Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who...Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.展开更多
Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventi...Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventional TKA.Methods：We conducted a retrospective analysis of 212 primary TKAs in 188 patients.Intramedullary （IM）-guided resection was applied on the femoral side while extramedullary （EM）-guided resection was used on the tibial side.Using full-length X-ray,the preoperative femoral valgus angle and lower extremity alignment,as well as 2-week postoperative femoral and tibial prosthetic coronal alignment and overall lower extremity alignment,were measured.Results：Postoperatively,good prosthetic alignment was achieved in 191 cases （90.1%） on the tibial side and in 144 cases （67.9%） on the femoral side （χ^2 =5.441,P =0.02）.Multiple linear regression analysis was used to assess the effect of different alignment sides on the overall alignment in the coronal plane.Data were divided into five subgroups based on the valgus or varus status of the prostheses.The standardized regression coefficients of the femoral and tibial prosthetic alignment on the overall alignment were 0.666 and 0.414,respectively;in varus on both sides were 0.658 and 0.377,respectively;in valgus,0.555 and 0.030;femoral side varus and tibial side valgus,0.702 and 0.211;femoral side valgus and tibial side varus,-0.416 and 0.287.The study showed that the overall low extremity alignment was statistically influenced by the prosthetic alignment,except for the tibial prosthetic alignment when femoral prosthesis was in valgus （P =0.153）.Conclusions：In conventional TKA,tibial side EM-guided resection may offer satisfactory postoperative alignment,and femoral resection relying on IM guide may lead to more undesirable results.Postoperative coronal alignment is mainly affected by the femoral resection.Therefore,femoral side operation should receive adequate attention from the surgeons.展开更多
Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-oct...Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.Methods Homemade prosthetic component consisting of expanded polytetrofluoroethylene （ePTFE）,terylene film,and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels,can fix vessels better using the stent without occlusive bleeding.Forty male mongrel dogs were used,20 for biomechanical tests and 20 for animal experiments.In the biomechanical test,dogs were randomly divided into two groups （n=10 each）,one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE.Of the 40 specimens,10 were used for adhesive and 10 for suture specimens for tension strength test,whereas the remaining specimens were used for bursting pressure test.In animal experiments,dogs were also divided into adhesive and suture groups （n=10）,only of the left carotid artery.Recording the operational time,bleeding or not.Vessels were tested using color Doppler ultrasound,the inner diameter was measured,and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography （DSA） were also performed.Specimens were then analyzed histologically.Results In the adhesive and suture groups,the specimens could afford atension strength of （23.80±1.51） N versus （24.60±1.08） N （P ＞0.05）,the bursting pressure was （52.03±.2.43） kPa versus （50.04±3.51） kPa （P ＞0.05）,and the mean time of anastomosis was （15.20±0.55） minutes versus （25.97±0.58） minutes （P ＜0.05）.One dog in the adhesive group was bleeding from the suture.One dog from each group presented with thrombosis at 1 week.After measuring using ultrasound,the stenosis degree of all dogs were no more than 30�展开更多
The features of electromyographic （EMG） signals were investigated while people walking on different terrains, including up and down slopes, up and down stairs, and during level walking at different speeds, The featu...The features of electromyographic （EMG） signals were investigated while people walking on different terrains, including up and down slopes, up and down stairs, and during level walking at different speeds, The features were used to develop a terrain identification method. The technology can be used to develop an intelligent transfemoral prosthetic limb with terrain identification capability, The EMG signals from 8 hip muscles of 13 healthy persons were recorded as they walked on the different terrains. The signals from the sound side of a transfemoral amputee were also recorded. The features of these signals were obtained using data processing techniques with an identification process developed for the identification of the terrain type. The procedure was simplified by using only the signals from three muscles. The identification process worked well in an intelligent prosthetic knee in a laboratory setting.展开更多
Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mit...Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.展开更多
This paper presents an anthropomorphic prosthetic hand using flexure hinges, which is controlled by the surface electromyography （sEMG） signals from 2 electrodes only. The prosthetic hand has compact structure with ...This paper presents an anthropomorphic prosthetic hand using flexure hinges, which is controlled by the surface electromyography （sEMG） signals from 2 electrodes only. The prosthetic hand has compact structure with 5 fingers and 4 Degree of Freedoms （DoFs） driven by 4 independent actuators. Helical springs are used as elastic joints and the joints of each finger are coupled by tendons. The myoelectric control system which can classify 8 prehensile hand gestures is built. Pattern recognition is employed where Mean Absolute Value （MAV）, Variance （VAR）, the fourth-order Autoregressive （AR） coefficient and Sample Entropy （SE） are chosen as the optimal feature set and Linear Discriminant Analysis （LDA） is utilized to reduce the dimension. A decision of hand gestures is generated by LDA classifier after the current projected feature set and the previous one are ＂pre-smoothed＂, and then the final decision is obtained when the current decision and previous decisions are ＂post-smoothed＂ from the decisions flow. The prosthetic hand can perform prehensile postures for activities of daily living and carry objects under the control of EMG signals.展开更多
