Objective To compare the influence of different end-tidal concentrations of sevoflurane on transcranial electrical four-limb muscle motor evoked potential (MEP) monitoring. Methods Twenty ASA Ⅰ-Ⅱpatients aged 23-62 years undergoing craniotomy were enrolled. Triangular muscle, biceps brachii muscle, triceps brachii muscle, brachioradialis muscle, extensor digitorum communis muscle, abductor pollicis brevis abductor digiti minimi muscle, rectus femoris muscle, tibialis anterior muscle, gastrocnemius muscle and abductor hallucis were selected for MEPs recording. Sevoflurane was introduced at 0.5, 0.75, 1.0 and then 1.3 MAC (15 min each), and the effects on MEPs were studied. Results ①Maximum MEP amplitude was observed at abductor pollicis brevis muscle in upper limb and abductor hallucis muscle in lower limb at baseline and 0.5 MAC. Up to 1.0 MAC, there was no significant difference in MEP amplitude among extensor digitorum communis muscle, abductor pollicis brevis and abductor digiti minimi muscle. ②The success rate of MEP recording from abductor pollicis brevis muscle and abductor hallucis muscle was 100% during the administration of 0.5-1.0 MAC sevoflurane. ③The MEP amplitude was decreased and the latency was increased in a sevoflurane dose-dependent manner. Conclusions Abductor pollicis brevis muscle and abductor hallucis muscle were suitable for MEP monitoring during the administration of 0.5-1.0 MAC sevoflurane.

Objective To investigate the risk factors,clinical prediction and intrapartum management of shoulder dystocia in non-macrosomia.Methods Totally 7 811 cases of vaginal delivery were retrospectively reviewed from Juanary 2009 to December 2013 in Shengjing Hospital.Shoulder dystocia was found in 11 cases (0.14％,11/7 811),including 1 case of macrosomia and l0 cases of non-macrosomia (shoulder dystocia group).Each non-macrosomia shoulder dystocia case was matched with 10 cases of normal delivery in the same week,which were selected randomly as the control group.The tendency and risk factors of shoulder dystocia in macrosomia and non-macrosomia were analyzed,and the following data between the two groups were compared,including the height of uterus fundus,abdominal circumference of the pregnant woman,the increasing of body mass index(BMI),fetal biparietal diameter (BPD),fetal femur length (FL),duration of every stage of labor,birth weight of the newborn,head circumference and chest circumference of the newborn,Apgar score.Results (1) There were 213 macrosomias among the 7 811 vaginal deliveries,with the incidence of 2.73％ (213/7 811).Only 1 shoulder dystocia was macrosomia (0.46％,1/213); while the other 10 cases were non-macrosomia (0.13％,10/7 598).(2) From 2009 to 2013,the macrosomia happened by 24 cases (2.32％,24/1 034),42 cases (3.61％,42/1 164),46 cases (2.60％,46/1 772),62 cases (3.01％,62/2 060),39 cases (2.19％,39/1781),respectively.The incidence of macrosomia had no significant difference among these 5 years (P＞0.05).The shoulder dystosia occurrence without macrosia in these 5 years were 1 case (0.10％,1/1 034),3 cases (0.26％,3/1 164),2 eases (0.11％,2/1 172),2 cases (0.10％,2/2 060),2 cases (0.11％,1/1 781),respectively.The incidence of shoulder dystocia without macrosomia had no significant difference among these 5 years (P＞0.05).(3) In the should dystocia group,5 cases were complicated with premature rupture of membrane (5/10),4 cases were mother≥ 35 years old (4/10),3 cases were multipara(3/10),3 cases had gestational diabetes mellitus(3/10),3 cases were occiput posterior during the first stage of labor(3/10),3 cases had prolonged second stage of labor (3/10) and 6 cases had routine lateral incision (6/10).In the control group,3 cases were complicated with premature rupture of membrane(3/10); 1 case was mother≥35 years old (1/10); 2 cases were multipara(2/10),3 cases had gestational diabetes mellitus (3/10),1 case had prolonged second stage (1/10) and 7 cases had routine lateral incision (7/10).(4) There were no significant difference in the height of uterus fundus,BMI,BPD,FL,and duration of the first stage of labor between the shoulder dystocia group and the control group (P＞0.05).Compared with the control group,the increasing of BMI [(6.8±3.1) vs (4.8± 1.4) kg/m2],the time of the second stage of labor[(86±65) vs (38±28) minutes] and abdominal circumference[(108±8) vs (101±7) cm] were significantly higher in the shoulder dystosia group (P＜0.05).(5)There were significant difference in the chest circumference of the newborn [(34.0±1.6) vs (32.2±1.9) cm] and the ratio of chest circumference to head circumference of the newborn [(0.99±0.03) vs (0.97±0.03)] between the two groups(P＜0.05).The 1-minute Apgar score of the newborn (7.4±2.8) was significantly lower than the control group (10.0±0.0) (P＜0.01).Clavicular fracture occurred in 3 newborns and brachial plexus injury occurred in 4 newborns in the shoulder dystosia group.Conclusion It is difficult to predict shoulder dystocia in non-macrosomia.Shoulder dystocia of non-macrosomia could be predicted by measurement of the head circumference,chest circumference,the ratio of chest circunfference to head circumference by using prenatal ultrasound.The risk factors may complicated with premature rupture of membrane,abnormal occiput position during the first stage of labor and prolonged second stage of labor.

