Objective To study the erythrocytic morphological changes in unwashed autologous drainage blood after total knee arthroplasty (TKA), on account of the postoperative anemia status that was poorly improved after reinfusion. Methods 20 patients (34 knees) underwent TKA from November 2000 to March 2001. There were 6 males and 14 females, whose average age was 66 years (range, 32-79 years). TKA was performed unilaterally in 6 patients, and bilaterally in 14 patients. The disorders were diagnosed as OA in 17, RA in 2 and AS in 1 respectively. All of them received unwashed autologous drainage blood reinfusion, using CBCⅡ Consta VacTM blood salvage system. Blood routine tests were performed preoperatively and on the second and seventh day postoperatively. Blood routine and blood smear tests were also performed on the preoperative blood samples, the postoperative venous blood and drainage blood samples at the first and sixth hour respectively. Erythrocytic morphological changes in these samples were observed under light and electric microscope. Results In the unilateral TKA group, the blood loss in the operation was 208.3 ml, the mean volume of drainage blood was 910 ml,of which 708.3 ml was reinfused; One patient received 800 ml of allogenic bank blood due to postoperative anemia. In the bilateral TKA group, the blood loss, the mean volume of the drainage blood and reinfused volume of blood were 296.4 ml, 1718.2 ml and 1370 ml respectively; Five patients received a total amount of 2200 ml of allogenic bank blood, the average volume was 440 ml. Anemia of different degrees was found at the 2nd and 7th day postoperatively. Compared to venous blood, the levels of hemoglobin and hematocrit were lower in shed blood, and more erythrocytes were deformed. Conclusion The relatively large number of deformed erythrocytes is one of the important reasons that the anemia status is poorly improved postoperatively after reinfusion.

OBJECTIVETo observe the reconstruction features of adventitia in senescent rats, and to explore the intervention mechanism of Chinese herbs (CH, extracts from Radix Ginseng, Radix Notoginseng, and Rhizoma Chuanxiong).

METHODSTotally 85 20-month senescent rats were randomly divided into 5 groups according to body weight, i.e., the aging model group, the high dose CH group, the middle dose CH group, the low dose CH group, the Losartan group, 17 in each group. Another 14 2-month old Wistar rats were selected as a young group. Extracts of CH at the daily dose of 1493. 4, 746. 7, and 373. 4 mg/kg were administered to rats in the 3 CH groups respectively by gastrogavage. Losartan suspension at the daily dose of 10 mg/kg was administered to rats in the Losartan group by gastrogavage. Equal volume of distilled water was administered to rats in the aging model group and the young group. All medication was performed once daily. After 15-week intervention, morphological changes of thoracic aorta were observed by HE staining. The types, distribution, and contents of vessel wall collagens were determined using picric acid picrosirius red staining. The plasma renin activity (PRA) , the concentration of rennin angiotensin II (Ang II), and the content of Ang II in adventitia were detected by radioimmunoassay. The content of hydroxyproline ( Hyp) was detected by biochemical analysis. mRNA contents and protein expressions of angiotensin II receptor 1 (AT1R) and angiotensin II receptor 2 (AT2R) were detected by real-time PCR (RT-PCR) and Western blot.

RESULTSCompared with the young group, thickened adventitia, increased adventitia thickness/caliber, accumulated collagen fiber, increased area of type I collagen, decreased area of type III collagen, decreased type III/I collagen area ratio (P <0. 05), decreased plasma PRA and Ang II (P < 0.01, P < 0.05), increased contents of Ang II and Hyp in adventitia, down-regulated mRNA and protein expressions of AT1R, and up-regulated mRNA and protein expression of AT2R could be seen in the aging model group (P < 0.05). Compared with the aging model group, morphological changes could be improved in the 3 CH groups. Adventitia thickness/caliber was reduced in middle and high dose CH groups, as well as the Losartan group. The area of type I collagen was reduced and the area of type III collagen was enlarged, type III/I collagen area ratio obviously increased, contents of adventitia Hyp was obviously lowered in the high dose CH groups and the Losartan group (P < 0.05, P < 0.01). Ang II levels in adventitia decreased in middle and high dose CH groups and the Losartan group (P < 0.05, P < 0.01). There was no statistical difference in PAR among all groups (P > 0.05). Compared with the aging model group, mRNA expression of AT1R all increased in each treatment group (P < 0.01); mRNA expression of AT2R also increased in middle and high dose CH groups (P < 0.05). Protein expression of AT1R increased in the high dose CH group and the Losartan group (P < 0.01, P < 0.05); protein expression of AT2R also increased in middle and high dose CH groups (P < 0.05).

