Objective To explore the effects and feasibility of minimal local analgesic dose of hyperbaric levobupivacaine in elderly patients undergoing unilateral spinal anesthesia during lower limb orthopedic surgery.Methods Seven hundred and fifty-six elderly patients who scheduled lower limb orthopedic surgery were assigned to levobupivacaine group (383 patients) and bupivacaine group (373 patients) by random digits table method.Haemodynamic change were monitored before,during and after anesthesia.The level and duration of sensory and motor block in each group were evaluated.Results Compared with bupivacaine group,the sensory block and motor block onset time was significantly longer in levobupivacaine group [(5.9 ± 1.4) min vs.(4.2 ± 0.3) min,(11.7 ± 3.0) min vs.(9.1 ± 3.3) min] (P ＜0.05),but the motor block duration was shorter [(152.8 ± 17.5) min vs.(195.4 ± 18.7) min] (P ＜ 0.05).The scores of maximum motor block in levobupivacaine group was significantly lower than that in bupivacaine group[(1.1 ±0.3) min vs.(2.3 ±0.6) min](P＜ 0.05).There was no significant difference in peak sensory block and haemodynamic between two groups (P ＞ 0.05).Conclusions Although levobupivacaine may be less potent than bupivacaine,it may be preferred for elderly patients with lower limb surgery because of satisfactory spinal anesthesia,good hsemodynamic stability and fast motor block regression.

Professor LIU Yan-chi is a well-known Chinese medicine experts at home and abroad,came from family medicine,is the country,s third and fourth groups academic heir tutors of the old Chinese teacher academic experience,full of rich academic experience.This paper introduces the Professor LIU diseases for urban residents to make good use Ziyin academic thinking,followed by the introduction of its common Ziyin drugs(Deodeok,Ophiopogon japonicus,Dendrobium).Finally,through listing,Professor LIU treating habitual constipation with producing Jin and clearing away heat,treating Parkinson,s disease with nouringing yin and calming endopathic wind and removing heat,summarized in flexible mode of thinking and bring us enlightenment.

Tumor stage and lymph node involvement are the most important prognostic factors for patients with locally advanced cervical cancer. For cervical cancer, gynecologic oncologists generally apply the criteria of the International Federation of Gynecology and Obstetrics(FIGO). However, in the current FIGO 2018 staging system, stage ⅢC is based only on the anatomical location of metastatic lymph nodes, without considering local tumor factors and other lymphatic status parameters, which limits its prognostic significance to a certain extent. The aim of this article is to summarize the influence of local tumor factors and different lymphatic status parameters on prognosis and treatment options for stage ⅢC cervical cancer.

Recently a number of acupuncture clinical trial projects mainly conducted by conventional scientists have generated many negative results. A large meta-analysis of patient-level acupuncture data for the treatment of chronic pain conditions have demonstrated that the effects of verum acupuncture on pain improvement have statistically significant, but small, differences compared with sham-acupuncture procedures and no difference between acupuncture points and non-points. These conclusions have puzzled the acupuncture community and made confusion for acupuncture research and practices. The purpose of this paper was to compare differences between acupuncture clinical practices and the trial studies, which include "acupuncture technical principles", "acupuncture clinical trial design", and "acupuncture practice based on the theory of traditional Chinese medicine". These factors contribute to the puzzle between the acupuncture community/practice and acupuncture clinical trials, which can be improved in future studies.
Acupuncture Points ; Acupuncture Therapy ; Chronic Disease ; Clinical Trials as Topic ; Humans ; Meta-Analysis as Topic ; Pain Management ; methods ; Research Design

Objective To investigate the correlations between the level of blood lactic acid (Lac),lactate clearance rate (LCR) and emergency stratification Ⅰ or Ⅱ as well as the prognosis in patients.Methods A retrospective analysis was conducted.The clinical data of 370 critically ill patients with emergency stratification Ⅰ or Ⅱ accompanying with hyperlactacidemia admitted to emergency center of People's Hospital of Wuwei City during January 2013 to April 2015 were analyzed.The patients were allocated into two groups:Lac ≥ 10 mmol/L (n =181) and Lac 4-10 mmol/L (n =189).Base excess (BE),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and hospital mortality were compared between the two groups.The differences in initial Lac,6-hour LCR and APACHE Ⅱ score were compared between survival group and death group as well as emergency stratification Ⅰ and Ⅱ groups.The correlation between initial Lac,6-hour LCR and APACHE]Ⅱ score was analyzed by Pearson correlation method.Results ① With the increase in Lac level,the negative deviation extent of BE and APACHE Ⅱ score in critical patients were gradually increased [BE (mmol/L):-16.74 ± 8.21 vs.-5.98 ± 8.43,APACHE Ⅱ score:27.6 ± 5.6 vs.20.1 ± 4.8],and hospital mortality was increased [76.79％ (139/181) vs.43.39％ (82/189),all P ＜ 0.01].② The initial Lac and APACHE Ⅱ score of the death group were significantly higher than those of the survival group [initial Lac (mmol/L):8.81 ± 4.71 vs.4.43 ± 2.82,APACHE Ⅱ score:23.6 ± 5.6 vs.17.3 ± 3.7],and 6-hour LCR was significantly decreased [(12.26 ± 6.47)％ vs.(35.16± 10.63)％,all P ＜ 0.01].③ Patients in emergency stratification Ⅰ group had a higher initial Lac and a higher APACHE Ⅱ score but a lower 6-hour LCR level than those in emergency stratification Ⅱ group [initial Lac (mmol/L):8.7±2.6 vs.6.8±2.0,APACHE Ⅱ score:25.2±6.3 vs.16.3±4.7,6-hour LCR:(14.8±4.7)％ vs.(33.5±5.8)％,both P ＜ 0.01].④ It was shown by correlation analysis that initial Lac was significantly positively correlated with APACHE Ⅱ score (r =0.731,P =0.017) in 370 emergency critical ill patients,while 6-hour LCR was negatively correlated with APACHE Ⅱ score (r =-0.694,P =0.010).Conclusions The early arterial blood Lac of patients with emergency stratification Ⅰ was significantly higher than emergency stratification Ⅱ,and the 6-hour LCR in patients with emergency stratification Ⅱ was significantly higher than emergency stratification Ⅰ.Furthermore,the Lac level and LCR were simple and easy to implement as compared with APACHE Ⅱ score in emergency critical ill patients.

