In Vivo Kinematics of Functional Ankle Instability Patients and Lateral Ankle Sprain Copers During Stair Descent

Patients with mechanic ankle instability experience increased tibiotalar and subtalar joint laxity. However, in vivo joint kinematics in functional ankle instability (FAI) patients and lateral ankle sprain (LAS) copers, especially during dynamic activities, are poorly understood. Ten FAI patients, 10 LAS copers, and 10 healthy controls were included in this study. A dual fluoroscopic imaging system was used to analyze the tibiotalar and subtalar joint kinematics during stair descent. Five key poses of stair descent were analyzed. Kinematic data from six degrees of freedom were calculated utilizing a solid modeling software. The range of motion and joint positions in each degree of freedom were compared among the three groups. The tibiotalar joints of FAI patients and LAS copers were significantly more inverted than those of healthy controls during the foot strike (p = 0.016, = 0.264). The subtalar joints of FAI patients were significantly more anteriorly translated (pose 2, p = 0.003, = 0.352; pose 3, p < 0.001, = 0.454; pose 4, p = 0.004, = 0.334), inverted (pose 4, p = 0.027, = 0.234; pose 5,p = 0.034, = 0.221), and externally rotated (pose 4, p = 0.037, = 0.217; pose 5; p = 0.004, = 0.331) than those of healthy controls during the mid‐stance and the heel off. The FAI patients showed excessive tibiotalar inversion and subtalar joint hypermobility during stair descent. Meanwhile, the LAS copers maintained subtalar joint stability, and only showed excessive tibiotalar inversion in foot strike. These data provide insight into the mechanisms behind the development of FAI after initial LAS. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1860–1867, 2019     

生物型与骨水泥型假体全髋关节置换术治疗老年移位型股骨颈骨折的疗效分析

目的 比较生物型与骨水泥型假体全髋关节置换术(THA)治疗老年移位型股骨颈骨折(DFNF)的临床疗效.方法 前瞻性纳入2015年7月—2018年6月佳木斯大学附属第一医院骨科收治的老年DFNF患者128例,男性71例,女性57例;年龄61～84岁,平均72.7岁.骨折原因:跌伤75例,撞伤32例,高处坠落伤21例.依据随机数字表法分为生物型假体THA组(BPTHA组,n=64)与骨水泥型假体THA组(CPTHA组,n=64).BPTHA组行生物型假体髋关节置换,CPTHA组行骨水泥型假体髋关节置换.观察两组术中出血量、手术时间、术后引流量等围术期指标及住院时间.比较术前及术后6、12个月髋关节功能(Harris),血清前列腺素缓激肽(BK)、5-羟色胺(5-HT)等疼痛因子水平及视觉模拟评分(VAS),血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)、红细胞沉降率(ESR)等炎性反应指标水平;分析术后并发症发生情况.结果 两组术中出血量、手术时间、术后引流量差异均无统计学意义(P>0.05);BPTHA组住院时间长于CPTHA组[(19.76±2.24)d vs.(15.37±1.71)d,P<0.05].术后6个月,BPTHA组Harris评分低于CPTHA组[(81.72±8.37)分vs.(86.68±8.85)分,P<0.05];术后12个月,BPTHA组Harris评分高于CPTHA组[(95.54±9.67)分vs.(90.72±9.12)分,P<0.05].术后6个月,BPTHA组血清BK、5-HT、SAA、CRP、ESR水平及VAS均高于CPTHA组(P<0.05);术后12个月,BPTHA组血清BK、5-HT、SAA、CRP、ESR水平及VAS均低于CPTHA组(P<0.05).BPTHA组并发症发生率为3.13％,CPTHA组并发症发生率为4.69％,两组比较差异无统计学意义(P>0.05).结论 BPTHA、CPTHA均可应用于老年DFNF的临床治疗,但CPTHA近期疗效优于BPTHA,而BPTHA远期疗效优于CPTHA.     

Effects of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer: A protocol of randomized controlled trial

Background:Gastrointestinal complications and malnutrition are common problems that affect postoperative rehabilitation and survival of patients with esophageal cancer. Evidence has shown that probiotics have a positive effect on improving gastrointestinal complications and nutritional status of patients with esophageal cancer after surgery, but there is a lack of prospective studies on this topic. We designed this prospective randomized controlled trial to evaluate the effects of probiotics on gastrointestinal complications and nutritional status in patients with postoperative esophageal cancer.Methods:This is a prospective, randomized, double-blind, placebo-controlled trial. It was approved by the Clinical Research Ethics Committee of our hospital. 192 patients will be randomly divided into probiotics group and the placebo group in a 1:1 ratio. After operation, probiotics and placebo will be given orally for 8 weeks. The indexes of nutritional status and incidence of digestive tract complications will be recorded and the data will be analyzed by SPSS 18.0 software.Discussion:This study will evaluate the effect of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer. The results of this study will provide clinical basis for the use of probiotics in postoperative treatment of esophageal cancer.Trial registration:OSF Registration number: D DOI 10.17605/OSF.IO/QHW86     

