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Gancao Fuzitang originates from the Treatise on Febrile Diseases and Miscellaneous Diseases （《伤寒杂病论》） and is mainly used to treat pain in the bones and joints and symptoms such as no flexion or extension. It has the effect of tonifying the spleen and kidney and removing dampness and turbidity， so it is widely used in the clinical treatment of various bone and joint diseases. This article reviewed the clinical research and mechanism of Gancao Fuzitang in the treatment of bone and joint diseases. The research has found that this prescription has good efficacy in treating bone and joint diseases such as rheumatoid arthritis， rheumatoid arthritis， ankylosing spondylitis， gout， and intervertebral disc herniation. Its mechanism of action may be related to regulating the level of inflammatory factors， antioxidation， and the protein expression of inflammatory and apoptotic cell-related pathways， improving bone and joint diseases， and alleviating related symptoms. This study can provide a reference for further deepening the research on the prevention and treatment of bone and joint diseases with Gancao Fuzitang.
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Nucleotide binding oligomeric dome-like receptor protein 3 （NLRP3） inflammasome is an intracellular sensing protein complex， and it is an important player in the innate immune system， capable of sensing foreign pathogens and endogenous danger signals. After tissue injury， the activation of the NLRP3 inflammasome induces the release of the pro-inflammatory cytokines interleukin （IL）-1β and IL-18， while promoting gasdermin D-mediated pyroptosis. Existing studies have shown that NLRP3 inflammasome plays a key role in the occurrence and development of common bone and joint diseases such as osteoporosis， osteoarthritis， rheumatoid arthritis， and gouty arthritis by inducing inflammatory cascade reaction and accelerating bone resorption and cartilage destruction. Therefore， blocking the NLRP3 inflammasome signaling pathway may be an effective strategy to treat or prevent bone and joint diseases. Currently， researchers have developed and tested several drugs that selectively target the NLRP3 inflammasome in animal and clinical studies， but the progress has been poor due to obvious side effects and high prices. Traditional Chinese medicine （TCM） has been widely recognized in the treatment of bone and joint diseases due to its unique advantages of multi-target， multi-pathway， multi-mechanism synergism， low price， and low side effects. With the deepening of research， the targeted intervention of NLRP3 inflammasome by TCM in the treatment of bone and joint diseases has attracted wide attention. In this paper， the mechanism of NLRP3 inflammasome in osteoarthritis was summarized by analyzing relevant literature in China and abroad in recent years， and the progress of targeted intervention of NLRP3 inflammasome by TCM in the treatment of bone and joint diseases was systematically reviewed， so as to provide new ideas and theoretical basis for the treatment of bone and joint diseases.
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Objective:To study the therapeutic effect of bone peptide combined with rifapentin and levofloxacin on bone and joint damage caused by brucellosis.Methods:A prospective study was conducted to select 64 patients with brucellosis bone and joint damage admitted to Shanxi Provincial People's Hospital from January 2017 to June 2021. They were randomly divided into a control group (32 cases) and an observation group (32 cases) using a random number table method. The control group was treated with rifapentin and levofloxacin, while the observation group was treated with bone peptide on the basis of the control group, with a treatment period of 8 weeks, and the peripheral venous blood sample was collected before and after treatment. The visual analogue scale (VAS), activity of daily living (ADL) score, serum C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)] levels were compared before and after treatment.Results:The total effective rates of treatment in the observation group and the control group were 90.62% (29/32) and 65.62% (21/32), respectively, with statistically significant differences between the groups (χ 2 = 5.85, P = 0.016). After treatment, the VAS score of the observation group was lower than that of the control group ( t = 8.29, P < 0.001), and the ADL score was higher than that of the control group ( t = 6.77, P < 0.001). Both groups had lower VAS scores after treatment than before treatment in the same group ( t = 21.72, 15.09, P < 0.001), and higher ADL scores than before treatment in the same group ( t = 22.49, 12.54, P < 0.001). After treatment, the levels of CRP, PCT, ESR, TNF-α, and IL-6 of the observation group were lower than those of the control group ( t = 8.11, 10.75, 4.64, 5.11, 4.55, P < 0.001); the levels of CRP, PCT, ESR, TNF-α, and IL-6 in the two group were lower than these before treatment in the same group ( t = 14.21, 21.47, 11.21, 15.07, 9.73, 15.50, 21.30, 7.52, 6.78, 4.93, P < 0.001). Conclusion:The bone peptide combinated with rifapentin and levofloxacin has a good therapeutic effect on bone and joint damage caused by brucellosis, which can significantly reduce pain and cellular inflammatory reactions in patients, and improve their quality of life.
