Objective:To evaluate the accuracy of the domestic "Skywalker" surgical robot in implementing personalized lower limb alignment reconstruction scheme in total knee arthroplasty (TKA) and the short-term clinical outcome of robotic assisted TKA.Methods:From September 2020 to January 2021, the data of patients who received surgical robot assisted TKA in 5 clinical centers in China (Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Southwest Hospital affiliated to Third Military Medical University, The Affiliated Hospital of Qingdao University, The First Affiliated Hospital of Chongqing Medical University and Yantai Yuhuangding Hospital, and Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine was the group leader) were prospectively collected and retrospectively analyzed. There were 24 males and 82 females with an average age of 67.6±7.3 years, (range 45-80 years); Average body mass index 26.42±4.31 kg/m 2, all the operation were performed by "Skywalker" surgical robot system according to preoperative design based on CT. The operation time, intraoperative blood loss, hospitalization days and postoperative complications were recorded, and the imaging indexes including hip-knee-ankle (HKA), lateral distal angle of femur (LDFA) and medial proximal angle of tibia (MPTA) measured before and after the operation, implant model indexes (preoperative planning implant model and postoperative implant model) and short-term clinical efficacy indexes [Western Ontario and McMaster Universities (WOMAC) osteoarthritis index] pain score, stiffness score, joint function score, total score and SF-12 score before and 3 months after the operation) were compared. Results:The average follow-up period was 109.60±9.80 d, (range 95-143 d). The average operation time of 106 patients was 105.30±23.22 min; The average intraoperative blood loss was 141.70±58.33 ml; The average length of hospitalization was 5.82±2.80 d. One patient had ischemic stroke after operation, and one patient had abnormal liver function after operation. According to the judgment of the investigator, all of them were not related to the operation. The actual angle error is the difference between the preoperative planning angle and the postoperative measurement angle. The absolute error of 99.1% (105/106) of the HKA angle was within 3°, 90.8% (69/76) of LDFA, 98.7% (75/76) of the MPTA. In 45 patients in one center where data were available, the actual implant models used in all patients were consistent with the preoperative planning size, and there were only differences in version selection such as Asian condyle. WOMAC pain score, joint function score, total score was improved from 7.34±2.85, 25.10±9.85, 34.75±13.02 to 3.34±2.66, 14.68±9.64, 18.66±13.49 before and after operation, respectively, which were statistically significant ( P<0.001) and SF-12 physiological score and psychological score were improved form 27.24±6.42, 30.68±8.26 to 38.83±5.74, 39.36±7.85 before and after operation, respectively, which were statistically significant ( t=7.33, P<0.001; t=4.53, P=0.043). Conclusion:Domestic surgical robot system "Skywalker" can assist the surgeon to achieve accurate and personalized reconstruction of lower limb alignment and achieve satisfactory short-term clinical outcomes. The long-term clinical outcomes of personalized reconstruction and survival rate of implant still need to be further studied.

Objective:To summarize the self-management experience of patients with coronary heart disease, so as to provide a basis for medical and nursing staff to build and improve the self-management system of coronary heart disease.Methods:Qualitative studies on the self-management experience of patients with coronary heart disease were retrieved by computer in PubMed, Embase, Web of Science, CINAHL, Cochrane Library, Joanna Briggs Institute (JBI) , China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Literature Database from database establishment to June 30, 2021. The articles were evaluated using the Quality Evaluation Standard for Qualitative Research (2016) of Australia JBI Evidence-based Health Care Center, and the results were summarized using the Meta-synthesis.Results:A total of20 articles were included, and 59 research results were extracted. A total of 12 new categories were formed by induction and combination, which were integrated into 3 integrated results, namely the driving factors of self-management, the blocking factors of self-management, the trajectory and path of self-management.Conclusions:Self-management of patients with coronary heart disease is a tortuous process influenced by multiple factors. Collaboration and support from families, healthcare systems, society, and governments are needed to promote patients' adherence to long-term self-management and improve their prognosis and quality of life.

