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Objective:To evaluate the optimized efficacy of single-injection thoracic paravertebral block (TPVB) with multiple adjuvant drugs combined with general anesthesia for modified radical mastectomy (MRM) for breast cancer.Methods:Sixty American Society of Anesthesiologists physical statusⅠ or Ⅱ patients, aged 20-60 yr, with body mass index<30 kg/m 2, scheduled for elective primary modified radical mastectomy for breast cancer under general anesthesia, were divided into 2 groups ( n=30 each) using a random number table method: single-injection TPVB with multiple adjuvants group (group PV-SI) and continuous infusion via TPVB group (group PV-CI). In group PV-SI, single-injection TPVB was performed with 0.25% ropivacaine 25 ml, dexamethasone 3 mg, buprenorphine 120 μg, and adrenaline 2.5 μg/ml, and general anesthesia was performed after induction of anesthesia.In group PV-CI, the mixture of 0.25% ropivacaine 25 ml and epinephrine 2.5 μg/ml was injected after induction of anesthesia, and then 0.125% ropivacaine 8 ml/h was continuously infused via TPVB until 48 h after operation.At the end of operation, a patient-controlled intravenous analgesic pump was connected and programmed to deliver a bolus dose of morphine 2 mg with a lockout interval of 10 min and no loading dose and background infusion.The duration of postoperative analgesia, total consumption of morphine within 48 h after operation, occurrence of nausea and vomiting, and patient′s recommendation and satisfaction were recorded. Results:There was no significant difference in the duration of postoperative analgesia, total consumption of morphine within 48 h after operation, incidence of nausea and vomiting, and rates of patient′s recommendation and satisfaction between PV-SI group and PV-CI group ( P>0.05). Conclusion:Single-injection TPVB with multiple adjuvants combined with general anesthesia can be used as an optimized strategy to improve the postoperative analgesia in the patients undergoing MRM for breast cancer.
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Perioperative cardiac arrest is a significant cause of perioperative mortality in patients.The first clinical practice recommendation dedicated to the management of perioperative cardiac arrest was published in 2021 and contains 22 specific recommendations.This clinical practice recommendation includes indicators to monitor during treatment, the sequence of defibrillation and chest compressions, the use of epinephrine and antiarrhythmic drugs, treatment strategies for specific types of perioperative cardiac arrest, the use of adjunctive therapies such as ultrasound to assist in treatment, setting appropriate hemodynamic and respiratory parameters, and temperature management.This clinical practice recommendation is essential for effective management of perioperative cardiac arrest and will also provide guidance for further exploration of the management of perioperative cardiac arrest in the future.
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Sepsis is defined as life-threatening organ dysfunction secondary to a dysregulated host response to infection.It is considered a major cause of death and health loss worldwide.Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021, released in October 2021, included 93 total statements, which addressed screening and initial resuscitation, infection, hemodynamics, ventilation, additional therapies, and goals of care and long-term outcomes.This review interpreted the content ofthe guidelines and also analyzed the underlying issues.The guidelines provide a more accurate framework and guidance for the diagnosis and treatment of sepsis, and may also provide an opportunity to urge researchers in the field of sepsis worldwide to implement further individualized research.
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Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, of which the pathogenesis is complex and the mortality rate is high. However, current basic research is facing the dilemma of high heterogeneity and difficult translation to clinical practice. In-depth basic research is one of the most important ways to break through the "bottleneck" of clinical diagnosis and treatment of sepsis. The purpose of this review is to analyze the current progress and challenges in the field of basic research on sepsis, and look forward to the potential research directions in the future. Cell function, energy metabolism, microbiota, epigenetics and recovery period of sepsis may be the research priorities.