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Objective:To investigate the diagnostic value of 99mTc-methylenediphosphonate(MDP) whole body bone scintigraphy in early brucellosis patients with bone and joint injuries. Methods:According to the Diagnosis for Brucellosis (WS 269-2019), combined with epidemiological history, clinical manifestations and serological tests, from November 2020 to April 2021, 15 early brucellosis patients (the course of disease was within 6 months) who had not received any drug treatment diagnosed at the Department for Brucellosis Prevention and Control, Qinghai Institute for Endemic Disease Prevention and Control were selected as the research subjects, and 99mTc-MDP whole body bone scintigraphy was performed on the patients to evaluate the images and analyze the pathological changes. Results:The 99mTc-MDP whole body bone scintigraphy of 15 patients with early brucellosis showed abnormalities, and the abnormal concentration of radionuclides mainly occurred in the 8th to 12th thoracic vertebrae (T8-12), the 1st to 2nd lumbar vertebrae (L1-2) and L4-5. Among them, the thoracic vertebrae abnormalities were T8, T9, T10, T11 and T12 in 1 case each; lumbar vertebrae abnormalities were 1 case of L1, 1 case of L2, 4 cases of L4, and 5 cases of L5. Conclusions:The 99mTc-MDP whole body bone scintigraphy is abnormal in patients with early brucellosis. Bone scintigraphy has certain value in the diagnosis of bone and joint injuries in patients with early brucellosis.
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Objective:To analyze the clinical characteristics and pathogen distributions of the patients with bone and joint infection.Methods:The clinical data and etiological results of 225 patients with bone and joint infection from January 2008 to October 2020 in Huashan Hospital, Fudan University were retrospectively analyzed.Statistical analysis was conducted by chi-square test.Results:Of the 225 cases with bone and joint infection, 75.6%(170/225) were extremities and other osteomyelitis, 16.0%(36/225) were suppurative arthritis, 8.4%(19/225) were spinal osteomyelitis. Non-implants related infection accounted for 80.4%(181/225) of the cases, while 19.6%(44/225) of the cases were implants related infection. The main clinical manifestations were localized pain (48.4%(109/225)), dyskinesia (47.6%(107/225)), localized swelling (28.9%(65/225)), fever (28.0%(63/225)), and increased purulent exudation (24.9%(56/225)). The proportions of localized pain (55.8%(101/181)) and fever (31.5%(57/181)) of non-implants infection were higher than those of implants infection (18.2%(8/44) and 13.6%(6/44), respectively), while the proportion of increased purulent exudation in implants infection (50.0%(22/44)) was higher than that in non-implants infection (18.8%(34/181)). There were all significant differences between the two groups ( χ2=15.49, 5.60 and 18.45, respectively, all P<0.050). Of the 225 cases, 63 cases(28.0%) had complications with other site infection, especially soft tissue infection and bloodstream infection. A total of 106 strains of pathogens were isolated from 225 specimens, 58.5%(62/106) of them were Gram positive bacterium.Among them, 34.0%(36/106) were Staphylococcus aureus, with the rate of methicillin resistant Staphylococcus aureus (MRSA) isolation accounting for 11.3%(12/106). Laboratory tests showed that 40.4%(91/225) of the patients had elevated erythrocyte sedimentation rate (ESR), 32.9%(74/225) patients had elevated C-reactive protein (CRP). Proportions of patients with elevated ESR (43.6%(79/181)) and CRP (37.6%(68/181)) in non-implants infection were significantly higher than those in implants infection (27.3%(12/44) and 13.6%(6/44), respectively). There were significant differences between the two groups ( χ2=3.94 and 9.19, respectively, P=0.047 and 0.002, respectively). Conclusions:The main clinical manifestations of bone and joint infection are localized pain, dyskinesia, localized swelling, fever and increased purulent exudation. Patients with bone and joint infection are easy to be complicated with soft tissue infection and bloodstream infection, and often accompanied by increased ESR and CRP levels. Gram positive bacterium are the main pathogens.
