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Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.
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Humans , Venous Thromboembolism/etiology , Multiple Myeloma/diagnosis , Risk Assessment , Risk Factors , ROC Curve , Retrospective StudiesABSTRACT
Objective:To investigate the clinical efficacy and safety of ixazomib-based therapy in patients with relapsed or refractory multiple myeloma (RRMM) .Methods:A retrospective analysis was performed on the efficacy and adverse reactions of 53 RRMM patients treated with a combined regimen containing ixazomib in the Hematology Department of Beijing Jishuitan Hospital from July 8, 2018 to November 30, 2020. Among them, 6 patients received ID regimen (ixazomib + dexamethasone) , 30 patients received ID regimen + immunomodulator, and 17 patients received ID regimen + other chemotherapy drugs.Results:Fifty-three patients with RRMM received ixazomib-based therapy. The median previous treatment line was 3, the median treatment course was 6 (2-30) , and the median follow-up time was 21 months (2-32 months) . The overall response rate (ORR) was 54.7% (29/53) after 2 courses of treatment. Among them, 26.4% (14/53) had very good partial response (VGPR) and 28.3% (15/53) had partial response (PR) . The ORR of the ID regimen group, ID regimen + immunomodulator group and ID regimen + other chemotherapy group were 83.3% (5/6) , 56.7% (17/30) and 41.2% (7/17) respectively, with no statistically significant difference among the three groups ( P=0.208) . The median time to progression (TTP) of 53 patients was 8 months (1-24 months) . The most frequent adverse events of ixazomib treatment were gastrointestinal reactions such as nausea, vomit and diarrhea, with an incidence of 37.7% (20/53) , and the incidence of grade 3-4 was 5.7% (3/53) . The most common hematological adverse events were thrombocytopenia (15.1%, 8/53) , neutropenia (11.3%, 6/53) and anemia (9.4%, 5/53) . Grade 1-2 peripheral neurotoxicity occurred in only 7.5% (4/53) of patients. Conclusion:Ixazomib has good efficacy and safety for the patients with RRMM in the real world.
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Objective:To investigate the clinical efficacy and safety of bendamustine combination regimen in the treatment of patients with relapsed or refractory multiple myeloma (RRMM).Methods:From March 2020 to December 2020, 16 patients with RRMM were treated with bendamustine combination regimen in Beijing Jishuitan Hospital. The efficacy and adverse events (AEs) of bendamustine combination regimen were retrospectively analyzed in the 16 patients.Results:The median treatment lines for 16 patients with RRMM who received bendamustine combination regimen was 4 lines, and the median course of treatment was 3 (1-8). The median follow-up time after bendamustine treatment started was 5.3(1.3-9.2)months. Among the 16 cases, the disease control rate (DCR), overall response rate(ORR), and ≥ very good partial remission (VGPR) rate were 13/16, 5/16, 4/16 respectively. The median PFS was 4.9 months. Among them, the ORR of bendamustine combined with immunomodulators was higher. AEs were anemia, leukopenia, neutropenia, thrombocytopenia and fatigue. No patients who stopped treatment and adjusted the dose due to AEs.Conclusions:Bendamustine combination regimen is an effective and safe regimen for relapsed/refractory multiple myeloma.
