Objective To compare the knee of patient controlled subcutaneous injection of morphine analge-sia after hip joint replacement ( PCSA ) and intravenous morphine patient-controlled analgesia ( PCIA ) effect and safety of postoperative analgesia.Methods 60 patients undergoing artificial total knee arthroplasty patients were selected and randomly divided into PCIA group of 30 cases,30 cases in group PCSA, two patients were completed under epidural anesthesia in the operation.Group PCIA and group PCSA single dose divided into 1mg/and 2.5mg/, lock time divided into 5min,20min,in the postoperative pain perception,from the patient's own pain medication.After 4h,8h,12h,24h record patient morphine dosage,frequency,pain score (VAPS),mean arterial blood pressure and re-spiratory rate,compose degree,analgesic effects were compared between the two groups.Results In group PCSA after 24h treatment for the total dose was (30.41 ±10.00) mg,significantly higher than that of group PCIA (18.03 ± 6.04)mg,there was significant difference between the two groups (t=3.98,P<0.05);but after each time point of the two groups of patients the average dosage had no statistically significant difference (P>0.05).PCIA group after 0-4h and >4-8h analgesia and sedation were better than those in PCSA group (t=3.4,3.2,3.5,3.7,all P<0.05), PCIA group,the incidence rate of nausea and vomiting was 30%,higher than 12%in the PCSA group,there was sig-nificant difference between the two groups (χ2 =5.76,P<0.05).Conclusion The two kinds of methods of analge-sia has a good analgesic effect,but PCSA analgesia is slower,less adverse reactions,should be given a loading dose at the beginning before PCSA,in order to improve the early analgesia effect.

Objective To analyze the changes of bone mineral density (BMD) and the incidence of osteoporosis in elderly people in Xuzhou area by measuring BMD, and provide reference to osteoporosis prevention and control. Methods From 2005 to 2008, BMD were measured in 1204 elderly people by dual energy X-ray absorptiometry (DEXA). The measurement included the neck of femur and L2-4 of lumbar. All subjects were divided into multiple sections with every 5 year interval. Osteoporosis was diagnosed according to the criteria of BMD peak minus 2. 5 SD. BMD values and the incidence of osteoporosis were analyzed among different age and gender groups. Results BMD of different sites decreased year by year in both male and female in Xuzhou area. After 55years of age BMD decreased more in female than in male ( P ＜ 0. 01 ). The incidence of osteoporosis in female was higher than that in male. Conclusions We should reinforce the health education on osteoporosis prevention. Intervention should be conducted in females older than 55 years and males older than 65 years to decrease the occurrence of osteoporosis.

BACKGROUND:Although the nickel-titanium occluder in the treatment of congenital heart disease has a better clinical effect, arrhythmia wil be more likely to develop in late stage. OBJECTIVE:To investigate the effect of nickel-titanium wire on expression of sarcoplasmic reticulum Ca~(2+)-ATPase and ryanodine receptor of rat myocardial cels. METHODS:Thirty Sprague-Dawley rats were obtained and randomly divided into two groups: experimental and control groups. The nickel-titanium wire was implanted to the apex of heart of rats in the experimental group. Rats in the control group received no special treatment. Rat mycardial cels were harvested at the 1th, 3rdand 6th months after operation. The gene and protein expressions of sarcoplasmic reticulum Ca~(2+)-ATPase and ryanodine receptor of rat myocardial cels were detected using RT-PCR and immunohistochemistry, respectively. The inflammatory reactions were detected using hematoxylin-eosin staining. RESULTS AND CONCLUSION:After the nickel-titanium wire was implanted into the rat myocardium, inflammatory reaction was induced by inflammatory cel infiltration in the experimental group, with hyperplasia of fibrous tissue. The inflammatory reaction gradualy disappeared as the implanted time extended. No inflammatory cel infiltration was visible in the control group. There was no significant difference in the gene and protein expressions of sarcoplasmic reticulum Ca~(2+)-ATPase and ryanodine receptor of rat myocardial cels at different time points after operation between these two groups. It showed that nickel-titanium wire had no influence on the expressions of sarcoplasmic reticulum Ca~(2+)-ATPase and ryanodine receptor of rat myocardial cels. These results suggest that nickel-titanium occluder-related arrhythmia may have little relationship with abnormal protein expression of sarcoplasmic reticulum Ca~(2+)-ATPase and ryanodine receptor.

