10.3969/j.issn.1000-8179.2013.12.009

Objective To observe the levels of Th1 and Th2 type cytokines of peripheral blood CD+4 T lymphocytes at different stage of treatment of colonic cancer,in order to find out the laboratory evidence of tumor immunotherapy.Methods The peripheral blood lymphocytes were stimulated by stimulator in order to enhance the expression of cytokines.Then specific fluorescent-conjugated monoclonal antibodies were added to combine with its specific antigens.Cytokines were detected by flow cytometry.Results At different stage of treatment of colonic cancer,the levels of Th1 type cytokines of each stage was significant.The levels of Th2 type cytokines at each stage were not significant.The IFN-γ//IL-4 ratio were significantly different during tumor immunothempy.Conclusion At different stage of treatment of colonic cancer,the levels of Th,type cytokines were obviously associated with treatment.The levels of Th2 type cytokines had no association with treatment.Among them,the changes of Th1/Th2 ratio (IFN-γ/IL-4) had more correlation with tumor immunotherapy.So the reasonable immunotherapy can reverse Th1/Th2 ratio and immune inhibition.

Objective To observe the efficacy of ultrasound-guided erector spinae plane (ESP) block on intraoperative and postoperative analgesia in patients undergoing chronic empyema. Methods Sixty patients scheduled for elective decortication of pleural fibreboard under video-assisted thoracoscopic, 35 males and 25 females, aged 30-70 years, falling into ASA physical status Ⅰ or Ⅱ, were randomized into 2 groups: ESP block combined with general anesthesia group (group E) and only general anesthesia group (group G). Patients in group E received ESP block before general anesthesia, while patients in group G received general anesthesia only. All patients received patient controlled intravenous analgesia (PCIA). The thoracic paravertebral space were recorded using ultrasound. Dermatomes of sensory block on midclavicular line were recorded at 20 min after ESP block. The amount of remifentanil, duration of stay in post-anesthesia care unit, the frequency of PCIA pressing, the pain analog scale (VAS) scores during rest and movement at 1, 4, 12, 24, 48 h after operation were recorded. Results Twenty-four patients in group E showed unclear thoracic paravertebral space, dermatomes of sensory block at 20 min after ESP block were 4.9 ± 1.0 on midclavicular line. The consumption of remifentanil and duration of stay in post-anesthesia care unit and the frequency of PCIA pressing in group E were significantly less than that in group G (P ＜ 0.05). The VAS scores at 1, 4, 12, 24 h in group E were lower than those of group G (P ＜ 0.05). Conclusion The ultrasound-guided erector spinae plane block were safe and effective for patients undergoing chronic empyema, and provided satisfactory intraoperative and postoperative analgesia.

Objective To investigate the effect of ultrasound-guided erector spinae plane block(ESPB)on early postoperative respiratory function and inflammatory cytokines in patients with multiple rib fractures(MRFs).Methods Fifty-eight patients who underwent MRFs surgery,42 males and 16 females,aged 18-64 years,BMI 18.5-30.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were selected from February 2019 to December 2021.The patients were divided into two groups using random number method:ESPB combined with general anesthesia group(group E)and general anesthesia alone group(group G),29 pa-tients in each group.All the patients in group E underwent ultrasound-guided ESPB in the lateral decubitus position after general anesthesia induction,and 0.5％ropivacaine 0.4 ml/kg was administered.Forced vital capacity(FVC),arterial blood gas analysis,VAS pain scores at rest and cough were recorded before anes-thesia induction,at discharge from PACU,24 and 48 hours after operation.The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery and the number of rescue analgesia were re-corded.The concentrations of IL-6 and TNF-α were recorded before anesthesia induction,24 and 48 hours after operation.Results Compared with group G,the FVC was significantly higher,and the VAS score and PaCO2 were significantly lower in group E at discharge from PACU,24 and 48 hours after operation(P＜0.05).The number of effective PCIA compressions during 0-24 hours and 24-48 hours after surgery,the rate of rescue analgesia,the concentrations of IL-6 and TNF-α 24 and 48 hours after operation in group E were significantly lower than those in group G(P＜0.05).Conclusion Ultrasound-guided ESPB can pro-vide good postoperative analgesia,promote early postoperative recovery of respiratory function in patients with MRFs.

