BACKGROUND: With the development of new materials and the improvement of prosthesis design, total knee arthroplasty(TKA), a commonly used surgery, has exhibited satisfying effect on the treatment of rheumatoid arthritis and osteoarthrosis. However, many problems still remain a headache to operation performers.OBJECTIVE: To discuss how to select the prosthesis for total knee replacement and to summarize the key factors that affect the curative effect.DESIGN: A controlled study of the effect before and after the operation.SETTING: Department of Orthopedics, First Hospital of Xi'an Jiaotong University.PARTICIPANTS: Thirty-six patients(24 males and 12 females) who received TKA in the Department of Orthopaedics, First Hospital of Xi'an Jiaotong University during February 2000 to September 2003 were included in this study.METHODS: A retrospective study was carried out. Thirty-six patients(48knees) underwent total knee replacement, and the knee joint function was evaluated with American John N Install scoring system. The post-operation effect was evaluated by comparing the scores of each diseased knee before and after the operation.MAIN OUTCOME MEASURES: The function of knees and the score of every knee before and after operation were evaluated.RESULTS: The mean score before operation was 39, but it was 85 after follow-up visit. Totally 95% of them were up to the standard. The pain was reduced after the operation. The flexion-extension function and mobility of the knee joints improved obviously.CONCLUSION: TKA with posterior stabilized prosthesis and resection of posterior cruciate ligament(PCL) improved the function of the diseased knees after the operation. And the operation was simple and without complications. The key factors that affect the curative effect include the mechanical balance of the soft tissues during the operation, perioperative anticoagulant treatment for the prevention of deep vein thrombosis(DVT) and postoperative rehabilitation training. Peripheral tissue of knee joints should be released adequately; otherwise, it may cause unstable joint or limitation of joint activity.

Objective To investigate the psychological status and related factors in patients with mainte-nance hemodialysis in Huzhou city.Methods 376 cases of maintenance hemodialysis were selected as the research subjects in Huzhou First People's Hospital.The anxiety and depression status in maintenance hemodialysis patients were investigated by issuing questionnaires.To study the relationship between anxiety and depression,gender,age, social support,nutritional status,complications,and in maintenance hemodialysis patients.At the same time,the quality of life was evaluated by SF -36 scale.Results Issuing 376 questionnaires,a total of 373 points,the effective recovery rate was 99.20%.In 373 patients,there were 182 patients (48.79%)with no depression,mild depression in 78 cases (20.91%),moderate depression in 59 cases (15.82%),severe depression in 54 cases (14.48%). 51.21% patients had different degree of depression.Of the 373 patients,there were 123 patients (32.97%)with no anxiety,mild anxiety in 141 cases (37.80%),mild and moderate anxiety in 55 cases (14.75%),moderate anxiety in 33 cases (8.85%),severe anxiety in 21 cases (5.63%).A total of 67.03% patients had different degrees of anx-iety.Huzhou city maintenance hemodialysis,female patients had depression rate of 80.70%,anxiety rate of 65.50%, which were significantly higher than the rate of depression 55.45%,anxiety rate 39.11% in male patients,the differ-ences were statistically significant (P <0.01 -0.05).In maintenance hemodialysis patients,the anxiety and depres-sion status gradually increased with age.Severe malnutrition in maintenance hemodialysis patients,the rate of depres-sion,anxiety rates were 80.65%,90.32%,the rates of depression,anxiety were 44.49%,61.81% in normal and mild malnutrition patients,the differences were statistically significant (all P <0.01).SF -36 scale showed that most of the patients with maintenance hemodialysis patients had poor quality of life,and the function was limited. Conclusion Maintenance hemodialysis patients,the general existence of anxiety and depression in the mental state in Huzhou city.Moreover,the psychological state of the patients is influenced by sex,age,nutrition status,and other factors.In clinical,it is needed to provide effective psychological intervention for patients to improve the quality of life,according to the psychological status and related factors of maintenance hemodialysis patients.

Objective To explore the clinical effect of holistic nursing in the operation room for surgical children patients. Methods 120 patients required surgical treatment were selected and divided into the control group(45 cases)and the observation group(75 cases)randomly.The control group was given routine nursing,the observation group was given holistic nursing including preoperative interview,psychological care and all the preparations,strict check upon going into the operation room and before surgery,to help children keep graceful position,to cooperate closely with the anesthetist and surgeon,to observe the condition of patients and give good infusion management,to give continued observation of the disease condition after surgery,to make children safe escort back to the ward,and to make transfer with ward nurses.The treatment effect was compared between two groups. Results Two groups of children passed the period of operation and anesthesia safely,without appearing accidental situation.The satisfaction degree of the observation group was significantly higher than the control group.One case appeared operation accident and two cases appeared anesthesia awareness in the control group,and they were correctly handled.No one appeared operation accident and anesthesia awareness in the observation group.The differences between the two groups were significant. Conclusions Application of holistic nursing in the operation room for children patients puts forward higher requirements for nurses.It can help children cooperate with surgery better to achieve better surgical results,which is worthy of promotion.

