Objective To study the characteristic and influential factor of the hidden blood loss after total knee arthroplasty (TKA) so as to provide a reference frame for clinical work. Methods There were 75 patients with osteoarthritis of the knee who were operated with unilateral primary TKA. The patients including 21 males and 54 females at a mean age of 68.7 years were retrospectively analyzed.The perioperative blood loss and the hidden blood loss following TKA were calculated by Gross formula. It was analyzed that if the perioperative blood loss and the hidden blood loss following TKA were affected by gender, haemostasis during operation with deflating tourniquet and reinfusion of the drained blood. Results The preoperative blood loss was (1551.3 ± 369.6) ml and the hidden blood loss was (792.3 ±228.6) ml. The hidden blood loss of male was significantly higher than that of female (P ＜ 0.05). The hidden blood loss was reduced by haemostasis during operation with deflating tourniquet (P ＜ 0.05) but was not affected by postoperative shed blood reinfusion. Conclusions The lowest value of Hct is a representative parameter for calculation of the hidden blood loss. There is no significant difference between male and female about the relative hidden blood loss. Haemostasis during operation with deflating tourniquet can reduce teh hidden blood loss but not affect the total perioperative blood loss. Reinfusion of the drained blood can reduce the transfusion rate but does not affect the total preoperative blood loss and the hidden blood loss.

[Objective] To investigate the feasibility of posterior interbody parvule-impacted bone graft fusion.[Method] A retrospective study was performed in 31 patients admited to our hospital in 2003~2006(M=14,F=17).The ages were 55 to 80,with an average of 66.2 years.There were 9 cases of spondylolisthesis,6 of degenerative unstability and 16 of developmental stenosis.All patients underwent posterior interbody impact bone graft fusion and pedicle screw fixation.The pre-and post-operative JOA score were used to calculate the improvement rate.The postoperative bending-extending plain films were taken to observe whether the fusion was successful.[Result]All patients were followed up for 12~18 months.Three patient had leg symptoms at postoperation and were released 3 months later.Thirteen patients had fusion at 6 month,16 had union at 12 month,and 2 had union at 18 month.The lumbar lordosis angle and intervertebral height got significant restoration.The spinal fusion rate was 100%.No dura tear leakage of cerebrospinal fluid or wound infection was found.No graft absorption,displacement or collapse occurred.There were 16 cases excellent,12 cases good,and 3 cases fair.JOA score was 24~29(average 27.4?1.9)at postoperation.The improvement rate was 89.4%.[Conclusion] Posterior interbody parvule-impacted bone graft is a feasible fusion method.The method is simple and cheap,with advantages of less injury and high fusion rate.

[Objective]To investigate the diagnosis and treatment of lumbosacral nerve roots anomalies. [Method]Etiological factors,typing,diagnosis and treatment of lumbosacral nerve roots anomalies confirmed by operation were analyzed.Operative treatment included wide laminectomy(n=8),hemilaminectomy(n=8) and enlargement fenestration(n=9).[Result]The presenting symptoms of lumbosacral nerve roots anomalies often resulted from lumbar disc herniation or spinal canal stenosis.The typs of lumbosacral nerve roots anomalies included conjoined nerve roots(n=10),closely adjacent roots(n=8),thickening of nerve roots(n=2),caudal origin roots(n=2),division of nerve roots(n=1),double nerve roots(n=1),and anastomosis of nerve roots(n=1).The levels of nerve roots anomalies were L4 in 1,L5 in 14,and S1 in 10.Only 5 cases were diagnosed preoperatively by myelography,CT or MRI.The others were found at operation.All patients were followed up for more than 2 years.Postoperatively,the results were rated as excellent in 12,good in 8,and fair in 4.One patient had residual radiating pain in the lower lims and weakness in dorsiflexion of the foot. [Conclusion] Radicular symptoms of lumbosacral nerve roots anomalies are changeable.The preoperative diagnosis is difficult to establish by myelography,CT or MRI(axial and sagittal plane).It is necessary to heighten the sensitivity of diagnostic modalities.It may improve the surgical outcomes to expose sufficiently,to explore the nerve roots carefully and to decompress thoroughly.

