BACKGROUND:The blood loss and the need of blood transfusion after bilateral total knee arthroplasty are very high. Therefore, the use of medicine such as tranexamic acid in total knee arthroplasty is overheated in recent years. Tranexamic acid has been proved to be able to decrease the blood loss after total knee arthroplasty, while the study of its use in bilateral total knee arthroplasty is seldom. OBJECTIVE:To observe the effect and safety of tranexamic acid on perioperative blood loss and the change of hemoglobin in patients undergoing bilateral total knee arthroplasty. METHODS: We selected 69 patients who received bilateral total knee arthroplasty and divided them into two different groups randomly. The patients in the experimental group were given 1 g of tranexamie acid dissolved in 100 mL of 5% glucose solution through intravenous infusion. Those in control group were only given 5% glucose solution 100 mL. Total blood loss, intraoperative blood loss, the hidden blood loss, amount of postoperative drainage, the ratio of blood transfusion, hemoglobin, D-dimer, prothrombin time and activated partial thromboplastin time were studied and compared between the two groups. We also observed the incidence of thrombotic events between the two groups. RESULTS AND CONCLUSION:The blood loss of the experimental group was significantly lower compared to the control group (t=2.194-2.908,P < 0.05). The blood transfusion rate of experimental group was significantly lower compared to the control group (χ2=5.219,P=0.022). The hemoglobin of the experimental group was significantly higher than that of the control group at 3 and 5 days after replacement (t=-3.481, 2.319,P < 0.05). No significant difference in prothrombin time and activated partial thromboplastin time was detectable between the two groups before and after replacement (P > 0.05). Thrombotic events were not visible in both groups. Venous ultrasonography in the lower extremity did not reveal deep venous thrombosis. Above results suggest that tranexamic acid can significantly reduce intraoperative blood loss in patients undergoing bilateral total knee arthroplasty, decreases the requirement of blood transfusion and the dynamic change of hemoglobin, and does not increase the risk of thrombosis.

Objective To detect the expression of SSX and to correlate it with clinical indicators of primary hepatocellular carcinoma (HCC).Methods The expression of SSX1-5 mRNA and SSX1 protein were respectively detected by RT-PCR and Western blot and immunohistochemistry staining.The relation between the expression of SSX mRNA and SSX1 protein with clinical indicators were analysed.Results SSX1,SSX2,and SSX3 mRNA were expressed in hepatocellular carcinoma cell lines BEL-7404,Hep G2,and SMMC-7721.In 26 HCC samples,SSX1-SSX5 mRNA was detectable in 53.8％,42.3％,50.0％,46.2％ and 26.9％.The expression of SSX1 mRNA was not related to serum AFP levels (P ＞0.05).Specific expression was both found in the normal group and the high value group.The expression rate of SSX1 mRNA was 85.7％ in the older group,which was higher than in the younger group (16.7％,P ＜ 0.05).The expression rate of SSX1 protein was 50％ in HCC tissues,which was not seen in the caner-adjacent or cirrhosis tissues.In 49 HCC paraffin tissue section samples,the expression rate of SSX1 protein was higher than that in caner-adjacent tissues (46.9％ vs 18.4％,P ＜ 0.05).The expression rate of SSX1 protein was 68.3％ in the large hepatocellular carcinoma group,which was higher than in the small hepatocellular carcinoma group (29.6％),(P ＜ 0.05).Conclusions SSX1 mRNA is expressed with a high percentage and specificity in HCC and their products are new potential promising targets for antigen-specific immunotherapy of HCC.The detection of SSX1 expression has the potential value for auxiliary diagnosis of HCC.

Purpose To implement lower artery angiography in patients with peripheral arterial occlusive disease, and to investigate the feasibility of lower extremity gemstone spectral CT angiography in improving image quality.Materials and Methods Forty-eight patients suspected with lower extremity arterial occlusive diseases were randomly divided into research group and control group. Research group (24 cases) were carried out gemstone spectral CT angiography (CTA) scan and control group (24 cases) were scanned with multi-slice spiral CT (CTA). The CT value of the common iliac artery, popliteal artery and its branches was measured and contrast to noise ratio (CNR) were calculated in both groups. The images were evaluated independently by 2 senior physicians based on a 5-level evaluation standard.Results The CT value of common iliac artery, popliteal artery, anterior tibial artery and the CNR in research group were all higher than those in control group (t=8.7, 7.9, 12.6 and 17.2,P<0.01), but the background noise was lower than that in control group (t=1.5,P<0.01). The scores of two image quality accessed by physician 1 and 2 were 110:90 and 111:93 respectively with statistical difference (Z=-7.6 and-8.0, P<0.01).Conclusion The image obtained by gemstone spectral CT optimal single energy image technique is much better than that by conventional multi-slice spiral CT in lower extremity angiography.

