OBJECTIVETo study the effects of transcutaneous electrical nerve stimulation on multimodal analgesia after total knee arthroplasty.

METHODSSixty patients diagnosed as knee osteoarthritis and suffered unilateral total knee arthroplasty in the department of orthopedics, Zhejiang Traditional Chinese Medicine Hospital from March 2009 to May 2012 were randomly divided into control group and test group, 30 cases in each group. All the patients received celecoxib preoperatively, knee periarticular injection with the drug mixture intraoperatively, and celecoxib and morphine sulfate controlled-release tablets postoperatively. The patients in the test group were also treated with transcutaneous electrical nerve stimulation each day after operation. All the patients started doing functional exercises at 24 h after operation. Postoperative visual analogue scales(VAS), passive and active range of motion of knee joint,and complications were recorded.

RESULTSThe VAS scores of test group during postoperative 24 h to 1 week were 3.39 +/- 0.69, 2.79 +/- 0.51, 2.16 +/- 0.52, and 1.07 +/- 0.57 separately,which were lower than 3.80 +/- 0.86, 3.22 +/- 0.58, 2.53 +/- 0.54 and 1.38 +/- 0.52 in the control group. The passive and active range of knee joint motion in the test group during postoperative 24 h to 2 weeks were (30.67 +/- 3.65) degrees, (39.17 +/- 3.96) degrees, (47.83 +/- 4.86) degrees, (93.67 +/- 7.30) degrees, (107.67 +/- 7.51) degrees and (29.83 +/- 5.33) degrees, (78.33 +/- 8.24) degrees, (95.17 +/- 5.94) degrees respectively,which were higher than (28.67 +/- 3.92) degrees, (36.83 +/- 4.25) degrees, (45.17 +/- 5.17) degrees, (89.83 +/- 7.25) degrees, (103.17 +/- 7.37) degrees and (24.17 +/- 10.26) degrees, (73.83 +/- 9.07) degrees, (91.33 +/- 7.42) degrees in the control group. In the test group, 19 patients had ring-shaped haemostasis impression to some extent in the skin of knee joint to different degree, and 5 patients had blister formation.

CONCLUSIONIt is meaningful to apply transcutaneous electrical nerve stimulation for treating multimodal analgesia after total knee arthroplasty,which can not only relieve patients' postoperative pain, and also promote the rehabilitation of knee function as far as possible.

Aged ; Aged, 80 and over ; Analgesia ; Arthroplasty, Replacement, Knee ; adverse effects ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Pain, Postoperative ; etiology ; therapy ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome

Objective To evaluate the methods of standard patient (SP)combined with case-based learning (CBL ) in humanistic quality cultivation for interns in the department of thoracic surgery. Methods Medical interns in the department of thoracic surgery were divided randomly into experimental(n=30)and control group(n=30)respectively. In experimental group,SP combined with CBL was used while in control group traditional teaching was used. At the end of the study,teaching effect was assessed by the final examination and questionnaires and the data were processed by t test andX2 test. P<0.05 signifies statistical differences. Results There was no significant difference in test scores between the two groups (P>0.05). Scores of history-taking,medical check-up,paper writing quality in the final examination in experimental group were significantly higher than those in control group(P<0.01). Satisfaction degrees of doctor-patient communication,responsibility and service attitude in experimental group were better than those of control group(X2=16.484,10.335,20.376,32.851,P<0.01). Conclusions SP combined with CBL teaching method can stimulate the students' interests in thoracic surgery practice,improve the doctor-patient relationship and strengthen the ability of human-istic concern. It is a better clinical thoracic practice teaching method and it is beneficial to cultivating medical students with humanistic concern.

