Objective To observe the clinical efficacy of ModifiedYigongsan Formula combined with Aidi-injection on advanced gastric cancer.Methods Totally 64 cases of patients with advanced gastric cancer were randomly divided into treatment group and control group with 32 cases in each group. Both groups were treated with Aidi-injection for intravenous drip, continuous infusion for 2 weeks. The treatment group was treated with Modified Yigongsan Formula, daily 1 agent, oral administration after lunch, for 4 weeks continuously; the control group did not take other medicine. The tumor markers (CEA, CA199), TCM syndrome score and physical condition score of the patients before and after treatment were observed.ResultsAfter treatment, the TCM syndrome score in the treatment group was significantly improved than that in the control group; the total effective rate was 84.38% (27/32) in the treatment group, and 43.75% (14/32) in the control group; the treatment group was significantly higher than that in the control group (P<0.05). The Karnofsky score of the treatment group was significantly higher than that of the control group (P<0.05). The tumor markers of two groups had no significant difference before and after treatment (P>0.05). Conclusion ModifiedYigongsan Formula combined with Aidi-injection on advanced gastric cancer tumor marker improvement was not obvious, but the improvement of TCM syndrome and physical condition of patients is very obvious.

Objective To evaluate the effect of dexmedetomidine on baroreflex in the patients.Methods Forty-five ASA physical status Ⅰ or Ⅱ patients,aged 20-60 yr,with body mass index 18-24 kg/m2,scheduled for elective partial thyroidectomy or nasal polypectomy under general anesthesia,were randomly divided into 3 groups (n =15 each) using a random number table:control group (group C),low-dose dexmedetomidine group (group LD) and medium-dose dexmedetomidine group (group MD).Dexmedetomidine 0.5 μg/kg was injected intravenously followed by infusion at 0.2 μg· kg-1 · h-1 in group LD.Dexmedetomidine 1.0 μg/kg was injected intravenously followed by infusion at 0.5 μg· kg-1 · h-1 in group MD.After 30 min of dexmedetomidine infusion,a modified Oxford pharmacologic technique was used for evaluating baroreflex sensitivity.Results There was no significant difference in baroreflex sensitivity between the three groups.Conclusion Dexemedtomidine exerts no effect on baroreflex in the patients.

Objective To investigate the method and the effects of the surgical treatment of massive subretinal hemorrhage and vitreous hemorrhage associated with age related macular degeneration. Methods A retrospective study of 14 consecutive patients underwent a complete pars plana vitrectomy. Retinotomy was carried out for removing subretinal hemorrhage by using balanced salt solution. Complete air fluid exchange and gas or silicone oil tamponade were performed in all patients. The follow up period was within 3～7 months. Results Atrophy of eyeball in 2 eyes (14.3%) postoperatively. Improvement of corrected final visual acuity and anatomical retinal reattachment were achieved in 12 (85.7%) of the 14 eyes postoperatively. Seven days after operation, muddy sand hemorrhage in anterior chamber occurred in 4 (28.6%) of the eyes and paracenteses of anterior chamber were performed for these eyes. Conclusion Surgical intervention should be applied in the eyes with the massive subretinal hemorrhage associated with age related macular degeneration in order to avoid the affected eyes becoming atrophic due to the subsequent complication of vitreous hemorrhage, anterior chamber muddy sand hemorrhage,ghost cell glaucoma or retinal detachment.

