Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia / 北京大学学报(医学版)

OBJECTIVE@#Severe hip osteoarthritis, caused by bone or joint maldevelopment, biomechanical transformation and previous surgical intervention, is inclusively existed in spondyloepiphyseal dysplasia (SED). To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED.@*METHODS@#From January 2017 to June 2019, 374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons, of whom 9 patients (6 males and 3 females) with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation. The short-term outcomes were observed.@*RESULTS@#All the patients were implanted with Johnson & Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty. They were followed up for an average period of 20 months. Except for one muscular calf vein thrombosis case, no complications, such as aseptic loosening, joint dislocation, fracture, neurovascular injury, deep vein thrombosis and infection were observed in all the 9 patients. Before the surgery, the average Harris hip score was 35.55, while the average of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was 56.56. The level of quality of life indicated by SF-12 score was 41.56 on average. The mean pre-operation visual analogue scale (VAS) was 7.44. At the last follow-up, the average Harris hip score increased to 89.56, whereas the average WOMAC declined to 41.11. Compared with the baseline point, the average SF-12 score went up to 56.33. Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up. In addition, post-operative increase of several pelvic-related parameters including pelvic incidence, pelvic tilt and sacral slope could be observed in the SED patients. The average measured pelvic incidence, pelvic tilt and sacral slope were 68.95°±4.60°, 52.75°±1.06° and 17.45°±1.77° before operation, respectively; whilst the mean value of these specific parameters increased to 76.98°±5.12°, 60.51°±4.35° and 18.10°±2.02°, respectively. The even leg lengths of the lower extremities were obtained after total hip arthroplasty.@*CONCLUSION@#Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.

Analysis on risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fractures in elderly patients / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the risk factors of functional recovery after intramedullary nail fixation for femoral intertrochanteric fracture in elderly patients, and to propose corresponding measures to promote postoperative hip function recovery.</p><p><b>METHODS</b>From June 2012 to June 2015, 74 patients after intramedullary nail fixation surgery were analyzed, including 33 males and 41 females, with an average age of(75.07±7.89) years old, and divided into well-function group(55 patients) and bad-function group(19 patients) according to Sanders function criterion. Age, gender, bone density, fracture type, systemic disease, complication, rehabilitation exercises with therapist or not, nourishment state, anesthesia method, fracture reduction condition, ASA classification, tip apex distance were reviewed and analyzed by t test, non-parametric test, χ² test and Logistic analysis.</p><p><b>RESULTS</b>Univariate analysis showed that age, bone density, nourishment state, ASA classification, anesthesia method, fracture reduction condition, rehabilitation exercises with therapist, and tip apex distance were the risk factors for the recovery of hip function. Logistic analysis showed that bone density(0.006, OR=0.077), rehabilitation exercises with therapist(0.006, OR=0.070), ASA classification(<0.001, OR=0.049), nourishment state (0.046, OR=0.188) were the risk factors for the functional recovery.</p><p><b>CONCLUSIONS</b>Bone density, rehabilitation exercises with therapist, ASA classification, nourishment state were the risk factors for the functional recovery of intramedullary nail fixation for intertrochanteric fracture in elderly patients. Multidisciplinary cooperation and fast track surgery system should be set up to promoting the hip functional recovery.</p>

Evidence-based Evaluation of Current Global Idiopathic Thrombocytopenia Purpura Guidelines of Children / 中国药房

OBJECTIVE: To evaluate evidence-based guidelines of current global pediatric idiopathic thrombocytopenic purpura (ITP) drug therapy, and to provide evidence-based reference for pediatric ITP diagnosis and treatment, the formulation of guideline in China. METHODS: Retrieved from PubMed, Embase, National Guideline Clearinghouse, Guidelines International Network, TRIP medical database, CBM, CJFD, VIP and WANFANG DATA, etc., the evidence-based treatment guideline involving pediatric ITP were included, and methodological quality of the guideline was evaluated by using AGREE Ⅱ tool. The similarities and differences of the guidelines were analyzed and compared. RESULTS: A total of 7 pediatric ITP evidence-based guidelines were included, among which 2 came from US, 2 came from Italy, 2 came from British and another one came from Malaysia. The quality of 7 guidelines were not good, among which 6 guidelines were recommended as grade B and 1 guideline was recommended as grade C; only one GRADE evidence-based guideline was found. The score of included guideline in the field of AGREE Ⅱ was in descending order as scope and purpose, clarity, rigor of development, stakeholder involvement, applicability, editorial independence. The main recommended drugs of these guidelines were: glucocorticoids, intravenous immunoglobulin, anti-D-immunoglobulin, while some guidelines recommend platelet, rituximab and combined medication. CONCLUSIONS: The quality of evidence-based guidelines of ITP for children is in low level and should be improved. There is no evidence-based guideline of ITP for children in China. It is suggested to develop high quality evidence-based guideline for ITP children in China based on AGREE Ⅱ items.

