Incidence of knee periprosthetic fractures after total knee arthropoasty is increased,and is a challenging clinical problem. Treatment options include conservative and operative methods. Only the doctor have sufficient and systematic understanding of periprosthetic fractures and consider both advantages and dis-advantages before deciding the appropriate treatment, the satisfying treatment outcome will be got. we re-viewde the type, treatment methods and outcomes of periprosthetie fractures of total knee arthroplasty repor-ted in recent years.

Objective To investigate the hysteromyoma treated with the gonadotropin releasing hormone agonist(GnRH-a)and the impact on immunologic function.Methods 130 cases selected from the patients with hysteromyoma enrolled from January 2016 to December 2016 in hospital have been randomly divided into two groups.The control group has been treated with mifepristone while the study group GnRH-a.Results The sizes of uterus and myoma of both groups have no significant difference before treatment.After treatment, both of them are significantly improved, and those of the study group is significantly smaller than that of the control group(P<0.05).The levels of serum sex hormone and immunologic function of both groups have no significant difference before treatment.They are both improved after treatment, and the study group is significantly better than the control group(P<0.05).Conclusion Applying GnRH-a therapy to the patients with uterine myoma benefits for improving the therapeutic effect, which can improve the serum sex hormone levels and immunologic function.

Objective To evaluate the outcome of lung volume reduction surgery (LVRS)under video-assisted thoracoscopy in patients with severe chronic obstructive pulmonary emphysema.Methods The follow-up date of 68 patients with severe emphysema underweut LVRS by video-assisted thoracoscopy were analyzed retrospectively betweeu June 2002 to June 2012.Mean FEV1.0 、FCV 、RV、PO2 、PCO2 、mean 6MWT were assessed before their surgery and 6 months,1-year and 2-years after their surgery respectively.Results Compared with their preoperative results,Lung function,arterial blood gasanalysis and 6-minute walk distance (6-MWD) increased outstanging.Conclusion LVRS by VATS provides significant clinical and physiological improvement for the majority of patients with severe chronic obstructive pulmonary emphysema.

Evidence from Western countries suggests that built environmental attributes can influence the physical activity participation in adults, but whether or not this is the case for Chinese is unknown. Also, the strength of the relationship of environment to physical activity may differ by age group. The present study examined age-related differences in associations between perceived neighborhood environment and walking in Chinese women dwelling in Beijing. Cross-sectional data were collected through an internet-based survey. Total of 737 women aged 30 to 59 years responded. All of them were then divided into three groups based on the age: aged from 30-39, from 40-49 and from 50-59. In addition to socio demographic information, the perceived neighborhood environment was measured by Neighborhood Environment Walkability Scale Questionnaire, and their walking time per week was collected through International Physical Activity Questionnaire. To measure relationship between perceived neighborhood environment and walking time, partial correlations were computed, adjusting for socio demographics. Walking time was significantly related to residential density in aged 40-49 years, and land use mix-access, walking/cycling facilities, traffic safety variables in aged 50-59 years. The present study indicates that there would be differences in associations between neighborhood attributes by age-groups. Future, public health promotion of walking activity and the design of interventions need to consider the contribution of neighborhood level built environment influences.

Porpose: Physical inactivity is a modifiable risk factor for many chronic diseases. In China, inactive lifestyle is increasing yearly on Chinese adults by rapid economic development which produces their lifestyle changes. Thus, we investigated the prevalence and socio-demographic correlates of meeting the physical activity recommendation among Chinese adult internet users.Methods: Data were analyzed for 1394 Chinese adults who responded an internet based cross-sectional survey. The International Physical Activity Questionnaire Chinese version was used to determine whether the individuals met the physical activity recommendation (150minutes/week) on the ACSM/AHA guideline. Demographic data (gender, age, marital status, employment status, educational level, annual income level, and body mass index) were also obtained. A multivariate logistic regression analysis was utilized.Results: Overall, 87.3% of respondents met the physical activity recommendation. Age and annual income were significantly associated with meeting the physical activity recommendation. Women aged 40-49 years were more likely to meet the physical activity recommendation than those aged 30-39 years (OR = 2.12). Women with annual incomes of 40000∼50000 Yuan were more likely to meet the physical activity recommendation than those with annual incomes of 30000 Yuan or less (OR = 2.40).Conclusion: The high prevalence rate and different socio-demographic correlates of meeting physical activity recommendation were observed among Chinese adults compared with these in developed countries. Specific strategies accounting for such socio-demographic correlates may be needed for effectively promoting physical activity among Chinese adults.

