Objective:To observe the effect of general anesthesia combined with serratus anterior plane block (SAPB) on the quality of life and postoperative pain of patients undergoing breast cancer surgery.Methods:The clinical data of 80 patients with breast cancer undergoing elective modified radical mastectomy admitted to the Affiliated Hospital of Guilin Medical College from January 2020 to March 2021 were retrospectively analyzed. According to different anesthesia methods, they were divided into control group and observation group, with 40 cases in each group. The control group received simple general anesthesia, while the observation group received general anesthesia combined with SAPB. The degree of postoperative pain in the two groups at 3, 6, 12 and 24 h after surgery was evaluated with the Numerical Rating Scale (NRS) score, and the postoperative recovery at 24 h after surgery and quality of life at 3 h and 6 months after surgery were evaluated with the Quality of Recovery-40 (QoR-40) score and the Short Form of Health Survey (SF-36). The serum levels of pain related cytokines[neuropeptide Y (NPY), prostaglandin E2 (PGE2), and 5-hydroxytryptamine (5-HT) ] in the two groups were compared. The complications of the two groups were recorded.Results:The NRS score in the observation group at 6 h and 12 h after operation were lower than those in the control group (all P<0.05). The QoR-40 score at 24 h after operation and SF-36 score at 6 months after operation in the observation group were higher than those in the control group (all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). The NPY, PGE2 and 5-HT levels of patients in the observation group were lower than those in the control group at 24 h after operation (all P<0.05). Conclusions:The use of general anesthesia combined with SAPB in modified radical mastectomy for breast cancer can alleviate postoperative pain and improve long-term quality of life, which may be related to the reduction of pain related cytokine secretion.

Objective:To explore the role of comprehensive first aid skills training in improving medical students' comprehensive first aid ability.Methods:Eighty-seven medical students were enrolled in this study, and received the training of comprehensive first aid skills developed by the emergency medicine teaching and research section of our hospital. The scores of individual first aid ability, emergency handling ability, team cooperation ability, organization and coordination ability and communication ability before and after the training were analyzed. At the same time, a questionnaire survey was conducted among students to understand their evaluation and recognition of the training. SPSS 10.0 was used for t test. Results:After the training, the total score of comprehensive first aid ability was increased significantly [(73.55±3.89) vs. (63.53±3.06)], and the scores of emergency handling ability [(10.11±1.43) vs. (8.01±1.16)], team cooperation ability [(11.38±1.21) vs. (8.15±0.99)], organization and coordination ability [(10.68±1.17) vs. (8.15±0.99)] and communication ability [(9.64±1.31) vs. (7.55±1.08)] were also significantly increased ( P<0.05). However, there was no significant difference in the scores of individual first aid ability mastery before and after training. In all, 80.46%-96.55% of the students think that the training of comprehensive first aid skills is conducive to the improvement of their comprehensive first aid ability, and all of the students are willing to use this training in the future. Conclusion:Comprehensive first aid skill training is beneficial to improve medical students' comprehensive first aid ability.

Objective:To investigate the protective effects of Elabela(ELA) on the renal injury of db/db mice and its possible mechanism.Methods:Sixteen eight-week-old male db/db mice were intraperitoneally injected with ELA(5 mg·kg -1·day -1) or equivalent normal saline( n=8) for 8 weeks. Eight age-matched male db/m mice received equivalent normal saline injection as normal control. At the end of the experiment, blood and urine samples were obtained for HbA 1C and urinary albumin/creatinine(ACR) measurements. Immunohistochemistry was used to observe the expression of ELA. Histopathological changes in kidney tissue were observed by HE staining and Masson staining. The levels of collagen type Ⅳ(Col-Ⅳ) and transforming growth factor-β1(TGF-β1) as well as Yes-associated protein(YAP) phosphorylation in kidney tissue were examined by western blot. Results:Immunohistochemistry results showed that ELA expression was decreased in the renal tissue of db/db mice as compared with that of db/m mice( P<0.05). After ELA treatment, ACR and blood pressure were markedly decreased in db/db mice( P<0.05), but without significant changes in the body weight and HbA 1C. Renal tubular epithelial cells edema, basement membrane thickening, and increased collagen fiber in db/db were improved by ELA administration. Compared with db/m mice, the levels of TGF-β1 and Col-Ⅳ expression, as well as YAP phosphorylation were significantly increased in renal tissue of db/db mice(0.98±0.08 vs 0.68±0.10, 1.10±0.14 vs 0.51±0.08, 3.38±0.72 vs 0.81±0.13, all P<0.05), which were down-regulated after ELA administration(0.80±0.06, 0.51±0.05, 2.21±0.22, all P<0.05). Conclusion:ELA may improve the renal injury of db/db mice by regulating the signaling pathway of YAP, thereby delaying the development of diabetic nephropathy.

