Evidence-based anesthesia’s core thinking is to abide by evidence,which means clinical decision must be based on objective research result,personal experiences and patients` actual situation. The thinking of EBA will magnificently promote the conversion of model of clinical anesthediology education,and will make significant influence on clinical teaching,scientific research, and clinical practice. According to the current situation,try to give out new teaching model of evidence-based practice of anesthesiology and offer teaching methods and practical procedures.

BACKGROUND:Although the preparation of bone tissue engineering scaffolds can achieve satisfactory results by solvent casting/particulate leaching, in situ molding method, electrospinning, phase seperation/freeze drying, gas foaming, there are stil some deficiencies in the accuracy, pore uniformity, spatial structure complexity, personalized stents. ＜br> OBJECTIVE:To prepareβ-tricalcium phosphate bone tissue engineering scaffolds using 3D printing. ＜br> METHODS:Drug-loadedβ-tricalcium phosphate scaffolds were prepared with 3D printing, and the structure was observed to measure its porosity and mechanical strength. The scaffold was immersed in simulated body fluid for 15 weeks to observe the quality change. The scaffold was co-cultured with rat bone marrow mesenchymal stem cells for 7 days to observe celladhesion and morphological changes. Rat bone marrow mesenchymal stem cells were cultured in extracts of drug-loadedβ-tricalcium phosphate scaffold and low-glucose Dulbecco's modified Eagle’s medium containing 15%fetal bovine serum for 24, 48, and 72 hours, to determine the absorbance values and cytotoxicity grading, respectively. Meanwhile, the cells were subjected to osteogenic culture for 1 week, and ＜br> the alkaline phosphatase activities in two groups were detected. ＜br> RESULTS AND CONCLUSION:The prepared scaffold showed irregular micropores, high porosity, uniform pore distribution, high pore connectivity rate, and large compressive strength. The drug-loadedβ-tricalcium phosphate scaffold degraded completely with 15 weeks, and cancellous bone defect repair was completed in the same period. Rat bone marrow mesenchymal stem cells adhered to the surface of drug-loadedβ-tricalcium phosphate scaffold and went deep into the scaffold, showing good growth and proliferation. The activity of alkaline phosphatase was also improved. These findings indicate that the drug-loadedβ-tricalcium phosphate scaffold has good biocompatibility.

The essence of training for clinical postgraduates is comprehensive capacity,including clinical and scientific research capacity,and the demand for the former is relatively higher than the latter. By means of discussion on the source and the educational system for postgraduates,we try to train clinical anesthesiology postgraduates with high diathesis and meet the needs of clinical anesthesia.

Clinical practice is an important teaching stage for interns of anesthesiology in medical universities.We discuss advantages and disadvantages for different teaching modes in the course of clinical practice,aiming at choosing a better one to optimize practice quality and bringing up graduates with high diathesis.

[Objective]To summarize the clinical experience on anesthesia techniques for surgery of spinal tumors.[Method]A total of 546 patients undergoing surgery of spinal tumors were retrospectively studied,and the complications of surgery were also collected.[Result]There was no perioperative death.The average degree of blood loss was 1997ml per patient who usually required a large volume of blood transfusion.Acute pumonlary edema were occurred in 3 patients who were suspected to develop larynx edema immediately after operation.A perioperative visual loss following cervical spine surgery was also founded.[Conclusion]It is important to prevent and minimize blood loss by varied techniques during operation.Peventing adverse effect of operative position on patients and protecting their airway are also crucial for spinal surgery.

Objective:To observe the ultrastructure of biological living skin equivalent in vitro.Methods:Keratinocytes and fibroblasts were sourced from the back skin of legally aborted human foetus.Fibroblasts were seeded into bovine type I collagen gel and cultured for 3 days.Keratinocytes were seeded on the surface of collagen gel and cultured for another 2 days,then the equivalent skin was exposed to air-liquid interface to form a protective cornified layer.Histological structure and ultrastructure of the equivalent skin were observed by light microscope and transmission electron microscope.Results:The morphogy of equivalent skin of full thickness consisted of epithlium and dermis.Epithelium was made up of stratum basale,stratum spinosum,stratum granulosum and stratum corneum.lntercellular bridge existed within the cells of different layers.Some ultrastructures in epithelium such as desmosome,Lamelle,tonofibrils and lipid droplet were found in the equivalent skin.Conclusion:Tissue-engineered skin may have the features of natural skin.

