APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…     

Effects of dexamthasone with different doses on aquaporin-4 in brain of intracerebral hemorrhage rats

Objective:To determine the relationship between the expression of aquaporin-4(AQP4) after intracerebral hemorrhage and dexamethasone treated. Methods:Collagenase Ⅶ was injected in caudate nucleus in a stereotaxis frame to establish the intracerebral hemorrhage(ICH) animal models. The intracerebral hemorrhage(ICH) rats were randomly divided into four groups: the sham group (group A), the ICH group(group B), low dose-treated group(group C), moderate dose group(group D) and high dose group(group E). The groups were respectively received an intraperitoneal dexamethasone injection with 1 mg/kg, 15 mg/kg, 30 mg/kg, twice a day for three days. The brain water content(BWC), the permeability of blood-brain barrier(BBB) and the expression of AQP4 were observed. Results:Both the BBB disruption and AQP4 expression decreased in treated groups, and the AQP4 expression had a dose-dependent manner in the dexamethasone treatment. And it seemed that low dose dexamethasone was in favor of brain swelling elimination, but the higher dosage had not similar effect. Conclusion:Dexamethesone may play a critical role on expression of AQP4 in the physiopathology of hemorrhagic edema.     

Recent advancement on autoantigens, autoantibodies and inflammatory cells in subepidermal autoimmune bullous diseases

Subepidermal autoimmune bullous diseases （SABD） are some autoimmune skin diseases that can present in a variety of forms and can be a challenging disease to treat. An overview of the different forms of SABD are discussed including bullous pemphigoid （BP）, epidermolysis bullosa acquisita （EBA）, cicatricial pemphigoid （CP）, bullous systemic lupus erythematosus （BSLE）, and Anti-p200 pemphigoid. Emphasis on recent advancement is presented. In recent years, improved knowledge of the mechanisms of intercellular and cell-matrix adhesion has led to better understanding of the blistering process in some SABD. Defects of such structures cause the subepidermal bullous diseases and have also led to the discovery of new diseases （e.g. anti-p200-pemphigoid）. Recent studies have outlined the important role of autoantibodies, mast cell lymphocytes and their cytokines in pathogenesis of SABD.     

Venous Thrombosis in the Elderly

Venous thrombosis is a common disorder with a high morbidity and mortality. But in the elderly may all be different compared with young or middle-aged adults.     

REASSESSMENT OF DEFIBRASE IN TREATMENT OF ACUTE CEREBRAL INFARCTION： A MULTICENTER, RANDOMIZED, DOUBLE-BLIND,PLACEBO-CONTROLLED TRIAL

Objoctive To evaluate the efficacy and safety of defibrase in patients with acute cerebral infarction by a large sample, multicenter, randomized, double-blind, placebo-controlled clinical trial. Mothods Patients with acute cerebral infarction within 12 hours of stroke onset were randomly assigned to receive either an initial intravenous infusion of defibrase 15 U plus normal saline 250 mL or 250 mL of normal saline only. Subsequent infusions of defibrase 5 U or placebo （normal saline） were given on the 3rd, 5th, 7th, and 9th day, respectively. Both groups received standard care of acute cerebral infarction. The primary efficacy outcome was functional status （Barthel Index） at 3 months after treatment. Safety outcome were bleeding events and mortality rate. Secondary outcome included Chinese Stroke Scale （CSS） score at 14 days and recurrence rate of stroke at 1 year. A total of 1053 patients were enrolled at 46 centers from September 2001 to July 2003, and 527 patients were randomly assigned to receive defibrase and 526 to receive placebo. A similar proportion of patients in both groups completed a full course of treatment. There was a significantly greater proportion of favorable functional status （Barthel Index 1≥95） in defibrase group than in placebo group at 3 months （52.2% vs. 42.8%, P 〈 0.01）, and the proportion of dependent functional status （Barthel Index ≤60） was a little lower in defibrase group compared with placebo group （27.7% vs. 32.4%）. These differences were more obvious among patients who were treated within 6 hours of stroke onset. Patients in defibrase group had better improvement with respect to CSS score than those in placebo group at 14 days （P 〈 0.05）. Recurrence rate of stroke at 1 year was lower in the defibrase group compared with placebo group （6.2% vs. 10.1%, P = 0.053）. Patients in defibrase group had higher risk of extracranial bleeding events （4.7% vs. 1.5%, P 〈 0.01 ） and a tendency of higher risk of symptomatic intracranial hemorrhage. The hemorrhage incidence was higher in patients with fibrinogen level 〈 130 mg/dL than ≥ 130 mg/dL （10.6% vs. 3.8%, P 〈 0.05）. Mortality rate at 3 months were slightly higher in defibrase group than placebo group （5.9% vs. 4.2%）. Conclusions The defibrase is effective to improve neurological function and function of daily living for patients with acute cerebral infarction within 12 hours of symptom onset. The efficacy was even better for acute cerebral infarction within 6 hours of onset. The increased risks of intra- and extracranial hemorrhage during defibrase administration were related to the plasma fibrinogen level.     

