Objective To compare the effect of different sevoflurane induction methods on hemodynamics and immune function in elderly patients with tumor. Methods One hundred and sixty elderly patients with tumor underwent general anesthesia were enrolled, the patients were divided into observation group and control group according to the anesthesia method with 80 cases each. The observation group was received induction method of initial concentration of 2%sevoflurane and increased by 1% per 3 times breathing and then to a final concentration of 4%- 5%. The control group was received 5% sevoflurane induction concentration. The anesthesia induction time, intubation time, recovery time and untoward reaction were recorded. The changes of heart rate, mean arterial pressure (MAP), oxygen saturation of pulse (SpO2), bispectral index (BIS) and CD3+, CD4+, CD8+, CD4+/CD8+were observed. Results There were no statistical differences in BIS, heart rate, SpO2, CD3 +, CD8 + and incidence of untoward reaction between 2 groups (P>0.05). The MAP at immediate intubation in observation group was significantly higher than that in control group:(69.38 ± 10.42) mmHg (1 mmHg=0.133 kPa) vs. (58.52 ± 6.12) mmHg, but the MAP at after intubation was significantly lower than that in control group: (77.12 ± 11.31) mmHg vs. (90.13 ± 9.24) mmHg, there were statistical differences (P<0.05). The anesthesia induction time and intubation time in observation group were significantly longer than those in control group:(110.1 ± 14.2) s vs. (101.4 ± 15.8) s and (341.2 ± 57.3) s vs. (310.4 ± 60.8) s, but the recovery time was significantly shorter than that in control group: (271.2 ± 31.3) s vs. (321.8 ± 41.5) s, there were statistical differences (P<0.05). The CD4+and CD4+/CD8+at end of surgery and 1 d after surgery in observation group were significantly higher than those in control group, CD4+:0.241 ± 0.027 vs. 0.182 ± 0.034 and 0.332 ± 0.039 vs. 0.284 ± 0.042, CD4+/CD8+: 0.84 ± 0.12 vs. 0.69 ± 0.13 and 1.09 ± 0.52 vs. 0.93 ± 0.43, there were statistical differences (P<0.05). Conclusions Induction method of gradually increasing concentration of sevoflurane enables the hemodynamics of elderly tumor patients more stable. In addition, this method can reduce the inhibitory effect on T lymphocytes to some extent.

Objective To compare the efficacy of different doses of ropivacaine for ultrasound-guided axillary brachial plexus block in children.Methods One hundred and twenty ASA Ⅰ or Ⅱ children,aged 5-12 yr,scheduled for elective surgery for hand injury,were equally and randomly divided into 4 groups according to the doses of ropivacaine:0.35,0.3,0.25 and 0.20 ml/kg groups.The children received oral midazolam 30 min before surgery.Propofol was given by target-control infusion after admission to the operating room.When the pediatric patients lost consciousness and had no response to verbal command,axillary brachial plexus block was performed under the guidance of ultrasound.0.25 ％ ropivacaine 0.35,0.3,0.25 and 0.20 ml/kg were injected to block the radial,median,ulnar,musculocutaneous and medial antebrachial cutaneous nerves.Additional ketamine was given when needed during operation.The duration of block and consumption of general anesthesia and complications were recorded.The degree of sensory block of the region innervated by each nerve and effectiveness of block were assessed.Results The rate of effective block of the radial nerve,median nerve and musculocutaneous nerve was significantly lower,the number of patients requiring ketamine was larger and the duration of block was shorter in group 0.2 ml/kg than in 0.35,0.30 and 0.25 ml/kg groups (P ＜ 0.05).There was no significant difference in the parameters mentioned above between 0.35,0.30 and 0.25 ml/kg groups (P ＞ 0.05).No pediatric patients developed block-related complications in each group.Conclusion Ultrasound-guided axillary brachial plexus block with 0.25 ％ ropivacaine 0.25 ml/kg can provide better block in children.

