RESUMEN
Objective:To evaluate the effect of goal-directed hemodynamic management of muscle oxygen saturation (SmO 2) on the postoperative renal function in hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors. Methods:Eighty-six essential hypertension patients, aged 18-64 yr, with body mass index ≤ 30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective laparoscopic radical gastrectomy for gastrointestinal tumors under general anesthesia, were divided into 2 groups ( n=43 each) using a random number table method: routine group (group C) and SmO 2 goal-directed group (group S). The fluctuation of mean arterial pressure (MAP) and heart rate (HR) were maintained < 20% of the preoperative baseline value by adjusting infusion speed and vasoactive drugs in group C. SmO 2 was maintained not less than 70% or not less than the baseline value by evaluating cardiac output (CO), HR, stroke volume, stroke volume variation, systemic vascular resistance index and MAP and by adjusting infusion rate and vasoactive drugs in group S. SmO 2, HR, MAP, CO, cardiac index (CI), stroke volume variation and systemic vascular resistance index were recorded before anesthesia induction (T 0, baseline value), at the beginning of surgery (T 1), at 40 min after the start of pneumoperitoneum (T 2), at 5 min after the end of pneumoperitoneum (T 3), and at the end of surgery (T 4). The glomerular filtration rate was measured before surgery and at 24 h after surgery, and the occurrence of decline in postoperative acute renal function was recorded.Intraoperative hypotension, fluid input and output, postoperative tracheal extubation time, length of hospital stay, occurrence of acute kidney injury and transfer to ICU, and the Quality of Recovery-15 scale score at 24 h after operation were recorded. Results:Compared with group C, SmO 2 at T 1-3 and CO and CI at T 3 were significantly increased, SVRI at T 2-4 was decreased, the intraoperative infusion volume and urine volume were increased, the glomerular filtration rate and Quality of Recovery-15 scale score were increased at 24 h after surgery, the incidence of decline in acute renal function was decreased ( P<0.05), and no significant change was found in the incidence of intraoperative hypotension, blood loss, postoperative extubation time, length of hospital stay, incidence of acute kidney injury and rate of transfer to ICU in group S ( P>0.05). Conclusions:SmO 2 goal-directed hemodynamic management can reduce the development of decline in postoperative acute renal function and improve the quality of postoperative recovery of hypertensive patients undergoing laparoscopic radical gastrectomy for gastrointestinal tumors.
RESUMEN
Objective:To explore the clinical outcomes of articulating spacers in the treatment of chronic knee periprosthetic joint infection (PJI).Methods:A retrospective study was conducted of the 38 patients who had undergone stage-two revision for chronic knee PJI from January 2014 to January 2020 at Department of Articular Surgery, The First Affiliated Hospital to Fujian Medical University. They were 8 men and 30 women, aged from 37 to 84 years (average, 66.2 years). The PJI was unilateral in all, affecting 19 left sides and 19 right sides. According to the kind of spacers used in the stage-one revision, they were divided into 3 groups: metal-polyethylene one (10 cases), metal-cement one (15 cases) and cement one (13 cases). In the stage-two revision following infection control, the spacers were removed for sonication and microbial culture. Infection control, range of motion (ROM), Knee Society Score (KSS), and complications were followed up.Results:The 38 patients were followed up for an average of 30.8 months (from 13 to 75 months). All patients underwent spacer implantation at stage-one revision and infection was controlled in 37 of them (97.4%, 37/38). After stage-one revision, metal-polyethylene, metal-cement and cement groups achieved 95.0°±11.3°, 92.9°±8.3° and 75.5°±11.9° in ROM, 79.4±6.1, 77.3±4.0 and 73.0±7.2 in clinical KSS and 67.5±11.8, 69.0±10.4 and 60.8±11.0 in functional KSS, showing significant improvements in the above indexes between preoperation and postoperation ( P<0.05). The ROMs for the metal-polyethylene and metal-cement groups were significantly better than for the cement group ( P<0.05). A total of 32 patients completed stage-two revision, with 7 in the metal-polyethylene group, 12 in the metal-cement group and 13 in the cement group. Respectively, ROMs after stage-two revision were 104.6°±9.8°, 98.5°±8.7° and 86.1°±8.9°, clinical KSSs 85.3±4.6, 82.7±4.3 and 78.0±4.8 and functional KSSs 78.6±6.9, 77.3±8.2 and 69.5±8.3 for the metal-polyethylene, metal-cement and cement groups, showing significant improvements after stage-one revision ( P<0.05). The postoperative sonication fluid culture showed negative results in all. Conclusions:Articulating spacers can effectively control knee PJI and improve the knee function during revision interval and after revision. Metal spacers may lead to a better range of motion than traditional cement ones.
