Objective To evaluate the key points of anesthetic management for retroperitoneoscopic nephrectomy combined with inferior vena cava ( IVC ) tumor thrombectomy. Methods Perioperative clinical data of 3 patients undergoing retroperitoneoscopic nephrectomy combined with IVC tumor thrombectomy from December 2010 to June 2014 were retrospectively analyzed.There were 2 cases of level Ⅰthrombus and 1 case of level Ⅱthrombus.All the patients were given general anesthesia with intubation.Brief inferior vena cava occlusion was performed in the patient with level Ⅱ thrombus. Results The operation was completed smoothly in all the cases without conversions to open surgery. The operating time was 244, 333, and 289 min, respectively. The total IVC control time for level Ⅱ thrombus was 10 min.No intraoperative pulmonary embolism and other severe anesthetic complications occurred. One patient with level ⅠIVC thrombus was extubated and sent back to surgical ward after surgery, and the remaining 2 patients underwent intensive care monitoring overnight and were extubated and discharged to surgical ward on the next day. Conclusions Retroperitoneoscopic nephrectomy and IVC thrombectomy is a brand-new, difficult but feasible procedure. Anesthesiologist should have a full recognition of surgical procedures and make perfect anesthetic plan to ensure close collaboration. Furthermore, circulatory swing during IVC clamping and perioperative severe complications such as pulmonary embolization and massive hemorrhage cannot be neglected.

[Summary] Regional cerebral oxygen saturation ( rSO2 ) can be used to monitor the changes of cerebral oxygen demand and supply, and postoperative cognitive dysfunction ( POCD ) is a relatively common adverse effect following cardiac surgery. The intraoperative rSO2 decrease may associate with the incidence of POCD. Real-time intraoperative monitoring of rSO2 and necessary interventions performed to correct cerebral rSO2 desaturation may reduce the incidence of POCD of cardiac surgery.

BACKGROUND:Vascular endothelial growth factor(VEGF)can promote vascular endothelial regeneration,inhibit thrombosis,and attenuate neonatal intimal thickness and luminal stenosis degree.OBJECTIVE:The present study established atherosclerosis models in rabbits and observed the effects of local transfection of VEGF gene on restenosis after angioplasty.DESIGN,TIME AND SETTING:A randomized controlled animal experiment was performed at the Laboratory of Microorganism,Tongji Medical College,Huazhong University of Science and Technology between November 2004 and December 2006.MATERIALS:Rabbits were daily raised with high-fat diet to create atherosclerosis models.Twenty successful rabbit models were randomly and evenly divided into a control group and a gene treatment group.METHODS:The DcNDA 3.0 recombinant human VEGF165(hVEGF 165)was trimsferred to the ventral aorta through the use of Foley's catheters.and the pcDNA3.0 was transfefred in the controls.MAIN OUTCOME MEASURES:At 1,2,and 4 weeks after surgery,luminal area of left renal artery opening was measured by MRI.At 2 and 4 weeks after surgery,the ratio for intimal to medial area was obtained through the use of HMIAS-2000 high definition color medical image analysis software.Simultaneously,vascular endothelial cell regeneration was observed by immunohistochemistry of factor Ⅷ related antigen.RESULTS:The pcDNA3.0/hVEGF 165 could be successfully transferred through the use of Foley's catheters.At 2 and 4 weeks after surgery,luminal area was larger in the gene treatment group than in the control group(P<0.01);simultaneously, the ratio of intimal to medial area was significantly smaller in the gene treatment group than in the control group(P<0.05).In the gene treatment group,expanded vascular endothelial cell regeneration was accomplished at 2 weeks after surgery,while in the control group,it took 4 weeks.CONCLUSION:pcDNA3.0/hVEGF 165 gene transduction can promote local vascular endotllelialization and apparently attenuate restenosis degree and intiaml thickening.