Objective To investigate the effects of alcohol on hippocampal apoptosis-inducing factor (AIF) and caspase-3 expression in cercbral ischemia/reperfusion in rats.Methods Sixty-eight healthy adult male Wistar rats were randomly divided into a sham operation group (n =4) and a saline control group as well as low-dose (1.0 g/kg),medium-dose (1.5 g/kg) and high-dose (2.0 g/kg) ethanol groups.The saline control group and each dose alcohol group were redivided into ischemia/reperfusion 0,1,2 and 3 h subgroups according to the intervention time points (n =4 in each group).A model of middle cerebral artery ischemia/reperfusion in rats was induced by the suture method.The corresponding doses of ethanol or an equal volume of saline were injected intraperitoneally at ischemia for 2 h and reperfusion for 0,1,2 and 3 h in the alcohol groups and the saline control group.At ischemia for 2 hand reperfusion for 24 h,the neurological deficit in rats was evaluated by using behavioral score.Immunohistochemistry assay was used to detect the expressions of AIF and caspase3 in the hippocampus of ischemic sides at ischemia for 2 hand reperfusion for 24 h.Results The behavior evaluation showed that the neurological deficit score was 0 in the sham operation group.The neurological deficit scores in the different dose ethanol groups were significantly lower than those in the saline control group at the same intervention time points (all P=0.000),and there were significant differences between the same intervention time points in the different dose ethanol groups (all P =0.000).The high-dose ethanol group was the lowest.There were no significant differences between the different intervention time points in the same dose ethanol groups (all P＞0.05).Immunohistochemistry revealed that the numbers of positive cells of AIF and caspase-3 in the sham operation group were 17.21 ±2.86 and 20.60 ±4.39,respectively,and they were significantly less than those in the saline control group and the each dose ethanol group at ischemia/reperfusion 0 h (all P =0.000); the number of positive cells of hippocampal AIF and caspase-3 in the different dose ethanol groups were all significantly less than those in the saline control group at the same intervention time points (all P =0.000).There were significant differences between the same intervention time points in the different dose ethanol groups (all P =0.000),and the high-does ethanol group was the lowest.There were no significant differences between the different intervention time points in the same dose ethanol groups (all P =0.000).Conclusions Alcohol has protective effect on the cerebral tissue in ischemia/reperfusion injury in rats.Its mechanism may be associated with the inhibition of AIF and caspase-3 expression.

OBJECTIVETo study the effect of hypoxia on cofilin activation in intestinal epithelial cells and its relation with distribution of tight junction protein zonula occludens 1 (ZO-1).

METHODSThe human intestinal epithelial cell line Caco-2 was used to reproduce monolayer cells. The monolayer-cell specimens were divided into control group (no treatment), hypoxic group ( exposed to hypoxia), and normoxic group (exposed to normoxia) according to the random number table. Western blotting was used to detect the protein expressions of cofilin and phosphorylatedl cofilin (p-cofilin) of cells in normoxic group and hypoxic group exposed to normoxia or hypoxia for 1, 2, 6, 12, and 24 h and control group, with 9 samples in control group and 9 samples at each time point in the other two groups. The other monolayer-cell specimens were divided into hypoxic group (exposed to hypoxia) and control group (no treatment) according to the random number table. Cells in hypoxic group exposed to hypoxia for 1, 2, 6, 12, and 24 h and control group were obtained. Morphology and distribution of F-actin was observd with laser scanning confocal microscopy, the ratio of F-actin to G-actin was determined by fluorescence method, and distribution of ZO-l and cellular morphology were observed with laser scanning confocal microscopy. The sample number of last 3 experiments was respectively 3, 6, and 3 in both hypoxic group (at each time point) and control group. Data were processed with paired ttest, analysis of variance of repeated measurement, and LSD-t test.