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Objective To investigate the prevalence of osteoarthrosis and the association between hot spring bathing and osteoarthrosis among local adults in typical hot spring areas of Guizhou Province. Methods A face-to-face questionnaire survey was conducted among residents aged from 30 to 65 in five typical hot spring areas, including Xifeng(Xifeng County, Guiyang), Jianhe(Jianhe County, Qiandongnan), Fodingshan(Shiqian County, Tongren), Guiyu(Wudang District, Guiyang)and Huishangu(Suiyang County, Zunyi). Residents' basic information, bone and joint diseases prevalence, hot spring bathing, and other health-related behaviors were investigated in this study. The prevalence of local bone and joint diseases was analyzed, and binary logistic regression was used to calculate OR(95%CI)to analyze the association between hot spring bathing and bone and joint diseases. Results A total of 3 708 adults(1 648 males and 2 060 females)were included as the statistical analysis survey subjects, and 794 people reported bone and joint diseases, accounting for a prevalence rate of 21.41%, 95% CI: 0.201-0.227. The prevalence of females(24.56%)was higher than that of males(17.48%)(P < 0.001). The prevalence rates of diseases increased with age(χtrend2=130.265, P < 0.001). There were also statistically significant differences in the prevalence rate of bone and joint diseases among different genders, age groups, occupations, education levels, and smoking behaviors(P < 0.05). After gender, age, occupation, education and smoking were adjusted for, compared with the group who never took hot spring baths, participants who took hot spring baths occasionally(OR=0.793, 95%CI: 0.631-0.996)and frequently(OR=0.713, 95%CI: 0.536-0.948)were associated with a lower risk of bone and joint diseases. Conclusion The prevalence of osteoarthrosis is 21.41% in the typical hot spring areas of Guizhou Province. Older or females have a higher risk of prevalence of bone and joint diseases. Hot spring bathing may be associated with a lower risk of bone and joint diseases.
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BACKGROUND: Previous studies on the clinical efficacy of total knee arthroplasty in the treatment of rheumatoid arthritis have been reported, but the effects of total knee arthroplasty on joint function and related biochemical parameters in patients with rheumatoid arthritis are little reported. Thereafter, more clinical evidence is needed. OBJECTIVE: To analyze the effect of total knee arthroplasty on joint function and related biochemical indicators in patients with rheumatoid arthritis. METHODS: Clinical data of 64 patients with 64 knees who underwent total knee arthroplasty were retrospectively analyzed. Comparative analysis of Hospital for Special Surgery, range of motion of the knee joint and quality of life scores before and 1 year after surgery was conducted. Changes of biochemical indicators such as C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were detected. The incidence of complications at 1 month after surgery was recorded. The study was approved by the Ethical Committee of Changzhou Traditional Chinese Medicine Hospital, and all patients signed the informed consents. RESULTS AND CONCLUSION: (1) Compared with the baseline levels, the Hospital for Special Surgery score, range of motion of the knee joint and quality of life scores at 1 year after surgery was significantly increased (P < 0.01), and the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate were significantly decreased (P < 0.01). (2) One patient developed infection and two patients developed deep vein thrombosis of the lower extremity, which was relieved after symptomatic treatment. These results imply that total knee arthroplasty has a good clinical effect on rheumatoid arthritis, which can improve knee function and reduce the levels of C-reactive protein, rheumatoid factor and erythrocyte sedimentation rate, and has good safety.
