Objective To investigate the effect of one-stage total hip arthroplasty (THA) for advanced active tuberculosis of the hip.Methods Data of 19 patients who had received one-stage THA for advanced active tuberculosis of the hip in our hospital from September 1998 to October 2010 were retrospectively analyzed.There were 14 males (15 hips) and 5 females (5 hips),aged from 21 to 74 years (average,44.1 years).According to the clinicoradiologic classification of tuberculosis of the hip introduced by Babhulkar and Pande,there were 3 cases of grade Ⅲ and 16 cases of grade Ⅳ.The average time interval from onset of symptoms to THA was 15.1 weeks (range,5-26 weeks).Chest radiographs showed old pulmonary tuberculosis in 3 patients.One patient had a sinus tract in hip skin.The diagnosis was confirmed by histopathology in all patients.The antituberculous medication was applied for at least 2 weeks preoperatively and 9 to 12 months postoperatively.Results All patients were followed up for 12 to 142 months (average,57 months).Dislocation of the hip occurred in 1 patient 6 days after operation,which was cured by manual reduction.Tuberculosis recurrence occurred in 1 patient 5 months after operation,which was cured after debridement without removing component and antituberculous medication for 1 year.Cup loosening was found in 1 patient 9 years after operation.No reactivation of infection or implant loosening was found in other patients.The average Harris score improved from preoperative 35 (range,27-46) to 90 (range,65-96) at final follow-up.Conclusion One-stage THA can be safely performed in advanced active tuberculosis of the hip,which can relief symptoms and improve hip function.

Objective To investigate the feasibility and clinical effect of one-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis.Methods From January 2003 to December 2010,11 patients with old femoral condyle fracture combined with knee osteoarthritis,including 4males and 7 females,aged from 38 to 77 years (average,58.3 years),underwent one-stage total knee arthroplasty.There were 8 cases of supracondylar fracture,and 3 cases of intercondylar fracture.Moreover,there were 2 cases of knee fibrous ankylosis with mild amyotrophy,3 cases of collateral ligaments injury of the knee,2 cases of fibrous union,and 2 cases of infective nonunion.Results All patients were followed up for 6 to 72 months (average,41.3 months).The HSS score improved from preoperative 6.65±7.01 (range,0-13)to 88.5±6.18 (range,81-95) at final follow-up.The range of motion of the knee improved from preoperative 32.7°±17.6° (range,0°-50°) to 101.3°±9.8° (range,85°- 115°) at final follow-up.One case underwent knee disarticulation 6 years after operation owing to infection.For other patients,there were no complications such as infection,deep vein thrombosis,knee instability,component loosening and inequality of lower limb.Conclusion One-stage total knee arthroplasty is a technically difficult but effective method for patients with old femoral condyle fracture and knee osteoarthritis.

Objective To study the indication,surgical technique and clinical results of the uncemented hip arthroplasty for unstable intertrochanteric fractures in elderly patients.Methods Twenty-three elderly patients with unstable interthochanteric fractures were treated with uncemented hip arthroplasty,including 6 males and 17 females with an average age of 77.6 years (range,73-95 years).According to the Evans-Jensen classification,there were 2 cases of type ⅡA,9 of type ⅡB,and 12 of type Ⅲ.Osteoporosis was classified according to the Singh index,there were 2 cases of Ⅳ,8 of Ⅲ,12 of Ⅱ and 1 of Ⅰ.Results All patients were followed up with an average of 31 months (range,12-64 months).The average Harris score improved from 33.1 1±6.58 points preoperatively to 87.12±5.05 points at the time of the last follow-up.Radiologically,there were 16 cases of fixation by bone ingrowth; nonunion of lesser trochante fracture was noted in 3 cases; proximal displacement of greater trochante was found in one patient.Intraoperative proximal femoral fracture was encountered in two cases; deep venous thrombosis was found in three cases and one case died of pulmonary embolism.One case who experienced acute left ventricular failure recovered by medical treatment.There was no aseptic loosening,peri-prosthetic infections,dislocation or ectopic ossification.Conclusion The short-term results of uncemented hip arthroplasty in elderly patients with unstable intertrochanteric fractures were satisfactory.

