BACKGROUND:Skin preparation before surgery has been described as a preventive measure for reducing infections following total knee arthroplasty.OBJECTIVE:To investigate the prophylactic effect of skin preparation on the infections after total knee arthroplasty.METHODS:A total of 422 patients (493 knees) who were candidate for primary total knee arthroplasty,including 98 males and 327 females.They were from 40 years old to 84 years old,averaging 60 years old.According to the different ways of preoperative skin preparation,the patients were divided into 3 groups,razor skin preparation group (n=290 patients,331 knees),dehairing agent skin preparation group (n=74 patients,88 knees),and skin cleaning on the surgical morning group (n=61 patients,74 knees);the limb infections after replacement were observed.RESULTS AND CONCLUSION:All patients were followed up for 0.5-5.5 years,with an average of 3.9 years.The infection incidence after total knee arthroplasty in the razor skin preparation group,dehairing agent skin preparation group,skin cleaning on the surgical morning group were 1.81%,2.27%,1.35%,respectively.It is indicated that there is no significant difference in the infection rate of skin preparation by different methods following total knee arthroplasty.

ObjectiveTo evaluate the efficacy of fiberoptic bronchoscope( FOB )-guided tracheal intubation with laryngeal mask airway (LMA) in patients undergoing anterior cervical spine surgery.MethodsForty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-55 yr,weighing 50-75 kg,mallampatis Ⅰ or Ⅱ,scheduled for anterior cervical spine surgery under general anesthesia,were randomly divided into 2 groups( n =20 each): FOBguide tracheal intubation (group FOB) and FOB-guided tracheal intubation with LMA group (group LMA).Anesthesia was induced with mindazolam 0.04 mg/kg,fentany 3-4 μg/kg,cis-atracuriun 0.2 mg/kg and propofol 2 mg/kg.Tracheal intubation was performed at 3 min after cis-artracurium iv.Auditory evoked potential index was maintained at 10-20.The intubation time,the number of successful intubation,hypertension,tachycardia and hypoxemia were recorded.The number of successful LMA placement,LMA placement time and LMA shift after extubation were recorded.Blood stain at LMA removal and complications were also recorded.ResultsThe rate of successful LMA placement at first attempt was 90％ and placement time was ( 13 ± 3) s.The rate of successful intubation in the both groups was 100％.The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group LMA than in group FOB ( P ＜ 0.05).Hypertension,tachycardia and hypoxemia were not found in the two groups.The number of LMA shift was 8 (40％).The number of blood stain and slight sore throat was 1 respectively in group LMA.There was no other complications in the both groups.Conclusion FOB-guided tracheal intubation with LMA can provide effective ventilation during operation,improve the success rate at first attempt and shorten the intubation time in patients undergoing cervical spine surgery.

Objective To evaluate the efficacy of fiberoptic bronchoscope(FOB)-guided orotracheal intubation with Glidescope videolaryngoscopy in elderly patients.Methods Forty ASA Ⅰ or Ⅱ patients,agaed 65-77yr,weighing 43-82 kg,scheduled for abdominal surgery under general anesthesia with trcheal intubation,were randomly divided into 2 groups ( n =20 each):group FOB and FOB-guided tracheal intubation with Glidescope videolaryngoscopy(group Glidescope).Anesthesia was induced with mideazolam 0.04 mg/kg,cis-atracutium 0.2 mg/kg,fentany 2-3 μg/kg and propofol 1.5 mg/kg,orotracheal intubation was performed 3 min after intravenous cis-artracurium.The intubation time,success rate of orotracheal intubation and hypoxemia were recorded.The number of glottic exposure,epiglottic exposure with Glidescope videolargngoscopy were recorded in group Glidescope.Results The intubation time was shorter and success rate of orotracheal intubation at first attempt was higher in group Glidescope than in group FOB ( P ＜ 0.05).The number of glottic exposure with Glideseope videolaryngoscopy was 15 patients(75％ ) and epiglottic exposure was 5 patients(25％ ) in group Glidescope.Hypoxemia was not found in the two groups.Conclusion FOB-guided orotracheal intubation with Glidescope videolaryngoscopy shorten the intubation time and higher success rate,and can be used effectively in the elderly patients.

