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ObjectiveTo investigate the effect of xenon post-conditioning on autophagy after spinal cord ischemia/reperfusion injury (SCIRI) in rats and its relationship with protein kinase B (Akt) signaling pathway. MethodsA total of 30 male rats were randomized into sham-operated group (sham group), spinal cord ischemia/reperfusion injury group (I/R group) and I/R + xenon post-conditioning group (Xe group), with ten rats in each group. In the latter two groups, SCIRI was induced by clamping the abdominal aorta for 85 minutes followed by reperfusion for four hours. Xe group inhaled xenon and oxygen (1∶1) for one hour at one hour after initiation of reperfusion, while the other groups inhaled nitrogen and oxygen (1∶1) for one hour. After the reperfusion, they were assessed with Basso-Beattie-Bresnahan (BBB) scale and slanting board test. And then, their spinal cords of L3-5 were obtained. Nissl staining was used to count the number of normal neurons. Western blotting was used to detect the protein expression of Akt, p-Akt, p62, Beclin 1, microtubule-associated protein 1 light chain 3 (LC3) Ⅰ, LC3 Ⅱ. The mRNA expression of Beclin 1, p62 and LC3 Ⅱ in the spinal cord was measured with reverse transcription real-time quantitative polymerase chain reaction. ResultsCompared with the sham group, the BBB score and the maximum inclination of the slanting board test decreased, the count of normal neurons decreased, the protein expression of p62 and the p-Akt/Akt ratio decreased (P < 0.01), the protein and mRNA expression of Beclin 1 and LC3 Ⅱ, and the LC3 Ⅱ/LC3 Ⅰ ratio increased, the p62 mRNA expression decreased (P < 0.01) in the I/R group. Compared with the I/R group, the BBB score and the maximum inclination of the slanting board test increased, the count of normal neurons increased, the protein expression of p-Akt and p62 increased, the p-Akt/Akt ratio increased, the protein and mRNA expression of Beclin 1, LC3 Ⅱ and LC3 Ⅱ/LC3 Ⅰ ratio decreased, and the mRNA expression of p62 increased (P < 0.01) in Xe group. ConclusionXenon post-conditioning may relieve SCIRI in rats, which is related to activating Akt signaling pathway to inhibit autophagy.
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Objective To observe the evolution of astrocytes,GDNF,BDNF and Jak-STAT signal pathway after spinal cord ischemia-reperfusion injury in rabbits.Methods Spinal cord ischemia was induced by means of balloon occlusion of the infrarenal aorta for 22 minutes in 54 male New Zealand white rabbits.We assigned rabbits to 9 groups (n =6),one sham group,eight operation groups.The operation process in the sham group was the same as the operation group except the ischemia reperfusion of the spinal cord.At 0 h,1 h,2 h,3 h,8 h,24 h,48 h and 72 h after reperfusion,animals were sarcrificed and the spinal cord was removed for histologic,immunohistochemical study and western blotting.Results Normal neurons were decreased with the extension of reperfusion time.Levels of GFAP increased at 3 h and reached a peak at 48 h after reperfusion.GDNF was increased reaching two peaks after injury,the first peak was at 3 h,the second was at 72 h.BDNF level was increased and peaked at 24 h after reperfusion.The expression of p-STAT3 showed a biphasic pattern which peaked at 1h and 48 h.GFAP,GDNF,BDNF were rare and the level of p-STAT3 could be neglected in sham group.Conclusion Spinal cord ischemia-reperfusion injury could induce the activation of astrocytes,the expression of GDNF,BDNF and the activation of JakSTAT signal pathway.They showed different expression rules in this study.
