Objective　To evaluate the effect of vascular endothelial growth factor (VEGF) on tumor angiogenesis, and its usage in tumor therapy. Methods　The recent literatures about VEGF and angiogenesis were reviewed and analyzed. The advances of VEGF study were summarized. The effects of anti-angiogenesis in tumor biological therapy were introduced.Results　Angiogenesis had been identified as an important factor for promoting tumor growth. VEGF was a basic and pivotal factor in tumor angiogenesis. The anti-angiogenesis treatments aimed at VEGF, including the applications of VEGF inhibitor and gene therapy of adenovirus medium, had got great progress. Conclusion　 VEGF is a leading factor of tumor angiogenesis, the anti-angiogenesis therapy aimed at VEGF has probably provided a new chance to malignant tumor treatment.

ObjectiveTo assess the factors influencing plasma B-type natriuretic peptide(BNP) levelsin patients with chronic atrial fibrillation (AF).MethodsClinical and echocardiographic information weredetected or collected.Level of plasma BNP were measured through immunofluorescence quantitified method in222 CAF patients.The patients were divided into two groups according to left ventricular ejection fraction(LVEF) :LVEF ≥50％ (normal group) and LVEF ＜ 50％ (case groups) .LVEF was detected by transthoracicechocardiography.Fasting Blood Glucose, total cholesterol, triglycerides, highdensity lipoprotein cholesterol, low density lipoprotein cholesterol, creatinine, blood urea nitrogen, uric acid, were measured, and history ofhypertension, diabetes mellitus and smoking, were recorded.ResultsSerum levels of BNP in patients of chronicAF with LVEF ＜ 50％ were significantly higher than those with LVEF≥50％ (Mean Rank, 158.00 and 87.78 ,Z=-7.705, P ＜ 0.001) .In multiple logistic regression analysis, male gender (OR: 13.115,95％ CI 3.382 to50.860,P ＜0.001),history of hypertension(OR:3.710,95％ CI 1.104 to 12.472 ,P = 0.034) ,lower TC(OR: 0.397,95％ CI 0.214 to 0.735, P = 0.003) , LVEF(OR :0.791,95 ％ CI 0.723 to 0.867, P ＜ 0.001) , history ofsmoking(OR: 4.660,95％ CI 1.256 to 17.281, P = 0.021)were significant and independent determinants ofBNP elevation.ConclusionLower LVEF, male gender, history of hypertension and smoking, lower plasma TCare independent predictors of plasma BNP levels in patients with chronic AF.

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.

Objective To summarize the experience in diagnosis and treatment of primary splenic neoplasm (PSN). Methods The clinical data of 31 patients with PSN treated in our hospital were retrospectively analyzed. Results Amongst the patients, 25 were diagnosed as PSN postoperatively. Fifteen out of the 19 patients with benignancy were treated with splenectomy, and the others underwent partial splenectomy or tumor excision. Eleven out of the 12 patients with malignancy received splenectomy (including two by excision of pancreatic body and tail), and the other one underwent biopsy alone. The pathological types were as follows: varieties of cyst in 11, angiocavemoma in 4, inflammatory pseudotumor in 2, cavernous lymphangioma in 1, cystic degeratin of liomyoma in 1, malignant lymphoma and lymphsarcoma in 6, hemangiosarcoma in 3, fibrosarcoma in 1, liomyosarcoma in 1 and malignant fibrous histiocytoma in 1. Three patients with malignancy survived for 5 years. The reason was that they received radical splenectomy in combination with chemotherapy or radiotherapy and immunotherapy. Conclusions PSN should be diagnosed mainly according to clinical manifestations and image examination. The differentiation between benignancy and malignancy depends on CT, hemangiography and determination of seros AKP and ? GT levels. Early diagnosis, radical operation and comprehensive treatment are important for improving the prognosis of PSN.

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.

