BACKGROUND: Clinical trial evidence is limited to identify better topical non-steroidal anti-inflammatory drugs (NSAIDs) for treating knee osteoarthritis (OA). We aimed to compare the clinical efficacy and safety of flurbiprofen cataplasms (FPC) with loxoprofen sodium cataplasms (LSC) in treating patients with knee OA. METHODS: This is an open-label, non-inferiority randomized controlled trial conducted at Peking University Shougang Hospital. Overall, 250 patients with knee OA admitted from October 2021 to April 2022 were randomly assigned to FPC and LSC treatment groups in a 1:1 ratio. Both medications were administered to patients for 28 days. The primary outcome was the change of pain measured by visual analog scale (VAS) score from baseline to day 28 (range, 0-10 points; higher score indicates worse pain; non-inferiority margin: 1 point; superiority margin: 0 point). There were four secondary outcomes, including the extent of pain relief, the change trends of VAS scores, joint function scores measured by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and adverse events. RESULTS: Among 250 randomized patients (One patient without complete baseline record in the flurbiprofen cataplasms was excluded; age, 62.8 ± 10.5 years; 61.4% [153/249] women), 234 (93.6%) finally completed the trial. In the intention-to-treat analysis, the decline of the VAS score for the 24-h most intense pain in the FPC group was non-inferior, and also superior to that in the LSC group (differences and 95% confidence interval, 0.414 (0.147-0.681); P <0.001 for non-inferiority; P = 0.001 for superiority). Similar results were observed of the VAS scores for the current pain and pain during exercise. WOMAC scores were also lower in the FPC group at week 4 (12.50 [8.00-22.50] vs . 16.00 [11.00-27.00], P = 0.010), mainly driven by the dimension of daily activity difficulty. In addition, the FPC group experienced a significantly lower incidence of adverse events (5.6% [7/124] vs . 33.6% [42/125], P <0.001), including irritation, rash and pain of the skin, and sticky hair uncovering pain. CONCLUSIONS This study suggested that FPC is superior to LSC for treating patients with knee OA in pain relief, joint function improvement, and safety profile.
Humans ; Female ; Middle Aged ; Aged ; Osteoarthritis, Knee/drug therapy* ; Flurbiprofen/therapeutic use* ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use* ; Pain/drug therapy* ; Treatment Outcome ; Double-Blind Method

OBJECTIVE: To evaluate the effectiveness of Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures. METHODS: The data of 17 patients with Cho type ⅡC distal clavicular fractures, who were treated with Kirschner wire fixation and coracoclavicular ligament reconstruction with suture anchor between June 2019 and June 2021, was retrospectively analyzed. There were 11 males and 6 females with an average age of 38.7 years (range, 19-72 years). The fractures were caused by falling in 12 cases and traffic accident in 5 cases. All patients had fresh closed fractures. The interval from injury to operation was 1-5 days (mean, 2.6 days). The preoperative injury severity score (ISS) was 6-27 (mean, 10.2). The operation time, intraoperative blood loss, hospital stay, fracture healing, and postoperative complications were analyzed. The shoulder joint function was evaluated by disabilities of the arm, shoulder, and hand (DASH) score and Constant score at last follow-up. RESULTS: All operations were completed successfully. The operation time was 20-50 minutes (mean, 31.6 minutes). The intraoperative blood loss was 30-100 mL (mean, 50.6 mL). The hospital stay was 4-9 days (mean, 5.3 days). All incisions healed by first intention. All patients were followed up 12-16 months (mean, 13 months). All clavicle fractures healed, and the healing time was 8-15 weeks (mean, 11 weeks). No complications such as fracture displacement or nonunion caused by internal fixation failure occurred. During the follow-up, skin irritation caused by the Kirschner wire withdrawal occurred in 3 cases. The Kirschner wires were removed after fracture healing in 17 patients. At last follow-up, the Constant score of shoulder joint was 90-100 (mean, 98.2). The DASH score was 0-10 (mean, 1.5). CONCLUSION Kirschner wire fixation combined with coracoclavicular ligament reconstruction with suture anchor in the treatment of Cho type ⅡC distal clavicle fractures has less postoperative complications and slight complications. It is convenient to remove the internal fixator. The Kirschner wire does not fix the distal clavicle fracture through the acromion, which has little effect on shoulder joint function and can obtain good effectiveness.
Male ; Female ; Humans ; Adult ; Bone Wires ; Clavicle/injuries* ; Suture Anchors ; Blood Loss, Surgical ; Retrospective Studies ; Fractures, Bone/surgery* ; Fracture Fixation, Internal ; Ligaments, Articular/surgery* ; Postoperative Complications ; Treatment Outcome