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Objective:To compare the efficacy of HES 130/0.4 and acetate Ringer′s solution (A-HES) and HES 130/0.4 and normal saline (NS-HES) for volume therapy in the patients undergoing non-cardiac surgery with general anesthesia.Methods:Two hundred and fifty American Society of Anesthesiologist physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-32 kg/m 2, undergoing noncardiac surgery with general anesthesia, were divided into group A-HES and group NS-HES using the stratified block randomization technique.A-HES and NS-HES 15 ml/kg were intravenously infused over 1 h immediately after induction of anesthesia in A-HES and NS-HES groups, respectively.Mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP) were recorded before and after infusion, and the maximum changing rate of MAP and HR and the maximum change in CVP were calculated.The pH value, BE and HCO 3- were recorded before infusion and at 15 min after the end of infusion, and Hb, Hct, electrolytes, blood glucose, blood biochemical parameters and parameters of coagulation function were measured.The occurrence of abnormal blood biochemical parameters, blood glucose, and parameters of coagulation function, intraoperative requirement for vasoactive drugs, occurrence of HES-related adverse events, and intraoperative fluid intake and output were recorded. Results:A total of 251 cases were actually enrolled in this study, with 125 cases in group A-HES, and 126 cases in group NS-HES.Compared with group NS-HES, no significant change was found in the maximum changing rate of MAP and HR and the maximum change in CVP ( P>0.05) in group A-HES, and non-inferiority analysis showed that group A-HES was not inferior to group NS-HES.Compared with group NS-HES, the concentrations of BE and HCO 3-, K + , Ca 2+ and Mg 2+ were significantly increased, the concentrations of Na + and Cl - were decreased, the PT was shortened, the incidence of abnormal PT was decreased at 15 min after the end of infusion ( P< 0.05), and no significant change was found in the other parameters mentioned above in group A-HES ( P>0.05). Conclusion:The volume expanding effect of A-HES and its effect on liver and kidney function are not significantly different from those of NS-HES, however, A-HES has certain advantages in maintaining acid-base balance, electrolyte stability and coagulation function.
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In order to effectively prevent infection or severe acute respiratory syndrome coronavirus 2 transmission among medical staff during tracheal intubation in patients with suspected or confirmed coronavirus disease 2019(COVID-19), and to ensure the safety of personnel who will perform the endotracheal intubation, we made a literature review to analyze the airway management for SARS patients from China and abroad in 2003. Relevant documents, consensus of diagnosis and therapy for patients with COVID-19 from the National Health Commission, and guidelines of relevant academic societies were also reviewed.Thus, we provide suggestions on infection control for performing endotracheal intubation in patients with COVID-19 mainly as follows.Medical staff should fully understand the infection risk of COVID-19 and strengthen the training before the procedure.It is suggested that the indication of endotracheal intubation should be properly defined, and the need for intubation as emergent or elective should be evaluated early with preparation made in advance.During the implementation of endotracheal intubation, the procedure should be completed by the most experienced personnel in airway management using the tools they master best, and a rapid sequential induction of endotracheal intubation is recommended.
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Immune metabolism is an emerging highlight in recent years.Revealing the metabolic characteristics of different immune cells in different responses may provide new perspective and direction for the pathogenesis and therapy of many immune-related diseases.Sepsis is a complex systemic inflammation caused by trauma,infection and other pathogenic factors.The immune cells have different metabolic features at different stages of the disease.These metabolic features are also involved in the regulation of immune cell proliferation,differentiation and function.By summarizing and analyzing the relevant literatures of immune cell metabolism and inflammation regulation in recent years,the metabolic regulatory factors of different immune cell subgroups and the related characteristics of immune cell metabolism in patients with sepsis were summarized.The in-depth understanding of the metabolic state in different immune cells,and the pathophysiological mechanism of septic immune disorders,especially the immune paralysis stage,would provide a theoretical basis for the clinical application of immune metabolic therapy.
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OBJECTIVE@#To investigate the changes in the expression of voltage-gated potassium channel subunit KCNA2 in the dorsal root ganglion (DRG) neurons of rats with osteoarthritis (OA) pain induced by sodium monoiodoacetate and explore the mechanism.@*METHODS@#A total of 156 adult male Sprague-Dawley rats were randomly divided into blank control group, saline group and intra-articular monoiodoacetate injection-induced OA group. The paw withdrawal mechanical threshold (PWMT) was measured before and at 1, 2, 4, and 6 weeks after monoiodoacetate injection. At 4 weeks after the injection, the pathological changes in the knee joints were analyzed using HE staining and Safranin O-Fast Green staining, and the expression of activating transcription factor 3 (ATF-3) and inducible nitric oxide synthase (iNOS) in the DRG neurons were detected by immunofluorescence staining. The expression of mRNA in the DRG neurons was detected by RT-qPCR at 1, 2, 4 and 6 weeks after the injection. The expression of KCNA2 in the DRG was measured by Western blotting, and the methylation level of promoter region was measured by MSPCR at 4 weeks after the injection.@*RESULTS@#The PWMT of the rats in OA group was significantly decreased at 2, 4, and 6 weeks after the injection as compared with the baseline ( < 0.05 or < 0.001) as well as the control group ( < 0.05 or < 0.001). Four weeks after the intra-articular injection, fractures and defects on the surface of the articular cartilage, bone hyperplasia, and blurred tidal line were observed in the rats in OA group, but no obvious pathological changes were detected in the control or saline groups. Compared with those in the control group, the expressions of ATF-3 and iNOS were significantly increased ( < 0.01) at 4 weeks after injection; the expression of mRNA at 2, 4 and 6 weeks and the expression of KCNA2 protein at 4 weeks were all significantly decreased ( < 0.05 or < 0.01), and the methylation level of gene was significantly increased at 4 weeks after the injection in OA group ( < 0.01).@*CONCLUSIONS@#The expression of KCNA2 is decreased in the DRG neurons of rats with OA pain likely as a result of enhanced methylation of promoter region.
