Temporal structured illumination and vision-transformer enables large field-of-view binary snapshot ptychography.

Ptychography, a widely used computational imaging method, generates images by processing coherent interference patterns scattered from an object of interest. In order to capture scenes with large field-of-view (FoV) and high spatial resolution simultaneously in a single shot, we propose a temporal-compressive structured-light Ptychography system. A novel three-step reconstruction algorithm composed of multi-frame spectra reconstruction, phase retrieval, and multi-frame image stitching is developed, where we employ the emerging Transformer-based network in the first step. Experimental results demonstrate that our system can expand the FoV by 20× without losing spatial resolution. Our results offer huge potential for enabling lensless imaging of molecules with large FoV as well as high spatial-temporal resolutions. We also notice that due to the loss of low-intensity information caused by the compressed sensing process, our method so far is only applicable to binary targets.

Multi-focused electric and magnetic field sourcing from an azimuthally polarized vortex circular hyperbolic umbilic beam.

In this paper, one kind of multi-focusing electric and magnetic field which is sourced from an azimuthally polarized vortex circular hyperbolic umbilic beam (APVCHUB) is presented. After passing through a high NA objective, both the electric and magnetic fields of the APVCHUBs will focus multiple times, and a high-purity longitudinal magnetic field (p q =80%) will be generated. Besides, the mutual induction of the vortex phase and azimuthal polarization changes the electric and magnetic fields' vibration state and intensity distribution, making the longitudinal magnetic field carry an m-order concentric vortex. Our findings suggest that the APVCHUB could have potential applications in magnetic particle manipulation, extremely weak magnetic detection, data storage, semiconductor quantum dot excitation, etc.

Autofocusing field constructed by ring-arrayed Pearcey Gaussian chirp beams.

In this work, we propose and demonstrate the ring-arrayed Pearcey Gaussian chirp beams (RAPGCBs) synthesized by multiple two-dimensional Pearcey beams. The general analytical formula for the propagation of RAPGCBs is presented. We find that, depending on synthesized number n, the profiles of the beams present different polygonal shapes, and the autofocusing properties can be controlled by chirp factor ß. Furthermore, we study the properties of the RAPGCBs carrying optical vortices (OVs). It shows that a single OV or two positive OVs form an autofocusing hollow field, and opposite OVs will annihilate, which results in greatly increased autofocusing ability. Our experimental results agree with the simulations. Such beams have potential applications in particle trapping and biology medical fields.

Multi-focus autofocusing circular hyperbolic umbilic beams.

We propose and demonstrate a type of multi-focus autofocusing beams, circular hyperbolic umbilic beams (CHUBs), based on the double-active variable caustics in catastrophe theory. The mathematical form is more general compared to circular Airy, Pearcey and swallowtail beams. The CHUBs can generate multi-focus at its optical axis, while the on-axis intensity fluctuates up to two orders of magnitude that of the maximum intensity in the initial plane. Using the concept of topographic prominence, we quantify the autofocusing ability. We construct the criteria for selecting the effective foci, and then explore the influence of related parameters. Our findings suggest that the CHUBs could be a suitable tool for multi-particle manipulation, optical tweezers, optical lattices and related applications.

Acoustic regularities in infant-directed speech and song across cultures.

When interacting with infants, humans often alter their speech and song in ways thought to support communication. Theories of human child-rearing, informed by data on vocal signalling across species, predict that such alterations should appear globally. Here, we show acoustic differences between infant-directed and adult-directed vocalizations across cultures. We collected 1,615 recordings of infant- and adult-directed speech and song produced by 410 people in 21 urban, rural and small-scale societies. Infant-directedness was reliably classified from acoustic features only, with acoustic profiles of infant-directedness differing across language and music but in consistent fashions. We then studied listener sensitivity to these acoustic features. We played the recordings to 51,065 people from 187 countries, recruited via an English-language website, who guessed whether each vocalization was infant-directed. Their intuitions were more accurate than chance, predictable in part by common sets of acoustic features and robust to the effects of linguistic relatedness between vocalizer and listener. These findings inform hypotheses of the psychological functions and evolution of human communication.

The Lineage Differentiation and Dynamic Heterogeneity of Thymic Epithelial Cells During Thymus Organogenesis.

