Objective To study the ketone luo acid tromethamine analgesia in patients with knee osteoarthritis joint replacement in advance of inflammatory factor and the influence of stress state. Methods Choice for knee osteoarthritis knee joint replacement patients 61 cases, were randomly divided into control group (30 caese) and the observation group (31caese), the control group only received intravenous anesthesia compound epidural block, on the basis of the observation group receied ketone luo acid tromethamine analgesia in advance, the contrast analysis of two groups of patients with preoperative and postoperative VAS score, cytokines and cortisol levels. Results The observation group of patients with postoperative pain VAS score (24 h, 48 h, 72 h) were significantly lower than control group (P<0.05);Observation group with 24h after IL - 8, TNF alpha level significantly lower than the control group (P<0.05), the observation group after 48h of IL-6, IL-8, TNF-a levels were significantly lower than control group (P<0.05).0bservation group 24h after surgery in patients with Cor significantly lower than the control level (P<0.05), after 48 h Cor and ACTH level observation group were significantly lower than the control group (P<0.05).Conclusion Ketone luo acid tromethamine analgesia in advance can obviously relieve knee osteoarthritis pain after joint replacement, and can significantly reduce inflammatory factor levels, reduce the postoperative patients with stress state.

Objective To observe the effect of carvedilol and metoprolol in patients with chronic heart failure (CHF) and its effect on TNF-α and IL-6.Methods 94 cases of CHF were randomly classified into carvedilol group with 47 cases and metoprolol group with 47 cases, which were treated with metoprolol and metoprolol,respeetively.The clinical effects and the lovels of TNF-α and IL-6 were compared.Results The clinical effeetive rate in carvedilol group was significantly higher than that in metoprolol group( P < 0.05 ).After treatment, the levels of TNF-α and IL-6 were significantly decreased in both groups (P < 0.05 ).Moreover, the levels of TNF-α and IL-6 in carvedilol group were significantly lower than those in metoprolol group after treatment (P < 0.05).Conclusion Carvedilol in improving clinical effective rate and decreasing the levels of TNF-α and IL-6 was better than metoprolol,whieh played an important role in treatment of CHF.

ObjectiveTo investigate the association between serum level of osteopotin(OPN) and disease activity of rheumatoid arthritis (RA) patients, and explore the importance of OPN in the pathogenesis of interstitial lung disease (ILD) in RA. MethodsSixty-five RA patients and 20 healthy controls were pros-pectively enrolled. RA patients were divided into active group(n=43) and inactive group(n=22), and ILD groups (n=24) and non-ILD group (n=41). Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of OPN in patients with RA and healthy controls, and the relationship between OPN and other clinical and laboratory findings were analyzed.Results① Serum OPN tended to be significantly higher in RA patients (median, 18.0 ng/ml) than in the healthy controls (median, 14.3 ng/ml), P<0.01; ②The serum level of OPN in RA patients showed a significant positive correlation with the course of disease, numbers of tender joints , ESR and CRP, but no positive relationship was found in number of swollen joints; ③ The serum level of OPN was significantly higher in RA-ILD patients(median, 20.0 ng/ml) than that in non-lLD (median, 17.0 ng/ml, P<0.05). And there was remarkable negative correlation between the concentration of serum OPN and the value of PaO2, but no association was found with pulmonary function %VC and %DLCO. ④ Compared with the non-ILD group, the ILD group had more active disease in terms of tender joint counts and swollen joint counts, ESR, CRP(P<0.01) and the serum titer of RF-IgM,(P<0.05). ConclusionOPN plays a role in the pathogenesis of RA and is related to the disease activity. It may serve as an active disease inflammatory marker of RA . OPN may be involved in the pathogenesis of RA related ILD and is associated with the severity of pulmonary damage.

Objective To investigate the relationship between the level of tumor necrosis factor (TNF)? and the clinical features of multiple sclerosis(MS). Methods The TNF? level of 58 MS patients (MS group) was determined by means of sandwich enzyme-linked immunosorbent assay (ELISA). The correlative analysis between level of TNF? and the Expanded Disability Status Scale (EDSS), the clinical data (including the duration of disease,the number of relapses and the age of onset) were take in MS patients. Results (1)TNF? level was significantly increased in MS acute stage compared with those in MS remission stage and healthy controls (P

This paper introduces the feature of binocular indirect ophthalmoscope and its application in ophthalmologic examination and operation. Compared with direct ophthalmoscope, binocular indirect ophthalmoscope has many special advantages owing to its unique illumination system and principle of formation of image. Most of ocular fundus diseases can be diagnosed correctly by binocular indirect ophthalmoscope. The view is that the inspection technique of binocular indirect ophthalmoscope is the most convenient and predominant in fundus examination, ophthalmology operation and treatment until now, and is of value in use.

Objective To determine the prevalence of pain beyond the osteoporotic vertebral com-pression fracture (OVCF) in patients undergoing percutaneous vertebral augmentation and the response of pain to the treatment. Methods A retrospective study of 104 patients undergoing percutaneous vertebral augmentation (pereutaneous vertebroplasty and pereutaneous kyphoplasty) was performed to examine the lo-cations and severities of pain beyond the OVCF before and after operation. The Visual Analog Sscale (VAS,10-point scale) and Activities of Daily Living (ADL, 5-point scale) were used. Results Of the 104 patients, 48 (46.2%) suffered pain beyond the OVCF. The pain was firstly located in the sacrococeygeal region and buttocks (26.0%), secondly in the abdomen and sub-xiphoid process (10.6%) and thirdly in the flank, ribs and chest (9.6%) . For all the cases, the mean VAS score decreased from 8.9±0. 8 before vertebral augmentation to 2.9±1.4 after augmentation (t=37.410, P=0.000), and the mean ADL score decreased from 4.1±0.6 before operation to 2.0±0.7 after operation (t=25.331, P =0.000) . For the patients suffering pain beyond the OVCF, the mean VAS score decreased from 8.8±0.9 before vertebral augmentation to 2.8±1.5 after augmentation (t=23.722, P=0.000), and the mean ADL score decreased from 4.2±0.7 before operation to 2.0±0. 7 after operation (t=15.373, P=0.000). The decreases in VAS and ADL scores were not affected by the pain. Conclusion The pereutaneous vertebral augmentation can effectively relieve the pain beyond the OVCF.

