Objective To observe the clinical effects and security of spinal-epidural anesthesia in elderly patients with hip replacement.Methods 40 elderly patients classified Ⅱ ～ Ⅲ grade by ASA,treated by hip replacement and spinal-epidural anesthesia,the SBP,DBP,HR,SpO2 at preceding anesthesia,5min,10min,15min,30min after anesthesia was observed,and the influence of anesthesia on hemodynamics was evaluated.Results After anesthesia,the SBP,DBP,HR,SpO2 had no significant difference with preceding anesthesia,had no naupathia,sick up and headache.Conclusion The combined spinal-epidural anesthesia has effect on hemodynamic,safe for the elderly patients therapy by hip arthroplasty anesthesia.

ObjectiveTo investigate current status of community health management for hypertensive patients.Methods A total of 59 communities from 5 provinces of China were selected by cluster sampling methods,and 55 communities responded.The detailed health management for hypertensive patients was collected through structured interviews. Results (1) Self-management support in health education:the rates of diet control,physical exercise and medication guide were 100.0％ (55/55),96.4％(53/55) and 98.2％ (54/55),respectively,and the rates of home blood pressure monitoring,patientdoctor cooperation,and social mental guidance were 83.6％ (46/55),85.5％ (47/55) and 85.5％ (47/55),respectively.(2) Delivery system redesign:the rates of doctor training,branch cooperation,routine follow-up study and health promotion were 100.0％ ( 55/55 ),67.3％ ( 37/55 ),72.7％ (40/55) and 74.5 ％ (41/55),respectively.(3) Decision support:the rates of embedding evidence-based guidelines on daily clinical practice,expert consultation and health maintenance were 72.7％ (40/55),67.3％ (37/55)and 92.7％ (51/55),respectively.(4) Clinical information systems:the usage rates of long-term followup or monitoring system were 80.0％( 44/55 ) and 89.1％ ( 49/55 ),respectively. ( 5 ) Community resources and policies:the rates of health promotion,environment supporting and community action were 96.4％ (53/55),72.7％ (40/55) and 85.5％ (47/55),respectively.(6) Health system support:the rates of using effective evaluation indexes,senior leader supporting,continuous policy making and increased reimbursement of medical insurance in health-care organizations were 81.8％ (45/55),85.5％ (47/55),74.5％ (41/55) and 61.8％ (34/55),respectively.The rates of providing incentives,increasing staff in community,encouraging general practitioner to participate in policy making and increasing the salary of general practitioner were 58.2％ (32/55), 50.9％ ( 28/55 ), 54.5％ ( 30/55 )and34.5％ ( 19/55 ),respectively.ConclusionThe community hypertension management in some areas of China considers the principles of chronic disease models,and may play an important role in the prevention and control of high blood pressure in communities.

Objective To improve clinicians' understanding of tuberculosis as the adverse event of the tumor necrosis factor alpha (TNF-α) antagonists therapy. Methods Two rheumatoid arthritis (RA) patients were reported to develop lymphoid tuberculosis and pulmonary tuberculoma after TNF-α antagonists therapy. The relevant literature were reviewed. Results The first ease was a 62 year-old female RA patient. Her skin PPD reaction was negative and chest X-ray was normal before the therapy. Following 4 doses of infliximab injection (each dose of 3 mg/kg) which were completed within 3 months, the patient developed fight supraclavicular lymphoids tuberculosis in the 5th month after the last treatment. The patient completely recovered after lymphoids excision and antituberculosis therapy with 4 anti-tuberculosis medications combination. The second case was a 44 year-old female RA patient. She did not take the skin PPD test and chest X-ray before the therapy. The patient developed fever and chest distress after etanercept therapy (25 mg hypodermic twice per week ) for 1.5 months. The chest X-ray showed a shadow in the median lobe of the right lung, which had gradually developed to a pulmonary tuberculoma. The patient's physical condition improved after the tubereuloma resection. It has been reported in recent years that ① TNF-α antagonists therapy could increase the incidence of tuberculosis, ② the incidence at which infliximab associated tuberculosis was higher than etanercept, ③ the majority of the patient having tuberculosis were old people, and ④ the incidence of extrapulmonary tuberculosis and the disseminated tuberculosis were higher than regular tuberculosis. Conclusion TNF-α antagonists may decrease the host defense ability against mycobacterium tuberculosis and increase the incidence of tuberculosis. The pre-treatment tuberculosis screening, as well as tuberculosis monitoring during and after treatment is mandatory.

Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study.All subjects received one dose of 25 mg rhTNFR:Fc injected to the target knee joints after synovial fluid being drawn away before injection.They were followed up for four weeks after injection.The primary end-point was the 4-week change in the moditied hospital for special surgery (HSS) knee score for the target knee.The secondary end-point were the 4-week change in patients assessment of the knee,and investigators assessment of knee,pain VAS of the knee joint when walking or standing,the range of knee inflexion,circumference of the knee cross section,synovium thickness detected by ultrasound in the part of the thickest synovium in the suprapatellar bursa.Paired t test,independed t test and Wilcoxon test were used for statistical analysis.Results Twenty-seven SpA patients and fifteen RA patients were included in the trial.The modified HSS knee score for the SpA group was 66±14 at baseline,86±11 (P＜0.05) at follow-up,and for the RA group,the score was 64±13 at baseline,80±9 (P＜0.05) at follow-up.24.2％ (16.5％-41.9％) improve-ment on the modified HSS knee score was achieved in the SpA group,while 22.2％ (15.3％-37.7％) improvement on the modified HSS knee score was achieved in the RA group (P＞0.05).31.8％ (9.3％-57.3％) improvement on the synovium thickness was achieved in the SpA group,while 1.5％ (-19.3％-25.5％) improvement on the synovium thickness was achieved in the RA group (P＜0.05).Adverse events were observed in six patients in SpA group and two patients in RA group.No serious adverse events had been observed.Conclusion Single intra-articular rhTNFR:Fc injection is an effective and safe therapeutic option for knee arthritis in both SpA and RA patients.This treatment may relieve knee synovitis in SpA patients more effectively than in RA patients.

96 anterior teeth with different degree of caries in 80 patients were randomly divided into 2 groups(n =48 teeth,40 patients). In the experimental group the teeth were repair with nanometer resin filling,in the control group with ceramic crown.In 0.5 to 1 year follow-up,the satisfaction rate and the clinical success rate were similar in the 2 groups(P >0.05).Application of nano resin aesthetic restoration can lower tooth injury,postoperative complications and the cost.

Objective:To detect the expressions of COX-2 protein and BCL-2 protein in transitional mucosa adjacent to rectal carcinoma,and determine whether the transitional mucosa was the cancer precursor event.Methods:Mucin histochemical method was employed to detect the distal mucosa 2 cm away from rectal tumor and the transitional mucosa was found in 54 cases of rectal carcinoma.Immunohistochemical method was used to investigate the expressions of BCL-2 and COX-2 protein in the specimen of rectal carcinoma mass,transitional mucosa and non-transitional mucosa,and 20 cases of normal rectal mucosa,and the points of the expressions of COX-2 protein and BCL-2 protein were counted.Results:35.19%(19/54)of distal mucosa were characterized as the transitional mucosa.The expressions of COX-2 and BCL-2 protein were detected in carcinoma mass and distal mucosa.Significant difference was observed in carcinoma mass and transitional mucosa(p<0.01).But there were no significant differences between the expressions of those in transitional mucosa and non-transitional mucosa(p>0.05),as well as transitional mucosa and normal mucosa(p>0.05).Conclusion:The performance of transitional mucosa was not the cancer precursor event,but the non-specificity reaction of carcinoma or inflammation.

Objective To explore the influence of self-concealment level on patients'quality of life and clinical curative effect for curing refractory chronic prostatitis(RCP)by high-intensity focused ultrasound(HIFU). Methods Patients of RCP who meet the diagnostic criteria were assessed with the Self-Concealment Scale(SCS), TDL's table of self-assessing quality of life and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI).The patients whose SCS score were above the average score plus a standard deviation were taken as the high SCS group,and whose SCS Score were below the average score minus a standard deviation were taken as the low SCS group.The scores for CPSI and TDLs table of self-assessing quality of life and the clinical curative effect of the two groups were determined before and after the treatment by HIFU, respectively.Results The SCS score(35.75±10.34) of the RCP patients before HIFU treatment was significantly higher than the norm for male college students(29.20±8.73)(t=4.26,P<0.01).Two and six weeks after the HIFU application,the CPSI of both the high and the low SCS group decreased significantly(P<0.01),and the CPSI of the low SCS group de-creased more greatly than that of the high SCS group(P<0.01).The scores for TDL Life Quality Scale of low SCS group were significantly higher before and after two and six weeks'HIFU treatment than that of high self-concealment group(P<0.01).The TDL quality of life scale score of thelow SCS group increased respectively after two and six weeks'HIFU treatment (P<0.01),while for the high SCS group,this score increased only after six weeks' HIFU treatment(P<0.05).Six weeks after HIFU treatment,the clinical curative effect for the low SCS group was, observably better than that for high self-concealment(P<0.05).The SCS scores was significantly positive with CPSI scores(P<0.01),and significantly negative with the scores of TDL Life Quality Scale (P<0.01).Conclusion The symptom abatement,quality of life and clinical curative effect the RCP patients with a high self-concealment level were respectively worse after the HIFU treatment than that for whom with a low self-concealment level.