Epithelial-mesenchymal transition (EMT) is a complex transformation process and plays an important role in the invasion of cancer cells. The morphological transformation in cancer cells are accompanied by various cellular processes such as alterations in cell adhesion, cell matrix degradation, changes in epithelial markers and mesenchymal markers. Mucin (MUC) is widely distributed in epithelial cells of various tissues and organs and plays an important role in EMT. Meanwhile, MUC also can mediate signal transduction and cell adhesion, participate in tumor invasion and metastasis. This article reviewed the advances in research on EMT and MUC in tumors.

Objective To analyze the complications of radical vaginal hysterectomy in patients with locally bulky cervical cancer.Methods All 258 patients of early cervical cancer (stage Ⅰ A2-Ⅱ A) selected in our hospital during the period of June 2011 to June 2016 undergoing radical vaginal hysterectomy and laparoscopic pelvic lymph node dissection were analyzed.All cases were divided into observation (locally bulky) and control (conventional) groups.Comparison analysis was performed for complications of the two groups and the influence of neoadjuvant chemotherapy on the complications of local bulky patients.Results The incidence of complications in the observation group was 26 cases (27.9％),higher than that in the control group of 28 cases (17.0％),the difference was statistically significant (P ＜ 0.05).The incidence of bladder injury (5 cases vs 2 cases) in observation group was significantly higher than that in control group (P ＜ 0.05).For patients with locally bulky early cervical cancer,the incidence rate of complications of the neoadjuvant chemotherapy group (15.8％) was significantly lower than the simple operation group (36.4％) (P ＜ 0.05).The incidence rate of ureteral injury in neoadjuvant chemotherapy group (0 cases vs 6 cases) was significantly lower than that in simple operation group (P ＜ 0.05).Conclusions Early cervical cancer patients with locally bulky (stage Ⅰ B2/ 1Ⅱ A2) had higher incidence of complications of radical vaginal hysterectomy,and neoadjuvant chemotherapy can reduce the incidence of surgical complications.

Objective:To analyze the efficacy and safety of targeted drug apatinib combined with tegafur, gimeracil and oteracil capsules (TS-1) in the second-line treatment of advanced gastric mucinous adenocarcinoma. Methods: Totally 48 patients with ad-vanced gastric mucinous adenocarcinoma treated with the second-line regimen were randomly divided into the control group and the treatment group with 24 ones in each. The control group received the chemotherapy of TS-1, and the treatment group received apatinib additionally. The adverse reactions and objective effects were observed. Results:The objective response rate (ORR) was 54. 1% and 33. 3% in the treatment and the control group, respectively. The disease control rate (DCR) was 83. 3% and 54. 2% in the treatment and the control group, respectively. There were significant differences on ORR and DCR in both groups(P<0. 05), while no statisti-cal difference was shown in the adverse reactions (P>0. 05) between the two groups. Conclusion:Apatinib combined with TS-1 ex-hibits evident short-term therapeutic effect on advanced gastric mucinous adenocarcinoma, and the adverse reactions can be tolerated.

Objective:To analyze the efficacy and safety of targeted drug apatinib combined with tegafur, gimeracil and oteracil capsules (TS-1) in the second-line treatment of advanced gastric mucinous adenocarcinoma. Methods: Totally 48 patients with ad-vanced gastric mucinous adenocarcinoma treated with the second-line regimen were randomly divided into the control group and the treatment group with 24 ones in each. The control group received the chemotherapy of TS-1, and the treatment group received apatinib additionally. The adverse reactions and objective effects were observed. Results:The objective response rate (ORR) was 54. 1% and 33. 3% in the treatment and the control group, respectively. The disease control rate (DCR) was 83. 3% and 54. 2% in the treatment and the control group, respectively. There were significant differences on ORR and DCR in both groups(P<0. 05), while no statisti-cal difference was shown in the adverse reactions (P>0. 05) between the two groups. Conclusion:Apatinib combined with TS-1 ex-hibits evident short-term therapeutic effect on advanced gastric mucinous adenocarcinoma, and the adverse reactions can be tolerated.

