[Reconsideration of the indications for unicompartmental knee arthroplasty].

Unicompartmental knee arthroplasty (UKA), a procedure that has gradually emerged in recent years, is considered an effective treatment for resolving knee pain and restoring good function due to its significant clinical advantages. In the 1980s, Kozinn and Scott proposed the classic indications as selection criteria to identify ideal candidates for UKA. However, as treatment concepts, surgical instruments, surgical techniques, and prosthesis designs for this disease have improved, these indications proposed more than 30 years ago appear too limited, leading to some limitations in the widespread use of UKA. Specifically, surgeons have offered new perspectives on issues related to obesity, age, patellofemoral arthritis, severe varus deformity of the knee, anterior cruciate ligament deficiency, flexion contracture, failed high tibial osteotomy and post-traumatic arthritis. For this reason, this article will briefly discuss modern perspectives involving the indications for UKA based on current evidence with the aim of providing a reference for the reader.

[Epidemiological and molecular characteristics of human brucellosis in Qinghai province, 2005-2019].

Objective: To analyze the epidemiological and molecular characteristics of human brucellosis in Qinghai province from 2005 to 2019 and provide basic data for brucellosis prevention and control. Method: The data about human brucellosis in Qinghai from 2005 to 2019 were collected from the information system of China CDC to describe the spatial, population and time distributions of human brucellosis cases in Qinghai. The isolated strains were identified and typed with traditional methods, BCSP31-PCR, AMOS-PCR and multi-locus variablenumber tandem repeat (MLVA-16). Results: A total of 577 human brucellosis cases were reported in Qinghai from 2005 to 2019, the average prevalence rate was 0.07 per 100 000 person, there were statistic differences among different years. The disease occurred all the year around, but mainly during March-October. The 577 cases were distributed in 31 counties (cities/districts) from 6 autonomous prefectures (cities). The prevalence rats of five counties were high, i.e. Menyuan Hui autonomous county (22.88%, 132/577), Tianjun county (10.57%, 61/577)、Xining city (10.57%, 61/577), Henan Mongol Autonomous County (10.51%, 58/577) and Haiyan county (9.53%, 55/577). Age of the cases ranged from 8 years to 82 years, and the male to female ratio of the cases was 1.8∶1 (374/203). The prevalence rate in herdsman (47.83%, 276/577) was highest among different occupational populations. Ten isolates were all Brucella melitensis strains, belonging to biovar 3, and clustering analysis indicated that the 10 strains had 5 genotypes, in which 2 were distinct, the remaining 3 were same. MLVA-16 analysis indicated that the 10 strains had close relationship with 26 B. melitensis strains isolated in Qinghai previously. Conclusions: The prevalence of brucellosis increased in Qinghai in recent years, we should strengthen the population based brucellosis surveillance and reporting. MLVA-16 indicated the gene diversity of the Brucella strains, suggesting that MLVA-16 can be used for genetic diversity analysis and molecular epidemiology survey to improve brucellosis surveillance.

Allogeneic hematopoietic stem cell transplantation in children with aplastic anemia.

The aim of this study was to prospectively investigate the efficacy and safety of fully matched allogeneic hematopoietic stem cell transplants in children with severe aplastic anemia in China. A total of twenty patients with severe aplastic anemia were enrolled in our study. Thirteen cases underwent transplantation with fully human leukocyte antigen (HLA)-matched, granulocyte-colony stimulating factor (G-CSF)-primed bone marrow and peripheral blood stem cells (PBSCs) from matching sibling donors. One patient received fully HLA-matched bone marrow from an unrelated donor. Six patients received fully HLA-matched G-CSF-primed PBSCs from unrelated donors. The conditioning regimen included fludarabine, cyclophosphamide, and rabbit anti-thymocyte globulin. Graft-versus-host disease prophylaxis was conducted with cyclosporin A and short-course methotrexate. The median follow-up duration was 3.08 years (range, 0.83-8.41years). The median time of neutrophil recovery (>0.5 x 10(9)/L) was 14 days (range, 10-20 days), and the median time of platelet recovery (>20 x 10(9)/L) was 19 days (range, 14-31 days). The survival rate at the cutoff point of follow-up was 95.0% (19/20). Initial engraftment rate was 95% (19/20). Late graft failure (graft failures occurring 1 year or longer after transplantation) was observed in one patient. Only one patient developed Grade I acute graft-versus-host disease. Two cases suffered from Epstein- Barr virus (EBV)-associated post-transplant lymphoproliferative disorder and remitted after treatment with rituximab. One patient was diagnosed with hyperthyroidism 2.5 years after transplantation. Our study indicated that allogeneic hematopoietic stem cell transplantation is an effective and safe treatment for children with severe aplastic anemia in China.

