Objective To report our early experience for treatment of infected total knee arthroplasty (TKA) using antibiotic-loaded articulating cement spacer. Methods From June 2004 to April 2005, 5 patients with periprosthetic knee infection were treated with 2-stage reimplantation protocol. The study group included 1 male and 4 females, with average age of 67 years(range, 57-75 years). The initial procedure consisted of thorough debridement, removal of prosthesis and implantation of antibiotic-loaded articulating cement spacer. The postoperative course consisted of graduated knee motion and partial weight-bearing activity. Each patient received a 6-week course of organism-sensitive antibiotic therapy. The high restricted total knee prosthesis was reimplanted after infection controlled. Results 3 patients had a basic diagnosis of rheumatoid arthritis and two of them took steroid for a long time. The other two patients suffered from osteoarthritis before primary TKA were both with diabetes. Sinuses were emerged in all of 5 patients and blockage phenomenon was found in two of them. There were no cases of fracture, dislocation, or instability associated with articulating cement spacer. The average time between the two stages was 15 weeks. All 5 patients were able to ambulate with assistance and flex the knee without difficulty in the interval before reimplantation. The average knee flexion was 95? and the average knee society score(KSS) was 81 points. A mean ten months follow-up was evaluated after reimplantation. There were no recurrence, or new infections after reimplantation. Conclusion Infection after a TKA can be successfully managed with an antibiotic-loaded articulating cement spacer and knee motion can be preserved in the interval prior to implantation. The end result is effective treatment of infection and facilitation of reimplantation.

Mother-to-child transmission (MTCT)is an important way of hepatitis B virus (HBV)transmission.Blocking the HBV MTCT has a great significance for the prevention and treatment of hepatitis B.This article reviews the current blocking strategies implemented in the antepar-tum,peripartum,and postpartum stages,and summarizes the controversies existing in the blocking strategies in different stages.The significance of HBV occult infection and germ cell transmission in the HBV MTCT is analyzed.The results indicate that the current strategies for the prevention of hepatitis B MTCT need further improvement.Attentions should be focused on HBV occult infection and germ cell transmission.

Objective To explore the relationship between the HBV‐DNA ,ALT ,AST and NO ,iNOS ,SOD levels in serum of patients with chronic hepatitis B(CHB) .Methods 24 patients with mild CHB ,30 patients with moderate CHB ,18 patients with se‐vere CHB and 30 healthy individuals were selected and set in group A ,B ,C and D ,respectively .The serum levels of HBV‐DNA , ALT ,AST ,NO ,iNOS ,and SOD were detected by FQ‐PCR and chemical analysis respectively .Results There were significant difference in the levels of ALT ,AST ,NO ,iNOS and SOD between group D and group A ,B and C (P<0 .05) .The serum level of ALT was positive relative to the levels of NO and iNOS(r=0 .487 ,0 .521 ,P<0 .05) ,and was negative relative to the level of SOD (r= -0 .574 ,P<0 .05) .The serum level of AST was positive relative to the levels of NO and iNOS(r=0 .453 ,0 .545 ,P<0 .05) , and was negative relative to the level of SOD(r= -0 .484 ,P<0 .05) .Conclusion With the increase of ALT and AST levels ,the levels of NO and iNOS increase ,and the level of SOD decreases simultaneously in CHB patients .It is suggested hepatocellular inju‐ry .

Objective To report the medium-term follow-up results for deep venous thrombosis(DVT) after total knee arthroplasty(TKA).Methods Between July 2003 and March 2004,55 patients(63 knees)who had had TKA were followed up for DVT.In follow-ups 1 to 2 weeks after TKA,their clinic symptoms,Doppler ultrasonograms and venograms were analyzed.In the following out-patient follow-ups done at every six months,we observed their clinic symptoms and Doppler uhrasonograms for the operated lower extremity.Venography was done only for those who had severe DVT symptoms.Results The venography one week after TKA conformed that DVT occurred in 34 patients(41 knees,61.8%).Two weeks after operation,DVT vanished in 12 cases,but deterio- rated to the proximal part in two cases.The follow-ups averaged 36.6 months(range,32 to 40 months).The results at five time points showed that the incidence of DVT did no decrease with lapse of time(P＞0.05).Conclusion No matter whether DVT occurs in the perioperative period,incidence of DVT in the medium term varies little.

OBJECTIVE:To observe the therapeutic effect of Shenfu Injection in combination of rougui for oxaliplatin-induced neurotoxicity.METHODS:A total of 73 cases with malignant tumor were randomly divided into control group and treatment group:the control group was treated with chemotherapy alone,in which oxaliplatin was included;the treatment group was treated intravenously with Shenfu Injection 40～60ml for 7～10d plus orally with 3g Rougui decoction prior to chemothera_py.RESULTS:Incidences of neurotoxicity for the treatment group and the control group were 13.5% and 55.6%,respectively.Significant differences were noted between 2 groups(P

