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Objective:To evaluate the effect of long-term intake of ω-3 polyunsaturated fatty acids (ω-3 PUFAs) on the activation of hippocampal microglia in a mouse model of postoperative cognitive dysfunction (POCD).Methods:Ninety-six clean-grade healthy male C57BL/6 mice, aged 8 weeks, weighing 18-24 g, were stratified according to body weight and divided into 4 groups ( n=24 each) by a random number table method: control diet group (group C), ω-3 PUFAs group (group ω), control diet plus POCD group (group C+ P) and ω-3 PUFAs plus POCD group (group ω+ P). Mice were fed a special ω-3 PUFAs diet (DHA 0.14 g/100 g, EPA 0.03 g/100 g) for 12 weeks in group ω and group ω+ P, while mice were fed with a control diet for 12 weeks in group C and group C+ P.Tibial fracture procedures were performed under isoflurane anesthesia to develop the POCD model after 12 weeks of feeding.The fear conditioning test and Y maze test were performed on 1st and 3rd days after developing the model.The mice were sacrificed after behavioral tests, and the hippocampal tissues were removed for determination of the contents of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (by gas chromatography-mass spectroscopy), density of Iba-1 positive microglia (by immunofluorescence staining), and expression of mature brain-derived neurotrophic factor (mBDNF) and precursor brain-derived neurotrophic factor (pro-BDNF) (by Western blot), and contents of interleukin-1beta (IL-1β) and interleukin-6 (IL-6) (by enzyme-linked immunosorbent assay). Results:Compared with group C, the contents of DHA and EPA were significantly increased, the percentage of freezing time in the contextual test was increased, mBDNF/pro-BDNF ratio was increased ( P<0.05), no significant change was found in the rotation accuracy in Y maze test, density of Iba-1 positive microglia and contents of IL-1β and IL-6 in hippocampus ( P>0.05) in group ω ( P<0.05), and no significant change was found in the contents of DHA and EPA ( P>0.05), the percentage of freezing time in the contextual test and accuracy of rotation in Y maze test were decreased on 1st and 3rd days after operation, the density of Iba-1 positive microglia and contents of IL-1β and IL-6 were increased, and mBDNF/pro-BDNF ratio was decreased in group C+ P ( P<0.05). Compared with group C+ P, the contents of DHA and EPA were significantly increased, the percentage of freezing time in the contextual test and accuracy of rotation in Y maze test were increased on 1st and 3rd days after operation, the density of Iba-1 positive microglia and contents of IL-1β and IL-6 were decreased, and mBDNF/pro-BDNF ratio was increased in group ω+ P ( P<0.05). Conclusions:Long-term intake of ω-3 PUFAs can improve cognitive function in a mouse model of POCD, and the mechanism may be related to inhibition of activation of hippocampal microglia, reduction of inflammatory responses, and thus increasing the mBDNF/Pro-BDNF ratio.
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Objective:To combine micro-course and flipped classroom, integrate the application of online WeChat group and teaching video, build a new teaching framework, and seek the application of flipped classroom based on "micro-course" in clinical skills training of general anesthesia and tracheal intubation for medical students.Methods:A total of 82 clinical medicine intern students of Batch 2015 and 2016 from Nnajing Drum Tower Hospital were selected as the research subjects to complete the internship (for two weeks). The teaching reform group (44 people) adopted the flipped classroom based on "micro-course"; the traditional group (38 people) adopted traditional teaching. Organized by the undergraduate teaching and research department, the number of tracheal intubation cases and the number of excellent scores were recorded during the two-week internship in anesthesia. After the rotation, a questionnaire survey was conducted to evaluate the mastery of endotracheal intubation operation and satisfaction with the teaching and training arranged by the department. SPSS 23.0 was used to conduct t test and non-parametric test. Results:The number of outstanding cases of tracheal intubation in the teaching reform group was higher than that in the traditional group, and the number of outstanding cases of tracheal intubation in girls was higher than that in boys, and the difference was statistically significant ( P<0.05). The self-assessed scores of the students' mastery of tracheal intubation and the satisfaction with clinical practice training in the teaching reform group were higher than those in the traditional group, and the difference was statistically significant ( P<0.05). Conclusion:Compared with traditional teaching, the flipped classroom based on "micro-course" has more advantages in the clinical skills training of medical tracheal intubation.
