Fast-track surgery is the basis for the use of new medical evidence to optimize the management of perioperative patients.The surgeon forms a set of perioperative treatments by integrating and applying these new evidences to reduce the physical and psychological stress response of patients,and to speed up the rehabilitation of patients.Fast-track Surgery has been used in the treatment of a variety of diseases,including cardiac surgery,total knee replacement,and colorectal surgery.Gastric cancer was the fourth in the most common cancer sorts and the second in death rate in the world.Surgery is a milestone in the treatment of gastric cancer,and is the only effective means to cure.Fast-track surgeryy in the treatment of gastric cancer is still constantly improving.This article reviews the application of fast-track surgery in gastric cancer surgery.

Objective:To discuss the active impact of the domestic breast X-ray machine upgrade at the diagnosis breast disease. Methods:After the transformation of domestic breast X-ray machine, adoption the IP board instead of the film cartridge, complete digital mammography system. Results:Computed X-ray imaging processing image quality is better than traditional X-ray photography piece, within two years, completed a total check of more than 400 patients, overall diagnosis rate more than 95%. Conclusion:Buy the CR system All levels of the hospital, Can take advantage of the existing the ordinary breast X-ray machine equipment, Carry out breast Digital Imaging System.

1 303 syphilis patients had seen their doctors at the STD clinic of our hospital in 2012 . All first-visit syphilis patients were screened for HIV. The HIV-infected individuals were tested for syphilis. 8 cases were con-firmed to be HIV-infected individual, which constituted 0. 6% of syphilis cases. 4 cases were male and 4 cases were female among 8 cases. There were 4 cases of secondary syphilis and 4 cases of latent syphilis. Patients with syphilis and HIV infections accounted for 44% of all the HIV-infected individuals during the year.

This study was aimed to analyze characteristics of Chinese Materia Medica ( CMM ) preparations in order to identify the long-term development direction of this discipline and suggest key questions and strategies to solve the problems. According to the development track of CMM preparation, traditional Chinese medicine (TCM) basic theories and modern new drug research techniques were combined with the author's experiences on modernization study of TCM. This article discussed key issues of CMM preparation development direction, characteristics and is-sues need to be solved and their countermeasures. The results showed that the development direction for CMM preparation discipline should entirety unify CMM preparation system. The medical resource should be convenient which include animal, plant and mineral products. The single determinacy (effectiveness, stability and controlled) and compatibility (prediction, optimization and lowest toxin) will be applied in the guidance of CMM preparation system. In order to achieve goals mentioned above, key issues need to be solved are efficiency categories for in-gredients, genetical stabilities and one sampling charge, emigration rules of properties among ingredients, the ki-netic and stable rules of ingredient extraction, controlled rules for integral models or for disorder and torrent, e-valuation rules in vivo and in vitro, microscopic and macroscopic qualities, determinacy for single administration and compatibility for combination applications. It was concluded that the CMM preparation is a series of integral unified effective ingredient preparations that behave the determinacy for single administration and compatibility for combination applications.

The PIK3CA gene codes p100α,the catalytic subunit of phosphatidylinositol 3-kinase (PI3K) and is involved in the initiating the PI3K/AKT pathway.PIK3CA plays its biological roles through.downstream PI3K pathway. PIK3CA gene mutants can be detected in many kinds of tumors. The mutant PIK3CA gene can abnormally activate PI3K pathway,leading to the abnormal cell cycle,decreased cell adhesion,down regulated apoptosis and neovascularization,and then promotes tumor genesis and development.Recent researches have found that mutant PIK3CA gene is closely correlated with the genesis,development,differentiation,metastasis and drug resistance of colorectal cancer.Research of PIK3CA in colorectal cancer may provide significant evidence for the early diagnosis,gene screen,therapeutic regimen making,recurrence and follow up.

Objective To establish an HPLC method for simultaneous contents determination of paeoniflorin, protocatechuic acid and chlorogenic acid in Penyanjing Capsule. Methods The chromatographic separation was performed on a SHIMADZU VP-ODS-C18 column (4.6 mm × 250 mm, 5 μm); the column temperature was maintained at 30 ℃; A gradient elution of acetonitrile-0.15% phosphoric acid aqueous solution was adopted at the flow rate of 1.0 mL/min; The UV detection wavelengths were at 231, 255, and 326 nm; The injection volume was 20 μL. Results Paeoniflorin, protocatechuic acid and chlorogenic acid could be separated efficiently with this condition. The regression equation was Y=1546.4128X+127.0756 (r=0.9999), Y=2925.8468X+2204.1076 (r=0.9998), Y=893.9045X-261.7315 (r=0.9994), respectively. Paeoniflorin, protocatechuic acid and chlorogenic acid were linear in the range of 150.054–1254.50 ng, 162.33–1352.75 ng, 11.43–95.25 ng, and the average recoveries were 97.60%, 102.09% and 98.52%. Conclusion The method is simple, convenient and accurate, which can be used to the quality control of Penyanjing Capsule.

