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To train homogeneous and excellent anesthesiologists who understand basic theory and clinical specialty, and response quickly and precisely to the emergency clinical condition. The Department of Anesthesiology, The First Affiliated Hospital of Army Medical University applied the integrated medical education mode combined with problem-based learning (PBL) to conduct the teaching of standardized residency training. We have always integrated relevant knowledge with "the alteration of pathophysiology" as the core, and standardized training teaching ideas with cases as the main line. A patient case bank has been set up based on the concept of integrated medical education, PBL training as the center, and the pathophysiological changes during anesthesia operation as the main line, which effectively achieves the goal of integrating theoretical knowledge with clinical practice. It is not only train high-quality anesthesiologists, but also improve their ability to find, analyze, and solve problems, so that the trainees form a habit of self-learning and continuous learning through the training.
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Objective:To evaluate the relationship between degrees of biliary obstruction and levels of lipid peroxidation in patients.Methods:A total of 140 patients of both sexes, with biliary obstruction, without biliary puncture and drainage, aged 40-64 yr, with body mass index of 18.5-23.9 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, were selected.The patients with different degrees of biliary obstruction were divided into 4 groups ( n=35 each) according to Child-Pugh grade total bilirubin (TBIL) concentrations: group A (TBIL<17 μmol/L), group B (17 μmol/L≤TBIL<34 μmol/L), group C (34 μmol/L≤TBIL<51 μmol/L) and group D (TBIL≥51 μmol/L). The serum TBIL, direct bilirubin (DBIL), indirect bilirubin (IBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bile acid (TBA) and malondialdehyde (MDA) concentrations were measured.The correlation between serum MDA concentration and degree of biliary obstruction was tested by Spearman correlation analysis. Results:Compared with group A and group B, the serum DBIL, IBIL, ALT, AST, TBA and MDA concentrations were significantly increased in group C and group D ( P<0.05), and there was no significant difference in the parameters mentioned above between group A and group B ( P>0.05). Compared with group C, the serum DBIL, IBIL, ALT, AST, TBA and MDA concentrations were significantly increased in group D ( P<0.05). Serum MDA concentration was positively correlated with degree of biliary obstruction ( r=0.54, P<0.05). Conclusion:The degree of biliary obstruction can reflect the level of lipid peroxidation in patients.
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Teaching rounds are an important part of hospitals at all levels to carry out clinical teaching work and improve medical quality. Taken anesthesia-related knowledge as the center, based on the patient's pathophysiology and anesthesia physiological changes, our department asked the core questions such as the impact of the operation method and anesthesia plan, then students answered, and finally closed the loop after the case. This process is called problem-based learning (PBL) teaching rounds. It is found that the teaching rounds can help improve the ability of anesthesiologists to solve problems, learn independently, and learn throughout their lives, thereby improving the teaching quality of standardized residency training of anesthesiology.
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Clinical teaching round is one of main teaching methods during standardized training for residents. However, the particularity of standardized resident training in clinical anesthesia determines that it is difficult to apply the teaching round model of other disciplines. In this study, seven core contents of Mini-Clinical Evaluation Exercise (Mini-CEX) were modified after considering the characteristics of anesthesia specialty and applied to the teaching rounds of standardized training for residents of anesthesia , thus promoting the standardization and improving the quality of anesthesia teaching rounds.
