Objective To study the effects of patient-controlled intravenous analgesia (PCIA) on plasma endothelin-1 (ET-1) of patients after mitral valve replacement.Methods One hundred and twenty ASA Ⅱ -Ⅲ patients undergoing mitral valve replacement were randomly divided into four groups, 30 cases in each group. The patients were given PC IA with lornoxicam 16 μ g/(kg·h ) in group L, fentanyl 0.2 μ g/( kg·h) in group F, tramadol 0.2 mg/(kg·h) in group T,and without PCIA in group D. VAS score and Ramsay score were recorded at 8,12,24 and 48 h after operation.The plasma ET-1 levels were detected using radioimmunoassay before anesthesia induction,at 8,12 and 24 h after operation.Results VAS scores in group L, F,T were lower at 8,12 h after operation than those in group D,Ramsay scores in group L, D were lower than those in group F,T.ET-1 levels in group L,F and T were significantly lower than those in group D at 8,12 and 24 h after operation (P <0.05).The numbers of dizziness, nausea,vomiting after operation in group L[3.3%(1/30) ,3.3%( 1/30),0]and group D(0)were significantly less than those in group F[13.3% (4/13), 13.3%(4/13), 10.0%(3/30)]and group T[10.0%(3/30), 26.7%(8/30), 16.7%(5/30)](P < 0.05).Conclusion PCIA with lornoxicam is a better method of suppressing the increase of plasma ET-1 levels with less side effects in the patients after mitral valve replacement.

Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.

Objective To investigate the application of repeated myocardial perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation. Methods Fifteen cases met difficult cardiac resuscitation after release of aortic cross-clamping under open heart operation were analyzed retrospectively. They were perfused with or without repeated aortic clamping, with warm blood cardioplegic solution until electric activity of cardiac muscle stop. Results All cases got cardiac resuscitation and detached from-cardiopulmonary bypass (CPB) successfully,9 cases perfused with warm blood cardioplegic solution without repeated aortic clamping got cardiac resuscitation automatically(7 cases) or after defibrillation for one time (2 cases),5 cases experiencing repeated aortic clamping and perfused with warm blood cardioplegic solution for two times got cardiac resuscitation automatically (3 cases) or after defibrillation for one time (2 cases) and another one experiencing for four times. Conclusion Application of repeated perfusion on difficult cardiac resuscitation after aortic unclamping under open heart operation is effective.

Objective To observe the effects of different hypothermia on cerebral oxygen metabolism during cardiopulmonary bypass(CPB).Methods 20 patients undergoing valvular replacements were randomly divided in two groups:shallow hypothermia group(30℃) and middle hypothermia group(26℃).Blood gas analysis and lactate concentration in arterial and internal jugular vein blood were monitored at 3 time points during operation,from which the arterial-internal jugular venous oxygen content difference(Ca-jvO 2),cerebral oxygen extraction ratio(ERO 2),cerebral lactate production(ADVL) were calculated.Results CaO 2,Ca-jvO 2 and ERO 2 of the two groups were significantly reduced(P0 05) at the same time points.Ca-jvO 2 at the T 3 time point was both lower(P

Objective To explore the effect of femtosecond laser-assisted in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)femtosecond laser in the treatment of myopic astigmatism with thin cornea.Methods From September 2022 to September 2023,128 pa-tients with thin cornea myopic astigmatism in the hospital were selected and randomly divided into FS-LASIK group(64 cases,128 eyes,receiving FS-LASIK)and SMILE group(64 cases,124 eyes,receiving SMILE).The visual acuity[uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA)]before surgery and at 1 year after surgery,refractive parameter spherical equivalent(SE)at 3,6 and 12 months after surgery,corneal surface morphology[average corneal curvature(KAve),surface regularity index(SRI),surface asymmetry index(SAI)]before surgery and at 1 year after surgery,corneal biomechanic indicators[corneal expansion comprehensive deviation analysis index(BAD-D),corneal biomechanical index(CBI),total biomechanical index(TBI)]and corneal injury degree[corneal endothelial cell count,corneal endothelial cell size,coefficient of variation(C V)]and differences in postoperative astigmatism correction vector indicators[magnitude of error(ME),angle of error(AE),correction index(CI),and index of success(IOS)]were compared.Residual stromal bed thickness and the incidence of complications after surgery were recorded.Results One year after surgery,both UCVA and BCVA in both groups were improved compared with preoperation(P＜0.05),but there were no significant between-group differences(P＞0.05).At 3,6,and 12 months postoperatively,the SE levels in both groups were higher than preoperation(P＜0.05);however,there were no statistically significant differences in SE levels between the groups at above time points(P＞0.05).One year after surgery,KAve,SRI,and SAI in both groups were lower than preoperative levels,and the SMILE group was lower than those in the FS-LASIK group(P＜0.05).One year after operation,BAD-D and TBI in both groups were higher than preoperative levels,while CBI was lower than preoperative levels;however,BAD-D and TBI in the SMILE group were lower than those in the FS-LASIK group,and CBI was higher than that in the FS-LASIK group(P＜0.05).One year after surgery,corneal endothelial cell counts in both groups were lower than preop-erative levels,and CV of corneal endothelial cell size was higher than preoperative levels;however,corneal endothelial cell count in the SMILE group were higher than those in the FS-LASIK group,and the CV of corneal endothelial cell size was lower than that in the FS-LASIK group(P＜0.05).There were no statistically significant differences in ME,AE,CI,and IOS between the two groups(P＞0.05).The residual stromal bed thickness was(302.01±55.03)μm in the FS-LASIK group and(310.23±46.03)μm in the SMILE group after surgery,with no statistically significant be-tween-group difference(t=1.284,P=0.200).One year after surgery,there were 5 cases of dry eye in the FS-LASIK group and 2 cases in the SMILE group,with no statistically significant differ-ence in incidence of dry eye between the two groups(x2=1.227,P=0.268).Conclusion For patients with myopic astigmatism with thin cornea,both FS-LASIK and SMILE can achieve satisfac-tory improvement in visual acuity and refractive state,and the latter one has a relatively small impact on the integrity of corneal structure,biomechanical stability and surgical injury.

