Objective:To assess the role of polymerase chain reaction(PCR)in serum sauples,in the diagnosis of osteoarticular tuberculosis(OTB)in a setting where only clinical and imaging diagnoses determine the treatment.Methods...Objective:To assess the role of polymerase chain reaction(PCR)in serum sauples,in the diagnosis of osteoarticular tuberculosis(OTB)in a setting where only clinical and imaging diagnoses determine the treatment.Methods:A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients,based on clinical and radiological[X-ray or magnetic resonance imagng/computecl tomography]features.They were scrcened by in-house nested PCR.In addition,a few specimens were examined by Gram stain,acid-fast bacilli stain,histand routine bacterial culture.A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls.Results:of the 44 clinically suspected OTB patients,in-house nested PCR was positive in 40(91%)cases;PCR was negative in 38(97%)negative controls.Sensitivity and specificity of our in—house nested PCR was 90.3%and 97.4%,respectively.The PCR report was available within 48 h.It was possible to standardize serum PCR technique and in positive cases,a good n was observed in terms of an adequate treatment response.Conclusions:Nested PCR in serum samples is a rapid,highly sensitive and specific modality for OTB detection,PCR should be performed in addition to clinical evaluation,imaging studies,acidfast bacilli staining,culture and histopathology diagnosis,if possible.展开更多
BACKGROUND Osteoarticular tuberculosis(OATB) is a severe form of extrapulmonary TB, which causes notable morbidity and warrants a high index of suspicion for prompt management. The diagnosis of OATB poses a challenge,...BACKGROUND Osteoarticular tuberculosis(OATB) is a severe form of extrapulmonary TB, which causes notable morbidity and warrants a high index of suspicion for prompt management. The diagnosis of OATB poses a challenge, because of the difficulty of collecting the samples and, secondarily, the paucibacillary nature of lesion, which gives poor sensitivity and reproducibility, with long turnaround time of routine/conventional laboratory tests and the requirement for invasive procedures and expertise. The Xpert MTB/RIF assay has been approved by the World Health Organization as a rapid diagnostic tool for diagnosing pulmonary and extrapulmonary TB.AIM To emphasize the diagnostic efficiency of gene Xpert for OATB in suspected patients in a tertiary care hospital of Eastern India.METHODS This retrospective study was conducted in the Department of Microbiology and Orthopaedics by analyzing the data of the gene Xpert assay over a 3-year duration from January 2018 to February 2021. Demographic and clinical data were recorded. The diagnostic efficiency of gene Xpert was evaluated against the composite reference standard(CRS).RESULTS A total of 37 cases fell into positive, probable, and possible categories of osteoarticular TB out of 112 patients included in the study by CRS;gene Xpert result was positive in 35 out of the 37 different CRS categorized cases. Of the 112 cases, culture was put in 40 cases, and, of these cultures, 5 cases showed the growth of MTB. Of these, 4 cases were included in the 35 cases diagnosed by gene Xpert.Smear microscopy was positive in 6 out of 37 CRS categorized cases. When compared with CRS, the sensitivity of gene Xpert assay, culture, and smear was found to be 94.6%, 13.5%, and 16.2%, respectively, while specificity in all the three types of tests was 100%. When kappa statistics were applied, the percentage of agreement gene Xpert, culture, and microscopy with CRS was found to be 95%, 20%, and 22.6%, respectively. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improved conditions.CONCLUSION Gene Xpert could detect 31 extra cases with a low and very low mycobacterial load that were missed by the routine culture methods. Hence, more samples should be processed for molecular diagnostic methods like gene Xpert along with other conventional methods for the validation of the molecular test prospectively for the timely diagnosis of osteoarticular TB.展开更多
