Minimally Invasive Surgical Approaches and Traditional Total Hip Arthroplasty: A Meta-Analysis of Radiological and Complications Outcomes

BACKGROUND: Minimally invasive total hip arthroplasty (MITHA) remains considerably controversial. Limited visibility and prosthesis malposition increase the risk of post-surgical complications compared to those of the traditional method. METHODS: A meta-analysis was undertaken of all published databases up to May 2011. The studies were divided into four subgroups according to the surgical approach taken. The radiological outcomes and complications of minimally invasive surgery were compared to traditional total hip arthroplasty (TTHA) using risk ratio, mean difference, and standardized mean difference statistics. RESULTS: In five studies involving the posterolateral approach, no significant differences were found between the MITHA groups and the TTHA groups in the acetabular cup abduction angle (p = 0.41), acetabular anteversion (p = 0.96), and femoral prosthesis position (p = 0.83). However, the femoral offset was significantly increased (WMD = 3.00; 95% CI, 0.40-5.60; p = 0.02). Additionally, there were no significant differences among the complications in both the groups (dislocations, nerve injury, infection, deep vein thrombosis, proximal femoral fracture) and revision rate (p>0.05). In three studies involving the posterior approach, there were no significant differences in radiological outcomes or all other complications between MITHA or TTHA groups (p>0.05). Three studies involved anterolateral approach, while 2 studies used the lateral approach. However, the information from imaging and complications was not adequate for statistical analysis. CONCLUSIONS: Posterior MITHA seems to be a safe surgical procedure, without the increased risk of post-operative complication rates and component malposition rates. The posterolateral approach THA may lead to increased femoral offset. The current data are not enough to reach a positive conclusion that lateral and anterolateral approaches will result in increased risks of adverse effects and complications at the prosthesis site

Effectiveness of initiating biologics in severe asthma patients with high steroid exposure

Peer reviewedPostprin

Biomarker-defined clusters by level of Type 2 inflammatory involvement in severe asthma

Peer reviewedPostprin

Major ion chemistry and weathering processes of the Danjiangkou Reservoir, China

A total of 40 water samples were collected from five sites in the Danjiangkou Reservoir, an important drinking water source in China. Over the period November 2004–June 2006, eight field surveys were conducted and water temperature, pH, EC, major ions (Na+, K+, Ca2+, Mg2+, Cl- , SO2- 4 and HCO- 3 ) and Si were monitored to determine their temporal and spatial patterns across the reservoir. The controlling factors were analysed using the stoichiometry of the water chemicals and multivariate statistics including a correlation matrix and analysis of variance. The results revealed that waters in the reservoir are sub-alkaline and have a low solute load, and most water variables exhibit notable spatial and temporal variations. The major ion chemistry of the reservoir was controlled by carbonate weathering (of limestone) with the dominant ions Ca2+ and HCO- 3 contributing 63–81% and 73–81% to the major cation and anion budgets, respectively. Carbonate dissolution was produced by both sulfuric and carbonic acids; in particular carbonic acid and silicate contributed little to the reservoir waters, while SO2- 4 was important and originated primarily from anthropogenic inputs. This research will help water quality conservation in the Danjiankou Reservoir, China

Redesign of a cross-reactive antibody to dengue virus with broad-spectrum activity and increased in vivo potency

Affinity improvement of proteins, including antibodies, by computational chemistry broadly relies on physics-based energy functions coupled with refinement. However, achieving significant enhancement of binding affinity (>10-fold) remains a challenging exercise, particularly for cross-reactive antibodies. We describe here an empirical approach that captures key physicochemical features common to antigen–antibody interfaces to predict protein–protein interaction and mutations that confer increased affinity. We apply this approach to the design of affinity-enhancing mutations in 4E11, a potent cross-reactive neutralizing antibody to dengue virus (DV), without a crystal structure. Combination of predicted mutations led to a 450-fold improvement in affinity to serotype 4 of DV while preserving, or modestly increasing, affinity to serotypes 1–3 of DV. We show that increased affinity resulted in strong in vitro neutralizing activity to all four serotypes, and that the redesigned antibody has potent antiviral activity in a mouse model of DV challenge. Our findings demonstrate an empirical computational chemistry approach for improving protein–protein docking and engineering antibody affinity, which will help accelerate the development of clinically relevant antibodies.National Institutes of Health (U.S.) (Grant R37 GM057073-13

The establishment of COPD organoids to study host-pathogen interaction reveals enhanced viral fitness of SARS-CoV-2 in bronchi

Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation and infective exacerbations, however, in-vitro model systems for the study of host-pathogen interaction at the individual level are lacking. Here, we describe the establishment of nasopharyngeal and bronchial organoids from healthy individuals and COPD that recapitulate disease at the individual level. In contrast to healthy organoids, goblet cell hyperplasia and reduced ciliary beat frequency were observed in COPD organoids, hallmark features of the disease. Single-cell transcriptomics uncovered evidence for altered cellular differentiation trajectories in COPD organoids. SARS-CoV-2 infection of COPD organoids revealed more productive replication in bronchi, the key site of infection in severe COVID-19. Viral and bacterial exposure of organoids induced greater pro-inflammatory responses in COPD organoids. In summary, we present an organoid model that recapitulates the in vivo physiological lung microenvironment at the individual level and is amenable to the study of host-pathogen interaction and emerging infectious disease.Ministry of Health (MOH)National Medical Research Council (NMRC)National Research Foundation (NRF)Published versionThis research was supported by the National Research Foundation Singapore under its COVID-19 Research Fund administered by the Singapore Ministry of Health’s National Medical Research Council (MOH000409) (to S.H.C) and National Medical Research Council COVID19RF2-0006 (to L-F.W and D.E.A.) and by the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist Award (CSA) (MOH-000710) (S.H.C)