Does operative fixation of isolated fractures of ulna shaft results in different outcomes than non-operative management by long arm cast?

Objective

The optimal treatment for isolated fractures of ulnar shaft is debatable. The purpose of this study was to compare functional outcomes and radiological union in patients treated for isolated fractures of the ulnar shaft by open reduction and internal fixation and a long arm cast.

种植体即刻负重或早期负重与延期负重相比对种植体成功率影响的Meta分析

目的系统评价种植体即刻负重或早期负重与延期负重相比对种植体成功率的影响。方法计算机检索PubMed、EMbase、CNKI等数据库,收集1997~2007年间国内外所有有关种植体即刻负重或早期负重与延期负重对比的随机对照试验或前瞻性病例对照研究。对纳入研究进行质量评价、数据提取,并进行Meta分析。结果共检索到16篇符合纳入与排除标准的文献,剔除两篇重复报道后,纳入14个研究进行Meta分析,其中5篇为随机对照试验。Meta分析结果显示,与延期负重相比,早期负重种植体失败率略低,但差异无统计学意义[OR=0.54,95%CI(0.22,1.33),P=0.18];纳入所有病例对照研究再分析以及进行敏感性分析,结果也是如此。与延期负重相比,即刻负重种植体总失败率更大,但差异无统计学意义[OR=1.51,95%CI(0.53,4.25),P=0.44];分析随机对照试验时虽有即刻负重更有利于种植体成功的趋势,但差异亦无统计学意义;进行敏感性分析时除剔除Jo等的文献后结果不一样外,其余结果均显示即刻负重与延期负重对种植体成功率的影响无统计学差异。结论现有的有限证据表明,当骨质较好(至少为Ⅲ级骨)时,早期负重比延期负重有更有利于种植体成功的趋势;而即刻负重和延期负重相比,种植体成功率差异无统计学意义。受纳入文献数量和质量的限制,本次Meta分析结果尚有待于高质量的大样本随机对照试验以予证实。     

The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial

Non‐removable offloading is the ‘gold standard’ treatment for neuropathic diabetic plantar forefoot ulcers. However, removable offloading is the common ‘standard of care’. We compared three removable offloading devices for ulcer healing efficacy. In this multicentre, randomised controlled trial, 60 persons with neuropathic diabetic plantar forefoot ulcers were randomly assigned to wear a custom‐made knee‐high cast [BTCC (bivalved TCC)], custom‐made ankle‐high cast shoe or a prefabricated ankle‐high forefoot‐offloading shoe (FOS). Primary outcome was healing at 12 weeks. Dynamic plantar pressures, daily stride count and treatment adherence were assessed on a randomly selected subset (n = 35). According to intention‐to‐treat analysis, 58% of patients healed with BTCC [OR 0·77 (95% CI 0·41–1·45) versus FOS], 60% with cast shoe [OR 0·81 (95% CI 0·44–1·49) versus FOS] and 70% with FOS (P = 0·70). Mean ± SD peak pressure in kPa at the ulcer site was 81 ± 55 for BTCC, 176 ± 80 for cast shoe and 107 ± 52 for FOS (P = 0·005); stride count was 4150 ± 1626, 3514 ± 1380 and 4447 ± 3190, respectively (P = 0·71); percentage of 2‐week intervals that patients wore the device <50% of time was 17·3%, 5·2% and 4·9%, respectively. Non‐significant differences in healing efficacy between the three devices suggest that, when non‐removable offloading is contraindicated or not available, each can be used for plantar forefoot ulcer offloading. Efficacy is lower than previously found for non‐removable offloading maybe because suboptimal adherence and high stride count expose the patient to high repetitive stresses. These factors should be carefully considered in decision making regarding ulcer treatment.     

Analysis of the factors causing tight cast syndrome after closed reduction and casting of pediatric distal radius fractures

Objective

The aim of this study was to evaluate the most important factors which can cause “tight cast syndrome’’ (TCS) in pediatric patients with distal radius fractures.

Food-dependent disintegration of immediate release fosamprenavir tablets: In vitro evaluation using magnetic resonance imaging and a dynamic gastrointestinal system

In the present study, we demonstrated the value of two advanced tools, the TNO gastric and small Intestinal Model (TIM-1) and magnetic resonance imaging (MRI), for the in vitro evaluation of food-dependent disintegration of immediate release fosamprenavir tablets. Upon introduction of a tablet with the nutritional drink Scandishake Mix® in the stomach compartment of TIM-1, simulating the fed state, disintegration and fosamprenavir dissolution were significantly postponed compared to the fasted state (lag time 80 ± 23 min). This resulted in a lag in the appearance of bioaccessible fosamprenavir (<5% during the first 2 h), even though the nutritional state did not significantly alter the cumulative bioaccessibility after 5 h. These results were in agreement with the previously observed postprandial delay in gastric fosamprenavir tablet disintegration and subsequent amprenavir absorption in healthy volunteers. Therefore, TIM-1 can be used in tablet development to identify food-induced disintegration issues causing unexpected clinical behavior. From a mechanistic perspective, we applied MRI to illustrate impaired water ingress in fosamprenavir tablets immersed in the nutritional drink compared to simulated gastric fluid. This effect may be attributed to both competition between nutritional components and the tablet for the available water (indicated by reduced rotational and translational diffusion) as well as the possible formation of a food-dependent precipitation layer on the HPMC-coated tablet.     

