Clinical practice of anesthesia is an important phase for interns to be professional physicians.In order to improve teaching quality of anesthesiology,we should attach great importance to following three aspects:stressing medical ethics and standardize medication,inspiring activity of the students,reinforcing self-construction of the teachers.Mutual action between teaching and learn-ing can only bring about the improvement of teaching quality in anesthesiology.

Objective To investigate the effect and safety of Guard wire technology in percutaneous coronary intervention( PCI) of ostial lesions and the treatment of passing ostial lesions. Methods Thirty?five cases patients needing PCI of ostial lesions were selected and divide randomly in to A group(n=18) and B group(n=17) . A group used Guard wire technology and B group used common method. The X?ray exposure time,complications,the amount of contrast agents of two groups were analyzed. Forty?six cases patients needing the treatment of passing ostial lesions were divided randomly into C group( n=25) and D group( n=21) . C group used Guard wire technology and D group used common method. Complications of two groups were investigated. Results The X?ray exposure time, the amount of contrast agents and complications of A group were fewer than that of B group,the difference were significant((5. 7±0. 6) min vs. (9. 3±1. 1) min,(84. 3 ±6. 4) ml vs. (94. 1±10. 0) ml,6%(1/18) vs. 35%(6/17);t or χ2=-11. 80,-3. 50,4. 80;P<0. 05). The complications of C group was lower than that of D group,and the difference was significant( 4%( 1/25) vs. 29%( 6/21);χ2=5. 30,P<0. 05) . Conclusion Guard wire technology is safe and useful in percutaneous coronary intervention of ostial lesions and the treatment of passing ostial lesions,and it is feasible in clinical practice.

Objective To investigate the effects of levosimendan on percutaneous coronary intervention ( PCI) in patients with ischemic heart failure. Methods From January 2013 to June 2016,eighty patients with ischemic heart failure undergoing coronary intervention in Pingdingshan People′s Hospital No. 1 were randomly divided into treatment group ( 40 cases) and control group ( 40 cases) . The treatment group was treated with levosimendan on the basis of routine medicine 2 days before operation,and the control group was given routine medication before operation. The baseline clinical data, operative success rate, complications, left ventricular ejection fraction ( LVEF%) after 1 month, 6 min walking distance, plasma brain natriuretic peptide ( BNP ) , creatinine and other cardiac and renal functions were observed and compared between the two groups. Results The differences of the baseline clinical characteristics including age (65. 5±3. 9 vs. 63. 9±3. 6),male (26 cases (65. 0%) vs. 23 cases (57. 5%) ),hypertension (21 cases (52. 5%) vs. 19 cases (47. 5%) ),diabetes (17 cases ( 42. 5%) vs. 14 cases ( 35. 0%) ) , hyperlipidaemia ( 30 cases ( 75. 0%) vs. 29 cases ( 72. 5%) ) , smoking (21 cases (52. 5%) vs. 19 cases (47. 5%) ),COPD (7 cases (17. 5%) vs. 6 cases (15. 0)%), LDL?C ( (4. 5±1. 0) mmol/L vs. (4. 4±1. 1) mmol/L),BMI ( (25. 9±3. 3) vs. (25. 6±3. 5) ) were not significant (t/χ2=1. 30,0. 47,0. 20,0. 47,0. 07,0. 20,0. 09,0. 49,0. 39,P=0. 20,0. 49,0. 66,0. 49,0. 80, 0. 66,0. 76, 0. 63, 0. 70 ) . There was no significant difference in coronary artery lesion between two groups, including single vessel lesion (11 cases (27. 5%) vs. 15 cases (37. 5%) ),double vessel lesion ( (22 cases ( 55. 0%) vs. 19 cases ( 47. 5%) ) ,three vessel lesion ( ( 7 cases ( 17. 5%) vs. 6 cases ( 15. 0%) ) and left main coronary artery disease (7 cases (17. 5%) vs. 6 cases (15. 0%) ) (Z=-0. 88,P=0. 38). The time of percutaneous coronary intervention ( ( 51. 0±8. 6) min vs. (49. 6 ±9. 6) min),the time of X?ray exposure ( (20. 3±7. 0) min vs. (18. 4±5. 6) min),material consumption ( (123. 2±16. 6) ml vs. (117. 3±25. 1) ml) between two groups have no difference ( t/χ2=0. 70,1. 39,1. 24,P=0. 49,0. 17,0. 22) . There were significant differences between the two groups in the success rate of operation ( 38 cases ( 95. 0%) vs. 31cases ( 77. 5%) , heart failure ( 1 cases ( 2. 5%) vs. 6cases ( 15. 0%) ) and complications ( 2 cases ( 5. 0%) vs. 11 cases (27. 5%) ) (χ2=5. 17,3. 91,7. 44,P=0. 02,<0. 05,<0. 01). Compared with the control group,the treatment group had greater advancement in LVEF,6 min walking distance,BNP and creatinine level at one month after operation ( F=6. 10,63. 60,51. 00,348. 00,P=0. 02,<0. 01,<0. 01,<0. 01) . Conclusion Levosimendan can effectively improve the heart function and renal function, improve the success rate of PCI in patients with ischemic heart failure and reduce the incidence of complications.

