The use of five or more drugs (polypharmacy) is common problem in the elderly,and need to attach importance.Optimization of drug treatment is a major part of medication in older adults,and also is a challenge to clinical physician.Beers Criteria provided by American Geriatrics Society (AGS) is a strong guarantee for improving medication safety in older adults

This paper reports a brief account of current research work on Oenotherae biennis L., including the utilization of nature resource, pharmacological action and clinical efficacy.

BACKGROUND: The previous methods for the repair of tendon defect include end-to-end method, autologous tendon graft, tendon al ograft or artificial tendon transplantation, but each method has its advantages and disadvantages. OBJECTIVE: To investigate the feasibility of constructing tissue-engineered tendon by rabbit bone marrow mesenchymal stem cells as seed cells which were induced by bone morphogenetic protein 12 and with col agen-polyglycolic acid composite as frameworks in the repair of rabbit tendon defects. METHODS: Bone marrow was separated from rabbit proximal femur to harvest cells, and the cells were passaged to the second generation and induced with 10 μg/L bone morphogenetic protein 12. Then the passage 2 cells were implanted into the prefabricated tissue-engineered tendon on the polyglycolic acid stitch with certain percentage together with col agenⅠsolution. The rabbits were used to establish the Achil es tendon defect models, and different methods were used to repair Achil es tendon defect: tissue-engineered tendon, col agenⅠ-polyglycolic acid stitch and end-to-end suturing in silk. Morphology, mechanics and shistopathology of the tissue-engineered tendon were observed. RESULTS AND CONCLUSION: Pathomorphological observation of histological section after 12 weeks showed that multiple fusiform fibroblasts were homogeneously distributed in col agen in the direction of stress mechanics.Fibrocytes increased obviously, new smal vessels could be seen and col agen was found aligned compactedly. In col agen Ⅰ-polyglycolic acid stitch group, a part of fibroplasia hyperplasia accompanied by granulation tissue formation could be seen, the col age fibers were in loose filamentous network and the cells were distributed disorderly and unevenly. Granulation tissue formed around the fibrous tissue in the silk group. Biomechanics strength in bone morphogenetic protein 12+polyglycolic acid group was better than that in the col agen Ⅰ-polyglycolic acid group, and there was significant difference when compared with suture silk group. The biomechanics strength of the bone morphogenetic protein 12+polyglycolic acid group was lower than that of normal tendon. It is possible to construct a tissue-engineered tendon with autologous bone marrow mesenchymal stem cells as seed cells induced by bone morphogenetic protein 12 and with the col agen-polyglycolic acid as the framework. Constructed tissue-engineered tendon has biomechanics characteristics and can be used to repair Achil es tendon defect.

Objective To investigate the effect of hyperthermia combined with chemotherapy on the changes of immunity balance of Th1/Th2 and cytokines such as interleukin-2 (IL-2),interferon-γ (IFN-γ),IL-4,IL-10,and vascular endothelial growth factor (VEGF) in non-small cell lung cancer (NSCLC) patients.Methods Fifty patients with advanced NSCLC were randomly divided into thermochemotherapy group (n =25,received whole body hyperthermia combined TP chemotherapy),and chemotherapy group (n =25,received TP chemotherapy alone).The immunity balance of Th1/Th2,IL-2,IFN-γ,IL-4,IL-10,and VEGF levels before therapy and 1 week after therapy were observed.At the same time,the above observation indices were also detected as normal control in 20 healthy volunteers.Results Compared to the chemotherapy group,the proportion of Th1 cells from thermochemotherapy group was significantly increased after therapy (P =0.002) and that of Th2 cells was dropped markedly (P =0.006).There was no difference in the levels of IL-2,IFN~,IL4,IL-10,and VEGF between thermochemotherapy and chemotherapy groups before therapy (P ＞ 0.05).However,the expressions of ILA,IL-10,and VEGF in the NSCLC group were significantly higher than normal group (P ＜ 0.01).The IL-2 and IFN-γ levels were significantly decreased in NSCLC group (P ＜0.01).After therapy 1 week,the concentration of IL-2 and IFN-γfrom thermochemotherapy and chemotherapy groups were higher than before,with statistical significance (P ＜0.01).In addition,IL-4 and IL-10 levels of two groups were significantly decreased in comparison with before therapy (P ＜ 0.01),and it showed a striking difference in cytokines (IL-2,IFN-γ,IL-4,and IL-10) between two groups (P ＜ 0.05).However,the concentration of VEGF in chemotherapy group patients before and after chemotherapy had no significant difference (P ＞ 0.05).The concentration of VEGF from thermochemotherapy group patients after therapy were lower than chemotherapy group patients,the difference had statistical significance (P ＜ 0.01).Conclusions Thermochemotherapy can significantly prompt the Th2 to Th1 shift in both cells and cytokines of advanced NSCLC compared to chemotherapy alone.Moreover,thermochemotherapy also reduces the expression of VEGF,which may prevent the formation of new blood vessels in tumor tissue.

