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Objective:To evaluate devascularized bone surface culture for identification of microorganisms for osteomyelitis.Methods:A prospective study was conducted to include the eligible patients who were diagnosed with osteomyelitis and treated at Division of Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Nanfang Hospital from December 2021 to January 2023. Their infected bone tissues were collected for both bone sample culture (BSC) and general sample culture (GSC). For BSC, the devascularized bone fragments, harvested intraoperatively, were put flat on sterile culture plates with solidified agar, their surface was gently covered with cooled and molten tryptone soy agar, and then the plates with bone samples were incubated at 37 ℃ with 5% CO 2. Meanwhile, 5 suspected samples of infected bone tissue were randomly harvested by 5 independent instruments for laboratory GSC. The culture time, bacterial species, and bacterial positive rate were compared between the 2 culture methods. Results:Included were a total of 73 patients [59 males and 14 females with an age of 49.0(31.0, 58.5) years]. The culture time for BSC [1 (1, 1) d] was significantly shorter than that for GSC [3 (2, 3) d], and the total positive rate of BSC [78.1% (57/73)] was significantly higher than that of GSC [61.6% (45/73)] ( P<0.05). The bacterial species cultured by GSC were consistent with those cultured by BSC. Conclusion:In identification of microorganisms for osteomyelitis, since BSC may be quicker and lead to a higher positive rate of bacterial culture than GSC, it can be used as an optional choice besides GCS.
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Objective:To evaluate the efficacy of implant surface culture in identification of pathogens for fracture device-related infection.Methods:A prospective study was conducted to include the eligible patients who were diagnosed with infection after fracture fixation and needed surgical removal of the implants according to treatment principles at Division of Orthopaedics and Traumatology, Department of Orthopaedics and Traumatology, Nanfang Hospital from November 2020 to January 2023. With informed consent, after rinsing with aseptic normal saline twice, their implants were gently covered with a thin layer of tryptone soy agar medium. Thereafter, the implants were incubated at 37 ℃ with 5% CO 2. Changes on the surface and in the surroundings of the implants were observed every day for consecutive 2 weeks to avoid drying up by supplementing the medium when necessary. Once pathogen colonies formed, samples were collected at 3 independent sites using sterile swabs for laboratory identification. Comparisons were made between the samples from implant surface culture and the intraoperative multisite samples from conventional culture. Results:Included were a total of 75 patients [56 males and 19 females with an age of (46.2±15.4) years]. The most common infection site was the tibia (37 cases), and the most common type of implants was plate and screw (59 cases). The positive rate of implant surface culture was significantly higher than that of conventional culture (86.7% vs. 52.0%, P<0.001). 80.5% (29/36) of the negative patients detected by the conventional culture obtained positive results by the implant surface culture; three of the positive patients detected by the conventional culture obtained negative results by the implant surface culture. The culture results were positive by both culture methods in 36 patients, and consistent by both culture methods in 35 patients, yielding a consistent rate of 97.2% (35/36). The time for implant surface culture was significantly shorter than that for conventional culture [1 (1, 2) d versus 3 (3, 4) d] ( P<0.001). Of the 65 positive patients by the implant surface culture, 59 were detected with monomicrobial infection, with Staphylococcus aureus on the top (29 cases). Conclusion:As the implant surface culture, a novel method, may be superior to the conventional culture in a significantly higher positive rate and a shorter culture time, it may be used as an effective adjunct to the conventional culture in identification of pathogens for fracture device-related infection.