Impact of overweight and obesity on US renal cell carcinoma incidence trends (1995-2018)

In the United States, renal cell carcinoma (RCC) incidence and the prevalence of obesity, an established risk factor for RCC, have been increasing for several decades. RCC is more common among older individuals. We sought to quantify the contribution of excess adiposity to the rising incidence of RCC among individuals 60 years or older. National Institutes of Health-American Association of Retired Persons Diet and Health Study data (n = 453 859 participants, enrolled in 1995-1996, age at enrollment 50-71 years) were used to estimate multivariable-adjusted hazard ratios (HRs) for RCC across body mass index categories and HRs associated with smoking. Population attributable fractions (PAFs) were calculated using estimated HRs and annual overweight/obesity prevalence from the National Health Interview Survey (1985-2008). PAF estimates were combined with RCC incidence from Surveillance, Epidemiology and End Results-13 to calculate annual percent changes in RCC incidence attributable (and unrelated) to overweight/obesity. We found that between 1995 and 2018, among individuals aged 60 years and older, PAF for overweight/obesity increased from 18% to 29% for all RCCs. In comparison, the PAF for smoking declined from 12% to 9%. RCC incidence increased 1.8% per year (95% confidence interval [CI] 1.5%-2.1%) overall, while RCC incidence attributable to overweight/obesity increased 3.8% per year (95%CI 3.5%-4.2%) and RCC incidence unrelated to overweight/obesity increased 1.2% per year (95% CI 0.9%-1.4%). In conclusion, overweight/obesity appears to have contributed importantly to the rising incidence of RCC in the United States since the mid-1990s. Public health interventions focused on reducing overweight and obesity could help substantially in curbing this trend.     

Dorsal suspension for Morton’s neuroma: A comparison with neurectomy

BackgroundThe purpose of this study was to investigate and compare the clinical outcomes of dorsal suspension with those of neurectomy for the treatment of Morton’s neuroma.MethodsWe conducted a retrospective study of dorsal suspension and neurectomy group. The dorsal suspension was performed by dorsal transposition of neuroma over the dorsal transverse ligament after neurolysis. The visual analog scale (VAS), the Foot and Ankle Ability Measure (FAAM), postoperative satisfaction, and complications were evaluated.ResultsBoth groups reported significant pain relief, and there were no significant differences between the groups with respect to postoperative pain. The postoperative FAAM outcomes showed no significant between-group differences. Satisfaction analysis showed ‘excellent’ and ‘good’ results in the dorsal suspension and neurectomy groups (95% and 77.7%, respectively). Complications of numbness and paresthesia reported in the dorsal suspension group (5% and 5%, respectively) were significantly fewer than those of neurectomy group (61.1% and 33.3%, respectively) (both, p < .05).ConclusionsWith its favorable results, dorsal suspension can be another operative option for the treatment of Morton’s neuroma.Level of Evidence: Level III, retrospective comparative case series.     

蒙特卡罗模拟法评价第一代头孢菌素预防手术部位感染的给药方案

目的：探讨第一代头孢菌素预防Ⅰ类切口手术部位感染的既往方案在目前微生物药敏下的预防效果。方法：基于药动学/药效学（PK/PD）理论利用蒙特卡洛模拟法进行探讨。以头孢唑林和头孢噻吩为考察药物，金黄色葡萄球菌、凝固酶阴性葡萄球菌和链球菌属为目标菌群，给药间期内游离药物浓度位于最低抑菌浓度（MIC）之上的时间占一个给药间期的百分比（fT>MIC）为PK/PD靶指数，利用蒙特卡罗模拟头孢唑林和头孢噻吩既往方案对抗目标菌群达到PK/PD靶指数的累积反应分数（CFR）≥90%为标准探讨给药策略及预防效果。结果：对于成人（体质量以60 kg计），头孢唑林仅“1 g，q 2 h”“2 g，q 4 h”“3 g，q 4 h”和“术前1 g；术中0.5 g，q 2 h”的方案，头孢噻吩仅“2 g，q 3 h”和“术前2 g；术中1 g，q 3 h”的方案对各目标菌群的CFR≥90%，两者其他的既往方案均无法达到CFR≥90%标准。结论：应用第一代头孢菌素预防Ⅰ类切口手术部位感染时，应注意选择合适的给药方案（CFR≥90%），以确保预防效果。