Out of the boxes,out of the silos: The need of interdisciplinary collaboration to reduce poor-quality medical products in the supply chain

In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area.     

Prospective characterization of incident hepatic steatosis in pediatric and adolescent patients after total pancreatectomy with islet autotransplantation

BackgroundHepatic steatosis has been described as a common finding in adults following total pancreatectomy with islet autotransplantation (TPIAT) but it is unknown if this occurs in children and adolescents.ObjectivesTo define the frequency of post-TPIAT hepatic steatosis in a sample of children and adolescents and to identify clinical predictors of incident steatosis post-TPIAT.MethodsIn this prospective study, consecutive participants at least 1-month post-TPIAT underwent a liver MRI with proton density fat fraction (PDFF) and blood draw at our pediatric academic medical center between April 2021 and January 2022. Comparison clinical pre-TPIAT liver MRI or ultrasound and insulin use and graft function data were extracted from the medical record. T-tests were used for the comparison of means across continuous variables between participants with and without post-TPIAT steatosis.ResultsA total of 20 participants (mean: 13 ± 4 years; 12 female) were evaluated. Mean liver PDFF at research MRI was 7.4 ± 6.2% (range: 2–25%). Seven participants (35%) had categorical hepatic steatosis (PDFF>5%) post-TPIAT, five of whom had pre-TPIAT steatosis, reflecting a 13% (2/15; 95% CI: 2–40%) incidence of post-TPIAT steatosis. Participant characteristics were not significantly different between subgroups with and without post-TPIAT steatosis. Mean PDFF at research MRI was not different between graft function subgroups (7.5% optimal/good vs. 7.3% marginal/failure; p = .96).ConclusionOur study shows a moderate prevalence but low incidence of hepatic steatosis in a small sample of children and adolescents post-TPIAT. This study raises questions about a causal relationship between TPIAT and hepatic steatosis.     

���IJ����������������ܻ�������ǰ��Ѫ�弰����Һ��IL-8��IL-10��⼰���ֵ�о�

??Objective    To discuss the influence of basic periodontal therapy on the level of IL-8?? IL-10 in serum and gingival crevicular fluid in patients who have chronic periodontitis complicated by coronary heart disease. Methods     A total of 65 cases of patients with chronic periodontitis complicated by coronary heart disease were selected and divided into two groups randomly??Group A of 35 patients who received the basic periodontal therapy and cardiac medical treatment??Group B of 30 patients who received cardiological treatment only. Then??select 25 patient who had developed chronic severe periodontitis with non-systematic disease to establish group C and give them the basic periodontal therapy only. Observe the changes of the IL-8??IL-10 levels in serum and gingival crevicular fluid and the periodontal infection indexes??BI??PD??. Results    The results showed that after three months of basic periodontal therapy the periodontal clinical indices of both group A and group C became better and the IL-8 level obviously reduced??while the IL-10 level obviously increased. There was no obvious difference between group A and group B in each examination index before the therapy. After three months??we found that the periodontal infection index??SBI PD??of group A was obviously better than group B. Compared to group B??the IL-8 level of group A obviously reduced??and the IL-10 level obviously increased. The difference was statistically significant??P < 0.05??. Conclusion    The basic periodontal therapy can effectively improve periodontal conditions of the patients with chronic periodontal diseases??and reduce the risk of breaking the normal cardiovascular function.     

