At present,the teaching resource for anesthetic residents training is more and more insufficient.The safe and standardized training course based on medical simulation teaching meets the training demand of comprehensive quality and professional skill for anesthetic residents training.Basic and advanced anesthetic training can raise the operational level while comprehensive anesthetic ability training can improve the ability of clinical thinking,organization,coordination and crisis management.The use of medical simulation teaching is insufficient in anesthetic residents training.It is highly recommended to guide anesthetic residents training by the government policy.

Objective The aim of this study was to determine the effective concentration of epidural ropivacaine for analgesia in 50% of parturients (EC50) in the first stage of labor. Methods Thirty-three ASA Ⅰ -　Ⅱ nulliparous women with 2-3 cm cervical dilatation who requested epidural analgesia were enrolled in the study. Epidural catheter was placed at L3-4 and advanced for 3-4 cm in the epidural space in a cephalad direction. 20 ml of ropivacaine solution of which the EC50 was being tested was given through the catheter into epidural space. The EC50 was determined by up-and-down sequential experiment. The initial concentration of the epidural ropivacaine being tested was decided to be 0.15% . If effective the next parturient received ropivacaine of a lower concentration; if ineffective the concentration of ropivacaine was increased in the next parturient. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . Analgesia was assessed by VAS score (1-10) . If VAS score was less than 3 within 30 min of ropivacaine administration, analgesia was defined as effective.Results Among the 33 parturients enrolled, three were excluded from the study because of uncertain analgesic efficacy. The results showed that the EC50 of epidural ropivacaine for analgesia in the first stage of labor was 0.063% [95% confidence interval (CI) was 0.05972%-0.06688%] .Conclusion The EC50 epidural ropivacaine for analgesia in the first stage of labor is 0.063 % determined by sequential experiment method.

Objective To determine the prevalence of vulvovaginal candidiasis(VVC) in pregnant women,to test its antifungal susceptibility to miconazole,clotrimazole,fluconazole, itrocona- zole,and nystatin and to treat VVC with miconazole in pregnancy. Methods Vaginal swabs were collected from unselected pregnant women in prenatal clinic. The antifungal susceptibility of 131 strains of Candidas to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin were detected by Neo-Sensitabs susceptibility testing. 66 cases of VVC were treated with 6 day-course of miconazole(400 mg/d). Results The prevalence of VVC in pregnant women was 12.7%(127/1000). 37.4%(374/1000) had previous VVC. 0.6%(6/1000)of women were recurrent VVC(RVVC),which occupied 4.7%(6/127) of VVC. C. albicans was the most frequently(87.1%) isolated pathogen followed by C. glabrata (9.9%) ,C. tropicalis(1.5%),and C. krsei(1.5%). The resistant rate of C. albicans to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin was 10.5%、2.6%、 6.1%、 7.9%,and 0. All 13 strains of C. glabrata was susceptible to miconazole,nystatin and susceptible or susceptible-dependent-upon-dose (SDD) to clotrimazole,fluconazole,and itroconazole. The mycological cure rate of miconazole on day 7～14 and day 28～42 was 84.8%(56/66 cases) and 80.3% (53/66 cases). Conclusions VVC is very common in pregnancy. C. albicans is the predominant Candida species in VVC and has some resistance to miconazole,clotrimazole,fluconazole,itroconazole,and nystatin. Miconazole therapy is effective on VVC treatment in pregnant women. Non-effective treatment might be associated with Candidas resistance.

