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.

The clinical application of arthroscopic minimally invasive treatment of shoulder joint disease technology has become a routine,and it has been widely carried out around the world.Compared with the traditional open surgery,it only needs to establish a few channels in the shoulder and then the diagnosis and treatment of the structure under the acromion and glenoid joint internal lesions can be completed through the arthroscopic technique under direct vision,of course,including local collection of pathological specimens.Shoulder arthroscopic surgery has the advantages of simple operation technique,small economic burden of patients,small tissue trauma,quick recovery and high accuracy of disease diagnosis.At present,there are two main options for shoulder arthroscopy:the beach chair position (BCP) and the lateral decubitus position (LDP).The choice of surgical position for surgeons is closely related to the intraoperative operation,the risk of complications,the efficacy of surgery,and the cost of setting the posture.Shoulder arthroscopy of these two positions have their own advantages and disadvantages:in the BCP,the surgeon gets a better anatomical operation experience,if necessary,can be converted into open surgery at any time.Without continuous traction,upper limb nerve and vascular damage caused by traction can be avoid.But the incidence of cerebral ischemic events in patients may increase in the BCP.There is also possibility of the nerve damage of the pillow small nerve,great auricular nerve,lateral femoral cutaneous nerve and other nerves.In theory the risk of air embolism in the patients will increase in the BCP,and the cost of setting the position is also higher than the LDP.While in the LDP due to the patient's forearm continuous traction,the surgeon can get a more extensive operating space,and the occurrence of cerebral ischemic events is very rare.In the treatment of anterior shoulder instability after shoulder arthroscopic surgery,there is a lower recurrence rate in the LDP.The cost of setting the position is also significantly lower than the BCP.Of course,the disadvantages of the LDP is also obvious.In the LDP,the brachial plexus and other nerves or vascular injury may increase due to the continuous traction of the forearm.Meanwhile sustained traction in the LDP is also a risk factor for thrombosis,and so on.Therefore,there is still a debate about the optimal location of the shoulder arthroscopy.Many clinicians choose shoulder arthroscopic position based on their own experience and habits.

Objective To analyze the epidemiological features of Galeazzi fractures from 2003 through 2012 in The Third Affiliated Hospital to Hebei Medical University. Methods We retrospectively analyzed the data of Galeazzi fractures between January 2003 and December 2012 in the Third Affiliated Hospital to Hebei Medical University. The data from 2003 through 2008 were defined as group A and those from 2008 through 2012 as group B. The general information was compared between the 2 groups. The epi-demiological characteristics and trends during the 10 years were analyzed concerning gender, age and fracture type of the patients. Results A total of 153 Galeazzi fractures were recorded, accounting for 0. 81％ of ulnoradial fractures and 0. 12％ of all fractures. There were 109 males and 44 females, with a male/female ratio of 2. 48:1. The age range from 11 to 20 years had the highest constituent ratio ( 22. 22％) and type Ⅱthe highest proportion ( 76. 47％) . There were 74 cases in group A, with a male/female ratio of 2. 22:1. There were 79 cases in group B, with a male/female ratio of 2. 76:1. There was no significant difference between the 2 groups concerning the male/female ratio ( P > 0. 05 ) . The median age for group A was 29 years, significantly younger than that for group B ( 34 years ) ( P <0. 05 ) . The high risk age was from 11 to 20 years in group A (32. 43％) and from 21 to 50 years (22. 78％) in group B. Compared with group A, the constituent ratio of age range from 11 to 20 years in group B was significantly lower and the constituent ratio of age range from 41 to 50 years significantly higher ( P <0. 05 ) . There were no significantly differences between the 2 groups concerning the constituent ratio of each fracture type ( P> 0. 05 ) . Conclusions Galeazzi fractures accounted for 0. 81％ of ulnoradial fractures and 0. 12％ of all fractures. There were more male patients than female ones. The age range from 11 to 20 years and typeⅡhad the highest constituent ratios. Compared with the first 5 years, the latter 5 years witnessed increased mean age.

Background: Replacing damaged anterior cruciate ligaments (ACLs) with tissue-engineered artificial ligaments is challenging because ligament scaffolds must have a multiregional structure that can guide stem cell differentiation. Here, we designed a biphasic scaffold and evaluated its effect on human marrow mesenchymal stem cells (MSCs) under dynamic culture conditions as well as rat ACL reconstruction model in vivo. Methods: We designed a novel dual-phase electrospinning strategy wherein the scaffolds comprised randomly arranged phases at the two ends and an aligned phase in the middle. The morphological, mechanical properties and scaffold degradation were investigated. MSCs proliferation, adhesion, morphology and fibroblast markers were evaluated under dynamic culturing. This scaffold were tested if they could induce ligament formation using a rodent model in vivo. Results: Compared with other materials, poly(D,L-lactide-co-glycolide)/poly(ε-caprolactone) (PLGA/PCL) with mass ratio of 1:5 showed appropriate mechanical properties and biodegradability that matched ACLs. After 28 days of dynamic culturing, MSCs were fusiform oriented in the aligned phase and randomly arranged in a paving-stone-like morphology in the random phase. The increased expression of fibroblastic markers demonstrated that only the alignment of nanofibers worked with mechanical stimulation to promote effective fibroblast differentiation. This scaffold was a dense collagenous structure, and there was minimal difference in collagen direction in the orientation phase. Conclusion Dual-phase electrospun scaffolds had mechanical properties and degradability similar to those of ACLs. They promoted differences in the morphology of MSCs and induced fibroblast differentiation under dynamic culture conditions. Animal experiments showed that ligamentous tissue regenerated well and supported joint stability.

