Objective To explore the optimal method of anesthesia in radical resection of gastric cancer by comparing the effects of two anesthesia techniques on the balance of Th1/Th2 in order to provide evidence for clinical anesthesia manage-ment.Methods Forty patients who underwent elective radical resection of gastric cancer were randomized into two groups:in-halation anesthesia group(group S)and total intravenous anesthesia group(group P),in which sevoflurane and propofol were ad-ministered for the induction and maintenance of anesthesia,respectively.The general data of the patients were collected,the tis-sue type of tumors obtained and the fluid infusion and blood loss volumes recoded.The VAS score was obtained 1 h,6 h and 5 d after the surgery.Before the induction of anesthesia,6 h and 5 d after surgery,the blood samples were drawn to determine the serum levels of IL-1β,IFN-γ,TNF-α,IL-2,IL-6 and IL-10.Flow cytometry was used to detect the proportion of CD3+CD8-IFN-γ+ and CD3+CD8-IL-10+ cells and the Th1/Th2 ratio was calculated.Results The level of IL-6 was increased post-sur-gically in groups S and P(P<0.05).There were no significant changes in the levels of IL-1β,IL-2 and IL-10 in groups S and P and in the levels of TNF-αand IFN-γ,and the Th1/Th2 ratio in group S between before the induction of anesthesia and different time points after the surgery(P>0.05).The levels of TNF-αand IFN-γ,and the Th1/Th2 ratio were significantly increased in group P 5 d after the surgery(P<0.05).Conclusion Total intravenous anesthesia with propofol can enhance Th1 response and it is an ideal anesthetic method for radical resection of gastric cancer.

Objective To compare the efficacy and toxicity of thalidomide-COMP (T-COMP) and thalidomide-VAD (T-VAD) regimens in previously untreated multiple myeloma (MM) patients.Methods Forty-nine newly diagnosed MM patients were randomly allocated to either A group (thalidomide-MP/-COMP,19 cases) or B group (thalidomide-VAD,30 cases).All patients received thalidomide 200 mg p.o.daily.Patients in group A received additionally vincristine 0.4 mg i.v.on day 1-4,cyclophosphamide 200 mg i.v.on day 1-4,melphalan 4 mg tid p.o.on days 1-5,prednisone 60 mg p.o.daily on days 1-5.Patients in group B received additionally vincristine 0.4 mg i.v.on day 1-4 and epirubicin 10 mg/m2 i.v.,on day 1-4 and dexamethasone 40 mg p.o.daily on days 1-4,9-12 and 17-20 for the first cycle and on days 1-4 for the next three cycles.Treatment was administered every 28 days.The therapeutic response was evaluated based on the International Myeloma Working Group Criteria (IMWG 2006) after the treatment.The toxicity was graded according to NCI common terminology criteria for adverse events v 3.0.Results On an intention-to-treat basis,at least partial therapeutic response was observed.The rates were 73.7 ％ and 53.3 ％ in group A and B respectively (x2 =2.029,P =0.154).Overall survival (OS) rate at 2 years were 52.6 ％ (10/19) in group A and 53.3 ％ (16/30) in group B,respectively (x2 =2.468,P =0.116).Considering overall toxicity,constipation,peripheral neuropathy,dizziness/somnolence,skin rash and edema were significantly higher in group B compared with group A,but the incidence of toxicities grade 3-4 was low and similar in both arms.Conclusion The overall response rate of T-MP/T-COMP regimen is similar with that of T-VAD regimen,suggesting this regimen cannot be chosen as the first treatment for patients with non-implantation therapy.

