Objective The purpose was focused on discussing the causes of sciatic nerve injury following total hip replacement in order to introduce the methods for protecting sciatic nerve during operation by reviewing 655 consecutive total hip replacement and total hip revision. Methods From January 1998 to December 2001, 655 total hip replacement and total hip revision cases were performed in our hospital, 9 cases of which occurred as sciatic nerve injury postoperatively. There were 8 cases in 587 primary total hip replacements and one case in 68 total hip revisions. The 9 patients included 3 males with 3 hips and 6 females with 6 hips with an average age of 51 years ranging from 35 to 67 years old. In the group, 4 cases were diagnosed as avascular necrosis of femoral head, 2 cases as congenital acetabular dysplasia accompanied with osteoarthritis, 1 case as ankylosing spondylitis, 1 case as rheumatoid arthritis and 1 case as loosening of prosthesis. 8 prosthetic components of the hip were fixed by uncement, and the other one was fixed by cement. Results All of the 9 patients experienced sciatic nerve palsy sooner after operation, 8 cases of which suggested simple injury of common peroneal nerve, and 1 case a combined injury of common peroneal nerve and tibial nerve. Of the 9 cases, 7 cases underwent leg lengthening or soft tissue release because of hip joint stiffness during operation. After six to forty-eight months follow-up, the function of sciatic nerve was recovered completely in eight cases after half a year. The other one received total hip revision was not recovered from sciatic never palsy in six months, and the operation of never incision and exploration was performed. During operation, part of the sciatic nerve was found to become thinner without marked compression and other injury. Then release soft tissue around the injured never, the function of sciatic nerve was partly recovered one year after operation. Conclusion It is concluded that sciatic nerve injury associated with total hip arthroplasty is most commonly caused by over-lengthening the low extremity and mechanical compression. The function of sciatic nerve may be recovered in most patients with incomplete injury.

BACKGROUND: Chronic musculoskeletal pain can cause disability and decreased quality of life of patients. Probing into the therapeutic methods of musculoskeletal disease and choosing proper treatment drugs are important for patients.OBJECTIVE: To evaluate the efficacy and tolerance of controlled-release tramadol in patients with moderate to severe chronic pain of musculoskeletal origin.DESIGN: A self-control study was conducted.SETTING: Arthrtosis Institute, People' s Hospital Affiliated to Peking University.PARTICIPANTS: Patients who were in the Orthopaedic Outpatient Service,People' s Hospital of Peking University were involved. This observational study was conducted in 40 adults who experienced moderate to moderately severe chronic musculoskeletal pain that was not controlled by routine nonsteroidal anti-inflammatory drugs(NSAID) therapy.INTERVENTIONS: Any NSAIDs and other analgesics were prohibited. Patients initially took 50 mg of controlled-release tramadol (Tramcontin) every 12hours, supplemented by every 50 mg if insufficient pain relieved. Recommended daily maximum dose was 400 mg per day. The observation lasted for 4 weeks. The patients were asked for document therapy-relevant data every day and were interviewed every week to doctor assessment.MAIN OUTCOME MEASURES: Pain intensity before and after treatment, pain remission degree, all side effects and their severity.RESULTS: All cases were finished the study and no one withdrew from follow-up. No eligible patients exited from the study because of therapeutic failure or intolerance. In comparison with the initial visual analogue scale (VAS) mean value 6. 80 ± 1.84, the average VAS value at the end of observation was 1.00 ± 1.46, which had significant difference( P ＜ 0. 001) . An average pain reduction of (85. 50±5.35)%was obtained, among which 78% were absolutely and obviously lessened. Side effects were reported in 9cases (22%).Drowsiness and dizziness(6 cases) was the most common, followed by nausea (3 cases), vomiting (1 case), somnolence (2 cases), constipation and urinary retention (1 case) and blurred vision (1 case).CONCLUSION: Tramcontin, as slow-release tramadol, proved to be an effective, safe, and easy-to-use central acting analgesic has an important role in the management of chronic musculoskeletal pain. Light side effect and good tolerance has provided a new choice for treatment of chronic pain in the orthopaedic department.