AIM To establish the HPLC fingerprints of flavonoids in Ziziphi spinosae Semen and to determine the contents of two constituents.METHODS With spinosin as a reference peak,the HPLC fingerprints of ten batches of samples were established.The analysis of methanol extract of flavonoids in Ziziphi spinosae Semen was performed on a 30 ℃ thermostatic Agilent TC-C18column (4.6 mm × 250 mm,5 μm),with the mobile phase comprising of acetonitrile-0.1％ acetic acid flowing at 1 mL/min in a gradient elution manner,and the detection wavelength was set at 280 nm.RESULTS There were ten common peaks in the HPLC fingerprints,eight of which (vicenin-Ⅱ,glucosylvitexin,isospinosin,spinosin,6'-pyridyloylspinosin,6'-p-hydroxybenzoylspinosin,6'-feruloylspinosin and 6'-p-coumaroylspinosin) were identified.Spinosin and 6'-feruloylspinosin showed good linear relationships within the ranges of 15.00-40.00 μg and 5.00-14.00 μg,whose average recoveries (RSDs)were 100.5％ (1.6％) and 100.4％ (1.6％),respectively.CONCLUSION This accurate,simple and reliable method can be used for the quality control of flavonoids in Ziziphi spinosae Semen.

Objective To know the distribution of pathogenic bacteria in the hospital ,and to provide scientific evidence for con‐trolling hospital infection and clinical medication .Methods Samples of the hospitalized patients and the data of bacteria culture and isolation in the hospital were collected and statistically analysed retrospectively from January 2011 to December 2013 .Bacterial iden‐tification and drug sensitivity test were carried out by using VITEK 2 Compact automated bacterial identification and drug sensitive system .The clinical distribution and drug resistance characteristics of the strains were analyzed by using WHONET5 .4 and SPSS17 .0 software .Results In the hospital ,71 929 specimens were received from 2011 to 2013 totally ,the detection rate of patho‐genic bacteria was 18 .5% .Sputum(62 .8% ) ,secretions and pus(11 .3% ) ,blood(10 .3% ) were the top three types of specimens which had larger positive numbers .Gram negative bacteria are the main kind of pathogenic bacteria in the hospital ,accounting for 73 .3% .Gram positive bacteria accounted for 25 .0% .E .coli(21 .1% ) ,Pseudomonas aeruginosa(14 .8% ) ,Acinetobacter baumannii (12 .5% ) ,Klebsiella pneumoniae (12 .2% ) and Staphylococcus aureus(11 .04% ) were the top five pathogenic bacteria .The drug resistance of the isolates were as follows .Gram‐negative bacteria showed resistance of different extents to broad‐spectrum penicil‐lins ,quinolones ,cephalosporins except for the 4th generationsand and aminoglycosides .Over 80% Staphylococcus aureus showed re‐sistance to penicillin ,erythromycin and clindamycin ,but the rate to Oxacillin were decreasing year by year .Enterobacteria were still most sensitive to carbapenems with a sensitive rate over 98 .6% .However ,the emergence of Carbapenem‐resistent enterobacteria from 2011 to 2013 was worthy of clinical attention .Conclusion The type of positive specimens were mainly sputum .Gram negative bacteria are the main pathogenic bacteria ,and have obvious multi-drug resistance .E .Coli is the superiority strains ,fungal infection rate are increasing year by year .Doctors and hospital infection controlling department should pay attention to the monitoring of bac‐terial resistance and improve the rational use of antimicrobial drugs .