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OBJECTIVE@#To investigate the expression of CD319 and CD269 in plasma cells of patients with multiple myeloma (MM) and the feasibility of using CD319 instead of CD38 as a gating antigen in immunophenotyping and minimal residual disease (MRD) monitoring.@*METHODS@#The expression levels of CD319 and CD269 antigens in clonal bone marrow plasma cells of 387 patients were detected by CD38/CD138 gating strategy with 8-color flow cytometry, and the stability of antigens was also analyzed, and the sensitivity and correlation of two different gating strategies employing CD319/CD138 and CD38/CD138 were compared as well. The control group consisted of 53 cases with non-malignant blood disease matched by age and sex.@*RESULTS@#Monoclonal plasma cells were detected in 303 of 387 MM patients, among which 277 cases (91.42%) were positive for CD269, and all cases were positive for CD319 (100%). In newly diagnosed MM (NDMM) and recurrent refractory MM (RRMM) patients, the expression levels of CD269 were 97.53% (0-99.92%) and 94.96% (0.22%-99.99%), respectively, while levels of CD319 were 99.90% (87.77%-100%) and 99.78% (63.12%-100%), respectively. The expression levels of CD269 and CD319 in the control group were 97.00% (77.00%-100%) and 100% (89.00%-100%), respectively. There were no significant differences in the expression levels of CD269 and CD319 among NDMM, RRMM and the control group. Patients acquiring therapeutic effects were divided into complete remission (CR) group, very good partial response (VGPR) group and partial response (PR) group. Gating with CD38/CD138, median MRD values were 0.76% (0-1.88%), 0.77% (0-4.96%) and 1.75% (0.09%-10.90%) in the three groups, respectively, while gating with CD319/CD138, median MRD values were 0.57% (0.18%-1.96%), 1.07% (0.12%-4.85%) and 1.77% (0.08%-8.22%), respectively. There was no significant difference in MRD level by the two gating strategies, but a good correlation between the two (r=0.808, P<0.05). In addition, in 4 patients treated by CD38 monoclonal antibody (DARA), the expression level of CD38 was observed to be down-regulated or even negative after treatment. When the MRD level was very low, CD38/CD138 gating resulted in false MRD@*CONCLUSION@#CD319 and CD269 express stably and continuously in plasma cells of MM patients at different disease stages. CD319 can be used as an alternative of CD38 for immunophenotyping and MRD detection, especially for MRD detection after DARA treatment, while CD269 is suitable for detection before BCMA-CAR-T treatment.
Subject(s)
Humans , Flow Cytometry , Immunophenotyping , Multiple Myeloma , Neoplasm Recurrence, Local , Neoplasm, Residual , Plasma CellsABSTRACT
Objective To establish a UPLC-Q-TOF-MSE fingerprint of Yiqi Fumai Injection (YQFM) for providing reference for visual, easy and overall control of its quality. Methods The chromatographic separation was performed on a Waters Acquity UPLC HSS T3 (100 mm × 2.1 mm, 1.8 μm) column with the mobile phase consisting of acetonitrile and 0.1% formic acid for gradient elution. The flow rate was 0.3 mL/min, and the column temperature was 30 ℃. The capillary voltage was set at 2.5 kV. The nebulization gas was set to 800 L/h at 400 ℃, and the source temperature was 100 ℃. The BPC obtained with negative ion ESI mass spectra were selected for the fingerprint analysis. Similarity evaluation was used to evaluate the quality of YQFM from different batches. Based on the intensities of the ions for common peaks, HCA and PCA were performed using SPSS 19.0 and Simca-P software. Results The UPLC-Q-TOF-MSE fingerprint of YQFM was established by using 28 batches of sample and 18 common peaks were found, of which 15 mutual peaks from Ginseng Radix et Rhizoma rubra, three mutual peaks from Ophiopogonis Radix. Compared with the reference substances and references, 16 of the common peaks were identified and the similarity of 28 batches samples were over 0.970. 28 batches of YQFM could be divided into four grades when the sum of squared Euclidean distance is 5-10 in the result of HCA; PCA got seven principal components through dimension reduction and accumulative contribution rate reached 84.989%. By fitting the load factor model of the first principal component, ten markers greatly impacting on the quality were found. The comprehensive evaluation function of YQFM in different batches was constructed according to the principal component score. Among 28 batches of YQFM, the comprehensive score of S28 was the best, closely followed by S22, S11 and S9, while S14 and S13 was the worst. Conclusion The utilization of UPLC-Q-TOF-MSE fingerprint coupled with chemical pattern recognition could objectively and effectively assess the quality of YQFM, can provide a more comprehensive reference for the quality control of YQFM.
