[Development of bariatric surgery in the context of precision medicine].

Precision medicine, which is based on individualized medicine, is a new medical model developed with the cross-application of genome sequencing technology, bioinformatics, and big data science. The establishment of precision medicine model is conducive to maximize the efficient utilization of medical resources and patient benefits. Bariatric surgery is an emerging branch of general surgery in the new century. Although the development of bariatric surgery still has a long way to go, precision medicine will add significant value to the rapid and positive development of the branch of bariatric surgery. In the context of precision medicine, bariatric metabolic surgery is now in its infancy. Currently, the successful implementation of precision control in bariatric surgery is initially focusing on the prediction of postoperative weight and the study of body weight differences in epigenetics. However, there are still gaps to be filled in the area of postoperative recovery, nutritional support treatment, and realization of individualized treatment based on big data. In the future, the integration of large-scale resource and data information can be realized by establishing the multi-center clinical sample library and perfecting the data collection of long-term follow-up and clinical information. Meanwhile, we can conduct deep biological data mining effectively with the big data platform, while using data reference to achieve accurate prediction and control of obesity treatment, so as to formulate detailed implementation plans and detailed procedure standard. Last but not least, we should pay attention to the patients' privacy and prevent personal health information leakage.

Photonic crystal resonators for inverse-designed multi-dimensional optical interconnects.

We experimentally demonstrate a 400 Gbit/s optical communication link utilizing wavelength-division multiplexing and mode-division multiplexing for a total of 40 channels. This link utilizes a novel, to the best of our knowledge, 400 GHz frequency comb source based on a chip-scale photonic crystal resonator. Silicon-on-insulator photonic inverse-designed 4 × 4 mode-division multiplexer structures enable a fourfold increase in data capacity. We show less than -10 dBm of optical receiver power for error-free data transmission in 34 out of a total of 40 channels using a PRBS31 pattern.

[Clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower extremity].

Objective: To observe the clinical effects of free latissimus dorsi myocutaneous flap combined with artificial dermis and split-thickness skin graft in the treatment of degloving injury in lower limbs. Methods: A retrospective observational study was conducted. From December 2017 to December 2020, 8 patients with large skin and soft tissue defect caused by degloving injury in lower extremity were admitted to Ningbo No.6 Hospital, including 5 males and 3 females, aged from 39 to 75 years, with wound area of 25 cm×12 cm-61 cm×34 cm. The free latissimus dorsi myocutaneous flap with latissimus dorsi muscle in the width of 12-15 cm and flap area of 20 cm×8 cm-32 cm×8 cm was used to repair the skin and soft tissue defect of bone/tendon exposure site or functional area. The other defect was repaired with bilayer artificial dermis, and the flap donor site was sutured directly. After the artificial dermis was completely vascularized, the split-thickness skin graft from thigh was excised and extended at a ratio of 1∶2 to 1∶4 and then transplanted to repair the residual wound, and the donor site of skin graft was treated by dressing change. The survival of latissimus dorsi myocutaneous flap, artificial dermis, and split-thickness skin graft after operation was observed, the interval time between artificial dermis transplantation and split-thickness skin graft transplantation was recorded, and the healing of donor site was observed. The appearance and function of operative area were followed up. At the last outpatient follow-up, the sensory recovery of flap was evaluated by British Medical Research Council evaluation criteria, the flap function was evaluated by the comprehensive evaluation standard of flap in Operative Hand Surgery, the scar of lower limb skin graft area and thigh skin donor area was evaluated by Vancouver scar scale, and the patient's satisfaction with the curative effects was asked. Results: The latissimus dorsi myocutaneous flap survived in 6 patients, while the distal tip of latissimus dorsi myocutaneous flap was partially necrotic in 2 patient and was repaired by skin grafting after resection at split-thickness skin grafting. The artificial dermis survived in all 8 patients after transplantation. The split-thickness skin graft survived in 7 patients, while partial necrosis of the split-thickness skin graft occurred in one patient and was repaired by skin grafting again. The interval time between artificial dermis transplantation and split-thickness skin graft transplantation was 15-26 (20±5) d. The donor site of latissimus dorsi myocutaneous flap healed with linear scar after operation, and the thigh skin graft donor site healed with scar after operation. The patients were followed up for 6-18 (12.5±2.3) months. The color and elasticity of the flap were similar to those of the surrounding skin tissue, and the lower limb joint activity returned to normal. There was no increase in linear scar at the back donor site or obvious hypertrophic scar at the thigh donor site. At the last outpatient follow-up, the sensation of the flap recovered to grade S2 or S3; 3 cases were excellent, 4 cases were good, and 1 case was fair in flap function; the Vancouver scar scale score of lower limb skin graft area was 4-7 (5.2±0.9), and the Vancouver scar scale score of thigh skin donor area was 1-5 (3.4±0.8). The patients were fairly satisfied with the curative effects. Conclusions: In repairing the large skin and soft tissue defect from degloving injury in lower extremity, to cover the exposed bone/tendon or functional area with latissimus dorsi myocutaneous flap and the residual wound with artificial dermis and extended split-thickness skin graft is accompanied by harvest of small autologous flap and skin graft, good recovery effect of functional area after surgery, and good quality of healing in skin grafted area.

