OBJECTIVE To analyze the reason of wound infection after total joint replacement and to present the prophylactic management measures.METHODS Totally 632 total joint replacements in 587 patients between Jul 2002 and Jun 2005 were retrospectively reviewed.There were 445 cases with total hip replacements and 187 cases with total knee replacements.The specimens for bacterial culture were taken from the hands of the surgical staffs,the medical devices and the air flow in the operation theater monthly.RESULTS In this series,5 cases developed wound infections,with 2 cases of total hip replacement and 3 cases of total knee replacement,where 4 cases with deep infections and one case with superficial infection.The total infection rate was 0.79%(5/632).In the 5(infection) cases,there were 2 cases having the same bacterial culture as the air culture.CONCLUSIONS(Improvement) of the management in the operation theater,check of the laminar air flow device regularly,sufficient drainage and prevention of other medical iatrogenic infections are crucial for prevention of the infection after total joint replacement.

Proton pump inhibitors in clinical use is increasingly common and the drug-induced disease caused by them has an upward trend.Through the retrospective analysis of the retrieved literature,this article provides a reference for the rational use of proton pump inhibitors and reduces the occurrence of related drug-induced diseases.

Objective:To investigate the correlationship between levels of erythrocyte receptor type1(E-CR1) and disease activity and abnormal criteria of immunology in systemic lupus erythematosus (SLE)and to study the E-CR1 levels in pathogenesis of SLE.Methods:The fluorescence intensity in sera from 72 patients with SLE and 20 cases of normal controls was detected by flucytometry.Complement(C3,C4),immunoglobulins(IgG,IgA and IgM),gammaglobulins(?-G),erythrocyte sediment rate(ESR) and blood cell counts,including white blood cell(WBC),red blood cell(RBC),hemoglobin(HGB),hematocrit(HCT),mean corpuscular volume(MCV)and platelet(PLT) were detected at the same time.The scoring instruments of systemic lupus activity measure (SLAM) were used to evaluate disease activity.Results:The E-CR1 levels in patients with SLE were lower significantly than that in normal controls (P

Objective To investigate the effect of traditional Chinese medicine on the renal function and quality of life in patients with early diabetic nephropathy (DN).Methods 78 diagnosed as DN and TCM syndrome type belonged to cases of yin deficiency of liver and kidney were included in the study,they were randomly divided into the control group(40 cases)and observation group (38 cases).The two groups underwent conventional treatment of western medicine,the observation group received traditional Chinese medicine.The 24h urine protein counts,blood glucose (FBG,2hPG),lipid column (TC,TG,LDL -C,HDL -C),UAER,ACR,SCR,bun and quality of life of SF-36,adverse reaction were observed.Results The blood glucose,blood pressure,UAER,ACR,SCR,BUN,SF -36 score,urinary protein count of the two groups were improved than before treatment.6 months after treatment,the 24h urine protein of observation group was (1.02 ±0.42)g,which was significantly lower than the control group,the difference was statistically significant (t =2.702,P <0.05).After treatment,UAER,ACR,SCr,BUN of the observation group were (82.09 ±10.74)mg/24h,(84.92 ±9.33)mg/g,(108.43 ±38.35)mmol/L,(6.17 ±2.65)mmol/L, which were better than the control group,the differences were statistically significant (t =8.960,P <0.01;t =15.528,P <0.01;t =11.987,P <0.01;t =10.566,P <0.01).No adverse reaction was observed.Conclusion The combination of Chinese and western medicine in the treatment of early DN has good efficacy and better than the use of western medicine alone,it can improve renal function and is safe and reliable.

Objective To establish the rat model of experimental subarachnoid hemorrhage (SAH) and to detect the expression of ADAMTS-4 in early brain injury(EBI) after SAH in rats .Methods Totally 72 adult male SD rats were randomly divided into 2 groups ,the control group and SAH group .The expression of ADAMTS-4 and the content of brain Evans Blue(EB) were detected . The ADAMTS-4 inhibitor α2-macroglobulin was used to study the relationship between the expression of ADAMTS-4 and blood-brain barrier permeability .Results The expression of the mRNA and protein of ADAMTS-4 increased dramatically at 24 h and the contents of EB increased progressively at 12 h after SAH .The protein expression of ADAMTS-4 and the content of brain EB was positive correlated(r=0 .917 ,P<0 .05) .The expression of ADAMTS-4 was inhibited by α2-macroglobulin(P<0 .05) and the con-tents of EB decreased dramatically (P<0 .05) .Conclusion ADAMTS-4 may be involved in the pathological progression of early brain injury after SAH .

Objective:To investigate the inductive function of tumor necrosis factor(TNF)-? to dentritic cell(DC) and its effect on erythroid hematopoiesis.Methods:Human CD34~+ cells was separated and purified by MACS method.With the existence of stem cell factor(SCF),interleukin-3(IL-3) and erythropoietin(EPO),CD34~+ cells were cultured together with TNF-? through external fluid.The expanding times of cells and their superficial markings were analysed by flow cytometry.Meanwhile,the morphological transformation of expanding cells was observed by microscope.Results:TNF-? could inhibit the development of glycophorin A(GPA;a specific erythroid marker) positive cells,while stimulates the growth of those GPA negative of non-erythroid cells.These cells usually possess the morphological characteristic of DCs and express phenotypical markers of DCs accordingly.Those erythroid progenitor cells which contact directly with DCs appear to have the change of cellular apoptosis.Conclusion:The inhibition of TNF-? to erythroid hematopoiesis is probably related to the induction of DCs proliferation.The possible reason for cellular apoptosis of erythoid progenitor cells may be their direct contact with DCs.

