ObjectiveTo evaluate the efficacy and safety of dupilumab in the treatment of moderate-to-severe asthma. MethodsA retrospective study was conducted among patients with moderate-to-severe asthma who were treated with dupilumab and inhaled corticosteroids (ICS) combined with long acting beta-agonist (LABA) in Department of Respiratory, Beijing Chao-yang Hospital from May, 2021 to April, 2022. Paired t-test or Mann-Whitney U test was applied to compare the Asthma Control Test (ACT) scores, number of acute exacerbations per year, type 2 inflammatory biomarkers, blood total IgE and results of pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 as percentage of predicted (FEV1%pred), FEV1/FVC, peak expiratory flow (PEF), maximal expiratory flows (MEF) at 75% (MEF75), 50% (MEF50) and 25% (MEF25) of the vital capacity PEF, and maximal mid-expiratory flow (MMEF) or FEF25%-75%, at the end of follow-up with those before treatment. Adverse reactions were recorded during the treatment. ResultsA total of 47 patients with moderate-to-severe asthma were included in the study, among them 17 and 30 received treatment with dupilumab or ICS/LABA. At the time of 12 months after treatment with dupilumab, the patients' ACT score and pulmonary function tests were significantly increased compared with those at the baseline. In contrast, patients' fractional exhaled nitric oxide (FeNO), blood total IgE, blood basophil counts and annual acute exacerbations were significantly decreased in comparison with those at the baseline. The doses of oral corticosteroids added by 7 patients at the baseline was gradually reduced and finally discontinued after treatment of dupilumab. There were 4, 2, 1 and 1 patients developed injection site reaction, pruritus, erythema and fatigue, respectively, which were mild and recovered without treatment. There was no serious adverse reaction observed, and only 1 case developed herpes zoster which was recovered after treatment. ConclusionDupilumab shows marked efficacy in the treatment of moderate-to-severe asthma with favorable safety.
Objective To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. Methods Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. Results Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference (P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant (P<0.05). The score of lower limb deformity was significantly higher than that before operation (P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. ConclusionSingle Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
ObjectiveTo explore the corrective strategies and clinical efficacy of osteotomy surgery for severe lower limb deformities in hypophosphatemic rickets. MethodsA retrospective analysis was conducted on 29 patients with severe lower limb deformities of hypophosphatemic rickets who underwent surgical treatment between February 2012 and August 2024. There were 9 males and 20 females. The age ranged from 13 to 53 years old, with an average of 24.6 years old. All patients were deformities of both lower limbs, presenting as 24 cases of O-shaped legs, 2 cases of wind-blown deformities, and 3 cases of X-shaped legs. Based on the full-length films of both lower limbs in the standing position before operation, the osteotomy planes of the femur, tibia, and fibula were designed. Among them, if both the same-sided thigh and calf were deformed, staged surgeries of both lower limbs were selected. If only the thigh or calf were deformed, simultaneous surgeries of both lower limbs were selected. The femur deformity was corrected immediately after osteotomy at the deformed plane; the osteotomy fragment was temporarily controlled with an external fixator, which was removed after perform internal fixation with a steel plate. After fibular osteotomy, the Ilizarov frame or Taylor frame was installed on the tibia and fibula. The threaded rods were removed and then tibial osteotomy was performed on the deformed plane. Patients using the Taylor frame did not undergo deformity correction during operation. The external fixators were adjusted starting 7 days after operation to correct the varus, valgus, and rotational deformities of the lower limb. Patients using the Ilizarov frame corrected the rotational deformity of the tibia during operation. The external fixator was adjusted starting 7 days after operation to correct the varus and valgus deformities of the lower limb. During the treatment period, the patient could walk with partial weight-bearing on the operated limb with crutches. The external fixator was removed after the bone healed. Before operation and at last follow-up, the medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), anatomic lateral distal femoral angle (aLDFA), posterior distal femoral angle (PDFA), and mechanical axis deviation (MAD), lower limb rotation, limb length discrepancy (LLD) were measured. The self-made scoring criteria were adopted to evaluate the degree of lower limb deformity of the patients. ResultsAll operations were successfully completed, and no complications such as nerve or vascular injury occurred. The adjustment time of the external fixator of the lower limb after operation was 28-46 days, with an average of 37.4 days. The wearing time of the external fixator ranged from 134-398 days, with an average of 181.5 days. Mild pin tract infections occurred in 2 limbs. The osteofascial compartment syndrome occurred in 1 limb after operation. No complications related to orthopedic adjustment of the external fixator occurred in other patients. All patients were followed up 6-56 months, with an average of 28.2 months. At last follow-up, full-length films of both lower limbs in the standing position showed that the coronal mechanical axes of the lower limbs of all patients returned to the normal. At last follow-up, MPTA, LDTA, PPTA, aLDFA, PDFA, MAD, lower limb rotation, LLD, and the score of lower limb deformity significantly improved when compared with those before operation (P<0.05). There was no significant difference in ADTA between pre- and post-operation (P>0.05). The degree of lower limb deformity were rated as moderate in 2 cases and poor in 27 cases before operation and as excellent in 7 cases, good in 18 cases, and moderate in 4 cases at last follow-up, with an excellent and good rate of 86.2%. ConclusionFor severe lower limb deformities in hypophosphatemic rickets, immediate correction of deformities with femoral osteotomy and internal plate fixation, as well as gradually correction of deformities with tibiofibular osteotomy and circular external fixation (Ilizarov or Taylor frame), have satisfactory therapeutic effects.