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 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.

There are many problems about multiple breast cancer (MBC),such as whether it results from intramammary spread of a single tumor, or from two or more separate neoplastic events? Whether MBC has inferior outcome compared with unicentric lesions? Whether MBC is suit for conservative surgery and the sentinel lymph node biopsy, and so on. Thus: We reviewed the prospect for diagnosis and therapy of MBC.

Objective To evaluate the effects of breastfeeding behavior through the implementation of family-centered empowerment education in primiparas.Methods According to random digit table,128primiparas in our hospitals were divided into the experimental group and the control group with 64 cases in each group from August 2014 to April 2015.At last 58 patients in the observation group and 59 patients in the control group completed the research.Those primiparas in the experimental group were given the familycentered empowerment education.The control group received conventional methods.Results The scores of breastfeeding self-efficacy,perceived social support and breastfeeding behavior of primiparas in the experimental group were 129.64±12.94,58.94±8.97,89.84±11.32,higher than the control group,101.78±78.67,50.27±10.56,71.56±12.03,the differences had statistical significance between two groups,t=9.656-10.487,P ＜ 0.05.Conclusions Using the family-centered empowerment education can effectively improve the breastfeeding self-efficacy,perceived social support and breastfeeding behavior in primiparas.

The paper analyzes deficiencies in traditional manual screening of critical values , telephone notifications and manual record-ing of critical value reports , as well as problems existing in current critical value reporting systems in China .It designs a stable , timely and accurate reporting system for test critical values and mainly introduces the system design , system function and application features .

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.

Objective To explore the application effects of PDCA circulation on behavior management in discharged patients with first cerebral infarction. Methods Patients with first attack of cerebral infarction were enrolled from the department of neurology of the First Hospital of Anhui Medical University from April 2013 to March 2015. According to their admission numbers, patients were divided into the observation group (94 cases) and the control group (80 cases). Besides of the regular personalized secondary prevention, the observation group was also applied for the PDCA cycle for nine months. Stroke Behavior Change Inventory was used to evaluate the changes of their lifestyle and medication compliance one year after discharge for two groups. Results After the observed patients were discharged one year, the changed extent of these five behaviors including quitting smoking, regular monitoring blood pressure and sugar, appropriate exercise, pressure control in the observation group were 0.00 (0.00, 3.00), 1.68 (1.00, 3.00), 1.00 (0.00, 2.00), 1.20 (0.75, 2.00), 1.00 (0.00, 1.00) points, and these in the control group were 0.00 (0.00, 1.0)0, 1.00 (0.00, 2.00), 0.00 (0.00, 1.00), 1.00 (1.00, 2.00), 0.00(0.00, 1.00) points. The observation group in these parameters had significantly higher than the control group (Z=-3.166--2.419, P < 0.05). The changed extent of these behaviors in the medication compliance such as reducing blood glucose, blood pressure, atrial fibrillation, cardiovascular disease, and stroke prevention in the observed group were 0.00 (0.00, 0.00), 0.00 (0.00, 2.00), 0.00 (0.00, 0.00), 0.00 (0.00, 0.00), 3.00 (3.00, 3.00) points, and these in the control group were 0.00 (0.00, 0.00), 0.00 (0.00, 0.79), 0.00 (0.00, 0.00), 0.00 (0.00, 0.80), 0.00 (0.00, 1.50) points. The observation group in these parameters had significantly higher the above parameters than the control group (Z=-8.081--2.595, P<0.05). Conclusions Application of the PDCA circulation in the patients with first attack of cerebral infarction after their discharge can help them correct lifestyle and increase their medical treatment compliance, which is beneficial for secondary prevention of cerebral infarction.

Objective To investigate the expressions of COX-2 and p53 in human colorectal carcinoma and their correlations with clinicopathological features of colorectal carcinoma. Methods The expressions of COX-2 and p53 were determined by immunohistochemical staining in 72 surgical specimens of colorectal carcinoma and 21 normal mucosal tissues. Results The positive rates of COX-2 and p53 in colorectal carcinoma were 70.8 % and 62.5 %, respectively. The differences between carcinoma group and normal tissues group were statistically significant(P