Mini-Incision versus Standard Incision Total Hip Arthroplasty Regarding Surgical Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose

It remains controversial whether mini-incision (MI) benefits patients in total hip arthroplasty (THA). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of MI on surgical and functional outcomes in THA patients.

Methods

A systematic electronic literature search (up to May 2013) was conducted to identify RCTs comparing MI with standard incision (SI) THA. The primary outcome measures were surgical and functional outcomes. According to the surgical approach taken, MI THA patients were divided into four subgroups for sub-group meta-analysis. Standardized mean differences (SMDs) or risk differences (RDs) with accompanying 95% confidence intervals (CIs) were calculated and pooled using a fixed-effect or random-effect model according to the heterogeneity.

Results

A total of 14 RCTs involving THA 1,174 patients met the inclusion criteria. The trials were medium risk of bias. The overall meta-analysis showed MI THA reduced total blood loss (95% CI, -201.83 to -21.18; p=.02) and length of hospital stay ( 95% CI, -0.67 to -0.08; p=.01) with significant heterogeneity. However, subgroup meta-analysis revealed posterior MI THA had perioperative advantages of reduced surgical duration ( 95% CI, -8.45 to -2.67; P<.001), less blood loss ( 95% CI, -107.20 to -1.73; P=.04) and shorter hospital stay ( 95% CI, -0.74 to -0.06; p=.002) with low heterogeneity. There were no significant differences between MI and SI THA groups in term of pain medication dose, functional outcome (HHS), radiological outcome or complications (P>.05, respectively).

Conclusions

Although no definite overall conclusion can be arrived at on whether MI THA is superior to SI THA, posterior MI THA clearly result in a significant decrease in surgical duration, blood loss and hospital stay. It seems to be a safe minimally invasive surgical procedure without increasing the risk of component malposition or complications.     

The Effect of Hemodynamic Remodeling on the Survival of Arterialized Venous Flaps

Objective

To evaluate the effect of hemodynamic remodeling on the survival status of the arterialized venous flaps (AVFs) and investigate the mechanism of this procedure.

Materials and Methods

Two 7 x 9 cm skin flaps in each rabbit (n=36) were designed symmetrically in the abdomen. The thoracoepigastric pedicle and one femoral artery were used as vascular sources. Four groups were included: Composite skin grafts group and arterial perfusion group were designed in one rabbit; AVF group and hemodynamic remodeling group by ligation of the thoracoepigastric vein in the middle were outlined in another rabbit. Flap viability, status of vascular perfusion and microvasculature, levels of epidermal metabolite and water content in each group were assessed.

Results

Highly congested veins and simple trunk veins were found using angiography in the AVF group; while a fairly uniform staining and plenty of small vessels were observed in the hemodynamic remodeling group. The metabolite levels of the remodeling group are comparable with those in the arterial perfusion group. There was no statistically significant difference in the percentage of flap survival between the arterial perfusion group and hemodynamic remodeling group; however, significant difference was seen between the AVF group and the hemodynamic remodeling group.

Conclusions

Under the integrated perfusion mode, the AVFs are in an over-perfusion and non-physiological hemodynamic state, resulting in unreliability and unpredictability in flap survival; under the separated perfusion mode produced by remodeling, a physiological-like circulation will be created and therefore, better flap survival can be expected.     

HIV-1整合酶链转移反应抑制剂的荧光筛选方法

整合酶被认为是抗HIV-1药物研究的理想靶点之一。为了建立便捷高效的整合酶链转移反应抑制剂筛选方法,首先将HIV-1整合酶原核表达载体pNL-IN转化入大肠杆菌感受态细胞BL21(DE3)进行原核表达,并用镍琼脂糖凝胶进行亲和纯化,获得了纯度和活性均较高的整合酶重组蛋白;然后设计了生物素标记的供体DNA和FITC标记的靶DNA,用链霉亲和素磁珠捕获反应体系中的DNA产物;最后用荧光分析仪检测DNA产物的荧光信号,并计算待测样品的抑制率。用已知整合酶抑制剂S-1360和MK-0518对筛选方法进行了验证,测定结果与已有实验数据相当,表明本筛选方法能够有效应用于HIV-1整合酶链转移反应抑制剂的筛选。与现有的整合酶链转移反应抑制剂筛选方法相比,本筛选方法步骤更为简化、耗时更短、成本更低。     

肾移植术后HCMV感染与淋巴细胞亚群及肾功能的相关性

目的：肾移植患者由于术前透析及术后服用免疫抑制剂,显著增加了人巨细胞病毒（Humancytomegalovirus,HCMV）原发感染和潜伏感染被激活的机会。观察HCMV感染情况与血T淋巴细胞亚群及肾功能的变化,以探讨其相关性及临床意义。方法：跟踪收集40例肾移植患者术前、术后血标本,应用RT-PCR技术检测HCMV,流式细胞术检测淋巴细胞亚群,结合肾功能判断是否发生急性排斥或移植肾功能恢复延迟。结果：肾移植术后HCMV感染率为52．5％,10例出现症状性感染（25％）,出现阳性时间35．7±15．3天。症状性感染组CD3-bCD4＋的水平和CD4＋／CD8＋的比值较无活动性感染组和正常对照组均降低,CD8＋水平较其他组升高,差异有显著性意义（P〈0．05）。无症状性活动感染者与无活动性感染者各指标比较差异无显著性。活动性感染组急性排斥或移植肾功能恢复延迟发生8例（38．1％）,无活动性感染组发生1例（5．2％）,差异具有统计学意义（x^2=6．15,P〈0．05）。结论：肾移植术后HCMV感染能显著引起T淋巴细胞亚群变化,尤其是CD4＋／CD8＋。并与急性排斥或移植肾功能恢复延迟密切相关联,在其发生发展中可能起着重要的作用。三者相互联系、相互作用、互为因果,对进一步机制的研究及临床诊断治疗、预后方面有一定意义。     

