Objective To compare the efficacy of tramadol for patient-controlled intravenous versus provicial epidural analgesia (PCIA vs PCEA) and their effects on the T-lymphocyte subsets and natural killer (NK) cells during postoperative period in patients undergoing gynecological operation for tumor. Methods Thirty-nine ASA Ⅰ-Ⅱ patients aged 18-83 yr undergoing elective surgery for ovarian cancer or uterine cancer or myoma were randomly divided into two groups : PCIA group (n = 21) and PCEA group ( n = 18). Premedication consisted of intramuscular atropine 0.5 mg and phenobarbital 0.1 g. Operation was performed under epidural anesthesia. Epidural catheter was inserted at T12 -L1 approximately 3-4 cm into epidural space cephalad. The patients received a test dose of 2% lidocaine 5 ml. The first dose was 2% lidocaine 10-12 ml followed by 0.5% bupivacaine 5 ml every 45-60 min. Tramadol 100 mg was given iv in PCIA group or epidurally in PCEA group 15 min before the end of surgery. 100 ml of PCIA solution contained tramadol 800 mg (16 ml), haloperidol 5 mg (1 ml) and normal saline 83 ml and 100 ml of PCEA solution contained tramadol 400 mg (8 ml), haloperidol 5 mg (1 ml) and NS 91 ml. The PCA pump was set to deliver a background infusion at 2 ml?h-1 and a bolus dose 0.5 ml with lock-out interval of 15 min. Analgesia was assessed using VAS. Venous blood samples were taken for determination of T-lymphocyte subset (CD3+ , CD4+ , CD8+) and NK cell counts by flow cytometry the day before surgery and on 1st and 2nd postoperative day. Results The postoperative analgesia was satisfactory in both groups, and there was no significant difference in VAS scores between the two groups. No vomiting and respiratory depression were observed in both groups. The NK cell counts decreased significantly on the 1 st and 2nd postoperative day as compared with the preoperative value (P

Objective To investigate the expressions of Toll-like receptor 4 (TLR4) and high mobility group box 1 (HMGB1) expression on distant tissue during the intestinal ischemia/reperfusion and the effects of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) intervention in rats.Methods Forty-eight Sprague-Dawley male rats,weighing (281.50 ± 22.68) g,were randomly divided into three groups (n =16) after gastrostomy:normal diet (N) group,enteral nutrition (EN) group and EN plus ω-3 PUFAs (PUFA) group.Each group was further divided into lymph drainage (I/R + D) and non-drainage (I/R) sub-groups (n =8 each) according to whether treated with intestinal lymph drainage.All the rats were subjected to 60 min ischemia by clamping the superior mesenteric artery,followed by 120 min reperfusion,while the rats in the I/R + D subgroups were treated with intestinal lymph drainage for 180 min at the same time.Results The interleukin-6 level in lymph in N (I/R + D) group was significantly higher than in the EN (I/R + D) and PUFA (I/R + D) groups (PUFA vs EN vs N:(154.57 ±69.30) ng/L vs (97.58 ±40.34) ng/L vs (85.35 ±23.93) ng/L,P =0.021).Besides,the serum level of HMGB1 in PUFA (I/R + D) group was significantly lower compared to the other 5 groups [PUFA (I/R) vs EN (I/R) vs N (I/R) vs PUFA (I/R + D) vs EN (I/R + D) vs N (I/R + D):(2.95 ± 1.17) μg/L vs (3.86 ±0.99) μg/L vs (4.45 ± 1.73) μg/L vs (1.71 ±1.41) μg/Lvs (2.11±0.56) μg/Lvs (3.13 ±0.79) μg/L,P=0.000],and it also decreased in the PUFA (I/R) and EN (I/R) groups than the N (I/R) group (respectively,P ＜ 0.05).Furthermore,the serum endotoxin level in PUFA (I/R) group was significantly lower compared to the N (I/R) and EN (I/ R) groups[PUFA(I/R) vsPUFA (I/R+D) vsEN (I/R) vs N (I/R):(0.020±0.004) EU/mlvs (0.028 ±0.006) EU/ml vs (0.028 ±0.005) EU/ml vs (0.018 ±0.006) EU/ml,P=0.014].Together the serum tumor necrosis factor-α level in both PUFA (I/R) and PUFA (I/R + D) groups were significantly lower than theEN (I/R),N (I/R) and N (I/R+D) groups [PUFA (I/R+D) vs PUFA (I/R) vs EN (I/R) vsN (I/R) vs N (I/R+D):(12.03 ±6.57) ng/L vs (14.32 ±6.11) ng/Lvs (23.27 ±15.60)ng/L vs (27.42 ± 10.37) ng/L vs (26.87 ± 5.30) ng/L,P =0.013].The jejunum and ileum mucosa in all the I/R groups showed swelling and atrophy and appeared fragile,while the PUFA groups showed less yellow staining and injury than the other two groups (P ＜ 0.05,respectively).In addition,the expressions of TLR4 mRNA in jejunum,ileum,and liver in all the drainage groups were respectively lower than the corresponding non-drainage groups [jejunum:PUFA (I/R) vs EN (I/R) vs N (I/R) vs PUFA (I/R+D) vs EN (I/R+D) vsN (I/R+D):2.32±0.62vs3.08±1.29vs3.50±2.44vs 1.62±0.79vs 1.67±1.11 vs 1.94±0.81,P=0.025; ileum:PUFA (1/R) vsEN (1/R) vsN (1/R) vs PUFA (1/R+D) vsEN (1/R+D) vs N (1/R+D):2.67±1.08 vs 5.22 ± 3.96 vs 6.95 ±4.92 vs 1.70±0.68 vs 1.80±0.29 vs3.68±1.47,P=0.012; liver:PUFA (1/R)vsEN (1/R)vsN (1/R)vs PUFA (1/R+D)vsEN (1/R+D)vsN (1/R+D):5.67 ±1.94 vs 7.50 ±3.89 vs 7.18 ±4.55 vs 1.70 ±0.86 vs 3.90 ± 1.95 vs 4.12 ±2.11,P =0.001],which was consistent with the reduction of HMGB1 and the decrease of nuclear factor-κB activity in intestine,liver,and lung (P =0.000).Conclusions Lymph drainage and ω-3 PUFAs intervention can reduce the production of HMGB1 and inflammation factors,inhibit the expression of HMGB1 and TLR4 mRNA,and thus alleviate distant tissue injury caused by intestinal L/R.

