Objective To evaluate the efficacy of mid-axillary approach to transversus abdominis plane (TAP) block in each abdoninal and back region.Methods Twenty patients of both sexes,aged 18-64 yr,with body mass index of 20-27 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,who had expected operation time ＜1 h,were enrolled in the study.Ultrasound-guided TAP block was performed on the left side via the mid-axillary line with 0.25％ levobupivacaine 0.5 ml/kg.TAP block was assessed by cold stimulation (75％ alcohol) and acupuncture in each abdominal and back region (the left side of the body was divided into 19 regions using the anatomical landmarks on the body surface).The positive condition in each region at 20 min after administration was recorded.Results The regions in which the positive rate ≤5％ were 11,14,17 and 18 regions.The regions in which the positive rate ＞5％-20％ were 8,15 and 19 regions.The regions in which the positive rate ＞20％-50％ were 12,13 and 16 regions.The regions in which the positive rate ＞50％-70％ were 1 and 4 regions.The regions in which 70％ ＜ the positive rate ＜ 95％ were 7,9 and 10 regions.The regions in which the positive rate ≥ 95％ were 2,3,5 and 6 regions.Conclusion Mid-axillary approach to TAP block is effective in the left middle-lower regions of the anterior abdominal wall,however,it is ineffective in the left upper region between mid-axillary and posterior axillary lines and in the low back region.

AIM:To explore the effects of miR-21 on biological behavior of colon cancer cells and their sensi-tivity to epidermal growth factor receptor monoclonal antibody cetuximab .METHODS:Lentiviral vectors were constructed to generate up-and down-regulations of miR-21 lentiviruses (LV-miR-21 and LV-anti-miR-21, respectively), and the cor-responding negative control viruses (LV-miR-21 NC and LV-anti-miR-21 NC, respectively) were also constructed.The vi-ruses were used to infect human colon cancer RKO cells .The changes of the miR-21 expression level , the cell prolifera-tion, the colony-forming ability, the cell apoptosis and the sensitivity of the cells to cetuximab were detected by real -time PCR, MTT assay, soft agar colony assay , flow cytometry and CCK-8 assay.RESULTS: The lentivirus titers of LV-miR-21, LV-miR-2 NC, LV-anti-miR-21 and LV-anti-miR-21 NC were 3.0 ×1012 TU/L, 6.0 ×1011 TU/L, 2.0 ×1012 TU/L and 8.0 ×1011 TU/L, respectively.The infection efficiency was over 80% by the observation of green fluorescence .The miR-21 expression level , the cell proliferation , and the colony-forming ability in LV-miR-21 group were significantly higher than those in LV-anti-miR-21 group.The early apoptotic rate and the inhibitory rate of cetuximab for the cells in LV-anti-miR-21 group were higher than those in LV-miR-21 group.CONCLUSION: miR-21 promotes the proliferation of colon cancer cells.Down-regulation of miR-21 enhances the sensitivity of the colon cancer cells to the targeted therapy drug cetuximab.

AIM The proofs of evidence-based medicine of Qingkailing Injection's effect on viral hepatitis are lack in spite of the wide use of Qingkailing Injection in medical practice.This study aims to use Meta-analysis to evaluate its clinical effect and safety.METHODS Such databases as CNKI,VIP and Wanfang were searched for randomized controlled trials related to Qingkailing Injection in treatment of viral hepatitis,which were published officially between 1996--2016.Revman 5.3 software was used to conduct Meta-analysis for the effective rate,rate of adverse reaction,the decrease rate of ALT,AST and TBIL of Qingkailing Injection.Meanwhile,subgroup analysis was conducted to the clinical effect of doses [＜ 0.5 mL/(kg · d),0.5-0.67 mL/(kg · d),＞0.67 mL/(kg · d)],treatment courses (≤ 14 d,＞ 14 d),manufacturers (Beijing University of Chinese Medicine Pharmaceutical Factory,Shenwei Pharmaceutical Company,Shanxi Taihang Pharmaceutical Company),year (1996 to 2002,2003 to 2009,2010 to 2016).RESULTS Fourteen studies were included according to the criterion.The results of Meta-analysis showed that the total effective rate,the decrease rate of ALT,AST and TBIL in Qingkailing Injection group were significantly higher than those in the control group (P ＜ 0.05).Whereas,no significiant differences were found between Qingkailing Injection group and the control group of its rate of adverse reaction (P ＞ 0.05).Subgroup-analysis showed that the effective rate of Qingkailing in doses subgroup,treatment courses subgroup,manufacturers subgroup and year subgroup were significantly higher than those of the control group.CONCLUSION Qingkailing Injection has obvious benefit in the treatment of viral hepatitis,which can reduce the activity of ALT and AST,also can reduce the content of TBIL.But we should pay attention to the prevention of allergic reaction in the clinical use.

