In this review,concepts concerning etiology and nonoperative and operative treatment methods have been analyzed.This article is based almost exclusively on peer-reviewed studies.The etiology of nontraumatic osteonecrosis of the femoral head may have genetic basis.The interaction between certain risk factors and a genetic predisposition may determine whether this disease will develop in a particular individual.Early diagnosis and intervention prior to collapse of the femoral head is key to a successful outcome of joint-preserving procedures.The rational for use of joint-sparing procedure in the treatment of this disease is based on radiographic measurements and findings with other imaging modalities.The results of joint-preserving procedures are less satisfactory than the results of total hip arthroplasty for femoral head than have already collapsed.New pharmacological measures as well as the use of growth and differentiation factors for the prevention and treatment of this disease may eventually alter our treatment approach,but it is necessary to await results of clinical research with long-term follow-up of these patients.

OBJECTIVE:To determine the dissolubility of paracetamol in Ganmaoqing tablets produced by different manufactories and to evaluate the internal qualities METHODS:The content of paracetamol in Ganmaoqing tablets was determined by HPLC with Nova-Pak C18 or Sphereclone ODS(2) column as fixed phase and methanol-water(1∶3) as mobile phase Paracetamol was detected at 249 nm with UV detetor The flow rate was 0 5ml/min Rotating basket method was used in dissolution test RESULTS:The method could determine the content of paracetamol in Ganmaoqing tablets satisfactorily The dissolution rates of eight samples were quite different CONCLUSION:The method is simple,rapid and reliable It is very necessary to establish the dissolubility standard for Ganmaoqing tablets

Objective To observe the effect of bisoprulol on malignant ventricular arrhythmia (MVA) and heart rate turbulence (HRT) in ambulatory electrocardiogram monitoring for twenty-four hours in patients with unsta-ble angina pectoris (UAP). Methods 40 UAP patients with premature ventricu]ar beats were observed. All patients were examined with ambulatory electrocardiogram monitoring for twenty-four hours before and after bisoprolol (5mg, Qd) was administered for 7 days. The number of patients with MVA、turbulence onset (TO) and turbulence slope (TS) were analyzed. Results After bisoprolol was administered for 7 days in patients with UAP,the number of pa-tients with MVA decreased by 14.2%. TO decreased and TS increased, and HRT was improved. Conclusions HRT had clinical prognostic value for malignant ventricular arrhythmia and sudden death in patients with UPA. Bisoprolol can improve HRT and reduce the incidence of MVA.

Objective To evaluate timing of tracheal intubation impact on the therapeutic effect of acute severe organophosphate poisoning( ASOPP) patients. Methods Retrospectively analyze 82 ASOPP patients with respiratory failure ( RF). The patients were divided into timely tracheal intubation group(n = 42) and delay tracheal intubation group (n =40) ,and compare the therapeutic effect of these two groups. Results Compared with timely tracheal intubation patients and delay tracheal intubation patients,total time of mechanical ventilation,hospital day decreased significantly (P<0.01) ,cure rate increased significantly (P<0.01) ,but complications [intermediate myasthenia syndrome (IMS) .pulmonary infection,cardiac damage and so on] had no significant difference(P>0.05). Conclusion It was exact that the therapeutic effect of timely tracheal intubation on rescuing the ASOPP patients, and the best time to tracheal intubation was in RF early period.

Objective To investigate the influencing factors of pain and the changes of vital signs in newborn infants. Methods Forty two newborn infants were rated by the behavioral scale of acute pain in newborn infants. The scores of pain were compared among infants with different gender,gestational age,birth weight,birth age,type of puncture and whether by vaginal birth or not. At the same time,the respiration rate,heart rate,blood pressure and oxygen saturation (SO2)were dynami-cally recorded by the multi-function monitor in the process of puncture. Results The average score of pain was 7.6. There was no significant difference among newborn infants with different gender,gestational age,birth weight and type of puncture(P> 0.05),while significant differences among infants with different birth age and whether by vaginal birth or not (P=0.015 and 0.043 respectively). In the process of puncture,the SO2 was significantly decreased,while the respiration rate,heart rate,sys-tolic and diastolic blood pressure were significantly increased. Conclusions Pain is prevalent in newborn infants and accom-panied by obvious changes of vital signs. The means of childbirth and birth age have significant influence on the neonatal pain. It is suggested to pay close attention to the neonatal pain and take effective interventions.