Evidence-based Evaluation on the Current Status of Global Antibacterial Use Surveillance / 中国药房

OBJECTIVE:To provide evidence-based basis for the continuous improvement of antibacterial use surveillance in China.METHODS:Retrieving from 3 biomedical literature databases as Medline,Embase,Cochrane Library,48 health administrative departments and academic institutions,relevant literatures on antibacterial surveillance networks/ projects were acquired and extracted,including basic information,data collection,analysis and reporting methods,etc.Descriptive analysis method was adopted to analyze the status quo of global antibacterial surveillance networks/projects.RESULTS:A total of 21 literatures were included,involving 16 antibacterial surveillance networks/projects.Among them,there were 3 international projects and 13 national projects,mainly in European (countries) (56.25％,9/16).Sixteen antibacterial surveillance networks/projects were established to monitor and compare the use of antibacterials,analyze the antibacterial use trend and its correlation with bacterial resistance,and evaluate implementation effect of antibacterial management policy.The responsible agencies were mainly the health administrative departments,and the funding agencies were mainly related government departments.Hospital and community were main surveillance objects.There were 2 surveillance networks/projects for antibacterial use in children,and 6 surveillance networks/projects contained medication data of children.Only Strama in Sweden alone analyzed medication data in children.Fourteen surveillance networks/projects promulgated data collection methods or contents;data collection was mainly based on active reporting and involved the data of drug use/consumption and population/ patient.Except for ESAC-Net,ARPEC,NAUSP,data validation method was not mentioned in other surveillance networks/projects.Data analysis was most common in medical institutions and antibacterial categories,and defined daily dose was the most commonly used statistical indicators of antibacterial consumption.Ten surveillance networks/projects promulgated surveillance reports which were mostly published annually.CONCLUSIONS:Antibacterial surveillance have been widely operated worldwide.But there is a lack of monitoring and analysis of antibacterial use in special population including children.In addition,data validation is the weak link of antibacterial surveillance,so the quality of data collection still need to be improved.

Evidence-based Evaluation of Monitoring System for Global Short Drugs / 中国药房

OBJECTIVE:To systematically evaluate the monitoring system for global short drugs,and provide evidence-based reference and policy recommendations for developing the short drug monitoring in China. METHODS:Relevant literatures pub-lished in PubMed,Embase,CNKI,Wanfang,VIP database from building to Apr. 3rd in 2017 were retrieved by using"Drugs (cheap drugs,essential medicines,emergency drugs) storage""Short drugs""Insufficient supply of drugs""Drug shortage"as Chinese keywords,and"Drug storage""Out-of-stock drug""Stortage of medicine""Stock out of medicine"as English keywords. Literatures about monitoring system for short drugs in Baidu,Google and national or regional health administration websites were collected,and general information,data collection,data validation,data reporting method,feedback and improvement measures of monitoring system were extracted. RESULTS & CONCLUSIONS:Totally 25 literatures were included,20 national or regional health administration websites were retrieved. 11 countries and European Union had established monitoring system for short drugs. The main reporting agencies in each country were different,which were production enterprises,business enterprises and medical in-stitutions. It was mainly reported by network. Data validation was mainly conducted by specialized departments or groups for short drugs in each country. The monitoring reporting included information of short drugs and discontinued drugs. Countermeasures in each country mainly included looking for alternative drugs,encouraging production,temporary import,looking for new or other sources of raw materials and speeding up the approval of short drugs. Besides, precautions included implementation relevant laws and guidelines for short drugs,and increasing the cooper-ation with non-government departments,etc. Monitoring sys-tem for short drugs needs to be further improved in China. Itis suggested to establish monitoring and early warning platform for short drugs,and hierarchical intervention mechanism,improv-ing relevant laws and developing guidelines on managing short drugs.

N-acetylcysteine for Idiopathic Pulmonary Fibrosis: A Systematic Review / 中国药房

OBJECTIVE:To review therapeutic efficacy of N-acetylcysteine (NAC) for idiopathic pulmonary fibrosis (IPF),and to provide evidence-based reference.METHODS:Retrieved from Central database,PubMed,EMBase,CBM,CJFD,Wanfang database and VIP,randomized controlled trials or semi-randomized controlled trials about NAC (unlimited single drug or combination) vs.placebo/blank control in the treatment of IPF were collected.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane collaboration's bias risk assessment tool(2014 edition).RESULTS:A total of 10 studies were included(2 RCT,8 qRCT),involving 742 patients.Results of Meta-analysis showed that compared to placebo/blank control,NAC couldn't reduce the mortality of IPF patients [OR=1.14,95％ CI(0.50,2.62),P=0.76],but could significantly improve subjective symptom remission rate[OR=3.17,95％ CI (1.98,5.07),P＜0.001] and dyspnea score [SMD =-2.54,95 ％ CI (-5.02,-0.06),P=0.04].CONCLUSIONS:For IPF,NAC can't decrease the mortality of patients,but can relieve main symptoms and dyspnea.

