ObjectiveTo study the anesthesia effect,safety and reliability of etomidate combined with remifentanil in elderly patients. Methods40 patients scheduled for abdominal operation were divided into two groups with 20 cases each: etomidate group(group A)and propofol group(group B).Anesthesia induction: midazolam 0.04mg/kg,remifentanil 1.5 μg/kg(time＞60s),atracurium 0.6mg/kg,group A to etomidate 0.2mg/kg(30 ～ 60s),(T1),1 min before trachea intubation(T2),1 min after trachea intubation(T3),5 min after cutting skin(T4),5 min after exploration(T5),5min after cutting ill focus(T6),3min after tracheal extubation(T7),30min after operation(T8).At the same time,observed analepsia condition. ResultsIn group B,SBP and DBP were lower than those in group A at T2,T3,T4 and T5(all P＜0.05).In group B,DBP was lower than those in group A at T6 and HR was lower than those in group A at T3 and T7(all P＜0.05).In group B,SBP and DBP were lower than before anesthesia at T2,T3,T4 and T5(all P＜0.05).In group B,DBP was lower than before anesthesia at T6 and HR was lower than before anesthesia at T2(all P＜0.05).In group A,HR was faster than before anesthesia at T7(P＜0.05).The time of openingeyes,remove-tracheal tube in B group was less than those in A group(all P＜0.05).Both groups without memory about operation,anesthesia was content. ConclusionEtomidate combined with remifentanil anesthesia was milder than propofol group to elderly patients ardiovascular effects.It was better than propofol group for elderly patients.

Objective To investigate the relationship between choroidal telangiectasia and subfoveal choroidal thickness in the patients with central serous chorioretinopathy.Methods Eighty-four patients (84 eyes) with central serous chorioretinopathy in our hospital from February 2015 to April 2016 were selected,based on the fluorescein angiography the patients were divided into 3 groups:Mild group (leakage at 9-10 minutes after injection,26 cases),moderate group (leakage at 5-8 minutes after injection,37 cases),severe group (leakage at 5 minutes after injection,21 cases).The choroidal capillary dilatation was assessed by OCTA,and subfoveal choroidal thickness in three groups and patients with different foveal choroidal expansion degree were measured by EDI-OCT,and correlation analysis was performed.Results The proportion of severe dilation of choriocapillae in mild group,moderate group,severe group were 7.69％,13.52％ and 23.81％,respectively.The subfoveal choroidal thickness was sequentially increased in mild group,moderate group,severe group (P ＜ 0.05).The subfoveal choroidal thickness in patients with mild,moderate and severe dilatation of choroidal capillaries were (306.59 ± 74.18) μm,(367.21 ± 85.04) μm and (416.27 ± 104.56) μm,respectively (P ＜ 0.05).The degree of choroidal telangiectasia in patients with central serous chorioretinopathy had a positive correlation with the thickness of subfoveal choroid (r =0.812,P =0.037).Conclusion The degree of choroidal telangiectasia and subchondral choroidal thickness in patients with central serous chorioretinopathy are significantly increased with the severity of the disease,and there is a positive correlation between them.

Objective To investigate the effects,safety,controlling of controlled hypotension induced by remifentanil during endoscopic sinus surgery.Methods Forty patients with ASA grade Ⅰ～Ⅱ undergoing selective endoscopic sinus surgery,were randomly assigned into remifentanil group(A group)and nitroglycerin group(B group).After routine inducing,controlled hypotension was induced before the main procedure of surgery.A group was given remifentanil(1μg/kg)by intravenous injection,then remifentanil(0.3～0.8μg·kg~(-1)·min~(-1))was used in group A to keep mean arterial pressure between(MAP)60 and 80 mm Hg.B group was given fentanyl(0.03～0.08 μg·kg~(-1)·min~(-1))and nitroglycerin(2～5 μg·kg~(-1)·min~(-1))to keep mean arterial pressure(MAP)between 60 to 80 mm Hg till the main procedure of surgery was finished.Observing MAP and HR change before controlled hypotension,during controlled hypoteusion and after stopping controlled hypotension.Observing the time of opening-eyes,remove-tracheal tube and surgical field quality.Results The two groups were comparable with regard to the surgical field rating(P＞0.05).MAP in two groups during controlled hypotension were lower than those before controlled hypotension(P＜0.05),in A group,MAP were comparable with those in B group during controlled hypotension(P＞0.05).In B group there was rellexible tachycardia during controlled hypotension.HR in A group during controlled hypotension was lower than those before controlled hypotension(P＜0.05).HR during controlled hypotension in A group was lower than those in B group(P＜0.01).The time of opening-eyes,remove-tracheal tube in A group was less than those in B group(P＜0.01).ConclusionRemifentanil cound induce and sustain controlled hypoteusion.It was safe and feasible.It was better than nitroglycerin group for controlled hypotension in endoscopic sinus surgery.