Objective To explore the effect of femtosecond laser-assisted in situ keratomileusis(FS-LASIK)and small incision lenticule extraction(SMILE)femtosecond laser in the treatment of myopic astigmatism with thin cornea.Methods From September 2022 to September 2023,128 pa-tients with thin cornea myopic astigmatism in the hospital were selected and randomly divided into FS-LASIK group(64 cases,128 eyes,receiving FS-LASIK)and SMILE group(64 cases,124 eyes,receiving SMILE).The visual acuity[uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA)]before surgery and at 1 year after surgery,refractive parameter spherical equivalent(SE)at 3,6 and 12 months after surgery,corneal surface morphology[average corneal curvature(KAve),surface regularity index(SRI),surface asymmetry index(SAI)]before surgery and at 1 year after surgery,corneal biomechanic indicators[corneal expansion comprehensive deviation analysis index(BAD-D),corneal biomechanical index(CBI),total biomechanical index(TBI)]and corneal injury degree[corneal endothelial cell count,corneal endothelial cell size,coefficient of variation(C V)]and differences in postoperative astigmatism correction vector indicators[magnitude of error(ME),angle of error(AE),correction index(CI),and index of success(IOS)]were compared.Residual stromal bed thickness and the incidence of complications after surgery were recorded.Results One year after surgery,both UCVA and BCVA in both groups were improved compared with preoperation(P＜0.05),but there were no significant between-group differences(P＞0.05).At 3,6,and 12 months postoperatively,the SE levels in both groups were higher than preoperation(P＜0.05);however,there were no statistically significant differences in SE levels between the groups at above time points(P＞0.05).One year after surgery,KAve,SRI,and SAI in both groups were lower than preoperative levels,and the SMILE group was lower than those in the FS-LASIK group(P＜0.05).One year after operation,BAD-D and TBI in both groups were higher than preoperative levels,while CBI was lower than preoperative levels;however,BAD-D and TBI in the SMILE group were lower than those in the FS-LASIK group,and CBI was higher than that in the FS-LASIK group(P＜0.05).One year after surgery,corneal endothelial cell counts in both groups were lower than preop-erative levels,and CV of corneal endothelial cell size was higher than preoperative levels;however,corneal endothelial cell count in the SMILE group were higher than those in the FS-LASIK group,and the CV of corneal endothelial cell size was lower than that in the FS-LASIK group(P＜0.05).There were no statistically significant differences in ME,AE,CI,and IOS between the two groups(P＞0.05).The residual stromal bed thickness was(302.01±55.03)μm in the FS-LASIK group and(310.23±46.03)μm in the SMILE group after surgery,with no statistically significant be-tween-group difference(t=1.284,P=0.200).One year after surgery,there were 5 cases of dry eye in the FS-LASIK group and 2 cases in the SMILE group,with no statistically significant differ-ence in incidence of dry eye between the two groups(x2=1.227,P=0.268).Conclusion For patients with myopic astigmatism with thin cornea,both FS-LASIK and SMILE can achieve satisfac-tory improvement in visual acuity and refractive state,and the latter one has a relatively small impact on the integrity of corneal structure,biomechanical stability and surgical injury.

To implement the strategy of healthy China and promote the construction of "new medicine science", it is urgent to focus on new needs and challenges to advance the reform of medical education curricula in China. Using literature research methods, we summarize the process of modern medical education curriculum reforms in the United States, and discuss the main features of the third-round reforms—introducing the concept of value-based medicine, offering health systems science courses, and promoting the curriculum system reform from the perspectives of learning time, curriculum integration, and learning methods. Based on these features, we put forward the enlightenment for the reform of medical education curricula in China.