Bone Density Conservation Agents ; Dental Implants ; Diphosphonates ; Humans

Objective To evaluate the influences of femoral rotation on dynamic alignment of the lower extremity in TKA by computer assisted surgical technology.Methods From July 2013 to August 2013,76 consecutive patients with knee osteoarthritis undergone primary-single TKA in our hospital were enrolled,including 46 males and 30 females,aged from 64 to 78 years (average,71 years).All surgeries were completed by the same professional doctor.The PFC (fixed-bearing posterior stabilized) Sigma rotating-platform was selected for all patients,and computer navigation system (Stryker(R) Navigation System Ⅱ-Cart (Stryker corporation,Kalamazoo,Michigan,USA) was used.External rotation osteotomy of the distal femur during TKA was completed according to the pre-operative external rotation angle (ERA),intraoperative transepicondylar axis (TEA) and anteroposterior (AP) line.Passive dynamic alignment of the lower extremity during knee flexion was recorded.The variation trend of hip-knee-ankle (HKA) alignment and the influences of femoral external rotation osteotomy were analysed.Results ERA calculated by the computer navigation system according to Whiteside line,TEA and the mean of Whiteside line and TEA was 5.54°±2.86°,5.21°±2.60° and 5.34°±2.38°.Compared with the ERA measured by CT,no method was better than the other two.Postoperative deviation of HKA alignment from 0° to 90° flexion was associated with the rotational alignment of the femoral component.Trend of HKA alignment during knee flexion tended to be varus,valgus or neutral according to different angles of external rotation osteotomy of the distal femur.Conclusion The HKA alignment changes during the knee flexions.External rotation osteotomy of the distal femur played a crucial role in determining dynamic HKA alignment in TKA.

OBJECTIVE To discuss the efficiency method of improving consciousness and action for occupational infection protection among grass root medical staff.METHODS To conduct multiform health education,found restrict system,inspect and supervise,optimize protection flow,consummate protection establishment,and strengthen important link management in key departments in order to realize the system intervention among grass root medical staff.RESULTS Due to the system intervenion,the understanding rate of occupational infection protection knowledge improved from 48% to 96%,the average rate of occupational infection protection improved from 56.6% to 97.7% with significant differences(P

Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.

Objective: To evaluate the effects of orthopedic robot navigation system used in core decompression combined with bone graft surgery for osteonecrosis of the femoral head (ONFH). Methods: A retrospective analysis was performed on 9 patients (16 hips) underwent core decompression surgery combined with bone graft treatment for early ONFH in ARCO Ⅱat Department of Osteoarthropathy, Yantaishan Hospital from June 2016 to February 2018.There were 7 males and 2 females, aged 44.6 years (range: 28-60 years). All surgery procedures were completed by the same doctor under the navigation of orthopedic surgery robot using the specific designed tools. The preoperative and postoperative Harris Hip Score and visual analogue score were compared and the time of intraoperative X-ray fluoroscopy was recorded. Results: The mean follow-up period was (12.7±3.5)months (range: 6-18 months). Four cases of treatment failure were observed in 16 hips at the last follow-up and the hip survival rate was 12/16.In stage ARCO Ⅱa, Ⅱb and Ⅱc, the survival rate was 1/1, 2/2, and 9/13.The Harris Hip Score (88.3±1.9 vs.70.0±3.8, t=16.81, P=0.000) and visual analogue score (3.7±0.7 vs. 0.9±0.6, t=13.49, P=0.000) were improved significantly at the last follow-up compared with preoperative value. The total times of intraoperative X-ray fluoroscopy were 15.9±2.5, including 5.8±1.2 before the insertion of the guiding wire and 10.1±1.7 after the insertion of the guiding wire. Conclusions The domestic orthopedic surgery robot can be applied successfully in the core decompression combined with bone graft surgery for ONFH . It is less invasive with less fluoroscopy time and better bone graft effects.

OBJECTIVETo investigate the influences of the distal femoral cut, the anterior and posterior femoral cuts, the proximal tibial cut on the dynamic alignment of the lower extremity in total knee arthroplasty.

METHODSBased on the three-dimensional geometric model, imitating the flexion movement of the knee without axial rotation after total knee arthroplasty, the influence of each of the three bone cuts on the dynamic alignment was analyzed with the assumption of standard bone cuts of the other two and equality of the medial and lateral soft tissue balancing. The dynamic alignment was defined as the angle between the mechanical axis of the tibia and the sagittal plane of the body when the knee was in any angle of flexion. With two of the three major bone cuts standard, the track of the tibial movement was established when the other one bone cut deviated from the ideal section of angle A. Based on the principle of geometry, the mathematical formula were established to present the influences of three bone cuts on the dynamic alignment of the lower extremity.

