Clinical Decision on Disorders of Consciousness After Acquired Brain Injury: Stepping Forward / 神经科学通报·英文版

Major advances have been made over the past few decades in identifying and managing disorders of consciousness (DOC) in patients with acquired brain injury (ABI), bringing the transformation from a conceptualized definition to a complex clinical scenario worthy of scientific exploration. Given the continuously-evolving framework of precision medicine that integrates valuable behavioral assessment tools, sophisticated neuroimaging, and electrophysiological techniques, a considerably higher diagnostic accuracy rate of DOC may now be reached. During the treatment of patients with DOC, a variety of intervention methods are available, including amantadine and transcranial direct current stimulation, which have both provided class II evidence, zolpidem, which is also of high quality, and non-invasive stimulation, which appears to be more encouraging than pharmacological therapy. However, heterogeneity is profoundly ingrained in study designs, and only rare schemes have been recommended by authoritative institutions. There is still a lack of an effective clinical protocol for managing patients with DOC following ABI. To advance future clinical studies on DOC, we present a comprehensive review of the progress in clinical identification and management as well as some challenges in the pathophysiology of DOC. We propose a preliminary clinical decision protocol, which could serve as an ideal reference tool for many medical institutions.

Research progress on pharmacological mechanism of polygona-polysaccharose / 国际中医中药杂志

Polygona-polysaccharose is an important indicator to measure the quality of Polygonati Rhizoma. The polygona-polysaccharose has the effect of lowering blood sugar, regulating blood lipid, anti-fatigue, improving learning and memory ability. The Polygonati Rhizoma, as a Chinese herbal medicine with homology of medicine and food, has a good prospect and application value in the development of food and health products.

Finite Element Analysis on Biomechanical Properties of Traditional Trajectory and Modified Cortical Bone Trajectory / 医用生物力学

Objective To study mechanical properties of traditional trajectory (TT) and modified cortical bone trajectory (MCBT) on osteoporotic vertebrae through finite element analysis. Methods The three-dimensional model of L4 segment was established, and pedicle screw (PS) (diameter 6.0 mm, length 45 mm) and MCBT screw (diameter 4.5 mm, length 40 mm) were placed on both sides of the lumbar spine. The pull-out strength and the load-displacement ratio of screws in two different screw trajectories under up, down, left, right working conditions were analyzed, and the stability between the screw and vertebral body under osteoporotic conditions was evaluated. Results Compared with TT, the pull-out strength of MCBT screw was increased by 13.1%. Compared with PS, the load-displacement ratio of MCBT screw under up, down and left working conditions was increased by 57.2%, 32.4%, and 31.6%. Under right working condition, although the load-displacement ratio of MCBT screw was higher than that of PS, no statistical difference was found. The load-displacement ratio of vertebral body in MCBT group under lateral bending and axial rotation was significantly higher than that in TT group. The load-displacement ratio of vertebral body in MCBT group under flexion was lower than that in TT group. Although the load-displacement ratio of vertebral body in MCBT group under extension was higher that that in TT group, no statistical difference was found. Conclusions MCBT is superior to TT in pull-out strength, screw stability and vertebral body stability under lateral bending and axial rotation, but its vertebral body stability under flexion and extension was weaker than that of TT. The research findings demonstrate the superiority of MCBT under osteoporotic conditions and lay the foundation for clinical application of MCBT.

Research on the influence of mental fatigue on information resources allocation of working memory / 生物医学工程学杂志

Mental fatigue is the subjective state of people after excessive consumption of information resources. Its impact on cognitive activities is mainly manifested as decreased alertness, poor memory and inattention, which is highly related to the performance after impaired working memory. In this paper, the partial directional coherence method was used to calculate the coherence coefficient of scalp electroencephalogram (EEG) of each electrode. The analysis of brain network and its attribute parameters was used to explore the changes of information resource allocation of working memory under mental fatigue. Mental fatigue was quickly induced by the experimental paradigm of adaptive N-back working memory. Twenty-five healthy college students were randomly recruited as subjects, including 14 males and 11 females, aged from 20 to 27 years old, all right-handed. The behavioral data and resting scalp EEG data were collected simultaneously. The results showed that the main information transmission pathway of the brain changed under mental fatigue, mainly in the frontal lobe and parietal lobe. The significant changes in brain network parameters indicated that the information transmission path of the brain decreased and the efficiency of information transmission decreased significantly. In the causal flow of each electrode and the information flow of each brain region, the inflow of information resources in the frontal lobe decreased under mental fatigue. Although the parietal lobe region and occipital lobe region became the main functional connection areas in the fatigue state, the inflow of information resources in these two regions was still reduced as a whole. These results indicated that mental fatigue affected the information resources allocation of working memory, especially in the frontal and parietal regions which were closely related to working memory.

