Gastric cancer is one of the most common malignancies in the digestive system.Most of the patients with gastric cancer have advanced disease at the time of diagnosis.Chemotherapy is still the mainstay of treatment for advanced gastric cancer,but efficacy of chemotherapy was modest.Molecular targeted therapies have emerged as a novel approach to the treatment of both hematological and solid tumors in recent years.The understanding of molecular biological mechanisms underlying the formation,progression and metastasis in advanced gastric cancer has enabled us to use the new approach to treat this disease in clinical practice.These therapeutic strategies include targeting EGFR signal transduction pathway,anti-angiogenesis,targeting NF-?B signal transduction pathway and cyclin-dependent kinase inhibitors.In this review,a brief introduction of the current status of the molecular targeted therapies in the treatment of gastric cancer was presented.Bevacizumab,anti-VEGF monoclonal antibody targeting the angiogenesis pathway has been approved for the treatment of colorectal cancer by FDA,has been reported to show effectiveness in metastatic gastric cancer when combined with cytotoxic agents.Inhibition of NF-?B signal transduction pathway such as PS-341(proteasome inhibitor,bortezomib) approved for the treatment of refractory or recurrent multiple myeloma by FDA has also been used to combine with chemotherapy for gastric cancer.There are also encouraging reports on the combination of standard chemotherapy with Cetuximab,Matuzumab,Gefitinib,Erlotinib and Trastuzumab which target the EGFR and HER2 signal transduction pathways.Flavopiridol is a cyclin-dependent kinase inhibitor with low molecullar weight that aims at the regulatory process of the cell cycle but this needs further clinical trial.

Objective To investigate the effect of hypertensive perfusion which induced by norepinephrine on the TNF-α and IL-6 in serum and the activity of Na~+-K~+-ATPase in lung tissue and to observe the morphology of lung tissue. Method Ten domestic pigs were suffered from ventricular fibrillation for 4 minutes and applied cardiopulmonary resuscitation. The pigs they were divided into two groups. Hypertensive perfusion group( n = 5) :the mean arterial pressure, which induced by norepinephrine was maintained as 130% as baseline for 4 hours; nor-real perfusion group( n = 5) : the mean arterial pressure was maintained as baseline for 4 hours, too. Hemodynamic parameters was observed, blood samples were extracted to detect the TNF-α and IL-6 in serum at the time of baseline, 10 min, 2 h and 4 h after successful resuscitation. The expression of Na~+ -K~+ -ATPase in lung tissue and the change of ultrastmeture and pathology in lung tissue was detected at 24 h. All values were analyzed by student' s t test. Results There was no influence on hemodynamic parameters except the blood pressure and heart rate in hypertensive perfusion group. The release of TNF-α and IL-6 were reduced(P < 0.01 ) and the activity of Na~+-K~+ -ATPase was upgraded in hypertensive perfusion group. Hypertensive perfusion could play a protective role on the morphology of alveolar cell. Conclusions Hypertensive perfusion which induced by norepinephrine could reduce the release of inflammatory cytokines, upgrade the activity of the Na~+-K~+-ATPase, decrease the consumption of surfactant and have an important protective effect on lung tissue.

AIM: To study the protective effects of crocetin on the doxorubicin-induced damage in rats with myocardial mitochondria. METHODS: Rats were given intraperitoneal injection of doxorubicin to induce cardiotoxicity. After continuous oral administration of crocetin, the rats were sacrificed, and myocardial mitochondria were isolated. The mitochondrial membrane potential (MMP), O~-_2. production, the activity of respiratory chain complex IV and glutathione peroxidase (GSH-PX), and DNA fragmentation were determined. The expression level of COII gene was determined through RT-PCR. RESULTS: Crocetin increased the activity of respiratory chain complex IV and GSH-PX, MMP and the expression level of COII and decreased DNA fragmentation and superoxide anion radical O~-_2. production in rats with myocardial mitochondria. CONCLUSION: Crocetin may decrease the damage in rat myocardial mitochondria induced by doxorubicin.

For the nasal anatomic structure and characteristics of endoscopic sinus surgery, nasal packing is the main method for nasal hemostasis.At present, there are two kinds of nasal packing biomaterials:absorbable and non-absorbable materials.Each kind of materials has their own characteristics.Merocel highly expansive sponge is a kind of non-absorbable material.It is made of polymeric material and has a high hydrophilicity.It is expansive uniformly in the nasal cavity, and gives the same pressure to all parts, especially the lacunae.Its texture is flexible, and it has small damage to the nasal mucosa.The texture of calcium alginate dressing is soft, and it has no toxicity.It has little stimulation to the nasal cavity and small damage to the nasal mucosa.It has slight local reaction and no obviously pain response after packing.Its efficacy on hemostasis is good.Gelatin sponge is a kind of absorbable material.It has high efficiency on hemostasis and few side reactions.It has protection and promotion of mucosa healing, as well as anti-inflammation.Besides those mentioned above, there are many other common materials, including vaseline gauze and Rhine haemostatic materials.By understanding the characteristics of the packing materials, we should select the different kinds of materials in accordance with the type of hemorrhage and range of operation.

