Genetic modification of acetogens and optimization of fermentation process in C1-gas bioconversion / 生物工程学报

The current linear economy model relies on fossil energy and increases CO2 emissions, which contributes to global warming and environmental pollution. Therefore, there is an urgent need to develop and deploy technologies for carbon capture and utilization to establish a circular economy. The use of acetogens for C1-gas (CO and CO2) conversion is a promising technology due to high metabolic flexibility, product selectivity, and diversity of the products including chemicals and fuels. This review focuses on the physiological and metabolic mechanisms, genetic and metabolic engineering modifications, fermentation process optimization, and carbon atom economy in the process of C1-gas conversion by acetogens, with the aim to facilitate the industrial scale-up and carbon negative production through acetogen gas fermentation.

Expression of miR-106b-5p in children with primary immune thrombocytopenia and its correlation with T cells / 中国当代儿科杂志

OBJECTIVES@#To study the expression level of plasma miR-106b-5p in primary immune thrombocytopenia (ITP) and its correlation with the levels of T helper 17 cell (Th17) and regulatory T cell (Treg) and the Th17/Treg ratio.@*METHODS@#A total of 79 children with ITP (ITP group) and 40 healthy children (control group) were selected as subjects. According to the treatment response, the 79 children with ITP were divided into three groups: complete response (n=40), partial response (n=18), and non-response (n=21). Quantitative real-time PCR was used to measure the expression level of miR-106b-5p. Flow cytometry was used to measure the frequencies of Th17 and Treg, and the Th17/Treg ratio was calculated. The correlation of the expression level of plasma miR-106b-5p with the frequencies of Th17 and Treg and the Th17/Treg ratio was analyzed.@*RESULTS@#Compared with the control group, the ITP group had significantly higher levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significantly lower level of Treg (P<0.05). After treatment, the ITP group had significant reductions in the levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significant increase in the level of Treg (P<0.05). Compared with the partial response and non-response groups, the complete response group had significantly lower levels of miR-106b-5p, Th17, and Th17/Treg ratio (P<0.05) and a significantly higher level of Treg (P<0.05). The correlation analysis showed that in the children with ITP, the expression level of plasma miR-106b-5p was positively correlated with the Th17 level and the Th17/Treg ratio (r=0.730 and 0.816 respectively; P<0.001) and was negatively correlated with the Treg level (r=-0.774, P<0.001).@*CONCLUSIONS@#A higher expression level of miR-106b-5p and Th17/Treg imbalance may be observed in children with ITP. The measurement of miR-106b-5p, Th17, Treg, and Th17/Treg ratio during treatment may be useful to the evaluation of treatment outcome in children with ITP.

Strategies for improving the scientific research ability of trainees in standardized residency training of dermatology / 中华医学教育探索杂志

In this paper, combined with the characteristics of rotational learning of dermatologists, we have taken various measures such as improving the scientific research training system, strengthening the awareness of scientific research, optimizing the teaching mode, adding new assessment mechanism, hand-in-hand teaching and other measures to realize the close combination of clinical and scientific research, and lay a solid foundation for the cultivation of high-quality innovative talents in dermatology.

Clinical guidance on endoscopic management of colonic polyps in Singapore

Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.

Metabolic engineering study on biosynthesis of 4-hydroxybenzyl alcohol from L-tyrosine in Escherichia coli / 中国中药杂志