Objective To compare the effects of short- term high- intensity interval training (HIT) and moderate continuous training (MCT) on inflammatory mediators for healthy young males. Methods 19 healthy young male volunteers were randomized into HIT group (n=6), MCT group (n=7) and no training control (CON, n=6) group. The groups of HIT and MCT accepted treadmill exercise once per 2 days to 6 times (2 weeks), and the CON group did not accepted treadmill exercise. The levels of high-sensitive C-reactive protein (hs-CRP), interleukin (IL) -1α, IL-6 and tumor necrosis factor α (TNF-α) were detected 3 days before exercise, immediately after the first exercise, 3 days after the course. Results There was no difference among groups in the level of hs-CRP, IL-1α, IL-6 and TNF-α in all the time (P>0.05). The concentration of IL-1α increased in the MCT group after the first exercise (P<0.01), and also the concentration of IL-6 in the CON group after the course (P<0.05). Conclusion It needs further srudy for the significance of HIT and MCT in the levels of inflammatory media.

OBJECTIVE: To explore the effects of different analgesia methods after UPPP. METHOD: Ninety cases of patients uvulopalatopharyngoplasty were divided into 3 groups randomly, and 30 cases in each group. The group A was the blank control group without any analgesia measures. The cases in group B were treated with intramuscular injection of parecoxib sodium 40 mg after surgery immediately, and continued injecting 40 mg after 12 hours, 24 hours and 36 hours respectively. 100 mg tramadol replaced 40 mg parecoxib sodium in group C. The VAS scoring was performed after surgery 12, 24, 36, 48, 72, 96 hours in 3 groups, and we observed adverse reaction such as lethargy, nausea, vomiting, dizziness, skin rash and so on. RESULT: The group B and C reduced the pain significantly compared with blank control group. The pain scores in group B were significantly decreased than that in group C (P<. 05). CONCLUSION The analgesic effect of parecoxib sodium after UPPP is significant and better than tramadol. It is worthy to use widely in clinical due to its better effect and less side effect.
Analgesia ; methods ; Analgesics ; therapeutic use ; Humans ; Injections, Intramuscular ; Isoxazoles ; therapeutic use ; Pain Measurement ; Pain, Postoperative ; Palate ; surgery ; Pharynx ; surgery ; Tramadol ; therapeutic use ; Uvula ; surgery

Objective To investigate the predictive value of T,B,and NK lymphocyte subsets jointly detected in poor prognosis in patients with sepsis.Methods Totally 101 patients with sepsis were enrolled for prospective study.The percentages of lymphocyte sub-populations in peripheral blood were detected within 48 h after admission.The outcomes of patients during hospitalization were observed by follow-up study.The predictive value of lymphocyte sub-populations jointly detected in death risk was assessed.Results The percentages of CD3,CD3 +/CD4 + in patients with septic shock were lower than those in patients with mild/moderate sepsis and severe sepsis.The percentages of CD3+/CD8+,CD3-/CD19 +,CD4 +/CD8 + in patients with severe sepsis and septic shock were lower than those in patients with mild/moderate sepsis.The percentage of CD (16 +56) + in severe sepsis and septic shock was higher than that in mild/moderate sepsis group (P ＜ 0.05).The total number of monocytes in the deaths was higher than that in survivals.The percentages of CD3,CD3-/CD19 +,CD3 +/CD4 +,CD4 +/CD8 + were lower in deaths than those in survivals (P ＜ 0.05).The CD3-/CD19 +,CD3 +/CD8 and CD4 + / CD8 + were protective factors against sepsis with their OR values of 0.235,0.006 and 0.108,respectively.The ROC curve of lymphocyte subsets jointly detected,APACHE]] score and SOFA score to predict the risk of death were 0.993,0.877 and 0.848,respectively.The misjudgment rate of discriminating disease severity function of lymphocyte subgroups jointly detected was 19.8％,and that of outcomes was 4％.Conclusion The percentages of lymphocyte sub-populations in patients with sepsis is abnormal,and therefore,the lymphocyte subgroups jointly detected has value in the judgment of disease severity and prognosis in patients with sepsis.