OBJECTIVE:To compare the effects of morphine and nalbuphine on related indexes of maternal after cesarean sec-tion. METHODS:A total of 120 maternal underwent cesarean section were randomly divided into observation group(60 cases)and control group (60 cases). After surgery,observation group was given Nalbuphine hydrochloride injection 20 mg+0.75% Ropiva-caine hydrochloride injection 20 mL for patient-controlled epidural analgesia. Control group was given Morphine hydrochloride injec-tion 8 mg+0.75% Ropivacaine hydrochloride injection 20 mL for patient-controlled epidural analgesia. VAS score,systolic pres-sure,diastolic pressure,respiration rate(RR),SpO2 at the onset of analgesia(T0),6 h(T1),12 h(T2),24 h(T3)and 48 h(T4) after analgesia as well as the levels of IL-6,IL-8,CRP and PRL at T0,T3,T4 were observed in 2 groups. The satisfaction rate of analgesia and the occurrence of ADR were also observed. RESULTS:There was no statistical significance in satisfaction rate of an-algesia between 2 groups(96.67% vs. 98.33%,P>0.05). At T0,T1,T4,there was no statistical significance in VAS score between 2 groups(P>0.05). VAS scores of 2 groups at T2-3 were significantly higher than at T0,T1,T4,with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statistical significance in diastolic pres-sure,RR and SpO2 between 2 groups at T0-2(P>0.05). The systolic pressure of 2 groups at T3-4 were significantly higher than at T0, with statistical significance(P<0.05);but there was no statistical significance between 2 groups(P>0.05). There was no statisti-cal significance in the levels of IL-6,IL-8,CRP or PRL between 2 groups at T0(P>0.05). The levels of IL-6,IL-8 and CRP in 2 groups at T3 were significantly higher than at T0,but the observation group was significantly lower than the control group;at T4,the levels of IL-6,IL-8 and CRP in control group were significantly higher than at T0,with statistical significance(P<0.05),but there was no statistical significance in observation group,compared to at T0(P>0.05). The levels of PRL in 2 groups at T3-4 were significantly higher than at T0,and increased gradually as time;the observation group and significantly higher than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group was significantly lower than control group,with statistical significance(P<0.05). CONCLUSIONS:For maternal after cesarean section,nalbuphine is similar to mor-phine in analgesic effect and cardiovascular effect,but it is better than morphine in reducing inflammatory level,promoting lacta-tion and safety.

Objective The patients with metastatic spinal tumors often suffered from severe back pain and spinal cord compression directly caused by tumor tissue or severe spine kyphosis.In order to treat or prevent spinal cord paralysis,decompression and stabilization should be performed on the patients with spinal pain and /or severe spinal cord compression.Methods From July1998through July2001,62patients(27women and35men)with metastatic spinal tumors had been treated at our department.Of 62patients,the thoracic vertebrae were involved in37cases,lumbar vertebrae in19and cervical vertebrae in6.Among43of 62patients who pre sented with neurological dysfunction,24patients were incompletely para plegic and the others were completely paraplegic.The fol low-up ranged from8to36months.Results Pain relief was ob-tained in58of 62patients(94%),and good neurological recovery was obtained in33of the43patients.Improved bowel and bladder function was obtained in12of 25patients who presented with bowel and blad der dysfunction.After decompression,neurological function,evaluated as Frankel grade E or D,was ob-tained in5patients whose neurological function had been evaluated as Frankel grade A or B,and other9pa-tients ex perienced a neurological recovery from Frankel grade A or B to C or D.Conclusion The time developing from neurological dysfunction to complete para plegia is the most important prognostic factor.Poor prognosis is often inevitable when complete paraplegia appeared less than48hours.Complete loss of bowel and bladder function is also a factor for poor prognosis.Decompression should be performed immedi -ately if the patient is presented with neurological dysfunction.Spinal metastasis of thyroid or breast cancer has a rela tive good prognosis.However,metastasis of lung or liver cancer is associated with a short-term survival.Neu rological function of patients with spinal metastasis at thoracic region is more difficult to recover.Com-mon motor and sensory functions are often improved earlier than bowel and bladder function.Thorough re-section of metastatic tumor and stable in ternal fixation should be performed when single vertebra is involved.Conservative tumor resection,decompression and posterior internal fixation should be performed when two or more seg ments are involved in order to alleviate paraplegia,improve spinal stability and the quality.[

