ABSTRACT
Objective:To explore the cost-effectiveness of alfacalcidol and cinacalcet for the treatment of secondary hyperparathyroidism in dialysis patients compared with parathyroidectomy.Methods:A total of 60 patients with secondary hyperparathyroidism treated at the Third People's Hospital of Chengdu from 2011 to 2020 were studied, patients were randomly divided into three groups: cinacalcet group, alfacalcidol group and parathyroidectomy group, with 20 cases in each group.Result:The improvement rate of bone pain and skin pruritis in parathyroidectomy group were higher than that in cinacalcet group and alfacalcidol group ( χ2=16.282, P<0.001; χ2=12.823, P=0.002). After 12 months of treatment, iPTH in the parathyroidectomy group and the cinacalcet group was significantly lower than that in the alfacalcidol group ( HR=1.36, 95% CI: 1.00-1.72, P<0.001; HR=1.27, 95% CI: 0.91-1.63, P<0.001); Serum calcium in the parathyroidectomy group was significantly lower than that of the other two groups ( HR=0.18, 95% CI: 0.12-0.24, P<0.001; HR=0.14, 95% CI: 0.08-0.20, P<0.001). The cost of complications management in the parathyroidectomy group was the lowest ( H=40.534, P<0.001), with bone pain being the most cost concern ( H=38.494, P<0.001). Patients with iPTH>2 800 pg/ml had the highest costs than with 800~1 800/ml and 1 800~2 800/ml ( H=43.798, 37.260, P<0.001). Conclusion:Surgical treatment should be the first choice for patients with secondary hyperparathyroidism, especially for patients with iPTH>2 800 pg/ml and bone pain.
ABSTRACT
Treatment of scaphoid nonunion after failed surgery for acute scaphoid fracture presents a unique challenge.Prior surgery complicates evaluation of the patient and increases the technical difficulty of future procedures.Healing of nonunion is crucial to prevention of carpal collapse and progressive arthritis.It is required to identify whether the technical factors or treatment methods led to the failure of primary surgery.CT is important for confirming nonunion and planning revision surgery.Several studies have described the use of bone grafts and fixation devices for scaphoid nonunion repair,including nonvascularized and vascularized bone grafts,screws,pins,and plates.Satisfactory healing rates have been achieved using nonvascularized bone grafts supplemented with screw or wire fixation,especially in the absence of bone necrosis.Although vascularized grafts require high demanding surgical skills,they improve the odds of union in the setting of osteonecrosis.
ABSTRACT
BACKGROUND:The main change of knee osteoarthritis is cartilaginous degeneration and secondary bone hyperplasia. The mechanism of these pathological changes is unclear, but some experiments have proved that the onset of knees osteoarthritis is closely related to inflammatory substances. OBJECTIVE:To discuss the role of inflammatory substances in the pathogenesis of knee osteoarthritis. METHODS:According to diagnostic criteria set by the American Colege of Rheumatology, we selected 60 knee osteoarthritis patients as experimental group, and another 60 patients undergoing the operative treatment of traumatic amputation or meniscus injury (except knee injury) as control group. After extracting synovial fluid samples from two groups, ELISA assay method was used to detect the levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor α, basic fibroblast growth factor, and osteopontin. The nitric oxide level in the synovial fluid was detected with nitric oxide detection kit. The content of lipid peroxidase was detected using TBA fluorescence method. RESULTS AND CONCLUSION:We found higher levels of interleukin-1β, interleukin-6, interleukin-8, interleukin-10, tumor necrosis factor α, basic fibroblast growth factor, osteopontin, nitric oxide, and lipid peroxidase in knee osteoarthritis patients, and these levels were positively correlated with knee osteoarthritis. These inflammatory substances are realy involved in the inflammation process of knees osteoarthritis.