As a basic teaching method in the medical education system represented by British and USA, overseas elective posting for medical student is playing significant role in enriching medical students’ internship experience as well as improving their comprehensive knowledge and skills. Besides it’s also essential for cultivating modern and high-quality medical talents in line with international stan-dard. Therefore the purpose of the paper is to provide some references for carrying out international ex-change at students’ level smoothly in domestic medical universities and colleges by simply introducing some good experiences and measures from several typical foreign medical colleges.

Objective To investigate the effect of penehyclidine hydrochloride combined with low tidal volume ventilation on lung function in patients with lower abdominal operation.Methods Sixty elderly patients who underwent elective lower abdominal operation were divided into three groups by random digits table method:the conventional tidal volume group (group A),penehyclidine hydrochloride combined with conventional tidal volume group (group B) and penehyclidine hydrochloride combined with low tidal volume group (group C),20 cases in each group.The patients in group B and group C were given penehyclidine hydrochloride 0.01 mg/kg before induction of anesthesia.The patients in group A were given equal volume of saline.After induction of anesthesia and mechanical ventilation modes:the patients in group A and group B were given tidal volume 10 ml/kg,the patients in group C were given tidal volume 6 ml/kg.After mechanical ventilation in anesthetized (T1),1 h after anesthesia (T2),2 h after anesthesia (T3),8 h after anesthesia (T4),24 h after anesthesia (T5),the level of tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6),pH,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),the calculation of oxygenation index (PaO2/FiO2) were measured and compared.The pulmonary complications after operation 1 day were recorded.Results The level of TNF-α,IL-6 in three patients at T1 had no significant difference (P ＞ 0.05).The level of TNF-α,IL-6 at T2-5 in group C were significantly lower than those in group A and group B (P ＜ 0.05).Compared with group A and group B,the level of PaO2 and PaO2/FiO2 at T2-5 were increased in group C (P ＜ 0.05).None pulmonary complications were occurred in three groups.Conclusions Penehyclidine hydrochloride combined with low tidal volume ventilation may improve arterial oxygen in patients with lower abdominal operation,reduce the lung injury induced by mechanical ventilation,protective effect on lung function.

The data collected from some hospitals by searching literature, consulting experts, communicating and reviewing with doctors and database providers were analyzed with how to rationally select and use medical informa-tion proposed.

Objective To evaluate the effects of different blood-saving strategies on postoperative cellular immune function in patients undergoing resection for liver cancers.Methods Sixty-six ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,with hepatocellular carcinoma classification G1-G3 and clinicopathological staging Ⅰ-Ⅳ,undergoing elective resection for liver cancers,were randomly divided into 3 groups (n =22 each) using a random number table:low central venous pressure group (L group),acutenormovolemic hemodilution group (A group),and acute normovolemic hemodilution combined with low central venous pressure group (AL group).Acute normovolemic hemodilution was performed after endotracheal intubation.Right jugular vein was cannulated for central venous pressure monitoring.Blood withdrawn from the radial artery at a rate of 25-40 ml/min was simultaneously replaced by iv infusion of the equal volume of 130/0.4 hydroxyethyl starch at the same rate until the target Hct (30％) was achieved.In A and AL groups,central venous pressure was maintained at 3-5 cm H2O during the procedure of liver parenchyma transection.Peripheral venous blood samples were taken before operation (T1,baseline) and on postoperative days 1,3 and 5 (T2-4) to determine the percentage of regulatory T-lymphocytes (CD4 + CD25 +,CD25 + Foxp3+),effective T-lymphocytes (CD8 +,CD4 + CD25-) and natural killer (NK) cells by flow cytometry.Results Compared with the baseline value at T1,the percentage of CD4 + CD25 +and CD25 + Foxp3+ was significantly decreased,and the percentage of CD8 + and CD4 + CD25-was increased at T3,4,and the percentage of NK cells was decreased at T2 in A and AL groups,and the percentage of CD4 + CD25 +and CD25 + Foxp3+ was decreased,and the percentage of CD8 + and CD4 + CD25-was increased at T4,and the percentage of NK cells was decreased at T2,3 in group L (P ＜ 0.05).Compared with L group,the percentage of CD4 + CD25 + and CD25 + Foxp3+ was significantly decreased at T3,the percentage of CD8 + was increased at T3,4,and the percentage of NK cells was increased at T3 in AL group (P ＜ 0.05).Conclusion Acute normovolemic hemodilution combined with low central venous pressure provides slighter inhibitory effect on the immune function of T-lymphocytes and NK cells in patients undergoing resection for liver cancers than either alone.