[Ultrasound biomicroscopic differences between fellow eyes of acute angle-closure glaucoma and chronic angle-closure glaucoma].

Objective: To compare the structural differences of the anterior segment between fellow eyes of acute angle-closure glaucoma (AACG) and the eyes of chronic angle-closure glaucoma (CACG) with milder glaucomatous damage. Methods: In this case-control study, patients with AACG (41 eyes) and CACG (46 eyes) without prior treatment in the glaucoma clinic of Peking University People's Hospital from September 2016 to October 2018 were enrolled. Ultrasound biomicroscopy was performed under dark condition. Parameters were measured on images including lens vault (LV), anterior chamber depth (ACD), iris thickness (IT750 and IT2000), angle-opening distance (AOD500 and AOD750), and trabecular iris angle (TIA500 and TIA750). The independent t-test was used to compare the continuous variables of the fellow eyes of AACG patients and the eyes of CACG patients with milder glaucomatous damage. After adjusting for age and gender, univariate and multivariate logistic regression analyses were performed to explore the most important parameters that may distinguish AACG from CACG. Results: The mean age of AACG patients was (65±10) years old and the age of CACG patients was (67±12) years old (P>0.05). The ACD [(1.79±0.25) mm vs. (1.99±0.34) mm], IT750 [(0.39±0.07) mm vs. (0.43±0.05) mm], AOD500 [(0.12±0.06) mm vs. (0.15±0.07) mm], TIA500 (10.91°±5.23° vs. 13.93°±6.33°), and TIA750 (9.33°±5.02° vs. 13.93°±6.82°) were less and the LV [(0.99±0.44) mm vs. (0.72±0.30) mm] was greater in the fellow eyes of AACG as compared to the eyes of CACG with milder glaucomatous damage (all P<0.05). In the forward multivariate logistic regression analysis, every 1-degree decrease in TIA750 (odds ratio=0.872, 95%CI: 0.794 to 0.958, P<0.01) and every 1-mm increase in LV (odds ratio=14.138, 95%CI: 2.348 to 85.130, P<0.01) were significantly associated with AACG. Conclusions: Compared with the eyes of CACG with milder glaucomatous damage, fellow eyes of AACG have thinner peripheral iris thickness, narrower angle width, shallower ACD, and greater LV. LV and TIA750 may play important roles in distinguishing eyes predisposed to AACG or CACG. (Chin J Ophthalmol, 2021, 57: 672-678).

[Modified posteromedial approach via lateral side of flexor hallucis longus for the treatment of posterior Pilon fracture].

