Objective To investigate the efficacy of anesthesia with propofol-remifentanil given by targetcontrolled infusion (TCI) for thymectomy in patients with myasthenia gravis ( MG). Methods Forty-five ASA Ⅰ or Ⅱ MG patients aged 16-64 yr weighing 45-95 kg undergoing thymectomy were studied. Anesthesia was induced with TCI of propofol (target plasma concentration 4 μg/ml) and remifentanil (target effect-site concentration 4 ng/ml). Thracheal intubation was performed after topical anesthesia with 2% lidocaine 2-3 ml and then the patients were mechanically ventilated. Anesthesia was maintained with TCI of propofol ( target plasma concentration 3-5 μg/ml) and remifentail (target effect-site concentration 3-6 ng/ml). Sufentanil 0.15 μg/kg was injected intravenously for analgesia 30 min before operation. The success rate of intubationat at first attempt, body movement in response to skin incision, recovery time, extubation time, extubation condition at the end of operation and cardiovascular events were recorded. Results Thracheal intubation was performed successfully in all patients. The success rate of intubation at first attempt was 100%. No body movement occurred during skin incision in the patients.Recovery time was 1.0-3.2 min and extubation time 2.6-7.0 min. All patients were successfully extubated at the end of operation. Bradycardia developed in 3 patients and hypotension in 4 patients during induction, but they all returned to normal after symptomatic treatment. Bradycardia developed in 3 patients during operation, but returned to normal after symptomatic treatment. Conclusion Anesthesia with TCI of propofol and remifentanil can be used safely and effectively in MG patients undergoing thymectomy.

Angiogenesis is an important feature of malignant neoplasm and plays an essential role in the genesis,growth and metastasis of tumors. CT perfusion imaging (CTPI),as one of the functional imaging techniques reflecting neovascularity of neoplasm,perfectly combines anatomical imaging with physiological information and can be used in a range of clinical areas,such as differentiation between benign and malignant lesions,early detection of malignancy or metastasis,prediction of tumor behavior and the assessment of responses to therapies. Many researches have been done on perfusion CT in tumors of the brain,thyroid gland,salivary gland,mammary gland,lungs,liver,esophagus,kidney,colorectum,and so on. The present article reviews the basic principles of perfusion CT and its clinical application in tumors.

Tumors are classified into two major categories,benign and malignant.One main difference between malignant and benign tumors is their tendency to metastasize and recur.The metastasis itself is an ominous sign for prognosis and responsible for most cancer deaths.The metastatic "cascade" comprises a lot of steps,including escape from the primary tumor site,penetration of local stroma,entry of local vascular or lymphatic vessels,aggregation with platelets,interaction with and adhesion to distant endothelia,extravasation,recolonization,and expansion,all the time avoiding effective immune clearance and being able to survive.It has now been shown to contain stem cell-like cells called cancer stem cells(CSC) in several solid tumors.Although generally rare,these cells appear to be highly tumorigenic and may drive tumor formation and mediate tumor metastasis.

Up to date, there are two types of drugs approved to treat hepatitis B: interferons and nucleos (t) ide analogues. However, the therapies are limited in the clinical context because of the negative side effects of interferon-α and the development of substantial viral resistance to nucleos (t) idic inhibitors. Therefore, new drugs with novel structures and mechanisms are needed. In this article, the drugs approved by FDA or the European Commission for treating chronic hepatitis B virus infection, as well as those under clinical trials, and several compounds in preclinical studies are reviewed. Additionally, some potential targets and strategies to combat chronic hepatitis B virus infection are discussed.

Objective To investigate the pharmacodynamics of sufentanil required to inhibit the body movement induced by tetanic stimulation and skin incision when combined with propofol in patients undergoing thoracic or abdominal surgery. Methods Fifty ASA Ⅰ or Ⅱ patients aged 18-57 yr undergoing elective thoracic or abdominal surgery were randomized into 5 groups sufentanil target effect-site concentration (Ce) (n = 10 each):0.07, 0.10, 0.14, 0.20 and 0.28 ng/ml groups. Anesthesia was induced with TCI of propofol at the target plasma concentration of 3.0-3.2 μg/ml. As soon as the patients lost consciousness, infusion of sufentanil with the corresponding Ce was started in the each group. One tetanic stimulus (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) was given after the target effect-site and plasma concentrations were balanced. Tracheal intubation was facilitated with succinylcholine 1.5 mg/kg. The concentrations of propofol and sufentanil were maintained until 4 min after skin incision. The body movement was observed during tetanic stimulation and skin incision. The effective effect-site concentration (EC50, EC94) of sufentanil and 95% confidence interval (CI) were calculated using probit regression analysis. Results The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation when combined with propofol were 0.12 (95% CI 0.09-0.14) ng/ml and 0.20 (95% CI 0.17-0.31) ng/ml respectively. The EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 (95% CI 0.11-0.16) ng/ml and 0.21 (95% CI 0.17-0.29) ng/ml respectively. There was no significant difference in the EC50 and EC95 of sufentanil between the two different stimuli (P ＞ 0.05). Conclusion The EC50 and EC95 of sufentanil required to inhibit the body movement induced by tetanic stimulation (frequency 50 Hz, intensity 80 mA, wave length 0.25 ms) when combined with propofol were 0.12 and 0.20 ng/ml respectively, the EC50 and EC95 of sufentanil required to inhibit the body movement induced by skin incision when combined with propofol were 0.13 and 0.21 ng/ml respectively and there was no significant difference in the pharmacodynamics between the two different stimuli, indicating that tetanic stimulation as an alternative to skin incision can be used to evaluate the pharmacodynamics of anesthetics.