Many applications of wireless sensor networks can benefit from fine-grained localization. In this paper, we proposed an accurate, distributed localization method based on the time difference between radio signal and sound wave. In a trilateration, each node adaptively chooses a neighborhood of sensors and updates its position estimate with trilateration, and then passes this update to neighboring sensors. Application examples demonstrate that the proposed method is more robust and accurate in localizing node than the previous proposals and it can achieve comparable results using much fewer anchor nodes than the previous methods.

Neurogenesis is a process in which the neuronal stem cells differentiate into functional neurons including the cell proliferation,differentiation and migration.Previously,it was believed that neurogenesis is a prenatal process and the adult ependymal cells are incapable of regeneration.Now it is clear that mammalian brain retains the ability to generate new ceils in specific regions.One of the regions is subventricular zone of the lateral ventricles,new generated neurons and glial cells later migrate to olfactory and repair dysosmia through the RMS road.Here we will review the advances in adult neurogenesis in mammal subventficular zone.

Objective To investigate the effect of folic acid intervention on plasma homocysteine (Hcy) metabolic changes and pulse wave velocity(PWV)in patients with type H hypertension. Methods Patients(hos-pitalized from March 2014 to December in our hospital)with H type hypertension were randomly divided into treat-ment group and control group randomly ,and were given routine antihypertensive drug therapy. Treatment group was given oral folic acid 0.8 mg,1 times a day,the control group was given placebo,1 times a day. All patient were treated for 12 months. Changes of plasma Hcy and PWV levels were observed. Results 432 patients(Han nationality)with type H hypertension were enrolled in this study with the age of 61.7 ± 13.6 years old and the ratio of men and women is 1.3:1. The most common diseases were coronary heart disease and type 2 diabetes mellitus. 2 groups were treated for a period of 12 months,with follow-up time from 6 to 10 months(average duration in 8 months). After treatment,the difference between plasma Hcy(Z=-7.63,P=0.000)and PWV(Z=-3.16,P=0.002)levels of the two groups were statistically significant. Conclusion Folic acid intervention can significantly reduce the level of plasma Hcy in patients with type H hypertension ,slow down the progression of atherosclerosis and reduce the risk factors of cardiovascular disease.

The association of serum uric acid ( SUA ) and urine albumin-to-creatinine ratio ( ACR ) in patients with type 2 diabetes mellitus was explored. The ACR abnormal rate was higher in hyperuricemia group( P＜0.01 ). ACR level was positively correlated with SUA( P＜0.01 ). The general linear model showed that SUA was a risk factor in ACR. Patients with hyperuricemia and type 2 diabetes mellitus were apt to have abnormal ACR and develop early renal damage.

