[Objective]To evaluate the effect of integrated management of blood loss in total knee arthroplasty (TKA ) between gypsum fixed up, ice compress,elastic bandage and only with elastic bandage. [Methods]From January 2006 to August 2008,107 patients undergoing TKA were randomized divided into integrated management group( 54 cases) and control group( 53 cases).Sex,age and deseases in two groups were comparative.The patients in integrated management were treated with elastic bandage,gypsum fixed up,leg elevated by 35 degrees at the hip with knee extended, continuous cold therapy.The patient in control group were only treated with single elastic bandage.The loss of blood during 2 h, 12 h, 24 h postoperative were analyzed.[Results]The blood loss was 170 ml(85~505 ml),210 ml(105~560 ml), 260 ml(110~580 ml)at 2 h、12 h、 24 h postoperative in integrated management group,and 180 ml(110~900 ml), 320 ml(115~930 ml),390 ml(170~970 ml) in control group.The blood loss in integrated group was obviously and a statistically significant difference was found between the two groups (P

[Objective] To develop a new method of measuring the posterior condylar angle(PCA)interoperatively,and determine the relationships of the PCA to the femoral shaft-transcondylar angle(FSXC)、the tibial plateau-tibial shaft angle(TPTS)and the femoral shaft-tibial shaft angle(FSTS)in southern Chinese people with osteoarthritic knees.[Methods]During July 2007 to March 2008,the PCA was measured directly in 30 osteoarthritic knees undergoing total knee arthroplasty with the PCA Conimeter designed by the author.There were 29 patients including 3 males and 26 females,and the average age was 66.6 years(range,50~78 years),18 left knees and 12 right knees.The radiologic measurements were performed preoperatively on weight-bearing long leg AP radiographs,which included FSXC,TPTS and FSTS.A linear correlation analysis was performed to determine the relationships of PCA to the FSXC,TPTS and FSTS.[Results]The value of the PCA was 5.2??2.6?.The values of the FSXC and TPTS were 8.6??2.9?and 4.1??4.0?,and both had significant linear correlationships with the value of the PCA(P

Objective To analyze the cause and treatment effect of pelvis obliquity accompanied with the gluteal muscle contracture. Methods 84 cases of gluteal muscle contracture with pelvis obliquity and their pelvis obliquity direction were examined. During surgery it was emphasized that release of the glutaeus minimus and glutaeus medius muscle contracture must be complete in order to expect correction of pelvis obliquity. Results Among the 84 cases of gluteal contracture with the pelvis obliquity, 76(90％ ) cases had gluteal muscle contracture of the longer limp. Follow-up had been done in 68 cases for 2.6 years. The pelvis obliquity disappeared completely in 63 of the 68 cases. Among the 63 cases, 61 cases underwent operation once while 2 cases needed revision operation. 3 of 68 cases were corrected partly. The other two cases had unstability in steps as a result of poor function of the gluteal abductors. Conclusion The main cause of the pelvis obliquity is contracture of the glutaeus minimus and medius muscles. The glutaeus minimus muscle contracture is an important factor that cause the pelvis obliquity in gluteal muscle contracture and should be released completely by surgery.

ObjectiveTo investigate the affection of Shujinxi external granule on the knee joints function after meniscus suture.Methods60 patients who undertook meniscus suture were randomly recruited into two groups,30 cases in each group.The control group accepted conventional rehabilitation training,while the treatment group received Shujinxi external granule on the basis of the conventional rehabilitation training.Both groups were treated for two weeks for a therapeutic course,and statistics analysis was made after 3～4therapeutic courses.ResultsThe average postoperative knee activity after 8 weeks and 12 weeks was [ (114.1 ±18.6)° and [(129.6±10.3)° ],in thetreatment group,comparing to [(89.7±t2.5 )° and (112.7±16.6)° ]in the control group,the difference was statistically significant (P＜0.05).the IKDC score and the Lysholm score of treatment group after 12 weeks was [(84.76±5.21) and (92.54±3.22)],while the control group was [(79.63±4.67) and (85.61±4.92)],the difference was significant (P＜0.05).ConclusionShujinxi external granule can promote the recovery of knee joints function after the operation of meniscus suture.

