BACKGROUND: Critical organ hypofunction and complications are common in elderly patients, so perioperative treatment becomes important for the success of total knee replacement (TKR).OBJECTIVE: To explore clinical perioperative complications of TKR in the patients over 70 years old. DESIGN, TIME AND SETTING: Retrospective analysis of case data was performed at First Hospital of Gannan Medical University and People's Hospital of Peking University from January to December 2002.PARTICIPANTS: 109 patients (168 knees), including 29 males and 80 females, underwent TKR. Of them, 50 underwent single knee surgery, aged (74.2±15.1) years (range 70-85 years), and 59 underwent bilateral knee surgery, aged (73.4±13.2) years (range 70-85 years). In addition, 92 cases (84.4%) were obesity, and 88 were complicated by internal diseases. METHODS: The surgery was performed by the same operator. All patients underwent patellar replacement with Scorpio posterior stable knee prosthesis. Knee anterior median incision and medial patellar approach was applied, and anterior and posterior cruciate ligaments were excised during the surgery, osteophyma and corpus liberum of posterior articular capsule were cleared. Patellofemoral joint track was tested until meeting the requirements. The prosthesis was fixed using antibiotics mixed with bone cement, and the incision was sutured at flexed position.MAIN OUTCOME MEASURES: Early complications following replacement; knee joint and functional evaluation.RESULTS: During surgery and 24 hours after replacement, 8 cases developed hypertension, 7 cases hypotension, and 6 cases arrhythmia. All patients safely passed the perioperative period under treatment of related departments. One case developed pulmonary embolism, 1 case deep infection, 3 cases pulmonary infection, 5 cases urinary system infection, 1 case rapid reduction of platelet caused by Subining, 1 case cognitive disturbance, and 1 case dislocation of knee joint (Charcot arthritis). According to standards of HSS, the knee joint scores were significantly improved from 26.1 prior to replacement to 82.0 at discharge, and function scores were significantly improved from 32.1 prior to replacement to 89.1 at discharge. During 12.4-month follow-up (range 3-22 months), 18 cases lost the follow up; the retention rate was 83.5%. Of 91 retention patients, knee pain disappeared or relieved, restored self-care ability, and no prosthesis loosening or infection was found. At the final follow up, the HSS knee joint scores were significantly improved from 82.0 at discharge to 85.4, and function scores were improved from 89.1 at discharge to 92.3 at discharge.CONCLUSION: Skilled operative technique and positive treatment of complication can effectively prevent perioperative infection, dislocation and other complications following total knee replacement.

ObjectiveTo observe the serum levels of IL-6,IL-10 and IL-1 in children with Kawasaki disease and its clinical significance.Methods38 childrey with of Kawasaki disease were selected as observction group,then selected 38 cases of normal children as control group.Serum IL-6,IL-10 and IL-1 levels were observed two groups.ResultsObservation group IL-6,IL-10 and IL-1 levels were higher(t =10.3877,15.1010,15.1243,all P＜0.05),acute phase of observation group IL-6,IL-10,IL-1,etc.levels were significantly higher than the sub-acute phase patients ( t =9.7594,11.6486,11.6622,all P ＜ 0.05 ) and control group ( t =11.7032,11.7718,11.8267,all P ＜0.05 ).48h apoptosis rate in the control group( 2.8 ± 0.8 )％ was significantly lower than in children with Kawasaki disease(38.3 ±7.9)％ (t =38.59,P ＜0.01 ).Platelets increased[ (464.0 ± 110.2) × 109/L] of the IL-1 level in children with Kawasaki disease(663 ±94)ng/L was significantly higher than those without elevated platelet [ (307.0 ±104.9) × 109 /L ] of children( 492 ± 92 ) ng/L ( t =13.1044,P ＜ 0.05 ).ConclusionThedetection of serum IL-6,IL-10 and IL-1 levels may aid clinical diagnosis of the condition of children with Kawasaki disease,complications and treatment,have important clinical significance.

