Two-incision technique for minimally invasive total hip arthroplasty

Recently, there has been considerable interest and debate over the application of minimally invasive surgical approaches to primary total hip arthroplasty. The 2-incision technique employs intermuscular and internervous planes to gain access to the hip joint while minimizing the disruption of muscles and tendons. Through the anterior incision, the femoral neck is osteotomized and the head removed, followed by preparation and cementless reconstruction of the acetabulum. The posterior incision permits femoral preparation and reconstruction with a cementless stem. The potential benefits of this technique include decreased perioperative blood loss and pain, more rapid recovery of hip function and return to normal activity, a reduced length of hospital stay, and cosmetically appealing small scars. Other essential considerations include appropriate patient selection, adherence to surgical principles, and familiarity with specialized instruments and implants.     

Acute kidney injury, mortality, length of stay, and costs in hospitalized patients

The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.     

Identification of a unique transgenic mouse line that develops megabladder, obstructive uropathy, and renal dysfunction

Urinary tract malformations, obstructive uropathy, and hypoplasia/dysplasia are extremely important in terms of pediatric health care costs, with end-stage renal failure in children estimated to cost >$15 billion annually in the United States alone. Even so, little is known regarding the mechanisms that control these processes. Identified was a unique mutant mouse model that develops in utero megabladder, resulting in variable hydroureteronephrosis and chronic renal failure secondary to obstructive uropathy. These animals, designated mgb for megabladder, possess a primary defect in bladder smooth muscle development that is apparent by embryonic day 15. The mgb mouse represents an excellent model for the study of normal and pathogenic bladder development, including the postnatal progression of chronic renal failure that results from the development of in utero obstructive uropathy.     

A comparison of tenocytes and mesenchymal stem cells for use in flexor tendon tissue engineering

PURPOSE: Tissue-engineered tendon grafts will meet an important clinical need. To engineer tendons, we used acellularized allogeneic tendon as scaffold material. To determine the ideal cell type to seed the scaffolds, we studied in vitro characteristics of epitenon tenocytes, tendon sheath fibroblasts, bone marrow-derived mesenchymal stem cells (BMSCs), and adipoderived mesenchymal stem cells (ASCs). Subsequently, we implanted reseeded acellularized tendons in vivo as flexor tendon grafts. METHODS: Tenocytes, sheath fibroblasts, BMSCs, and ASCs were obtained from adult rabbits. For all cell lines, collagen 1, 2, and 3 immunocytochemistry was performed, and proliferation was assessed by hemacytometry and senescence by beta-galactosidase staining. Flexor tendons were acellularized after harvest. Tendons were assessed by histology after in vitro reseeding with each of the cell types after 1, 4, and 8 weeks. Finally, reseeded tendons and controls were implanted in a flexor profundus tendon defect. After 6 weeks, the reseeded tendons were harvested and assessed by histology. Statistical analysis for cell proliferation was performed using analysis of variance and t-tests with Bonferroni correction. RESULTS: All cell types had similar collagen expression. Cell proliferation was higher in ASCs in late passage compared with early passage and in ASCs compared with epitenon tenocytes at late passage. The other cell types were similar in growth characteristics. No senescence was detected. In vitro assessment of reseeded constructs showed the presence of cells on the construct surface. In vivo assessment after implantation showed viable cells seen within the tendon architecture in all cell types. CONCLUSIONS: This study suggests that the four cell types may be successfully used to engineer tendons. Adipoderived mesenchymal stem cells proliferate faster in cell culture, but the cell types were similar in other respects. All could be used to successfully repopulate acellularized tendon in vivo as flexor tendon grafts.     

Radiofrequency thermal ablation of a splenic metastasis

Effective local ablation of large tumors with radiofrequency has been made possible by recent advancements. Tumor ablation with radiofrequency has been described mainly in the liver, but also recently in the kidney, adrenal gland, lung, and breast. A rapidly growing splenic metastasis from renal cell carcinoma was effectively treated percutaneously, with US guidance. Focal splenic disease may not be a common indication for ablation; however, further work is necessary to evaluate the safety and efficacy of this procedure in this setting.     

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目的 报告成功实施腹腔镜迷你胃旁路术治疗单纯性肥胖并2型糖尿病病人1例。方法 第二军医大学附属长海医院微创外科于2007年11月对1例伴有2型糖尿病的单纯性肥胖症病人行腹腔镜迷你胃旁路术。结果 病人手术顺利，手术时间135min，术中出血20mL。术后30d内无手术并发症，随访30d，体重下降15kg，体重指数（BMI）减少4．9。术后第8天停用一切降糖药物，各项糖尿病检查指标均正常。结论 腹腔镜迷你胃旁路术是相对安全、简单的术式，近期减重效果良好，对2型糖尿病具有很好的治疗效果。     

Electronic textbooks as a professional resource after dental school

In two previous studies of dental students' attitudes about the VitalSource Bookshelf, a digital library of dental textbooks, students expressed negative opinions about owning and reading electronic textbooks. With the assumption that dentists would find the digital textbooks useful for patient care, the authors surveyed recent graduates to determine if their attitude toward the VitalSource Bookshelf had changed. A brief survey was sent to 119 alumni from the classes of 2009 and 2010 of one U.S. dental school. Forty-seven (39.5 percent) completed the questionnaire. Eighteen respondents (48.3 percent) reported using the e-textbooks often or sometimes. The twenty-nine dentists who said they have not used the collection since graduation reported preferring print books or other online sources or having technical problems when downloading the books to a new computer. Only five respondents selected the VitalSource Bookshelf as a preferred source of professional information. Most of the respondents reported preferring to consult colleagues (37.8 percent), the Internet (20 percent), or hardcopy books (17.8 percent) for information. When asked in an open-ended question to state their opinion of the Bookshelf, nineteen (42.2 percent) responded positively, but almost one-third of these only liked the search feature. Six respondents reported that they never use the program. Twenty-two said they have had technical problems with the Bookshelf, including fifteen who have not been able to install it on a new computer. Many of them said they have not followed up with either the dental school or VitalSource support services to overcome this problem. Our study suggests that dentists, similar to dental students, dislike reading electronic textbooks, even with the advantage of searching a topic across more than sixty dental titles.