Objective: To compare the clinical efficacy between proximal femoral nail antirotation (PFNA) versus InterTAN nail in the treatment of senile patients with unstable femoral intertrochanteric fracture. Methods: A retrospective study was conducted of the 164 senile patients with unstable femoral intertrochanteric fracture who had been treated at Department of Orthopedics, Shougang Hospital Affiliated to Peking University from January 2013 to March 2018. InterTAN nailing was performed in 93 of them, including 30 men and 63 women with an age of 84.5±2.4 years; by the AO classification, there were 53 cases of type 31-A2.2, 28 cases of type 31-A2.3 and 12 cases of type 31-A3. PENA fixation was performed in the other 71 patients, including 19 men and 52 women with an age of 83.8±2.3 years; by the AO classification, there were 41 cases of type 31-A2.2, 22 cases of type 31-A2.3 and 8 cases of type 31-A3. The 2 groups were compared in terms of weight-bearing time, thigh pain, hip function, imaging complications and postoperative quality of life. Results: The 2 groups were comparable because there were no significant differences between them in preoperative general data (P>0.05). In the InterTAN nail group, the incidence of imaging complications [5.4%(5/93)] was significantly lower than in the PFNA group [18.3%(13/71)], the weight-bearing time (60.0±13.6 d) significantly shorter than in the PFNA group (65.8±11.0 d), and the incidence of thigh pain [3.2%(3/93)] significantly lower than in the PFNA group [12.7%(9/71)] (all P< 0.05). Of this series, 153 patients obtained an average follow-up of 39 months (from 12 to 75 months). At the last follow-ups, the Harris scores in the InterTAN nail group (78.3±12.2) were significantly higher than in the PENA group (73.6±11.3) (P<0.05). The InterTAN nail group scored significantly higher in physical functioning (68.6±15.4), general health perceptions (78.2±10.3), vitality (74.0±12.6) and mental health (80.6±9.9) in the 36-item short form health survey (SF-36) than the PFNA groups did (64.1±9.9, 74.9±9.0, 69.9±10.9 and 77.4±8.8) (all P<0.05). Conclusions Both internal fixation procedures are able to heal the fracture and restore the hip function in the senile patients with unstable femoral intertrochanteric fracture. However, InterTAN nail may have the advantages of earlier weight-bearing, lower incidence of varus deformity and better recovery of postoperative quality of life.

BACKGROUND:The conservative treatment of humeral fracture is difficult to achieve a good reduction. Minimaly invasive percutaneous plate fixation has been widely used, and has good repair results, but the specific mechanism of action is not clear.
OBJECTIVE:To compare the repair effect of different fixation methods on proximal humerus fractures.
METHODS: From August 2011 to October 2014, we selected 96 patients with proximal humerus fractures from the Shougang Hospital of Peking University. These patients were equaly divided into two groups according to the principle of random draw. Patients in the control group were treated with open reduction and conventional surgery fixation. Patients in the treatment group received minimaly invasive percutaneous plate fixation. Operation time, intraoperative blood loss, incision length and postoperative hospital stay were recorded in both groups. At 8 weeks after treatment, patients received radiography to identify the reduction. Range of motion of the shoulder joint was scored. Within 8 weeks after treatment, the occurrence of complications was observed and compared in both groups.
RESULTS AND CONCLUSION:Intraoperative blood loss, incision length and postoperative hospital stay were significantly less in the treatment group than in the control group (P < 0.05). No significant difference in operation time was found between the two groups (P > 0.05). At 8 weeks after treatment, the excelent and good rate of reduction was significantly higher in the treatment group than in the control group (98%, 81%,P < 0.05). Flexion, abduction, external rotation and internal rotation scores were significantly higher in the treatment group than in the control group (P < 0.05). Bone compartment syndrome, vascular injury, infection and bleeding were significantly lower in the treatment group than in the control group (P < 0.05). These findings confirm that compared with open reduction and internal fixation, minimaly invasive percutaneous plate fixation of proximal humerus fractures has less impact on the body, can promote reduction of the fracture, has few complications, and contributes to the recovery of shoulder function.

Objective To carry out a meta-analysis on the published data in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). Methods We searched the MEDLINE, EMBASE, Cochrane data base for systematic reviews and China biological medicine for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1975 to May 2010. Eight studies met the inclusion criteria. Two authors independently extracted the data from these studies. The data were analyzed using the RevMan 4. 2. 10 software. Result In patients with SAP, prophylactic antibiotics did not reduce pancreatic infection (OR = 0. 67,95% CI:0. 43～1. 02,P = 0. 06), surgical intervention (OR = 0. 90,95% CI: 0. 60～ 1. 36 ,P = 0. 63) and mortality rate (OR = 0. 69,95% CI: 0. 41～1. 15,P=0. 16). Conclusion Antibiotic prophylaxis of SAP did not reduce mortality. It did not protect against pancreatic infection and the frequency of surgical intervention.

