BACKGROUND: With the improvement of artificial joint materials, continuous consummation of prothesis design and the maturity of total knee replacement (TKR), excellent effects has been achieved in treatment of serious rheumatoid arthritis (RA) and osteoarthritis with TKR. At present, it is generally thought in China and abroad that staged rehabilitative treatment of step by step should be conducted as early as possible after TKR, which can promote the recovery of patient's knee joint function, and enable patients to freely care themselves so as to enhance their qualities of life.OBJECTIVE: To explain the rehabilitative treatment after TKR and relevant researches.DATA SOURCES: A computer based search of Medline database for relevant articles from January 1998 to August 2005 were conducted with the key words of "total knee replacement, rehabilitation, therapy" and the language was limited to English. Meanwhile, Chinese journal full-text database and Wanfang database were retrieved for relevant Chinese papers from January 1990 to December 2004 with the key words of "total knee replacement, rehabilitation, therapy".STUDY SELECTION: Data were checked in the first trial, accepting criteria:①Items, procedures, process and announcements in the rehabilitative treatment after TKR. ② Retrospective investigations about specific cases. Exclusive criteria: repetitive researches.DATA EXTRACTION: A total of 37 literatures in accordance with above requirements were retrieved and 22 repetitive researches were excluded.Fifteen articles were in accordance with the inclusive criteria: 3 were reviews about TKR and relevant rehabilitative treatment, 8 were clinical researches related to rehabilitative treatment after TKR, 4 were analyzing researches on relevant factors of rehabilitative treatment after TKR. Besides,there were 3 other relevant monographs.DATA SYNTHESIS: Rehabilitative treatment was extremely important to the clinical effects of TKR, which was the key reason why anticipated effects could be achieved after TKR. Exercise for power, training of motion of joint, proprioceptive sensation training and gait training were the most important contents of postoperative rehabilitation treatment. Comprehensive rehabilitative training was essential to maximum recovery of knee joint function including various agonistic muscle training plus extending and flexing power of knee joint; continuous passive training of motion of knee joint in early period plus motion of joint; proprioceptive sensation training in amelioration of motor controllability, postural rectification and balance-keep capability and gait training in correction of abnormal gait.CONCLUSION: Staged rehabilitative treatment of step by step after TKR should be conducted as early as possible, which is absolutely important to exercise for power, training of motion of joint, proprioceptive sensation training, gait training and promotion of functional recovery of knee joints in patients.

Objective To observe the regulatory effects of the preventive acupuncture and moxibustion at Guanyuan (RN4) points in ovariectomized rats, and discuss the mechanism of preventive acupuncture and moxibustion on hyoathalamus-pituitary-ovary (HPO) axis. Methods Totally 48 female SD rats were divided into 5 groups, including normal group, sham operation group, ovariectomized rats group, preventive acupuncture group and preventive moxibustion group. Except normal group and sham operation group, rats were ovariectomized after preventive acupuncture and preventive moxibustion for 30 d in corresponding groups. ELISA was used to determine the levels of E2, ER, GnRH, FSH and LH in the tissues including hypophysis, hypothalamus and uterus. Results Compared with the normal group, E2, ER and GnRH level in the tissue of the model group was significantly lower (P<0.01), the levels of FSH and LH increased obviously (P<0.01). Compared with the model group, E2, ER and GnRH level of preventive acupuncture group and preventive moxibustion group increased in different degree (P<0.05). FSH and LH level reduced in different degree (P <0.05). There was no obvious difference between preventive acupuncture and preventive moxibustion group (P>0.05). Conclusions The preventive acupuncture and preventive moxibustion at Guanyuan (RN4) has benign modulation to disordered HPO axis of ovariectomized rats. The ability of preventive acupuncture and preventive moxibustion are almost the same.

Objective To evaluate the value of multi-slice spiral CT (MSCT) angiography in diagnosis of thoracic vascularemergency.Methods 25 cases suspected of thoracic vascular emergency were examined with MSCT. Two dimensional and three dimensionalimaging methods were used. Results Central pulmonary embolism 10 cases, aortic dissection 12 cases,aneurysm 2 cases and takayasuarteritis with stricture of kidney artery were found by two dimensional imaging(MPVR,CPR),and the extent, size and details of lesions couldbe showed well. The space relationship and calcifation of aorta were displayed in three dimensional imaging(SSD,VR,MIP). Therelationship between intraluminal embolism and the wall of pulmonary artery, as well as intimal flap and reentry of dissection could bevealuated by CTVE.Conclusion Associated with imaging post processing,MSCT angiography is an effective method in diagnosis of thoracic vascular emergency.

