OBJECTIVE:To explore the effect of dexmedetomidine with different doses combined with ropivacaine on the bra-chial plexus block. METHODS:Totally 90 patients with upper extremity surgery of brachial plexus block were randomly divided in-to test group,control group 1 and control group 2. Test group was treated with 0.375%ropivacaine 40 ml+dexmedetomidine 100μg, brachial plexus injection;control group 1 was treated with 0.375% ropivacaine 40 ml+dexmedetomidine 50 μg,brachial plexus in-jection;and control group 2 was treated with 0.375% ropivacaine 40 ml,brachial plexus injection. Onset time of sensory and motor nerve block,block duration,postoperative pain time for the first time and pain score,analgesia duration,quality of analgesia and muscle relaxant,before anesthesia induction(T0),plasma cortisol concentrations in nerve block 10 min (T1),the start of surgery (T2)and incidence of adverse reactions were observed. RESULTS:The onset time of sensory and motor nerve block and postopera-tive pain score for the first time in test group werecontrol group 1>control group 2,plasma cortisol concentrations at T1 and T2 were higher than T0,and T2>T1>T0,test group0.05). CONCLUSIONS:Ropivacaine combined with 100 μg dexmedetomidine can effectively im-prove brachial plexus block and shorten the onset time of sensory and motor nerve block,with good safety.

Objective To investigate the expression of vascular endothelial growth factor (VEGF) and Bax in non‐small cell lung cancer (NSCLC) and clinical value .Methods Paraffin specimens were collected from 80 cases of NSCLC tissues(NSCLC group) and 20 cases of normal lung tissue adjacent to benign lesions(control group) .Western blot and immunohistochemistry were used to dectect the expression of VEGF and Bax .The relationship of the expression of VEGF and Bax with histological classifica‐tion ,stage ,lymph mode metastasis were analyzed .Results The expression of VEGF in NSCLC group was higher than that in con‐trol group ,the differences were statistically significant (P<0 .05) .The higher expression of VEGF in the group of stage Ⅲ‐Ⅳ was obtained than that in the group of stage Ⅰ‐Ⅱ (P<0 .05) .The higher expression of VEGF in the group with lymph mode metasta‐sis was obtained than that in the group without lymph mode metastasis (P<0 .05) .The expression of VEGF was not found to be related with histological classification (P>0 .05) .The expression of Bax in NSCLC tissue was lower than that in normal tissue ,the differences was statistically significant (P<0 .05) .The lower expression of Bax in the group of stage Ⅲ‐Ⅳ was obtained than that in the group of stage Ⅰ‐Ⅱ (P<0 .05) .The lower expression of Bax in the group with lymph mode metastasis was obtained than that in the group without lymph mode metastasis (P<0 .05) .The expression of Bax was not found to be related with histological classification (P>0 .05) .The expression of VEGF was negatively correlated with Bax in NSCLC (P<0 .05) .Conclusion The ex‐pression of VEGF played a promoting effect in the NSCLC ,and was negatively correlated with the expression of Bax protein ,and the expression of the two could provide a basis for the diagnosis and prognosis of NSCLC .

ObjectiveTo observe the efficacy of maintenance hormonal treatment after response to chemotherapy in advanced breast cancer. Methods8 patients with advanced breast cancer were treated with chemotherapy,maintenance hormonal therapy were given after response to chemotherapy.The efficacy was evaluated every 2 cycles of chemotherapy and 2 months of endocrine therapy according to RECIST standard.Results8 patients received chemotherapy for 2-8 cycles (median 4 cycles). All patients got PR, the duration of chemotherapy was 1-6 months (median 2 months), the time to failure of chemotherapy was 4 months. Until the last follow-up day (31th December 2010), the time to progression was 6-86 months (median 13.5 months).Survival was 6-86 months(median 21.5 months).Seven patients quit the chemotherapy due to severe side effects of hematologic toxicity,fatigue or nausea vomiting.One patient died because of allergy to paclitaxol.Conclusion Maintenance hormonal treatment after patients with metastatic breast cancer response to chemotherapy may prolong the duration of effective therapy and improve the QOL.

