The management of periprosthetic fracture following total knee arthroplasty (TKA) remains a challenging problem. Periprosthetic fractures are increased with increasing TKA times,aging,and increased activity after TKA. Periprosthetic fractures after TKA involves the femur,tibia,or patella,in particular at the supracondylar region of the femur. In addition,periprosthetic fractures can also occur in operation. According to fracture morphology,various cause factors,and the timing of fracture,a number of treatment options are available to treat this complex problem. Appropriate fracture classification would assist clinical physicians to evaluate fracture site,type,bone loss and prosthesis fixation. Because of the complexity,periprosthetic fractures often require tailored treatment to attain a more individualized treatment strategy to promote fracture healing,reconstruct bone mass and maintain joint function. Recently,with improving internal fixation materials and surgical techniques,the methods of surgical treatment of periprosthetic fracture have made great progress.

BACKGROUND:With the continuous development of minimal y invasive techniques and computer navigation assistive technology, they have powerful attraction and development prospects in theory and practice. But there are controversies and misunderstandings in the application and efficacy of total knee arthroplasty.
OBJECTIVE:To summarize and evaluate the definition indications, contraindications and complications of minimal y invasive total knee arthroplasty, as wel as the advantages and disadvantages after replacement and the application of computer navigation assistive technology.
METHODS:A computer-based retrieve was performed in CNKI database and PubMed database for the articles on minimal y invasive total knee arthroplasty from 2003 to 2013. The key words of“minimal y invasive total knee arthroplasty, minimal incision total knee arthroplasty, computer navigated total knee arthroplasty, computer assisted total knee arthroplasty”in English and Chinese were put in the title and abstract. The articles on the minimal y invasive total knee arthroplasty and computer assisted total knee arthroplasty were included, and the old and repetitive articles were eliminated. Final y, 44 articles were included for review according to the inclusion criteria.
RESULTS AND CONCLUSION:Knee joint diseases can seriously affect the life quality of the patients. Minimal y invasive total knee arthroplasty is a newly developed technique in recent ten years, which can provide a new choice for the patients. Studies have shown that minimal y invasive total knee arthroplasty has the advantages of reducing postoperative pain, decreasing the direct cost and fastening the recovery. The computer navigated total knee arthroplasty can make the force line more precise after replacement. But there exist many problems according to the reports at home and abroad, especial y the life and prosthesis and time for revision, those are the fatal factors for the patients. But minimal y invasive surgery is the developing trend of orthopedic surgery.

Objective In order to know preoperative gastrointestinal cancer patients' quality of life and the related factors. Methods A cross-sectional study was conducted in 356 preoperative gastrointestinal cancer patients. The data were analyzed using descriptive, linear correlation and multiple regression analysis. Results The total number of valid return was 323, and the valid usable return rate was 90.7%.The preoperative gastrointestinal cancer patients' quality of life reached the middle level and varied with gender, age, residence, income and psychological state. Emotional function, physical function and fatigue were influencing factors of total quality of life. Conclusions Anxiety and emotional function were the main influencing factors of preoperative gastrointestinal cancer patients' quality of life.

OBJECTIVE To investigate the susceptible factors and the methods of prevention and treatment of nosocomial deep fungal infection in intensive care unit(ICU).METHODS The clinical information of 798 patients in ICU was investigated from Jul 2005 to Jun 2007.The risk factors,species,drug-resistance and the methods of prevention of fungal infection were analyzed.RESULTS Fungal infections were found in 137 cases(17.2%).The lower respiratory tract accounted for 72.3% in 137 cases with fungal infection.A total of 180 strains of fungi were isolated,Candida albicans,C.tropicalis and C.glabrata accounted for 43.3%,25.6% and 23.3%.The resistance characteristics to fluconazole,itraconazole,5-fluorocytosine and amphotericin B were relatively weak.The factors related to nosocomial fungal infection were the severity of the underlying disease,long-term use of antibiotics and glucocorticoid and invasive procedure.CONCLUSIONS Proper use of antibiotics and immuno-depressor,reduction of unnecessary operation and early diagnosis are the keys in prevention of systemic fungal infection.