Objective To summarize our surgical experience in repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits,Methods Six patients with multiple digital defects were treated in our department between June 1996 and March 2005.At the first stage,free iliac bone grafts were used to repair defects of proximal phalanges and temporary syndactyly between adjacent affected fingers was created through digital palmar skin sutures.The defects were covered with free flap transfer finally.Dorsalis pedis flaps were used in four patients,a lateral arm flap in one and a lateral thoracic flap in one respectively.At the second stage,a partial debulking procedure and division of syndaetyty followed three to six months later.Additional procedures were performed in three eases to reconstruct the digital extensor function through tendon transfer.The follow-ups ranged from six months to nine years.Results The flaps survived uneventfully in the six patients postoperatively.The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap debulking procedures and division of syndactyly.Follow-up X-Ray examinations showed good lilac bone union and nearly normal structure of digital bone.The distal interphalangeal extension restored to normal in the three cases after extensor reconstruction.Conclusions Iliac bone graft to repair phalangeal defects and free flap transplantation to cover skin defects can be a good treatment for compound defects of proximal phalanx and dorsal skin at multiple digits.Secondary plastic procedure may greatly improve the appearance of a reconstructed digit,and extensor re- construction the function of distal interphalangeal extension too.

Objective To study the correlation between high resolution computed tomography manifestations and expression of transforming growth factor beta,tumor necrosis factor alpha in radiationinduced lung injury of rats,and to investigate the vslues of cytokine detection and HRCT scanning for the prediction and early diagnosis of radiation-induced lung injury.Methods Forty-eight Sprague-Dawley (SD)rats were randomly divided into eight groups,group A was normal control group.and group BH were irradiated with a single dose of 15 Gy to the lungs.HRCT scanning Wag performed before and 1 week,2,4,8,12,16,24 weeks after radiation in group A-H respectively.The expression of TGF-beta and TNF-alpha were detected with ELISA. All the rats were killed to observe pathological changes of their lungs.HRCT signs,levels of cytokine were simultaneously compared and analyzed.The t-test and Spenrman rank correlation were used for the statistics.Results Four HRCT signs were observed during the 24 weeks after radiation,including ground-glass opacity(1 case),patchy consolidation(8 cases),massive consolidation(7 cases)and fibrosis(3 cases).The average levels of TGF-beta in group B-H[(3.33±0.47),(3.20±0.65),(3.12±0.45),(3.54±0.80),(3.30±1.13),(2.49±0.67),(4.19±0.22)μg/L,respectively]were hisher than the control group[(0.45±0.14)μg/L.P＜0.05].At 24 weeks the average level increased to the highest peak[(4.19 4-0.22)μg/L,P＜0.05].At 1 week and 2,4,8,12 weeks after radiation,the average level of TNF-alpha in radiation group[(236.52±29.01),(214.91±34.53),(270.97±42.12),(208.83±86.51),(208.83±82.23)ng/L]was hisher than the control group[(31.78±0.92)ng/L,P＜0.05].The average level increased to the highest peak [(270.97±42.12)ng/L,P＜0.05]at 4 weeks.The average level at 16 and 24 weeks[(60.63±38.49),(32.07±1.05)ng/L]dropped to the level similar to the control group(P＞0.05).There were no rank correlations between HRCT manifestations and expression of TGF-beta and TNF-alpha(rs=0.5570 and 0.1013.P＞0.05).HRCT signs were correlated with pathological changes.Conciusions The monitoring of TGF-beta and TNF.alpha in the serum after irradiation can predict the development of radiation-induced lung injury.There are no rank correlations between HRCT manifestations and expression of TGF-beta and TNF-alpha.

