BACKGROUND:Analgesia in different ways can be selected for the elderly in hip and knee arthroplasty. Considering the actual situation of the elderly patients, choice of anesthesia should be reasonable in order to achieve fast acting, long lasting time and good analgesic effect. OBJECTIVE:To explore the analgesic effect of ropivacaine of lumbar epidural anesthesia on elderly knee arthroplasty. METHODS:A total of 78 elderly patients aged 80-96 years, who were treated with hip and knee arthroplasty in the Shenyang Orthopaedic Hospital from September 2011 to September 2014, were enrol ed in this study. They were equal y and randomly assigned to control group and observation group, and separately administered continuous epidural anesthesia and lumbar epidural anesthesia with ropivacaine. The excel ent and good rate, onset time, anesthetic induction, frequency of use of Duffing mixture, and adverse reactions were compared between the two groups. RESULTS AND CONCLUSION:The excel ent and good rate of analgesic effect was higher in the observation group (97%) than in the control group (87%) (P<0.05). Onset time was significantly shorter, the dose of anesthetic was significantly less, frequency of use of Duffing mixture was significantly less in the observation group than in the control group (P<0.05). The difference was not significant in adverse reactions between the two groups (P>0.05). Above results indicated that lumbar epidural anesthesia of ropivacaine obtained good analgesic effects during elderly knee arthroplasty.

Objective To study the diagnosis and treatment of primary aldosteronism. Method 507 cases of primary aldosteronism were reviewed. Result Serum potassium was lower in aldosterone producing adenoma (APA) as compared to idiopathic hypersteronism (IHA) (2.35?0.53) mmol/L vs ( 2.94 ? 0.55 ) mmol/L.Aldosterone in serum and 24h urine were higher in APA than in IHA ( 1 027.67 ? 531.84 )pmol/L and (69.25?43.77) mmol/L vs (781.14?310.24)pmol/L and (37.12?9.99) mmol/L.The diagnosis rate on B ultrasonography was 83.9% and on CT 93.1%.The postural stimulation test was more sensitive in IHA and on imaging procedures both the adenals were increased in size or with small nodule.In aldosterone producing adrenocortical carcinoma (APC),there were pronounce increase of cortisol and dehydroisoandrosterone and the tumor size was usually greater than 5cm.APA and APC should be treated surgically but the prognosis was only favorable for APA not for APC.IHA should be treated medically. Conclusion Serum and urine aldosterone were significantly higher in APA and serum potassium lower than in IHA.Postural stimulation test,B ultrasonography and CT were helpful to the diagnosis of APA.In patients with a single APA especially complicated by adrenal atrophy,partial adnalectomy of the affectd side is indicated whereas total adrenalectomy of the affected side is mandatory if the APA is multiple or there is adrenal hyperplasia.

Objective To study the diagnosis and treatment of adrenocorticotrophic hormone (ACTH) independent Cushing syndrome. Methods A retrospective review was done on 89 patients with ACTH independent Cushing syndrome, including 85 cases of adrenal tumors with hypercorticism, 2 cases of adrenocortical adenocarcinoma and 2 cases with ACTH independent macronodular adrenal hyperplasia. Results Favorable results were observed from the surgery for 85 cases of adrenal tumors combined with hypercorticism.Two cases with ACTH independent macronodular adrenal hyperplasia were cured by bilateral adrenolectomy. Adrenal cortical adenocarcinoma was unresectable for both the patients who survived 7 and 9 months respectively. Plasma ACTH,dexamethasone suppression test,B ultrasonography and CT scan were useful for the diagnosis and differentiated diagnosis of ACTH independent Cushing syndrome. Conclusions Prognosis of adrenal tumors with hypercorticism and ACTH independent macronodular adrenal hyperplasia is favorable after surgery,whereas the prognosis of adrenal cortical adenocarcinoma is poor.

Objective To analyzed the use of oral hypoglycemic drugs in our hospital for reference of clinical rational use of this kind of drugs. Methods The sorting methods of defined daily dose (DDDs) and the frequency of oral hypoglycenic drugs were used for analysis. Results The list of leading DDDs was glucosidase inhibitor, which accounted for 31.13 % of the total, followed by biguanides which accounted for 21.49%. Conclusions The glueosidase inhibitor, a new type oral hypoglycemic drugs used for lowering postprandial blood sugar level showed remarkable efficacy and safety, so it is currently the first choice for patients with diabetes.

Randomized sampling-based questionnaire among 2000 community residents and personal contact with selected populations were conducted.Based on incidence or clinical featuxes of dermatosis and venereal diseases and recognition-related impact factor analyses,we provided evidence for community-based health education and behavior intervention.Our findings showed that itching was the most common skin disease,and fungous infection displayed an increasing trend.Viral diseases increased significantly in recent years.Patients failed to understand the skin diseases,although they partly had some misleading information about venereal diseases.Health care providers should perform more health education and behavior interventions regarding dermatosis and venereal diseases for community residents to improve their health condition or quality of life.

