BACKGROUND:Periprosthetic femoral fracture after total knee arthroplasty is related with the osteoporosis, bone defects, prosthesis, frail patients and high complication rate, so it is difficult to prevent and treat.
OBJECTIVE:To explore the risk factor, classification, treatment, rehabilitation and prophylaxis of periprosthetic femoral fracture after total knee arthroplasty based on the reviewed and summarized articles published in recent years.
METHODS:A computer-based online search was conducted in PubMed database from January 1, 1990 to December 31, 2011 and in SpringerLink database from 1980 to 2011 for the related articles with the key words of“periprosthetic fracture, knee”in English. A total of 626 articles were retrieved.
RESULTS AND CONCLUSION:According to inclusion and exclusion criteria, the articles were screened and 40 articles were included final y. The results showed that with the extensive development of total knee arthroplasty, the incidence of periprosthetic femoral fracture was increased gradual y;due to the poor prognosis, we should pay attention to the prevention. The risk factors of periprosthetic femoral fracture included patients’ internal factor that was hard to control, and some external factors such as the surgical techniques. Rorabeck classification was commonly applied for periprosthetic femoral fracture after total knee arthroplasty, but it was not perfect in clinical application. Kim classification wil be better for clinical guidance. The treatment of periprosthetic femoral fracture included nonoperative treatment, open reduction and internal fixation, retrograde intramedul ary nailing and revision arthroplasty. An appropriate treatment is chosen depending on fracture classification, local bone quality, patients’ medical and nutritional status. At present, however, there is not a perfect guideline for the selection of appropriate treatment method. But the early functional exercise is beneficial to prevent the related complications caused by longtime immobilization and the loss of joint function. Therefore, the indications must be under strict control in the treatment of periprosthetic femoral fracture after total knee arthroplasty. Except the firm fixation, early exercise for the patients should be encouraged at the same time.

Objective To investigate the changes and roles of hypoxia inducible factor 1?(HIF 1?) expression in myocardial tissues in rats following severe scald. Methods Male Wistar rats inflicted with 40% TBSA Ⅲ degree scald were used as animal models. HIF 1? protein in myocardial tissues was detected by Western blot and immunohistochemical technique. Results HIF 1? protein expression in rat myocardial tissues increased significantly in the early stage following scald. The difference in HIF 1? level between the left and right ventricles was significant. The increased HIF 1? protein was mainly located in the nucleus. Conclusion HIF 1? protein expression in myocardial tissues of rats can be induced by severe scald and HIF 1? protein expression in the left ventricle is significantly higher than that in the right ventricle. The increased HIF 1? protein in the nucleus can induce downstream cytokine expression.

OBJECTIVE: To investigated influence of co-stimulatory signal produced by CD40/CD40 ligand (CD40L) on proliferation and differentiation of leukemic stem cells and B cells as well as the role of CD40L anti-leukemia.DATA SOURCES: We searched Pubmed database and Springer database for the related literatures on CD40/40L, leukemic stem cell and leukemia published from January 1995 to December 2005, using the keyword "CD40, 40L, leukemic stem cell, leukemia" in English.STUDY SELECTION: We focused on published data that included the literatures of experimental groups and control groups, excluded obviously no random experiments, no random clinical studies and repeated researches.DATA EXTRACTION: We collected 30 experimental articles on influence of co-stimulatory signal produced by CD40/CD40L on proliferation and differentiation of leukemic stem cells and B cells as well as the role of CD40L anti-leukemia. Twenty-three articles that met inclusion criteria, excluded 7 articles were the same research ones.DATA SYNTHESIS: Twenty-three trials included influence of co-stimulatory signal produced by CD40/CD40L on proliferation and differentiation of leukemic stem cells, B cells and prognosis of leukemia, and the treatment of leukemic patients by CD40L. We analyzed the influence and role of co-stimulatory signal produced by CD40/CD40L on proliferation and differentiation of leukemic stem cells, B cells and leukemia.CONCLUSION: The evidence conformed that co-stimulatory signal produced by CD40/CD40L promoted proliferation and differentiation of leukemic stem cells , B cells, and it is important for the occurrence,progress and prognosis of leukemia. CD40/CD40L plays a crucial part in immune response, and proves wide application in the immune therapy of leukemia.

