BACKGROUND: The change of the axial angle of the lower limb is related to the occurrence and development of osteoarthritis.OBJECTIVE: To analyze the correlation between the change of lower limb power line and pain area in the knee osteoarthritis patients.METHODS: Totally 65 knee osteoarthritis patients were selected as pain group and 30 healthy people were selected as control group. All the participants took anteroposterior and lateral knee radiographs through PACS imaging systems to collect six imaging indexes, including install index, the degree of tibiofemoral joint subluxation, tibiofemoral inside and outside joint clearance ratio, femoral angle, tibial angle and tibiofemoral angle. Knee osteoarthritis patients in pain group were divided into two common clinical pain areas which were proparea and medial area.RESULTS AND CONCLUSION: (1) The insall index, the degree of tibiofemoral joint subluxation, tibiofemoral inside andoutside joint clearance ratio between knee osteoarthritis patients in pain group and people in healthy control group hadsignificant differences. There was no statistical significance in the femoral angle, tibial angle and tibiofemoral angle. (2) In terms of the comparison between proparea and medial area in knee osteoarthritis patients in pain group, tibiofemoral joint subluxation degree was statistically different. (3) These findings suggest that there was a higher patella in knee osteoarthritis patients who were in pain, more severe in the degree of tibiofemoral joint subluxation, and more limited in tibiofemoral inside and outside joint clearance ratio. The degree of tibiofemoral joint subluxation of proparea was more severe than medial area in pain group.

Objective To investigate the correlation between diabetic distress and coping styles among patients with type 2 diabetes. Method One hundred inpatients with type 2 diabetes were engaged in the investigation of their diabetes distress and coping styles by the diabetes distress scale (DDS) and medical coping modes questionnaire (MCMQ) and the correlation between them. Results The average score of diabetic distress was (2.17 ± 0.71), which was at mild level. 57%of them were at the higher level of diabetic distress. Confrontation and avoidance dimensions were lower than the norm in coping styles, and the acceptance dimension was higher than the norm (all P<0.01). The average scores of diabetic distress, regimen-related distress and physician-related distress subscales were negatively correlated with confrontation (all P<0.05). The average score on diabetic distress and the subscales were positively correlated with avoidance and acceptance dimension (all P<0.01). Conclusions Diabetic distress is prevalent in type 2 diabetic patients and the degree of positive coping is still not insufficient. The diabetic distress is negatively correlated to the confrontation, and positively correlated to the avoidance and the acceptance dimension. The medical staff should instruct the patients to adopt positive coping styles, and avoid negative coping styles to reduce diabetic distress. It will be conductive to the physical and mental rehabilitation of the patients as well.

BACKGROUND: At present, the basic underlying molecular mechanism regulating the interactions among venous endothelial cells, platelets, leukocytes, and promoting local deep vein thrombosis microenvironment formation, still remains unclear, and there is no ideal method for early diagnosis of deep vein thrombosis. OBJECTIVE: To study the underlying role of nuclear factor kappa B1 and tissue factor in rats with deep vein thrombosis. METHODS: A total of 67 Sprague-Dawley rats were randomly divided into control group (n=10) and model group (n=57). Deep vein thrombosis model was established by a clamping and sewing method in femoral vein combined with cast fixation. The incidence and serious degree of thrombus were observed by dissecting rat femoral vein in different time points (2.5 and 25 hours after modeling). The model group was further divided into pre-thrombogenesis group (2.5 hours after modeling), thrombogenesis group (25 hours after modeling) and non-thrombogenesis group (25 hours after modeling). Then total RNA was extracted from the localized femoral venous endothelial tissue. The candidate genes, associated inflammation and thrombosis, were screened by a special gene chip. Then the gene expression of nuclear factor kappa B1 and tissue factor was further identified by real-time polymerase chain reaction. RESULTS AND CONCLUSION: Pre-thrombogenesis group had no thrombogenesis, while thrombogenesis group have 23 cases with thrombosis and non-thrombogenesis group have 22 cases without thrombosis. The results of gene chip hybridization analysis and real-time PCR found that the mRNA expression of nuclear factor kappa B1 and tissue factor in rat femoral vein endothelial tissue were significantly up-regulated at 2.5 hours after modeling (pre-thrombogenesis group was higher than control group) (P < 0.05), and continued up-regulating at 25 hours after modeling (thrombogenesis group was higher than the pre-thrombogenesis group, non-thrombogenesis group and control group) (P < 0.05). The results from present study indicate that up-regulating expressions of nuclear factor kappa B1 and tissue factor in local femoral venous endothelial tissue of rat deep vein thrombosis models may play a key role in initiating venous thrombosis.

