Objective To investigate the effect of L-N6-(1-iminoethyl) Lysine(L-NIL) on ischemia-reperfusion (I/R) -induced lung injury in a rat model of lung transplantation. Methods Pathogen free male SD rats weighing 250-350g were used as donor and recipient rats in this study. The animals were randomly divided into 3groups (n = 6 each): sham operation group (group S); lung tratsplantation group (group L) and lung transplantation + L-NIL (selective iNOS inhibitor) group (group L-NIL). In group L and L-NIL orthotopic left lung allograft transplantation was performed. In group L-NIL 3 mg/kg was injected iv at the beginning of reperfusion. The donor lungs were removed from live donor rats and placed in Euro-collins solution at 4 ℃. The lung transplantation was performed under microscope and non-suture cuff technique was used. The implanted donor lungs were ventilated and reperfused. 0.5% Evans blue 0.2 ml was injected iv during reperfusion. The donor lungs were removed after being implanted, ventilated and reperfused for 2 h for microscopic examination and determination of iNOS, endothelial NOS (eNOS) and myeloperoxidase (MPO) activity and malondialdehyde (MDA) and Evans blue content in the lung tissue and W/D lung weight ratio. Results Lung transplantation significantly inceased W/D ratio, iNOS and MPO activity, and Evans blue and MDA content in the lung tissue and decreased eNOS activity in group L as compared with group S. L-NIL iv significantly attenuated the increase in the variables mentioned above and ameliorated capillary congestion and inflammatory cell infiltration in the lung. Conclusion Intravenous L-NIL administered at the beginning of reperfusion can reduce I/R injury to the transplanted donor lungs.

Objective To explore the method of anesthesia and intra-operative management for robotic thoracic surgery. Methods Twelve patients who underwent robotic thoracic surgery using the Da Vinci surgical system were anesthetized with general anesthesia combined with T4-8 paravertebral block. After induction of anesthesia, a double-lumen endotracheal tube was positioned by bronchofibroscope to allow onelung ventilation during intra-operative procedure. Hemodynamics and respiratory function were routinely monitored and arterial blood gas (ABG) were tested during operation. Results All patients could tolerate the anesthesia for robotic thoracic surgery and there was no hospital mortality. The arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after induction were (35.2 ± 3.6) mm Hg( 1 mm Hg =0.133 kPa) and (213.3 ± 57.5) mm Hg respectively; PaCO2 and PaO2 30 min after one -lung ventilation were (37.9 ± 4.8) mm Hg and ( 125.3 ± 36.5) mm Hg respectively. When the one-lung ventilation started about 58% (7/12) of the patient developed temporarily low SpO2 (over 0.90) and recovered to 0.95 soon when using 3 - 5 cm H2O( 1 cm H2O = 0.098 kPa) positive end expiratory pressure (PEEP). The anesthesia time was ( 291.5 ± 99.4) min, the time for one-lung ventilation was (206.3 ± 93.4) min, the volume of blood loses in operation was ( 171.7 ± 110.3 ) ml and the tracheal catheter extration time was ( 16.3 ± 4.5 ) min, all the patients left ICU on the second day after surgery. Conclusions The anesthesia for robotic thoracic surgery with Da Vinci surgical system is multiplicity, the hemodynamics and respiratory function can be instable, it is a new challenge for the technology and management of anesthesia. Good one-lung ventilation is important for this surgery, ventilation parameter need to be adjusted when hypoxia occurred and PEEP could be used to the ventilated lung. General anesthesia combined with paravertebral block will be a good option for postoperative pain control and minimal hemodynamics disturb ance.

0.05), whereas the value of new bone grafted with pDBM was significantly lower than that of the normal group (P0.05); but the CUS of the pDBM grafted group was significantly lower than that of normal radius (P0.05). Histological analysis exhibited that most of the DBM was absorbed and substituted by matured new cortical bone in the treated defects of both groups 6 weeks postoperatively, whereas in the untreated group, the defects were only filled with fibrous connective tissue in their mid-portion. Conclusion The sDBM and pDBM are both effective in repairing segmental bone defects. The properties of new bone induced by grafts with sDBM are superior to that of pDBM in biomechanics. These materials can be used in clinical practice as bone graft extenders or enhancers.

