BACKGROUND:Periprosthetic fracture of the femoral of the knee after total knee arthroplasty is one of the common complications,and there is a lack of biomechanical research on the periprosthetic fractures of the femoral of the knee under different bone strength conditions.The three-dimensional finite element analysis can provide a biomechanical basis for clinical practice. OBJECTIVE:To investigate the biomechanical changes of anterior femoral notching after total knee arthroplasty under different bone strengths,and to provide a mechanical basis for the clinical prevention of supracondylar femoral periprosthetic fractures after knee arthroplasty. METHODS:The femoral CT data of healthy adults were obtained,and the three-dimensional model of femoral lateral replacement of the knee joint was established by Mimics,Geomagic studio,and Solidworks software.Anterior femoral notching models of different depths were constructed,and the models were imported into ANSYS software to analyze the changes of biological stress on the femoral condyle with different bone strengths and different anterior femoral notching depths.The stress changes of the femoral anterior condyle section after and before the filling of anterior femoral notching with bone cement were analyzed. RESULTS AND CONCLUSION:(1)Under any bone strength,the supracondylar stress increased with the depth of anterior femoral notching.In normal bone conditions,there was a stress abrupt change point when the anterior femoral notching depth was between 3 mm and 4 mm.In the case of osteoporosis,there was a stress abrupt point when the anterior femoral notching depth was between 2 mm and 3 mm.(2)When anterior femoral notching occurred during knee arthroplasty and the depth exceeded the thickness of the bone cortex,the supracondylar stress of the femoral gradually increased as the bone strength decreased.(3)The stress of the anterior femoral condyle section decreased when the model with an anterior femoral notching depth of 3 mm was filled with bone cement.(4)The results show that anterior femoral notching should be avoided during knee arthroplasty,especially in patients with osteoporosis.If anterior femoral notching occurs during surgery,bone cement can be used to evenly fill the anterior femoral notching to reduce the supracondylar stress of the femur and reduce the incidence of periprosthetic fractures of the femoral joint

This paper summarized PENG Qinghua's experience in treating age-related dry eye based on the theory of ministerial fire. Guided by the theory of ministerial fire， it is believed that the key pathogenesis of age-related dry eye is transgression of ministerial fire， and kidney yang deficiency-cold， kidney yin depletion， and spleen-earth insufficiency are the causes of transgression of ministerial fire. The general principle of treatment is to conceal the ministerial fire. For kidney yang deficiency-cold and floating ministerial fire， the treatment should tonify the kidney and warm yang， and return fire to its origin， with Yin Huo Decoction （引火汤）； for kidney yin depletion and frenetic stirring of ministerial fire， the treatment should tonify the kidney and supplement essence， enrich yin and reduce fire， with Sancai Fengsui Pellet （三才封髓丹）； and for spleen-earth insufficiency， and fumigation of ministerial fire， the treatment should strengthen and activate spleen qi， and reinforce soil and hidden fire， with Renshen Huangqi Decoction （人参黄芪汤）.

Objective:To compare the in vitro antibacterial activities of Cefpodoxime proxetil and Cefixime against common pathogens of community acquired pneumonia in children, and to provide basis for guiding the rational use of antibiotics in clinical practice. Methods:The pathogens of 100 cases of community acquired pneumonia in Children′s Hospital of Jiangxi Province from June 2018 to October 2019 were analyzed retrospectively.The sensitivity and resis-tance of these pathogens to Cefpodoxime proxetil and Cefixime were measured separately by the broth dilution method (tube) recommended by the Clinical & Laboratory Standards Institute (CLSI), and the results were compared.Results:(1)The 50% minimum inhibitory concentration(MIC 50) and MIC 90 values of Cefpodoxime proxetil to Streptococcus, Haemophilus influenzae and Moraxella catarrhalis were all within the sensitive range, showing that Cefpodoxime proxetil had a strong antibacterial effect.The MIC 50 values of Cefixime to Streptococcus pneumoniae and Haemophilus influenza were within the sensitive range, while the MIC 90 values showed that these two types of bacteria were resistant to Cefixime.The remaining bacteria were resistant to Cefpodoxime proxetil and Cefixime to varying degrees.(2)The minimum bactericidal concentration (MBC) ranges of Cefpodoxime proxetil to Streptococcus pneumoniae and Haemophilus influenzae were significantly lower than those of Cefixime to these two types of bacteria, indicating that Cefpodoxime proxetil had stronger bactericidal activities than Cefixime.The MBC 50 and MBC 90 values of the two drugs to Moraxella catarrhalis, β-Streptococcus pyogenes and Streptococcus lactis were still within the sensitive range of MIC, suggesting that both drugs had a strong bactericidal effect.The remaining bacteria showed resistance to the two drugs to varying degrees.(3)The sensitivity rates of 100 selected pathogens to Cefpodoxime proxetil and Cefixime were 70.00% (70/100 strains) and 57.00% (57/100 strains), respectively.The resistance rates of the 100 pathogens to the two drugs were 22.00% (22/100 strains) and 39.00% (39/100 strains), respectively, and the difference between the two groups was statistically significant ( χ2=7.40, P=0.03). Conclusions:Cefpodoxime proxetil has high sensitivity to common pathogens of children with community-acquired pneumonia, so it can be used as the initial empirical treatment of respiratory tract bacterial infection in children.It is also an appropriate sequential antibiotic therapy for common respiratory tract bacterial infection in children.