Objective To study the effects of bone marrow mesenchymal stem cells (BMSCs) transplantation on the ischemia-reperfusion injury of the intestine in rats.Methods BMSCs were isolated from femur of male Wistar rats and cultured,and the phenotypes of third generation cultured cells were identified.B16-F10-Luc-G5 cells were injected into the intestinal submucosa and traced by Luciferin.Intestinal ischemia-reperfusion injury models were established in male Wistar rats,which were divided into the experimental group (1 ml BMSCs suspension which contained 5 × 106 cells was injected into the intestinal submucosa) and the control group (1 ml normal saline was inject into the intestinal submucosa).Then,serum and intestinal tissue samples were collected at 0,2,6,24,72 and 120 h after operation.Diamine oxidase,D-lactate and TNF-α were tested by ELISA,intestinal tissue samples were observed under the Light microscopy and transmission electron microscopy,and tight junction protein-1 (ZO-1) was detected by using Western blotting and immunohistochemistry.Results BMSCs were isolated and cultured successfully and they colonized in the intestine.The pathological changes of the intestine in experimental group were milder than in control group. Intestinal mucosal barrier was more intact in experimental group than in control group.In the experimental group and control group,DAO was (11.36 ± 1.89) and (14.27 ± 2.09)IU/ml (P＜0.05) at 6th h after injection,and that was (5.04 ± 1.04) and (7.35 ± 1.46) IU/ml (P＜0.05) at 24h after injection,respectively.In the experimental group and control group,D-lactate was (1.57 ± 0.25) and ( 1.93 ± 0.19) mmol/L (P＜0.05) at 6th h after injection,and that was ( 1.09 ± 0.13) and ( 1.41 ± 0.07) mmol/L (P＜0.01 ) at 24th h after injection,respectively.In the experimental group and control group,TNF-α was (266.09 ± 8.84) and (286.81 ± 11.54) ng/L (P＜0.01 ) at 6th h after injection,and that was (190.39 ± 4.24) and (218.49 ± 15.51 )ng/L (P＜0.01 ) at 24th h after injection,respectively.The expression of ZO-1 protein was higher in experimental group than in control group. ConclusionInjection of BMSCs into could protect the intestine from ischemia-reperfusion injury in rats.

Objective To evaluate ketamine-induced cerebral protection in mice with traumatic brain injury (TBI) by magnetic resonance imaging (MRI).Methods Thirty-two pathogen-free healthy male C57BL/6 mice,aged 8 weeks,weighing 26-30 g,were divided into 4 groups using a random number table:control group (group C,n=7),ketanine group (group K,n=7),TBI group (n=9) and TBI plus ketamine group (group TBI+K,n =9).TBI was produced with a pneumatically driven controlled cortical impact device.Ketamine 150 mg/kg was intraperitoneally injected at l h after operation in TBI+K and K groups,while the equal volume of normal saline was given instead in TBI and C groups.Open field test was conducted at 24 h,72 h and 7 days after operation.The animals in TBI and TBI+K groups were scanned by T1-weighted MRI at 6,24 and 72 h after operation,the animals in C and K groups were scanned by MRI at 24 h after operation,and the development of cerebral edema was observed.Results MRI scan showed no cerebral edema in C and K groups,and different degrees of cerebral edema were found in TBI and TBI+K groups.Compared with group C,the locomotor distance was significantly shortened at 24 and 72 h after operation in group TBI (P＜0.05).Compared with group TBI,the size of cerebral edema was significantly decreased,and the locomotor distance was prolonged at 24 and 72 h after operation in group TBI+K (P＜0.05 or 0.01).Conclusion MRI method further clarifies that ketamine can produce cerebral protection to some extent in mice with TBI.

Objective To analyze the clinicopathological factors on the prognosis and investigate the necessity of adjuvant chemotherapy for patients with stage Ⅱ colorectal cancer.Methods The clinical data of 255 patients with stage Ⅱ colorectal cancer who were admitted to the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2005 were collected.The survival curve was drawn by Kaplan-Meier method,and the survival rate of the patients were analyzed by Log-rank test.Factors influencing the survival were analyzed by Cox regression model.Results All patients were followed up till April 23,2010,and the mean time of follow-up was (63 ± 22)months.The median survival time was 63 months.The 5-year and tumor-free survival rates were 85.3％ and 83.7％,respectively.The 5-year overall and tumor-free survival rates of patients without preoperative bowel obstruction or perforation were 86.9％ and 85.6％,which were sigaificantly higher than 72.7％and 68.4％ of patients with preoperative bowel obstruction or perforation(x2 =4.546,4.573,P ＜ 0.05 ).The 5-year overall and tumor-free survival rates of patients with negative resection margin were 85.5％ and 83.9％,which were significantly higher than 75.0％ and 75.0％ of patients with positive resection margin(x2 =7.020,6.009,P ＜ 0.05 ).The result of multivariate analysis revealed that preoperative bowel obstruction or perforation were the independent risk factors for patients with stage Ⅱ colorectal cancer(Wald =4.477,relative risk =2.371,95 ％ confidence interval:1.066-5.275,P ＜ 0.05 ).The 5-year overall and tumor-free survival rates were 87.3％ and 86.0％ for patients who received adjuvant chemotherapy,and were 82.2％ and 80.3％ for patients who did not receive adjuvant chemotherapy (P ＞ 0.05 ).Conclusions Preoperative bowel obstruction or perforation are independent risk factors for the survival of patients with stage Ⅱ colorectal cancer.Adjuvant chemotherapy could not improve the prognosis of patients with stage Ⅱ colorectal cancer.