Objective To explore the complications of the total elbow arthroplasty after the resection of the peri-elbow tumor. Methods Between June 1998 and June 2002, eight patients underwent total elbow arthroplasty after resection of tumors, which involved 7 males and 1 female (mean age, 42.6 years; range, 22-63 years). The patients included 1 metastasis, 1 GCT, 2 MFH, 1 osteosarcoma, 1 lymphoma, 1 desmoid fibroma, and 1 synovial sarcoma. The tumors located 3 in distal humerus, and 5 in proximal ulna. For those of the distal humerus, after the resection of the tumors, the origins and the insertions of the musculi flexors, extensor, pronators and supinators were repaired as far as possible. The application of the prothesis was relatively simple, the prosthetic stem of the distal humerus was cemented, the intercondylar notch was sawn off, but both the lateral and medial epicondyles were kept, the prothesis impacted in the notch; While for those tumors located on the proximal ulna, the stem was spiraled in the intramedullary cavity, Patients were evaluated according to the Mayo Elbow Performance Score. Results All the patients were followed up at least one year or to death (mean duration, 2.5 years). Pain scores decreased from a mean of 3.6 to 2.0. Mean elbow motion from extention to flexision arc improved from 29? to 73? (range, 55?-105?). Seven cases were excellent or good (87.5%), and only one was poor (12.5%). There were none of the complications, such as infection, incision non-union and nerve injury. All patients without local recurrence as well. The X-ray didn't reveal any sign of loosening or breakage for the artificial elbow joint. Conclusion Total elbow arthroplasty after resection of tumors can decrease the pain and improve the function substantially. For metastatic tumors, this technique can be also used to alleviate symptom if there is no other good option.

Objective To discuss the techniques of tumor resection, pelvic reconstruction and postoperative management by reviewing the patients with malignant pelvic tumors in recent years. Methods 76 patients with primary malignant pelvic tumors were treated operatively between July 1997 and July 2003. The series comprised 47 males and 29 females. 31 cases were diagnosed as chondrosarcoma, 15 as Ewing sarcoma, 7 as osteosarcoma, 3 as lymphoma, 3 as malignant fibrohistiocytoma (MFH), 1 as hemangiopericytoma, 2 as myeloma, 13 as giant cell tumor(GCT). According to Enneking's division, the most common region of the primary pelvic tumor involved was region Ⅱ (51 cases), followed by region Ⅰ (16 cases) and region Ⅲ (9 cases). 16 cases were reconstructed with threaded pins and cement after resection of the ilium. 9 patients had local resection of pubis and ischium. 21 patients had hemipelvectomy. Among 30 patients with periacetabular tumors, 8 were reconstructed with hemipelvic prosthesis, 7 with saddle prosthesis, 6 with replantation of cauterized tumor bone and total hip arthroplasty, 9 with cemented total hip replacement after curettage of lesion. Results After 16 months to 6 years follow-up, among the 21 patients with hemipelvectomy, 4 patients had local relapse because the sacrum invaded by the tumors. 7 of 25 patients with lesions in regionⅠ or region Ⅲ had local relapse postoperatively due to the marginal incision to the acetabula. Among the 21 patients who had tumor resection and reconstruction in region Ⅱ, 4 had local relapse, 3 of which reconstructed with cauterized hemipelvis. As for functional recovery, all of the 25 patients with lesions in region Ⅰand region Ⅲcould walk postoperatively without assistance of a cane. 21 patients with acetabular reconstruction after resection of lesions in region Ⅱ could sit and stand normally and walked with a cane, some of them even had normal gait. Conclusion The major principle of treatment for primary pelvic tumor is that en bloc resection, only then the functional reconstruction of pelvic ring can be considered. Operators should be acquainted with advantages and shortcomings of different reconstructive methods of acetabulum to prevent the complications.

