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Objective@#To investigate the effects of remifentanil combined with propofol on hemodynamics, inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.@*Methods@#From June 2017 to August 2018, 112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table, with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0), 0.5h(T1), 1h(T2) and awake(T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response, stress response and immune function indicators at T0, T2 and T3 were recorded.@*Results@#Compared with T0, T1 and T2, the MAP of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.834, 4.484, 5.378, tobservation group=6.420, 7.006, 6.152, all P<0.05). Compared with T0, the HR of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=5.943, tobservation group=7.722, all P<0.05). Compared with T1 and T2, CO of the two groups was higher at T3, and the differences were statistically significant(tcontrol group=4.276, 2.262, tobservation group=6.318, 5.132, all P<0.05). There were no statistically significant differences in MAP, HR and CO between the two groups at T0, T1, T2 and T3(all P>0.05). The doses of norepinephrine in the observation group and the control group were (1 587.7±287.5)μg and (1 937.9±397.6)μg, respectively, and the difference was statistically significant(t=5.341, P<0.05). The serum levels of C reactive protein(CRP), tumor necrosis factor alpha(TNF-α) and interleukin 6(IL-6) increased with time in the two groups, and the differences were statistically significant(tcontrol group=17.06, 36.13, 19.07, 3.822, 9.466, 2.874, 14.18, 26.87, 16.21, tobservation group=11.72, 20.79, 11.01, 2.810, 6.559, 3.716, 10.52, 24.56, 17.64, all P<0.05). At T2 and T3, the serum levels of CRP, TNF-α and IL-6 in the observation group[T2: CRP (89.63±17.65)mg/L, TNF-α (51.16±10.16)ng/L, IL-6 (34.26±6.25)ng/L, T3: CRP (136.15±26.25)mg/L, TNF-α (58.64±11.12)ng/L, IL-6 (67.56±12.67)ng/L]were lower than those in the control group[T2: CRP (112.15±22.34)mg/L, TNF-α (59.56±11.58)ng/L, IL-6 (42.65±8.37)ng/L, T3: CRP (175.16±34.75)mg/L, TNF-α (65.79±11.35)ng/L, IL-6 (79.02±14.56)ng/L], the differences were statistically significant(t=5.919, 6.703, 4.080, 3.367, 6.010, 4.443, all P<0.05). Compared with T0, serum levels of epinephrine(E), cortisol(Cor) increased in two groups at T2 and T3, and the differences were statistically significant(tcontrol group=10.03, 8.096, 8.679, 7.029, tobservation group=6.473, 4.728, 6.330, 4.727, all P<0.05). Compared with T2, serum levels of E and Cor in two groups at T3 were decreased, and the differences were statistically significant(tcontrol group=2.400, 2.638, tobservation group=2.260, 2.162, all P<0.05). At T2 and T3, the serum levels of E, Cor in the observation group[T2: E (286.36±41.02)ng/L, Cor (262.52±29.89)μg/L, T3: E (270.35±33.59)ng/L, Cor (253.23±30.28)μg/L]were lower than those in the control group[T2: E (312.56±38.75)ng/L, Cor (287.56±38.76)μg/L, T3: E (295.79±35.12)ng/L, Cor (270.25±30.15)μg/L], the differences were statistically significant (t=3.457, 3.917, 3.828, 2.981, all P<0.05). At T0, T2 and T3, there were no statistically significant differences in CD3+, CD4+, CD8+ and CD4+/CD8+ between the two groups(all P>0.05).@*Conclusion@#Remifentanil combined with propofol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock, and can alleviate inflammation and stress response.
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Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.
