Objective To report our early experience for treatment of infected total knee arthroplasty (TKA) using antibiotic-loaded articulating cement spacer. Methods From June 2004 to April 2005, 5 patients with periprosthetic knee infection were treated with 2-stage reimplantation protocol. The study group included 1 male and 4 females, with average age of 67 years(range, 57-75 years). The initial procedure consisted of thorough debridement, removal of prosthesis and implantation of antibiotic-loaded articulating cement spacer. The postoperative course consisted of graduated knee motion and partial weight-bearing activity. Each patient received a 6-week course of organism-sensitive antibiotic therapy. The high restricted total knee prosthesis was reimplanted after infection controlled. Results 3 patients had a basic diagnosis of rheumatoid arthritis and two of them took steroid for a long time. The other two patients suffered from osteoarthritis before primary TKA were both with diabetes. Sinuses were emerged in all of 5 patients and blockage phenomenon was found in two of them. There were no cases of fracture, dislocation, or instability associated with articulating cement spacer. The average time between the two stages was 15 weeks. All 5 patients were able to ambulate with assistance and flex the knee without difficulty in the interval before reimplantation. The average knee flexion was 95? and the average knee society score(KSS) was 81 points. A mean ten months follow-up was evaluated after reimplantation. There were no recurrence, or new infections after reimplantation. Conclusion Infection after a TKA can be successfully managed with an antibiotic-loaded articulating cement spacer and knee motion can be preserved in the interval prior to implantation. The end result is effective treatment of infection and facilitation of reimplantation.

Objective To investigate the MRI features of intracranial solitary fibrous tumors/hemangiopericytomas (SFT/HPC),and to compare these findings with those of intracranial meningiomas.Methods The clinical features and MRI findings in 28 patients of intracranial SFT/HPC (SFT/HPC group)and 68 patients of meningiomas (meningiomas group) confirmed by operation and pathology were retrospectively analyzed.The indicators of two groups were compared.Results Shape of tumor,signal homogeneous,signal voids of vessel in tumor,hypointense signal nodules on T2WI and enhanded,cystic or necrosis in tumor,meningeal tail sign,changes of the nearby bone,sex,Ki-67％ level,blood lose in surgery had significant differences between SFT/HPC group and meningiomas group (all P＜0.05).Conclusion There are some differences between intracranial SFT/HPC and meningiomas.It is helpful in diagnosis and differential diagnosis through the comparative analysis of the imaging signs.

Objective:　To analyze the causes of distal femoral nonunion and delayed union and assess the outcome of the corresponding treatment, retrograde intramedullary interlocking nail (RIIN). 　　Methods:　From June 1995 to December 1998, 15 patients (9 males and 6 females) with distal femoral nonunion and delayed union were treated with RIIN. The average age of the patients was 34.5 years (23-46 years). Bone grafting was performed in 10 patients, closed reaming was done in the other 5 patients. Correction osteotomy was performed in 2 patients, and intra-articular release of knee adhesion in 11 patients. X-ray examination and knee society clinical rating system (KSS) were used to evaluate the results. 　　Results:　All fractures were followed up for at least 9 months with average follow-up duration of 14.5 months (9-33 months). Solid union was documented in all patients at 6.4 months on average. There were no infections or malunions in this series. Based on the final follow-up data, acceptable functional range of motion (ROM) of over 90° was achieved in most patients. The average ROM was 93.5° with significant improvement of 28° (42.7%, P＜0.05) compared with the preoperative ROM. The average knee score was 96. Excellent ROM emerged in 13 patients. The knee function score was 90.5 on average. 　　Conclusions:　The main causes of distal femoral nonunion and delayed union are improper indications and improper use of the implants. RIIN is an effective alternative for treatment of distal femoral nonunion and delayed union because it can provide a stable and reliable fixation which is beneficial for early functional exercise of knee. Bone grafting, closed reaming and intra-articular release of knee adhesion should be considered in order to enhance the bone healing and improve ROM and the knee function.

