Objective To prepare the cleavable PEG and RGD co-modified liposome for tumor targeting.Methods Liposomes were prepared by film-ultrasonic method.The particle size,Zeta potential and stability in FBS were evaluated.Cellular uptake by HepG2 cell was explored.MTT assay was used to evaluate the cytotoxicity of blank liposomes. Results The particle diameter of C/RGD-LP was (104.8 ±5.5 )nm with the Zeta potential of (-4.45 ±1.75 )mV.The cellular uptake of C/RGD-LP increased 2.8 times after Cys was added.The C/RGD-LP showed little cytotoxicity to HepG2 cell.Conclusion Cleavable PEG and RGD co-modified liposomes were easy to prepare and has a special application value for targeting tumor.

AIM: To investigate the possibility of transfecting siRNA into rabbit cervical cells in transformation zone by the method of solid phase in vivo and to verify the effectivity of siRNA transfection by modifying the permeability of the cervical epithelium. METHODS: A sense strand small-interference RNA (siRNA) for human papillomavirus type 16 (21 bp) was designed and labeled with Cy3. siRNA-Lipo2000-carbomer gum was prepared. Twelve rabbits were included in the study and divided into experimental group and control group. In order to modify the permeability of cervical epithelium, hypertonic saline solution at concentration of 200 mmol/L was used to infuse the cervix in the experimental rabbits for 10 min, and normal saline was used for the control animals. The siRNA-Lipo2000-carbomer gum was applied to the surface of the rabbit cervix. Twenty-four hours later, the rabbits were sacrificed, and the cervix was isolated, cut into 2 parts, one part was for rapid frozen sectioning and the efficiency of transfection was observed under fluorescence microscope, another part was prepared by paraffin embedding and sectioning, and the form of cervical histiocytes was observed. Twelve SCID mice with SiHa cell cervical tumor, divided into experimental group and control group, were also used in the study. The mice in experimental group were treated with siRNA-Lipo2000-carbomer gum for 7 d. The control mice were treated with Lipo2000-carbomer gum only. Five days later, the mice were sacrificed and the tumor was collected, and the HPV16-DNA was measured by PCR. RESULTS: (1) Red fluorescence (Cy3) in cervical epithelium was observed in all rabbits. However, no different effect of siRNA transfection was found between the ways of modifying the cervical epithelium permeability. (2) No abnormal change such as flare, swelling and ulcer at all cervical tissue was observed, the cervical cell form was normal. (3) The titer of HPV16-DNA was decreased significantly after siRNA transfection (P<0.05). CONCLUSION: Transfection of siRNA into rabbit cervical epithelium in vivo is successful by using the method of solid phase and inhibits the processes of HPV-DNA, indicating that using RNAi is a practical way to treat HPV infection in human cercix and to decrease the incidence of cercical carcinoma.

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Objective To study the expressions of α1-AT and VEGF-C in human bronchoalveolarcarcinorrm, and the relation of the expression to the patholo~cM differentiation and clinical stage. Methods All 49 Darffin embedding samples of patients with bronchoalveolar carcinoma were studied. α1-AT and VEGF-C were detected by immunohistochemical SP method.Automated image analyzer was used to quantify α1-AT and VEGF-C expressions.Results The immunohistochemical positive stainings of α1-AT and VEGF-C in brown or dark brown were located in cytopla8m.The expression levels of α1-AT and VEGF-C were not related with the gender,age,tumor position and size,and histology subtypos(P＞0.05).It Was found that the expression of α1-AT in patients with local lymph node metastasis was significantly lower than those without node metastasis(P＜0.001).It was found that the expression of VEGF-C in patients with local node metastasis significantly higher than th08e without node metastasis(P＜0.001).There Was a negative correlation between the expression level of α1-AT and the expression level of VEGF-C in bronchoalveolar carcinoma(r=-0.324,P＜0.05).Conclusion α1-AT and VEGF-C could be secreted by bronehoalveolar carcinoma.Bronehoalveolar carcinoma with lower α1-AT expression and higher VEGF-C expression is more likely to have lymph node metastasis.Lower α1-AT expression and higher VEGF-C expression can participate in the mechanism of lymph node metastasis in carcinoma together.