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Objective To establish a quantitative analysis of multi-components with a single-marker (QAMS) method for the determination of nine components in Yiqi Fumai Injection (YFI). Methods Ginsenoside Rb1 was used as internal reference substance. The relative correlation factors (f) of ginsenosides Rg1, Re, Rf, Rc, Ro, Rb2, Rd, and schisandrin were calculated and established by HPLC. The separation was performed on a Diamonsil® C18 column (2) (250 mm × 4.6 mm, 5 μm), with the mobile phase consisting of acetonitrile and 0.05% phosphoric acid water for gradient elution. The column temperature was 30 ℃, and the detection wavelength was set at 203 nm, flow rate was 1 mL/min. The results were compared with those obtained by the external standard method in 25 batches of YFI. Results Ginsenosides Rg1, Re, Rf, Rb1, Rc, Ro, Rb2, Rd, and schisandrin had good relations within the ranges of 0.929-4.644, 0.818-4.089, 0.732-3.660, 1.461-7.305, 0.636-3.181, 0.618-3.092, 0.788-3.941, 0.758-3.789, and 0.178-0.889 μg, respectively. The recovery rates were 97.08%-100.94%. The f values of ginsenosides Rg1, Re, Rf, Rc, Ro, Rb2, Rd, and schisandrin to ginsenoside Rb1 were 1.970, 0.929, 1.196, 0.870, 0.830, 0.786, 0.906, and 12.082. The two methods did not show the significant difference in assay results. Conclusion The QAMS method is feasible and credible, and could be used to determine the multiple components in YFI.
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BACKGROUND:In view of the unavoidable problems of autogenous and al ogenous bone grafts, it is an urgent need to develop biodegradable bone substitute materials, among which is calcium phosphate material that has become a hot spot in the domestic and foreign research. OBJECTIVE:To develop a biodegradable calcium phosphate material for bone repair based on tetracalcium phosphate (TTCP). METHODS:The biodegradable calcium phosphate cement made from TTCP, dicalcium phosphate anhydrous and different constituents of curing liquids was prepared under room temperature (about 25 ℃). The effects of solid components, liquid components as well as calcinations and drying temperature on the physical and biological performances were detected through X-ray diffraction test, hardness test, decay in a simulated body fluid, hemolysis and cytotoxicity tests, respectively, to select the bone repair material with excel ent performances. RESULTS AND CONCLUSION:When the calcination temperature was lower than 1300 ℃, TTCP was rarely available;only close to 1400 ℃, the relatively pure TTCP was gained. A large number of pure TTCP were gained by rapid cooling because of avoidance of the moisture impact, but slow cooling made the main products to be hydroxyapatite, suggesting that rapid cooling is essential to obtain pure TTCP. With the increase of the proportion of citric acid solution in the liquid phase, the pH values and the hemolysis rate in the bone cement soak solution were increased gradually, illustrating that citric acid solution is easy to induce hemolysis. In vitro cel experiments showed that the hemolysis rate of bone cement with a solution of 2:1 NH4/Na ratio was the lowest, and the biocompatibility was the best, which was the most favorable to cel growth. Cements was made of calcined powders sieved at 1400 ℃ and showed the shortest initial setting time, least effect on pH values, lowest disintegration rate and hemolysis rate, and slightest inhibition effect on the cel proliferation, indicating that the bone cements made of sieved powder after 1400 ℃ calcination is more suitable for clinical application.
