Endoplasmic reticulum stress(ERS) is a kind of subcellular pathological state,and associated with many diseases.Recently,the research of ERS on chondrocyte is at the beginning stage,and may be involved in pathogenisis of rheumatoid arthritis(RA) and osteoarthritis(OA).It has been proved that ERS can interfere the differentiation of chondrocyte,decrease the synthesis of abnormal protein,attenuate the injury of cell.But overreaction of ERS can cause chondrocyte apoptosis through an independent pathway without of Fas and NO.There are three signal transmission passages in ERS:ATF-6(activating transcription factor 6)、Ire 1(inositol-requiring 1)and PERK(PKR-like ER kinase).The three protein molecules activate apoptotic genes by TRAF-2(TNF receptor-associated factor 2)and GADD153(growth arrest and DNA-damage-inducible gene 153),initiate the chondrocyte apoptosis.Therefore,ERS may effect the pathogensis of RA and OA by modulating chondrocyte function and inducing apoptosis,but more research are needed to reveal the mechanism.

Objective To investigate the methods of diagnosis and treatment for delayed infection after hip arthroplasty. Methods From March 1998 to April 2004, 11 patients with delayed infection after hip arthroplasty were analyzed retrospectively. There were 4 males and 7 females with average of 66 years, ranging from 49 to 81 years. The interval between infection and primary hip arthroplasty varied from 9 to 96 months(mean 25.5 months). Pain is the most common symptom in all patients with an infected hip arthroplasty. Abnormal ESR was observed in 9 cases. The increase of CRP was found in 8 patients, and fistula occurred in 5 patients. Radiography findings, such as loosening, osteolysis, and endosteal scalloping, are present on 10 patients. One-stage exchange arthroplasty was performed in 8 patients, among whom 7 prostheses with antibiotic-impregnated cement and one with plain cement for fixation were chosen. Two-stage exchange arthroplasty was performed in 3 patients. After thorough irrigation and debridement of the infected joint and the removal of the femoral and acetabular components, a temporary spacer with irrigation device and antibiotic-loaded beads or a bulb were inserted between the first and second stage. The interval was a minimum of 4 weeks. During the delayed reconstruction, the final prostheses were fixed with antibiotic-loaded cement after the infection was eliminated. Results All 11 patients were followed up for a period of 8 to 72 months. Fracture of femoral shaft happened during the debridement in one patient. None of recurrent infection was found during the average 29.3 months follow-up. Conclusion No test is 100 percent specific; therefore, the diagnosis of infection relies on the patients' history, and the physical examination findings, and the lab test combined with results of imaging study, etiology as well as pathology. The key to success is that the treatment must be tailored to the patients' status.

OBJECTIVE:To investigate clinical efficacy of intravenous drip of alprostadil combined with acupuncture in the treatment of diabetic foot ulcer and its effects on inflammatory factors levels and wound microvascular density. METHODS:A total of 72 patients with diabetic foot ulcer in our hospital during May 2014 to Sept. 2015 were divided into observation group and con-trol group according to random number table,with 36 cases in each group. Control group was given Alprostadil injection 10μg add-ed into 250 mL 0.9% Sodium chloride injection intravenously,qd,on the basis of routine treatment as insulin. Observation group was additionally given acupuncture therapy (Sanyinjiao,Zusanli,Fenglong,Yanglingquan,Yinlingquan and other acupuncture points),qd,on the basis of control group. Treatment courses of 2 groups lasted for 3 weeks. Clinical efficacy,wound healing time,fasting blood glucose,urine microalbumin,inflammatory factors,wound microvascular density as well as the occurrence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(91.67%)was significantly higher than that of control group(72.22%),and wound healing time was significantly shorter than control group,with statistical signifi-cance(P<0.05). Before treatment,there was no statistical significance in fasting blood glucose,urine microalbumin and inflamma-tory factors between 2 groups (P>0.05). After treatment,above indexes of 2 groups were significantly lower than before,and urine microalbumin and inflammatory factors of the observation group was significantly lower than the control group,with statisti-cal significance (P<0.05). 14,21 d after treatment,wound microvessel density of observation group was significantly higher those of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Intrave-nous drip of Alprostadil combined with acupuncture can boost angiogenesis through mitigating inflammatory reactions,thus shorten the time of wound healing and enhance therapeutic efficacy.

