BACKGROUND:It is stil controversial whether computer-assisted navigation elevated the accuracy and clinical outcomes of total knee arthroplasty.
OBJECTIVE:To analyze the literatures in English and Chinese on computer-assisted navigation total knee arthroplasty, and to evaluate the clinical outcomes between computer-assisted navigation and conventional total knee arthroplasty.
METHODWe retrieved PubMed, Ovid, Elsevier, China National Knowledge Infrastructure and Digital Library for literatures concerning randomized control ed trial of clinical outcomes of computer-assisted navigation and total knee arthroplasty published from January 1st 2005 to December 31st 2013. Meta analysis was performed with RevMan 5.0 software from the Cochrane col aboration. Clinical outcomes of computer-assisted navigation total knee arthroplasty and conventional technique were compared. The heterogeneity of data was checked.
RESULTS AND CONCLUSION:A total of 16 randomized control ed papers were included in this analysis. Computer-assisted navigation group consisted of 1 322 knees, and the conventional group consisted of 1 299 knees. Compared with the conventional group, patients in the computer-assisted navigation group had a significantly lower risk of implant malalignment at more than 3° as wel as more than 2°, malalignment for both coronal femoral component and coronal tibial component of>3°, and both sagittal femoral component alignment and tibial slope at>3° malalignment. The meta-analysis did not find a significant difference in the sagittal tibial component alignment, the rates of complications, axial (rotational) alignment of the femoral component and the tibial component between both groups. These data indicated that computer-assisted navigation group had significant improvement in alignment of the limb and the component position, but long-term clinical outcomes using computer-assisted surgery in total knee arthroplasty require further investigation.

BACKGROUND:Whether tranexamic acid can effectively and safely reduce blood loss and al ogeneic transfusion rate in total hip arthroplasty remains controversial at present. OBJECTIVE:To assess the efficacy and safety of tranexamic acid administration in total hip arthroplasty using meta-analysis. METHODS:Clinical randomized control ed trials concerning tranexamic acid application in total hip arthroplasty published from January 1969 to December 2013 were retrieved from the PubMed, Ovid, Elsevier, Cochrane library, China National Knowledge Infrastructure and Wanfang database. Intraoperative blood loss, postoperative blood loss, total blood loss, al ogeneic transfusion rate and incidence of venous thromboembolism were compared using meta-analysis between the tranexamic acid and control groups. Detection and literature references were used as supplementary data. RevMan 5.0 software provided by Cochrane col aboration was used for meta-analyses. Conclusion was obtained according to analysis. The analysis checked the heterogeneity of data. RESULTS AND CONCLUSION:After comprehensive and rigorous screening, 19 high-quality (Jadad score not less than 3) randomized control ed studies were included. Meta-analysis results demonstrated that compared with the control group, tranexamic acid decreased the total blood loss [weighted mean difference (WMD)=-341.04, 95%confidence interval (CI) (-508.10,-173.97), P<0.001], intraoperative blood loss [WMD=-63.26, 95%CI (-111.33,-15.18), P=0.01] and postoperative blood loss [WMD=-229.53, 95%CI (-338.11,-120.94), P<0.000 1], and diminished al ogeneic transfusion rate [relative risk=0.45, 95%CI (0.35, 0.57), P<0.000 1] in patients undergoing total hip arthroplasty. No significant difference in incidence of venous thromboembolism was detectable. These data suggested that tranexamic acid could reduce blood loss and transfusion rate in patients undergoing total hip arthroplasty without increasing the risk of incidence of venous thromboembolism.

When Playmonas cardiformis is exposed to different ZnSO4 concentration, its growth rate decreases gradually with the increase of ZnSO4 concentration which is more than 1 mmol?L~-1. More than 8 mmol?L~-1 ZnSO4 can lead to the death of playmonas subcordi- formis. But the production of MT-like increases with the increase of ZnSO4 concentration by AAS determination. The effect of indution is remarkable. The production of MT-like reaches 2. 1ing per gram wet weight when the concentration of ZnSO4 is 1 mmol?L~-1.

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.