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Objective To investigate the drug resistance and its changes of Staphylococcus aureus (SA) in children with bone and joint infection caused by hematogenous dissemination in Zunyi area.Methods A retrospective study was performed on the clinical data of 95 cases with bone and joint infections caused by SA from January 2008 to December 2016 in the Affiliated Hospital of Zunyi Medical College,in which there were 53 boys and 42 girls with a mean age of 5.6 years (ranging from 10 days to 14 years),including 39 cases of acute osteomyelitis,31 cases of acute suppurative arthritis,19 cases of chronic osteomyelitis,and 6 cases of acute osteomyelitis and arthritis.According to the results of drug sensitivity,the drug resistance of SA was analyzed,and the detection rates of Methicillin resistant Staphylococcus aureus (MRSA) were compared in different genders and timeframes,and the drug resistance of SA to other antibiotics were also analyzed.Results The detection rate of MRSA was 50.53％ (48 cases) in 95 cases,the resistance rate to Penicillin was 92.63％ (88 cases),and to Lincomycin,Erythromycin,Tetracycline and Cefoxitin were 64.21％ (61 cases),57.90％ (55 cases),55.79％ (53 cases) and 53.68％ (51 cases) respectively,but to Sulfamethoxazole Co.,Gentamicin and Rifampicin it was relatively low[25.26％ (24 cases),11.58％ (11 cases),6.32％ (6 cases) respectively],while the resistance to Moxifloxacin,Linezolid,Tigecycline,Vancomycin and Nitrofurantoin was not found.The detection rate of MRSA in boys (52.83 ％,28/53 cases) was slightly higher than that of girls (47.62％,20/42 cases),but the difference was not statistically significant (x2 =0.255,P ＞0.05).The detection rates of MRSA in 2008-2010,2011-2013 and 2014-2016 were 27.78％ (5/18 cases),51.61％ (16/31 cases) and 58.70％ (27/46 cases) respectively,and it was obviously higher in 2014-2016 than in 2008-2010,and the difference was statistically significant (x2 =4.95,P ＜ 0.05).The drug resistance rate of SA to Lincomycin,Erythromycin and Cefoxitinis was obviously higher in 2014-2016 than in 2008-2010,and the differences were all statistically significant (all P ＜ 0.05).Conclusions The drug resistance of SA is high with the bone and joint infection caused by hematogenous dissemination in children,and the detection rate of MRSA and the drug resistance of SA to a variety of antimicrobial agents are gradually increasing.
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STUDY DESIGN: Retrospective observational study. PURPOSE: The aim of this study was to assess the distribution of age and site of infection in patients with musculoskeletal tuberculosis (TB) and determine the number of TB/human immunodeficiency virus (HIV) coinfections as well as the incidence of multidrugresistant (MDR) TB. OVERVIEW OF LITERATURE: Of all TB cases, 1%–3% show skeletal system involvement and 30% are HIV coinfected. Although the reported distribution of skeletal TB is majorly in the spine, followed by the hip, knee, and foot/ankle, the epidemiology of extrapulmonary TB and especially musculoskeletal TB remains largely unknown, particularly in areas with a high prevalence of the disease. METHODS: This is a retrospective study of a consecutive series of patients admitted to a tertiary care facility in an area with the highest prevalence of TB worldwide. TB was confirmed on tissue biopsy with polymerase chain reaction testing (Xpert for Mycobacterium tuberculosis and rifampicin resistance), culturing, or histological analysis. Data were analyzed regarding demographic information, location of the disease, HIV coinfections, and drug resistance. RESULTS: In all, 125 patients (44 children; 35%) with a mean age of 27 years (range, 1–78 years) were included. Age peaks were observed at 5, 25, and 65 years. Spinal disease was evident in 98 patients (78%). There were 66 HIV-negative (53%) and 29 (23%) HIVpositive patients, and in 30 (24%), the HIV status was unknown. Five patients (4%) showed MDR TB. CONCLUSIONS: The age distribution was trimodal, spinal disease was predominant, MDR TB rate in our cohort was high, and a large portion of TB patients in our hospital were HIV coinfected. Hence, spinal services with sufficient access to operating facilities are required for tertiary care facilities in areas with a high TB prevalence.
