BACKGROUND:Periprosthetic femoral fracture after total knee arthroplasty is related with the osteoporosis, bone defects, prosthesis, frail patients and high complication rate, so it is difficult to prevent and treat.
OBJECTIVE:To explore the risk factor, classification, treatment, rehabilitation and prophylaxis of periprosthetic femoral fracture after total knee arthroplasty based on the reviewed and summarized articles published in recent years.
METHODS:A computer-based online search was conducted in PubMed database from January 1, 1990 to December 31, 2011 and in SpringerLink database from 1980 to 2011 for the related articles with the key words of“periprosthetic fracture, knee”in English. A total of 626 articles were retrieved.
RESULTS AND CONCLUSION:According to inclusion and exclusion criteria, the articles were screened and 40 articles were included final y. The results showed that with the extensive development of total knee arthroplasty, the incidence of periprosthetic femoral fracture was increased gradual y;due to the poor prognosis, we should pay attention to the prevention. The risk factors of periprosthetic femoral fracture included patients’ internal factor that was hard to control, and some external factors such as the surgical techniques. Rorabeck classification was commonly applied for periprosthetic femoral fracture after total knee arthroplasty, but it was not perfect in clinical application. Kim classification wil be better for clinical guidance. The treatment of periprosthetic femoral fracture included nonoperative treatment, open reduction and internal fixation, retrograde intramedul ary nailing and revision arthroplasty. An appropriate treatment is chosen depending on fracture classification, local bone quality, patients’ medical and nutritional status. At present, however, there is not a perfect guideline for the selection of appropriate treatment method. But the early functional exercise is beneficial to prevent the related complications caused by longtime immobilization and the loss of joint function. Therefore, the indications must be under strict control in the treatment of periprosthetic femoral fracture after total knee arthroplasty. Except the firm fixation, early exercise for the patients should be encouraged at the same time.

Objective To observe the regulation of sry-related high-mobility-group box-containing 2 (Sox2) on epidermal growth factor receptor(EGFR)and on the sphere formation rate of glioma stem cells .Methods Promoter reporter plasmids of epidermal growth factor homologous receptor ErbB2 ,ErbB3 ,ErbB4 were respectively constructed .Sox2 expression plasmid was co-transfected together with the reporter plasmid into U251 cells .Then the luciferase activity was analyzed by dual-luciferase reporter assay sys-tem to test the regulation of Sox2 on ErbB2 ,ErbB3 ,ErbB4 promoters .Sphere formation assay was used to observe selfrenew of the cancer stem cells after transfection of Sox 2 .The expression of EGFR and ErbB2 proteins in the spheres was examined by Western blot .Results Sox2 could dose-dependently increase the ErbB2 ,ErbB3 ,ErbB4 promoter drived luciferase activity .Sox2 promotes the sphere-forming rate of U251 cells and upregulates the expression of EGFR and ErbB2 in the spheres .Conclusion Sox2 could up-regulate the expression of EGFR and promote selfrenew of glioma stem cells .

BACKGROUND: Degenerated cervical intervertebral discs can release many kinds of cytokines and inflammatory mediums, which plays an important role in onset and development of cervical syndrome.OBJECTIVE: To observe the effect of anti-cytokine Chinese herb combined with western drug (anti-hyperosteogeny capsule combined with glucosamine hydrochloride capsule) and gene therapy, on the contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) of degenerated cervical intervertebral discs in rabbits.DESIGN: Randomized controlled observation.SETTING: Department of Orthopaedics and Central Laboratory of Hebei People's Hospital.MATERIALS: The experiment was carried out in the Central Laboratory of Hebei People's Hospital from March 2003 to January 2004. A total of 35 New Zealand rabbits of both genders were selected and divided into 7groups according to randomly digital table: normal control group, shallowlayer model group, whole-layer model group, shallow-layer medicine group,whole-layer medicine group, shallow-layer gene group and whole-layer gene group. There were 5 rabbits in each group.METHODS: Except normal control group, rabbits in other 6 groups were used to establish models of dynamic dysequilibrium of cervical vertebra through cutting muscles of cervical back to induce degeneration of cervical intervertebral discs. Superficial group of muscle in cervical region was resected in shallow-layer groups, and both superficial and deep group of muscle was resected in whole-layer groups. ① Seven months after operation, rabbits in medicine groups were respectively treated with 1.1 g/kg anti-hyperosteogeny capsule (consisting of gouji, gusuibu, jixueteng, laifuzi,niuxi, nvzhenzi, roucongrong, shudihuang and yinyanghuo, etc.; Jiangsu Kangyuan Pharmaceutical Company Limited) and 0.06 g/kg glucosamine (Shanxi Zhongyuanwei Pharmaceutical Company Limited), which was dissolved into 20 mL distilled water. The medicine was administrated twice a day for 1 month. ② After anesthetization of rabbits in gene groups, recombinant plasmid DNA combined with transforming growth factor-β1 (TGF-β1) was injected to C2-3, C3-4 and C4-5 intervertebral disc (20μL per intervetebral disk). Eight months after modeling, rabbits in each group were sacrificed and C3-4 and C4-5 intervertebral disc was used as samples. In addition, contents of IL-1β and TNF-α were measured with double-antibodies-sandwich-ELISA method.MAIN OUTCOME MEASURES: Contents of IL-1β and TNF-α in cervical intervertebral discs of rabbits at 8 months after modeling.RESULTS: All 35 rabbits were involved in the final analysis. Eight months after modeling, for contents of IL-1β and TNF-α, shallow-layer model group was higher than normal control group (P ＜ 0.05-0.01); shallow-layer medicine group and shallow-layer gene group were obviously low er than shallow-layer model group (P ＜ 0.05); whole-layer medicine group and whole-layer gene group were lower than whole-layer model group (P＜ 0.05-0.01).CONCLUSION: The degenerated intervertebral discs can release many kinds of cytokine and inflammatory mediators which can enhance the degeneration of cervical intervertebral discs. Antihyperosteogeny capsule combined with glucosamine hydrochloride capsule and gene therapy can obviously reduce the contents of IL-1β and TNF-o in degenerated cervical intervertebral discs.