Objective To evaluate the effect of 6% hydroxyethyl starch (HES) 200/0.5 on the pulmonary capillary permeability in oleic acid induced acute lung injury (ALI) and investigate the possible mechanism of the therapeutic effect of HES. Methods Forty male SD rats weighing 280-370 g were randomly divided into four groups: group I balanced solution (control); group II 6% HES 200/0.5; group III gelatin and group IV dextran 40. The animals were anesthetized with intraperitoneal 3% pentobarbital 30-40 mg?kg-1 . Right external jugular vein was cannulated. Oleic acid 0.06 ml?kg-1 was given iv.10 ml?kg-1 of the above-mentioned different solutions was infused over 1.5 h in the four groups. Then 0.5% Evan's blue 1ml was injected iv. Four hours later the animals were sacrificed and lungs removed for pathologic examination under microscope, and determination of lung water content [ (wet weight -dry weight)/wet weight ? 100% ] . Lung Evan's blue content was determined by formamide extracting method. Lung MDA content and MPO activity were also determined.Results Lung water and Evan's blue contents were significantly lower in group II than those in any other groups. MPO activity and MDA level in group II were lowest among the four groups. Conclusions HES can decrease pulmonary capillary permeability, attentuate pulmonary edema and lung injury, and depress MPO activity and MDA level. The underlying mechanism may be due to its depressant effect on PMN aggregation and lipid peroxidation.

Objective To evaluate the effects of different doses of compound Xuelian capsule on bone cancer pain (BCP) in rats.Methods Fifty pathogen-free adult female Sprague-Dawley rats,weighing 200-220 g,aged 7-8 weeks,were randomly divided into 5 groups (n =10 each) using a random number table:sham operation group (group S),group BCP,and compound Xuelian capsule 50,100 and 200 mg · kg-1 · d-1 groups (group CX50,group CX100 and group CX200).BCP was produced by injecting Walker256 mammary gland carcinoma cells into the intramedullary space of the right femur bone.At 11-21 days after inoculation of the tumor ceils,normal saline containing compound Xuelian capsule 50,100 and 200 mg · kg 1 · d 1 was injected through a tube into stomach once a day in CX50,CX100 and CX200 groups,respectively.The mechanical paw withdrawal threshold (MWT) and limb use score were measured at 1 day before inoculation of the tumor cells (baseline) and 4,7,11,14,17,19,and 21 days after inoculation of the tumor cells.Results Compared with group S,the MWT at 4-21 days after inoculation of the tumor cells was significantly decreased,and limb use score was significantly decreased at 11-21 days after inoculation of the tumor cells in BCP,CX50,CX100 and CX200 groups (P＜0.05).Compared with group BCP,the MWT was significantly increased at 19-21 days after inoculation in group CX50,at 17-21 days after inoculation in group CX100 and at 14-21 days after inoculation in group CX200,and limb use score was significantly increased at 14-21 days after inoculation in group CX100 and at 17-21 days after inoculation in group CX200 (P＜0.05).Conclusion Compound Xuelian capsule 50,100 and 200 mg· kg 1 · d 1 (for 11 consecutive days) can reduce BCP in a dose-dependent manner in rats.