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Objective To analyze the correlation of intervertebral disc degeneration with the blood perfusion of its adjacent border of vertebral body by dynamic contrast‐enhanced MRI (DCE‐MRI) .Methods 3 .0T DCE‐MRI examinations were performed in 15 patients (50 discs) .Intervertebral discs from L1 to L5 were classified to normal group(17 discs) and degeneration group(33 discs) based on the Pfirrmann grading system .The DCE‐MRI pharmaeokinetic parameters of the region of interest(ROI):volume transfer constant (Ktrans ) ,blood volume(BV) and blood flow (BF) were obtained .Independent sample t test was used to compare normal group and de‐generation group .Results In normal group (n=17) ,the mean Ktrans ,BV and BF were (0 .036 2 ± 0 .011 2)min-1 ,(4 .81 ± 1 .17) mL/100 mL ,(5 .68 ± 1 .55) mL · min-1 · 100 mL -1 for the superior border of vertebral body ,and (0 .042 ± 0 .012 9)min-1 ,(5 .03 ± 0 .797) mL/100 mL ,(6 .02 ± 1 .28) mL · min-1 · 100 mL -1 for the inferior border of vertebral body .In degeneration group (n=33) ,the mean Ktrans ,BVand BF were (0 .030 4 ± 0 .011 2)min-1 ,(4 .22 ± 1 .03) mL/100 mL ,(4 .73 ± 1 .38) mL · min-1 · 100 mL-1 for the superior border of vertebral body ,and (0 .033 8 ± 0 .012 5) min-1 ,(4 .07 ± 0 .940) mL/100 mL ,(4 .72 ± 1 .43) mL · min-1 · 100 mL -1 for the inferior border of vertebral body .By statistical analysis :(1)There were no significant differences between superior border and inferior border of vertebral body in Ktrans ,BV and BF in normal group(t= -0 .98 ,-0 .479 ,0 .533 respectively ,P>0 .05 ) .(2)There were no significant differences between superior border and inferior border of vertebral body in K trans ,BV and BF in degeneration group(t= -0 .906 ,0 .497 ,0 .013 respectively ,P>0 .05) .(3)There were significant differences between normal group and degeneration group in Ktrans ,BV and BF(t= -2 .26 ,-3 .01 ,-2 .99 respectively ,P<0 .05) .Conclusion The bone marrow per‐fusion in degeneration group is decreased when compared to normal group with dynamic contrast‐enhanced MRI .Intervertebral disc degeneration correlates with the loss of its blood supply .
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Objective To explore the effect of multi-detector computed tomography (MDCT)scan parameters and imaging post-processing methods on metallic artifacts,so as to achieve the perfection in reduction of artifacts caused by metallic implants.Methods Water phantom with titanium alloy steel plate was scanned under MDCT with alternating scan parameters including tube voltage, tube current,pitch and focal spot.The areas of image artifacts were measured and correlated with the scan parameters.Another 1 5 postoperative patients with vertebral implantation scaned with the conventional scan parameters were also included in the study.Ima-ging post-processing including multi-planar reconstruction (MPR),window width and level adjustment,and volume rendering tech-nique (VRT)was performed by using optimized and conventional methods,respectively,and then the image quality was evaluated. Results The areas of image artifacts under the differnt tube voltage,pitch,and focal spot were statistically different.With the in-crease of the tube voltage or the decrease of the pitch,the area of image artifacts decreased gradually.The area of image artifacts scanned with the small focal spot was smaller than the large one.There was no significant difference for the area of image artifacts scanned with the different tube currents.The metallic artifacts decreased by using the soft tissue algorithm (Kernel B40f)in the bone window reconstruction,wide windows (2 000 HU window width,600 HU window level)in observing,and VRT.Conclusion Selection of appropriate MDCT scan parameters and imaging post-processing methods can reduce the metal artifacts,improve the image quality and diagnosis.
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In this paper, a kind of skin dressing, agarose- grafting- hyaluronic acid (Ag-g-HA) sponge was applied to test the modified agarose based scaffold for skin regeneration. The bFGF loading agarose-grafting hyaluronan scaffold had homogenous porosities, and the loaded bFGF was bioactive in 2 weeks. The Ag-g-HA sponge was applied into skin of mice, and it was found that the dressing promoted skin regeneration and no infection and leakage in lesion site took place. H&E staining results showed that the repaired skin was similar to autologous skin. These demonstrate that Ag-g-HA sponge has a promise in skin regeneration.
Subject(s)
Animals , Female , Mice , Bandages , Fibroblast Growth Factor 2 , Physiology , Hyaluronic Acid , Therapeutic Uses , Mice, Inbred C57BL , Polysaccharides , Therapeutic Uses , Random Allocation , Seaweed , Chemistry , Sepharose , Therapeutic Uses , Surgical Sponges , Wound Healing , Wounds and Injuries , TherapeuticsABSTRACT
This study was aimed to investigate the anti-leukemia activity of Tel03 in vivo. The K562 xenografted leukemia model was established and mice were divided randomly into three groups. Mice of different group were treated with PBS (control), 5 mg/kg Tel03 or 15 mg/kg Tel03 (ip, twice a week) respectively. Tumor volume, body weight and other behavior were observed regularly. Cell apoptosis was detected with TUNEL assay and the expression levels of Bcl-2 and Bax were detected by Western blot. The results indicated that Tel03 exerted anti-leukemia activity in mouse model. Tel03 significantly reduced tumor volume in Tel03-treated group compared with control. In addition, 5 mg/kg Tel03 induced cell apoptosis without exerting apparent toxicity in mice. After Tel03 treatment, the expression of Bcl-2 was inhibited, however, the expression of Bax was up-regulated. It is concluded that G-quadruplex ligand Tel03 can induce cell apoptosis in leukemia mouse model, and this agent may be a potential anticancer drug.
