Traditional Chinese medicine manipulative reduction combined with percutaneous vertebroplasty for treating type Ⅲ Kummell's disease: A case report

BACKGROUND A patient with type Ⅲ Kummell’s disease had a ruptured posterior cortex of the fractured vertebral body, which caused spinal cord compression. An open surgery was considered the best choice of operation. However, the patient and her family refused open surgery and instead demanded a minimally invasive surgical treatment such as percutaneous vertebroplasty(PVP). After preoperative discussion, we finally adopted the novel therapy of traditional Chinese medicine manipulative reduction(TCMMR) combined with PVP.CASE SUMMARY A patient with type Ⅲ Kummell’s disease exhibiting bone block-induced spinal cord compression was admitted to our hospital. She suffered from a variety of medical disorders but refused open surgery, and instead asked for PVP surgery. TCMMR, in parallel with PVP, was used to restore the height of the compressed vertebral body and reduce the symptoms of spinal cord compression by the bone block in order to strengthen the vertebral body and prevent further collapse. The surgery was very successful. The height of the compressed vertebra was restored, and the symptom of spinal cord compression by bone block was reduced successfully via TCMMR. The fractured vertebra was solidified by the PVP. The pain visual analog score declined from preoperative 7 scores to postoperative 2 scores, and the Frankel spinal cord scale increased from preoperative D degree to postoperative E degree.CONCLUSION The new method has advantages in treating patients with type Ⅲ Kummell’s disease who cannot be treated with open surgery.

右半结肠切除术后切口持续灌注罗哌卡因应用效果的临床观察

目的观察切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠在右半结肠切除术后镇痛中的应用效果。方法选取2014年2月-2015年10月锦州医科大学沈阳军区总医院收治的行右半结肠切除术的60例患者,随机分为观察组与对照组,每组30例。观察组术后采用切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠镇痛,对照组术后采用静脉注射帕瑞昔布钠镇痛。比较两组患者术后6、20、32、44和56 h的疼痛评分(NRS评分),术后第1天、第2天和第3天晨起体温,术后第1天和第3天白细胞计数及中性粒细胞百分数,以及术后首次排气时间、术后住院时间、切口及总的并发症发生率等。结果观察组术后6、20、32、44和56 h NRS评分优于对照组(P<0.05)。两组患者术后白细胞计数和中性粒细胞百分数,术后体温及术后住院天数差异均无统计学意义(P>0.05),但观察组术后补救镇痛人数大于对照组(P<0.05),术后首次排气时间较对照组提前(P<0.05)。观察组术后切口并发症的发生率与对照组差异无统计学意义(P>0.05),但总的并发症发生率低于对照组(P<0.05)。结论切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠与单纯静脉注射帕瑞昔布钠相比,可更有效地缓解右半结肠切除患者术后疼痛,促进胃肠功能恢复,减少患者术后恶心和总的并发症的发生率。

The levels of serum cystatin C, brain natriuretic peptide in traumatic patients and correlation analysis with traumatic severity

Objective:To observe the levels of serum cystatin C (Cys C), brain natriuretic peptide (BNP) in traumatic patients and correlation analysis with traumatic severity.Methods:120 emergency traumatic patients in emergency department of our hospital were rolled from December 2015 to December 2016, who were divided into minor trauma group (n=41), severe trauma group (n=43) and critical trauma group (n=36) according to the injury severity score (ISS). The levels of serum Cys C, BNP of the patients in the 3 groups were detected on 0 h, 24 h, 3 d and 7 d after admission respectively. Pearson correlation analysis of the levels of serum Cys C, BNP and ISS.Results: There were no significant differences in the levels of serum Cys C, BNP on 0 hours between the three groups;There were no significant differences in the levels of serum Cys C, BNP on 0 h, 24 h, 3 d and 7 d in minor trauma group;The levels of serum Cys C, BNP on 24 h, 3 d and 7 d were all higher than those of 0 h in severe trauma group, and the levels of serum Cys C on 3 d and 7 d were both higher than those of 24 h;The levels of serum Cys C, BNP on 24 h, 3 d and 7 d were all higher than those of 0 h in critical trauma group, the levels of serum Cys C, BNP on 3 d and 7 d were both higher than those of 24 h, and the levels of serum Cys C on 7 d were higher than those of 3 d;The levels of serum Cys C, BNP in severe trauma and critical trauma groups were significantly higher compared with minor trauma group on 24 h, 3 d and 7 d. Pearson correlation analysis, the level of serum Cys C were positively correlated with ISS, the level of serum BNP were positively correlated with ISS.Conclusion:Different levels of traumatic patients had different levels of serum Cys C, BNP increased at different times. Pearson correlation analysis showed that the levels of serum Cys C, BNP were both positively correlated with traumatic severity, which suggested that the levels of serum Cys C, BNP may be important indicators of traumatic severity and could provide important reference value for clinical evaluation of traumatic severity.

