Objective To evaluate the effect of alveolar recruitment maneuver on the perioperative pulmonary function in the morbidly obese patients undergoing laparoscopic sleeve gastrectomy.Methods Forty morbidly obese patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,with body mass index ≥ 40 kg/m2,scheduled for elective laparoscopic sleeve gastrectomy,were randomly divided into either control group (group C) or alveolar recruitment maneuver group (group R) using a random number table,with 20 patients in each group.Patients in group C were treated with volume-or pressure-controlled ventilation after creation of pneumoperitoneum,maintaining the peak inspiratory pressure (Ppeak) ≤ 30 cmH2O and partial pressure of end-tidal CO2 35-40 mmHg.Patients in group R received alveolar recruitment maneuver once every 30 min starting from creation of pneumoperitoneum until the end of surgery.Patients were transfered to post-anesthesia care unit (PACU) with endotracheal tube which was extubated when the unified extubation standard was achieved in PACU.The patients who stayed in PACU for 2 h showing no indications for extubation were transfered to intensive care unit for continuous ventilation support.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,and at the end of pneumoperitoneum,blood samples were collected from the radial artery for blood gas analysis.Immediately after intubation,immediately after creation of pneumoperitoneum,at 30,60 and 90 min of pneumoperitoneum,at the end of surgery,and immediately before discharge from PACU,Ppeak,plateau pressure (Peat),and dynamic lung compliance were recorded.The time for achieving extubation standard and time for achieving the standard for discharge from PACU were recorded.Patients were followed up until discharge,and the feeding time and duration of hospital stay were recorded.Results Compared with group C,PaO2 and oxygenation index were significantly increased at 90 min of pneumoperitoneum,at the end of surgery,and immediately before discharge from PACU,Ppeak was decreased at 60 and 90 min of pneumoperitoneum and immediately after the end of pneumoperitoneum,Pplat was decreased at 60 and 90 min of pneumoperitoneum,the dynamic lung compliance was increased at 30,60 and 90 min of pneumoperitoneum and immediately after the end of pneumoperitoneum,and the time for achieving extubation standard,time for achieving the standard for discharge from PACU,feeding time,and duration of hospital stay were shortened in group R (P＜0.05 or 0.01).In group C,one patient did not present with indications for extubation and were transfered to intensive care unit for continuous ventilation support.Conclusion Intraoperative alveolar recruitment maneuver can effectively improve the intraoperative pulmonary function and promote the recovery of postoperative pulmonary function in the morbidly obese patients undergoing laparoscopic sleeve gastrectomy.

The paper described practices in QC management pathway of death cases of the hospital.These refer to intensive education,clarification of access standard,death cases quarterly readings and administrative investigation,strict supervision among others.Authors pointed out that QC pathway can improve quality of care significantly,yet QC pathway calls for fair accountability,systemic care for patient safety,and all-staff involvement in QC improvement.

OBJECTIVE To analyze the high incision infection rate in abdominal operation in order to take effective preventive measures.METHODS Totally 2302 cases of abdominal operation in general surgery were investigated retrospectively from Jan 2005 to May 2007.The diagnosis standard was based on the Diagnosis Standard of Hospital Infection(Draft) published by Ministry of Health of the People′s Republic of China in Jan 2001.RESULTS From them 113 cases suffered incision infection.The infection rate was 4.85%,accounted for 81.54% of all surgical operation incision infections.The pathogenic bacteria in the samples taken during the operation were the same as those in the secretion of postoperative incision in terms of species and source.CONCLUSIONS The key points of prevention of incision infection are sterile operation,flushing of abdominal cavity and enhanced detection of environment hygiene in operating room.The infection rate could be lowered through observation and nursing care of postoperative incision and proper use of antibiotics.