Objective To assess the effect of different postoperative body positions on respiratory func-tion of patients undergoing shoulder arthroscopy under general anesthesia with interscalene brachial plex-us block.Methods Seventy patients undergoing arthroscopic repair of the supraspinatus tendon were ran-domly allocated to a supine position group and a group with a 30° head elevation.Patients in both groups were in a horizontal position before anesthesia,and diaphragm movement was measured under B-ultrasound as baseline.Promptly after removal of the endotracheal tube upon arrival at the anesthe-sia recovery room,the supine group was conducted blood gas analysis,and monitored heart rate,res-piration,non-invasive arterial blood pressure and blood oxygen saturation,wearing a mask for oxygen supplementation,while the group with a 30° head elevation was given identical nursing procedures af-ter the bed's head was elevated 30°.Then right after entering the anesthesia recovery room,as well as 5 and 15 minutes after deoxygenation,the oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2)and percutaneous oxygen saturation(SpO2)were recorded and compared between the two groups.Moreover,the diaphragmatic movements during deep breathing before nerve block and pri-or to discharge from the anesthesia recovery room were measured,and such adverse reactions as hypox-emia,labored breathing and glossoptosis were observed.Results Compared with the supine position group,a significant increase in the average PaO2 and SpO2 15 minutes after deoxygenation,diaphrag-matic movement during deep breathing and comfort was observed in the group with a 30° head eleva-tion,but a significant decrease in the incidence of postoperative laboured breathing and glossoptosis.However,no significant differences were found between the two groups in the incidence of hypoxemia and the average PaO2,PaCO2 and SpO2 immediately after entering the anesthesia recovery room and 5 minutes after deoxygenation.Conclusion Elevating the head of the bed by 30° enhances respiratory function in patients undergoing shoulder surgery with general anesthesia intubation and intermuscular groove brachial plexus block,compared to the supine position.Although no significant reduction in hy-poxemia incidence is observed,there is a notable relief of adverse reactions such as laboured breath-ing and glossoptosis,which makes patients feel more comfortable.Therefore,such posture care is wor-thy of application in clinical practice.

Child ; China ; Humans ; Iodine ; urine ; Sodium Chloride, Dietary

It is the current confusion encountered by integrated Chinese and Western medicine that how to find the breakthrough direction of integrating Chinese and Western medicine， from crossover to integration to innovation， and open up a new horizon of integrated Chinese and Western medicine. The progress of Chinese medicine lay in expanding the scope of diagnosis and treatment with the help of modern diagnostic and therapeutic equipments and developing “micro” identification， while the progress of Western medicine lay in looking at “macro” and developing systemic medicine and integrated medicine， both of which are in the direction of each other. The “state-target identification and treatment” may become an important way to build a modern diagnosis and treatment system of integrated Chinese and Western medicine， and the thinking mode of “from target to state” is a further refinement and development on the basis of the theoretical system of “state-target identification and treatment”， which provided a clearer solution for the current stage of the integrated Chinese and Western medicine model， and pointed out the important development direction for the future integrated Chinese and Western medicine. From the perspective of strategic level and diagnosis and treatment practice， it integrated the “target-state” thinking mode into the modern diagnosis and treatment model of the integrated Chinese and Western medicine， i.e.， “Western medicine as the basis and treating with Chinese medicine； Chinese medicine as the basis and treating with Western medicine”. On the one hand， Western medicine should strengthen the reference to the traditional theories and holism of Chinese medicine， and advocate a higher level of education on the integrated Chinese and Western medicine under the guidance of the traditional theories of Chinese medicine. On the other hand， the “from target to state” mode of thinking should be applied to guide the establishment of diagnostic and treatment strategies and clinical selection of medicines in clinical practice， so as to locate the target and adjust the body state in a gradual and orderly manner， and to provide practical methods for the modern clinical work of the integrated Chinese and Western medicines. Chinese and Western medicine systems can learn from each other， combine organically， give full play to their respective strengths， and form an internal law， so as to make breakthroughs and innovations in the integrated Chinese and Western medicine model.