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 investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction.Methods Sixty ASA Ⅱ or Ⅲ patients aged 65-76 years [mean (70.4±6.3) years],weighing 50-75 kg,with moderate and severe pulmonary dysfunction,who were scheduled for elective radical operation for esophageal cancer,were randomly divided into 3 groups (n=20,each) by using a random number table:the control group (group C),RIPC group (group OR) and RIPC plus dexmedetomidine group (group ORD).At 10 min after endotracheal intubation,group ORD was induced by three cycles of 5 min of lower extremity ischemia followed by 5 min of reperfusion,at the same time a loading dose of dexmedetomidine 0.5 μig / kg was infused iv over 15 min,and then was infused at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.Group OR was induced by three cycles of 5 min of lower extremity ischemia followed by 5min of reperfusion without dexmedetomidine.Group C received only the equal volume of normal saline.Blood samples were obtained from radial artery immediately before anesthesia induction (T0),before one lung ventilation (T1),at 1 h after one lung ventilation (T2),the end of surgery (T3) and 24 h after operation (T4).Blood gas analysis was done at T1,T2,and T3.Plasma superoxide dismutase (SOD) activity and concentration of malonyldialdehyde (MDA),matrix metallo-proteinase-9 (MMP-9),interleukin-6(IL-6) and white blood cell (WBC) and neutrophil granulocyte (PMN) counts were measured at T0,T2,T3 and T4.The complications including pulmonary infection and atelectasis were recorded at 1,3 and 7 days after operation.Results At T2-3,PaO2 was higher in groups of OR and ORD than in group C Group ORD had higher PaO2 than did group OR [(265±15) mmHg,(305±23) mmHg vs.(231±17) mmHg,(273±21)mmHg,(312±24) mmHg vs.(242±18) mmHg,F=34.791 and 31.813,P＜0.01].At T2-3,RI was lower in groups of OR and ORD than in group C,and group ORD had lower RI than did group OR [(1.48±0.16),(1.14 ±0.14) vs.(1.86±0.18);(1.35±0.13),(0.96±0.09) vs.(1.73±0.15),F=119.260 and 164.855,P＜0.01].At T3-4,SOD activity was higher in group OR and ORD than in group C,and group ORD had higher SOD activity than did group OR [(83.6 ± 7.8) U/mg prot,(97.6± 9.5) U/mgprot vs.(70.5±7.4) U/mgprot;(73.5 ± 6.3) U/mgprot,(87.7 ± 8.9) U/mgprot vs.(61.6 ± 5.4) U/ mgprot,F=94.540 and 90.839,P＜0.01].At T3-4.plasma concentration of MDA,MMP-9,WBC and PMN counts were lower in group OR and ORD than in group C,and the above indices were lower in group ORD than in group OR [(7.5 ± 1.4) nmol/mgprot,(5.8 ± 1.0) nmol/mgprot vs.(9.5 ±1.5) nmol/mgprot;(8.2± 1.5) nmol/mgprot,(6.5 ± 1.0) nmol/mgprot vs.(10.1 ±1.6) nmol/mgprot;(205±23) μg/L,(173±21) μg/L vs.(237±26) μg/L,(179±16) μg/L,(158±12) μg/L vs.(203± 20) μg/L;(8.0±0.5) ×109/L,(7.2±0.6) × 109/L vs.(9.2±0.8)×109/L;(9.4±0.7) ×109/L,(8.2±0.6)×109/Lvs.(11.2±0.8) ×109/L;(7.4±0.7) ×109/L,(6.5±0.5) ×109/Lvs.(8.3 ±0.8) ×109/L,(7.8±0.8) ×109/L,(6.7±0.6) ×109/L vs.(9.2±0.9) ×109/L,F=98.872,52.723;198.307,47.622,20.319,36.935,18.197,35.036,respectively,all P＜0.01].At T2-4,IL-6 level was lower in groups of OR and ORD than in group C,and group ORD had lower IL-6 level than did group OR [(105±14) ng/L,(86±12) ng/L vs.(127±18) ng/L;(125±19) ng/L,(101±16) ng/ L vs.(156±22) ng/L;(110±16) ng/L,(89±12) ng/L vs.(132±20) ng/L,F=85.449,139.848,124.129,respectively,P＜0.01].The incidences of postoperative pulmonary infection and atelectasis were lower in group OR and ORD than group C,and group ORD had lower incidences of postoperative pulmonary infection and atelectasis than did group OR (x2 =6.303 and 14.545,P ＜ 0.05).Conclusions RIPC combined with dexmedetomidine can improve pulmonary function in elderly patients with thoracotomy and pulmonary dysfunction,may relieve the inflammatory reaction and oxidation reaction during perioperative period and finally help to improve the prognosis of patients.

