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.

Objective:To evaluate the effectiveness of conducting multiple arthroplasty to treat multiple joints disease in terms of quality of life ( QOL) and function improvement.Methods:We compared our results with the reported results of single and dual arthroplasty to see if there is any improvement in QOL, functional scores or complications.In this study, 13 patients admitted to Department of Adult Reconstruc-tive Surgery, Beijing Jishuitan hospital from 2005 to 2009 were included.Questionnaires SF-36 were used to evaluate the QOL.Harris hip score, American Knee Society Score ( KSS) were used to evaluate the joint function.The patients were evaluated before surgery to the latest follow up.Results:SF-36 has changed as follow:physical function 4.17 ±14.43→65.83 ±24.76, role physical 25.00 ±26.11→60.42 ±45.8, bodily pain 23.83 ±21.41→76.88 ±20.89, general health 53.33 ±33.87→76.67 ± 14.67, vitality 50.42 ±17.25→71.67 ±16.28, social functioning 29.17 ±33.50→73.96 ±33.90, role emotional 22.08 ±35.61→77.77 ±41.03, mental health 53.33 ±25.70→82.67 ±14.41, which indicated that they all improved greatly after the surgery ( P <0.05 ) .Harris score increased from 37.68 ±14.71 before the surgery to 83.36 ±13.54 after the surgery.KSS has also showed sharp im-provement (P<0.001) in both clinical score (42.52 ±23.83→77.74 ±20.67) and function score (-2.61 ±22.56→65.65 ±30.76).Conclusion:Multiple arthroplasty is one of the most effective me-thods which can markedly improve the quality of life in patients with multiple joints disease.But compli-cations are common and joint functions are relatively poor.

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 (P<0.01);the mean version for sections 3 and 4 did not differ from the mean postoperative stem version (P>0.05).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.

Objective Our goal was to summarize the clinical data of the combined anteversion of both stem and cup measured by CT method after total hip arthroplasty and to evaluate the accuracy of conventional freehand technique for positioning the combined anteversion by comparing the results to the Dorr′s “safe zone” .Methods We prospectively studied 206 primary total hip arthro-plasties .For all the arthroplasties ,we used posterior lateral approach and conventional freehand technique without any alignment guides .12 surgeons performed all the 206 arthroplasties .Postoperatively all the patients were examined by CT scan within one week .We measured radiographic anteversion of acetabular components using a 3D CT method and measured femoral components anteversion using CT scans .Acetabular anteversion ,femotal component anteversion and combined anteversion were statistically ana-lyzed .Results In all the 206 hips ,the mean acetabular components anteversion was 16 .23° ± 8 .27° ,76 .21% of cases was in Lewin-neck′s safe range of 5°-25° .The mean femoral components anteversion was 23 .79° ± 10 .70° .The mean combined anteversion was 40 .02°± 13 .50° ,65 .05% was in safe range of 25°-50°recommended by Dorr .The acetabular components anteversion ,femoral com-ponents anteversion and combined anteversion placed by senior surgeons was no significantly different from those placed by junior orthopedic surgeons(P>0 .05 ,0 .726 ,0 .143 ,0 .061 ,respectively) .Conclusion The conventional freehand technique is an inaccurate method for positioning the cup anteversion or the combined anteversion .The experience of surgeons can not significantly improve this accuracy .

Based on the effect for replenishing Qi and preventing exhaustion, this essay provides a method to rebuild the quality evaluation system of Panax ginseng. As an independent medical system, the traditional Chinese medicine (TCM) science lacks enough credible evidences to support its theory and thereby wants more relevant studies. Current, it is a misunderstanding for experimental studies on TCM to prove TCM drugs from the angle of western medicine. Therefore, following study modes are recommended to researchers focusing on either the theory of the unique importance of class origin or the theory of the unique importance of techniques. Under the guidance of TCM theories, a new TCM assessment mode, consisting of clinical efficacy, pharmacological effect and effective components, is established in line with clinical application of TCMs. Studies on Chemical fingerprint or active ingredient are made on effective components. In-depth studies are worth to the viewpoint to rebuild the TCM quality reassessment system. On the basis of analysis on ancient herbal literatures and experience in clinical application of TCMs, the author proves the irreplaceable effect of P. ginseng. (pure ginseng decoction) is to replenish Qi and prevent exhaustion. Based on the major effect, a pharmacological model is established in combination with modern clinical efficacy to screen effective components of ginseng herbs and make a quality assessment on safety and efficiency of clinical application of P. ginseng, in order to provide theoretical and experimental basis for cultivation, development and utilization of P. ginseng resources on Changbai mountain.
Drugs, Chinese Herbal ; pharmacology ; Fatigue ; prevention & control ; Humans ; Medicine, Chinese Traditional ; methods ; Panax ; Qi