Ultrastructural changes in the spiral organ of cochlea at various intervals after exposure to impulse noise were investigated. Guinea pigs were exposed to 10 impulses noise of 166 dB SPL peak level which had duration of 0.1 ms. Thirteen of the exposed animals were used to systematically measure threshold shift at regular intervals from 30 min to 30d post-exposure. The other fourteen animals who had been exposed to the same impulse noise were killed for transmission electron microscopy (TEM) examination at the same intervals, respectively. The recovery pattern of threshold shift showed a nonmonotonic type. There was a progressive deterioration of changes in the hair cells between 30 min and 8h after exposure. Intracellular degeneration reached a peak at 8h and marked edema and swelling leading to deformation of the outer hair cells (OHCs), fused stereocilia, large vesicles in cytoplasm and swollen submembraneous cisterns were found. After that time the extent of degeneration in the hair cells reduced. The time sequence of changes in the spiral organ of cochlea in the present study was associated with the recovery pattern of threshold shift.

Guinea pigs were exposed to either 110dB SPL white noise for 30min (ITS group )or 120 dB SPL for 150 nun (PTS group). At varying postexposure intervals, threshold shifts were assessed using auditory cortex evoked response to tone bursts and intracellular ultrastructural changes in the spiral organ of cochleae were exmained with a transmission electron microscope.. The threshold shifts induced by 110dB noise were reversible while those induced by 120dB noise were generally irreversible. In the TTS cochleae, damage was confined to the third row of OHCs where depolymerization of actin filaments within the stereocilia, slight celluar swelling and small vacuolization were found. The subnuclear area and nerve-endings were not involved. In the PTS cochleae, the inner hair cells (IHCs) and the first row of OHCs were affected. The abnormilities consisted of ruptures and holes in the cuticular plates, fusion of stereocilia, marked edema, tranclucence of subcuticular region, swelling of submembraneous cisterns and large vesiculation in the efferent nerve-endings blow OHCs. Based on the ultrastructural observations, structural bases in cochleae for TTS and PTS, sequence of pathological changes in hair cells as well as reversibility of specific pathologies were suggested.

Objective: To observe the effect of home visit on joint function and complications of patients undergoing hip replacement. Methods: Ninety cases of patients with artificial hip replacement who were admitted to our hospital from January to December 2017 were randomly divided into two groups by random Number Table Method.45 patients in the control group were given routine nursing after discharge, and 45 patients in the observation group were treated with home visit nursing. The hip function and living ability of the two groups were evaluated 8, 12, 16 weeks after discharge,and the complication rate was compared. Results: The self-care ability scores of the observation group at 8, 12 and 16 weeks after discharge were 102.23±11.20, 108.36±10.41, 116.25±10.36 higher than those of the control group at 97.86±10.35), 100.21±14.26, 104.23±15.6, with significant differences (t=1.922, 3.097, 4.294, P < 0.05 or 0.01). The Harris scores of the observation group at 8, 12 and 16 weeks after discharge were 82.31±11.27, 87.38±10.05, 95.10±11.23 higher than those of the control group at 78.02±10.23, 83.41±11.74, 89.43±11.62, with significant differences (t=1.891, 1.723, 2.343, P < 0.05). The incidence of complications in the observation group at 16 weeks after discharge was 0 lower than 13.33% (6/45) in the control group (χ²=6.429, P=0.011). Conclusions Home visit intervention can improve the self-nursing ability of the patients after hip joint operation, promote the recovery of hip function and life ability, and reduce the complications.

Acute Achilles tendon rupture is a common sports injury, is currently the best treatment for acute Achilles tendon rupture there are more controversial programs in the clinical, their treatment is divided into conservative treatment and surgical treatment. Conservative treatment for a long time, and then the higher Achilles tendon rupture rate, postoperative recovery slow. There are a number of complications traditional open surgery, and minimally invasive surgery in recent years developed a new technology that minimizes the exposure of the wound, reduce surgical trauma scope, shorten the operation time and reduce wound infection rate increasing importance in clinical practice, worthy of recommendation.