Although much progress has been made recently in revealing the heterogeneity of the thymic stromal components, the molecular programs of cell lineage divergency and temporal dynamics of thymic epithelial cell (TEC) development are largely elusive. Here, we constructed a single-cell transcriptional landscape of non-hematopoietic cells from mouse thymus spanning embryonic to adult stages, producing transcriptomes of 30,959 TECs. We resolved the transcriptional heterogeneity of developing TECs and highlighted the molecular nature of early TEC lineage determination and cortico-medullary thymic epithelial cell lineage divergency. We further characterized the differentiation dynamics of TECs by clarification of molecularly distinct cell states in the thymus developing trajectory. We also identified a population of Bpifa1+ Plet1+ mTECs that was preserved during thymus organogenesis and highly expressed tissue-resident adult stem cell markers. Finally, we highlighted the expression of Aire-dependent tissue-restricted antigens mainly in Aire+ Csn2+ mTECs and Spink5+ Dmkn+ mTECs in postnatal thymus. Overall, our data provided a comprehensive characterization of cell lineage differentiation, maturation, and temporal dynamics of thymic epithelial cells during thymus organogenesis.

[Early incision, decompression and screw fixation for the treatment of Lisfranc injuries with foot osteofascial compartment syndrome].

OBJECTIVE: To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome. METHODS: Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect. RESULTS: All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor. CONCLUSION: Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.

Surgical or nonsurgical treatment for nontraumatic rotator cuff tears: Study protocol clinical trial.

BACKGROUND: The optimal treatment for symptomatic, nontraumatic rotator cuff tear is unknown. The primary aim of this randomized controlled trial is to compare functional improvement after surgical and conservative treatment of nontraumatic rotator cuff tears. METHODS: This is a single-centre, randomized clinical trial with a follow-up of 12 months. Patients older than 18 years with magnetic resonance imaging - confirmed nontraumatic rotator cuff tears that are suitable for either surgery or nonsurgery treatment is enrolled. The primary outcome is Constant score. Secondary outcome measures include visual analog scale (VAS) score, patient satisfaction, and American Shoulder and Elbow Surgeons (ASES) score. All scores are assessed by an independent observer who is blinded to the allocation of groups. RESULTS: The study will provide much needed data on surgical vs nonsurgical treatment for nontraumatic rotator cuff tears. Results of this study may help patients, clinicians, and policy makers assess the pivotal question on comparative effectiveness of surgery vs nonsurgical for rotator cuff tears. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5442).

Selective inhibition of cyclooxygenase-2 protects porcine aortic endothelial cells from human antibody-mediated complement-dependent cytotoxicity.

BACKGROUND: Cyclooxygenase-2 (COX-2) is an inducible enzyme with catalytic activity for biosynthesis of prostaglandins which are the key mediators of inflammation. COX-2 is also the therapeutic target for widely used non-steroidal anti-inflammatory drugs (NSAIDs). However, the involvement of COX-2 in xenotransplantation (eg, pig-to-non-human primate) remains poorly recognized. METHODS: We investigated the mechanisms that regulate COX-2 expression and the effects of COX-2 on porcine aortic endothelial cell (PAEC) viability using in vitro pig-to-primate xenotransplantation model and in vivo pig-to-mouse cellular transplant model. Regulation of COX-2 expression was assessed by real-time quantitative polymerase chain reaction (qPCR) and Western blotting. The effects of inhibition or downregulation of COX-2 on PAEC viability were assessed by propidium iodide (PI)-Annexin V staining and Cell Counting Kit-8 assay. RESULTS: Human serum triggered robust COX-2 expression in PAECs in a dose- and time-dependent manner. Induction of COX-2 expression by human serum was partially through activation of both canonical and non-canonical nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κb) signaling and increasing intracellular calcium. Cytokines like tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß), IL-17, were able to induce COX-2 expression. Selective inhibition of COX-2 by celecoxib dramatically decreased PAEC death in vitro and in vivo as defined by propidium iodide (PI)-Annexin V staining. Consistently, downregulation of COX-2 expression by NF-κb inhibitors or calcium chelator BAPTA decreased human serum-induced PAEC death as well. Silencing of COX-2 expression by small interfering RNA (siRNA) protected PAEC viability when transplanted under kidney capsule of C57BL/6 mice. CONCLUSIONS: Taken together, our data suggest that COX-2 is highly induced in PAECs by xenogenic serum and associated with human antibody-mediated complement-dependent cytotoxicity. COX-2 might be a potential therapeutic target to improve xenotransplantation.