ObjectiveTo review the experience with surgical removal of meningiomas in the falx cerebri and sagittal sinuses.MethodsThirteen patients with meningiomas in the falx cerebri and sagittal sinuses were retrospectively analyzed.ResultsTumors in eleven patients were totally removed( Simpson Grade Ⅰ and Ⅱ ),while in two patients they were subtotally resected( Simpson Grade Ⅲ and Ⅳ ).After operations,no patient died.ConclusionAdequate surgical exposure,efficient management of operative bleeding,protection and replacement of the sagittalsinus,and avoidence of damage to the brain tissues were the key factors to improve operative effect.

Objective To observe the effect of intrathecal p38 MAPK inhibitor(SB203580) treatment on neuropathic pain and the expression of p38 MAPK and BDNF in dorsal horn of spinal cord in rats with chronic constriction injury(CCI),So as to investigate the possible mechanisms of neuropathic pain.Methods Totally 30 SD rats were evenly randomized into 3 groups(n=10) :sham group receiving intrathecal injection of sodium chloride,control group receiving intrathecal injection of sodium chloride and CCI surgery,and SB203580 group receiving intrathecal injection of SB203580 and CCI surgery.SB203580(0.1 ml/kg) was administered 0.5 h before and 1-14 d after CCI surgery.The mechanical thresholds were tested 24 h before and 4-14 d after CCI surgery.p38 MAPK expression and BDNF release in the dorsal horn were determined using immunohistochemistry method 14 d after CCI surgery.Results The mechanical thresholds in the control and SB203580 groups were significantly lower after CCI surgery compared with that before CCI surgery(P0.05).Compared with the sham operation group,the mechanical thresholds were significantly lower in the other two groups after CCI surgery(P

Objective To investigate the biochemical properties of rat improved perfusion-acellular pancreatic bioscaffold (APB).Methods The fresh pancreas from 10 rats were perfused through portal vein.The histological structure,ECM composition and DNA quantification of APB were evaluated.For the biocompatibility study,a 0.5 cm2 APB construct was surgically placed within a dorsal subcutaneous pocket of mice.Results The pancreatic tissue become translucent and the macroscopic three-dimensional architectures of native pancreas are retained after decellularization.The extracellular matrix (ECM) ultrastructures were well preserved.Immunofluorescence staining showed that collagen Ⅰ,Ⅳ,fibronectin and laminin were maintained in the APB after decellularization.DNA quantification of APB decreased significantly (P ＜ 0.05).The histological analysis of the subcutaneous implantation site showed the presence of immunological response surrounding the partially degraded APB.The histological remold score was 10.4 ± 1.8 at 14 days and 13.8 ± 1.3 at 28 days.The proliferation of AR42J cell line with the expression of amylase as the marker of exocrine acinar cells can be detected on the recellularized APB.Conclusion APB in this study met the stringent requirement to define a successful decellularization.The technique allowed the efficient generation of APB with preserved 3D architecture and represented a biocompatible scaffold capable of integrating within host tissue.

Objective To compare the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block(BPB).Methods One hundred and twenty patients,ASA Ⅰ-Ⅲ,aged 18-80 yr,scheduled for upper extremity surgeries of both gender,were randomized into two groups(n =60):supraclavicular group(group SCB)and infraclavicular group(group ICB).The anesthetic mixture consisted of ropivacaine 0.375％ and lidocaine 1％ in equal volumes with epinephrine 1∶200 000,the total dose was 0.5 ml/kg.The block performance time,duration of anesthesia and success of anesthesia(surgery was accomplished without supplementary block)were recorded.A blinded observer assessed pinprick sensory block in the seven distal nerve territories(axillary,radial,musculocutaneous,median,ulnar,medial antebrachial and medial brachial cutaneous nerves)every 5 min up to 30 min after injection.Success of nerve block,side effects and complications were recorded during and after operalion.Results Group ICB was superior in success rate of anesthesia and nerve block of ulnar,medial antebrachial and medial brachial cutaneous nerves,the rate of parasthesia was lower and the block performance time was longer compared with group SCB(P ＜ 0.05).No major complications occurred in both groups.Conclusion Under ultrasound guidance,infraclavicular BPB is superior to supraclavicular approach.