on the basis of analyzing the teaching methods available.the article explores the reverse thinking teaching method of Pharmacdogy and the characteristics of the course and the students,in order to stimulate students'interest and initiative in study as well as culture their clinical thinking ability.

ObjectiveTo study the effect of microteaching on entrance education of internship in neonatal intensive care unit ( NICU ).Methods80 interns of clinical medicine speciality were divided into experimental group and control group.Microteaching was used in the entrance education of experimental group,and traditional teaching method was used in that of control group.To compare the teaching effects by analyzing the results of immediate evaluation,evaluation of clinical teacher and satisfaction survey in parents of hospitalized children.ResultsThe results of immediate evaluation,evaluation of clinical teacher and satisfaction survey in parents of hospitalized children were significantly increased in experimental group compared with control group.ConclusionMicroteaching could dramatically improve the teaching effects of entrance education of internship in NICU.

Objective To investigate the expression of CEA, NSE and CYFRA21-1 in lung cancer, and the significance of combined determination of three tumor markers in the detection of lung cancer. Methods CEA, NSE and CYFRA21-1 levels in serum of 65 patients with lung cancer, 50 patients with benign lung diseases and 38 normal adults were measured by enzyme linked immunosorbent assay (ELISA). The association of CYFRA21-1, NSE, and CEA level with the type of lung cancer in pathology were also studied. Results In comparison, the serum levels of CEA, CYFRA21-1 were increased more obviously in patients with lung cancer than that of patients with benign lung diseases and the normal adults (P<0.01). The levels of serum and the sensitivity of CEA, NSE and CYFRA21-1 were related to pathology type. The sensitivity and specificity increased by combined measurement of CEA, NSE, and CYFRA21-1. Conclusion These findings suggest that the serum CEA, NSE and CYFRA21-1 levels is increased in patients with lung cancer, and the increasing extents is not same in lung cancer with different pathology types. CEA, NSE and CYFRA21-1 are significant in adjuvant diagnosis of lung cancer.

Objective To investigate the effects of ginkgo flavone on the expression of NF-κB and TLR4 in the liver of mice with nonalcoholic fatty liver disease (NAFLD). Methods 120 KM mice were randomly divided into the control group, model group, as well as high, medium and low dosage of ginkgo flavone groups. The animal model of NAFLD in mice was constructed with high fat diet. The pathological changes of liver, liver index , the serum TNF-α, IL-6 , TG , NF-κB and TLR4 in hepatic tissue was observed after 8 weeks of administration. Results Compared with the model group, the level of liver index, serum TG, TNF-α, IL-6 and the expression of NF-κBp65 in the ginkgo flavone groups dramatically decreased 8 weeks after the administration. And the hepatic steatosis was milder. There was no statistical differences in the expression of TLR4 between the ginkgo flavone groups and the control group (P > 0.05). Conclusions These results suggested the closely relationship between TLR4/NF-κB inflammatory pathway and NAFLD. Ginkgo flavone had the therapeutical effects on NAFLD by anti-inflammatory and lipid-lowering action, but no effect was observed on the expression of TLR4 in hepatic tissue.

Objective To investigate the effects of recombinant human erythropoietin (rhEPO) on the expression of vascular endothelial growth factor (VEGF) protein and mRNA in lung tissue of premature rat model of the new type bronchopulmonary dysplasia (BPD).Methods Lipopolysaccharide (LPS) or PBS was injected into 60 pregnant rats on the 15th day of gestation.The premature rats by cesarean delivery on the 21th day of gestation were divided into 5 groups:PBS+ air group,PBS+ hyperoxia group,LPS+hyperoxia group,PBS+hyperoxia+rhEPO group,LPS+hyperoxia+rhEPO group.In rhEPO intervention groups,after 6 h exposure to hyperoxia,rhEPO (1 200 IU/kg) was administrated subcutaneously,once every other day for 7 times.The survival rate,body weight,lung weight and lung weight/body weight ratio and pathological changes of lung tissue were observed,the expression levels of VEGF protein and mRNA in the lung tissue were determined by Western blot and RT-PCR at the 1st,7th and 14th day after hyperoxia exposure.Results Compared with the PBS+air group,the survival rate and body weight were decreased,the lung weight was increased,the lung pathological damages were more serious,the expression levels of VEGF protein and mRNA in lung tissue were decreased after hyperoxia exposure.These changes were more notable in the LPS+hyperoxia group (P＜0.05).The lung weight/body weight ratio showed an increasing tendency (P＞0.05).The above indexes were improved after rhEPO intervention (P＜0.05).Conclusion rhEPO could increase the survival rate and produce certain intervention and treatment effects by regulating the VEGF relative pathway in BPD model rats.