BACKGROUND: Previous artificial ligament is easy to break for material fatigue and to appear synonitis for materialbiocompatibility.OBJECTIVE: To observe the application effect of ligament advanced reinforcement system (LARS) artificial ligament inreconstruction of anterior cruciate ligament via follow-up.DESIGN, TIME AND SETTING: An own control, follow-up observation was performed between August 2004 andJanuary 2007 at the Department of Orthopedics and Joint Surgery, Shanghai Changzheng Hospital, Shanghai, China.PARTICIPANTS: Twenty-eight patients with anterior cruciate ligament injury, including 16 with sport injury and 12 withvehicle accident injury.MATERIALS: The main component of LARS artificial ligament (Laboratoire d'Applieation et de Recherche Scientifique,France) is the high-tenacity polyester fiber polyethylene terephthalate.METHODS: Twenty-eight patients with anterior cruciate ligament injury were performed arthroscopic reconstruction of theligament with LARS artificial ligament and were averagely followed up for 20 months.MAIN OUTCOME MEASURES: Patients' anterior drawer test, Lysholm score, range of motion prior to transplantationand in follow-up.RESULTS: The knee unstable symptom of 28 patients disappeared, anterior drawer test was negative, joint function wasgood with the flexion of 5.71 to 129.64 degrees. Average Lysholm score raised from (45.7±9.82) points prior totransplantation to (86.5±6.44) points after transplantation (P < 0.001). All patients resumed normal activities at 2 monthsafter transplantation, without acute or chronic synovitis and host response to materials.CONCLUSION: LARS artificial ligament is a relatively safe transplantation material and especially suitable to reconstructanterior cruciate ligament with sport injury. Mid-/short-term follow-up shows good result.

Objective To compare the early results of total knee arthroplasty using high flexion (HF) versus standard posterior-stabilized (PS) prosthesis tibial insert. Methods From February 2005 to July 2008, 203 patients (216 knees) underwent total knee arthroplasty using Genesis Ⅱ prosthesis and were randomly distributed into group A (98 patients with 107 knees, HF insert) or group B (105 patients with 109 knees, PS insert). There were no significant differences between the two groups in the preoperative Knee Society score (KSS) knee score, KSS function score, and range of motion. They were followed-up for 1 year and compared using KSS knee score, KSS function score and range of motion. Results 91 patients (98 knees)were followed up in group A, and 94 patients (96 knees) were followed up in group B. The postoperative knee active range of motion was 121.1°±6.9° in group A, and was 118.6°±8.1° in group B. The improvement of knee active range of motion was 17.1°±13.3° in group A, and was 16.1°±18.8° in group B. The postoperative range of passive motion of group A and group B were 127.2°±7.1° and 121.0°±7.8° respectively. The postoperative KSS knee score was 86.9±7.6 in group A, and was 87.5±6.8 in group B. The postoperative KSS function score was 91.2±8.7 in group A, and was 90.1±9.3 in group B. The range of passive motion of groupA was better than that of group B (P ＜0.05). There were no significant differences between the two groups in other aspects. Complications include deep vein thrombosis (DVT), 4 patients in group A and 3 in group B,wound fat liquefaction, 3 patients in group A and 5 in group B, synarthrophysis, 2 patients in group A and 3 in group B. Conclusion This prospective randomized clinical trial demonstrates no differences between PS and HF in early clinical outcomes, except the range of passive flexion.

