Effect of umbilical vein catheterization on portal vein blood flow and its relationship with gastrointestinal complications in neonates / 中华围产医学杂志

Objective:To explore the effect of umbilical vein catheterization (UVC) on portal vein blood flow velocity (PBFVe) and its relationship with gastrointestinal (GI) complications in neonates.Methods:A prospective study was conducted on neonates with indications for UVC and achieving one-time successful catheterization at Gansu Provincial Women and Child-care Hospital from March 2019 to March 2021. Successful UVC was defined as the umbilical catheter reaching the entrance of the inferior vena cava and right atrium through the ductus venosus. PBFVe was measured by bedside ultrasound before and after UVC. All subjects were divided into two groups as those with GI complications anytime from insertion to withdrawal (complication group), and those with no GI complications (no complication group) to compare the PBFVe value before UVC and the percentage of decrease in PBFVe after UVC. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the risk factors of GI complications and the predictive value of the percentage of decrease in PBFVe after UVC.Results:Of 91 subjects included, 59.3% (54/91) had no GI complications, and 40.7% (37/91) had. After UVC, PBFVe was decreased than before in neonates both with and without GI complications [(11.3±1.8) vs (14.7±2.4) cm/s; (12.4±1.7) vs (14.2±1.8) cm/s, t=－16.92 and－17.62, respectively, both P<0.05]. PBFVe before UVC were similar between the two groups. However, the complications group had a lower PBFVe after UVC ( t=－2.98, P=0.004) and a higher percentage of decrease in PBFVe [(22.5±6.0)% vs (12.6±4.9)%, t=8.65, P<0.001] when compared with the no complications group. Multivariate logistic regression analysis showed that the body weight was the protector of GI complications ( OR=0.294, 95% CI:0.089-0.974, P=0.045), and the percentage of decrease in PBFVe was the risk factor ( OR=1.478, 95% CI:1.249-1.749, P<0.001). The area under the curve of the percentage of decrease in PBFVe for predicting GI complications was 0.919 (95% CI:0.843-0.966, P<0.001). The cut-off value was 16.9% with a sensitivity of 89.2% and a specificity of 85.2%. Conclusions:UVC can reduce the PBFVe of neonates. The more the PBFVe decreases, the greater the possibility of GI complications.

Diameter of ductus venous and angle between ductus venous and sagittal part of left portal vein associated with success rate of neonatal umbilical venous catheterization / 中华围产医学杂志

Objective:To explore the effect of the angle between sagittal part of left portal vein and ductus venous(AsLPVDV), and the diameter of ductus venous(DDV) on the success rate of umbilical venous catheterization (UVC) in neonates.Methods:This was a retrospective study including 80 neonates requireing UVC in Gansu Provincial Women and Child-care Hospital from April 2020 to January 2021. According to the results of UVC, they were grouped into the success group(successful insertion of catheter, n=76) and failure group(failed to insert, n=4), or one-time success group (successful after first insertion attempt, n=43) and non-one-time success group(successful after several attempts or failed to insert, n=37). The AsLPVDV and the DDV were measured before UVC by bedside ultrasound. For those with obstruction of catheterization were guided by pressing the abdomen in right side recumbent position under real-time ultrasound monitoring. The success rate of UVC and the differences of AsLPVDV and DDV among different groups were compared. Chi-square test, t test, or U test were adopted for the comparison among groups. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the AsLPVDV and the DDV in predicting the one-time success of UVC. Results:The total success rate of UVC was 95%(76/80) and the one-time success rate was 53.8%(43/80). A larger AsLPVDV and DDV were observed in the success group compared with the failure group [(142.2±8.3)° vs (133.6±3.2)°, (3.0±0.4) vs(1.8±0.4) mm, t=6.284 and 2.064, both P<0.05] as well as in one-time success group compared with the non-one-time success group [(147.5±6.2)° vs (135.2±4.7)°, (3.1±0.3) vs (2.8±0.6) mm, t=9.956 and 2.939, both P<0.05]. Area under the curve of AsLPVDV and DDV in predicting one-time success of UVC were 0.944(95% CI:0.869-0.983) and 0.811 (95% CI:0.708-0.890), respectively. The cut-off value was 140.4° for AsLPVDV and 2.9 mm for DDV, with the sensitivity of 93.0% and 90.7%, and specificity of 91.9% and 64.9%, respectively. Conclusions:The success rate of UVC is related to AsLPVDV and DDV. AsLPVDV is of high value in predicting the one-time success of UVC.

