OBJECTIVE: To explore the role of antibiotic-eluting absorbable calcium sulfate in treating periprosthetic infection after one-stage revision of knee arthroplasty. METHODS: A retrospective analysis was performed on 36 patients(36 knees)who underwent phaseⅠrevision for periprosthesis infection after total knee arthroplasty from January 2018 to March 2022. All patients were underwent knee cavity puncture before operation and had positive results of aseptic body fluid culture, 21 patients received revision combined with antibiotic loaded calcium sulfate at stageⅠ(calcium sulfate group) during operation, and 15 patients underwent renovation at stageⅠ(revision group). There were 9 males and 12 females in calcium sulfate group, aged from 54 to 76 years old with an average of(67.6±6.2) years old. There were 15 patients in revision group, including 4 males and 11 females, aged from 60 to 75 years old with average of (69.6±4.1) years old. The levels of serum C-reactive protein (CRP), interleukin-6 (IL-6) at 7, 14, 30 and 90 days after operation were compared between two groups, and the rate of end-infection control at follow-up were compared. The systemic antibiotic application time, hospital stay and postoperative complications were observed between two groups. RESULTS: Calcium sulfate group were followed up for 12 to 29 months with an average of(18.9±4.2) months, and the infection control rate was 90.5%;while revision group were followed up 18 to 29 months with average of (21.6±3.7) months, and the infection control rate was 86.7% (13/15). There were no significant differences in follow-up time and infection control rate between two groups(P>0.05). Postoperative levels of CRP and IL-6 at 7, 14 and 30 days in calcium sulfate group were (32.79±11.48), (15.50±6.52), (9.36±3.32) mg·L^-1 and (17.31±6.15) pg·ml^-1, respectively;which were lower than those in revision group (40.65±11.32), (30.15±10.57), (18.97±5.86) mg·L^-1 and (25.54±6.73) pg·ml^-1, had statistical differences(P<0.05). There were no significant differences in IL-6 levels at 7 and 14 days after operation and CRP levels at 90 days after operation between two groups (P>0.05). The hospitalization time and systemic antibiotic application time in calcium sulfate group were (18.4±2.2) and (63.5±21.4) d, respectively;which were better than those in revision group (20.5±2.4) and (82.7±16.9) d, and had statistical differences(P<0.05). No significant wound complications and hypercalcemia were observed in calcium sulfate group. CONCLUSION Antibiotic eluted absorbable calcium sulfate could be used to treat periprosthetic knee infection, significantly reducing CRP levels in the early postoperative period, shortening hospital stay and systemic antibiotic application time, but it does not significantly improve the control rate of revision infection at stageⅠ.
Humans ; Male ; Female ; Aged ; Prosthesis-Related Infections/surgery* ; Middle Aged ; Calcium Sulfate/administration & dosage* ; Arthroplasty, Replacement, Knee/adverse effects* ; Retrospective Studies ; Anti-Bacterial Agents/therapeutic use* ; Interleukin-6/blood* ; C-Reactive Protein/metabolism* ; Reoperation ; Knee Prosthesis/adverse effects*

BACKGROUND: Injectable calcium sulfate is a clinically proven osteoconductive biomaterial, and it is an injectable, resorbable and semi-structural bone graft material. The purpose of this study was to validate the clinical outcomes of injectable calcium sulfate (ICS) grafts as compared with those of a demineralized bone matrix (DBM)-based graft for filling in contained bony defects created by tumor surgery. METHODS: Fifty-six patients (41 males and 15 females) with various bone tumors and who were surgically treated between September 2003 and October 2007 were included for this study. The patients were randomly allocated into two groups, and either an ICS graft (28 patients) or a DBM-based graft (28 patients) was implanted into each contained defect that was developed by the surgery. The radiographic outcomes were compared between the two groups and various clinical factors were included for the statistical analysis. RESULTS: When one case with early postoperative pathologic fracture in the DBM group was excluded, the overall success rates of the ICS and DBM grafting were 85.7% (24/28) and 88.9% (24/27) (p > 0.05), respectively. The average time to complete healing was 17.3 weeks in the ICS group and 14.9 weeks in the DBM group (p > 0.05). Additionally, the ICS was completely resorbed within 3 months, except for one case. CONCLUSIONS: Although the rate of resorption of ICS is a concern, the injectable calcium sulfate appears to be a comparable bone graft substitute for a DBM-based graft, with a lower cost, for the treatment of the bone defects created during surgery for various bone tumors.
Absorbable Implants ; Adolescent ; Adult ; Biocompatible Materials/*administration & dosage ; Bone Demineralization Technique ; Bone Matrix/*transplantation ; Bone Neoplasms/radiography/surgery/*therapy ; Bone Substitutes/*administration & dosage ; Calcium Sulfate/*administration & dosage ; Child ; Child, Preschool ; Curettage ; Female ; Humans ; Infant ; Injections ; Male ; Middle Aged ; Wound Healing ; Young Adult

OBJECTIVETo assess the efficacy of calcium-magnesium (Ca/Mg) infusion and glutathione (GSH) for preventing the neurotoxicity induced by oxaliplatin.

