BACKGROUND:In the elderly patients with a variety of diseases, poor physical and compensatory ability results in a high demand for anesthesia during hip replacement and internal fixation. Lumbar epidural anesthesia with ropivacaine is the commonly used method of narcotic analgesics, but this method of anesthesia has been less studied in elderly hip replacement and internal fixation. OBJECTIVE: To investigate the effects of lumbar epidural anesthesia with ropivacaine in elderly hip replacement and internal fixation. METHODS: Data of fifty elderly patients with hip replacement implants and internal fixation, who were treated in the Department of Orthopedics, Affiliated Hospital of Xizang Minzu University from February 2014 to August 2015, were analyzed. 50 patients were randomly divided into continuous epidural anesthesia group and ropivacaine lumbar epidural anesthesia group, with 25 patients in each group. Anesthetic effect was compared. Self questionnaire on risk factors was used for non-conditional Logistic multivariate analysis between the two groups. RESULTS AND CONCLUSION: (1) Anesthetics onset time, the amount of local anesthesia, the use of trimetaphan camsilate agent number, complete block time, heart rate after anesthesia and complication rate were significantly less in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (2) The highest block level, Bromage score, mean arterial pressure after anesthesia and anesthesia satisfaction rate were significantly higher in the ropivacaine lumbar epidural anesthesia group than in the continuous epidural anesthesia group (P < 0.05). (3) Logistic multivariate analysis on postoperative cognitive dysfunction showed that postoperative cognitive dysfunction was strongly associated with age, education, complications, and hip arthroplasty (P < 0.05). (4) Results verified that lumbar epidural anesthesia with ropivacaine showed ideal effects in hip arthroplasty and internal fixation. Postoperative recovery was rapid, and it is safe and reliable.

From the Government’s fully guarantee stage to the stage of independent organization of medicine, then to the market-oriented reforms and the new health care reform exploration stages, the public hospitals reform fol-lows different institutional logics, but the institutional dilemma have emerged at all stages including the little coupling between the institutional arrangements and environment, the public welfare and benefit wandering, the management system instability, and the breakdown of the financial investment and control costs mechanisms. The Government should elaborate conditions for the spontaneous public hospitals reform on the institutional environment in order to em-bed intrinsic motivation of the induced institutional change into the imposed institutional change. There should be positive interaction between the government and the market in order to form a reasonable and orderly competitive land-scape to the market of medical services. Payment should be reformed which has significant influence on internal medi-cal service system incentives.

Objective To observe the effects ofShenkang bolt on the IL-10 and IL-6 of patients with continous ambulatory peritoneal dialysis (CAPD).MethodsA total of 60 patients with CAPD were divided into the control group (n=30) andShenkang bolt observation group (n=30). The control group was treated with convertional treatment of CAPD, low salt, low fat, low phosphorus and high quality diet. The observation group was treated withShenkang bolt based on control group treatment. The clinic effect was detected after treatment for 8 weeks. The serum creatinine was determinated by basic picric acid method, and blood urea nitrogen was determinated by urease test. The clinic and biochemical indicator of Scr, BUN, 24h urine volume, Kt/Vurea, RRF, and ultrafiltration volume were compared between the two groups. The IL-10 and IL-6 were detected by ELISA analysis.Results After treatment, IL-10 (19.56 ± 4.38μg/mlvs. 8.98 ± 2.05μg/ml,t=4.392,P<0.01) was significantly higher in observation group than that in control group, and IL-6 (21.82 ± 3.57μg/mlvs. 49.66 ± 5.26μg/ml,t=5.264,P<0.01) was significantly lower in observation group than that in control group. The RRF (7.86 ± 2.12vs. 5.31 ± 1.62;t=2.436, P=0.046) and ultrafiltration volume (421.37 ± 81.61 ml/dvs. 321.23 ± 71.94 ml/d;t=2.617, P=0.038) was significantly higher in observation group than those in control group. ConclusionShenkang bolt could help patients with CAPD balancethe immune, suppress inflammation and improve the RRF and ultrafiltration volume.

In the use of antiepileptic drugs in patients with epilepsy,1/3 of the patients with epilepsy can not get effective control,showing resistance to antiepileptic drugs.Now the mechanism of drug resistance is considered to be caused by multiple factors work together.The concept and connotation between drug-resistant epilepsy and refractory epilepsy are different.Since 2010,the international union of antiepileptic proposeddrug-resistant epilepsy expert consensus,different medical centers use the new defition to study different populations and confirm that the new definition is effective and reliable.However,there are some controversier about the drug dosage,drug kinds,judge for determining evaluation index and the treatment judgement in that definition.

Biofilm formation makes bacteria adopt a multicellular lifestyle.Compared to planktonic cells, biofilm-grown cells express an increased resistance to antimicrobial agents.Bacterial biofilm formation is a crucial step in the pathogenesis of many subacute and chronic bacterial infections.In clinical setting, biofilm can cause bacterial biofilm disease and biomaterial associated infection.Understanding the mechanisms involved in biofilm-associated antimicrobial resistance is key to the development of new solutions.

Food Safety ; International Cooperation ; Risk Assessment

Objective To investigate effects cytokine of rhIFN-a and their on ultrastructure of hypertrophic scar derived fibroblasts and explore its mechanism.Methods Hypertrophic scar fibroblasts cultivated in vitro were observed and analysed through transmission elextron microscope(TEM).Then the effects of rhIFN-a on biological behavior and pathological changes of hypertrophic scar fibroblasts have been determined.(Results) Compared with the control group,the experimental rhIFN-a group could be observed changes in inhibition of fibroblasts growth and proliferation with the mitochondrion swelling,its ridge dissolving and apoptosis promoting.Conclusions rhIFN-a can suppress growth and proliferation of hypertrophic scar fibroblasts and promotes apoptosis.This indicates that ,as a negative modulation factor,rhIFN-a is important in the treatment of hypertrophic scar.

Objective: To investigate the changes of gastric intramucosal pH(pHi)and the association with hemody namics and oxygen utilization during cardiopulmonary bypass (CPB). Method: Adults (n=15)free of hepatic, pulmonary,and renal diseases undergoing nonemergent heart surgery,were selected. After induction of general anesthesia and endotracheal intubation,a tonometer nasogastric tube was positioned in the stomach to determine the intramucosal pH. Hemodynamics and oxygen utilization data and phi were measured at four times:30 minutes after induction of anesthesia; 15 minutes after termination of cardiopulmonary bypass; at the terminal of the surgery;and 1 day after the surgery. Result: Cardiac index significantly increased(P

Telomerase activity in 43 biopsy of gastric mucosa was detected with the modified telomeric repeat amplification protocol(TRAP) assay to elucidate pathogenesis of gastric cancer.The detected positive rates were as follows:87%(20/23) in gastric cancer,28 6%(2/7) in moderate and non-typical gastritis ,0%(0/10 in atrophic and superficial gastritis,respectively.These results suggest that the detection of telomerase activity may play a significant role in the diagnosis of gastric cancer.

Cervical anterior decompression and fusion is currently used in the treatment of cervical spondylosis.This paper reviews the surgical complications and its prevention measures,so as to provide some references to reduce the complications and improve operative efficacy.