Objective; To study estrogen receptor gene Xbal and Pvu Ⅱ polymorphisms in patients with aggressive periodontitis (AgP). Methods; Xbal and Pvu Ⅱ DNA was extracted by Chelex-100 and amplified by PCR from buccal swabs of 48 cases of AgP patients and 60 normal controls. The PCR products were analyzed by polymerase chain reaction linked fragment length polymorphism (PCR-RFLP) assay. Results: There were significant differences of the distribution of Xba I genotype between AgP group and control group, female AgP group and female control group, male AgP group and male control group(P<0.05). There was no difference of Pvu D genotype distribution between patient group and control group (P>0.05). Multivariate Logistic Regression Analysis showed that male group was less susceptible to AgP than female group(OR =0. 352), the older was less susceptible to AgP than the younger(OR =0.950), and the xxXx genotype was less susceptible to AgP than XX genotype [OR(Xx) =0.224, OR(xx) = 0.678). Conclusion: Specific relationship is found between the susceptibility of AgP and the ER gene-Xbal polymorphism. People with XX genotype is more susceptive to AgP than xx, Xx genotypes.

Objective To investigate the effect of leptin on the secretion of chemokine in THP1 cells and explore its related mechanism, and to provide basis for research on the role of leptin in immune response.Methods The expressions of Ob-Rb and Ob-Rt in THP1 cells were detected by RT-PCR and flow cytometry (FCM).The THP1 cells at logarithm growth phase were selected and randomly divided into blank control group and different concentrations(10,50,100,200μg· L-1 )of leptin groups.Transwell chamber assay was performed to detect the number of invated THP1 cells.The THP1 cells were divided into blank control group and 100μg·L-1 leptin group.Western blotting method was carried out to detect the expressions of p-AKT,p-ERK 1/2,and p-STAT3 in THP1 cells.The THP1 cells were divided into blank control group and 100μg·L-1 leptin group,100μg·L-1 leptin+ DMSO group,100μg·L-1 leptin+50μmol·L-1 AG490 group,100μg·L-1 leptin+10μmol·L-1 LY294002 group and 100μg·L-1 leptin+ 10 mol·L-1 PD980590 group.RT-PCR and Western blotting methods were performed to detect the expression of IL-8.Results Ob-Rb and Ob-Rt were highly expressed in THP1 cells. Compared with blank control group,the number of invated THP1 cells was significantly increased in 50,100,and 200μg·L-1 leptin groups (P<0.05).Compared with blank control group,the expressions of p-STAT3,p-ERK 1/2 and p-AKT in THP1 cells were up-regulated in 100 ug·L-1 leptin group(P<0.05).Compared with blank control group,the mRNA and protein expressions of IL8 in THP1 cells in 50,100,and 200μg·L-1 leptin groups were remarkably increased(P<0.05);compared with 100μg·L-1 leptin group,the expressions of IL-8 in THP1 cells in 100μg·L-1 leptin+10 mol·L-1 PD980590 group and 100μg·L-1 leptin+10μmol·L-1 LY2 94002 group were decreased(P<0.05),while the expression of IL-8 in 100μg·L-1 leptin+ 50μmol·L-1 AG490 group had no change(P>0.05).Conclusion leptin can up-regulate the expression of chemokine in THP1 cells,which might be associated with PI3K-AKT and MAPK/ERK 1/2 signaling pathways.

