The use of tourniquets in total knee arthroplasty (TKA) helps to obtain a blood-free operating space and clear anatomical landmarks, reduce the operation time and intraoperative bleeding and facilitate bone cement fixation. Arterial calcification is relatively common in the elderly people. There is still no consensus on whether it is safe to use tourniquets in patients with arterial calcification in total knee arthroplasty. Some studies showed that the use of tourniquets in patients with vascular calcification does not increase postoperative complications. Other studies showed that the use of tourniquets in patients with calcification will increase postoperative vascular complications. This article reviews the use of tourniquets in patients with vascular calcification. It is recommended that patients with vascular calcification should undergo detailed lower extremity vascular and cardiovascular assessments before surgery. The consult to a vascular surgeon is important. For patients with extensive vascular calcification, It's better to avoid the use of tourniquets during TKA to reduce possible complications.

Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pneumonia ; blood ; complications ; diagnosis ; Prognosis ; Retrospective Studies ; Sepsis ; blood ; complications ; diagnosis ; Tumor Necrosis Factor-alpha ; blood

Objective:To improve the quality standard for Kangshiming mixtures. Methods:The identification of Angelicae Sinen-sis Radix, Astragali Radix and Phellodendri Chinensis Cortex was carried out by TLC. The contents of puerarin and paeoniflorin in the preparations were determined by HPLC. Results:The spots displayed in TLC were clear without interference from the negative control. The linear range for puerarin was 1. 64-49. 20μg·ml-1(r=0. 999 9) and 4. 22-63. 30μg·ml-1(r=0. 999 6) for paeoniflorin. The average recovery was 99. 63%(RSD=2. 14%,n=9) and 99. 05%(RSD=2. 70%,n=9) for puerarin and paeoniflorin, respectively. Conclusion:The method is accurate, reliable and specific, and can be used in the quality control of Kangshiming mixtures.

Objective To analyze clinical outcome of anterior atlantoaxial transarticular screw fixation in treatment of atlantoaxial instability.Methods Thirty-two patients with atlantoaxial instability treated between March 2004 and June 2009 were enrolled in the study.The patients consisted of 21 males and 11 females,at age of 22-64 years (mean 49 years).Atlantoaxial instability was attributed to old odontoid fracture in 10 patients,free odontoid malformation in 16,transverse ligament rupture in two,and rheumatoid arthritis in four.Anterior atlantoaxial transarticular screw fixation under monitoring of cortical somatosensory evoked potential (CSEP) was performed for all patients.Operation time,intraoperative blood loss,and complications were recorded.Japanese Orthopedic Association (JOA) scoring system was used to evaluate neurologic function preoperatively and at one year postoperatively.Results Operation lasted for average 98 minutes and intraoperative blood loss averaged 110 ml.Injuries on esophagus,nerve and vertebral arteries as well as leakage of cerebrospinal fluid were not observed in operation.All patients received a follow-up of 12-31 months.JOA score was increased from preoperative 9.8 points to 15.8 points at one year postoperatively,with improvement rate of 83％.Bone fusion and satisfactory internal fgxation were achieved in all patients.Hypoglossal nerve injury symptom was found in two patients postoperatively and was recovered two months later.Conclusion Anterior atlantoaxial transarticular screw fixation is an effective treatment for atlantoaxial instability.

Objective To investigate the relationship between acute biliary pancreatitis (ABP) and anomalous pancreaticobiliary duetal union (APBDU). Methods 131 patients with ABP were enrolled to test the serum total bilirubin (TB), alanine amintransferase (ALT), aspartate amintransferase (AST), alkaline phosphates (ALP), γ-glutamyl transferase (γ-GT). All the patients received medical treatment, and then these tests were performed again. Thereafter, all the patients underwent selective surgery and intra-operative cholangiography was performed to observe the pancreaticobiliary duetal union. Results 27 patients (20.6%) with APBDU were found in 131 patients. Among them, 8 cases (29.6%) was B-P subtype (TypeⅠ), 16 cases (59.3%) was P-B subtype (TypeⅡ) , and the remaining 3 cases was mixed subtype (TypeⅢ). A significant decrease of ALT, AST, ALP, γ-GT after non-surgical treatment in both group of APBDU and NAPBDU was noted (P＜0.05). The serum levels of ALT, AST,γ-GT in APBDU patients were (71.81± 23.19) U/L, (47.85±27.87) U/L, (52.86±31.49) U/L, respectively; and in NAPBDU patients were (51.96±15.40) U/L, (40.77±16.58) U/L, (34.86±26.47) U/L. The difference was statistically significant (P＜0.05). Condusions APBDU is an important etiology of ABP.