Objective To evaluate the effect of compound K ( CK) on spinal Toll?like receptor 4 ( TLR4) expression during morphine?induced hyperalgesia in rats. Methods Thirty?six healthy male Spra?gue?Dawley rats in which intrathecal catheters were successfully implanted were randomly divided into 3 groups ( n=12 each) using a random number table: control group ( group C) , morphine?induced hyperal?gesia group ( group M) , and morphine + CK group ( group M+CK) . Starting from 5 days after successful implantation, normal saline 10 μl, morphine 10 μg, and morphine 10 μg + CK 10 μg were injected in?trathecally twice a day for 7 consecutive days. Tail?flick latency ( TFL) to a thermal nociceptive stimulus was measured at 1 day before administration ( T0 , baseline) and at 30 min after the initial administration on 1st, 3rd, 5th and 7th days (T1?4), and the percentage of maximum possible effect (MPE) was calculated. The rats were sacrificed after the last measurement of tail?flick latency, and the lumbar segment ( L3?5 ) of the spinal cord was removed for determination of the expression of TLR4 by Western blot. Results MPE was significantly lower at T3,4 than at T1 in M and M+CK groups ( P<0?05) . Compared with group C, MPE was significantly lower at T2?4 , and the expression of TLR4 was up?regulated in M and M+CK groups ( P<0?05). Compared with group M, MPE was significantly increased at T1?4, and the expression of TLR4 was down?regulated in group M+CK ( P<0?05 ) . Conclusion The mechanism by which CK alleviates mor?phine?induced hyperalgesia is associated with down?regulation of TLR4 expression in rats.

Objective To investigate the effect of sevoflurane post-conditioning on the expression of poly (ADP-ribose) polymerase (PARP) in the cerebral cortex during focal cerebral ischemia/reperfusion (I/R) in rats and the mechanism.Methods Fifty-four male Sprague-Dawley rats,weighing 250-320 g,were randomly divided into3 groups (n =18 each) using a random number table:sham operation group (S group),I/R group and sevoflurane post-conditioning group (Sevo-pc group).The animals were anesthetized with intraperitoneal chloralhydrate 300 mg/kg.In Sevo-pc and I/R groups,focal cerebral ischemia was induced by middle cerebral artery occlusion using a nylon thread with rounded tip inserted into the right internal carotid artery and advanced cranially until resistance was met.The occlusion was maintained 1 h,followed by 24 h reperfusion.The animals in Sevo-pc group inhaled 2.7％ sevoflurane for 1 h starting from onset of reperfusion.At 24 h of reperfusion,neurological deficits were assessed,and then the rats were decapitated.The brains were immediately harvested for determination of the cerebral infarct size (by TTC staining) and expression of PARP in the ischemic cerebral cortex (by immunohistochemistry).The number of apoptotic cells was counted using TUNEL.The apoptosis index was calculated.Results Compared with group S,the neurological deficit scores and apoptotic cells were significantly increased,the cerebral infarct size was enlarged,and the expression of PARP in the ischemic cerebral cortex was up-regulated in I/R and Sevo-pc groups (P ＜ 0.05 or 0.01).The neurological deficit scores and apoptotic cells were significantly lower,the cerebral infarct size was smaller,and the expression of PARP in the ischemic cerebral cortex was downregulated in Sevo-pc group (P ＜ O.05 or 0.01).Conclusion Sevoflurane post-conditioning can reduce focal cerebral I/R injury in rats and down-regulation of PARP expression in the cerebral cortex may be involved in the mechanism.

Objective To compare the effects of fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) on classifications and locations of choroidal neovascularization (CNV) located under subretinal hemorrhage in age-related macular degeneration, and on the area-measuring of subretinal hemorrhage. Methods The medical record of 177 patients with subretinal hemorrhage associated with AMD confirmed by photochrome of ocular fundus, FFA and ICGA examinations were retrospectively reviewed. The locations and classifications of CNV on the images of FFA and ICGA in the 177 patients and the area of subretinal hemorrhage of 30 patients randomly selected from the 177 patients were analyzed and measured. Results On the images of FFA, the locations and classifications of CNV could be defined in 160 patients (90.4%), and CNV was considered eligible for laser therapy in 24 patients (13.6%). On the images of ICGA, the locations and classifications of CNV could be defined in 175 patients (98.9%),and CNV was considered eligible for laser therapy in 51 patients (28.8%). There was no statistical difference of the locations (Z=-0.383,P=0.701) and classifications (?2=2.993,P=0.810) of CNV on the images of FFA and ICGA. The areas of blocked fluorescence measured on the images of FFA (=26.610 mm2 and M= 13.548 mm2) were larger than those of ICGA (=24.714 mm2, M=12.875 mm2) with statistical differences (Z=-3.000,P=0.003) between FFA and ICGA. Conclusions ICGA is beneficial for imaging CNV located under subretinal hemorrhage, and may increase the number of the patients who are considered eligible for laser treatment. The effect of measurement of the area of subretinal hemorrhage in AMD evaluated by FFA is better.

