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 explore the clinical features and treatment of children with acute severe viral myocarditis.Methods The clinical data of presentation,diagnosis,therapy and prognosis of children who were admitted in our hospital from Jan 2005 to Jan 2012 with acute severe viral myocarditis(severe myocarditis group) were analyzed retrospectively.Twenty-three cases of normal healthy children in the same period were selected as control group.The levels of serum cardiac troponin(CTn)-Ⅰ and N-terminal pro-brain natriuretic peptide(NT-proBNP) were detected by ELISA method,the changes of left ventricular ejection fraction and left ventricular fraction shortening were understood by color doppler echocardiography.Results The level of CTn-Ⅰin severe myocarditis group was significantly higher than that of control group,the difference was statistically significant [(18.67 ± 12.31) ng/ml vs (0.02 ±0.01) ng/ml,P ＜0.05].Compared with the acute phase,the level of CTn-Ⅰshowed a trend of gradual decline in 7 d [(0.55 ±0.24) ng/ml],basic close to normal in 14 d [(0.06 ±0.03) ng/ml] (P ＜0.05).The level of NT-proBNP increased significantly in severe myocarditis group compared with control group [(3 067.26 ± 902.79) pg/ml vs (80.04 ± 17.79) pg/ml,P ＜0.05].Compared with acute phase,the levels of NT-proBNP were closed to normal in 7 d [(648.63 ±342.37) pg/ml] and 14 d [(213.58 ± 129.51) pg/ml] (P ＜ 0.05).The left ventricular ejection fraction [(52.63 ± 6.98) ％ vs (71.39 ± 2.41) ％] and left ventricular fraction shortening [(32.1 ± 2.97) ％ vs (40.04 ± 2.31) ％] in severe myocarditis group were significantly lower than those in control group (P ＜ 0.05).Conclusion Acute severe viral myocarditis of children was characterized by rapid onset,severe illness and high mortality.Early use of adrenal cortical hormone and gamma globulin under the comprehensive treatment and application temporary pacemaker can help patients to recover from the disease.

To explore the clinical significance of serum cardiac troponin I (cTnI) for the detection of myocardial injury in children with Kawasaki disease (KD) in acute stage, the levels of serum cTn I, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactic dehydrogenase (LDH) and glutamic oxalacetic transaminase (GOT) were determined in 40 children with KD and 23 controlled children without heart disease, respectively. The results showed that the levels of serum cTn I and CK-MB in the KD group were significantly higher than those in the controlled group (P＜0.001),while no obviously differences of CK, LDH and GOT were noticed between two groups (P＞0.05). cTn I was more sensitive comparing to CK-MB for the detection of myocardial injury (P＜0.05). It is concluded that the determination of cTn I and CK-MB will be available for the diagnosis of myocardial injury in children with KD in acute stage, and the determination of cTn I is more sensitivity and specificity comparing to CK-MB.

Objective To evaluate the effects of pretreatment with different doses of phosphocreatine on hepatic ischemia-repeffusion (I/R) injury in rats.Methods.Thirty male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 5 groups (n =6 each):sham operation group (group S),hepatic I/R group (group I/R),and pretreatment with different doses of phosphocreatine groups (groups P1-3).Hepatic I/R was induced by 90 min occlusion of the hepatic artery and portal vein entering the middle and left lobes of the liver followed by 4 h reperfusion in anesthetized rats.Phosphocreatine 50,150 and 450 mg/kg were injected via the tail vein at 60 min before ischemia in groups P1-3,respectively.In groups S and I/R,the equal volume of normal saline was given instead.Blood samples were taken from the abdominal aorta at 4 h of reperfusion for determination of plasma alanine aminotransferase (ALT),aspartate aminotransferase (AST),TNF-α and IL-1β concentrations.The rats were then sacrificed and the livers were removed for determination of myeloperoxidase (MPO) activity (by ELISA),intercellular adhesion molecule-1 (ICAM-1) expression (by immunohistochemistry),and cell apoptosis (by TUNEL) and for microscopic examination (by electron microscopy).Results The MPO activity in liver tissues,plasma ALT and AST activities,TNF-α and IL-1β concentrations and the number of apoptotic cells were significantly higher in groups I/R and P1-3 than in group S,while lower in groups P1-3 than in group I/R (P ＜ 0.05).The parameters mentioned above were decreasedin turn in groups P1-3 (P ＜ 0.05).Conclusion Phosphocreatine pretreatment can attenuate the hepatic I/R injury in rats in a dose-dependent manner and inhibition of the inflammatory responses is involved in the mechanism.

