Objective To investigate the effect of intraoperative hypothermia and warming on hemostasis using thromboelastography(TEG)during radical esophagus cancer operation performed under general anesthesia combined with thoracic epidural block.Methods Sixteen ASA Ⅰ or Ⅱ patients undergoing elective radical esophagus cancer operation were randomly allocated to one of two groups(n=8 each):control group and warming group.The patients were unpremedicated.The operating room temperature was set at 21℃.Epidural catheter was placed at T_(7,8) and advanced 4 cm into epidural space.Correct epidural placement was confirmed by a test dose of 4 ml 1% lidocaine.0.375% bupivacaine was used during operation.General anesthesia was induced with fentanyl,thiopental and succinylcholine and maintained with isoflurane inhalation and intermittent i.v.boluses of vecuronium after endobronchial intubation with double lumen catheter.The patients were mechanically ventilated (V_T=8-10 ml?kg~(-1),RR=10-12 bpm,I:E=1:2,FiO_2=100%).In warming group TC-2000 wanning system (Thermacave,USA)was used.The lower part of the body was warmed for 45 min before induction of anesthesia (temperature was set at 38℃).After induction warming was continued(temperature was set at 43℃).In control group no wanning was provided.The fluid infused during operation was all warmed to 37℃.Tympanic temperature measurement was started from 20 min before induction and recorded every 10 min afterwards.TEG was performed before induction of anesthesia(T_0) and at 150 min after induction(T_1).The blood samples were divided into 2 aliquots of which one was tested at 37℃ and the other at patient's actual core temperature.Results The two groups were comparable with respect to age,sex,body weight duration of operation and the amount of fluid infused during operation.At T_1 the tympanic temperature was 34.7?0.4℃ in control group and 36.5?0.3℃ in warming group.At T_1 in control group the reaction time(R)and clot formation time(K)were significantly prolonged and a angle was significantly reduced when TEG was measured at core temperature compared with those measured at 37℃ (P＜0.05).At T_1 when TEG was measured at core temperature R and K were significantly shorter and a angle was significantly wider in warming group than in control group (P＜0.05).There was no significant difference in MA between the two groups at T_1.Conclusion Mild hypothermia developed during operation can impair bemostasis.Maintenance of normal body temperature(core temperature)during operation is necessary.

OBJECTIVE:To determine the resistance of clinically isolated bacteria to meropenem METHODS:The resistance of 150 clinically isolated strains to meropenem and several other antibiotics was detected by K-B method and the drug resistant spectra to E coli were compared between meropenem and imipenem RESULTS:The sensitivity of 130 clinical isolates to meropenem was 100% No cross resistant strains of E coli was found to meropenem and imipenem CONCLUSION:Meropenem is highly sensitive to the clinical isolates,and its antibacterial spectrum is similar to that of imipenem

Objective To evaluate the short -term efficacy and adverse reactions of gemcitabin combined with nedaplatin to patients with metastatic triple -negative breast cancer after taxane and/or anthracycline treatment. Methods Thirty -three patients with anthracycline and/or taxane -resistant metastatic triple -negative breast cancer received gemcitabin and nedaplatin regimen:gemcitabin 1 000 mg/m2,d1,8 days,intravenous;nedaplatin 80mg/m2,d1,intravenous.Treatments were repeated every 21 days and response rate was evaluated every two cycles. Results Of 33 patients, complete remission ( CR) in 1 case ( 3.03%), partial remission ( PR) in 13 cases (39.39%),stable disease(SD) in 11 cases(33.33%),progressive disease(PD) in 8 cases(24.24%),objective response rate was 42.42%.The main adverse reaction was bone marrow suppression and gastrointestinal reaction. Conclusion Combination therapy of gemcitabin and nedaplatin is an effective and well tolerated rescue regimen in anthracycline and/or taxane -resistant metastatic triple -negative breast cancer patients.

Objective The objective of this study was to investigate the expression and clinical significance of transcription factors Sp1 and Survivin in breast cancer and to further analyze their correlation.Methods Seventy cases of breast cancer patients were diagnosed as breast cancer from June 2013 to June 2015.The expression of Sp1 and Survivin in 70 cases of breast cancer and 20 cases of adjacent normal tissues were detected by immunohistochemical staining.The relationship was detected between the protein expression and the clinicopathological parameters of breast cancer.Results The positive rates of Sp1 and Survivin in breast cancer were 71.43% and 78.57%,respectively.The positive rates of Sp1 and Survivin were 30% and 10% in adjacent normal breast tissues.They showed a significant difference(P<0.05).In breast cancer tissues,there were no differences in the lymph node metastasis,TNM stage and vessel infiltration(P>0.05).There were also no differences in the age,tumor size and histological grade of patients with breast cancer(P>0.05).In breast cancer tissues,there was a significant positive correlation between Sp1 and Survivin expression(r=0.517,P<0.01).Conclusion The transcription factors Sp1 and Survivin are closely related to the pathogenesis of breast cancer,which may serve as an adjunctive index for the diagnosis of breast cancer.It has certain guiding value for clinical diagnosis,treatment and prognosis of breast cancer.

