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 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 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 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.

From August 2006 to June 2011 among consecutive 18 294 patients underwent thoracic surgery from Shanghai Chest Hospital,41 developed adverse events during peri-anesthesia period and the incidence was 0.224％,and the constituent ratios of the predictable and unpredictable events were 15％ and 85％,respectively.Cardiac arrest and massive hemorrhage were the main clinical manifestation of the adverse events and the constituent ratios were 37％ and 24％,respectively.Among the inducements for adverse events,patient's factor,surgical factor,anesthesia factor,patient-surgery factor,patient-anesthesia factor and patient-surgery-anesthesia factor accounted for 12.2％,48.8％,12.2％,7.3％,7.3％ and 12.2％,respectively.The ratio of death from adverse events was 17％ (7 cases),and among the inducements for adverse events causing death,surgical factor,patient-surgery factor and patient-surgery-anesthesia factor accounted for 43％,43％ and 14％,respectively.The incidence of adverse events was 1.093％ in the patients underwent operation on trachea,which was significantly higher than that in the patients underwent operation on lung (0.223％),mediastinum (0.236％) and esophagus (0.194％).In conclusion,although the adverse events which occurred during peri-anesthesia period in the patients underwent thoracic surgery were rare,they threatened the safety of patients.Surgical factor was not only the main inducement,but also the risk factor for death,and cardiac arrest and massive hemorrhage were the main clinical manifestation of the surgery-related adverse events.For cardiac arrest,as long as it was found in time and treated appropriately,the serious consequences could be avoided.For massive hemorrhage,more attention should be paid due to be the main reason of death,and the prevention depended on the surgeon's improvement of diagnosis and surgery.It was difficult to predict patient-related the adverse events and careful monitoring was required.For the anesthesia-related adverse events,they were mostly due to the poor airway management,so preoperative airway assessment should be strengthened.

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.

Objective To discuss the application and effect evaluation of the standard operation procedure ( SOP ) teaching method during applying surgical practice teaching in local medical college . Method 123 undergraduate students from Grade 2011 clinical medical major in Medical College of Shaoguan University were selected as objects of study. The students were divided into test (odd) group and control (even) group by draw. The two groups were taught by the same teachers, while the SOP method was applied to the test group (n=62) and the traditional surgical clinical teaching method was applied to the control group (n=61). Meanwhile, we used a combined method of the formative assessment and final assess-ment to compare and analyze the teaching feedback. After their graduate internship, we compared their autonomous study capability, clinical evaluation thought, normativity of the operation and capability in their intern positions as well as the degree of satisfaction of the test of two groups by doing a survey among them. All these were analyzed by SPSS 18.0 software, and t test was used to compare two groups' measurement in-formation and count data with chi-square. Results The comprehensive evaluation scores of the test group were significantly higher than the control group, in which the margin was of statistical value [(79.394 ± 8.049) vs. (71.703±10.462), t=39.632, P=0.000]. The percentage of excellence of the test group was signif-icantly higher than the control group, in which the margin was of statistical value (59.68% vs. 39.35%, χ2=5.082, P=0.024). The percentage of failure of the test group was lower than the group taught by the tradi-tional method, in which the margin was of statistical value (3.22%vs. 16.39%, χ2=4.652, P=0.031). Its for-mative assessment result on the evaluation of the experimental teaching process and summative assessment scores were higher than the control group, and the difference was statistically significant [formative scores points: (46.018 ±5.749) vs. (42.771 ±6.459), t=19.445, P=0.000; summative scores: (33.659 ±3.437) vs. (29.063±4.366), t=36.249, P=0.000]. As far as their clinical graduate internship adaptation capabilities were concerned, students from the test group had more satisfaction on the teaching feedback over 4 perspectives than the other group, in which the margin was of statistical value. Experimental groups' satisfaction showed that: 93.55% of students thought the standard operation procedure (SOP) teaching method was beneficial to improving their clinical practice skills, 91.94%thought that it improved their surgical clinical work ability to adapt, 85.48% thought it helped to cultivate their surgical clinical thinking and innovation ability. Conclusions The SOP teaching method in surgical practice teaching helps to enhance students' clinical operation and adaptation capability and promote the teaching quality.