Objective:To investigate the influence of joint line alteration on the mid-term clinical effects of primary medial pivot total knee arthroplasty (MP-TKA).Methods:Data of a total 189 patients (233 knees) with 30 males (30 knees) and 159 females (203 knees) with age 66.42±6.12, diagnosed as knee osteoarthritis and underwent primary MP-TKA from January to December 2015, were retrospectively analyzed. All cases were followed up for at least 4 years. The patients were divided into four groups according to the extent of alteration, namely <-4 mm, -4- mm, 0- mm and >4 mm. Range of motion (ROM), Knee Society's Knee Scoring System (KSS), the Western Ontario and McMaster University (WOMAC) osteoarthritis index score were compared preoperatively and at 4 years postoperatively.Results:The postoperative follow-up duration was 52.20± 2.94 months (48-59 months). A total of 133 knee (57%) had joint line raised and 100 cases (43%) joint line distal shifted. The overall height of joint line before surgery was 16.56±3.54 mm (7.33-25.32 mm) and 17.34±2.92 mm (7.25-25.43 mm) postoperatively. The average alteration was 0.78±3.17 mm (-6.00-9.91 mm) with statistically significant difference ( t=-2.596, P=0.010). There was no statistical difference among the four groups in terms of gender, body mass index, pre-operative tibia slope and post condylar offset. The overall preoperative ROM of the all groups was 90.45°±20.44°, which increased from baseline to 108.95°±12.55° at 4 years postoperatively ( t=-22.381, P<0.001). There was statistical difference in term of ROM among each group ( F=7.101, P<0.001). The ROM in group 0- mm and >4 mm was significantly higher than that in group <-4 mm and -4- mm ( P<0.05). The KSS function score and clinic score at 4 years postoperatively were significantly higher that those before surgery, the WOMAC score was statistically lower at 4 years postoperatively ( F=0.723, P<0.001; F=1.138, P<0.001; F=2.502, P<0.001). There was no significant difference among the four groups in terms of KSS score and WOMAC ( P>0.05). One case in >4 mm group had gasket prolapse at 6 month after surgery and 3 cases with immediate anterior knee pain occurred in <-4 mm group. Conclusion:MP-TKA can lead to significant joint line alteration. The overall ROM after surgery is positively correlated with the quantity of joint line alteration. However, there was no correlation between quantity of joint line alteration and the joint function scores. Thus, MP-TKA can achieve good mid-term clinical effects.

Objective: To discuss the effects of sample storage time and temperature on lymphocyte subsets detected by flow cytometry. Methods: Use flow cytometry to detect lymphocyte subsets of a total of 53 blood samples from hospitalized and out-patient patients in Qinghai Provincial People′s Hospital from October 26, 2018 to March 30, 2019. The test was completed within 4 hours after sample collection, which is the control group. The treatment groups are as follows: pretreatment was completed within 4 hours and detected after saving samples at room temperature (group A) for 24 and 36 hours; the tests were performed after keeping samples at room temperature (group B) for 24, 48, 72 hours; completed detection after preserving samples in 4 ℃ condition (group C) for 24, 48, 72 hours. Results: In treatment group A, there was no significant difference in the results of lymphocyte subsets detected after 24 hours of storage compared with the control group(P>0.05); after 36 h of storage, CD3+and CD3+CD8+T lymphocytes percentages were significantly increased [(74.28±11.31)% vs (73.78±11.33)%, (32.15±14.82)% vs (31.00±14.79)%; all P<0.05], while CD19+cells percentage were markedly decreased [(15.60±12.23)% vs (16.11±12.38)%; P<0.05]. In group B, compared with the control group, there was no obvious change in lymphocyte subsets tested after 24 hours(P>0.05); after 48 hours of storage, CD19+cells percentage were observably reduced [(15.60±12.09)% vs (16.11±12.38)%; P<0.05], while other results showed no obvious change (P>0.05); after 72 hours of storage, CD3+and CD3+CD8+T cells percentages elevated significantly [(75.78±11.18)% vs (73.78±11.33)%, (32.57±14.90)% vs (31.00±14.79)%; all P<0.05], and CD19+cells percentage decreased markedly [(14.89±11.92)% vs (16.11±12.38)%; P<0.05]. In group C, there also was no significant change in the results between detecting after 24 hours and the control group(P>0.05); after 48 hours of storage, CD3+CD8+T cells percentage elevated obviously [(32.03±14.95)% vs (31.00±14.79)%; P<0.05] and CD19+cells percentage decreased markedly [(15.32±11.97)% vs (16.11±12.38)%; P<0.05]; after 72 hours of storage, CD3+and CD3+CD8+T cells percentages were significantly increased [(75.63±11.08)% vs (73.78±11.33)%, (32.62±14.98)% vs (31.00±14.79)%; all P<0.05], while CD56+and CD19+cells percentages were reduced observably [(8.21±6.52)% vs (9.02±6.80)%, (14.83±11.79)% vs (16.11±12.38)%; all P<0.05]. Conclusions The blood samples can be kept at room temperature and the testshould be completed within 48 h if the detection of lymphocyte subsets by flow cytometry cannot be performed in time; for the samples that have been pretreated, detection can be completed after saving at room temperature for 24 h, and the above treatments had no significant effect on the inspection results.