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Child , Humans , Age Distribution , Biopsy , Cohort Studies , Coinfection , Drug Resistance , Epidemiology , Hip , HIV , Incidence , Knee , Mycobacterium tuberculosis , Observational Study , Polymerase Chain Reaction , Prevalence , Retrospective Studies , Rifampin , Spinal Diseases , Spine , Tertiary Healthcare , TuberculosisABSTRACT
Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Objective To provide data evidence for early diagnosis of bone and joint damage derived from brucellosis by analyzing its clinical and imaging characteristics.Methods Patients with brucellosis accepted in Ji'nan Infectious Disease Hospital form December 2013 to December 2014 were selected.Patients with bone and joint damage confirmed through imaging were further studied,their epidemiological and clinical characters,CT and MRI characteristics,treatment and outcome were summarized.Results Total of 97.8％ (45/46) patients had a clear contact history,most of them worked in poultry farming,taking up to 67.4％ (31/46).July to October was its peak time for attacking,taking up to 58.7％ (27/46).The clinical manifestations of patients were joint pain,swelling and activities obstacles.In the CT images,there was obvious bony destruction,characterized by multiple round or large areas of low density insect damage sample spots.There was osteosclerotic bone lesions or osteophyte formatted in edge.The paravertebral soft tissue was swelling,and the vertebral body deformation was not obvious,and there was vertebra small joint damage occasionally.In the MRI images,there was vertebral ligaments damage,or soft tissue damage,or osteoproliferation at the edge of the vertebral bodies.There was abnormal signal T1W1 or T2W1 signal,and FS-T1W1 showed high signal,while FS-T2W1 showed slightly high signal.The diagnosis rate of CT,MRI and CT combined MRI for bone and joint damage derived from brucellosis was 76.1％ (35/46),84.8％ (39/46) and 91.3％ (42/46),respectively.The main therapeutic drugs were doxycycline and rifampicin,and the clinical effective rate was 91.3％ (42/46).Conclusion The epidemiological characters,CT and MRI characteristics of bone and joint damage derived from brucellosis have certain representativeness,and the comprehensive investigation is beneficial for clinical diagnosis.
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Objective To summarize the bacterial types and drug resistance of children with bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College in recent 9 years,so as to provide reference for rational use of antibiotics in clinics.Methods A retrospective study was performed on the clinical data of 102 children with hematogenous bone and joint purulent infection in the Affiliated Hospital of Zunyi Medical College from January 2008 to October 2016,in which there were 57 boys and 45 girls with a mean age 5.5 years old(from 10 days to 14 years old),among which 38 cases were acute osteomyelitis,30 cases were pyogenic arthritis,27 cases were chronic osteomyelitis,and 7 cases were arthritis with hematogenous osteomyelitis.The results of blood culture,pus culture and antibiotic sensitivity test results were analyzed and summarized.Results The results of blood culture or pus culture in 102 cases were all infected by single bacteria,including 89 cases of staphylococcus aureus(SA),accounting for 87.30％,3 cases (2.94％) of micrococcus scarlatinae,2 cases (1.96％) of klebsiella pneumoniae,2 cases (1.96％) of staphylococcus haemolyticus,and 1 case (0.98％) of methicillin-resistant staphylococcus epidermidis,streptococcus pneumoniae,streptococcus mitis,enterococcus hirae,enterobacter cloacae and pseudomonas aeruginosa,respectively.The resistance rate of SA to penicillin was 92.1％,but to Lincomycin,Erythromycin,Cefoxitin and Tetracycline it was more than 50.0％,and to Sulfamethoxazole,Gentamicin and Rifampicin it was quite low,and the resistant strains to Linezolid,Quinupristin/Dafoe Putin,Mo Xisha star,Tigecycline,Vancomycin,Levofloxacin,Nitrofurazone were no found.There were not multi drug resistant strains to be found except in the 45 cases of methicillin-resistant staphylococcus aureus(MRSA) and 1 case of methicillin-resistant staphylococcus epidermidis.Conclusion SA is the main pathogenic bacteria of bone and joint purulent infection in children in the local area.The resistant rate of penicillin and the detection rate of MRSA are high in the hematogenous osteoarticular infections caused by SA,but no vancomycin resistant cases were found.
