BACKGROUND:Total knee arthroplasty had been generaly accepted as the final treatment plan, relieving pain and reconstructing function of knee joint. However, whether drainage tube can be used after replacement is stil controversial.
OBJECTIVE:To compare the clinical effects of drainageversusnondrainage after primary unilateral total knee arthroplasty.
METHODS:Total 102 patients undergoing primary unilateral total knee arthroplasty were randomly divided into 2 groups. In the drainagegroiup, a drainage tube was used. In the nondrainage group,
drainage tube was not used. Total blood loss was calculated by recording the hemoglobin and hematocrit before operation and that after 1, 3, 7 days of operation. The pain visual analogue scale scores, arthrocele, ecchymosis, infection rate, and deep venous thrombosis of lower extremity were examined and analyzed postoperatively. Knee Society Scores were recorded at 1 year postoperatively. Above indexes were compared between the two groups.
RESULTS AND CONCLUSION:(1) Total blood loss and blood transfusion rate were significantly higher in the drainage group than in the nondrainage group (P< 0.05). (2) There was no statisticaly significant difference in the pain visual analogue scale scores, arthrocele, ecchymosis, infection rate, and deep venous thrombosis of lower extremity between the two groups after replacement (P> 0.05). (3) No significant difference in Knee Society Scores was detected between the two groups (P> 0.05). (4) Results indicated that the total blood loss and blood transfusion rate may decrease significantly in patients without wound drainage after total knee arthroplasty. Limb sweling and ecchymosis area were not increased. No significant difference in infection, deep venousthrombosis of lower extremity and knee function was detectable between the two groups. Thus, total knee arthroplasty without wound drainage is safe and does not have obvious adverse consequences.

Objective To discover the role of MCPH1 in DNA double-strand damage induced by ionizing radiation and its relationship with H2AX in esophageal cancer cell ECA109. Methods ECA109 cancer cells accepted 8 Gy 1 h after irradiation were collected for protein extraction and immunofluorescence then MCPH1 and H2AX protein expression and nuclear foci changes were observed. A stable low expression of H2AX cell lines was established and MCPH1 and H2AX protein expression and nuclear foci changes induced by ionizing radiation after silence H2AX were detected. Results (1)A stable low expression of H2AX cell lines in ECA109 cells was successfully constructed. (2)Ionizing radiation could cause the increase of r-H2AX and MCPH1 protein expression, as the same as nuclear focus increase of r-H2AX and MCPH1. (3)The protein level and nucleus focus of r-H2AX and MCPH1 were significantly reduced in ECA109 after silence H2AX. Conclusion MCPH1 is the part of DNA damage response triggered by ionizing radiation and is located in damage response downstream and can be regulated by H2AX.

Objective To investigate the recent curative effect and adverse reactions of radiotherapy combined with temozolomide in non-small cell lung cancer (NSCLC) patients with brain metastases.MethodsThe clinical date of 51 NSCLC patients with brain metastases were retrospective analyzed in Department of Radiation Oncology of Affiliated Hospital of Hebei University.Patients were divided into experimental group (n=26) and control group (n=25) according to the different treatment methods.The experimental group underwent whole brain and local tumor radiotherapy plus temozolomide.The control group only received whole brain and local tumor radiotherapy.The recent curative effect and adverse reactions of the two groups were analyzed.Results The Karnofsky performance status score of patients in the experimental group was obviously improved than that in the control group (76.2±6.4 vs.72.8±5.3), with a significant difference (t=2.06, P=0.04).The total effective rate in the experimental group was higher than that in the control group (80.8% vs.64.0%), but there was no statistically significant difference (χ2=1.80, P=0.18).Compared with the control group, the incidences of nausea and vomiting (80.8% vs.28.0%) and bone marrow suppression (84.6% vs.24.0%) in the experimental group were significantly higher, with significant differences (χ2=14.33, P=0.00;χ2=18.91, P=0.00).There were similar incidences of headache (69.2% vs.60.1%), liver and kidney damage (73.1% vs.64.0%) in the two groups, with no significant differences (χ2=0.47, P=0.49;χ2=0.47, P=0.49).Conclusion Radiotherapy combined with temozolomide can improve the quality of life in NSCLC patients with brain metastases, which has controllable and tolerable adverse reactions.