Background and purpose:The effect of TPF (docetaxel, cisplatin and 5-lfuorouracil) induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma is unclear. This study aimed to compare the outcomes and tolerance of neoadjuvant chemotherapy with TPF versus cisplatin and 5-lfuorouracil (PF) followed by concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma patients.Methods:Patients with locoregionally advanced nasopharyngeal carcinoma were randomly divided into 2 groups: Group TPF and Group PF. Group TPF: One hundred and sixteen nasopharyngeal carcinoma patients received TPF consisting of docetaxel at 60 mg/m2 on day 1, cisplatin at 60 mg/m2 on day 1, and 5-lfuorouracil at a dose of 750 mg/m2by 24 h continuous infusion for 5 days for 3 cycles with a 21 day interval; Group PF: One hundred and sixteen nasopharyngeal carcinoma patients received PF consisting of cisplatin at 80 mg/m2 on day 1, and 5-lfuorouracil at a dose of 750 mg/m2by 24 h continuous infusion for 5 days for 3 cycles with a 21 day interval. After the completion of neoadjuvant chemotherapy, all the patients received intensity modulated radiation therapy (IMRT) with concomitant chemotherapy consisting of 2 cycles of cisplatin at 80 mg/m2 on day 1 and day 22. The prescribed doses were 6 810 cGy at 2.27 Gy/fraction to the gross tumor volume (GTV) with 5 daily fractions per week for 6 weeks. The acute toxicity and tumor response rate (RR), including complete response (CR) and partial response (PR), were evaluated. Addition-ally, the 5-year progress-free survival (PFS) rates and overall survival (OS) rates were further evaluated.Results:RR of Group TPF was higher than that of group PF at the end of neoadjuvant chemotherapy and within 13 weeks of the completion of concurrent chemoradiotherapy. The median recurrence time of TPF group was 2.98 years, and the 5-year PFS was 84.48%. The median recurrence time of PF group was 2.32 years, and the 5-year PFS was 82.75%. There was no statistically signiifcant difference between the 2 groups (P=0.458). The 5-year OS of TPF group was 87.06%, and for the PF group was 85.34%. There was no statistically signiifcant difference between the 2 groups (P=0.274). The incidence of leukopenia, thrombocyte penia, liver and kidney damage, diarrhea and mucosa necrosis in TPF group were signiifcantly higher than those in PF group (P<0.001). TheⅢ andⅣ degrees adverse reactions in TPF group were sig-niifcantly higher than those in PF group (P<0.001).Conclusion:TPF induction chemotherapy was not superior to the PF regimen for locoregionally advanced nasopharyngeal carcinoma patients. It should not be recommended in terms of more acute toxicity.