Objective To investigate the changes of plasma bone morphogenetic protein-4 (BMP-4) levels in patients with coronary heart disease (CHD) and rosuvastatin intervention effect on BMP-4 level.Methods Fifty-two patients with CHD and 35 health people were enrolled in this study as CHD group and control group.ELISA method was used to detect the concentration of plasma BMP-4.Analyzed the relationship between plasma BMP-4 and blood lipids,flow-mediated dilation (FMD),nitric oxide (NO),cyclooxygenase-2 (COX-2),malondialdehyde (MDA) and superoxide dismutase (SOD).And observed the changing of plasma BMP-4 before and after rosuvastatin intervention.Results Plasma BMP-4 level in CHD patients was (7.53 ± 1.20) μg/L,higher than that of control group ((3.81 ± 0.79) μ g/L,t =3.541,P =0.006).After rosuvastatin treatment,plasma BMP-4 level in CHD patient was decreased from (7.53 ± 1.20) μg/L to (5.40± 0.98) μg/L (t =1.436,P =0.001).Plasma BMP-4 level was positively correlated with COX-2,MDA,low-density lipoprotein cholesterol,total cholesterol (r =0.395,0.350,0.274,0.288 respectively,P ＜ 0.01 or P ＜0.05).But,it was negatively correlated with NO,high-density lipoprotein cholesterol,SOD,FMD (r =-0.291,-0.253,-0.476,-0.320 respectively,P ＜0.01 or P ＜0.05).COX-2,SOD and FMD were independent risk factors of plasma BMP-4 in patients with CHD.Conclusion Oxidative stress and endothelial dysfunction are in patients with CHD.Rosuvastatin treatment can remarkably reduce plasma BMP-4 level,alleviate vascular endothelium injury induced by oxidative stress and improve endothelial function in patients with CHD.

Objective To discuss the nursing countermeasures of common problems in patients with spinal fracture. Methods All patients received evidence- based nursing in on:ler to tackle problems such as pain, paralysis, pulmonary infection, pressure ulcer, urinary tract infection and deep vein thrombosis. Results No one complicated with pulmonary infection, pressure ulcer and deep vein thrombosis, 2 with lower limb swelling and 3 with urinary tract infection. Conclusions Evidence- based nursing is the base of clinic nursing. It can not only improve the quality of nursing and benefit patients,but also can expand the nurses' knowledge.

Objective To compare different dose of remifentanil combined with propofol for painless abortion and approach to an appropriate dose of remifentanil.Methods Ninety pregnant women with ASA 1 were randomly divided into three groups(n=30)before administrating remifetanil,a bolus midazolam 1 mg was injected inminutes later.These two drugs did not stop administration until three minutes before the end of negative suction.MAP,HR,SpO2,BIS,RR,VT,PET CO2 were monitored.The onset,operation and recovery time,sedation score and adverse reaction were recorded.Results Sedation scores were significantly different between group A and C [(3.90±0.97)and(4.90±0.85),t=4.24,P＜0.01].Three cases in group A were found moving.MAP,HR,BIS decreased as compared witll baseline.HR reduced significantly in group C(P＜0.05,P＜0.01).Respiratory movement was lower and shallower.RR,VT decreased compared to preoperative one.PET C02 increased gradually (P＜0.05,P＜0.01).There were two cases of respiratory depressing in group A,four cases in group B and ten cases in group C(five cases apnea more than three minutes).All patients used oxygen mask to maintain SpO2＞95%.Incidence of adverse reactions such as chest titanic,nausea and vomiting,itching were of no difference among three groups(P＞0.05).All patients were satisfied with anesthesia.Conclusion The appropriate infusing dose of remifetory devices such as oxygen mask and monitoring life signs are very important to prevent respiratory depress and bradycardia during operation.

OBJECTIVETo discuss the necessity of MRI as a routine examination for diagnosis of glomus tumor.

METHODSFrom Nov. 2013 to July 2014, 7 cases of glomus tumor were treated in our department. All patients had typical clinical symptoms of glomus tumor and received preoperative X-ray and/or MRI examination. The diagnosis was confirmed by postoperative histopathologic examination. All the patients were retrospectively analyzed by reviewing the preoperative examination results and PubMed search results.

RESULTS2 cases underwent only X-ray examination before operation with no positive results. 3 cases underwent both X-ray and MRI. No positive finding happened in X-ray, while MRI showed glomus tumor characteristic on T1- and T2-weighted images which demonstreated a more intense signal after injection of gadolinium. The last 2 cases underwent only MRI examination, which revealed positive images of glomus tumor.

CONCLUSIONSMRI plays an important role in diagnosis of glomus tumor and should be adopted as a routine examination.