Background Proliferative vitreoretinopathy (PVR):no blood vessels,fibrous membrane cell proliferation occurs retinal surface.The development of specific mechanisms has not been completely clarified,but the retinal pigment epithelium(RPE) and platelet-derived growth factor(PDGF) for the past few years are the research hotspot.Objective To explore the effects of hypoxia on the production of PDGF-BB and proliferation in cultured human RPE (hRPE) cells.Methods In the experimental group,10,15,20,30,40 μmol/L CoCl2 were used to mimic hypoxia environment of hRPE cells,the control group did not add CoCl2 on cultured hRPE cells.By using reverse transcriptive PCR (RT-PCR) and enzyme linked immunosorbent assay(ELISA),the expression of PDGF-BB mRNA and protein was detected,and detected proliferation of hRPE cells by MTT.The cells were divided into 6 groups,different siRNAs were transfected into PDGF-BB siRNA1 group,PDGF-BB siRNA2 group,PDGF-BB siRNA3 group (because PDGF-BB has three different siRNAs,one of which is a valid siRNA),β-actin siRNA group,unrelated sequence siRNA group,only Lip2000 was plused in the blank control group.After transfection of 4-6 hours,except for blank control group,the other five groups were added to PDGF-BB mRNA and protein and its effect on the proliferation of hRPE cells obviously CoCl2 concentrations (15 μmol/L) simulated hypoxia environment of 24 hours,the detection of PDGF-BB mRNA and protein and hRPE cell proliferation rate.Results Neither PDGF-BB mRNA or protein was found in the blank control group.The production of PDGF-BB mRNA and protein in hRPE cells cultured by different concentrations were different,with significant differences among them (F=43.737,P＜0.01;F=54.612,P＜0.05),and the expressions of PDGF-BB mRNA and protein of 15 μmol/L CoCl2 group were more than other groups,with significant differences between the two groups (all at P＜0.05).MTT showed that PDGF-BB protein and hRPE cell proliferation rate in different concentions of CoCl2 groups were different,with significant differences among them(F=95.379,P＜0.01 ; F =63.375,P＜0.05),the expression of PDGF-BB protein was more and hRPE cell proliferation rate was higher in 15 μmol/L CoCl2group than other groups,with significant differences between the two groups (all at P＜0.05),postive correlation was found between PDGF-BB protein and hRPE cell proliferation rate (r =0.994,P＜0.05).The production of PDGF-BB mRNA and protein in the different siRNA transfected groups were different,with significant differences among them (F =156.330,125.650,both at P＜0.01),and the expressions of PDGF-BB mRNA and protein of PDGF-BB siRNA2 group were more than other groups,with significant differences between them(all at P＜0.05).MTT showed that PDGF-BB protein and hRPE cell proliferation rate in different siRNA transfectedgroups were different,with significant differences among them (F =73.131,98.564,both at P＜ 0.01).The expression of PDGF-BB protein was less and hRPE cell proliferation rate was lower in PDGF-BB siRNA2 group than other groups,with significant differences between them (all at P ＜ 0.05),postive correlation was found between PDGF-BB protein and hRPE cell proliferation rate (r =0.996,P＜0.05).Conclusions Proper hypoxia can induce the expression of PDGF-BB,PDGF-BB expression can significantly promote the proliferation of hRPE cells.In the transfection targeting PDGF-BB siRNA,PDGF-BB expression is suppressed,can effectively reduce the value of hRPE cell hyperplasia.