Objective To investigate the role of N-acetylcysteine as a protective agent in rifampicin-induced hepatic injury of mice. Methods Thirth-two Kunming mice were randomly divided into four groups(n=8 each).The mice in each group were injected intraperitoneally with 0.9% sodium chloride solution (control), N-acetylcysteine (NAC), combination of rifampicin (R), or NAC and R (NAC+R) once every day.After 14 days, the liver index (LI), alanine aminotransferase (ALT) and aspartate aminotransferase ( AST) activity in serum, and the level of malondialdehyde( MDA) ,superoxide dismutase( SOD) activity in liver tissues were measured respectively.Hepatic tissue morphology was observed under light microscope. Results Macroscopic analysis revealed that rifampicin led to severe liver tissue injury,including a wide range of hepatocellular vascular congestion,fatty change and local necrosis, whereas the administrationof NAC produced a significant reduction of rifampicin-induced hepatotoxicity .LI,ALT and AST activities in R or NAC+R group were significantly elevated as compared with the control group(P<0.01) .LI, activities of ALT and AST in serum,and MDA levels in liver tissues in NAC+R group were significantly lower than those in R group ( P<0.01) ,but the SOD activity in NAC+R group was increased significantly in comparison with R group (P<0.01). Conclusion Rifampicin was able to cause severe hepatic injury.Pre-administration of NAC reduced the side-effect induced by the treatment with the rifampicin.

We investigate the different expression of toxin gene mazF3,6,9 and antitoxin gene mazE3,6,9 in the drug-resistance Mycobacterium tuberculosis,we used quantitative real-time polymerase chin reaction method to detect the expression level of toxin gene mazF3,6,9 and antitoxin gene mazE3,6,9 in M.tuberculosis (20 mono-resistance strains,20 multidrug resistance strains and standard strain H37Rv).The differences of gene expression levels between groups were analyzed by oneway ANOVA.Contrasting with control group,toxin genes mazF6,9 were up-regulated expression levels both in mono-resistance (11.1519±22.31721;8.4306±17.97897) and multidrug resistance (4.6016±1.29018;6.9627±6.92948),had statistical significance (P＜0.01),mazF3 expression levels had statistical significance neither in mono-resistance nor in multidrug resistance (P＞0.05);antitoxin genes mazE3 was in down-expression level,and had statistical significance both in mono-resistance (0.3606±0.12527) and multidrug resistance (0.2016±0.16542) (P＜0.01),mazE6 had no statistical significance (P＞0.05)either in mono-resistance or multi drug resistance,mazE9 only in multidrug resistance(0.3989±0.37679) was in downexpression level,and has statistical significance (P＜0.001).The toxin gene mazF6,9 and antitoxin gene mazE3,9 may participate in the drug-resistance formation of M.tuberculosis.

Objective To discuss the Clinical character of pulmonary tuberculosis combined malignant lymphoma and its Pathogenesis,and to review the literature.Methods Eighteen cases of pulmonary tuberculosis combined malignant lymphoma from 1996 to 2003 were retrospectively analyzed by its clinical manifestations,X-ray features,diagnosis and treatments.Results 18 cases were all infiltrative pulmonary tuberculosis,13 them were calcification focals,5 were active pulmonary tuberculosis;5 of all were Hodgkin’s lymphomas,13 of all were non-Hodgkin′s lymphomas.16 cases were lymphomas after tuberculosis,2 cases tuberculosis after lymphomas,none were co-existent malignant lymphoma and tuberculosis.Tuberculosis may precede or complicate a lymphomatous process during the development of both diseases,This might is linked to immune deficiency and chronic inflammation;Lymphomas might cause pulmonary tuberculosis,it might cause the immune turbulence of an individual,Pulmonary tuberculosis infection occurring during or after the radiotherapy and chemotherapy of lymphoma.Conclusions It may pulmonary tuberculosis combined malignant lymphoma in the patients in the endemic areas of tuberculosis,Appropriate invasive biopsy procedures are necessary for early diagnosis.

Aim To study the effects of polyamine analogue CPENSpm on the human lung cancer line A549 in cell proliferation and apoptosis.Methods MTS was used to assay the cell proliferation,chemical analysis methods were used to determine the activities of enzymes in the polyamine metabolism,HPLC was performed to assay the intracellular concentration of polyamines,Sub-G1 and DNA fragmentation assays were used to determine the cell apoptosis.Results Treating A549 lung cancer cells by CPENSpm resulted in:①cell-growth inhibition and cell apoptosis;②inhibition of ODC(key enzyme in polyamine synthetic pathway)and activation of SSAT and SMO(key enzymes in polyamine catabolism);③great decrease of intracellular polyamine concentrations.MDL72527,the SMO inhibitor,can antagonize the effect of CPENSpm on inhibiting the proliferation of A549 cells.Conclusion CPENSpm inhibits proliferation and induces apoptosis of human A549 lung cancer cell line by interfering the polyamine metabolism,depleting intracellular polyamine contents that are need by quick-growth of cancer cells and inducing production of H2O2.

