Treatment and clinical rehabilitation of Pilon fracture

AIM：To analyze the effect of three kinds of method on different types of Pilon fracture and advance the beat treatment plan.METHODS:From March 1989 to August 2000,107 patients were regarded as having Pilon fracture by two hospitals,among which 76 cases were followed up.They were divided into three groups according to treatment method.A group included 24 cases with the treatment of manual reduction,traction of calcaneus and plaster exopexy.B group included 30 cases with the treatment of AO key-shaped anatomical steal plate.C group included 22 cases with the treatment of limited internal fixation combined with exopexy stand.RESULTS:After 6months to 8years follow-up,it was found that three kinds of treatment methods had obvious differences on the complications and effects of different types of fracture.In A group,the excellent and good rate of treatment on I type fracture was 70%,Ⅱ type was 25%,Ⅲ type was 0%.In B group,the excellent and good rate of treatment on I type fracture was 78.6%,Ⅱ type s 87.5%,Ⅲ type was 37.5%.In C group,the excellent and good rate of treatment on I type was 75%,Ⅱ type was 80%.CONCLUSION:Summarizing kinds of factors,the treatment of A group applied in I type fracture,B group applied in Ⅱ type fracture and C group applied in Ⅲ type fracture.     

Treatment of of rheumatic disease by Chinese druge fumigation and steaming

AIM:To observe therapeutic effect of fumigation and steaming with Chinese drugs in the rheumatic diseases.METHODS:Drugs removing rheumatic disease,warming channels and dispersing cold,activating blood circulation were used for fumigation and steaming treatment in 84 cases with rheumatic diseases,once a day,20min each time,10times as a treatment course.Among them,4 cases received treatment for 2 and 3 course of treatment respectively.RESULTS:18 cases were corrected completely,64 were improved,2 showed no improvement,and total effective rate was 98%CONCLUSION:Through hot and therapeutic effect of drugs,lesions can be managed directly in fumigation and steaming trestment.     

Treatment and functional rehabilitation of extremity bone tumor by microsurgery

INTRODUCTIONApplicationofmicroscopyintroducedrevolutionarychangesinsur－gicalfield．Accompaniedwithimprovedradiotherapyandchemio－therapy，itbecomesanimportantprerequisiteofcancertherapy．DISTALLIMBREPLANTATIONWITHBONETUMORRE－SECTIONThisoperationisappliedintotreatmentofmalignantandprogressivetumorandincludedreplantationwithlimbresectionandrotationre－plantationwithtumorsectionresection．ReplantationwithtumorsectionresectionReplantationwithtumorsectionresectionisappliedt…     

The Diagnosis and Treatment of Obscure Intra—abdominal Lesions

The most common cause of fractures in the elderly is falling.

Urinalysis, hemoglobin determination and a thoracic roentgenogram always should be obtained for the elderly patient with a major fracture. Determination of the sedimentation rate of erythrocytes aids in assessment of the patient for treatment.

Treatment should be selected on an individual basis. Good nursing care is most important, and the patient should be provided with a familiar environment or familiar articles to decrease disorientation and delirium. If surgical intervention is indicated, it should be accomplished with dispatch in accord with good surgical principles.

The physician's obligation to the patient continues after the fracture has healed until the patient is returned to the best possible condition according to the injury sustained.     

Assessment and Management of Cancer- and Cancer Treatment–Related Cognitive Impairment

Cognitive impairment resulting from cancer and subsequent treatment is one of the most common and troubling sequelae experienced by cancer survivors. Cancer survivors report that cognitive impairment negatively affects their quality of life. Appropriate assessment and management of cognitive impairment is critical to providing optimal care to cancer survivors. The purpose of this article is to briefly describe the state of evidence on incidence, possible mechanisms, and presentation of cancer- and cancer treatment–related cognitive impairment and to provide guidance for its assessment and management. We focus on management with nonpharmacological and pharmacological interventions that may have clinical utility.     

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Purpose of Review

Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement. A main source for antibiotic tolerance and treatment failure is bacterial production of biofilm—a resilient barrier against antibiotics, immune system, and mechanical debridement. The purpose of this review is to explore some novel approaches to treat PJI and biofilm-related infections.

Recent Findings

Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides.

