphometric data at 30 days was also consistent with this.Conclusion:Under the animal experimental condition, compared with the common titanium alloy implant, the TiO2 nanofilm can reduce the heat production of the titanium alloy implant in the 2450 MHz microwave field and has no adverse effect on fracture healing. This study opens up a promising new idea for the application of microwave therapy to metal implants in human body.

Extensive muscle atrophy is a common occurrence in orthopaedics patients who are bedridden or immobilized. The incidence is higher in intensive care unit (ICU) inpatients. There is still controversy about how to use neuromuscular electrical stimulation (NMES) in ICU patients. We aim to compare the effectiveness and safety of NMES to prevent muscle atrophy in intensive care unit (ICU) patients without nerve injury. ICU patients without central and peripheral nerve injury were randomized into experimental group I (Exp I: active and passive activity training (APAT) + NMES treatment on the gastrocnemius and tibialis anterior muscle), experimental group II (Exp II: APAT + NMES treatment on gastrocnemius alone), and control group (Ctl: APAT alone). Changes in the strength of gastrocnemius, the ankle range of motion, and the muscle cross-section area of the lower leg were evaluated before and after the intervention. Also, changes in prothrombin time, lactic acid, and C-reactive protein were monitored during the treatment. The gastrocnemius muscle strength, ankle joint range of motion, and cross-sectional muscle area of the lower leg in the three groups showed a downward trend, indicating that the overall trend of muscle atrophy in ICU patients was irreversible. The decrease in gastrocnemius muscle strength in Exp I and Exp II was smaller than that in the control group (P < 0.05), but there was no difference between Exp I and Exp II. The decrease in active ankle range of motion and cross-sectional area of the lower leg Exp I and Exp II was smaller than that in the control group (P < 0.05), and the decrease in Exp I was smaller than that of Exp II (all P < 0.05). The curative effect in Exp I was better than in Exp II. There were no significant differences in the dynamic changes of prothrombin time, lactic acid, and C-reactive protein during the three groups (P > 0.05). In addition to early exercise training, NMES should be applied to prevent muscle atrophy for patients without nerve injury in ICU. Also, simultaneous NMES treatment on agonist/antagonist muscle can enhance the effect of preventing muscle atrophy. This study was prospectively registered in China Clinical Trial Registry ( www.chictr.org.cn ) on 16/05/2020 as ChiCTR2000032950.

骨骼肌的生长和维持依赖于对肌肉活动与机械负荷的刺激反应,肌肉活动减少或机械负荷减少都会导致废用性肌萎缩,如因疾病长期卧床、骨折外伤石膏固定及其他原因需肢体制动等均会造成废用性肌萎缩,其主要特征是肌肉蛋白合成代谢下降,分解代谢增强,主要表现有肌肉湿重减少、肌纤维横截面积减少、慢肌纤维向快肌纤维转换、肌肉力量下降等[1-3].

股骨大粗隆撕脱骨折在临床工作中较为少见,易发生漏诊.因股骨大粗隆处肌肉止点附着较多,其受伤机制多是收缩肌群强烈收缩所致,对骨折块的牵拉力较大,使得骨折块发生移位较多.因此临床保守治疗难以保持骨折块复位的稳定性,易导致患者患肢外展无力,髋关节活动受限.近年来,本科室采用链条板空心钉对股骨大粗隆撕脱骨折进行切开复位内固定,临床效果满意.现将3例病例治疗体会报告如下.