METHODSThis is a randomized, double blind, placebo controlled clinical trail. The patients receiving FOLFOX4 chemotherapy for their solid tumor were randomized to receive Ca/Mg, GSH or normal saline with chemotherapy simultaneously. The incidence and severity of oxaliplatin-induced neurotoxicity were observed. The ECOG performance status was recorded and compared among the 3 groups.

RESULTSNinety-three patients admitted in our department from Mar 2006 to Dec 2007 were entered into this study, including 29 patients in the Ca/Mg group, 33 in the GSH group and 31 in the chemotherapy alone group. The incidences of acute neurotoxicity were 82.8%, 90.9% and 93.5%, respectively. At the third cycle, the incidences of grade 1-2 chronic neurotoxicity were 37.9%, 48.5% and 42.0%, respectively. No grade 3 neuropathy was observed. After 6 cycles, the incidence of grade 1-2 neuropathy was increased to 68.2%, 88.9% and 85.2%, respectively. A lower percentage was observed in Ca/Mg arm without a statistically significant difference, and grade 3 neuropathy occurred in 5 patients. After 9 cycles, the incidence of grade 1-2 neuropathy was increased to 81.3%, 90.0% and 92.9%, respectively. Grade 3 neuropathy occurred in another 2 patients. No statistically significant difference was observed among the 3 arms. Changes of patient's ECOG score after chemotherapy were similar.

CONCLUSIONThis study didn't provide evidence that Ca/Mg infusion and GSH can prevent the oxaliplatin-induced neurotoxicity.

Adolescent ; Adult ; Aged ; Anticonvulsants ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Calcium Gluconate ; administration & dosage ; Colorectal Neoplasms ; drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Fluorouracil ; adverse effects ; therapeutic use ; Glutathione ; therapeutic use ; Humans ; Infusions, Intravenous ; Leucovorin ; adverse effects ; therapeutic use ; Magnesium Sulfate ; administration & dosage ; Male ; Middle Aged ; Neurotoxicity Syndromes ; etiology ; prevention & control ; Organoplatinum Compounds ; adverse effects ; therapeutic use ; Stomach Neoplasms ; drug therapy ; Young Adult

The gentamicin sulfate carried calcium sulfate (GSCS) implants were fabricated by the coagulating method, and the release rate of the gentamicin tested by UV-spectrometer and the absorbing rate of the calcium sulfate carrier in vitro were studied. The release patterns of two types of GSCS were compared. The trend of daily weight loss of GSCS was found being similar to that of pure calcium sulfate, which suggested that the gentamicin part has little effect on the absorbing pattern of calcium sulfate. The release rate of gentamicin is controlled by the erosion rate of calcium sulfate, so GSCS with different amount of gentamicin has the same release patterns. The DRP value of ED is higher than that of CO during the early stage, while the DRP value of ED is lower than that of CO during the late stage. The GSCS samples were implanted into the defect mold on the radii of the rabbits to investigate the potential for the use of GSCS implants as bone fillers, and the results revealed that new bone had been induced in a great part of the defect at 14 weeks after operation.
Animals ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; Bone Regeneration ; drug effects ; Calcium Sulfate ; administration & dosage ; Gentamicins ; administration & dosage ; pharmacokinetics ; Implants, Experimental ; Rabbits ; Radius Fractures ; therapy

OBJECTIVETo value the use of an injectable minimally invasive calcium sulfate cement for displaced tibial plateau fractures.

METHODSThirteen patients with lateral tibial plateau fractures treated with internal fixation and bone grafting were matched with 13 patients treated using internal fixation and an injectable calcium sulfate cement. The clinical data were retrospectively analyzed. All patients were followed up for a minimum of one year. The peri-operative complication, quality of reduction, maintenance of reduction, function assessment and development of post-traumatic osteoarthritis was compared in both groups.

RESULTSTen patients in the internal fixation and bone graft group had excellent anatomical reductions as judged on immediate post-operative radiographs but some loss of reduction on follow-up at one year was observed in 8 of the 13 (61%) cases. Twelve patients from the MIIG group had an excellent reduction on immediate post-operative radiographs but 3 (23%)demonstrated some loss of reduction of the plateau at one year follow-up (P < 0.05).

CONCLUSIONSThe use of MIIG and internal fixation is associated with more favourable clinical results than conventional treatment with internal fixation and bone grafting for lateral tibial plateau fractures.

