Objective: To evaluate the rationality of the use of antibiotic prophylaxis in the perioperative period of herniorrhaphy. Methods: Seventy-five cases of herniorrhaphy discharged in March, June and September of 2009 were collected. Parameters including indications, the types of antibacterial drugs, time of administration, solvent choice, usage and dosage, combination, etc, were assessed for the rationality according to the "the guiding principles of clinical use of antibacterial drugs"and other relevant documents. Results: The antibacterial drugs application rate was 100%, while the rationali-ty of the drug selection, the drug administration route, the single dose and the number of dosing, was 70.7%, 100% , 100% and 93.3% respectively. Sixty-two patients(82.7%)were treated with antibacterial drugs at 0.5～2 hours before surgery, and the average time course of the prophylactic use of antibiotics after surgery was 2.3 days. Conclusions: Some problems existed for the use of antibiotic prophylaxis in the perioperative period of herniorrhaphy. Surgeon should ensure the correct use of the antibacterial drugs to make the safety, efficiency, rationality, and economy for the patients.

Objective To study the expression of Adiponectin (AD) and its receptors Adiponectin receptor 1 (Adipo R1) and Adipo R2 in the synovial fluids and the synovium of rheumatoid arthritis (RA). Methods ELISA was used to determine the levels of AD in 23 RA and 23 osteoarthritis (OA) patients. Real-time PCR and Western blot techniques were employed to study the expression of AD, AdipoR1 and AdipoR2 in the synovium of 10 RA and OA patients. Results It was observed that approximately twice more adiponeetin in the synovial fluids of patients with RA than with OA. Adiponectin and AdipoR1, but not AdipoR2 mRNA, were significantly expressed in synovium of RA patients in comparison with OA. Adiponectin and AdipoR1 protein were wuch more expressed in synovium from RA than those from OA. Conclusion High expression of Adiponectin and AdipoRl is likely to contribute to the formation of inflammatory joints in RA.

Objective:To analyze the clinico-pathological characteristics, pathological diagnosis, and treatment of rhabdoid tu-mor. Methods:The medical records of four rhabdoid tumor patients that were admitted to the Tianjin Medical University Cancer Insti-tute and Hospital since 2000 were analyzed based on existing literature. Results:In one of the four cases, the tumor originated from the kidney, whereas in the other three, the tumor occurred from extra-renal soft tissues. Histologic analysis revealed that the tumor cells were loosely arranged with diffuse growth, vesicular nuclei, dyed cytoplasm, visible eosinophilic inclusions, and more nuclear fission. The results of immunohistochemical staining showed that the vimentin and epithelial membrane antigen were positive, whereas CK, CD99, CD34, and S-100 were positive at different degrees. MyoD1, Desmin, and INI-1 were negative. Conclusion:Rhabdoid tumor is rare and highly aggressive. It occurs mainly in the kidney and can also be found in other systems. The unique pathological form and im-munohistochemical staining observed on the tumor can be used as reference for diagnosis.

Objective To analyze the short-term clinical efficacy of the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis through total hip arthroplasty combined with internal fixation.Methods From January 2011 to June 2014 a total of 28 cases of ipsilateral femoral intertrochanteric fractures with femoral head necrosis were selected,and they were all treated with open reduction and greater trochanter plate fixation combined with total hip arthroplasty.The time of operation, amount of bleeding,time of bone healing of the greater trochanteric fracture,postoperative complications, rate of internal fixation device loosening,incidence of infection,and the Harris score of the hip joint before and after operation were recorded and statistically analyzed.Results The mean operative time was (174.0±27.1)min and the mean blood loss was (530.0±132.0)mL.There were 2 cases of deep venous thrombosis in the lower extremities,and there was no serious complications occured among the remaining cases.All patients were followed up for 12 to 24 months,averagely (16.3±7.0) months.All the 28 patients get bony union of the large trochanter,with the average healing time of (5.0±1.5) months.The preoperative Harris score was (28.0±7.1) points, while it was (86.5±5.3) points after the surgery, and the difference was statistically significant(t=-21.699,P=0.000).At the end of the follow-up,there was no internal fixation device loosening, no cable breakage,and no infection cases.Conclusion Total hip arthroplasty combined with internal fixation for the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis, especially the large trochanteric fractures, were of reliable fracture fixation, good initial stability and good joint function recovery.And it can maintain fracture stability and early recovery of joint function,so that intertrochanteric fractures and femoral head necrosis were treated simultaneously,and its recent clinical results were satisfactory.