Objective To investigate the clinical manifestations and genetic features of children with papillorenal syndrome caused by PAX2 gene mutation.Methods Clinical manifestations,imaging changes and sequencing data were collected and analyzed from a family with papillorenal syndrome who were diagnosed in Wuhan Children's Hospital in February 2018."PAX2","papillorenal syndrome" and "renal coloboma syndrome" were used as key words to search in China National Knowledge Infrastructure,Wangfang Data Knowledge Service Platform,PubMed and Human Gene Mutation Database up to April 2018.Results A ten years old girl was admitted due to "edema and urine output decreased for one week".Lab showed BUN 25.30 mmol/L,Scr 766.5 μmol/L,Urine protein 3.6 g/24 h.Imaging examination showed bilateral vesical and ureter reflux combined with left duplex kidney and duplication of ureter.Developmental dysplasia of the left hip was also found.The father of the patient had been diagnosed with chronic kidney disease for 10 years and on hemodialysis for 6 years.Next generation sequencing revealed that both the father and daughter carried a heterozygous nonsense mutation in the exon3 c.219C ＞ G(p.Y73X) of PAX2.No Chinese literature ever was reported about papillorenal syndrome.Ninety-four articles in English were retrieved and 177 patients with papillorenal syndrome were confirmed by gene analysis with a total of 92 PAX2 variants.Ten nonsense mutations had been reported.Developmental dysplasia of the hip (DDH) never be reported before.Conclusion Papillorenal syndrome caused by PAX2 mutation can mainly manifest as abnormal development of both kidney and optic nerve,which may be accompanied by other systemic abnormalities,it is rarely reported in China.DDH may be a new phenotype of papillorenal syndrome.

Objective: To explore the correlation between blood pressure and urinary phthalandione, MMP, MEP, MnBP, MiBP, PAEs. Methods: Three schools were selected from Shenzhen, China for the present study. A total of 765 firstgrade students of Han ethnicity were recruited voluntarily from the selected schools during September 2016 to June 2017. They were divided into normal blood pressure (BP) group (lower than P90 group) and high BP group (BP≥P90). Linear and Logistic regression models were used to analyze the relationships between blood pressure and urine phthalate metabolite levels. Results: Urinary MMP and MnBP in students of high BP group were significantly higher than that of students in normal BP group(t=13.12, 3.97, P<0.05). Linear regression models showed that Z score increased when MMP and MnBP levels increased(P<0.05). Logistic regression model suggested that the risk of high BP increased with the increment of MMP level adjusting creatinine, sex, age and BMI(OR=1.47, P<0.05). There was no statistical significance in the differences after adjusting many factors including family income and education level of parents(P>0.05). Conclusion Urinary phthalate metabolite levels are positively associated with blood pressure in first-grade children.

