Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty.

AIMS AND OBJECTIVES: To evaluate the efficacy and safety of a comprehensive protocol for constipation prevention. BACKGROUND: Constipation is a common problem for patients undergoing total hip arthroplasty (THA), yet sparse evidence is available to guide constipation prevention after THA. DESIGN: Randomised controlled superiority clinical trial. METHODS: This randomised controlled study was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). A total of 80 THA patients were randomised to receive only preoperative education about lifestyle or the combination of education with postoperative abdominal massage and polyethylene glycol 4,000 (Forlax®). Efficacy outcomes included rates of postoperative constipation and enema rescue, as well as time to first postoperative defecation and readmission within 30 days. Safety outcomes were number and type of adverse events. RESULTS: Patients who received combination treatment showed a significantly lower rate of postoperative constipation during hospitalisation than patients who received only preoperative education (25% versus 55%), and they showed a significantly lower rate of enema rescue (12.5% versus 40%). Many more patients receiving combination treatment experienced their first defecation within two postoperative days than patients who received only preoperative education (62.5% versus 35.9%). In contrast, the two groups were similar in terms of constipation rate on postoperative days 15 and 30, rate of readmission within 30 days and rate of postoperative adverse events. CONCLUSIONS: These results suggest that our comprehensive protocol can relieve constipation after THA, reduce the need for enema rescue and shorten time to first defecation without sacrificing safety. More work is needed to optimise and develop this protocol further. RELEVANCE TO CLINICAL PRACTICE: Constipation is a distressing problem that frequently occurs after THA. This study confirmed that a comprehensive protocol including preoperative education, postoperative abdominal massage and polyethylene glycol 4,000 can effectively relieve constipation after THA without sacrificing safety.

Monostotic fibrous dysplasia at C7 treated with vertebroplasty: a case report and review of the literature.

BACKGROUND: Monostotic fibrous dysplasia (MFD) involving the spine is rare, and the treatment options are controversial. Surgery is needed when patients suffer from persistent pain, spinal cord compression/injury, and vertebral collapse/instability. Treatment methods include biopsy/observation, corpectomy with instrumented fusion, posterior fusion, vertebroplasty (VP), curettage and bone graft, and complete removal of the vertebra with a combined anterior and posterior fusion procedure. CASE PRESENTATION: The patient was a 56-year-old woman with a 2-year history of neck pain. No obvious abnormalities were detected on neurological or physical examination, and laboratory findings were all within normal limits. An imaging examination suggested a C7 vertebral bone tumor. The patient refused to continue conservative observation treatment and requested surgery. Open VP of the C7 vertebral body was carried out, and her postoperative neck pain was completely relieved. The postoperative pathological results supported the diagnosis of fibrous dysplasia, and the patient was ultimately diagnosed with MFD. At the 12-month follow-up visit, the patient reported no clinical symptoms, and no signs of tumor recurrence were detected. CONCLUSION: VP can relieve pain while stabilizing the spine. Thus, the surgical treatment of MFD vertebral lesions by VP is a valuable option.

Parental exposure to sulfamethazine and nanoplastics alters the gut microbial communities in the offspring of marine madaka (Oryzias melastigma).

The individual and combined toxicity of antibiotics and nanoplastics in marine organisms has received increasing attention. However, many studies have been mostly focused on the impacts on the directly exposed generation (F0). In this study, intergenerational effects of sulfamethazine (SMZ) and nanoplastic fragments (polystyrene, PS) on the growth and the gut microbiota of marine medaka (Oryzias melastigma) were investigated. The results showed that parental exposure to dietary SMZ (4.62 mg/g) alone and PS (3.45 mg/g) alone for 30 days decreased the body weight (by 13.41% and 34.33%, respectively) and altered the composition of gut microbiota in F1 males (two months after hatching). Interestingly, parental exposure to the mixture of SMZ and PS caused a more modest decrease in the body weight of F1 males than the PS alone (15.60% vs 34.33%). The hepatic igf1 level and the relative abundance of the host energy metabolism related phylum Bacteroidetes for the SMZ + PS group were significantly higher than those for the PS group (igf1, increased by 97.1%; Bacteroidetes, 2.876% vs 0.375%), suggesting that the parentally derived mixture of SMZ and PS might influence the first microbial colonization of gut in a different way to the PS alone. This study contributes to a better understanding of the long-term risk of antibiotics and nanoplastics to marine organisms.

