BACKGROUND & AIMS: :Chronic pain may result from hyperexcitability following activation of spinal NMDA receptors. A naturally-derived mammalian peptide, histogranin, may possess NMDA antagonist activity. This study explored the possibility that stable analog [Ser1]Histogranin (SHG) could reduce chronic pain. Neuropathic pain was induced using the chronic constriction injury model (CCI). Intrathecal injection of SHG markedly attenuated the hyperalgesia and allodynia resulting from CCI, nearly normalizing responses. These results suggest that the natural peptide histogranin may be a novel adjunct in neuropathic pain management.

背景与目标： ：慢性疼痛可能是由脊柱NMDA受体激活后的过度兴奋引起的。天然来源的哺乳动物多肽，组织颗粒蛋白可能具有NMDA拮抗剂活性。这项研究探讨了稳定的类似物[Ser1] Histogranin（SHG）可以减轻慢性疼痛的可能性。使用慢性收缩损伤模型（CCI）诱发神经性疼痛。鞘内注射SHG明显减轻了CCI引起的痛觉过敏和异常性疼痛，使反应趋于正常。这些结果表明，天然肽组织颗粒蛋白可能是神经性疼痛治疗的新辅助剂。

BACKGROUND & AIMS: :Peripheral neuropathic pain is a unique form of chronic pain that afflicts up to 50% of persons with AIDS. The purpose of this pilot study was to examine the effects of ice massage to reduce neuropathic pain and improve sleep quality and to determine the feasibility of a larger study. A repeated measures design was used. The three treatments consisted of ice massage, dry-towel massage, and presence. Consecutive sampling was used to select 33 persons with AIDS who had neuropathic pain. Although the results of the study were negative, there was a decrease in pain intensity over time with both the ice massage and towel massage, suggesting that the intervention has some clinical benefit.

背景与目标： ：周围神经性疼痛是慢性疼痛的一种独特形式，可折磨多达50％的艾滋病患者。这项初步研究的目的是检验冰按摩对减轻神经性疼痛和改善睡眠质量的作用，并确定一项更大研究的可行性。使用了重复测量设计。这三种治疗包括冰按摩，干毛巾按摩和临场感。连续抽样选择了33名患有神经性疼痛的艾滋病患者。尽管研究结果为阴性，但冰按摩和毛巾按摩的疼痛强度均随时间降低，表明该干预措施具有一定的临床益处。

BACKGROUND & AIMS: CONTEXT:Chronic pain in patients with advanced cancer poses a serious clinical challenge. The Δ9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (U.S. Adopted Name, nabiximols; Sativex(®)) is a novel cannabinoid formulation currently undergoing investigation as an adjuvant therapy for this treatment group. OBJECTIVES:This follow-up study investigated the long-term safety and tolerability of THC/CBD spray and THC spray in relieving pain in patients with advanced cancer. METHODS:In total, 43 patients with cancer-related pain experiencing inadequate analgesia despite chronic opioid dosing, who had participated in a previous three-arm (THC/CBD spray, THC spray, or placebo), two-week parent randomized controlled trial, entered this open-label, multicenter, follow-up study. Patients self-titrated THC/CBD spray (n=39) or THC spray (n=4) to symptom relief or maximum dose and were regularly reviewed for safety, tolerability, and evidence of clinical benefit. RESULTS:The efficacy end point of change from baseline in mean Brief Pain Inventory-Short Form scores for "pain severity" and "worst pain" domains showed a decrease (i.e., improvement) at each visit in the THC/CBD spray patients. Similarly, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 scores showed a decrease (i.e., improvement) from baseline in the domains of insomnia, pain, and fatigue. No new safety concerns associated with the extended use of THC/CBD spray arose from this study. CONCLUSION:This study showed that the long-term use of THC/CBD spray was generally well tolerated, with no evidence of a loss of effect for the relief of cancer-related pain with long-term use. Furthermore, patients who kept using the study medication did not seek to increase their dose of this or other pain-relieving medication over time, suggesting that the adjuvant use of cannabinoids in cancer-related pain could provide useful benefit.