Diagnosis and treatment for rupture and bleeding of accessory hepatic aneurysms / 中华消化外科杂志

Rupture and bleeding of accessory hepatic aneurysms is clinically rare. Computed tomography angiography (CTA) or multislice reconstruction can provide reliable basis for clinical diagnosis. Interventional surgery is the main treatment method. A successful case of interventional embolization of ruptured accessory hepatic aneurysm in our hospital was reported. The accessory hepatic artery variation of this patient belongs to Michels type 4. The bleeding site of the variant artery was identified by CTA and digital subtraction angiography. Satisfactory results were obtained after interventional embolization and follow-up.

Neuroimage-Based Consciousness Evaluation of Patients with Secondary Doubtful Hydrocephalus Before and After Lumbar Drainage / 神经科学通报·英文版

Hydrocephalus is often treated with a cerebrospinal fluid shunt (CFS) for excessive amounts of cerebrospinal fluid in the brain. However, it is very difficult to distinguish whether the ventricular enlargement is due to hydrocephalus or other causes, such as brain atrophy after brain damage and surgery. The non-trivial evaluation of the consciousness level, along with a continuous drainage test of the lumbar cistern is thus clinically important before the decision for CFS is made. We studied 32 secondary mild hydrocephalus patients with different consciousness levels, who received T1 and diffusion tensor imaging magnetic resonance scans before and after lumbar cerebrospinal fluid drainage. We applied a novel machine-learning method to find the most discriminative features from the multi-modal neuroimages. Then, we built a regression model to regress the JFK Coma Recovery Scale-Revised (CRS-R) scores to quantify the level of consciousness. The experimental results showed that our method not only approximated the CRS-R scores but also tracked the temporal changes in individual patients. The regression model has high potential for the evaluation of consciousness in clinical practice.

Neuroimage-Based Consciousness Evaluation of Patients with Secondary Doubtful Hydrocephalus Before and After Lumbar Drainage / 神经科学通报·英文版

Hydrocephalus is often treated with a cerebrospinal fluid shunt (CFS) for excessive amounts of cerebrospinal fluid in the brain. However, it is very difficult to distinguish whether the ventricular enlargement is due to hydrocephalus or other causes, such as brain atrophy after brain damage and surgery. The non-trivial evaluation of the consciousness level, along with a continuous drainage test of the lumbar cistern is thus clinically important before the decision for CFS is made. We studied 32 secondary mild hydrocephalus patients with different consciousness levels, who received T1 and diffusion tensor imaging magnetic resonance scans before and after lumbar cerebrospinal fluid drainage. We applied a novel machine-learning method to find the most discriminative features from the multi-modal neuroimages. Then, we built a regression model to regress the JFK Coma Recovery Scale-Revised (CRS-R) scores to quantify the level of consciousness. The experimental results showed that our method not only approximated the CRS-R scores but also tracked the temporal changes in individual patients. The regression model has high potential for the evaluation of consciousness in clinical practice.

Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify cellular leiomyoma / 中华放射学杂志