Objective To evaluate the effects of exogenous hydrogen sulfide (H2S) on nitric oxide (NO) and nitric oxide synthase (NOS) during lung ischemia-reperfusion in a rat model of lung transplantation.Methods Forty pathogen-free male Sprague-Dawley rats,weighing 250-350 g,aged 2-3 months,were used as donor and recipient rats in this study.The animals were randomly divided into 4 groups (n =10 each):sham operation group (group S); lung transplantation group (group L); lung transplantation + H2S synthesis-CSE inhibitor D,L-propargylgylcine (PPG) group (group PPG); lung transplantation + exogenous H2S donor NaHS group (group NaHS).The donor lungs were removed from live donor rats and placed in low potassium dextran solution at 4 ℃.Orthotopic left lung transplantation was performed using modified three-cuff technique and the time for cold ischemia was 50-70 min.In PPG and NaHS groups,PPG 37.5 mg/kg and NaHS 14 μmol/kg were injected intraperitoneally at 5 min before opening of the hilum of the transplanted lung.The implanted donor lungs were ventilated and reperfused.The donor lungs were removed after being implanted,ventilated and reperfused for 2 h for microscopic examination and for determination of wet to dry lung weight (W/D) ratio and the levels of malondialdehyde (MDA),myeloperoxidase (MPO),inducible NOS (iNOS),endothelial NOS (eNOS),and NO.Results Compared with group S,W/D ratio and the levels of MDA,iNOS,NO and MPO were significantly increased,and the content of eNOS was decreased in group L,and no significant change was found in the parameters mentioned above in group NaHS.Compared with group L,W/D ratio and the levels of MDA,iNOS,NO and MPO were significantly increased,and the content of eNOS was decreased in group PPG,and W/D ratio and the levels of MDA,iNOS,NO and MPO were decreased,and the content of eNOS was increased in group NaHS.The pathological changes of lungs were significantly attenuated in group NaHS as compared with group L.Conclusion Exogenous H2S can attenuate the lung ischemia-reperfusion injury in a rat model of lung transplantation,and decreased iNOS activity and increased eNOS activity are involved in the mechanism.

Research-oriented study is a comprehensive learning method focusing on the experimental process deriving from a main issue.Given our clinical teaching experience in years,we incorporated the research-oriented studies into the undergraduate Clinical Medicine course for grade 2009,integrating the trait of the clinical skills education and our local professional training objectives.In the studies,students selected their own topic,designed and did their experiments,searched for the information,processed and analyzed the experiment result and finally completed the thesis.Practice showed that after the strict implementation of research learning plan,students' learning interest,innovative thinking,practical skills,research ability and cooperation spirit all significantly enhanced.

Objective To evaluate the ventilation modes and factors influencing the tidal volume(VT)in the nonventilated lung during one-lung ventilation(OLV)in patients undergoing thorascopic surgery using electrical impedance tomography.Methods Thirteen American Society of Anesthesiologists physical statusⅠ or Ⅱ patients of both sexes,aged 45-64 yr,weighing 45-80 kg,undergoing elective pulmonary surgery performed via video-assisted thoracoscope,were enrolled in the study.After anesthesia induction,a double lumen tube was placed,and correct tube placement was confirmed with a fiberoptic bronchoscope.Two-lung ventilation and OLV were performed sequentially when in supine position with a fixed VT of 8 ml/kg and respiratory rate(RR)of 12 breaths/min.When the patients were turned to lateral position(with the operated lung on the upper side),correct placement of the tube was reconfirmed with a fiberoptic bronchoscope.Bilateral lungs were ventilated with VT of 8 ml/kg and RR of 12 breaths/min,and unilateral lungs were then ventilated in the following modes in sequence:VT 8 ml/kg and RR 12 breaths/min for the lung on the upper side;VT 8 ml/kg and RR 12 breaths/min for the lung on the lower side;VT 8 ml/kg,RR 12 breaths/min and positive end-expiratory pressure(PEEP)4 cmH2O for the lung on the lower side;VT 6 ml/kg and RR 16 breaths/min for the lung on the lower side;VT 4 ml/kg and RR 24 breaths/min for the lung on the lower side.Each ventilation mode stabilized for 2 min.At 2 min of OLV in each mode,electrical impedance tomography was used to record the ventilation mode in the nonventilated lung,anesthesia machine was used to record VT in the nonventilated lung,and the percentage of VT on nonventilated side in VT on ventilated side(VT-non/VT-ven%)was calculated.When the unilateral lung on the lower side was ventilated in lateral position,logistic regression analysis was used to analyze the correlation between VT on ventilated side(no PEEP)and that on nonventilated side.Results Opposite ventilation was found in the nonventilated lung during OLV.VT-non/VT-ven% was significantly higher in lateral position than in supine position(P<0.05).VT-non/VT-ven% was significantly higher when the lung on the lower side was ventilated than that when the lung on the upper side was ventilated(P<0.05).Four cmH2O PEEP exerted no effect on VT-non/VT-ven%.When the lung on the lower side was ventilated in lateral position,there was a linear positive correlation between VT on ventilated side(no PEEP)and that on nonventilated side(r=0.899,P<0.05).Conclusion During OLV in patients undergoing thorascopic surgery,there is opposite ventilation in the nonventilated lung,and VT is influenced by body positions and VT in contralateral lungs.

