Objective To investigate the impact of the COX-2 specific inhibitor parecoxib on postoperative serum cytokines and early cognitive function in the elderly patients undergoing knee replacement.Methods Seventy-two elderly patients undergoing knee replacement were divided into a control group (group Ⅰ)and parecoxib group (group Ⅱ).MMSE score were compared at preoperative 1 d and postoperative 1 d,3 d,7 d.Before induction of anesthesia (T1 ),postoperative 6 h (T2 ),1 d (T3 ),3 d (T4 ),7 d (T5 ),the serum IL-1β,IL-6 concentrations were measured,meanwhile the serum S-100βwere measured in T2 .Results At postop-erative 1 d,3 d,the MMSE score in group Ⅰ was significantly lower compared with the preoperative (P <0.05).IL-6 in T2 ,IL-1βin T3 increased in both group.In group Ⅱ,three days later,the exaltation of plasma inflammatory factors returned to the preopera-tive level,but this process last untill T5 in group Ⅰ.The plasma concentration of IL-6 in T2 ,T3 ,T4 and IL-1βin T3 ,T4 in group Ⅰwere higher than group II (P <0.05).At T2 ,the serum S-100βin group Ⅰ was (1 625 ± 364)pg/mL higher than group Ⅱ(1 263 ±174)pg/mL(P <0.05).Conclusion The protective effection of COX-2-specific inhibitor parecoxib upon postoperative cognitive decline in elderly patients undergoing orthopedic surgery may be related to inhibition of peripheral cytokine release.

Total glucosides of paeony root ( TGPs ) ( 5 ~40mg/kg, ip ) had a dose-related hypothermal effect in mice and rats, which was related to the environment temperature. But TGPs ( 40mg/kg, ip or iv ) showed no significant hypothermal effect in guinea-pigs or rabbits. TGPs ( 2, 4 mg/kg, icv ) had a potential hypothermal effect in rats. Chlopheniramine had antagonist effect on hypothermal effect of TGPs in mice and rats.

Objective To determine in vitro susceptibility of itroconazole,voriconazole,caspofungi,and amphotericin B against 82 clinical strains of filamentous fungi.Methods Etest method was used to test the in vitro susceptibilities of itroconazole,voriconazole,caspofungi,and amphoteriin B against aspergillus fumigatus,A.flavus,A.niger,A.terreus,A.nidulans,et al.Results The MIC range of 4 antifungal agents were 0.03~2.00 mg/L and 0.01~32.00 mg/L against A.fumigatus and A.flavus,respectively.But amphotericin B had higher MIC90 value which was 16mg/L against A.flavus than A.terreus(MIC90 3.00 mg/L),A.fumigatus(MIC90 0.75 mg/L),and A.niger(MIC90 0.25 mg/L).Conclusion Itroconazole,voriconazole,caspofungi,and amphotericin B have different susceptibility patterns against various types of filamentous fungi.It's necessary to identify fungi to level of species and perform antifungal susceptibility test in serious patients.

Colorectal cancer(CRC)ranks the third in incidence and mortality rate among human tumors. Tumor relapse,me?tastasis and drug resistance remain the main obstacle to the success of CRC treatments. Compared to traditional chemotherapy ,target therapy seems to treat tumors in more precise and rational fashion with good response and often less toxic side-effect. Although target agents provide hope for more effective therapy,recent clinical studies have shown only modest benefit from target therapy similar to tra?ditional chemotherapy. Primary and secondary resistance to target agents is still observed and contributes to CRC treatment failure. The review summarizes research progress in the mechanism of drug resistance to target therapy in CRC treatment.

BACKGROUND:Tissue-engineered bone in the treatment of large bone defects has obvious advantages especial y when the autologous ilium transplantation is limited, which can effectively fil bone defects.
OBJECTIVE:To investigate the rationality of intramedul ary nailing support and tissue-engineered bone fil ing in the treatment of fibrous dysplasia of the proximal femur and the biocompatibility of the tissue-engineered bone.
METHODS:Seven patients with fibrous dysplasia of the proximal femur were subjected to intramedul ary nailing support and tissue-engineered bone fil ing.
RESULTS AND CONCLUSION:Al of the seven patients underwent more than 8 months of fol ow-up, no rejection reaction and other complications occurred. After 4-6 weeks of fixation, al the seven patients removed hip spica braces, with a good hip mobility. After 10-12 weeks, X-ray review showed no pathological fracture, internal fixation loosening and narrow neck stem angle. Using the Harris hip score evaluation of the hip function, the affected side of the seven patients was optimized. After 16-18 weeks, X-ray films reviewed good creeping substitution in the affected area treated with the intramedul ary nailing support and bone graft. After 24-26 weeks, new bone appeared within the scope of lesions. After 1.0-1.5 years, bone creeping substitution was basical y completed in the intertrochanteric region, and original lesions were invisible on X-ray films. These findings confirmed that intramedul ary nailing support and tissue-engineered bone fil ing for treating fibrous dysplasia of the proximal femur has good effectiveness, exhibiting stable internal fixation and avoiding resection of autogenous iliac bone. Tissue-engineered bone has a good biocompatibility in the medium-term fol ow-up, with good hip function activities.

