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  • 文章类型: Journal Article
    膝关节骨性关节炎的关节内注射是疼痛管理的治疗选择之一,并延迟了膝关节手术的需要。该程序已推广了各种材料,范围从皮质类固醇到粘胶补充剂到最近的自体生物材料。尽管人们对材料选择的关注和兴趣日益增加,功效,安全,以及这种干预的效果,尚未使用Scopus数据库进行全面的文献计量分析。在这个文献计量分析中,我们回顾了2003年至2023年的Scopus数据库,以调查有关关节内注射治疗膝骨关节炎的文献.本综述共纳入1,318篇符合选择标准的文章。干预趋势自2006年以来呈现变化,2006年以前以注射糖皮质激素和透明质酸为主。然而,从2010年开始,生物制剂出现了明显的转变,比如富含血浆的蛋白质,和自体材料,包括骨髓抽吸和基质血管部分。这种转变反映了人们对再生医学的兴趣日益增加,以及这些新疗法提供改善结果的潜力。绝大多数文章是由来自欧洲国家的研究人员和临床医生撰写的,美利坚合众国(美国),和澳大利亚。同样,引用次数最多的大部分文章是由这些地区的研究人员和临床医生撰写的.这种在关节内注射领域使用Scopus的综合文献计量分析有可能成为研究人员的路线图,临床医生,和政策制定者,促进知情决策,促进合作倡议,并指导未来研究的发展,以进一步推进膝关节内注射的选择,特别是在膝骨关节炎的管理。
    Intraarticular injection of osteoarthritis knee is one of the treatment options for pain management and delays the need for knee surgery. Various materials have been promoted for the procedure, ranging from corticosteroid to viscosupplement to the more recent autologous biological materials. Despite the increasing attention and interest in regard to the material selection, efficacy, safety, and effect of this intervention, a comprehensive bibliometric analysis using the Scopus database has yet to be conducted. In this bibliometric analysis, we reviewed the Scopus database from 2003 to 2023 to investigate the literature on intraarticular injection for the treatment of knee osteoarthritis. A total of 1,318 articles that satisfied the selection criteria were included in this review. The trend of intervention shows changes since 2006, with corticosteroid injection and hyaluronic acid as the main topics of publication before 2006. However, starting in 2010, there has been a noticeable shift towards biological agents, such as plasma-rich proteins, and autologous materials, including marrow aspiration and stromal vascular fraction. This shift reflects the increasing interest in regenerative medicine and the potential of these newer therapies to provide improved outcomes. The overwhelming majority of the articles were authored by researchers and clinicians from across European countries, the United States of America (USA), and Australia. Similarly, most of the articles with the highest number of citations were authored by researchers and clinicians from these regions. This comprehensive bibliometric analysis using Scopus in the domain of intraarticular injection has the potential to act as a roadmap for researchers, clinicians, and policymakers, facilitating informed decision-making, promoting collaborative initiatives, and guiding the development of future studies to further advance the options of knee intraarticular injection, specifically in the management of knee osteoarthritis.