Objective To study compatibility rule of herb-pair in rhubarb after compatibilities with fructus aurantii Immaturus,Chinese goldthread rhizome,moutan cortex,peach seed and kansui radix stir-baked with vinegar, and to observe its anti-inflammation and acute toxicity. Methods Mice were gavaged by 15,30 g?kg-1 rhubarb and rhubarb, rhubarb frutus aurantii immaturus rhizoma coptidis, radix et rhizoma rhei peony, rhubarb, semen persicae and rhubarb extracts from euphorbia kansui, respectively, in the morning and evening once, for 7 d.The effects of five different compatibility of Rhubarb on acute inflammation were observed in the mouse paw swelling induced by carrageenan. The classical method were used to determine acute toxicity of rhubarb and the contents of five different compatibility of rhubarb. Results Compared with the control group, the contents of five different compatibility of rhubarb with high and low dosage groups(30,15 g?kg-1 ) could inhibit the paw edema in mice,reduce NO and MDA production and enhanced activity of SOD in mice inflammatory tissue. The LD50 was not determined. Calculated by crude drug content, the MLD of rhubarb compatibilities with fructus aurantii immaturus, Chinese goldthread rhizome,moutan cortex,peach seed and kansui radix stir-baked with vinegar were 145.33,142.30,117.53,103.45, 113.09,182.36 g?kg-1 respectively, which were respectively equal to 581,569,470,418,452 ,729 times of people, s daily dried medicinal herb dosage. Conclusion The five different herb-pair have anti-inflammation effects after compatibility of Rhubarb, and it got best effects when rhubarb compatibility with kansui radix stir-baked, the next were rhubarb compatibility with Chinese goldthread rhizome and moutan cortex. It was basic security and low toxicity of herb-pair in rhubarb after compatibilities.

OBJECTIVE To invesigate the prevalence of SHV-producing Enterobacteriaceae isolates in Hunan Province and identify the subtype of SHV encoding gene and the epidemiological aspect of SHV-producing isolates. METHODS Isolates were collected and identified as well as subjected to ESBLs detection.PCR and DNA sequencing were used to determine the genotype of SHV enzymes.The homology of SHV-producing strains were detected by RAPD. RESULTS Twenty-six of 171 Enterobacteriaceae isolates were confirmed to produce blaSHV genes,and 5 subtypes of SHV-type ?-lactamases were determined,including 9 strains of SHV-28,7 strains of SHV-12,7 strains of SHV-1,2 strains of SHV-11 and 1 strain of SHV-5.There were 6 RAPD types in 19 isolates of SHV-producing Klebsiella pneumoniae,5 RAPD types in 5 isolates of SHV-producing Enterobacter cloacae. CONCLUSIONS SHV-12 is the predominant genotype of SHV ESBLs producing Enterobacteriaceae in Hunan Province,and clone spread has played a certain role in SHV-type ?-lactamase producing K.pneumoniae.SHV ESBLs are not found in Escherichia coli.

Objective To explore the differences of the joint function and the patient's satisfaction between two different methods to reconstruct limb length for unilateral Crowe Ⅳ developmental dysplasia of the hip (DDH).Methods The clinical controlled study were used.21 cases with unilateral DDH Crowe Ⅳ treated with total hip arthroplasty were divided into 2 groups randomly.The patients in the first group were reconstructed the limb with the compensatory length and those in the second group were did with the real length.The patients were followed up 10 years.Two independent sample t-test was used to compare these two operations.Harris scores and SF-36 scores were used in the test.Survival analysis with Kaplan-Meier method was involved in the survival of the prosthesis and then test with Log-rank test.X-ray films of different period were compared to confirm the prosthetic loosening.Results Seventeen patients were followed up 8-10 years.There were no significant differences both in Harris score and most of the SF-36 scores at the median follow-up of 10 years.The item mental healthy of SF-36 expressed significant difference.Five patients required revision.There were 10 cases suffered with polyethylene wear,6 cases with severe osteoporosis in greater trochanter,and 3 cases with osteolytic reaction.Conclusion There are no significant differences between the two surgical method in the survival rate of prosthesis and the joint function in the median follow up.The satisfaction of the control groups is lower than the trial groups both at the early stage after the operation and the median follow up.The revision rate between the two groups is similar but the reason is different.