No clinical benefit of gender-specific total knee arthroplasty: A systematic review and meta-analysis of 6 randomized controlled trials

Background and purpose

There is no consensus regarding the clinical relevance of gender-specific prostheses in total knee arthroplasty (TKA). We summarize the current best evidence in a comparison of clinical and radiographic outcomes between gender-specific prostheses and standard unisex prostheses in female patients.

Methods

We used the PubMed, Embase, Cochrane, Science Citation Index, and Scopus databases. We included randomized controlled trials published up to January 2013 that compared gender-specific prostheses with standard unisex prostheses in female patients who underwent primary TKAs.

Results

6 trials involving 423 patients with 846 knee joints met the inclusion criteria. No statistically significant differences were observed between the 2 designs regarding pain, range of motion (ROM), knee scores, satisfaction, preference, complications, and radiographic results. The gender-specific design (Gender Solutions; Zimmer Inc, Warsaw, Indiana) reduced the prevalence of overhang. However, it had less overall coverage of the femoral condyles compared to the unisex group. In fact, the femoral prosthesis in the standard unisex group matched better than that in the gender-specific group.

Interpretation

Gender-specific prostheses do not appear to confer any benefit in terms of clinician- and patient-reported outcomes for the female knee.Women account for almost two-thirds of knee arthroplasties (Kurtz et al. 2007). Recently, a possible effect of gender on functional outcomes and implant survivorship has been identified (Vincent et al. 2006, Ritter et al. 2008, Kamath et al. 2010, Parsley et al. 2010, O’Connor 2011). Gender differences in the anatomy of the distal femur are well documented (Conley et al. 2007, Yue et al. 2011a, b, Yan et al. 2012, Zeng et al. 2012). Women tend to have a less prominent anterior condyle (Conley et al. 2007, Fehring et al. 2009), a higher quadriceps angle (Q-angle) (Hsu et al. 1990, Woodland et al. 1992), and a reduced mediolateral to anteroposterior aspect ratio (Chin et al. 2002, Chaichankul et al. 2011). Investigators have found that standard unisex knee prostheses may not equally match the native anatomy in male and female knees (Clarke and Hentz 2008, Yan et al. 2012). A positive association between the femoral component size and the amount of overhang was observed in females, and femoral component overhang (≥ 3 mm) may result in postoperative knee pain or reduced ROM (Hitt et al. 2003, Lo et al. 2003, Mahoney et al. 2010).The concept of gender-specific knee prostheses was introduced to match these 3 anatomic differences in the female population (Conley et al. 2007). It includes a narrower mediolateral diameter for a given anteroposterior dimension, to match the female knee more closely. Additionally, the anterior flange of the prothesis was modified to include a recessed patellar sulcus and reduced anterior condylar height (to ovoid “overstuffing” during knee flexion) and a lateralized patellar sulcus (to accommodate the increased Q-angle associated with a wider pelvis).Several randomized controlled trials (RCTs) have failed to establish the superiority of the gender-specific prosthesis over the unisex knee prosthesis in the female knee (Kim et al. 2010a, b, Song et al. 2012a, Thomsen et al. 2012, von Roth et al. 2013). In contrast, other studies have found higher patient satisfaction and better radiographic fit in the gender-specific TKAs than in the standard unisex TKAs (Clarke and Hentz 2008, Parratte et al. 2011, Yue et al. 2014). We therefore performed a systematic review and meta-analysis to compare the clinical and radiographic results of TKA in female patients receiving gender-specific prostheses or standard unisex prostheses.     

Skeletal muscle expression and abnormal function of beta-myosin in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy is an important inherited disease. The phenotype has been linked, in some kindreds, to the beta-myosin heavy chain (beta-MHC) gene. Missense and silent mutations in the beta-MHC gene were used as markers to demonstrate the expression of mutant and normal cardiac beta-MHC gene message in skeletal muscle of hypertrophic cardiomyopathy patients. Mutant beta-myosin, also shown to be present in skeletal muscle by Western blot analysis, translocated actin filaments slower than normal controls in an in vitro motility assay. Thus, single amino acid changes in beta-myosin result in abnormal actomyosin interactions, confirming the primary role of missense mutations in beta-MHC gene in the etiology of hypertrophic cardiomyopathy.     