Objective To assess the efficacy and safety of leflunomide in active ankylosing spondylitis.Methods Totally 62 cases of active ankylosing spondylitis were included,and divided randomly into leflunomide group(n=26)and methotrexate group(n=36).The patients in leflunomide group received an oral leflunomide loading dose of 50 mg or 40 mg once daily for the first 3 days followed by a maintenance dose of 50 mg or 40 mg once weekly,according to whether the bodyweight was more than 50 kg or less than 50 kg,respectively.The patients in methotrexate group were prescribed oral methotrexate 5 mg once in the first week,10 mg once in the second week,15 mg once in the third week and thereafter weekly.Sulfasalazine was prescribed 0.75 three times daily in both groups.The Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)and The Bath Ankylosing Spondylitis Metrology Index(BASIM)scoring instruments were used to assess the responsiveness to leflunomide and methotrexate at entry,three months,six months,twelve months and eighteen months after treatment,respectively.Laboratory data including peripheral blood counts(WBC,HGB,RBC),erythrocyte sedimentation rates(ESR),liver enzymes,serum creatinine,urinary sediments were detected at the same time.Sacroiliac joints CT scan and other involved joints x-ray radiograph examinations were taken at entry,six months,twelve months and eighteen months after treatment,respectively.Results Twenty-two cases in leflunomide group and 29 cases in methotrexate group were followed up to eighteen months.BASDAI in leflunomide group was significantly lower(P

Objective To study the immunological changes and clinical features of pachydermodactyly.Methods Thirteen cases of pachydermodactyly were studied and the literature about this disease was reviewed.Results The mean disease onset age was (16?3)years,11 of whom were male,2 were female;clinical feature was chronic non-inflammatory bulbous swelling of proximal interphalangeal joints,most of which distributed symmetrically;there were no abnormal results in immunological examination;X-ray showed only soft tissue swelling with no articular or bone damage.Conclusion Pachydermodactyly belongs to rheumatological diseases,and should be differentiated from other arthritis involving PIP joints.

Objective To compare and analyze the clinical effects of different local anesthetics on continuous epidural anesthesia for percutaneous enucleation of nucleus pulposus. Methods A total of 40 patients underwent lumbar intervertebral discoscopy (PTED) from November 2015 to November 2016, according to the choice of anesthesia is divided into group A and group B, 20 cases in each group. Group A used 0.5％lidocaine local anesthesia, group B treated with continuous epidural anesthesia (1 ％ lidocaine 3 mL+0.5％ ropivacaine).Analysis of two groups before operation, the curative effect, VAS score, modified Bromage score, intraoperative pain perception includes four criteria, namely, mild, moderate and severe, the former two satisfactory anesthetic effect; the latter two are not satisfied with the anesthesia. Results Two cases without postoperative cerebrospinal fluid leakage occurred, nerve root injury and other complications; two groups of patients with pain satisfaction difference was statistically significant (P<0.05); compared with group A, the levels of HR and MAP in group B were more stable (P<0.05). Conclusion Continuous epidural anesthesia is more suitable for PTED than local anesthesia. It can reduce the pain and the occurrence of cardiovascular and cerebrovascular accidents in patients, and does not affect the patients' lower limb movement score.

Objective To evaluate the relationship between von Hippel-Lindau (VHL) gene mutations and the prognosis of Chinese sporadic clear cell renal cell carcinoma (CCRCC). Methods VHL gene mutations were detected by polymerase chain reaction (PCR), direct DNA sequencing in 74 paired specimens of sporadic CCRCC and normal kidney. The mutation findings, pathologic fea-tures and prognostic characteristics were analyzed. Results Fifty-one patients (68.9%) were in clinical stage T1, 9 patients (12.2%) were in T2 and 14 patients (18.9%) were in T3. In the aspect of pathological grade, 15 patients (20.3%) were in G1, 50 patients (67.6%) were in G2 and 9 pa-tients (12.2%) were in G3. VHL gene mutations were detected in 40 of 74 cases (54.1%). There were no significant differences of VHL gene mutations in different pathological grade and clinical stage of CCRCC, P=0.915, P=0.237, respectively. All patients were followed up for 34 to 107 months (mean 71 months). Seven patients died of CCRCC. Another 11 patients developed CCRCC related me-tastasis. Five-year tumor-free survival was 78%. The incidence of death or metastasis of CCRCC in VHL gene mutation group (15.0%, 6/40) was significant lower than non-mutation group (35.3%,12/34), P=0.043. Logistic regression results showed that lower tumor pathological grade and stage, better patients' prognosis would be (P=0.016, P=0.024, respectively). However, VHL gene muta-tion was related with better prognosis (P=0.033). This association was stronger among patients with high grade tumors (G3, P=0.048). Conclusions There are frequent VHL gene mutations in spo-radic Chinese CCRCC. Tumors' pathological grade and clinical stage are the important parameters for prognosis. However, VHL mutations are strongly associated with better cancer specific survival for CCRCC patients. These associations are relatively stronger in patients with high grade tumors.