Enhanced biological properties of biomimetic apatite fabricated polycaprolactone/chitosan nanofibrous bio-composite for tendon and ligament regeneration.

The development of tailored nanofibrous scaffolds for tendon and ligament tissue engineering has been a goal of clinical research for current researchers. Here, we establish a formation of novel nanofibrous matrix with significant mechanical and biological properties by electro-spinning process. The fine fibrous morphology of the nanostructured hydroxyapatite (HAp) dispersed in the polycaprolactone/chitosan (HAp-PCL/CS) nanofibrous matrix was exhibited by microscopic (SEM and TEM) techniques. The favorable mechanical properties (load and modulus) were achieved. The load and modulus of the HAp-PCL/CS composite fibers was 250.1N and 215.5MPa, which is very similar to that of standard value of the human tendon and ligament tissues. The cellular responses and biocompatibility of HAp-PCL/CS nanofibrous scaffolds were investigated with human osteoblast (HOS) cells for tendon regeneration and examined the primary osteoblast mechanism by in vitro method. The morphological (FE-SEM and fluorescence) microscopic images clearly exhibited that HOS cells are well attached and flatted on the nanofibrous composites. The HAp dispersed PCL/CS nanofibrous scaffolds promoted higher adhesion and proliferation of HOS cells comparable to the nanofibrous scaffolds without HAp nanoparticles. The physic-chemical and biological properties of the synthesized nanofibrous scaffold were very close to that of normal ligament and tendon in human body. Over all, these studied results confirmed that the prepared nanofibrous scaffolds will be effective biomaterial of tendon ligament regeneration applications.

[Preparation and biocompatibility of a novel strontium-containing calcium sulfate].

OBJECTIVE: To prepare a novel strontium-containing calcium sulfate and assess its and biocompatibility. METHODS: A novel strontium-containing α-calcium sulfate hemihydrate (Sr-caS) bone substitute as prepared with hydrothermal reaction and examined for X-ray diffraction (XRD), Fourier transform infrared (FTIR) and thermogravimetric differential scanning calorimetric (TG-DSC) patterns. The biocompatibility of the material was evaluated by in vitro cytotoxicity test in L-929 cells, hemolysis test of blood, and in vivo implantation test in SD rats. RESULTS: The XRD spectra of the prepared Sr-CaS powder highlighted 3 strong characteristic peaks of α-CaSO4 at 14.63°, 25.72° and 29.80° with a strontium-specific peak at 24.78°. The FTIR patterns of Sr-CaS resembled those of CaS. TG-DSC results showed that the material contained a non-evaporable water content of 6.03%. In vitro cytotoxicity test in L-929 cells suggested that the material had a class 1 cytotoxicity, and the hemolysis rate of its aqueous extract was 4.3%. The material implanted in the muscular tissues of SD rats maintained a steady state in the surrounding tissues. CONCLUSION: This strontium-containing calcium sulfate material we prepared shows an excellent biocompatibility for potential use as a novel artificial bone material.

Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis.

OBJECTIVE: The aim of this study was to compare the effect of operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients regarding clinical results, complications, and additional surgeries. METHODS: Six electronic databases (Medline, Embase, Clinical, Ovid, Biosos, and Cochrane Central Register of Controlled Trials) were systematically searched to identify randomized controlled trials (RCTs). Eligible RCTs published between 1960-2012 comparing operative vs. nonoperative treatment of comminuted proximal humeral fractures were included. Trial quality was assessed using the modified Jadad scale. Data from included studies were pooled with the use of fixed-effects and random-effects models with mean difference and risk ratios for continuous and dichotomous variables, respectively. Sensitivity analysis was performed to account for bias in patient selection. RESULTS: Six studies matched the selection criteria, reporting on 287 patients. One hundred fourty-four patients (50.17%) were managed nonoperatively, 20 patients (6.97%) underwent tension band fixation, 55 patients (19.16%) were treated with locked plate, and 68 patients (23.69%) underwent hemiarthroplasty. Mean follow-up ranged from 12-50 months. Results showed no significant difference in post-treatment Constant scores and DASH scores, but conservative treatment showed superior results compared to operative treatment using EQ-5D™. Compared with operative treatment, nonoperative treatment led to significantly fewer complications and additional surgeries. Findings from subgroup analyses remained consistent with these outcomes when compared to nonoperative treatment with tension band fixation, locked plate fixation, and hemiarthroplasty. CONCLUSION: Compared with operative treatment for closed comminuted proximal humeral fractures in elderly patients, conservative treatment can effectively reduce the risk of additional surgeries and complications. However, there is no statistical difference between operative and nonoperative treatment in terms of clinical outcomes.