Objective:To evaluate the effect of electromyographic biofeedback treatment on ulnar nerve injury in different degrees, and explore the correlation between ulnar nerve injury classification and electromyographic biofeedback therapy.Methods:A total of 96 patients with different degrees of ulnar nerve injury were divided into grade 1,2,3 (a=b=c=32) according to the McGowan classification, then they were randomly divided into control group (n=48) and treatment group (n=48). The control group was treated with medicine, kinesitherapy and laser physiotherapy, while the treatment group received electromyographic biofeedback therapy in addition,15 minutes per time, once a day, treated lasted for 8 weeks. The ulnar nerve function was regraded and analyzed to evaluate the effect after treatment.Results:After 8 weeks'treatment, patients of McGowan grade 1 in both groups were improved (P<0.05), and the improvement rate both were 75.00%. Patients of McGowan grade 2 had little improvement in the control group (P>0.05), and the improvement rate was 18.75%, while an obvious improvement in the treatment group (P<0.05), and the improvement rate was 75.00%. Patients of McGowan grade 3 in both groups had little improvement (P>0.05), and the improvement rate of the control group and the treatment group was 6.25%and 12.50%respectively.Conclusion:Electromyographic biofeedback therapy is not effective in treating ulnar nerve in McGowan grade 1, highly effective in McGowan grade 2, and combined treatment is significantly better than traditional therapy alone; but it is not effective in McGowan grade 3.

王先生溜冰时不慎滑倒,左手撑地后感到左手腕部疼痛难忍,马上就近就医.拍X线片显示未见骨折,医生嘱咐其减少活动,未做其他处理.休息3天王先生依然疼痛难忍,于是到上海市第六人民医院就诊.经检查,王先生左前臂下尺桡关节分离、左手舟状骨骨折,医生给予支具固定.

Microwave diathermy treatment has been successfully applied to such patients as for it can induce clinical hyperthermia to healing muscle skeletal injuries. However, as a contraindication, patients implanted with metallic implants for internal fixation of bone fracture could not take the microwave diathermy treatment. This is mainly due to microwave induced sudden temperature rise in metal implants, which will lead to heat damages in local tissues. The aim of this study is to improve the heat-resisting effect of titanium implants by modifying its surface. A uniform TiO2 coating has been designed and fabricated on the surface of Ti (TA3) substrate by the method of anodic oxidation to inhibit the excessive heat generation of metallic implants. In vitro microwave irradiation experiment, the temperature of Ti substrate increased 2.5 degrees C, TiO2 coated substrate increased only 1.4 degrees C, decreasing almost 50% under the same testing condition. The results indicate that the anodized TiO2 coating may be an effective method to reducing the temperature rise of the metal implants during microwave diathermy treatment, which will provide a potential rehabilitation solution to internal fixation of bone fracture.

Objective:To investigate the prevention knowledge of cervical spondylosis, lubar intervertebral disc protrusion, knee osteoarthritis and stroke, and their satisfaction and demand for community rehabilitation services in Shanghai residents, in order to popularize rehabilitation knowledge and improve rehabilitation treatment services in later stage, and to provide baseline data for establishing a complete three-level rehabilitation network and provide high-quality community rehabilitation services.Methods:The permanent residents in six street community health service centers and a level II hospital in Xuhui district (including Changqiao street, Caohejing street, Tianlin street, Tianping street, Xietu street, Xujiahui street and Dahua hospital) were chosed as the experimental group and subjects of the late intervention, and the residents in Putuo district (including Changfeng street, Caoyang street and other streets) as the control group. The time limit for investigation was from November 2013 to February 2014. Residents in Xuhui and Putuo district were investigated with questionnaire of their awareness of prevention knowledge of cervical spondylosis, lubar intervertebral disc protrusion, knee osteoarthritis and stroke, and satisfaction degree of community rehabilitation services by random cluster sampling, then their demands were analyzed.Results:We provided 4 000 questionnaires in Xuhui district, 3 461 were effective of the 3 565 recovered ones, the efficient rate was 97.08%. Correspondingly, we provided 1 000 questionnaires in Putuo district, 792 were effective of the 810 recovered ones, the efficient rate was 97.78%. The residents'awareness degrees of basic knowledge about cervical spondylosis, lubar intervertebral disc protrusion and knee osteoarthritis in two districts were 79.55%-95.05%, but the awareness degrees was deficient about stroke, especially in Putuo district, the awareness degrees was only 43.06%. The satisfaction degree of residents in Xuhui district on the rehabilitation equipment was 90.86%, the doctors'diagnosis and treatment was 80.33%, the technician skill was 83.17%, and the comprehensive rehabilitation services was 79.44%. The satisfaction degree of residents in Putuo district on the rehabilitation equipment was 60.21%, the doctors'diagnosis and treatment was 59.47%, the technician skill was 63.30%, and the comprehensive rehabilitation services was 63.29%.Conclusion:The understanding of cerebrovascular diseases, and regular education should be strengthened, residents in Shanghai are lack in participation to the community rehabilitation, and the coverage of rehabilitation treatment need to be improved. The facilities, medical teams and the services of community rehabilitation in Shanghai should be strengthened. More favorable policy should be issued to develop the community rehabilitation in Shanghai to meet the needs of the residents.

