Application of four-grade functional activity score in early pain management of patients after radical mastectomy / 中国实用护理杂志

Objective:To investigate the application of four-grade functional activity score (FAS) in early pain management of patients after radical mastectomy, so as to provide theory basis for the early management of cancer pain.Methods:Ninety-six patients underwent radical mastectomy in Sichuan Maternal and Child Health Hospital from April 2019 to June 2020 were enrolled, and divided into two groups by random number table methods, each with 48 cases. The control group received routine nursing combined with Numerical Rating Scale (NRS), based on this, the study group received FAS. Then the pain degree, first activity time of out-of-bed, surgical wound recovery time, drainage tube placement time, hospital stay length, quality of life (FACT-B), upper limb function, and incidence of complications were compared between the two groups.Results:NRS score at the initial event, first activity time of out-of-bed, surgical wound recovery time, drainage time, hospital stay length were (3.42 ± 1.54) points, (8.52 ± 1.20) h, (7.42 ± 2.43) d, (6.25 ± 2.13) h, (7.58 ± 2.31) d in the study group, and (5.76 ± 1.43) points, (12.42 ± 1.42) h, (10.12 ± 2.52) d, (10.08 ± 2.42) h, (10.16 ± 3.44) d in the control group, there were significant differences between the two groups ( t values were 4.31-14.53, all P<0.05). The incidence of complications was 6.25% (3/48) in the study group, and 16.67% (8/48) in the control group, there was significant difference between the two groups ( χ2=6.56, P<0.05). The total score of FACT-B, joint activity at 1 month after operation, effective cough and turning times with 1 d after operation were (84.48 ± 11.75) points, (28.75 ± 2.58)°, (6.64 ± 2.35) times, (6.10 ± 1.45) times in the study group, and (75.26 ± 11.88) points, (15.38 ± 4.76)°, (3.43 ± 1.25) times, (4.35 ± 1.13) times in the control group, there were significant differences between the two groups ( t values were 3.82-17.11, all P<0.05). There was significant difference in the muscle strength of grade between the two groups ( Z=1.21, P<0.05). Conclusions:FAS in the early pain management of patients after radical mastectomy can shorten the first activity time of out-of-bed and hospital stay length, relieve pain, promote muscle and joint function exercise, reduce the incidence of complications, and improve the quality of life.

Therapeutic Observation of Shipiyin Combined with Diosmin in Treatment of Lymphedema with Spleen Yang Deficiency Syndrome After Modified Radical Mastectomy / 中国实验方剂学杂志

ObjectiveTo investigate the clinical effect of Shipiyin combined with diosmin in the treatment of lymphedema with spleen Yang deficiency syndrome（SYDS）after modified radical mastectomy and the specific effect on the function of the affected limb. MethodEighty-two patients with lymphedema with SYDS after modified radical mastectomy from outpatient and inpatient department of breast department and oncology department of the First Affiliated Hospital of Hunan University of Chinese Medicine were randomly divided into an observation group（41 cases） and a control group（41 cases）. The control group was given diosmin tablets（0.9 g per time， two times per day）on the basis of conventional treatment，and the observation group was given Shipiyin（one dose per day）on the basis of the control group. The course of treatment was 14 days. The clinical symptoms were observed and the limb circumference，traditional Chinese medicine（TCM） syndrome score，functional assessment of cancer therapy-breast cancer（FACT-B） score，disability of arm， shoulder and hand questionnaire（DASH） score，and joint range of motion were measured to analyze the TCM syndrome therapeutic effect and clinical efficacy. ResultAfter 14 days of treatment， the total effective rate of the observation group was 85.37% （35/41） and that of the control group was 63.41% （26/41） in the TCM symptoms， showing a statistically significant difference （Z=-2.212， P<0.05）. In terms of the clinical efficacy， the total effective rate in the observation group was 82.93% （34/41） and that in the control group was 75.61% （31/41）， indicating a statistically significant difference （Z=-2.061， P<0.05）. Compared with the situations before treatment， the scores of clinical symptoms such as the swelling of the upper limb， pain， sense of heaviness， stuffiness， fatigue， fullness， tightness， and skin keratosis and pruritus in the two groups were significantly lowered （P<0.01） after treatment. Compared with the control group， the observation group could better improve the swelling and fullness（P<0.01），as well as the feeling of pain，heaviness，stuffiness，fatigue，tightness，skin keratosis and pruritus （P<0.05）of the upper limbs of patients. The affected limb circumference， TCM syndrome score， and DASH score decreased significantly， while the FACT-B score and upper limb joint range of motion increased significantly in the two groups after treatment （P<0.01）. Compared with the control group， the observation group showed significantly reduced limb circumference at 10 cm proximal to the elbow striae， lowered TCM syndrome score， elevated FACT-B score（P<0.05）， decreased DASH score and improved range of motion of the upper limb joint （P<0.01） after treatment. ConclusionShipiyin combined with diosmin has better clinical efficacy in the treatment of lymphedema with SYDS after modified radical mastectomy than diosmin alone，which can better improve the clinical symptoms，signs，quality of life and limb functional activity of patients. This provides a new clinical program for the treatment of lymphedema after breast cancer surgery with integrated Chinese and western medicine.

