Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty.

BACKGROUND: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. METHODS: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. RESULTS: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. CONCLUSIONS: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

The Effect of the AcrySof natural lens on glare disability and photostress.

PURPOSE: To investigate whether implanting "blue-filtering" yellow intraocular lenses (IOL) could provide a visual benefit in terms of glare disability and photostress recovery. DESIGN: A case-control study. METHODS: Researchers masked to group assignments tested 58 subjects: 17 with yellow IOLs (AcrySof Natural; SN60WF; Alcon Laboratories Inc, Fort Worth, Texas, USA), 20 with clear IOLs, and 21 phakic controls. Photostress recovery and visual acuity under veiling glare conditions were assessed in a Maxwellian view optical system. Photostress recovery was assessed by measuring the time required to detect a grating stimulus (1 degree diameter) after a 5-second exposure to an intense circular disk (1 degree diameter) of broad-band xenon light. For the veiling glare experiment, subjects fixated on the grating stimulus, and the intensity of a broad-band xenon annulus (the glare source, 10 degrees inner, 12 degrees outer diameter) was adjusted until the grating stimulus was no longer seen. RESULTS: Subjects with AcrySof Natural (P < .0001) and clear IOLs (P < .035) could withstand significantly more light than the phakic controls. Subjects with the AcrySof Natural lens could withstand significantly more light (P < .02) than subjects with clear IOLs. Photostress recovery was significantly longer for subjects with clear IOLs vs phakic controls (P < .01), but the AcrySof Natural lens was not different from phakic controls (P < .09). Photostress recovery was similar between subjects with clear or AcrySof Natural lens (P < .32). CONCLUSION: The AcrySof Natural lens is related to reduced glare disability relative to a clear IOL or phakic controls.

SEMAPHORE1 functions during the regulation of ancestrally duplicated knox genes and polar auxin transport in maize.

The expression of class 1 knotted1-like homeobox (knox) genes affects numerous plant developmental processes, including cell-fate acquisition, lateral organ initiation, and maintenance of shoot apical meristems. The SEMAPHORE1 gene product is required for the negative regulation of a subset of maize knox genes, the duplicated loci rough sheath 1 and gnarley1 (knox4). Recessive mutations in semaphore1 result in the ectopic expression of knox genes in leaf and endosperm tissue. Genetic analyses suggest that SEMAPHORE1 may regulate knox gene expression in a different developmental pathway than ROUGH SHEATH2, the first-identified regulator of knox gene expression in maize. Mutations at semaphore1 are pleiotropic, disrupting specific domains of the shoot. However, unlike previously described mutations that cause ectopic knox gene expression, semaphore1 mutations affect development of the embryo, endosperm, lateral roots, and pollen. Moreover, polar transport of the phytohormone auxin is significantly reduced in semaphore1 mutant shoots. The data suggest that many of the pleiotropic semaphore1 phenotypes result from defective polar auxin transport (PAT) in sem1 mutant shoots, and support models correlating down-regulated knox gene expression and PAT in maize shoots.