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Objective:To evaluate the effect of tetramethylpyrazine on hippocampal inflammatory responses in rats with sepsis-associated encephalopathy.Methods:Sixty healthy male Sprague-Dawley rats, aged 12-14 weeks, weighing 240-270 g, were divided into 4 groups ( n=15 each) using a random number table method: sham operation group (group Sham), sepsis-associated encephalopathy group (group SAE), low-dose tetramethylpyrazine group (group L-TMP), and high-dose tetramethylpyrazine group (group H-TMP). Sepsis-associated encephalopathy was induced by cecal ligation and puncture (CLP) in anesthetized rats.Tetramethylpyrazine 5 and 20 mg/kg were intraperitoneally injected once a day in L-TMP and H-TMP groups, respectively, at 5 days prior to CLP.Morris water maze test was performed at 1-5 days after CLP to assess the cognitive function, and the escape latency and ratio of time spent in the target quadrant were recorded.Five rats were sacrificed at 1 day after CLP, the brains were removed, and the hippocampi were isolated for determination of the contents of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and IL-6 by enzyme-linked immunosorbent assay.Rats were sacrificed after the end of Morris water maze test, and hippocampi were removed for detection of the expression of Toll-like receptor 1 (TLR1), activated caspase-3, Bax and Bcl-2 by using Western blot. Results:Compared with group Sham, the escape latency was significantly prolonged, the ratios of time spent in the target quadrant were decreased, the expression of TLR1, activated caspase-3 and Bax was up-regulated, and the expression of Bcl-2 was down-regulated in group SAE, group L-TMP and group H-TMP, and the contents of IL-1β, TNF-α and IL-6 were significantly increased in group SAE and group L-TMP ( P<0.05). Compared with group SAE, the escape latency was significantly shortened, the ratio of time spent in the target quadrant was increased, the contents of IL-1β, TNF-α and IL-6 were decreased, the expression of TLR1, activated caspase-3 and Bax was down-regulated, and the expression of Bcl-2 was up-regulated in group L-TMP and group H-TMP ( P<0.05). Conclusion:The mechanism by which tetramethylpyrazine reduces sepsis-associated encephalopathy may be related to inhibiting hippocampal inflammatory responses in rats.
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Objective To screen the risk factors for blood coagulation abnormality in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods A total of 140 patients undergoing elective OPCABG were included in this study,and combined intravenous-inhalational anesthesia was performed during operation.The patients were divided into normal group and abnormal group according to whether or not blood coagulation abnormality developed during operation and within 48 h after operation.The data such as gender,age,body mass index,American Society of Anesthesiologists physical status,the number of operation per year for surgeons,comorbidities (hypertension and diabetes mellitus),preoperative hematocrit (Hct),left ventricular ejection fraction,arterial oxygen pressure,liver function,operation time and requirement for intraoperative continuous cardiac output monitoring,positive end expiratory pressure,tranexamic acid,ulinastatin and hydroxyethyl starch,postoperative acidosis and hypothermia were recorded.Results Blood coagulation abnormality was found in 43 patients,and the incidence was 31％.The results of logistic regression analysis showed that the number of operation per year for surgeons＜ 50,preoperative abnormal liver function,preoperative Hct＜35％,surgery time≥240 min,no use of continuous cardiac output monitoring during operation and postoperative hypothermia were risk factors for blood coagulation abnormality in patients undergoing OPCABG.Conclusion The number of operation per year for surgeons＜50,preoperative abnormal liver function,preoperative Hct ＜ 35％,operation time ≥ 240 min,no use of continuous cardiac output monitoring during operation and postoperative hypothermia are risk factors for blood coagulation abnormality in patients undergoing OPCABG.
