Progress of antibiotic-loaded bone cement in joint arthroplasty / 中华医学杂志(英文版)

Bone cement, consisting of polymethyl methacrylate, is a bioinert material used for prothesis fixation in joint arthroplasty. To treat orthopedic infections, such as periprosthetic joint infection, antibiotic-loaded bone cement (ALBC) was introduced into clinical practice. Recent studies have revealed the limitations of the antibacterial effect of ALBC. Moreover, with the increase in high infection risk patients and highly resistant microbes, more researches and modification of ALBC are required. This paper reviewed latest findings about ALBC for most popular and destructive pathogens, summarized the influence of antibiotic kind, drug dosage, application method, and environment towards characteristic of ALBC. Subsequently, new cement additives and clinical applications of ALBC in joint arthroplasty were also discussed.

The microbiology and antimicrobial susceptibility of the infected knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To describe the microbiology, antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA)and to provide reference for the diagnosis and treatment of this complication.</p><p><b>METHODS</b>The medical data of the patients with infected knee arthroplasty, who were managed with revision surgery between January 1995 to December 2011 were reviewed. Twenty-nine cases were identified and majority of the patients were female (23/29). Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months). The microbiology and antimicrobial susceptibility were analyzed.</p><p><b>RESULT</b>The overall positive rate of cultures was 65.5% (19/29). The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19) and Staphylococcus Aureus (SA) (5/19). Rare pathogens of Mycobacterium (2/19) and fungi (1/19) were also identified. Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type IV infection.</p><p><b>CONCLUSIONS</b>Gram-positive bacterias are the main pathogen, resistant and rare pathogens should be payed attention to. Antibiotic treatment for infected TKA should be based on the results of drug susceptibility. Vancomycin allows infected knee arthroplasties before the result.</p>

Comparison of blood loss during total knee arthroplasty between haemophilic arthropathy and osteoarthritis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the amount of blood loss and the efficacy of clotting factor in controlling blood loss during total knee arthroplasty.</p><p><b>METHODS</b>The medical documents of 18 patients with haemophilic arthritis (HA) secondary to haemophilia A and 19 patients with osteoarthritis (OA) were retrospectively reviewed. Demographic data,functional and hematological test results,the amount of blood loss and transfusion,and complications were analyzed.</p><p><b>RESULTS</b>The median amounts of total and external blood loss were 2240 ml(1892-3415 ml) and 1326 ml(934-2256 ml)in the HA group, which were significant higher than those in the OA group [1746 ml(1259-2246 ml)and 846 ml (504-1217 ml), respectively]. The median amounts of external blood loss in the two groups were 680 ml(370-1330 ml)and 730 ml(200-1190 ml)and there was no significant difference(p=0.620). Moreover, more patients in the HA group required blood transfusion (84.2% vs. 47.4%), and more red cells were transfused per patient in the HA group (2.3 U vs. 0 U).</p><p><b>CONCLUSIONS</b>The total blood loss and hidden blood loss are higher in the HA patients than in OA patients during total knee arthroplasty, although the external blood loss is basically the same. Management with more clotting factor may decrease the blood loss in HA patients.</p>

The efficacy and complications of one stage posterior vertebral column resection for severe spinal deformities / 中华外科杂志

<p><b>OBJECTIVE</b>to evaluate the outcomes and complications of posterior vertebral column resection in the treatment of severe and fixed spinal deformities.</p><p><b>METHODS</b>from January 2008 to January 2010, 15 consecutive cases (4 males, 11 females) of severe and fixed spinal deformities managed by single posterior vertebral column resection with transpedicular instrumentation were investigated retrospectively. The diagnosis included congenital scoliosis in 10 cases, adolescent idiopathic scoliosis in 1 case, congenital kyphosis in 3 cases, tuberculous kyphosis 1 case. Radiographs were measured to determine the regional coronal and sagittal curve magnitude, and the coronal and sagittal balance preoperatively, postoperatively and at the final follow-up. Operative reports and patient charts were reviewed to record operation time, intraoperative blood loss and complications.</p><p><b>RESULTS</b>the mean resected vertebrae was 1.8 (range, 1 - 5). The mean operation time was 331 min (range, 240 - 450 min) with an average blood loss of 1453 ml (range, 800 - 3000 ml). The average follow-up time was 13 months (range, 3 - 24 months). The regional scoliosis was corrected from 111° to 51°with a correction rate of 54.0%, and regional kyphosis from 104° to 39° with a correction rate of 62.5%. No obvious loss of correction was noted at the final follow-up. The coronal trunk shift improved from 19.5 mm preoperatively to 18.1 mm postoperatively and 12.4 mm at final follow-up. The sagittal balance improved from 20.0 mm preoperatively to -2.0 mm postoperatively and -1.1 mm at the final follow-up. Complications included partial pleural rupture requiring repair in 3 cases, transient muscle weakness of one lower limb after surgery but recovered completely at 6 month follow-up in 2 cases, and tightness of thorax after surgery in one case.</p><p><b>CONCLUSIONS</b>posterior vertebral column resection is effective in treatment of severe and rigid spinal deformities. But it is a technique-demanding procedure with higher risks of major neurologic complications.</p>

