BACKGROUND:The tourniquet is usualy fuly used or bilateraly used in partial time during bilateral total knee arthroplasty. However, very few people try to use it on one side and on the other side in partial time.
OBJECTIVE:To investigate the effective strategy of using a tourniquet in simultaneous bilateral total knee arthroplasty.
METHODS:80 patients (160 knees) with severe osteoarthritis who underwent simultaneous bilateral total knee arthroplasty in the Department of Orthopedics, Chinese PLA Medical School from January to December 2013 were divided into two groups according to the different tourniquet strategies. In test group (n=40), left knees did not receive tourniquet, and right knees received tourniquet in partial time. In control group (n=40), al knees received tourniquet in the whole time. The perioperative and postoperative blood loss, 3-day postoperative thigh sweling rate and pain visual analog scale, 3-week and 1-year postoperative Knee Society Score were recorded in both groups.
RESULTS AND CONCLUSION:There were no statisticaly significant differences between two groups in perioperative total blood loss (P > 0.05). However, postoperative blood loss in test group was less than that in control group (P < 0.05). The visual analog scale scores were significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). Visual analog scale scores on the left side were lower than on the right side in the test group at 3 days post surgery (P < 0.05). Bilateral thigh sweling rate was significantly lower in the test group than in the control group at 3 days after surgery (P < 0.05). The thigh sweling rate was lower on the left side than on the right side in the test group at 3 days after surgery (P < 0.05). Knee Society Score was higher in the test group than in the control group in the early stage, and no significant difference in long-term Knee Society Score was detected (P > 0.05). These findings verify that taking the strategy that the first knee without tourniquet and the second knee with part time tourniquet technique in simultaneous bilateral total knee arthroplasty wil aleviate pain and sweling after operation and promote early functional rehabilitation without increasing the perioperative total blood loss.

A total of 358 high-risk pregnant women were divided randomly into observation (A) and control (B) groups.Group A:15ml 10％ calcium gluconate was injected intravenously during the second stage of labor at full dilatation.And 10 U oxytocin was injected intramuscularly upon an immediate delivery of fetal anterior shoulder.Then 400 μg misoprostol was inserted into anus at 5 cm; Group B:10 U oxytocin was injected intramuscularly upon an immediate delivery of fetal anterior shoulder.Then 400 μg misoprostol was inserted into anus at 5 cm.Statistically significant differences existed in the amount of bleeding loss after delivery for 2 h and 24 h (P ＜ 0.01),the time limit of the third labor (P ＜ 0.01) and the occurrence rate of postpartum hemorrhage (P ＜ 0.01).No significant difference existed between two groups in the Apgar score of the first minute (P ＞ 0.05).An intravenous infusion of calcium gluconate plus oxytocin and misoprostol after birth could reduce the rate of postpartum hemorrhage.Worthy of clinical application,this method has no effect upon Apgar score.

Objective To report arthroscopic reconstruction of anterior cruciate ligament (ACL) with iliotibial tract autograft and gracilis tendon by Moriya s method and to evaluate its clinical results. Methods The iliotibial tract autograft of about one third length was dissected with the tibial attachment kept. Then the trimmed gracilis tendon was wrapped in the iliotibial tract to reconstruct ACL. 16 patients (12 males and 4 females) were treated in this way. The anterior drawer test and the Lachman s test were all positive before operation, indicating that anteromedial and posterolateral bundles of ACL were totally broken, which was proved by arthroscopy. Results All patients were followed up for 4 to 17 months (mean 9 months). According to the criteria for knee ligament function evaluation set up by Japanese Association of Orthopaedics( JOA) , 10 patients scored ≥ 90 points, 5 patients 80 to 90 points, and 1 patient ≤ 80 points.The excellent and good rate was 93.75% . Conclusion Iliotibial tract autograft transfer with gracilis tendon to reconstruct ACL under arthroscopy boasts convenience in harvesting grafts, simplicity in performance and excellent results, without evidence of damaging extension and flexion tendons of the knee or causing patellofemoral pain. [