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Objective To analyze risk factors of continuous renal replacement therapy (CRRT) in patients with severe serum creatinine levels elevation undergoing off-pump coronary artery bypass grafting (OPCABG).Methods The perioperative data of 45 patients with severe elevation of preoperative serum creatinine levels undergoing OPCABG were investigated based on the perioperative CABG database from Feb, 2012 to Jul, 2016.The postoperative treatment rates of CRRT were recorded and the risk factors were identified by multivariate logistic regressions.Results There were 9 patients (20%) who suffered from CRRT after OPCABG in all 45 recruitment patients.Compared with non-CRRT patients, there were higher levels of serum creatinine (Cr) and blood urea nitrogen (BUN) before surgery, a lower volume of urine during surgery, a higher level of serum creatinine at postoperative 12 hour and 24 hour, longer ICU staying time and higher in-hospital mortality after surgery in patients with CRRT (P＜0.05 or P＜0.01).Multivariate logistic regression analysis demonstrated that preoperative level of serum creatinine (OR=1.05, 95% CI 1.05-1.10, P=0.046) was the independent risk factor of postoperative CRRT in patients with severe serum creatinine levels elevation undergoing OPCABG.At the value of postoperative 12 hour serum creatinine up to 166 μmol/L, the incidence of postoperative CRRT in patients increased 5% by postoperative 12 hour serum creatinine increasing 1 μmol/L(OR=1.05, 95% CI 1.01-1.08, P=0.013).However at the value of postoperative 12 hour serum creatinine above 350 μmol/L, ceiling effect was apparent.Conclusion This study shows that 20% patients with preoperative severe serum creatinine level elevation are suffered from CRRT after OPCABG procedure and preoperative level of serum creatinine is predominant factor of postoperative CRRT.
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Objective To investigate the short- and mid-term outcomes of after off-pump coronary artery bypass grafting (OPCABG) in patients with severe elevation of preoperative serum creatinine levels (SEPSC). Methods The perioperative data of SEPSC patients undergoing OPCABG were investigated based on the perioperative CABG database from Feb. 2012 to Jul. 2016. The patients were also followed up for the perioperative complication, short and medium-term survival were estimated. Results The mean age of the patients was 65.4(45-85) years. The in-hospital mortality was 4.4% and the CRRT rate was 19.6%(9 case). Survival analyses revealed a survival ratio of 100% at one year, 97.6% at two years. Short-Form Mini Nutritional Assessment was used to show that 13(28.3%) patients had malnutrition. Conclusions SEPSC patients can be candidates for OPCABG procedure. The mortality in hospital and 2-year survival rate of SEPSC patients after OPCABG procedure are both considered within an acceptable range. OPCABG may be performed in these patients with a satisfactory survival rate with the development of surgical instruments and medical treatment.
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Objective: To observe the activation of microglia and the changing rule of inflammatory cytokine as IL-6, IL-10 and nuclear factor-κB (NF-κB) in experimental rabbits after spinal cord ischemia reperfusion (SCIR) injury in order to provide theoretical basis for post-conditioning time. Methods: Rabbit SCIR injury model was established by thoracic aorta balloon occlusion. 54 New Zealand male adult white rabbits were divided into 9 groups: Sham group (the animals received balloon implantation without occlusion), SCIR-0h group (reperfusion was conducted at 0 hour of spinal cord ischemia), SCIR-1h, -2h, -3h, -8h, -24h,-48h and -72h groups. n=6 in each group. The number of normal and apoptosis neurons, the levels of Iba-1, IL-6, IL-10 and NF-κB in spinal tissue were examined and compared among different groups respectively. Results: The number of normal neuron was decreasing with the extended reperfusion time, TUNEL-positive neuron began to increasing in SCIR-8h group and the peak was reached in SCIR-24h group. The expression of Iba-1 began to elevating in SCIR-2h group and the peak was obtained in SCIR-8h group; NF-κB began to rising in SCIR-3h group and the peak was observed in SCIR-8h group; both IL-6 and IL-10 arrived the peak in SCIR-24h group. The expressions of NF-κB, IL-6 and IL-10 were positively related to Iba-1 level. Conclusion: Microglia activation had dynamic changes in experimental SCIR rabbits and the expression levels of NF-κB, IL-6 and IL-10 were positively to microglia activation; post-conditioning time at front and back to microglia activation may reduce neuron injury.
