Comparison of direct anterior approach and posterolateral approach in supine position for total hip arthroplasty / 中国组织工程研究

BACKGROUND: The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty. In recent years, total hip replacement by direct anterior approach has been applied in clinic gradually, and has achieved good treatment outcomes. OBJECTIVE: To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty. METHODS: Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included, including 35 males and 55 females, aged 35-70 years. The patients were divided into direct anterior approach group (n=45) and posterolateral approach group (n=45) by the random number table method. Postoperative follow-up was used to evaluate the Harris hip scores, Visual Analogue Scale scores, initial fixation mass of prosthesis and safe range of the cup. The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 3-51 months, with an average 14 months. There were 2 cases of intraoperative great trochanteric fracture, 1 case of femoral lateral cutaneous nerve injury, 4 cases of femoral nerve injury, and 20 cases of tensor fascia lata injury. No such complications occurred in the posterolateral approach group. (2) The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery (P 0.05). (3) In the direct anterior approach group, the femoral prosthesis of 44 hips was in neutral position, and 1 hip was in varus position. The initial fixation quality of all prosthesis was excellent. In the posterolateral approach group, the femoral prosthesis of 43 hips was in neutral position, 2 hips were in varus position and all prosthesis initial fixation quality was excellent. No significant difference was found between two groups (P > 0.05). (4) The ratio of acetabular cups in the safety range of Lewinnek in the direct anterior approach group was higher than that in the posterolateral approach group (100%, 82%, P < 0.05). (5) These results imply that compared with the posterolateral approach, direct anterior approach in supine position for total hip arthroplasty can significantly reduce postoperative pain, promote postoperative early rapid recovery, obtain more accurate angle of the acetabular prosthesis, and be more conducive to the equalization of both lower limbs. It is a safe and reliable approach. However, direct anterior approach has certain technical difficulty and needs a learning curve. And there are some complications different from other approaches.

Associations of polymorphisms of methionine synthase A2756G and methionine synthase reductase G66A with the risks of coronary artery disease: a meta-analysis / 中华预防医学杂志

<p><b>OBJECTIVE</b>To evaluate the associations between polymorphisms of methionine synthase(MTR) A2756G and methionine synthase reductase(MTRR) G66A and risk of coronary artery disease.</p><p><b>METHODS</b>Literatures in Medline reporting the relationship between polymorphisms of MTR A2756G and MTRR G66A and risk of coronary artery disease from January 1990 to May 2010 were searched. A total of 14 relevant articles were selected and 13 of them met the criteria. A Meta-analysis was performed to estimate the pooled odds ratio (OR) to evaluate the relationship between polymorphisms of MTR A2756G and MTRR G66A and risk of coronary artery disease. All analyses were performed using the STATA statistical software.</p><p><b>RESULTS</b>Among the 13 studies, eight case-control studies containing 2143 cases of coronary artery disease and 2270 controls were included in the analysis of MTR A2756G and risk of coronary artery disease. Meanwhile, five case-control studies with 811 cases of coronary artery disease and 387 controls were included in the analysis of MTRR G66A and risk of coronary artery disease. In the analysis of MTRR G66A related to the risk of coronary artery disease, there were 246 GG carries, 397 AG carriers and 168 AA carriers in the group of coronary artery disease, against 102 GG carriers, 203 AG carriers and 82 AA carriers in the control group. Compared with the MTRR GG carriers, the risk of coronary artery disease decreased significantly by 27% (OR = 0.73, 95%CI: 0.54 - 0.99) and 25% (OR = 0.75, 95%CI: 0.56 - 1.00) (Egger's test t = -0.19, P = 0.862) in the MTRR 66 AG and AG/AA carriers, respectively, and also decreased in the MTRR AA carriers but significant difference was observed (OR = 0.84, 95%CI: 0.42 - 1.68). There was no significant association between coronary artery disease and MTR A2756G.</p><p><b>CONCLUSION</b>These results suggest that MTRR66 may play a role in coronary artery disease susceptibility. MTRR 66 A allele carries are associated with a statistically significant decreased risk of coronary artery disease susceptibility.</p>

TLR4-MD2 signaling pathway induced by endotoxin / 中国药理学通报

Recent evidence suggests Toll-like receptor 4 (TLR4) and its accessory protein MD2 mediate endotoxin/lipopolysaccharide (LPS) signaling. LPS binds to LPS binding protein (LBP) in plasma and is delivered to CD14. Next, LPS is transferred to TLR4-MD2 complex. LPS activates several intracellular signaling pathways that include the NF-κB pathway and three mitogen-activated peotein kinase (MAPK) pathway: extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) and p38. These signaling pathways in turn activate NF-κB and AP-1 (c-fos/c-jun), which coordinate the induction of many genes encoding inflammatory mediators. Targeting the signaling molecule in the pathway will develop new remedies for treatment of inflammatory disorder.