Analysis of sonography videourodynamic studies in characteristics of patients with female bladder outlet obstruction / 中华泌尿外科杂志

In this study, sonography video urodynamic studies (SVUDS), which combined synchronically urodynamic studies with trans-perineal and trans-abdominal sonography, were used to detect female bladder outlet obstruction (FBOO). The dynamic changes of urethra and surrounding pelvic floor structure during storage and voiding phase were observed by SVUDS and the causes of FBOO were analyzed. And the findings were as follows: 13 patients showed organ prolapse, there was an urethral angulation deformity during urination; 5 cases had abnormal urination as the urethral opening was not good in the middle of urination period; 4 cases had urethral stricture, as the proximal end of the obstruction dilated during urination, and the obstruction site showed no relaxation; 1 case had primary bladder neck obstruction with an incomplete opening of the bladder neck during urination; 3 cases had idiopathic bladder outlet obstruction and the sphincter of bladder neck and urethra opened well during urination.

Role of oxidation reaction in decrease in activity of acetylcholinesterase in diaphragm of rats with sepsis / 中华麻醉学杂志

Objective To evaluate the role of oxidation reaction in the decrease in the activity of acetylcholinesterase (AChE) in the diaphragm of rats with sepsis.Methods Thirty pathogen-free healthy adult male Sprague-Dawley rats,weighing 220-260 g,were divided into 3 groups using a random number table:sham operation group (group S,n=8),sepsis group (group Sep,n =12) and antioxidant group (group Ant,n=10).Sepsis was induced by cecal ligation and puncture.Group S underwent simple laparotomy.N-acetylcystein 20 mg/kg was injected subcutaneously at 3,6,12 and 18 h after operation,and deferoxamine 20 mg/kg was injected subcutaneously at 3 h after operation in group Ant,while the equal volume of normal saline was given instead in S and Sep groups.At 24 h after operation,the surviving rats were sacrificed,and the diaphragm was removed for determination of the malondialdehyde (MDA) content and activities of AChE,myeloperoxidase (MPO),superoxide dismutase (SOD) and catalase (CAT).SOD/CAT ratio was calculated.Results Compared with group S,the AChE activity was significantly decreased,and MPO and SOD activities were increased in Sep and Ant groups,the MDA content and SOD/CAT ratio were significantly increased,and the CAT activity was decreased in group Sep,and the CAT activity was significantly increased in group Ant (P＜0.05).Compared with group Sep,the AChE and CAT activities were significantly increased,and the MDA content,MPO and SOD activities and SOD/CAT ratio were decreased in group Ant (P＜0.05).Conclusion Oxidation reaction is partially involved in the decrease in the activity of AChE in the diaphragm of rats with sepsis.

The establishment and application of case database of critical illness in anethesia teaching pro-gram / 中华医学教育探索杂志

Objective To establish case database of critical illness and explore the effect of critical case-based learning in the anesthesia teaching program as well as its influence on clinical thinking ability of students. Methods Case database of critical illness was built with foxtable software and ASAⅢ~Ⅴpatients undergoing anesthesia were included in the case database. Patients' information were recorded according to the sequence of pre-operative evaluation,intra-operative management and post-operative recovery. We designed a student questionnaire to investigate the effect of critical case-based learning. And we also compared the effect of critical case-based learning and traditional teaching on undergraduate interns, residents, and graduate students by scores of case analysis test. Data analysis used t test. Results The critical cases database is characterized by authenticity, hierarchy and for-wardness. Survey result of questionnaire shows that the proportions of students who believe critical case-based learning helps to strengthen the links of theory and clinical practice, to improve expression skills, and to promote active classroom atmosphere, solidarity and cooperation are 80%, 71.6% and 68.3%respectively. Compared with those who received traditional teaching, the residents and graduate students who received critical case-based learning get significantly higher scores in case analysis test. However, the difference of scores between undergraduate interns receiving traditional teaching or criti-cal case-based learning has no significance. Conclusion The establishment of critical cases database and its application in anesthesia teaching program have effectively improved clinical thinking ability of anesthesia residents and graduate students.