Effect of Danggui Buxuetang on Functional Activity of Endothelial Progenitor Cells Exposed to Shear Stress / 中国实验方剂学杂志

Objective:To investigate the effect of Danggui Buxuetang（DGBX）on the functional activity of rat endothelial progenitor cells（EPCs）exposed to different luminar shear stress （SS）. Method:EPCs isolated from rat bone marrow were incubated on a parallel plate flow chamber at a steady SS of 0， 0.12， 1.2， 2.4 Pa for 6 h，then the cells exposed to different SS were randomly divided into 8 groups： control group （perfused with serum free medium），simvastatin group（0.1 μmol·L^-1simvastatin），3 DGBX groups（low，medium，high-dose DGBX）and 3 inhibitor groups（3 DGBX groups with LY294002）. After 12 h，the samples were collected for the detection of cell proliferation ，migration，tubule formation ，the secretion of nitric oxide （NO） ，and the expressions of endothelial nitric oxide synthase（eNOS） mRNA and protein kinase B（Akt），respectively. Result:Compared with the control group，simvastatin and DGBX（high-dose）could both promote the functional activities and NO secretion，and up-regulate the expressions of eNOS mRNA and Akt protein in EPCs exposed to different SS（<italic>P</italic><0.05），while DGBX（mid-dose）could do these only at 0 Pa. However，LY294002 could inhibit all effects of DGBX on EPCs. Conclusion:SS seems to play an important role in the effect of DGBX on EPCs，and DGBX could promote the functional activity of EPCs exposed to SS by up-regulating the expressions of NO/eNOS/Akt.

Systematic Review on Studies of in vivo Patellofemoral Joint Kinematics / 医用生物力学

Patellar tracking disorder is recognized as one of the major causes of the pathophysiological mechanism in patellofemoral pain syndrome. This paper reviewed the results of patellofemoral kinematic analyses and summarized the motion characteristics of six-degrees-of-freedom (6DOF) of patellofemoral joints under different functional activities. Patella has a relatively unified trend in lateral, anterior and posterior translation, tilt and flexion. However, different measurements limit an in-depth comparison between studies. In the future, widely applying magnetic resonance(MRI) or/and dual fluoroscopic imaging system (DFIS), standardizing the establishment of coordinate system or definition and use of morphological parameters, and increasing sample size will contribute to explicating the 6DOF motion characteristics of patellofemroal joints in vivo and improve the clinical evaluation on kinematic function of patellofemroal joints.

In vitro functional similarity assessment of a proposed biosimilar BAT1706 to bevacizumab / 药学学报

Biosimilars are biological medicinal products that are highly similar to an already licensed reference product in terms of quality, safety, and efficacy. BAT1706 is being developed by Bio-Thera Solutions, Ltd. as a proposed biosimilar candidate to bevacizumab reference product (Avastin®). Bevacizumab acts by specifically binding to vascular endothelial growth factor A (VEGF-A), and preventing the interaction of VEGF-A with its receptors on the surface of endothelial cells, then blocking the downstream signaling pathway mediated by ligand-receptor, and inhibiting endothelial angiogenesis, thus inhibiting tumor growth. Comprehensive analytical characterization studies incorporating orthogonal analytical techniques were performed to compare the in vitro functional activities of BAT1706 and Avastin®. BAT1706 and Avastin® showed highly similar binding activity to multiple VEGF-A isoforms and equivalent VEGF-A neutralizing activity, as well as inhibitory activity of VEGF receptor (VEGFR)-2 tyrosine kinase autophosphorylation. Both products exhibited similar binding of the Fcγ receptors and a lack of Fc-related effector functions such as antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC). Overall, the results demonstrate that BAT1706 and Avastin® are highly similar in terms of in vitro functional activities.