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  • 文章类型: Journal Article
    肝肺综合征(HPS)是由肺内血管异常扩张和分流定义的,导致氧气交换受损。这种情况是由肝脏之间复杂的相互作用引起的,胃肠系统,还有肺.这个复杂的系统主要影响肺内皮,免疫调节,和呼吸道上皮细胞。因此,这有助于HPS的病理性肺部改变。已经提出了基于氧缺乏严重程度的分类系统来对HPS的生理功能进行分级。对比增强超声心动图被认为是识别肺部异常血管扩张的主要放射学评估。which,结合肺泡-动脉梯度升高,对做出诊断至关重要。肝移植是唯一有效的确定性治疗方法,可以逆转病情。尽管经常没有症状,HPS在移植前具有显著的死亡风险,不管肝脏疾病的严重程度。同时,关于肝移植后存活率的数据各不相同.与引入MELD之前的时期相比,采用终末期肝病(MELD)标准例外政策模型显着改善了HPS患者的结果。这篇综述总结了目前的理解,强调HPS诊断和治疗的最新进展。此外,它的目的是通过从实验模型和转化研究中得出的见解来增强对疾病基本机制的理解。
    Hepatopulmonary syndrome (HPS) is defined by abnormally dilated blood vessels and shunts within the lungs, leading to impaired oxygen exchange. This condition results from intricate interactions between the liver, the gastrointestinal system, and the lungs. This complex system primarily affects pulmonary endothelial, immunomodulatory, and respiratory epithelial cells. Consequently, this contributes to pathological pulmonary changes characteristic of HPS. A classification system based on the severity of oxygen deficiency has been proposed for grading the physiological dysfunction of HPS. Contrast-enhanced echocardiography is considered the primary radiological evaluation for identifying abnormal blood vessel dilations within the lungs, which, combined with an elevated alveolar-arterial gradient, is essential for making the diagnosis. Liver transplantation is the sole effective definitive treatment that can reverse the course of the condition. Despite often being symptomless, HPS carries a significant risk of mortality before transplantation, regardless of the severity of liver disease. Meanwhile, there is varying data regarding survival rates following liver transplantation. The adoption of the model for end-stage liver disease (MELD) standard exception policy has notably improved the results for individuals with HPS compared to the period before MELD was introduced. This review offers a summary of the present understanding, highlighting recent advancements in the diagnosis and treatment of HPS. Furthermore, it aims to augment comprehension of the condition\'s fundamental mechanisms through insights derived from experimental models and translational research.
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  • 文章类型: Case Reports
    Opalski综合征是Wallenberg综合征(延髓外侧综合征)的一种罕见变种,表明伴随同侧偏瘫是由于延髓外侧和颈脊髓内的梗塞,这也延伸到锥体后截流影响皮质脊髓束。
    一名56岁男子最初表现为单侧头痛伴右侧颈椎疼痛。因此,他出现了Wallenberg综合征的症状:眩晕,发音困难,构音障碍,右肢体共济失调有跌倒倾向,和上睑下垂,除了同侧偏瘫。最初进行的弥散加权成像MRI(DWIMRI)显示延髓背外侧急性梗塞。因此,轴向T2加权MRI显示同一区域的高强度局灶区,即使磁共振血管造影(MRA)显示相应的椎动脉完全狭窄。
    Opalski综合征可由不同的病因如血管闭塞或夹层引起。虽然症状可能有所不同,患者通常表现为突然虚弱,眩晕,和步态不稳定。诊断通常依赖于MRI或DW-MRI。治疗取决于个体因素,可能涉及药物和监测。可能发生呼吸衰竭等并发症,但与Opalski综合征没有直接联系。适当的管理包括解决缺血性危险因素和确保适当的营养。
    该病例强调了在临床怀疑同侧延髓外侧梗死和超急性同侧偏瘫患者的鉴别诊断中早期纳入Opalski综合征的重要性。
    UNASSIGNED: Opalski syndrome is a rare variant of Wallenberg syndrome (lateral medullary syndrome) that demonstrates concomitant ipsilateral hemiplegia due to infarctions within the lateral medulla and the cervical spinal cord, which also extend to the post-pyramidal decussation to affect the corticospinal tract.
    UNASSIGNED: A 56-year-old man initially presented with a unilateral headache with right cervical pain. Consequently, he developed symptoms that indicate Wallenberg syndrome: vertigo, dysphonia, dysarthria, right limb ataxia with a tendency to fall, and ptosis, in addition to ipsilateral hemiparesis. The diffusion-weighted imaging MRI (DWI MRI) performed initially demonstrated an acute infarct in the dorsolateral medulla. Accordingly, an axial T2-weighted MRI showed a hyperintense focal region in the same area, even as magnetic resonance angiography (MRA) revealed complete stenosis of the corresponding vertebral artery.
