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Objective To compare the anesthetic effects,safety and side effects of the mixture with different ratios of etomidate to propofol in painless gastroscopy.Methods Two hundred patients scheduled for painless gastroscopy,95 males and 105 females,aged 18 to 65 years,BMI 18.5-27.0 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomized into two groups,group A (the ratio of eto-midate and propofol volume 1:1);group B (the ratio of etomidate and propofol volume 1:2).All of the patients were injected with sufentanil 0.1 μg/kg at first.All patients were given the first dose of 0.15-0.2 ml/kg intravenously slowly.Repeated doses of 1-2 ml etomidate-propofol were administered to maintain an adequate level of sedation.HR,SBP,DBP and SpO2were monitored.The dosages of etomidate and propofol were recorded.At the same time the induction time,the operation time,the recovery time and the leaving time were recorded.And low blood pressure,hypoxia saturation,re-spiratory obstruction,muscle fibrillation,nausea and vomiting and other adverse reactions were re-corded.Results There was no significant difference between group A and group B in the induction time,the operation time,the recovery time,the leaving time,perioperative hypotension,periopera-tive hypoxia and injection pain.The dosage of etomidate in the group A was significantly more than in the group B (P<0.01).The dosage of propofol in the group A was significantly less than in the group B(P<0.05).The incidence of myoclonus in group A was notably higher than that in the group B (P<0.01),The incidence of nausea and vomiting in group A was higher than that in the group B (P<0.05).Conclusion Etomidate plus propofol (1:2)had less incidence of myoclonus and nausea and vomiting,and it is more suitable for gastroscopy than 1:1 EP mixture.
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Objective To observe the effect of acupuncture at Tianzhu (BL10) on Blood Stasis Type lumbar disc herniation (LDH). Methods From October, 2013 to October, 2015, 108 LDH cases were randomized into observation group (n=53) and control group (n=55) in accordance with the order of visiting. The observation group received Tuina and acupuncture mainly at Tianzhu, while the control group only received Tuina, for four weeks. The clinical efficacy and improvement of Japanese Orthopaedic Association (JOA) scores were record-ed, and the Visual Analogue Scale (VAS) and serum levels of interleukin-6 (IL-6) were measured before and after treatment. Results The VAS score and IL-6 content decreased in both groups after treatment (t>4.220, P3.745, P<0.001). The total effective rate was 94.34% in the observation group, more than 81.82% in the control group (χ2=3.997, P=0.046). The incidence of impromvement of JOA scores was 90.57%in the observation group, more than 76.36%in the control group (χ2=3.920, P=0.048). Conclusion Acupuncture at Tianzhu based on Tuina is more effective on Blood Stasis Type lumbar disc herniation, in term of pain and function, which may relate with decrease of the level of IL-6.
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Objective To investigate the therapeutic efficacy of acupuncture plus Bobath therapy in treating motor dysfunction of the core muscles in patients with hemiplegia after cerebral stroke.Method Totally 144 patients with post-stroke hemiplegia were divided into a control group, treatment group 1 and treatment group 2. The treatment group 1 was intervened by Bobath therapy, while the treatment group 2 was by abdominal acupuncture and scalp acupuncture in association with Bobath therapy. The recruited patients were examined for the manual muscle strength rating of the abdominal core muscles, Berg Balance Scale (BBS) score, and Barthel Index (BI) score on the day of admission, the 30th day and 60th day after admission.Result There were no significant inter-group differences in comparing the core muscle strength, BBS, and the Activities of Daily Living (ADL) on the day of admission (P>0.05). The core muscle strength, BBS, and ADL were significantly increased on the 30th and 60th day after admission in the three groups (P<0.05), and the scores in treatment group 2 were significantly higher than that in the control group and treatment group 1 (P<0.05).Conclusion Acupuncture plus Bobath therapy can significantly improve the motor dysfunction of the core muscles in patients with hemiplegia after cerebral stroke.