OBJECTIVE: To analyze the prevalence and influencing factors of multisite work-related musculoskeletal disorders(WMSDs) of workers in a railway vehicle manufacturing enterprise. METHODS: A total of 366 male workers in the assembly and riveting workshop of a railway vehicle manufacturing enterprise were selected as the research subjects using the cluster sampling method. The Chinese Musculoskeletal Questionnaire was used to investigate the prevalence of multiple sites of WMSDs. Multiple logistic regression analysis was used to analyze the influencing factors. RESULTS: The total prevalence of WMSDs was 56.3%(206/366). The prevalence of WMSDs in all parts from high to low was as follows: lower back(35.5%), hand and wrist(27.6%), neck(23.2%), shoulder(21.0%), knee(19.9%), upper back(18.6%), hip and leg(18.0%), ankle/foot(15.8%) and elbow(12.3%)(P<0.01). The total prevalence of multisite WMSDs was 38.0%(139/366). The prevalence of WMSDs in different numbers of parts from high to low was as follows: 6 or more parts(12.0%), 2 parts(10.7%), 3 parts(6.6%), 5 parts(5.5%) and 4 parts(3.3%)(P<0.01). Multiple logistic regression analysis results showed that the overweight and obese workers had higher risk of multi site WMSDs than those with normal body mass index(P<0.05).Those with long-term low heads, frequent bending, long bending of the elbows, and higher frequency of work requirements, and less frequently communicated with the leader had higher risk of multi site WMSDs(P<0.05). CONCLUSION: The prevalence of multisite WMSDs in railway vehicle manufacturing enterprise is relatively high. The influencing factors include individual factors, adverse ergonomic factors and psychosocial factors.

OBJECTIVE: To investigate the correlation of mental workload and prevalence of work-related musculoskeletal disorders musculoskeletal disorders( WMSDs) in railway vehicle manufacturing workers.METHODS: A total of 362 male workers in assembling and welding workshop from a railway vehicle manufacturing enterprise were selected as study subjects by cluster sampling method.The level of mental workload and prevalence of WMSDs were investigated using a revised Subjective Workload Assessment Technique and China Musculoskeletal Questionnaire.RESULTS: The median score of mental workload was 67 and the prevalence rate of WMSDs was 56.9%.The multivariate logistic regression analysis results indicated that the higher the mental workload of railway vehicle manufacturers,the higher their risk for WMSDs after excluding the influence of confounding factors( P < 0.05).Workers in welding work showed a higher risk than those in assembling work( P < 0.01).Workers with fast work rhythm showed higher risk of WMSDs than those with regular working rhythm( P < 0.01).Workers with comfortable working environment and temperature showed lower risk of WMSDs than those with uncomfortable working environment and temperature( P < 0.01).CONCLUSION: The mental workload can increase the risk of WMSDs,with a dose-effect relationship in railway vehicle manufacturing workers.The type of work,work frequency and the temperature in working environment are also influencing factors of WMSDs.

