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Assessment of the effectiveness of weight-adjusted antibiotic administration,for reduced duration,in surgical prophylaxis of primary hip and knee arthroplasty

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world Journal of Orthopedics 2024年第2期15卷 170-179页

作者： Tosan Okoro Michael wan Takura Darlington Mukabeta Ella Malev Marketa Gross Claudia williams Muhammad Manjra Jan Herman Kuiper john Murnaghan Department of Arthroplasty Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom School of Medicine Keele UniversityStaffordshire ST55BGUnited Kingdom St Joseph’s Health Centre Unity Health TorontoToronto M6R 1B5Canada Department of Arthroplasty The Royal London HospitalBarts Health NHS TrustLondon E11BBUnited Kingdom Department of Arthroplasty Sunnybrook Holland Orthopaedic and Arthritis CentreToronto M4Y 1H1Canada Institute for Science and Technology in Medicine Keele UniversityStaffordshire ST51BGUnited Kingdom

BACKGROUND Prophylactic antibiotics have significantly led to a reduction in the risk of postoperative surgical site infections(SSI)in orthopaedic surgery.The aim of using antibiotics for this purpose is to achieve serum and tissue drug levels that exceed,for the duration of the operation,the minimum inhibitory concentration of the likely organisms that are encountered.Prophylactic antibiotics reduce the rate of SSIs in lower limb arthroplasty from between 4%and 8%to between 1%and 3%.Controversy,however,still surrounds the optimal frequency and dosing of antibiotic administration.AIM To evaluate the impact of introduction of a weight-adjusted antibiotic prophylaxis regime,combined with a reduction in the duration of administration of post-operative antibiotics on SSI incidence during the 2 years following primary elective total hip and knee arthroplasty METHODS Following ethical approval,patients undergoing primary total hip arthroplasty(THA)/total knee arthroplasty(TKA)with the old regime(OR)of a preoperative dose[cefazolin 2 g intravenously(IV)],and two subsequent doses(2 h and 8 h),were compared to those after a change to a new regime(NR)of a weight-adjusted preoperative dose(cefazolin 2 g IV for patients120 kg)and a post-operative dose at 2 h.The primary outcome in both groups was SSI rates during the 2 years post-operatively.RESULTS A total of n=1273 operations(THA n=534,TKA n=739)were performed in n=1264 patients.There was no statistically significant difference in the rate of deep(OR 0.74%(5/675)vs NR 0.50%(3/598);fishers exact test P=0.72),nor superficial SSIs(OR 2.07%(14/675)vs NR 1.50%(9/598);chi-squared test P=0.44)at 2 years postoperatively.with propensity score weighting and an interrupted time series analysis,there was also no difference in SSI rates between both groups[RR 0.88(95%CI 0.61 to 1.30)P=0.46].CONCLUSION A weight-adjusted regime,with a reduction in number of post-operative doses had no adverse impact on SSI incidence in this population.

关键词： Antibiotics weight-adjusted Hip and knee arthroplasty Surgical site infection

The risk of prostate cancer on incidental finding of an avid prostate uptake on 2-deoxy-2-[^(18)F]fluoro-D-glucose positron emission tomography/computed tomography for non-prostate cancer-related pathology:A single centre retrospective study

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Asian Journal of Urology 2024年第1期11卷 33-41页

作者： Anthony Franklin Troy Gianduzzo Boon Kua David wong Louise McEwan James walters Rachel Esler Matthew J.Roberts Geoff Coughlina john w.Yaxley Department of Urology The Wesley HospitalBrisbaneQLDAustralia wesley Medical Research BrisbaneQLDAustralia School of Medicine The University of QueenslandBrisbaneQLDAustralia Department of Radiology Wesley Medical ImagingBrisbaneQLDAustralia Department of Urology Royal Brisbane and Women's HospitalBrisbaneQLDAustralia

