Total joint replacement (e.g.total hip replacement,total knee replacement) is one of the most common and most successful orthopaedic procedures.Infection after total joint arthroplasty is a devastating complication that causes pain and dysfunction,increases the cost.It is important to prevent postoperative infection.There are preoperative,perioperative and postoperative risk factors of total joint replacement,and preventions should base on these risk factors.This article reviews muhiple preoperative,perioperative and postoperative risk factors of postoperative infection and the preventions based on these risk factors.

Objective To investigate the effect and related mechanism of CD137 stimulation on aortic atherosclerotic plaque calcification in high fat diet fed ApoE-/-mice and on calcification of vascular smooth muscle cells (VSMCs).Methods (1) ApoE-/-mice fed with high fat diet were randomly divided into 3 groups:CD137 activated group (treated by 200 μg CD137 agonist i.p.once per week for 6 weeks,n =5);CD137 inhibited group (anti-CD137 group:200 μg anti-CD137 antibody + 200 μg CD137 agonist,i.p.,once per week for 6 weeks,n =5) and control group (n =5).Von kossa staining was used to observe the calcification of the aortic plaque and VSMCs.Immunohistochemistry was used to observe the expression of BMP-2 and Runx2 which are known mediators of osteogenic differentiation.(2) The mouse aortic VSMCs were obtained by Patch-attaching method.The calcium content was measured by Methylthymol Blue complexone method.The mRNA expressions of bone morphogenetic protein 2 (BMP-2) and Runx2 were measured by real-time fluorescent quantitative PCR (RT-PCR).The protein levels of BMP-2,Runx2 of the VSMCs were determined by Western blot.Results (1) In vivo,the plaque calcified area in ApoE-/-mice was significantly larger in CD137-agonist group than that in control group ((1.75 ± 0.33) × 104 μm2 vs.(0.23 ±0.07) × 104 μm2,P ＜0.01),and this effect was significantly reduced by cotreatment with CD137-antagonist ((0.83 ± 0.30) × 104 μm2 vs.(1.75 ± 0.33) × 104 μm2,P ＜ 0.05).The levels of BMP-2 and Runx2 were all significantly upregulated in CD137-agonist group than in control group (both P ＜ 0.01),again,this effect was blocked by cotreatment with CD137-antagonist (P ＜0.05).(2) Consistent with the in vivo results,VSMCs calcification was also more serious in CD137-agonist group than in control group,which could be significantly attenuated by eotreatment with CD137-antagonist.In VSMCs,calcium content level in CD137-agonist group was higher than in control group ((0.001 3 ± 0.000 2) mmol/mg protein vs.(0.000 7 ±0.000 1) mmol/mg protein,P ＜ 0.01),which could be significantly reduced by co-treatment with CD137-antagonist ((0.000 9 ± 0.000 2) mmol/mg protein vs.(0.001 3 ± 0.000 2) mmoL/mg protein,P ＜0.01).The mRNA and protein levels of BMP-2 and Runx2 were significantly upregulated in CD137-agonist group compared with the control group (P ＜ 0.05),which could be significantly down-regulated by cotreatment with CD-137 antagonist (P ＜ 0.05).Conclusion CD137 activation can promote vascular calcification in high fat diet fed ApoE-/-mice both in vivo and in vitro.

