At present, the theory and experiment teaching of forensic toxicology are faced with difficulties such as lake of practical cases and toxic types, content being abstract and difficult to un-derstand. On that account, we collected and collated many typical cases from Public Security Bureau and our school's medico legal expertise center, and then a relatively systematic and complete teaching case base in forensic toxicology has been constructed, and will be supplement constantly, so as to pro-vide extensive teaching resources and improve the teaching quality of forensic toxicology.

From May 2012 to May 2013, 60 chronic male smokers received an intravenous infusion of dexmedetomidine 1 μg/kg (Group D, n=30) or an equal volume of normal saline (Group C, n=30) before anesthesia induction.At time of dexmedetomidine or normal saline dosing , after induction of anesthesia, 1 and 3 min after intubation, the heart rates and rate-pressure products were significantly lower in Group D than Group C ( P<0.05 ).Thus the dosing of dexmedetomidine before anesthesia induction could suppress the cardiovascular responses of endotracheal intubation in chronic smokers and avoid increasing myocardial oxygen consumption so as to protect heart functions.

Objective To investigate the long-term effects of midazolam and penehyclidine hydrochloride on learning and memory function of mice.Methods According stratified random block design ,80 KM mice were divided into 4 groups: midazolam 1mg/kg(group M,n=20), penehyclidine hydrochloride 0.2mg/kg(group P,n=20),midazolam 1mg/kg + penehyclidine hydrochloride 0.2mg/kg(group M+P,n=20) and control group(group NS,n=20);20 mice in each group were divided randomly into testing memory acquisition(n=10) and memory consolidation(n=10) further.For behavioral testing a step-through passive avoidance test was used,in order to evaluate the effects of the agents administruted on the memory acquisition before fraining and on the memory consolidafion immediately after fraining.The step-through latencies and the numbers of errors 1,2,3,4,5,6 and 7 day after the training were recorded.Results Administration of midazolam impaired memory acquisition and consolidation when administrated alone or in combination with penehyclidine hydrochloride, and this effect persisted for 3 days . Administration of midazolam combinated with penehyclidine hydrochloride did not worsen the effect on memory acquisition,but worsen the effect on memory consolidation obviously. Furthermore, administration of midazolam combinated with penehyclidine hydrochloride impaired memory function persisting longer than that of administration of midazolam alone.Conclusions Administration of midazolam and penehyclidine hydrochloride as premedication was advantageous for prevention of awareness during operation, nevertheless was attributed to one of the causations of POCD.

Aim To investigate the effects of midazolam and penehyclidine hydrochloride on learning and memory function of mice.Methods According to stratified random block design,80 KM mice were divided into 4 groups:midazolam 1 mg?kg-1(group M,n=20),penehyclidine hydrochloride 0.2 mg?kg-1(group P,n=20),midazolam 1 mg?kg-1+penehyclidine hydrochloride 0.2 mg?kg-1(group M+P,n=20)and control group(group NS,n=20),and 20 mice in every group were divided randomly into exper-iments of testing memory acquisition(n=10)and memory consolidation(n=10)further.To evaluate the behavioral alteration with these agents,a step-through passive avoidance test was used.Mice were administrated agents before training section for testing memory acquisition,and administrated agents immediately after training section for testing memory consolidation.The step-through latencies and the number of errors on 1,2,3,4,5,6 and 7 day after the training were recorded.Results Midazolam impaired memory acquisition and consolidation when administrated alone or in combination with penehyclidine hydrochloride.Administration of midazolam combinated with penehyclidine hydrochloride did not worsen the effect on memory acquisition,but worsen the effect on memory consolidation obviously.Furthermore,administration of midazolam combinated with penehyclidine hydrochloride impaired memory function persisting longer than that of administration of midazolam alone.Conclusion Administration of midazolam and penehyclidine hydrochloride would result in inhibiting learning and memory function of mice.

Objective To investigate the protective effect of sirolimus pretreatment against liver ischemia-reperfusion(I/R)injury in rat model and the possible mechanism.Methods Forty-eight male SD rats were randomized into four groups (12/group):A:sham group with saline,B:sham group with sirolimus,C:saline-operated group,D:sirolimus-operated group.The rats were pretreated with either saline or sirolimus (2 mg·kg~(-1)·d~(-1))by oral gavage for two weeks．The rat partial liver model of I/R injury was established,and the samples were collected at the 24th h after the I/R The serum ALT and AST levels were determined,the histologic changes were observed by HE staining under the light microscopy,the frequency of CD4~+ CD25~+ T cells among mononuclear cells in liver tissue was analyzed by using flow cytometry,the expression of Foxp3 mRNA was detected in liver tissue by real-time PCR,and the serum TGF-β,IL-10 levels were measured by enzyme-linked immunosorbent assay (ELISA).Results Serum ALT and AST levels were significantly decreased and the histological damage was significantly alleviated in the sirolimus-operated group as compared with saline-operated group(P<0.05).The percentage of CD4~+ CD25~+ T cells among mononuclear cells in groups A,B,C,and D was(6.12±1.87)%,(22.36±6.75)%,(4.53±1.02)% and(13.29±3.16)% respectively in liver tissue The expression levels of the Foxp3 mRNA were significantly higher in sirolimus group than in saline group(P<0.05).The ELISA showed that sirolimus could significantly increase the levels of TGF-β and IL-H)(P<0.05).Conclusion Pretreatment of sirolimus can effectively protect against liver ischemia-reperfusion injury in rats,which may be related to induction of CD4~+ CD25~+ Foxp3~+ T regulator cells by sirolimus,and the increase of TGF-β and IL-10 secretion to inhibit the imflammatory response.

