Objective To explore the effect, safety and value of propofol combined with fentanyl in painless gastrointestinal endoscopy.Methods 1 200 patients were collected and divided into normal group and painless group,600 cases in each group.Normal gastrointestinal endoscopy was performed on unanesthetic patients,while painless gastrointestinal endoscopy was operated on anesthetic patients with Propofol and Fentanyl.The safety and clinical effect were compared between the two groups.Results 1 200 cases of patients were able to complete the gastrointestinal endoscopy examination successfully with no serious side effects.Compared with normal gastrointestinal endoscopy,the patients undergoing painless gastrointestinal endoscopy examination guaranteed more comfortable experiences,suffering less pain and side effects.The differences were significant between the two groups (all P < 0.05 ).Conclusion Propofol combined with fentanyl in painless gastrointestinal endoscopy was a safe,effective and painless process and was worthy of promoting widely.

Objective To evaluate the clinical effects and complications in treating colonic polyps between endoscopic submucosal dissection and laparoscopy.Methods 69 colonic polyps patients diagnosed by colonoscopy with the basal body diameter of the colonic polyp >2.0 cm were enrolled in this study. All the patients were divided into study group (n = 41) and control group (n = 28) according to patients' decision, and then treated with ESD and laparoscopic surgery separately. After treatment, all the patients were followed up and repeated colonoscopy after 6 months. Clinical data were recorded and analyzed at the end of the research.Results Patients were successfully operated in both groups. 1 case in each group was diagnosed of malignant tumor and needed further treatment. The average operation time in study group and the control group was (85.00± 36.50) min and (110.00 ± 45.70) min (P < 0.05), length of hospital stay of the two groups were (10.69 ± 3.09) d and (11.61 ± 6.41) d (P < 0.05), and average cost of hospitalization of the two groups were (15.7 ± 2.7) ten thousand RMB and (30.6 ± 5.9) ten thousand RMB (P < 0.05). Percentage of complications in the study group was 2.43% comparing to 14.29% of control group(P < 0.05). 1 case in the study group complicated with enteron hemorrhage. Complications in the control group was 2 cases of ileus, 1 case of infection, 1 case of intestinal fistula. No recurrence was found in the two groups after 6 months in the repeat colonoscopy.Conclusion Both of the two treatments are effective for patients with wide base colonic polyps, but malignant tumor must be cautioned when treating with wide base colonic polyps. Endoscopic submucosal dissection requires proficient skill while with less impairment and cost.

Objective To investigate the efficacy and safety of long guidewire exchange technique in performing cerebral angiography via radial artery approach.Methods The clinical data of 257 patients,who received cerebral angiography during the period from June 2014 to May 2016 at Daxing Hospital of Capital Medical University,Beijing,China,were retrospectively analyzed.Among the 257 patients,186 had type Ⅱ or type Ⅲ aortic arch.According to the different looping technologies for Simmons-2 catheter used in the performance of cerebral angiography,these 186 patients were divided into the study group (n=90) and the routine group (n=96).The success rate of radial artery puncturing,the success rate of Simmons-2 catheter looping formation,the success rate of supra-arch arterial catheterization,the time spent for angiography,the radiation exposure time,complications,etc.were recorded.Results The success rate of radial artery puncturing was 100％ in both groups.The success rate of Simmons-2 catheter looping formation in the study group was 97.8％,which was significantly higher than 72.9％ in the routine group (P＜0.05).The success rates of catheterization for the left subclavian artery,left common carotid artery and right carotid artery in the study group were 97.8％,97.8％ and 97.8％ respectively,which were remarkably higher than 72.9％,72.9％ and 72.9％ respectively in the routine group (P＜0.05).No statistically significant difference in the success rates of catheterization for right subclavian artery and for right vertebral artery existed between the two groups (P＞ 0.05).The time spent for angiography in the study group and the routine group was (22.5±9.4) min and (28.3±8.3) min respectively.The radiation exposure time in the study group was (8.9±4.5) min,which was obviously lower than (12.6±6.5) min in the routine group (P=0.017 and P=0.035,respectively).The incidences of complications in the study group and the routine group were 4.4％ and 5.2％ respectively,the difference was not statistically significant (P＞0.05).No severe complications,such as intracranial arterial embolie events,puncture bleeding,arterial occlusion,etc.,occurred in all patients of both groups.Conclusion The use of long guidewire exchange technology can improve the success rate of Simmon-2 catheter looping formation and the success rate of supra-arch arterial catheterization,it can also shorten the time for angiography procedure and reduce the radiation exposure time.This technique is very effective with higher safety.Therefore,this long guidewire exchange technique should be used as a common method for cerebral angiopraphy via radial artery approach in patients with type Ⅱ or type Ⅲ aortic arch.