CONCLUSIONSAdventitia remodeling occurred in aged rats, manifested as thickened adventitia and accumulated collagens, disordered ratios of collagen I and III. Its mechanism might be possibly associated with aactivation of renin-angiotensin system (RAS). Extracts from Radix Ginseng, Radix Notoginseng, and Rhizoma Chuanxiong could improve adventitial remodeling possibly by interfering multi-targets, such as Ang II and AT1R, thereby delaying vascular aging.

Adventitia ; drug effects ; Aging ; Angiotensin II ; Animals ; Aorta, Thoracic ; Drugs, Chinese Herbal ; pharmacology ; Losartan ; Panax ; Plant Roots ; RNA, Messenger ; Rats ; Rats, Wistar ; Renin-Angiotensin System ; Rhizome

Objective To observe the efficacy of bloodletting therapy plus narrow band ultraviolet B (NB-UVB) in treating prurigo nodularis.Method According to the randomized controlled principle, the enrolled patients were divided into a treatment group and a control group. The treatment group was intervened by bloodletting cupping at the selected acupoints and the topical areas plus NB-UVB once every other day; the control group was by orally taking Mizolastine sustained release tablets and external application of Halometasone cream.Result The total effective rate was 85.7% in the treatment group versus 61.9% in the control group, and the difference was statistically significant (P<0.01).Conclusion Bloodletting therapy plus NB-UVB can produce a content efficacy in treating prurigo nodularis, with few adverse reactions.

Objective: To study the effects of propafenone on action potential (AP) of rabbit ventricular myocytes with the tonic block and use-dependent block of transient sodium current (INa-T). Methods: A total of 10 adult New Zealand white rabbits were sacriifced and 10 individual ventricular myocytes were isolated by enzyme digestion method. Microelectrode technologies were used to record AP-related parameters: maximum diastolic potential (MDP), maximum rate of rise of the action potential upstroke (Vmax), action potential amplitude (APA) and action potential duration at 20%, 50% and 90% (APD20, APD50 and APD90).INa-T was measured, I-V curves and peak currents at different frequencies were detected by whole cell patch clamp before and after propafenone perfusion at 10 μmol/L. Results: There was no statistical difference in MDP at before and after propafenone perfusion as (-80 ± 6) mV vs (-82 ± 5) mV,P>0.05. After perfusion, APA was signiifcantly decreased as (95 ± 12) mV vs ( 125 ± 10) mV,P<0.05, the Vmax slowed down as (330 ± 43) V/s vs (420 ± 54) V/s,P<0.05, while APD20, APD50 and APD90 were unchanged as (8 ± 2) ms vs (6 ± 2) ms,P>0.05, (16 ± 3) ms vs (12 ± 3) ms,P>0.05 and (86 ± 14) ms vs (85 ± 12) ms,P>0.05. After propafenone perfusion, I-V curve ofINa-T was shifted upward and the peak current was decreased as (3001 ± 383) pA vs (4193 ± 378) pA, P<0.05. Before perfusion, when stimulated at 0.06 Hz, 1 Hz, 2 Hz, 5 Hz and 10 Hz, there were no signiifcant use-dependent block inINa-T , and no real difference inINa-T between the 10th and 1st pulse,P>0.05. After perfusion, no significant use-dependent block was observed when stimulated at 0.06 Hz and 1 Hz,P>0.05, while at 2 Hz, 5 Hz and 10 Hz, propafenone perfusion demonstrated signiifcant use-dependent block uponINa-T with the inhibition fractions of (22 ± 11)%, (38 ± 14)% and (52 ± 17)% respectively, those were signiifcantly different from the inhibition fractions at either 0.06 Hz or 1Hz,P<0.05. When the inhibition fractions were compared by each 2 conditions, allP<0.05. Conclusion: Propafenone may slow down the Vmax of AP, reduce APA and without the impact on APD; the effects onINa-T is not only in tonic block, but also more obviously in use-dependent block in isolated ventricular myocytes of New Zealand rabbit. Such inlfuences minimized the impact on QT interval and meanwhile, decreased the incidence of brad arrhythmia.