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Objective To analyze the application value of T-SPOT .TB and PPD test in the diagnosis of bone and joint tuberculo-sis .Methods A total of 94 patients with tuberculosis of the bone and joint receiving surgery or conservative treatment from January 2014 to August 2016 were collected in this study ,50 patients with osteoarthritistreated by surgical treatment of bone surgery were recruited as objects too .All the objects received T-SPOT .TB and PPD test ,and the diagnosis value were compared .Results The diagnostic sensitivity ,specificity ,positive predictive value ,negative predictive value and accuracy of PPD test were 46 .81% , 98 .00% ,97 .78% ,49 .49% ,64 .58% ,those of T-SPOT .TB were 93 .62% ,100% ,100% ,89 .29% ,95 .83% .The sensitivity ,nega-tive predictive value and the coincidence rate of PPD test were less than those of T-SPOT .TB and joint test ,the differences were statistically significant(P<0 .05) ,T-SPOT .TB ,combined with the diagnostic sensitivity ,specificity ,positive predictive value ,nega-tive predictive value ,with rate no significant difference(P>0 .05) .Six cases were misdiagnosed by T-SPOT .TB ,they were all in the early stage of spinal tuberculosis ,showed cavities ,but no spinal nerve defect .One cases were erroneous diagnosis ,while 50 cases were misdiagnosed by PPD test ,all the symptoms of misdiagnosed patients were relatively mild ,with rheumatoid arthritis and other autoimmune diseases .Conclusion T-SPOT .TB is an ideal method for diagnosis of bone and joint tuberculosis ,but present interfer-ence factors ,the operation of PPD testis simply ,but lack of sensitivity ,however it has certain value in screening .
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Background: Bone and joint infections (BJI) are relatively common in children, and community -acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is the leading cause in some countries. Aim: To evaluate epidemiological data, clinical and microbiological features and outcome of BJI. Methods: A prospective descriptive study was conducted. Results: 40 patients (p) completed the study. Bacterial cultures were positives in 30 p (75%): CA-MRSA was found in 19 p, methicillin-sensitive S. aureus in 6 p, and others in 5 p. Cultures were negatives in 10 p (25%). Median treatment duration was 28 days (r: 21-40 d); Analyzing patients with CA-MRSA positive cultures separately, initial CRP was higher (Md 76 vs 50 mg/L, p < 0.02), normalization occurred later (Md 14 days vs 7days, p < 0.03), and duration of treatment (Md 32 days vs 23, p < 0.004) as well as hospital stay (Md 9 days vs 7, p = 0.12) were longer. Sequelae were present in 3 p and 1 relapsed: All of them with CA-SAMR. Conclusion: CA-MRSA was the leading cause of BJI and was associated with higher CRP on admission, later normalization and longer treatment duration. Complications as drainage requirement, and sequelae were common in those p.
Introducción: Las infecciones osteo-articulares (IOA) son relativamente comunes en los niños, siendo la infección por Staphylococcus aureus resistente a meticilina de la comunidad (SARM-Co) una de las más frecuentes. Objetivo: Evaluar los datos epidemiológicos, características clínicas, microbiológicas y de evolución en niños con IOA. Métodos: Estudio descriptivo prospectivo. Resultados: Se incluyeron 40 pacientes (p). Los cultivos fueron positivos en 30 p (75%). Se aisló SARM-Co en 19 p; S. aureus sensible a meticilina en 6 p; otros microorganismos en 5 p. La duración del tratamiento fue de 28 días Md (r: 21-40 d). En los p con cultivos positivos para SARM-Co, la PCR inicial fue mayor (Md 76 vs 50 mg/L, p < 0,02), la normalización se produjo después (Md 14 días vs 7 días, p < 0,03) y la duración del tratamiento (Md 32 días vs 23, p < 0,004), así como la estancia hospitalaria (Md 9 días vs 7, p = 0,12) fueron más prolongados. En la evolución 1 p recayó y 3 tuvieron secuelas; en todos se aisló SARM-Co. Conclusión: SARM-Co fue la causa más frecuente de las IOA y se asoció con mayor valor de PCR al ingreso, normalización tardía, mayor duración del tratamiento, y complicaciones.