Objective A retrospective analysis was conducted on 1 202 cases of total knee replacements (TKR) during the periord of 14 years, in order to study the special clinical features of the patients and their knee deformities, with the final purpose of finding the appropriate methods for the management. Methods From April 1987 to Augest 2001, 1202 cases of total knee arthroplasty were performed for 833 patients. There were 464 unilateral TKRs in 464 patients, and 738 bilateral TKRs in 369 patients. The diagnosis of the clincal conditions were osteoarthritis (include synovial chondromatosis and kaschin beck disease), rheumatoid arthritis, ankylosing spondylitis, also included were some rare rheumatic diseases of the knee such as pigmented villonodular synovitis, tuberculous arthritis, Charcot arthritis, hemophilic arthritis and psoriatic arthritis. Patients in this series also had several kinds of severe deformities such as genu varus with dislocation or medial plateau defect, genu valgus, flexion contracture of the knee, flexion deformity with joint fusion, flexion joint fusion with subluxation, and deformity in the low extremities involving multiple joints in patients with JRA. Results Some severe deformities were considered as contraindication of surfacing total knee replacement, however the life quality of patients had significant improvement after operations. Through the improvement of surgical skill, the complications following TKR in severe knee flexion deformity are less in number than that happened in the early days. Conclusion 1) TKR in China at the moment is facing more challenges and difficulties than that in the developed countries. 2)The proper types of prosthesis should be selected beforehand in order to get the good result. 3) Physical therapy is very important in the rehabilitation following TKR, so that the establishment of full time rehabilitation team is mandatory. 4)The key point for promoting TKR treatment for patients with various knee disease is to develop homemade prosthesis in China. [

Objective To explore the techniq ue and clinical result of total knee replacement in flex-ion ankylosed knee.Me thods From December1987to December2000,30TKRs in16patients were per formed by means of medial parapatellar approach,secondary osteotomy and soft tissue balance for knees with bony ankylosis in flexion position.At the same t ime,an appropriate technique was adopted to excise the patella-femoral joint while the femoral-tibial joint was ankylosed,so that the bone distribution an d the ori-entation of joint line were made appropriately to facilitate implan t prostheses.By measuring the range of mo-tion(ROM)and HSS score system ,the effects of this operative methods and the procedure of osteoto my were evaluated.In this group,there were12males and4females.The average age at s urgery was33.6years old(range,20to69years).All knees were fixed at a n average of 46.5?(range,15?to95?),with ROM of 0?.HSS scores w ere in average of 31.4points(16to47points).Of the16cases,14cases underwent bilat-eral TKRs,and2cases unilateral TKR.Results In the present series,the operative time lasted for 1.6hours(range,1.2to2.1h)ther e were3cases suffering from paralysis of unilateral common peroneal nerve for half a year,there was no other complication happened in this group.The mean f ollow-up was67.1months(range,1to14years),the average ROM of knee wa s72.5?(range,60?to100?),lack of full ex ten sion(ex-tension l ag)was7.8?(range,0?to15?).HSS of knee joint was average78.7p oints(range,71to89points),Comparing with the pre-operation,there was i mprovement of 47.3scores.Conclusion Al though it is more difficult to perf orm TKRS in bony ankylosed knee than in those without ankylosis,how ever,by using tech niques of medial parapatellar approach,secondary osteotomy,soft ti ssue balance and the appropriate way to ex cise patellar-femoral joint and fem ur-tibial joint which were naturally ankylosed,the ankylosed knee defor mi ti es could be corrected successfully,and TKR is also possible to improve the func tion of knee and life quali ty in these patients significantly.

