Objective To compare the effect of different sevoflurane induction methods on hemodynamics and immune function in elderly patients with tumor. Methods One hundred and sixty elderly patients with tumor underwent general anesthesia were enrolled, the patients were divided into observation group and control group according to the anesthesia method with 80 cases each. The observation group was received induction method of initial concentration of 2%sevoflurane and increased by 1% per 3 times breathing and then to a final concentration of 4%- 5%. The control group was received 5% sevoflurane induction concentration. The anesthesia induction time, intubation time, recovery time and untoward reaction were recorded. The changes of heart rate, mean arterial pressure (MAP), oxygen saturation of pulse (SpO2), bispectral index (BIS) and CD3+, CD4+, CD8+, CD4+/CD8+were observed. Results There were no statistical differences in BIS, heart rate, SpO2, CD3 +, CD8 + and incidence of untoward reaction between 2 groups (P>0.05). The MAP at immediate intubation in observation group was significantly higher than that in control group:(69.38 ± 10.42) mmHg (1 mmHg=0.133 kPa) vs. (58.52 ± 6.12) mmHg, but the MAP at after intubation was significantly lower than that in control group: (77.12 ± 11.31) mmHg vs. (90.13 ± 9.24) mmHg, there were statistical differences (P<0.05). The anesthesia induction time and intubation time in observation group were significantly longer than those in control group:(110.1 ± 14.2) s vs. (101.4 ± 15.8) s and (341.2 ± 57.3) s vs. (310.4 ± 60.8) s, but the recovery time was significantly shorter than that in control group: (271.2 ± 31.3) s vs. (321.8 ± 41.5) s, there were statistical differences (P<0.05). The CD4+and CD4+/CD8+at end of surgery and 1 d after surgery in observation group were significantly higher than those in control group, CD4+:0.241 ± 0.027 vs. 0.182 ± 0.034 and 0.332 ± 0.039 vs. 0.284 ± 0.042, CD4+/CD8+: 0.84 ± 0.12 vs. 0.69 ± 0.13 and 1.09 ± 0.52 vs. 0.93 ± 0.43, there were statistical differences (P<0.05). Conclusions Induction method of gradually increasing concentration of sevoflurane enables the hemodynamics of elderly tumor patients more stable. In addition, this method can reduce the inhibitory effect on T lymphocytes to some extent.

In the non-invasive magnetic nerve stimulation of human brain, the coil of figure "8" is mostly used. The peak maximum is corresponding to the center of the coil, and the negative peak value is corresponding to the twain edges of the coil, the latter one is apt to cause abnormal nerve excitation. In this text, we put emphasis on the study of abnormal stimulation induced in magnetic stimulation and analyse the electric field intensity of the figure-8 coil. Aiming at the large negative value of intensity, we develop a new structure coil to restrain abnormal stimulation. Theoretical simulation is demonstrated here also.
Computer Simulation ; Electric Stimulation ; instrumentation ; methods ; Electromagnetic Fields ; Electromagnetic Phenomena ; instrumentation ; Equipment Design

