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OBJECTIVE@#To systematically evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) as second-line drugs for the treatment of convulsive status epilepticus (CSE) in children.@*METHODS@#English and Chinese electronic databases were searched for the randomized controlled trials comparing the efficacy and safety of LEV and PHT as second-line drugs for the treatment of childhood CSE. RevMan 5.3 software was used for data analysis.@*RESULTS@#Seven studies with 1 434 children were included. The Meta analysis showed that compared with the PHT group, the LEV group achieved a significantly higher control rate of CSE (@*CONCLUSIONS@#LEV has a better clinical effect than PHT in the treatment of children with CSE and does not increase the incidence rate of adverse events.
Assuntos
Criança , Humanos , Anticonvulsivantes/efeitos adversos , Levetiracetam/uso terapêutico , Preparações Farmacêuticas , Fenitoína/efeitos adversos , Estado Epiléptico/tratamento farmacológicoRESUMO
Objective To investigate the effect of dynamic regulation of negative pressure values in vacuum sealing drainage (VSD) on healing of soft tissue wounds.Methods From January 2013 to December 2015,115 patients were treated at our institute for open soft tissue defects of Gustilo-Anderson type ⅢaⅢc.They were 69 males and 46 females,aged from 17 to 76 years (average,44.7 years).They were divided into 4 groups to be subjected to different negative pressure values.Group A (n =29) was subjected to negative pressure values from-40 to-20 kPa,group B (n =29) to values from-80 to-60 kPa,group C (n =29) to values from-40 to-20 kPa for the first 72 hours followed by values from-80 to-60 kPa,and group D (n =28) to values from-60 to-80 kPa for the first 72 hours followed by values from-40 to -20 kPa.The 4 groups were compared in terms of drainage volume,wound shrinking,cleaning time,healing time and complications.Results The drainage volumes on the 7th day in groups B and D (4.89 ± 0.66 mL/cm2 and 4.33 ± 0.96 mL/cm2) were significantly higher than those in groups A and C (2.90 ± 0.67 mL/cm2 and 2.99 ±0.56 mL/cm2);the wound shrinking areas on the 14th day in groups B and D (14.16 ± 1.77 cm2 and 13.84 ± 1.65 cm2) were significantly larger than in groups A and C (12.57 ± 1.92 cm2 and 10.95 ± 1.37 cm2) (P ＜ 0.05).The cleaning time in group A was significantly longer than in the other 3 groups (P ＜ 0.05).The healing time in groups A and C was longer than in groups B and D (P ＜ 0.05).The incidences of pain in groups B and C were significantly higher than in groups A and D (P ＜ 0.05).The incidences of infection and blocking in group A were higher than in the other 3 groups (P ＜ 0.05).Conclusion Dynamic regulation of negative pressure values from-80 to-60 kPa for the first 72 hours followed by values from-40 to-20 kPa is an optimal choice for VSD management of soft tissue defects due to adequate drainage,obvious wound shrinking,quick cleaning and healing,and limited complications.
