Objective To investigate the effect of different methods of volume therapy on tissue oxygenation in elderly patients undergoing radical operation for gastrointestinal tumor.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ＞ 65 yr,weighing 42 -85 kg,undergoing elective radical operation for gastrointestinal tumor,were randomized into 3 groups ( n =20 each):lactated Ringer' s solution (LR) group ( group Ⅰ ),LR + 0.6 ％ hydroxyethyl starch (HES) 130/0.4 (2 ∶ 1 ) group ( group Ⅱ ) and LR + 0.6 ％ HES 130/0.4 ( 1 ∶1 ) group ( group Ⅲ ).Anesthesia was induced with propofol,vecuronium and fentanyl and maintained with sevoflurane,remifentanil and vecuronium.The patients were mechanically ventilated after tracheal intubation.PETCO2 was maintained at 30-35 mm Hg.Transcutaneous partial pressure of oxygen (TcPO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were measured within 5 min before fluid infusion (To ),25-30 min after beginning of fluid infusion (T1),within 5 min before skin incision (T2),within 5 min after skin incision (T3 ),within the first hour after beginning of surgery (T4),within the second hour after beginning of surgery (T5 ) and within 5 min before the end of surgery (T6 ).The average value within each time period was obtained.Blood gas analysis was performed simultaneously and PaO2 and PaCO2 were recorded.The fluid infused,urine volume,blood loss and requirement for norepinephrine,RBC and plasma were recorded during operation.The time when the patients passed the flatus,duration of stay in ICU and postoperative complications were recorded.Results There was no significant difference in TcPO2,TcPCO2,PaO2,PaCO2,the time when the patients passed the flatus,duration of stay in ICU and the incidence of postoperative complications among the three groups ( P ＞ 0.05).TcPO2 and PaO2 were significantly higher at T2-6 in the three groups and TcPCO2 was significantly lower at T3 in group Ⅲ than those at To and T1 ( P＜ 0.05 or 0.01).TcPCO2 was significantly lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group Ⅰ,the requirement for norepinephrine was significantly lower ( P ＜ 0.05),and no significant change was found in the fluid infused,urine volume,blood loss and requirement for RBC and plasma in groups Ⅱ and Ⅲ ( P＞0.05).Conclusion When LR,LR+0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1) is used for volume therapy,tissue oxygenation is improved,however,LR + 0.6％ HES 130/0.4 (2∶1) or LR + 0.6％ HES 130/0.4 (1∶1 ) is better in maintaining circulatory stability than LR infused alone and is more suitable for elderly patients undergoing radical operation for gastrointestinal tumor.

Objective To investigate the relative factors of insulin resistance(IR)during elective abdominal surgery and the mechanism of IR induced by surgery.Methods Fourteen patients underging elective abdominal surgery were studied.Fasting blood glucose(FBG),fasting plasma insulin(FPI),plasma TNF-α,IL-6 and CRP were tested for elective surgery patients on the day before,during operation and on one day after surgery.Insulin resistance index(HOMA-IR)and the index of insulin secretion(HOMA-β)were ealculated with homeostasis model assessment(HOMA).Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before operation and at the end of operation by use of RT-PCR.Results Significant differences were found in fasting blood glucose (5.95±1.08)mmol/L vs(8.92±2.41)mmol/L,fasting plasma insulin(19.95±3.33)mU/L vs(25.44±5.36)mU/L,IL-6(33.98±5.01)ng/L vs(45.29±7.81)ng/L and plasma TNF-α(86.70±9.27)ng/L vs(114.46±15.33)ng/L during and after operation(P＜0.01).A significant elevation of HOMA-IR levels was found after operation compared with that before operation[(9.59±2.89)vs(4.111.86)](P＜0.001).However there wag no significant difference in HOMA-β among three points(groups)of time(P=0.103).The result of RT-PCR showed that the expression of GLUT4 in muscle of patients at the end of operation reduced significantly compared with preoperation(t=12.488,P＜0.001)but there was no significance in INSR mRNA expression(P=0.165).ISI showed negative correlation with opermive time(r=-0.736、P＜0.001),blooding during operating (r=-0.594、P=0.032)and post-operative TNF-α(r=-0.641、P=0.018).Conclusion Insulin resistance occurs in elective abdominal surgery patients.The defective site is at postreceptor.To shorten the operation time,control the intensity of surgery and reduce the bleeding is helpful for decreasing IR.

