BACKGROUND:The coagulation function of patients after joint replacement is enhanced during the perioperative time, the coagulation disorder can easily lead to the deep vein thrombosis, which wil seriously affect the rehabilitation and prognosis of patients. The embolus fal ing off from venous thrombosis can lead to acute pulmonary embolism, severe cases can be life-threatening. So the early diagnosis of postoperative deep vein thrombosis and acute pulmonary embolism is very important.
OBJECTIVE:To review the research progress of clinical diagnosis of thrombosis in the perioperative patients after orthopaedic joint replacement.
METHODS:A computer-based retrieve in PubMed database and CNKI database were conducted by the first author for the articles on the clinical diagnosis of thrombosis in the perioperative patients after orthopaedic joint replacement from January 2008 to May 2013 with the key words of“arthroplasty, deep venous thrombosis, pulmonary artery embolism, risk factor, diagnostic approach, anticoagulant, perioperative period, research progress”in English and Chinese. A total of 165 articles were screened out, and final y 50 articles were included according to the inclusion criteria.
RESULTS AND CONCLUSION:After joint replacement surgery, various risk factors were associated with the etiology and pathogenesis of deep venous thrombosis, such as vascular and tissue impairments, limb fixation, pain stress, and hemorrhagic fluid caused coagulation disorder, were the main reasons to thrombosis. Deep vein thrombosis and pulmonary embolism had variety of clinical manifestations, many diagnostic approaches were widely applied in clinic, but each one has its laminations. So the positive diagnosis intervention should be performed according to the common clinical manifestations, general y begin from the routine examinations of ultrasound and electrocardiogram, and the combination of various methods was preferred if necessary in order to increase the positive diagnosis rate to the maximum extent, and take drug intervention immediately after diagnosis to avoid the happening of adverse events. Several new types of oral anticoagulants appear in clinical trials, and the outcomes are very promising, but the widely clinical application needs further observation.

Objective To analyze dialectical thinking and medication laws of TCM master LI Ji-ren in treating rheumatoid arthritis (RA); To provide references for clinical medication. Methods Medical cases of RA in outpatient department of the First Affiliated Hospital of Wannan Medical College during January 2014 to June 2015 treated by Professor LI Ji-ren. SPSS18.0 statistical software was used to carry out frequency analysis, correlation analysis, and cluster analysis. Results The included medical cases covered 123 cases, 199 prescriptions and 211 kinds of medicine. The total medication frequency was 3503, with 52 kinds of high frequency medicine (>10%), including Astragali Radix, Angelicae Sinensis Radix, Scorpio, Spatholobi Caulix, and Sargentodoxae Caulix. 36 kinds of medicine belonged to Liver Meridian of Foot-Jueyin (69.2%); 21 kinds of medicine belonged to Kidney Meridian of Foot-Shaoyin (40.4%); 20 kinds of medicine belonged to Spleen Meridian of Foot-Taiyin (38.5%); 16 kinds of medicine belonged to Heart Meridian of Hand-Shaoyin (30.8%). High frequency medicine was mainly to be sweet, spicy and bitter. High frequency medicine was mainly to be medicine with the functions of clearing heat, tonifying (tinifying qi, blood, yang and yin), activating blood and expelling stasis, and expelling rheumatism. 127 pairs of high frequency medicine was in positive correlation, among which 36 pairs showed the correlation coefficient >0.9. High frequency cluster analysis could be mainly divided into 6 categories. Conclusion The medication laws in this study and Professor LI Ji-ren's treatment for RA emphasize consolidating basis, and are in accordance with the ideas of expelling wind and humidity, activating blood and expelling stasis and stopping pain, which can provide references for clinic.