Objective To evaluate the value of histogram parameters of dynamic contrast-enhanced MRI (DCE-MRI) in the diagnosis of cellular leiomyoma. Methods Seventy one patients with leiomyomas confirmed by pathology who underwent preoperative DCE-MRI were enrolled in this retrospective study. Quantitative perfusion histogram parameters (including median, mean, skewness, kurtosis, energy, entropy) were measured for each patient. Leiomyoma was divided into degeneration, ordinary and cellular types according to pathology. One-way analysis of variance and Least significant difference were used to compare the differences among the parameters of the three groups which were normal distribution and equal variances, while Kruskal-Walls test and Mann-Whitney U test were used to compare the parameters that did not conform to normal distribution or variance. ROC curves were drawn to evaluate the diagnostic efficiency of different parameters. Results Among the three groups,the values of Ktrans(median, mean, kurtosis, energy, entropy), Kep(median, mean, skewness, kurtosis, entropy), Ve(median, mean, skewness, kurtosis) and Vp(median, mean, skewness, kurtosis, energy, entropy) had statistical difference (all P<0.05). The values of Ktrans, Kep, Vp (median, mean) and Ktrans (entropy) of the cellular group were higher than those of the degeneration and ordinary groups. While the values of Ktrans (kurtosis, energy) and Kep (skewness) of the cellular group were lower than the other two groups;then the value of Kep (kurtosis) of the cellular group was lower than the ordinary group and the value of Kep (entropy) of the cellular group was higher than the ordinary group;and the values of Ve (median, mean, kurtosis) and Vp (entropy) of the cellular group were higher than those of the ordinary group. The values of Ve (skewness) and Vp (skewness, kurtosis and energy) of the cellular group were lower than those of degeneration group. ROC curves found that when Ktrans(median)was 0.994/min, its sensitivity was 100.0％, the specificity was 73.8％, and the area under ROC was 0.905;when Ktrans(mean) was 1.170/min, its sensitivity was 90.0％, the specificity was 85.2％, the area under ROC was 0.921. And the areas under ROC of Ktrans (kurtosis, energy, entropy), Kep (median, mean, skewness, kurtosis, entropy), Ve (median, mean, skewness), Vp (median, mean, skewness) were also high (ranging from 0.711 to 0.872). Conclusion Histogram analysis of DCE-MRI quantitative perfusion is applicable for identification of cellular leiomyoma.

Clinical effect of polymer-free sirolimus-eluting Nano stent on patients with coronary artery stenosis / 实用医学杂志

Objective To study the safety and effectiveness of polymer-free sirolimus-eluting Nano stent in patients with unstable angina pectoris. Methods Three hundred and twenty-one patients with unstable angina pectoris were divided into Nano stent group(group A,n=157)and Endeavor resolute stent group(group B,n=164). The cardiovascular events were compared postoperative 12 months. The minimal intima cavity area and mini-mum bracket section area and neointimal area were compared postoperative 12 months by intravascular unltrasound (IVUS). Results There were 7 cases of cardiovascular events in group A and 6 in group B postoperative 12 months(P=0.727)and 2 patients in group A and 3 in group B were re-implanted stent because of restenosis post-operative 12 months(P=0.672). The neointimal area were(0.31 ± 0.11 mm2)in group A and(0.29 ± 0.12 mm2) in group B postoperative 12 months(P = 0.985). The minimal intima cavity area(P = 0.921)and the minimum bracket section area(P=0.934)were narrower postoperative 12 months than immediately after the operation in two groups. Conclusion With less cardiovascular events and being safe and reliable,the clinical effect of polymer-free sirolimus-eluting Nano stent implantation is similar to that of Endeavor resolute stent implantation.

The value of MR diffusion tensor imaging in evaluating diffuse axonal injury / 中国医师杂志

Objective To investigate the clinical value of MR diffusion tensor imaging (DTI) in evaluating diffuse axonal injury (DAI).Methods The DTI imaging data of DAI patients and healthy volunteers were analyzed retrospectively.Fractional anisotropy (FA) values were measured in corpus callosum,etc.The serum myelin basic protein (MBP) was detected.Results Compared to the control group,the FA values were lower in genu of corpus callosum,splenium of corpus callosum,anterior limb of the internal capsule,posterior limb of the internal capsule and thalamus in DAI group (P ＜ 0.01,P ＜ 0.05).The mean FA values of two groups were negatively correlated with serum MBP levels (r =-0.755,P =0.001).Conclusions DTI can noninvasively reflect the damages of white matter fibers in DAI patients,and it has importantly clinical significance in evaluating prognosis and therapeutic effect of DAI patients.

Application of 3.0T magnetic resonance diffusion weighted imaging in evaluating the effect of advanced gastric cancerˊs neoadjuvant chemotherapy / 肿瘤研究与临床