Multi-holed biplane drill guide-assisted percutaneous anterior odontoid screw fixation.

BACKGROUND: The use of percutaneous anterior screw fixation for odontoid fractures has been widely reported. Because the anatomical characteristics of the odontoid and the screw occupy three-dimensional space, it is challenging to establish the screw trajectory quickly and correctly during the operation. OBJECTIVE: The purpose of this study was to introduce a multi-holed biplane drill guide that can be used to optimize the guide needle trajectory in percutaneous anterior odontoid screw fixation. METHODS: Twenty-one patients with type II or rostral type III odontoid fractures were treated with percutaneous anterior single screw fixation. Of these, 12 patients had an unsatisfactory initial guide needle position. A drill guide was used to provide a variety of guide needle tracks. RESULT: All 12 patients successfully underwent guided screw placement without vascular or neurological complications. Postoperative X-ray and/or CT scans showed that the internal fixation position was satisfactory. At the end of the follow-up period, all patients exhibited bony union without loosening or fractures of the internal fixation. CONCLUSION: With the imperfect initial position of the guide needle as a reference, the multi-holed biplane drill guide can provide a variety of needle trajectory options in the sagittal and coronal planes for percutaneous anterior odontoid screw fixation. The operator can quickly obtain the ideal guide needle trajectory.

Polymer brushes-containing coordination polymer networks on monolith for rapid solid phase extraction of multi-class drug residues in meat samples.

A new solid phase extraction sorbent, based on poly(methacrylic acid) brushes-containing coordination polymer networks on monolith, was in-situ synthesized in a commercial syringe filter via surface grafting. Extraction of twenty model analytes, including nine sulfonamides, eight steroid hormones, and three quinolones, could be efficiently achieved by the monolithic hybrid filter due to multi-interactions. Through simple filtering steps, fast extraction (60 s of adsorption and 60 s of desorption) could be achieved. Furthermore, the monolithic hybrid filter was used to analyze the model compounds in chicken meat samples in combination with ultra-performance liquid chromatography-tandem mass spectrometry. Compared with other adsorption sorbents in reported literatures, the proposed monolithic hybrid filter allowed for shorter purification time, simplified sample pretreatment procedure, and comparable LODs and LOQs of 0.1-3 µg kg-1 and 0.4-10 µg kg-1, respectively. The recoveries for all analytes ranged from 83.9% to 103% with inter-day relative standard deviation lower than 10%. The results demonstrated that the developed analytical method was highly efficient and operationally convenient, and had a great potential for high throughput analysis of multi-residues.

Combined use of intravenous and topical tranexamic acid following cementless total hip arthroplasty: a randomised clinical trial.

PURPOSE: This study was designed to compare the efficacy and safety of the combined use of tranexamic acid (TXA) with the intravenous (IV) or local use alone in total hip arthroplasty (THA). METHODS: 210 patients were randomised to a IV group, a local group or a combined group. Participants received 1.5 g IV-TXA in the IV group, 3 g local TXA in the local group, or 1 g IV-TXA combined with 2 g local TXA in the combined group. The primary outcomes were total blood loss (TBL), maximum haemoglobin drop, and the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE). RESULTS: TBL was (776.75 ± 188.95) ml in the combined group, which was significantly lower than in the IV group or the local group (p = 0.015, p = 0.001 respectively). Likewise, the mean values of maximum hemoglobin drop in the combined, IV, and local groups were 2.98 ± 0.78, 3.36 ± 0.78, and 3.89 ± 0.72 g/dL, respectively, with a significant intergroup difference (p<0.001 for all). Asymptomatic DVT was detected in 1 patient of the IV group, and 2 patients of the combined group with the use of ultrasound. There were no episodes of PE, and no significant differences were seen between groups in terms of complications. CONCLUSIONS: Combined use of intravenous TXA and local TXA in primary unilateral THA can effectively decrease total blood loss and increase postoperative haemoglobin levels without influencing complication rates. It is suggested that this combined TXA regimen is more effective in decreasing blood loss in cementeless THA than intravenous or local administration alone.