Objective To evaluate the changes of serum total prostate specific antigen (TPSA) with age and its significance in differential diagnosis of prostate cancer (PCa) and prostatic hyperplasia (BPH). Methods TPSA and free prostate specific antigen (FPSA) in 146 cases of PCa, 108 cases of BPH and 210 cases of healthy subjects were detected by electrochemiluminescence. Results There was a positive correlation between age and serum TPSA level (r=0.265, P<0.01). The levels of TPSA in PCa and BPH groups were (85.40 ±56.70) μg/L and (7.90 ±7.00) μg/L, and the difference was statistically significant (t=8.310, P= 0.001); FPSA levels were (5.16±4.90) μg/L, (1.50±1.36) μg/L, and the difference was statistically significant (t= 3.152, P= 0.030). In patients with TPSA levels ranging from 4.0 to 20.0 μg / L (diagnostic gray zone), the levels of TPSA in PCa and BPH groups were (8.82±4.01)μg/L and (8.41±3.95)μg/L, and the difference had no statistical significance (t= 0.198, P= 0.256); The levels of FPSA were (1.18 ±0.91) μg/L and (2.32±1.20) μg/L, the ratio of FPSA/TPSA were 0.12±0.08 and 0.24±0.23, and the differences were statistically significant (t= 23.56, P= 0.020; t= 32.45, P= 0.006). When FPSA/TPSA ratio was 0.16, its sensitivity and specificity for PCa were 84.4%and 79.8%, respectively. Conclusions Serum TPSA levels vary with age, and 95 % of all age groups should be used as the medical criterion to improve the specificity and accuracy of PSA in diagnosing with PCa. The ratio of FPSA/TPSA has a significant clinical value in differential diagnosis of PCa and BPH in patients with TPSA indiagnostic gray zone.

BACKGROUND:Patients with rheumatoid arthritis have high cardiovascular disease risks and postsurgical complications such as postoperative infection and wound healing problems in the process of total joint arthroplasty. OBJECTIVE:To retrospectively review the peri-operative risks when undergoing total joint replacement in patients with rheumatoid arthritis, and assess these risks, propose solutions to guide clinical practice for better peri-operative management. METHODS:The studies related with perioperative cardiovascular risk, the risk of infection of total joint replacement were retrieved by the first author from PubMed database, GOOGLE academic database, CNKI database, Wanfang database, VIP database from 2000 to 2015 through computer. The key words in English and Chinese were respectively“Rheumatoid arthritis, Total joint arthroplast, Perioperative management, Infection, Postsurgical complications, Corticosteroid, Disease modifying antirheumatic drugs, Biologics”. Old and repetitive studies were excluded. RESULTS AND CONCLUSION:A total of 97 articles were retrieved. Total y 53 articles which content was inconsistent with the research themes were excluded, and 44 papers were included in the analysis. We should make a comprehensive cardiovascular examination for the patients with rheumatoid arthritis before operation. If the cardiovascular disease of the patient is unstable, this condition should be clarified and treated appropriately before surgery, otherwise, patients need to check heart function, and predict the operation risk;We should reasonably arrange the anti-rheumatism medicines and corticosteroid during perioperative, so as to make a balance between reducing postoperative infection and preventing the condition relapse;Because rheumatoid arthritis often easy to erode the cervical spine, we should conduct routine imaging examination for the patients before total joint replacement. Movement should be gentle when general anesthesia was needed.

Objective To assess the efficacy of high dose dexamethasone combined with bortezomib and thalidomide in multiple myeloma (MM) patients with acute renal failure.Methods 23 newly diagoosed MM patients with acute renal failure were treated with high dose dexamethasone combined with bortezomib and thalidomide.Results Reversal of renal failure was documented in 58.3 ％ (7/12) of those severe renal failure patients and 81.8 ％ (9/11) of renal failure patients.Renal function was reversed in 69.5 ％ (16/23) of all patients.The total response rate for MM was 60.9 ％ (14/23).The median time to response was 2 (1-5) months. Overall survival (OS) at 3 years was 56.5 ％ and the median survival time was 34.4 months.Conclusion Renal failure was reversible in the majority of newly diagnosed MM patients treated with highdose dexamethasone containing regimens.The addition of novel agents thalidomide and (or) bortezomib is safe and induces a more rapid renal failure reversal compared with routine chemotherapy.