Objective To explore the possibility of non-discarding blood after cisplatin hyperther-mic antiblastic perfusion(HAP)in treating the patients with malignant bone tumor of lower extremity.Methods Forty patients consisted of 31osteosarcomas and9malignant fibrous histiocytomas of bone.The clinical stages were wholly classified intoⅡB stage according to Ennekings surgical staging system for muscu-loskeletal tumors.The patients were divided into three groups:group1:discarding blood group(10cases),in whom200ml of the400ml blood remaining in heart-lung machine was discarded after HAP;group2:Non-discarding blood group(25cases),the blood remaining in heart-lung machine was not discarded after HAP and re-infused into systemic circulation;group3:systemic chemotherapy group(5cases),cisplatin was infused intravenously.The regional and the systemic blood cisplatin concentrations were determined at3,30and60minutes during HAP,and the systemic blood cisplatin concentrations were determined at0,0.5,1,2,4,8,12,24,48and72hours after HAP in the group1and group2.While1h after cisplatin infusion in-tra venously in the group3,the blood cisplatin concentration were also measured.Results The regional blood cis platin concen tra tions were high er than that in systemic blood at the time during HAP.The systemic blood cisplatin concen trations after HAP,ex cept at0minute in the group2were higher than that in the group1,there were sig nificant statistic differences between the two groups.The systemic blood cisplatin con-cen trations after HAP in the group2were simi lar to that after systemic chemotherapy.No severe adverse ef-fects in the group1were found.The Ennek ings surgical stagings for the tumors were turned fromⅡB intoⅡA in all the patients.Conclusion The method of non-discarding blood after HAP is available,it is not only local treatment ,but also systemic chemotherapy in the patients with malignant bone tumor of lower ex-tremi ty for limb-salvage surgery.

Objective To investigate the common pathogens in neonatal infections with premature rupture of membranes (PROM).Methods From May 2007 to November 2010,16 356 neonates who were admitted to Bayi Children's Hospital were assigned to this study. The related clinical and laboratory information were recorded,including PROM and its time of duration,results of blood culture and other clinical data.Results A total of 3432 patients accompanyed with PROM among 16 356 infants (21.0％).There were 1060 full-term neonates (30.9％ ) and 2372 premature infants (69.1％ ) among 3432 PROM cases.The incidence of infectious disease was 35.8％ ( 1227/3432 ) in infants with PROM.The overall positive rate of blood culture was 7.6％ ( 260/3432 ) in infants with PROM:10.5％ ( 111/1060 ) in term infants and 6.3％ (149/2372) in premature infants ( x2 =18.370,P =0.000).The common pathogenic organisms were gram positive ( G + ) cocci ( 58.5％ ) and gram negative ( G- ) bacilli ( 33.8％ ) ( x2 =31.695,P =0.000 ).The most common organisms included Staphylococcus epidermidis,Staphylococcus homis,Klebsiella pneumoniae,Escherichia coli and Hemolytic staphylococci,accounting for 75.8％ of the total blood culture positive patients.Fungal infection accounted for 7.7％ of the total infectious diseases,which was all in premature infants. The blood culture-positive rate in patients with PROM duration ＜24 h,≥24 hand ≥72 h were 7.7％ ( 119/1544),7.2％ (99/1382),and 9.6％ (42/439) ( x2 =2.701,P =0.259 ),respectively.Conclusions G + coccus is the most common pathogenic bacteria of neonatal infection related to PROM,followed by G- bacillus.Fungi are detected mainly in premature infants.The blood culture-positive rate may not increase with the extension of time of PROM.

AlM:To evaluate the efficacy of combined pranoprofen eye drops and artificial tears on the treatment of mild to moderate dry eye syndrome after trabbeculectomy.METHODS:This prospective case control study included 63 cases (63 eyes) of patients with mild to moderate dry eye syndrome after trabbeculectomy in our hospital from November 2013 to June 2013. All subjects were randomly divided into two groups. Observation group was treated with combined pranoprofen eye drops and artificial tears and control group received simple artificial tears marking the eyes at 1, 2, 4wk. The patient's symptoms, signs, BUT, S▏t, and FL were observed before treatment and 1, 2, 4wk after treatment.RESULTS: After 2wk, the symptoms of observation group were improved, there was statistically significant difference (P<0. 05). FL difference of each group was statistically significant ( P<0. 05 ); After 4wk, symptoms and signs were improved. There was statistically significant difference ( P < 0. 05 ). The BUT of the observation group and corneal FL scores of two groups showed significant differences (P<0. 05). CONCLUSlON: Artificial tears joint pranoprofen eye drops has good curative effect in the treatment of mild to moderate dry eye syndrome after trabbeculectomy.

OBJECTIVETo evaluate the efficacy and safety of three antithrombotic agents on venous thromboembolism (VTE) after unilateral total knee arthroplasty.