Objective: To compare the clinical efficacy and the level of muscle and soft tissue damage between modified posteromedial approach via lateral side of flexor hallucis longus and modified posteromedial approach in the treatment of posterior Pilon fracture. Methods: Total of 43 patients (27 males and 16 females, aged from 19 to 71 years) diagnosed with posterior Pilon fracture from June 2016 to June 2018 in Foshan Hospital of Traditional Chinese Medicine were randomly divided into observation group (modified posteromedial approach via lateral side of flexor hallucis longus, 21 cases) and control group (modified posteromedial approach, 22 cases) according to the operation approach. The preoperative waiting time, intraoperative time, intraoperative blood loss, hospitalization time and the complications were recorded and compared between the two groups. The differences of blood creatine kinase (CK), myoglobin (Myo) and C-reactive protein (CRP) at different time points before and after operation were compared between the two groups to elevate the level of muscle and soft tissue damage. The fracture reduction qualities of the two groups were compared by Burwell-Charnley criteria. The differences of fracture healing time, range of motion of metatarsophalangeal joint of the great toe (MTP-ROM), ankle range of motion (Ankle-ROM), American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS) score of pain were compared between the two groups at the last follow-up. Results: The observation group and the control group were followed-up for (19±6) months and (16±8) months, respectively; there was no significant difference between the two groups (P>0.05). There were no significant differences in preoperative waiting time, intraoperative blood loss, hospitalization time and fracture healing time between the two groups (all P>0.05). At the last follow-up, there was no significant difference in the MTP-ROM and Ankle-ROM between the two groups (both P>0.05); the AOFAS score of the observation group was 88.2±7.8 and it was 84.5±7.6 in the control group (P>0.05); the VAS score of the observation group was (0.9±1.0) and it was (1.3±0.8) in the control group(P>0.05). Anatomical reduction rate in observation group was higher than that in control group (90.5% vs 81.8%, P>0.05). The operation time in the observation group was (87±16) min and it was (98±11) min in the control group (P<0.05). CK, Myo and CRP were increased in both groups after surgery, but there was no statistical significance between groups at the same time point (all P>0.05). There was no nerve injury in the observation group, while 2 cases (9.0%) of nerve paralysis occurred in the control group. No incision infection and checkrein deformity of the Hallux was found in the two groups. Conclusion: The modified posteromedial approach via lateral side of flexor hallucis longus can obtain good operative field exposure, and does not increase muscle and soft tissue injury, with shorter operative time and fewer complications, without nerve injury and checkrein deformity, it is a safe approach for the treatment of posterior Pilon fracture.

[Clinical characteristics of Kaposiform lymphangiomatosis: a report of 8 cases].

Objective: To investigate the clinical symptoms, treatment intervention and prognosis of Kaposiform lymphangiomatosis(KLA). Methods: Medical information and clinical characteristics data of 8 KLA patients who were admitted to Department of Pediatric Surgery of West China Hospital of Sichuan University from January 2016 to February 2019 were retrospectively reviewed and analyzed. There were 5 males and 3 females with age of 5.8 years old (from 8 months to 29 years old). Results: The lesions in all patients were diffusely distributed. In all 8 patients, the lung and mediastinum were involved with different degrees. Three cases had lesions involving pelvic and abdominal organs. Three cases had lesions involving bones. One case simultaneously involved pelvic and abdominal organs, and 1 case was involved laryngeal and neck. The clinical characteristics were mainly respiratory symptoms. In the laboratory tests, 6 patients had different degrees of thrombocytopenia (minimum 3 × 10(9)/L), and 4 patients had severe fibrinogen reduction (minimum 0.42 g/L). Three patients had prolonged activated partial thromboplastin time (up to 64.2 seconds) and 3 patients had prolonged prothrombin time (up to 18.6 seconds). After surgery (including thoracotomy, chest tube, pericardiocentesis, splenectomy) and empiric medicine therapy (vincristine, sirolimus and corticosteroid), the symptoms improved in 1 case, 2 cases died of complications, 2 cases were stable and 3 cases progressed up to February 2019. Conclusions: KLA is a rare disease that should be differentiated from other types of vascular diseases. Currently, there is no consensus treatment guidelines exist. Accurate diagnosis in KLA can be a challenge. The situation in patients with KLA is prone to rapid deterioration and progress. Future research efforts should seek to develop target-specific drugs for KLA.