Objective To compare different dose of remifentanil combined with propofol for painless abortion and approach to an appropriate dose of remifentanil.Methods Ninety pregnant women with ASA 1 were randomly divided into three groups(n=30)before administrating remifetanil,a bolus midazolam 1 mg was injected inminutes later.These two drugs did not stop administration until three minutes before the end of negative suction.MAP,HR,SpO2,BIS,RR,VT,PET CO2 were monitored.The onset,operation and recovery time,sedation score and adverse reaction were recorded.Results Sedation scores were significantly different between group A and C [(3.90±0.97)and(4.90±0.85),t=4.24,P＜0.01].Three cases in group A were found moving.MAP,HR,BIS decreased as compared witll baseline.HR reduced significantly in group C(P＜0.05,P＜0.01).Respiratory movement was lower and shallower.RR,VT decreased compared to preoperative one.PET C02 increased gradually (P＜0.05,P＜0.01).There were two cases of respiratory depressing in group A,four cases in group B and ten cases in group C(five cases apnea more than three minutes).All patients used oxygen mask to maintain SpO2＞95%.Incidence of adverse reactions such as chest titanic,nausea and vomiting,itching were of no difference among three groups(P＞0.05).All patients were satisfied with anesthesia.Conclusion The appropriate infusing dose of remifetory devices such as oxygen mask and monitoring life signs are very important to prevent respiratory depress and bradycardia during operation.

Objective To investigate the clinical features and treatment ofBrucellosis disease in children in recent years.Methods The clinical data of 24 children withBrucellosis disease admitted during January 2011 to December 2015 were retrospectively analyzed.Results In 24 children, 18 was male and 6 was female and average age was 9.8±3.13 years (4-14 years). Twenty-four children were diagnosed withBrucellosis disease by positive tiger red plate agglutination tests and their antibody titer was 1:800-1:100. The children lived mainly in the pastoral areas; four cases (16.67%) had sick family members and cattle and sheep; three cases (12.5%) had histoty of contact only with sick family members; 12 cases (50.00%) had cattle and sheep exposure history; 3 cases (12.5%) had raised cattle or sheep at home in the past 2 years; 2 cases (8.33%) had not have clear transmission route. The onset of the disease occurred year round, with the highest incidence in June and July. The common clinical symptoms were fever, arthralgia, weak, sweat, and anorexia, combined with hepatomegaly and splenomegaly. Patients younger than 8 years old were treated with rifampin and sulfamethoxazole. Patients equal to or older than 8 years old were treated with doxycycline and rifampin. Twenty-three children had been cured after treatment. Only one child stopped taking the drugs 3 weeks after discharge, which resulted in recurrence.Conclusion For children living in pasturing area suffered with unexplained recurrent fever, brucellosis disease should be considered and ruled out.

Objective To explore the relationship between serum tumor markers and cervical cancer by using Logistic regression, and to further establish the diagnosis model of squamous cell carcinoma antigen (SCC) in cervical cancer by using chi-squared automatic interaction detector (CHAID) analysis of decision tree.Methods Total of 581 cases of cervical cancer,342 cases of cervical benign diseases and 341 cases of healthy controls who detected tumor markers in Taizhou Hospital of Zhejiang during 2010-2013, were retrospectively studied.The test results of carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), SCC, and alpha fetoprotein (AFP) were reviewed.The Logistic regression were firstly used in screening the related tumor markers of cervical cancer, and then the CHAID method of decision tree was used in determining the values of the related tumor markers on the diagnosis of cervical cancer.The SCC elevated cases of uterine disease from January 2014 to December 2014 were collected to verify the diagnostic value of SCC in cervical cancer patients.Results Logistic regression analysis showed that among the 5 tumor markers which might be associated with cervical cancer, SCC was the only one which had statistical significance between cervical cancer and cervical benign diseases (Wald x2 =22.120,P =0.000), the OR and its 95％ CI was 1.900 (1.454-2.483).With the SCC numerical increases, the proportion of patients with cervical cancer also gradually increased, when SCC ＞ 2.20 μg/L, the positive predictive value was 94.7％.In 284 cases of SCC higher than 2.20 μg/L who considered as uterus related diseases, there were 270 cases (95.1％) who were eventually confirmed as cervical cancer.Conclusion There was a good diagnostic value of SCC for cervical cancer patients.

