Objective To evaluate the effect of continuous spinal anesthesia with a "catheter-over-needle" system which diminished the leakage of CSF through the hole in the dura alongside the inserted catheter and minimizes the risk of post-dura-puncture headache. Methods Sixty ASA Ⅰ - Ⅱ patients aged over 60 yr, scheduled for transurethral prostatectomy, were randomly divided into two groups of 30 patients in each group: group I continuous spinal anesthesia (CSA); group Ⅱ continuous epidural anesthesia(CEA) . Catheter was placed at L2-3 or L3-4. Both groups received 0.5% bupivacaine for surgery. A loading dose of 1.5-2.5 ml (groupⅠ ) or 8-13 ml (group Ⅱ) was given. If the surgery exceeded 2 h a third of the loading dose was injected. For postoperative analgesia a mixture of 0.125% bupivacaine + 0.0006% fentanyl was used. In group I the PCA setting was loading dose 0.5ml, background infusion at 0.5 ml/h, bolus dose 0.5 ml and lock-out interval 8 min. In group Ⅱ the loading dose was 2 ml followed by background infusion at 2 ml/h and bolus dose was 2 ml with lock-out interval of 15 min. Onset time and level of analgesia were recorded during surgery and VAS pain score and movement of lower extremities (modified Bromage score) were assessed. Postoperative PCA was maintained for 50 h. Results The demographic data including age, height and body weight were comparable between the two groups. There was no significant difference in the duration of surgery between the two groups. The onset of block was significantly faster in group I (3.5 ?2.3) min than that in the group Ⅱ (9.5 ?3.4) min. Motor blockade was less intense in group Ⅱ as assessed by modified Bromage score. Analgesia was more satisfactory in group I as less patients received fentanyl and droperidol iv during surgery in group I . Thetotal amount of bupivacaine used during postoperative analgesia was significantly less in group I , only about one-fifth of the total amount used in group Ⅱ. Two patients complained of headache in group I but in group Ⅱ there was also one patient complaining of headache. Conclusion Continuous spinal anesthesia has the advantage of faster onset of block, better analgesia, more intense motor block with less local anesthetic.

Objective To observe the effects of sevoflurane pretreatment on lung metastasis of mouse Lewis lung cancer (LLC)cells.Methods Mouse LLC cells were inoculated in culture plate. After being cultured for 24 h the cells were randomly divided into four groups:group control (CC), group 1% sevoflurane (SC1),group 2% sevoflurane (SC2),and group 3% sevoflurane (SC3).Cells of group SC1-3 were exposed to 1%,2%,3% sevoflurane for 4 h respectively,cells of group CC were exposed to 95%O 2-5%CO 2 mixture air,and were then cultured for another 24 h.The invasive activity of cells was determined by Transwell assay.The migration of cells was evaluated by wound scratch assay.The expression of MMP-2 and MMP-9 in cells were detected by ELISA.Thirty-two C57BL/6 mice were divided into four groups (n = 8):group control (CM),group 1% sevoflurane (SM1),group 2% sevoflurane (SM2),and group 3% sevoflurane (SM3).LLC cells of group SC1-3 were injected into caudal vein of mouse in group SM1-3 respectively.Cells of group CC were injected into mouse of group CM.Lung metastasis inhibitory rates were evaluated after 3 weeks. Results Compared with group CC,the invasive activity and migration of cells in group SC1-3 were decreased significantly,group SC1 >group SC2 >group SC3 (P <0.05 );the protein expression of MMP-2 and MMP-9 was significantly down-regulated with sevoflurane concentration increased,group SC1 >group SC2>group SC3 (P <0.05).Compared with group CM,lung metastasis inhibitory rates of group SM1-3 were increased significantly,group SM1 < group SM2 < group SM3 (P < 0.05 ). Conclusion Sevoflurane can inhibit the lung metastasis of mouse LLC cells,which maybe through down-regulating the expression of MMP-2 and MMP-9 in mouse LLC cells.

Objective To investigate the effects of serum from patients receiving isoflurane and sevoflurane on the invasion and migration ability of human lung adenocarcinoma cell line A549. Methods Twenty ASAⅠorⅡ lung cancer patients aged 40 ~ 68 yr undergoing radical surgery were randomly divided into sevoflurane group (SEV group, n = 10) and isoflurane group (ISO group, n = 10). The concentration of sevoflurane or isoflurane maintained 1.5 MAC during anesthesia. Ten healthy volunteers were selected as control group. Serum was separated from blood sample taken at the end of surgery. A549 cells were randomly divided into sevoflurane group (group SEV, n = 10), isoflurane group (group ISO, n = 10) and control group (group C, n = 10). Cells of SEV group and ISO group were treated with 10% serum as respect to anesthetics for 24 hours. Cells of group C were treated with serum of control group. The invasion ability of cells was evaluated by Transwell assay. The migration ability of cells was determined by wound healing assay. The expressions of MMP-2 and MMP-9 in A549 cells were detected by ELISA. Results Compared with group C and ISO group,the number of invasive cells in group SEV was reduced significantly (P < 0.05). The levels of MMP-2 and MMP-9 in group SEV were significantly decreased compared with those of group C and ISO group (P<0.05). Conclusion The serum of patients receiving sevoflurane anesthesia can attenuate the metastatic ability of A549 cells through inhibiting the expression of MMP-2 and MMP-9.

