Objective To explore and analyze the anesthetic effects of different doses of ropivacaine combined with lidocaine for epidural anesthesia in elderly patients undergoing hysterectomy.Methods A total of 100 elderly patients who required hysterectomy in our hospital from April 2009 to June 2012 were randomly divided into the low dose group and the high dose group (n=50,each group).The low dose group was given 10 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia,and the high dose group was given 15 mg ropivacaine combined with lidocaine for lumbar epidural anesthesia.The anesthetic effects in the two groups were observed.Results The onset time of sensory block and highest plane time were significantly shorter in high dose group than in low dose group [(159±21) s vs.(225±23) s,(7.3±1.3) min vs.(9.2±1.5) min,respectively,t=3.412 and 2.877,both P＜0.05)].The maintenance time of highest plane was significantly longer in high dose group than in low dose group [(57.3±8.1) min vs.(45.3±7.2)min,t=2.623,P＜0.05].The onset time of movement block was shorter in high-dose group than in low dose group[(4.3±1.2) min vs.(6.9±1.3) min,t=3.109,P＜0.05],while the maintenance time of movement was longer in high-dose group than in low dose group[(161 ± 16) min vs.(133 ±14) min,t=2.793,P＜0.05].There were no significant differences in modified Bromage Score between the two groups (P＞0.05).The excellent anesthetic effect was significantly higher in high dose group than in low dose group (90％ vs.80％,x2 =4.33,P＜0.05).There were no significant differences in the incidence of adverse reactions between the two groups (P＞0.05).Conclusions The application of 15 mg ropivacaine combined with lidocaine has a better anesthetic effect for lumbar epidural anesthesia in elderly patients undergoing hysterectomy.It can provide a reference for the clinical practice.

Objective To establish the cell model of restenosis in vitro and investigate the effects of fenofibrate on the prevention and treatment of the restenosis.Methods Human umbilical vein endothelial cells(HUVECs) were cultured in vitro.The study was designated to 5 groups:(1) control group,(2) LPC group,(3) low-concentration fenofibrate(10 ?mol/L) group,(4) midium-concentration fenofibrate(50 ?mol/L) group,and(5) high-concentration fenofibrate(100 ?mol/L) group.Proliferation and apoptosis of HUVECs were assessed by MTT assay,flow cytometry(FCM) and fluorescence microscopy respectively.Results Compared with the control group,LPC could inhibit the growth and induce apoptosis of HUVECs as well as decrease NO production in HUVECs.Fenofibrate could increase the proliferation and decrease the apoptosis of HUVECs,and also enhance NO production of HUVECs.Conclusion Fenofibrate could improve proliferation and reduce apoptosis and enhance NO production of HUVECs through lysophosphatidylcholine,which may be an important route for fenofibrate to prevent and treat the restenosis after percutaneous coronary intervention.

Objective To investigate the efficacy of remifentanil-propofol-atracurium combined general anesthesia for cesarean section.Methods One hundred and twenty ASA Ⅰ or Ⅱ parturients scheduled for elective cesarean section were enrolled in the study.Anesthesia was induced with iv injection of remifentanil 1.0 μg/kg,propofol 2.0 mg/kg and atracurium 0.4 mg/kg and maintained with iv infusion of remifentanil 9.0 μg· kg-1 · h-1,propofol 12.0 mg· kg-1 · h-1 and intermittent iv doses of atracurium 0.3 mg/kg.Hemodynamic parameters were recorded during anesthesia.Blood samples were taken from the umbilical artery after delivery for blood gas analysis.Apgar score and assessment of neonatal neurological behavior score were recorded.The emergence time,time of recovery of bowel function and intraoperative awareness were also recorded in parturients.Results The blood gas indexes,Apgar score and assessment of neonatal neurological behavior score in neonates and hemodynamic parameters during anesthesia in parturients were within the normal range.The emergence time was (5.0-± 0.5) min.No severe adverse reactions was found during the perioperative period.The postoperative followup showed that no intraoperative awareness occurred and the time of recovery of bowel function was (16.2 ± 0.7)h.Conclusion The efficacy of remifentanil-propofol-atracurium combined general anesthesia is good for cesarean section without obvious adverse effects on parturients and neonates.

Objective To explore the effects of walking exercise on glycometabolism,dynamic blood pressure and the quality of life of patients with both hypertension and type 2 diabetes on the basis of conventional drug treatment.Methods Sixty-two patients with both hypertension and diabetes who could support taking walking exercise of more than 5,000 steps/d were randomly divided into a walking exercise group (32 cases) and a control group (30 cases).Both groups were given conventional drug treatment (including valsartan,acarbose and metformin).Those in the walking exercise group took more than 10,000 steps/d of aerobic exercise while the patients in the control group were just given normal community care.This continued for a period of 3 months.Fasting plasma glucose (FPG),glycated hemoglobin-A1C (HbA1c),fasting insulin (FINS),the homeostasis model of assessment for insulin resistence index (HOMA-IR),the homeostasis model of assessment for insulin sensitivity (HOMA-IS),dynamic blood pressure parameters and quality of life were observed.Results In the walking exercise group,the FPG,HbA1c,FINS,HOMA-IR,HOMA-IS,dynamic blood pressure and quality of life indicators were all significantly different after 3 months of daily walking exercise compared with either baseline or the control group.Conclusion Accompanied by conventional drug therapy,10,000 steps/d of walking exercise can improve the glucose metabolism,dynamic blood pressure and quality of life of patients suffering from mild hypertension and type 2 diabetes.

