Objective To explore the clinical results of total knee arthroplasty (TKA) in the treatment of knees with bony ankylosis in extension.Methods From June 2000 to June 2007,10 patients had knees with bony ankylosis in extension were treated with TKA,including 4 males and 6 females,with an average age of 49 years (range,29 to 63 years).The primary diseases were as follows:ankylosing spondylitis in 3 cases,rheumatoid arthritis in 2 cases,hemophilic arthritis in 1 care,traumatic arthritis in 3 cases and pyogenic arthritis in 1 case.The range of motion (ROM) was 0° in all knees,and the average HSS (the Hospital for Special Surgery) score before operation was 32.5±10.26.Two patients underwent bilateral TKA,and 8 underwent unilateral TKA.Results All patients were followed up for 3 to 10 years (average,5.3 years).The average HSS score was improved to 87.75±6.45 at the last follow-up,and there was significant difference compared with that before operation (t=18.668,P=0.000).The average ROM was improved to 97.08°±11.57°at the last follow-up,and there was remarkable difference compared with that before operation (t=29.063,P=0.000).The postoperative complications included cutaneous necrosis in 2 cases,deep venous thrombosis of lower limb in 1 case,periprosthetic fracture in 1 case,and deep prosthetic infection in 1 case who underwent revised TKA later.The postopertative X-ray showed no looseness of the prostheses.Conclusion TKA through medial parapatellar approach,with dissection of the rectus femoris,secondary osteotomy and soft tissue balance intraoperatively is effective in the treatment of knees with bony ankylosis in extension,which can correct the ankylosed knee deformitis successfully.Combining with the correct rehabilitation exercise,it is possible to improve significantly the function of knee and life quality in these patients.

Objective: To observe the effects of Radix Glycyrrhizae polysaccharide on regulatory T cells (Treg) in spleen and lymphocyte transformation ratio in tumor-bearing mice so as to explore the mechanisms of its immunoregulatory function. Methods: Fifty BALB/c mice were randomly divided into normal group, untreated group, cyclophosphamide group, Radix Glycyrrhizae polysaccharide group and Radix Glycyrrhizae polysaccharide plus cyclophosphamide group. Except normal group, mice were subcutaneously implanted H22 tumor cells in the right axillary region. After 24 h, mice in normal and untreated group were subcutaneously injected with physiological saline, while mice in the cyclophosphamide group were intraperitoneally injected with cyclophosphamide and mice in Radix Glycyrrhizae polysaccharide group were subcutaneously injected with polysaccharide. Fourteen days later, Treg cells of spleen were detected by flow cytometry and lymphocyte transformation ratio was detected by methyl thiazolyl tetrazolium method. Results: The proportion of Treg cells was significantly higher in the untreated group than in the normal group, and was lower in the Radix Glycyrrhizae polysaccharide group than in the untreated group (P

ObjectiveTo standardize the service for mental disability in community, and evaluate scientifically the effect of rehabilitation measures and social factors on the prognosis of disease.MethodsIn the communities selected by cluster sampling method, family-social rehabilitation service was established. The observe groups or specified observers were selected by the community committee, and the maintenance treatment and rehabilitation evaluation were made by psychiatrists.ResultsAfter community rehabilitation treatment, schizophrenia could be compliant with maintenance treatment, which led to satisfactory social function evaluation and rehabilitation result.Conclusion Community rehabilitation treatment could increase the compliance with medical treatment and decrease the occurrence of relapse.

Objective To observe the steps of vascular smooth muscle cells (VSMCs) calcification induced by high phosphate enviroment in vitro. Methods VSMCs were incubated with high phosphate (2.5 mmol/L or 3.5 mmool/L) medium for different times. Expression of core binding factor α1(Cbfα1), osteopontin(OP), collagen type Ⅰ(Col Ⅰ), osteocalcin(OC) and α-smooth muscle actin (α-SMA) was investigated by Western blot, immunofluorcscencc staining and real time PCR. Mineral deposition was assessed by von Kossa aad Alizarin red staining. Ultrastructure of VSMCs calcification was observed by electron microscopy (EM). Results Up-regulated expression of osteoblast-specific transcription factor Cbfα1 in the nuclei oceured at as early as 12 hours. The protein of Col Ⅰ and OP was up-regalated when VSMCs were incubated in high phosphate medium for 3 days, and content of OC increased at the time of 6 days. When cultured in 2.5 mmol/L phosphate medium for 15 days, VSMCs lost their lineage marker α-SMA, developed granular calcium deposits. Moreover, the results of real time PCR indicated mRNA level of OP and Col Ⅰ increased at day 1, OC increased at day 5 and α-SMA level decreased at day 10, respectively. Ultrastructural analysis also confirmed the presence of collagen and matrix vesicles in the cells. Conclusion VSMCs phenotype transformation induced by high phosphate enviroment is an orchestrated, highly regulated process.

Objective To report the modified liver mobilization technique in management of renal cell carcinoma with intrahepatic inferior vena cava thrombus. Methods 10 cases (7 men and 3 women at the average age of 49 years) of renal cell carcinoma with intrahepatic inferior vena cavs thrombus were reviewed.The operations were carried by using father clamp to control inferior vena cava,combined with hepatic portal blocking. Results There was no postoperative complication.The average blood loss was 800 ml.The mean hospital stay was 13 days.The time of follow-up ranged from 1 to 48 months. Conclusions The technique of using father clamp to control suprahepatic inferior vena cava combined with hepatic portal blocking is feasible for the treatment of the renal cell carcinoma with intrahepatic inferior vena cava thromhosis.