N-acetylcysteine for Idiopathic Pulmonary Fibrosis: A Systematic Review / 中国药房

OBJECTIVE:To review therapeutic efficacy of N-acetylcysteine (NAC) for idiopathic pulmonary fibrosis (IPF),and to provide evidence-based reference.METHODS:Retrieved from Central database,PubMed,EMBase,CBM,CJFD,Wanfang database and VIP,randomized controlled trials or semi-randomized controlled trials about NAC (unlimited single drug or combination) vs.placebo/blank control in the treatment of IPF were collected.Meta-analysis was performed by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane collaboration's bias risk assessment tool(2014 edition).RESULTS:A total of 10 studies were included(2 RCT,8 qRCT),involving 742 patients.Results of Meta-analysis showed that compared to placebo/blank control,NAC couldn't reduce the mortality of IPF patients [OR=1.14,95％ CI(0.50,2.62),P=0.76],but could significantly improve subjective symptom remission rate[OR=3.17,95％ CI (1.98,5.07),P＜0.001] and dyspnea score [SMD =-2.54,95 ％ CI (-5.02,-0.06),P=0.04].CONCLUSIONS:For IPF,NAC can't decrease the mortality of patients,but can relieve main symptoms and dyspnea.

Complications of percutaneous kyphoplasty non-related with bone leakage in treating osteoporotic thoracolumbar vertebral compression fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the complications of percutaneous kyphoplasty except bone leakge for the treatment of osteoporotic thoracolumbar vertebral compression fractures.</p><p><b>METHODS</b>From October 2008 to October 2012,178 patients with 224 osteoporotic vertebral compression fractures were treated with percutaneous kyphoplasty under local anethsia. There were 72 males and 106 females,ranging in age from 58 to 92 years old,with an average of 75.3 years,including 93 thoracic vertebrae and 131 lumbar vertebrae. The complications except bone cement leakage were analyzed during operation and after operation.</p><p><b>RESULTS</b>All operations were successful and all patients were followed up from 12 to 60 months with an average of 26.2 months. No death was found. Bone cement leakage occurred in 27 cases, about 15.1% in 178 cases; and complications except bone cement leakage occurred in 15 cases. There was 1 case with cardiac arrest,was completely recovery by cardiopulmonary resuscitation (CPR) immediately; and 1 case with temporary absence of breathing,was recovery after treatment. There were 3 cases with fall of blood pressure and slower of heart rate; 1 case with intestinal obstruction; 2 cases with local hematoma and 1 case with intercostal neuralgia. Vertebral body fractures of 2 cases were split by bone cement and the fractures of adjacent body occurred in 4 cases.</p><p><b>CONCLUSION</b>It's uncommon complication except bone cement leakge in treatment of osteoporotic thoracolumbar vertebral compression fractures with percutaneous kyphoplasty. The complication of cardiopulmonary system is a high risk in surgery; and cytotoxicity of bone cement,nervous reflex,fat embolism and alteration of intravertebral pressure may be main reasons.</p>

Analysis of perioperative complications of percutaneous kyphoplasty for osteoporotic vertebral compression fracture / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the perioperative complications of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture.</p><p><b>METHODS</b>From June 2009 to December 2011, 63 patients with osteoporotic vertebral compression fracture underwent PKP, there were 18 males and 45 females with an average age of 75.3 years ( ranged, 62 to 91). All patients with severe back pain and without neurological symptoms and signs, which were confirmed by X-ray and MRI. Among them,there were 63 cases with severe osteoporosis, 37 cases with hypertension, 10 with coronary artery disease, 29 with anemia, 26 with diabetes, 11 with chronic obstructive pulmonary diseases and 8 with gastritis and peptic ulcer. The common perioperative complications were retropectively reviewed.</p><p><b>RESULTS</b>Preoperative complications occured in 9 cases (14.3%), including hypostatic pneumonia (1 case), electrolyte disturbances (2 cases), urinary tract infection (2 cases), moderate anemia(2 cases),electrolyte disturbances combined with moderate anemia (1 case), hypostatic pneumonia combined with delirium (1 case). Intraoperative and postoperative. complications occurred in 17 cases (26.9%), there were bone cement correlated complications in 9 cases (14.3%), in which 2 cases of toxic reaction of bone cement and 7 cases of leakage (2 cases had clinical symptoms); there were non-bone cement correlated complications in 3 cases (4.8%), in which 1 case of focal hematoma caused by paracentesis, 1 case of transient nerve injury, 1 case of left intercostal neuralgia;there were transient hyperpathia in 5 cases after operation. All complications result in no severe consequence after treatment.</p><p><b>CONCLUSION</b>Perioperative complications of percutaneous kyphoplasty are not uncommon,however,these complications may not cause serious consequence after active treatment,so prevention and treatment are important for it.</p>