Objective To analyze causes for complications after proximal femoral intramedullary nail treating unstable femoral intertrochanteric fractures in the elderly.Methods A total of 172 cases of unstable intertrochanteric fractures treated with proximal femoral intramedullary nail from December 2001 to May 2007 were reviewed upon postoperative complications to find out the causes for complications and discuss countermeasures.Results Of all, 149 cases were followed up for 6-42 months(mean 18. 5 months), which showed excellence rate of 89. 0% in aspect of functional recovery of the hip. Postoper-ative systemic complications occurred in 26 cases and local complications in 21.Condusions Proxi-real femoral intramedullary nail can be used in most elderly patients with unstable intertrochanteric frac-tures. A thorough evaluation of physiological function, treatment of preoperative comorbidities and aug-mentation of surgical technique are prerequisites for operation safety and decrease of complications.

Objective To discuss the results and characteristics of surgical treatments through anterior or posterior approach for thoracolumbar burst fractures. Methods The retrospective review included 43 cases with an average age of 30.4 years from September, 1999 to November, 2004. The surgical approach was chosen according to conditions of the injury. 17 cases received an anterior approach operation. The Frankel scale was used for assessment of nerve function. 3 cases were rated as Grade A, 12 as Grade B, 19 as Grade C, and 9 as Grade D before surgery. Results The mean follow-up period was 36.7 months. There were no severe postoperative complications, such as deterioration of nerve function. All the cases showed notable improvement. Except in 3 cases of complete paraplegia, the improvement was 1.6 and 1.3 Frankel grades respectively for the anterior and posterior approach operations. Conclusions The anterior and posterior approaches are different in advantages and characteristics. The surgery through anterior approach provides more decompression and better maintenance of sagittal plane alignment.

Objective To investigate the expression of VEZT and its clinical pathological significance in gastric cancer tissues,and to construct the VEZT over-expression vector.Methods The expression of VEZT was examined in 119 cases of gastric carcinoma and their corresponding normal mucus tissues by SP immunohistochemical staining.The relationships between the VEZT expression levels and its clinicopathological characteristics,prognosis were also investigated.VEZT cDNA was extracted and amplificated from 293 cells by polymerase chain reaction (PCR).Using DNA recombinant technique,the target gene was connected to the pEGFP-N1 vector to construct recombinant plasmid vector after the target gene and pEGFP-N1 were purified.The recombinant plasmid was identificated by 1％ enzyme electrophoresis and DNA sequencing.Results The VEZT-positive expression in gastric carcinoma was 30.3％ and 60.5％ in normal gastric tissues.VEZT expression in high differentiated cancer tissues was higher than that in lower differentiated tissues(x2 =5.002,P ＜ 0.05),expression of VEZT in early gastric cancer was significantly higher than that in patients with advanced gastric cancer (x2 =5.551,P ＜ 0.05),expression of VEZT in patients without lymph node metastasis was significantly higher than that of lymph node metastasis (x2 =5.878,P ＜ 0.05).Patients with positive VEZT expression have better prognosis than the negative patients(x2 =6.908,P ＜ 0.01).The target fragment,consistent with the theoretical value,was verified by gel electrophoresis.DNA sequencing confirmed that the gene sequence had no mutation and the eukaryotic expression plasmid vector pEGFP-N1-hVEZT was successfully constructed.Conclusions VEZT protein was correlated with TNM staging,tumor stage,invasion depth and lymph node metastasis,positive VEZT expression predicting better five year survival.The VEZT over-expression plasmid vector was successfully constructed.

Objective:To explore whether cigarette smoking extract (CSE) has influence on fluorescence protein ex-pression of thrombomodulin (TM) on surface of African green monkey kidney fibroblast cells (COS-7) or not . Methods:When TM-green fluorescent protein (GFP) plasmid was successfully constructed ,COS-7 cells were trans-fected by it ,then incubated by prepared 5% CSE (5% CSE group) ,PBS of certain volume was added to serum-free minimal essential medium (MEM ,simple medium) ,which was cultured at the same time and treated as control group .Flow cytometry counting method was used to detect change of TM-GFP expression amount on COS-7 surface at different time point .Results:Compare with control group ,there were no significant difference in the expression of TM-GFP on COS-7 surface at 1h and 6h in 5% CSE group [1h :(134.99 ± 18.41) vs .(146.61 ± 12.06) ,6h :(116.89 ± 27.28) vs .(123.89 ± 39.24) ,P>0.05 both] .Conclusion:The 5% cigarette smoking extract has no influ-ence on fluorescence expression of thrombomodulin on surface of African green monkey kidney fibroblast cells .

