BACKGROUND:Total knee arthroplasty mainly used fixed platform, but more and more movable platform was selected year by year in the clinic. Rotary platform theoretical y can apparently improve the curative effects, but it has not been verified in the clinic.
OBJECTIVE:To summarize the design characteristics and clinical results of Gemini MKII (Link, Germany) rotary platform.
METHODS:From January 2004 to January 2009, 108 patients (119 knees) including 31 males and 77 females were treated with total knee arthroplasty by using Gemini MKII system. There were 97 unilateral cases and 11 bilateral cases at the first stage of replacement. Preoperative diagnosis:1 case of hemophilic arthritis, 1 case of venereal Charcot’s disease, 8 cases of post-traumatic arthritis, 11 cases of rheumatoid arthritis, and 87 cases of degenerative osteoarthritis. The prosthesis was fixed with bone cement. None received patel ar replacement. RESULTS AND CONCLUSION:None experienced infection, femoral condyle fracture or nerve and vascular damage. Except bilateral replacement, the average operation time of unilateral replacement was (56±13) minutes. Average postoperative hemoglobin decreased (25±5) g/L. After replacement, hemoglobin maintained over 100 g/L in 83 patients (86%), without blood transfusion. Knee joint score and function score recovered to (92.0±4.7) points and (90.3±6.8) points at half years after replacement, and became (94.4±3.2) points and (91.6±5.9) points during final fol ow-up, which was significantly improved as compared with that pre-replacement (P<0.01). No revision surgery should be done for lining prolapse or spin out, osteolysis and prosthesis loosening. These results indicated that the early and midterm results of Gemini MKII rotating-platform prosthesis were satisfactory, but the long-term results remain to be confirmed.

BACKGROUND: Activated by Ca2+, phospholipase A2 will aggravate the influx of Ca2+ or the release of intracellular Ca2+, and then forms a vicious circle, which results in a continuous increase in free calcium level and leads to server injury in neural cells.OBJECTIVE: To discuss the protective effects of nimodipine on acute ischemic brain injury caused by activation of phospholipase A2.DESIGN: A completely randomized controlled trial.SETTING: Intensive Care Unit (ICU) of Children's Hospital, Chongqing Medical University.MATERIALS: From January 2001 to October 2003, it was completed at the ICU of Children' s Hospital, Chongqing Medical University. Thirty male rats were selected and divided into sham operation group, ischemia group and nimodipine treated group randomly, with 10 rats in each group.METHODS: In sham operation group, the right common carotid artery was identified by blunt dissection without ligation under anesthesia in rats. In ischemia group, at 30 minutes before cerebral ischemia, 2 mL saline was injected intraperitoneally. In nimodipine treated group, at 30 minutes before cerebral ischemia, 0.2 g/L nimodipine (2 mg/kg) was injected intraperitoneally. In all the three groups, the duration between ischemia and decollation was 120 minutes. Rats were decollated under anesthesia and their brains were taken out to assess the activity of phospholipase A2, the free calcium level in brain cells, the brain water content and the changes in mRNA levels of type Ⅱ phospholipase A2 (secretive phospholipase A2) and type Ⅳ phospholipase A2 (cytoplasmic phospholipase A2) in brain tissue.pholipase A2) and type Ⅱ phospholipase A2 (cytoplasmic phospholipase A2)in brain tissue were measured in rats in all the groups.pholipsse A2 in brain tissue: In ischemia group and nimodipine treated group, the activity of phospholipase A2 were higher than that in sham operation group [(57.8 ±7.2),(42.5±6.1), (17.1±5.3)%, P＜ 0.05-0.01], and it was a litter lower in nimodipine brain cells: It was higher in nimodipine treated group and ischemia group than that in sham operation group [(775.8±105.5), (497.2±45.9), (103.8±10.3) μmol/L,P ＜ 0.05-0.01], and it was lower in nimodipine group than in ischemia group (P ＜ 0.01).that in sham operation group [(82.9±0.5), (80.0±1.1), (72.1±0.01)%, P ＜ 0.05-0.01], and it was lower in nimodipine treated group than that in ischemia group (Ppase A2 could be detected in brain tissue. And the mRNA level of type Ⅱ phospholipase A2 in brain tissue was very low. At 120 minutes after ischemia, mRNA of type Ⅱ phospholipase A2 was detectable and the expression of type Ⅱ phospholipase A2 was increased. Compared to ischemia group, the expression of type Ⅱ phospholipase A2 was not decreased in nimodipine treated group while the expression of type Ⅱ phospholipase A2 was decreased.CONCLUSION: Nimodipine is capable of decreasing the free calcium level in brain cells, the activity of phospholipase A2 in brain tissue and the brain water content after ischemia. However, it cannot significantly inhibit the expressions of type Ⅱ phospholipase A2 and type Ⅱ phospholipase A2 after cerebral ischemia.