RESUMEN
Objective:To investigate whether the prophylactic use of a dose of sensitive antibiotics before revision for periprosthetic joint infection (PJI) may affect the positive rate of intraoperative specimen culture.Methods:This prospective study recruited the patients who underwent revision due to PJI from July 1, 2017 to February 1, 2019 at Department of Orthopaedics, The First Affiliated Hospital to Fujian Medical University. After use of antibiotics was stopped in all patients for 2 weeks before operation, synovial fluid was extracted for culture to confirm pathogenic bacteria and drug sensitivity and some/all of the prostheses were removed during operation. According to their sequence number of admission, the patients were randomly divided into group A and group B. Samples were taken in group A after a dose of sensitive antibiotics was administered 30 to 60 minutes before revision while a dose of sensitive antibiotics was given in group B after all samples were taken. Intra-operatively, synovial fluid, tissue grinding fluid (TGF) and ultrasonic prosthesis lysate (UPL) were taken for aerobic and anaerobic culture. According to whether there was a positive culture of at least one microbiological specimen, the preoperative and intraoperative culture results were analyzed and compared between the 2 groups.Results:A total of 32 PJI patients were included in this study due to positive culture of synovial fluid before operation, with 16 cases in group A and 16 in group B. The most common infection bacteria were staphylococci (59.3%, 19/32). There was no significant difference in age, gender, mode of operation, Tsukayama classification, prosthesis removal, preoperative ESR, CRP, synovial fluid white blood cell count (SF-WBC) or polymorphonuclear cell percentage (PMN) between the 2 groups. The positive rates of synovial fluid, tissue, TGF and UPL were 81.3% (13/16), 62.5% (10/16), 93.8% (15/16) and 93.8% (15/16) for group A, and 87.5% (14/16), 68.8% (11/16), 93.8% (15/16) and 100.0% (16/16) for group B, showing insignificant differences between the 2 groups ( P>0.05). The positive rates of TGF and UPL culture showed no significant difference between them in group A or in group B ( P>0.05), but they were significantly higher than those of traditional tissue culture ( P<0.05). Conclusions:As prophylactic use of antibiotics before PJI revision may not affect the positive rate of intraoperative specimen culture, it is not necessary to postpone use of prophylactic antibiotics before PJI revision. Furthermore, as positive rates of TGF and UPL culture are similar but significantly higher than those of traditional tissue culture, tissue grinding can be used to improve the positive rate of tissue culture.