    UNASSIGNED: Opalski syndrome can result from different etiologies such as vascular occlusion or dissection. Although symptoms may vary, patients commonly present with sudden weakness, vertigo, and gait instability. Diagnosis often relies on MRI or DW-MRI. Treatment is tailored depending on individual factors and may involve medications and monitoring. Complications like respiratory failure can occur but are not directly linked to Opalski syndrome. Proper management includes addressing ischemic risk factors and ensuring appropriate nutrition.
    UNASSIGNED: This case highlights the importance of including Opalski syndrome early in the differential diagnosis of patients with clinically suspected ipsilateral lateral medullary infarction and hyperacute ipsilateral hemiparesis.
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  • 文章类型: Journal Article
    人工智能(AI)通过利用数据来构建可以为临床工作流程提供信息的模型,显示出改善医疗保健的潜力。然而,需要访问大量不同的数据来开发健壮的可概括模型。由于法律原因,跨机构的数据共享并不总是可行的,安全,和隐私问题。联合学习(FL)允许对AI模型进行多机构培训,避免数据共享,尽管有不同的安全和隐私问题。具体来说,在FL期间交换的见解可能会泄露有关机构数据的信息。此外,当在执行计算的实体之间存在有限的信任时,FL可能引入问题。随着FL在医疗保健中的应用越来越多,必须阐明潜在的风险。因此,我们在这项工作中总结了隐私保护的FL文献,特别是在医疗保健方面。我们提请注意威胁并审查缓解方法。我们预计这篇评论将成为医疗保健研究人员关于FL安全和隐私的指南。
    Artificial intelligence (AI) shows potential to improve health care by leveraging data to build models that can inform clinical workflows. However, access to large quantities of diverse data is needed to develop robust generalizable models. Data sharing across institutions is not always feasible due to legal, security, and privacy concerns. Federated learning (FL) allows for multi-institutional training of AI models, obviating data sharing, albeit with different security and privacy concerns. Specifically, insights exchanged during FL can leak information about institutional data. In addition, FL can introduce issues when there is limited trust among the entities performing the compute. With the growing adoption of FL in health care, it is imperative to elucidate the potential risks. We thus summarize privacy-preserving FL literature in this work with special regard to health care. We draw attention to threats and review mitigation approaches. We anticipate this review to become a health-care researcher\'s guide to security and privacy in FL.
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  • 文章类型: Journal Article
    肾动脉去神经已重新成为高血压患者的潜在治疗选择,尤其是那些对常规药物治疗有抵抗力的人.这篇全面的综述探讨了仔细选择患者的重要性,程序技术,临床疗效,安全考虑,肾动脉去神经在高血压管理中的未来方向。利用广泛的现有证据,本综述旨在全面了解该方法及其在当代高血压治疗模式中的作用.
    Renal artery denervation has re-emerged as a potential therapeutic option for patients with hypertension, especially those resistant to conventional pharmacotherapy. This comprehensive review explores the importance of careful patient selection, procedural techniques, clinical efficacy, safety considerations, and future directions of renal artery denervation in hypertension management. Drawing upon a wide range of available evidence, this review aims to provide a thorough understanding of the procedure and its role in contemporary hypertension treatment paradigms.