As an important active ingredient in the rare Chinese herb Gastrodiae Rhizoma and also the main precursor for gastrodin biosynthesis, 4-hydroxybenzyl alcohol has multiple pharmacological activities such as anti-inflammation, anti-tumor, and anti-cerebral ischemia. The pharmaceutical products with 4-hydroxybenzyl alcohol as the main component have been increasingly favored. At present, 4-hydroxybenzyl alcohol is mainly obtained by natural extraction and chemical synthesis, both of which, however, exhibit some shortcomings that limit the long-term application of 4-hydroxybenzyl alcohol. The wild and cultivated Gastrodia elata resources are limited. The chemical synthesis requires many steps, long time, and harsh reaction conditions. Besides, the resulting by-products are massive and three reaction wastes are difficult to treat. Therefore, how to artificially prepare 4-hydroxybenzyl alcohol with high yield and purity has become an urgent problem facing the medical researchers. Guided by the theory of microbial metabolic engineering, this study employed the genetic engineering technologies to introduce three genes ThiH, pchF and pchC into Escherichia coli for synthesizing 4-hydroxybenzyl alcohol with L-tyrosine. And the fermentation conditions of engineering strain for producing 4-hydroxybenzyl alcohol in shake flask were also discussed. The experimental results showed that under the conditions of 0.5 mmol·L~(-1) IPTG, 15 ℃ induction temperature, and 40 ℃ transformation temperature, M9 Y medium containing 200 mg·L~(-1) L-tyrosine could be transformed into(69±5)mg·L~(-1) 4-hydroxybenzyl alcohol, which has laid a foundation for producing 4-hydroxybenzyl alcohol economically and efficiently by further expanding the fermentation scale in the future.

Distinct Effects of Social Stress on Working Memory in Obsessive-Compulsive Disorder / 神经科学通报·英文版

Stress might exaggerate the compulsion and impair the working memory of patients with obsessive-compulsive disorder (OCD). This study evaluated the effect of stress on the cognitive neural processing of working memory in OCD and its clinical significance using a “number calculation working memory” task. Thirty-eight patients and 55 gender- and education-matched healthy controls were examined. Stress impaired the performance of the manipulation task in patients. Healthy controls showed less engagement of the medial prefrontal cortex and striatum during the task under stress versus less stress, which was absent in the patients with OCD. The diagnosis × stress interaction effect was significant in the right fusiform, supplementary motor area, precentral cortex and caudate. The failure of suppression of the medial prefrontal cortex and striatum and stress-related hyperactivation in the right fusiform, supplementary motor area, precentral cortex, and caudate might be an OCD-related psychopathological and neural response to stress.

Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

Background@#Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population. @*Methods@#A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures. @*Results@#Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs.Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT.Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001). @*Conclusions@#Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, shortduration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.

Efficiency and safety of percutaneous ultrasound-guided radiofrequency ablation for right adrenal metastases from hepatocellular carcinoma / 中华超声影像学杂志

Objective:To retrospectively summarize and evaluate the efficiency and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) for adrenal metastasis (AM) from hepatocellular carcinoma (HCC).Methods:From October 2009 to September 2018, 16 patients with AM from HCC who underwent percutaneous RFA in the First Affiliated Hospital of Sun Yat-Sen University were enrolled in the study. The complete ablation and local tumor progression rates were elevated, and the side effects and complications were summarized.Results:The median ablation time of AM was 16 min. The complete ablation rate was 87.5% (14/16). After the follow-up period of 3 to 55 months, among the patients with complete ablation, there were 3 patients were detected local tumor progression (LTP), the LTP rate was 21.4% (3/14). As for the side effects and complications, 3 patients were diagnosed as hypertension crisis (3/16, 18.8%), 2 showed reduced heart rate and 1 of them exhibited frequent premature ventricular contraction which resulted in termination of ablation. There was no ablation-related death or adrenal failure.Conclusions:Percutaneous US-guided RFA is safe and effective in the treatment of AM originated from HCC.

Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

Background@#Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population. @*Methods@#A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures. @*Results@#Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs.Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT.Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001). @*Conclusions@#Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, shortduration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.

Effects of Ramipril on the expression of connexin 43 in cerebral arteries of spontaneously hypertensive rats / 生理学报