BACKGROUND: The molecular mechanism and core regulatory network of deep vein thrombosis are not fully clarified yet.OBJECTIVE: To explore the roles of oxidative stress and Rac1/2 in rat deep vein thrombosis.METHODS: Deep vein thrombosis model in SD rats was established by a champing method femoral veins clamping combinedwith fixation of the lower extremity with plaster. The incidence and serious degree of thrombus were observed by dissecting ratfemoral vein at different time points (2.5 and 25 hours after modeling). The model rats were divided into pre-thrombogenesisgroup (2.5 hours after modeling), thrombogenesis group (25 hours after modeling) and non-thrombogenesis group (25 hours aftermodeling). Then total RNA and protein were extracted from the femoral venous wall tissues.RESULTS AND CONCLUSION: Colorimetry results showed that compared with the non-thrombogenesis group, theconcentration of malondiadehyde in rat femoral vein wall tissues of the thrombogenesis group was the highest (P < 0.05), followedby that of the pre-thrombogenesis group (P < 0.05). The concentrations of total superoxide dismutase and glutathione reductasein the thrombogenesis group were the lowest, followed by those in the pre-thrombogenesis group (P < 0.05). The results of genechip hybridization analysis and real-time PCR showed that compared with the non-thrombogenesis group, the expressions ofRac1 and Rac2 in rat femoral vein wall tissues of thrombogenesis group increased the most, followed by that of thepre-thrombogenesis group (P < 0.05). These findings indicate that the up-regulation of malondialdehyde and Rac1/2 as well asthe activity decrease of total superoxide dismutase and glutathione reductase may lead to the formation of deep venousthrombosis.