[Clinical prognostic factors of adult supratentorial glioblastoma].

Objective: To analyze the treatment effect of patients with glioblastoma (GBM) and explore prognostic factors. Methods: The clinical data of 635 patients diagnosed as GBM at Neurosurgical Oncology Department Ⅳ of Beijing Tiantan Hospital, Capital Medical University from January 2007 to March 2018 were retrospectively reviewed. There were 386 males and 249 females with an age of (48.7±11.8) years (range: 18-75 years). Patients were divided into three groups according to the time of admission: 2007-2010 group(n=174), 2011-2014 group (n=237) and 2015-2018 group (n=224). Kaplan-Meier plot was used to analyze the effects of different treatment periods, treatment schemes and clinical factors on the survival of patients with GBM. Cox proportion hazard regression analysis was used to identify independent prognostic factors. Results: The median progression-free survival (PFS) and overall survival (OS) of patients in 2007-2010 group, 2011-2014 group, 2015-2018 group was 9.0 months (95% CI: 7.5-10.5), 10.0 months (95% CI: 8.8-11.2), 12.0 months (95% CI: 10.7-13.3) and 17.0 months (95% CI: 13.2-20.8), 20.0 months (95% CI: 16.9-23.1), 23.0 months(95% CI: 17.5-28.5), respectively. The PFS and OS of patients improved significantly over the years (χ(2)=9.693, P=0.008 and χ(2)=8.616, P=0.013). Multivariate survival analysis showed that age, extent of resection, radiotherapy and tumor distant dissemination were independent prognostic factors (all P<0.05). Conclusions: With the continuous development of clinical treatment regimen, the therapeutic effect of Chinese GBM patients has improved remarkably. Age, extent of resection, radiotherapy and tumor distant dissemination are independent prognostic factors associated with survival time.

[Identification of circulating tumor cells in peripheral blood for gliomas by detection of aneuploid cells].

Objective: To investigate the feasibility of detecting circulating tumor cells based on capture of heteroploid chromosome cells in peripheral blood of glioma patients. Methods: A total of 88 patients who were considered to suffer from gliomas and 10 healthy volunteers were enrolled in this study during January 2016 to December 2016 at Beijing Tiantan Hospital, from whom 6 ml preoperative blood was collected. Subtraction enrichment (SE)-immunostaining FISH (iFISH) was applied to capture the heteroploid chromosome 8 cells in those samples. Meanwhile, centromere probe 8(CEP-8)-FISH was used to identify aneuploid cells in 10 tumors and 10 brain tissues. Results: Numerous heteroploid chromosome 8 cells were observed in tumors whereas negative result was present in brain tissues (P<0.01). CTC was successfully detected in 90.9% glioma patients, in contrast, only one healthy volunteer was shown with a heteroploid chromosome 8 cell (P<0.01). Glial fibrillary acidic protein was not exhibited in the overwhelming majority of CTC (96.1%). High grade glioma (HGG) without IDH mutation possessed much more CTC than low grade (12.0 vs 2.2), P<0.01. Furthermore, multiploidy (≥5 copies) CTC accounted for a much significant percentage in HGG, either in tumors originating from oligodendrocyte or astrocyte (75.9% vs 56.0%), P<0.01; 62.7% vs 51.7%, P=0.016, respectively). Conclusion: CTC could be identified and enumerated in glioma by detecting aneuploidy cells in blood. The number and multiploidy proportion of CTC may be correlative with tumor grade and molecular characteristics.

[The application of cortical and subcortical stimulation threshold in identifying the motor pathway and guiding the resection of gliomas in the functional areas].

