The application of topical antibiotics for the prevention of infections in primary joint arthroplasty. An umbrella review of systematic reviews and meta-analysis.

This umbrella review aim to explore the effect of topical antibiotics in infection prevention after primary joint arthroplasty, and provide a specific theoretical basis for clinical treatment. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE, Medline, and the Cochrane Library on infection prevention by topical antibiotics from inception to 10 April 2023. The two researchers individually and strictly screened the literature according to the inclusion and exclusion criteria, performed the literature quality evaluation and data extraction, and used Stata 17 for data analysis. This study included six studies with one systematic review and five meta-analyses. The pooled analysis showed that topical antibiotic administration effectively reduced the incidence of overall infection and periprosthetic joint infection. However, it does not reduce the risk of superficial infection. Besides, the topic of antibiotics significantly increases the incidence of other sterile complications of the incision. According to the current evidence, topical application of antibiotics can reduce the incidence of overall infection and periprosthetic joint infection after primary joint arthroplasty. Although it increases the incidence of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision making. However, they should not be discarded due to side effects.

Association between ultrasound BI-RADS signs and molecular typing of invasive breast cancer.

Objective: To explore the correlation between ultrasound images and molecular typing of invasive breast cancer, so as to analyze the predictive value of preoperative ultrasound for invasive breast cancer. Methods: 302 invasive breast cancer patients were enrolled in Heping Hospital affiliated to Changzhi Medical College in Shanxi, China during 2020 to 2022. All patients accepted ultrasonic and pathological examination, and all pathological tissues received molecular typing with immunohistochemical (IHC) staining. The relevance between different molecular typings and ultrasonic image, pathology were evaluated. Results: Univariate analysis: among the four molecular typings, there were significant differences in tumor size, shape, margin, lymph node and histological grade (P<0.05). 1. Size: Luminal A tumor was smaller (69.4%), Basal -like type tumors are mostly larger (60.9%); 2. Shape: Basal-like type is more likely to show regular shape (45.7%); 3. Margin: Luminal A and Luminal B mostly are not circumscribed (79.6%, 74.8%), Basal -like type shows circumscribed(52.2%); 4. Lymph nodes: Luminal A type tends to be normal (87.8%), Luminal B type,Her-2+ type and Basal-like type tend to be abnormal (35.6%,36.4% and 39.1%). There was no significant difference in mass orientation, echo pattern, rear echo and calcification (P>0.05). Multivariate analysis: Basal-like breast cancer mostly showed regular shape, circumscribed margin and abnormal lymph nodes (P<0.05). Conclusion: There are differences in the ultrasound manifestations of different molecular typings of breast cancer, and ultrasound features can be used as a potential imaging index to provide important information for the precise diagnosis and treatment of breast cancer.

Correlation analysis between rim enhancement features of contrast-enhanced ultrasound and lymph node metastasis in breast cancer.

OBJECTIVE: To explore the correlation between rim enhancement features of contrast-enhanced ultrasound and lymphatic metastasis, and to provide theoretical support for clinical treatment of breast cancer. METHODS: 387 breast cancer patients (748 axillary lymph nodes in total) treated in our hospital from January 2017 to January 2020 were selected and analyzed by contrast-enhanced ultrasound. Pathological examination showed that 540 axillary lymph nodes showed metastasis whereas 208 axillary lymph nodes did not show metastasis. Univariate analysis and Logistic stepwise regression were used to analyze the correlation between rim enhancement features of contrast-enhanced ultrasound and axillary lymph node metastasis of breast cancer. RESULTS: Peripheral halo, peripheral convergence, rim enhancement, enhancement mode, enhancement amplitude, enhancement sequence, expansion after enhancement, peak intensity, time to peak, area under curve, thrombolysis in myocardial infarction, perfusion sequence, aspect ratio, and maximum cortical thickness were all related to lymph node metastasis of breast cancer by univariate analysis, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that enhancement mode, enhancement amplitude, extension after enhancement, maximum cortical thickness, peak intensity and time to peak were all related to lymph node metastasis of breast cancer. CONCLUSION: Rim enhancement features of contrast-enhanced ultrasound of breast cancer are related to lymph node metastasis, which will provide a guidance for clinical treatment of breast cancer.