RESULTSThe protein expressions of cofilin and p-cofilin of cells between normoxic group exposed to normoxia for 1 to 24 h and control group showed no significant changes (with values from -0.385 to 1.701, t(p-cofilin)values from 0. 040 to 1.538, P values above 0.05). There were no obvious differences in protein expressions of en filmn of cells between hypoxic group exposed to hypoxia for 1 to 24 h and control group ( with values from 1.032 to 2.390, P values above 0.05). Compared with that in control group, the protein expressions of p-cofilin of cells were greatly reduced in hypoxic group exposed to hypoxia for 1 to 24 h (with values from 4.563 to 22.678, P values below 0.01), especially exposed to hypoxia for 24 h. The protein expressions of cofilin of cells between normoxic group and hypoxic group at each time point were close ( with t values from -0.904 to 1.433, P values above 0.05). In hypoxic group, the protein expressions of p-cofilin of cells exposed to hypoxia for 1, 2, 6, 12, and 24 h were 0.87 +/- 08, 0.780 .05, 0.89 +/- 0.07, 0.68+0. 07, and 0.57 +/- 0.06, respectively, significantly lower than those in normoxic group (0.90 +/- 0.07, 0.97 +/- 0.06, 1.00 +/- 0.06, 1.00 +/- 0.05, and 0.99 +/- 0.05, with t values from 3.193 to 16.434, P values below 0.01). In control group, F-actin in the cytoplasm was abundant, most of it was in bunches. The trend of F-actin was disorderly in hypoxic group from being exposed to hypoxia for 1 h, shortened in length or even dissipated. The ratios of F-actin to G-actin of cells in hypoxic group exposed to hypoxia for 12 and 24 h (0.89 +/- 0.12 and 0.84 +/- 0.19) were obviously decreased as compared with that in control group (1. 00, with t values respectively 3. 622 and 3. 577, P values below 0.01). There were no obvious differences in the ratios of F-actin to G-actin of cells between hypoxic group exposed to hypoxia for 1, 2, and 6 h and control group ( with values from 0.447 to 1.526, P values above 0.05). In control group, cells were compact in arrangement, and ZO-1 was distributed continuously along the cytomnembrane. From being exposed to hypoxia for 2 h, cells became irregular in shape in hypoxic group. ZO-1 was distributed in discontinuous fashion along the cytomembrane with breakage in hypoxic group exposed to hypoxia for 24 h.

CONCLUSIONSHypoxia may cause the disorder of dynamic balance between F-actin and G-actin by inducing cofilin activation, which in turn leads to the changes in distribution of tight junction protein ZO-1 in intestinal epithelial cells.

Actin Depolymerizing Factors ; Actins ; Blotting, Western ; Caco-2 Cells ; drug effects ; physiology ; Epithelial Cells ; cytology ; drug effects ; Humans ; Hypoxia ; metabolism ; Intestinal Mucosa ; drug effects ; metabolism ; pathology ; Intestines ; Oxygen ; pharmacology ; Tight Junctions ; drug effects ; metabolism ; Zonula Occludens-1 Protein ; metabolism

High-fat diet-induced insulin resistance rat model was assessed by euglycemic-hyperinsulinemic clamp technique.Compared with the control group,the vaspin mRNA expression in adipose tissue was significantly decreased in insulin resistant rats induced by high-fat diet( P＜0.05 ),which was increased by metformin( P＜0.05 ).These data indicate that metformin may ameliorate insulin resistance in rats via upregulating vaspin mRNA expression.

Objective To explore the effect of the ?-blocker —metoprolol on the treatment of vasovagal syncope(VVS) in children.Methods Twenty-nine children with unexplained syncope and positive responses to head-up tilt test(HUT) were included in the study.Sixteen of them took metoprolol(treatment group) and 13 of them took vitamin B or oryzanol (control group) at least 2 weeks and HUT were repeated and syncope episodes were observed.Results In treatment group,9 of 16 patients had no syncope episode while 5 of 16 patients had fewer syncope episodes,1 case had more syncope episodes,and 1 case remained the same.HUT were repeated and 6 of 9 cases had negative outcome.In control group,1 of 13 patients had no syncope episode while 5 of 13 patients had fewer syncope episode,3 cases had more syncope episodes and 4 cases remained the same.HUT were repeated and 3 of 7 cases had ne-(gative) outcome.Conclusion These results indicate that adminstering metoprolol orally may be effective for VVS in children.

