The Results of Total Hip Arthroplasty After Sugioka Transtrochanteric Anterior Rotational Osteotomy for Osteonecrosis

Background

Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.

Molecular approaches for forensic cell type identification: On mRNA,miRNA, DNA methylation and microbial markers

Human biological traces have the potential to present strong evidence for placing a suspect at a crime scene. In cases, the activity that led to deposition of an individual's cellular material is increasingly disputed, for which the identification of cell types could be crucial. This review aims to give an overview of the possibilities of the employment of mRNA, miRNA, DNA methylation and microbial markers for tissue identification in a forensic context. The biological background that renders these markers tissue-specificity is considered, as this can affect data interpretation. Furthermore, the forensic relevance of inferring certain cell types is discussed, as are the various methodologies that can be applied. Forensic stains can carry minute amounts of cell material that may be degraded or polluted and most likely cell material of multiple sources will be present. The interpretational challenges that are imposed by this compromised state will be discussed as well.     

Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery

BackgroundHip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA.MethodsPatients aged 60 years or more undergoing conversion THA within one year following intertrochanteric or femoral neck fracture were identified and propensity-matched to patients sustaining hip fractures treated surgically but not requiring conversion within the first year. Patients who had two-year follow-up (91 conversions; 247 comparisons) were analyzed for 6-month, 12-month, and 24-month mortalities, 90-day readmissions, surgical complications, and medical complications.ResultsNonunion and screw cutout were the most common indications for conversion THA. Mortalities were similar between groups at 6 months (7.7% conversion versus 6.1% nonconversion, P = .774), 12 months (11% conversion versus 12% nonconversion, P = .999), and 24 months (14% conversion versus 22% nonconversion, P = .163). Survivorships were similar between groups for the entire cohort and by fracture type. Conversion THA had a higher rate of 90-day readmissions (14% versus 3.2%, P = .001), and medical complications (17% versus 6.1%, P = .006). Inpatient and 90-day orthopaedic complications were similar.ConclusionConversion THA for failed hip fracture surgery had comparable mortality rates to hip fracture surgery, with higher rates of perioperative medical complications and readmissions. Conversion THA following hip fracture represents a potential “second hit” that both surgeons and patients should be aware of with initial decision-making.     

Factors for conversion in laparoscopic cholecystectomy for acute cholecystitis: Is timing important?

Aim: Laparoscopic cholecystectomy is regarded as the gold standard treatment for gallstones. Conversion to open cholecystectomy is still common, and preoperative factors to predict conversion are useful in clinical practice. The aim of this study was to evaluate preoperative factors that could predict conversion in acute cholecystitis. Methods: This is a retrospective review of 83 patients with a diagnosis of acute cholecystitis who had laparoscopic cholecystectomy carried out as an emergency operation. Clinical, biochemical, and operative factors were analyzed for association with conversion. Results: A total of 83 patients were recruited to this study. The overall conversion rate was 33.7% (28/83). A longer duration of symptoms before presentation (P = 0.005) and surgery that was carried out over 48 h after admission (P = 0.022) were associated with a higher conversion rate. Emergency operations that began between 20.00 hours and 08.00 hours were also associated with a higher rate of conversion (P = 0.003). Other factors that were associated with conversion included male sex (P = 0.004), low albumin level upon admission (P = 0.024), prolonged prothrombin time (P = 0.040), and a raised serum total bilirubin level (P = 0.024). ASA scores were found to be similar in both groups (P = 0.509). Multivariate analysis by logistic regression showed that the independent risk factors for conversion in emergency laparoscopic cholecystectomy were surgery >48 h after admission (P = 0.028), emergency operation started between 20.00 hours and 08.00 hours (P = 0.026), and longer duration of symptoms before presentation (P = 0.034). Conclusions: Laparoscopic cholecystectomy should be carried out within 48 h of the patient being admitted for acute cholecystitis. The operation should be carried out during the daytime.     

白色念珠菌对五种抗真菌药物体外敏感性研究

目的了解白色念珠菌对常用抗真菌药物的敏感性情况,为临床正确选择抗真菌药物和有效控制该菌引起的感染提供依据。方法采用美国国家临床实验标准委员会(NCCLS)推荐的微量肉汤稀释法,测定从临床标本中分离的102株白色念珠菌对五种抗真菌药的最低抑菌浓度(MIC)。结果酮康唑、氟胞嘧啶和伊曲康唑对102株白色念珠菌MIC较低,其MIC90分别为0.25μg/ml、0.5μg/ml和0.5μg/ml。两性霉素B和氟康唑MIC90分别为2μg/ml和8μg/ml。受试菌对氟胞嘧啶敏感率最高为100%,对氟康唑和伊曲康唑的敏感率分别为88.3%和75.5%。对氟康唑耐药的9株菌株也同时对伊曲康唑耐药。结论受试白色念珠菌对氟胞嘧啶敏感率最高,未发现耐药菌株;酮康唑对受试菌抗菌活性最强,对唑类药物存在耐药性,且该类药物之间存在交叉耐药。     

