Incidence and risk factors associated with hospital-acquired pressure ulcers following total hip arthroplasty: A retrospective nationwide inpatient sample database study

AimTo examine the incidence and risk factors associated with hospital-acquired pressure ulcers (HAPUs) following total hip arthroplasty (THA) using a large-scale national database.Material and methodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), total charges during hospitalization, in-hospital mortality, preoperative comorbidities, and perioperative complications were assessed.ResultsThe general incidence of HAPUs after THA was 0.05%, with a fluctuating trend annually. Patients suffered from HAPUs were older, less likely through elective admission, more likely in large hospital, more usage of Medicare, and less possibly paying via Private insurance. Additionally, the occurrence of HAPUs was associated with more preoperative comorbidities, longer LOS, extra total charges, and higher in-hospital mortality. Risk factors associated with HAPUs included advanced age (≥75 years), large hospital, multiple comorbidities (n ≥ 3), diabetes with chronic complications, drug abuse, liver disease, fluid and electrolyte disorders, metastatic cancer, peripheral vascular disorders, psychoses, chronic renal failure, peptic ulcer disease, and weight loss. Besides, HAPUs were associated with inflammatory arthritis and femoral neck fracture (compared with primary/secondary osteoarthritis), frailty/senility, osteoporosis, acute renal failure, pneumonia, postoperative delirium, urinary tract infection, deep vein thrombosis, sepsis/septicemia, wound dehiscence/non-healing surgical wound, periprosthetic joint infection, and mechanical prosthesis-related complications. Conclusion: It is beneficial to study the risk factors associated with HAPUs after THA to ensure the preventive management and optimize outcomes although a low incidence was identified.     

Regenerative medicine of pancreatic islets

The pancreas became one of the first objects of regenerative medicine,since other possibilities of dealing with the pancreatic endocrine insufficiency were clearly exhausted.The number of people living with diabetes mellitus is currently approaching half a billion,hence the crucial relevance of new methods to stimulate regeneration of the insulin-secreting β-cells of the islets of Langerhans.Natural restrictions on the islet regeneration are very tight;nevertheless,the islets are capable of physiological regeneration via β-cell self-replication,direct differentiation of multipotent progenitor cells and spontaneous α-to or δ-to β-cell conversion(trans-differentiation).The existing preclinical models of β-cell dysfunction or ablation(induced surgically,chemically or genetically) have significantly expanded our understanding of reparative regeneration of the islets and possible ways of its stimulation The ultimate goal,sufficient level of functional activity of β-cells or their substitutes can be achieved by two prospective broad strategies β-cell replacement and β-cell regeneration.The "regeneration" strategy aims to maintain a preserved population of β-cells through in situ exposure to biologically active substances that improve β-cell survival,replication and insulin secretion,or to evoke the intrinsic adaptive mechanisms triggering the spontaneous non-β-to β-cell conversion.The "replacement" strategy implies transplantation of β-cells(as non-disintegrated pancreatic material or isolated donor islets) or β-like cells obtained ex vivo from progenitors or mature somatic cells(for example,hepatocytes or a-cells) under the action of small-molecule inducers or by genetic modification.We believe that the huge volume of experimental and clinical studies will finally allow a safe and effective solution to a seemingly simple goal-restoration of the functionally activeβ-cells, the innermost hope of millions of people globally.     

全髋关节置换术后患者早期抗阻训练的最佳证据总结

目的 检索、获取全髋关节置换患者术后早期抗阻训练的相关证据,并对最佳证据进行总结。方法 使用计算机检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库、美国国立临床诊疗指南数据库、英国国家医疗保健优化研究所指南库、苏格兰校际指南网络、新西兰指南协作组网站、Cochrane Library、PubMed、EBSCO、荷兰学术期刊全文数据库、中国知网、万方、维普和中国生物医学文献数据库及骨科相关网站关于全髋关节置换患者术后早期抗阻训练的相关证据,包括指南、最佳实践、临床决策、系统评价、专家共识及相关原始研究,检索时限为2009年1月1日—2020年4月20日。由3名研究者对纳入的文献质量进行评价,并提取符合质量标准的文献证据。结果 共纳入文献20篇,包括指南2篇、临床决策1篇、随机对照试验研究6篇、系统评价7篇、专家共识2篇、病例对照研究1篇、队列研究1篇。结合专业人员的判断,围绕抗阻训练的评估、时间、强度、方式、地点、方案、不良反应及监测8个方面,共汇总13条最佳证据。 结论 总结的关于全髋关节置换患者术后早期抗阻训练的最佳证据,可为医护人员的临床应用提供循证依据。     

Infective endocarditis in patients who have undergone transcatheter aortic valve implantation: a review

BackgroundTranscatheter aortic valve implantation (TAVI) has been approved for the treatment of severe aortic stenosis since 2008 and recent trials have shown that TAVI is at least non-inferior to surgical aortic valve replacement (SAVR) with regards to short-term efficacy and safety in patients across all surgical risk profiles. Prosthetic valve endocarditis of the transcatheter heart valve is a feared complication; data on the risk of infective endocarditis (IE) subsequent to TAVI are now gradually emerging.ObjectivesWe set forth to conduct a review of the incidence, diagnosis, microbial aetiologies, prevention, outcome and management of TAVI-IE.SourcesFrom the MEDLINE database we included a total of 12 observational studies and five studies of long-term results from randomized controlled trials.ContentThe incidence of TAVI-IE was reported to be between 0.7% and 3.0% per person-year. The most common microbes were reported to be enterococci, Staphylococcus aureus, streptococci and coagulase-negative staphylococci. International guidelines on prevention strategies of IE recommend good sanitary conditions including cutaneous care, good oral hygiene and good care of dialysis catheters. Antibiotic prophylaxis is recommended by guidelines prior to dental procedures in patients with TAVI; however, evidence is sparse. The majority of the patients included in this review with TAVI-IE had an indication for surgical intervention due to IE (50.0% or more); however, only a small subset of the patients underwent surgery (16.4% or less). The in-hospital mortality was around 25%, i.e. of the same order of magnitude as in prosthetic valve IE in general, but varied substantially between studies (from 11% to 64%).ImplicationsThe US Food and Drug Administration's approval of TAVI in patients at low surgical risk may change the characteristics of patients with TAVI, which may influence the incidence, management, and outcome of patients with TAVI-IE.     

Reasons for replacement of restorations in permanent teeth in general dental practice

OBJECTIVE: The analysis of reasons for the replacement of 9,805 amalgam, composite, glass ionomer, resin modified glass ionomer and 'other' restorations in permanent teeth in general dental practice. DESIGN: The data were subdivided on the bases of age and gender of the patients, the types of restorations and the clinicians' gender, experience and practice setting. RESULTS: The clinical diagnosis of secondary caries was the main reason for replacement of all types of restorations studied, followed by fracture of restorations, especially bulk fracture, irrespective of patient's age. Bulk discoloration was the third most common reason for replacement of resin based materials in adults, but it rarely occurred in adolescents 18 years and younger. The reasons for replacement of restorations were not associated with the gender of the patients. Subgroupings based on the clinicians' gender showed that female clinicians diagnosed secondary caries more often than male clinicians. Otherwise, the reasons for replacements were similar for both genders of clinicians. Subdivision of restorations based on the years since graduation of the clinicians resulted in small groups. The youngest group of clinicians diagnosed relatively more secondary caries both for amalgam and composite restorations than the most experienced group. CONCLUSION: The clinical diagnosis secondary caries was the main reason for replacement of all types of restorations studied.     

Current concepts in the management of ankle arthritis

Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.