METHODSFrom November 2011 to March 2014, 149 patients undergoing unilateral total knee arthroplasty for knee osteoarthritis were reviewed. Among them, there were 66 males and 83 females, ranging in age from 48 to 76 years old. All the cases were randomly divided into three groups including Aspirin group, low-molecular-weight heparin (LMWH) group, and rivaroxaban group, according to antithrombotic agents. Deep vein thrombosis (DVT), pulmonary embolism (PE) and bleeding complication (including wound ecchymosis, hematoma and other local complications, gastrointestinal, cardiovascular, urinary hemorrhage and other major bleeding events) of antithrombotic agents were observed and analyzed statistically at the 6 week, 8 week, and 12 week after operation.

RESULTSAmong patients who received Aspirin (48 cases), 4 patients had DVT, in 1 patient had PE, and 2 patients had bleeding complication. Among 54 patients in low-molecular-weight heparin group, 3 patients had DVT, 1 patient had PE, and 3 patients had bleeding complication. While among those patients received the rivaroxaban (47 cases), 3 patients had DVT, 0 patient had PE, and 11 patients had bleeding complication. There were no statistically differences among three groups on DVT, and PE (P>0.05). The incidence of bleeding complication in rivaroxaban group was higher than the other two antithrombotic agents, and the difference among the three groups was statistically significant (P<0.05).

CONCLUSIONAspirin, low-molecular-weight heparin, and rivaroxaban could effectively reduce the incidence of VTE after total knee arthroplasty, and their efficacy was similar. Rivaroxaban has a higher incidence of bleeding complication and further clinical trials are required to be conducted to assess the safety of rivaroxaban in clinical.

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; Aspirin ; therapeutic use ; Case-Control Studies ; Female ; Fibrinolytic Agents ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Rivaroxaban ; therapeutic use ; Venous Thromboembolism ; prevention & control

Objective To explore the feasibility and safety of the biliary passage dilator assisted percutaneous endoscopic gastostomy(PEG)in natural orifice translumenal endoscopic surgery(NOTES).Methods Eleven hybrid dogs were recruited to the study.One dog was used for pilot study of biliary passage dilator assisted PEG.The rest ten were divied into 2 groups randomly(5 per group), receiving conventional PEG and biliary passage dilator assisted PEG, respectively.The efficacy and safety of these 2 methods in NOTES were compared.Two weeks later, routine gastroscopy was performed to detect the healing of luminal incision and all animals were sacrificed to explore the possible complications in the abdominal cavity.Results With the assistance of the biliary passage dilator, successful transgastric access to the peritoneal cavity was achieved in the pilot study.Biliary passage dilator assisted PEG was completed in all the 5 dogs of the experimetal group, while tradional PEG succeded in only 4.The average transgastric puncture time in the biliary passage dilator assisted PEG(7.0 ± 1.7 min)was significantly shorter than that of conventional PEG (11.0 ± 3.2 min, P ＜ 0.05).Nine dogs survived for 2 weeks postoperatively without loss of weight or peritonitis.Endoscopy showed transgastric puncture healed well.Autopsy revealed no gross adhering zone,bleeding, injury of adjacent organs or abcasses.Conclusion Compared with the conventional PEG, the biliary passage dilator assisted PEG shows the advantages of reduced difficulty and shoter time of puncture without any apparent complications.There is a good prospect of its application in NOTES.

Objective To evaluate the effect of ion chamber sensitive volume on absolute dose verification in CyberKnife plan.Methods Solid water phantoms were scanned by a CT scanner, single-field plan, multi-field isocentric plan and sequential optimized plan were designed by the treatment planning system.Absolute doses were measured at the specified point in each plan using the ion chambers with sensitive volumes of 0.007 cm3(A16), 0.24 cm3(A12 s), and 0.6 cm3(PTW30013) and compared with calculated values.Results For the single-field plan, the relative error increased as the aperture size of collimator decreased;with relative errors within ±2%, the smallest aperture sizes of collimator were 12.5 mm (A16), 25 mm (A12 s), and 30 mm (PTW30013).For the multi-filed isocentric plan, the relative errors were 0.26%±3.90%(A16),-6.28%±14.33%(A12 s), and-9.41%±14.10%(PTW30013).For the sequential plan optimized with 15 mm cone, the relative error was 0.79%±1.43%;for the sequential plan optimized with 7.5 mm cone, the relative error was 2.01%±8.39%.In absolute dose verification for clinical plans, there was no significant difference between the results measured by these ion chambers (P=0.985).Conclusions There is no significant effect of ion chamber sensitive volume on absolute dose verification in CyberKnife plan under the following two situations:(1) the collimator with a relatively large aperture is used;(2) the sensitive volume of ion chamber is totally covered by the prescription isodose line.