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Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH.Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient.Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed.Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.

Traditionally, the practice of the tibial component placement in total knee arthroplasty has focused on achieving maximum coverage without malrotation. However, the concept of maximizing coverage has not been well defined or researched and yet biased results are often produced. This study aimed to evaluate the effect of a prioritizing maximum coverage positioning strategy on the rotational alignment by using a strict computer algorithm. Computed tomographic scans of 103 tibial specimens were used to reconstruct three-dimensional tibia models. A virtual surgery was performed to generate the resection plane with a posterior slope of 7° on the proximal tibia. Symmetrical and anatomical tibial components were placed and analyzed with an automated program designed for approximating the maximum coverage based on the coherent point drift algorithm. We found that the average tibial coverage achieved across all specimens and implants was 85.62 ± 3.65%, ranging from 83.64 ± 4.10% to 86.69 ± 3.07%. When placed for maximal tibial coverage, the mean degree of rotation related to the Insall line was − 0.73° ± 4.53° for all subjects, 23% of the tibial components were malrotated. The average percentage position of the baseplate anteroposterior axis over the patellar tendon was 26.95 ± 14.71% from the medial edge. These results suggest that with specific design and proper placement of the component, approximating the maximum tibial coverage in total knee arthroplasty does not necessarily result in implant malrotation. The current tibial baseplates have shown good performance on the coverage when aligned parallel to the Insall line with the anteroposterior axis positioned between the medial 1/3 and medial 1/6 of the patella tendon.

Background Leptomeningeal metastasis (LM) is associated with poor prognosis in non‐small cell lung cancer (NSCLC). The aim of this study was to investigate the efficacy and safety of osimertinib combined with bevacizumab for LM from epidermal growth factor receptor mutation (EGFRm) NSCLC. Methods We conducted a phase II single‐arm prospective clinical trial of EGFRm NSCLC with LM treated with osimertinib combined with bevacizumab. LM response assessment was based on the modified RANO LM radiological criteria; CNS and extra‐CNS response was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. The primary end points included LM progression‐free survival (PFS) and objective response rate (ORR); the secondary end points included safety and LM overall survival (OS). Results A total of 14 patients were included in the study, with a median age of 61 years, and they were predominantly female (64%). EGFR mutations were reported in exons 19 del (n = 7) and 21 L858R (n = 7). When LM was diagnosed, 12 (85.7%) patients had clinical symptoms, 71.4% (10/14) of patients were diagnosed with LM by cytology, and five (35.7%) patients had a performance status (PS) score > 2. The median LM PFS was 9.3 months (95% CI: 8.2–10.4), and the LM ORR was 50%. The safety findings in the present study were consistent with the known profile of osimertinib with bevacizumab; the median LM OS was 12.6 months, and the one‐year survival rate was 35.7%. Conclusions Osimertinib combined with bevacizumab is an appropriate treatment option for patients with LM from EGFRm NSCLC. Key points Significant findings of the study To date, there is no prospective clinical study on the treatment of osimertinib combined with bevacizumab in EGFRm NSCLC with LM. What this study adds The median LM PFS was 9.3 months (95% CI: 8.2–10.4), and the LM ORR was 50%, the median LM OS was 12.6 months, and the one‐year survival rate was 35.7%. Osimertinib combined with bevacizumab is an appropriate treatment option for patients with LM from EGFRm NSCLC., we evaluated the first phase II prospective clinical trial to assess the efficacy and safety of osimertinib combined with bevacizumab for LM from EGFRm NSCLC. Osimertinib combined with bevacizumab is an appropriate treatment option for patients with LM from EGFRm NSCLC.

BackgroundWhen reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site.MethodsWe retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R.ResultsN varied from 9.8–15.2 mm and M varied from 20.7–24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5–2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level.ConclusionsOur findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally.Trial registrationRetrospectively registered.