Summary

Several promising treatment strategies for PJI are available to be tested further. The next requirement for most of the novel treatments is reproducing their effects in clinically representative animal models of PJI against clinical isolates of relevant bacteria.

     

Treatment of subtrochanteric fracture with femoral interlocked intramedullary pin and rehabilitation exercise

Background:Femoralsubtrochantericfracturemeansfractureshappened5cmawayfrominferiormarginlevelofsmalltrochanter.Mostofthiskindoffractureisunstablefracturescausedbytraumamostlyandcharacterizedwithlargemalposition,splinteredanddif-ficulttobetreated.Itwillleadtoaseriesofseverecomplicationsiftreatedimproperly.Objective:Toevaluatetheclinicaleffectofthefemoralinter-lockingintramedullarynailingforthetreatmentofsubtrochantericfracture.Unit:DepartmentofOrthopedics,FirstHospitalofSuzhouU-niversitySub…     

Treatment of paralysis and aphasia by drug given through common carotid artery and ultrasonic wave

Background：Paralysisfollowinginjurymaybecausedbycompressionoflanguageormotioncenterindominanthemispherebyedema，hematomaorbraincontusionafter．Commonly，injuryofcenteroflanguageandmotionisincomplete．Anumberofbasicresearchindicatedthatmostofneuronslocatedinrangearoundinjurylosttheirfunctionduetobloodsupplyreduction，orcontactinterruptionandimpulsereductionfrompathologicalchangesinlanguageandmotioncenterduetodistaleffect．Theseneuronsaresilentelectrically，buttheystillmaintainnormalironbalance…     

Prevention and Treatment of Staphylococcus aureus Pneumonia with a β-Cyclodextrin Derivative

