Safety and Efficacy of 4 mg·kg⁻¹ Sugammadex for Simultaneous Pancreas-Kidney Transplantation Recipients: A Prospective Randomized Trial.

BACKGROUND Simultaneous pancreas-kidney transplantation (SPK) is a time-consuming and important surgical procedure, which can provide a physiological mean of achieving normoglycemia and render patients free of dialysis. The potential clinical benefits of sugammadex include fast and predictable reverse deep neuromuscular blockade (NMB), but whether sugammadex affects the function of SPK grafts is uncertain. MATERIAL AND METHODS Forty-eight patients were studied and reversed deep NMB with either sugammadex (n=24) or neostigmine (n=24). The safety variables included serum creatinine (Scr), creatinine clearance rate (CCr), serum amylase (AMS), blood glucose (Glu), mean arterial pressure (MAP), and heart rate (HR). Secondary outcomes were time from administration of sugammadex/neostigmine at the scheduled time to recovery of a TOF ratio to 0.7 and 0.9, and post-acute pulmonary complications. RESULTS Scr at T2-6 was significantly lower than that at T0-1 (P<0.01), while CCr was higher (P<0.05). Between the 2 groups, Scr, CCr, and AMS were similar at the same timepoints (P>0.05). MAP, HR, and Glu were higher in group S than in group N at T1 (P<0.05). The recovery time of TOF=0.7 was 3 (2.4-4.2) min for group S and 12.1 (10.2-15.9) min for group N (P<0.001), and recovery time to TOFr ≥0.9 was 4.8 (3.6-7.1) min for group S and 23.5 (19.8-30.8) in group S. Compared to group N, group S had lower risk for post-acute pulmonary complications: supplemental oxygen requirements 0 vs 4 (16.7%), pulmonary atelectasis 0 vs 2 (0.83%), pneumonia 1 (4.2%) vs 3 (12.5%), and hypoxemia 1 (4.2%) vs 4 (16.7%). CONCLUSIONS Sugammadex administration is safe and effective for SPK transplantation recipients.

Polydopamine and hyaluronic acid immobilisation on vancomycin-loaded titanium nanotube for prophylaxis of implant infections.

Titanium nanotube (Ti-NT) is an attractive substrate for local drug delivery, however, it is difficult to control the burst drug release and achieve sustained release from these nanotubes. In the present study, we investigated the feasibility of controlling drug release from Ti-NT within polydopamine and hyaluronic acid films, to achieve antibacterial activity and osteogenic promotion. Vancomycin was loaded into the Ti-NT by lyophilisation. Dopamine and hyaluronic acid were immobilized on the vancomycin-loaded Ti-NT surface through alternate deposition technique. The anti-infective and osteogenic abilities of the polydopamine and hyaluronic acid-modified Ti-NT were then investigated. Our results demonstrated that polydopamine and hyaluronic acid-modified Ti-NT exhibited improved drug loading and release control for 7 days. Compared with the vancomycin-loaded Ti-NT, the polydopamine and hyaluronic acid-modified Ti-NT exhibited better antibacterial ability, and the hyaluronic acid-modified Ti-NT promoted the osteogenic differentiation of rat bone marrow stem cells. Our results demonstrated that Ti-NT biofunctionalized with polydopamine and hyaluronic acid can help overcome the limitations of Ti-NT, by improving drug loading, antibacterial activity and osteogenic ability.

Risk factors for and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures.

OBJECTIVE: To investigate the related risk factors and predictive nomogram of postoperative hypoxaemia in elderly patients with femoral neck fractures. METHODS: This study included patients aged ≥65 years who underwent surgical treatment of acute femoral neck fractures. Univariate and multivariate logistic analyses were performed to determine the incidence of and risk factors for postoperative hypoxaemia. A predictive nomogram was constructed based on the multivariable model. Using the bootstrap method, discrimination was determined by the C-index and calibration plot. RESULTS: The logistic regression analysis showed that the anaesthesia type, surgical procedure, American Society of Anesthesiologists (ASA) classification, preoperative hypoxaemia occurrence, and age were independent predictors of development of postoperative hypoxaemia. The predictive formula for hypoxaemia was established as follows: hypoxaemia=-0.8668×spinal anaesthesia (whether)+0.1162×nerve anaesthesia (whether)+1.9555×plate/screw fixation (whether)+1.4950×hip replacement (whether)+0.4883×ASA classification+1.7153×preoperative oxygenation index+0.1608×age. With the bootstrap method, the prediction curve fit well with the ideal curve, suggesting that the prediction curve constructed in this study has good predictive ability. CONCLUSIONS: Anaesthesia type, surgical procedure, ASA classification, preoperative hypoxaemia occurrence, and age were risk factors for postoperative hypoxaemia in elderly patients with femoral neck fractures. The predictive nomogram was designed for preoperative assessment of the risk of postoperative hypoxaemia by calculating the risk score.

