Renal cancer is a common malignant tumor in urology, with complicated pathogenesis and no obvious clinical symptoms. Metastatic renal cancer accounts for 20%-30% of the newly diagnosed renal cancer. The 5-year survival rate for metastatic patients is less than 10%.At present, the main non-surgical treatment means of mRCC include cytokines and targeted drug therapy, and immunotherapy has also become a research hotspot of mRCC. The current status and research progress of mRCC therapy were reviewed. The medical treatment methods of metastatic renal cancer, such as receptor tyrosine kinase inhibitors and mTOR inhibitors; immunotherapies, such as immunosuppressants for PD-1/PD-L1 were also discussed.

OBJECTIVE:To investigate the effects of Dexmedetomidine hydrochloride injection on elderly patients underwent thoracic surgery during anesthesia recovery period. METHODS:Totally 60 elderly patients underwent thoracic surgery in our hospi-tal during Jun. 2014-Feb. 2016 were selected as research objects and then divided into control group and observation group ac-cording to even and odd-numbered admission order,with 30 cases in each group. Control group was given Propofol injection 0.5-1 mg/kg intravenously 5 min after mask oxygen inhalation. Observation group was given Dexmedetomidine hydrochloride injec-tion 0.5-1.0 μg/kg intravenously. Both group were successively given Etomidate emulsion injection 0.1-0.2 mg/kg,Sufentanil citrate injection 0.3 μg/kg and Cisatracurium besilate for injection 0.2 mg/kg intravenously for anesthesia induction;tracheal intubation was performed and ventilator was used to assist ventilation after anesthesia induction. And then control group was given continuous intravenous dripping of propofol 3-6 mg/kg·h;observation group was given continuous intravenous dripping of Dexmedetomidine hydrochloride injection 0.2-0.5 μg/(kg·h). At the same time,both group were given continuous intravenous dripping of sufentanil 0.1-0.2 μg/(kg·min)and cis-atracurium 1.5-2 μg/(kg·min),and continuously inhaled 1%-2% sevoflurane for anesthesia mainte-nance. Hemodynamic index(HR,MAP,SpO2),postoperative recovery,the occurrence of delirium,restlessness,cough and involun-tary movement were observed in 2 groups before surgery (T0),after anesthesia induction (T1),at the moment of sputum suction and extubation(T2),5 min after extubation(T3),30 min after extubation(T4). RESULTS:At T2 and T3,HR and MAP of control group were increased significantly compared to at T0,T1,and higher than those of observation group,with statistical significance (P<0.05). At T0,T1,T4,there was no statistical significance in HR and MAP between 2 groups (P>0.05). At T0,T1,T2,T3, T4,there was no statistical significance in SpO2 level between 2 groups(P>0.05). The breathing recovery time,eye openning time and extubation time of observation group were significantly shorter than those of control group,with statistical significance (P<0.05). The incidence of postoperative restlessness,delirium,cough and involuntary movement in observation group were signifi-cantly lower than control group,with statistical significance (P<0.05). CONCLUSIONS:Dexmedetomidine hydrochloride injec-tion can keep hemodynamics stable in elderly patients underwent thoracic surgery during anesthesia recovery period.,shorten recov-ery time and reduce the occurrence of stress response as postoperative delirium,restlessness,cough,involuntary movement.

Objective To study the clinical characteristics and misdiagnostic causes of acute perforation of peptic ulcer (APPU) in children ,ao as to improve the diagnosis and treatment . Methods The clinical data of 26 cases of APPU in children were analysed retrospectively. Results The clinical manifestations include abdominalgia , abdominal distension, nausea and vomiting, fever; tension of abdominal muscle , epigastrium tenderness, rebounding pain,and gurgling sound attenuation or disappearance . The diagnosis was made preoperatively in 10 cases , and misdiagnosed in the other 16 cases . All patients underwent perforation repairing operation . There was no mortality in this series. All the patients were followed up for 1 to 2 years,and only 2 cases (7.7%) had peptic ulcer reccurrence. Conclusions Peptic ulcer in children often occurrs in schoolage and most of ulcers were duodenal ulcer. The clinical manifestation of APPU in children has no specific clinical presentation . The early diagnosis of APPU in children is difficult. Combined use of X ray with B ultrasonic examination can apparently improve the accurate rate of diagnosis. Once the diagnosis is made ,the surgical treatment should be performed as early as possible. The perforation repair should be chosen at first. Anti-Hp treatment should be given postoperatively.