Clinical deep remission and related factors in a large cohort of patients with rheumatoid arthritis

Background:Clinical remission is the treatment target in rheumatoid arthritis (RA).This study aimed to investigate clinical remission and related factors in a large cohort of patients with RA.Methods:This study composed of 342 patients with RA.Data were collected by face-to-face interview of 1049 patients with RA who visited the Department of Rheumatology of three teaching hospitals from September 2015 to May 2016.The patients with RA were clinically assessed by rheumatologists and a four-page questionnaire was completed on site.Subsequently,patients fulfilled remission criteria were further analyzed.The practicability of different definitions of remission of RA was rated by a panel of rheumatologists.Sustained intensive disease modifying anti-rheumatic drug (DMARD) treatment was defined as a combination treatment with two or more DMARDs for at least 6 months.Results:In this cohort of 342 patients with RA,the proportions of patients achieving remission were 38.0%,29.5%,24.9%,21.1%,19.0%,18.1%,and 17.0%,based on criteria of disease activity score in 28 joints (DAS28) using CRP (DAS28-CRP),DAS28 using ESR (DAS28-ESR),routine assessment of patient index data 3 (RAPID-3),Boolean,simplified disease activity index (SDAI),clinical disease activity index,and the newly described clinical deep remission (CliDR),respectively.Boolean and CliDR are the best in practicability scored by rheumatologists (7.5 and 8.0,respectively).Compared with the non-sustained intensive group,sustained intensive treatment with DMARDs yielded higher remission rates of 25.6%,23.8%,and 21.3% in patients with RA based on Boolean (χ^2=3.937,P=0.047),SDAI (χ^2=4.666,P=0.031),and CliDR criteria (χ^2=4.297,P=0.038).The most commonly prescribed conventional synthesized DMARDs (csDMARDs) in patients with RA was leflunomide,followed by methotrexate,and hydroxychloroquine.Compared with the non-remission group,patients achieving remission had a longer median duration of DMARDs (45.0 [22.8–72.3] months,Z=-2.295,P=0.022).Conclusions:The findings in this study indicated that clinical deep remission is achievable in patients with RA.Sustained intensive DMARD treatment is needed to achieve a better outcome in RA.

Clinical Relevance of Autoantibodies against Interleukin-2 in Patients with Systemic Lupus Erythematosus

Background： Increased serurn autoantibodies against interleukin-2 （anti-IL-2 autoantibodies） were reported in patients with systemic lupus crythematosus （SLE） and in patients receiving IL-2 therapy. This study aimed to explore the clinical relevance of serum anti-IL-2 autoantibodies and the interactions between low-dose IL-2 therapy and serum anti-IL-2 autoantibodies. Methods： Serum samples were collected from 152 SLE patients and 100 age- and gender-matched healthy controls （HCs）. Among them, 75 SLE patients were followed tip for 10 weeks, and all of them were treated with corticosteroids, antimalarials, and/or immunosuppressants. Forty-six out of the 75 SLE patients received low-dose IL-2 therapy additionally. Clinical and laboratory parameters were collected at baseline and week 10. Serum anti-lL-2 autoantibodies were determined by enzyme-linked immunosorbent assay. Results： Compared with HCs, median levels and positive rates of sernm anti-IL-2 autoantibodics were higher in SLE patients （32.58 [23.63, 45.23] arbitrary unit [AU] vs. 37.54 [27.88, 60.74] AU, P- 0.006, and 5.0% vs. 18.4%, P = 0.002, respectively）. Compared to those without the corresponding disorders, serum anti-IL-2 autoantibody was increased in patients with alopecia （49.79 [36.06, 64.95] AU vs. 35.06 [25.40, 58.46] AU, P = 0.033）, but it was decreased in those with lupus nephritis （31.71 [22.60, 43.25] AU vs. 44.15 [31.43, 68.52] AU, P= 0.001 ）. Moreover, serum anti-I L-2 autoantibody was positively correlated with serum IgA （r= 0.229, P = 0.005）, total lgG （r= 0.327, P 〈 0.001 ）, and total lgM （r=0.164, P = 0.050）. Treatment with exogenous IL-2 was not significantly associated with serum anti-IL-2 autoantibody. In addition, no significant difference was found in serum anti-lL-2 autoantibody between responders and nonresponders to low-dose I L-2 therapy. Conclusions： Serum anti-lL-2 autoantibody was increased and associated with disease severity in SLE. Exogenous low-dose IL-2 did not significantly induce anti-IL-2 autoantibody production.