Objective To compare the change of management time for patients with acute cerebrovascular disease before and after re-accreditation of Grade Ⅲ Class A in a general hospital.Methods Electronic medical records of 490 patients diagnosed as acute cerebrovascular disease(215 cases of cerebral infarction,275 cases of cerebral hemorrhage) managed in Zhongnan Hospital of Wuhan University from June 2015 to July 2016 were collected,including 262 patients managed before re-accreditation (group A,June 2015 to December 2015) and 228 patients admitted after re-accreditation (group B,January 2016 to July 2016).In group A,there were 109 cases of cerebral infarction and 153 cases of cerebral hemorrhage(68 caused by trauma);in group B there were 106 cases of cerebral infarction and 122 cases of cerebral hemorrhage(54 caused by trauma).The time in emergency department (ED time),time waiting for admission (admission time) and the total management time (total time) were analyzed and compared between two groups.Results The ED time in group A and group B was 44.5 (30.0,71.5) and 39.0 (20.3,69.0) min (Z =-2.103,P =0.036) respectively;the admission time was 35.0 (25.8,50.0) and 39.0 (27.3,55.8) min(Z =-2.211,P=0.027);and total time was 85.0(62.8,120.0)and 82.5(61.0,119.0) min(Z =-0.356,P =0.722) in two groups respectively.For patients of cerebral infarction in group A and B the ED time was 49.0 (33.5,81.5) and 41.0 (29.8,74.3) min(Z =-1.872,P =0.061);the admission time was 37.0(27.0,52.0) and 36.0(25.0,52.3) min(Z =-0.516,P =0.606);and total timewas97.0(69.5,131.0)and 83.5(62.0,118.3) min(Z=-1.914,P=0.056).For patients of cerebral hemorrhage in group A and B,the ED time was 42.0 (28.0,64.0) and 35.0 (17.8,65.0) min (Z=-1.426,P =0.154);the admission time was 34.0(24.5,49.0)and 41.0(31.0,61.0) min (Z=-3.353,P =0.001);and total time was 79.0(58.0,108.0) and 82.0(60.0,120.8) min (Z =-1.052,P =0.293).Conclusions After re-accreditation of Grade Ⅲ Class A Hospital the total waiting time for patients of cerebral infarction is decreased significantly in emergency department,however,for patients of cerebral hemorrhage the waiting time for admission is longer.

Objective To analyze the CT and MR imaging features of intracranial teratomas to improve the diagnostic accuracy.Methods Twenty patients with intracranial teratomas,admitted to and performed surgery in our hospital from January 2010 and January 2014,were chosen;the teratoma was confirmed by histopathology.The CT and MR imaging features,clinical and pathology materials of these patients were retrospectively analyzed.Results Twelve immature teratomas,7 mature teratomas and one teratoma with malignant transformation were noted;18 patients were in the central line area and 2 were not.In the 9 patients performed CT scan,7 showed heterogeneous mass;peritumoral calcification was more common than intratumoral calcification,and it turned out to be round with diameter less than 1 cm,while intratumoral calcification was multifocally strip and patchy.In the 17 patients performed MR imaging,14 showed heterogeneous signal and fatty signal was detected in 3;enhanced MR imaging showed that 6 presented nodular enhancement,3 presented multilocular enhancement markedly,patchy enhancement showed in 2,and one showed marked enhancement in mural nodule and cystic wall.In 8 patients performed diffusion-weighted imaging,7 displayed hypointense to isointense and one demonstrated isointense to hyperintense.Conclusions Intracranial teratoma has some characteristic imaging features,so by combining clinical materials,it should be considered when fatty component is detected in a heterogeneous intensity tumor with multiple cystic change,calcification and a hypointense to isointense signal on DWI;however,pathology is needed to make a definite diagnosis.

Objective:To analyze the causes of SARS-CoV-2 nosocomial infection among healthcare workers (HCWs) and explore the effective precaution strategies in Emergency Center.Methods:The data of SARS-CoV-2 infected HCWs from January 5 to March 2, 2020 were retrospectively analyzed and compared under different conditions in Emergency Center of Zhongnan Hospital of Wuhan University.Results:Totally 13 SARS-CoV-2 infected HCWs (12 confirmed cases and 1 suspected case) were included in this study. The overall infection rate was 17.8% (13/73). The infection rates in outpatient/rescue room, isolation observation room and isolationin patient ward were 11.8% (4/34), 20.0% (3/15), 25% (6/24), respectively. The infection rate of physician was 13.0% (3/23), and the infection rate of nurse was 20.0% (10/50). All the infected HCWs had the definite exposure with confirmed or suspected COVID-19 patients. One asymptomatic cases were identified by laboratory findings of SARS-CoV-2 infection screening. There was no new confirmed SARS-CoV-2 infected HCWs after February 5, 2020. All the infected HCWs were cured.Conclusions:Under the epidemic of COVID-19, HCWs of Emergency Center have a high risk of occupational exposure and infection, especially for staffs working in COVID-19 isolation units. Scientific prevention and control management can effectively reduce the risk of SARS-CoV-2 infections and ensure the occupational safety for HCWs in Emergency Center.

