This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P<0.01)，Cortisol concentration decreased after anesthesia induction(P<0.05)，IL-2 concentration decreased at the end of operation(P<0.05)，and sIL-2R lever did not change.The investigation suggested that general anesthesia with propofol,fentanyl and isoflane can suppress CA and cortisol increase resulting from induction of anesthesia. There was no change in IL-2 level.However it can not suppress the increase of stress hormones and decrease of IL-2 due to operation.The stress response correlate with immune functions.

This study was set up to observe the changes in stress and immune functions in upper abdominal surgery after general anesthesia.In thirty elective upper abdominal operation patients,general anesthesia was induced with propofol,fentanyl,scoline and maintained with isoflane and atrumium. Catecholamines(CA),cortisol,interleukin-2(IL-2) and soluble interleukin-2 receptor(sIL-2R) were measured before anesthesia,after induction of anesthesia,at the end of operation,and on the first and third postoperative days.The results showed that epinephrine(E),norepinephrine(NE) concentration increased at the end of operation and on the first postoperative day(P

Endostatin is a novel anti-angiogenic drug which through multiple pathway inhibits vascular endothelial growth factor expression,to achieve the purpose of the inhibition of tumor angiogenesis.The drug in the treatment of non-small cell lung cancer in pre-clinical study and clinical application show that:used alone have anti-tumor effect; combined with radiotherapy and chemotherapy can obtain short-term curative effect,and does not increase treatment related toxicity.The adverse effect of the drug is mild and can be well tolerated.

During radiotherapy, ionizing radiation can damage some structures of the heart, including pericardium, myocardium, cardiac valve, conducting system, and coronary artery. Radiation-induced cardiac injury can manifest as abnormalities in many aspects including myocardium enzymes, perfusion imaging, electrocardiogram, strain rate imaging.

Objective To compare the efficacy and toxicity of inductive chemotherapy with pemetrexed followed by radiotherapy for patients with lung adenocarcinoma .Methods Patients with stage Ⅲa/b or Ⅳ and histologically confirmed lung adenocarcinoma were evaluated from July 2008 to April 2012 ( n=95 ) .Patients re-ceived inductive chemotherapy with pemetrexed or paclitaxel followed by thoracic radiotherapy or chemotherapy with pemetrexed alone,respectively.Primary end point was the tumor response rate (RR),progression-free sur-vival(PFS),1-year survival rate and toxicity.Results Tumor RR were 83.3%,81.8%and 62.5% in three groups of inductive chemotherapy with pemetrexed or paclitaxel followed by thoracic radiotherapy or chemotherapy with pemetrexed alone ,respectively.PFS was 12.0 months,10.9 months and 5.7 months.The 1-year survival rate was 80.0%,78.7%and 46.8%.Tumor RR and PFS were statistically superior in pemetrexed/radiotherapy versus pemetrexed alone ,and toxicity was significantly lower than in paclitaxel /radiotherapy.Conclusion The treatment of pemetrexed/radiotherapy for lung adenocarcinoma could prolong the survival of patients .Compared with the treatment of paclitaxel/radiotherapy ,pemetrexed/radiotherapy provides similar efficacy with better tolera-bility and more convenient administration .

BACKGROUND:The growth of mesenchymal stem cells in vitro in different conditioned media is different evidently. So it is necessary to choose a more suitable medium. OBJECTIVE:To contrast and observe the proliferation of human umbilical cord mesenchymal stem cells in three kinds of media and to check the immunophenotype and differentiation ability of mesenchymal stem cells. METHODS:Human umbilical cord mesenchymal stem cells were col ected by explant method in sterile conditions. After subculturing by T75 incubation bottles, the third generation of mesenchymal stem cells were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 medium containing 5%fetal bovine serum, Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum and Mesen PRO RSTM medium. After 1, 3, 5, 7 days of culture, the cells were counted to draw a growth curve. Immunophenotype of the third generation of umbilical cord mesenchymal stem cells were determined by flow cytometry and the ability of osteogenic and adipogenic differentiation was also detected. RESULTS AND CONCLUSION:The third generation of cells cultured highly expressed CD44, CD73, CD90, CD105, but did not express CD29, CD31, CD34, HLA-DR. The oil red O staining showed a lot of little red lipid drops after adipogenic induction;alizarin red staining showed osteoblast-like cells after osteogenic induction, indicating umbilical cord mesenchymal stem cells in vitro have the potential of multi-directional differentiation. After observation and counting, the colony and shape of cells cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum were superior to those cultured in the other two media. Therefore, it is concluded that Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum is preferred for cellsubculture.