Summary of clinical experience on tracheobronchial foreign bodies in children for 10 years / 中国小儿急救医学

Objective:To investigate the clinical manifestations and characteristics of tracheobronchial foreign bodies in children, and improve the diagnosis and treatment of foreign bodies.Methods:A retrospective analysis was performed on the clinical data of children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between January 2010 to December 2019.The children with tracheobronchial foreign body who were treated in the Maternal and Child Health Hospital of Gansu Province.Results:A total of 967 cases were operated by soft electronic bronchoscope, and foreign bodies were removed by means of foreign body forceps or nets.Among them, 19 cases(3 cases with subglottic foreign bodies, one with row of pins, and the rest 15 cases with foreign bodies completely wrapped by granulation)were not removed, two cases were spontaneously coughed, and 946 cases (97.8%)were removed.Bronchial foreign bodies in children were more common in boys, with the ratio of male to female being 2.14∶1.The main age of onset was 1-3 years old(88.8%). The incidence was slightly higher in rural areas than that in urban areas(46.5% in urban areas, 53.5% in rural areas). Foreign bodies were inhaled most in March and least in June.From the perspective of season, winter and spring were more than summer and autumn.The foreign body types inhaled were mainly exogenous plant foreign body, accounting for 93.0%, among which peanut(31.7%)and melon seeds(19.2%)were the most common.The duration of foreign body inhalation was up to 347 cases(35.9%)in 1-3 days.There were 501 cases(51.8%)with endoscopic endobronchial inflammation, and 196 cases of children with varying degrees of granulomatous hyperplasia, accounting for 39.1% and 20.3% of the total.The foreign body in the right bronchus accounted for 50.0% and the left bronchus for 43.7%.There were 793 cases confirmed by imaging, with a positive rate of 81.9%, and 90.9% confirmed by CT.Conclusion:About 88.8% of tracheobronchial foreign bodies occurred in 1 to 3 years of age.The occurrence of foreign bodies had obvious gender, urban-rural and seasonal distribution characteristics, and more cases were male, in rural and winter as well as spring.

Study on the relationship of the expression level of Calpain-9 with occurrence and metastasis of gastric carcinoma / 中华老年医学杂志

Objectives To explore the correlation of the expression lcvel of Calpain-9 in gastric carcinoma with clinico pathological features and metastasis of gastric cancer.Methods The expression level of Calpain-9 in gastric carcinoma and matched para-cancerous normal mucosa tissues were detected by Western blotting and immunohistochemistry in 146 patients with gastric cancer respcctively.The relationship between the expression level of Calpain 9 and the various clinicopathological indexes was analyzed.Results The expression level of Calpain-9 was significantly lower in cancerous tissues than in matched para cancerous normal mucosa tissues (P ＜ 0.05),with significantly different expression levels of Calpain-9 in different gastric cancerous histological differentiation degrees,different clinical stages,and with or without a lymph node metastasis(all P＜ 0.05).But no statistical difference was found in different sexes,different ages,different tumor sizes,with or without a distant metastasis (all P＞0.05).The spearman's correlation analysis showed that thc expression level of Calpain-9 in gastric cancer was negatively correlated with lymph node metastasis (r=-0.3826,P＜0.05).Conclusions The expression level of Calpain-9 in gastric cancer tissues is decreased,is negatively correlated with clinical stages,pathological differentiation,and cancerous lymph node metastasis.

Clinical value of contrast-enhanced ultrasonic contrast in the diagnosis of thyroid microcarcinoma / 中国基层医药