Treatment of senile osteoporotic vertebral compression fractures with percutaneous kyphoplasty under local anesthesia / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of percutaneous kyphoplasty (PKP) in treating senile osteoporotic vertebral compression fractures under local anesthesia.</p><p><b>METHODS</b>From May 2007 to May 2010,129 patients with osteoporotic vertebral compression fractures were treated with PKP under local anesthesia. There were 47 males and 82 females, ranging in age from 61 to 92 years old,with an average of 73.7 years old,including 88 segments of thoracic vertebrae and 101 segments of lumbar vertebrae. Visual analogue scale (VAS),height of vertebral body,Cobb's angle were evaluated before and after operation.</p><p><b>RESULTS</b>Operations were performed successfully in all patients and these patients were followed up from 24 to 60 months with an average of 34.2 months. Preoperative,postoperative two weeks and at final follow-up,VAS score was 7.9+/-2.5,2.8+/-1.8,3.0+/-2.2,respectively;Cobb angle was (28.3+/-13.7)degree, (16.2+/-9.8)degree, (19.1+/-10.3)degree, respectively. There was significant difference between postoperative and preoperative, and between at final follow up and preoperative (P<0.05). The height of vertebral body obtained partial recovery. Bone cement leakage occurred in 23 vertebrae (with proportion of 17.8%) during operation,among one patient with temporary clinical symptom of radiculalgia. All lumbago obtained obviously anesis after operation, 1 case complicated with respiratory depression and recovered after resuscitation; 1 case complicated with intestinal obstruction and improved after treatment, 1 case complicated with fracture separation of vertebral body by bone cement, and 4 cases complicated with fracture of adjacent vertebral body.</p><p><b>CONCLUSION</b>Percutaneous vertebral kyphoplasty is an effective method for treatment of senile osteoporotic vertebral compression fractures,which can expeditiously relieve pain and effectively recovery height of vertebral body and Cobb angle,it has advantages of minimal invasive. The results of short and mid-term follow-up were satisfactory, long-term follow-up is still needed. Correctly choosing the operative indication and improving surgical technique may avoid complications, especially bone cement leakage which is the most frequent complication.</p>

Observation for the process of Vibrio vulnificus inducing dendritic cell apoptosis / 中华微生物学和免疫学杂志

Objective To observe the process of Vibrio vulnificus inducing dendritic cell strain apoptosis.Methods We established the mixed culture model of mouse dendritic cell ( DC 2.4 strain) and Vibrio vulnificus( Vv1.1758 strain ),analyzed morphological characteristics of cell apoptosis by DAPI fluorescence staining,detect DNA fragmentation level of apoptosis cells by DNA Ladder assay,analyze DC2.4 apoptosis rate by Annexin V FITC/PI staining,determine activities of caspase-3 and caspase-8 by means of spectrophotometric method and detect changes of mitochondrial transmembrane potential ( △ Ψm ) by JC-1 fluorescence labeling.Results After Vv1.1758 strain and DC2.4 cell were mixed and cultured for 4 h,DAPI fluorescence staining showed typical apoptosis characteristics-chromatin condensation and marginalization; DNA agarose gel electrophoresis showed apoptosis band; apoptosis rates at 2,4 and 6 h were respectively (37.8±9.8) ％,(54.3 ± 12.7 ) ％ and ( 68.2± 14.6 ) ％ ; Mitochondrial transmembrane potentials (△Ψm) at 1 h,2 h and 4 h reduced by 7.1％,16.1％ and 46.7％ respectively; caspase-8 activity increased at 1.5 h and reached the peak at 2 h [ (2.48±0.19) U/μg],while caspase-3 activity started to increase at 3h and reached the peak at 4 h [ ( 1.91 ±0.16) U/μg ].Conclusion Vibrio vulnificus could induce dendritic cells by two pathways: reducing mitochondrial transmembrane potential and activating caspase-8 promoter and finally activate effector caspase-3 to promote apoptosis.