BACKGROUND:Hidden blood loss, a frequent occurrence fol owing artificial joint replacement, greatly affects the recovery from total hip arthroplasty. Many factors have been shown to have a correlation with the hidden blood loss, but the specific mechanism is not yet clear.
OBJECTIVE:To investigate the correlation of patients’ baseline (sex, age, underlying disease, obesity), prosthesis types, surgical time with hidden blood loss fol owing total hip arthroplasty, as wel as the association between hidden blood loss and prognosis.
METHODS:Ninety patients undergoing total hip arthroplasty were enrol ed in this study. Using Gross formula, we calculated the total blood loss according to height, weight, and pre-and post-operative hematocrit, and subtracted the dominant loss of blood to get the quantitative value of hidden blood loss. According to the criterion, the 90 patients were divided to two groups:group I:volume of hidden blood loss>480 mL, group II:volume of hidden blood loss<480 mL. Then we analyze the difference in the gender, age, underlying disease, type of prosthesis, surgical time between the two groups, and whether there was a correlation between these factors and hidden blood loss. Al the patients were fol owed for 1 year. Perioperative complications and survival curves were observed and monitored in the two groups.
RESULTS AND CONCLUSION:There were 39 patients in the group I, including 64.1%males, 64.1%hypertension patients, 35.9%diabetic patients, 7.7%patients receiving cement prosthesis;while, there were 51 patients in the group II, including 37.3%males, 25.5%hypertension patients, 5.9%diabetic patients, 35.3%patients receiving cemented prosthesis, showing a significant difference between the two groups. Based on these experimental findings, age, hypertension, diabetes mel itus, type of prosthesis were shown to be factors independently associated with hidden blood loss;however, obesity and smoking exhibited no correlation with hidden blood loss. In addition, a statistical difference in the survival rate was found at admission and during the 1-year fol ow-up.

Objective To observe the therapeutic effect of single lower limb traction plus massage for the lumbosacral tunnel syndrome.Methods The selected 80 candidate patients were divided into the observation group with 38 patients and treatment group with 39 patients. The observation group received single lower limb traction plus massage and the treatment group received pelvic traction plus massage. Both groups therapy last 5 days, The Japanese orthopaedic association scores (JOA) was evaluated for subjective symptoms, signs, functional activity and bladder function score. The therapeutic effect was evaluated.Results The total effective rate (94.7% vs. 82.1%;χ2=12.160,P=0.007) in the observation group was significantly higher than that in the control group. O, The scores of JOA at one week after treatment (20.2 ± 2.0 vs. 18.3 ± 2.8;t=3.419, P<0.01) and two weeks after treatment (24.4 ± 1. 4vs. 22.6 ± 3.0;t=3.359,P<0.01) in the observation group were significantly higher than those in the control group.Conclusions The single lower limb traction plus massage can improve the clinical symptoms of patients with lumbosacral tunnel syndrome, and be superior to the pelvic traction plus massage.

Objective To assess the effect of the pulsatile catheter (PUCA) pump support on cardiac resuscitation in sheep,and to provide a new approach for saving cardiac arrest patients. Methods Cardiac arrest was induced by ventricular fibrillation in 11 sheep. These sheep were divided into three groups including no support (n=3), delayed support (n=2) and immediate support (n=6). Time for cardiac resuscitation and the ratio of success to failure in each group were recorded. Hemodynamic parameters including heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), central venous pressure(CVP),right ventricular end-diastolic pressure (RVEDP),left atrial pressure (LAP), and left ventricular end-diastolic pressure (LVEDP) were monitored and recorded at 5, 60 and 180 min after cardiac resuscitation with PUCA pump. Results Time for cardiac resuscitation in no support group, delayed support group and immediate support group was (38.3±5.8),(43.5±9.2) and (48.7±23.8)minutes, respectively(P＞0.05),and the ratio of success to failure was 0/3,0/2 and 5/1, respectively ( P＜0.05). After cardiac resuscitation with the PUCA pump support, MAP, SBP and DBP increased gradually(P＜0.05).Conclusions PUCA pump can maintain the hemodynamic stability in a sheep model of cardiac arrest,and can thus increase the success rate of cardiac resuscitation. It may be suitable for resuscitating cardiac arrest patients.