Objective:To analyze therapeutic effect of homocysteine (Hcy)‐lowering therapy on serum levels of Hcy and inflammatory factors in patients with coronary heart disease (CHD ) after percutaneous coronary intervention (PCI) .Methods :A total of 82 CHD patients who received PCI in our hospital were selected .According to random number table ,they were randomly and equally divided into routine treatment group (received routine postoperative therapy) and Hcy‐lowering group .Serum levels of Hcy ,inflammatory factors ,N‐terminal pro‐brain natriuretic pep‐tide (NT‐proBNP) and soluble intercellular adhesion molecule‐1 (sICAM‐1) were compared between two groups . Results :1) On six months and one year after treatment ,compared with routine treatment group ,serum Hcy level significantly reduced [after six months: (15.39 ± 1.83) μmol/L vs . (13.21 ± 1.35) μmol/L ,after one year :(15.61 ± 1.62)μmol/L vs . (8.73 ± 0.72)μmol/L] in Hcy‐lowering group ;2) after six‐month treatment ,compared with routine treatment group ,there were significant reductions in serum levels of CRP [ (67.27 ± 7.51) mg/L vs . (37.11 ± 6.32) mg/L] ,IL‐6 [ (87.58 ± 7.21)μg/L vs . (60.17 ± 5.45)μg/L] ,procalcitonin [PCT , (21.34 ± 3.04) ng/L vs .(15.61 ± 2.32) ng/L] ,NT‐proBNP [ (298.37 ± 53.28) pg/ml vs .(104.28 ± 13.17) pg/ml] and sI‐CAM‐1 [ (391.83 ± 75.04) ng/ml vs .(162.18 ± 30.26) ng/ml] in Hcy‐lowering group , P<0.05 all .Conclusion:Hcy‐lowering therapy is help to reduce serum Hcy level ,relieve systemic inflammatory response and protect myocar‐dial function in CHD patients after PCI .

Objective To investigate the effect of tail vein injection of exogenous bone marrow mesenchymal stem cells (BMSCs) on proliferative,osteogenic and adipogenic potential of BMSCs in ovariectomized osteoporotic rats.Methods The animal model of osteoporosis (OP) was established 3 months after ovariectomy (bilateral ovarian resection)in healthy 10-week-old female SD rats with the same batch and weight.The healthy 8-week-old SD GFP rats were selected in the same way as the BMSCs source.The experiment was divided into BMSCs group and control group.The BMSCs (1×106) marked with GFP were injected into BMSCs group rats by tail vein injection.One week after injection,BMSCs were isolated,cultured and purified in vitro to the 3rd,4th passage in all groups.The MTT method was used to detect the growth curves of BMSCs.The oil red O dyeing and alizarin red staining (ARS) were used to compare the adipogenic and osteogenic potential between the two kinds of BMSCs,respectively.The RT-PCR was used to detect the expression of osteogenesis-related genes (Runx2,osteocalcin and osteopontin) and adipogenesis-related genes (PPARγ and LPL) in BMSCs.Results Compared with the control group,the growth curve of BMSCs in BMSCs group rose significantly; the calcified nodule increased significantly after osteogenic induction; the lipid droplet decreased significantly after adipogenic induction.RT-PCR results showed that the Runx2,osteocalcin and osteopontin mRNA expression increased,while the peroxisome PPARγ and LPL mRNA expression decreased in BMSCs group.Conclution By tail vein injection of exogenous BMSCs,the proliferative and osteogenic potential of BMSCs in ovariectomized osteoporotic rats is enhanced,while the adipogenic potential is reduced,which provides a possibility of stem cell therapy for osteoporosis.