Peripheral nerve block technique is one of the basic skills necessary to residents and it is also one of the difficult points in the resident standardized training in the department of anesthesiology. In order to maximize the learning effect of the anesthesia professional residents in the case of limited number of cases, we need to constantly enrich the teaching technologies and teaching methods. Human 3D anatomy is used for theory teaching to maintain comprehension of nerve anatomy; Ultrasound-guided nerve block technique and ultrasound simulation training are used for nerve block practice to improve nerve block skills;Problem-based learning teaching method is introduced in nerve block cases to increase the residents' ability of clinical cases management.

Objective To explore the expression of recombinant adenovirus hypoxia-inducing factor-1? (HIF-1?) and its effects on the angiogenesis in a rat model of acute hindlimb ischemia. Methods (1) Recombinant adenovirus HIF-1?-Al?564 (Ad-H564 for short) was amplified in large scale in HEK293A cells and concentration gradient centrifuged in CsCl, purified by dialysis and then its titer was determined by spectrophotometry. (2) A model of acute ischemia in rats' hind limb was reproduced, and 72 rats were randomly allocated into Ad-LacZ group, Ad-H0 group, Ad-H564 group and control group (18 rats for each group). After the HIF-1? mRNA expression was detected, six rats of control group were intramuscularly injected with normal saline (NS group) to serve as control. Angiography and vascular cast were carried out in another two groups with in each six rats to serve as sham operated controls. In to hind limb skeletal muscles of rats of Ad-LacZ, Ad-H0 and Ad-H564 groups Ad-LacZ, Ad-H0 and Ad-H564 were respectively injected, normal saline was given to the rats of NS group, and nothing was given to the rats in sham group. (3) HIF-1? mRNA expression was determined by RT-PCR on the 1st, 3rd, 5th and 7th day after injection. (4) Selective arteriography and vascular cast were performed to evaluate the vascular density. Results (1) PCR and gene sequencing suggested that correct recombinant adenovirus HIF-1? was obtained after being amplified and purified, and the titer of adenovirus was 1011OPU/ml. (2) RT-PCR showed that the highest expression of HIF-1? mRNA (0.544 7?0.141 2) was seen in Ad-H564 group, and the value was significantly different compared with that of normal group and Ad-LacZ group (P=0.000), but it did not show significant difference compared with that of Ad-H564 group and Ad-H0 group (0.533 0?0.041 6, P=0.368). The expression of HIF-1? mRNA reached the highest value on the 7th day in all the groups. (3) Arteriography on the 28th day after injection showed that the density of the collateral vessels was higher in Ad-H564 group than that in Ad-H0 group, but no significant difference was found. Vascular casts showed denser microvasculature in Ad-H564 group than that in the other groups. Conclusions The present study suggests that single site mutation may enhance the expression of human HIF-1? gene in the local muscles, facilitate angiogenesis in the ischemic tissue, but no significant difference was found between the wild-type and the mutated HIF-1? genes.

Heparin-induced thrombocytopenia is a profoundly dangerous,potentially lethal,immunologically mediated adverse drug reaction to unfractionated heparin or low-molecular weight heparin.Clinical vigilance of this disease process is important to ensure its recognition,diagnosis,and treatment.Misdiagnosis of the syndrome,as well as misunderstanding of the disease process,continues to contribute to its morbidity and mortality.In this comprehensive review,the authors highlight heparin-induced thrombocytopenia's clinical presentation,diagnostic principles,and treatment.

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.