Objective To investigate the effect of group feedback and formative assessment respectively on teaching effectiveness of endotracheal intubation (ETI).Methods After atheoretical lecturing and theoretical test,eighty three undergraduates were randomized into concurrent-feedback group and groupfeedback group.ETIsimulation training was given respectively by providing concurrent or group feedback in the two groups,and then undergraduates received a skill assessment.After atheoretical lecturing and theoretical test,other 91 undergraduates were randomized into final-assessment group and formative-assessment group.ETIsimulationtraining and skill assessment were given in final-assessment group.Before training,first skill assessment was performed in formative-assessment group,and then feedback was delivered based on the assessment.After training,second skill assessment was given again.Skill assessment was evaluated using the criterion-based task specific checklist combined with global rating scale.t-test was used for comparison between groups.Results There was no statistical difference (P=0.212) in theoretical scores between group-feedback group,and concurrent-feedback group.Skill assessment score of group-feedback group (39.4 ± 4.9) was higher than that in concurrent-feedback group (35.4 ± 4.7),with statistical difference (P=0.000).There was no statistical difference (P=0.395) in theoretical scores between formative-assessment group and final-assessment group.Score of formative-assessment group (39.3 ± 6.2) was higher than that in final-assessment group (32.2 ± 2.4),with statistical difference (P=0.000).Conclusion Terminal feedback or formative assessment could enhance teaching effectiveness of endotracheal intubation among medical students.

Objective To investigate the distribution of genotypes in chronic HBV infection (CHB) and acute HBV infection (AHB) patients in Shanghai. Methods Sixty-two patients with AHB and 73 patients with CHB admitted to ('hanghai Hospital of Shanghai between 2003 and 2007 were studied. Viral genotypes of all the patients were determined by direct gene sequencing.Meanwhile, epidemiological, clinical and biochemical parameters of all patients were collected. Mean values of different groups were compared by t test while frequency was compared by chi square test. Results The major prevalent genotypes in both AHB and CHB patients were genotype B and C (48.4% vs 51.6% in AHB patients and 26.0% vs 74.0% in CHB patients). The proportion of genotype B was higher in AHB patients compared to CHB patients (P= 0.02). Epidemiological factors and clinical outcomes were not statistically different among patients with different viral genotypes. The proportion of genotype C was much higher in CHB patients compared to AHB patients (P=0.006). The main transmission route of AHB was heterosexual interaction which was 18 out of 62 (29.0%), but in CHB patients, it was prenatal transmission which was 38 out of 73 (52.1%). Conclusions In shanghai, the main HBV genotypes in both AHB and CHB patients are genotype B and C. The proportion of genotype B is relatively high in AHB patients while proportion of genotype C is more common in CHB patients. There is no significant relationship between genotypes and the clinical outcomes of AI-IB patients.

Objective:To explore the changes of cerebra flow in retroperitoneoscopic surgery.Methods: Twenty-two patients undergoing retroperitoneoscopic surgery were selected.We measured Vm、Delt and PI with transcranial Dopple(TCD),and measured endothelin(ET),neurol peptide Y(NPY),Calcitonin gene-related peptide(CGRP) in plasma before CO2 insufflation,after CO2 insufflation,and after CO2 deflation.Results:Vm and Delt increased significantly at 30 min after pneumoperitonenum,and reached the peak at 90 min after pneumoperitonenum.PI decreased significantly 90 min after pneumoperitonenum.The plasma concentrations of ET and NPY increased significantly 60 min after pneumoperitonenum. Conclusion:Cerebra flow changes significantly in patients undergoing retroperitoneoscopic surgery,which is correlated to the changes of plasma CO2 and vascular bioactive substances.

Objective To study the influence of the structure and performance of tracheal intuba-tion model on teaching effect. Methods Three models of tracheal intubation with different structures were named M1, M2 and M3. A total of 91 medical students of grade 5 were enrolled, divided randomly into group A, B and C after theoretical knowledge learning of 30 minutes and examination, rained respectively on the M1, M2 and M3 for 90 minutes, and then evaluated. The models were changed within the three groups and students were then trained and evaluated for the second time. Comparison of the results was performed among the three groups. After one month, group A, B and C received examination and evaluation again. Students and instructors were asked to fill in the rating scale for M1, M2 and M3. Results ①No statistically significant differences were found in the number (31, 28, 32), gender (male/female, 10/21, 9/19, 12/20) and the pre-training test score of the students among the three groups. ②The score of the first evaluation on M1 was significantly lower in group A than in group B and C, while the scores of the second and third examination were significantly higher in group A than in the other two groups. ③The score after one month was significantly higher in group A than in group B and C. ④M1 scores (4, 5; 4.63, 5) were significantly higher than those in group B (3, 4; 2, 2.5) and group C (2, 3; 2, 2.25). Conclusion The structure and performance of the training model of tracheal intubation can indeed influence the teaching effect.