AIM: There is a controversial argument about the choice of total hip replacement (THR) and bipolar artificial femoral head replacement (FHR) for elderly patients with femoral neck fracture. This study was designed to explore the long-term biocompatibility and functional recovery of joints in patients over 70 years with femoral neck fracture by THR and bipolar artificial FHR. METHODS: Sixty patients with femoral neck fracture over 70 years were enrolled from the First Department of Bone and Joint Surgery in the First Hospital of Jilin University from January 2002 to December 2006. There were 21 cases (8 males and 13 females) receiving THR, with a mean age of (72.1?3.5) years, and 18 of them were complicated with internal diseases. While 39 cases (16 males and 23 females) received bipolar artificial FHR, their average ages was (75.1?6.4) years, and 35 of them were complicated with internal disease. ①Choice of artificial prosthesis: Sixteen prosthesis were produced by Germany Link Company and American Zimmer Company, 44 artificial joints were offered by Beijing Mengtaiyin Medical Instrument Co., Ltd. ②All the patients were operated by senior doctors who were qualified for post technique owing to more than 10-years working experience about artificial joints. ③The mean time of follow-ups for all patients was 37 months. The difference was compared in biocompatibility between materials and host, joint function, Harris scoring, time of operation, blood loss, time of hospitalization, cost of hospitalization and adverse effect. RESULTS: ①Comparison of biocompatibility: Two revisions for abrasion of acetabular wall were carried out 5 years after bipolar artificial FHR, and there was no infection of incision, dislocation of hip joint or loose of artificial joint in other patients of these two groups. ②Comparison of adverse effect: There was one patient with complications of pain and red swelling of hip in each group. No infection occurred around the prosthesis, and these two patients recovered after symptomatic treatment. ③Comparison of follow-ups for joint function: The average Harris scores was 89.8?8.6 in THR group and 72.7?9.5 in bipolar artificial FHR group, and there were significant differences in these two groups (P 0.05). ⑤Comparison of operation time and blood loss: The average operation time were (150.2?24.3) minutes in THR group and (105.8?22.1) minutes in bipolar artificial FHR group, with significant differences (P

Objective To investigate expression of CXCR4 and CXCR7 protein and mRNA, which are the receptors of stromal cell derived factor-1α(SDF-1α), in the bone marrow mesenchymal stem cells (BMSCs);to explore the role of SDF-1α/CXCR4/CXCR7 axis in migration of BMSCs in vitro and the possible mechanism .Method BMSCs were isolated from rats and cultured in vitro.CD29, CD44 and CD34 of the cells were identified by flow cytometry .CXCR4-selective antagonist AMD 3100 and CXCR7-specific neutralizing antibody were applied to block CXCR 4 and CXCR7 respectively.The expressions of CXCR4 and CXCR7 mRNA and protein on BMSCs were detected with RT-PCR and Western blotting .Transwells chamber test was used to observe the migration of BMSCs .The BMSCs were divided into the BMSCs group ( A ) , the AMD3100 pretreated BMSCs group ( B ) , the CXCR7-specific neutralizing antibody pretreated BMSCs group(C), the AMD3100 +CXCR7-specific neutralizing antibody pretreated BMSCs group ( D).Result Flow cytometry showed that the expressions of CD 44 and CD29 were positive, while the expression of CD34 was negative in the third passage of BMSCs (P3-BMSCs).CXCR4 and CXCR7 protein and mRNA were both expressed in P3-BMSCs. Compared with the A group, the expression of CXCR4 and CXCR7 protein declined significantly in the B group and the D group;the protein expression of CXCR7 in the C group was lower compared with the A group (P<0.05).However, the expression of CXCR4 mRNA and CXCR7 mRNA had no significant difference between groups .SDF-1αfactor promoted migration of BMSCs ( P <0.05 ).Compared with the 0μg/L group, the numbers of migrated cells were increased significantly in both of the 10μg/L group and the 100μg/L group ( P<0.01 ) .The number of migration of BMSCs was significantly higher in the 100μg/L group than that of the 10μg/L group ( P <0.01 ) .AMD3100 and CXCR7-specific neutralizing antibody both inhibited significantly the migration of BMSCs ( P<0.05 ) , and the attenuate effect was more significant when they worked together ( P<0.05 ) .Conclusion CXCR4 and CXCR7 receptors are co-expressed in P3-BMSCs;the SDF-1αfactor can promote the migration of BMSCs in the concentration dependent manner ;SDF-1α/CXCR4/CXCR7 axis is involved in the migration of BMSCs , and both of the CXCR4 and CXCR7 receptors have a synergistic promoting effect to the BMSCs migration .