（＋）—伪麻黄碱向（—）—麻黄碱的转化

目的：研究用“一步法”由（＋）－伪麻黄碱向（－）－麻黄碱的转化 。方法：加入等摩尔量的乙肝作催进剂,以冰醋酸为溶剂,回流反应１．５－４h。结果：（＋）－的麻黄碱以８０％－８５％的产率转化为（－）－麻黄碱。结论 本方法步骤少,操作简单,时间短,转化率高,后处理简便,成本低,易于工业在生产,具有良好的经济效益和社会效益。     

腹腔镜胆囊切除术中转开腹30例临床分析

目的:探讨腹腔镜胆囊切除术中转开腹原因。方法:回顾分析1102例腹腔镜胆囊切除术的临床资料。结果:腹腔镜胆囊切除术成功率97.3%,中转开腹30例,占2.7%,其中胆囊急性化脓性炎症及胆囊萎缩致Calot三角解剖不清22例,出血4例,胆管损伤2例,胆囊癌2例。结论:腹腔镜胆囊切除术中转开腹原因依次为Calot三角解剖不清、出血、胆管损伤、胆囊癌。严格腹腔镜手术程序可降低严重并发症发生率。     

复方地塞米松乳膏微生物限度检查方法的验证试验

[目的]建立复方地塞米松乳膏微生物限度检查法，并对方法进行验证。[方法]采用《中国药典》2005年版二部附录微生物限度包含的方法对复方地塞米松乳膏进行方法验证，通过比较回收率来确定适宜的检查方法。[结果]复方地塞米松乳膏微生物限度细菌检查可采用常规法，霉菌和酵母菌检查宜采用薄膜过滤法。[结论]该方法有效可行，可用于该品种的微生物限度检查。     

前列地尔联合复方鳖甲软肝片治疗慢性乙型肝炎肝硬化的疗效观察

目的探讨复方鳖甲软肝片联合前列地尔治疗慢性乙型肝炎肝硬化的临床疗效。方法选取2013年4月—2016年6月在雅安市人民医院接受治疗的126例慢性乙型肝炎肝硬化患者作为研究对象,随机分为对照组和治疗组,两组各63例。对照组患者口服复方鳖甲软肝片,4片/次,3次/d;治疗组患者在对照组的基础上静脉注射前列地尔注射液,5μg加入到10mL生理盐水中,1次/d。两组患者均治疗6周。观察两组的乙肝病毒的脱氧核糖核酸(HBV-DNA)转阴率、乙肝E抗原(HBeAg)转阴率及HBeAg转换率,比较治疗前后两组患者的Child-Pugh评分、肝功能指标以及肝纤维化指标的变化。结果治疗组的HBV-DNA转阴率、HBeAg转阴率和HBeAg转换率分别为77.8%、54.0%、44.4%,均显著高于对照组的55.6%、30.2%、27.0%,两组比较差异具有统计学意义(P0.05);两组患者的Child-Pugh评分均降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组的Child-Pugh评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的丙氨酸氨基转移酶(ALT)和总胆红素(TBIL)显著降低,凝血酶原活动度(PTA)升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组的肝功能指标明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、IV型胶原(Ⅳ-C)、层黏连蛋白(LN)均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组的肝纤维化指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论复方鳖甲软肝片联合前列地尔治疗慢性乙型肝炎肝硬化疗效显著,可有效改善肝功能和肝纤维化,具有一定的临床推广应用价值。     

原人参二醇类皂苷(PPD)在酶反应中转化动态及其产物稀有皂苷的制备

目的为了生物转化低成本制备人参稀有皂苷,利用Aspergillus g.848菌的粗酶与市售的原人参二醇类皂苷(PPD)混合皂苷反应,制备人参稀有皂苷C-K、C-Mc、F_2单体和4种异构体的Rh2组皂苷。方法酶与PPD皂苷反应,生成稀有皂苷;用HPLC法测定PPD皂苷原料和产物皂苷的组成,用硅胶柱法分离产物中的单体皂苷,用NMR法确认产物单体皂苷结构;用UPLC-MS法确认产物Rh2组。结果原料PPD中含有人参皂苷Rb_1、Rd、Rb_2、Rc和4种异构体的人参皂苷Rg3组;酶反应时,若生产以F_2为主的皂苷时,最佳反应时间为1.5~2.0h;若生产以C-K为主的皂苷时,反应时间为24.0~30.0h;若生产以Rh2组为主的皂苷时,反应6.0~12.0h时,Rg_3组产量低而Rh_2组产量高。以C-K为主的皂苷生产中,从30 g的PPD皂苷酶反应得到20 g产物,经硅胶柱分离,得到8.16 g的C-K、1.01 g的C-Mc、0.45 g的F_2单体和0.19 g的Rh_2组皂苷,并以NMR和UPLC-MS法核对了其结构。结论 PPD皂苷经酶转化成功地制备了高活性C-K、C-Mc、F_2和Rh_2组皂苷。