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Objective To evaluate the effect of tetramethylpyrazine on autophagy in the hippocam-pal neurons of rats with sepsis-associated encephalopathy. Methods Sixty SPF healthy male Sprague-Daw-ley rats, aged 11-14 weeks, weighing 200-240 g, were divided into 3 groups(n=20 each)using a ran-dom number table: sham operation group(group Sham), sepsis group(group Sep)and tetrameth-ylpyrazine group(group TMP). Sepsis was induced by cecal ligation and puncture(CLP), and group Sham only underwent simple laparotomy. Tetramethylpyrazine 10 mg∕kg was injected intraperitoneally at 1 h before CLP in group TMP. Morris water maze test was performed in 10 rats randomly selected at 12 and 36 h after CLP. Then the rats were sacrificed, and hippocampi were isolated for determination of the expres-sion of microtubule-associated protein 1 light chain 3Ⅰ(LC3Ⅰ), LC3Ⅱ, Beclin-1 and p62 in hipp-ocampal tissues by Western blot, and the LC3Ⅱ∕LC3Ⅰratio was calculated. Results Compared with group Sham, the escape latency was significantly prolonged, the rate of time spent in the target quadrant was decreased, the LC3Ⅱ∕LC3Ⅰratio was increased, the expression of Beclin-1 was up-regulated, and the expression of p62 was down-regulated at 12 and 36 h after CLP in group Sep and group TMP(P<005). Compared with group Sep, the escape latency was significantly shortened, the rate of time spent in the target quadrant was increased, the LC3Ⅱ∕LC3Ⅰratio was decreased, the expression of Beclin-1 was down-regulated, and the expression of p62 was up-regulated at 12 and 36 h after CLP in group TMP(P<005). Conclusion The mechanism by which tetramethylpyrazine reduces sepsis-associated encephalopa-thy is related to inhibiting autophagy in the hippocampal neurons of rats.
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Objective To evaluate the effects of different degrees of coagulation disorders after surgery on short-term prognosis in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods A total of 410 patients of both sexes,aged 18-79 yr,with body mass index of 16-28 kg/m2,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ,scheduled for elective cardiac surgery with CPB,were enrolled in the study.After induction of general anesthesia,the patients were tracheally intubated and mechanically ventilated.Combined intravenous-inhalational anesthesia was used.The patients were divided into 3 groups according to the coagulation function at 6 h after surgery:normal function group (n =55),mild disorder group (n =237) and severe disorder group (n =118).Postoperative mechanical ventilation time,duration of intensive care unit stay,length of hospitalization and complications during hospitalization were recorded.Results Compared with normal function group,the length of hospitalization was significantly prolonged,and the rate of delayed discharge from hospital was increased in mild disorder group,and the ventilation time,duration of intensive care unit stay and length of hospitalization were significantly prolonged,the rate of delayed extubation,rate of prolonged intensive care unit stay and rate of delayed discharge from hospital were increased,and the hepatic and nephritic insufficiency and incidence of re-thoracotomy for bleeding were increased in severe disorder group (P＜0.05),and no significant change was found in the incidence of postoperative complications in mild disorder group (P＞0.05).Conclusion For the patients undergoing cardiac surgery with CPB,postoperative mild coagulation disorders exert no effect on short-term prognosis,however,postoperative severe coagulation disorders produce poor prognosis,and correction of severe coagulation disorders should be taken into account.
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Objective To evaluate the efficacy of parecoxib sodium combined with ultrasound guided transversus abdominis plane (TAP) block for analgesia after gynecological laparoscopic surgery. Methods Sixty patients (45 to 65 years old, 53- 72 kg and ASA gradeⅠorⅡgrade) who had underwent general anesthesia in laparoscopic hysterectomy were randomly divided into parecoxib group and control group, with 30 cases in each group two groups were in general anesthesia after tracheal intubation in. The ultrasound guided TAP block was performed in all patients after tracheal intubation in general anesthesia. After the operation, the control group was intravenously injected with 40 mg parecoxib sodium, and the control group was given 0.9%sodium chloride of the same volume. Operation time, pain visual scale (VAS) scores and body comfort scale (BCS) scores were recorded and compared. Results The levels of VAS scores in parecoxib sodium group were significantly lower than those in control group after 4, 8 and 24 h: (0.9 ± 0.2) scores vs. (1.9 ± 0.4) scores, (1.1 ± 0.4) scores vs. (2.7 ± 0.2) scores, (1.3 ± 0.3) scores vs. (3.1 ± 0.2) scores, and there were significant differences (P<0.05). The levels of BCS scores in parecoxib sodium group were significantly higher than those in control group after 4, 8 and 24 h: (2.9 ± 0.4) scores vs. (2.2 ± 0.3) scores, (2.8 ± 0.3) scores vs. (1.9 ± 0.4) scores, (2.6 ± 0.5) scores vs. (1.7 ± 0.4) scores, and there were significant differences (P<0.05). Conclusions Parecoxib sodium combined with ultrasound guided TAP block for analgesia after gynecological laparoscopic surgery can provide a good analgesic effect.