Aim To investigate the enhancing effect of L-carnitine as a sensitizer on tumor necrosis factor-re-lated apoptosis inducing ligand ( TRAIL)-induced ap-optosis in glioma cells. Methods Glioma cell U87 was used as model cell line. Cell viability was determined by CCK-8 , and apoptosis was assessed by Annexin V-FITC/PI staining, caspase-3 activity and expres-sion. The expression and transcription of nuclear factor kappa B ( NF-κB ) and FLICE inhibiting protein ( c-FLIP) were measured by RT-PCR and Western blot. In addition, NF-κB was knockdown to analyze its regu-lating effect on c-FLIP expression. Results The com-bination treatment with TRAIL and L-carnitine signifi-cantly inhibited cell proliferation and induced apopto-sis. Compared with control, combinational treatment significantly suppressed the transcription and expres-sion of c-FLIP as well as translocation of NF-κB. Through silencing NF-κB, NF-κB was found to act as upstream signaling to regulate c-FLIP. Conclusion L-carnitine sensitizes TRAIL-induced tumor cell apoptosis via suppression of NF-κB-dependent c-FLIP expres-sion.

ObjectiveTo study the pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries with or without CPB.MethodsSixteen ASA Ⅱ or Ⅲ patients aged 56-64 yr weighing 52-78 kg undergoing cardiac surgery were divided into 2 groups ( n ＝ 8 each):group Ⅰ off-pump coronary artery bypass grafting and group Ⅱ valve replacement.Radial artery and peripheral vein were cannnlated.A bolus of sufentanil 5μg/kg was administered iv after induction of anesthesia.Blood samples were obtained from radial artery at 1,3,5,10,20,30,60,120,180,240,360 min after sufentanil injection.Plasma was immediately separated and stored at - 80 C for determination of plasma sufentanil concentration by liquid c hromatography-mass spectrometry.Pharmacokinetic parameters were calculated by 3P97 pharmacological program.ResultsThe pharmacokinetic profile of sufentanil was best described by a three-compartment open model.The 3 exponential equations in group Ⅰ,before and during CPB in group Ⅱ were:Cp(t) ＝ 11.7 e-0.47t + 1.9 e0.043t + 0.27 e-0.0032t ; Cp(t) ＝ 33.4 e-1.87t + 7.1e-0.103t +2.0 e-0.0248t and Cp(t) ＝ 23.8 e-0.54t + 5.2 e0.054t + 0.15 e-0.0017t respectively.There was significant difference in most of the pharmacokinetic parameters between the 2 groups.ConclusionsThe pharmacokinetics of sufentanil in patients undergoing different cardiac surgeries can be described by ~compartment open model.Low cardiac function and CPB can reduce its drug metabolism rate and prolong the duration of action.

Objective To assess the effect of different ages on sufentanil pharmacokinetics in patients undergoing cardiac valve replacement.Methods Sixteen NYHA Ⅱ or Ⅲ patients undergoing selective cardiac valve replacement were randomly divided into two groups:elderly group (aged 65-69 years,group Ⅰ,n =8) and young adult group (aged 36-45 years,group Ⅱ,n =8).Intravenous and intra-arterial cannulae were placed.Sufentanil 5 μg/kg injected intravenously during anesthesia induction.Blood samples from the radial artery were obtained at 1,3,5,10,20,30,60,120,180,240 and 360 min after sufentanil injection (3 ml each).Then 1 ml plasma was immediately separated from the 3 ml blood sample and stored at - 80 ℃ until being assayed.Plasma sufentanil concentration was determined with liquid chromatography mass spectrometry and pharmacokinetic parameters were calculated with 3P97 pharmacologicl program.Results Plasma sufentanil concentration versus the time decay curve in patients undergoing cardiac valve replacement before cardiopulmonary bypass (CPB) was fitted to a twocompartment model and could be expressed by bi-exponential equations:Cp (t) =27.4 e-0.41t + 3.2 e-0.029t in group Ⅰ and Cp (t) =14.4 e-0.51t +3.4 e-0.032t in group Ⅱ,respectively.There were significant differences in t 1/2 α,t1/2 β and CL between the two groups ( P ＜ 0.05 or 0.0l ).During CPB,plasma sufentanil concentration versus the time decay curve in patients undergoing cardiac valve replacement was fitted to a three-compartment model and could be expressed by tri-exponential equations:Cp(t) =22 e-0.51t + 3.5 e-0.045t + 0.21 e-0.0029 t in group Ⅰand Cp(t) =15 e-0.52t + 3.9 e-0.048t + 0.32 e-0.004t in group Ⅱ,respectively.There were no significant differences in pharmacokinetic parameters between the two groups ( P ＞ 0.05).Conclusion There are significant differences in sufentanil phannacokinetic characteristics before CPB but different ages have no obvious influence on sufentanil pharmaco-kinetics during CPB.

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy(SAE).Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome (SIRS)positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit (ICU).Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure (100%),in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases (33.3%),the cerebral ischemic lesions in four cases(66.7%).The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.