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Objective To investigate the effects of remifentanil combined with propofol on hemodynamics,inflammatory stress response and immune function in patients with acute abdomen complicated with septic shock.Methods From June 2017 to August 2018,112 patients with acute abdomen complicated with septic shock who admitted to the First Affiliated Hospital of Xiamen University were enrolled in the study.They were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was anesthetized with sevoflurane combined with propofol.The observation group was anesthetized with remifentanil combined with propofol.The hemodynamic parameters of the patients entering the operating room(T0),0.5h(T1),1h (T2) and awake (T3) after anesthesia were recorded.The intraoperative norepinephrine dosage was recorded.The inflammatory response,stress response and immune function indicators at T0,T2 and T3 were recorded.Results Compared with T0,T1 and T2,the MAP of the two groups was higher at T3,and the differences were statistically significant(tcontrol group =4.834,4.484,5.378,tobservation group =6.420,7.006,6.152,all P ＜0.05).Compared with T0,the HR of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =5.943,tobservation group =7.722,all P ＜ 0.05).Compared with T1 and T2,CO of the two groups was higher at T3,and the differences were statistically significant (tcontrol group =4.276,2.262,tobservation group =6.318,5.132,all P ＜ 0.05).There were no statistically significant differences in MAP,HR and CO between the two groups at T0,T1,T2 and T3 (all P ＞0.05).The doses of norepinephrine in the observation group and the control group were (1 587.7 ± 287.5) μg and (1 937.9 ±397.6) μg,respectively,and the difference was statistically significant(t =5.341,P ＜0.05).The serum levels of C reactive protein(CRP),tumor necrosis factor alpha(TNF-α) and interleukin 6 (IL-6) increased with time in the two groups,and the differences were statistically significant(tcontrol group =17.06,36.13,19.07,3.822,9.466,2.874,14.18,26.87,16.21,tobservation group =11.72,20.79,11.01,2.810,6.559,3.716,10.52,24.56,17.64,all P ＜ 0.05).At T2 and T3,the serum levels of CRP,TNF-α and IL-6 in the observation group [T2:CRP (89.63 ±17.65) mg/L,TNF-α (51.16 ± 10.16) ng/L,IL-6 (34.26 ± 6.25) ng/L,T3:CRP (136.15 ±26.25) mg/L,TNF-α (58.64 ± 11.12)ng/L,IL-6 (67.56 ± 12.67)ng/L] were lower than those in the control group[T2:CRP (112.15 ±22.34) mg/L,TNF-α (59.56 ± 11.58) ng/L,IL-6 (42.65 ± 8.37) ng/L,T3:CRP (175.16 ±34.75) mg/L,TNF-α (65.79 ± 11.35) ng/L,IL-6 (79.02 ± 14.56) ng/L],the differences were statistically significant (t =5.919,6.703,4.080,3.367,6.010,4.443,all P ＜ 0.05).Compared with T0,serum levels of epinephrine(E),cortisol(Cor) increased in two groups at T2 and T3,and the differences were statistically significant(tcontrol group =10.03,8.096,8.679,7.029,tobservation group =6.473,4.728,6.330,4.727,all P ＜ 0.05).Compared with T2,serum levels of E and Cor in two groups at T3 were decreased,and the differences were statistically significant (tcontrol group =2.400,2.638,tobservation group =2.260,2.162,all P ＜ 0.05).At T2 and T3,the serum levels of E,Cor in the observation group [T2:E (286.36 ± 41.02) ng/L,Cor (262.52 ± 29.89) μg/L,T3:E (270.35 ±33.59)ng/L,Cor (253.23 ±30.28)μg/L]were lower than those in the control group[T2:E (312.56 ±38.75)ng/L,Cor (287.56 ± 38.76) μg/L,T3:E (295.79 ± 35.12) ng/L,Cor (270.25 ± 30.15) μg/L],the differences were statistically significant (t =3.457,3.917,3.828,2.981,all P ＜ 0.05).At To,T2 and T3,there were no statistically significant differences in CD3+,CD4+,CD8+ and CD4+/CD8+ between the two groups (all P ＞ 0.05).Conclusion Remifentanil combined with propefol anesthesia can make hemodynamics more stable in patients with acute abdomen complicated with septic shock,and can alleviate inflammation and stress response.
