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| 1 | Use of antibiotic-loaded cement in total knee arthroplasty显示文摘Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement(ALBC) is helpful when treating an infection in total knee arthroplasty(TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in the literature, its pros and cons. Many authors have recommended the use of ALBC also in primary TKA for infection prophylaxis, but the evidence based on data from National Registries, randomized clinical trials and meta-analysis suggest a protective effect of ALBC against infection when used in hips, but not(or only mild) in knees. A possible explanation to this finding is that the duration and quantity of locally elevated antibiotic levels after surgery are smaller in TKA, due to the smaller amount of cement used for fixation in TKA-only a layer in the bone surface. There are some concerns about the routine use of ALBC in primary TKA as prophylaxis against infection: Firstly, there is a risk of hypersensivity or toxicity even when the chance is highly improbable. Secondly, there is a reduction in the mechanical properties of the cement, but this can be probably neglected if the antibiotic is used in low doses, not more than 1 g per 40 g cement package. Another significant concern is the increased economic cost, which could be overlooked if there were enough savings in treating fewer prosthetic infections. Finally, there is also a risk of selection of antibiotic-resistant strains of bacteria and this could be the main concern. If used, the choice of the antibiotic mixed in ALBC should consider microbiological aspects(broad antimicrobial spectrum and low rate of resistant bacteria), physical and chemical aspects(thermal stability, high water solubility), pharmacological characteristics(low risk to allergic reactions or toxicity) and economic aspects(not too expensive). The most commonly used antibiotics in ALBC are gentamicin, tobramycin and vancomycin. In conclusion, there is a paucity of randomized clinical trials in the use of ALBC in primary TKAs and the actual evidence of the effect of ALBC in reducing the risk of infection is insufficient. This, in addition to concerns about patient safety, risks of increase in the antibiotic resistance of microorganisms and the increase in costs in the procedure, lead us to recommend a cautious use of ALBC, perhaps only in high-risk patients(immunocompromised, morbidly obese, diabetic and patients with previous history of fracture or infection around the knee) unless the benefits of ALBC use were fully proven. Meanwhile, the rigorous use of peri-operative prophylactic systemic antibiotics and adoption of efficient antiseptic procedures and improved surgical techniques must be considered the gold standard in infection prevention in TKA surgery. | Pedro Hinarejos Pau Guirro Lluis Puig-Verdie Raul Torres-Claramunt Joan Leal-Blanquet Juan Sanchez-Soler Joan Carles Monllau | 2015 | World Journal of Orthopedics2015，6，11： | 5 |
| 2 | Liver fat deposition and mitochondrial dysfunction in morbid obesity:An approach combining metabolomics with liver imaging and histology显示文摘AIM: To explore the usefulness of magnetic resonance imaging(MRI) and spectroscopy(MRS) for assessment of non-alcoholic fat liver disease(NAFLD) as compared with liver histological and metabolomics findings. METHODS: Patients undergoing bariatric surgery following procedures involved in laparoscopic sleeve gastrectomy were recruited as a model of obesityinduced NAFLD in an observational, prospective, singlesite, cross-sectional study with a pre-set duration of 1 year. Relevant data were obtained prospectively and surrogates for inflammation, oxidative stress and lipid and glucose metabolism were obtained through standard laboratory measurements. To provide reliable data from MRI and MRS, novel procedures were designed to limit sampling variability and other sources of error using a 1.5T Signa HDx scanner and protocols acquired from the 3D or 2D Fat SAT FIESTA prescription manager. We used our previously described 1H NMRbased metabolomics assays. Data were obtained immediately before surgery and after a 12-mo period including histology of the liver and measurement of metabolites. Values from 1H NMR spectra obtained after surgery were omitted due to technical limitations.RESULTS: MRI data showed excellent correlation with the concentration of liver triglycerides, other hepatic lipid components and the histological assessment, w h i c h e xc l u d e d t h e p r e s e n c e o f n o n-a l c o h o l i c steatohepatitis(NASH). MRI was sufficient to follow up NAFLD in obese patients