Objective: To describe paraclinical, therapeutic and evolutionary aspects of osteoarticular tuberculosis in Abidjan. Materials and Method: We realized a descriptive retrospective study carried out in the Rheumatology ...Objective: To describe paraclinical, therapeutic and evolutionary aspects of osteoarticular tuberculosis in Abidjan. Materials and Method: We realized a descriptive retrospective study carried out in the Rheumatology Department of the University Hospital Center of Cocody in Abidjan about 550 patients over a period of 10 years from January 2004 to December 2013. The paraclinical, therapeutic and evolutionary data had interested us. Results: Osteoarticular tuberculosis represented 12.13% of 4531 rheumatic diseases identified during the study period. The tuberculin skin test was positive in 78.49% of cases. An inflammatory syndrome was present with erythrocyte sedimentation rate and C-reactive protein respectively into 69.45% and 76.54% of cases. The research of Mycobacterium tuberculosis was realized into 176 of cases which 50% was positive. Polymerase chain reaction and biopsy of tissue were performed respectively in 8 and 6 cases. Plain radiography (89.82%) and computed tomography (83.63%) were the most realized imaging. Computed tomography has contributed for the diagnostic in 99.78% of cases. The majority of our patients (82.91%) received anti-tuberculous treatment which consisted of two months of combination of rifampicin (R), isoniazid (H), pyrazinamide (Z) and Ethambutol (E) (2RHZE), followed by 10 months of rifampicin (R) and isoniazid (H) (10 RH). The outcome in patients on this treatment was favorable in 528 cases (96%). Conclusion: This study revealed that the research of Mycobacterium tuberculosis was often realized and positive. On the contrary, polymerase chain reaction and biopsy of tissue were rarely performed. The main imaging is computed tomography. Our protocol of treatment is effective.展开更多
Type 1 or 2 diabetes can be complicated by numerous non-specific joint conditions. Sometimes revealing, these affections are frequent but often remain unrecognized. However, they are the cause of a significant functio...Type 1 or 2 diabetes can be complicated by numerous non-specific joint conditions. Sometimes revealing, these affections are frequent but often remain unrecognized. However, they are the cause of a significant functional handicap. The objective of this work is to describe the osteoarticular rheumatological disorders in diabetics consulting or hospitalized in the rheumatology and internal medicine departments of the National Hospital of Niamey and the Magori Polyclinic. This was a cross-sectional study at the Rheumatology Department in collaboration with the Internal Medicine Department within the National Hospital of Niamey and Polyclinic Magori over a period of 7 months (December 2018 to July 2019). One hundred (100) diabetic patients with osteoarticular diseases were collected, 75% of whom were women with a female/male sex ratio of 0.33. The average age was 56 years with extremes of 21 and 90 years. Forty-three percent (43%) of the patients had diabetes for more than 10 years, with an average age of 13 years. The average BMI was 28.08 ± 5.42 kg/m<sup>2</sup>. Poor glycemic control was found in the majority of patients (92%). Gonarthrosis was the most common disease associated with diabetes (89%). In the context of joint stiffening syndrome, the most frequent problem was a protruding finger, found in 4% of patients, followed by retractile capsulitis in 3% of the 100 cases. Infectious complications were dominated by septic arthritis in 4% of patients. The presence of one or more degenerative complications of diabetes (nephropathy, retinopathy, nephropathy) was the most frequent factor associated with osteoarticular diseases in our diabetic patients. This work underlines the great variety and frequency of osteoarticular affections during diabetes, hence the interest in optimal glycemic control of a close collaboration between rheumatologists and endocrinologists in order to avoid as much as possible the development of these rheumatological affections which are the source of pain and functional handicap, being able to even engage the vital prognosis.展开更多
