Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2 ml of autologous blood into the superior joint compartment and 1 ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.     

无针喷射心肌打孔给药的实验研究

目的 探讨应用无针喷射技术进行心肌打孔给药的规律.方法 改造INJEX无针注射系统,采用正交实验设计选择注射系统的不同喷射容量、喷口直径,以蓝色墨水对离体心肌组织进行喷射,记录喷射压强及孔道深度,并分析各因素与观察指标的相关性.制作琼脂糖凝胶模型,对其进行喷射打孔,观察喷射液体的分布情况并分析喷口直径与孔道直径的相关性.结果 正交实验结果表明,喷射容量、喷口直径作为两个独立因素影响喷射压强及喷射深度.液体喷射后呈茎叶状分布,喷射孔道直径与喷口直径呈一般线性相关(r=0.96).结论 利用无针喷射技术可实现注射深度及孔道直径可控的心肌打孔给药.     

A transendocardial delivery and intracardiac ultrasound irradiation treatment catheter

Abstract

Objectives: This study introduces the structural design, working principles, performance testing and treatment effects of a newly developed ultrasonic irradiation delivery and treatment catheter system that integrates interventional catheterization technology.

Background: Systemic administration method needs a high dose of gene and induces side effect of non-target organ delivery. Direct intramyocardial injection of a low-dose angiogenic gene followed by insonation treatment can enhance gene expression. So, a novel transendocardial gene delivery and intracardiac ultrasound irradiation strategy was tested.

Methods: The medical interventional ultrasonic therapeutic apparatus is comprised of an ultrasonic irradiation catheter and a host. The ultrasonic irradiation catheter, which is equipped with an advance-and-retreat convenient miniature syringe needle and a miniature piezoelectric transducer on the tip, was used. Twelve dogs were divided into three groups: (1) EGFP and US (EGFP?+?US), (2) EGFP alone and (3) control group. In the EGFP?+?US group, EGFP plasmid DNA (500?µg) was injected and followed by intracardiac insonation. In the EGFP alone group, EGFP plasmid DNA (500?µg) was injected without insonation. In the control group, saline was injected.

Results: The catheter can enter the heart through percutaneous intervention to realize intramyocardial injection, directly irradiate cardiac muscular tissues at close range and correctly control the ultrasonic irradiation energy delivered to cardiac muscular tissues. Compared with the EGFP gene group, an average sixfold enhancement in gene expression was achieved in the EGFP EGFP?+?US group (p?<?0.05).

Conclusions: The experimental results confirmed that the treatment catheter was safe and reliable, which can realize transendocardial intramyocardial gene injection in the left ventricular chamber, and the ultrasonic parameter can increase gene expression after intracardiac ultrasonic irradiation. The intracardiac ultrasound irradiation treatment catheter may be a useful delivery and therapy tool in the future.     

The effects of elevated fibroblast growth factor 23 on mandibular growth in rats

ObjectiveThe aim of this study is to elucidate the local effects of fibroblast growth factor 23 (FGF23) in on mandibular condylar growth in growing rats.DesignGrowing Sprague–Dawley rats received intra-temporomandibular joint injections of phosphate buffer solution (PBS), adenovirus-mediated green fluorescent protein (Ad-GFP) or adenovirus-mediated fibroblast growth factor 23 (Ad-FGF23), which were marked as groups A, B, and C, respectively. In vitro, we treated rat mandibular cartilage chondrocytes with PBS, Ad-GFP, and Ad-FGF23.ResultsThe mandibular condyles in group C grew smaller sizes than those in the other control groups due to significant differences among the experimental and control groups with the value of C–D, Q–R (P ≤ 0.05), accompanied by diminished bone mass of sub-cartilage condyles via micro CT analysis. Histologically, the length of the hypertrophic zone was diminished and was associated with decreasing chondrocyte proliferation in group C. Quantitative real-time PCR indicated significant decreases in the expression of chondrogenesis marker genes, including Type X collagen (Col X) and SRY-type box 9 (Sox 9). Moreover, elevated Ad-FGF23 suppressed chondrocyte proliferation and the expression of the chondrogenic differentiation markers Col X and Sox 9 of in vitro.ConclusionsLocal injection of FGF23 suppressed the development and decreased the bone mass of condyles through the decreasing the formation of condylar cartilage, specifically by regulating condylar cartilage cell viability and chondrogenesis expression.     