Objective To evaluate the feasibility and clinical results of one-stage total knee arthroplasty in patients with extra-articular deformity and osteoarthritis of the knee. Methods From June 2006 to April 2010, 9 patients with osteoarthritis of the knee and extra-articular deformity underwent one-stage total knee arthroplasty, including 2 males and 7 females with an average age of 51 years (range, 34-69). These deformities were in the tibia in 4 patients and in the femur in 5. The deformity resulted from fracture malunion in 8 cases and dysplasia in one. There were 6 uniplanar and 3 biplanar deformities. The average angle of the femoral deformities was 13.3° in the coronal plane (ranged from 8° to 22°) and 11.3° in the sagittal plane (ranged from 6° to 15°). One femur had a 10° deformity of external rotation. The average angle of the tibial deformities was 16° in the coronal (ranged from 11° to 22°), One was 21° in the sagittal plane. Results The mean follow-up period was 29 months (range, 7-54) after surgery. The average HSS score improved from 18.7 points preoperatively to 89.8 points at the time of the last follow-up. The average arc of knee motion improved from 46.7° preoperatively to 100.6° postoperatively. The average deviation of mechanical axis of knee was improved from 11.8° of excursion preoperatively to 1° of excursion at the time of the last follow-up. One patient had an unsatisfactory clinical result from delayed union at the esteotomy site. No complications such as infection, DVT, ligament instability, patella problem or component loosening. Conclusion One-stage total knee arthroplasty is a technically difiicult but effective treatment for patients with osteoarthritis of the knee and extra-articular deformity. We recommend that if feasible total knee arthroplasty with intra-articular bone resection and soft-tissue balancing for these patients.

BACKGROUND:Surface modification of orthopedic implants can reduce or prevent bacterial adhersion. Bacteriostatic and bactericidal ingredients released from special coating of metal surfaces prevent orthopedic surgery infection. OBJECTIVE:To prepare hydroxyapatite/nano-silver composite coating on the surface of medical titanium based on different preparation parameters and to observe the release properties of silver ions on the composite material surface in the simulated body fluid. METHODS:Using pulse electrochemical methods, hydroxyapatite and nano-silver were deposited in the solution containing silver, calcium and phosphate ions. Scanning electron microscopy, X-ray diffraction and energy dispersive spectroscopy were used to characterize its morphology and composition. The composite titanium materials containing 0.5, 1 mmol/L silver were immersed in the simulated body fluid, and Ag+concentration was detected by atomic absorption spectrometry at the different time points. RESULTS AND CONCLUSION:Nanoparticles were uniformly distributed in the coating which was interwoven with the nano needle-like hydroxypatite and dot-like silver particles. After high temperature processing, the coating became denser, and hydroxypatite became more crystal and silver particles exhibited no agglomeration. In the simulated body fluid, Ag+release was maximal at 1-7 days and became stable at 7-30 days which maintained an effective antimicrobial concentration. The material containing 0.5 mmol/L Ag+showed a lower amount of Ag+released than cytotoxic concentration at 30 days, but the material containing 1 mmol/L Ag+could release the total of Ag+close to the critical value of celltoxicity at 30 days. Above al , the material containing 0.5 mmol/L Ag+is more secure in the clinical application.

Objective To investigate the surgical methods and clinical effects of total knee arthroplasty (TKA) in patients with severe valgus knee deformity.Methods From January 2007 to December 2012,22 patients with 23 severe valgus knee deformity underwent TKA by means of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants were retrospectively analyzed.They were 7 males and 15 females,aged from 41 to 78 years,with an average age of 65 years.Tibiofemoral angle (angle between the femur and tibia anatomic axis) was 22°-50°,with an average of 34.6±2.4°.Among them,17 cases were osteoarthritis,5 cases were rheumatoid arthritis,3 cases complicated with patella dislocations,1 case complicated with medial instability,3 cases of 4 knees complicated with flexion contracture.Posterior stabilized prosthesis were used in 21 cases of 22 knees,constrained prosthesis were used in 1 case of 1 knee,5 cases accepted intraoperative patellar replacement.Clinical and radiographic evaluations including range of motion (ROM),the Hospital for Special Surgery (HSS)knee score and the tibial and femur angle (T-F angle) were performed at follow-up.Results The duration of follow-up averaged 30.5 months.The average HSS score improved from 19.6±4.7 points preoperatively to 89.7±3.6 points at the time of the last follow up.The average ROM improved from 43.7°-±5.8° preoperatively to 110.6°±7.5°.The average T-F angle was 8.6°±0.8°.We had 5 patella replacements,2 medial instability cured by using articular branches,2 palsies of nervus peroneus communis recovering after 3 months.No complications such as infection,DVT,or component loosening.Conclusion The techniques of medial parapatellar approach,standard osteotomy and only lateral soft tissue release with posterior stabilized implants can deal with a severe valgus knee deformity very successfully in patients undergoing primary total knee arthroplasty,and provide excellent results.