BACKGROUND: The skill to culture osteoblasts primarily has been well developed. However, trypsinase can affect membrane protein of osteoblasts if the time of digestion is long. Therefore, it is of great significance to select an ideal method to avoid the damage from trypsinase to cells as possible when culturing osteoblasts.OBJECTIVE: To explore a novel method to isolate and culture SD rat osteoblasts in vitro, and identify the functions of the cells.DESIGN: Observational study.SETTING: Department of Orthopaedics, First Affiliated Hospital of Jinan University.MATERIALS: This experiment was carried out in the Department of Orthopaedics, First Affiliated Hospital of Jinan University from March to May in 2007. Eight SPF 24-hour old SD rats were used in the experiment. The rats, irrespective of gender, were provided by the Experimental Animal Center of Nanfang Medical University. The experimental animals were disposed according to ethical criteria. The main reagents were detailed as follows: collagenase Ⅱ (Sigma Company);trypsin (Sigma Company); alkaline phosphatase (ALP) kit (Nanjing Jiancheng Biological Products Company); SABC-1021(Wuhan Boster Biotechnology Company).METHODS: 24-hour old SD rats were chosen for experiment. The newly born SD rats were sacrificed by anesthesia and the cranial bones of the rats were obtained cleanly, erased completely of the periosteum and cut to blocks of I mm3. The cranial bones were digested by 0.25 % trypsinase for 20 minutes, then by 0. 1% type Ⅱ collagenase for 60 minutes. The digestive time of trypsinase was controlled in the process of digestion to avoid to harm the cells. The liquid was gathered and centrifuged. The cells were cultured in culture flask and were purified by many times adhered.MAIN OUTCOME MEASURES: Morphology observations under the inverted phase contrast microscope, transmission electron microscope, and scanning electron microscope were performed. The phenotype, calcium tuberculation and the expression of alkaline phosphatase were studied with alizarin red staining and modified Gomori Ca-Co assays respectively.The cells were also evaluated with collage Ⅰ immunohistochemical staining.RESULTS: The cultured cells had active proliferation ability. Cells showed multi-angle or fusiform shape. Nucleus was immature and organell was plentiful. Therefore, they had typical morphological characters of osteoblasts. Moreover, they showed the osteoblastic phenotypes such as their synthesis of alkaline phosphatase, collage Ⅰ and formation of calcium tuberculations.CONCLUSION: The cells cultured by our modified enzymatic digestion method had typical morphological and biological characteristics of osteoblasts.

Objective To discuss the effective methods to improve the teaching effect of Basis of Nursing and cultivation of high-quality persons. Methods We randomly divided 87 nursing students into the test group(42 eases) ,which adopt the combination of grouped scene teaching with role-playing teaching and the control group (45 cases),which received routine teaching methods.The effect of the two teaching methods was evaluated by questionnaires. Results The total score and the score of each section of the questionnaires in the test group were higher than those of the control group(P ＜ 0.05 ). Conclusions The combination of scene teaching with role-playing teaching could inspire students' interest,strengthen the role consciousness and improve their comprehensive quality.

Objective To explore TCM syndrome and treatment regular for AIDS dementia complex (ADC). Methods Through literature retrieval, the review of medical records and clinical investigation, expert questionnaires survey was carried out. Results The recovery rate of complete questionnaires in the 1st survey was 88.89%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the concept, clinical features, diagnostic criteria, syndrome differentiation and treatment of insufficiency of kidney essence, nursing, period of treatment and curative effect standard were more than others, CV<0.076. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of heart and liver yin were smaller, and CV was within 0.168–0.234. The recovery rate of complete questionnaires in the 2nd survey was 96.00%. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of the etiology and pathogenesis, syndrome differentiation and treatment of deficiency of kidney and liver were more than the 1st survey, and CV was within 0.065–0.106, which was smaller than the 1st survey. The agreement rate, the arithmetical mean, the weight coefficient, the mean level and the rank sum of syndrome differentiation and treatment of deficiency of kidney and liver were smaller, and CV was 0.156. The weight coefficient of the 1st and 2nd survey were within 0.072–0.087, 0.071–0.089. The questionnaire reliability of the 1st and 2nd survey were 0.916 and 0.886 respectively. The half reliability of the 1st and 2nd survey were 0.81 and 0.79 respectively. Conclusion TCM syndrome and treatment regular for ADC is preliminarily formed.