[The biological safety evaluation of a new developed silicone rubber for inflatable silastic prosthesis].

OBJECTIVE: The biological safety of a new developed silicone rubber for inflatable silastic prosthesis (SRISP) was evaluated. METHODS: Following the GB/T 16886.10-2005 standard, YY/T 0127.13-2009 standard, and GB/T 16886.11- 2011 standard, samples were prepared and tested by animal experiments, such as guinea pig maximization test, oral mucous membrane irritation test, and short-term systemic toxicity test (oral route). RESULTS: No obvious erythema and edema in the guinea pig abdominal skin were observed after 24, 48, and 72 h of stimulating touch, thus indicating that SRISP does not cause potential skin sensitivity. No local response to SRISP was found, and the visual observation and pathological findings of oral mucosa were normal and similar to that of the control group. Therefore, SRISP had no irritation response to oral mucosa. No clinical signs of toxicity were observed in rats, and no significant differences in weight and weight relative growth rate between extract group and blank control group (P > 0.05) were found. Thus, SRISP had no short-term systemic toxicity. CONCLUSION: These results indicated that SRISP met the requirement of biomedical materials and had good bio- security.

Modulation of mononuclear phagocyte inflammatory response by liposome-encapsulated voltage gated sodium channel inhibitor ameliorates myocardial ischemia/reperfusion injury in rats.

BACKGROUND: Emerging evidence shows that anti-inflammatory strategies targeting inflammatory monocyte subset could reduce excessive inflammation and improve cardiovascular outcomes. Functional expression of voltage-gated sodium channels (VGSCs) have been demonstrated in monocytes and macrophages. We hypothesized that mononuclear phagocyte VGSCs are a target for monocyte/macrophage phenotypic switch, and liposome mediated inhibition of mononuclear phagocyte VGSC may attenuate myocardial ischemia/reperfusion (I/R) injury and improve post-infarction left ventricular remodeling. METHODOLOGY/PRINCIPAL FINDINGS: Thin film dispersion method was used to prepare phenytoin (PHT, a non-selective VGSC inhibitor) entrapped liposomes. Pharmacokinetic study revealed that the distribution and elimination half-life of PHT entrapped liposomes were shorter than those of free PHT, indicating a rapid uptake by mononuclear phagocytes after intravenous injection. In rat peritoneal macrophages, several VGSC α subunits (NaV1.1, NaV1.3, NaV1.4, NaV1.5, NaV1.6, NaV1.7, NaVX, Scn1b, Scn3b and Scn4b) and ß subunits were expressed at mRNA level, and PHT could suppress lipopolysaccharide induced M1 polarization (decreased TNF-α and CCL5 expression) and facilitate interleukin-4 induced M2 polarization (increased Arg1 and TGF-ß1 expression). In vivo study using rat model of myocardial I/R injury, demonstrated that PHT entrapped liposome could partially suppress I/R injury induced CD43+ inflammatory monocyte expansion, along with decreased infarct size and left ventricular fibrosis. Transthoracic echocardiography and invasive hemodynamic analysis revealed that PHT entrapped liposome treatment could attenuate left ventricular structural and functional remodeling, as shown by increased ejection fraction, reduced end-systolic and end-diastolic volume, as well as an amelioration of left ventricular systolic (+dP/dt max) and diastolic (-dP/dt min) functions. CONCLUSIONS/SIGNIFICANCE: Our work for the first time demonstrates the therapeutic potential of VGSC antagonism via liposome mediated monocyte/macrophage targeting in acute phase after myocardial I/R injury. These results suggest that VGSCs in mononuclear phagocyte system might be a novel target for immunomodulation and treatment of myocardial I/R injury.