Objective To evaluate the clinical significance of serum level of vascular endothelial growth factor (VEGF),angiopoietin (Ang)-1 and Ang-2 in patients with rheumatoid arthritis (RA).Methods Serum levels of VEGF,Ang-1 and Ang-2 were measured with enzyme linked immunosorbent assay (ELISA).Twenty-one healthy subjects,24 osteoarthritis patients and 82 rheumatoid arthritis patients were included.We defined active and inactive group according to RA disease active score,while early active RA and late active RA group were defined on the basis of disease course.There were 28 early active patients,32 late active patients and 22 inactive patients with rheumatoid arthritis.At the same time 29 RA patients were examined with ultrasound.Synovial hypertrophy (US joint count SH,US index SH),synovial fluid(US joint count SF,US index SF),resistance index and power Doppler signal (US joint PD,TSS) were scored.The correlation was analyzed.We also detected the serum levels of VEGF,Ang-1,Ang-2,ESR,CRP and DAS28 in 25patients with active RA after 3 month regular treatment.We used one-way ANOVA to compare the differences between groups,and Wilcoxon test to compare the differences between before and after treatment.We analyzed the correlation with linear correlation or Spearman rank test.Results The serum level of VEGF [(1285 ±272) pg/ml],Ang-1 [(0.55±0.25)ng/ml] in patients with rheumatoid arthritis were higher than osteoarthritis patients [(934±80) pg/ml,(0.32±0.16) ng/ml] and normal controls [(565±115) pg/ml,(0.24±0.21) ng/ml],and the serum level of Ang-2 [(1.36±0.40) ng/ml] was higher than normal controls [(0.52±0.32) ng/ml].The serum level of VEGF [(1355±194) pg/ml] in early active patients was higher than late active patients [(1096±477) pg/ml] and inactive patients [(862±91) pg/ml].The serum level of Ang-1 in early active patients,late active patients and inactive patients with rheumatoid arthritis had no statistically significant differences.The serum level of Ang-2 in inactive patients [(2.0±2.0) ng/ml] was significantly higher than late active patients [0.9±0.8) ng/ml].The serum level of VEGF was positively correlated with US joint SH,US index SH,US joint PD,and TSS.The serum level of Ang-1 was positively correlated with US joint SH,US joint PD,and TSS.The serum level of VEGF and Ang-1 were negatively correlated with RI.The serum level of Ang-2 was not correlated with US joint SH,US index SH,US joint SF,US index SF,US joint PD,TSS and RI.In the active RA patients,the serum level of VEGF,Ang-1 and Ang-2 was positively correlated with each other.In the inactive RA patients,the serum level of VEGF,Ang-1 and Ang-2 was not correlated with each other.The serum level of VEGF and Ang-1 before treatment was slightly higher than that of after treatment,but the difference was not statistically significant.The serum level of Ang-2 after treatment was significantly higher than that before treatment.ESR,CRP and DAS28 of after treatment were lower than those before treatment.Conclusion The serum VEGF and Ang-1 level could be used as useful index to reflect RA synovial thickening and angiogenesis The serum level of Ang-2 could be used as one of the efficacy indices.They may influence each other,and they may be the key factors that mediate the onset and development of RA angiogenesis and synovial inflammation.

