WFU

2023年3月25日 星期六

髖關節疼痛可能的原因有哪些 / Possible Etiology of Hip Pain

 

骨病變:骨折、挫傷、骨壞死、腫瘤、耻骨炎

Bone lesions: fracture, contusion (hip pointer), osteonecrosis, tumor, osteitis pubis

 

關節病變:關節唇撕裂、軟骨損傷、股骨髖臼夾擠、骨關節炎、感染性關節炎、風濕性疾病

Joint pathology: labral tear, chondral damage, femoroacetabular impingement (FAI), osteoarthritis, septic arthritis, rheumatologic conditions

 

肌肉和肌腱損傷:內收肌拉傷、股四頭肌拉傷(股直肌最常見)、膕旁肌(大腿後肌)拉傷、外在型彈響髖

Muscle & tendon injuries: Adductor strain, Quadriceps strain (rectus femoris most common), Hamstring strain, External snapping hip

 

大轉子疼痛症候群(轉子滑囊炎)

Greater trochanteric pain syndrome (trochanteric bursitis)

 

神經壓迫 - 周邊神經或腰薦神經根的壓迫(尤其是伴隨下背痛)

Nerve compression — Compression of peripheral nerves or lumbosacral nerve roots (especially accompanied by low back pain)

 

主動脈髂動脈供應不全

Aortoiliac arterial insufficiency

 

其他罕見的髖痛原因(例如:梨狀肌綜合症、Gilmore groin、彈響髖、圓韌帶撕裂)。

Other, infrequent causes of hip pain (e.g., piriformis syndrome, Gilmore groin, snapping hip, ligamentum teres tear.)

 

 

常發生骨轉移或脊椎轉移的原發性腫瘤(Primary tumors that often leads to bone or spinal metastasis)

 

脊椎、骨骼相關疼痛原因有很多可能性(例如下背痛可能的原因) 

原發性腫瘤遠端轉移是其中一種

那麼,有哪些腫瘤較容易發生骨轉移及脊椎轉移呢?


根據研究

大約有三分之二的癌症患者會發展出骨轉移 

美國每年有大約 35 萬人死於骨轉移 

有時骨轉移在臨床上不可見,只有在大體解剖時才能發現,因此無法報告骨轉移的實際發生率 

骨轉移實際上比原發性骨癌更常見,發生比率為 25比1


骨骼是癌症轉移第三常見的部位,僅次於肺部及肝臟


最常導致骨轉移的原發性腫瘤依發生率順序為:「攝護腺癌、乳癌、腎臟癌、肺癌和甲狀腺癌。」


其他常發生骨轉移的腫瘤:黑色素瘤、淋巴瘤、肉瘤(sarcoma)和胃腸道惡性腫瘤,以及子宮癌。


大約三分之二的脊椎轉移來自肺癌 (24.6%) 、前列腺癌 (20.7%)和乳癌 (16.5%)

若以平均累積發病率計算(mean cumulative incidence )則為前列腺癌 (20.04%)、肺癌 (17.68%)、和乳癌 (10.94%)

其中大約9%的脊椎轉移病例無法確定原發腫瘤來源


根據大體解剖研究

骨轉移的發生率為:

乳癌 73%(範圍為 47% 至 85%)

攝護腺癌 68%(範圍為 33% 至 85%)

甲狀腺癌 42%(範圍為 28% 至 60%)

肺癌 36%(範圍為 30% 至 55%)

腎臟癌 35%(範圍為 33% 至 40%)

食道癌 6%(範圍為 5% 至 7%)

胃腸道癌 5%(範圍為 3% 至 11%)

直腸癌 11%(範圍為 8% 至 13%)

另外根據其他研究

除了上列癌症

膀胱癌(40%)及黑色素瘤(14-45%)亦有較高的骨轉移機率




 References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265280/

https://www.sciencedirect.com/science/article/pii/S2212137422000367

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444408/

https://www.uptodate.com/contents/epidemiology-clinical-presentation-and-diagnosis-of-bone-metastasis-in-adults



2023年3月24日 星期五

The Philosophy Behind The Matrix

 


If I had to choose my favorite movie, I wouldn't hesitate to pick The Matrix series that started in 1999 (although I do admit the fourth movie was⋯ you know). 


Of course, I think the most impressive one was the first movie when it was released. 

With its unique world view, spectacular special effects, and innovative fight choreography, it still doesn't feel outdated even after more than twenty years.

Whether you watch it as an action movie or from a philosophical perspective, you can enjoy it. 

I even think that if you combine action and philosophy in the ratings, there still isn't a movie that can compare to it.


