Objective To investigate the effects of different anesthesia methods on immunity in patients underwent radical resection of rectal carcinoma.Methods 82 patients underwent radical resection of rectal carcinoma were divided into two groups,each group had 41 cases.A group received total intravenous anesthesia while B group received total intravenous anesthesia combined with eqidural anesthesia.CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells were inspected before induction of anesthesia(T0),2 h after skin incision(T1),2 h(T2) and 24 h(T3) after the end of operation.The T-lymphocyte subsets,activated T cells and NK cells were measured by flow cytometry. Visual analogue scale(VAS) was observed at T2 and T3.Results The VAS score of T2,T3 in A group[(3.86 ± 0.46)points,(3.62 ±0.26)points]were higher than those in B group[(1.67 ±0.57)points,(1.94 ±0.42)points] (all P<0.05).The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1,T2,T3 were lower than those of T0 in A group(all P<0.05);The percentages of CD3+,CD4+,CD4+/CD8+,CD3+HLA-DR+and NK cells of T1, T2 were lower than those of T0 in B group ( all P <0.05 );The percentages of CD3+, CD4+, CD4+/CD8+, CD3+HLA-DR+ and NK cells of T1, T2, T3 in A group were lower than those in B group ( all P <0.05 ). Conclusion Total intravenous anesthesia combined with eqidural anesthesia produces less immune suppression than total intravenous anesthesia.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

Objective To evaluate the efficacy of different treatment regimens for children with acute promye-locytic leukemia (APL)with positive PML -RARa fusion gene.Methods Thirty -two newly diagnosed APL patients were included in this study,treated either with all -trans -retinoic acid (ATRA)and chemotherapy (CT)(group A) or with ATRA and arsenic trioxide (ATO)(group B).Clinical situation and clinical efficacy were analyzed in patients in different groups.They were also separated into low risk group,intermediate risk group and high risk group according to different risk criteria.Clinical characteristics,complete remission,long -time survival and urine arsenic concentra-tion were analyzed and compared.Results (1 )Fourteen of 1 5 patients (93.3%)in group A achieved hematological complete remission (HCR)with a median time of 38 days (28 -63 days).Sixteen of 1 7 patients (94.1 %)in group B achieved HCR with a median time of 29 days (1 0 -42 days),which was significantly shorter than group A,and there was a significant difference between 2 groups(t =3.53,P =0.002).(2)The 5 -year event -free survival (EFS)of group A and group B was (60.0 ±1 2.6)% and (81 .9 ±9.5)%,respectively;the 5 -year EFS of group B was almost 20% higher than group A;while there was no significant difference between the 2 groups(χ2 =1 .1 5,P =0.28).The 5 -year overall survival (OS)of group A and group B was (72.2 ±1 1 .9)% and (94.1 ±5.7)%,respectively,the 5 -year OS of group B was almost 20% higher than group A;while there was no significant difference between the 2 groups(χ2 =2.88,P =0.1 6).(3)The 5 -year EFS of low plus intermediate group and high risk group patients was (74.0 ±1 0.1 )% and (64.8 ±1 4.3)%,the 5 -year EFS of low plus intermediate group was almost 1 0% higher than high risk group,but there was no significant difference between the 2 groups(χ2 =0.1 4,P =0.71 ).The 5 -year OS of low plus intermediate group and high risk group patients was (84.7 ±8.1 )% and (71 .3 ±1 4.1 )%,the 5 -year OS of low plus intermediate group was almost 1 0% higher than high risk group,while there was no significant difference be-tween the 2 groups(χ2 =0.36,P =0.55).(4)ATO related side effects were mild,including abnormal liver tests and e-lectrocardiogram,but were invertible after supportive therapy.At the end of each chemotherapy course,the urine arsenic concentration remained low and no chronic arsenic toxicity or second malignancies were found during the follow -up period.Conclusions The ATRA plus ATO regimen is a promising and better treatment for childhood APL with positive PML -RARa fusion gene compared with conventional chemotherapy.It was necessary to take risk stratification in APL patients.