ObjectiveTo investigate the effects of partial hepatic ischemia/reperfusion (I/R) on choline acetyltransferase(ChAT) expression in hippocampal neuron in mice.MethodsOne hundred adult male mice,aged 2 months,weighing 20-25 g,were randomly divided into 5 groups (n =20 each): normal control group(group C),sham operation group(group S),groups I/R1,I/R2,I/R3.Partial hepatic ischemia was produced by clamping left hepatic artery and portal vein for 20,30,40 min respectively followed by reperfusion in groups I/R1,I/R2,I/R3.Passive avoidance task was performed with 10 mice in each group at 4-9 and 18-23 d after operation respectively.The animals were sacrificed and their brains were removed for determination of the expression of ChAT in CA3 of hippocampal neuron.ResultsCompared with group C,the latency was significantly shortened and number of errors increased in groups I/R1 and I/R2 at 4-7 d after operation and in group I/R3 at 4-9 d after operation,the expression of ChAT in hippocampal neuron down-regulated in groups I/R1,I/R2 and I/R3 at 9 d after operation( P ＜0.05 or 0.01).There was no significant difference in the latency and number of errors at 18-23 d after operation and the expression of ChAT in hippocampal neuron at 23 d after operation among groups C,I/R1,I/R2 and I/R3 ( P ＞ 0.05).Compared with group I/R1,the number of errors was significantly increased at 4 and 5 d after operation in group I/R2,the latency shortened at 4-6 d after operation and number of errors increased at 4-9 d after operation in group I/R3,and the expression of ChAT in hippocampal neuron down-regulated at 9 d after operation in groups I/R2 and I/R3 ( P ＜ 0.05 or 0.01 ).There was no significant difference in the latency and number of errors at 18-23 d after operation and the expresson of ChAT in hippocampal neuron at 23 d after operation among groups I/R1,I/R2 and I/R3 ( P ＞ 0.05).ConclusionPartial hepatic I/R can result in transient cognitive impairment in mice by down-regulating the expression of ChAT in hippocampal neuron.

Objective To investigate the effect of creatine phosphate sodium on postoperative cognitive function of the patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Forty patients of both sexes,aged 52-70 yr,weighing 52-84 kg,of American Society of Anesthesiologists physical status Ⅲ,scheduled for elective OPCABG,were divided into either creatine phosphate sodium group (group CPS) or control group (group C) using a randon number table,with 20 patients in each group.Total intravenous anesthesia was applied during operation to maintain bispectral index value at 40-60 and hemodynamics stable.After induction of anesthesia,creatine phosphate sodium 15 mg/kg (in 100 ml of normal saline) was infused over 30 min via the central vein in group CPS,and the equal volume of normal saline was infused over 30 min instead of creatine phosphate sodium in group C.Postoperative visual analogue scale scores were maintained ≤ 3.Before induction of anesthesia,immediately after the end of operation,and at 24 and 48 h after operation,arterial blood samples were collected for determination of serum C-reactive protein concentrations by immunoturbidimetry.The cognitive function was assessed on day 1 before operation and day 7 after operation,and the development of postoperative cognitive dysfunction was recorded.Results Compared with group C,the concentrations of serum C-reactive protein at 24 and 48 h after operation and incidence of postoperative cognitive dysfunction were significantly decreased in group CPS (P＜0.05).Conclusion Creatine phosphate sodium can improve postoperative cognitive function of the patients undergoing OPCABG.

