[Objective]To observe the effect of preemptive analgesia with continuous epidual anesthesia in total knee arthroplasty.[Methods]Fifty-four patients who were treated in author's hospital were randomly assigned into two groups with 27 patients in each.One group was treated with 0.125% ropivacaine 2 ml/h through epidual catheter since 12 hours before the operation.The other group was given saline at the same rate.All the patients received general anaesthesia in the operation.The use of patient controlled analgesia(PCA) with epidual anesthesia was initiated 48 hours after operation.PCA was used as a supplement when the patients comldn't bear the pain.The following variations were compared between these two groups:visual analog score(VAS),the incidences of complication,deep vein thrombosis(DVT),the time of the ability to actively reach 90 degree knee flexion,the range of motion(ROM) and the chronic pain after operation.[Results]The following variations were statistically significantly lower in ropivacaine group than that in the saline group:VAS,DVT,the time to reach 90 degree knee flextion,while ROM 6 months and 1 year after operation were significant higher.There were no statistically significant differences between groups in the incidence of the side effects during the two days after the operation and the chronic pain for a longer time.[Conclusion]Preemptive analgesia with continuous epidual anesthesia can alleviate the early stage of the pain after total knee arthroplasty,decrease the incidence of the complication and increase the rang of motion without obvious side effects.

Objective To explore the fraction risk in patients with osteoporosis and effects of antiosteoporosis therapy on fracture healing.Methods All the recruited subjects were senile patients with fracture in lower extremity and were treated in the Department of Orthopaedics in Shandong Qianfoshan Hospital from Aug.2006 to Feb.2011.In the total 15 cases,10 were female and 5 were male,aged from 53 to 65 years (average 56.7 years old).After surgical reduction and internal fixation,all the 15 patients did free-weight and continous passive motion (CPM) functional exercise and received anti-osteoporosis treatment.X-ray was taken to show the preoperative and postoperative lumbar vertebrae and fracture position.Meanwhile,bone mineral density and blood calcium level and phosphate level were measured.Results Thirteen out of 15 patients were healed for bone fracture after a 3-month treatment,meeting the clinical standards of the fracture healing.The clinical fracture healing rate was 86.67％.Blood calcium level,phosphate level and the bone mineral density were significantly different between that before and after the treatment ( P ＜ 0.05 ).Conclusion Osteoporosis not only increases the risk of fracture,but also has an adverse effect on the bone healing.Anti-osteoporosis therapy has a positive role to the fracture healing in the senile patients with osteoporosis.

0.05). The 5-year survival rate of cyclinD1-posit ive patients was significantly lower than that of cyclinD1-negative patients ( P

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease.NOTCH3 missense mutation causes its coded cysteine occurring odd change and then affects the conformation and function of protein of NOTCH3.The abnormal NOTCH3 protein has vascular smooth muscle toxicity and finally deposits in the cerebral small blood vessels and causes the disease.Usually,CADASIL can be suspected by its typical clinical manifestations and neuroimaging findings.Its diagnosis needs genetic testing or skin biopsy to find the outer granular osmiophilic deposits of small vascular smooth muscle cells or immunohistochemical NOTCH3-ECD staining positive.For nearly two decades,the studies on genetics,pathogenesis,clinical manifestations,and diagnostic techniques of CADASIL have made great progress,however,many important questions have not been fully clarified and have new discoveries,such as the NOTCH3 gene mutation pattern and loci,and the relationship between gene phenotype and clinical phenotype,optimization of diagnosis process,depth study of pathogenic mechanism,exploration of new discoveries,new therapeutic targets and concepts.This article reviews the genetic characteristics,pathogenesis,and clinical diagnosis and treatment technology of CADASIL.

Objective To investigate the trends in incidence and mortality of esophageal cancer from 1981 to 2002 in Tianjin,China and to predict future trends and facilitate future prevention.Methods All new cancer cases registered in the Tianjin Cancer Registry between 1981 and 2002 were reviewed.Yearly age-specific,crude and age-adjusted incidence rates were calculated for males and females.Secular trends of incidence and mortality were indicated by the estimated annual percentage change(EAPC).Results A total of 8206 cases of esophageal cancer were reported in Tianjin form 1981 to 2002,with 5533 males and before 45 years,but increased rapidly after 45 years.The median age of esophageal cancer cases was 69 years,with quartile range from 62 to 75 years.The peak for age specific incidence in females was 75-80 years,which was earlier than that in males(aged 80-85).But recent data indicated that the peak age in females had increased and became similar to that of the males.The crude and age-standardized incidence rates(ASIR)of esophageal cancer decreased in last 22 years.For male and female,crude incidence decreased by 2.22% and 3.56% per year and ASIR decreased by 5.18% and 6.56% per year.The mortality of esophageal cancer decreased in the last 22 years.Conclusion The incidence of esophageal cancer decreased in the last 22 years in Tianjin,but there is little overall improvement in survival.