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Objective To investigate the clinical efficacy of a novel path of lymph node dissection combined with peripheral vascular occlusion for the treatment of gastric cancer in stage ⅢC.Methods The clinical data of 142 patients with gastric cancer in stage Ⅲ C who were admitted to the 175th Hospital of PLA from January 2006 to December 2009 were retrospectively analyzed.Seventy patients received novel path of lymph node dissection combined with peripheral vascular occlusion (combined group) and 72 patients received simple lymph node dissection via the novel path (simple group).The positive rate of mRNA expression of carcinoembryonic antigen (CEA) and the distal metastatic rate of tumor cells between the 2 groups were compared.Patients were followed up via outpatient examination,phone call and in-patient examination till January 2013.The measurement data and the enumeration data were analyzed using the t test and the chi-square test,respectively.Results The operation time,volume of blood loss and number of lymph nodes dissected were (184 ± 26) minutes,(282 ± 80) mL and 28 ± 5 in the combined group,(180 ± 28)minutes,(355 ± 85)mL and 27 ± 5 in the simple group,with no significant difference between the 2 groups (t =0.882,5.267,0.496,P ＞ 0.05).The positive rates of mRNA expression of CEA of the combined group and the simple group were 10.0％ (7/70) and 9.7％ (7/72),with no significant difference between the 2 groups (x2 =0.003,P ＞ 0.05).The positive rates of mRNA expression of CEA after lymph node dissection of the combined group and the simple group were 2.9％ (2/70) and 16.7％ (12/72),with significant difference between the 2 groups (x2 =8.240,P ＜ 0.05).The positive rates of mRNA expression of CEA after total gastrectomy of the combined group and the simple group were 4.3％ (3/70) and 4.2％ (3/72),with no significant difference between the 2 groups (x2=0.001,P ＞ 0.05).All patients were followed up at postoperative year 1,and 139 patients were followed up at postoperative year 3.The median time of follow-up was 33.5 month (range,12.0-42.0 month).The 1-year distal metastatic rate of the combined group and the simple group were 7.1％ (5/70) and 8.3％ (6/72),with no significant difference between the 2 groups (x2=0.070,P ＞0.05).The 3-year distal metastatic rate of the combined group and the simple group were 33.3％ (23/69) and 51.4％ (36/70),with significant difference between the 2 groups (x2=4.660,P ＜0.05).The distal metastatic rates of distal parenchymatous organs of the combined group and the simple group were 10.1％ (7/69) and 44.3％ (31/70),with significant difference between the 2 groups (x2=20.390,P ＜ 0.05).Conclusions Novel path of lymph node dissection combined with peripheral vascular occlusion can block the lymph node and blood backflow,and thus effectively reduces the distal metastatic rate of gastric cancer in stage ⅢC after operation.
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Pathological types of gastric cancer in stage Ⅲ C include T4a-SEN3,T4b-SIN2,T4b-SIN3.Celiac artery metastatic lymphadenopathy fused into blocks,usually from bottom to top.Limited operation space revealed anatomical and pathological factors,the dissection of the celiac artery lymph nodes,processing the left gastric artery root difficulty.Application of novel celiac artery lymph nodes dissection path,avoiding the limitation of the celiac artery lymph node dissection space exposure factors,so that the dissection of the celiac artery lymph nodes is more complete,processing the left gastric artery root easily,reduce the amount of bleeding,shorten operation time,increase the average lymph node dissection and the Ⅲ C gastric cancer resection rate.
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Objective To investigate the expression of CD44V6 in thyroid neoplasms and its significance. Methods The expression of CD44V6 in paraffin-embeded thyoid carcinoma tissue from 100 patients (50 with lymph node metastasis,50 without) and 20 patients with thyroid adenoma was measured by immunohistochemistry staining. Results Positive expression of CD44V6 in the group of thyoid carcinoma was 72%, significantly higher than the group of thyroid adenoma.Positive expression of CD44V6 in the group of thyoid carcinoma with lymph node involvement was 90%,significantly higher than the group of thyoid carcinoma without lymph node involvement.In patients with different pathological grade,different clinical stage and different survival time, the positive expression of CD44V6 was significantly different. Conclusions The results suggest that CD44V6 can be regarded as an valuable molecular markers to distinguish benign thyroid tumor from malignant tumor, to predict lymph node metastasis and prognosis.