OBJECTIVETo define the optimal development time of micro-computed tomography (micro-CT) venography in cervical cancer patients and establish 3D CT-based digital pelvic model of the patients.

METHODSThirty patients with cervical cancer stratified by FIGO surgical staging underwent micro-CT scanning of the arterial phase and the venous phase with a delay time of 70, 90 and 120 s. The images were interpreted independently by two experienced radiologists to define the optimal development time in venous phase and establish the imaging diagnosis. Based on the pelvic CT scan data, we segmented the images using the abdominal medical image-3D visualization system followed by 3D image reconstruction to establish the 3D digital pelvic model using FreeForm Modeling System to modify the reconstructed images.

RESULTSThe optimal images were obtained by scanning with a 90-sec delay time. Micro-CT was not sensitive to IB1 phase or earlier phases (1/5), but efficient in advanced stages (≥IB2 phase). In our cases, 25 were diagnosed by micro-CT with a diagnostic accuracy of 64%. Based on these CT data, the pelvic 3D model covering the main organs, vessels, cervical neoplasm, and supplying vessels of the tumor in the pelvic cavity were successfully reconstructed to allow spatial observations of the uterus and the neighboring organs.

CONCLUSIONThe 3D digital pelvic model reconstructed provides a means for staging cervical cancer and facilitates further surgical simulation studies.

Female ; Humans ; Imaging, Three-Dimensional ; methods ; Middle Aged ; Models, Anatomic ; Neoplasm Staging ; Tomography, X-Ray Computed ; methods ; Uterine Cervical Neoplasms ; diagnostic imaging

Objective To explore the MR imaging characteristics of brain tumors in infants to improve the diagnosis and early treatment.Methods Twelve infants with brain tumors (less than 1 year old),performed surgery in our hospital from April 2008 to August 2014 and proved by pathology,were collected in our study; the clinical data and MR imaging features were reviewed retrospectively.Results Among the 12 infants,4 (33％) had tumors located at the lateral ventricle,3 (25％) at the cerebral hemisphere,one (8.3％) at the pineal region,one (8.3％) at the suprasellar region,one (8.3％) at the cerebral convexity,one (8.3％) at the cerebellar hemisphere and one (8.3％) at the fourth ventricle.These tumors included immature teratoma (n=3),choroid plexus tumor (n=3),atypical teratoid/rhabdoid tumor (n=2),medulloblastoma (n=1),anaplastic ependymoma (n=1),pilomyxoidastrocytomas (n=1) and infantile fibrosarcoma (n=1).Diversity of MR imaging features was found in different types of brain tumors; tumors as immature teratoma,atypical teratoid/rhabdoid tumor and infantile fibrosarcoma showed mainly mixed signal intensity on T1-weighted images and T2-weighted images,and these tumors displayed heterogeneously enhancement at MR imaging; choroid plexus tumors and medulloblastoma showed isointenseon T1-weighted images and T2-weighted images mostly,and both had obvious enhancement; anaplastic ependymoma showed isointensity signal on T1-weighted images,slightly hyperintenseon T2-weighted images and heterogeneously enhancement; pilomyxoidastrocytomas were hypointenseon Tl-weighted images,hyperintenseon T2-weighted images and homogeneous enhancement.Conclusions Immature teratomas,choroid plexus tumors and embryonal tumors are common in infants.Supratentorial tumors are mostly found.Typical features are showed in some brian tumors,but part of atypical tumors remain challenging in diagnosis.To improve diagnostic accuracy,imaging data should be accumulated in the future.

OBJECTIVETo investigate the level of zinc (Zn) and copper (Cu) in whole blood among general population from 8 provinces in China, and to analyze the characteristics of distribution among different regions.

METHODSThis cross-sectional study was performed in 8 provinces from eastern, middle and western China between 2009 and 2010, including 13 110 subjects from 24 regions, and the blood and urine samples were collected. The ICP-MS was applied to test the content of ICP-MS in blood samples, and the results were used to analyze the characteristics of contents and distributions of Zn and Cu among population from different ages, genders and regions groups.

