Capsular Management in Direct Anterior Total Hip Arthroplasty: A Randomized,Single-Blind,Controlled Trial

BackgroundThe direct anterior approach (DAA) is a popular approach to total hip arthroplasty (THA). Unlike the posterior approach, the importance of anterior capsular management is unknown. This randomized controlled trial compares capsular repair versus capsulectomy.MethodsThis single-surgeon, single-blinded, parallel-group randomized controlled trial occurred between 2013 and 2016. Patients undergoing unilateral, primary THA for osteoarthritis consented to undergo blinded, simple randomization to anterior capsulotomy with repair or anterior capsulectomy. Primary outcome measures included hip range of motion, hip flexion strength, and pain with seated hip flexion. Secondary outcome measures included surgical time, estimated blood loss, postoperative complications, and hip disability and osteoarthritis outcome score. Data were prospectively collected intraoperatively, six weeks, six months, an average of over 5 years postoperatively.ResultsNinety-eight patients were ultimately enrolled in the trial; 50 received capsulectomy and 48 received capsulotomy. No significant differences were seen in preoperative demographics or in primary or secondary outcomes during this study. No difference was seen in pain at final follow-up at average > 5 years postoperatively.ConclusionThis study demonstrates that capsular management in DAA THA does not affect postoperative pain or range of motion. The anterior capsule’s role in prosthetic stability after DAA THA remains uncertain, but it does not currently appear that repair provides benefit and may lead to increased surgical time and blood loss. As such, capsular management in DAA THA is at surgeon discretion.     

Impact of Dexamethasone on Length of Stay and Early Pain Control in Direct Anterior Approach Total Hip Arthroplasty With Neuraxial Anesthesia

BackgroundDexamethasone has been shown to reduce postoperative pain and opioid consumption for total joint arthroplasty patients; however, its impact on patients who received neuraxial anesthesia (NA) is not well described. We examined the impact of perioperative dexamethasone on outcomes for patients undergoing direct anterior approach total hip arthroplasty (THA) under NA.MethodsA retrospective review was conducted for 376 THA patients from a single institution. Univariate analysis was used to compare postoperative outcomes for 164 THA patients receiving dexamethasone compared to 212 who did not receive dexamethasone.ResultsNo differences in age, gender, body mass index, or American Society of Anesthesiologists (ASA) Score were observed between the groups. Patients receiving perioperative dexamethasone reported statistically significantly lower postanesthesia care unit (PACU) pain numeric rating scale (Dexamethasone 1.6 vs No dexamethasone 2.3, P = .014) and received lower PACU morphine milligram equivalents (MME) (Dexamethasone 8.57 vs No dexamethasone 11.44, P < .001). Patients receiving dexamethasone had significantly shorter LOS (Dexamethasone 29.40 vs No dexamethasone 35.26 hrs., P < .001).ConclusionPerioperative dexamethasone is associated with decreased postoperative pain and narcotic consumption, and shorter length of stay for patients undergoing primary direct anterior approach THA with NA.     

A prospective observational study of the rapid detection of clinically-relevant plasma direct oral anticoagulant levels following acute traumatic injury

In urgent clinical situations, such as trauma, urgent surgery or before thrombolysis, rapid quantification of direct oral anticoagulant plasma drug levels is warranted. Using the ClotPro® analyser, we assessed two novel viscoelastic tests for detection of clinically-relevant plasma drug levels in trauma patients. The ecarin clotting time was used to assess the plasma concentration of dabigatran and Russell´s viper venom clotting time to determine the plasma concentration of direct factor Xa inhibitors. In parallel, plasma concentrations were analysed using plasma-based chromogenic assays. A total of 203 simultaneous measurements were performed. Strong to very strong linear correlations were detected between ecarin clotting time and plasma concentration of dabigatran (r = 0.9693), and between Russell´s viper venom clotting time and plasma concentrations of apixaban (r = 0.7391), edoxaban (r = 0.9251) and rivaroxaban (r = 0.8792), all p < 0.001. An ecarin clotting time ≥ 189 seconds provided 100% sensitivity and 90% specificity for detecting plasma dabigatran concentrations ≥ 50 ng.ml^-1. Corresponding Russell´s viper venom clotting time cut-off values were ≥ 136 seconds for apixaban (80% sensitivity, 88% specificity), ≥ 168 seconds for edoxaban (100% sensitivity, 100% specificity) and ≥ 177 seconds for rivaroxaban (90% sensitivity, 100% specificity). Detection of drug levels ≥ 100 ng.ml^-1 was also investigated: for dabigatran, an ecarin clotting time ≥ 315 seconds yielded 92% sensitivity and 100% specificity; while Russell´s viper venom clotting time cut-offs of 191, 188 and 196 seconds were calculated for apixaban (67% sensitivity, 88% specificity), edoxaban (100% sensitivity, 75% specificity) and rivaroxaban (100% sensitivity, 91% specificity), respectively. We have demonstrated strong positive correlations between plasma drug levels and clotting time values in the specific ClotPro assays. Cut-off values for detecting clinically-relevant drug levels showed high levels of sensitivity and specificity.     

