OBJECTIVE To find out the situation of the use of preventive application of antimicrobial in orthopedic perioperative patients and to evaluate the rationality of use. METHODS To make a survey of the use of antimicrobials in orthopedic perioperative patients during Apr-Jun 2004 and to evaluate the kinds,frequency,combined administration,course,effectiveness,etc. RESULTS 99.2% patients had received antimicrobials involving 14 kinds.62.8% from them used one.34.5% used two and 2.7% used three. CONCLUSIONS It is necessary to strengthen the management of preventive antimicrobial in orthopedic patients during perioperative period.

Objective To analysis the rational use of human albumin in patients with hypoproteinemia in our hospital.Methods The drug evaluation criteria of human albumin were developed and the patients of different gen-dem,ages,departments,clinical diagnoses,human albumin species,administration,doses,course of treatment and pur-poses in our hospital were investigated.Results The using rate of human albumin in patients with hypoproteinemia was 53.1% in our hospital,20% human albumin accounted for the most(89cases),and the consumption of human albumin used in department of respiration was the most in our hospital (70cases).Diagnosis of 14 cases were not anastomosis with indications and 8 cases hadprolonged use and no indicative use and inappropriate medication. Conclusion The irrational use of human albumin are existed in our hospita1.We should develop the drug using standard of human albumin and strictly grasp the indications of drug use to avoid overuse of human albumin.

Objective To compare the effect of the conventional teaching programs and logical thinking ability training program of ultrasound medical profession. Methods 85 ultrasound medical junior students were randomly divided into control group (n=40) and experimental group (n=45) re-spectively. Experimental group was provided with logical thinking ability cultivation to develop logical thinking of students, and the key was to enable students to find the key problems of ultrasound in the diagnosis of the disease and put forward measures to solve them and control group carried on the con-ventional teaching. Teaching effect, the medical record analysis test scores, clinical skills examination and questionnaire score were compared between the two groups, using SPSS 18.0 software for statisti-cal analysis of the data. Results (1)Students in the experimental group thought that compared with the control group, their interest in learning improved, the ability of clinical analysis enhanced, inter-action between teachers and students and learning efficiency and self-study ability increased and the difference has statistical significance. (2)The experimental group's scores of medical records analysis, the assessment scores of clinical skills and the student questionnaire score were higher than those of the control group and the two groups' score difference was statistically significant. Conclusion To strengthen the training of medical ultrasound medical imaging direction students' logical thinking ability can significantly improve the quality of teaching, and it is worthy to be promoted and applied.

BACKGROUND:Evaluation plan for the neuro-musculo-skeletal system model and motor function was little.However,the three-dimensional gait analysis can transfer qualitative analysis and object description which widely used in orthopedics and rehabilitation medicine to quantitative evaluation with more objective and precise.OBJECTIVE:To evaluate gait kinematics and kinetic changes after total knee replacement based on 12 months follow up using three-dimensional gait analysis.DESIGN,TIME AND SETTING:The comparative observation and case-control study was performed in the Gait Analysis Room of the Department of Rehabilitation Medicine in the Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University from January 2007 to May 2008.PARTICIPANTS:Ten patients with knee osteoarthritis following total knee replacement were chosen as treatment group;concurrently,ten patients whose baseline data were matched with the treatment group without problems in nerve,muscle,skeletal system and equilibrium were selected as the control group.METHODS:Ten patients in the treatment group underwent rehabilitation training,then compared time-distance,kinematic,and mechanical parameters which were measured at 3,6,12 months after total knee replacement with the control group.MAIN OUTCOME MEASURES:Time-distance parameter,kinematic parameter,mechanical parameter and knee functional scores.RESULTS:Pace,step frequency,gait speed,and time of injured leg standing were notably decreased,while time of uninjured leg standing,duration of gait cycle were obvious prolonged compared with the control group(P

