Clinical skills training is a key factor for improvement of the quality of clinical teaching.Developing highly specific clinical skills training specification is an important step to improve the quality of gynecologic oncology clinical teaching.Based on its importance,a'four steps training strategy,known groups-building specification-train thinking-make a request is developed and used by Dept.of Obsterics and Gynecology,the 3rd Affiliated Hospital,Kunming Medical University.It guides students to achieve the basic theory,basic knowledge and basic skills through a comprehensive way,and it also encourages students with highly learning initiative of gynecologic oncology clinical skills.On the other side,in the clinical skills training will lead teachers to develop their thinking and enhance the enthusiasm of teaching.This method provides a new sight for gynecologic oncology clinical skills training in a new manner.

Objective To evaluate the effect of clonidine added to ropivacaine for epidural anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients aged 24-62 yr, weighing 50-76 kg, scheduled for elective gynecological surgery under epidural anesthesia were randomly assigned to one of four equal groups of 15 patients each, according to the dose of clonidine added to ropivacaine solution: group 1 (R) received no clonidine and served as control; group 2-4 in which clonidine 50, 100 or 150 ug was added to 0.75% ropivacaine 25 ml (R-C 50, R-C 100, R-C 150). Epidural anesthesia was performed at L2-3. Epidural catheter was inserted into epidural space and advanced in cephalad direction for 3.5 cm. Ropivacaine solution was prepared and provided by a specially designated person. A test dose of 5 ml of ropivacaine was given. 5 min later when epidural placement of catheter was confirmed, the rest 20 ml of ropivacaine was given in fractions of 5 ml every 2-3 min. At the beginning of operation midazolam 2.5-3.5 mg was given iv. During operation if the patient felt uncomfortable when viscera were being pulled, ketamine 0.5 mg? kg-1 was given iv. The onset and duration of analgesia, the height of black, the degree of motor block as well as adverse effects were recorded. Results The onset time of motor block was significantly shorter, the duration of analgesia was significantly longer, the incidences of visceral pain and shivering were significantly lower and ketamine requirement was significantly reduced in group R-C 100 and R-C 150 as compared with group R. However the incidence of hypotension, the amount of fluid infused and epinedrine requirement were significantly increased in group R-C 150. Conclusion The addition of clonidine 100 ug to 0.75 % ropivacaine 25 ml improves the effect of epidural block without increasing adverse effects.

Objective To investigate the influence of acute hypervolemic hemodilution (AHH) on pharmacodaynamics of cisatracurium in patients undergoing general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-60 yr scheduled for major abdominal surgery under general anesthesia were randomly allocated into 2 groups (n = 30 each): control group and AHH group. Each group was further divided into 3 subgroups according to the initial dose of cisatracurium (30, 40, 50 μg/kg) . The radial artery and right internal jugular vein were cannulated. BP, HR, CVP, SpO_2, P_(ET) CO_2 and body temperature were continuously monitored. The response of left adductor pollicis muscle to TOF stimulation of ulna nerve was monitored using TOF- Watch~R SX (Organon). Both groups received 10 ml/kg multiple electrolyte solution (plasma-Lyte A) during induction of anesthesia. In group AHH 15 ml/kg 6% hydroxyethyl starch (HES) 130/0.4 solution was infused via internal jugular vein over 30-40 min in addition to plasma-Lyte A. Five minutes after completion of plasma-Lyte A or HES, cisatracurium 30, 40 or SO fig/kg was injected iv in the respective subgroups. After the maximal T_1 block was achieved, the second dose was given to reach a total dose of 100 μg/kg. The onset time, duration of clinical action, total duration of action and recovery index were recorded. The doses for 50% , 90% and 95% T_1 depression (ED_(50), ED_(90), ED_(95)) were calculated by Probit method. Results The ED_(50), ED_(90), ED_(95) of cisatracurium were significantly higher in AHH group than in control group. The onset time of cisatracurium was significantly longer but clinical and total duration of action was significantly shorter in AHH group than in control group. There was no significant difference in recovery index between the two groups. Conclusion AHH can decrease the potency of cisatracurium.

Objective:To observe the effect of old RBCs transfusion on cognitive function in rats and the improvement effect of mi -nocycline.Methods: Male SD rats at the age of 6 months were randomly divided into 4 groups.The RBCs were obtained from male rats by centrifuging the total blood and stored at 4℃.The rats of fresh RBCs group (group F) were transfused with the RBCs stored for 1 day.The rats of old RBCs group (group O) were transfused with the RBCs stored for 7 days.The rats of treatment group (group T) received 40 mg· kg-1 minocycline with intraperitoneal injection before the transfusion .The rats of the control group ( group C) were transfused with the normal saline .The brain levels of IL-1βand IL-6 were determined with Quantikine ELISA kits in 24 hours after the blood transfusion (n=6).The rats were subjected to Barnes maze tests after 1 week of the blood transfusion (n=10).Results:The brain levels of IL-1βand IL-6 in group O were higher than those in group C and F (P<0.05), which were lower in group T than those in group O(P<0.05).The rats of group O spent longer time finding the target box than those of group C and F in the Barnes maze (P<0.05), and the time was shorter in group T than that in group O (P<0.05).Conclusion: Old RBCs transfusion plays a role in neuro-inflammation and induces cognitive dysfunction in rats , which may be improved by minocycline .

