Trans-interlamina percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy using the new Delta system.

To describe the rationale and surgical technique and compare the clinical effect of posterior percutaneous endoscopic cervical discectomy (PPECD) using the Delta system versus that of conventional PPECD (key-hole) surgery for the treatment of symptomatic cervical spondylotic radiculopathy (CSR). A retrospective analysis was performed on 106 single-segment CSR patients between February 2016 and February 2017, 50 of whom underwent conventional PPECD (key-hole), and 56 underwent PPECD using the Delta system. The operative time, intraoperative blood loss, intraoperative complications and postoperative hospital stay were recorded, and the clinical effect was evaluated by the indicators of the Neck Disability Index (NDI), arm-visual analog scale (arm-VAS), neck-VAS, EQ-5D and MacNab classification at the last follow-up. All patients underwent the operation successfully, and 106 patients were followed up. The operative time of the Delta group was 60.47 ± 0.71 min, while the operative time of the key-hole group was 75.46 ± 0.41 min. The difference between the two groups was statistically significant (P < 0.05). However, there was no significant difference between the two groups in terms of blood loss and hospital stay (P > 0.05). The VAS, NDI and EQ-5D scores of the neck and upper limbs in the two groups were significantly better than those before surgery at 1 week after surgery and at the last follow-up (P < 0.05). However, there was no significant difference between the two groups at the last follow-up (P > 0.05). At the last follow-up, there was no significant difference between the two surgical methods when evaluated using the modified MacNab criteria. The imaging results showed that the herniated disc was removed completely and the nerve root was decompressed. The complication rate in the Delta group (3/56, 5.35%) was significantly lower than that in the conventional key-hole group (5/50, 10.0%). PPECD using the Delta system for CSR may be a feasible and promising alternative surgical plan. Compared with the traditional key-hole method, this surgical system can not only provide the surgeon with a larger surgical field of vision but also reduces the operation time and complication rates.

Serum Fibrinogen Test Performs Well for the Diagnosis of Periprosthetic Joint Infection.

BACKGROUND: Serum fibrinogen (FIB) is an acute-phase glycoprotein in the infection response that may stop excessive bleeding. The purposes of this study are to determine the value of FIB that can be used to differentiate between periprosthetic joint infection (PJI) and aseptic loosening of the prosthesis, and to determine the clinical significance of FIB for analyzing infection outcomes after first-stage surgery. METHODS: This retrospective study included 90 patients undergoing total knee arthroplasty or total hip arthroplasty revision from January 2015 to August 2019. PJI was confirmed in 53 patients (group A), and the other 37 patients were diagnosed with aseptic loosening of the prosthesis (group B). Only 21 patients in group A documented the results for serum FIB, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) after spacer insertion, so the postoperative serological marker levels of the these patients were also assessed. RESULTS: The FIB, CRP, and ESR levels were significantly higher in group A than in group B (P < .001). The area under the receiver operating characteristic curve was highest for FIB at 0.928. Analyses of FIB levels revealed a sensitivity of 79.25% and a specificity of 94.59%. FIB levels were significantly lower in patients with PJI after spacer insertion (P < .001). CONCLUSION: FIB is an adequate test to aid in diagnosing PJI, and it is not inferior to CRP and ESR in distinguishing between PJI and aseptic loosening of the prosthesis. It is an especially useful tool in assessing infection outcomes after first-stage surgery.

Risk Factors for Antibiotic-associated Diarrhea in Chinese Adult Patients:A Meta-analysis / 中国药房

OBJECTIVE:To evaluate the risk factors for antibiotic-associated diarrhea (AAD) in Chinese adult patients systematically,and to provide evidence-based reference in clinic. METHODS:Retrieved from CNKI,VIP,CBM,Wanfang database,PubMed and Embase,etc.,disease control studies about AAD risk factors of Chinese adult patients were collected.The retrieval time limit ranged from Jan. 2000 to Jan. 2018. Meta-analysis was performed by using Rev Man 5.2 software after data extraction and quality evaluation of included literatures with NOS scale. RESULTS:A total of 14 literatures were included, involving 20 914 patients. The result of Meta-analysis showed that age ≥65 years [OR＝2.36,95%CI(1.99,2.79),P＜0.001], fasting [OR＝4.65,95%CI(3.79,5.69),P＜0.001],use of acid suppressant [OR＝5.82,95%CI(3.77,8.98),P＜0.001],serum albumin ≤30 g/L [OR＝2.40,95%CI(2.00,2.88),P＜0.001],invasive operation [OR＝3.95,95%CI(3.03,5.15),P＜0.001], stay in ICU [OR＝2.93,95%CI(2.38,3.60),P＜0.001],hospitalization time ≥10 d [OR＝4.08,95%CI(3.31,5.03),P＜0.001], antibiotic species ≥3 kinds [OR＝1.98,95%CI(1.56,2.51),P＜0.001] and duration of antibiotics use ≥10 d [OR＝6.16,95%CI (3.22,11.76),P＜0.001] were significantly correlated with the occurrence of AAD. CONCLUSIONS:Age ≥65 years,fasting, use of acid suppressant,serum albumin ≤30 g/L,invasive operation,stay in ICU,time of hospitalization ≥10 d,antibiotic species≥3 kinds and duration of antibiotics use≥10 d are risk factors for AAD in Chinese adult patients.

High-affinity glutamate transporters and chronic pain / 中南大学学报(医学版)

Glutamate serves as a major excitatory neurotransmitter in the mammalian central nervous system and is stored in synaptic deft by an uptake system that is dependent on the high-affinity glutamate transporters (ETTAs),which locate in the plasma membrane of glial cells and neurons.ETTAs can rapidly terminate the action of glutamate and maintain its normal physiological functions.If the content or function of glutamate transporters is abnormal,it can result in many physiological dysfunctions.Studies have demonstrated that high-affinity glutamate transporters play an important role in the development of chronic pain,which might be a new therapeutic target for the pain.