Objective To study the influencing elements in x-Gal staining method and optimize the reactive conditions so that nonspecific background can be eliminated and grafted exogenous cells carrying LacZ gene can be discerned correctly. Methods C17 2 cells (carrying lzcZ gene) were injected into the right lateral ventricle both in the adult and newborn animals. After one week they were perfused using two methods, then the slices were stained at different pH and incubating time respectively. The X-gal positive cells in hippocampus were counted under light microscope. Results Background staining in this method has close correlation with the species and age of the host animals and it decreases when pH is higher or incubating time is shorter. The results are the best when pH 9 5 and the incubating time is 1*!h.Conclusion The reliability of X-gal staining method depends on optimization of several parameters, including pH, incubating time, perfusion etc. It is necessary to establish the correspondent controls.;

Purpose To evaluate the subclassifications of pT2 diseases in tumor-nodes-metastases ( TNM) staging system for prostate cancer. Methods A retrospective analysis of the medical records of patients who underwent radical prostatectomy ( RP) with the diag-nosis of clinically localized PCa was conducted. Any preoperative therapies, in terms of active surveillance, hormone therapy or radia-tion were exclusion criteria. The RP specimens were completely embedded and histopathologically evaluated for extraprostatic exten-sion, seminal vesicle invasion and staged according to the 2002/2010 TNM staging criteria. Results Using current 2002/2010 TNM staging criteria, in all, 15 cases of the tumors were pT2, 10 cases were pT3a, and 5 cases were pT3a. When subclassification of pT2, 2 cases of the tumors were pT2a, 13 cases of the tumors were pT2c, and none was identified as a pathological T2b tumor. Conclusion The results of the present study suggest that the pathological substaging criteria of organ-confined prostate cancer via methods used in the current 2002/2010 TNM staging system may not be appropriate. Efforts should be made to upgrade the current TNM staging system for prostate cancer.

Objective To explore the relationship among just-world belief,optimism and life satisfaction in colleges.Methods According to convenience sampling principle,370 colleges were selected and assessed with the just world scale for college students (JWS),satisfaction with life scale (SWLS) and the life orientation test-revised (LOT-R) ;and data were analyzed using correlation analysis and regression analysis.Results ①The scores of just-world belief,optimism and life satisfaction were (3.22 ± 0.46),(3.50 ± 0.57),and (3.70 ± 1.21),all of which were higher than middle points.②The scores of just-world belief were positive correlated with the scores of optimism and life satisfaction (r =0.44,0.36,P ＜ 0.01),and the scores of optimism also were positive correlated with life satisfaction(r =0.38,P ＜ 0.01).③ The just-world belief and optimism can positively predict life satisfaction directly(β =0.24,0.29,P ＜ 0.01),and the two factors had interaction(β=0.09,P＜ 0.05).Among optimistic students,life satisfaction of low just-world belief ones were much worse than that of high just world belief ones.However,among pessimistic students,the differences of life satisfaction between high and low just-world belief ones became little.Conclusion Just-world belief of colleges has significant predictive effect on life satisfaction,and the two factors had interaction.

Objective To establish a method for HPLC fingerprint determination of the triterpene acids in poria peel.Methods Ethanol solvent and ultrasound method were used to extract the sample. The chromatographic conditions of RP-HPLC were:acefonitrile-0.5%phosphoric acid(linear gradient elution),the detection wavelength being 242 nm, temperature at 30℃and flow rate being 1.0mL?min-1. Ten batches of poria peel produced in different places were measured.The common model was set up to calculate the correlation coefficient, cos?between every batch vector and the total standard model vector, thus to define the similarity.Results There was much difference in the constituent content of poria peel produced in different places and batches.Conlusion The HPLC fingerprint of triterpene acids is stable and reprodacible,which is useful for standard cultivation and quality evaluation of the crud drug of poria peel.