Objective To investigate the adverse reactions by stereotactic body radiation therapy(SBRT)for advanced hepatocellular carcinoma and summarize nursing experience.Methods Forty-one patients with advanced hepatocellular carcinoma from the radiation department of Sun Yat-sen University Cancer Center from July 2010 to May 2012 were enrolled in this retrospective study.The adverse reactions were closely observed and the patients were given pertinent nursing.Results The effectiveness rate was 56.2%.During the therapy,36 patients developed nausea/vomiting of grade 1-2,taking up 87.8%,18 had grade 1-3 elevation of liver enzymes,taking up 43.9%,16 had grade 1-2 decrease of white blood cells,taking up 39.0%,8 had grade 1 anemia,taking up 19.5%and 21 had grade 1-2 decrease of blood platelet,taking up 51.2%.The adverse reactions were contained satisfactorily through careful observations and pertinent nursing.Conclusions The toxic reactions by SBRT are nausea,vomiting,enzymes elevation and decrease of whole blood cell.Therefore,nurses need to observe these toxic reactions carefully and give pertinent care to the patients so as to prevent the complications,especially radiation-induced liver injury.

Objective:To compare the difference of epileptiform discharges detection in patients with epilepsy between the 25 electrodes electroencephalogram (EEG) system proposed by the International Federation of Clinical Neurophysiology in 2017 and the previous 19 electrodes EEG system.Methods:Patients suspected of epilepsy or with confirmed epilepsy who need a follow-up EEG were collected in Zhongshan Hospital, Fudan University from March 2018 to November 2019, and conventional video-EEG recording was performed on all patients for two hours with the standard 25 electrodes EEG system. Two neurophysiologists reviewed the recordings blindly using the 19 electrodes system and the 25 electrodes system, marking the epileptiform discharges and their amplitudes. Finally, the data were statistically analyzed.Results:A total of 403 patients were included in the study, in which 263 cases were diagnosed as epilepsy, including 129 cases of generalized epilepsy, 115 cases of temporal lobe epilepsy, 13 cases of frontal lobe epilepsy, two cases of parietal lobe epilepsy and four cases of occipital lobe epilepsy. In 115 temporal lobe epilepsy patients, 76 (66.09%) and 100 (86.96%) records were detected epileptiform discharges by the 19 or 25 electrodes EEG system respectively, and the difference was statistically significant (χ2=13.939, P<0.001). While in patients with non-temporal lobe epilepsy, there was not statistically significant difference between the two systems. In 76 patients whose temporal epileptiform discharges were detected by the two systems, the amplitudes of epileptiform discharges in the newly-added inferior temporal electrodes (F9/F10, T9/T10, P9/P10) and the original temporal electrodes (F7/F8, T7/T8, P7/P8) were (61.53±22.64) μV and (48.25±20.90) μV, respectively, with statistically significant difference between the two groups ( t=5.486, P<0.001). In patients with abnormal [79.59% (39/49) vs 61.22% (30/49), χ2=3.967, P=0.046] and normal [95.45% (42/44) vs 70.45% (31/44), χ2=9.724, P=0.003] imaging, the ability of the 25 electrodes EEG system to detect epileptiform discharges was higher than that of the 19 electrodes EEG system. Conclusion:The 25 electrodes EEG system can significantly improve the detection ability of temporal epileptiform discharges in patients with epilepsy, which is recommended for regular use to increase the detection ability of temporal area abnormal wave and assist the diagnosis and treatment of epilepsy.