RESULTSAll of the three kinds of bone cuts in total knee arthroplasty influenced the dynamic alignment of the lower extremity not just in one static position, but during the whole range of motion. At the θ angle of knee flexion, the alignment of the lower extremity was arcsin(cosθsinA) when the varus/valgus femoral component alignment was A; the alignment of the lower extremity was arcsin(sinθsinA) when the rotational femoral component alignment was A; the alignment of the lower extremity was A when the varus/valgus tibial component alignment was A.

CONCLUSIONThe influences of the distal femoral cut, the anterior and posterior femoral cuts, the proximal tibial cut on the dynamic alignment of the lower extremity in total knee arthroplasty are dynamically changed during the flexion movement of the knee.

Arthroplasty, Replacement, Knee ; Femur ; surgery ; Humans ; Knee Joint ; Range of Motion, Articular ; Rotation ; Tibia ; surgery

Objective To investigate the antimicrobial resistance ,molecular phenotypes ,virulence gene profiles of Salmonella A gona (S .A gona) isolated from patients with acute diarrhea ,and to better understand its epidemic trend ,prevention and treatment .Methods Clinical data and stool samples of patients with acute diarrhea during April to October in 2013 and 2014 from the Second Hospital of Tianjin Medical University were collected .Enrichment culture ,biochemical identification and serotyping analysis were used to isolate and identify S .A gona strains .The isolated strains were further analyzed with antibiotics susceptibility test ,pulsed field gel electrophoresis (PFGE) ,multiple locus sequence typing (MLST ) , Quinolone resistance determining region (QRDR) .Plasmid-mediated quinolone resistance (PMQR) and β-lactamases genes (TEM ,SHV ,OXA ,and CTX-M) were amplified by polymerase chain reaction (PCR) and sequencing .The representative genes carried by Salmonella pathogenicity islands (SPI) 1 — 6 ,9 — 12 and virulence plasmids were amplified by PCR .And the clinical characteristics of S .Agona infection were analyzed .Results Among 119 non-repetitive (non-typhoidal salmonella ,NTS) isolates during the two years ,eight isolates (6 .7％ ) of S .A gona were identified . The resistance rate of S .A gona strains to streptomycin was 100 .0％ , those to ampicillin and gentamicin were 62 .5％ ,to levofloxacin ,ciprofloxacin and nalicixic acid were 25 .0％ ,to chloramphenicol ,amoxillin/clavulanic acid and piperacillin tazobactam were 12 .5％ .The strains were susceptible to other drugs .All 8 isolates had the identical ST13 genotype .PFGE showed 5 clones ,and 4 out of 5 isolates had the exact same patterns of PFGE and drug susceptibility .Two (fluoroquinolones ,FQ) resistant strains carried gyrA mutation leading to amino acid substitutions at position 87 in GyrA ,and no PMQR genes was detected ,while one of which was sensitive to ciprofloxacin by K-B method .All five ampicillin-resistant isolates were positive for TEM-1b gene and one isolate of them was resistant to β-lactam/β-lactamase inhibitor complex .The representative genes carried by SPI 1 — 6 , 9 ,11 ,12 (hilA ,sseL ,mgtC ,siiE ,sopB ,pagN ,bapA ,pagC and sspH2) were 100 .0％ positive ,while the genes carried by SPI10 (sef A ) virulence plasmids (spvB , prot6E) were negative . Two patients with FQ resistant strains infection were clinically diagnosed with bacillary dysentery ,and the remaining six cases with FQ susceptible strains infection were clinically diagnosed with acute gastroenteritis .Conclusions FQs-resistant and multi-drug resistant S .A gonaisolates have emerged in clinical settings .These isolates carry a variety of virulence genes .Resistance to FQ of S .Agonamay cause more severe illness .ST13 might be the dominant genotype of S . A gona in China ,and we should try to prevent the infection outbreak of S .A gona .

Genomic alterations are commonly found in the signaling pathways of fibroblast growth factor receptors (FGFRs). Although there is no selective FGFR inhibitors in market, several promising inhibitors have been investigated in clinical trials, and showed encouraging efficacies in patients. By designing a hybrid between the FGFR-selectivity-enhancing motif dimethoxybenzene group and our previously identified novel scaffold, we discovered a new series of potent FGFR inhibitors, with the best one showing sub-nanomolar enzymatic activity. After several round of optimization and with the solved crystal structure, detailed structure-activity relationship was elaborated. Together with metabolic stability tests and pharmacokinetic profiling, a representative compound () was selected and tested in xenograft mouse model, and the result demonstrated that inhibitor was effective against tumors with FGFR genetic alterations, exhibiting potential for further development.