The academic orientation determines the development direction of the subject, and also puts forward the corresponding requirements for the professional teaching. The deep development of anes-thesiology, perfect preoperative evaluation, refined management of clinical anesthesia and ultimately improv-ing the prognosis of patients are the total development directions of anesthesiology. Perioperative patient home (PSH) advocates taking patients as the center, dominated by anesthesia, based on evidence-based medicine in the perioperative period, solidarity and cooperation of multiple disciplines, the integration of a variety of medical resources, and providing continuous and efficient medical services for patients. PSH is required to ensure the safety of clinical anesthesia, reduce the incidence of anesthesia mortality and serious
complications, and improve the long-term survival rate and quality of life by improving the clinical work of the department of anesthesia. Practicing PSH, the anesthetic doctors should have the academic idea of the treatment of anesthesia. The concept requires making comprehensive use of a variety of teaching methods, putting emphasis on the training of basic knowledge, and in the teaching of basic knowledge, infiltrating the overall and local thinking and using lecture method in cooperation with the case teaching. To make solid promotion of PSH concept, we should use CBL teaching, strengthening the management of clinical anesthesia, and striving to promote the clinical practice of PSH.

Objective To discuss the agreement between pulse pressure variation of radial artery and pulse pressure variation of dorsal pedalartery in neurosurgery.Methods Twenty-five patients undergoing selective craniotomy under general anesthesia were enrolled.The following data were monitored and recorded respectively after tracheal intubation general anesthesia under different time:radial artery pulse pressure variability (PPV1) and dorsalis pedis pulse pressure variation (PPV2).Tidal volume was set to 8 ml/kg.Bland-Altman plots were created to assess agreement between PPV1 and PPV2.Results The mean differences and the limits of agreement between PPV1 and PPV2 are 20 min after induction of anesthesia 0.5% (-1.9%-2.8%), boneless flap instantly-0.5% (-3.8%-2.9%), Cut the dura mater instantly-0.1% (-3.2%-3.0%), and bone flap 0.1% (-2.4%-2.6%).Conclusion Dorsal pedal artery pulse pressure variation in neurosurgery craniotomy has certain guiding significance to the monitoring and management.

Objective:This study aimed to compare the efficacy and adverse reactions of two different chemotherapeutic regi-mens. In particular, chemotherapy with paclitaxel liposome was administered in combination with either S-1 or oxaliplatin as the first-line therapy of advanced gastric cancer. Methods:A total of 118 patients with advanced gastric cancer were randomly divided into groups A (61 cases) and B (57 cases). In group A, paclitaxel liposome combined with S-1 was administered;in group B, paclitaxel lipo-some combined with oxaliplatin was applied. The short-term efficacy, adverse reactions, Karnofsky performance status score, median time to progression (mTTP), and median overall survival (mOS) of the two groups were observed and compared. Results:No signifi-cant differences were observed in the objective response rate, disease control rate, and mTTP between groups A and B (31.1% vs. 29.8%, 75.4%vs. 71.9%, 4.2 months vs. 3.8 months;P>0.05). The mOS rates were 10.5 and 8.9 months in groups A and B, respectively, with statistically significant differences (P=0.006). The incidence of degreesⅢtoⅣdiarrhea and peripheral nerve toxicity was signifi-cantly higher in group B than in group A (P<0.05). No statistical differences were found between the two groups in terms of other side effects. Conclusion:The two paclitaxel liposome-based regimens showed similar therapeutic effect in patients with advanced gastric cancer. S-1/paclitaxel liposome treatment could be more effective in terms of mOS and had a tendency of lower toxicity.

The global and local,goal and destination,treatment and reinjury are three common critical thinking,which has the vital significance to the teaching of anesthesiology.Through the classroom interpretation of the pathogenesis,we preliminarily cultivate the students' global and local thinking by guiding students to find the primary problem in the global and local and finding out the breakthrough point of disease treatment.Through the case teaching,we promote students to constantly strengthen their goal and destination thinking by guiding students to select target,determine the endpoint,and solve the problem in stages to make the treatment of the critically ill patient which students simulate has good operability.Through adoption of problem based learning,we make students know how to achieve the optimal treatment effect by guiding them to have extensive discussions and have access to information so as to cultivate students' treatment and reinjury thinking and enhance their global and local thinking at the same time.

It described the status quo of the healthcare system in South Korea, and the milestones of the country to achieve universal coverage of social medical insurance. The paper presented in focus the development from multiple social medical insurance funds to a universal social medical insurance system in South Korea, and analyzed those serious setbacks including monopolizing private medical organizations, lack of first-visit and referral system, and excessive percentage of personal payment, as a result of unparallel progress of the reform of medical insurance and that of healthcare system. Authors hope to be inspirational for the ongoing reforms in the social medical insurance system and healthcare system, in an effort to avoid likewise mistakes.

