In anesthetic clinical teaching,Dalian Medical University Department of Anesthesiology pays more attention to humanity education and keeps improving teaching methods.It also adopts the methods of “the combination of the virtual and reality”,multiple apprentices,PBL and other ways to enhance students' operational skills development and promote their clinical thinking.

Objective To investigate the change of levels of related cytokines,including transforming growth factor-β2 (TGF-β2),basic fibroblast growth factor (bFGF),platelet-derived growth factor (PDGF),interleukin-6 (IL-6),interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) and behavior in streptozotocin-induced diabetic rats between the before and after fracture,at the same time,to analyse the relativity of them.Methods The rat models of diabetic were induced by intraperitoneal injection of streptozotocin,which were divided into different diabetes mellitus group (DM group) randomly.The right tibiofibula of all the rats of diabetes mellitus group and normal control group(NC group) were broken,and then treated with external fixation.The bone callus formation was evaluated by X-ray.When all the operation above was completed,the rats were domesticated in different cages.The concentration of related cytokines of the DM groups and NC group was detected at different time.Results The behavior changes of diabetes fracture rats were distinct and appeared a series symptoms such as bradykinesia,dull,polydipsia,polyphage,polyuria,emaciated obviously.The concentration of related cytokines (TGFβ2,BFGF,PDGF,IL-6,IL-8 and TNF-α) of the two groups was detected at 1,2 and 4 weeks.The difference between them was significantly(TNF-α:the concentration of NC group were (9.87 ± 1.06) ng/ml,(14.07 ± 1.43)ng/ml and(12.02 ± 1.02) ng/ml; the concentration of DM group were (11.65 ± 1.18) ng/ml,(16.29 ± 1.24)ng/ml and(13.87 ± 1.25)ng/ml ; P ＜ 0.05).X-ray films showed that the fracture healing of NC group was more superior than that of DM group.Conclusion The reduction of TGF-β2,BFGF,PDGF and the increase of IL-6,IL-8,TNF-α in early fracture are one of important reasons for delayed union and nonunion in diabetic rats.At the same time,there is a cooperative action between them.Dynamic observation of the concentration of related cytokines will provide eliable experimental data to estimate fracture healing,delayed union and nonunion.It is favourable to acquaint the regulatory mechanism of fracture healing at molecular level.

Objective:To investigate the clinic-cytology and histopathology of non-Hodgkin lymphoma (NHL) in breasts. Mothods:Twelve cases of NHL of the breast were studied by fine-needle aspiration biopsy (FNAC), histopathology and immunohistochemistry, and whose clinical data were analysed at the same time. Results:In 12 cases of NHL, 3 cases were T-cell NHL and 9 cases were B-cell NHL. Cytologically, the T-cell NHL cells were mostly arranging in diffuse patterns. The tumor cells were oval and pleomorphism. Some of them had distorted nucleus and thin nuclear envelope.The nucleus showed irregular course chromatin and visible nueleoic. Histopathologically, some of the tumor cells distributed around the blood vessels, and there was an obvious phenomenon of “blood-vessel-closing”. B-cell lymphoma cells were arranginy in diffuse pattern, and showed round and ellipse in shape with a clot and course granular chromatin and visible nueleoic and karyoknesis. Lymphoepithelia lesions were seen. Immunohistochemistry showed that CD3, CD43, and CD 45RO in T-cells NHL were positive.CD20, CD74 and CD79a in B-cells NHL were negative. CK, EMA, ER and PR in NHL were all negative. Conclusion:NHL of breast is extremely rare, and its definite diagnosis depends on various examination methods.

Objective: The Thinprep liquid-based cytology test(TCT) is a new technique applied to cytopathologic diagnosis in recent years.The purpose of this study was to analyze the diagnostic coincidence between lung puncture liquid-based cytology and histopathology.Methods: A total of 408 tissue specimens obtained by CT-guided percutaneous translung biopsy were observed under the optical microscope after fixation,embedding,sectioning and staining,and the cells in the washing fluid for puncture needles were detected by TCT.Then the diagnostic coincidence was analyzed between cytological and pathological biopsies.Results: Of the 408 cases detected by liquid-based cytology,148(36.3%) were diagnosed as cancer,32(7.8%) as suspected cancer,38(9.3%) as heterocyst and 190(44.9%) were negative,as compared with 183(44.9%),21(5.1%),22(5.2%) and 182(44.6%) by histopathology.The results showed a correlation between the two methods(P

Objective: To investigate the advantage of ThinPrep cytological test in tumor diagnosis by fine needle aspiration cytology. Methods: Using fine needle aspiration for smears,some of smears were made in conventional smears,the remains aspirating needles were washed with a transport washing solution.ThinPrep slides were made using the ThinPrep Processor. Results: In 84 cases FNA samples,49 cases were breast,29 cases were lymph node and 6 cases were others.Comparing with conventionally prepared specimens,ThinPrep processed samples showed the advantage in sensitivity or specificity.The lack of cellular debris,blood and exudates improve the ability to detect cellular abnormalities and speed up the time required for screening in ThinPrep processed samples.Rapid cell transfer from the sampling device to the transporing fluid containing the fixative ensure preservation of cell details with minimal artifactual changes. Conclusion: The use of Thinprep and by combination of FNAC and immunocytochemistry cytopathological diagnosis can be improved significantly.

Objective Cervical lymph node enlargement may be attributed to inflammation or tumors .This study was to analyze the pitfalls in fine-needle aspiration cytology ( FNAC) of cervical lymph nodes and the measures for avoiding misdiagnosis of cervical lymph node lesions . Methods We retrospectively analyzed the data about 435 cases of FNAC in comparison with the results of corre-sponding tissue biopsies in cervical lymph nodes . Results Among the 435 cases, 7 showed disagreement between the results of cytolog-ic and histologic diagnoses, which included 5 males and 2 females, at the age of 41 to 71 (58.4 ±8.9) years.Six of the cases presented with local lymph node enlargement and 1 with generalized lymphadenopathy, all with enlarged lymph nodes palpable 1-4 cm in diameter . Based on the results of FNAC, 1 case of malignant lymphoma was misdiagnosed as lowly differentiated adenocarcinoma, 1 case of lympho-ma misdiagnosed as poorly differentiated metastatic carcinoma, 2 cases of lymphoma diagnosed as lymphoproliferation and recommended for biopsy, 1 case suggestive of malignant tumor without further classification, and 2 cases microscopically characterized and recommended for lymph node biopsy.Compared with the results of the biopsy, FNAC achieved a 99.3%coincidence rate of qualitative diagnosis (432/425), with a misdiagnosis rate of 1.6%(7/435). Conclusion FNAC plays a very important role in the initial identification of the nature of lymph node lesions and the type of tumors.Practiced puncture skills and intimate knowledge about the histopathological features, diagnostic criteria, and differential diagnosis of the lymphatic system disorders are essential for improving the diagnostic accuracy of FNAC .