Objective To explore the effect of GAS MAN assisted instruction on theory learning of volatile anesthetics in anesthesiology residency training.Methods A total of 32 residents in the first stage of anesthesiology training were enrolled and randomly assigned to either study(S) or control (C) group.Theory-test l(Test-1) was conducted for all residents after the lecture-based learning (LBL).Next,reference book self-reading strategy was used in both groups while computer-based simulation(CBS) using GAS MAN was only developed in S group.Then,theory-test 2(Test-2)was conducted for residents in both groups and residents in S group completed the questionnaire smvey.In addition,thirty-four resident teachers observed the CBS courses and completed the questionnaire smvey.Results The mean scores of Test-1 did not differ significantly between the two groups(P=0.64).However,the mean Test-2 score of S group(81.3 ± 13.6) was significantly higher than that of C group(61.3 ± 15.4) (P=0.001).100％(16/16) residents believed that CBS was beneficial to the theoretical study of volatile anesthetics,93.8％(15/16) residents considered GAS MAN could help understand the concepts and improve efficiency during self-learning.97.1％ (33/34) and 91.2％ (31/34)resident teachers agreed that CBS was helpful for analyzing complex concepts and improving study effectiveness,respectively.Conclusions CBS using GAS MAN improves theory knowledge and study effectiveness for anesthesia residents.Both residents and resident teachers find GAS MAN highly ac ceptable.Therefore,GAS MAN has the potential to be the assistant teaching tool for LBL in anesthesiology residency-training program.

OBJECTIVE:To compare the contents of loganic acid,swertiamarin,6′-O-β-D-glucosyl gentiopicroside,gentiopi-croside,sweroside,isoorientin and isovitexin in wild and cultivated Gentiana officinalis,and to provide basis for rational use of G. officinalis. METHODS:UPLC method was adopted. The separation was performed on ACQUITY UPLC? BEH C18 column (50 mm × 2.1 mm,1.7 μm) with mobile phase consisted of methanol-0.04% phosphoric acid (gradient elution) at the flow rate of 0.3 ml/min. The detection wavelength was set at 242 nm,and column temperature was 30 ℃. RESULTS:For loganic acid,swertiama-rin,6′-O-β- D-glucosyl gentiopicroside,gentiopicroside,sweroside,isoorientin and isovitexin,a good linearity was obtained in the range of 2.1-537.1 μg,1.05-270 μg,0.92-236 μg,11.1-2 830 μg,0.75-192 μg,0.167-102 μg,0.216-52.80 μg(r≥0.999 5), respectively. Their average recoveries were 97.72%-99.84%(RSD≤3.39%,n=6). The contents of loganic acid,swertiamarin, 6′-O-β-D-glucosyl gentiopicroside,gentiopicroside,sweroside and isoorientin in the wild sample were higher than in the cultivat-ed;the content of isovitexin was lower than the cultivated,but there was no statistical significance(P>0.05). The sum of gentiopi-croside and loganin acid content were all higher than 2.5% in both wild and cultivated samples,and met the requirements of 2015 edition of Chinese Pharmacopoeia(first part). CONCLUSIONS:The content difference of 7 indicative constituents in wild and cul-tivated G. officinalis is not statistically significant,and the indicative constituents of the pharmacopoeia is qualified.

Objective To observe the clinical effect of intravenous thrombolytic therapy for central retinal artery occlusion (CRAO) with poor effect after the treatment of arterial thrombolytic therapy.Methods Twenty-four CRAO patients (24 eyes) with poor effect after the treatment of arterial thrombolytic therapy were enrolled in this study.There were 11 males and 13 females.The age was ranged from 35 to 80 years,with the mean age of (56.7± 15.6) years.There were 11 right eyes and 13 left eyes.The visual acuity was tested by standard visual acuity chart.The arm-retinal circulation time (A-Rct) and the filling time of retinal artery and its branches (FT) were detected by fluorescein fundus angiography (FFA).The visual acuity was ranged from light sensation to 0.5,with the average of 0.04±0.012.The A-Rct was ranged from 18.0 s to 35.0 s,with the mean of (29.7±5.8) s.The FT was ranged from 4.0 s to 16.0 s,with the mean of (12.9±2.3) s.All patients were treated with urokinase intravenous thrombolytic therapy.The dosage ofurokinase was 3000 U/kg,2 times/d,adding 250 ml of 0.9％ sodium chloride intravenous drip,2 times between 8-10 h,and continuous treatment of FFA after 5 days.Comparative analysis was performed on the visual acuity of the patients before and after treatment,and the changes of A-Rct and FT.Results After intravenous thrombolytic therapy,the A-Rct was ranged from 16.0 s to 34.0 s,with the mean of (22.4 ±5.5) s.Among 24 eyes,the A-Rct was 27.0-34.0 s in 4 eyes (16.67％),18.0-26.0 s in 11 eyes (45.83％);16.0-17.0 s in 9 eyes (37.50％).The FT was ranged from 2.4 s to 16.0 s,with the mean of (7.4± 2.6) s.Compared with before intravenous thrombolytic therapy,the A-Rct was shortened by 7.3 s and the FT was shortened by 5.5 s with the significant differences （x2=24.6,24.9;P＜0.01).After intravenous thrombolytic therapy,the visual acuity was ranged from light sensation to 0.6,with the average of 0.08 ± 0.011.There were 1 eye with vision of light perception (4.17％),8 eyes with hand movement/20 cm (33.33％),11 eyes with 0.02-0.05 (45.83％),2 eyes with 0.1-0.2 (8.33％),1 eye with 0.5 (4.17％) and 1 eye with 0.6 (4.17％).The visual acuity was improved in 19 eyes (79.17％).The difference of visual acuity before and after intravenous thrombolytic therapy was significant (x2=7.99,P＜0.05).There was no local and systemic adverse effects during and after treatment.Conclusion Intravenous thrombolytic therapy for CRAO with poor effect after the treatment of arterial thrombolytic therapy can further improve the circulation of retinal artery and visual acuity.