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Dendrobium moniliforme (L.) Sw., an herb of the Orchidaceae family, has long been used in traditional medicine to strengthen bones, nourish the stomach, and promote the production of bodily fluid. Recently, polysaccharides isolated from Dendrobium have been used in functional foods and nutraceutical products. A traditional method to process Dendrobium is to soak fresh stems in an ethanol solution, which is the most important factor to ensure high yields of aqueous-extractable polysaccharides. The present study was carried out to investigate the potential acute toxicity of D. moniliforme aqueous extract (DMAE), by a single oral dose in Sprague-Dawley rats. The test article was orally administered once by gavage to male and female rats at doses of 0, 2,500, and 5,000 mg/kg body weight (n=5 male and female rats for each dose). Throughout the study period, no treatment-related deaths were observed and no adverse effects were noted in clinical signs, body weight, food consumption, serum biochemistry, organ weight, or gross findings at any dose tested. The results show that a single oral administration of DMAE did not induce any toxic effects at a dose below 5,000 mg/kg in rats, and the minimal lethal dose was considered to be over 5,000 mg/kg body weight for both sexes. With respect to cytotoxicity, the cell viability of human embryonic kidney (HEK293) cells was less than 50% when the cells were treated with 10 mg/mL aqueous extract for 24 h.
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Animals , Female , Humans , Male , Rats , Administration, Oral , Biochemistry , Body Weight , Cell Survival , Dendrobium , Dietary Supplements , Ethanol , Functional Food , In Vitro Techniques , Kidney , Medicine, Traditional , Methods , Orchidaceae , Organ Size , Polysaccharides , Rats, Sprague-Dawley , StomachABSTRACT
Objective To measure the effect of prostaglandin E1 (PGE1) lipid microsphere on cardiac haemodynamics and oxygen metabolism during the perioperative period in the infants with ventricular septal defect(VSD)and severe pulmonary artery hypertension (PAH).Methods Forty infants [(7.1 ± 3.3) years old] with VSD and severe PAH who underwent surgery under cardiopulmonary bypass were involved in the study.They were divided into 2 groups averagely:control group (20 cases) and experimental group (20 cases).All the patients were continuously intravenous pumping of nitroglycerin or PGE1 during the perioperative period.The effect of PGE1 on cardiac haemodynamics and oxygen metabolism between the 2 groups were measured during 72 hours postoperatively.Results The statistical analysis demonstrated that the values trend of mean arterial blood pressure (mABP),mean pulmonary arterial pressure (mPAP),mPAP/mABP,pulmonary vascular resistance index (PVRI),left ventricular stroke work index (LVSWI) were affected during 72 h postoperative period (P ＜0.05).The mABP at 48 h,LVSWI at 48 h,72 h in experimental group were significantly higher than those in control group (all P ＜0.05).The mPAP at 8 h,48 h,PVRI at 72 h and pulmonary arterial wedge pressure (PAWP)at 12-48 h in experimental group were significantly lower than that in control group (all P ＜ 0.05).Compared to postoperative period,mABP at 12 h,72 h,mPAP at 4-12 h,48 h were increased significantly in control group (P ＜ 0.05) ; mABP and LVSWI at 8-72 h,right ventricular stroke work index at 48 h,72 h and cardiac index at 72 h were significantly increased (P ＜0.05),while PVRI and PAWP at 72 h,mPAP/mABP at 24-72 h were significantly decreased in experimental group (P ＜ 0.05).There were no significant differences in the values of oxygen metabolism between both groups (P ＞0.05).Conclusions LipoPGE1 can significantly decrease the pulmonary arterial pressure,which can enhance cardiac function and decrease the duration of intubation after surgery.