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Objective To study the extraction technology and optimize the extraction process of Fuyuan Xingnao gran-ule.Methods The preliminary extraction process was designed by routine extraction method combined with the results of pharmacological activity experiment.The extraction process was optimized with orthogonal test.Results The extract was ob-tained by ethanol reflux extraction,water decoction extraction or ethanol precipitation followed by filtration and concentration. The optimal process for ethanol reflux extraction was extracting twice with 50% ethanol.The ratio of liquor to dry material was 8∶1 for the first time and 6∶1 for the second time.The extraction time was 120 minutes for the first time and 80 minutes for the second time.The optimal process for water decoction extraction was extracting twice with 120 minutes and 80 minutes each time.The ratio of liquor to dry material was 10∶1 for the first time and 8∶1 for the second time.The extraction temper-ature was100 ℃.The best ethanol precipitation process was 16 hour extraction with 80% ethanol.The ratio of ethanol to dry material was 2∶1.Conclusion The quality of Fuyuan Xingnao granule extract with this optimized extraction process was in line with requirements of Pharmacopoeiaof the People's Republic of China 2015,4 Volumes(0104 granule).
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Aim To study the effects of propofol on apoptosis of cortical astrocytes isolated from neonatal rats.Methods Pure astrocytes(AST)were obtained from the cultured cerebral cortical cells and identified by the GFAP stain technology in neonatal rats.AST cells were treated with different concentrations of propofol(0,10,30,90 μmol·L-1)for 8 hours.Cell viability was measured by MTT method,and the apoptosis was detected by Annexin V/PI double staining.Cytochrome C(cyt-C)leakage was detected by Western blot.Caspase-3 and caspase-9 activities were measured by spectrophotometry.Results AST cells were administered with different concentrations of propofol(0,10,30,90 μmol·L-1)for 8 hours.It decreased the survival rate in a concentration-dependent manner,induced the leakage of cyt-C in mitochondria,up-regulated the expression of pro-apoptotic protein caspase-3 and caspase-9,and induced AST apoptosis.Conclusion Propofol induces the apoptosis of astrocytes in neonatal rat cortex in vitro,which may be related to the activation of mitochondria apoptosis pathway induced by mitochondrial cyt-C release.
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Objective To evaluate the effect of electro-acupuncture (EA) at Zusanli (ST36) acupoint on blood coagulation during intestinal ischemia-reperfusion (I/R) in rats.Methods Forty healthy male Sprague-Dawley rats,aged 6-8 months,weighing 250-300 g,were divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),EA at Zusanli acupoint group (group EA),EA at non-acupoint group (group NE) and α7 nicotinic acetylcholine receptor antagonist α-bungarotoxin (α-BGT) group (group α-BGT).Intestinal I/R was induced by clamping the superior mesenteric artery for 4-5 min followed by 120 min of reperfusion.Bilateral Zusanli acupoints were stimulated with an electric stimulator (frequency 3 Hz,voltage 2-4 V,wave length 2 ms) for 30 min starting from the time point immediately after beginning of ischemia in group EA,while EA was performed at the points 5 mm lateral to the bilateral Zusanli instead in group NE.In group α-BGT,α-BGT 1 μg/kg was intraperitoneally injected at 45 min before ischemia,and the other treatments were similar to those previously described in group EA.Blood samples were collected from the abdominal aorta at 120 min of reperfusion for determination of the concentrations of tumor necrosis factor alpha (TNFα),tissue factor (TF),antithrombin (AT),tissue plasminogen activator (tPA),fiber plasminogen activator inhibitor-1 (PAl-l) and D-dimer in plasma (by enzyme-linked immunosorbent assay) and platelet count (PLT).The animals were sacrificed after blood sampling,the distal ileum specimens were removed for examination of the pathological changes with a light microscope,and the damage to the intestinal mucous membrane was assessed and scored according to Chin.Results Compared with group S,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,and the plasma AT concentration and PLT were decreased in I/R,NE and α-BGT groups,the concentrations of plasma TNFα and TF were significantly increased,and the plasma AT concentration was decreased in group EA,and Chiu's scores were significantly increased in I/R,EA,NE and α-BGT groups (P＜ 0.05).Compared with group I/R,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly decreased,the plasma AT concentration and PLT were increased,and Chiu's scores were decreased in group EA (P＜0.05),and no significant change was found in the variables mentioned above in NE and α-BGT groups (P＞0.05).Compared with group EA,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,the plasma AT concentration and PLT were decreased,and Chiu's scores were increased in group NE (P＜0.05).Conclusion EA at Zusanli acupoint can improve blood coagulation during intestinal I/R in rats,and the mechanism is related to activating the cholinergic anti-inflammatory pathway.