Objective: To investigate the relationship between the expressions of hypoxia inducible factor-1α (HIF-1α) and cellular adhesion molecules in human pancreatic adenocarcinoma, and discuss the mechanism for the promoting effects of HIF-1α on cancer invasiveness and metastasis and the clinical significance. Methods: Expressions of HIF-1α, E-cadherin and integrin β1 were detected by immunohistochemistry in 34 cases of radically resected pancreatic cancer tissues and 10 normal pancreatic tissues. The association of the expression of HIF-1α with the expression of E-cadherin and integrin β1 and the relationship between expression of HIF-1α and clinical features were analyzed. Results: There were overexpressions of HIF-1α, abnormal expression of E-cadherin, and high expression of integrin in pancreatic cancer tissues. Expression of HIF-1α negatively correlated with E-cadherin but had no significant relationship with expression of integrin. Expression of HIF-1α correlated with pathological staging and lymph node metastasis. Abnormal expression of E-cadherin was associated with tumor differentiation, pathological staging, and lymph node metastasis. Expression of integrin had no correlation with clinical features. Conclusion: HIF-1α promotes cancer invasiveness and metastasis by regulating abnormal expression of E-cadherin. Immunhistochemistry results indicated that detection of HIF-1α and E-cadherin may be valuable for judging the potential malignancy of pancreatic cancer.

OBJECTIVETo observe the effects of moxibustion and treadmill exercise on transcutaneous oxygen tension and exercise capacity in lower limbs of peripheral arterial disease (PAD).

METHODSTotally 58 mild-to-moderate PAD patients were assigned to the control group (18 cases), the moxibustion group (20 cases), and the treadmill exercise group (20 cases) by random digit table. Patients in the control group received conventional drug therapy for 12 weeks. Patients in the moxibustion group and the treadmill exercise group additionally received moxibustion [at Zusanli (ST36), Sanyinjiao (SP6), Yongquan (KI1)] and treadmill exercise respectively, once per day, 5 times per week for 12 weeks in total. Ankle-Brachial Index (ABI) , transcutaneous oxygen tension (TcPO₂), 6-min walking test (6MWT), and walking impairment questionnaire (WIQ) were assessed before and after treatment.

RESULTSCompared with the control group and the same group before treatment, there was no statistical difference in ABI in the moxibustion group and the treadmill exercise group (P > 0.05). But TcPO₂, 6MWT, and WIQ were obviously elevated (P < 0.01). Besides, 6MWT and WIQ assessment of the treadmill exercise group were better than that of the moxibustion group (P < 0.01) after intervention.

CONCLUSIONMoxibustion and treadmill exercise could improve the exercise capacity and TcPO₂of lower limbers in PAD patients.

Exercise Test ; Exercise Therapy ; Exercise Tolerance ; Humans ; Lower Extremity ; physiopathology ; Moxibustion ; Oximetry ; Oxygen ; blood ; Peripheral Arterial Disease ; therapy ; Surveys and Questionnaires ; Walking

OBJECTIVETo investigate whether bortezomib can enhance the sensitivity of human prostate cancer (PCa) cells to natural killer (NK) cell-mediated cytotoxicity, and whether it produces the same effect on different PCa cell lines.

METHODSWe treated androgen-dependent PCa LNCaP cells and androgen-independent PCa DU145 cells with bortezomib at the concentrations of 0, 5, 10, 15, 20 and 25 nmol/L for 24, 48 and 72 hours, and then detected the proliferation and apoptosis of the tumor cells by CCK-8 and Annexin V/PI, respectively.

RESULTSThe proliferation rates of the DU145 cells treated with 15, 20 and 25 nmol/L bortezomib were (82.79 +/-2.04)%, (73.59+/- 2.95)% and (74.16+/- 6. 16)% at 48 hours and (71.24+/- 5.30)%, (51.20+/- 2.91)% and (38.02+/- 2.67)% at 72 hours, and those of the LNCaP cells were (77.04+/- 7.74)% , (42.61 +/- 6.62)% and (23.85 +/-6.04)% at 48 hours and (36.45 +/-7.02)%, (14.94 +/-5.76)% and (11.65 +/-5. 87)% at 72 hours, both significantly inhibited as compared with the control group (P <0.05). At 24 hours, the apoptosis rates of the DU145 cells treated with 15, 20 and 25 nmol/L bortezomib were (14.41 +/- 1.32)% , (16.13 +/- 1.55)% and (14.48 +/- 1.42)% , and those of the LNCaP cells treated with 20 and 25 nmol/L bortezomib were (12.77 +/- 1.28)% and (14. 84 +/- 1.65)% , significantly higher than those of the control group (P <0.05) , and the DU145 cells showed an even higher sensitivity to bortezomib than the LNCaP cells. Bortezomib failed to sensitize these two cell lines to NK cell-mediated cytotoxicity in short-term assay, while long-term assay manifested that the apoptosis rates of DU145 and LNCaP cells after treated with 20 nmol/L bortezomib + NK cells were (41.83 +/- 5.06)% and (30.31 +/- 3.62)% , respectively, significantly higher