Here are some philosophical insights that came to me after watching the movie:


  1. What is “Me “? What is real?


The movie brings up a concept that's very relevant to physiology: everything you perceive and experience is just an electronic signal in your brain.


Morpheus: "What is real? How do you define 'real'? If you're talking about what you can feel, what you can smell, what you can taste and see, then 'real' is simply electrical signals interpreted by your brain."


With this premise, many discussions can be extended. 


For example, what is "me"? 

Is my body "me"? 

Are electronic signals "me"? 


When stimuli are transmitted to the brain through electronic signals, what "thing" is accepting the final electronic signal? 

If electronic signals are neutral, what "thing" has preferences, choices, or aversions towards them? 

When you want to perform an action or even unconsciously maintain physiological functions such as heartbeat, breathing, and intestinal motility, what "thing" is driving the first electronic signal and causing a series of physiological actions?


Since everything is just a "signal," can you call the world you live in and your feelings "real"? 

If the nature of a signal is constantly changing and short-lived, why is there a "strong delusion" of a "fixed and unchanging me"?


The concept of "I love you." 

Is the concept of "I" real? 

Is the idea and emotion of "love" real? 

Is the existence of "you" real? 

Is this "you" an objective existence, or is it the "you" that “I “ perceive in my world?


Interestingly, Neo finally sees through the world of the matrix made up of code, breaks the limitations of the matrix, and becomes The One. 

This process is like that of many achievers in religion who see through the illusions of the world and produce various incredible abilities.


  1. What is "choice"; determinism, fatalism, free will


The plot of movies often touches on this question, either subtly or overtly. 

For example, when Neo becomes The One, is it due to the setting of the matrix, the arrangement of fate, or his own choice? 

After becoming The One, does his actions follow the preset plan of the matrix, the guide of Oracle or are they his own choices?

For other characters, whether human or part of the matrix system, their existence and actions are predetermined by the system, influenced by Oracle, or are they the result of their own choices?


The movie has a classic scene that explores this topic.

https://www.youtube.com/watch?v=eVF4kebiks4


Oracle : I'd ask you to sit down, but, you're not going to anyway. And don't worry about the vase.

Neo : What vase?

[Neo turns to look for a vase, and as he does, he knocks over a vase of flowers, which shatters on the floor] 

Oracle : That vase.

Neo : I'm sorry...

Oracle : I said don't worry about it. I'll get one of my kids to fix it.

Neo : How did you know?

Oracle : Ohh, what's really going to bake your noodle later on is, would you still have broken it if I hadn't said anything?


There is a similar story in China.


Shao Yong, a master of Yi Jing (a  traditional divination book in China) during the Northern Song Dynasty, divined with accuracy. One day, he divined for his own flower vase and concluded that it would shatter at noon on that day. Out of curiosity, he waited to see what would happen. 

As the time approached, his wife called him to have lunch, but he ignored her. 

In a fit of anger, his wife smashed the flower vase!


Was the shattering of the flower vase predetermined? 

If Oracle didn't speak up and Shao Yong didn't divine, would the vase still have been broken?


Is one's destiny predetermined or determined by free will?

Is choice a result of true free will, a predetermined choice, or an illusion of choice in a predetermined context?


To choose, is  free or not free?


Furthermore, is existence free or unfree?

 (As Agent Smith said in The Matrix, "We're not here because we're free; we're here because we're not free.")


As for the decision to write this blog post and for you to be reading it now, was it a predetermined choice or one made by free will?



駭客任務(The matrix)背後的哲學

 


如果要選出一部自己最喜愛的電影

我會毫不遲疑選擇1999年開始上映的駭客任務系列(好啦 我知道第四集有點...)


當然 我覺得最令人震撼的莫過於第一集推出的時候

獨特的世界觀、精采的電影特效、創新的武打動作設計

即使二十多年後觀賞依然不覺得過時

無論以動作娛樂或文青哲學的角度觀賞

都能樂在其中

甚至私心覺得 

若將動作娛樂跟哲學意涵兩者一起納入評分

至今仍無任何電影能出其右


以下為筆者觀影後一些哲學發想


1. 何謂我?何謂真實? 

電影裡提到了一個非常符合生理學的概念:


你所感知、經歷的一切


不過是大腦的電子訊號。



墨菲斯:什麼是“真實”? 你如何定義“真實”? 如果你在談論你能感覺到什麼,你能聞到什麼,你能嚐到什麼和看到什麼,那麼“真實”只是你的大腦解譯的電信號

Morpheus:“What is real? How do you define 'real'? If you're talking about what you can feel, what you can smell, what you can taste and see, then 'real' is simply electrical signals interpreted by your brain.



