BACKGROUND: With the development of new materials and the improvement of prosthesis design, total knee arthroplasty(TKA), a commonly used surgery, has exhibited satisfying effect on the treatment of rheumatoid arthritis and osteoarthrosis. However, many problems still remain a headache to operation performers.OBJECTIVE: To discuss how to select the prosthesis for total knee replacement and to summarize the key factors that affect the curative effect.DESIGN: A controlled study of the effect before and after the operation.SETTING: Department of Orthopedics, First Hospital of Xi'an Jiaotong University.PARTICIPANTS: Thirty-six patients(24 males and 12 females) who received TKA in the Department of Orthopaedics, First Hospital of Xi'an Jiaotong University during February 2000 to September 2003 were included in this study.METHODS: A retrospective study was carried out. Thirty-six patients(48knees) underwent total knee replacement, and the knee joint function was evaluated with American John N Install scoring system. The post-operation effect was evaluated by comparing the scores of each diseased knee before and after the operation.MAIN OUTCOME MEASURES: The function of knees and the score of every knee before and after operation were evaluated.RESULTS: The mean score before operation was 39, but it was 85 after follow-up visit. Totally 95% of them were up to the standard. The pain was reduced after the operation. The flexion-extension function and mobility of the knee joints improved obviously.CONCLUSION: TKA with posterior stabilized prosthesis and resection of posterior cruciate ligament(PCL) improved the function of the diseased knees after the operation. And the operation was simple and without complications. The key factors that affect the curative effect include the mechanical balance of the soft tissues during the operation, perioperative anticoagulant treatment for the prevention of deep vein thrombosis(DVT) and postoperative rehabilitation training. Peripheral tissue of knee joints should be released adequately; otherwise, it may cause unstable joint or limitation of joint activity.

Objective To investigate the psychological status and related factors in patients with mainte-nance hemodialysis in Huzhou city.Methods 376 cases of maintenance hemodialysis were selected as the research subjects in Huzhou First People's Hospital.The anxiety and depression status in maintenance hemodialysis patients were investigated by issuing questionnaires.To study the relationship between anxiety and depression,gender,age, social support,nutritional status,complications,and in maintenance hemodialysis patients.At the same time,the quality of life was evaluated by SF -36 scale.Results Issuing 376 questionnaires,a total of 373 points,the effective recovery rate was 99.20%.In 373 patients,there were 182 patients (48.79%)with no depression,mild depression in 78 cases (20.91%),moderate depression in 59 cases (15.82%),severe depression in 54 cases (14.48%). 51.21% patients had different degree of depression.Of the 373 patients,there were 123 patients (32.97%)with no anxiety,mild anxiety in 141 cases (37.80%),mild and moderate anxiety in 55 cases (14.75%),moderate anxiety in 33 cases (8.85%),severe anxiety in 21 cases (5.63%).A total of 67.03% patients had different degrees of anx-iety.Huzhou city maintenance hemodialysis,female patients had depression rate of 80.70%,anxiety rate of 65.50%, which were significantly higher than the rate of depression 55.45%,anxiety rate 39.11% in male patients,the differ-ences were statistically significant (P <0.01 -0.05).In maintenance hemodialysis patients,the anxiety and depres-sion status gradually increased with age.Severe malnutrition in maintenance hemodialysis patients,the rate of depres-sion,anxiety rates were 80.65%,90.32%,the rates of depression,anxiety were 44.49%,61.81% in normal and mild malnutrition patients,the differences were statistically significant (all P <0.01).SF -36 scale showed that most of the patients with maintenance hemodialysis patients had poor quality of life,and the function was limited. Conclusion Maintenance hemodialysis patients,the general existence of anxiety and depression in the mental state in Huzhou city.Moreover,the psychological state of the patients is influenced by sex,age,nutrition status,and other factors.In clinical,it is needed to provide effective psychological intervention for patients to improve the quality of life,according to the psychological status and related factors of maintenance hemodialysis patients.

