Objective To explore the mechanism of therapeutic action of needle knife “regulating sinews and treating bones” on knee osteoarthritis (KOA) by observing the effect of needle knife intervention on KOA rabbit behaviors, mechanical characteristics of patellar ligament (PL), and expressions of interleukin-4 (IL-4), matrix metalloproteinase-3 (MMP-3) and aggrecan in knee cartilages.Methods Forty New Zealand rabbits were randomly allocated to blank, model, needle knife and electroacupuncture groups, 10 rabbits each. A rabbit model of KOA was made by the modified Videman method of immobilization in extension position. After model making, the needle knife and electroacupuncture groups received needle knife and electroacupuncture treatments, respectively. A behavioral assessment was made using the modified Lequesne MG knee grade evaluation method in every group after model making and treatment. The samples were taken after treatment. PL tension, stress relaxation and creep state were tested using a Bose Electro Force 3300 protracted test machine. Cartilage cell IL-4 expression was examined by ELISA. MMP-3 mRNA and aggrecan mRNA expressions were detected by real-time PCR.Results After model making, there was a statistically significant difference in the Lequesne MG score between the model and blank groups (P<0.01); there was no statistically significant difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P>0.05). There was a statistically significant post-treatment difference in the Lequesne MG score between the needle knife or electroacupuncture group and the model group (P<0.01,P<0.05) and between the needle knife and electroacupuncture groups (P<0.05). There were statistically significant post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the model and blank groups (P<0.01,P<0.05). There were statistically significant post-treatment post-treatment differences in PL maximum stress, maximum displacement, elastic modulus, stress relaxation rate and creep rate between the needle knife and model groups (P<0.01,P<0.05). There was a statistically significant post-treatment difference in elastic modulus between the electroacupuncture and model groups (P<0.01). The IL-4 content and aggrecan mRNA expression decreased significantly and MMP-3 mRNA expression increased significantly in the model group after model making and there were statistically significant differences compared with the blank group (P<0.01,P<0.05). After treatment, the IL-4 content increased significantly in the needle knife and electroacupuncture groups compared with the model group (P<0.01,P<0.05) and aggrecan mRNA expression tended to increase in the two groups. The regulation of aggrecan mRNA and MMP-3 mRNA expressions was better in the needle knife group than in the electroacupuncture groups, but there was no statistically significant difference compared with the model group (P>0.05).Conclusion The mechanism of action of needle knife treatment on KOA may be that it improves ligament mechanical characteristics, regulates intra-articular stress environment, and modulates aggrecan mRNA and MMP-3 mRNA expressions and inhibits cartilage degeneration through IL-4 mechanical signal pathway, to produce the therapeutic effect of “regulating sinews and treating bones”.

Objective To observe the incidence rate of anaemia and analyze the nutritional situation in the elderly population.Methods From April to August 2010,a total of 2052 elderly persons from out-department of Tianjin First Center Hospital were divided into four age groups:65-69years group (n=528),70-74 years group (n=593),75-79 years group (n=423) and 80 years and over group (n= 508).The body mass index (BMI),haemoglobin (Hb),mean corpuscular volume (MCV),triglyceride (TG),creatinine (Cr),serum albumin (ALB) and ferritin (Fer) were tested and evaluated using K-W test.Results (1) Anaemia was found in 90 subjects (4.4 %),4.0% in men and 6.l% in women,9.5% in 80 years and over group.The subjects with Hb level less than 90g/L were all 80 years and over.(2)There were significant differences among the groups in BMI,TG,Cr,ALB,Hb,MCV and Fer levels (all P＜0.01).There were significant differences among four groups in Hb and ALB levels (P＜0.01 ),and partially differences in TG, Cr and MCV levels (P＜0.05).(3)The Hb level was significantly correlated with TG, ALB, Fer and MCV levels (r=0.115,0.211, 0.114 and 0.089, all P＜0.01 ) from Pearson analysis.Conclusions Anemia incidence in elderly population is increased along with aging and is higher in women than in men, especially higher in 80 years and over group.Nutritional situation gets worse with aging.

Objective To analyze the relevance between the point-of-care testing (POCT) and routine test in BNP testing .Meth-ods The whole blood samples or plasma samples from 40 inpatients were detected brain natriuretic peptide (BNP) by the Alere Triage? MeterPro fluorescence immunoassay analyzer (POCT ) or the Beckman Coulter Access ?2 chemiluminescence analyzer (routine test) ,respectively .The acquired data were subjected to comparative analysis according to the CLCS EP 9-A2 .Results The linear regression of the BNP content in the blood samples detected by POCT and the routine test was good ,the correlation coeffi-cient(r) was 0 .999 7 .Conclusion POCT and the routine test have good correlation in BNP testing .POCT for BNP testing has higher reliability and is applicable for clinical detection .

Objective To compare the clinical efficacy and safety of transurethral plasmakinetic resection of prostate (PKRP) and transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH). Methods Two groups of BPH patients (78 patients in each group) were treated by PKRP and TURP,respectively. The clinical efficacy and safety indices were reviewed and compared for both intra- and inter-groups. Results In PKRP group,the operative time,intraoperative bleeding, the rates of postoperative temporary urinary incontinence (within 2 months) ,secondary hemorrhage (within 4 weeks),and urethral stricture (within 3 months) were ( 64?21) min, ( 247?84) ml, 26. 9% ( 21/78 ) , 1. 3% ( 1/78 ) and 2.6% (2/78) ,respectively; while in TURP group, these parameters were (78?18) min, (432?132) ml, 48.7% (38/78) , 10. 3% (8/78) and 12. 8% ( 10/78 ), respectively; there were significant differences between the 2 groups (P 0. 05). Conclusions PKRP and TURP have similar efficacy in the treatment of BPH,but PKRP is safer than TURP. Thus,PKRP is a better treatment option for BPH.