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BACKGROUND: Current commonly used bone graft materials include cancellous bone or bone blocks from ilium, tibia, fibula and others. There is no report of bone graft and fusion in cervical spine from manubrium sterni. OBJECTIVE: To measure lateral X-ray of cervical vertebrae with no degeneration and manubrium sterni samples to explore feasibility of autologous cancellous bone graft of manubrium sterni with pyramesh in anterior cervical spinal fusion surgery, so as to develop a new source of autogenous bone graft.METHODS: A total of 40 manubrium sterni specimens were selected and the length, maximum width and minimum width, thickness, anterior and posterior cortex thickness of manubrium sterni were measured. Manubrium sterni area was calculated: the length, maximum width and minimum width were 4 mm reduced from those of manubrium sterni, its thickness was 2 mm reduced from that of manubrium sterni. The formula of measuring the manubrium sterni volume is (maximum width of manubrium sterni + the minimum width of manubrium sterni)×length of manubrium sterni × thickness of manubrium sterni×1/2. Intervertebral height and vertebral height from C2 to C7 were measured from lateral cervical radiograph of 106 patients with cervical radiolopathy, and the length of pyramesh needed in anterior cervical spinal surgery for one, two, three discs resection, one vertebra plus two discs resection and two vertebrae plus three discs resection was calculated. RESULTS AND CONCLUSION: The manubrium sterni volume was (17 735.51±5 234.92) mm3 and the volume of bone-grafting area was (8 982.83±2 427.76) mm3. The length of pyramesh and volume of bone used in operation were minimal for one disc resection, and maximal for two vertebrae plus three discs resection. The volume of bone graft in the pyramesh was significantly less than the donor area in any anterior cervical spinal fusion operation. Results show that autologous cancellous graft of manubrium sterni combined with pyramesh supporting can be used in anterior cervical spinal fusion surgery. Compared with autologous iliac graft, this method is simpler and does not influence early functional exercise or walking bearing weight.
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BACKGROUND: During thoracolumbar anterior operation, implant collapse is an important factor for affecting outcome in patients with thoracolumbar fracture. In particular, osteoporotic patients commonly developed implant collapse, nail channel loose, bone disunion, kyphosis deformation. Bioactive artificial vertebrae of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) has good biocompatibility and biological safety and is an ideal substitute for vertebral body bone graft. OBJECTIVE: To investigate the efficacy of the bioactive artificial verteificial vertebrae of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) for osteoporotic thoracolumbar burst fracture. DESIGN, TIME AND SETTING: A retrospective case analysis was conducted at the Department of Spinal Surgery, Affiliated Hospital of Luzhou Medical College from January 2004 to January 2008. PARTICIPANTS: A total of 20 patients with moderate and severe osteoporotic thoracolumbar fracture (6 males and 14 females) aged 51 -82 years, with an average of 69 years were enrolled in this study. There were 17 cases of fresh fracture and 3 cases of old fracture. n-HAyPA66 was produced by the Sichuan Guona Science and Technology Co., Ltd. This artificial vertebral body was in 10-35 mm diameter, 30-100 mm length, circular cylinder shape, 3-12 mm midheaven diameter, 2.5-6.5 mm tubal wall thickness, with the presence of 2 mm holes surrounding the vertebral body. The contact area of the vertebral body was 78.5-176.7 mm2. Fixity was anterior nail plate system (titanium alloy material) produced by Foshan Shitaibao Company. METHODS: Following conventional tracheal intubation and general anesthesia, at right arm recumbent, according to various fracture-involved segments, different regions were incised and treated with anterior decompression, implanted with artificial vertebrae with the bioactive artificial verteificial vertebrae n-HA/PA66 and fixed with steel plate. MAIN OUTCOME MEASURES: Fracture healing and implant loose were observed by radiograph. Cobb angle, the height of damaged vertebral body and spinal cord function score were compared prior to surgery, 3 months following surgery and the last follow-up. RESULTS: All the patients were successfully operated. Bleeding 200-800 mL during surgery and operation time ranged from 2.0 to 3.0 hours. There were 1 case of pulmonary infection and 1 case of delayed wound healing. A total of 20 patients were followed up for 6-42 months (averagely 18 months). Postoperative radiograph review demonstrated that closed vertebral body was healed three to four months. No significant displacement of implant was found. There was less loss of reestablished vertebral body height. Internal fixation position was good, without nail breakdown or internal fixation loose/displacement. At 3 months following surgery, significant differences in Cobb angle, the height of damaged vertebral body and spinal cord function score were detected compared with that before surgery (P < 0.05). No significant difference in postoperative two follow-up was detected (P > 0.05). CONCLUSION: The bioactive artificial vertebrae of n-HA/PA66 can increase the fusion area, reduce local pressure and prevent loosening of implants and sinking into the vertebrae, finally resulting in restoration of vertebral body height.