Objective: This study aimed to analyze the application of cortical and subcortical stimulation threshold in identifying the motor pathway and guiding the resection of gliomas in the functional area, and to illustrate the minimal safe threshold by ROC method. Methods: Fifty-seven patients with gliomas in the functional areas were enrolled in the study at Beijing Tiantan Hospital from 2015 to 2017. Anesthesia was maintained intravenously with propofol 10% and remifentanil. Throughout the resection process, cortical or subcortical stimulation threshold was determined along tumor border using monopolar or bipolar electrodes. The motor pathway was identified and protected from resection according to the stimulation threshold and transcranial MEPs. Minimal threshold in each case was recorded. Results: Total resection was achieved in 32 cases(56.1%), sub-total resection in 22 cases(38.6%), and partial resection in 3 cases(5.3%). Pre-operative motor disability was found in 9 cases. Compared with pre-operative motor scores, 19 exhibited impaired motor functions on day 1 after surgery, 5 had quick recovery by day 7 after surgery, and 7 had late recovery by 3 months after surgery. At 3 months, 7 still had impaired motor function. The frequency of intraoperative seizure was 1.8%(1/57). No other side effect was found during electronic monitoring in the operation. The ROC curve revealed that the minimal safe monopolar subcortical threshold was 5.70 mA for strength deterioration on day 1 and day 7 after surgery. Univariate analysis revealed that decreased transcranial MEPs and minimal subcortical threshold ≤5.7 mA were correlated with postoperative strength deterioration. Conclusions: Cortical and subcortical stimulation threshold has its merit in identifying the motor pathway and guiding the resection for tumors within the functional areas. 5.7 mA can be used as the minimal safe threshold to protect the motor pathway from injury.

Antinociceptive Effects of Botulinum Toxin Type A on Trigeminal Neuropathic Pain.

Previous studies have demonstrated that botulinum toxin type A (BoNT-A) attenuates orofacial nociception. However, there has been no evidence of the participation of the voltage-gated sodium channels (Navs) in the antinociceptive mechanisms of BoNT-A. This study investigated the cellular mechanisms underlying the antinociceptive effects of BoNT-A in a male Sprague-Dawley rat model of trigeminal neuropathic pain produced by malpositioned dental implants. The left mandibular second molar was extracted under anesthesia, followed by a miniature dental implant placement to induce injury to the inferior alveolar nerve. Mechanical allodynia was monitored after subcutaneous injection of BoNT-A at 3, 7, or 12 d after malpositioned dental implant surgery. Subcutaneous injections of 1 or 3 U/kg of BoNT-A on postoperative day 3 significantly attenuated mechanical allodynia, although 0.3 U/kg of BoNT-A did not affect the air-puff threshold. A single injection of 3 U/kg of BoNT-A produced prolonged antiallodynic effects over the entire experimental period. Treatment with BoNT-A on postoperative days 7 and 12, when pain had already been established, also produced prolonged antiallodynic effects. Double treatments with 1 U/kg of BoNT-A produced prolonged, more antiallodynic effects as compared with single treatments. Subcutaneous administration of 3 U/kg of BoNT-A significantly inhibited the upregulation of Nav isoform 1.7 (Nav1.7) expression in the trigeminal ganglion in the nerve-injured animals. These results suggest that antinociceptive effects of BoNT-A are mediated by an inhibition of upregulated Nav1.7 expression in the trigeminal ganglion. BoNT-A is therefore a potential new therapeutic agent for chronic pain control, including neuropathic pain.

[3.0 T MR diffusion tentor imaging in the differential diagnosis of breast mass lesions].