Objective To investigate clinical curative effect of partial foraminotomy after C4.5 ossification of posterior longitudinal ligament (OPLL) on preventing C5 nerve root palsy.Methods A total of 155 patients with OPLL were treated with expansion open-door laminoplasty (EOLP) between January 2008 and October 2012,including 75 male patients and 80 female patients,with average age of 54.5 (ranging from 38 to 75).Among them,90 cases took EOLP (open team),and 65 cases took EOLP and C4.5 partial foraminotomy (incision team).Clinical curative effect and imaging evaluation were used in 8 weeks and 12 months after operation.JOA scores,JOA scores improvement rate,C5 nerve root palsy occurrence rate,neurological function of patients with C5 nerve root palsy and the prognosis,cervical curvature index,opening angular variation,backward drift distance of anterior margin and posterior margin of the spinal cord were evaluated after 8 weeks and 1 year after the surgery.Results The operation time was 90-140 min,with the average time of 110±14 min;mean bleeding volume was 160±45 ml (ranging from 100 to 250 ml);follow-up visit time was 15.4 months on average (ranging from 12 to 18 months).JOA score and improvement rate after 8 weeks and 1 year of the operation have no statistical significance.The C5 nerve root palsy occurrence rate in open team was 8.89％ (8/90),while that in incision team was 4.62％ (3/65).The difference of two groups has statistical significance.C5 nerve root palsy all happened in laminar opening side.Comparison of cervical curvature index of two groups before the operation and after 8 weeks of the operation and inter-group comparison have no statistical significance.The difference between laminar opening angle after 1 year of the operation and laminar opening angle after 8 weeks has no statistical significance.The difference of backward drift distance of anterior margin of the spinal cord at different time after the operation and inter-group difference have no statistical significance.The difference in backward drift distance of posterior margin of the spinal cord between 1 year after the operation and 8 weeks after the operation has no statistical significance.Conclusion Treating OPLL with EOLP and C4.5 partial foraminotomy can reduce occurrence rate of C5 nerve root palsy,but has no significant influence on JOA score improvement rate.

Objective To explore the clinical effects of S-1 single agent chemotherapy for the patients undergoing radical resection of cholangiocarcinoma.Methods The clinical data of 51 patients receiving radical resection of cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Zhejiang University from November 2011 to December 2013 were retrospectively analyzed.After radical resection of cholangiocarcinoma,25 patients receiving non-special treatment and 26 patients receiving S-1 single agent chemotherapy were divided into the operation group and chemotherapy group,respectively.S-1 was taken orally twice per day.Forty mg/once of S-1 was applied to patients with the body surface area ＜ 1.25 m2,50 mg/once of S-1 was applied to patients with the body surface area ≥ 1.25 m2 and ＜ 1.50 m2,and 60 mg/once of S-1 was applied to patients with the body surface area ≥ 1.50 m2.The 14 days usage and 7 days withdrawal of S-1 were used as one course of treatment.The standard usage of S-1 was 6-8 courses of treatment.All the patients were followed up by outpatient examination and telephone interview till December 1,2014.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results Twenty-six patients in the chemotherapy group finished the courses of chemotherapy without chemotherapy-related death,and 14 patients had chemotherapy adverse reactions with remission after discontinuation of S-1.All the 51 patients were followed up for 5-37 months with a median time of 19 months.The median overall survival time,1-,3-year overall survival rates,tumor-free median survival time and 1-,3-year tumor-free survival rates were 22 months (range,18-27 months),72.3％,42.9％,21 months (range,16-26 months),60.0％,55.0％ in the operation group and 32 months (range,29-35 months),84.6％,44.4％,26 months (range,21-31 months),76.9％,61.9％ in the chemotherapy group,respectively.There was a significant difference in the overall survival between the 2 groups (x2=6.032,P ＜ 0.05).There was no significant difference in the tumor-free survival between the 2 groups (x2=0.498,P ＞ 0.05).Conclusion S-1 single agent chemotherapy after radical resection of cholangiocarcinoma could improve the survival of patients,while no obvious advantages of inhibiting tumor recurrence is observed.

