Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis.

PURPOSE: To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. METHODS: In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. RESULTS: In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. CONCLUSION: Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.

[Biomechanical study of polymethyl methacrylate bone cement and allogeneic bone for strengthening sheep vertebrae].

OBJECTIVE: To investigate the feasibility and mechanical properties of polymethyl methacrylate (PMMA) bone cement and allogeneic bone mixture to strengthen sheep vertebrae with osteoporotic compression fracture. METHODS: A total of 75 lumbar vertebrae (L 1-L 5) of adult goats was harvested to prepare the osteoporotic vertebral body model by decalcification. The volume of vertebral body and the weight and bone density before and after decalcification were measured. And the failure strength, failure displacement, and stiffness were tested by using a mechanical tester. Then the vertebral compression fracture models were prepared and divided into 3 groups ( n=25). The vertebral bodies were injected with allogeneic bone in group A, PMMA bone cement in group B, and mixture of allogeneic bone and PMMA bone cement in a ratio of 1∶1 in group C. After CT observation of the implant distribution in the vertebral body, the failure strength, failure displacement, and stiffness of the vertebral body were measured again. RESULTS: There was no significant difference in weight, bone density, and volume of vertebral bodies before decalcification between groups ( P>0.05). After decalcification, there was no significant difference in bone density, decreasing rate, and weight between groups ( P>0.05). There were significant differences in vertebral body weight and bone mineral density between pre- and post-decalcification in 3 groups ( P<0.05). CT showed that the implants in each group were evenly distributed in the vertebral body with no leakage. Before fracture, the differences in vertebral body failure strength, failure displacement, and stiffness between groups were not significant ( P>0.05). After augmentation, the failure displacement of group A was significantly greater than that of groups B and C, and the failure strength and stiffness were less than those of groups B and C, the failure displacement of group C was greater than that of group B, and the failure strength and stiffness were less than those of group B, the differences between groups were significant ( P<0.05). Except for the failure strength of group A ( P>0.05), the differences in the failure strength, failure displacement, and stiffness before fracture and after augmentation in the other groups were significant ( P<0.05). CONCLUSION: The mixture of allogeneic bone and PMMA bone cement in a ratio of 1∶1 can improve the strength of the vertebral body of sheep osteoporotic compression fractures and restore the initial stiffness of the vertebral body. It has good mechanical properties and can be used as one of the filling materials in percutaneous vertebroplasty.

A bone substitute composed of polymethyl-methacrylate bone cement and Bio-Gene allogeneic bone promotes osteoblast viability, adhesion and differentiation.

BACKGROUND: Increasing reports on new cement formulations that address the shortcomings of PMMA bone cements and various active components have been introduced to improve the biological activity of PMMA cement. OBJECTIVE: Evaluating the biological properties of PMMA cements reinforced with Bio-Gene allogeneic bone. METHODS: The MC3T3-E1 mouse osteoblast-like cells were utilized to determine the effects of Bio-Gene + PMMA on osteoblast viability, adhesion and differentiation. RESULTS: The combination of allogeneic bone and PMMA increased the number of adherent live cells compared to both control group and PMMA or Bio-Gene group. Scanning electron microscopy observed that the number of cells adhered to Bio-Gene + PMMA was larger than Bio-Gene and PMMA group. Compared with the control and PMMA or Bio-Gene group, the level of ALP and the number of calcium nodules after osteoinduction was remarkably enhanced in Bio-Gene + PMMA group. Additionally, the combination of Bio-Gene and PMMA induced the protein expression of osteocalcin, osterix and collagen I. CONCLUSION: The composition of PMMA and allogeneic bone could provide a more beneficial microenvironment for osteoblast proliferation, adhesion and differentiation. PMMA bone cement reinforced with Bio-Gene allogeneic bone may act as a novel bone substitute to improve the biological activity of PMMA cement.

Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors.

BACKGROUND: Total knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively. MATERIAL AND METHODS: Three hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors. RESULTS: Total blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban. CONCLUSIONS: Posterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.

mRNA expression of CK19, EGFR and LUNX in patients with lung cancer micrometastasis.

To evaluate the clinical significance of mRNA expression of cytokeratin 19 (CK19), epidermal growth factor receptor (EGFR) and lung-specific X protein (LUNX), a total of 42 patients who were diagnosed with non-small cell lung cancer (NSCLC) by pathology were studied retrospectively. The messenger RNA (mRNA) expression levels of CK19, EGFR and LUNX in the peripheral blood were analyzed using reverse transcription-polymerase chain reaction (RT-PCR). The expression of CK19 mRNA did not differ significantly according to the location, size, clinical stage or differentiation of the primary tumor (all P>0.05). However, there was a significant difference in the level of CK19 mRNA expression between squamous carcinoma and adenocarcinoma. The positive rates of EGFR mRNA in the patient and the healthy control groups were 69.0 and 12.5%, respectively, and were significantly different (P<0.05). The positive rates of LUNX mRNA in the two groups were 40.5 and 0%, respectively, and were significantly different (P<0.05). The results indicate that the mRNA expression of CK19, EGFR and LUNX in the peripheral blood is of significant clinical value for the diagnosis of micrometastasis and the prognosis of lung cancer.