Objective To investigate the imaging diagnostic value of the early avascular necrosis of the femoral head(ANFH) in adult.Methods There were 25 cases (34 hips) with early ANFH diagnosed by imaging and clinical data.Radiography,CT and MRI findings of ANFH were analysed comparatively.Results In the 34 ANFH included stage Ⅰ 13 hips,stage Ⅱ 21 hips.The diagnostic accurary was 32.4% for X-ray,61.8% for CT and 100% for MRI.Conclusion MRI is better than the other technique in early finding the lesions of ANFH,and the diagnostic sensitivity and accuracy of MRI are higher than that of CT and X-ray.

Objective To compare the EC50 ～ EC95 for propofol and remifentanil targetcontrolled infusion(TCI)at loss of consciousness (LOC) and without response to a standard Hoxious painful stimulus in elderly and young adult patients.Methods A total of 102 (American society of anesthesiologists) ASA Ⅰ-Ⅱ patients undergoing elective surgery under general anesthesia were enrolled in this study and divided into control group (aged 18-64 years,n=52) and elderly group (aged≥65 yrs,n=52).Propofol TCI was started at target plasma concentration (Cp) of 1.2 mg/L and the Cp increased by 0.3 mg/L every 30s until loss of consciousness (LOC),kept the target effectsite concentration (Ce) of propofol at LOC.Remifentani TCI was started at Cp of 2.0 μg/L,increased by 0.3 μg/Levery 30s until loss of somatic response to a tetanic stimulus (50Hz,80mA,0.25ms,4s) Cp,Ce,systolic blood pressure (SBP),diastolic blood pressure (DBP),mean artery pressure (MAP) and heart rate(HR) were recorded.The Ce of propofol at LOC,the Ce of remifentanil at loss of somatic response to noxious stimulus in 50％-95％ of the patients (EC50-EC95),and 95％ confidence interval were determined by probit method.The adjustment required for TCI propofol with remifentanil in elderly patients was explored.Results In elderly group,the propofol Ce at LOC was (2.0±0.3) mg/L,significantly lower than that in control group (2.9±0.2) mg/L (t=6.168,P＜0.01) and EC50-EC95 of remifentanil at loss of somatic response to noxious stimulus in elderly group (3.5-5.4) μg/L was similar to that in control group (3.7-5.9) μg/L.Conclusions For TCI propofol and remifentanil in elderly patients,the requirement of Ce of propofol is significantly decreased and Ce of remifentanil required in elderly patients is similar to adult patients.

