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Objective:To determine the dose-effect relationship of norepinephrine in the treatment of hypotension after spinal anesthesia in cesarean section.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, body mass index of 20-35 kg/m 2, blood pressure 100-140 mmHg, heart rate 60-100 beats/min, scheduled for elective cesarean section, were divided into 6 different doses of norepinephrine groups (NE2, NE4, NE6, NE8, NE10 and NE12 groups) using a random number table method, with 15 cases in each group.The maternal basal systolic blood pressure was measured after entering the operating room.Anesthesia was performed by injecting hyperbaric bupivacaine 9 mg into the subarachnoid space over 45 s. When hypotension occurred for the first time after anesthesia (systolic blood pressure was lower than 80% of the baseline value), norepinephrine 2, 4, 6, 8, 10 and 12 μg (diluted to 5 ml in normal saline) were intravenously injected in NE2, NE4, NE6, NE8, NE10 and NE12 groups, respectively.Systolic blood pressure was measured at 60 s after completion of injection.The effective treatment of hypotension was defined as the recovery of systolic blood pressure to more than 80% of the baseline value.The logistic regression analysis method was used to draw the dose-effect curve of norepinephrine in treating hypotension after spinal anesthesia in cesarean section.The median effective dose (ED 50), 95% effective dose (ED 95) and 95% confidence interval (CI) were calculated.The time to first hypotension, effective treatment of hypotension, and occurrence of bradycardia and nausea and vomiting after intravenous injection of norepinephrine were recorded.The Apgar scores of the neonates at 1 and 5 min after birth were recorded.The umbilical artery blood samples of neonates were collected immediately after cutting the cord for blood gas analysis. Results:There was no significant difference in the incidence of maternal basal systolic blood pressure, time to first hypotension, bradycardia, and nausea and vomiting among the six groups ( P>0.05). The rate of effective treatment of hypotension increased with the increase of the dose in the six groups ( P<0.05). There was no significant difference in Apgar score and indexes of umbilical artery blood gas analysis at 1 and 5 min after birth among the six groups ( P>0.05). The ED 50 (95% CI) of norepinephrine in the treatment of hypotension after spinal anesthesia in cesarean section was 4.0 (3.0 to 5.0) μg, and the ED 95 (95% CI) was 11.8 (8.9-20.4) μg. Conclusion:The ED 50 and ED 95 of norepinephrine are 4.0 and 11.8 μg, respectively, when used for treating hypotension after spinal anesthesia in cesarean section.
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Objective To evaluate the effect of therapeutic hypercapnia on cerebral oxygen metabo?lism in the patients undergoing thoracoscopic surgery in beach chair position ( BCP ) . Methods Sixty pa?tients of both sexes, aged 18-32 yr, with body mass index of 19-24 kg∕m2 , of American Society of Anes?thesiologists physical statusⅠorⅡ, scheduled for elective bilateral thoracic sympathectomy performed via a thoracoscope, were divided into control group ( group C ) and hypercapnia group ( group H ) , with 30 patients in each group using a random number table. After induction of anesthesia, all the patients in both groups were tracheally intubated and mechanically ventilated using the ventilation regimen low tidal vol?ume intermittent positive pressure ventilation combined with low level of positive end?expiratory pressure ( 5 cmH2 O) , maintaining arterial carbon dioxide partial pressure ( PaCO2 ) at 35-45 mmHg. PaCO2 was maintained at 45-55 mmHg by adjusting the respiratory rate after the patients were placed in BCP in group H. Anesthesia was maintained with target?controlled infusion of propofol and intermittent intravenous boluses of rocuronium and sufentanil. Bispectral index value was maintained at 45-55. Before anesthesia induction ( baseline) , at 5 min after intubation, and at 5, 10, 15 and 20 min after the patients were placed in BCP, blood samples were taken from the radial artery and jugular bulb for blood gas analysis, jugular ve?nous bulb oxygen saturation was measured, and arteriovenous blood O2 content difference, cerebral O2 ex?traction rate, and venous to arterial blood lactate concentration difference were calculated. Results Com?pared with group C, PaCO2 and jugular venous bulb oxygen saturation were significantly increased, and ar?teriovenous blood O2 content difference and cerebral O2 extraction rate were significantly decreased at at 5, 10, 15 and 20 min after the patients were placed in BCP in group H ( P0?05) . Conclusion Therapeutic hypercapnia can improve the cerebral oxygen metabolism in the patients undergoing thoracoscopic surgery in BCP .
