Patients’ first-year adherence to different anti-osteoporotic therapy after hip fractures

BackgroundOsteoporosis medication treatment is recommended after geriatric fractures. However, the percentage of patients receiving anti-osteoporotic treatment after a hip fracture is extremely low.ObjectivesThe aim of this study was to evaluate the adherence to different anti-osteoporotic medications in elderly patients following hip fracture.MethodsThis retrospective study included 520 patients treated with osteoporotic hip fracture between March 2014 and June 2019. The patients were asked to choose the medication for osteoporosis treatment at discharge. Adherence was monitored by follow-up visits to the outpatient clinic at 1 year following surgery.ResultsOf 520 patients with baseline data, osteoporosis medications were prescribed to 250 (48.1%) patients. Of these patients, 110 (44.0%) took subcutaneous denosumab, 69 (27.6%) took oral selective estrogen receptor modulator, 55 (21.0%) took intravenous bisphosphonate. At 12 months, we followed up 178 (71.2%) patients. Of those prescribed a bone protection medication, only 85 patients (34.0%) reported still taking their medication 1 year later. The rate of adherence to 6-month subcutaneous denosumab injection was significantly higher than that for quarterly intravenous bisphosphonates (p = 0.024) or daily oral tablets (p = 0.028). Conclusions: This study revealed patients' adherence for osteoporosis treatments after hip fracture. 6-month subcutaneous denosumab injection was preferred over 3-month intravenous injection or daily oral tablets in this elderly population and exhibited significant lower discontinuation rates. However, because of the limited power of the study, further research is required to identify the reasons behind non-adherence and to improve adherence to anti-osteoporosis medications.     

宫颈人乳头瘤病毒感染治疗的研究进展

高危型人乳头瘤病毒(HPV)感染与子宫颈癌密切相关,越来越多的女性饱受该病毒带来的困扰。治疗HPV感染对预防宫颈癌至关重要,现代医学关于HPV感染的治疗方式主要有物理治疗、药物治疗、手术治疗及多种新型治疗方式。本文在查阅文献的基础上发现,不同治疗方式各有优劣,将多种治疗方式联合应用,可以提高宫颈细胞学检查及HPV转阴率,从而达到最佳疗效。     

Chin-on-Chest in Neck of Femur Fracture (COCNOF) sign: A simple radiographic predictor of frailty and mortality in hip fracture patients

IntroductionFragility fractures are a significant public health challenge often occurring as a result of frailty. Identifying patients who have increased risk of adverse outcomes can aid treating teams in managing these patients appropriately. We hypothesise that the appearance of the patient's head overlapping the lung fields (named Chin on Chest in Neck of Femur sign (COCNOF)) in the admission chest radiograph was a predictor of increased mortality at 3, 6 and 12 months.MethodsAll consecutive patients admitted with hip fracture between 1^st January – 31st December 2019 were analysed. We collected patient characteristics, AMTS score, ASA grade, length of stay, place of discharge, Nottingham Hip Fracture Score, Rockwood Frailty score, Charlson Comorbidity Index and presence of COCNOF sign. The main outcome measures were mortality at 90 days, six months and 12 months following admission.Results469 patients with a mean age of 81.9 (SD 8.4) were included. 18% of patients were COCNOF positive. Univariate analysis showed positive COCNOF sign to be associated with higher mortality at 90 days (19.1 vs 10.8%; RR 1.95, 95%CI 1.05 – 3.63,p=0.03), six months (31.5% vs 14.2%; RR 2.77, 95%CI 1.62 – 4.72, p<0.001) and twelve months (41.6% vs 17.1%; RR 3.45, 95%CI 1.62-4.72, p<0.001). In the multivariate regression models the strongest predictors of mortality were age, gender and CCI it is therefore likely that the COCNOF sign is acting as a surrogate marker of these variables within the univariate models.ConclusionOur results suggest that COCNOF sign is a simple radiographic marker which can be used to identify patients with higher levels of frailty and increased risk of mortality following hip fracture.     

消退素在牙髓、根尖周及牙周组织炎症环境中的活髓保存及再生作用

背景:细菌感染是牙髓及根尖周组织感染的主要病因,保存活髓和再生牙髓逐渐成为临床治疗牙髓及根尖周疾病的重要研究方向。消退素(resolvin)是ω-3多不饱和脂肪酸衍生而来的脂质介质,具有促进组织炎症消退、炎症状态恢复的作用。目的:回顾消退素在炎症调控中的研究进展及其在牙髓、根尖周及牙周组织炎症中的应用,以期为临床牙髓组织炎症状态的恢复及再生提供研究基础。方法:应用计算机在PubMed数据库、维普数据库、万方数据库及中国知网(CNKI)中国期刊全文数据库检索2014年1月至2020年6月相关文献,以“消退素,作用,信号通路”为中文检索词,以“resolvin,effect,signaling pathway”为英文检索词,最终纳入35篇文献归纳总结消退素的作用;以“消退素,牙髓炎,根尖周炎,牙周炎,口腔”为中文检索词,以“resolvin,pulptitis,periapical,periodontitis,dental”为英文检索词,最终纳入31篇文献归纳总结消退素在口腔不同组织和疾病中的应用,其余3篇解释说明文章内容。结果与结论:文章系统回顾了消退素的种类及作用,详细回顾了消退素在牙髓、根尖周及牙周组织炎症性疾病中的作用及机制,为其临床应用于牙髓组织炎症后的活髓保存及再生提供研究依据。     

大芬戈尔德菌致肱骨骨髓炎1例报道并文献复习

目的了解大芬戈尔德菌的特点及其引起疾病的临床特征,提高对该菌引起感染性疾病的认识。方法回顾性分析1例诊断为大芬戈尔德菌骨髓炎患者的临床资料,结合文献复习探讨大芬戈尔德菌感染性疾病的特征。结果该例患者临床表现和实验室检查符合大芬戈尔德菌感染性骨髓炎的特征,脓液和组织培养有大芬戈尔德菌生长,术后无复发。复习、汇总文献及该例患者,共32例(男性13例,女性10例,9例未提及),其中骨和关节(包括假体)感染16例、感染性心内膜炎5例、蜂窝织炎3例、乳腺感染3例、其他5例;临床表现主要与受累组织系统相关。31例经外科手术联合抗菌药物治疗后痊愈,1例血流感染患者死亡。结论骨关节感染,尤其假体植入后关节感染,应警惕大芬戈尔德菌所致,必要时给予经验性抗厌氧菌治疗。     

尝试教学法在普外科急腹症教学中的应用

目的探讨尝试教学法在临床教学中的应用价值。方法选取2019年8—9月在滨州医学院附属医院进行外科学急腹症临床见习的滨州医学院临床医学专业2016级本科见习生共40名作为研究对象。采用随机分组法将其分为实验组与对照组,由同一指导老师分别采用尝试教学法及传统教学法进行授课,待课程结束后及时进行考核,来对比两种教学方法的效果。结果实验组学生在基础理论知识、临床操作技能、诊疗思维均优于对照组,在外科学习兴趣、临床操作能力、阅读文献能力、理论联系临床能力及临床诊疗思维等方面均较对照组明显提升,差异均具有统计学意义(P<0.05)。结论尝试教学法在临床实践教学中具有应用价值。