Objective To explore the potential role of high levels of adiponectin (AD) in the inflammatory joint of rheumatoid arthritis (RA). Methods ELISA was used to measure the levels of AD, IL-Iβ,IL-6, IL-8, TNF-α, MCP-1 and MMP-9 in the synovial fluids of RA and osteroarthritis (OA), the levels of these cytokines were tested after the synovial fibroblasts (SFLs) were stimulated with AD. Doublelabeling immunohistochemistry was used to analyze the expression of AD in RA synovium. Cytokines were measured by ELISA after SFLs were stimulated with AD. The expression of RANKL was detected by real-time PCR after MH7A were treated with AD and IL-6 ANOVA, Student's t-test, Mann-Whitney U-tese, Spearman's-test were used for statistical analysis. Results High levels of AD in RA synovial fluids were correlated with IL-6 levels. Double labeling immunohistochemistry showed that AD was localized in fibroblasts. MCP-1 and IL-6 were dramatically increased in human synovial fibroblasts following incubation with recombinant AD for 24 h. RANKL mRNA was significantly increased in MH7A after treated with AD and IL-6. Conclusion High levels of AD in the inflammatory joints of RA are likely to contribute to the high expression of IL-6, MCP-1 and RANKL, which may play an important role in the chronic inflammation, osteoclasts activation and bone erosion in RA.

Objective To investigate the diagnosis and treatment characteristics of pure red cell aplasia (PRCA)caused by human parvovirus (HPV)B19 infection after renal transplantation.Methods Two cases with PRCA caused by HPV B19-induced after renal transplantation,who were treated in the Department of Organ Transplantation,Nanfang Hospital,Southern Medical University,were summarized.Combined with literature review,the clinical characteristics,diagnostic method,course of treatment and prognosis of such disease were investigated.Results Two renal transplant recipients developed severe anemia early after transplantation with progressive deterioration and failed transfusion therapy.Other causes of anemia were ruled out and two patients were diagnosed as PRCA caused by HPV B19 infection according to bone marrow aspiration and biopsy as well as HPV DNA detection by fluorescent polymerase chain reaction (PCR).The symptoms of anemia were improved significantly after adjustment of immunosuppressive treatment protocol and intravenous immunoglobulin (IVIG).Conclusions For patients with unexplained and progressed anemia early after renal transplantation,especially those complicated with reticulocyte deficiency,the possibility of PRCA caused by HPV B19 infection shall be considered.The results of bone marrow aspiration and fluorescent PCR are the main bases for diagnosing PRCA.Immunosuppressive agents reduction and application of IVIG are the major treatment measures.Most of patients have great prognosis after treatment,but this disease is likely to recur.

Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.