Objective To investigate the clinical value of contrast-enhanced ultrasonic contrast in the diagnosis of thyroid microcarcinoma .Methods A total of 115 patients with thyroid nodules diagnosed surgically and pathologically were selected .Chose a series of contrast pulse contrast imaging ( CPS ) features of Acuson sequoia 512 color Doppler ultrasound diagnostic apparatus and Italy Bracco company production of ultrasound contrast agent SonoVue, the patients received routine ultrasonography firstly , then received ultrasonic contrast.Results Of 115 nodules,49 malignant nodules,including 49 cases of papillary thyroid carcinoma ,1 case of papillary carcinoma with metastasis;66 benign nodules,including 54 cases of nodular goiter(3 cases with calcification),7 cases of adeno-mas(1 case with calcification ),left thyroid sub acute thyroiditis in 1 case,4 cases with benign nodules .Benign nodules were more common than malignant nodules , the boundary was clearly more than the malignant nodules , low echo in less malignant nodules ,the blood flow signal was less than that of malignant nodules (χ2 =9.356,9.144, 9.832,6.581,all P <0.05).Benign nodules enhanced significantly more than the uniform malignant nodules, malignant nodules enhanced significantly less than the low , enhanced significantly more than the malignant clear boundary nodules(χ2 =6.130,5.791,23.206,all P<0.05).The specificity,sensitivity and accuracy of contrast-enhanced ultrasound were higher than conventional ultrasound (χ2 =6.971, 7.462, 7.152, all P<0.05 ). Conclusion Ultrasonic contrast has high clinical value in the diagnosis of thyroid microcarcinoma , and the sensitivity , specificity and accuracy are high , and can significantly improve the detection rate of thyroid microcarcinoma .

Colorectal lipoma: clinical analysis of 9 cases / 中华全科医师杂志

Nine cases of colorectal lipoma who were admitted from January 2005 to December 2016 were reported.The pathological diagnosis was confirmed after surgery,and all 9 cases were cured and discharged.All patients were followed up and were alive by January 2017.

Investigation and Analysis of Medication Safety among Rural Residents in Yongzhou City of Hunan Province / 中国药房

OBJECTIVE:To provide reference for ensuring the medication safety of rural residents well.METHODS:A questionnaire survey was conducted among 162 rural residents of 27 townships in 11 counties (districts) from Yongzhou city of Hunan province.The survey data was analyzed statistically.RESULTS:A total of 5 670 questionnaires were issued and 4 376 valid questionnaires were recovered,with an effective recovery rate of 77.2％.73.6％ residents did not considered the incompatibility among drugs when receiving two or more drugs;the proportion of increasing or decreasing drug dosage and changing drugs at will was in high level.Most of the residents who had common drugs in the family did not pay enough attention to the custody of the reserved drugs and lacked of basic knowledge;the proportion of residents who bought drugs mainly from pharmacies was the highest (50.7％);in addition,nearly 20％ bought drugs mainly through the Intemet and other ways.More than half of the residents surveyed did not understand the drug instructions;after ADR occurred,more than half of the residents surveyed would stop or change their drugs voluntarily;more than 70％ of the residents surveyed did not know or did not pay attention to characteristics and incompatibility of drugs.CONCLUSIONS:Because of the low level of education,the lack of common sense of safe drug use in local rural residents and unbalanced allocation of medical resources,the phenomenon of irrational drug use is widespread and the safety of medication is not ideal;there is a lot of room for improvement.

Investigation and Analysis of Medication Safety among Rural Residents in Yongzhou City of Hunan Province / 中国药房

OBJECTIVE:To provide reference for ensuring the medication safety of rural residents well.METHODS:A questionnaire survey was conducted among 162 rural residents of 27 townships in 11 counties (districts) from Yongzhou city of Hunan province.The survey data was analyzed statistically.RESULTS:A total of 5 670 questionnaires were issued and 4 376 valid questionnaires were recovered,with an effective recovery rate of 77.2％.73.6％ residents did not considered the incompatibility among drugs when receiving two or more drugs;the proportion of increasing or decreasing drug dosage and changing drugs at will was in high level.Most of the residents who had common drugs in the family did not pay enough attention to the custody of the reserved drugs and lacked of basic knowledge;the proportion of residents who bought drugs mainly from pharmacies was the highest (50.7％);in addition,nearly 20％ bought drugs mainly through the Intemet and other ways.More than half of the residents surveyed did not understand the drug instructions;after ADR occurred,more than half of the residents surveyed would stop or change their drugs voluntarily;more than 70％ of the residents surveyed did not know or did not pay attention to characteristics and incompatibility of drugs.CONCLUSIONS:Because of the low level of education,the lack of common sense of safe drug use in local rural residents and unbalanced allocation of medical resources,the phenomenon of irrational drug use is widespread and the safety of medication is not ideal;there is a lot of room for improvement.