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Objective:To study the clinical characteristics and death risk factors of the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020.Methods:The clinical data were retrospectively analyzed of the 894 patients with fall-related injuries who had been admitted to Department of Trauma Center, The First People's Hospital of Kashgar Prefecture, Xinjiang Uygur Autonomous Region from January 2019 to December 2020. Recorded were the patient's gender, age, location of fall, month of fall, fall height, major injury site, injury severity score (ISS) and Glasgow score (GCS). The clinical characteristics and death risk factors of the fall patients were analyzed.Results:Of the 894 patients, 72.3%(646/894) were male and 86.9%(777/894) fell from a height from 1 to 6 meters. Their ages ranged mainly from 15 to 59 years old (74.3%, 664/894). Home was the most frequent site for falls (60.2%, 538/894) and the patients who fell in summer months (from June to August) were the most (32.3%, 289/894). Twenty-one patients (2.3%, 21/894) died. There were significant differences in the major injury site, blood transfusion, ISS score and GCS score between the dead and survival patients ( P<0.05). The multivariate logistic regression analysis showed that the injury to the head, face and neck [ OR=10.936, 95% CI: 1.177 to 101.627, P=0.035] and GCS score ≤12 [ OR=5.640, 95% CI: 2.658 to 11.968, P< 0.001] were the death risk factors for the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020. Conclusions:In the patients with fall-related injuries in parts of Kashgar Prefecture during 2019-2020, males aged from 15 to 59 years old were the high-risk group of falls. Months with a high incidence of falls were from June to August. The fall patients with injuries to the head, face and neck and with a GCS score of ≤12 were at a high risk of death.
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Objective:To investigate the clinical efficacy of intramedullary nailing combined with bone cement in repair of segmental bone defects after tumor resection.Methods:A retrospective analysis was conducted of the 5 patients with malignant bone tumor who had been treated at Department of Orthopaedics, Qiannan People's Hospital from April 2018 to September 2019 for remaining segmental bone defects following limb salvage surgery. They were 4 males and one female, aged from 11 to 55 years (average, 35.4 years). Their defects ranged from 6 to 21 cm (average, 12.3 cm) after tumor resection. By the Karnofsky performance score (KPS) for long-term quality of life, all of them scored less than 50 points. Of them, 3 were treated by interlocking intramedullary nails and bone cement filling, and 2 by elastic intramedullary nails and bone cement filling. In the 2 cases with defects of 21 cm and 13 cm, the fixation was assisted by a plate and an external fixator. Defect length after resection, operation time and intraoperative bleeding were recorded; the efficacy was evaluated by the Enneking functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system, visual analogue scale (VAS), and KPS.Results:All the 5 patients had uneventful surgery, with operation time ranging from 112 to 225 min (average, 154.2 min), intraoperative bleeding from 300 to 500 mL (average, 382 mL), and defect length after resection from 6 to 21 cm. The 5 patients were followed up for 6 to 28 months. Of them, 2 died of disease progression 6 and 7 months after surgery, respectively. According to the Enneking's evaluation, one patient scored 28 points, 2 patients 23 points and 2 patients 21 points, giving a high degree of satisfaction. Their VAS scores 6 months after surgery ranged from 1 to 6, averaging 3.6; their postoperative KPS scores ranged from 60 to 80, averaging 72.Conclusion:In repair of segmental bone defects after tumor resection, intramedullary nailing combined with bone cement filling can relieve pain of patients and lead to satisfactory short-term curative efficacy.
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Incidence of acute closed Achilles tendon rupture is high in clinic. Accurate diagnosis of this injury depends on a combination of physical signs and imaging examinations. Although conservative and surgical interventions are common for acute closed Achilles tendon rupture, its optimal treatment remains controversial. This literature review focuses on the research progress concerning this injury so as to analyze its risk factors, diagnostic methods, treatments, early functional rehabilitation, postoperative complications and prognosis evaluation.