Object iv e To observe the intermediate-term results of the H /G total hip arthroplast y.Methods Thirty-fivecases(40hips)with the H /G THA were reviewed with an average of 7.5years fol-low-up(range,6to10.2years).In th is grou p,the primary lesions of hip included avascular necrosis of femoral head(1 2hips,10cases),congenital dysplasia of hip(9hips,8cases),femoral ne ck fracture(8hips,8cases),osteoarthritis(4hips,4cases),reversion(3 hips,3cases)and ankylosing spondylitis(4hips,2cas-es).The clinical res ults were scored with Harris methods.The roentgenographic results were analyzed with Am stutz meth ods.Results Theclinical average Harris scores were95in3-year follow-up,89in5-year fol-low-up,83in7.5-year follow-up. Roentgenographic results of femoral components showed20hips with in-tra medu llary ossification,18hips with cortical hypertrophy around the distal prosthe ses,25hips with lo cal re-di olucent line,10hips with osteolysis in femu r calar and2hips with implants subsiding less than7mm.Roentgenographic resul ts of acetabular component revealed20hips with radi olucent line(8compo n ents with around radiolu cent,12components with local radiolucent ),7hips with osteolysis and1hip with polyethylene lining defluxion.Conclusion Theresul ts of clinical and roentgenographic performance in mid-dle-term is not as go od as that in short-term.The abnormal bone reaction is evidently higher in mid dle-term than in short-term.Though the above-mentioned manifestation is only restricted on the roentgenogram with-out clinic symptom,however,further fol low-up is need ed.It should be noted that one case had revi sion be-cause of the polyethylene lining defluxion resulted from clip loosening on the metal ace tabular com po nent ;although this seldom happens both at home and abroad,more attention should be paid to the revi sion case re-sulted from the mechanical m alfunction not from the prosthesis loosening.

Objective To evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of intertrochanteric hip fractures in elderly patients. Methods Between 2004 and 2009,10 patients were treated with hip arthroplasty after the failed treatment of intertrochanteric fracture.There were six females and four males,at mean age of 75.7 years ( range,68-84 years).The initial treatment of fractures included dynamic hip screw (DHS) fixation in three cases,dynamic condyle screw (DCS) fixation in one,proximal femur fixation with reconstruction interlocking nail in three and conservative treatment without internal fixation in three.The failed procedures included avascular necrosis in four cases,cephalic implant cutting in three,nonunion in two and malunion associated with osteoarthritis in one.Joint hip replacement was performed except for pre-operative infection.Harris score at follow-up was recorded and prosthesis position was evaluated by imaging. Results Six patients were treated with total hip arthroplasty with a cemented cup (three patients) and an uncemented cup ( three patients) and four with a bipolar hemiarthroplasty.A long-stem implant was used in 5 of the 10 hips.The average duration of follow-up was 4.6 years (2-7 years).The mean duration of surgery was 128 minutes and mean blood loss was 764 ml.The mean Harris hip score increased from 37 preoperatively to 85 postoperatively.The functional results were satisfactory.One 84-year-old patient with the implant intact died 2 years postoperatively from a brain hemorrhage. Conclusions Hip arthroplasty is an effective salvage procedure after the failed treatment of intertrochanteric fractures in elderly patient.Most patients have better pain relief and functional improvements in spite of technical difficulties than primary arthroplasty.In the meantime,attention should be paid to patients with poor bone quality,bone loss,or articular cartilage damage.

