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

Tissue factor is a powerful promoter of blood clotting in vivo , it plays an important role In hematischesis, tissue repair and thrombogenesis. In recent years, it is discovered that tissue factor can discriminate and regulate cell signal transduction, promote neogenesis of blood vessel and inflammatory reaction, regulate cell adhesion and movement, have a intimate relationship with invasion and metastasis of malignant tumor. In this article, we review the effects of tissue factor on malignant tumor metastasis.

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.

The arginine vasopressin (AVP) and oxytocin (OT) in thymic nurse cells (TNCs) of mice were stained by the method of immunogold and indfrect immunofluorescence, PAP immunocytochemical technique. TNCs of mice were shown immunocytochemical reactivity with antfserum of AVP and OT. The posttive areas were much denser near the cells membrane and around TNC-lymphocytes (TNC-Ls). It was implicated that TNCs might serve as neuroendocrine cells and might play a role in TNC-Ls differentiation via secreting AVP and OT.

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.

Objective To study the clinical features of acute pancreatitis (AP) in elderly patients. Methods The elderly AP patients from January 1993 to October 1999 in our hospital were studied retrospectively. Results There are 83 cases with a male to female ratio of 1 5∶1 and a median age of 72 7 years.AP was diagnosed in 83 cases for 107 times which included 80 times of mild AP and 27 times of severe AP 13 patien with APts were diagnosed for more than one times.Abdominal pain was the primary symptom in 94 4% patients. 6 patients had no pain 53 0%(44/83) and 84 6%(11/13) patients had cholelithiasis and recurrent AP respectively.60 5% and 72 6% patients were diagnosed by type B ultrasonic and CT respectively . Conclusions In elderly AP patients,abdominal pain was the primary symptom, but a part of patients had no typical symptoms.Cholelithiasis including biliary sludge was an inducement especially in recurrent AP patients. Type B ultrasonic and CT examination were important means in diagnosis.

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