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Objective:To explore the role of clinical pharmacists participating in the management of prophylactic antibiotics during the perioperative period of thoracic surgery, and to evaluate the effects after participating in the practice.Methods:The use of antimicrobials during the perioperative period of thoracic surgery in Wenjiang Hospital of Sichuan Provincial People's Hospital in August 2019 (pre-practice) was retrospectively analyzed. The existing problems were summarized, and the possible causes of the existing problems were analyzed. The improvement measures were jointly developed by clinical pharmacists and physicians. Clinical pharmacists continued to manage the use of antimicrobials by means of medication order reviews, ward rounds for pharmacy service, and medication training. The use of prophylactic antibiotics during the perioperative period of thoracic surgery was compared between August 2019 (pre-practice group) and December 2019 (post-practice group) and the practical effect was evaluated.Results:Clinical pharmacists reviewed perioperative patients' medication orders once a day, ward rounds for pharmacy service twice a week, and medication training once a month. Twenty-two patients were enrolled before practice, and 26 patients were enrolled after practice. There were no significant differences in age, sex, body weight, operative time, type of surgical incision, and preventive use of antibiotics between the two groups (all P > 0.05). In the post-practice group, the appropriate time for preoperative administration was 100.0%, which was significantly higher than 88.2% in the pre-practice group. The reasonable rate of preoperative preventive drug selection was 100.0%, which was significantly higher than 44.4% in the pre-practice group ( χ2 = 17.50, P < 0.001). In the post-practice group, the duration of preventive medication was (1.82 ± 0.59) days, which was significantly shorter than (7.54 ± 3.25) days in the pre-practice group ( t = 11.97, P < 0.001). In the post-practice group, the cost of antibacterial drugs was 316.00(237.00,454.25) yuan, which was significantly lower than 1 136.00(391.81 , 2 184.65) yuan in the pre-practice group ( Z = -2.78, P < 0.05). The defined daily dose of antibiotics among inpatients was 2.67(2.00,3.42), which was significantly lower than 8.88(3.92 , 19.18) in the pre-practice group ( Z = -3.26, P < 0.05). There were no significant differences in the incidence of postoperative pulmonary infection and total length of hospital stay between the two groups (both P > 0.05). Conclusion:Clinical pharmacists participating in the management practice of perioperative prophylactic antibiotics in thoracic surgery can effectively promote the rational application of perioperative antibiotics, markedly improve the reasonable rate of prophylactic drug delivery, shorten the course of prophylactic drugs, reduce the cost of antibiotics, decrease the defined daily dose of antibiotics, without increasing the risk of postoperative pulmonary infection and the total length of hospital stay.
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Anterior knee pain continues to be a major problem following total knee arthroplasty (TKA). Patellofemoral joint is closely associated to the occurrence of the anterior knee pain, so it is also called patellofemoral joint pain. Overstuff of patellofemoral joint and patella maltracking are the main factors for anterior part of the post-operative pain. They are resulted from the change of native morphology and Q angle of patellofemoral joint after operation. Instead of non-modifiable patients' congenital and genetic factors, they are mainly related to the improper surgical techniques and the mismatch between prostheses and native patellofemoral morphology. The reason of the mismatch is that the prosthesis is unable to cover all kinds of differences of the patellofemoral morphology among races and genders. In addition, some surgical techniques, including patellar replacement, circumpatellar denervation, femoral and patellar prostheses location, and the selection of the type of prosthesis, also affect the occurrence of anterior knee pain. The above mentioned factors may eventually lead to excessive and uneven distribution of the patella-femoral loads, which would compress and simulate the peripheral nerves around the joint. Ultimately, they result in the anterior knee pain. Therefore, the following effective strategies could lead to relief anterior knee pain and improve patients overall satisfaction after TKA, including improvements of prostheses design, patellar resurfacing, circumpatellar denervation, infrapatellar fat padpreservation or using mobile-bearing rotating-platform.
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Objective To study the feasibility and early efficacy of matrix?induced autologous chondrocyte implantation repairing knee joint cartilage injury. Methods The Matrix?induced autologous chondrocyte implantation was used to repair knee joint cartilage injury in 13 cases (11 males and 2 females) with knee joint cartilage injury from April 2012 to March 2013. The av?erage age was 27.5 years old. All cases were suffering from unilateral focal cartilage defect of knee joint with International Carti?lage Repair Society (ICRS) chondral defect classification system grade III or IV, visual analogue scale (VAS)>3, and all of which had corresponding pain symptoms. The average defect area was 4.2 cm2. Standardized rehabilitation exercise was carried out after matrix?induced autologous chondrocyte implantation. Patients were followed up for 1 years, and knee injury and use osteoarthritis outcome score(KOOS), International Knee Documentation Committee (IKDC), subjective knee form and Lysholm score were col?lected to assess the function. Meanwhile, magnetic resonance observation of cartilage repair tissue (MOCART) score was used to assess the magnetic resonance imaging. Results All patients had been followed?up for 1 year. One patient had meniscus repair under arthroscopy for the meniscus injury caused by downstairs sprain in 6.5 months postoperative, so the score of 12 months post?operative was excluded. The knee range of motion was decreased in 3 months postoperative (123.1°±8.0°) compared to preopera?tive one (135.4°±5.7°), and has no difference in 6 months (136.1°±6.1°) and 12 months postoperative (135.1°±3.6°) compared to preoperative one. The 5 subsets of KOOS score were decreased in 3 months compared to preoperative one, and were significantly increased in 6 months and 12 months. The IKDC has no difference in 3 months (26.1±3.9) compared to preoperative one (43.5± 6.5), and were significantly increased in 6 months (53.3±5.8) and 12 months (62.8±7.2) compared to preoperative one. The magnet?ic resonance observation of cartilage repair tissue (MOCART) score was increased in 12 month(73.3±17.9)compared to preopera?tive one(51.5 ± 12.6). Conclusion MACI is a good technology for knee joint cartilage injury. It has a good clinical effect on re? pairing cartilage injury effectively and restoring the function of knee joint.