Migraine without aura treated with balance acupuncture therapy:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To assess the effect of balance acupuncture for migraine without aura.</p><p><b>METHODS</b>Blind evaluation was conducted. Forty patients with migraine without aura were randomized into an observation group and a control group, 19 cases in each one with 1 patient dropped out respectively. In the observation group,, the middle point was used in the hollow before the 1, 2 metatarsal combination, and in the control group, a sham point was applied in the hollow before the 3, 4 metatarsal combination. The manipulation in the two groups was the same. The treatment was given for 4 weeks, once a day, 5 times a week. The comprehensive score and visual analogue scale (VAS) were used before and after treatment, as well as 4 weeks after treatment.</p><p><b>RESULTS</b>The comprehensive score and VAS score after treatment in the observation group decreased after treatment (both<0.05), of which the total headache time and attack number for one month were lower than those before treatment (both<0.05), but at follow-up the VAS score was higher than that after treatment (<0.05). The above indices in the control group were not significantly different from those before treatment (all>0.05). All the indices in the observation group after treatment and at follow-up were lower than those in the control group (all<0.05). The different values for the comprehensive score and VAS score before and after treatment, before treatment and at follow-up in the observation group were better than those in the control group (all<0.05). The different values after treatment and at follow-up had no significant difference between the two groups (both>0.05).</p><p><b>CONCLUSIONS</b>Balance acupuncture atachieves obvious effect for migraine without aura, which can relieve pain.</p>

Correlation of Serum Hs-CRP, D-dimmer and Lp-PLA2 Levels with Vulnerable Plaque of Coronary Artery Atherosclerosis in Patients with Coronary Heart Disease / 现代生物医学进展

Objective:To investigate the correlation of serum hs-CRP,D-dimmer and Lp-PLA2 with vulnerable plaque of coronary artery atherosclerosis in patients with coronary heart disease.Methods:Selected 106 cases of patients in our hospital from January 2014 to December 2015,all taken coronary angiography and intravascular ultrasound.Divided into three groups according to the results of the examination,the levels of serum hs-CRP,D-dimmer and Lp-PLA2 were examined and compared,and the correlation with fiber cap thickness,plaque eccentricity index,and vascular remodeling index were tested by Pearson correlation analysis.Results:Serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group and stable plaque group were significantly higher than that of the control group (P＜0.05),and the serum levels of hs-CRP,D-dimmer and Lp-PLA2 of vulnerable plaque group were significantly higher than that of stable plaque group (P＜0.05);hs-CRP was negative correlated with the thickness of fibrous cap (r=-0.712,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.813,0.756;D-,P＜0.05),D-dimmer was negative correlated with the thickness of fibrous cap (r=-0.654,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.912,0.853,P＜0.05);Lp-PLA2 was negative correlated with the thickness of fibrous cap (r=-0.796,P＜0.05),and positive correlated with eccentric plaque index and vascular remodeling index (r=0.836,0.729,P＜0.05).Conclusion:Hs-CRP,D-dimmer and Lp-PLA2 have high correlation with vulnerable plaque in coronary artery disease,can be used as reference indexes for assessing the instability of coronary atherosclerotic plaque.

Investigation of Pharmaceutical Services by 357 Retail Pharmacies in Rural Area in Yongzhou of Hunan Province / 中国药房

OBJECTIVE:To provide a reference for promoting and strengthening pharmaceutical services by retail pharmacies in rural area in Yongzhou of Hunan. METHODS:Investigation was conducted on 13 aspects including the service concept,service mode,service process,service contents,hardwares and softwares and professional quality of practitioners of 357 retail pharmacies in rural area in Yongzhou of Hunan to know about current pharmaceutical services. RESULTS & CONCLUSIONS:In this area, 78.9% of pharmacies operated in the name of a licensed pharmacist or pharmacist who did not work in that pharmacy;only 53.3%of practitioners were pharmacy graduates;the proportion of the practitioners who takes part in training every year was less than 30.0%,average training time was not more than 8 hours;65.3% of practitioners in the pharmacies were not aware of the concept of pharmaceutical services;the pharmacies which were not equipped with basic hardwares and softwares for pharmaceutical servic-es accounted for 47.0%,those which had not established a pharmaceutical service management process accounted for 87.4%;and less than 10.0% of retail pharmacies provided door-to-door pharmaceutical services. Safe,effective and rational drug use should be achieved by intensifying the management and training for retail pharmacy practitioners,standardizing the contents of pharmaceutical services,establishing standard pharmaceutical service process,defining basic hardwares and softwares for pharmaceutical services, strengthening performance appraisal and evaluation for pharmaceutical services and urging the pharmacy to serve society.

