This review largely deals with the peptide toxins elaborated by marine cone snails of the genus Conus . Each species of Conus contains in its venom 50 to 200 different peptides directed at different macromolecular targts. These include competitive antagonists of postsynaptic nicotinic receptors (a-conotoxins), blockers selective for Na+ channels in skeletal muscle (u- conotoxins), blockers of presynaptic of antagonists of postsynaptic Ca2+ channels (w-conotoxins), activators of Na+ channels (s-conotoxins), blockers of K+ channels (k-conotoxins), blockers of nicotinic receptor channels (u-conotoxins) and antagonists of NMDA receptors (cono-sleeper).The small size of the peptides (13 to 30 residues is typical) has facilitated synthesis of many of them. A very attractive feature is the highly cross-linked conserved 2 to 3 disulfide bonds which make conotoxins conformationally rigid, some of conotoxins, however, are stabilized by r-carboxyglutamates. The Structure-Activity Relationships of conotoxins and a brief perspective have been reviewed in the paper.

Ultrasound-guided peripheral nerve block is widely used in clinical practice because of its high accuracy and safety. Residents must pass formal training to master this technique. However, residents are not familiar with the related anatomical structure of nerve block, and lack of basic ultrasonic knowledge, operation skills, simulation training, understanding of the corresponding complications, the optimal concentration and dose of local anesthetic drugs. In order to solve the above problems, we have taken measures such as basic theoretical knowledge learning, application of anatomy and ultrasound software, simulation training and grading training so that residents in standardized training of anesthesiology could fully grasp the clinical application of ultrasound-guided peripheral nerve block techniques.

Objective To investigate the blood-saving effect of controlled low central venous pressure (CLCVP) in different types of hepatectomy.Methods Ninety ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 37-76 yr,weighing 40-75 kg,undergoing elective hepatectomy,were divided into 6 groups according to the surgical approach and whether CLCVP was used during surgery (n =15 each):CLCVP1-3 groups and nonCLCVP1-3 groups (NCLCVP1-3 groups).The standard hepatectomy,half liver resection and irregular hepatectomy were performed in CLCVP1-3 groups,respectively,with CLCVP.The standard hepatectomy,half liver resection and irregular hepatectomy were performed in NCLCVP1-3 groups,respectively,without CLCVP.In CLCVP1-3 groups,from skin incision to the end of liver resection,CVP was maintained ≤ 5 cm H2 O through adjustment of the position,fluid restriction and iv infusion of nitroglycerin,and norepinephrine was infused simultaneously to maintain mean arterial pressure ≥ 60 mm Hg.In NCLCVP1-3 groups CVP was maintained at 6-12 cm H2O.Intraoperative blood loss and blood transfusion were recorded.Results Compared with NCLCVP1-3 groups,intraoperative blood loss was significantly decreased in CLCVP1-3 groups (P ＜ 0.05).Compared with NCLCVP3 group,the amount of blood transfusion was significantly decreased,the constituent ratio of intraoperative blood loss ＜ 200 ml was increased,and the constituent ratio of intraoperative blood loss ＞ 1000 ml was decreased in group CLCVP3 (P ＜ 0.05).Conclusion CLCVP can decrease the intraoperative blood loss and blood transfusion in patients undergoing irregular hepatectomy.

Objective To explore the more effective measures for the prevention of deep vein thrombosis (DVT ) by comparing the different efficacy between the multimodal strategy and liberal measures .Methods From July 2011 to June 2013 ,medical records of 289 patients who had accepted total knee replacement (TKR) were collected .Patients were divided into two groups according to whether exploring to the multimodal strategy or liberal measures after TKR .The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,intermittent pneumatic compression ,and postoperative continues femoral nerve block analgesia .Patients in group A were treated during July 2011 to June 2012 ,and accepted liberal measures for the prevention of DVT .Patients in group B were treated after June 2012 ,and accepted multimodal strategy .The data of each group were collected for statistical analysis on the following aspects :DVT occurrence rate ,DVT distribution ,age ,gender ,body mass index ,disease ,operation duration ,volume of blood loss and transfusion during operation phase ,drainage volume after TKR .Results The DVT occurrence rate of patients in group B were significantly lower than that of patients in group A (P<0 .05) .No significant difference were foun-ded in the DVT distribution between the two groups(P>0 .05) .Conclusion The multimodal strategy consisted of sequentially used perioperative intermittent pneumatic compression ,postoperative low molecular weight heparin ,and postoperative continues femoral nerve block analgesia is more effective than liberal measures for the prevention of DVT .

