Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty—At a Minimum of 15-Year Follow-Up

BackgroundLow polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up.MethodsWe evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views.ResultsCT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage.ConclusionOur study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.     

牛鼻子引流术在严重糖尿病足感染创面中的临床应用

目的探讨牛鼻子引流术（nose ring drain，NRD）治疗严重糖尿病足感染创面的临床效果。方法回顾分析 2017 年 6 月—2019 年 6 月采用 NRD 治疗的 35 例严重糖尿病足感染创面患者临床资料。男 24 例，女 11 例；年龄 28～82 岁，平均 54.5 岁。均为 2 型糖尿病患者，糖尿病病程 3～20 年，平均 9.4 年。糖尿病足病程 4 个月～2 年，平均 1.16 年。左足 16 例，右足 19 例。根据 Wagner 分级：2 级 11 例，3 级 20 例，4 级 4 例；均为糖尿病足创面中重度感染。术后创面采用“蚕食样”持续清创至表皮再生愈合。治疗过程中分析并总结创面分泌物细菌培养类型、临床抗生素使用时间，创面愈合方式、愈合时间、截肢比例等指标。结果35 例患者均随访，随访时间 3～6 个月，平均 4.5 个月。术后创面细菌培养结果显示，金黄色葡萄球菌 5 例、铜绿假单胞菌 4 例、大肠埃希菌 5 例、阴沟肠杆菌 3 例、凝固酶阴性葡萄球菌 3 例，其他类型 15 例。临床抗生素使用时间 3～15 d，平均 9.1 d。创面自溶性愈合，无需植皮，创面愈合时间 62～82 d，平均 72.3 d；随访过程中 3 例（8.6%）患者因血糖控制不佳，感染大面积扩散导致截肢 。创面愈合患者原创面处未出现感染复发及新生溃疡。结论应用 NRD 治疗严重糖尿病足感染创面，能有效控制创面感染，促进创面再生愈合，无需植皮且操作简便。     

Bacteremia due to high-level daptomycin-resistant Corynebacterium striatum: A case report with genetic investigation

Corynebacterium striatum, generally considered an opportunistic organism in humans, has recently been known to develop high-level daptomycin resistance (HLDR) shortly after drug exposure. To date, however, only several such clinical isolates have been described in the literature and clinical background of the resistant pathogen remains to be elucidated. Here, we report a case involving a C. striatum strain with HLDR harboring novel nucleotide mutations, together with a review of the relevant literature. To the best of our knowledge, this is the first well-investigated clinical report from Japan including a genetic investigation. Considering the rapid emergence of HLDR C. striatum in vitro experiment, there could be a number of underreporting cases. Scrupulous attention is required when administering daptomycin for the treatment of C. striatum infections, even if the organism has initially exhibited susceptibility.     

Effects of calcium channel blocking agents on reperfusion arrhythmias

The effect of the calcium antagonists nifedipine (NF) and diltiazem (DT) on reperfusion after release of circumflex coronary artery (CX) occlusion was studied in open-chest dogs. Dogs were randomized to receive a bolus of 5 μg/kg NF (seven dogs), 1 μg/kg NF (nine dogs), or vehicle (nine dogs). After bolus, high and low dose NF dogs were infused with 1 μg/kg/min NF. All dogs then underwent 30 minutes CX occlusion followed by reperfusion. Dogs that did not develop ventricular fibrillation (VF) in the first 10 minutes of reperfusion were considered survivors. NF caused a dose-related increase in CX blood flow and decrease in mean arterial pressure (MAP), significant at the higher dose. Reperfusion VF occurred in five of nine low dose NF dogs, five of seven high dose NF dogs, and five of nine controls. Another 21 dogs were randomized to receive a bolus of 0.2 mg/kg DT (11 dogs) or vehicle (10 dogs). Infusion rates (and an additional bolus injection, if necessary) were chosen to produce a 10 to 20 mm Hg drop in MAP. CX occlusion and reperfusion were performed as above. Reperfusion VF occurred in 9 of 11 DT dogs vs 8 of 10 controls. Thus neither nifedipine nor diltiazem enhanced survival during reperfusion of myocardium previously subjected to 30 minutes of ischemia.     

自动快速广谱药物检测系统在急性药物中毒患者的应用

目的 探讨广谱药物检测系统（REMEDi HS)在急性药物中毒患者诊断中的应用。方法 用REMEDi HS分析了1200例患者血液、尿液及胃液等的药物成分。结果 在被检测的1200例中,中毒频率较高的前5类药物依次为苯二氮卓类镇静催眠药、吩噻嗪类抗精神失常药、二苯氮卓类抗精神失常药、三环类抗抑郁药和阿片类毒品。单药检出率较高的10个药物分别是艾司唑仑（10.25%)、地西泮（9.25%)、西咪替丁（4.33％）、氯丙嗪（3.50%)、氯氮平（2.75%)、咖啡因（2.58%)、尼可刹米(2.42%)、吗啡（1．92％）、利多卡因（1．75％）和阿普唑仑（1．50％）。结论 REMEDi HS能较好地对中毒患者机体内的药物进行快速地定性和定量分析,为中毒患者的抢救提供实验依据。