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Objective:To characterize limb traumatic osteomyelitis in a regional trauma center in South China.Methods:The case system at Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital was searched for the data of confirmed limb traumatic osteomyelitis from January 1, 2010 through September 1, 2019. The clinical items collected were gender, age of onset, cause of injury, injury nature (open or closed), infected site (single site or multiple sites), intraoperative culture of pathogenic microorganisms, number and type of pathogenic microorganisms, and amputation. The above data were sorted out and analyzed statistically.Results:A total of 674 patients suffered limb traumatic osteomyelitis in South China with a male to female ratio of 4.81∶ 1. The limb traumatic osteomyelitis resulted mainly from open injury (64.09%, 432/674). It was mainly caused by a traffic accident (39.51%, 211/534). It was featured by single-site infection (83.68%, 564/674). It affected mainly the lower limbs: the tibia (53.19%, 300/564), the femur (18.97%, 107/564), the calcaneus (11.70%, 66/564) and other foot bones (4.61%, 26/564). The positive rate of intraoperative microorganisms culture was 65.26% (355/544). In the majority of patients (74.65%, 265/355), the traumatic osteomyelitis was caused by infection of a single pathogenic microorganism. The most common single pathogenic microorganism was Staphylococcus aureus (38.11%, 101/265), followed by Pseudomonas aeruginosa (20.00%, 53/265). The rate of amputation related to traumatic osteomyelitis was 3.71% (25/674), and the overall disability rate was 4.45% (30/674).Conclusions:In South China, more males were prone to limb traumatic osteomyelitis. Most cases were secondary to an open fracture and caused by a traffic accident. Traumatic osteomyelitis usually occurred at a lower limb. The most common pathogenic microorganism was Staphylococcus aureus.
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Objective:To study the effect of doctor-nurse cooperation responsibility system in medical care in patients with pulmonary thromboembolism.Methods:A total of 208 patients with suspected pulmonary thromboembolism were selected as research objects from Oct 1 st, 2017 to Oct 1 st, 2018. Among them, there were 144 patients with high risk pulmonarythromboembolism, 64 patients with diagnosed pulmonary thromboembolism. They were divided into control group and experimental group randomly by admission time, 104 patients for each group. Therein, there were 74 patients with high risk pulmonary thromboembolism, and 30 patients with diagnosed pulmonary thromboembolism in control group, 70 patients with high risk pulmonary thromboembolism, and 34 patients with diagnosed pulmonary thromboembolism in study group. The patients in control group were given conventional nursing management mode and patients in study group were given all-in-one nursing mode in medical care. The nursing effects were compared between the two groups. Results:The missing report rate in the control group was 8.1% (6/74), high risk identification leakage rate was 12.2% (9/74), the preventive drug treatment leakage rate was 8.1% (6/74), and the physical preventive leakage treatment rate was 9.5% (7/74). The experimental group about the missing report rate was 2.9% (2/70), high risk identification leakage rate was 4.3%(3/74), The preventive drug treatment leakage rate was 2.9% (2/70), physical preventive leakage treatment rate was 4.3% (3/70), all of these items were lower than those of the control group, and patient satisfaction of the high risk patients had significant differences between the two groups ( χ2 values were 6.08-7.51, P<0.05). And the inspection checklist leakage rate of the control group [43.3% (13/30)] was higher than that of the experimental group [17.6% (6/34)], the health education awareness rate of the control group was [36.7% (11/30)], lower than that of the experimental group [91.2%(31/34)], patient satisfaction of the control group [40.0% (12/30)] was lower than that of the experimental group [94.1% (32/34)], these items had significant differences between the two groups ( χ2 values were 10.26, 4.57, 4.22, P<0.05). Conclusions:Doctor-nurse cooperation responsibility system in medical care have improved the implementation rate of prevention and treatment intervention of pulmonary thromboembolism, and improve the health education awareness rate and satisfaction rate of patients. It makes the prevention and control management of pulmonary thromboembolism for patients more effectively.