Objective This study assesses a feasible and safe volume threshold for chest tube removal following a VATS lobectomy.Methods The study included 168 consecutive patients who underwent VATS lobectomy or bilobectomy with two insicion between August 2012 and February 2014.Eligible patients were randomized into 3 groups:Group A (chest tube removal at the drainage volume of 150 ml/d or less.n =49) ; Group B (chest tube was removed when the drainage volume was less than 300 ml/d.n =50) ; Group C(chest tube removal when the drainage was less than 450 ml/d.n =51).And there were 18 patients who were excluded.All patients got the same postoperative care with a clinical pathway,and all patients were followedup 7 days after discharge from hospital.The time of extracting drainage tube,postoperative hospital stay,postoperative VAS values,dosage of analgesic,incidence of complications and thoracocentesis were measured.Results There were no statistically significant differences among 3 groups with general information and incidence of complication (P ＞ 0.05).And there were statistically significant differences between Group A and Group B with the time of extracting drainage tube,postoperative hospital stay,postoperative VAS values,dosage of analgesic(P ＜ 0.05).But there were no statistically significant differences between Group A and Group B with incidence of thoracocentesis(P ＞0.05).Analysis of data showed no statistically significant differences between Group B and Group C with postoperative hospital stay,postoperative VAS values and dosage of analgesic (P ＞ 0.05),but there were statistically significant differences for incidence of thoracocentesis (P ＜ 0.05).Conclusion A 300 ml/d volume threshold for chest tube removoal after VATS lobectomy is feasible and safe,and it can bring more advantages than the 150 ml/d volume threshold.On the other hand,a 450 ml/d volume threshold for chest tube removoal after VATS lobectomy may increase the risk of thoracocentesis.

AIM: To explore the pathogenic mechanism of high altitude pulmonary edema(HAPE). METHODS: Haemodynamic changes and effects of 100 percent oxygen breathing were measured by Swan-Ganz thermistor catheters, high altitude healthy volunteers were served as controls. RESULTS: The important features of haemodynamic changes in HAPE: (1)Pulmonary arterial pressure was raised; (2)Pulmonary arterial resistance and cardiac output were raised; (3)Pulmonary artery wedge pressures and right atrial pressure were normal; (4)Pulmonary arterial pressure and resistance were induced by oxygen breathing. CONCLUSIONS: The normal pulmonary artery wedge pressures with a high cardiac output indicated that HAPE was recognized as a form of noncardiogenic pulmonary edema. The pulmonary hypertension may play an important role in the development of HAPE.

Background Studies have shown that stress during pregnancy can affect the growth and development of fetuses and offspring, and this effect has sex differences, but the results are controversial, and there are few studies on the emotional damage of offspring of different sexes caused by stress during pregnancy. Objective This experiment is designed to observe the effect of chronic stress during pregnancy on emotional damage of offspring of different sexes. Methods Thirty-two SD female rats were randomly divided into a model group and a control group (16 rats in each group), 24 male rats were divided into a model mating group (n=16) and a control mating group (n=8). Each rat of the model group was reared in a single cage and received chronic unpredictable mild stress (CUMS) for 28 d, including hot water swimming for 5 min, cold water swimming for 5 min, tail pinching for 2 min, crowding for 24 h, moist bedding for 24 h, cage shaking for 30 min, and space restriction for 2 h. One stressor was administered daily and the same stressor did not repeat within 7 d. Blood was collected from the endocanthal vein of the two groups of female rats 1 d before and 1, 7, 14, 21, and 28 d after stress, the plasma was separated by centrifugation, and ¹³¹I radioimmunoassay was used to measure plasma corticosterone concentration. On postnatal day 21 (PND21), 16 offspring rats (half male and half male) were randomly selected from each group, their plasma corticosterone concentration was measured on PND28 and PND42, and their emotional damage was measured on PND42. Results The plasma corticosterone levels of dams in the model group on the 14th, 21th, and 28th days of stress [(394.02±97.40), (444.12±90.43), and (463.71±107.75) μg·L⁻¹] were higher than those in the control group [(285.63±81.64), (341.78±48.39), and (320.42±84.76) μg·L⁻¹] (all P< 0.05). On PND28 and PND42, the plasma corticosterone levels in the female model offspring group [(543.30±90.21) and (530.76±83.10) μg·L⁻¹] were higher than those in the female control offspring group [(397.77±64.27) and (325.78±61.03) μg·L⁻¹] (both P<0.05). In the sugar water preference test, the total fluid consumption [(10.74±1.28) mL], sugar water consumption [(5.50±1.30) mL], and 1% sucrose preference percentage [(20.36±3.41) %] in the female model offspring group were lower than those in the female control offspring group [(13.74±2.06) mL, (8.56±2.04) mL, and (62.11±8.05) %] (all P<0.05). In the open field test, the horizontal score, vertical score, and cleaning times of the male model offspring group were lower than those of the male control offspring group (all P<0.05). In the tail suspension test, the immobility time of the female and male model offspring groups [(126.95±39.88) and (70.24±28.98) s] was longer than the control offspring groups of the same sex [(54.30±24.99) and (38.63±18.91) s] (both P<0.05), and the duration of immobility time in the female model offspring group was longer (t=3.253, P=0.006). In the forced swimming test, the immobility time of the female model offspring group [(7.97±6.66) s] was longer than that of the female control offspring group [(1.85±2.12) s] (t=2.478, P=0.037). On PND42, the plasma corticosterone level of female offspring was negatively correlated with total fluid consumption, sugar water consumption, and 1% sucrose preference percentage (r=−0.621, r=−0.728, r=−0.699; P<0.05), and positively correlated with immobility time in the tail suspension test and immobility time in the forced swimming test (r=0.571, r=0.712; P<0.05), However, there was no correlation between plasma corticosterone and emotional indicators on PND42 in male offspring (P>0.05). Conclusion Chronic stress during pregnancy causes emotional damage to the offspring, and female offspring show depression-like behaviors.