BACKGROUND:Gait analysis enable to convert qualitative analysis and description used for a long time in orthopedic examination and rehabilitative treatment into objective and precise quantitative assessment. At the present, with the development of science and technology, three-dimensional (3D) gait analysis is more and more widely, extensively used in orthopedic surgery and rehabilitation medicine abroad, while much less in China.OBJECTIVE: To study the parameters of time-distance, kinematics, kinetic and electromyography (EMG) in healthy subjects and patients with backbone, hip, knee or ankle joint diseases.DESIGN: Comparative observation and control study.PARTICIPANTS: From December 2004 to July 2005, 40 healthy subjects and 112 patients suffering from backbone and hip, knee, ankle joint disease were selected from the Department of Rehabilitative Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University and analyzed by three dimensional gait analysis system (VICON 612 system made by Britain VICON Company). 112 patients including 42 males with the mean age of (46.2 ± 2.3) years and 70 females with the mean age (41.2 ± 3.5) years were screened by skilled clinicians after surgical and rehabilitative treatment.Among them there were 21 patients with cervical vertebra, 26 patients with prolapse of lumbar intervertebral disc and lumbar spinal stenosis. The number of hip, knee, ankle joint disease was 12, 34, 19 respectively. Total hip replacement was included in hip joint disease, anterior cruciate ligament (ACL) reconstruction was included in knee joint disease, talipes equinovarus was included in ankle joint disease. Meanwhile, 40 healthy subjects who were 20-40 years old, male or female, without any clinical symptom of backbone and limbs volunteered in the study.METHODS :Gait analysis were carried out on 40 healthy volunteers and 112 operational and rehabilitative treatment patients with spinal and lower limb diseases using VICON 612 system made by Britain VICON Company.MAIN OUTCOME MEASURES: The time-distance parameters (cadence, step length, walking speed), kinematics parameters (knee flexion/extension degree, hip flexion/extension degree, ankle dorsi/plantar degree), kinetic parameters (knee force in Z axis, hip force in Z axis, normalized force in Z axis) and EMG parameters (vastus lateralis SEMG) of lower limbs were examined.RESULTS: A total of 40 healthy subjects and 112 patients were involved in the analysis of results. ① Time-distance parameter: Cadence, as well as step length and walking speed of patients with backbone disease, patients with hip joint disease, patients with knee joint disease, and patients with ankle joint disease were lower than those of healthy subjects,and the difference between two groups was significant (P ＜ 0.05-0.01). ② Kinematic and kinetic parameters of all joints in upper limbs: One year after left ACL knee reconstruction, the extension of left knee in initial contact phase was 9° less than that of right one and the stress in Z axis of left knee was much less than that of right one; One year after left THA,the flexion of left hip in initial contact phase was 8.5° less than that of right one, the extension of left hip in terminal stance phase was 3° less than that of right one, during stance phase the stress in Z axis of left hip was much less than that of right one; As to an infantile paralysis patient with talipes equinovarus, the dorsiflexion of left ankle in initial contact phase was 12° less than that of right one, the plantar flexion of left ankle in terminal stance phase was 5° less than that of right one. The stress in Z axis of left ankle during stance phase was much less than that of right one. However, the difference in range of motion and stress in Z axis was not significant between the left and right knee joint in healthy people. ③ One year after left total knee arthroplasty, the dynamic surface electromyogram signals of left vastus lateralis is much lower than that of right vastus lateralis in a gait cycle.CONCLUSION: 3D gait analysis enables tprovide objective basis for making operation scheme for orthopedic surgery and after-operation rehabilitation therapy, and assessing curative effect of rehabilitation therapy.

