Objective To compare the efficacy of self-made bone cement spacers containing vancomycin(vancomycin spacer)and Link infection-treating spacers(Link type spacer)for chronic infection after total hip arthroplasty(HTA)and investigate the choice of spacers for the two-stage revision of infection.Methods The study included 26 patients with infection combined with HTA,aged 32-82 years(mean 69.5 years).In the first stage,after complete debridement and removal of infected prostheses,the vancomycin spacers were implanted in 14 patients,while the Link type spacers were implanted in the rest 12 patients.Two weeks of intravenous administration of antibiotics and then six weeks of oral administration of antibiotics were done postoperatively.White blood cells(WBCs),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were measured periodically after operation.THA revision was performed in the second stage.Clinical outcomes were evaluated according to the pre-and post-operative Harris hip score.Results All patients obtained primary healing of incision after complete debridement,removal of prostheses and implant of the vancomycin spacers or the Link type spacers.Two-stage revision surgery was performed at 3-11.5 months after the one-stage surgery(mean 5.2 months).The follow-up ranging from 12 to 33 months(mean 20.8 months)manifested no signs of reinfection.The mean Harris hip score was increased from 27.9 points before one-stage operation to 52.9 points before two-stage operation,and 83.6 points at the latest follow-up(P＜0.05)One of 12 vancomycin spacers was broken before the revision surgery,as was free from the Link spacers.Conclusions(Ⅰ)Two-stage revision is an effective method in the treatment of infection after HTA because of high eradication rate of infection,effective pain relief and good postoperative functional result.(2)The vancomycin spacers and the Link type spacers can both effectively control infection and restore part of limb function.(3)The Link type spacers take advantages of simple in operation and the function improvement of the limbs during the intermittent period of treatment,but disadvantages of the catheters being prone to block,limited slow release of antibiotics and high cost of treatment.Thereby,the Link type spacer is suitable for the patients with relatively strong constitution,little serious infection,or high requirement of limb functions at the interval of two operations.

Objective To analyze and compare two potency assay methods of protamine sulfate.Methods Heparin titration method was according to foreign pharmacopoeia,while biological assay method was according to China pharmacopoeia(2015).Results The absorbance at the end-point was stable at 0.10 mg/mL and 0.15 mg/mL test solutions.The relative standard deviations(RSDs)of potency results were all less than 5%.Three test solutions and volumes of the titrant had a good linear relationship(R2 =1.000).The results of titration method were significantly related to those of biological assay(P=0.013),with similar RSD(P>0.05).However,the potency of titration method were significantly lower than those of biological assay (P=0.045).Conclusion Heparin titration method is good-using,convenient,and need to be applied widely at home.

Objective To investigate the effect on the miemvnscular density(MVD)and the expression of vascular endothelial growth factor(VEGF)in VX2 tumor after transcatheter arterial chemoembolization(TACE)combined with endostatin.Methods The VX2 tumor model wag established.The rabbits bearing tunlor were randomly divided into three groups as the control group.TACE group and TACE combined with endostatin group.with 10 rabbits in each group.In the control group,normal saline was administered via the hepatic artery.In the TACE group,lipiodol(0.2 ml/kg)and ADM(2.g/kg)were administered.Lipiodol(0.2 ml/kg),ADM(2 mg/kg)and endostatin(2 mg/kg)were administered for each rabbit in the TACE combined with endostatin group.Seven days after operation,the rabbits were sacrificed and the tumors were removed.Immunohistochemistry wag performed to demonstrate the expression of VEGF and the MVD wag caleulated.The ANOVA wag used for statistics.Results The average absorbance values of VEGF were 0.130±0.038.0.200±0.049 and 0.120±0.047 respectively for the 3 groups.There was signiflcant difference among the three groups(F=9.42,P＜0.01).rnle expression of VEGF in the TACE group was the hiShest among the 3 groups.Compared with the otIler two groups,there had signifieant differences(q=4.93,5.63,P＜0.01).The average absorbance value of the TACE combined with endostatin group was lower than that of control group,but there was no significant difference between them(q=0.70,P＞0.05).The values of MVD were(80±17),(84±16)and(57±13)/HPF for the 3 groups respectivelv.There wag significant difference among them(F=8.70,P＜0.01).111e value of MVD in the TACE combined with endestatin group was the lowest, and there were significant differences when compared with the control group (q=4.63, P＜0.01) and the TACE group (q =5.48, P＜0.01).There was no significant difference between the control group and the TACE group (q = 0.85, P ＞ 0.05) in MVD.Conclusion Compared with chemoembolization only, ehemoembolization combined with endostatin can significantly depress the expression of VEGF and decrease the angiogenesis of the tumor.The combined method has a beneficial effect on prognosis of hepatic tumor.