RESULTSTotally, the mean (95%CI) contents of Cu and Zn in blood were 795 (791-799)µg/L and 3 996(3 976-4 015) µg/L, respectively. The characteristics of distribution of Cu content were as followed, the content of males were lower than it of females (male:767 µg/L; female: 822 µg/L, t = -13.302, P < 0.01). The contents of blood Cu in groups of people aging 6-12, 13-16, 17-20, 21-30, 31-45 and 46-60 years old were separately 860(853-868), 758(748-769), 734(728-734), 782(774-790), 811(795-827) and 820(815-826) µg/L. The differences showed statistical significance (F = 78.77, P < 0.01). The blood Cu content of people in eastern China (800µg/L) were also significantly higher than it in middle (774 µg/L)and western China (782 µg/L) (F = 10.94, P < 0.01). Distribution of blood Zn content showed characteristics as follows: the Zn content was higher in males than in females (male 4 085 µg/L and female 3 908 µg/L, t = 8.78, P < 0.01). The contents of blood Zn in groups of people aging 6-12, 13-16, 17-20, 21-30, 31-45 and 46-60 years old were separately 3 306 (3 261-3 350), 3 888 (3 839-3 937), 3 948 (3 902-3 994), 4 272(4 228-4 315), 4 231(4 180-4 281) and 4 250 (4 205-4 294)µg/L, which showed significant statistical differences (F = 233.68, P < 0.01). The blood Zn content of people in eastern China (3 938 µg/L) were significantly lower than it in middle (4 237 µg/L)and western China (4 105 µg/L) (F = 53.16, P < 0.01). In addition, the study also compared the relation between content of Cu and Zn and the frequency of eating seafood. The results found that the frequency of eating seafood could influence the content of Cu and Zn (Cu: F = 13.54, P < 0.01; Zn: F = 200.20, P < 0.01).

CONCLUSIONThe contents and distributions of Cu and Zn in blood differs among people from different groups in ages, genders and regions. The baseline data of this study provided reliable scientific evidence for further research.

Adolescent ; Adult ; Child ; China ; epidemiology ; Copper ; blood ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Zinc ; blood

OBJECTIVETo assess the levels of polycyclic aromatic hydrocarbons monohydroxy metabolites in urine of general population in China among 8 provinces, provide the baseline of the metabolites in the general population.

METHODSFrom 2009 to 2010, 18 120 subjects of general population aged 6-60 years old were recruited from 24 areas among 8 provinces in east, west and central areas of China mainland by cluster random sampling. The information of the living environment and health condition were collected by questionnaire and spot urine samples were collected, 4 680 urine samples were analysed by high performance liquid chromatography with tandem mass spectrometry, and monohydroxy metabolites distribution in urine among groups of gender and ages were analysed.

RESULTSGeometric means (GM) of 2-naphthol, 1-naphthol, 3-phenanthrol and 1-hydroxypyrene concentration in urine (95%CI) were 1.85 (1.75-1.95), 1.55 (1.50-1.61), 0.57 (0.54-0.59) and 0.82 (0.78-0.85) µg/L, respectively;and median are 2.44, <0.50, 0.72 and 0.90 µg/L, respectively. The concentration between male and female were significantly different (P < 0.01), and the concentration among the groups of population were significantly different (P < 0.01), the GM of 2-naphthol among the groups of population aged 6-12, 13-16, 17-20, 21-30, 31-45 and 46-60 years old were 1.60, 1.56, 1.69, 2.23, 1.91 and 1.86 µg/L (χ(2) = 17.90, P < 0.01), the GM of 1-naphthol in the groups were 1.30, 1.16, 1.53, 1.68, 1.80 and 1.52 µg/L (χ(2) = 76.22, P < 0.01), the GM of 3-phenanthrol in the groups were 0.78, 0.76, 0.55, 0.42, 0.50 and 0.99 µg/L (χ(2) = 66.48, P < 0.01), the GM of 1-hydroxypyrene in the groups were 0.77,0.64, 1.00, 0.84, 0.84 and 0.57 µg/L (χ(2) = 51.48, P < 0.01), respectively.

CONCLUSIONThe distribution of monohydroxy metabolites levels in urine of general population were different, it provided a basic data for the further study of polycyclic aromatic hydrocarbons biomonitoring in the population.

Adolescent ; Adult ; Child ; China ; epidemiology ; Cross-Sectional Studies ; Environmental Exposure ; Female ; Humans ; Male ; Middle Aged ; Naphthols ; urine ; Polycyclic Aromatic Hydrocarbons ; urine ; Pyrenes ; urine ; Sentinel Surveillance ; Young Adult