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ObjectiveDahl salt-sensitive (Dahl/SS) rats are hereditary salt-sensitive hypertensive rats.Its pathogenesis is similar to that of human primary hypertension,CPB established in Dahl/SS rats provides an animal model for the study of CPB in patients with primary hypertension.MethodsMale 14-16 weeks old Dahl/SS rats weighing 360-390 g were fed with high salt (8％ NaCl) diet for 4 weeks before the experiment.Ten Dahl/SS rats were randomly divided into 2 groups ( n =5 each) according to the CPB time:groups Ⅱ and Ⅲ underwent CPB for 120 and 75 min respectively.Another 7 male 14-16 weeks old ordinary SD rats weighing 410-490 g undergoing CPB for 120 min were used as control group (group Ⅰ ).Anesthesia was induced with isoflurane inhalation.Orotraeheal intubation was performed.The animals were mechanically ventilated.Right jugular vein and tail artery were cannulated for venous drainage and arterial inflow from CPB circuit.Blood was oxygenated with a customized mini-oxygenator.Blood gases were analyzed and blood glucose concentration was determined.MAP was recorded before (baseline) and at 30 and 60 min of CPB and 30 and 90 min after CPB.The rate of changes in MAP and blood glucose concentration and survival rate at 7 d after termination of CPB were recorded.ResultsThere was no significant difference in blood gases among the 3 groups.The rates of change in MAP and blood glucose concentration were significantly higher during and after CPB in Dahl/SS rats than in control SD rats in a duration of CPB dependent manner.The survival rate at 7 d after CPB was 7/7 (in group Ⅰ ),1/5 (in group Ⅱ ) and 4/5 (in group Ⅲ ) respectively.ConclusionA model of 75 min CPB is established successfully in Dahl/SS rats.
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Valproic acid (VPA) is a well-known anti-epileptic and mood stabilizing drug. A growing number of reports demonstrate that VPA is neuroprotective against various insults. Despite intensive efforts to develop new therapeutics for stroke over the past two decades, all treatments have thus far failed to show clinical effect because of treatment-limiting side effects of the drugs. Therefore, a safety-validated drug like VPA would be an attractive candidate if it has neuroprotective effects against ischemic insults. The present study was undertaken to examine whether pre- and post-insult treatments with VPA protect against brain infarct and neurological deficits in mouse transient (tMCAO) and permanent middle cerebral artery occlusion (pMCAO) models. In the tMCAO (2 hr MCAO and 22 hr reperfusion) model, intraperitoneal injection of VPA (300 mg/kg, i.p.) 30 min prior to MCAO significantly reduced the infarct size and the neurological deficit. VPA treatment immediately after reperfusion significantly reduced the infarct size. The administration of VPA at 4 hr after reperfusion failed to reduce the infarct size and the neurological deficit. In the pMCAO model, treatment with VPA (300 mg/kg, i.p.) 30 min prior to MCAO significantly attenuated the infarct size, but did not affect the neurological deficit. Western blot analysis of acetylated H3 and H4 protein levels in extracts from the ischemic cortical area showed that treatment with VPA increased the expression of acetylated H3 and H4 at 2 hrs after MCAO. These results demonstrated that treatment with VPA prior to ischemia attenuated ischemic brain damage in both mice tMCAO and pMCAO models and treatment with VPA immediately after reperfusion reduced the infarct area in the tMCAO model. VPA could therefore be evaluated for clinical use in stroke patients.
