BACKGROUND:Early knee ioint prosthesis is used to relieve severe pain of patients．With continuous modification，the knee joint prosthesis with high flexion has developed．OBJECTIVE：To compare the clinical outcome between fixed platform high—flexion prosthesis and rotating platform high-flexion prosthesis following total knee arthroplasty．DESIGN：Non-randomized concurrent control trial of patients．PARTICIPANTS：Thirty-four patients(50 knees)with severe osteoarthritis underwent total knee replacement in Department of Bone and Joint,Tianjin Union Medicine Center from January to December 2006．METHODS：Of 34 patients，16(25 knees)underwent fixed platform high-flexion prosthesis replacement(LPS flexion，Zimmer，USA)，and 18(25 knees)underwent rotating platform high-flexion prosthesis replacement(PFC sigma RPF prosthesis．Johnson & Johnson,USA)．MAIN OUTCOME MEASURES：Knee joint function was evaluated using Hospital for Special Surgery Knee Score (HSS)before and 2 weeks，1，3 and 6 months after surgery．In addition，range of flexion of the knee was observed at 6 months postoperatively．RESULTS：Thirty-four cases completed the treatment and were followed up for 6 months．HSS scores of patients undergoing rotating platform high-flexion prosthesis replacement were higher than fixed platform high·flexion prosthesis replacement group at 2 weeks postoperatively(P<0．05)，while no differences were found in HSS scores at 1，3 and 6 months after surgery(P>0．05)．In addition，there were no significant differences in the range of flexion of the knee at 6 months postoperatively[(130．4±15．2)°，(129．9±13．8)°，P>0．05]．CONCLUSION：Fixed platform and rotating platform high-flexion prosthesis replacement exhibit similar early effects on severe osteoarthritis．

Objective To investigate the effects of post-propofol anesthesia on cognitive function and hippocampus proteome expressions in aged rats.Methods Thirty healthy male Wistar rats aged 20 months were randomly divided into control group(n =15) and propofol group(n =15).The control group was injected with normal saline of 6 ml/kg intraperitoneally and propofol was injected intraperitoneally with propofol 60 mg/kg.The rats in both groups underwent Step-down Test to assess cognitive function at the first day and at the seventh day after the termination of drug administration.Five rats were decapitated randomly each time after the two step-down tests and their hippocampi were removed for two-dimensional gel electrophoresis and mass spectrometric analysis.Results In the step-down test,aged rats in the propofol group showed significantly learning impairment and decreased memory abilities at the 1st day after propofol anesthesia as compared with those in the control group.In learning phase of the 1st day,the latency of the propofol group is (29.5 ± 7.6)s as compared with(19.7 ± 7.0)s of the control group,while the error time is 3.6±1.2 vs.1.6 ±0.8 in the propofol group vs the control group,and the total time of electric shock is(65.2 t 10.6)s vs.(42.7 ± 10.3)s in the propofol group vs the control group(all P＜0.01).The latency of the memory phase in the propofol group is also decreased as compared with that in the control group(31.4±14.3)s vs.(111.2± 23.7) s,(P＜0.01).On the 7th day after anesthesia,there was no significant difference between the two groups.There were 17 differentially expressed proteins on the 1st day after propofol anesthesia,6 of them were up-regulated and 11 proteins were down-regulated (P ＜ 0.05).On the 7th day,there were 10 differentially expressed proteins,and the expression of 5 proteins was down-regulated (P ＜ 0.01).Conclusions Aging rats receiving propofol anesthesia show cognitive function decline,but do not show a long-term decline.The mechanism may be related to the different expressions of hippocampal proteins.

Extraction of teeth is the most basic and widely used operation of oral and maxillofacial surgery. According to characteristics of extraction of teeth, the author views medical ethics principles which in the diagnoses and treatments process from the aspect of medical ethics, they are,①Doctors must intensify their own quality and self - cultivations and establish the idea of " People First ". ②Doctors must carry on the overall and systematic inspection, make the plan of diagnoses and treatments synthetically toimplement the idea of " People First ". ③Doctors should pay attention to interact with patient, meet different patients' demands and create the harmonious medical environment.

