99Tc-亚甲基二膦酸盐治疗股骨头坏死动物研究及初步临床应用

目的 地塞米松诱导兔股骨头坏死后用^99Tc-亚甲基二膦酸盐治疗并观察疗效，以供初步临床应用于中、晚期股骨头无菌性坏死参考，了解^99Tc-亚甲基二膦酸盐的治疗价值。方法 新西兰白兔33只为动物模型制作材料，其中18只采用注射地塞米松针剂建立股骨头坏死模型，模型建立后分成3组，每组6只；正常对照组、股骨头坏死模型组和股骨头坏死模型^99Tc-亚甲基二膦酸盐治疗组。^99Tc-亚甲基二膦酸盐治疗14周后取实验兔股骨头作病理切片,分析^99Tc-亚甲基二膦酸盐治疗前、后股骨头X线、CT摄片、^99Tc-MDP骨显像检查结果。临床明确诊断为股骨头无菌性坏死患者67例，分为^99Tc-亚甲基二膦酸盐治疗组39例和传统保守治疗对照组28例。治疗40周后比较^99Tc-MDP骨显像、X线摄片、CT检查，同时结合患者的症状作出综合评价。结果采用肌肉注射地塞米松针剂4周的新西兰白兔病理证实股骨头骨质疏松伴坏死模型成立。在^99Tc-亚甲基二膦酸盐治疗前、后时间内取各组实验兔股骨头X线、CT摄片、^99Tc-MDP骨显像和病理分析比较：正常对照组无变化，股骨头坏死模型组对照组股骨头骨质疏松加重，模型^99Tc-亚甲基二膦酸盐治疗组的股骨头骨质疏松有较明显的改善。临床所采用^99Tc-亚甲基二膦酸盐治疗组40周随访结果：^99Tc-亚甲基二膦酸盐治疗组中6例改善，31例稳定，仅2例无效。常规保守治疗对照组6例稳定，19例无效，仅3例改善。结论 ^99Tc-亚甲基二膦酸盐是一种核素锝-99(^99Tc)标记二膦酸盐的化合物，动物试验结果显示对骨质疏松有较明显的稳定病情发展和镇痛作用，部分有修复作用。初步临床应用表明：^99Tc-亚甲基二膦酸盐治疗组与传统保守治疗对照组比较，前者治疗骨头无菌性坏死疗效较明显。     

阿仑膦酸钠预防比格犬人工假体松动的生物力学研究

目的 探讨阿仑膦酸钠对比格犬人工假体与骨界面间骨强度的影响.方法 选取12只成年比格犬制备人工假体模型,采用随机数字表法分成试验组和对照组,各6只.试验组给予口服阿仑膦酸钠,而对照组给予等量的安慰剂.12周后处死动物,取出含有人工假体的标本,进行生物力学检测.采用两独立样本t检验进行统计学分析.结果 试验组人工假体与骨界面间的拔出强度显著高于对照组,差异有统计学意义（P＜0.05）,试验组人工假体与骨界面间的扭转强度也高于对照组,差异有统计学意义（P＜0.05）.结论 阿仑膦酸钠能够显著增加人工假体与骨界面间的强度,进而预防了比格犬人工假体的松动.这对于预防和治疗人工关节的无菌性松动有好的指导意义.     

无菌药品生产环境悬浮粒子的不确定度评定

目的：分析影响无菌药品生产工艺环境中悬浮粒子不确定度的来源,提高检测结果的准确性。方法分析影响因素,建立数学模型,评价测量过程中各不确定度分量。结果取转=2(95%置信概率)时,扩展不确定度为U(M0.05)=5364粒/m3,U(M5)=88粒/m3。结论对无菌药品生产工艺环境的悬浮粒子数的不确定度主要是由仪器的测量性能和采样点的分布及测量引入的。     

Icariin protects against titanium particle-induced osteolysis and inflammatory response in a mouse calvarial model

Periprosthetic osteolysis and subsequent aseptic loosening are common in implant failure, a complication with revision surgery being the only established treatment. Wear particle-induced inflammation and extensive osteoclastogenesis play critical roles in periprosthetic osteolysis. A recent approach in limiting osteolysis is therefore focused on inhibiting osteoclastic bone resorption. This study aimed to investigate the potential impact of icariin, the major ingredient of Epimedium, on titanium particle-induced osteolysis in a mouse calvarial model. Eighty-four male C57BL/J6 mice were divided randomly into four groups. Mice in the sham group underwent sham surgery only, whereas animals in the vehicle, low- and high-concentration icariin groups received titanium particles. Mice in the low- and high-concentration icariin groups were gavage-fed with icariin at 0.1 or 0.3 mg/g/day, respectively, until sacrifice. Mice in the sham and vehicle groups received phosphate-buffered saline daily. After 2 weeks, mouse calvariae were collected for micro-computed tomography, histomorphometry and molecular analysis. Icariin significantly reduced particle-induced bone resorption compared with the vehicle group. Icariin also prevented an increase in receptor activator of nuclear factor kappa B ligand/osteoprotegerin ratio and subsequently suppressed osteoclast formation in titanium particle-charged calvariae. In addition, immunohistochemical analysis and enzyme-linked immunosorbent assay showed icariin significantly reduced expression and secretion of tumor necrosis factor-α, interleukin-1β and interleukin-6 in the calvariae of titanium-stimulated mice. Collectively, these results suggest that icariin represents a potential treatment for titanium particle-induced osteolysis and could be developed as a new therapeutic candidate for the prevention and treatment of aseptic loosening.     