Objective This study was to understand the structure characteristics of prophages in the genome of Enterococcus hirae R17,and also to analyze their interaction relationships with the host bacterium.Methods The gene distribution and gene encoding characteristics of prophages in the genome of Enterococcus hirae R17 were identified using the PHAST software.The virulence gene,antimicrobial resistance genes,and environmental resistance genes in the prophages were also analyzed.Results Three prophages were found on the chromosome of Enterococcus hirae,including two incomplete prophage elements (Prophage-1 and Prophage-2) and one complete prophage (Prophage-3).Some function genes of bacteria were found in the sequence of three prophages,including nucleotide transportation and metabolism related genes.One incomplete prophage carrying erythromycin-and bacitracin-resistance genes was identified in the plasmid,which suggested that prophage induced gene horizontal transfer caused erythromycin-and bacitracin-resistance of Enterococcus hirae R17.Conclusion This study laid a solid foundation for the diversity analysis of prophages of Enterococcus hirae.Prophages played an important role in promotion of antimicrobial resistance of enterococci.Scientists should pay more attention to the spread of antimicrobial resistance and pathogenicity induced by prophages.

BACKGROUND: Acute renal failure following heart failure assisted circulation have been extensively reported. However, little data have been available concerning morphological analysis of kidney tissues under that condition.OBJECTIVE: To observe morphological change of ischemia/reperfusion kidney in a sheep pulsatile catheter (PUCA) pump short-term support for heart failure model and explore causes of acute renal failure in assisted circulation patients.DESIGN, TIME AND SETTING: Self-contrast animal experiment was performed at the laboratory of Department of Cardiothoracic Surgery, Renji Hospital of Shanghai Second Medical University between July 2003 and April 2004.MATERIALS: PUCA pump was provided by Gerhard Rakhorst, Professor of Biomedical Engineering, University of Groningen.METHODS: After ischemic heart failure in 10 sheep was induced successfully and subsequently ischemia/reperfusion kidney was developed, PUCA pump was activated to support the hemodynamics for 3 hours.MAIN OUTCOME MEASURES: Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 45 minutes after the support. Kidney biopsy specimens for light and electron microscopy were obtained 3 hours after support.RESULTS: PUCA pump support was successful in 7 of 10 sheep for 3 hours. During support with the PUCA pump,Hemodynamic parameters gradually restored to normal and stable condition, and blood pressure was close to baseline at the end of experiment. On both light and electron microscopy examination, mild acute kidney change was observed after ischemia/reperfusion. Cytosis in renal glomerulus associated with vasodilatation hyperemia, endepidermis in renal tubules hydropic degeneration, vasodilatation hyperemia and Interstitial edema in renal medulla were the main findings.CONCLUSION: PUCA pump could successfully maintain the hemodynamics for 3 hours in a sheep acute heart failure model,but pathological change in ischemia/reperfusion kidney was remained. It is impossible to predict prognosis of renal function on hemodynamic data alone during support.

Objective To quantify the correlations between Elekta XVI cone beam CT dose and various scanning protocols,providing mathematical models to assess the protocol-dependency of imaging dose during imnage guided radiotherapy.Methods Based on standard protocols and various combinations of kVp and mA on an XVI mounted on an Elekta Versa HD accelerator,the air KERMA was measured at various positions in a standard PTW CTDI body phantom using calibrated PTW 30009 kV chamber and UNIDOS webline electrometer.Weighted CT dose index (CTDIw) was computed thereafter.SigmaPlot 10.0 was used to fit the measurements against mA and/or kVp yielding empirical functions.Results Under standard protocols,the CTDIw of Varian OBI was only 11.23％ (chest) and 9.15％ (pelvis) of Elekta XVI.Using the default and other 4 investigated kVp values,the central and peripheral KERMA were both proportional to mA,and vet the slope value a varied dramatically from 0.479 to 6.679.Major affecting factors included kVp settings,measurement locations,and dosimetric mnetrics,etc.None linear regressions were used to fit kVp against KERMA at various locations and CTDIw (R2 ＞ 0.997).The differences between all coefficients were statistically significant (P ＜ 0.05).The impact of changing both mA and kVp on the dose to phantom center can be described as mGy =(5.917-0.197 ×kVp+0.002 × kVp2-5.063 × 10-6 × kVp3) × mA.Conclusions Imaging dose of Elekta XVI is strongly dependent on scanning paraneters.The proposed mathematical models can be used as efficient and robust indicators of such dependency.