Objective To explore the risk factors for infantile hemangiomas with the emphasis on perinatal factors and socioeconomic and environmental status.Methods A questionnaire survey was carried out targeting mothers and their babies who admitted to the Department of Prevention and Health Care of China-Japan Friendship Hospital for registration from Jan.1st,2009 to Dec.31st,2011.Information gathered included maternal basic information,perinatal factors before and during pregnancy,and socioeconomic and environmental status.Photos and record of the position and size of the pathological change were taken once infantile hemangiomas were diagnosed.Univariate analysis and multivariate Logistic regression analysis were carried out to investigate the risk factors.Results One thousand nine hundred and ninety-eight questionnaires with detail information were collected,among which 94 infants were diagnosed with infantile hemangiomas (4.7 ％).It showed that maternal age≥ 30 (OR =2.687,95％ CI:1.615-4.472,P =0.000),multiple pregnancies (OR =1.730,95 ％CI:1.032-2.901,P=0.038),female infants (OR =1.855,95 ％ CI:1.187-2.899,P =0.007 ),threatened abortion ( OR =3.135,95％ CI:1.487-6.609,P =0.003),amniocentesis (OR =2.754,95 ％CI:1.278-5.938,P =0.010),family history of hemangiomas (OR =2.978,95 ％ CI:1.127-4.049,P=0.032) and video display terminals exposure ＞45 h/week (OR=3.166,95％CI:2.027-4.944,P=0.000) were closely associated with infantile hemangiomas development.Conclusions The elderly maternal age,multiple pregnancies,female infants,threatened abortion,amniocentesis and family history of infantile hemangiomas and long-time exposure of video display terminals might be the risk factors for infantile hemangiomas.

Objective To evaluate the effect of psychological interventions for patients with urnary cancer on pain and quality of life.Methods One hundred and twenty patients were randomized into research and control group.Each group contained 60 cases. The study group received regular analgesic treatment and psychological interventions.The control group received the same scheme but for psychological interventions.As LQ-C30 was applied to evaluate patients' pain intensity and quality of life respectively.Result The pain relief rate of study group acquired is different significantly from control group, as well as in a higher score in global quality of life, role function, emotional function (P<0.05).Conclusions High-quality psychological care service can improve the quality of life of patients and release cancer pain.

Objective To explore the effect of infrared spectral analysis in analyzing of the chemical composition of renal staghorn calculi and its relationship with urinary tract infections. Methods From June 2014 to June 2016, the clinical data of 186 patients with renal staghorn calculi were collected. The stone composition were analyzed by infrared spectroscopy and traditional chemical titration, and the stones infection were detected by microbial analysis system. The relation between stones infection, urinary tract infection and stone composition were analyzed. Results The results of infrared spectroscopy and traditional chemical titration in detecting renal staghorn calculi ingredient had no significant differences (P>0.05). In 186 patients, 56 patients (30.11%) was in infected group, and 130 patients (69.89%)was in non-infected group. The abnormal urine rate, urinary tract infection rate, medistream urine positive infection rate and cotton swabs positive infection rate in infected group were was significantly higher than those in non-infected group: 73.21%(41/56) vs. 50.77%(66/130), 19.64%(11/56) vs. 3.85%(5/130), 50.00%(28/56) vs. 6.15%(8/130), 67.86%(38/56) vs. 8.46%(11/130), P<0.01. The carbonate apatite stones rate and six water magnesium ammonium phosphate rate in infected group were significantly higher than those in non-infected group: 21.43%(12/56) vs. 5.37%(7/130), 57.14%(32/56) vs. 2.31%(3/130), P<0.01. The calcium oxalate rate and uric acid rate in non-infected group were significantly higher than those in infected group:50.00%(65/130) vs. 5.36%(3/56), 24.62%(32/130) vs. 1.79%(1/56), P<0.01. Conclusions Analysis of staghorn calculi ingredient caused by urinary bacterial infection with infrared spectroscopy is simple, reliable and easy to operate. It is important for postoperative infection prevention.

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS), and explore the efficacy of endoscopic treatment in patients with esophageal submucosal tumor. Methods Sixty-eight patients with esophageal submucosal tumor were selected, and the tumor was derived from the muscularis mucosa and submucosa according to the common endoscope and endoscopic ultrasonography detection. Endoscopic mucosal resection (EMR) was applied to remove submucosal tumor with diameter less than 1.0 cm, endoscopic piecemeal mucosal resection (EPMR) or endoscopic submucosal dissection (ESD) was applied to remove submucosal tumor with diameter 1.1 - 1.5 cm, and ESD was applied to remove submucosal tumor bigger than 1.5 cm. Samples were examined by pathology after treatment. Results Tumors in all the patients were completely removed, and the tumor diameter was 0.6-2.3 cm. Forty-one cases were treated with EMR, 9 cases were treated with EPMR and 18 cases were treated with ESD. Four patients had intra-operative bleeding that was stopped by electrocoagulation hemostasis. No perforation occurred in all cases. Postoperative pathology revealed 43 cases had leiomyoma, 23 cases had interstitialoma, and 2 cases had lipoma. Patients were reviewed by gastroscope 3 months after operation. The white scars formed in all patients, and there was no residue or recurrence. Conclusions Different origin layers and property of esophageal submucosal tumor can be diagnosed accurately by EUS, and endoscopic therapy (EMR, EPMR and ESD) is an effective treatment for submucosal tumor from muscularis mucosa and submucosa. Endoscopic therapy is safe and effective. It provides sufficient pathological information.