Objective To analyze the clinical value of low molecular heparin calcium combined with early rehabilitation intervention in the prevention of deep vein thrombosis after internal fixation of intertrochanteric fractures.Methods 100 patients with internal fixation for treatment of femoral intertrochanteric fracture from January 2014 and October 2015 were selected and randomly divided into two groups:the control group of 50 cases, treated with low molecular weight heparin low molecular weight heparin by abdominal subcutaneous injection of drug therapy and routine nursing intervention service, observation group of 50 cases, in the control group based on the use of early rehabilitation intervention.The incidence of deep venous thrombosis after operation in two groups was recorded, and the changes of platelet count and coagulation markers were observed before and after intervention in the two groups.Results The observation group of patients with postoperative deep venous thrombosis incidence rate of 4%, significantly lower than the control group 16%, the difference was statistically significant (P<0.05), the two groups after the intervention each time the platelet count was higher than that of before intervention, four weeks after the intervention, the observation group of platelet count (239.51 ±34.62) ×109/L, significantly higher than the control group (235.23 ±28.87) ×109/L, the difference was statistically significant (P<0.05), the two groups before the intervention of each marker concentration, the difference was not statistically significant, patients in the observation group after the intervention, the blood coagulation markers concentrations were significantly lower than before treatment, and were significantly lower than the control group after the intervention.The comparison between the two groups, the difference was statistically significant (P<0.05).There was no chest pain, chest tightness, dyspnea and other symptoms of pulmonary embolism in the two groups , and no adverse reactions were found.Conclusion The application of low molecular weight heparin calcium combined with early rehabilitation intervention can effectively reduce the incidence of deep venous thrombosis after intertrochanteric fracture fixation.

Objective To investigate the drug sensitivity and distribution of main pathogenic pathogens in hospitalized patients with respiratory hospital diabetes bacteria and provide reference for the prevention and treatment of diabetes mellitus in experimental infection in patients with respiratory hospital.Methods 69 cases of diabetes mellitus complicated with respiratory infection were selected, their clinical data ( laboratory, imaging and etiological examination data) were complete,and their intact specimens for testing and identificated were throat swabs, sputum smear, sputum culture, protected specimen brush sampling, pathogens culture, and drug susceptibility test of pathogenic bacteria were isolated from the statistical data of 69 patients and prognosis.Results 69 strains of pathogenic bacteria were isolated, identified and isolated from the specimens of all the patients in the study.Among them, there were a total of 86 strains of pathogenic bacteria, including gram positive bacteria (46 strains), gram negative bacteria (27 strains) and fungi (13 strains) .Staphylococcus aureus, Streptococcus pneumoniae, Staphylococcus epidermidis to teicoplanin, clindamycin, amoxicillin and levofloxacin sensitive rate is less than 50%, while to oxacillin, vancomycin, linezolid, ampicillin, imipenem, moxifloxacin susceptibility rate >50%.Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae to ceftriaxone, ceftazidime, amoxicillin, amikacin drug sensitivity of less than 50% of cefoxitin, piperacillin/tazobactam, cotrimoxazole, imipenem, meropenem, netilmicin susceptibility rate >50%.69 patients were diagnosed before treatment with antiviral drugs, antibiotics, antibiotics adjusted according to the etiology and drug sensitivity test results and antiviral drugs, improved in 49 cases of patients to the hospital treatment of 14 cases, 6 cases were converted to sepsis after rescue invalid death.Conclusion The diabetic patients hospitalized in respiratory pathogens of nosocomial infection in a wide range of pathogen susceptibility differences , understand the distribution of pathogens in patients with regular and drug resistance, provide guidance for the prevention and treatment experience, reduce the infection rate of patients with respiratory infection in patients with hospital provided treatment of high pertinence has important significance.

Objective To explore the roles of MircroRNA-217 ( Mir-217 ) , silent information regulator 1 (Sirt1), and hypoxia-inducible factor-1α(HIF-1α)in high glucose-induced inflammation and fibrosis in rat glomerular mesangial cells( RMCs) . Methods RMCs were pre-incubated with a Sirt1 activator resveratrol prior to high glucose treatment or transfected with Sirt1 small interfering RNA( siRNA) , HIF-1αsiRNA, and Mir-217 inhibitor. Real-time PCR was used to analyze the expressions of Mir-217, Sirt1 mRNA, and HIF-1α mRNA; Western blot was used to observe the protein expressions of Sirt1, HIF-1α, connective tissue growth factor(CTGF), endothelin-1(ET-1), and fibronectin( FN) . Enzyme-linked immunosorbent assay was applied to detect protein expression of transforming growth factor-β1(TGF-β1)and vascular endothelial growth factor(VEGF). Results High glucose increased Mir-217, HIF-1α, CTGF, ET-1, FN, TGF-β1, and VEGF expressions(all P<0. 01), while decreased Sirt1 expression. In addition, Mir-217 gene silencing or 25μmol/L resveratrol suppressed high glucose-stimulated expressions of HIF-1α, CTGF, endothelin-1, FN, TGF-β1, and VEGF(all P<0. 01). Conclusion Mir-217 mediates high glucose-induced inflammation and fibrosis in RMCs via Sirt1/HIF-1αsignal pathway. This study provides new evidence to clarify the protective mechanisms of Sirt1 in diabetic nephropathy.