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OBJECTIVE：To systematically evaluate the effectiveness and safety of classical prescription versus antihistamines in the treatment of eczema. METHODS ：Retrieved from CBM and CNKI ，randomized controlled trials （RCTs）about classical prescription（trial group ）versus antihistamines （control group ）in the treatment of eczema were collected. The qualities of included literatures were evaluated by modified Jadad scale after literature screening and data extraction ，and Meta-analysis was performed by using Rev Man 5.3 software. RESULTS ：Totally 19 RCTs involving 1 829 patients were included. Meta-analysis showed that total response rate of patients with Shire Yunfu type [OR ＝5.67，95％CI（3.44，9.33），P＜0.000 01]，Pixu Shiyun type [OR ＝4.23， 95％ CI（1.89，9.46），P＝0.000 4]，Xuexu Fengzao type [OR ＝3.57，95％ CI（2.36，5.41），P＜0.000 01] in trial group were significantly higher than that of control group. There were no statistical differences in the incidence of ADR between patients with Shire Yunfu type [OR ＝0.72，95％CI（0.21，2.41），P＝0.59]，Pixu Shiyun type [OR ＝0.31，95％CI（0.01，13.57），P＝0.54]，Xuexu Fengzao type [OR＝1.08，95％ CI（0.18，6.59），P＝0.93] in trial group and control group. After treatment ，the levels of TNF-α [SMD＝－1.67，95％CI（－2.04，－1.31），P＜0.000 01]，IL-6 [SMD＝－1.53，95％CI（－1.88，－1.17），P＜0.000 01] and IL-8 [SMD＝－1.75，95％CI（－2.28，－1.21），P＜0.000 01] in patients with Shire Yunfu type in trial group were significantly lower than control group. There was no statistical significance in CD 4+ levels [SMD ＝1.51，95％CI（－0.37，3.38），P＝0.12] between Shire Yunfu type patients in trial group and control group. CONCLUSIONS ：Therapeutic efficacy of classical prescription in treatment of eczema is better than antihistamines，with similar safety . Modified Longdan xiegan decoction can significantly reduce the levels of inflammatory cytokines in patients with Shire Yunfu type.
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Early management of open extremity fractures and treatment of chronic osteomyelitis,in general,require thorough debridement.Radical debridement of the contaminated or infected bone tissues usually results in bone defects.If such bone defects are not dealt with properly,they can easily deteriorate into infected ones.Treatment of infected bone defects can be extremely complicated.Application of local antibiotic delivery system can simultaneously fill the bone defects,prevent and treat the infection by delivering a high concentration of antibiotics to the lesion.The clinical antibiotic carriers can be divided roughly into 2 types:non-biodegradable and biodegradable.The biodegradable type involves bioceramic,natural polymer,synthetic polymer and composite materials.This literature review summaries the characteristics and clinical applications of current local antibiotic carriers.
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Objective To investigate the association between tumor necrosis factor-α(TNF-α)and lymphotoxin α(LTα) gene single nucleotide polymorphisms (SNPs) and susceptibility to extremity post-traumatic osteomyelitis in Chinese population.Methods We used SNaPshot genotyping method to detect genotypes of 6 TNF-α gene SNP sites (rs1799964,rs1800630,rs1799724,rs1800750,rs1800629 and rs361525) and 1 LT α gene SNP site of rs909253 in 189 patients with post-traunatic osteomyelitis and 200 healthy controls.Genetic models were applied to investigate the potential links between the above-mentioned SNPs and risks of developing post-traumatic osteomyelitis.Results Outcomes revealed that the frequency of mutant allele C of rs909253 in the patient group was statistically higher than that in healthy controls (54.23％ versus 45.00％,P =0.010,OR =1.448,95％ CI 1.092 ～ 1.921).Significant correlations were found between rs909253 and risk of developing post-traumatic osteomyelitis by recessive model (CC versus CT+TT,P=0.012,OR=1.868,95％CI1.150～3.035) and homozygote model (CCversusTT,P=0.021,OR=2.016,95％ CI 1.111～3.658).The frequency of CC (29.63％) in the patient group was higher than that in the control group (17.50％).With regard to rs1800629 site of TNF-oα gene,we only found that the frequency of mutant allele A (4.23％) in the patient group was statistically lower than that(7.75％) in the control group (P=0.040,OR=0.526,95％ CI 0.283 ～0.978).Conclusions LTαgeneSNP site rs909253 may be linked with elevated risk of developing post-traumatic osteomyelitis in Chinese population.Mutant allele C may be a risk factor and people with genotype of CC may be a group at a higher risk of developing post-traumatic osteomyelitis in China.
