Background Atrial fibrillation (AF) is one of the most prevalent arrthythmias. Hypertension independently accounts for more AF cases than any other risk factors. Therefore,prevention of risk factors in patients with essential hypertensives(EH) is important for early prevention and diagnosis of AF. However,only a few data are available regarding left ventricle remodeling in essential hypertensive patients with atrial fibrillation(EH+AF). Objective To study the characteristics of left heart remodeling and function and its clinical significance in EH+AF,and predict some risk factors of AF. Methods All 561 patients were recruited which included EH+AF(n=224),EH alone(n=171),AF alone(n=166) with normal subjects as control(n=157). Interventricula septal thickness at end-diastole(IVSTd),posterior left ventricular wall thickness at end-diastole(LVPWTd),left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),left atrial dimension (LAD),left ventricular ejection fraction stroke volume(LVEF),stroke volume(SV)cardiac output(CO)were measured with echocardiography. Left ventricular mass(LVM),left ventricular mass index(LVMI)and relative wall thickness(RWT)were calculated. Results LVM,LVMI,IVSTd,LVPWTd,LVESD,LVEDD,LAD,RWT in the EH+AF group were significantly greater than those in the AF alone or EH alone patients(P

BACKGROUND:Periprosthetic joint infection is a complication that is difficult to deal with after joint arthroplasty. Early diagnosis is the key to treatment. To find a fast response, high-sensitivity and high-specificity molecular biomarker can significantly optimize the diagnosis process of periprosthetic joint infection. OBJECTIVE:To monitor blood procalcitonin, interleukin-6 and lipopolysaccharide binding protein levels, to compare with blood leukocyte count and C-reactive protein levels, to identify above indexes, and to distinguish sensitivity and specificity of periprosthetic joint infection. METHODS: A total of 81 patients with pain after arthroplasty who were treated in Affiliated Hospital of Jining Medical Colege from January 2008 to December 2013 were enroled in this study. The repair surgery of al patients was divided into two stages. In the first stage, complete debridement and the instalation of temporary occupancy device were conducted. After 3 months averagely, two-phase reconstruction was performed. At 1 day before surgery, venous blood was colected. Calcitonin, interleukin 6, lipopolysaccharide binding protein, leukocyte count and C- reactive protein levels were detected. During the operation, synovial membrane and sample of false envelope around the prosthesis were colected. Bacterial and histological examinations were performed. The sensitivity and specificity were calculated using receiver operating characteristic curve.
RESULTS AND CONCLUSION: One-way analysis of variance results showed that the receiver operating characteristic curve of lipopolysaccharide binding protein was bigger, 0.962; 95 confidence interval 0.924-1.000. Diagnostic value was optimal, and the critical value was 23.5 μg/L. These data suggested that when lipopolysaccharide binding protein exceeded 23.5 μg/L before surgery, periprosthetic joint infection would be identified. The receiver operating characteristic curve of C-reactive protein was 0.871. The receiver operating characteristic curve of leukocytes was close to 0.5. The diagnostic value of leukocyte count on periprosthetic joint infection was not great. These findings indicate that lipopolysaccharide binding protein has good application prospect in the diagnosis of periprosthetic joint infection after joint replacement, and shows high positive predictive rate and negative predictive rate of periprosthetic joint infection.

BACKGROUND:Failure of anterior cruciate ligament reconstruction can be caused by multiple factors, which requires a revision surgery. However, there are few studies about the revision of anterior cruciate ligament. OBJECTIVE:To investigate the primary cause, indication, methods and effectiveness of revision after the failure of anterior cruciate ligament reconstruction. METHODS: Thirty patients with instability undergoing anterior cruciate ligament reconstructions were subjected to revision under arthroscopy. After revision, a systemic analysis was performed based on KT-2000 examination, the International Knee Documentation Committee (IKDC) scale, Lysholm and Tegner scores. RESULTS AND CONCLUSION:Of the 30 cases, 9 cases were reconstructed with bone-patelar tendon-bone autograft, 14 cases with hamstring tendon autograft, 7 cases with hamstring tendon alograft. Twelve cases had a femoral tunnel in the front of the predicted one, 1 case had knee stiffness, 8 cases had a tibial tunnel in the front of the predicted one, and 8 cases had both the femoral and tibial tunnels in the front of the predicted ones. One case had a malposited interference screw which reconstructed with bone-patelar tendon-bone autograft; one case complicated by posteromedial corner injury was not reconstructed. The reconstructed anterior cruciate ligament was absolutely ruptured and absorbed in 12 cases, and 18 cases had obviously loosen but stil partly linked reconstructed ligament. None had severe incompletion of spongy bone. Al cases received primary revision. Ten cases reconstructed with ipsilateral hamstring tendon, 14 cases reconstructed with contralateral hamstring tendon, and 6 cases with LARS ligament. The mean side-to-side difference of KT-2000 examination at 90° and 30°, the mean IKDC, Tegner and Lysholm scores were significantly improved after revision. There were many reasons leading to failure of anterior cruciate ligament reconstruction, such as malposition of the bone tunnel, invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision folowing anterior cruciate ligament reconstruction.