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Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) in elderly patients undergoing hip surgery.Methods:The medical records of elderly patients, aged ≥ 65 yr, of American Society of Anesthesiologists (ASA) physical statusⅠ-Ⅳ, who underwent hip surgery from June 2013 to May 2019, were retrospectively collected.The patients′ sex, age, body weight, preoperative comorbidities, history of smoking and alcohol, results of the last laboratory test before surgery; mode of anesthesia, intraoperative medication, body temperature monitoring, fluid intake and output, operation time, anesthesia time; postoperative PPCs and postoperative nausea and vomiting, requirement for rescue analgesia, length of hospital stay, and perioperative blood transfusion were all collected.According to the occurrence of PPCs, patients were divided into PPCs group and non-PPCs group.Multivariable logistic regression was used to determine the risk factors for PPCs.Results:A total of 1 204 patients were finally enrolled in this study, 75 patients developed PPCs, and the incidence was 6.22%.The results of multivariate logistic regression showed that ASA physical status Ⅲ or Ⅳ, preoperative respiratory disease, postoperative transfer to intensive care unit, and perioperative blood transfusion were risk factors for PPCs, and general anesthesia combined with nerve block was a protective factor for PPCs in elderly patients undergoing hip surgery ( P<0.05). Conclusions:ASA physical status Ⅲ or Ⅳ, preoperative respiratory disease, postoperative transfer to intensive care unit, and perioperative blood transfusion are risk factors for PPCs, and general anesthesia combined with nerve block is a protective factor for PPCs in elderly patients undergoing hip surgery.
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Objective:To evaluate the effect of α-ketoglutarate (AKG) on postoperative delirium (POD) in aged mice.Methods:Eighty male C57BL/6N mice, aged 18 months, weighing 30-35 g, were divided into 4 groups ( n=20 each) using a random number table method: control+ solvent group (group C), control+ AKG group (group C+ AKG), surgery+ solvent group (group S) and surgery+ AKG group (group S+ AKG). Dimethyl 2-oxoglutarate 0.6 mg/kg was injected intraperitoneally for 3 consecutive days before surgery in C+ AKG and S+ AKG groups, while the equal volume of normal saline was given in C and S groups.Exploratory laparotomy was performed under anesthesia with isoflurane to establish POD model.The behaviors of mice in each group were tested at 24 h before surgery and 6, 9 and 24 h after surgery using buried food test (the latency to eat food), open field test (total distance, latency to the center, time and freezing time spent in the center) and Y maze test (duration in the novel arm and the number of entries into the novel arm), respectively.Then the animals were sacrificed at 6 h after operation, hippocampal tissues were removed for determination of the expression of microglia-specific marker ionized calcium binding adaptor molecule-1 (Iba-1), the number of Iba-1 positive cells (using immunofluorescence staining), and the expression of interleukin-1beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) in hippocamapus (by Western blot). Results:Compared with group C, the latency to eat food at eath time point was significantly prolonged, latency to the center at 6 and 9 h after surgery was prolonged, time spent in the center at 6 and 9 h after surgery was shortened, freezing time at 6, 9 and 24 h after surgery was shortened, the number of entries into the novel arm at 6 and 9 h after surgery was decreased, duration in the novel arm at 6 h after surgery was shortened, the expression of Iba-1 was up-regulated, the number of Iba-1 positive cells was increased, and the expression of IL-1β and TNF-α in hippocampus was up-regulated in group S ( P<0.05), and no significant change was found in the behaviors indexes in group C+ AKG ( P>0.05). Compared with group S, the latency to eat food at each time point was significantly shortened, latency to the center at 9 h after surgery was shortened, time spent in the center at 6 and 9 h after surgery was prolonged, freezing time at 9 and 24 h after surgery was prolonged, the number of entries in the novel arm at 9 h after surgery was increased, the expression of Iba-1was down-regulated, the number of Iba-1 positive cells was decreased, and the expression of IL-1β and TNF-α in hippocampus was down-regulated in group S+ AKG ( P<0.05). Conclusion:AKG can alleviate POD, and the mechanism may be related to inhibiting the activation of microglia and and thus reducing inflammatory responses in aged mice.