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Osteomyelitis/microbiology , Staphylococcal Infections/microbiology , Anti-Bacterial Agents/pharmacology , Arthritis, Infectious/drug therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Microbial Sensitivity Tests , Methicillin-Resistant Staphylococcus aureus/drug effects , Osteomyelitis/drug therapy , Prospective Studies , Staphylococcal Infections/drug therapyABSTRACT
Objective To analyze and discuss the clinical value of tuberculosis infection T cell ELISPOT test and tuberculosis antibody test used in bone and joint tuberculosis.Methods The patients with suspected bone and joint TB diagnosed and treated in Xishan people's Hospital of Wuxi City from 2012 to 2014 were selected as the objects of this study.They were taken randomly,which divided into T-SPOT.TB test group and tuberculosis antibody test groups.Each group had 162 per-sons.The patients of T-SPOT.TB test group were tested by tuberculosis infection T cell enzyme-linked immunosorbent spot test,tuberculosis antibody test group were taken tuberculosis antibody test,comparative analysis of the sensitivity and speci-ficity of two diagnostic methods were contrastively analyzed.Results The sensitivity and specificity of T-SPOT.TB test group were 93.43% and 84.00%.The sensitivity and specificity of tuberculosis antibody in the experimental group were 40.44% and 53.85%.There was statistical difference between two groups (χ2 =184.62,7.86,all P <0.05).The false posi-tive rate and the false negative rate of T-SPOT.TB test group were 16.00% and 6.57%.The false positive rate and the false negative rate of tuberculosis antibodies in the experimental group were 26.92% and 59.56%,respectively.There was statis-tical difference between two groups (χ2 =7.86,156.18,all P <0.05).In addition,the positive and negative predictive values of T-SPOT.TB test group were 96.97% and 70.00%.Positive and negative predictive values of tuberculosis antibody in the experimental group were 88.71% and 14.74%.There was statistical difference between two groups (χ2 = 20.27,73.06,all P <0.01).Conclusion Compared to experimental tuberculosis antibody,TB infection of T cells ELISPOT test had high sen-sitivity and specificity in the diagnosis of bone and joint tuberculosis.It’s worthy of spreading.
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Purpose To investigate the clinicopathological changes of the diffuse-type giant cell tumor of the bone and joint. Methods 42 cases of the diffuse-type giant cell tumor of the bone and joint were studied and the follow-up data were reviewed. Results The male patients were 19 and the female were 23, with the male to female ratio of 1 ∶ 1. 2. The age of the patients was 8~69 years (the average age was 37. 6). It was displayed that the patients presented local pain and swelling (34 cases), including dysfunction (18 ca-ses) of the bone and joint. Clinically, the lesions located on the knee joint ( 71. 4%) in 30 cases, the hip and ankle in 9 cases (21. 4%), and the wrist elbow in 3 cases (7. 1%). 27 cases were examined by MRI. Among them, the diffuse-type giant cell tumor was diagnosed in 9 cases (33. 3%). The effusive lesions of the joint presented in 5 cases, the non-specific synovial lesions and others in 3 cases. The obviously diffuse hyperplasia of synovial cells with nodular growth pattern was found. However, a high proliferative in-dex of the tumor cells and the rich-cell tumor were found. But there was no tumor necrosis. Histopathologically, the tumor cells of dif-fuse-type giant cell tumor contained marked brown pigments, multinucleated giant cells formation and a lot of lymphocytes proliferation or follicular reaction in 17 cases (40. 5%) with invasive growth and involvement of the joint and surrounding tissue. 6 cases recurred (20%) , including 2 cases with 2 times. Conclusions The diffuse type-giant cell tumors most commonly involve the knee, followed by the hip and ankle. Preoperative examination of MRI can be help for the diagnosis of the tumor. Histopathologically, diffuse-type gi-ant cell tumor with synovial cells rich-hyperplasia and the villous structures formation more likely recur. The main biological character-istics of diffuse-type giant cell tumor are invasive growth pattern, usually into the soft tissue around the joints.
