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Progress and Challenges of Diabetic Foot Diagnostic and Treatment 糖尿病足诊断与治疗的进展与挑战
IF 0.3 Pub Date : 2023-01-08 DOI: 10.55453/rjmm.2023.126.3.7
C. Constantin, M. Georgescu, I. Staicu
"Diabetic foot is one of the main long-term complications of diabetes, having a significant impact on a patient’s quality of life. However, prevention by daily checking of the limbs and observance of the rules of care remains particularly important to avoid total or partial amputation. This paper aims to highlight the main challenges and progress in the treatment of the diabetic foot. To achieve this, we analyzed a database consisting of more than 100 articles published in recent years, approaching the treatment of the diabetic foot. The main problems that occur with the diabetic foot are peripheral vascular disease and diabetic neuropathy. These can lead to blisters and skin lesions that can eventually lead to ulcers in the lower limbs and even amputation. In conclusion, prevention is the main method of treatment for diabetic foot, followed by the treatment of each complication depending on when it is identified and its severity. "
糖尿病足是糖尿病的主要长期并发症之一,对患者的生活质量有重大影响。然而,通过每天检查四肢和遵守护理规则进行预防对于避免完全或部分截肢仍然特别重要。本文旨在强调糖尿病足治疗的主要挑战和进展在此,我们分析了一个由近几年发表的100多篇文章组成的数据库,这些文章探讨了糖尿病足的治疗方法。糖尿病足的主要问题是周围血管疾病和糖尿病神经病变。这些会导致水泡和皮肤损伤,最终导致下肢溃疡,甚至截肢。总之,预防是糖尿病足的主要治疗方法,其次是每种并发症的治疗,具体取决于何时发现及其严重程度。“
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引用次数: 0
Image of a Junior Officer in Military Personnel Participating in Combat Operations with Symptoms of Post-traumatic Stress Disorder 一名有创伤后应激障碍症状的军事人员参加战斗行动的初级军官的形象
IF 0.3 Pub Date : 2023-01-08 DOI: 10.55453/rjmm.2023.126.3.8
Yanina Matsegora, O. Kolesnichenko, I. Prykhodko, Vira Kramchenkova, A. Bolshakova, O. Zaitseva, K. Marushchenko, Y. Rumiantsev, I. Tovma
"According to the results of the conducted study there were distinguished the peculiarities of perception of the image of a junior officer by servicemen who participated in hostilities and had various PTSD symptoms. The study included 233 male servicemen with combat experience. The age of the participants varied from 20 to 55 years. It was determined that the image perception of the direct commander by the servicemen who did not have any PTSD symptoms had been influenced by both the key features of the modern way of fighting and the way a protective mechanism of consciousness acted, which gave the possibility to maintain mental health under combat conditions. These servicemen considered the awareness, kindness, and physical strength of their commander to be not important. The first stage was occupied by his/her ability to adequately fulfill his/her leadership function and the power of his/her spirit – the courage and love of the Motherland, which formed his/her reliability. Servicemen who had PTSD symptoms were less satisfied with the role of a junior officer and considered him/her to be less capable of meeting their expectations. They were less interested in commanders who could involve them in situations that required quick, brave action and complete responsibility for the entrusted part of common affairs. The most important factors in the structure of the direct commander image in both studied groups were the power of personality (the ability of self-regulation); however, the servicemen with PTSD symptoms had a specific orientation of these factors – to help their subordinates. They were quite selfishly aimed at using their direct commanders as a way of getting help. "