Background: Replacing damaged anterior cruciate ligaments (ACLs) with tissue-engineered artificial ligaments is challenging because ligament scaffolds must have a multiregional structure that can guide stem cell differentiation. Here, we designed a biphasic scaffold and evaluated its effect on human marrow mesenchymal stem cells (MSCs) under dynamic culture conditions as well as rat ACL reconstruction model in vivo. Methods: We designed a novel dual-phase electrospinning strategy wherein the scaffolds comprised randomly arranged phases at the two ends and an aligned phase in the middle. The morphological, mechanical properties and scaffold degradation were investigated. MSCs proliferation, adhesion, morphology and fibroblast markers were evaluated under dynamic culturing. This scaffold were tested if they could induce ligament formation using a rodent model in vivo. Results: Compared with other materials, poly(D,L-lactide-co-glycolide)/poly(ε-caprolactone) (PLGA/PCL) with mass ratio of 1:5 showed appropriate mechanical properties and biodegradability that matched ACLs. After 28 days of dynamic culturing, MSCs were fusiform oriented in the aligned phase and randomly arranged in a paving-stone-like morphology in the random phase. The increased expression of fibroblastic markers demonstrated that only the alignment of nanofibers worked with mechanical stimulation to promote effective fibroblast differentiation. This scaffold was a dense collagenous structure, and there was minimal difference in collagen direction in the orientation phase. Conclusion Dual-phase electrospun scaffolds had mechanical properties and degradability similar to those of ACLs. They promoted differences in the morphology of MSCs and induced fibroblast differentiation under dynamic culture conditions. Animal experiments showed that ligamentous tissue regenerated well and supported joint stability.

Objective To explore the effect of immune senescence on lung cancer metastasis and reveal the mechanism of Fuzheng traditional Chinese medicine Jinfukang in the prevention and treatment of the metastasis. Methods A lung metastasis model of Lewis lung cancer cells was established in C57BL/6 mice with different ages (15 months, 6 months, and 2 months). Mice in the 6-month-old group were given Jinfukang intragastrically for 42 days. Pulmonary metastasis was analyzed by in vivo imaging, anatomical microscopic observation, and HE staining. The proportion of memory T cells and NK cells in peripheral blood was detected by flow cytometry. Results The lung metastatic tumor formation rate of 15-month-old and 6-month-old mice was significantly higher than that of 2-month-old mice (all P < 0.05). Abundance of CD4+T cells in peripheral blood was positively correlated with age (2-month-old vs. 6-month-old, P=0.041; 2-month-old vs.15-month-old, P=0.041; 6-month-old vs.15-month-old, P=0.953). The abundance of NK cells was negatively correlated with age (2-month-old vs. 6-month-old, P=0.009; 2-month-old vs.15-month-old, P=0.009; 6-month-old vs. 15-month-old, P=0.574). However, the survival time of mice in the Jinfukang group was longer (P > 0.05) and the level of NK cells in peripheral blood was significantly higher (P=0.029) than those in the normal saline group. Conclusion Immune senescence can promote the metastasis of lung cancer. The prolongation of the survival time of mice administered with Jinfukang may be related to delaying immune senescence and increasing the number of NK cells.

Hip arthroscopy has become a routine treatment for the localized hip lesions.With the rapid development of arthroscopy,the number of surgeries has increased greatly.Though hip arthroscopy is considered as low risk operation,its complications have been constantly reported and noted.There are two major types in hip arthroscopy surgeries:conventional operative complications and special complications.Conventional operative complications include venous thromboembolism,hemorrhage,and pain.Special complications are associated with arthroscopic techniques and local anatomical structures of the hip,such as the perineal nerve,the lateral femoral cutaneous nerve,the acetabular labium or the iatrogenic injury of the cartilage surface of the femoral head.Hip arthroscopy has obvious advantages such as small surgical wound and rapid recovery,but its complications can not be ignored.Joint surgeons must fully recognize it and keep vigilant so as to avoid complications as much as possible.This review will systematically elaborate the complications of hip arthroscopic surgery from general and special aspects so as to provide ideas for reducing the occurrence of complications in hip arthroscopic surgery.

Objective To evaluate the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing heterotopic ossification after hip arthroscopy.Methods Literature search was conducted in PubMed,Embase,Cochrane Library,CNKI and Wanfang data with time range from January 1973 to November 2017.Clinical case control articles on NSAIDs in preventing heterotopic ossification after hip arthroscopy were screened based on the inclusion and exclusion criteria.Meta analysis was done using RevMan 5.3 software to investigate the incidence of complications such as heterotopic ossification and gastrointestinal bleeding after hip arthroscopy in patients taking NSAIDs orally.Results Six articles were included in the study,with a total of 754 cases and 536 controls.NSAIDs reduced the incidence of heterotopic ossification after hip arthroscopy (RR =0.09,95％ CI 0.03-0.27,P ＜ 0.05).Selective COX-2 inhibitor celecoxib (RR =0.17,95％ CI 0.03-0.91,P ＜ 0.05) and PG synthase inhibitor of naproxen (RR =0.17,95％ CI 0.09-0.32,P ＜ 0.05) were also effective in preventing heterotopic ossification.There was no significant difference in the incidence of gastrointestinal complications between the cases and controls after NSAIDs prophylaxis (RR =2.17,95％ CI 0.92-5.12,P ＞ 0.05).Conclusion NSAIDs can effectively reduce the incidence of heterotopic ossification after hip arthroscopy and does not increase the incidence of postoperative gastrointestinal complications.Therefore,it is effective and safe to use NSAIDs to prevent the occurrence of heterotopic ossification after hip arthroscopy.