A Study To Analyse The Effects Of Fascial Manipulation On The Lateral Thigh Region In Mechanical Low Back Pain

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders, affecting up to 90% of people at some point in their lifetime. Up to 50% will have more than one episode of back pain. Previous studies have highlighted the benefits of fascial manipulation for chronic low back pain over manual therapy alone. But early detection of densification of specific points in the lateral thigh region in low back pain subjects in an acute phase itself will be of benefit in resolving the back pain as the deep friction on these points aims at restoring the physiological gliding properties of the fascia and lead to immediate pain relief in the low back, increased range of motion and improved functions. Methods: Sixty individuals were enrolled for the study and were randomly allotted to two groups using a simple random method, were samples were randomly allocated by the primary investigator before baseline assessment. Control group subjects in Group A received conventional exercises, including core stability exercises. Experimental group subjects in Group B received Fascial manipulation to the lateral aspect of the thigh region in the lower limb. Both the groups received interferential therapy for 20 minutes as a part of conventional treatment for low back pain for 15 days. The subjects were assessed for their pain level, using NPRS score, and range of motion (ROM) was assessed to find any restriction in the lumbar region due to fascial densification. The functional activities of daily life were assessed using the ODI scale. The above scores were recorded before and after the interventions for both the groups. Results: The pre-test and post-test results were analyzed using a Paired and Unpaired t-test. The outcome measures of the Numeric Pain Rating Scale, Modified Schober's test, the Oswestry Disability Index were used for the study. A comparison of post-test values between Group A and Group B using unpaired t-test revealed a significant difference of p<0.001 in terms of pain relief, improved Range of motion, and functional ability of subjects in Group B than subjects in Group A. Conclusion: Fascial manipulation technique on lateral thigh region proved to be effective than conventional exercises as it showed a clinical and significant effect in decreasing pain and disability and improving the range of motion and functional activities of daily living in subjects with mechanical low back pain.

Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population - A descriptive study

Background: Falls is one of the common problems faced by elderly population and in preventing falls in India, research has largely focused on identification and management of risk factors, but the circumstances of the fall and its associated factors are sparsely researched. Objectives: The primary objective is to find the prevalence of fall, investigate risk factors, and its circumstances for falls and level of functional independence in elderly population. The secondary objective is to find out fear of fall (FOF) and its association of demographic factors on elderly population. Methods: This was a cross-sectional study; 2049 elderly population of 60 years and above were recruited by one-stage cluster sampling technique within Mumbai, Panvel, and Thane cities, Maharashtra. Data were collected using a questionnaire, Fall Efficacy Scale-International, Barthel Index, and Kuppuswamy Scale. Obtained responses were analyzed using SPSS software; descriptive statistics and Chi-square test were applied. Results: The prevalence of falls in this study found as 24.98%. Demographic factors such as age group, education, marital status, and socio-economic status had demonstrated a significant association with older adults (P < 0.05); 44.92% of falls occurred in the morning, the majority of falls (65.43%) occurred indoors, 56.45% of the fallers reported to had slips, and 60.55% of the fallers had sustained injuries. From the total participants, 34.70% of the fallers reported FOF, 23.67% of the fallers expressed reduced functional activities, and 18.06% of the fallers demonstrated affection in activities of daily living. Conclusion: This study reveals fall as a significant health problem and provides insight into the influencing risk factors for falls among older adults.