藉由這個前提

可以延伸很多討論


比方說

什麼是我?身體是我嗎?電子訊號是我嗎?


當外界的刺激藉由電子訊號傳到大腦,

是「什麼」去接受最後一個電子?

電子訊號如果是中性的,

那是「什麼」對他產生了好惡、取捨的想法?

當你想要做一個動作,

甚至是無意識的維持生理機能如心跳、呼吸、腸胃蠕動

是「什麼」去驅動第一個電子訊號進而引發一連串的生理動作?


既然所有的一切都是「訊號」

那麼

你所身處的世界以及感覺

是否可以稱之為「真實」?


訊號的本質既然是不停變動且短暫的

為何會有「固定不變的我」的「堅固妄想」?


所謂的「我愛你」

「我」這個概念是真實的嗎?

「愛」這個意念、情緒是真實的嗎?

「你」這個存在是真實的嗎?這個「你」是客觀存在的「你」、還是「我」的世界所感受到的「你」?


有趣的是

男主角終於看破母體世界是由代碼所構成

因而打破母體世界的限制,成為救世主(The one)

這樣的過程 就像許多宗教裡的成就者 

看破世間的假象

產生各種不可思議的神通



2.什麼是「選擇」;宿命論、決定論、自由意志

電影的劇情不時隱晦或明顯地碰觸這個問題

比如主角成為「救世主」,是母體的設定、命運的安排、還是自己的選擇?

成為救世主後的所作所為,是母體預設、祭師指引、還是主角自己的選擇?

其他角色、無論是人類抑或母體程式,他們的存在及作為,是系統預設好的、被祭師引導暗示的、還是出於自己的選擇?


電影有一經典片段

https://www.youtube.com/watch?v=eVF4kebiks4


祭師:不用擔心花瓶。

Neo:什麼花瓶?

[Neo 轉身尋找一個花瓶,當他這樣做時,他打翻了一個花瓶,花瓶在地板上碎裂]

祭師:那個花瓶。

尼奧:對不起……

祭師:我說過不用擔心。 我會讓我的一個孩子來修理它。

尼奧:你怎麼知道的?

祭師:哦,真正會讓你困惑的是,如果我什麼都不說,你還會把它弄壞嗎?

Oracle : I'd ask you to sit down, but, you're not going to anyway. And don't worry about the vase.

Neo : What vase?

[Neo turns to look for a vase, and as he does, he knocks over a vase of flowers, which shatters on the floor] 

Oracle : That vase.

Neo : I'm sorry...

Oracle : I said don't worry about it. I'll get one of my kids to fix it.

Neo : How did you know?

Oracle : Ohh, what's really going to bake your noodle later on is, would you still have broken it if I hadn't said anything?


中國也有類似的故事


邵雍,北宋易學大師,占卦準驗,

某天心血來潮

為自家花瓶占卦、

得出將於當日午時破碎之結論,

心生好奇故坐等看會發生何事讓花瓶破碎。

直至時辰將至,

其妻喊其吃午飯皆不理,

妻一怒下將花瓶摔碎。


花瓶是否註定破碎?

如果祭師沒開口,邵雍沒占卦,花瓶是否仍會被摔碎?


人的命運 是註定的 還是自由意志決定的?


所謂的選擇,是真正自由意志下選擇,還是在選擇前就已經選擇?抑或在被設定好的情境下產生選擇的錯覺?


選擇,是一種自由,抑或是一種不自由?


更進一步的問題,存在,究竟是自由,還是不自由?

(Agent Smith: We're not here because we're free; we're here because we're not free. )



決定寫這篇網誌的我,正在看網誌這篇的你,是宿命決定的選擇、還是自由意志的選擇?


Mechanism and Application of High-Intensity Focused Electromagnetic (HIFEM) Therapy

 

Previously, we introduced a secret weapon used by professional athletes for injury recovery: the only patented tendon and ligament repair agent in the world.

https://uroprolo.blogspot.com/2023/02/stabha-soft-tissue-adapted.html

This time, we will introduce another secret weapon for rehabilitation after professional athletes' injuries: the High-Intensity Focused Electromagnetic (HIFEM) therapy.

 

 

History:

During the Cold War, the Soviet Union used electromagnetic fields to treat cosmonauts who had spent extended periods in space. 

Due to the lack of gravity and exercise, These cosmonauts suffered from a loss of bone density and muscle. When they returned to Earth, they had weakened bones and muscles.

To solve this problem, the Soviet Union used pulsed electromagnetic field (PEMF) therapy in combination with medications to increase bone density and combat bone loss. 