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Animals , Male , Rats , Disease Models, Animal , Ganglia, Spinal , Knee Joint , Metabolism , Osteoarthritis , Metabolism , Pain , Metabolism , Promoter Regions, Genetic , Rats, Sprague-DawleyABSTRACT
Objective To evaluate the role of different opioid receptors in morphine postconditioning-induced reduction of ischemia-reperfusion (Ⅰ/R) injury in isolated rat hearts.Methods Healthy adult male Sprague-Dawley rats,aged 7-8 weeks,weighing 250-300 g,were anesthetized with chloral hydrate.The hearts were removed and retrogradely perfused with oxygenated K-H solution in a Langendorff apparatus.Forty-eight Langendorff-perfused rat hearts were divided into 4 groups (n=12 each) by a random number table method:Ⅰ/R group,morphine postconditioning group (M group),δ receptor antagonist naltrexone plus morphine postconditioning group (N+M group) and κ receptor antagonist nor-binaltorphimine plus morphine postconditioning group (B+M group).Hearts were subjected to 4 cycles of perfusion with K-H solution containing 1 μmol/L morphine for 15 s and then with K-H solution containing no morphine for 15 s in group M.In N+M group and B+M group,hearts were perfused with 5 μmol/L naltrindole and 5 μmol/L nor-binaltorphimine,respectively,starting from 10 nin of equilibration until 5 min of reperfusion,and morphine postconditioning was similar to those previously described in group M.Heart rate and the maximum rate of increase or decrease in left ventricular pressure (±dp/dtmax) were recorded at 20 min of equilibration and 30 and 60 nin of reperfusion.Corona~ effluent was collected at 20 min of equilibration and 60 min of reperfusion for measurement of the activity of creatine kinase by colorimetric assay.Eight hearts were obtained at 60 min of reperfusion for determination of myocardial infarct size.Four hearts were obtained at 60 min of reperfusion for detection of the expression of microtubule-associated protein 1 light chain 3 Ⅰ (LC3 Ⅰ) and LC3 Ⅱ by Western blot.LC3 Ⅱ/LC3 Ⅰ ratio was calculated.Results Compared with the baseline value at 20 min of equilibration,heart rate and +dp/dt were significantly decreased at 30 and 60 min of reperfusion,and the activity of creatine kinase in coronary effluent was increased at 60 min of reperfusion in four groups (P＜0.05).Compared with group Ⅰ/R,the activity of creatine kinase in coronary effluent,percentage of myocardial infarct size and LC3 Ⅱ/LC3 Ⅰ ratio were significantly decreased in group M (P＜0.05).Compared with group M,the activity of creatine kinase in coronary effluent,percentage of myocardial infarct size and LC3 Ⅱ/LC3 Ⅰ ratio were significantly increased in N+M and B+M groups (P＜0.05).Conclusion δ and κ opioid receptors are involved in morphine postconditioning-induced reduction of Ⅰ/R injury in isolated rat hearts,and the mechanism may be related to inhibiting the level of autophagy.