Adult ; Aged ; Bone Cements ; Bone Transplantation ; methods ; Calcium Sulfate ; administration & dosage ; Combined Modality Therapy ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Closed ; surgery ; Humans ; Ilium ; transplantation ; Injections ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; surgery ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo compare the solubilities of ephedrine and d-pseudo-ephdrine in the compound of traditional Chinese drugs--Maxing Shigan decoction with and without ultramicro-pulverizations using a RP-HPLC procedure.

METHODThe analytical column was a YMC ODS-C18(4.6 mm x 150 mm,4 microm). A mixture of water-acetonitrile-sodium dodecyl sulfate-phosphorous acid (650:350:5:1) was used as the mobile phase at flow rate of 1.5 mL x min(-1). The column temperature was 50 degrees C and the wavelength was 210 nm.

RESULTIn this way, ephedrine and d-pseudo-ephedrine of the compound samples can be separated well and showed significant differences before and after the ultramicro-pulverizations.

CONCLUSIONFor the Maxing Shigan decoction, the dissolution rates and solubilites of ephedrine and d-pseudo-ephedrine ultramicro-pulverization were greatly improved.

Calcium Sulfate ; chemistry ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; isolation & purification ; Ephedra ; chemistry ; Ephedrine ; analysis ; chemistry ; Glycyrrhiza uralensis ; chemistry ; Particle Size ; Plants, Medicinal ; chemistry ; Powders ; Prunus ; chemistry ; Solubility ; Technology, Pharmaceutical ; methods

We report a case of the accidental intravenous administration of a large dose of magnesium sulfate during cesarean section. A 41-year-old woman, at 33 weeks gestation, with pregnancy-aggravated hypertension, headache and generalized edema presented in acute labor and showed fetal bradycardia on a nonstress test. Laboratory tests demonstrated an increased level of magnesium (5.4 mg/dl). A cesarean section was performed under general anesthesia with O2-N2O-enflurane and vecuronium. After delivery 2,000 mg of magnesium sulfate was mixed with the lactated Ringer's solution 1,000 ml and 550 ml administered to the patient. After noticing the accidental infusion of the magnesium sulfate, we replaced the lactated Ringer's solution with normal saline 1,000 ml and performed arterial blood gas analysis, checked serum electrolyte, including Mg2+ and Ca2+, and had monitored depth of muscle relaxation and vital signs. The level of magnesium had increased to 8.9 mg/dl after the accidental magnesium infusion. For about one and half hours after emergence from general anesthesia, she complained of dyspnea and paraparesis of extremities. To treat the hypermagnesemia, 3% calcium gluconate 1,000 mg and furocemide were given intravenously to antagonize magnesium and to increase the urine output. The depth of neuromuscular block was frequently monitored using a nerve stimulator. After conservative treatment, she recovered from the effect of the hypermagnesemia and was discharged on the fifth postoperative day. Anesthesiologists must to keep in mind the preoperative patients' pathophysiologic conditions, check co-administered drugs and the contents of intravenously connected solutions.
Administration, Intravenous* ; Adult ; Anesthesia, General ; Blood Gas Analysis ; Bradycardia ; Calcium Gluconate ; Cesarean Section* ; Dyspnea ; Edema ; Extremities ; Female ; Headache ; Humans ; Hypertension ; Magnesium Sulfate* ; Magnesium* ; Muscle Relaxation ; Neuromuscular Blockade ; Paraparesis ; Pre-Eclampsia ; Pregnancy ; Vecuronium Bromide ; Vital Signs

This study demonstrates that prophylactic effect of plaster and cataplasm contained ketoprofen in adjuvant arthritis therapy by X-ray. Adjuvant arthritis was induced by a single injection of Freund's complete adjuvant. Mature female Sprague-Dawley rats were designated to 3 groups such as nontreated control, plaster-treated (PT) and cataplasm-treated (CT), each of which was composed of ten animals. The PT and the CT groups showed reduced primary paw swelling, but secondary paw swelling was not affected. Bony changes were observed in all regions of the femur and tibia of the nonadjuvant-injected leg and the adjuvant-injected leg. The mean radiographic scores of the PT and the CT groups were significantly lower than those of the control group from day 0 to 7 of the experimental period (p<0.05, p<0.01). The CT rats showed reduced poly-arthritis development than the PT rats. Our results suggest that radiographic assessment of bony changes is more suitable for measuring changes in long bones such as femur or tibia than in vertebrae. The prophylactic effect of CT prominently suppressed edematous swelling and bony changes in arthritic limb compared with PT.
Animals ; Anti-Inflammatory Agents, Non-Steroidal/*pharmacology ; Arthritis, Experimental/*prevention & control ; Calcium Sulfate ; Drug Carriers/administration & dosage ; Excipients/*administration & dosage ; Female ; Freund's Adjuvant ; Ketoprofen/*administration & dosage/analogs & derivatives/therapeutic use ; Rats ; Rats, Sprague-Dawley