Objective:To review the risk of prostate cancer(PCa)in men with incidentally reported increased intraprostatic uptake at 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography(18F-FDG PET/CT)ordered at Department of Urology,The wesley Hospital,Brisbane,QLD,Australia for non-PCa related pathology.Methods:Retrospective analysis of consecutive men between August 2014 and August 2019 presenting to a single institution for 18F-FDG PET/CT for non-prostate related conditions was conducted.Men were classified as benign,indeterminate,or malignant depending of the results of prostate-specific antigen(PSA),PSA velocity,biopsy histopathology,and three-Tesla(3 T)multiparametric MRI(mpMRI)Prostate Imaging Reporting and Data System score,or gallium-68-prostate-specific membrane antigen(68Ga-PSMA)PET/CT results.Results:Three percent(273/9122)of men demonstrated 18F-FDG avidity within the prostate.Eighty-five percent(231/273)were further investigated,including with PSA tests(227/231,98.3%),3 T mpMRI(68/231,29.4%),68Ga-PSMA PET/CT(33/231,14.3%),and prostate biopsy(57/231,24.7%).Results were considered benign in 130/231(56.3%),indeterminate in 31/231(13.4%),and malignant in 70/231(30.3%).PCa was identified in 51/57(89.5%)of the men who proceeded to biopsy,including 26/27(96.3%)men with Prostate Imaging Reporting and Data System scores 4-5 mpMRI and six men with a positive 68Ga-PSMA PET/CT.The most common Gleason score on biopsy was greater than or equal to 4+5(14/51,27.5%).68Ga-PSMA PET/CT was concordant with the 18F-FDG findings in 26/33(78.8%).All 13 men with a positive concordant 18F-FDG,3 T mpMRI,and 68Ga-PSMA PET/CT had PCa on biopsy.There was no statistically significant difference in the 18F-FDG maximum standardized uptake value between the benign or malignant groups(5.7 vs.6.1;p=0.580).Conclusion:In this study,after an incidental finding of an avid intraprostatic lesion on 18F-FDG PET/CT,70 of the 231 cases(30.3%;0.8%of the entire cohort)had results consistent with PCa,most commonly as Gleason scor

关键词： Prostatecancer Positionemission tomography Multiparametric magneticresonance imaging Prostatebiopsy

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将医疗保健干预措施从试验转化为实践

英国医学杂志中文版 2010年第6期13卷 361-365页

作者： Paul Glasziou Iain Chalmers Douglas G Altman Hilda Bastian IsabeUe Boutron Anne Brice Gro Jamtvedt Andrew Farmer Davina Ghersi Trish Groves Carl Heneghan Sophie Hill Simon Lewin Susan Michie Rafael Perera Valerie Pomeroy Julie Tilson Sasha Shepperd john w williams 周久顺(译) 张孔来(校) Department of Public Health and Primary Care University of Oxford Oxford OX3 7LF James Lind Initiative Oxford OX2 7LG Centre for Statistics in Medicine Oxford OX2 6UD German Institute for Quality and Efficiency in Health Care Cologne Germany INSERM Universite Paris Paris France Norwegian Knowledge Centre for the Health Services Oslo Norway Department of Research Policy and Cooperation world Health Organization Geneva BMJ London Centre for Health Communication and Participation Australian Institute for Primary Care La Trobe University Victoria Australia Division of Psychology and Language Sciences University Coflege London London WC1E 7HB Health and Social Sciences Research Institute Faculty of Health University of East Anglia Norwich Division of Biokinesiology and Physical Therapy University of Southern California Los Angeles CA USA Duke Evidence -based Practice Center Duke University and Durham VA Medical Center Durham NC USA 中国医学科学院基础医学研究所流行病与卫生统计学教研室

成千上万的试验结果从未被用于实践，因为其发表的报告未能详细地描述具体的干预措施。如何才能改进这些报告呢？

关键词：干预措施医疗保健试验转化

Quantitative Applications of weather Satellite Data for Nowcasting: Progress and Challenges

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Journal of Meteorological Research 2024年第3期38卷 399-413页

作者： Jun LI Jing ZHENG Bo LI Min MIN Yanan LIU Chian-Yi LIU Zhenglong LI w.Paul MENZEL Timothy J.SCHMIT john L.CINTINEO Scott LINDSTROM Scott BACHMEIER Yunheng XUE Yayu MA Di DI Han LIN Key Laboratory of Spatial Data Mining and Information Sharing of Ministry of Education National and Local Joint Engineering Research Center of Satellite Geospatial Information Technology Fuzhou University Innovation Centre for Fengyun Meteorological Satellite (FYSIC) National Satellite Meteorological Centre China Meteorological Administration School of Atmospheric Sciences and Guangdong Province Key Laboratory for Climate Change and Natural Disaster Studies Sun Yat-sen University and Southern Laboratory of Ocean Science and Engineering Key Laboratory of Geographic Information Science (Ministry of Education) East China Normal University Research Center for Environmental Changes Academia Sinica Cooperative Institute for Meteorological Satellite Studies University of Wisconsin-Madison Sensors and Calibration Branch STAR/NESDIS wuxi University School of Computer Science Chengdu University of Information Technology Collaborative Innovation Center on Forecast and Evaluation of Meteorological Disasters Nanjing University of Information Science & Technology

Monitoring and predicting highly localized weather events over a very short-term period, typically ranging from minutes to a few hours, are very important for decision makers and public action. Nowcasting these events usually relies on radar observations through monitoring and extrapolation. with advanced high-resolution imaging and sounding observations from weather satellites, nowcasting can be enhanced by combining radar, satellite, and other data,while quantitative applications of those data for nowcasting are advanced through using machine learning techniques.Those applications include monitoring the location, impact area, intensity, water vapor, atmospheric instability, precipitation, physical properties, and optical properties of the severe storm at different stages(pre-convection, initiation,development, and decaying), identification of storm types(wind, snow, hail, etc.), and predicting the occurrence and evolution of the storm. Satellite observations can provide information on the environmental characteristics in the preconvection stage and are very useful for situational awareness and storm warning. This paper provides an overview of recent progress on quantitative applications of satellite data in nowcasting and its challenges, and future perspectives are also addressed and discussed.