Objective To investigate the outcome of the free double-skin paddle string-type composite fibular flap in the reconstruction of the combined defects of ulna and radium. Methods From June 2005 to July 2009, 5 cases with combined defects of ulna and radium were reconstructed using the free double-skin paddle string-type composite fibular flap. The length of fibular segment for the reconstruction of ulnar defect ranges from 4.5 to 7.5 cm. The length of fibular segment for the reconstruction of radial defect ranges from 5.5 to 7.0 cm. The size of the flap varies from 5.0 cm × 3.0 cm to 8.0 cm × 5.5 cm. At the 12 month follow-up, the function of reconstructed forearm was evaluated based upon Enneking scoring system.Results Ten flaps in the 5 cases all survived. The time for the transplanted fibula healed on the radium and ulna was 4-6 months. The 5 patients were followed up from 14 months to 2 years. The forearm rotation functions were excellent in 2 cases, good in 2 cases and poor in 1 case. The eligible rate was 80%. The average Enneking score was 24.8, which indicated an average of 81.3% recovery of limb function. Conclusion Bone graft with blood supply can ensure the activity of osteocytes, which facilitates the fracture union.Whilst, the procedure can reconstruct multi-location and multi-tissue defects in the forearm. Therefore, the double-skin paddle string-type composite fibular flap is an ideal alternative for the reconstruction of the combined defects of ulna and radium and the skin.

Objective:To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods:The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed. Of all the patients, 177 underwent modified systematic biopsy, named TRUS group, 217 patients accepted pre-biopsy bpMRI examination, undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System (PI-RADS) score < 3 or MRI-TRUS cognitive fusion targeted prostate + systematic biopsy if PI-RADS score ≥ 3, named MRI group. The median age of TRUS group was 66 (61, 74) years old, prostate specific antigen (PSA) was 9.52 (7.26, 12.30) ng / ml, and prostate volume (PV) was 36.84 (28.95, 57.72)ml. The median age of MRI group was 66 (59, 72) years old, PSA was 8.84 (6.65, 12.16) ng/ml, and PV was 39.45 (29.25, 58.69)ml. There was no difference in above parameters between the two groups. The χ 2 test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) between the two groups. Results:There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group [51.41% (91/177) vs. 48.39% (105/ 217), P = 0.550], but the detection rates of CsPCa were significantly different [26.55% (47/177) vs. 36.41% (79/217), P = 0.037]. In patients with PSA ≤ 10 ng / ml, there was no significant difference in the detection rates of prostate cancer between the two groups [43.62% (41/94) vs. 43.08% (56/130), P = 0.936], but there was a significant difference in the detection rates of CsPCa [17.02% (16/94) vs. 28.46% (37/130), P = 0.047]. There was no significant difference in the detection rates of prostate cancer [60.24% (50/83) and 56.17% (48/87), P= 0.504] and the detection rates of CsPCa [37.35% (31/83) vs. 48.28% (42/87), P = 0.150] between the two groups. The total detection rates of the last two needles in TRUS group and MRI group were 23.16% (41/177) and 36.63% (86/217), respectively, with significant difference ( P=0.001); the detection rates of CsPCa in the last two needles were 11.86% (26/177) and 29.03% (63/ 217), respectively, with significant difference ( P < 0.001). In MRI group, the detection rates of prostate cancer in patients with PI-RADS score <3, 3, 4, 5 were 21.21% (7/33), 25.84% (23/89), 73.24% (52/71), 95.83% (23/24), respectively; the detection rates of CsPCa were 12.12% (4/33), 17.98% (16/89), 54.93% (39/71), 83.33% (23/24), respectively. Conclusions:In patients with PSA ≤ 20 ng / ml, prostate biopsy based on bpMRI may improve the detection of CsPCa, especially in patients with PSA ≤ 10 ng/ml.

Limulus Factor C, a serine protease zymogen from the amoebocytes of the limulus, has high affinity for endotoxin. When Factor C is activated by endotoxin, it hydrolyses artificial tripeptide substrate and measurable products are released, so it can be used as an alternative reagent for endotoxin analysis. Factor C gene of Tachypleus tridentatus was obtained through RT-PCR and the recombinant protein was expressed by Bac-to-Bac/BmNPV baculovirus expression system in silkworm larvae. The activity of Factor C was detected with diluted serum of silkworm larvae, and the sensitivity of endotoxin detected was 0.2 EU/mL when the serum was diluted at 1:500. The silkworm larvae expressed limulus Factor C could be used to develop a new low-cost endotoxin test reagent.
Animals ; Arthropod Proteins ; biosynthesis ; Baculoviridae ; Bombyx ; metabolism ; Enzyme Precursors ; biosynthesis ; Genetic Vectors ; Larva ; metabolism ; Recombinant Proteins ; biosynthesis ; Serine Endopeptidases ; biosynthesis