Objective To explore the related factors of hepatitis B virus(HBV) drug resistance and their clinical significance . Methods The retrospective analysis was performed on the dinical data in 153 cases of CHB in our hospital during 2011-2013 .The 8 viral drug resistance loci of 4 known nucleosides analogues lamivudine ,adefovir ester ,entecavir and telbivudine were performed the direct sequencing by using the double DNA end termination method(Sanger method);the related clinical factors of drug‐resist‐ant virus genotypes were statistically analyzed and the correlation between prognosis and drug resistance was analyzed .Results A‐mong 153 patients with CHB ,47 cases(29 .8% ) appeared virus genotype drug‐resistant ,the common sites were 204M‐I(18 cases) , 204M‐V(8 cases) ,followed by 181A‐T(10 cases) ,181A‐V(5 cases) ,then 180L‐M (14 cases) .The proportion of viral drug resist‐ance in the patients with family history ,HBeAg positive ,using the nucleotide analogues in the past and the baseline ALT≥5 times was significantly increased ,the incidence rates were 38 .8% ,34 .8% ,34 .6% and 50 .0% respectively .The multivariable COX re‐gression found that HBV‐DNA genetic drug resistance increased the risk of progression to cirrhosis of the liver ,the OR value was 4 .704(95% CI:1 .199 -18 .454) .Conclusion the Sanger method for direct sequencing is reliable and accurate method of HBV‐DNA genotype drug resistance .The proportion of viral drug resistance in the patients with a family history of hepatitis B ,HBeAg positive ,using nucleotide analogues and baseline ALT≥5 times is significantly increased;HBV‐DNA genotype drug resistance also increases the risk of progression to cirrhosis of the liver .

Objective To investigate the effect of short bowel syndrome treated with living-related small bowel transplantation(SBT).Methods A male patient with residual intestine 20cm in length,which resulted from subtotal small bowel resection and right hemi-colectomy owing to intestinal volvulus,received a living-related SBT.The donor was the patient′s mother.Donor specific blood transfusion,50mL/per week,was carried out for 8 weeks.Cytomegalovirus infection status in both donor and recipient was negative.A 160cm segment of intestine was transplanted.The graft ileocolic artery and vein was anastomosed to the recipient′s infrarenal aorta and inferior vena cava end-to-side,respectively.A distal ileostomy was performed.(Immunosuppression),anti-infection and anticoagulation therapy,and nutritional support were given(postoperatively).Results The donor had an uneventful recovery.No technical complications were observed.The recipient was alive and well 31 weeks after operation.No graft rejection or infection was found.The(patient) was taken off TPN 8 weeks after operation,and got a low-fat meal.The result of D-xylose test was near normal.Conclusions Living-related small intestine transplantation is an effective treatment for short bowel syndrome.

Objective To investigate the effects of X-ray beam hardening from contrast agent on CT values on CTA images.Methods The 20 mL syringes were numbered 1 to 26.The syringe 1,4,7,23 and 20 were filled with 1 mL,0.8 mL,0.6 mL,0.4 mL and 0.2 mL of iodine contrast medium (300 mg I/mL),respectively,and then mixed each of them with 0.9％ NaC1 solution to get a total of 20 mL solution in each syringe.The rest of 26 syringes were filled with 20 mL of 0.9％ NaC1 solution,as the experimental group to simulate carotid artery CTA examination.Matched 26 numbered syringes were filled with 20 mL 0.9％ NaC1 solution respectively,as control group to simulate plain scan.CT scans were performed,CT values were measured,and then the difference of CT values of 0.9 ％ NaCl solution in two groups was analyzed statistically.Results The mean,maximum and minimum CT values of saline in the experimental group vs control group were (-0.139±10.322) HU vs (5.585±2.939) HU,14.6 HU vs 9.7 HU,-23.8 HU vs-2.4 HU,respectively,and the differences were significant (t=2.695,P＜0.05).The CT values of saline around the high concentrations of iodine solution showed a large fluctuation range.Conclusion The X ray beam hardening effects caused by high concentration of iodine contrast on carotid artery CTA phase,may cause significant fluctuations of CT values.

Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.

Objective:To explore the application effect of case-based learning (CBL) in teaching magnetic resonance imaging (MRI) for non-imaging clinical professional postgraduates.Methods:Eighty non-imaging clinical professional postgraduates who had standardized residency training from 2017 to 2019 were selected as the participants and were randomly divided into two groups, experimental group and control group. The experimental group adopted CBL, and the control group adopted traditional teaching mode. After the standardized training in the radiology department, the differences in image reading scores, theoretical scores and course evaluation were compared between the two groups. SPSS 25.0 statistical software was used for analysis. Independent t test was used for the measurement data of normal distribution, Mann-Whitney U test was used for the measurement data of skewed distribution, and categorical variables were compared by chi-square test. Results:In the reading scores of MRI, the scores of the experimental group and the control group were (82.53 ± 5.72) points and (77.38 ± 6.14) points respectively, and the number of students in the experimental group whose reading scores were between 80-100 segment was 63.6% higher than that in the control group, with significant differences between the two groups ( P < 0.001), but without significant differences in theoretical average scores between the two groups ( P > 0.05). In addition, in the course evaluation, except for the index of learning burden, there were significant differences in other indexes between the experimental group and the control group ( P < 0.05). Conclusion:In the teaching of MRI, the application of the CBL helps non-imaging clinical professional postgraduates improve their MRI diagnostic thinking and independent reading ability.