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.

Objective To compare the efficacy of different doses of ropivacaine for ultrasound-guided axillary brachial plexus block in children.Methods One hundred and twenty ASA Ⅰ or Ⅱ children,aged 5-12 yr,scheduled for elective surgery for hand injury,were equally and randomly divided into 4 groups according to the doses of ropivacaine:0.35,0.3,0.25 and 0.20 ml/kg groups.The children received oral midazolam 30 min before surgery.Propofol was given by target-control infusion after admission to the operating room.When the pediatric patients lost consciousness and had no response to verbal command,axillary brachial plexus block was performed under the guidance of ultrasound.0.25 ％ ropivacaine 0.35,0.3,0.25 and 0.20 ml/kg were injected to block the radial,median,ulnar,musculocutaneous and medial antebrachial cutaneous nerves.Additional ketamine was given when needed during operation.The duration of block and consumption of general anesthesia and complications were recorded.The degree of sensory block of the region innervated by each nerve and effectiveness of block were assessed.Results The rate of effective block of the radial nerve,median nerve and musculocutaneous nerve was significantly lower,the number of patients requiring ketamine was larger and the duration of block was shorter in group 0.2 ml/kg than in 0.35,0.30 and 0.25 ml/kg groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between 0.35,0.30 and 0.25 ml/kg groups (P ＞ 0.05).No pediatric patients developed block-related complications in each group.Conclusion Ultrasound-guided axillary brachial plexus block with 0.25 ％ ropivacaine 0.25 ml/kg can provide better block in children.

Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor.Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups.In the modified technique group (group A,n =10),tumor was resected until the ureteral orifice was exposed.Then,a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire.In control group (group B,7 cases),after ureteral orifice exposed,the guide wire and ureteral stent was placed with cystoscopy.The demographic,oncological baseline and operative factors were evaluated between two groups.Results There was no difference in tumor grade and maximum diameter between two groups (P ＞ 0.05).The operation time in group A was significantly shorter than that in group B [(39.5 ± 14.8)min vs (59.3 ± 16.2) min,P =0.020],and the intraoperative vision clarity score was better in group A as well [(7.7 ± 1.3) vs (5.9± 1.2),P =0.010].There was no statistical difference between the two groups in the complication.Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement.

Objective To determine the median effective target plasma concentration (Cp50) of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients.Methods Pediatric patients of both sexes,aged 5-12 yr,who grown normally,scheduled for elective forearm or hand surgery,were enrolled in this study.Children were premedicated with oral midazolam 0.2 mg/kg at 30 min before anesthesia.The initial target Cp of remifentainil was 5.0 ng/ml.The target Cp was determined by up-and-down sequential method.Each time Cp increased/decreased by 20％ in the next patient depending on the response of the previous patient to puncture.The ratio between the two successive concentrations was 1.2.The puncture was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as puncture-induced movement of truncus,limbs and/or head and neck.The Cp50 and 95 ％ confidence interval of remifentainil were calculated by Dixon method.Results Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block was 3.9 ng/ml,and 95 ％ confidence interval was 3.6-4.2 ng/ml.Conclusion Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block is 3.9 ng/ml in pediatric patients.

To investigate the effects of oxymatrine injection (OI) combined with low-dose paclitaxel on expressions of mRNAs and proteins of vascular endothelial growth factor (VEGF) and CXC chemokine receptor 4 (CXCR4) in human gastric carcinoma SGC-7901 cells.

Objective To explore the efficacy and safety of Gemcitabine and Cisplatin combination chemotherapy in treatment of muscle-invasive urothelial cell carcinoma.Methods Analyse of 72 cases of patients with muscle-invasive urothelial cell carcinoma receiving chemotherapy from September 2010 to September 2012,including 47 male and 25 female,the avarage age was 65 (86-33).All patients were received GC chemotherapy (Gemcitabine 800-1 000 mg/m2,ivgtt,dl,d8,d15; Cisplatin 70 mg/m2,ivgtt,d2).Efficacy was reviewed after 1 cycle of chemotherapy.Results Fifty-one cases in all the patients completed two or more chemotherapy cycles and CR 10 cases,PR 27 cases,total effective rate was 51.39％ (37/72).The main toxic reactions included nausea,vomit,myelosuppression,and then damage of liver and renal function.Cconclusion GC regimen is a good choice for urothelial cell carcinoma.Close follow-up and the usage of adjuvant drugs can contribute to reduce the side effect of chemotherapy.