Subject(s)
Animals , Female , Humans , Mice , Apoptosis , G-Quadruplexes , K562 Cells , Mice, Inbred BALB C , Mice, Nude , Proto-Oncogene Proteins , Metabolism , Proto-Oncogene Proteins c-bcl-2 , Xenograft Model Antitumor Assays , bcl-2-Associated X Protein , MetabolismABSTRACT
BACKGROUND: It has vedfied that seaweed polysacchande-agarose modifiers have their medical application value. OBJECTIVE: To perform skin regeneration trials using sprayable activated agarose/gelatin solution, and to explore the possibility of egarose modifier as skin dressing for skin regeneration. METHODS: To prepare 3% sprayable mixture with the dissolved activated agarose and gelatin at a certain ratio, and then filtrated with millopore for sterilization to prepare activated agarose (egarose degradation for 8 hours) and gelatin degradation, and made into different ratios (1: 0, 1: 1, 1: 2, 1: 3). A total of four rabbits were obtained, and four sites were selected on the back of each rabbit, totally 16 experimental sites. The sprayable activated agarose/gelatin mixture (1: 1, 1: 2, 1: 3) was directly sprayed on the four lesion sites. Sprayable activated agarose for two sites and simple gelatin for two sites served as controls. The effects of the wounds sprayed with,dressing were observed at 4 weeks following surgery. RESULTS AND CONCLUSION: At 7 days following surgery, the cover film had broken in mixture of activated agarose and gelatin at 1: 3, and remaining three were intact. No infection or inflammation occurred in wound of four ratios. Following comparison, the wound was rapidly healed in 1: 2 ratio dressing. The additional gelatin showed promoting effects on wound healing significantly. Hematoxylin-eosin staining demonstrated that skin with the dressing was similar to autologous skin, which verified that sprayable activated agarose/gelatin have a premise in skin regeneration.
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BACKGROUND: The key factor for cartilage repair is an orient differentiation of seed cells in three-dimensional scaffold; however,clear cartilage is haply observed in the three-dimensional scaffold.OBJECTIVE: To investigate the chondrogenesis of bone marrow mesenchymal stem cells (BMSCs), chondrocytes (CCs) and adipose-derived adult stromal cells (ADAS) in three-dimensional scaffolds METHODS: BMSCs, CCs, and ADAS were primary-cultured from goat bone marrow following trypsin digestion and amplified in monolayer. P1 BMSCs, P3 CCs, and P3 ADAS were implanted into collagen/hyaluronic acid scaffold at different concentrations of 10%, 20%, 50%, 80%, and 100%, and the cells were then three-dimensionally cultured in serum-free culture media. Two weeks later, SO staining and immunohistochemical staining were employed to observe the synthesis between of chondroitin sulfate and type Ⅱ collagen.RESULTS AND CONCLUSION: The seeded cells had chondrogenesis in scaffolds under certain conditions. In details, BMSCs in 20% (W/W) hyaturonan/collagen Ⅰ scaffolds could perform a hyaline-cartilaginous phenotype when they were expanded with less than 3 passages and cultured in a chondrogenic medium, and CCs did better than BMSCs in chondrogenesis with high passage number; however, ADAS just showed a minor chondrogenesis even in a pellet culture. BMSCs and CCs were better than ADAS as seeded cells for cartilage tissue engineering and regenerative medicine.
