BACKGROUND:Epidural anesthesia and combined spinal-epidural anesthesia are commonly used approaches for surgical anesthesia in elderly patients, and each has their advantages and disadvantages. Suitable anesthesia approach can stabilize the cycle, reduce the surgical risk and complications, and improve the success rate of treatment. OBJECTIVE:To analyze and compare the anesthesia effect of epidural anesthesia and combined spinal-epidural anesthesia in the elderly patients during hip arthroplasty, and explore the effect of different approaches on the on hemodynamics. METHODS:80 elderly patients undergoing hip arthroplasty were randomly divided into experimental group and control group, with 40 cases in each group. The experimental group received combined spinal-epidural anesthesia. The control group received epidural anesthesia. The mean arterial pressure, central venous pressure, and heart rate variability at each time point, sensory and motor block onset and recovery times, each block plane after 30 minutes of anesthesia, Bromage score of motor block, and anesthetic effects in both groups of patients were compared. RESULTS AND CONCLUSION:The mean arterial pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly lower than the experimental group at the same time point and before anesthesia (P<0.05). The heart rate at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). The central venous pressure at 5 minutes, 30 minutes of anesthesia and after surgery in the control group was significantly higher than that before anesthesia and the experimental group at the same time point (P<0.05). Sensory and motor block onset time in the experimental group was significantly shorter, while the sensory and motor block recovery time was significantly higher than the control group (P<0.01). After patients in the two groups were anesthetized for 30 minutes, each block plane and Bromage score of motor block showed no significant difference (P>0.05). Anesthetic effect in the experimental group was significantly better than the control group(χ2=5.691 7, P=0.017 0<0.05). Compared with epidural anesthesia, the combined spinal-epidural anesthesia can reduce hemodynamic changes in patients with hip replacement surgery, and has better anesthesia effect.

Objective:A study was conducted to determine the expression of acetyl-coa carboxylase product of phosphorylation (P-ACC) and an enzyme called cyclooxygenase 2 (COX-2) in non-small cell lung cancer (NSCLC) tissue, as well as the relationship and correlations between tumor size, lymph node metastasis, clinical stage, and pathological type. Methods: Sixty-two patients with NSCLC lung cancer tissues were included in the patient group, whereas 20 patients who underwent lobectomy for other reasons and had normal lung tissues were included in the control group. Immunohistochemical streptavidin peroxidase method was used to detect the expression of P-ACC and COX-2 in lung cancer and normal lung tissues. Results:The positive expressions of P-ACC and COX-2 in NSCLC lung cancer and normal lung tissues were significantly different (P<0.05). In NSCLC tissues, the positive expression of P-ACC was significantly associated with tumor size (P<0.05), but was not significantly associated with lymph node metastasis, clinical stage, and pathological type. We found no correlation between the positive expression of COX-2 and tumor size, lymph node metasta-sis, clinical stage and pathological type. Further analysis revealed that the positive expression of P-ACC and COX-2 in NSCLC was sig-nificantly and negatively correlated (r=-2.37, P=0.032). Conclusion:The positive expression of COX-2 in NSCLC greatly increased compared with that of P-ACC, and a significantly negative correlation was observed between them. We propose that the positive expres-sion of P-ACC reduction may activate the positive expression of COX-2 and promote the occurrence, development, invasion, and metas-tasis of NSCLC.

OBJECTIVE: To raise clinical awareness of carcinoembryonic antigen(CEA) increased as initial manifestation of medullary thyroid cancer(MTC) and explore the diagnosis and treatment. METHOD: Clinical data of 2 cases CEA increased as the initial presentation of MTC were retrospectively analyzed and clinical manifestations of the disease, diagnosis, treatment were also discussed by literature reviewing. RESULT: Two patients received thyroid ipsilateral lobe total resection, MTC was confirmed by intraoperative frozen pathology, re-total resection of the contralateral lobe and bilateral VI lymph node dissection were performed. Lymph nodes had no metastasis confirmed by pathological frozen examination. CEA returned to normal within 2 months after surgery. No tumor recurrence and metastasis were found after follow-up for 3 to 24 months. CONCLUSION CEA increased as the initial presentation MTC was rare and clinical identification of CEA increased disease should be taken into account the MTC as possible. Total thyroidectomy and bilateral VI lymph node dissection was the main surgical treatment for it.
Adult ; Carcinoembryonic Antigen ; metabolism ; Carcinoma, Neuroendocrine ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Thyroid Neoplasms ; metabolism ; pathology