Objective To observe the influence of congenital heart disease(atrial septal defect,ASD)to intervene closure on the right structure of children(<1 5 years)and adults(1 5-65 years)and to make the safety assessment.Methods Totally 1 1 1 un-derwent interventional treatment of complications in patients with ASD in our hospital from 2010 to 2013 were retrospective ana-lyzed.Closure on changing of right heart structure of child and adult were measured by ultrasonic cardiogram.Closure falls off,shut valve insufficiency,arrhythmia,residual shunt were recorded by ultrasonic cardiogram and electrocardiogram.making statistical a-nalysis.Results The inner diameter of the right atrium(RAD),right ventricle diameter(RVD),pulmonary artery diameter(PA) and right ventricular outflow tract(RVOT)were decreased compared with pre-operation(P < 0.05 ),during the follow-up 1,3,6 month,they was continue decreased in the aged between1 5-65 group(P <0.05),but was stable in less than 1 5 years old age group (P >0.05 ).The complication rate of children and adults were 25.0% and 21.3% respectively,and there were no significantly difference(P >0.05),and was no serious complications.Conclusion Congenital heart disease intervention of atria septal defects can improve heart right structure,which can benefit both children and adult,there is no difference in complication rates.All of these have less serious complications,high safety,curative effect affirmation.

Objectives To observe the frequencies of mutations at glycophorin A(GPA)of erythro-cytes in patients with high arsenic coal poisoning(HACP)in comparison with normal controls.Methods The peripheral erythrocytes were isolated and immunolabelled,and were detected by flow cytometry in40patients and18normal adults.Results The mutation frequencies(MF)were(21.23?13.97)?10 -6 for type NN,(33.13?25.72)?10 -6 for type NO,(110.90?63.58)?10 -6 for type MM,and(20.35?21.26)?10 -6 for type MO of erythrocytes in patients with HACP,which were significantly higher than those in normal controls.The mutation frequencies were(31.50?16.13)?10 -6 for type NN,(54.50?38.13)?10 -6 for type NO,(159.33?66.22)?10 -6 for type MM,and(45.16?12.69)?10 -6 for type MO of erythrocytes in tumor group of HACP patients,which were significantly higher than those of non-tumor group of the patients.Conclusions Arsenic poisoning may induce the mutation at the glycophorin-A locus of erythrocytes,sug-gesting that arsenic may be one of potential mutagens.GPA-MF may serve as a parameter for the detection of patients with HACP.

In 2009, Ministry of Health mapped out the Guiding Principle of Clinical Pathway. Rehabilitation is different with early treatment of common diseases. This paper mainly introduces the objective of rehabilitation clinical pathway, organization of management system,guiding principle of mapping-out and implementation and evaluation and improvement of medical quality.

Objective To compare the incidence of postoperative complications and long-term survival rates in pancreatic head cancer with extended and standard lymphadenectomy,and conclude an appropriate cleaning range.Methods Published randomized controlled trials about pancreatoduonectomy with extended lymphadenectomy (ELPD) vs standard lymphadenectomy (SLPD)in pancreatic cancer patients on Pubmed,Embase and the Cochrane library were retrieved from database building to October 1st 2017 with the keywords including "pancreatoduonectomy " " pancreatic adenocarcinoma whipple lymphadenectomy extended " and "standard".Obtained literatures were screened independently by two researchers(the PRISMA statement).After included literatures reviewed and data extracted,a meta-analysis was carried out using Revman 5.3 software.Results A total of 7 RCTs were included in the analysis,and the total number of cases was 850,of which 426 cases were extended lymph node dissection and 424 were standard.The results showed that the ELPD group had longer operation time (373.1 min and 318.4 min,respectively,P =0.003),increased intraoperative bleeding and blood transfusion (681.5 ml and 556.2 ml,respectively,P =0.03).The incidence rate of postoperative complications (40.8％ and 28.9％,respectively,P =0.0006) and the delayed gastric emptying (16.2％ and 10.0％,P =0.02),postoperative hospitalization time (19.7 d and 15.0 d,P ＜ 0.05) also increased in ELPD group.At the same time,the 1-、3-、5-year survival rate (66.0％ and 70.8％,P =0.17;24.7％ and 27.5％,P=0.41;16.6％ and 14.3％,respectively,P=0.45) was not improved in pancreatic cancer patients.Condusion ELPD increase the postoperative complications and prolong the hospital stay of pancreatic cancer patients and did not improve postoperative survival rate at the same time,SLPD should be preferred during the operation.By summarizing the latest research progress.