背景与目标： 背景：晚期癌症患者的慢性疼痛提出了严峻的临床挑战。 Δ9-四氢大麻酚（THC）/大麻二酚（CBD）口腔粘膜喷雾剂（美国采用名称，nabiximols;Sativex®）是一种新型大麻素制剂，目前正在接受治疗，作为该治疗组的辅助疗法。
目的：这项随访研究调查了THC / CBD喷雾剂和THC喷雾剂在缓解晚期癌症患者的疼痛方面的长期安全性和耐受性。
方法：共有43例癌症相关疼痛患者尽管使用了阿片类药物长期服用，但仍没有足够的镇痛作用，他们参加了先前的三组试验（THC / CBD喷雾剂，THC喷雾剂或安慰剂），为期两周的父母随机对照试验，参加了这项开放性，多中心的后续研究。患者自行滴定THC / CBD喷雾剂（n = 39）或THC喷雾剂（n = 4）以缓解症状或最大剂量，并定期检查其安全性，耐受性和临床获益证据。
结果：THC / CBD喷剂患者每次就诊时，“疼痛严重程度”和“最严重疼痛”域的平均简短疼痛清单-简表得分的基线变化的功效终点显示出降低（即改善）。同样，欧洲癌症生活质量研究和治疗组织问卷-C30的得分显示，失眠，疼痛和疲劳程度较基线水平有所降低（即有所改善）。这项研究没有引起与广泛使用THC / CBD喷雾剂相关的新安全隐患。
结论：这项研究表明，长期使用THC / CBD喷雾剂通常具有良好的耐受性，没有证据表明长期使用THC / CBD喷雾剂可减轻癌症相关疼痛。此外，继续使用研究药物的患者并未寻求随时间增加这种药物或其他缓解疼痛药物的剂量，这表明在与癌症相关的疼痛中辅助使用大麻素可提供有益的益处。

BACKGROUND & AIMS: :The perception of visceral pain is a complex process involving the spinal cord and higher order brain structures. Increasing evidence implicates the gut microbiota as a key regulator of brain and behavior, yet it remains to be determined if gut bacteria play a role in visceral sensitivity. We used germ-free mice (GF) to assess visceral sensitivity, spinal cord gene expression and pain-related brain structures. GF mice displayed visceral hypersensitivity accompanied by increases in Toll-like receptor and cytokine gene expression in the spinal cord, which were normalized by postnatal colonization with microbiota from conventionally colonized (CC). In GF mice, the volumes of the anterior cingulate cortex (ACC) and periaqueductal grey, areas involved in pain processing, were decreased and enlarged, respectively, and dendritic changes in the ACC were evident. These findings indicate that the gut microbiota is required for the normal visceral pain sensation.

背景与目标： ：内脏痛的感觉是一个复杂的过程，涉及脊髓和高级大脑结构。越来越多的证据表明肠道菌群是大脑和行为的关键调节因子，但是肠道细菌是否在内脏敏感性中起作用尚待确定。我们使用无菌小鼠（GF）评估内脏敏感性，脊髓基因表达和与疼痛相关的脑结构。 GF小鼠表现出内脏超敏反应，并伴随着脊髓Toll样受体和细胞因子基因表达的增加，这可以通过用常规定殖的（CC）菌群在出生后定植来实现。在GF小鼠中，前扣带回皮质（ACC）和导水管周围灰色的体积（参与疼痛处理的区域）分别减小和增大，并且ACC中的树突状变化是明显的。这些发现表明，肠道菌群是正常内脏痛感所必需的。

BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： ：医疗保健方面的改进缓慢，部分原因是医生和护士缺乏提高质量，患者安全和跨专业团队合作的技能。本文报道了Josiah Macy Jr. Foundation和医疗保健改善研究所的“质量与安全重组”倡议，该倡议旨在将改善和患者安全纳入医疗和护理学校课程。在2009-10学年的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动（其中87％是跨专业的，涉及医学和护理学的学生），涉及六所大学的1,374名学生。这项工作产生了本文中介绍的见解，其中的学习目标需要跨专业的教育；如何为所有学生创建基于临床的改进学习；以及如何证明对学生的行为，组织实践和对患者的好处的影响。该计划的一个普遍遇到的限制因素是缺乏足够数量的临床教师来准备教授改善护理的知识。而且，此类计划缺乏强有力的评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: :The feasibility of using a subcutaneously implanted portal system attached to a conventional 16-gauge epidural catheter has been evaluated in 50 patients with sever pain associated with cancer. This technique allowed for the percutaneous epidural administration of morphine at 8-12-hourly intervals for pain control. The mean duration of implantation was 12 weeks and the longest period a portal remained in situ was 36 weeks. Five portals had to be removed for various reasons. The injection system has blocked on eight occasions due to catheter blockage (six times) and portal blockage (two occasions). These patients have continued to obtain excellent analgesia when either catheter or portal were replaced. In a cadaver, 300 injections were simulated using either 22-gauge Huber point needles or disposable needles (25 gauge) and the injectate examined by both light and scanning electron microscopy. Both needle types resulted in particulate contamination which was greater with the recommended Huber point needles.

背景与目标： ：已对50例与癌症相关的严重疼痛的患者评估了使用皮下植入的门禁系统连接传统的16号硬膜外导管的可行性。该技术允许以8-12小时的间隔经皮硬膜外给予吗啡以控制疼痛。平均植入时间为12周，而门户留在原位的最长时间为36周。由于各种原因，必须删除五个门户。由于导管阻塞（六次）和门静脉阻塞（两次），注射系统已发生八次阻塞。当更换导管或门静脉时，这些患者继续获得出色的镇痛效果。在尸体中，使用22号Huber点针或一次性针头（25号针头）模拟了300次注射，并通过光学和扫描电子显微镜对注射进行了检查。两种类型的针都导致微粒污染，建议的Huber点式针污染更大。

BACKGROUND & AIMS: :Neuropathic pain is a result of complex interactions between peripheral and central mechanisms with multiple potential therapeutic targets. However, the complexity of these mechanisms and relative youth of translational pain research, which is in its infancy, have prevented translation of successful basic bench research to human therapy. Most of the clinically available neuropathic pain treatments are borrowed from other therapeutic areas, such as antidepressants and antiepileptics, or involve application of older therapy, such as opioids. Exceptions are ziconotide, tapentadol, and the high-concentration capsaicin patch. Similar to all other analgesic agents, these provide only partial pain relief in subsets of patients. The standard of care for patients with chronic neuropathic pain is multimodal and multidisciplinary. For most patients to achieve and maintain satisfactory pain relief a combination of therapeutic agents is necessary, providing the empiric basis for rational polypharmacy, which has become a standard approach as well.

背景与目标： ：神经性疼痛是外周和中枢机制与多个潜在治疗靶点之间复杂相互作用的结果。但是，这些机制的复杂性以及相对较年轻的转化性疼痛研究尚处于起步阶段，因此阻碍了成功的基础实验研究向人类疗法的转化。大多数临床上可用的神经性疼痛疗法是从其他治疗领域（如抗抑郁药和抗癫痫药）借来的，或涉及使用较老的疗法（如阿片类药物）。齐考诺肽，他喷他多和高浓度辣椒素贴剂除外。与所有其他止痛药相似，这些止痛药仅能部分缓解部分患者的疼痛。慢性神经性疼痛患者的护理标准是多模式和多学科的。对于大多数患者来说，要达到并维持令人满意的止痛效果，必须结合治疗药物，为合理的多药治疗提供经验基础，这也已成为一种标准方法。

