Acute total hip arthroplasty for older patients with acetabular fractures: A meta-analysis

ObjectiveMultiple treatment options for acetabular fractures in geriatric patients exist. However, no large-scale studies have reported the outcomes of acute total hip arthroplasty (THA) in this patient population. We systematically evaluated all available evidence to characterize clinical outcomes, complications, and revisions of acute THA for acetabular fractures in geriatric patients.MethodsMeta-analysis of 21 studies of 430 acetabular fractures with mean follow-up of 44 months (range, 17−97 months). Two independent researchers searched and evaluated the databases of Ovid, Embase, and United States National Library of Medicine using a Boolean search string up to December 2019. Population demographics and complications, including presence of heterotopic ossification (HO), dislocation, infection, revision rate, neurological deficits, and venous thromboembolic event (VTE), were recorded and analyzed.ResultsWeighted mean Harris Hip Score was 83.3 points, and 20% of the patients had reported complications. The most common complication was HO, with a rate of 19.5%. Brooker grade III and IV HO rates were lower at 6.8%. Hip dislocation occurred at a rate of 6.1%, 4.1% of patients developed VTE, deep infection occurred in 3.8%, and neurological complications occurred in 1.9%. Although the revision rate was described in most studies, we were unable to perform a survival analysis because the time to each revision was described in only a few studies. The revision rate was 4.3%.ConclusionsAcute THA is a viable option for treatment of acetabular fracture and can result in acceptable clinical outcomes and survivorship rates in older patients but with an associated complication rate of approximately 20%. Considering the limited treatment options, THA might be a viable alternative for appropriately selected patients.     

Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

利福霉素类药物治疗结核病的临床应用研究进展

结核病是由结核分枝杆菌复合群引起的传染性疾病，是全球主要的流行病种之一。利福平是当前最主要的一线抗结核药物，因其长期应用和不规范治疗，利福平耐药逐渐增加，利福喷丁、利福布汀等利福霉素类衍生物在抗结核治疗方面起到了重要作用。基于利福霉素类药物的药理及药动学特性，对该类药物在结核病治疗中进行最优用药选择分析，并对该类药物与其他抗结核药物联用进行综述，旨在为利福霉素类抗结核药物的临床用药提供文献依据。     

超顺磁性氧化铁标记大鼠骨髓基质细胞经门静脉移植MRI活体示踪的研究

目的观察1．5T场强MRI联合动物专用线圈是否可以活体示踪经门静脉移植的纳米级超顺磁性氧化铁颗粒标记的骨髓基质细胞（bone marrow stromal cells BMSCs），为介人性门静脉骨髓基质细胞移植治疗终末期肝脏疾病的研究提供进一步的依据。方法供体大鼠5只，梯度密度离心分离BMSCs，纳米级超顺磁性氧化铁颗粒和脂质体转染BMSCs，体外经普鲁士蓝染色和HE染色确定细胞标记率。受体大鼠15只，分为5组，分别为对照组和纳米级超顺磁性氧化铁颗粒标记的骨髓基质细胞经门静脉移植人正常大鼠肝脏后2h、3d、7d及2周组。1．5T场强MRI联合动物专用线圈行T1W、T2W和T2＊序列扫描，观察肝脏信号改变情况，与对照组比较，并且与组织切片对照。结果纳米级超顺磁性氧化铁颗粒和脂质体转染BMSCs，细胞标记率〉95％。经门静脉移植人正常大鼠肝脏后，T2＊序列扫描显示经标记的BMSCs在肝内显示弥漫性的结节性低信号影，移植后2h到2周均可见到细胞在受体肝脏内存在，组织学切片显示信号缺失部位与铁颗粒标记细胞相一致。结论纳米级超顺磁性铁氧体颗粒标记的大鼠BMSCs经门静脉移植后可以通过1、5T场强行MRI活体示踪，为临床干细胞移植的应用提供可行的示踪方法。     

