Objective The aim of this study was to investigate the effects of different anesthetic drugs and techniques on serum SIL-2R, IL-6 and TNF-? in cancer patients undergoing elective thoracic surgery, trying to find a reasonable anesthesia for patients with compromised immune function. Methods Eighteen ASA Ⅰ-Ⅱ cancer patients(male 12, female 6) undergoing elective thoracic surgery were studied. The age ranged from 46-47 years. 6 patients suffered from lung cancer and 12 from cancer of esophagus or cardia. The patients received no radio-or chemotherapy before surgery. They were premedicated with intramuscular pethidine 50mg and atropine 0.5mg. Esophogus and cardia cancer patients were randomly divided into two groups: group Ⅱ and Ⅱ . Group Ⅲconsisted of only lung cancer patients. Group I received general anesthesia combined with continuous epidural block and postoperative epidural analgesia. An epidural catheter was inserted at T7-8 or T8.9 before general anesthesia. Anesthesia was induced with 2% thiopental sodium 5mg kg-1 and vecuronimn 0.06-0 .08mg kg-1 and maintained with 1%-2% isoflurane inhalation with epidural 2% lidocaine 6-7m1o h-1 . After operation epidural analgesia was produced with 0.125% bupivacaine 5-6ml h-1 for 72 h. In group Ⅱ the induction of general anesthesia was the same as in group Ⅰ , but anesthesia was maintained with ketamine infusion 1-2mg kg-1h-1 and epidural 2% lidocaine 6-7ml h-1. Postoperative analgesia was produced with epidural 0.1% bupivacaine + 0.0003% fentanyl 5-6m1o h-1 for 72 h. In group Ⅲ the induction and maintenance of anesthesia were the same as in group Ⅱ but postoperative analgesia was produced with epidural 0.1 % ketamine 4-5ml h-1. Blood samples were taken from peripheral vein before anesthesia, before and 2 h after skin incision and on the 1st, 3rd and 5th day after operation for determination of serum SIL-2R, IL-6 and TNF-? by ELISA(Genozyme Co) Results The serum SIL-2R, IL-6 and TNF-? levels were comparable before anesthesia and operation among the three groups. Serum SIL-2R decreased significantly at 2 h after skin incision(P

Objective To investigate the antibiotic-resistant gene mecA and the prevalence of Panton-Valentine leukocidin (PVL) gene, toxic shock syndrome toxin (TSST-Ⅰ) gene in S. aureus. Methods A total of 74 S. aureus were collected from clinical specimens. The mecA, PVL and TSST-Ⅰ genes were detected by PCR.Results PVL gene was identified in 22 S. aureus isolates. The prevalence of PVL was 29.7% in S. aureus, 36.6% in MRSA and 21.2% in MSSA. The difference was not statistically significant (P>0.05). The prevalence of MRSA was 55.4% in 74 S. aureus. The prevalence of TSST-Ⅰ gene was 6.8%. TSST-Ⅰ gene was not detected in MSSA.Conclusions MRSA strains show highly resistant to antibiotics. PVL- and TSST-Ⅰ-positive S. aureus are more pathogenic.

Objective To investigate the effect of solution-focused therapy on the care burden and negative emotions of the primary caregivers with elderly patients with hip fractures. Methods One hundred and sixty-eight elderly patients with hip fractures and caregivers were divided into intervention group and control group with 84 pairs by random digits table method, and the two groups were given continual nursing care. At the same time, the primary caregivers of intervention group accepted the solution-focused therapy. Caregiver Burden Inventory (CBI), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were used as the evaluation indexes. Results Before intervention, the score of CBI, SAS,SDS was (42.07 ± 4.24), (50.75 ± 11.21), (51.59 ± 13.18) points in control group and (42.10 ± 3.96), (50.48 ± 12.59), (52.96 ± 13.51) points in intervention group, and there was no significant differences between two groups (P>0.05). After intervention, the score of CBI, SAS, SDS was (40.49±3.17), (50.64±11.33), (50.14±10.25) points in control group and (28.95±2.87), (36.73±9.45), (41.60±8.23) points in intervention group, and there was significant differences between two groups (t=5.42, 8.73, 7.45, all P<0.05). Conclusions Solution-focused therapy can effectively reduce the care burden of the primary caregivers of elderly patients with hip fractures and alleviate their anxiety and depression.