BACKGROUND & AIMS: PURPOSE:Many women with hormone receptor-positive breast cancer discontinue effective aromatase inhibitor (AI) treatment due to joint symptoms. METHODS:We conducted a single-arm, open-label, phase II study evaluating glucosamine-sulfate (1,500 mg/day) + chondroitin-sulfate (1,200 mg/day) for 24 weeks to treat joint pain/stiffness in postmenopausal women with early stage breast cancer who developed moderate-to-severe joint pain after initiating AIs. The primary endpoint was improvement in pain/stiffness at week 24 assessed by the Outcome Measure in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria. Secondary endpoints assessed changes in pain, stiffness, and function using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index for hips/knees and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH) for hands/wrists. The Brief Pain Inventory (BPI) assessed pain interference, severity, and worst pain. RESULTS:Of 53 patients enrolled, 39 were evaluable at week 24. From baseline to week 24, 46 % of patients improved according to OMERACT-OARSI criteria. At week 24, there were improvements (all P < 0.05) in pain and function as assessed by WOMAC and M-SACRAH, and in pain interference, severity, and worst pain as assessed by BPI. Estradiol levels did not change from baseline. The most commonly reported side effects were headache (28 %), dyspepsia (15 %), and nausea (17 %). CONCLUSIONS:In this single-arm study, 24 weeks of glucosamine/chondroitin resulted in moderate improvements in AI-induced arthralgias, with minimal side effects, and no changes in estradiol levels. These results suggest a need to evaluate efficacy in a placebo-controlled trial.

背景与目标： 目的：许多患有激素受体阳性乳腺癌的妇女由于关节症状而停止有效的芳香化酶抑制剂（AI）治疗。
方法：我们进行了单臂，开放标签，II期研究，评估硫酸氨基葡萄糖（1500毫克/天）硫酸软骨素（1200毫克/天）持续24周，以治疗绝经后早期女性的关节痛/僵硬启动AI后发展为中度至重度关节痛的乳腺癌。主要终点是通过风湿病临床试验和国际骨关节炎研究协会（OMERACT-OARSI）标准中的结果评估标准评估的第24周疼痛/僵硬的改善。次要终点是使用西安大略省和麦克马斯特大学的骨关节炎（WOMAC）指数评估臀部/膝盖的疼痛，僵硬和功能的变化，以及评估手的慢性类风湿性关节炎（M-SACRAH）的改良评分/ wrists。简短疼痛清单（BPI）评估了疼痛的干扰，严重程度和最严重的疼痛。
结果：在入组的53例患者中，有39例在第24周得到了评估。从基线到第24周，根据OMERACT-OARSI标准，有46％的患者得到了改善。在第24周时，WOMAC和M-SACRAH评估的疼痛和功能以及BPI评估的疼痛干扰，严重程度和最严重疼痛得到改善（所有P <0.05）。雌二醇水平与基线相比没有变化。最常见的副作用是头痛（28％），消化不良（15％）和恶心（17％）。
结论：在这项单臂研究中，葡萄糖胺/软骨素的24周可导致AI引起的关节痛适度改善，副作用最小，雌二醇水平也无变化。这些结果表明需要在安慰剂对照试验中评估疗效。

BACKGROUND & AIMS: OBJECTIVE:Anticipated pain with intrauterine device (IUD) insertion may be a barrier to widespread use. Our objective was to evaluate the efficacy of intracervical 2% lidocaine gel for pain relief with IUD insertion. STUDY DESIGN:We performed a double-blind, randomized controlled trial of women undergoing IUD insertion. Participants were randomly assigned to 2% lidocaine or placebo gel. Study gel (3 mL) was placed 3 minutes prior to IUD insertion. Pain scores were measured at various time points using a 10-point visual analog scale. RESULTS:Of the 200 participants randomized, 199 completed the study. Pain scores among lidocaine and placebo arms were similar at tenaculum placement (lidocaine and placebo: median, 4; range, 0-10; P = .15) and with insertion (lidocaine: median, 5; range, 1-10; placebo: median, 6; range, 0-10; P = .16). These results did not differ by parity. CONCLUSION:Topical or intracervical 2% lidocaine gel prior to IUD insertion does not decrease pain scores.