"根据所进行的研究结果,参战并有各种创伤后应激障碍症状的军人对初级军官形象的感知有不同的特点。这项研究包括233名有战斗经验的男性军人。参与者的年龄从20岁到55岁不等。据确定,没有任何创伤后应激障碍症状的军人对直接指挥官的形象感知受到现代战斗方式的主要特征和意识保护机制的作用方式的影响,这使得在战斗条件下保持心理健康成为可能。这些军人认为指挥官的觉悟、善良和体力并不重要。第一个阶段是他/她充分履行领导职能的能力和他/她的精神力量——对祖国的勇气和热爱,这构成了他/她的可靠性。有创伤后应激障碍症状的军人对下级军官的角色不太满意,认为他/她不太有能力满足他们的期望。他们对指挥官不太感兴趣,因为指挥官可以让他们参与需要迅速、勇敢行动和对共同事务的委托部分完全负责的情况。在两个研究群体中,直接指挥官形象结构中最重要的因素是人格力量(自我调节能力);然而,有创伤后应激障碍症状的军人对这些因素有一个特定的定位——帮助他们的下属。他们非常自私地利用他们的直接指挥官作为获得帮助的一种方式。”
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引用次数: 0
Aesthetic Principles in Nasal Reconstruction after Squamous Cell Carcinoma Resection 鳞状细胞癌切除后鼻再造的美学原则
IF 0.3 Pub Date : 2023-01-08 DOI: 10.55453/rjmm.2023.126.3.11
A. Grigore, A. Oproiu, I. Florescu
"A successful nose reconstruction is represented by a normal look and nasal breathing preservation. The choice of method is based on the site, size, depth of the defect, donor availability, and surgeon experience. There are multiple methods of restoring nasal cover, from primary repair to healing by secondary intention, from primary suture, skin graft to locoregional flaps, but all of them should be integrated into a personalized approach, keeping the nasal functions, a good aesthetic outcome and without any tumor infiltration. This paper consisting of a retrospective study of 9 patients diagnosticated with squamous cell carcinoma revealed the importance of skin properties and skin changes during aging. Despite all aesthetic principles, skin is the most important resource in facial reconstruction. "
“成功的鼻重建以正常的外观和鼻呼吸保护为代表。方法的选择取决于缺损的部位、大小、深度、供体的可用性和外科医生的经验。恢复鼻覆盖物有多种方法,从初次修复到二次愈合,从初次缝合、皮肤移植到局部皮瓣,但所有方法都应该采用个性化方法,保持鼻腔功能,美观效果好,无任何肿瘤浸润。本文对9名被诊断为鳞状细胞癌的患者进行了回顾性研究,揭示了皮肤特性和衰老过程中皮肤变化的重要性。抛开所有美学原则不谈,皮肤是面部重建中最重要的资源。“
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引用次数: 0
Comparison of Serum Vitamin D Levels with Glucose, Lipid, and the Other Biochemical Parameters: A Cross-Sectional Study 血清维生素D水平与葡萄糖、脂质和其他生化参数的比较:一项横断面研究
IF 0.3 Pub Date : 2023-01-08 DOI: 10.55453/rjmm.2023.126.3.14
Y. Sezgin, Y. Hacıoğlu, A. Kaplan
"Since vitamin D is synthesized from cholesterol, it is claimed to be associated with insulin resistance, suggesting that there may be an association between vitamin D glucose and lipids. For this reason, we aimed to investigate a relationship between vitamin D and biochemical parameters, including glucose and lipids. This cross-sectional study included 198 patients .admitted to the family medicine outpatient clinic between June and December 2016. There was no significant correlation between vitamin D and serum glucose, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, calcium, magnesium, sodium, TSH, and body mass index values in both men and women. There was a correlation between vitamin D and total cholesterol and LDL cholesterol levels in the younger subjects below 41 years (p=0.002). Regression analysis with other variables showed no statistical significance between vitamin D levels on LDL-C levels (P=0.309). Despite previous studies, our study did not confirm the effects of vitamin D on serum glucose, lipid, calcium, and other biochemical parameters. However, these results suggest that the standard up-to-date literature showing the relationship between vitamin D and various metabolic and hormonal disorders may need to be confirmed by new large-scale studies. "
