Objective To compare the clinical effects of remifentanil combined with sevoflurane or with isoflurane in elderly patients undergoing radical gastrectomy for cancer and their recovery.Methods Sixty-two patients,who scheduled for radical gastrectomy for cancer was randomly divided into remifentanil combined with sevoflurane group ( SR group,n =31 ) and remifentanil combined with isoflurane group ( IR group,n =31 ).They were classified into American Society of Anesthesiology(ASA) physical status Ⅱ and ,The procedure of two Anesthesia was same,in which remifentanil was continually pumped into at the same velocity using micro pump immediately after intubation,tili the target density in plasma increased to 6 μg/L.Sevoflurane at 1.5％ to 2.0％ was inhaled in the SR group,whereas isoflurane at 1％ to 2％ in the IR group.The inhalation was ended at 5 mins before the surgery was completed,Remifentanil was stopped while stuturing,and 0.1 mg of Remifentanil was injected at 20 mins before the surgery was completed.The heart rate(HR) and blood pressure were recorded at before induction of anesthesia (T0),after induction of anesthesia ( T1 ),immediate intubation ( T2 ),surgery after the start of 5 min ( T3 ),30 min (T4) and the time of surgery ( T5 ),respectively.The recovery time and extubation time,and quality score for awakening after extubation (OAAS) were also recorded.Results There were no significant differences in HR,SBP and DBP at every time points observed between the two groups.The recovery time( 10.4 ± 3.9)mins and extubation time(5.9 ± 3.1 )min in SR group was significantly shorter than that of(16.3 ± 5.8) min and (9.7 ±2.5) min in the IR group(t =6.25 and 4.19,P =0.02 and 0.01,respectively ).The OAAS after extubation in the two groups gradually increased,and immediately after extubation and extubation after 10 min,OAAS in the SR group was(4.1 ± 1.2),which was significantly higher than that of (2.9±1.0)in the IR group(t =3.27,P =0.03).Conclusion Either stevoflurane-remifentanil or isoflurane remifentanil anesthesia can be used safely in elderly patients undergoing radical gastrectomy for cancer.Anesthesia with Sevoflurane-remifentanil provides better faster recovery than isoflurane- remifentanil in elderly patients.

Objective To study the prevention and treatment of stress ulcer after abdominal surgery by pantoprazole.Methods 46 cases with standing abdominal surgery were randomly divided into 2 groups;Used ranitidine or pantoprazole respectively for prevention of stress ulcer in perioperation. Furthermore, there were 12 alimentary hemorragic patients with stress ulcer treated by omerprazole or pantoprazole respectively.Results The pH of gastric juice in pantoprazole group was higher than that in ranitidine group,the morbidity of stress ulcer in pantoprazole group was lower than in ranitidine group. All of 12 stress ulcer cases were cured,and the cured time in pantoprazole group was shorter than in omerpazole group.Conclusions Pantoprazole is a good agent to prevent and treat the stress ulcer after abdomimd surgery.

Objective To observe the PML protein expression of hepatocellar carcinoma tissue and cells lines and As 2 O3 regulate its expression .Methods Immunohistochemistry was used to examine the PML protein expression of hepatocellar carcinoma tissue . Western blot analysis were used to observe PML protein expression of hepatocellar carcinoma tissue of 12 cases ,5 hepatocellar car-cinoma cell lines ,such as HuH7 ,HepG2 ,Hep3B ,SMMC-7721 ,MHC97H .Western blot analysis was used to detected the PML pro-tein expression of these hepatocellar carcinoma cell lines after 72-96 h treated with 0 .25 μg/mL of As2 O3 .Results Immunohisch-enmical staining showed that the PML protein was expressed in both cytoplasm and nucleus ,did not well-distributed in hepatocellar carcinoma cells .There was no significant differences of PML protein expressed among differently differentiated stages of hepatocel-lar carcinoma cells .Western blot analysis found that hepatocellar carcinoma tissues of 12 cases with hepatocellar carcinoma ex-pressed PML protein ,and there was significant difference of PML protein expressed among 12 cases suffer with hepatocellar carci-noma .hepatocellar carcinoma cell lines ,such as HuH7 ,HepG2 ,Hep3B ,SMMC-7721 and MHC97H all expressed PML protein ,and there was little difference of PML protein expressed among hepatocellar carcinoma cell lines .The PML protein expression of HuH7 ,HepG2 ,Hep3B ,SMMC-7721 and MHC97H cell after 72-96 h treated with 0 .25 μg/mL of As2O3 significant decreased . Conclusion Hepatocellar carcinoma tissue and cells may express PML protein ,and As2 O3 may regulate this protein expression as well .PML protein may be the target molecule of As2 O3 treating HCC .

