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Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia, including Department of Anesthesiology, Neurosurgery, Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.
ABSTRACT
Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia , including Department of Anesthesiology , Neurosurgery , Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.
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BACKGROUND: Adipokines are secreted by adipose tissue, including a series of cytokines and chemokines. Additionally, adipokines have been found to play certain roles in pro- and anti-inflammatory regulation. OBJECTIVE: To analyze the regulatory effect of various adipokines in the inflammatory process of autoimmune response and immune diseases, thus providing the strategy for controlling and treating autoimmune diseases and searching effective indexes for assessing disease development, incidence of complications and prognosis. METHODS: CNKI and PubMed databases were retrieved for the articles addressing the role of adipokines in autoimmune diseases published from 1986 to 2016 using the keywords of adipokine, autoimmune in English and Chinese, respectively. RESULTS AND CONCLUSION: Adipose tissue plays a critical role in metabolism regulation, and its effect on the immune system has emerged through a series of studies concerning adipokines regulating immune response. Adipokines exert various functions, and regulate metabolism and inflammation. In the development and occurrence of autoimmune diseases, some factors for immune responses remain unclear, and in-depth studies on adipokines will be helpful for lifting the veil of autoimmune diseases.
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Objective To explore the effect of R-(-)-α-methylhistamine (RAMH) on the isoflurane exposure induced neuronal apoptosis and memory impairment in the developing rats.Methods Twenty-eight 6-7 days SD rats were randomly divided into four groups:control (CON) group (intraperitoneal injection of 5％ glucose [0.1 mL/10 g],isoflurane (ISO) group (intraperitoneal injection of 5％ glucose [0.1 mL/10 g] and then exposure to 1.6％ ISO for 6 hours),RAMH group (intraperitoneal injection of RAMH [10 mg/kg],and RAMH+ISO group (after intraperitoneal injection of RAMH [10 mg/kg] for 30 min,then exposure to 1.6％ ISO for 6 hours).Morris water maze test was employed to investigate the learning and memory ability.Immunofluorescence and Western blotting were employed to determine the neuronal apoptosis and p53 expression in the hippocampus of rats,respectively.Results Morris water maze test showed that the time in the target quadrant of ISO group was significantly shorter than that of CON group (n =7,P＜0.01),while the time of RAMH+ISO group was significantly longer than the ISO group (n =7,P＜0.05).The number of apoptotic neurons in hippocampus in the ISO group was significantly increased compared with either the CON group or the RAMH+ISO group (n=5,both P＜0.01).Compared with the CON group,the expression of p53 protein in hippocampus was significantly increased in the ISO group (n =6,P＜0.01),while p53 expression in the RAMH+ISO group was significantly lower than that in the ISO group (n =6,P＜0.01).Conclusion RAMH can ameliorate ISO exposure induced neuronal apoptosis and memory impairment in the developing rat.
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Resident standardization training is an important part of postgraduate medical educa-tion and anesthesiology rotation is an important part in resident standardization training. Anesthesiology rotation is an effective way to improve the efficiency of hospital operation and is an important starting point to promote 'comfortable medical' and hospital upgrades. To improving the quality of training , anes-thesiology department should establish training and supervision system clearly , organize teacher training regularly. Continuous improvements in institutional mechanism can be achieved by detailed theoretical studies, technical operations and departmental rotation examination requirements as well as by exchanging ideas between teachers and students.
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Objective To compare the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block(BPB).Methods One hundred and twenty patients,ASA Ⅰ-Ⅲ,aged 18-80 yr,scheduled for upper extremity surgeries of both gender,were randomized into two groups(n =60):supraclavicular group(group SCB)and infraclavicular group(group ICB).The anesthetic mixture consisted of ropivacaine 0.375％ and lidocaine 1％ in equal volumes with epinephrine 1∶200 000,the total dose was 0.5 ml/kg.The block performance time,duration of anesthesia and success of anesthesia(surgery was accomplished without supplementary block)were recorded.A blinded observer assessed pinprick sensory block in the seven distal nerve territories(axillary,radial,musculocutaneous,median,ulnar,medial antebrachial and medial brachial cutaneous nerves)every 5 min up to 30 min after injection.Success of nerve block,side effects and complications were recorded during and after operalion.Results Group ICB was superior in success rate of anesthesia and nerve block of ulnar,medial antebrachial and medial brachial cutaneous nerves,the rate of parasthesia was lower and the block performance time was longer compared with group SCB(P ＜ 0.05).No major complications occurred in both groups.Conclusion Under ultrasound guidance,infraclavicular BPB is superior to supraclavicular approach.