ObjectiveTo assess and compare the resting energy expenditure measured by indirect calorimetry (MREE) and calculated with Harris-Benedict formula adjusted with correction factors (CREE) in critically ill surgical patients receiving mechanical ventilation,and to evaluate the relationship between resting energy expenditure and the severity of diseases.MethodsFrom August 2008 to February 2010,21 patients fitting the inclusion criteria were selected into the present study.The data of the patients were collected to calculate acute physiology and chronic health evaluation Ⅱ score ( APACHE Ⅱ score) and multiple organ dysfunction score ( Marshall score).MREEs were measured using indirect calorimetry of a MedGraphics CCM/D System,and CREEs were calculated at the same time with the Harris-Benedict formula.ResultsWithin the week of nutrition support,the mean CREE of the 21 patients was significantly higher than the mean MREE [ ( 8305.09 ± 1392.76 ) kJ vs.(6544.84 ±2079.65) kJ,P =0.000].The differences between MREE and CREE were statistically significant on the 0 ( P =0.000),1 ( P =0.000 ),2 ( P =0.000 ),and 4 day ( P =0.003 ) of nutritional support.There was no correlation between MREE and CREE (r =0.064,P =0.408 ),nor between MREE and APACHE Ⅱ ( r=-0.045,P =0.563 ).There was a correlation between MREE and Marshall score (P =0.001 ),but the correlation coefficient was low ( r =0.263).ConclusionsThe Harris-Benedict prediction modified with correction factors for severity of diseases overestimates the resting energy expenditure of critically ill surgical patients.Indirect calorimetry is a more accurate method for determining resting enenrgy expenditure.

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.

Objective To assess the value of primary resection and anastomosis with intraoperative colonic defecation in the patients with obstructive left colonic cancer. Methods From January 2000 to January 2008, 39 patients undergoing emergency laparotomy for left colonic cancers with complete obstruction were analyzed retrospectively. Results The patients were 25 males and 14 females, with a median age of 68.5 years (range: 57～78 years). The primary tumors were located at splenic flexure (3/7.7%), descending colon (8/20.5%), sigmoid colon (15/38.5%), boundary of sigmoid colon and rectum (8/20.5%), and superior segment of rectum (5/12.8%). Primary resection and anastomosis with intraoperative colonic de-fection were performed in 18 patients with left hemicolectomy, 13 patients with sigmoid colectomy and 8 pa-tients with anterior resection. Early complications included wound infection in 4 patients (wound disruption in 1 patient) and pulmonary infection in 5 patients. One patient complicated with anastomotic leakage and intra-abdominal abscess died of tumor metastasis after reoperation. Another one died of respiratory failure secondary to pulmonary infection. Morbidity and mortality was 25.6% and 5.1% respectively. Conclusion Primary resection with intraoperative colonic defecation can be applied to patients with malignant colonic complete obstruction with good operative results.

Objective To assess the value of primary resection and anastomosis without intraoperative irrigation in the patients with obstructive left colonic cancer. Method Between January 2000 and January 2008, 93patients underwent primary resection and anastomosis for colonic cancers were analyzed retrospectively. Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) was performed in 43 patients with obstructive left colonic caner and traditional left-sided colectomy in 50 cases without obstruction. Both groups of patients were comparable in terms of gender, nutritional status, underlaying disease, tumor location and stage, etc ( P = 0.83,0.13,0.29,0.51,0.38). The average age of the patients with colonic obstruction was significant older than that of the cases without obstruction (61.2 ± 8.6 vs. 58.1 ±7.8, P =0.010).The operative results were compared between patients with obstructive colonic cancer and cases without obstruction.Results The mean hospital stay of the primary anastomosis group and traditional left-sided colectomy group were (16.6±7.8) d and (12.4±5.4) d respectively, and the former was significant longer than the latter (P =0.002). The costs of hospitalization in the two groups were (50192.8 ± 39727.4) RMB and (46489.3 ±29543.1)RMB respectively (P = 0.04) . The morbidity and mortality in the two groups were 25.6% (11/43) vs. 18%(9/50) (P =0.375) and 2.3% (1/43) vs. 2.0% (1/50) (P =0.714) respectively, and there were no significant difference between the two groups. Conclusions Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) compares favorably with traditional left-sided colectomy in safety and efficiency for left colonic cancer with obstruction.