As one of the most catastrophic complications, prosthetic joint infection remains one of the most stubborn medical problems.However, the biomarkers and laboratory tests commonly used often exhibit either a low sensitivity or a low specificity, which makes it still difficult to diagnose.Therefore, we summarize a number of recent new developments home and abroad, and overview from the aspects of serological markers, synovial fluid markers, radionuclide imaging methods, preoperative periprosthetic tissue biopsy, in-traoperative periprosthetic tissue culture, histological analysis of periprosthetic tissue and new molecular technology.

OBJECTIVE:To establish the method for simultaneous determination of alantolactone,isoalantolactone,gallic acid,emodin,aloe-emodine,rhein,physcion and chrysophanol in Liuwei nengxiao pills.METHODS:HPLC method was adopted.The determination was performed on Diamonsil C18 with mobile phase consisted of methanol-acetonitrile-0.1％ glacial acetic acid (gradient elution) at the flow rate of 1.0 mL/min.The detection wavelengths were set at 254 nm (alantolactone,isoalantolactone,emodin,aloe-emodine,rhein,physcion and chrysophanol),270 nm (gallic acid).The column temperature was 25 ℃,and sample size was 10 μ L.RESULTS:The linear ranges of alantolactone,isoalantolactone,gallic acid,emodin,aloe-emodine,rhein,physcion,chrysosphanol were 0.121-3.63 μg(r=0.999 9),0.122-3.66 μg(r=0.999 9),0.219-6.57 μg(r=0.999 9),0.016 4-0.492 μg(r=0.999 7),0.017 3-0.519 μg(r=0.999 9),0.015 3-0.459 μg(r=0.999 9),0.007 2-0.216 μg(r=0.999 9),0.016 2-0.486(r=0.999 9).The limits of quantification were 0.41,0.26,0.35,0.13,0.17,0.14,0.15,0.13 ng;limits of detection were 0.12,0.08,0.11,0.04,0.05,0.04,0.05,0.04 ng.RSDs of precision,stability and reproducibility tests were all lower than 2.0％.The recoveries were 98.05％-102.46％ (RSD=1.75 ％,n=6),98.55％-102.89％ (RSD=1.91％,n=6),98.53 ％-102.34％ (RSD=1.66％,n=6),101.71％-103.41％ (RSD =0.57 ％,n=6),101.04％-103.01％ (RSD=0.69％,n=6),101.63％-102.75％ (RSD=0.39 ％,n=6),96.94％-101.11％ (RSD=1.61％,n=6),98.06％-99.10％ (RSD=0.40％,n=6).CONCLUSIONS:The method is accurate,simple and suitable for simultaneous determination of 8 components in Liuwei nengxiao pills.

?With the deepening study of quercetin, some studies show that quercetin can protect lens, with pharmacological activities such as antioxidation and anti-apoptosis and so on. And they can delay the occurring and developing of cataract. The development and utilization of the quercetin will be expected to be a new means of prevention and treatment of cataract. The article takes in the research progress of that quercetin on the lens with antioxidation, inhibiting aldose reductase and anti- apoptosis and its mechanisms.