Objective To compare the effects of sevoflurane,isoflurane and desflurane on transcranial electrical motor evoked potentials(MEPs)in patients undergoing neurosurgery.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing neurosurgery were randomly divided into 3 groups(n = 20 each): sevoflurane group,isoflurane group and desflurane group.BIS value and MEPs were monitored.The end-tidal concentrations of sevoflurane,isoflurane and desflurane were adjusted and maintained at 0.50,0.75,1.00 and 1.30 MAC respectively for at least 15 min during 6 stimuli delivered at 1000 Hz and 300 V lasting for 75 μs.The amplitudes and latency of MEPs and BIS value were recorded before administration(baseline)and the each stable state (T1-4).The failure rate of MEPs was also recorded.Results The amplitude of MEPs and BIS value were significantly decreased at T1.2 and the latency of MEPs was prolonged at T1-4 in desflurane group compared with sevoflurane and isoflurane groups(P＜0.05).There was no significant difference in the amplitudes and latency of MEPs and BIS value between group sevoflurane and isoflurane(P＞0.05).The failure rates of MEPs were 0 at baseline,T1 and T2,0,5% and 20% at T3 ,and 5%,20% and 45% at T4 in sevoflurane,isoflurane and desflurane groups respectively.The failure rate of MEPs was significantly higher in desflurane group than in sevoflurane and isoflurane groups(P＜0.05).Conclusion Desflurane has greater suppressive effect on MEPs than sevoflurane and isoflurane.1.00 MAC of sevoflurane and isoflurane,while 0.75-1.00 MAC of desflurane may be the suitable end-tidal concentration for MEP monitoring.

Objective To explore how to isolate and culture human primordial germ cells(PGCs).Methods Human embryonic fibroblasts(HEFs) isolated from embryos at 2 to 3 months of age received a radiation of 60Co ?-ray and then served as feeder layer cells.Cells collected from trypsinized human embryonic gonadal ridges and dorsal mesenteries(5 to 9 weeks post-fertilization) were cultured on HEF feeder layers in the medium with recombinant human leukemia inhibitory factor(LIF),recombinant human basic fibroblast growth factor(bFGF) and forskolin.Histochemical and immunocytochemical assays were used to identify the stage specific embryonic antigen-1and 4(SSEA-1/4) of the cultured cells.Reverse transcription polymerase chain reaction(RT-PCR) was used to identify the expressions of specific genes,including Oct-4,Ifitm-3,stella,Mvh and DAZL.Embryonic bodies were cultured as while.Results The collected cells were growing on the feeder layer and formed a typical nestlike multicellular colonies.The cells showed diploid chromosome in karyotype analysis and expressed SSEA-1/4 and specific genes,Oct-4,Ifitm-3,stella,Mvh and DAZL,indicating that the cells were PGCs.When cultured in hanging drop,the PGCs developed into embryonic bodies,showing multipotential ability.Conclusion Human PGCs can be isolated from genital ridges and dorsal mesenteries of embryos and cultured in vitro on HEF feeder layer.The formation of the embryonic stem cell colony can be observed,and the cells cultured by this method is confirmed to be embryonic germ cells.

AIM To determine the contents of chemical consituents in Lycii Fructus from Qaidam Basin.METHODS Spectrophotometry was adopted in the content determination of polysaccharides,total flavonoids and carotenoid.HPLC was applied to the content determination of betaine and scopoletin.Kjeldahl method was used for the content determination of protein.Then principal component analysis was performed.RESULTS The contents of carotenoid,betaine and scopoletin in samples from six growing areas showed obvious differences (P ＜ 0.05),while those of polysaccharides,total flavonoids and protein exhibited no obvious differences (P ＞ 0.05).The contents of various constituents in samples at three picking time also had no obvious differences (P ＞ 0.05).The comprehensive score of principal components of samples from Delingha City was the highest,followed by that from Ulan County.CONCLUSION The quality of Lycii Fructus from Qaidam Basin from Delingha City is the best.

