ABSTRACT
Objective:To investigate the prevalence of positive hepatitis C virus (HCV) antibody, HCV RNA and genotype distribution of HCV in high-risk populations in Pudong New Area, Shanghai City, so that to provide evidence for making "hepatitis C micro elimination" strategies in Shanghai area.Methods:A survey with proportional sampling method was conducted among the high-risk populations, including people who inject drugs (PWID), voluntarily or compulsorily accepted drug detoxification or methadone treatment, human immunodeficiency virus voluntary counseling and testing (HIV VCT) outpatients, sexually transmitted disease (STD) outpatients, and commercial sex workers, who participated in the routine physical examination activities held by the community health service centers and public hospitals of Pudong New Area from July 2021 to November 2022. The residual plasma samples were collected from medical examinations. HCV antibody was tested in all samples. HCV RNA and HCV genotype were tested in samples with positive HCV antibody results.Results:A total of 1 000 HCV high-risk people were screened, including 453 PWID, 166 human immunodeficiency virus (HIV) infectors, 245 STD outpatients, and 136 commercial sex workers. The positive rates of HCV antibody in the four categories of personnel were 21.85%(99/453), 1.81%(3/166), 1.22%(3/245) and 0(0/136), respectively. The positive rate of HCV RNA was 42.68%(35/82) among HCV antibody positive people in high-risk populations. As much as 74.29%(26/35) of HCV RNA positive people had junior high school education or less, and 77.14%(27/35) of them were not married. Among the 12 samples tested for HCV genotype, five were genotype 3, five were genotype 6, and two were subtype 1b.Conclusions:PWID is the main high-risk HCV infection population, who should be the target of the following "hepatitis C micro elimination" strategies. The proportions of genotype 3 and genotype 6 are high in the high-risk HCV infection populations, and the pan-genotype direct-acting antiviral agent treatment may be more suitable in this situation. HCV infected persons in high-risk groups have low education level and marriage rate, which indicates that education and care in community are needed.
ABSTRACT
Objective To analyze the epidemic characteristics of imported dengue fever in Pudong New Area of Shanghai from 2008 to 2020，and to explore its prevention and control strategy and measures． Methods The data of dengue fever cases in Pudong New Area from 2008 to 2020 were collected from the China Information System for Disease Control and Prevention. Descriptive epidemiological method was used to analyze the epidemic characteristics. Results A total of 45 cases of dengue fever were reported in Pudong during 2008-2020, all the cases were mild, and no deaths were reported．The male-to-female ratio was 2.46:1. The group aged 20-49 years accounted for 86.67%．The most common occupation was commercial service personnel and cadres (25 cases, accounting for 55.56%). The peak of incidence was from July to October with a total of 35 cases (77.78%). All the cases were imported from abroad, mainly from Southeast Asia and South Asia (43 cases, 95.56%). 15 cases (33.33%) had been ill before entry. 22 cases (48.89%) were first treated in tertiary hospitals. The median time intervals from onset to first clinic visit, from first clinic visit to diagnosis, and from onset to diagnosis were 1.0 d, 5.0 d, and 7.0 d, respectively. Serotypes of dengue virus were mainly Type I, Type III and Type II, which were 9 cases, 7 cases, and 6 cases, respectively. Conclusion The epidemic situation of dengue fever in Pudong New Area from 2008 to 2020 is relatively stable, all imported from abroad. The focus of the prevention and control is to promote the health education for overseas travelers, strengthen the monitoring sensitivity at border ports, enhance the diagnostic level of medical institutions, and timely find and report cases.