OBJECTIVE: To investigate the differential diagnostic value of DTI parameters in breast mass lesions by comparing apparent diffusion coefficient (ADC), fractional aniotropy (FA) and maximum eigenvalue (λ1)of normal glandular tissue, benign lesions and malignant lesions. METHODS: A total of 71 women patients with 74 mass lesions between December 2013 and October 2015 were enrolled from Beijing Chao-Yang Hospital.MRI protocol included dynamic contrast-enhanced MRI (DCE-MRI)and diffusion tentor imaging(DTI) were executed.The ADC, λ1 and FA of lesions and normal glandular tissue were calculated.The ADC, λ1 and FA of lesions were compared by paired t test between the benign/malignant tumors and the contratlateral healthy breast tissue.ROC curve analysis was performed to compare diagnostic performance based on the area under the curve(AUC). The sensitivity and specificity of the DCE-MRI combined with ADC and DCE-MRI combined with λ1 were calculated. RESULTS: The ADC, FA and λ1 values of malignant lesions were (1.09±0.18)×10(-3) mm(2)/s, 0.22±0.02 and(0.97±0.19)×10(-3) mm(2)/s , these values of benign lesions were (1.52±0.19)×10(-3) mm(2)/s, 0.21±0.02 and(1.79±0.19)×10(-3) mm(2)/s, there were statistically significant differences (all P<0.05). Area under the curve of ADC, FA and λ1 were 0.990, 0.605 and 0.978, respectively. The AUC of FA was lower than that of ADC and λ1(P<0.01, <0.01), but there was no difference between the AUC of ADC and that of λ1(P=0.131 6). The sensitivity DCE-MRI combined with ADC and DCE-MRI combined with λ1 was 88.6% vs 97.1%(P=0.353 3), the specificity was 84.6% vs 97.4%(P=0.113 0). CONCLUSION: ADC and λ1 is helpful to differentiate malignant from benign in mass lesions.

Effects of corn type and fasting time before slaughter on growth and plasma index in weaning pigs.

A 2 × 2 factorial experiment was conducted to evaluate the effects of dietary corn type (waxy corn [WC] vs. nonwaxy corn [NC]) and fasting period (2 h vs. 12-16 h) before slaughter on growth and plasma index in weaning pigs. Twenty-four crossbred barrows (8.26 ± 0.47 kg) were allotted to 4 treatments with 6 replications of 1 pig per replicate metabolism cage. Waxy corn contained less fat, a lower amylase:amylopectin ratio, more CP, and more starch than NC. Pigs fed the WC diet had lower jejunum digesta pH compared with those fed the NC diet ( < 0.05). Maltase activity in the jejunum and ileum mucosa ( < 0.01), sucrose activity in the ileum mucosa ( < 0.01), and amylase activity in the pancreas and jejunum digesta ( < 0.05) were increased in pigs fed the WC diet relative to those fed the NC diet. But the total tract apparent digestibility (TTAD) of starch and CP was lower for the WC group ( < 0.05). Ingestion of the NC diet resulted in higher ( < 0.05) ADG and ADFI in the second week but did not affect ADG ( = 0.091) and the feed:gain ratio (F:G; = 0.077) during the whole experiment period. The plasma glucose ( < 0.01) concentration was higher and high-density lipoprotein cholesterol (HDL-C; < 0.01) concentrations was lower in the hepatic portal vein in pigs fed the WC diet relative to those fed the NC diet. Fasting 2 h before slaughter decreased the jejunum and ileum digesta pH compared with the 12-h fasting group ( < 0.01). Villus height increased in the duodenum ( < 0.01) and jejunum ( < 0.05) and the villus height:crypt depth ratio increased in the duodenum ( < 0.05) of pigs after shortening the fasting period before slaughter. Shortening the fasting time before slaughter resulted in higher plasma glucose ( < 0.05) concentrations and a higher HDL-C:low-density lipoprotein cholesterol (LDL-C) ratio ( < 0.05) whereas the LDL-C ( < 0.05) concentrations were reduced in the hepatic portal vein. The results of this experiment indicate that although the production performance of both WC and NC diets is equal, the glucose concentration is higher and HDL-C is lower in the portal vein for the WC diet, and fasting time before slaughter has an influence on the plasma index and intestinal morphology in weaning pigs.

[The understanding of Epstein-Barr virus associated lymphoproliferative disorder].