Objective To observe efficacy of endoscopic biliary drainage (ENBD) in the preventionand treatment of post-ERCP pancreatitis and hyperamylasemia. Methods A total of 120 patients with choledocholithiasis who underwent ERCP from May 2013 to May 2015 were included in the study. ENBD was performed in 60 patients(test group), and the other 60 patients who didn't undergo nasal biliary drainage were designated as control group. Results The incidence rates of PEP and hyperamylasemia in the test group were 1.7% and 20.0%, respectively, significantly lower than those in the control group 13.3%and 50.0%. Conclusion ENBD can be effective in preventing post-ERCP acute pancreatitis and hyperamylasemia occurred.

Objective To construct the pshuttle-Egr-1-hSmac plasmid and transfect human breast cancer MDA-MB-435 cells,and to observe its radiotherapy enhancing effect on tumor cells.Methods The empty vector pshuttle and pshuttle-Egr-1-hSmac plasmid were transfected into MDA-MB-435 cells by liposomal.At different time(4,8,12,24 and 48 h)after irradiation with 2.0 Gy X-ray and 24 h after irradiation with 0.5 -5.0 Gy,the total RNA and protein were collected and extracted from these cells to analyze the Smac mRNA and protein expression levels with RT-PCR and Western blotting methods. The cells were divided into control, pshuttle, pshuttle-Egr-1-hSmac,2.0 Gy irradiation group, pshuttle + 2.0 Gy irradiation and pshuttle-Egr-1-hSmac+2.0 Gy irradiation groups.MTT method was used to evaluate cell proliferation,and the cell survival ability was measured with clone formation assay;Annexin Ⅴ/PI double staining and PI single staining were used to examine the apoptosis and cell cycle of MDA-MB-435 cells. Results There was no Smac mRNA expression in MDA-MB-435 cells in control and pshuttle groups,but the Smac mRNA expression levels in MDA-MB-435 cells in pshuttle-Egr-1-hSmac plasmid group were gradually increased with the time prolongation, and reached the maximum at 24 and 48 h;the Smac mRNA expression levels in MDA-MB-435 cells were increased gradually 24 h after irradiation of 0.5 - 5.0 Gy X-ray with the increasing of irradiation doses, and reached the maximum after 2.0 and 5.0 Gy irradiation. The Smac protein expression levels in pshuttle-Egr-1-hSmac plasmid group were increased gradually with the time prolongation,and reached the maximum at 24 h.The Smac protein expression lervels were increased 24 h afer irradiation of 0,0.5,1.0,2.0 and 5.0 Gy X-ray,especially in 5.0 Gy group. The MTT results showed that the A490 values in 2.0 Gy,pshuttle+2.0 Gy and pshuttle-Egr-1-hSmac groups 24, 48,and 72 h after irradiation were lower than those in control group(P<0.01);the A490 values of MDA-MB-435 cells in pshuttle-Egr-1-hSmac group after 1.0-5.0 Gy X-ray irradiation were lower than those in 0 Gy group (P<0.05 or P<0.01);the survival fraction(SF)in pshuttle-Egr-1-hSmac group was lower than those in control group (P<0.01).The percentages of the cells at G0/G1 and S phase in pshuttle-Egr-1-hSmac group were lower than those in 2.0 Gy group(P<0.01),the percentage of the cells at G2/M phase was higher than that in 2.0 Gy group (P<0.01);the apoptotic rate of the cells in pshuttle-Egr-1-hSmac group was higher than that in 2.0 Gy group (P<0.01).Conclusion X-ray irradiation can significantly increase the Smac mRNA and protein expression levels in MDA-MB-435 cells transfected with pshuttle-Egr-1-hSmac plasmid,inhibit the cell survival rate,and induce G2/M arrest and apoptotic increasing;Smac gene combined with radiotherapy could significantly increase the radiosensitivity of breast cancer cells.