BACKGROUND: The skill to culture osteoblasts primarily has been well developed. However, trypsinase can affect membrane protein of osteoblasts if the time of digestion is long. Therefore, it is of great significance to select an ideal method to avoid the damage from trypsinase to cells as possible when culturing osteoblasts.OBJECTIVE: To explore a novel method to isolate and culture SD rat osteoblasts in vitro, and identify the functions of the cells.DESIGN: Observational study.SETTING: Department of Orthopaedics, First Affiliated Hospital of Jinan University.MATERIALS: This experiment was carried out in the Department of Orthopaedics, First Affiliated Hospital of Jinan University from March to May in 2007. Eight SPF 24-hour old SD rats were used in the experiment. The rats, irrespective of gender, were provided by the Experimental Animal Center of Nanfang Medical University. The experimental animals were disposed according to ethical criteria. The main reagents were detailed as follows: collagenase Ⅱ (Sigma Company);trypsin (Sigma Company); alkaline phosphatase (ALP) kit (Nanjing Jiancheng Biological Products Company); SABC-1021(Wuhan Boster Biotechnology Company).METHODS: 24-hour old SD rats were chosen for experiment. The newly born SD rats were sacrificed by anesthesia and the cranial bones of the rats were obtained cleanly, erased completely of the periosteum and cut to blocks of I mm3. The cranial bones were digested by 0.25 % trypsinase for 20 minutes, then by 0. 1% type Ⅱ collagenase for 60 minutes. The digestive time of trypsinase was controlled in the process of digestion to avoid to harm the cells. The liquid was gathered and centrifuged. The cells were cultured in culture flask and were purified by many times adhered.MAIN OUTCOME MEASURES: Morphology observations under the inverted phase contrast microscope, transmission electron microscope, and scanning electron microscope were performed. The phenotype, calcium tuberculation and the expression of alkaline phosphatase were studied with alizarin red staining and modified Gomori Ca-Co assays respectively.The cells were also evaluated with collage Ⅰ immunohistochemical staining.RESULTS: The cultured cells had active proliferation ability. Cells showed multi-angle or fusiform shape. Nucleus was immature and organell was plentiful. Therefore, they had typical morphological characters of osteoblasts. Moreover, they showed the osteoblastic phenotypes such as their synthesis of alkaline phosphatase, collage Ⅰ and formation of calcium tuberculations.CONCLUSION: The cells cultured by our modified enzymatic digestion method had typical morphological and biological characteristics of osteoblasts.

Objective To explore the clinical effect of holistic nursing in the operation room for surgical children patients. Methods 120 patients required surgical treatment were selected and divided into the control group(45 cases)and the observation group(75 cases)randomly.The control group was given routine nursing,the observation group was given holistic nursing including preoperative interview,psychological care and all the preparations,strict check upon going into the operation room and before surgery,to help children keep graceful position,to cooperate closely with the anesthetist and surgeon,to observe the condition of patients and give good infusion management,to give continued observation of the disease condition after surgery,to make children safe escort back to the ward,and to make transfer with ward nurses.The treatment effect was compared between two groups. Results Two groups of children passed the period of operation and anesthesia safely,without appearing accidental situation.The satisfaction degree of the observation group was significantly higher than the control group.One case appeared operation accident and two cases appeared anesthesia awareness in the control group,and they were correctly handled.No one appeared operation accident and anesthesia awareness in the observation group.The differences between the two groups were significant. Conclusions Application of holistic nursing in the operation room for children patients puts forward higher requirements for nurses.It can help children cooperate with surgery better to achieve better surgical results,which is worthy of promotion.

