Objective:To describe the long-term characteristics and trend changes in the incidence and mortality of female breast cancer in Shanghai from 1 973 to 2017,aiming to provide references for exploring the etiology of breast cancer and formulating strategies and measures for prevention,intervention and control. Methods:Joinpoint software was used to analyze the trend changes in the incidence and mortality of female breast cancer in Shanghai from 1 973 to 2017,and an age-period-cohort model was constructed to explore the effects of age,year of diagnosis,and birth cohort on long-term trend changes. Results:From 1 973 to 2017,there were 68 192 new cases of female breast cancer in Shanghai,with a diagnosed rate of 31.72/100 000.The incidence rate continued to rise,and the risk of the disease continued to rise from the age of 20 years,and the rise rate accelerated significantly after the age of 40 years.There were 21 535 female breast cancer deaths from 1 973 to 2017.The mortality rate was stable,with a death rate of 8.62/100 000,and the risk of death increased significantly from the age of 45 years.The effects of age,period and cohort had a significant impact on the incidence of breast cancer(P＜0.01),while the increase in mortality rate was related to age and cohort effects(P＜0.01). Conclusion:The incidence rate of female breast cancer in Shanghai is still rising rapidly,and the mortality trend is generally stable,suggesting that the treatment is effective and the quality of life is improved.However,breast cancer is still the main malignant tumor among females in Shanghai.It should be continued to implement prevention and control strategies such as lifestyle intervention and screening of high-risk individuals to further strengthen the prevention and control of breast cancer.

Objective:To describe the epidemiological features and temporal trends of colorectal cancer in urban Shanghai from 1973 to 2017. Methods:Data on colorectal cancer in urban Shanghai was obtained through Shanghai Cancer Registry and Vital Statistics System.Joinpoint analysis was used to describe the temporal trends and annual percent change(APC)and age-period-cohort analysis was used to estimate the association between age,period and birth cohort and colorectal cancer. Results:A total of 105 847 cases and 60 447 deaths of colorectal cancer were diagnosed in urban Shanghai over the 45-year study period.Both the number of new cases and the number of deaths showed an increasing trend.In the same period,the age-standardized incidence of colorectal cancer in urban areas of Shanghai increased significantly from 14.1/100 000 in 1973 to 27.7/100 000 in 2017,while the age-standardized mortality rate increased from 8.2/100 000 to 10.7/100 000.The overall average annual age-standardized incidence and mortality rates were 20.4/100 000 and 11.0/100 000,respectively.With the increase of age,the age-standardized morbidity and mortality of colorectal cancer showed an obvious upward trend.Taking 1993-1997 as reference,the risk of colorectal cancer in Shanghai reached the highest in 2013-2017,and the corresponding relative risk was 1.2(95％confidence interval:1.2-1.3),while the lowest was 0.9(95％confidence interval:0.8-1.0)during 1973-1977.Mortality risk,on the contrary,decreased with the increase of time.Before 1953-1957,the risk of colorectal cancer in urban Shanghai increased with the increase of birth cohort time,and then showed a downward trend.There was a corresponding decline in the risk of colorectal cancer death among people born after 1957. Conclusion:The incidence and mortality of colorectal cancer in Shanghai showed an increasing trend from 1973 to 2017,but the prevalence trend of colorectal cancer is still different among different populations.