Objective To study the effects of human insulin-like growth factor 1(hIGF-1) gene transfection on the proliferation of NIH3T3 fibroblasts.Methods The plasmid of pcDNA3.1-hIGF-1 was transfected into NIH3T3 fibroblasts by using Lipofectin method.The positive cell clones were selected with G418 and cultured for 4 weeks.The stable expression of hIGF-1 in the positive cells was determined by in situ hybridization and immunocytochemical analysis.MTT assay and flow cytometer analysis were used to observe the proliferation of NIH3T3 fibroblasts.Results hIGF-1 mRNA and protein expressed in NIH3T3 fibroblasts transfected with pcDNA3.1-hIGF-1 by in situ hybridization and immunocytochemical analysis.MTT assay showed the A value of transfected NIH3T3 fibroblasts rose,compared with untransfected NIH3T3 fibroblasts group,the difference was significant(P

Objective To investigate the effectiveness of target-controlled infusion (TCI) of etomidate and remifentanil for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixtynine ASA Ⅰ or Ⅱ patients of both sexes,aged 35-71 yr,weighing 41-83 kg,scheduled for elective EBUS-TBNA,were randomly divided into 3 groups ( n =23 each).In group Ⅰ,anesthesia was induced with TCI of propofol and iv injection of fentanyl 4 μg/ml,and the target plasma concentration (Cp) of propofol was set at 3-4 μg/ml.In group Ⅱ ,anesthesia was induced with TCI of propofol ( Cp 3-4 μg/ml) and remifentanil ( Cp 5 ng/ml).In group Ⅲ ,anesthesia was induced with TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml).After the patients lost consciousness,laryngeal mask airway was inserted to perform mechanical ventilation.PETCO2 was maintained at 30-40 mm Hg.BIS value was maintained at 40-60.The use of vasoactive agents (perdipine,ephedrine,atropine and esmolol) and occurrence of bucking during operation,emergence time,and the occurrence of nausea and vomiting within 24 h after operation were recorded.Blood samples were collected from the femoral vein at 30 min before induction,at the end of operation and at 24 h after operation for determination of the plasma cortisol concentration.Results The incidence of bucking and nausea and vomiting was significantly lower,the emergence time was significantly shorter,and the number of patients who needed vasoactive agents during operation was significantly smaller in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜ 0.05).The number of patients who needed vasoactive agents during operation was significantly smaller in group Ⅲ than in group Ⅱ (P ＜0.05).Compared with groups Ⅰ and Ⅱ,the plasma cortisol concentration was significantly decreased at the end of operation in group Ⅲ (P ＜ 0.05).There was no significant difference in the plasma cortisol concentration at each time point between groups Ⅰ and Ⅱ (P＞0.05).Conclusion TCI of etomidate (Cp 0.3-0.4 μg/ml) and remifentanil (Cp 5 ng/ml) can provide satisfactory anesthesia for EBUS-TBNA with few adverse effects.

Objective To explore the clinical features and risk factors causing recurrent cerebral hemorrhage, as well as effective prevention and control measures.Methods The data of 25 patients with recurrent cerebral hemorrhage were analyzed retrospectively in order to investigate the clinical characteristics, pathogenesis and prevention and control measures.Results 25 patients had a total of 27 times recurrence and 78 per cent of them were within two years. Recurrent types were mainly basal nuclei-basal nuclei type, followed by the cerebral lobe-cerebral lobe type, and the recurrence more occurred in the contralateral hemisphere. Re-bleeding risk factors included complications, poor prognosis. For bleeding aneurysm, it was a major measure of effectively controlling bleeding recurrence to fine out the cause of disease in time.Conclusion Actively looking for major risk factor causing cerebral hemorrhage is the key of effectively controlling recurrence of cerebral hemorrhage.