In order to study the resistance of Neisseria (N.) gonorrhoeae to the fluoroquinolone and detect mutation patterns of quinolone resistance-determining regions (QRDRs) of clinical isolates in Shanghai,China,a total of 80 clinical isolates of N.gonorrhoeae were consecutively collected from Shanghai.The MIC of fluoroquinolone for the isolates was examined by using the agar dilution method and the mutation profiles of the QRDRs of gyrA and parC were analyzed by sequencing and restriction fragment length polymorphism (RFLP).Chi-square test was used for comparison of the mutation patterns.The results showed that:(1) High percentages of the 8 isolates were resistant to ciprofloxacin (95.0%),ofloxacin (95.0%) and lomefloxacin (97.5%),only one strain was susceptible to the ciprofloxacin.(2) Sensitive strains had a substitute of Asp95→Ala in the gyrA,and all isolates that were resistant or intermediated to the ciprofloxacin,had a double mutation in the gyrA (Set91,Ala 92 and Asp95).Some strains also had a mutation in the parC.(3) The MICs of these isolates were significantly associated with the mutation patterns in the gyrA and parC.A double mutation of gyrA combined with parC87 mutation was a predominant pattern in Shanghai and could mediate high level resistance to ciprofloxacin.It suggests that mutations in the QRDRs of gyrA and parC .may be re-sponsible for the fluoroquinolone resistance.And fluoroquinolone could not be used as the first line antibiotics for gonorrhea treatment any more in Shanghai,China.

BACKGROUND:The majority of people do not believe that the femoral component flexion in total knee arthroplasty affect or affect little postoperative function and it is the only that the radiographic films is not satisfactory.So it has not caused people's enollgh attention.But the femoral component flexion affects the results of total knee arthroplasty obviously.OnJECTIVE:To investigate the curative effects of femoral component installed in the position of flexion during the operative procedure of total knee arthroplasty(123 knees)on the follow up results in 78 patients.DESIGN:Grouping contrast observation.SETTlNG:First Department of Bone and Joint,Wangjing Hospital of China Academy of Traditional Cllinese Medicine.PARTlCIPANTS:123 knees(78 patients)were given total knee arthroplasty in the First Department of Bone and Joint,Wangjing Hospital of China Academy of Traditional Chinese Medicine from October 2001 to June 2004.Seventeen(13.8%,15 patients)knees were found with femoral component flexion(FCF),in which there were 5 male cases and 10 female cases,aged from 47 to 81 years old.106(63 patients)knees were found without FCF,in which there were 22 male cases and 41 female cases,aged from 47 to 79 years old.METHODS:Total knee arthroplasties about their HSS rating scores,ranges of motion and flexion contractures werecompared in the two groups before operation and after operation,and the degrees of the FCF angle and the distances of femoral component flexion were measured.MAIN OUTCOME MEASURES:①Femoral Drostllesis flexion measurement;②HSS scores and activity:③femoral prosthesis flexion angle and distance buckling;④adverse events and side effects.RESULTS:Follow up lasted for one year above.①The degrees of flexion of femoral components were from 7°to 19°(average 11.3°)and the distance of flexion was from 2 mm to 4 mm(average 2.6 mln)in those 17 knees of total knee arthroplasty.②Differences in HSS rating scores and range of motion were not statistically significant(P＞0.05)before operations between the group of femoral component flexion and the group of femoral component plane.However,after operations the above aspects in the group of femoral component flexion were less than that in the group of femoral component plane significantly(P=0.01,P＜0.01),and were statistically significant(P=0.02,P＜0.01)between post-operations and pre-operations in HSS rating scores and range of motion respectively in the two groups.③The statistic differences in cases and angles of flexion contractures of postperations between the group of femoral component flexion and the group of femoral component plane were significant(P＜0.01),the situation in the group of femornl component flexion were more bad than that in the group of femoral component plane,but were all improved significantly in cases and angles of flexion contractures after operations in the two groups(P＜0.05,P＜0.01).④There was one case with the right deep venous thrombosis and one case with myositis ossifican in non-FCF group,and there was one case in FCF group with impingement sign between patellar and component.CONCLUSION:The findings show that femoral component flexion will increase the incidence of knee flexion contracture and result in knee extension dysfunction after total knee arthroplasty surgery.

