Objective:To investigate the effect of early ambulation time on lower limbs muscle strength and fear of falling in patients with total knee arthroplasty, so as to provide basis for promoting the postoperative rehabilitation of patients undergoing total knee arthroplasty.Methods:A total of 210 patients after unilateral total knee replacement from July 2018 to December 2019 in the Second Affiliated Hospital of Soochow University were included and assigned to experimental group 1, experimental group 2 and experimental group 3 by random digits table method, each group contained 70 cases, and the patients began ambulation at 16, 20, 24 hours after knee replacement, respectively. The peak torque (PT) of knee joints flexors and extensor as well as hamstrings quadriceps ratio (H/Q) were compared among three groups at 1 week, 1 month and 3 months after knee replacement. The fall efficiency was evaluted by Modified Fall Efficacy Scale (MFES), the fear of falling rate was conducted by single item method.Results:After 1 month of knee replacement, the PT of knee joints flexor and extensor and H/Q were (18.73±5.49) N·m, (37.56±7.76) N·m, (48.08±9.19)% and (18.44±5.27) N·m, (37.04±7.07) N·m, (47.49±9.30)% in the experimental group 1 and experimental group 2, which were higher than those in the experimental group 3(16.38±2.85) N·m, (33.75±6.75) N·m, (43.48±7.17)%, the differences were statically significant ( t values were 2.316-3.057, P<0.05). After 1 week of knee replacement, the fear of falling rate were 72.3%(47/65) and MFES scores were (3.14±0.58) points in the experimental group 1, 53.7%(36/67), (3.81±0.65) points and 50.8%(32/63), (3.87±0.74) points in the experimental group 2 and experimental group 3, the fear of falling rate significantly increased and MFES scores significantly decreased in the experimental group 1 compared to the experimental group 2 and experimental group 3, the differences were statistically significant ( χ2 values were 5.780, 4.878, t values were 6.221, 6.129, P<0.05). Conclusions:Twenty hours after knee replacement is the best time for ambulation, which can shortern the time for lower limbs muscle strength recovery and reduce the risk of fear of falling.

Objective To discuss the anti-inflammatory effect and its possible mechanism of different insulin concentration on IκB, NF-κB and TNF-α mRNA in monocytes stimulated by lipopolysaccharide and to detect the key molecule P-Akt in PI3K/ Akt signaling pathway at the cellular level. Methods The peripheral blood (10 ml)is collected from 30 type 2 diabetics (T2DM). Then, the mononuclear cells are centrifugally separated based on density gradient and divided into five different groups:the control (Con)group; the low concentration insulin 100 mU/L(L-Ins)group; the combination of low concentration insulin 100 mU/L and LY-294002 10 μmol/L(L-Ins+LY) group; the high concentration insulin 1000 mU/L (H-Ins) group, The combination of high concentration insulin 1000 mU/L and LY- 294002 10 μmol/L(H-Ins+LY) group. Two subgroups were set in each category. After incubating for 24 hours, the lipopolysaccharide (100 ng/ml)was added and the mononuclear cell culture of peripheral blood was continued. One hour later, the activities of P-Akt, IκBα and NF-κB of one subgroup were detected using western blot; two hours later, monocytes of the other subgroup were collected and the level of TNF-a mRNA was detected using real-time PCR Results Compared with Con group, the expressions of P-Akt and IkB were higher in L-Ins group and H-Ins group (P<0. 05), the expressions of NF-κB and TNF-a mRNA were lower in L-Ins group and H-Ins group (P<0. 05). Compared with L-Ins group, the expressions of P-Akt and IκB were higher in H-Ins group (P<0. 05), but the expressions of NF-κB and TNF-a mRNA were lower (P< 0. 05). Compared with L-Ins + LY group (H-Ins + LY group), the expressions of IκB and P-Akt were higher(P<0. 05)and the expressions of NF-κB and TNF-a mRNA were lower in L-Ins group (H-Ins group)(P<0. 05). Compared with Con group, no significant variations were shown in the expressions of P-Akt, IkB and NF-κB in L-Ins+LY group and H-Ins+LY group (P>0. 05) except for the high expressions of TNF-a mRNA (P<0. 05). There is no significant difference between L-Ins+LY group and H-Ins+LY group (P>0. 05). Conclusion The direct anti-inflammatory effect of insulin is verified in a dose dependent manner. Insulin may regulate the synthesis and secretion of inflammatory cytokines by activating PI3K/Akt pathway, increasing IkB and affecting the state of NF-κB. Insulin may increase the synthesis and secretion of inflammatory cytokines through other pathways when the PI3K/Akt pathway is blocked.