The present study was designed to examine whether Ramipril (an inhibitor of angiotensin-converting enzyme) affected spontaneous hypertension-induced injury of cerebral artery by regulating connexin 43 (Cx43) expression. Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR) were randomly divided into WKY, WKY + Ramipril, SHR, and SHR + Ramipril groups (n = 8). The arterial pressure was monitored by the tail-cuff method, and vascular function in basilar arteries was examined by pressure myography. Hematoxylin-eosin (HE) staining was used to show vascular remodeling. The expression and distribution of Cx43 was determined by using immunofluorescence and immunohistochemistry analysis. The protein and mRNA levels of Cx43 were examined by Western blot and real-time PCR analysis, respectively. The results showed that chronic Ramipril treatment significantly attenuated blood pressure elevation (P < 0.01, n = 8) and blood vessel wall thickness in SHR (P < 0.01, n = 8). The cerebral artery contraction rate in the SHR group was higher than that in the WKY group (P < 0.05, n = 8). The cerebral artery contraction rate in the SHR + Ramipril group was lower than that in the SHR group (P < 0.05, n = 8). Pretreatment with 2-APB (Cx43 non-specific blocker) or Gap26 (Cx43 specific blocker) significantly decreased the vasoconstriction rate, while pretreatment with AAP10 (Cx43 non-specific agonist) significantly increased the vasoconstriction in the SHR + Ramipril group (P < 0.05, n = 8). In addition, the expression of Cx43 mRNA and protein in cerebral arteries of SHR group was higher than that of WKY group (P < 0.05, n = 8). The mRNA and protein expression of Cx43 in cerebral arteries of SHR + Ramipril group was significantly lower than that of SHR group (P < 0.05, n = 8). These results suggest that Ramipril can down-regulate the expression of Cx43 mRNA and protein in cerebral arterial cells of SHR, lower blood pressure, promote vasodilation, and improve arterial damage and vascular dysfunction caused by hypertension.

Endoscopic submucosal dissection of colonic lesions: first 50 cases at a local institution

INTRODUCTION@#Endoscopic submucosal dissection (ESD) in the colon and rectum has been developed with good reported outcomes. The main advantage of ESD is the ability to perform en bloc resection, which has implications for complete excision and pathological analysis. Locally, the use of ESD in colonic lesions has seen recent traction. Our study aimed to review the outcomes of the first 50 cases of endoscopic excision of advanced colonic lesions using ESD at our institution.@*METHODS@#This was a retrospective study of all patients who underwent ESD at our institution from September 2010 to October 2016. Data collected included patient demographics, resection technique, conversion rate and morbidity.@*RESULTS@#51 patients underwent ESD during the study period. All patients were of American Society of Anesthesiologists (ASA) class 1-3. Their median age was 60.0 years and the majority (n = 36) were male. The mean procedure time was 80.9 minutes. 36 (76.6%) of cases underwent en bloc resection. 4 (7.8%) cases required conversion to surgery, mainly due to difficulty in raising the colonic lesions. 3 (5.9%) patients had malignancy as the final histology. 2 (4.3%) patients had recurrence during surveillance scope. No cases of early mortality were reported.@*CONCLUSION@#Our results suggest that ESD for advanced colonic lesions can be safely performed. Expertise needs to be developed to achieve satisfactory en bloc resection rates.

Gene cloning and prokaryotic expression of glycosyltransferase from Ligustrum quihoui / 中国中药杂志

According to the previous results from transcriptome analysis of Ligustrum quihoui, a glycosyltransferase gene(xynzUGT) was cloned by rapid amplification of cDNA ends(RACE). The full length cDNA of xynzUGT was 1 598 bp, consisting of 66 bp 5'-UTR, 1 440 bp ORF and 92 bp 3'-UTR. The ORF encoded a 480 amino-acid protein(xynzUGT) with a molecular weight of 54 826.67 Da and isoelectric point of 5.82. The structure of enzyme was analyzed by using bioinformatics method, the results showed that the primary structure contained a highly conserved PSPG box of glycosyltransferase, the secondary structure included α helix(38%), sheet(12.1%) and random coil(49.9%), and tertiary structure was constructed by peptide chain folding to form two face-to-face domains(often referred to as a Rossmann domains), between which a substrate binding pocket is sandwiched. The phylogenetic tree analysis indicated that xynzUGT might catalyze glycosylation of phenylpropanoids, such as tyrosol. Further simulation experiment of molecular docking between enzyme and tyrosol showed that Gly138 and Ser285 located in the binding pocket interacted with tyrosol by hydrogen bonding. SDS-PAGE analysis exhibited that the prokaryotic expression system successfully expressed recombinant xynzUGT with molecular weight of 58 370.57 Da, but it exists in the form of non-soluble inclusion bodies. Using the molecular chaperone and enzyme co-expression method, the soluble expression was promoted to some extent. The above works laid the foundation for further studying on enzymatic reaction and clarifying the functional mechanism of enzyme.