BACKGROUND:Studies have indicated that the abnormal expression of tumor necrosis factorreceptor-associated protein 1 (TRAP1) is closely related to the occurrence and development of a variety of tumors. Therefore, targeted inhibition of TRAP1 expression has become an important target for the treatment or intervention of tumor growth. OBJECTIVE:To explore the effect of the TRAP1 gene silencing on the proliferation and apoptosis of human laryngeal squamous cel carcinoma stem cel s. METHODS:CD24-CD44-human laryngeal squamous cel carcinoma stem cel s were isolated by flow cytometry. Interfering RNA (siRNA) sequences for smal molecule TRAP1 gene was designed and transferred into human laryngeal cancer stem cel s by LipofectamineTM 2000. Flow cytometry, MTT assay, cel clone formation assay and TUNEL apoptosis assay were used to evaluate the effect of silencing TRAP1 gene on the proliferation and apoptosis of CD24-CD44+laryngeal cancer stem cel s. RESULTS AND CONCLUSION:Compared with CD24+CD44-cel s, CD24-CD44+cel s upregulated OCT4, SOX2, NANOG and TRAP1 expression levels (P<0.05). However, the expression of TRAP1 protein in human laryngeal squamous cel carcinoma was significantly decreased after RNA interference (P<0.05). The growth rate of TRAP1 gene silenced human laryngeal squamous cel carcinoma was significantly reduced (P<0.05), the cel arrest was in the G0/G1 phase, the number of cel s in the S phase was decreased (P<0.05), and there was no significant change in the M phase. TRAP1 gene silencing significantly inhibited the proliferation of human laryngeal squamous cel carcinoma stem cel s (P<0.05). Compared to the non-transfected cel s, the TRAP1 gene silencing significantly reduced the clone formation ability of transfected human laryngeal squamous cel carcinoma stem cel s (P<0.05), and TRAP1 gene silenced-human laryngeal squamous cel carcinoma stem cel s were more easy to trigger apoptosis by upregulating BAD and BAX expression levels (P<0.05). Overal , our experimental results indicate that the specific interference of TRAP1 gene expression could inhibit the proliferation and promote apoptosis of human laryngeal squamous cel carcinoma stem cel s.

Cas9 is a RNA-guided double stranded DNA nuclease that participates in the CRISPR/Cas9 system. Wide-type Cas9 directly silences the expression of target gene by gene splicing. The engineered dCas9 protein with the mutation at D10A and H840A lacks the Cas9' s endonuclease function but keeps its DNA binding activity. dCas9 can activate special genes by fusing with transcription activator. Meanwhile,it can inhibit the gene transcription by directly binding to the target gene and stop gene transcrip?tion. Combination of light sensitive structures and CRISPR can produce light-inducible CRISPR/Cas9 system for control of gene expres?sion. This system is able to activate or inhibit gene expression via the use of controlling blue light(470 nm). In this review,we mainly discuss the development of the light inducible CRISPR/Cas9 system as well as its application in the control of gene expression.

Objective To explore the protective effect of a small balloon on bifurcation lesions by applying a single stent treatment of coronary bifurcation lesions strategy. Methods Fifty patients with coronary bifurcation lesions were randomly divided into A group and B group( 25 cases for each group ). Patients in A group were treated with the pre-entry protection branch guide wire to complete the main branch balloon pre-dilation,stenting,while in B group were treated with the set aside the branches of a small balloon. The information of main branch balloon pre-dilation,stenting were recorded. The blood flow slowed down,the incidence of side branch occlusion or stent placement,and the incidence of postoperative 24 h troponin I( cTnI) levels were measured. Results Nine cases(36%)in A group occurred lower branch blood flow,which due to 4 cases(16% )with significantly narrow branch stenting,2 cases(8%)with complete occlusion. There were only 2 cases(8%)with decrease branching blood flow in B group,and the difference was significant(P=0. 041, 0. 022). The cases with higher cTnI after 24 h in A group were 11( 39%),significantly higher in group B (3(12 %);P =0. 027 ). Conclusion Compared with the traditional protection guidewire,the approach of setting aside a small balloon to protect important branch can effectively prevent important branch occlusion, branch involvement due to lower incidence of myocardial infarction.

