This paper reports the nursing experience of 5 cases of Charcot's arthropathy undergoing rotating hinge prosthesis knee replacement. The nursing care focused on psychological nursing, preoperative examinations, control of blood glucose and treatment of syphilis during preoperative period, as well as wound care, management of drainage tube, prevention of complications and early functional exercise during the postoperative period. All cases were followed up through 6 to 60 months. The short-term outcomes were satisfying. One patient suffered from periprosthetic femoral fracture at 23-month after the operation, and healed up eventually after open reduction and internal fixation.

Objective:To evaluate the role of the AMP-activated protein kinase (AMPK)-silent information regulator 1 (SIRT1)-nuclear factor-κB (NF-κB) signaling pathway in reduction of brain injury by panax notoginseng saponins (PNS) in mechanically ventilated rats.Methods:Seventy-two SPF-grade male Sprague-Dawley rats, aged 10 weeks, weighing 357-377 g, were divided into 6 groups ( n=12 each) by a random number table method: sham operation group, model group, PNS low dose group, PNS medium dose group, PNS high dose group, and PNS high dose+ compound C group. PNS 12.5, 25 and 50 mg/kg were intraperitoneally injected in PNS low dose group, PNS medium dose group and PNS high dose group, respectively. In PNS high dose+ compound C group, PNS 50 mg/kg was intraperitoneally injected, and 10 min later compound C 0.2 mg/kg was injected via the tail vein. Normal saline 10 ml/kg was intraperitoneally injected in sham operation group and model group. Drugs or normal saline was injected at 30 min before mechanical ventilation in each group. Mechanical ventilation model: The animals were mechanically ventilated for 6 h, with ventilation frequency 40 times/min, tidal volume 40 ml/kg in model group; The animals were mechanically ventilated for 6 h, with tidal volume 10 ml/kg in sham operation group. Morris water maze test was used to detect the learning and memory function of rats, the concentrations of serum interleukin-1beta (IL-1β), IL-6, tumor necrosis factor-alpha (TNF-α) and dopamine (DA) were detected by enzyme-linked immunosorbent assay, the neuronal counts in the hippocampal CA1 region were determined by Nissl staining, and the expression of P2Y1 purine receptor (P2Y1R), dysbindin-1 and AMPK in hippocampal CA1 region was detected by Western blot. The phosphorylated SIRT1 (p-SIRT1) to SIRT1 ratio and phosphorylated NF-κB p65 (p-NF-κB p65) to NF-κB ratio in hippocampal CA1 region was calculated. Results:Compared with sham operation group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, the time of staying at the target platform quadrant was shortened, the serum concentrations of IL-1β, IL-6 and TNF-α were increased, the serum DA concentration was decreased, the nerve count in hippocampal CA1 region was decreased, the expression of P2Y1R and dysbindin-1 was up-regulated, the expression of AMPK was down-regulated, the p-SIRT1/SIRT1 ratio was decreased, and the p-NF-κB p65/NF-κB p65 ratio was increased in model group ( P<0.05). Compared with model group, the escape latency was significantly shortened, the number of crossing the original platform quadrant was increased, the time of staying at the target platform quadrant was prolonged, the serum concentrations of IL-1β, IL-6 and TNF-α were decreased, the serum DA concentration was increased, the nerve count in hippocampal CA1 region was increased, the expression of P2Y1R and dysbindin-1 was down-regulated, the expression of AMPK was up-regulated, the p-SIRT1/SIRT1 ratio was increased, and the p-NF-κB p65/NF-κB p65 ratio was decreased in PNS low dose group, PNS medium dose group and PNS high dose group ( P<0.05). Compared with PNS high dose group, the escape latency was significantly prolonged, the number of crossing the original platform quadrant was reduced, the time of staying at the target platform quadrant was shortened, the serum concentrations of IL-1β, IL-6 and TNF-α were increased, the serum DA concentration was decreased, the nerve count in hippocampal CA1 region was decreased, the expression of P2Y1R and dysbindin-1 was up-regulated, the expression of AMPK was down-regulated, the p-SIRT1/SIRT1 ratio was decreased, and the p-NF-κB p65/NF-κB p65 ratio was increased in PNS high dose+ compound C group ( P<0.05). Conclusions:The mechanism by which PNS reduces brain injury may be related to activation of the AMPK-SIRT1-NF-κB signaling pathway in mechanically ventilated rats.

Objective:To establish a HPLC method for the simultaneous determination of adenosine,genistein and 5-hydroxymel-lein in Xylarin nigripes powder.Methods:The chromatographic separation was carried out on a Pntulips@BP-C18column (250 mm× 4.6 mm,5 μm) at 35℃. The mobile phase consisted of acetonitrile-0.1% formic acid with gradient elution at a flow rate of 1.0 ml ·min-1,and the detection wavelength was 254 nm. Results:The linear range of adenosine was 0.162-1.62 μg(r=0.999 2). The average recovery was 98.12% and the RSD was 1.32% (n=6). The linear range of genistein was 0.02-0.2 μg(r=0.999 9). The average recovery was 98.89% and the RSD was 1.10% (n =6). The linear range of 5-hydroxymellein was 0.022-0.22 μg(r =0.999 9). The average recovery was 99.87% and the RSD was 0.98% (n=6). Conclusion:The method can be used to determine the contents of adenosine,genistein and 5-hydroxymellein,which provides the basis for the quality control and the further research of Xylaria nigripes.