Objective To compare target volume and dosimetry between computed tomography (CT)?and magnetic resonance imaging (MRI)?guided three?dimensional (3D) conformal brachytherapy for locally advanced cervical cancer, and to provide evidence for optimization of the image?guided approach and improvement of treatment regimen. Methods Thirteen patients with locally advanced cervical cancer who were treated with radical radiotherapy in our hospital in 2014 were enrolled as subjects. All patients received MRI?guided 3D conformal intracavitary/ interstitial brachytherapy. All patients received MRI and CT scans for each brachytherapy fraction, based on which the target volume delineation, intracavitary/ interstitial regimen design, and intracavitary?only treatment regimen design were performed. Comparison of data between MRI and CT scans was performed using paired t test. Results The width and volume of the high?risk clinical target volume ( HR?CTV) were significantly smaller in the MRI simulation than in the CT simulation ((38.0±9?? 4) mm vs. (45.1±8?? 7) mm, P= 0?? 000;(34.2±15?? 3) cm3 vs. (42.9±20?? 4) cm3 , P= 0?? 002), and the width, thickness, and volume of the intermediate?risk clinical target volume (IR?CTV) were also significantly smaller in the MRI simulation than in the CT simulation ((58.8±9?? 4) mm vs. (65.4±10?? 3) mm, P= 0?? 000;(34.8±6?? 3) mm vs. (37.5±6?? 3) mm, P= 0?? 001;(90.9±28?? 5) cm3 vs. (109.0±36?? 4) cm3 , P= 0?? 000). The D90 values for HR?CTV and IR?CTV were significantly higher in the MRI simulation than in the CT simulation (87?? 6 Gy vs. 85?? 8 Gy, P= 0?? 013;67?? 7 Gy vs. 66?? 3 Gy, P= 0?? 005), while the average D2 cm3 values for the bladder and rectum were significantly lower in the MRI simulation than in the CT simulation ( 73?? 1 Gy vs . 75?? 5 Gy , P= 0?? 011 ; 61?? 0 Gy vs . 65?? 7 Gy , P= 0?? 000 ) . Conclusions Compared with the MRI simulation, the CT simulation overestimates the width of target volume. MRI has substantial advantages in dosimetry for target volume and normal tissues. The intracavitary/ interstitial treatment can make up the reduced dose for the target volume resulting from the CT simulation.

Objective To evaluate the efficacy of liver grafts with warm ischemia and with different cold preservation time in liver transplantation.Methods The clinical data of 154 patients who received liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2007 were retrospectively analyzed.The warm ischemia time of the liver grafts obtained from the non-heart-beating donors was within 10 minutes.According to cold perservation time of the liver grafts,patients were divided into 3 groups:the cold preservation time of the liver grafts was within 8 hours,8-12 hours and above 12 hours in group I(n=58),group Ⅱ(n=62)and group Ⅲ(n=34),respectively.The peak level of alanine aminotransferase(ALT),primary graft dysfunction(PGD)after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections and the survival of liver grafts and recipients among the 3 groups were analyzed via chi-square test,t test and variance analysis.Results No PGD was detected in the 3 groups after liver transplantation.All patients were followed up for 8-32 months.The peak level of ALT,incidence of infection and biliary complication,survival of liver grafts and recipients were(482±357)U/L,12%(7/58),12%(7/58),86%(50/58)and 88%(51/58)in group Ⅰ,and were(1274±608)U/L,29%(10/34),26%(9/34),68%(23/34)and 71%(24/34)in group Ⅲ,with significant difference between the 2 groups(t=5.23,X~2=4.28,6.77,4.51,4.28,P<0.05).The peak level of ALT in group Ⅱ was(953±424)U/L,which was significant higher than(482±357)U/L in group Ⅰ(t=4.76,P＜0.05).Conclusions Liver grafts with a warm ischemia time shorter than 10 minutes could tolerate the injury caused by cold preservation with the maximum time of 12 hours.The incidences of biliary complications and postoperative infections are significantly increased and the survivals of liver grafts and recipients are decreased when the cold preservation time exceeds 12 hours.