Objective To explore whether CD137-CD137L signaling can promote angiogenesis in atherosclerosis plaque via activating nuclear factor of activated T cells c1 (NFATc1).Methods Apolipoprotein E knock out mice were divided into the following groups:control group (n =5),CD137 activated group(n =5) and CD137 inhibited group (n =5).Immunohistochemistry was performed to detect the expression of CD31 in aortic plaque.Endothelial cells (bEnd.3) were purchased from ATCC and divided into the following groups:control group,IgG isotype control group,CD137 activated group and CD137 inhibited group.Western blot was used to determine total protein and nucleoprotein expression of NFATc1.The expression level of CD137 protein on the surface of endothelial cells was detected by flow cytometry (FCM) and CD137 protein of lysate of endothelial cells was detected by enzyme-linked immunosorbent assay (ELISA).Transwell assay was used to observe the migration ability of endothelial cells.Matrigel tube formation ability of endothelial cells were tested in the following groups:control group,CD137 activated group,silent NFATc1 + CD137 activated group,CD137 inhibited group,and over expressed NFATc1 + CD137 inhibited group.Results (1) In vivo,the expression level of CD31 was significantly higher in the aortic plaque of CD137 activated group than in control group(1 191 ± 187 vs.115 ± 30,P ＜ 0.05),while which was significantly downregulated in CD137 inhibited group (450 ± 92,P ＜ 0.05).(2) The level of nucleoprotein(3.07 ±0.03 vs.1.00 ±0.00,P ＜0.05) and total protein(2.18 ± 0.30 vs.1.00 ±0.00,P ＜0.05) of NFATc1 were significantly higher in CD137 activated group than in IgG isotype control group.The level of nucleoprotein(0.82 ±0.04) and total protein(0.84 ± 0.09) of NFATc1 were significantly lower in CD137 inhibited group than in CD137 activated group(both P ＜ 0.05).(3) FCM results showed that the fluorescence intensity of CD137 on the cell membrane was significantly higher in endothelial cells stimulated by TNF-α than in normal endothelial cells(5 163 ± 329 vs.1 660 ± 162,P ＜ 0.05).(4) ELISA examination showed that the level of CD137 protein was significantly higher in endothelial cells stimulated by TNF-α than in normal endothelial cells ((573.4 ± 23.7) pg/mg vs.(69.5 ± 16.7) pg/mg,P ＜ 0.05).(5) Migration cell number was remarkably higher in CD137 activated group than in IgG isotype control group(1.19 ±0.13 vs.1.00 ±0.00,P ＜0.05) and significantly lower in CD137 inhibited group(0.82 ± 0.06) than in control group (P ＜ 0.05).(6) Values of the formation of the tube length ((5.76 ± 0.18) mm vs.(4.21 ± 0.11) mm,P ＜ 0.05) and branch number (29.38 ± 1.28 vs.21.13 ± 0.96,P ＜0.05) were both significantly higher in CD137 activated group than in the control group.The formation of the tube length ((1.90 ±0.11)mm) and branch number(8.91 ±0.72) were significantly lower in silent NFATc1 + CD137 activated group than in the CD137 activated group (both P ＜ 0.05).The formation of the tube length ((1.28 ± 0.34) mm) and branch number (5.07 ± 0.35) were also significantly decreased in the CD137 inhibited group compared with the CD137 activated group (both P ＜ 0.05).Compared with the CD137 inhibited group,the formation of the tube length ((4.82 ± 0.09)mm) and branch number(24.44 ± 1.05) in the over expressed NFATc1 + CD137 inhibited group was increased (both P ＜ 0.05).Conclusion CD137 can promote the angiogenesis in atherosclerosis plaque by activating NFATc1.

[Objective]To evaluate the knowledge,attitude and practice(KAP)of medication use and safety among the patients with acquired immune deficiency syndrome(AIDS)in a 3A-grade hospital of Guangzhou city,and to provide scientific basis for AIDS prevention and treatment.[Methods]A questionnaire survey was conducted among AIDS patients aged 18 years and above in our hospital to investigate their KAP regarding medication use and safety.[Results]A total of 549 questionnaires were collected,of which 503 were valid,with an effective recovery rate of 91.6%.The average scores of KAP were(14.58±8.49),(25.21±6.92)and(47.58±3.33),respectively,with the scoring rates of 36.46%,63.02%,and 95.16%,respectively.There were statistically significant differences(P＜0.05)in knowledge scores among people with different ages,education levels and occupations.Multiple linear regression showed that education level and medical insurance status had most significant impact on knowledge scores(P<0.05).Significant differences were found in attitude scores among people with different education levels(P<0.05),as well as in practice scores among people with different occupations(P<0.05).Multiple linear regression revealed that age,occupation,knowledge score and attitude score had a significant impact on practice scores(P<0.05).Patients expected to receive pharmaceutical care services from the pharmacists via face-to-face communication,network platform and telephone consultation on medication knowledge such as adverse drug reactions and response measures,drug-drug interactions,missed medication and response measures,medication adherence measures,etc.[Conclusions]AIDS patients in this hospital have a good awareness of medication safety,but their knowledge of medication use needs improvement.Some bad habits may affect their compliance,resulting in safety hazards.Therefore,there is an urgent demand for pharmaceutical care services related to rational drug use.