Objective To explore the effects and feasibility of minimal local analgesic dose of hyperbaric levobupivacaine in elderly patients undergoing unilateral spinal anesthesia during lower limb orthopedic surgery.Methods Seven hundred and fifty-six elderly patients who scheduled lower limb orthopedic surgery were assigned to levobupivacaine group (383 patients) and bupivacaine group (373 patients) by random digits table method.Haemodynamic change were monitored before,during and after anesthesia.The level and duration of sensory and motor block in each group were evaluated.Results Compared with bupivacaine group,the sensory block and motor block onset time was significantly longer in levobupivacaine group [(5.9 ± 1.4) min vs.(4.2 ± 0.3) min,(11.7 ± 3.0) min vs.(9.1 ± 3.3) min] (P ＜0.05),but the motor block duration was shorter [(152.8 ± 17.5) min vs.(195.4 ± 18.7) min] (P ＜ 0.05).The scores of maximum motor block in levobupivacaine group was significantly lower than that in bupivacaine group[(1.1 ±0.3) min vs.(2.3 ±0.6) min](P＜ 0.05).There was no significant difference in peak sensory block and haemodynamic between two groups (P ＞ 0.05).Conclusions Although levobupivacaine may be less potent than bupivacaine,it may be preferred for elderly patients with lower limb surgery because of satisfactory spinal anesthesia,good hsemodynamic stability and fast motor block regression.

Objective To evaluate the effects of intravenous analgesia with dezocine combining sufentanil in hip and knee arthroplasty for elderly patients.Methods Ninety patients with ASA Ⅱ ～ Ⅲ and aged ≥ 65 years who were scheduled for hip and knee arthroplasty under CSEA and treated with intravenous analgesia post-operation were selected and divided into three group (20 cases):group Ⅰ (sufentanil 2.5μg/kg + droperidol 2.5 mg),group Ⅱ (sufentanil 2.0 μ g/kg + dezocine 10 mg + droperidol 2.5 mg) and group Ⅲ (intramuscular dezocine 10 mg and sufentanil 2.0 μ g/kg + droperidol 2.5 mg),which were diluted to be 100 ml by adding saline.VSA,Ramsay score as well as side effects were recorded at 6,12 and 24 h after operation.75 mg meperidine was administered intramuscularly as rescue medication when VAS was above 5.Results Compared with group Ⅰ and Ⅲ,group Ⅱ showed better outcomes regarding to the VAS and less side effects.Ramsay score 6 h after operation and the amount of patients who needed meperidine in group Ⅲ were higher than those in the other two groups (P ＜ 0.05).Conclusion Dezocine combining with sufentanil in elderly patients underwent low limb arthroplasty shows better postoperative analgesia effects with less side effects,and it's worth for clinical application.

Objective Combination of chemotherapy regimens and chemoradiotherapy to the curative effect of locally advanced nasopharyngeal carcinoma is unclear. The carcinoma radiotherapy adverse reaction and curative effect were investigated in nedaplatin plus fluorouracil in the same period radiotherapy(Group NF)compared with cisplatin(DDP)in the same period (Group DDP)in the treatment of locally advanced nasopharyngeal. Method Patients with locally advanced(ⅢandⅣB)nasopharyngeal carcinoma(NPC)in Sun yat?sen university cancer hospital were enrolled and divided into two groups:222 cases in the NF group and 165 cases in the DDP group. The adverse reaction,5?year progression?free survival(PFS)and overall survival(OS)for 5 years were evaluated in two groups. Results The 5?year PFS in the NF and DDP group was 85.13%and 82.42%,respectively, with no significant difference. The 5?year OS in the NF and DDP group was 85.58% and 82.42%,respectively, with no significant difference. The proportion of oral mucositis in the NF group was significantly lower than that in the DDP group. Conclusion Nedaplatin plus fluorouracil radiation therapy has similar curative effect ,adverse reaction with cisplatin plus the same radiation therapy in the treatment of locally advanced nasopharyngeal carcinoma.

