[Objective]To review our experience in treatine infection after total knee arthroplasty with debridement and component retention to determine To the feasibility,indication,factors related to success and failure,and the main points of technique.[Method]Since 1990 to 2004,9 patients were treated with debridement and component retention at our department.[Result]Four of 9 patients successfully retained their component at most recent follow-up,without ongoing infection(mean 18 months,range 10～25 months).We have not draw the statistically significant factors that related to successful and failure,but the factors such as acute infection,surfacing replacement,immediate debrided after onset of symptoms,and the bacteria sensitive to antibiotic were relate to success.[Conclusion]Debridement and component retention can be used in acute postoperative infection and later acute hematogenous infection after total knee replacement,but timing and indication must be chosen strictly.

Objective Vascular mild cognitive impairment(VaMCI) refers to mild cognitive impairment caused by or associated with vascular causes.This study aims to investigate the characteristics of the cognitive impairment in patients with vascular mild cognitive impairment (VaMCI).Methods Seventy-five patients with VaMCI(VaMCI group) and 38 healthy old subjects whose age, sex and education level match the VaMCI group patients(control group) were recruited from the department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between Jan 2016 and June 2016.The neuropsychological examinations were used to evaluate the severity of cognitive impairment, specifically including the Minimum Mental State Examination(MMSE), Montreal cognitive assessment scale(MoCA), Clinical Dementia Rating(CDR), Activity of Daily Living Scale(ADL), Hachinski ischemic score table, Hamilton Depression Scale(HAMD) and Auditory Verbal Learning Test(AVLT).The Fazekas scale was used to assess the severity of white matter lesions, and the medial temporal lobe atrophy rating scale(MTA) was used to evaluate the atrophic severity of medial temporal lobe.Results The overall cognitive function score in VaMCI group was significantly lower than the control group [MMSE [25.7±2.3 vs 28.4±2.0] MoCA [22.8±3.9 vs 26.3±3.7]], the differences was statistically significant(P<0.05);as well as the AVLT-I [5.1±1.0 vs 8.9±1.9], AVLT-D [3.7±1.0 vs 9.8±1.5] and AVLT-R [7.6±1.9 vs 12±1.5] scores in VaMCI group was significantly lower than the control group, the differences was statistically significant(P<0.05), which suggested patients with VaMCI have overall cognitive impairment, especially memory impairment.But Fazekas and MTA scores in VaMCI groups were higher than the control group, the differences was statistically significant(P<0.05).Correlation analysis showed that the scale of medial temporal lobe atrophy had a negative relationship with the performance of MoCA (r=-0.434,P=0.002).Conclusion Our findings demonstrate patients with VaMCI have significant cognitive impairment, especially memory impairment, which may be correlated to the severity of the white matter lesions and the medial temporal lobe atrophy.

Objective Investigate the clinical features of the neurological disorders in patients after pulmonary thromboendarterectomy (PTE) for chronic pulmonary thromboembolism , analyze the factorial. Methods A retrospective study was made of 26 patients who underwent PTE between 2002 and 2010 in Beijing Chao-Yang hospital. The symptom of neurological system disorders occurred in the survivors were been investigate. The preoperative conditions and the perioperative conditions of all survivors were investigated. Compared the differences between the groups with neurological system disorders and the groups without. Results There were 22 patients of 26 survived after the surgery. Cardiac function of the survivors improved, and the quality of life improved significantly. 5 cases of the 22 survivors had symptoms of neurological system disorders. 3 patients showed lethargy, delirium, memory disorders, brain CT found no abnormal, symptoms recovered within 2 weeks. The fourth patient showed ataxia, unsteady gait, dance-like movements symmetry, in addition to the above symptoms, brain CT no abnormal showed,brain MRI showed bilateral abnormal signal in the midbrain, basal ganglia, symptoms improved and discharged after 8 weeks, the symptoms completely disappeared 6 months, and the abnormal signals in brain in MRI disappeared. The fifth patient with similar symptoms to the fourth, brain CT no abnormal found, be discharged 10 weeks after the operation, recovery is poor, living part of themselves. The postoperative neurological disorders occurred in the patients of Jamieson surgery type Ⅲ type, Ⅳ type of larger proportion, (P = 0.024), longer circulatory arrest surgery (P = 0.034). Conclusion The neurological disorders postoperative PTE often showed diffuse symmetric cerebral cortex and basal ganglia nerve dysfunction, brain MRI showed abnormal signal corresponding region, the majority of symptoms disappeared in 2 - 8 weeks, abnormal signal in brain MRI could disappeared after 6 months. Neurological dysfunction occurs in patients with more difficult surgical procedure, longer circulatory arrest, suggesting that with the surgery cerebral ischemia and hypoxia related.

