为提高我院康复科护士的护理水平，采用康复理论学习、技术操作及其分别考核的方法，对护士进行继续教育。结果经统计学t检验，P＜0．01，有显著性差异。证明对护士进行继续教育和考核有明显的提高作用，应予推广实施。

ObjectiveTo compare the clinical effect and security of Reparil Gel on osteoarthritis of the knee.Methods60 patients were randomly divided into Reparil Gel group and Fenbid group, who applied Reparil Gel or take Fenbid orally respectively. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess patients' pain, joint stiffness and disability of knee on 0 week, 2 week, 6 week after treatment. The side effect was observed.ResultsBoth group showed good clinic effect on 2 weeks (P<0.05)and 6 weeks (P<0.001)after treatment. Significant difference between two group was found 2 weeks after treatment, but there was no difference 6 weeks after. There was no side effect had been observed in Reparil Gel group, while stomachache, nausea or anorexia had been found in 4 case of Fenbid group 2 weeks after, and 8 case of Fenbid group 6 weeks after.ConclusionReparil Gel are same effective as Fenbid, but less side effect happened.

Objective To improve clinicians' understanding of tuberculosis as the adverse event of the tumor necrosis factor alpha (TNF-α) antagonists therapy. Methods Two rheumatoid arthritis (RA) patients were reported to develop lymphoid tuberculosis and pulmonary tuberculoma after TNF-α antagonists therapy. The relevant literature were reviewed. Results The first ease was a 62 year-old female RA patient. Her skin PPD reaction was negative and chest X-ray was normal before the therapy. Following 4 doses of infliximab injection (each dose of 3 mg/kg) which were completed within 3 months, the patient developed fight supraclavicular lymphoids tuberculosis in the 5th month after the last treatment. The patient completely recovered after lymphoids excision and antituberculosis therapy with 4 anti-tuberculosis medications combination. The second case was a 44 year-old female RA patient. She did not take the skin PPD test and chest X-ray before the therapy. The patient developed fever and chest distress after etanercept therapy (25 mg hypodermic twice per week ) for 1.5 months. The chest X-ray showed a shadow in the median lobe of the right lung, which had gradually developed to a pulmonary tuberculoma. The patient's physical condition improved after the tubereuloma resection. It has been reported in recent years that ① TNF-α antagonists therapy could increase the incidence of tuberculosis, ② the incidence at which infliximab associated tuberculosis was higher than etanercept, ③ the majority of the patient having tuberculosis were old people, and ④ the incidence of extrapulmonary tuberculosis and the disseminated tuberculosis were higher than regular tuberculosis. Conclusion TNF-α antagonists may decrease the host defense ability against mycobacterium tuberculosis and increase the incidence of tuberculosis. The pre-treatment tuberculosis screening, as well as tuberculosis monitoring during and after treatment is mandatory.

Objective: To optimize the formula and preparation process of docetaxel-loaded pluronic P123 micelles. Methods:Docetaxel-loaded pluronic P123 micelles were prepared by a thin-film hydration method and optimized by central composite design and response surface methodology. The influencing factors including the quantity of docetaxel, volume of organic phase, volume of hydra-tion and temperature of hydration were investigated with the entrapment efficiency as the index. The morphology of micelles was ob-served under a transmission electron microscope. The particle diameter and zeta potential were determined. The in vitro release property was measured by a dialysis method. Results:The relationship between the influencing factors and the evaluation parameter was fitted by multi-linear equation, quadratic polynomial equation and cubic polynomial equation, respectively. The results showed that the cubic polynomial equation was superior to the others according to the correlation coefficient. Docetaxel-loaded pluronic P123 micelles were spherical with the mean diameter, zeta potential, polydispersity index, encapsulation efficiency and drug loading of 108. 3 nm,-3. 99 mV, 0. 265, (97. 91 ± 0. 28)% and (3. 72 ± 0. 12)%, respectively. The cumulative release in vitro reached 95. 03% in 120 h, and docetaxel-loaded pluronic P123 micelles had notable sustained-release property. Conclusion: The technical process for do-cetaxel-loaded pluronic P123 micelles is simple and usable, and docetaxel-loaded pluronic P123 micelles show high encapsulation effi-ciency and notable sustained-release property.

Objective To investigate the effect of cognition training on the recovery of balance after stroke. Methods forty-five hemiplegic strokd patents with cognition deficit were revruited and sddigned into an experimental group and a control group according to the results of an assessment with Loewenstein's Occupational Therapy Cognition Assessment battery (LOTCA). The patients in the two groups folloled routine systmatic rehabilitation programs. The patients in the (LOTCA). The patients in the two groups followed routine systmatic rehabilitation programs.The patiena in the experimental group received pertinent cognition training 5 days/week for 6 weeks. LOTCA,Brunel's Balance Assessment (BBA), the Berg Balance Scale (BBS) and Brunnatrom functional categories were enployed to evaluate the patients before and after treatment with regard to their cognition, balance control and motor function in their lower limbs. Results After treatment, there were statistically significant differences between preand post-treatment BBA and BBS scores in all groups. Average BBA, BBS and LOTCA scores in the experimental group were significantly higher than in the control group. The improvements in BBS, BBA and LOTCA scores in the experimental grou were significantly greater than in control group. Conclusion Cognition treatment can contribute significantly to improving balance and postural control among stroke survivors.