Long-term results for traumatic sternoclavicular joint dislocation treated with a sternoclavicular joint-specific plate.

BACKGROUND: The treatment of traumatic sternoclavicular joint (SCJ) dislocation (SCJD) with internal fixation has been reported with good short-term results, but data on its long-term results are scarce. METHODS: Patients with traumatic SCJD treated with an SCJ-specific plate between January 2003 and January 2018 were evaluated retrospectively. All implants were routinely removed. Data from radiography, the American Shoulder and Elbow Surgeons score, the visual analogue scale and abduction and forward elevation of the shoulder were collected and evaluated before the index surgery, at implant removal and at the latest follow-up. RESULTS: A total of 22 patients were included in this study with a mean follow-up period of 94.8 months. All patients maintained good reduction after the index surgery and implant removal. The visual analogue scale significantly improved from 7.1 ± 1.3 before the index surgery to 0.9 ± 1.0 at implant removal (P < 0.001) and to 1.0 ± 1.1 at the latest follow-up (P < 0.001); the American Shoulder and Elbow Surgeons score significantly improved from 37.9 ± 10.1 to 90.8 ± 7.8 (P < 0.001) and to 86.7 ± 8.6; and both abduction and forward elevation of the shoulder significantly improved at the latest follow-up (P < 0.001). There was no significant difference in the clinical results after implant removal. CONCLUSION: Traumatic SCJD treated with an SCJ-specific plate appeared to be efficient, with satisfactory clinical and radiological results at long-term follow-up.

Diagnostic value of ultrasound combined with magnetic resonance imaging in different stages of breast cancer.

Diagnostic value of ultrasound (US) and magnetic resonance imaging (MRI) in breast cancer were investigated. One hundred and forty breast cancer patients diagnosed in Heping Hospital Affiliated to Changzhi Medical College from June 2016 to June 2018 were collected, used as breast cancer group, 80 patients with benign breast tumor in the same period were the benign group. Pathological results were used to compare the diagnostic coincidence of US and MRI in breast cancer patients. The positive expression case rates of estrogen receptor and progesterone receptor were significantly higher in breast cancer group than those in benign group, but that of human epidermal growth factor receptor 2 (Her-2) was significantly lower in breast cancer group than that in benign group (all P<0.05). The sensitivity (SEN) of MRI alone and that of US combined with MRI were higher than that of US alone (P<0.05). The specificity (SPE) of MRI alone was lower than that of US alone and US combined with MRI (P<0.05). The NPV of US combined with MRI was significantly higher than that of US alone (P<0.05). The Youden index (YI) of US combined with MRI was significantly higher than that of US alone and MRI alone. In the diagnosis of N2, that of US combined with MRI was significantly higher than those of US alone and MRI alone (P<0.05). In stages of M0 and M1 among three methods, those of MRI alone and US combined with MRI were higher than that of US alone (P<0.05). US combined with MRI for the diagnosis of breast cancer has higher SEN and SPE, with better accuracy rate for the identification of each stage. Reducing the incidence of missed diagnosis and misdiagnosis that may be caused by single diagnosis and treatment, it is conducive to clinical screening and guiding clinical symptomatic treatment.

[Clinical efficacy of low-dose oral theophylline for treating mild asthma].

OBJECTIVE: To observe the role of theophylline in relieving airway symptoms and inflammation in patients with mild asthma. METHODS: Fifty-six patients with mild asthma were randomly divided into treatment group (n=41) receiving oral theophylline at daily dose of 4 to 6 mg/kg for 16 weeks and control group (15 cases) without medication other than beta2 antagonist, which was administered when necessary in both groups. Peripheral blood T-lymphocyte subsets (CD3(+), CD4(+), and CD8(+)) and pulmonary function (PEF(am) and PD(20)) before and at 8 and 16 weeks during treatment were measured. RESULTS: Significant difference was observed in CD3+ and CD4(+) T-lymphocyte subsets after medication with theophylline (P<0.05) in the patients, and PEF(am) and PD(20) were also significantly different from those of the control group (P<0.05). Theophylline significantly improved the clinical symptom scores (P<0.05) and decreased the asthma attacks. CONCLUSION: Low-dose oral theophylline may significantly relieving airway inflammation in patients with mild asthma.