股骨转子间骨折的稳定性重建概念演化与研究进展

目v84;总结�8fd1;年来�80a1;প8;�8f6c;子间প8;ة8;ղ8;稳定性重建方面v84;i82;念演化与814;究�8fdb;展。方法查阅国Q85;外ݯ8;关e87;献并结Հ8;�81ea;�8eab;经š8c;，从�80a1;প8;�8f6c;子间প8;ة8;v84;�89e3;剖特点、稳定W8b;প8;ة8;与不稳定W8b;প8;ة8;分类、稳定性复位与不稳定性复位、术中加S8b;初始稳定与术后滑Ԫ8;N8c;次稳定、Q85;固定术后稳定性�8bc4;估、早期下地站立�8d1f;重等方面�8fdb;�884c;总结分析。结果�80a1;প8;�8f6c;子间প8;ة8;发生N8e;�80a1;প8; 888;干骺端�8f6c;换区，具有天然v84;Q85;翻不稳定倾向。প8;ة8;复位�8d28;量是影响后续Q85;固定物[89;放v84;最重�8981;前提因素。判断প8;ة8;复位�8d28;量有对线T8c;对位两方面，对线采ݒ8; Garden 指数；ղ8;对位方面，–8f;着皮�8d28;对位理念࿰8;正性、中性、�8d1f;性）v84;提出，特别强�8c03;前Q85;侧皮�8d28;v84;ݯ8;互825;住支撑࿰8;�89e3;剖、正性），是�83b7;得প8;ة8;稳定性复位v84;关键，�800c;不Q8d;强�8c03;后Q85;侧小�8f6c;子প8;块v84;作ݒ8;。术后影像学v84;稳定性�8bc4;分为早期下地站立�8d1f;重提供N86;量化指807;。但术中v84;前Q85;侧皮�8d28;支撑复位，ղ8;术后头 888;প8;块滑Ԫ8;�83b7;得N8c;次稳定v84;�8fc7;程中，仍有皮�8d28;对位丢失现�8c61;，需814;究其危险因素T8c;防�8303;措施。结�8bba;�80a1;প8;�8f6c;子间প8;ة8;ղ8;取得�826f;好对线v84;基840;上，只�8981;�83b7;得N86;前Q85;侧皮�8d28;v84;ݯ8;互825;住T8c;支撑，并ݒ8;Q85;固定զ8;8b0;维持住，就�83b7;得N86;术后稳定性。术后稳定性�8bc4;分ӱ8;�826f;�8005;，可以[89;Ԗ8;地早期下地�8d1f;重、站立�884c;�8d70;活Ԫ8;。     

改良内固定融合术治疗成人Ⅱ型痛性足副舟骨

目v84;探�8ba8;改�826f;Q85;固定�878d;Հ8;术治疗成人ⅡW8b;痛性�8db3;副�821f;প8;࿰8;painful accessory navicular，PAN）v84;疗ٔ8;。方法2016 年 1 ٰ8;—2017 年 12 ٰ8;，采ݒ8;改�826f;Q85;固定�878d;Հ8;术治疗 29 O8b;࿰8;37 �8db3;）ⅡW8b; PAN。其中男 12 O8b;，女 17 O8b;；年Ÿ84; 18～50 \81;，平均 41.4 \81;。扭伤 24 O8b;，无明显�8bf1;因 5 O8b;。患�8005;均�884c; 6 个ٰ8;以上保[88;治疗，症状无明显改U84;。术前及末次–8f;�8bbf;时采ݒ8;8e;国矫形�8db3;�8e1d;协会࿰8;AOFAS）中�8db3;�8bc4;分�8bc4;估临^8a;疗ٔ8;；X 线片测量�8ddf;প8;倾斜�89d2;、�8ddd;প8;第 1 �8dd6;প8;�89d2;、�8ddd;�821f;关�8282;包容�89d2;、�8ddd;প8;第 2 �8dd6;প8;�89d2;。结果术后 1 O8b;出现切口浅�8868;感染，经加强换�836f;后ؐ8;Հ8;；其余患�8005;切口均Ⅰ期ؐ8;Հ8;，无深ऎ8;感染或প8;髓p8e;发生。29 O8b;均�83b7;–8f;�8bbf;，–8f;�8bbf;时间 12～33 个ٰ8;，平均 25.1 个ٰ8;。X 线片示关�8282;面均N8e;术后 2～5 个ٰ8;ؐ8;Հ8;，平均 3.4 个ٰ8;。–8f;�8bbf;期间未�89c1;Q85;固定物松Ԫ8;或断�88c2;。末次–8f;�8bbf;时，AOFAS 疼痛、功�80fd;、力线�8bc4;分及总分以及�8ddd;�821f;关�8282;包容�89d2;、�8ddd;প8;第 1 �8dd6;প8;�89d2;T8c;�8ddd;প8;第 2 �8dd6;প8;�89d2;均�8f83;术前显�8457;改U84;，差异有统�8ba1;学意义࿰8;P<0.05）；�8ddf;প8;倾斜�89d2;手术前后差异无统�8ba1;学意义࿰8;t=1.097，P=0.276）。 结�8bba;采ݒ8;改�826f;Q85;固定�878d;Հ8;术治疗成人ⅡW8b; PAN 可有ٔ8;缓�89e3;症状，患�8db3;功�80fd;恢复�826f;好，并发症少。     