【Objective】To observe the therapeutic effect of traditional Chinese comprehensive therapy for the treatment of lumbar disc herniation.【Methods】Forty-one lumbar disc herniation patients received oral use of herbal medicine,external application of herbal medicine,fumigation and steaming with herbal medicine as well as pelvis traction.Fifteen days constituted one treatment course.【Results】After treatment,25 were cured,13 effective,3 ineffective and the total effective rate was 92.68%.【Conclusion】Comprehensive therapy including oral use of herbal medicine,external application of herbal medicine,fumigation and steaming with herbal medicine as well as pelvis traction has a good effect on relieving symptoms.

Objective:To explore the relationship between arrival time and the retention in emergency room and the prognosis in patients with severe trauma.Methods:The clinical data of 1 738 emergency trauma patients in emergency intensive care from trauma center information system of the First Affiliated Hospital of Soochow University were extracted. The emergency retention was the time in the emergency room ≥ 4 h. The 24 h of the day was divided into three shifts at 8:00, 15:00 and 22:00. Logistic regression model was used to calculate the crude OR and adjusted OR after adjustment by age, sex and RTS of emergency shifts, and COX regression analysis was performed with emergency death as the endpoint. Results:Among the total of 1 738 patients with severe trauma, there were 852 (49.02%) cases of emergency retention. Taking the morning shift as the reference baseline, the risks of emergency retention in middle shift and night shift were increased gradually. The OR value of night shift was statistically significant ( P<0.01), and the crude OR and adjusted OR were 2.21 (95% CI: 1.71-2.86) and 2.36 (95% CI: 1.76-3.18), respectively. The univariate COX regression model indicated that the crude HR of night shift was statistically significant ( HR=0.26, 95% CI: 0.08-0.90, P=0.033). However, the multivariate COX regression model showed no statistically significant differences in the adjusted HR of middle shift ( HR=0.96, 95% CI: 0.43-2.14, P=0.914) and night shift ( HR=0.40, 95% CI: 0.08-1.85, P=0.238), respectively. Conclusions:The arrival time of emergency trauma patients might be a contributor to the emergency retention, and night shift patients are more likely to encounter retention, but there is no significant effect on patient death.

BACKGROUND:Under physiological conditions, nerve roots can move along with the movement of limbs and spine. However, the mechanisms of nerve root stretch injury under physiological conditions and the neurological dysfunction after injury are unclear.
OBJECTIVE:To review the reason of nerve root stretch injury, and to analyze the mechanism of nerve function from biomechanics, pathology and neurophysiology.
METHODS:A computer-based online search of PubMed database was undertaken by the first author to identify the articles related to the research of nerve root injury and nerve stretch injury between 1990 and 2012, with the key words of“nerve root, nerve, stretch injury”. A total of 391 articles were screened out. The articles on the anatomy and biomechanics research of nerve root were included, as wel as the pathology and neurophysiology research after nerve root stretch injury. Final y, 44 articles were included for review.
RESULTS AND CONCLUSION:Nerve root can be stretched along with limbs and spine movement. However, diseases or trauma may cause pathological nerve root stretch, and thus leading neurological dysfunction. The nerve root is often influenced stretch because of its anatomical and tissue structure. Mechanical injury mechanism of stretch composes of peripheral (peripheral nerve conduction stress) and central mechanism (displacement of spinal cord content). Pathological studies found that the local fibrosis is caused by the extracted serum protein that difficult to remove after injury, and this is because of the shortage of lymphatic system in nerve roots. Fibrosis can cause nerve root ischemia, affect the nerve function, and change the biomechanical properties of nerve root. Nerve root injury can cause primary and secondary injury of internal axons, and this is the main reason for neurological dysfunction after injury.

By means of literature review,expert interviews and experts sorting,the authors identified three approaches of medical humanities care,and applied them to three clinical departments of top ten incidence of medical disputes of the hospital in 2012.These departments have similar number of beds,and covered both internal medicine and surgery departments.The purposes of the study are to evaluate the effects of medical humanities care measures in clinical departments,and to make relevant thoughts and suggestions.

Using the method of semi -structure interviews to pre-interview 6 experts and officially interview10 experts , then the record of the interview was compiled into the paper .Using the grounded theory method to encode material of the interview , a summary was made for each case base on data collation and analysis .This paper ana-lyzed the humanities concern the connotation of the application in the construction of a harmonious doctor -patient relationship and the specific measures .On the basis of the application of humanistic care in the construction of a harmonious doctor -patient relationship , significance and limitation is discussed .