In recent years, there are increasing articles concerning Epstein-Barr virus associated lymphoproliferative disorder (EBV+ LPD), and the name of EBV+ LPD is used widely. However, the meaning of EBV+ LPD used is not the same, which triggered confusion of the understanding and obstacles of the communication. In order to solve this problem. Literature was reviewed with combination of our cases to clarify the concept of EBV+ LPD and to expound our understanding about it. In general, it is currently accepted that EBV+ LPD refers to a spectrum of lymphoid tissue diseases with EBV infection, including hyperplasia, borderline lesions, and neoplastic diseases. According to this concept, EBV+ LPD should not include infectious mononucleosis (IM) and severe acute EBV infection (EBV+ hemophagocytic lymphohistiocytosis, fatal IM, fulminant IM, fulminant T-cell LPD), and should not include the explicitly named EBV+ lymphomas (such as extranodal NK/T cell lymphoma, aggressive NK cell leukemia, Burkitt lymphoma, and Hodgkin lymphoma, etc.) either. EBV+ LPD should currently include: (1) EBV+ B cell-LPD: lymphomatoid granulomatosis, EBV + immunodeficiency related LPD, chronic active EBV infection-B cell type, senile EBV+ LPD, etc. (2) EBV+ T/NK cell-LPD: CAEBV-T/NK cell type, hydroa vacciniforme, hypersensitivity of mosquito bite, etc. In addition, EBV+ LPD is classified, based on the disease process, pathological and molecular data, as 3 grades: grade1, hyperplasia (polymorphic lesions with polyclonal cells); grade 2, borderline (polymorphic lesions with clonality); grade 3, neoplasm (monomorphic lesions with clonality). There are overlaps between EBV+ LPD and typical hyperplasia, as well as EBV+ LPD and typical lymphomas. However, the most important tasks are clinical vigilance, early identification of potential severe complications, and treating the patients in a timely manner to avoid serious complications, as well as the active treatment to save lives when the complications happened.

Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial.

INTRODUCTION: Post total knee replacement pain control using parenteral opioids results in significant side effects like nausea and vomiting. Periarticular injections are used to control pain without these side effects. This study aimed to evaluate the safety and efficacy of periarticular steroid injection in patients undergoing total knee arthroplasty, as well as assess the patient's functional outcomes over a period of two years. METHODS: A total of 100 patients who underwent total knee arthroplasty were randomised into two groups. The treatment group received periarticular infiltration with triamcinolone acetonide, bupivacaine and epinephrine. The control group received only bupivacaine and epinephrine. The postoperative analgesic regime was standardised for all patients. The immediate postoperative outcomes evaluated included pain score, morphine consumption, time to ambulation, straight leg raise, range of motion and duration of hospital stay. Longer-term outcomes were assessed at 1, 3, 6 and 24 months using the SF-36 questionnaire and Oxford Knee Score. RESULTS: Patients in the treatment group had significantly lower pain scores, reduced morphine consumption and earlier discharge. They also had better range of knee motion and were able to regain muscular strength earlier. There was no increase in major complications such as infection or tendon rupture in the treatment group. There was no difference between the groups with regard to the medium-term outcomes of up to two years. CONCLUSION: This modality of pain control is safe and efficacious for post total knee replacement pain control.

AiiA-mediated quorum quenching does not affect virulence or toxoflavin expression in Burkholderia glumae SL2376.

AIM: The primary objective of this study was to determine the effects of quorum quenching in the pathogenicity and toxoflavin production of Burkholderia glumae causing bacterial rice grain rot. METHODS AND RESULTS: An acyl-homoserine lactonase (aiiA) gene from Bacillus sp. was expressed in B. glumae under the control of a constitutive promoter. Acyl-homoserine lactone production in the aiiA-transformants was reduced significantly, and the aiiA-expressing B. glumae strain reduced the severity of soft rot when the strain was co-inoculated with a soft-rot pathogen, Pectobacterium carotovorum ssp. carotovorum SCCI. However, the aiiA-transformant still caused rice seedling rot and rice grain rot. The aiiA-expressing strains had wild-type levels of transcription from the genes in the toxoflavin biosynthetic operon, and as well as wild-type levels of toxin production. CONCLUSIONS: Our results show that aiiA-mediated quorum quenching does not affect virulence or toxoflavin production in B. glumae. SIGNIFICANCE AND IMPACT OF THE STUDY: Indirect quorum quenching may prove an ineffective approach to the control of rice grain rot, because it reduces, but does not eliminate entirely homoserine lactones in B. glumae. Virulence of rice grain rot was retained despite reduction in homoserine lactones by the expression of aiiA in B. glumae.