Objective To evaluate the differences of serum TSH of suspicious subclinical hypothyroidism determined by four automatic biochemical analyzers and the impact on clinical diagnosis and treatment.Methods Taking results of Roche Cobas e601 laboratory test as a reference, 103 serum samples with TSH 2.50-10.00 mU/L(90 with TSH≥4.27 mU/L) and normal FT3, FT4 were selected.Four different automatic biochemical analyzers (Cobas e601, Immulite2000, Centaur XP, I2000) were used to measure TSH of the serum samples at the same time.Wilcoxon signed rank test, Spearman correlation analysis were used for data analysis.Results TSH (M(P25, P75)) measured by 4 methods were 5.20(4.73, 6.40), 2.95(2.59, 3.48), 3.30(2.94, 4.15) and 4.10(3.43, 4.75) mU/L, which varied significantly from one assay to another (z values:-8.78,-8.41,-7.64,-8.09,-8.50, all P<0.05).The correlations between methods were of great differences (rs ranged from 0.45 to 0.92).Significant differences existed in each other for subclinical hypothyroidism diagnosis based on TSH cutoff respectively.Conclusion Results from different automatic immunoassay analyzers in patients with TSH of 2.50-10.00 mU/L varied widely, hence, it is indeterminate to diagnose subclinical hypothyroidism only relies on a single serum TSH test.

Objective To compare the consistence and difference between the assay results of the second generation of Tg (Tg Ⅱ) and the first generation of Tg (Tg Ⅰ) immunoassay,as well as to evaluate the impact of Tg Ⅱ on the clinical management of thyroid diseases.Methods Serum samples of 249 patients (30 with benign thyroid disorders and 219 with DTC;64 males and 185 females,average age 43.0 years)were collected and assayed by Tg Ⅱ and TgⅠ kits simultaneously.The measuring ranges of TgⅠ and TgⅡ were 0.10-1 000.00 μg/L and 0.04-500.00 μg/L,respectively.Data were analyzed by the Wilcoxon rank sum test and Spearman correlation analysis using IBM SPSS 19.0.Results The assay results of TgⅡ and TgⅠ strongly correlated (rs =0.979,P＜0.05).However,the median value of TgⅡ (2.31 (0.06-13.17) μg/L) was lower than that of TgⅠ(3.63(0.41-16.84) μg/L)(z=-13.25,P＜0.001).The difference between Tg Ⅱ and Tg Ⅰ got bigger when TgⅠ value decreased more.TgⅡ values were 11.09％ lower than TgⅠ (5.61(1.07-26.39) μg/L) vs 6.31(2.07-33.93) μg/L;z=-4.78,P＜0.05) in 30 patients with benign thyroid disorders and 37.71％ lower (2.18(0.07-7.47) μ.g/L) vs 3.50(0.39-10.18) μg/L;z=-9.02,P＜0.001) in 108 DTC patients without 131 Ⅰ treatment.But the above changes had no influence on clinical diagnosis and treatment.In the 71 DTC patients post 131Ⅰ treatment with low TSH and normal TgAb,there were 3 cases with TgⅠ＞1.0 μg/L but TgⅡ＜1.0μg/L,and 12 cases with TgⅠ＞0.1 μg/L but TgⅡ＜0.04 μg/L.Conclusions Serum TgⅡand Tg Ⅰ assay results are strongly correlated,though Tg Ⅱ value is slightly lower than Tg Ⅰ value.This difference may have no significant influence on the clinical diagnosis of thyroid diseases.However,TgⅡ may be better to evaluate the curative effect in some DTC patients post 131Ⅰ therapy.