Objective To investigate the dosimetric differences between Utrecht applicator and ring applicator in three-dimensional (3D) conformal brachytherapy for locally advanced cervical cancer.Methods Twenty-five patients with locally advanced cervical cancer were treated with magnetic resonance imaging-guided 3D conformal brachytherapy.Utrecht applicator and ring applicator were used interchangeably for 96 cycles.Patients were divided into two groups according to the type of applicator.Each group received 48 cycles of treatment, in which ring applicator was first applied for 26 cycles and Utrecht applicator was first applied for 22 cycles.High-risk clinical target volume ( HR-CTV) , width, thickness, and D90 at the point A level, D2 cm3 of organs at risk (OARs), V7 Gy , W7 Gy,A, V7 Gy ,A, and W/T7 Gy were evaluated and analyzed using paired t-test.Results There were no significant differences in HR-CTV and the width, thickness, and D90 at the point A level between the Utrecht group and the ring group ( P=0.487;P=0.340;P=0.857;P=0.921);there were no significant differences in D2 cm3 values of bladder, rectum, sigmoid, and bowel between the two groups ( P=0.136;P=0.802;P=0.985;P=0.458);there were no significant differences in V7 Gy and T7 Gy,A between the two groups ( P=0.076;P=0.435) .The Utrecht group had a significantly larger W/T7 Gy,A than the ring group ( P=0.002 ) .Conclusions Utrecht applicator is appropriate for patients with relatively large width and width/thickness ratio of HR-CTV at the point A level.

Objective To evaluate the immunogenicity and immunoprotective effect of heat shock protein 60 kDa (SjHSP60) of Schistosoma japonicum in mice after immunization and challenge infection, and explore the mechanism. Methods B cell/an?tibody?related databases and analysis tools were used to predict B?cell epitopes of SjHSP60. The mice were immunized with the recombinant SjHSP60 and challenged with S. japonicum cercariae. SjHSP60?specific antibodies in serum were detected by ELI?SA. The level of splenocyte proliferation was determined by 3H?TdR incorporation. Ex vivo suppression assay was performed to in?vestigate the effects of CD4 +CD25 + regulatory T cells (Tregs) induced by SjHSP60. Results SjHSP60 possessed multiple pre?dominant regions of B?cell epitopes. SjHSP60 induced a significant increase in both SjHSP60?specific IgG levels (P < 0.01) and splenocyte proliferation (P < 0.01) with a higher IFN?γ production (P < 0.01). However, the immunization with SjHSP60 resulted no significant reduction in adult worms (P > 0.05) and liver?accumulated eggs (P > 0.05) in S. japonicum?infected mice. Ex vivo assay showed that CD4+CD25+ Tregs from SjHSP60?immunized mice enhanced immunosuppressive activity. Conclusion SjH?SP60 has a dual role in host immune system, being involved in the induction of dominant humoral and cellular immune responses as well as in the enhancement of immunosuppression.

AIM: To determine the differences in phosphoproteome between LPS stimulated THP-1 cells with and without previous oxidative stress for screening of more potential regulators.METHODS: Differentiation of THP-1 cells into macrophages was induced by treatment with 100 ?g/L PMA for 36 h. Differentiated cells were rested for additional 36 h without PMA treatment, then treated with 100 ?mol/L H2O2 or medium for 1 h followed by LPS or medium treatment for 30 min. After desalted, phosphoproteins were enriched by phosphoprotein metal affinity column, and were run on 2-D electrophoresis, then the spots were analyzed to show the difference between LPS group (cells treated with LPS alone) and H2O2+LPS group (LPS stimulated cells also pretreated with H2O2). Finally, some of these spots were identified by MS and subsequent bioinformatic analysis was also conducted. RESULTS: Compared to LPS group, 29 reproducibly changed spots on the 2-D map in H2O2+LPS group were visualized and selected for MS analysis. Among these, 12 down-regulated spots (include those disappeared), 17 up-regulated spots (include those newly emerged) were selected. Up to now, 5 of these were identified, which were shown to be involved in various cellular processes such as proteolysis, signal transduction and protein folding. Among these, proteasome beta-4 subunit, which was dramatically down-regulated in H2O2+LPS group, was a major component of the proteasome complex and might participate in LPS signalling through various ways.CONCLUSION: With comparative phosphoprotein-affinity profiling, the interference brought by highly abundant house-keeping proteins is minimized, rendering us to detect less abundant signalling molecules. Aforementioned 5 proteins, especially proteasome beta-4 subunit, might be involved in LPS pathway reprogrammed by oxidative stress.

Fatal anaphylactic shock is common in forensic practice. However, it is difficult to diagnose for lacking specific pathological and morphologic changes in forensic autopsy. The application of some biochemical indicators is of great significance. This paper reviews the biological characteristics of some biochemical indicators and detection methods. The forensic application, problems and prospects of these indicators are also introduced in details. The stable biochemical indicators, IgE, tryptase and chymase, show great potential and advantages in the identification of fatal anaphylactic shock in forensic medicine.