ABSTRACT
Objective:To investigate the role and mechanism of rat bone marrow mesenchymal stem cells (BMSC) in wound healing.Methods:Isolated BMSCs were cultured in vitro and induced to differentiate into epithelioid cells to promote wound healing by epidermal growth factor (EGF) and fibroblast growth factor (FGF). The expression levels of Tcf3, cytokeratin-18 (CK-18), CK-19 and p63 were evaluated by Western blot and real-time fluorescence quantitative polymerase chain reaction (qRT-PCR). Cell activity was detected by cell counting kit-8 (CCK-8) and clone formation test. The level of Tcf3 protein and the degree of skin repair were evaluated by immunohistochemical staining and HE staining. Then, small interfering RNA (siRNA) targeting rat Tcf3 gene was used to silence Tcf3 , and a rat wound healing model was established to detect the effect of Tcf3 on wound healing. Results:The results of Western blot and qRT-PCR showed that EGF and FGF could promote the expression of CK-18, CK-19 and p63 in BMSC and reduce the expression of Tcf3 ( P<0.05). Immunohistochemical staining and HE staining showed that after silencing Tcf3 in BMSC, CK-18, CK-19 and p63 mRNA and protein were highly expressed and the proliferation ability was enhanced ( P<0.05). Luciferase and Western blot results showed that after silencing Tcf3 in BMSC, the Wnt activity and nuclear expression of β- Catenin was enhanced, while after adding XAV-393 to BMSC medium, the Wnt activity and the nuclear expression of β- catenin decreased ( P<0.05). Compared with si-Tcf3 group, the clone formation and cell growth ability of si-Tcf3 + XAV-393 group decreased after adding XAV-393 to BMSC medium on the basis of silencing Tcf3 ( P<0.05). Double luciferase assay showed that after silencing Tcf3 in BMSC, the activation level of Notch 1 pathway increased, but after adding Notch 1 signal inhibitor DAPT, its activity and expression level decreased ( P<0.05). Compared with si-Tcf3 group, the protein expression of CK-18, CK-19 and p63 in siRNA-Tcf3 + DAPT group decreased ( P<0.05). In the rat trauma model, the expression levels of Tcf3 protein and mRNA in skin increased significantly on the 4th, 8th and 12th day after injury (especially on the 12th day) ( P<0.05). The expression level of Tcf3 in si-Tcf3 BMSC group was lower than that in normal BMSC group ( P<0.05). Compared with the normal BMSC group, the wound healing effect of si-Tcf3 BMSC group was more significant: thicker dermis, more hair follicles and greater proliferation space. Conclusions:Silencing Tcf3 can enhance the wound healing effect of BMSC in rats, which will provide a new way to accelerate skin regeneration.
ABSTRACT
Objective To understand the spatial epidemic characteristics of hand-foot-mouth disease in Pudong New Area of Shanghai from 2015 to 2018, and to provide reference for prevention and control. Methods SPSS 21.0 software was used for statistical analysis of the reported incidence of hand-foot-mouth disease, ArcGIS 10.2 software was used to make geographic distribution map, and OpenGeoDa software was used to make spatial autocorrelation analysis. Results The global Moran's I autocorrelation coefficient of the reported incidence rate of hand-foot-mouth disease in various streets and towns in Pudong New Area of Shanghai was 0.38, which was statistically significant (P=0.001). Local spatial autocorrelation analysis found that 5 streets were in high-high area. Conclusion The geographical distribution of reported incidence of hand-foot-mouth disease in various streets and towns of Pudong New Area in Shanghai was spatially aggregated, and the reported incidence decreased from north to south.
ABSTRACT
Objective@#To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.@*Methods@#A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range: 15.6-38.1 kg/m2).@*Results@#In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170).@*Conclusions@#Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.
