Necrotising myositis – learnings for a plastic surgeon

BackgroundNecrotising myositis (NM) is a life-threatening emergency. Prompt treatment is associated with more favourable outcomes, but early diagnosis is challenging. The initial absence of cutaneous signs and symptoms coupled with delayed recognition commonly result in higher rates of morbidity and mortality.ObjectivesAnalyse data regarding demographics, epidemiology, aetiology, clinical manifestations, diagnosis and treatment of previously reported cases. This publication is intended for plastic surgeons in training to help them look out for this disease.Search methods/criteriaPublications reporting necrotising myositis between 1974 to January 2020 were identified from Embase, Medline All, Web of Science Core Collection, Google Scholar and Cochrane Central Register of Controlled Trial.Data collection and analysis: Identified studies were exported to an end note library. In animal studies, studies relating to statin-induced myotoxicity and auto-immune myositis were excluded. The quality of included case reports was assessed using JBI Critical Appraisal Checklist for Case Reports.Main resultsThe most common initial presentation was a few days of antecedent prodromal flu-like symptoms associated with muscle pain. The mean age was 43.3 years and 82% had no significant medical history. The most frequent misdiagnoses were muscle strain (11%), deep vein thrombosis (10%) and viral illness (9%). Seventy-four per cent of presentations were due to Group A Streptococcus infections and only 3.5% of cases were polymicrobial. The most common clinical course following the initial presentation was rapid deterioration into profound sepsis and progression into multi-organ failure. The overall mortality rate was 36.5%.ConclusionsNM is a life-threatening muscle infection. It is a diagnostic conundrum as initial presentation is often only myalgia without features of preceding trauma. We propose that a high index of suspicion and increased awareness will reduce morbidity.OtherPROSPERO (registration number CRD42018087060). Nil funding/conflict of interest.     

Is the T-shaped acetabular fracture really likes a "T"? A study based on three-dimensional fracture mapping

ObjectivesTo explore the morphological pattern of T-shaped acetabular fractures (T-SAFs) by mapping the fracture line using 3D software.Material and methodsWe retrospectively reviewed 1298 consecutive patients with acetabular fractures, and a total of 56 T-SAF patients were enrolled. After the simulated reduction of each fracture in the software, the fracture lines of all patients were overlaid and plotted on a template. A frequency heat map was generated according to the differences in fracture line density distribution. According to the location of fracture lines, all cases were divided into three groups: posterior group, anterior group, extra-posterior group. In surgically treated patients, the surgical approach, fixation methods, and reduction quality were recorded or evaluated.ResultsThe transverse fracture line was sinuous without involving the acetabular roof, and the longitudinal fracture line sloped forward or backward along the edge of the acetabular fossa to split the obturator foramen. The anterior and posterior edges of the acetabular fossa, the transition zone of the acetabular roof and anterior wall, the transition zone of the superior pubic ramus and anterior wall, and the posterior wall near the greater sciatic notch were areas with high rates of fracture incidence. The posterior group included 26 patients (46.4%) and the distribution of fracture lines resembled a “T” or “Y”. The anterior group included 25 patients (44.6%) and the distribution of fracture lines resembled a “7″. The extra-posterior group included 5 patients (8.9%) and the fracture lines run through the ischial body. The surgical strategies vary among different groups of T-SAF patients.ConclusionOur findings shed light on the characteristics of fracture lines for T-SAFs and provide a reference for surgical treatment strategies.     

多囊卵巢综合征中西医研究进展

多囊卵巢综合征是一种生殖功能障碍与糖代谢异常并存的内分泌紊乱综合征。是目前青中年妇女发病率较高的内分泌系统疾病，此病可由多方面因素诱发引起下丘脑-垂体-卵巢功能轴紊乱。是育龄期妇女月经不调，不孕等疾病的主要诱因。     

稽留流产孕早期预测模型的构建与验证

目的构建稽留流产(missed abortion,MA)患者在孕早期流产危险因素列线图。方法纳入2017年2月至2019年10月因稽留流产于中国建筑第二工程局职工医院治疗的孕妇125例为研究组,随机纳入同时期正常孕妇126例为对照组,分析两组患者临床基本资料:年龄、环境因素、动物接触史、叶酸使用、文化程度、流产情况、疾病史、激素水平等。采用Logistic回归分析对孕早期发生稽留流产的危险因素进行分析,应用R软件建立孕早期稽留流产预测列线图,并进行验证。结果研究组孕妇年龄、睾酮(testosterone,T)水平高于对照组,而催乳素(prolactin,PRL)、雌二醇(estradiol,E2)、孕酮(progesterone,P)水平低于对照组,差异均有统计学意义(P<0.05);Logistic回归分析提示孕妇年龄(OR=1.809,P=0.003)、吸烟饮酒(OR=78.120、P=0.044)、职业暴露(OR=61.238,P=0.021)、T水平(OR=5.432,P=0.001)是孕早期发生MA的危险因素。PRL(OR=0.376,P=0.003)、E2(OR=0.258,P=0.016)、P(OR=0.396,P=0.005)是孕早期发生MA的保护因素。预测孕早期MA发生的相关危险因素的C-index为0.912(95%CI:0.874-0.943)。结论列线图中孕妇年龄、环境因素、激素水平能较准确的预测孕早期发生MA的风险。     