As a promising manufacturing technology,three-dimensional(3D)printing technology is widely used in the medical field.In the treatment of osteoarticular defects,the emergence of 3D printing technology provides a new op...As a promising manufacturing technology,three-dimensional(3D)printing technology is widely used in the medical field.In the treatment of osteoarticular defects,the emergence of 3D printing technology provides a new option for the reconstruction of functional articular surfaces.At present,3D printing technology has been used in clinical applications such as models,patient-specific instruments(PSIs),and customized implants to treat joint defects caused by trauma,sports injury,and tumors.This review summarizes the application status of 3D printing technology in the treatment of osteoarticular defects and discusses its advantages,disadvantages,and possible future research strategies.展开更多
BACKGROUND Brucellosis is the most common zoonosis worldwide and is endemic in the Middle East,Africa,Asia,and Latin America.However,it is uncommon in Central Europe,and periprosthetic infections caused by Brucella ar...BACKGROUND Brucellosis is the most common zoonosis worldwide and is endemic in the Middle East,Africa,Asia,and Latin America.However,it is uncommon in Central Europe,and periprosthetic infections caused by Brucella are therefore rare.Due to the low prevalence and nonspecific clinical presentation of the disease,accurate diagnosis can be challenging;no gold standard currently exists for treating brucellosis.CASE SUMMARY Here,we present a 68-year-old Afghan woman living in Austria with a periprosthetic knee infection caused by Brucella melitensis.The interval from total knee arthroplasty to septic loosening was five years.A profound medical history and examinations suggested that the patient had been suffering from unrecognized chronic osteoarticular brucellosis prior to total knee arthroplasty.She was successfully treated by two-stage revision surgery and combined antibiotic therapy over three months.CONCLUSION Clinicians should consider brucellosis as a possible cause of chronic arthralgia and periprosthetic infection in patients originating from countries with a high brucellosis burden.展开更多
骨结核是一种严重危害人体健康的骨科感染性疾病,其病灶组织破坏的最大特点是骨质的吸收及破坏,其中破骨细胞是骨吸收的主要细胞。破骨细胞是由造血干细胞分化而来的多核细胞,通常是由核因子κB受体活化因子配体(receptor activator of ...骨结核是一种严重危害人体健康的骨科感染性疾病,其病灶组织破坏的最大特点是骨质的吸收及破坏,其中破骨细胞是骨吸收的主要细胞。破骨细胞是由造血干细胞分化而来的多核细胞,通常是由核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)与核因子κB受体活化因子(receptor activator for nuclear factor-κB,RANK)调控产生。结核分枝杆菌可以通过RANKL信号通路激活破骨细胞生成转录因子,以增强破骨细胞对骨质的吸收。笔者通过综述RANKL信号通路的结构及破骨细胞的研究进展,以及它们在骨结核临床治疗中可能发挥的潜在作用,为该领域的研究提供新的思路。展开更多
Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These compli...Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.展开更多
Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of ...Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.展开更多
目的:评价宏基因组二代测序(metagenomic next generation sequencing,mNGS)技术对髋/膝关节结核的诊断价值。方法:采用回顾性研究方法,收集2019年6月至2021年6月河北省胸科医院收治的34例髋/膝关节感染患者资料,按照病原菌种类分为关...目的:评价宏基因组二代测序(metagenomic next generation sequencing,mNGS)技术对髋/膝关节结核的诊断价值。方法:采用回顾性研究方法,收集2019年6月至2021年6月河北省胸科医院收治的34例髋/膝关节感染患者资料,按照病原菌种类分为关节结核组(16例)和非结核感染性疾病组(18例),分别对所有患者感染病灶组织样本进行常规细菌学培养和分枝杆菌培养(MGIT 960培养)、结核分枝杆菌(MTB)-DNA扩增检测及mNGS检测。以临床诊断为参照标准,比较分枝杆菌培养、MTB-DNA扩增和mNGS检测对髋/膝关节结核的诊断效能。结果:mNGS对非结核感染性疾病组中病原体的检出率为100.0%(18/18);对髋/膝关节结核的阳性检出率为93.8%(15/16),明显高于MTB-DNA扩增检测[50.0%(8/16)]和MGIT 960培养[25.0%(4/16)],差异均有统计学意义(χ^(2)=7.575,P=0.015;χ^(2)=15.676,P=0.000)。以临床诊断为参照标准,mNGS诊断髋/膝关节结核的敏感度[93.8%(15/16)]、阴性预测值[94.7%(18/19)]和Kappa值(0.942)均明显高于常规培养[分别为25.0%(4/16)、60.0%(18/30)和0.260]和MTB-DNA扩增检测[分别为50.0%(8/16)、69.2%(18/26)和0.515],但3种检测方法的特异度和阳性预测值均为100.0%。结论:mNGS技术可有效检出髋/膝关节感染性疾病病原菌,在关节结核诊断中具有更高的诊断效能,可提供重要临床指导。展开更多