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Objective:To explore the mechanism of Akt3 gene knockout on neuropathic pain induced by sciatic nerve ligation.Methods:Twelve Akt3 knockout mice with SPF grade C57BL/6 mice as background were randomly divided into Akt3 gene knockout + Sham group (Akt3 -/-+ Sham, n=6)and Akt3 gene knockout + CCI group(Akt3 -/-+ CCI, n=6). Twelve wild type C57BL/6 mice were randomly divided into wild + Sham group (WT + Sham, n=6) and wild + CCI group (WT + CCI, n=6) by random number table. Chronic sciatic nerve ligation was used to make neuropathic pain model in CCI group, and sham group was subjected to sham operation. The paw withdrawal mechanical threshold (PWMT) was measured 1 day before operation and 7 days after CCI. Three mice were randomly killed in Sham group 7 days after modeling, and 3 mice in CCI group were killed at 7 days and 14 days respectively.The L3-5 spinal cord segment was taken. Akt3, phosphorylated Akt (p-Akt), GSK3β and phosphorylated NR2B (p-NR2B) were detected by Western blot. SPSS 21.0 software was used for statistical analysis. Results:Group time interaction effects of PWMT, the expression of protein Akt3, p-Akt, GSK3β, p-NR2B in spinal cord were significantly different ( F=16.667, 269.899, 26.651, 572.998, 37.836, P<0.01). Compared with the Akt3 -/-+ Sham group, the PWMT in Akt3 -/-+ CCI group was significantly lower((0.34±0.20)g, (1.18±0.11)g, P<0.01), and the expression of p-Akt((0.90±0.08), (0.51±0.06), P<0.01), GSK3β((0.74±0.04), (0.29±0.02), P<0.01) and p-NR2B((0.96±0.11), (0.71±0.04), P<0.05) in spinal cord increased. Compared with the WT+ CCI group, the PWMT of the Akt3 -/-+ CCI group was obviously lower((0.34±0.20)g , (0.49±0.12)g, P<0.05), and the expression of p-Akt((0.90±0.08), (1.02±0.17), P<0.05)decreased, and the expression of GSK3β((0.74±0.04), (0.57±0.09), P<0.01) and p-NR2B((0.96±0.11), (0.91±0.08), P<0.05) increased. Conclusion:After Akt3 gene knockout, the aggravation of neuropathic pain after sciatic nerve ligation may be related with the change of Akt/GSK3β/NR2B expression.
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This study was a single-center large-sample case-control study.Data of 1 106 elderly patients who underwent unilateral total hip arthroplasty from June 2013 to May 2019 were collected, including items such as patient′s baseline characteristics, comorbidities, perioperative medication, intraoperative blood pressure, and postoperative outcomes.Patients were divided into postoperative nausea and vomiting(PONV)group and non-PONV group according to whether nausea and vomiting occurred within 24 h after operation.Logistic regression analysis was used to determine the risk factors for PONV.The incidence of PONV was 11.03%.Female, intraoperative use of dezocine, and intraoperative hypotension(duration>3 min or cumulative time>6 min)are independent risk factors for PONV, while femoral neck fractures and intraoperative use of dexamethasone are protective factors.
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OBJECTIVE@#To study the effect of dexmedetomidine (Dex) on cognitive dysfunction induced by tibial fracture in rats.@*METHODS@#Sixteen male SD rats were randomized into control group and tibial fracture group, and the behavior indicators were measured on days 1, 3, 5 and 7 after tibial fracture and the expressions of CX3L1 protein and mRNA in the hippocampus were detected. Another 24 male SD rats were randomly divided into control group, tibial fracture group, and tibia fracture with CX3CL1 antibody group, and the behavior indicators and hippocampal CX3L1 protein expression were evaluated after corresponding treatments. In another experiment, we randomized 24 male SD rats into control group, tibial fracture group and tibial fracture with Dex treatment, and tested their hippocampal CX3L1 protein and mRNA expressions as well as the behavior indicators after the treatments.@*RESULTS@#Compared with the control rats, the rats with tibial fracture spent significantly less time in the novel arm on days 1, 3, 5 and 7 after the fracture ( < 0.05) with obviously lowered expressions of CX3L1 protein and mRNA in the hippocampus ( < 0.05). In the rats with tibial fracture, treatment with CX3CL1 antibody further decreased the time spent in the novel arm ( < 0.05) and the expression level of CX3L1 protein in the hippocampus ( < 0.05); In contrast, treatment with Dex significantly increased the time spent time in the novel arm ( < 0.05) and enhanced the hippocampal expressions of CX3L1 protein and mRNA in rats with tibial fractures ( < 0.05).@*CONCLUSIONS@#Dex can alleviate cognitive dysfunction induced by tibial fracture in rats by increasing the expression of CX3CL1 in the hippocampus.