“由于维生素D是由胆固醇合成的,它被认为与胰岛素抵抗有关,这表明维生素D葡萄糖和脂质之间可能存在关联。因此,我们旨在研究维生素D与包括葡萄糖和脂质在内的生化参数之间的关系。这项横断面研究包括198名患者2016年6月至12月期间的门诊。维生素D与男性和女性的血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白、钙、镁、钠、TSH和体重指数之间没有显著相关性。在41岁以下的年轻受试者中,维生素D与总胆固醇和低密度脂蛋白胆固醇水平之间存在相关性(p=0.002)。与其他变量的回归分析显示,维生素D水平与低密度脂素胆固醇水平之间没有统计学意义(p=0.009)。尽管之前有研究,但我们的研究没有证实维生素D对血糖、脂质、钙,以及其他生物化学参数。然而,这些结果表明,显示维生素D与各种代谢和激素紊乱之间关系的标准最新文献可能需要通过新的大规模研究来证实。“
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引用次数: 0
Postirradiation Angiosarcoma – A Late, Severe Complication of Radiotherapy for Mammary Neoplasm 放射后血管肉瘤——乳腺肿瘤放射治疗的晚期严重并发症
IF 0.3 Pub Date : 2023-01-08 DOI: 10.55453/rjmm.2023.126.3.3
Raluca Lascu, A. Alexandru, Alexandra Oltenescu, Oana Vlaicu, R. Andrei
"Angiosarcoma is a malignant tumor derived from the endothelium of the blood and lymphatic vessels. Its aggressive behavior results in a poor prognosis for the patients. Radiation-associated angiosarcoma is a rare recently described particular subtype of angiosarcoma best shown in patients after treatment of breast cancer. The latency period of development is approximately 8 years, thus the 5-year standard follow-up after mammary neoplasm therapy needs to be extended up to 10 years. Radiotherapy is an independent risk factor for angiosarcoma development. Rapid diagnosis is essential for prompt therapeutical intervention to improve the patient’s prognosis. The importance of early diagnosis is emphasized by a case of a 54 years old woman, with a diagnosis of breast cancer treated by sectorectomy and radiotherapy 7 years prior, presenting to our Dermatology Department for the recent occurence of erythemato-violaceous cutaneous patches on the area subjected to radiotherapy. "
血管肉瘤是一种源自血管内皮和淋巴管的恶性肿瘤。其攻击性行为导致患者预后不良。辐射相关性血管肉瘤是最近发现的一种罕见的特殊亚型血管肉瘤,最见于乳腺癌治疗后的患者。发展潜伏期约为8年,因此乳腺肿瘤治疗后5年的标准随访需要延长至10年。放疗是血管肉瘤发展的独立危险因素。快速诊断是必要的及时治疗干预,以改善患者的预后。早期诊断的重要性是通过一个54岁的女性病例来强调的,她被诊断为乳腺癌,7年前接受了部门切除术和放疗,最近在接受放疗的区域出现红斑-紫色皮肤斑块,到我们的皮肤科就诊。”
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引用次数: 0
Investigating the Operational Management Challenges of a Reference Military Hospital in the COVID-19 Pandemic 新冠肺炎大流行期间参考军队医院运营管理挑战调查
IF 0.3 Pub Date : 2023-01-02 DOI: 10.55453/rjmm.2023.126.1.5
Mahboubeh Rouhollahei, Esmat Davoudi-Monfared, A. Shahriyari, M. S. Isfeedvajani
"Introduction: Following the crisis of coronavirus outbreak in numerous regions of the world, this epidemic enhanced promptly in most countries, including Iran, and sent a host of patients in need of medical services to hospitals. This study aimed to investigate the challenges of operational management of a reference military hospital during the pandemic COVID-19. Methods: This research is a qualitative study with the content analysis method with a deductive and guided approach. Data collection was conducted through a semi-structured interview method and utilizing a questionnaire designed based on the management functions of the Hospital Incident Command System (HICS). The targeted sampling method and participants in this study included senior-middle managers working in organizational positions of the reference hospital in 2020 employed during the organizational position in Covid-19 Pandemic. Classifications and coding were performed employing MAXQDA 2018 software. Results: The findings of this study were explored in the form of strengths, weaknesses, and challenges. Weaknesses included taking surprise, early and non-missionary