Objective To investigate the effect of remimazolam on intraoperative neurophysiological monitoring(IONM)in spinal surgery.Methods Sixty patients undergoing elective spinal surgery for IONM were selected strictly according to the criteria,33 males and 27 females,aged 18-55 years,BMI 18-24 kg/m2,ASA physical status Ⅰ-Ⅲ.The patients were randomly divided into two groups:remimazolam group(group R)and propofol group(group P),30 patients in each group.Remimazolam was used in group R and propofol was used in group P during induction and maintenance of anesthesia.HR,MAP,and BIS values were recorded when patients entered the room(T0),immediately after endotracheal intubation(T1),at the time of muscle relaxant withdrawal(T2),30 minutes after muscle relaxant withdrawal(T3),and 50 minutes after muscle relaxant withdrawal(T4).The current intensity and amplitude of the first motor evoked potential(MEP)were recorded.The waiting time from drug withdrawal to the first induced MEP was recorded.The amplitude and latency of somatosensory evoked potential(SEP)and MEP at T4 were recorded.Operation time,anesthesia time,intraoperative remifentanil dosage,the use of vasoactive drugs,recovery time,extubation time,and adverse reactions were recorded.Results Compared with group P,HR and MAP were significantly increased at T1-T4(P＜0.05),the amplitude of MEP induced for the first time were significantly increased(P＜0.05),the amplitudes of SEP and MEP at T4 were significantly in-creased and the latency period was significantly shortened(P＜0.05),the dosage of remifentanil was sig-nificantly decreased(P＜0.05),the number of bradycardia or hypotension were significantly decreased(P＜0.05),and the recovery time and extubation time were significantly shortened in group R(P＜0.05).Conclusion Remimazolam can be safely used in spinal surgery requiring IONM,with small circu-lation fluctuation,quick recovery,less postoperative adverse reactions,little effect on SEP and MEP,which is conducive to improving the quality of IONM.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

Objective:To investigate the epidemiological characteristics and current status of surgical management for esophageal cancer in China.Methods:A national database was setup through a network platform. The clinical data of esophageal cancer treated by surgery was collected from 70 major hospitals in China between January 2009 and December 2014.Results:Complete data of 8 181 cases of esophageal cancer patients who underwent surgery were recorded in the database and recruited in the analysis. Among them, 6 052 cases were male and 2 129 were female, the average age was 60.5 years.The epidemiological investigation results showed that 148 cases (1.8%) had history of psychological trauma, 7 527 cases (92.0%) were lower social economic status, 5 072 cases (62.0%) were short of fresh vegetables and fruits, 6 544 cases (80.0%) ate rough food frequently, 3 722 cases (45.5%) drank untreated water directly from lake or river or shallow well, 3 436 cases (42.0%) had a unhealthy eating habit, including habits of eating food fast (507 cases, 6.2%), eating hot food or drinking hot tea/soup (998 cases, 12.2%), eating fried food (1 939 cases, 23.7%), 4 410 cases (53.9%) had the habits of smoking cigarettes and 2 822 cases (34.5%) drank white wine frequently.The pathological results showed that 7 813 cases (95.5%) were squamous cell carcinoma, 267 cases were adenocarcinoma (3.3%), 25 cases were adenosquamous cell carcinoma (0.3%) and 50 cases were small cell carcinoma (0.6%). A total of 1 800 cases (22.0%) received preoperative neoadjuvant therapy due to locally advanced disease or difficulty of resection. The esophagectomies were performed through left thoracotomy approach in 5 870 cases (71.8%), through right chest approach in 2 215 cases (27.1%), and the remain 96 cases (1.2%) received surgery though other approaches.A total of 8 001 cases (97.8%) underwent radical resection, the other 180 cases (2.2%) received palliative resection. The 30-day postoperative mortality rate was 0.5%, the overall ≥ grade Ⅱ postoperative complication rate was 11.6% (951 cases). The 1-yr, 3-yr, and 5-yr overall actual survival rates were 82.6%, 61.6%, and 52.9%, respectively.Conclusions:The data analysis of the national database for esophageal cancer shows that bad eating habits or eating rough food without enough nutrients, lower social and economic status, drinking white wine and smoking cigarettes frequently may be correlated with tumorigenesis of esophageal cancer. However, strong evidences produced by prospective observation studies are needed. Overall, the long-term survival of esophageal cancer patients has been improved gradually due to the application of advanced surgical techniques and reasonable multimodality treatment.