Objective To compare the efficacy of ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia and single general anesthesia in patients undergoing thyroidectomy.Methods 60 patients with ASAI ~II undergoing thyroidectomy,in accordance with the random number table,were divided into bilateral superficial cervical plexus block combined with general anesthesia group (group A)and single general anesthesia group(group B),30 cases in each group.In group A,the patients were provided ultrasound -guided bilateral superficial cervical plexus block with 0.4% ropivacaine 40 ml(20 mL for each side)before general anesthesia induction.In group B,the patients were directly induced for general anesthesia.The patients of the two groups had the same general anesthesia induction drugs.SBP,DBP and HR were monitored and recorded at the time of pre -anesthesia,skin incision, postoperation and extubation.The cumulative amount of propofol and remifentanil during the operation were recorded. The extubation time was recorded and each patient was assessed 1,2,3,4h after surgery for resting VAS score. Results Blood pressure and heart rate at the different time points during operation were higher than pre -anesthesia significantly in group B[skin incision SBP (134.8 ±8.5)mmHg,the end of operation SBP (123.4 ±5.1)mmHg, tracheal extubation SBP (138.7 ±8.5)mmHg vs preanesthesia SBP (117.3 ±9.8)mmHg,t =7.39,3.02,9.04,all P =0.00;skin incision DBP (86.7 ±7.6)mmHg,the end of operation DBP (80.6 ±7.8)mmHg,tracheal extubation DBP (87.4 ±5.8)mmHg vs preanesthesia DBP (75.6 ±6.6)mmHg,t =6.04,2.68,7.35,all P =0.00;skin incision HR (92.4 ±6.5)times/min,the end of operation HR (86.8 ±6.3)times/min,tracheal extubation HR (96.9 ± 7.2)times/min vs preanesthesia HR (78.9 ±6.8)times/min,t =7.86,4.67,9.96,all P =0.00].The cumulative amount of general anesthesia during operation in group A was less than that in group B,the extubation time in group A was shorter than that in group B[propofol doses of group A (650.6 ±50.3)mg vs group B (762.3 ±43.5)mg,t =9.2,P =0.00;remifentanil doses of group A (0.61 ±0.08)mg vs group B (0.95 ±0.06)mg,t =18.62,P =0.00;extubation time of group A (10.6 ±5.1)min vs group B (15.5 ±5.2)min,t =3.68,P =0.00].The resting VAS score at the different time points after surgery in group A was less than that in group B[the resting VAS score at 1,2, 3,4h after surgery in group A vs group B,(0.99 ±0.81)vs (1.75 ±1.23),t =2.83,P =0.00;(1.23 ±1.02)vs (3.45 ±0.84),t =9.2,P =0.00;(2.80 ±0.85)vs (3.71 ±1.19),t =3.41,P =0.00;(3.11 ±1.02)vs (5.19 ± 1.36),t =6.7,P =0.00],there were statistically significant differences.Conclusion Ultrasound -guided bilateral superficial cervical plexus block combined with general anesthesia used in patients undergoing thyroidectomy can maintain the intraoperative hemodynamic stability effectively,reduce the amount of general anesthetics,shorten the extubation time,and ease the early postoperative pain,the efficacy is significantly better than single general anesthesia.

Objective To observe the clinical effect of dexamethasone combined with dezocine on the ultrasound guided interscalene brachial plexus block.Methods Accordance with the random number table,80 patients with ASAⅠ ~Ⅱ undergoing upper extremity operations were divided into four groups,with 20 cases in each group:group A was treated with 0.45% ropivacaine mesylate 20mL;group B was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg 20mL;group C was treated with 0.45% ropivacaine mesylate combined with dezocine 0.1mg/kg 20mL;group D was treated with 0.45% ropivacaine mesylate combined with dexamethasone 0.1mg/kg and dezocine 0.1mg/kg 20mL.The onset time,maximum block time,analgesia duration and the incidence of adverse reactions were recorded in the four groups.Results The onset time of group C and group D were faster than group A and group B[group C(3.65 ±0.88)min vs.group A(5.60 ±0.88)min,group B(5.35 ±0.81)min,t =7.303, 6.367,all P =0.000;group D(3.30 ±0.80)min vs.group A,group B,t =8.614,7.678,all P =0.000],the maximum block time of group C and group D were faster than those of group A and group B[group C(8.45 ±1.19)min vs. group A(12.75 ±2.05)min,group B(12.65 ±1.90)min,t =8.583,8.383,all P =0.000;group D(7.80 ±0.89)min vs.group A,group B,t =9.880,9.680,all P =0.000].The analgesia duration of the other groups were longer than those of group A[group B(430.50 ±30.86)min,group C(435.00 ±38.46)min,group D(534.50 ±46.73)min vs. group A(314.50 ±33.32)min,t =9.696,10.072,18.388,all P =0.000],group D was the best(group D vs.group B,group C,t =8.693,8.317,all P =0.000),there were no significant differences between group B and group C (group C vs.group B,t =0.376,P =0.708).In the 80 patients,only one case of group C had postoperative nausea and vomiting symptoms,there were no significant differences between the groups(all P >0.05).Conclusion Dexa-methasone combined with dezocine on the ultrasound guided interscalene brachial plexus block is a method with faster onset time,shorter maximum block time,longer analgesia duration,and it has less adverse reactions and better anesthetic effect,and it is more suitable for upper extremity operations.