Objective To determine the risk factors for development of early acute renal failure (ARF) after orthotopic liver transplantation (OLT) in patients with normal renal function.Methods Sixty ASA Ⅱ or Ⅲ patients aged 28-64 yr weighing 35-88 kg undergoing OLT were studied.Their preoperative serum Cr and BUN were within normal range.Early ARF was defined as serum Cr≥132 μmol/L and/or BUN≥18 mmol/L within 24 h after operation.The patients were divided into 2 groups: ARF group and non-ARF group.Arterial blood samples and urine specimens were collected before induction of anesthesia for determination of blood β2-micreglobulin(β2-MG) and urinary β2-MG and N-acetyl-β-D-glucurenidnse (NAG). Factors including preoperative liver function,preoperative blood and urinary β2-MG,the amount of urine output and bank blood infused during operation,MAP during anhepatic and neohepatic phase,the amount of vnsoactive drugs and diuretics used during operation,hypotension and arrbythmia during operation were recorded.The risk factors were identified by logistic regression analysis.Results Logistic analysis indicated that serum β2-MG higher than normal value before operation and persistent hypotensien during operation were closely correlated with development of early ARF after OLT.Conclusion Serum β2-MG higher than the normal value before operation.and persistent hypotension during operation are the risk factors for early ARF after OLT.

Objective To explore the better strategy of cardiopulmonary resuscitation (CPR) and electric defibrillation skills training and assessment on nurses in order to improve the first-aid level of nursing staff.Methods 1 258 nurses of a hospital were trained and assessed in batches.Core group and instruc -tor team were established,multimedia lecture,situation simulation training ahd network self-learning were available.Paperless examinations were conducted.Results of the examinations were analyzed by SPSS19.0,and the comparison between the two groups of independent samples were analyzed by Mann-Whitney U test.Results All the 1 258 nurses were qualified,for the median score was 88.0 and the quartile spacing was 7.5.The step-scores of step1-3,13,14,22,23 were high,while the step-scores of step5,7-17,16-21,24,25 were low.Compared with nurses without professional-titles,nurses with professional-titles got better results in total score,step 8-12 and step17-21,and the differences were statistically significant(P＜0.05).Conclusions It is necessary to pay attention to the training and assessment of CPR and electric defibrillation skills on nurses.Advanced and effective training methods need to be used to carry on regular training and assessment.For the weak links and low-grade nursing staff,intensive training needs to be conducted to improve the entire skill level of nurses.

Objective:To clarify the effect of voltage-gated proton channel 1 (Hv1) on the migration and invasion of breast cancer cells. Methods:The protein expression of Hv1 was detected in human breast cancer cell lines with different metastatic abilities. SiRNA technique was used to down-regulate the expression of Hvl in breast cancer MDA-MB-231 cells. Scratch and matrigel invasion methods were used to observe the effect of Hvl on the migration and invasion of breast cancer cells, and the relevant molecular mechanism was explored. Results:Hv1 was highly expressed in the highly metastatic breast cancer cell line MDA-MB-231. Hvl was more highly expressed in MDA-MB-231 cells with higher metastatic ability. The SiRNA sequence target at Hvl inhibited Hvl expression. Scratch and matrigel invasion experiments showed that the migration and invasion of MDA-MB-231 cells were significantly attenuated when Hv1 was knocked down by siRNA targeting Hv1. Zymography experiment on matrix metalloproteinase indicated that the enzyme activities of MMP-2 markedly decreased. Conclusion:Hv1 promoted the migration and invasion ability of breast cancer cells.

OBJECTIVE To analyze the clinical cases of fungal infections and drug resistance to provide a basis for the treatment of mycotic infection.METHODS A total of 215 cases of fungal strains were identified by API 20C AUX.Drug susceptibility was determined by Rosco slip diffusion.RESULTS In 215 fungal strains of specimens,Candida accounted for 87.9%,of which C.albicans accounted for 37.2%.The yeast-like fungi sensitivity rate to amphotericin B,nystatin and ketoconazole respectively was 100.0%,97.9% and 93.5%.CONCLUSIONS Candida are the most common pathogens in the 215 fungal stains.Yeast-like fungi is sensitive to amphotericin B,nystatin and ketoconazole.