BACKGROUND:Pressure sensitive instrumented shoes are fast and easily used tools to measure ground reaction forces. Currently researches about the utilities of these systems in assessment of gait in children with neurological diseases have been started to run.OBJECTIVE: To find the gait characteristics of dynamic plantar pressure in children with spastic cerebral palsy. DESIGN: A cross-sectional study.SETTINGS: Department of Rehabilitation, Songgang People's Hospital; Department of Rehabilitation, Shenzhen Children's Hospital; Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS: ① Patient group: Twenty children with spastic cerebral palsy were selected from Shenzhen Children's Hospital from May 2004 to April 2005, including 9 boys and 11 girls, aged 26-66 months old, and they all could walk for more than 10 m independently. ② Normal control group: 52 healthy children with normal walking ability were enrolled, including 28 boys.and 24 girls, aged 35-76 months old.METHODS: Ultraflex gait analysis system was used to perform continuous plantar pressure tests of both groups of children. Diagram and data of dynamic plantar pressures in gait were recorded and analyzed with a computer. MAIN OUTCOME MEASURES: ① 10 sequential gait cycles were chosen from the continuous stable steps to calculate the average data with the software; ② Differences of the characteristic parameters of plantar pressure curve between the two groups.RESULTS: ① The curves of plantar pressure to time of testees in the normal control group were of the wave shapes with two peaks and one valley. Half of the CP children could not perform the two-peak shape pressure curve in the gait analysis. One kind of abnormal plantar pressure curve style was a wave shape with only one peak. Another kind of abnormal plantar pressure curve style was a shape showing asymmetry between sides and variation in different steps even in the same side. Two-peak shapes of dynamic plantar pressure were recorded in 10 CP children. ② Characteristic parameters picked up from the curves of plantar pressure had been compared between the two groups. Significant difference have been found in ts of both sides and tz1,tz2,tz3 on the right side between the two groups. It was shown that the single-limb support time of both sides in the CP children was longer than that in healthy children [left: (0.879± 0.658), (0.472±0.051) s; right: (0.818±0.682), (0.478±0.050) s; P ＜ 0.01]. The tz1 and tz3 on the right side in the CP children were longer and while the tz2 was shorter than those in the healthy children. CONCLUSION: ① Using dynamic plantar pressure gait analysis system, plantar pressure curves can be observed directly, and information about kinetic characters can be drawn straightly. ② Part of patients with spastic CP could not perform the two-peak shape pressure curves in gait analysis. In patient can be recorded of two-peak shape dynamic plantar pressure curves, ts of both sides are shorter than those in healthy children, tz1 and tz3 on the right side is longer and tz2 is shorter than those in healthy children.

BACKGROUND: Improper practice during military training is likely to cause various training wounds, among which patellar tendinosis is the common one.OBJECTIVE: To explore the onset characteristics of patellar tendinosis caused by military training and incidence changes after the implementation of interventions.DESIGN:Sampling investigation.SETTING: Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA; Department of Surgery, Hospital of Chinese PLA Garrison in Hong Kong PARTICIPANTS: Male army soldiers aged 18-24 years were recruited from a full-time training army in August 2000 (non-intervention group) and August 2001 (intervention group). The same training program was carried out among the 2,783 soldiers in non-intervention group and 5,824 soldiers in the intervention group.METHODS: The investigation group was composed of medical workers with senior and intermediate professional titles. Uniform diagnostic standard was made before the investigation, and questionnaire survey wascombined with on-the-spot inspection on soldiers who complained about knee joint pain following training. Those who conformed to the diagnosis were inquired of their training state in detail and possible causes; meanwhile knee X-ray examination was also conducted. Soldiers in the non- intervention group were subjected to the investigation of the incidence and cause of patellar tendinosis due to fulltime training without given any preventive intervention. By contrast, soldiers in the intervention group were given preventive and therapeutic interventions and then subjected to the investigation into the interventional outcomes one year later.MAIN OUTCOME MEASURES: The incidence of patellar tendinosis in soldiers of the two groups.RESULTS: The first and second investigations were conducted on the 2 783 soldiers and 5 824 soldiers, respectively. All of them entered the rediers of the non-intervention group (the incidence of 0.61%) as compared to 15 soldiers in the intervention group (the incidence of 0.26%) (P＜0.01).tenderness. Patel1ar bone X-ray inspection on 12 of them displayed patellar ciated with run-jump training projects; 23 cases were caused by 400 mbarrier training and 7 cases by 5 km cross-country training.CONCLUSION: Patellar tendinosis during military training is mostly caused by run-jump training and can be remarkably prevented by preventive interventions.