Animals ; Gene Silencing ; physiology ; Gene Targeting ; Genetic Therapy ; methods ; Genomics ; Humans ; RNA Interference ; RNA, Small Interfering ; genetics ; therapeutic use ; RNA-Induced Silencing Complex

Objective To investigate the effects of cobalt chloride(COCl2)induced rat alveolar epithelial cell apoptosis and the significance of related apoptosis protein hypoxia inducible factor-lalpha(HIF-1 a)expression. Methods Alveolar epithelial cells were cultured in vitro and divided into four groups with 6 samples in each.Hypoxia 4 h group:added 500μmol/L COCl2 for 4 hours inducing alveolar epithelial cell hypoxia;hypoxia 24 h group:co-cultured with COCl2 for 24 hours;hypoxia 48 h group:co-cultured with CoCl2 for 48 hours;control group:no CoCl2 added.The apoptosis rates were detected by fluorescent microscope and flow cytometry.The apoptosis morphological changes of the cell were observed by transmission electron microscopy.The protein expression of HIF-la was detected bv Western Blot. Results (1)Fluorescent microscope results showed that apoptosis rate in hypoxia 4 h、24 h、48 h group[(5.83±0.76)%,(15.00±3.28)%and(51.50±3.00)%],were higher than control group[(1.50±0.50)%](P＜0.05).(2)Flow cytometry analysis reached the same results as with fluorescent microscope.(3)Typical morphological changes of apoptosis were observed in hypoxia 24 h group.(4)HIF-1α expression in hypoxia 4 h、24 h and 48 h groups[0.69±0.035,1.02±0.044 and 0.71±0.046],were higher than control group(0.21±0.026)(P＜0.01).(5)Positive correlations were found between relative amount of HIF-1αprotein and apoptosis rate by fluorescent microscope and flow cytometry analysis(r=0.484,P=0.016;r=0.713,P=0.009).Conclusions Hypoxia could induce apoptosis of alveolar epithelial cells,which may participate in the pathogenesis of hypoxia-induced lung injury.

Objective To estabolish the ALDH2 Glu504Lys genotyping technique for oral swab sample type based on PCR-gold magnetic nanoparticle chromatographyl.Methods According to the ALDH2 Glu504Lys gene the specific primers were designed by ARMS-PCR technique.Optimized the optimal ALDH2 Glu504Lys oral swab reaction system and PCR reaction procedures based on the routine reaction conditions and reaction procedure of laboratory PCR.60 samples of oral swabs were collected and tested by gold magnetic nano-chromatography.The results were verified by sequencing.Results The detected 60 cases of oral swab samples contain 16 cases heterozygous mutation,wild type 42 cases,homozygous mutation 2 cases and then the results by Goldmag nanoparticle detection was perfectly matched with sequencing results.Conclusion The Goldmag nanoparticles chromatographic detection technique of ALDH2 Glu504Lys buccal swabs system was established.With accuracy,fastness,reliability,it is worthy of clinical promotion.

The goal of this work was to explore the prospect of standardized application of an in-vitro bioactivity assay for recombinant human follicle-stimulating hormone based on a reporter gene. The relative accuracy, intermediate precision, linearity and applicable range of the method were validated according to the General Rules of Chinese Pharmacopoeia 2020 edition Volume IV (9401). Three laboratories used this method to determine the in-vitro biological activities of six batches of drug product and three batches of drug substance manufactured by two different companies. The consistency of the potency determined by three laboratories, the intra-laboratory precision and inter-laboratory precision were analyzed. The method was optimized during the collaborative validation. The results of method validation meet the requirements of the General Rules of Chinese Pharmacopoeia 2020 edition Volume IV (9401). Aiming to resolve the problems found in the collaborative validation, the medium for cell seeding, the pre-diluted buffer solution of standard and sample, and the means of removing and discarding supernatant after stimulation were optimized. After optimization, there was no significant difference in the bioactivity among the different laboratories (P > 0.05), indicating statistical equivalency. Intra-laboratory and inter-laboratory precision were good and the geometric coefficient of variation (GCV%) were both less than 15%. In conclusion, the reporter gene assay has good intra-laboratory repeatability and inter-laboratory reproducibility and is suitable for analyzing recombinant human follicle-stimulating hormone drug product and drug substance by different manufacturers. It is expected to be used as a standardized method for the determination of the in-vitro bioactivity of such products.

