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.

With the transformation of medical model,technical improvement,and the development of various medical laws and regulations,requirement for medical ethics is being increased in clinical medical education gradually.Under this circumstance,medical simulation education come into being and evolves prosperously.However,present application of medical simulation education is imperfect and far from satisfaction in China.This article summarizes the relation of medical ethics and medical simulation education.

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 discuss the diagnosis and treatment of non-specific ureteritis. Methods Considered by the Court left pelvis area occupying one case, and there are special non-specific symptoms in patients with treatment ureteritis recalled while literature and discuss the effective non-specific ureteritis diagnosis and treatment. Results Surgery did not undergo resection of the left kidney ureter, only stripping, removal of parcels renal pelvis, ureter choco-late-like substance. Conclusion Patients with a lower back pain, clinical history of macroscopic haematuria, imag-ingstudies revealed hydronephrosis, renal pelvis and ureter wall thickening, irregular, or beaded change, ureteral peri-stalsis is poor, should be carefully and spontaneous perirenal hemorrhage, ureteral cancer identification, If by related tests, imaging examination and cytological examination failed to diagnose patients, feasible with bilateral renal pelvis ureter surgical exploration, avoid blindly kidney ureteral resection.