Current status and prospects in brain research projects / 中华麻醉学杂志

In the trends of large-scale brain research projects around the world, the China Brain Project aims to promote the understanding of the basic principles of the brain, and use the basic research of neuroscience to serve some urgent social and economic needs at the same time.As we approach the launch of this effort aimed at revolutionizing our understanding of cognitive principles of the brain, early diagnoses of brain diseases and brain-like intelligence technologies, it is timely to review the new progress in recent international brain research projects, and the deployment and future trajectory of neuroscience research in China.

Recommendations for anesthesia management and infection control in elderly patients with COVID-19 / 中华麻醉学杂志

During the epidemic of coronavirus disease 2019 (COVID-19), the infection of the elderly population will bring great challenges to clinical diagnosis and treatment, outcome and management.Combined with the characteristics of anesthesia and the pathophysiological characteristics of COVID-19 on lung function impairment in elderly patients, Chinese Society of Anesthesiology formulated the " Recommendations for anesthesia management and infection control in elderly patients with COVID-19″. This recommendation expounds preoperative visit and infection control, anesthesia management protocol, anesthesia monitoring, anesthesia induction/endotracheal intubation, anesthesia maintenance and infection control, intraoperative lung protection strategy, anti-stress and anti-inflammatory management, hemodynamic optimization, infection control during emergence from anesthesia, and postoperative analgesia in elderly patients with COVID-19, and provides the reference for the safe and effective implementation of anesthesia management in elderly patients during the prevention and control of COVID-19 epidemic.

AIDS associated with pneumocystis carinii severe pneumonia during epidemic of coronavirus disease 2019: a case report / 中华麻醉学杂志

The identification and diagnosis of coronavirus disease 2019 (COVID-19) is of great significance in the treatment of COVID-19. Based on Diagnosis and Treatment Protocol for COVID-19 (Trial Version 5) issued on February 8, 2020 by the National Health Commission, there is no fungal pneumonia among the disease listed in the identification and diagnosis item. Thus, we reported a case of patient with AIDS associated with pneumocystis carinii severe pneumonia admitted to Shanghai Fourth People′s Hospital affiliated to Tongji University School of Medicine in January, 2020, which was helpful in improving the identification and diagnosis of COVID-19.

Fighting against outbreak of coronavirus disease 2019: suggestions to anesthesia practioners / 中华麻醉学杂志

In the medical treatment activities to fight against the coronavirus disease 2019 epidemic, many anesthesia practioners in the country, especially the intensive care unit (ICU) medical staff, are on the front line and perform the therapeutic procedures with high risk of infection such as tracheal intubation, sputum suction, bronchoscopy and so on in ICU with most high risk of infection. What should the anesthesia practioners pay attention to? In the fight against the SARS epidemic in 2003, the author served as ICU director of SARS designated hospital, the Beijing Xiaotangshan hospital, for nearly 2 months and had some experience. Combining the situation of this epidemic, the author puts forward some personal suggestions: 1. Improving the success rate of critically ill patients is an important basis to avoid social panic. 2. For confirmed and suspected patients, non-emergency surgery should not be performed if possible; 3. For confirmed and suspected patients who must undergo surgery, the highest level of protection must be taken; 4. Before the outbreak is resolved, unconventional treatment must be taken even if anesthesia is performed for routine surgery. 5. Ensuring self-protection is the greatest contribution to the control of the epidemic.

Establishment of risk prediction models of acute renal injury after cardiac surgery: a literature analysis / 中华麻醉学杂志

Acute renal injury (AKI) is one of the serious complications after cardiac surgery.The incidence of AKI after cardiac surgery was 5%-42%.It is independently associated with an increase in costs of treatment, prolongation of hospital stay, and increase in short- and long-term mortality rates.Currently, there is no effective treatment for AKI after cardiac surgery.Early identification of high-risk patients, early prevention and early treatment can reduce the incidence and severity of AKI after cardiac surgery.Risk prediction models of AKI after cardiac surgery can help clinicians identify high-risk patients and thus carry out corresponding measures.This paper aimed to provide a reference for the use of the model and to indicate the direction for further research though analyzing the literature information about the establishment of risk prediction model of AKI after cardiac surgery in recent years.