Clinical data of 53 patients (69 knees), who were treated at the Division of Joint Surgery, Department of Orthopaedics, Changzheng Hospital from January 1998 to December 2006, were retrospectively analyzed. These patients suffered from wound-healing complications following total knee arthroplasty. Wound skin problems included skin flare, disruption of wound, local hematoma, skin necrosis and deep infection. Local wound care was performed in 58 knees, debridement and secondary closure in 6 kness, and primary management of the soft tissue defect was achieved with local muscle flaps in 3 knees, with the fasciocutaneous flap in 1 knee, and with fasciocutaneous flap and skin grafting in 1 knee. Mean follow-up was 1.9 years. All wound was healed well. It is indicated that corresponding management should be used for treating wound-healing complications following total knee arthroplasty.

Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy (oxaliplatin +capecitabine,XELOX) for the resectable locally advanced adenocarcinoma of esophageal-gastric junction (AEG).Methods The prospective study was conducted.The clinicopathological data of 106 locally advanced AEG patients who were admitted to the Cancer Hospital of Shantou University Medical College from January 2011 to December 2014 were collected.All the patients were divided into the treatment group and control group by single blind,randomized,controlled random number table.Patients underwent preoperative neoadjuvant chemotherapy (XELOX) + surgery + postoperative adjuvant chemotherapy (XELOX) in the treatment group and surgery + postoperative adjuvant chemotherapy (XELOX) in the control group.Total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy were applied to patients by the same team of doctors.Observation indicators:(1) treatment situations;(2) results of postoperative pathological examination;(3) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the postoperative tumor recurrence or metastasis and patients' survival up to February 2017.Measurement data with normal distribution were represented as (-x)±s,and comparisons between groups were evaluated with the t test.Measurement data with skewed distribution were described as M (range) and analyzed by the nonparametric test.Comparisons of count data were analyzed using the chi-square test.The ordinal data were compared using the nonparametric test.Survival rate and curve were respectively calculated and drawn by the Kaplan-Meier method and survivals were compared using the Long-rank method.Results One hundred and six patients were screened for eligibility,including 54 in the treatment group and 52 in the control group.(1) Treatment situations:① preoperative neoadjuvant chemotherapy:54 in the treatment group received 2-4 cycle neoadjuvant chemotherapy.During the chemotherapy,gastrointestinal reaction,grade 1-2 granulocytopenia,elevated alanine transaminase (ALT) and grade 3 granulocytopenia were detected in 21,17,8,1 patients,and 7 patients had no adverse reaction.The complete response(CR),partial response (PR),stable disease (SD) and progressive disease (PD) of neoadjuvant chemotherapy in the treatment group were detected in 4,27,20 and 3 patients,respectively.Of 54 patients in the treatment group,4,13,25 and 12 were in grade 0,1,2 and 3 of response to preoperative chemotherapy,respectively.② Surgical situations:preoperative carcinoembryonic antigen (CEA) in the treatment and control groups were respectively 4.71 μg/L (range,0.20-36.19 μg/L) and 14.09 μg/L (range,0.71-178.20 μg/L),with a statistically significant difference between groups (Z =-1.92,P＜ 0.05).All patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy + D2 lymphadenectomy.Operation time in the treatment and control groups were respectively (210± 31) minutes and (195 ±26) minutes,with a statistically significant difference between groups (t =-2.45,P ＜ 0.05).Volume of intraoperative blood loss,cases with intraoperative blood transfusion,time to postoperative anal exsufflation,time to defecation,time for initial diet intake,cases with postoperative complications and duration of hospital stay were respectively (216± 172) mL,6,(4.3± 1.0) days,(4.5±0.8)days,(3.1±0.5)days,11,(15.0±5.0)days in the treatment group and (174±108)mL,4,(4.2± 1.0) days,(4.4± 0.8) days,(3.1 ± 0.5) days,15,(15.0± 5.0) days,with no statistically significant difference between groups (t=-1.01,x2 =0.36,t=-0.31,-0.88,-0.36,x2 =1.03,t=-0.38,P＞0.05).③Postoperative adjuvant chemotherapy:all the patients completed the postoperative adjuvant chemotherapy.The granulocytopenia,elevated ALT and gastrointestinal reaction occurred in 25,5,28 patients in the treatment group and 21,7,30 patients in the control group,respectively,with no statistically significant difference between groups (x2 =0.38,0.47,0.36,P＞0.05).Some of the patients were merged with multiple adverse reactions.(2) Results of postoperative pathological examination:maximum tumor dimension,cases with lymphovascular invasion,perineural invasion,T0,T2,T3,T4 (T stage),stage 0,Ⅰ,Ⅱ and Ⅲ1 (TNM stage) were respectively (3.6±1.4)cm,5,10,4,10,20,20,4,7,15,28 in the treatment group and (4.5±1.7)cm,24,30,0,2,13,37,0,1,12,39 in the control group,with statistically significant differences between groups (t=-2.88,x2 =18.14,17.30,Z=14.74,8.13,P＜0.05).(3) Follow-up and survival situations:of 54 patients in the treatment group,52 were followed up for 4-72 months,with a median time of 32 months;of 52 patients in the control group,49 were followed up for 5-71 months,with a median time of 36 months.The postoperative diseasefree survival time,1-,3-and 5-year tumor-free survival rates,postoperative overall survival time and 1-,3-and 5-year overall survival rates were respectively 26 months (range,3-72 months),79.5％,64.7％,61.3％,27 months (range,5-72 months),88.3％,69.2％ and 62.1％ in the treatment group.Seventeen patients had tumor recurrence,including 2 with intraperitoneal local recurrence and 15 with distant metastasis.The postoperative disease-free survival time,1-,3-and 5-year tumor-free survival rates,postoperative overall survival time and 1-,3-and 5-year overall survival rates were respectively 33 months (range,2-71 months),89.7％,55.4％,55.4％,33 months (range,5-71 months),91.8％,72.1％ and 59.7％ in the control group.Nineteen patients had tumor recurrence,including 8 with intraperitoneal local recurrence and 11 with distant metastasis.There was no statistically significant difference in disease-free survival and overall survival between groups (x2 =0.018,0.596,P＞0.05).There was a statistically significant difference in cases with local recurrence between groups (x2=4.41,P＜ 0.05) The tumor-free survival time and overall survival time in the treatment group were respectively 29 months (range,8-72 months),38 months (range,10-72 months) in 31 patients with CR and PR and 11 months (range,3-68 months),18 months (range,4-68 months) in 23 patients with SD and PD,showing statistically significant differences in tumor-free and overall survival times (x2=5.27,7.72,P＜0.05).Concluslon Neoadjuvant chemotherapy with oxaliplatin and capecitabine is safe and effective for patients with the resectable locally advanced AEG,it can also decrease tumor stage and reduce local recurrence,but fail to demonstrate a survival benefit.

