AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In ...AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection,instituting a standard protocol for all the described steps appears beneficial.展开更多
目的:建立一种高效便捷的定点突变方法,为基因表达调控以及蛋白质结构和功能的研究提供技术支撑。方法:以构建单核细胞增生李斯特菌(Listeria monocytogenes)中编码胆碱水解酶(bile salt hydrolase,BSH)的bsh基因突变启动子为例,采用一...目的:建立一种高效便捷的定点突变方法,为基因表达调控以及蛋白质结构和功能的研究提供技术支撑。方法:以构建单核细胞增生李斯特菌(Listeria monocytogenes)中编码胆碱水解酶(bile salt hydrolase,BSH)的bsh基因突变启动子为例,采用一对完全互补并带有突变位点的引物扩增携带bsh基因启动子的重组质粒DNA全序列,通过DpnⅠ消化PCR产物中剩余的甲基化的模板DNA,酶切后的PCR产物直接转化大肠杆菌,从而获得含有突变启动子的重组质粒。结果:通过一步法定点突变技术成功构建了bsh基因的三种突变启动子。结论:该方法简单高效,只要把握好对引物设计,高保真的DNA聚合酶、模板DNA的浓度以及PCR扩增程序的选择,突变成功率可以达到100%。展开更多
Atomic layer deposition(ALD)attracts great attention nowadays due to its ability for designing and modifying catalytic systems at the molecular level.There are several reported review papers published recently discuss...Atomic layer deposition(ALD)attracts great attention nowadays due to its ability for designing and modifying catalytic systems at the molecular level.There are several reported review papers published recently discussing this technique in catalysis.However,the mechanism on how the deposited materials improve the catalyst stability and tune the reaction selectivity is still unclear.Herein,catalytic systems created via ALD on stepwise preparation and/or modification under self-limiting reaction conditions are summarized.The effects of deposited materials in terms of electronic/geometry modification over the catalytic nanoparticles(NPs)are discussed.These effects explain the mechanism of the catalytic stability improvement and the selectivity modification.The unique properties of ALD for designing new catalytic systems are further investigated for building up photocatalytic reaction nanobowls,tandem catalyst and bi-active-component metallic catalytic systems.展开更多
文摘AIM To define a ten-step protocol that reduced the incidence of surgical site infection in the spine surgery practice of the senior author and evaluate the support for each step based on current literature.METHODS In response to unexplained increased infection rates at our institution following spine surgery,a ten-step protocol was implemented:(1) preoperative glycemic management based on hemoglobin A1 c(HbA1 c);(2) skin site preoperative preparation with 2% chlorhexidine gluconate disposable cloths;(3) limit operating room traffic;(4) cut the number of personnel in the room to the minimum required;(5) absolutely no flash sterilization of equipment;(6) double-gloving with frequent changing of outer gloves;(7) local application of vancomycin powder;(8) re-dosing antibiotic every 4 h for prolonged procedures and extending postoperative coverage to 72 h for high-risk patients;(9) irrigation of subcutaneous tissue with diluted povidone-iodine solution after deep fascial closure; and(10) use of Dura Prep skin preparation at the end of a case before skin closure. Through an extensive literature review,the current data available for each of the ten steps was evaluated.RESULTS Use of vancomycin powder in surgical wounds,routine irrigation of surgical site,and frequent changing of surgical gloves are strongly supported by the literature. Preoperative skin preparation with chlorhexidine wipes is similarly supported. The majority of current literature supports control of HbA1 c preoperatively to reduce risk of infection. Limiting the use of flash sterilization is supported,but has not been evaluated in spine-specific surgery. Limiting OR traffic and number of personnel in the OR are supported although without level 1 evidence. Prolonged use of antibiotics postoperativelyis not supported by the literature. Intraoperative use of Dura Prep prior to skin closure is not yet explored.CONCLUSION The ten-step protocol defined herein has significantly helped in decreasing surgical site infection rate. Several of the steps have already been shown in the literature to have significant effect on infection rates. As several measures are required to prevent infection,instituting a standard protocol for all the described steps appears beneficial.
文摘目的:建立一种高效便捷的定点突变方法,为基因表达调控以及蛋白质结构和功能的研究提供技术支撑。方法:以构建单核细胞增生李斯特菌(Listeria monocytogenes)中编码胆碱水解酶(bile salt hydrolase,BSH)的bsh基因突变启动子为例,采用一对完全互补并带有突变位点的引物扩增携带bsh基因启动子的重组质粒DNA全序列,通过DpnⅠ消化PCR产物中剩余的甲基化的模板DNA,酶切后的PCR产物直接转化大肠杆菌,从而获得含有突变启动子的重组质粒。结果:通过一步法定点突变技术成功构建了bsh基因的三种突变启动子。结论:该方法简单高效,只要把握好对引物设计,高保真的DNA聚合酶、模板DNA的浓度以及PCR扩增程序的选择,突变成功率可以达到100%。
基金supported by the U.S. Department of Energy, Office of Science, and Office of the Basic Energy Sciences, under Contract DE-AC-02-06CH11357~~
文摘Atomic layer deposition(ALD)attracts great attention nowadays due to its ability for designing and modifying catalytic systems at the molecular level.There are several reported review papers published recently discussing this technique in catalysis.However,the mechanism on how the deposited materials improve the catalyst stability and tune the reaction selectivity is still unclear.Herein,catalytic systems created via ALD on stepwise preparation and/or modification under self-limiting reaction conditions are summarized.The effects of deposited materials in terms of electronic/geometry modification over the catalytic nanoparticles(NPs)are discussed.These effects explain the mechanism of the catalytic stability improvement and the selectivity modification.The unique properties of ALD for designing new catalytic systems are further investigated for building up photocatalytic reaction nanobowls,tandem catalyst and bi-active-component metallic catalytic systems.