Objective To observe the characteristics of collateral circulation blood flow of ipsilateral ophthalmic artery in patients with internal carotid artery occlusion. Methods The imaging data of 20 patients with internal carotid artery occlusion were analyzed retrospectively. There were 11 males and 9 females, aged from 30 to 65 years, with an average age of (45±3) years. All the patients underwent digital subtraction angiography and transcranial Doppler examination, and 6 patients underwent simultaneous magnetic resonance angiography. The blood supply and collateral circulation of the ipsilateral ophthalmic artery were observed . Results All the patients had unilateral internal carotid artery occlusion. The blood supply of the ipsilateral internal carotid artery and ophthalmic artery comes from the collateral circulation between the middle meningeal artery branches of the external carotid artery and the ophthalmic artery in 18 patients (90.0%); it also comes from the anterior communicating artery of the contralateral internal carotid artery in 16 patients (80.0%); and the posterior communicating artery of the contralateral internal carotid artery in 12 patients (60.0%), respectively. Conclusion The blood flow of the ipsilateral ophthalmic artery mainly comes from the middle meningeal artery branch of the ipsilateral external carotid artery, also comes from the anterior and posterior communicating arteries of the contralateral internal carotid artery.

Objective To observe the effect of interventional thrombolytic therapy for central retinal artery occlusion (CRAO) with ipsilateral internal carotid artery occlusion via supratrochlear artery retrogradely or external carotid artery anterogradely.Methods Nine CRAO patients (9 eyes) were enrolled in this study,including 5 males and 4 females.The mean age was (45.2 ± 18.1) years.The mean onset duration was 24 hours.There were 4 eyes with vision of no light perception,3 eyes with light perception and 2 eyes with hand movement.Fundus fluorescein angiography (FFA) examination showed that the retinal artery was filled with delayed fluorescence.The peak of fluorescence was seen in the anterior part of the artery,and some of the eyes showed retrograde filling.The arm-retinal circulation time (A-Rct) was ≥35 s in 4 eyes,≥35 s-＜25 s in 5 eyes.The filling time of retinal artery and its branches (FT) was ≥ 15 s in 2 eyes,≥ 12 s-＜15 s in 3 eyes,≥9 s-＜ 12 s in 4 eyes.All the patients received the treatment of interventional thrombolytic therapy via supratrochlear artery retrogradely (8 eyes) or external carotid artery anterogradely (1 eye) according to the indications and contraindications of thrombolytic therapy in acute cerebral infraction patients.Urokinase (0.4 million U in total) was intermittently injected into the arteries.After artery thrombolysis,the changes of digital subtraction angiography (DSA),filling time of retinal artery and its branches on FFA within 24 hours and the visual acuity were observed.According to the A-Rct and FT on FFA,the therapeutic effects on retinal circulation were defined as effective markedly (A-Rct≤ 15 s,FT ≤2 s),effective (A-Rct was improved but in the range of 16-20 s,FT was in 3-8 s) and no effect (A-Rct was improved but ≥21 s,FT≥9 s).The related local or systemic complications were recorded.Results After the injection ofurokinase into the catheter,the ophthalmic artery and its branches were increased in 6 eyes (66.7％),and the development of the eye ring was significantly more than that of the eyes before thrombolysis.The circulation time in ophthalmic artery was speeded up for 2 s before thrombolysis in 3 eyes,3 s in 3 eyes,and 4 s in 2 eyes.Within 24 hours after thrombolysis treatment,the A-Rct was significantly decreased than that of before interventional therapy.The retinal circulation was effective markedly in 4 eyes (44.4％),effective in 4 eyes (44.4％) and no effect in 1 eyes (11.2％).The vision was improved 3 lines in 4 eyes (44.4％),2 lines in 3 eyes (33.3％),1 line in 1 eye (11.2％) and no change in 1 eye (11.2％).There were no abnormal eye movements,vitreous hemorrhage and incision hematoma,intracranial hemorrhage,cerebral embolism,and other local and systemic adverse effeetives during the follow-up.Conclusions The interventional thrombolytic therapy via supratrochlear artery retrogradely or external carotid artery anterogradely for CRAO with the ipsilateral internal carotid artery occlusion can improve retinal circulation and vision.There are no related local or systemic complications.

