BACKGROUND: Bone joint immobilization is often used to prevent the injured tissue from secondary injury.OBJECTIVE: To investigate the effects of knee immobilization on biomechanical changes in rabbit patellar tendon and ultrastructure morphology. METHODS: Twenty adult rabbits were assigned into two groups. The left hindlimbs of rabbits in the immobilized group (n = 10) were immobilized by plaster of paris and two adjustable aluminium splints for 6 weeks, while those left hindlimbs in the control group (n = 10) served as controls. Rabbit knees were immobilized in extension and the ankle was immobilized at 90°flexion for 6 weeks. Then the patellar tendon-bone complex was harvested to observe the biomechanical properties and ultrastructure changes of patellar tendon. RESULTS AND CONCLUSION: After 6-week immobilization, the tensile strength and tangent modulus of patellar tendon-bone complex were decreased to 64.44% and 53.08% of the control values (P < 0.01). However, there was no significant difference in the elongation at failure and the maximum load between the immobilized and control groups. The curves of stress and strain of patellar tendon based on the average material constant were greatly different. The cross-sectional area of patellar tendon was significantly larger in the immobilized group than in the control group (P < 0.01). Smaller collagen fibrils took the predominance in the immobilized group. These results showed that immobilization of knee joint could result in biomechanical changes of patellar tendon and produce influence on patellar tendon.

[Objective] To explore the causing and prevention factors of peroneal nerve injury after total knee arthroplasty(TKA).[Method] Nine postoperative peroneal-nerve injury in 9 patients were documented in a retrospective review of 2000 consecutive total knee arthroplasties performed at one institution from Jan.1996 to Jun.2007.Six fresh cadaver knees were executed TKA to observe the causing factors of peroneal nerve injury in operation.[Result]The causing factors of the 9(0.45%)patients were not clear.Cadaver knees TKA suggested the dangerous handlings by turns include the belows:①lifting distal femur by encircle dragging may enhance lesion probability of common peroneal nerve.②risk for common peroneal nerve to set Hoffman crook not paralleling longitudinal axis of tibia or posterior the lateral collateral ligament.③excessive straightening knee joint after the prosthesis had been fixed.[Conclusion]Lifting distal femur by encircle dragging should be avoided while peeling posterolateral joint caps and caput laterale musculi gastrocnemii.The location,inserting orientation and depth of Hoffman crook should be taken care of.Hyperextension of the knee should be avoided.

Objective To evaluate the indications and clinical efficacy of the different surgical methods for lumbosacral tuberculosis.Methods 112 patients suffering from lumbosacral tuberculosis from January 1998 to October 2011 were reviewed retrospectively.Based on American Spinal Injury Association (ASIA) grading system,31 case was classified as grade C,32 as grade D and 49 as grade E.The affected locations were L5,S1 in 66 cases,L4-S1 in 32,and L5-S2in 14 cases.41 cases (posterior group) underwent posterior pedicle screw instrumentation,debridement and allograft; and 38 cases (anterior group) underwent one-stage anterolateral debridement plus allograft and internal fixation.33 (posterior-anterior group) cases experienced posterior pedicle screw instrumentation and anterior debridement and allograft.All cases underwent routine support and anti-tuberculosis treatment before and after operation.The change of erythrocyte sedimentation rate (ESR),signs of tuberculosis activity,graft fusion,neurological recovery and correction of deformity were evaluated in follow-up and compared among three groups.Results The average operating time in posterior,anterior and posterior-anterior group was (150±22) m in,(140± 18) min,(180± 1 8) min respectively.ESR and C-reactive protein (CRP) were recovered to normal 3 months post surgery.The quality of life total score of lumbosacral tuberculosis patients was very low (55.54 ± 9.23).After surgery and drug treatment,the total score and each dimension scores of the SF-36 were significantly improved.Postoperative ASIA classification and 1umbosacral angle were significantly improved.Tuberculosis recurrence occurred in three cases,fixation loosening in two cases,fixation fracture in one case,and all above cases were cured after revision surgery.The others all were cured and bone graft fusion was determined.Conclusion The quality of life of lumbosacral tuberculosis patients were impacted seriously,and which could be significantly improved with surgical intervention.According to the patient MRI,CT characteristics,surgical approach selection was based on lesion location.Effective internal fixation was based on the extent of damage in bone structure and anatomical characteristics.Following above principles,satisfactory clinical results could be achieved.

Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.

ObjectiveTo investigate the safety and early clinical efficiency of dynamic cervical implant (DCI) internal fixation to treat cervical disc herniation.Methods From September 2009 to December 2010,31 patients with herniation of cervical disc underwent DCI implantation.The operation time and blood loss were recorded and analyzed.Neck disability index (NDI),Japanese Orthopaedic Association (JOA) score,and visual analogue scale(VAS) score were used to evaluate neurofunctional recovery pre- and post-operation.Routinely,the patients accepted X-ray examination preoperatively and postoperatively.We used White's measurement to measure the range of motion(ROM) and height ratio of implant segment and the superior vertebra pre- and post-operation.ResultsThe average operation time and amount of bleeding were 45 (30-60) min and (100±30) ml respectively.The average postoperative follow-up was 14 months (range,6-20).The average NDI (50.5±16.2 vs.19.6±4.3,P＜0.05),JOA score (12.3±1.6 vs.13.9±1.8,P＜0.05) and VAS score (6.3±2.6 vs.3.1±2.2,P＜0.05) changed significantly at the last follow-up compared with those pre-operation.There were no significant differences in the average ROM of implant segment (9.6°±4.2° vs.6.9°±5.3°,P＞0.05),the height ratio of implant segment and the superior vertebra(2.6±0.1 vs.2.5±0.1,P＞0.05) and the angle of functional spine unit(2.6°±5.2° vs.1.7°±2.9°,P＞0.05) at last follow-up compared with those preoperation.ConclusionUsing DCI to treat cervical disc herniation had shorter operation time and less bleeding advantages,and the early clinical effect was satisfactory.It may retain the cervical biomechanical movement in some degree,maintain the cervical stability.