Objective To discuss the effective methods to improve the teaching effect of Basis of Nursing and cultivation of high-quality persons. Methods We randomly divided 87 nursing students into the test group(42 eases) ,which adopt the combination of grouped scene teaching with role-playing teaching and the control group (45 cases),which received routine teaching methods.The effect of the two teaching methods was evaluated by questionnaires. Results The total score and the score of each section of the questionnaires in the test group were higher than those of the control group(P ＜ 0.05 ). Conclusions The combination of scene teaching with role-playing teaching could inspire students' interest,strengthen the role consciousness and improve their comprehensive quality.

Objective To investigate the alterations and phenotypes of dendritic cells, inflamma-tory monocytes and macrophages in immunocompetent mice during Pneumocystis murina ( P.murina) infec-tion for further analysis of the function of these cells during P.murina infection.Methods Wild type male C57BL/6 mice at age 6-8 weeks were randomly divided into two groups including the group with P.murina infection and the group receiving sham surgery.The mice without any intervention were used to set up the blank control group.The loads of P.murina strains in lung tissues of each mouse were quantified by TaqMan real-time fluorescence polymerase chain reaction after the infection.Histopathological examination was per-formed to evaluate the degree of inflammation in lung tissues.The numbers of dendritic cells, inflammatory monocytes and macrophages in lung tissues, peripheral blood and bone marrow samples, and the changes of inflammatory monocytes in spleen tissues were measured by flow cytometry analysis.The expression of major histocompatability complexⅡ(MHCⅡ), CX3C chemokine receptor 1 (CX3CR1) and CC chemokine re-ceptor 2 ( CCR2 ) by dendritic cells, inflammatory monocytes and macrophages in lung tissues during P.murina infection were analyzed by flow cytometry analysis.All of the data were collected one, two, three and four weeks after the corresponding treatments.Results The loads of P.murina strains in P.murina in-fected mice were elevated after two and three weeks infection, but decline at week 4 (P>0.05).Significant pathological changes including the alveolar destruction, inflammatory cell infiltration and thickened alveolar septum in mice with P.murina infection were observed under a microscope at week 3 and week 4.Compared to the sham surgery treatment group, the number of CD11c+CD11b+dendritic cells were increased in lung tissues, but decreased in blood samples during P.murina infection ( P<0.05) .The levels of inflammatory monocytes in blood samples fell at week 3 and then rose at week 4 during P.murina infection (P<0.05). No significant difference with the change of macrophages in mice was observed during P.murina infection ( P>0.05).The CD11c+CD11b+dendritic cells in lung tissues of mice with P.murina infection expressed high levels of MHCⅡand CX3CR1, and low levels of CCR2.The inflammatory monocytes in lung tissues of mice expressed high levels of CCR2, moderate levels of MHCⅡand low levels of CX3CR1 during P.murina in-fection.High levels of CX3CR1 and low levels of MHCⅡ and CCR2 were observed in macrophages from lung tissues of mice with P.murina infection.Conclusion Highly expressed CD11c+CD11b+dendritic cells and MHCⅡwere detected in lung tissues of mice during P.murina infection, indicating that CD11c+CD11b+dendritic cells were involved in the host defense against P.murina infection.

Objective To explore the risk factors for infantile hemangiomas with the emphasis on perinatal factors and socioeconomic and environmental status.Methods A questionnaire survey was carried out targeting mothers and their babies who admitted to the Department of Prevention and Health Care of China-Japan Friendship Hospital for registration from Jan.1st,2009 to Dec.31st,2011.Information gathered included maternal basic information,perinatal factors before and during pregnancy,and socioeconomic and environmental status.Photos and record of the position and size of the pathological change were taken once infantile hemangiomas were diagnosed.Univariate analysis and multivariate Logistic regression analysis were carried out to investigate the risk factors.Results One thousand nine hundred and ninety-eight questionnaires with detail information were collected,among which 94 infants were diagnosed with infantile hemangiomas (4.7 ％).It showed that maternal age≥ 30 (OR =2.687,95％ CI:1.615-4.472,P =0.000),multiple pregnancies (OR =1.730,95 ％CI:1.032-2.901,P=0.038),female infants (OR =1.855,95 ％ CI:1.187-2.899,P =0.007 ),threatened abortion ( OR =3.135,95％ CI:1.487-6.609,P =0.003),amniocentesis (OR =2.754,95 ％CI:1.278-5.938,P =0.010),family history of hemangiomas (OR =2.978,95 ％ CI:1.127-4.049,P=0.032) and video display terminals exposure ＞45 h/week (OR=3.166,95％CI:2.027-4.944,P=0.000) were closely associated with infantile hemangiomas development.Conclusions The elderly maternal age,multiple pregnancies,female infants,threatened abortion,amniocentesis and family history of infantile hemangiomas and long-time exposure of video display terminals might be the risk factors for infantile hemangiomas.

