90 min, isoflurane concentration was increased or a bolus dose of fentanyl (25-50 ?g) was given i.v.. The BIS values before and during anesthesia and at extubation, emergence time, extubation time, the time between the end of operation and Aldrete anesthesia recovery score≥9, MMSE score and isoflurane consumption were recorded and compared between the two groups. Results The total amount of isoflurane consumed was 34% lower in BIS group than in control group. The average BIS values were higher and end-tidal isoflurane concentration was lower in BIS group than in control group. The time from the end of surgery to eye-opening, to extubation and Aldrete score≥9 were significantly shorter in BIS group than in control group. The MMSE score was significantly decreased at 1 h after operation as compared to the baseline score before induction of anesthesia while in control group MMSE score was still significantly decreased at 2 h after operation. Conclusion Titration of isoflurane using BIS monitoring can reduce the dose of isoflurane during operation and contribute to faster recovery from anesthesia in elderly patients undergoing intra-abdominal surgery.

【Objective】To evaluate the therapeutic effect of comprehensive therapy for supine and prone external rotationed ankle fracture.【Methods】Thirty-nine patients with supine and prone external rotationed ankle fracture were treated with manipulative reduction,plaster and splint fixation,functional exercises and steaming with herbal medicine decoction(mainly composed of Herba Lycopodii,Herba Speranskia tuberculatae,Caulis Spatholobi,Semen Persicae,Flos Carthami,Radix Angelicae Sinensis,Rhizoma Chuanxiong,Myrrha,Lignum Sappan,Rhizoma Drynariae,Radix Dipsaci,Radix Achyranthis Bidentatae,Ramulus Cinnamomi,etc.)【Results】X-ray film after reduction showed that apposition of fracture was good in 39 patients.The fixation time ranged from 6~11 weeks,averaged 8 weeks.The fracture union achieved in all of the patients,and the time for union was 53~84 days,averaged 58 days.The therapeutic effect in 39 patients was as follows:excellent in 28,good in 6,ordinary in 3,ineffective in 2 and the excellent and good rate being 87.2%.【Conclusion】A satisfactory effect can be achieved when applying proper reduction methods for different types of ankle fracture,and when adopting functional exercises and steaming with herbal medicine decoction.

Objective:To investigate perioperative management of anesthesia for septic shock.Methods:Anesthesia performed on an elderly patient with septic shock who underwent emergency surgery in Beijing Hospital was analyzed and summarized, with a literature review.Results:Etomidate, Ketamine, cis Atracurium and Remifentanil are preferred for anesthesia induction, and Remifentanil and Sevoflurane are the first choices for anesthesia maintenance.Combined application with Dexmedetomidine may improve patients' prognosis.For septic shock patients with new-onset atrial fibrillation, β-blockers are preferred for perioperative anti-arrhythmia.If necessary, propafenone or amiodarone can be used for cardioversion.Perioperative ultrasound evaluation may be used to guide perioperative fluid therapy and vasoactive drug administration for septic shock in the future.Conclusions:Anesthesiologists should place a high value on and have a good command of the main aspects of perioperative management of anesthesia for septic shock.