Objective To examine whether the increase of carbon monoxide (CO) induced by oral methylene chloride (MC) administration in recipients before heart transplantation would protect heart grafts against isehemia/reperfusion (I/R) injury associated with transplantation and to explore the possible mechanism.Methods Inbred male Balb/c mice were used as donors and recipients to establish cervical heart transplantation model Recipients were treated with either MC (100 mg/kg or 500 mg/kg,per os)(group MC 100 mg,n=10;group MC 500 mg,n=12) or olive oil(0.15 ml,per os.group olive,n=10) 3 h prior to anesthesia.Age-matched norwlal mice served as controls (group N,n=5).The serum COHb and the CO content of myocardial tissue were measured at 0,1,3,6,12,24 h after oral MC administration.Half of recipients were killed at 3 and 24h after transplantation for senum or cardiac graft samples.The serum cTnI levels,the mRNA levels of TNF-α,IL-10,Bcl-2,Bax.the protein levels of NF-κB and the ultrastructures of myocardium were examined.Results As tompared with group olive.the serum COHb and tissue CO were increased significantly and peaked within 3 h in group MC 100 mg and group MC 500 mg.The serum cTnI levels in group MC 100 mg and group MC 500 mg were significantly decreased (P<0. 01 ), especially in group MC 500 mg. The increase of CO in recipients of group MC100 mg and group MC 500 mg significantly inhibited the proinflammatory gene expression of TNF-α mRNA and the pro-apoptotic gene expression of Bax mRNA (P<0. 01), and increased the anti-apoptotic gene expression of Bcl-2 mRNA (P<0. 01), but did not increase the anti-inflammatory gene expression of IL-10 mRNA (P>0. 05) in the heart grafts. As compared with group N, the myocardial NF-κB activation was increased significantly in group olive,group MC 100 mg and group MC 500 mg (P<0. 01 ), but there was no significant difference among the later three groups (P>0. 05). The myocardial ultrastructure was also alleviated significantly in group MC 100 mg and group MC 500 mg as compared with group N. Conclusion The increase of CO induced by MC in recipients suppresses pro-inflammatory and pro-apoptotic gene expression and efficiently ameliorates transplant-induced heart I/R injury. The possible mechanism does not seem to be associated with down-regulation of the NF-κB signaling pathway.

The characteristics for the ex vivo expansion of the endothelial progenitor cells (EPCs) were explored. CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded under the same conditions as those for total MNC, coincubation of CD34+ and CD34- from the same donor for EPCs. In addition, the effects of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis were examined. EPCs were determined and quantified by immunocytochemistry and flow cytometry. The results showed that both coculture of CD34+ and CD34- and total MNC led to a significant increase in the expansion of CD34+ cells as compared with CD34 enrichment (P < 0.05). There was a tendency toward decreased apoptosis in cultures when early passage was performed immediately after cord like structures appeared. VEGF had no significant effect on apoptosis (P > 0.05). These differentiated EPCs were positive for CD34+, von Willebrand factor (vWF), KDR, CD31 staining and phagocytized acetylated low-density lipoprotein (LDL). CD34+ cells accounted for (68.2 +/- 6.3)% of attaching (AT) cells at day 7 of culture. It was suggested the most efficient method to ex vivo expansion of EPCs was coculture of CD34+ and CD34- or total MNC. Early passage makes cell apoptosis rate decrease. VEGF had no significant effect on ex vivo expansion of EPCs.