Objective To observe the effects of oldhamianoside Ⅱ on the invasive 'ability of prostatic carcinoma DU-145 cells,and to investigate the potential mechanism.Methods After treatment of DU-145 cells with oldhamianoside Ⅱ,MTT assay was used to test the effect of oldhamianoside Ⅱ on the cell proliferation.The invasive ability was assessed with a transwell cell culture chamber.Immunocytochemistry stain was used to investigate the expression of matrix metalloproteinase(MMP-2)and CXC-chemokine receptor 4 (CXCR4).Results The proliferation of DU-145 cells was inhibited after treatment with oldhamianoside Ⅱ.In vitro invasion assay indicated that the cells moved through the membrane were(180.3 ± 14.6)/field in the control group,while decreased to(100.4 ±1.5),(80.2±2.7)and(60.1 ±5.3)/field in 0.25,0.5 and 1μg/mL oldhamianoside Ⅱ treated DU-145 cells respectively.Comparing to control group,the cells of oldhamianoside Ⅱ groups moved through the membrane were decreased remarkably(P ＜0.05).Immunocytochemistry showed that the expression of MMP-2 and CXCR4 were decreased of oldhamianoside Ⅱ groups.Conclusions Oldhamianoside Ⅱ can inhibit the invasiveness of DU-145 cells,which is related to the down regulation the expression of MMP-2 in DU-t45 cells.Oldhamianoside Ⅱ can inhibit the prostate cancer cells metastasis to the bone,which is related to the down regulation the expression of CXCR4 in DU-145 cells.

Objective To study the drug resistance of Staphylococcus aureus in 2006 -2011 ,and to provide the evidence for treatment infection .Methods The isolated bacteria were identified and antibiotic sensitivity were tested by automated system in 503 Staphylococcus aureus collected from 2006 to 2011 .Methicillin resistant Staphylococcus aureus(MRSA) was screened by oxacillin disk diffusion .Results 503 strains mainly derived from secretion and sputum .The incidence of MRSA was 44 .9% during 6 years . Detection rate of MRSA was decreased year by year .The difference was statistically significant between 2009 ,2010 ,2011 and 2006 , 2007 ,2008(P<0 .05) .No resistance to quinupristin/dalfopristin ,linezoiid ,vancomycin and nitrofurantoin was found .The resistance of Staphylococcus aureus was below 30% to levofloxacin ,imipenem ,compound sulfamethoxazole and rifampicin ,above 80% to ce-fazolin and penicillin .Although the resistant to cefazolin ,levofloxacin ,imipenem was risen ,the resistant rate of rest antibiotics was downed year after year .Conclusion Monitoring of drug resistance should be strengthened .The antimicrobial therapy should be de-fined on the basis of drug-sensitive test in order to control the incidence of infection and to delay the growth of clinical resistant strains of Staphylococcus aureus .