Staphylococcus aureus pneumonia is a common, potentially life-threatening infection caused by this human pathogen. The only therapies available to treat S. aureus pneumonia are antibiotics, a modality that is jeopardized by the organism''s remarkable ability to acquire antimicrobial resistance. S. aureus alpha-hemolysin is a pore-forming cytotoxin that is essential for the pathogenesis of pneumonia. Strains lacking this cytotoxin are avirulent in a murine model of pneumonia; likewise, vaccine-based strategies that antagonize the toxin afford protection against lethal disease. Disruption of the function of this toxin therefore provides a potent mechanism to prevent and/or treat S. aureus pneumonia. β-Cyclodextrin derivatives are small molecules with a sevenfold symmetry that mirrors the heptameric alpha-hemolysin. These compounds block the assembled alpha-hemolysin pore, compromising toxin function. We report that a modified β-cyclodextrin compound, IB201, prevents alpha-hemolysin-induced lysis of human alveolar epithelial cells. This protective effect does not result from the ability of the β-cyclodextrin to impair formation of the oligomeric alpha-hemolysin on the cell surface, supporting a role for this molecule in blockade of the lytic pore. An examination of IB201 in murine S. aureus pneumonia demonstrated that administration of this compound prevents and treats disease, protecting against mortality. Consistent with the vital importance of alpha-hemolysin in pneumonia caused by methicillin-sensitive and highly virulent methicillin-resistant S. aureus strains, IB201 protects against lethal challenge with both types of isolates. These observations, coupled with a favorable safety profile of β-cyclodextrin compounds, provide a novel strategy that may be developed to combat S. aureus pneumonia.Staphylococcus aureus is a gram-positive human pathogen that is able to cause a multitude of diseases ranging in severity (21). Of the many infections and toxinoses mediated by S. aureus, pneumonia is among the most prominent, accounting for an estimated 50,000 staphylococcal infections per year in the United States alone (18, 20). As one of the leading etiologic agents of ventilator-associated pneumonia, S. aureus has long plagued the intensive care environment (14, 19). Further, this pathogen is now increasingly recognized as an important cause of community-acquired pneumonia, displaying the capacity to infect a population of otherwise healthy adults and children (9, 10, 19). A number of these reported cases of community-acquired disease have occurred on the backdrop of an intercurrent respiratory viral infection, often caused by influenza (8, 9, 15). The fulminant nature of coinfection with influenza and S. aureus is evident in mortality rates that approach or exceed 50%, highlighting an apparent synergy of these pathogens in the lung environment. Both the reliance of an aging population on intensive care therapies and the current threat of epidemic or pandemic influenza underscore the large populations of diverse individuals that are at significant risk for the development of S. aureus pneumonia.Complicating the clinical management of staphylococcal pneumonia is the fact that over half of S. aureus isolates are currently classified as methicillin-resistant S. aureus (MRSA), harboring genes that render these isolates insensitive to a once potent class of antimicrobial agents (14). Recent clinical observations have documented that mortality from MRSA pneumonia can exceed 50%, defining the severity of disease caused by this organism (1). The estimated direct medical cost to treat a patient suffering with S. aureus pneumonia is in excess of $35,000, imparting a significant burden on the economy (30). The combined risks of a changing disease epidemiology and widespread drug resistance among S. aureus strains mandate the development of novel strategies to both prevent and treat disease. Recent investigations highlighting the pore-forming cytotoxin alpha-hemolysin (Hla) as essential for the pathogenesis of S. aureus pneumonia have provided opportunities to design and investigate new strategies to combat this disease (5, 6, 28).S. aureus strains lacking Hla display a profound defect in virulence in a murine model of pneumonia (4, 5). Consistent with this observation, antagonism of the toxin through a number of distinct immunization strategies has been demonstrated to provide protection against disease (6, 28). Hla displays a detrimental effect on the lung epithelium, resulting in cellular injury and death as well as the generation of proinflammatory mediators (23, 29). The toxin also has the capacity to target the pulmonary vascular endothelium, as treatment of isolated pulmonary arteries ex vivo results in increased vascular resistance and vascular leakage (31, 32). In addition to its role in the lung, this toxin plays a critical role in S. aureus pathogenesis in intraperitoneal, intramammary, and corneal models of infection (3, 7, 27). Hla is secreted by the majority of S. aureus strains as a water-soluble monomer (2, 26). This monomeric form binds to susceptible host cell membranes and through a well-detailed series of intra- and intermolecular interactions, subsequently assembles into a stable homoheptameric transmembrane pore with a 2-nm internal diameter (11, 17, 33).With the essential nature of alpha-toxin in mind, Karginov et al. used structure-inspired drug design to demonstrate that a hepta-6-substituted β-cyclodextrin derivative, termed IB201, is able to prevent alpha-toxin-mediated hemolysis of rabbit red blood cells (rRBCs), a cell type that is highly sensitive to the lytic action of the toxin (16). Previous investigations had demonstrated the utility of unsubstituted β-cyclodextrin as an adapter molecule, capable of lodging in the central pore of alpha-hemolysin and facilitating the use of the toxin as a biosensor (12, 13). An investigation of IB201 revealed that this molecule blocks ion conductance through the assembled hemolysin pore, consistent with the ability of the cyclodextrins to insert into the pore itself. The inhibitory effect of IB201 on ion conductance and red blood cell hemolysis are both observed in the low micromolar concentration range, demonstrating the potency of this molecule as an inhibitor of the S. aureus alpha-hemolysin. Interestingly, McCormick et al. have recently utilized methyl-β-cyclodextrin plus cholesterol to inhibit the activity of S. aureus alpha-hemolysin, revealing that this treatment affords protection against toxin-induced corneal erosions in a rabbit model of S. aureus keratitis (22). We report herein that the β-cyclodextrin derivative IB201 is able to prevent alpha-toxin-mediated alveolar epithelial cell lysis in vitro and is also able to prevent mortality associated with S. aureus pneumonia in a murine model of infection.     

Can Appropriate Diagnosis and Treatment of Childhood Asthma Reduce Excessive Antibiotic Usage?

Introduction

This study compared the frequency of antibiotic usage and the number of asthma episodes before and after the diagnosis and treatment of pediatric asthma patients who were followed up by specialists.

Subjects and Methods

Included in this study were 334 patients (211 males and 123 females) of 2–16 years of age who were diagnosed with asthma and followed up for at least 1 year in our clinic. The frequency of antibiotic usage and the number of asthma episodes in the year prior to diagnosis and treatment were compared to these same variables after 1 year of follow-up by specialists.