A five-fingered,multi-sensory and biomimetic hand is presented.The cambered palm is specially designed by utilizing the knowledge of anatomy.The position of each finger is arranged according to human hand skeleton.Eac...A five-fingered,multi-sensory and biomimetic hand is presented.The cambered palm is specially designed by utilizing the knowledge of anatomy.The position of each finger is arranged according to human hand skeleton.Each finger with three phalanges could fulfill flexion-extension movement independently.All the fingers are designed using coupling link mechanism.The location of the thumb is designed by maximizing interaction area between the thumb and other fingers.The opposite thumb could grasp along a cone surface,while maintaining its function.The hardware architecture is divided into control system and human-machine interaction system.The mechanical parts,sensors and motion control systems are integrated in the hand structure.In addition,a skin-like glove is designed,which makes the hand more humanlike.According to our primary experimental results,the hand can accomplish several grasp modes by applying an intuitive surface electromyography control scheme.The success rate of 10 modes is up to 90%.展开更多
To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematic...To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.展开更多
BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the nativ...BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit展开更多
Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 t...Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 to March 2023 in the hospital were selected.They were randomly divided into an observation group and a control group,with 40 cases in each group.Both groups of patients received routine treatment and care.The patients in the control group used routine oral care methods to carry out oral care,the patients in the observation group carried out oral care on the basis of the control group,observation and analysis of the patients'mastery of oral knowledge,as well as the depth of the probing and the level of clinical attachment.Results:The oral knowledge mastery of the observation group was 72.31±6.98 after the nursing intervention,which was significantly higher than the score of 86.12±7.36 of the patients in the control group who used conventional oral care,and the difference was statistically significant at P<0.05;the depth of probing and the clinical attachment level of the observation group were 2.43±0.58 and 4.31±0.86 respectively,which were significantly better than those of the control group.The depth of probing and clinical attachment level scores of the observation group were 2.99±0.54 and 5.36±1.02 respectively,and P<0.05 was considered statistically significant.Conclusion:The combination of conventional treatment and oral care can effectively improve the treatment effect of implant denture prosthesis for chronic periodontitis.However,it is necessary to pay attention to the psychological counseling of the patients in the specific clinical application to ensure that the patients can actively cooperate with the clinical treatment.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
We previously developed a powered hip prosthetic mechanism with kinematic functions of hip flexion-extension and abduction-adduction,and its theoretical and simulation-based kinematics were verified.Because internal-e...We previously developed a powered hip prosthetic mechanism with kinematic functions of hip flexion-extension and abduction-adduction,and its theoretical and simulation-based kinematics were verified.Because internal-external hip rotation has a positive effect on the movements of human lower limbs according to medical research,we developed a novel hip prosthetic mechanism based on a previous hip prosthesis that possesses motion characteristics similar to those of a human bionic hip,and the motion characteristics of multiple Degrees-of-Freedom(DoFs)were analyzed after kinematic modeling.Then,a walking model of the human‒machine model was established,and the walking stability of an amputee,which reflects the rehabilitation effect,was explored while the hip prosthetic mechanism considered the internal-external rotation of the hip.Finally,a prototype and its verification platform were built,and kinematic validation of the hip prosthetic mechanism was carried out.The results showed that the designed Parallel Mechanism(PM)possesses human-like motion characteristics similar to those of a human bionic hip and can be used as a hip prosthesis.Moreover,the existing motion characteristic of internal-external hip rotation can enhance the walking stability of an amputee via this hip prosthetic mechanism.展开更多
With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections...With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.展开更多
Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prostheti...Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET 展开更多
Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as the...Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient's symptoms,valve location,degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively,pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology,epidemiology,diagnostic approach and treatment options for aortic and mitral valve PVO.展开更多
Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocar...Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a展开更多
基金This project was partially supported by a grant from the National Natural Science Foundation of China （No.81273972）.
