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 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 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 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 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

Objective To discuss the CT value measurement of the soft tissue such as sludged blood,gel foam and residual nucleus in vertebral canal at the early stage after lumbar discectomy.Methods 40 patients of lumbar disc herniation were divided into gel foam group and sludged blood group randomly.There were 22 males,18 females,with the mean age 50.6 years(ranged from 25 to 75 years).All patients underwent lumbar CT scan before operation and CT values of herniated nucleus were measured(simulating residual nucleus after operation).Same surgeon group performed posterior approach discectomy through open window in the vertebral plate.A long column roll of gel foam was placed epidurally at the site where nucleus were take out to stop bleeding in gel foam group.While in sludged blood group just douched with saline.All patients underwent lumbar CT scan one week after operation and CT values of the soft tissue in vertebral canal measured.The CT values before and after operation and between groups were compared and analyzed.Results CT values of the herniated disc of 40 patients were 43.70-66.70 HU.CT values of the soft tissue in vertebral canal of 20 patients gel foam group were(23.00?3.36)HU.Paired-samples t test of the values of herniated nucleus before operation and the gel foam showed t=12.32,P=0.00,with statistic significance.CT values of the soft tissue in vertebral canal of sludged blood group were(25.60?6.75)HU.Paired-samples t test of the values of nucleus before operation and sludged blood showed t=13.84,P=0.00,with statistic significance.Independent-samples t test of values of gel foam group and sludged blood group showed t=-0.78,P=0.46.No significant differences existed.Conclusion CT value measurement is valuable to distinguish the nature of the soft tissue in vertebral canal in clinical use.

[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.

[Objective] To study the mechanism and clinic characteristic to the serious spinal cord compression from vertebral tuberculosis in the absence of nenrologic deficits.[Method]A total of 15 patients with serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits were treated by one-stage debridement,lilac grafting and internal fixation.The clinical characters were retrospectively analyzed.[Result]All these patients had no sinus formation and no recurrence of spinal tuberculosis during average the follow-up of 3.8 years(range:6 months to 7 years).In 5 cases with incomplete paraplegia,3 cases improved 2 grades,1 case was no change and 1 case became serious.[Conclusion]The serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits has a long history in illness,the spinal cord is in crisis condition even it can get adjustment by itself.The early one-stage treatment of debridement,iliac grafting and internal fixation can guarantee the restore the spinal cord and spine stability.