BACKGROUND: With the prevalence of total knee arthroplasty, periprosthetic joint infection as a serious complication has been an issue of concern.OBJECTIVE: To summarize the advances in the diagnosis and treatment of infection after total knee arthroplasty.METHODS: The first author searched the PubMed and CNKI databases for the literatures related to the diagnosis and treatment of infection after total knee arthroplasty using the keywords of total knee arthroplasty,infection in English and Chinese, respectively. The repetitive articles were excluded, and the risk factors,diagnosis, classification and treatment of infection after total knee arthroplasty were summarized.RESULTS AND CONCLUSION: (1) The infection after artificial knee replacement is closely related to the patient's preoperative condition, operation skills and postoperative status. (2) Diagnosis of infection is based on the detailed understanding of the patients' situation and complete auxiliary examinations. (3) The treatment methods include antibiotics, debridement and retention, reversion, arthrodesis, as well as amputation. (4) Periprosthetic infection is a serious complication after total knee arthroplasty, and early diagnosis and treatment are critical. Furthermore,choosing an appropriate individualized treatment scheme for different patients is important.

Objective:To investigate the short-term efficacy of totally laparoscopic distal gastrectomy (TLDG) after endoscopic submucosal dissection (ESD) versus direct TLDG for early gastric cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 623 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2014 to December 2019 were collected. There were 405 males and 218 females, aged from 26 to 86 years, with a median age of 62 years. Of 623 patients, 25 cases undergoing TLDG after ESD were divided into ESD+TLDG group and 598 cases undergoing TLDG directly were divided into TLDG group. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations of TLDG; (3) stratification analysis of the ESD+TLDG group. The propensity score matching was conducted by 1∶2 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range) and comparison between groups was done using the Mann-Whitney U test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 75 of 623 patients had successful matching, including 25 in the ESD+TLDG group and 50 in the TLDG group. Before propensity score matching, the body mass index (BMI), cases with tumor diameter ≤20 mm, 21 to 30 mm or>30 mm, cases with tumor classified as stage Ⅰ, stage Ⅱ or stage Ⅲ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1, 0 of the ESD+TLDG group, respectively, versus (24.3±2.7)kg/m 2, 238, 125, 235, 312, 126, 160 of the TLDG group, showing significant differences in the above indicators between the two groups ( t=2.744, Z=?2.834, ?4.209, P<0.05). After propensity score matching, the BMI, cases with tumor diameter ≤20 mm, 21 to 30 mm or >30 mm, cases with tumor classified as stage Ⅰ or stage Ⅱ of clinical staging were (22.3±3.6)kg/m 2, 16, 6, 3, 24, 1 of the ESD+TLDG group, versus (23.6±2.9)kg/m 2, 29, 12, 9, 48, 2 of the TLDG group, showing no significant difference between the two groups ( t=1.542, Z=?0.597, 0.000, P>0.05). (2) Intraoperative and postoperative situations of TLDG: after propensity score matching, the operation time and time to postoperative drainage tube removal were 180 minutes(range, 124 to 289 minutes) and 6 days(range, 4 to 13 days) of the ESD+TLDG group,respectively,versus 170 minutes(range, 106 to 250 minutes) and 6 days (range, 4 to 9 days) of the TLDG group, showing significant differences between the two groups ( Z=-2.396, -3.039, P<0.05). Cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL, the number of lymph node dissected, duration of postoperative hospital stay, cases with perioperative complications as incision fat liquefaction, delayed gastric emptying, anastomotic bleeding or pulmonary infection were 7, 9, 9,34(range, 16 to 58), 8 days(range, 6 to 31 days), 1, 1, 0, 0 of the ESD+TLDG group,respectively,versus 18, 26, 6, 39 (range, 22 to 68), 8 days (range, 6 to 29 days), 0, 0, 1, 1 of the TLDG group, showing no significant difference between the two groups ( Z=-1.703, -1.958, -1.139, χ2=0.033, P>0.05). Cases with anastomotic bleeding were recovered after hemostasis under endoscopy and cases with other perioperative complications were recovered after conservative treatment. (3) Stratification analysis of the ESD+TLDG group. ① For 5 cases undergoing TLDG ≤14 days after ESD and 20 cases undergoing TLDG >14 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 170 to 289 minutes), 0, 3, 2, 36(range, 9 to 57), 7 days(range, 5 to 9 days), 8 days(range, 7 to 9 days), 1 and 180 minutes (range, 124 to 253 minutes), 8, 6, 6, 34(range, 8 to 78), 6 days(range, 4 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.536, ?1.993, ?0.238, ?0.932, ?0.589, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ② For 13 cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss as <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 200 minutes(range, 145 to 289 minutes), 2, 6, 5, 34(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 11 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 3, 3, 34(range, 16 to 78), 6 days(range, 5 to 13 days), 8 days(range, 6 to 31 days), 1, respectively, showing a significant difference in the operation time of TLDG between the two groups ( Z=?2.241, P<0.05), while showing no significant difference in the volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay between the two groups ( Z=?1.471, ?0.163, ?0.084, ?0.194, P>0.05) and no significant difference in cases with perioperative complications between the two groups ( P>0.05). ③ For 15 cases undergoing TLDG ≤28 days after ESD and 10 cases undergoing TLDG >28 days after ESD, the operation time of TLDG, cases with the volume of intraoperative blood loss <50 mL, 50 to 100 mL or >100 mL during TLDG, the number of lymph node dissected, time to postoperative drainage tube removal, duration of postoperative hospital stay, cases with perioperative complications were 190 minutes (range, 145 to 289 minutes), 2, 7, 6, 33(range, 8 to 57), 6 days(range, 4 to 11 days), 8 days(range, 6 to 31 days), 1 and 179 minutes(range, 124 to 240 minutes), 6, 2, 2, 37(range, 16 to 78), 6 days (range, 5 to 13 days), 8 days(range, 6 to 14 days), 1, respectively, showing no significant difference in the operation time of TLDG, volume of intraoperative blood loss during TLDG, the number of lymph node dissected, time to postoperative tube removal and duration of postoperative hospital stay between the two groups ( Z=?1.619, ?2.000, ?0.667, ?0.370, ?0.057, P>0.05), and no significant difference in cases with perioperative complications between the two groups ( P>0.05). Conclusions:Compared with cases undergoing TLDG directly, the operation time to TLDG and time to drainage tube removal after TLDG for cases undergoing ESD+TLDG are prolonged, but there is no difference in the short-term efficacy. For cases undergoing TLDG ≤21 days after ESD and cases undergoing TLDG >21 days after ESD, there is a significant difference in the operation time of TLDG.