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P < 0.05). (2) The cervical curvature index in the group A was significantly improved (P < 0.05), but the index had no significant change in the group B. (3) The axial systems were significantly improved in both groups, especially in the group A (P < 0.05). (4) The neurological function was significantly improved in both groups (P < 0.05), which showed no significant difference between two groups (P > 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Objective To investigate the effects of traditional Chinese medicine colquhounia root tablet on the expression of tight junction protein claudin-2 and ZO-1 in bronchial epithelium tissues of rats with acute lung injury (ALI), and to study the mechanism of protective effect of colquhounia root tablet on ALI. Methods Twenty-four healthy male Sprague-Dawley (SD) rats were randomly divided into control group, ALI group and colquhounia root tablet pretreatment group, with 8 rats in each group. The model of ALI was reproduced by intravenous injection of oleic acid 0.04 mL/kg, and the rats in cont rol group were given the same amount of normal saline (NS) instead. The rats in colquhounia root tablet pretreatment group were intragastric administrated with colquhounia root tablet of 600 mg·kg-1·d-1 (2 mL) for 10 days before model reproduction, and the rats in control group and ALI group were given the same amount of NS. At 4 hours after model reproduction, the blood was drawn from abdominal aorta, and bronchoalveolar lavage fluid (BALF) was collected for determination of protein content in plasma and BALF, and the lung permeability index (LPI) was calculated. The rats were sacrificed to collect lung tissues for determination of lung wet/dry weight ratio (W/D), the changes in pathology of lung tissue were observed after hematoxylin and eosin (HE) staining with light microscope, and lung injury score (LIS) was evaluated. The immunohistochemic al staining was used to detect the expression and localization of claudin-2 and ZO-1 in bronchial epithelium tissues. The protein expressions of claudin-2 and ZO-1 in bronchial epithelium tissues were determined by Western Blot. Results Compared with control group, the lung injury in ALI group was more obvious including cellular edema and structural disorder of intercellular connection by optical microscope, and LIS, W/D ratio, and LPI were significantly increased (LIS: 3.81±0.42 vs. 0.40±0.08, W/D: 7.68±0.64 vs. 4.44±0.39, LPI: 0.89±0.15 vs. 0.38±0.05, all P < 0.01). Claudin-2 and ZO-1 were mainly expressed in the bronchial epithelium cell, and the expression degrees were significantly weakened in ALI group as compared with control group. It was shown by Western Blot results that compared with control group, the protein expressions of claudin-2 and ZO-1 were significantly down-regulated in ALI group [claudin-2 protein (gray value): 0.43±0.31 vs. 2.16±1.33, ZO-1 protein (gray value): 1.25±0.41 vs. 2.82±0.76, both P < 0.01]. Compared with ALI group, colquhounia root pretreatment could effectively diminish the degree of ALI (LIS: 1.22±0.39 vs. 3.81±0.42, W/D: 4.62±0.84 vs. 7.68±0.64, LPI: 0.46±0.07 vs. 0.89±0.15, all P < 0.01), and the protein expressions of claudin-2 and ZO-1 were significantly up-regulated [claudin-2 protein (gray value): 2.98±0.91 vs. 0.43±0.31, ZO-1 protein (gray value): 2.35±0.51 vs. 1.25±0.41, both P < 0.01]. Conclusion Administration of colquhounia root table could attenuate lung injury induced by oleic acid with improving epithelial barrier function via up-regulate the expression claudin-2 and ZO-1, which play a protective effect on the lung of rats with ALI.

Objective To compare and evaluate the clinical efficacy and side effect of vinorelbine plus gemcitabine and vinorelbine plus cisplatin combinations in advanced non-small-cell lung cancer(NSCLC). Methods 56 cases with non-treated advanced NSCLC were unrandomly divided into two groups: the GN group (27patients) treated with vinorelbine plus gemcitabine, the NP group (29 patients) treated with vinorelbine plus cisplatin,1/3 weeks×2～6 cycles. Results For the GN group, the overall response rate was 37.7 %, MTTP was 5.1months,one year survival rate (1-ySR) was 40.7 %. There were no significant difference in the response rates and the survival rates for the GN group compared with the NP group (P ＞0.05); But on the side effect of toxicities, WHO grade anemia and nausea/vomiting and tiredness of the GN group was significantly milder than the NP group (P ＜ 0.05). Conclusion Vinorelbine combined Gemcitabine regimen (GN) is active and well-tolerated. It is worth to investigate GN recommended as the first line chemotherapeutic regimen for the treatment of patients with advanced NSCLC.