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Objective To compare the intubating conditions between dexmedetomidine and remifentanil when combined with sevoflurane-nitrous oxide (N2O) for anesthesia induction in the pediatric patients.Methods A total of 122 pediatric patients,aged 4-10 yr,of American Society of Anesthesiologists physical status Ⅰ,undergoing elective plastic surgery,were randomly divided into dexmedetomidine group (group D,n =61) and remifentanil group (group R,n=61).Eight percent sevoflurane and 60％ N2O were inhaled for induction of anesthesia,and the fresh gas flow was set at 6 L/min.After disappearance of eyelash reflex,dexmedetomidine 1 μg/kg and remifentanil 1 μg/kg were intravenously injected over 50-60 s in D and R groups,respectively,and 1 min later tracheal intubation was performed.The intubating conditions were graded,and the satisfactory intubating conditions and successful intubation were recorded.The development of adverse cardiovascular reactions and complications such as hyoxemia and laryngospasm before and after intubation and postoperative pharyngodynia was recorded.Results Compared with group D,no significant change was found in the success rate of intubation,rate of satisfactory intubation,intubating condition grade or incidence of postoperative pharyngodynia (P＞ 0.05),and the incidence of hypertension and sinus tachycardia after intubation was significantly increased in group R (P＜0.05).No pediatric patients developed hyoxemia,laryngospasn or sinus tachycardia in two groups.Conclusion When 8％ sevoflurane and 60％ N2O are inhaled for anesthesia induction,combing with dexmedetomidine 1 μg/kg produces better clinical efficacy than combing with remifentanil 1 μg/kg in improving the intubating conditions for pediatric patients.
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During sepsis, circulating leukocytes are in a hyper inflammatory state, and with the progress of the inflammation, immune cells may become tolerated. Glycolysis and pentose phosphate pathway are up-regulated but oxidative phosphorylation is suppressed in hyper inflammatory cells, whereas during immune tolerance, glycolysis is often down-regulated. In this review, we will summarize the changes of cellular metabolic pathways in monocytes and macrophages during sepsis. We also review how the metabolism of glucose, amino acids, and fatty acids affect the function of monocytes and macrophages in sepsis. Current literature indicated that metabolism plays a significant role in regulating the functions of immune cells in sepsis, which might be a potential therapy for sepsis and deserved further research.
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Objective To evaluate the optimal degree of neuromuscular blockade for inhibiting obturator nerve-muscle responses induced by transurethral resection of bladder tumor (TURBT) with general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes,aged 26-64 yr,weighing 50-80 kg,scheduled for elective TURBT for lateral bladder wall tumors with general anesthesia,were divided into 3 groups (n =30 each) using a random number table:low-dose mivacurium group (group L),medium-dose mivacurium group (group M) and high-dose mivacurium group (group H).After mivacurium 0.15 mg/kg was injected intravenously during anesthesia induction,mivacurium was continuously infused at a rate of 0.2,0.3 and 0.4 mg · kg-1 · h-1 in L,M and H groups,respectively,until the end of operation.Neuromuscular blockade was continuously monitored during operation.When T1％ and TOF count (TOFC) disappeared,post tetanic count (PTC) was used.ROC curve was applied to analyze the relationship between the occurrence of obturator nerve-muscle responses and degree of neuromuscular blockade.Results T1％ and TOFC were recorded in 16 patients (15 cases in group L,1 case in group M) during the resection of tumor,and the obturator nerve-muscle response was observed in all of these patients.In the other 74 patients,T1％ and TOFC disappeared,and PTC recorded was 10.0±3.1 (group L,n=15),6.0± 3.5 (group M,n=29) and 4.0±2.2 (group H,n=30).Among the 74 patients,the obturator nerve-muscle response was found in 18 patients (8 cases in group L,10 cases in group M).The area under the ROC curve of PTC value in predicting the occurrence of obturator nerve-muscle responses was 0.882 with a PTC cut-off of 9 (P＜0.05).The sensitivity and specificity were 87.3％ and 72.2％,respectively.Conclusion In order to inhibit the obturator nerve-muscle response during TURBT with general anesthesia,the optimal degree of neuromuscular blockade should be kept not more than 9 for PTC.