Objective To study the safety and efficacy of laryngeal mask airway(LMA) used in breast cancer general anesthesia. Methods Forty ASA Ⅰ or Ⅱ patients with breast cancer scheduled for selective radical mastectomy under general anesthesia were allocated randomly to either laryngeal mask airway group(group A,n =20) or tracheal tube group(group B, n = 20). SBP, DBP, HR, SpO2 of patients before anesthesia(To)/after intubation immediately (T1) and 5 minutes(T2) after intubation tracheal tube or laryngeal mask intubation/after extubation immediately (T3) and 5 minutes(T4) of after extubation tracheal tube or laryngeal mask were recorded. The different incidence of anesthetic complications and side effect were observed in both groups because intubation and extubation. Results In group B, SBP, DBP and HR were significantly higher than those in group A at T1 and T3 (P ＜ 0.05). Agitation, bucking and pharyngodynia incidence rate in group B were significantly higher than group A(P ＜ 0.05). Conclusion Ventilation with LMA in patients underwent breast cancer radical correction was better than endotracheal intubation general anesthesia in keeping stable hemodynamics and producing less anesthetic complications.

Objective To investigate the short-term efficacy and safety of gefitinib combined with dendritic cells-cytokine induced killer (DC-CIK) cells in the treatment of advanced lung adenocarcinoma.Methods Fifty patients with lung adenocarcinoma who in previous had underwent radiotherapy and first-line chemotherapy failure received DC-CIK in combination with gefitinib treatment,blood count changes,imaging data,carcinoembryonic antigen and changes in the quality of life before and after treatment were compared and evaluated.Results DC-CIK could improve effectively and relieve bone marrow suppression response after chemotherapy and significantly increase the WBC content of blood (P ＜ 0.01).After treatment,the tumor carcinoembryonic antigen (CEA) was significantly lower in patients (P ＜ 0.01).Fifty cases of patients in complete remission (CR) were 0 cases,partial remission (PR) were 24 cases,stable disease (SD) were 17 cases and progression (PD) were 9 cases,and the response rates (RR) were 48％;The quality of life of patients was significantly improved (P ＜ 0.05).Common adverse reactions were rash,diarrhea,chill and fever,but mild symptoms could be relieved after symptomatic treatment.Conclusions Gefitinib with autologous DC-CIK cell infusion second-line treatment of advanced lung cancer have a certain short-term efficacy,without significant adverse reactions.Gefitinib with autologous DC-CIK cell therapy can mitigate the response of bone marrow suppression in patients with advanced lung cancer and improve the quality of life of patients.Long-term effect remains to be investigated.

Objective To study the efficacy of low dose of combined angiotensin Ⅱ type 1 receptor blockade(ARB)valsartan with angiotensin-converting enzyme inhibitor(ACEI)ramipril on the expression of the gene of angiotensin Ⅱ type 1 receptor(AT1R)and type 2 receptor(AT2R)in cardiovascular vessels and brain in SHR.Methods SHRs 7-8 weeks old were received valsartan 30 mg/(kg?d),or ramipril 1 mg/(kg?d),or valsartan 15 mg/(kg?d)combined with ramipril 0.5 mg/(kg?d)by gavage for three months.SBP,LV/BW ratio,plasma angiotensin Ⅱ,plasma and myocardial NO levels were determined.The severity of myocardial interstitial fibrosis was assessed by image analysis.ACE mRNA,AT1R mRNA and AT2R mRNA expression were detected in the LV myocardium,aorta and brain by the RT-PCR.Results Combined low dose of valsartan and ramipril was shown to reduce more significantly the expression of AT1R mRNA and ACE mRNA in myocardium,aorta and brain than valsartan or ramipril monotherapy(AT1R mRNA:P