Objective To evaluate the safety and efficacy of two surgical procedures including retropubic space pathway and obturator foramen pathway in treatment of the old women with stress urinary incontinence (SUI). Methods Intravaginal Slingplasty (IVS) procedure by retropubic space pathway was performed in 52 cases with simple SUI from June 2003 to June 2005. And the modified Transobturator Vaginal Tape Inside-Out (TVT-O) procedure was carried out in 112 cases with simple SUI from October 2005 to October 2008, using self-tailed polypropylene mesh and helical needles. The comparative retrospective study was performed between these two groups. Results The cure rate was 80.8% (42/52) and the improvement rate was 13.5% (7/52) in IVS group. And the corresponding data were 84.8% (95/112) and 11.6% (13/112) in modified TVT-O group. The 3 (5.8%) cases failed in IVS procedure and 4 (3.6%) cases failed in modified TVT-O procedure at 1 month's follow-up. All of the 7 patients received the 'Tong's hammock procedure' and no cases failed at 6 and 12 month's follow-up. One case of vaginal erosion was found in each group although good effect of continence was observed. Meshes were removed in these two patients and then the 'Tong's hommock procedure' was performed which turned out to be good outcome. Bladder injuries were found in 3 cases when route cystoscopy was performed. No significant difference in efficacy was found between these two groups(P＞0. 05). In modified TVT-O group, operative duration, blood loss and medical cost were significantly reduced as compared with IVS group (P＜0. 01). Conclusions Both of the two surgical procedures of modified TVT-O versus IVS are simple, safe and mini-invasive procedures with high efficacy. However, the modified TVT-O procedure is more easy to be adopted by patients due to short operative time and lower medical cost.

BACKGROUND: The femoral intramedul ary guides in total knee arthroplasty require high precision, complex operation, it is very important for prosthesis and joint function to choose more precise positioning method and determine the correct needle point. OBJECTIVE: To study the effect of needle point position on prosthesis arrangement when applying different femoral intramedul ary guides methods in total knee arthroplasty. METHODS: Total y 80 patients who received the treatment of total knee arthroplasty in Changshu No.1 People’s Hospital from January 2012 to July 2015 were selected and divided into test and control groups according to random number table (n=40/group). The patients in the test group accepted CT scan for femoral intramedul ary guides. The theoretical position of femoral intramedul ary guides entry point was marked using radiographic parameters. In the control group, the traditional total knee arthroplasty technology was used to mark the entry point of femoral intramedul ary guides. The needle point position when applying different femoral intramedul ary guide methods was observed. The effect of femoral intramedul ary guides on prosthesis arrangement in total knee arthroplasty was discussed. RESULTS AND CONCLUSION: Compared with the control group, the distance from entry point to femoral anatomic line on positive and lateral X-ray film in the test group was shorter, femoral prosthesis lateral angle and physiological valgus angle were closer to the theoretical value, distance from intersection of femur axis and femoral condyle to block center was shorter; the differences were statistical y significant (P < 0.05). These results demonstrate that compared with the traditional two-dimensional intramedul ary positioning, the needle point position of three-dimensional CT scan stimulative positioning is more accurate. The location more concentrates on within intercondylar fossa 2-5 mm, more front of intercondylar fossa 3-10 mm, three-dimensional CT scan stimulative positioning is a reliable choice for femoral intramedul ary guides.