Objective To select the appropriate postoperative analgesia,through the application of different methods in the postoperative analgesia of the patients with breast cancer.Methods Ninety female patients undergoing unilateral breast cancer radical surgery in general anesthesia,aged 35-60 years,weighing 45-80 kg,falling into ASA physical status Ⅰ or Ⅱ,were ran domly divided into simple intravenous postoperative analgesia group (group P,n =30),local infiltration plus intravenous postoperative analgesia group (group R,n =30),ultrasound guided thoracic nerve block plus intravenous postoperative analgesia (group TP,n =30),group P used dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group R used 0.375％ ropivacaine 20 ml local infiltration added dexmedetomidine 2μg/kg plus sufentanil 2 μtg/kg,group TP used 0.375％ ropivacaine 20 ml vertebral side block added dexmedetomidine 2μg/kg plus sufentanil 2 μg/kg.The VAS scores and Ramsay score was recorded 6,12,24,48 h after surgery,the deep sleep quality score at preoperative postoperative 24 h and 48 h,the number of postoperative analgesia pump pressure,the use of sufentanil and the nausea,vomiting,itching,bradycardia,respiratory depression happened in 24 h were documented.Results The VAS scores in groups R and TP 6 h after surgery were significantly lower than that of group P.The VAS scores in group TP 12 h after surgery were significantly lower than that of groups R and P (P＜0.05).The sedation scores were not statistically significant among the three groups.The deep sleep quality scores at 24 h in group TP were significantly lower than those of groups R and P (P＜ 0.05).The number of compressions and the use of the sufentanil in 24 h after surgery in group TP were significantly lower than those of groups R and P,and that in group R was significantly lower than that in group P (P＜0.05).The incidence of nausea,vomiting,itching,bradycardia,respiratory depression were not statistically significant in 24 h,and there were no postopera tive complications related to neurologic blocking of lateral vertebral nerve.Conclusion Three methods were safe and effective for postoperative analgesia in patients with radical surgery breast cancer.Ultrasound guided by thoracic nerve block combined intravenous postoperative analgesia was obviously better than local infiltration plus infiltration postoperative analgesia and infiltration postoperative analgesia in terms of postoperative analgesia,quality of sleep and the number of sufentanil.

Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.

microRNAs (miRNAs) are an extensive class of -22-nucleotide (nt) endogenous noncoding RNAs regulating life activities ofmetazoans through binding to 3'-untranslated regions (3'-UTRs) of their target genes. This work aimed to identify yan gene in the silkworm, reveal its expression profile and confirm if it is one target of bmo-miR-7 and, as such, have potential for contributing to better understanding of the molecular mechanisms involved in the metamorphosis of silkworm. Based on homolog searching and PCR amplification, we cloned the coding sequence (CDS) of Bmyan, which encodes 476 amino acid residues and contains SAM-PNT and ETs domains. Quantitative PCR (q-PCR), RT-PCR and microarray data revealed high expression of Bmyan in the head, body wall and ovary of day-3 fifth instar larval silkworm, low or no expression in other tissues. It was lowly expressed in the early larval stages, but highly expressed from late spinning to day 4 pupa. The 3'-UTR of Bmyan was obtained by rapid-amplification of cDNA ends (3'RACE) and predicted to contain two potential recognition sites of bmo-miR-7. The luciferase reporter vector containing the 3'-UTR of Bmyan was constructed and co-transfected into BmE cell line with the mimic of bmo-miR-7 and the decreased relative activity of luciferase showed that Bmyan is one target of bmo-miR-7. This work helps further functional analysis of bmo-miR-7 and Bmyan in the silkworm.
3' Untranslated Regions ; Animals ; Bombyx ; genetics ; Cell Line ; Cloning, Molecular ; Female ; Genetic Vectors ; Insect Proteins ; genetics ; Larva ; Metamorphosis, Biological ; MicroRNAs ; genetics ; Pupa

Objective To evaluate the multimodal treatment outcomes and patterns of treatment failure in esthesioneuroblastoma at a single institution. Methods One hundred and twelve patients who were newly diagnosed with esthesioneuroblastoma but no distant metastasis in our institution from 1979 to 2014 were retrospectively analyzed. The treatment modes, outcomes, and patterns of treatment failure in these patients were analyzed. According to the modified Kadish staging system, the numbers of patients with stage A, B, C, and D esthesioneuroblastoma were 1, 23, 60, and 28, respectively. Fifty?one patients received surgery and postoperative radiotherapy with or without chemotherapy;forty?six patients received radiotherapy with or without chemotherapy;eleven patients received preoperative radiotherapy and surgery with or without chemotherapy;three patients received surgery with or without chemotherapy; one patient received chemotherapy alone. The survival rates were calculated using the Kaplan?Meier method. Results In all patients, the 5?year sample size was 44, and the 5?year overall survival ( OS ) and disease?free survival ( DFS) rates were 66?4% and 54?7%, respectively. The 5?year OS and DFS rates were 91% and 82% in patients who received preoperative radiotherapy and surgery with or without chemotherapy, 80% and 66% in patients who received surgery and postoperative radiotherapy with or without chemotherapy, and 46% and 37% in patients who received radiotherapy with or without chemotherapy. Three patients treated with surgery alone had relapse of the disease;one patient treated with palliative chemotherapy survived 6 months. Treatment failed in 47 ( 42%) out of 112 patients. In patients with failed treatment, 53% had distant metastasis as the first pattern of treatment failure, 36% had locoregional relapse, and 11% had concurrent distant metastasis and locoregional relapse. Conclusions Surgery combined with radiotherapy is still the recommended multimodal treatment regimen for esthesioneuroblastoma. The multimodal treatment achieves satisfactory local?regional control rate and treatment outcomes in the treatment of esthesioneuroblastoma. The major pattern of treatment failure is distant metastasis.