Objective To evaluate the efficacy of remifentanil combined with propofol in children of different age undergoing short-term ophthalmologic operation.Methods Forty-eight children aged 4-12 yr undergoing elective short-term ophthalmologic operation were divided into 4 groups(n=12 each)according to age and anesthetics:group ⅠPK aged 4-7 yr and group ⅡPK aged 8-12 yr received ketamine and propofol combined anesthesia;group ⅠPR aged 4-7 yr and group ⅡPR aged 8-12 yr received remifentanil and propefol combined anesthesia.In group ⅠPK and ⅡPK the anesthesia was induced with intravenous bolus of ketamine 2 ms/kg and ketamine 1-2 ms/kg.In group ⅠPR and ⅡPR the anesthesia was induced with intravenous remifentanil 1 μg/kg and respiratory rate(RR),cerebral state index(CSI)and SpO2 were recorded before anesthesia induction(baseline),2 min after induction,at the initiation of the operation,15 min after the initiation of operation and at emergence from anesthesia.Adverse effects during and after the operation,induction time,analepsia time,conscious recovery time and total sedation time were recorded.The mean infusion rate of remifentanil was calculated.Results Compared with the baesline,SP,DP,HR,RR and CSI were significantly decreased in 4 groups(P＜0.05).RR,CSI and incidence rates of adverse effects were significantly lower,and the emergence time and the recovery time of consciousness were significantly shorter in group ⅠPR and ⅡPR than in group ⅠPK and ⅡPK(P＜0.05).The average infusion rate of remifentanil was lower in group ⅡPR than in group ⅠPR(P＜0.05).Conclusion Remifentanil combined with propofol can produce good anesthetic effect in children undergoing short-term ophthalmologic operation,with less adverse effects,stable hemodynamics and rapid emergence from anesthesia.The dosage of remifentanil is difierent in children at different ages.