Objective To compare the changes in myocardial fibrosis degree and left ventricular function before versus after percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD).Methods 121 elderly patients diagnosed as CHD with a single vessel by coronary angiography were enrolled.All patients were treated with PCI guided by thrombolysis in myocardial ischemia (TIMI) grade,symptoms and fractional flow reserve (FFR) comprehensively,and reviewed by coronary angiography after 12 months.The changes in serum concentration of procollagen type Ⅰ (PC I),procollagen type Ⅲ (PC Ⅲ),laminin (LN),hyaluronic acid (HA) and aldosterone (ALD) before versus 3,12 months after PCI were detected by enzyme-linked immunosorbent assay (ELISA).Left ventricular ejection fraction (LVEF),left ventricular enddiastolic diameter (LVEDD),plasma N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) level and 6-minute walk test (6MWD) were assessed before and 3,12 months after PCI.The correlations were analyzed between FFR and serum procollagen type Ⅲ level,between serum PC Ⅲ level and plasma NT-proBNP level,and between serum ALD level and serum levels of PC Ⅰ,PC Ⅲ,LN,HA.Results All patients were treated with PCI successfully.At 12 months after PCI,stenosis with different degree were found in implanted stents or some large vessels in 6 cases by coronary angiography FFR=0.56-0.82).The serum levels of PC Ⅰ,PC Ⅲ,LN,HA,ALD,LVEDD and the plasma levels of NT-pro BNP were lower at 3 months after PCI than at preoperative follow-up (all P＜0.05),but LVEF was higher at 3 months after PCI than at preoperative fellow-up (P＜0.05),and the change trends in above observations were more significantly at 12 months after PCI.Linear correlation analysis showed that there was negative correlation between FFR and PC Ⅲ (r=-0.67,P＜0.01).There were positive correlations between PC Ⅲ and NT-proBNP,between ALD and PCⅠ,PC Ⅲ,LN,HA respectively (r=0.67,0.52,0.55,0.46,0.51,all P＜0.01).Conclusions PCI comprehensively guided by TIMI grade,symptoms and FFR can reduce myocardial fibrosis,improve cardiac function and quality of life in elderly patients with single coronary heart disease.

Objective To evaluate the clinical effects of medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of the patellar dislocation.Methods From January 2007 to January 2010,16 cases of patellar dislocation were included in this group.Lysholm score was averaged preoperatively.Arthroscopic-assisted in the semitendinosus tendon autograft reconstruction of the medial patellofemoral ligament,the central graft were fixed on the inner edge of the patellar in the upper 1/3 and the mid-point location,the end were fixed on the channel of femoral epicondyle and adductor tubercle.Results All the patients that lined progressive knee rehabilitation after operation,returned to normal walking for 3 months,6 months could be sports.Followed up for 7-54( 26.36 ± 20.48 ) months,all of patients incision were healed as grade Ⅰ,knee function were normal.Postoperative Lysholm score (93.21 ± 4.68) scores compared with preoperative ( 76.53 ± 8.35 ) scores was significant difference (P ＜ 0.05 ).Conclusions Using the semitendinosus tendon autograft for the treatment of the patellar dislocation method is simple and can effectively restore normal patellar trajectory.At the same time,which is an effective surgical method to treat recurrentdislocation of the patellar.