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  • 文章类型: Journal Article
    目的:这项研究的目的是提出脊髓刺激(SCS)的关键技术和监管里程碑,以视觉表现的叙事时间表来管理慢性疼痛,尽可能依靠原始来源。
    方法:我们根据科学出版物和美国食品药品监督管理局(FDA)的批准,确定了促进和加强治疗的SCS技术进步。我们提出的里程碑仅限于在关键适应症和新技术验证的背景下首次使用。我们主要关注疼痛管理,但其他适应症(例如,多发性硬化症中的运动障碍)在影响技术发展时被包括在内。
    结果:我们为SCS技术和美国FDA里程碑制定了全面的视觉和叙事时间表。自1960年代提出以来,SCS神经调节的科学技术不断发展。进展跨越引线设计(从桨式到经皮,和增加的电极触点)和刺激器技术(从无线电力到内部供电和可充电,有了小型化的部件,和可编程多通道设备),具有扩展的刺激程序灵活性(例如突发和千赫刺激频率),以及使用功能(如远程编程和磁共振成像条件兼容性)。
    结论:此时间表代表了SCS技术的发展以及FDA批准的适应症的扩展。
    OBJECTIVE: The aim of this study was to present key technologic and regulatory milestones in spinal cord stimulation (SCS) for managing chronic pain on a narrative timeline with visual representation, relying on original sources to the extent possible.
    METHODS: We identified technical advances in SCS that facilitated and enhanced treatment on the basis of scientific publications and approvals from the United States (US) Food and Drug Administration (FDA). We presented milestones limited to first use in key indications and in the context of new technology validation. We focused primarily on pain management, but other indications (eg, motor disorder in multiple sclerosis) were included when they affected technology development.
    RESULTS: We developed a comprehensive visual and narrative timeline of SCS technology and US FDA milestones. Since its conception in the 1960s, the science and technology of SCS neuromodulation have continuously evolved. Advances span lead design (from paddle-type to percutaneous, and increased electrode contacts) and stimulator technology (from wireless power to internally powered and rechargeable, with miniaturized components, and programmable multichannel devices), with expanding stimulation program flexibility (such as burst and kilohertz stimulation frequencies), as well as usage features (such as remote programming and magnetic resonance imaging conditional compatibility).
    CONCLUSIONS: This timeline represents the evolution of SCS technology alongside expanding FDA-approved indications for use.
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  • 文章类型: Journal Article
    颅骨融合是一种非典型的颅骨形状,其特征是颅骨缝线过早融合。它是颅面外科医生遇到的最常见的先天性异常之一,每2000-2500名新生儿中就有一名。它分为两种主要类型:综合征和非综合征。在综合症中,患者出现涉及躯干的其他异常,脸,或四肢。而在非综合征中,唯一的异类是过早融合,通常涉及一个缝合;最常见的亚型是单冠状,矢状,双冠带,metopic,还有Lambdoid.因此,在自然时间之前的过早融合限制了大脑生长的空间,颅内压升高,会对脑组织造成损伤,影响孩子的发育。这篇综述全面提供了非综合征性颅骨融合的详细概述,旨在强调早期和准确诊断的重要性。并确定最合适的干预措施,无论是手术或保守的方式。最佳治疗方法产生最有利的美学和功能结果。
    Craniosynostosis is an atypical skull shape characterized by the premature fusion of cranial sutures. It is one of the most common congenital anomalies encountered by craniofacial surgeons, with a prevalence of one in every 2000-2500 births. It is classified into two main types: syndromic and nonsyndromic. In syndromic, the patient presents with other abnormalities involving the trunk, face, or extremities. While in nonsyndromic the only anomy is the premature fusion, which usually involves one suture; the most common subtypes are unicoronal, sagittal, bicoronal, metopic, and lambdoid. As a consequence, premature fusion before its natural time restricts the space for the brain to grow, increases intracranial pressure, causes damage to the brain tissue, and affects the development of the child. This review comprehensively provides a detailed overview of nonsyndromic craniosynostosis and aims to highlight the importance of early and accurate diagnosis, and determining the most suitable intervention, whether surgical or conservative modalities. The optimal treatment approach produces the most favorable aesthetic and functional outcomes.