Objective To investigate the correlation of blood-brain barrier (BBB) damage and depression in patients with cerebral small vessel disease (CSVD).Methods Consecutive patients with CSVD admitted to hospital were enrolled prospectively.The patients completed head MRI and cerebrospinal fluid (CSF) examination after admission.The BBB damage degree was evaluated by using albumin CSF/serum ratio (Q-Alb).At 3 months after onset,the depression was assessed according to the Hamilton depression scale (HAMD) and the American Diagnostic and Statistical Manual of mental disorders,4th edition (DSM-Ⅳ).The correlation between the BBB damage and depression in patients with CSVD was analyzed,Results A total of 130 consecutive patients with CSVD were enrolled,including 58 (44.62％) had depression within 3 months.There were significant differences in the proportions of patients with lacunar infarction (43.10％ vs.26.39％;x2 =4.008,P =0.045),leukoaraiosis (75.86％ vs.58.33％;x2 =4.408,P =0.036),and cerebral microbleed (27.59％ vs.12.50％;x2 =4.707,P =0.030),and baseline National Institutes of Health Stroke Scale (NIHSS) scores (5.02 ± 2.51 vs.3.60 ± 2.43;t =3.256,P =0.001),Fazekas scales of deep white matter (2.35 ± 1.00 vs.1.56 ± 1.05;t =4.358,P ＜0.001) and the proportion of Q-AIb category (x2 =6.852,P =0.033) between the depression group and the non-depression group.Multivariate logistic regression analysis showed that the baseline NIHSS scores (odds ratio [OR] 1.248,95％ confidence interval [CI] 1.027-1.517;P =0.026),leukoaraiosis (OR 14.786,95％ CI 1.776-123.111;P=0.013),Fazekas scales of deep white matter (OR 1.847,95％ CI 1.210-2.819;P=0.004),and Q-Alb (OR 30.417,95％ CI 3.662-252.643;P =0.004) had significant independent correlation with depression.Conclusions The BBB damage is independently associated with depression in patients with CSVD.

Objectlve investigate the role of Toll-like receptor 2 (TLR2) on polymorphonuclear neutrophil (PMN) during perioperative period in the development of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthotopic liver transplantation (OLT).Methods Twenty patients (18 male and 2 female, aged 33-58 yr and weighing 52-73 kg) with ASA Ⅲ or Ⅳ (NYHA Ⅱ or Ⅲ )undergoing OLT were studied. Blood samples were collected from the central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia (T1, baseline), at 25 min of anhepatic phase (T2), 3 h (T3) and 24 h after beginning of reperfusion of the allograft (T4). The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immunosorbant assay (ELISA). The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the two groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 and the serum IL-8 concentration was significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group ( r= 0.607, P ＜0.05).Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.

AIM: To study the changes of serum levels of thromboxane A_2(TXA_2) and prostacyclin(PGI_2) in cirrhosis patients during liver transplantation.METHODS: Samples were obtained from 24 cirrhosis patients in end at five time points during liver transplantation.TXA_2 and PGI_2 level were measured by radioimmunoassay.Arterial and mixed venous blood samples used for blood gas analysis were taken at the same time.Intrapulmonary shunt(Qs/Qt) was calculated according to the standard formula.The hemodynamics parameters including continuous cardiac output index(CI),HR,mean artery blood pressure(MABP),MPAP,CVP,PAWP,SVRI,PVRI were measured during liver transplantation.RESULTS:(1) MABP decreased significantly in the early stage of anhepatic period and neohepatic period.(2) CVP,MPAP and PAWP decreased significantly during anhepatic period.They increased significantly after graft reperfusion and remain the high level.(3) CI declined significantly during anhepatic period and increased at 10 min postreperfusion of new liver.(4) SVRI and PVRI increased during anhepatic period and were higher than baseline level at 15 min after reperfusion.SVRI was lower than baseline level at 30 min after reperfusion.(5) Compared with the baseline level,6-keto-PGF1? and TXB_2 increased significantly.Compared with the level before vascular cross-clamping,6-keto-PGF1? decreased during neohepatic period and it had significant difference in statistics at the end of operation.CONCLUSION: Serum levels of TXA_2 and PGI_2 significantly change during liver transplantation and may affect the system and pulmonary circulation to some extent.