Objective To analysis the malignant performance characteristics of tumor stem cell-like side popula-tion cells in patients with cervical cancer. Methods The cervical cancer cells were obtained from surgical resection tumor tissue. The tumor stem cell-like side population cells were isolated by flow cytometry. The cell growth curve was drawn by MTT assay. The invasion ability of tumor cells was compared by transwell assay. The clonogenic capacity was detected by clone formation in soft agar. The expression level of ABCG2 protein, a drug-resistant gene, was detected by immunofluores-cence method. Finally, these cells were transplated into the subcutaneous of de thymus mice. The rate of tumor formation was compared between groups. Results The results from flow cytometry assay showed the percentage of cervical cancer stem cell-like side population cells was 1.39%. Compared with the non-side population cells, the side population cells grow quickly, showed the enhanced invasion ability and colony forming ability. There was more high expression level in ABCG 2 protein of side population cells. The tumor form rate was 100%(10/10) in the side population cells and the non-side popula-tion cells was 20%(2/10). Conclusion The cervical cancer stem cell-like side population cells have more malignant perfor-mance characteristics than that of non-side population cells, which maybe a core target for cancer gene therapy in the future.

AIM: To explore the effects of uremic serum on proliferation and trans-differentiation of human renal tubular epithelial cells. METHODS: Human renal tubular epithelial cell line (HK-2) was cultured in RPMI-1640 medium. The proliferation effects of uremic serum at different concentrations were evaluated by methylene blue assay (MTT method) and flow cytometry. The positive cells percentage of ?-smooth muscle actin(?-SMA)in different concentration uremic serum medium was also measured by flow cytometry in vitro. RESULTS: Absorbance 490 (A 490) was increased in 5%-20% uremic serum groups compared with that in normal controls with the use of MTT. Cells in G 1 phase were decreased, but proliferation index (PI) was increased in 10%-20% uremic serum groups compared with that in normal controls with the use of flow cytometry. No significant difference of cell proliferation index was found among uremic serum groups. The positive percentage of ?-SMA cells was increased significantly in uremic serum groups compared with that in normal controls, and increased in parallel with the increasing of uremic serum concentration. CONCLUSION: Uremic toxin may accelerate renal tubulointerstitial fibrosis through promoting renal tubular epithelial cell proliferation and trans-differentiation in patients with chronic renal failure.

Objective To observe the safety and efficiency of SpO_2 -Allen's test in peri -puncture radial artery cannulation for invasive blood monitor. Methods 50 patients were selected for the radial artery cannulation in surgical intensive care unit(SICU). All of them were still sober. All of the patients were examined by SpO_2 -Allen's test and Allen's test before radial artery cannulation, 3 days after puncture and after pulling out the cannula. Resluts The results of Allen's test of 42 patients were negative,while those of 49 patients were negative in SpO_2 - Allen's test. Statistics difference existed between group of SpO_2 - Allen's text and group of Allen's text(P

Objective To evaluate the renal protective effect of targeted abdominal perfusion pressure (APP) treatment in intra-abdominal hypertension (IAH) and further investigate its related mechanisms.Methods Twelve healthy pigs were randomly divided into experimental group and control group,each group had 6 pigs.All animals were collected urine volume each hour,continuously monitored mean arterial pressure (MAP) and renal cortical blood flow after anesthesia.IAH models were established by intraperitoneally injecting carbon dioxide in all animals,the baseline MAP,intra-abdominal pressure (IAP)and APP were obtained before IAH models established.In both groups,IAP was raised gradually from 0 mm Hg to 10 mm Hg,20 mm Hg and 30 mm Hg.In control group,IAP was maintained at 30 mm Hg for 8 hours with-out any other interventions.In experimental group,the animals were intravenously given with norepinephrine in order to get a target level of APP equal to its baseline values after 15 minutes of the onset of 30 mm Hg IAP.Changes of renal cortical blood flow,serum creatinine,TNF-α,IL-6 and urine IL-18 with the alteration of IAP in both groups were explored.Animals were then sacrificed for renal histopathology after 8 hours of the onset of 30 mm Hg IAP.Results With the increase of IAP,renal cortical blood flow in both groups was significantly decreased (P ＜ 0.01).Compared to its baseline,serum Cr and urinary IL-18 were significantly up-regulated after the maintenance of IAP at 30 mm Hg for 6 hours in both groups (P ＜ 0.05).However,in experimental group,which utilized a strategy of targeted APP,significant improvement of the renal cortical blood flow was observed (P ＜ 0.01),and urinary IL-18 was significantly lower than the control group (P ＜ 0.05).Renal histopathological examination found no obvious abnormalities either in control group or in experimental group.Conclusions The targeted APP treatment may have some renal protective function within the first 8 hours of IAH by improving renal cortical blood flow rather than affecting systemic inflammatory response.