CHANGES OF SINGLE FIBER ELECTROMYOGRAPHY IN PATIENTS WITH INFLAMMATORY MYOPATHIES

Objective To assess the significance of single fiber electromyography (SFEMG) in diagnosis of inflammatory myopathies and the correlation with other assistant examination findings.Methods SFEMG were recorded from the extensor digitorum communis of 34 patients with polymyositis or dermatomyositis and compared with the fmdings of routine electromyography (EMG), serum creatine kinase (CK) determination,and muscle biopsy.Results SFEMG recordings in 34 patients were all abnormal. The prominent feature was markedly increased fiber density (FD) with normally or mildly increased jitter. FD ranged from 1.0 to 6.0 (2.34±0.43). Jitter ranged from 5 to 78μs (41.6±10.3 μs). The potential pairs with jitter values greater than 55 μs ranged from 0% to 55% (7.7% ± 11.8%). Block was detected at one recording site in only one patient. Routine EMG demonstrated myogenic lesions in only 24 patients (70.6%). FD was a little higher in the normal-EMG subgroup or the neurogenic-EMG subgroup than myogenic-EMG subgroup but without statistical significance. Elevated CK levels were found in 75% patients (24/32). FD in the normal CK subgroup was significantly higher than that in the elevated CK subgroup (2.62±0.40 vs. 2.28±0.40, P ＜ 0.05). Muscle pathologies were consistent with the diagnosis of myositis in 75% (15/20).Conclusion SFEMG is of great value in the diagnosis and disease process understanding of inflammatory myopathies for the clinically suspected patients with normal routine EMG, CK levels, and muscle biopsies.     

Over-expression of hypoxia-inducible factor 1 alpha increases angiogenesis of LNCaP cells

Objective:To evaluate the effect of HIF-1 α over-expression on angiogenesis in human prostate cancer cells. Methods:LNCaP cells(a human prostate cancer cell line) were transfected with the recombinant plasmid pcDNA3.1(-)-HIF-1α with Lipofectamine 2000 system. The positive clones were selected by G418 being further confirmed by Western blot and immunofluorescence. The expression levels of VEGF, iNOS and Ang- Ⅱ were determined. Results:The expression of HIF-1α in the LNCaP/HIF1α cells was significantly increased in transfected cells, which induced the up-regulation of VEGF, iNOS, whereas Ang- Ⅱ expression remained un- changed. Conclusion :Over-expression of HIF-1α can induce angiogenesis proteins and may improve the angiogenesis potency of prostate cancer.     

Advances in studies of phospholipids as carriers in skin topical application

Objective： This article provides an overview of characteristics of phospholipids, the characteristics and influential factors of liposome and microemulsion as carriers for skin delivery of drugs, and the latest advances of the phospholipids carriers in transdermal delivery systems. The perspective is that phospholipids carriers may be capable of a wide range of applications in the transdermal delivery system.     

MEDIASTINAL CAVERNOUS HEMANGIOMA： REPORT OF ONE CASE

MEDIASTINAL cavernous hemangioma is a kind of primary mediastinal mesenchymal tumor that occurs rarely in any age. It was first reported by Shennon1 in 1914. In this study we reported a case of mediastinal cavernous hemangioma with abnormal vessel originating from left brachiocephalic vein.     