Objective To establish a loop-mediated isothermal amplification(LAMP) quantitative method for rapid detection of Japanese encephalitis and dengue fever virus.Methods According to the LAMP principle,design primers for LAMP detection and reaction system,establish LAMP detection method,and to evaluate the linear relationship between initial copy number and the specificity,sensitivity,repeatability and the reaction time(fluorescence signal value of 1×104 corresponding time).Results One sets of LAMP primers could be used to complete the detection work in 0.5 h.The sensitivity of LAMP detection technology was 10 times higher than that of the classical PCR technology,and no cross reaction with other viruses,and the coefficient of variation of the average test was less than 5%.There was a good linear relationship between cycle threshold and template concentration.Conclusion This method has high specificity,sensitivity,simple operation,which is easy to get the results,low equipment requirements and rapid,suitable for primary health institutions and the field inspection agencies for wide applications.

OBJECTIVE:To systematically review the efficacy of Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy in the treatment of malignancies,and provide evidence-based reference for clinical treatment. METHODS:Re-trieved from CNKI,CBM,VIP,Wanfang Database PubMed,EMBase,Web of Science,randomized controlled trials (RCT) about Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy(test group)versus radiotherapy or chemothera-py alone(control group) in the treatment of malignancies were collected. Meta-analysis was performed by using RevMan5.3 soft-ware after data extract and quality evaluation by Cochrane 5.1.0. RESULTS:Totally 7 RCTs were enrolled,involving 567 patients. Results of Meta-analysis showed,the effective rate [OR=1.99,95%CI(1.27,3.14),P=0.003] and improvement rate of life quality [OR=2.95,95%CI(1.75,4.97),P<0.001] in test group were significantly higher than control group,cell abnormal rate [OR=0.26,95%CI(0.16,0.41),P<0.001] was lower than control group,the differences were statistically significant. There were no obvi-ous adverse reaction in 2 groups. CONCLUSIONS:Ginseng polysaccharideinjection combined with radiotherapy or chemotherapy is effective in the treatment of malignancies.

Objective To evaluate the tolerance of preoperative neoadjuvant chemoradiotherapy (neoCRT) plus esophagectomy, as well as the short-term outcome, tumor resection rate, incidence of postoperative complications, and perioperative mortality, in patients with locally advanced esophageal cancer.Methods This study included 74 patients with thoracic esophageal cancer who were admitted to our hospital from May 2011 to June 2015.Chemotherapy and radiotherapy were performed concurrently.The chemotherapy consisted of vinorelbine (25 mg/m2 on days 1, 8, 22, and 29) and cisplatin (25 mg/m2 on days 1-4 and 22-25).The radiotherapy was conventionally fractionated with a total dose of 40 Gy (2.0 Gy/d).At 4-8 weeks after chemoradiotherapy, esophagectomy was performed (neoCRT+surgery group);definitive chemoradiotherapy (DCRT) was performed in the patients who refused surgery (DCRT group);follow-up was performed in the patients who refused any anti-cancer therapies after neoCRT (neoCRT group).Results Forty-four patients underwent neoCRT+surgery, with a radical resection (R0) rate of 100% and a pathological complete response (pCR) rate of 43%;17 patients received DCRT;13 patients received neoCRT alone.For the neoCRT+surgery group, DCRT group, and neoCRT group, the 2-year overall survival (OS) rates were 79%, 75%, and 17%, respectively, and the 2-year disease-free survival (DSF) rates were 75%, 55%, and 17%, respectively.There were significant differences in OS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.001), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.415).There were significant differences in DFS between the neoCRT group and the neoCRT+surgery group (P=0.000) and between the neoCRT group and the DCRT group (P=0.002), but no significant difference was observed between the neoCRT+surgery group and the DCRT group (P=0.416).The rate of clinical response to preoperative neoCRT was 87% for all patients.Fifty-six patients (76%) developed grade ≥3 myelosuppression due to preoperative neoCRT.The incidence rates of postoperative pulmonary infection, anastomotic leakage, and anastomotic stenosis were 21%, 12%, and 7%, respectively, and the perioperative mortality rate was 2%.Conclusions For patients with locally advanced esophageal cancer, preoperative neoCRT plus surgery can increase the clinical response rate and pCR rate, reduce the tumor stage, and improve the survival, but chemoradiotherapy toxicities and perioperative complications cannot be ignored.

Teaching anesthesia-physiology is a subject worth to be discussed.Arranging the high quality teachers to teach,making a careful study and preparation of the teaching materials,teaching plan and enhancing the teachers’teaching art should be first emphasized.And then the advantages of using multimedia should be given full play in combination with various kinds of methods to let the students become active class participants so as to improve the teaching effect in anesthesia-physiology.