AIM: To investigate the apoptosis and molecular mechanism of human hepatocellular carcinoma HepG2 cells induced by ginsenoside Rh4.METHODS: Human hepatocellular carcinoma HepG2 cells were treated with ginsenoside Rh4 at doses of 10, 20 and 40 μmol/L, and the inhibitory effect of ginsenoside Rh4 on HepG2 cell viability was measured by MTT assay.The apoptotic rate of HepG2 cells was analyzed by flow cytometry.The morphological changes of the HepG2 cells were observed by Hoechst 33258 and TUNEL staining.The expression of apoptosis-related proteins Bax, Bcl-2, caspase-3 and caspase-9 was determined by Western blot.RESULTS: Ginsenoside Rh4 promoted apoptosis of HepG2 cells in a dose-dependent manner.TUNEL and Hoechst 33258 staining showed that the cells appeared obvious shrinking, swelling and rupture after treated with ginsenoside Rh4 for 24 h.The results of Western blot showed that with the increasing concentrations of ginsenoside Rh4, the expression of pro-apoptotic proteins Bax, cleaved caspase-3 and caspase-9 increased, while anti-apoptotic protein Bcl-2 decreased gradually.CONCLUSION: Ginsenoside Rh4 induces apoptosis of human hepatocellular carcinoma HepG2 cells, and the main mechanism may be related to down-regulation of Bcl-2 and up-regulation of Bax, cleaved caspase-3, and caspase-9.

Objective To explore TCM syndrome and treatment regular for AIDS dementia complex (ADC). Methods Through literature retrieval, the review of medical records and clinical investigation, expert questionnaires survey was carried out. Results The recovery rate of complete questionnaires in the 1st survey was 88.89%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the concept, clinical features, diagnostic criteria, syndrome differentiation and treatment of insufficiency of kidney essence, nursing, period of treatment and curative effect standard were more than others, CV<0.076. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of heart and liver yin were smaller, and CV was within 0.168–0.234. The recovery rate of complete questionnaires in the 2nd survey was 96.00%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of kidney and liver were more than the 1st survey, and CV was within 0.065–0.106, which was smaller than the 1st survey. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of syndrome differentiation and treatment of deficiency of kidney and liver were smaller, and CV was 0.156. The weight coefficient of the 1st and 2nd survey were within 0.072–0.087, 0.071–0.089. The questionnaire reliability of the 1st and 2nd survey were 0.916 and 0.886 respectively. The half reliability of the 1st and 2nd survey were 0.81 and 0.79 respectively. Conclusion TCM syndrome and treatment regular for ADC is preliminarily formed.

Objective To evaluate the effect of psychological interventions for patients with urnary cancer on pain and quality of life.Methods One hundred and twenty patients were randomized into research and control group.Each group contained 60 cases. The study group received regular analgesic treatment and psychological interventions.The control group received the same scheme but for psychological interventions.As LQ-C30 was applied to evaluate patients' pain intensity and quality of life respectively.Result The pain relief rate of study group acquired is different significantly from control group, as well as in a higher score in global quality of life, role function, emotional function (P<0.05).Conclusions High-quality psychological care service can improve the quality of life of patients and release cancer pain.