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Animals , Humans , Mice , Blotting, Western , Brain , Brain Ischemia , Histone Deacetylase Inhibitors , Infarction, Middle Cerebral Artery , Injections, Intraperitoneal , Ischemia , Neuroprotective Agents , Reperfusion , Stroke , Valproic AcidABSTRACT
<p><b>OBJECTIVE</b>To investigate the value of cardiac troponin I (cTnI) levels in assessing myocardial protection by remifentanil precondition against myocardial injury induced by off-pump coronary artery bypass (OPCAB).</p><p><b>METHODS</b>Twenty-four patients undergoing OPCAB were randomized into control and remifentanil preconditioning group (n=12). All the patients received pretreatment with oral diazepam (10 mg), intramuscular morphine (10 mg) and hyosine (0.3 mg). General anesthesia was induced with midazolam (0.08 mg/kg), etomidate (0.1-0.3 mg/kg), fentanyl (5-10 microg/kg), and rocuronium (1 mg/kg), and maintained with isoflurane inhalation and propofol infusion. Intermittent fentanyl and pipecuronium were given intravenously. In remifentanil preconditioning group, remifentanil (5 microg/kg in 50 ml normal saline) was infused in 10 min after anesthesia induction, and only NS was administered in the control group. Blood samples were obtained before and at 0, 2, 6, 24, and 48 h after the operation to determine serum cTnI levels.</p><p><b>RESULTS</b>In both of the two groups, the cTnI levels increased significantly at the postoperative time points (0, 2, 6, 24, and 48 h) as compared with those before the operation (P<0.05). The cTnI levels of remifentanil preconditioning group were markedly decreased after the operation in comparison with those of the control group (P<0.05).</p><p><b>CONCLUSION</b>Remifentanil preconditioning decreases the cTnI levels and reduces myocardial injury induced by OPCAB.</p>
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Aged , Female , Humans , Male , Coronary Artery Bypass, Off-Pump , Heart , Ischemic Preconditioning, Myocardial , Myocardial Reperfusion Injury , Blood , Metabolism , Myocardium , Metabolism , Piperidines , Pharmacology , Postoperative Period , Time Factors , Troponin I , Blood , MetabolismABSTRACT
PURPOSE: Organophosphorus (OP) pesticides are differentiated into 3 groups according to their toxicity. The differences in chemical composition of each OP pesticide determines its toxicokinetic characteristics. There are few human studies that address the clinical results of poisoning according to the OP pesticide. In this study, we aimed to examine the differences in clinical features among self-poisoning from 4 highly toxic OP pesticides. METHODS: The 4 kinds of OP poisonings included 17 cases of Dichlorvos, 17 cases of EPN, 17 cases of methidathion, and 13 cases of phosphamidon. We set primary outcomes as GCS, atropine dose required, duration of patient need for atropine, proportion who required ventilation, duration on ventilation, and the interval from ingestion to ventilation. Secondary outcomes were the proportion of OP-induced delayed neuropathy, duration of ICU stay, and proportion who required additional infusion of pralidoxime chloride (PAM). RESULTS: The EPN group required the largest amount of atropine, the longest duration of atropine use, the longest duration for support of mechanical ventilation, and the longest ICU stay. Furthermore the proportion who required additional PAM and neuropathy were in the EPN group. However, the EPN group had the longest interval from ingestion to ventilatory support. Meanwhile, the Dichlorvos group exhibited comparatively mild clinical features. CONCLUSION: Throughout this study, we found different clinical features to each OP pesticide poisoning. It can be explained by differences in chemical composition, which determined the speed of aging, the reactivation rate of OPenzyme, the metabolism, the fat solubility, and other characteristics of the pesticides.
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Humans , Aging , Atropine , Dichlorvos , Eating , Organophosphorus Compounds , Organothiophosphorus Compounds , Pesticides , Phosphamidon , Pralidoxime Compounds , Respiration, Artificial , Solubility , VentilationABSTRACT
OBJECTIVES: The Allergic rhinitis and its impact on asthma (ARIA) guidelines were suggested for use to classify allergic rhinitis (AR). However, few studies have been performed in Asians. The objective of this study is to identify the clinical characteristics of AR in Korean patients according to the ARIA guidelines. METHODS: For the study, 610 patients who had been diagnosed with allergic rhinitis at Seoul National University Bundang Hospital and 545 patients who had been diagnosed with allergic rhinitis at 3 local clinics were included. All the patients were categorized into 4 groups, such as the mild intermittent, mild persistent, moderate-severe intermittent and moderate-severe persistent groups. The patients were given a questionnaire on allergic rhinitis-related symptoms and they underwent blood tests, including the blood eosinophil count and the serum total IgE level. RESULTS: The most prevalent type was the moderate-severe persistent group (34.7%), and the moderate-severe intermittent group (17.1%) was the rarest. There were significant differences among the 4 groups for olfaction (P<0.001), self-awareness of rhinitis (P=0.013), a previous history of AR (P<0.001), self-awareness of asthma (P=0.001) and allergic conjunctivitis (P<0.001). On the allergy laboratory tests, there was a significant difference between the groups for the eosinophi count (P=0.004). The number of blood eosinophil was more in the persistent groups than in the intermittent groups. CONCLUSION: According to the ARIA guidelines, the moderate-severe persistent group was the most prevalent for Korean patients. Blood eosinophilia and olfactory dysfunction were the most severe in the moderate-severe persistent group.