BACKGROUND: Implantation of artificial joint of bone cement can result in long-term blocking of recipient site medullary canal and blood vessel lesion, and lead to changes in intraosseous pressure and bone blood flow of distal femoral shaft.OBJECTIVE: To explore the changes in the intraosseous pressure and bone blood flow of distal femoral shaft after blockage of the proximal and middle femoral medullary canal by bone cement.DESIGN: Controlled observation.SETTING: People's Hospital of Guangxi Zhuang Autonomous Region.MATERIALS: The experiment was performed at the Experimental Animal Center of Chongqing Medical University between July 2002 and April 2003. Thirty-two healthy adult New Zealand rabbits were selected and randomly divided into model group (n=24) and control group (n=8). Polymethyl methacrylate (PMMA) TJ bone cement was provided by Tianjin Synthetic Materials Research Institute.METHODS: The rabbit model was established by infusing femoral medullary canal of left side with PMMA. The lateral greater trochanter of anesthetized rabbits were resected below the third trochanter through spatium intermusculare by posterior lateral femur approach, but the neck of femur was remained to expose intertrochanteric fossa and entry of medullary canal following by intramedullary reaming to 1/2 length of femur. The wound was washed repeatedly to remove the destroyed myeioid tissues, and was dried with gauze. Bone cement was prepared by manually stirring powder with solution at a ratio of 2:1, until dough shape formed. A small piece of dough-shaped bone cement was filled in middle femoral stenosis as cavity blocker. Ten minutes later, the solidified bone cement was re-blended until dough shape and implanted into medullary canal fully. When the bone cement was completely solidified, the incision was sutured. The 24-modeled rabbits were randomly divided into 4 subgroups according to the following observation time points (n=6): postoperative 0 day (T0),4th week (T4), 8th week (T8) and 16th week (T16).MAIN OUTCOME MEASURES: ①Physiological pressure-measuring instrument was used to detect and compare the intraosseous pressure of bilateral distal femoral medullary canal of the model and control groups. ②Radionuclide bone imaging was used to detect and compare the dynamic and static images of bilateral distal femoral of the rabbit models at different time points.RESULTS: Thirty-two rabbits were all included in final analysis with no loss. ①There were no significant differences in the intraosseous pressure between the distal femurs in normal rabbits (P＞0.05); the pressure of the experimental side increased significantly compared with control side (P＜0.01). In model group, there were no significant differences in the intraosseous pressure between the control sides of rabbits at different time points (P＞0.05), but the experimental sides presented continuous high intraosseous pressure state. The pressure of T4 was higher than that of T16 (P＜0.05); there were no significant differences between any other two time points (P＞0.05). ②Compared with the dynamic and static images at different time-points, the counting of nuclide in the experimental sides was markedly lower than the control sides at T0 and T4 while higher at T8 and T16; the count reached the peak at T16. There were no significant differences in the nuclide counting ratio between T0 and T8, T0 and T16, T4 and T16, T8 and T16, T4 and T8, respectively except T0 and T4 (P＜0.05). The dynamic and static radionuclide bone imaging showed the same changes.CONCLUSION: The intraosseous and intramedullary blood circulation is severely damaged after blocking of the proximal and middle femoral medullary canal with bone cement, resulting in local alterations of hymodynamics, a series of changes in intraosseous pressure and bone blood flow in the distal femur, which causes continuous and a long-term high intraosseous pressure.

BACKGROUND:There are so many researches on the complication of artificial joint of bone cement on clinics, but the effect of implanting artificial joint of bone cement on the structure of distal joint is unclear.OBJECTIVE:To explore the structural changes of distal joint after blocking the proximal and middle femoral medullary cavity with bone cement.DESIGN:Controlled observation.SETTING:The People's Hospital of Guangxi Zhuang Autonomous Region.MATERIALS:A total of 26 healthy adult New Zealand rabbits, of clean grade and both genders,weighing 2.6-3.5 kg,were offered by the Experimental Animal Center of Chongqing Medical University.Polymethyl methacrylate (PMMA) TJ bone cement,16# antrum needle for puncture (outer diameter 1.6 mm,inner diameter 1.05 mm,length 80 mm), light microscope of Japan Olympus Company (BH-2), and transmission electron microscope of Japan Hitachi Company (H-600).METHODS:The experiment was completed in the Experimental Animal Center of Chongqing Medical University from July 2005 to April 2006.Eighteen rabbits were randomly selected as model group,while other 8 ones ware served as control group.The rabbit model was established by infusing femoral medullary cavity of left side with PMMA.Due to the specific anatomic structure of appearing the third trochanter, the anesthetized rabbits were adopted to incise the lateral greater trochanter below the third trochanter through spatium intermusculare of posterior lateral femur, remaining the neck of femur, so as to expose intertrochanteric fossa and entry of medullary cavity,which was expanded to 1/2 length of femur by using cavity file of different thickness repeatedly. Then wound surface was washed fob many times to remove the destroyed myeloid tissues, and was dried with strips. Bone cement was prepared by manually stirring powder with solution at a ratio of 2:1, until it demonstrated dough shape. In order to control the depth of bone cement into femoral medullary cavity, a small piece of dough-shaped bone cement was filled in middle femoral stenosis as cavity blocker.Ten minutes later,the solidified bone cement was re-blended as dough shape and implanted into medullary cavity fully.Afterwards, the bone cement was completely solidified and the incision was sutured. At the 4th, 8th and 16th weeks postoperatively,6 rabbits of each model group and all controlled rabbits were killed respectively to obtain the samples of distal femoral articular synovium, cartilage and subchondral bone. The histological examinations included hematoxyiin-eosin (HE) staining, toluidine blue (TB) staining and immunohistochemistry. Transmission electron microscope was used to detect the changes of cartilage and subchondral bone in distal joint of left femur.MAIN OUTCOME MEASURES: ①The structural changes of distal femoral articular synovium, cartilage and subchondral bone by HE staining,TB staining,immunohistochemistry.②The histological changes of distal articular cartilage and subchondral bone in left femur by transmission electron microscope.RESULTS:①HE staining:The damages to articular cartilage,synovial tissues and subchondral bone aggravated with time.At the 16th week of modeling,the articular cartilage was destructed,the bone structure was severely damaged,with the synovial tissue proliferation and swelling;TB staining (the 16th week):All the layers of articular cartilage appeared loss of stain; Immunohistochemistry (the 16th week): Collagen Ⅱ of the chondrocytes was positively stained. And transforming growth factor (TGF)-β1 staining of articular synoviocytes and chondrocytes appeared positive.②Transmission electron microscope: The lesions to articular chondrocytes and bone cells aggravated progressively with time, part of which presented necrosis and collapse at the 16th week.CONCLUSION: The intramedullary blood circulation is severely damaged after blocking the proximal and middle femoral medullary cavity with bone cement. Conversely, the bone metabolism disorders in dista0 femur. which results in the degeneration or necrosis of distal femur, cartilage and synovial tissue.