Treatment with recombinant lubricin attenuates osteoarthritis by positive feedback loop between articular cartilage and subchondral bone in ovariectomized rats.

Osteoarthritis (OA) is a most commonly multifactorial degenerative joint disease along with the aging population, particularly in postmenopausal women. During the onset of OA, articular cartilage and subchondral bone act in concert as a functional unit. This present study is to investigate the effects of early or late treatment with recombinant lubricin on the onset of osteoarthritis (OA) in ovariectomized (OVX) rats. We found that both early and late recombinant lubricin treatments attenuated the onset of OA by positive feedback loop between articular cartilage and subchondral bone, although late treatment contributed to a lesser effect compared with early treatment. Specifically, treatment with recombinant lubricin protected articular cartilage from degeneration, demonstrated by lower proteoglycan loss, lower OARSI scores, less calcification cartilage zone and reduced immunostaining for collagen X (Col X) and matrix metalloproteinase (MMP-13) but increased the expression of lubricin, in comparison with vehicle-treated OVX rat group. Further, chondroprotective effects of lubricin normalized bone remodeling in subchondral bone underneath. It's suggested that treatment with recombinant lubricin inhibited the elevation of TRAP and Osterix positive cells in OVX rats and led to the normalization of subchondral bone microarchitectures with the suppression of subsidence of bone volume ratio (BV/TV) and trabecular thickness (Tb.Th) and the increase of trabecular separation (Tb.Sp) in vehicle-treated OVX rats. What's more, the normalization of subchondral bone in turn attenuated the articular cartilage erosion by inhibiting vascular invasion from subchondral bone to calcified cartilage zone, exemplified by inhibiting the elevation of CD31 positive cells in calcified cartilage and angiography in subchondral bone. Together, these results shed light that both early and late recombinant lubricin treatments attenuate the onset of OA by balancing the interplay between articular cartilage and subchondral bone in OVX rats, while also providing a further rationale for its therapeutic targeting to postmenopausal OA and suggesting that treatment timing is a pivotal factor for better effect acquisition.

A novel resorbable strontium-containing α-calcium sulfate hemihydrate bone substitute: a preparation and preliminary study.

Distraction osteogenesis after aggrieved bone segment resections is promising in the treatment of bone tumors and osteomyelitis. However, there is ambiguity with regard to the optimal choice of bone substitute, with biodegradability and excellent bone repair performance constituting key requirements. The purpose of this study was to develop a novel resorbable strontium-containing α-calcium sulfate hemihydrate (Sr-CaS) bone substitute to provide an alternative option for surgeons that better meets these requirements. The Sr-CaS was prepared using co-precipitation and hydrothermal methods and analyzed using x-ray diffraction (XRD), Fourier transform infrared (FTIR) scanning and thermogravimetric differential scanning calorimeter (TG-DSC) patterns. Cytotoxicity by tetrazolium bromide (MTT), sub-acute toxicity and hemolysis tests were performed to assess the initial biocompatibility of the new bone substitute. Radiographic analysis, micro-CT measurements and histological observation were used to evaluate the bone repair ability in rat tibia bone defects. The XRD and FTIR patterns of Sr-CaS were both very similar to CaS and the product had comparable characteristics similar to α-CaS as demonstrated by TG-DSC. Cytotoxicity of the substitute was class 1 (no cytotoxicity) and hemolysis was 4.3% (no hemolysis). Sub-acute toxicity was not seen after a 14 day evaluation. The substitute was radio-opaque. The empty group exhibited the lowest levels of both bone mineral densities (BMD) and bone volume/total volume (BV/TV) of the defects when compared to all other groups. The two Sr-CaS groups resulted in significantly greater BMDs and BV/TV of the defect compared to the CaS only group. However, there was no significant difference between the 5% and 10% Sr-CaS groups. The Sr-CaS was resorbable with satisfactory biocompatibility. The doped strontium ions enhanced the bone repair performance of CaS in a rat model and the new substitute demonstrated promising results for clinical use.