Objective To compare the efficacy and safety of modified FOLFOX4 program with docetaxel-oxaliplatin-5-fluorouracil (DOF) program as neoadjuvant chemotherapy in stage Ⅲ gastric cancer patients.Methods In 86 cases of stage Ⅲ gastric cancer patients,42 received modified FOLFOX4 chemotherapy,44 cases were treated by DOF program.After two cycles of chemotherapy,the treatment effect and adverse reactions were evaluated.Results The total effectiveness in modified FOLFOX4 group and DOF group was 60％ (25/42) and 68％ (30/44) respectively (P ＞ 0.05).Tumor control rate was 83％ (35/42) and 89％ (39/44) respectively (P ＞ 0.05).The incidence of nausea,vomiting and leukopenia was higher in DOF group than modified FOLFOX4 group (P ＜ 0.05).The D2 lymph node dissection rate between modified FOLFOX4 group and DOF group was 80％ (20/25) and 87％ (26/30) respectively (P ＞ 0.05),the R0 resection rate was 72％ (18/25) and 83％ (25/30) respectively (P ＞ 0.05).In 43 R0 resection patients using FOLFOX4 the median survival time was 38.7 months,1-,3-year survival rate was 90％,and 60％ ; while that in DOF group the median survival time was 39.6 months,1-,3-year survival rate was 95％,and 75％.Multivariate analysis showed that postoperative TNM stage only was an independent risk factor for prognosis.Conclusions TNM stage was the independent risk factor for prognosis of gastric carcinoma patients after radical gastrectomy.

Objective To analyze the clinical data of children with Langerhans cell histiocytosis (LCH),to discuss the therapeutic effect,and to analyze the factors related to prognosis.Methods A total of 45 children diagnosed as LCH were divided into group A (18 cases with bone lesion only),group B(6 cases with soft tissue lesion),and group C (21 cases with viscera lesion) according to Shanghai Children's Hospital-LCH-2007 scheme [SCH-LCH-2007 (modified DAL-HX83/90) scheme].(1) Initial treatment:group A was treated with Prednisone (Pred) + Vincristine (VCR) for 28 weeks,and group B was treated with Pred + VCR + Etoposide (VP16) + Mercaptopurine (6MP) for 43 weeks,and group C was treated with Pred + VCR + VP16 + Methotrexate (MTX) +6MP for 52 weeks.(2) Re-treatment scheme after relapse included:①upgrading treatment,group A to group B,group B to group C.②Individual treatment for group C included VP16 modification,and maintained Thymosin and/or Ciclosporin etc.Results The total survival rate was 93.3％ (42/45 cases) and recurrence rate was 26.7％ (12/45 cases).Children in group A and B were all effective,while 2 patients in group C died,and 1 case missed follow-up.Multi-factor analysis showed that the factors like age,sex,group,skeleton,soft tissue,erythra,lymph gland,lung,mouth,ears,hypophysis pituitary had no statistical significance,but liver,spleen and blood involvement had statistical significance in disease relapse:liver (P=0.007 1),spleen (P=0.016 9),and blood (P=0.011 1).Conclusion LCH can affect several organs of children and relapse,and modified DAL-HX83/90 scheme is very effective.The liver,spleen and hematopoiesis system involvement is correlates with the relapse.

Objective To optimize the helicopter pilot helmet with mounted display in order to enhance wearing comfort.Methods The problems of the helmet were analyzed,and the trends of the helmet were discussed in foreign countries and China,and then optimization was carried out from the aspects of function,structure,design,material and etc.Results Optimization measures were proposed from the aspects of safety protection,ergonomics,platform display,night vision,tracking and positioning,material and industrial art to improve the designs of all functional modules of the helmet.Theoretical references were provided for the design of lightweight and tailored helmet.Conclusion Aviation ergonomics has to be considered to enhance wearing comfort and reliability when designing new-type helicopter pilot helmet with mounted display.