ObjectiveTo explore the expression and clinical significance ofaquaporin (AQP) 1 and AQP 4 in human pulmonary adenocarcinoma H1299 cell line.MethodsH1299 cell line in human pulmonary adenocarcinoma(pulmonary adenocarcinoma group) were obtained,the expressions of AQP1 and AQP4 in mRNA level and their locations were determined in H1299 cell line respectively by semiquantitative reverse transcription polymerase chain reaction (RT-PCR) and Western blot analysis.The migration of tumor cells were observed by Matrigel invasion assay.Then normal tissues adjacent of pulmonary adenocarcinoma (above cancer line 3 cm,no tumor cell with pathological proven) were as control group.ResultsThe results of RT-PCR showed that AQP1,AQP4 mRNA was 1.030 ± 0.070 and 1.140 ± 0.190 in conlrol group,which were lower than those in pulmonary adenocarcinoma group (2.021 ± 0.250 and 2.180 ±0.180)(P＜0.05 ).The results of Western blot showed AQP1,AQP4 located on the membrane of H1299 cell.Both AQPI and AQP4 mRNA expressed very high in pulmonary adenocarcinoma group,while expressed very low in control group (P＜0.05).Matrigel invasion assay showed that the invasion was positively related to AQP1,AQP4(r =0.351,P ＜ 0.05 ).ConclusionAQP1,AQP4 significantly over express in H1299 cell line,both of them phy important roles in the growth of tumor tissue and cell migration.

Objective To summarize the perioperative characters of femoral neck fractures in patients aged at over 80 years by analyzing the surgical treatment procedures. Methods A retrospective study was done on data of patients with femoral neck fractures treated surgically from June 2000 and June 2008. There were 25 males and 36 females, at average age of 83.4 years (80-94 years). Of all, there were 53 patients with fresh fractures including six with type Garden Ⅰ or Ⅱ fractures and 47 with type Garden Ⅲ or Ⅳ fractures, eight with old fractures ( all type Garden Ⅳ). Fifty-one patients (84%) were accompanied with preexisted internal medical or neurological diseases. Six patients with type Garden Ⅰ or Ⅱ fractures were treated with cannulated screw fixation (CSF). Among 55 patients with type Garden Ⅲ or Ⅳ fractures inclu-ding 47 fresh fractures and 8 old ones, 53 patients were treated by hip hemiarthroplasty (HHA) but the other two by cemented total hip arthroplasty (THA) because of preexisting hip osteoarthritis. Results The average operation duration and blood loss were 51 minutes and 50 ml in CSF group, 81 minutes and 180 ml in HHA group, 105 minutes and 350 ml in THA group. Fifteen patients (25%) had postoperative com-plications, mostly hypotension, cardiac insufficiency and atrial fibrillation, accounting for 12%. Postoperative hemoglobin was decreased by 11.9%, 17.1% and 18. 1% on average respectively in CSF group, HHA group and THA group, and postoperative albumin decreased by 10.8%, 18. 1% and 20.2% on average respectively in CSF group, HHA group and THA group. There were 17 patients (28%) with hemoglobin below 100 g/L and four (7%) with albumin below 30 g/L after operation. Conclusions The patients aged ≥80 years with femoral neck fractures are usually accompanied with preexisted internal medical or neurological diseases and have high risk in operation. Adequate preoperative preparation and active prevention and treatment of perioperative complications are important for successful operation and good postoperative results.

Descurainiae, Lepidii Semen and their it adulterants were identified by analysising their ITS2 sequences. The genomic DNA was extracted from 46 samples including Descurainiae and Lepidii Semen and their it adulterants. Their ITS2 sequences were amplified, and purified PCR products were sequenced. Sequence assembly and consensus sequence generation were performed using CodonCode Aligner v 4.25. The genetic distances, variable sites and the neighbor-joning (NJ) phylogenetic tree were computed by MEGA 6.0 in accordance with the Kimura 2-parameter (K2P) model. The results showed that the intra-specific genetic distances of Descurainia sophia and Lepidium apetalum were 0.021 and 0.010, which were smaller than inter-specific ones of D. sophia, L. apetalum and their adulterants. The NJ tree showed that both D. sophia and L. apetalum were clustered into one monophyletic branch, and clearly separated with their sibling species. Therefore ITS2 sequence was able to identify Descurainiae and Lep-idii Semen and its adulterants to ensure the quality of medicines and clinical efficacy.