Objective To explore the clinical value of single utility port video-assisted thoracoscopic surgery ( VATS ) for mediastinal tumor . Methods A retrospective analysis was performed on clinical data of 55 patients with mediastinal tumor who received surgical treatment with single utility port video-assisted thoracoscopic surgery in this department from December 2013 to June 2016.Routinely, the surgery was conducted by intraoperatively inserting the thoracoscope via an incision at the seventh intercostals space on the midaxillary line as the observation hole , and making a 3-4 cm transverse incision at the fourth intercostals space between the midaxillary line and the anterior axillary line as the operation hole .Postoperatively , the observation hole served as the passage for closed thoracic drainage tube . Results Among the 55 patients, 50 received total thoracoscopic surgery .In 3 cases with relatively large tumor, the surgery was conducted with additional assisted small incisions .Thoracotomy was carried out in another 2 cases due to bleeding when separating pulmonary artery branch and difficult hemostasis under thoracoscopy .The surgery duration was (100 ±46) min, the intraoperative blood loss was (85 ±38) ml, the postoperative chest drainage volume was (450 ±80) ml, the postoperative time to chest tube withdrawal was (3.0 ±1.6) d, and the postoperative duration of hospital stay was (6.2 ±1.5) d in the 50 cases of VATS.All the patients recovered well .Postoperatively , there were 1 case of myasthenic crisis , 2 cases of pneumothorax and 3 cases of pleural effusion, all of which were improved with symptomatic treatment .All the 55 cases were followed up for 2-24 months (mean, 11.2 ±7.3 months) and there were no tumor recurrences . Conclusion Single utility port VATS of mediastinal tumor resection has advantages in safety , efficacy, and cosmetic outcomes , being worthy of further clinical application .

Objective:To establish a simplified anatomical model with the selected rabbits widely distributed in China′s dry region as the reference species and compare the result of internal exposure dose coefficients based on the present mode and ERICA.Methods:A simplified anatomical model based on anatomy and geometry was established for rabbits. Combined with Monte Carlo program, the deposited energy of radionuclide particles in rabbit tissues/organs was obtained, and the internal and external exposure dose coefficient for rabbits was calculated following the empirical formula.Results:Simplified anatomy model-based dose coefficients were 129I 4.81 × 10 -6, 137Cs 4.34 × 10 -5, and 134Cs 3.81 × 10 -5(μGy·h -1)/(Bq·kg -1) for internal exposure and 129I 3.16 × 10 -7, 137Cs 2.39 × 10 -4 and 134Cs 6.22 × 10 -4(μGy·h -1)/(Bq· kg -1) for external exposure. respectively. ERICA-based dose coefficients were 129I 4.44 × 10 -5, 137Cs 1.94 × 10 -4 and 134Cs 2.34 × 10 -4(μGy·h -1)/(Bq·kg -1) for internal exposure and 129I 2.19 × 10 -6, 137Cs 2.52 × 10 -4 and 134Cs 6.95 × 10 -4(μGy·h -1)/(Bq·kg -1) for external exposure, respectively. Conclusions:The simplified anatomical model established is based on the measured data and focuses on the radiation doses to biological tissues/organs, and the calculated result based on the present model are closer to the actual situation, and can provide reference values for the reference biological evaluation of non-human species.