Objective:To evaluate the effect of astaxanthin on neuropathic pain in rats and the role of spinal heme oxygenase-1 (HO-1).Methods:Seventy-two SPF-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, in which intrathecal catheters were successfully implanted, were divided into 6 groups ( n=12 each) by a random number table method: blank control group (group C), sham operation group (Sham group), neuropathic pain (NP) group, NP plus dimethyl sulfoxide (DMSO) group (NP + DMSO group), NP plus astaxanthin group (NP + AST group) and NP plus zinc protoporphyrin plus astaxanthin group (NP+ ZnPP+ AST group). NP was induced by chronic constriction injury in anesthetized rats.In Sham group, the sciatic nerve was only isolated without ligation.At 5 days after establishing the model, 0.5% DMSO 10 μl was intrathecally injected in NP+ DMSO group, astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ AST group, HO-1 inhibitor zinc protoporphyrin 24 μg (dissolved in 10 μl DMSO) was intrathecally injected, and 3 h later astaxanthin 1 μg (dissolved in 10 μl DMSO) was intrathecally injected in NP+ ZnPP+ AST group.Injection was given once a day for 10 consecutive days in the 3 groups mentioned above.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before establishing the model and 3, 7 and 14 days after establishing the model.The rats were sacrificed at 14 days after establishing the model, and the L 4-6 lumbar segments of the spinal cord were removed for determination of the contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), superoxide dismutase (SOD) and glutathione peroxidase (GHS-PX)(by enzyme-linked immunosorbent assay) and expression of HO-1 (by Western blot). Results:Compared with group C and group Sham, the MWT was significantly decreased and TWL was shortened at each time point after establishing the model, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was up-regulated in the other four groups, the SOD and GSH-PX contents were significantly decreased in NP group, NP+ DMSO group and NP+ ZnPP+ AST group, and the SOD and GSH-PX contents were significantly increased in NP+ AST group ( P<0.05). Compared with NP group, the MWT was significantly increased and TWL was prolonged at 7 and 14 days after establishing the model, the contents of TNF-α and IL-1β were decreased, and the expression of HO-1 was up-regulated in NP+ AST group, the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05), and no significant change was found in the parameters mentioned above in NP+ DMSO group ( P>0.05). Compared with NP+ AST group, the MWT was significantly decreased and TWL was shortened at 7 and 14 days after establishing the model, the contents of SOD and GSH-PX were decreased, the contents of TNF-α and IL-1β were increased, and the expression of HO-1 was down-regulated in NP+ ZnPP+ AST group ( P<0.05). Conclusion:Astaxanthin can reduce NP in rats, and the mechanism is related to up-regulating the expression of HO-1 in the spinal cord and inhibiting oxidative stress and inflammatory responses.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Objective To evaluate the efficacy of dexmedetomidine combined with remifentanil for drug-induced sleep endoscopy (DISE) in the patients with snoring. Methods Sixty patients of both sexes with snoring, aged 18-61 yr, with body mass index of 21. 0-33. 1 kg∕m2 , of American Society of Anesthe-siologists physical statusⅠ or Ⅱ, scheduled for elective DISE, were randomly divided into either dexme-detomidine combined with propofol group (group P) or dexmedetomidine combined with remifentanil group (group R), with 30 patients in each group. Dexmedetomidine was infused within 10 min in a loading dose of 0. 6 μg∕kg, followed by an infusion of 0. 6 μg·kg-1 ·h-1 for 10 min in both groups. Then propofol was given by target-controlled infusion with the initial target effect-site concentration (Ce) of 1. 0 μg∕ml in group P, and remifentanil was given by target-controlled infusion with the initial target Ce of 1. 5 ng∕ml in group R. At 2 min after the target effect-site and plasma concentrations were balanced, the Ces of propofol and remifentanil were adjusted by increments of 0. 2 μg∕ml and 0. 2 ng∕ml, respectively, until satisfactory snoring occurred and then the Ce was maintained at this level in P and R groups. Bispectral index value was re-corded at 5 min after admission to the operating room (T1 ), at 20 min of dexmedetomidine infusion (T2 ), at 2 min after the target effect-site and plasma concentrations were balanced (T3 ), at the beginning of DISE (T4 ), when the nasopharyngolarygnoscope reached the site of oropharynx (T5 ) and at the end of DISE (T6 ). Observer's Assessment of Alertness∕Sedation scale scores were recorded at T1-4 . The time for prepar-ing sedation, recovery time, the lowest value of SpO2 and development of adverse events were recorded. Re-sults Sixty patients completed DISE successfully. Compared with group P, the bispectral index value at T3-6 was significantly increased, the time for preparing sedation was prolonged, the recovery time was short-ened, the lowest value of SpO2 was increased, and the incidence of respiratory depression was decreased in group R (P< 0. 05). There was no significant difference in Observer's Assessment of Alertness∕Sedation scale scores at T1-4 between two groups ( P> 0. 05). Conclusion Combination of dexmedetomidine and remifentanil produces better efficacy for DISE than combination of dexmedetomidine and propofol in the pa-tients with snoring.

