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EARLY CLINICAL OUTCOME OF TOTAL KNEE ARTHROPLASTY FOR FLEXIONCONTRACTURE DEFORMITY KNEES OFDIFFERENT DEGREES

Objective To make a retrospective analysis on an early clinical outcome of total knee arthroplasty (TKA) for the knees with different degrees of flexion-contracture deformities. Methods Ninety-seven knees of 65 patients undergoing total knee arthroplasty with the Scorpio posterior-stabilized knee prosthesis from January 2000 to December 2003 were reviewed, including 51 osteoarthritis patients (74 knees) and 14 rheumatoid arthritis patients (23 knees). Thirtythree patients underwent unilateral TKA, and 32 patients underwent bilateral TKA. The average range of motion (ROM) before operation was 82.8°(range, 5-140°).According to the preoperative flexion-contracture degrees of the knees, these patients were divided into 2 groups, group A and group B. Group A consisted of the patients with flexioncontracture less than 20° (range, 0-15°), and group B consisted of the patients with flexion-contracture not less than 20° (range, 20-60°). In group A, the average flexion-contracture degree, ROM, KSS (knee society score), and function score were 10.7±8.0°, 104.6±20.0°, 29.1±18.0, and 32.6±20.7, respectively. But the corresponding data were much worse ingroup B than in group A, which were 28.2±7.8°, 60.8±26.6°, 12.1±13.2, and 26.8±18.1. All the operations were primary total knee arthroplasty, and they were performed by the same group of surgeons. The time for the prosthesis installed lasted for 25.6 minutes, and the average tourniquet time was 34.7 minutes. Three or four days after operation, the patients began the continuous passive motion (CPM) and active functional exercise of the knee.Results The patients were followed up for an average of 2 years and 7 months(range, 8 mon-3.5 yr). During the follow-up period, the average flexion-contracture degree, ROM, KSS, and function score in group A were 0.4±2.1°, 108.6±19.0°, 82.1±13.8, and 72.3±29.1, respectively; and the corresponding data in group B were 1.3±3.2°, 986±16.4°, 75.9±8.2, and 81.4±26.9, respectively. There was no significant difference between the 2 groups. No revision or deep infection was found. Conclusion The curative effect is mainly determined by the surgeon’s good operational skills, rich clinical experience, and familiarity with the prosthesis, and it is not influenced by severity of the knee flexioncontracture deformity. The knee ROM after TKA, which has a “toward middle ROM”phenomenon, is influenced by many clinical factors. It is very important for the patientto perform a functional exercise of the knee as early as possible after operation. 

INFLUENCE OF EARLY CONTROLLED PASSIVE MOBILIZATION ON FREE TENDON GRAFT

A comparative study was given to a group of grafted tendons on rabbits either with complete immobilization or early controlled passive mobilization of the affected parts immediately following operation. In the study, the healing mechanism, adhesion formation and breaking strength at the grafted site of the tendons were included. The results showed that early controlled passive mobilization had no influence on the survival and its healing process, but the adhesion surrounding tendons would be looser and the vessels on the surface, of the grafted tendons would be orientated longitudinally enhancing tendon gliding promoted collagen it would also promote collagen production and thus increased the rupturing strength at the grafted site.

Establishing Medical Risk Monitoring and Early Warning System for Quality Improvement and Patient Safety

Evidence of Therapy of Early Parkinson＇s Disease

Patients with early Parkinson＇s disease should be treated rationally in order to improve their quality of life and reduce the motor complications. The early employment of drugs which provides sustained central dopamine agonism and dopaminergic neuroprotection may reach this aim to some extent. Evidence of effective therapy in early Parkinson＇s disease will be introduced including： dopamine agonists, monoamine oxidase inhibitor 13, coenzymeQ10, L-dopa and a gait training.