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Objective To investigate the effect of labetalol in treatment of severe preeclampsia clinical effect.Methods The control group of severe preeclampsia patients received routine clinical treatment,the study group were treated with labetalol,two groups of patients with severe preeclampsia were treated for 7 d.Results After treatment,the two groups of DBP,SBP,HR,and 24 HUP were significantly lower than before,the study group improved the above indicators better(P<0.05).The study group of patients with severe preeclampsia premature delivery rate,postpartum hemorrhage rate,neonatal asphyxia rate(10.20%,8.16%,6.12%)were significantly lower than the control group(28.57%,34.69%,20.41%)(P<0.05).Conclusion The application of conventional therapy combined with labetalol can significantly improve the hypotensive effect of severe preeclampsia,is conducive to the protection of maternal physical and mental health and life safety.
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Objective To study the clinical features,treatment methods and clinical outcomes of acute tibialis posterior tendon rupture.Methods Using [(posterior tibial tendon) OR (tibialis posterior tendon)] AND (rupture OR injury OR disruption OR trauma OR tear) as the search words,we searched the PubMed database to retrieve the 19 articles involving 24 cases of acute tibialis posterior tendon rupture.The injury mechanisms,X-ray manifestations,operational findings,treatment methods and clinical outcomes were analyzed.Results The mechanisms of the fracture-related tibialis posterior tendon rupture included motor accident (50.0％,12/24),falling from a height (41.7％,10/24) and sports injury (8.3％,12/24).The tendon rupture was mostly complicated with malleolar fracture (91.7％,22/24),especially the pronation type (70.8％,17/24).Direct suture of the tendon was adopted in 91.7％ of the cases (22/24).Favorable outcomes were achieved in 95.5％ of the cases (21/24).Conclusions Acute tibialis posterior tendon rupture is mostly seen in high-energy medial malleolus fracture.The mechanism of the rupture might be tendon distraction or bone flake incision.Early operation can lead to favorable outcomes.
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Objective To investigate the clinical efficacy of buttress plating for patients with posterior pilon fracture.Methods From April 2012 to January 2015,12 patients with posterior pilon fracture of the distal tibia were treated in our hospital.They were 7 men and 5 women,30 to 56 years of age (average,41.2 years).According to the CT classification by Haraguchi et al.,5 cases belonged to type I,3 to type Ⅱ and 4 to type Ⅲ.All the patients underwent open reduction and internal fixation with buttress plate via either a posterolateral approach or a dual posterolateral-posteromedial approach.All the patients were available for follow-up.The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS).The radiological evaluation was performed using the osteoarthritis-score (OA-score).Results The patients obtained an average follow-up of 21.2 months (range,from 12 to 30 months).Bone fractures united after an average of 15 weeks (range,from 13 to 19 weeks).The time for full weight walking averaged 16 weeks,ranging from 15 to 23 weeks.The ankle plantar flexion ranged from 36° to 42° (average,40.4°);the ankle dorsal extension ranged from 38° to 44° (average,42.6°).At the final follow-ups,the AOFAS scores ranged from 82 to 97 (average,88.2);the OA-score ranged from 0.6 to 0.8 (average,0.71);the VAS scores during rest,active motion and weight-bearing walking ranged from 0.5 to 0.8 (average,0.66),from 0.6 to 0.9 (average,0.82) and from 1.2 to 1.8 (average,1.41),respectively.No fracture malunion,implant loosening,pain or stiffness of the affected ankle was observed at the final follow-ups.Conclusion Buttress plating for posterior pilon fractures can lead to satisfactory clinical outcomes,because it ensures rigid fixation which in turn enables earlier postoperative mobilization.