母婴铁代谢及其相互影响的初步报告

通过对孕中期,分娩时妇女及其所生婴儿之脐血的血红蛋白(Hb),红细胞游离原卟啉(FEP),FEP/Hb 的初步观察,证实,无论母亲贫血、缺铁、还是正常,均不影响脐血的Hb,FEP,FEP/Hb,给孕中期妇女补充铁剂可以明显地降低产时妇女的贫血患病率,随机分组进行不同方式的孕期给药没有显示出给铁剂+叶酸+维生素C 与铁剂+维生素C 在脐血Hb,FEP/Hb 之间有差异。     

Study of vascular smooth muscle cell calcification induced by hyperphosphate and intervented by phosphonoformic acid

Objective:To evaluate the effects of different concentrations of phosphate on calcium deposition and osteocalcin level in cultured bovine aortic smooth muscle cell,investigate the mechanism of hyperphosphatemia to evoke calcification of vascular smooth muscle cell and observe the effects of phosphonoformic acid(PFA)in different concentrations on vascular calcification.Methods:The bovine aortic smooth muscle cells(BASMC)were cultured.Calcium deposition and the expression of osteocalcin of BASMC in different concentrations of phosphate(1.5mmol/Land2.0mmol/L)and PFA were determined by o-cresolphthalein complexone and radioimmunity methods,respectively.Osteocalcin mRNA expressions were determined by RT-PCR.Results:After six or nine days of BASMC cultured,the calcium deposition in Pi 2.0 mmol/L group was more than that in Pi 1.5 mmol/L group[(77.187±11.692)μg/(mg·protein)vs(25.768±1.750)μg/(mg·protein),P＜0.01 and(125.399±16.677)μg/(mg·protein)vs(29.046±2.635)μg/(mg·protein),P＜0.01 respectively].The calcium deposition was dependent on time and dosage of phosphate treatment.After 72 h culture the osteocalcin in Pi2.0 mmol/L group was more than that in Pi1.5 mmol/L group[in supernatant,(1.503±10-2±2.601×10-3)ng/(μg·protein)vs(2.981×10-3±8.382×10-4)ng/(μg·protein),P＜0.001],the same was found in osteocalcin mRNA expression[OC/GAPDH,(1.906±0.132)vs(0.748±0.037),P＜0.001].Compared to Pi 1.5mmol/L group,bovine smooth muscle cells(BSMC)cultured in media containing Pi 2.0 mmol/L phosphate levels increased calcium deposition[On day 6,(77.187±11.692)μg/(mg·protein)vs (25.768±1.750)μg/(mg·protein),P＜0.001].Elevated phosphate treamaent of BSMCs also enhanced the expression of the osteoblastic differentiation marker osteocalcin[On day 3,Pi 2.0 mmol/L group vs Pi 1.5mmol/L group,(1.503×10-2±2.601×10-3)ng/(μg·protein)vs(2.981×10-3±8.382×10-4)ng/(ug·protein),P＜0.001].PFA decreased ciacium deposition and osteocalcin expression statistically[Pi 2.0 mmol/L PFA1.0 mmol/L group vs Pi 2.0 mmol/L group,ciacium deposition,(37.729±5.899)μg/(mg·protein)vs(77.187±11.692)μg/(mg·protein),P＜0.001];Osteocalcin in supernatant,(4.529±10-3±1.250×10-3)ng/(μg·protein)vs(1.503×10-2±2.601×10-3)ng/(μg·protein),P＜0.001;osteocalcin mRNA expression,OC/GAPDH,(0.642±0.092)vs(1.89±0.165),P＜0.01].Conclusion:Hyperphosphate may directly promote calcium deposition and the osteocalcin expression of BASMCs.It may be a new explanation for the phenomenon of vascular calcification in hyperphosphatemic conditions.Hyperphosphatemia is an independent factor to stimulate vascular calcification.PFA can inhibit calcium deposition and osteocalcin expression induced by elevated phosphate.PFA may be a new medicine to treat vascular calcification induced by elevated phosphate.