Objective To investigate the prevalence rate of healthcare-associated infection(HAI)in Xiangya Hospital,and provide reference for preventing and controlling HAI.Methods The cross sectional surveys on preva-lence rates of HAI,cross-sectional antimicrobial use,and bacterial detection among all hospitalized patients on the given days in 2000-2014 (except 2006)were carried out by combination of bedside investigation and medical record reviewing.Results The prevalence rates of HAI in 2000-2014 decreased from 6.30% to 3.91%,difference was statistically significant (χ2 = 35.14,P < 0.001 );prevalence rates of community-associated infection(CAI)were 15.61%-15.76%,there was no significant difference among each year.General intensive care unit (ICU)had the highest prevalence rate;respiratory tract was the most common site of both HAI and CAI;urinary catheterization rate showed a decreased tendency,arteriovenous catheterization rate showed a increased tendency,difference were both significant(χ2 = 5.21,96.24,respectively,both P <0.001).In 2008 - 2014,pathogenic detection rates for specimens from patients receiving therapeutic antimicrobial agents were 36.37%-44.51%,from patients with HAI were 34.00%-44.99%,detection rate of pathogens causing HAI were 41.57%-68.48%,all showed a increased tendency,difference was significant (χ2 = 22.78,10.03,26.49,respectively,all P < 0.001 ).Gram-negative bacteria were the main pathogens causing infection;both cross sectional and combination antimicrobial usage rates declined (P < 0.05 ).Conclusion Prevention and control of HAI,and antimicrobial management has achieved preliminary success,prevalence rate of HAI and cross sectional antimicrobial usage rate declined obviously,the main pathogen is gram-negative bacteria,and the major infection site is lower respiratory tract.

Objective: To evaluate the impact of ultra-high-molecular-weight polyethylene (UHMWPE)-Ribbond fibers, when combined with different restorative materials, on fracture resistance and marginal adaptation of isolated primary molar defects, to provide a reference for clinical practice. Methods: This study was approved by the Ethics Review Committee. A total of 72 extracted primary molars with complete crowns were collected, and 66 primary molars were randomly assigned as experimental groups for the fracture resistance and microleakage tests. The molars were divided into six groups (n = 11) based on the type of restorative materials and the application of Ribbond fibers: Group A1, 3M Filtek Z250 + Ribbond; Group A2, 3M Filtek Z250; Group B1, Beautifil II LS + Ribbond; Group B2, Beautifil II LS; Group C1, 3M Filtek Bulk Fill + Ribbond; and Group C2, 3M Filtek Bulk Fill. Groups A1, B1 and C1 received the fiber-reinforcing technique, whereas Groups A2, B2 and C2 received the direct restorative technique; the remainings were in Group D (blank control group), which did not receive treatment for the fracture resistance test. The fracture resistance test was divided into six experimental groups and one blank control group (n = 6). Primary molar teeth in each experimental group were prepared with Class II cavities and filled. The fracture load of all samples was detected, and the fracture mode was analyzed after thermal cycling. The microleakage test was divided into six experimental groups, with five in each group. Class I cavities with a diameter of 3 mm and depth of 2.5 mm were prepared within the mesial and distal marginal ridges on the occlusal surface and filled for primary molars in each group. Marginal microleakage was assessed after thermal cycling. Results: The fracture resistance test results showed that the fracture resistance in groups that received the fiber-reinforcing technique was greater than that in groups that received the direct restorative technique: Group A1>Group A2, Group B1>Group B2, Group C1>Group C2 (P<0.05). The application of Ribbond fibers increased fracture resistance to all tested restorative materials by 37.08% to 39.34%. The proportion of tooth frac-ture decreased significantly in groups A1, C1 compared with A2, C2, with a significant increase in the occurrence rate of “Repairable” (P<0.05). The fracture resistance in Group A1 was significantly greater than that in Group B1 and Group C1 (P<0.05). The marginal microleakage test results showed that the microleakage depth in groups that received the fiber-reinforcing technique was smaller than that in groups that received the direct restorative technique: Group A1Conclusion The application of Ribbond fibers combined with various restorative materials could enhance fracture resistance and diminish the microleakage depth to improve marginal adaptation.