Objective:To clarify the relationship between postoperative tumor recurrence and the type and dosage of immunosuppressants in patients undergoing liver transplantation.Method:A retrospective analysis was conducted on the clinical data of patients who underwent liver transplantation for liver cancer from September 2007 to January 2019 at the Department of Hepatobiliary Surgery, First Affiliated Hospital of Chongqing Medical University. According to whether there was tumor recurrence after liver transplantation, the patients were divided into the case group and the control group. The etiology, alpha-fetoprotein level, Child-Pugh score, model for end-stage liver disease (MELD) score, and cancer nodules, number of tumors, diameter of largest cancer nodule, microvascular infiltration (MVI), large vessel infiltration, Edmondson grade of tumor differentiation, postoperative immunosuppression regimen, and blood trough concentration of tacrolimus or cyclosporine were compared between the two groups. The effects of calcineurin inhibitor (CNI) exposure in groups of patients on tumor recurrence were compared, and statistically significant factors were included in the Cox regression analysis. Using the BCLC staging standard of liver cancer, all the subjects were stratified, and the influence of CNI exposure on tumor recurrence was further analyzed.Results:This study included 50 patients. There were 15 patients in the case group, aged (45.8±8.2) years, with 13 males (86.7%). There were 35 patients in the control group, aged (45.4±12.0) years, 31 males (88.6%). The diameter of the largest cancer nodule in the case group was significantly larger than that in the control group [(5.9±3.0) cm vs (3.5±1.8) cm, P<0.05]. The tacrolimus exposure levels in the case group at 14 d after operation were significantly higher than the control group[(11.7±7.7)ng/ml vs (5.9±3.0)ng/ml, t=2.48], 1 month after operation [(12.2±4.5) ng/ml vs (7.8±4.3) ng/ml, t=2.82], 9 months after operation [(6.9±4.0) ng/ml to (4.7±2.0) ng/ml, t=2.21] and the area under the curve at 1 year after operation [(100.1±21.1) vs (74.4±19.2), t=3.66], all P<0.05. Survival analysis showed that the cumulative tumor-free survival rate of the CNI high-exposure group was significantly lower than that of the CNI low-exposure group (52.2% vs 85.2%, χ 2=6.52, P<0.05). Multivariate analysis using the Cox proportional hazards regression model showed that the largest cancer nodule diameter ( RR=1.23, 95% CI: 1.01-1.60) and high CNI exposure ( RR=4.02, 95% CI: 1.10-14.74) were independent risk factors for tumor recurrence after liver transplantation. Stratified analysis showed that of the 17 patients with BCLC stage B, 6 patients (66.7%) with high CNI exposure developed tumor recurrence, while only 1 patient (12.5%) with low CNI exposure developed tumor recurrence. The difference was statistically significant ( P<0.05). Survival analysis showed that the cumulative tumor-free survival rate of patients with CNI high-exposure was significantly lower than that of patients with CNI low-exposure (33.3% vs 87.5%, χ 2=5.74, P<0.05). Of the 8 patients with BCLC stage C, 4 patients developed tumor recurrence with CNI high-exposure (100.0%). There was no tumor recurrence in patients with low CNI exposure. The difference between groups was statistically significant ( P<0.05). Survival analysis showed that the cumulative tumor-free survival rate of patients with high CNI exposure was significantly lower than that of low CNI exposure (0 vs 100.0%, χ 2=6.80, P<0.05). Conclusions:Tumor recurrence after liver transplantation was not significantly related to the type of immunosuppressant used. High CNI exposure was a risk factor for tumor recurrence after liver transplantation.

Objective To investigate if the endothelin-1 (ET-1),nitric oxide(NO) can affect renal artery blood flow and explore the clinical value of ultrasonography in hypertensive disorder complication pregnancy.Methods 18 patients of gestational hypertension,18 patients of gently preeclampsia,20 patients of severe preeclampsia and 20 normal pregnancy women were chosen in random.Color Doppler ultrasonography was used to detect the peak systolic velocity (PSV),end diastolic velocity (EDV),resistive index (RI),pulsatility index (PI) of renal interlobar artery.The levels of serum ET-1 and NO were measured by enzyme-linked immunosorbent assay (ELISA) and nitric acid recovery respectively.Results The level of EDV in preeclampsia patients were significant lower than the control group (P ＜0.05).The levels of RI,PI,S/D in preeclampsia patients were significant higher than the control group (P ＜0.05).The level of ET-1 in study group was higher than control group (P ＜0.01).The level of NO in study group was lower than control group (P ＜0.01).There was positive correlation between the RI,PI,S/D of renal interlobar artery and the level of serum ET-1.There was inverse correlation between the RI,PI,S/D of renal interlobar artery and the level of serum NO.Conclusions Endothelial dysfunction can cause unbalance of renal vessel systolic-diastolic function.The level of renal artery blood flow parameters can reflect the state of vessel function and have clinical value in hypertensive disorder complication pregnancy.

Objective To compare the effect of electroacupuncture at head points and body points on glucose metabolism of the cerebral motor function regions in normal subjects.Methods To observe the change of glucose metabolism of cerebral motor area in normal subjects between before and after acupuncture during the movement by PET.Talairach coordinates(Atlas of brain) and statistical parametric mapping(SPM) software were used to deal with the acquired imaging data.Results ① Acupuncture at Baihui(GV20) and left Qubin(GB7) could increase metabolism of glucose in bilateral Lps and precuneus,the activation of left area in the brain being more significant.②Acupuncture at right Quchi(LI11) and Zusanli(ST36) change metabolism of glucose in left gyrus precentralis,right loblus paracentralis,right gyrus frontalis medialis,both cerebellums and both putarnens.Conclusion All acupoints can change glucose metabolism in cerebral structures related to motor function in the bilateral cerebral hemispheres,different acupoints active different motor areas.The function of acupuncture is a kind of comprehensive regulative process.