背景与目标： 目的：宫内节育器（IUD）插入会导致预期的疼痛可能是广泛使用的障碍。我们的目标是评估2％利多卡因腹腔内凝胶治疗宫内节育器疼痛缓解的效果。
研究设计：我们对接受宫内节育器植入的妇女进行了一项双盲，随机对照试验。参与者被随机分配到2％利多卡因或安慰剂凝胶中。在插入宫内节育器之前3分钟放置研究凝胶（3 mL）。使用10点视觉模拟量表在各个时间点测量疼痛评分。
结果：在随机分配的200名参与者中，有199名完成了研究。利多卡因和安慰剂组之间的疼痛评分在触角放置（利多卡因和安慰剂：中位数，4；范围，0-10； P = .15）和插入时（利多卡因：中位数，5；范围，1-10；安慰剂：中位数为6；范围为0-10； P = 0.16）。这些结果在均等方面没有差异。
结论：在宫内节育器插入前局部或颅内使用2％利多卡因凝胶不会降低疼痛评分。

BACKGROUND & AIMS: BACKGROUND:Many brain areas participate to supraspinal control of nociception. In these regions, few studies have investigated the role of glial cells in supraspinal plasticity and the effect of 7-day intrathecal nerve growth factor-like (BB14®, Blueprint Biotech, Milano, Italy) treatment. METHODS:In male Sprague-Dawley rats, we evaluated by immunohistochemistry the morphological and molecular rearrangement of neuroglial network occurring in several supraspinal brain regions involved in pain processing following spared nerve injury (SNI) of the sciatic nerve. In particular, the medial prefrontal cortex, the amygdala (Amy), the nucleus accumbens (Acb), the thalamus and the periaqueductal gray were analysed. RESULTS:Despite the modifications occurring in the dorsal horn of spinal cord following SNI, no significant changes in the Iba1 and glial fibrillary acidic protein (GFAP) expression were detected in all the analysed supraspinal regions, except for the Amy, showing a remarkable GFAP increase. Interestingly, neuropathic rats also displayed a significant increase of glial transporters (GTs) in all the supraspinal regions. Finally, the analysis of vesicular glutamate transporter 1 (vGLUT1) and vesicular gamma-aminobutyric acid (GABA) transporter (vGAT) expression revealed a significant enhancement of glutamatergic/GABAergic ratio in all selected brain regions of SNI animals, except for Acb. Both glial activation in the Amy and alteration of GTs and vGLUT/vGAT levels observed in neuropathic animals were largely reversed by BB14® treatment. CONCLUSIONS:All together, these data strengthen the role of supraspinal neuroglial network plasticity in the establishment of neuropathic pain syndrome. The hallmark is represented by the divergence between glial reaction confined to Amy and the widespread changes in the GT distribution and glutamate/GABA ratio detected in the other supraspinal region.

背景与目标： 背景：许多大脑区域参与了脊髓上的伤害感受控制。在这些地区，很少有研究研究神经胶质细胞在棘上棘可塑性中的作用以及鞘内神经生长因子样7天疗法的效果（BB14®，Blueprint Biotech，米兰，意大利）。
方法：在雄性Sprague-Dawley大鼠中，我们通过免疫组织化学方法评估了坐骨神经备用神经损伤（SNI）后参与疼痛处理的多个棘上大脑区域中神经胶质网络的形态和分子重排。特别地，分析了内侧前额叶皮层，杏仁核（Amy），伏隔核（Acb），丘脑和导水管周围的灰色。
结果：尽管SNI后脊髓背角发生了改变，但除Amy外，在所有分析的脊髓上上区均未检测到Iba1和神经胶质纤维酸性蛋白（GFAP）表达的显着变化，显示GFAP显着增加。有趣的是，神经病变大鼠在所有棘上神经区也显示出神经胶质转运蛋白（GTs）的显着增加。最后，对囊泡谷氨酸转运蛋白1（vGLUT1）和囊泡γ-氨基丁酸（GABA）转运蛋白（vGAT）表达的分析显示，除Acb外，SNI动物所有选定大脑区域的谷氨酸能/ GABA能比均显着提高。在神经病动物中观察到的Amy中的神经胶质激活以及GTs和vGLUT / vGAT水平的改变都可以通过BB14®治疗大幅度逆转。
结论：这些数据加在一起增强了脊髓上神经胶质网络可塑性在建立神经性疼痛综合征中的作用。具有标志性的特征是仅限于Amy的神经胶质反应与在其他上棘突区域中检测到的GT分布和谷氨酸/ GABA比的广泛变化之间存在差异。

