BACKGROUND: Critical organ hypofunction and complications are common in elderly patients, so perioperative treatment becomes important for the success of total knee replacement (TKR).OBJECTIVE: To explore clinical perioperative complications of TKR in the patients over 70 years old. DESIGN, TIME AND SETTING: Retrospective analysis of case data was performed at First Hospital of Gannan Medical University and People's Hospital of Peking University from January to December 2002.PARTICIPANTS: 109 patients (168 knees), including 29 males and 80 females, underwent TKR. Of them, 50 underwent single knee surgery, aged (74.2±15.1) years (range 70-85 years), and 59 underwent bilateral knee surgery, aged (73.4±13.2) years (range 70-85 years). In addition, 92 cases (84.4%) were obesity, and 88 were complicated by internal diseases. METHODS: The surgery was performed by the same operator. All patients underwent patellar replacement with Scorpio posterior stable knee prosthesis. Knee anterior median incision and medial patellar approach was applied, and anterior and posterior cruciate ligaments were excised during the surgery, osteophyma and corpus liberum of posterior articular capsule were cleared. Patellofemoral joint track was tested until meeting the requirements. The prosthesis was fixed using antibiotics mixed with bone cement, and the incision was sutured at flexed position.MAIN OUTCOME MEASURES: Early complications following replacement; knee joint and functional evaluation.RESULTS: During surgery and 24 hours after replacement, 8 cases developed hypertension, 7 cases hypotension, and 6 cases arrhythmia. All patients safely passed the perioperative period under treatment of related departments. One case developed pulmonary embolism, 1 case deep infection, 3 cases pulmonary infection, 5 cases urinary system infection, 1 case rapid reduction of platelet caused by Subining, 1 case cognitive disturbance, and 1 case dislocation of knee joint (Charcot arthritis). According to standards of HSS, the knee joint scores were significantly improved from 26.1 prior to replacement to 82.0 at discharge, and function scores were significantly improved from 32.1 prior to replacement to 89.1 at discharge. During 12.4-month follow-up (range 3-22 months), 18 cases lost the follow up; the retention rate was 83.5%. Of 91 retention patients, knee pain disappeared or relieved, restored self-care ability, and no prosthesis loosening or infection was found. At the final follow up, the HSS knee joint scores were significantly improved from 82.0 at discharge to 85.4, and function scores were improved from 89.1 at discharge to 92.3 at discharge.CONCLUSION: Skilled operative technique and positive treatment of complication can effectively prevent perioperative infection, dislocation and other complications following total knee replacement.

Objective To investigate the tumor necrosis factor alpha gene single nucleotide polymorphism (SNP) in Chinese Han polymyositis/dennatomyositis (PM/DM) patients. Methods A casecontrol study of three TNF-α SNPs were undertaken and comparison between cases of PM/DM (n=69) and DM patients ( n=52 ) with normal subjects ( n=57 ) was performed. The genotype of every subject was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results There was no significant difference in the genotypes and alleles frequencies of the three TNF-α SNPs(-238,-308, and -1031)between PM/DM or DM and normal subjects. The haplotype AGT (-238, -308, -1031 ) significantly increased in controls vs PM/DM and DM (PM/DM, P=0.01; DM, P=0.02) subjects. The haplotype AGC was a significant risk factor for DM (P=0.04, 0R=9.84, 95%CI 1.39～69.57 ). The haplotype AGC increased in PM/DM (4.3%)vs controls(0.6% ), but the difference was not significant (P=0.09, OR 7.22, 95%CI 1.02～50.90). The haplotype GGC was significantly decreased in the DM subgroup vs healthy control subjects (P=0.04, OR=0.47,95%CI 0.23～0.99). Conclusion The TNF gene (-238,-308,-1031) haplotype AGC is a risk factor for DM.

Objective To investigate the effects of different doses of penehyclidine hydrochloride on postoperative cognitive function in the elderly patients.Methods Ninety-three ASA Ⅰ or Ⅱ elderly patients,aged ≥65 yr,weighing 55-71 kg,were randomly divided into 3 groups (n =31 each):penehyclidine hydrochloride 0.010 mg/kg group (group A),penehyclidine hydrochloride 0.015 mg/kg group (group B) and atropine 0.010 mg/kg group (group C).Their preoperative Mini-Mental State examination (MMSE) scores were ＞ 27.At 30 min before anesthesia,groups A,B and C received intramuscular penehyclidine hydrochloride 0.010 mg/kg,penehyclidine hydrochloride 0.015 mg/kg and atropine 0.010 mg/kg,respectively.The cognitive function of the patients was assessed within 72 h after operation using MMSE.Diagnostic criterion of postoperative cognitive dysfunction (POCD) was defined as MMSE score ≤27.POCD and the degree were recorded within 72 h after operation.Results Compared with group A,postoperative cognitive function was significantly decreased at each time point after operation and the incidence of POCD was significantly increased in group B (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group C (P ＞ 0.05).Compared with group B,postoperative cognitive function was significantly enhanced at each time point after operation and the incidence of POCD was significantly decreased in group C (P ＜ 0.05).Conclusion Penehyclidine hydrochloride can depress postoperative cognitive function and the effect is related to the dose.