王先生溜冰时不慎滑倒,左手撑地后感到左手腕部疼痛难忍,马上就近到医院看病.拍X线片显示未见骨折,医生嘱其减少活动,未做其他处理.3天中王先生觉得疼痛难忍,又到上海市第六人民医院就诊.经检查,王先生左前臂下尺桡关节分离、左手舟状骨骨折,给予支具固定. 55岁的张女士,年轻时在野战部队当兵,因为夜行军把右脚崴了,当时限于条件没有及时就医.之后她的右脚经常扭伤,有时踩着路上的一个小小的石子也会崴脚.反复的扭伤使她右脚踝处经常红肿、疼痛.半年后她才被批准到驻地医院检查,经X线拍片发现她右踝部下胫腓关节分离、骨折,医生用石膏为其进行了固定,一个月后拆除石膏,拍X线片显示骨折处骨痂仍未形成,疼痛亦未减轻.以后张女士就落下了右踝经常扭伤,迁延不愈.

5月1日至7日是世界职业病日.原本职业病似乎只是和那些危险、有污染的岗位有关.但是,当我们整日面对电脑而患上颈椎病、腰间盘突出、"鼠标手"的时候,我们就会感到"职业病"这个词离我们越来越近.尤其是颈椎病,正在不知不觉间成为越来越多上班族的"密友".

BACKGROUND: Non-surgical spinal decompression system can be used for the treatment of diseased intervertebral discs and avoid contraction and resistance of paravertebral muscle during traction. At present, there is lack of analysis of the efficacy of non-surgical spinal decompression in the treatment of lumbar disc herniation through surface electromyography. OBJECTIVE: To compare the effect of non-surgical spinal decompression system DRX9000 with conventional traction device in the treatment of lumbar disc herniation through surface electromyography. METHODS: Totally 60 patients with lumbar disc herniation were randomly divided into DRX9000 group and general traction group, with 30 cases in each group. The patients in DRX9000 group were treated with non-surgical spinal decompression system DRX9000 and the patients in general traction group were treated with conventional tractor. All patients underwent surface electromyography examination of erector spinal muscle and multifidus muscle before and after all treatment to evaluate the strength and fatigue of paravertebral muscle. The Visual Analogue Scale and Japanese Orthopaedic Association scores were used to assess the degree of pain and impairment due to lumbar disc herniation. RESULTS AND CONCLUSION: (1) After all of the treatment, the average electromyogram and mean power frequency slope of affected erector spinal muscle and multifidus muscle in both groups were increased than those before treatment (P < 0.05). The data of DRX9000 group were significantly higher than that of the general traction group (P < 0.05). (2) After all the treatment, the Visual Analogue Scale score decreased and the Japanese Orthopaedic Association score increased in both groups at the end of treatment compared with before treatment (P < 0.05). The Visual Analogue Scale score of DRX9000 group was significantly lower than that of the general traction group (P < 0.05) and the Japanese Orthopaedic Association score of DRX9000 group was significantly higher than that of the general traction group (P < 0.05). (3) These results showed that non-surgical spinal decompression system could effectively improve paravertebral muscle activity and muscle strength, lessen muscle fatigue, relieve pain, and improve function in patients with lumbar disc herniation, and its effect is obviously better than that of general traction.

