Objective To evaluate the feasibility of induction with sevoflurane-midaaolam-remifentanil for tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.Methods Twenty-two ASA Ⅰ-Ⅲ patients with huge mediastinal tumor,aged 22-64 yr,weighing 48-76 kg,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midaaolam 0.03 mg/kg and inhalation of 8％ sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 8％,followed by decrement of 2％ every 30 s until 4％.When the eyelash reflex disappeared,remifentani1 2 μ g/kg was injected slowly over I min and sevoflurane inhalation was stopped 30 s later.The patients were mechanically ventilated after tracheal intubation.MAP and HR were recorded before induction and immediately before and 1 min after inlubation.The time of disappearance of eyelash reflex was recorded.The inlubation condition was evaluated using VibyMogensen score.Results The time period from sevoflurane inhalation to disappearance of eyelash reflex was(110 ± 14)s.The success rate of tracheal intubation at the first attempt was 86％.The position of the glottis was higher in 2 patients,and tracheal intubation was successfully performed under the guide of fiberoptic bronchoscope.The satisfactory intubation conditions were found in 86％ of cases.Compared with that before anesthesia induclion,MAP and HR were significantly decreased immediately after intubation and at 1 min after intubation(P ＜ 0.05).SpO2 ＞ 95％ in all patients.BIS was maintained at 45-55 during the period(before intubation until 1 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifenlail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.

Objective Metabonomics method based gas chromatography-mass spectrometry (GC/MS)were used to analyze the urine samples of patients with hyperlipidemic pancreatitis (HLP) to describe the characteristics of metabolism changes of HLP,identify potential biomarkers,and investigate the role of metabonomics study in the management of AP.Methods 24 patients of HLP and 40 age,sex matched volunteers were enrolled and their urine samples were collected.The urine samples underwent preparation,derivation and GC/MS analysis,Orthogonal-Projection to Latent Structures-Discriminant Analysis (OPLS-DA)were performed to detect the metabolic profile difference between the HLP and control group.Results HLP patients can be precisely distinguished from healthy controls.21 metabolites (credibility ＞ 700 ) were identified using the reference compounds available in the libraries of NIST and Wiley.It was identified that levels of nicotinic acid,aconitie acid,citric acid,hippurie acid,hydroxyphenylacetic acid,hydroxyphenylpropionicacid were decreased,while the levels of tryptophan,tyrosine,tyramine,16-hexadecanoic acid,18octadecanoie acid were increased.It was also suggested that there was change in tricarboxylic acid cycle and gut bacterial flora,as well as fat metabolism and metabolism of amino acid.Conclusions There are differences between healthy controls and HLP patients in the term of GC/MS metabolic profiling,and the biomarkers in the metabolites could be found through metabonomics analysis,and the mechanisms of the metabolic changes could be explored.It was noted that the research of metabolites in the urine samples may be a useful tool to help diagnose and understand the pathogenesis of HLP.Metabonomics analysis is a promising research method.

Objective To evaluate the feasibility of induction with sevoflurane-midazolam-remifentail for tracheal intubation without muscle relaxants in neck brake patients.Methods Forty ASA Ⅰ or Ⅱ patients with cervical spine fracture with dislocation,aged 13-68 yr,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and inhalation of 5%sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 5%,followed by decrement of 1% every 30 s until 3%.When the eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 45s and 30 s later sevoflurane inhalation was stopped.The patients were mechanically ventilated after tracheal intubation.The time of disappearance of eyelash reflex was recorded.The intubation condition was evaluated using VibyMogensen score.Results All patients were successfully intubated at the first attempt.The time period from sevoflurane inhalation to disappearance of eyslash reflex was(69 ± 4)s.Coughing occurred in 3 cases during intubation.The satisfactory intubation conditions were found in 100% of cases.SpO2 ＞ 95% in all patients.BlS was maintained at 45-55 during the period(before intubation until 3 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifentail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in neck brake patients.

ObjectiveTo study the Electrocardiogram (ECG) changes in AIDS patients at different age grades. MethodsThe ECG of 400 AIDS patients at different age were analyzed retrospectively. Results(①)The rate of abnormal ECG in the age group of 46 ～50 years was significantly higher than 11 ～ 15(P =0. 008) ,21 ～25( P = 0. 041 ),31 ～ 35 ( P = 0. 022 ),41 ～ 45 ( P = 0. 001 ) and 51 ～ 55 ( P = 0. 047 ) years groups respectively. (②)The rate of bradyarrhythmia in the age group of 46 ～ 50 years was significantly higher than 31 ～ 35 (U = 2. 44) ,36 -40( U = 2. 18 ) ,41 ～ 45 ( U = 2. 57 ) years groups ( P ＜ 0. 05 respectively. (③)The rate of left atrial and ventricular hypertrophy in 11 ～ 15 years group was significantly lower than the age groups older than 46 (except for 51 ～ 55years group) ;those aged ＞60 had higher atrial and ventricular hypertrophy rate than 36 ～40,41 ～45 and 51 ～55years groups ( P ＜ 0. 05 respectively). ConclusionsAIDS patients at all ages may present abnormal ECG, which is positively correlated with age.

