BACKGROUND:Severe knee pain after total knee arthroplasty is an important factor for the poor recovery of knee function after replacement. How to give a satisfactory postoperative analgesia scheme is currently a hot research. OBJECTIVE:To explore the clinical effects of different analgesic program methods on postoperative pain and functional recovery in patients undergoing total knee arthroplasty. METHODS:From March 2010 to February 2014, 60 patients with unilateral knee arthroplasty were randomly divided into three groups:epidural analgesia group, intravenous analgesia group, and continuous femoral nerve block analgesia group. 20 patients in each group received corresponding postoperative analgesia. Visual Analogue Scale score before replacement, 1, 6, 24, 48 and 96 hours after replacement, the recovery of range of motion at 24, 48 and 72 hours after replacement, KSS score of the knee and adverse reactions after replacement were recorded and compared in each group. RESULTS AND CONCLUSION:Compared with the preoperative data, Visual Analogue Scale score was reduced in continuous femoral nerve block analgesia group at 1, 24, 48 and 96 hours after replacement (P<0.05). The recovery of range of motion was best in the continuous femoral nerve block analgesia group, fol owed by epidural analgesia group, and it was poorest in the intravenous analgesia group (P<0.05). Compared with the preoperative data, postoperative KSS scores increased at 1 and 3 months after replacement in the three groups (P<0.05). Compared with the continuous femoral nerve block analgesia group, knee joint function score was decreased in the intravenous analgesia group (P<0.05). Results verified that continuous femoral nerve block analgesia had good overal effects, helped the recovery of postoperative joint function, and was safe and reliable.

Objective To determine the pattern and incidence of congenital coronary anomalies (CCA) in adults undergoing coronary angiography. Methods The diagnostic angiographic data collected from October 2000 to October 2006 were reviewed, from which congenital coronary anomalies were found, and their angiographic features were studied. Results Among 1520 adults undergone coronary angiography, anomalous coronary arteries were found in 58 cases (3.82%). Depending on the anatomic characteristics of anomalous coronary arteries, these 58 cases were classified as following. Anomalies of origin and distribution were found in 26 cases (1.71%), among them separated origin of left anterior descending and left circumflex from left coronary sinus were found in 14 cases, left main trunk and left circumflex arising from right coronary sinus in 1 case for each, single left coronary artery in 2 cases, right coronary arteries arising from ascending aorta in 4 cases, from left coronary sinus in 3 cases, and from posterior coronary sinus in 1 case, respectively. Anomalies of coronary termination were observed in 11 cases (0.72%), and all of them were coronary artery fistulas. Anomalies of intrinsic coronary arterial anatomy in 21 cases (1.38%), among them myocardial bridge in 18 cases, hypoplasia of left circumflex artery in 2 cases, and sinus node artery arising from left posterior ventricular branch in 1 case. No anomalous collateral vessels were found. Conclusion Coronary angiography is one of the important methods of detecting anomalous coronary arteries. Classification based on the anatomic characteristics can help clarify the pattern and incidence of congenital anomalies of coronary arteries in adalts.

Objective To investigate the clinical features of acute coronary syndrome (ACS) combined with low T3 syndrome and its prognosis.Method Eighty-seven ACS patients with low free triiodothyronine (FT3) level (low FT3 group) and additional 64 ACS patients with normal FT3 level(control group) were selected in parallel; all the patients underwent coronary angiography.The contents of FT3,N-terminal pro-brain natriuretic peptide (NT-proBNP),cardiac troponin I (cTnI) and high sensitivity-C reactive protein (hs-CRP) were recorded,and the related factors were evaluated.The number of stenotic vessels was calculated.Results The contents of NT-proBNP,cTnI and hs-CRP in low FT3 group were elevated significantly compared with those in control group [(1242.14 ± 226.32) ng/L vs.(1126.36 ±195.55) ng/L,(0.92 ± 0.23) ng/L vs.(0.84 ± 0.19) ng/L,(6.46 ± 2.25) mg/L vs.(5.71 ± 1.78) mg/L],and there were significant differences (P ＜ 0.01 or ＜ 0.05).The contents of FT3 were negatively correlated with NT-proBNP,cTnI and hs-CRP in two groups (P ＜ 0.05).There was no significant difference in the number of stenotic vessels between two groups (x2 =4.512,P =0.105).Conclusion In patients with ACS,there is a negative correlation between contents of FT3 and the prognosis,but there is no correlation between contents of FT3 and the number of stenotic vessels.