Objective:To investigate the lung protective effect of driving pressure-guided lung protective ventilation strategy (LPVS) combined with pressure-controlled ventilation (PCV) in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:One hundred elderly patients scheduled for thoracoscopic radical resection of lung cancer from April 2021 to April 2022 in the Second Hospital of Shanxi Medical University were selected. Patients were aged 60-80 years old and American Society of Anesthesiologists (ASA) classification Ⅰ-Ⅱ. All patients were divided into 4 groups by using the random number table method, with 25 cases in each group. Group A received volume-controlled ventilation (VCV) + 5 cm H 2O (1 cm H 2O = 0.098 kPa) PEEP, group B received PCV+5 cm H 2O PEEP, group C received VCV+driving pressure-guided individualized PEEP, and group D received PCV+driving pressure-guided individualized PEEP. The arterial oxygen partial pressure (PaO 2) was recorded before one-lung ventilation (OLV) (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The serum concentrations of neutrophil elastase (NE) in radial artery blood samples of patients were measured at T 0 and 10 min after the end of OLV (T 3). The occurrence of postoperative pulmonary complications (PPC) within 5 d after surgery was recorded. Results:The PaO 2 of group A and B at T 1 [(135±50), (146±51) mmHg (1 mmHg = 0.133 kPa)] and T 2 [(137±46), (143±47) mmHg] were lower than those of group C and group D at T 1 [(168±27), (190±30) mmHg] and T 2 [(180±30), (183±24) mmHg] (all P < 0.05). The incidence of PPC within 5 d after surgery in group A was higher than that in group D [36% (9/25) vs. 4% (1/25)] ( P = 0.005). The concentration of NE at T 3 in group A [(202.8±9.7) ng/ml] was lower than that in group B, C and D [(182.5±12.0), (180.0±10.3), (160.6±13.0) ng/ml] ( P < 0.05). Conclusions:During OLV, driving pressure-guided LPVS combined with PCV can not only improve oxygenation, but also show obvious advantages in reducing inflammatory response. It is a safe and effective intraoperative ventilation strategy for elderly patients undergoing thoracoscopic radical resection of lung cancer.

Objective:To explore the effects of pressure controlled ventilation-volume guaranteed (PCV-VG) mode on intraoperative pulmonary ventilation and postoperative pulmonary complications (PPC) in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty patients of American Society of Anesthesiologists (ASA) classification Ⅱor Ⅲ, aged 65-80 years old, with body mass index (BMI) 18-30 kg/m 2, received thoracoscopic lobectomy under general anesthesia from November 2021 to June 2022 in the Second Hospital of Shanxi Medical University were recruited. The patients were divided into PCV-VG and volume-controlled ventilation (VCV) groups using the randomized number table method, with 30 patients in each group. The ventilatory parameters of two-lung ventilation were set to respiratory rate (RR) at 10-12 breaths/min, with a tidal volume (VT) of 8 ml/kg (ideal body weight). The ventilatory parameters of one-lung ventilation (OLV) were set at 12-16 breaths/min, with a VT of 6 ml/kg (IBW). The peak airway pressure (Ppeak), plateau airway pressure (Pplat), driving pressure (ΔP), dynamic lung compliance (Cdyn), end-tidal carbon dioxide (ETCO 2), heart rate (HR), mean arterial pressure (MAP), partial pressure of oxygen (PaO 2) and partial pressure of carbon dioxide (PaCO 2) were obtained at 1 min before OLV (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The incidence and severity of PPC, chest tube duration time and postoperative hospital stay time were recorded. Results:The Ppeak, Pplat and ΔP were higher and Cdyn was lower in both groups at T 1-T 2 than at T 0 (all P<0.001). The Ppeak, Pplat and ΔP were higher and Cdyn was lower in PCV-VG group than in VCV group (all P<0.05). There were no statistical differences in HR, MAP, ETCO 2, PaO 2 and PaCO 2 between the two groups (all P > 0.05). There were no statistical differences in the incidence of PPC [43.3% (13/30) vs. 30.0% (9/30)] and chest tube duration time [(4.4±0.9) d vs. (4.2±1.2) d] between VCV group and PCV-VG group (all P>0.05). Compared with VCV group, the proportion of patients with ≥grade 2 PPC was lower in PCV-VG group [10.0% (3/30) vs. 36.7% (11/30), χ2=5.96, P<0.05]. The postoperative hospital stay time in PCV-VG group was shorter than that in VCV group [(6.4±1.3) d vs. (8.0±1.9) d, t = 4.85, P<0.05]. Conclusions:PCV-VG mode can effectively reduce the severity of PPC, shorten the postoperative hospital stay time and improve the prognosis in elderly patients undergoing thoracoscopic lobectomy.

Objective: To analyze the anesthetic effect of dexmedetomidine in laparoscopic D2 radical gastrectomy and its influence on hemodynamics, visual analogue scale (VAS) and Ramsay sedation score after operation. Methods: A total of 86 patients who received laparoscopic D2 radical gastrectomy under general intravenous anesthesia in Shanxi Provincial Cancer Hospital from March 2017 to June 2017 were enrolled, and all the patients were divided into two groups by using random number table method. The observation group (43 cases) was intravenously injected with dexmedetomidine (0.6 μg/kg) before induction of general anesthesia, and the dose was changed to 0.4 μg/kg after 15 min with drug withdrawal till 30 minutes before surgery, the control group (43 cases) was given an equal volume of 0.9% normal saline. The mean arterial pressure (MAP) and heart rate change before anesthetic induction (T₁), tracheal intubation time (T₂), after intubation (T₃), section time (T₄) and the immediate time after intubation (T₅) were compared between the two groups. The VAS and Ramsay scores at 1 h and 4 h after surgery and the intraoperative doses of anesthesia maintenance drugs were also compared between the two groups. Results: The heart rate and MAP of the observation group were lower than those of the control group at the time of T₁, T₃-T₅, the differences were statistically significant (all P < 0.05). The VAS and Ramsay scores of the observation group were better than those of the control group at 1 h and 4 h after operation, and the differences were statistically significant (all P < 0.05). The intraoperative doses of propofol and remifentanil in the observation group were (964±251) mg and (3.1±0.8) mg, respectively, which were less than those in the control group [(1 485±425) mg and (4.8±0.8) mg], the differences were statistically significant (t = 9.913, P < 0.01; t = 9.834, P < 0.01). Conclusion Dexmedetomidine can reduce the stress response of patients with laparoscopic D2 radical anesthesia, enhance the sedative effect, and reduce the dosage of propofol and remifentanil, therefore, it has high clinical application value.