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:Based on previously theoretical derivation,it thought that assignment with 10 kinds of material attributes to three-dimensional model of bone can match the needs of finite element analysis,however,whether the results is consistent with actual needs to be validated by experimental results.OBJECTIVE:Twelve specimens of femoral superior segment were used for finite element analysis,which were verified with results of biomechanical testing,to explore a reasonable method for material assignment of bone.METHODS:All 12 specimens of femoral superior segment were treated with CT scan,three-dimensional reconstruction in Mimics 10.0 and volume meshing in Ansys.The finite element analysis group was divided into 2 kinds (compact bone and cancellated bone),10,50,100,200,400 kinds of material attributes groups based on the gray value.All models were assigned with material attributes and tested in Ansys for mechanics data of nodes on surface of femoral neck.In biomechanical testing group,12 specimens of femoral superior segment were treated with compressed testing to harvest mechanics data of measuring point same as that of finite element analysis group.RESULTS AND CONCLUSION:The one-way analysis of variance showed that the differences between the biomechanical testing group and finite element analysis group of 2 kinds of material attributes had no obvious significance (P=0.082).Compared to the 10,50,100,200,400 kinds of material attributes group,the difference had no significance (P > 0.39).However,the differences between the 2 kinds of material attributes and the 10,50,100,200,400 kinds of material attributes in the finite element analysis group were obviously difference (P< 0.05),which was no difference in the 10,50,100,200,400 kinds of material attributes (P>0.9).The results demonstrated that to assign 10 kinds of material attributes to three-dimensional model of bone can match the needs of finite element analysis.

Objective To evaluate the impact of preoperative prognostic nutritional index (PNI) on surgical outcomes and long-term survival of elderly patients with gastric cancer.Methods From Jan 2007 to Dec 2012,the clinicopathological data of 165 elderly patients (age ＞ 65 years old) with gastric cancer undergoing radical gastrectomy in the Second Hospital of Tianjin Medical University were analyzed retrospectively.PNI value was calculated by serum albumin (g/L) + 5 × lymphocyte count (× 109/L).The receiver operating characteristic (ROC) curve and Youden index was used to determine the cut-off value of PNI.Patients were then divided into low PNI group and high PNI group based on the cut-off value.The two groups were compared according to clinicopathological characteristics,postoperative complication and longterm survival.Results The mean PNI value was 46.1-± 5.3,When the PN1 was 46.4,the Youden index was maximal,with a sensitivity of 78％ and specificity of 59％.There were 79 patients in the low PNI group and 86 patients in high PNI group.No significant correlations between PNI and gender,age,BMI,pathological type,tumor diameter,extranodal metastasis and postoperative morbidity were observed.There were significant difference in the depth of invasion (x2 =6.732,P =0.009),N stage(x2 =13.191,P =0.004),TNM stage(x2 =12.137,P =0.000) and postoperative hospital stay (t =4.595,P =0.000).By Kaplan-Meier method,PNI (P =0.000),depth of invasion (P =0.002),N stage (P =0.000),TNM stage(P =0.000) and extranodal metastasis (P =0.031) had significant impacts on overall survival.PNI (P =0.016)and N stage (P =0.018) were independent factors for predicting overall survival rate.Conclusions PNI helps in evaluating preoperative nutritional status and postoperative prognosis for elderly patients with gastric cancer.

Objective To evaluate the surgical outcomes in octogenarians and older of gastric cancer and to identify the reasonable therapy for these patients.Methods From Jan 2000 to Dec 2010,the clinicopathological data of 533 patients with gastric cancer undergoing gastrectomy were analyzed retrospectively.We conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between 80 years and older (≥80 y,n =75) and younger (＜ 80 y,n =458).Results There were significant differences in comorbidities,anemia and histological type between the two groups.There was no significant difference in operative morbidity and mortality between the two groups.The 5-year survival rate for octogenarians was lower (21.1％) than nonoctogenarians (32.8％),but with no significant difference.TNM stage was the only independent prognostic factor for gastric cancer in octogenarians.Conclusions Older gastric cancer patients have comparative postoporative complication rate and survival with younger patients.

Adult ; Alanine Transaminase ; blood ; Bilirubin ; blood ; Female ; Hepatitis, Viral, Human ; blood ; therapy ; Humans ; Liver Function Tests ; Liver, Artificial ; Male ; Prothrombin ; analysis ; Treatment Outcome

Objective To study the expression of DKK3 protein and mRNA levels in gastric cancer and its correlation with the clinical prognosis of gastric cancer.Methods The expression of DKK3 protein in 158 gastric cancer specimens and paired adjacent non-cancerous tissues were detected by immunohistochemistry.The relationship between the protein expression and clinicopathological features was analyzed.Immunoblotting and real time quantitative PCR were used to examine the expression of DKK3 protein and mRNA levels in 76 paired fresh gastric cancer and adjacent non-cancerous tissues.Results The expression of DKK3 in gastric cancer tissues was lower than that in adjacent non-cancerous tissues (40.5％ vs.55.1％,x2 =41.442,P =0.000).DKK3 protein and mRNA levels in 76 cases were lower than that in adjacent non-cancerous tissues (1.096 ± 1.110 vs.3.476 ± 1.119,t =3.332,P =0.017;1.136 ± 1.013 vs.3.314 ± 1.105,t =2.673,P =0.022).There were close correlations between DKK3 expression and depth of tumor invasion (P =0.006),TNM stage (P =0.005) and lymphatic metastasis (P =0.009).The expression of DKK3 in gastric cancer was positively related with overall survival rate (47.4％ vs.28.0％,P =0.011),as an independent prognosis predictor (P =0.016).Conclusions DKK3 is an independent prognostic factor of gastric cancer,its decreased expression is significantly related with shortened survival time of gastric cancer patients.

Objective To study the correlation between status of methylation of DKK3 gene promoter and expression of its mRNA in gastric cancer.Methods Methylation of DKK3 gene promotor and its mRNA expression in 76 gastric cancer specimens and paired adjacent non-cancerous tissues were detected by methylation-specific PCR(MSP) and RT-PCR respectively.Results The expression of DKK3 mRNA in gastric cancer tissues was lower than that of adjacent non-cancerous tissues (43％ vs.60％,x2 =5.663,P =0.017).29 cases had methylation of DKK3 gene promoter for adjacent non-cancerous tissues.In gastric cancer tissues,however,44 cases had methylation of DKK3 gene promoter (38％ vs.58％,x2 =19.405,P =0.000).There were significant difference in depth of invasion (P =0.014),TNM stage (P =0.032),pathological grading (P =0.016) and lymphatic metastasis (P =0.007).There was distinct negative correlation between methylation of DKK3 gene promoter and expression of its mRNA (x2 =64.286,P =0.000).Conclusions Abnormal methylation of DKK3 gene promoter is an important mechanism of its inactivation,and might play an important role in carcinogenesis and progression of gastric cancer.

The present case report described a patient with paroxysmal atrial fibrillation who received pulsed-filed ablation guided by intracardiac echocardiography and 3-dimentional mapping system.All four pulmonary veins were isolated in the procedure,good clinical results and acute safety profile were achieved.The present case reveals the safety and feasibility of the technique for the treatment of paroxysmal atrial fibrillation.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.