Objective To evaluate the clinical value of 3.0T magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) on evaluation effect of neoadjuvant chemotherapy in advanced gastric cancer. Methods 3.0 T MRI DWI examination was performed in 42 cases of advanced gastric cancer diagnosed by gastroscopy and pathology, including 32 patients were examined with DWI both before and after chemotherapy. Lymph nodes of gastric cancer lesions and display ability of stomach were measured, and the area of the apparent diffusion coefficient (ADC) values in normal stomach and tumors were compared. ADC values were compared in the same patients before and after neoadjuvant chemotherapy and analyzed along with postoperative pathological examinations. Results In a total of 40 patients who received 74 DWI examinations, ADC values in tumor and lymph nodes were significantly higher than those in normal tissue. The ADC value in tumors was (1.348 ±0.278) ×10-3 mm2/s, and in 12 cases of stomach lymph node enlargement was (1.329±0.188) ×10-3 mm2/s. However, the average ADC value of normal stomach was (2.081± 0.189) ×10-3 mm2/s with significantly lower DWI than that of the former (P< 0.001). After chemotherapy, the ADC value in tumors was increased, which was (1.572 ±0.261) ×10-3 mm2/s (P< 0.001). After neoadjuvant chemotherapy, 16 patients received gastric cancer radical prostatectomy, and postoperative pathological TRG ratings of tumor were decreased with different extent. Tumor cell density (TCD) before treatment with an average of 4.45 ×10-5 / px2, which was downgraduated to 2.48 ×10-5 / px2 after chemotherapy and surgery. Negatively correlation between TCD values and ADC values were observed. Conclusion MRI DWI examination can effectively detect advanced stomach cancer and the associated lymph node enlargement. Comparison of tumor morphology and ADC values in advanced gastric cancer before and after neoadjuvant chemotherapy has clinical value in prognosis.

Value of dynamic contrast-enhanced MRI parameters of Extended Tofts and Exchange model in the differential diagnosis of hepatocellular carcinoma and hepatic metastases / 中华放射学杂志

Objective To analyze the value of dynamic contrast-enhanced MRI(DCE-MRI) parameters of Extended Tofts and Exchange model in the differential diagnosis of hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Methods A retrospective analysis of 40 pathologically confirmed cases was conducted , including 25 cases of HCC and 15 cases of hepatic metastases of colorectal cancer,all patients underwent DCE-MRI. Applying liver double blood supplement model , and respectively using Extended Tofts two-compartment model and Exchange model liver microvascular permeability parameters [volume transfer constant of the contrast agent(Ktrans), efflux rate from extracellular extravascular space to plasma(Kep), extravascular extracellular volume fraction(Ve)and blood plasma space volume fraction (Vp)] and the perfusion parameter hepatic arterial perfusion index(HPI) in the lesion parenchyma of HCC and metastases were calculated. We used t test to compare the differences of the parameters measured from the two types of tumors , statistically significant parameters between HCC and metastases were screened which compared with the gold standard of pathological findings in order to draw the ROC curves to evaluate the diagnostic efficacy of different model parameters, using χ2 test compared the diagnostic accuracy of optimal parameters between the two models. Results By using Extended Tofts and Exchange model , Ktrans value of HCC were (0.661 ± 0.402)/min and (0.604 ± 0.316)/min respectively, Ktrans value of hepatic metastases were (0.196±0.175)/min and (0.179±0.135)/min respectively;Vp value of HCC were (0.334±0.217) and (0.294± 0.098), Vp value of hepatic metastases were (0.089 ± 0.015) and (0.089 ± 0.022),respectively; HPI value of HCC were (0.680±0.281) and (0.769±0.245) , HPI value of hepatic metastases were (0.326±0.216), (0.373± 0.298), respectively. There were significant differences between HCC and hepatic metastases in Ktrans, Vp and HPI values in both models(P0.05).Drawn ROC curves of Ktrans, Vp, HPI , the Ktrans value (area under the curve of 0.869) among Extended Tofts model parameters was selected as optimal parameter to identify HCC and hepatic metastases; the HPI value (area under the curve of 0.845) among Exchange model parameters was selected as optimal parameter to differentiate these two types of tumors.The diagnostic accordance rate of Extended Tofts model and Exchange model were 80.0%(32/40), 82.5%(33/40), respectively ; There was no significant difference between them(χ2=0.082,P=0.775). Conclusions Parameters including Ktrans, Vp, HPI of the Extended Tofts model and Exchange model in DCE-MRI perfusion can be used to identify HCC and hepatic metastases of colorectal cancer. Among these parameters, Ktrans of Extended Tofts model and HPI of Exchange model have higher diagnostic value in differentiating HCC and hepatic metastases of colorectal cancer.