OBJECTIVE:To investigate therapeutic efficacy of bifidobacteria triple viable bacteria combined with infliximab in the treatment of moderate and severe ulcerative colitis(UC),and its effects on immune function. METHODS:Seventy-two UC pa-tients were selected from gastroenterology department of the First Affiliated Hospital of Chongqing Medical University during Jun. 2009 to Jan. 2015. They was divided into single group and combination group according to therapy plan,with 36 cases in each group. Single group was given infliximab 5 mg/kg,ivgtt,on 0,2nd,6th,8th week. Combination group was additionally given bi-fidobacteria triple viable bacteria 420 mg,tid. Both groups were treated for consercutive 2 months. Clinical efficacies were com-pared between 2 groups as well as the levels of humoral immunity and T cell function. The occurrence of ADR was observed in 2 groups. RESULTS:Clinical response rate of combination group was 86.11%,which was significantly higher than 52.78% of single group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in humoral immunity and T cell function between 2 groups(P>0.05). After treatment,the levels of CD4+ and CD4+/CD8+ were significantly increased in both 2 groups,while the levels of CD8+,Th1 and Th2 were significantly decreased;the combination group was significantly better than the control group,with statistical significance (P<0.05);there was no statistical significance in CD3+ between 2 groups before and after treatment(P>0.05). After treatment,the levels of IgA and IgG were increased significantly in 2 groups,and the level of C3 was decreased significantly;the combination group was significantly better than the control group,with statistical significance (P<0.05);there was no statistical significance in IgM content and C4 level between 2 groups before and after treatment (P>0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Bifidobacteria triple viable bacteria combined with infliximab shows significant therapeutic efficacy in the treatment of moderate and severe UC, and can significantly improve humoral immunity function and the recovery of T cell level,with good safety.

Objective To study the correlation between early cognitive function and severity of pain in elderly patients after operation. Methods Selective open abdominal operation was performed in 30 elderly patients admitted to our department from January 2009 to June 2009. Severity of pain was assessed using visual analogue scale ( VAS) and cognitive function was scored with Mini-Mental State Examination ( MMSE) ,animal fluency test ( AFT) and clock drawing test ( CDT) ,respectively,in 24 and 48 h after operation. Cognitive function of the patients was assessed from the view of neurophysiology. Pain was scored after operation with VAS. Variables were analyzed with the linear correlation analysis. Correlation between early cognitive function and severity of pain in elderly patients was observed after operation. Results No linear correlation was observed between scores on MMSE,VAS and AFT scales in 24 and 48 h after operation ( r = -0. 053,P = 0. 786; and r = -0. 052,P = 0. 783; and r = -0. 323,P = 0. 082; and r = -0. 038,P = 0. 841). A negative linear correlation was found between scores on CDT and VAS scales in 24 and 48 h after operation ( r = -0. 731,P =0. 000; and r = -0. 636,P = 0. 001). Conclusion Cognitive function including visual space structure function and implementing function in elderly patients after operation is correlated with the pain scores on VAS scale.

Objective To evaluate the feasibility and therapeutic effect of kyphoplasty in treating severe osteoporotic vertebral compressive fractures. Methods Thirty-five patients (48 vertebral bodies) with severe osteoporotic compressive fractures were included. There were 33 females and 2 males with the mean age of 74.2 years. The average compressive rate of the affected vertebral bodies was 77.0%. The thoracolumbar vertebrae were treated with kyphoplasties. Percutaneous puncture direction was adjusted according to compressive rate and shape of the vertebral bodies. The inflatable bone tamp was inserted into the fractured vertebral body. The balloon was inflated with low pressure and dilate-relieve-dilate method was applied. The balloon was deflated and withdrawn, leaving a cavity within the vertebral body, which then fulfilled with visualized bone cement. Preoperative and postoperative symptom level, complications and radiographic findings were recorded. Results All 35 patients tolerated procedure well. The mean heights of the anterior, mid and posterior vertebral body had improved from (0.8±0.1) cm, (0.8±0.2) cm, (2.1 ±0.8) cm preoperatively to (1.2±0.3) cm, (1.3±0.2) cm, (2.3±1.0) cm respectively after operation (P ＜0.05). There was significance difference between preoperative and postoperative heights of the anterior and mid vertebral body. The mean kyphosis was improved from 28.2°±5.2° before operation to 19.1°±4.9° after operation. Conclusion Kyphoplasty is feasible and effective for severe osteoporotic vertebral compressive fractures.

Objective To observe the clinical therapeutic outcomes and the radiographs changes of lumbar degeneration disease treated by dynamic stabilization device (Wallis). Methods Eighty-four cases of lumbar degeneration disease were treated by threaded fusion cage, from May 1997 to May 2002. The JOA scores, the rate of fusion,cage sink and adjacent segment degeneration were observed. Results The average hospitalizotion was 23.59 days. The mean operation time was 3.00 hours. The mean JOA scores were 13.93 before the operation,while 26.69 on the end of the following time respectively; there was statistical significant. The mean motion of operative segment was 5.22 before operation, while 2.44 on the end of the following time respectively. The mean extension of operative segment was 3.32 before operation ,while 1.39 on the end of the following time respectively. The mean motion of adjacent segment was 3.68 before operation, while 6.54 on the end of the following time respectively. The mean extension of adjacent segment was 1.95 before operation,while 3.95 on the end of the following time respectively. There were all statistical significant on those changes of Cobbs angel. Conclusions The long-term therapeuptic effect of WALLIS treatment for lumbar degeneration disease is reliable. The motion of operative segment was significant decreased, especially on extension. The motion of adjacent segment was significant increased, the degree extension of adjacent segment was also significant increased.