中医治疗恶性腹水研究简况

恶性腹水是肿瘤常见并发症,常规治疗方法疗效欠佳。中医药治疗恶性腹水近年来取得较满意的效果,有内治、外治、腔内注射、艾灸等治疗方法。     

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.     

Change of site of intra-articular injection of hypertonic dextrose resulted in different effects of treatment

Most minimally invasive treatments for dysfunction of the temporomandibular joint (TMJ) are empirical, and aimed at the painful trigger points with the purpose of preventing muscular spasm and restoring normal function. In this prospective study I investigated whether the choice of site of injection of hypertonic dextrose affected the benefits of treatment of internal derangement and pain. I studied 72 patients with pain and clicking as a result of dysfunction of the TMJ. Patients were divided into four groups with four separate sites for intra-articular injection. Dextrose was injected into the superior joint space, inferior joint space, retrodiscal tissue, and anterior capsule injection. Results showed that the retrodiscal site was the most effective for reducing clicking and subsequently improving derangement, while the inferior joint space was the best site for the relief of pain, and the extracapsular site should be used in cases of hypermobility. In conclusion, the injection site should be selected according to the symptoms being treated, and could be used as an adjunct to other sites to improve outcome.     

注射用两性霉素B治疗艾滋病/HIV感染合并深部真菌感染的不良反应及防护

目的:为临床合理应用注射用两性霉素B(AMB)治疗人类免疫缺陷病毒(HIV)感染或艾滋病(AIDS)合并深部真菌感染提供参考。方法:收集某院2010年1月至2012年2月期间住院治疗的3 202例HIV/AIDS患者的临床资料,分析其中使用AMB治疗深部真菌感染患者的不良反应(ADR)发生及防护。结果:HIV/AIDS合并深部真菌感染患者948例,感染率为29.61%;899例使用AMB,其中18例出现ADR,发生率为2.00%。AMB静脉滴注的ADR主要表现为发热、腹泻、瘙痒、肝功能异常及血液系统毒性。及时停药或减量,同时对症治疗,可有效地减少、减轻药物的ADR。结论:AMB虽ADR多见,但其疗效确切,是治疗HIV/AIDS合并深部真菌感染比较安全、有效、经济的选择。只要合理用药,严密监测用药后患者病情进展,尽早发现ADR,及时采取有效措施,并将心理护理贯穿治疗始终,就能保证患者治疗的顺利进行。     

Establishment of safety evidence for Xingxue Shuxuening injection

OBJECTIVE： To systematically investigate the safety of Xingxue Shuxuening injection（SXN） in preand post-marketing, and to ensure clinical drug safety.METHODS： Strict quality control in raw herb selection and production processes was adopted and pharmacology research on SXN was performed by the drug manufacturing company, Heilongjiang ZBD Pharmaceutical Co., Ltd. We systematically reviewed the safety literature of Xingxue SXN. Adverse drug reaction（ADR） data of the drug, extracted from Spontaneous Reporting System（SRS）, and clinical characters based on 20 hospital information systems（HIS） in China, were analyzed. Large-scale prospective safety monitoring and Risk Minimization Action Plans（Risk MAPs） of XingxueSXN were carried out.RESULTS： The quality of SXN was stable and controllable when it was produced. Drug toxicology studies found no effect on rabbits with hemolytic or condensed, local stimulation and muscle stimulation, and no allergic reactions in guinea pigs. The ADRs of Xingxue SXN were dizziness, phlebitis,and vomiting based on SRS data. The injection did not conform to instructions in clinical practice when we analyzed HIS database, and patient＇s abnormal blood urea nitrogen levels may be related to the drug, when analyzed using the propensity score method. A nested case-control study was designed and performed to analyze the influencing factors of suspected allergic reactions to SXN. The study showed that patients with an allergy history were more prone to allergic reactions（P〈0.001）,and some medicine combinations could cause allergic reactions.CONCLUSION： These studies have established a body of evidence on Xingxue SXN safety, and provide a good model for Chinese medicine injection for clinical safety. The Xingxue SXN production process and toxicology research indicate the safety of the injection. However, the use of the injection is not consistent with instructed clinical practice.Xingxue SXN causes ADRs perhaps from inappropriate usage or its