ObjectiveTo observe the effect and safety of postoperative patient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hysterectomy.Methods60 patients,ASA Ⅰ ～ Ⅱ,undergoing hysterectomy operation.were randomly divided into two groups.0.225％ ropivacaine with 0.005％ dezocine ( DR group) or 0.225 ％ ropivacaine with 0.003％ morphine (MR group) were given epidurally after surgery,respectively,with an initial loading dose 5m l,basal dose of 2ml/h,PCA dose of 0.5ml and lockout time of 15 min.Visual analogue score(VAS),Bruggemann comfort scale(BCS),Ramsay sedation score(RSS),PCEA effective compression of the times and adverse effects were determined and compared at 1 h,4h,8h,12h,24h 36h and 48h after operation.PCEA effective compression of the number and incidence of adverse reactions were observed.ResultsThere were no significant differences in VAS,BCS,RSS and PCEA effective compression of the times between two groups( all P ＞ 0.05 ).The percentage of nausea,vomiting and pruritus were significantly lower in group DR than that in group MR( all P ＜0.05).ConclusionPatient-controlled epidural analgesia with dezocine plus ropivacaine in patients underwent hysterectomy had analgesic effect and safety,with less advers eeffects.

Intensity-modulated radiotherapy (IMRT) is gradually replacing conventional radiation therapy and has become the mainstream radical treatment for patients with nasopharyngeal carcinoma (NPC). IMRT can conform and increase radiation doses to tu-mor-associated regions as well as decrease exposure doses and volumes on normal organs and tissues to avoid damage on critical or-gans. Aside from system and setup errors, other factors, such as the gradual reduction of the primary NPC lesion and the decrease in vol-ume of involved neck lymph nodes as well as body weight loss and changes in the head and neck shape during IMRT, may cause devia-tions in the radiation doses and volume delivered to the NPC targets and the organs at risk. These factors may affect the accuracy of IMRT. Several researchers have attempted to correct such deviations during IMRT for NPC patients by using adaptive radiotherapy (ART). The results indicate that ART is feasible to a certain degree and can correct the deviations, including decrease in tumor volume, body weight loss, and changes in head and neck shape of NPC patients.

Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.

Objective To analyze the clinical characteristics and assess the outcome of treatment for cervical cancer during pregnancy.Methods A cohort of 13 patients with cervical cancer diagnosed during pregnancy from January 2001 to September 2011 in Peking Union Medical College Hospital (PUMCH) was retrospectively studied.Clinical information,gestational age at diagnosis,treatment options and maternal and child outcomes were collected and analyzed.Results Thirteen patients out of 2030 cases of invasive cervical cancer were diagnosed during pregnancy with an incidence of 0.64％ (13/2030).The Mean gestational age at diagnosis of 13 patients is 21+6 weeks.Two cases were diagnosed during the first trimester,8 cases at second trimester and 3 cases at third trimester respectively.Vaginal bleeding during the pregnancy was main clinical manifestation presented in 8 patients and all thirteen cases were diagnosed by biopsy with pathological types of squamous cell carcinoma in 10 cases.The International Federation of Gynecology and Obstetrics (FIGO) stage was Ⅰ in eleven cases and stage Ⅱ in two cases.Six patients of them received treatment promptly after diagnosis.The other 7 patients had delayed treatment with mean diagnosis-treatment interval time of 65 days due to fertility reasons,who ended pregnancy by cesarean section at mean gestational age of 34+6 weeks,two of them received chemotherapy with cisplatin + fiuorouracil (PF)or cisplatin respectively before the end of the pregnancy,while the one with PF chemotherapy experienced neonatal death.The rest 6 neonatal outcomes were good.As follow-up of 13 cases:11 cases in stage Ⅰ received surgical treatment,and two of which had recurrence respectively,15 months and 7 months post surgery,and one case had died.One case of Stage Ⅱ patients died and one had recurrence after 53 months after radiotherapy.The recurrence rate in 13 cases was 3/13 and the mortality rate was 2/13.Conclusions Most cases of cervical cancer diagnosed during pregnancy were in early FIGO stage.For those patients diagnosed in late pregnancy with strong fertility demand,considering delayed treatment according to FIGO stage of the disease and fetus maturity is appropriate.Chemotherapy during pregnancy may cause neonatal complications.