Hidden blood loss after hip hemiarthroplasty using the superPATH approach: A retrospective study.

OBJECTIVE: The purpose of this study was to compare perioperative hidden blood loss after hip hemiarthroplasty via the SuperPATH approach and the conventional posterior approach (the Moore approach). PATIENTS AND METHODS: From January 2015 to January 2017, 130 patients (80.7 ±â€¯6.0 years) with displaced femoral neck fracture (Garden type III or IV) undergoing hip hemiarthroplasty were included in this study. As a non-randomisation study, Fifty-two patients (SuperPATH group) were operated using the SuperPATH approach, and 78 patients (Moore group) were operated with the conventional posterior approach (Moore approach). The demographic and relevant clinical information of the patients were collected. According to the combination formulas of Nadler, Gross and Sehat, the hidden blood loss (HBL) of each patient was calculated. Student's t-test for independent samples was used to compare the normally distributed variables and the Mann-Whitney U test was used to compare variables not following a normal distribution. RESULTS: The visible blood loss (VBL) in the SuperPATH group was 123.7 ±â€¯47.5 ml, the hidden blood loss (HBL) was 1084.1 ±â€¯816.8 ml and the HBL% was 82.7 ±â€¯16.5%. In the Moore group, the VBL was 303.6 ±â€¯139.6 ml, the HBL was 700.2 ±â€¯563.8 ml and the HBL% was 61.5 ±â€¯23.8%. The patients in the SuperPATH group had more HBL and HBL% (P < 0.05). However, no significant difference was observed of total blood loss (TBL) between the two groups (P = 0.125). CONCLUSIONS: HBL should not be ignored in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures, as it is a significant portion of TBL. Compared with the conventional approach, the SuperPATH approach had a greater amount of HBL. A better understanding of HBL after hip hemiarthroplasty may help surgeons improve clinical assessment and ensure patient safety.

Forsythiaside inhibited titanium particle-induced inflammation via the NF-κB signaling pathway and RANKL-induced osteoclastogenesis and titanium particle-induced periprosthetic osteolysis via JNK, p38, and ERK signaling pathways.

Wear particle-induced periprosthetic osteolysis is the primary complication of the total joint replacement; however, no conservative treatment except for reversal surgery is available for this disease. During the past decade, Chinese herbal medicines have been widely investigated to inhibit osteoclast differentiation, which may exhibit the potential to treat wear particle-induced periprosthetic osteolysis. The present study was aimed at the investigation of the effects of forsythiaside on osteocytes. The current data revealed that the forsythiaside treatment notably inhibited the titanium (Ti) particle-induced inflammation through impaired NF-κB signaling, thereby inhibiting TNF-α and IL-1ß. In addition, the in vitro study demonstrated that forsythiaside effectively prevented the RANKL-induced differentiation of osteoclasts and inhibited the expression of osteoclast-specific genes in osteoclasts via inhibition of the JNK signaling pathway. The in vivo study of Ti particle-induced implant-associated osteolysis indicated that forsythiaside could also inhibit osteoclastogenesis. In summary, forsythiaside could inhibit osteoclastogenesis and particle-induced inflammation, resulting in decreased secretion of inflammatory cytokines such as TNF-α and IL-1ß. On the other hand, forsythiaside could inhibit RANKL-induced osteoclastogenesis and Ti particle-induced periprosthetic osteolysis via JNK, ERK and p38 signaling pathways. Both the abovementioned biofunctions of forsythiaside contributed to the implant-associated particle-induced osteolysis. Thus, forsythiaside can act as a candidate drug for the precaution of implant-associated particle-induced osteolysis.

[Establishment of loop-mediated isothermal amplification (LAMP) for detecting Pneumocystis carinii].

Animal model of Pneumocystis carinii pneumonia (PCP) was established for acquiring lung tissue infected with P. carinii. After DNA from rat lungs was extracted, nuclear ribosome small subunit 18s rDNA of P. carinii was amplified by loop-mediated isothermal amplification method at 63 degrees C for 60 min. The product was digested by restriction enzyme Apal I. The results showed that 18s ribosome DNA (rDNA) of P. carinii was cloned into vector pGEX6p2, and the positive clones screened. Therefore, the loop-mediated isothermal amplification has been established for detecting P. carinii.