Objective To compare two different regimens of ultrasound-guided Continuous ad-ductor canal block (CACB)for postoperative analgesia and early ambulation after total knee arthro-plasty (TKA).Methods Sixty-seven patients scheduled for unilateral TKA undergoing spinal anes-thesia,13 males and 54 females,aged 18-85 years,BMI 18-30 kg/m2,ASA physical status Ⅰ-Ⅲ, were randomly divided into the continuous infusion group A (n=34)and the intermittent boluses group B (n=33).After the operations,ultrasound-guided CACB were administered and 20 ml of 0.2% ropivacaine was given as the loading dose.From then on,patients in both groups used electronic analgesic pumps containing 240 ml of 0.2% ropivacaine for postoperative analgesia.5 ml/h of 0.2% ropivacaine was continuously infused for 48 hours in the group A.5 ml of 0.2% ropivacaine was automated injected every 60 minutes in the group B.All infusion pumps were setted at a bolus dose of 5 ml,with a lock time of 30 minutes.The total consumptions of analgestic pum solution and dezoine, quadriceps muscle strength, active range of knee flexion, ambulation distance and occurrences of adverse reactions such as nausea and vomiting,dizziness,drowsiness,extravasating and errhysis were recorded at different time points postoperatively.Results The total consumptions of analgestic pum solution at 12,24 h postoperatively of group B were significantly reduced than that of group A (P<0.05).The 48 h total dezoine consumption of group B was significantly reduced than group A (P<0.05).Active range of knee flexion at 24,48 h and ambulation distance at 48,72 h of group B were significantly higher than group A (P<0.05).There was no statistical difference in quadriceps muscle strength between group A and group B.The incidence of nausea and vomiting in group A was significantly higher than that in group B,and there were no statistical difference in other adverse reactions between group A and group B.Conclusion Compared with the continuous infusion group,the intermittent bolus group for CACB after TKA can provide better analgesic effect and de-crease opioid use postoperatively,with little effect on motor nerve,promoting early ambulation.

Objective To evaluate the effect of wire-reinforced polyurethane epidural catheters on the success rate of epidural catheterization in the patients undergoing caesarean section.Methods A total of 182 pregnant patients,aged 25-43 yr,with body height of 145-178 cm,weighing 51-100 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were divided into 2 groups using a random number table:polyvinyl chloride epidural catheter group (group Ⅰ,n =94) and wire-reinfnrced polyurethane epidural catheter group (group 11,n=88).Spinal or epidural puncture was performed at L2,3 or L3,4 interspace,and the corresponding epidural catheter was inserted in each group aficr succcssful puncturc.Thc dcvclopment of difficult insertion,intravascular catheter insertion or paresthesia during puncture or insertion was defined as a failure of epidural catheterization.The occurrence of failed epidural catheterization was recorded.Results The failure rate of epidural catheterization was significantly lower in group 1Ⅱ than in gronp Ⅰ (P＜0.05).Conclusion Wire-reinforced polyurethane epidural catheters can raise the success rate of epidural catheterization in the patients undergoing caesarean section.