Objective To establish a real-time quantitative PCR(RQ-PCR)assay for fast detection of invasive fungi DNA in human whole blood samples with universal fungi primers and probe.Methods The universal fungi primers and the TaqMan-probe were designed on the basis of the multi-copy 5.8S region of the rDNA of the clinically most common invasive fungi.The invasive fungi genomic DNA were extracted with QIAamp?DNA Blood Mini Kit.A 20 μl RQ-PCR amplification system was established,and the simulated blood samples containing various given load of invasive fungi genome and the 71 whole blood samples of the surgical febrile patients were examined.Results The detection limit is 101 copies/μl amplification mixture,namely 105 copies/ml whole blood.The sensitivity and the specificity were 95.5％ and 97.6％,respectively; and the positive predictive value and negative predictive value were 98.7％ and 92.0％,respectively.The correlation coefficient of standard curve was between 0.9931 and 0.9977.The intra-and the inter-assay average coefficients of variation were(10.4 ±4.0)％ and(27.9 ± 2.0)％,respectively.The average relative recovery rate of fungi genomic DNA in blood samples was(91.0 ±7.6)％,and the average coefficients of variation of the relative recovery rate was(14.9 ±4.0)％.No fungi DNA was detected among the 71 blood samples of the surgical febrile patients.Conclusions The RQ-PCR assay for fast quantitative detection of invasive fungal DNA in human whole blood samples with the universal fungi primers and the TaqMan-probe was of high sensitivity,specificity,accuracy and precision,and is able to discriminate fungi from bacteria.The invasive fungi genome was not detected in this group of surgical patients,which may imply the less possibility of fungi translocation in the surgical febrile patients.

Objective To observe the effect of a variety dosage of dexmedetomidine on circulatory and cognitive func?tions in elderly patients who underwent hip orthopedic surgery. Methods A total of 120 patients who underwent hip ortho?pedic surgery, with age over 65 years old were recruited from 06/2013 to 09/2014 and were administered intravenously dex?medetomidine after epidural anesthesia. Based on the dosage of dexmedetomidine, patients were randomly divided into 3 groups with 40 cases in each group:Group A were given 0.2μg·h-1·kg-1 dexmedetomidine;Group B were given dexmedeto?midine 0.4μg · h-1 · kg-1, and group C were given 0.6μg · h-1 · kg-1. The heart rate (HR),mean arterial pressure (MAP), and pulse oxygen saturation (SpO2) were recorded at 6 time points, including the time entering operating room (T0), 10 min (T1), 20 min (T2) after drug administration, the time of drug withdrawal (T3), 10 min after drug withdrawal (T4) and the terminal time of surgery (T5) respectively. Cognitive function was evaluated by mini-mental state examination (MMSE) at the time points of 24 hours before surgery (t1), 12 hours (t2), 24 hours (t3), and 72 hours (t4) after surgery. Results All 3 groups of pa?tients show no significant difference of MAP, HR and SpO2 at T0 (P>0. 05).A significant decrease in MAP and HR were ob?served in Group C at T2 and T3 time points compared to those in Group A or Group B (P<0.05). There was no significant dif?ference in MMSE at time point T1 among all three groups (P > 0.05). However, compared to that in group A or group C, MMSE increased significantly at time point T2, T3 in group B (P<0.05). In addition, compared to group A or group C, the pa?tients in group B exhibited lower incidence of postoperative cognitive function disorder (P < 0.05). Conclusion Continu?ous intravenous infusion of Dexmedetomidine can be used in elderly patient who underwent hip orthopedic surgery at the dose of 0.4μg·h-1·kg-1 safely with little interference to circulatory and cognitive function in perioperative period.

OBJECTIVE:To evaluate therapeutic efficacy and safety of ubenimex combined with chemotherapy in the treatment of malignant tumor,and to provide evidence-based reference in clinic.METHODS:Retrieved from Central,PubMed,CJFD,VIP and Wanfang database,randomized controlled trials (RCTs) about ubenimex combined with chemotherapy (trial group) vs.single chemotherapy (control group) in the treatment of malignant tumor were collected.The quality of studies were evaluated by bias risk evaluation criteria of Cochrane system evaluator manual 5.1.0 after screening literatures and extracting data.Meta-analysis was performed by using Rev Man 5.3 statistical software.RESULTS:A total of 12 RCTs were included,involving 762 patients.The resuits of Meta-analysis showed that:shorter-term response rate [RR=1.24,95 ％ CI (1.08,1.43),P=0.002] and the improvement rate of life quality Karnofsky score [RR=1.69,95％ CI(1.46,1.95),P＜0.001] in trial group were significantly higher than control group;the incidence of gastrointestinal toxicity [RR=0.74,95％CI(0.57,0.94),P=0.02] and leucocyte suppression rate[Ⅰ °-Ⅳ°(＜3 months):RR=0.54,95％CI(0.37,0.79),P=0.002;Ⅲ°-Ⅳ°:RR=0.44,95％CI(0.29,0.68),P＜0.001] were significantly lower than control group,with statistical significance.CONCLUSIONS:Ubenimex combined with chemotherapy can improve malignant tumor,shorter-term efficacy and life quality,and reduce gastrointestinal and marrow toxicity.

