病毒性肝炎患者血清总胆汁酸测定及临床意义

目的 探讨血清总胆汁酸（TBA）测定在病毒性肝炎诊断中的价值。方法 用酶比色法对213例病毒性肝炎患及30例正常对照进行测定，并对结果进行统计处理。结果 正常对照组TBA为11.11±3.64umol/L。病毒性肝炎组急性期（或活动期）的TBA与正常对照组相比差异均有显（P＜0.01）各组中急性期（或活动）与恢复期相比差异亦具有显性（P＜0.01），在恢复期组中，慢性肝炎中度及肝硬变组与急性黄疸期比较差异具有显性（P＜0.05）。结论 血清TBA的含量与肝病的病变相关，对肝炎的诊断，预后判断及辅助鉴别诊断具有一定的价值。     

Low Mediterranean Diet scores are associated with reduced kidney function and health related quality of life but not other markers of cardiovascular risk in adults with diabetes and chronic kidney disease

Background and aimsHow Mediterranean-style diets impact cardiovascular and health outcomes in patients with diabetes and chronic kidney disease (CKD) is not well known. Our aim was to investigate the association between diet quality, using Mediterranean Diet Scores (MDS) and health outcomes.Methods and resultsThis is a post-hoc analysis of an RCT and longitudinal study investigating patients with diabetes and CKD. MDS was calculated annually. Scores were analyzed for correlation with lipids, HbA_1c, serum potassium, health-related quality of life (HRQOL) and depression. 178 diet records from 50 patients who attended two or more visits were included. Mean MDS was moderate (4.1 ± 1.6) and stable over time. Stage 1–2 vs 3–5 CKD had lower raw MDS (3.8 ± 1.5 vs 4.6 ± 1.5, p < 0.001). Having hyperkalemia was associated with a lower raw MDS scores (3.6 ± 1.6 vs 4.2 ± 1.5, p = 0.03) but not energy adjusted MDS. MDS was not associated with HbA_1c or lipids. High vs low MDS was associated with improved HRQOL (mental health 84.4 ± 14.3 vs 80.3 ± 17.1, p < 0.05; general health 62.6 ± 21.0 vs 56.3 ± 19.8, p < 0.001) and fewer depressive symptoms (9.1 ± 7.4 vs 11.7 ± 10.6, p = 0.01).ConclusionsLow MDS was associated with reduced kidney function and health related quality of life, but not other markers of cardiovascular risk. Further studies are needed to understand the nature and direction of the association between diet quality and disease outcomes in this population.     

Method for Simultaneous Determination of Free Concentration,Total Concentration,and Plasma Binding Capacity in Clinical Samples

Most quantitative research methods are based on measuring either the total or the free concentration of an analyte in a sample. However, this is often insufficient for the study of complex biological systems. The main objective of this research was to develop new methods for providing more information from samples: the free concentration (C_f), the total concentration (C_t), and the plasma binding capacity (PBC). Samples were processed using microextraction and ultrafiltration. For each of these techniques, two quantification procedures were used: addition of isotopically labeled standard and repeated analysis of the same sample. The new methods were validated by analyzing clinical samples and samples with known concentrations. Methods based on addition of labeled compound were found to be the fastest, and most reproducible. For analysis of clinical samples, methods based on microextraction were more sensitive and more accurate than those based on ultrafiltration. For analysis of pooled plasma samples, the overall accuracy of all approaches to determine PBC, testosterone C_f, and testosterone C_t was between 94 and 109%, 87–113%, and 94–122% respectively. The new approach goes beyond a simple concentration measurement, giving more information from clinical samples, with great potential for personalizing drug dosage and therapy to the needs of individual patients.     

Six year results of the Rebalance mobile bearing total ankle replacement

BackgroundWe report the outcomes of a prospective consecutive series of 267 total ankle replacements (TARs) using a new mobile bearing Rebalance® prosthesis.MethodsBetween April 2011 and December 2018, 267 consecutive Rebalance® prostheses were implanted in 255 patients at 3 different centers. Estimated survival curves with 95% confidence intervals were produced with the Kaplan–Meier method. 110 ankles were followed for at least 5 years and clinical and radiological outcomes were assessed in 92 of these ankles.ResultsTwenty-one ankles were revised at a mean of 34 (7–60) months. The estimated survival was 90% (95% CI 86–95) at 5 years and 88.3% (95% CI 83.–94 at 6 years. The ankles followed for at least 5 years demonstrated a median Likert score of 1 (1–4). Radiolucent zones were detected in 14% and osteolytic cysts in 3%.ConclusionThe survival rate of the Rebalance prosthesis conforms with other reports of similar designs. The satisfaction rate was high. Radiological zones and osteolytic cysts were found at a lower rate than usually reported for mobile bearing TARs. These results favour further use of this implant.     

Desmethyl Macrolide Analogues to Address Antibiotic Resistance: Total Synthesis and Biological Evaluation of 4,8,10-Tridesmethyl Telithromycin

There is an urgent need to discover new drugs to address the pressing problem of antibiotic-resistance. Macrolide antibiotics such as erythromycin (1) are safe, broad-spectrum antibiotics used in the clinic since 1954. Herein we report the synthesis and evaluation of 4,8,10-tridesmethyl telithromycin (3), a novel desmethyl analogue of the 3rd-generation drug telithromycin (2), which is a semisynthetic derivative of 1. Analogue 3 was found to possess antibiotic activity and was superior to telithromycin (2) when tested against resistant strains of S. aureus possessing an A→T mutation at position 2058 (E. coli numbering).     

Patello-femoral joint in total knee replacement

Total knee arthroplasty (TKA) surgery is a widely used treatment and has a high success rate. Despite its success, the patello-femoral articulation has been overlooked as a contributor to the successful outcome of TKA. Patello-femoral complications remain the leading cause of failed knee replacement, accounting for up to 10% of complications. To understand the concept of patellar mal-tracking, we explore the normal anatomy and biomechanics of the patello-femoral articulation, and review the surgical factors and complications related to patellar tracking, with an aim to discussing the concepts on how to avoid such complications. Surgeons should be aware of the frequent occurrence of abnormal patellar tracking, and should pay particular attention to the patello-femoral component of knee replacement surgery.     

(iii) Wear in highly crosslinked polyethylenes

Because of its improved wear-resistance, crosslinked polyethylene is now regarded as a desirable technology for hip articulations. In the present review, we focus specifically on applications of crosslinked polyethylene in the hip. We begin with an overview of the basic science concepts and terminology surrounding crosslinked polyethylene and the two main thermal processing techniques, which involve either annealing or remelting the polymer after irradiative crosslinking. The second part of the review is a critical assessment of the peer-reviewed literature on the subject of femoral head penetration and wear in crosslinked polyethylenes measured in clinical studies.