Protective Effect of Danggui Buxue Tang on Impaired Functional Activity of Endothelial Cells Exposed to Low Flow Shear Stress / 中国实验方剂学杂志

Objective: To investigate the protective effect of Danggui Buxue Tang(DGBX)with Angelicae Sinensis Radix(AS) and Astragali Radix(AR)at different radios on impaired functional activity of endothelial cells(ECs)exposed to low-fluid shear stress (FSS). Method: Low FSS was loaded by a parallel plate flow chamber,and ECs were divided into normal FSS group,low FSS group(each preincubated with M199 medium for 2 h),simvastatin group(preincubated with 0.1 μmol·L-1 simvastatin for 2 h),and 3 DGBX groups(preincubated with 3 g·L-1 AS and AR at 1:1,1:3,1:5 for 2 h,respectively). Then,the normal group was exposed to 1.2 Pa FSS,while the rest groups were all exposed to low FSS. At time points of 30,60, 360 min,the proliferation was detected by methyl thiazoly tetrazolium(MTT),the secretion of nitric oxide(NO) was detected by nitrase reduction test,and the mRNA and protein expressions of endothelial nitric oxide synthase(eNOS) were detected by Real-time fluorescence guantitative polymerase chain reaction(Real-time PCR) and Western blot,respectively. Result: Compared with the normal group, the secretion of NO and the expression of eNOS in ECs were both increased significantly at 60 min (PConclusion: DGBX could protect the functional activity of ECs exposed to low FSS.

Effect of rhizoma polygonati on functional activity of endothelial progenitor cells to delay senescense via decrease of ros / 中国药理学通报

Aim To investigate the effect of Rhizoma Polygonati( RP) on the functional activity and the level of reactive oxygen species (ROS) on the subculture of endothelial progenitor cells ( EPCs) in aging rats. Methods EPCs from bone marrow in rats were isolated and cultured in vitro and identified. The 2nd EPCs were divided into fourgroups, which were subcultured to the 4th, 6th and 8th passage with application of drug - serum containing RP or not. The positive rate of cell senescence was detected by beta - galactosidase, the proliferation, migration and tubule formation were assayed by MIT, transwell chamber and in vivo angio- gcnesis kit, respectively, and ROS level was detected by flow cytometry. Results In the process of EPCs subculture, the positive rate of cell senescence gradually increased, accompanied by a significant decrease in proliferation, migration and tubule formation. The level of ROS increased sharply (P<0. 05). RP could reduce the positive rate of cell senescence, enhance the functional activities, and decrease the level of ROS of EPCs significantly (P < 0. 05). Conclusions RP may delay the aging process of EPCs in vitro and protect the function of EPCs by decreasing the level of ROS.

Prediction of CpG islands and functional verification on promoters of FPS, SS, SE in Eleutherococcus senticosus / 中草药

Objective: To obtain the distribution and functional activity of CpG islands in promoters of FPS, SS, and SE from Eleutherococcus Senticosus. Methods: Based on the promoter sequence of FPS, SS and SE, CpG islands were predicted by using EMBOSS and Li Lab. The functional verification of transformed Arabidopsis thaliana was mediated by Agrobacterium tumefaciens by using GUS and pCAMBIA1301 plasmid as the reporter gene and expression vector respectively. Results: Two CpG islands were found in FPS and SS promoter with the lengths of 520 bp, 218 bp and 108 bp, 103 bp, and three CpG islands in SE promoter in 290 bp, 119 bp and 149bp. The promoters of FPS, SS and SE all had promoter activities at different level, in which SS promoter was the highest one. Conclusion: The functional verification and distributions of CpG islands in the promoters area of FPS, SS, and SE were reported in this research at first time, which established the foundation for the methylation analysis of FPS, SS, and SE and the further studying of the mechanism expression regulation in E. Senticosus.

Postural control during sit-to-stand movement and its relationship with upright position in children with hemiplegic spastic cerebral palsy and in typically developing children

OBJECTIVE: The purpose of this study was to compare postural control in typically developing (TD) children and children with cerebral palsy (CP) during the sit-to-stand (STS) movement and to assess the relationship between static (during static standing position) and dynamic postural control (during STS movement) in both groups. METHOD: The center of pressure (CoP) behavior of 23 TD children and 6 children with spastic hemiplegic CP (Gross Motor Function Classification System [GMFCS] I and II) was assessed during STS movement performance and during static standing conditions with the use of a force plate. The data obtained from the force plate were used to calculate CoP variables: anteroposterior (AP) and mediolateral (ML) amplitudes of CoP displacement and the area and velocity of CoP oscillation. RESULTS: According to the Mann-Whitney test, children with CP exhibited higher CoP values in all of the analyzed variables during the beginning of STS movement. Pearson's correlation verified a positive correlation between the CoP variables during both static conditions and the performance of STS movement. CONCLUSIONS: Children with spastic hemiplegic CP present major postural oscillations during the beginning of STS movement compared with typical children. Moreover, the observed relationship between postural control in static and dynamic conditions reveals the importance of body control in the static position for the performance of functional activities that put the body in motion, such as STS movement. .