undergoing bariatric surgery and data suggest usefulness in other clinical situations. The information provided by MRS replicated that obtained by MRI using the-CH3 peak(0.9 ppm), the-CH2- peak(1.3 ppm, mostly triglyceride) and the-CH=CH- peak(2.2 ppm). No patient depicted NASH. After surgery all patients significantly decreased their body weight and steatosis was virtually absent even in patients with previous severe disease. Improvement was also observed in the serum concentrations of selected variables. The most relevant findings using metabolomics indicate increased levels of triglyceride and monounsaturated fatty acids in severe steatosis but those results were accompanied by a significant depletion of diglycerides, polyunsaturated fatty acids, glucose-6-phosphate and the ATP/AMP ratio. Combined data indicated the coordinated action on mitochondrial fat oxidation and glucose transport activity and may support the consideration of NAFLD as a likely mitochondrial disease. This concept may helpto explain the dissociation between excess lipid storage in adipose tissue and NAFLD and may direct the search for plasma biomarkers and novel therapeutic strategies. A limitation of our study is that data were obtained in a relatively low number of patients.CONCLUSION: MRI is sufficient to stage NAFLD in obese patients and to assess the improvement after bariatric surgery. Other data were superfluous for this purpose. | Nahum Calvo Raúl Beltrán-Debón Esther Rodríguez-Gallego Anna Hernández-Aguilera Maria Guirro Roger Mariné-Casadó Lidón Millá Josep M Alegret Fàtima Sabench Daniel del Castillo María Vinaixa Miguelàngel Rodríguez Xavier Correig Roberto García-álvarez Javier A Menendez Jordi Camps Jorge Joven | 2015 | World Journal of Gastroenterology2015，21，24： | 2 |
| 3 | Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence :a randomized controlled trial 显示文摘 | Alves PG Nunes FR Guirro EC | 2011 | Rev Bras Fisioter2011，15，5： | 1 |
| 4 | Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial显示文摘 | Alves P G Nunes F R Guirro E C | 2011 | Rev Rras Fisioter2011，15，5： | 1 |
| 5 | Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion显示文摘 | Barbosa R I Marcolino A M de Jesus Guirro R R | 2010 | Lasersin medical science2010，25，3： | 1 |
| 6 | Femoral nerve block:assessment of postoperative analgesia in arthroscopic anterior cruciate ligament reconstruction显示文摘 | Guirro UB Tambara EM Munhoz FR | 2013 | Br J Anaesth2013，63，6： | 1 |
| 7 | Treatment of fracture sequelae of the proximal humerus:comparison of hemiarthroplasty and reverse total shoulder arthroplasty显示文摘 | Alentom-Geli E Guirro P Santana F | 2014 | Arch Orthop Trauma Surg2014，134，11： | 1 |
| 8 | Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a ran- domized controlled trial显示文摘 | Alves P G Nunes F R Guirro E C | 2011 | Rev Rras Fisioter2011，15，5： | 1 |
| 9 | Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection surgery for the treatment of breast cancer显示文摘 | Nascimben MC Caldeira de Oliveira Guirro E | 2011 | Breast Cancer Res Treat2011，127，： | 1 |
| 10 | Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection surgery for the treatment of breast cancer 显示文摘 | Nascimben Matheus C Caldeira de Oliveira Guirro E | 2011 | Breast Cancer Res Treat2011，127，3： | 1 |
| 11 | Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion显示文摘 | Barbosa RI Marcolino AM Guirro RRD Mazzer N Barbieri CH Fonseca MDR | | 0，，： | 1 |
| 12 | Assessment of anesthesi- ologists' rapid sequence induction technique in an university hospi- tal 显示文摘 | Guirro U B Martins C R Munechika M | 2012 | Rev Bras Anestesiol2012，62，3： | 1 |
| 13 | Assessment ofanesthesiologists, rapid sequence induction technique in an u-niversity hospital显示文摘 | Guirro U B Martins C R Munechika M | 2012 | Rev Bras Anestesiol2012，62，3： | 1 |
| 14 | Change in blood flow velocity demonstrated by Doppler ultrasound in upper limb after axillary dissection surgery for the treatment of breast cancer显示文摘 | Nascimben Matheus C Caldeira de Oliveira Guirro E | 2011 | Breast Cancer Res Treat2011，127，3： | 1 |
| 15 | Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion显示文摘 | Barbosa RI Marcolino AM de Jesus Guirro RR | 2010 | Lasers Med Sci2010，25，3： | 1 |
| 16 | Femoral nerve block: assessment of postoperative analgesia in arthroscopic anteri- or cruciate ligament reconstruction显示文摘 | Guirro UB Tambara EM Munhoz FR | 2013 | Braz J Anesthesiol2013，63，6： | 1 |
| 17 | Maxillary anterior alignmentstability in Class I and Class II malocelusions treated with or without extraction显示文摘 | Guirro WJ Freitas KM Janson G | 2016 | Angle Orthod2016，86，1： | 1 |
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