Objective To establish the GIOP model and extract BMSCs from the rat model.We aim to in-vesitigatethe effect ofrhPTH(1-34)for inhibiting β-catenin ubiquitination when combining with Micro-CT and bio-logical technology.We also investigate the influence of rhPTH(1-34)on the GIOP.Methods Female SPF emale rats wererandomly divided into normal control group,methylprednisolone group(model group),methylpredniso-lone+saline group(blankcontrol group)and methylprednisolone+rhPTH(1-34)group(test group). The proximal femoral cancellous bone was examined by Micro-CTand histopathological Staining. The expression of Wnt10b and β-catenin protein were detected. By comparing with inducedBMP-2,BMSCs were treated withrhPTH(1-34)and stained with ALP and alizarin red.Results(1)In Micro-CT,BV/TV,Tb.Th and Tb/N decreased,whereas Tb/sp increased in the test group comparedwith model group(P<0.05).ROI three-dimensional reconstruction of trabecu-lar bone in test group showed local bone repair;(2)Wnt10b and β-cateninexpression increased in the test group compared with the model model(P<0.05),indicating that rhPTH(1-34)can enhance the transcriptional activity of β-catenin(P<0.05)and promote the expression of Wnt10b andβ-catenin(P<0.05).Conclusion The inter-vention with rhPTH(1-34)can prevent GIOP by regulating the Wnt/β-catenin signaling pathway and inhibiting GIOP progress,which can improve the microstructure of bone.

Objective To establish a rat model of glucocorticoid-induced osteoporosis(GIOP)and to explore the interventional effect of the Chinese medicine Fufang Zhenzhu Tiaozhi(FTZ)capsules on regulation of mitogen-activated protein kinase kinase kinase 2(MEKK2)-Wnt coupling and inhibiting β-catenin ubiquitination, and to investigate the effect of FTZ on the bone mineral density and cell osteogenic ability. Methods SPF male rats were randomly divided into normal control group,methylprednisolone group(model group),methylprednisolone + saline group(blank control group) and methylprednisolone + FTZ group(experimental group). The proximal femoral cancellous bone was examined by mi-cro-CT and histopathology,and assessment of expressions of Wnt3a,MEKK2,and β-catenin proteins. Bone mesenchymal stem cells(BMSCs were isolated and treated with serum containing FTZ,stained by alkaline phosphatase and alizarin red. The expressions of osteogenic differentiation-related genes ALP,Runx2 and OCN,the expressions of MEKK2 and β-catenin proteins,and the transcription level of β-catenin/TCF were determined. Results 1)The micro-CT imaging showed that compared with the control group, the BV/TV, Tb.Th and Tb/N expressions were significntly decreased, and Tb/sp in-creased in the experimental group(P<0.05). Region of interest(ROI)three-dimensional reconstruction of trabecular bone in the experimental group showed improvement of bone trabeculae and local bone repair. 2)The pathology using he-matoxylin and eosin staining showed that in the experimental group,the bone trabecular density was higher than that of the model group,and observed a better trabecula morphology. 3)The Wnt3a,MEKK2 and β-catenin expressions in the exper-imental group were significantly increased compared with the model model(P<0.05). 4)After treated with FTZ and BMP2,the result of alkaline phosphatase and alizarin red staining indicated an enhanced osteogenic response(P<0.05) in the GIOP rat models. 5)After treatment with seum containing FTZ,The BMSCs isolated from the GIOP rats enhanced the transcriptional activity of β-catenin/TCF/LEF(P<0.05)and promoted the expression of β-catenin and MEKK2 pro-teins(P<0.05). Conclusions FTZ can ameliorate GIOP by regulating the MEKK2-Wnt coupling and inhibiting the β-catenin ubiquitination,and improve the bone microstructure.

Objective: To evaluate the efficacy and safety of drug-coated balloons (DCB) for de novo large coronary vessels. Methods: One hundred and two patients were retrospectively enrolled in this study, there were 104 lesions with the reference lumen diameter of target vessel more than 2.8 mm and patients were treated with DCB in de novo lesions during May 2015 and July 2017 in our center. Coronary artery angiography and quantitative coronary angiography were performed in 82 (80.4%) patients at follow up period ((8.1±1.7) months post procedure). The endpoints were late lumen loss (LLL) at follow up,and major adverse cardiac events (MACE) including cardiac death, myocardial infarction (MI), target lesion revascularization (TLR) and stent or target lesion thrombosis at 12 months post procedure. Results: Ninety-eight lesions were treated with DCB only, 6 (5.9%) bailout drug-eluting stent (DES) were used because of severe coronary dissection, 2 patients (2.0%) received revascularization driven by acute ischemic events during hospitalization. Cutting balloons and NSE balloons were used in 65.4% (68/104) and 26.0% (27/104) lesions. The lesion length was (12.57±3.58) mm and the DCB length was (19.87±4.55) mm. The late lumen loss was (0.01±0.52) mm during angiographic follow up. The TLR rate and overall MACE rate was 3.9% (4/102) and 3.9% (4/102) and there was no death,MI and target lesion thrombosis at 12 months follow up. Conclusion DCB treatment for de novo large coronary vessels is effective and safe.