Objective To evaluate the efficacy of streamline liner of pharyngeal airway ( SLIPA) in airway management of general anesthesia. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective breast surgery were randomized into 2 groups (30 cases each): SLIPA group (group S) and laryngeal mask airway (LMA) classic group (group L). Anesthesia was induced with propofol 2 mg/kg, sufentanil 0.15 μ g/kg and vecurium 0.08 mg/kg. SLIPA or LMA was inserted with digital manipulation. Anesthesia was maintained with 1% - 2% sevofluran and 50% N2O in 50% oxygen. The parameters of controlled ventilation were same in both groups. The attempt times, seal pressure and grade of fiberoptic (FOB ) laryngoscopy were measured. SpO2, PErCO2 and peak airway pressure were monitored every 15 minutes after successful laryngeal mask insertion. The complications such as regurgitation of gastric contents and sore throat were assessed by anesthesiologist after surgery. Surgery time, anesthesia time, extubation time and emergence time were recorded. Results Success rate of LMA insertion in both groups were 100%. The first attempt success rates were 90%( 27/30) in group S and 60%( 18/30) in group L (P< 0.05), the FOB grade 4 were 67%(20/30) in group S and 37% (ll/30)in group L(P< 0.05), the maximum seal pressures were (23.6 ± 4.7)cmH2O (1 cm H2O = 0.098 kPa) in group S and (18.8 ± 4.5) cm H2O in group L (P<0.05). SpO2, PErCO2 and peak airway pressure were within normal ranges. The occurrence of sore throat was similar in group S and group L (7 cases vs 6 cases). No signs of regurgitation were detected. Conclusion The SLIPA proved to be a simple, safe and effective airway instrument with little complications during the course of general anesthesia.

The pharmacodynamics of compound Guhuanzhixue granule(CGH- ZX)was studied.The results showed that CGHZX inhibited the contraction of rat's uterine smooth muscle and antagonized the vigorous contraction induced by oxytoxin in vitro,It exerted an anti-inflammatory effect in rats and miee with uteritis caused by various foreign bodies,This preseription also shertened the bleeding and coagulation times in mice.It is suggested that CGHZX is applicable to metrorrhagia,pain and uteritis occurring after setting of contra- ceptive ring.

ObjectiveTo detect the expressions of orotate phosphoribosyl transferase (OPRT) and dihydropyrimidine dchydrogenase (DPD) mRNA in gastric cancer tissues,and investigate their relationship with the clinicopathological factors.MethodsThe gastric cancer tissues and adjacent normal tissues were collected from 53 patients with gastric cancer at the Affiliated Hospital of Inner Mongolia Medical College from June 2007 to November 2008.The mRNA expressions of OPRT and DPD were detected by reverse transcriptional-polymerase chain reaction,and the correlation between the mRNA expressions of OPRT and DPD and the clinicopathological factors was analyzed.All data were analyzed by using the t test and the one-way analysis of variance.Results The mRNA expression of OPRT in the gastric cancer tissue was 1.15 ± 0.56,which was significantly higher than 0.88 ± 0.31 in the adjacent normal tissues ( t =3.66,P ＜ 0.05 ).The mRNA expressions of DPD in gastric cancer tissues and the adjacent normal tissues were 0.95 ± 0.50 and 0.90 ± 0.41,respectively,with no significant difference between the 2 groups (t =0.68,P ＞ 0.05 ).The mRNA cxprcssions of OPRT in the gastric cancer tissues with no lymph node metastasis was 1.42 ± 0.54,which was significantly higher than 1.00 ± 0.52 in the gastric cancer tissues with lymph node metastasis (t =7.94,P ＜ 0.05 ).Poorly differentiated adenocarcinoma (0.93 ± 0.24) and mucinous adenocarcinoma (1.58 ± 0.38) showed a significantly higher DPD mRNA expression than moderately differentiated or well differentiated adenocarcinoma ( 0.67 ± 0.36 ) ( F =27.71,P ＜ 0.05 ).Conclusions The mRNA expre ssion of OPRT in gastric cancer tissue is higher than that in the adjacent normal tissues,and its expression in patients with lvmph node metastasis is lower than that in patients without lymph node metastasis.Poorly differentiated adenocarcinoma showed higher DPD mRNA expression than moderately or well differentiated adenocarcinoma,and its expression is highest in mucinous adenocarcinoma.