Objective: To analyze clinical characteristics and wound repair methods and effects of patients with upper limb electric burns. Methods: Medical records of 136 patients with upper limb electric burn who met the inclusion criteria and hospitalized in our unit from January 2015 to March 2019 were retrospectively analyzed. Proportion in patients with electric burns in the same period, gender, age, admission time, categories, injury causes, injury voltage, burn area and depth of upper limb, simultaneous injury of both upper limbs, and early wound treatment measure of patients with upper limb electric burn were recorded. The main repair methods of each affected limb were classified and recorded. The overall efficacy of the patients was recorded, including postoperative wound complications and healing condition. The patients repaired with distal pedicled flaps and those with free flaps were followed up for 3 to 6 months. The survival rate of flaps were recorded, the function of affected limbs after operation was evaluated, and the satisfaction degree of patients was investigated by Curative Effect Score Table. The amputation rate, age, and burn area of upper limbs of patients caused by high-voltage and low-voltage electricity were compared. Data were processed with Wilcoxon rank sum test, chi-square test, or Fisher′s exact probability test. Results: (1) The number of upper limb electric burn patients accounted for 88.3% of 154 patients with electric burns hospitalized in the same period, including 117 males and 19 females, aged 1 year and 2 months to 72 years [(34±18) years], admitted 1 h to 48 d after injury, including 51 electricians, 32 rural migrant workers, 31 students and preschool children, and 22 patients belonging to other categories. Patients of the first two categories were mainly injured by work accidents, and those of the latter two categories mainly suffered from touching power source or power leakage. Among all the patients, 75 cases were injured by high-voltage electric burn, and 61 cases were injured by low-voltage electric burn, with burn area of upper limb from 0.2% to 16.0% [2% (1%, 5%)] total body surface area (TBSA) and area of wounds deep to bone from 0.2% to 15.0% [2% (1%, 5%)] TBSA. Two upper limbs in 54 cases were simultaneously injured, accounting for 39.7%. Early fasciotomy was performed for 73 limbs. (2) Thirteen affected limbs were treated with dressing change, 2 affected limbs were sutured directly after debridement, 56 affected limbs were repaired by skin grafting, 12 affected limbs were repaired by local flap, 45 affected limbs were repaired by distal pedicled flap, 22 affected limbs were repaired by free flap, and 40 affected limbs were amputated (accounting for 21.1%). (3) One case died of pulmonary infection, sepsis, and multiple organ failure after operation, and the rest patients were all cured. One case with avulsion of abdominal flap was repaired by skin grafting after dressing change. The anterolateral thigh flap in one case necrotized after transplantation, which was replaced by pedicled abdominal flap. Seven cases had small erosion on the pedicle or margin after transplantation of abdominal flap and were healed by dressing change. Six cases had local bruising at the distal end after transplantation of abdominal flap and were healed after conservative treatment such as hyperbaric oxygen. The other flaps survived well. (4) The survival rate of distal pedicled flap grafting was 97.8% (44/45), which was close to that of free flap grafting (95.5%, 21/22, P>0.05). The function recovery of affected limb after free flap grafting was better than that of distal pedicled flap grafting (Z=-3.054, P<0.01), but their satisfaction degree of patients was similar (Z=-0.474, P>0.05). (5) Patients with high-voltage electric burn had higher amputation rate, older age, and larger upper limb burn area than those with low-voltage electric burn (χ²=4.743, Z=-2.801, -6.469, P<0.05 or P<0.01). Conclusions Upper extremity electric burn often occurs in children, electricians, and rural migrant workers with high rate of amputation. Teachers and parents should strengthen safety education for children and manage power source of life well. Workers should improve safety awareness and operate standardly. Fasciotomy for relaxation should be performed for electric burn wound as soon as possible, and flap grafting can effectively repair wound after early debridement. The function recovery of affected upper limb repaired with free flap grafting is better.