Objective To establish the proposals of clinic and rehabilitation pathway for spine and spinal cord injury. Methods The experiences in clinic and rehabilitation treatment fields, the flow path of admission and the costs of hospitalization for spine and spinal cord injury patients in Chinese Rehabilitation Research Center were retrospectively summarized and analyzed. Related data in International Classification of Functioning, Disability and Health (ICF) core sets were also referred. Results The present proposals were applied to patients suffered from thoracic, lumbar or sacral spine injury with spinal cord injury. The proposals consisted of two parts: the surgical interventions in acute stage (within 2 weeks after injury) and clinic and rehabilitation treatments of spinal cord injury in sub acute and later stages (2 weeks to 6 months after injury). The criteria of surgical interventions in acute stage materialized the core therapies such as reconstruction of spine stability and neural decompression, etc. The criteria of treating spinal cord injury in subacute and later stages demonstrated the characteristic of combined therapy in which rehabilitation was the central element. Conclusion The establishment and implement of the present pathways were based on the time course of disease development and the staging feature of neural recovery and treatment after spinal cord injury. The purpose of this work is to improve the quality of medical service and reduce medical consumption.

Objective:To study the clinical and MRI features of alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis to compare with those of hepatic focal nodular hyperplasia (FNH) to arrive at a correct differential diagnosis.Methods:The data of 105 patients who underwent liver surgery for alpha-fetoprotein-negative hepatocellular carcinomas without cirrhosis at Zhongshan Hospital, Fudan University and the Traditional Chinese Medical Hospital of Nantong from March 2017 to November 2020 were retrospectively studied. There were 109 lesions in 95 males and 10 females. These patients had the age of (60.2±9.9) years. The data of 88 patients who were diagnosed to have hepatic FNH during the study period were collected, and there were 99 lesions in 36 males and 52 females. These patients had the age of (32.8±9.5) years. Variables including age, history of hepatitis B virus infection, T 1 weighted imaging (T 1WI), T 2 weighted imaging (T 2WI), diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), enhancement mode, lesion shape, lesion boundary and capsule were compared between the two groups. Results:The age and the proportion of patients with a history of hepatitis B in the alpha-fetoprotein-negative hepatocellular carcinoma and without cirrhosis group were significantly higher than those in the hepatic FNH group (both P<0.05). The proportion of lesions with quasi-circular shape, clear boundary and with capsule in hepatocellular carcinoma group were significantly higher than those in the hepatic FNH group (all P<0.05). There were also significant differences in the T 1WI, T 2WI, enhancement modes, DWI, and ADC map between the two groups of lesions (all P<0.05). The areas under the receiver operating characteristic curve for the alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis by the age >45.5 year, with a history of hepatitis B, with clear lesion boundary, with a "washin and washout" enhanced mode and with lesion encapsulation were 0.97(95% CI: 0.95-0.99), 0.79(95% CI: 0.72-0.85), 0.78(95% CI: 0.72-0.85), 0.94(95% CI: 0.90-0.97), 0.99(95% CI: 0.98-1.00) respectively. Conclusions:The presence of a capsule, clear lesion boundary and "washin and washout" enhanced mode are helpful in differentiating alpha-fetoprotein-negative hepatocellular carcinoma without cirrhosis with hepatic FNH.