Objective To assess the correlation of promoter methylation of DAPK1,RAR-β and MGMT with cervical lesions from cytology to histology,and to reveal the clinical value of DNA methylation in diagnosis of cervical intraepithelial neoplasia (CIN).Methods A total of 103 random-selected cervical samples were collected from residual liquid-based cytology specimens after clinical use in cytopathological diagnosis in outpatient clinic of obstetrics and gynecology,Peking Union Medical Collage Hospital from March 2010 to October 2010.Informed consent was obtained from each woman before the initiation of the study.The methylation seusitive-high resolution melt (MS-HRM) assay was used to evaluate promoter methylation of three genes ( DAPKI,RAR-β and MGMT) in 103 biopsy-confirmed liquid-based cervical cytology samples.Methylation levels and high-risk HPV DNA loading ( HC Ⅱ values) were analyzed in relation to both cytological and histological diagnosis.Results The methylation level of all three genes showed significant difference among the different cytological groups ( P =0.000,0.011 and 0.002,respectively).The methylation level of DAPK1 and RAR-β showed significant difference among the different histological groups ( P =0.000 and 0.021 ),while there was no significant difference for MGMT.DAPK1 methylation levels was 1.47％ in the CIN Ⅱ/high-grade precancerous lesions group,and 20.98％ in the normal/CIN I groups ( P =0.000 ),but there was no significant difference between CIN I/high-grade precancerous lesions and normal/CIN Ⅰ groups for RAR-β and MGMT.The combination of DAPK1/HR-HPV loading showed a sensitivity of 0.825 and an area under the receiver operating characteristic curve (ROC) curve (AUC) of 0.695 as diagnostic methods for detecting CIN Ⅱ/high-grade precancerous lesions.Conclusions DNA methylation such as DAPK1 and RAR-β,in combination with HR-HPV detection,may serve as biomarkers to detect CIN Ⅱ/high-grade precancerous lesions.Detection of methylated DNA from liquid-based cervical cytology specimens is technically feasible with the MS-HRM assay.

Alismatis Rhizoma(AR)is widely used in Chinese medicine,and its major bioactive components,tri-terpenes,reportedly possess various pharmacological activities.Therefore,it is very important to study the metabolism of triterpenes in vivo.However,the metabolism of AR triterpene extract has not been comprehensively elucidated due to its complex chemical components and metabolic pathways.In this study,an ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry method,which was based on the characteristic ions from an established database of known triterpenes,was used to analyze the major metabolites in rats following the oral administration of Alismatis Rhizoma extracts(ARE).As a result,a total of 233 constituents,with 85 prototype compounds and 148 metabo-lites,were identified for the first time.Hydrogenation,oxidation,sulfate and glucuronidation conjugation were the major metabolic pathways for triterpenes in AR.In addition,the mutual in vivo transformation of known ARE triterpenes was discovered and confirmed for the first time.Those results provide comprehensive insights into the metabolism of AR in vivo,which will be useful for future studies on its pharmacodynamics and pharmacokinetics.Moreover,this established strategy may be useful in meta-bolic studies of similar compounds.

Objective To analyze the serotypes of enteroviruses(EVs) isolated from patients with influenza-like illness in Beijing in 2017. Methods Oropharyngeal swab specimens were collected from pa-tients with influenza-like illness in eight districts of Beijing from July 2017 to October 2017. EVs were detec-ted by real-time PCR. Specific primers were synthesized and used to amplify the VP1 fragments of EVs. PCR products were sequenced and the results were compared with the reference sequences by using Basic Lo-cal Alignment Search Tool(BLAST) to identify the serotypes of isolated EVs. Results A total of 666 spec-imens were collected and 91 (13.66%) were positive for EVs. VP1 sequences of 66 EVs were successfully amplified and BLAST analysis revealed that these strains belonged to 14 serotypes,including seven serotypes of EV-A species,six serotypes of EV-B species and one serotype of Rhinovirus species. The predominant se-rotypes were CVA2 and CVA6. Eight out of 14 CVA6 strains that were collected in Shunyi District shared high homology. All seven CVB5 strains were collected in Shijingshan District and grouped into one cluster. Conclusion EVs causing influenza-like illness in Beijing in 2017 belonged to 14 serotypes and CVA2 and CVA6 were the predominant serotypes.

