The teaching team of undergraduates of anesthesiology in Anhui Medical University applied the primary trauma care system of encourage, heuristic teaching and practical teaching to further deepen the educational reform and improve teaching quality for undergraduate education.They designed the diversified section such as drills, discussion, teaching, questions, feedback and so on, implemented the simulation training of anesthesia crisis management skills and completed the feedback evaluation of comprehensive ability before and after the teaching, and then achieved the effect of improving the actual operation ability and clinical thinking capacity of students.So it is a good method and worth extending.

Objective To evaluate the relationship between histone deacetylase 3 (HDAC3) expression and the mechanism underlying mitigation of remifentanil postconditioning-induced protection of diabetic cardiomyocytes.Methods H9c2 cells were cultured in DMEM/F12 culture medium supplemented with 10％ fetal bovine serum.The cells were seeded in 6-well plates (2 ml/well) at a density of 105 cells/ml.After the cells were cultured for 12 h,the cells were attached to the wall and cultured for 48 h in the normoglycemic (5.5 mmol/L) or hyperglycemic (25 mmol/L) DMEM culture medium.The cells were then randomly divided into 6 groups (n =18 each) using a random number table:control group (group CON),hypoxia/reoxygenation group (group H/R),remifentanil postconditioning group (group RPC),hyperglycemia group (group HG),hyperglycemia plus hypoxia/reoxygenation group (group HG-H/R),and hyperglycemia plus remifentanil postconditioning group (group HG-RPC).In H/R,RPC,HG-H/R and HG-RPC groups,the cells were exposed to 95％ N2-5％ CO2 in an incubator for 5 h after changing the culture medium for Tyrode solution.In H/R and HG-H/R groups,the culture medium was changed to the DMEM/F12 culture medium supplemented with 10％ fetal bovine serum and glucose at the corresponding concentration,and the cells were then incubated for 1 h.In RPC and HG-RPC groups,the cells were incubated in the DMEM culture medium containing remifentanil at the final concentration of 1 μmol/L,and the cells were then incubated for 1 h.At 1 h of reoxygenation,the cell viability was measured by CCK-8 assay,the cell apoptosis was detected by AnnexinV-FITC/PI flow cytometry,and the expression of HDAC3 and caspase-3 in cells was detected by Western blot.The apoptotic rate was calculated.Results Compared with group CON,the cell viability was significantly decreased,the cell apoptotic rate was significantly increased,and the expression of caspase-3 and HDAC3 was significantly up-regulated in group H/R (P＜ 0.05).Compared with group H/R,the cell viability was significantly increased,the apoptotic rate was significantly decreased,and the expression of caspase-3 and HDAC3 was significantly down-regulated in group RPC (P＜0.05).Compared with group HG,the cell viability was significantly decreased,the apoptotic rate was significantly increased,and the expression of cspase-3 and HDAC3 was significantly up-regulated in group HG-H/R (P＜0.05).There was no significant difference in the parameters mentioned above between group HG-RPC and group HG-H/R (P＞0.05).Conclusion The mechanism underlying mitigation of remifentanil postconditioning-induced protection of diabetic cardiomyocytes is associated with hyperglycemia-induced up-regulation of HDAC3 expression.

Objective To evaluate the effect of dexmedetomidine on the postoperative cognitive function in the elderly patients with fragile brain.Methods One hundred and twenty elderly patients with fragile brain,aged 65-85 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with preoperative Mini-Mental State Examination score≥ 20,scheduled for elective gastroenteric surgical procedures,were randomly assigned to one of 2 groups (n =60 each) using a random number table:control group (group C) and dexmedetomidine group (group D).In group D,dexmedetomidine was intravenously infused in a loading dose of 0.4 μg/kg over 10 min before anesthesia induction,followed by an infusion of 0.4 μg · kg-1 · h 1until 30 min before the end of surgery.While the equal volume of 0.9％ nomal saline was given instead of dexmedetomidine in group C.Postoperative delirium was assessed within 3 days after operation using Confusion Assessment Method.Postoperative cognitive dysfunction was assessed at 7 days after operation using Mini-Mental State Examination.Results Compared with group C,the incidence of postoperative delirium was significantly decreased within 3 days after operation (P＜ 0.05),and no significant change was found in postoperative cognitive dysfunction at 7 days after operation in group D (P＞0.05).Conclusion Dexmedetomidine can decrease the occurrence of postoperative delirium in the elderly patients with fragile brain.