Objective To investigate the protective effect of glycine (Gly) on hypoxic injury to murine cardiomyocytes and the mechanisms. Methods The survival rate of cardiomyocyte survival was detected by trypan blue exclusion and lactate dehydrogenase (LDH) with an ultraviolet spectrophotometer. Ca 2+ changes in the cardiomyocytes were detected by laser confocal microscopy. Results Glycine markedly improved the survival rate of cardiomyocytes and decreased the release of LDH in cardiomyocytes after hypoxia. The protective effect was in a dose-dependent manner. Glycine could also block calcium overload after hypoxia. Conclusion Glycine has the protective effect on cardiomyocytes through the improvement of survival rate, decrease of LDH release, and blockage of calcium overload after hypoxia.

Dendritic cells(DCs),representing a heterogenous population of professional antigen-presenting cells,are the initiators and modulators of the immune responses.Studies indicate that regulatory T cells contribute to immune nullipotency and immune suppression via cell-cell contact or cytokine secretion.These two kinds of cells may be valuable tools for modulating immunity in the setting of autoimmunity,cancer,chronic viral infections and graft rejection,etc.Here we discuss the current knowledge on the functions of regulatory T cells and denditic cells-based immunoregulation and the applications.

Objective:To investigate the risk factors for refeeding syndrome (RFS) in patients with severe stroke.Methods:Patients with stroke admitted to the Neuro Intensive Care Unit, Nanfang Hospital, Southern Medical University and received enteral nutrition support >72 h from January 2013 to July 2019 were enrolled retrospectively. RFS was defined as a new onset of hypophosphatemia within 72 h after the start of nutritional support, that is, blood phosphorus <0.65 mmol/L and a decrease of >0.16 mmol/L from the baseline value. The independent risk factors for RFS were identified by multivariate logistic regression model. Results:A total of 209 patients with severe stroke were included, with a median age of 65 years (interquartile range [ IQR] 53 to 72 years), and 154 were males (73.7%); 136 patients had cerebral infarction (65.1%), 73 had intracerebral hemorrhage (34.9%). The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 15 ( IQR, 11-20), the median Glasgow Coma Scale score was 9 ( IQR, 6-12), the median Acute Physiology and Chronic Health Score was 16 ( IQR, 11-20), the median Nutrition Risk in Critically Ill (NUTRIC) score was 3 ( IQR 2-5), and the median Sequential Organ Failure Assessment (SOFA) score was 4 ( IQR, 3-6); the baseline median serum phosphorus was 1.05 mmol/L ( IQR, 0.90-1.19 mmol/L). A total of 34 patients (16.3%) developed RFS. Multivariate logistic regression analysis showed that male (odds ratio 3.565, 95% confidence interval 1.150-11.053; P=0.028) and patients with higher SOFA score (odds ratio 1.246, 95% confidence interval 1.077-1.442; P=0.032) were more likely to develop RFS. Conclusions:RFS is not rare in patients with severe stroke. Males and patients with severe disease are more likely to develop RFS.

Objective To discuss the effects of two different fluid resuscitation methods on early resuscitation and clinical prognosis in traumatic shock patients. Methods One hundred and twenty-six patients were treated with two different fluid resuscitation methods in traumatic shock (TS). These patients were randomly divided into 2 groups according to the strategy: the conventional resuscitation group (conventional group, 66 cases), the hypertouic saline solution resuscitation group (hypertonic saline group, 60 cases).The heart rate, blood pressure, breath, blood Na+ ,blood Cl-, the original thrombin time before and after the resuscitation and the syndrome were observed and analyzed. Results The input in the conventional group was (3000±500) mL, in the hypertonic saline group was (2000±200) mL. The difference of the input between the two groups was significant (P < 0. 05). The difference of the heart rate, blood pressure,breath, and the original thrombin time before and after half hour to one hour of the resuscitation in the two groups was not significant (P<0.05). The difference of the blood NA+, blood CL- and the original thrombin time before and after half hour to one hour of the resuscitation in the two groups was not significant (P <0. 05). The difference of the ARDS incidence, MODS incidence, cure rate and death rate from onset of the diseases to hospitalization in the two groups was significant (P <0. 05). Conclusions The fluid resuscitation strategy with hypertonic saline in early period of traumatic shock is efficient, which can work well with low fluid quantity, enhance blood pressure in short time, improve breath quality, save time for the operation of the primary injury, heighten the resuscitation rate, decrease the syndrome incidences and the death rate. The early fluid resuscitation strategy is worthy of clinical application and popularization.