Heart Defects, Congenital ; diagnostic imaging ; Humans ; Organ Size ; Radiography, Thoracic ; Syndrome

Objective To evaluate discuss the effect of percutaneous vertebraplasty in the treatment of compression fracture of vertebra in elderly patients with osteoporosis. Methods The clinical history of 13 elderly patients (5 male and 8 female), aged 61 to 78 years (nean 67 years), of spinal suffering from compression fracture of the vertebra, were retruspectively reviewed. Among them, 2 patients suffered compressed fracture of T11, 5 with fracture of T12, 3 with fracture of L1, 4 fracture of L2, and one suffered fracture of four vertebral bodies from T10 to L1. Percutaneous puncture were guided by C-arm X-ray or by computer navigation system, and a canal of 4.5 mm in diameter was created in the pedicle. A balloon was then introduced into the canal, and it was expanded. with radioopaque contrast medium under high pressure. The balloon was then removed after the height of the vertebral body was resumed as verified by X-ray. Bone cement in same volume and temperature was injected in the cavity which was newly formed. The treatment was completed with solidification of the bone cement. Results Low back pain disappeared in all 13 cases. Patients can be ambulatory in 6-8 hours postoperatively. The height of the vertebra body was basic recovered on postoperative X-ray, and kyphosis was rectified to a mean of 14 degrees (range10-28 degree). There was no relapse of low back pain or collapse of vertebral body after 1 to 12 months' follow up. Conclusion Percutaneous expansion of compressed vertebral body is a new kind of microsurgical, treatment for spinal compression fracture in elderly patients with osteoporosis, and it is simple and effective in relieving pain and recovering function.

Objective To investigate T cell-mediated anti-HBV effects of dendritic cells (DCs) sensitized by HBsAg in patients with HBV infection in vitro. Methods DCs isolated from peripheral blood mononuclear cells of HBV patients were cultured and proliferated in vitro, and then were stimulated with pure HBsAg before DCs maturation, and co-cultured with auto-T lymphocytes after DCs maturation. The T lymphocytes were then harvested 5 days later and added into the supernatant of 2.2.15 cell cultures. The supernatants were collected on 1st, 3rd, 5th and 7th day, respectively. ELISA was employed to detect HBeAg and the secretion of HBsAg, as well as to measure the concentration of IFN-? and IL-12 in culture supernatents. Results The proliferation and cytotoxicity of auto-T cells were markedly enhanced in the antigen stimulated DCs group compared with that of DCs without loaded antigen and only T lymphocyte group (P

Objective: To study the super high-dose chemotherapy in drug-resistance Ⅲ B osteasarcoma with autologous bone marrow transplantation. Methods: The chemotherapy was carried out in 4 patients with drug-resistance Ⅲ B osteosarcoma. The autologous bone marrow was harvested before chemotherapy and reinfused after chemotherapy when the serum concentration of methotrexate reduced to 1.0?10~(-7) mol/L. The chemotherapy included ,methotrexate 500 mg/kg , adriamycin 25 - 75 mg/m~2 and vincristine 1.5 mg/m~2 with low dose citrovorum factor rescue. Results: Four patients tolerated the chemotherapy well and felt better than before. The pulmonary metastases had various degrees of reduction in 2 patient and calcified in 1 patient, but progressed in 1 patient. Conclusion: Super high-dose chemotherapy has good response in drug-resistance ⅢB osteosarcoma and is safe with autologous bone marrow transplantation. This regimen is worth to be further studied and be used in ⅡB osteosarcoma.

Objective To determine the applicability of locally continuo u s application of alendronate for the prevention of prosthesis aseptic loosening. Methods Using the method of in vitro cell culture to detect the influence of a lendronate with different concentrations(1?10－11mol/L,1?10－9mol/L,1?10－7mo l/L,1?10－6mol/L,1?10－5mol/L) on the proliferation, secretion and osteogenesi s of human osteoblasts as well as the effect of the motility, respiration, phago cytosis and bactericidal ability. Results Higher concentration of alendronate(1 ?10－6mol/L,1?10－5mol/L) improved local antiinfection ability, but inhibited osteogenesis (1?10－5mol/L). Lower concentration(1?10－11mol/L,1?10－9mol/L,1 ?10－7mol/L) inhibited the bactericidal effect of neutrophils, but stimulated o steogenesis(1?10－11mol/L,1?10－9mol/L). Conclusion Locally continuously usin g alendronate around prosthesis to prevent and treat aseptic loosening must be h andled with discretion. Its concentration should not be below 1?10－6mol/L in the early period after arthroplasty operation, but the concentration should be 1?10－11mol/L or 1?10－9mol/L in the late period.