entry into the COVID-19 crisis, lack of appropriate depot, instant management, deficiencies in the training of patients and staff, poor functioning of the crisis management system, deficiencies in monitoring, and poor provision of psychological support. The strengths were the devoted and altruistic presence of the medical staff and managers, the financial support of the headquarters, the effective field research of the management team of the organization, and the proper management of the volunteer forces. The most significant challenge was the poor coordination with the relevant organizations, including the headquarters, the Defense Organization, and the Ministry of Health. Conclusions: The findings of this study demonstrate that in the peak period of the COVID-19 pandemic to promote the operational management of the hospital, sticking to the general policies of the organization, structured coordination with internal and external organizations, organized management of equipment and human resources, generating a robust documentation structure and decision-making based on the evidence, effective and practical use of the crisis management system, systematic training of staff and patients, prioritizing the safety of patients and staff, organized dissemination of information and systematic monitoring as well as evaluation are the most significant points to deal with the epidemic crisis. "
“导言:在世界许多地区爆发冠状病毒危机之后,这一流行病在包括伊朗在内的大多数国家迅速加剧,并将大量需要医疗服务的患者送往医院。本研究旨在探讨新冠肺炎大流行期间某参考军队医院运营管理面临的挑战。方法:本研究采用内容分析的定性研究方法,采用演绎和引导的方法。数据收集采用半结构化访谈法,根据医院事故指挥系统(HICS)的管理功能设计问卷。本研究的目标抽样方法和参与者为参考医院2020年组织岗位的中高层管理人员,在新冠肺炎大流行组织岗位期间就业。采用MAXQDA 2018软件进行分类和编码。结果:本研究的发现以优势、劣势和挑战的形式进行了探讨。不足之处包括猝不及防、过早和非传教性地进入COVID-19危机,缺乏适当的仓库和即时管理,对患者和工作人员的培训不足,危机管理系统功能不佳,监测不足,以及心理支持提供不足。其优势在于医务人员和管理人员的无私奉献、总部的财政支持、本组织管理团队的有效实地调研以及志愿部队的妥善管理。最重大的挑战是与包括总部、国防组织和卫生部在内的有关组织协调不力。结论:研究结果表明,在新冠肺炎大流行高峰期,促进医院的业务管理,坚持组织的总体政策,与内部和外部组织进行结构化协调,有组织地管理设备和人力资源,形成健全的文件结构和基于证据的决策,有效和实际地使用危机管理系统;对工作人员和患者进行系统的培训,优先考虑患者和工作人员的安全,有组织的信息传播,系统的监测和评估是应对疫情危机的最重要的一点。”
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引用次数: 0
The Relationship Between the Tolerance for Uncertainty and Psychophysiological Qualities of Servicemen 军人不确定性耐受性与心理生理素质的关系
IF 0.3 Pub Date : 2023-01-02 DOI: 10.55453/rjmm.2023.126.1.6
V. Kalnysh, A. Shvets, O. Maltsev, O. Nagovitsyn
"The purpose of this study was to establish the relationship between the tolerance for uncertainty level and several psychophysiological and psychological qualities of military specialists for determining additional approaches to occupational selection. The study was conducted on a group of servicemen who performed special tasks and were capable of responding to terrorism – 49 men (main group) and 19 military doctors (control group) – men aged 25-34 years. Tolerance for uncertainty was studied based on the modified S. Badnder’s method. The level of manipulation score (MAC) was assessed by the adapted I.A. Romanova and O.O. Zhdanov questionnaire (estimated by the so-called ""MacScale""). Psycho-physiological parameters were determined using a special computer program. Statistical analysis of data was performed by descriptive and nonparametric statistics, as well as a cluster, stepwise discriminant, and correlation analysis. A personality trait “tolerance for uncertainty” was valuable for the occupational activity of servicemen performing special tasks. The such feature had 63.3% of servicemen in