关键词： weather satellite quantitative applications nowcasting pre-convection

Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial

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Stroke & Vascular Neurology 2024年第1期9卷 38-49,I0035-I0046页

作者： Jason Philip Appleton Lisa J woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark Dixon Timothy J England Kailash Krishnan Grant Mair Keith w Muir john Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey L Saver Angela Shone Aloysius Niroshan Siriwardena Joanna M wardlaw Nikola Sprigg Philip M Bath Stroke University Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearch University of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials Unit Mental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of Medicine The George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science Center BeijingChina Neurology Royal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of Neurology King's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical Sciences University of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service NHS Trust NottinghamUK Stroke Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain Sciences Dementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurology and Psychology University of GlasgowGlasgowUK Bob Champion Research and Education Building University of East AngliaNorwichUK Institute of Neuroscience Newcastle UniversityNewcastle upon TyneUK Department of Neurology Leeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of LeicesterLeicesterUK Stroke Research in Stoke Institute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of Neurology Oslo University HospitalOsloNorway Research and Development Norwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke Center David Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate Services University of NottinghamNottinghamUK Community and Health Research Unit University of LincolnLincolnUK

Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is unclear.Here,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of onset.The primary outcome was a shift in scores on the modified Rankin scale(mRS)at day 90.Secondary outcomes included death;a global analysis(wei-Lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’markers.Data were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-whitney difference(MwD)with 95%CI.Results 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]min.Neuroimaging‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MwD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe stroke.Conclusions In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital trials.wHAT IS ALREADY KNOwN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those with acute stroke treated within 6hours of stroke

关键词： Glasgow nitrate random

诊断性试验和策略的证据质量和推荐强度的分级

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中国循证医学杂志 2009年第5期9卷 503-508页

作者： Holger J Schünemann Andrew D Oxman Jan Brozek Paul Glasziou Roman Jaeschke Gunn E Vist john w williams Jr Regina Kunz Jonathan Craig Victor M Montori Patrick Bossuyt Gordon H Guyatt 李晓黄程陈耀龙李幼平代表GRADE工作组

GRADE系统能对诊断性试验或策略的证据质量和推荐强度进行分级。本文旨在阐释在此过程中如何考虑患者的重要结局，

关键词：诊断性试验证据质量强度 E系统

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Seasonal changes in Hermit Thrush (Catharus guttatus) song syntax

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Avian Research 2024年第2期15卷 172-179页

作者： Sean P.Roach Luke C.McLean Jeff w.MacLeod Leslie S.Phillmore Psychology Department University of New Brunswick Saint John100 Tucker Park RoadSaint JohnNBCanada Department of Psychology and Neuroscience Dalhousie University1355 Oxford StHalifaxNSB3H 4J1Canada

In many songbird species,birdsong features phonological syntax,meaning that the units within their vocal se-quences are ordered in a non-random way that adheres to a rule.while such syntactical patterns have been richly described in many species,comparatively little is known about how those patterns contribute to song achieving its important functions.For each of song’s main functions,territorial defense and mate attraction,evidence of a role for syntax is limited.One species for which syntax has been thoroughly described is the Hermit Thrush(Catharus guttatus),which presents song types from their repertoires in a semi-predictable order and,in doing so,rapidly cycle up and down the frequency spectrum.The objective of the present study was to explore the importance of song syntax in the Hermit Thrush through a within-subject examination of how measures of syntax,such as the predictability of song type order within song sequences,shift over the breeding season.we hypothesized that,if such syntactical characteristics are important to breeding behaviour,they would be most prominent at the start of the breeding season when activity associated with territory establishment and mate attraction is most intense.Analysis revealed that,as predicted,the rigidness of song type ordering within se-quences was highest at the start of the season and declined thereafter.That song type sequences were most predictable at the vitally important early part of the breeding season fit our hypothesis that this aspect of song syntax is important to song’s functions related to territory establishment and/or mate attraction.Future work will clarify whether that role relates to one of song’s two main functions or serves song transmission in some broader way.