A meta-analysis of the effectiveness and safety of using tranexamic acid in spine surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the effectiveness and safety of using tranexamic acid (TXA) in reducing blood loss in spine surgery through a meta-analysis.</p><p><b>METHODS</b>Literatures before November 2009 were identified from the PubMed, EMBase, Cochrane library, CNKI and VIP databases. Relevant journals or conference proceedings were also searched manually. This study only enrolled high quality (Jadad scores ≥ 3) randomized controlled trials (RCTs). Two independent reviewers searched and assessed the literatures.Weighted mean difference (WMD) of blood loss and blood transfusions, odds ratio (OR) of transfusion rate and of deep vein thrombosis (DVT) rate in TXA-treated group versus placebo group were calculated across the studies. The statistical analysis were conducted by the software of RevMan 4.2.</p><p><b>RESULTS</b>Four double-blinded RCTs met the inclusion criteria for meta-analysis. The total sample size of these studies was 295. The use of TXA significantly reduced total blood loss [WMD = -523.74, 95%CI (-778.92, -268.56), P < 0.01], blood volumes of transfusion [WMD = -242.28, 95%CI (-394.02, -90.54), P = 0.002] and proportion of patients requiring blood transfusion [OR = 0.57, 95%CI (0.34, 0.93), P = 0.020], while did not raise the risk of DVT, as compared with placebo group.</p><p><b>CONCLUSIONS</b>This meta-analysis indicates that the use of TXA infusion for patients undergoing spine surgery is effective in reducing total blood loss, transfusion volumes and the rate of transfusion, yet doesn't raise the risk of postoperative DVT.</p>

An analysis on transcriptional regulation activity of human XBP1 gene 5' upstream DNA sequences / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze the transcription activation and possible regulation mechanism of human X-box binding protein 1(XBP1)gene 5'upstream DNA sequence in different cell lines.</p><p><b>METHODS</b>Six kinds of XBP1 promoter deletion mutants were cloned into pGEM-Teasy vector, which included XBP1 gene 5' upstream -1039 to 66 bp,-859 to 66 bp,-623 to 66 bp,-351 to 66 bp,-227 to 66 bp,-227 to -45 bp respectively. Every deletion mutant sequence was cut from Teasy-XBP1p by KpnI and Xho I, and subcloned into pCAT3-Basic to produce a set of constructs termed as p1-XBP1p, p2-XBP1p, p3-XBP1p, p4-XBP1p, p5-XBP1p, p6-XBP1p, respectively. The transcription activity of each construct was detected after transiently transfecting K562, HepG2,NIH-3T3 and L0(2)cell with FuGENE 6 transfection reagent. Cells transfected by pCAT3-Basic or pCAT3-Promoter were used as negative and positive controls. The activity of chloramphenicol acetyltransferase(CAT), which reflects the transcription activation of the XBP1 gene promoter, was detected by ELISA after 48 hours of transfection.</p><p><b>RESULTS</b>The reporter vectors of six kinds of XBP1 promoter deletion mutants were successfully constructed, as confirmed by restriction enzyme digestion and sequencing. The activities of p4-XBP1p and p5-XBP1p were higher than the other deletion mutants in K562 and HepG2. And the activity of p5-XBP1p was the highest in HepG2. There was no activity detected from any transfected NIH-3T3.</p><p><b>CONCLUSION</b>The XBP1 gene promoter can transactivate its downstream gene to transcription. The core sequence of XBP1 promoter was implied between -227 bp and 66 bp. This sequence was connected with the transcriptional activity of XBP1 promoter closely. Its transcription activity varies with different cell lines. XBP1 promoter might drive gene expression with cell-type specificity.</p>