Objective To analyze the efficacy and safety of different chemotherapy regimens for treatment of progressive patients with small cell lung cancer (SCLC) brain metastasis after radiotherapy. Methods 96 SCLC brain metastasis patients with progressive intracranial lesions after radiotherapy were divided into four groups: carmustine group (Group A, 28 cases), temozolomide group (Group B, 19 cases), topotecan group (Group C, 24 cases) and no chemotherapy group (Group D, 25 cases). Results In terms of brain metastases, there were no complete response cases in the whole groups. The rates of partial remission (PR), stable disease (SD) and progression of disease (PD) in Group A were 17.8%(5/28), 53.6%(15/28) and 28.6 % (8/28), respectively, the response rate (RR) of intracranial lesions was 17.9 % (5/28), and disease control (CR+PR+SD) rate was 71.4%(20/28). The rates of PR, SD and PD in Group B were 15.8%(3/19), 63.2 % (12/19) and 21.1 % (4/19), respectively, the RR of intracranial lesions was 15.8 % (3/19), and disease control rate was 78.9 % (15/19). The rates of PR, SD and PD in Group D were 8.3 % (2/24), 54.2 %(13/24) and 37.5 % (9/24), respectively, the RR rate of intracranial lesions was 8.3 % (2/24), and disease control rate was 62.5 % (15/24). In Group D, there was no response case, and 20 patients with PD (80.0 %) were found. The median progression-free survivals (PFSs) were (3.64 ±0.43) months, (4.68 ±0.49) months,(3.58 ±0.50) months, (2.60 ±0.31) months in Group A, B, C and D, respectively, and the median overall survivals (OSs) were (18.80±1.74) months, (18.76±1.85) months, (19.10±1.64) months and (9.64±0.84) months, respectively. The median OS of Group A, B or C was longer than that of Group D (P=0.002). The differences of grade Ⅲ-Ⅳhematologic toxicities among the four subgroups were not statistically different. Patients in Group B had better tolerance to nausea and vomit. In Group D, the central nervous system symptoms such as fatigue and headache occurred frequently. Conclusions The response rate and OS of SCLC brain metastasis patients with progressive intracranial lesions after radiotherapy are improved after chemotherapy, however, PFS is not significantly prolonged. The efficacies of carmustine, temozolomide and topotecan are similar in short and long term, besides, temozolomide shows less adverse events and a higher disease control rate. The application of chemotherapy that could penetrate the blood-brain barrier can improve the efficacy on SCLC brain metastasis patients with progressive intracranial lesions after radiotherapy with well tolerance.

Objective To develop a special stool collector for paraplegic patients with constipation,and to observe the clinical effects. Methods 52 paraplegic patients with constipation were divided into group A(30 cases) and group B(22 cases ).Group A used type one stool collector and goup B chose type two stool collector. The time of dealing with defecation, exposure time, pollution area, the usage of urinal pad, toilet paper, clean water before and after the special toilets were observed between the two groups. Results Each indicator significantly changed after using two types of stool collectors in the two groups of patients and above were significantly decreased. Conclusions The special stool collector for the paraplegic patients with constipation can effectively avoid the soakage of the anal and buttocks skin, reduce the environment pollution of the odor, reduce labor intensity and lower care costs.

Objective To investigate the relationship between extracellular matrix metalloproteinase inducer (EMMPRIN), the upstream regulatory factor of matrix metalloproteinase (MMPs), and the formation of atherosclerosis and the clinical type of coronary heart disease. Methods A total of 223 patients were classified into four groups according to results of coronary angiography (CAG) and clinical data: STEMI group (65 patients with ST-segment elevation myocardial infarction), NSTE ACS group (42 patients with non-ST-segment elevation acute coronary syndrome), SAP group (75 patients with stable angina pectoris) and normal control group (41 patients of CAG-negative). The mean fluorescence intensity (MFI) of EMMPRIN on monocytes of peripheral blood (PBMCs)were examined by flow cytometry. MMP-9 in serum was measured with ELISA; high-sensitivity C-reactive protein (hs-CRP) in serum was measured with immune velocity method. Results The EMMPRIN MFI on PBMCs in SAP group, STEMI group and NSTE ACS group was higher than that in the normal control group (P<0.05 or P<0.01). The EMMPRIN MFI in STEMI group and NSTE ACS group was higher than that in SAP group (P<0.05 or P<0.01). The expression characteristic of EMMPRIN on the PBMCs was consistent with that of hs-CRP and MMP-9 in each group. The EMMPRIN MFI of the PBMCs had positive correlation with the level of MMP-9 and hs-CRP in serum (r=0.168,P<0.05;r=0.305,P<0.01). Conclusion EMMPRIN may has promotive effect on the formation of atherosclerosis and unstablility of coronary heart disease as an upstream regulatory factor of MMPs

