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Objective To observe the effect of general anesthesia combined with epidural anesthesia on postoperative cogni‐tive dysfunction(POCD) in elderly colon cancer patient underwent laparoscopic radical operation .Methods 60 cases of elderly pa‐tients underwent laparoscopic radical colon cancer operation were sellected in Qionghai People′s Hospital of Hainan Province .The patients were divided into :general anesthesia control group(n=30)and general anesthesia combined with epidural anesthesia obser‐vation group (n=30) .The cognitive function was estimated by MMSE .The expression of S‐100βprotein was determined by ELISA analysis .Results The recovery time of respiratory depression ,drowsiness and extubation and remifentanil dosage was no no signifi‐cant differences between the two groups(P>0 .05) .The propofol dosage and rate of nausea and vomitting was lower in observation group than that in control group(P0 .05) .MMSE value was decrease after operation for 1 and 3 d(P0 .05) .The S‐100βexpression was increase after operation for 1 and 3 d(P<0 .05) .However ,the S‐100βexpression was lower in observation group than that in control group (P<0 .05) .Conclusion The general anesthesia combined with epidural anesthesia can decrease POCD in elderly colon cancer patient underwent laparoscopic radical operation ,with worthy of clinical application .
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Objective To investigate the effect of leukocyte-depleted intraoperative savaged blood on erythrocyte immunity and systemic inflammatory response during perioperative period patients.Methods Sixty patients required blood salvage were randomly divided into two groups by random digits table method with 30 cases each.The patients in control group were given routine autologous blood transfusion,while in observation group,the salvaged blood was filtered with a leukocyte depleting filter placed in the reinfusion circuit.Blood samples were collected from the central vein before anesthesia (T1),at the end of surgery(T2),and at 12 h (T3) and 36 h (T4) after operation in two groups.The rosette rates of RBC-C3b receptors (RBC-C3bRR) and RBC-immune complex (RBC-ICR) were determined.The leukocyte and neutrophil were counted.The plasma levels of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α) and malondialdehyde (MDA) were measured.Results Compared with control group,the plasma level of IL-6,TNF-α,MDA at T2-T4 in observation group was decreased[T2:(17.8 ± 1.6) ng/L vs.(20.8 ± 1.3) ng/L,(17.4 ± 2.3) ng/L vs.(23.1 ± 2.1) ng/L,(4.31 ± 0.33) nmol/L vs.(4.64 ± 0.73) nmol/L;T3:(21.2 ± 2.0) ng/L vs.(24.3 ± 2.4) ng/L,(12.3 ±2.1) ng/L vs.(18.6 ±1.9) ng/L,(3.97 ±0.35) nmol/L vs.(4.43 ±0.64) nmol/L;T4:(22.0 ± 1.3) ng/L vs.(28.4 ± 1.5) ng/L,(10.6 ± 1.7) ng/L vs.(14.6 ± 2.2) ng/L,(3.45 ± 0.57) nmol/L vs.(3.95 ± 0.40) nmol/L],RBC-C3bRR at T3-T4 in observation group was increased [T3:(15.3 ± 1.3)/100 RBC vs.(12.8 ± 1.5)/100 RBC ;T4:(15.8 ± 1.2)/100 RBC vs.(13.0 ± 1.5)/100 RBC],and there were significant differences (P ＜0.05).There was no significant difference in RBC-ICR,the leukocyte and neutrophil between two groups (P ＞ 0.05).Conclusion Leukocyte-deleted intraoperative salvaged blood is helpful to improve the erythrocyte immunity during perioperative period in patients,and the decrease in the systemic inflammatory response may be involved in the mechanism.
