Ultrasound-Guided Periprosthetic Biopsy in Failed Total Hip Arthroplasty: A Novel Approach to Test Infection in Patients With Dry Joints

BackgroundTo diagnose periprosthetic joint infection (PJI) preoperatively, ultrasound-guided joint aspiration (US-JA) may not be performed when effusion is minimal or absent. We aimed to report and investigate the diagnostic performance of ultrasound-guided periprosthetic biopsy (US-PB) of synovial tissue to obtain joint samples in patients without fluid around the implants.MethodsOne-hundred nine patients (55 men; mean age: 68 ± 13 years) with failed total hip arthroplasty (THA) who underwent revision surgery performed preoperative US-JA or US-PB to rule out PJI.ResultsSixty-nine of 109 patients had joint effusion and underwent US-JA, while the remaining 40 with dry joint required US-PB. Thirty-five of 109 patients (32.1%) had PJI, while 74/109 (67.9%) had aseptic THA failure. No immediate complications were observed in both groups. Technical success of US-PB was 100%, as the procedure was carried on as planned in all cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-JA were 52.2%, 97.8%, 92.3%, 80.3%, and 82.6%, while for US-PB, they were 41.7%, 100%, 100%, 80%, and 82.5%, respectively, with no significant difference (P = .779). Using the final diagnosis as reference standard, we observed a moderate agreement with both US-JA (k = 0.56) and US-PB (k = 0.50).ConclusionWe present a novel US-guided technique to biopsy periprosthetic synovial tissue of failed THA to rule out PJI. We found similar diagnostic performance as compared with traditional US-JA. This supports future larger studies on this procedure that might be applied in patients without joint effusion.     

布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果评价

目的 观察布地奈德联合福莫特罗干粉剂在急诊治疗重症支气管哮喘患者中的应用效果。方法 参照随机数字表法,将2017年7月—2019年6月在某医院接受急诊治疗的40例重症支气管哮喘患者分为两组,每组各20例。对照组患者采用布地奈德治疗,观察组在对照组基础上联合福莫特罗干粉剂治疗。两组患者均治疗1个月,观察两组C反应蛋白(CRP)、血常规水平及肺功能指标[第1秒用力呼气容积(FEV1)、FEV1与用力肺活量(FCV)比值(FEV1/FCV)和最大呼气流量(PEF)]。结果 治疗期间对照组患者夜间睡眠时憋醒次数为(13.55±3.25)次,观察组患者夜间睡眠时憋醒次数为(5.25±0.95)次;组间相比,差异有统计学意义(t=10.962,P<0.05);治疗后,观察组CRP、白细胞计数、嗜酸性粒细胞比率、淋巴细胞比率分别为:(12.36±1.43)mg/L、(6.31±1.05)×109/L、(4.82±2.03)%、(20.06±2.48)%,均低于对照组的(15.98±1.95)mg/L、(8.59±1.34)×109/L、(6.79±2.68)%、(25.09±3.12)%,(t值分别为6.695、5.990、2.621、5.644,P值均<0.05);治疗后,观察组FEV1、PEF及FEV1/FCV水平分别为:(2.51±0.70)L、(3.28±0.75)L/s、(75.38±8.49)%,均高于对照组(2.02±0.52)L、(2.76±0.66)L/s、(62.63±6.89)%,(t 值分别为2.513、2.328、5.215,P值均<0.05)。结论 布地奈德联合福莫特罗干粉剂在急诊重症支气管哮喘患者的治疗中效果较好,能有效改善CRP及血常规水平,提高肺功能。     

胆汁泡蛋白ELISA检测法的建立与初步临床应用

目的 建立胆汁泡蛋白快速检测法,筛选有效的胆石症防治手段。方法 获取３３．５ｋｄ胆汁泡蛋白,通过微量抗原免疫法获得高效价抗体,建立ＥＬＩＳＡ标准曲线;并应用ＥＬＩＳＡ法测定正常人、胆石症患者胆汁和血清中泡蛋白含量,同时观察不同溶石防药和利胆冲剂、胆酸钠等对泡蛋白的影响。结果 建立了ＥＬＩＳＡ标准曲线,其曲线方程为Ｙ＝０．０３５Ｘ（ｒ＝０．９９）;正常人胆汁和血清中３３．５ｋｄ泡蛋白含量都明显较胆固     