Objective To investigate the influence of gender on the enmcement of neuromuscular blocking effects of cisatracurium or rocuronium by sevoflurane. Methods Two hundred and forty ASA Ⅰ or Ⅱ patients, aged 20-60 yr, weighing 45-85 kg, scheduled for elective surgery under general anesthesia were assigned into 2 groups ( n = 120 each): cisatracurium group and rocuronium group. Each group were divided into 4 subgroups according to gender and anesthetics ( n = 30 each): female propofol group, male propofol group, female sevoflurane group and male sevoflurane group. Anesthesia was induced with midazolam, propofol and fentanyl. After loss of consciousness, the laryngeal mask was inserted and the patients were mechanically ventilated. Propofol groups received target-controlled infusion (TCI) of propofol (target plasma concentration 2-6 μg/ml), and sevoflurane groups inhalation of sevoflurane. Cisatracurium 0.15 mg/kg or rocuronium 0.6 mg/kg was injected intravenously 5 min after propofol infusion or after the end-tidal concentrion of sevoflurane was maintained at 1.71% (1 MAC) for 5 min. Neuromuscular block was assessed with accelerograph F (TOF-watch SX). Train-of-four (TOF) stimulation of ulnar nerve was used. The onset time, duration of peak effect and times for recovery of T1 to 25% and TOF ratio (TOFR) to 25% were recorded.Results Compared with propofol groups, the time for recovery of TOFR to 25 % for rocuronium, and the duration of peak effect and times for recovery of T1 to 25 % and TOFR to 25% for cisatracurium were significantly prolonged in female sevoflurane group, the onset time of rocuronium was significantly shortened, while the duration of peak effect and times for recovery of T1 to 25% and TOFR to 25% for rocuronium and cisatracurium were significantly prolonged in male sevoflurane group ( P ＜ 0.05 or 0.01 ). The times for recovery of T1 to 25% and TOFR to 25% for rocuronium and onset time of cisatracurium were significantly shorter in female than in male during sevoflurane anesthesia (P ＜ 0. 05 or 0.01 ). Conclusion The enhancement of rocuronium-induced neuromuscular block by sevoflurane is stronger in male than in female,but there is no gender variation in the enhancement of cisatracurium-induced neuromuscular block by sevoflurane.

Objective To investigate the clinical effects of continuous 3-in-1 femoral nerve block with stimulating catheters for patient controlled regional anesthesia(PCRA) in elderly patients after unilateral total knee replacement (TKR)surgery.Methods Thirty ASA Ⅰ - Ⅱ elderly patients wererandomly divided into two groups: FB group and Ⅳ group.FB group received continuous 3-in-1 femoral nerve block for postoperative analgesia with 0.2% ropivacaine plus 0.1 μg/ml sufentanil continuous infusion at 5 ml/h plus PCA boluses (1.0 ml/15 min).Ⅳ group received continuous intravenous analgesia with 1 μg/ml sufentanil plus 0.04 mg/ml tropisetron hydrochloride at 2 ml/h plus PCA boluses (0.5 ml/15 min).All patients were maintained analgesia for 48 hours.Results In FB group, the visual analogue scale(VAS) scores were 1.3 ±1.1, 1.2 ± 1.0, 1.1±0.9, 1.1 ± 1.0,1.0±0.9 at 4, 8, 12, 24, 48 hours after surgery under rest status respectively and were 3.04±1.4,2.3±1.3 at 24, 48 hours after surgery in active function training.These parameters in Ⅳ group were 4.0±1.6, 3.5±1.6, 3.2±1.4, 3.0±1.3, 2.5±1.2, 4.7±1.5 and 3.3±1.5 respectively, which were significantly different compared with FB group (t=5.358, 4.707, 4.852, 3.784, 3.743, 3.254,1.932,all P<0.05 or P<0.01).The incidence of nausea was higher in IV group than in FB group(P = 0.0022).Postoperative satisfaction ratings was higher (χ2 =41.1 ,P<0.01) and the total morphine use for 48 hours after operation was less(uc=2.412, P<0.01) in FB group than in Ⅳ group.Conclusions After TKR surgery, the continuous 3-in-1 femoral nerve block with stimulating catheters is an effective method with better pain relief,fewer side effects and higher satisfaction ratings in the elderly.