脊柱结核是最常见的骨结核,实施加速康复外科(enhanced recovery after surgery,ERAS)管理模式可以缩短脊柱结核患者的住院时间,降低并发症发生率和再入院率,减少医疗费用。目前,ERAS理念被越来越多的脊柱结核外科医师所接受,但还未形...脊柱结核是最常见的骨结核,实施加速康复外科(enhanced recovery after surgery,ERAS)管理模式可以缩短脊柱结核患者的住院时间,降低并发症发生率和再入院率,减少医疗费用。目前,ERAS理念被越来越多的脊柱结核外科医师所接受,但还未形成统一的专家共识,严重限制了其在脊柱结核外科中的应用。因此,中国防痨协会骨结核专业分会联合《中国防痨杂志》编辑委员会,在脊柱结核疾病自身特点的基础上,结合既往ERAS模式在脊柱结核诊疗应用中的研究成果,组织专家撰写了《加速康复外科理念在脊柱结核外科中应用的专家共识》,以期进一步规范及指导ERAS理念在脊柱结核外科中的应用,推动脊柱结核外科的进一步发展。展开更多
文摘Objective:To assess the role of polymerase chain reaction(PCR)in serum sauples,in the diagnosis of osteoarticular tuberculosis(OTB)in a setting where only clinical and imaging diagnoses determine the treatment.Methods:A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients,based on clinical and radiological[X-ray or magnetic resonance imagng/computecl tomography]features.They were scrcened by in-house nested PCR.In addition,a few specimens were examined by Gram stain,acid-fast bacilli stain,histand routine bacterial culture.A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls.Results:of the 44 clinically suspected OTB patients,in-house nested PCR was positive in 40(91%)cases;PCR was negative in 38(97%)negative controls.Sensitivity and specificity of our in—house nested PCR was 90.3%and 97.4%,respectively.The PCR report was available within 48 h.It was possible to standardize serum PCR technique and in positive cases,a good n was observed in terms of an adequate treatment response.Conclusions:Nested PCR in serum samples is a rapid,highly sensitive and specific modality for OTB detection,PCR should be performed in addition to clinical evaluation,imaging studies,acidfast bacilli staining,culture and histopathology diagnosis,if possible.
文摘BACKGROUND Osteoarticular tuberculosis(OATB) is a severe form of extrapulmonary TB, which causes notable morbidity and warrants a high index of suspicion for prompt management. The diagnosis of OATB poses a challenge, because of the difficulty of collecting the samples and, secondarily, the paucibacillary nature of lesion, which gives poor sensitivity and reproducibility, with long turnaround time of routine/conventional laboratory tests and the requirement for invasive procedures and expertise. The Xpert MTB/RIF assay has been approved by the World Health Organization as a rapid diagnostic tool for diagnosing pulmonary and extrapulmonary TB.AIM To emphasize the diagnostic efficiency of gene Xpert for OATB in suspected patients in a tertiary care hospital of Eastern India.METHODS This retrospective study was conducted in the Department of Microbiology and Orthopaedics by analyzing the data of the gene Xpert assay over a 3-year duration from January 2018 to February 2021. Demographic and clinical data were recorded. The diagnostic efficiency of gene Xpert was evaluated against the composite reference standard(CRS).RESULTS A total of 37 cases fell into positive, probable, and possible categories of osteoarticular TB out of 112 patients included in the study by CRS;gene Xpert result was positive in 35 out of the 37 different CRS categorized cases. Of the 112 cases, culture was put in 40 cases, and, of these cultures, 5 cases showed the growth of MTB. Of these, 4 cases were included in the 35 cases diagnosed by gene Xpert.Smear microscopy was positive in 6 out of 37 CRS categorized cases. When compared with CRS, the sensitivity of gene Xpert assay, culture, and smear was found to be 94.6%, 13.5%, and 16.2%, respectively, while specificity in all the three types of tests was 100%. When kappa statistics were applied, the percentage of agreement gene Xpert, culture, and microscopy with CRS was found to be 95%, 20%, and 22.6%, respectively. Follow-up of the gene Xpert positive patients after getting anti-tubercular treatment revealed improved conditions.CONCLUSION Gene Xpert could detect 31 extra cases with a low and very low mycobacterial load that were missed by the routine culture methods. Hence, more samples should be processed for molecular diagnostic methods like gene Xpert along with other conventional methods for the validation of the molecular test prospectively for the timely diagnosis of osteoarticular TB.