Objective To investigate the clinical efficacy and experiences of laparoscopic hepatectomy (LH) for segment Ⅶ and Ⅷ liver tumors.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 94 patients who underwent LH for segment lⅦ or Ⅷ liver tumors in the Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from June 2010 to August 2016 were collected.The operating space for operation was built under laparoscopy.According to liver cirrhosis grading,tumor size,adjacent relationship with major blood vessels and residual liver volume,non-anatomical and anatomical hepatectomies were selected by patients.During the operation,tumors were precisely pinpointed and plane of liver resection was determined,and then proper instruments of liver partition and techniques of hepatic inflow occlusion were selected.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative pathological examination;(3) follow-up and survival situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival up to July 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (interquartile range).Survival rate was caculated by the Kaplan-Meier method.Results (1) Surgical and postoperative recovery situations:all 94 patients received successful operations,without perioperative death,including 73undergoing non-anatomical hepatectomy and 21 undergoing anatomical hepatectomy.Fourteen patients had conversion to open surgery and 27 received hepatic inflow occlusion.The median operation time,median volume of intraoperative blood loss and cases with intraoperative blood transfusion were respectively 187.5 minutes (75.0minutes),200 mL (200 mL) and 15.Eighteen patients had postoperative complications,including 6 with pleural effusion,6 with abdominal effusion,1 with wound infection,1 with abdominal infection,1 with venous thrombosis,1 with bleeding,1 with coagulation disorders and 1 with hepatic insufficiency.Clavien-Dindo classification of complications:11,1,5 and 1 patients were detected in grade Ⅰ,lⅡ,Ⅲ and Ⅳ,respectively.All complications were improved by symptomatic treatment.The median duration of hospital stay was 7 days (6 days).(2) Postoperative pathological examination:results of tumor pathological examination showed that 45,5,9 and 35 patients were respectively confirmed as hepatocellular carcinoma,cholangiocarcinoma,metastatic hepatic carcinoma and benign liver tumor.(3) Follow-up and survival situation:59 patients with malignant tumors were followed up for 6.0-52.0 months,with a median time of 42.6 months.Postoperative 1-and 3-year overall survival rates of 59 patients with malignant tumors were 98.3％ and 84.7％,respectively.Conclusions LH for segment Ⅶ and Ⅷ liver tumors which is conducted in experienced medical center is safe and feasible,with definite effects.Building operating space for operation under laparoscopy,determining precise positioning of the tumor and plane of liver resection,and selecting proper instruments of liver partition and techniques of hepatic inflow occlusion are the key points of successful operation.

Objective To study the effects of 5-HT1A receptor in hippocampal dentate gyrus on anxiety behavior of adult rats with Parkinson's disease (PD).Methods PD model in rats was constructed by using 6-hydroxydopamine (6-OHDA) to lesion the medial forebrain bundle (MFB).In lesioned rats and sham-operated rats,we examined the changes of the number of TFH-positive neurons in the SNc and VTA.We also examined how 5-HT1A receptor of hippocampal dentate gyrus (DG) modulates the anxiety-related behavior using open field test and elevated plus-maze test,and examined monoamine neurotransmitter changes in the striatum,medial prefrontal cortex (mPFC),amygdale and ventral hippocampus using reverse-phase high performance liquid chromatography with electrochemical detection.Results In 6-OHDA-lesioned rats,the SNc of the injected side showed a total loss of TH-ir neurons compared with the unlesioned side,and the number of TH-ir neurons in the VTA on the lesioned side decreased significantly to (34± 2)％.The locomotor activity in 6-OHDA-lesioned rats decreased compared with that in sham-operated rats.Unilaterally lesioning the MFB decreased the percentage of time spent in the center in the open-field test and percentages of open arm entries and open arm time of elevated plus maze test when compared with sham-operated rats.In the sham-operated rats,intra-DG injection of 8-OH-DPAT did not affect anxiety-like behavior.In 6-OHDA-lesioned rats,intra-DG injection of 8-OH-DPAT significantly increased the percentage of time spent in the center at a dose of 100 ng and 500 ng when compared with saline injection into the DG.Injection of WAY-100635 did not affect rats in the two groups.Unilateral 6-OHDA lesions of the MFB in rats significantly decreased DA levels in the ipsilateral striatum,mPFC,amygdale and ventral hippocampus compared with those in sham-operated rats,but had no effect on 5-HT or NA levels in those structures.Conclusion Unilateral 6-OHDA lesion of the MFB not only totally damaged DA neurons in SNc and partly damaged DA neurons in VTA,but also decreased DA level in the ipsilateral striatum,mPFC,amygdale and ventral hippocampus.Unilateral 6-OHDA lesion of the MFB induces anxiety-related behavior,and activation of 5-HT1A receptor in the hippocampal dentate gyrus has anxiolytic effect in the rat model of Parkinson's disease.

