Objective:To observe the effects of muscle regions of meridians needling method combined with auricular point sticking on pain and lumbar range of motion in patients with chronic nonspecific low back pain. Methods:A total of 100 patients with chronic nonspecific low back pain were randomly divided into a control group and an observation group,with 50 patients in each group.Both groups received auricular point sticking treatment,while the control group received additional conventional acupuncture treatment,and the observation group received additional muscle regions of meridians needling method.The total effective rate of the two groups was compared after 4 weeks of treatment.Before treatment and after 1 week and 4 weeks of treatment,the visual analog scale(VAS)score was used to assess the degree of low back pain,and the modified-modified Schober(MMS)score was used to evaluate the lumbar range of motion. Results:There was statistical significance in comparing the total effective rate between the two groups(P<0.01).During the treatment process,as the number of treatments increased,the VAS score gradually decreased,and the MMS score gradually increased in both groups.After 1 week and 4 weeks of treatment,the VAS score in the observation group was lower than that in the control group(P<0.01),and the MMS score in the observation group was higher than that in the control group(P<0.01).During the treatment period,no serious adverse reactions occurred in either group. Conclusion:Based on auricular point sticking treatment,muscle regions of meridians needling method is more effective than conventional acupuncture in treating chronic nonspecific low back pain since it is able to significantly reduce the pain and improve the lumbar range of motion.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective To study the effects of selecting different fixing segments on biomechanical characteristics of the spine during the treatment of early onset scoliosis（EOS） by growing rod technique. Methods By using finite element method, four spine models (C6-S1 segments) fixed by growing rod were established: preoperative model, T1-L4 fixed model, T2-L4 fixed model, T3-L4 fixed model. Then 7 N·m torque load and 1 rad angular displacement load were applied on superior surface of C6 segment to analyze biomechanical characteristics for adjacent structure of the fixed vertebral body. Results The whole spinal range of motion (ROM) decreased significantly after operation. When the T2-L4 segment was fixed, the spine activity was mostly restricted, the compensatory activity of adjacent vertebrae increased significantly, and the intervertebral disc stress increased significantly. Conclusions When T2 segment is selected as the upper instrumented segment, the risk of proximal junctional kyphosis and spinal degeneration is the highest, which should be avoided in clinical surgery.

Objective To understand the cognitive level of urban and rural general practitioners in the concept, diagnosis and treatment of chronic obstructive pulmonary disease and to provide the basis for continuing medical education in basic level hospital for all general practitioners. Methods General practitioners from 21 urban community health service centers (group A) and 27 of the rural community health service centers (group B) were surveyed on chronic obstructive pulmonary disease knowledge through a anonymous questionnaire, the survey contents included five aspects of chronic obstructive pulmonary disease such as basic concept, diagnosis, grouping diagnosis, treatment on stable phase and acute exacerbation. Results The correct rates of five questions in group A were 25.89%, 17.26%, 5.58%, 4.06%, 18.78 and in group B were 8.97%, 8.55%, 5.13%, 4.27%, 17.52%. In chronic obstructive pulmonary disease concept and diagnosis, there was significant difference between two groups(χ2=21.99, P<0.05 and χ2=7.41, P<0.05) . Conclusion The level of the cognitive of COPD (chronic obstructive pulmonary disease) among the general practitioners is very poor, and is strong against to the management work of chronic obstructive pulmonary disease. We need more continuing medical ed-ucation on "the guidelines on diagnosis and treatment of chronic obstructive pulmonary disease " among the urban and rural general practitioners.

Objective To observe the effect of Zusanli acupoint injection of Astragalus Membranaceus Injection on patients with tumor leukopenia after radiotherapy and chemotherapy and its influence on cellular immune function.Methods According to clinical case of random table,60 cases of malignant tumor patients in Hubei province Xiangyang city hospital from March 2010 to August 2011 were randomly divided into two groups of 30 patients in each group.The treatment group was treated with Zusanli acupoint injection of Astragalus Injection therapy,while the control group was taken Leucogen,vitaminB4,batyl alcohol orally.Venous blood and peripheral white blood cell were taken in both groups before and after treatment.Direct immunofluorescence staining and flow cytometry were used for the detection of peripheral blood T lymphocyte total number and its subsets.Results ① clinical efficacy:Total effectiveness was 77.5％in the treatment group,and 52.5％ the control group,the difference was statistically significant between the two groups (x2=8.027,P＜0.05).Comparison of the white blood cell count and T lymphocyte subsets of peripheral blood:the white blood cell count was (3.56～4.21) × 109/L in the treatment group,and (2.89～3.39) × 109/in the control group,there was significant difference between two groups (t=2.435,P＜0.05); there was significant elevation of CD3 +,CD4+,CD4+/CD8 + [(62± 1.63) ％,(43 ± 0.80) ％,(1.48 ± 0.23) in the treatment group after the treatment comparing with (48± 1.25)％,(31 ± 0.74)％,(0.93± 0.12) before the treatment (P＜0.05 or 0.01),while there was no such changes in the control group.Conclusion Zusanli acupoint injection of Astragalus Injection may modulate the cellular immune function of patients with cancer.It is effective in the treatment of leukopenia after radiotherapy and chemotherapy.

