Effects of general anesthesia combined with epidural block or transverse abdominis plane block on intraoperative anesthetic dosages, stress response and inflammatory response in patients undergoing radical resection of colorectal cancer / 医学研究生学报

Objective The choice of perioperative analgesia regimens for radical resection of colorectal cancer is still controversial. The purpose of this study was to compare the effects of general anesthesia combined with epidural block or transverse abdominis plane block on surgical recovery of patients, and provide a basis for the choice of analgesic methods for radical resection of colorectal cancer. Methods The clinical data of 118 patients who underwent laparoscopic radical resection of colorectal cancer under general anesthesia in Affiliated Hospital of Nantong University between February 2016 and May 2018 were retrospectively analyzed, and the patients were divided into group A (epidural block, n=61) and group B (transverse abdominis plane block, n=57) according to anesthesia regimens. The two groups were given the same general anesthesia induction and maintenance medication. The dosages of general anesthetics in two groups were recorded, and the postoperative recovery situations (including first anal exhaust time, eating time, ambulation time, hospital stay and visual analogue scale score) were compared, and the stress indexes of heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), cortisol (Cor) and norepinephrine (NE)], immune indexes of CD4+, CD8+, CD4+/CD8+, total T lymphocyte count and natural killer cell (NK) count and inflammation indicators of human chemokine CXC ligand 8 (CXCL8), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were detected in two groups at different time points. Results The dosage of sufentanil in group A was lower than that in group B [(25.36±4.74) μg vs (28.43±3.69) μg] (P<0.001). The first anal exhaust time, eating time and first ambulation time in group A were shorter than those in group B (P<0.05). The VAS scores in group A were lower than those in group B at different time points (P<0.001). The levels of HR, MAP, Cor and NE in group A were lower than those in group B at T2~T3, and the SpO2 at T2 was lower than that in group B [(5.11±0.31)% vs (5.96±0.34)%] (P<0.05). At 24h after operation, the CD8+ and total T cell in group A were lower than those in group B [(20.79±13.02)% vs (26.91±10.22)%, (60.23±8.97)% vs (64.33±12.76)%] while the CD4+/CD8+ and NK cell count were higher than those in group B [(1.66±0.63) vs (1.25±0.95), (27.71±10.98)% vs (20.02±1.74) %] (P<0.05). The levels of CXCL8, IL-6 and TNF-α were lower than those in group B (P<0.05). There was no significant difference in the incidence rate of adverse reactions between group A and group B (3.28% vs 5.26%) (P>0.05). Conclusion General anesthesia combined with epidural block can reduce the dosages of anesthetic drugs in radical resection of colorectal cancer, reduce the body stress response and inflammatory response, and weaken the early immunosuppressive effects, and its overall analgesic effects are better than those of combined transverse abdominis plane block.

Antitumor activity and acute toxicity of total saponins from Paris forrestii / 药物评价研究

Objective To detect the antitumor activity of total saponins form Parisforrestii (PCT3) in vitro and in vivo and its acute toxicity by disposable ig administration.Methods The inhibitory effect of PCT3 on proliferation of human colorectal cancer cells (HCT-116) and human gastric cancer cells (SGC-7901) was detected by modified MTT assay,and the half inhibition concentration (IC50) was calculated.Acute toxicity test of PCT3 at doses of 1 646,2 352,3 360 and 4 800 mg/kg was performed by ig administration in mice.Mouse model of hepatocellular carcinoma (H22) was established with sc injection,and the mice were respectively ip given cisplatin 2 mg/kg (positive control),normal saline (negative control),ig given 0.5％ CMC-Na (solvent control),30,90 and 270 mg/kg PCT3 continuously for 9 d,and the inhibitory rate of tumor,body weight,liver,spleen,kidney and thymus coefficients were detected.Results PCT3 had significant inhibitory effect on the proliferation of HCT-116 and SGC-7901 cells,with IC50 values of 7.6 and 5.9 μg/mL,respectively.PCT3 induced animal diarrhea and activity inhibition in mice,the half lethal dose (LD50) was 1985.5 mg/kg.Compared with solvent control group,PCT3 had no significant effect on body weight of mice;270 mg/kg PCT3 had a significant inhibitory effect on H22 tumor mass (P ＜ 0.05),the inhibitory rate was 26.8％;There was no significant effect on the organ coefficient;compared with negative control group,cisplatin significantly inhibited the tumor growth and body weight (P ＜ 0.01),the inhibitory rates were 81.4％ and 37.4％ respectively;The liver,spleen and thymus coefficients were also significantly inhibited (P ＜ 0.05,0.01).Conclusion The tumor inhibitory rate of cisplatin is significantly higher than that of PCT3,but it also significantly inhibits mice body weight and liver,spleen,thymus coefficients.PCT3 shows obvious antitumor activity in vitro and in vivo,and the toxicity is not remarkable.It could be a potential antitumor agent in the future.