Objective To observe the changes of potassium ion (K+), lactic acid (Lac) and glucose (Glu) in swine with traumatic hemorrhagic shock (THS) inside the dry-heat environment and to explore its possible mechanism. Methods A total of 40 local Landrace piglets were randomly(random number) divided equally into 4 groups: the normal temperature sham operation group (NS), the normal temperature traumatic hemorrhagic shock group (NTHS), the dry-heat sham operation group (DS group) and the dry-heat traumatic hemorrhagic shock group (DTHS). The experiment was carried out in the artifi cia climate cabin simulated the special environment of northwest of China. After exposed to their respective environment[dry-heat environment: (40.5±0.5), plus(10±2)% humidity; normal temperature environment: (25±0.5), plus(35±5)% humidity] for 3 h. Laparotomy were performed in swine of all groups, and then splenectomy and partial hepatectomy were performed only in NTHS and DTHS. The process of exsanguination from the external iliac artery was established to make the MAP reaching to 40-50 mmHg, and thus the traumatic hemorrhagic shock model of swine was successfully made. Blood samples were collected from external iliac artery at different intervals including the time just after exposure for 3 h and the successful establishment of traumatic hemorrhagic shock model (0 h) and then every 30 min after 0 h, serum levels of K+, Lac and Glu were detected. The features of varied serum K+, Lac and Glu were observed in each group. All data were statistically analyzed using One-way ANOVA and Pearson correlation analysis. Results After exposed , the level of serum K+inside the dry-heat environment was higher than that of swine inside the normal temperature group ( P<0.01), however the Glu level was lower in the swine inside dry-heat environment than that of swine inside the normal temperature ( P<0.01).The level of serum K+and Lac of DTHS group were rapidly increased from the establishment of the model to the death in about 3 h, while those of NTHS group were increased slowly. The level of K+and Lac were positively correlated in the two groups amd the correlation coeffi cient were rDTHS=0.927 (P<0.01) and rNTHS=0.539 (P<0.01),respectively. The level of Glu was progressively decrease in DTHS group, while in NTHS group, it was not noticeable. The level of K+and Glu were negatively correlated in the two group, the correlation coeffi cient were rDTHS=-0.804 (P<0.01) and rNTHS=0.420 (P<0.01),respectively. Conclusions The changes of serum K+, Lac and Glu occurred sooner and more obvious in traumatic hemorrhagic shock models inside dry heat environment (DTHS) group than those in NTHS group. The level of serum K+positively correlated with Lac, however, negatively correlated with Glu, which suggested that hyperkalemia and acidosis should be paid more attention to the treatment of traumatic hemorrhagic shock inside the dry heat environment, and the hypoglycemia should be treated at the same time.

BACKGROUND: Previous studies have demonstrated that the well combination of decellularized matrix and appropriate seeded cells could construct a tissue-engineered kidney.OBJECTIVE: To review advances in kidney tissue engineering and decellularized matrix.METHODS: The first author retrieved CNKI, Wanfang and PubMed databases for articles addressing kidney tissue engineering published from January 1996 to April 2016. The key words were decellularized matrix,extracellular matrix,tissue engineering, kidney, seeded cells in English and Chinese,respectively.RESULTS AND CONCLUSION: The decellularized matrix loses its immunogenicity due to the removal of cellular components, while it retains the important bioactive components of the extracellular matrix and the ultrastructure of the tissues and organs, making it more and more important in kidney tissue engineering. The decellularized matrix especially exerts an important role in the tissue-engineered construction of the entire kidney as driven by recently emerging all-organ acellular cell technology. Remarkable advances in kidney tissue engineering and decellularized matrix have been made in recent years, and realized the construction of a certain functional tissue-engineered kidney. However, there are still many challenges on the way to construct a completely functional tissue-engineered kidney.BACKGROUND: Previous studies have demonstrated that the well combination of decellularized matrix and appropriate seeded cells could construct a tissue-engineered kidney.OBJECTIVE: To review advances in kidney tissue engineering and decellularized matrix.METHODS: The first author retrieved CNKI, Wanfang and PubMed databases for articles addressing kidney tissue engineering published from January 1996 to April 2016. The key words were decellularized matrix,extracellular matrix,tissue engineering, kidney, seeded cells in English and Chinese,respectively.RESULTS AND CONCLUSION: The decellularized matrix loses its immunogenicity due to the removal of cellular components, while it retains the important bioactive components of the extracellular matrix and the ultrastructure of the tissues and organs, making it more and more important in kidney tissue engineering. The decellularized matrix especially exerts an important role in the tissue-engineered construction of the entire kidney as driven by recently emerging all-organ acellular cell technology. Remarkable advances in kidney tissue engineering and decellularized matrix have been made in recent years, and realized the construction of a certain functional tissue-engineered kidney. However, there are still many challenges on the way to construct a completely functional tissue-engineered kidney.