中药配伍减毒增效的现代研究及思考

中药配伍是中医药临床应用的精华之一,合理配伍是保障中药临床用药有效性和安全性的重要措施。配伍后减毒增效机制的研究是诠释中药配伍合理性的关键内容。中药配伍机制研究正处于从体外到体内、成分到靶标、单一技术到多学科融合研究技术的转变历程,因此提出以“体外成分、体内过程、直接靶标”研究为基础,“中药配伍药理机制研究”为目的,从不同角度和不同层面探索中药配伍后作用机制的研究策略。     

Drugs affecting coagulation

The clotting cascade is a complex process and is an important survival mechanism. Major haemorrhage and thromboembolic events remain major causes of increased morbidity and mortality. Drugs affecting coagulation have primarily been utilized to treat or reduce the risk of thromboembolic events. However, the recent progress in the management of major trauma and treating coagulopathy has resulted in further research and development of drugs that improve clotting function. Knowledge of drugs used for both clinical circumstances is now required when working in anaesthesia or intensive care.     

黑龙工省基本医疗保险跨省异地就医直接结算现状及靶点问题分析

目的:分析黑龙江省基本医疗保险异地就医直接结算运行现状,找到靶点问题,并给出政策性建议。方法:采用SPSS 20.0软件对黑龙江省异地就医人次、统筹基金支付金额、实际报销比例及转外就医定点医院情况等进行描述性分析。结果:黑龙江省异地就医人次呈现直线上升趋势;作为参保省的统筹基金支付约是作为就医省的11.8(26.92/2.28)倍;实际报销比例差距较大,待遇差较严重;转外就医主要集中于京津的肿瘤专科医院与综合三级甲等医院。结论:基本医疗保险面临着严峻的基金外流问题挑战,亟需加快医疗卫生服务供给侧改革,实现医保与医疗服务的协同发展,同时将基本医疗保险异地就医直接结算政策嵌入黑龙江省特色发展战略,推动社会现代化发展。     

探讨DR颈椎斜位影像中应用组织均衡技术的优势

目的探讨颈椎斜位直接数字化X线摄影（direct digital radiography，DR）中，采用组织均衡技术的DR图像与标准DR图像的差别。方法利用中国医科大学附属第一医院引进的GE—Revolution XQ／Ⅰ型DR机对所摄的颈椎斜位影像中随机抽取100例作为分析资料。应用组织均衡技术对图像进行处理，同时与标准DR图像进行比较。结果应用组织均衡技术的图像，同一幅图像上不同部位的细节均可清晰显示；标准DR图像需调节不同的窗宽、窗位才能清晰显示或不能显示不同体厚部位的细节。结论在直接数字化X线摄影中，应用组织均衡技术能明显改善因受体厚度影响而难于观察部分的可视性，同时又不牺牲其他部分的细节显示，使DR的应用更完美。     

直流电场对鸡胚绒毛尿囊膜血管生成作用的研究

目的：探讨直流电场（electric fields．EF）对血管生成的影响及作用机制。方法：于发育第8天的鸡胚绒毛尿囊膜（chick embryo chorioallantoic membrane，CAM）上植入明胶海绵载体，其中加载不同强度EF，计数长入载体的血管和载体内的微血管密度（microvascular densily．MVD）。结果：150mV／mm、200mV／mm组在CAM上长入载体边缘的血管数和MVD与对照组间的有显著差别（p〈0．01）。结论：强度为150mV／mm、200mV／mm的直流电场能促进CAM的血管生成。     

细胞培养稳定同位素标记技术与肿瘤标志分子研究

以质谱为基础的定量蛋白质组学分析技术的发展,大大加快了肿瘤标志分子的研究进程。细胞培养稳定同位素标记技术,已成为目前定量蛋白质组学的主要策略之一,它将不同来源或不同状态的细胞分别培养于含轻/重型稳定同位素标记必需氨基酸的培养基中,经过若干次细胞倍增后,稳定同位素按照序列特异的方式,完全掺入到新合成的蛋白质中。通过比较标记前后同一肽段的质谱峰值变化,可以实现对蛋白质的精确定量。它具有样本需求量少、简单、直接、高效及定量准确等特点,不仅可以定性和定量地分析差异表达蛋白质,而且可以分析蛋白质翻译后修饰和蛋白质相互作用,已逐渐成为研究差异蛋白质组的重要工具之一,在肿瘤分子标志研究中发挥重要作用。     

Synthesis of merozoite proteins and glycoproteins during the schizogony of Plasmodium falciparum

We have investigated the protein and glycoprotein content of Plasmodium falciparum merozoites by metabolically labeling cultures of schizont-stage parasites with [³⁵S]methionine or with [³H]glucosamine followed by incubation in nonradioactive medium to allow the schizonts to mature into merozoites, infect new erythrocytes, and develop into ring-stage parasites. The ring stages were separated from schizonts by sedimentation through Percoll. Labeled proteins were resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and visualized by fluorography. Using [³⁵S]methionine, four major proteins (p) with apparent relative molecular weights (M_r) = 202k, 136k, 82k, and 46k and two proteins of intermediate labeling (M_r = 185k and 142k) were observed in the schizont-labeled ring-stage parasites. Because corresponding proteins were also observed in the schizont stage, we conclude that they had been present in the invading merozoite. In contrast, prominent proteins which were generally labeled during the ring stage and some major schizont-stage proteins were virtually absent in the schizont-labeled ring-stage. By labeling the parasite proteins with [³H]glucosamine followed by separation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, five major glycoproteins (gp) of apparent M_r = 185k, 88k, 56k, 46k, and 34k were identified. Their presence in both the schizont and the schizont-labeled ring stage demonstrated that the merozoite contains glycoproteins. Immune owl monkey serum recognized all five glycoproteins. A comparison of proteins by two-dimensional gel electrophoresis (isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis) suggested that p185 and gp185 were identical, as were p46 and gp46.