BACKGROUND: There are so many researches on complication of artificial joint of bone cement in clinics, but the effect of implanting artificial joint of bone cement on distal femoral shaft is unclear.OBJECTIVE: To provide an ideal animal model for study the effect on distal femoral shaft after implanting the artificial joint of bone cement.DESIGN: Controlled observation.SETTING: People's Hospital in Guangzi Zhuang Autonomous Region.MATERIALS: A total of 16 healthy adult New Zealand rabbits, of clean grade, of both genders, weighing 2.6-3.5 kg, were selected in this study.METHODS: The experiment was completed in the Experimental Animal Centerof Chongqing Medical University from July 2002 to April 2003. According to the third rotator, neck of femur of rabbits was not broken off;meanwhile, lateral part of greater trochanter was sawed up above the third rotator, entrance of medullary cavity of bone was found among fossas of rotator, and bone cement was perfused into left femoral medullary cavity by blocking of proximal and middle femoral medullary cavity with polymethyl methacrylate (PMMA) to establish the rabbit model. Right side of rabbits was regarded as the control. Rabbits were sacrificed under drugged state after modeling establishment.MAIN OUTCOME MEASURES: Results of gross femur and X-ray image of rabbits.RESULTS: A total of 16 rabbits entered the final analysis. ① Gross dissection showed that the femoral medullary cavities of rabbits were well filled with PMMA and completely blocked above their middle segments. It suggested that the method for setting up animal model achieved the purpose of blocking the proximal and middle femoral medullary cavity. ② X-ray image further confirmed that the femoral medullary cavities of rabbits were well filled with PMMA and completely blocked above their middle segments.CONCLUSION: The rabbit model was successfully established by blocking the proximal and middle femoral medullary cavity for imitating the fixed artificial joint of bone cement.