文摘Background The aim of this study was to determine the relationship between prosthesis coverage and postoperative hidden blood loss （HBL） in primary total knee arthroplasty （TKA）.Methods A total of 120 patients who had undergone unilateral TKA from August 2012 to May 2013 were retrospectively studied.The Gross formula was used to calculate the amount of HBL.Routine standard anteroposterior （AP） and lateral x-ray films of the knee joint were taken postoperatively and used to measure the percentages of coronal femoral and of coronal and sagittal tibial prosthetic coverage.Then Pearson＇s correlation analysis was performed to assess the correlations between the percentages of prosthetic coverage for each AP and lateral position and HBL on the first and third postoperative days.Results The volumes of HBL on the first and third postoperative days after TKA were （786.5±191.6） ml and （1 256.6±205.1） ml,respectively,and lateral x-ray film measurements of percentages of coronal femoral,tibial coronal,and sagittal prosthetic coverage were （87.9±2.5）％,（88.5±2.2）％,and （89.1±2.3）％,respectively.Pearson＇s correlation analysis showed statistically significant correlations between percentages of total knee prosthetic coverage for each AP and lateral position and volumes of HBL on the first and third postoperative days （P ＜0.05）.Conclusions HBL after TKA correlates with degree of prosthetic coverage.To some extent,the size of the surfaces exposed by osteotomy determines the amount of HBL.Choice of the appropriate prosthesis can significantly reduce postoperative HBL.Designing individualized prostheses would be a worthwhile development in joint replacement surgery.
文摘Background：A good postoperative alignment in total knee arthroplasty （TKA） is the key to achieving satisfactory results.We assessed the effect of femoral and tibial resection on the overall alignment after conventional TKA.Methods：We conducted a retrospective analysis of 212 primary TKAs in 188 patients.Intramedullary （IM）-guided resection was applied on the femoral side while extramedullary （EM）-guided resection was used on the tibial side.Using full-length X-ray,the preoperative femoral valgus angle and lower extremity alignment,as well as 2-week postoperative femoral and tibial prosthetic coronal alignment and overall lower extremity alignment,were measured.Results：Postoperatively,good prosthetic alignment was achieved in 191 cases （90.1%） on the tibial side and in 144 cases （67.9%） on the femoral side （χ^2 =5.441,P =0.02）.Multiple linear regression analysis was used to assess the effect of different alignment sides on the overall alignment in the coronal plane.Data were divided into five subgroups based on the valgus or varus status of the prostheses.The standardized regression coefficients of the femoral and tibial prosthetic alignment on the overall alignment were 0.666 and 0.414,respectively;in varus on both sides were 0.658 and 0.377,respectively;in valgus,0.555 and 0.030;femoral side varus and tibial side valgus,0.702 and 0.211;femoral side valgus and tibial side varus,-0.416 and 0.287.The study showed that the overall low extremity alignment was statistically influenced by the prosthetic alignment,except for the tibial prosthetic alignment when femoral prosthesis was in valgus （P =0.153）.Conclusions：In conventional TKA,tibial side EM-guided resection may offer satisfactory postoperative alignment,and femoral resection relying on IM guide may lead to more undesirable results.Postoperative coronal alignment is mainly affected by the femoral resection.Therefore,femoral side operation should receive adequate attention from the surgeons.