Objective To explore the value of joint detection of serum cystatin C (Cys C) ,retinol‐binding protein(RBP) ,urea ni‐trogen(BUN) and creatinine(Cr) in early diagnosis of nephropathy .Methods A total of 230 cases of inpatients with nephropathy form April 2013 to June 2014 were collected and divided into diabetic nephropathy group (130 cases)and hypertensive nephropathy group(100 cases) .Other 200 healthy individuals were collected as healthy control group .The serum levels of Cys C ,RBP ,BUN and Cr were detected by using the Hitachi 7180 automatic biochemistry analyzer .Results Compared with the healthy control group ,the sertum levels of Cys C ,RBP ,BUN and Cr were significantly increased in the diabetic nephropathy group ,and the serum levels of Cys C and RBP were significantly increased in hypertensive nephropathy group ,there were statistically significant differences (P<0 .05);while no statistically significant differences in serum levels of BUN and Cr were found between the hypertensive nephropathy group and healthy control group(P>0 .05) .Positive rates(81 .9% ) of the four indicators in the two nephropathy groups were high‐er than those in the healthy control group ,and the positive rate of joint detection of the four indicators was higher than single detec‐tion in patients with nephropathy .Conclusion Serum RBP and Cys C are sensitive indicators for early renal damage ,and combined with BUN and Cr could increase sensitivity of early diagnosis of nephropathy ,which has significant clinical value .

Objective To assess the safety of intrathecal administration of betamethasone.MethodsTwenty-four adult white rabbits of both sexes were randomly divided into four groups with 6 rabbits in each group.Group Ⅰ (blank control group)in which nothing was injected intrathecally;group Ⅱ(NS control group)in whichnormal saline(NS)0.2ml was injected into the subarachnoid space through great occipital foramen once a weekand the animals were killed at the end of the 3rd week;in group Ⅲ and Ⅳ betamethasone 200 ?g or 400 ?g in 0.2ml was injected intrathecally once a week instead of NS.The animals were anesthetized and killed by intra-aorticinjection of NS and 2% glutaraldehyde.The cervical section of the spinal cord(C_(1-6))was immediately removedand fixed with 2% glutaraldehyde for microscopic examination.Results No neural histo-pathologic changes shownby microscopic examination were observed in group Ⅰ and Ⅱ.In group Ⅲ and Ⅳ microscopic examination showeddifferent degrees of swelling and demyelination of the nerve fibers and edema and vacuolization ofmitochondria.Conclusion Intrathecal betamethasone can damage the spinal cord.

Rehabilitation is very important to the therapeutic effect of total knee arthroplasty, and it's also the key measure for the knee function to reach the expected effect after the surgery. The most important contents of rehabilitation therapies are the training of muscle strength, range of joint motion, joint position sense and gait. Integrated rehabilitation therapies was used to improve the knee function as possible, such as all kinds of training to improve the knee muscle strength of flex and extend; early training of continued positive motion of knee joint to improve the knee range of motion; the training of knee joint position sense to improve the ability of motion control, posture adjusting and balance keeping; the gait training to adjust the unusual gait.

Animals ; Chronic Pain ; Freund's Adjuvant/adverse effects* ; Humans ; Inflammation ; Male ; Pelvic Pain/etiology* ; Prostatitis ; Rats

Objective As important transcription factors, SOX2, TWIST and SNAIL are closely related to breast cancer me?tastasis. The aim of this study was to explore the expressions of SOX2, TWIST and SNAIL in breast cancer and the relationship between the three factors. Methods We collected 74 specimens of breast cancer and another 74 from paired normal tissue from January 2012 to January 2013. Using immunohistochemistry, we determined and compared the expression of SOX2 in the breast cancer and normal tissues. We also detected the expressions of TWIST and SNAIL proteins and analyzed the relationship of SOX2, TWIST and SNAIL ex?pressions with the clinicopathological characteristics of breast cancer as well as the correlation between the three proteins. Results The expression of SOX2 was significantly higher in the breast cancer than in the normal tissues (25.7% vs 8.1%, P=0.004) and corre?lated with the grade, lymph node metastasis, and TNM stage of breast cancer ( P<0.05) , while the expressions of TWIST and SNAIL were significantly correlated with lymph node metastasis and clinical TNM stages of the malignancy ( P<0.05) . The protein expression of TWIST was correlated positively with those of SOX2 ( Cc=0. 325, P<0.005) and SNAIL (Cc=0.308, P<0.008), and so was that of SNAIL with that of SOX2 (Cc=0.275, P<0.018). Conclusion The SOX2 protein is highly expressed in breast cancer. The expres?sions of SOX2, TWIST and SNAIL are closely related to lymph node metastasis of the malignancy and the three factors are interacted coor?dinatively in the metastasis of breast cancer.