Objective:To study the characteristics of intestinal tract pathological injury of rats in hypobaric hypoxia at different high altitude.Methods:30 male SD rats were randomly divided into 5 groups:Plain group (n=6),High-altitude (HA) 5000 m for 10 day group(n=6),HA 5000 m for 21day group(n=6),HA 6500 m for 10day group(n=6),HA 6500 m for 21day group (n=6).Rats were raised normally either in plain or simulated high altitude environment,at the corresponding time point,rats were euthanized,small intestines were harvested,fixed tissues were processed routinely into paraffin and sections were stained routinely with hematoxylin and eosin.Morphologic parameters were measured by optical microscope and then the pathological injury score were evaluated.Results:The pathological injury scores ofjejunnm and ileum in the high altitude group were significantly higher than that of the plain group (P＜0.01),the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 5000 m for 21 day group than that of the HA 5000 m for 10 day group,but significant lower than that of the HA 6500 m for 21 day group,the pathological injury scores of jejunum,ileum and colon were significantly higher in the HA 6500 m for 10 day group than that of the HA 5000 m for 10 day group(P＜0.01,P＜0.05).The pathological injury scores of colon were significantly higher in the groups of the high altitude than the plain group except for the HA 5000 m for 10 day group (P＜0.01,P＜0.05).The pathological injury scores of jejunum had significant different with that of the colon in the HA 5000 m for 21 day group (P＜0.05);the pathological injury scores of both jejunum and ileum had significant different with that of the colon in the HA 6500 m for 21 day group(P＜0.05,P＜0.01).Conclusions:The injuries of the intestinal mucosa became serious with the with rising altitude and the stayed time,the intestinal injuries were more serious than that of colon at same situation,however there were no significant different between jejunum and ileum,the injuries of colon happened later than intestine,and they correlated with the stay time in the high altitude,which indicated that intestinal injury should be pay more attention in the early time of entering the hypobaric hypoxia environment of the high altitude.

Objective To make a systematical review of the efficacy and safety of endoscopic variceal ligation versus endoscopic variceal sclerotherapy for treatment of esophageal variceal bleeding. Methods We electronically searched databases including PubMed, Web of Science, The Cochrane Library (Issue 2, 2016), CNKI, WanFang Data and from Jan., 1980, to Mar., 2015, collected randomized controlled trials (RCTs) about EVL versus EVS for the patients of esophageal variceal bleeding. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 24 studies including 2020 patients were included. The results of meta-analysis showed that, there were no signiifcant differences in the variceal eradication rate (RR=1.04, 95%CI 0.99 to 1.09, P=0.090) between the EVL group and the EVS group; Compared with the EVS group, the EVL group could significantly reduce the rate of variceal rebleeding (RR=0.69, 95%CI 0.59 to 0.81, P=0.000), the rate of mortality (RR=0.76, 95%CI 0.63 to 0.90, P=0.002) and the rate of complication (RR=0.41, 95%CI 0.26 to 0.63, P=0.000), but the rate of variceal recurrent rate of EVS group was lower than that of the EVL group (RR=1.67, 95%CI 1.40 to 2.01,P=0.000). Conclusion Current evidence shows that, the variceal eradication rate between EVL and EVS is similar, but the EVL has less incidence of variceal rebleeding and mortality and complication.

Objective To investigate the expression of circulating microRNA (miRNA) of rats with hypobaric hypoxia‐induced pulmonary hypertension (HPH) .Methods Commercial rat miRNA microarray was employed to detect and analyze the circulating miRNA profile in the serum samples of Sprague‐Dawley rats with hypobaric hypoxia‐induced HPH and controls .Furthermore ,differentially expressed candidate circulating miRNAs between HPH and control groups were validated by Real‐time quantitative PCR based on the case‐control study ,and receiver operating characteristic curve (ROC ) analysis was used to test the performance of four differentially expressed circulating miRNAs in discriminating HPH and control groups .Results Compared with those in the control group ,13 upregulated miRNAs and 10 downregulated miRNAs were identified in hypobaric hypoxia‐induced HPH rats by using miRNA microarray . And differentially expressed miR‐451 , miR‐505 , let‐7d and miR‐214 were validated by using RT‐PCR .ROC analysis showed that the area under the curve of miR‐451 ,miR‐505 and let‐7d was 0 .979 ,0 .938 and 0 .993 in discriminating HPH and control groups ,respectively .Conclusion The aberrant expression of circulating miR‐451 ,miR‐505 and let‐7d in serum may be correlated with the pathogenesis of HPH .