ABSTRACT
Objective@#To analyze the clinicopathological features of pseudotumor-like tissue around aseptic joint arthroplasty and aseptic lymphocytic vasculitis-associated lesions (ALVAL) scores. The characters of wear granules were observed.@*Methods@#Total 122 cases were retrieved from the surgical pathology files between May 2015 and August 2018 in the department of pathology in Beijing Jishuitan Hospital, which included the knee joint arthroplasty (10 cases) and hip arthroplasty (112 cases). There were 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). The pseudotumor-like tissue around aseptic joint arthroplasty were stained with HE and analyzed by two ALVAL score systems. The characters of wear granules were observed by light microscope and polarized light.@*Results@#The cohort included 62 females and 60 males. Patients′ age ranged from 29 to 86 years (mean 56 years). Compbell-ALVAL system includes synovial lining,inflammatory infiltrate and tissue organization. The scores were: low (0-4): 18cases; moderate (5-8): 101 cases; high (9-10): 3 cases. Oxford-ALVAL system only evaluated the inflammatory infiltrate,and the scores were:0 grade:56 cases; 1 grade:51 cases; 2 grade: 12 cases; 3 grade:3 cases. Cases with high score in the Compbell-ALVAL system were concordant with the 3 grade of the Oxford-ALVAL system. Under light microscope,the metal particles were small black granules; the polyethylene fibers were needle-like and easily visible in polarized light. The polymethylmethacrylate showed clear spaces because of particle melting.@*Conclusions@#The Compbell-ALVAL scoring system is based on the histologic analysis of pseudotumor-like tissue around aseptic joint arthroplasty, and the Oxford-ALVAL scoring systems is based on lymphocytic response. The wear particles could be differentiated by the features in the light microscope.
ABSTRACT
Objective@#To evaluate the role of histologicalpathology in the diagnosis of periprosthetic joint infection.@*Methods@#A total of 145 cases of joint arthroplasty during October 2017 and October 2018 from Beijing Jishuitan Hospital were collected. There were 23 cases of infection, including knee joint arthroplasty (12 cases) and hip arthroplasty (11 cases). There were 17 females and 6 males. Patients′ age ranged from 39 to 76 years (mean 63 years). The infection was diagnosed if there were >5 neutrophils per high power field in at least 5 high power field. The permanent sections were examined twice separately by two pathologists, and the interval time of histologic examination was at least two weeks. Sensitivity (SE), specificity (SP), positive predictivevalue (PPV), and negative predictive value (NPV) were calculated. The consistency evaluation of histologic examination of two pathologists was calculated by Kappa analysis.@*Results@#The neutrophil cells could locate scattered or focally in the synovium tissue of periprosthetic joint infection. Somewhere, the infiltration of vessel and the perivascular distribution could also exist. Opportunity coincidence rate between two pathologists was 91.3% (Kappa=0.817). The results showed that SE was 60.9%, SP was 100.0%, NPV was 93.1%, PPV was 100.0%.@*Conclusions@#The presence of polymorphonuclear cells in histologic examination is correlated with infection. There was high consistency between histologic examination and clinical diagnosis of joint arthroplasty.
ABSTRACT
Objective To analyze the status quo of joint surgeons' research level,explore possible influence factors for their research capacity.Methods A total of 140 joint surgeons from third grade hospital andsecondary hospital in Beijing were selected.The self-rating scale of scientific research was used for evaluation.Subjects were divided into two groups according to the high and low level of scientific research ability.In the middle and low level group,factors including age,working years,job title,education level,training opportunities,team situation,research activity time,hospital level,and job satisfaction were analyzed.Results The total scores of the research subject were distributed from 12 to 115,with a median of 69.5 (40～90).The four dimensions,accounted from low to high were statistical knowledge,software operation,scientific research basis and thesis writing.According to the single factor analysis,age,education level,chance of training,presence or absence of team,time of scientific research activities,hospital level,satisfaction with work were related to the level of scientific research capacity of joint surgeons (P＜0.05);multiple regression results shows that the impact level of scientific research,from large to small,is whether there are scientific research teams,job satisfaction,and time for scientific research activities.These three factors can explain the change of scientific research ability by 60.5％ (R2 =0.605).Conclusions The joint surgeon's research capacity is at a relatively high level,while the statistical knowledge and software operation scores are low,which calls for more study and mastery.Increasing the construction of scientific research teams,improving job satisfaction,and increasing the time for scientific research activities can improve the scientific research capacity.