Objective:To investigate whether endogenous hydrogen sulfide (H2 S)was involved in the pathogenesis of osteoarthritis (OA)and its underlying mechanism,to detect H2 S and its synthases ex-pression in knee cartilage in patients diagnosed with different severity of OA,and to explore the transcrip-tion and expression of gene MMP-13 in chondrocytes treated with IL-1βor H2S.Methods:Synovial fluids of the in-patients with different severity of OA hospitalized in Peking University First Hospital were collected for measurement of H2 S content using methylene blue assay.Articular cartilages of the patients who underwent knee arthroplasty were collected for the cell culture of relatively normal chondrocytes.The chondrocytes were cultured to the P3 generation and H2 S molecular probes were used for detection of endogenous H2 S generation in the chondrocytes.Immunocytochemistry was used to detect the localization of H2 S synthases including cystathionine β-synthase (CBS),cystathionine-γ-lyase (CSE),and mercap-topyruvate sulfurtransferase (MPST)in OA chondrocytes.Western blot was used to quantify the protein expressions of CSE,MPST,and CBS in cartilage tissues of the patients who were diagnosed with OA and underwent knee arthroplasty.The relatively normal human chondrocytes were cultured to passage 3 and then divided into 4 groups for different treatments:(1 )the normal control group,no reagent was added;(2)the IL-1βgroup,5 μg/L of IL-1βwas added;(3)the IL-1β+H2S group,200 μmol/L of NaHS was added 30 min before adding 5 μg/L of IL-1β;(4)the H2 S group,200 μmol/L of NaHS was added. The transcription and expression of gene MMP-13 in chondrocytes of each group were determined with Real-time PCR and Western blot,respectively.And the total NF-κB p65 and phosphorylated NF-κB p65 in chondrocytes were detected with Western blot.Results:The content of H2 S in the synovial fluid of degenerative knee was (14.3 ±3.3)μmol/L.Expressions of endogenous H2 S and its synthases including CBS,CSE and MPST were present in the cytoplasm of chondrocytes.CSE protein expression in Grade 3 (defined by outerbridge grading)cartilage tissues was significantly increased as compared with that of Grade 1 cartilage tissues (1.67 ±0.09 vs.1.26 ±0.11,P<0.05).However,no significant difference of CBS or MPST expression among the different groups was observed.The expression of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (1 .87 ±0.67 vs.0.22 ± 0.10,P<0.05 ),and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (0.55 ±0.11 vs.1.87 ±0.67,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The transcription of MMP-13 protein in the IL-1βgroup was significantly higher than that in the normal chondrocytes (31.40 ±0.31 vs.1.00 ±0.00,P<0.05), and that in the IL-1β+H2 S group was significantly decreased than that in the IL-1βgroup (24.41 ± 1.28 vs.31.40 ±0.31,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.The total NF-κB p65 in the IL-1βgroup was significantly higher than that in the normal chondrocytes (2.13 ±0.08 vs.0.73 ±0.08,P<0.05),and that in the IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (1 .24 ±0.13 vs.2.13 ±0.08,P<0.05 ),and that in the H2 S group had no significant difference compared with that in the normal control group.The phosphorylated NF-κB p65 in IL-1βgroup was significantly higher than that in the normal chondrocytes (1.30 ±0.13 vs.0.19 ±0.04,P<0.05),and that in IL-1β+H2S group was significantly decreased than that in the IL-1βgroup (0.92 ±0.26 vs.1.30 ±0.13,P<0.05),and that in the H2S group had no significant difference compared with that in the normal control group.Conclusion:H2 S affected the cartilage degeneration by partly inhibiting the degradation of extracellular matrix.