Exercise therapy is one of the comprehensive therapies for Alzheimer's disease besides drug treatment. But how to exercise is still controversial. The purpose of this study was to observe the effectiveness of moderate-intensity aerobic exercise (self-designed exercise program) on the cognitive function in patients with Alzheimer's disease. Sixty-five participants were randomly divided into aerobic exercise group (n=32) and control group (n=33). Patients in exercise group were given 40-min moderate intensity aerobic exercise training, 3 times per week for 4 months. The patients in control group only completed daily activities and did not receive aerobic exercise. Cognition function scales (MMSE, ADAS-cog and WMS-IV) were performed at baseline and after 4 and 8 months. After 4 months treatment and then 4 months follow-up, the MMSE and WMS-IV of exercise group were significantly higher than before treatment and control group (P<0.05). ADAS-cog was significantly lower than that before treatment and control group (P<0.05). After 4 months of treatment, the MMSE of control group was higher than before treatment (P<0.05). After 4 months follow-up, WMS-IV was significantly lower than that before treatment (P<0.05). The moderate-Intensity aerobic exercise can improve the cognitive function, especially memory function in AD patients.

The aim of the present study was to investigate the proliferation of skeletal muscle satellite cells (MSCs) under different amounts of microwave irradiation in fractures with titanium alloy internal fixation. A total of 45 male New Zealand adult white rabbits were used to establish a femoral shaft fracture and titanium alloy internal fixation model. The rabbits were randomly divided into the control group (group A) and the experimental groups (groups B and C). For 15 days, groups B and C were exposed to microwave treatment (25 or 50 W, respectively) for 10 min per day. The quadriceps femoris muscle was used for the isolation and culture of MSCs in vitro. The cultured cells were identified using cellular immunohistochemical staining. Transmission electron microscopy was used to observe mitochondrial ultrastructure damage, MTT assays were used to detect cell viability and cell cycle phases were analyzed by flow cytometry. The results revealed that, following 48 or 72 h of culture, cell viability was significantly greater in group B compared with group A, and was significantly lower in group C compared with group A (P<0.05). Compared with group A, the percentage of the cell population in the G0/G1 phase in group B was significantly decreased (P<0.05) and the proportion in the S and G2/M phases was increased (P<0.05). These results were reversed in group C; the percentage of cells in the S and G2/M phases was significantly lower (P<0.05) and in the G0/G1 phase was significantly higher (P<0.05) than in group A. These results suggested that in the healing of fractures with titanium, the proliferation of MSCs is significantly affected by microwave radiation in a dose-dependent manner.

With the acceleration of population aging, the incidence of senile osteoporotic fracture is rising, which attract more and more attention in the worldwide. In this paper, the osteoporotic fracture data including epidemiology, etiology, and pathogenesis were reviewed. The key section is rehabilitation exercise, and the related progress of drug therapy, exercise therapy, physical therapy and use of orthotics were also summarized. Key words: Aged; Osteoporotic fractures; Rehabilitation; Therapy

The psychological condition of caregivers of the patient with Alzheimer's disease(AD) will affect the treatment of disease. The caregiver psychological pressure and quality of life should also be concerned. This study will observe the effect of extended nursing based on “time it right” theory on psychological burden and quality of life of caregiver of AD patient. A total of 150 caregivers of patient with AD were divided into experimental group(EG) and control group(CG), 75 cases in each group. The patients of CG were given routine inpatient nursing and discharge nursing guidance of neurology department, meanwhile, the patients of EG received extended nursing based on “time it right” theory including meticulous and individualized nursing teaching, psychological counseling, and community rehabilitation, etc. The whole process lasted for 1 year. The scales of Zarit Caregiver Burden Interview (ZBI), symptom checklist 90(SCL-90), and the WHO of quality of life scale (WHOQOL-BREF) were performed before and after intervention in two groups. 1 years later, ZBI of the CG had no significant difference (P>0.05), while ZBI of the EG decreased significantly (P<0.05). There was a significant difference between the two groups (P<0.05). The finding indicated that the AD caregivers burden of the EG was relieved compared with the CG. The SCL-90 score of the CG was increased compared with before intervention (P < 0.05), while the SCL-90 score of the EG was decreased (P < 0.05). The statistically difference between the two groups were found (P < 0.05), which revealed that 1 years later the psychological burden of the EG was lighter than that of the CG. Compared with before intervention, the WHOQOL-BREF score of the CG was decreased significantly (P<0.05), while the WHOQOL-BREF score of the EG increased (P<0.05). There were statistical differences between the two groups (P<0.05), which showed that the quality of life of the EG was higher than that of the CG. The extended nursing based on “time it right” theory can obviously reduce the burden of caregivers of AD patient, improve their mental status and improve their quality of life.