Rasch analysis of the Oxford Knee Score.

OBJECTIVES: Use Rasch analysis to examine the psychometric properties of the Oxford Knee Score (OKS), particularly in respect to unidimensionality, and consistency of item functioning before and after total knee replacement and across age and gender groups. METHODS: The 12-item OKS was administered to 1,712 patients before the surgery, and 1,322 and 855 patients were administered the instrument repeatedly at the 6-month and 2-year postoperative assessments, respectively. Data were fitted to the Rasch partial credit model with the Winsteps program. Differential item functioning (DIF) analysis was performed, and fit statistics in combination with principal components analysis of the residuals were used to test the unidimensionality assumption. The fit criteria were set at 1.5 and 2.0 for infit mean-square (MNSQ) and outfit MNSQ, respectively. RESULTS: At baseline, item difficulty ranged from -1.86 to 1.78 logits, and person measures had a mean+/-SD of -0.01+/-0.89. Misfit items were "limping" and "night pain" in preoperative data and "limping" and "kneeling" in postoperative data. After removing items limping and kneeling and recoding item night pain, none of the items misfit at each of the time points and there was stability of item difficulty ordering across time. In the modified OKS set, five items displayed DIF by age and three by gender. CONCLUSION: The original OKS had adequate targeting and good coverage of knee severity levels in preoperative patients. The modified 10-item OKS data fit the Rasch model and had stable item difficulty ordering over time.

Thromboembolic prophylaxis for total knee arthroplasty in Asian patients: a randomised controlled trial.

PURPOSE: To compare the efficacy and safety of different modes of thromboembolic prophylaxis for elective total knee arthroplasty (TKA) in Asian patients. METHODS: 440 low-risk patients undergoing TKA were randomised into 4 equal groups: (1) no prophylaxis (control), (2) graduated compression stockings (GCS), (3) intermittent pneumatic compression (IPC), and (4) low-molecular-weight heparin (enoxaparin). Duplex ultrasonography was used as an assessment tool. RESULTS: The deep vein thrombosis point prevalence was highest in the control group (22%), which was significantly higher than in patients receiving IPC (8%, p=0.032) or enoxaparin (6%, p=0.001). One patient each in the control and GCS groups developed a non-fatal pulmonary embolism. Patients on enoxaparin received more blood transfusions and 2 of them had major bleeding complications. CONCLUSION: IPC is the preferred method of thromboprophylaxis for TKA in Asian patients.

Peri-articular steroid injection improves the outcome after unicondylar knee replacement: a prospective, randomised controlled trial with a two-year follow-up.

We have performed a prospective double-blind, randomised controlled trial over two years to evaluate the efficacy and safety of an intra-operative peri-articular injection of triamcinolone acetonide in patients undergoing medial unicondylar knee replacement. We randomised 90 patients into two equal groups. The study group received an injection of triamcinolone acetonide, bupivacaine, and epinephrine into the peri-articular tissues at the end of the operation. The control group received the same injection mixture but without the addition of triamcinolone. The peri-operative analgesic regimen was standardised. The study group reported a significant reduction in pain (p = 0.014 at 12 hours, p = 0.031 at 18 hours and p = 0.031 at 24 hours) and had a better range of movement (p = 0.023 at three months). There was no significant difference in the rate of infection and no incidence of tendon rupture in either group. The addition of corticosteroid to the peri-articular injection after unicondylar knee replacement had both immediate and short-term benefits in terms of relief from pain, and rehabilitation with no increased risk of infection.