Comparison of autonomic function using Valsalva ratio and 30:15 postural ratio prior to and after haemodialysis treatment

In published studies of chronic haemodialysis patients, the frequency of autonomic dysfunction varies widely. One reason for the variation may be the time of testing with respect to time of dialysis. The current study tests the hypothesis that autonomic function — as measured by heart rate responses to the Valsalva manoeuvre (Valsalva ratio) and 30:15 electrocardiogram (ECG) R—R interval to upright posture (postural ratio) — is different when patients are above dry weight (predialysis) than when they are at or below dry weight (postdialysis). The study also reviews available literature to analyze other factors that may affect the results of autonomic testing in this population. A total of 25 chronic haemodialysis patients underwent standard Valsalva and 30:15 R—R interval postural autonomic testing prior to and after haemodialysis. In addition, pre- and postdialysis orthostatic responses were measured and compared with a control population. The 30:15 ratio increased after dialysis (p = 0.001). The Valsalva ratio did not change with dialysis. Out of 25 subjects, seven had an abnormal 30:15 ratio prior to dialysis decreasing to two out of 25 patients postdialysis (p < 0.03). Orthostatic responses predialysis did not differ from those in the control group. Review of the literature shows great variability in definition of normal Valsalva and postural (30:15 R—R interval) ratios. Diabetic patients in the current and prior studies were more likely to have abnormal responses. In conclusion, the prevalence of autonomic dysfunction in chronic dialysis patients as determined by Valsalva and 30:15 ECG postural ratios may be influenced by the following factors: when subjects are studied with respect to their dialysis treatment; the number of subjects with diabetes; and the cut-off point used to define abnormal test results. Abnormal Valsalva ratios are less frequent when measured postdialysis.     

15kg负重沙漠干热应激行军速度和时间对人体GSH和SOD的影响

目的　探讨沙漠干热负重应激行军人体ＧＳＨ 和ＳＯＤ 作用机制。方法　对７４ 名１５ ｋｇ 负重在沙漠干热环境以不同速度和时间行军战士和对照人群血浆的变化进行了研究。结果　１５ ｋｇ 负重,３－５ｋｍ／ｈ 和５ ｋｍ／ｈ 行军者ＧＳＨ 在应激的最初１ 小时内迅速上升,约１ 小时达到高峰,之后迅速下降;随着行军速度的增加,机体抗氧化作用所消耗的ＳＯＤ 量增加,血浆ＳＯＤ 浓度亦随之下降。结论　从行军时间来看,在应激的最初１ 小时内,因应激诱导的ＧＳＨ 的合成和ＳＯＤ 的量增加,故沙漠干热环境负荷应激行军以１５ ｋｇ、３－５ ｋｍ／ｈ 为宜。     

鲑降钙素吸入粉雾剂的制备及其药剂学性质研究鲑降钙素吸入粉雾剂的制备及其药剂学性质研究

目的喷雾干燥法制备鲑降钙素吸入粉雾剂,考察其主要药剂学特性。方法按中国药典2000年版方法测定鲑降钙素吸入粉雾剂排空率及有效部位沉积量,扫描电镜观察粉粒的形态,激光粒度测定仪测定粉粒的粒径大小及分布,差热分析及X射线粉末衍射考察吸入粉雾剂载体的晶型。结果有效部位鲑降钙素沉积量均在10%以上,排空率均在90%以上;相对湿度在52%以下,粉粒呈圆整的分散状态;当RH=75%时粉粒发生较多的粘连和聚集;粉体平均粒径为1.67 μm;差热分析结果显示:吸入粉雾剂中L-亮氨酸的熔融热较单一组分在喷雾干燥后显著下降;X射线粉末衍射图谱中,吸入粉雾剂载体的衍射峰强度较喷雾干燥前显著下降。结论在鲑降钙素吸入粉雾剂载体系统中加入甘露醇,粉粒圆整,加入L-亮氨酸可形成超低密度载体;扫描电镜的结果提示,应严格控制吸入粉雾剂贮存时环境的湿度;喷雾干燥复合载体更有助于无定形的形成。     