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Objective To evaluate the effect of regional hypothermia on limb ischemia-reperfusion (I/R) injury in a rabbit model of hemorrhagic shock.Methods Eighteen healthy adult New Zealand white rabbits of both sexes,weighing 2.0-2.5 kg,were divided into 3 groups (n=6 each) using a random number table:sham operation group (S group),limb I/R group (I/R group) and regional hypothermia group (RH group).Rabbits were shot with 0.25 g steel ball with a 7.62 mm smoothbore at the middle and lower 1/3 of the left hindlimb in I/R and RH groups.When the blood pressure was stable for 30 min after injury,blood was drawn via the right femoral artery at a rate of 2 ml/min until mean arterial pressure decreased to 45-50 mmHg.Then a rubber tourniquet was used to ligate left hindlimbs 10 min later.The injured limb was cooled down for 4 h after applying tourniquet to maintain the subcutaneous temperature at 9-11 ℃ in group RH.After tourniquet was applied for 4 h,perfusion was restored and lasted 6 h.After catheterization (T0) and at 2,4 and 6 h of reperfusion (T1-3),blood samples were collected from the right femoral artery for blood gas analysis and for determination of tumor necrosis factor-α (TNF-α),interleukin-2 (IL-2) and IL-6 concentrations in serum (by enzyme-linked immunosorbent assay).The animals were sacrificed at T3,and tissues around the margin of the inferior lobe of right lung were obtained for examination of the pathological changes which were scored and for determination of wet to dry weight ratio (W/D ratio).Results Compared with group S,the respiratory rate was significantly increased and PaCO2 was decreased at T2,3,the pathological score and W/D ratio were increased,and the concentrations of TNF-α,IL-2 and IL-6 in serum were increased at T1-3 in I/R and RH groups (P＜0.05).Compared with group I/R,the respiratory rate was significantly decreased and PaCO2 was increased at T2,3,the pathological score and W/D ratio were decreased,and the concentrations of TNF-α,IL-2 and IL-6 in serum were decreased at T1-3 (P＜0.05),and the pathological score was significantly attenuated in group RH.Conclusion Regional hypothermia can reduce limb I/R injury in a rabbit model of hemorrhagic shock,and the mechanism may be related to inhibiting systemic inflammatory responses.
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Objective To dynamically observe the SDF-1 level in plasma,bone marrow,liver,lung and kidney,and to investigate their significance in obstructive jaundice and its complications. Method 48 male SD rats weighing about 200g were randomly divided into Sham group and CBDL group. The serum ALT ,AST and se-rum total bilirubin(TBIL)were detected at 7 d,14 d and 21 d after operation. General condition of rats in the two groups were observed. ELISA was applied in detecting expression of SDF-1 in plasma and supernate of tissue ho-mogenate. And mRNA expression of SDF-1 at different time was detected by qPCR assay. Results ALT,AST,TB increased rapidly after CBDL operation,the difference was significant compared with Sham group(P <0.05). The SDF-1 expression of plasma,liver tissue,lung tissue in CBDL rats at different time points were significantly higher than in Sham group. No significant difference was found in renal tissue. SDF-1 expression of bone marrow in 7 d,14 d,21 d was significantly lower in CBDL group than in Sham group. Conclusion Expression of SDF-1 in liver and lung tissues of obstructive jaundice rats significantly increased ,and decreased in marrow bone. This change may promote related stem cells mobilization and contribute to the pathological changes of obstructive jaun-dice.
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Objective To dynamically observe the SDF-1 level in plasma,bone marrow,liver,lung and kidney,and to investigate their significance in obstructive jaundice and its complications. Method 48 male SD rats weighing about 200g were randomly divided into Sham group and CBDL group. The serum ALT ,AST and se-rum total bilirubin(TBIL)were detected at 7 d,14 d and 21 d after operation. General condition of rats in the two groups were observed. ELISA was applied in detecting expression of SDF-1 in plasma and supernate of tissue ho-mogenate. And mRNA expression of SDF-1 at different time was detected by qPCR assay. Results ALT,AST,TB increased rapidly after CBDL operation,the difference was significant compared with Sham group(P <0.05). The SDF-1 expression of plasma,liver tissue,lung tissue in CBDL rats at different time points were significantly higher than in Sham group. No significant difference was found in renal tissue. SDF-1 expression of bone marrow in 7 d,14 d,21 d was significantly lower in CBDL group than in Sham group. Conclusion Expression of SDF-1 in liver and lung tissues of obstructive jaundice rats significantly increased ,and decreased in marrow bone. This change may promote related stem cells mobilization and contribute to the pathological changes of obstructive jaun-dice.
