负压封闭引流技术在骨科的临床应用进展

负压封闭引流(VSD)技术是临床上用来加速组织愈合、恢复外形及功能的重要治疗方法,最初应用于治疗软组织损伤和开放性骨折,在不断地优化后,现运用于各种类型疾病中,并取得了良好效果。随着对VSD技术在软组织损伤、创面感染和术后切口感染、骨筋膜室综合征、皮肤移植修复、骨髓炎的疗效及作用机制的深入研究,VSD技术已然变成近几年研究的热门之一。目前该技术已日臻完善,覆盖骨科疾病治疗的范围也逐年扩大,在临床疗效上获得了广泛认可,当然,这其中也存在美中不足的部分,需要各方人员不断推陈出新,共克难关。本文就负压封闭引流技术在骨科的临床应用进展作一综述,以利于VSD技术在临床中推广和进一步发展应用。     

Revision arthroplasty for periprosthetic joint infections: When to consider one-stage versus two-stage protocols?

For chronic periprosthetic joint infection, two-stage exchange arthroplasty has long remained the gold-standard treatment, but has come under scrutiny of late. Recent studies have shown increased costs, unacceptably high rates of recurrence for resistant organisms, and lower than expected rates of eventual reimplantation for subjects treated in a two-stage fashion. While the appeal of single-stage exchange arthroplasty has grown, rigorous data is lacking for universal application for all infections. Improvements in patient selection with set criteria for appropriate use will better define a treatment algorithm for optimum periprosthetic joint infection management moving forward.     

The pattern of infection and antibiotics use in terminal cancer patients

BackgroundAlthough cancer patients are susceptible to infection, there is no evidence-based published guideline on the appropriate use of antimicrobial treatment in this group of patients.MethodsWe retrospectively collected medical records of all terminal cancer patients who died in the oncology department over a 15-month period and were reviewed for the pattern of infection and causes of antimicrobial use during the patients’ last admission of life.ResultsA total of 258 eligible patients were enrolled, there was an equal distribution of males and females (M/F: 129/129), and the mean age was 60.5 years. 221 patients admitted with fever (85%), 22 patients (8.5%) got fever after hospitalization and 15 patients (5.8%) did not suffer from fever. Among patients with fever, 46 patients (18.9%) had two infection episodes and 197 patients (81.1%) had only one infection episode. The culture results revealed positive in 98 patients (40%) with gram-negative organisms were the dominant organisms. The major infection sites were the respiratory tract, urinary tract and wound. 114 patients (47%) received one antibiotic and 129 patients (53%) received more than one. The mean duration of hospitalization was significantly longer for infected patients than for uninfected patients (8.00 vs. 18.15 days, p = 0.0001). Outcome of antibiotic use revealed 42 patients (17.3%) with symptoms improved 71 patients (29.2%) with stationary symptoms and 130 patients (53.5%) revealed symptom deterioration.ConclusionsOur study revealed that antibiotic therapy for terminal cancer patients should be on a clear rationale. We need further study to clarify if there is survival effect with antibiotic use or not.     

Control of HIV infection: Escape from the shadow of Blimp‐1

Prior murine studies have demonstrated the pivotal role that Blimp‐1 has in the exhausted phenotype of T lymphocytes in chronic viral infection. In this issue of the European Journal of Immunology, Seddiki et al. [Eur. J. Immunol. 2013. 43: 510–520] demonstrate the applicability of this research to HIV infection. The authors do so by demonstrating differences in Blimp‐1 expression between T lymphocytes isolated from patients with chronic active HIV versus those from long‐term nonprogressors and showing that this is matched by differences in the cells’ capacity to produce IL‐2 and the level of expression of the inhibitory receptor PD‐1. The data presented here suggest that this may relate to differential regulation of Blimp‐1 by the micro RNA, mIR‐9. These findings complement current murine work and fit squarely within the research priorities, as outlined by the International AIDS Society, for determining a cure for AIDS.     

医院就诊患者肠道寄生虫感染状况调查

目的 了解医院就诊患者肠道寄生虫感染情况及临床特点,为健康状态的评估和采取有效防控措施提供依据.方法 对2010～2011年39 671例在广西医科大学第一附属医院就诊患者进行肠道寄生虫的病原学检查,并分析阳性患者的感染情况.结果 共查出感染者5 751例,总感染率为14.50％.检出8种寄生虫,感染率分别为华支睾吸虫5.96％、蛔虫0.45％、鞭虫0.24％、钩虫2.46％、溶组织内阿米巴0.82％、人芽囊原虫3.91％、蓝氏贾第鞭毛虫0.65％、人毛滴虫0.09％.男性感染率为16.78％,女性为10.77％,男性显著高于女性(P＜0.001); 30～岁组感染率最高,为24.19％;感染者大多有不良饮食习惯和或卫生习惯；感染者临床表现复杂多样、无特异性.结论 医院就诊患者土源性线虫感染率较低,但华支睾吸虫和人芽囊原虫感染率较高,是今后防治的重点,除早期诊断和药物治疗患者外,还应加强宣教工作力度,提高人群的疾病预防意识.