Objective To investigate the effect of intrathecal (IT) dexmedetomidine on the expression of cAMP response element-binding protein phosphorylation (p-CREB) in spinal dorsal horn in a rat model of bone cancer pain. Methods Sixty-four adult female Wistar rats weighing 200-240 g were randomly divided into 4 groups (n = 16 each): sham operation group (group S); bone cancer pain group (group BP); normal saline group ( group NS) ; dexmedetomidine group (group D) . Bone cancer pain was induced by injecting Walker 2S6 mammary gland carcinoma cell suspension (2 ×106 cells/ml) 10μl into the medullary cavity of the tibia in BP, NS and D groups. Groups S and BP received no IT injection. Croups NS and D received IT injection of NS 10 μl and dexme detomidine 5 μg/kg respectively 7 days after successful establishment of the model. Ten animals were selected from each group at 1 day before IT administration (T0), immediately before IT administration (T1 ) and at 1, 6, 12 and 24 h after IT administration (T2-5 ) and paw withdrawal threshold (PWT) to mechanical stimuli was measured with von Frey filaments. The other 6 rats in each group were sacrificed at T4 and the spinal cord was removed for determination of p-CREB expression in the spinal dorsal horn.Results PWT was significantly decreased at T1-5 and pCREB expression up-regulated at T4 in BP, NS and D groups compared with group S ( P ＜ 0.05) . Compared with group BP, PWT was significantly decreased at T2-5 and p-CREB expression down-regulated at T4 in group D ( P ＜0.03), while no significant change in PWT and p-CREB expression was found in group NS (P ＞ 0.05) .Conclusion IT dexmedetomidine can reduce the bone cancer pain through inhibiting the phosphorylation of CREB in rat spinal dorsal horn.

Natural orifice tranluminal endoscopic surgery,NOTES is a noval surgical method whose major ad vantage is the diminishing of surgieal scar,thus is benefical to a subgroup of special patients.The key issues related to the development of NOTES are the invention of instrument satisfing the clinical demand,the setting up of safe method of closing the transluminal acce88 and the training of doctors.

Objective To understand the trend of drinking-tea type fluorosis in the diseased areas in Inner Mongolia Autonomous Region,and to evaluate the effect of prevention and control measures.Methods In 2009 and 2012,6 monitored counties were selected in Inner Mongolia Autonomous Region; 5 diseased villages were selected in each monitored county,and 10 families were selected in each monitored village; fluorine content of brick tea was tested,and dental fluorosis conditions of all 8 to 12-year-old students and skeletal fluorosis conditions of all 36 to 45-year-old adults were examined.In 2012,in each monitored village,1 water sample of the drinking water source was collected respectively from five positions(east,south,west,north and the central of the village),and fluoride content of drinking water wastested.Results In 2009,the mean of brick tea fluorine content was 541.48 mg/kg in the monitored villages,and the fluoride content ≤ 300 mg/kg accounted for 17.62％.(49/278).In 2012,the mean of brick tea fluorine content was 536.06 mg/kg,and the fluoride content ≤300 mg/kg accounted for 11.00％(33/300).Total exceeding standard rate of the water fluoride content was 40.00％(12/30).In 2009,the detection rate of the children's dental fluorosis was 52.39％ (274/523),very mild,mild,moderate and severe cases accounted for 9.56％(50/523),19.86％(104/523),21.03％(110/523) and 1.91％(10/523),respectively.In 2012,the detection rate of the children's dental fluorosis was 35.71％(200/560),very mild,mild,moderate and severe cases accounted for 14.11％ (79/560),11.43％ (64/560),9.64％ (54/560),and 0.54％ (3/560),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =40 696.0,P ＜ 0.01).In 2009,the detection rate of adult skeletal fluorosis was 23.52％ (167/710),mild,moderate and severe cases accounted for 17.32％(123/710),4.51％(32/710) and 1.69％(12/710),respectively.In 2012,the detection rate of adult skeletal fluorosis was 20.12％ (103/512),mild,moderate and severe cases accounted for 17.38％ (89/512),2.54％ (13/512) and 0.20％ (1/512),respectively.Compared with 2009,the proportion of moderate and severe cases reduced in 2012(W =12 797.5,P ＜ 0.01).Conclusion The drinking-tea type fluorosis in Inner Mongolia Autonomous Region has been controlled to some degree,but still serious in some areas;prevention and control measures need to be further strengthened.