Objective To investigate the protective role of hydrogen sulfide and the expression of cystathionine gamma-lyase/hydrogen sulfide pathway in a mouse model of myocarditis induced by Coxsachie -virus B3(CVB3).Methods A total of 110 five-week-old BALB/c male mice were randomly divided into four groups:the control group, viral myocarditis group, sodium bisulfide (NaHS) group (50 μmol/kg) and DL-propargylglycine (PAG) group (40 mg/kg).The experimental model of viral myocarditis was induced by intraperitoneal injection of CVB 3.Then the four groups were respectively administered with PBS , PBS, NaHS and PAG from day 1 to day 10 after infection.Blood and heart specimens were harvested from 10 mice of each group on day 4 and day 10 for evaluation of myocardial edema .The pathological changes in heart tis-sues were observed through hematoxylin-eosin staining.Levels of H2 S, IL-6 and TNF-αwere measured by ELISA.The expressions of CSE and CVB 3 at mRNA level were determined by quantitative real time PCR ( qRT -PCR ) analysis and the expression of CSE at protein level was detected by Western blot .Results Compared with the control group , the levels of H2 S and the expressions of CSE at mRNA and protein levels were down-regulated in mice with CVB 3-induced myocarditis .With the treatment of NaHS , the levels of H 2 S in serum and tissue were both up-regulated , and the histopathological damage was alleviated .However , PAG as an irreversible CSE inhibitor inhibited the expressions of H 2 S and CSE and aggravated myocardial injury , inflammatory cells infiltration and interstitial edema .Moreover , the RT-PCR analysis also showed that the expression of CVB3 at mRNA level was inhibited by NaHS but enhanced by PAG .Conclusion The expres-sion of CSE/H2 S pathway is down-regulated in mice with CVB 3-induced viral myocarditis .PAG could pro-mote virus propagation and exacerbate the disease through inhibiting the production of endogenous H 2 S, while NaHS as a H2 S donor has a protective effect on infected myocardium by suppressing virus replication at an early stage .

Objective To investigate the change of leptin,nitric oxide (NO) and interleukin-6 (IL- 6) levels in serum of children with Kawasaki disease (KD) and the possible relationship between leptin,NO and IL-6 levels,explore the role of leptin,NO and IL-6 in the pathogenesis of KD.Methods Fourty-five children with KD were studied.Twelve of them had coronary artery lesions and 33 had non-coronary artery lesions;thirty healthy children and 18 children with juvenile idiopathic arthritis or Henoch-Scholeion purpuru were enrolled as control subjects.Serum was collected from each patients during acute stage of KD and remission.Leptin,NO and IL-6 contents were detected by radioimmuno-assay and spectrophotometry and enzyme-linked immunoserbent assay.Meanwhile,C-reactive protein (CRP) were examined.Results ① The concentrations of serum leptin,NO,IL-6 and CRP in children with KD were significantly higher in the acute stage of KD than those at clinical remission and those of the normal control group (q=26.24,25.23; 21.38,31.30;35.37,33.68;16.32,15.66;P＜0.01,respectively).No significant differences in serum leptin, IL-6 and CRP were found between the clinical remission group and the normal control group (q=1.02,1.04, 0.61,P＞0.05,respectively);The concentrations of serum NO were significantly higher at clinical remission group than those of the normal control group (q=11.31,P＜0.01).② There was no significant difference in the concentrations of serum leptin,IL-6 and CRP at the acute stage of KD than those in patients with and without coronary artery lesions (q=1.17,1.92,1.60,P＞0.05).The concentrations of serum NO were significantly higher at the acute stage of KD with coronary artery lesions than those of KD without coronary artery lesions (q=6.91,P＜0.01).③ The concentrations of serum leptin in children with juvenile idiopathic arthritis or Henoch-Scholeion purpura were signifietantly higher than those of the normal control group (t=13.26,P＜ 0.01).No significant differences in serum leptin were found between children with juvenile idiopathic arthritis or Henoch-Seholeion purpura and children with KD (t=1.28,P＞0.05).④ Correlation was found between serum leptin values and levels of the following parameters (P＜0.01);NO (r=0.69),IL-6 (r=0.55),CRP (r=0.42).However,there were no associations between leptin and leukocytes (r=0.21,P＞0.05) or serum albumin level (r=-0.24,P＞0.05).Association was found between serum NO and IL-6 (r=0.45,P＜0.01)or CRP(r=0.49,P＜0.01).Conclusion These results suggest that leptin,NO and IL-6 may have a role in the immunoinflammatory process of KD,especially in the acute phase.Further in vivo and in vitro studies are needed to establish the roles of leptin,NO and IL-6 in the pathogenesis of KD.