Outcomes of Microendoscopic Discectomy and Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation: A Comparative Retrospective Study

STUDY DESIGN: Retrospective, case control evaluation of 86 patients who underwent microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of lumbar disc herniation (LDH). PURPOSE: To evaluate the safety and the outcomes of MED and PTED for the treatment of LDH. OVERVIEW OF LITERATURE: MED and PTED are minimally invasive surgical techniques for lower back pain. Studies to date have shown that MED and PTED are safe and effective treatment modalities for LDH. METHODS: A retrospective study was performed in patients with LDH treated with MED (n=50) and transforaminal endoscopic discectomy (PTED; n=36) in our hospital. All patients were followed-up with self-evaluation questionnaires, Oswestry disability index (ODI), medical outcomes study 36-item short form health survey and MacNab criteria. All the patients in both groups were followed up to 12 months after the operation. RESULTS: ODI questionnaire responses were not statistically different between the MED and PTED groups (53.00 vs. 48.72) before treatment. Average scores and minimal disability after 5 days to 12 months of follow-up were 4.96 in the MED group and 3.61 in the PTED group. According to MacNab criteria, 92.0% of the MED group and 94.4% of the PTED group had excellent or good results with no significant difference. CONCLUSIONS: There was no significant difference between MED and PTED outcomes. Further large-scale, randomized studies with long-term follow-up are needed.

The Screening of Genes Sensitive to Long-Term, Low-Level Microwave Exposure and Bioinformatic Analysis of Potential Correlations to Learning and Memory / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To gain a better understanding of gene expression changes in the brain following microwave exposure in mice. This study hopes to reveal mechanisms contributing to microwave-induced learning and memory dysfunction.</p><p><b>METHODS</b>Mice were exposed to whole body 2100 MHz microwaves with specific absorption rates (SARs) of 0.45 W/kg, 1.8 W/kg, and 3.6 W/kg for 1 hour daily for 8 weeks. Differentially expressing genes in the brains were screened using high-density oligonucleotide arrays, with genes showing more significant differences further confirmed by RT-PCR.</p><p><b>RESULTS</b>The gene chip results demonstrated that 41 genes (0.45 W/kg group), 29 genes (1.8 W/kg group), and 219 genes (3.6 W/kg group) were differentially expressed. GO analysis revealed that these differentially expressed genes were primarily involved in metabolic processes, cellular metabolic processes, regulation of biological processes, macromolecular metabolic processes, biosynthetic processes, cellular protein metabolic processes, transport, developmental processes, cellular component organization, etc. KEGG pathway analysis showed that these genes are mainly involved in pathways related to ribosome, Alzheimer's disease, Parkinson's disease, long-term potentiation, Huntington's disease, and Neurotrophin signaling. Construction of a protein interaction network identified several important regulatory genes including synbindin (sbdn), Crystallin (CryaB), PPP1CA, Ywhaq, Psap, Psmb1, Pcbp2, etc., which play important roles in the processes of learning and memorye.</p><p><b>CONCLUSION</b>Long-term, low-level microwave exposure may inhibit learning and memory by affecting protein and energy metabolic processes and signaling pathways relating to neurological functions or diseases.</p>

Imaging features of Ewing sarcoma and primitive neuroectodermal tumor in sacrum / 中华放射学杂志

Objective To investigate the imaging features of Ewing's sarcoma and primitive neuroectodermal tumor (ES and PNET) in sacrum.Methods Imaging data were retrospectively collected and reviewed in 17 patients with ES and PNET confirmed by pathology.X-ray was performed in all patients,CT scans in 13 patients,and MR scans in 10 patients.Results All lesions were detected solitary and lateral.X-ray and CT features were lytic bone destruction in 12 cases,2 of them with bone sclerosis; one patient showed diffuse sclerosis.Soft tissue mass in pelvic cavity can be seen in 11 cases,9 of them with adjacent large blood vessels invasive and 4 patients with sacroiliac joints invasive.On post-contrast images,mild enhancement was found in 8 cases,and 5 patients with marked enhancement.MR images showed intermediate signal intensity on T1WI in 8 cases and heterogeneous moderate to high signal intensity on T2WI/fat suppression in 10 cases.DWI showed high signal intensity in 4 cases.Unlike CT scan,contrastenhanced MR images showed significant enhancement in 7 cases.Conclusions Ewing's sarcoma and primitive neuroectodermal tumor (ES and PNET) in sacrum have some specific imaging features.Imaging examination could provide reliable evidence for clinical diagnosis.