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Background Mooren 's ulcer is an immune-related corneal inflammatory disease,and its pathogenesis remains below understood.Previous studies showed that the imbalance of T helper cell type 1 (Th1) and Th2 cell play important roles in the development of some autoimmune diseases.Thereby the influence of Th1/Th2 cells on the pathogenesis of Mooren's ulcer is being concerned.Objective This study was to investigate the change of Th1 and Th2 subsets in periphery blood of patients with active Mooren's ulcer.Methods Eleven consecutive patients with active Mooren's ulcer and 8 age-and gener-matched healthy controls were included in Zhongshan Ophthalmic Center,Sun Yat-sen University from January 2012 to July 2013 under the approval of Ethic Committee of this hospital and informed consent of each subject.The peripheral blood samples of all the subjects were obtained separately and periphery blood mononuclear cells (PBMCs)were isolated.The percentages of Th1 and Th2 in the PBMCs were assayed by flow cytometer.The relative expressions of T-bet mRNA,GATA-3 mRNA and signal transducer and activator of transcription 5 (Stat5) mRNA in the PBMCs were examined and compared by real-time fluorescence quantitative PCR (RT-qPCR) Results The percentage of Th1 cells in CD4+ T cells and Th1/Th2 value was 0.21％ (0.11％,0.31％) and 8.01 (4.49,12.01) respectively in the Mooren's ulcer group,which were significantly lower than 0.35％ (0.22％,0.71％)and 23.90 (22.49,33.49)in the normal control group,respectively (Z =-2.01,P =0.04 ; Z =-3.06,P =0.00).However,no significant difference was found in the percentage of Th2 between the two groups (Z=-1.98,P＞0.05).The relative expressions of T-bet mRNA and GATA-3 mRNA in PBMCs were significantly lower in the Mooren's ulcer group than those in the normal control group (Z =-3.47,-3.06,both at P=0.00) ;While the relative expression of Stat5 mRNA in PBMCs was insignificant changed between the two groups (Z =-1.05,P =0.33).Conclusions Th1 and Th2 cells are unbalanced in the active Mooren's ulcer patients.In addition,the down-expression of relevant transcription factors in peripheral blood also is seen in these patients.It is inferred that Th1 and Th2 cells may participate in the progress of Mooren's ulcer.
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Metastasis is the main cause of the high mortality of lung cancer. Research is currently underway to understand metastasis at molecular level. Many molecular markers have been shown to participate in metastasis, including thymidylate synthase, angiogenesis lymphangiogenesis-related factors, cell adhesion molecules, extracellular matrix metalloproteinases, cytokines, and metastasis-associated genes. Elucidating the molecular mechanism of metastasis will help improve the early diagnosis and treatment of lung cancer.
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[Objective] To observe the effect of medical ozone on cartilage in the model of osteoarthritis(OA)to explore its therapeutic mechanism.[Method] Forty healthy adult SD rats were randomly divided into five groups :A(group normal)、B(group model)、C(group air),D(group O2~O3 35 ?g/ml)and E(group O2~O3 70 ?g/ml)(n=8 in each group).The OA model was duplicated by performed anterior eruciate ligament transection(ACLT)and partial meniscectomy of 1/3 inside.Air was injected into joints of group C,according to concentration different,which O2~O3 35 ?g/ml and O2~O3 70 ?g/ml were respectively injected into joints to D and E group every other day,every time 1～1.5 ml,and after a week injected again.After the model was successfully made,the condylar cartilage of femur was excised after 4 weeks for the observation by transmissive microscope of HE staining.Mankin's index was recorded.At the end of the experiment,douche fluid of the diseased joints were obtained for the measurements of superoxide dismutase(SOD)and malondialdehyde(MDA).[Result]The OA model in B group founded obviously degenerative changes under microscopy,resulting in mostly blue and green color destaining of Masson staining at superficial cartilage.The activity of SOD in the douche fluid of the diseased joints degraded and the quantity of MDA in the serum in the OA model group increased.The Mankin's index in the group D was significantly higher than that in the group B、 C(P
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The subject of clinical medicine contains abundant humanism educational material.When students start the clinic learning and contact with the patients for the first time,clinical teacher should endeavor to cultivate medical students' humanistic spirit in clinical practice.The paper discussed how to merge humanistic spirit into medical clinic teaching by illustrating the gynecology and obstetrics teaching.
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Objective To investigate the radiation pollution level of radon and ? radiation in air in different type of buildings. Methods 22 different type of rooms were selected and common measuring methods and REM-2 Radon exhalation rate apparatus and FD-125 Rn-Th measuring instrument were used. Results It indicated that the indoor radioactive contamination mostly root in the exhalation of soil and building material, secondly outdoor radon and ? radiation, water and the wall contributed little. Conclusion The results of the present paper have laid a foundation for the further study on the effect of radiation on human health and the protective technique.