Objective To prepare a recombinant pneumococcal surface protein A clade 4 ( PspA4) and to analyze its immunogenicity.Methods The gene encoding PspA4 protein was synthesized and inserted into pET-20b to construct the recombinant expression plasmid.The transformed E.coli strains carrying expression plasmid were induced to express PspA4 protein.ELISA was performed to analyze the ti-ters of PspA4-specific IgG in a mouse model.Results The recombinant PspA4 protein of high purity ( 90%) was successfully prepared.The titers of PspA4-specific antibody in mice received PspA4 immuniza-tion were 106 times higher than those of the blank control group, suggesting that the expressed PspA4 protein had the advantage of high immunogenicity.Conclusion This study suggested that the PspA4 protein might be used as one of the candidate protein for the development of pneumovax and laid a foundation for further in-vestigation on pneumococcal protein based vaccine.

Objective To investigate the outcome of a new designed extramedullary femoral osteotomy module and to compare with conventional intramedullary system in clinical study.Methods The extramedullary femoral osteotomy module was designed with the extramedullary alignment rod connecting with the T type rod at right angle,and it had a 5°-7° adjustable valgus design.The positioning module fixation screw was parallel with the epicondylar axis.The coronal plane of the distal femur bone cut was orientated by the extramedullary alignment rod pointing to the inguinal midpoint,and the sagittal plane was orientated by the extramedullary alignment rod keeping parallel with the distal femoral medullary cavity.The terminal distal femoral bone cut was conducted with suitable osteotomy after the orientation.Sixty patients who underwent unilateral total knee arthroplasty (TKA) from October 2015 to March 2016 were randomly divided into intramedullary and extramedullary group for prospective controlled study.Blood loss,drainage and the incidence of deep vein thrombosis (DVT) were evaluated at one week postoperatively.Knee valgus angle and femoral prosthesis flexion angle were analyzed at two weeks postoperatively.Moreover,the extramedullary femoral osteotomy module was used in 273 patients (78 males and 195 females) with an average age of 68.7 (range,57-82 years old) who underwent unilateral TKA from April 2016 to January 2017.Blood loss,operation duration and lower limb ultrasonography preoperatively and at one week postoperatively were recorded.Knee valgus angle and femoral prosthesis flexion angle were measured at 2 weeks postoperatively.Range of knee motion and Hospital for Special Surgery (HSS) knee score at six weeks postoperatively were also reported.Results In the randomized controlled trial,blood loss and drainage in extramedullary group was less than that in intramedullary group (t=-3.330,P=0.004).There was no significant difference in the incidence of DVT at 1 week postoperatively (x2=2.269,P=0.132) and the knee valgus angle and femoral prosthesis flexion angle at 2 weeks postoperatively within the two groups.In the clinical application,operation time was 60.13± 13.69 min,and blood loss and drainage was 109.11±70.73 ml.There were four cases of popliteal vein thrombosis,nine cases of posterior tibial vein thrombosis,and seventeen cases of muscular venous thrombosis at one week postoperatively.The incidence rate of DVT was 11.0％.There was no symptomatic pulmonary embolism at three months postoperatively.Knee valgus angle was 7.34°±0.69°,and 211 knees accounting for 77.3％ were in the range of ±3° error.Femoral prosthesis flexion angle was 6.43°±1.59°,and 273 knees were all in the range of ±10° error.Range of knee motion improved from 54.52±5.96 preoperative to 86.20±4.92 at six weeks postoperative.HSS knee score improved from 100.88°±7.51° preoperative to 110.42°±7.08° at six weeks postoperative.Conclusion The new designed extramedullary femoral osteotomy module used in distal femoral osteotomy during TKA can significantly reduce the risk of bleeding and the incidence rate of DVT postoperatively.Furthermore,patients can obtain as excellent prosthesis position and limb alignment as conventional intramedullary system.