Objective To explore the teaching effect ofOrgan-system-based curriculum in-tegrated model on clinical graduation field work. Method 150 clinical medical undergraduates of Grade 2009 from Shenyang Medical College selected, were randomly divided into the experimental group (75 persons) and the control group (75 persons). The experimental group adopted the means of the Organ-system-based curriculum integrated model, namely practicing according to human organ-system and the control group accepted the traditional pattern of discipline centered practice during the clinical graduation internship. The two groups of students carried out questionnaire survey and comprehend examinations when the practice ended, and then statistics analysis (the chi square test, t test) was done by the SPSS 19.0 software between the two groups in order to explore the teaching effect. Result The students' satisfaction degree from six aspects of the questionnaire survey showed in the experimental group was significantly higher than that in the control group (the degree of recognition of practicing pattern: χ2=11.437, P=0.003; the architectonic integrality: χ2=9.881, P=0.007; the im-provement of the autonomic learning ability χ2=9.643, P=0.008; the teaching method and means: χ2=11.006, P=0.004; motivating learning interest: χ2=13.550, P=0.001; increasing the ability of clinical thinking: χ2=13.309, P=0.001), and the average test scores of students from three parts of examination results showed by comprehend examinations (speculative knowledge examination: t=2.768, P=0.006;technical skill examination: t=2.212, P=0.029; clinical capability examination: t=5.015, P=0.000) in the experimental group was obviously higher than that in the control group and the difference was sig-nificant. Conclusion Organ-system-based curriculum integrated model on clinical graduation in-ternship is generally approved by the students, which has significantly improved the students' clinical thinking ability, and the quality of graduation internship teaching.

BACKGROUND:Nanohydroxyapatite/polyamide 66 composite is very close to the human cortical bone in terms of mechanical properties, and has osteogenic activity, which is a safe and reliable bone material. OBJECTIVE:To investigate the effect of nanohydroxyapatite/polyamide 66 composite bioactive supporting material on the restoration of vertebral structure and height. METHODS: Totaly 177 patients with spinal diseases, 116 males and 61 females, aged 17-81 years, were enroled, including 97 cases of spinal fractures, 5 cases of primary tumors of the spine, 17 cases of spinal tuberculosis and 58 cases of cervical spondylosis. The nanohydroxyapatite/polyamide 66 composite bioactive supporting body was filed into the bone grafts of patients and then subjected to anterior decompression and internal fixation. After 36 months of folow-up, imaging analysis, Frankel spinal cord injury classification, bone graft fusion, visual analog scale scores,Short Form 36 and Japanese Orthopedic Association scores were evaluated. RESULTS AND CONCLUSION:During the folow-up, except one patient with cervical spine fracture appeared to have slight supporting body displacement, there was no supporting body prolapse or rupture phenomena. The bone graft fusion rate was 96.0%, the average supporting body sinking distance was 1.7 mm. After treatment, 97 patients with spinal fractures had different degree of improvement in the neurological function (P < 0.05); the visual analog scale scores, Short Form 36 and Japanese Orthopedic Association scores were improved significantly in al the 177 patients compared with before treatment (P < 0.05). These results demonstrate that the use of nanohydroxyapatite/polyamide 66 composite bioactive supporting material for spinal reconstruction can improve the bone fusion rate, and restore the vertebral structure and height effectively.