Objective To evaluate the diagnostic value of low-dose volume perfusion imaging with 320-detector CT in differentia-ting solitary pulmonary nodules (SPNs).Methods 130 patients with 130 SPNs (79 malignant tumors,1 6 active inflammations,1 6 benign nodules and 1 9 chronic inflammations)underwent contrast-enhanced dynamic volume perfusion CT prospectively.50ml of contrast medium with iodine concentration of 370 mg I/mL was injected at a flow rate of 5 mL/s,and the scan began at 0 second or 4 seconds after the bolus injection.20 or 21 intermittent low-dose volume acquisitions were made with 2 s intervals,and the total ac-quisition time was 38 s or 40 s.Post-procession was performed using a perfusion software on the CT (Body Perfusion,Dual-input single compartment mode).The perfusion parameters (PF,BF,PPI),T-DC and TPF were measured or calculated,and then as-sessed.Results PF and PPI of active inflammation nodules showed significant higher value than those of the other three kinds of nodules,and there were significant differences in PF and PPI between active inflammation nodules and other kinds of nodules.The value of BF in malignant nodules was higher than that in the other three kinds of nodules,however no statistic significant difference in PPI was found between malignant and chronic inflammation nodules.The value of TPF in malignant and active inflammation nod-ules was higher than that in benign and chronic nodules,and there were statistic significant differences between malignant and active nodules and chronic ones.Six types of T-DC were displayed on SPNs:malignant,benign and chronic nodules showed a variety of T-DC types,and active inflammatory nodules showed only one type-typeⅠ.Conclusion Low-dose volume perfusion technique with 320-detector row CT can provide abundant information about blood flow of SPNs,and it may be regarded as an important technique in the differential diagnosis of SPNs.

Listeriamonocytogenes is a facultative intracellular bacterium that enters professional antigen presenting cells , presents passenger antigens to the major histocompatibility complex class I and II pathways ,then elicits CD+4 and CD+8 T-cell-mediated immune responses .It was demonstrated that attenuated Listeriamonocytogenes as a novel live vaccine vector in deliv-ering tumor antigens of cervical cancer and melanoma etc .,could induce strong protective immune response ,and shows effec-tive antitumor immunotherapeutics .This review discussed the characteristics of immune responses elicited by Listeria monocy-togenes ,and the progress of its antitumor immunotherapeutics as delivery vaccine vector .

Objective To evaluate the value of dual echo technique in combination with apparent diffusion coefficient(ADC) in differentiating acute benign vertebral fracture from metastasis.Methods 43 patients (mean age, 68.2 years) with 79 metastatic vertebrae and 59 patients(mean age,60) with 68 acute vertebral fractures were included in our study.The slices of largest size of lesion on T1WI were selected to measure and calculate the signal intensity ratio(SIR) and ADC of lesions.The difference of ADC values and SIR between benign acute vertebral fractures and vertebral metastasis were compared.Parallel test,serial test and receiver operating characteristic curve(ROC) analysis of logistic model were done.Results ADC values of metastasis and acute benign fracture were (1.32±0.5)×10~（-3）mm~2/s and (2.39±0.4)×10~(-3)mm~~2/s respectively,and SIR of them were 1.00±0.01 and 0.85±0.01 respectively,there were significantly different between these two entities with the two tests(P<0.05).The area under the curve(AUC) for SIR was 0.897 and for ADC was 0.960,there is significantly different between these two tests in AUC(P=0.02).When 0.97 as cut off value for SIR,the sensitivity and specificity were 84.81% and 76.47%% respectively,when 1.87×10~(-3)mm~2/s as cutoff value for ADC , the sensitivity and specificity were 93.67% and 91.18% respectively . The sensitivity and specificity were 99.04% and 69.73% respectively in the parallel tests and 79.44%,97.92% in the serial test.A combining predictor established with logistic regression model showed a high AUC:0.985,which was higher than that of ADC and SIR alone.The AUC under ROC for ADC was significantly larger than that of SIR . When 0.55 as cut off value for this combining predictor , the sensitivity and specificity were 98.73% and 95.59% respectively.Multiple comparisons were performed with LSD-t test :combining predictor>ADC>SIR,it showed that there was significantly different between indexes(P<0.05). Conclusion ADC in combination with SIR can improve the effects in differentiating benign acute vertebral fractures and vertebral metastasis.

Objective To study the therapeutic effect of liver resection for spontaneous rupture of primary(hepatocellular) carcinoma(SRHCC).Methods The clinical data of 15 patients with ruptured SRHCC treated by liver resection were retrospectively analysed.Results In this group there were 12 males and 3 females.Eight underwent emergent hepatectomy,2 cases had second stage surgery at 40 days after initial operation to control bleeding and 5 cases had operation after 40 days of conservative treatment.Operation included partial right hepatectomy in 8 patients,median lobectomy in one patient,left lateral lobectomy in 2 patients,left(median) lobectomy in 2 patients,left hemihepatectomy in 1 patient,right tumor resection in 1,and left tumor resection in one patient.One of 5 patients with Child grade B liver function died of liver failure at 5 days(after) operation.The operative mortality was 6.7%.Twelve of the 14 patients who surrived were followed up.The median postoperative survival time was 18 months.The 1-,3-and 5-year survival rates were(58.3)%,25%,16.7%,respectively.One patient has been alive and free of tumor for 6 years and 2 months.Conclusions Liver resection is the best treatment for ruptured SRHCC and should be performed when possible.Hepatic resection for SRHCC can result in a long survival time.