关键词： Birdsong Hermit Thrush Seasonal change Stereotypy Syntax

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Functional Outcomes of Adult Tibia Shaft Fractures Treated with Solid Intramedullary Nails versus Hollow Nails: A Systematic Review

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Open Journal of Orthopedics 2024年第3期14卷 149-172页

作者： Kwadwo Aning Abu Bernard Hammond Mohammed Issah Suglo Bukari Kizito Kakra Vormawor Ronald Awoonor-williams David Anyitey-Kokor Paa Kwesi Baidoo Dominic Konadu-Yeboah Department of Orthopaedics St. John of God Hospital Duayaw Nkwanta Ghana Directorate of Trauma and Orthopaedics Komfo Anokye Teaching Hospital Kumasi Ghana Department of Surgery Tamale Teaching Hospital Tamale Ghana Department of Orthopadics and Trauma Seventh Day Adventist Hospital Asamang Ghana

Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.

关键词： Tibia Shaft Fractures Functional Outcome SIGN Nail Hollow Nail

Superior antibody and membrane protein‑specific T‑cell responses to CoronaVac by intradermal versus intramuscular routes in adolescents

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world Journal of Pediatrics 2024年第4期20卷 353-370页

作者： Jaime S.Rosa Duque Samuel M.S.Cheng Carolyn A.Cohen Daniel Leung Xiwei wang Xiaofeng Mu Yuet Chung Tsun Ming Lau Manni wang wenyue Zhang Yanmei Zhang Howard H.w.wong Leo C.H.Tsang Sara Chaothai Tsz Chun Kwan john K.C.Li Karl C.K.Chan Leo L.H.Luk Jenson C.H.Ho wing Yan Li Amos M.T.Lee Jennifer H.Y.Lam Sau Man Chan wilfred H.S.wong Issan Y.S.Tam Masashi Mori Sophie A.Valkenburg Malik Peiris wenwei Tu Yu Lung Lau Department of Paediatrics and Adolescent Medicine The University of Hong KongHong KongChina School of Public Health The University of Hong KongHong KongChina HKU‑Pasteur Research Pole School of Public HealthThe University of Hong KongHong KongChina Research Institute for Bioresources and Biotechnology Ishikawa Prefectural UniversityNonoichiJapan Department of Microbiology and Immunology Peter Doherty Institute for Infectionand ImmunityUniversity of MelbourneMelbourneVICAustralia Center for Immunology and Infection C2i Hong KongChina

Background Optimising the immunogenicity of COVID-19 vaccines to improve their protection against disease is necessary.Fractional dosing by intradermal(ID)administration has been shown to be equally immunogenic as intramuscular(IM)administration for several vaccines,but the immunogenicity of ID inactivated whole severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)at the full dose is unknown.This study(NCT04800133)investigated the superiority of antibody and T-cell responses of full-dose CoronaVac by ID over IM administration in adolescents.Methods Participants aged 11–17 years received two doses of IM or ID vaccine,followed by the 3rd dose 13–42 days later.Humoral and cellular immunogenicity outcomes were measured post-dose 2(IM-CC versus ID-CC)and post-dose 3(IMCCC versus ID-CCC).Doses 2 and 3 were administered to 173 and 104 adolescents,respectively.Results Spike protein(S)immunoglobulin G(IgG),S-receptor-binding domain(RBD)IgG,S IgG Fcγreceptor IIIa(FcγRIIIa)-binding,SNM[sum of individual(S),nucleocapsid protein(N),and membrane protein(M)peptide pool]-specific interleukin-2(IL-2)+CD4+,SNM-specific IL-2+CD8+,S-specific IL-2+CD8+,N-specific IL-2+CD4+,N-specific IL-2+CD8+and M-specific IL-2+CD4+responses fulfilled the superior and non-inferior criteria for ID-CC compared to IM-CC,whereas IgG avidity was inferior.For ID-CCC,S-RBD IgG,surrogate virus neutralisation test,90%plaque reduction neutralisation titre(PRNT90),PRNT50,S IgG avidity,S IgG FcγRIIIa-binding,M-specific IL-2+CD4+,interferon-γ+CD8+and IL-2+CD8+responses were superior and non-inferior to IM-CCC.The estimated vaccine efficacies were 49%,52%,66%and 79%for IM-CC,ID-CC,IM-CCC and ID-CCC,respectively.The ID groups reported more local,mild adverse reactions.Conclusion This is the first study to demonstrate superior antibody and M-specific T-cell responses by ID inactivated SARSCoV-2 vaccination and serves as the basis for future research to improve the immunogenicity of inactivated vaccines.

关键词： CoronaVac Coronavirus disease 2019 Immunity Intradermal Vaccine