ObjectiveTo compare the analgesic effect of different treatment for herpes zoster neuralgia, and optimize herpetic neuralgia treatment. MethodsWe collected hospital inpatient data with herpes zoster by the First Military Medical Case Management System between January 1st, 2009 and December 20th, 2013. All the patients were divided into five groups according to different treatments. Patients in group A accepted valaciclovir capsules and doxepin hydrochloride tablets; patients in group B accepted valaciclovir capsules; patients in group C accepted valaciclovir capsule, nefopam hydrochloride tablets and doxepin hydrochloride tablets; patients in group D accepted valaciclovir capsules and nefopam hydrochloride tablets; patients in group E accepted valaciclovir capsules and non-steroidal anti-inflammatory drugs (including nimesulide capsules and ibuprofen sustained-release capsules). We collected such statistic data as sex, age, time of onset, time of pain disappearing after treatment. Then, we analyzed the difference among the groups on the time of pain disappearing. ResultsThere were 336 cases compliant with the standard in all the 898 cases of medical record data. The number of the patients was 72, 86, 66, 60 and 52; while the pain disappearing time after treatment was (5.94±2.54), (8.60±3.09), (5.77±1.85), (5.80±1.96) and (6.86±2.18) days, respectively in group A, B, C, D and E. Pain disappearing time after treatment of group B was significantly different from groups A, C, D, and E (P<0.05); group E was significantly different from groups A, C, and D (P<0.05); there was no significant difference between group A and groups C and D, and between group C and D (P>0.05). ConclusionThe combination of nefopam hydrochloride tablets, doxepin hydrochloride tablets, nimesulide capsules, and ibuprofen sustained-release capsules is effective in the treatment of herpes zoster neuralgia. The use of nefopam hydrochloride tablets with doxepin hydrochloride tablets is more effective than the combination of nimesulide capsules and ibuprofen sustained-release capsules. Doxepin hydrochloride tablets are not significantly different from nefopam hydrochloride tablets. Nefopam hydrochloride tablets and doxepin hydrochloride tablets are not associated with increased efficacy.
Objective To discuss the surgical procedures and curative effect of stiff 2-5 metacarpophalangeal (MP) joints after crash injury in hand. Methods Between January 2006 and June 2009, 7 cases of stiff 2-5 MP joints were treated by releasing the stiff MP joints and reconstructing the function of lumbrical muscle in one stage. There were 6 males and 1 female with an average age of 32 years (range, 18-56 years). All injuries were caused by crash. Six cases suffered from multiple metacarpal fracture or complex dislocation of MP joint and 1 case suffered from complete amputation at level of middle palm of hand. The interval from initial wound heal ing to hospital ization was 3 to 15 months. Before operation, the X-ray films showed fracture healed and the results of nipping paper test were positive. All hands were treated with physical therapy for 1 month. After the plaster external fixation for 6 weeks, the physical therapy and function training were given. Results All wounds healed by first intention. The patients had no joint instabil ity and extensor tendon side-sl ipping with normal finger function. Six patients were followed up from 6 months to 3 years. The extension and flexion of MP joint were 0° and 67-90°, respectively. The average grip strength of injured dominant hand reached 86.70% of normal side and non-dominant hand reached 66.70% of normal side. The average injured dominant tip pinch strength reached 83.52% of normal side and non-dominant tip pinch strength reached 61.30% of normal side. Based on total active motion (TAM) system of Chinese Medical Association for Hand Surgery, the results were excellent in 4 cases, good in 1 case, and fair in 1 case; the excellent and good rate was 83.33%. Conclusion In patients with stiff MP joint and lumbrical muscle defect, releasing stiff MP joint and reconstructing lumbrical function in one stage can recover the function of MP joint and achieve good outcome. Physical therapy plays an important role before operation.
Objective To investigate the anti-adhesive effect and underlying mechanism of dynamic and static stress stimulation on the early healing process of rat Achilles tendon injury. Methods Achilles tendon tissues of 15 male Sprague Dawley (SD) rats aged 4-6 weeks were isolated and cultured by enzyme digestion method. Rat Achilles tendon cells were treated with tumor necrosis factor α to construct the Achilles tendon injury cell model, and dynamic stress stimulation (dynamic group) and static stress stimulation (static group) were applied respectively, while the control group was not treated. Live/dead cell double staining was used to detect cell activity, ELISA assay was used to detect the expression of α smooth muscle actin (α-SMA), and real-time fluorescence quantitative PCR was used to detect the mRNA expression of collagen type Ⅰ (COL1A1), collagen type Ⅲ (COL3A1), and Scleraxis (SCX). Thirty male SD rats aged 4-6 weeks underwent Achilles tendon suture and were randomly divided into dynamic group (treated by dynamic stress stimulation), static group (treated by static stress stimulation), and control group (untreated), with 10 rats in each group. HE staining and scoring were performed to evaluate the healing of Achilles tendon at 8 days after operation. COL1A1 and COL3A1 protein expressions were detected by immunohistochemical staining, α-SMA and SCX protein expressions were detected by Western blot, and maximum tendon breaking force and tendon stiffness were detected by biomechanical stretching test. Results In vitro cell experiment, when compared to the static group, the number of living cells in the dynamic group was higher, the expression of α-SMA protein was decreased, the relative expression of COL3A1 mRNA was decreased, and the relative expression of SCX mRNA was increased, and the differences were all significant (P<0.05). In the in vivo animal experiment, when compared to the static group, the tendon healing in the dynamic group was better, the HE staining score was lower, the expression of COL1A1 protein was increased, the expression of COL3A1 protein was decreased, the relative expression of SCX protein was increased, the relative expression of α-SMA protein was decreased, and the tendon stiffness was increased, the differences were all significant (P<0.05). Conclusion Compared with static stress stimulation, the dynamic stress stimulation improves the fibrosis of the scar tissue of the rat Achilles tendon, promote the recovery of the biomechanical property of the Achilles tendon, and has obvious anti-adhesion effect.
In recent years, real-world evidence data (RWD) and real-world evidence (RWE) have gained substantial attentions from healthcare practitioners and health authorities worldwide. In particular, the needs from regulatory bodies have promoted the production and use of real-world evidence. In the context of drug and device evaluation and regulation decisions, the pattern for using real world evidence may differ. This article aimed to discuss the potential uses of RWE for pre-approval clinical evaluation, post-approval monitoring and evaluation, and associated regulatory decisions, which may ultimately improve the production and use of RWE for regulatory decisions.