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Objective To evaluate the overall failure rate of one or two-stage exchange arthroplasty for infections in total knee arthroplasty (TKA) and the predictors affecting the outcome of exchange.Methods Thirty-nine cases received one or two-stage exchange arthroplasty for periprosthetic joint infections after primary TKA in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Southeast Hospital affiliated to Xiamen University from January 2012 to November 2014 were reviewed.Periprosthetic tissue and articular fluid of all patients were analyzed by bacterial culture.All patients were followed up for more than one year.C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),procalcitonin (PCT) and blood routine were tested every four weeks,and the evaluation on pain,total periprosthetic function,range of motion and deformation of arthroplasty were conducted.Differences between groups were analyzed using chi-square test or Student's t test when appropriate.A stepwise selection approach in logistic regression analysis was used to screen key predictors for outcome of one or two-stage exchange for infections in TKA.Results There were 39 patients who had undergone one or two-stage exchange for infections in TKA,including 20 males (51.3％) and 19 females (48.7％) with an average age of (62.4±11.7) years.Among the 39 patients,18 gram-positive strains were isolated from specimens,and 6 gram negative strains,2 Mycobacterium tuberculosis and 1 candida albicans.Ten of 39 reimplantations developed reinfection.Between the success and failure groups,there were significant differences in the time from primary TKA to revision (P =0.023),operative time (P =0.029),multidrug resistant organisms (P =0.045),the preoperative and post-operative ESR (P=0.002 and P＜0.001,respectively) and post-operative CRP (P=0.018).Multivariable logistic regression analysis demonstrated that time from primary TKA to revision (OR =0.96,95％CI:0.92-1.00,P=0.025),preoperative ESR (OR=0.97,95％CI:0.95-1.00,P=0.045) and post-operative ESR (OR =0.94,95％ CI:0.91-0.98,P =0.002) were independent indicators associated with the outcome of one or two-stage revision.Conclusions The failure rate after revision for infected TKA is relatively high.The time from primary TKA to revision,preoperative and post-operative ESR could predict the outcome of one or two-stage revision effectively.

Objective To assess the value of multi-slice spiral CT angiography (MSCTA) in diagnosis of posterior nutcracker syndrome (NCS). Methods MSCTA of 15 patients clinically diagnosed as posterior NCS (patient group) and 50 subjects with normal renal vessels (control group) were retrospectively analyzed. The anatomy, course and relationship to the adjacent structure of left renal vein (LRV) and its branches were observed. The anteroposterior diameter (d1) and cross areas (s1) of the angle of control group and posterior abdominal artery (AA), the anteroposterior diameter (d2) and cross areas (s2) at the largest lumen near the renal hilar were measured and the ratio of s2/s1 and d2/ d1 were calculated.Results All LRVs posterior AA of patient group were compressed and narrowing with dilating apparently near the renal hilar. The difference of d2 was not significant (P＞0.05), but of other values were significant (P＜0.05).Conclusion MSCTA can show anatomy and three-dimentional trend clearly of LRV for posterior NCS, and evaluate the extent of narrow and dilating lumen accurately with cross areas measuring.

Chemotherapy-induced neuropathy is a serious clinical problem for patients receiving cancer treatment. The aim of this study was to investigate the potential efficacy of pregabalin in chemotherapy-induced neuropathy in rats. A total of 35 male Sprague-Dawley rats were randomly divided into 5 groups: group 1, naive control; group 2, treated with pregabalin (30 mg/kg p.o., for 8 days); group 3, docetaxel was given by single intravenous infusion at 10 mg/kg; groups 4 and 5, pregabalin at 10 mg/kg and 30 mg/kg respectively was orally administered for 8 days after the docetaxel treatment. On day 8, behavioral test was performed, and substance P and CGRP release in dorsal root ganglion (DRG) and sciatic nerve were analyzed by electron microscope. Our results showed that docetaxel induced mechanical allodynia, mechanical hyperalgesia, heat hypoalgesia, cold allodynia, and sciatic nerve impairment and substance P and CGRP release in DRG. However, oral administration of pregabalin (10 mg/kg and 30 mg/kg) for 8 consecutive days significantly attenuated docetaxel-induced neuropathy by ameliorating heat hypoalgesia, cold allodynia, impairment of sciatic nerve and reducing the release of substance P and CGRP. The findings in the present study reveal that pregabalin may be a potential treatment agent against chemotherapy-induced neuropathy.