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion.

Matrix_assisted laser desorption ionization_time of flight tandem mass spectrometry ( MALDI_TOF/TOF MS) and electrospray ionization_quadrupole_time of flight mass spectrometry ( ESI_Q_TOF MS) were used to confirm the structure of cyclic lipopeptide daptomycin fastly. First, the relative molecular weight 1916. 7107 of daptomycin was measured by ESI with error 0. 0007. The sample’s doubly charged peak m/z 809. 848 was selected as precursor ion for ESI_MS/MS analysis, and the exocyclic amino acid sequence C9 H19 CO_Trp_Asn_Asp was successfully matched. Second, the experimental conditions of cleaving daptomycin by lithium hydroxide ( LiOH) were optimized and the ring_opened process was monitored by MALDI_TOF/TOF MS. After obtaining ring_opened product with purity of above 95%, the MS/MS measurements by MALDI and ESI were carried out. The b+and y+of ring_opened product were completely matched, which confirmed the amino acid sequence of daptomycin. Finally, ESI_MS/MS conditions of ring_opened product were further optimized to obtain more low mass fragment ions for analyzing the structure of fatty acid chain and the cleavage pattern of fat chain in mass spectrometry was proposed. The method was fast, convenient, accurate and reliable for identifying cyclic lipopeptide compounds.

Objective To investigate the effect of controlled low central venous pressure(CLCVP) on blood loss and prognosis in different types of hepatectomy .Methods Two hundred and fifty seven patients underwent standard hepatectomy ,half liver resec‐tion or irregular partial hepatectomy from January 2011 to December 2012 in the First Affiliated Hospital of Chongqing Medical U‐niversity were retrospectively studied .Patients treated with CLCVP during hepatectomy were attributed to the CLCVP group .CVP of these patients were lowed to below 5 cm H2 O by minimizing fluid infusion and one or both of the following maneuvers :posture adjustment ,nitroglycerin administration .Alpha agonists were used when necessary to maintain the mean arterial pressure MAP at ≥60 mm Hg .Other patients been maintained with normal level of CVP by adjusting fluid administration were included in normal CVP group (NCVP) .Blood loss and transfusion volume ,length of hospital stay of the two groups were compared ,and the effects of different surgery type on CLCVP blood protection were evaluated .Results In the patients underwent standard hepatectomy or half liver resection ,intraoperative blood loss and transfusion were not statistically different between the two groups .While in the pa‐tients underwent irregular partial hepatectomy ,the CLCVP group suffered less blood loss and transfusion(P<0 .05) .Percentage of the patients with less than 200 mL blood loss and no transfusion of concentrated red cell in CLCVP group was higher than that of in NCVP group(P<0 .05) .Differences between the two groups in postoperative hospital stay were with no significance in all the operation types(P>0 .05) .Conclusion The efficiency of CLCVP on blood protection during hepatectomy is influenced by the sur‐gery type ,the blood protection is found to be significant only in irregular partial hepatectomy .No relationship was found between CLCVP and postoperative hospital stay in all types of hepatectomy .

Objective To set up a method of stools protein extraction,analysis and identification in order to get the new nonin-vasive indicators of human digestive diseases.Methods The stools proteins,collected from healthy persons,the patients with atrophic gastritis,those who suffed from gastric carcinoma and postoperative patients with gastric carcinoma respectively, were extracted in three different ways including saline,Tris-HCl buffer and Urea buffer,the best way was selected by using SDS-PAGE,then a preliminary analysis of stools proteins was performed by 1D LC-MS/MS.Results The methods of saline and Tris-HCl buffer could get more stools proteins than the method of urea.The proteins in stools from the healthy persons, the patients with atrophic gastritis,the patients with gastric carcinoma and postoperative patients with gastric carcinoma were all abundant and more than one hundred.There was a significant difference in stools protein maps among the various populations.Alpha1-antitrypsin,a number of immunoglobulin and keratin were identified in the stools from patients with gastric carcinoma but not postoperative patients with gastric carcinoma and the healthy persons.Conclusions In this re-search,there was a significant difference in stools protein maps among the healthy persons,the patients with atrophic gastri-tis,the patients with gastric carcinoma and postoperative patients with gastric carcinoma,not only the composition of stools proteins,but also the abundance of same proteins.Therefore,using proteomics technologies to screening of the noninvasive indicators in human stools is viable.The study recommended that the noninvasive indicators in human stools should be iden-tified with quantitative differences analysis combination of quality of mass spectrometer method in the future research.