In April 2016,the American Geriatrics Society(AGS)entered into a cooperative agreement with U.S.Department of Transportation.National Highway Traffic Safety Administration (NHTSA) updates and expands the Clinician's Guide to Assessing and Counseling Older Drivers to the 3rd Edition.The main goal of the Guide is to reduce traffic accidents and injuries to older drivers.According to the workflow of evaluation and management provided by Plan for Older Driver Safety(PODS),clinicians can conduct driving strategies after screening,evaluation and result analysis.The evaluation is done based on the Clinical Assessment of Driving Related Skills(CADReS) by a team including physicians,nurse practitioners,physician assistants,pharmacists,occupational therapists,driving rehabilitation specialists,and social workers.The CADReS including a series of assessment tools are used to evaluate in the key areas,such as vision,cognition,and motor/sensory function related to driving.Some measures will be taken based on the evaluation conclusions to help to explore the potential of driving safely for old adults.

BACKGROUND: Alendronate has been recently used for treating osteoporosis by inhibiting the activity of osteoclasts, but further clinical observation is necessary to compare its therapeutic effect with exclusive use of calcium supplement.OBJECTIVE: To observe the therapeutic effect of oral alendronate (tianke tablet) on the clinical symptoms and bone mineral density (BMD) of middle-aged and elderly patients for comparison with calcium gluconate.DESIGN: A self-controlled study and controlled trial with concurrent patients.SETTING: Department of Orthopedics, Shenzhen Hospital, Peking UniversityPARTICIPANTS: Sixty-eight middle-aged and elderly patients with osteoporosis were admitted in the Department of Orthopedics, Shenzhen Hospital of Peking University between July 1999 and July 2000. From these patients 62 at the age over 45 years without secondary osteoporosis were selected for this study, who were randomly divided into oral alendronate group (n=32) and oral calcium gluconate group (n=30).INTERVENTIONS: On the basis of comprehensive therapies, the patients in the alendronate group were given 10 mg alendronate daily and those in calcium gluconate group had 20 mL oral calcium gluconate solution (containing 100 mg calcium gluconate, equivalent to 9 mg calcium in every 10 mL) three times daily for three months. According to bodily pain relief, occurrence of new fracture and improvement in BMD, the therapeutic effect was assessed in three grades.RESULTS: Thirty patients in the alendronate group and 26 in the calcium gluconate group completed the study. Alendronate treatment for 3months significantly increased BMD of the patients [(0.716±0.082) g/cm2in comparison with that before treatment [(0.667±0.083) g/cm2, t= 2.473,P ＜ 0.01], whereas the BMD underwent no obvious changes after treatment with calcium gluconate [(0.671±0.081) g/cm2 before vs (0.680±0.073) g/cm2after treatment, t=1.812, P ＞ 0.05]. Significant difference in BMD after treatment was noted between the two groups (t=2.384, P ＜ 0.01). The effective rate was significantly higher in alendronate group than in calcium gluconate group (X2=14.9, P=0.005), but 7 patients complained of abdominal discomfort in the former group and the patients in calcium gluconate group reported no adverse effects.CONCLUSION: Alendronate can inhibit bone absorption, promote the recovery of bone matrix, and increase the bone mass, producing better effect than exclusive use of calcium gluconate oral solution in treatment of the osteoporosis in the middle-aged and the elderly.

Palliative and hospice care for patients suffering severe or end-stage illness with projected short life expectancy.Such services aim to improve patients' quality of life through prognosticating,prevention and treatment of their ailment.The main components include evaluation and treatment of symptoms,pain control,family care,alleviating and treating patients' psychological burden and depression,and offering comfort and dignity.Hospice and palliative care are different from euthanasia,because they neither hasten nor delay the dying process.Instead,they focus on patients'physical and psychological needs and helping patients to maintain their independence and make their own choice.As a new medical subspecialty,palliative and hospice care are considered one of the important frontier in modern medicine.They employ a multi-disciplinary team approach,and the team members require special skill sets including those in communication and symptom management.