OBJECTIVEThe clinical effect of the Shi's cervical reduction technique for cervical spondylosis and related disorders has confirmed, however, there were few studies on the body motion during manipulation in vivo study. This study is to summary the law of motion and the motion characteristics of the right operation shoulder, elbow, knee and ankle joints by data acquisition and analysis with the 3D motion capture system.

METHODSThe markers were pasted on the head, trunk, left and right acromion, elbow joint, wrist joint inner side and the outer side of the inner and the outer side and the lateral upper arm, forearm lateral, anterior superior iliac spine, posterior superior iliac spine, trochanter, femoral and tibial tubercle, inner and outer side of knee, ankle, fibular head, medial and lateral in first, 2,5 metatarsal head, heel and dual lateral thigh the calf, lateral tibia of one manipulation practioner, and the subject accepted a complete cycle of cervical "Jin Chu Cao and Gu Cuo Feng" manipulation which was repeated five times. The movement trajectory of the practioner's four markers of operation joints were captured, recorded, calculated and analyzed.

RESULTSThe movement trajectories of four joints were consistent, while the elbow joint had the biggest discrete degree. The 3D activities of the shoulder and elbow were more obvious than other two joints, but the degree of flexion and extension in the knee was significantly greater than the rotation and lateral bending.

CONCLUSIONThe flexibility of upper limb joint and stability of lower limb joint are the important guarantees for the Shi's cervical reduction technique, and the right knee facilitated the exerting force of upper limb by the flexion and extension activities. The 3D model built by the motion capture system would provide a new idea for manipulation teaching and further basic biomechanical research.

Adult ; Biomechanical Phenomena ; Cervical Vertebrae ; surgery ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Movement

The silicone tube flow chamber system has been used to study the effects of wall shear stress and circumferential stress on the cultured vascular endothelial cells (ECs). In solviong the problem of how to precisely simulate the wall shear stress and circumferential stress to which ECs are subjected under physiological conditions, it is very essential to select not only the appropriate geometrical and mechanical characteristic but also the proper preload and after-load of the silicone tube flow chamber. Firstly, a method to obtain the geometrical and mechanical characteristic of the chamber was given. Secondly, the procedure to simulate the two main mechanical stimuli under the physiological environment was proposed. Finally, the factors controlling the wall shear stress and circumferential stress were summarized.
Arteries ; cytology ; Biomechanical Phenomena ; Blood Flow Velocity ; physiology ; Cell Culture Techniques ; instrumentation ; methods ; Cells, Cultured ; Endothelial Cells ; cytology ; Humans ; Mechanotransduction, Cellular ; physiology ; Shear Strength ; Silicones ; Stress, Mechanical