Objective To evaluate the biomechanical effect of horizontal, vertical, and cruciate suture repairs and partial meniscectomy on contact mechanics. Methods Control group (complete meniscus), buckethandletear group and suture repaired group were recorded. The contact map of the control group was firstly recorded; simulated bucket handle medial meniscal tears were then created. Tears were treated with 1 of 3 suture repair techniques or partial meniscectomy. The 24 samples were treated randomly and thus there were 6 samples evaluated for every operation method. Instantaneous contact area (CA), mean contact pressure (MCP), and peak contact pressure (PCP) measurements were recorded with a pressure sensing system. CA, MCP, and PCP for intact stifles (control), stifles with simulated tears, and stifles after treatment were recorded and compared using 1-way repeated measures ANOVA. Results Stifleswithbuckethandletearshadsignificantlydecreased CA, increased MCP and increased PCP when compared with control group. All meniscal repair techniques reestablished normal contact mechanics. When comparing meniscal repair and partial meniscectomy, stifles with partial meniscectomy had lower CA, higher MCP and PCP than stifles undergoing repair (P = 0.851 and 0.987, respectively). Conclusions Contact mechanics obtained from each repair technique were mechanically superior to partial meniscectomy. Performing meniscal repair instead of partial meniscectomy with select meniscal tears may mitigate the development of degenerative joint disease.

Objective To identify risk factors for wound complications related to internal fixation of distal tibial fracture.Methods A total of 125 patients undergone open reduction and internal fixation of the distal tibial fracture between January 2008 and December 2011 were enrolled.There were 72 men and 53 women with mean age of 41.46 years.Factors contributing to operative wound complications assessed were demographic characteristics (age,gender,and smoking history),types of fracture,operative time,time from injury to operation,and concomitant diseases (diabetes and peripheral vascular disease).Patients with wound complications were defined as those requiring dressing care and oral or intravenous antibiotics or those requiring further surgical treatment.Results At follow-up,wound complications were recorded including 1 patient (0.8％) had surgical debridement and 10 patients (8.0％) had dressing care and oral or intravenous antibiotic therapy.Logistic regression analysis identified risk factors for wound complications were open fracture (OR =23.077,95％ CI 2.672-199.342,P ＜0.01) and age (OR =1.078,95％ CI 1.011-1.150,P ＜ 0.05).Otherwise,following factors exhibited no significant correlation with wound complications:age,body mass index,smoking history,types of fracture,multiple injury or not,and operative time.Conclusion Patients with older age or open fracture present an increased risk of wound complications after operation and need special concern.

BACKGROUND:Interlocking intramedul ary nail complications contain nail bent or broken, exit, re-fracture at spiketail or nail hole. Thus, our team designs a novel intramedul ary control ed dynamic nail.
OBJECTIVE:To evaluate the rationality and safety of intramedul ary control ed dynamic nail design and strength, and to give rational proposal for its clinical application.
METHODThe three-dimensional finite element models of composite femur, transverse fractures of the femoral shaft were constructed with intramedul ary control ed dynamic nailing. The stress and strain were detected under vertical loads and gait cycle.
RESULTS AND CONCLUSION:The maximum stress of the intact femur under the compression load was at femoral neck and the medial and lateral aspects of the femoral shaft;while the stresses of fractured femur were at the interface between screw and screw hole. In gait cycle, in case of intact bone, large stresses were found in the distal 1/2 of anteriomedialis of femoral shaft;while the stress distribution in fractured femur was similar with the 
former. Intramedul ary control ed dynamic nailing has the ability of generating compression between fragments. These suggest that intramedul ary control ed dynamic nailing is rational and good at design and biomechanical properties.