Child ; Eosinophilia ; diagnosis ; drug therapy ; Gastroenteritis ; classification ; diagnosis ; drug therapy ; Humans ; Male

OBJECTIVETo analyze effects of fracture of processus styloideus ulnae on prognosis in the treatment of distal radial fracture of type C according to AO classification.

METHODSThis was a retrospective case-control study, and the information was got ten through case evaluation and follow-up, including sex, age, patient satisfaction, Gartland & Werley score and radiographic score. There were 76 patient treated with open reduction and plate fixation in People's Hospital Affiliated to Peking University from July 2006 to July 2011. All the patients were divided into two groups: no combination with fracture of processus styloideus ulnae (group A, 56 cases), combination with fracture of processus styloideus ulnae (group B, 20 cases). The patients in group A and B were treated with open reduction and internal fixation; however the fracture of processus styloideus ulnae was not fixed. The indexes such as clinical data, bone grafting, joint movement, Gartland & Werley score and radiographic score were compared between two groups.

RESULTSThe ulnaris pain of patients in group B was more obvious than that in group A. The local VAS, palmar and dorsal flexion degree of wrist joint, motion VAS, patients satisfaction score, radial and ulnar deviation degree, pronation and supination of forearm degree, Gartland & Werley score and radiographic score were separately 0.1 ± 0.1, (51.1 ± 1.9)°, (60.2 ± 1.9)°, 0.6 ± 0.1 (23.1 ± 0.9)°, (28.7 ± 1.3)° (81.5 ± 2.6)°, (68.2 ± 2.7)° 1.9 ± 0.3, 89.6 ± 12.3 in group A; and separately 0.3 ± 0.3, (51.4 ± 2.3)°, (66.6 ± 1.7)°, 0.5 ± 0.2, (24.5 ± 2.0)°, (26.9 ± 1.8)°, (80.3 ± 2.5)°, (70.3 ± 3.7)°, 1.2 ± 0.4, 92.5 ± 7.5 in group B; there were no statistical differences in above indexes between two groups.

CONCLUSIONWhether the distal radial fracture with a concomitant unrepaired ulnar styloid fracture or not exerts no influence on mainly outcomes including function, radiography and motion of the wrist.

Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Prognosis ; Radius Fractures ; surgery ; Retrospective Studies ; Ulna Fractures ; surgery

After 4 weeks old male Sprague-Dawley rats were fed with normal diet and high-fat diet for 10 weeks,the rats were treated with metformin (200 mg/kg) for 6 weeks. Insulin sensitivity was determined by hyperinsulinemic-euglycemic clamp technique.Realtime PCR and western blot were used to measure mRNA and protein levels of chemerin in perirenal adipose tissue of rats.The results showed that the expressions of chemerin mRNA and protein were higher in high-fat diet-induced insulin resistant rats compared with rats fed with normal diet ( both P＜0.05 ),and these incremental findings were diminished by metformin treatment ( both P＜0.01 ).The levels of chemerin mRNA and protein were correlated well with the epididymis fat mass index.

Fed with high-fat diet and assessed by hyperinsulinemia-euglycemia clamp technique, rat models with insulin resistance were successfully induced. Compared with normal chow group ( NC ), serum concentrations of free-fatty acids(FFAs) and baseline insulin in high-fat diet group(HF) was higher( P＜0.05 ), the average glucose infusion rate from 60 to 120 min( GIR60-120 ) was lower( P＜0.01 ), and the expression of p-IRE-lα in the liver was higher( P＜0.05 ). Furthermore, the expression of p-IRE-1α in the liver was positvely correlated with the serum concentration of FFAs. All these data indicate that high-fat diet may induce endoplasmic reticulum stress in the liver by elevating serum concentration of FFAs, and may participate in the genesis of insulin resistance via p-IRE-1α.