Diabetes mellitus is a metabolic disease characterized by hyperglycemia. It is found that the incidence and mortality of abdominal aortic aneurysm (AAA) in diabetes mellitus patients are lower than that in non-diabetes mellitus patients. This review will present the protective role of diabetes mellitus and its treatment on the aortic disease process, aiming to provide more support for the clinical treatment of AAA.

Objective ToexplorethevalueofCTtargetreconstructionforpureground-glassnodules(pGGN)onidentifyingthe invasivenessofthelungadenocarcinoma.Methods ThepGGNs weredividedintopre-invasivegroup[atypicaladenomatoushyperplasia (AAH),andadenocarcinomainsitu(AIS)]andinvasivegroup[minimallyinvasiveadenocarcinoma(MIA),andinvasiveadenocarcinomas(IA)] accordingtothepathologicresults.ThemorphologicfeaturesofpGGNonCTincludedthelargestdiameters,CTvalue,pleuralindentation,air bronchogram,bubblelucency,vesselconvergence,vesseldilatation,lobulationandspeculation.Twodiagnosticiansevaluatedthemorphologic featuresofpGGNonCT.Binary L o g istic regressionwasusedtoassesstheassociationbetweenCTfindingsandhistopathological classification.ROCcurveanalysiswasusedindiameterandCTvalue.Results Betweenpre-invasiveandinvasivegroup,therewere significantdifferencesindiameter,CTvalue,spiculationandvesseldilatation(P<0.05).Nodifferencewasfoundinlobulated-margin,bubble lucency,airbronchogram,vascularconvergenceorpleuralindentationbetweenthetwogroups(P>0.05).Thediagnosticthresholds forpredictingpGGOinfiltrationwere8.75mminmaximumdiameterand-605HUinCTvaluerespectively.Conclusion ThepGGNwitha diametermorethan87.5mm,theCTvaluemorethan-605HU,andpresencesofspiculationandvesseldilatationsuggeststhatpGGOisinvasive.

Objective:To explore the effects of contingency theory-based health education in patients with diabetes mellitus.Methods:Totally 112 diabetic patients admitted into Affiliated Hospital of Shaoxing University from January 2017 to December 2018 were selected by convenient sampling and randomized divided into the control group and the intervention group, with 56 patients in each group. Patients in the control group received routine care, while patients in the observation group received contingency theory-based health education. The health knowledge level, self-care ability, self-efficacy and quality of life of the two groups before and after intervention were compared.Results:The health knowledge level of the intervention group after intervention was higher than that of the control group [ (17.15±2.28) vs. (13.20±2.94) ], and the difference was statistically significant ( P<0.01) . The scores of self-care ability, self-efficacy and quality of life of the intervention group were higher than those of the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The contingency theory-based health education can improve the disease knowledge, self-care ability, self-efficacy and quality of life of diabetic patients, which is worth promoting in clinical practice.