The role of low-grade infection in the pathogenesis of apparently aseptic tibial shaft nonunion

PurposeAim of this study was to determine the rate of low-grade infection in patients with primarily as aseptic categorized tibial shaft nonunion and lack of clinical signs of infection.MethodsIn a retrospective study between 2006 and 2013, all patients who underwent revision surgery for treatment of tibial shaft nonunion without clinical evidence of infection were assessed. Bacterial cultures harvested during nonunion revision, C-reactive protein (CRP) and/or white blood cell (WBC) values at hospital admission, outcome, and epidemiological data were analyzed.ResultsIn 88 patients with tibial shaft nonunion without any clinical signs of infection, bacterial samples remained negative in 51 patients. In 37 patients, microbiological diagnostic studies after long-term culturing demonstrated positive bacterial cultures whereas after short-term culturing for 2 days only 17 positive cultures were observed. In 12 cases a mixed culture with 2.3 different bacteria on average was detected. Among patients with negative bacterial cultures bone healing was achieved after 13.2 months. Nonunion with positive bacterial cultures required 19 (range 2-42) months until osseous healing (p = 0.009). Furthermore, nonunion with positive bacterial cultures require statistically more surgical revisions to achieve healing (2.9 ± 0.5 vs. 1.3 ± 0.1 additional procedure; (p = 0.003). Hematological studies carried out before surgical intervention did not demonstrate significant differences in CRP values (negative vs. positive cultures: 0.3 (range 0.3-2.8) mg/dl vs. 0.5 (range 0.3-5.7) mg/dl (p = 0.181) and in WBC values (negative vs. positive cultures: 7.4 (range 3.5-11.9) /nl vs. 7.3 (range 3.7-11.1) /nl (p = 0.723). Limitations of this study may include the varying amount of the at least four samples for microbiological diagnostics as well as the circumstance that for diagnosing low-grade infection swabs and tissue samples were included in this evaluation as being equivalent.ConclusionThe pathogenesis of nonunion may originate from low-grade infection even in patients without clinical signs of infection. In addition, nonunion with positive bacterial cultures require statistically more surgical revisions to achieve healing. Therefore, during any revision surgery, multiple bacterial samples are intended to be harvested for long-term culturing. Particularly, in tibial shaft nonunion following Gustilo-Anderson type III open fractures, low-grade infection should be suspected.Trial registration numberDRKS00014657.Date of registration04/26/2018 retrospectively registered     

高强度聚焦超声阻滞腰交感神经节对周围动脉闭塞动物模型外周血5-羟色胺及前列腺素E2的影响

目的 使用高强度聚焦超声(HIFU)对犬周围动脉闭塞模型进行腰交感神经节阻滞,观察对外周血5-羟色胺(5-HT)及前列腺素E2(PGE₂)的影响,探讨其治疗缺血性疼痛的可能机制。 方法 26只杂种家犬随机分为3组: HIFU疗组(A组),非治疗组(B组),正常对照组(C组)。A组和B组在无菌条件下制作后肢缺血模型, A组术后2周用HIFU阻滞第2~6腰交感神经节,B组不予处理。A组和B组每次随机选2只犬在治疗0周(造模后2周)、治疗后1周、2周、1个月、2个月、4个月分别抽血检测血5-羟色胺及前列腺素E2。 结果 A组和B组在治疗0周外周血5-HT和PGE₂含量与C组相比,均明显升高且差异有统计学意义(P<0.05)。A组治疗1周后外周血5-HT及PGE₂浓度呈逐渐下降趋势,而B组则总体呈现增高趋势。两组治疗1周后各时间点外周血5-HT及PGE₂比较,差异均有统计学意义(P<0.05)。 结论 慢性周围动脉闭塞缺血致痛可使犬外周血5-HT和PGE₂含量升高,HIFU阻滞腰交感神经节缓解疼痛的机制可能与降低外周血5-HT和PGE₂含量有关。     

Biologic therapy in Sjögren’s syndrome

Sjögren’s syndrome (SS) is a chronic autoimmune disease with complex and diverse clinical manifestations. It is characterized by lymphocyte infiltration of exocrine glands such as the salivary gland and lacrimal gland leading to insufficient secretion of the gland, manifested as dry mouth and dry eyes. In addition, it can involve extraglandular organs and cause systemic damage. The pathogenesis of SS is still unclear. At present, symptomatic treatment is the mainstay and there is a lack of effective therapy. With the development of molecular pathways underlying the pathogenesis of SS, more and more novel biological agents are used to treat SS. We summarized and analyzed the existing evidences on the efficacy of biological treatment of SS and their targets. Analysis of the efficacy of biological therapy and improvement of treatment strategies can help to give full play to its therapeutic advantages.