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Animals , Male , Rats , Cognitive Dysfunction , Dexmedetomidine , Hippocampus , Rats, Sprague-Dawley , Tibial FracturesABSTRACT
Objective To identify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery in elderly patients. Methods Four hundred and thirty patients, aged ≥ 65 yr, undergoing elective lower extremity fracture surgery from January 2010 to December 2014, were selected. Age, gender, American Society of Anesthesiologists (ASA) physical sta-tus, preoperative comorbidities (diabetes mellitus, cardio-cerebrovascular events and hemiplegia), preop-erative anemia, surgical site (hip and femur, knee joint and the site below the knee), anesthesia method (general anesthesia, neuraxial anesthesia), surgery time, intraoperative hypertension and hypotension, intraoperative blood loss, postoperative Hb≤90 g∕L in hospital and volume of postoperative drainage, post-operative pneumonia and admission to the intensive care unit after operation were recorded. The patients were divided into either cardio-cerebrovascular event group or non-cardio-cerebrovascular event group ac-cording to whether the patients developed cardio-cerebrovascular events after surgery in hospital. The pa-tients were divided into either survival group or dead group according to the living status 1 yr after surgery. The risk factors of which P values were less than 0. 05 would enter the multi-factor logistic regression analy-sis to stratify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following low-er extremity fracture surgery. Results Three hundred and seventy-two patients completed the study. A-mong the 372 patients, 35 patients developed postoperative cardio-cerebrovascular events in hospital, and the incidence was 9. 4％, logistic regression analysis showed that the preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ were risk factors for in-hospital postoperative cardio-cerebrovascular events. Thirty-three patients died within 1 yr after surgery, the mortality rate was 8. 9％, and logistic re-gression analysis showed that age≥75 yr, preoperative hemiplegia and development of cardio-cerebrovascu-lar events after surgery in hospital were postoperative 1-year mortality-related risk factors. Conclusion Preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ are the independent risk factors for in-hospital cardio-cerebrovascular events following lower extremity fracture surgery in elderly patients;age≥75 yr, preoperative hemiplegia and in-hospital postoperative cardio-cerebrovascular events are the in-dependent risk factors for 1-year mortality after surgery.
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Objective To evaluate the effects of GLYX-13 on cognitive function after long-time isoflurane anesthesia in mice. Methods A total of 192 healthy male C57∕B6J mice, aged 8 weeks, weig-hing 22-25 g, were divided into 4 groups(n=48 each)using a random number table: control group (group C), isoflurane anesthesia group(group I), GLYX-13 group(group G), and isoflurane anesthesia plus GLYX-13 group(group IG). The animals were exposed to 15% isoflurane for 6 h in I and IG groups. GLYX-13 1 mg∕kg was injected via the caudal vein at 2 h before anesthesia in G and IG groups. Novel ob-ject recognition test and contextual fear conditioning test were performed on 1st, 3rd and 7th days after an-esthesia. The expression of 2B subunits-containing NMDA receptor(NR2B)and cyclic adenosine mono-phosphate response element-binding protein(CREB)mRNA in the hippocampus was detected by quantita-tive real-time polymerase chain reaction after the end of behavioral tests on 1st, 3rd and 7th days after anes-thesia. Results Compared with group C, the percentage of time spent in exploring a novel object, dis-crimination index and percentage of freezing time were significantly decreased, and the expression of NR2B and CREB mRNA in the hippocampus was down-regulated in group I(P <005). Compared with group I, the percentage of time spent in exploring a novel object, discrimination index and percentage of freezing time were significantly increased, and the expression of NR2B and CREB mRNA in the hippocampus was up-regulated in group IG(P <005). Conclusion GLYX-13 can significantly improve the cognitive func-tion after long-time isoflurane anesthesia in mice.
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Objective To evaluate the role of spinal astrocytes in posttraumatic stress disorder (PTSD)-induced hyperalgesia in rats. Methods Forty pathogen-free healthy male Sprague-Dawley rats, aged 6-8 weeks,weighing 200-250 g, were divided into 4 groups(n=10 each)using a random number table:control group(group C), group PTSD, normal saline group(group NS)and fluorocitrate group (group FC).The rats were exposed to single prolonged stress for establishment of the PTSD model in PTSD, NS and FC groups. At 30 min before establishment of the model and 1-7 days after establishment of the model,normal saline 10 μl was intraperitoneally injected in group NS, and 1 nmol∕10 μl fluorocitrate 10 μl, an inhibitor of astrocyte activation, was intraperitoneally injected in group FC. The mechanical paw withdrawal threshold(MWT)was measured at 24 h before establishment of the model and on 1, 2, 3, 5 and 7 days after establishment of the model. Four rats were sacrificed after measurement of pain threshold on 1 and 7 days after establishment of the model, and the lumbar segment(L3-5)of the spinal cord was re-moved for determination of the expression of glial fibrillary acidic protein(GFAP, an astrocyte marker)u-sing Western blot. Results Compared with group C, the MWT was significantly decreased at each time point after establishment of the model,and the expression of spinal GFAP was up-regulated on 1 and 7 days after establishment of the model in PTSD,NS and FC groups(P<005). Compared with group PTSD, no significant change was found in the MWT at each time point in group NS(P>005),and the MWT was sig-nificantly increased at each time point after establishment of the model,and the expression of spinal GFAP was down-regulated on 1 and 7 days after establishment of the model in group FC(P<005).Conclusion Activation of spinal astrocytes is involved in PTSD-induced hyperalgesia in rats.