Objective To study the targeting ability of aptamer-modified PLGA nanoparticle encapsulated with gold nanorod and liquid perflurocarbon,and observe its mediated ultrasound/photoacoustic dual-modality imaging in vitro.Methods PLGA nanoparticle was prepared using double emulsion technique.Aptamer-modified PLGA nanoparticle was obtained by connecting,then PLGA nanoparticle was conjugated with MUC1 aptamer carbodiimide technique aimed to obtain aptamer-modified PLGA nanoparticle.Targeting ability of aptamer-modified PLGA nanoparticle to MCF-7 tumor cells in vitro was tested by fluorescence microscope.Besides,there were three control groups including PLGA nanoparticle group,aptamer group and HELA cell group.A commercial photoacoustic instrument was used to detect ultrasound/photoacoustic signal.Results A significant number of aptamer-modified PLGA nanoparticles gathered around the MCF-7 cells,however,the specific binding can not be observed in control groups.Both ultrasound and photoacoustic signal intensity of the aptamer-modified PLGA nanoparticles increased significantly when excited with laser.Conclusions The aptamer-modified PLGA nanoparticle was successfully prepared,and had superior targeting ability to MCF-7 cells,Morever,ultrasound/photoacoustic signal emitted the by nanoparticle increased significantly.These properties make the targeted nanoparticle a great potential to become a distinguished uhrasound/photoacoustic dual modality contrast agent,which lays good foundation for further targeted imaging application in vivo.

Objective To synthesize a photoacoustic contrast agent loaded with gold nanorod and liquid perflurocarbon which was used to observe its photoacoustic imaging in vitro,and then investigate the variation of the photoacoustic signal during and after the vaporization.Methods The PLGA nanoparticle (GNP)loaded with gold nanorod(GNR) and liquid perflurocarbon was synthesized via double emulsion technology.The experiments were divided into three groups:1)GNP group:PLGA nanoparticle loaded with gold nanorod and liquid perflurocarbon; 2) GNR group:gold nanorod ; 3) control group:PLGA nanoparticle unloaded with gold nanorod.A pulsed laser system was used to trigger the three samples.The photoacoustic image and time-signal intensity kinetics were acquired by the photoacoustic microscope.The optical microscope was used to observe the image after the vaporization.Results The gold nanoparticle was successfully prepared,the average size of the gold nanoparticle was 504.9 nm.after triggered by the pulsed laser system,the vaporized image of the GNP group could be observed by the optical microscope.The photoacoustic signal was detected in both GNP and GNR groups,and the signal intensity increased along with the concentration of the GNR.However,the photoacoustic signal of PLGA group was not detected.The photoacoustic signal kinetics of GNP group showed a descending trend from high signal amplitude to steadystate.The GNR group photoacoustic signal kinetics only showed a steady-state signal amplitude.Conclusions The PLGA nanoparticle loaded with gold nanorod and liquid perflurocarbon emerged a phase transient which produces a strong photoacoustic signal after triggered by pulsed laser system.This kind of phenomenon leads the nanoparticle to be a better photoacoustic contrast agent and lays a foundation for in vivo research and photothermal therapy in vivo.

Epidemiology,as a major subject in the field of public health science,plays a pivotal role in the construction and development of disease prevention and control system.It is also vital for the public health system to improve the emergency response ability and to cultivate high-quality talents.After analyzing current situation of graduate education of epidemiology,we found some problems.In our research,deepgoing dissection was carried out and possible solution was provided.

Objective To investigate the clinic technique and effect of treating lumbar disc herniation (LDH) with decompressor and ozone injection combined lumbar traction after surgery.Methods 110 contained LDH patients were randomly divided into two group:decompressor and ozone group,decompressor and ozone combined lumbar traction after surgery group.Under the guidance of CT,fifty-five patients in group A were treated by disc decompression with Decompressor through poster olateral approach,then ozone was injected into the lumbar disc or out side the lumbar disc,and the other fifty-five patients in group B were treated by lumbar traction after surgery that disc decompression and ozone injection same as the group A in once a day and one week of treatment.The theraputic effect was evaluated by comparing VAS,effective rate of therapy before and after treatment.Results The VAS score of two groups at 1,3,7 days between pre-and post-treatment had singificantly different(t =2.159,2.163,2.169,2.167,2.173,2.192,all P ＜0.05).110 case were followed up after 6 and 12 months,The good-excellent rate of therapy in B group 12 months were better than those of A group (x2 =74.23,75.11,all P ＜ 0.05).Conclusion Decompressor combined ozone injection and lumbar traction after surgery is an effective menthod for treatment of the central type mbar disc herniation.