Objective To explore the possibility of the inner vertical outer spiral complex tubular urethra scaffold vascularization in repairing long segment of urethral defect.Methods From August 2014 to October 2015,27 clean male New Zealand white rabbits were divided into 3 groups,S1 group was transfected recombinant vascular endothelial growth factor(VEGF) gene lentiviral vector group.S2 group was vascular pedicle transfer tube group.C group was simple stent group.A 3.0 cm inner vertical outer spiral complex scaffold was constructed by using the small intestine acellular matrix (SIS) and polylactic acid copolymer (PLGA) modified by type Ⅰ collagen surface,and adipose-derived mesenchymal stem cells (ADSC) and smooth muscle cells after transformation from New Zealand white rabbits.In S1 group,the seed cells were transfected by recombinant vascular endothelial growth factor (VEGF) gene lentivirus,which express VEGF protein.The complex scaffold was used to repair 3.0 cm rabbit urethral defect In S2 group,the untransfected cells were seeded into the scaffold and embedded in the skin near the groin artery 3 weeks for repairing urethral defect with vascular pedicle transfer tube.In group C,the unseeded scaffold was used to repair the urethral defect alone.Postoperative observation and urethrography were followed 4,8 and 24 weeks after implantation.The HE staining,fluorescence tracing,immunohistochemical and scanning electron microscopy were evaluated at the same phase.Results In S1 group,there were one urinary fistula and one urethral stricture-related death,respectively.The urethra was smooth and patent,histological examination showed active hyperplasia of urethral capillary.In S2 group,there were one urinary fistula and two urethral stricture-related deaths,respectively.The urethral was rough,local thinning or dilated.Fat accumulation and mucosal contraction were found in the urethral submucosal,respctively.In C group,there were one urinary fistula,three hypospadias,and three urethral stricture-related deaths.The thickness of the urethra was uneven and stricture bending.The urethral mucosa was poorly repaired and the scar was narrow.HE and CD31 staining showed that S1 and S2 groups were active in the proliferation of urethral capillaries,and the angiogenesis was abundant.VEGF staining showed that the cytoplasm of endothelial cell layer,smooth muscle layer of vascular wall and the urothelial epithelial cell layer were fully expressed at 24 weeks,especially in epithelial cell layer.CKpan staining showed that the epithelium of S1 and S2 group developed to stratified epithelium,and the morphology of urethra was similar to normal urethra at 24 weeks.The urethral epithelial in C group of grew poor as single-level,irregular arrangement,24 weeks is still a lack of effective stratified epithelium.HE and oα-SMA staining showed that the smooth muscle and actin gradually increased in group S1 and S2,α-SMA staining in group C was scarce and increased at 24 weeks.PLGA was encapsulated by the surrounding tissue and the structure of electrospinning was clear after 4 weeks,absorbed and degraded after 8 weeks and absorbed after 24 weeks.Conclusions The inner vertical outer spiral comnplex tubular urethra scaffold maybe a reasonable method in repairing long segment urethral defects,and the methods of tubular urethra scaffold vascularization by transfected VEGF gene recombinant lentiviral vector and vascular flap deserve more research.

Objective To investigate the role of B7/CD28 costimulation pathway blockade with adenovirus-mediated CTLA4-Ig gene in macrophage and CD8~+T cell infiltration and cell apoptosis in murine liver transplantation. Methods Rat pairs were divided into three groups: SD-to-Wistar transplantation control group, CsA-treated group and CTLA4-Ig-treated group. IHC and TUNEL were used to analyze the expression of CTLA4-Ig gene in liver and immune cells infiltrate and cell apoptosis in liver grafts. Pathology was done on all harvested grafts. ResultsCTLA4-Ig gene expression was positive in the donor liver on day 7 after administering adenovirus-mediated CTLA4-Ig gene via vein, and remained positive until day 60 after liver transplantation. Infiltration of immune cells in CTLA4-Ig-treated group was less than that in rejection control group. the apoptotic index of rejection group on day 3,5,7 was significantly higher than those of CTLA4-Ig-treated. Conclusions CTLA4-Ig gene was constantly expressed in the donor liver after single intravenousely injection into rats using adenovirus as vector. Adenovirus-mediated CTLA4-Ig gene therapy can inhibit infiltration of immune cells and apoptosis in grafts, thus prolonging the survival of recipients.