Forty-four patients suffering from hip pain after the hip and femoral head replacement were treated by revision for total hip arthroplasty in Spinal and Joint Surgery of Gaozhou People’s Hospital between August 2000 and August 2006. Forty-one patients were followed up. The surgeon, an associate chief physician, had been engaging in artificial joint field for 9 years, and performed artificial joint replacement for 620 patients. ①There were 26 patients with pain after artificial femoral head replacement, including 17 males and 9 females with an average age of 72.3 years (range, 67-79 years). Of the 26 patients, 12 had loosening of prosthesis stem, 8 acetabular wear, 3 dislocation of artificial femoral head, 2 ossification around the joints, and 1 periprosthetic fracture. ②Fifteen patients suffered with pain after total hip replacement, including 9 males and 6 females with an average age of 73.4 years (range, 66-80). Of them, there were 6 with loosening of prosthesis, 2 with loosening of acetabular prosthesis, 2 with wear of acetabular prosthesis, 2 with dislocation of artificial femoral head, 1 with infection of incision, 1 with delayed infection, and 1 with periprosthetic fracture. ③During follow up, 4 cases developed bone cement response symptoms such as acute hypotension, hypoxemia, and arrhythmia, but no rejection induced by artificial joint was found. X-ray films showed that no metal corrosion or acetabular polyethylene prosthesis degradation occurred. ④White blood count was generally elevated the day after revision of total hip arthroplasty, and mostly recovered 7 days after revision. Three patients had venous thrombosis of lower extremities. All 41 patients were followed up for 1-7 years, and odynolysis rate was 90.2%. The results indicate that the complications such as loosening of prosthesis, acetabular wear, dislocation of artificial femoral head, and ossification around the joints are main causes of hip pain after hip prosthesis replacement. Revision of total hip arthroplasty is an efficient method to relieve the pain.

Objective To explore the impact of different doses of dexmedetomidine on the anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy.Methods 90 patients with uterine fibroids with ASA class Ⅰ or Ⅱ who were going to undergoing general intravenous anesthesia laparoscopic hysterectomy were selected and they were divided into group A (dexmedetomidine 0.4μg·kg-1·h-1,n=30) and group B (dexmedetomidine 0.2μg·kg-1·h-1,n=30) and group C (no dexmedetomidine,n=30) by digital random method.The analgesia effect (VAS score) of group A,group B and group C preoperation and postoperative 1h,12h and 24h,and the sedation (Ramsay sedation score) were compared.General information,postoperative blood pressure,heart rate,pulse oxygen saturation,postoperative patients'' satisfaction on analgesic effect and the sedation effect and adverse reactions of the three groups were also compared.Results Age,body mass index and other basic information of three groups had no statistically significant differences (all P＞0.05).The preoperative VAS score of the three groups also had no statistically significant difference (F=0.625,P＞0.05).Postoperative 12h,24h,the VAS scores of group A and group B were lower than those of C group,which of group A were lower than group B (F=11.250,P＜0.05,F=21.181,P＜0.05).The Ramsay sedation score was higher than that of C group[(3.67±0.18) vs.(2.13±0.11)].The satisfaction of group A was significantly higher than group B and group C (96.67％ vs.73.33％,46.67％,χ2=25.953).The Ramsay sedation score and satisfaction were higher than those of group B (all P＜0.05).There were no significant differences in blood pressure (F=0.362,P＞0.05),pulse oxygen saturation (F=0.978,P＞0.05) and heart rate among the three groups before and after operation (F=1.268,P＞0.05).There was no obvious adverse reaction in the three groups.Conclusion Dexmedetomidine can promote anesthetic sedative and analgesic effect of anesthesia agents in hysterectomy of patients with uterine fibroids under laparoscopy,and the dose 0.4μg·kg-1·h-1 of dexmedetomidine has better effect,feasibility and safety,it is worthy of clinical promotion.

Objective To investigate whether the hyper-reactivity of monocytes from the patients with primary biliary cirrhosis (PBC) to LPS and Poly I ∶ C was associated with miR-146a.Methods Peripheral blood mononuclear cells from PBC patients and healthy controls were stimulated with 10 μg/ml of LPS or Poly I ∶ C.The levels of IL-1 β,IL-6,TNF-α and IFN-α in the culture medium were detected by ELISA.The relative expressions of miR-146a,miR-21,let-7e,miR-155 and miR-125b were detected by RT-PCR.The regulatory role of miR-146a on the production of inflammatory factors in LPS or Poly I ∶ C stimulated THP-1 cells was studied by gain-and-loss function assay.Results The up-regulation of miR146a,which was induced by both LPS or Poly I ∶ C,was impaired in the monocytes from PBC patients.The production of LPS or Poly I ∶ C induced inflammatory factor,could be enhanced by miR-146a down-regulation.Conclusion The hyper-reactivity of monocytes from PBC patients to LPS and Poly I ∶ C was associated with miR-146a.