Objective To observe the changes of PPARγ expression in ventilator-induced lung injury rats and explore the role of PPARγ in the pathogenesis of ventilator-induced lung injury. Methods Sixty male Sprague-Dawley rats were randomly divided into 3 groups ( n=21 each ):group N received large tidal volume with mechanical ventilation ( Vt=12 mL/kg);group C received lower tidal volume with mechanical ventilation ( Vt=6 mL/kg);group R received room air without mechanical ventilation. Rats in every group were randomly divided into 3 subgroups respectively by 1,4 and 8 h. The samples of lung were collected at 1,4 and 8 h after ventilation. Lung pathological examina-tion, total protein and white blood cells in bronchoalveolar fluid and wet-to-dry weight were detected. The exoressions of PPARγmRNA were detected by RTPCR;PPARγ protein in lung tissues was detected by western bolt. Result After 4 and 8 h ventilation in group N,total pro-tein and WBC in bronchoalvelor fluid,W/D were markedly higher than those of group C and R (P <0. 01). While PPARγ mRNA and PPARγ protein were decreased than those of group C and R (P<0. 01). There were no difference after 1 h ventilation in three group (P>0. 05). Conclusion PPARγmRNA and protein expressions in the rats lung tissue of ventilator-induced lung injury were decreased and as-sociated with inflammation and damage of lung tissue.

Objective To investigate the effects of ropivacaine infiltration combined with dezo-cine intravenous on stress response during recovery from general anesthesia in patients undergoing e-sophageal cancer surgery.Methods One hundred and forty-four patients of esophageal cancer under-going elective surgery were randomly divided into dezocine group (group D,n = 48 ),ropivacaine group (group R,n =47)and ropivacaine combined with dezocine group (group RD,n =49 ).Before slicing 10 min,patients in group D were taken 20 ml saline infiltration anesthesia (1∶200 000 epi-nephrine),while in group R and group RD were taken 20 ml 0.5% ropivacaine infiltration anesthesia. Patients in the group R were injected intravenously 2 ml saline,while in group D and group RD were injected intravenously 10 mg dezocine 30 min before the end of surgery.Peri-operative bleeding,oper-ation time,recovery time of anesthesia,extubation time and the dosage of propofol and sufentanil of three groups were recorded respectively.At the time points of before induction of anesthesia (T0 ), the end of the surgery (T1 ),removal trachea immediate (T2 ),10 min (T3 )and 30 min (T4 ),the blood pressures and heart rates were recorded,and the serum levels of malondialdehyde (MDA),epi-nephrine (E)and norepinephrine (NE)were detected.Results Recovery time of anesthesia and extu-bation time in group R and group RD were shorter than that in group D significantly (P <0.05).The dosage of propofol and sufentanil in group R and group RD were less than that in group D significantly (P <0.05).Compared with T0 ,SBP in three groups were elevated significantly at T1-T4 (P <0.05), DBP and HR in group D and group R increased significantly at T3 (P <0.05).DBP and HR in group RD at T3 were lower than that in group D and group R significantly (P <0.05).Compared with T0 , the levels of blood sugar,Cor,MDA,E and NE in three groups were elevated significantly at T1-T4 (P <0.05).The levels of blood sugar,Cor,MDA,E and NE in group RD at T1-T4 were lower than that in group D and group R significantly(P < 0.05 ).The incidences of agitation and elevation of blood pressure in group RD were lower than that in group D and group R significantly (P <0.05 ). Conclusion Ropivacaine infiltration combined with dezocine intravenous applied in the esophageal cancer surgery could effectively reduce the stress response during recovery from anesthesia,and de-crease the incidence of agitation.