PEMF was widely used in the Soviet Union and Eastern Europe and spread to Western Europe after the fall of the Berlin Wall. 

In the early 2000s, NASA conducted its own research into the use of PEMF and eventually filed its own patent for the use of PEMF in tissue regeneration

 

 

Principle:

HIFEM therapy is based on Faraday's law of electromagnetic induction. 

By changing the magnetic field, changes in the biological electric field are produced, resulting in a biological current. 

The effects of this magnetic field and biological current differ in different tissues and can promote wound healing, pain relief, bone fracture healing, muscle relaxation, nerve stimulation, muscle training, and joint movement.

Most importantly, according to the principle, this type of therapy is non-invasive and non-contact. 

Therefore, it can be widely used in various patients who need it without causing any harm.

 

 

Tissue Effects:

Traditional electrical stimulation has been proven to be effective in pain management and wound healing and is widely used in rehabilitation. 

However, there are some disadvantages because the electrodes need to be attached to the body surface to conduct current:

1.    The pain receptors are close to the skin surface, and external current can directly stimulate them, making it easy to feel pain.

2.    The intensity must be controlled; otherwise, it may cause skin damage.

3.    The current decreases with depth and cannot be transmitted to deeper tissues.

 

The above disadvantages are precisely the advantages of magnetic field therapy:

1.    No direct contactile current, so it does not cause pain.

2.    Does not damage the skin.

3.    The magnetic field can penetrate deeper tissues, and the treatment effect is better.

 

The biological current generated by the magnetic field can produce the following effects when applied to different tissues with different intensity, frequency, and waveform treatment modes:

       Fibroblast and collagen proliferation is increased following each treatment.

       Increased angiogenesis and collagen formation/maturation leading to wound healing.

       Accelerates swelling elimination, restoring normal blood flow, nutrients, and oxygenation of tissue.

       Damaged cells recover faster under treatment.

       Accelerated growth factor production at various stages of the tissue repair.

       Stimulate Osteogenesis and Chondrogenesis.

       Pain management

       Muscle training and reconstruction, improving movement function

       speed up muscle and tissue healing

       reduce muscle degradation or to increase blood circulation locally

       increase metabolic activity in the stimulated region to such an extent that the lipids (triglycerides) break into free fatty acids (FFA) and glycerol; this lipid breakdown leads to an overflow of FFA in the intracellular space and consequently initiates adipocyte dysfunction by the mechanism of endoplasmic reticulum stress (ER-stress) apoptosis

       modulate cell receptors binding, reducing the inflammatory response.

 

Although there are numerous effects that are difficult to list, it is evident that magnetic field therapy covers almost “all connective tissues!”

 

 

Therapy modes:

If based on functionality, it can be roughly classified into the following categories:

 

Pain relief

Joint lmobilization

Muscle relaxation

Muscle strength enhancement

Fracture healing

Spasm relief

Nerve repair

Muscle building and fat reduction

Urinary incontinence treatment

Sexual dysfunction treatment

 

Finally, why is high-intensity focused magnetic field therapy considered a secret weapon for athlete rehabilitation after injury?

 

Apart from providing repair effect for corresponding connective tissue, when an athlete is severely injured and forced to rest, muscle strength and physical ability may decline. 

The muscle strength enhancement function of magnetic field therapy can fill the training gap and help to build muscles and reduce fat, thereby maintaining physical condition and shortening the time to return to the competition!

Now, high-intensity focused magnetic field therapy is not just exclusive to athletes, it has become affordable  for the general public in terms of training and treatment!

 

References:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028041/

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346366/

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8370292/

 

https://pubmed.ncbi.nlm.nih.gov/2988718/

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764361/

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306936/

 

https://faseb.onlinelibrary.wiley.com/doi/epdf/10.1096/fj.03-0847fje

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830993/

 

https://onlinelibrary.wiley.com/doi/full/10.1111/jocd.15606

 

https://onlinelibrary.wiley.com/doi/10.1111/dth.13803

 

https://stemcellres.biomedcentral.com/articles/10.1186/s13287-019-1464-x

 

https://www.researchgate.net/publication/349863138_The_Effect_of_Pulsed_Electromagnetic_Fields_on_Angiogenesis

 

https://www.mdpi.com/1422-0067/22/9/5037

 

https://pubmed.ncbi.nlm.nih.gov/2019648/

 

https://www.sciencedirect.com/science/article/abs/pii/S1350453319302346

 

https://www.ijphy.org/index.php/journal/article/view/359

 

https://www.eastcoastpodiatry.sg/super-inductive-system-sis/