Objective To evaluate the diagnostic and prognostic value of the serum procalcitonin ( PCT ) level in the non-acquired immune deficiency syndrome ( AIDS ) immunocompromised critically ill patients suspected to have infection. Methods A retrospective study was conducted in the non-AIDS immunocompromised patients who were admitted to Department of Critical Care Medicine of Xiangya Hospital, Central South University during January 2011 to December 2014. Demographic characteristics, underlying disease, acute physiology and chronic health evaluationⅡ( APACHEⅡ) score at admission, and clinical records including baseline and peak levels of temperature, white blood count ( WBC ), PCT, and survival rate within 28 days, infection focus, infectious agents ( bacterial, fungi or mixed infection ), and the severity of infection ( sepsis, severe sepsis, or septic shock ) were recorded. Receiver operating characteristic ( ROC ) curve was plotted, and the diagnostic and protective value of above parameters was evaluated. Results A total of 98 patients ( 43 male and 55 female ) were enrolled in the study with a median age of 44 ( 28, 52 ) years old and a median APACHEⅡscore of 17 ( 11, 20 );47 with malignant hematological tumor, 45 with autoimmune diseases, and 6 post solid organ transplantation. Among them 53 patients ( 54.1%) died within 28 days. Twenty-seven patients were diagnosed as systemic inflammatory response syndrome ( SIRS ) without infection. Among 71 patients with infection, 45 were diagnosed as bacterial infection, 10 with fungal infection, and 16 with mixed infection. Sepsis was diagnosed in 7 patients, severe sepsis in 32 patients , and septic shock in 32 patients .①There was no statistical significance in the baseline and peak levels of PCT and WBC, or baseline level of temperature between the groups of SIRS patients without infection and infected patients. The peak level of temperature was significantly higher in the patients with infection as compared with that of the SIRS without infection patients [℃:39.4 ( 38.9, 40.0 ) vs. 38.8 ( 37.8, 39.2 ), Z=-3.268, P=0.001 ]. It was showed by subgroup analysis that in patients with hematological malignant disease or autoimmune diseases, higher level of body temperature was found in infection group compared with non-infection SIRS group [℃:39.5 ( 39.0, 40.0 ) vs. 39.0 ( 38.4, 39.4 ), Z=-2.349, P=0.019;39.0 ( 38.4, 39.5 ) vs. 38.2 ( 37.0, 38.9 ), Z=-2.221, P=0.026 ].②The baseline level of PCT (μg/L ) were 0.54 ( 0.20, 4.19 ), 2.78 ( 0.50, 9.54 ), 1.00 ( 0.45, 6.89 ), and 0.22 ( 0.07, 1.86 ) in non-infection SIRS patients or the patients with bacterial, fungal, and mixed infection, respectively. The peak level of PCT (μg/L ) were 4.19 ( 1.95, 13.42 ), 12.37 ( 3.82, 45.89 ), 1.82 ( 0.49, 17.86 ), and 5.14 ( 2.66, 12.62 ), respectively, in each subgroup. When the comparison was conducted among the patients with different infectious agent, the baseline level of PCT in patients with bacterial infection was significantly higher than that in SIRS patients without infection ( P=0.026 ) and mixed infection patients ( P=0.001 ), and the peak level of PCT was significantly higher than that in the SIRS patients without infection ( P=0.009 ) and the patients with fungal infection ( P=0.016 ). ROC curve showed that the higher value was found in the baseline and peak levels of PCT for diagnosis of septic shock in all patients [ area under ROC curve ( AUC ) of baseline level = 0.681±0.054, P = 0.001; AUC of peak level = 0.690±0.054, P=0.002 ], and the same value was also found in the baseline and peak levels of PCT for diagnosis of bacterial infection in the patients with malignant hematological tumor ( AUC of baseline level=0.687±0.080, P=0.008;AUC of peak level=0.697±0.079, P=0.021 ).③The peak level of PCT (μg/L ) were 4.05 ( 0.53, 31.22 ), 5.78 ( 2.14, 16.68 ), and 11.64 ( 2.94, 58.14 ) in subgroup of patients with sepsis, severe sepsis and septic shock, respectively, and they showed no statistical significance among subgroups ( P>0.05 ). A high serum level of peak PCT strongly indicated the presence of septic shock ( AUC=0.646±0.060, P=0.019 ), especially in the subgroup of patients with systemic autoimmune disease ( AUC=0.689±0.081, P=0.035 ).④The peak level of PCT (μg/L ) in the APACHEⅡ>18 group ( 38 cases ) was significantly higher than that of APACHEⅡ≤18 group [ 60 cases, PCT (μg/L ):11.64 ( 3.36, 39.39 ) vs. 4.42 ( 1.32, 14.70 ), P=0.016 ];there was a certain correlation between the peak level of PCT and the severity of the disease.⑤The peak level of PCT in death group was significantly higher than that of the survival group [μg/L:9.07 ( 3.05, 33.09 ) vs. 4.19 ( 1.26, 14.61 ), P=0.043 ]. ROC curve showed that the peak level of PCT might be valuable in predicting the prognosis in immunocompromised patients ( AUC=0.619±0.057, P=0.043 ). Conclusions The serum level of PCT is found to be a reliable marker for the diagnosis of bacterial infection in immunocompromised critical patients, especially in those with hematologic malignancy. Additionally, PCT provides a useful tool for evaluating the severity of infection and the prognosis of critically ill patients.