Results

The median age was 84 months (range: 24–192) and 212 (63s%) children were at school or in day care centers. Atopy and a family history of asthma were present in 200 (60s%) of the patients, and 137 (41s%) reported that at least one member of their household smoked. Antibiotics were used a median number of 7 times [interquartile range (IQR) = 6] in the year before the asthma diagnosis, and 2 times (IQR = 3) during the year after treatment (p < 0.001). The mean number of asthma episodes before diagnosis, i.e. 4 (IQR = 8) was reduced to 0 (IQR = 2) in the year after treatment when the patients were followed up by specialists (p < 0.001).

Conclusion

This study shows that appropriate diagnosis and treatment of childhood asthma significantly reduce the frequency of antibiotic usage and the number of asthmatic episodes.Key Words: Childhood, Asthma, Antibiotic usage     

Multicenter Retrospective Study of Cefmetazole and Flomoxef for Treatment of Extended-Spectrum-β-Lactamase-Producing Escherichia coli Bacteremia

The efficacy of cefmetazole and flomoxef (CF) for the treatment of patients with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) bacteremia (ESBL-CF group) was compared with that of carbapenem treatment for ESBL-EC patients (ESBL-carbapenem group) and with that of CF treatment in patients with non-ESBL-EC bacteremia (non-ESBL-CF group). Adult patients treated for E. coli bacteremia in four hospitals were retrospectively evaluated. The 30-day mortality rates in patients belonging to the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were compared as 2 (empirical and definitive therapy) cohorts. The adjusted hazard ratios (aHRs) for mortality were calculated using Cox regression models with weighting according to the inverse probability of propensity scores for receiving CF or carbapenem treatment. The empirical-therapy cohort included 104 patients (ESBL-CF, 26; ESBL-carbapenem, 45; non-ESBL-CF, 33), and the definitive-therapy cohort included 133 patients (ESBL-CF, 59; ESBL-carbapenem, 54; non-ESBL-CF, 20). The crude 30-day mortality rates for patients in the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were, respectively, 7.7%, 8.9%, and 3.0% in the empirical-therapy cohort and 5.1%, 9.3%, and 5.0% in the definitve-therapy cohort. In patients without hematological malignancy and neutropenia, CF treatment for ESBL-EC patients was not associated with mortality compared with carbapenem treatment (empirical-therapy cohort: aHR, 0.87; 95% confidence interval [CI], 0.11 to 6.52; definitive therapy cohort: aHR, 1.04; CI, 0.24 to 4.49). CF therapy may represent an effective alternative to carbapenem treatment for patients with ESBL-EC bacteremia for empirical and definitive therapy in adult patients who do not have hematological malignancy and neutropenia.Bacteremia caused by Escherichia coli is a common and significant problem in both community and health care settings (1). In recent years, the prevalence of extended-spectrum β-lactamase-producing E. coli (ESBL-EC) has increased dramatically worldwide. Effective treatment of ESBL-EC bacteremia has become challenging because ESBL-EC is usually resistant to cephalosporins, the first-line drug used for E. coli infections (2). At least partially due to the delay in effective treatment regimens, bacteremia caused by ESBL-EC is associated with a higher mortality rate than that caused by non-ESBL-EC (3). Currently, the standard therapy for ESBL-EC bacteremia is virtually limited to carbapenems (4, 5). Alternate therapies involving fluoroquinolones, sulfamethoxazole-trimethoprim, and aminoglycosides offer limited efficacy due to frequent coresistance mechanisms in ESBL-EC (2). To prevent carbapenem overuse and spread of carbapenem-resistant Enterobacteriaceae, alternative drug regimens are needed (6).β-Lactam/β-lactamase inhibitors and cephamycins (i.e., cefmetazole, cefoxitin, cefotetan, moxalactam, and flomoxef) are usually stable to hydrolysis by ESBLs (2). The MICs of β-lactam/β-lactamase inhibitors can increase as the inoculum increases (7); however, cephamycins (cefotetan and flomoxef) exert in vitro antibacterial activity even in the presence of high inocula (8, 9). Clinical data for β-lactam/β-lactamase inhibitors obtained with a large cohort of patients by using propensity score analysis have been published, but the conclusions are inconsistent (10, 11). In Japan, cefmetazole and flomoxef (CF) are frequently used to treat intra-abdominal infections or as prophylaxis for surgery. Thus, Japanese clinicians have sometimes used CF therapy for sepsis or bacteremia as empirical therapy or as definitive therapy when susceptibility was confirmed. However, clinical data evaluating the effectiveness of cephamycins for ESBL-EC bacteremia have not been reported yet.In this multicenter retrospective study using propensity score analysis, we evaluated the effectiveness of empirical and definitive CF treatments for ESBL-EC bacteremia in comparison with standard carbapenem therapy. We also evaluated patients with non-ESBL-EC bacteremia who were treated with a CF regimen to investigate potential associations between ESBL production and patient outcomes when E. coli bacteremia was treated with CF therapy.     