Objective To explore the technique of massive facial scar revision. Methods All 12 patients in the group were treated with expanded deltopectoral skin flap. In the primary surgery, expander was implanted underneath deltopectoral flap region through an incision inferior to the clavi-cle. The skin perforators of transverse cervical artery and thoracoacromial artery were ligated during surgery, and the internal thoracic artery was carefully preserved. After the deltopectoral skin flap was fully expanded, the second surgery was performed and the facial scar was released and the normal ana-tomic position of eyes, nose and month was restored. The deltopectoral skin flap was planed according to the size of the defect. The excised facial scar was converted to the flap pedicle and a hinge-like con-nection was formed. The flap was delayed and three weeks after the second surgery, the pedicle was divided. The flap from the pedicle was applied for the mental region scar revision. Results Unilateral or bilateral dehopectoral skin flaps were employed for the repair of extensive facial scar in 12 patients. Satisfactory results were achieved in all these patients. Conclusion Expanded deltopectoral skin flap is a good technique for the repair of extensive facial scar.

Objective To evaluate the effect of serratus plane block (SPB) combined with general anesthesia and SPB with patient-controlled nerve analgesia (PCNA) after surgery on the early postoperative quality of recovery in the patients undergoing radical mastectomy.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ female patients,aged 18-64 yr,weighing 45-70 kg,scheduled for elective unilateral modified radical mastectomy under general anesthesia,were assigned into 3 groups (n=20 each) using a computer software:SPB and general anesthesia plus patient-controlled intravenous analgesia (PCIA) group (SG+PCIA group),SPB and general anesthesia plus SPB with PCNA group (SG+PCNA group),and general anesthesia plus PCIA group (G+PCIA group).Ultrasound-guided ipsilateral SPB was performed before anesthesia induction.Analgesia was maintained with propofol-remifentanilsevoflurane,rocuronium or vecuronium was intermittently injected to maintain muscle relaxation.PCIA solution contained tramadol 800 mg and flurbiprofen axetil 100 mg in 54 ml of normal saline,and the PCA pump was set up to deliver a 2 ml bolus dose,with a 15 min lockout interval and background infusion at a rate of 0.5 ml/h after a loading dose of 5 ml.The location of the indwelling catheter was confirmed again using ultrasound at the end of surgery,PCNA solution contained 1％ ropivacaine 500 mg in 250 ml of normal saline,and the PCA pump was set up to deliver a 5 ml bolus dose,with a 45 min lockout interval and background infusion at a rate of 5 ml/h after a loading dose of 5 ml.The PCA pumps were used until 48 h after surgery.The automatic key was pressed when pain scores (numerical rating scale [NRS] scores) ≥ 4 at rest or during activity (at 45° ipsilateral upper extremity-up tilt).Quality of Recovery-40 (QoR-40) score was used to assess the early postoperative quality of recovery at 24 and 48 h after surgery.NRS scores at rest or during activity were recorded at 6,8,12,24 and 48 h after surgery.The total pressing times of PCA and occurrence of adverse reactions such as respiratory depression,pruritus,infection at the puncture site or pneumothorax were also recorded.Results Compared with group G+PCIA,the postoperative QoR40 scores were significantly increased,NRS scores at rest or during activity were decreased at each time point after surgery,and the total pressing times of PCA were reduced in SG+PCIA and SG+PCNA groups,the incidence of nausea and vomiting was significantly decreased in group SG+PCIA,and the incidence of nausea and vomiting and dizziness was significantly decreased in group SG+PCNA (P＜0.05 or 0.01).Compared with group SG+PCIA,the postoperative QoR-40 scores were significantly increased at 24 h after surgery,and NRS scores at rest or during activity were decreased after surgery in group SG+PCNA (P＜ 0.05 or 0.01).Conclusion SPB combined with general anesthesia and SPB with PCNA after surgery can raise the early postoperative quality of recovery in the patients undergoing modified radical mastectomy.