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Objective To identify key genes associated with fear conditioning memory by bioinfor-matics analysis of gene expression profiles from Gene Expression Omnibus(GEO). Methods Downloaded from GEO,GSE57465 microarray data were divided into control group and experiment groups(FC_0.5 h group and FC_2h group).The original data was normalized in the R software by the quantile method,and then converted the probe names to the gene names through the annotation package(illumina Mouse v2.db).The differentially expressed genes(DEGs)between the control and experimental groups were screened by the Limma method,selected Padj<0.05 and Fold Change>1.5 as DEGs.Clustering analysis,as well as GO and KEGG enrichment analysis were performed in DEGs.At last,DEGs translated proteins interaction network were established,and the key genes in the network were identified.Results 47 DEGs were screened,among them,FC_0.5h group consisted of 36 DEGs and FC_2h group consisted of 11 DEGs.GO and KEGG enrich-ment analysis suggested that DEGs were mainly enriched in ribosomes,participating in the signal pathway of protein synthesis in ribosomes,and also playing a biological role in the transcription and translation of posi-tive regulatory RNA polymerase II promoter.PPI network analysis showed that Egr2,Fos and Sgk1 which sig-nificantly increased,may play as hub proteins in the network. Conclusion Egr2,Fos,Sgk1 may play an im-portant role in the formation of fear conditioning memory.
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American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients,aged 11-18 yr,scheduled for elective posterior orthopedic surgery for adolescent idiopathic scoliosis from November 2011 to October 2015 in our hospital,were selected,and a total of 834 patients were included in the study.Data including age,gender,body height,body weight,Cobb angles,ASA physical status,osteotomy procedure,use of dexmedetomidine,the number of operation segments,duration of operation,intraoperative blood loss,volume of blood transfused and volume of fluid infused,volume of postoperative drainage and length of postoperative hospital stay were recorded.The patients were divided into dexmedetomidine group (group D,n =508) and non-dexmedetomidine group (group ND,n =326) depending on whether or not dexmedetomidine was used.Age,gender,body mass index,Cobb angles,ASA physical status,the number of operation segments,duration of operation,osteotomy procedure and use of dexmedetomidine were served as independent variables and analyzed using Stepwise multivariate linear regression.The results of Stepwise multivariate linear regression showed that osteotomy procedures,the number of operation segments,duration of operation and Cobb angles were positively correlated with intraoperative blood loss,and use of dexmedetomidine and body mass index were negatively correlated with intraoperative blood loss.Compared with group ND,the intraoperative blood loss,volume of crystalloid solution infused,volume of blood transfused and volume of postoperative drainage were significantly reduced in group D (P＜0.05).After a propensity score matching analysis,the intraoperative blood loss and volume of crystalloid solution infused were significantly reduced in group ND when compared with group D (P＜0.05).In conclusion,intraoperative use of dexmedetomidine is helpful in reducing intraoperative blood loss during orthopedic surgery for adolescent idiopathic scoliosis.