A SURGICAL TREATMENT OF EARLY PARTIAL CLOSURE OF THE EPIPHYSIAL PLATE

OBJECTIVE To introduce the technique of epiphysiolysis and epiphysis grafting in the treatment of early partial closure of the epiphysial plate in children, and evaluate its effect. METHODS Retrospective study was performed in 10 cases of cubitus varus and valgus, or genu varum and valgum due to early partial closure of the epiphysial plate, 6 cases received simple cuneiform osteotomy, and 4 cases received epiphysioloysis and epiphysis grafting. RESULTS Clinical outcoming after 6-month to 5-year’s follow-up showed 1 case deformity of recurrence and 2 cases of non-isometric limb after simple osteotomy, while no recurrence and isometric limb after epiphysiolysis and epiphysis grafting. CONCLUSIONEpiphysiolysis and epiphysis grafting may effectively prevent the recurrence of postoperative deformity, and restore the longitudinal growth of limb.

Psychological State of Local and Nonlocal Nurses During the Wenchuan Earthquake

【摘要】目的对一线临床科室参与汶川地震抗震救灾的外援护士和本土护士的社会支持系统进行调查研究。方法随机抽取抗震救灾一线科室(ICU、骨科、急诊)外援护士及本土护士各175名,设为外援组和本土组,采用对地震的自我认知问卷及社会支持评定量表(SSRS)进行测评。结果两组护士对地震相关知识的知晓情况、响应抗震救灾的行为表现、地震对专业的影响等方面无明显差异(Pgt;0.05);两组护士的社会支持总分均低于国内常模 (Plt;0.01),除外援组主观支持维度得分与国内常模无显著差异(Pgt;0.05)外,两组的社会支持其它各维度得分均低于国内常模,外援组的社会支持总分及主观支持、客观支持得分均高于本土组(Plt;0.01),两组对支持的利用度无明显差异(Pgt;0.05)。结论为抗震救灾一线科室护士提供积极的社会支持是保证心理健康的重要措施。【Abstract】ObjectiveTo evaluate the difference of psychological state between local and nonlocal nurses during the Wenchuan Earthquake. Methods A total of 175 local nurses and 175 nonlocal nurses were randomly selected and investigated by SSRS and the earthquake questionnaire. Results There were no significant differences in their knowledge about the earthquake, professional identity and action (Pgt;0.05). The total and the three dimensions scores of SSRS of the two groups were lower than those of the domestic norms (Plt;0.01) except the subjective support dimensions. The total scores, objective support and subjective support dimensions scores of nonlocal group were higher than that in the local group (Plt;0.01). In coping style questionaire, there were significant differences in solving problems and retreat factor(Plt;0.01)and no significant differences in remorse, salvation and illusion(Pgt;0.05). Conclusion The earthquake affected mental health of the nurses and their psychological state need to be much concerned,especially the nonlocal ones.

Discussion on the distribution characteristics and preventive effects of EEG patterns in acute mountain sickness

ObjectiveThe purpose of the research is to study the distribution and early warning of electroencephalogram (EEG) in acute mountain sickness (AMS). MethodsA total of 280 healthy young men were recruited from September 2016 to October 2016. The basic data were collected by the centralized flow method, the general situation of the division of the investigators after the training, the Lewis Lake score, the computer self-rating anxiety scale and depression scale, and the collection of EEG. Follow up in three months. Results94 of the patients with AMS, morbidity is 33%, 21 (22.34%) of the patients are moderate to severe, 73 (77.66%) are mild, morbidity is 26.67%. The abnormal detection rate of electrogram was 7.9% (22/280), which were mild EEG, normal EEG abnormal rate was 8.6% (16/186), abnormal detection rate of mild AMS was 4.1% (3/73), and the abnormal detection rate was 14.3% (3/21) in the medium / heavy AMS. The latter was significantly different from the previous (P < 0.05). Three months follow-up of this group of patients with 0 case of high altitude disease. Conclusions The EEG in AMS is mainly a rhythm irregular, unstable, poor amplitude modulation; or two hemisphere volatility difference of more than 50% or slightly increased activity. The result is statistically significant, suggesting that EEG distributions has possible early warning of AMS.