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Objective To evaluate the suppressive effect of dezocine ,lidocaine and ephedrine on fentanyl-induced cough . Methods A total of 120 patients ASA I-II ,scheduled for elective surgery under general anesthesia ,were randomly allocated into four groups (n= 30 ,each group) .Group Ⅰ ,Ⅱ ,Ⅲ ,Ⅳ were given saline (2 ml) ,dezocine (0 .1 mg/kg) ,lidocaine (1 mg/kg) or ephedrine(5 mg) ,respectively .One minute later all patients were injected with 4μg/kg of fentanyl ,after anoth-er one minute ,all patients were given midazolam (0 .1 mg/kg)+ propofol(2 mg/kg ,0 .4 ml/s)+cisatracurium (0 .2 mg/kg) . The incidence rate and severity of cough were recorded and hemodynamic parameters were also observed .Results The inci-dence rate of cough was 50% ,16 .7% ,13 .3% and 20% for group Ⅰ ,Ⅱ ,Ⅲ and Ⅳ ,respectively .Comparing to group I ,the incidence rate of cough was significantly lower (P<0 .05) in other groups ,but among the three experimental groups there was no significant difference in cough incidence rate and intensity .The hemodynamic changed of each group before and after the in-duction was consistent .Conclusion A priming dose of dezocine(0 .1 mg/kg) ,lidocaine (1 mg/kg) or ephedrine (5 mg) could effectively reduce the Fentanyl-induced cough response .
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Objective To observe the effect of combined continuous femoral nerve blockade (CFNB)with epidural morphine postoperative analgesia on total knee arthroplasty (TKA)in elderly patients.Methods Eighty elderly patients scheduled to undergo TKA were randomly divided into two groups:groups FN and FNM.Groups FNM and FN were received 0.1% morphine 2 ml and normal saline 2 ml through epidural space respectively at the end of surgery.After surgery,all patients were implanted catheter around femoral nerve guided by ultrasound,and were infused 0.2% ropivacaine 25 ml.Continuous infusion of 0.2% ropivacaine for femoral never block was administrated at a rate of 5 ml/h for 48 hours to all patients.VAS scores and bending degree during rest,active and passive exer-cise were recorded at time point of postoperative 24,48,72,96 h.Ambulation status on the fifth day after operation were observed.Satisfaction of hospitalization were graded before hospital discharge. Results Compared with group FN,VAS scores during rest,active and passive excercise were signifi-cantly decrease at 24 h in group FNM (P <0.05 or P <0.01).The bending degree of knee joints in group FNM were significantly greater compared with group FN at 24 h after surgery (P <0.01).Am-bulation status on the fifth day after surgery were significantly better in group FNM compared with group FN (P <0.05).The level of patient satisfaction was much higher in group FNM (P <0.05). Conclusion After TKA,CFNB combined with single epidural morphine injection can provide better analgesia and bending degree with a high level of satisfaction.
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Objective To observe the effect of electroacupuncture on back three-acupoints ( namely bilateral Dazhu, Fengmen, Feishu) on the protein and mRNA expression of transforming growth factor-beta 1 (TGF-β1) and Smad3 in asthmatic rat airway remodeling model, and to explore its therapeutic efficacy and molecular mechanism. Methods Rat asthma model was established by inhalation of ovalbumin. After sensitization for 6 weeks, rats were killed. And then the airway morphological parameters of rats were measured by image analysis. The protein and mRNA expression of TGF-β1 and Smad3 in lung tissues were detected by immunohistochemistry and real-time quantitative polymerase chain reaction (qRT-PCR) respectively. Results Compared with the blank group, the standardized values of muscle cross-sectional area including airway smooth muscle area (WAm) /perimeter of the basement membrane (Pbm), and bronchial inner wall area (WAi)/Pbm were increased in the model group. The protein and mRNA expression levels of TGF-β1 and Smad3 were also increased in the model group. In electroacupuncture group, the above observation indexes were decreased, and the differences were statistically significant ( P<0.05 compared with the model group). Conclusion The experimental results indicated that back three-acupoint electroacupuncture has an effect on remodeling airway, and one of the mechanisms is probably associated with the regulation of TGF-β1/Smad3 signaling pathway.