0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P

Objective To investigate pharmacokinetics of propofol administered by target-controlled infusion (TCI) in patients with liver failure. Methods Nine ASA Ⅳ patients with liver failure aged 32-53 years,weighing 60-81 kg,who would undergo liver transplantation,were enrolled in this study,and nine ASA Ⅰ-Ⅱ patients aged 22-59 years,weighing 46-70 kg,who would undergo selective upper abdominal surgery,were as control group. In the two groups,propofol was administered for 60 min by TCI via Graseby 3500 infusion pump incorporated with Stelpump software,while the target plasma propofol concentration was set at 2.5 ?g/ml. Arterial blood samples were taken immediately before and at 2,5,10,20,30,40,50,60,62.5,65,70,75,80,85,90 min after the start of propofol infusion,and the plasma concentrations of propofol were measured by using gas chromatography-mass spectrometry. The data obtained were analyzed by DAS pharmacokinetic software. Results The central volume of distribution (Vc),apparent volume of distribution (Vp) and total clearance (CL) were significantly larger in liver transplantation group than those in control group (P

Objective To evaluate the effect of propofol infusion on hepatic blood flow (HBF) and oxygen delivery and consumption in rabbit. Methods Thirty adult male rabbits weighing 1.6-2.4 kg were randomly allocated into 3 groups: group I high dose propofol (HP) ( n = 11); group II low dose propofol (LP) (n = 10) and group III control group (C) ( n = 9). The rabbits were anesthetized with intravenous 3 % pentobarbital 45 mg ?kg-1 and mechanically ventilated (VT = 10 ml?kg-1 RR = 40 bpm, I:E= 1:2) after tracheal intubation. ECG, urinary output and rectal temperature were continuously monitored. Portal vein and hepatic artery were dissected and exposed for measurement of blood flow using electromagnetic flowmeter. Catheters were inserted into carotid artery, portal vein and hepatic vein via the mesenteric vein and right femoral vein for collection of blood samples. After the circulation was stabilized for 30 min, propofol infusion was started at a rate of 1.2 mg ? kg-1 ? min-1 ( HP) or 0.4 mg?kg-1 ?min-1(LP). In control group normal saline was infused instead of propofol. Portal venous and hepatic arterial blood flow were continuously measured. Blood samples were obtained from carotid artery, portal vein and hepatic vein before ( baseline) and at 30, 50, 70 and 90 min of propofol infusion for determination of Hb, SO2, PO2 and PCO2. The hepatic O2 delivery (DO2 ) and consumption (VO2 ) were calculated. Results The three groups were comparable with respect to body weight, duration of operation, the volume of fluid infused and blood loss and urinary output. HBF was significantly higher at 30-90 min of propofol infusion in HP group than in C group, meanwhile DO2 and VO2 in HP group were significantly higher during propofol infusion than the baseline value before infusion and those in C group. However, there was no significant difference in DO2/VO2 ratio between HP and C group. Conclusion High dose propofol infusion improves liver blood flow and O2 delivery but it also increases hepatic O2 consumption. However the balance between hepatic O2 supply/demand remains unchanged.

Basic life support ( BLS ) is a very important clinical skill for medical students. However,current BLS education is lack of proper BLS skills evaluation protocol to give educational feedback both to instructors and students. This article is aimed to discuss the necessity of protocol of skills evaluation in basic life support education for medical students prior to their internship.

Objective To investigate the effect of formative assessment on skill acquisition of basic life support (BLS) among medical students. Methods Totally 206 undergraduates were ran-domized into control group (C group) and interventional group (F group). A BLS lecture was given in both groups. And then, 45 min BLS training and BLS skill assessment (after training) were given in C group. Undergraduates in F group received BLS skill assessment (formative assessment) before training, and 15 min feedback was delivered based on the assessment, then 30 min BLS training was conducted. Skills assessment was conducted again in F group after the training. Student's-t-test was used to compare the difference of skills between the two groups and P<0.05 signifies statistically sig-nificant differences. Results Score of F group (85.2±7.3) were higher than that in C group (68.2± 13.2), with statistical difference. Conclusion A formative assessment could significantly improve skill acquisition of BLS among medical students.

BACKGROUNDUp to now, locally advanced non-small cell lung cancer simutaneously involving carina, heart and great vessels is still regarded as contraindication for surgical treatment. However, the prognosis is very poor in these patients treated with chemotherapy and/or chemoradiotherapy. The aim of this study is to summarize the clinical experiences of carinoplasty combined with heart and great vessel plasty in the treatment of 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels or both in our hospital.

METHODSFrom March, 1988 to December, 2004, carinal resection and reconstruction combined with heart, great vessel plasty was performed in 84 patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously. The operative procedures in this series included as follows: (1) Right upper sleeve lobectomy combined with carinal resection and reconstruction, and right pulmonary artery sleeve angioplasty in 9 patients; (2) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium, and superior vena cava resection and Gortex grafts in 3 cases; (3) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 3 cases; (4) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery sleeve angioplasty and partial resection and reconstruction of left atrium in 10 cases; (5) Left upper sleeve lobectomy combined with carinoplasty and left pulmonary artery angioplasty in 9 cases; (6) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery sleeve angioplasty and resection of the aorta arch sheath in 6 cases; (7) Right upper-middle sleeve lobectomy combined with carinoplasty and right pulmonary artery sleeve angioplasty in 3 cases; (8) Left upper sleeve lobectomy combined with carinoplasty, left pulmonary artery angioplasty, resection of the aorta arch sheath and partial resection and reconstruction of left artium in 8 cases; (9) Right upper sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 4 cases; (10) Left sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 3 cases; (11) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and superior vena cava resection and reconstruction with Gortex grafts in 23 casese; (12) Right sleeve pneumonectomy combined with partial resection and reconstruction of left atrium in 1 case; (13) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and partial resection and reconstruction of left atrium in 1 case; (14) Right upper-middle sleeve lobectomy combined with carinoplasty, right pulmonary artery angioplasty and right inferior pulmonary vein sleeve resection and reconstruction in 1 case.

RESULTSThere were two operative death in this series. The operative mordality was 2.38%. A total of 32 patients had operative complications. The incidence of operative complications was 38.10%. The 1-, 3-, 5-and 10-year survival rate was 81.34%, 59.47%, 31.73% and 24.06% respectively.

CONCLUSIONS(1) It is feasible in technique that carinal resection and reconstruction combined with heart, great vessel plasty in the treatment of locally advanced non-small cell lung cancer involving carina, heart and great vessels simutaneously; (2) Multiple modality therapy based on carinal resection and reconstruction combined with heart and great vessel plasty can remarkably increase the survival rate, and improve the prognosis and quality of life in patients with locally advanced non-small cell lung cancer involving carina, heart and great vessels.