RELATION BETWEEN CHANGES OF THE HEPATIC ENERGY METABOLISM AND ALLOGRAFT VIABILITY IN EARLY PHASE AFTER ORTHOTOPIC LIVER TRANSPLANTATION

Objective To study the relation between changes of the hepatic energy metabolism and allograft viability in early phase after orthotopic liver transplantation, arterial blood ketone body ratio (AKBR) was measured in pre- intra and post-operative phase. Methods The monkeys were divided into two groups in accordance with survived times. A group (＞24h), 5 monkeys survived 29—168 postoperative hours; B group (＜24h), 9 monkeys survived only 5—22 hours. Results AKBR in all models immediately decreased to extraordinarily low state in anhepatic-phase (versus preanhepatic phase, Ｐ＜0.01), and A group recovered rapidly to the normal levels, and maintained continuously for 12 postoperative hours above the level of 0.7. In contrast in B group, AKBR decreased below 0.7 rapidly and failed to restore to the normal level. Within 12 hours postoperatively, in B group, AKBR was lower than 0.4. Conclusion AKBR is a sensitve indicator to the allograft viability in the early phase after hepatic transplantation.

CARTILAGE TISSUE ENGINEERING WITH ACELLULAR CARTILAGE MATRIX AS SCAFFOLD IN RABBIT MODEL

To study how to repair the cartilage defect according to the principles of tissue engineering with acellular cartilage matrix as scaffold material. Methods The ear cartilage was obtained from a New Zealand white rabbit(weighing 2.4 kg )and then treated by a modified Courtman’s four-step method to produce the acellular cartilage matrix. Eighteen New Zealand white rabbits (aged 6 months, weighing 2.4-2.6 kg) with no sex l imit were divided into three groups. Forevery rabbit, two pieces of ear cartilage measured 1 cm × 1 cm were excised in each ear. Defects were repaired as follows: group A with the combined graft of acellular cartilage matrix and perichondium, group B with acellular cartilage matrix and group C with perichondium. Three animals in each group were killed 4 and 12 weeks postoperatively, respectively. Tissue samples obtained were analyzed with gross observation, hematoxyl in-eosin stain, Safranine O-alcian blue stain and type II collagen messenger RNA in situ hybridization respectively. Results In gross observation, the repaired sites in groups A and B were not change meaningfully in their shape 4 weeks postoperatively; but they felt a bit of thicker and harder 12 weeks postoperatively. In group C two repaired sites formed scabs at 2 weeks and perforated at 5 weeks. In histological observation, there was a sl ight inflammatory reaction surrounding the acellular cartilage matrix 4 weeks after it was implanted in groups A and B. The inflammatory cells were mainly lymphocytes. The perichondrium graft in group C was collapsed in the defects in HE stain. The defect sites were negative for Safranine O-alcian blue stain and type II collagen mRNA in situ hybridization in all groups. At 12 weeks cells were found in the acellular matrix which arranged in irregular manner in group A in HE stain and was positive for Safranine O-alcian blue stain and type II collagen mRNA in site hybridization. In groups B and C, no new cell was found in HE stain and the repaired sites were negative for Safranine O-alcian blue stain and type II collagen mRNA in situ hybridization. Conclusion Acellular

The Role of a Regional State-level Hospital in Providing Logistical Support for Medical Teams from Other Provinces during Medical Rescue after Wenchuan Earthquake

During the medical rescue of Wenchuan earthquake, in accordance with the instruction of the Chinese Ministry of Health, West China Hospital set up the Medical Supply Center for Medical Teams from Other Provinces, put up standard storehouses within 10 hours, performed professional purchase, precisely distributed medical materials according to relevant demands, and decided the scientific route based on the distribution of medical teams from other provinces, so as to ensure the medical materials’ being delivered to the medical teams safely, promptly and accurately.