BACKGROUND:Preliminary data showed that the application of human platelet lysate to human umbilical cord mesenchymal stem cell culture can better maintain the characteristics of stem cells than the application of serum-free medium. However, the serum-free medium can better improve the proliferation of mesenchymal stem cells in vitro than the human platelet lysate.OBJECTIVE:To screen out a better mesenchymal stem cell cultivation system that can greatly maintain the characteristics and proliferation rate of human umbilical cord mesenchymal stem cells.METHODS:Six human umbilical cord specimens were inoculated in six culture systems, and the primary culture of umbilical cord mesenchymal stem cell was performed. These six culture systems were respectively MesenCult serum-free medium with 2% human platelet lysate (group A), StemPro serum-free medium with 2% human platelet lysate (group B), MesenCult serum-free medium (group C), StemPro serum-free medium (group D), low glucose-DMEM with 10% fetal bovine serum (group E), low glucose-DMEM with 10% human platelet lysate (group F). The cells were subcultured at 14 days after inoculation to compare the effects of different culture systems on the morphology, surface markers, differentiation and proliferation of human umbilical cord mesenchymal stem cells.RESULTS AND CONCLUSION:(1) The morphology of passage 3 cells in group D was elongated and uneven in size. The morphology of passage 3 cells was flattened in groups E and F, but the cells in the other groups were spindle-shaped and uniform. There were no significant changes in morphology and size between passage 3 and 5 cells in A and B. In group C, the morphology of passage 5 cells was more flattened and uneven in size compared with passage 3 cells. In group D, the morphology of passage 5 cells was more elongated than that of passage 3 cell. In group E, the morphology of passage 5 cells was more flattened than that of passage 3 cells. There was no significant difference in morphology between passage 3 and 5 cells in group F. (2) The expression rate of cell surface markers had no significant difference at different passages in each group. (3) The adipoinduction and osteoinduction rates were relatively higher in groups A and B compared with groups E and F, and lowest in groups C and D. (4) The cell proliferation rate for each passages in group A was significantly higher than that in group C. The cell proliferation rate for each passage in group B was significantly higher than that in group D. The cell proliferation rate for each passage in groups E and F was significantly lower than that in groups A and B. To conclude, these results suggest that the combination of serum-free medium with human platelet lysate could better maintain the characteristics and the proliferation efficiency of mesenchymal stem cells.

Objective To compare the clinical value of early enteral nutrition and parenteral nutrition therapy in postoperative patients of cholangiocarcinoma.Methods 56 cases of cholangiocarcinoma patients were randomly divided into early enteral nutrition group (EPN group) and parenteral nutrition group (PN group).All patients received nutritional support on the basis of metabolic support.Leukocyte count and neutrophil percentage decrease rate,total bilirubin decrease rate and hepatase (valley-C conversion) were counted at 3 and 7 days after operation.The decrease rate of aminase and glutamic oxaloacetic transaminase,recovery time of intestinal function (anal exhaust and defecation),incidence rate of surgical site infection (abdominal cavity and wound),hospitalization time after operation,incidence rate of bile leakage and hospitalization cost were compared between the two groups.Results The recovery time of intestinal function [(51.2 ±4.4) h],the decrease rate of leukocyte count (0.438 7 ±0.191 5) and neutrophil ratio (0.179 5 ± 0.046 1),the decrease rate of bilirubin (0.502 5 ± 0.153 5),alanine aminotransferase (ALT) (0.688 1 ±0.113 3),aspartate aminotransferase (AST) (0.617 0 ± 0.178 8) and hospitalization expenses [(87 852.37 ±9 127.04)yuan] in EPN group were better than those in PN group [(72.0 ± 12.9)h,0.090 5 ±0.120 3,0.083 4 ±0.036 8,0.201 5 ±0.077 8,0.251 6 ±0.419 0,0.230 9 ± 0.437,(109 036.69 ± 7 949.71) yuan,P ＜ 0.05].However,the incidence of abdominal distension (42.31％) was higher than that of PN group (13.33％,P ＜ 0.05).The incidence of bile leakage (7.69％) was not significantly different from that of PN group (13.33％,P ＞0.05).Conclusions Early enteral nutrition has obvious advantages in postoperative recovery of patients with cholangiocarcinoma.

Activated-Leukocyte Cell Adhesion Molecule ; Antigens, CD ; Carcinoma, Hepatocellular ; Cell Adhesion Molecules, Neuronal ; Fetal Proteins ; Hep G2 Cells ; Humans ; Liver Neoplasms ; RNA, Small Interfering