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<p><b>OBJECTIVE</b>To investigate the association of serum chemerin with degenerative aortic valve disease (DAVD) in patients with metabolic syndrome.</p><p><b>METHODS</b>From July, 2012 to July, 2013, 48 patients with metabolic syndrome (mean age 56.33∓6.14 years, including 25 male and 23 female patients), 48 patients with metabolic syndrome and DAVD (mean age 60.16∓6.72 years, 24 males and 21 females), and 48 adult healthy volunteers (mean age 52.94∓8.28 years, 23 males and 25 females) were examined for triglyceride, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein, fasting glucose, C-reactive protein and other biochemical indexes. Serum chemerin levels were detected using ELISA for all the subjects.</p><p><b>RESULTS</b>Patients with metabolic syndrome had higher levels of serum chemerin than the healthy subjects, and patients with DAVD had higher chemerin levels than those with DAVD. Multivariate logistic regression analysis showed that increased serum chemerin level is a predictor of aortic valve degeneration in patients with metabolic syndrome. Univariate linear regression analysis showed that serum chemerin levels, body mass index, systolic blood pressure, total triglyceride and C-reactive protein were associated with metabolic syndrome. Stepwise multiple linear regression analysis identified correlations of body mass index and C-reactive protein with serum chemerin level.</p><p><b>CONCLUSION</b>Elevated serum chemerin level can be a predictor for DAVD in patients with metabolic syndrome.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Aortic Valve , Blood Pressure , Body Mass Index , C-Reactive Protein , Metabolism , Chemokines , Blood , Cholesterol, LDL , Blood , Heart Defects, Congenital , Heart Valve Diseases , Intercellular Signaling Peptides and Proteins , Blood , Lipoproteins, HDL , Blood , Metabolic Syndrome , Blood , Triglycerides , BloodABSTRACT
Objective To investigate the effect of propofol combined with remifentanil or sufentanil on cognitive function in patients undergoing awake craniotomy. Methods Sixty ASA Ⅰ or Ⅱ neurosurgical patients undergoing resection of glioma in cerebral cortical functional area were divided into 2 groups by random digits table: propofol + remifentanil (group RF, 30 cases) and propofol + sufentanil (group SF, 30 cases). Scalp nerve block and local infiltration of incision and dura mater were performed in both groups with 0.5% ropivacaine. Propofol, remifentanil and sufentanil were administered by target controlled infusion. The target plasma concentration of remifentanil was set at 1-2 ng/ml and that of sufentanil at 0.1-0.2 ng/ml,propofol was set at 3-6 μg/ml at open skull stage. The patients were inserted laryngeal mask and mechanically ventilated. Bispectral index (BIS) was monitored as the depth of anesthesia. Mini-mental scale examination (MMSE) was investigated at the time of preoperative,intraoperative wake-up after the patients had been targeted capacity. Results Blood concentration of propofol in group RF was (1.10 ± 0.06)μg/ml, group SF was (0.98 ± 0.05)μ g/ml in patients during intraoperative wake-up. BIS in group RF changed from 46.4 ± 2.5 to 90.8 ± 3.2 during wake-up, group SF from 44.8 ± 2.1 to 89.9 ± 3.2. The cognitive function score was not significantly different at the time of preoperative and intraoperative assessment. Conclusion Propofol combined with remifentanil or sufentanil has no effect on cognitive function for the patients undergoing awake craniotomy.
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This study examined the adipocytokine-vascular interactions and link between epicardial adipose tissue and coronary artery atherosclerosis. Thirty-four patients undergoing open heart surgery were chosen randomly, and divided into group I (non-coronary artery disease group) and group II (coronary artery disease group). Blood samples were taken through peripheral vein prior to surgery. Plasma levels of a panel of proteins (adiponectin, IL-10, TNF-α) were detected by using ELISA. Epicardial adipose tissue was taken near the proximal tract of the right coronary artery and subcutaneous adipose was taken from the leg before cardiopulmonary bypassing, adiponectin and CD68 + were detected by using RT-PCR and immunohistochemistry. Our results showed that plasma adiponectin level was significantly lower in the group II as compared with group I (P<0.05). There were no differences in plasma concentration (IL-10, TNF-α, tatal-chol, HDL-chol, LDL-chol) between group I and group II. The number of CD68+ cells in epicardial adipose tissue of group II was significantly higher than that in subcutaneous adipose tissue. Adiponectin mRNA expression was 6 fold higher in subcutaneous adipose tissue than in epicardial adipose tissue of group II (P<0.01). Furthermore, the level of adiponectin mRNA in the epicardial adipose tissue in group II was also significantly lower than in group I (P<0.05). We are led to conclude that inflammation that occurs locally in epicardial adipose tissue of CAD contributes to the pathogenesis of coronary artery disease.