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Objective To evaluate the individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.Methods From January 2009 to December 2012,80 cases of coronary heart disease patients (aged 65-80 years) undergoing gastrointestinal surgery were divided into test group and control group by random digits table with 40 cases each.Traditional fluid therapy was used in control group in the intraoperative and postoperative period.Individualized fluid therapy was used in test group in the intraoperative and postoperative transferred to the intensive care unit (ICU) during the period of 24 h:in cardiac index (CI),stroke output index,stroke variation degree,under the guidance of indicators such as capacity titration type treatment.Hemodynamic index,fluid intake,incidence of cardiac adverse events and recovery of gastrointestinal function were compared in two groups into the operating room (T1),after anesthesia induction (T2),the operation started (T3),intraoperative 1 h (T4),the end of surgery (T5),transferred to the ICU 6 h (T6),transferred to the ICU 12 h (T7) and transferred to the ICU 24 h (T8).Results Compared with T1,two groups of patients with mean arterial pressure (MAP),central venous pressure (CVP),CI and stroke volume (SV) were lower than those at T2 [test group:(68.1 ±6.1) mm Hg(1 mm Hg =0.133 kPa) vs.(84.4 ±5.2) mm Hg,(5.5 ±0.8) cm H2O(1 cm H2O =0.098 kPa) vs.(6.2 ± 1.0) cm H2O,(2.8 ± 1.6) L/(min·m2) vs.(3.3 ± 0.8) L/(min·m2),(65.7 ± 4.5) ml vs.(74.3 ± 7.5) ml;control group:(65.4 ± 7.3) mm Hg vs.(85.1 ± 6.6) mm Hg,(4.6 ± 0.8) cm H2O vs.(6.4± 1.1) cm H2O,(2.7 ±0.7) L/(min·m2) vs.(3.3 ±0.6) L/(min·m2),(60.6 ± 7.6) ml vs.(73.8 ±7.5)ml],stroke variation degree (SVV) was significantly increased [test group:(15.9 ±5.1)％ vs.(12.1 ±5.9)％; control group:(15.8 ± 9.4)％ vs.(12.6 ± 8.4)％],there was significant difference (P ＜ 0.05).Compared with the same time of control group,MAP was higher at T3,CI was higher at T4 and T5,SV was higher at T2-T7,there was significant difference (P＜ 0.05).The total transfusion amount,crystal usage and urine in intraoperative and transferred to the ICU 24 h in test group were less than those in control group,while colloid usage was more than that in control group,there was significant difference (P ＜ 0.05).The incidence of cardiac adverse events between two groups had no significant difference (P =0.232).The postoperative ICU stay time,exhaust time,defecation time,into the liquid diets time and hospital stay in test group were less than those in control group [(37 ± 13) h vs.(55 ± 25) h,(72 ± 12) h vs.(99 ± 13) h,(92 ± 16) h vs.(113 ± 16) h,(4.0 ±0.8) d vs.(4.9 ± 1.9) d,(17 ±4) d vs.(27 ±5) d],there was significant difference (P ＜ 0.05 or ＜ 0.01).Conclusion In the elderly patients with coronary heart disease undergoing gastrointestinal surgery,individualized fluid therapy can effectively decrease adverse cardiac events,improve postoperative gastrointestinal function,and reduce length of hospital stay.
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Objective To investigate the effeets of insulin on the apoptosis of vascular endothelial cells cuinduced by burn$eruln in order to explore its possible mechamsm.Method Cultured human ECV304 cells were randomly divided into 33x)ups:control group,the ECV304 cells hured by 15%(V/V)rat normal,qertlm(t=6);bum semm group,the ECV3()4 cells simulated by 15%(V/V)self-made burn semm collected from rats with 30%TBSA full-thickness burns on the,back(n=6);and burn Serum+insulin group.the ECV304 cells cultared by insulin(10-7mol/L)and 15%(V/V) seIf-made rat bum serum(n=6).The transferase mediated nick end labeling(TUNEL) method was employed to measure the apoptosis of endothelial cells at 6 hours after stimulation.Meanwhile.immanohistochemical technique and Western blotting were used to determine the protein expressions of bcl-2 and eNOS.Data are expressed ills mean ±SEM.Statistical comparison was made using oneway analysis of vtriance.Significance was accepted at P<0.05.Results Compswith the control group,bum$erunl induced the apoptusis(18.5±3.1%)and down-regalated bcl·2(O.36±0.12)and p-eNOS(O.55±0.28)protein expressions of HUVECs(P<0.01).Burn 9AJ'unl+insulin significantly decreased the apoptosis(9.6 4-2.8%)and up-regulated bcl-2(0.944-0.25)and p-eNOS(0.89±0.16)protein expressions ofHU-VECs in comparison with the bum serllm group(P<0.01).eNOS showed no significant differences in three groups.Conclusions Insulin could markedly inhibit the apoptosis and up-regalate bcl-2 protein expression of HUVECs induced by bum serum,and its mec,harfism might involve the protein expression ofphosphorylated eNOS.