ABSTRACT
This meta-analysis aimed to confirm the efficacy and safety [side effect] of curcumin for osteoarthritis [OA]. Two researchers independently searched the database of Pub Med, EMBASE and Cochrane Library updated to November 2015 to find randomized controlled trials that reported the effect of curcumin on OA. The outcomes of this meta-analysis were Visual analogue scale [VAS], Western Ontario and McMaster Universities Osteoarthritis Index scale [WOMAC] and side effect. Furthermore, the quality assessment was performed with Cochrane Collaboration's tool. In addition, standardized mean difference [SMD] and 95% confidence interval [CI] were used for the analysis of continuous data, and the risk ratio [RR] and 95% CI were used to analyze dichotomous data. Sensitivity analysis was performed by using Stata 12.0. A total of 5 studies with 599 patients were included in this study. The results showed that curcumin could significantly improve the WOMAC score [SMD=-0.96; 95% CI:-1.81, -0.10; P=0.03] and VAS score of OA patients [SMD=-1.65; 95% CI:-2.11, -1.19]. Furthermore, the side effect rate of curcumin treatment was 0.81times higher than that of ibuprofen treatment. Curcumin can treat OA patients effectively, improving WOMAC score and VAS score, and the side effect of curcumin was not higher than that of ibuprofen
ABSTRACT
<p><b>OBJECTIVE</b>On the basic therapy, to assess the clinical effects of dynamic scalp acupuncture, scalp acupuncture combined with proprioceptive neuromuscular facilitation (PNF) therapy and simple PNF therapy for upper limb motor impairment in ischemic post-stroke spastic hemiplegia.</p><p><b>METHODS</b>A total of 90 cases were randomly assigned into a PNF group, a dynamic scalp acupuncture group and a scalp acupuncture group, 30 cases in each group. Basic therapy and PNF therapy were applied in the three groups. PNF therapy was used during scalp acupuncture in the dynamic scalp acupuncture group. PNF therapy was applied after scalp acupuncture in the scalp acupuncture group. The points were the upper 1/5 and middle 2/5 of (MS 6) and (MS 7) at the lesion side, the hemiparalysis contralateral side. The treatment was given for 6 months, once a day and 1 month as a course. The modified Ashworth scale (MAS), the Fugl-Meyer motor assessment (FMA) and Barthel index (BI) were observed before treatment and 2 weeks, 1 month, 3 months, and 6 months after treatment.</p><p><b>RESULTS</b>The MAS 1 month, 3 months and 6 months after treatment were improved compared with those before treatment in the three groups ( all <0.05), and the MAS results in the dynamic scalp acupuncture group were better than those in the PNF and scalp acupuncture group (all <0.05). The FMA and BI scores 1 month, 3 months and 6 months after treatment were higher than those before treatment (all <0.05). The FMA Scores in the 3 time points and after treatment in the dynamic scalp acupuncture group were higher than those in the other two groups (all <0.05).</p><p><b>CONCLUSION</b>PNF therapy during scalp acupuncture can relieve the spasmodic condition of patients with upper limb motor impairment in ischemic post-stroke spasmodic hemiplegia, and improve the limb function and life activity, which is better than PNF therapy after scalp acupuncture and simple PNF therapy.</p>
Subject(s)
Humans , Acupuncture Therapy , Brain Ischemia , Rehabilitation , Combined Modality Therapy , Hemiplegia , Rehabilitation , Therapeutics , Scalp , Stroke , Stroke Rehabilitation , Treatment OutcomeABSTRACT
Objective:To detect 11 kinds of illegally added chemicals in anti-fatigue health foods including sildenafil ,tadalafil, vardenafil , acetildenafil , homosildenafil , hydorxyhomosildenafil , norneosildenafil , aminotadalafil , pseudovardenafil , thioaildenafil and noracetildenafil.Methods:An HPLC-MS/MS method was used with LUNA C18(250 mm ×4.6 mm, 5μm)as the analysis column and triethylamine phosphate , acetonitrile and methanol as the mobile phase with gradient elution at the flow rate of 1ml.min-1 .An ESI+scan and an MS/MS mode were applied .The qualitative and quantitative analysis were carried out by HPLC-MS/MS.Results:Through the detection of 100 batches of samples , 85 batches were only found illegally added chemical substance sildenafil mainly at the concentration of 5-15 mg per granule .Conclusion:The method of HPLC-MS/MS can be used as a powerful screening tool for the rapid drug screening in basic level drug control laboratories to reduce chemical substances illegally added in anti -fatigue health foods .