Explanation of Six Yang Meridians “Dominating in Bodily Diseases” / 上海针灸杂志

The description of the circulation of qiand blood in twelve meridians and the symptoms of diseases in which they dominate inMiraculous Pivot·Meridianshas a certain guiding significance for clinical diagnosis and treatment. But in the book, six yang meridians “dominating in bodily diseases is considered as “fluid”, “humor”, “qi”, “blood”, “sinew” and “bone” dominating in bodily diseases. That is puzzling and prone to doubt. The authors perform a multi-angle analysis from the characteristics of circulation of qi and blood and functional activityof qi in meridians and give a reasonable explanation by referring also to other sections and chapters inHuangdi’s Internal Classic.

IL-13 R110Q, a Naturally Occurring IL-13 Polymorphism, Confers Enhanced Functional Activity in Cultured Human Bronchial Smooth Muscle Cells

PURPOSE: Interleukin (IL)-13, a Th2-type cytokine, plays a pivotal role in the pathogenesis of asthma through its direct effects on airway smooth muscles. A naturally occurring IL-13 polymorphism, R110Q, is strongly associated with increased total serum IgE levels and asthma. In the present study, we aimed to determine whether the IL-13 R110Q variant would display different biochemical properties or altered functions in comparison with wild-type (WT) IL-13 in cultured human bronchial smooth muscle cells (hBSMCs). METHODS: Culture supernatants and cell proteins were collected from cultured hBSMCs that were treated with 50 ng/mL IL-13 or IL-13 R110Q for 24 hours. Eotaxin released into hBSMC culture medium was determined by ELISA. The expression levels of the high-affinity IgE receptor (FcepsilonRI) alpha-chain, smooth muscle-specific actin alpha chain (alpha-SMA), smooth muscle myosin heavy chain (SmMHC), and calreticulin in the cells were measured on Western blots. RESULTS: Compared with WT IL-13, treatment with the IL-13 R110Q variant resulted in a significant increase in eotaxin release as well as significant, although modest, increases in the expression levels of alpha-SMA, SmMHC, calreticulin, and FcepsilonRI alpha-chain. CONCLUSIONS: The results of the present study suggenst that the IL-13 R110Q variant may enhance enhanced functional activities in hBSMCs.

IL-13 R110Q, a Naturally Occurring IL-13 Polymorphism, Confers Enhanced Functional Activity in Cultured Human Bronchial Smooth Muscle Cells

PURPOSE: Interleukin (IL)-13, a Th2-type cytokine, plays a pivotal role in the pathogenesis of asthma through its direct effects on airway smooth muscles. A naturally occurring IL-13 polymorphism, R110Q, is strongly associated with increased total serum IgE levels and asthma. In the present study, we aimed to determine whether the IL-13 R110Q variant would display different biochemical properties or altered functions in comparison with wild-type (WT) IL-13 in cultured human bronchial smooth muscle cells (hBSMCs). METHODS: Culture supernatants and cell proteins were collected from cultured hBSMCs that were treated with 50 ng/mL IL-13 or IL-13 R110Q for 24 hours. Eotaxin released into hBSMC culture medium was determined by ELISA. The expression levels of the high-affinity IgE receptor (FcepsilonRI) alpha-chain, smooth muscle-specific actin alpha chain (alpha-SMA), smooth muscle myosin heavy chain (SmMHC), and calreticulin in the cells were measured on Western blots. RESULTS: Compared with WT IL-13, treatment with the IL-13 R110Q variant resulted in a significant increase in eotaxin release as well as significant, although modest, increases in the expression levels of alpha-SMA, SmMHC, calreticulin, and FcepsilonRI alpha-chain. CONCLUSIONS: The results of the present study suggenst that the IL-13 R110Q variant may enhance enhanced functional activities in hBSMCs.