Objective To investigate the clinical significance of serum interleukin-6(IL-6),C-reactive protein(CRP) and procalcitonin(PCT) in early diagnosis of postoperative infection after artificial femoral head replacement in rabbits.Methods Selected 64 healthy New Zealand white rabbits,and randomly divided them into the experimental group and the control group,with 32 cases in each group.All of the 64 rabbits underwent left femoral hip replacement.Rabbits in the experimental group were injected with staphylococcus aureus into the left hip joint immediately after artificial femoral head replacement,while rabbits in control group were injected with the same amount of saline.The changes of IL-6,CRP and PCT in synovial fluid of all rabbits were measured.Took synovial fluid and 3 pieces of synovial membrane to make bacterial culture 9 days after surgery.Results The bacterial culture of the experimental group was positive for staphylococcus aureus while it was negative in the control group.One day after surgery,the levels of IL-6,CRP and PCT in synovial fluid of two groups were significantly higher than those before operation(P<0.05),but the difference between the two groups was not statistically significant(P>0.05).The levels of IL-6,CRP and PCT in the synovial fluid of the experimental group were significantly higher than those of the control group at the 3rd,6th and 9th day after operation(P<0.05).There was a significant increase in IL-6,CRP and PCT levels in the two groups at the first and 3rd day after operation(P<0.05).At 6th days after operation,the levels of IL-6,CRP and PCT in synovial fluid of experimental group continued to increase(P<0.05),and they began to decrease in the control group (P<0.05).PCT gradually restored preoperative level at 6th days after operation(P>0.05),and IL-6 and CRP gradually restored preoperative level at 9th days after operation(P>0.05).The sensitivity and specificity of IL-6,CRP and PCT combined test were 96.9% and 90.6% respectively,which were significantly higher than those of individual indexes.Conclusion Combined detection of serum IL-6,CRP and PCT levels in the infection model of artificial femoral head replacement can provide some help for the early diagnosis of infection after clinical hip arthroplasty.

OBJECTIVETo establish the method of high-performance liquid chromatography HPLC for the determination of N-acetyl-S-(2-carbamoylethyl)-cysteine (AAMA) in urine.

METHODSAfter acid hydrolysis, AAMA in urine was converted into S-2-carboxyethyl cysteine (CEC). CEC reacted with the derivative reagent ophthalaldehyde and formed the derivative with strong fluorescence absorption. The HPLC-fluorescence detector was applied, with an excitation wavelength of 340 nm and an emission wavelength of 450 nm.

RESULTSUrinary AAMA demonstrated an excellent linearity in the range of 5.3~123.5 μmol/L, with a correlation coefficient of 0.9994. The minimum detectable concentration was 0.1 μmol/L (the volume of urine sample was 1.0 ml), the recovery of standard addition was 97.4%~104.2%, and the between-run precision was 2.3%~4.3%. The sample could be stored in the refrigerator for at least 7 days at a temperature of 4℃.

CONCLUSIONThe method is simple, with a low cost, a high sensitivity, and good precision and accuracy, and the instrument and equipment commonly seen in laboratories are applied. Therefore, this method is worthy of wide application.

Objective To use diagnosis related group (DRGs ) for the first time in overall evaluation of inpatient service performance evaluation of major diagnostic category (MDC)for all the Beijing municipal hospitals,and recommend how to strengthen Beijing municipal hospitals system in diagnosis and treatment ability of main diseases and improve inpateint service performance.Methods BJ-DRGs burster software was used to analyze the first page information of the medical records of cases discharged from all the Beijing municipal hospitals between 2012 and 2014 to determine the weight of each DRG,and based on such weight the related indicators of such hospitals and central hospitals in 2012, 2013,2014 were compared and analyzed.Results Improvements were found in such indices as diagnosis and treatment difficulty of 50% MDC,time efficiency of 81.8% MDC,cost efficiency of 77.3% MDC, and general capacity of 54.5% MDC for all Beijing municipal hospitals.In addition,the municipal hospitals were found superior to the central hospitals in such indices as cost efficiency of 68.2% MDC, and time efficiency of 59.1% MDC.On the other hand however,they were found inferior to the central hospitals in such indices as diagnosis and treatment difficulty of 72.7% MDC,and the comprehensive ability index of the two systems were found equivalent.Another finding was that there was no obvious improvement of the coverage of disease types at major tertiary hospitals in Beijing for the past three years.Municipal hospitals of greater contribution of MDC weight were highly consistent with the hospitals assigned with national key projects of disciplinary developments. Conclusion The comprehensive evaluation results of inpatient service performance of main diseases at Beijing’s municipal hospitals based on DRGs system,showed that the Beijing’s hospital authority had played an important role in improving inpatient service performance especially in reducing the burden of patients,improving the service efficiency through increasing government investment,optimizing service organization and implementation of performance management.But it also suggested that measures such as collectivize construction and management should be taken to improve municipal hospitals’linical specialty ability, improve the MDC diagnosis and treatment difficulty,and resume their functions of tertiary hospitals.