OBJECTIVE:To isolate and purify three principal degraded impurities of mitiglinide calcium (impurity A,B,C) and identify their structures,establish HPLC method for content determination of impurity A,B,C. METHODS:Mitiglinide calci-um was used as raw material and reacted with acid;3 impurities were then separated by HPLC and their structures were elucidated by IR,MS,1H NMR,13C NMR,LC-ESI-MS and ORD. 3 impurities of 3 batches of mitiglinide calcium were determined,and the determination was performed on Agilent Extend-C18 column with mobile phase consisted of 0.01 mol/L sodium acetate solution-ace-tonitrile-triethylamine(60:40:0.1,pH=3.0)at the flow rate of 1.0 ml/min. The detection wavelength was set at 210 nm and sam-ple size was 20 μl. The response tests of 3 impurities and mitiglinide calcium were conducted. RESULTS:After treated with acid, impurity A,B,C had been obtained,and their purity were 99.05%,98.87%,99.98%,respectively after isolation and purifica-tion;after identifying the structure, 3 impurities were S-2-bezylsuccinic acid, S-2-bezylsuccinic acid-4-methyl ester, methyl (2S)-2-benzyl-3-(cis-hexahydroisoindolin-2-ylcarbonyl) propionate;methodological study of content determination of impurities were all up to the requirement. The linear range of impurity A,B,C were 0.387 5-3.875,0.395-3.95 and 0.392 5-3.925 μg/ml(all r were 1.000 0). The response value of impurity A,B,C and mitiglinide calcium were 2.316 1,2.636 1,2.617 8 and 2.620 4,re-spectively. CONCLUSIONS:The structures of 3 principal degraded impurities of mitiglinide calcium have been identified and con-firmed;the content of them can be determined by HPLC main component self-comparison method.

To understand the use in recent 10 years of(GB/T 12346-2006),a standard of The People's Republic of China,so as to provide the evidence for its further establishment and revision,we investigated and analyzed the application ofthrough relevant literature and the textbook. It is found that making use of the standard is being realized in various types of articles and it is described in almost all the textbooks. Implementing the standard intensively promotes the standardization of acupuncture-moxibustion education and clinical manipulation as well as the academic exchange domestically and overseas. In turn,its scientificalness and authority are further strengthened.

OBJECTIVETo explore the correlation between propagated sensation along meridian (PSM) and TCM constitution at different age stages.

METHODSAccording to age, 840 participants were divided into a youth group (326 cases), a middle aged group (243 cases) and an elderly group (271 cases). The TCM constitution of all the participants was evaluated, and the PSM test was performed. The distribution of TCM constitution, the occurring rate and transmission of PSM in each group were observed and compared; the correlation between PSM and the TCM constitution was preliminary investigated by Logistic regression analysis.

RESULTSThe distribution of nine types of TCM constitution in three groups:the proportion of normal constitution and partial constitution were significantly different (all<0.05); the occurring rate and transmission of PSM in three groups were not significantly different (all>0.05); the proportion of occurring rate for nine types of TCM constitutions in the whole population, from high to low, presented special intrinsic quality, neutral quality,-deficiency quality,-deficiency quality,-deficiency quality, damp-heat quality, phlegm-dampness quality,-stagnation quality and blood-stasis quality; besides, the proportion of occurring rate for different TCM constitutions in the youth group, middle aged group and elderly group was similar to that of whole population. The Logistic regression analysis results indicated the neutral quality (=0.025) and special intrinsic quality (=0.018) were positively while blood-stasis quality (=0.043) was negatively related with PSM in all subjects; the-deficiency quality (=0.025), phlegm-dampness quality (=0.019), blood-stasis quality (=0.012) and-stagnation quality (=0.035) were negatively related with PSM in youth group; the neutral quality (=0.001) was positively related with PSM inthe middle aged group; the neutral quality (=0.006) anddeficiency quality (=0.004) were positively related with PSM in the elderly group.

CONCLUSIONSThe occurrence of PSM in different age stages is related with TCM constitution, which could be increased in clinical treatment to improve acupuncture efficacy.