Improved surgical exposure and early clinical outcomes using a femoral-release-first technique in direct anterior approach during total hip arthroplasty

BACKGROUND

Total hip arthroplasty (THA) performed using the direct anterior approach (DAA) has demonstrated favourable early-, mid-, and long-term outcomes. However, the traditional femoral release technique remains technically demanding and is associated with challenges and a heightened risk of complications. This study aimed to compare the clinical outcomes of patients who underwent THA with DAA performed using either the femoral-release-first (FRF) or the traditional approach (TA) strategy.

METHODS

A retrospective analysis of demographics, clinical and radiological outcomes, and occurrence of complications was performed using data from 106 patients between 2018 and 2019. The patients were categorised into two groups: FRF (44 hips) and TA (69 hips).

RESULTS

The FRF group showed a reduced operative time, haemoglobin (Hb) drop, postoperative hospital stay, and more optimal acetabular cup anteversion angles. Furthermore, during the first 2 months postoperatively, the FRF group demonstrated superior visual analogue scale, Harris Hip, and Oxford Hip scores. In the TA group, two hips experienced greater trochanter fractures, and one experienced delayed incision healing.

CONCLUSIONS

Compared with the TA, employing the FRF strategy during THA with DAA resulted in improved outcomes within the first 2 months postoperatively and comparable functional recovery beyond this period. The FRF method exhibited advantages such as favourable acetabular exposure and alignment and a reduced risk of complications. Therefore, the FRF strategy may be a favourable option.

Lipoprotein A, combined with alanine aminotransferase and aspartate aminotransferase, contributes to predicting the occurrence of NASH: a cross-sectional study

Background

Nonalcoholic steatohepatitis (NASH) progresses from simple nonalcoholic fatty liver (NAFL) and has a poor prognosis. Abnormal lipid metabolism is closely related to the occurrence and development of nonalcoholic fatty liver disease (NAFLD). This study aimed to study the relationships between serum lipid metabolites and NASH, and to improve the early diagnosis of NASH.

Methods

This study included 86 NAFLD patients (23 NASH and 63 NAFL), and 81 unaffected individuals as controls from West China Hospital between October 2018 and May 2019. With lipid metabolites as the focus of the study, the differences in lipid metabolites were compared between the control group, NAFL patients, and NASH patients. Logistic regression analysis was used to examine the risk factors of NASH. Finally, receiver operating characteristic curve (ROC curve) was used to analyze the efficacy of the metabolites in NASH prediction.

Results

The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lipoprotein A (LPA) increased with the severity of NAFLD. In NAFLD patients, LPA (OR:1.61; 95%CI: 1.03–2.52) was a potential risk factor for NASH, and ROC analysis showed that the combination of LPA, ALT, and AST had a greater predictive efficiency for NASH.

Conclusions

Abnormal apolipoprotein/lipoprotein is closely related to lipid metabolism disorder in patients with NAFLD. In NAFL, the combination of LPA, ALT, and AST contributes to predicting the occurrence of NASH. LPA may be a potential biomarker and therapeutic target for diagnosing and treating NASH.

[Interference of Exogenous Insulin on Insulin Detection Test by Electrochemiluminescence Immunoassay]

OBJECTIVE

To explore the interference of exogenous insulin therapy on insulin detection test by electrochemical luminescence immunoassay (ECLIA).

METHODS

Insulin level was determined by ECLIA. According to the requirements of EP7-A2 of American Society for Clinical Laboratory Standards Institute Standards, paired difference experiment was conducted to evaluate the interference of 8 kinds of exogenous insulin on insulin detection, dose effect experiment was conducted to determine the relationship between exogenous insulin concentration and interference degree.

RESULTS

When the interfering substance concentrations were ≤250 μU/mL, Gansulin N^Ⓡ, Gansulin R^Ⓡ, Humulin R^Ⓡ,Novolin R^Ⓡ and Lantus^Ⓡ all showed linear positive interference, while Levemir^Ⓡ showed a linear negative interference in high concentrations insulin and non-interfering in low concentrations insulin, Humalog^Ⓡ and Novo Rapid^Ⓡ showed non-interference in insulin detection.

CONCLUSIONS

The use of different exogenous insulin may have different interference on insulin measurement, which need laboratorians and physicians notice to avoid misdiagnosis.

[Bushen Jiedu Recipe Protected Radiation Induced Hematopoietic Injury]

Objective To observe the protective effects of Bushen Jiedu Recipe (BJR) on radia- tion induced hematopoietic injury. Methods C57BL/10J mice TLR4 gene (TLR4 +/+) and knockout mice (TLR4 -/-) were randomly divided into 3 groups, the blank control group, the radiation model group, the BJR group. Sampling was respectively performed at day 1 , 14, and 30 after radiation. The general condi- tion of mice was observed. White blood cell (WBC) , red blood cell ( RBC) , and platelet ( PLT) were counted in each group. Thigh bone of mice was collected for bone marrow specimen. Bone marrow slice was prepared. Pathomorphological changes were observed under electron microscope. Results Com- pared with the blank control group, WBC, RBC, and PLT all decreased or showed a decreasing tendency after one day radiation. RBC and PLT significantly decreased after 14 days of radiation (P <0. 01 , P < 0. 05). Counts of WBC and RBC were higher in the TLR4 +/+ BJR group than in the rest 2 groups (P < 0. 01 , P <0. 05). No statistical difference in RBC or PLT between mice after 30 days of radiation and mice in the blank control group (P >0. 05). PLT count in the TLR4 +/+ BJR group was most approximate to the normal value. WBC count obviously increased, but still with statistical difference as compared with the blank control group (P <0.01). WBC count recovered most rapidly in the TLR4 +/+ BJR group. Results under light microscope showed the structure of bone marrow was injured to different degrees in all mice except those in the TLR4 +/+ BJR group. Conclusion BJR could attenuate radiation induced hematopoi- etic injury possibly through TLR4 signal pathway, thus playing significant radioprotective roles.