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Objective To understand the distribution and antimicrobial resistance of pathogens isolated from bone and joint infection sites of orthopedic patients,so as to provide reference for prevention and therapy of bone and joint infection.Methods 114 specimens from bone and joint infection sites of orthopedic patients between June 2010 and October 2013 were surveyed,pathogens and antimicrobial susceptibility of pathogens were analyzed.Results A total of 145 pathogenic isolates were obtained,62.07%(n=90)of which were gram-negative bacteria,34.48%(n=50)were gram-positive bacteria,2.07%(n=3)were Candida spp .,and 1 .38%(n =2)were anaerobic bacteria. The top 4 pathogens were Pseudomonas aeruginosa (20.69%),Staphylococcus aureus (12.41 %),Escherichia coli (11 .03 %),and Enterobacter cloacae (9.65%).These pathogens presented remarkable resistance.The resistant rate of Pseudomonas aeruginosa to ceftazidime was up to 40.00%;the resistant rates of Escherichia coli to com-pound sulfamethoxazole,ciprofloxacin and levofloxacin were all 100.00%.Conclusion Gram-negative bacteria are the major pathogens in orthopedic ward,the isolated strains are resistant to multiple antimicrobial agents.
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With the advances in surgical treatment, antibiotic therapy and the current resources for accurate diagnosis and differentiated approaches to each type of osteomyelitis, better results are being obtained in the treatment of this disease. After a careful literature review carried out by a multiprofessional team, some conclusions were made in order to guide medical approach to different types of osteomyelitis, aiming to obtain better clinical outcomes and reducing the social costs of this disease. Acute and chronic osteomyelitis are discussed, with presentation of the general epidemiological concepts and the commonly used classification systems. The main guidelines for the clinical, laboratory and imaging diagnosis of infections are discussed, as well as the guidelines for surgical and antimicrobial treatments, and the role of hyperbaric oxygen as adjuvant therapy.
Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Hyperbaric Oxygenation , Osteomyelitis/diagnosis , Osteomyelitis/therapy , Acute Disease , Chronic Disease , Combined Modality TherapyABSTRACT
Objective To investigate the effect of the role playing teaching method applied in clinical teaching of bone and joint. Methods Totally 100 clinical medicine undergraduates practiced in bone and joint department from 2010 to 2012 in our hospital were taken as research objects and were divided in to conventional group and substitution group in accordance with the admission order. Clinical teaching was used for 50 interns in conventional group while role playing teaching method was used for 50 interns in substitution group. Theoretical knowledge score,skill operation score,self-efficacy scores,teachers' satisfaction degree with the treatment and compliance of patient were observed and compared. SPSS 19.0 statistical software was used for data analysis and processing. Measurement data were analyzed by independent samples t test and enumeration data were analyzed by χ2 test. P<0.05 was considered statistically significant. All data were expressed as x±s. Results Theoretical knowledge score,skill operation score and self-efficacy score were (97.3 ± 3.6)points,(95.3 ± 3.3) points and (97.2 ± 5.3)points in substitution group while (86.5 ± 4.7)points,(81.6 ± 3.8)points and (82.4 ± 5.5)points in conventional group,with statistical differences (P<0.05). Satisfaction de-gree was 80.0%(40/50)in conventional group and 96.0%(48/50)in substitution group,with statisti-cal differences(P<0.05). Conclusions Role-playing method is feasible in bone and joint clinical teaching. It can effectively improve the interns' active learning capacity and skills to operate,promote patients' communication,improve patients' compliance and is simple to operate,therefore worthy of clinical application.
ABSTRACT
Objective To evaluate the distribution of pathogens causing bone and joint purulent infections and the bacterial resistance to antibiotics,and to provide reference of clinical antibiotic therapy.Methods A total of 514 patients who had bone and joint purulent infections in Department of Orthopedics of Shangrao People’s Hospital from Jan 2009 to Jun 2013 were retrospectively analyzed. Results 296 strains of Gram-negative bacteria were isolated,the infection rate was 47.2%,among which 296 strains of Escherichia coli were the most common infection pathogen,the infection rate was 15.6%,followed by Acinetobacter baumannii,Pseudomonas aeruginosa,and the infection rates were 11.8%,11.3%.331 strains of Gram-positive bacteria were isolated,the infection rate was 52.8%.Staphylococcus epidermidis,Staphylococcus aureus,were the common infection pathogens,following the infection rates were 21.5%,13.7%.Gram-negative bacteria had the highest sensitivity to imipenem,while Gram-positive bacteria had sensitivity to vancomycin.Conclusion Gram-positive bacteria is the main pathogens with bone and joint purulent infections.Selection of antibiotics according to the drug sensitive test has important clinical significance.