文摘Background Currently,adhesive technique is popular in vascular repair but not widely used for defective vessels.This study aimed to determine the feasibility and effectiveness of repairing defective vessels with 2-octyl-cyanoacrylate and a homemade prosthetic component.Methods Homemade prosthetic component consisting of expanded polytetrofluoroethylene （ePTFE）,terylene film,and homemade soluble hollow stent mixed with adhesive can replace autologous graft and suture in repairing defective vessels,can fix vessels better using the stent without occlusive bleeding.Forty male mongrel dogs were used,20 for biomechanical tests and 20 for animal experiments.In the biomechanical test,dogs were randomly divided into two groups （n=10 each）,one group repaired on the two sides of the carotid arteries with 2-octyl-cyanoacrylate and homemade component and another group repaired with suture and ePTFE.Of the 40 specimens,10 were used for adhesive and 10 for suture specimens for tension strength test,whereas the remaining specimens were used for bursting pressure test.In animal experiments,dogs were also divided into adhesive and suture groups （n=10）,only of the left carotid artery.Recording the operational time,bleeding or not.Vessels were tested using color Doppler ultrasound,the inner diameter was measured,and the degree of stenosis at 8 weeks was evaluated digital subtraction angiography （DSA） were also performed.Specimens were then analyzed histologically.Results In the adhesive and suture groups,the specimens could afford atension strength of （23.80±1.51） N versus （24.60±1.08） N （P ＞0.05）,the bursting pressure was （52.03±.2.43） kPa versus （50.04±3.51） kPa （P ＞0.05）,and the mean time of anastomosis was （15.20±0.55） minutes versus （25.97±0.58） minutes （P ＜0.05）.One dog in the adhesive group was bleeding from the suture.One dog from each group presented with thrombosis at 1 week.After measuring using ultrasound,the stenosis degree of all dogs were no more than 30�
基金Supported by the National Natural Science Foundation of China (No30170242) and the National High-Tech Research and Developmen(863) Program (No. 2001AA320601) of China
文摘The features of electromyographic （EMG） signals were investigated while people walking on different terrains, including up and down slopes, up and down stairs, and during level walking at different speeds, The features were used to develop a terrain identification method. The technology can be used to develop an intelligent transfemoral prosthetic limb with terrain identification capability, The EMG signals from 8 hip muscles of 13 healthy persons were recorded as they walked on the different terrains. The signals from the sound side of a transfemoral amputee were also recorded. The features of these signals were obtained using data processing techniques with an identification process developed for the identification of the terrain type. The procedure was simplified by using only the signals from three muscles. The identification process worked well in an intelligent prosthetic knee in a laboratory setting.
文摘Background: Tuberculous endocarditis is a rare but serious complication of heart valve replacement surgery. We report the case of a 24-year-old patient, who presented with tuberculous endocarditis after mechanical mitral valve replacement, with a favorable clinical course following anti-tuberculosis treatment. Case Presentation: We report a 24-year-old male patient, admitted to the cardiac surgery department of the Fann Hospital (Dakar, Senegal), for the management of severe mixed (rheumatic and endocarditic) mitral insufficiency with associated tricuspid insufficiency. He had a history of recurrent angina and polyarthralgia in childhood, was hospitalized several times for refractory global cardiac decompensation, and for a suspected infective endocarditis a month before his admission. On admission, the clinical examination revealed signs suggestive of mitral and tricuspid insufficiency. Transthoracic echocardiography revealed severe post-endocarditic mitral insufficiency with A3 amputation, highly mobile 15 mm vegetations on the free edge of the large valve, moderate tricuspid insufficiency, and severe pulmonary artery hypertension. Mechanical mitral valve replacement and tricuspid valve annuloplasty using autologous pericardial strip were performed via median sternotomy. After ten days, the patient presented with global cardiac decompensation associated with a clinico-biological infectious syndrome, and tans-oesophageal echography revealed an abscess at the sinotubular junction, communicating with the aorta. A thoraco-abdomino-pelvic CT scan was done, which revealed a bilateral alveolar-interstitial syndrome with mediastinal lymphadenopathy. Anti-tuberculosis treatment with RHZE was initiated for 06 months. The clinical course was favorable. Conclusion: Tuberculous endocarditis in prostheses is a serious complication of heart valve replacement surgery, which may evolve favorably under medical treatment.
基金This work is supported by National Natural Science Foundation of China （Grant Nos. 51575187 and 91223201）, Science and Technology Program of Guangzhou （Grant No. 2014Y2-00217）, Science and Technology Major Project of Huangpu District of Guang-Zhou （Grant No, 20150000661）, the Fundamental Research Funds for the Central University （Grant No. 2015ZZ007） and Natural Science Foundation of Guangdong Province （Grant No. S2013030013355）.