BACKGROUND: Microwave treatment is a common physical therapy method that can increase the temperature and blood circulation of deep tissues, and is used for improving fracture repair. However, microwave treatment cannot be used if there is surgically implanted metal plate or screw. OBJECTIVE: To observe the dame of microwave treatment to the tissues surrounding the titanium alloy implants. METHODS: Forty-four New Zealand white rabbits were randomized into experimental and control groups. The model of the fracture at the middle of the femur was established in all rabbits, and the rabbits in the experimental group were implanted with titanium alloy internal fixation systems. A 30-day microwave treatment (2 450 MHz, 20 W or 40 W, 20 minutes daily) was applied to the fracture site in all rabbits at 3 days after operation. RESULTS AND CONCLUSION: After 20 W of wave microwave treatment, the temperature of tissues around the implants showed no significant increase or severe heat injury. While, 40 W of wave microwave treatment significantly increased the temperature of tissues around the implants and the tissue was damaged severely. Our results indicate that, the low-dosage microwave treatment may be a promising method in the rehabilitation therapy of fractures with titanium alloy internal fixation.

腕管综合征源于正中神经在手腕部的腕管内受卡压,其发病率在美国约为0.4％,我国尚无明确统计,在门诊临床工作中此症多见于中老年女性.随着移动设备的普及,因为疲劳、使用过度,腕管综合征有年轻化趋势,“鼠标手”的出现就是表现之一.

66岁的林阿姨终于当上了外婆,对小孙孙非常疼爱,宝宝醒着就不离手地抱着,宝宝睡着了还兴致盎然地编织花花绿绿的毛衣毛裤,朋友见了,笑称宝宝穿到5岁都够了.可是宝宝不到1岁时,林阿姨的双手腕开始感觉疼痛,做家务都觉得痛,甚至半夜痛醒、麻醒.林阿姨先看了骨科,医生诊断其患有“腕管综合征”,可以手术治疗.但是林阿姨害怕手术,故来我科就诊.经过必要的检查,我们认为林阿姨可以先用保守方法治疗,如果疗效不明显,再手术亦不迟 后来,林阿姨接受康复医学科三个月的规范治疗后,症状得到了控制.

目的 观察SDS9900颈椎脊柱减压系统治疗神经根型颈椎病患者的临床疗效及复发率.方法 选取本院康复医学科门诊治疗的神经根型颈椎病患者112例并随机分为治疗组及对照组各56例.治疗组采用SDS9900颈椎脊柱减压系统及动态干扰电治疗,对照组则用常规颈椎牵引及动态干扰电治疗.于治疗前、治疗6周后对两组患者采用目测类比评分法(visual analog scales,VAS)及颈椎病临床评价量表(elinicol assessment scale for cervical spondylosis,CASCS)对两组患者进行评定,并于治疗结束后3个月、6个月、1年对患者进行随访.结果 两组患者分别经6周治疗后,发现患者VAS评分及CASCS评分结果均较治疗前好转,上述指标均以治疗组的改善幅度较显著,与对照组间差异具有统计学意义(P＜0.05);3个月后随访,两组复发率无统计学差异;6个月后,治疗组复发率低于对照组(P＜0.05),1年后,治疗组复发率明显低于对照组(P＜0.01);结论 SDS9900颈椎脊柱减压系统可有效缓解神经根型颈椎病患者的疼痛,提高颈椎功能,并具有较好的远期疗效且复发率低.