Background More efforts have been made in the functional protection of the glaucoma ganglion cells (RGCs) nowadays.As main ingredient,astragalus polysaccharides (APS) enhances neuron regeneration protein expression and promotes peripheral nerve recovery.But whether APS has a protecting effect on RGCs is incompletely clear.Objective The purpose of this study was to evaluate the neuroprotective effect of APS on the RGCs in a rat model of experimental glaucoma.Methods Forty-four SPF SD rats were divided into 4 groups randomly as follows:normal control group,negative control group,low dose APS group and high dose APS group,with 10 rats for each group.APS of 500 mg/kg or 2000 mg/kg (2.5 ml) was administered by gavage feeding once daily for 2 weeks in low dose or high dose of APS group,respectively,and the same volume of normal saline solution was applied instead of APS in the model control group.Two weeks later,aspirate 0.2 ml aqueous followed by methylcellulose injected into the anterior chamber to create the acute ocular hypertension model in the three groups above.No any intervention was performed in the normal control group.The rats were sacrificed on the fifth day after model established to take a retinal section.Ocular hypertension-induced damage was evaluated by regular retina histopathologic examination.Immunolhistochemistry for caspase-3 and TUNEL kits were used to determine the expression of caspase-3 protein in retina and apoptosis rate of RGCs.Retinal cross-sections were analyzed by Image Pro Plus 5.1 software to determine the thickness of various retinal layers and the positive staining cell density in the retinal ganglion cell layer (RGCL).Results On the fifth day after establishment of models,intraocular pressure (IOP) was significantly elevated in the model control group,low dose APS group and high dose APS group in comparison with the normal control group (t=-8.900,-10.700,-11.300,P＜0.01).Retinal morphology was normal in the rats of the normal control group,but in the model control group,rat retina was significantly thickened from severe retinal edema and cell arrangement disorder.Mild retinal abnormality was seen in the low dose APS group;while obvious retina edema was in high dose APS group.The entire retinal thickness,outer nuclear layer thickness and retinal nerve fiber thickness values were lower in the low dose APS group than those of model control group (t =-23.700,-14.770,-11.640,P＜0.01).However,no difference was found in outer nuclear layer thickness and retinal nerve fiber thickness values between high dose APS group and normal control group (t =-0.780,-0.460,P ＞ 0.05).Percentage of positive RGCs for caspase-3 protein and rate of apoptotic RGCs were significantly reduced in low dose APS group compared with model control group (caspase-3:F=87.710,P=0.001;RGCs apoptosis:F=272.840,P＜0.01).Conclusions 500 mg/kg APS can protect retina and RGCs against ocular hypertension-induced damage.The protection of APS is non-dosedependent.

Objective To explore the correlations between the scarlet fever and meteorological factors in Zhejiang Province. Methods The data which was been analyzed including month case of scarlet fever and meteorological factors from JAN 2005 to DEC 201 4,were analyzed for the degree and characteristic of the correlations between the scarlet fever and meteorological factors with generalized additive model(GAM).Results There were negative correlation between scarlet fever and meteorological factors including water vapor pressure and hours of sunshine.There were complex nonlinear correlations between scarlet fever and meteorological factors including precipitation,average barometric pressure,average wind speed and average temperature .The relationship between scarlet fever and meteorological factors including average barometric pressure,average wind speed and average temperature showed approximate quadratic function.The precipitation above 3 500(0.1 mm),average barometric pressure above 1 0 200(0.1 hPa)and under 1 0 050(0.1 hPa),average wind speed between 1 8.7 -23.6 (0.1 m/s)and average temperature between 1 00 -250 (0.1 ℃) were the suitable meteorological condition for scarlet fever.Conclusion There were complex nonlinear correlations between the scarlet fever and meteorological factors.Precipitation,average barometric pressure,average wind speed and average temperature may be associated with the incidence of scarlet fever.

Objective To explore the situation and question of standardized training of residents/graduate students in cardiac surgery by questionnaire survey. Methods From September 2010 to May 2012, 61 resident physicians/graduate students were chosen as research objects in Department of Cardiac Surgery, Peking University Third Hospital. A total of 61 questionnaires were sent out, with a recovery rate of 100%,and an effective rate of 95.1%.The contents of investigation included standardized training content design, standardized training management, the time and"environment" pressure, compliance training effect analysis,student opinion and others,a total of 14 options.EpiData 2.1a software was used to sort and record the data. SPSS 17.0 software was used for statistical analysis. The enumeration data were compared by chi square test.Results During the period of training,the most expected teaching method was"small lecture", accounting for 63.8%; The most difficult part of the process of cardiac surgery training was "postoperative care", accounting for 69%; 100% of the trainees thought that it would be helpful for future work through cardiac training;8.3% of the trainees thought the teachers of cardiac surgery teaching consciousness was not strong; resident weekend "in the hospital" was higher than the proportion of graduate students, and most graduate students chose weekend "in the experiment and research work", the difference was statistically significant (P<0.05). Conclusion Appropriate standardized training program should be combined with the students' background; Teaching team construction and clinical reasonable and effective clinical skills train-ing system is an important link to ensure the quality of teaching.The combination of residents' standardized training and postgraduate education of professional degree remains to be tracked and evaluated in a long time.The feedback from all aspects of the training should be paid more attention to,and the training details should be improved.