ABSTRACT
Objective:To assess the therapeutic effect of mucopolysaccharide polysulfate cream in prevention of postoperative scars.Methods:One hundred postoperative patients were divided into an experimental group and a control group (each n=50).After stitch removal,the experimental group wiped mucopolysaccharide polysulfate cream,and the control group wiped urea cream.The scars of the two groups were evaluated by Vancouver Scar Scale (VSS) on the day of stitch removal and in the 4th,8th,12th,16th,20th,24th,28th,and 32th weeks during the treat process.Results:At the beginning of treatment,the total VSS scores in the experimental group were always lower than that in the control group (P＜0.05).There was no difference between the two groups in the color scores at each time point of follow-up (P＞0.05).Form the 20th week,the vascular distribution scores in the experimental group were lower than that in the control group (P＜0.05).And the thickness and flexibility scores in the experimental group were lower at each time point of follow-up (P＜0.05).There were no differences between the two groups in wounds in head,face,or neck in the total VSS scores and all index scores (P＞0.05),and the total VSS scores in the experimental group,who had wounds in chest,shoulder,or back,or had wounds in waist,abdomen,or hip,or had wounds in extremity,were lower than that in the control group (P＜0.05).The vascular distribution and thickness scores in the experimental group,who had wounds in chest,shoulder,or back,were better than that in the control group (P＜0.05).Conclusion:Wiping mucopolysaccharide polysulfate cream after operation as soon as possible can effectively prevent scar hyperplasia,and it is worth to be widely applied in clinic.
ABSTRACT
Objective To explore the correlation between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level with the occurrence of ischemic stroke and prognosis in the patients with hypertension . Methods Eighty-eight patients with hypertension in this hospital from January 2013 to January 2016 were se-lected ,including 34 cases of simple hypertension and 54 cases of hypertension complicating ischemic stroke . The Lp-PLA2 level was detected .The severity of ischemic stroke was evaluated on 1 ,14 d after admission by adopting the NIHSS .The patients with hypertension complicating ischemic stroke were divided into the good prognosis group and poor prognosis group according to the NIHSS change situation .Moreover the independent predictive factors of prognosis were evaluated by adopting the Logistic multivariate regression .Results The Lp-PLA2 level in the patients with hypertension complicating ischemic stroke was significantly higher than that in the patients with simple hypertension .The Lp-PLA2 level (OR=1 .523 ,95％ CI=1 .323-1 .657) and NIHSS score (OR=3 .275 ,95％ CI=1 .402 -6 .208) at admission were the independent predictive factors of poor prognosis .Conclusion Serum Lp-PLA2 level is closely correlated with the occurrence and prognosis of ische-mic stroke in the patients with hypertension ,which can serve an evaluation index for the occurrence and prognosis of ischemic stroke in the patients with hypertension and provides an objective basis for the clinical therapy .