AIM　To improve the treatmemt efficacy and reduce the side effect of carboplatin (CBP), the antitumor drug was incorporated into niosomes (NS). METHODS　Lung targeted niosomes of CBP (CBP-NS) were prepared by the method of hand shaking. The ultraviolet absorption spectrophotometric method was used for the determination of CBP. The method of dynamic dialysis was used for in vitro release of CBP from CBP-NS. The S-180 lung neoplasms models were established by iv cancer cells in mice. The number of pulmonary nodules was examined for evaluating the therapeutic efficacy. RESULTS　The data showed that the mean diameter of CBP-NS was 3.72 μm, with a span of 0.66. The entrapment ratio of CBP in CBP-NS was 29.2% and the CBP-NS were stable for three months stored at 3℃-5℃, 15℃-25℃ or 37℃ (relative humidity 75%). The release profile in vitro could be described by a biexpotential equation. The calculated values of the three targeting parameters indicated that CBP-NS showed good targeting efficiency. The results of therapeutic trials showed that the antitumor effects were significantly increased by injection of CBP-NS compared with CBP in the treatment of mice with lung carcinoma. CONCLUSION　The results indicated that CBP-NS have good targeting efficiency in vivo, and the biodegradable CBP-NS may decrease the side effects of carboplatin and improve its therapeutic efficacy.

AIM　To establish innovational triangular phase diagrams for preparation of pharmaceutical microemulsion (ME) with low toxicity as a result of reducing the amount of the emulsifiers. METHODS Lecithin and polyoxyethylene octyl phenyl ether (OP) were used as emulsifiers (E), absolute alcohol and n-octyl alcohol as assistant emulsifiers (A), ethyl oleate and olive oil as the oil phase (O). For the innovational triangular phase diagrams, lecithin-ethyl oleate-water and absolute alcohol (optimized ratio W/A=0.6)system, and OP(olive oil and n-octyl alcohol (O/A=0.34)-water system were used for preparation of the ME. While for the traditional triangular phase diagrams, OP and n-octyl alcohol (E/A=Km=1.5)-olive oil-water system, lecithin and absolute alcohol (E/A=Km=1.12)-ethyl oleate-water system were used. Then, the corresponding amounts of the emulsifiers used in both methods were compared. RESULTS　In the ME of lecithin systems by the innovational and the traditional methods, the amounts of emulsifier are 6%-28% and 28%-29.6%, respectively. In the ME of OP systems by the innovational and the traditional methods, the amounts of emulsifier are 23%-40% and 27.6%-49.8%, respectively. CONCLUSION　The method of innovational triangular phase diagram for preparation of ME is superior to the traditional method in finding out the lower amounts of emulsifiers for ME, and is a feasible method with guiding significance for preparing ME.

ObjectiveTo identify the proteins presented variation during ischemia/reperfusion injury (I/RI) in liver transplantation (LT).MethodsAt Mar.2009,a total of nine liver sample tissues,three samples obtained from each donor liver at three different time points,were studied.The time points were as follows:(1) the time point immediately after donor liver was harvested (T1) ; (2) the time point just before the anastomosis of hepatic artery and potal vein (T2),during this time period the donor liver was kept in ice cold and transported,then back-table prepared,during time from T1 to T2,ischemia injury occurred; (3) the time after donor reconnected to the recipient (T3),during which the donor liver was subjected to reperfusion injury.The three time points represent normal control,ischemia injury,and reperfusion injury respectively.By using method of 2DE-MALDI-TOF and mass-spectrum,the differential expression of these protein at T1,T2,and T3 time point were compared.ResultsFrom the 1580 proteins that were isolated,19 ischemia/reperfusion injury (I/RI)-related proteins that varied markedly from time point T1 to T2 and from time point T2 to T3 were identified.They were metabolic enzyme,molecular chaperone,redoxase,cytoskeleton protein,signal transduction protein,and binding protein,respectively.The character of each protein was further analized based on their functions.ConclusionsFor the first time,we detected the protein related to I/RI during LT.We obtained independent proteomics information of ischemia injury,and reperfusion injury,respectively.Further functional analyses of these proteins may improve the understanding of the critical biological processes during I/RI.Medicine intervention on the I/RI-related proteins may result in improved survival of the recipients.

