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Objective:To compare the effects of ultrasound-guided dynamic needle tip positioning (DNTP) and long axis in-plane (LAX-IP) techniques for axillary vein puncture and catheterization.Methods:One hundred Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 20-28 kg/m 2, scheduled for elective axillary vein cannulation, were divided into 2 groups ( n=49 each) using the random number table method: DNTP group and LAX-IP group.Axillary vein puncture was performed using DNTP technique and LAX-IP technique under ultrasound guidance in DNTP group and LAX-IP group, respectively.Successful puncture at first attempt, overall successful catheterization, the number of needle tip redirection, and axillary vein puncture time and catheterization time were recorded.The occurrence of complications such as axillary artery puncture, posterior wall penetration of axillary vein, hematoma formation, pneumothorax, and nerve injury was recorded. Results:Compared with group LAX-IP, the success rate of puncture at first attempt was significantly increased, the number of cases required needle redirection was decreased, and the puncture time was shortened ( P<0.05), and no significant change was found in the logarithm of the posterior wall penetration of axillary vein in group DNTP ( P>0.05). No complications such as arterial puncture, hematoma, pneumothorax, or nerve injury occurred in two groups. Conclusions:Compared with LAX-IP technique, ultrasound-guided DNTP technique can dynamically observe the position of the needle tip, the operation is simple and safe, and it is worthy of clinical promotion when used for axillary vein puncture and cannulation.
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Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.
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Objective:To evaluate the effect of dexmedetomidine on pyroptosis in rats with endotoxin-induced acute lung injury (ALI).Methods:Sixty SPF male Sprague-Dawley rats, aged 6 weeks, weighing 200-220 g, were divided into 5 groups ( n=10 each) by a random number table method: control group (group C), ALI group and different doses of dexmedetomidine groups (D 1-3 groups). In ALI group and D 1-3 groups, LPS 5 mg/kg was intraperitoneally injected to establish endotoxin-induced ALI model.Immediately after establishing the model, dexmedetomidine 12.5, 25.0 and 50.0 μg/kg were intraperitoneally injected in D 1-3 groups, and the equal volume of normal saline was intraperitoneally injected in group C, once a day for 14 consecutive days.After the end of administration, the rats were sacrificed, the left bronchus was lavaged, and the left bronchoalveolar lavage fluid (BALF) was collected for determination of the concentrations of interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and the lung tissue was taken for determination of the wet/dry weight ratio (W/D ratio) and expression of cleaved-caspase-1, N-terminal of the spliceosome (GSDMD-N), IL-18 and IL-1β (by Western blot) and for microscopic examination of the pathological changes (with a light microscope). Results:Compared with group C, the W/D ratio of lung tissues was significantly increased, the concentrations of IL-1β, IL-6 and TNF-α in BALF were increased, the expression of cleaved-caspase-1, GSDMD-N, IL-1β and IL-18 in lung tissues was up-regulated ( P<0.05), and the pathological damage was aggravated in ALI group and D 1-3 groups.Compared with group ALI, the W/D ratio of lung tissues was significantly decreased, and the concentrations of IL-1β, IL-6 and TNF-α in BALF were decreased, the expression of cleaved-caspase-1, GSDMD-N, IL-1β and IL-18 in lung tissues was down-regulated in a dose-dependent manner ( P<0.05), and the pathological damage was significantly reduced in D 1-3 groups. Conclusion:The mechanism by which dexmedetomidine attenuates endotoxin-induced ALI may be related to inhibition of pyroptosis and reduction of inflammatory responses in rats.