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Objective To evaluate the effect of linoleic acid on lipopolysaccharide (LPS)-induced release of inflammatory factors in the macrophages of mice.Methods The peritoneal macrophages obtained from C57BL/C mice were seeded in 24-well plates at a density of 4× 105 cells/well and in 6-well plates at a density of 2× 106cells/well.The cells were incubated and attached to the wall overnight in a 5％ CO2 incubator in humidity at 37 ℃.The experiment was performed in 2 parts.Part Ⅰ The cells in 24-well plates were randomly divided into 5 groups (n =8 each) using a random number table:control group (group C);LPS group;3 different concentrations of linoleic acid groups (LA1-3 groups).The sterile anhydrous alcohol 1 μl was added in group LPS,0.1,0.5 and 1.0 mol/ml linoleic acid 1 μl were added in LA1-3 groups,respectively,and 30 min later 100 μg/ml LPS 1 μ,l was added in LPS and LA1-3 groups.The culture medium was collected at 6 h after LPS administration to measure the concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in the supernatant by enzyme-linked immunosorbent assay.PartⅡ The cells in 6-well plates were randomly divided into 3 groups (n =6 each) using a random number table:control group (group C);LPS group;0.5 mol/ml linoleic acid group (group LA).The sterile anhydrous alcohol 1 μl was added in group LPS,0.5 mol/ml linoleic acid 1 μl was added in group LA,and 30 min later 100 μg/ml LPS 1 μl was added in LPS and LA groups.At 1 h after administration of LPS,the expression of Toll-like receptor 4 (TLR4) was determined by flow cytometry,and the expression of phosphorylated nuclear factor kappa B (NF-κB) p65 (p-NF-κB p65),phosphorylated extracellular signal-regulated protein kinase (p-ERK) and phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK) was determined by Western blot.Results Part Ⅰ Compared with group C,TNF-α and IL-6 concentrations in the supernatant were significantly increased in LPS and LA1 3 groups (P ＜ 0.05).Compared with group LPS,TNF-α and IL-6 concentrations in the supernatant were significantly decreased in LA1 3 groups (P＜0.05).Compared with group LA1,TNF-α and IL-6 concentrations in the supernatant were significantly decreased in LA2 and LA3 groups (P＜0.05).Compared with group LA2,TNF-α and IL-6 concentrations in the supernatant were significantly decreased in group LA3 (P ＜ 0.05).Part Ⅱ Compared with group C,the expression of TLR4,p-NF-κB p65,p-ERK and p-p38 MAPK in macrophages was significantly up-regulated in LPS and LA groups (P＜0.05).Compared with group LPS,the expression of TLR4,p-NF-κB p65,p-ERK and p-p38 MAPK in macrophages was significantly down-regulated in group LA (P＜0.05).Conclusion Linoleic acid can inhibit LPS-induced release of inflammatory factors in the macrophages of mice,and the mechanism may be related to the inhibition of TLR4 signaling pathway activation.
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Sepsis is a leading cause of death in critically ill patients.The definitions of sepsis and septic shock were introduced in 1991 and last revised in 2001.Since considerable advances had occurred to its pathophysiology and management,an update definitions for sepsis and septic shock were released in February 2016 by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.This article is to review the development and limitations of previous versions of sepsis definition,and summarize the sepsis 3.0 definition and its clinical diagnosis criteria.These updated definitions and clinical criteria will play vital roles in providing important reference frame for clinical trials,and facilitating early recognition and timely management of patients with sepsis.
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The metabolic response to stress plays a key role in the adaptive response during critical illness.Multiple mechanisms including the stimulation of the sympathetic nervous system,inflammation,and immune responses were involved.Insulin resistance is one of the main features in metabolic response to stress.Metabolic response to stress was manifested by disorders of energy consumption,such as glucose,lactic acid,lipids,and proteins.The decrease in fat-free body mass and cell mass,relative excess of adipose tissues,and increased extracellular fluid volumes were also involved.Therapeutic interventions,including hormone supplementation,enhanced protein intake,and early mobilization,are considered for prevention and therapy of metabolic response to stress.The review aims to summarize the pathophysiological mechanisms,clinical consequences,and therapeutic implications of metabolic response to stress in critical illness.