单纯 Ilizarov 环形外固定技术治疗合并骨筋膜室综合征的胫骨平台骨折

目v84;探�8ba8;单纯 Ilizarov 环形外固定b80;术治疗Հ8;并প8;筋�819c;室综Հ8;_81;v84;�80eb;প8;平台প8;ة8;v84;疗ٔ8;。方法2013 年 9 ٰ8;—2017 年 3 ٰ8;，收治 30 O8b;Հ8;并প8;筋�819c;室综Հ8;_81;v84;�80eb;প8;平台প8;ة8;患�8005;，采ݒ8;单纯 Ilizarov 环形外固定b80;术治疗。男 23 O8b;，女 7 O8b;；年Ÿ84; 23～43 \81;，平均 34.4 \81;。�81f4;伤原因：交通N8b;故伤 12 O8b;，ভ8;处坠�843d;伤 4 O8b;，摔伤 8 O8b;，重物838;伤 6 O8b;。受伤�81f3;入院时间 1～12 h，平均 4.8 h。প8;ة8; Schatzker 分W8b;：ⅡW8b; 1 O8b;、ⅢW8b; 3 O8b;、ⅣW8b; 10 O8b;、ⅤW8b; 7 O8b;、ⅥW8b; 9 O8b;。30 O8b;均因প8;筋�819c;室综Հ8;_81;�884c;切开减S8b;；切开减S8b;�81f3;手术时间为 10～15 d，平均 12.5 d。治疗后采ݒ8;�819d;关�8282;学会�8bc4;分系统࿰8;KSS）及 Ilizarov 方法814;究与应ݒ8;协会࿰8;ASAMI）协�8bae;�8bc4;价�819d;关�8282;功�80fd;。结果手术时间 110～155 min，平均 123.1 min；术中出�8840;量 100～500 mL，平均 245 mL；术后住院时间 3～5 d，平均 3.8 d。患�8005;均�83b7;–8f;�8bbf;，–8f;�8bbf;时间 20～24 Ն8;，平均 22.7 Ն8;。除 2 O8b;患�8005;出现”88;道感染_81;�8c61;外，无其他并发症发生。X 线片复查显示প8;ة8;均ؐ8;Հ8;，ؐ8;Հ8;时间 10～20 Ն8;，平均 14.6 Ն8;。末次–8f;�8bbf;时，�819d;关�8282; KSS 临^8a;�8bc4;分总分为 70～95 分，平均 87.5 分；功�80fd;�8bc4;分总分为 70～90 分，平均 79.0 分。参照 ASAMI 协�8bae;�8bc4;价�83b7;ӱ8; 24 O8b;、�826f; 3 O8b;、可 2 O8b;、差 1 O8b;。结�8bba;对N8e;Հ8;并প8;筋�819c;室综Հ8;_81;v84;�80eb;প8;平台প8;ة8;，单纯 Ilizarov 环形外固定b80;术治疗后患�8005;关�8282;功�80fd;可以基本恢复且并发症少，是一 879;ݯ8;对[89;Ԗ8;、有ٔ8;v84;治疗方法。     