The density of acetylcholine receptor in orbicular muscle of mouth and gastrocnemius muscle and the difference in their affinity with rocuronium / 中华麻醉学杂志

Objective To compare the density of acetylcholine receptor (AchR) in orbicular muscle of mouth and gastrocnemius muscle and their affmity with rocuronium, trying to elucidate the mechanism for the difference in the sensitivity of the muscles innervated by facial and peripheral nerve respectively to muscle relaxant.Methods Eight pathogen-free adult male SD rats weighing 180-220 g were used in this study. Muscle strips were isolated from orbicular muscle of mouth and gastrocnemius muscle. Each muscle strip was further divided into 6 smaller and slender strips of same size using dissection microscope. One strip was stained with acetylcholinesterase to measure end-plate surface area (ESA). The other 5 strips were exposed to different concentrations of rocuronium (0, 2.5, 5.0, 7.5, 10.0μg/ml). The mean density of AchR at end-plate was obtained by AchR0/ESA. (AchR0 was defined as the number of AchR per end-plate without being exposed to rocuronium. AchRE was defined as the number of free AchR per end-plate after being exposed to different concentrations of rocuronium. ) The degree of saturation of AchR with different concentrations of rocuronium at each neuromuscular junction was calculated by (AchR0 - AchRE)/AchR0 which reflects the affinity of AchR with the rocuronium in orbicular muscle of mouth and gastrocnemius muscle. Results The density of AchR was significantly lower while the affinity with rocuronium was higher in gastrocnemius muscle than in orbicular muscle of mouth ( P ＜ 0.05). Conclusion The density of AchR is lower and the affinity of AchR at end-plate with rocuronium is significantly greater in gastrocnemius muscle innervated by sciatic nerve than in orbicular muscle of mouth innervated by facial nerve. This may explain the mechanism for different sensitivity of the muscles innervated by facial and peripheral nerves to rocuronium.

The comparison of hemodynamics and respiratory mechanics between flexible reinforced laryngeal mask airway and tracheal intubation in functional endoscopic sinus surgery / 复旦学报（医学版）

Objective To compare the hemodynamics and respiratory mechanics between flexible reinforced laryngeal mask airway (FRLMA) and tracheal intubation (TI) in functional endoscopic sinus surgery. Methods Forty-six patients (ASA) scheduled for selective functional endoscopic sinus surgery under general anesthesia were allocated randomly to either flexible reinforced laryngeal mask airway group (FRLMA, n=23) or tracheal intubation group (TI, n=23) with mechanical ventilation. MAP and HR were recorded before anesthesia induction, before intubation, after intubation immediately, before extubation and after extubation immediately. Parameters for respiratory mechanics included peak inspiratory pressure (PIP), plateau airway pressure (P_(plateau)), mean airway pressure (P_(mean)), positive end expiratory pressure (PEEP), peak inspiratory flow (FI_(max)), peak expiratory flow (FE_(max)), and end tidal CO_2 (P_(Et)CO_2). All of the above indicators were recorded 5, 10 and 15 minutes after intubation. Meanwhile, arterial gas analysis was examined. Complications such as aspiration, coughing, pharyngeal pain, hoarseness, muscular soreness and unseal of FRLMA were followed up 24 hours after extubation. Results MAP and HR were significantly higher in group TI than those in group FRLMA after intubation and extubation (P<0.05). PIP, P_(plateau), P_(mean) and VD/VT were significantly higher in group TI than those in group FRLMA (P<0.05). Complications such as coughing, pharyngeal pain and muscular soreness were significantly lower in FRLMA group than that in TI group (P<0.05). Conclusions The application of FRLMA on functional endoscopic sinus surgery is a simply handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory mechanics and low incidence of postoperative upper airway complications.