Objective:To compare the numerical rating scales (NRS) and Oswestry disability index (ODI) of denosumab in Chinese postmenopausal osteoporosis patients after 3 months, and analyze the early adverse reactions to provide reference for clinical diagnosis and treatment.Methods:Using a prospective study method, 260 patients with postmenopausal osteoporosis who were outpatients and inpatients in the Second Affiliated Hospital of Soochow University from September 2020 to October 2021 were selected, and general information, including age, height, weight, bone mineral density, history of fragility fractures, and use of anti-osteoporosis drugs. All subjects received denosumab 60 mg subcutaneously, and were given calcium and vitamin D at the same time. Pain was scored by NRS before treatment and 3 months after treatment, and functional improvement was assessed by ODI.Results:After 3 months of denosumab treatment in postmenopausal women with osteoporosis, among patients with different age groups, different degrees of osteoporosis, history of fragility fractures, and history of use of anti-osteoporosis drugs, NRS score and ODI score were lower than those before treatment, and the difference was statistically significant ( P<0.05). In addition, in patients with a history of fragility fractures (mainly vertebral fractures), the NRS scores and the ODI score decreased more significantly, and the difference was statistically significant ( P<0.05); the NRS score and ODI score decreased more significantly in patients with severe osteoporosis than in patients with osteoporosis, and the difference was statistically significant ( P<0.05); the BMD value of lumbar spine was negatively correlated with the reduction of NRS score before and after treatment ( P=0.042). In this study, 260 patients had musculoskeletal pain in 6 (2.3%), fatigue in 5 (1.9%), rash in 4 (1.5%), urinary tract infection in 2 (0.7%), and dizziness in 2 (0.7%), 2 case of fever (0.7%), 1 case of hypocalcemia (0.4%), a total of 22 cases of adverse reactions were reported, and the overall adverse reaction rate was 8.5%. Conclusion:Denosumab can improve pain symptoms and functional disability early in the clinical application of Chinese postmenopausal women with osteoporosis, and the incidence of adverse reactions is low. Especially for postmenopausal female osteoporosis patients with severe osteoporosis, low lumbar spine bone density, and a history of fragility fractures (mainly vertebral fractures), the application effect is more significant.