Effect of early enteral nutrition on postoperative recovery in patients with colon cancer / 肿瘤研究与临床

Objective To investigate the clinical application of early postoperative enteral nutrition in patients undergoing colon cancer operation.Methods 90 patients suffering from colon cancer were randomly divided into the enteral nutrition group,indwelling stomach tube group and the control group.The control group was given conventional treatment and the indwelling gastric tube group was received postoperative intermittent clamping of stomach tube and enteral nutrition.Moreover,patients in the enteral nutrition group were pulled out the tube on the first postoperative day while giving enteral nutrition.All patients were observed for exhaust defecation time,length of hospital stay postoperative and nutrition indicators.Results Exhaust defecation time,length of hospital stay postoperative had significant difference among three groups.Indwelling stomach tube group set minimum length of stay and first passage of flatus and defecation in the three groups [the enteral nutrition group:(50.07±11.59) h,(76.75±27.37) h,(10.1 1±1.57) d,the control group:(62.03±12.31) h,(90.67±25.64) h,(11.80±1.83) d,indwelling stomach tube group:(43.53±11.94) h,(61.17± 22.67) h,(8.70±1.53) d (P ＜ 0.05)].The levels of hemoglobin and plasma albumin one week after operation were statistically lower than pre-operation,while that the level of these nutrition indicators were higher in indwelling stomach tube group compare to control group (all P ＜ 0.05).The same result was observed between enteral nutrition group and control group.Whereas,the change of nutrition indicators between the enteral nutrition group and the control group was not statistical significant (P ＞ 0.05).Conclusion Indwelling stomach tube combined with enteral nutrition is a reasonable choice for patients after colonic cancer surgery.

Analysis of related factors on anastomotic leak after total mesorectal excision in middle and lower rectal cancer / 中国医师进修杂志

Objective To investigate the reasons and prevention measures of anastomotic leak after total mesorectal excision (TME) in middle and lower rectal cancer.Methods Clinical data of 216 cases of middle and lower rectal cancer patients from March 2005 to March 2013 were retrospectively analyzed.Results All the 216 cases,anastomotic leak occurred in 19 cases,which from March 2005 to February 2009 surgery in 96 cases,13 cases of anastomotic leak,from March 2009 to March 2013 surgery in 120 cases,6 cases of anastomotic leak.Time of the anastomotic leak occurrence was postoperative 4-10 d with an average of 7.3 d.There was no correlation between the occurrence of postoperative anastomotic leak and gender,Dukes stage,histological type and incomplete intestinal obstruction (P ＞ 0.05).However,there was correlation with the age,tumor distance from the anal margin lower end,anemia,hypoproteinemia,diabetes and the stapler hand-sewn anastomosis strengthen (P ＜ 0.05 or ＜ 0.0 1).Sixteen cases were healed by conservative treatment,3 patients with severe anastomotic fistula underwent transverse colostomy surgery to cure.Conclusions Anastomotic leak after TME in middle and lower rectal cancer is caused by a variety of factors,fine operation technique,good agreement,full-effective drainage and anal is the key factor to reduce the occurrence of anastomotic leak.Anemia,hypoproteinemia,diabetes and low anastomotic are the risk factors for the anastomotic leak,most cases of anastomotic leak are able to cured by conservative treatment,and if the conservative treatment fails,then choose the right time to colostomy.

A comparison of efficacy of dexmedetomidine and pethidine for prevention of postoperative shivering in patients requiring general anesthesia / 中华麻醉学杂志

Objective To compare the efficacy of dexmedetomidine and pethidine for prevention of postoperative shivering in patients requiring general anesthesia.Methods Sixty ASA Ⅰ-Ⅲ patients of both sexes,aged 18-75 yr,weighing 40-85 kg,were randomly divided into 2 groups (n =30 each) ∶ pethidine group (group P) and dexmedetomidine group (group D).At the end of pneumoperitoneum,pethidine 0.5 mg/kg and dexmedetomidine 1 μg/kg were infused intravenously over 10 min in groups P and D,respectively.The shivering,respiratory depression,somnolence,nausea and vomiting,bradycardia and hypotension were recorded within 1 h after operation.Results There were no significant differences in the incidence and degree of shivering between group D and group P (P ＞ 0.05).The incidences of respiratory depression and nausea and vomiting were significantly lower,and the incidence of bradycardia was significantly higher in group D than in group P(P ＜ 0.05).Conclusion The efficacy of dexmedetomidine for prevention of postoperative shivering is better than pethidine in patients requiring general anesthesia.