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This study was aimed to investigate the growth inhibition effect of diimide G-quadruplex ligand on leukemia cells and to explore its molecular mechanisms. K562 leukemia cell lines were treated with various concentrations of the diimide G-quadruples ligand small molecule (0.1 - 10 micromol/L). Trypan blue exclusion assay was used to evaluate the proliferation inhibition. Cell apoptosis was observed using terminal deoxynucleotide transferase-mediated dUTP nick end labeling (TUNEL). Telomerase activity was analyzed by telomere repeat amplification protocol. Gene expression was detected by microarray and confirmed by RT-PCR assay. The results showed that diimide small molecule inhibited the proliferation of K562 cells and induced apoptosis of these cells. After treating with diimide G-quadruplex ligand, telomerase activity of K562 cells was reduced and the transcriptional levels of some important genes were changed significantly. These genes were involved in cell apoptosis, cell signaling pathway and other key functions. In conclusion, the diimide G-quadruplex ligand is a small molecule that inhibits the proliferation and induces apoptosis in leukemia cells, and these functions may be related to telomerase inhibition and regulation of some important gene transcription.
Subject(s)
Humans , Apoptosis , Cell Proliferation , G-Quadruplexes , K562 Cells , Leukemia , Genetics , Pathology , Ligands , Microarray Analysis , Telomerase , MetabolismABSTRACT
Polyamide is a synthetic small molecule that recognizes predetermined sequences in the minor groove of DNA with affinities and specificities compared to those of DNA-binding proteins. Polyamide can suppress gene transcription by interfering with the attachment of natural transcription factors and DNA. The alkylating polyamides represent a novel approach for sequence-specific gene silencing, which might be applied to gene therapy. The research on suppression of gene transcription by polyamide was reviewed in this paper.
Subject(s)
Animals , Humans , Gene Silencing , HIV , Genetics , Neoplasms , Genetics , Nylons , Pharmacology , Transcription, GeneticABSTRACT
To explore the relationship between inactivation of TGF-beta signaling pathway and acute leukemia, the expressions of TGF-beta1, TbetaRII and c-myc in the bone marrow mononuclear cells were detected by S-P immunocytochemical staining. The results showed that no significant difference of TGF-beta1 exepression was found between the patients and the control (P > 0.05), the expression of TbetaRII was significantly lower in patients than in control (P < 0.05) and the expression of c-myc was significantly higher in patients than in control (P < 0.05). There was no significant difference of TGF-beta1, TbetaRII and c-myc exepression between acute nonlymphoid leukemia and acute lymphoid leukemia (P > 0.05). Expressions of TbetaRII and c-myc were negatively correlated (r = -0.474, P < 0.01). In conclusion, the leukemic cells escape from the growth inhibitory effect because of the inactivation of TGF-beta signaling pathway; downregulation of TGF-beta receptor II cause c-myc overexepression and leukemogenesis.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Acute Disease , Bone Marrow Cells , Metabolism , Immunohistochemistry , Leukemia , Metabolism , Pathology , Proto-Oncogene Proteins c-myc , Receptors, Transforming Growth Factor beta , Transforming Growth Factor beta1ABSTRACT
Objective To analyze the influence of different types of seizures and nonepileptic events on peripheral white blood cell (WBC)counts. Methods We prospectively collected blood samples from all patients and detered WBC count to evaluate the relation of each type of seizure,duration,frequencies,and ttme lapse between a seizure and collection of blood sample to peripheral WBC count. Results Peripheral WBC count was elevated in about 50% cases after a generalized seizure. The length of a seizures was positively associated, whereas its frequencies and the lapse time was negatively correlated with the increase in WBC counts. Conclusion Peripheral WBC counts increase significantly after a generalized seizure.