螺旋CT导引下肺部肿瘤射频热消融治疗的应用研究

目的 通过对肺肿瘤射频热消融（RFA）治疗效果的观察，评价其技术特点、安全性和疗效。方法 30例肺肿瘤患者共46个肿瘤接受了RFA治疗（其中肺部原发性肿瘤20例，转移瘤10例），在CT引导下将消融电极刺入到距肿瘤边缘组织1cm处，根据病灶大小，将子针打开至合适直径，达到靶温度后，持续7～15min。对患者进行1～9个月的随访，通过胸部X线片和增强螺旋CT观察治疗效果。结果 30例患者46个肿瘤，共做消融灶123个，治疗区域坏死率为100％。（1）随访1个月30例，46个肿瘤瘤体完全消融41个，占89.13％；部分消融5个，占10.87％。（2）随访3～9个月26例，40个肿瘤病灶完全缓解（CR）33个，部分缓解（PR）4个，无变化（NC）2个，进展（PD）1个，总有效率达925％（37／40）。结论 RFA治疗肺部肿瘤疗效肯定、安全，是1种应用前景较好的方法。     

Pediatric asthma quality of life questionnaire (PAQLQ): Validation among asthmatic children in Thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai-translated version of the PAQLQ. The study design consisted of a five-week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained-interviewer administered the PAQLQ and performed spirometric measurements. Fifty-one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross-sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, beta-agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbach's alpha-coefficient = 0.83-0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra-class correlation coefficient--ICC = 0.84) and for total score (alpha = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.     

浮肩损伤的临床特征和治疗

目的 总结浮肩损伤（floating shoulder injury，FSI）的临床特征和治疗效果。方法1993年1月-2004年9月收治浮肩损伤患者8例，除2例行锁骨固定带固定外，其余6例均行手术治疗，其中单纯行锁骨切开复位重建钢板内固定1例，同时行肩胛骨内固定5例。受伤至手术时间为2h～7d，平均3．5d，术后6个月对患肩功能进行Constant评分判定疗效，并对浮肩损伤的临床特征和治疗进行总结。结果6例患者经过6个月～3年（平均11个月）的随访，锁骨和肩胛骨骨折均愈合，肩关节活动范围无明显受限，但有2例患者在举重物时肩关节有轻度的疼痛，1例患侧上肢肌力较对侧稍减弱。术后6个月患肩功能Constant评分平均为93分。结论浮肩损伤多为高能量暴力所致的不稳定性肩胛带损伤，在治疗方案上尚存争议。但对移位明显的浮肩损伤以及有伴发伤的浮肩损伤进行手术治疗是必要的。     

肝细胞核因子-κB异常激活与肝细胞癌变

核因子-κB（nuclear factor-κB，NF-κB）是具有和某些基因上启动子区固定核苷酸序列结合而启动该基因转录的蛋白质。NF-κB是具有多向性调节作用的核转录因子，可调控多种基因（免疫、炎症反应、病毒和原癌基因）的转录表达。激活的NF-κB参与癌症的启动、发生及发展过程，在炎症性相关的肝癌（HCC）发生发展中呈高表达，在肝细胞炎症与癌变间起桥梁作用，其中包括肝脏免疫炎症反应相关基因、肝炎病毒相关基因和原癌基因的转录表达。在肝癌组织中异常激活，可抑制细胞凋亡，促进肝细胞存活，与肝癌的发生发展密切相关。     

不同浓度氯氮平对小鼠空腹血糖和骨骼肌葡萄糖转运蛋白4基因表达的影响

目的探讨氯氮平对雄性C57BL/6小鼠空腹血糖和骨骼肌葡萄糖转运蛋白4(GLUT4)基因表达的影响。方法将63只雄性C57BL/6小鼠随机分为3组,每组21只,分别灌胃给予蒸馏水、氯氮平4mg/kg及氯氮平20mg/kg,于给药后3h、1周、4周以试纸法测定各组空腹血糖,用逆转录-聚合酶链反应测定GLUT4mRNA表达。结果(1)灌药后3h、1周氯氮平4mg/kg组和氯氮平20mg/kg组空腹血糖和GLUT4mRNA的表达与空白对照组相比,差异无统计学意义(P>0.05);(2)灌药后4周氯氮平4mg/kg组和20mg/kg组的空腹血糖值[(5.6±0.5)mmol/L和(5.8±0.5)mmol/L]高于空白对照组[(4.6±0.6)mmol/L],而GLUT4mRNA的表达(0.50±0.14和0.48±0.12)却低于空白对照组(0.85±0.27),差异均有统计学意义(P<0.01)。结论氯氮平可以慢性升高空腹血糖,降低GLUT4mRNA的表达,可能是抗精神病药长期应用后血糖升高的发生机制之一。