ABSTRACT
Objective To evaluate the clinical outcome of Vancouver B2 and B3 periprosthetic femoral fractures treated with uncemented modular stems.Methods From September 2011 to April 2014,Twenty-four patients (12 males and 12 females,with the average age 63 years,ranging from 28 to 85 years) with periprosthetic femoral fractures (16 Vancouver B2 and 8 Vancouver B3) were treated with uncemented modular stems.Revision arthroplasty was conducted in all cases by using modular stems with 12 cerclage wirings and 11 great trochanter claw plates.One patient was treated with revision arthroplasty without additional fixations.Extended trochanter osteotomy was performed on 11 patients.Cortical strut allograft was used in 9 patients with severe femoral bone loss.Intraoperative complications including vascular or nerve injury and systemic complications including cardiovascular events,cerebrovascular events and deep vein thrombosis were recorded.Severe postoperative complications such as nonunion,re-fracture,periprosthetic joint infection and dislocation were recorded.The clinical outcome was evaluated by Harris score,Visual Analogue Score and Parker Mobility Score.The radiological outcome was taken to observe the healing status,stem subsidence and stability of the prosthesis.Results Two patients were lost to follow-up.Twenty-two patients were clinically followed-up.Radiological data was recorded in 16 patients.The average follow-up was 33 months (range,12-68 months).All fractures healed within 6 months.The average Harris score improved from 4.0± 1.1 preoperatively to 78.8± 16.2 postoperatively (t=-20.195,P=0.000).The mean Parker Mobility Score improved from 0.5±0.9 preoperatively to 7.0± 1.8 postoperatively (t=-14.835,P=0.000).The mean Visual Analogue Score decreased from 6.4± 1.2 preoperatively to 2.0± 1.5 postoperatively (t=10.879,P=0.000).No nonunion,infection or dislocation was found.One patient underwent re-operation because of re-fracture.Eight mm of prosthesis subsidence was observed in one case at 3 months postoperatively,and reached stable fixation at 6 months postoperatively without further subsidence.Conclusion Uncemented modular stems can achieve distal fixation and implant stability of periprosthetic femoral fractures while retaining optimal biomechanics of the hip.Assisted by femoral reconstruction techniques such as extended trochanter osteotomy,cortical strut allograft,great trochanter claw plates and cerclage wiring,revision arthroplasty using uncemented modular stems could realize optimal outcomes in treating Vancouver B2 and B3 periprosthetic femoral fractures.
ABSTRACT
Objective To explore the influence of lovers''communication patterns and matching on their depression symptoms. Methods 300 pairs of dating couple were recruited from nine universities in Hebei,Henan,Beijing and Shanghai by convenience sampling principle. They were asked to fulfill the com-munication patterns questionnaire-short form and center for epidemiologic studies depression scale.Polynomial regression model with response surface method was adopted to analyze the results. Results ( 1) The scores of demands/withdraw,completely avoid,constructive communication of boys and girls were (3.93±1.10,4.10 ±1.09)(6.65±1.70,6.49±1.74)(3.85±1.70,4.02±1.98),and the scores of depression of boys and girls were (1.60±0.42,1.61±0.42).Boys depression was significantly positive correlated with its own demands/withdraw communication( r=0.222, P<0.01),and significantly positive correlated with girls demands/with-draw communication ( r=0.118, P< 0.05).Girls depression was significantly negative correlated with con-structive communication of their own( r=-0.407, P<0.01),and significantly negative correlated with the boys constructive communication ( r=-0.306, P<0.01). (2)Demand/withdraw communication could predict their own depression positively both for males and females( t=5.489,b=0.267, P<0.01, t=2.538,b=0.138, P<0.05).Constructive communication could predict depression negatively both for males and females( t=-5.158,b=0.382, P<0.01;t=-4.539,b=0.299, P<0.001 ).Males'' avoidance communication pattern could predict their own depression positively( t=1.918,b=0.174, P<0.05).(3)Males''constructive communication scores could predict females'' depression negatively( t=-3.306,b=0.189, P<0.01 ).(4)The consistency of communication pattern could influence couples'' depression. Conclusion Constructive communication con-tributes to lovers'' mental health and reduce the probability of their depression;Demand/withdraw communi-cation and avoidance communication increase their depression risk.
ABSTRACT
Objective:To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).Methods: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital.A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study.There were 17 males and 5 females,and the median age was 48 years(range: 34-67 years).All the surgery was done by DAA method by two senior surgeons.The clinic characters,early surgery treatment results and complications were analyzed.Results: We used the cementless stems in all the cases.The average operating time was (167±23) min;the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL;the wound drainage in average was (111±73) mL Most of the patients could move out of the bed by themselves on the first day after operation,5 patients could walk without crutches on the first operating day,and 13 patients could squat on the third days after operation.The patients were discharged averagely 4 days after operation.We followed up all the patients for averagely 16 months (range: 8-24 months).There was no loosening or failure case in the latest follow up.In the study,2 patients had great trochanter fracture,2 patients had thigh pain,4 patients had lateral femoral cutaneous nerve palsy,and 3 patients had muscle damage.The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).Conclusion: The DAA THA can achieve faster recovery and flexible hip joint after operation.However it is a kind of surgery with high technique demanding.Carefully selected patients,and skilled technique,can help the surgeon avoid the early complications.It is associated with high complication rate in the learning curve for bilateral DAA THA.