Objective To investigate the mechanism underlying sufentanil postconditioning-induced reduction of myocardial ischemia-reperfusion (I/R) injury in rats through evaluating the relationship between phosphatidylinositol 3-kinase/serine-threonine kinase (PI3K/Akt) signaling pathway and mitochondrial permeability transition pore (mPTP).Methods Forty-eight pathogen-free healthy male SpragueDawley rats,aged 3 months,weighing 250-300 g,were divided into 4 groups (n=12 each) using a random number table:sham operation group (group S),group I/R,sufentanil postconditioning group (group SP) and snfentanil postconditioning plus PI3K inhibitor wortmannin group (group SP +W).The rats were anesthetized with 20％ urethane 5 ml/kg.Myocardial I/R was induced by ligation of the anterior descending branch of left coronary artery for 30 min,followed by 120 min reperfusion.Sufentanil 1.0 μg/kg was injected via the sublingual vein at 5 min before reperfusion in SP and SP+W groups.Wortmannin 15 pμg/kg was injected via the sublingual vein at 5 min before reperfusion,and then sufentanil 1.0 μg/kg was given in group SP+W.Blood samples were taken from the abdominal aorta at the end of reperfusion for detection of serum cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) concentrations.The rats were then sacrificed and hearts were removed for determination of cell apoptosis (by TUNEL),nicotinamide adenine dinueleotide (NAD+) content (by speetrophotometry),and expression of phosphorylated Akt (p-Akt) in myocardial tissues (by Western blot).Apoptosis index (AI) was calculated.The myocardial mitochondria and cytoplasm were isolated for detection of the expression of cytochrome c (Cyt c) and apoptosis-inducing factor (AIF) using Western blot.Results Compared with group S,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was up-regulated,the expression of Cyt e and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in I/R,SP and SP+W groups (P＜0.05).Compared with group I/R,the serum cTnI and CK-MB concentrations and AI were significantly decreased,the content of NAD+ was increased,the expression of p-Akt was up-regulated,the expression of Cyt c and AIF in mitochondria was up-regulated,and the expression of Cyt c and AIF in cytoplasm was down-regulated in group SP (P＜0.05).Compared with group SP,the serum cTnI and CK-MB concentrations and AI were significantly increased,the content of NAD+ was decreased,the expression of p-Akt was down-regulated,the expression of Cyt c and AIF in mitochondria was down-regulated,and the expression of Cyt c and AIF in cytoplasm was up-regulated in group SP+W (P＜0.05).Conclusion Sufentanil postconditioning can activate PI3K/Akt signaling pathway,inhibit mPTP opening,mitigate mitochondrial injury and inhibit apoptosis in cardiomyocytes,thus attenuating myocardial I/R injury in rats.

BACKGROUND:From the biological structure, the posterior cruciate ligament is surrounded by the synovial folds of posterior capsule, arising from the inner side of the medial femoral condyle to the posterior part of tibial intercondyloid spine. The main traditional treatment method for posterior cruciate ligament tibial avulsion fracture is open operation, but it is difficult in anatomic reduction, cannot ful y restore knee joint stability and has a great negative impact on the normal function of posterior cruciate ligament. OBJECTIVE:To investigate the effects of arthroscopic implant internal fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament. METHODS:120 patients with tibial avulsion fracture of the posterior cruciate ligament were randomly assigned into treatment group and control group, with 60 cases in each group. The control group was given the traditional open surgery, and the treatment group was given the arthroscopic surgery. After 3 months, International Knee Documentation Committee (IKDC) scores and Lysholm scores were detected in the two groups;the knee joint range of motion was determined before and 3 months after treatment. RESULTS AND CONCLUSION:Wounds were healed at stage I in al patients with no serious complications. There was no difference in the knee joint range of motion between the two groups before treatment, but the range of motion was increased significantly in both two groups at 3 months after treatment (P<0.05), meanwhile which was higher in the treatment group than the control group (P<0.05). At 3 months after treatment, the excel ent knee function rate was significantly higher in the treatment group (97%) than the control group (88%) according to the Lysholm scores;the IKDC scores were significantly higher in the treatment than the control group in terms of claudication, support, pain, swel ing, and squat (P<0.05). These results indicate that the arthroscopic implant fixation of tibial avulsion fracture of the posterior cruciate ligament has better short-term effects to promote recovery of knee joint function, but no serious complications.