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Objective To evaluate the role of autophagy in survival of hypoxia-preconditioned bone marrow mesenchymal stem cells (BMSCs) in damaged tissues resulting from spinal cord ischemiareperfusion (I/R) injury in rats.Methods In vitro experiment Rat BMSCs were seeded in 12-well plates at a density of 1× 106 cells/ml (1 ml/well) , and randomly divided into 6 groups (n =30 wells each) : control group (group C) , normoxia-incubated group (group N) , hypoxic preconditioning (HP) group (group H), HP + AMP-activated protein kinase (AMPK) inhibitor Compound C group (group HC), HP + autophagy inhibitor 3-methyladenine group (group HM) and HP + mammalian target of rapamycin (mTOR) inhibitor rapamycin group (group HR).In HC, HM and HR groups, 10 mmol/L Compound C, 5 mmol/L 3-methyladenine and 10 nmol/L rapamycin were added to the culture medium, respectively, at 3 h before HP.Twelve wells in each group were selected, and the expression of phosphorylated AMPK (p-AMPK) , phosphorylated mTOR (p-mTOR), microtubule-associated protein 1 light chain 3 Ⅰ (LC3 Ⅰ), and LC3 Ⅱ in BMSCs was determined.Eighteen wells in each group were selected, and BMSCs were co-cultured with 500 μ mmol/L H2O2 for 24 h, the survival and apoptotic rate of BMSCs were measured, and the activities of caspase-9 and caspase-3 were detected.In vivo experiment Adult male Sprague-Dawley rats, weighing 300-350 g, aged 3 months, underwent spinal cord I/R.A total of 192 rats with spinal cord I/R injury were randomly divided into C, N, H, HC, HM and HR groups (n =32 each) using a random number table.At 30 min of reperfusion, BMSC suspension 5 μ l (1×106 cells/ml) processed in N, H, HC, HM and HR groups of in vitro experiment was implanted into the lumbar segment (L1-5) of the spinal cord in N, H, HC, HM and HR groups, respectively.Neurological function was scored at 4, 12, 24 and 48 h of reperfusion.The lumbar segment of spinal cord was removed for detection of apoptosis in BMSCs.Results In vitro experiment Compared with group N, the p-AMPK expression, LC3 Ⅱ/LC3 Ⅰ and survival rate were significantly increased, and p-mTOR expression, apoptotic rate and activities of caspase-9 and caspase-3 were decreased in group H (P＜0.05).Compared with group H, the p-AMPK expression, LC3 Ⅱ/LC3 Ⅰ and survival rate were significantly decreased, and p-mTOR expression, apoptotic rate and activities of caspase-9 and caspase-3 were increased in group HC, LC3 Ⅱ/LC3 Ⅰ and survival rate were decreased, and apoptotic rate and activities of caspase-9 and caspase-3 were increased in group HM, and p-mTOR expression, apoptotic rate and activities of caspase-9 and caspase-3 were decreased, and LC3 Ⅱ/LC3 Ⅰ and survival rate were increased in group HR (P＜0.05).In vivo experiment Compared with group N, the neurological function scores were significantly increased, and the number of apoptotic BMSCs was decreased in group H (P＜0.05).Compared with group H, neurological function scores were significantly decreased,and the number of apoptotic BMSCs was increased in HC and HM groups (P＜O.05).Conclusion Enhanced autophagy is involved in survival of hypoxia-preconditioned BMSCs in damaged tissues resulting from spinal cord I/R injury, and the mechanism is associated with activated AMPK/mTOR pathway in rats.
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Objective To evaluate the effect of lactulose on spinal cord ischemia-reperfusion (I/R) injury in rats.Methods One hundred forty-four male Sprague-Dawley rats, aged 3 months, weighing 300-350 g, in which gastric tube was successfully inserted, were randomly divided into 4 groups (n=36 each) using a random number table: sham operation group (group S), spinal cord I/R group (group I/R), lactulose group (group L), and lactulose + antibiotics group (group LA).Spinal cord ischemia was induced by occlusion of the thoracic aorta combined with controlled hypotension for 9 min, followed by reperfusion.Lactulose 0.5 g/kg was administered intragastrically immediately after onset of reperfusion in group L.Metronidazole 30 mg/kg and gentamicin 40 mg/kg were administered intragastrically three times a day during 1-3 days before operation in group LA, and the other procedures were similar to those previously described in group L.Hydrogen concentration in cerebrospinal fluid was detected before ischemia and at 10, 30, 60, 90, 120, 150 and 180 min after reperfusion.At 12, 24 and 48 h of reperfusion, 8 rats in each group were sacrificed, and the L3-5 segment of the spinal cord was isolated for determination of nuclear factor E2-related factor 2 (Nrf2) expression (by Western blot), superoxide dismutase (SOD) activity (by using xanthine oxidase method), catalase (CAT) activity (ammonium molybdate method), and 8-hydroxy-2'-deoxyguanosine (8-OHdG), 3-nitrotyrosine (3-NT) and malondialdehyde (MDA) contents (by ELISA).Neurological function was assessed and scored at 48 h of reperfusion.Six animals in each group were then sacrificed after assessment of neurological function, and the L3-5 segment of the spinal cord was removed for detection of apoptotic neurons.The cell survival rate and apoptotic rate were calculated.Results Compared with group S, no significant change was found in the hydrogen concentration in the cerebrospinal fluid at each time point, and in the level of Nrf2, CAT and SOD at 12, 24 and 48 h of reperfusion, the contents of 8-OHdG, 3-NT and MDA were significantly increased, the neurological scores and cell survival rate were decreased, and the apoptotic rate was increased in group I/R, and the hydrogen concentration in the cerebrospinal fluid at 30-180 min of reperfusion was increased, the level of Nrf2, CAT and SOD was increased at 12, 24 and 48 h of reperfusion, and no significant change was found in the contents of 8-OHdG, 3-NT and MDA, neurological scores, cell survival rate, and apoptotic rate in group L.Compared with group I/R, the hydrogen concentration in the cerebrospinal fluid at 30-180 min of reperfusion was increased, the level of Nrf2, CAT and SOD was increased, the contents of 8-OHdG, 3-NT and MDA were decreased, the neurological scores and cell survival rate were increased, and the apoptotic rate was decreased in group L, and no significant change was found in the parameters mentioned above in group LA.Conclusion Lactulose can reduce spinal cord I/R injury in rats.