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  • 文章类型: Journal Article
    最大自愿咬合力(MVBF)的大小由下颌提升肌的联合作用决定,是下颌生物力学和反射过程的改变。咬力(BF)测量可以产生有关颌骨肌肉活动和功能的有价值的信息。咬力测量的准确性取决于几个变量,包括年龄,性别,错牙合,龋齿,假牙和颞下颌关节(TMJ)。这些信息对于评估咀嚼系统的发展和功能至关重要,识别潜在的异常或损伤,并指导儿科患者的适当治疗干预措施。本文的目的是回顾有关影响咬合力的因素以及这些因素在评估牙齿发育和指导咬合力相关问题的儿科患者干预措施中的重要性的文献。此外,为不同年龄段的咬合力建立标准值可以帮助监测生长并检测与预期模式的任何偏差。测量儿科患者的咬合力对于全面的口腔健康评估和管理具有重要意义。
    The amount of maximum voluntary bite force (MVBF) is determined by the combined action of the jaw elevator muscles, which are altered jaw biomechanics and reflex processes. Bite force (BF) measurements can yield valuable information on the activity and function of the jaw muscles. The accuracy of biting force measurements depends on several variables, including age, gender, malocclusion, dental caries, dental prostheses and temporomandibular joint (TMJ). This information is essential for evaluating the development and function of the masticatory system, identifying potential abnormalities or impairments and guiding appropriate treatment interventions for paediatric patients. The aim of this article is to review the literature on the factors affecting bite force and the importance of these factors in assessing dental development and guiding interventions for paediatric patients with bite force-related issues. Additionally, establishing normative values for bite force in different age groups can aid in monitoring growth and detecting any deviations from expected patterns. Measuring bite force in paediatric patients is significant in comprehensive oral health assessment and management.
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  • 文章类型: Journal Article
    背景:帕金森病(PD)是一种以运动障碍为特征的神经退行性疾病,尤其是在步态障碍方面。物理治疗,专注于特定任务的培训,已证明在缓解PD患者的症状和增强功能能力方面具有一定的功效。重复经颅磁刺激(rTMS)已成为改善PD患者运动功能的潜在治疗干预措施。
    目的:这篇综述文章旨在研究rTMS与任务特定训练相结合对PD患者步态表现的影响。
    方法:PubMed,物理治疗证据数据库(PEDro),和Scopus都进行了相关研究。搜索的重点是研究将rTMS与特定任务训练相结合以改善PD患者步态表现的有效性的研究。
    结果:4项研究被确定为符合资格标准,并被纳入研究。rTMS与特定的跑步机训练和负重练习相结合,可以显着提高步行效率,包括步行速度的提高,自我流动性,和步进率。此外,rTMS和特定任务培训的结合,比如基于跑步机的训练,在增强PD患者的步态表现方面显示出希望。
    结论:针对初级运动皮层(或M1)的高频rTMS可导致步行速度提高,自我流动性,和步进率。然而,关于有步态问题的个体的辅助运动区(SMA)的低频刺激的研究有限.需要进一步的研究来确定rTMS的最佳参数,比如力量,频率,和刺激的持续时间,值得考虑加入额外的训练方式,包括认知练习。
    BACKGROUND: Parkinson\'s disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD.
    OBJECTIVE: This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD.
    METHODS: PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD.
    RESULTS: Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD.
    CONCLUSIONS: High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.
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  • 文章类型: Journal Article
    胫骨干骨折是最常见的骨科损伤之一。胫骨干开放性骨折相对常见,因为骨周围的软组织很少。尽管这些伤害很普遍,最优固定策略仍然是一个争论的话题。本文的目的是回顾有关开放性胫骨干骨折固定策略的现有文献,包括髓内钉,外固定,和电镀。
    Tibial shaft fractures are one of the most common orthopaedic injuries. Open tibial shaft fractures are relatively common because of the paucity of soft tissue surrounding the bone. Despite the prevalence of these injuries, the optimal fixation strategy is still a topic of debate. The purpose of this article was to review the current literature on open tibial shaft fracture fixation strategies including intramedullary nailing, external fixation, and plating.
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