Objective:To investigate the analgesic effect of nalbuphine combined with sufentanil on elderly patients with colorectal cancer after laparoscopic surgery.Methods:From January 2017 to December 2019, 106 elderly patients with colorectal cancer underwent laparoscopic surgery in Jiangshan People's Hospital were divided into observation group (53 cases) and control group (53 cases) according to the random digital table method.The control group was given sufentanil analgesia, and the observation group was given nalbuphine analgesia on the basis of the control group.The recovery time and catheter extubation time, pain visual analogue score (VAS) scores at 3, 12 and 24 hours after operation, changes of stress response before and 24h after operation, and adverse reactions were compared between the two groups.Results:The recovery time [(9.87±1.42)min] and catheter extubation time [(13.24±3.51)min] in the observation group were shorter than those in the control group [(17.34±2.98)min and (21.83±5.62)min] ( t=16.474, 9.438, all P<0.05). The postoperative 12h VAS score[(1.63±0.19)points] and 24h VAS score[(1.06±0.13)points] in the observation group were lower than those in the control group [(2.37±0.27)points and (1.83±0.32)points] ( t=16.318, 16.230, all P<0.05). The serum levels of Cor [(234.18±19.98)μg/L] and NE [(1.59±0.21)mmol/L] in the observation group were lower than those in the control group [(287.24±14.26)μg/L and (1.97±0.16)mmol/L] ( t=15.737, 10.479, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusion:Nalbuphine combined with sufentanil has good analgesic effect on elderly patients with colorectal cancer after laparoscopic surgery, and can reduce the postoperative stress response.

Objective To investigate the effect of dexmedetomidine on sedation and cognitive function in elderly pa-tients after abdominal operation. Methods From January 2013 to January 2014 in our department,100 cases of abdominal operation were randomly divided into observation group (infusion of dexmedetomidine﹚ and control group (infusion of saline﹚,50 cases in each group, compared two groups of patients before treatment and 10 min after administration, 30 min after administration of Ramsay score changes,changes in the two groups before operation 1 days, 1 days after operation,postoperative 3 days,7 days after operation,MMSE score, the two groups before operation (T0﹚, 5 min after operation(T1﹚,before extubation 15 min T2﹚,extubation 30 min(T3﹚systolic blood pressure (SBP﹚,diastolic blood pres-sure (DBP﹚,heart rate(HR﹚ and oxygen saturation(SpO2﹚changes. Results Patients with 10 min after administration, 30 min Ramsay after administration scores were higher than those in the control group,there was significant difference (P<0.05﹚. The MMSE score of the patients in control group after operation 1 d, postoperative were lower than that of the observation group,there was significant difference (P<0.05﹚. 2 groups of patients with T2 in T3,SBP levels were significantly higher than T0,but the control group was significantly higher than those in the observation group,there was significant difference(P<0.05﹚. Patients in the control group DBP level was T0 increased significantly,and the level of DBP in patients with T2 group,T3 was significantly higher than that in the control group,and the observation of DBP level significantly changes in T0-T2 group were not significant (P>0.05﹚. Patients in control group and T1-T3 in HR were higher than that of the observation group,there was significant difference(P<0.05﹚. Conclusion Dexmedetomidine for sedation in elderly patients after abdominal operation,the cognitive function of patients recovered quickly,and can maintain the stability of hemodynamics.

Objective To investigate the relationship between the stress induced glucose up-regulation and brainstem infarction. Methods Three hundred and sixty-six patients of cerebral infarction in the department of neurology were included in this study. Stress induced glucose up-regulation was reflected by stress induced glucose up-regulation ratio (SIGUT), and the level of SIGUT was compared between groups of brainstem and non-brainstem infarction. SIGUT was categorized into 4 groups according to the quartiles, and relative variables were compared among 4 groups. The level-risk relationship between high level of SIGUT and brainstem infarction was performed through logistic regression. Results The level of SIGUT was higher in group of brainstem infarction than that in group of non-brainstem infarction: 1.060 ± 0.272 vs.1.159 ± 0.301(P＝0.020). The percent of male, diabetes, brainstem infarction and level of FBG, HbA1c, NIHSS was obviously different in the 4 groups of SIGUT according to the quartiles (P<0.05). High level of SIGUT was correlated to brainstem infarction in the single-factor or multivariable logistic regression adjusted for relative variable (P < 0.05). Conclusions Stress induced glucose up-regulation is correlated to the brainstem infarction, which is prone to happen in brainstem infarction, and the magnitude is more prominent.

OBJECTIVE: To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI). MATERIALS AND METHODS: Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark. RESULTS: The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = −0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = −0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001). CONCLUSION: MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.
Blood Volume ; Echocardiography ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Perfusion Imaging ; Reperfusion ; Stroke Volume ; Troponin T ; Troponin