CONCLUSIONBortezomib enhances the sensitivity of than those after treated with either bortezomib or NK cells alone (P <0.05). PCa cells to NK cell-mediated cytotoxicity and adds to the effect of current cancer therapies, and it is more efficacious for androgen-independent prostate cancer.

Apoptosis ; drug effects ; Boronic Acids ; pharmacology ; Bortezomib ; Cell Line, Tumor ; Cytotoxicity, Immunologic ; drug effects ; Humans ; Killer Cells, Natural ; drug effects ; Male ; Prostatic Neoplasms ; pathology ; Pyrazines ; pharmacology

[Objective]To evaluate temporary balloon occlusion of the abdominal aorta in sacral tumors surgical operation as a useful adjuvant technique.[Method]Temporary balloon occlusion of abdominal aorta was used in 36 patients during the sacral tumors surgical operations(study group).Another 32 patients with sacral tumors who receive the preoperative arterial embolization theraphy were used as control group.The quantity of blood loss during the surgery,the whole surgery time,the complication,mean days in hospital,recovery days post-operation and recurrence rate were recorded.The results in two groups were compared with each other.[Result]The time of operations of study group was(149.19?73.81)minutes.The loss of blood was(826.67?509.11)ml.Two cases had complication after operation.Mean days in hospital were(26.05?7.08)d.Recovery days post-operation were(34.61? 8.22)d.Recurrence rate of six months was 5.5 %.Recurrence rate of one year was 11%.Recurrence rate of two years was 16%.The time of operations of control group was(221.33?45.19)min.The loss of blood was( 1 652 ?706.99)ml.Eight cases had complications after operation.Mean days in hospital were(37.93?7.63)d.Recovery days post-operation were(46.03?9.67)d.Recurrence rate of six months was 18%.Recurrence rate of one year was 31%.Recurrence rate of two years was 40.6%.[Conclusion]The effect of temporary balloon occlusion of abdominal aorta is reliable.It significantly reduced the time of operations,the loss of blood,complications,mean days in hospital,recovery days post-operation and recurrence rate.It makes the operation of sacral tumors much more safer than before.

[Objective] To evaluate the therapeutic effect of early composite treatment in patients with cervical spinal cord injury(SCI) caused by diving injury.[Method]27 patients of SCI caused by diving injury,including complete SCI in 15 patients and incomplete SCI in 12 patients,were analyzed.Early composite treatment scheme were as follows:(1) systemic treatment: respiratory support and effective circulation volume for maintenance of systolic pressure more than 90mmHg and oxygen saturation more than 90%.(2) Early pharmacological treatment such as methylprednisolone and dexamethasone.(3) Immobilization and reduction of the injured cervical spine by skull traction.(4) Early cervical decompression,reduction,graft and internal fixation.(5) Early hyperbaric oxygen therapy after operation.The stability and fusion of the injured segments and the complications of the hardware were observed on the X-ray film postoperatively.The spinal cord function was evaluated with ASIA grades and sensorymotor scores.[Result]All 27 patients were followed up for 12 to 36 months,with an average of 28 months.No intra-operative and post-operative complications,the incision healed well.The injured segments were stable and all bone grafts acquired fusion in 3 months,no plates or screws broken or loosen.The neurological recovery were detected in 13 patients.The neurological recovery rate was 20% in complete SCI,83.3% in incomplete SCI,48.1% in the total.The ASIA grades of the sensory and motor scores could hardly be improved postoperatively in complete spinal cord injury while in incomplete spinal cord injury the ASIA grades and sensorymotor scores increased significantly.[Conclusion]Early composite treatment of cervical spinal cord injury caused by diving injury can significantly improve neurological function of the cervical spinalcord injury patients.