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Objective:To evaluate the accuracy of bedside lung ultrasound in predicting postoperative pulmonary complications (PPCs) in the patients undergoing radical resection of gastrointestinal cancer.Methods:One hundred and eight patients of both sexes, aged >18 yr, undergoing elective radical resection of gastrointestinal cancer with general anesthesia, were enrolled in the study. Lung ultrasound was performed before surgery (T 1) and at 2, 4 and 7 days after surgery (T 2-4). Lung ultrasound score (LUS) and B-line score were recorded. Serum procalcitonin (PCT) concentrations and blood routine were recorded, and systemic immune-inflammatory index (SII) was calculated. All the patients underwent chest CT examination before surgery and 7 days after surgery. The results of chest CT and clinical diagnosis were used as the gold standard for PPCs. The occurrence of PPCs within 7 days after surgery was recorded. The patients were divided into PPCs group and non-PPCs group according to the development of PPCs. Spearman′s correlation analysis was used to analyze the correlation of B-line score and LUS with PPCs, PCT and SII. The receiver operating curve was used to evaluate the accuracy of B-line score and LUB in predicting PPCs. Results:One hundred and three patients were finally enrolled in the study, including 45 patients in PPCs group and 58 patients in non-PPCs group, and the incidence of PPCs was 43.7%. Both B-line score and LUS were positively correlated with PPCs at T 1 ( P<0.001), and B-line score and LUS were positively correlated with PCT and SII at T 2-4 ( P<0.001). The AUC (95% confidence interval) of B-line score and LUB in predicting PPCs were 0.926 (0.879-0.972) and 0.909 (0.852-0.965), respectively ( P<0.001), the best cut-off values of B-line score and LUB in predicting PPCs were set at 25.5 and 11.5 respectively, and the sensitivity and specificity of B-line score were 0.80 and 0.88 respectively, and the sensitivity and specificity of LUB were 0.78 and 0.93 respectively. Conclusions:Bedside pulmonary ultrasonography (B-line score and LUS) can accurately predict the occurrence of PPCs in the patients undergoing radical resection of gastrointestinal cancer and dynamically evaluate the condition of PPCs, and B-line score >25.5 and LUS score >11.5 indicate a high risk of PPCs.
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Objective:To evaluate the accuracy of airway ultrasonic parameters in predicting difficult mask ventilation (DMV) in obese patients.Methods:Ninety-six patients of both sexes, aged >18 yr, with body mass index of 28- <40 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective surgery under general anesthesia with endotracheal intubation, were selected. The airway was evaluated at 1 day before surgery to record the thyromental distance, modified Mallampati classification and upper lip bite test classification. Before anesthesia induction, the mandibular condylar motion, longitudinal cross-sectional area and transverse diameter of the tongue were measured by ultrasound, and the tongue volume was calculated. Mask ventilation was performed after anesthesia induction, DMV classification was recorded, DMV was defined as DMV classification Ⅲ and Ⅳ, and the patients were divided into non-DMV group (NDMV group) and DMV group. Spearman correlation analysis was used to analyze the correlation between each parameter and DMV, the receiver operating characteristic (ROC) curve was used to evaluate the accuracy of each parameter in predicting DMV, and the cut-off value was determined based on the principle of Jorden index at maximum. Results:Ninety-six patients were finally included in the study, with 64 patients in NDMV group and 32 patients in DMV group. Compared with NDMV group, the increase in age, modified Mallampati grade, upper lip biting test grade, longitudinal cross-sectional area of tongue, transverse diameter of tongue and volume of tongue were significantly increased, and the thyromental distance and mandibular condylar motion were decreased in DMV group ( P<0.05). Age ( r=0.283), modified Mallampati grade ( r=0.668), upper lip biting test classification ( r=0.826), tongue longitudinal cross-sectional area ( r=0.598), tongue transverse diameter ( r=0.578) and tongue volume ( r=0.707) were positively correlated with DMV ( P<0.01), and thyromental distance ( r=-0.623) and mandibular condylar motion ( r=-0.666 ) were negatively correlated with DMV ( P<0.05). The area under curve (95% confidence interval) of tongue longitudinal cross-sectional area, tongue transverse diameter, tongue volume, and mandibular condylar motion for DMV prediction were 0.870 (0.780-0.961), 0.858 (0.768-0.948), 0.937 (0.864-1.000), 0.912 (0.835-0.990), respectively ( P<0.01), and the predicted cut-off values were 22.61 cm 2, 4.29 cm, 100.60 cm 3 and 1.18 cm, respectively, the sensitivity was 90%, 83%, 90% and 90%, respectively, the specificity was 80%, 80%, 95% and 95%, respectively. Conclusions:Tongue volume and mandibular condylar motion measured by ultrasound are highly accurate in predicting DMV in obese patients. Tongue volume> 100.60 cm 3 or mandibular condylar motion< 1.18 cm suggests a high risk of DMV.