Objective:To study the effects and the related molecular mechanisms of miR-148a-3p on the proliferation,invasion and migration of salivary adenoid cystic carcinoma SACC-LM cells.Methods:miR-148a-3p mimics and inhibitors,siRNA targeting EG-FR and their corresponding controls were transfected into SACC-LM cells.Bioinformatics was used to predict the potential target genes of miR-148a-3p.EGFR and miR-148a-3p mRNA expression levels were examined by qRT-PCR and the protein levels of EG-FR were detected by Western blotting.CCK-8,scratch,and Transwell assays were used to study the proliferation,migration,and invasion of SACC-LM cells,respectively.The direct targeting relationship between miR-148a-3p and EGFR was examined by using the double luciferase reporter gene assay.Statistical analysis of the data was performed by SPSS 22.0 software.Results:Overexpres-sion or inhibition of miR-148a-3p significantly inhibited or promoted the proliferation,invasion and metastasis of SACC-LM cells re-spectively(P＜0.05).Bioinformatics and double luciferase assay showed that miR-148a-3p directly targeted and regulated the expres-sion of EGFR(P＜0.001).Downregulation of EGFR inhibited the proliferation,migration and invasion of SACC-LM cells(P＜0.05)and partially reversed the promoting effect of miR-148a-3p inhibition(P＜0.05).Conclusion:The downregulation of miR-148a-3p leads to the abnormally high expression of its target gene EGFR,and promotes the proliferation,invasion,and migration of salivary adenoid cystic carcinoma cells.

Objective:Based on the specific cleavage and non-specific "trans-cleavage" activities of the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein(CRISPR/Cas13), we established a visually amplification-free rapid detection technique of 2019-nCoV nucleic acid. This technique is easily processed with a low detection limit and good specificity.Methods:According to the 2019-nCoV gene sequence, specific CRISPR RNAs were screened and designed by bioinformatics analysis, and then synthesized as universal signal-strained RNA transcription targets in vitro to establish and optimize the reaction system. Moreover, the 2019-nCoV pseudoviral nucleic acid was used as a standard substance to evaluate the detection limit. A total of 65 positive samples were collected from various 2019-nCoV variants, while 48 negative samples included other clinically common respiratory pathogens, such as influenza A virus, influenza B virus, human parainfluenza virus, Klebsiella pneumonia, etc. All samples were tested by quantitative PCR (qPCR), digital PCR, and the method established in this study. The sensitivity and specificity of the newly established method were analyzed and evaluated. Results:With the newly established technique, the detection time for 2019-nCoV nucleic acid could be minimized to 6 minutes. In addition, the detection limit was 14 copies/μl when assisted by the displaying instrument, whereas it increased to 28 copies/μl with the naked eye. This technique had a sensitivity and specificity of 98.5% (66/67) and 100% (46/46) respectively, showing no statistically significant difference compared to the gold standard qPCR( P=1). Conclusions:This study has successfully established a CRISPR/Cas13a-based visually rapid detection technique for 2019-nCoV nucleic acid. This technique offers the advantages of a simple process, convenient operation, low environmental operating requirements, a detection limit close to qPCR, and a strong potential for on-site testing applications.

OBJECTIVE：To s tudy improvement effect and mech anism of ilicifoliosids alkaloid A （HBOA）on non-alcoholic fatty liver disease in rats. METHODS ：SD rats were randomly divided into blank control group ，model group ，Silybin capsule group（positive control ，26.25 mg/kg），HBOA high-dose ，medium-dose and low-dose groups （100，50，25 mg/kg），with 10 rats in each group. Except that blank control group fed normal feed ，the other groups were continuously fed with high-fat diet for 8 weeks to induce non-alcoholic fatty liver disease model. Form the 9th week ，blank control group and model group were given constant volume of 0.6％ CMC-Na solution ，and administration groups were given corresponding drugs by intragastric admini- stration，once a day ，for consecutive 4 weeks. The general information of rats were observed and the body weight increase ，organ （liver，kidney and spleen ）indexes were calculated ；the contents of AST ，ALT，TC，TG and NEFA in liver tissue were detected ， and SOD，GSH-Px activities and MDA content in the serum were also determined. The protein expression of PPARα in liver tissue was detected by immunohistochemistry. RESULTS ：Compared with blank control group ，the body mass increase and liver index of rats in model group were increased significantly （P＜0.01）；fat deposition could be observed in the liver ；the activities of SOD and GSH-Px in serum were reduced significantly ，and the contents of MDA ，the contents of AST ，ALT，TC，TG and NEFA in liver tissue were significantly increased ，and the protein expression of PPARα was decreased significantly（P＜0.01）. Compared with model group ，the body mass increase and liver index of the rats were decreased significantly in administration groups （P＜0.05 or P＜0.01），liver fat deposition was improved ，the activity of SOD and GSH-Px in serum （except for HBOA low-dose group ）were increased significantly while MDA content ，the contents of AST ，ALT，TC（except for HBOA low-dose group ），TG（except for HBOA low-dose group ） and NEFA in liver tissue were decreased significantl y，while protein expression of PPAR α 15177460685@163.com was increased significantly （P＜0.05 or P＜0.01）. Some of the above indexes of HBOA high-dose group were 电话：0771-5302433。E-mail：junlin898@126.com significantly better than HBOA medium- and low-dose group（P＜0.05）. CONCLUSIONS ：HBOA has a certain improvement effect on non-alcoholic fatty liver disease in rats caused by high-fat diet ，and its mechanism may be related to improving lipid metabolism disorders ，anti-oxidative stress and up-regulating the expression of PPARα.