Objective To determine the median effective target plasma concentration (Cp50) of remifentainil inhibiting body movement evoked by puncture during brachial plexus block in pediatric patients.Methods Pediatric patients of both sexes,aged 5-12 yr,who grown normally,scheduled for elective forearm or hand surgery,were enrolled in this study.Children were premedicated with oral midazolam 0.2 mg/kg at 30 min before anesthesia.The initial target Cp of remifentainil was 5.0 ng/ml.The target Cp was determined by up-and-down sequential method.Each time Cp increased/decreased by 20％ in the next patient depending on the response of the previous patient to puncture.The ratio between the two successive concentrations was 1.2.The puncture was performed after the target effect-site and plasma concentrations were balanced.Body movement was defined as puncture-induced movement of truncus,limbs and/or head and neck.The Cp50 and 95 ％ confidence interval of remifentainil were calculated by Dixon method.Results Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block was 3.9 ng/ml,and 95 ％ confidence interval was 3.6-4.2 ng/ml.Conclusion Cp50 of remifentainil inhibiting body movement evoked by puncture during brachial plexus block is 3.9 ng/ml in pediatric patients.

Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor.Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups.In the modified technique group (group A,n =10),tumor was resected until the ureteral orifice was exposed.Then,a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire.In control group (group B,7 cases),after ureteral orifice exposed,the guide wire and ureteral stent was placed with cystoscopy.The demographic,oncological baseline and operative factors were evaluated between two groups.Results There was no difference in tumor grade and maximum diameter between two groups (P ＞ 0.05).The operation time in group A was significantly shorter than that in group B [(39.5 ± 14.8)min vs (59.3 ± 16.2) min,P =0.020],and the intraoperative vision clarity score was better in group A as well [(7.7 ± 1.3) vs (5.9± 1.2),P =0.010].There was no statistical difference between the two groups in the complication.Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement.

To investigate the effects of oxymatrine injection (OI) combined with low-dose paclitaxel on expressions of mRNAs and proteins of vascular endothelial growth factor (VEGF) and CXC chemokine receptor 4 (CXCR4) in human gastric carcinoma SGC-7901 cells.

Objective To investigate the effects of ischemic preconditioning on the cholesterol content and the activity of Na+-K+-ATPase of hepatocytes following cold preservation in rats.Methods Twenty-five rats were randomly divided into five groups,including control group (C),cold preservation group (Ⅰ),ischemic preconditioning group (ⅠP),atorvastatin (30 μmol/L) treatment group (A30),and atorvastatin (100 μmol/L) treatment group (A100).The cholesterol content and the activity of Na+ -K+ -ATPase were assessed.Results The cholesterol contents on the rat liver tissue cell membrane in the C group,Ⅰ group,ⅠP group,A30 group and A100 group were (310.4 ± 27.5),(187.7±13.1),(394.3±25.9),(201.8±14.6) and (122.6±7.7) nmol/mg protein,and activity of the Na+ -K+ -ATP enzyme was (46.55 ± 3.20),(27.4 ± 2.81),(52.71 ± 3.02),(30.67 ±2.78) and (19.64 ± 2.11) μmol Pi/hr mg protein,respectively (P＜0.05).There was no significant difference in the plasma membrane phospholipid content among the five groups (P＞0.05).Conclusion Reduction of cholesterol content and Na+ K+ -ATPase activity on the liver cytoplasmic membrane is one of the factors causing donor liver cold preservation injury,but ischemic preconditioning can significantly improve cell membrane Na+ -K+ -ATPase activity and increase cytoplasmic membrane cholesterol content. Use of atorvastatin statins can reduce cytoplasmic membrane cholesterol synthesis,and significantly decrease Na+ -K+ -ATPase activity,thereby alleviating the donor liver cold preservation injury.