Objective To discuss the effect of QGY/CDDP hepatoma lines multi-drug resistance (MDR) reversed by gene transfection of mdr1,mrp-ASODN+ultrasound contrast agent+ultrasound.Methods The QGY/CDDP cells were transfected by mdr1,mrp ASODN+ultrasound contrast agent+ultrasound irradiation respectively and detected of the various indicators:cell adhesion rate,cell sensitivity to cell drug-resistance,the mRNA expression of mdr1 and mrp gene,the expression of P-gp and MRP protein. Results After mdr1-ASODN transfection,the drug sensitivity and expression of P-gp,MRP protein of QGY/CDDP cells were smaller changes(P＞0.05),and the rate of cells adherent and expression of resistance gene mRNA were obvious changes(P＜0.05).After mrp-ASODN transfection,the cells adherent rate,the drug sensitivity,the expression of resistance gene mRNA and P-gp,MRP protein were obvious changes respectively(P＜0.05),the experiment group(group 2')had bigger effects(P＜0.05).Conclusions mdr1. mrp-ASODN+ultrasound contrast agent+ultrasound irradiation could safely partly reverse MDR of hepatoma cells,which is a potential new approach for gene therapy.

Objective: To identify barriers of evidence-based practice in venous blood specimen collection. Methods: Totally 12 nurses from Zhongshan Hospital Fudan University participated in the non-structure interviews. Data were analyzed by category analysis. Results: There were 8 barriers, including standard operation procedure of blood specimen collection was not updated in time, lacking of education and professional support for evidence-based nursing, lacking of effective superintendence, rising economic cost, deficiency of technology and equipment, sufficient nurses, deficiency of evidence-based practice environment. Conclusions Establishing and implementing an evidence-based standard operation procedure, strengthening personnel education, looking for professional support, developing link management, reasonable allocation of human resources and flexible scheduling, creating an evidence-based practice environment, seeking technical and equipment support and evaluating evidence to control costs are benefit to promote the best evidence of venous blood collection to achieve clinical transformation.

Pulsatile drug delivery system,capable of releasing drug at the predetermined times according to clinical therapeutic requirements,can be used to treat several rhythmic diseases.Majority of individuals experience the rise in the blood pressure in the early morning hours,which potentially leads to serious cardiovascular complications.The purpose of the study was to develop pulsatile candesartan cilexetil core-in-cup tablets according to human circadian rhythm of blood pressure.The factors influencing t_(lag) were evaluated by in vitro drug release and tablet erosion observations.In addition,the jugular artery pressures vs times courses of rabbits were recorded after oral administration of commercial candesartan cilexetil tablets or the developed core-in-cup tablets.The quantity and characteristics of the excipients in top layers in the tablets were found to modify t_(lag).In vivo studies showed that the onset times indicating the decreases in the blood pressures of commercial tablets and core-in-cup tablets were (98 ± 17) min and (278 ±29) min,respevtively.In vivo t_(lag) of the prepared core-in-cup tablets was (180 ± 34) min in rabbits,which is consistent with the goal of design.

Objective To sutdy the anti-inflammatory action and pharmacodynamics of Liushen Cataplasm (LC). Methods The anti-inflammatory action of LC was observed on mice models of xylene-induced ear swelling and on the rat models of carrageenan-induced pedal swelling. With the decrease of pedal swelling as the parameter,the pharmacodynamics of LC was studied. The apparent parameters of pharmacodynamics were estimated based on the time-effect curve. Results LC showed a potent anti-inflammatory effect. The effect-time curve can be described by the one-compartment model. The main pharmacodynamic parameters were as follows:t1/2(Ka)=2.11727h,t1/2(Ke)=3.13464h,AUC=3.33131 mg?kg?h-1,respectively. Conclusion Liushen Cataplasm shows a potent anti-inflammatory effect. The effect-time curve can be described by the one-compartment model.

Aim To investigate the role of mitochondrial aldehyde dehydrogenase 2 ( ALDH2) in the cardio-protection of ischemic postconditioning in isolated rat hearts. Methods Hearts isolated from male Sprague-Dawley rats were perfused on a langendorff apparatus and subjected to 30 min of regional ischemia( occlusion of left anterior descending artery) followed by 120 min reperfusion. Ischemic postconditioning was achieved by 6 cycles of 10 s reperfusion/10 s global ischemia starting at the beginning of reperfusion. The ventricular hemodynamic parameters and lactate dehydrogenase ( LDH) release during reperfusion were measured. The infarct size was measured by TTC staining method. The expressions of ALDH2,Bcl-2 and Bax at mRNA level of left anterior myocardium were detected by RT-PCR analysis. Results In contrast to ischemia and reperfusion,ischemic postconditioning improved the recovery of left ventricular developed pressure,rate pressure product during reperfusion,and reduced LDH release and infarct size. The expressions of ALDH2 mRNA level and the ratio of Bcl-2 /Bax were increased. Adminis-tration of ALDH2 antagonist cyanamide at the beginning of reperfusion attentuated the role of ischemic postconditioning. Conclusion Ischemic postconditioning plays a role in the cardioprotection partially through increasing mitochondrial ALDH2 mRNA expression.