Objective To enhance the management in identifying the surgical sites to comply with national standards.Methods A nurse-physician collaboration management team was set up to investigate the current identification of surgical sites in every operating room which violates regulations,with the causes analyzed and countermeasures proposed.Working hand in hand,doctors and nurses figured out the management details for preoperatively identifying the surgical sites and reengineering of the surgical process.With the responsibilities clarified and training enhanced,the surgeons,anesthesiologists,ward nurses and operating room nurses were held responsible for the process and improvements of identifying the surgical sites.The number of patients with unreasonable identification of surgical sites was calculated before and after establishment of nurse-physician collaboration management team.Results The reasonable identification rates of surgical sites were 37.94% before the reform and 80.94% after;incorrect use of all types of the surgical site identification can be minimized in the reform.Conclusion The management of nurse-physician collaboration is conducive to enhancing the reasonable identification rate of surgical sites,thus improving the quality of care and correctness of operations.

Objective To evaluate the predictive value of ultrasonography of the respiratory variability index of inferior vena cava internal diameter (IVC-RVI) in preoperative fluid responsiveness evaluation of hip fracture in geriatric patients.Methods A retrospective case-control study was used to analyze 39 cases of elderly hip fractures admitted to the Daping Hospital of Army Medical Center from August 2017 to February 2018,including 15 males and 24 females,aged 65-92 years [(80.9 ±7.9)years].The heart rate (HR),mean arterial pressure(MAP),cardiac output (CO),and cardiac stoke volume (SV)were recorded five minutes after the patient entered the operating room and within 5 minures after capacity load test.The inferior vena cave during expiration (IVCe) and inferior vena cave during inspiration (IVCi) were measured by ultrasound before and after volume load test and the difference in IVC-RVI was calculated.Volumetric positive group were the cases of SV change (△SV) ≥15％ (positive group,n =21),and volume negative group were the cases of △SV ＜ 15％ (negative group,n=18).The correlations between various ultrasonic parameters and SV were analyzed by comparing HR,MAP,CO,SV,SV,IVCe,IVCi and IVC-RVI before and after the capacity load test.The predictive value of IVC-RVI for preoperative volumetric reactivity in elderly patients with hip fractures was evaluated by using the receiver operative characteristic (ROC) curve and Pearson correlation analysis.Results Prior to the volumetric load test,no significant difference was observed between the two groups concerning HR,MAP,CO,SV,and IVCe (P ＞ 0.05),IVCi in the positive group was significantly smaller than that in the negative group (P ＜ 0.05),and IVC-RVI in the positive group was significantly larger than that in the negative group (P ＜ 0.05).After the volumetric load test,there was no statistically significant difference between the two groups in CO,IVCe,IVCi,and IVC-RVI (P ＞ 0.05),HR in the positive group was smaller than that in the negative group (P ＜ 0.05),and MAP and SV in the positive group were significantly larger than that in the negative group (P ＜ 0.05).Compared with that before capacity load test,MAP,CO,and SV in the positive group increased after the capacity load test (P ＜ 0.05),while the HR difference was not statistically significant (P ＞ 0.05).HR,MAP,CO,and SV showed no significant difference in the negative group before and after capacity test (P ＞ 0.05).IVC-RVI assessed the area under the curve (AUC) was 0.80 ± 0.08 for preoperative volumetric responsiveness in elderly hip fractures (P ＜ 0.05),with a critical point of 20.69％,sensitivity of 77.78％,and specificity of 76.19％.After Pearson correlation analysis,IVC-RVI was positively related to △SV (OR =0.367,P ＜ 0.05).Conclusion Ultrasonography of the respiratory variability of IVC can predict the preoperative fluid responsiveness of hip fracture in geriatric patients and guide for clinical rehydration.

Objective:To explore the clinical and genetic features in a case of fatal familial insomnia (FFI).Methods:A case of 39 years old woman diagnosed as progressive supranuclear palsy based on the preliminary manifestation of imbalance and frequent falls was reported. The clinical features, imaging characteristics, electroencephalogram and polysomnography of the patient were analyzed, and the blood samples from the patient were collected for the sequencing of prion protein (PRNP) gene.Results:This patient is a middle-aged woman, whose clinical manifestations were posture instability and retropulsion, rapid progressive dementia and dysarthria, sleep-related dyspnea and laryngeal stridor, with autonomic symptoms of hypertension, sweating, tachycardia and irregular breathing. The results of PRNP gene sequencing revealed that the mutation of gene D178N/129M was detected.Conclusions:Laryngeal stridor plays an important role in the diagnosis of FFI. Posture instability and retropulsion are relatively rare in the FFI clinical symptom spectrum. Here, a case of FFI presenting with posture instability and retropulsion during the early stage with Met/Met at the polymorphic codon 129 is reported in China.