Objective To investigate the effect of butylphthalide and sodium chloride injection postconditioning on focal cerebral ischemia-reperfusion (I/R) injury and endoplasmic reticulum stress in rats.Methods Thirty-six male SPF Sprague-Dawley rats,aged 2-3 months,weighing 260-280 g,were randomly divided into 3 groups (n =12 each):sham operation group (group S),focal cerebral I/R group (group I/R) and butylphthalide and sodium chloride injection postconditioning group (group Buty).The animals were anesthetized with intraperitoneal 10 ％ chloral hydrate 300 mg/kg.Focal cerebral I/R was induced by occluding right middle cerebral artery for 2 h followed by 24 h reperfusion in I/R and Buty groups.Butylphthalide and sodium chloride injection 2.5 mg/kg was injected via the tail vein immediately after onset of reperfusion in Buty group,while the equal volume of normal saline was injected in I/R group.Neurological deficits were assessed and scored at 24 h of reperfusion,and then the brain was isolated for detection of neuronal apoptosis (by TUNEL) and the expression of glucose-regulated protein 78 (GRP78) and caspase-12 in ischemic cerebral cortex (by immunohistochemistry) in brain tissues.Apoptosis index was calculated.Results Compared with group S,the neurological deficit scores and apoptosis index were significantly increased,and the expression of GRP78 and caspase-12 was up-regulated in I/R and Buty groups (P ＜ 0.05 or 0.01).Compared with group I/R,the neurological deficit scores and apoptosis index were significantly decreased,the expression of GRP78 was up-regulated,and the expression of caspase-12 was down-regulated in group Buty (P ＜ 0.05).Conclusion Butylphthalide and sodium chloride injection postconditioning can reduce focal cerebral I/R injury in rats,and inhibition of endoplasmic reticulum stressmediated cell apoptosis is involved in the mechanism.

Current therapies of organ failure or a wide range of tissue defect are often not ideal. Transplantation is the only effective way for long time survival. But it is hard to meet huge patients demands because of donor shortage, immune rejection and other problems. Tissue engineering could be a potential option. Choosing a suitable scaffold material is an essential part of it. According to different sources, tissue engineering scaffold materials could be divided into three types which are natural and its modified materials, artificial and composite ones. The purpose of tissue engineering scaffold is to repair the tissues or organs damage, so could reach the ideal recovery in its function and structure aspect. Therefore, tissue engineering scaffold should even be as close as much to the original tissue or organs in function and structure. We call it "organic scaffold" and this strategy might be the drastic perfect substitute for the tissues or organs in concern. Optimized organization with each kind scaffold materials could make up for biomimetic structure and function of the tissue or organs. Scaffold material surface modification, optimized preparation procedure and cytosine sustained-release microsphere addition should be considered together. This strategy is expected to open new perspectives for tissue engineering. Multidisciplinary approach including material science, molecular biology, and engineering might find the most ideal tissue engineering scaffold. Using the strategy of drawing on each other strength and optimized organization with each kind scaffold material to prepare a multifunctional biomimetic tissue engineering scaffold might be a good method for choosing tissue engineering scaffold materials. Our research group had differentiated bone marrow mesenchymal stem cells into bile canaliculi like cells. We prepared poly(L-lactic acid)/poly(ε-caprolactone) biliary stent. The scaffold's internal played a part in the long-term release of cytokines which mixed with sustained-release nano-microsphere containing growth factors. What's more, the stent internal surface coated with glue/collagen matrix mixing layer containing bFGF and EGF so could supplying the early release of the two cytokines. Finally, combining the poly(L-lactic acid)/poly(ε-caprolactone) biliary stent with the induced cells was the last step for preparing tissue-engineered bile duct. This literature reviewed a variety of the existing tissue engineering scaffold materials and briefly introduced the impact factors on the characteristics of tissue engineering scaffold materials such as preparation procedure, surface modification of scaffold, and so on. We explored the choosing strategy of desired tissue engineering scaffold materials.
Glucosides ; chemistry ; Humans ; Stents ; Tissue Engineering ; Tissue Scaffolds ; chemistry

OBJECTIVETo explore a simple but novel method of strengthening gypsum material by cyanoacrylate infiltration. To evaluate the influence of cyanoacrylate on the mechanical properties of dental gypsum models.