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Objective To compare remifentanil?propofol target?controlled infusion ( TCI ) with sufentanil?propofol TCI for sedation and analgesia in the patients undergoing local anesthesia. Methods Sixty patients, aged 17?54 yr, with body mass index 0?? 05). Conclusion Remifentanil?propofol TCI provides similar sedative and analgesic efficacy to that a?chieved by sufentanil?propofol TCI in the patients undergoing local anesthesia.
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Objective To investigate the distribution and antibiotic resistance of clinical pathogen isolated from patients of intra-abdominal infection associated sepsis in surgical intensive care unit (SICU ) during recent 5 years ,then instruct clinical application of antibiotics reasonably .Methods Abdominal drainage of 65 patients of intra-abdominal infection associated sepsis were collected from January 2008 to December 2012 .All the specimens were analyzed for pathogen distribution and drug susceptibility .Results A total of 151 strains of pathogenic bacteria was isolated ,in which Gram-negative bacteria were the most popular pathogen (104 strains ,68 .9% ) ,whereas Gram-positive bacteria and fungi accounted for 19 .2% (29 strains) and 11 .9% (18 strains) ,respectively . The five most common pathogens were Escherichia coli(23 .2% ) ,acinetobacter baumannii(15 .2% ) ,enterococcus faecium(13 .2% ) , pseudomonas aeruginosa(8 .6% ) ,andklebsiella pneumonia(7 .9% ) .The rate of the ESBL-producing strains of escherichia coli and pneumonia pneumonia were 80 .0% and 33 .3% .Both of them showed low resistance to carbapenem antibiotics .The proportion of multidrug resistantstrains and extensive drug resistant strains of acinetobacter baumannii was 56 .5% and 30 .4% ,respectively .Con-clusion The resistance of the pathogen isolated from the patients of intra-abdominal infection associated sepsis in SICU is seriously high .Early and rational using of antibiotics is of great importance to control the production and transmission of drug resistance .
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Objective To compare the effect of different stylet angulation and endotracheal tube camber on time to intubation with Tosight?? video laryngoscope.Methods One hundred and twenty patients of 18 to 55 years old,ASA Ⅰ or Ⅱ,with no difficult airway signs and history,were random-ized into three groups with different endotracheal tube bending angle:group A(angle 40°),group B (angle 60°)and group C(angle 80°).For patients in all three groups,after rapid sequence induction, the Tosight?? oral intubation were applied.The Cormack-Lehane grading,glottic exposure time, times of tracheal intubation,hemodynamic response and complications were recorded.Results Tra-cheal intubation with the Tosight were successfully completed for all three groups.The success rate of first time intubation in groups A,B and C were 37 (92.5%),39 (97.5%)and 40(100.0%),respec-tively.3 patients in group A and 1 patient in group B finished the intubation with the second try after the stylet angle was changed.The mean time to glottic exposure had no significant difference in groups A,B and C.The time to complete tracheal intubation in group C was significantly shorter than that in groups A and B (P < 0.05 ).There was no significant hemodynamic changes for all three groups,and no serious complications were detected.Conclusion When the Tosight?? is used for adult endotracheal intubation 40°,60°,80°angled stylets can all well assist endotracheal intubation.Among which 80°angled slylet has obvious advantages in intubation success rate and shortest intubation time.