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The incidence of sternoclavicular joint dislocation is rare due to its specially physiological anatomy. At present, the main therapy of sternoclavicular joint dislocation is operation, including the sternoclavicular joint reconstruction, internal clavicle resection and internal fixation with thoracoclavicular joint. Overall,surgical treatment is difficult to operate and has high risk. The article summarized the relevant literature and reviewed the treatment of sternoclavicular joint dislocation as follows.
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Objective To explore the effect of Jintiange capsule on treatment of postmenopausal osteoporosis (PMOP) and its mechanism.Method 133 patients diagnosed as PMOP and meeting the standard were collected from Oct.2011 to Aug.2015 in our hospital.They were randomly divided into two groups:treatment group and the control group.The control group received calcium and alendronate,while the treatment group received 3 Jintiange capsules 3 times daily on the basis of the control group.The lumbar bone densit (BMD),greater trochanter BMD,femoral neck BMD,Ward triangle BMD,visual analogue score (VAS) of knee and back,the serum levels of bone glaprotein (BGP),alkaline phosphatase (ALP),β-C-terminal telopeptide of type Ⅰ collagen (β-CTX),N-terminal propeptide of type Ⅰ procollagen (PINP) and adverse reactions were recorded before and after treatment.Results The lumbar BMD,greater trochanter BMD,femoral neck BMD,ward triangle BMD of treatment group after treatment were higher than those before treatment and those of the control group (P＜0.05).VAS score of knee and back of treatment group were lower than those of the control group (P＜0.05).The serum levels of BGP,ALP,β-CTX,PINP of treatment group were lower than those of the control group (P＜0.05).The adverse reactions rate of two groups had no significant difference (P＞0.05).Conclusion Jintiange capsule can significantly reduce bone metabolism level,increasing BMD,reducing bone loss,relieving knee and back pain of PMOP,without increasing complication rates,which is worthy to be promoted due to high safety and efficacy.
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Objective To investigate the effect of resistance nodulation division (RND) efflux pumps on reduced susceptibility to tigecycline in carbapenem-resistant Acinetobacter baumanii.Methods Totally 631 isolates of Acinetobacter baumanii were collected from 16 hospitals in 7 provinces in 2010.Genes oxa-51 and oxa-23 were detected by PCR method,and the ST profiles were determined by multilocus sequence typing (MLST).The disk susceptibility assay was used to determine the inhibition zone diameters of β-lactams,aminoglycosides,macrolides,tetracyclines,carbapenems,tigecycline and polymyxin.The minimum inhibitory concentration (MIC) of tigecycline was determined by E-test in strains with inhibition zone diameters ≤ 12 mm on tigecycline.The expression of operon genes adeB,adeG and adeJ was determined with efflux pump inhibitor NMP (N-methyl-2-pyrrolidone) for detection of efflux pump inhibitor phenotype.The isolates of Acinetobacter baumanii which were resistant both to tigecycline and carbapenems and with the inhibited phenotype of efflux pump inhibitor were collected as the experiment group,the isolates which were susceptible to tigecycline but resistant to carbapenems were collected as the control group,and ATCC 19606 was used as the reference strain.The expressions of adeABC,adeFGH and adeIJK were quantified by q-PCR at the transcriptional level.Genes adeR,adeS and adeL were amplified and sequenced using PCR method to find polymorphic locus and insertion sequences.Results There were 32 isolates of Acinetobacter baumanii with reduced susceptibility to tigecycline and carbapenem-resistant.Eight isolates were with the inhibited phenotype by efflux pump inhibitor.And 4 strains which were susceptible to tigecycline but resistant to carbapenems were selected as the control.The expressions of adeABC in A518,Z1219 and A527 of experiment group were 13-fold,5-fold and 7-fold higher than reference strain ATCC19606,respectively.The expressions of adeFGH and adeIJK were up-regulated slightly in some isolates.Transcript of adeABC was not found in control group strains A207 and A1731,and the expressions of adeABC,adeFGH and adeIJK were not up-regulated in other isolates.The single nucleotide polymorphism (SNP) was detected in adeR (E220K) and adeS (A130D),respectively.ISAab1 insertion sequence was identified in adeS of adeABC-over expressed isolates.No mutation was found in adeL.Conclusion High expression of adeABC pump may play an important role in tigecycline resistance in carbapenem-resistant Acinetobacter baumannii,mainly due to the insertion of ISAba1 sequence in its regulator gene adeS,but other mechanism of tigecycline resistance may not be excluded.
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Objective To investigate the prevalence and dissemination mechanism of 16S rRNA methylase genes in extended-spectrum beta-lactamases(ESBLs)-producing Enterobacteriaceae in China.Methods PCR amplification and DNA sequencing were used for screening and identifing 16S rRNA methylase genes and ESBLs genes.Minimal inhibitory concentrations(MICs)of the antimicrobial agents were detected by Etest.Conjugation and plasmid extract were performed to study dissemination mechanism of 16S rRNA methylase genes and ESBLs genes.Results Only one strain.Klebsiella oxytoca strain ZJ157 was screened as positive for armA gene from 447 ESBLs-producing isolates,which also contained CTX-M-15 and TEM-1 genes.It was resistant to aminoglycesides,ciprofloxacin,and most β-lactams,except carbapenems,polymyxin E and tigecyeline.Resistance to amikacin and β-lactams was transferred to a recipient Escherichia coli 600 by conjugation experiment.arntA.CTX-M-15 and TEM-1 genes were detected in the transconjugant.A plasmid about 55 kb was extracted from Klebsiella oxytoca ZJl57 and the transconjugant.Conclusions A 16S rRNA methylase gene armA was detected in an isolate of Klebsiella oxytoca.armA,CTX-M-15 and TEM-1 genes can be co-transferred in the same plasmid leading to multi-drug resistance.