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A 65 years old male, who had complained of severe lower back pain with generalized muscular weakness, nausea and constipation since last 18 months, showed typical loboratory and radilogical findings of primary hyperparathyroidism. It had extensive skeletal involvement and some urological complication. The mass, which was palpated in the right upper corner of the thyroid, was surgically completely removed. It was measured 8×4×3 cm, and was weighed 38 gm. Microscopic examination revealed adenoma of the parathyroid gland consisting of small dark chiefe ells. Postoperative course has been satisfactory. (
Subject(s)
Humans , Male , Adenoma , Constipation , Hyperparathyroidism, Primary , Low Back Pain , Muscle Weakness , Nausea , Parathyroid Glands , Thyroid GlandABSTRACT
This is an analysis of 137 feet of triple arthrodesis over a period of 23 years.1964–1987. The average period of follow-up was 4 years and 2 months. The results are as follows. 1. The ratio of male to female was 64 to 68 cases, and right to left was 75 to 62 feet. 97 feet(70. 8%) were operated on between late 1960 and early 1970. 89 cases(67.4%) came for their initial examination when they were aged between 9–20 years. Age at the surgery was between 55/12–50 years, and among them 134 feet(97.8%) were operated after age of 8 years. 2. 128(93.4%) out of 132 cases were residual poliomyelitis, and 97(70.8%) out of 137 feet were equinovarus. 3. 100 out of 132 cases receiving triple arthrodesis also received a total of 179 additional procedures simultaneously to achieve better correction. The major additional procedure was. Achilles tendon lengthening in 81 cases followed by plantar fasciotomy in 49 cases. 4. Surgical approach was by Ollier's method, and arthrodesis by Lambrinudi's method. 5. 134 out of 137 feet required triple arthrodesis in order to correct the deformity. On this operative procedure it was utmost important to dissect the tarsal bones and surrounding soft tissues thoroughly to loosen and rearrange the joints. In this way even severe deformity was corrected satisfactorily. 6. At the time of Achilles tendon lengthening by Z-plasty deviding it longitudinally, on the tibial side the tendon was cut at the calcaneal attatchment, and on the fibular side at the proximal end. We think that this produced more efficient and satisfactory results especially in the correction of equinovarus. 7. Internal fixation was done by one staple on 110 feet and two staples on 7 feet. On one staple use, it was inserted connecting the talus and the cuboid. More firm contact between two bones as it progressing into bone was achieved by placing with slightly spread legged staple. 8. We could not find any pseudoarthrosis or delayed union. It is assumed the reason for this was good dissection of bone and joint, firm internal and external immobilization, and good postoperative management. 9. Talar and navicular necrosis occurred in 6 feet(4.4%), but did not affect the final fusion of the arthrodesis. In relatively severe necrosis, we found flattening of the talus and complaint of considerable pain but nevertheless, no special additional procedure was done. 10. We found some cases of postoperative degenerative hypertrophic osteoarthritis in tibio-talar and navicular-cuneiform joint. We feel this phenomenon is due to compensatory stress emanating from the fusion of three joint, and new contact of articular surfaces with changed biomechanical force. 11. When doing triple arthrodesis, the optimal age for surgery is 10-12 years, i.e., before the completion of bone growth, the reason is during the remaining period of bone growth, there is opportunity for the bone and other tissues to adjust to the newly formed stresses of weightbearing and joint motion. 12. Of a total of 137 feet receiving triple arthrodesis, excellent results were seen in 31(23%), good in 82(60%), fair 20(14%) and failed in 4(3%).