Objective To investigate bone nutritional status of neonates and their mothers as well as the correlation between them by estimating the concentrations of 25-(OH)D3, calcium and phosphorus in maternal blood and cord blood at birth, and by measuring the bone speed of sound (SOS) of neonates and their mothers with quantitative ultrasound within 3 days after birth. Methods The concentrations of 25-(OH)D3, calcium and phosphorus in the serum were estimated both from 32 pregnant women who had a term delivery and from the umbilical cord at birth. Within 3 days after delivery, the bone SOS values of the mothers measured from their radius and neonates from their tibia were estimated and the correlation between the mothers and their neonates was analyzed. Thirty-nine non-pregnant healthy women who at the same age as the pregnant women were selected as control group and had their bone SOS measured. The difference of bone SOS between pregnant and healthy non-pregnant women was compared. Results There was positive correlation between cord blood and maternal blood 25-(OH)D3 concentration [(14. 7±7. 8) nmol/L and (30. 3±10. 2) nmol/L, r= 0 . 680, P=0. 000]. The calcium and phosphorus concentration in cord blood [2.36±0. 28)mmol/L and (1.57±0.76) mmol/L] were significant higher than that in maternal blood E(2.09± 0. 17) mmol/L and (1.04±0. 28) mmol/L], but no correlation was found (r=0. 146, P=0. 467; r=0. 148, P=0. 445). No significant correlation was shown in the bone SOS between the infants and their mothers[(3054±76)m/s and (4170+241)m/s, r=0. 223, P=0. 220]. The concentration of 25-(OH)D3 in cord blood was closely correlated with the bone SOS of infants(r=0. 412, P=0. 026). The SOS of healthy women was obviously higher than that of pregnant women [(4258±100)m/s vs (41704±241)m/s, P=0. 043]. Conclusions There are close correlations between fetus and their mothers in vitamin D status and also between vitamin D status and fetus bone development. Some pregnant women may be short of vitamin D in autumn and winter in Shanghai and we should monitor the bone nutritional states for pregnant women.

BACKGROUND: Most of the displaced fractures of calcaneus reed operation treatment. Because early postoperative dirigation is sometimes ignored,most patients receive only good anatomic reduction but less pleased functional reduction.OBJECTIVE: To compare the effect of different starting time of the postoperative dirigation on the functional recovery of the joint of the foot after the operation of the fracture of calcaneus with joint surface displacement.DESIGN: Non-randomized and concurrently controlled retrospective analysis with blind evaluation.SETTING: Orthopedic Department of Renji Hospital of Shanghai Second Medical University.PARTICIPANTS: Cases with the fracture of the calcaneus with joint surface displacement, in the Orthopedic Department of Renji Hospital of Shanghai Second Medical University were chosen from October 2000 to June 2003. There were totally 64 cases(72 sides), male 40 sides and female 32sides, whose ages varied from 22 to 68 years old. According to the starting time of the postoperative dirigation, the cases were divided into two groups,the 1-week dirigation group with 34 cases(38 sides), male 20 sides and female 18 sides, and the 6-week dirigation group with 30 cases(34 sides), male 20 sides and female 14 sides.METHODS: Totally 64 cases were involved in the result analysis. In the two groups, the same operative therapeutic methods and postoperative dirigation were taken except the starting time of the dirigation. The dirigation was started respectively 1 or 6 weeks after the operation and lasted for 6weeks. Six months later, follow-ups were done according to the Maryland Grade(excellent 90-100, good 75 -89, moderate 50 -74, poor ＜ 50) to evaluate the activity of the talocrural joint and the stability of the anterior half of the foot and the gait as well.MAIN OUTCOME MEASURES: Primary results: the postoperative function of the injured foot of the two groups. Secondary results: the adverse events and side effect.Maryland Grade: In the 34 cases(38 sides) of the 1-week dirigation group,the average mark was 87. 8, and in the 30 cases(34 sides) of the 6-week dirigation group, the average mark was 73.2, and the difference had signifigroup, 3 cases had poor healing of the incision, and achieved the healing after 2-week medication. And 2 cases had injury of the lateral dorsal cutaneous nerve of the foot. In the 6-week dirigation group 2 cases had poor healing of the incision and achieved the healing after 2-week medication, and 1 case had injury of the lateral dorsal cutaneous nerve of the foot. There was no significant difference between the two groups.CONCLUSION: After the operation of the fracture of calcaneus with joint surface displacement, early application of dirigation is beneficial to the functional recovery of the foot and talocrural joint without unsafety.