Objective:To investigate the safety, economic effect, and short-term clinical efficacy of ambulatory total hip arthroplasty (THA) in the treatment of hip osteopathy within.Methods:This study retrospectively reviewed patients who underwent 48-hour outpatient THA and conventional primary THA from July 2020 to July 2021. Gender, age, body mass index (BMI), clinical diagnosis, place of resident, length of hospital stay, duration of the surgery, hemoglobin, albumin, C-reactive protein (CRP) and D-dimer before and 1 day after surgery, the visual analogue scale (VAS) was obtained postoperative day 2, hip joint modified Harris score before and 1 month after surgery, readmission and reoperation within 1 month after operation as the data of evaluations were extracted and compared in this study.Results:A totally of 150 cases were involved in this study, which including 75 cases with 48-hour outpatient primary THA and 75 cases with conventional primary THA. There was no significant difference between the two groups in terms of age, sex, BMI, education level, preoperative diagnosis, and preoperative Harris score ( P>0.05), but a significant difference was found in term of residence (χ 2=6.29, P=0.043), that the patients in the outpatient group were all from Zhejiang Province and 48% (36/75) of them were from Hangzhou City. While, in the conventional group, 6 patients were from other provinces. The length of stay was 2.13±0.52 days and operation time was 59.73±18.91 minutes in the outpatient group, which were both shorter than those (6.71±1.44 days and 66.91±22.40 min) in the conventional group ( t=25.91, P<0.001 for the length of hospital stay; t=2.12, P=0.036 for operation time). Compared with the conventional group, outpatient group saved the average hospital cost (4.60±0.44 vs. 5.20±0.72 ten thousand yuan, t=6.16, P<0.001). The VAS on the second day after surgery 3.45±0.75 was higher in the outpatient group than in the conventional group (3.45±0.75 vs. 3.16±0.94 points, t=2.09, P=0.039). The modified Harris score was without statistical significance ( t=0.42, P=0.677) 1 month after surgery in both groups. 75 patients in the outpatient group, 7 patients delayed discharge (were not discharge within 48 hours), and the rate of delayed discharge was 9.3%. Reasons for delayed discharge included poor pain control in two cases, one case had postoperative nausea and vomiting, one case had failed to meet rehabilitation standards, hypotension in one case, the intraoperative infection in one case and postoperative fever within 48 hours in one case. Conclusion:Outpatient THA can reduce the length of hospital stay, operative time and total cost of hospitalization. It has similar safety and early clinical efficacy as conventional THA. However, a small proportion of patients would delay discharge.

Objective:To improve the quality standard for Jinhuanglian oral liquid. Methods:The three herbs in the preparation, Honeysuckle, Scutellaria Baicalensis Georgir and St John's Wort, were identified by TLC qualitatively. The content of chlorogenic acid in Lonicerae Japonicae Flos was determined by HPLC. The chromatographic separation was carried out on a Promosil C18 (250 mm × 4. 6 mm,5 μm) column at 25℃. The mobile phase consisted of acetonitrile-0. 4% phosphoric acid (10 :90) with gradient elution at a flow rate of 1. 0 ml·min -1 , and the injection volume was 10μl. The detection wavelength was 327 nm. Results:The spots in TLC were clear without any interference. The linear range of chlorogenic acid was 5.325-170.400 μg·ml-1(r=0.9998). The average recovery was 97. 95% and the RSD was 2. 04%(n=6). Conclusion:The method is reliable and easy to operate,which can be used as the quality control method for Jinhuanglian oral liquid.

Objective:To improve the quality standard for Jinhuanglian oral liquid. Methods:The three herbs in the preparation, Honeysuckle, Scutellaria Baicalensis Georgir and St John's Wort, were identified by TLC qualitatively. The content of chlorogenic acid in Lonicerae Japonicae Flos was determined by HPLC. The chromatographic separation was carried out on a Promosil C18 (250 mm × 4. 6 mm,5 μm) column at 25℃. The mobile phase consisted of acetonitrile-0. 4% phosphoric acid (10 :90) with gradient elution at a flow rate of 1. 0 ml·min -1 , and the injection volume was 10μl. The detection wavelength was 327 nm. Results:The spots in TLC were clear without any interference. The linear range of chlorogenic acid was 5.325-170.400 μg·ml-1(r=0.9998). The average recovery was 97. 95% and the RSD was 2. 04%(n=6). Conclusion:The method is reliable and easy to operate,which can be used as the quality control method for Jinhuanglian oral liquid.