ABSTRACT
Objective To investigate the early outcomes of revision hip arthroplasty using restoration modular (RM) stem.Methods Fifty-nine patients underwent revision hip arthroplasty with RM stem from April 2012 to June 2015 in our center with a minimal of two years follow-up.The patients including 24 male and 35 female had a median age of 61.0 (56,66) years.The median BMI was 24.0 (22.5,26.0) kg/m2,while the median interval from the primary surgery was 10.5 (6.0,14.5) years.The rea sons for revision inculded infection in 8 patients,aseptic loosening in 45,recurrent dislocation in 1,and periprosthetic fracture in 5.There were 3 cases of type B2 and 2 cases of B3 periprosthetic fracture according to Vancouver classification.The bone defects severity was conducted according to Paprosky classification that 14 patients in type Ⅱ,31 in type ⅢA,8 in type ⅢB,and 1 in type Ⅳ.Acetabular component were revised in 56 cases.Patients were followed up at 3 months,6 months,1 year and annually thereafter for clinical and radiological evaluation.Results All the patients were followed up with a median duration of 30.4 (27.3,37.9)months,the median Harris score significantly improved from 37 (31,53) points preoperatively to 84 (80,95) points at the last follow up (Z=-6.681,P=0.000).There were 3 patients had perforation or fracture intra-operatively,two of them were fixed by strut allograft.The other one who did not compromise the implant stability was not fixed.Extended trochanteric osteotomy was applied in 14 cases and they healed well at 3-6 months during follow-up.There was one case of early dislocation at 6 days postoperatively,which was treated with close reduction and immobilization without recurrence.No infection,stem fracture,hematoma formation and sciatic nerve injury were reported.No femoral component loosening was identified at the latest follow-up.Median subsidence was 1.0 (0,2.0) mm with the maximum case 6.0 mm and 3 cases 3.5 mm.All of subsidence developed within the first year postoperatively but without further aggravation.The affected leg lengthened 17.5± 10.1 mm (range 2-40 mm) after operation.The affected leg was shorter 17.5± 12.6 mm (shorter 44.4 mm to longer 3.0 mm) than that in the normal side pre-operatively.However,the distinction decreased to 0.1±9.6 mm postoperatively (shorter 24.8 mm to longer 22.4 mm,t=-10.538,P=0.000).Conclusion Early satisfactory results are achieved in hip revision using RM modular stem at the femoral side.The modular design could simplify the surgical procedure with better control of leg length and joint stability.Long-term follow-up is still required for further evaluation.
ABSTRACT
Objective To explore the relationship between big-five personality,and public mood of volunteers,and to find out the moderator effect of justice sensitivity.Methods A total of 1 022 volunteers were investigated.The Big-Five Inventory (BFI),Public Mood Scale (PMS),Justice Sensitivity Inventory (JSI) were applied to all subjects.Results The average score was (19.77±4.49) for extraversion,(26.69± 4.13) for agreeableness,(23.33±5.37) for conscientiousness,(12.49±4.91) for neuroticism,(24.95±5.44)for openness,(8.78±3.23) for positive public mood,(3.46±3.06) for negative public mood and correlated with (26.85± 10.55) for observer sensitivity.The extraversion,agreeableness,conscientiousness and openness were correlated with positive public mood(β=0.31,P＜0.01;β=0.25,P＜0.01;β=0.29,P＜0.01;β=0.26,P＜0.0 1),and negatively correlated with public mood (β=-0.14,P＜0.01;β=-0.29,P＜0.01;β=-0.20,P＜0.01;β=-0.08,P＜0.01).Neuroticism was negatively correlated with positive public mood (β=-0.27,P＜0.01),and positively correlated with negative public mood (β=0.31,P＜0.01).The interaction effect of agreeableness and observer sensitivity negatively correlated with positive public mood,negative public mood (β=-0.09,P＜0.01;β=-0.07,P＜0.05).The interaction effect of neuroticism and observer sensitivity was positively correlated with positive public mood (β=0.08,P＜0.01).Conclusion Observer sensitivity plays a regulative role between big-five personality and mental health,and can slow the negative impact of low agreeableness to positive public mood,strengthen the impact of low agreeableness to negative public mood,and slow the negative impact of high neuroticism to positive public mood.