METHODSGypsum specimens were polished to the dimension of 35 mmx4 mmx4 mm. Butyl-cyanoacrylate was diluted with chloroform at different concentrations, namely 20% and 30% cyanoacrylate. Gypsum specimens were infiltrated by diluting one component of cyanoacrylate at different concentrations for 8 h and then dried for analysis. The changes in elastic modulus, fracture toughness, compressive strength, biaxial strength, brinell hardness were measured. The data were analyzed using software OriginPro 8.

RESULTSThe viscosity measurements indicated that diluted cyanoacrylate were Newtonian fluids and the viscosity increased slightly within the 48 hours of preparation but still similar as water at room temperature, which could be used to infiltrating gypsum. The gypsum infiltrated with cyanoacrylate exhibited good physicochemical properties. The biaxial strength, fracture toughness, compressive strength and brinell hardness of the gypsum were improved by 39%, 30%, 63% and 18%, respectively.

CONCLUSIONCyanoacrylate can significantly improve the strength of gypsum model which indicates the potential clinical application.

Objective To compare the efficacy of suprainguinal approach and pubic tubercle approach to obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumor.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-80 yr,with body mass index of 17.5-31.0 kg/m2,scheduled for elective transurethral resection of bladder tumor,were randomly divided into 2 groups (n =30 each) using a random number table:pubic tubercle approach group (group P) and suprainguinal approach group (group S).Nerve blocks were performed using a 100-mm insulated needle for ONB (21-gauge) under the guidance of a nerve stimulator.In group P,the insertion point of the needle was 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle.In S group,the insertion point of the needle was at the midpoint of the line drawn in the inguinal crease between the femoral artery and the inner border of the adductor longus tendon and the needle was advanced 3 cm cephalad in the major axis of thigh.The number of puncture eliciting contraction of adductor muscle,time taken to elicit contraction of adductor muscle starting from onset of puncture,depth of puncture,and highest visual analog scale (VAS) pain scores during application of the block were recorded.The myodynamia of adductor muscle was evaluated.The development of complications was also recorded.Results Compared with group P,the number of puncture,highest VAS scores,and myodynamia of adductor muscle at 4 and 6 min of blockade were significantly decreased,the time taken to elicit contraction of adductor muscle was shortened,and the success rate of puncture at first attempt was increased in group S (P ＜ 0.05 or 0.01).There was no significant difference in the incidence of puncture point bleedings between the two groups (P ＞ 0.05).Conclusion The suprainguinal approach for ONB offers more accurate location,faster onset,lighter degree of noxious stimulation and better safety than the pubic tubercle approach in patients undergoing transurethral resection of bladder tumor.

Objective To investigate the result and side effect of late course accelerated three-di-mensional conformal radiotherapy (3DCRT) for esophageal carcinoma. Methods From July 2003 to March 2006, 55 patients with esophageal carcinoma receiving 3DCRT were randomly divided into late course accel-erated radiation group (group A, 27 patients) and conventional fractionation group (group B, 28 patients). The prescribed dose in group B was 64 -66 Gy, 2 Gy per fraction, 1 fraction per day, 5 fractions per week for about 6.5 weeks. Patients in group A received conventional fractionation irradiation for the first 4 weeks. Then the dose was increased to 3 Gy per fraction to a total dose of 67 -70 Gy. The treatment course in group A was about 6 weeks. The treatment response, acute site effects, 1-, 3-and 5-year local control rates and o-verall survival rates of the two groups were observed. Results In group A, 23 patients (85%) achievedcomplete response (CR) and 4(15%) achieved partial response (PR). While in group B, 16 patients (57%) achieved CR and 12(43%) achieved PR. The CR rate was significant higher in group A (χ~2 = 5.24,P=0.022). The 1-, 3-, 5-year local control rates were 85%, 54%, 54% in group A, and 70%, 56%, 33 % in group B (χ~2 = 0.68, P = 0.409), respectively. The 1 -,3-,5-year overall survival rates of the two groups were 81%, 37%, 29% and 61%, 39%, 23% (χ~2 = 0.06, P = O. 804), respectively. Both lo-cal control and overall survival were similar between the two groups. The incidences of acute radiation esoph-agitis in the two groups were similar (85% vs. 89% ;χ~2 =0. 00,P=0. 959), and the incidence of radiation pneumonitis was slightly higher in group A than in group B (67% vs 43% ;χ~2 =3.14,P =0.076). By the last follow up, 19 patients in group A and 21 in group B died. Among them, 10 in group A and 15 in group B died of local failure, while 7 in group A and 5 in group B died of metastasis. Conclusions When com-pared with conventional fractionation 3DCRT, late course accelerated 3DCRT for esophageal carcinoma can achieve better results in clinical response, though not in long-term local control or survival. The incidence of acute radiation esophagitis and pneumonitis is clinically acceptable.