Objective To assess language function in children with benign epilepsy with centrotemporal spikes in children(BECTS) and its association with the age of epilepsy onset.Methods We assessed language function in 63 children with BECTS and 30 age and sex matched controls by the subtest of CWISC.Results Children with BECTS performed significantly worse on all language tasks as compared to controls and overall better language function was positively correlated with older age of the child.Early age at seizure onset demonstrated significant negative correlation with language dysfunction,age below 6 years being related to the lowest performance scores(P ＜ 0.05).There was no relationship between the language function and the laterality of epileptic focus,seizure treatment status,or the duration of epilepsy(P ＞ 0.05).There was significant relationship between the language dysfunction and onset age of epilepsy (P ＜ 0.05).Conclusion Children with BECTS have language difficulties that are more pronounced in younger age group.Despite better language functioning in older children with BECTS,their verbal abilities remain inferior to those of children without epilepsy.Early age at seizure onset is a significant factor predicting worse language functioning in children with BECTS.

Objective To observe the infiltration situation of Langerhans cells(LC)in laryngeal squamous cell carcinoma tissue and to investigate its clinical significance.Methods Seventy-two cases of laryngeal squamous cell carcinoma were selected and the tumor tissue in all cases was operatively resected.The immunohistochemical SP method was adopted to detect the infiltration situation of LC in laryngeal squamous cell carcinoma tissue.Then the relationship between the LC infiltration degree with tumor stage,relapse,metastasis and prognosis was analyzed.Results Among 72 cases of laryngeal squamous cell carcinoma,27 cases(37.5％)were LC infiltration degree of +,37 cases(37.5％)were ++ and 18 cases(25.0％)were +++.The LC infiltration degree in laryngeal carcinoma tissue was correlated with the cervical lymph node metastasis,recurrence,disease free survival,3-year survival and 5-year survival(P＜0.05),and had no correlation with the age,classification,TNM stage and postoperative radiotherapy(P>0.05).Conclusion LC infiltration can be seen in the tumor tissue of the patients with laryngeal squamous cell carcinoma.The LC infiltration degree is higher,indicating that the prognosis would be better.

Objective To evaluate the effects of thrombus aspiration on postoperative clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients with emergency percutaneous coronary intervention(PCI).Methods From September 2009 to January 2012,a total of 239 patients with STEMI undergoing emergency PCI (thrombus aspiration + PCI (n =118) and PCI (n =121)) were enrolled in this study.The angiographic and clinical results were retrospectively analyzed and compared between the two groups of patients.Results There were significant differences between the thrombns aspiration group and the PCI group on instant blood flow TIMI3 grade (106 (89.8％) vs.96 (79.3％) ; x2 =5.026,P ＜ 0.05),ST-segment depression rate at two hours after surgery (101 (85.6％) vs.90 (75.2％) ; x2 =5.500,P ＜ 0.05),ejection fraction within one week after surgery (68 (57.6％) vs.52 (43.0％) ; x2 =5.130,P ＜ 0.05),incidence of reinfarction during hospitalization (0 (0) vs.5 (4.1％) ; x2 =4.980,P ＜ 0.05).There were no significant statistical difference between the two groups on the average length of stay ((10.05 ± 5.40) d vs.(10.40 ± 5.03) d; t =-0.525,P ＞ 0.05),incidence of ventricular fibrillation during surgery (4 (3.4％) vs.3 (2.5 ％ ; x2 =0.174,P ＞ 0.05),heart failure during hospitalization (15 (12.7％) vs.18 (14.9％) ; x2 =0.235,P ＞0.05),Malignant arrhythmias (12 (10.2％) vs.15 (12.4％) ; x2 =0.296,P ＞ 0.05),and mortality rate (2 (1.7％) vs.5(4.1％);x2 =1.248,P ＞0.05).Conclusion Application of thrombus aspiration,which is a safe and effective way,may improve the clinical outcomes in acute ST-segment elevation myocardial infarction patients with emergency PCI.

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.

Sixty gynecological patients undergoing laparoscopic surgery during October 2010 to June 2011were randomly divided into 2 groups:laryngeal mask airway proseal ( PLMA group,n =30 ) and laryngeal mask airway classic (CLMA group,n =30).Laryngeal mask was inserted after induction.The heart rate (HR),mean arterial pressure (MAP),airway sealing pressure,the average time of placement,the pulmonary satisfaction and complications were recorded.There was no significant difference in heart rate and MAP between the two groups(P＞0.05).The airway sealing pressure [ (26 ±6) cm H2O ( 1cm H2O =0.098 kPa) vs.(16±5) cm H2O],the average time of placement [(36±5) vs.(24±6) s)] and the excellent lung ventilation(90％ vs.73％ ) in the PLMA group were more significantly increased than those in the CLMA group(P ＜0.05).PLMA can assure good airway sealing and is more suitable for gynecological patients undergoing laparoscopic surgery.