OBJECTIVE: To draw the attention to mucosal antral cyst, thus reduce the probability of missed diagnosis and missed treatment by retrospectively analyzing 17 cases of eye pain patients with no obvious nasal symptoms in our department from January 2003 to September 2011. METHOD: All patients were performed ophthalmologic examination including eye position, eyesight, refraction, visual field, intraocular pressure and fundus examination, and the results showed that all of them had no eye disease. After excluding the deviation of nasal septum, concha bullosa and Haller gas room, CT scanning of paranasal sinus showed the maxillary sinus cyst. The patients were operated by nasal endoscope through joint path of middle meatus or inferior meatus and given antibiotics after operation. The nasal cavity packing was removed 24 hours postoperatively and the patients were discharged from hospital a week later. All the patients continued using intranasal corticosteroids and were followed up for half a year to observe whether the eye pain disappeared or recurred, when various processing was given to the surgical cavity with the help of nasal endoscope. RESULT: Among the 17 cases, 14 cases of eye pain disappeared after the operation, and the remaining 3 patients got symptomatic relief without recurrence during the follow-up period. CONCLUSION Mucosal antral cyst can cause eye pain. After excluding eye disease, once we diagnosed patients for mucosal antral cyst and the routine application of corticosteroids treatment was proved to be invalid, we should take operation treatment as early as possible, regardless of the size and location of the cysts.
Adolescent ; Adult ; Cysts ; complications ; diagnosis ; Eye Pain ; diagnosis ; etiology ; Female ; Humans ; Male ; Maxillary Sinus ; Middle Aged ; Mucous Membrane ; Paranasal Sinus Diseases ; complications ; diagnosis ; Retrospective Studies ; Young Adult

Objective To observe the application effects of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients .Methods Fifty patients undergoing radical resection of colorectal cancer in our hospital within nearly two years were divided into two groups,according to number table mehtod ,25 cases in each group.Patients of group A were injected with 0.45%ropivacaine mesylate 20 mL in ultrasound-guided bilateral TAP after the end of surgery before extuba-tion;the patients of group B were injected with the same amount of normal saline in ultrasound -guided bilateral TAP block,Postoperative patient -controlled intravenous analgesia with sufentanil was provided to all patients . The VAS score of two groups after operation record the postoperative dosage of sufentanil in 24h,pressing times of analgesia pump ,the satisfaction of patients with postoperative analgesia and adverse reactions .Results The VAS score of group A(1.08 ±0.86),(1.60 ±0.71),(1.92 ±0.49),(2.28 ±0.61),(2.44 ±0.51)were lower than that of group B(1.88 ±0.73),(2.24 ±0.72),(2.68 ±0.56),(2.96 ±0.54),(3.24 ±0.44).The dos-age of sufentanil in group A(53.20 ±1.39)μg vs.group B(59.18 ±2.82)μg,pressing times of analgesia pump,group A(10.40 ±2.78)vs.group B(22.36 ±5.63),the satisfaction of patients with postoperative analge-sia,group A(9.12 ±0.78)vs.group B(7.52 ±0.77).There were 2 cases of postoperative nausea and vomiting in group B vs 8 cases in group A,The above -mentioned indexes difference had statistical significance except postoperative 4h score.The indicators of respiratory depression in the two groups did not occur .Conclusion The application of postoperative analgesia of ultrasound -guided transversus abdominis plane ( TAP) block in radical resection of colorectal cancer patients ,can reduce postoperative intravenous analgesic drug usage ,decrease the in-cidence of adverse reactions induced by opioid drugs ,and the analgesic effect is more effective with the positioning accuracy ,convenient operation ,less injury ,high safety and suitable for clinical application .

Hepatitis B is a kind of common infectious diseases,often shows no symptoms in the early phase.But the disease can be diagnosed by the modem techniques in advance.So with the modem scientific technology for diagnosis,we can treat the disease atavery early time with TCM to improve the therapeutic effects.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223％.The constituent ratio of cesarean section under general anesthesia was 1.75％, the constituent ratio of emergency cesarean section under general anesthesia was 60.2％, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7％.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway (LMA) group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score (P＞0.05).There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.