Efficacy of Jet ventilation with Manujet Ⅲ for removal of airway foreign body in children / 中华麻醉学杂志

Objective To evaluate the efficacy of manually controlled jet ventilation with Manujet Ⅲ apparatus (VBM Co, Germany) for removal of airway foreign body in children. Methods One hundred and twenty ASA Ⅰ or Ⅱ children aged 10 months-12 yr, weighing 8-35 kg undergoing removal of airway foreign body were randomly divided into 3 groups (n=40 each) : group Ⅰ spontaneous respiration (SR) ; group Ⅱ intermittentpositive pressure ventilation through the short side tube of the rigid bronchoscope (IPPV) and group Ⅲ manually controlled jet ventilation with Manujet Ⅲ (JV). Anesthesia was induced with methylprednisolone 2 mg/kg, propofol 2 mg/kg and γ-OH 70 mg/kg in group SR (Ⅰ) and with methylprednisolone 2 mg/kg, propofol 4-5 mg/kg, fentanyl 1.5 μg/kg and succinylcholine 2 mg/kg in group IPPV and JV (Ⅱ,Ⅲ). The bronchescope insertion condition, the occurrence of hypoxia during and after operation, body movement during operation, the rate of successful removal of the foreign body, the duration of operation, anesthesia emergence time and perioperative side effects were recorded. Resulls The rate of good bronchescope insertion condition and successful removal of airway foreign body were significantly higher, the rate of hypoxia during and after operation, body movement, breath holding and restlessness were significantly lower and duration of operation and anesthesia emergence time were significantly shorter in group IPPV and JV than in group SR (P<0.05). The rate of intraoperative hypoxia was significantly lower in group JV than in group IPPV (P<0.05). Conclusion Jet ventilation with Manujet Ⅲ can reduce the occurrence of hypoxia during removal of airway foreign body in children and does not interfere with the operation.

Effects of propofol, midazolam and thiopental sodium on outcome and amino acids accumulation in focal cerebral ischemia-reperfusion in rats / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the effects of propofol, midazolam and thiopental sodium on outcomes and amino acid accumulation in focal cerebral ischemia-reperfusion in rats.</p><p><b>METHODS</b>Male Sprague Dawley (SD) rats were scheduled to undergo 3-hour middle cerebral artery occlusion by intraluminal suture and 24-hour reperfusion. Neurologic outcomes were scored on a 0-5 grading scale. Infarct volume was shown with triphenyltetrazolium chloride staining and measured by an image analysis system. Concentrations of various amino acids (aspartate, glutamate, glycine, taurine, and gama-aminobutyric acid) were measured after 3 hours of reperfusion using high performance liquid chromatography. Propofol, midazolam and thiopental sodium were given intraperitoneally at the beginning of reperfusion.</p><p><b>RESULTS</b>Both propofol and midazolam attenuated neurological deficits and reduced infarct and edema volumes. Propofol showed better neurological protection than midazolam while thiopental sodium did not exhibit any protective effect. Both propofol and midazolam decreased excitatory amino acids accumulation, while propofol increased gama-aminobutyric acid accumulation in ischemic areas in reperfusion.</p><p><b>CONCLUSION</b>Propofol and midazolam, but not thiopental sodium, may provide protective effects against reperfusion induced injury in rats subjected to focal cerebral ischemia. This neurological protection may be due to the acceleration of excitatory amino acids elimination in reperfusion.</p>

Effects of propofol, midazolam and thiopental sodium on outcome of focal cerebral ischemia-reperfusion in rats / 中国新药与临床杂志

AIM: To investigate the effects of propofol, midazolam and thiopental sodium on neurologic and histologic outcome from focal cerebral ischemia-reperfusion in a rat model of reversible middle cerebral artery occlusion (MCAO). 　METHODS: Male SD rats were scheduled to undergo 3 h MCAO by intraluminal suture and 24 h reperfusion. Neurologic outcome was scored with a 0-5 grading scale. Infarct volume was shown with TTC staining and measured by image analysis system. Ultrastructure of the tissues taken from the brim of the damaged area was examined under electron microscope. 　RESULTS: Both propofol and midazolam could attenuate neurologic deficits, reduce infarct and edema volumes, and ameliorate ultrastructure damage at the brim of lesion. Propofol showed better neuroprotection than midazolam while thiopental sodium did not exhibit protective effect.　CONCLUSION: Propofol and midazolam, but not thiopental sodium, can provide protective effects against reperfusion induced injury in rats subjected to focal cerebral ischemia.