Objeetive To detect ERG11 gene mutations in clinical isolares of Candida albicans resistant to fluconazole.and discuss their relationship with formation of drug resistance.Methods Clinical specimens were collected.CHROMagar mediuln and amplification of the fragment spanning the conserved sequence of 25S rDNA including some transposable introns.were used to identify subtype Candida albicans isolates.FIuconazole sensitivity was detected in vitro through microdilution and Rosco tablets.The other three fragment of ERG11 gene were amplified and followed by sequencing with resistant type strain ATCC 76615-19 and Candida albicans Darlington strain with two sensitive isolates as controh.Results Fifteen resistant isolates of Candida albicans were found,all of which were type A.Sixteen silent mutations and 11 missense mutations were detected.Mutations in ATCC 76615-19 and Darlington strain were same with what had been reported.In the 2 sensitive strains.G640A(E165K),A945C(E266D)and G1609A/G(V488I)occurred,as well as the other 9 silent mutations.Only G487T(A114S)and T916C(Y257H)existed in each of 14 resistant isolates.In the other one resistant isolate,T541C(Y132H),T495A(D116E),A530C (K128T)and T1493A(F449Y)occurred Mong with 8 silent mutations.Conclusions The occurrence of G487T(A114S)and 1916C(Y257H)in 14 isolates from different sources suggested they may involve in fluconazole resistance.The novel mutation T1493A(F449Y)can appear in resistant isolves of Candida albicans.

Objective To evaluate the accuracy of bispectral index (BIS) in predicting outcomes in patients with cerebral hemorrhage.Methods A total of 103 patients of either sex with acute cerebral hemorrhage,aged 18-77 yr,with body mass index of 17-29 kg/m2,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing craniotomy for evacuation of hematoma,were enrolled in this prospective study.BIS electrodes were adhered to the forehead of patients,and the BIS value was continuously recorded for 20 min.The maximum BIS value (BISmax) and minimum BIS value (BISmin) were recorded,and the mean BIS value (BISmean) was calculated.The patients were divided into 2 groups according to Glasgow Outcome Scale (GOS) scores assessed at 6 months after surgery:good outcome group (GOS score≥ 3) and poor outcome group (GOS score 1 or 2).The receiver operating characteristic curve of BIS in predicting outcomes was plotted,and the area under the curve (AUC) and 95％ confidential interval (CI) were calculated.The best cut point and sensitivity and specificity were calculated according to the BIS value when Youden index reached the maximal value.Results The AUC (95％ CI) for BISmax in predicting outcomes was 0.903 (0.830-0.976),the best cut point 79,the sensitivity 84％,the specificity 86％,and Youden index 0.695.The AUC (95％ CI) tor BISmin in predicting outcomes was 0.841 (0.760-0.921),the best cut point 43,the sensitivity 86％,the specificity 71％,and Youden index 0.577.The AUC (95％ CI) for BISmean in predicting outcomes w() 0.883 (0.800-0.958),the best cut point 60,the sensitivity 90％,the specificity 76％,and Youden index 0 562.Conclusion BIS can accurately predict outcomes in patients with acute cerebral hemoorrhage,and BISmax provides the highest accuracy.