Objective To study the effect and toxicity ofgefitinib combined with selected radiotherapy in the treatment of patients with advanced non-small-cell lung cancer (NSCLC). Methods From March 2006 to February 2009,10 of 13 advanced NSCLC patients who got benefit from gefitinib were enrolled to treatment group (gefitinib concurrent selected radiotherapy) and control group (gefitinib only), with 5 cases in each group. The response was evaluated as progression free survival (PFS) and overall survival (OS).Results No patient got complete remission (CR). Ten of 13 patients got partial remission (PR) and stable disease (SD). The 1 year and 2 years survival rate was 53.8%(7/13) and 46.2%(6/13) respectively. The median PFS in treatment group and control group was 24 months and 8 months respectively(P= 0.0019). The median OS was 32 months and 10 months respectively (P= 0.0062). The main toxicities were reversible skin rash and diarrhea,and 3 patients developed asymptomatic radiation pulmonary fibrosis. Conclusions Gefitinib combining with selected radiotherapy is effective and tolerated in patients with advanced NSCLC. It may prolong PFS and OS. It may be a rational choice for the standard and individualized treatment of NSCLC.

Corticotropin-releasing factor (CRF)is a neuroendoerine peptide that stimulates the synthesis and release of adrenecortieotropic hormone from the pituitary. CRF widely distributed in the body has been implicated in the regulation of endocrine, neural, behavioral responses and has relevance in the the physio- logical effects and pathophysiology of gut. The delayed gastric emptying, inhibited small intestinal transit and stimulated colonic transit are the most common responses evoked by CRF. CRF delay gastric emptying by ac- tivating CRF2 receptor while the stimulation of colonic motility is mediated by the activation of CRF1 recep- tor. Development of antagonists of CRF receptor may treat a new therapeutic strategy for treatment of stress- related gastrointestinal disease.

Objective To retrospectively analyse the anterior and posterior surgical approaches in treatment of unstable burst thoracolumbar fractures and compare radiographic measurement parameters of beth surgical techniques so as to provide references for surgical treatment of such kind of fracture. Methods The study selected 41 patients with unstable thoracolumbar fracture treated with either anterior neurodecomprossion and fixation (n=19) or posterior reposition and internal fixation by pedicle screw (n=22) from January 2003 to December 2005. All patients were followed up for 24-48 months ( mean 38 months) and divided into anterior approach group and posterior approach group. Sagittal alignment was assessed by the Cobb angle depending on lateral radiographs. Results The Cobb angle of the anterior approach group was average 27.3°on admission but 3.1°postoperatively and 4.6° at follow-up; while the Cobb angle of posterior approach was average 26.1° on admission, 3.0°postoperatively and 12.5°at follow-up. There was no statistical difference between Cobb angle on admission and postoperative one (P>0.05) but showed significant differences between them at follow-up ( P<0.01). Conclusion The anterior surgical approach can consistently yield better maintenance of kyphotic correction compared with the posterior surgical approach.

Objective To investigate the feasibility and safety of laparoscopic radical resection for rectal carcinoma.Methods A total of 80 patients with rectal carcinoma received laparoscopic radical resection in our hospital from March 2004 to January 2008.During the operation,adequate proximal and distal bowel segments,and mesentery and lymph nodes surrounding the tumor were resected completely.And then lower anterior resection(Dixon)and sigmoid colostomy for abdominal perineal resection(Miles)were implemented.Results Among the 80 patients,4 were converted to open surgery during the operation,and the other 76 patients were treated by laparoscopy successfully.Dixon surgery was performed on 44 cases with a mean operation time of(178?38)minutes,intraoperative blood loss of(61?17)ml,excised lymph nodes number of(11.3?2.9),and postoperative hospital stay of(7.1?3.2)days.Miles were carried out on 32 patients,in which the mean operation time was(231?49)minutes and intraoperative blood loss was(210?178)ml;a mean of(12.9?3.7)lymph nodes were resected,the postoperative hospital stay was(9.3?4.1)days.No residual cancer was found in the patients.After the treatment,1 patient developed stoma stenosis,5 showed perineal wound infection,1 had anastomotic leak,and 6 complained of urinary retention immediately after the surgery.No patient had postoperative hemorrhage or died after the procedure.Follow-up was achieved in 70 cases for 9 to 48 months,during which 5 patients had recurrence,2 died of multiple organ failure induced by multiple metastasis,and 5 patients developed ileus.Conclusion Laparoscopic resection for rectal carcinoma is safe and feasible for selected patients,when the surgeons are skilled with experience on both open colectomy and laparoscopic surgery.

One hundred male weanling rats were fed a zinc deficient diet(ZD) containing 7.9ppm Zn for 4 weeks. 56 rats selected as ZD models were divided into 7 groups in random. The rats in 6 test groups were supplied a diet with 40, 60, 80 ppm of zinc enokitake (ZE) and zinc sulfate (ZS) respectively, while the remainder were fed the ZD diet continuously. 5 weeks later, the plasma zinc in 60,80 ppm ZE groups was significantly higher than that in ZS groups in the same doses. The correct rate of learning and memory showed the same trend.Though after that zinc in 60 ppm groups was added to 120 ppm, but the 120 ppm Zn group failed to show greater effect. And the rats in 80ppm ZE group also had the highest level of femur zinc. The RBA of ZE was 207% for plasma and 181% for femur to ZS.The study shows that ZE has a higher biological availability than ZS.