Brain ; blood supply ; Fetus ; blood supply ; Heart Defects, Congenital ; diagnostic imaging ; Humans ; Infant, Newborn ; Middle Cerebral Artery ; diagnostic imaging ; Ultrasonography, Doppler, Color ; Ultrasonography, Prenatal

Objective To observe the clinical effects and complications of primary trigeminal neuralgia treatment with radiofrequency thermocoagulation on gasserian ganglion. Methods Under the guidance of C-arm or DSA and with Hartel method, we percutaneously punctured the oval foramen to gasserian ganglion and performed radiofrequency times. Results Pain was completed eliminated in 53 of the 56 patients, which was regarded as degree Ⅰ of clinical cure with the curativeness rate being 96.4%; 1 case was of degree Ⅱ; 1 case was of degree Ⅲ; 1 case had no effect. The rate of satisfactory effectiveness was 96.4% and the total rate of efficacy was 98.2%. No severe complications were observed. Conclusion Radiofrequency thermocoagulation is a safe and effective method to treat primary trigeminal neuralgia with few severe complications.

Objective To investigate the effect of Helicobacter pylori (Hp) on the degranulation of mast cells and the permeability of gastric mucosa in BALB/c mice, in order to provide further evidence for the important role of Hp in the pathogenesis of chronic urticaria (CU). Methods Seventy healthy BALB/c mice were randomly classified into 3 different groups, namely, Hp group (n = 30), fed with Hp liquid once every 3 days for a total of 7 times, and two control groups, alcohol group (n = 20) fed with 45 percent alcohol solution, and bovine serum albumin (BSA) group (n = 20) fed with BSA 2% solution. Alteration in the blood sucrose level was used to assess the permeability of gastric mucosa. Toluidine blue staining of gastric mucosa was used to assess the total number of mast cells, the amount of degranulated mast cells and the per-centage of degranulated cells after feeding. Results There was a statistically significant difference between the total number of mast cells (F = 207.59, P < 0.01 ) and the percentage of degranulated mast cells (F = 108.16, P <0.01 ) among the three groups, with the highest number and percentage observed in the Hp group followed by the alcohol group. In both groups, the concentration of blood sucrose was increased after feed-ing, with a higher increase in the alcohol group; no significant change occurred in the concentration of blood sucrose in the BSA group (F = -4.06, P > 0.05 ), which differed significantly from the other two groups (F =277.03, P< 0.01 ). Conclusions Hp infection could increase the number and degranulation of mast cells in gastric mucosa, resulting in the release of histamines and vasoactive mediators, which may be related to the manifestation of urticaria.

Objective To explore the long-term effect, prognosis and administration of corticosteroid treatment on autoimmune pancreatitis (AIP). Methods Clinical data were analyzed in 13 diagnosed and followed up AIP patients of Peking Union Medicine College Hospital during August 2004 to August 2008. Results Of 13 patients, 12 were males and 1 was female, with a mean age of 58.7 years old, and a mean follow-up of 30 months. Of 11 patients compliated with bile duct disease,biliary stents were placed in 9 patients and already taken out. Corticosteroid treatment was received by cured patients. The average corticosteroid therapeutic time was 9.2 months, 7.9 months in 6 biliary stent placed patients, 13.4 months in corticosteroid treated alone patients, the statistical difference was significant (P = 0. 023). Serum inflammatory parameters normalized range from 5. 3 to 8.8 weeks. After corticosteroid treatment, pancreas enlargement improved in all patients at the first imaging reexamination (1.0 to 11.3 weeks), pancreatic size normalized in 9 patients with an average of 16.6 weeks corticosteroid treatment. No relapsing sign was found with imaging examination during follow-up. Of 8 newly onset diabetes patients, glucose level normalized in 4 patients after corticosteroid treatment. Two patients complicated with autoimmune hepatitis developed early hepatic cirrhosis symptoms at the end of the follow-up. Swollen submandibular gland enlargement relapsed in one patient after corticosteroid withdrawn for six months. Conclsion AIP patients responsed well to corticosteroid treatment. Placement of biliary stent could shorten corticosteroid therapeutic time.Patients with bile duct complications and newly onset diabetes could partially relieve after the corticosteroid treatment, the prognosis of patients with autoimmune hepatitis complications was relatively poor.