Effect of Ankle-Foot Retractor on Ankle Joint Motion and Equilibrium Function of Stroke Hemiplegic Patients / 中国康复理论与实践

@#Objective To study the effects of ankle-foot retractor on ankle joint motion and equilibrium function of stroke hemiplegic patients.Methods 74 patients were divided into two groups: observation group (n=36) and control group (n=38). The control group was trainedby routine rehabilitation training program and electro-uprise bed, the observation group was trained by ankle-foot retractor based on routinerehabilitation training program. The effect was evaluated after 8 weeks. Results After training, either the observation group or the controlgroup showed significant improvement at motion of ankle joint, activity of daily living (ADL), and equilibrium function, but the observationgroup was better than the control group (P<0.001). Conclusion Ankle-foot retractor plays a positive role on motion of ankle joint, ADL andequilibrium function in stroke patients.

Effect of Motor Imagery on Balance Ability in Hemiplegics after Stroke / 中国康复理论与实践

@#Objective To study the effect of motor imagery on balance rehabilitation in hemiplegics after stroke.Methods 20 hemiplegic patients who were in chronic stage(above 6 months)were randomly divided into two groups.Normal rehabilitation was performed in the whole stage and motor imagery was added in group A in stage Ⅰ and group B in stage Ⅱ.All patients were assessed with Berg Balance Scale(BBS),blance subscale of the Fugl-Meyer Assessment(FM-B),max affected limb-loading per weight and Functional Independence Measure(FIM)at the beginning and the ending of the every stage,respectively.Results The deference scores of BBS and FIM,as well as max affected limb-loading per weight between in the stage with motor imagery was better than those in the stage without motor imagery(P<0.01),as well as that of FM-B score(P<0.05).Conclusion Motor imagery can improve balance rehabilitation and activity of daily living in chronic hemiplegics.

Estimates of Space Radiation Exposure to Astronauts Using Male Voxel Model Based on MRI / 航天医学与医学工程

Objective To predict the astronaut organs radiation exposure and related health risks in the space radiation environment, the calculated method is studied. Methods A male voxel human model based on MRI and radiation data bank was build. The calculation was carried out with Monte Carlo particle transporting program GEANT4. Results The organ absorbed dose distribution and the effec-tive doses to the model in isotropic proton fields with energies ranges from 10 MeV to 500 MeV were obtained. Conclusion Based on the Chinese astronaut voxel model and the data set of proton spectrum measured in the space cabin, the cumulated dose in the model is gotten. The calculated skin dose is about 148.6 μGy/d, which is within in the range of 100 -300 μGy/d, published by USA and Russia.

Risk factors for skin necrosis around incision after total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the risk factors of skin necrosis around incision after total knee arthroplasty, and explore measures for prevention and treatment.</p><p><b>METHODS</b>From January 2003 to November 2005, skin necrosis around incision occurred to 15 out of the 382 cases (494 knees) treated by total knee arthroplasty. The data of the 15 cases were analyzed. Preoperative hospital for special surgery knee score (HSS) was 60 points on average.</p><p><b>RESULTS</b>All wound were healed after debridement. However, the recover time was over 3 weeks longer than the healing time by first intention. Extensor weakness with anterior knee pain appeared among 9 patients, and 6 months later, the symptoms improved obviously. At two years follow-up, the average range of motion was 92 degrees, and the average HSS improved to 86. There were no secondary infection and deformity in the group.</p><p><b>CONCLUSIONS</b>It is the key to prevent skin necrosis around incision during total knee arthroplasty that surgeons must accurately grasp technique of minimally invasive surgery for total knee arthroplasty. To acquire satisfactory outcome, it is imperative to perform debridement as soon as possible while the skin necrosis happens. At the same time, it is important to persist in doing adequate functional exercises throughout the period of treatment.</p>

Perioperative management in hemophilic arthropathy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical results and improve perioperative management in patients with hemophilic arthropathy.</p><p><b>METHODS</b>From May 2002 to March 2007, 20 patients with hemophilic arthropathy were admitted. Fourteen patients (20 knees) were performed total knee arthroplasty, and 6 patients (8 hips) were performed total hip arthroplasty, while 2 patients were performed ankle arthrodesis. The average preoperative HSS score, hip Harris score and ankle AOFAS score were 83, 89 and 78 points respectively.</p><p><b>RESULTS</b>All patients had been followed up, and the mean time was 27.3 months. The average postoperative knee HSS score increased to 83 points, and hip Harris score increased to 89 points, while the AOFAS score increased to 78 points. Delayed bleeding and deep venous thrombosis and late infection with loose prosthesis occurred in one case respectively.</p><p><b>CONCLUSIONS</b>Arthroplasty and arthrodesis are promising for severe hemophilic arthropathy to obtain pain relief and functional improvement Correct perioperative management is the key to successful treatment in hemophilic arthropathy.</p>