BACKGROUND:Nowadays,liver grafts for transplantation are clinically sourced from non-heart-beating donors.Moreover,there is still no uniform determination of safe time limit points for non-heart-beating donor liver in warm ischemia and cold preservation.OBJECTIVE:To evaluate the application safety and curative effects of warm ischemia liver graft affected by varied cold ischemia time (CIT) in liver transplantation.DESIGN,TIME AND SETTING:A randomized controlled observation was performed in the Organ Transplantation Center,First Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2007.PARTICIPANTS:154 cases who underwent non-heart-beating liver transplantation were included in this study.All liver graftsinvolved had a warm ischemia time(WIT) less than 10 minutes.METHODS:All cases were assigned into 3 groups according to CIT:group Ⅰ (CIT＜8 hours,n=58),group Ⅱ (CIT 8-12hours,n=62),and group Ⅲ (CIT 13-16 hours,n=34).The liver grafts were randomly allocated for the patients.Following liver transplantation,the same immunosuppression protocol was employed for each group.MAIN OUTCOME MEASURES:Following surgery,peak level of alanine aminotransferase (ALT),primary graft dysfunction (PGD) after liver transplantation,acute rejection response,biliary complications,vessel complications,perioperative infections,graft and recipient survival rate were compared among 3 groups.RESULTS:Follow-up time was 8-32 months.No PGD was detected in all 154 cases.Group Ⅱ showed postoperative ALT peak levels significantly higher than group Ⅰ (P＜ 0.05).There was no significant difference between groups Ⅰ and Ⅱin terms of acute cellular rejection,perioperative infection,biliary complication,vessel complication,graft survival rate,and recipient survival rate (P＞0.05).Compared with group Ⅰ,the group Ⅲ exhibited significantly increased postoperative ALT peak level,biliary complications,and perioperative infections,and significantly decreased graft and recipient survival rate (P＜0.05).CONCLUSION:Non-heat-beating-liver grafts with less than 10 minutes of warm ischemia can tolerance 12 hours of cold ischemia.More than 12 hours,postoperative liver transplantation complications ascend and,contradictorily,graft and recipient survival rate descend.

Objective To investigate the effects of ischemic preconditioning on the cholesterol content and the activity of Na+-K+-ATPase of hepatocytes following cold preservation in rats.Methods Twenty-five rats were randomly divided into five groups,including control group (C),cold preservation group (Ⅰ),ischemic preconditioning group (ⅠP),atorvastatin (30 μmol/L) treatment group (A30),and atorvastatin (100 μmol/L) treatment group (A100).The cholesterol content and the activity of Na+ -K+ -ATPase were assessed.Results The cholesterol contents on the rat liver tissue cell membrane in the C group,Ⅰ group,ⅠP group,A30 group and A100 group were (310.4 ± 27.5),(187.7±13.1),(394.3±25.9),(201.8±14.6) and (122.6±7.7) nmol/mg protein,and activity of the Na+ -K+ -ATP enzyme was (46.55 ± 3.20),(27.4 ± 2.81),(52.71 ± 3.02),(30.67 ±2.78) and (19.64 ± 2.11) μmol Pi/hr mg protein,respectively (P＜0.05).There was no significant difference in the plasma membrane phospholipid content among the five groups (P＞0.05).Conclusion Reduction of cholesterol content and Na+ K+ -ATPase activity on the liver cytoplasmic membrane is one of the factors causing donor liver cold preservation injury,but ischemic preconditioning can significantly improve cell membrane Na+ -K+ -ATPase activity and increase cytoplasmic membrane cholesterol content. Use of atorvastatin statins can reduce cytoplasmic membrane cholesterol synthesis,and significantly decrease Na+ -K+ -ATPase activity,thereby alleviating the donor liver cold preservation injury.