Background and purpose:Aberrant expressions of microRNAs (miRNA, miR)are reported in various cancers and may associate with cancer occurrence, development, invasion and metastasis, thereby functioning as either tumor suppressors or oncogenes. This study attempted to observe the expression of miR-214 in pancreatic cancer and to explore its clinical signiifcance.Methods:Real-time PCR was used to detect the miR-214 expressions between pancreatic cancer tissues and matched adjacent tissues. The correlations of miR-214 expression with clinic-pathological features and clinical prognosis were analyzed.Results:MiR-214 expression was up-regulated in 69.4%(25/36) of tumor tissue specimens. The relative expression level of miR-214 was signiifcantly higher in tumor tissues than in matched adjacent tissues (3.45vs 1.52,P<0.01). Higher miR-214 level was strongly associated with T3-T4 stage (P=0.018). The Kaplan-Meier analysis revealed that patients with higher expression of miR-214 had a shorter survival time (P=0.032).Conclusion:The expression of miR-214 is associated with clinic-pathological features and patient’s clinical prognosis, so it may be used as a potential diagnostic biomarker and a prognostic predictor in patients with pancreatic cancer.

Because of massive defects requiring repair, a flap with blood supply of extraterritorial blood vessels is often needed clinically, which is a little bigger than that with blood supply of axial blood vessels. In order to provide theoretical evidence for the survival of such a flap, we designed a 11cm ? 15 cm flap involving the thoracodorsalic and the lateral thoracic arteries on a rat's lateral thorax and abdomen. The flap was stained by methylene blue and filled with emulsion. The diameters of the anastomotic branches within the flap were measured at different times. The volumes of blood flow on different points of the flap were observed quantitatively by means of ECT scanning. The vitality of the flap was also observed.Our experiment proved that anastomotic branches between blood vessels are the anatomic bases for extra-territorial flap. Blood flows from one blood vessel supplying zone to another through the anastomotic branches between the blood vessels. After the flap formed, The diameters of its anastomotic branches would grow larger.Since 1988, we have designed 33 extra-territorial flaps on cervicothorac area. The flaps have survived well. Our present experiment provided the flap with theoretical evidence that an extraterritorial flap can be devised provided that there is abundant anastomosis between the two axial blood vessels.

Objective To study the serum levels of melatonin,tumor necrosis factor alpha (TNF-α) and interferon gamma (IFN-γ) in multiple sclerosis (MS) patients and the correlation with disability.Methods Forty patients with multiple sclerosis were collected as MS group and 30 healthy participants were collected as control group.Serum levels of melatonin and cytokines,including IFN-γ and TNF-,were detected in all participants by the enzyme-linked immunosorbent assay (ELISA) method;disability status of patients with MS was evaluated by EDSS scale.The relevant analysis between serum melatonin,TNF-α,IFN-γ levels and EDSS score in patients with MS was conducted.Results The concentration of serum melatonin in MS group was significantly lower than control group (P＜0.01).TNF-α levels were higher than control group (P＜0.05) and the difference was statistically significant between MS patients and control group.Among MS group and control group,no significant correlation with the serum levels of IFN-γ was seen.The serum melatonin level was inversely correlated with EDSS score in MS patients (r =-0.76,P＜0.01),and positively correlated with TNF-α (r =0.83,P＜0.01) and as compared to IFN-γ,no significant correlation was found (r =0.17,P＞0.05).Conclusion The decrease of melatonin and increase of TNF-α can be a factor in the inflammatory reaction in patients with MS,and is closely related with dysfunction occurring in multiple sclerosis.Serum melatonin and TNF-α can be used as laboratory indicators to monitor clinical curative effect and evaluate prognosis of MS.