Objective:To investigate the advantage of three dimensional(3D)-printed tissue compensators in radiotherapy for superficial tumors at irregular sites.Methods:A subcutaneous xenograft model of prostate cancer in nude mice was established. Mice were randomly divided into no tissue compensator group( n=6), common tissue compensator group( n=6), and 3D-printed tissue compensator group( n=6). Computed tomography (CT) images of nude mice in the 3D-printed tissue compensator group were acquired. Compensator models were made using polylactic acid, and material properties were evaluated by measuring electron density. CT positioning images of the three groups after covering the corresponding tissue compensators were acquired to delineate the gross tumor volume (GTV). Nude mice in the three groups were irradiated with 6 MV X-rays at the prescribed dose. The prescribed dose for the three groups was 1 500 cGy. The dose distribution in the GTV of the three groups was calculated and compared using the analytical anisotropic algorithm in the Eclipse 13.5 treatment planning system. The metal-oxide-semiconductor field-effect transistor was used to verify the actual dose received on the skin surface of nude mice. Results:The air gap in the 3D-printed tissue compensator group and the common tissue compensator group was 0.20±0.07 and 0.37±0.07 cm 3, respectively ( t=4.02, P<0.01). For the no tissue compensator group, common tissue compensator group, and 3D-printed tissue compensator group, the D95% in the target volume was (1 188.58±92.21), (1 369.90±146.23), and (1 440.29±45.78) cGy, respectively ( F=9.49, P<0.01). D98% was (1 080.13±88.30), (1 302.76±158.43), and (1 360.23±48.71) cGy, respectively ( F=11.17, P<0.01). Dmean was (1 549.08±44.22), (1 593.05±65.40), and (1 638.87±40.83) cGy, respectively ( F=4.59, P<0.05). The measured superficial dose was (626.03±26.75), (1 259.83±71.94), and (1 435.30±67.22) cGy, respectively ( F=263.20, P<0.001). The percentage variation in tumor volume growth after radiation was not significantly different between the common tissue compensator group and the 3D-printed tissue compensator group ( P>0.05). Conclusions:3D-printed tissue compensators fit well to the body surface, which reduces air gaps, effectively increases the dose on the body surface near the target volume, and provides ideas for radiotherapy for superficial tumors at some irregular sites.

Objective: To compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO. Methods: From January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using ttest. Results: At 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. Conclusions Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.

Objective:Partial stereotactic ablative boost radiotherapy(P-SABR)is a method to deliver SABR boost to the gross tumor boost volume(GTVb), followed by conventionally fractionated radiotherapy to the whole tumor area(GTV). GTVb is the max volume receiving SABR while ensuring the critical organ-at-risk(OAR)falloff to 3 GyE/f. We investigated the potential advantage of proton therapy in treating bulky non-small cell lung cancer(the tumor length greater than 8 cm).Methods:Nine patients with bulky NSCLC treated with photon P-SABR in our institute were selected. For the treatment planning of proton therapy, the GTVb target area was gradually outwardly expanded based on the photon GTVb target area until the dose to critical OARs reached 3 GyE/f. The GTV and CTV areas remained the same as photon plan. A proton intensity-modulated radiation treatment plan(proton-IMPT), a photon intensity-modulated radiation treatment plan(photon-IMRT)and a photon volumetric modulated arc therapy(photon-VMAT)were created for each patient, respectively. The dosimetric parameters of different treatment plans were compared.Results:The volume ratio of GTVb-photon and GTVb-proton to GTV was(25.4±13.4)% and(69.7±30.0)%,respectively( P<0.001). In photon-IMRT, photon-VMAT, and proton-IMPT plan groups, the mean dose of CTV was(76.1±4.9)Gy, (78.2±3.6)Gy, and(84.7±4.9)Gy, respectively; the ratio of tumor volume with Biologic Effective Dose(BED)≥ 90 Gy to GTV volume was(70.7±21.7)%, (76.8±22.1)%,and(97.9±4.0)%,respectively. The actual dose and BED to the tumor area of the proton-IMPT plan group were significantly higher than those of the photon plan group(both P<0.05). Besides, the OARs dose was significantly decreased in the proton-IMPT group, with(49.2±22.0)%, (56.8±19.0)% and(16.1±6.3)% of the whole lung V5 for photon-IMRT, photon-VMAT and proton-IMPT, respectively(all P<0.001). Conclusions:Larger GTV boost target volume, higher BED and reduced OARs dose can be achieved in proton plans compared with photon plans. Proton P-SABR is expected to further improve the local control rate of bulky NSCLC with fewer adverse effects.