Objective To understand the distribution condition of resources of medicinal plant of Euodiae Fructus;To provide references for resource conservation and standardized plantation of Euodiae Fructus. Methods Literature search, interview survey and field survey were conducted to investigate the resource conditions of the main producing areas of Euodiae Fructus. Samples were collected and TKW of the medicinal plant was weighted. Results Currently, the main producing areas of Euodiae Fructus are provinces of Jiangxi, Guizhou, Hubei, Hunan and part of provinces and places of Guangxi, Anhui, Zhejiang, Shanxi, and Chongqing. Commercial Euodiae Fructus mainly comes from private investors. The wild resources of Euodiae Fructus are few. The TKW of the medicinal plant is within 5.34-45.62 g, with great differences. The national annual output of cultivated Euodiae Fructus is around 3500 t. The production and marketing is in balance. The price for Euodiae Fructus is relatively stable. Conclusion The plantation of Euodiae Fructus is dispersing, with small scale, low degree of standardization and intensification, and great quality differences. Standardized, large-scale, and industrialized plantation base should be established, and the assessment system for medicine quality should be perfected, with a purpose to ensure the qualified and stable production of Euodiae Fructus. Meanwhile, wild resource production should be enhanced to maintain the biological diversity and promote the sustainable development of Euodiae Fructus.

ObjectiveTo detect mRNA and protein expression of steroidogenic factor-1 ( SF-1 ) and DAX-1 in human adrenocortical tumors and normal adrenal cortex,and to investigate the effect of SF-1 and DAX-1 on the steroidogenesis and development of adrenocortical tumors.Methods Total RNA and protein was extracted from angiotensin Ⅱ unresponsive aldoterone-producing adenomas ( A Ⅱ -U-APA,n =12 ),angiotensin Ⅱ responsive aldoterone-producing adenomas ( AⅡ -R-APA,n =5 ),cortisol-producing adenomas ( CPA,n =10 ),adrenal nonfunctional adenomas ( NFA,n =10 ),aldosterone-producing carcinoma ( APC,n =2 ) and normal adrenal cortex ( NAC,n =8).To analyze gene expression of SF-1,DAX-1,ACTH receptor(ACTHR),and β-actin by real-time quantitative PCR in different tissues.The protein expression of SF-1,DAX-1,and β-actin in the same tissues by Western blot.To study the relationship of ACTHR,SF-1,and DAX-1 with clinical data in adrenocortical tumors.ResultsThe expression of SF-1,DAX-1 mRNA and protein was different in NAC,AⅡ -U-APA,A Ⅱ -R- APA,APC,CPA,and NFA tissues [ relative expression of SF-1 mRNA:24.58±2.45,23.89±3.17,21.59±3.00,(38.75,44.16),14.17±2.80,and 36.38±3.50; DAX-1 mRNA:0.57±0.06,0.37±0.05,0.43±0.05,( 1.52,1.21 ),0.39 ±0.04,and 0.83 ±0.08 ; SF-1 protein:0.76 ±0.11,0.76 ±0.10,0.73 ±0.07,(1.24,1.40),0.55±0.04,and0.98±0.10; DAX-1 protein:0.65±0.14,0.39±0.13,0.43±0.14,(1.18,1.02),0.56±0.04,and 1.03±0.13 ; all P＜0.05 or P＜0.01 ].There was negative correlation by higher SF-1/DAX-1 ratio and tumor size in AⅡ -U-APA tissues.The mRNA and protein expression of SF-1 was lower in CPA and there was the positive correlation with tumor size.Conclusion SF-1 and DAX-1 might play a key role in the development of the adrenocortical tumorigenesis and steroidogenic tissues.