Objective To study the clinical application value of individualization portal for knee arthroscope meniscoplasty. Methods The clinical data of 100 patients who had underwent knee arthroscope meniscoplasty were retrospectively analyzed. In the patients, 50 cases were performed with routine portal (group A), and other 50 cases were performed with individualization portal (group B). The operation time, curative effect and incidence of complications were compared between 2 groups. Results The operation time in group B was significantly lower than that in group A:(28.8 ± 3.1) min vs. (39.5 ± 5.4) min, and there was statistical difference (t = 12.151, P<0.01). There was no statistical difference in excellent and good rate between group A and group B: 94%(47/50) vs. 96%(48/50),χ2=0.522, P>0.05. The incidence of meniscus and cartilage injury in group B was significantly lower than that in group A: 2% (1/50) vs. 14% (7/50), and there was statistical difference (χ2 = 4.891, P<0.05). There was no statistical difference in incidence of hematoma between 2 groups (P>0.05). There was no ligament injury, infection, vascular and nerve injury, deep vein thrombosis, instrumentation damage and synovial fistula. Conclusions The individualization portal for knee arthroscope meniscoplasty is more convenient. It can shorten operation time and decrease meniscus and cartilage injury. But it has no influence on clinical effect and other complications.

Objective To evaluate the efficacy of anesthesia with etomidate administered by TCI in combination with continuous iv remifentanil infusion titrated to maintain BIS values at 40-60 for non-cardiac surgery in a prospective randomized single-blinded multicenter controlled clinical study.Methods Two hundred and forty-four ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr undergoing non-cardiac surgery lasting less than 3 h were randomly allocated into 2 groups:etomidate group (group E,n =123) and propofol group (group P,n =121 ).The patients were unpremedicated.A bolus of midazolam 0.03 mg/kg was injected iv immediately before induction of anesthesia.Anesthesia was induced with sufentanil 0.3-0.4 μg/kg and TCI of etomidate (effect-site concentration (Ce) =0.5-1.0 μg/ml) or propofol (Ce =3-4 μg/ml).Tracheal intubation was facilitated with rocuronium 0.9 mg/kg.The patients were mechanically ventilated (VT 8-10 ml/kg,RR 10-12 bpm,FiO2 =1 ).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of etomidate ( Ce =0.3-0.8 μg/ml ) or propofol ( Ce =3-4 μg/ml) in combination with continuous iv infusion of remifentanil at 0.1-1.0 μg· kg-1 ·min-1 and intermittent iv boluses of rocuronium.BIS values were maintained at 40-60 during operation.Sufentanil 0.1 μg/kg was administered iv before skin closure.Ce at loss of consciousness,during maintenance of anesthesia and at emergence,the consumption of remifentanil and vasoactive agents,the emergence time and extubation time were recorded.The incidences of injecton pain,post-operative nausea and vomiting (PONV) and emergence agitation were measured.Results Ce of etomidate at loss of consciousness,at emergence and during maintenance of anesthesia was (0.50 ± 0.22),(0.16 ± 0.09) and 0.22-0.39 μg/ml respectively.The incidence of injection pain and the consumption of vasoactive agents were significantly lower but more remifentanil was needed in group E than in group P (P ＜0.05 or 0.01).There was no significant difference in emergence time and extubation time between the 2 groups (P ＞ 0.05).The incidence of PONV and emergence agitation were significantly higher during recovery in group E than in group P ( P ＜ 0.05 ).Conclusion The hemodynamics is stabler during operation,but the incidence of PONV and emergence agitation are significantly higher during recovery in group E than in group P.Etomidate induces little injection pain.

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.

5-fluorouracil (5-Fu) is a basic drug in the treatment of advanced gastric cancer. It is widely used in chemotherapy regimens for metastatic gastric cancer. However, the reaction rate was only 10%~30% when used 5-Fu alone. Interindividual variation in the enzyme activity of the 5-Fu metabolic pathway can affect the metabolism extent of 5-Fu and the efficacy of chemotherapy based on 5-Fu. In this review the roles of thymidylate synthase and thymi-dine phosphorylase enzymes factors involved in the 5-Fu metabolic pathway and the efficacy of fluoropyrimidine treat-ment in the metastatic gastric cancer are discussed.