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To evaluate the effect of exogenous hydrogen sulfide on phenotypic transformation of alveolar macrophages in a mouse model of endotoxin-induced acute lung injury (ALI).Methods Thirty pathogen-free healthy male C57BL/6 mice,aged 8 weeks,weighing 18-20 g,were divided into 3 groups (n =10 each) using a random number table:sham operation group (group Sham),group ALI and exogenous hydrogen sulfide group (group NaHS).In group Sham,normal saline was intratracheally instilled and intraperitoneally injected.In ALI and NaHS groups,lipopolysaccharide 20 mng/kg was intratracheally instilled,and normal saline and sodium hydrosulfide (28 μmol/kg) 100 μl were intraperitoneally injected,respectively,every day.Mice were sacrificed at day 3 after administration of lipopolysaccharide,and lungs were removed for measuremnent of the lung coefficient and expression of inducible nitric oxide synthase (iNOS) and arginase (by immunohistochemistry) and for microscopic examination of the pathological changes.Lung injury was evaluated by the index of quantitative assessment (IQA).Results Compared with group Sham,the lung coefficient and IQA were significantly increased,and the expression of iNOS and arginase in lung tissues was up-regulated in group ALI (P＜0.05).Compared with group ALI,the lung coefficient and IQA were significantly decreased,the expression of iNOS in lung tissues was down-regulated (P＜0.05),and no significant change was found in the expression of arginase in lung tissues in group NaHs (P＞0.05).Conclusion Exogenous hydrogen sulfide mitigates endotoxin-induced ALI through inhibiting phenotypic transformation of alveolar macrophages to M1 subtype in mice.
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Objective To observe the effect of dexmedetomidine on plasma SDF-1 level in in hepatic portal occlusion operation.Methods Fifty patients with live cancer undergoing elective partial hepatectomy were selected,no gender limitation,aged 42 to 71,body mass index(BMI) 18.5 ～ 26.0 kg/m2,ASA grade Ⅱ or Ⅲ.The patients were randomly divided into 2 groups(n=25):control group and dexmedetomidine group.The dexmedetomidine group was performed the pump injection of dexmedetomidine 1 μg/kg at 15 min before induction of anesthesia.After induction the rate was changed to 0.4μg · kg-1 · h-1 until 15 min before the end of operation;the control group adopted the same method for conducting continuous intraverous infusion of the same capaci ty of 0.9％ sodium chloride.The peripheral venous blood was collected in 2 groups at preoperative 1 h (T0),postoperative 1 h (T1),postoperative 1 d (T2),postoperative 3 d(T3).The plasma SDF-1 level was detected by using enzyme-linked immunosorbent assay(ELISA).Results There was no statistically significant difference in liver resection range,blood loss,first porta hepatis vessel occlusion time,anesthesia time and plasma SDF-1 level before surgery between the two groups (P＞0.05).Compared with pre-operation,plasma SDF-11evel at T1,T2,T3 time point was significantly increased (P＜0.05).The plasma SDF-1 level at T1,T2,T3 time point in the dexmedetomidine group was lower than that in the control group(P＜0.05).Conclusion SDF-1 expression is significantly increased during perioperative period in the patients with hepatic portal occlusion operation,and intraoperative continuous dexmedetomidine can significantly reduce the SDF-1 level,which inhibits the chemotaxis and accumulation of inflammatory ceils to some extent.