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Objective:To evaluate the analgesic efficacy of pericapsular nerve group (PENG) block in elderly patients undergoing hip replacement under subarachnoid block.Methods:Fifty patients of both sexes, aged 65-89 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index 20-30 kg/m 2, undergoing unilateral hip arthroplasty, were divided into 2 groups ( n=25 each) by a random number table method: PENG group and fascia iliaca compartment block (FICB) group.In PENG group, 0.4% ropivacaine hydrochloride 20 ml was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In FICB group, 0.4% ropivacaine 30 ml was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.Subarachnoid block was performed in both groups.Visual analog scale scores and scores for satisfaction with analgesia at rest and during activity were recorded before blockade (T 0), at 10, 20 and 30 min after blockade (T 1-3) and when placed in the position for spinal anesthesia (T 4). The cumulative consumption of sufentanil, effective pressing times of analgesic pump, and development of related complications were recorded at 6, 12, 24 and 48 h after operation (T 5-8). Results:Compared with FICB group, the VAS scores at rest and during activity were significantly decreased at T 1-4, and scores for satisfaction with analgesia during activity were increased in PENG group ( P<0.05). There was no significant difference between the two groups in the cumulative consumption of sufentanil and effective pressing times of analgesic pump ( P>0.05). One patient developed postoperative delirium in group FICB, and no patients developed puncture site infection and nerve damage after operation in two groups. Conclusion:PENG block produces better analgesic efficacy than FICB when used for elderly patients undergoing hip replacement under subarachnoid block.
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Objective To evaluate the effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion in patients.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-60 yr,with body mass index of 19-25 kg/m2,scheduled for elective thoracic interbody fusion with the vertebral segments involved in the operation ＜6,were divided into 3 groups (n =30 each) using a random number table method:general anesthesia group (group G),dexmedetomidine group (group D) and dexmedetomidine plus erector spinae plane block group (group DE).In group D and group DE,dexmedetomidine was intravenously infused over 10 min at a loading dose of 0.5 μg/kg starting from 30 min before anesthesia induction,followed by continuous infusion of 0.5 μg · kg-1 · h-1 until 15 min before the end of operation.In group DE,bilateral erector spinae blocks were performed under ultrasound guidance at 20 min before anesthesia induction,and 0.25％ ropivacaine 30 ml was injected into each side.Patients received patient-controlled analgesia (PCA) after operation.The consumption of propofol was recorded.The patients were followed up for 48 h after operation,and the pressing times of PCA and consumption of sufentanil were recorded.The emergence time,extubation time and volume of blood loss were also recorded.Blood samples were collected from the radial artery immediately before induction (T1),at 30 min of operation (T2),and at 1 h and 1,3 and 5 days after operation (T3-6) for determination of plasma CD42+,HLA-DR+ and CD14+ concentrations,white blood cell (WBC) count (by electrical impedance method) and plasma C-reactive protein (CRP) concentrations (by latex-enhanced scattering turbidimetry assay).CD42+/CD14+ and HLA-DR+/CD14+ ratios were calculated.Results Compared with group G,the pressing times of PCA and consumption of sufentanil were significantly decreased,CD42+/CD14+ ratio was decreased,and HLA-DR+/CD14+ ratio was increased at T3-6 in group D,and the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42+/CD14+ ratio was decreased,HLA-DR+/CD14+ratio was increased at T3-6,and the plasma CRP concentrations and WBC count were decreased at T2-6 in group DE (P ＜0.05).Compared with group D,the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42+/CD14+ ratio was decreased at T5,HLA-DR+/CD14+ratio was increased at T3.4,and the plasma CRP concentrations and WBC count were decreased at T3-6 in group DE (P ＜0.05).Conclusion Dexmedetomidine combined with erector spinae plane block can reduce inflammatory responses and improve cellular immune function after thoracic interbody fusion in patients.