儿童外伤性白内障50例临床分析及护理

[目的]通过对儿童外伤性白内障围术期相关护理因素的分析,确定患儿的心理特征及健康需求。[方法]对不同年龄段患儿采用了不同的护理措施。[结果]通过对外伤性白内障患儿的护理,使之能最好的配合手术,50例儿童外伤性白内障手术前后矫正视力比较,差异具有统计学意义(χ2=32.29,P<0.05)。[结论]采用针对性的围术期护理措施,是取得良好治疗效果保障之一。     

国外药典与中国药典的无菌检查用真菌培养基的灵敏度比对

微生物培养基是微生物生长繁殖需要的一种生物营养物质。无菌试验用培养基是药品无菌检验的重要手段，中国药典无菌检查法中检查真菌用的培养基改良马丁培养基是用于检查样品是否污染真菌。而BP、EP、USP、JP等国家药典用大豆-酪蛋白消化培养基检查此项。进口药品的药品标准及厂报标准大多都参照国外药典制定，为了与国际接轨，了解大豆-酪蛋白消化培养基能否替代改良马丁培养基，我们参照中国药典培养基灵敏度检查法对中国药典改良马丁培养基与大豆-酪蛋白消化培养基进行了比对试验。现报告如下.     

系统性红斑狼疮伴肝,肾损害时血浆P选择素测定意义

为探讨粘附分子Ｐ选择素在系统性红斑狼疮（ＳＬＥ）发病中的作用，本文采用ＥＬＩＳＡ法检测ＳＬＥ患者血浆Ｐ选择素含量。结果表明３０例患者血浆Ｐ选择素平均水平较正常对照明显升高（Ｐ〈０．０１）。其中ＳＬＥ伴肝、肾损害者的血浆Ｐ选择素显著高于不伴有肝、肾损害者（Ｐ〈０．０１），后者与正常对照组相比，也有显著差异。此外，ＳＬＥ患者血浆Ｐ选择素变化与血沉（ＥＳＲ）呈正相关（ｒ＝０．４６７，Ｐ〈０．０１）；但与     

SUMOylation plays a role in gemcitabine- and bortezomib-induced cytotoxicity in human oropharyngeal carcinoma KB gemcitabine-resistant clone

Bortezomib, a novel dipeptide boronic acid proteasome inhibitor, has been shown in previous studies to be synergistic with gemcitabine; however, the molecular mechanisms are not fully understood. Because post-translational modification of proteins, such as ubiquitination and SUMOylation, plays a critical role in governing cellular homeostasis, we explored this further by treating human oropharyngeal carcinoma KB wild-type (KBwt) and gemcitabine-resistant (KBGem) cells with gemcitabine and bortezomib in a time-dependent and sequence-dependent manner. Treatment with bortezomib at 4 to 8 hours post-gemcitabine significantly induced cell death in KBwt cell lines. However, in KBGem cells, bortezomib alone was just as cytotoxic. Using reporter assays, nuclear factor-kappaB (NF-kappaB) activity was found to be 5-fold higher in KBGem cells than that in KBwt cells, and the combination treatment decreased NF-kappaB activity by 44% in KBwt cells and 28% in KBGem cells, respectively. By Western blot analyses, treatment with gemcitabine and bortezomib resulted in a cleavage of NF-kappaB in KBwt but not in KBGem cells. SUMOylation capacity was modulated by transducing KBwt and KBGem cells with lenti-SUMO-1 or the unconjugatable lenti-SUMO-1aa followed by drug treatment. The expression of cyclins A, D1, and E was differentially regulated by SUMOylation capacity in KBGem but not in KBwt cells. We report herein that the activation of NF-kappaB signaling plays a critical role in eliciting KBwt cell survival against gemcitabine, whereas the role of SUMOylation in modulating the steady-state levels of key cell cycle regulator proteins seems more significant in KBGem cells.     