Objective To investigate the imaging features of the nigrosomes-1 region in the substantia nigra at 3.0 T with enhanced gradient echo T2 star weighted angiography(ESWAN), and to explore its clinical value in the evaluation of Parkinson disease (PD). Methods Fifty-four patients diagnosed with PD (PD group), and 51 non-PD volunteers (N-PD group) were scanned with 3.0 T ESWAN, who had selected randomly. The widths of the typical high signal correspondence with the nigrosomes-1 region (a), the width at the middle of the substantia nigra (b) and the width of the banded high signal of which the oval structure were not displayed (c) were measured and collected. The result of reclassification performed by 2 physicians were compared with clinical gold standard. Specificity and sensitivity were calculated; Eleven outpatients with clinically suspected PD but undiagnosed (UD group) were continusouly selected. They received the same scanning and were performed with imaging diagnosis according to the conclusions of previous studies, then compared the imaging diagnosis with the final clinical diagnosis. Results In non PD group, hyperintensity of nigrosomes-1 were shown in 49 cases (96.1%) in bilateral or unilateral of the SN, the hyperintensity were shaped as“drop”, wedge or oval and the average size (a/b) was (0.31 ± 0.07)mm approximately; PD group, all 54 cases (100.0%) of the oval rear the“drop”were completely disappeared. The sensitivity of the loss of the hyperintensity of nigrosomes-1 for the diagnosis of PD was about 100.0%(54/54)and the specificity of it was about 96.08%(49/51). In UD group, 7 cases with the“drop”completely missed and 1 case with smaller“c”were clinically proven to PD, 2 cases with the typical hyperintensity and 2 case with larger“c”were proven to Parkinson plus syndrome. Conclusions The nigrosomes-1 typical hyperintensity in PD patients' substantia nigra on the 3.0 T ESWAN are disappeared. There may be an effective method for PD and Parkinson's plus syndrome identification that by analyzing of the presence or absence of the typical hyperintensity and its size in the patients with symptoms of PD.

Studies have shown that the clinical manifestation of patients with neuropsychiatric disorders might be related to the abnormal connectivity of brain functions. Psychogenic non-epileptic seizures (PNES) are different from the conventional epileptic seizures due to the lack of the expected electroencephalographically epileptic changes in central nervous system, but are related to the presence of significant psychological factors. Diagnosis of PNES remains challenging. We found in the present work that the connectivity between the frontal and parieto-occipital in PNES was weaker than that of the controls by using network analysis based on electroencephalogram (EEG) signals. In addition, PNES were recognized by using the network properties as linear discriminant nalysis (LDA) input and classification accuracy was 85%. This study may provide a feasible tool for clinical diagnosis of PNES.
Brain ; physiopathology ; Electroencephalography ; Epilepsy ; Humans ; Seizures ; diagnosis