Objective To evaluate the role of β-arrestin-1 in penehyclidine hydrochloride (PHC)-induced inhibition of lipopolysaccharide (LPS)-caused increase in pulmonary microvascular permeability in human pulmonary microvascular endothelial cells (PMVECs).Methods Human PMVECs were seeded in 6-well plates (2 ml/well) or in culture flasks (4 ml/flask) at the density of 1 × 105 cells/ml and divided into 5 groups (n=15 each) using a random number table:empty plasmid transfection group (group C),LPS plus empty plasmid transfection group (LPS group),PHC plus LPS plus empty plasmid transfection group (P+LPS group),LPS plus β-arrestin-1 short hairpin RNA (shRNA) transfection group (LPS+shRNA group) and PHC plus LPS plus β-arrestin-1 shRNA transfection group (P+LPS+shRNA group).In LPS and LPS+shRNA groups,the cells were transfected with empty plasmid 1.5 μg or with plasmid containing 15 nmol/L β-arrestin-1 shRNA,LPS with the final concentration of 0.1 μg/ml was added at 24 h of incubation,and the cells were then incubated for 1 h.In P+LPS and P+LPS+shRNA groups,the cells were transfected with empty plasmid 1.5 μg or with plasmid containing 15 nmol/L β-arrestin-1 shRNA,PHC with the final concentration of 2 μg/ml was added at 24 h of incubation,LPS with the final concentration of 0.1 μg/ml was added at 1 h of incubation,and the cells were then incubated for 1 h.The cell permeability was measured using Transwell chambers.The expression of heat shock protein (HSP27) was detected by immunofluorescence.The expression of β-arrestin-1,p38 mitogen-activated protein kinase (p38MAPK) and phosphorylated p38MAPK (p-p38MAPK) was detected by Western blot.The ratio of pp38MAPK/p38MAPK was calculated.Results Compared with group C,the cell permeability was significantly increased,the expression of HSP27 was up-regulated,p-p38MAPK/p38MAPK ratio was increased,and the expression of β-arrestin-1 was down-regulated in LPS,LPS + shRNA and P + LPS + shRNA groups (P＜0.05),and no significant change was found in the parameters mentioned above in group P+LPS (P＞ 0.05).Compared with group LPS,the cell permeability was significantly decreased,the expression of HSP27 was down-regulated,p-p38MAPK/p38MAPK ratio was decreased,and the expression of β-arrestin1 was up-regulated in group P +LPS,and p-p38MAPK/p38MAPK ratio was significantly increased (P＜0.05),and no significant change was found in the other parameters in group P+LPS+shRNA (P＞0.05).Compared with group P+LPS,the cell permeability was significantly increased,the expression of HSP27 was up-regulated,p-p38MAPK/p38MAPK ratio was increased,and the expression of β-arrestin-1 was down-regulated in group P+LPS+shRNA (P＜0.05).Conclusion The mechanism by which PHC inhibits LPS-induced increase in pulmonary microvascular permeability is totally related to β-arrestin-1 in human PMVECs.

Objective To investigate the clinical efficacy of Dahuang Xiaozhi Suppository combined with tetracycline in treating type Ⅲ prostatitis infected with nano-bacteria. Methods Totally 120 patients of type Ⅲprostatitis infected with nano-bacteria were randomly divided into treatment group and control group, with 60 cases in each group. Both groups were disabled anti-infective drugs and other preparations for diet and life intervention. Both groups received tetracycline, once a tablet, twice a day, orally. The treatment group received Dahuang Xiaozhi Suppository, once a capsule, once a day, placing in the anus 3-4 cm. 10 d was a treatment course, for 3 courses. The clinical efficacy, major symptoms improving time, NIH-CPSI, leukocyte count and ecithin corpuscles in expressed prostatic secretion (EPS), urinary flow rate, and cytokine content of TNF-α, IL-6, IL-8, were evaluated. Results The total effective rate was 100.0% (60/60) in treatment group and 83.3% (50/60) in the control group, and treatment group was higher than the control group (P<0.05). Pelvic pain, urinary symptom, and scrotum wet improvement time of treatment group were lower than the control group (P<0.05). Compared with before the treatment, the NIH-CPSI pain scores, urinary symptom scores, life quality score, leukocyte count and TNF-α, IL-6, IL-8 content of EPS in both groups were significantly lower after treatment (P<0.05), and the cases with lecithin corpuscles +++ - ++++ in both groups significantly increased after treatment (P<0.05). The urinary peak flow rate and mean flow rate in both groups were higher after treatment (P<0.05). There was statistical significance in the scores of NIH-CPSI pain, urinary symptom and life quality, leukocyte count and TNF-α, IL-6, IL-8 content of EPS, and the cases with lecithin corpuscles ++++ between the two groups (P<0.05). Conclusion Dahuang Xiaozhi Suppository can improve the efficacy of treating type Ⅲ prostatitis infected with nano-bacteria. Combining Dahuang Xiaozhi Suppository with tetracycline can reduce prostate inflammation, with obvious efficacy.