Objective To evaluate the effects of different doses of ephedrine combined with hydroxyethyl starch as a volume preload for preventing hypotension in caesarean section before combined spinal and epidural anesthesia.Methods 250 pregnant wemen undergoing cesarean section were randomly allocated into the control group (n =50) and the observation group(n =200)(group was divided into A,B,C,D group,each group 50 cases).Control group preloaded Lactated Ringer's solution 250ml before CSEA.A group preloaded hydroxyethyl starch combined with 5mg ephedrine; B group preloaded hydroxyethyl starch combined with 10mg ephedrine.C group preloaded hydroxyethyl starch combined with 15mg ephedrine; D group preloaded hydroxyethyl starch combined with 15mg ephedrine.The parturient SBP,HR and untoward reaction were monitored in five experimental groups.Results Compared with T0 A group parturient SBP was lower at T1,T2,T5 [(111.8 ± 17.18)mm Hg,(114.58 ± 19.80)mm Hg,(115.06 ± 10.39) mum Hg vs (120.88 ± 13.24) mm Hg,all P ＜ 0.05)].Compared with B,C,D group,statistical differences were found at T1,T4,T6[(111.8 ± 17.18)mm Hg vs (120.78 ± 14.47)mm Hg,(118.56 ± 14.25)mm Hg,(118.42 ± 18.71)mm Hg.(125.58 ± 14.45) mm Hg vs (120.02 ±21.15)mm Hg,(115.92 ± 17.56)mm Hg,(119.00 ±12.49)mm Hg.(118.08 ±9.09)mm Hg vs (121.52 ± 10.92) mm Hg,(116.04 ± 11.61)mm Hg,(124.98 ± 9.16) mm Hg,all P ＜ 0.05].Compared with T0 parturient HR was undulation at T1,T5 (P ＜ 0.05).Compared with C,D group,statistical differences were found at T1,T3,T4,T6 [(82.92 ± 19.55) times/min vs (98.86 ±17.82)times/min,(96.72 ± 17.91) times/min.(89.04 ± 16.68) times/min vs (92.10 ± 16.55) times/min,(98.46 ± 19.49) times/min.(87.56 ± 17.13) times/min vs (98.86 ± 16.76) times/min,(88.58 ± 19.22) times/min.(93.20 ± 14.07) times/min vs (98.80 ± 11.69) times/min,(90.98 ± 10.93) times/min.all P ＜ 0.05].In B and C group,parturient SBP and HR were steady and the untoward reaction was very few.Although parturient SBP of D group was steady,but HR obviously fast during operation (P ＜ 0.05).Compared with B,C group,statistical differences were found at T4,T6 (P ＜ 0.01).Conclusion The optimum dose is 10 ～ 15 mg of ephedrine.It combined with hydroxyethyl starch as a volume preload can keep the stable of blood circulation.

Objective To establish a gata4 gene knockout zebrafish model of congenital heart disease, and construct transcription activator-like effector nuclease ( TALEN) vectors targeting gata4 gene.Method We construct TALEN vectors targeting zabrafish gata4 gene using unit assembly method and the in vitro-transcribed TALEN mRNAs were microinjected into one-cell stage zebrafish embryos.The efficiency of TALEN was identified by injected embryos, and mutations of zebrafish were screened and confirmed the different types through PCR and enzyme digestion.Results We successfully constructed correct targeting vectors by enzyme digestion and sequencing, and the gene knockout efficiency was 35.18%.We screened the mutant zebrafish and confirmed different types of gata4 gene mutations.Conclusions A gata4 knockout zebrafish model is successfully established, it can provide a good animal model for further research of congenital heart diseases.

At present, zebrafish has played an increasingly important role in models for human development and diseases and several areas of life sciences.As a newly laboratory animal resource, standardization research has become the technical bottleneck to be solved and an inevitable trend.In this review, we summarized the research history and character-istics of zebrafish and the status of quality standardization.We also discussed the main problem facing by the standardiza-tion research of zebrafish as a newly laboratory animal.We hope that the data can provide useful reference for the develop-ment of zebrafish quality standardization research.