RESUMEN
Objective:To explore whether MRI WARP sequence can provide clearer musculoskeletal images to guide the operation for patients with periprosthetic joint infection (PJI) by comparing MRI WARP sequence images with conventional sequence images.Methods:The data were analyzed retrospectively of 23 PJI patients who had been diagnosed and treated at Department of Orthopedics, The First Affiliated Hospital to Fujian Medical University from January 2020 to February 2021. They were 13 females and 10 males, with an average age of 62.8 years (from 32 to 88 years). According to the MRI sequences, they were divided into a WARP group ( n=14) subjected to MRI scanning by WARP sequence and a conventional group ( n=9) subjected to MRI scanning by conventional sequence. The gender, age, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) were recorded for both groups. The signal-to-noise ratios were compared between the 2 sequences and 2 experts evaluated the clarity and surgical guidance of the images. Results:There was no significant difference in gender, age, CRP or ESR between the 2 groups, showing comparability ( P>0.05). The 2 experts showed consistency in evaluation of image sharpness and surgical guidance ( P<0.05). The WARP group was significantly better than the conventional group in image sharpness score [2.25(2.0, 2.6) versus 1.00 (0.5, 1.0)], surgical guidance score [2.00(1.5, 2.5) versus 0.50(0, 0.8)], and signal-to-noise ratio [47.28 (32.8, 74.3) versus 21.67(13.5, 31.4)] ( P<0.05). Conclusion:MRI WARP sequence can provide clearer musculoskeletal images than conventional MRI sequence to better guide the operation for PJI patients.
RESUMEN
Objective:To investigate the value of metagenomic Next-Generation Sequencing (mNGS) in etiological diagnosis of osteoarticular nontuberculous mycobacterial (NTM) infection.Methods:From January 2014 to October 2019, 119 patients were definitely diagnosed as osteoarticular infection at Department of Bone Tumor & Joint Surgery, The First Affiliated Hospital to Fujian Medical University. All of them underwent conventional culture followed by mNGS to screen out those with NTM infection by the etiological testing. Optimized culture was conducted for NTM infections. Demographic data, and results of conventional culture, mNGS and optimized culture were recorded for patients with NTM infection.Results:mNGS showed that 12 of the 119 patients with osteoarticular infection (12/119, 10.1%) had NTM infection. They were 6 males and 6 females aged from 31 to 82 years(average, 51.1 years). There were 5 cases of slowly-growing mycobacterial type and 7 cases of rapidly-growing mycobacterial type. The positive rate of primary culture was only 16.7% (2/12) by the conventional culture, but increased to 66.7% (8/12) by the optimized culture. The positive rate of optimized culture was 100% (7/7) for the rapidly-growing mycobacterial type and 20% (1/5) for the slowly-growing mycobacterial type.Conclusion:As the positive rate of conventional culture is low for patients with osteoarticular NTM infection, mNGS is superior due to its advantage in accurate etiological diagnosis, especially for that of rapidly-growing mycobacterial type.
RESUMEN
Objective:To analyze the clinical efficacy of two-stage total hip arthroplasty in the treatment of chronic septic hip arthritis.Methods:From January 2008 to March 2020, 17 patients with chronic septic hip arthritis (17 hips) received two-stage total hip arthroplasty at Department of Orthopaedic Surgery, The First Affiliated Hospital to of Fujian Medical University. They were 11 males and 6 females, with an average age of 54.5 years (from 19 to 77 years) and 9 left and 8 right hips affected. There were 10 cases of primary septic hip and 7 cases of secondary infection after hip surgery. Three patients had undergone debridement in other hospitals and one patient had developed a sinus tract. In the first stage operation, the diseased femoral head and neck were resected to implant an articulating spacer after thorough debridement; in the second stage operation, the spacer was removed to implant a uncemented artificial hip prosthesis in 16 cases or a cemented artificial hip prosthesis in one case. Recorded were the results of microbial culture, operation time, intraoperative blood loss, and therapeutic outcomes of the patients.Results:Pathogenic data were available in 13 patients and the culture was negative in 4. The pathogens were detected by metagenomic next-generation sequencing in 2 patients with culture negative. In the first stage operation, operation time averaged 140.6 min (from 90 to 176 min) and intraoperative blood loss 361.8 mL(from 100 to 1 000 mL); in the second stage operation, operation time averaged 130.3 min (from 91 to 166 min)and blood loss 291.2 mL(from 50 to 700 mL). The average interval between the first and the second stage operations was 115.0 days(from 66 to 227 d). During the interval, spacer fracture occurred in one case, spacer dislocation in one case and lower extremity deep venous thrombosis in one case. All the patients were followed up for 12 to 82 months (average, 36.7 months) after second stage operation. The inflammatory indexes decreased to normal in all the 17 patients and infection recurrence was observed in none of them.Conclusions:Two-stage total hip arthroplasty may result in a high rate of successful treatment of chronic septic hip arthritis. Specific use of sensitive antibiotics after identification of specific pathogenic microorganisms by multiple methods is the key to a successful treatment.