Objective To investigate the correlation between three gene locus polymorphisms of X-ray repair cross-complementary protein 1 (XRCC1) exon (Arg194Trp, Arg280His and Arg399Gln) and the risk of colorectal cancer (CRC). Methods A case-control study was performed in 250 CRC patients (case group, 128 colon cancer patients and 122 rectal cancer patients) and 213 healthy individuals (control group). The three gene locus polymorphism of XRCC1 was tested by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. The genotype distribution and allele frequency of each locus was analyzed with SPSS 10.0 software. Results There was no significant difference in allele frequency of XRCC1 at 194 and 399 loci (P > 0.05). However, the 280 Arg/His allele frequency of XRCC1 was higher in case group than that in control group (OR=1.66,95%CI:1.01~2.73,P=0.047). The 280Arg/His allele frequency was higher in rectal cancer group than that in control group (OR =1.82,95%CI:1.02~3.27). The frequency of 280His allele (Arg280His and His280His) was higher in case group than that in control group (OR=1.85,95%CI:1.06~3.22). However, it was a relative low risk factor of colon cancer and there was no significant difference between colon cancer group and control group (OR=1.85, 95%CI:1.06~3.22). Conclusions There was no correlation between XRCC1 Arg194Trp and Arg399Gln polymorpohisms and the risk of CRC. However, 280Arg/His genotype may increase the risk of CRC, and 280His allele is a risk factor of rectal cancer.

Objective To investigate the correlation between ICRU reference point dose and dosevolume parameters of organs at risk (OARs) under different bladder and rectal filling status in threedimensional conformal brachytherapy for locally advanced cervical cancer.Methods A total of 31 patients who received magnetic resonance imaging-guided three-dimensional conformal brachytherapy for cervical cancer in 96 fractions were enrolled.The ICRU rectal and bladder reference points were determined in the treatment planning system,and the doses at these points were recorded and compared with the dose-volume parameters of the rectum and bladder.The paired t-test was used to analyze the differences between them.Results Bladder DICRU was lower than bladder D0.1cm3 and D1 cm3 (P=0.000 and 0.000),higher than bladder D5 cm3 and D10cm3 (P=0.000 and 0.000),and similar to bladder D2 cm3 (P=0.345).Under the bladder filling status,bladder DICRU was lower than D2cm3.Rectal DICRU was lower than rectal D0.1 cm3 and D1cm3 (P =0.000 and 0.002),higher than rectal D5 cm3 and D 10 cm3 (P =0.000 and 0.000),and similar to rectal D2cm3 (P=0.058).The ICRU bladder and rectal reference point doses were positively correlated with corresponding D2 cm3.In the case of bladder volume ≥ 200 cm3,the ICRU bladder reference point dose underestimated bladder D2 cm3.In the case of rectal volume ≥ 37 cm3,the ICRU rectal reference point dose overestimated rectal D2 cm3.Conclusions In three-dimensional conformal brachytherapy,it is generally safe to use D2 cm3 as an index to evaluate OARs,but when the bladder or rectum is in an empty status,the ICRU bladder or rectal reference point doses should be considered.

Objective To explore the efficacy and safety of Gemcitabine and Cisplatin combination chemotherapy in treatment of muscle-invasive urothelial cell carcinoma.Methods Analyse of 72 cases of patients with muscle-invasive urothelial cell carcinoma receiving chemotherapy from September 2010 to September 2012,including 47 male and 25 female,the avarage age was 65 (86-33).All patients were received GC chemotherapy (Gemcitabine 800-1 000 mg/m2,ivgtt,dl,d8,d15; Cisplatin 70 mg/m2,ivgtt,d2).Efficacy was reviewed after 1 cycle of chemotherapy.Results Fifty-one cases in all the patients completed two or more chemotherapy cycles and CR 10 cases,PR 27 cases,total effective rate was 51.39％ (37/72).The main toxic reactions included nausea,vomit,myelosuppression,and then damage of liver and renal function.Cconclusion GC regimen is a good choice for urothelial cell carcinoma.Close follow-up and the usage of adjuvant drugs can contribute to reduce the side effect of chemotherapy.

Fatal anaphylactic shock is common in forensic practice. However, it is difficult to diagnose for lacking specific pathological and morphologic changes in forensic autopsy. The application of some biochemical indicators is of great significance. This paper reviews the biological characteristics of some biochemical indicators and detection methods. The forensic application, problems and prospects of these indicators are also introduced in details. The stable biochemical indicators, IgE, tryptase and chymase, show great potential and advantages in the identification of fatal anaphylactic shock in forensic medicine.