文摘Objective: To describe paraclinical, therapeutic and evolutionary aspects of osteoarticular tuberculosis in Abidjan. Materials and Method: We realized a descriptive retrospective study carried out in the Rheumatology Department of the University Hospital Center of Cocody in Abidjan about 550 patients over a period of 10 years from January 2004 to December 2013. The paraclinical, therapeutic and evolutionary data had interested us. Results: Osteoarticular tuberculosis represented 12.13% of 4531 rheumatic diseases identified during the study period. The tuberculin skin test was positive in 78.49% of cases. An inflammatory syndrome was present with erythrocyte sedimentation rate and C-reactive protein respectively into 69.45% and 76.54% of cases. The research of Mycobacterium tuberculosis was realized into 176 of cases which 50% was positive. Polymerase chain reaction and biopsy of tissue were performed respectively in 8 and 6 cases. Plain radiography (89.82%) and computed tomography (83.63%) were the most realized imaging. Computed tomography has contributed for the diagnostic in 99.78% of cases. The majority of our patients (82.91%) received anti-tuberculous treatment which consisted of two months of combination of rifampicin (R), isoniazid (H), pyrazinamide (Z) and Ethambutol (E) (2RHZE), followed by 10 months of rifampicin (R) and isoniazid (H) (10 RH). The outcome in patients on this treatment was favorable in 528 cases (96%). Conclusion: This study revealed that the research of Mycobacterium tuberculosis was often realized and positive. On the contrary, polymerase chain reaction and biopsy of tissue were rarely performed. The main imaging is computed tomography. Our protocol of treatment is effective.
文摘Type 1 or 2 diabetes can be complicated by numerous non-specific joint conditions. Sometimes revealing, these affections are frequent but often remain unrecognized. However, they are the cause of a significant functional handicap. The objective of this work is to describe the osteoarticular rheumatological disorders in diabetics consulting or hospitalized in the rheumatology and internal medicine departments of the National Hospital of Niamey and the Magori Polyclinic. This was a cross-sectional study at the Rheumatology Department in collaboration with the Internal Medicine Department within the National Hospital of Niamey and Polyclinic Magori over a period of 7 months (December 2018 to July 2019). One hundred (100) diabetic patients with osteoarticular diseases were collected, 75% of whom were women with a female/male sex ratio of 0.33. The average age was 56 years with extremes of 21 and 90 years. Forty-three percent (43%) of the patients had diabetes for more than 10 years, with an average age of 13 years. The average BMI was 28.08 ± 5.42 kg/m<sup>2</sup>. Poor glycemic control was found in the majority of patients (92%). Gonarthrosis was the most common disease associated with diabetes (89%). In the context of joint stiffening syndrome, the most frequent problem was a protruding finger, found in 4% of patients, followed by retractile capsulitis in 3% of the 100 cases. Infectious complications were dominated by septic arthritis in 4% of patients. The presence of one or more degenerative complications of diabetes (nephropathy, retinopathy, nephropathy) was the most frequent factor associated with osteoarticular diseases in our diabetic patients. This work underlines the great variety and frequency of osteoarticular affections during diabetes, hence the interest in optimal glycemic control of a close collaboration between rheumatologists and endocrinologists in order to avoid as much as possible the development of these rheumatological affections which are the source of pain and functional handicap, being able to even engage the vital prognosis.
基金the National Key R&D Program of China(No.2019YFB1706900).
文摘As a promising manufacturing technology,three-dimensional(3D)printing technology is widely used in the medical field.In the treatment of osteoarticular defects,the emergence of 3D printing technology provides a new option for the reconstruction of functional articular surfaces.At present,3D printing technology has been used in clinical applications such as models,patient-specific instruments(PSIs),and customized implants to treat joint defects caused by trauma,sports injury,and tumors.This review summarizes the application status of 3D printing technology in the treatment of osteoarticular defects and discusses its advantages,disadvantages,and possible future research strategies.