CO2点阵激光早期控制唇裂二期整复术后瘢痕的疗效观察

目v84;�89c2;察比�8f83;CO₂点阵激光早期控制唇�88c2;术后N8c;期整复术术区瘢痕v84;临^8a;疗ٔ8;。方法治疗组为43O8b;接受唇�88c2;术后鼻唇ݗ8;形N8c;期整复术v84;患�8005;，早期采ݒ8;CO₂点阵激光治疗，对照组为70O8b;曾接受一期唇�88c2;手术v84;患�8005;，对两组6个ٰ8;后v84;瘢痕恢复情况�8fdb;�884c;比�8f83;；分析术后�8ddd;离激光开始治疗时间v84;长短，性别两因素对激光治疗瘢痕疗ٔ8;v84;差异。结果1）治疗组v84;疗ٔ8;ӱ8;N8e;对照组࿰8;P<0.000 1），治疗组中显ٔ8;T8c;有ٔ8;所组成v84;总有ٔ8;s87;�8fbe;90.7%；2）男女疗ٔ8;差异无统�8ba1;学意义࿰8;P=0.487），手术后1年Q85;v84;患�8005;，手术后�8ddd;离开始瘢痕治疗v84;时间<3个ٰ8;与≥3个ٰ8;之间，疗ٔ8;无明显统�8ba1;学差异࿰8;P=0.055）。结�8bba;CO₂点阵激光ղ8;唇�88c2;N8c;期整复术术后瘢痕v84;治疗中具有�8f83;为86e;切v84;疗ٔ8;。且与患�8005;v84;性别无明显ݯ8;关性。手术后1年Q85;v84;患�8005;，术后�8ddd;离开始瘢痕治疗v84;时间<3个ٰ8;T8c;≥3个ٰ8;疗ٔ8;无差异，因此ղ8;唇�88c2;N8c;期手术后v84;1年Q85;早期对瘢痕�8fdb;�884c;干 884;可�83b7;得�826f;好v84;ٔ8;果。     

PD-L1高表达晚期非小细胞肺癌患者单纯免疫治疗与免疫联合化疗疗效比较

�80cc;景与目v84;以免疫8c0;查点抑制剂࿰8;immune checkpoint inhibitors, ICIs）为代�8868;v84;免疫治疗�8d8a;来�8d8a;广泛地应ݒ8;N8e;�80ba;癌治疗。然�800c;，对N8e;程^8f;性死亡受体配体1࿰8;programmed cell death-ligand 1, PD-L1）ভ8;�8868;�8fbe;，即�80bf;瘤比O8b;�8bc4;分࿰8;tumor proportion score, TPS）≥50%v84;晚期非小细�80de;�80ba;癌࿰8;non-small cell lung cancer, NSCLC）患�8005;，采ݒ8;单纯免疫治疗�8fd8;是免疫�8054;Հ8;化疗ղ8;临^8a;上仍ֵ8;N89;�8bae;。本814;究ٞ8;ղ8;�8bc4;估PD-L1ভ8;�8868;�8fbe;v84;晚期NSCLC患�8005;接受单纯免疫治疗与免疫�8054;Հ8;化疗v84;疗ٔ8;。方法本814;究回 87e;性分析N86;49O8b;PD-L1ভ8;�8868;�8fbe;晚期NSCLC患�8005;v84;临^8a;�8d44;料。PD-L1�8868;�8fbe;采ݒ8;22C3抗体�884c;免疫组化染�8272;，按TPS判�8bfb;PD-L1�8868;�8fbe;水平。比�8f83;不同临^8a;特_81;分组患�8005;v84;客�89c2;缓�89e3;s87;࿰8;objective response rate，ORR）T8c;无�8fdb;展生ֵ8;时间࿰8;progression free survival, PFS）。结果免疫单�836f;与免疫�8054;Հ8;化疗组v84;ORR分别为47.1%࿰8;8/17）T8c;43.8%࿰8;14/32），差异无统�8ba1;学意义࿰8;P=0.825）。免疫单�836f;与免疫�8054;Հ8;化疗组v84;中位PFS分别为8.0个ٰ8;T8c;6.8个ٰ8;，差异无统�8ba1;学意义࿰8;P=0.502）。并对本组PD-L1ভ8;�8868;�8fbe;患�8005;免疫治疗v84; 884;测因素�8fdb;�884c;N86;分析，结果显示，一线免疫治疗ORR࿰8;12/19, 63.2%）显�8457;ӱ8;N8e;N8c;线及以上免疫治疗࿰8;10/30, 33.3%），差异有统�8ba1;学意义࿰8;P=0.041），N8c;�8005;间PFS无差异。年Ÿ84;、性别、Ճ8;烟史、功�80fd;状态�8bc4;分࿰8;performance status, PS）、病理类W8b;、�80bf;瘤大小、�80bf;瘤淋巴结�8f6c;移࿰8;tumor node metastasis, TNM）分期与ORRT8c;PFS不ݯ8;关。结�8bba;PD-L1ভ8;�8868;�8fbe;v84;晚期NSCLC患�8005;接受免疫单�836f;T8c;免疫�8054;Հ8;化疗v84;疗ٔ8;ݯ8;�8fd1;。PD-L1ভ8;�8868;�8fbe;患�8005;一线免疫治疗v84;ORR更佳。对此类人群v84;最佳治疗方848;有_85;N8e;前瞻性临^8a;814;究�8fdb;一步探索。     