BACKGROUND & AIMS: OBJECTIVE:Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). METHODS:One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). RESULTS:After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). CONCLUSION:In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.

背景与目标： 目的：尽管有证据表明增加股四头肌力量对膝关节症状有有益作用，但对膝关节结构的影响尚不清楚。我们进行了这项研究，以检查有症状膝骨关节炎（OA）患者的股内侧截面积（CSA）变化与膝关节疼痛，胫骨软骨体积和膝关节置换风险之间的关系。
方法：117名有症状膝骨关节炎的受试者在基线，2岁和4.5岁接受了膝部磁共振成像。在基线和第2年测量中侧股静脉CSA。在基线以及第2和4.5年测量胫骨软骨体积。在基线和第2年，通过西安大略和麦克马斯特大学的骨关节炎指数评估膝关节疼痛。确定了4年内膝关节置换的频率。确定回归系数（B）和比值比以及95％的置信区间（95％CI）。
结果：校正混杂因素后，基线膝关节内侧内侧CSA与当前膝关节疼痛呈负相关（r = -0.16，P = 0.04），并且与基线至2年时胫骨内侧软骨体积减少呈负相关（B系数-10.9 [95％CI- 19.5，-2.3]），但不包括胫骨基线软骨体积。此外，从基线期到2年内，腓肠肌CSA的增加与同期膝关节疼痛的减轻有关（r = 0.24，P = 0.007），胫骨内侧软骨损失从2年减少到4.5年（B系数-16.8） [95％CI -28.9，-4.6]），并在4年内降低了膝关节置换的风险（赔率0.61 [95％CI 0.40，0.94]）。
结论：在有症状的膝骨关节炎患者中，股骨内侧vast增大与膝关节疼痛减轻和膝部有益的结构变化有关，这表明管理膝部疼痛和优化股骨内侧media肌对于减少OA进展和随后的膝关节起重要作用。替代品。

BACKGROUND & AIMS: :Previous surveys showed a poor quality of the web sites providing health information about low back pain. However, the rapid and continuous evolution of the Internet content may question the current validity of those investigations. The present study is aimed to quantitatively assess the quality of the Internet information about low back pain retrieved with the most commonly employed search engines. An Internet search with the keywords "low back pain" has been performed with Google, Yahoo!® and Bing™ in the English language. The top 30 hits obtained with each search engine were evaluated by five independent raters and averaged following criteria derived from previous works. All search results were categorized as declaring compliant to a quality standard for health information (e.g. HONCode) or not and based on the web site type (Institutional, Free informative, Commercial, News, Social Network, Unknown). The quality of the hits retrieved by the three search engines was extremely similar. The web sites had a clear purpose, were easy to navigate, and mostly lacked in validity and quality of the provided links. The conformity to a quality standard was correlated with a marked greater quality of the web sites in all respects. Institutional web sites had the best validity and ease of use. Free informative web sites had good quality but a markedly lower validity compared to Institutional websites. Commercial web sites provided more biased information. News web sites were well designed and easy to use, but lacked in validity. The average quality of the hits retrieved by the most commonly employed search engines could be defined as satisfactory and favorably comparable with previous investigations. Awareness of the user about checking the quality of the information remains of concern.