ObjectiveTo investigate the influence of the number of T-junctions between central venous catheter and pressure transducer on measurement of central venous pressure (CVP) in patients.Methods A prospective controlled study was conducted. The patients with CVP monitoring in Department of Critical Care Medicine of the Fifth Center Hospital in Tianjin from February to October in 2014 were enrolled. The patients were divided into three groups according to the number of T-junction between central venous catheter and pressure transducer: without T-junction control group and 1, 2, 3 T-junctions groups. In each patient, corresponding CVP values with different number of T-junctions placed between the central venous catheter and pressure sensors were determined within a certain period, and a square-wave graphic was obtained and preserved on the monitor. The own frequency (fn) and the attenuation coefficient (D) of the system of pressure measurement were calculated after measurement of the shock wave following a square-wave to obtain the distance between two vibrations and the amplitude of the shock wave. The difference in CVP, fn and D were compared among the groups.Results A total of 20 cases were enrolled, and 150 groups of data were collected.① With the increase in the number of T-junction, CVP showed a tendency of gradual reduction. The CVP of the groups of control and 1, 2, 3 T-junctions was (7.00±1.60), (7.00±3.00), (5.00±2.00), and (4.00±1.00) mmHg (1 mmHg = 0.133 kPa), respectively. The CVP of 3 T-junctions group was significantly lower than that of the control group (F = 9.333,P = 0.015).② With an increase in the number of T-junction, fn showed a tendency of gradual increase. The fn of groups control and 1, 2, 3 T-junctions was (12.30±0.79), (16.00±0.91),(18.10±1.75), (20.90±2.69) Hz, respectively. The fn of 1, 2, 3 T-junctions group was significantly higher than that of the control group (F1 = 45.962,F2 = 45.414,F3 = 46.830, allP = 0.000); the fn of groups 2 and 3 T-junctions was significantly higher than that of 1 T-junction group (F1 = 5.827,P1 = 0.042;F2 = 15.038,P2 = 0.004), but there was no significant difference between the groups of 2 T-junctions and 3 T-junctions (F = 3.800,P = 0.087).③ With an increase of the number of T-junction, D also showed a tendency of gradual increase. The D of 1, 2, 3 T-junction group was 1.62±0.27, 1.60±0.22, 1.82±0.25, and 2.15±0.58, respectively. There were no differences among four groups.ConclusionAfter the application of T-junctions between central venous catheter and pressure transducer, CVP values will be underestimated, the reason of which is considered to be the increase in length and thinner lumen of the T-junctions.

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.

Objective To compare the systemic pathologic physiology parameter changes in sheep drowning in freshwater and seawater. Methods The experimental animals were healthy crossbred sheep. According to the envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning (immediately after water injection) and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin (HE) staining. Results ① The changes in systemic hemodynamic: there was no significant difference in hemodynamics before drowning between the two groups.Compared with before drowning, heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), left ventricular maximum systolic force index (dPmax), and pulmonary wedge pressure (PAWP) immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased (mmHg/s: 919.83±14.51 vs. 2 628.42±59.75, P < 0.01), which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning (L/min: 8.25±0.66 vs. 5.75±0.73, P < 0.01). Global end-diastolic volume (GEDV) and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV (mL): 642.92±7.29 vs. 638.25±7.00, PAWP (mmHg, 1 mmHg = 0.133 kPa): 5.83±1.19 vs. 5.42±1.08, both P > 0.05]. Compared with immediately after drowning, MAP, CO and PAWP at 30 minutes after seawater drowning were significantly lowered [MAP (mmHg): 90.50±3.58 vs. 159.42±3.18, CO (L/min): 2.37±0.45 vs. 10.33±0.73, PAWP (mmHg): 4.17±0.72 vs. 11.75±1.82, all P < 0.01], which were lower than those before drowning till 120 minutes. After drowning for 30 minutes, MAP, CO and PAWP in seawater group were significantly lower than those in freshwater group [MAP (mmHg): 90.50±3.58 vs. 117.42±1.78, CO (L/min): 2.37±0.45 vs. 8.25±0.66, PAWP (mmHg): 4.17±0.72 vs. 24.83±1.27], dPmax was significantly increased (mmHg/s: 1 251.42±62.50 vs. 919.83±14.51, all P < 0.01), and the tendency continued till 120 minutes. There was no significant difference in HR at all the time points between the two groups. ② The changes in urine: after freshwater drowning, the animals had hemoglobinuria and lasted until the end of the experiment, and the time of hemoglobinuria occurrence was at 20-35 minutes after drowning with an average of (25.30±5.15) minutes. After seawater drowning, the change in urine was not found until the end of the experiment.③ The variations of each organ tissue in pathology and hematology at 120 minutes after drowning: after freshwater drowning, the systemic tissue edema was found in organs such as heart, kidney, liver, spleen, and small intestine. After seawater drowning, there were different degrees of edema in the systemic organs, and some of them shrank. Conclusions After freshwater drowning, the animals showed decreased dPmax, increased CO and blood volume, edema and hemolysis of the tissue cells. After seawater drowning, CO and blood volume decreased, and some tissue cells were in atrophy.