Objective To ensure the medical security of the astronauts,new targeted strategies were adopted after summarizing the experience in Chinese astronauts rescue and medical aid at the main landing site,the specialty and characteristics of landing were analysied.Methods Search the publications about astronaut medical aid domestic and abroad,summarize the rescue and medical aid experiences from Shenzhou 5 to Shenzhou 10.In consideration of prolonged on-orbit time,the cold weather conditions at the landing zone of Shenzhou 11,new targeted strategies were presented.Results On the basis of the original helicopter emergency platform and first aid equipment,the emergency aid procedures were optimized,personal warm clothing,a heat preservation box,insulation blanket,self-heating pads and intraosseous rapid infusion system were used to ensure the medical security of astronauts in cold weather at the main landing site.Conclusions With the procedures optimized and the targeted strategies performed,the astronauts' s rescue and medical aid project was fully meet the cold and complex conditions at main landing site.

Objective To screen and prepare a broad-spectrum monoclonal antibody against Strep-tococcus pneumoniae ( S. pneumoniae) surface protein A ( PspA) and to evaluate its potential in clinical prac-tice. Methods Hybridoma cells were screened and inoculated into the abdominal cavities of BALB/c mice to prepare antibodies in ascites. Monoclonal antibodies were obtained by ammonium sulfate precipitation and protein A affinity chromatography and then identified by SDS-PAGE and Western blot. Their specificity, iso-forms and killing activities in vitro were analyzed. Results A broad-spectrum monoclonal antibody that rec-ognized PspA subclasses 2, 3 and 4 was obtained. Its in vitro killing rate against S. pneumoniae reached 40. 3％. Conclusions A broad-spectrum monoclonal antibody that could specifically bind to PspA was suc-cessfully prepared with a strong in vitro killing activity. This study provided reference for clinical diagnosis of S. pneumoniae-related diseases, quality assessment of S. pneumoniae vaccines and further research on mono-clonal antibody therapeutics.

Objective To summarize the medical security experience in first-aid and resuscitation for astronauts at the exit of capsule after the spacecraft returns to the main landing site in the process of human spaceflight in China,and thus to provide a powerful security measures for Chinese aerospace medicine.Methods The medical support experiences were summarized in human spaceflight from "Shenzhou V" to "Shenzhou X",relevant reports on emergency rescue and resuscitation were consulted in in-orbit process and after emergency return and landing for domestic and foreign astronauts,astronauts' physiological changes in cardiopulmonary resuscitation were analyzed during emergency return,and then,corresponding strategies were proposed and tested in practice (actual combat) by combining with the flight characteristics of the spacecraft "Shenzhou XI".Results On the basis of the original emergency treatment,the countermeasures for the cardiopulmonary resuscitation were proposed after the spacecraft returned to the main landing site in human spaceflight,the emergency equipment was adjusted,the emergency procedures were optimized,and anti-fog glidescopes were added,laryngeal masks were introduced to perform supraglottic ventilation as the quickest and most effective airway opening measure on site.In addition,ultrasound examination was applied in practice as an important treatment and assessment method for basic life support and advanced life support.All these could ensure the rescuing ability on cardiopulmonary resuscitation during their stay in space for the medium-term and after their return to the main landing site.Conclusions During the return of the astronauts of the spacecraft "Shenzhou XI" to the main landing site,the first aid and support program had been improved specifically and the process had been optimized to ensure the successful completion of medical security mission of China's human spaceflight.

Objective To identify the chemical constituents of Xiakucao Xiaoliu mixture by high performance liquid chromatography-high resolution time-of-flight mass spectrometry (HPLC-TOF/MS). Methods The chromatographic separation ACE (3.0mm×150 mm) column was used. The mobile phase was methanol (A) and 0.1% formic acid (B). The gradient elution was: 0-5 min, 5% A; 5-10 min, 5%-15% A; 10-30 min, 15%-45%A; 30-40 min, 45%-70%B; 40-50 min, 70%-90%B. The injection volume was 2 μl. The flow rate was 0.4 ml/min. The column temperature was 25°C. The mass spectrometry was characterized by time-of-flight mass spectrometry, using ESI ion source. The common monitoring was in positive and negative ion mode. The reference ion was m/z 121.9856, 1033.9881. The scanning range was m/z 100-1200. Results A total of 37 chemical constituents were identified in the Xiakucao Xiaoliu mixture, 8 in the positive ion mode fragment voltage of 160 V, 28 in the negative ion mode fragment voltage of 160 V, and 19 in the fragment voltage of 260 V. Both positive and negative ions had 4 responses. The negative ion mode has 16 responses under both fragment voltages. And the ingredients were medicinal. Conclusion An effective method for the identification of the chemical constituents of Prunella vulgaris L. by HPLC-TOF/MS was established, which laid a foundation for its quality control and in-depth study in vivo.