Optimization of parameters for improvement of phenol degradation by Rhodococcus UKMP-5M using response surface methodology

Phenol is a toxic compound and is one of the major pollutants contained in the waste water from petroleum and its downstream industries. Response surface methodology (RSM) was used to optimize medium composition and culture condition for enhancement of growth of Rhodococcus UKMP-5M and phenol degradation rate in shake flask cultures. Phenol and (NH₄)₂SO₄ concentrations as well as temperature were the most significant factors that influenced growth and phenol degradation. Central composite design (CCD) was used for optimization of these parameters with growth, and degradation rates were used as the responses. Cultivation with 0.5 g/L phenol and 0.3 g/L (NH₄)₂SO₄ and incubation at 36 °C greatly enhanced growth of Rhodococcus UKMP-5M, where the final cell concentration increased from 0.117 g/L to 0.376 g/L. On the other hand, the degradation rate was greatly increased in cultivation with 0.7 g/L phenol and 0.4 g/L (NH₄)₂SO₄ and incubation at 37 °C. In this cultivation, the time taken to degrade 1 g/L phenol in the culture was reduced from 48 h to 27 h. The model for both responses was found significant and the predicted values were found to be in a good agreement with experimental values and subsequently validated. Increases in phenol degradation rate during Rhodococcus UKMP-5M cultivation corresponded well with increasing phenol hydroxylase activity.     

Naphtho‐γ‐pyrones from Endophyte Aspergillus niger Occurring in the Liverwort Heteroscyphus tener (Steph.) Schiffn.

Bioactivity‐guided fractionation of the cytotoxic extract of Aspergillus niger, an endophytic fungus from the Chinese liverwort Heteroscyphus tener (Steph .) Schiffn ., afforded five new naphtho‐γ‐pyrones, rubrofusarin‐6‐O‐α‐D ‐ribofuranoside ( 1 ), (R)‐10‐(3‐succinimidyl)‐TMC‐256A1 ( 2 ), asperpyrone E ( 3 ), isoaurasperone A ( 4 ), and isoaurasperone F ( 5 ), as well as four known ones, dianhydroaurasperone C ( 6 ), aurasperone D ( 7 ), asperpyrone D ( 8 ), and asperpyrone A ( 9 ), together with a cytotoxic cyclic pentapeptide, malformin A₁ ( 10 ). Their structures were determined by extensive spectroscopic analysis. The absolute configurations of dimeric naphtho‐γ‐pyrones 3 – 9 were also determined by analysis of their respective CD spectra.     

Nanoporous Polytetrafluoroethylene/Silica Composite Separator as a High‐Performance All‐Vanadium Redox Flow Battery Membrane

A novel low‐cost nanoporous polytetrafluoroethylene (PTFE)/silica composite separator has been prepared and evaluated for its use in an all‐vanadium redox flow battery (VRB). The separator consists of silica particles enmeshed in a PTFE fibril matrix. It possesses unique nanoporous structures with an average pore size of 38 nm and a porosity of 48%. These pores function as the ion transport channels during redox flow battery operation. This separator provides excellent electrochemical performance in the mixed‐acid VRB system. The VRB using this separator delivers impressive energy efficiency, rate capability, and temperature tolerance. In additon, the flow cell using the novel separator also demonstrates an exceptional capacity retention capability over extended cycling, thus offering excellent stability for long‐term operation. The characteristics of low cost, excellent electrochemical performance and proven chemical stability afford the PTFE/silica nanoporous separator great potential as a substitute for the Nafion membrane used in VRB applications.     

金属烤瓷全冠修复老年人活髓隐裂牙适应证及临床疗效

目的：探讨老年人活髓隐裂牙应用金属烤瓷全冠修复临床效果及适应症。方法：选取本院2006年1月至2011年1月期间收治的356例老年活髓隐裂牙合计621颗为研究对象,根据患牙疼痛程度随机将患者分为咬合疼痛组（A组）104例合计215颗患牙,咬合伴过敏性冷热刺激痛组（B组）122例合计232颗患牙,咬合伴延续性冷热刺激疼痛组（C组）130例合计174颗患牙,所有患者均接受金属烤瓷全冠修复,观察患者在治疗后1个月、6个月、12个月、18个月、24个月治愈情况以及牙髓及根尖周病变及牙髓发生情况。结果：与C组相比,A组、B组术后1个月、6个月、12个月、18个月、24个月治愈率以及总有效率较高,差异有统计学意义（P〈0．05）。结论：金属烤瓷全冠修复适合于轻微咬合疼痛以及咬合伴过敏性冷热刺激痛的患者,而对于咬舍伴延续性冷热刺激疼痛的患者则宜先行根管治疗术再进行全冠修复。     

临床药学ESP课程设计

随着国际药学交流日益频繁,人们开始关注专门用途英语课程设计。这门课程主要是帮助学习者更好地适应职业交流的需要。尽管对于专门用途英语的需求日益增强,依然很少有人关注职业药师的需求。本文为中国的职业药师提供课程设计指导,以满足他们的需求。文章首先回顾了与课程设计相关的个案。设计这类课程时,主要问题是分析学习者的特定需求。其他问题包括：目标、语法结构、习得技巧以及评估等。