Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears

Purpose of ReviewThe role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes.Recent FindingsSurgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion.SummaryMeniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.     

Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management

Purpose of Review8.5 to 50% of total joint arthroplasty (TJA) patients are reported to have preoperative malnutrition. The narrative review identifies the relationship between preoperative malnutrition for TJA patients and postoperative outcomes as well as the use of perioperative nutritional intervention to improve postoperative complications.Recent FindingsBiochemical/laboratory, anthropometric, and clinical measures have been widely used to identify preoperative nutritional deficiency. Specifically, serum albumin is the most prevalent used marker in TJA because it has been proven to be correlated with protein-energy malnutrition due to the surgical stress response. However, there remains a sustained incidence of preoperative malnutrition in total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients due to a lack of agreement among the available nutritional screening tools and utilization of isolated laboratory, anthropometric, and clinical variables. Previous investigations have also suggested preoperative malnutrition to be a prognostic indicator of complications in general, cardiac, vascular, and orthopaedic surgery specialties.SummarySerum albumin, prealbumin, transferrin, and total lymphocyte count (TLC) can be used to identify at-risk patients. It is important to employ these markers in the preoperative setting because malnourished TKA and THA patients have shown to have worse postoperative outcomes including prolonged length, increased reoperation rates, increased infection rates, and increased mortality rates. Although benefits from high-protein and high-anti-inflammatory diets have been exhibited, additional research is needed to confirm the use of perioperative nutritional intervention as an appropriate treatment for preoperative TJA patients.     

人参果总皂苷(SFPG)联合舍曲林治疗高血压病合并抑郁症的疗效及副反应观察

摘要 目的 探讨人参果总皂苷(SFPG)联合舍曲林治疗高血压病合并抑郁症的临床疗效及安全性。方法 选取88例高血压病合并抑郁症患者随机分为SFPG加舍曲林组和舍曲林单用组,在治疗前和用药后2,4,6周用HAMD评分量表评定其疗效,以TESS量表评定并观察两者的副作用。结果 治疗6周末,与舍曲林单用组相比,联合组HAMD评分的减分率有显著性差异,且不良反应明显减少(P<0. 01) ,合用组有效率为93.00%,单用组有效率为77.80%,两比较差异有显著性(P<0. 01)。两组患者用药6周TESS评分比较有显著性差异 (P<0. 01)。结论 SFPG对高血压病合并抑郁症的治疗有显著的辅助作用,副反应较单用舍曲林减少。     

教学过程的规范化研究

通过教学过程规范化的研究和实施 ,将“全面质量管理”的理念引入教学管理工作中 ,明确岗位职责 ,量化考核工作实绩 ,使教师养成求真务实、精益求精的工作作风 ,克服工作中的随意性 ,减少失误 ,提高教学工作整体质量和效率 ,从而保障优秀人才的培养。     

Therapeutic effects of total alkaloids of Tripterygium wilfordii Hook f. on collagen-induced arthritis in rats

Ethnopharmacological relevance

Tripterygium wilfordii Hook f. is one of Traditional Chinese Medicines which is commonly used to treat rheumatoid arthritis (RA). The total alkaloids were the main constituent part of Tripterygium wilfordii Hook f. It has a great significance to study the effects of the total alkaloids of Tripterygium wilfordii Hook f. (ATW) on RA.

Aim of the study

This paper aims at investigating the therapeutic effect of ATW on RA and its possible mechanism, and providing a theoretical and experimental basis for the clinical use of ATW.

Materials and methods

The model of wistar rats of type II collagen-induced arthritis (CIA) was made, and the rats were perfused a stomach with ATW for 4 weeks continuously. Then the levels of interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-<alpha>, in the serum of CIA rats were detected by enzyme linked immunosorbent assay (ELISA), and the joint pathological section of CIA rats was observed by hematoxylin and eosin (HE) staining method and the expression of IL-6, IL-8, nuclear factor kappa B (NF-κB), TNF-α were measure by immunohistochemistry staining method.

Results

Compared with model group, ATW could significantly reduce paw swelling and suppresse articular cartilage degenerated. The results also found that there was significant reduction levels of IL-6, IL-8 and TNF-α in serum of CIA rats treated with ATW and ATW inhibited the expression of IL-6, IL-8, NF-κB, TNF-α in synovial tissue.