Background When reconstructing a hip with developmental dysplasia with high dislocation, sub-trochanteric shortening osteotomy is always needed for placing the acetabular component in the anatomical position. However, the procedure can result in some complications, such as the non-union of the osteotomy. We evaluated the contact area and coincidence rate between the proximal and distal fragments at different levels and lengths of femoral osteotomy and determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union of the osteotomy site. Methods We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the area overlapped between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R. Results N varied from 9.8 to 15.2 and M varied from 20.7 to 24 mm, with both demonstrating a gradually decreasing trend in the proximal to distal direction. At the lengths of osteotomy ranging of 0.5–2 cm, there were no differences in S between the different levels of osteotomy in each group. At lengths of osteotomy ≤ 2.5 cm, a significant higher coincidence rate was noted from the level of 2 cm below the lesser trochanter to other positions below the level. At lengths of osteotomy of 3–5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. Conclusions Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. In consideration of the stability of the prostheses, it appears appropriate that the location of osteotomy should be slightly shifted distally.

Background Early screening and diagnosis of radiation-induced heart disease are difficult in patients with chest radiation exposure. sST2 involved in myocardial stress or injury. We aimed to evaluate short-term sST2, B-type natriuretic peptide (BNP) and the left ventricle ejection fraction (LVEF) changes and the relationship between sST2 and heart dose in patients who receive chest radiation. Methods We prospectively collected thoracic malignancy cancer patients from October 2016 to August 2018 who received chest radiotherapy. sST2 and BNP was measured before (recorded as preST2, preBNP), in the middle (recorded as midST2, midBNP) and after radiotherapy (recorded as postST2, postBNP). LVEF was detected using echocardiography before and after radiotherapy. BNP and sST2 among pre, mid, post groups were compared using nonparametric test. LVEF was compared using pair t-test. Standardized sST2 was calculated as postsST2/presST2. The correlation of standardized sST2 and heart dosimetry parameters were measured by Spearman’s correlation test. Results Sixty patients were enrolled, including 37(61.67%) lung cancer, 18(30.00%) esophageal cancer and 5 (8.33%) thymoma patients. The median preST2, midST2, postST2 was 3.86 (IQR1.56-8.37), 6.33 (IQR 2.01-9.32) and 8.00 (IQR 4.2- 10.9) respectively. sST2 elevated with the progression of thoracic irradiation (p

To retrospectively analyze the functional outcomes and complications in patients who underwent hip arthroplasty with enhanced recovery after surgery (ERAS) program for femoral neck fractures. Between June 2015 and May 2019, 1138 patients with femoral neck fractures were treated in our department. According to the Garden classification system, 467 cases were type III and 671 cases were type IV with an average age of 74.9 ± 8.8 years (range, 59–96 years). All patients underwent hip arthroplasty with ERAS. The clinical outcomes of these patients were retrospectively analyzed at the final follow-up using the Harris hip score (HHS). The median follow-up was 21.2 months (range, 6–36 months). The mean time to surgery and the length of hospitalization after surgery were 2.4 and 2.2 days, respectively. Eight hundred and fifty-two patients (74.9%) were operated within 48 hours from admission, 1052 cases (92.4%) were discharged within 48 hours after surgery. Twelve patients (1.05%) were readmitted for prosthetic dislocation. None of the patients suffered from infection, periprosthetic fractures, and/or prosthetic loosening. The HHS at the final follow-up was 92.7 ± 7.6, with an excellent or good rate of 90.2%. Patient-oriented ERAS optimizes the interventional measures during the perioperative period for geriatric patients with femoral neck fractures and can improve their short-term clinical outcomes without increased readmission rates.

To evaluate short-term clinical results of fixed-bearing unicompartmental knee arthroplasty (UKA) for patients with medial compartmental knee osteoarthritis.From January 2015 to December 2017, 62 patients with medial compartmental knee osteoarthritis were treated by fixed-bearing UKA. Among them, including 19 males and 43 females, aged from 47 to 83 years old with an average of (65.3±8.2) years old. The courses of disease ranged from 5 to 72 months with an average of(19.4±14.3) months. Postoperative complications were observed, VAS score was used to observe degree of pain relief, Hospital for Special Surgery(HSS) score was used to evaluate clinical effects.All patients were followed up from 4 to 40 months with an average of(19.9 ±10.2) months. The incision healed well without blood transfusion, hospital stays ranged from 2 to 10 days with an average of (3.5±1.6) days. No deep infection, dislocation, loosing or per prosthetic fracture occurred after operation, while 1 patient suffered from posterior tibial vein thrombosis. HSS score improved from 69.9±7.2 before operation to 90.1±7.4 at final following-up, and 51 patients obtained excellent results, 9 patients good and 2 moderate. VAS score decreased from 3.8±0.9 before operation to 1.1±0.9 at final following-up.Fixed-bearing UKA for medial compartmental knee osteoarthritis could obtain short-term clinical results for shorter hospital stay, less complications. with fewer complication and fast recovery.