Objective To establish a rat model of bone cancer pain by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Methods Sixty female Wistar rots weighing 180-200 g were randomly divided into 4 groups (a=15each):groupⅠ normal control; group Ⅱsham operation; group Ⅲtumor cell inoculation + normal saline (NS) and group Ⅳtumor cell inoculation + flurbiprofen. NS 0.2 nd and flurbiprofen 10 mg/kg in 0.2 ml were injected IV at 2 h before determination of pain threshold on 14 and 17 d after inoculation oftumor cells in groupⅢand Ⅳ respectively. On day 0, 4, 7, 10, 14, 17 and 21 after inoculation pain threshold was measured after determination of body weight. X-ray examination of the tibia was performed on day 14 after inoculation. The animals were killed on day 21 after inoculation for microscopic examination of the inoculated tibia. Results The animals started losing weight and the threshold to yon Frey hair stimulation was decreased from dhy 10 after inoculation in group Ⅲand Ⅳ. X-ray examination showed destruction of bone and microscopic examination showed tumor growing in tibia. Flurbiprofen significantly decreased mechanical hyperalgesia in group Ⅳ. There was no significant difference in paw withdrawal latoney to radiant heat among the 4 groups. Conclusion A model of bone cancer pain can be made by inoculation of Walker 256 mammary gland carcinoma cells into tibia characterized by mechanical hyperalgesia.

The strategy of optimizing anesthetic management was carried out in all the patients un?dergoing thoracic surgery in our hospital from January 1, 2012: the patients were monitored using routine electrocardiogram combined with invasive arterial blood pressure monitoring, double?lumen central venous catheter pathway was established, and when severe bradycardia ( heart rate<40 beats∕min) occurred, inter?vention was carried out immediately, and chest compression was performed timely. Medical records of 15 212 patients from July 1, 2006 to December 31, 2011 ( before optimizing anesthetic management) as well as medical records of 17 078 patients from January 1, 2012 to January 15, 2015 ( after optimizing an?esthetic management) were reviewed. The data including baseline patient characteristics as well as the time period and causes of cardiac arrest, rescue time, rescue measures, successful resuscitation and prognosis in the patients developing intraoperative cardiac arrest were collected. Before optimizing anesthetic manage?ment, 28 patients developed cardiac arrest, the incidence was 0?184%, successful resuscitation was found in 25 cases, the success rate of resuscitation was 89%, and there were 3 cases in whom resuscitation failed due to massive hemorrhage?induced cardiac arrest. After optimizing anesthetic management, 17 patients de?veloped cardiac arrest, the incidence was 0?109%, massive hemorrhage?induced cardiac arrest was not found in patients, and the success rate of resuscitation was 100%. Prognosis was good after surgery in suc?cessfully resuscitated patients. Compared with the values before optimizing anesthetic management, the in?cidence of cardiac arrest was significantly decreased (P=0?05), and no significant change was found in the other parameters after optimizing anesthetic management ( P>0?05) , and the incidence of cardiac arrest was decreased by 45% after optimizing anesthetic management. In conclusion, the strategy of optimizing anesthetic management is helpful in decreasing the occurrence of cardiac arrest during thoracic surgery.