Objective To investigate the application value of multiple imaging techniques in the multidetector computed tomography (MDCT) combined with assessment of vascular invasion using a tumor-to-vessel contact (TVC) computed tomography grading system in preoperative evaluation of pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 66 patients with pancreatic cancer who were admitted to the Wuxi No.2 People's Hospital of Nanjing Medical University between February 2012 and July 2017 were collected.Surgical results of 66 patients showed that tumors of 48 and 18 patients were respectively located in head or uncinate process of the pancreas and body and tail of pancreas.The 317 vessels of 66 patients were detected.Fifty patients underwent radical resection and 250 vessels were detected,resected tumor diameter was (2.7± 1.4) cm (range,1.3-7.7 cm);16 underwent palliative operation and 67 vessels were detected.Patients received enhanced scans of MDCT,and multiplanar reformatted (MPR),curved planar reconstructions (CPR),CT angiography (CTA),arterial and venous images of three-dimensional (3D) CT and negative-contrast CT cholangiopancreatography (nCTCP) were build.The morphology evaluation of pancreatic tumor was done by a senior radiology physician.The peripancreatic vascular invasion was evaluated using a TVC computed tomography grading system by two senior radiology physicians.Two physicians read collectively films and then achieved consistent results if there was a disputed result.Observation indicators:(1) tumor detection and morphology evaluation by MDCT;(2) detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT;(3) TVC grading results of peripancreatic vascular invasion by MDCT;(4) correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results;(5) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was per-formed to detect postoperative survival up February 2018.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).The measured values of tumor diameter by MDCT and surgical resection were done by Pearson correlation analysis.The Spearman analysis was used to analyze the correlation in the consistency of the vascular invasion results evaluated by two viewers and between TVC grading evaluation results and surgical grading results.Results (1) Tumor detection and morphology evaluation by MDCT:66 patients underwent MDCT,nCTCP combined with MPR images showed that there were 63 low-density tumors and 3 isopycnic tumors.The nCTCP images of 66 patients showed that 42 had biliary system dilatation and pancreatic duct dilatation,11 had pancreatic duct dilatation,5 had pancreatic duct break and 8 didn't have obvious signs of biliary and pancreatic duct dilatation and break.Results of MDCT of 66 patients showed that 48 tumors were located in head or uncinate process of pancreas,18 in the body and tail of pancreas,showing a consistency with surgical results.Pearson correlation analysis showed that measured values of tumor diameter was (2.7± 1.4) cm (range,1.3-7.2 cm) in 50 patients with radical resection,with a correlation with measured values of tumor diameter of surgical resection (r =0.904,P＜0.05).(2) Detection of processing images on vascular invasion signs and vascular anatomical variations after MDCT:results of MDCT in 2 patients with radical resection showed that vascular variations were confirmed intraoperatively;left gastric artery directly started with celiac axis in 1 patient,common hepatic artery started with superior mesenteric artery,and celiac axis was invaded by tumor tissues,with grading 2 of TVC grading evaluation;accessory left hepatic artery in 1 patient started with gastroduodenal artery and was invaded by tumor tissues,with grading 2 of TVC grading evaluation.Results of MDCT in 2 patients with palliative operation showed peripancreatic vascular invasion,tumor of 1 patient invaded inferior vena cava,and tumor of other patient invaded superior mesenteric artery and involved the first branch of superior mesenteric artery.(3) TVC grading results of peripancreatic vascular invasion by MDCT:there was an overall positive correlation of TVC grading evaluation results in 317 peripancreatic vessels invasion of 66 patients between two physicians (r =0.827,P＜0.05).There was a positive correlation of TVC grading evaluation results in celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein between two physicians (r=0.661,0.911,0.809,0.911,0.614,P＜0.05).(4) Correlation between TVC grading results of peripancreatic vascular invasion by MDCT and surgical grading results:there was an overall positive correlation in 317 peripancreatic vessels invasion of 66 patients between TVC grading evaluation results and surgical grading results (r=0.806,P＜0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the artery group (celiac axis,common hepatic artery and superior mesenteric artery) and vein group (superior mesenteric vein and portal vein) (r=0.703,0.823,P＜ 0.05).There were positive correlations between TVC grading evaluation results and surgical grading results in the celiac axis,common hepatic artery,superior mesenteric artery,superior mesenteric vein and portal vein (r =0.792,0.464,0.823,0.809,0.812,P＜0.05).(5) Follow-up and survival situations:56 of 66 patients were followed up for 3-18 months,with a median time of 7 months.During the follow-up,53 patients had tumor metastases,including 50 deaths and 3 survivors with tumor;3 patients had tumor-free survival.Conclusion Multiple imaging techniques in the MDCT combined with assessment of vascular invasion using a TVC computed tomography grading system can accurately evaluate morphology of pancreatic tumor and peripancreatic vascular invasion,and increase accuracy of preoperative assessment of pancreatic cancer.