Objective:To compare the clinical effects of restrictive blood transfusion combined with hyperbaric oxygen preconditioning (HBOPC) and restrictive blood transfusion in the treatment of hip,knee arthroplasty (THA,THA).Methods:40 patients in the period of epidural anesthesia,femoral nerve hysteresis hip and knee arthroplasty were selected and randomly divided into two groups:restrictive transfusion group (maintain 80 g/L≤ Hb ＜100 g/L,n=20) and restrictive blood transfusion combined with HBOPC (HBOPC+maintain 80 g/L =Hb ＜100 g/L,n=20).The red blood cell transfusion,red blood cell transfusion rate,perioperative Hb,blood oxygen saturation (SO2),the incidence of hypotension during operation,hospitalization time and postoperative cerebral infarction,acute pulmonary embolism,pneumonia,myocardial infarction,wound infection rate and 90 days mortality rate were compared between two groups.Results:Compared with the restrictive transfusion group,the postoperative Hb,blood oxygen saturation (SO2) of restrictive blood transfusion combined with HBOPC group were significantly increased(P ＜ 0.05);the red blood cell transfusion,red blood cell transfusion rate,incidence of pneumonia,wound infection rate were significantly decreased (P＜0.05).Conclusion:Restrictive blood transfusion combined with hyperbaric oxygen preconditioning could improve the anoxic state of the hip,knee arthroplasty patients,which could effectively reduce red blood cell transfusion,reduce postoperative complications,has good clinical curative effect.

Objective To improve the differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) by a contrast analysis of imageological features.Methods Thirty-six patients who had postoperative pathological with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC.The imageological results of these AIP and PC patients were analyzed.Results AIP was significantly less than PC in the enhanced CT of a mass or enlargement of the pancreatic head,enlargement of the lymph nodes around the pancreas,dilation and interrupt in pancreatic and bile duct,peripheral vascular and organ involvement (11/27 vs.28/40,2/27 vs.17/40,13/27 vs.32/40,1/27 vs.10/40,8/27 vs.26/40,2/27 vs.15/40,0/27 vs.15/40,0/27 vs.10/40,P ＜ 0.05).AIP was significantly more than PC in the enhanced CT of a diffusely enlarged pancreas,calcification or pancreatic calculus,capsule-like rim or the vague peripancreatic fat interval (4/27 vs.0/40,7/27 vs.0/40,10/27 vs.6/40,P ＜ 0.05).AIP was significantly less than PC in the three-dimensional ultrasonography of dilation diameter of pancreatic duct and dilation of common bile duct [(0.421 ± 0.270) cm vs.(0.594 ± 0.270) cm,1/18 vs.16/26,P＜ 0.05].AIP was significantly less than PC in the magnetic resonance cholangiopancreatography of dilation of common bile duct and interrupt in pancreatic duct (7/13 vs.16/18,1/13 vs.10/18,P ＜ 0.05).Conclusion AIP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive imageological features

Objective To explore the changes of mTOR signaling in LPS/D-gal-induced acute hepatitis in mice . Methods Twenty-six healthy adult female ICR mice were divided into two groups:the control group and experimental group, 13 mice in each group .LPS/D-gal was used to induce acute hepatitis in the mice .The survival of mice was moni-tored within 24 hours after LPS/D-gal challenge .At 6 hours after challenge , samples of serum and liver tissue were collect-ed for further analysis.Results Injection of LPS/D-gal resulted in acute death of the mice within 24 hours.At 6 hours post LPS/D-gal injection , the blood levels of ALT and AST were significantly increased .The mRNA expression of inflammatory cytokines Tnfa and Il6 was up-regulated in LPS/D-gal-induced hapatitis , in which DNA fragmentation and activation of caspase-3 were subsequently observed .Immunoblot analysis showed that both mTOR pathway and NF-κB pathway were ac-tivated.Unexpectedly , inhibition of mTOR signaling could neither decrease the apoptosis in the liver nor increase the sur -vival of mice .Conclusions The results of the present study indicate that mTOR signaling may play pleiotropic roles in the pathogenesis of LPS/D-gal-induced hepatitis .

Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.

Objective To understand the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Methods Taking a survey among the pre-hospital emergency physicians(80 people)and nurses(248 people)by Questionnaire of ethics conflicts during pre-hospital emergeney service,to investigate the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Resulls (8.046±6.990)%of the patients who needed treatments refused to be treated completely,and(14.544±10.558)%of them refused partially.(14.451±14.747)% of the patients who needed ambulance transport refused to be delivered.In the patients who refused treatments and transportation.payment problem accounted for(23.52±19.79)%,(22.22±20.84)%of them did not believe they needed.(5.77±4.47)%of them wished to die,(19.44.4±18.65)%of them were hard to be idenfified.Other reasons accounted for(30.08±25.78)%.(20.31.4±16.66)% of the patients refused the ambulance crews' judge for some state.(29.66.4±24.02)%of the patients who got the pre-hospital emergency service were not necessary to call an ambulance.(22.1 l±19.52)%of the patients' demand conflicted with pre-hospital emergency services network management system.Conclusions There exists some conflicts between the pre-hospital patients and ambulance crews' determinations.