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Objective To evaluate the role of Src kinase in liver injury in endotoxemic mice.Methods Forty-eight female BABL/c mice,aged 3-4 months,weighing 15-20 g,were randomly divided into 3 groups (n =16 each) using a random number table:control group (C group),endotoxemia group (lipopolysaccharide (LPS) group) and Src kinase inhibitor PP2 group (PP2 group).Endotoxemia was induced by intraperitoneal LPS 20 mg/kg in LPS and PP2 groups,while the equal volume of PBS was given in group C.In PP2 group,PP2 1 mg/kg was injected intraperitoneally at 2 h after LPS administration.At 6 h after LPS or PBS injection,8 mice in each group were chosen,and blood samples were collected from the abdominal aorta for determination of the serum levels of alkaline phosphatase (ALP).The mice were then sacrificed and livers were removed for determination of nuclear factor E2-related factor 2 (Nrf2) level,superoxide dismutase (SOD) activity,malondialdehyde (MDA) content and myeloperoxidase (MPO) activity in liver tissues.The other 8 mice in each group were sacrificed at 24 h after LPS or PBS injection,and the livers were harvested for examination of pathological changes.Results Compared with C group,the serum levels of ALP and MDA content and MPO activity in liver tissues were significantly increased,and SOD activity and Nrf2 levels in liver tissues were decreased in LPS and PP2 groups.Compared with LPS group,the serum levels of ALP and MDA content and MPO activity in liver tissues were significantly decreased,and SOD activity and Nrf2 levels in liver tissues were increased in PP2 group.The pathological changes of liver tissues were significantly attenuated in PP2 group as compared with LPS group.Conclusion Src kinase is involved in endotoxemia-induced liver injury in mice.
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Objective To investigate the effect of dexmedetomidine on awareness during intraoperative Wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia .Methods 36 patients ,requiring intraoperative arousal test during posterior spinal surgery were randomly divided into the group D (DEX ,n= 18) and C (NS ,n= 18) .DEX 1 μg/kg followed by 0 .2 μg · kg -1 · h-1 and equal volume NS were infused respectively 10 min before anesthesia induction and maintenance of anesthe-sia in two groups .Hemodynamic parameters were monitored 5 min(T1) before anesthesia induction ,3 min(T2)after anesthesia in-duction ,at the beginning of wake-up test(T3) ,at the end of the test(T4) and 5 min(T5) after deepen anesthesia respectively . Meanwhile the wake-up time ,success rate of arousal ,incidence agitation and the dosage of nitroglycerin during wake-up were also recorded .Results Successive rate of arousal awakening time between two group had no statistically significance (P>0 .05) .less in-cidence of agitation was found in group D compared with group C ,the dosage of nitroglycerin used during wake-up in group D was less than that in group C(P<0 .05) .Conclusion Dexmedetomidine auxiliary propofol remifentanil anesthesia can effectively implement intraoperative wake up ,during the awakening the hemodynamic was more smoothly ,and it has lower incidence of adverse events .
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Nuclear factor-E2-related factor 2(Nrf2)is a member of C′n′C transcription factor family.It is an important transcrip-tion factor for regulation of cellular redox status and can be seen in all kinds of tissues .Recent studies have demonstrated that rapid deg-radation of Nrf2 after gene-induced antioxidative stress is as important as transcription and activation of Nrf 2 and the nuclear export of Nrf2 is a prerequisite for rapid degradation of Nrf2 in the cytosol.This review focuses on the mechanism of nuclear export of Nrf 2.
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AIM: To study the effects of tumor necrosis factor-α (TNF-α) on the transcriptional activity of nuclear factor-erythroid 2-related factor 2 (Nrf2) in pulmonary microvascular endothelial cells. METHODS: Rat pulmonary micro-vascular endothelial cells (PMVECs) were cultured by lung tissue block pasted methods, and identified immunocytochemically using Ⅷ factor-related antigen. The cells were treated with different doses TNF-α (prepared in serum-free medium) for 4 h. Subcellular localization and levels of Nrf2 in PMVECs were observed with immunocytochemical methods. Nuclear extract were obtained to assayed transcriptional activity of Nrf2 with EMSA. Total RNA were isolated to assay the mRNA expression of Nrf2 by RT-PCR. RESULTS: The protein level of Nrf2 in the nuclei and transcriptional activity increased dose-dependently in PMVECs after treated with TNF-α at concentrations of 2.5, 5.0 or 10.0 μg/L. However, the protein level of Nrf2 in nuclei and transcriptional activity decreased dose-dependently in PMVECs after treated with TNF-α at concentrations of 20 or 40 μg/L. No different mRNA expression of Nrf2 in PMVECs treated with TNF-α at all concentration above was observed. CONCLUSION: Transcriptional activity of Nrf2 increases in PMVECs treated with low or moderate doses of TNF-α and decreases in PMVECs treated with high doses of TNF-α.