the studied group. The specificity of the occupational activity of military doctors was the quality of manipulation of people. Moreover, those who were the most tolerant of uncertainty had an inverse relationship with Machiavellianism, which indicates the existence of compensatory psychological mechanisms balancing and harmonizing service and personal relationships among micro-teams of servicemen. Servicemen with a lower level of tolerance for uncertainty had positive relationships with several psychophysiological functions (strength and mobility of nervous processes, quality of dynamic memorization), which confirms the idea of psychophysiological mechanisms to enhance tolerance for uncertainty by increasing the working capacity of these people. Such personal quality as tolerance for uncertainty is a valuable occupationally important feature that allows performing the selection of servicemen who are more efficient and reliable in the performance of official duties tasks. "
“这项研究的目的是建立对不确定性水平的容忍度与军事专家的几种心理生理和心理素质之间的关系,以确定职业选择的其他方法。这项研究是在一组执行特殊任务并有能力应对恐怖主义的军人身上进行的——49名男性(主要组)和19名军医(对照组)——年龄在25-34岁之间。基于改进的S. Badnder方法,研究了不确定度容忍度。运用I.A. Romanova和O.O. Zhdanov改编的问卷(采用所谓的“MacScale”评估)来评估操纵得分(MAC)水平。心理生理参数是用一种特殊的计算机程序确定的。数据的统计分析采用描述性和非参数统计,以及聚类、逐步判别和相关分析。人格特质“对不确定性的容忍”对执行特殊任务的军人的职业活动是有价值的。研究组中有63.3%的军人有此特征。军医职业活动的特殊性在于对人的操控性。此外,最能容忍不确定性的军人与马基雅维利主义之间存在负相关关系,表明存在平衡和协调军人微团队服务与个人关系的补偿心理机制。不确定性耐受力水平较低的军人的心理生理功能(神经过程的强度和流动性、动态记忆的质量)与不确定性耐受力呈正相关,这证实了军人通过提高工作能力来增强不确定性耐受力的心理生理机制。容忍不确定性这样的个人素质是一种宝贵的职业重要特征,它使我们能够选择在执行公务任务方面更有效、更可靠的军人。”
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引用次数: 0
The Effect of Reciprocal Imitation Training on Increasing Expressive Vocabulary of Children with Autism Spectrum Disorders 相互模仿训练对自闭症谱系障碍儿童表达性词汇量增加的影响
IF 0.3 Pub Date : 2023-01-02 DOI: 10.55453/rjmm.2023.126.1.7
Zahra Malmir, Nasibeh Soltani
"Objective: One of the areas of impairment in childhood autism spectrum disorders is delayed imitation. Due to the defect in the social function of imitation in these children and its negative consequences on lexical and verbal skills, Researchers in the field of educating autistic children consider increasing imitation skills to be a very important therapeutic goal. Previous studies have shown the effects of improving imitation on increasing the social, linguistic, and verbal skills of these children. In the present study, the effect of reciprocal imitation training on increasing the vocabulary of autistic children was investigated. Materials and Methods: This was an interventional study with a pretest-posttest design. 16 autistic children were trained in crossborder imitation based on expressive vocabulary in 96 sessions. After performing post-test and data collection in data analysis from the McNemar test to determine the changes of each word before and after the intervention and the Wilcoxon Marked Test was used to determine changes in vocabulary categories before and after the intervention and the level of statistical significance was considered (P> 0.05). Results: The results of data analysis show that the average number of responses ""expresses"" in each of the words after the intervention increased significantly in all vocabulary groups (P> 0.05). It seems that the intervention resulted in significant changes in participants. Conclusion: The results of this study show that teaching the method of reciprocal imitation has a significant effect on increasing the number of expressive words in autistic children. "