Objective Early evaluate the feasibility and reproducibility of sorafenib-targeted therapy for hepatocellular carcinoma by RECIST1.1, mRECIST and three-dimensional volume measurement. Methods Seventy patients with pathology or typical imaging findings confirmed as hepatocellular carcinoma along with the sorafenib-targeted treatment for more than 2 months between October 2004 to April 2017 in the Fifth Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Patients underwent chest, abdominal and pelvic CT scans and enhanced scans before and after 2 weeks of sorafenib treatment. Two physicians used RECIST 1.1, mRECIST, and volume measurement criteria to evaluate the efficacy of treatment. According to their averaged results, the patients were divided into two groups (control group and non-control group). Kaplan-Meier survival analysis was used to compare the prognostic values between different response evaluation criterias for early predicting the efficacy of sorafenib-targeted therapy in advanced hepatocellular carcinoma. Kappa test was used to assess the efficacy response consistency in intra-group and inter-group. Results Based on mRECIST and RECIST 1.1 measurements, the control group included 34 cases, and the non-control group included 36 cases. Based on semi-automatic volume measurement, the control group included 38 cases, and the non-control group included 32 cases. Before the treatment with sorafenib, the RECIST 1.1 and mRECIST methods were used. There was a high degree of consistency between the two doctors (Kappa values were 0.79 and 0.71, respectively), and the semi-automatic volume measurement method was extremely consistent (Kappa value was 0.90); the consistency in intra-observer by three different methods was extremely high (Kappa values were 0.91, 0.85, 0.97, respectively). After the treatment with sorafenib, the consistency between the two radiologists using RECIST 1.1 measurement was high (Kappa value was 0.65), the consistency of mRECIST measurement was moderate (Kappa value was 0.52), and the consistency of tumor volume measurement was extremely high (Kappa The value was 0.83), the consistency in intra-observer using the above three methods was high or very high (Kappa values were 0.86, 0.74, 0.90, respectively). The RECIST 1.1 and mRECIST measurements were less sensitive in early evaluation of sorafenib-targeted treatment, and there was no significant difference between the control group and the non-control group (P=0.578 and 0.613) while the semi-automatic volumetric measurement was sensitive (P=0.004). Conclusion Semi-automated three-dimensional volume measurement which has better intra-and inter-group consistency and reproducibility can reflect the efficacy of sorafenib-targeted therapy for hepatocellular carcinoma in early stage.

Objective To study the association between reasons for smoking and results related to successful smoking cessation. Methods A community-based case-control study was conducted with 642 male adults recognized as successful spontaneous smoking quitters being the subject cases while another 700 male adults who had failed to quit smoking were served as the controls. Russell Reason for Smoking Questionnaire(RRSQ)was used to investigate the reasons for smoking. Dominance logistic regression was performed to determine the relative importance of reasons for starting smoking and the endpoint of successful quit smoking. Results After adjusting the potential confounders of age,age of smoking initiation,marital status,profession,and education,the adjusted means of sedative and stimulation of RRSQ in the successful quitters were significant lower than that in the failed quitters. Results from the dominance logistic regression showed that the first two important factors for smoking cessation were sedative and stimulation of RRSQ,followed by psychological image,automatic,hand-mouth activity,indulgence,and addiction. Conclusion This study demonstrated that factors as dependence-addiction showed more important impacts than the social-psychological ones on the endpoint of successful smoking cessation.

The aim of the present study was to explore the differentially expressed genes in the blood vessel endothelial cells (BVECs) between diffuse large B-cell lymphoma (DLBCL) and reac- tive lymph node hyperplasia (RLNH), and to perform an initial bioinformatics analysis on a novel gene, C20orf14, which is highly expressed in lymph node of lymphoma. The mRNA of the tissue from the BVECs of DLBCL and RLNH tissues was labeled with biotin respectively and hybridized with expression profile microarray, and the differentially expressed genes were obtained. Initial bio- informatics analysis was performed on a novel gene named C20orf14. Its gene structure, genomic lo- calization, the physical and chemical characteristics of the putative protein, subcellular localization, functional domain etc. were predicted, and the systematic evolution analysis was performed on the similar proteins among several species. By using expression profile microarray, many differentially expressed genes were uncovered. The efficient bioinformatics analysis have fundamentally identified that C20orfl4 was a nuclear protein, and may be involved in the post-transcription modification of mRNA. Therefore, microarray is an efficient and high throughout strategy for the detection of differ- entially expressed genes, and C20orf14 is thought to be a potential target for tumor metastasis re- searches by bioinformatics analysis.

