New approaches to moderate CRISPR-Cas9 activity: Addressing issues of cellular uptake and endosomal escape

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Method’s corner: Allergist’s guide to network meta-analysis

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.     

84例产褥感染的临床特点及常见致病微生物耐药性分析

目的 研究产褥感染的危险因素及常见致病微生物耐药情况，为临床治疗提供参考。方法 回顾性分析我院2017 年1 月～2019 年12 月发生的84 例产褥感染病例的临床资料，与同时期未发生产褥感染的200 例产妇进行对照研究，分析产褥感染的影响因素，并对分离获得的致病微生物进行耐药性分析。结果 感染组妊娠糖尿病、产钳助产、宫口开全后中转剖宫产患者的分布率高于对照组，差异有统计学意义（P＜0.05）；经多因素Logistic 回归分析，妊娠糖尿病是产褥感染的独立影响因素（P＜0.05）。本研究中共检出致病微生物40 株，其中革兰阴性菌13 株（占32.50%），革兰阳性菌10 株（占25.00%），支原体16 株（占40.00%），衣原体1 株（占2.50%），革兰阴性菌中以大肠埃希菌最常见，对二代头孢菌素类抗生素耐药率20%。革兰阳性菌以金黄色葡萄球菌最常见，对青霉素及头孢菌素耐药率高，未发现对亚胺培南及万古霉素耐药。结论 产钳助产、妊娠糖尿病、宫口开全后中转剖宫产是产褥感染可能的危险因素，其中，妊娠糖尿病是产褥感染的独立危险因素。目前临床常见致病微生物谱及耐药率未发生明显变化。     

Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study

BackgroundPosterior-stabilized antibiotic cement articulating spacers (PS spacers) reduce spacer mechanical complications in prosthetic knee infections (PKIs); however, joint dislocation after femoral cam fracture has been reported. We hypothesized that the rate of post-cam mechanical complications is lower in PS spacers with an endoskeleton-reinforced cam.MethodA retrospective study of PKIs using PS spacers with or without a Kirschner wire–reinforced cam (K-PS or nK-PS spacers, respectively) was conducted between 2015 and 2019. The rates of post-cam mechanical complications and reoperation, as well as risk factors for post or cam failure, were analyzed.ResultsThe cohort included 118 nK-PS and 49 K-PS spacers. All patients were followed up for 2 years. The rate of joint subluxation/dislocation after femoral cam fracture was lower in K-PS (0%) than in nK-PS spacers (17.8%; P = .002). The reoperation rate for spacer mechanical complications was lower in K-PS (0%) than in nK-PS spacers (11.9%; P = .008). The identified risk factors for femoral cam fractures were body mass index ≥25 kg/m², femoral spacer size ≤2, and surgical volume ≤12 resection arthroplasties per year.ConclusionThis preliminary study highlights that K-PS spacers have a lower rate of post-cam mechanical complications than nK-PS spacers. We recommend the use of PS spacers with endoskeleton-reinforced cam when treating PKIs performed by surgeons with lower surgical volumes, especially in patients with higher body mass index and smaller femoral spacer sizes.     

新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估

目的：探索新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估。方法:收集2017年至2020年间于浙江省湖州市妇幼保健院收住入院的103例持续性枕后位难产孕妇, 其中以产钳分娩的60例孕妇为研究组，53例以剖宫产术分娩的孕妇为对照组，评估其分娩结局，分析两种分娩方式对孕产妇的影响。采用χ2 检验比较剖宫产及产钳分娩两组的新生儿窒息、产后出血、产时、产后感染、软产道裂伤（包括会阴III度裂伤、阴道裂伤、宫颈裂伤）、切口预后不良的差异。结果：研究组产后出血、产时发热、产后发热发生率[分别为1.66%（1/60）、1.66%（1/60）、3.33%(2/60），χ2 值分别为（4.514 和5.698、4.826，P值分别为 0.040 和 0.020、0.030）]，明显低于对照组[分别为11.32%（6/53）、13.20%（7/53）、15.09%(8/53）]，但是研究组会阴III度裂伤、宫颈裂伤、阴道裂伤、发生率为分别为[15.00%（9/60）、13.33%（8/60））、（11.66%（7/60）），明显高于对照组（1.88%（1/53）、1.88%（1/53）、3.77%（2/53））]，差异有统计学意义（P值均＜0.05）。但研究组的新生儿窒息发生率及切口预后不良的比例分别为[5（8.33%）、4（6.66%）]，略低于对照组[（6（11.32%）、4（7.54%）]，差异无统计学意义（χ2值分别为0.286、0.233，P 值均＞0.05）。结论：新产程标准下持续性枕后位难产孕妇选择产钳分娩可明显降低产时、产后感染及产后出血的发生率，但软产道裂伤发生率较高，差异有统计学意义。所以持续性枕后位难产孕妇选择产钳分娩是相对比较安全的分娩方式，但同时需要注意软产道裂伤的发生。     

百克钳在腹腔镜子宫肌瘤剔除术中的应用

目的:分析百克钳在腹腔镜子宫肌瘤剔除术中的应用效果.方法:纳入2017年2月~2019年2月在本院接受腹腔镜子宫肌瘤剔除术治疗的患者92例为观察对象,按照随机双盲法将患者分为百克钳组与超声刀组,各46例.结果:百克钳组患者手术时间、术后排气时间以及住院时间与超声刀组患者均无明显差异(P>0.05);百克钳组患者术中出血量明显少于超声刀组患者(P<0.05).结论:在为子宫肌瘤患者实施腹腔镜子宫肌瘤剔除术治疗的过程中,百克钳的运用减少了患者术中出血量,手术时间以及恢复时间均较短,安全性相对较高.