Objective To explore the effect of TNF-αon expression of TROP-2 and to explore the role of TROP-2 in the metastasis and invasion of colon cancer HCT-116 cells. Methods HCT-116 cells were cultured and treated with 0, 10, 20, 30, 50, 100 and 200μg/L TNF-α. Cell viability was assessed by MTT. The expression of TROP-2 was determined by western blot. The effects of 20μg/L TNF-αon cell migration and invasion were investigated by wound healing assay and Transwell method. Small interfering RNA (siRNA) was used to knock down endogenous TROP-2 expression. The transcrip?tion and translation levels of TROP-2 were detected by qPCR and Western blot respectively. The migratory and invasive ca?pability of HCT-116 cells transfected with TROP-2 siRNA were checked by wound healing assay and Transwell method re?spectively. Results There is no significant change of cell viability between HCT-116 cells treated with 0,10, 20, 30 and 50μg/L TNF-α, but cell viability of HCT-116 decreased significantly with treatment of 100μg/L and 200μg/L TNF-α. Low concentration of TNF-α(≤50μg/L) led to increase of TROP-2 protein expression that peaks when 20μg/L TNF-αwas add?ed. High concentration of TNF-α(100, 200μg/L) result in decrease of TROP-2 protein. TROP-2 siRNA significantly down-regulated the expression of TROP-2 at both mRNA and protein levels in colon cancer HCT-116 cells. Compared with con?trol group, silencing TROP-2 by TROP-2 siRNA inhibited the migratory and invasive capability of HCT-116 cells. Wound healing rate and the number of transwell cell both decreased in siRNA group compared with those of control group ( P <0.05). Conclusion The mechanism that low concentration of TNF-α promoted HCT-116 cells migration and invasion might be through up-regulating the expression of TROP-2.

SUMMARY Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen , and it could be an unpre-dictable and life-threatening cause during anesthesia .The main purpose of this paper is to report a case of anaphy-lactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period .A 63-year-old man, with a mass on his adrenal , was scheduled to a laparoscopic adrenal tumor excision .During the anesthesia induction period , after administrated sul-fentanil, propofol and rocuronium , the blood pressure was decreased and the heart rate was increased .Then, the patient had rash on his whole body and developed an anaphylactic shock .After being treated with the anti-allergic agents and norepinephrine , the rash disappeared and the vital sign become stable .The patient felt nothing uncom-fortable during the two weeks ’ follow-up.Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period .The most common inducements are muscle relaxant , latex and antibiotics .Anaphylactic reac-tions in the perioperative period are often serious and potentially life-threatening conditions , involving multiple or-gan systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils .Before anesthesia , we should acquire the allergic history .During the anesthesia period , the vi-tal sign and the skin should be observed carefully .

Objective To investigate effective treatment modalities and the related factors influencing prognosis of patients with gallbladder cancer.Methods The clinical data of 76 gallbladder carcinoma patients admitted to the Department of General Surgery,PLA Nanjing General Hospital from January 2005 to October 2015 were analyzed retrospectively.Follow-up was carried out via telephone or outpatient service until January 2016.Cox regression and Kaplan-Meier models were performed for survival analysis.Results 69 patients were treated with surgery and/or postoperative adjuvant chemotherapy.The remaining 7 patients with liver or distant metastases who did not undergo surgery received chemotherapy.24 patients died from cancer relapse,37 patients died from disease progression after giving up treatment,and 7 patients were lost to follow-up.The remaining 8 patients were still alive at the time of follow-up.The depth of cancer invasion (HR =2.736),the type surgical procedure (HR =2.207),and adjuvant chemotherapy (HR =0.603) were significant impact factors of survival for GBC patients.Adjuvant chemotherapy was a protective factor.The average survival in the chemotherapy-naive group was (10.6 ± 1.9) months,the single chemotherapy group (18.5 ± 2.8) months,and the combined chemotherapy group (26.9 ± 6.4) months.There were no significant differences among these groups.Conclusions The depth of cancer invasion,types of surgical procedure particularly radical cholecystectomy,and adjuvant chemotherapy were significant factors of survival in patients with GBC.Radical cholecystectomy combined with arterial and intravenous chemotherapy using gemcitabine and oxaliplatin showed benefits in survival in GBC patients.