Preparation of maternal strain A/PR/8/34 HA antiserum for influenza virus classical reassortment. A/PR/8/34 virus was digested by bromelain after inactivation and purification. 5%-20% sucrose continuous density gradient centrifugation method was used to purify HA protein. SIRD method was used to select the target protein. SDS-PAGE method was used to identified HA protein. High Immunogenic A/PR/8/34 HA protein was successfully prepared and HI titer reached 10240. High purity HA antiserum was identified by SIRD method. The key reagent in the classical reassortment of influenza virus was prepared, and the complete set of technical methods were explored, which laid the foundation for the independent research and development of seasonal influenza vaccine strains of China.
Animals ; Antibodies, Viral ; immunology ; Electrophoresis, Polyacrylamide Gel ; Female ; Hemagglutination Inhibition Tests ; Hemagglutinin Glycoproteins, Influenza Virus ; analysis ; immunology ; Humans ; Influenza A Virus, H1N1 Subtype ; genetics ; immunology ; Influenza, Human ; immunology ; virology ; Rabbits ; Reassortant Viruses ; genetics ; immunology

Objective To investigate the clinical treatment strategy of concomitant diseases and perioperation complications in elderly patients with hip fracture aged ≥ 80 years and the clinical prognosis.Methods A retrospective analysis was conducted in 95 hip fracture patients aged 80 and over years(80～90 years old) undergoing operation.There were 42 cases with femoral neck fractures and 53 cases with intertrochanteric fracture.71 cases (74.7％) had preoperative concomitant medical diseases.Screw fixation was performed in 3 cases (3.2％),hemiarthroplasty in 75 cases (78.9％),total hip replacement in 4 cases (4.2％),proximal femoral nail antirotation (PFNA) in 9 cases (9.5 ％) and reconstruction interlocking nail fixation in 4 cases (4.2 ％).Results No mortality was found during hospitalization.Postoperative anemia was the most common (74.7％),followed by hypoproteinemia (68.4％),digestive disorders (30.5％),electrolyte disturbance (28.4％) and psychiatric symptoms (15.8 ％).At least one-year follow-up was made in 73 cases.39 cases (53.4 ％) acquired independent activities after surgery,48 (65.8％) patients recovered to the preoperative level of activity.The concomitant diseases before surgery (OR =0.23,P =0.011),preoperative ability of activity (OR=0.23,P=0.025),the American Society of Anesthesiology (ASA) classification (OR=0.19,P=0.025) were the related factors influencing the one-year mortality.Conclusions The treatment of concomitant diseases should be emphasized in treating fracture.The active prevention during preoperative,intraoperative,postoperative period could reduce or avoid fatal complications and acquire good functions.

Objective To investigate the influences of gender,age,and body mass index (BMI)on the arterial stiffness in hypertensive patients.Methods A total of 1026 hypertensive patients were enrolled in this study from 6 community health centers in Baoshan District and Shanghai Third People's Hospital.The Related medical histories and carotid-femoral(C-F) pulse wave velocity (PWV) were recorded and PWV were re-tested in 672 patients after 1 year's follow-up.The C-F PWV was analyzed from different group of Gender,age and BMI at baseline and after follow up.Results (1)C-F PWV of the male hypertensive patients were higher than that of female's and the corresponding figures were (13.63 ±3.07)m/s and (12.59±2.85)m/s(P ＜0.01).After one year's follow up,C-F PWV was increased in both male and female with corresponding figures of (14.11 ± 3.58) m/s and (13.51 ± 3.56) m/s (P ＜ 0.05).(2) The C-F PWV was increased with age.The corresponding figures were [(11.11 ± 2.00) m/s for age group 30 ～ 50 years old,(12.73 ± 2.77) m/s for age group ＞ 50 ～ 70 years old,and (14.74 ± 3.29) m/s for age group ＞ 70 years old,all P ＜0.01].After one year's follow-up,C-F PWV of three age groups was increased and the corresponding figures were [(11.36±1.78)m/s(P ＞0.05),(13.39±3.33)m/s(P ＜0.01),and (15.68 ±3.94)m/s(P ＜0.05)].The increased range of C-F PWV (from high to low) was age group ＞ 70,age group ＞ 50 ～70 and age group 30 ～50.(3) C-F PWV of patients with BMI ≥ 24 kg/m2 was significantly lower than that of patients with BMI ＜24 kg/m2 and the corresponding figures were [(12.93 ±2.89)m/s and (13.39 ±3.18)m/s,P ＜0.05].After one year's follow up,C-F PWV was increased and the figures were [(13.54 ± 3.54) rn/s and (14.27±3.61) m/s,respectively(P ＜0.01)].Conclusions Except BMI,gender and age were the important influence factors on arterial stiffness.