Objective To explore the effect of galanin ( GAL) on locus coeruleus ( LC) neurons from neonatal rat and mechanism with its receptor GalR and potassium channel.Methods Brain slices from neonatal rats were prepared and the resting membrane potential and spontaneous action potential of LC neurons were recorded with whole cell patch-clamp configuration.GAL, AR-M1896 and potassium channel blockers were bath applied with different concentration.Results Bath application GAL induced hyperpolarization and inhibited firing rate of LC neurons.However, AR-M1896 ( a selective GalR2 agonist) did not induce significant effect on LC neurons, only at very high concentration(1μM) it induced slight hyperpolarization and reduced firing rate.The inhibitory effect of GAL was partially blocked by TEA ( an antagonist of voltage-dependent potassium channel) and significantly blocked by BaCl2(an antagonist of inward-rectifying potassium channels), while other potassium channels blockers such as Glybenclamide(ATP-sensitive potassium channel blocker),Charybdotoxin(large-conductance Ca2 +-activated K + channels blocker),Apamin(small-conductance Ca2 +-activated K +channels blocker) failed to block it.Conclusion GAL inhibits LC neurons from neonatal rats, mainly through GalR1.TEA-sensitive potassium channels and inward-rectifying potassium channels, but not ATP-sensitive potassium channel and calcium-activated potassium channel, are involved in this inhibition.

Objective:To investigate the influence of propofol on the binding function of GABA A receptor. Methods: By using radioligand receptor binding assay, effects of propofol on the specific binding of 3H GABA and saturation curves of GABA A receptor were observed in cortical membrane preparations from mouse cerebral cortex. Results: Specific binding experiments showed that propofol at the concentrations of 10 300 ?mol/L markedly enhanced the specific binding of 3H GABA( P 0.05). Conclusion: Clinical concentrations of propofol can enhance the binding function of GABA A receptor through increasing the affinity of the low affinity binding site of GABA.

Objective To establish a real-time quantitative polymerase chain reaction (RQ-PCR) assay for fast detection of Aspergillus fumigatus genome in human whole blood samples and explore its clinical application.Methods The primers and the TaqMan-probe were designed on the basis of the multi-copy ITS1-5. 8S region of the rDNA of Aspergillus fumigatus. The Aspergillus fumigatus genomic DNA were extracted with QIAamp(R) DNA Blood Mini Kit.A 20 μl RQ-PCR amplification system was established, and the simulated blood samples containing various given load of Aspergillus fumigatus genome and the 66 whole blood samples of the surgical febrile patients were examined. Results The detection limit of the RQ-PCR instrument is 10-1 genomes/μl DNA sample,namely 78 CFU/ml whole blood. The specificity and the sensitivity were 94. 25% and 99. 04% respectively; and the positive predictive value and negative predictive value were 97. 63% and 97. 62% respectively. The average relative error of the quantitative results was (3. 67 ±13. 19)%, and the intra- and the inter-assay average coefficients of variation were (12.38 ± 1. 53)% and (16. 27 ±2. 72)% , respectively. The average recovery rate of Aspergillus fumigatus genomic DNA in human whole blood samples was (107. 81 ±25. 92)% , and the average coefficient of variation of the average recovery rate was (26. 24 ± 5.62) % . No Aspergillus fumigatus genomic DNA was detected among the 66 blood samples of the surgical febrile patients. Conclusions The RQ-PCR assay for fast quantitative detection of Aspergillus fumigatus genome in human whole blood samples is of high sensitivity, specificity,accuracy and precision. The Aspergillus fumigatus genome was not detected in this group of surgical febrile patients.