Objective To evaluate the mechanical stability of alternative reconstruction methods after total en bloc spon?dylectomy in the lower lumbar spine. Methods Eight adult fresh cadaveric lumbosacral spines (L1-S1) were adopted. Total en bloc spondylecotmy of the L4 vertebra was performed after intact testing. Four designed reconstruction samples were tested for the range of motion (ROM) of the spine:1) expandable artificial vertebral body and short posterior instrumentation at L3-L5 (SP), 2) ex?pandable artificial vertebral body and short posterior instrumentation with additional anterolateral fixation at L 3-L5 (ASP), 3) ex?pandable artificial vertebral body and multilevel posterior instrumentation at L2-S1 (MP), 4) expandable artificial vertebral body and multilevel posterior instrumentation with additional anterolateral fixation at L2-S1 (AMP). Nondestructive biomechanical test?ing was performed on each construct under loading control. The ROM for each construct was obtained by applying pure moments in flexion, extension, lateral bending, and axial rotation. Results In flexion, extension and lateral bending, the ROM of all the re?constructed constructs significantly decreased compared to the intact. The ROM of specimens with anterolateral fixation was less when compared to the ones without additional fixation. In lateral bending, MP (L:1.87° ± 0.32° , R:1.97° ± 0.33° ), ASP (L:1.89° ± 0.37°, R:2.08°±0.36°) and AMP (L:1.32°±0.29°, R:1.61°±0.33°) provided significantly less ROM than the SP (L:3.14°±0.35°, R:3.44°±0.34°). In axial rotation, the ROM of ASP (L:4.21°±0.58°, R:4.02°±0.59°) and AMP (L:3.56°±0.55°, R:3.52°±0.48°) was significant decreased when compared to the intact state (L: 7.47° ± 1.00° , R:7.57° ± 0.84° ). MP (L:6.33° ± 0.71° , R:5.88° ± 0.62°), ASP and AMP showed significantly less ROM than the short posterior fixation (L:9.28°±1.01°, R:9.48°±0.98°). AMP sig?nificantly decreased the ROM compared to MP. Conclusion After total en bloc spondylectomy of lower lumbar, long segmental fixation provided more stability to the construct than the short one. Compared to posterior fixation, circumferential fixations showed a higher stability. In contrast, multilevel segmental instrumentation with circumferential fixation did not provided more stability than the short constructs.

Objective:To explore the application of 3D printing technology-assisted standardized applicator in the image-guided adaptive brachytherapy (IGABT) for cervical cancer.Methods:Twenty-three patients with stage Ⅲ B cervical cancer with extensive paracervical invasion after external irradiation (45 Gy/25f) were treated with IGABT, and the prescription dose was 7 Gy/f×4f. According to the regression of tumor on MRI before and after external irradiation, the range of brachytherapy was determined, and the under dose area of standard intracavitary/interstitial applicator (IC+ IS) was estimated. The virtual transperineal needle channel was inserted in the under dose area, the angle, spacing and depth of implantation were optimized. The auxiliary templates were designed with graphic design software, and 3D printing technology was utilized to print the auxiliary templates. The auxiliary templates were closely combined with the standardized applicator. Under the anesthesia condition, ultrasound-guided applicator was completed, and patients were scanned with MRI image after operation. The MRI images were introduced into treatment planning system (TPS) to delineate the target area and organs at risk, and the treatment plans were optimized to complete the plan evaluation and treatment. Results:The average printing time of templates was (3.5±1.0) h, 382 implant needles were inserted guided by auxiliary templates, (4.2±1.5) template-guided implant needles were used in each fraction and the weight ratio was (16.49±9.50)%. The total dose of HR-CTV D 90% EQD 2Gy, α/ β=10 was (90.45±3.03) Gy, and IR-CTV D 90% EQD 2Gy, α/ β=10 was (66.46±3.68) Gy. The D 2cm 3 EQD 2Gy, α/ β=3 of the bladder, rectum, small intestine and sigmoid colon were (82.69±2.60) Gy, (73.20±2.52) Gy, (69.35±3.32) Gy and (69.39±3.27) Gy, respectively, all of which met the clinical dose requirements. The 1-and 2-year local control rates were 96% and 87%, 87% and 70% for the distant metastasis-free survival rates, and 96% and 78% for thea overall survival rates, respectively. Conclusion:The auxiliary applicators made by 3D printing technology can effectively compensate for the dose insufficiency of the standard applicator in the paracervical and other areas during the clinical brachytherapy in patients with stage Ⅲ B cervical cancer, providing an effective method for the brachytherapy of advanced cervical cancer.

OBJECTIVETo increase local blood supply of bone graft, a novel posterior lumbar spine fusion method with orthotopic paraspinal muscle-pediculated bone flaps was constructed, and the fusion rate and clinical effect.were observed.

METHODSFrom June 2007 to December 2010, 117 patients of lumbar spinal stenosis or lumbar destabilization treated with the novel posterior lumbar fusion method were studied, 49 males and 68 females, aged from 40 to 77 years, average 61.5 years. Clinical effect was evaluated by JOA and VAS score preoperatively and postoperatively, and the fusion result was evaluated by three-dimensional CT reconstruction postoperatively.