     

Impact of hepatitis B virus infection on maternal and infant outcomes of women with gestational diabetes mellitus: A three-year retrospective study

AimsTo explore the impact of HBV infection on maternal and infant outcomes of GDM women.MethodsWe retrospectively identified 8126 women with GDM in China from July 2017 to June 2020, and divided them into GDM with HBV infection group (n = 483) and GDM with non-HBV infection group (n = 7643). Two sample t-test and Chi-square test were used to compare differences between groups. Logistic regression models were used to explore the association between HBV infection and maternal and infant outcomes.ResultsPlacental abruption (PA), (2.3% vs. 1.0%, P = 0.008), placenta previa (4.3% vs. 2.8% p = 0.044), intrahepatic cholestasis of pregnancy (ICP), (6.4% vs. 3.0%, P < 0.001), cesarean section (52.0% vs. 46.0%, P = 0.011), fetal chromosomal abnormalities (1.2% vs. 0.4%, P = 0.021), and neonatal hyperglycemia (1.9% vs. 3.6%, P = 0.047) were more likely to occur in GDM with HBV infection group. After adjusting for the covariates, HBV infection was found to be associated with ICP (aOR, 2.35; 95% CI: [1.58–3.50]), PA (aOR, 2.34; 95% CI: 1.22–4.47), and fetal chromosomal abnormalities (aOR, 2.88; 95% CI: 1.18–7.03).ConclusionsHBV infection was associated with part of maternal and infant outcomes in the GDM population.     

文仲渝主任中医师治疗小儿肠系膜淋巴结炎经验

文仲渝主任中医师结合小儿生理病理特点及重庆地区地理环境、饮食习惯,认为该地区小儿肠系膜淋巴结炎病因病机为脾胃薄弱,运化失司,湿浊内生,聚湿成痰,饮食积滞,湿、痰、积滞阻碍气机,气滞血瘀,不通则痛。脾弱为本,湿、痰、滞、瘀为标,本虚标实,虚实夹杂。治以运脾化湿、消滞和中、行气止痛,自拟腹痛方并随证加减,同时配合日常饮食及生活方面的调护,临床疗效显著。附案例1则,以资验证。     

严重急性呼吸综合征冠状病毒2疫情期间儿童肾脏病房感染防控思维导图

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的疫情已经持续了近2个月,现处于疫情胶着的状态。因儿童SARSCoV-2感染症状不典型,慢性肾脏疾病(CKD)患儿是高危感染人群,儿童肾脏专科病房的管理在复工、返校压力下,面临疫情防控的新挑战,国家临床研究中心肾脏病房、重庆市医学会儿科专委会肾脏学组,为进一步做好肾脏专科病房的疫情防控工作,结合目前疫情和相关防控建议,推荐SARS-CoV-2疫情期间儿童肾脏病房感染防控思维导图,以供儿童肾脏专科病房参考。     

“三神针”治疗中风后失眠

目的:观察"三神针"对中风后失眠患者睡眠质量的改善情况及其对血清褪黑素(melatonin,MT)和5-羟色胺(5-hydroxytryptamine,5-HT)的影响。方法:将70例中风后失眠患者随机分为试验组和对照组各35例。对所有患者予以基础治疗及恢复治疗。治疗组采用"三神针"为主进行治疗,对照组采用普通针刺治疗。每天1次,每周治疗5次,每次留针30 min,2周为1个疗程,共治疗2个疗程。对所有病例治疗前后进行匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)、失眠严重指数量表(insomnia severity index,ISI)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分及MT、5-HT含量对比,并对治疗过程中遇到的不良事件进行记录。结果:两组PSQI各因子及总分比较,差异有统计学意义(P<0.05);两组ISI评分比较,差异有统计学意义(P<0.05);两组HAMA、HAMD评分比较,差异有统计学意义(P<0.05);试验组有效率97.14%(34/35),对照组有效率82.86%(29/35),两组比较,差异有统计学意义(P<0.05);两组均未出现明显不良反应。结论:"三神针"选穴合理精妙,临床疗效确切,能显著改善中风后失眠患者的PSQI评分、HAMD评分、HAMA评分、ISI评分,改善患者的不适症状,是一种疗效好、痛苦小、易接受的治疗方案。