ObjectiveTo study the expression level of HER-2 gene in the same pathological stage gastric cancer,and discuss the feasibility of HER-2 gene being the prognostic indicator.MethodsThe expression of HER-2 in gastric cancer was detected by immunohistocehmical technique and analyzed in relation with the pathological stage and prognosis of the patients.ResultsThe total positive rate of HER-2 in gastric cancer was 33.64％ (37/110).In stage Ⅱ,the weakly and strongly positive rates of gastric cancer were 21.31％ ( 13/61 ) and 9.84％ (6/61).In stage Ⅲ,the weakly and strongly positive rates of gastric cancer were 20.41％ (10/49) and 16.33％ (8/49).In the same pathological stage,the survival rate of patients with negative HER-2 expression was higher than weakly positive ones.And the survival rate of patients with strongly positive HER-2 expression was the lowest.The difference had statistical significance (P ＜ 0.01).ConclusionThe prognosis of patients in the same stage was correlated with the expression level of HER-2,which can be used to evaluate the biological behavior and prognosis of gastric cancer.

BACKGROUND: The in vitro amplification is a primary method for harvesting endothelial progenitor cells (EPCs) due to its simple operation and low cost.OBJECTIVE: To isolate EPCs from rabbit bone marrow to further observe the effects of autologous EPCs on promoting vascular endothelial repair.DESIGN, TIME AND SETTING: An open experiment was performed at the laboratory of Department of Internal Medicine, Changzheng Hospital, Second Military Medical University of Chinese PLA between March 2005 and February 2006. MATERIALS: Eight New Zealand rabbits of either gender, aged 6-8 months, weighing (2.5:L-0.5) kg, were included in this study. Rabbit bone marrow was taken for isolation of bone marrow mononuclear cells by density centrifugation. METHODS: Bone marrow-derived mononuclear cells were inoculated at 1×106/cm2 and cultured for 7 days in M199 medium containing vascular endothelial growth factors and basic fibroblast growth factors. EPCs were identified by Dil-labeled acetylated low-density lipoprotein (Dil- Ac-LDL) and FITC-labeled lectin BS-1 staining. Cells that phagocytized Ac-LDL displayed red fluorescence, cells that combined with lectin BS-1 showed green fluorescence, and cells that were labeled with both exhibited orange fluorescence. Expression levels of CD133, CD134, and Flk-lwere detected using immunofluorescent staining and through the use of flow cytometer.MAIN OUTCOME MEASURES: ① Cellular morphology observation. ② Proliferative capacity of EPCs.③EPCs identified by Dil- Ac-LDL and FITC-labeled lectin BS-1. ④ lmmanohistocbemical identification of EPCs. ⑤Flow cytometry identification of EPC surface marker.RESULTS: ① Cellular morphological observation: the newly isolated bone marrow-derived mononuclear cells exhibited a round appearance. Following 72-hour culture, adherent cells grew in colony cluster, presenting with round or irregular appearance, and nuclear division was obvious. By day 7, flaky cell colonies mutually connected together, presenting with shuttle-shaped endothelioid cells.② Proliferative capability of EPCs: in the 2-4 days of culture, EPCs proliferated fast, and the proliferation slowed down thereafter, exhibiting a typical "S" -shaped appearance. By days 6 and 7, EPC proliferation accelerated again, with the absorbance values of 0.58±0.15 and 0.62±0.23, respectively. ③ Over 95% of EPC cytoplasm exhibited red fluorescence after stained with Ac-LDL, appropriately 100% of cytoplasm exhibited green fluorescence after stained with FITC-labeled lectin BS-1, and over 90% of cytoplasm exhibited orange fluorescence after double staining. ④ Immonohistochemistry and flow cytometry results revealed positive expression of EPC surface markers CD133, FIK-1, and CD34.CONCLUSION: Cell population with EPC characteristics can be successfully isolated from rabbit bone marrow by in vitro amplification.