Objective To explore the characteristics of RR-Lorenz plot in persistent atrial fibrillation (AF) patients complicating with escape beats and rhythm though ambulatory electrocardiogram.Methods The 24-hour ambulatory electrocardiogram of 291 persistent AF patients in second affiliated hospital of Zhengzhou university from July 2005 to April 2013 were retrospectively analyzed and the RR interval and the QRS wave were measured.Patients were divided into two groups according to the distribution of the RR-Lorenz point [AF without escape beats and rhythm group (Group A,n =259) and AF with escape beats and rhythm group (Group B,n =32)].The characteristics of RR-Lorenz plot between the two groups were compared.Results (1) Fan-shaped RR-Lorenz plots were evidenced in Group A.(2) In Group B,30 cases showed fan-shaped with L-shaped and a short dense rods along 45° line.The proportion of escape beats and rhythm was 0.28％ (275/98 369)-14.06％ (11 263/80 112).The other 2 cases in group B showed no typical RR-Lorenz plots features.Conclusion RR-Lorenz plot could help to quickly diagnose persistent AF complicating with escape beats and rhythm according to the typical RR-Lorenz plot characteristics in 24-hour ambulatory electrocardiogram.

OBJECTIVEA Meta-analysis was performed to assess the association of defective hepatic cytochrome P450 2A6 (CYP2A6) gene with smoking behaviors.

METHODSAll eligible studies published up to 2014 were searched out from PubMed, China National Knowledge Internet (CNKI), ISI Web of knowledge (ISI), vip citation databases (VIP), Chinese BioMedical Literature (CBM) and Elsevier Science Direct, searching words were "smok*","nicotine dependence","CYP2A6","cytochrome P450 2A6","polymorphism","mut*"and"varia*", while 436 articles were concluded. Meta-analysis was performed using Statal 3.1.

RESULTSA total of ten studies were finally included. We didn't find a significant effect of defective CYP2A6 gene on smoking initiation (fixed effect model (FEM): OR = 0.90, 95%CI: 0.78-1.03, I(2) = 25.8%), smoking persistence (random effect model (REM): OR = 0.85, 95%CI: 0.59-1.23, I(2) = 66.3%) and smoking cessation (REM: OR = 0.89, 95%CI: 0.57-1.40, I(2) = 67.1%). But it showed a significant protective effect of CYP2A6*4 on smoking initiation (FEM: OR = 0.78, 95%CI: 0.61-0.99, I(2) = 28.2%), smoking persistence (FEM: OR = 0.53, 95%CI: 0.36-0.77, I(2) = 41.0%) and smoking cessation (REM: OR = 0.49, 95%CI: 0.31-0.80, I(2) = 0.0%).

CONCLUSIONSThis Meta-analysis suggested that there was not a protective effect of defective CYP2A6 gene against smoking behaviors. But smokers with whole CYP2A6 gene deletion would be less likely to start smoking, less smoking persistence and more likely to quit smoking successful than smokers with wild CYP2A6 gene.

Aryl Hydrocarbon Hydroxylases ; Asian Continental Ancestry Group ; China ; Cytochrome P-450 CYP2A6 ; Gene Deletion ; Humans ; Polymorphism, Genetic ; Protective Factors ; Smoking ; Smoking Cessation ; Tobacco Use Disorder

In this study,the current status for breast diseases in a region with high-incidence of cervical cancer were epidemiologically investigated.From March to August,2009,17618 women,from Wufeng area of Hubei province,China,were recruited to screen breast diseases by using breast infrared diagnostic apparatus.Other diagnostic methods,such as B-mode ultrasound,X-ray mammography,needle biopsy and pathological examination were,if necessary,used to further confirm the diagnosis.The screening showed that 5990 of 17618 cases (34.00％) had breast diseases,5843 (33.16％) had mammary gland hyperplasia,48 (0.27％) had breast fibroadenoma,ll (0.06％) had breast carcinoma,and 88 (0.50％) had other breast diseases.The peak morbidity of breast cancer was found in the women aged 50-0 ages.The morbidity of breast cancer was significantly increased in women elder than or equal to 50 years old (n=8,0.157％) in comparison with that in the subjects younger than 50 years old (n=3,0.024％) (u=2.327,P＜0.05).It was shown that the occurrence of breast diseases was concentrated in women aged 20-40 years,while the total morbidity reached its peak at the age of 30 years and then decreased sharply after age of 40.Compared with the patients elder than or equal to 40 years old (n=3289,27.46％),the morbidity rate of breast diseases was significantly increased in women less than 40 years old (2648 cases,47.18％; P＜0.001).However,there was no significant difference in the morbidity of breast diseases between the age group of 20-29 years and that of 30-39 years (P=0.453),and both of them were high.There was no significant association between the morbidity of breast diseases and cervical cancer.Since the morbidity of breast diseases was higher among young women,more attention should be paid to the screening of breast diseases among young women for early diagnosis.