Objective Based the previous studies, the present study was performed to investigate the antagonistic effects of different doses of Astragaloside IV on the immune function of Treg mediated by HMGB1 in vitro and its potential mechanism.Methods CD4+CD25-T cells isolated from the spleens of male BABL/c mice by magnetic beads were seeded on 48-well cell culture plates and were randomly divided into four groups as follows(12 holes per group). Normal control group: CD4+CD25-T cells were cultured merely. Treg group: Tregs(100μl) and CD4+CD25-T cells were co-cultured in ratio of 1:10. HMGB1+Treg group: Tregs(100μl) stimulated by HMGB1(1μg/ml) for 72 h and CD4+CD25-T cells were co-cultured in ratio of 1∶10. HMGB1+AST IV+Treg group: Tregs(100μl) stimulated by HMGB1(1μg/ml) and AST IV(100μg/ml)for 72 h were co-cultured with CD4+CD25-T cells in ratio of 1:10. CD4+CD25-T cells and supernatants were again collected on post-culture 72 hour. The proliferation of CD4+CD25- T cells was analyzed by MTT test, the activity of NFAT and the contents of cytokines of IL-2 released into supernatants were also determined by means of ELISA. Results When CD4+CD25-T cells were co-cultured with Tregs, the cell proliferation(0.166±0.039) and the levels of NFAT(0.156±0.035) and IL-2(2.38±0.58) in supernatant were markedly decreased as compared with those in the control group(P<0.01). However, the contrary results were found when CD4+CD25-T cells were co-cultured with Treg stimulated by HMGB1. Compared with those in the(HMGB1+Treg) group, the contrary results were showed with a dose-dependent in the(HMGB1+ASTⅣ+Treg) group.Conclusion ASTⅣcan rivalry the effects of HMGB1 on immune function of Treg in vitro, this result indicate that ASTⅣhas the therapeutic action on inflammation promoted by HMGB1.

To investigate the effect of Yisui Jiedu Recipe (YSJDR), a compound traditional Chinese herbal medicine, on cytokines and their corresponding just another kinase 2-signal transducers and activators of transcription 5 (JAK2-STAT5) signal transduction pathway in bone marrow hematopoietic cells from patients with myelodysplastic syndrome-refractory anemia (MDS-RA).

Objective To evaluate the radiation dose to patients using radial and femoral artery access in coronary angiography (CAG) and intracoronary stenting (IS) ,provide basis for clinical intervention path .Methods The data of 190 samples (43 by femo-ral and 147 by radial) underwent CAG and 54 samples (17 by femoral and 37 by radial) underwent CAG+IS were analyzed retro-spectively .All samples were divided into two groups (radial group and femoral group) by different approach ,and radiation dose in different approach were analyzed .Results There was no significant difference of Dose Area Product (DAP) and Cumulative Dose (CD) using femoral and radial access in CAG (P>0 .05) .Separating two samples which CD were much higher than others ,the mean DAP was 23 .93 Gy · cm2 and the mean CD was 358 .85 mGy using radial vs .27 .06 Gy · cm2 and 369 .57 mGy using femoral , not distinctive either(P=0 .734 ,P=0 .834) .In CAG+IS ,the mean DAP was 82 .64 Gy · cm2 using radial and it was 78 .11 Gy · cm2 using femoral ,and the mean CD was 1 286 .41 mGy using radial and it was 1 267 .76 mGy using femoral .There were no signifi-cant difference in both DAP and CD (P=0 .705 ,P= 0 .919) .Conclusion The radiation dose of DAP and CD were not different when using radial access and using femoral access in CAG and CAG +IS .