ABSTRACT
Objective To investigate the early outcomes of reconstruction of severe acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment in total hip replacement.Methods From April 2014 to December 2015,23 patients (24 hips) underwent total hip arthroplasty by the use of tantalum trabecular metal cups combined with tantalum augments.There were 11 males (12 hips) and 12 females (12 hips),with the average age 54 years (range,38-65 years).We tried to reconstruct an annular support for the cup.If an annular support cannot be reconstructed,the cup obtains primary stability based on the three point fixation rationale.Flexible placing of the TM cup combined with the augments helped reconstruction of the socket ring or supporting points,thus achieving rigid primary stability of the cup and restoring center of rotation.Harris hip score and Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score were recorded.Any severe intraoperative complications including vascular or nerve injury and severe postoperative complications such as periprosthetic joint infection,dislocation or periprosthetic fracture were reported.The vertical position of the center of rotation from the interteardrop line and the horizontal position of the center of rotation from the teardrop were measured and analyzed.Results The average follow-up duration was 16 months (range,7-28 months).The mean Harris hip score was 35.3±12.1 preoperatively and 82.7±8.3 postoperatively (t=-16.991,P＜0.001).The mean WOMAC score was 39.1 ±24.0 preoperatively and 87.2± 11.4 postoperatively (t=-7.671,P＜ 0.001).The average vertical location of the center of rotation was 44.02± 11.65 mm preoperatively and 22.96±8.24 mm postoperatively.All the tantalum cups and augments were stable.There was no periprosthetic joint infection,dislocation,nerve injury or periprosthetic fracture.Conclusion Reconstruction of Paprosky Ⅲ acetabular bone defects by the use of tantalum trabecular metal cup combined with tantalum augment can achieve good primary stability and restore the center of rotation with almost normal hip biomechanics.The short-term outcomes are satisfied.
ABSTRACT
Objective:To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans.Methods:In 32 total hip arthro-plasty (THA),we performed CT scans before and after operation.Four possible levels (lesser trochan-ter,5 mm above,10 mm above and 15 mm above the lesser trochanter)of broach version were calculated based on the pre-operative CT scan.Stem versions were measured on the post-operative CT scan.We de-termined the difference between the preoperative broach version and the postoperative stem version using the Student’s t-test for paired samples assuming equal variance.Results:For the operated hips,pre-operative hip version differed according to the level of measurement.Our findings showed that the average femoral version was 37.0°±11.0°at the level of the lesser trochanter (section 1),34.3°±10.6°at 5 mm above the lesser trochanter (section 2),28.1°±10.9°at 10 mm above the lesser trochanter (sec-tion 3),and 22.4°±13.7°at 15 mm above the lesser trochanter (section 4),and that the average ver-sion for the femoral neck (FNV)was 12.9°±13.8°.The postoperative hip version was the stem version (FSV),which we found to be an average of 26.1°±11.0°.The mean femoral version for section 1 and 2 was larger than the mean postoperative stem version (P0.05).The mean femoral neck version was less than the mean postoperative stem version (P<0.01);the difference was 13.2°±11.1°of the in-creased anteversion on average for the FSV compared with FNV.Conclusion:The accuracy of estimated femoral version after arthroplasty depends on broach level.When it is 10 mm above the lesser trochanter, stem version estimation is accurate,but below that level,there is a tendency to overestimate.