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Objective To evaluate the effects of different levels of neuromuscular blockade(NMB)on transcranial electric motor-evoked potentials(TCeMEPs)during idiopathic scoliosis.Methods Thirty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 11-23 yr,weighing 31-62 kg,scheduled for elective idiopathic scoliosis under general anesthesia,were enrolled in the study.NMB was monitored with train of four(TOF)-Watch SX.The levels of partial NMB were classified into 5 states according to TOF ratio(TOFR)and TOF counts:1 or 2 TOF counts(TOF1),3 TOF counts and TOFR≤15%(TOF2),TOFR 16%-25%(TOF3),TOFR 26%-50%(TOF4),TOFR 51%-75%(TOF5) and TOFR>75%(no NMB).Each state was maintained for 10 min.Failure and false-positive findings in TCeMEP monitoring,development of unexpected body movement and satisfaction with NMB were recorded.Results Compared with no NMB,the failure and false-positive rates of TCeMEP monitoring were significantly increased,the incidence of unexpected body movement was decreased,and the rate of satisfactory NMB was increased at TOF1,TOF2 and TOF3(P0.05),and the incidence of unexpected body movement was decreased and the rate of satisfactory NMB was increased at TOF4,the rate of satisfactory NMB was increased at TOF5(P0.05).Compared with those at TOF4,no significant change was found in the failure or false-positive rates of TCeMEP monitoring(P>0.05),the incidence of unexpected body movement was significantly increased,and the rate of satisfactory NMB was decreased at TOF5(P<0.05).Conclusion Maintaining TOFR at 26%-50% the partial NMB during surgery does not affect TCeMEP monitoring during idiopathic scoliosis and meets the intra-operative NMB requirements simultaneously,and it is the optimum NMB for this type of surgery.
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Objective To determine the risk factors for postoperative cognitive dysfunction (POCD) after orthopedic surgery for adolescent idiopathic scoliosis.Methods Sixty-five patients with adolescent idiopathic scoliosis,aged 11-18 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective orthopedic surgery with general anesthesia,were enrolled in this study.On admission to hospital (T0),before surgery (T1),at the end of surgery (T2) and on 2nd day after surgery (T3),blood samples were taken from the peripheral vein for determination of serum interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α) concentrations.Cognitive function was evaluated using a set of neuropsychological tests at 1 day before surgery and 7 days after surgery.Baseline patient characteristics such as age,gender,years of education and medical history,intraoperative fluid intake and output,surgery time,extubation time,postoperative visual analog scale score and related complications were recorded.Patients were divided into either POCD group or non-POCD group according to the diagnostic criteria of POCD.Logistic regression analysis was used to pick out the risk factors for POCD.Results Sixty-three patients completed this trial.The incidence of POCD was 24％.Compared with non-POCD group,the serum IL-10 concentration at T0 and serum TNF-α concentration at T3 were significantly increased,the IL-10/TNF-α ratio was decreased,and the length of postoperative hospital stay was prolonged in POCD group (P＜0.05).The results of logistic regression analysis showed that increased concentrations of serum IL-10 at T0 and TNF-α at T3 were risk factors for POCD.Conclusion Increased serum concentrations of IL-10 on admission to hospital and TNF-α on 2nd after surgery are risk factors for POCD in the patients with adolescent idiopathic scoliosis.
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Objective To explore the effect of pre-treatment of subcutaneous injection of ketamine on remifentanil induced hyperalgesia and K+/Cl-cotransporter 2,KCC2) expression on spinal cord of rats.Methods60 male adult SD rats were randomly divided into five groups(n=12 in each group):control group (group C),the incision group(group I),the incision plus remifentanil group(group I+R),the incision plus ketamine group(group I+K) and the incision plus remifentanil and ketamine group(group I+R+K).Mechanical withdrawal threshold (MWT) was evaluated at 24 hours before incision(T0),2 hours,6 hours,24 hours and 48 hours after incision(T1~T4).The lumbar spinal cords of rats were taken out at T4 time point and the KCC2 detected was detected by immunofluorescence analysis and western blot analysis.ResultsCompared with group C(T1(14.5±1.7)g,T2(14.2±1.1)g,T3(13.9±1.8)g,T4(14.2±1.1)g),MWT of other groups at T1 (I(5.6±0.8)g,I+R(3.2±1.0)g,I+K(6.8±1.7)g,I+R+K(5.1±1.6)g),T2 (I(6.9±1.0)g,I+R(4.3±1.2)g,I+K(8.0±1.4)g,I+R+K(6.2±1.5)g),T3 (I(7.6±0.9)g,I+R(5.4±1.1)g,I+K(10.3±1.2)g,I+R+K(7.1±1.1)g),T4 (I(8.9±1.1)g,I+R(7.5±1.4)g,I+K(11.3±1.2)g,I+R+K(8.3±1.2)g)and the expression of KCC2 at T4 decreased (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+R (T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g) decreased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 decreased significantly (P<0.05).Compared with group I(T1(5.6±0.8)g,T2(6.9±1.0)g,T3(7.6±0.9)g,T4(8.9±1.1)g),MWT of group I+K (T1(6.8±1.7)g,T2(8.0±1.4)g,T3(10.3±1.2)g,T4(11.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).Compared with group I+R(T1(3.2±1.0)g,T2(4.3±1.2)g,T3(5.4±1.1)g,T4(7.5±1.4)g),MWT of group I+R+K (T1(5.1±1.6)g,T2(6.2±1.5)g,T3(7.1±1.1)g,T4(8.3±1.2)g) increased at all time points after incision (T1~T4)(P<0.05) and the expression of KCC2 at T4 increased (P<0.05).ConclusionPre-treatment of subcutaneous injection of ketamine can reduce the hyperalgesia of rats induced by remifentanil and reduce the inhibition of KCC2 expression on dorsal horn of spinal cord.