Objective To evaluate the efficacy and side effects of extensive regional field radiotherapy concurrent with chemotherapy for locally advanced esophageal cancer.Methods Of the 101 patients with locally advanced esophageal cancer patients,44 patients were treated by involved field radiotherapy alone,29 patients treated by involved field radiotherapy combined with chemotherapy,and 28 patients received extensive regional field radiotherapy combined with chemotherapy,the total dose of radiotherapy was 60 Gy.The clinical target volume (CTV) of involved field included the gross tumor volume (GTV) plus a 0.8 cm lateral margin,the tumor plus a nominal 3-5 cm cephalad and caudal margin.Extensive regional field radiotherapy was delivered in two steps:the CTV included the CTV of the involved field plus elective nodal region in the first step;in the second step,the CTV definition was same with the CTV of the involved field.Synchronous chemotherapy regimens included TP and NP.Results 90.1％patients completed planned radiotherapy,all patients in the concurrent chemotherapy groups completed at least one cycle of chemotherapy.The follow-up rate was 99％.Twenty-four and 42 patients completed followed-up more than 24 months in the radiotherapy alone and concurrent chemoradiotherapy group,respectively.The median survival time of the involved field radiotherapy group,involved field chemoradiotherapy group and extensive regional field chemoradiotherapy group was 13,21 and 19 months,respectively;the 2-year overall survival (OS) rate was 15％,48％ and 46％,respectively for the three groups.The 2-year OS rate was improved significantly in the chemoradiotherapy group (x2 =6.83,P =0.033).Compared with radiotherapy alone group,the incidence of grade three or four bone marrow suppression was higher in the concurrent chemoradiotherapy group (53％: 0 ％,x2 =32.94,P =0.000),the remaining adverse events (acute radiation pneumonitis,acute radiation esophagitis,esophageal fibrosis,late radiation lung injury) had no significant intergroup differences (x2 =5.56,6.70,2.39,0.42,P =0.235,0.349,0.881,0.981).Conclusions Compared with radiotherapy alone,concurrent chemoradiotherapy can improve the survival rate for locally advanced esophageal cancer.The side effects of the extensive regional field radiotherapy combined with chemotherapy is well tolerated.But the efficacy of the extensive regional field radiotherapy combined with chemotherapy needs further research.

Aim To observe the protective effect of glycine from myocardial cell injury of the isolated rat heart induced by endotoxin. Methods 21 male SD rats,weghting(250?30)g,were randomly divided into three groups:control group(n=7),endotoxin group(n=7),glycine/endotoxin group(n=7).Heart were isolated from the rats and perfused on Langendorff apparatus with Krebs-Henseleit(KH)buffer(Saturation 95%+5% CO_2)at a constant pressure(8.33 kPa)and temperture(37℃). The activities of lactate dehydrogenase(LDH),creatine kinase(CK),superoxide dismutase(SOD) and the level of malondialdehyde (MDA) of efflux from coronary artery, monophasic action potential(MAP)were determined at the certain time(0,20,50,80 min). Results Monophasic action potential were markedly improved in Gly/ET group. Glycine can attenuate the release of LDH,CK from myocardial cell. The activity of SOD and the level of MDA were close to control group. Conclusion Glycine can protect myocardial cells of the isolated rat heart from the damage induced by endotoxin.

Objective To discuss the clinical value of protein induced by vitaminK absence antagonist-Ⅱ (PIVKA-Ⅱ)and al-pha-fetoprotein (AFP)in diagnosing primary hepatocellular carcinoma (PHC).Methods There were 178 samples from in-patients in Fuzhou Infectious Disease Hospital,including 54 patients with PHC,39 patients with liver cirrhosis,55 patients with hepatitis and 30 cases of healthy.Serum levels of PIVKA-II and AFP levels were detected by LUMI-PULSEG1200 au-tomatic immunity analyzer and Abbott automatic immunity analyzer respectively,and the difference between the levels was compared.Analyzed the areas under the receiver operating characteristic curves (ROC-AUC)and compared the sensitivity and specificity of single PIVKA-II or AFP assay,and the combined detection of PHC.Results The serum level of PIVKA-Ⅱ in hepatocellular carcinoma group was 274 mAU/ml,which was higher than that in liver cirrhosis group (23 mAU/ml), chronic hepatitis group (26 mAU/ml)and healthy group (21 mAU/ml)(P<0.001),and the levels of AFP in PHC group was 84.0 ng/ml,which was higher than that in liver cirrhosis (21.78 ng/ml)and healthy groups (2.8 ng/ml).But it was not statistically significant (P=0.585)compared with those in the chronic hepatitis group (66.8 ng/ml),the results of re-ceiver operating characteristic (ROC)curve showed that the area under the curve of PIVKA-Ⅱ was 0.776,higher than the AFP (0.649),(Z=2.262,P=0.023 7).Serum PIVKA-Ⅱ (≥40 mAU/ml)had a sensitivity of 78.52% and a specificity of 76.23% in the diagnosis of PHC,While serum AFP (≥10 mg/ml)had a sensitivity of 77.78% and a specificity of 34.64%in the diagnosis of PHC.A combination of serum levels of PIVKA-Ⅱ and AFP could increase the sensitivity in the diagnosis of PHC (vs PIVKA-Ⅱ,P=0.031;vs AFP,P=0.016)and specificity (vs PIVKA-Ⅱ,P=0.004;vs AFP,P=0.001).Con-clusion Serum PIVKA-Ⅱ have high clinical application values in diagnosing PHC.A combination of serum levels of PIV-KA-Ⅱ and AFP could increase the sensitivity and specificity in diagnosis of PHC.