AIM: To explore the ex vivo expansion characteristics of the endothelial progenitor cells (EPCs). METHODS: CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded at the same conditions as that for total MNC, coincubation of CD34+ and CD34- from the same donation for EPCs. In addition, we tested the effect of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis. EPCs were determined and quantified by immunocytochemistry and flow cytometry. RESULTS: Coculture of CD34+ and CD34-,total MNC led to a significant increase in the expansion of CD34+ cells compared with CD34 enrichment (P0.05). These differentiated EPCs were stained positive for CD34+, von Willebrand factor (vWF), KDR, CD31 and incorporate acetylated low-density lipoprotein (LDL). CD34+ and AC133+cells accounted for 68.2%?6.3% (n=6) and 57.2%?9.8% (n=6) of attaching (AT) cells at day 7 of culture, respectively. CONCLUSIONS: Coculture of CD34+ and CD34- or culture of MNC enhances ex vivo expansion of EPCs. Early passage decreases apoptosis rate, VEGF has no significant effect on ex vivo expansion of EPCs.

AIM: To determine the combined effect of transmuscle laser revascularization (TMR) and endothelial progenitor cells(EPCs) treatment on ischemic hindlimb of nude rats.METHODS: Mononuclear cells (MNCs) isolated from human umbilical cord-blood (HUCB) by density gradient centrifugation were expanded in vitro. Immunocytochemistry and flow cytometry studies were performed. EPCs were labeled with 1, 1'- dioctadecyl-1 to 3, 3, 3', 3'- tetramethyl-indocarbocyanine perchlorate (DiI) before injected into the laser induced channels or ischemic region. Acute ischemic limb was created in 4 groups of nude rats by ligating right external iliac artery. All animals were divided randomly into the following four groups: TMR+EPCs group: local transplantation of EPCs into laser channels; TMR group: transmuscular channels were created without EPCs; EPCs group: EPCs were injected into ischemic hindlimb; control group: ischemic model without TMR or EPCs. All rats underwent femoral artery ultrasonic blood flow measurements of the ischemic and nonischemic limbs to obtained a flow ratio [femoral artery flow index (FAFI): right femoral artery flow /left femoral artery flow] at baseline (after ligating artery immediately) and 28 days postoperation, and then the samples of ischemic limb muscle underwent histochemical and immunohistologic analysis. RESULTS: The attached cells expressed endothelial cell (ECs) markers (KDR, CD34, CD31, AC133 and von Willebrand factor) and exhibited function similar to that of ECs judged by Ac-LDL incorporation. Flow cytometric analysis disclosed that AT cells were positive for CD34 (62%?7%) and AC133 (57.2%?9.8%) at day 7 of culture. 28 days after therapy, FAFI was significantly higher in the TMR +EPCs (0.66?0.09, P0.05). FAFI in the control group was unchanged and no difference was found between TMR group and control group. TMR+EPCs (5.66?0.77), TMR (4.96?0.31) as well as EPCs (4.68?0.44) treatment resulted in an increased number of capillaries in the treated regional area compared with control group (2.60?0.31, P

The characteristics for the ex vivo expansion of the endothelial progenitor cells (EPCs)were explored. CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded under the same conditions as those for total MNC, coincubation of CD34+ and CD34- from the same donor for EPCs. In addition, the effects of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis were examined.EPCs were determined and quantified by immunocytochemistry and flow cytometry. The results showed that both coculture of CD34+ and CD34 and total MNC led to a significant increase in the expansion of CD34+ cells as compared with CD34 enrichment (P＜0.05). There was a tendency toward decreased apoptosis in cultures when early passage was performed immediately after cord like structures appeared. VEGF had no significant effect on apoptosis (P＞0.05). These differentiated EPCs were positive for CD34+, von Willebrand factor (vWF), KDR, CD31 staining and phagocytized acetylated low-density lipoprotein (LDL). CD34+ cells accounted for (68.2±6.3) % of attaching (AT)cells at day 7 of culture. It was suggested the most efficient method to ex vivo expansion of EPCs was coculture of CD34+ and CD34- or total MNC. Early passage makes cell apoptosis rate decrease.VEGF had no significant effect on ex vivo expansion of EPCs.