10.3969/j.issn.1000-8179.2013.12.013

Hepatectomy for huge hepatocellular carcinoma (HCC) is difficult due to its huge size and the compression and invasion to the surrounding tissues as well as the important vascular systems.Surgical resection of huge carcinoma in the caudate lobe is a big challenge for hepatobiliary surgeons because of its special location and complex anatomical structure.As the improvement of surgical techniques in recent years,especially the promotion of the concept of precision liver surgery,many surgeons begin to take the challenge of resection of huge HCC in the caudate lobe in a variety of ways.In April 2014,a male patient aged 58 years with huge HCC in the caudate lobe was admitted to the Anhui Provincial Hospital.Precision right hemihepatectomy combined with caudate lobectomy was performed on this patient without occlusion of the hepatic inflow,and the efficacy was satisfactory.The key techniques involved in this procedure were discussed in this article.

Objective To investigate the effects of multimodal analgesia of parecoxib and fentanyl on perioperative immune functions in patients of hepatocellular carcinoma (HCC).Methods Eighty HCC patients scheduled for hepatectomy were randomly divided into two groups:parecoxib sodium combined with fentanyl group (group P,40 cases) and fentanyl group (group C,40 cases).The percentages of CD3 +,CD4+,CD8+,CD4+/CD8+ T cells,CD3-CD16+ CD56+ (NK),interleukin-4 (IL-4),interferon-γ (IFN-γ) and the ratio of IFN-γ/IL-4 were detected at the following time points:30 minutes before induction of anesthesia (T0),at the end of the surgery (T1),24 h after surgery (T2) and 72 h after surgery (T3).The analgesic effects were estimated by visual analogue scale (VAS) after surgery.Total fentanyl consumption and adverse effects were also recorded.Results The percentages of CD3 + T cells were significantly lower in group C than that in group P at T2 (t =2.155,P ＜0.05).The percentages of NK in group P were recovered nearly to baseline (T0) at T2,which was higher than that of group C (t =2.791,P ＜0.05).In group C,the percentages of CD3 + T cells and NK has not recovered to baseline at T3 (respectively t =3.065,3.231,P ＜ 0.05).In group P,IL-4 serum levels were significantly lower than those in group C,while IFN-γ serum levels were significantly higher than those in group C at T2 (respectively t =2.173,2.100,P ＜0.05).From T2 to T3,the ratio of IFN-γ/IL-4 significantly increased in group P than those in group C (respectively t =3.259,2.203,P ＜ 0.05).VAS scores at rest and on cough in group P were significantly lower than those in group C at 2 h,6 h,12 h and 24 h after operation (respectively t =8.661,9.726,9.147,7.109,P＜0.05;t =8.569,9.614,9.144,8.509,P＜0.05).The total fentanyl consumption in group P was lower than that in group C (t =2.636,P ＜ 0.05).There were no significant differences regarding the incidence of adverse effects between the two groups.Conclusions Perioperative multimodal analgesia of parecoxib sodium combined with fentanyl enhances the analgesic efficacy,and reduces the dosage of opioid consumption,helps recover the cell immunity function of HCC patients after hepatectomy.

Objective To investigate the diagnostic value of dynamic MRI with coupling agent filled vaginal and rectumin the display of vaginal vault prolapse and rectocele. Methods Thirty three female patients, who were diagnosed with pelvic organ prolapse with Ⅲ degrees and above by gynecologic outpatient clinic and prepared to be treated with surgery were prospectively collected. All of them underwent two types of dynamic MRI, one was routine dynamic MRI (Group A) and the other was dynamic MRI with vaginal and rectum filled with coupling agent (Group B). Two radiologists evaluated and scored the display of vaginal vault and rectocele on these two groups of dynamic MRI images. According to the joint result of two radiologists, two gynecologists made surgical planning. Kappa test was used to compare the consistency of scores performedby two radiologists, and Fisher exact test was used to compare the differentiation fromboth groups, as well as the differentiation of probability of high uterosacral ligament suspension.Results The Kappa value of both groups was 0.65 and 1.00 respectively, where the consistency of Group B was superior than Group A. There were significant differences between the two groups(P<0.01), where Group B was better than Group A. Based on the imaging results of Group A, 7 patients (21.2%, 7/33) were decided to make high uterosacral ligament suspension. Based on the imaging results of Group B, 20 patients (60.6%, 20/33) were decided to make high uterosacral ligament suspension, and differences were statistical significance between the two groups(P<0.05). Conclusions Fo purpose of the displaying vaginal vault and rectocele, the dynamic MR imaging with vaginal and rectum filled with coupling agent was better than routine method. The proposed method can provide important information and reference for the establishment of surgical planning.