Correlation between carotid atherosclerosis and coronary artery atherosclerosis, and their relationship with peripheral blood macrophage colony stimulatory factor, C-reactive protein and plaque stability / 中国医师进修杂志

Objective To explore the correlation between carotid atherosclerosis and coronary artery atherosclerosis, and their relationship with macrophage colony stimulatory factor (M-SCF), C-reactive protein(CRP) and plaque stability.Methods A total of 400 patients having underwent a selective coronary angiography were divided into no coronary heart disease (NCHD) group (93 cases), acute coronary artery syndrome(ACS) group (202 cases) and stable angina pectoris(SAP) group ( 105 cases).Based on coronary angiography plaque morphology, the patch was typed as Ⅰ, Ⅱ and Ⅲ and based on ultrasound for the carotid artery, plaque was typed as stable and unstable plaques.The plaque type, the levels of peripheral blood M-SCF, CRP was compared among ACS group,SAP group and NCHD group.Results Coronary artery atherosclerosis was mainly type Ⅱ in ACS group[78.7%(159/202)], and carotid atherosclerosis was mainly unstable[69.3%(140/202)].Coronary artery atherosclerosis of type Ⅰ , Ⅱ , Ⅲ was 40.0%(42/105), 30.5% (32/105) and 29.5%(31/105) in SAP group,and carotid atherosclerosis was mainly stable.The levels of peripheral blood M-SCF, CRP in ACS group were higher than those in SAP group and NCHD group (P＜ 0.05 ) ,and there was no significant difference between SAP group and NCHD group (P＞ 0.05 ).The levels of peripheral blood M-SCF, CRP in coronary artery atherosclerosis with type Ⅱ were higher than those with type Ⅰ , Ⅲ (p＜ 0.05).The levels of peripheral blood M-SCF, CRP in carotid atherosclerosis with unstable plaque were higher than those with stable (P ＜ 0.05 ).Conclusion Coronary arteriosclerosis is closely related with carotid arteriosclerosis.The levels of M-SCF and CRP are related to plaque structural characteristics and plaque stability.

Effect of different target plasma concentrations of remifentanil on sedative effect of propofol / 中华麻醉学杂志

Objective To investigate the effect of different target plasma concentrations (Cp) of remifentanil on sedative effect of propofol. Methods Eighty adult ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing elective laparoscopic cholecystectomy were randomly assigned into 4 groups (n = 20 each). Anesthesia was induced with TCI of remifentanil (Cp = 2, 4 and 8 ng/ml in group Ⅱ-Ⅳ respectively) and propofol TCI (the initial Cp of propofol was 2 μg/ml in the 4 groups). Then the Cp of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and the Cp of propofol were recorded as the patient lost consciousness.The Cp and consumption of propofol were recorded when BIS value decreased to 50. Results BIS value was significantly increased, while the Cp of propofol was significantly decreased as the patient lost consciousness, and the Cp and consumption of propofol were significantly decreased when BIS value decreased to 50 in group Ⅲ - Ⅳ compared with group Ⅰ (P ＜ 0.05). Conclusion Remifentanil 4 ng/ml is the suitable Cp for anesthesia when combined with propofol.