Abstract: Ferritin is widely present in various organisms and is responsible for storing excess iron to maintain iron balance in vivo. Due to its inherent targeting ability, natural cavity structure, reversible self-assembly, high biocompatibility, and easy modification, ferritin is considered to be an ideal delivery system, which is widely used in many fields. This review summarizes the biological characteristics, functionalization, drug loading strategies, research progress and application prospects of ferritin-based nanocarrier systems in biomedical fields, such as drug delivery, biocatalysis, photodynamic therapy, medical imaging and vaccine research, aiming to provide some reference for related biomedical research based on ferritin delivery systems.

OBJECTIVETo study the effect of chemotherapy assisted with shenqi fuzheng injection (SFI) on senile patients with non-small cell lung cancer (NSCLC).

METHODSOne hundred and twenty old patients with NSCLC were treated with NP chemotherapeutic protocol, to the 60 patients in the treated group among them, additional medication of SFI was started one week before the beginning of chemotherapy. The short-term therapeutic efficacy, long-term survival rate, changes on quality of life (QOL) and immune function of patients, and hematological toxicity of therapy were observed.

RESULTSDifference between the two groups on short-term therapeutic effect, 1- and 2-year survival rate showed no significance (P>0.05), but the 3-year survival rate in the treated group was 26.6%, while that in the control group was 11.7%, showed that the former was higher than the latter. After treatment QOL of the treated group was better than that of the control (P<0.05). Besides, the hematological toxicity and affection on immune function of chemotherapy after treatment in the treated group were all lower than those in the control group showing significant difference (P<0.05).

CONCLUSIONSFI has definite toxicity relieving effect on chemotherapy in treating senile NSCLC.

Adenocarcinoma ; drug therapy ; immunology ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; drug therapy ; immunology ; Carcinoma, Squamous Cell ; drug therapy ; immunology ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Injections ; Lung Neoplasms ; drug therapy ; immunology ; Male ; Middle Aged ; Phytotherapy ; Quality of Life

Objective To analyze the clinicopathological features and prognosis of patients in endometrial cancer with bone metastases. Methods A retrospective review of medical records was performed to analyze patients with endometrial cancer who developed bone metastases at Peking Union Medical College Hospital (PUMCH) from January 2004 to December 2017, including patients with bone metastases at the diagnosis of endometrial cancer and at recurrence of endometrial cancer. The patient′s clinicopathological features, bone metastasis characteristics, treatment process and prognoses were also analyzed. Results The incidence of bone metastasis of endometrial cancer in PUMCH from 2004 to 2017 was 0.57% (14/2 458). (1) General clinical pathological features: the median age of the 7 patients with bone metastases diagnosed at the time of initial diagnosis was 50 years old, and the main pathological type was endometrioid carcinoma (n=5). The median age of the other 7 patients was 57 years old, with no significant difference comparing to the former groups (P=0.559). (2) The majority site of bone metastasis in endometrial cancer were discovered in pelvic bones, followed by the tibia. (3) Treatment: according to the staging of endometrial cancer, a comprehensive treatment based on surgery was performed, and one patient with isolated bone metastases underwent resection of bone metastasis. (4) Prognosis: nine out of the 14 patients died during the follow-up period. The median over all survival time was 25.5 months (range: 7.7-258.0 months). The median survival of population after diagnosis of bone metastases was 15.0 months (range: 3.0-51.0 months). The survival rate of endometrial cancer at 1-year after diagnosis of bone metastasis was 71.4%. The 2-year survival rate was 40.8%. (5) No independent prognostic factors affecting survival was found (P>0.05). Conclusions The incidence of bone metastasis in endometrial cancer is less than 1%. Bone metastasis could occur at the diagnosis of endometrial cancer or recurrence of endometrial cancer. Bone metastasis suggests a poor prognosis. There is no standard follow-up and treatment protocols so that individualized treatment is needed.