Objective To evaluate the outcomes of surgical repair of typeⅢ pulmonary atresia with ventricular septal de-fect( PA/VSD) .Methods Retrospectively analyzed the clinical data of 98 patients with type Ⅲ PA/VSD who underwent sur-gical repair in the Department of Cardiovascular Surgery , Guangdong Cardiovascular Institute from September 2005 to December 2014.There were 54 males and 44 females at the mean age of(4.2 ±4.8) years and the mean weight of(13.2 ±10.0) kg. There were 67 patients in palliative repair group and 31 patients in radical repair group .There were 85 patients underwent on-pump operation including 9 beating heart cases.Results The mean bypass time was(121.2 ±49.4)min, the mean aorta cross-clamping time was(75.4 ±31.8) min.The overall postoperative mortality was 6.1%(6/98).For the survival patients, the mean ventilation time was(106.7 ±184.3) h, the mean ICU stay was(8.9 ±10.9) days and the mean hospital stay was (33.4 ±17.0)days.During follow-up period, 28 patients were underwent re-operation, the postoperative mortality was 7.1%(2/28).There were no differences in postoperative status between two groups.Conclusion The outcomes of surgical repair for type Ⅲ PA/VSD was good.Preoperative evaluation of the pulmonary development and MAPCAs were helpful for choosing surgical options.Re-operation was recommended to those appropriate patients.

Objective To summarize the outcomes of reconstructing right ventricular outflow tract with conical perucardial conduit in type Ⅲ pulmonary atresia with ventricular septal defect (PA/VSD).Methods We retrospectively analyzed the clinical data of 7 patients with type Ⅲ PA/VSD who underwent surgical repair in the Department of Cadiovascular Surgery,Guangdong Cardivascular Institute from January 2012 to August 2014.There were 3 males and 4 females at a median age of 2.5 years (range,1.4 to 10.8 years) and a mean weight of(11.4 ± 3.4) kg.All patients were underwent right ventricular outflow tract reconstruction with conical pericardial conduit.Results The mean bypass time was (132.7 ± 32.5) min,the mean aorta cross-clamping time was(71.9 ± 15.1) min.There was 1 patient with diaphragmatic paralysis and 1 patient with chylothorax,both of whom were underwent surgical intervention.There was 1 patient with postoperative pneumonia.The ventilation time was 17.8-356.9 hours.There was no in-hospital death.The mean ICU stays was 2.8-21.5 days and the mean hospital stays was 13-74 days.All patients were alive and no severe anoxia during follow-up.Conclusion The early outcomes of reconstructing right ventricular outflow tract with conical pericardial conduit in type Ⅲ PA/VSD was good.Preoperative evaluation of the pulmonary development and MAPCAs were helpful for making rational choice.

Objective To investigate the feasibility and accuracy of volumetric measurement of necrotic lesion using CT and MRI,and to assess the value of necrotic lesion volume in predicting collapse of the femoral head in patients with avascular necrosis of the femoral head(ANFH). Methods Comparison among CT,MRI and gross section was performed in 25 femoral heads of 18 patients who underwent total hip replacement for established ANFH.The volume of necrotic lesion was measured using fluid displacement.CT and MRI data were transferred to a computer to calculate the volume of necrotic lesion using software.One way ANOVA was used to compare the volumes of necrotic lesion measured by CT,MRI and gross section.A total of 62 patients (92 hips) who were diagnosed with ANFH but without collapse by CT were followed up 24 months.Student t-test was used to compare the ratio of the volumes of the necrotic lesion and entire femoral head in the hips with and without collapse and ROC curve analysis was carried out.Results CT and MRI coincided with gross section in the necrotic area,proliferative area and extralesional area.The volumes of the necrotic lesion measured by CT,MRI and gross section were ( 20.5 ± 5.2 ),( 21.4 ± 4.8 ),( 20.9 ± 5.2 ) cm3,respectively.There was no significant difference among the necrotic volumes measured by the three methods(F =0.185,P =0.831 ).In fifty-seven out of 92 hips,collapse of the femoral head occurred during the follow-up.The ratio of the volumes of the necrotic lesion and entire femoral head was higher in hips with collapse than in hips without collapse[ (34.5 ±9.3)％ vs.(23.4 ±8.4)％ ;t =5.749,P=0.000].The area under the ROC curve was 0.808. Conclusions The volume of the necrotic lesion plays an important role in the collapse of femoral head in patients with ANFH.Both CT and MRI can identify the shape and location of the necrotic lesion intuitively and stereospecifically and can determine the volume of the necrotic lesion accurately.