Screening of cognitive impairmentby general internists usingtwo simple instruments / Rastreio de comprometimento cognitivo por médicos generalistas com dois instrumentos simples

General internists (GIs) tend to overlook cognitive impairment in the elderly. Lack of time to diagnose and/or poor knowledge on how to use screening instruments may be the reasons for this shortcoming. Objectives: To verifythe efficacy of simple instruments in the screening of cognitive impairment in elders. Methods: In a previous study, 248 patients aged 65 that had been assisted by GIs within outpatient services of a public university hospital in São Paulo, Brazil, were evaluated. The Mini-Mental State Examination and/or the Informant Questionnaire on Cognitive Decline in theElderly (short-IQCODE) were employed to classify patients into probable cognitively impaired cases or otherwise. Other testsand questionnaires were also applied, but were not used to perform this classification. After full assessment and consensus meetings, cases were classified into dementia, cognitively impaired not demented, and without cognitive impairment. Inthis study, the sensitivity and specificity of the combined use of the category fluency test (CFT) and the Functional Activities Questionnaire (FAQ) was evaluated as if used as screening instruments for the whole sample. Results: The combined useof the CFT and/or FAQ showed sensitivity of 88.3% and specificity of 76.5% in the screening of cognitive impairment for thewhole sample. Conclusions: Two simple and easy-to-apply instruments showed high sensitivity and reasonable specificity,and are probably useful for the screening of cognitive impairment in the elderly in outpatient services.

Médicos generalistas (MGs) normalmente não detectam comprometimento cognitivo em idosos. Falta de tempopara realizar a triagem de comprometimento cognitivo e pouco conhecimento sobre a forma de realizá-la podem ser asrazões desta falha. Objetivos: Verificar a eficácia de instrumentos simples no rastreio de comprometimento cognitivo em idosos. Métodos: Em um estudo prévio, 248 pacientes com idade 65, que tinham sido assistidos por MGs em serviçosambulatoriais de um hospital universitário público em São Paulo, Brasil, foram avaliados. O Mini-Exame do Estado Mentale/ou o Questionário com Informante sobre Declínio Cognitivo em Idosos (Short-IQCODE) foram utilizados para classificaros pacientes em casos prováveis de cognição prejudicada ou não. Outros testes e questionários também foram aplicados,mas não foram usados para esta classificação. Depois de avaliação completa e reuniões de consenso, os casos foramclassificados como demência, cognição alterada não demência e sem comprometimento cognitivo. Neste estudo avaliamos asensibilidade e a especificidade do uso de dois instrumentos, o teste de fluência verbal (TFV) e o Questionário de AtividadesFuncionais (QAF), se eles tivessem sido empregados como instrumentos de rastreio para toda a amostra. Resultados: O uso combinado do TFV e/ou do QAF mostrou sensibilidade de 88,3% e especificidade de 76,5% no rastreio de comprometimentocognitivo em toda a amostra. Conclusões: Dois instrumentos simples e de fácil aplicação mostraram alta sensibilidade erazoável especificidade e são provavelmente úteis para o rastreio de comprometimento cognitivo de idosos em ambulatórios. Palavras-chave: rastreio, demência, comprometimento cognitivo, questionário, atividade funcional, fluência verbal, médico generalista.

Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur / Functional outcomes and quality of life one year after surgical management of trochanteric fractures