Treatment of complete dislocation of acromiodayicular joint with the modi-fied Dewar operation and postoperative recoyery of joint function

BACKGROUND: Many scholars have reported the clinical practices and effect of Dewar operation, otherwise pain and dysfunction often occur after operation.OBJECTIVE: To investigate the effect of Dewar operation combined with postoperative rehabilitation exercises on complete dislocation of acromioclavicular joint.UNIT: Department of Surgery, Baiyun' ebo Iron Mine Staff Hospital of Baotou City     

Treatment of moderate and severe cancer pain by Lornoxicam：32 cases report

AIM:To study efficacy,safety,administration approaches of pellet of lornoxicam in treating pain caused by moderate and advanced cancers(improt clinical verification).METHODS:Multiple center ,random,double blind,and self-control method was used.Lornoxicam and positive control drug (tramadol) was randomly labeled as A and B.All qualified patients accepted A and B in tum.Purge drugs was given during interavl.Number evaluation method was used to assay pain level and changes .Effective period,optimal relief time,and duration were computed.Level of adverse effects and its re-lation with drugs were evaluated.RESULTS:32 patients were evaluated in-cluding 22 cases of moderate pain and 10 of advanced pain.When ap-proaches of drug administered were stratified,there was no significant dif-ference in efficacy between A and B considering single drug titration for drug administration according to need or time.Administration approaches in-cluded 2 pellets a time,twice a day(2#BID);1 pellet a time,three times a day(1#TID);1 pellet a time,twice a day(1#BID).When stratification was carried out according to pain severity,efficacy of A and B for moderate pain and severe pain varied between 74.2%-92.3%,55.0%-92.6%,re-spectively.There was no significant difference.Work time,optimal relief time,and duration for A and B were about 0.8 hour,1.5 hour,and 8.2 hour.There was no statistical significance.Incidence of adverse effect for lornoxicam and tramadol was 20.0% and 33.3%,respectively(P&;lt;0.05).Superiority score for them was 7.6&;#177;2.4 and 6.1&;#177;2.1,respectively(P&;lt;0.05).CONCLUSTON:Lomoxicam had favorable effect on moderate and severe cancer pain,and is similar to drug of second rung such as tramadol.But its adverse reactions are slighter and less common compared with tra-madol.Patients‘ content degree for lornoxicam is higher than that for tra-msdol.2#BID,1#TID,1#BID are more common.Considering small sample,its efficacy,therapeutic effect,safety need further investigation.     

THA—A Review of the Literature and Its Use in Treatment of Five Overdose Patients

Abstract

Background: This in vitro investigation was performed to study the adsorption characteristics of fluoxetine to activated charcoal and its commercial formulation Carbomix® powder in simulated gastric (pH=1.2) and intestinal (pH=7.2) fluid environments. Methods: Solutions containing fluoxetine and charcoal were incubated at 37°C for one hour. Reversed phase high performance liquid chromatography was used for the determination of free fluoxetine concentrations (range 0.2–8 ug/mL) in the diluted filtrate. Results: The maximum adsorption capacities at pH 1.2 for activated charcoal and Carbomix were 223 and 333?mg/g, respectively; at pH 7.2 they were 301 and 453?mg/g, respectively. The affinity constant values at pH 1.2 of activated charcoal and Carbomix were 441 and 122 L/g, respectively, while at pH 7.2 they were 482 and 589 L/g, respectively, indicating a strong binding of fluoxetine onto charcoals. Conclusions: Relative to the toxic and lethal doses in cases of fluoxetine intoxications, both types of charcoals tested were found effective for adsorption at gastric and intestinal pH. Adsorbed fluoxetine was significantly increased at intestinal pH, consistent with predominant adsorption of the undissociated form of the drug. We conclude that activated charcoal and Carbomix have adsorptive properties appropriate to medical treatment in cases of fluoxetine overdose