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The characteristics for the ex vivo expansion of the endothelial progenitor cells (EPCs)were explored. CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded under the same conditions as those for total MNC, coincubation of CD34+ and CD34- from the same donor for EPCs. In addition, the effects of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis were examined.EPCs were determined and quantified by immunocytochemistry and flow cytometry. The results showed that both coculture of CD34+ and CD34 and total MNC led to a significant increase in the expansion of CD34+ cells as compared with CD34 enrichment (P＜0.05). There was a tendency toward decreased apoptosis in cultures when early passage was performed immediately after cord like structures appeared. VEGF had no significant effect on apoptosis (P＞0.05). These differentiated EPCs were positive for CD34+, von Willebrand factor (vWF), KDR, CD31 staining and phagocytized acetylated low-density lipoprotein (LDL). CD34+ cells accounted for (68.2±6.3) % of attaching (AT)cells at day 7 of culture. It was suggested the most efficient method to ex vivo expansion of EPCs was coculture of CD34+ and CD34- or total MNC. Early passage makes cell apoptosis rate decrease.VEGF had no significant effect on ex vivo expansion of EPCs.
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The characteristics for the ex vivo expansion of the endothelial progenitor cells (EPCs) were explored. CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded under the same conditions as those for total MNC, coincubation of CD34+ and CD34- from the same donor for EPCs. In addition, the effects of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis were examined. EPCs were determined and quantified by immunocytochemistry and flow cytometry. The results showed that both coculture of CD34+ and CD34- and total MNC led to a significant increase in the expansion of CD34+ cells as compared with CD34 enrichment (P 0.05). These differentiated EPCs were positive for CD34+, von Willebrand factor (vWF), KDR, CD31 staining and phagocytized acetylated low-density lipoprotein (LDL). CD34+ cells accounted for (68.2 +/- 6.3)% of attaching (AT) cells at day 7 of culture. It was suggested the most efficient method to ex vivo expansion of EPCs was coculture of CD34+ and CD34- or total MNC. Early passage makes cell apoptosis rate decrease. VEGF had no significant effect on ex vivo expansion of EPCs.
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The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass (CPB)were randomly allocated into two groups: L-carnitine group (n= 12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia) and control group (n= 11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine). Serum cardial troponin I (cTnI) levels,the left ventricular ejection fraction (LVEF), and cardiac index (CI) were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL). From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group (P＜0.05). Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group (P＜0.05). Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells (electron microscopy examination) and decreased the amounts of apoptotic cardiac muscle cells (TUNEL). Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group (P＜0.01). It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.
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To explore the relation between human heat shock protein 70 (hsp70) and TLR4 in human monocytes in vitro, human monocytes were stimulated with various concentrations of HSP70, and TNF-alpha production in supernatants was measured by ELISA. Pre-incubated with or without anti-TLR4 mAb, and stimulated with hsp70 (5.0 microg/ml), NF-kappaB p65 of human monocytes in different time points were detected by immunohistochemistry and monocyte surface expression of TLR4 was measured by flow cytometry. After the human monocytes were pre-incubated with various concentrations of anti-TLR4 and stimulated with hsp70 (5.0 microg/ml), TNF-alpha production in supernatants was measured. The results showed that hsp70 enhanced NF-kappaB activation, which was clearly inhibited by anti-TLR4, with the positive cell ratios being 67.44%, 39.17%, 31.56% and 28.05 %, respectively. TLR4 was rapidly down-regulated in the presence of hsp70. MFI of TLR4 on monocytes in different time points were 87.77 +/- 5.38, 78.16 +/- 6.01 and 45.17 +/- 4.97 (P<0.05), 26.98 +/- 5.83 (P<0.01), respectively. Moreover, hsp70-induced TNF-alpha production by human monocytes was inhibited by anti-TLR4. It is suggested that TLR4 is involved in the hsp70-mediated activation of innate immunity.
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Humans , HSP70 Heat-Shock Proteins , Metabolism , In Vitro Techniques , Monocytes , Metabolism , Toll-Like Receptor 4 , Metabolism , Transcription Factor RelA , Metabolism , Tumor Necrosis Factor-alpha , MetabolismABSTRACT
Objective To explore the protective effects of Ulinastatin on lung transplantation. Methods Orthotopic pulmonary autograft transplantation models of 24 New Zealand rabbits were established and randomly divided into four groups: groupⅠ (control group,n=6), groupⅡ(given 6000U/kg UTI 30min before ischemia, n=6), groupⅢ(given 12000U/kg UTI 30min before ischemia, n=6), groupⅣ(given 12000U/kg UTI respectively 30min before ischemia and during reperfusion, n=6). Then blood samples were taken from left and right atrium respectively before ischemia, and 30min after reperfusion for white blood cells counting. lung tissue DMA content was measured and lung biopsy were performed respectively before ischemia and 2h after reperfusion. Results Compared with groupⅠ, in groups Ⅱ,Ⅲ and Ⅳ, the white cell ratio of right atrium/left atrium was significantly lower, the ratio of wet/dry lung tissue weight and lung tissue DMA content were lower, and the pathological lesion was less. Conclusion Ulinastatin has protective effects on rabbit lung transplantation.