Extent of field change in colorectal cancers with BRAF mutation

<p><b>INTRODUCTION</b>Sporadic colorectal cancers with BRAF mutations constitute two distinct subgroups of colorectal cancers. Recent studies have linked the presence of the BRAF mutation to a familial inheritance pattern. This was a proof-of-concept study that aimed to examine: (a) the extent of field change in sporadic colorectal cancers with BRAF mutation; and (b) the extent of resection margins required and the pattern of DNA mismatch repair protein loss in these tumours.</p><p><b>METHODS</b>Eight microsatellite instability-high tumours with positive BRAF mutation from an existing histopathological database were selected for BRAF mutation and mismatch repair protein analysis.</p><p><b>RESULTS</b>All the resection margins were negative for BRAF mutation. Three tumours had loss of MLH1 and PMS2 expressions, and five tumours had no protein loss. Six peritumoral tissues were negative and one was positive for BRAF mutation.</p><p><b>CONCLUSION</b>The results suggest that any early field change effect is restricted to the immediate vicinity of the tumour and is not a pan-colonic phenomenon. Current guidelines on resection margins are adequate for BRAF mutation-positive colorectal cancers. Any suggestion of a hereditary link to these tumours is likely not related to germline BRAF gene mutations. The pattern of protein loss reinforces previous findings for the two subgroups of BRAF mutation-positive colorectal cancers.</p>

The progress of ultrasound-responsive drug delivery systems for the treatment of hepatocellular carcinoma / 中国医师杂志

This article summarized the mechanism of Ultrasound-responsive drug delivery systems (URDDS) and the research progress of URDDS for hepatocellular carcinoma therapy.

Rapid diagnosis of venous catheterization complications: an ultrasound imaging study / 中国医师杂志

Objective To explore the value of ultrasound imaging in complications associated with venous catheterization.Methods Patients (n =853) underwent ultrasound imaging examination after venous catheterization.Ultrasonography manifestations of venous catheterization complications and clinical curative effect were analyzed and summarized.Results Phlebitis,thrombus and mechanical complications were found by ultrasound imaging examination.Pneumothorax,hemothorax,arterial puncture and hematoma were among the main mechanical complications.Among the 853 patients,85 cases (9.96％) were found to have complications by ultrasound examination,with 35 cases (4.10％) of phlebitis,26 cases (3.05％) of catheter-related thrombus and 24 cases (2.81％) of mechanical complications.Conclusions In summary,a variety of venous catheterization complications can be diagnosed using ultrasound imaging non-invasively,effectively and efficiently.Real-time ultrasound imaging examination can dynamically monitor the develop ment and evolution of venous catheterization complications and effectively evaluate outcomes.

Preparation of sorafenib and doxorubicin loaded nanodroplets and its ultrasound-sensitive in vitro:experimental study / 中华超声影像学杂志

Objective To prepare ultrasound(US)responsive nanodroplets(NDs)simultaneously loaded with anticancer drug Sorafenib(SF)and Doxorubicin(DOX),and to characterize its ultrasound responsibility in vitro and in vivo.Methods The SF/DOX NDs were prepared using the thin-film hydration method.The particle diameter,Zeta potential and drug-encapsulation efficiency were characterized.The acoustic droplets vaporization activity was monitored by in vitro ultrasound imaging and light microscope. The cavitation effect was monitored by in vitro ultrasound imaging and transmission electron microscopy. Results SF/DOX NDs were round in shape,the mean diameter and Zeta potential of SF/DOX NDs was (498 ± 67.34)nm,-(38.87 ± 3.78)mV,respectively.The entrapment efficiency of SF and DOX was (58.14±2.93)%,(51.23±4.11)%,respectively.SF/DOX NDs underwent a phase transition into bubbles and could be continuously imaged for more than 25 min in vitro,and afterward therapeutic ultrasound pulse induced inertial cavitation and substantially enhanced treatment.Conclusions US-responsible SF/DOX NDs are prepared using thin-film hydration mehtod,it can enhance ultrasonic echo in vitro and release anticancer drug by the aid of US exposure,which possesses greater researching and applicating value.