Objective To learn the current obstetric beds allocation,obstetric service delivery and access in midwifery institutions at various levels in the localities and nationwide as well as the trends,and assess the equity of obstetric beds allocation,for the purpose of recommending on a reasonable adjustment of obstetric beds allocation in these institutions.Methods Random sampling made in 44 cities in China for questionnaire survey on obstetric beds allocation,service delivery and utilization in 2008～2010 at all midwifery institutions in these cities.Interview of health administrators and medical workers at obstetric of midwifery institutions in 6 counties.Results Every thousand square kilometers in China average 5.9 midwifery institutions,and every thousand people average 0.24 obstetric beds.During 2008 ～ 2010,the number of beds and midwifery service delivery kept a growing trend while in townships obstetric service deliveries maintain a falling trend.The fairness index of maternity beds layout nationwide is 0.021283.Obstetric beds supply and demand ratio in different regions ranges among 0.97～ 1.41.The number of deliveries made in county level hospitals is 54.1％,but the beds in such hospitals account for but 48.1％.Conclusion The equity of obstetric beds allocation is good in terms of population layout.The quantity of obstetric beds meets the current needs nationwide,while the allocation of obstetric beds is less than reasonable among obstetric institutions of various levels in the country.The authors recommend a better control and adjustment of midwifery institutions layout,especially more such hospitals at the township level to meet the need of women delivery in hospital in remote areas.

Objective To observe the cerebral hemodynamics in ischemic stroke patients after compound anisodine acupoint injection.Methods 40 stroke patients were measured with transcranial color Doppler before and 4 h,24 h after compound anisodine acupoint injection.Results After injection,the velocity of the cerebral artery showed some increase,the end diastolic velocity of the ophthalmic artery increased and the pulsitility index decreased(P<0.05).Conclusion The compound anisodine acupoint injection may improve the flow velocity of ophthalmic artery and cerebral artery.

Objective To evaluate the efficacy and safety of adding neoadjuvant chemotherapy following neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.Methods A total of 80 patients confirmed with locally advanced rectal cancer were enrolled during January 2012 and December 2015 in Guizhou Medical University Affiliated Cancer Hospital and were randomized with the method of lottery into the experimental group and the control group.In the experimental group,40 patients received 4 cycles of FOLFOX4 after chemoradiotherapy and then had total mesorectal excision (TME).Another 4 cycles of FOLFOX4 were administered after surgery.In the control group,40 patients had TME surgery 6-8 weeks after chemoradiotherapy and received 8 cycles of FOLFOX4 as adjuvant chemotherapy.Pelvic radiotherapy dose was 50 Gy in 25 fractions,5 days per week for 5 weeks.5-Fu continuous infusion was administered throughout radiotherapy.The pCR rate,downstaging rate,R0 resection rate,local recurrence rate,distant metastasis rate,survival rate,incidence of toxicities,surgical complications and completion of treatment were observed.Results The pCR rate was 20.0％ in the experimental group and 5.0％ in the control group (x2 =4.114,P ＜ 0.05).The downstaging rate was 77.4％ in the experimental group and 55.6％ in the control group(P ＞ 0.05).No statistically significant difference was observed in R0 resection rate,3-year local recurrence rate,3-year distant metastasis rate and 3-year survival rate between the two groups (P ＞ 0.05).Patients in the experimental group had higher completion rate of 8 cycles of systemic chemotherapy (87.1％ vs.61.5％,x2 =4.985,P ＜0.05).No statistically significant difference was observed in acute toxicities and postoperative complications.Conclusions Adding systemic chemotherapy after neoadjuvant chemoradiotherapy for locally advanced rectal cancer has significantly higher pCR rate and lower toxicities and side events compared with chemoradiotherapy alone.Longer follow-up and larger scale of clinical research are needed.Trial registration Chinese clinical trial registry,ChiCTR-IPR-17010454.

Objective To investigate the effect of nutrition intervention on psychological stress combining with sleep deprivation in rats. Methods Seventy-five male SD rats were randomly divided into five groups:control group,composite factor group,composite factor control group,nutrition group Ⅰ and nutrition group Ⅱ. The rat model of 14d psychological stress combining with 48h sleep deprivation was established by Communication Box and improved small platform methods. Rats in the 2 nutrition groups were gavaged with corresponding nutriment everyday; those in other groups were treated with gavage of physiological saline. Morris water maze place navigation test was employed to train rats and measure the ability of rats' spatial working memory. The antioxygenic potential of rats' blood serum and some nutrients were measured with corresponding kits. Results Compared with the composite factor group,the escape latency of all quadrants shortened significantly (P