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Objective To investigate the effect of propofol pretreatment on hypoxia-induced apoptosis of alveolar epithelial type Ⅱ (AE Ⅱ) cells in fetal rats. Methods Primary cultured AE Ⅱ cells isolated from fetal rats were seeded in 96-well plates (1 × 106/L, 180 μl/well) and randomly assigned to one of 3 groups (n = 72each):normal control group (group C), hypoxia group (group H) and propofol-hypoxia group (group P-H).Group H and P-H were exposed to hypoxia (5% O2). In group P-H, propofol (final concentration 5 μ mol/L) was added 1 h prior to hypoxia (5% O2). The apoptotic rate and expression of hypoxia-inducible factor (HIF)-1αmRNA, Bnip3L mRNA, HIF-1α protein and Bnip3L protein were determined at 3, 12, 24 and 48 h of hypoxia.Results The apoptotic rate and expression of HIF-1α mRNA, Bnip3L mRNA, HIF-lα protein and Bnip3L protein were significantly up-regulated in group H compared with group C (P ＜ 0.05). Propofol pretreatment could significantly inhibit the hypoxia-induced changes mentioned above (P ＜ 0.05). Conclusion Propofol pretreatment can inhibit hypoxia-induced apoptosis of AE Ⅱ cells, and the mechanism is related to inhibition of HIF-1αactivation and down-regulation of Bnip3L expression in fetal rats.
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Preoperative anesthetic interview is not only an important part of clinical teaching,but also a vital tache of improvement for medical treatment quality.Unlike internal medicine and surgery,interview for anesthesiology department has its own characteristics.Anesthesiology department of Changzheng hospital has put great emphasis on preoperative anesthetic interview.Some experiences about preoperative anesthetic interview were introduced in our article.
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[Objective]To summarize the clinical experience on anesthesia techniques for surgery of spinal tumors.[Method]A total of 546 patients undergoing surgery of spinal tumors were retrospectively studied,and the complications of surgery were also collected.[Result]There was no perioperative death.The average degree of blood loss was 1997ml per patient who usually required a large volume of blood transfusion.Acute pumonlary edema were occurred in 3 patients who were suspected to develop larynx edema immediately after operation.A perioperative visual loss following cervical spine surgery was also founded.[Conclusion]It is important to prevent and minimize blood loss by varied techniques during operation.Peventing adverse effect of operative position on patients and protecting their airway are also crucial for spinal surgery.
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Clinical practice is an important teaching stage for interns of anesthesiology in medical universities.We discuss advantages and disadvantages for different teaching modes in the course of clinical practice,aiming at choosing a better one to optimize practice quality and bringing up graduates with high diathesis.
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Evidence-based medicine(EBM)is an inevitable development tendency of clinical medicine education in 21 century.Its core thinking is to combine evidence,personal experiences and patients'actual situation.The thinking of EBM will magnificently promote the conversion of conception and model of clinical education and will make significant influence on clinical teaching,scientific research and clinical practice.
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It is an important way for interns to evaluate and test quality of teaching and results of practice by means of clinical check.Applying dynamic simulation of anesthesia in our university,we statistically analyzed check results for interns of anesthesia specialty from 1996 to 2003 to invest present problems,aiming at perfecting clinical practice and teaching work of anesthesia specialty and favoring to cultivating talents with high diathesis.
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We made our specific teaching program for these students with evidence-based medicine theory,according to their teaching characteristics. They studied the research methods of evidencebased medicine,and learned to search informations,write reviews,discuss clinical cases, design subjects under the guidance of teachers. Their scientific research ability was improved after these practices and training program.
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The essence of training for clinical postgraduates is comprehensive capacity,including clinical and scientific research capacity,and the demand for the former is relatively higher than the latter. By means of discussion on the source and the educational system for postgraduates,we try to train clinical anesthesiology postgraduates with high diathesis and meet the needs of clinical anesthesia.
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Evidence-based anesthesia’s core thinking is to abide by evidence,which means clinical decision must be based on objective research result,personal experiences and patients` actual situation. The thinking of EBA will magnificently promote the conversion of model of clinical anesthediology education,and will make significant influence on clinical teaching,scientific research, and clinical practice. According to the current situation,try to give out new teaching model of evidence-based practice of anesthesiology and offer teaching methods and practical procedures.
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Objective To observe the effect of intrathecal p38 MAPK inhibitor(SB203580) treatment on neuropathic pain and the expression of p38 MAPK and BDNF in dorsal horn of spinal cord in rats with chronic constriction injury(CCI),So as to investigate the possible mechanisms of neuropathic pain.Methods Totally 30 SD rats were evenly randomized into 3 groups(n=10) :sham group receiving intrathecal injection of sodium chloride,control group receiving intrathecal injection of sodium chloride and CCI surgery,and SB203580 group receiving intrathecal injection of SB203580 and CCI surgery.SB203580(0.1 ml/kg) was administered 0.5 h before and 1-14 d after CCI surgery.The mechanical thresholds were tested 24 h before and 4-14 d after CCI surgery.p38 MAPK expression and BDNF release in the dorsal horn were determined using immunohistochemistry method 14 d after CCI surgery.Results The mechanical thresholds in the control and SB203580 groups were significantly lower after CCI surgery compared with that before CCI surgery(P0.05).Compared with the sham operation group,the mechanical thresholds were significantly lower in the other two groups after CCI surgery(P