Antitumor activity and acute toxicity of total saponins from Paris forrestii / 药物评价研究

Objective To detect the antitumor activity of total saponins form Parisforrestii (PCT3) in vitro and in vivo and its acute toxicity by disposable ig administration.Methods The inhibitory effect of PCT3 on proliferation of human colorectal cancer cells (HCT-116) and human gastric cancer cells (SGC-7901) was detected by modified MTT assay,and the half inhibition concentration (IC50) was calculated.Acute toxicity test of PCT3 at doses of 1 646,2 352,3 360 and 4 800 mg/kg was performed by ig administration in mice.Mouse model of hepatocellular carcinoma (H22) was established with sc injection,and the mice were respectively ip given cisplatin 2 mg/kg (positive control),normal saline (negative control),ig given 0.5％ CMC-Na (solvent control),30,90 and 270 mg/kg PCT3 continuously for 9 d,and the inhibitory rate of tumor,body weight,liver,spleen,kidney and thymus coefficients were detected.Results PCT3 had significant inhibitory effect on the proliferation of HCT-116 and SGC-7901 cells,with IC50 values of 7.6 and 5.9 μg/mL,respectively.PCT3 induced animal diarrhea and activity inhibition in mice,the half lethal dose (LD50) was 1985.5 mg/kg.Compared with solvent control group,PCT3 had no significant effect on body weight of mice;270 mg/kg PCT3 had a significant inhibitory effect on H22 tumor mass (P ＜ 0.05),the inhibitory rate was 26.8％;There was no significant effect on the organ coefficient;compared with negative control group,cisplatin significantly inhibited the tumor growth and body weight (P ＜ 0.01),the inhibitory rates were 81.4％ and 37.4％ respectively;The liver,spleen and thymus coefficients were also significantly inhibited (P ＜ 0.05,0.01).Conclusion The tumor inhibitory rate of cisplatin is significantly higher than that of PCT3,but it also significantly inhibits mice body weight and liver,spleen,thymus coefficients.PCT3 shows obvious antitumor activity in vitro and in vivo,and the toxicity is not remarkable.It could be a potential antitumor agent in the future.

A comprehensive prevention programs on AIDS, HBV and syphilis among pregnant women and couples experienced premarital medical examination / 中华流行病学杂志

Objective To evaluate the effect of comprehensive prevention programs on HIV,HBV and syphilis transmission from mother to child and between premarital couples. Methods HIV, HBV and syphilis were screened among pregnant women with interventional measure for infected women; HIV, HBV and syphilis (TP) were screened among premarital couples with medical advice. Results The HIV,HBsAg and TP positive rates were 8.4‰(111/13 280) ,54‰(711/13 186)and 12.8‰( 159/12 401 ) respectively among pregnant women and the total positive rate of the three diseases was 73.8‰ which was significantly higher than HIV positive rate (P＜0.001). The positive rates of HIV, HBsAg and TP were 17.6‰(464/26 324), 95.3‰( 1826/19 152) and 18.6‰(355/19 099) respectively among premarital couples and the total positive rate of the three diseases was 131.5‰ which was significantly higher than HIV positive rate alone (P＜0.001).Comprehensive prevention was more economical than prevention for HIV alone. Conclusion The comprehensive strategies for prevention of HIV, HBV and syphilis was feasible, effective and economical that could help to actively conduct the preventive measures.

Nevirapine related hepatotoxicity: the prevalence and risk factors in a cohort of ART naive Han Chinese with AIDS / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To investigate the incidence of hepatotoxicity in acquired immunodeficiency syndrome (AIDS) patients on combined anti-retroviral therapy (cART) containing nevirapine (NVP) and to assess the risk factors and its impact on cART.</p><p><b>METHODS</b>330 AIDS patients from March 2003 to June 2008 at local county were enrolled and a retrospective study using Kaplan-meier survival and Multivariate logistic regression modeling was conducted.</p><p><b>RESULTS</b>267 out of 330 patients received NVP based cART and 63 cases received EFV-based cART. The deference of prevalences of hepatotoxicity between the two groups is statistically significant (Chi2 = 6.691, P = 0.01). 133 out of 267 (49.8%) patients on NVP based cART had at least one episode of ALT elevation during a median 21 months (interquartile ranges, IQR 6, 37) follow-up time, amounts for 28.5 cases per 100 person-years. Baseline ALT elevation (OR = 14.368, P = 0.017)and HCV co-infection (OR = 3.009, P = 0.000) were risk factors for cART related hepatotoxicity, while greatly increased CD4+ T(CD4) cell count was protective against hepatotoxicity development (OR = 0.996, P = 0.000). Patients co-infected with HCV received NVP-based cART had the higher probability of hepatotoxicity than those without HCV co-infection (Log rank: Chi2 = 16.764, P = 0.000). 23 out of the 133 subjects (17.3%) with NVP related hepatotoxicity discontinued cART temporarily or shifted NVP to efavirenz.</p><p><b>CONCLUSION</b>NVP related hepatotoxicity was common among ARV naive HIV infected subjects in our cohort. Baseline ALT elevation and HCV co-infection were associated statistically with the development of hepatotoxicity. Hepatotoxicity led to discontinuing cART temporarily or switching to other regimens in some subjects. It suggested that NVP should be used with caution in patients co-infected with HCV among whom anti-HCV therapy before cART initiation may contribute to minimizing the probability of NVP associated hepatotoxicity.</p>

Survey on spousal transmission of human immunodeficiency virus / 中华传染病杂志

Objective To investigate the spousal transmission of human immunodeficiency virus (HIV)and its related factors in HIV epidemic area,which can be beneficial to prevent HIV from transmitting.Methods Three hundred and forty-six couples with one spouse were anti-HIV positive were cross-sectionally investigated.Blood samples were taken from the spouse of subjects whose anti- HIV were positive to detect the anti-HIV antibody and from 70 acquired immune deficiency syndrome (AIDS)patients to do the sequencing of the serum HIV provirus DNA.Results In 346 couples,99 were infected by spousal transmission and its transmission rate was 28.6%.One spouse of 125 couples were infected with HIV by paid blood donation,14.4%(18)of the other spouse were infec- ted by spousal transmission.One spouse of 135 couples were infected by paid blood transfusion, 23.7%(32)of the other spouse were infected by spousal transmission.Eighty-six couples were infec- ted by extramarital sexual contact,49(57.0%)got spousal transmission.Thirty-seven(69.8%) subjects were infected by husband-to-wife transmission and 12(36.4%)were from wife to husband. The difference between them was significant(P