The therapy of removing beat and toxic,strengthening the body to cultivate the fundamental is the mainstream of treating cancer in traditional Chinese medicine up to now,and the therapy of warming yang has been rarely involved.While the pathogenesis of tumor is spleen and kidney yang deficiency in root,and phlegm,stasis,and poison entangled with each other at the secondary position; the main therapeutical principle of tumor is simultaneous application of purging-tonifying therapy while focusing on protecting yang.The author believes that the treatment of cancer should pay attention to the whole concept,especially warming yang for patients with advanced tumors.The therapy of warming yang is an effective way to get rid of phlegm and blood stasis.Patients after radiotherapy and chemotherapy should be paid more attention to warming yang.

Objective To explore the application of mesangial thyroid resection in papillary thyroid carcinoma(PTC) with central lymph node dissection,and its influence on postoperative recurrence.Methods 76 cases with PTC were divided into two groups according to random number table,each group in 38cases.The control group was given primary lesions radical prostatectomy and routine central lymph node dissection,the treatment group was given primary lesions radical prostatectomy and central lymph node dissection by thyroid mesangial resection.The parathyroid function,injury of recurrent laryngeal nerve and local recurrence were compared between the two groups.Results Compared with before surgery,the levels of serum PTH and blood calcium were significantly decreased at the 1st,3rd day after surgery (all P ＜ 0.05),while there were no statistically significant differences in serum PTH and blood calcium at the 7th day after surgery(all P ＞0.05).The levels of serum PTH and blood calcium at the lst,3rd,7th day after surgery between the two groups had no statistically significant differences(all P ＜ 0.05).The incidence rate of injury of recurrent laryngeal nerve in the treatment group was significantly lower than that in the control group (5.3％ vs.21.1％,x2 =4.15,P ＜ 0.05).The secondary surgery rate and local recurrence within 2 years in the treatment group were significantly lower than those in the control group (0％ vs.15.8％,2.6％ vs.18.4％,x2 =6.51,4.69,all P ＜ 0.05).Conclusion Primary lesions radical prostatectomy and central lymph node dissection by thyroid mesangial resection can be used as theroutine operation for PTC,which can effectively produce complete dissection,reduce injury of recurrent laryngeal nerve and local recurrence.

Objective To survey the quantity of clinical practice of medical trainees in practice,analyze the status characteristics and main problems,and put preference for practice teaching administrative departments.Methods In June 2016,all students finishing internship in some military medical university were gathered and surveyed by the person in charge.Using self-made questionnaires,the students were asked to anonymously fill out the quantity of clinical practice by themselves respectively in different department and in various capacities.515 questionnaires were provided and 479 valid results were collected (93.0％).Using SPSS 16.0,the number of trainees in different genders,specialties and categories was analyzed by variance analysis and SNK test (22 comparison).Results The numbers of clinical practice as first assistants and second assistants in surgical medicine were the most,which were 5.70 and 5.29 in average,while those in specialty medicine were the least (al1＜2.85 in various capacities).The quantity of clinical practice in different specialties and sorts as second assistants in intemal medicine showed statistical significance (F=2.646,F=2.682;P=0.008,P=0.031) and SNK test showed that those in navy general practice medicine (5.81) and soldiers (4.59) operated more.The quantity of clinical practice in different specialties and sorts as first assistants in special medicine showed statistical significance (F=2.166,F=2.765;P=0.029,P=0.027) and SNK test showed that those specialties in pharmacy (3.33) and clinical medicine (3.22) and soldiers (3.03) operated more.Conclusion The quantity of clinical practice of medical trainees has characteristics with surgical medicine most and there is no links with genders.In the departments with more opportunities,the differences among different groups are not obvious,while in the less operating departments,the students with higher motivations operate more.Therefore,these departments should focus on mobilizing the enthusiasm of students.Besides,the quantity of clinical practice in medical trainees should be looked upon objectively and the operations should be done under the guide of the teachers and on the basis of considering the security of patients.

Food allergy( FA) is a growing health problem which affects young children′s growth. Re-cent studies have showed that leukotrienes can contract gastrointestinal smooth muscle,increase intestinal perm-bility,and it is obviously related to the development of FA gastrointestinal disorder. Leukotriene receptor antago-nists have provided a good therapeutic option and showed clinical benefits in the management of the FA gastroin-testinal disorder.