Objective To study the recurrence of colon adenoma after endoscopic high-frequency electric polypectomy.Methods The data of 238 patients undergoing endoscopic polypectomy between 2000 and 2008 were retrospectively analyzed.The cumulative recurrence rates at 0-2 years,＞2-5 years and ＞5-8 years after polypectomy,median recurrence time and main risk factors for recurrence were identified based on the features of adenomas detected on initial colonoscopy.Results The cumulative recurrence rates of adenoma at the surveillance examination were 61％,81％,and 84％ for the three intervals,respectively.On multivariate analysis,gender,age,extra-colonic tumor history,alcohol drinking history and adenoma number at initial examination were the independent risk factors of adenoma recurrence.Conclusion We suggest a 2-year surveillance interval for Chinese patients with colonic adenoma after the initial endoscopic polypectomy,a 20-month surveillance interval for males over 60 years old who have more than 2 sdenomas at the initial colonoscopy,and an even shorter interval for those with exira-colonic tumor history or alcohol drinking history.

Objective To explore.the effect of operative treatment for more than 70-year-old patients with osteoporotic hip fracture,and analyze the clinical feature,perioperative management and choices of operative treatment.Methods One hundred and fifty-nine patients of more than 70-year-old with osteoporotic hip fracture were operated from June 2007 to October 2010.Fracture type:38 cases with intertrochanteric fracture while femoral neck fracture in 121 cases.Results One hundred and thirty-five cases were followed up after operation ranging from 3 to 43 months.There were 2 cases by proximal femur nail internal fixation,13 cases by proximal femur locked plate internal fixation,15 cases by dynamic hip screwinternal fixation,48 cases by bipolar femoral head arthroplasty and 57 cases by total hip arthroplasty.The Harris scores of various surgical method above respectively were 100.0％ (2/2),76.9％ ( 10/13 ),80.0％(12/15),89.6％ (43/48),96.5％ (55/57).Conclusions The operation plays an important role in the treatment of elderly osteoporotic hip fracture,having so many advantages as earlier mobilization,less complications and better life quality.But it is important to pay attention to perioperative management and choose reasonable surgical approach according to classification of fracture.

BACKGROUND:Lateral retinacular release is effective to treat anterior knee pain, but it has not been confirmed through the parameters of the knee joint. OBJECTIVE: To analyze the relevant parameters on the axial X-ray films of the patela before and after lateral retinacular release and then to find out the efficient parameters for patelofemoral joint disorders on the axial X-ray film of the patela, which are of most clinical significance. METHODS: Fifty patients with anterior knee pain were included randomly who admitted at the Department of Joint Surgery, Affiliated Hospital of Jining Medical University from February 2009 to December 2013, including 45 cases of Outerbridge I-III undergoing arthroscopic lateral retinacular release+articular cartilage repair and 5 cases of Outerbridge IV undergoing lateral retinacular release+knee joint surface replacement. RESULTS AND CONCLUSION:After lateral retinacular release, the congruence angle, patelofemoral index and tilt angle were al reduced significantly (P < 0.05 orP < 0.01), but there was no change in the lateral patelofemoral angle (P > 0.05). The patelar trajectory restored to the corresponding central position of the femoral condyle, and meanwhile, no joint hematoma, deep vein thrombosis and patelar subluxation occurred. These findings indicate that the lateral retinacular release is of great significance for treatment of anterior knee pain induced by lateral patelofemoral compression.