即刻种植和常规种植在牙齿缺失修复中的临床应用效果

目的通过与常规种植对比,探讨即刻种植在牙齿缺失修复中的临床效果。方法选择2010年6月～2011年6月在我院因牙齿缺失进行牙齿种植的患者60例,随机分为研究组和对照组各30例。研究组采用即刻种植法．对照组采用常规种植法,比较两组的近期疗效和远期疗效。结果两组1、3、6个月的ISQ值比较．差异无统计学意义（P〉0．05）;不同时间点组内比较,差异也无统计学意义（P〉0．05）;随访24个月,两组牙齿松动、牙周组织红肿及溢脓情况比较,差异无统计学意义（P〉0．05）。结论牢固掌握即刻种植的适应证及操作要点,选择即刻种植可以达到与常规种植相似的临床效果,同时能够缩短治疗疗程、减轻患者痛苦。     

Algorithm for an Aesthetically Pleasing Nipple–Areola Complex with the Use of the C-V Flap in Cases of Skin-Sparing Mastectomy and Immediate Reconstruction

Background  This article provides an algorithm for achieving an aesthetically pleasing nipple–areola complex in cases of skin-sparing mastectomy and immediate reconstruction Methods  If the contralateral nipple was big enough and the nipple-sharing technique could be used in the future for reconstruction, we left a round skin paddle at the time of the skin-sparing mastectomy and immediate flap reconstruction. The diameter of the round skin paddle was approximately the same as the contralateral areola. For nipple reconstruction we placed the graft from the contralateral nipple in the middle of the aforementioned skin paddle. If the contralateral nipple was not sufficiently large for use as a donor, then the C-V flap was used for nipple reconstruction. In these cases we deliberately left an oval skin paddle when the skin-sparing mastectomy and immediate flap reconstruction were performed. The short diameter of the oval skin paddle was approximately the same as the diameter of the contralateral areola. The position and the height of the C-V flap were marked in order to transform the oval skin paddle to a round one when the donor site of the C-V flap was closed. Results  Following this algorithm an optical illusion of a nipple–areola complex that is similar to the contralateral normal one is created. Conclusion  From our experience this algorithm can help create an aesthetically pleasing nipple–areola complex and also provides a ready pattern to our tattoing experts for the dermatography of the nipple–areola complex.     

Quantifying the amount of padding improves the comfort and function of a fibreglass below-elbow cast

Aim

To determine the quantity of cotton underpadding needed for a comfortable, functional, below-elbow fibreglass cast.

Methods

In this randomised, prospective, crossover, clinical trial, 45 people with minimally displaced distal radial fractures were enrolled to randomly receive, 14 days after injury, a fibreglass below-elbow cast with either two or four layers of cotton underpadding. The characteristics of the recipients were recorded. After 2 weeks of immobilisation, participants completed a numerical survey evaluating parameters of comfort and underwent clinical and radiographic assessment. They then crossed over to receive the other fibreglass cast design, the process was repeated, and they indicated their cast preference, if any.

Results

Of 37 people who completed the study, 20 preferred the two-layer model, 13 the four-layer model and 4 had no preference. No significant trend for one design over the other was shown (p = 0.1), nor any statistical association between preference and participant characteristics or the order in which cast models were received.

Conclusions

Participants did state a preference, but this was not related to recipient characteristics. Neither cast design was significantly the more comfortable; and both models were safe and functionally satisfactory.     

上颌前牙单牙即刻非功能性负重种植的临床研究

目的探讨上颌前牙美观区单牙即刻非功能性负重人工牙种植的临床效果。方法对26例26颗上颌前牙种植者,在置入种植体的同时,接入临时基台行复合树脂暂时冠临时修复,2～6个月后,更换永久性烤瓷冠修复体。结果种植体置入后,随访12-72个月,没有种植体丢失。前12个月平均边缘骨丧失为0．78mm,随访期内,累积平均骨丧失为1．17mm。结论严格掌握适应证,上颌前牙单牙即刻非功能负重种植,能满足患者临时的美观需求,临床效果良好。