Objective To address the standard first-line management under the new diagnostic criteria in adult immune thrombocytopenia (ITP). Methods A retrospective analysis was conducted involving 178 adult ITP patients treated with high-dose dexamethasone or prednisone in Qilu Hospital from March 2004 to November 2009 using new diagnostic criteria. Results The median age was 41 years with a male/female ratio of 0. 73: 1. Among the 178 ITP patients, 87 were newly diagnosed, 30 persistent ITP, 58 chronic ITP, and 3 unable to follow up. The efficacy rates among 167 patients able to assess in the three groups were 77.4% ( 65/84 ), 64. 0% ( 16/25 ) and 62. 1% ( 36/58 ) respectively, and their complete remission (CR) rates were 57. 1% (48/84), 36. 0% (9/25) and 32. 8% (19/58). The efficacy rate and CR rate of the newly diagnosed ITP category were significantly higher than those of the chronic ITP category (x2 = 3. 917, P ＜ 0. 05 ;x2 = 8. 186, P ＜ 0. 01 ). The patients treated with high-dose dexamethasone or prednisone therapy had no significant differences in sex, age or blood platelet count before treatment.Moreover, the short or long term response rates and the CR rates between the two therapies had no statistically significant differences while the former had a shorter onset time ( F = 10. 34, P ＜ 0. 01 ).Conclusions The study sets up a basis for the application of the recommended new definition and outcome criteria for adult ITP. Dexamethasone therapy is favored as first-line therapy.

Objective To observe the effects and toxicity of nimotuzumab combined paclitaxel and carboplatin in the treatment of advanced non small cell lung cancer .Methods 168 cases of patients with advanced non-small cell lung cancer were randomly divided into study group and control group ,with 84 cases in each group .Study group was treated with nimotuzumab 200 mg ,1 times per week ,for 6 weeks ,two weeks later the patients were treated with 200 mg and stopped when the disease progressed ,paclitaxel lipo-some(135 mg/m2 ,iv drip 3 h ,1 days) ,carboplatin(300 mg/m2 ,iv drip ,1 days);the control group was given paclitaxel liposome(135 mg/m2 ,iv drip 3 h ,1 days) ,carboplatin(300 mg/m2 ,iv drip ,1 days) ,21 days for 1 cycle .Results Study group RR 38 .1% (32/84);control group RR 23 .8% (20/84)(P<0 .05) .The main side effects of two groups of were gastrointestinal reaction and bone marrow suppression ,there were 64 cases of above Ⅱ digestive tract reaction in the study group ,accounting for 76 .2% ,52 cases ofⅡ degrees of bone marrow suppression ,accounting for 61 .9% ,52 cases of Ⅱ degrees of alopecia ,accounting for 61 .9% ;54 cases of control group Ⅱ digestive tract reaction ,accounting for 66 .7% ,54 cases of Ⅱ degrees of bone marrow suppression ,accounting for 66 .7% ,and 58 cases of Ⅱ degrees of alopecia ,accounted for 57 .1% (P>0 .05) .In the study group ,progression-free survival period was 7 .8 months ,the median survival period was 14 .2 months;in the control group ,progression-free survival period was 5 .1 months ,the median survival period was 9 .8 months(P<0 .05) .Conclusion nimotuzumab combined paclitaxel and carboplatin in the treatment of advanced non small cell lung cancer has good clinical curative effect ,and would not increase adverse reactions .It is worthy of clinical application .

Objective To investigate the effects of clonidine on the visceral pain induced by acute myocardial ischemia. Methods Male SD rats weighing 250-280 g were operated upon under general anesthesia with intraperitoneal methane 1.2 g/kg and local infiltration of the skin incision. After tracheal intubation, the animals were mechanically ventilated (VT = 5-7 ml/kg, RR = 75 bpm). The anterior descending branch of left coronary artery was occluded with a snare through the left 4 th intercostal space. The animals were then fastened to a brain stereotaxic instrument and a burr hole was made in the skull. A glass micro-electrode was inserted into the brain. The discharges of noxious stimulation responding neuron (NSRN) in parafascicular nucleus were recorded. Twenty-four rats detected NSRN showed response to coronary artery occlusion (CAO) were randomly divided into 4 groups (n =6 each): group Ⅰ CAO + normal saline 0.1 ml; group Ⅱ CAO + elonidine 30 μg; group Ⅲ CAO + clanidine 100 μg; group Ⅳ CAO + clonidine 100 μg + yohimbine (an α2-adrenergic receptor antagonist) 200 μg. In group Ⅳ , clonidine was administered intravenously 15 min after CAO, and then yohimbine was injected intravenously 15 min later. The discharges of NSRN were recorded every 5 min for 60 min from the beginning of CAO. Results Clonidine 100 μg significantly inhibited the increased frequency of nociceptive discharge rate of NSRN after CAO. However, this effect could be blocked by the α2-adrenergic receptor antagonist yohimbine.Conclusion Clonidine 100 μg can reduce the visceral pain induced by acute myocardial ischemia through activiting α2-adrenergic receptor.