RESUMEN
Objective:To study the clinical significance of bilateral asymmetric signs of lungs of bedside ultrasound in order to improve the diagnosis and treatment of pulmonary diseases and protocol of pulmonary ultrasound.Methods:The ultrasound imaging data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Qingdao University from September 2017 to May 2019 were retrospectively analyzed. The clinical data of patients were collected, and the lung ultrasound image data and clinical diagnosis were sorted and analyzed.Results:A total of 535 critical patients ultrasound imaging data were reviewed, and 469 patients who were unable to obtain clear lung ultrasound images and lung symmetry signs were excluded. Finally, a total of 66 patients with ultrasound bilateral lung asymmetry signs during hospitalization were enrolled in the analysis. Seventeen patients (25.76%) had pneumothorax with unilateral pleural slide or lung spot, 12 (18.18%) had pneumonia with unilateral focal B line, fragment sign and tissue like sign, 21 (31.82%) had unilateral pleural effusion with unilateral liquid dark area, 8 (12.12%) had sputum obstruction with unilateral local lung consolidation and bronchial filling sign with atelectasis, and 5 (7.58%) had deep tracheal intubation. The above ultrasonic diagnoses were confirmed by chest X-ray, chest CT, fiberoptic bronchoscopy and laboratory examination. One patient with unilateral focal B-line was transferred to another hospital for treatment, and 2 patients died of sudden death due to disappearance of unilateral pleural sliding sign or unilateral pulmonary pulsation sign. The clinical diagnosis was not clear (4.54%).Conclusion:The asymmetric signs of pulmonary ultrasound clearly indicate the existence of pulmonary diseases that need to be treated in a timely manner, and the pulmonary ultrasound examination protocol of bilateral contrast is helpful for clinical diagnosis.
RESUMEN
Objective@#To investigate and compare the capability of metagenomic next-generation sequencing (mNGS) in detecting pathogens and diagnosing of periprosthetic joint infection (PJI) from synovial fluid and sonicate fluid of patients who underwent revision arthroplasty.@*Methods@#Thirty-five consecutive patients who underwent revision arthroplasty from May 2018 to November 2018 were included prospectively. There were 22 males and 13 females, 11 hip revisions and 24 knee revisions. All the patients were divided into the PJI group and aseptic loosening (AL) group. Synovial fluid and sonicate fluid of the explanted prostheses were obtained for microbiological culture and mNGS tests. Periprosthetic tissues were only collected for culture. Synovial fluid of three patients undergoing primary arthroplasty been treated by sonication as the negative control group concurrently. Comparisons of microbiological results and diagnostic value from mNGS and culture tests were performed.@*Results@#In the 13 culture-positive PJI patients, mNGS results of synovial fluid were positive in 12 cases, while culture and mNGS results were completely consistent at species level in 7 cases, consistent at the genus level in 1 case. mNGS results of sonicate fluid were positive in 13 cases, while culture and mNGS results were completely consistent at species level in 9 cases, consistent at the genus level in 1 case. In 7 culture-negative PJI patients, 6 cases had consistent mNGS results at species level both from synovial fluid and sonicate fluid, however, one case had positive mNGS result only from sonicate fluid. All culture results and mNGS results of synovial fluid were negative in all 15 AL patients, however, mNGS results of sonicate fluid was positive in 1 AL case. Cultures and mNGS results were negative in all three pairs of negative-control samples. In all 70 samples, mNGS detected 24 pathogens in sonicate fluids and 22 pathogens in synovial fluids. There was no significant difference in number of raw reads and human reads ratio between mNGS of sonicate fluid and synovial fluid. mNGS of sonicate fluid generated significantly higher number of microbial reads and of stringently mapped reads of pathogen in species-level than that of synovial fluids. There was no significant difference in diagnostic sensitivity of PJI between mNGS of sonicate fluids and synovial fluids (90.0% vs 100.0%). Both of them were significantly higher than that of culture of synovial fluid, periprosthetic tissues. Diagnostic sensitivity of sonicate fluid mNGS was not significantly higher than that in culture of sonicate fluid (65%). The specificities were similar among various microbiological testing methods.@*Conclusion@#mNGS of either synovial fluid or sonicate fluid from patients who underwent revision arthroplasty can be used to detect the presence of pathogens effectively and diagnose PJI accurately. mNGS can identify more pathogens and generate a higher number of pathogenic reads from sonicate fluids than synovial fluid. mNGS of synovial fluids has met the clinical diagnostic demands for most PJI patients. mNGS of sonicate fluid could be applied in some cases.