Subject(s)
Female , Humans , Male , Achilles Tendon , Arthrodesis , Bone Development , Clubfoot , Congenital Abnormalities , Follow-Up Studies , Foot , Immobilization , Joints , Leg , Methods , Necrosis , Osteoarthritis , Poliomyelitis , Pseudarthrosis , Surgical Procedures, Operative , Talus , Tarsal Bones , Tendons , Weight-BearingABSTRACT
This is an analysis of 1282 cases of poliomyelitis from patient records gathered over a 20 year period from the year of 1964. The results are as follows : 1. The most visits recorded in any one year were 301(23%) in 1965. The most visits recorded in a 5 year period were 961(67%) in the years of 1965–1969. 2 Of a total of 1158 cases whose year of onset was recorded, the earliest onset was in 1900: only one case. Since 1981 no new onsets have been recorded. However, the majority of cases : 1014(87%) showed an onset between 1955–1974. 3. Of a total of 1282 cases whose place of residence at primary examination was recorced, 891(70%) resided in Seoul and 391(30%) in the rural areas. 4. Of a total of 1282 cases whose sex was recorded, males comprised 777(61%) and females 505(39%). 5. Of a total of 883 cases whose season of onset were recorded: 526(60%) onsets occured in the warm, 272(31%) in the cool, and 85(9%) in the cold season of yesr. 6. Of a total of 1155 cases whose age at onset was recorded, the youngest was 4 months and the oldest 28 years of age. The largest group comprising 915 cases(79%) were two years of age or younger. 7. Of a total of 1146 cases whose period between onset and primary visit was recorded: 182(16%) were in acute, 414(36%) were within convalescent, and 732(64%) were in residual stage. 8. Of a total of 1268 cases whose age at initial examination was recorded, 233(18%) were two years or younger, 1021(81%) were 14 years or younger. 9. Of a total of 445 cases whose vaccination history was recorded, 234(53%) had been vaccinated prior to onset. Of those only 112(48%) had completed the required course of vaccincation. 10. Of the total of 1282 cases, deformities resulting from muscular paralysis were recorded in 1099(86%) cases. The number of deformities occuring in these cases totalled 3141: 189 deformities(6%) were in the trunk, 64(2%) were in upper extremity, and 2888(92%) were in lower extremity. Among the lower extremity, 1270(40%) were in the foot. The most frequent single deformity was knee flexion with the total of 464(15%). 11. Of a total of 798 cases whose leg length was verified, 394 were measured by scanogram and 404 cases by measurement of actual leg length. The greatest leg length discrepancy was 12cm in a 17 year-old male, and the most average discrepancy in those bone growth completing, age of 17–20 years, was 3.2cm. 12. Of a total of 1282 cases, 503(39%) cases had prescriptions for supportive devices, but only 316(25%) cases actually had made and wore them. Among those prescriptions, the most common type prescribed was the long-leg brace, which totalled 351. 13. Of the total of 1282 cases, 449(35%) received 1297 surgical procedures, an average of 2.9 per patient. The operations on soft tissue comprised 734(57%) procedures : 348 tendon transplantations with the most(170 procedures) on peroneals, 147 tendon lengthenings with the most(146 procedures) on Achilles tendon, and 234 fasciotomies with the most (117 procedures) on iliotibial band. The operations on bone and joint comprised 563(43%) procedures : 274 leg length equalizations with the most(172 procedures) of growth stimulation, 186 arthrodeses with the most(115 procedures) of triple arthrodesis of the foot, and 92 osteotomies with the most(41 procedures) on tibis. 14. Since problems remaining in the residual stage of poliomyelitis are almost always permanent, observation of these cases over a long period of time has generated invaluable experience from which we have gained considerable knowledge. 15. It has been a revelation to see the considerable degree of compensation in growing children such as a decrease in leg length discrepancy as the end of growth approached. Cases of so called hand-knee gait showing hypertrophy of fingers have lost this in a few years, following corrective measures. 16. We feel that all cases of leg length discrepancy do not need to be treated uniformly, considering the power of the ability of growing children to compensate without any inter vention. 17. Prediction of type of motion or deformities using physical examination of muscular paralysis is very difficult because the compounding factors of not only the paralysis of various muscles but the individual characteristics. The age, sex, lifestyle, motivation etc. have been shown to have an over-riding influence. 18. Decisions to brace or operate should not be made hastily but only after careful and thorough examination. We saw many quite severely disabled cases walk remarkably well without braces or surgery by their own means of compensation or device. 19. Cases with almost no lower extremity muscle power except for 20–30% hip rotators could walk surprisingly well using the sartorius muscle as a main controlling force. So we dubbed their manner of walking the sartorius gait. 20. Bracing can be very burdersome, and decisions to brace should not be made on the textbook alone. Some cases happily choose surgery over bracing. 21. For one time surgical procedure, it is better to choose bone over soft tissue for a better result. When the surgery is two stage, soft tissue surgery done after bone and joint surgery has healed will produce better results. 22. We must all realize that not only poliomyelitis, but also all chronic diseases need mental treatment as well as physical. Because, in rehablitation mental disablity is more harmful than physical in the final analysis.