目的:儿童自闭症谱系障碍的障碍之一是延迟模仿。由于自闭症儿童社会模仿功能的缺陷及其对词汇和语言技能的负面影响,自闭症儿童教育领域的研究者认为提高模仿技能是一个非常重要的治疗目标。先前的研究表明,提高模仿能力对提高这些孩子的社交、语言和口头表达能力有影响。本研究旨在探讨互惠模仿训练对自闭症儿童词汇量增长的影响。材料与方法:本研究为介入研究,采用前测后测设计。对16名自闭症儿童进行了96次基于表达性词汇的跨界模仿训练。在数据分析中进行后测和数据收集,采用McNemar检验确定干预前后每个单词的变化情况,采用Wilcoxon标记检验确定干预前后词汇类别的变化情况,并考虑有无统计学意义(P> 0.05)。结果:数据分析结果显示,干预后各词汇组平均每个单词中出现“表达”的次数显著增加(P < 0.05)。似乎干预导致了参与者的显著变化。结论:本研究结果表明,互惠模仿教学对提高自闭症儿童的表达词数量有显著的效果。
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引用次数: 0
The Endocrine Approach of Melanoma: The Puzzle of Estrogen Receptors Expression 黑色素瘤的内分泌途径:雌激素受体表达之谜
IF 0.3 Pub Date : 2023-01-02 DOI: 10.55453/rjmm.2023.126.1.4
F. Șandru, A. Popa, M. Dumitrașcu, Ruxandra D. Sinescu-Bălțăteanu, Ș. Bucur, M. Carsote
"Melanoma outcome seems different between females and males, with a potential protective role of estrogen (E) through estrogen receptors (ER) expression into the tumor. In the study of ERs, both alfa (ERα) and beta (ERβ) is a well-known endocrine elements in non-melanoma tumors, like mammary and endometrial cancer. Immunohistochemistry (IHC) assessment of melanoma concerning ERs represents a path to explore the tumor profile to provide useful information concerning the prognostic and potential adjuvant treatment. Currently, this is not a routine practice, nor a mandatory step for deciding the medical therapy. Typically, IHCs are based on usual kits for mammary tumors regarding ERs configuration. Prior/concomitant use of oral contraceptives and hormonal replacement therapy is not correlated with a better prognostic in melanoma; neither have they represented a contraindication for survivors of melanoma; a subset of tumors might present a higher ER expression which is potentially targeted by the hormone-based treatment as SERMs (Selective Estrogen Receptors Modulator), for instance, tamoxifen. Experimental studies on melanoma cell lines confirmed the anti-tumor activity of ERβ which might function as a prognostic marker. G-protein-coupled estrogen receptors in melanocytes and keratinocytes might be involved, too. Additional crosstalk of TGF-β (Transforming Growth Factor β), respective IGF1 (Insulin-like Growth Factor), and ERα expression are involved in tumorigenic pathways. Recent preclinical studies showed the potential benefits of diarylpropionitrile, a selective agonist of ERβ; pyrazole derivates 21-23 can block ERs. Murine melanoma models showed the interference of anti-estrogenic medication (like molecule fulvestrant) to enhance immune checkpoint blockade, a modern approach to solid cancers. The proliferation of melanoma might be partially explained by ERs; whether this is generally applicable or there is a subgroup of tumors particularly related to E status is still debatable. The subject of E status in melanoma is far from clear at this point and further studies are necessary concerning this particular issue to implement it as a practical approach in the daily management of a disease that still has a very severe prognostic nowadays "
“黑色素瘤的结局在女性和男性之间似乎不同,雌激素(E)通过雌激素受体(ER)在肿瘤中的表达发挥潜在的保护作用。在ER的研究中,αα和β(ERβ)都是非黑色素瘤肿瘤(如乳腺癌和癌症)中众所周知的内分泌成分。免疫组织化学(IHC)关于ER的黑色素瘤评估代表了一条探索肿瘤特征的途径,以提供有关预后和潜在辅助治疗的有用信息。目前,这不是一种常规做法,也不是决定药物治疗的强制性步骤。通常,IHC是基于关于ER配置的乳腺肿瘤常用试剂盒。先前/同时使用口服避孕药和激素替代疗法与黑色素瘤的更好预后无关;它们都不是黑色素瘤幸存者的禁忌症;肿瘤的一个子集可能表现出更高的ER表达,其可能被基于激素的治疗作为SERM(选择性雌激素受体调节剂)(例如他莫昔芬)靶向。对黑色素瘤细胞系的实验研究证实了ERβ的抗肿瘤活性,这可能是一种预后标志物。黑色素细胞和角质形成细胞中的G蛋白偶联雌激素受体也可能参与其中。TGF-β(转化生长因子β)、IGF1(胰岛素样生长因子)和ERα表达的额外串扰参与肿瘤发生途径。最近的临床前研究表明,ERβ的选择性激动剂二芳基丙腈具有潜在的益处;吡唑衍生物21-23可以阻断ER。小鼠黑色素瘤模型显示了抗雌激素药物(如分子富维司琼)的干扰,以增强免疫检查点阻断,这是一种治疗实体癌的现代方法。黑色素瘤的增殖可能部分由ER解释;这是否普遍适用,或者是否存在与E状态特别相关的肿瘤亚群,仍有争议。黑色素瘤中E状态的主题目前还远不清楚,有必要对这一特定问题进行进一步的研究,以将其作为一种实用的方法来实施,这种疾病目前仍有非常严重的预后。”