Objective To observe the changes of serum potassium concentration in rectal cancer patients from the admission to before the operation,to provide clinical evidence for preventing serum potassium disorder during and after their operation.Methods Monitoring of the changes of serum potassium concentration of 40 cases of rectal cancer patients according to three time points including the first day of admission,before taking of cathartics and the morning before operation.They were divided into different groups according to their age(young,middle age and elderly group),gender(male and female group),diet(normal,decreased slightly and serious decline group) and course(long,middle and short course group) of disease.The serum potassium concentration was observed between each time point of each group and SPSS13.0 statistical software was used to analyze the changes above.Results The mean of all patients' serum potassium concentration was (4.09 ± 0.62) mmol/L on the first day of admission,was (3.83 ± 0.46) mmoL/L before taking of cathartics that was decreased compared to the former and there was significant difference (P ＜ 0.01),it was (3.36 ±0.40) mmol/L on the morning of operation and had significant difference with the above two groups (P ＜ 0.01).It hadn't significant difference between different gender and age groups at different time points (P ＞ 0.05) except between the young group and the elderly group in the morning of the operation (P ＜ 0.05).There were statistically significant differences between the different diet condition and different course at anytime point (P ＜ 0.01).Conclusions The rectal cancer patients were possiblely in hypokalemia before operation,the causes might be relative to the long course of disease,the decreased diet,the aged and infirm,the diet structure change after admission and taking cathartics cleaning intestinal tract.

Objective In order to provide clinical evidence of reducing postoperative complications of procedure for prolapse and hemorrhoids and observe the effects of constipation on postoperative complications of procedure for prolapse and hemorrhoids.Methods One hundred and sixty cases of hemorrhoid were divided into two groups according to whether suffering from constipation:there were eihgty cases who were suffered from constipation in the experimental group and eighty cases who were not suffered from constipation in the control group.All patients' postoperative bleeding,anal edema,stool impaction and satisfaction were observed within 30 days and these data were compared and analysed by using SPSS 13.0 software.Results In the experimental group,the postoperative bleeding incidence was 37.5 ％ (30/80),the anal edema incidence was 31.3 ％ (25/80),the stool impaction inci dence was 8.6％ (7/80),and the patients' satisfaction rate was 88.6％ (71/80).In the control group,the postoperative bleeding incidence was 18.6％ (15/80),the anal edema's incidence was 15.0％ (12/80),the stool impaction incidence was 1.3％ (1/80),and the patients' satisfaction rate was 97.5％ (78/80).All the indexes above were different statistically in the two groups (P ＜ 0.05).Conclusion constipation could increase complications and reduce the degree of satisfaction after procedure for prolapse and hemorrhoids.

The ideal treatment and recovery of osteoarticular injury remain to be resolved. Small intestinal submucosa (SIS), a naturally-occurring decellularized extracellular matrix, has been recognized as an ideal scaffold for tissue engineering and widely used in repairing various tissues and organs. Nowadays its application has also been gradually increased in the field of orthopedics. We reviewed laboratorial studies and clinical trails about the application of SIS in bone and joint repair, aiming to evaluate its effects on the repair of bone, cartilage, meniscus, ligament and tendon. SIS has showed promising results in repairing bone, meniscus, ligament or tendon. However, additional studies will be required to further evaluate its effects on articular cartilage and tendon-bone healing. How to optimize SIS material,is also a focused problem concerned with making SIS a potential therapeutic option with high value for orthopedic tissue repair.
Animals ; Cell- and Tissue-Based Therapy ; Humans ; Intestinal Mucosa ; cytology ; Intestine, Small ; cytology ; Joint Diseases ; physiopathology ; surgery ; therapy ; Tissue Engineering ; instrumentation ; methods ; Tissue Scaffolds ; chemistry