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China.

SETTING: Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China. OBJECTIVES: To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion. DESIGN: Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ(2) test and log-binomial regression were used for data analysis. RESULTS: Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2-1.5), 1.2 (95%CI 1.0-1.4) and 1.1 (95%CI 1.0-1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7-11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0-12.8). CONCLUSION: The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.

Contexte : Treize centres de traitement par méthadone (MMT) dans le Yunnan, la province la plus touchée par le virus de l'immunodéficience humaine (VIH) en Chine.Objectifs : Déterminer, parmi les participants VIH négatifs, la proportion de perdus de vue (ceux qui ont manqué l'examen de suivi à 6 mois), les facteurs associés à cet abandon du suivi, le taux de séroconversion VIH et les facteurs associés.Schéma : Etude prospective de cohorte d'octobre 2008 à avril 2011. Tous les participants ont rempli un questionnaire structuré prétesté afin d'identifier ces facteurs et on leur a proposé un test VIH tous les 6 mois. L'analyse des données a été réalisée à l'aide du test χ2 et de la régression logarithmique binomiale.Résultats : Sur 1146 patients, 541 (47%) ont été perdus de vue en 2 ans et demi. Les facteurs associé à cet abandon comprenaient : <6 mois de séjour préalable dans un centre MMT, localisation peu pratique du centre et dose moyenne de méthadone ⩽60 mg/jour avec un risque relatif (RR) ajusté de 1,4 (IC95% 1,2­1,5), 1,2 (IC95% 1,0­1,4) et 1,1 (IC95% 1,0­1,3), respectivement. Le taux global de séroconversion était de 6,6% personnes-années (IC95% 3,7­11). Le fait de ne pas vivre avec un partenaire contribuait à un taux plus élevé de VIH avec un RR ajusté de 3,6 (IC95% 1,0­12,8).Conclusion : Le taux de rétention des participants à un traitement en centre MMT au Yunnan n'était pas satisfaisant. Une prestation de services décentralisée au niveau communautaire avec observation directe du traitement serait plus pratique et pourrait améliorer cette rétention.

Marco de referencia: Trece consultorios de tratamiento de mantenimiento con metadona en Yunnan, la provincia donde se observa la más alta carga de morbilidad por la infección causada por el virus de la inmunodeficiencia humana (VIH) en la China.Objetivos: Determinar la proporción de pérdidas durante el tratamiento de mantenimiento con metadona en los pacientes sin infección por el VIH (es decir, los pacientes que no acudieron al seguimiento mensual durante 6 meses), los factores que se asociaron con esta pérdida, la tasa de conversión de la serología frente al VIH y los factores relacionados con la seroconversión.Métodos: Se llevó a cabo un estudio prospectivo de cohortes entre octubre del 2008 y abril del 2011. Se administró a todos los participantes un cuestionario estructurado validado, destinado a captar los factores asociados y se les propuso la prueba diagnóstica del VIH cada 6 meses. En el análisis de los datos se aplicó la prueba de la χ2 y un análisis de regresión logarítmica binaria.Resultados: De los 1146 pacientes se perdieron durante el seguimiento 541 (47%) en 2,5 años. Los factores que se asociaron con una proporción más alta de pérdidas fueron los siguientes: una duración del tratamiento previo de mantenimiento con metadona <6 meses (riesgo relativo ajustado [RRa] 1,4; IC95% 1,2­1,5), una localización poco práctica del consultorio (RRa 1,2; IC95% 1,0­1,4) y una dosis promedio de metadona ⩽60 mg/día (RRa 1,1; IC95% 1,0­1,3). La tasa global de seroconversión frente al VIH fue 6,6 (IC95% 3,7­11,0) por 1000 años-persona. El hecho de no vivir en pareja contribuyó a una tasa más alta de serologías positivas, con un RRa de 3,6 (IC95% 1,0­12,8).Conclusión: En Yunnan, el índice de fidelización al tratamiento de mantenimiento con metadona de los participantes es deficiente. Se podría mejorar la retención de los pacientes mediante la descentralización de la prestación de los servicios hacia la comunidad y una mejor adaptación de la observación directa del tratamiento.

[Observation on the action of extractum semen Persicae on anti-fibrosis of liver].

It was observed that Extractum Semen Persicae acted obviously on hepatic fibrosis induced by CCl4. Through promoting the degradation of collagens type I, II, IV, VI and fibronectin, ESP has proved helpful in markedly reducing the fibrous septa composed of both collagenous and reticular fibers as well as in repairing the structure of hepatic tissues.