Efficacy of laparoscopic surgery for rectal cancer / 中华消化外科杂志

Objective To investigate the safety and clinical outcome of laparoscopic resection of rectal cancer. Methods The clinical data of 347 patients with rectal cancer who were admitted to the Shanxi Tumor Hospital from May 2004 to July 2008 were prospectively analyzed. Of all the patients, 343 met the inclusion criteria,and they were randomly allocated to laparoscope group (n = 169) and open group (n= 174). The diameter of the tumors, number of lymph node dissected, length of rectum resected, morbidity, the mean operation time, number of patients receiving blood transfusion, time to out-of-bed activity, first flatus, bowel movement and liquid diet were observed. All data were analyzed using the t test and chi-square test. The survival rate was calculated using the Kaplan-Meier method. Results The diameter of the tumors, number of lymph node dissected, length of rectum resected and number of patients receiving blood transfusion in the laparoscope group were (4.3 ± 1.3 ) cm, 7 ± 5,(19.1±2.2)cm and 4, and they were (4.2±1.3)cm, 7 ±5, (19.0±2.3)cm and 8 in the open group,respectively, with no significant difference between the two groups ( t = 0. 629, - 0. 726, 0. 562, x2 = 1. 264,P ＞0.05). The mean operation time in the laparoscope group was 19 minutes longer than that in the open group (t = 7. 904, P ＜ 0.05 ). The time to out-of-bed activity, first flatus, bowel movement and liquid diet in the laparoscope group were 0.6, 0.3, 0.3 and 0.6 days earlier than those in open group( t = - 6. 392, - 3.581, - 3. 802,- 3. 493, P ＜ 0.05 ). There were no significant differences in postoperative infection, anastomotic leakage, intestinal obstruction and deep vein thrombosis between the two groups ( x2 = 0. 236, 0. 354, 0. 000, 0. 000, P ＞0.05). A total of 167 patients in the laparoscope group and 172 patients in the open group had been followed upuntil 1 may, 2010. The 1-, 2-year survival rates were 94.0% and 82.6% in the laparoscope group and 95.3% and 91.2% in the open group. There was no significant difference in the 2-year survival between the two groups (x2 =0.541, P ＞0.05). The survival time of the patients in the laparoscope group and open group were 55.9 and 57.9 months, respectively. Conclusions Laparoscopic surgery is safe and feasible for patients with rectal cancer, with quick recovery after the operation.

The role of Survivin and VEGF in angiogenesis of colorectal tumor / 肿瘤研究与临床

Objective To identify the role of survivin and VEGF in angiogenesis of colorectal tumor by investigating tissue expression of survivin, VEGF and CD34 in human colorectal tumors. Methods Immunohistochemical staining for the paraffin sections by using the polyclonal antibodies of survivin, monoclonal antibodies of VEGF and CD34, was performed by the standard avidin-biotin-peroxidase technique. The percentage of positive cell and quantitative analysis were made by image analysis system, which also helped to calculate the amount of MVD. Results The immunoreactivity of survivin significantly increased in the transition from adenoma with low dysplasia to adenoma with high dysplasia (P <0.01). Similar changes in protein expression were observed for VEGF and MVD. The expression of survivin was closely related with that of VEGF. Both were positively correlated with MVD. Conclusion Survivin promotes angiogenesis of colorectal tumor together with VEGF. VEGF may be the potential causes of reexpression of survivin during colorectal tumorigenesis.

Effects of ketamine on MAC_(BAR) of sevoflurane in patients undergoing abdominal surgery / 中华麻醉学杂志

ObjectiveTo evaluate the effects of ketamine on the minimum alveolar concentration of scvoflurane for blunting adrenergic responses to skin incision (MAC_(BAR)) in patients undergoing abdominal surgery. Methods Forty-four ASA Ⅰ or Ⅱ patients aged 30-60 yr undergoing elective abdominal surgery were randomly divided into 2 groups (n=22 each) : control group (group K_0) and ketamine group (group K_1). Anesthesia was induced with propofol 2 mg/kg and fentanyl 3 μg/kg. Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg. The patients were mechanically ventilated. Anesthesia was maintained with sevoflurane inhalation (the initial end-tidal concentration 3% ). Ketamine at 14 μg·kg~(-1)·min~(-1) was infused at the same time in group K,. The patients' response to skin incision was described as positive if MAP or HR increased by≥15%. If the response was positive, the end-tidal concentration of sevoflurane for the next patient was increased by 0.5%, while if negative, decreased by 0.5% . ResultsThe MAC_(BAR) of scvoflurane was 3.25 % (95 % confidence interval 3.05%-3.45%) in group K_0, and 2.20% (95% confidence interval 1.96%-2.44%) in group K~1. The MAC_(BAR) of sevoflurane was significantly lower in group K~1 than in group K_0 (P<0.05). Conclusion Ketamine infusion at 14 μg·kg~(-1)·min~(-1) can reduce MAC_(BAR) of sevoflurane and enhance the inhibitory effect of sevoflurane on the stress response.