Are platelet concentrates an ideal biomaterial for arthroscopic rotator cuff repair? A meta-analysis of randomized controlled trials.

PURPOSE: The present study aims to conduct a meta-analysis of Level I evidence studies to investigate the efficacy of concomitant platelet concentrate (PC) used in arthroscopic rotator cuff repair. METHODS: We systematically searched electronic databases to identify randomized controlled trials (RCTs) evaluating the role of PC augmentation in arthroscopic rotator cuff repairs for patients with full-thickness tears. The search strategy followed the requirements in the Cochrane Library Handbook. The primary outcome was retearing of the rotator cuff. Functional outcomes were analyzed in terms of Constant score, specific Constant pain score, University of California, Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST) score, and American Shoulder and Elbow Surgeons (ASES) score. RESULTS: Seven studies with a total of 417 patients available at the latest follow-up reporting data about retears were analyzed in this meta-analysis. However, 4 studies with Constant scores (n = 237), 3 studies with UCLA scores (n = 168), 2 studies with Constant pain scores (n = 164), 2 studies with ASES scores (n = 101), and 2 studies with SST scores (n = 121) were analyzed. The retear rates and functional scores showed that there was no significant efficacy of PC application in arthroscopic rotator cuff repairs. CONCLUSIONS: This meta-analysis of high-level evidence suggests that PCs have no benefit regarding retear rate and overall clinical outcomes for the arthroscopic repair of full-thickness rotator cuff tears. LEVEL OF EVIDENCE: Level II, meta-analysis of randomized controlled trials.

Efficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trials.

PURPOSE: To examine the efficacy and safety of single-dose local infiltration of analgesia (LIA) for post-operative pain relief in total knee arthroplasty (TKA) patients. METHODS: A systematic electronic literature search (up to Aug 2013) was conducted to identify the RCTs that address the efficacy and safety of single-dose LIA in the pain management after TKA. Subgroup analysis was conducted to determine changes of visual analog score (VAS) values at six different postoperative time points. Weighted mean differences or relative risks with accompanying 95% confidence intervals were calculated and pooled using a random effect model. RESULTS: Eighteen trials involving 1858 TKA patients met the inclusion criteria. The trials were liable to medium risk of bias. The VAS values at postoperative 2h, 4h, 6h, 12h, 24h, and 48h per patient were significantly lower in the LIA group than in the placebo group, and the former group also had less morphine consumption and better early functional recovery including range of motion, time to straight leg raise and 90° knee flexion than the latter group. No significant difference in length of hospital stay or side effects was detected between the two groups. CONCLUSIONS: The current evidence shows that the use of single-dose LIA is effective for postoperative pain management in TKA patients, with satisfactory short-term safety. More high-quality RCTs with long-term follow-ups are required for examining the long-term safety of single-dose LIA. LEVEL OF EVIDENCE: I, II.

Effect of treadmill exercise timing on repair of full-thickness defects of articular cartilage by bone-derived mesenchymal stem cells: an experimental investigation in rats.

OBJECTIVE: Current medical practice for the treatment of articular cartilage lesions remains a clinical challenge due to the limited self-repair ability of articular cartilage. Both experimental and clinical researches show that moderate exercise can improve articular cartilage repair process. However, optimal timing of moderate exercise is unclear. We aimed to evaluate the effect of timing of moderate treadmill exercise on repair of full-thickness defects of articular cartilage. DESIGN: Full-thickness cartilage defects were drilled in the patellar groove of bilateral femoral condyles in a total of 40 male SD rats before they were randomly assigned into four even groups. In sedentary control (SED) group, no exercise was given; in 2-week (2W), 4-week (4W) and 8-week groups, moderate treadmill exercise was initiated respectively two, four and eight weeks after operation. Half of the animals were sacrificed at week 10 after operation and half at week 14 after operation. Femoral condyles were harvested for gross observation and histochemical measurement by O'Driscoll scoring system. Collagen type II was detected by immunohistochemistry and mRNA expressions of aggrecan and collagen type II cartilage by RT-PCR. RESULTS: Both 10 and 14 weeks post-operation, the best results were observed in 4W group and the worst results appeared in 2W group. The histochemistry scores and the expressions of collagen type II and aggrecan were significantly higher in 4W group than that in other three groups (P<0.05). CONCLUSIONS: Moderate exercise at a selected timing (approximately 4 weeks) after injury can significantly promote the healing of cartilage defects but may hamper the repair process if performed too early while delayed intervention by moderate exercise may reduce its benefits in repair of the defects.