Objective To understand the molecular epidemiology of penicillin resistance Streptococcus pneumonia (PNSP) isolated from children in Guangzhou area to provide the experimental basis for clinical prevention and control of Streptococcus pneumonia infectious diseases.Methods Specific primers were designed according to Genebank,penicillin binding protein(PBP) genes PBP1A,PBP1B,PBP2A,PBP2B,PBP2X,PBP3 were amplified by PCR.The sequencing analysis was performed.The PCR products were digested by Hinf I,and the restriction fragment length polymorphism (RFLP) was analyzed.Results DNA of PNSP was successfully extracted,the PCR results showed that in 50 strains of PNSP,the positive rates of bacterial strains containing PBP1A,PBP1B,PBP2A,PBP2B,PBP2X and PBP3 were 48.9%,64.4%,71.1%,31.1%,40.0% and 31.1% respectively.The sequencing showed that their homologies with known sequences in GenBank were 99%,98%,100%,97%,95% and 100% respectively.Using RFLP in Hinf I showed that PBP1A,PBP1B,PBP2A and PBP3 only had one kind of genotype,PBP2B and PBP2X had two kinds of genotypes,the positive rates were 71.4%,28.6%,66.7% and 33.3% respectively.Conclusion The gene distribution of PNSP strains among children in Guangzhou is dominated by PBP2A,PBP1B and PBP1A,there are two subtypes in PBP2B,PBP2X when digested by Hinf I,in which the predominant subtype >65%.

Objective To compare the safety and efficacy of oblique supine position and lithotomy position in suctioning flexible ureteroscopic lithotripsy. Methods 82 patients with upper urinary calculi were divided into two groups. Group 1 included 47 patients who were treated by suctioning flexible ureteroscopy in oblique supine position. Group 2 included 35 patients who were treated in lithotomy position. There was no significant statistical difference in age, gender and complications between the two groups before surgery (P > 0.05). The operative time, stone-free rates at postoperative 30 d, renal pelvic pressure (RPP), postoperative complications (graded by the Clavien system) and length of stay were compared. Results Retrograde Intrarenal Surgery (RIRS) was successful in 73 cases, and 9 cases of patients were done successfully after indwelling DJ tube 2 weeks. Compared with lithotomy position, a significantly greater stone-free rate of 30 d, shorter operative time (P < 0.05). There was no difference in complication rate of Clavien grade I and Clavien grade II, RPP and length of stay (P > 0.05). Conclusions Suctioning flexible ureteroscopic lithotripsy in the oblique supine position is safe, and more effective than supine lithotomy position.

Objective To explore the effect of cigarette smoke exposure on testis structure and nitric oxide (NO) level in testis of rats.Methods A total of 160 adult male SD rats were divided into control group and low,medium,high dose groups.The smoke-exposed rats were respectively exposed to the smog for the periods of 2,4,6,8 and 12 weeks,10 rats in each group.The smoke-exposed rats were exposed to cigarette smoke for 0.5 h per day.The testicular tissue structure was observed and the body mass and the NO level of testis were measured.Results Compared with the control group and low dose group,the body mass of the rats was significantly lower in the medium and high dose groups exposed for 4,6,8,12 weeks (P<0.05).Compared with the medium dose groups,the body mass of the rats was significantly lower in the high dose group exposed for 8 weeks and 12 weeks (P<0.05).And with the increase of exposure dose,the reducing was even more obvious.Compared with the control group and low and medium dose groups,NO level in testis of rats was significantly increased in the high dose groups exposed for 2,4,6,8 weeks (P<0.05).Compared with the control group,NO level in testis of rats was significantly increased in the medium dose groups exposed for 8 weeks (P<0.05).Compared with the control group,NO level in testis of rats was significantly increased in the low,medium and high dose groups exposed for 12 weeks (P<0.05);and compared with the low dose group,NO level in testis of rats was significantly increased in the medium and high dose groups(P<0.05).Conclusion Cigarette smoke exposure may have impacts on testis tissue and lead to the increase of NO level in testis of male rats.