Objective To analyze the concept of Peabody Developmental Motor Scale-Fine Motor (PDMS-FM). Methods Concept con-tained in each item of PDMS-FM was discussed and determined by 3 rehabilitation physicians or therapists. They were linked to the catego-ries of International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) by 2 rehabilitation physi-cians according to the linking rules after discussion. Third party intervened informally if there was a disagreement. Results Ninety-eight items from the PDMS-FM linked to 21 categories of the 3rd level within 13 categories of the 2nd level, belong to b1 Mental Functions, b7 Neuromusculoskeletal and Movement-related Functions, d1 Learning and Applying Knowledge, d4 Activities and d5 Self-care, a total of 5 categories of the 1st level. Eighty items linked to d4, and 40 items linked to d1. Conclusion PDMS-FM mainly focuses on the activities, es-pecially Carrying, Moving and Handling Objects and Basic Learning of Learning and Applying Knowledge.

Objective:To analyze the incidence, biochemical and molecular characteristics, and gene mutation spectrum of neonatal methylmalonic acidemia (MMA) in Shaanxi province.Methods:This study involved 146 152 newborns undergoing neonatal screening for methylmalonic acidemia by tandem mass spectrometry in Northwest Women's and Children's Hospital from January 2014 and December 2019. Clinical manifestations and follow-up data of newborns diagnosed with MMA and their acylcarnitine profiles and gene mutations were analyzed. According to whether they had elevated homocysteine or not, these patients were divided into two groups, the complicated group and the isolated MMA group. The control neonates were those excluded from having methylmalonic acid by re-examination. Kruskal-Wallis and Mann-Whitney U test was conducted for statistical analysis. Results:(1) Twenty-one cases of MMA were confirmed with an incidence of 1/6 960, including 11 cases (52.4%) of isolated MMA (isolated MMA group) and 10 (47.6%) complicated by elevated homocysteine (complicated group). Eight patients in the isolated group had symptoms within one month after birth, mainly feeding difficulties, vomiting, drowsiness, poor response and infection, and five died. Patients in the complicated group were all diagnosed before developing typical clinical symptoms, and no developmental abnormalities were reported during follow-up. (2) Blood propionyl carnitine and its ratios to acetylcarnitine and free carnitine in the isolated MMA and complicated groups were higher than those in the control group [ M (min-max), 9.26 (3.70-37.78) μmol/L and 7.27 μmol/L (3.58-13.62 μmol/L) vs 4.51 μmol/L (1.48-8.69 μmol/L), H=23.239; 1.12 (0.32-2.43) and 0.74 (0.36-1.90) vs 0.25 (0.09-0.45), H=47.061; 0.94 (0.12-1.92) and 0.56 (0.18-1.03) vs 0.17 (0.06-0.38), H=36.868; all P<0.001]. The blood methionine level in the complicated group was significantly lower than that in the isolated MMA group [7.64 μmol/L (3.40-19.25 μmol/L) vs 24.22 μmol/L (10.73-56.55 μmol/L), U=3.000, P<0.001]. (3) All 21 patients carried complex heterozygous mutations or homozygous mutations in pathogenic genes, including 15 distinct MMUT mutations and 13 distinct MMACHC mutations. In the isolated MMA group, the most common mutation was c.323G>A (p.Arg108His) in the MMUT gene with a positive rate of 13.6%, and an unreported mutation, c.1676+11A>G, with unidentified clinical significance, was also found. The most common mutations in the complicated group were c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in the MMACHC gene, and the positive rates were both 20.0%. Moreover, two unreported variants, c.430-2A>C and c.648_650delAGA (p.216_217delSEinsS), were detected and suspected to be pathogenic. Conclusions:MMA is not uncommon in Shaanxi province. Children with isolated MMA tend to be more severe clinically. The identification of hotspot mutations, including c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in MMACHC gene and c.323G>A (p.Arg108His) in MMUT gene, provides a foundation for further genetic screening, counseling, and prenatal diagnosis, and is conducive to reduce the mortality and disability rate of neonatal MMA.