OBJETIVO: Avaliar o impacto que as fraturas transtrocanterianas produzem sobre a qualidade de vida de pacientes idosos, tratados cirurgicamente, durante o período de um ano de acompanhamento. MATERIAL E MÉTODO: Foram selecionados 73 idosos com fratura transtrocanterina, com idade igual ou superior a 65 anos de ambos os sexos. Foi aplicado questionário padronizado, para se obter informações quanto aos hábitos de vida, atividade física, funcionalidade, deambulação e estado cognitivo. Foram excluídos os óbitos ocorridos durante o estudo, pacientes que não deambulavam, com doenças neurológicas ou fraturas patológicas. RESULTADOS: A média de idade foi 80,17 ± 7,2, sendo 75 por cento do sexo feminino. Ao comparar as somatórias das atividades de vida diária (p=0,04) e instrumentais da vida diária (p=0,004), obtidas na pré e pós-fratura, os pacientes tornaram-se mais dependentes pós-fratura. Atividades de vida diária que apresentaram piora pós-fratura foram: tomar banho (p=0,04), ir ao banheiro (p=0,02) e vestir-se (p=0,04). Todas as atividades instrumentais da vida diária apresentaram diferença significativa, apresentando maior dependência funcional pós-fratura, assim como aumento da necessidade de auxílio a deambulação (p=0,00002), idade avançada (p=0,01) e não realizar atividades domésticas (p=0,01). A baixa pontuação no teste Minimental estava associada com uma maior dependência para realizar as atividades da vida diária na pré-fratura (p=0,00002) e pós-fratura (p=0,01). CONCLUSÃO: Após um ano, as atividades de vida diária que dependiam dos membros inferiores pioraram significativamente, todas as atividades instrumentais de vida diária apresentaram piora significativa em mais de 50 por cento dos pacientes e mais da metade dos pacientes que andavam sem apoio perderam esta capacidade.

OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of monitoring. METHODS: Were selected 73 elderly with transtrochanteric femur fracture, aged equal or over than 65 years and of both sexes. All participants underwent a standardized questionnaire which obtained information on lifestyle habits, functionality, physical activity, ambulation and cognitive state. Were excluded patients who died, not walking, with neurological diseases and pathological fractures. RESULTS: The average age was 80.17 ± 7.2 years and 75 percent was female. When comparing the summation of activities of daily living (p = 0.04) and instrumental daily living (p = 0.004) obtained before and after fracture, the patients become more dependent after fracture. Activities of daily living that worsened after fracture were bathing (p = 0.04), toileting (p = 0.02) and dressing (p = 0.04). All instrumental activities of daily living showed a significant difference, with functional dependence after fracture, increased need for walking aid (p = 0.00002), aged (p = 0.01) and not doing housework (p = 0.01). The low score on the test Minimental was associated with a greater dependence to perform activities of daily living before (p = 0.00002) and after (p = 0.01) fracture. CONCLUSION: After a year, activities of daily living that depended on the lower limbs worsened significantly, all instrumental activities of daily living were significantly worse in more than 50 percent of patients and more than half of patients who walked without support lost this ability.

Limb-salvage Operation for Pelvic Bone Tumors / 대한정형외과학회잡지

From Sept. 1987 to Mar. 1993, 14 cases of pelvic bone tumors took surgical treatment. Male to female ratio was 7:7, with an average age of 31.9 years. Pathological diagnosis were chondrosarcoma 7(1 ; secondary), metastatic thyroid cancer 2, and each one case of giant cell tumor, desmoplastic fibroma, metastatic synovial sarcoma, malignant fibrous histiocytoma(MFH), and enchondroma. According to the Enneking's classification for the type of surgical resection, we performed 4 cases of type II+III resection, 4 type IA, 2 type I+II, 2 type III, and each one of II and IIA+III. Types of reconstruction were hip fusion(3 cases), heat treated autogenous bone graft combined with total hip replacement arthroplasty(4), bone graft(2), cement spacer(1) or saddle prothesis(1). Simple resection was done for 3 cases. Wide surgical margin was achieved in 12 cases, marginal margin in 1 and intralesional magin in 1. Complications occurred in 3 cases(21.4%) : 1 graft failure ; 1 lymphedema ; and 1 delayed union. The average follow-up period was 27.4(8-60) months. During follow up, lung metastasis developed in MFH case but no local recurrence was noted in all. By the criteria of American Musculoskeletal Tumor Society(MSTS), the average score for functional activities was 21(70% of normal). The function of the extremity with reconstructed or undestroyed pelvic ring was better than that with disrupted pelvic ring(functional scores ; 24.6 vs 12.3 respectively). Due to the Korean life style using hypocaust, fused hip was not good for indoor activity. For the malignant pelvic bone tumor not involving femoral neurovascular bundle, limb-salvage using internal pelvectomy and reconstruction of pelvic ring can be indicated as a surgical procedure, instead of the hindquarter amputation.