[Effects of exercise of different intensity on early repair of full-thickness articular cartilage defects and expressions of MMP-3 and TIMP-1 in rats].

OBJECTIVE: To evaluate the effects of treadmill running exercise of different intensity on early repair of full-thickness defects on the patellofemoral articular surface and the changes in the expressions of matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in SD rats. METHODS: Twenty-four male SD rats with full-thickness defects on the patellofemoral articular surface were randomly assigned into sedentary control (SED) group and low-, moderate- and high-intensity running groups (LIR, MIR, and HIR groups, respectively). The running groups were trained on treadmill for 6 consecutive weeks. Blood samples were collected to detect serum MMP-3 and TIMP-1 levels using ELISA before and after the experiment, and the femoral trochlea were collected to assess tissue repair by gross appearance scoring and O Driscoll histological scoring with Safranine O-Fast Green staining and Toluidine blue staining. RESULTS: In rats in SED group, the defect was filled with hyaline articular cartilage-like tissues, as compared to fibrous tissues in LIR and MIR groups and subchondral bone damage in HIR group. The SED group scored the highest and HIR group the lowest among the 4 groups in gross appearance scoring and O Driscoll histological scoring. No significant differences were found in MMP-3 or TIMP-1 levels among the groups before training (P>0.05), but after 6 weeks of training, serum MMP-3 and TIMP-1 levels differed significantly among the 4 groups (P<0.05), and all the 3 running groups had a significantly higher MMP-3 level than the control group (P<0.05). After the 6-week training, TIMP-1/MMP-3 ratio was significantly higher in SED group than in the 3 running groups, and was the lowest in HIR group. CONCLUSION: Both low- and moderate-intensity exercise failed to promote resurfacing of full-thickness cartilage defects on the patellofemoral articular surface in rats, and high-intensity exercise even induces subchondral bone damage. The expression of MMP-3 and TIMP-1 is related to exercise, and the TIMP-1/MMP-3 ratio reflects the extent of tissue repair.

Mini-incision versus standard incision total hip arthroplasty regarding surgical outcomes: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: It remains controversial whether mini-incision (MI) benefits patients in total hip arthroplasty (THA). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of MI on surgical and functional outcomes in THA patients. METHODS: A systematic electronic literature search (up to May 2013) was conducted to identify RCTs comparing MI with standard incision (SI) THA. The primary outcome measures were surgical and functional outcomes. According to the surgical approach taken, MI THA patients were divided into four subgroups for sub-group meta-analysis. Standardized mean differences (SMDs) or risk differences (RDs) with accompanying 95% confidence intervals (CIs) were calculated and pooled using a fixed-effect or random-effect model according to the heterogeneity. RESULTS: A total of 14 RCTs involving THA 1,174 patients met the inclusion criteria. The trials were medium risk of bias. The overall meta-analysis showed MI THA reduced total blood loss (95% CI, -201.83 to -21.18; p=.02) and length of hospital stay ( 95% CI, -0.67 to -0.08; p=.01) with significant heterogeneity. However, subgroup meta-analysis revealed posterior MI THA had perioperative advantages of reduced surgical duration ( 95% CI, -8.45 to -2.67; P<.001), less blood loss ( 95% CI, -107.20 to -1.73; P=.04) and shorter hospital stay ( 95% CI, -0.74 to -0.06; p=.002) with low heterogeneity. There were no significant differences between MI and SI THA groups in term of pain medication dose, functional outcome (HHS), radiological outcome or complications (P>.05, respectively). CONCLUSIONS: Although no definite overall conclusion can be arrived at on whether MI THA is superior to SI THA, posterior MI THA clearly result in a significant decrease in surgical duration, blood loss and hospital stay. It seems to be a safe minimally invasive surgical procedure without increasing the risk of component malposition or complications.