To analyze and evaluate the clinical outcomes of enhanced recovery after surgery(ERAS) for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.From January 2015 to December 2016, 466 patients with femoral neck fractures were admitted in our department. Among them, 154 patients were more than 80 years old, with an average age of (83.9±3.2) years old (ranged, 80 to 96 years old), including 27 males and 127 females. According to Garden classification system, 68 cases were type III and others were type IV. ERAS for hemiarthroplasty were performed for all the patients. The time before operation, blood transfusion rate, complications rate, lenth of stay and Harris score system were evaluated.Among 154 patients, 142 patients were followed up, with an average duration of 24.6 months(ranged, 14 to 38 months). Thirty-two patients (20.8%) completed the operation within 48 hours after admission, 67 patients(43.5%) completed the operation within 72 hours after admission, 76 patients(49.4%) discharged within 48 hours after operation, and the blood transfusion rate was 15.9%. One patient was re-hospitalized because of prosthetic dislocation. The re-hospitalization rate was 0.6%. No other patients were re-hospitalized because of superficial or deep infection or periprosthetic fracture. At the latest follow-up, the Harris hip score was 90.2±7.1, 106 patients got an excellent result, 23 good and 9 fair.ERAS for hemiarthroplasty can effectively shorten hospitalization time, relieve pain, reduce blood transfusion rate, reduce postoperative complications, and do not increase the readmission rate of elderly patients with femoral neck fracture, which can achieve good clinical efficacy.

The transmission antennas in cooperative systems are spatially distributed on multiple nodes, so the received signal can be asynchronous due to the propagation delays. In this paper, we propose a novel feedback mechanism for cooperative relay networks to improve the performance by increasing the forwarding delay. In contrast to a previous work by the authors, where the performance is poor for small delay, the proposed feedback scheme in amore attractive scenario where the destination can deal with any delay with the better performance. Simulation results illustrate the performance of the proposed scheme in comparison with forward and backward interference cancellation (FBIC) scheme without feedback. Finally, we demonstrate that the greater the delay, the more obvious advantages of the algorithm complexity than bounded delay tolerant Alamouti codes (BDT-AC).

The purpose of this study was to compare the biomechanical strength of four different fixation methods for a posteromedial tibial plateau split fracture. Twenty-eight tibial plateau fractures were simulated using right-sided synthetic tibiae models. Each fracture model was randomly instrumented with one of the four following constructs, anteroposterior lag-screws, an anteromedial limited contact dynamic compression plate (LC-DCP), a lateral locking plate, or a posterior T-shaped buttress plate. Vertical subsidence of the posteromedial fragment was measured from 500 N to 1500 N during biomechanical testing, the maximum load to failure was also determined. It was found that the posterior T-shaped buttress plate allowed the least subsidence of the posteromedial fragment and produced the highest mean failure load than each of the other three constructs (P=0.00). There was no statistical significant difference between using lag screws or an anteromedial LC-DCP construct for the vertical subsidence at a 1500 N load and the load to failure (P>0.05). This study showed that a posterior-based buttress technique is biomechanically the most stable in-vitro fixation method for posteromedial split tibial plateau fractures, with AP screws and anteromedial-based LC-DCP are not as stable for this type of fracture.

To evaluate the early clinical results of two stage hip replacement after failed internal fixation for femoral neck fractures in young patients.From June 2008 to June 2010,24 patients with femoral head necrosis caused by failed internal fixation were treated with hip arthroplasty. Among them, 12 patients were male and 12 patients were female, with an average age of 42.9 years old (ranged, 18 to 58). According to Harris score and X-ray examination, the clinical result was evaluated.Twenty-three cases were followed up with an average age of 34.4 months (ranged, 25 to 48). After operation, 1 case complicated with the dislocation of hip joint. No deep infection of hip joint, prosthetic loosing or peripheral fracture was found. The mean Harris score was 90.9 +/- 4.3, and 18 obtained excellent results, 4 good and 1 fair.Although treatment of femoral head necrosis with two stage hip replacement after failed internal fixation is difficult during operation, its early result is satisfactory.