背景与目标： ：以前的调查显示，提供有关下腰痛的健康信息的网站质量很差。但是，Internet内容的快速和持续发展可能会质疑这些调查的当前有效性。本研究旨在定量评估使用最常用的搜索引擎检索到的有关腰痛的Internet信息的质量。 Google，Yahoo！®和Bing™已使用英语进行了关键字为“腰痛”的Internet搜索。每个搜索引擎获得的前30个匹配均由5个独立的评分者进行了评估，并根据从先前工作得出的标准进行了平均。根据网站类型（机构，免费，商业，新闻，社交网络，未知），所有搜索结果均归类为声明是否符合卫生信息质量标准（例如HONCode）。三个搜索引擎检索到的匹配的质量非常相似。该网站的目的明确，易于浏览，并且大多缺乏所提供链接的有效性和质量。在各个方面，对质量标准的符合与网站质量的显着提高相关。机构网站具有最佳的有效性和易用性。与机构网站相比，免费的信息网站质量好，但有效性明显较低。商业网站提供了更多有偏见的信息。新闻网站的设计良好且易于使用，但缺乏有效性。由最常用的搜索引擎检索到的匹配的平均质量可以定义为令人满意，并且可以与以前的调查相媲美。用户关于检查信息质量的意识仍然值得关注。

BACKGROUND & AIMS: OBJECTIVE:To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint. STUDY DESIGN:A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient. RESULTS:The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. CONCLUSION:That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.

背景与目标： 目的：评估磁共振成像（MRI）在诊断椎间盘位置和结构，椎间盘穿孔，关节积液以及颞下颌关节骨和骨髓变化方面的有效性的证据。
研究设计：进行了PubMed文献检索，包括特定的索引词和人工检索。两名审稿人对相关出版物的证据水平进行了评估，等级为高，中或低。基于此，诊断功效的证据等级被评为强，中度强，有限或不足。
结果：文献检索产生494种图书，其中22种具有相关性。没有出版物具有高水平的证据，有12种具有中等水平的证据，有10种低水平的证据。以敏感性，特异性和预测值表示的诊断功效的证据等级不足。
结论：证据不足，强调需要结合公认的方法学标准对MRI的诊断功效进行高质量的研究。

BACKGROUND & AIMS: :To study the force-velocity characteristics of human knee-hip extension movement, a dynamometer, in which force was controlled by a servo system, was developed. Seated subjects pressed either bilaterally or unilaterally a force plate, a horizontal position of which was servo-controlled so as to equalize the measured force and a force command generated by a computer at a time resolution of 2 ms (force clamp). The force command was based on the relation between maximum isometric force and foot position within the range between 70% and 90% of "leg length" (LL: longitudinal distance between the sole of the foot and the hip joint), so that the same force relative to the maximum isometric force was consistently applied regardless of the foot position. By regulating the force according to this function, the force-velocity relation was determined. The force-velocity relation obtained was described by a linear function (n=17, r=-0.986 for 80% LL, r=-0.968 for 85% LL) within a range of force between 0.1 and 0.8F(0) (maximum isometric force). The maximum force extrapolated from the linear regression (F(max)) coincided with F(0) (n=17, F(0)/F(max)=1.00+/-0.09 for 80% LL and 1.00+/-0.20 for 85% LL). Also, the velocity at zero force (V(max)) was obtained from the extrapolation. When compared to the bilateral movements, unilateral movements gave rise to a smaller F(max) but the same V(max), suggesting that V(max) is independent of force and therefore represents the proper unloaded velocity. It is suggested that some neural mechanisms may be involved in the force-velocity relation of the knee-hip extension movement, and make it exhibit a linear appearance rather than a hyperbola.