Objective To investigate the cognition on patient safety culture of resident doctors re-ceiving standardized training in two affiliated hospitals, analyze the effectiveness of publicity and education in patient safety culture and put forward suggestions for improvements. Methods A total of 913 resident doctors receiving standardized training in the two affiliated hospitals during 2014 to 2016 were enrolled. Their cognition on patient safety culture were investigated using questionnaire surveys from May to October in 2016, and the main factors influencing the cognition on patient safety culture in standardized training were put forward through expert interviews. All statistical analyses were performed with SPSS 17.0 software with Chi-square test. Results The response rate of the questionnaire was 87.62％ (800/913). Three factors were involved in the patient safety system, including the hospital security objectives, security feedbackchannels, and adverse event warning mechanism. The cognitiive level of A hospital (68.96％, 62.52％, 62.81％) was higher than that of B hospital (52.99％, 46.16％, 47.01％), and the difference was statistically significant (P<0.05). The publicity of pre-service training, education in the department, and encouragement from teachers (82.13％, 84.48％, 78.33％) was better in A hospital than in B hospital (68.38％, 71.8％, 62.39％) (P<0.05). The reporting rate of adverse events in A hospital was higher than that in B hospital (P <0.05). Conclusion It is necessary for hospitals to further intensify the publicity and education on patient safety culture. We can improve students' cognition on patient safety culture to reduce medical errors by cre-ating a favorable atmosphere, establishing standardized admission education and training system, improving teachers' teaching ability, and strengthening the training for clinical skills.

Objective:To study the effects of various extracts of Tongkat Ali on uric acid excretion and renal function in rats with hyperuricemia. Methods:Totally 60 male Wistar rats were equally divided into the blank group,the model group,the positive control group,chloroform group,ethyl acetate group and n-butanol group. The rats were fed with yeast extract,adenine and potassium oxonate to make the model of hyperuricemia. After the animal model was made successfully,the other groups continued to give the modeling a-gent except for the blank group,and the other groups were given the corresponding medicine except for the model group after giving the modeling agent for one hour. After the model agent was given for 14 days,the levels of uric acid(UA),urea nitrogen(UN) and cre-atinine (Cr) in serum and urine and the activity of xanthine oxidase (XOD) in serum and liver were measured. Results: Compared with those in the model group,the levels of uric acid in chloroform group and n-butanol group were significantly lower than those in the model group (P<0.05),besides,the levels of uric acid and creatinine in urine in chloroform group and n-butanol group significantly increased (P<0.05). Compared with that in the model group,the XOD activity of chloroform group and n-butanol group significantly decreased (P<0.01). Compared with those in the positive control group,the levels of UA,Cr and UN in serum and urine and the ac-tivity of XOD in serum and liver in chloroform group, ethyl acetate group and n-butanol group had no significant differences (P >0.05). The levels of UA,Cr and UN in serum and urine and the activity of XOD in serum and liver in chloroform group,ethyl acetate group and n-butanol group had no significant differences (P>0.05). Conclusion: The chloroform extract and n-butanol extract in Tongkat Ali can reduce the serum level of uric acid in rats with hyperuricemia induced by adenine, yeast extract and potassium ox-onate,and the function may be related with the activity inhibition of xanthine oxidase.

Objective:To evaluate the influencing factors of inconsistency between γ-interferon release test QFT-GIT and etiological results in tuberculosis patients.Methods:The clinical data of 1 398 patients with positive Mycobacterium tuberculosis infection confirmed by pathogen culture after QFT-GIT test who were admitted to Hangzhou Chest Hospital Affiliated to Zhejiang University School of Medicine from September 2017 to August 2021 were retrospectively analyzed. There were 1 242 cases in whom both the pathogenic culture and QFT-GIT results were positive(consistent result group) and 156 cases in whom the QFT-GIT test results were negative or indeterminate(inconsistent result group). Logistic regression was used to analyze the influencing factors of inconsistent results between QFT-GIT and tuberculosis pathogenic tests. SPSS 25.0 software was used to analyze the data. Results:The overall incidence of inconsistency between QFT-GIT and tuberculosis etiological results was 11.16% (156/1 398). The incidence of inconsistency was 0, 7.09% (63/889) and 19.58% (93/475) in patients aged <18, 18-<65 and ≥65 years old, respectively; the incidence of inconsistency in age group ≥65 was higher than that in age groups <18 and 18-<65 ( χ2=6.584 and 36.762, P<0.01). Multivariate Logistic regression analysis showed that age ( OR=1.026, 95% CI 1.016-1.037), smoking ( OR=1.649, 95% CI 1.159-2.347), chronic liver disease ( OR=1.868, 95% CI 1.213-2.876), cardiovascular disease ( OR=2.353, 95% CI 1.361-4.069) and blood albumin level ( OR=0.956, 95% CI 0.928-0.985) were independent influencing factors for the inconsistency between the results of QFT-GIT and tuberculosis etiology. Conclusion:Patients with advanced age, smoking, chronic liver disease, cardiovascular disease and low albumin level are more likely to have inconsistent results between QFT-GIT and tuberculosis etiological tests.