RESULTSSeventeen cases lost of follow up, the rest were followed up from 7 to 38 months, average 19 months. There was significant difference between pre- and postoperative JOA and VAS score (P < 0.01), the preoperative JOA score was 10.3 ± 1.9, and 25.4 ± 4.2 at the latest follow-up, the improvement rate was 81.0% ; the preoperative VAS score was 8.5 ± 0.8, and 2.3 ± 0.4 at the latest follow-up. The three-dimensional CT reconstruction showed that 126 of the 133 segments formed solid fusion in 100 patients who completed the follow-up, the fusion rate was 94.7%.

CONCLUSIONThe novel posterior lumbar fusion method make the bone graft position more precise, stable and increases the fusion rate, which can effectively reduce pseudarthrosis and have a promising clinical effect.

Adult ; Aged ; Bone Transplantation ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spinal Stenosis ; surgery ; Treatment Outcome

Objective:To explore the clinical efficacy and adverse reactions of the combination of external beam radiotherapy followed by three-dimensional intracavitary brachytherapy in patients with inoperable locally advanced rectal cancer.Methods:Clinical data of 11 patients with inoperable locally advanced rectal cancer, 7 male and 4 female, admitted to China-Japan Union Hospital of Jilin University from 2013 to 2015 were retrospectively analyzed. All patients received pelvic external irradiation (50 Gy in 25 fractions), followed by a three-dimensional intracavitary brachytherapy boost (15-20 Gy in 3-4 fractions, 1 fraction/week). External beam radiotherapy was used to boost the dose to the perirectal lymph nodes (60-66 Gy in 30-33 fractions). All patients received concurrent chemotherapy with Capecitabine during external beam radiotherapy. Efficacy evaluation was performed using the RECIST standard. Survival and local control rates were calculated using the Kaplan- Meier method. Early and late radiotherapy responses were assessed using the RTOG lesion grading criteria. Results:The CTV D 90% EQD 2 Gy of HDR 3D-ICBT among 11 patients was (21.3±1.60) Gy. The complete response (CR) and partial response (PR) rates were 64% and 27%, respectively, yielding an objective response rate (CR+PR) of 91%. With a median follow-up time of 36 months, the 1-, 2-, and 3-year overall survival rates were 82%, 64% and 46%, respectively. The 1-, 2-, 3-year disease-free survival rates were 64%, 45% and 27%, respectively. The 3-year local control rate was 46%. One patient presented with lung metastases after 8 months, 7 patients experienced grade 1-2 acute intestinal reactions and 5 patients developed grade 1-2 acute bladder reactions, only one patient had grade 2 myelosuppression; long-term grade 1-2 intestinal reactions occurred in 5 patients, and 1 patient had long-term grade 1-2 bladder reaction. All the radiation-induced toxicities were alleviated by medication administration. Conclusions:External beam radiotherapy followed by three-dimensional intracavitary brachytherapy can be a safe and effective surrogate in patients with inoperable locally advanced rectal cancer, which yields reliable clinical efficacy and tolerable adverse reactions.

Inherited retinal diseases (IRDs), including retinitis pigmentosa, Usher syndrome, Cone-Rod degenerations, inherited macular dystrophy, Leber's congenital amaurosis, Leber's hereditary optic neuropathy are the most common and severe types of hereditary ocular diseases. So far more than 200 pathogenic genes have been identified. With the growing knowledge of the genetics and mechanisms of IRDs, a number of gene therapeutic strategies have been developed in the laboratory or even entered clinical trials. Here the progress of IRD research on the pathogenic genes and therapeutic strategies, particularly gene therapy, are reviewed.
Biomedical Research ; methods ; trends ; Clinical Trials as Topic ; Genetic Predisposition to Disease ; genetics ; Genetic Therapy ; methods ; trends ; Humans ; Mutation ; Retinal Diseases ; genetics ; therapy ; Treatment Outcome