BACKGROUND: To compare the clinical efficacy of stereotactic body radiotherapy (SBRT) versus surgery for early-stage non-small cell lung cancer through evidence based medicine analysis. METHODS: A systematic search was performed in the PubMed, EMBASE, CNKI and Wan Fang databases to find studies published before June 2020. Two authors independently extracted the data and assessed the eligibility. All of the statistical analyses were performed using Stata 13.0. Subgroup analysis were performed according to the score matching study and operation type (lobectomy, segmentectomy and thoracoscopic assisted surgery). RESULTS: Finally, 14 articles were included, including 15,841 cases in SBRT group and 17,708 cases in operation group. 10 articles used propensity score matching methods for survival analysis. Thirteen were retrospective cohort studies and one was randomized controlled trial. The results of meta-analysis showed that the overall survival rate of the surgery group and the SBRT group was statistically significant. The overall survival rate of the SBRT group (HR=1.51, 95%CI: 1.31-1.74) was inferior to that of the surgery group. In the subgroup analysis of the surgical type, there was no statistical difference between the SBRT group and each surgical type. The difference of overall survival rate between SBRT group and surgery group was statistically significant (HR=1.66, 95%CI: 1.45-1.90) in studies of propensity score matching. There was no statistically significant difference in cancer-specific survival between the surgery and SBRT groups (HR=1.12, 95%CI: 0.83-1.52). CONCLUSIONS The overall survival rate of surgical treatment is better than that of SBRT, but it has no obvious advantages in cancer specific survival rate.

OBJECTIVE：To inv estigate the effects of 4-hydroxy-2（3H）-benzoxazolone on inflammatory and apoptosis signaling pathways in non-alcoholic fatty liver disease （NAFLD）model rats. METHODS ：SD rats were divided into normal control group（10 rats）and modeling group （50 rats）. Normal control group was given basic diet ，and modeling group were given high-fat diet to induce NAFLD model. After modeling ，the rats were divided into normal control group ，model group ，silibinin group （26.25 mg/kg），and 4-hydroxy-2（3H）-benzoxazolone high-dose ，medium-dose and low-dose groups （100，50，25 mg/kg），with 8 rats in each group. Normal control group and modeling group were given 0.6％ CMC-Na intragastrically ，and other groups were given relevant medicine 10 mL/kg intragastrically ，once a day ，for consecutive 4 weeks. After last medication ，the serum levels of albumin（ALB），total protein （TP），globulin（GLB），ALB/GLB and free fatty acid （FFA）were detected ；TUNEL staining was used to observe the apoptosis of rat hepatocytes. Western blot assay was used to detect the protein expression and phosphorylation level of inflammatory signaling pathway related proteins [Toll-like receptor 4（TLR4），myeloid differentiation factor 88（MyD88）， nuclear factor-κB p65（NF-κB p65），NF-κB inhibitor protein（IκBα）] in liver tissue as well as the expression of apoptosis signaling pathway related proteins [B cell lymphoma 2（Bcl-2），Bax，caspase-3]. RESULTS ：Compared with model group ，serum levels of TP （except for low-dose group ），GLB and FFA ，the protein expression of TLR 4（except for low-dose group ），MyD88 （except for medium-dose group ）and caspase- 3，the phosphorylation levels of NF-κB p65 and IκBα protein were decreased significantly（P＜0.05 or P＜0.01）. The ratio of A LB/GLB in serum and the ratio of Bcl- 2/Bax in liver tissue were significantly increased（P＜0.05 or P＜0.01），and the phenomenon of hepatocyte apoptosis was improved. CONCLUSIONS ：4-hydroxy-2 （3H）-benzoxazolone can ameliorate NAFLD in rats ，and the mechanism may be associated with inhibiting the expression TLR 4/ MyD88/NF-κB signaling pathway-related proteins and apoptosis-related proteins in liver tissues.