文摘This paper presents an anthropomorphic prosthetic hand using flexure hinges, which is controlled by the surface electromyography （sEMG） signals from 2 electrodes only. The prosthetic hand has compact structure with 5 fingers and 4 Degree of Freedoms （DoFs） driven by 4 independent actuators. Helical springs are used as elastic joints and the joints of each finger are coupled by tendons. The myoelectric control system which can classify 8 prehensile hand gestures is built. Pattern recognition is employed where Mean Absolute Value （MAV）, Variance （VAR）, the fourth-order Autoregressive （AR） coefficient and Sample Entropy （SE） are chosen as the optimal feature set and Linear Discriminant Analysis （LDA） is utilized to reduce the dimension. A decision of hand gestures is generated by LDA classifier after the current projected feature set and the previous one are ＂pre-smoothed＂, and then the final decision is obtained when the current decision and previous decisions are ＂post-smoothed＂ from the decisions flow. The prosthetic hand can perform prehensile postures for activities of daily living and carry objects under the control of EMG signals.
基金the National Natural Science Foundation of China(No.50435040)the National High Technology Research and Development Program (863) of China (No.2008AA04Z203)
文摘A five-fingered,multi-sensory and biomimetic hand is presented.The cambered palm is specially designed by utilizing the knowledge of anatomy.The position of each finger is arranged according to human hand skeleton.Each finger with three phalanges could fulfill flexion-extension movement independently.All the fingers are designed using coupling link mechanism.The location of the thumb is designed by maximizing interaction area between the thumb and other fingers.The opposite thumb could grasp along a cone surface,while maintaining its function.The hardware architecture is divided into control system and human-machine interaction system.The mechanical parts,sensors and motion control systems are integrated in the hand structure.In addition,a skin-like glove is designed,which makes the hand more humanlike.According to our primary experimental results,the hand can accomplish several grasp modes by applying an intuitive surface electromyography control scheme.The success rate of 10 modes is up to 90%.
基金Supported by Beijing Natural Science Foundation(Grant No.L172021)National Natural Science Foundation of China(Grant No.51875033).
文摘To assist an amputee in regaining his or her daily quality of life,based on analysis of the motion characteristics of the human hip,a 2-UPR/URR parallel mechanism with a passive limb was designed.The inverse kinematics of this mechanism was analyzed based on a closed-loop vector method.The constrained Jacobian matrix and kinematic Jacobian matrix of each limb were then analyzed,and a 6×6 fully Jacobian matrix was constructed.Based on this,kinematic performances were analyzed and summarized.Finally,the dynamic model of the mechanism was constructed based on the virtual work principle,and its theoretical solution was compared with the numerical results,which were obtained in a simulation environment.Results showed that the prosthetic mechanism had a larger rotating workspace and better mechanical performance,which accorded a range of motion and bearing capacity similar to that of the human hip in multiple gait modes.Moreover,the validity of the dynamic model and inverse kinematics were verified by comparing the theoretical and simulation results.Furthermore,with flexion and extension,the torque change in the hip prosthetic mechanism was similar to that of the human hip,which demonstrated the feasibility of the hip prosthetic mechanism and its good dynamic performance.
文摘BACKGROUND Advances in implant material and design have allowed for improvements in total knee arthroplasty(TKA)outcomes.A cruciate retaining(CR)TKA provides the least constraint of TKA designs by preserving the native posterior cruciate ligament.Limited research exists that has examined clinical outcomes or patient reported outcome measures(PROMs)of a large cohort of patients undergoing a CR TKA utilizing a kinematically designed implant.It was hypothesized that the studied CR Knee System would demonstrate favorable outcomes and a clinically significant improvement in pain and functional scores.AIM To assess both short-term and mid-term clinical outcomes and PROMs of a novel CR TKA design.METHODS A retrospective,multi-surgeon study identified 255 knees undergoing a TKA utilizing a kinematically designed CR Knee System(JOURNEY™II CR;Smith and Nephew,Inc.,Memphis,TN)at an urban,academic medical institution between March 2015 and July 2021 with a minimum of two-years of clinical follow-up with an orthopedic surgeon.Patient demographics,surgical information,clinical outcomes,and PROMs data were collected via query of electronic medical records.The PROMs collected in the present study included the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement(KOOS JR)and Patient-Reported Outcomes Measurement Information System(PROMIS■)scores.The significance of improvements in mean PROM scores from preoperative scores to scores collected at six months and two-years postoperatively was analyzed using Independent Samples t-tests.RESULTS Of the 255 patients,65.5%were female,43.8%were White,and patients had an average age of 60.6 years.Primary osteoarthritis(96.9%)was the most common primary diagnosis.The mean surgical time was 105.3 minutes and mean length of stay was 2.1 d with most patients discharged home(92.5%).There were 18 emergency department(ED)visits within 90 d of surgery resulting in a 90 d ED visit rate of 7.1%,including a 2.4%orthopedic-related ED visit rate and a 4.7%non-orthopedic-related ED visit