RESUMEN
Objective@#To investigate the urodynamic characteristics and clinical significance of bladder function in patients with parkinsonism dominant multiple system atrophy (MSA-P) with abnormal urination. @*Methods@#The clinical data of 58 patients with multiple system atrophy (MSA) and urinary dysfunction who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018 were analyzed. The bladder function status of MSA-P patients was evaluated, and the characteristics of urinary motility examination results were analyzed. @*Results@#According to the diagnostic criteria, 51 patients were MSA, and seven patients were suspicious, all diagnosed as MSA-P. All MSA-P patients had abnormal urination with different symptoms, including dysuria (77.6%), frequent urination (62.1%), urgency (62.1%), urinary incontinence (65.5%), urinary retention (12.1%). Of the MSA-P patients with abnormal urination, the maximum flow rate (Qmax) was (12.46±2.85) ml/s, the average flow rate (Qave) was (5.19±2.06) ml/s, the voided volume was (171.73±11.47) ml, postvoid residual urine was (136.15±10.47) ml, maximal detrusor pressure was (20.78±3.55) cmH2O, bladder compliance was (16.59±2.91) ml/cmH2O, normal desire to void was (223.64±11.02) ml, and maximal capacity was (287.57±12.51) ml. The Qmax, Qave, voided volume, maximal detrusor pressure, bladder compliance, normal desire to void, and maximal capacity of patients with MSA-P with abnormal urination were significantly decreased, while the bladder residual urine volume was significantly increased, with statistically significant differences compared to normal reference values (P<0.05). @*Conclusion@#The urinary motility of bladder function in patients with MSA-P and urinary abnormalities is mainly characterized by decreased bladder compliance and detrusor dysfunction, while urodynamic testing is helpful for early diagnosis.