Objective To investigate the membrane topology of transient receptor potential(TRP)channel. Methods Glycosylation method was used to investigate the membrane integrations of each hydrophobic segment of canonical TRP(TRPC5). Results In TRPC5 channel,S4?S8 segments were integrated into membrane with Ncyt/Cexo and Nexo/Ccyt orientations sequentially ,and C?terminus was intracellular. S1?S3 segments were integrated into membrane with two possible types. One was that S1 and S3 were integrated into membrane,whereas S2 was left out of the membrane on the cytosolic side;and the other was a mixed type that S1 and S3 were exposed to cytoplasm respectively. Both of them,the N?termi?nus was intracellular. Conclusion S4?S8 segments of TRPC5 are transmembrane segments. The integrations of S1?S3 segments into membrane need to be further investigated.

As a result of observation in lab. ,it showed that the rice straw attracted snail well,it at-tracted uninfected and infected snails, and adult and young snails respectively without singnificant difference. On this basis,we can investigate the snails under water by rice straw curtains during water raising season. This paper reported that the method for weaving rice straw curtain fixed by stone,and using foamed plastics as buoy were easy and convenient. The rate of snail-attraction was highest when it took 14 hours ,especially in August.

Objective To establish an early,simple and rapid colloidal gold strip method for the detection of IgM against hantavirus nucleocapsid protein in patients with hemorrhagic fever with renal syndrome(HFRS).Methods Purified recombinant Hantavirus nucleoprotein(rNP)was labeled by colloidal gold particles and then sprayed and fixed on fiberglass membrane as the combination pad.Anti-Human IgM(μ-chain specific)antibody produced in goat was fixed in the detection area,and mouse antihantavirus antibody was fixed in the quality control area.Both of them were on nitrocellous membrane strip in tandem.Together with a specimen pad ahead.The conbination pad and the nitrocellous membrane were assembled into a test strip.The colloidal gold strip assay was compared with ELISA for evaluation of specificity and sensitivity.Results The colloidal gold strip tests showed positive in the serum samples from 50 cases of HFRS which was clinically diagnosed and then verified by ELISA within 10-15 minutes.Whereas 30 serum samples of healthy donors have tested negative.Conclusions Our new colloidal gold immunochromatographic test strip method was well concordant with the ELISA assay,but the former was more raoid and simole.It could be used primary medical services.

Objective To evaluate the effect of infiltration anesthesia at Calot's triangle on postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.Methods One hundred and forty patients,aged 18-64 yr,with 18 kg/m2 ≤ body mass index ≤ 31 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,were randomly divided into 2 groups (n =70 each):control group (group A) and infiltration anesthesia at Calot's triangle group (group B).In group B,1％ ropivacaine 10 ml was injected into Calot's triangle before dissection of the gallbladder,while the equal volume of normal saline was injected into Calot's triangle in group A.The patients in both groups received patient-controlled intravenous analgesia (PCIA) for 48 h starting from 10 min before the end of surgery.The VAS score was maintained below 4 during PCIA.When VAS score ≥ 4,lasting for more than 30 min,tramadol 1.5 mg/kg was injected intravenously.The consumption of physic liquor for PCIA,and requirement for tramadol were recorded.The incidence of puncture-related damage to Calot's triangle and local anesthetic intoxication and adverse effects such as nausea and vomiting within 48 h after surgery were also recorded.The first postoperative flatus time was recorded.Results Compared with group A,the consumption of physic liquor for PCIA,requirement for tramadol,and consumption of tramadol were significantly reduced,and no significant change was found in the incidence of nausea and vomiting and the first postoperative flatus time in group B.No puncture-related damage to Calot's triangle occurred in A and B groups.There was no local anesthetic intoxication in group B.Conclusion Infiltration anesthesia at Calot's triangle can optimize postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.