Objective　To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy.　Methods　A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients.　Results　Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing.　Conclusions　Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis.

Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic partial nephrectomy. Methods From June 2002 to December 2009, 113 cases of renal tumor received retroperitoneal laparoscopic partial nephrectomy. The age ranged from 26 to 73 years. The tumor located in left side in 51 cases and right side in 62 cases with the mean diameter of 3.7 cm(1.2-6.3cm). During the procedure, the renal artery was separated and then clamped with bulldog. The renal parenchymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis were then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully.There was no open conversion. The mean operation time was 85 min(60- 125 min), the mean warm ischemic time was 24 min(19-43 min). The pathology studies revealed 87 cases of clear cell carcinoma, 9 cases of papillary renal cell carcinoma, 7 cases of chromophobe cell carcinoma, 6 cases of perivascular epithelioid renal cell tumor and 4 cases of renal oncocytoma. The surgical margin was negative in all cases. There was no complication of urine leakage. Gross hematuria occurred in 2 cases.During 3-41 months of following up, there was no recurrence. Conclusion Retroperitoneal laparo-scopic partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.

Objective:To observe the efficacy and safety of Iguratimod in reducing the level of panel reactive antibodies in renal transplant recipients.Methods:The clinical data of 35 patients with PRA-positive renal transplant recipients were retrospectively analyzed. All recipients were treated with Iguratimod for PRA-positive. The changes in PRA levels before and after treatment and the adverse events were observed.Results:Of the 35 recipients, 4 of them were discontinued due to pulmonary infection, and 2 patients were discontinued during the observation period. 3 patients were lost to follow-up. A total of 26 recipients were included. When Iguratimod was taken to 9 months, the PRA was reviewed. 71.5 % of the 207 sites showed a downward trend, 69.9 % of the 107 class I sites and 75.9 % of the 41 class II site showed a downward trend, and there was no difference in renal function before and after treatment. There were no significant changes in blood routine, liver function, blood lipids, and blood glucose. There were no other adverse events.Conclusions:Iguratimod can effectively reduce the level of PRA in renal transplant recipients with less adverse events.

Objective:To observe the efficacy and safety of quadruple low-dose immunosuppressant maintenance therapy of sirolimus(SRL), calcineurin inhibitors(CNIs), mycophenolate mofetil(MMF)and glucocorticoid in recipients switched within three months after renal transplantation.Methods:This retrospective study recruited 61 recipients on quadruple immunosuppressive therapy within three months after renal transplantation from 2013 to 2018. The changes of serum creatinine(SCr), blood urea nitrogen(BUN), hemoglobin(HGB), white blood cell(WBC), platelet(PLT), liver function, fasting blood-glucose(FBG), serum lipid, electrolyte and urine protein before and after using this protocol were recorded.Results:No significant difference existed between before and after protocol switching in WBC or serum sodium. But after protocol switching, significant differences could be observed in SCr, BUN, serum calcium, serum potassium, aspartate transaminase(AST), PLT, alanine transaminase(ALT), HGB, FBG, triglycerides(TG)and cholesterol(TC, P<0.05). Urine protein negative rate was 44.26 % before switching. However, it was 81.97 % after protocol switching. After switching during a 1-year follow-up period, the incidence of pulmonary infection rate was 24.59 %, the incidence of BKV infection rate 4.92 %, the incidence of transplant renal artery stenosis 3.28 % and the incidence of acute rejection 6.56 %. Conclusions:Quadruple low-dose immunosuppression maintenance therapy of SRL, CNIs, MMF and glucocorticoid switched within 3 months after renal transplantation may be an effective and safe protocol of improving renal allograft function and enhancing recipient prognosis.

Objective To discuss the risk factors on short-term prognosis after kidney transplantation from donors after cardiac death (DCD). Methods We retrospectively analyzed the information of donors and recipients who performed DCD donor kidney transplantation in our center between January 2011 and August 2015, including 64 donors and 95 recipients. Also, we analyzed the potential relationship among donors' clinical characteristics and the early recovery of graft function, including the incidence of delayed graft function(DGF)and the serum creatinine (SCr) on the 90th day, and infection rate after kidney transplantation.Results We found that when donors had the factors of WIT>10 min, urine volume<100 ml/h, SBP≤100 mmHg or a history of CPR, the incidence of recipients' DGF were 55.6%,73.3%,62.5%,77.8% respectively with a significant difference. Recipients would have more chance to be infected if donors have the following characteristics: male, older than 50 years, died of cerebral hemorrhage which was caused by cardiovascular diseases, WIT>30 min, treated in ICU for more than 10 days or infection. Conclusions Nowadays, DCD has become the main graft source in Chinese kidney transplantation. This research indicates that the donors' factors may affect the recovery of graft function and the incidence of infection after kidney transplantation to some extent.By evaluating rigorously and preserving quality of renal grafts carefully, DCD would become more safe and valid.