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Objective To evaluate the effect of verapamil on the expression of K+-Cl-cotransporter 2 (KCC2) in spinal dorsal horns during remifentanil-induced hyperalgesia in a rat model of incisional pain.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,aged 6-7 weeks,weighing 250-300 g,were divided into 4 groups (n=8 each) using a random number table:control group (group C),incisional pain group (group Ⅰ),incisional pain plus remifentanil plus verapamil group (group I+R+ V) and incisional pain plus remifentanil group (group I+R).Normal saline was subcutaneously infused in group C.A 1 cm long incision was made in the plantar surface of the right hindpaw in anesthetized rats in group Ⅰ.Verapamil 5 mg/kg was intraperitoneally injected at 10 min before establishment of the incisional pain model in group I+R+V.In I+R and I+R+V groups,the model of incisional pain was established,and remifentanil was subcutaneously infused for 30 min at a rate of 80 μg · kg-1 · h-1 simultaneously.The mechanical paw withdrawal threshold (MWT) to yon Frey filament stimulation was measured at 1 day before establishment of the model (T0) and 2,6,24 and 48 h after establishment of the model (T1-4).The rats were sacrificed after measurement of MWT at T4,and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of KCC2 by immunofluorescence.Results Compared with group C,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in the other groups (P＜0.05).Compared with group Ⅰ,the MWT was significantly decreased at T1-4,and the expression of KCC2 was down-regulated in group I+R (P＜0.05).Compared with group I+R,the MWT was significantly increased at T1-4,and the expression of KCC2 was up-regulated in group I+R+V (P＜0.05).Conclusion The mechanism by which verapamil reduces remifentanil-induced hyperalgesia is related to up-regulation of the expression of KCC2 in spinal dorsal horns in a rat mnodel of incisional pain.
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Objective To summarize the experience of general anesthesia management in pregnant women with pulmonary hypertension who had to undergo cesarean section. Methods Clinical data, anesthesia methods and outcome of 6 pregnant women with pulmonary hypertension were analyzed. Among them, 1 case of patent ductus arteriosus had to undergo cesarean section twice, because the interval time of twice cesarean section was longer (2 years), and the number of pregnant women was counted to 7 cases. Results Seven patients had to undergo cesarean section with general anesthesia, and all the pregnant women′s hemodynamic were stable during the operation. After operation, 1 pregnant woman discharged from hospital against the doctor′s advices because of massive brain infarction, and the others were all rehabilitated. Seven newborns status:preterm in 3 cases, cardiopulmonary resuscitation in 2 cases, the Apgar score of the others newborns was 9-10 scores. Conclusions Pregnant women with pulmonary hypertension have high peri-operative risk, especially those who undergo general anesthesia. To improve the survival rate, anesthetist should reinforce the perioperative care, maintain oxygen supply, reduce the stress response, maintain the preload and blood pressure, and avoid the increasing of pulmonary pressure.
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Objective To determine the reliability and validity of the Chinese edition of the Amster-dam preoperative anxiety and information scale ( APAIS) for the assessment of preoperative anxiety of Chi-nese patients.Methods The APAIS was translated into Chinese version.One hundred and thirty patients undergoing elective surgery were enrolled to complete the APAIS,STAI-S,VAS-A at the day before surgery, and thirty subjects received a re-test of APAIS at the day of surgery.Results The average score of Chinese version of APAIS anxiety scale and information scale were (7.37±3.51) and (3.67±1.94),respectively. Cronbachαfor the anxiety scale was 0.84 and information scale was 0.78,respectively.Test-retest reliability were r=0.746(P<0.01) and r=0.655(P<0.01) ,respectively.Factor analysis showed anxiety and the desire for information were found,which explained 73.82%of variance.The anxiety scale of APAIS significantly corre-lated with STAI-S and VAS-A,Correlation Coefficient were r=0.720(P<0.01) and r=0.641(P<0.01) ,respec-tively.Conclusion The Chinese version of the APAIS has good reliability and validity to quick measure the preoperative anxiety and desire for information of patients.