The blood concentrations of the pharmacodynamic substances of traditional Chinese medicines (TCMs) are usually very low. How can they exert pharmacological actions, in which forms (original form, metabolite or the both) do they exert the actions. To answer these questions, we proposed a new concept ofEffective Formsof pharmacodynamic substances of TCMs and a hypothesis of additive effect of multiple constituents of TCMs. The hypothesis includes that the aggregate or summation of Effective Forms of pharmacodynamic substances of TCMs is the core material base of the effi-cacy of TCMs, and the additive effect of the blood concentrations of different Effective Forms is one part of the action mechanism. The additive effect of the different Effective Forms of a TCMs means an additive effect of numerous con-stituents or/and metabolites on a same target, and therefore the efficacy brought by the addition of the concentrations of all these compounds, which different from the synergy effect of multi-constituents on multi-targets. Studies on the disposition of TCMs showed that a constituent can be biotransformed to many metabolites (up to more than 50 metabolites);different constituents can produce the same metabolites;many metabolites (up to 10 compounds for each metabolite) are isomers or homologues; some constituents can be converted to each other in vivo; and some metabolites are bioactive. These com-pounds having the similar structure are likely to have the same pharmacological effects on the same target, which could provide experimental evidences for the concept ofEffective Formsand the hypothesis ofAdditive Effect. We suggest that the Effective Forms and Additive Effects of the pharmacodynamic substances of TCMs should be extensively investi-gated in the future, and the results of such researches will help us further understand the pharmacodynamic substances and action mechanism of TCMs, and give a new explanation 'Toxicities Scattering Effect' for 'Why the toxicities of TCMs are low', and propose a new strategy for quality control of TCMs.

Objective To evaluate the feasibility and safety of thoracoscopic radical resection of non-small cell lung cancer(NSCLC)patients under laryngeal mask anesthesia. Methods A total of 40 patients with NSCLC from March to August 2016 in NanFang Hospital of Southern Medical University were recruited and divided into two groups,the laryngeal mask anesthesia(n=20)and the intubation anesthesia group(n=20). Patients from two groups were followed up. Post-operativerecovery ,systemic inflammation response and quality of life were assessed. Results There was no significant difference between the laryngeal mask anesthesia and the intubation anesthesia group in the operation time ,the lowest oxygen saturation ,the maximum end-tidal carbon dioxide partial pressure and the surgical field and the satisfaction of anesthesia and blood loss. Post-operative time to eat ,postoperative use of antibiotics , postoperative hospital stay and drainage time were much shorter in the laryngeal mask anesthesia group ,which also had lowerlevel of white blood cells ,neutrophils and C-reactive protein. Patients with NSCLC undergoing laryngeal mask anesthesia had much higher scores in the quality of life evaluation. Conclusion Thoracoscopic radical resectionunder laryngeal mask anesthesia is safe and feasible for NSCLC patients. It has advantages in reducing the systemic inflammatory response ,accelerating the recovery rate and improving postoperative life quality.

Objective To explore the pancreatic kininogenase enteric-coated tablets in the treatment of diabetic retinopathy (DR) patients and its effect on the optic disc and macula retinal hemodynamics. Methods 86 cases (140 eyes) of DR patients were randomly divided into pancreatic kininogenase group and normal group with 43 cases in each group, two groups were treated with basic therapy, pancreatic kininogenase group were combined with pancreatic kininogenase treatment. The best corrected visual acuity and the clinical effect of optic disc and macula retinal hemodynamic changes were compared between two groups. Results After treatment, the best corrected visual acuity (BCVA) in pancreatic kininogenase group was greater than the normal group (P<0.05), the retinal neovascularization and fluorescein leakage area in pancreatic kininogenase group was less than the normal group (P<0.05). The disc vascular and macular retinal blood flow volume (VOL), blood flow velocity (FLW)values in pancreatic kininogenase group were larger than those of normal group, and the clinical curative effect of pancreatic kininogenase group was better than that of normal group (P<0.05). Conclusion Pancreatic kininogenase enteric-coated tablets in the treatment of DR patients can improve the optic disc and macular retinal hemodynamic parameters, improve visual acuity and reduce the retinal neovascularization and fluorescein leakage area, so as to improve the clinical treatment effect.

Objective:To investigate the stability of flurbiprofen axetil lipid microspheres injection combined with 0. 9% sodium chloride injection or 5% dextrose injection, and provide theoretical basis for the clinical application. Methods:The content changes of flurbiprofen axetil in the mixture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chloride injection or 5% dextrose injection were determined in 5 h at 25℃ away from light, and the changes in the appearance and particle size of flurbiprofen axetil lip-id microspheres were investigated. The changes in the appearance and particle size of flurbiprofen axetil lipid microspheres in the mix-ture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chloride injection before and after freezing and thawing were also investigated. Results:The appearance, particle size and content had no significant changes in all mixtures in 5 h at 25 ℃ away from light. The appearance and particle size of flurbiprofen axetil lipid microspheres in the mixture before and after freezing and thawing had no significant changes as well. Conclusion:The mixture of flurbiprofen axetil lipid microspheres injection and 0. 9% sodium chlo-ride injection or 5% dextrose injection is stable in 5 h away from light.

Objective To assess the effects of p27mt gene transfection on the proliferation and apoptosis of human hepatocellular carcinoma cell (HCC) lines SMMC-7721. Methods A replication deficient adenovirus vector encoding p27mt (Ad-p27mt) was used and p27mt cDNA was transfected into human SMMC-7721 cell lines in vitro. The synthesis of DNA in SMMC-7721 cells was determined by using 3H-thymidine incorporation; the cell apoptosis was determined by flow cytometry, TUNEL method and DNA fragmentation analysis. Results The virus titer was 7.95?1012 cfu/ml, the transduction efficiency was 100 % when multiplicity of infection ≥50, FCM analysis revealed a sub-G1 cell peak in Ad-p27mt transduced hepatocellular carcinoma cell lines. Agarose electrophoresis showed marked ladder .The difference of apoptotic index between the Ad-p27mt group and the control group was statistically significant (58.6?4.3, vs 4.5?1.6, P