Aseptic meningitis associated with chronic sulindac use for osteoarthritis: a case report

We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.     

Sjögren's syndrome with bilateral spontaneous fracture of the femoral neck following aseptic necrosis of the femoral head

Abstract

A woman with Sjögren's syndrome concurrently suffered bilateral fractures of the femoral neck without any proximate cause, while she had aseptic necrosis of the femoral head resulting from the treatment for Sjögren's syndrome. According to previous reports, fractures of the femoral neck following aseptic necrosis of the femoral head are attributed to primary diseases such as systemic lupus erythematosus (SLE) or idiopathic thrombocytopenic purpura (ITP), and steroids are administered in most cases. Heterogeneous bone regeneration after necrosis causes irregularity in its mechanical strength depending on which regions of frailty are generated. Patients with aseptic necrosis of the femoral head whose bone density is considerably reduced need careful medical attention to avoid fractures of the femoral neck caused by weak forces.     

A case of cerebral salt-wasting syndrome associated with aseptic meningitis in an 8-year-old boy

Cerebral salt-wasting syndrome is a disorder in which excessive natriuresis and subsequent hyponatremic dehydration occur in patients with intracranial diseases. Cerebral salt-wasting syndrome often develops in patients with severe neurosurgical disorders, such as hydrocephalus, cerebral infarction, and tuberculous meningitis. Here, we report on the case of an 8-year-old boy with cerebral salt-wasting syndrome associated with aseptic meningitis. He showed mild developmental retardation and had a history of convulsion. Four days after his admission, cerebral salt-wasting syndrome abruptly started: natriuresis and hyponatremia gradually improved over 10 days. To the best of our knowledge, this is the first report on cerebral salt-wasting syndrome associated with clinically benign aseptic meningitis.     

人工髋关节置换后假体无菌性松动的因素及其防治

目的：通过对近些年关于人工髋关节置换后假体无菌性松动的不同方面最新进展进行汇总、探讨,进一步认识人工髋关节置换后假体无菌性松动。 方法：应用计算机检索中国期刊全文数据库1997-01/2008-12有关人工髋关节置换后假体无菌性松动的相关文章,检索词“人工关节;置换;无菌性松动”。纳入标准: ①人工髋关节置换后假体无菌性松动的诊断标准、生物及机械因素。②人工髋关节置换后假体无菌性松动的治疗、预防。 结果：人工髋关节置换后假体无菌性松动的发病机制较为复杂,其主要原因是磨损颗粒,其次是力学因素,它们共同结果是造成骨吸收、骨溶解,最终导致假体松动。其过程还与许多细胞因子的参与密切相关。针对引起关节假体无菌性松动的发病机制,可以从关节材料、抑制磨损颗粒移动、促进成骨及抑制骨吸收等方面来防治。 结论：人工髋关节置换后假体无菌性松动发病机制较为复杂,是多种因素作用的结果,涉及不同的学科领域。随着各学科的发展,人工髋关节置换后假体无菌性松动将逐步被彻底认识。     

Impact of intraoperative behavior on surgical site infections

Background

The aim of this study was to identify intraoperative risk factors for surgical site infections (SSIs), which are accessible to interventions. We evaluated the effect of extensive intraoperative antiseptic measures and the impact of the behavior of members of the surgical team on SSIs.

Methods

Standard versus extensive antiseptic measures were randomly assigned in 1,032 surgical patients. The adherence to principles of asepsis by members of the surgical team was assessed prospectively.

Results

The rate of SSI was 14% with standard antiseptic measures and 15% with extensive measures (P = .581). Multivariate analysis identified following independent risk factors: lapses in discipline (odds ratio [OR] 2.02, confidence interval [CI] 1.05-3.88), intestinal anastomosis (OR 6.74, CI 3.42-13.30), duration of operation more than 3 hours (OR 3.34, CI 1.82-6.14), and body mass index >30 kg/m² (OR 1.98, CI 1.22-3.20).

Conclusion

Extensive measures of antisepsis did not reduce the incidence of SSI. A lapse to adhere to principles of asepsis was identified as an independent risk factor for the development of SSI (ClinicalTrials.gov number, NCT00555815).