Conclusion

ATW not only could inhibit the symptom of CIA rats significantly but also could inhibit the production of IL-6, IL-8, TNF-α in serum and the expression of IL-6, IL-8, NF-κB and TNF-α in synovial tissue targeting the inflammatory. ATW would be a drug as a novel botanical drug for the treatment of RA.     

胡桃楸茎枝、叶和果实中总鞣质的动态变化

目的 考察不同时间采收的胡桃楸茎枝、叶和果实中总鞣质的动态变化规律.方法 采用分光光度法测定胡桃楸茎枝、叶和果实中总鞣质.结果 不同时间采收的胡桃楸茎枝、叶和果实中总鞣质的平均质量分数分别为25.68、57.24、38.91 mg/g.胡桃楸茎枝中总鞣质的动态变化无一定的规律,而胡桃楸叶和果实中总鞣质的量分别随叶和果实的生长而增加.结论 胡桃楸叶中总鞣质的质量分数最高,茎枝中总鞣质的质量分数最低.胡桃楸叶和果实中总鞣质质量分数的动态变化与各自的生长周期吻合.     

白血病患者造血干细胞移植前单次全身照射的预后分析

Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.     

Ionized and total magnesium concentration in patients with severe preeclampsia-eclampsia undergoing magnesium sulfate therapy

AIM: As ionized magnesium is the active form of magnesium and exerts a therapeutic effect, the present study was performed to determine the levels and correlations between ionized and total magnesium under baseline and therapeutic conditions in patients with severe preeclampsia and eclampsia receiving magnesium sulfate. METHODS: Fifty singleton patients with severe preeclampsia received a loading dose of 4 g of magnesium sulfate, followed by 2 g per hour as maintenance dose until 24 h after delivery, or 24 h after the last seizure in case of postpartum convulsions. Serial blood samples were taken before magnesium sulfate infusion, 30 min and 240 min after the initiation of the infusion and 4 h after the discontinuation of the drug. Data were analyzed by repeated measure ANOVA and paired t-test. RESULTS: Baseline levels of total and ionized magnesium were 2.4+/-0.6 mEq/L and 1.3+/-0.5 mEq/L (mean+/-SD), respectively. Putative level of 4 mEq/L of total magnesium was not obtained in up to 42% of patients during the treatment. There was not any significant correlation between the two forms of magnesium under baseline and therapeutic conditions. CONCLUSION: Despite the effectiveness of the standard regimen of magnesium sulfate in the treatment and prevention of eclamptic seizures, it can not provide the proposed therapeutic level of magnesium in all patients. With respect to the lack of correlation between ionized and total magnesium, further studies are necessary to investigate the superiority of measurement of ionized, rather than total magnesium, for titration of therapeutic magnesium sulfate infusion.     

帕瑞昔布钠超前镇痛对髋关节置换术患者IL-6和TNF-α的影响

目的：探讨帕瑞昔布钠超前镇痛对髋关节置换术后患者炎症细胞因子的影响,并进一步观察术后镇痛效果。方法本组患者60例,年龄40~65岁,ASAⅠ-Ⅱ级,择期在全麻下行髋关节置换术。随机分成观察组和对照组,每组30例。麻醉前20 min观察组静脉注射帕瑞昔布钠40 mg（用生理盐水稀释成4 mL）,对照组静脉注射生理盐水4 mL。分别于静推帕瑞昔布钠或生理盐水前10 min（T1）、术毕（T2）、术后6 h（T3）、术后12 h（T4）、术后24 h（T5）采上肢静脉血样,测定IL-6、TNF-α的血浆浓度。采用视觉模拟评分法（VAS）评价术毕即刻、术后2 h、6 h、12 h、24 h镇痛效果。结果患者血浆IL-6浓度于T3、T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆IL-6浓度于T3、T4、T5时点比对照组显著降低,差异有统计学意义（P〈0.05）。患者血浆TNF-α浓度于T4、T5时点较术前显著升高,差异有统计学意义（P〈0.05）;观察组血浆TNF-α浓度在T4、T5时间点比对照组显著降低,差异有统计学意义（P〈0.05）。观察组患者在术毕即刻、术后2 h、6 h、12 h VAS评分均显著低于对照组,差异有统计学意义（P〈0.05）。结论帕瑞昔布钠超前镇痛可有效缓解全髋关节置换术患者术后疼痛,抑制炎性介质释放,降低神经系统敏感性,利于患者术后康复。