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Humans , Asian People , Asthma , Conjunctivitis, Allergic , Eosinophilia , Eosinophils , Hematologic Tests , Hypersensitivity , Immunoglobulin E , Rhinitis , Rhinitis, Allergic, Perennial , Smell , Surveys and QuestionnairesABSTRACT
In order to investigate the central nervous mechanism and the diseases involved in catecholamine transmitter secretion, the dynamics of catecholamine release is studied in single cell, brain slice or in vivo. Noradrenaline is an important neurotransmitter and modulator in the central nervous system (CNS) and the peripheral nervous system (PNS). In the present paper, we first compared three real-time methods used to measure noradrenaline secretion in single cells (membrane capacitance, amperometry and confocal fluorescence microscopy imaging). Compared to the electrophysiological method and fluorescence microscopy, the basic usage of the carbon fiber electrode (CFE) in neuroscience research was presented as an example. Then, we presented a primary description of ion channels, including voltage-gated Na(+), K(+) and Ca(2+) channels in locus coeruleus (LC) neurons in rat brain slices. Finally, we presented example recordings of combined patch-clamp and amperometry measurements in LC neurons, indicating Ca(2+)-dependent quantal noradrenaline release following Ca(2+) influx through Ca(2+) channels.
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Animals , Rats , Central Nervous System , Physiology , Ion Channels , Physiology , Norepinephrine , Bodily Secretions , Patch-Clamp TechniquesABSTRACT
The Cry1Ab differs most significantly from the other related ICPs by its absence of a carboxyl terminus of 28 amino acids including four cysteines; consequently it is less stable. We report that the helper protein P20 plays a role in the expression and crystallization of Cry1Ab. Three Cry1Ab expression plasmids pT1B, pP1B, and pDP1B, were constructed based on the shuttle vector pHT3101. The vector pT1B does not contain the p20 gene, pP1B carries p20, and pDP1B contains p20 with cry1A(c) promoter. Transformants were obtained by electroporating the plasmids into Bacillus thuringiensis acrystalliferous mutant CryB. Western blot demonstrated that crylAb was expressed as a 130 kD protein in all the transformants, and some of the protein was partially degraded into a 60 kD peptide. Quantitative protein analysis indicated that the amount of the 130 kD protein varied in the transformants and was in the ratio of 1:1.4:1.5 for PT1B, pP1B and pDP1B respectively. For the 60 kD proteins, the ratio was 1:1.1:1.6. Microscopic examination revealed that the size of the typical pyramidal crystals in the three transformants was in the order of T1B < P1B < DP1B. Bioassay showed that T1B, P1B and DP1B were all toxic to the larvae of Helicoverpa armigera with similar LC50. This study suggested that P20 plays a role in the expression and crystallization of Cry1Ab.
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Animals , Bacillus thuringiensis , Genetics , Metabolism , Bacterial Proteins , Genetics , Metabolism , Pharmacology , Biological Assay , Methods , Blotting, Western , Electroporation , Endotoxins , Genetics , Metabolism , Pharmacology , Hemolysin Proteins , Genetics , Metabolism , Pharmacology , Microscopy, Electron, Transmission , Moths , Promoter Regions, Genetic , GeneticsABSTRACT
The vip3 A gene in a size of 2.3 kb amplified from wild-type Bacillus thuringiensis strain S184 by PCR was cloned into pGEM-T Easy vector and its sequence was analysized by DNASTAR. The plasmid pOTP was constructed by inserting vip3A-S184 gene into the expression vector pQE30 and then was transformed into E. coli M15. E. coli M15 cells harbouring the plasmid pOTP were induced with 1 mmol/L IPTG to express 89 kD protein which was confirmed to be Vip3A-S184 by Western blot. Experiments showed that about 19% of Vip3A-S184 proteins were soluble, and others were insoluble proteins and formed inclusion bodies observed by transmission electron microscopy(TEM). The target protein was purified under the native condition and the polyclonal antibody was prepared by immunizing rabbits. The polyclonal antibody was used to detect Vip3A proteins expressed in Bacillus thuringiensis. Bioassay showed that Vip3A-S184 showed a high toxicity against 3 tested insect larvae including Spodoptera exigua, Spodoptera litura and Helicoverpa armigera.