Antinociceptive effect of physostigmine and interaction of intravenous physostigmine with intrathecal morphine in rats / 中国新药与临床杂志

AIM: To investigate the antinociceptive effect of anticholinesterase agent physostigmine at different postoperative time, and the interaction of intravenous physostigmine with intrathecal morphine in rats. METHODS: Six groups of rats were operated on for intrathecal and intravenous catheterization. Nociceptive responses of hind paws of each animal were measured with "plantar stimulation" test 1-3 h and 3 d postoperatively. Animals received intravenous (iv) physostigmine, intrathecal (ith) morphine, or combination of both. The antinociceptive effect of each group was converted to the percent maximum possible effect (% MPE). RESULTS: Administration of physostigmine 1-3 h after operation resulted in dramatic increase in % MPE. The effects of combinations of iv physostigmine and ith morphine were more pronounced at early postoperative time. The potency of low dose combination was significantly greater than that of double doses of both drugs. The % MPE of the observed effects of all combinations was significantly higher than that of the expected additive effects. CONCLUSION: The antinociception of physostigmine occurs at early postoperative time. The interaction of iv physostigmine with ith morphine indicates their synergistic effect.

Effects of propofol ,midazolam and thiopental on amino acid accumulation in ischemic areas in rats subjected to focal cerebral ischemia/reperfusion / 中华麻醉学杂志

Objective Increasing evidence shows that excitatory amino acids (EAAS) play an important role in the development of brain ischemia/reperfusion damage EAAS accumulation in ischemic tissues induces a sequence of biochemical reactions and eventually leads to cell death The aim of this study was to investigate the effects of propofol ,midazolam and thiopental on amino acid accumulation in ischemic areas in rats subjected to focal cerebral ischemia Methods Male SD rats weighing 240 260g were anesthetized with 10% chloral hydrate 350mg/kg and middle cerebral artery (MCA) occlusion was performed according to the method of Longa The animals were divided into 5 groups of 6 7animals each: group A (ischemia group) received 3 h MCA occlusion without reperfusion and medication; group B (ischemia/reperfusion group) received 3 h MCA occlusion followed by 3 h reperfusion without medication; group C,D and E received propofol or midazolam or thiopental 50mg/kg intrapentoneally after MCA occlusion but before reperfusion Commom carotid artery(CCA),external carotid artery (ECA) and internal carotid artery(ICA) were exposed through a longitudinal incision in the neck A 4 0 nylon thread with rounded tip was inserted into ICA through ECA and threaded cranially until slight resistance was felt The distance from the bifurcation of CCA to the tip of the nylon thread was about 22 cm In this way MCA was occluded After 3 h MCA occlusion the nylon thread was withdrawn to allow reperfusion After 3 h reperfusion the animals were sacrificed with lethal dose of chloral hydrate Brain was removed immediately Hemispheres of both sides were weighed separately and kept at -75℃ Concentrations of various amino acids (aspartate,glutamate,glycine,taurine and GABA) of each hemisphere were measured with high performance liquid chromatography Results Propofol and midazolam significantly reduced aspartate and glutamate accumulation in ischemic areas during reperfusion Propofol augmented but midazolam diminished GABA accumulation Thiopental had no significant effect Conclusions Propofol and midazolam may provide neuroprotection through acceleretion of excitatory amino acid elimination during reperfusion but thiopental does not

Effect of salvia miltiorrkiza and its effective composition on hypoxic pulmonary vaoconstriction in guinea pig / 中华麻醉学杂志

The experiment was designed to investigate the effect of salvia miltiorrhiza (Danshen ) and its effective composition, phenyl lactic acid (Danshensu )on the hypoxic pulmonary vasoconstriction (HPV). Acute hypoxia was induced by replacing mixed gas 95%O2+ 5 %CO2 with 95%N2 + 5 %CO2. Hypoxic pulmonary vasoconstriction was diminished by injectic Danshen, Injectic Danshen compound and Danshensu with concentration dependently. Tile effect of Danshensu was the most,and Injectic Danshen Co was second by comparison. The results suggested that Danshen can antagonist HPV which was mainly produced by Danshensu, one of the effective composition of Danshen,and that more potent inhibitory action on HPV was by Injectio Danshen compound compared with Injectio Danshen,and this may be related to the addition of Dalbergia odorifera , the other composition of Injectic Danshen compound.