BACKGROUND: After reviewing the literature, the author found that most of the epidemiological data related to cancer pain was reported by physicians from the point of view of treatment, or of patients' response to the treatment. Although the nurses in oncology department are most direct participants in the cancer pain management, there is less investigation about the nurses' knowledge, attitudes to and skills of cancer pain management.OBJECTIVE: The purpose of this investigation was to provide information so as to suggest the nursing managers and educators in specifically propagating and disseminating the knowledge of cancer pain management.DESIGN: A sampled investigation.SETTING: Integrated Medicine Ward, College of Clinical Oncology,Peking University.PARTICIPANTS: The participants of this investigation were 128 nurses who took part in the National Tumor Care Academic Exchanges and Seminar Conference held in June 1998.METHODS: This investigation was carried out through a survey questionnaire and the questionnaire was designed on the basis of the Cancer Analgesics Questionnaire (for nurses use only) established by the Oncology Profession Committee of Chinese Nursing Association in 1993, furthermore,suggestions from experts were adopted.MAIN OUTCOME MEASURES:①The perception about "three-step analgesic ladder";②currently most commonly used analgesics in clinical;③assessment methods for cancer pain④knowledge of being addicted to analgesics⑤attitude of nursing staff to cancer pain management.RESULTS: The number of those who could correctly designate the relationship of three steps and pain intensity was 82(64.0% ). Only one person could correctly write down the contents of three steps analgesic ladder (0.7%) . Physician's orders for analgesics for cancer pain in the responders' hospitals were classified into the following types: temporary order:54.0%; when necessary, 38.0%; long-term order, 24.0%. But none of the nurses could mark correctly the range of mild, moderate and severe grade on the scale. Only 49.2% (63/128) of the nurses considered that "The pain scale should be determined according to the cancer patients' self-perception to the pain intensity(chief complaint)" . Among the responders, only 12.5% (16/128) of them accepted that "the incidence of addiction occurred as a result of analgesics used for pain control is less than 1% ". Only 26. 5% (34/128) of the responders could distinguish the concepts of tolerance, physical dependence, and addiction.CONCLUSION: From the results of the investigation, we can see that, the nursing professionals do not have sufficient knowledge about "three-step analgesic ladder". The popularization of related knowledge among nurses has been delayed severely. Nurses will obtain the knowledge of cancer pain management by clinical experience instead of in regular ways. The attitude of nursing personnel to cancer pain treatment is one of the important factors that affect the pain management. The frontline nurses should master the pharmacological characteristics of opioids so as to explain it to the patients and their relations distinctly. Nurses should bring into play a more powerful action in reducing the "addiction-phobia" due to their professional characteristics. We suggest that the latest new progress in cancer pain treatment should be incorporated into the normal textbooks on the management of cancer pain. We also propose that the methods of cancer pain treatment,contents of the principle of drug prescription be included in the training of a medical care personnel of oncology professional before entering into clinic.

Objective To interpret the major characteristics of literatures cited by 2015 ATA management guidelines for adult patients with thyroid nodules and DTC (2015 version).Methods The titles,datelines of the references,the medical specialties and regional distribution of the journals,and the definition of the scientific evidence rating for relevant references were extracted and analyzed.The data were roughly compared with those of 2009 revised ATA management guidelines for patients with thyroid nodules and DTC (2009 version).Results A total of 1 078 literatures,from 172 journals and 8 books,were cited by 2015 version,with 63 years spacing from 1952 to 2015.Extensive medical specialties were involved.The journals were world-wide distributed but the regional bias was obvious.Compared to the 2009 version,2015version adopted more recent literatures,and used more evidence rating for the recommendations.However,references with high-quality evidence were both less than 50％ in the two versions.Conclusion Huge amount of references with multi-specialties have been cited in 2015 version,however the regional distribution bias is distinctive and references with high-quality evidence are still insufficient.

Objective To investigate the diagnostic value of 64-slice CT angiography (CTA) to head and neck artery pathological changes.Methods One hundred patients with clinical suspicion of head and neck vascular lesions were retrospectively analyzed.Sixty four cases of lesions were detected by 64-slice CTA,and were checked by Digital Subtraction Angiography (DSA) within a week.First,the correlation of 64-slice CTA and DSA diagnosis of head and neck artery stenosis grade was counted.Then DSA was taken as the gold standard.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA to diagnose head and neck arteries stenosis were calculated.Results Of 64 cases of patients,2 cases of congenital vascular dysplasia,including 1 case with internal carotid artery in 2 cases,the remaining 60 patients had different degree of stenosis.The sensitivity,specificity,positive predictive value,and negative predictive value of 64-slice CTA was 95.34％,99.48％,97.62％,and 98.98％,respectively.Among 60 narrow patients,the plaque number was 205,including 88 soft plaques,56 mixed plaques,and 61 calcified plaque.Conclusions The 64-silce CTA has multiple advantages including rapid,noninvasiveness,high accuracy and safety,and high application value in the diagnosis of head and neck vascular lesions.It is worth promoting.