Objective To investigate the effects of different doses of ulinastatin on severe thermal injuryinduced myocardial damage in rats. Methods One hundred and eighty female SD rats weighing 180-220 g were usedin this study. Thirty percent of the total body surface (TBS) was shaved chemically with 20% sodium sulphate and then exposed to 92 ℃ water for 18 s. The animals with third degree thermal injury involving 30% of the TBS were randomly divided into 3 groups (n = 60 each): group Ⅰ thermal injury (group TI); group Ⅱ and Ⅲ received intraperitoneal ulinastatin 40 000 and 80 000 U/kg respectively immediately after thermal injury (group U1 , U2). The TI group received equal volume of normal saline IP instead of ulinastatin. Blood samples were taken from abdominal aorta before (baseline) and at 1, 3, 6, 12 h after thermal injury for determination of serum concentrations of cTnI, IL-1β, IL-6, IL-10 and TNF-α (10 samples at each time points). Ten animals were sacrificed at each time point after blood sampling. The myocardial specimens were obtained for microscopic examination and measurement of MDA content and SOD activity. Results Compared with group TI, the serum concentrations of cTnI, IL-1β, IL-6 and TNF-α and MDA content in myocardium were significantly decreased and the myocardial SOD activity was significantly increased in group U1 , while in group U2 the senum concentrations of cTnI, IL-Iβ, IL-6 and TNF-α and myocardial MDA content were significantly increased and the myocardial SOD activity was significantly decreased. There was no siginificant difference in the serum concentrations of IL-10 among the three groups. Microscopic examination showed that myocardial damage was accentuated in group U2 as compared with group U1. Conclusion Ulinastatin 40 000 U/kg can ameliorate severe thermal injury-induced myocardial injury through inhibition of inflammatory response and lipid peroxidation response, whereas ulinastatin 80 000 U/kg accentuates myocardial damage.

Objective To evalute the incidence and epidemiologic characteristics of Kawasaki disease (KD) in Wenzhou,China.Methods We used a questionnaire survey and reviewed the medical records and reports of all patients with KD diagnosed during the 10 year periods from January,2001 to December,2010.Results We studied 827 inpatients diagnosed with KD during the 10-years period from 2001 to 2010.There were 613 cases (74.12％) with complete KD.The ratio of male to female ratio was 2.28∶1.Age at onset ranged from 37 days to 13 years old,and the peak age group was 1 year old.The disease occurred in all of the seasons,but the peak was from April to June.The incidence of cardiovascular damage in acute KD was 34.6％,and the most common sequela was coronary artery dilatation.There were16 patients with coronary aneurysm.Fifty-three patients did not respond to immunoglobulin (6.4％),and 12 patients (1.5％) developed recurrent KD.After treatment,114 cases (13.8％) developed neutropenia.There were no deaths during hospitalization.Conclusion Patients with KD has become more and more in Wenzhou.Cardiovascular damages were similar to those in Beijing and Guangzhou,but higher than that reported in Japan.