significant for the precaution of gastric cancer risk population. Aims:To explore gastric cancer susceptibility gene profiling in an area in Shanghai,and to assess the risk of gastric cancer susceptibility. Methods:A total of 152 patients with primary gastric cancer at Shanghai Pudong Hospital were enrolled,and 152 demographic characteristics matched patients with non-gastrointestinal diseases,non-tumor were served as controls. Gene polymorphism was determined by allele specific polymerase chain reaction. Susceptibility gene of gastric cancer was screened. Multiple genes interactions were analyzed and multiple genes risk was evaluated by DEMCHUK model. Results:Univariate analysis showed that CYP2E1,NAT2M1,NAT2M2,NAT2,XRCC1194,MTHFRA1298C,VDR TaqⅠ were susceptibility genes of gastric cancer. Multivariate analysis showed that CYP2E1(C1/ C1),NAT2M1(T/ T),NAT2M2(A/ A),XRCC1194( T/ T)and MTHFRA1298C(A/ C)were susceptibility genotypes. Synergistic effect was found between genes except MTHFRA1298C (A/ C)with NAT2M1(T/ T)and NAT2M2(A/ A)(P ﹤0. 05). Multiple genes risk analysis showed that combination OR of multiple genes was highly correlated with gene frequency,and the risk of gastric cancer was increased with the increasing number of susceptibility genes. Conclusions:CYP2E1(C1/ C1),NAT2M1(T/ T),NAT2M2( A/ A),XRCC1194( T/ T) and MTHFRA1298C( A/ C) are susceptibility genotypes of gastric cancer. Carrying multiple susceptibility genes can significantly increase the risk of gastric cancer.

Objective To investigate the relationship between maintaining concentration and loss of consciousness (LOC) concentration of propofol target controlled infusion (TCI) in patients undergoing heart valve replacement.Methods Thirty patients undergoing elective heart valve replacement were enrolled to receive propofol by ladder plasma TCI for anesthesia induction,8 males and 22 females.The initial plasma concentration (Cp) of propofol was set to 1.0 μg/ml,0.3 μg/ml Cp was increased every 1 min until LOC when the prediction effect-cite concentration (Ce) reached 0.5 μg/ml,then sufentanil 0.8-1.0 μg/kg and rocuronium 0.6-0.9 mg/kg were given for intubation.When BIS reached 50,Cp was decreased to the level of Ce.All the surgeries were performed under hypothermia CPB.MAP,HR,CVP,CO,SV,SVR,BIS,propofol Cp and Ce values were recorded at baseline (T0),LOC (T1),BIS reached 50 (T2),and other time points during operation (T3-T9).The correlation analysis between propofol Ce at LOC and perioperative variables were completed.Results In correlation analysis,there was a significant positive correlation between propofol Ce at LOC and baseline CO,SV (P<0.01),there was a significant negative correlation between propofol Ce at LOC and age (P<0.05),there was a significant positive correlation between propofol Ce at LOC and propofol Ce at T2-T9(P<0.01).Conclusion In patients undergoing valvular replacement,the Ce of propofol at maintenance are related to the concentration of propofol at LOC,which is helpful for adjusting the Ce of propofol at maintenance according to the Ce of propofol at LOC.

Objective To evaluate the effect of therapeutic hypercapnia on the balance between cer-ebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the beach chair posi-tion(BCP). Methods Forty-eight patients of both sexes, aged 21-64 yr, weighing 45-80 kg, of Ameri-can Society of Anesthesiologists physical statusⅠorⅡ, scheduled for elective arthroscopic shoulder surgery in the beach chair position, were divided into 2 groups(n=24 each)using a random number table: control group(group C, end-tidal pressure of carbon dioxide 35-40 mmHg)and therapeutic hypercapnia group (group H, end-tidal pressure of carbon dioxide 45-50 mmHg). The regional cerebral oxygen saturation (rSO2)was recorded after induction and before BCP, immediately after BCP, at 3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 min after BCP and at the end of surgery(T0-12). The occurrence of cerebral desaturation events, extubation time, duration of stay in postanesthesia care unit, development of nausea and vomiting and requirement for vasoactive drugs were recorded during surgery. Results Compared with the baseline at T0, the rSO2was significantly decreased at T1-12in group C and at T2-6in group H(P<005). The rSO2was significantly higher at T1-12, and the incidence of cerebral desaturation events was lower in group H than in group C(P<005). There was no significant difference between the two groups in the extubation time, dura-tion of stay in postanesthesia care unit, incidence of nausea and vomiting or requirement for vasoactive drugs (P>005). Conclusion Therapeutic hypercapnia can improve the balance between cerebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the BCP.