Objective To compare the efficacy, tolerance and cost of interferon (IFN) α-2b and adefovir (ADV) in patients with chronic hepatitis B (CHB) for two years. Methods The treatmentnaive outpatients with CHB were treated with IFN α-2b or ADV according to intention to treat.Among 77 patients, 34 were treated with recombinant IFN α-2b 5 MU once every other day subcutaneously (IFN group), 43 were treated with ADV 10 mg/day orally (ADV group). The medications were stopped or the regimens were changed due to intolerant adverse reactions or without effects according to intention to treat. The patients were followed up for 24 months. The therapeutic effects, adverse reactions, compliance and cost of two initial treatments were compared. The data were analyzed by Fisher exact probability test. Results The complete virological response (HBV DNA＜500 copy/mL) rates after 12 months of therapy in IFN group and ADV group were 41.2% (14/34)and 67. 4 % (29/43), respectively, while the alanine aminotransferase (ALT) normalization rates were41.2% (14/34) and 93. 0% (40/43), respectively. The rates in ADV group were both significantly greater than those in IFN group (both P＜0.01). There were no statistically significant differences of HBeAg negative rate and HBeAg seroconversion rate between the two groups. In IFN group, the expulsion rate was 23. 5% (8/34), the therapy was discontinued in 8. 8% (3/34) of patients due to adverse reactions and the medication was changed in 47.1% (16/34) of patients. In ADV group, there were no adverse reactions associated with medication during 2-year therapy and patients were well tolerant, the expulsion rate was 7.0% (3/43) and the regimen in 9.3% (4/43) of patients was changed (P＜0.01). The comparison of therapeutic cost between the two groups showed that the cost of anti-viral therapy, management with adverse reactions and laboratory examinations in IFN group were all higher than those in ADV group. The average cost per person of two years was increased with RMB 4855 yuan in IFN group. Conclusion In HBeAg-positive CHB patients, ADV is cost-effective and suitable choice for initial antiviral treatment.

Bacterial cellulose (BC) is a new kind of natural biological nano-materials which displays unique physical, chemical and mechanical properties. It has high bioactivity, good biocompatibility, and biodegradability. BC fiber has a nanoporous structure and certain nano-pore size distribution, and a large number of nanopores can be used as a "template". BC can be used as a template to synthesize nano-composite materials with three-dimensional network structure through biomimetic synthesis. BC can also be used as a template to stabilize and disperse the polymers which are easily assembled into a cluster or bundle in the ultra-fine fiber network structure. The BC template could be removed in order to change or optimize the properties of the composite material. The process can make use of the synergy between the BC template and inorganic materials to make a new type of hollow molecular sieve. It can synthesize a variety of nanoscale metal oxides with the hollow network. The present study of template svnthesis based on BC is introduced in this paper.

Objective The purpose of this study was to investigate the occupation stress and quality of life among teachers in medical university,and analyze the correlation between the occupational stress and the quality of them.Methods Totally 249 teachers in medical university of Anhui province were investigated with the instruments of the occupational stress scale and the Chinese version of World Health Organization Quality of Life Brief(WHOQOL-BREF).Results The findings showed that:The coefficient of correlation was-0.374 between occupational stress and quality of life in teachers in medical university(r =-0.374,P ＜0.001).Conclusion The score of social relations dimension,the environment dimension and utilization of support have statistical significance with different sex and age of teachers in medical university.There was negative correlation between the occupational stress and the quality of life in teachers in medical university.

Objective To discuss on the effect of simulation training of vocational protection among nurses with lower age and services seniority in trauma surgery department. Methods The training of vocational protection was divided into the curricula content and simulation training, 37 nurses were trained with the method of combining theory with practice,the items before and after the training were tested with t test. Results The mastering degree of occupational exposure knowledge after the training significantly improved compared with that before training. After simulation training various protection technique greatly alleviated. Each score of comprehensive clinical evaluation after the training also increased. Conclusions We should strengthen occupational protection in clinical work in order to prevent nosocomial infection.Detail education and situational education should be paid attention to during the training according to their ability,so that satisfactory results can be achieved.