文摘BACKGROUND Brucellosis is the most common zoonosis worldwide and is endemic in the Middle East,Africa,Asia,and Latin America.However,it is uncommon in Central Europe,and periprosthetic infections caused by Brucella are therefore rare.Due to the low prevalence and nonspecific clinical presentation of the disease,accurate diagnosis can be challenging;no gold standard currently exists for treating brucellosis.CASE SUMMARY Here,we present a 68-year-old Afghan woman living in Austria with a periprosthetic knee infection caused by Brucella melitensis.The interval from total knee arthroplasty to septic loosening was five years.A profound medical history and examinations suggested that the patient had been suffering from unrecognized chronic osteoarticular brucellosis prior to total knee arthroplasty.She was successfully treated by two-stage revision surgery and combined antibiotic therapy over three months.CONCLUSION Clinicians should consider brucellosis as a possible cause of chronic arthralgia and periprosthetic infection in patients originating from countries with a high brucellosis burden.
文摘骨结核是一种严重危害人体健康的骨科感染性疾病,其病灶组织破坏的最大特点是骨质的吸收及破坏,其中破骨细胞是骨吸收的主要细胞。破骨细胞是由造血干细胞分化而来的多核细胞,通常是由核因子κB受体活化因子配体(receptor activator of nuclear factor-κB ligand,RANKL)与核因子κB受体活化因子(receptor activator for nuclear factor-κB,RANK)调控产生。结核分枝杆菌可以通过RANKL信号通路激活破骨细胞生成转录因子,以增强破骨细胞对骨质的吸收。笔者通过综述RANKL信号通路的结构及破骨细胞的研究进展,以及它们在骨结核临床治疗中可能发挥的潜在作用,为该领域的研究提供新的思路。
文摘Osteoarticular complications are common after renal transplantation. The complications may result from the bone condition prior to transplantation or the iatrogenic effects of the treatments administered. These complications lead to significant morbidity and mortality, in addition to chronic pain and functional impairment. We report the clinical case of bilateral avascular necrosis (AVN) of the femoral head in a kidney transplant recipient. Clinical Case: 53-year-old male with a history of chronic hypertension. He underwent chronic hemodialysis for 12 months and was treated with Entecavir for chronic hepatitis B. The patient received a kidney transplant from a non-related living donor. Induction therapy included Thymoglobulin along with tapered corticosteroids, reaching a dose of 5 mg/day after 3 months, Mycophenolate mofetil (2 g/day), and Tacrolimus adjusted based on residual levels. There was good recovery of renal graft function. After six months, the patient reported bilateral hip pain and functional impairment of both lower limbs. Pelvic X-rays showed signs suggestive of bilateral AVN of the femoral heads. The diagnosis was confirmed by MRI. The patient underwent right hip drilling and total left hip replacement (THR). A right THR was performed a year later. Conclusion: AVN constitutes a frequent cause of morbidity and mortality after RT. The pathophysiology of osteonecrosis remains complex and multifactorial. We emphasize the importance of conducting a thorough assessment of bone health in patients both before and after RT.
文摘Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.
文摘脊柱结核是最常见的骨结核,实施加速康复外科(enhanced recovery after surgery,ERAS)管理模式可以缩短脊柱结核患者的住院时间,降低并发症发生率和再入院率,减少医疗费用。目前,ERAS理念被越来越多的脊柱结核外科医师所接受,但还未形成统一的专家共识,严重限制了其在脊柱结核外科中的应用。因此,中国防痨协会骨结核专业分会联合《中国防痨杂志》编辑委员会,在脊柱结核疾病自身特点的基础上,结合既往ERAS模式在脊柱结核诊疗应用中的研究成果,组织专家撰写了《加速康复外科理念在脊柱结核外科中应用的专家共识》,以期进一步规范及指导ERAS理念在脊柱结核外科中的应用,推动脊柱结核外科的进一步发展。