OBJECTIVE: To evaluate the curative effect and clinical significance of bone cement on coagulation functions during percutaneous vertebroplasty in patients with osteoporotic spinal compression fractures.METHODS: A total of 24 patients, comprising 18 females and 6 males, aged 69 years averagely (range 48-83 years), with 44 osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty in Department of Spinal Surgery, Third Hospital of Hebei Medical University between December 2006 and December 2007. The fracture segment was within T_5-L_3 (20 thoracic vertebrae and 24 lumbar vertebrae). Under the guidance of C-arm fluoroscopy, bone marrow biopsy needle was inserted percutaneously via transpedicular way into the fractured vertebrae. Polymethylmethacrylate (PMMA, bone cement) was injected into the fractured vertebrae. The relative parameters were observed in all patients 10 minutes before, 10 minutes, 30 minutes, 1 hour, 2 hours and 3 hours after bone cement implantation, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), plasma protamine paracoagulation test (3P test), and D-dipolymer (D-D). RESULTS: PT was decreased, and FIB, 3P test, D-D were increased 10 minutes after bone cement implantation in percutaneous vertebroplasty peaked at 1 hour and gradually decreased afterward; moreover, there were significant difference between bone cement preimplantation and 10 minutes, 30 minutes, 1 hour, 2 hours and 3 hours after bone cement implantation (P < 0.05), but no difference was observed in APTT and TT (P > 0.05). The influence of bone cement on the parameters was vanished in 3 hours after bone cement implantation, and all indexes were similar to pre-implantation (P > 0.05).CONCLUSION: Bone cement implantation causes temporal hypercoagulabale state in percutaneous vertebroplasty. It is important to monitor blood clotting state in 3 hours after bone cement implantation in order to avoid thrombus disease.

Objective To study the clinicopathological characteristics and immunophenotype of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods Retrospective analysis was performed for the clinical materials,pathological features and immunohistochemical phenotype characteristics of the 23 SPN cases.Results Ratio of male to female was 1:10;the average age was 32 years.10(43％) patients had no clinical symptoms,12 (52％) patients had abdominal pain,abdominal distention or diarrhea;1 patient had jaundice.Tumors were in the head of pancreas in 10(43％) cases,and were in the tail or body of pancreas in 13 cases.Grossly,tumors were solid-cystic or solid;the maximum diameter were from 1.3 cm to 17 cm,with the average of 5.9 cm;12 (52％) cases appeared encapsulated.Histopathologically,21 (91％) cases appeared to exhibit a fibrous capsule surrounding the tumors,and the fibrous capsule invasion were observed in all these cases;Pancreas tissues were involved in 8(35％) cases.Tumor cells arranged in sheets,nests and pseudopapillary patterns.Hemorrhage,necrosis and cystic degeneration were often seen.Tumor cells were positive for vimentin,β-catenin,CK,CD10,PR,CD56 and Syn.Tumor were mostly negative for CgA and Ki-67.23 cases were followed up for 2 to 44 months,and all were alive.Conclusion SPN is a low degree malignant tumor often seen in young women with various histological patterns and multiple immunophenotypes.Definite diagnosis of SPN can be made by combining clinicopathological characteristics with a panel of immunohistochemicat marks.SPN grows slowly,often responds to surgical resection and rarely recur.

Objective To investigate the macrophages (Mφ) phenotype mechanism in acute kidney injury caused by severe acute pancreatitis (SAP).Methods Sixty-four male Wistar rats were randomly divided into control group (SO) and SAP group (n =32 in each group).SAP rat model was made by retrograde cholangiopancreatic injection of 5％ sodium taurocholate.At 2,6,12 and 24 h after modeling,the samples of blood and kidney tissue were collected.The levels of blood urea nitrogen (BUN) and creatinine (Cr) were detected by using automatic biochemical analyzer.The expressions of IL-12,TNF-α,IL-10 and TGF-β mRNA of kidney tissue were detected by fluorescence quantitative polymerase chain reaction (QRT-PCR).The levels of CD68,iNOS and Arg-1 were measured by Western blot.Results In the SAP group at each interval,BUN and Cr concentrations were significantly higher than those of the control group (P ＜ 0.01,P ＜ 0.05) ; Compared with the control group,the expressions of IL-12,TNF-α,IL-10 and TGF-β mRNA in renal tissue of SAP group were significantly higher (P ＜ 0.01,P ＜ 0.05).In the SAP group,the levels of CD68,iNOS and Arg-1 were higher than those in the control group.Conclusions Inflammation and inflammatory imbalances may be pathological factors of acute kidney injury following SAP.

Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

OBJECTIVE To investigate the bacterial resistance of clinical isolates from pediatric hospital for the guidance of rational use of antibiotics.METHODS Disc diffusion test(Kirby-Bauer method) was used to study the antimicrobial resistance(fastidious bacteria were detected by E test).WHONET5 was applied for analysis.(RESULTS) In the period of study from 2002 to 2003,2 303 strains which were the first isolated from each patient were collected.Of 2 303 clinical isolates,Gram positive organisms accounted for 29.7%,Gram negative ones for 70.3%.Escherichia coli,Klebsiella spp,Staphylococcus aureus,coagulase-negative staphylococci and Pseudomonas aeruginosa were the most common strains among the isolates.Meticillin-resistant S.aureus(MRSA) and meticillin-resistant coagulase(-negative) staphylococci(MRCNS) accounted for 9.7% and 67.6% of S.aureus and coagulase-negative(staphylococci),respectively.Resistant rates of MRSA and MRCNS were higher than that of meticillin-susceptible S.aureus(MSSA) and meticillin-susceptible coagulase-negative staphylococci(MSCNS) to antimicrobial agents commonly used in clinic.No vancomycin resistant strains of staphylococci were found. 4.1% of Enterococcus spp were vancomycin resistant strains.Resistant rate of Streptococcus pneumoniae was 11.9% to penicillin. Most of isolates of Enterobacteriaceae were susceptible to imipenem.The incidences of E.coli and Klebsiella spp producing extended spectrum beta-lactamases(ESBLs) isolates were 49.7% and 63.1%,respectively.The resistance rates of(ESBLs) producing strains to antimicrobial agents(except carbapenems) were higher than those of ESBLs nonproducing ones.CONCLUSIONS Bacterial resistance is still or even a more serious clinical problem than before.The(surveillance) of antimicrobial susceptibility in pediatric hospital is of great significance.It is also very important to promote the rational use of antimicrobial agents so that resistance is minimized and take effective strategy for the control of the problem.