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The expression of microRNA (miRNA) is closely related to radio-chemosensitivity in glioma stem cells (GSCs).Moreover,the growth of glioma stem cells could be inhibited comprehensively by increasing radio-chemosensitivity and apoptosis,simultaneously with the regulation of a single miRNA,which has been confirmed by some researches.Thereby microRNA is prospective for the adoption as a specific agent in targeted therapy of glioma,so as to increase the radio-chemosensitivity in glioma stem cells.
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To assess a novel cell manipulation technique of tissue engineering with respect to its ability to augment superparamagnetic iron oxide particles (SPIO) labeled mesenchymal stem cells (MSCs) density at a localized cartilage defect site in an in vitro phantom by applying magnetic force. Meanwhile, non-invasive imaging techniques were use to track SPIO-labeled MSCs by magnetic resonance imaging (MRI). Human bone marrow MSCs were cultured and labeled with SPIO. Fresh degenerated human osteochondral fragments were obtained during total knee arthroplasty and a cartilage defect was created at the center. Then, the osteochondral fragments were attached to the sidewalls of culture flasks filled with phosphate-buffered saline (PBS) to mimic the human joint cavity. The SPIO-labeled MSCs were injected into the culture flasks in the presence of a 0.57 Tesla (T) magnetic force. Before and 90 min after cell targeting, the specimens underwent T2-weighted turbo spin-echo (SET2WI) sequence of 3.0 T MRI. MRI results were compared with histological findings. Macroscopic observation showed that SPIO-labeled MSCs were steered to the target region of cartilage defect. MRI revealed significant changes in signal intensity (P<0.01). HE staining exibited that a great number of MSCs formed a three-dimensional (3D) cell "sheet" structure at the chondral defect site. It was concluded that 0.57 T magnetic force permits spatial delivery of magnetically labeled MSCs to the target region in vitro. High-field MRI can serve as an very sensitive non-invasive technique for the visualization of SPIO-labeled MSCs.
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Objective To investigate the outcomes of arthroscopic reduction and internal fixation with cannulate lag screw for avulsion fracture of tibial intercondylar anterior eminence.Methods From May 2004 to December 2007,30 cases of tibial intercondylar anterior eminence avulsion fracture were treated by arthroscopic reduction and fixation with cannulated lag screw.Among the patients,there were 10 females and 20 males,ranging from 15 to 79 years old with an average age of 32.0.There were 12 fresh fractures and 18 old fractures.According to Meyers-McKeever-Zaricnyl's classification systems,there were 8 cases of type Ⅱ,15 cases of type Ⅲ,and 7 cases of type Ⅳ.Patients were encouraged to do postoperative rehabilitation,such as active joint extension and flexion,exercise of isometric contraction of quadriceps femoris.The treatment outcomes were evaluated by Lysholm and Irrgang knee score system.Results All patients were followed up for 3 months to 60 months(averaging 31.2 months).X rays revealed bony healing 2 months after operation.The joints were stable.Negative Lachaman and drawer and jerk tests were found in all cases,and there was no dysfunction in the knee joints.Lysholm scores were increased from(60.8?1.5)to(95.5?3.5)while Irrgang scores increased from(55.5?3.3)to(90.5?2.5).Conclusion Arthroscopic treatment of avulsion fracture of tibial intercondylar anterior eminence is an easy approach with minimal invasion,and has reliable reduction and fixation with satisfied results.
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Objective To explore the role of expression of membrane Fas(mFas)antigen and serum soluble Fas(sFas)in acute leukemia.Methods Strept avidin-biotin complex method of immunohistochemical staining assay and sandwich enzyme-linked immunosorbent assay(ELISA)were used to detect the expression of mFas antigen in bone marrow cells and serum sFas in 30 patients with acute leukemia in Binzhou Medical College Affiliatd Hospital from November 2001 to September 2002,which was compared with normal control group.The relation between expression of serum sFas and chemotherapy outcome were evaluated too.Results The expression of mFas antigen in ALL(5.62?2.27)% and ANLL(8.80?4.15)% were respectively and significantly lower than that in normal control group(28.75?11.20)%(P