Objective To explore the effects of sodium arsenie on Metallothionein(MT) isoforms genes expression,and to study the relevance between the MT expression and cell survival percentage. Methods Healthy persons blood was extracted aseptically and the lymphocytes were separated. The lymphocytes were treated by 0 (control) ,2,5,10,15,30,60 μmol/L sodium arsenites, respectively. The cell survival percentage was determined by methyl thiazolyl tetrazolium(MTT) reduction assay at 24,48,72 h intervals, while the expression of MT-1 and MT-2 were examined by RT-PCR in 72 h. Results The cell survival percentage in 2,5μmoL/L groups were (115.50± 11.80)% and (130.49±8.28)%,which were all higher than those in the control group [(100.00±0.00)%,all P < 0.05]at any intervals. In 10,15,30,60 μmol/L groups,the cell survival percentage[(78.12±9.33)%,(71.62± 10.82)%,(52.06±3.05)%,(40.98±5.41)%]increased along with the decrease of concentration,which showed a significant difference between these groups and the control group and 2,5μmol/L groups(all P < 0.05). There was no significant difference on MT-1 expression after exposed to different concentration sodium arsenites (0,2,5,10,15,30,60 μmol/L) for72 h(0.925±0.123,1.082±0.504,1.103±0.170,0.927±0.056,0.730±0.307,0.604± 0.173,0.540±0.075,all P > 0.05). The expression of MT-2 in 2,5μmol/L groups(1.503±0.212,1.557±0.377) was up regulated compared with that in control group(0.702±0.112) and MT-2 also expressed more than that in other groups(all P < 0.05). However,the expression of MT-2 declined when the concentraion was 10,15,30,60 μmol/L(0.814±0.139,0.679±0.201,0.607±0.229,0.533±0.102). There was no significant difference among the groups (all P > 0.05). The expression level oE MT-1,MT-2 was positively correlated with the cell survival pereentage(r = 0.955,0.909,all P < 0.05). Conclusions The sodium arsenite at concentration of 10 μmoL/L might inhibit the expression of MT of lymphocytes and low concentration sodium arsenite (2,5 μmol/L) might stimulate the lymphocytes to regulate the expression of MT-2 to higher levels,which can increase the cell survival percentage and exert the function of protecting cells.

Although previous reports showed drug-eluting stent (DES) could effectively inhibit neointima formation, in-stent restenosis (ISR) remains an important obstacle. The purpose of this study was to investigate different effects of paclitaxel on proliferation and cell cycle regulators between vascular smooth muscle cells (VSMCs) and vascular endothelial cells (VECs) of rats in vitro. The cultured VSMCs and VECs of rats from the same tissues were examined by using immunohistochemistry, flow cytometry and Western blotting in control and paclitaxel-treated groups. The results showed paclitaxel could effectively inhibit proliferation of VSMCs and VECs. However, as compared with VECs, proliferation of VSMCs in paclitaxel-treated group decreased less rapidly. The percentage of cells in G0-G1 and G2-M phases was reduced, and that in S phase increased after treatment for 72 h. The expression of cyclin D1 and B1, p27 and PCNA in VSMCs of paclitaxel-treated group was up-regulated, but that of p21 down-regulated as compared with VECs. It is concluded that there are significant differences in the expression of cell cycle regulators and proliferation rate between paclitaxel-treated VSMCs and paclitaxel-treated VECs, suggesting that the G1-S checkpoint regulated by paclitaxel may play a critical role in the development of complications of DES, which provides new strategies for treatments of ISR.