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Objective To investigate the effects of dehydrocorydaline(DHC) on complete Freund's adjuvant (CFA)-induced mechanical hyperalgesia in mice.Methods 40 mice were divided randomly into 4 groups (CFA test:experiment group =8,control group =8;locomotor activity and organ coefficient test:experiment group=12,control group =12).Subcutaneously injected CFA in the plantar of mice to establish pain model.The experimental group mice were injected with 10 mg/kg DHC while the control group mice received 10％ DMSO.The paw withdrawal mechanical threshold(PWMT) of mice was tested before and after administration of DHC.The effects of DHC on spontaneous activity and organ coefficient were observed in mice.Results The basic values of PWMT showed there were no statistically significant differences between experimental group and control group ((10.27± 1.34)g vs (10.28 ±0.35)g,P＞0.05).Compared with the control group,the values of PWMT in experimental group at 0.5 h,1 h,2 h,3 h after administration of DHC were significantly increased(0.5 h:(8.18±0.87) g vs (4.85±0.65) g;1 h:(7.85±0.59) g vs (4.84±0.54) g;2 h:(7.36±0.49) g vs (4.90±0.59) g;3 h:(6.66±0.45) g vs (5.00±0.36) g;all P＜0.01).Compared with the control group,no significant effect was observed on the number mice crossed grids and lifted forelimb and stood in 2 min in the experimental group (P＞ 0.05).And no significant effect was observed on the liver,kidney,spleen,heart,lung and brain organ coefficient in the experiment group (P＞0.05).Conclusion DHC can alleviate CFA-induced mechanical hyperalgesia in mice.
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Objective To explore the effects of protective lung ventilation strategy applied from anesthesia induction period on lung compliance and oxygenation in patients undergoing gyneco-logical laparoscopic surgery.Methods A total of 60 female patients underwent gynecological laparo-scopic surgery were randomly divided into protective lung ventilation strategy beginning from induction group (group A),protective lung ventilation strategy beginning after intubation group (group B),conventional ventilation group (group C).All the three groups received intermittent posi-tive ventilation.The oxygen concentration was 100% and oxygen flow rate was 2 L/min,the inhalation and exhalation ratio was 1∶2.Group A was given low tidal volume+low PEEP+lung recruitment ma-neuver (from induction,i.e.after the disappearance of spontaneous breathing,take mask ventilation lasted for 5 minutes with a tidal volume of 6 ml/kg,respiratory rate was 1 6 times/min,PEEP was 5 cm H 2 O,which was applied every 30 min);group B was given low tidal volume+low PEEP+lung recruitment maneuver (before intubation:tidal volume was 10 ml/kg,respiratory rate was 10 times/min;after intubation:tidal volume was 6 ml/kg,respiratory rate was 1 6 times/min,PEEP was 5 cm H 2 O,which was applied every 30 min);group C:tidal volume was 10 ml/kg,respiratory rate was 10 times/min.Ppeak,Pmean,CL were recorded at induction (T0 ),after intubation (T1 ),30 min (T2 ),60 min (T3 )during operation,release of pneumoperitoneum (T4 ).The arterial blood gas analysis was performed at T0 ,T1 ,T3 and after extubation (T5 ).Then the oxygenation index (OI)and pulmonary shunt fraction (Qs/Qt)was calculated.Results The Ppeak and Pmean were significantly higher among the three groups after pneumoperitoneum (T1 ,T2 ,T3 ,T4 )compared with T0 (P <0.05),Ppeak of group C was significantly higher compared with that of group A and group B and Pmean at T2 increased significantly (P < 0.05 );The CL of three groups decreased obviously after pneumoperitoneu (P <0.05),CL of group C was lower significantly than that of group A and group B at T3 ,T4 (P <0.05)while the difference between group A and group B were not significant.The OI of the three groups decreased significantly after exthbation (P <0.05)and the difference among the three groups was not significant.Qs/Qt of three groups increased obviously at T3 and decreased at T5 (P <0.05),Qs/Qt of group C was higher significantly than that of group A and group B at T3 (P <0.05).Only one patient in group C got pulmonary infection.Conclusion Compared with conventional ventilation,the protective lung ventilation strategy can significantly improve the lung compliance and oxygenation function in the patients undergoing gynecological laparoscopic surgery.