Objective To investigate the increased expression of microRNA-146a(miR-146a) in peripheral blood mononuclear cells (PBMC) of patients with chronic immune thrombocytopenic purpura (ITP) and its clinical significance. Methods Twenty-eight patients with chronic ITP and 28 healthy controls matched with age and gender were enrolled in this study. Fluorescent quantitative PCR reaction was used to detect the relative expression of miR-146a in their PBMC. The serum concentration of TNF-α, IL-2,IL-1 β and IFN-γ were measured by ELISA. CCK-8 method was used to detect the proliferation ability of PBMC , which transfected with miR-146a mimics or inhibitor and then stimulated with platelet . Results The relative expression of miR-146a in ITP patients was higher than that of healthy controls. The increased expression of miR-146a was negatively correlated with the serum TNF-α, IL-2 and IFN-γ. The PBMC transfected with miR-146a mimics had reduced expression of IL-2 and proliferation when stimulated with platelet.In contrast, the opposite effect was observed with the miR-146a inhibitors transfection. Conclusion MiR146a was involved in the pathogenesis of chronic ITP by controlling IL-2 production and PBMC proliferation.Thus, it may be a potential therapy target for chronic ITP.

Objective To detect the expression of IL-27 in PBC (primary biliary cirrhosis)patients and the possible involvement of IL-27 signal pathway in PBC. Methods The gene transcription and protein expression levels of IL-27 in patients with PBC, chronic hepatitis B(CHB) group and healthy controls(HC) were measured by real-time PCR, ELISA, flow cytometry and immunohistochemistry. AST,ALP, ALT, TBIL, GGT were determined and their correlation with IL-27 was also analyzed. Results IL-27 was significantly elevated in patients with PBC and IL-27 is present in the liver tissues of patients with PBC. Expression of IL-27 on CD4+T cells was increased in patients with PBC(72.40% ±6.22% ) and CHB(59.40% ± 7.03%) compared with HC(1.70%±0.55%,P＜0.01). Expression of IL-27 protein was increased in patients with PBC [( 126.25 ± 36.00 ) pg/ml] compared with CHB [( 51.81 ± 23.30 )pg/ml, P ＜ 0. 01] and HC[(34.19 ± 9.70) pg/ml, P ＜ 0.01], and it was positively correlated with GGT( r = 0.554, P＜0.01) and TBIL (r = 0.559,P＜0.01), but no correlation with ALT, AST, ALP.Conclusion These facts indicated the key role of IL-27 in the immune inflammatory reaction in patients with PBC.

Objective To observe the effect of traditional Chinese medicine enema on renal insufficiency of diabetic nephropathy.Methods 76 patients with diabetic nephropathy were divided into the treatment group and the control group with 38 patients in each group.The treatment group were offered traditional Chinese medicine enema based upon routine treatment for 8 weeks,the control group received routine treatment only.The clinical symptom,fasting blood glucose,24h urine albumin,serum creatinine (Scr),urea nitrogen (BUN) were observed and compared before and after treatment.Results The two groups showed significant differences in clinical symptom and degree of renal function alleviation.Conclusions Traditional Chinese medicine enema proved to be one of the effective methods for treatment of renal insufficiency of diabetic nephropathy.

Objective To investigate the effect of slice orientation on the popliteomeniscal fasciculi (PMF) MR imaging and its normal MRI appearances. Methods Volumetric MRI data of 40 knees of healthy volunteers were acquired using an isotropic 3D turbo spin echo (TSE) MR sequence. The posterior tangential line to both femoral condyles was used as the reference line, and the long axis sectional images of the popliteal hiatus region were reformatted at 0°, 15°, 30°, 45°, 60°, 75° and 90° to the reference line. The MRI appearances of the PMF were scored respectively and classified. The final scores of the PMF at each slice angle were statistically analyzed by a repeated measure ANOVA. Results At 0°, 15°, 30°, 45°, 60°, 75° and 90° slice angles: scores of the anteroinferior fasciculi were (1.7±0.7), (1.8±0.6), (1.9±0.6), (2.0±0.7), (1.9±0.7), (1.8±0.8) and (1.0±0.5),respectively. Scores of the posterosuperior fasciculi were (1.5±0.7), (1.9±0.7), (2.1±0.6), (2.2±0.6),(2.2±0.6), (2.0±0.8) and (1.7±0.8), respectively. There were statistically significant differences in the average scores at each slice angle for both anteroinferior fasciculi (F = 29.744, P = 0.000) and posterosuperior fasciculi (F = 19.770,P =0.000). The anteroinferior fasciculi and the posterosuperior fasciculi had highest average scores at the angle of 45°. The percentage of type A, B and C of anteroinferior fascicali were 20.0% (8/40), 75.0% (30/40) and 5.0% (2/40), respectively. The percentage of type A, B and C of posterosuperior fasciculi were 37.5% (15/40) ,62.5% (25/40) and 0% (0/40) ,respectively. Conclusion The anteroinferior fasciculi and the posterosuperior fasciculi can be well depicted at the angle of 45° slice orientation.