RESUMEN
Objective To investigate and compare the capability of metagenomic next?generation sequencing (mNGS) in detecting pathogens and diagnosing of periprosthetic joint infection (PJI) from synovial fluid and sonicate fluid of patients who un?derwent revision arthroplasty. Methods Thirty?five consecutive patients who underwent revision arthroplasty from May 2018 to November 2018 were included prospectively. There were 22 males and 13 females, 11 hip revisions and 24 knee revisions. All the patients were divided into the PJI group and aseptic loosening (AL) group. Synovial fluid and sonicate fluid of the explanted pros?theses were obtained for microbiological culture and mNGS tests. Periprosthetic tissues were only collected for culture. Synovial fluid of three patients undergoing primary arthroplasty been treated by sonication as the negative control group concurrently. Com?parisons of microbiological results and diagnostic value from mNGS and culture tests were performed. Results In the 13 culture? positive PJI patients, mNGS results of synovial fluid were positive in 12 cases, while culture and mNGS results were completely consistent at species level in 7 cases, consistent at the genus level in 1 case. mNGS results of sonicate fluid were positive in 13 cas?es, while culture and mNGS results were completely consistent at species level in 9 cases, consistent at the genus level in 1 case. In 7 culture?negative PJI patients, 6 cases had consistent mNGS results at species level both from synovial fluid and sonicate fluid, however, one case had positive mNGS result only from sonicate fluid. All culture results and mNGS results of synovial fluid were negative in all 15 AL patients, however, mNGS results of sonicate fluid was positive in 1 AL case. Cultures and mNGS results were negative in all three pairs of negative?control samples. In all 70 samples, mNGS detected 24 pathogens in sonicate fluids and 22 pathogens in synovial fluids. There was no significant difference in number of raw reads and human reads ratio between mNGS of sonicate fluid and synovial fluid. mNGS of sonicate fluid generated significantly higher number of microbial reads and of stringent?ly mapped reads of pathogen in species?level than that of synovial fluids. There was no significant difference in diagnostic sensitivi?ty of PJI between mNGS of sonicate fluids and synovial fluids (90.0% vs 100.0%). Both of them were significantly higher than that of culture of synovial fluid, periprosthetic tissues. Diagnostic sensitivity of sonicate fluid mNGS was not significantly higher than that in culture of sonicate fluid (65%). The specificities were similar among various microbiological testing methods. Conclusion mNGS of either synovial fluid or sonicate fluid from patients who underwent revision arthroplasty can be used to detect the pres?ence of pathogens effectively and diagnose PJI accurately. mNGS can identify more pathogens and generate a higher number of pathogenic reads from sonicate fluids than synovial fluid. mNGS of synovial fluids has met the clinical diagnostic demands for most PJI patients. mNGS of sonicate fluid could be applied in some cases.
RESUMEN
BACKGROUND:The living standard of farmers and herdsmen in Xinjiang Uygur Autonomous Region, China is significantly lower than that of urban residents in general. Meanwhile, the shortage of doctors and medicines and lack of medical knowledge are the main reasons for local farmers and herdsmen to suffer from knee osteoarthritis. Most of the farmers and herdsmen are not aware of or prevent knee osteoarthritis in the early days to remove pathogenic factors, which results in a serious condition at the time of their medical treatment. OBJECTIVE: To investigate the main pathogenic factors of knee osteoarthritis in Uygur, Kazakh and Han populations in pastoral areas of northern Xinjiang Uygur Autonomous Region, China.METHODS:The permanent residents of Uygur, Kazakh and Han ethnic groups in northern Xinjiang, China who met the criteria were selected by the method of stratified, multistage and cluster random sampling during June 2012 to October 2014. The investigation of knee osteoarthritis was conducted among al the residents who meet the inclusion criteria using the method of home scene closed questionnaire. X-ray lateral plain film examination of the knee joint was performed among the patients presenting with the symptoms of knee osteoarthritis. The database was established. The multi-factor and unconditional Logistic regression analysis was conducted among the 40 variables using SPSS 20.0 software. RESULTS AND CONCLUSION:The 3 402 of 3 540 questionnaires were valid. The Logistic regression analysis suggest that the common pathogenic factors in Han, Uygur and Kazakh ethnic groups are associated with older ages, female gender, high body mass and drink alcohol. Smoking, history of internal disease, high education level, standing position, climbing, trauma, family history, fried food, housing conditions and amenorrhea, different nationalities, churchgoing of ethnic minorities are also the major risk factors. Among the three ethnic groups, the prevalence of female patients in Uygur and Kazak ethnic groups is significantly higher than that of Chinese Han nationality. The morbidity is different among these three nationalities. The dietary preferences cannot be determined as the related influencing factor of knee osteoarthritis. Whether the means of transportation, residence climate and environment, the number of pregnancies and deliveries, drinking tea or not, the type of tea are related to knee osteoarthritis remains unclear.