Objective To evaluate the clinical efficacy of the over-the-scope-clip (OTSC) for endoscopic closure of acute refractory non-variceal upper gastrointestinal bleeding. Methods This retrospective study selected 16 refractory patients, including 2 cases with Mallory-Weiss syndrome, 7 cases with gastric ulcer, 1 case with gastric carcinoma and 6 cases with duodenal ulcer, underwent OTSC treatment of acute non-variceal upper gastrointestinal bleeding from January 2015 to June 2016 as study subjects. Results All of the 16 patients with bleeding lesions were successfully controlled. The successful rate is 100.0%. The mean procedure of OTSC for endoscopic bleeding closure was between 5.0 and 6.0 min. Conclusion The Over-the-Scope-Clip system is safe and effective for closure of acute non-variceal upper gastrointestinal bleeding in refractory patients, and deserves further clinical applications.

Objective To evaluate the feasibility of ETView visual endotracheal intubation in elderly patients with a potentially difficult airway under general anesthesia.Methods A total of 80 patients scheduled for elective surgery,with at least three characteristics indicative of an increased risk for difficult tracheal intubation and aged 65-86 years with American Society of Anesthesiologists (ASA) grade [Ⅱ or Ⅲ,were selected and randomly assigned into 2 groups:the control group (Group C) and the ETView visual endotracheal intubation group (Group E) (n=40 for each).After induction with propofol 0.5-1.5 mg/kg,sufentanil 0.2 μg/kg,and rocuronium 0.6mg/kg,regular tracheal intubation and ETView visual endotracheal intubation were conducted in Group C and Group E respectively.Blood pressure and heart rate were recorded before induction (T0),before initial intubation (T1),at successful intubation (T2),and 5min after successful intubation (T3).Duration of catheterization,number of intubation attempts,rate of successful intubation at first attempt and complications within 2 days of intubation were also recorded.Results The duration of catheterization and the number of intubation attempts were lower in Group E than in Group C[(34±6) s vs.(48± 22) s,(1.0±0.0) vs.(1.4±0.4),t=2.484 and 2.373,respectively,P=0.017 and 0.023,respectively].The rate of successful intubation at first attempt was higher in Group E than in GroupC (100％ or 40 cases vs.75％ or 30 cases),x2=5.714,P=0.017).There was no significant difference in hemodynamic changes and the rate of postoperative hoarseness between the two groups (P＞0.05 for both).Conclusions ETView visual endotracheal intubation shows excellent safety in elderly patients with a difficult airway under general anesthesia,with shorter catheterization duration and a higher rate of successful intubation at first attempt than regular intubation.

BACKGROUND:Bone marrow stromal stem cels have a strong osteogenic potential, which are currently the most ideal seed cels for tissue engineering. However, there is no clinical report on the treatment of benign bone tumors and tumor-like lesions using bone marrow stromal stem cel transplantation.
OBJECTIVE: To investigate thein vivo perfusion method of inducing bone marrow stromal stem cels, and the clinical effects of bone marrow stromal stem cels on benign bone tumors and tumor-like lesions.
METHODS: Sixty-five cases of benign bone tumors and tumor-like lesions were divided into three groups according to the different treatments: bone graft group (n=30) and bone marrow stromal stem cels group (n=35). In the bone graft group, alogeneic bone was soaked in normal saline for 30 minutes, and then implanted into the bone defect site. In the bone marrow stromal stem cels group, 20-40 mL of bone marrow from each patient was extracted to isolate, purify and culture bone marrow stromal stem cels that were then perfused into the bone defect site.
RESULTS AND CONCLUSION:Under the inverted phase contrast microscope, the perfused cels appeared as a spherical shape, with different sizes. Initialy, there were more hematopoietic cels in the perfusion cel culture. With the extension of the culture time, adherent spindle cels and suspended red blood cels appeared, which were mostly round and triangular. Al the patients were folowed up for 1-12 months and healed wel after surgery. Compared with the bone graft group, infection rate and healing time were both lower in the bone marrow stromal cel group. To conclude, in vivo perfusion of bone marrow stromal stem cels used for construction of tissue-engineered bone promotes blood supply reconstruction and bone healing in patients with benign bone tumors and tumor-like lesions, which is of high clinical values.