BACKGROUND:The interaction of neural network and motor function in post-stroke brain tissue remains unclear.
OBJECTIVE:To observe neural network impairment fol owing subacute stroke by using diffusion tensor imaging, and to investigate the relationship with neurological defects and motor dysfunction.
METHODS:A total of 19 patients after subactue stroke and 20 healthy adults were examined with diffusion tensor imaging. The fol owing parameters were compared:fractional anisotropy, apparent diffusion coefficient, asymmetry indices of fractional anisotropy and apparent diffusion coefficient. The neurological defect and motor function were evaluated with the corresponding scales. The 10-meter walking speed was measured. The correlation of diffusion tensor imaging parameters with the scale scores and 10-meter walking speed was analyzed.
RESULTS AND CONCLUSION:The stroke group exhibited reduced fractional anisotropy value asymmetry and fractional anisotropy value in bilateral posterior limbs of the internal capsule. Apparent diffusion coefficient value asymmetry and apparent diffusion coefficient value in the posterior limb of the internal capsule were lower than control unaffected side (P<0.05). Apparent diffusion coefficient value and apparent diffusion coefficient value asymmetry in posterior limb of the internal capsule showed a strong negative correlation with Fugl-Meyer assessment scores of the lower extremities (P<0.05). Diffusion tensor imaging parameters is closely linked with motor dysfunction of the lower extremities in subacute stroke patients. Local stroke lesion-caused neurological defect is the leading cause of motor dysfunction of the lower extremities.

Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study.All subjects received one dose of 25 mg rhTNFR:Fc injected to the target knee joints after synovial fluid being drawn away before injection.They were followed up for four weeks after injection.The primary end-point was the 4-week change in the moditied hospital for special surgery (HSS) knee score for the target knee.The secondary end-point were the 4-week change in patients assessment of the knee,and investigators assessment of knee,pain VAS of the knee joint when walking or standing,the range of knee inflexion,circumference of the knee cross section,synovium thickness detected by ultrasound in the part of the thickest synovium in the suprapatellar bursa.Paired t test,independed t test and Wilcoxon test were used for statistical analysis.Results Twenty-seven SpA patients and fifteen RA patients were included in the trial.The modified HSS knee score for the SpA group was 66±14 at baseline,86±11 (P＜0.05) at follow-up,and for the RA group,the score was 64±13 at baseline,80±9 (P＜0.05) at follow-up.24.2％ (16.5％-41.9％) improve-ment on the modified HSS knee score was achieved in the SpA group,while 22.2％ (15.3％-37.7％) improvement on the modified HSS knee score was achieved in the RA group (P＞0.05).31.8％ (9.3％-57.3％) improvement on the synovium thickness was achieved in the SpA group,while 1.5％ (-19.3％-25.5％) improvement on the synovium thickness was achieved in the RA group (P＜0.05).Adverse events were observed in six patients in SpA group and two patients in RA group.No serious adverse events had been observed.Conclusion Single intra-articular rhTNFR:Fc injection is an effective and safe therapeutic option for knee arthritis in both SpA and RA patients.This treatment may relieve knee synovitis in SpA patients more effectively than in RA patients.

Objective　 To study the prevalence and relevant risk factors of low blood pressure and its influence on cardiovascular diseases in China. Methods　A cross-sectional study for low blood pressure was conducted using the data of the third national survey of blood pressure in 1991. Low blood pressure was defined for systolic (SBP) and diastolic (DBP) pressure less than the tenth percentile for the sample (SBP≤98mmHg and DBP≤60mmHg). Results　The prevalence of low blood pressure for males and females were 2.7% and 7.4%, respectively. The prevalence of low blood pressure for females was higher than that of males (P<0.01). Prevalence of low blood pressure was 7.62%, 6.97%, 4.40%, 3.22%, 2.65%, 1.94% for age groups 15～, 25～, 35～, 45～, 55～, 65～, respectively. The prevalence of low blood pressure was gradually declined with aging. There was large variation in the prevalence of low blood pressure for different minorities. The prevalence of low blood pressure was higher in the southern rather than the northern part of China. Logistic regression showed that the age (OR 0.97, 95%CI 0.97～0.98, per 10 mmHg), BMI (OR 0.80, 95%CI 0.80～0.81), drinking (OR 0.89, 95%CI 0.86～0.93) and heart rate (OR 0.981, 95%CI 0.980～0.982) had reverse relationship with low blood pressure. The sex had a positive relationship with low blood pressure. The prevalence of stroke and myocardial infarction in the population with low blood pressure was lower than that of normal pressure or hypertension (P<0.01). Conclusion　The prevalence and relevant risk factors of low blood pressure in China were various. We speculate that low blood pressure in Chinese population appears to be a normal state of physiology.The difinite influence in health needs cohort studies to confirm.