Objective To observe effects of the direct impaction onthe cell survival and the bone formation of the tissue engineered bone modified by the adenovirus mediated human bone morphogenetic protein 2 (Adv-hBMP2) gene and to verify the feasibility of the impacted grafting with it. Methods The marrow stromal cells (MSCs) were separated from the canine bone marrow and were cultured. MSCs were transfected with the Adv-hBMP2 gene and combined with the freeze-dried cancellous bone (FDB) to form the tissue engineered bone. Four days after the combination, the tissue engineered bone was impacted in a simulated impactor in vitro and implanted in the mouse. The cell survivals were evaluated with SEM 1 and 4 days after the combination, immediately after the impaction, and 1 and 4 days after the impaction, respectively. The bone formation and the allograft absorption were histologically evaluated respectively. Results There were multiple layers of the cells and much collagen on FDB before the impaction. Immediately after the impaction, most of the cells on the direct contact area disappearedand there was much debris on the section. Some of the cells died and separatedfrom the surface of FDB at 1 day, the number of the cells decreased but the collagen increased on the surface at 4 days. Histologically, only the fibrous tissue was found in FDB without the cells, the bone formation on FDB was even in distribution and mass in appearance before the impaction, but declined and was mainly on the periphery after the impaction in the AdvhBMP2 modified tissue-engineered bone. Conclusion The simulated impaction can decrease the cells survival and the bone formation of the AdvhBMP-2 modified tissue-engineered bone. The survival cells still function well.It is feasible to use the tissue engineered bone in the impaction graft.
ObjectiveTo discuss the clinical effects of micro implant anchorage combined with orthodontic positioning in the guided eruption of impacted maxilla anterior teeth. MethodsThirty-two patients with maxillary impacted teeth treated between 2010 and 2013 were selected, including 13 males and 19 females, aged from 13 to 26 years old, with an average age of (18.5±4.5) years. The extraction of the teeth and the local expansion of the extraction of the teeth were used to provide enough space for the impacted maxilla anterior teeth. The micro implant anchorage combined with orthodontic positioning was applied to treat 32 patients with 39 maxillary impacted teeth. Then, we observed the feasibility and efficacy of the therapeutic method. ResultsThe 39 impacted teeth were all successfully tracked and well aligned with good periodontal attachment. Pulp vitality test showed that 13 pulp reaction were retarded and 26 appeared normal. ConclusionThe micro implant anchorage combined with orthodontic positioning is effective in guided eruption of impacted anterior maxillary teeth.
Objectives To describe background, measures and impacts of building essential healthcare system in the developed and developing countries aboard. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. The resources we searched included electronic databases, websites of health institutions and governments and search engine Google. Any reports of implemented strategy to develop an essential healthcare package were included. Pre-designed data extraction form was used for collecting strategies and study method of included studies. Then the extracted information was analyzed and described. Result 166 studies covering 72 countries were included, most of which were studies in the middle and low Countries. In terms of study objectives, many studies (160 articles) aimed to describe strategies, while few studies(6 articles) were to evaluate effectiveness of strategies. Most of studies evaluating effectiveness were cross-sectionnary data, Except one time cohort study with intervention. Conclusions Strategies to implement essential healthcare system varies in the different country because of diversity of political, culture and economic background and different goals. The experience in transition countries gives us more high lights.
Coronavirus disease (COVID-19) is currently a world-wide major public health event. Since study sites of clinical trials are primarily at healthcare institutions and investigators are primarily clinicians, the epidemic inevitably has a huge impact on a large number of ongoing clinical trials. The proper implementation of clinical trials in key aspects and the quality of core data collection will greatly influence the validity of the final results. In this paper, we analyzed the potential impact of the outbreak of a new epidemic infectious diseases on the clinical trials from seven aspects, which involves the selection of study participants, randomization, blinding, implementation of intervention measures, follow-up of primary outcomes, safety monitoring and project management. Corresponding countermeasures were put forward.
【Abstract】 Objective To summarize the application and research status of the hip protector (HP) and to discuss the current problems and further research direction. Methods HP related literature in recent years was reviewed and analyzed. Results Biomechanics experiment studies have shown that HP could protect hip joint from fractures caused by falling, however, the protective effect of HP has not shown clinically. Conclusion HP biomechanical experiments show better protective effect, which may be related with the lower impact energy; in clinical application, poor compliance of HP is considered as the main reason of weak protective effect.
ObjectiveTo observe the efficacy of and influencing factors for kirschner wire limited internal fixation plus external fixation for patients with tarsometatarsal fracture dislocation. MethodsThe efficacy of kirschner wire limited internal fixation plus external fixation treatment for patients with tarsometatarsal fracture dislocation treated between January 2004 and June 2009 was retrospectively analyzed,and we also investigated the impact of surgery time and ligament damage on its long-term prognosis. ResultsTwenty patients were included,consisting of 16 male and 4 female patients,ranging from 15 to 57 years old.The mean time of follow-up was 24.5 months,ranging from 11 to 41 months.At the time of follow-up,there were 5%(1/20),10%(2/20),50%(10/20) and 35%(7/20) patients with AOFAS ankle-hindfoot score at 0~69,70~79,80~89 and 90-100,respectively;and the excellent rate was 85% in total.In this cohort,the acceptance rate of the results of treatment was 95% at discharging and 85% at the final follow-up,and the difference between the above two time-points was not statistically significant.In addition,patients with earlier surgery treatment and lower degree of ligament injury had better long-term prognosis. ConclusionFor patients with tarsometatarsal fracture dislocation,treatment with kirschner wire limited internal fixation plus external fixation can not only effectively restore joint function,but also has minimum surgical trauma,and it is an effective method for the treatment of tarsometatarsal joint injuries.