Objective:To analyze the prognostic factors of robot-assisted radical cystectomy (RARC).Methods:The clinical data of 224 patients underwent RARC from December 2014 to December 2018 in Nanjing Drum Hospital were reviewed. There were 193 males and 31 females, aged 36-92 years, with mean of 68 years. There were 7 patients(3.1%)undergoing neoadjuvant chemotherapy, the ASA scores of 125 patients (55.8%) were more than 2, and the mean body mass index was 23.4(15.4-35.5)kg/m 2. All patients were treated with RARC, with 72(32.1%) patients undergoing intraoperative blood transfusion. Kaplan-Meier method was used to analyze recurrence-free survival rate (RFS), cancer-specific survival rate (CSS) and overall survival rate (OS). Cox multivariate risk ratio model was used to evaluate the correlation between survival outcome and perioperative and pathological factors in patients treated with RARC. Results:For pathological status, there were 82 of ≤T 1, 64 of T 2, 57 of T 3 and 21 of T 4. Of all the patients, 49(21.9%) had lymph node metastasis, 12(5.4%) had positive surgical margin, 82(36.6%) had lymphovascular invasion(LVI), and 41(18.3%) underwent adjuvant chemotherapy. Follow-up time was between 11-60 months, and the median follow-up time was 24 months. The 5-year cumulative OS, RFS and CSS were 57.15%, 48.84% and 59.60%, respectively. Univariate Cox regression analysis showed that T stage( HR=5.764, 95% CI 1.926-17.249, P=0.002; HR=4.086, 95% CI 1.611-10.364, P=0.003; HR=9.391, 95% CI 2.118-41.637, P=0.003), N stage( HR=6.446, 95% CI 3.438-12.087, P<0.001; HR=5.661, 95% CI 3.086-10.385, P<0.001; HR=5.980, 95% CI 2.982-11.992, P<0.001), LVI( HR=3.319, 95% CI 2.008-5.486, P<0.001; HR=2.894, 95% CI 1.782-4.701, P<0.001; HR=3.471, 95% CI 2.017-5.974, P<0.001), American Society of Anesthesia (ASA)score( HR=2.888, 95% CI 1.619-5.150, P<0.001; HR=1.765, 95% CI 1.060-2.940, P=0.029; HR=2.612, 95% CI 1.424-4.792, P=0.002), body mass index( HR=0.886, 95% CI 0.819-0.957, P=0.002; HR=0.885, 95% CI 0.819-0.955, P=0.002; HR=0.862, 95% CI 0.792-0.938, P=0.001), age( HR=1.580, 95% CI 1.250-1.997, P<0.001; HR=1.362, 95% CI 1.088-1.705, P=0.007; HR=1.530, 95% CI 1.190-1.968, P=0.001) and intraoperative blood transfusion( HR=1.899, 95% CI 1.160-3.108, P=0.011; HR=2.218, 95% CI 1.371-3.587, P=0.001; HR=2.227, 95% CI 1.312-3.782, P=0.003) were significantly related to survival outcome. Multivariate Cox regression analysis showed that T stage( HR=4.506, 95% CI 1.433-14.175, P=0.01; HR=3.159, 95% CI 1.180-8.454, P=0.022; HR=7.810, 95% CI 1.674-36.444, P=0.009), N stage( HR=6.096, 95% CI 2.981-12.467, P<0.001; HR=5.368, 95% CI 2.683-10.740, P<0.001; HR=5.539, 95% CI 2.497-12.288, P<0.001) and ASA score( HR=6.180, 95% CI 2.371-16.110, P<0.001; HR=2.702, 95% CI 1.175-6.215, P=0.019; HR=6.471, 95% CI 2.290-18.286, P<0.001) were independent predictors of RFS, CSS and OS, and adjuvant chemotherapy( R=0.434, 95% CI 0.202-0.930, P=0.032) could only predict OS. Conclusion:T stage, N stage and ASA were main independent predictors of postoperative survival outcomes, and adjuvant chemotherapy was independent predictor of OS.