Objective To evaluate the effects of different sedation depths of propofol on postopera-tive delirium in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB)and the relationship with regional cerebral oxygen saturation(rSO2). Methods Forty American Society of An-esthesiologists physical statusⅢorⅣpatients of both sexes, aged 26-64 yr, with body mass index of 17-25 kg∕m2, scheduled for elective aortic valve replacement with CPB, were divided into A and B groups (n=20 each)using a random number table. The infusion rate of propofol was adjusted to maintain the cor-responding anesthetic depth with 50≤BIS value<60 during CPB in group A and with 35≤BIS value<45 during CPB in group B. Bilateral rSO2was measured using the near infrared spectroscopy from admission to the operating room until the end of skin suturing. The minimum rSO2was recorded, and occurrence of low cerebral oxygen saturation(rSO2was less than 55% or the decrease in rSO2>20% of the baseline)was ob-served. Postoperative delirium was evaluated using Confusion Assessment Method for the Intensive Care Unit (ICU)from 12 h after admission to ICU until discharge from ICU. Results The incidence of postoperative delirium, low cerebral oxygen saturation and minimum rSO2were significantly lower in group B than in group A(P<005). Conclusion Maintaining 35≤ BIS value< 45 during CPB can reduce the develop-ment of postoperative delirium and is related to improving intraoperative rSO2in patients undergoing cardiac valve replacement.

Objective: To evaluate the effect of anesthesia management based on regional cerebral oxygen saturation (rSO₂)-bispectral index (BIS)-goal-directed hemodynamic multi-modal monitoring on acute kidney injury (AKI) after cardiac valve replacement. Methods: A total of 238 patients of both sexes, aged 18-75 yr, weighing 45-95 kg, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ (New York Heart Association class Ⅱ or Ⅲ ), undergoing elective cardiac valve replacement, were assigned into routine experience group (group C, n=122) and multi-mode monitoring group (group M, n=116) using a random number table method.After admission to the operating room, the invasive blood pressure of radial artery, central venous pressure, electrocardiogram, SpO₂ and end-tidal pressure of carbon dioxide were recorded in group C, and rSO₂, BIS, stroke volume variation, cardiac index and stroke volume index were monitored based on the monitoring in group C. The patients were tracheally intubated when BIS value was about 50.BIS value was maintained between 45 and 55, rSO₂ was maintained not less than 20% of the baseline value or the absolute value not less than 55%, and fluctuation in mean arterial pressure did not exceed 20% of the baseline value, and stroke volume index was maintained >25 ml/m² and cardiac index>2.5 L·min^-1 ·m^-2, maintaining not lower than the baseline value before induction in special conditions.The intraoperative volume of fluid infused, infusion of allogeneic blood, consumption of propofol, time of cardiopulmonary bypass, aortic cross-clamping time, anesthesia time, operation time, occurrence of AKI within 48 h after operation, renal replacement therapy, extubation time, duration of intensive care unit stay, postoperative length of hospital stay, development of other serious postoperative complications and fatality rate at day 30 after operation were recorded. Results: Compared with group C, the incidence of AKI was significantly decreased, the volume of plasma infused and consumption of propofol were reduced, the extubation time, duration of intensive care unit stay and postoperative length of hospital stay were shortened (P<0.05), and no significant change was found in the rate of renal replacement therapy, constituent ratio of AKI degree, incidence of other serious postoperative complications or mortality rate at day 30 after operation in group M (P>0.05). Conclusion Anesthesia management based on rSO₂-BIS-goal-directed hemodynamic multi-modal monitoring can decrease the occurrence of AKI after cardiac valve replacement.