ObjectiveTo explore impact factors related to the clinical applicability of guidelines, and provide suggestions for better development and implementation of guidelines. MethodsThe CNKI database was electronically searched to collect clinical guidelines issued by the Chinese Medical Association and the Chinese Medical Doctor Association from 2015 to 2020. Sixty-one guidelines were randomly selected from included guidelines and each guideline was evaluated by medical staff from three regions using the instrument for evaluating clinical applicability of guidelines (version 2.0). Statistical data were described, and t-test or rank sum test or chi-square test were used for comparison between groups. The impact factors were screened by stepwise logistic regression analysis. ResultsA total of 6 904 valid questionnaires were collected from 119 medical institutions in 26 provinces of China. The more familiar with the guidelines and the more consistent with the wishes of patients or their families, the overall standardized score of the clinical applicability of guidelines would be higher. In addition, the more familiar with the guidelines, the standardized scores in each field would be higher. The higher emphasis on guidelines compliance, the higher the feasibility standardized score. ConclusionIn order to improve the clinical applicability of guidelines, developers should pay attention to whether the recommendations are consistent with the wishes of patients or their families. Then, medical institutions should pay attention to the compliance of guidelines. Finally, medical personnel should be familiar with the recommendations.
ObjectiveTo discuss the imaging manifestations of ulnar impaction syndrome, and to evaluate the diagnostic value of MR imaging. MethodsThe clinical data of 18 patients with clinical standard-proved ulnar impaction syndrome between January 2010 and June 2013 were retrospectively reviewed. ResultsSeventeen cases were diagnosed as ulna positive variation (94.6%), and the range of ulnar variance was 1.5 to 3.8 mm and the average ulnar variance was 2.6 mm. Neutral variance was found in one case. Fourteen cases had avascular necrosis or bone sclerosis of semilunar bone, and avascular necrosis or bone sclerosis of the triquetrum and ulnar was presented in 12 cases and 3 cases respectively on X-ray detection. CT scan showed that 16 cases of semilunar bone abnormalities (6 with ischemic necrosis), triquetrum osteonecrosis in 4 cases, and both necrosis of semilunar bone and triquetrum in 3 cases. On MRI, all cases had different degrees of damage, degeneration of semilunar bone, triquetrum, ulnar and triangular fibocartilage complex (ulnar side of the proximal end of the lunate in 18, radial side of the triquetrum in 17, distal joint surface of ulnar in 12, and triangular fibocartilage complex in 15). In the early stage, lesions were presented as edema of bone marrow and followed as different sizes of cystic change. Articular surface was collapsed later. ConclusionUlnar positive variance has important reference value in the diagnosis of ulnar impaction syndrome. MRI can show the early change of ulnar impaction syndrome, and provide reliable decision basis for clinical diagnosis and treatment.
This paper is aimed to introduce the definition and application of Population Impact Measures (PIMs). The PIMs use Number Need to Treat (NNT) for reference and generalize the variables of clinical research to interest population, which then can be used to measure the effectiveness of interventions and the harmfulness of risk factors, so as to provide evidence for making public health policy. Of the PIMs, the variables used for measuring the effectiveness of interventions include Disease Impact Number (DIN), Population Impact Number (PIN) and Number of Events Prevented in your Population (NEPP); The variables used for measuring the harmfulness of risk factors include Exposure Impact Number (EIN), Exposed Cases Impact Number (ECIN), Population Impact Number (PIN), Case Impact Number (CIN) and Population Impact Number of Eliminating a Risk factor (PIN-ER-t).
ObjectiveTo evaluate the effectiveness of total hip arthroplasty (THA) with impacted autologous bone grafting and a cementless cup in the treatment of rheumatoid arthritis (RA) with protrusio acetabuli. MethodsBetween January 2001 and April 2009, 18 cases (20 hips) of RA with protrusio acetabuli were treated, including 6 males and 12 females with an average age of 46 years (range, 36-62 years). The disease duration was 3-10 years (mean, 6 years). Preoperative Harris score was 40.25±6.68. The protrusio acetabuli was (5.70±4.26) mm. According to Sotelo-Garza and Charnley classification criterion, there were 12 hips of type 1 (protrusio acetabuli 1-5 mm), 5 hips of type 2 (6-15 mm), and 3 hips of type 3 (>15 mm). All patients received THA with impacting bone graft and cementless prosthesis for recovery of acetabular center of rotation. ResultsThe average operation time was 74 minutes (range, 48-126 minutes); the average blood loss was 350 mL (range, 150-650 mL). Deep venous thrombosis of lower extremity and poor healing of incision occurred in 3 and 2 cases respectively. Other patients achieved primary healing of incisions. The mean time of follow-up was 108 months (range, 60-156 months). According to X-ray films, bone grafting fusion was observed within 6 months after operation. At last follow-up, the Harris score was 87.20±4.21, showing significant difference when compared with preoperative score (t=-27.68, P=0.00); the protrusio acetabuli was (-1.11±0.45) mm, showing significant difference when compared with preoperative value (t=5.66, P=0.00). No loosening of acetabular components was found. ConclusionFor RA patients with protrusio acetabuli, THA with impacted autologous bone grafting and a cementless cup has satisfactory medium term effectiveness.