Objective:To compare the efficacy of different volume of ropivacaine for subomohyiod anterior suprascapular nerve block (aSSNB) in the patients undergoing arthroscopic shoulder surgery with general anesthesia.Methods:One hundred and thirty-five patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective arthroscopic shoulder surgery, were divided into 3 groups ( n=45 each) using a random number table method: 0.5% ropivacaine 5 ml group (L group), 10 ml group (M group), and 15 ml group (H group). Before induction, aSSNB was performed with 0.5% ropivacaine 5, 10 and 15 ml in L, M and H groups, respectively.Diaphragmatic excursion, occurrence and degree of diaphragmatic paralysis, decrease in SpO 2, dyspnea and Horner syndrome were recorded at 30 min after injection.The intraoperative consumption of remifentanil and cardiovascular events were recorded.The extubation time, length of post-anesthesia care unit stay, and duration of sensory block were recorded.Quality of Recovery-15 scale score and score for patient′s satisfaction with analgesia were recorded.The first pressing time of analgesic pump, effective pressing frequency of analgesic pump, requirement for rescue analgesia, nausea, vomiting and nerve block-related complications within 24 h after surgery were recorded. Results:Compared with group L, the incidence of diaphragmatic paralysis was significantly increased, the degree of diaphragmatic paralysis was aggravated, the first pressing time of analgesic pump and duration of sensory block were prolonged, the effective pressing times of analgesic pump was reduced, and the requirement for rescue analgesia was decreased in M and H groups, and the decrease in SpO 2 was significantly increased, and the introperative consumption of remifentanil was decreased in group H ( P<0.05). Compared with group M, the decrease in SpO 2 and incidence of diaphragmatic paralysis were significantly increased, the degree of diaphragmatic paralysis was aggravated, the first pressing time of analgesic pump and duration of sensory block were prolonged ( P<0.05), and no significant change was found in the introperative consumption of remifentanil, the effective pressing times of analgesic pump or requirement for rescue analgesia in group H ( P>0.05). There was no significant difference in the incidence of cardiovascular events, score for patient′s satisfaction with analgesia, incidence of dyspnea and extubation time, length of post-anesthesia care unit stay, Quality of Recovery-15 sacle score, and the incidence of nausea and vomiting among three groups ( P>0.05). There were no Horner syndrome and nerve block-related complications in the three groups. Conclusions:Subomohyoid aSSNB with 0.5% ropivacaine hydrochloride 10 ml provides optimal efficacy when used for subomohyiod anterior suprascapular nerve block in patients undergoing arthroscopic shoulder surgery with general anesthesia.