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Objective To investigate the related index of early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.Methods 13 cases of the acute-on-chronic liver failure caused by chronic hepatitis B were collected in our department,39 cases of chronic hepatitis B were randomly paired to analyze the difference index.ROC curve analysis was conducted for the different data,then to choose the data whose AUC (area under the curve)is >0.8 to accumulate points,while the cutoff value in the light of Youden index was indentified.Each accu-mulating points data would score 1 point if it is≥cutoff value,otherwise,it would score 0 points.ROC curve analysis was conducted for the total accumulating points,the cutoff value of the total accumulating points according to Youden index was indentified,the sensitivity and specificity were calculated.Results The data of which AUC are >0.8 include glutamic-pyruvic transaminase (ALT)/Upper Limit Of Normal (ULN),neutrophil count (N),alkaline phosphatase (AKP)/ULN,glutamic-oxalacetic transaminease(AST)/ULN,direct bilirubin/total bilirubin(Dbil/Tbil),total bile acid(TBA),whose AUC were respectively 0.869,0.874,0.897,0.917,0.919 and 0.978,while their cutoff value were respectively 18.57,3.1 ×109/L,0.99,22.21,44.41%and 140.20μmol/L.The cutoff value of total accumula-ting points of the six data was 4 points,AUC was 0.987,Youden index was 0.949,and their sensitivity for ealier diag-nosis for the acute -on -chronic liver failure caused by chronic hepatitis B was 100%,specificity was 94.87%. Conclusion The accumulating points of the six data aboved (ALT/ULN,N,AKP/ULN,AST/ULN,Dbil/Tbil,TBA) will help the early diagnosis of acute-on-chronic liver failure caused by chronic hepatitis B.
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Purpose of this study was to validate that Subtenon [SB] Triamcinolone [TA] injection is an alternative to Intravitreal [IV] Triamcinolone [TA] injection for the treatment of diabetic macular edema [DME]. Forty eyes were selected having DME due to type 1 or type 2 diabetes. All the patients were treated with photocoagulation. IVTA was administered in one eye and SBTA in following eye of same patient. Improvement in visual acuity, macular edema and intraocular pressure was assessed before treatment and on 2[nd], 4[th], 8[th] and 12[th] week after treatment. After administration of IVTA, MVA was reduced from baseline value [0.805 +/- 0.069Log/MAR] to [0.577 +/- 0.091 Log/MAR, p < 0.001] at the end of treatment. Similar results were observed after SBTA administration. MVA was reduced from [0.814 +/- 0.082Log/MAR] to [0.49 +/- 0.080 Log/MAR, p < 0.001] at 12th week. After IVTA injection Central macular thickness was significantly reduced to [246.8 +/- 25 microm, p < 0.001] from [390.5 +/- 17 microm]. There were no significant [p=0.51] difference in both eyes receiving different routes of same treatment. After SBTA injection CMT was significantly reduced to lower values [241.5 +/- 27 microm, p < 0.001] from [394.4 +/- 21 microm]. Intraocular pressure after IVTA administration was high [2.32 +/- 0.72 mm/Hg, p=0.04] as compared to baseline [1.82 +/- 0.94 mm/Hg]. Similar pattern was also seen after SBTA administration but to significant extent. Elevation of IoP was observed in both eyes. Subtenon Triamcinolone injection is an alternative to Intravitreal Triamcinolone Injection for Diabetic Macular Edema
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Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response.