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To evaluate the value of the vaccinations with 3 strains of gene-deleted mutants from pseudorabies virus(PRV), PRV TK-, PRV gE-/gI- and PRV TK-/gE-/gI- after to exposure to the wild Fa strain, these mutant strains from the PVR reference isolate Fa were used to vaccinate 4 weeks old PRV-free pigs with a dosage of 105 PFU each ,and followed by nasally challenged by the parental Fa strain with a dosage of 107 PFU at 14 days post vaccination. The pathological changes, virus discharge and distribution were evaluated after vaccination and challenge. It was found that the histopathological observations in the 10 collected samples including cerebrum, cerebellum, heart, liver, lungs, spleen, kidneys, tonsils, lymph nodes and trigeminal ganglion from these 3 mutant strains showed that the rates of occurrence of pathological changes in various organs were 4/10, 3/10 and 4/10 respectively, whereas that of the positive controls were 9/10. The damage in lungs was more serious in pigs vaccinated with PRV TK-mutant and positive control in comparison with other groups of pigs inoculated, and the damages in cerebrum, cerebellum and trigeminal ganglion in positive controls were more serious than those of pigs vaccinated with the 3 gene-deleted mutants. However, the tonsils, the main organ for latent infection were damaged mildly in the pigs inoculated with these 3 gene-deleted mutants in comparison with that of the positive controls. As demonstrated by Southern blot analysis, all the vaccinated pigs could discharge viruses by secretion through nasal cavity, but the soldier pigs were not infected successively by the gene-deleted mutants and the gene-deleted mutants were also unable to establish infection in cerebrum and cerebellum. Nevertheless, they could not effectively block discharge of PRV Fa after exposure to Fa virus, but could block effectively the virulent Fa virus invading into cerebrum and cerebellum. From these observation, it is evident that the deleted mutants of the TK, gE/gI , TK/gE/gI genes can block the invasion of virulent Fa virus into cerebrum and cerebellum and lessen the damages on multiple organs or tissues ,indicating that the deleted mutant of TK/gE/gI gene may be the most promising candidate of vaccine strain for development of the commercial vaccine.
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Objective To study the relationship between the expression of vascular endothelial growth factor (VEGF) and invasion, metastasis of primary hepatocellular carcinoma (PHCC). Methods Paraffin-embedded specimens from 30 patients with PHCC undergoing radical resection were studied. Agiogenesis was assessed by the expression of VEGF and microvascular density (MVD) using LSAB immunohistochemical staining. Results (1) The level of VEGF and MVD in PHCC was higher than that in the paratumorous tissue (P<0.05). (2) The level of VEGF expression and MVD in PHCC with tumor metastasis or in nonencapsulated tumors were higher than that in PHCC without metastasis or in well encapsulated tumors (P<0.05). (3) There was no significant differance in the expression of VEGF and MVD between large PHCC (diameter >5cm) and small ones (diameter ≤5cm). (4) The expression of VEGF was positively correlated with MVD (P<0.01). Conclusions The expression of VEGF and MVD are highly correlated with invasion and metastasis in PHCC, may serve as a parameter for determining tumor metastasis and prognosis which may suggest a new idea to supervise and treat PHCC.
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Objective To study the diagnosis, therapy and prevention of bile duct carcinomas in choledochal cysts. Methods We retrospectively analysed clinico pathologic data, the ways of operation and living time of 11 patients with bile duct carcinomas in choledochal cysts in two hospitals from 1986 to 1997. Results There were complete excision of the choledochal cysts associated with choledochojejunostomy in 4 patients, exploration of bile duct and drainage with T shape tube in 3 patients. And there were also the excision of the wall of bile duct cysts and the tumor and cholangioplasty, choledochocystoduodenostomy, biopsy, pancreaticoduodenectomy and cholangiojejunostomy at the porta hepatis, resection of original rhynchostoma of choledochojejunostomy in one patient, respectively. One patient has lived for 3.6 years after radical resection. Others lived for 13.6 months after operation. Conclusions It is the key of improving and lengthening lives to find this disease in the early stage and to resect radically as early as possible.
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Objective To explore the surgical treatment and perioperative management of carotid body tumors.Methods Fifteen patients with carotid body tumor were operated upon after appropriate perioperative management.Results Among the 15 cases,6 underwent simple tumor excision,7 had co-resection of carotid body tumor and carotid artery,and 2 cases had arterial anastomosis of common carotid artery and internal carotid artery after co-resection of carotid body tumor.There was no mortality after operation in this series.All patients were followed up from 1 year to 3 years (average,15.3months).Operative incisions healed by primary intention.The pressure symptoms of carotid body tumor disappeared after operation,but two patients had temporary headache for 3months,and one patient died of cerebral infarction.Injury of hypoglossal nerve occurred in one patient but it recovered after treatment.There were no recurrences of carotid body tumor after operation.Conclusions Adequate perioperative management can improve the effect and safety of operation,and decrease operative complications of patients with carotid body tumor.
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Objective To study the relationship between the expression of vascular endothelial growth factor (VEGF) and invasion, metastasis of primary hepatocellular carcinoma (PHCC). Methods Paraffin-embedded specimens from 30 patients with PHCC undergoing radical resection were studied. Agiogenesis was assessed by the expression of VEGF and microvascular density (MVD) using LSAB immunohistochemical staining. Results (1) The level of VEGF and MVD in PHCC was higher than that in the paratumorous tissue (P5*!cm) and small ones (diameter ≤5*!cm). (4) The expression of VEGF was positively correlated with MVD (P