Objective To explore the measures to prevent recurrent laryngeal nerve (RLN)injury during thyroid surgery.Methods The clinical data of 223 patients undergone thyroid surgery were retrospectively analyzed.Among the 223 surgeries,69 sides were undergone regional protection act of RLN and 191 sides were performed RLN exposure.Results There were 2 cases of RLN injury from the regional protection operation of RLN,including 1 case of temporary nerve injury which could be resulted from surgery clamp and 1 case of permanent nerve injury which might be caused by mistaking ligation during surgery.There was only 1 case of temporary nerve injury in RLN exposure procedure which was probably caused by the postoperative nerve edema and was recovered 2 months after the operation.The total RLN injury rate was 1.35％.Conclusion For benign thyroid lesions and non-dorsal lesions or during partial excision of the gland,the regional protection of RLN is helpful to prevent RLN injury.In cases with dorsal lesions of thyroid or contralateral RLN injury,or during lobe subtotal resection,lobe resection and reoperation,exposing RLN to prevent injury is necessary.Taking different approaches based on the profiles of lesions and surgical procedures to prevent RLN injury can significantly reduce the risk of RLN injury.

Objective To investigate the possible protective effects of hydrogen sulfide (H2S) on rats with multiple organ dysfunction syndrome (MODS). Methods NaHS was taken as a donor of H2S. Forty Sprague-Dawley rats were divided into 5 groups with 8 rats in each group:sham group,MODS 12 h model group,MODS 24 h model group,NaHS protection 12 h and 24 h groups. The content of superoxidase dismutase (SOD),malondialdehyde (MDA),glutathione peroxidase (GSH-Px),alanime transaminse (ALT),creatine kinase (CK) and creatinine (Cr) in serum were measured,respectively. The histopathological changes in the heart,liver,lung,kidney and small intestine were observed. Results The serum content of SOD and GSH-Px was significantly higher in protected H2S groups (P

Purpose To investigate the value of cytopathological diagnosis in combination with histopathological diagnosis for peripherial and diffuse lung diseases by biopsy specimens under CT guidance.Methods A total of 370 cases of lung biopsy specimens under CT guidance were reviewed.The correlation between cytopathological diagnosis and histopathological diagnosis was analyzed.The sensitivity and false negative rate of cytopathological diagnosis,histopathological diagnosis and the combinational diagnosis method were calculated,and the accordance rate of cytopathological diagnosis with histopathological diagnosis was analyzed.Results Among the 370 cases,histopathological diagnosis revealed 177 (47.84％) cancers,22 (5.95 ％) malignant tumors,16 (4.32％) suspicious malignancy,12 (3.24％) atypical cells and 143 (38.65 ％)negative findings,whereas the corresponding number for cytopathological diagnosis were 166(44.87％),10(2.70％),16(4.32％),49(13.24％)and 129(34.87％).The two diagnosis methods were correlated (P ＜ 0.001).The sensitivity of cytopathological diagnosis,histopathological diagnosis and the combinational method were 80.00％ (192/240),89.58％ (215/240) and 98.33％ (236/240),respectively.The eytopathologieal diagnosis and the histopathologieal diagnosis had a statistically significant difference in the sensitivity (P ＜ 0.05).The difference in sensitivity between the combinational method and the histopathological diagnosis was statistically significant(P ＜ 0.05).Overall,66.15％ (127/192) of the cytopathogically positive cases were precisely typed by cytopathological diagnosis.Complications during or after the operation were found in 14.59％ of cases,among which 31 had pneumothorax and 23 had bleeding in the needle passage or bloody sputum,all improving after appropriate treatment.Conclusion Percutaneous lung biopsy under CT guidance is a safe,sensitive and accurate method for diagnosis of lung diseases,and the combinational use of cytopathological diagnosis and histopathological diagnosis significantly increases the rate of diagnosis and has a favorable clinical application value.