Objective To analyze the distribution of traditional Chinese medicine (TCM) syndromes and characteristics of patients with acute respiratory distress syndrome (ARDS), and to provide reference for further clinical study of ARDS. Methods The clinical data of ARDS patients admitted to the Department of Critical Care Medicine of Affiliated Hospital of Chengdu University of TCM from November 2017 to February 2019 were retrospectively analyzed. The general data (gender and age) and inducing cause of disease, clinical manifestations, intensive care unit (ICU) stay time, total hospitalization time, outcome in ICU, outcome in 28-day follow-up and TCM syndromes were recorded. The different degrees of disease severity, the clinical manifestations and distribution characteristics of TCM syndromes were analyzed. Results A total of 110 patients with ARDS were enrolled, including 2 patients in mild ARDS group, 33 patients in moderate ARDS group and 75 patients in severe ARDS group. In the etiology analysis of ARDS, infection was the commonest cause, including 46 cases of pulmonary infection (41.8%), 27 cases of sepsis (24.5%), 4 cases of abdominal cavity infection (3.6%), 2 case of urinary tract infection (1.9%), and 13 cases had surgical histories (11.8%). The stay in ICU was 9.00 (3.00, 18.00) days and the total hospital stay was 18.00 (10.00, 30.00) days. The mortality in ICU was 32.7% (36/110), and that in 28-day follow-up was 60.0% (66/110). The clinical symptoms of the patients in moderate and severe groups ARDS were mainly dyspnea, cough, fever, sputum, chest tightness, and palpitations, accounting for 75.0% (81/108), 43.5% (47/108), 28.1% (31/108), 26.9% (29/108), 22.2% (24/108) and 25.9% (28/108), respectively. Compared with the ARDS moderate group, the proportions of patients with dyspnea, cough and palpitation in severe ARDS group were significantly higher [80.0% (60/75) vs. 63.6% (21/33), 50.7% (38/75) vs. 27.3% (9/33), 33.3% (25/75) vs. 9.1% (3/33), respectively, all P < 0.05]. The main TCM syndromes were yang deficiency, exuberant heat-toxin, and wind-heat invading lung, accounting for 53.7% (58/108), 28.7% (31/108), and 25.0% (27/108) respectively. The proportion of patients with exuberant heat-toxin syndrome in severe ARDS group was obviously higher than that in the moderate ARDS group [34.7% (26/75) vs. 15.2% (5/33), P < 0.05], while the proportion of patients with wind-heat invading lung syndrome in moderate ARDS group was more than that in the severe ARDS group [42.4% (14/33) vs. 17.3% (13/75), P < 0.05]. Conclusion ARDS is a critical illness with high mortality and various complicated clinical symptoms, the TCM syndromes of ARDS are mainly yang deficiency, exuberant heat-toxin, wind-heat invading lung, and intermingling of deficiency and excess easily leading to collapse syndrome.

An intravascular ultrasound-enhanced thrombolysis excitation system with adjustable frequency, amplitude and duty cycle was designed based on FPGA (ZYNQ-7Z020). Firstly, the FPGA generated waveform amplitude binary data based on direct digital frequency synthesis (DDS) technology, and then the data was converted into burst signal through an external daughter card, which included D/A conversion circuit, active low-pass filter, power amplifier circuit and impedance matching circuit. The test results demonstrated that the output waveform reached the target with advantages of simple implementation and flexible control, the peak negative pressure generated from ultrasound transducer was doubled by means of an electrical impedance matching network. In vitro thrombus models were applied to verify the excitation system, it turned out that ultrasound cavitation effect generated could accelerate the penetration of urokinase and increase the thrombolysis rate by about 20%.
Amplifiers, Electronic ; Electric Impedance ; Thrombolytic Therapy ; Ultrasonography ; Ultrasonography, Interventional

【Objective】 In this study， reactive oxygen species （ROS） scavenger N-acetyl-L-cysteine （NAC） was used to explore the inhibitory effect and mechanism of artesunate （ART） on pancreatic carcinoma （PC） cells. 【Methods】 Different concentrations of ART interfered with 3 PC cell lines CFPAC-1， Capan-2 and BxPC3. Cell viability was measured by CCK8； cell migration ability was measured by Transwell method， and the expressions of migration-related proteins E-cadherin， N-cadherin and Vimentin were measured by Western blotting. ROS probe DCFH-DA was used to measure intracellular ROS； LC3 cell immunofluorescence （IF） was used to detect the formation of intracellular autophagosomes. After adding NAC or autophagy inhibitor 3-MA， the cell viability was tested again by CCK8， and the expressions of p-AMPK/ AMPK， p-mTOR/mTOR， p62 and LC3Ⅱ/Ⅰ were detected by Western blotting. 【Results】 ART inhibited the growth of CFPAC-1 and Capan-2 in a time- and dose-dependent manner. After treatment of CFPAC-1 and Capan-2 cells with 200 μmol/L of ART for 48 h， the expression of E-cadherin was upregulated， while N-cadherin and Vimentin were downregulated， and the cell migration ability was significantly reduced. ART significantly upregulated intracellular ROS level and promoted the formation of autophagosomes. NAC could reduce the inhibitory effect of ART on CFPAC-1 and Capan-2 cells， upregulate p-AMPK/AMPK， P62 and LC3Ⅱ/Ⅰ， downregulate the expression of p-mTOR/mTOR， and intensify autophagy. 3-MA could not reverse the inhibitory effect of ART on PC cells. 【Conclusion】 ART is dependent on ROS， but not on autophagy， in exerting an anti-pancreatic carcinoma effect. NAC attenuates the inhibitory effect of ART on PC cells by activating protective autophagy through AMPK/mTOR signaling pathway.

Background: and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities. Methods: This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups. Results: Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]). Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.