Objective To evaluate the role of intra-aortic balloon pumping(IABP) in high risk patients with acute myocardial(AMI).Methods The clinical data of all patients with acute myocardial infarction treated with IABP admitted into the first affiliated hospital to PLA General Hospital from January 2004 to May 2008 was collected.The efficacy of the IABP was evaluated. Results A total number of 23 patients with acute myocardial infarction were treated with IABP.17patients received revascularization therapy. Death rate was 30.4%.Conclusion IABP is safe in high risk patients with AMI who represented poor hemodynamic status or cardiogenic shock,and it can sufficiently stablieze the hemodynamic status,improve cardiac function and can decrease in-hospital mortality.

objective To investigate the clinical relevance of antinuclear antibodies (ANA)in patients with systemic sclerosis(SSc).Methods Clinical data were collected from 283 patients with SSc admitted to Peking Union Medical College Hospital(PUMCH)from 1981 to 2009.A retrospective analysis was carried out.Results In the 283 patients,253(89.4%)were female.The mean age at onset was 35.9±12.6 years and mean disease duration 4.3 ±4.5 years.There were 125(44.2%)patients with diffuse SSc(dcSSc) and 158(55.8%)with limited cutaneous SSc(lcSSc).Of all the patients,96.8%were positive for ANA,54.4% for anti-Scl-70 antibodies,6.4%for anticentromere antibodies(ACA),23.7%for anti-ribonucleoprotein(RNP) antibodies,7.1%for anti-Sm antibodies,25.1%for anti-SSA antibodies,7.1%for anti.SSB antibodies,and 1.1%for anti-Jo-1 antibodies.No patients were positive for anti-rRNP antibodies.Only one patient was positive for both anti-Scl-70 antibodies and ACA.The positivity rate of ACA in patients with leSSe was higher thanthat in those with dcSSc(P<0.05).Conclusion The detection of antinuclear antibodies is helpful for the diagnosis,classification,prognosis evaluation and management of SSc.

Objective To investigate the association between atrial fibrillation (AF) and epicardial adipose tissue (EAT) by echocardiography.Methods One hundred and thirty-eight patients of AF in First Affiliated Hospital of Chinese People's Liberation Army General Hospital from March 2014 to June 2016 were divided into two groups,including paroxysmal AF group with 87 casesand persistent AF group with 51 cases,and 112 cases of sinus rhythm were chosen as control group.Epicardial adipose tissue was measured using echocardiography in all patients,and the conventional parameters were recorded.One-way analysis of variance was used to compare the thickness of EAT in patients with paroxysmal AF group,persistent AF group and sinus rhythm group,and LSD-t test was used in further comparison between two groups.Multivariable logistic regression analysis was used to analyze the risk factors of AF.The receiver-operating characteristic (ROC) cure of EAT and left atrium diameter (LAD) were drawn to predict the incidence of AF.The correlation between EAT thickness and LAD was analyzed by Pearson correlation analysis.Results The thickness of EAT in patients with persistent AF,paroxysmal AF and sinus rhythm group were (4.75± 1.83),(4.32 ± 1.76) and (1.38 ± 0.68) mm,respectively.Epicardial adipose tissue was significantly larger in paroxysmal AF and persistent AF patients compared with that of sinus rhythm group,and the differences were statistically significant (t=-9.541,11.439,both P ＜ 0.01).Logistic regression analysis indicated that EAT thickness and LAD were independent risk factors of atrial fibrillation (odds ratio:3.17,95％ confidence interval:1.31-7.68,P ＜ 0.01;odds ratio:2.65,95％ confidence interval 1.69-4.15,P ＜ 0.05).The area under the curve (AUC) of EAT and LAD to predict presence of AF were 0.784 and 0.865,and the best threshold value were 4.45 mm and 40.00 mm,respectively.Pearson correlation analysis showed that the EAT thickness and LAD had significantly positive correlation (r=0.512,P ＜ 0.01).Conclusions The increase of EAT thickness is significantly correlated with the incidence of AF and is independent to traditional risk factors.Therefore,the increase of EAT thickness has certain clinical value to predict AF.

Objective To observe the characteristics of the two-dimensional global strain index in patients with different degrees heart failure with speckle tracking echocardiography. Methods Totally 35 myocardial infarction patients with heart failure and 28 healthy subjects (control group) were enrolled in the study. The patients were divided into mild (n=14), moderate (n=13), and severe heart failure subgroup (n=8) according to left ventricular ejection fraction (LVEF). The systolic longitudinal strain (LS), radial strain (RS) and circumferential strain (CS) were measured of left ventricular with two-dimensional speckle tracking technique. The average value of left ventricular 18 segmental LS, RS and CS was calculated as the global longitudinal strain (GLS), the global radial strain (GRS) and the global circumference strain (GCS), respectively. LVEF and left ventricular end diastolic volume (LVEDV) were also measured with conventional two-dimensional echocardiography. The global two-dimensional strain and heart function between two groups were compared. The change of GLS, GRS and GCS of different heart failure and the relationship between them and LVEF were analyzed. Results Compared with control group, GLS, GRS and GCS reduced in heart failure groups (P<0.01). In heart failure groups, GLS significantly decreased with the decrease of LVEF, the difference of GLS was significant (P<0.05). GCS in severe heart failure subgroup was lower significantly than that in mild and moderate heart failure subgroups (P<0.05). No significant difference was found in GCS between mild and moderate heart failure subgroups (P>0.05). There was no significant difference in GRS among heart failure subgroups (P>0.05). GLS was closely correlated to LVEF (r=-0.65, P<0.01), GCS was also correlated to LVEF (r=-0.55, P<0.01). Conclusion The changes of GLS, GRS and GCS is different in different degrees of heart failure. GLS is closely correlated to the change of LVEF. The change of GLS, GRS and GCS may reflect degrees of myocardial injury.