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Animals , Bacillus thuringiensis , Genetics , Bacterial Proteins , Genetics , Pharmacology , Base Sequence , Cloning, Molecular , Escherichia coli , Genetics , Insecticides , Pharmacology , Molecular Sequence Data , Pest Control, Biological , Recombinant Proteins , Pharmacology , SpodopteraABSTRACT
Objective To assess the cerebral protective effects of different doses of propofol during mild hypothermic cardiopulmonary bypass (32℃-35℃) .Methods Thirty consecutive ASA Ⅱ-Ⅲ patients aged 18-50 years, undergoing elective cardiac surgery under mild hypothermic CPB were randomly divided into 3 groups: in group Ⅰ and Ⅱ the patients were given a bolus of propofol 1 mg kg-1 at the beginning of CPB followed by propofol infusion at a rate of 3 mg ? kg -1? h -1 (group Ⅰ ) or 6 mg? kg-1 ?h-1 (group D ) till the end of CPB and in group Ⅲthe patients received midazolam infusion at 0.2 mg? kg-1 h-1 instead of propofol. Anesthesia was induced with intravenous midazolam 0.15 mgkg-1 ,fentanyl 5 ?g kg-1 and vecuronium 0.1 mg? kg-1 .After tracheal intubation fentanyl 30-50 ?g kg-1 was infused during CPB and muscle relaxation was maintained with intermittent iv boluses of vecuronium. Surgery was performed with mild hypothermic CPB(32℃-35℃ ) .Arterial blood pH and PaCO2 were maintained within normal range and MAP was maintained at 50-80 mm Hg during CPB. Hematocrit was maintained at 25%-30% .Internal jugular vein(IJV) was cannulated and the catheter was advanced retrogradely till jugular bulb. Naso-pharyngeal temperature was monitored. Blood samples were taken simultaneously from artery and UV befor CPB (A) ,when mild hypothermia was being stably maintained(B) ,when the patients were rewarmed to 361 (C)and 30min(D),4-6 h(E)and 24 h(F) after discontinuation of CPB, for determination of cerebral oxygen metabolism and balance, cerebral lactate production (CLP), blood malondialdehyde (MDA) and superoxide dismutase (SOD) levels. CLP was calculated from arterial-cerebral venous blood lactate difference /arterial blood lactate concentration. Lactate oxygen index (LOI) was calculated from arterial-cerebral venous blood lactate difference /arterial-cerebral venous blood O2 content difference.Results In group I (low propofol dose) 30% patients developed cerebral O2 inbalance during rewarming but blood MDA, CLP and LOI were decreased. In midazolam group (group Ⅲ) cerebral O2 balance was improved but there was no depression of blood MDA, CLP and LOI. In groupⅡ (high propofol dose) cerebral oxygenation was improved and blood MDA level, CLP and LOI were significantly decreased.Conclusion The study shows that propofol infusion at a rate of 6 mg?kg-1? h-1 during CPB can improve cerebral oxygenaton, inhibit blood MDA level, CLP and LOI, and plays a role in the cerebral protection during cardiac surgery with CPB, but more vasoconstrictors are needed.