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Objective To evaluate the effect of dexmedetomidine on nerve regeneration following cerebral ischemia-reperfusion (Ⅰ/R) in mice and the role of transforming growth factor-beta 1 (TGF-β1) in brain tissues.Methods Sixty healthy SPF male C57BL/6J mice,weighing 23-25 g,aged 8-10 weeks,were divided into 5 groups (n =12 each) using a random number table method:sham operation group (group Sham),Ⅰ/R group,dexmedetomidine group (group D),dexmedetomidine plus IgG1 isotype control monoclonal antibody group (group DI) and dexmedetomidine plus TGF-β1 neutralizing monoclonal antibody group (group DA).Cerebral Ⅰ/R was induced by occlusion of the middle cerebral artery followed by reperfusion.Dexmedetomidine 50 μg/kg was intraperitoneally injected every 24 h for 14 days starting from 14 days of reperfusion in group D.TGF-β1 neutralizing monoclonal antibody 20 μg and IgG1 isotype control monoclonal antibody 20 μg were intraperitoneally injected at 30 min prior to dexmedetomidine injection in group DA and group DI,respectively.5-bromodeoxyuridine (BrdU) 100 mg/kg was intraperitoneally injected and injected again at an 8-h interval on 27 days of reperfusion.Forced swimming test (FST),sucrose consumption test (SCT) and open field test (OFT) were performed at 16 h after the second administration of BrdU.After the end of behavior testing,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone on ischemic side was measured by immunohistochemistry,and the expression of TGF-β1 protein and mRNA in brain tissues in ischemic area was detected using Western blot and real-time polymerase chain reaction,respectively.Results Compared with group Sham,the time spent floating in FST was significantly prolonged,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were decreased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was increased,and the expression of TGF-β1 protein and mRNA was up-regulated in group Ⅰ/R (P＜0.05 or 0.01).Compared with group Ⅰ/R,the time spent floating in FST was significantly shortened,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were increased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was increased,and the expression of TGF-β1 protein and mRNA was up-regulated in group D (P＜0.05 or 0.01).Compared with group D,the time spent floating in FST was significantly prolonged,the percent of time spent in the central region in OFT and sucrose solution intake in SCT were decreased,the number of Ki67,BrdU and BrdU/DCX positive cells in the subventricular zone was decreased in group DA (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group DI (P＞0.05).Conclusion Dexmedetomidine can relieve depression and anxiety following cerebral Ⅰ/R,thus promotes nerve regeneration and the mechanism is related to up-regulating the expression of TGF-β1 in brain tissues of mice.
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Objective To evaluate the effect of dexmedetomidine on endoplasmic reticulum stress during intestinal ischemia-reperfusion (I/R) in mice.Methods Thirty SPF healthy male C57BL/6 mice,aged 8 weeks,were divided into 3 groups (n=10 each) using a random number table method:sham operation group (S group),intestinal I/R group (I/R group) and dexmedetomidine group (DEX group).The superior mesenteric artery was only isolated but not clamped in S group.The model of intestinal I/R injury was established by clamping superior mesenteric artery for 20 min followed by 24 h of reperfusion in I/R group and DEX group.Dexmedetomidine 25 μg/kg was intraperitoneally injected at 30 min before ischemia in DEX group,while the equal volume of normal saline was given instead of dexmedetomidine in S group and I/R group.Mice were sacrificed at 24 h of reperfusion,and small intestinal tissues was obtained for examination of the pathological changes and ultrastructure of intestinal epithelial cells and for determination of cell apoptosis,expression of CCAAT-enhancer binding protein homologous protein (CHOP),transcription factors (ATF4),and X-4 box binding protein 1 (XBP1) mRNA (by real-time polymerase chain reaction),and expression of CHOP,Bcl-2,Bax and caspase-3 in intestinal tissues (by Western bolt).The apoptosis index (AI) and ratio of Bcl-2 to Bax were calculated.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,Chiu's score and AI were significantly increased,the expression of CHOP,ATF4 and XBP-1 mRNA,CHOP,Bax and caspase-3 was up-regulated,and the expression of Bcl-2 was down-regulated,and Bcl-2/Bax ratio was decreased in I/R group and DEX group (P＜0.05).Compared with I/R group,Chiu's score and AI were significantly decreased,the expression of CHOP,ATF4 and XBP-1 mRNA,CHOP,Bax and caspase-3 was down-regulated,and the expression of Bcl-2 was up-regulated,and Bcl-2/Bax ratio was increased in DEX group (P＜0.05).Conclusion The mechanism by which dexmedetomidine reduces intestinal I/R injury may be related to regulating endoplasmic reticulum stress and inhibiting cell apoptosis in mice.