Objective To evaluate the effect of small-dose ketamine on the onset time and course of modified electroconvulsive therapy (MECT) in mentally depressed rats.Methods Sixty SPF adult male SpragueDawley rats,aged 2-3 months,weighing 220-250 g,were randomly divided into 6 groups (n =10 each) using a random number table:normal control group (group C),depression group (group D),ECT group,propofol + ECT group (group PE),ketamine + ECT group (group KE) and ketamine + propofol + ECT group (group KPE).The depression model was established by chronic unpredictable mild stress (CUMS).Mter CUMS,C,D and ECT groups received intraperitoneal normal saline 8 ml/kg,group PE received intraperitoneal propofol 100 ml/kg,group KE received intraperitoneal ketamine 10 ml/kg,and group KPE received intraperitoneal ketamine 10 ml/kg + propofol 80 ml/kg.All the groups received ECT once a day for 7 consecutive days starting from the time point when righting reflex was lost except C and D groups.Open-field test was performed before CUMS,at 1 day after CUMS and at the end of each ECT (T0 8).The total distance and the number of standing on the back legs were recorded.Morris water maze test was performed at 2 days after CUMS and 1 day after the end of therapy,and the escape latency and time of staying at the original platform quadrant were recorded.Results Compared with group C,the total distance was shortened and the number of standing on the back legs was reduced,the escape latency was prolonged,and the time of staying at the original platform quadrant was shortened at T1-8 in D,ECT,PE and KE groups and at T1 5 in KPE group,and no significant was found in KPE group in the total distance,number of standing on the back legs,escape latency,and time of staying at the original platform quadrant at T6-8.Compared with group D,the total distance was prolonged and the number of standing on the back legs was increased at T6-8 in ECT and PE groups and at T4-8 in KE and KPE groups,the escape latency was prolonged,and the time of staying at the original platform quadrant was shortened in ECT group,and the escape latency was shortened,and the time of staying at the original platform quadrant was prolonged in KPE group.Compared with ECT and PE groups,the total distance was prolonged and the number of standing on the back legs was increased at T4-7 in group KE and at T4-8 in group KPE,and the escape latency was shortened,and the time of staying at the original platform quadrant was prolonged in KPE group.Compared with group KE,the total distance was prolonged and the number of standing on the back legs was increased at T6.7,the escape latency was shortened,and the time of staying at the original platform quadrant was prolonged in KPE group.Conclusion Small-dose ketamine can shorten the onset time and course of MECT in mentally depressed rats.

The formative assessment system has been applied to the internship education for the clinical anesthesia with the aim to improve students' initiative and to evaluate their outcomes more compre-hensively. The students' performance in the shift exchange, case discussion, raising question, solving question at the time points of after the preclinical train, one month and 3 months into the anesthesia internship, and after the completion of internship, and their capability in preoperative patient assessment, condition report, clinical practice, review writing have been evaluated to determine the educational quality and to instruct the improvement of educational approach. Assess process takes into account both the individuality and the gen-eral character of the students and feedbacks the evaluation result to improve the practice teaching The im-plementation of the evaluation can promote students' autonomous learning and comprehensively evaluate students' practice process.

BACKGROUND:Gastric cancer stem cels involved in the neoadjuvant chemotherapy and conventional treatment are closely associated with relapse of gastric cancer. However, this conclusion has not yet been confirmed.
OBJECTIVE:To investigate the effects of gastric cancer stem cels in tumor invasion and metastasis and its effect on angiogenesis ability.
METHODS:We prepared nude mouse models of gastric cancer to isolate and culture gastric cancer stem cels. Harvested gastric cancer stem cels were detected in cel scratch test, ring test, inhibition rate test, cel migration test and tumorigenicity test.
RESULTS AND CONCLUSION:After 7 days of culture, the cels exhibited adherent growth but a lack of regularity that most cels were in a tadpole shape. In the cel scratch test, the scratch width was significantly different at 0 and 24 hours (P < 0.05). Under an inverted microscope, the cels were found to form a ring in the ring test. The 50% inhibiting concentration of gastric cancer stem cels induced by oxaliplatin was significantly lower than that induced by 5-fluorouracil (P < 0.05). The number of cels passing through the basilar membrane was significantly increased after cel migration (P < 0.05). After implantation of gastric cancer stem cels, the gastric tissue quality was significantly higher than that in normal nude mice of gastric cancer (P < 0.05). These findings indicate that gastric cancer stem cels responsible for tumor invasion and migration have stronger angiogenesis ability.