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From June 2004 to December 2005 anesthesia was done for 43 patients undergoing orthotopic heart transplantation (OHT) in Fuwai Hospital. Most patients were premedicated with oral diazepam 5-10 mg, and intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.1-0.3 mg. Radial artery was cannulated and Swan-Ganz catheter was placed. ECG, direct BP, HR, CVP, PAP, CO, SpO2, SvO2, PETCO2 were monitored before and during operation. Anesthesia was induced with midazolam 1-3 mg, etomidate 0.2-0.3 mg?kg-1 , fentanyl 5-15?g?kg-1 or sufentanil 50-100?g, vecuronium 0.1 mg?kg-1 or rocuronium 0.6 mg?kg-1 , and maintained with isoflurane inhalation and propofol infusion and intermittent i. v. boluses of fentanyl or sufentanil and vecuronium. Hemodynamic suppression was mild during anesthesia. The average duration of aortic cross-clamping and CPB was 57-133 min and 123-230 min. The cardiovascular support used for weaning the patients from CPB included dopamine, ephedrine and isoproterenol. Nitroglycerin, NO and iloprost were administered for pulmonary artery vasodilation. Pacing was started at the termination of CPB because of bradycardia in 1 of 43 patients. Sinus rhythm appeared after the patients were weaned from CPB and the function of the transplanted heart was satisfactory. Basiliximab, cyclosporine A, cellcept and methyl prednisolone were administered for immunosuppression during perioperative period. Forty-two of the 43 patients were discharged from hospital without any rejection episodes or other complications. One patient died of multiple organ failure after heart-kidney transplantation.
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Objective To evaluate the efficacy and safety of 0.75% ropivacaine versus 0.75% bupivicaine for combined spinal and epidural anesthesia(CSEA) for cesarean section. Methods Forty primiparae(ASA Ⅰ-Ⅱ) scheduled for elective cesarean section were divided into two groups: ropivacaine group received 0.75% ropivacaine 1 .2-1 . 4ml(9-10. 5mg) for spinal anesthesia and bupivicaine group received same amount of 0.75% bupivicaine. During operation when spinal analgesia was inadequate, 1.6% lidocaine was supplemented via epidural catheter. Blood pressure , heart rate and SpO2 were monitored. Sensory block(pin prick), motor block(modified Bromage scale), quality of analgesia and relaxation of abdominal wall were assessed. Apgar score of the neonates and umbilical artery blood gas as well as side effects were recorded. Results There was no significant difference between the two groups in age, height, body weight of the patients and duration of operation. The height of block was comparable between the two groups but the onset time was longer and duration of block was shorter in ropivacaine group. Analgesia and muscle relaxation were satisfactory and Apger score was 10 at 1 mm and 5mm in both groups. Blood gas values were within normal range in both groups. Motor block was weaker with ropivacaine than that with bupivacaine(P
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Objective It was estimated that about 70% patients suffered from mild brain function disturbances after cardiac surgery with CPB Methods for early detection of brain injury after CPB in current use like EEG, transcranial Doppler, CT, MRI are expensive and not sensitive It was repored that combined assays of S 100 protein and NSE were conducive to early detection of brain ischemic injury and prediction of the prognosis The purpose of this study was to assess the changes in cerebral blood S 100 protein and NSE levels during and after open heart surgery with mild hypothermic CPB Methods 15 consecutive ASA Ⅱ Ⅲ patients undergoing elective open heart surgery under CPB were studied Aortic cross clamping time was 30 60 min and CPB time was less than 120 min Patients with hypertension and neurologic or endocrine diseases were excluded Anesthesia was induced with midazolam 0 15mg/kg, fentanyl 5?g/kg and vecuronium 0 1mg/kg Fentanyl 30 50 ?g/kg was continuously infused after tracheal intubation and during CPB Vecuronium was given intermittently to maintain muscle relaxation Midazolam was infused at 0 2mg?kg -1 h -1 during CPB Temperature was reduced to 32℃ 35℃ during CPB Aterial blood pH and PCO 2 were maintained within normal range and Hct between 25% 30% during CPB Internal jugular vein was caunulated and the catheter was advanced retrogradely until jugular bulb Jugular venous blood samples were taken for determination of S 100 protein and NSE content before CPB (A),when mild hypothermia (32℃ 35℃ ) was steadily maintained (B), rewarming to 36℃ (C), 30 min (D),4 6h (E) and 24h (F) after termination of CPB Results (1) After institution of CPB, S 100 protein level increased significantly (P
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No abstract available.