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Objective:To establish a synthetic cyclic citrullinated peptide induced arthritis model in mice, explore immunogenicity and arthritogenicity of this peptide. Methods: 36 DBA/1 mice were randomly divided into three groups, which were injected the type Ⅱ collagen ( CⅡ, CIA ) emulsion, cyclic citrullinated vimentin peptide ( CCit-Vim, CCV-IA ) emulsion, cyclic citrullinated vimentin peptide conjugated KLH ( CCit-Vim+KLH,CCV+K-IA) emulsion on day 0 and 21,respectively. Using arthritis index( AI) ,paw swelling to evaluate the incidence of arthritis;ELISA tested serum anti-CCit-Vim antibody,anti-CⅡantibody,anti-CCP antibody and TNF-α, IIF detected AKA;Histopathology of the ankle joint was obsearved. Results: There were three mice appeared arthritis in CCV+K-IA,the incidence rate of 25%,but arthritis occurs later time,short duration,and the incidence and extent of arthritis were lower than the CIA. CCV-IA no arthritis performance. CCV+K-IA produce anti-CCit-Vim antibody were significantly higher than those in CIA (1. 32±0. 59 vs 0. 78±0. 27,P=0. 031). While Anti-CCP antibody of CCV+K-IA were significantly lower than CIA (54. 73±7. 33 vs 64. 37±9. 91,P=0. 007). The anti-CⅡ antibody in CCV+K-IA and CCV-IA were lower than the CIA(15. 73±2. 10, 16. 71±3. 03 vs 19. 50±2. 36,P<0. 05). The TNF-α produced by CCV+K-IA and CIA were both significantly higher than the CCV-IA (645. 61±35. 26,618. 98±53. 32 vs 533. 63±79. 49,P<0. 05). The AKA positive rate of CCV+K-IA is 50% (6/12),significantly higher than CCV-IA 25% ( 3/12 ) and CIA 16. 67% ( 2/12 ) . Histopathology of the ankle showed that the CCV-IA and CCV+K-IA have a mild synovial hyperplasia,no obvious synovial pannus formation and inflammatory cell infiltration. Conclusion:The cyclic citrul-linated peptide conjugated KLH not only has stronger immunogenicity but also has arthritogenicity. It induced a higher positive rate of AKA than CⅡ.
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Objective To determine the optimum dose of dexmedetomidine through evaluating the effects of different doses of dexmedetomidine combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.Methods Sixty ASA physical status Ⅱ patients of both sexes,aged 18-60 yr,with body mass index 20-26kg/m2,Child-Pugh grade A,undergoing radical resection for stomach or colon cancer,were randomly assigned into 3 groups (n=20 each):propofol and remifentanil group (group Ⅰ),low-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅱ) and high-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅲ).In Ⅱ and Ⅲ groups,dexmedetomidine was infused at a rate of 0.2 μg·kg-1 · h-1 and 0.4 μg·kg 1 · h-1,respectively,until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.4 μg/kg and 0.8 μg/kg,respectively,was infused at 10 min before induction of anesthesia.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentration 2-4 μg/ml),iv infusion of remifentanil 0.2 μμg·kg-1 · h-1 and intermittent iv boluses of rocuronium 0.15 mg/kg.BIS value was maintained at 40-60.Before dexmedetomidine infusion (T0),at 2 min before intubation (T1),at 1 min after intubation (T2),immediatay after zskin incision (T3),and at 30 min of surgery (T4),arterial blood samples were taken for measurement of concentrations of plasma norepinephrine (NE) and epinephrine (E).The emergence time,adverse cardiovascular events,and the development of nausea and vomiting and restlessness during recovery from anesthesia were recorded.Results Compared with group Ⅰ,the plasma concentration of propofol was significantly decreased,and the incidence of tachycardia and restlessness during recovery from anesthesia were significantly decreased in Ⅱ and Ⅲ groups,and the incidence of bradycardia during operation was significantly increased,and the incidence of hypertension during recovery from anesthesia was significantly decreased,and the emergence time was prolonged in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,the plasma concentration of propofol was significantly decreased,the incidence of bradycardia during operation was increased,and the emergence time was prolonged in group Ⅲ (P ＜0.05).The plasma NE and E concentrations were significantly higher at T2.3 in group Ⅰ,and were lower at T1-4 in Ⅰ and Ⅲ groups than those at T0 (P ＜ 0.05).Conclusion 0.4 μg/kg injected before induction of anesthesia followed by infusion at 0.2 μg·kg-1 · h-1 is the recommended optimum method for application of dexmedetomidine when combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.