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.

Objective To evaluate the effects of intravenous analgesia with dezocine combining sufentanil in hip and knee arthroplasty for elderly patients.Methods Ninety patients with ASA Ⅱ ～ Ⅲ and aged ≥ 65 years who were scheduled for hip and knee arthroplasty under CSEA and treated with intravenous analgesia post-operation were selected and divided into three group (20 cases):group Ⅰ (sufentanil 2.5μg/kg + droperidol 2.5 mg),group Ⅱ (sufentanil 2.0 μ g/kg + dezocine 10 mg + droperidol 2.5 mg) and group Ⅲ (intramuscular dezocine 10 mg and sufentanil 2.0 μ g/kg + droperidol 2.5 mg),which were diluted to be 100 ml by adding saline.VSA,Ramsay score as well as side effects were recorded at 6,12 and 24 h after operation.75 mg meperidine was administered intramuscularly as rescue medication when VAS was above 5.Results Compared with group Ⅰ and Ⅲ,group Ⅱ showed better outcomes regarding to the VAS and less side effects.Ramsay score 6 h after operation and the amount of patients who needed meperidine in group Ⅲ were higher than those in the other two groups (P ＜ 0.05).Conclusion Dezocine combining with sufentanil in elderly patients underwent low limb arthroplasty shows better postoperative analgesia effects with less side effects,and it's worth for clinical application.

BACKGROUND:At present, the development of reprogramming technology provides a wide prospect for stem cellresearch. Through the ectopic co-expression of reprogramming factors, the somatic cells can be reprogrammed to a pluripotent state, termed as induced pluripotent stem cells, which can avoid the ethical controversy faced in the research and application of embryonic stem cells. Also, we can generate patient-specific and disease-specific induced pluripotent stem cells, which significantly decrease immuno-rejection. However, reprogramming technology faces some chal enges, such as low efficiency and safety.
OBJECTIVE:Based on the characteristics of induced pluripotent stem cells and the principles of reprogramming, to detail the progress in reprogramming technology from five aspects, including cellresources, carriers, transcription factors, microRNA and signal transduction pathway. 
METHODS:A computer-based online retrieval was performed to search papers published form January 1990 to April 2013 in VIP periodical ful-text database, Wanfang periodical ful-text database, CNKI periodical ful-text database, PubMed database and Springer database with key words of“reprogramming, induced pluripotent stem cell, signal transduction pathway, epigenetics, microRNA, transcription factor, vector, somatic cell, smal molecule compound, safety”both in Chinese and English. After excluding objective-independent papers, 67 papers were included for further analysis.
RESULTS AND CONCLUSION:By exploring different cellresources, different carriers, various combination of transcription factors, microRNAs or inhibition of the signal transduction pathways, the reprogramming efficiency and safety have been improved greatly. However, currently, induced pluripotent stem cells stil could not meet the requirement of clinical application. To achieve the clinical application of induced pluripotent stem cells, it is urgent to explore the mechanism of reprogramming, and to optimize the programming strategy.

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.

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.

Objective To investigate the expression of nerve tissue protein S-100(S-100)and gap junctional protein connexin 43(Cx43) in rat adenohypophyseal folliculo stellate cells(FSCs) under the influence of ovariectomized osteoporosis(OVX-OP) and estrogen replacement therapy(ERT). Methods Sixty 10 month old female rats were randomly divided into sham operation control group(Sham), ovariectomy group (OVX) and ovariectomy+ERT group (OVX+ERT). L4-6 bone mineral density(BMD) of the animals in Sham group and OVX group were measured by dual energy X-ray absorptiometry(DEXA) at the end of 6 weeks after operation. From 7th week, rats in OVX+ERT group were treated with nilestriol(1 mg?kg -1?week-1) for 6 weeks. Rat L4-6 BMD in OVX+ERT group were measured at the end of 12 weeks after operation. Expression of S-100 and Cx43 in FSCs was detected using immunofluorescent histochemistry and laser scanning confocal microscopy(LSCM). Results L4-6 BMD was significantly lower in OVX group (0.193?0.006) g/cm2 than in Sham group(0.211?0.013) g/cm2 and in OVX+ERT group (0.204?0.010) g/cm2 (P

Objective To evaluate the result of anterolateral interbody fusion combined with transpedicle fixation for patients with kyphosis due to tuberculosis of the thoracic spine. Methods There were totally 17 patients, 11 male and 6 female in this study. The average age was 36.4 years, ranging from 23 to 56 years old. All tuberculous lesions were located in low thoracic spine, two vertebral bodies were involved in 9 patients and three vertebral bodies involved in 8 patients. The average kyphosis angle was 25 degrees, ranging from 15 to 34 degrees. Mild neurological function deficiency (Frankel Grade C or D) were present in 5 patients. All patients were treated with one stage posterior transpedicle fixation and anterolateral interbody fusion combined with 9 month antituberculous medication. Results All patients were followed up for 2 to 4 years postoperatively. All incisions were healed up primarily. Interbody fusion was achieved in all patients from 4 to 6 months after operation. All patients were cured and there was no recurrence within follow up period. The average kyphosic angle was 7 degree postoperatively, and the average correction of kyphosis angle was 18 degree, which was maintained well within follow up period. Patients with neurological function deficiency achieved complete recovery one year after operation. Conclusion Anterolateral interbody fusion combined with transpedicle fixation provides rigid fixation and good stability for early fusion and facilitates tuberculous kyphosis correction. This one stage procedure is effective in decreasing duration of antituberculous medication and increasing curing rate of spinal tuberculosis.