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005)The complete block times were (270?22)min, (204?14)min and (129?12)min respectively, with significant differences among three groups (P
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The effect of transcutaneous stimulation to Hegu, Fengchi and Yuyao points with Han's Acupoint Nerve Stimulator on enflurane anesthsia and the hemodynamic changes during craniotomy were studied in 80 neurosurgical patients. The results showed that acupoint electric stimulation decreased the inhalating concentration and consumption of enflurane. The expired concentration of enflurane in HANS group was significantly lower than that in control group by a reduction of 37.8 % -47. 0%. The cardiovascular depression was lesser during operation, and the patients recovered faster and more stable after operation in HANS group. It was concluded that acupoint stimulation with HANS significantly potentiated the anesthetic effect and decraesed the side effect of enflurane.
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AIM: To determine the combined effect of transmuscle laser revascularization (TMR) and endothelial progenitor cells(EPCs) treatment on ischemic hindlimb of nude rats.METHODS: Mononuclear cells (MNCs) isolated from human umbilical cord-blood (HUCB) by density gradient centrifugation were expanded in vitro. Immunocytochemistry and flow cytometry studies were performed. EPCs were labeled with 1, 1'- dioctadecyl-1 to 3, 3, 3', 3'- tetramethyl-indocarbocyanine perchlorate (DiI) before injected into the laser induced channels or ischemic region. Acute ischemic limb was created in 4 groups of nude rats by ligating right external iliac artery. All animals were divided randomly into the following four groups: TMR+EPCs group: local transplantation of EPCs into laser channels; TMR group: transmuscular channels were created without EPCs; EPCs group: EPCs were injected into ischemic hindlimb; control group: ischemic model without TMR or EPCs. All rats underwent femoral artery ultrasonic blood flow measurements of the ischemic and nonischemic limbs to obtained a flow ratio [femoral artery flow index (FAFI): right femoral artery flow /left femoral artery flow] at baseline (after ligating artery immediately) and 28 days postoperation, and then the samples of ischemic limb muscle underwent histochemical and immunohistologic analysis. RESULTS: The attached cells expressed endothelial cell (ECs) markers (KDR, CD34, CD31, AC133 and von Willebrand factor) and exhibited function similar to that of ECs judged by Ac-LDL incorporation. Flow cytometric analysis disclosed that AT cells were positive for CD34 (62%?7%) and AC133 (57.2%?9.8%) at day 7 of culture. 28 days after therapy, FAFI was significantly higher in the TMR +EPCs (0.66?0.09, P0.05). FAFI in the control group was unchanged and no difference was found between TMR group and control group. TMR+EPCs (5.66?0.77), TMR (4.96?0.31) as well as EPCs (4.68?0.44) treatment resulted in an increased number of capillaries in the treated regional area compared with control group (2.60?0.31, P
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AIM: To explore the ex vivo expansion characteristics of the endothelial progenitor cells (EPCs). METHODS: CD34+ cells were selected from umbilical cord blood mononuclear cells (MNC) by MiniMACS system, expanded at the same conditions as that for total MNC, coincubation of CD34+ and CD34- from the same donation for EPCs. In addition, we tested the effect of vessel endothelial growth factor (VEGF) and passage on cell differentiation, expansion kinetics and apoptosis. EPCs were determined and quantified by immunocytochemistry and flow cytometry. RESULTS: Coculture of CD34+ and CD34-,total MNC led to a significant increase in the expansion of CD34+ cells compared with CD34 enrichment (P0.05). These differentiated EPCs were stained positive for CD34+, von Willebrand factor (vWF), KDR, CD31 and incorporate acetylated low-density lipoprotein (LDL). CD34+ and AC133+cells accounted for 68.2%?6.3% (n=6) and 57.2%?9.8% (n=6) of attaching (AT) cells at day 7 of culture, respectively. CONCLUSIONS: Coculture of CD34+ and CD34- or culture of MNC enhances ex vivo expansion of EPCs. Early passage decreases apoptosis rate, VEGF has no significant effect on ex vivo expansion of EPCs.