Long-Term Results of Cementless Total Hip Arthroplasty for Patients With High Hip Dislocation After Childhood Pyogenic Infection

BackgroundThe purpose of this study is to analyze the 10-year outcomes of cementless, modular total hip arthroplasty (THA) in adult patients who had high dislocation secondary to childhood pyogenic arthritis.MethodsWe retrospectively followed 56 consecutive patients who underwent cementless, modular THA for the late sequelae of childhood septic arthritis of the hip from 2001 to 2011. There were 23 men and 33 women with a mean age of 47 years (24 to 68). Of the 56 hips, 25 were classified as Crowe type III and 31 as type IV. Mean follow-up was 10.7 years.ResultsOne hip with a quiescent period of 23 years had recurrence of infection. Revision surgery was performed in 2 patients because of loosening and breakage of femoral stem and new infection with no correlation with childhood sepsis, respectively. The mean Harris hip scores improved from 44.2 points preoperatively to 87.5 points at final follow-up. Similarly, the Hip dysfunction and Osteoarthritis Outcome Score and hip pain also significantly improved at the latest follow-up. The mean acetabular cup abduction was 40.8° and the mean anteversion 27.8°, respectively. There were 5 cases of transient nerve palsy and 5 cases of intraoperative fracture.ConclusionTHA can reliably restore the abnormal anatomy and provide good results in these young and active patients who had high hip dislocation secondary to childhood pyogenic arthritis with a relatively high incidence of complications. However, these complications can be treated.     

Bundled Payment “Creep”: Institutional Redesign for Primary Arthroplasty Positively Affects Revision Arthroplasty

Background

Revision total joint arthroplasty (TJA) is associated with increased readmissions, complications, and expense compared to primary TJA. Bundled payment methods have been used to improve value of care in primary TJA, but little is known of their impact in revision TJA patients. The purpose of this study is to evaluate the impact of a care redesign for a bundled payment model for primary TJA on quality metrics for revision patients, despite absence of a targeted intervention for revisions.

Impact of whole egg intake on blood pressure,lipids and lipoproteins in middle-aged and older population: A systematic review and meta-analysis of randomized controlled trials

Background and aimEffects of whole egg consumption on cardiovascular diseases (CVD) risk in the middle-aged and older population remain unclear due to inconsistent findings from observational and randomized controlled trials (RCTs). This meta-analysis aimed to assess the impacts of whole egg and egg category (whole eggs versus egg substitutes) intake quantity on CVD risk factors from systematically searched RCTs. Egg substitutes were hypothesized to have minimal effects of the blood lipid and lipoprotein profile as they are void of dietary cholesterol.Methods and resultsAs many as 434 studies identified from PubMed, Cochrane Library, CINAHL and Medline (Ovid) databases were screened and data were extracted from 8 selected RCTs. Quality of the selected studies were assessed and the overall effect sizes of weighted mean differences (WMD) were calculated using a random effects model. Non-differential effects in blood pressures, lipids and lipoproteins were observed when >4 whole eggs/week compared to ≤4 whole eggs/week were consumed. Intake of >4 whole eggs/week compared to equivalent amounts of egg substitutes caused greater elevations in blood total cholesterol (WMD: 0.198 mmol/L; 95% CIs: 0.056, 0.339), HDL cholesterol (WMD: 0.068 mmol/L; 95% CIs: 0.006, 0.130) and LDL cholesterol (WMD: 0.171 mmol/L; 95% CIs: 0.028, 0.315) but did not differentially affect triglycerides concentration.ConclusionOverall, the results support the notion that quantity of whole egg intake does not affect CVD risk factors and consuming egg substitutes may also be beneficial compared to whole eggs on lowering CVD risk in the middle-aged and older population.     

中国经肛全直肠系膜切除结构化培训尸体手术训练中学员表现分析

目的 分析参加经肛全直肠系膜切除（taTME）结构化培训尸体手术训练中学员表现。方法 针对2018年4月至2019年7月参加taTME结构化培训研讨会的学员，通过问卷调查获取数据，分析学员在尸体手术训练过程中各步骤的技术表现、术中困难及并发症以及术后标本直肠系膜完整度等结果。结果 共45名学员参加taTME结构化培训研讨会，其中39名学员返回问卷。荷包缝合方面，5名（12.8%）学员未能独立完成，7名（17.9%）学员需要经过两次或以上尝试来完成荷包缝合。在各方向直肠系膜间隙的切开分离过程中，85%～90%学员能在教员不同程度上的口头指导下亲自完成。最终标本直肠系膜完整性的评价中，系膜不完整的标本共5例（12.8%），系膜近乎完整的标本共18例（46.2%），系膜完整的标本共16例（41.0%）。术中并发症及遇到困难方面，18名（46.2%）学员进入错误间隙，1名（2.6%）学员出现直肠穿孔，4名（10.3%）学员出现荷包失败，2名（5.1%）学员出现尿道损伤。单因素分析发现只有学员培训前独立完成taTME手术的例数≥1例为术中不出现并发症的影响因素。结论 参加培训的学员在荷包缝合、直肠全层切开以及直肠系膜间隙的分离等各重要手术步骤中获得较为充足的亲自上手练习机会，较丰富的工作经验以及腹腔镜全直肠系膜切除术（TME），经肛门内镜微创手术（TEM）、经肛门微创手术（TAMIS）的手术经验并不能降低taTME手术经肛操作部分的术中并发症发生率。参加包含尸体手术训练的taTME结构化培训有助于降低术中并发症发生率并提高手术安全性。     