Results obtained in a joint Japanese-Chinese field study in Hainan Island are presented. Three national minority groups, Li, Miao and Hui, together with Han as control were studied. A total of 23 blood genetic markers comprising 9 blood groups, 7 red cell enzymes and 7 serum proteins, and also alpha and beta thalassemias were examined, and phenotype and allele frequencies are tabulated. The distributions of allele frequencies differ markedly among the four groups, although falling in general within that of southern Chinese. Two sample groups of Li, i.e., Qi-Li and Benti-Li, are more similar to each other than the two sample groups of Miao, probably reflecting different backgrounds in migratory history of Li and Miao. Judging from high frequencies of both alpha and beta thalassemias and G-6PD deficiency in Li and Miao, it was considered that malaria played a major role in determining these characteristics.

The posterolateral shearing tibial plateau fracture is uncommon in the literature, however with the increased usage of computer tomography (CT), the incidence of these fractures is no longer as low as previously thought. Few studies have concentrated on this fracture, least of all using a biomechanical model. The purpose of this study was to compare and analyse the biomechanical characteristics of four different types of internal fixation to stabilise the posterolateral shearing tibial plateau fracture. Forty synthetic tibiae (Synbone, right) simulated the posterolateral shearing fracture models and these were randomly assigned into four groups; Group A was fixed with two anterolateral lag screws, Group B with an anteromedial Limited Contact Dynamic Compression Plate (LC-DCP), Group C with a lateral locking plate, and Group D with a posterolateral buttress plate. Vertical displacement of the posterolateral fragment was measured using three different strengths of axial loading force, and finally loaded until fixation failure. It was concluded that the posterolateral buttress plate is biomechanically the strongest fixation method for the posterolateral shearing tibial plateau fracture.

In order to efficiently determine ancestor-descendant relationships between any two random XML nodes and the document-order between the nodes and to avoid re-labeling for updates, much research about labeling schemes has been conducted. In this paper we present a new efficient XML encoding and labeling scheme for dynamic XML document called CFE (Continued Fraction-based Encoding) which labels nodes with continued fractions. CFE has three important properties which form the foundations of this paper: (1) CFE supports that codes can be inserted between any two consecutive CFE codes with the orders kept and without re-encoding the existing nodes; (2) CFE is orthogonal to specific labeling schemes, thus it can be applied broadly to different labeling schemes or other applications to efficiently process the updates; (3) Moreover, CFE supports all structural relationships query in XPath. The experimental results show that CFE provides fairly reasonable XML query processing performance while completely avoiding re-labeling for updates.

Genetic polymorphisms of the complement components C6 and C7 in two Chinese populations (Beijing and Guangzhou) were investigated, using isoelectric focusing and immunoblotting technique. Three common and four rare allotypes of C6 were observed, and one of the rare allotypes was considered to be a new variant. Ten different patterns of C7 observed were classified into three homozygous and seven heterozygous phenotypes, indicating occurrence of four common and a new variant alleles. The new variants of C6 and C7 detected were designated as C6 B21 and C7 6, respectively. There was no statistically significant difference for C6 and C7 allele frequencies between the Beijing and the Guangzhou populations except forC7*4. TheC7*4 frequency was shown to be significantly higher in Beijing than in Guangzhou. No significant positive association between C6 and C7 alleles was found.

The genetic polymorphism of serum group-specific component (Gc) was studied in two Chinese (Han) populations using isoelectric focusing followed by immunofixation. Six common and seven rare variant phenotypes were observed among 155 samples from Beijing and 256 samples from Guangzhou. The frequencies for the common alleles,Gc*1F,Gc*1S, andGc* 2, were 0.4774, 0.2000, and 0.3065, respectively, for Beijing, and 0.4316, 0.2891, and 0.2734, respectively, for Guangzhou. Only the frequency ofGc*1S showed a statistically significant difference between the two localities. The rare Gc variants observed were: Gc 1A3, Gc 1A8, Gc 1C18 and Gc 2A4. Furthermore, two new rare Gc variants were detected and named Gc 1C50 and Gc 2A19.