Objective To investigate the affecting factors on auditory and speech performances in preschool children with unilateral cochlear implantation (CI) .Methods The clinical data of the preschool children (n=165) with unilateral cochlear implantation in the Second Xiangya hospital from January 2006 to April 2013 were collected . These children received rehabilitation according to the method recommended by the China Rehabilitation Research Center for Deaf Children ,and the data were analyzed retrospectively .The categories of auditory performance (CAP) and speech intelligibility rating (SIR) were used to assess their auditory and speech performances .The relationships between the performance and gender ,implanted age ,genotype ,inner ear malformation ,history of hearing aid were evaluated .Results Implanted ages and genotypes were associated with the auditory and speech performance of par‐ticipants (P<0 .05) ,while genders ,hearing aid experience ,and inner ear malformations(enlarged vestibular aque‐duct syndrome ,EVAS)were not significant related (P<0 .05) .Children were found to have achieved better CAP and SIR growths when CI was implanted during 1~3 years old and 2~4 years old ,respectively (P<0 .05) .The outcomes of CI recipients with GJB2 mutation were significantly better than those of the GJB2-nonrelated CI recipi‐ents (P<0 .05) .Conclusion This study provides evidence that CIs during first 1~3 years old having better auditory rehabilitation results than those of during 4~6 years old ,and CIs during 2~4 years old obtaining a better speech development in the first 12 months after operation .Deaf children with GJB2 mutation show better auditory and speech performances after CIs than those of the peers without GJB2 mutation .CIs can be effectively performed in deaf children associated with EVAs as in those without EVAS .

Objective:To investigate the differences between emergency surgery and selective surgery treatment of ankle fractures with dislocation .Methods:In the study , 40 patients with ankle fracture and dislocation were treated and followed up from May 2013 to May 2014, and all the data were collected and analyzed .The subjects involved 29 male patients and 11 female patients .The patients were randomly separated into two groups , and the patients in group A were given surgical intervention within 6 hours af-ter injury , while those in group B were initially given close reduction and given selective operation when the soft tissue condition got better .Group A contained 13 male patients and 7 female patients with average age of 37.10;Group B consisted of 15 male and 5 female, with average age of 37.85.Results:The Baird-Jackson score was applied for assessment of the patients ’ outcomes.According to the score , the outcomes were classified into excellent , good, fair, and poor.In group A (emergency group), the outcomes were 13 (65.0%), 4 (20.0%), 3 (15.0%), and 0, respectively.In group B ( selective group), they were 11 (55.0%), 7 (35.0%), 2 (10.0%), and 0, respectively.The numbers of the patients from excellent to poor were 24 (55.0%), 11 (27.5%), 5 (12.5%), and 0, respectively. Conclusion: There is no significant difference in postoperative function between the two groups , however , early surgical intervention can benefit in accomplishing anatomical reduction much easier and shortening the time of hospitalization , which is cost-saving for the patients .

SUMMARY Pregnancy-related pelvic ring disease brings great suffering to pregnant women, including the separation of the pubic symphysis and sacroiliac joint pain.Hormonal changes leading to ligamentous laxity is the main reason for pregnancy-related pelvic ring disease.In normal pregnant cases, and the physiologic widening at the symphysis is about 3-7 mm.When the widening of the symphysis is more than 10 mm, it may lead to symptoms and need active treatment.Currently the diagnosis of the pubic symphysis separation is based on the clinical symptoms and signs.The treatment of acute pubic symphysis separation bases on conservative therapy, includes bed rest and physical therapy.But when the widening of the symphysis is more than 4 cm, the surgery intervention may be a good treatment.If the conservative treatment is not obviously effective, the surgery consists of plate fixation in the pubic symphysis and sac-roiliac screw fixation.Other indications for the surgical intervention include inadequate reduction, recur-rent diastasis, intractable symptoms, and open rupture.

Objective To establish a method of identification of DKO mouse model of Duchenne muscular dystro-phy, and to assess the dystrophin regeneration after stem cell transplantation.Methods Heterozygous mice were mated and the resulting offspring were used to identify their genotype by SSP-PCR.The plasma creatine kinase level was measured by biochemical analyzer and histological changes in the DKO mice were analyzed using HE staining.Human umbilical cord mesenchymal stem cells were prepared and injected into the DKO mice hindlimb muscle, and dystrophin expression was de-tected by immunofluorescence staining at 2 months after injection.Results Mating of heterozygous mice generated three kinds of genotype offsprings, and 21.2%of the offsprings were identified as DKO genotype (285 bp) .DKO mice showed dystrophic symptoms, their plasma creatine kinase level was as high as 16988.52 ±617.48 IU/L, and significant histologi-cal changes including diverse myocyte sizes, numerous centrally nucleated cells and connective tissue proliferation or in-flammatory cells infiltration.Human dystrophin expression was detected in the DKO mouse hindlimb muscle at two months after injection of human umbilical cord mesenchymal stem cells.Conclusion DKO mouse genotype can be identified by SSP-PCR, and DKO mouse is an ideal animal model for studies of stem cell therapy for Duchenne muscular dystrophy.