OBJECTIVETo investigate the effects of metformin on the proliferation and apoptosis of human oral cancer cell line KB in vitro.

METHODSHuman oral cancer cell line KB was exposed to different doses of metformin (0, 1.25, 2.5, 5, 10, and 20 mmol/L), and the changes in cell viability were detected using MTT assay. Colony formation of the cells was observed following an 8-day metformin exposure. The changes in mitochondrial membrane potential were measured by JC-1 assay, and PI staining was used to observe the cell apoptosis. Western blotting was employed to detect the changes in the protein expressions of GRP78 and activated caspase-3.

RESULTSMetformin exposure caused time- and dose-dependent suppression of KB cell proliferation, and exposure to 5 mmol/L metformin for 24, 48 and 72 h resulted in cell survival rates of 68.0%, 36.9%, and 14.5%, respectively. Metformin significantly inhibited KB cell colony formation. Exposure of the cells to increased concentrations of metformin gradually increased the apoptotic rate and decreased mitochondrial membrane potential. Metformin caused an initial up-regulation followed by a down-regulation of GRP78 expression in KB cells and increased the expression of activated caspase-3.

CONCLUSIONMetformin can inhibit the proliferation and induce apoptosis of KB cells, the mechanism of which may involve the activation of the mitochondrial apoptotic pathway and endoplasmic reticulum stress.

Apoptosis ; drug effects ; Caspase 3 ; metabolism ; Cell Proliferation ; drug effects ; Heat-Shock Proteins ; metabolism ; Humans ; KB Cells ; Membrane Potential, Mitochondrial ; drug effects ; Metformin ; pharmacology

Objective To analyze the characteristics of school public health emergencies in Zhejiang Province, and to provide current suggestions for prevention and control. Methods A descriptive epidemiological analysis was conducted for the public health emergencies occurred in schools from 2014 to 2016 in Zhejiang Province. The data was derived from Emergency Public Reporting System. Results A total of 100 public health emergencies occurred in schools and 3 784 cases were reported during 2014-2016 in Zhejiang Province, meanwhile no death occurred. There were two peak seasons every year for the emergency report. Forty percent of the emergencies were reported during November to January of the following year, and 31.00 % were during April to May. The emergencies occurred on all the municipal districts when Ningbo accounted for 50.00%. The schools and kindergartens in rural area, town and urban area reported 37, 28 and 35 emergencies respectively. The main etiology of emergencies included varicella(37.00%), hand-foot-mouth disease(29.00%), norovirus(22.00%). The median duration of varicella outbreaks was 31.67d, which was longer than others. The scale of influenza and norovirus outbreaks were larger, and the median cases were 76 and 49 respectively. The time of emergencies detecting was significantly different between different detecting patterns. Conclusion The prevention and control of school emergencies was still urgently. There were still some deficiencies in the identification and active reporting of the epidemic, which need to be solved, while taking advantage of the surveillance system for sick absence. The future strategies should focused on reinforcing immunization and improving health habits to promote school health.

BACKGROUND:The use of normal hyaline cartilage to repair large areas of full-thickness knee cartilage defect has been a hot topic recently; however, a follow-up study with a relative large number of patients is required. OBJECTIVE:To make a preliminary study concerning the methods and therapeutic effects of tissue-engineered cartilage (TEC) implantation for treating large-area full-thickness knee cartilage defects. METHODS:Twenty-one patients (23 knees) diagnosed with cartilage defect of the knee joint (Outbridge III-IV) were enrolled. The area of the cartilage defect was 3.5-11.2 cm2. All of the patients were given TEC treatment. Postoperative functional exercise of the knee joint was carried out in these patients as planned. We regularly reviewed the knee MRI and calculated visual analog scale score, International Knee Documentation Committee (IKDC) score, and Lysholm score. RESULTS AND CONCLUSION:All the patients were followed up for 3 to 12 months. Postoperatively knee pain relieved obviously, and the visual analog scale score was significantly declined compared with the preoperation (P<0.05). All the patients manifested painless 1 year after surgery. The 1-year postoperative MRI showed that the injured cartilage grew well. The thickness and MRI signal of the graft was the same as the normal cartilage, and the bone healed completely. The IKDC and Lysholm scores were significantly improved at 3, 6, 12 months after the surgery, and the difference was statistically significant before and after the surgery (P<0.05). Overall, TEC is an improved technique of chondrocyte implantation, which is an effective and safe method for cartilage defect repair.