Objective To discuss the effect of azithromycin on the airway inflammation in children at high risk for asthma by detecting the serum concentration change of eosinophil cationic protein(ECP), intedeukin-8(IL-8) and nitrogen oxide(NO), and also to explore the effect of azithromycin on secondary prevention of asthma. Methods Two hundred and twenty three cases of primary asthmatic attack with atopy (eczema, family asthmatic history) were collected and divided into four groups(group A, B,C,D) after asthmatic symptoms relief, group A was taken orally with azithromycin(5mg/kg Biw), group B was inhaled budesonide(0.5mg Bid), group C was taken orally with singulair (4mg qN),and group D was only given with symptomatic treatment. The vein blood was sampled on the first day in hospital, before and after medication respectively when treatment of three months was completed. Serum concentration of ECP and IL-8 was obtained by ELISA methods, and NO was measured by nitric acid enzyme reduction method. Clinic service and telephone follow-up was taken for one year. Results After three monthes intervention, there was significant difference in the serum concentration of ECP, IL-8 and NO at group A, B, C compared with group D( P<0.01 ). There was no significant difference in decrease of ECP and NO between group A and B( P > 0.05), but decrease of ECP and NO in group C was significant difference compared with group A( P<0.01). The serum concentration of IL-8 in each group was obviously decreased especially in group A, and difference was obvious between group A and group B,C( P<0.01). There was no significant difference in the cases of asthma recurrence within three months and asthmatic recurrence within one year between group A and group B, group C and group D respectively. Conchlsions (1)The medication of azithromycin might result to decrease the serum concentration of ECP and NO, especially for IL-8 in children at high risk for asthma. (2)The effects of azithromycin on change of ECP and NO in children at high risk for asthma were similar to budesonide, but different with montelukast, while the inhabitant effects of IL-8 were different with inhaled steroid hormone and leukotriene receptor obviously. (3)There was some valid contribution of azithromycin actting on the secondary prevention of asthma in our investigation.

AIM:To observe the effect of Rheum emodi Wall on expess level of TNF-?、IL-1? and IL-6 on acute ischemic stroke(ACI)at high altitude. METHODS: 65 patients aith ACI at high altitude(2 260 m)were randomly divided into treatment group(34) and control groups(31).both groups received danshen-safflower injection.Meanwhile treatment group took Rheum emodi decoction orally for 4 weeks,while control group doesn't.Serum levels of TNF-?、IL-1? and IL-6 were measured by radioimmumoassay. RESULTS: The treatment group showed much higher rates of improvement than control group(88.24%;70.97%)after weeks.Serum levels of TNF-?、IL-1? and IL-6 decreased significantly in patients with ACI at treatment group as compared with those of control group. CONCLUSION: Rheum emodi Wall can improve the nervous function of ACI by reducing TNF-?、IL-1? and IL-6 content in serun.

Objective: To review the experience of valvuloplasty in children aged 4 months to 6 years. Methods: 199 children aged 4 months to 6 years (mean age, 2.94 years) and weight 3.1 kg to 22.0 kg (mean, 11.7 kg) underwent valvuloplasty under CPB from January 1990 to December 2001. 21 patients with isolated valvular lesions mitral incompetence(MI) in 7, tricuspid incompetence(TI) in 6, aortic incompetence(AI) in 1, aortic stenosis(AS) in 1, MI and TI in 2, MI and AI in 2, MI and AS in 1,MI and mitral stenosis in 1, the remain 178 patients had valvular disease with other pathologies (MI=122, TI=26, AI=9, MI+TI=13, tricuspid stenosis=2, AS=2, MI and AI=2, MI+AS=2). The procedures of valvuloplasty included leaflet resection and repair, annulus remodeling, choral shortening, transferal etc. depended on the anatomical variation of the lesions. Associated cardiac anomalies were corrected simultaneous. Results: There were 4 early deaths (2.0%) including 2 heart failure, 1 severe infection and 1 pulmonary hypertension. No late death was encountered during the period of 4.7 years (range 2 months-8 years) follow-up. Conclusion: Good result may be expected in valvuloplasty in children aged 4 months to 6 years.

Objective:To observe and assess the hemorheological efficacy of yixinshu capsules in the treatment of"deficiency of both vital energy and yin or blood stasis"chest-spleen-syndrome patients.Method:According to the stand- ard of the diagnosis of coronary heart diseases and deficiency of both vital energy and yin or blood stasis chest-bi-syndrome, 60 cases were collected from Jan.2006 to Feb.2007 in ward and clinic.Each case was treated with yixinshu capsule for four weeks and its hemorheological efficacy and routine blood change were observed and compared before and after the treat- ment.Result:The yixinshu capsules improved various hemorheological indexes more significantly after the treatment than before it (P0.05).Conclusion:Yixinshu capsules are an effective medicine for the chest-spleen-syndrome case,and recommendable for clinical treatment.

Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.