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引用次数: 0
Dichotomisation of Rotator Cuff Tendinopathy in Shoulder MRIs Reveals the Need for Further Diagnostic Improvements: A Cohort Study 肩部核磁共振成像中旋转袖肌腱病变的二分法揭示了进一步改进诊断的必要性:一项队列研究
IF 0.3 Pub Date : 2023-01-02 DOI: 10.55453/rjmm.2023.126.1.3
G. Avram, A. Stefan, Miruna Harabagiu, D. Cuzino, Szekely Tamas, Szekely Lazlo, F. Săvulescu, Ș. Mitulescu, E. Cernat
"Background: Rotator cuff tendinopathy is most often described as a continuum between the normal cuff and rotator cuff tears with calcific tendinitis having its place along this continuum. Although many studies have focused on the role of magnetic resonance imagining (MRI) in diagnosing the extent of rotator cuff tears and their associated findings with good interobserver reliability, the same cannot be stated about MRI tendinopathy findings. Because of this discrepancy in diagnostic reliability, tendinopathy tends to be overtreated with injections when associated with symptoms, thus potentially increasing the risk of calcific tendinitis and progression toward rotator cuff tears. This study aims to assess whether diagnosing shoulder MRI tendinopathy patterns through dichotomization can accelerate clinical progress toward consensus. Methods: This study is a large retrospective cohort of 184 patients that underwent a 1.5T shoulder MRI for shoulder pain. Inclusion criteria were acromioclavicular arthrosis diagnosed in patients of any age. Exclusion criteria were partial or complete rotator cuff tears. Tendinopathy was considered the dependent variable and registered as a dichotomous variable while acromioclavicular joint arthrosis together with gender was categorical and age was the continuous variable. An attempt was made to generate a clinically significant binary logistic regression to assess the odds ratio of diagnosing tendinopathy based on age, gender, and acromioclavicular joint arthrosis status. Results: An overwhelming proportion of patients was positive for tendinopathy findings (95.11%). 64.12% of patients were within the active age group with patients within the 50-59 group being diagnosed the most with rotator cuff tendinopathy. Conclusions: Due to the high variability of MRI findings that can be considered positive for rotator cuff tendinopathy, an overwhelming skew toward a positive diagnosis was observed, thus dichotomizing tendinopathy diagnosis is not appropriate for clinically relevant conclusion-making "
“背景:肩袖肌腱病通常被描述为正常肩袖和肩袖撕裂之间的连续体,钙化肌腱炎在这个连续体中占有一席之地。尽管许多研究都集中在磁共振成像(MRI)的作用上在以良好的观察者间可靠性诊断肩袖撕裂的程度及其相关结果时,MRI腱病变的结果却不能如此。由于诊断可靠性的差异,当肌腱炎与症状相关时,往往会过度注射治疗,从而可能增加钙化肌腱炎和发展为肩袖撕裂的风险。本研究旨在评估通过二分法诊断肩部MRI腱病变模式是否可以加速临床共识的进展。方法:本研究是一个由184名患者组成的大型回顾性队列,这些患者因肩部疼痛接受了1.5T肩部MRI检查。纳入标准是在任何年龄的患者中诊断的肩锁关节病。排除标准为部分或全部肩袖撕裂。肌腱病变被认为是因变量,并被登记为二分变量,而肩锁关节病和性别是分类的,年龄是连续变量。尝试生成一个具有临床意义的二元逻辑回归,以评估基于年龄、性别和肩锁关节状态诊断腱病的比值比。结果:绝大多数患者(95.11%)的肌腱病变结果呈阳性。64.12%的患者处于活动年龄组,其中50-59岁组的患者被诊断为肩袖肌腱病变最多。结论:由于MRI检查结果的高度可变性可被认为是肩袖腱病变的阳性,观察到向阳性诊断的压倒性倾斜,因此将腱病变诊断分为二类不适合做出临床相关结论。”
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Romanian Journal of Military Medicine
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