个案管理师主导的骨安全分级预防方案在乳腺癌患者中的应用

目的探讨以个案管理师为主导的骨安全分级预防方案在乳腺癌患者中的应用效果。方法选取乳腺癌患者272例,按入院时间分为对照组和干预组各136例。对照组采取骨质疏松常规预防护理措施,干预组给予以个案管理师为主导的骨安全分级预防方案,对两组患者持续随访2年,分析比较两组患者骨质疏松风险等级、骨质疏松发生率以及骨质疏松性骨折发生率。结果对照组119例和干预组127例完成全程研究及随访。干预组骨质疏松风险等级、骨质疏松发生率以及骨质疏松性骨折发生率显著低于对照组(均P<0.05)。结论以个案管理师为主导的骨安全分级预防方案可有效提高乳腺癌患者骨安全管理成效,改善患者预后。

唑来膦酸治疗原发性骨质疏松症临床疗效研究

目的：探讨唑来膦酸联合钙尔奇D治疗原发性骨质疏松症临床疗效及安全性。方法：唑来膦酸注射液4mg，用0．9％氯化钠注射液或5％葡萄糖注射液100ml稀释后静脉滴注，滴注时间≥15min。同时口服钙尔奇D片600mg，1次／d，疗程为12个月。结果：本组43例患者经唑来膦酸联合钙尔奇D治疗6个月、12个月后骨痛症状明显改善，较治疗前骨痛NRS评分明显降低，差异有统计学意义（P〈0．05），腰椎L1-4。与股骨颈骨密度（BMD）值，较治疗前有明显增长，差异有显著性（P〈0．05），而患者血钙（Ca）、血磷（P）检测值与治疗前比较无明显变化，差异无统计学意义（P〉0．05），骨形成标志物OC、BALP值下调，治疗后12个月两者测定接近于正常值，其中OC值治疗后12个月较治疗前下降明显，差异有统计学意义（P〈0．05）；而骨吸收标志物β-CTx、DPD／Cr比值，治疗后下降迅速，与治疗前比较，差异具有显著性（P〈0．05）。结论：唑来膦酸联合钙尔奇D治疗原发性OP可有效改善骨痛症状与骨代谢相关指标，增加骨量，不良反应少，患者依从性较好。

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament （PDL） injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth： the premolar group （PM, z2=38）, first molar group （FM, n=66）, and second molar group （SM, n=58）. All the patients received computer-controlled PDL injection with 4% articaine and 1 ＇ 100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups （92.1%, 53.0%, 93.1%, respectively; 2 X =34.3, P〈0.01）. Both the PM and SM groups showed higher success rates than that of the FM group （v=l, f=16.73, P〈0.01, v=l, Z = 4.5, X2 2 P〈0.01）. No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

Safety evaluation on the clinical application of Tenghuangjiangu tablet for osteoarthritis:a hospital registration study

To evaluate the treatment safety of Tenghuangjiangu tablet on osteoarthritis,3365 osteoarthritis patients whose prescription included Tenghuangjiangu tablet from 15 hospitals were involved in the prospective and multi-center clinical trial.Tenghuangjiangu tablet dosage was decided by instruction or doctors’experience.The course of treatment and observation was 4 weeks.The adverse drug reactions were observed in the treatment process.Results showed male and female patients were 1018(30.25%)and 2347(69.75%),respectively,and 528 patients had allergic history.The patients’average age was 58.30±8.99 years,and the average disease course was 33.29±37.40 months.The average score of WOMAC scale was 95.07±42.42,which indicated the light conditions.2275 patients were treated with combined drug regimen.There were two adverse drug reactions in this research.One reaction was skin rashes with itching and the interventions were stopped original drugs and give antianaphylactic treatment.The other reaction was stomach discomfort with disgusting and the intervention was stopped the original drugs temporarily,then continued to take two drugs after 3 days and the reaction didn’t appear.The accident rate of adverse drug reaction was 0.059%.The safety of Tenghuangjiangu tablet clinical application was good,and the mechanism of adverse drug reaction should be researched in-depth.

Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease

AIM： To evaluate the safety and feasibility of bone marrow cell （BMC） transplantation in patients with chronic liver disease on the waiting list for liver transplantation. METHODS： Ten patients （eight males） with chronic liver disease were enrolled to receive infusion of autologous bone marrow-derived cells. Seven patients were classified as Child-Pugh B and three as Child-Pugh C. Baseline assessment included complete clinical and laboratory evaluation and abdominal MRI. Approximately 50 mL of bone marrow aspirate was prepared by centrifugation in a ficoll-hypaque gradient. At least of 100 millions of mononuclear-enriched BMCs were infused into the hepatic artery using the routine technique for arterial chemoembolization for liver tumors. Patients were followed up for adverse events up to 4 mo. RESULTS： The median age of the patients was 52 years （range 24-70 years）. All patients were discharged 48 h after BMC infusion. Two patients complained ofmild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 （2.19 ± 0.9） and 4 mo （2.10 ± 1.0） after cell transplantation that baseline levels （238 ± 1.2）. Albumin levels 4 mo after BMC infusion （3.73 ± 0.5） were higher than baseline levels （3.47 ± 0.5）. International normalized ratio （INR） decreased from 1.48 （SD = 0.23） to 1.43 （SD = 0.23） one month after cell transplantation. CONCLUSION： BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.

Safety and Quality Attributes of Sucuk-Like Product Made with Mechanically Deboned Broiler/Beef

In this study, sucuk-like products （SLP） has a great consumption in Turkey, which are produced with broiler or mixture of beef and broiler meat and after stuffing into artificial casings heat treatment is applied after rapid fermentation. Quality （color, pH, texture） and safety （2-thiobarbituric acid reactive substance （TBARS） value and biogenic amine） attributes of SLP made with broiler, mechanically deboned meat （MDM） of broiler chicken, mix of broiler chicken and beef, or mix of MDM of broiler chicken and MDM of beef were investigated, pH values of samples had similar range. Mechanically deboned meat containing samples have higher TBARS values than that of others. Samples made with MDM of broiler chicken have higher histamine, tyramine, putrescine and total biogenic amine concentrations than samples made with broiler chicken. There was no significant difference （P 〉 0.05） between total biogenic amine contents of fermented and non-fermented samples. Also, samples gave similar measured and calculated color values. Hardness, gumminess and chewiness values of samples made with MDM of broiler chicken were significantly higher （P 〈 0.05） than samples made with broiler chicken. It was observed that addition of mechanically deboned meat could result in loss of safety and quality attributes of sucuk-like products.

Dynamic hip screw with locking side plate： a viable treatment option for intertrochanteric fracture

Objective： Dynamic hip screw （DHS） is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from I% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate. Methods： Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS （group A） and locking DHS （Combi plate, group B）. We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score. Results： Coxa valga was found more frequently in group A than in group B （12% vs. 0%, P=0.42）. Coxa vara showed the same trend （12% vs. 8%, P=0.81）. Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B （8% cases） than in group A （4% cases, P=0.98）. The rate of anteversion angle restoration within 10° of sound side was also higher in group B （100% vs. 88%, P=0.85）. The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications. Conclusion： The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.

Double level Chance-type fractures of spine in ankylosing spondylitis

Chance fractures are usually associated with seat belt injuries. Mechanism is always related to flexion-distraction at vertebral level. Double level Chance-type fractures have rarely been reported in published literature. We presented such a fracture at D10 and L3 level in a 38-year-old patient with ankylosing spondylitis. Management was done with posterior decompression and short segment fixation separately.

Influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations in total hip arthroplasty

Objective： To study the influences of head/neck ratio and femoral antetorsion on the safe-zone of operative acetabular orientations, which meets the criteria for desired range of motion （ROM） for activities of daily living in total hip arthroplasty （THA）. Methods： A three-dimensional generic, parametric and kinematic simulation module of THA was developed to analyze the cup safe-zone and the optimum combination of cup and neck antetorsion. A ROM of flexion ≥ 120°, internal rotation ≥ 45° at 90° flexion, extension ≥ 30° and external rotation ≥ 40° was defined as the criteria for desired ROM for activities of daily living. The cup safe-zone was defined as the area that fulfills all the criteria of desired ROM before the neck impinged on the liner of the cup. For a fixed stemneck （CCD）-angle of 130°, theoretical safe-zones fulfilling the desired ROM were investigated at different general headneck ratios （GR=2, 2.17, 2.37, 2.61 and 2.92） and femoral anteversions （FA=0°, 10°, 20° and 30°）. Results： Large GRs greatly increased the size of safezones and when the CCD-angle was 130°, a GR〉2.37 could further increase the size of safe-zones. There was a complexinterplay between the orientation angles of the femoral and acetabular components. When the CCD-angle was 130°, the optimum relationship between operative acetabular anteversion （OA） and femoral antetorsion （FA） could be estimated by the formula： OA=-0.80×FA＋47.06, and the minimum allowable operative acetabular inclination （OImin） would be more than 2 10.5 ×GR^-2255. Conclusions： Large GRs greatly increase the size of safe-zones and it is recommended that the GR be more than 2.37 so as to extend the acceptable range of error that surgeons cannot avoid completely during operation. As to the optimum operative acetabular inclination （OI）, surgeons need to make a decision combining with other factors, including stress distribution, soft tissue and cup wear conditions, as well as patients＇ individual situations and demands. The data obtained from this study and the module of THA can be used to assist surgeons to choose and implant appropriate implants.

Evaluating the safety of high arch dams with fractures based on numerical simulation and geomechanical model testing

It is important to estimate the probability of fracture extension and its impact on the safety of arch dams with fractures. Numerical simulation and geomechanical model test were combined to evaluate the overall stability and the extension probability of fractures. Numerical simulation forecasted the dam displacement and the operating behavior based on the parameters obtained from the back analysis. Geomechanical model test was based on small block masonry and the models with or without fractures were both tested. The results show that the deformation of dams is in line with general rules at a normal water load and the extension probability of the existing fractures is very small, which has no significant impact on the global stability of dams. Moreover, the failure process of arch dams with the existing fractures in dams at overload scenarios is similar to the one without the embedded fractures, i.e., the failure crack which is not caused by the existing fractures inside comes into being on the surface of dams itself.

Analysis of safety and effect of reconstructing anterior and middle columns by single posterior approach in treating lumbar burst fractures

Objective： To explore the safety and effect of the technique of reconstructing anterior and middle columns by posterior approach in treating lumbar burst fractures. Methods： From July 2005 to January 2007, 22 cases （18 males and 4 females, aged 28-57 years, 42.7 years on average） of lumbar burst fractures were treated with surgical procedures in our hospital. Based on the routine posterior approach, one of the transverse processes of the injured vertebra was incised to get access to the lateral side of the injured vetebral body. After all the displaced fracture fragments were cleared away and the spinal canal was decompressed, the titanium mesh packed with autografts was implanted from the lateral side to reconstruct the anterior and middle columns. The adjacent above and below segments of the vetebral body were fixed with transpedicular screws. The operation time, intraoperative blood loss, vertebral height, degree of kyphotic deformity and comprised spinal canal were documented. Results： The average operation time was 3.5 hours （ranging 2.8-5.8 hours） and the average blood loss was 820 ml （ranging 650-2 100 ml）. All the cases were followed up for 17.2 months on average （ ranging 12-28 months）. The height of the injured vetebral body was restored from 24 % （12%- 45%） preoperatively to 96% （95%-99%） postoperatively （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury and 1 case was involved in the loosening of the connected rod of the pedicle screw system 3 months postoperatively. Conclusions： The technique of implanting the titanium mesh by posterior approach is effective and safe enough to reconstruct the anterior and middle columns in treating lumbar burst fractures.