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OBJECTIVE:To approach the feasibility of replacing pyrogen test by bacterial endotoxin test(BET)in assaying the injectio puerarin.METHODS:Kinetic turbimetric assay(KTA)was used to determine the bacterial endotoxin,and an inhi?bition and strengthen test by using the EDS-99bacterial endotoxin systems was adopted for assaying injectio puerarin.RES_ ULTS:The regression equation of standard curve was logT=2.7957—0.2422logC,r=—0.9973;Injectio puerarin did not interfere with limulus test agent in1∶60dilution.CONCLUSION:This method is slight in interference and accurate in de?tection result,and can be used in routine assay.
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Objective To investigate the inhibitory effects of intensive insulin on myocardium expression of tumor necrosis factor alpha(TNF-?)in severely burnt rats and its correlative mechanism.Methods In eighteen SD rats the right jugular vein and the left ventricle were cathetetized,and were divided into three groups randomly:(1)the sham burn group,the rats were treated by sham burn;(2)the burn group,the rats were inflicted with 30%TBSA Ⅲ degree burn,and then given fluid resuscitation routinely;(3)the intensive insulin group,the rats received intensive insulin treatment after burn,and the liquid volume given was equal to the burn group.The level of plasma glucose contents,the left ventricular systolic pressure(LVSP)and left ventricular end-diastolic pressure(LVEDP)were recorded at 1,2,3,4,5,6h after burn,and animals were sacrificed at 6 hours after burn.The level of TNF-? in myocardium tissue was assayed by ELISA,and mRNA expression was determined by real-time PCR.Western blot was used to detect I?B? phosphorylation and degradation in left ventricle tissue.Meanwhile,burn serum-challenged cardiomyocytes were also used to detect the levels of insulin and LY294002,a specific insulin activation inhibitor,on the phosphorylation of I?B?.Results The animals showed stress hyperglycemia after burns,the function of heart was damaged(LVSP degraded and LVEDP increased),the level of TNF and the expression of mRNA in the myocardium increased apparently,I?B? phosphorylation and degradation increased in left ventricle tissue and burn serum-challenged cardiomyocytes.Given the intensive insulin treatment to keep the blood glucose level between 4.5 to 5.2 mmol/L,the function of heart was significantly improved,the level of TNF-? was apparently lowered,and the I?B? phosphorylation and degradation were significantly decreased.LY294002 could abolish the inhibitory effect of insulin,and it acted on the I?B? phosphorylation on burn serum-challenged cardiomyocytes model.Conclusion Intensive insulin may decrease the activation of NF-?B through diminishing the I?B? phosphorylation and degradation,which inhibit the transcription and expression of TNF-? in myocardial cell,and improve the heart function accordingly.
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Endocrine-paracrine (EP) cells, also known as APUD or neuroendocrine cells, have been known to exist in the mammalian genito-urinary system. A fairly common localization is in the prostate and urethra. In this study we demonstrated for the first time the presence of small number of EP cells in the dissociated epithelial cells of the seminal vesicles of the guinea pig. The EP cells exhibited yellow FIF, while a few green or yellow-green FIF cells can be observed after L-dopa treatment. They were stained positive by the Masson-Fontana's method but consistently negative with the Grimelius silver methods indicating that they were of argentaffin nature or other paracrine cells.