BACKGROUND: Available evidence suggests that following spinal cord injury, obvious reduction of Mg2+ level occurs in both the serum and the injured spinal cord, which has significant effects on cell membrane permeability, vascular regulation as well as secondary spinal cord injury.OBJECTIVE: To investigate the protective effects of magnesium sulfate (Mg2SO4) administered via intraperitoneal injection on the injured spinal cord of SD rats.DESIGN: A randomized controlled experiment.SETTING: Department of Orthopedics, Renmin Hospital of Wuhan UniversityMATERIALS: Forty-eight adult male SD rats were allocated randomly into experiment group and control group with 24 rats in each.INTERVENTIONS: The experiment was conducted in the Laboratory of Department of Orthopedics, Renmin Hospital of Wuhan University from April to August 2002. One hour after establishment of spinal cord injury models, the rats in the controlled group were injected intraperitoneally with normal saline, while those in the experiment group were given intraperitoneal injection of 300 mg/kg Mg2SO4. At each time point of 4, 8 and 24 hours after the treatment, 6 rats were selected from each group for measuring free Ca2+ concentration in the cells at the site of injury with spectrofluorometer . The activities of superoxide dismutase (SOD) in the spinal cord were detected by means of xanthine oxidation and thiobarbituric acid was used to determine the concentration of malondialdehyde (MDA). Lowered SOD activity and decreased MDA level were considered to suggest the protective effect of Mg2SO4 against spinal cord injury. Inclined plane test was used to assess the spinal cord function at 8, 24 hours and 1 week after the injury, in which the rat was made to stand on an inclined plate covered by a piece of rubber and the plate was inclined gradually until the rat was no longer able to stay in the original position for 5 s, and the inclination of the plate was recorded. The test was performed 3 times for each rat and the plate inclinations were averaged. An increased inclination indicated improvement of the spinal cord function.MAIN OUTCOME MEASURES: ① Intracellular Ca2+ concentration at the injury site. ② Changes in SOD activity and MDA concentration in the spinal cord. ③ Results of spinal cord function evaluation of the rats.RESULTS: Intracellular Ca2+ concentration at 8 and 24 hours after the injury was significantly lower in the experimental group than in the control group [(376.5±36.2)×10-9vs (425.9±32.7)×10-9 mol/L and (316.3±13.9)×10-9vs (350.2±29.4)×10-9 mol/L, respectively, P ＜ 0.05]. Compared with the control group at each time point, MDA concentration was significantly decreased, while SOD activity of SOD was increased in the experiment group (P ＜ 0.01). The improvement of spinal cord injury was not obvious in the experiment group and was significantly higher than that in the control group until I week after the injury [(53.3±4.3)° vs (44.3±5.7)°, P ＜ 0.05].CONCLUSION: Intraperitoneal Mg2SO4 injection may significantly lower the concentration of intracellular Ca2+ at the injury site and alters the product of lipid peroxidation, suggesting its neuroprotective effect against spinal injury so as to lighten secondary spinal injury in rats.

Objective: To investigate the effects of FGFR1OP and p57/Kip2 proteins on the genesis and progression of gliomas and their clinical significance. Methods: The expression of FGFR1OP and p57/Kip2 in 54 glioma specimens was detected by SP immunohistochemical technique. The relationship between the ex-pression levels of those proteins and various clinical pathologic factors was evaluated. Results: The expres-sion of FGFR1OP and p57/Kip2 was found in 66.7% and 44.4% gliomas, respectively. The OD value of FG-FR1OP was 0.131±0.010 in high grade gliomas, and 0.118±0.010 in low grade ones, with a statistical signifi-cance (t=-5.497, P=0.000), showing that higher expression of FGFR1OP was significantly associated with glo-ma cell differentiation. The OD value of p57/Kip2 was 0.156±0.008 in high grade gliomas, and 0.165±0.006 in low grade ones, with a statistical significance (t=0.296, P=0.014), showing that lower p57/Kip2 expression was correlated with high grade gliomas. FGFR1OP was negatively correlated with p57/Kip2 in gliomas (r=-0.732, P<0.01). Conclusion: Increased expression of FGFR1OP and/or decreased expression of p57/Kip2 may play an important role in the genesis and progression of gliomas and may indicate a poor prognosis.

Objective To investigate the effect of the optimal prescription of huiru yizeng on rats with hyperplasia of mammary gland and hyperprolactinemia. Methods Fifty-six female Wistar rats were randomly divided into 7 groups (n=8), including normal control group, model control group, sodium chloride group, bromocriptin group, rupi sanjie group, the original prescription group and optimizing prescription group. Rat model of mammary gland hyperplasia with hyperprolactinemia was replicated in 6 groups but not the normal control group. The successfully established experimental rats were given corresponding drugs by intragastric gavage. After 30 days, the levels of the estradiol, progesterone, and prolactin were detected, and the pathomrphology of glandular tissue was observed. Results Prolactin levels of model control group, the original prescription group and optimize prescription group were (69.47 ±6.08), (53.13 ±10.59), and (28.41 ±6.37) pg·mL-1, respectively . Compared with that in the model control group, the contents of prolactin in both the optimal prescription group and the original prescription group were reduced, but the optimal prescription group was better (P<0. 01). In the original prescription group, the lobules of mammary gland showed a few of hyperplasia, the individual alveoli and duct showed a slight hyperplasia, and a small amount of secretions was found in the duct. The degree of the hyperplasia was alleviated in the optimal prescription group similar to that observed in the normal control group, which showed that there was no hyperplasia in the lobules of mammary gland or no secretions in the duct. Conclusion The therapeutic effects of the optimal prescription are much better than the original prescription, which can effectively lower the level of prolactin, adjust the balance among the prolactin , estrogen and progesterone, and alleviate the pathological hyperplasia of mammary glands in the model rats.

Objective To investigate the feasibility and curative effect of botulinum toxin type A(BTX-A)point injection under the guidance of type-B ultrasonic on upper limb spasticity after stroke.Methods 18 cases were divided into two groups:9 cases for treatment group were treated with point injection BTX-A in 5 points with the guidance of type-B ultrasonic diagnosis,other 9 cases for control were only injected experientially.They were evaluated with the modified Ashworth scale(MAS)and the time taking effect were recorded.Results Compared with the control,the scores of MAS in the treatment group improved,and they came into effect more quickly(P<0.05).Conclusion The point injection of BTX-A under the guidance of type-B ultrasonic was practicable for and effective on upper limb spasticity after stroke.