[Evaluation of prevalent status of kala-azar in endemic area of Hubei Province]

OBJECTIVE

To identify the diagnosis of 14 cases with "kala-azar" previously reported in Hubei Province since 1989 and to evaluate the present status of the disease.

METHODS

Bone marrow smear, immunological test (LDTand IFAT), mouse inoculation, fungi culture, vector (Phlebotomus) and reservoir host (dog) survey.

RESULTS

Among the 14 cases, 12 cases were progressive disseminated histoplasmois, one was an imported case and another one was a remnant skin type "kala-azar" case. An immunological survey was conducted during 1997-1999 in 25 townships located in 23 counties of 9 prefectures and cities. A total of 13,890 persons had been examined by LDT, the positive rate was 0.07%, no positive case was found among the persons under 40 years of age. During the survey, 1,756 persons had been examined by IFAT, the results were negative. No Phlebotomus chinensis had been found in the surveyed area. A total of 302 dogs were examined, no sick dog had been found.

CONCLUSION

Kala-azar has been eradicated in Hubei Province.

Heparin and the phenotype of adult human vascular smooth muscle cells

To study mechanisms controlling growth and phenotype in human vascular smooth muscle cells, we established culture conditions under which these cells proliferate rapidly and achieve life-spans of 50-60 population doublings. In medium containing heparin and heparin-binding growth factors, growth rate and life-span of human vascular smooth muscle cells increased more than 50% relative to cultures with neither supplement, and more than 20% compared to cultures supplemented only with heparin-binding growth factors. In contrast to observations made in rat vascular smooth muscle cells, smooth muscle-specific alpha-actin in the human cells was expressed only in the presence of heparin and colocalized with beta/gamma nonmuscle actins in stress fibers, not in adhesion plaques. Heparin, in the presence of heparin-binding growth factors, also caused more than 170% stimulation of tracer glucosamine incorporation into hyaluronic acid and a 7.5-fold increase in hyaluronic acid accumulation. In comparison, total sulfate incorporation into sulfated glycosaminoglycans increased by less than 40%. In light of our previous findings that heparin suppresses collagen gene expression, we conclude that heparin induces human vascular smooth muscle cells exposed to heparin-binding growth factors to remodel their extracellular matrix by altering the relative rates of hyaluronic acid (HA) and collagen synthesis. The resulting hyaluronic-acid-rich, collagen-poor matrix may enhance infiltration of CD44/hyaluronate-receptor-bearing T-lymphocytes and monocytes into the vascular wall, an early event in atherogenesis.

[An epidemiological study on clonorchiasis sinensis in Hubei Province]

An epidemiological study on clonorchiasis sinensis was conducted in 62 counties and cities in Hubei Province during 1987-1991, and clonorchis sinensis was identified in 52 counties and cities. Human population studies showed there were patients with clonorchiasis sinensis in 29 of 31 counties and cities investigated, with infection rates of 0.1%-16.2%. There were five species in two families of freshwater spiral shells as first intermediate host of clonorchis sinensis, 31 species in seven families of freshwater fish (with five species of fish newly discovered) and one species of freshwater shrimp as second intermediate host, and six species as reservoir host. Studies revealed holding small fish in the mouth and eating undercooked roasted fish were two major modes of transmission for clonorchiasis sinensis in the province.

[An epidemiological survey of Clonorchiasis sinensis of 17 counties/cities of Hubei Province Research Institute for Parasitic Diseases]

An epidemiological survey was made on Clonorchiasis sinensis for the first time in 17 counties/cities of Hubei Province in 1988. The pathogen of clonorchiasis sinensis was found in 14 of the 17 counties/cities. Individual examination of some population was carried out and in 7 counties/cities, all the people were found to be infected. The infection rate was more than 10% in some of the places surveyed. Most of the cases were youngsters. The chief mode of infection was the habit of eating undercooked fish or holding fish in the mouth. These results showed that Clonorchiasis sinensis infection has been widespread in Hubei Province and in some areas the infection was serious attention should therefore be paid to its control without delay.

The frequency of late reversibility in SPECT thallium-201 stress-redistribution studies

The frequency of thallium-201 late reversibility was prospectively assessed in 118 patients who had stress-redistribution thallium-201 studies by single photon emission computed tomography (SPECT). These patients demonstrated two or more segments with nonreversible defects at 4 h imaging and underwent late (18 to 72 h) redistribution imaging. When the criterion of late reversibility was defined as greater than or equal to 1 segment with 4 h nonreversible defects demonstrating late reversibility, it was present in 62 (53%) of the 118 patients and 164 (22%) of 762 segments. When the criterion of greater than or equal to 2 segments was used, late reversibility was found in 41 (35%) of 118 patients and 143 (19%) of 762 segments. The frequency of detected reversible defects increased from 27% at 4 h imaging to 43% at combined 4 h and late imaging (p less than 0.0001) and was significantly increased in all myocardial regions. In comparing the efficacy of initial and late imaging alone versus performing initial, 4 h and late imaging for the identification of reversible defects, 421 (94%) of 449 segments classified as reversible by the latter protocol were also correctly identified by the early and late imaging only approach, with the remaining 6% (28 segments) comprising those segments demonstrating the reversible pattern at 4 h and the nonreversible pattern at late imaging. No major differences were noted with respect to clinical, stress electrocardiographic and scintigraphic variables between the 118 patients undergoing late imaging and 98 additional randomly selected patients with two or more nonreversible defects at 4 h, who did not have late imaging.(ABSTRACT TRUNCATED AT 250 WORDS)