Objective:To compare the effects of freshwater and seawater drowning on sheep's pulmonary circulation hemodynamics and respiratory mechanics.Methods:According to the random number table method, healthy crossbred sheep were divided into freshwater drowning group ( n = 12) and seawater drowning group ( n = 12). 30 mL/kg of freshwater or seawater was infused respectively through trachea for approximately 5 minutes. Before the drowning, immediately after drowning, and 30, 60, 120 minutes after drowning, the systemic circulation hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO)] were monitored by pulse indicator continuous cardiac output (PiCCO); the respiratory parameters were obtained through the ventilator, including tidal volume (VT), lung compliance (Cdyn), oxygenation index (PaO 2/FiO 2), peak airway pressure (Ppeak)]; PiCCO and the right heart floating catheter (Swan-Ganz catheter) was used to measure pulmonary hemodynamic parameters [pulmonary systolic pressure (PAS), pulmonary diastolic pressure (PAD), pulmonary artery wedge pressure (PAWP), and extravascular lung water (EVLW)]. The animals were sacrificed at the end of the experiment, and the amount of residual water in the respiratory tract was measured; the pathological changes in the lung tissue were observed by hematoxylin-eosin (HE) staining. Results:① Systemic circulation hemodynamics: compared with the values before drowning, HR, MAP, and CO at the time of immediately after drowning in both freshwater and seawater were significantly increased and peaked. In addition, all indicators in the freshwater drowning group were significantly higher than those in the seawater drowning group [HR (bpm): 170.75±1.87 vs. 168.67±2.27, MAP (mmHg, 1 mmHg = 0.133 kPa): 172.92±1.62 vs. 159.42±3.18, CO (L/min): 13.27±0.71 vs. 10.33±0.73, all P < 0.05].② Respiratory parameters: compared with values before drowning, PaO 2/FiO 2, VT, and Cdyn decreased immediately in both freshwater and seawater drowning groups, Ppeak was significantly increased; in addition, the values in the seawater drowning group were decreased or increased more significantly than freshwater drowning group [PaO 2/FiO 2 (mmHg): 37.83±1.99 vs. 60.42±5.23, VT (mL): 86.25±7.66 vs. 278.75±9.67, Cdyn (mL/cmH 2O): 8.86±0.33 vs. 23.02±0.69, Ppeak (cmH 2O, 1 cmH 2O = 0.098 kPa): 42.17±2.69 vs. 17.67±1.15, all P < 0.01]. In addition, PaO 2/FiO 2 in the freshwater drowning group was gradually increased over time, while the seawater group continued to decline.③ Pulmonary circulation hemodynamic parameters: PAS, PAD, PAWP at the time of immediately after drowning in both freshwater and seawater groups were significantly higher than before drowning; in addition, the freshwater drowning group was significantly higher than the seawater drowning group [PAS (mmHg): 34.58±2.87 vs. 26.75±1.66, PAD (mmHg): 27.25±1.22 vs. 16.75±0.87, PAWP (mmHg): 27.83±1.85 vs. 11.75±1.82, all P < 0.01]. Thereafter, PAS and PAD in the freshwater drowning group gradually decreased, while the parameters in the seawater drown group continued to increase. PAWP gradually decreased after freshwater or seawater drowning, and recovered to pre-drowning levels 120 minutes after drowning and 30 minutes after drowning, respectively. EVLW continued to increase after freshwater drowning, reaching a peak at 30 minutes, and then decreased, until 120 minutes after drowning was still significantly higher than that before drowning (mL/kg: 10.73±1.27 vs. 7.67±0.69, P < 0.01); EVLW could not be measured.④ Residual water in the respiratory tract: residual water in the freshwater drowning group was significantly less than that in the seawater drowning group (mL: 164.33±25.21 vs. 557.33±45.23, P < 0.01).⑤ HE staining: partial alveolar atrophied in the freshwater drowning group, some alveolar spaces were broken, alveolar spaces and alveolar cavity showed a little powdery substance deposition; it was noted that alveolar expanded in the seawater drowning group, alveolar spaces were broken and bleeding and edema were obvious in the interstitial space. Conclusion:The effect of seawater drowning on the respiratory mechanics and pulmonary circulation of animals is more obvious than that of freshwater drowned animals, and the amount of residual water in the respiratory tract is also significantly more than that of freshwater drowned animals.