Purpose To explore the clinicopathological features and molecular characteristics of primary CD5+diffuse large B cell lymphoma(DLBCL).Methods Immunohisto-chemistry and next-generation sequencing(NGS)were used to compare the pathological features,immunophenotypes,and mo-lecular characteristics between primary CD5+DLBCL and CD5-DLBCL,and to analyze their relationship with prognosis and clinical characteristics of patients.Results Among 311 DLBCL patients,there were 46 cases(14.7％)of CD5+DLBCL.There were no statistically significant differences in patient gen-der,clinical staging,international prognostic index between CD5+DLBCL and CD5-DLBCL,and between CD5+DLBCL with and without MYD88 L265P mutation(P＞0.05).Immuno-phenotypically,the overexpression of BCL2(69.5％vs 49.4％,P=0.003)and the co-expression of BCL2 and C-MYC(26％vs 14％,P=0.04)were higher in the CD5+DLBCL group than those in the CD5-DLBCL group;the expression of C-MYC(53％vs 20％),BCL6(93.3％vs 61.3％),Ki67(93.3％vs 64.5％),and co-expression(46.7％vs 20.8％)were higher in the CD5+with MYD88 L265P mutation group than those in the CD5+without MYD88 L265P mutation group(P＜0.05).Survival analysis showed that the disease progres-sion-free survival time of patients in the CD5+DLBCL group tended to be shorter than that of patients in the CD5-DLBCL group(P=0.09).Furthermore,the disease progression-free survival time of patients in the CD5+without MYD88 L265P mutation group was significantly longer than that of patients in the CD5+with MYD88 L265P mutation group(P=0.04).NGS detection found differences in the distribution of accompan-ying mutated genes between CD5+DLBCL and CD5-DLBCL groups.ConclusionCD5 expression and CD5+with MYD88 L265P mutation may be potential indicators of poor prognosis in DLBCL patients.

OBJECTIVETo evaluate the efficacy and safety of leflunomide in comparison with methotrexate (MTX) on patients with rheumatoid arthritis (RA) in China.

METHODSFive hundred and sixty-six patients with active rheumatoid arthritis were randomly assigned to receive leflunomide at 20 mg once daily or MTX at 15 mg once weekly in a controlled trial. Five hundred and four patients completed the 12-week treatment and some patients continued the treatment for 24 weeks.

RESULTSBoth leflunomide and MTX could improve the symptoms, signs, and joint function, but there were no changes in X-ray observations of patients with rheumatoid arthritis. In the leflunomide group, the overall rates of effectiveness at 12 weeks and 24 weeks were 86.94% and 92.31% respectively; the rates of remarkable improvement were 64.95% and 79.81% respectively. In the MTX group, the overall rates of effectiveness at 12 weeks and 24 weeks were 84.04% and 83.15% respectively; the rates of remarkable improvement were 56.81% and 75.28% respectively. According to intent-to-treat analysis, the ACR 20% response rates at 12 weeks and 24 weeks in the leflunomide group were 62.54% and 67.18% respectively, compared with 60.08% and 61.32% respectively in MTX group. No statistical differences were shown in the efficacy between the two groups (P > 0.05). The adverse events in the leflunomide group were gastrointestinal symptoms, skin rash, alopecia, nervous system symptoms, decreased leukocyte count, and elevation of alanine aminotransferase (ALT). Most of these side effects were mild and transient. The incidence of adverse events in the leflunomide group was 16.84%, significantly lower than that in MTX group (28.17%, P = 0.002).

CONCLUSIONSLeflunomide is effective in the treatment of RA with less adverse events than MTX. Its efficacy is similar to MTX, but the incidence of adverse events and the rate of withdrawal due to adverse events were lower in the leflunomide group than in MTX group.

Antirheumatic Agents ; adverse effects ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Female ; Growth Inhibitors ; adverse effects ; therapeutic use ; Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Isoxazoles ; adverse effects ; therapeutic use ; Male ; Methotrexate ; adverse effects ; therapeutic use ; Middle Aged