Objective To investigate the flora distribution and drug resistance status in the Affiliated Hospital of Academy of Military Medical Sciences so as to provide experimental data for clinical doctors to use antibiotics more efficiently.Methods The clinical data of pathogenic bacterial infections over nearly one year in our hospital were retro -spectively analyzed .Results There were 3815 strains of pathogenic bacteria isolated from the sample .The percentage of Gram-positive strains was 36.4%while that of Gram-negative bacteria was 63.6%.The most common bacteria were Esche-richia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus epidermidis.In terms of drug tolerance , Enterobacteriaceae remained highily sensitive to carbapenems .The total resistance rate was 2%-5%.The resistance rate of A.baumannii to meropenem and imipenem was 60%.There were still a few pan-drug resistant strains among K.pneumoniae,A.baumannii and P.aeruginosa,but there were no drug resistant strains to vancomycin , tige-cycline and linezolid in Staphylococcus.The resistance rate of Enterococcus faecium to vancomycin was 9%.The bacteria were distributed predominantly in ICU ,Department of Hematology and Department of Oncology .The samples were mainly composed of phlegm specimens .Conclusion The high distribution in the three departments mentioned above is largely re-lated to the diseases being treated .The specimens from the lower respiratory tract show more types of bacteria that are mostly drug-resistant, and the isolating rate of vancomycin resistant Enterococcus and carbapenems resistant K.pneumoniat is com-paratively high .

Objective To analyze the rule of lymph node metastasis in thoracic esophageal carcinoma,and to study the proper radiation target. Methods From September 1986 to December 1997,549 patients with esophageal carcinoma who had undergone radical reseetion were divided into surgery alone group (S,275 patients) or surgery plus radiotherapy group( S + R,274 patients). Radiotherapy was begun 3 to 4 weeks after operation. The radiation target included beth supra-clavicular areas and the entire mediastinum. The total dose was 50 Gy in 25 fractions over 5 weeks for the supra-clavicular areas and 60 Gy in 30 fractions over 6 weeks for the entire mediastinum. Results The 5-year overall survival of patients with lymph node metastasis in one anatomic site and two anatomic sites was 31.5% and 13.9% (P=0.013), respectively. For patients with > 2 positive nodes metastasis receiving surgery alone, the corresponding 5-year survival was 24.8% and 4.9% (P=0.046) ,respectively. The median number of dissected lymph nodes of the upper-,middle-and lower-segment esophageal carcinoma was 13,17 and 20, respectively. The rate of metastatic lymph node in the para-esophagus region was the highest(61.5%-64.9%) ,which was not different among the different primary sites(P=0.922). The anastomotic stoma recurrence rate of the upper-segment esophageal carcinoma was higher than that of the middle- or lower-segment carcinomas(16.7% ,3.1% ,and 7.7%, χ2=9.02,P<0.05). Conclusions For the thoracic esophageal carcinoma,the number of anatomic sites of lymph node metastasis is an important factor affecting the survival. The lower rate of lymph node metastasis of the upper segment esophageal carcinoma may be corrected with the less lymph node dissected. The rate of lymph node metastasis in para-esophageal region is not related with the lesion segment. The anastemotie stoma is an important radiotherapy target for upper segment esophageal carcinoma.

Objective To evaluate the treatment effects of chemotherapy comparing with chemotherapy and radiotherapy in the limited-stage small cell lung cancer (SCLC). Methods 234 patients were cyto-pathologically diagnosed and staged as limited small cell lung cancer. The patients were treated with combined chemotherapy and radiotherapy,in which 22 cases were treated by alone chemotherapy (C),39 patients by chemotherapy plus radiotherapy(C+R),and 173 cases by combined chemotherapy and radiotherapy + chemotherapy (C+R+C). The chemotherapy regimen included CE (or PE),CAP or CAV for 4~6 cycles. Irradiation treatment covering the primary tumor,the ipsilateral hilar nodes and mediastinum was delivered once daily with 6 megavoltage X-ray beam to a median irradiation does of 56 Gy being given in 5~6 weeks. Results The 1-,2-,3-,and 5-year overall survival rates were 76.5%,38.2%,25.3%,15.6% respectively,and the median survival time (MST) was 19 months. There was a significantly difference on the survival rate between C+R+C group and C+R group or C group (P