Objective:To compare the cuff pressure and leakage volume and the related complications of filling the tracheal tube cuff by minimum air leakage method and cuff pressure manometer method after endotracheal intubation, so as to provide theoretical basis for patients who was intubated to obtain appropriate cuff pressure.Methods:A prospective randomized controlled study was conducted. 100 patients admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from December 2015 to June 2019 were enrolled. According to the random number table method, the patients were divided into the experimental group and control group, with 50 patients in each group. After successful endotracheal intubation, all patients were placed in a supine position with the head of the bed raised by 30°. The experimental group used the minimum air leakage method, and used the cuff pressure manometer to obtain the cuff pressure. In the control group, cuff pressure was maintained at 25-30 cmH 2O (1 cmH 2O = 0.098 kPa). Parameters such as cuff pressure and ventilator leakage volume at the beginning and 4 hours, 8 hours after the inflation were compared between the two groups, as well as the incidence of ventilation-associated pneumonia (VAP) and airway complications after extubation. Results:Among the 100 cases, 53 were males and 47 were females. The age ranged from 23 to 87 years old, with an average of (68.53±8.46) years old. The intubation time ranged from 1 to 16 days.① At 4 hours and 8 hours after inflation, the cuff pressures of the two groups were lower than that of the first time of inflation, and the air leakage of the ventilator increased gradually with the extension of time. Compared with the control group, cuff pressures at each time point in the experimental group were significantly higher than those in the control group [mmHg (1 mmHg = 0.133 kPa): 33.72±9.14 vs. 25.68±5.26 at 0 hour, 30.54±7.81 vs. 24.35±4.93 at 4 hours, 26.57±5.64 vs. 22.42±4.14 at 8 hours, all P < 0.05], and ventilator leakage volumes were smaller than those in the control group (mL: 25.57±8.51 vs. 34.65±9.47 at 0 hour, 40.54±8.51 vs. 60.34±7.85 at 4 hours, both P < 0.05). ② The incidence of VAP in the experimental group was significantly lower than that in the control group (4% vs. 10%, P < 0.05). There was no statistically significant difference in the incidence of other airway complications between the experimental group and control group (airway mucosal edema: 14% vs. 12%, ulcer: 8% vs. 6%, tracheal esophageal fistula: 0% vs. 0%, hoarseness: 4% vs. 6%, cough: 30% vs. 34%, sore throat: 28% vs. 32%, tracheal softening: 0% vs. 0%, cuff rupture: 10% vs. 8%, all P > 0.05). Conclusions:The optimal cuff pressure is very important for preventing VAP and reducing airway complications. The minimum air leakage method makes the clinical obtained endotracheal intubation cuff pressure more accurately, with less air leakage, safe and effective, and it is worthy of clinical promotion.

Objective:To identify the pathogenic characteristics of a suspected gonadal mosaicism Becker muscular dystrophy (BMD) family, and provide provide basis for pregnancy selection of similar families.Methods:A BMD family admitted to Hunan Jiahui Genetics Hospital from June 2012 to September 2019 was systematically reviewed. The medical history and family history of the proband were checked, and multiplex ligation-dependent probe amplification was used to detect the deletion/duplication of 79 exons of the Duchenne muscular dystrophy (DMD) gene in the proband, fetuses, and parents. Moreover, potential variants were verified by combining PCR amplification, short tandom repeat polymorphic linkage analysis, and real-time fluorescence quantitative PCR. High-quality embryos are screened for transplantation after preimplantation genetic testing for monogenic (PGT-M). And amniotic fluid was collected in the second trimester for prenatal diagnostic verification.Results:According to the phenotype analysis of the proband, the initial clinical diagnosis was BMD, and the exon 45-50 deletion in DMD gene was detected. The mutation was not detected in the mother′s peripheral blood, but when she was pregnant again, the prenatal diagnosis showed that the fetus had the same deletion mutation as the proband. Neither of two vitro embryos tested by PGT-M has the deletion mutation, then single embryo transfer was performed nor was pregnancy successful. After confirmation of prenatal diagnosis during pregnancy, a normal baby girl was born by full-term cesarean section.Conclusions:This BMD family was a family with two consecutive BMD homodeletion mutations, and the mutation of the DMD gene was not detected in the peripheral blood of the proband′s mother and two embryonic cells, suggesting that the mother may be a gonad chimeric carrier of this deletion mutation. The combined application of prenatal diagnosis and PGT-M provides a reference approach to effectively avoid the birth of similar children.

Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.