阿伐他汀调节大鼠脊髓损伤后白细胞介素1β及半胱氨酸蛋白酶3基因的表达

目的:观察阿伐他汀对脊髓损伤后SD大鼠白细胞介素1β及半胱氨酸蛋白酶3基因表达的影响。方法:实验于2005-05/09在华中科技大学同济医学院附属同济医院矫形外科实验室完成。选择健康成年雌性SD大鼠78只,随机数字表法分为假手术组6只,阿伐他汀治疗组36只和生理盐水对照组36只,后两组每组又分损伤后1,4,12h,1,3,7d6个时相点,每个时相点6只。阿伐他汀治疗组于损伤前7d开始用阿伐他汀加生理盐水经口给药(5mg/kg,1次/d)直至处死,生理盐水对照组用相同体积的生理盐水代替。采用Allen打击法造成大鼠脊髓损伤,于术后不同时相点取伤段脊髓组织,用反转录-聚合酶链反应分析脊髓受损部位白细胞介素1β及半胱氨酸蛋白酶3mRNA表达。结果:纳入动物78只,均进入结果分析。①阿伐他汀治疗组大鼠脊髓损伤后4h白细胞介素1βmRNA表达(A)低于生理盐水对照组(分别为0.480±0.100,2.610±0.330,P<0.01)。②阿伐他汀治疗组大鼠脊髓损伤后1d半胱氨酸蛋白酶3mRNA表达(A)低于生理盐水对照组(分别为0.589±0.056,0.676±0.072,P<0.05)。结论:阿伐他汀能降低大鼠脊髓损伤后炎性细胞因子白细胞介素1β及半胱氨酸蛋白酶3的基因表达。     

Adenovirus-expressed human hyperplasia suppressor gene induces apoptosis in cancer cells

Hyperplasia suppressor gene (HSG), also called human mitofusin 2, is a novel gene that markedly suppresses the cell proliferation of hyperproliferative vascular smooth muscle cells from spontaneously hypertensive rat arteries. This gene encodes a mitochondrial membrane protein that participates in mitochondrial fusion and contributes to the maintenance and operation of the mitochondrial network. In this report, we showed that an adenovirus vector encoding human HSG (Ad5-hHSG) had an antitumor activity in a wide range of cancer cell lines. We further focused on the lung cancer cell line A549 and the colon cancer cell line HT-29 and then observed that Ad5-hHSG induced apoptosis both in vitro and in vivo. Confocal laser scanning microscopy and electron microscopy revealed that cells infected with Ad5-hHSG formed dose-dependent perinuclear clusters of fused mitochondria. Adenovirus-mediated hHSG overexpression induced apoptosis, cell cycle arrest, mitochondrial membrane potential (DeltaPsim) reduction and release of cytochrome c, caspase-3 activation, and cleavage of PARP in vitro. Overexpression of hHSG also significantly suppressed the growth of subcutaneous tumors in nude mice both ex vivo and in vivo. In addition, Ad5-hHSG increased the sensitivity of these cell lines to two chemotherapeutic agents, VP16 and CHX, and radiation. These results suggest that Ad5-hHSG may serve as an effective therapeutic drug against tumors.     

作业流程重组在病区药物配送模式转变过程中的应用研究

目的探讨作业流程重组(Business Process Reengineering,BPR)在病区药物配送模式转变过程中的应用价值。方法采用作业流程重组中"系统性重新整合"(Systematic Redesign)的方法,对病区药物配送工作流程进行重组。将重组后住院患者药物配送时限作为研究观测指标,重组前同期住院患者药物配送时限作为对照指标,分别统计两组住院患者长期医嘱及临时医嘱药物平均每天配送时间,并进行比较。结果研究组住院患者长期医嘱及临时医嘱药物平均每天配送时间均较对照组缩短,差异均有极显著意义(u值分别为13.77、18.82,P均<0.01)。结论在确保医疗服务质量的前提下,对原有的一些不合理的药物配送流程进行重组,使作业流程简化,可明显缩短药物配送时间,对进一步提高护理质量及工作效率具有重大意义,值得临床推广应用。