基于芍药甘草汤的4种中药润肤霜对特应性皮炎的治疗作用及机制

目的:探讨4种中药润肤霜对2,4-二硝基氟苯(DNFB)致特应性皮炎小鼠的治疗作用及机制。方法:BALA/c小鼠按体质量随机分成正常组、模型组、空白膏霜组(润肤霜A组),芍药甘草汤组(润肤霜B组),芍药甘草汤加马齿苋,人参和忍冬藤组(润肤霜C组),芍药甘草汤加人参和忍冬藤组(润肤霜D组),给药剂量均为25 g·kg~(-1),以及阳性药他克莫司软膏组(3 g·kg~(-1)),每组10～12只。除正常组外,其余各组用0.5%DNFB涂抹小鼠背部脱毛皮肤,每只100μL,连续7 d。第7天起,各组给予相应润肤霜外用干预,1次/d,连续15 d,正常组和模型组不给药。每周称量动物体质量1次,每周对动物背部皮肤进行评分3次,记录皮损状况分值;处死小鼠后,取左右耳,打孔称量双耳质量并计算肿胀度;取背部皮肤固定,苏木素-伊红(HE)染色进行病理组织学检查,观察小鼠背部皮肤组织病理改变并评分;末次给药后取血,酶联免疫吸附测定(ELISA)检测血清中免疫球蛋白E(IgE)含量;蛋白免疫印迹法(Western blot)检测皮肤组织中信号传导与转录激活因子3(STAT3),磷酸化(p)-STAT3蛋白的表达。结果:与正常组比较,模型组小鼠体质量持续性降低,造模区出现红斑、水肿、干燥、脱屑、结痂剥脱等炎性改变,皮损状况分值显著增加;耳部皮肤角质层增厚,耳肿胀度明显增加;镜下见表皮局部坏死脱落、表皮增厚、表皮增生,角质层的角化过度和角化不全,以及皮下组织炎症细胞浸润等病变;血清IgE含量显著性增高;皮肤组织中p-STAT3的表达增加。与模型组比较,润肤霜C和D组小鼠体质量明显增加(P0.01),皮损状况评分明显降低(P0.05,P0.01);润肤霜B,C,D组较模型组小鼠耳廓肿胀度显著减少(P0.01);润肤霜C组小鼠背部皮肤坏死缺损和表皮增生的病变程度较模型组明显减轻(P0.05,P0.01);润肤霜C和D组小鼠血清中IgE含量较模型组明显降低(P0.05,P0.01);润肤霜C组小鼠皮肤组织中p-STAT3蛋白表达明显低于模型组(P0.05)。结论:润肤霜B,C,D对特应性皮炎均有一定的治疗效果,其中润肤霜C的治疗作用最为明显,作用机制可能与其抑制血清IgE含量的升高,及抑制STAT3的磷酸化,从而降低炎性细胞因子的水平有关。     

Automated total kidney volume measurements in pre-clinical magnetic resonance imaging for resourcing imaging data,annotations, and source code

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Electromagnetic Navigated Versus Conventional Total Knee Arthroplasty—A Five-Year Follow-Up of a Single-Blind Randomized Control Trial

BackgroundThe objective of this study is to provide the 5-year follow-up results of a randomized study comparing conventional versus electromagnetic computer navigated total knee arthroplasty.MethodsAnalysis of 127 patients (66 navigated and 61 conventional surgeries) was performed from a prospective, single-blinded, randomized controlled trial. Patient-reported outcome measures were collected at 5 years after surgery and compared with previously published 1-year clinical outcomes. Five-year surgical revision rates were collated and compared between intervention groups.ResultsOverall, there have been continued improvements in the clinical scores of patients in both groups when compared with clinical data at 1 year; however, at 5 years, there is no statistical difference in any of the patient-reported outcome measures between conventional and navigated surgery. Interestingly, improved implant survivorship was observed in the navigated (0% revision rate) compared with the conventional group (4.9% all-cause revision rate).ConclusionElectromagnetic computer navigated technology produces similar clinical outcomes compared with traditional surgery. Further work is required to monitor implant survivorship, and clinical outcomes with long-term follow-up, to determine the cost effectiveness of this technology.