Objective To understand information of initial sexual behavior age of females in Linxiang district of Yunnan province and investigate HPV and HPV vaccine awareness of rural women ,health workers and government staff .Methods During Decem-ber 2009 to December 2010 ,750 cases aged from 15 to 59 years included rural women ,government officials and medical staff in Linxiang district were randomly selected and investigated .Results The age of first sex was (22 .4 ± 2 .3) years old .The number of sexual partners was (1 .2 ± 0 .3) and proportion of premarital sex was low (8 .8% ) .HPV vaccine awareness of rural women was 8 .59% .The proportion of people who knew HPV vaccine could prevent cervical cancer was 6 .57% .The proportion of people who wanted to be vaccinated was 97 .66% .The cost of HPV vaccine which rural women could accept was 300 yuan .Conclusion Women in Linxiang area of Yunnan province have less premarital sex and lack of awareness in HPV .

Objective To compare the effectiveness and safety of Onyx and n-butyl-2-cyanoacryhte (NBCA) for the embolization of cerebral arteriovenous malformations (AVMs).Methods The clinical data of 53 patients with cerebral AVMs (31 in the NBCA group and 22 in the Onyx group) were analyzed retrospectively.The safety and effectiveness of the 1-year follow-up were compared.The size of AVMs (diameters ＜3 cm,3-6 cm,and ＞6 cm) and the Spetzler-Martin grade were used to conduct subgroup analysis.Results There were no significant differences in the baseline data and AVM morphologies.The embolization rate in the Onyx group was significantly higher than that in the NBCA group (P ＜ 0.05),but there were no significant differences in the incidences of postoperative hemorrhage (1/22 vs.1/31;P=1.000)and neurological deficit (1/22 vs.3/31;P=0.633) in the 1-year follow-up after procedure.The subgroup analysis showed that the embolization rates of the small and medium-sized cerebral AVMs in the Onyx group were significantly higher than those in the NBCA group (all P ＜ 0.05),and the embolization rates of cerebral AVMs with different Spetzler-Martin grades in were significantly higher than those in the NBCA group (all P ＜0.05).Conclusion Onyx is equivalent to NBCA in safety but better in efficacy.

Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; Pleural Effusion

Objective To establish a rabbit model of acute lung injury induced by one-lung ventilation (OLV) .Methods Sixteen New Zealand white rabbits weighing 2.3-2.7 kg were randomly divided into 2 groups (n=8 each):conventional tidal volume(VT) group (group Ⅰ) and high VT group (group Ⅱ).All the rabbits were tracheostomized and a tracheal tube was inserted into the right bronchus for right lung ventilation in the two groups. VT was set at 6 ml/kg in group Ⅰ and at 12 ml/kg in group Ⅱ and the other ventilatory parameters were the same in the two groups (FiO2 50% , RR 40 bpm, I∶E=1∶2). Immediately before OLV(T0) and at 1, 2 and 3 h of OLV (T1-3), peak airway pressure was measured and arterial blood samples were taken for blood gas analysis and oxygenation index (OI) was calculated. The animals were sacrificed at 3 h of OLV and lung tissues obtained for microscopic examination.The lung injury was scored. W/D lung weight ratio was calculated. Bron-choalveolar lavage fluid (BALF) was collected for measurement of protein concentrations and neutrophil counts. Results The peak airway pressure was significantly higher at T1-3 in group Ⅱ and OI was significantly lower at T2,3 in the two groups than those at T0(P＜0.05) .W/D lung weight ratio and lung injury scores of the right lung were significantly lower than those of the left lung in the two groups(P＜0.05).The peak airway pressure was significantly higher at T1-3, OI was significantly lower at T3, and W/D lung weight ratio, protein concentrations and neutrophil counts in BALF and lung injury scores of the right lung were significantly higher in group Ⅱ than in group Ⅰ(P＜0.05). Conclusion OLV with VT of 12 ml/kg for 3 h can successfully establish a rabbit model of acute lung injury.

This study was aimed to find the fragmentation pathways of Schisandrin B using the Discovery Studio by electrospray ionization mass spectrometry (ESI-MSn). The first and multi-stage mass spectrum diagrams were obtained. The results showed that mass spectrometry fragments of Schisandrin B was analyzed under the positive mode, the cracking rings are mainly occurred, and free radicals such as H2O, -CH3 and -OCH3 were lost. It was concluded that this study enriched the mass spectral decomposition, and provided basis for the study on chemical constituents of lignan compounds.

ObjectiveTo explore the effect of acupuncture combined with training of the modified rehabilitation apparatus on upper limb motor function of patients with ischemic stroke.Methods86 patients with ischemic stroke were divided randomly into the treatment group ( treated by acupuncture combined with training of the rehabilitation apparatus) and the control group (treated by simple acupuncture). The upper limb motor function of two groups was evaluated by Fugl-Meyer Assessment (FMA) before and after treatment.ResultsAfter 28 days treatment, scores of FMA of two groups were all raised significantly, but it was significantly greater for the treatment group than the control group (P<0.01).ConclusionIt is shown that acupuncture combined with training of the rehabilitation apparatus can improve the upper limb motor function and activity of daily living of patients with ischemic stroke.