Objective To evaluate the efficacy and safety of chinese mednine in treatment of avascular necrosis by evidence-based medicine principles.Methods Search 1994-2010 Chinese full-text periodical database,VIP Articles journal database and the Wanfang database have been published in the medical treatment of avascular necrosis of the clinical trial literature,Revman 4.2 software was used for statistical analysis.Results A total of 11 randomized controlled trials included 1490 cases of patients meet the criteria,compared with the control group of traditional Chinese medicine treatment of avascular necrosis of the efficiency test results of the analysis of the merger:Z =2.89,P ＜ 0.01,the combined RR of 2.00,95％ confidence interval(1.25,3.19); All trials were not reported significant adverse reactions.Conclusion Chinese medicine treatment of avascular necrosis had good efficacy and safety.

Objective To compare the clinical efficacy of programmed intermittent epidural bollus (PIEB)+patient controlled epidural analgesia (PCEA)and continuous epidural infusion (CEI)+PCEA for labor analgesia.Methods One hundred nulliparous parturients with cervical dilation of 2-3 cm were randomly assigned to PIEB group or CEI group for labor,with 100 parturients in each group.The background infusion in PIEB group delivered 8 ml bolus at a rate of 6 ml/min per 1 hour, in group CEI at 8 ml/h.Blood pressure,VAS score and modified Bromage score before labor anesthe-sia (T0 ),10 min after labor anesthesia (T1 ),30 min after labor anesthesia (T2 ),1 h after labor an-esthesia (T3 ),2 h after labor anesthesia (T4 ),the uterus opening to the full extent (T5 ),childbirth (T6 ),1 h after childbirth (T7 ),proportion of PCEA request,hourly ropivacaine and sufentanil con-sumption,uterine contraction,fetal heart,total delivery time,analgesic time,delivery mode,number of cases using oxytocin,adverse reactions,neonatal Apgar score,maternal satisfaction score were ob-served.Results The VAS score of PIEB group was significantly lower than that of CEI group at T4-T6 (P <0.01).Compared with the CEI group,protortion of PCEA request,the dosage of drug was de-creased obviously in group PIEB (P <0.05),the maternal satisfaction of PIEB group was significantly higher than that of CEI group (P <0.05).There was no significant difference in the blood pressure, duration and interval time of uterine contraction,fetal heart,total delivery time,analgesic time,deliv-ery mode,number of cases using oxytocin,adverse reactions,neonatal Apgar score and weight among two groups.Conclusion Compared with the CEI+PCEA,the need of PCEA and the dosage of drug was decreased obviously,the VAS score was significantly lower,the maternal satisfaction was signifi-cantly higher and adverse reactions did not increase in the PIEB+PCEA.

Purpose To investigate the clinicopathologic characteristics, differential diagnosis, treatment and prognosis of differentia-ted-type vulvar intraepithelial neoplasia ( dVIN) . Methods Clinicopathologic findings and immunophenotypes of 6 cases diagnosed as“dVIN” were retrospectively analyzed, and the relevant literatures were also reviewed. Results 6 patients were all female ranged 53~80 years old with mean age of 62 years old. Clinical aspects included leukoplakia vulvar, pruitis, irritation, pain, ulcer and so on. The histopathological features were hyperplasia of basal and parabasal layer with elongation and anastomosing reteridges. Cells were marked atypia with obvious nucleoli, atypical mitosis, and dyskeratosis. In the middle and surface layer, cells were well differentiated with pronounced intercellular bridges, and eosinophilic cytoplasm, hyperkeratosis and parakeratosis. Oedema and band of infiltration of chronic inflammatory cells of subepidermal could been seen. Immuohistochemistry showed the expression rates of p53 and p16 in totally 6 cases were 83. 3% (5/6), 0 (0/6), respectively. The Ki-67 index was more than 90% in basal and parabasal cells. Four patients were followed up ( mean follow-up 17 months, range 6~36 months) , one patient died at 9 months later after surgery, another patient recurred at 6 months later after surgery, both of the 2 cases were all with invasive lesions after resection, and the rest two cases had no recur in 18 months and 36 months after surgery, respectively. Conclusion dVIN is a high grade squamous intraepithelial lesions of vulvar with low incidence rate, but had more risk of progression. p53, p16 and Ki-67 stain were useful in the diagnosis of dVIN.