文摘Objective:To explore the effect of observation of oral care in implant denture restoration of chronic periodontitis.Methods:80 patients with chronic periodontitis implant denture restoration admitted from March 2022 to March 2023 in the hospital were selected.They were randomly divided into an observation group and a control group,with 40 cases in each group.Both groups of patients received routine treatment and care.The patients in the control group used routine oral care methods to carry out oral care,the patients in the observation group carried out oral care on the basis of the control group,observation and analysis of the patients'mastery of oral knowledge,as well as the depth of the probing and the level of clinical attachment.Results:The oral knowledge mastery of the observation group was 72.31±6.98 after the nursing intervention,which was significantly higher than the score of 86.12±7.36 of the patients in the control group who used conventional oral care,and the difference was statistically significant at P<0.05;the depth of probing and the clinical attachment level of the observation group were 2.43±0.58 and 4.31±0.86 respectively,which were significantly better than those of the control group.The depth of probing and clinical attachment level scores of the observation group were 2.99±0.54 and 5.36±1.02 respectively,and P<0.05 was considered statistically significant.Conclusion:The combination of conventional treatment and oral care can effectively improve the treatment effect of implant denture prosthesis for chronic periodontitis.However,it is necessary to pay attention to the psychological counseling of the patients in the specific clinical application to ensure that the patients can actively cooperate with the clinical treatment.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
基金the financial support provided by the Key Research and Development Program of Zhejiang Province under Grant 2021C03050in part by the Scientific Research Project of Agriculture and Social Development of Hangzhou under Grant 2020ZDSJ0881+1 种基金in part by the National Natural Science Foundation of China under Grant 52275004in part by the State Key Program of National Natural Science Foundation of China under Grant 62333023.
文摘We previously developed a powered hip prosthetic mechanism with kinematic functions of hip flexion-extension and abduction-adduction,and its theoretical and simulation-based kinematics were verified.Because internal-external hip rotation has a positive effect on the movements of human lower limbs according to medical research,we developed a novel hip prosthetic mechanism based on a previous hip prosthesis that possesses motion characteristics similar to those of a human bionic hip,and the motion characteristics of multiple Degrees-of-Freedom(DoFs)were analyzed after kinematic modeling.Then,a walking model of the human‒machine model was established,and the walking stability of an amputee,which reflects the rehabilitation effect,was explored while the hip prosthetic mechanism considered the internal-external rotation of the hip.Finally,a prototype and its verification platform were built,and kinematic validation of the hip prosthetic mechanism was carried out.The results showed that the designed Parallel Mechanism(PM)possesses human-like motion characteristics similar to those of a human bionic hip and can be used as a hip prosthesis.Moreover,the existing motion characteristic of internal-external hip rotation can enhance the walking stability of an amputee via this hip prosthetic mechanism.
基金CAMS Innovation Fund for Medical Sciences(no.2022-I2M-1-023)Natural Science Fund for Distinguished Young Scholars of Tianjin(no.22JCJQJC00110)+3 种基金Natural Science Foundation of China(no.32071356,no.82272158,no.82100518)Science&Technology Projects of Tianjin of China(22JCYBJC00050,21JCQNJC01530)Fundamental Research Funds for the Central Universities(no.3332022069)Science&Technology Projects of Hubei Province(2023EHA057).
文摘With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.
文摘Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET
文摘Prosthetic valve obstruction(PVO) is a rare but feared complication of mechanical valve replacement. Diagno-stic evaluation should focus on differentiating prosthetic valve thrombosis(PVT) from pannus formation,as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient's symptoms,valve location,degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively,pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology,epidemiology,diagnostic approach and treatment options for aortic and mitral valve PVO.
文摘Dear editor,Fungal endocarditis is a rare disease with a poor prognosis,suboptimal diagnostic tools responsible for long diagnostic delays in most cases,and poorly defined activity of most antifungal agents in endocarditis.^([1])The burden of diagnosis still lies with clinicians:they need a