Objective To evaluate the effect of curcumin on spinal inflammatory factor in rats with diabetic neuropathy. Methods Diabetic neuropathy was induced by intraperitoneal injection with 1% STZ (60 mg/kg) in sprague-dawley rats. These diabetic rats were randomly allocated to diabetic group (D group, n=10) and curcumin group ( C group , n = 10 ) . Another 10 age-matched normal rats served as controlled group ( N group , n = 10 ) . 28 days after STZ injection, the rats in C group received daily intragastric administration of curcumin (200 mg/kg) whereas those in D group received the same volume of normal saline for 2 weeks. Caudal vein blood glucose levels at T1( before STZ injection)and at T2-T8(2、7、14、21、28、35、42 days after STZ injection)from all rats were detected. Responses to the mechanical stimulus were measured with von Frey filament, and paw withdraw threshold (PWT) was recorded at T1 and at T3 to T8. At T8,the rats were killed and lumbar segments of spinal cord were removed to detect TNF-αand IL-6 content. Results Compared to N group, rats in both C and D group showed hyperglycemia at T2 to T8 (P<0.05) and lower PWT at T4~ 8 (P < 0.01). Compared to D group, C group showed higher PWT at T7,8(P<0.05). Both D and C group showed higher levels of blood sugar at T2 ~ 8 than that at T1 (P < 0.05). C group showed higher PWT at T7,8 than that at T6(P<0.05). Compared to N group,spinal TNF-αand IL-6 content increased in both D and C groups (P<0.05). Compared to D group, C group had reduction of TNF-αand IL-6 concentration (P < 0.05). Conclusion Curcumin can attenuate diabetic neuropathic pain on rats probably by reducing inflammatory factor in spinal cord.

BACKGROUND:Valgus knee deformity is rare in the clinic. The therapeutic effects of artificial knee arthroplasty are worse than varus knee deformity. There is no unified opinion for replacement approach, soft tissue release method and procedure and prosthetic choice at present.
OBJECTIVE:To summarize case data and to observe clinical effects of total knee arthroplasty for valgus knee deformity.
METHODS:Clinical data of 37 cases of valgus knee deformity (42 knees) undergoing total knee arthroplasty, who were treated by the same group of physicians in the First Department of Orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine from January 2010 to December 2012 were retrospectively analyzed. There were 11 males (13 knees) and 26 females (29 knees), at the age from 56 to 78 years, with an average age of 63.7 years. The differences in range of motion, femorotibial angle and Hospital for Special Surgery knee score were compared before and after replacement. Clinical effects of total knee arthroplasty for valgus knee deformity were evaluated.
RESULTS AND CONCLUSION:The postoperative fol ow-up lasted from 6 to 36 months. Knee joint range of motion increased from preoperative 68.5° to an average of postoperative 108.5°. Femorotibial angle reduced from preoperative 16.82° to postoperative 5.62° on average. The average Hospital for Special Surgery knee score increased from preoperative 39 points to postoperative 88 points (P<0.05). These results suggested that the curative effect of total knee arthroplasty for valgus knee deformity is proved. Total knee arthroplasty is an effective way to improve deformity.

Objective To observe the difference of morphology and phagocytosis between alveolar macrophages (AMs) and pulmonary interstitial macrophages (IMs). Methods AMs were collected by lung lavage and IMs by treatment of the lung tissue with DNAse and collagenase. The two cell populations were analyzed with respect to morphology by transmission electron microscopy, and the variation of these macrophages of phagocytosis were tested by malachite green colorimetry. Results There were great differences in morphology between AMs and IMs. The phagocytosis of AMs was much stronger than that of IMs. Conclusion There is functional and morphological heterogeneity between AMs and IMs. IMs should not be regarded as the precursors to AMs.

Objective To establish a rat model of bone cancer pain-chronic morphine tolerance. Methods Thirty-six adult female Sprague-Dawley rats weighing 180-200 g in which intrathecal catheters were successfully placed without complications were randomly divided into 3 groups ( n = 12 each) :group sham operation (group S),group chronic morphine tolerance (group M) and group bone cancer pain + chronic morphine tolerance (group BM). Bone cancer pain was induced by intra-tibia inoculation of Walker256 mammary gland carcinoma cells (4 ×102 cells/μl) in group BM, while in group M heat-inactivated Walker256 mammary gland carcinoma cells were given instead, and then 10 days later, intrathecal morphine 20 μg,/kg was administered twice a day for 9 consecutive days. The mechanical paw withdrawal threshold (MWT) and mechanical paw withdrawal duration (MWD) were measured before inoculation, at day 1, 3, 6 and 9 after inoculation, and at day 1, 3, 5, 7 and 9 of morphine administration. The degree of bone destruction was assessed by radiological analysis at day 9 after inoculation. After the last measurement of pain threshold, the rats were given innoxious touch-stimulus. The rats were sacrificed 3 h after stopping the stimulus, and L4-6 segment of the spinal cord was isolated to determine the expression of Fos protein in the spinal dorsal horn. Results Compared with group S, MWT was significantly decreased, MWD was significantly prolonged and the expression of Fos protein was up-regulated in group M ( P ＜ 0.05 or 0.01 ). MWT was significantly decreased, MWD was significantly prolonged, bone destruction scores were significantly increased,and the expression of Fos protein was up-regulated in group BM compared with group M ( P ＜ 0.05 or 0.01 ). Conclusion A rat model of bone cancer pain-chronic morphine tolerance is successfully established.