Dry eye after LASIK: Comparison of outcomes for Asian and Caucasian eyes

Background : Dry eye is a common complication of LASIK surgery. Our clinical impression was that post‐LASIK dry eye was more problematic for our Asian patients. The aim of this study was to determine if dry eye after LASIK is more prevalent, more sustained and more severe in Asian eyes compared with Caucasian eyes. Methods : This study was based on a retrospective analysis of a clinical database. Data (n = 932 eyes, 932 patients) was collected before and after (week 2 and months 1, 3 and 6) LASIK surgery. Patients were defined as Asian if both parents were of East Asian ethic origin. Assessments included dry eye symptoms, ocular surface staining, tear volume, tear secretion, tear film stability and corneal sensation. Results : Asian eyes had greater ocular surface staining, poorer tear film stability and lower tear volume before LASIK and at all times after LASIK. Dry eye symptoms occurring ‘often or constantly’ were more prevalent at all time points after LASIK in Asian eyes. Chronic dry eye persisting six months or more after LASIK was diagnosed in 28 per cent of Asian eyes and 5 per cent of Caucasian eyes (p < 0.001). Asian patients with chronic dry eye were predominantly female, reported dry eye symptoms, had greater ocular surface staining and lower tear secretion, stability and volume before surgery. After LASIK, Asian eyes had a slower return to pre‐operative values for ocular surface staining, tear volume and corneal sensation. Discussion : The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.     

Comparing the Discriminative Validity of Two Generic and One Disease-Specific Health-Related Quality of Life Measures in a Sample of Patients with Dry Eye

OBJECTIVE: The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity. METHODS: Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sj?gren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe). RESULTS: Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions. CONCLUSIONS: The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.     

Directed sampling for electrolyte analysis and water content of micro-punch samples shows large differences between normal and ischemic rat brain cortex

Changes in sodium, potassium, and water content in brain tissue are important in the progression of pathology that follows ischemic stroke. Determining these parameters regionally in rodent models of experimental ischemia has been limited because typical tissue weights of more than 35 mg are too large. Identifying ischemic tissue to direct tissue sampling towards ischemic cortex is also represents a difficult generally unresolved area. We suggest that larger differences between normal and ischemic cortex of sodium, potassium, and water content than previously observed can be obtained from directed sampling of 2-mg brain tissue in a model of focal cerebral ischemia. In five rats, the middle cerebral artery and both common carotid arteries were occluded for 4.9+/-0.13 h (mean+/-SEM). Punch-sampling of 1-mm diameter tissue cores for water content (H(2)O%) by the wet-dry method, and [Na(+)] and [K(+)] by flame photometry, was guided by the observation of a subtle change in the surface reflectivity of ischemic cortex of quickly dried, 20-microm frozen brain sections, that was confirmed by MAP2 immunohistochemistry. The ratio of the lesion areas as determined by the reflective change and MAP2 immunoreactivity was 0.96+/-0.03 (n=5). In ischemic cortex H(2)O% was 79.9%+/-0.8%, [Na(+)] was 550+/-25 mEq/kg dry-weight, and [K(+)] 94.2+/-19.2 mEq/kg dry-weight (n=5), all significantly different from the values in border zone cortex, and in cortex contralateral to ischemic cortex and border zone (for all samples n=60, mean wet weight 2.037+/-0.046 mg). Differences between ischemic and normal cortex were 5.4+/-1.1%, 317+/-21 mEq/kg dry-weight, -304+/-27 mEq/kg dry-weight (n=5) for H(2)O%, [Na(+)], and [K(+)]. These differences between ischemic and normal cortex are 1.4-2.5, 1-3.11, and 1.4-3.5 times greater, respectively, than previous results obtained using samples weighing 35 mg or more. These results extend the association of sodium and potassium with ischemic brain edema in the rodent model, and show that these classical measurements can keep pace with the regionality of histochemical and morphological methods.