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Objective To evaluate the effect of propofol on high-mobility group box 1 protein (HMGB1)/Toll-like receptor 4 (TLR4) signaling pathway during hepatic ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six clean-grade healthy male Sprague-Dawley rats,aged 3 months,weighing 250 -300 g,were divided into 3 groups (n=12 each) using a random number table method:sham operation group (group S),hepatic I/R group (group I/R) and propofol group (group P).Hepatic I/R injury was induced by occluding the portal vein and hepatic artery supplying the left and middle lobes of the liver for 1 h followed by 6-h reperfusion in anesthetized rats.Propofol was infused via the tail vein at a rate of 12 mg ·kg-1 · h-1 starting from 20 min before ischemia until 6 h of reperfusion in group P.The rats were sacrificed at 6 h of reperfusion,and the left lobe of the liver was removed for microscopic examination of the pathological changes which were scored and for determination of the expression of HMGB1,TLR4,tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-6) in liver tissues (by Western blot).Results Compared with group S,pathological scores of liver tissues were significantly increased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was up-regulated in I/R and P groups (P＜0.05).Compared with group I/R,pathological scores of liver tissues were significantly decreased,and the expression of HMGB1,TLR4,TNF-α and IL-6 was down-regulated in group P (P＜ 0.05).Conclusion The mechanism by which propofol reduces liver I/R injury is associated with blocking HMGB-1/TLR4 signaling pathway and inhibiting inflammatory responses in rats.
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Objective To evaluate the effect of sevoflurane postconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) in rats.Methods Forty-five clean-grade healthy male SpragueDawley rats,weighing 280-350 g,were divided into 3 groups (n=15 each) using a random number table method:sham operation group (S group),cerebral I/R group (I/R group) and sevoflurane postconditioning group (SP group).Focal cerebral I/R injury model was established by Zea-Longa method in chloral hydrate-anesthetized rats.The animals in SP group inhaled 2.4％ sevoflurane for 30 min starting from onset of reperfusion.The expression of autophagy-related proteins LC3 and beclin-1 was detected by Western blot at 2 h of reperfusion.The cerebral cortex was removed for examination of the morphology and number of autophagosomes with an electron microscope.Neurological deficit was assessed and scored at 24 h of reperfusion.Rats were sacrificed at 72 h of reperfusion for determination of the cerebral infarct size.Results Compared with S group,the neurological deficit score was significantly increased,the percentage of cerebral infarct size was increased,LC3Ⅱ/LC3Ⅰ ratio in cerebral cortex was increased,the expression of beclin-1 was up-regulated,and the number of autophagosomes was increased in I/R and SP groups (P＜0.05).Compared with I/R group,the neurological deficit score was significantly decreased,the percentage of cerebral infarct size was decreased,LC3Ⅱ/LC3Ⅰ ratio in cerebral cortex was decreased,the expression of beclin-1 was down-regulated,and the number of autophagosomes was reduced in SP group (P＜0.05).Conclusion Sevoflurane postconditioning mitigates focal cerebral I/R injury through inhibiting autophagy in rats.
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BACKGROUND:Cdh1 has been shown to express in rat hippocampus and cortex in a large number. Moreover, in vitro test demonstrated that Cdh1 expression was higher in neurons than in neural stem cel s, which possibly associated with the differentiation of neural stem cel s into neurons. However, the effects of anaphase promoting complex Cdh1 on ischemic neuronal damage remain unclear. OBJECTIVE:To investigate the expression of Cdh1 and its downstream substrate in primary cultured neurons with oxygen-glucose deprivation. METHODS:Primary neurons from cortex of postnatal 24-hour rat pups were cultured in vitro, and identified by immunofluorescence staining. The oxygen-and glucose-deprived models were established by three gas incubator fil ed with nitrogen in sugar-free Earle’s solution. After 1 hour of hypoxia, reoxygenation was conducted. Real-time fluorescent quantitative PCR was used to detect the mRNA expression of Cdh1 and its downstream substrates Skp2, Cyclin B1 before hypoxia, 6 hours, 1, 3, 7 days after oxygen glucose deprivation. RESULTS AND CONCLUSION:After oxygen glucose deprivation, the expression of Cdh1 and Cyclin B1 in primary neurons was increased (P<0.05), while Skp2 expression was decreased (P<0.05). Above data indicated that Cdh1 expression in neurons increased after oxygen-glucose deprivation. It may degrade Skp2 and participate in hypoxic neuronal apoptosis by ubiquitination.
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@#ObjectiveTo investigate the expression of APC-Cdh1 protein after cerebral ischemia-reperfusion injury.Methods60 male Sprague-Dawley rats were randomly divided into Sham-operated group(SH) and ischemia-reperfusion group(IR). The rats of ischemia-reperfusion groups were induced by four-vessel occlusion (4-VO). At different times after injury, the expression of APC-Cdh1 of rat hippocampus was observed by Western blotting and immunohistochemistry.ResultsCompared with sham-operated group, the expression of Cdh1 protein significantly decreased 1 day and increased obviously 3 days, but decreased again 7 days after injury in ischemia-reperfusion group. The immuno-staining showed that APC-Cdh1 was highly cerebral cortex and hippocampus in ischemia-reperfusion group. ConclusionAPC-Cdh1 may be involved in the central nervous system injury.