Practice and reflection on the training of clinical professional postgraduates in dermatology / 中华医学教育探索杂志

The training of professional postgraduates is one mode of medical postgraduate training,which more emphasizes the cultivation of clinical practice and ability.The problems existing in the training of professional degree postgraduates in dermatology are analyzed in this article,such as weak foundation of scientific research foundation,lack of supervision and evaluation,and the challenges from dermatology characteristics.The solutions including the training objectives,project design,the optimization of teaching process and evaluation,the training of comprehensive ability will be discussed in this article.The purpose is to improve the quality of training,to give some advice for providing high quality professional degree postgraduates.

Investigation and analysis of the characteristics and drug sensitivity of bacteria in skin ulcer infections / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Skin ulcer is a common type of disease affecting patients' health and quality of life, and bacterial infection increases the difficulty of its management.</p><p><b>METHODS</b>The present study collected the results of bacterial culture sampled from the surface of 110 cases of skin ulcers at our hospital from January 2011 to December 2012. We analyzed the constituent ratios of ulcer surface bacteria, the change in the main infectious bacteria and the results of drug-sensitivity testing for common bacteria. In addition, the characteristics of bacterial infection of skin ulcers were summarized.</p><p><b>RESULT</b>Of the 110 samples, 90 isolated bacteria were cultured. Sixty-one were Gram-negative bacteria, mainly comprising Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli. In addition, 23 isolates were Gram-positive bacteria, mainly comprising Staphylococcus aureus and Enterococcus faecalis. The probability of a negative bacterial culture in 2012 was significantly lower than that in 2011 (16.7% vs. 40.0%, p < 0.01). Moreover, the probability of P. aeruginosa infection in 2012 was significantly higher than that in 2011 (31.7% vs. 14.0%, p < 0.01). P. aeruginosa was resistant to seven commonly used antibiotics. Both K. pneumoniae and E. coli had higher resistance to ampicillin. E. cloacae were not sensitive to piperacillin/tazobactam. Acinetobacter baumannii was resistant to all the tested drugs. S. aureus, E. faecalis and Staphylococcus epidermidis had high resistance to clindamycin. There was other drug resistance to reflect the higher rate of skin bacterial resistance.</p><p><b>CONCLUSION</b>Skin bacterial resistance rate is high. Gram-negative bacteria gradually account for the majority, and P. aeruginosa becomes the most important skin infection pathogen. These characteristics of bacterial infections of skin ulcers provide a significant reference for guiding the selection of antibiotics, better controlling infections of skin ulcers and accelerating the healing of skin ulcers.</p>

Current therapeutic progression of Rifampicin in prosthetic joint infection / 中华骨科杂志

Prosthetic joint infection (PJI) is a devastating complication that can occur after any arthroplasty procedure and is associated with significant morbidity and substantial healthcare costs.Recently,the use of Rifampicin in PJI subjects has become a hot research direction in the field of orthopaedics,its efficacy is definite and encouraging.But till date,to the best of our knowledge,we still have no associated reports about the application of Rifampicin on PJI.Therefore,articles concerned with the administration of Rifampicin in PJI subjects published till date were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang and Weipu databases.The articles,which met the inclusion and exclusion criteria,were summarized into the following categories:1) The development and the application status of Rifampicin on PJI;2) The therapeutic mechanism of Rifampicin on PJI;3) The usage of Rifampicin in the postoperative antimicrobial therapy.By reviewing the associated articles,we found out that PJI is difficult to treat,because the causative bacteria forms and exists in a biofilm that is adherent to the prosthetic surface.The formation and maturation of the bacterial biofilm is a time dependent process.The longer the biofilm exists,the troublesome it gets to eradicate.Rifampicin not only has an excellent anti-staphylococcal activity,but also has a very good oral bioavailability and good bone penetration.The application of Rifampicin may significantly improve the surgical success rate especially after debridement and retention in PJI subjects.However,the optimal course,dosage and route of administration still need further exploration.

Changing models of care for emergency surgical and trauma patients in Singapore

The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.