骨填充网袋椎体成形术与经皮椎体后凸成形术治疗Kümmell病的疗效比较

目v84;比�8f83;প8;86b;充网�888b;椎体成形术࿰8;Vesselplasty）与经皮椎体后ԟ8;成形术࿰8;percutaneous kyphoplasty，PKP）治疗 Kümmell 病v84;临^8a;疗ٔ8;。方法2015 年 1 ٰ8;—2018 年 12 ٰ8;收治 63 O8b; Kümmell 病患�8005;，其中 28 O8b;采ݒ8; Vesselplasty 治疗࿰8;Vesselplasty 组），35 O8b;采ݒ8; PKP 治疗࿰8;PKP 组）。两组患�8005;性别、年Ÿ84;、病程、প8;密度 T 值、প8;ة8;�8282;段及术前疼痛�89c6;�89c9;模拟�8bc4;分࿰8;VAS）、Oswestry 功�80fd;障88d;指数࿰8;ODI）、伤椎前߱8;ভ8;度、后ԟ8; Cobb �89d2;等一�822c;�8d44;料比�8f83;，差异均无统�8ba1;学意义࿰8;P>0.05），具有可比性。�8bb0;录两组手术时间、术中透�89c6;时间、প8;水泥ێ8;射量、প8;水泥渗漏s87;、প8;水泥弥散面积s87;T8c;–8f;�8bbf;期间并发症发生情况，以及术前、术后 1 d、末次–8f;�8bbf;时 VAS �8bc4;分、ODI、伤椎前߱8;ভ8;度、后ԟ8; Cobb �89d2;。 结果两组患�8005;均�83b7;–8f;�8bbf;，–8f;�8bbf;时间 12～36 个ٰ8;，平均 24.2 个ٰ8;。Vesselplasty 组手术时间、术中透�89c6;时间、প8;水泥ێ8;射量、প8;水泥弥散面积s87;均明显小N8e; PKP 组࿰8;P<0.05）。Vesselplasty 组প8;水泥渗漏s87;࿰8;7.14%）明显低N8e; PKP 组࿰8;34.29%）࿰8;χ²=5.153，P=0.023）。两组患�8005;术后 1 d 及末次–8f;�8bbf;时 VAS �8bc4;分、ODI、伤椎前߱8;ভ8;度、后ԟ8; Cobb �89d2;均�8f83;术前显�8457;改U84;࿰8;P<0.05），术后两组间比�8f83;差异均无统�8ba1;学意义࿰8;P>0.05）。–8f;�8bbf;期间两组均未�89c1;术椎Q8d;84c;陷，Vesselplasty 组邻椎প8;ة8;发生s87;࿰8;7.14%）与 PKP 组࿰8;14.29%）比�8f83;，差异无统�8ba1;学意义࿰8;χ²=0.243，P=0.622）。 结�8bba;Vesselplasty T8c; PKP 治疗 Kümmell 病疗ٔ8;ݯ8;似，均�80fd;有ٔ8;缓�89e3;患�8005;疼痛症状，改U84;生活�8d28;量，ऎ8;分恢复伤椎ভ8;度，矫正椎体后ԟ8;。但前�8005;具有手术时间短、术中透�89c6;时间少、প8;水泥渗漏少等ӱ8;势。