Objective To evaluate the effect of dexmedetomidine on action potential duration (APD)of rat ventricular myocytes and the role of α2receptors. Methods Eighteen ventricular myocytes acutely isolated from Sprague-Dawley rats by enzymatic hydrolysis were divided into 3 groups(n=6 each) using a random number table: dexmedetomidine group(D group), yohimbine group(Y group)and dexmedetomidine plus yohimbine group(DY group). Isolated ventricular myocytes were first perfused for 2 min with Tyrode′s solution alone, and APD at 90% repolarization(APD90)was recorded using whole-cell patch-clamp technique. D, Y and DY groups were subsequently perfused for 2 min with Tyrode′s solution containing dexmedetomidine 10-9mol∕L, yohimbine 10-6mol∕L, and dexmedetomidine 10-9mol∕L plus yo-himbine 10-6mol∕L, respectively, and APD90was recorded. The percentage of changes in APD90was calcu-lated. Results Compared with the isolated ventricular myocytes perfused with Tyrode′s solution alone, APD90of ventricular myocytes was significantly prolonged in group D(P<0. 01), and no significant change was found in APD90of ventricular myocytes in Y and DY groups(P>005). The percentage of changes in APD90of ventricular myocytes was significantly shortened in group DY and group Y when com-pared with group D(P<005). Conclusion Dexmedetomidine can prolong APD90of rat ventricular myo-cytes, and the mechanism is related to activating α2receptors.

Objective:Understand the status of brushing teeth behavior of preschoolers in Shaanxi Province, to provide basis for oral health of preschoolers.Methods:By adopting the methods of multi-stage, stratified, geometric and cluster sampling, 1 370 kindergarten students at the age of 3-5 in Shaanxi Province were sampled as respondents to implement oral health questionnaire.Results:49.2%(674/1 370) children brushed their teeth every day, including only 14.8%(203/1 370) children brushing their teeth twice or above. Therefore, the difference of the brushing frequency (≥ 1 time/day) between urban and rural areas had obvious statistical significance ( χ2 value was 47.588, P<0.01). 98.7%(741/750) children used toothpaste, including only 6.9% (51/741) using toothpaste with fluoride. Therefore, the use of toothpaste between urban and rural areas has no statistical significance. Only 0.5% (4/751) children started to brush their teeth when their first deciduous tooth erupted. Therefore, the age for children starting to brush their teeth between urban and rural areas had obvious statistical significance ( χ2 value was 24.217, P<0.01). 65.2% (490/751)parents never helped their children to brush teeth, parents in rural areas even reached to 72.8% (227/312). Therefore, the brushing frequency for parents helping their children to brush teeth between urban and rural areas had statistical difference ( χ2 value was 16.192, P<0.01). Conclusions:The status of brushing teeth behavior of preschoolers in Shaanxi Province is lower than the national level, and the level in rural areas is obviously lower that in urban areas. The education and cultivation on brushing teeth behavior should be further strengthened in the future propaganda and education, especially, the power of propaganda on children and parents in rural areas should be strengthened.

Objective To determine the feasibility of OZAKI procedure aortic valve neo-cuspidization(AVneo) for the treatment of aortic valve disease in our institution.Methods Twelve consecutive patients from November 2015 to October 2016 received AVneo in our single center are retrospected.Their mean age was(41.3 ± 16.9) years old.There were 11 males and 3 females.3 patients had aortic stenosis and 11 patients had aortic insufficiency.Autologous pericardium was used to reconstruct 3 aortic leaflets independently.The distance between each commissure was measured by a specific sizer to decide the size of each leaflet.Suturing the pericardial leaflets onto each aortic annulus.Results There was no perioperative mortality.No operations converted to prosthetic valve replacement.1 patient experienced IABP therepy for 2 days,for ventricular tachycardia repeatedly happened when cardiac rebeating intraoperation.Echocardiography one week after surgery showed an average maximum flow velocity of aortic valve of(162.9 ± 34.2) cm/s,average peak pressure gradient of(11.1 ± 4.9) mmHg (1 mmHg =0.133 kPa).Except 1 patient had moderate regurgitation after surgery,the rest of 13 patients showed less than mild aortic regurgitation.Conclusion OZAKI procedure AVneo provides good short-term results in patients with various aortic valve disease.