背景与目标： ：为了研究人的膝关节伸展运动的力-速度特性，开发了一种测力计，其中的力由伺服系统控制。坐着的受检者双向或单向按压推力板，该推力板的水平位置由伺服控制，以使测得的力和计算机以2 ms的时间分辨率产生的力指令相等（力夹）。力指令基于最大等距力与脚位置之间的关系，且该关系在“腿长”的70％至90％（LL：脚底与髋关节之间的纵向距离）之间的范围内始终相对于最大等距力施加力，而不管脚的位置如何。通过根据该功能调节力，确定了力-速度关系。在0.1至0.8F（0）（最大）之间的力范围内，通过线性函数（n = 17，对于80％LL为r = -0.986，对于85％LL为r = -0.968）描述了所获得的力-速度关系。等轴测力）。从线性回归（F（max））推算出的最大力与F（0）（n = 17，F（0）/ F（max）= 1.00 /-0.09（对于80％LL）和1.00 /-0.20（对于85） ％ 二）。另外，通过外推获得零力时的速度（V（max））。与双边运动相比，单边运动会产生较小的F（max），但具有相同的V（max），这表明V（max）与力无关，因此代表适当的空载速度。提示某些神经机制可能参与了膝关节伸展运动的力-速度关系，并使其表现出线性外观而不是双曲线。

BACKGROUND & AIMS: :To evaluate the effectiveness of intravenous clodronate in ameliorating refractory bone pain in patients with metastatic bone disease, 60 patients with established osseous metastases and persistent bone pain were randomized to receive either clodronate (600 mg or 1500 mg in 500 mL of normal saline) or 500 mL of saline as placebo. After 2 weeks, the patients were crossed over to receive the alternate treatment. After another 2 weeks, each patient and investigator made a blinded choice. Daily visual analogue scales (VAS) and analgesic diaries were recorded throughout the study period. Forty-six patients were evaluable (77%). A treatment x period interaction was identified in the VAS and daily morphine equivalent dose (DMED) scores. First period analysis of the VAS scores for general pain, pain at rest, and pain upon movement demonstrated an average reduction of 13, 14, and 24 mm, respectively, from baseline, but were not significantly different from changes following placebo. The average change in DMED was -6.4 (SE = 2.9) following clodronate and was +24.6 (SE = 14.9) following placebo (p = 0.03). In the blinded choice of which agent resulted in improvement in pain, 26 (57%) patients chose clodronate, 12 (26%) chose placebo, and eight (17%) had no preference (p = 0.0021). For the investigators who also made a blinded selection, clodronate was chosen in 30 (65%) patients, placebo in ten (22%) patients, and no difference was apparent in six (13%) (p < 0.0001). Intravenous clodronate appeared to have analgesic effect in patients with refractory bone pain due to metastatic bone disease. The optimal dose and duration of effect require further evaluation, particularly in patients with stable disease and persistent bone pain.

背景与目标： ：为评估静脉使用氯膦酸盐缓解转移性骨病患者难治性骨痛的有效性，随机将60例骨转移明确且持续性骨痛的患者随机接受氯膦酸盐（600毫克或1500毫克于500毫升生理盐水中）或500 mL生理盐水作为安慰剂。 2周后，将患者交叉接受替代治疗。再过2周后，每个患者和研究者都做出了盲目的选择。在整个研究期间记录每日视觉模拟量表（VAS）和止痛日记。 46名患者可评估（77％）。在VAS和每日吗啡当量剂量（DMED）评分中确定了治疗x周期相互作用。对一般性疼痛，静止性疼痛和运动性疼痛的VAS评分的第一阶段分析显示，与基线相比平均减少了13 mm，14 mm和24 mm，但与安慰剂治疗后的变化无显着差异。氯膦酸盐治疗后DMED的平均变化为-6.4（SE = 2.9），安慰剂治疗后为24.6（SE = 14.9）（p = 0.03）。在对导致疼痛改善的药剂的盲目选择中，有26名（57％）患者选择了氯膦酸盐，12名（26％）患者选择了安慰剂，而八名（17％）患者没有偏爱（p = 0.0021）。对于同样盲目选择的研究者，在30名（65％）患者中选择了氯膦酸，在十名（22％）患者中选择了安慰剂，在六名（13％）中没有发现明显的差异（p <0.0001）。在由于转移性骨病导致的难治性骨痛患者中，静脉注射氯膦酸盐似乎具有镇痛作用。最佳剂量和效果持续时间需要进一步评估，尤其是在疾病稳定且持续存在骨痛的患者中。