Objective:To investigate the expressions of miR-20a-5p and lysine (K) demethylase 6B (KDM6B) in osteosarcoma tissues and the effects of miR-20a-5p targeting KDM6B on the proliferation, migration and invasion of osteosarcoma cells and tumor growth.Methods:The clinicopathological and paracancerous tissues of 20 patients with osteosarcoma admitted to the First Affiliated Hospital of Chinese Medical University from January 2017 to March 2019 were collected. Quantitative real-time PCR (qRT-PCR) was used to detect the expression levels of miR-20a-5p and KDM6B mRNA in tissues. The osteosarcoma MG63 cells were divided into control group, mimic NC group, miR-20a-5p mimic group, and NC+ empty vector group, miR-20a-5p+ empty vector group, miR-20a-5p+ KDM6B group. The expression levels of miR-20a-5p and KDM6B mRNA of all groups were detected by qRT-PCR. Western blotting was used to detect the expression level of KDM6B. CCK-8 assay, cell scratch test and Transwell test were used to detect cell proliferation, migration and invasion ability. According to the random number table method, nude mice were divided into NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group, with 5 mice in each group. Tumor growth ability was detected by tumor xenograft nude mouse models.Results:The relative expression level of miR-20a-5p mRNA in osteosarcoma tissues was 0.55±0.27, and that in paracancerous tissues was 1.22±0.28, with a statistically significant difference ( t=7.701, P<0.001). The relative expression level of KDM6B mRNA in osteosarcoma tissues was 1.66±0.19, and that in paracancerous tissues was 1.00±0.15, with a statistically significant difference ( t=12.219, P<0.001). After transfection of miR-20a-5p, KDM6B mRNA and protein expression levels decreased with the increase of miR-20a-5p expression level. After miR-20a-5p transfection for 48 h, the cell proliferation abilities of the blank control group, mimic NC group and miR-20a-5p mimic group were 0.83±0.04, 0.81±0.03 and 0.52±0.01 ( F=89.655, P<0.001), compared with the blank control group and mimic NC group, the cell proliferation ability was significantly inhibited in the miR-20a-5p mimic group (both P<0.001). The cell proliferation abilities of NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were 0.83±0.05, 0.52±0.01 and 0.67±0.05 ( F=43.919, P<0.001), compared with the NC+ empty vector group, the cell proliferation ability was significantly inhibited in the miR-20a-5p+ empty vector group ( P<0.001); compared with the miR-20a-5p+ empty vector group, the cell proliferation ability of miR-20a-5p+ KDM6B group increased significantly ( P<0.001). The scratch healing rates of the blank control group, mimic NC group and miR-20a-5p mimic group were (32.51±2.73)%, (30.26±3.22)% and (13.52±1.77)% ( F=46.314, P<0.001), compared with the control group and the mimic NC group, the scratch healing rate of the miR-20a-5p mimic group was significantly decreased (both P<0.001). The scratch healing rates of NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were (31.34±3.11)%, (12.15±1.64)% and (28.93±2.89)% ( F=47.511, P<0.001), compared with the NC+ empty vector group, the scratch healing rate of the miR-20a-5p+ empty vector group was significantly decreased ( P<0.001); compared with the miR-20a-5p+ empty vector group, the scratch healing rate of miR-20a-5p+ KDM6B group was significantly increased ( P=0.001). The numbers of transmembrane cells in the blank control group, mimic NC group and miR-20a-5p mimic group were 114±16, 108±11 and 42±6 ( F=36.282, P<0.001), compared with the control group and mimic NC group, the number of transmembrane cells of the miR-20a-5p mimic group was significantly decreased (both P<0.001). The numbers of transmembrane cells in the NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group was 143±11, 39±4 and 139±12 ( F=112.120, P<0.001), compared with the NC+ empty vector group, the number of transmembrane cells of the miR-20a-5p+ empty vector group was significantly decreased ( P<0.001); compared with the miR-20a-5p+ empty vector group, the number of transmembrane cells of the miR-20a-5p+ KDM6B group was increased significantly ( P<0.001). The tumor volumes of mice for 21 d in the NC+ empty vector group, miR-20a-5p+ empty vector group and miR-20a-5p+ KDM6B group were (1 667.50±250.40) mm 3, (129.20±21.00) mm 3 and (775.41±77.51) mm 3 respectively, with a statistically significant difference ( F=77.651, P<0.001). The tumor weights of the 3 groups were (1.35±0.18) g, (0.12±0.01) g and (0.61±0.03) g respectively, with a statistically significant difference ( F=104.191, P<0.001). Conclusion:The expression of miR-20a-5p is significantly decreased in osteosarcoma tissues, and the expression of KDM6B is significantly increased in osteosarcoma tissues. Overexpression of miR-20a-5p may inhibit the proliferation, migration and invasion of osteosarcoma cells and tumor growth by targeting to reduce the expression of KDM6B.