Objective:To systematically evaluate the efficacy and safety between neoadjuvant chemoradiotherapy followed by surgery and immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer.Methods:Literature review was performed from PubMed, Embase, Cochrane Library, Web of Science, CBM, Wanfang, CNKI and VIP from the inception date to February, 2020 using the key words including "pancreatic neoplasm, pancreatic cancer, surgery, preoperative chemoradiotherapy, neoadjuvant chemoradiotherapy" in both English and Chinese. The randomized controlled clinical trials (RCTs) of neoadjuvant chemoradiotherapy followed by surgery versus immediate surgery in the treatment of resectable and borderline resectable pancreatic cancer were searches. Literature screening, data extraction and estimation of the risk of bias were independently conducted by two researchers. The HR and 95% CI were used for estimating the overall survival time. The R 0 resection rate, overall incidence of postoperative complications, and mortality rate throughout treatment were assessed by the RR and 95% CI. The heterogeneity of the studies was analyzed using the I2 test. Results:A total of 4 RCTs were included. Among 400 patients, 197 cases were assigned into the neoadjuvant chemoradiotherapy combined with surgery group and 203 in the immediate surgery group. The results of Meta-analysis showed that patients in the neoadjuvant chemoradiotherapy followed by surgery group obtained longer overall survival ( HR=0.76, 95% CI: 0.60-0.97, P=0.03) and higher R 0 resection rate ( RR=1.72, 95% CI: 1.40-2.13, P<0.01). Besides, the overall incidence of postoperative complications ( RR=1.02, 95% CI: 0.73-1.43, P=0.90) and mortality rate throughout treatment ( RR=1.19, 95% CI: 0.48-2.93, P=0.71) did not significantly differ between two groups. Conclusions:During the treatment of resectable or borderline resectable pancreatic cancer, neoadjuvant chemoradiotherapy followed by surgery may bring more survival benefits than immediate surgery and does not increase the incidence of postoperative complications and mortality rate throughout treatment. Therefore, neoadjuvant chemoradiotherapy followed by surgery can be used as a recommended treatment for patients with resectable or borderline resectable pancreatic cancer.

Objective To study the expression of amplified in breast cancer 1 (AIB1) protein in the tissues of ovarian carcinoma and its relationship with clinicopathological factors,and to analyze the predictive value of AIB1 in clinical prognosis of patients with ovarian carcinoma.Methods Immunohistochemistry was used to detect the expression of AIB1 protein in the tissues of 112 patients with ovarian carcinoma,and compare the AIB1 protein expression levels of patients with various clinicopathological features.The survival analysis was conducted by Kaplan-Meier method.The multivariate analysis was performed to explore the relationship between the expression of AIB1 protein and clinical prognosis of the patients with ovarian carcinoma.Results The positive expression rate of AIB1 protein in the tissues of ovarian carcinoma was 67.9％ (76/112).The positive expression rate of AIB1 protein was associated with the degree of the tumor differentiation (x2 =32.483,P ＜0.001) and the International Federation of Gynecology and Obstetrics (FIGO) staging (x2 =14.324,P ＜0.001),but not with the age (x2 =0.001,P =0.989) or pathological type (x2 =0.106,P =0.745).Compared with the patients with the higher expression of AIB1,the median disease-free survival of patients with the lower expression of AIB1 was longer (48.7 months vs.36.7 months,x2 =3.026,P =0.022),and there was also extended trend in the median overall survival (60.2 months vs.43.6 months,x2 =0.916,P =0.055).The multivariate survival analysis showed that FIGO staging (RR =3.396,P =0.021) and AIB1 expression status (RR =1.407,P =0.049) were independent prognostic factors affecting the survival of patients.Conclusion The overexpression of AIB1 protein is correlated with the degree of differentiation and FIGO staging.Patients with a high expression of AIB1 have poor predicted prognosis.The expression of AIB1 protein can be considered as one of the prognostic indicators in the patients with ovarian carcinoma.

Objective:To systematic review the clinical efficacy and safety of neoadjuvant chemotherapy and neoadjuvant concurrent chemoradiotherapy for resectable esophageal squamous cell carcinoma.Methods:Literature search was performed from Web of Science, Pubmed, Cochrane Library, Embase, CBM, Wanfang Data, CNKI and Chongqing VIP. The clinical controlled studies of neoadjuvant chemotherapy versus neoadjuvant concurrent chemoradiation in the treatment of resectable esophageal squamous cell carcinoma was searched. Relevant outcome indicators were analyzed by Revman 5.3 statistical software.Results:Nine studies were included, with a total of 1, 369 patients. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy had lower overall survival rates at 3 and 5 years( OR=0.68, 95% CI: 0.53-0.86, P<0.05; OR=0.51, 95% CI: 0.34-0.77, P<0.05) , lower pathological complete remission rate( OR=0.28, 95% CI: 0.18-0.45, P<0.05)and R0 resection rate( OR=0.39, 95% CI: 0.22-0.68, P<0.05), The total postoperative complication rate is similar( OR=1.07, 95% CI: 0.75-1.51, P>0.05). Conclusion:Neoadjuvant concurrent radiochemotherapy maybe superior to neoadjuvant chemotherapy among patients with resectable esophageal squamous cell carcinoma.