[Expert consensus on diagnosis and treatment of latent tuberculosis infection in patients with rheumatic diseases]

Rheumatic diseases, a typical kind of autoimmune disease, are often treated with glucocorticoids, immunosuppressants, biological agents, and small-molecule targeted drugs, which often leads to immune dysfunction in patients and increases the risk of activation of latent tuberculosis infection. To regulate the screening, diagnosis, and prophylactic treatment of latent tuberculosis infection in patients with rheumatic diseases, reduce the risk of developing active tuberculosis and improve the prognosis, Peking University Shenzhen Hospital, Shenzhen Third People's Hospital and Peking Union Medical College Hospital jointly organized domestic experts in the field of rheumatology and tuberculosis to establish the expert consensus on the diagnosis and treatment of latent tuberculosis infection in patients with rheumatic diseases. This consensus focuses on epidemiology, the importance of screening, screening methods, and prophylactic anti-tuberculosis treatment strategies for latent tuberculosis infection combined with rheumatic diseases.

[The clinical analysis of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis]

OBJECTIVE

To analyze the etiology of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis, and make suggestion for treatment.

METHODS

Retrospective study for 8 patients with thoracolumbar focal kyphosis who underwent surgical treatment and suffered instrumentation failure from June 2005 to December 2011 was made. The surgical procedures included pedicle subtraction osteotomy (PSO), anterior opening-posterior closing osteotomy and correction (AOPC), and posterior vertebral column resection (VCR). The reasons of instrumentation failure were analyzed and revision surgeries were performed.

RESULTS

The incidence of instrumentation failure was 6.3%. The average occurrence time was 22.5 months after surgery. Except one had failure in 3 months after surgery, all cases happened after 1 year. In this series, there were 5 cases with post-tuberculosis, 2 cases with post-traumatic kyphosis and 1 case with congenital kyphosis. For the surgical procedure, 7 cases underwent VCR and 1 case AOPC. After the instrumentation failure, all cases had back pain, and 3 of them had combined neurological symptoms. The reasons or risk factors of instrumentation failure included non-fusion of bone graft, VCR procedure, sink of the titanium mesh, insufficiency of anchor sites, and more severe kyphosis. All the 8 cases were treated with revision surgery and got good results.

CONCLUSIONS

The instrumentation failure of thoracolumbar focal kyphosis is relatively late occurred, and can develop with various reasons. Positive revision surgery is suggested for the instrumentation failure, and good results can be expected.

Effects of Different Treatment Options on the Prognosis of Wasp Stings

Introduction

Severe wasp sting injuries often threaten patient's life. We compared the effects of three different therapies on the prognosis of wasp stung patients.

Methods

We conducted a randomised single-blind controlled trial. Patients stung by wasp were randomly assigned to one of the three treatment groups: group A received symptomatic treatment; those complicated with acute renal failure and haemolysis also received haemoperfusion combined with haemodialysis; for patients with severe haemolytic anaemia, plasmapheresis were applied; for patients with haemodynamic instability, continuous renal replacement therapy was used. Group B received intravenous methylprednisolone injection, 80 mg/d for continuous 3 days in addition to the symptomatic therapy; for patients with haemolysis, methylprednisolone 0.5 g/d was injected intravenously for 3-5 days. For group C, in addition to all treatments administrated to group B patients, subcutaneous injection of 0.5 ml 0.1% epinephrine was given immediately after admission. Primary endpoint was mortality. Major complications (gastrointestinal haemorrhage, toxic encephalopathy, haemolysis, and acute left ventricular failure) and serum enzyme spectrum elevate (alanine aminotransferase [ALT], creatine kinase [CK] isoenzyme and serum creatinine) were secondary endpoints.

Results

Of 134 patients recruited, 45, 44 and 45 patients were assigned to group A, B or C respectively. Therapy in group C reduced mortality compared with group A and B (respectively 24.4%, 9.09%, 0.00% for group A, B, C respectively; p<0.001); there was no significant effects on major complications among three groups (p >0.1). The incidence of elevated ALT was significantly lower in group B and group C than in group A (p<0.001). The incidence of elevated CK isoenzyme was significantly lower in group C than in group A and group B (p<0.001).

Conclusions

For patients with concurrent organ impairment by wasp sting, early combination of epinephrine and methylprednisolone with supportive treatment with renal replacement therapy can effectively reduce the incidence of organ damage and mortality. (Hong Kong j.emerg.med. 2013;20:270-275)

[Clinical research on arteriovenous internal fistula made by various blood vessels]

OBJECTIVE

To compare the permeability and incidence rate of complication of arteriovenous internal fistula made by autogenous, homologous, and artificial Teflon blood vessels.

METHODS

Two hundred and forty one cases with arteriovenous internal fistula made by autogenous, homologous, and artificial Teflon blood vessels were followed up to compare the permeability and incidence rate of complication at 6 months, 1 year, 3 years, and 5 years.

RESULTS

The incidence rate of complication of autogenous blood vessels was lowest, it had no statistical differences compared with arteriovenous internal fistula made by homologous blood vessels. The permeability of arteriovenous internal fistula made by homologous blood vessels was highest, and it had no statistical differences compared with autogenous blood vessels. The permeability of arteriovenous internal fistula made by artificial Teflon blood vessels was lowest, but the incidence rate of complication was highest, and it had significantly statistical differences compared with arteriovenous internal fistula made by autogenous blood vessels (P < 0.01).

CONCLUSION

Arteriovenous internal fistulas made by autogenous and homologous blood vessels have high permeability and low incidence rate of complication, they are superior to the arteriovenous internal fistula made by artificial Teflon blood vessels.

[Daunomycin-human albumin microspheres (dau-ha-ms)--preparation, characterization and use in experimental cancer therapy]

For the purpose of enhancing the therapeutic index and reducing the toxic effect of chemotherapeutic drugs, Dau-HA-Ms was prepared, mostly as monodispersed microspheres with a mean diameter of 52 +/- 16 microns, ranging from 29 to 194 microns, being suitable for the use of transarterial embolization (TAE) therapy. Dau released effectively in physiological saline solution from microspheres without burst release. The spectrophotometric characteristics and cytotoxic effect in vitro of the released Dau remained unchanged, retaining the original physicochemical and biological properties. It was demonstrated that 30% of mice bearing S-180 sarcoma ascites treated with intraperitoneal injection of Dau-HA-MS survived longer than 6 months, while all tumor bearing control mice and Dau treated tumor bearing mice died within 21 and 14 days, respectively. The results show that Dau-HA-MS is therapeutically more effective and less toxic than Dau, Dau-HA-MS can possibly be used in TAE therapy for human liver cancer.