雷火灸联合搐鼻疗法治疗脾肾阳虚型乙肝肝硬化腹水的疗效观察

[目的]观察雷火灸联合搐鼻疗法治疗脾肾阳虚型乙肝肝硬化腹水的临床疗效。[方法]将中医辨证为脾肾阳虚型乙肝肝硬化腹水患者随机分为对照1组、对照2组及观察组,每组42例,3组均接受西医常规治疗,对照1组采用雷火灸治水四穴;对照2组采用中草药搐鼻疗法;观察组采用雷火灸治水四穴联合搐鼻疗法。疗程为4周,治疗后对各项指标进行观察。[结果]观察组分别与2个对照组临床总有效率比较差异有统计学意义(P<0.05)。治疗后,3组患者的中医症状评分、丙氨酸转氨酶、总胆红素、体重、腹围、脾厚、门静脉内径显著降低,且观察组显著低于对照1组、对照2组,均差异有统计学意义(P<0.05);治疗后白蛋白、凝血酶原活动度、平均24 h尿量显著升高,且观察组显著高于对照1组、对照2组,均差异有统计学意义(P<0.05)。[结论]雷火灸治水四穴联合搐鼻疗法可以明显改善乙肝肝硬化腹水患者的肝功能、凝血功能及临床症状,降低门静脉压力、提高血浆胶体渗透压,临床疗效显著。     

Quality of life in caregivers of a family member with serious mental illness: Evidence from China

Purpose

To evaluate the quality of life (QoL) and social support among family caregivers of a family member with a mental illness and to identify factors associated with the QoL.

干扰素在恶性淋巴瘤自体移植后早期干预的应用

目的:观察非霍奇金淋巴瘤（non-Hodgkin's lymphoma，NHL）患者自体造血干细胞移植（autologous hematopoietic stem cell transplantation，ASCT）术后应用重组人α-2b干扰素（α-2b IFN）进行早期干预治疗的临床疗效。方法:选取18例行ASCT的NHL患者为研究对象，移植前疾病评估均未达到完全缓解（complete remission，CR），试验组血象恢复后给予IFN 3 000 000 U次/隔日干预治疗，3个月后停用；对照组未行干扰素干预治疗，分析总体疗效及两组对比的生存情况。结果:随访中位时间为34（10~50）个月，患者中位生存时间为37（31~45）个月，3年总体无进展生存（progressive free survival，PFS）、总生存（overall survivial，OS）分别为54.7%、66.8%。ASCT后试验组1年内无疾病复发，2年内复发率为12.5%；对照组1年内复发率为20%，2年内复发率为30%。结论:NHL患者在ASCT后给予重组人α-2b IFN早期干预治疗，患者耐受性好，可能降低移植后早期复发率。     

腰痛宁胶囊联合艾瑞昔布片治疗强直性脊柱炎寒湿瘀阻证60例临床观察

目的 观察腰痛宁胶囊联合艾瑞昔布片治疗强直性脊柱炎寒湿瘀阻证的临床疗效。方法 120例患者随机分为治疗组和对照组各60例；对照组口服艾瑞昔布片，治疗组口服艾瑞昔布片、腰痛宁胶囊。比较两组患者治疗前后巴氏AS功能指数（BASFI）、巴氏AS病情活动指数（BASDAI）、评分，血沉（ESR）、C反应蛋白（CRP）水平，中医证候评分，评定综合疗效。结果 两组治疗前BASDAI、BASFI评分，ESR、CRP水平，中医证候评分比较差别不大，治疗后组内比较，两组各项评分及ESR、CRP水平均降低（P<0.05），治疗后组间比较，治疗组各项评分及ESR、CRP水平低于对照组（P<0.05）；治疗组总有效率86.67%优于对照组的65.00%（P<0.01）。结论 腰痛宁胶囊能有效改善强直性脊柱炎临床证候，降低炎症指标及疾病活动度，改善患者功能活动指数，疗效确切。     

A population-based study on the epidemiology of firearm-related injury in Nova Scotia

ObjectiveFirearm-related trauma is a significant cause of preventable mortality. In 2020, Nova Scotia experienced the largest mass shooting in Canadian history. The objective of this study was to describe the epidemiology of firearm-related injury and death in Nova Scotia and to assess for factors associated with mortality.MethodsA retrospective observational study of all major trauma patients in Nova Scotia who sustained firearm-related injuries between 2001 and 2020 was conducted. Data was collected from the Nova Scotia Trauma Registry and the Nova Scotia Medical Examiner Service. Injury rates were evaluated over time, by age/sex, and by intent (assault/homicide, self-harm, other), and were mapped by municipality. Characteristics of survivors and non-survivors were compared using t-tests and chi-square analysis. A multivariate logistic regression model was created to assess for predictors of mortality.ResultsA total of 776 firearm-related injuries occurred over the 19-year study period, for an overall age- and sex-adjusted firearm injury rate of 4.44 per 100,000 population. Patients ranged in age from 6 to 92 years (mean 45.0±19.2 years) and most were male (95.6%; 742/776). Injuries were predominantly self-inflicted (65%; 504/776). The majority of patients died from their injuries (72%; 558/776); 64% (497/776) died at the scene. The overall age- and sex-adjusted firearm mortality rate was 3.18 per 100,000. Most non-survivors had injuries that were self-inflicted (83.2%; 464/558). Increasing age (OR 1.02, 95% CI 1.00-1.04) and increasing Injury Severity Score (OR 1.11, 95% CI 1.07-1.15) were associated with greater likelihood of mortality. Activation of the trauma team was associated with survival (OR 0.04, 95% CI 0.02-0.10).ConclusionTrauma patients with firearm-related injuries were predominantly male and most injuries were self-inflicted among middle-aged to older patients. Younger patients tended to be victims of homicide/assault and were more likely to survive their injuries.