Neuroprotective Autophagic Flux Induced by Hyperbaric Oxygen Preconditioning is Mediated by Cystatin C / 神经科学通报·英文版

We have previously reported that Cystatin C (CysC) is a pivotal mediator in the neuroprotection induced by hyperbaric oxygen (HBO) preconditioning; however, the underlying mechanism and how CysC changes after stroke are not clear. In the present study, we demonstrated that CysC expression was elevated as early as 3 h after reperfusion, and this was further enhanced by HBO preconditioning. Concurrently, LC3-II and Beclin-1, two positive-markers for autophagy induction, exhibited increases similar to CysC, while knockdown of CysC blocked these elevations. As a marker of autophagy inhibition, p62 was downregulated by HBO preconditioning and this was blocked by CysC knockdown. Besides, the beneficial effects of preserving lysosomal membrane integrity and enhancing autolysosome formation induced by HBO preconditioning were abolished in CysC rats. Furthermore, we demonstrated that exogenous CysC reduced the neurological deficits and infarct volume after brain ischemic injury, while 3-methyladenine partially reversed this neuroprotection. In the present study, we showed that CysC is biochemically and morphologically essential for promoting autophagic flux, and highlighted the translational potential of HBO preconditioning and CysC for stroke treatment.

Effectiveness and accuracy of a domestic continuous non-invasive blood pressure device in monitoring intraoperative blood pressure / 中华麻醉学杂志

Objective To evaluate the effectiveness and accuracy of a domestic continuous non-invasive blood pressure (NIBP) device in monitoring intraoperative blood pressure.Methods Sixty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective surgery under general anesthesia,were included in the study.The invasive blood pressure (IBP) and NIBP were simultaneously measured in the radial artery.Systolic and diastolic blood pressure (SBP,DBP) was continuously recorded,and the paired data and data of waveform were collected.For paired data,the agreement was evaluated using Bland-Altman analyses between the two monitoring methods.For waveform data,Pearson linear correlate analysis was performed between the two monitoring methods.Results For paired data,the bias of NIBP value from IBP value were (-2.1±5.4) mmHg (95％ CI-3.5-0.7 mmHg) and (2.6±6.4) mmHg (95％ CI 1.0-4.3 mmHg) for SBP and DBP,respectively.The 95％ limit of agreement of bias between the two methods was-12.6-8.5 mmHg for SBP and-10.0-15.3 mmHg for DBP.For waveform data,the bias of NIBP value from IBP value were (-2.1±6.5) mmHg (95％ CI-3.7-0.4 mmHg) and (3.1±6.8) mmHg (95％ CI 1.3-4.8 mmHg) for SBP and DBP,respectively.The correlation coefficient between the two methods was O.82 for SBP and 0.88 for DBP,P＜0.01.Conclusion The effectiveness and accuracy of this domestic continuous NIBP monitoring device in monitoring intraoperative blood pressure is clinically acceptable.

Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery / 临床麻醉学杂志

Objective To observe whether transcutaneous electrical acupoint stimulation (TEAS) could improve the emergence and recovery of patients undergoing robotic gynecologic surgery,and to explore the mechanism behind it.Methods Patients (aged 18-65 years,BMI 18-30 kg/m2,ASA grade Ⅰ or Ⅱ) scheduled for elective robotic gynecologic surgery were screened and randomized into three groups:group TEAS (groups T),no acupoint group (group N) and control group (group C),receiving TEAS (ST-36,SP6,BL59,BL60),stimulation at bilateral hips and no-stimulation respectively.Stimulations were given from 30 min before anesthesia induction to the end of surgery.Recovery measurements during emergence,PACU stay and 24 h after surgery were recorded.Levels of serum AQP4,MMP9 and S100β were analyzed.Results Time to response to verbal command and time to extubation in group T [(18.3± 6.7) min and (19.4 ± 6.6) min respectively] were significantly shorter than those in group C [(21.9±7.3) min and (23.1±7.3) min respectively] (P ＜0.05).Maximum VAS scores during PACU stay were significantly lower in group T than that in groups C and N (P＜0.05).Postoperative AQP4 level in group T significantly decreased compared with baseline (P＜0.05).However,postoperative MMP9 and S100β level in group C significantly in creased compared with the baseline (P＜0.05 or P＜0.01).Conclusion TEAS could fasten emergence of patients after robotic gynecologic surgery and improve postoperative analgesia.Mechanisms involving AQP4,MMP9 and S100β may be involved.

Role of hippocampal PI3K∕Akt signaling pathway in exogenous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice / 中华麻醉学杂志

Objective To evaluate the role of hippocampal phosphatidylinositol 3-kinase∕serine-threonine kinase (PI3K∕Akt) signaling pathway in exogenous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice. Methods A total of 100 pathogen-free healthy adult male C57BL∕6 mice, aged 8-12 weeks, weighing 20-25 g, in which the lateral ventricle was catheter-ized, were divided into 5 groups (n = 20 each) using a random number table: control group (group C), isoflurane group (group I), orexin A group (group OA), orexin A plus dimethyl sulfoxide group (group OA+D) and orexin A plus PI3K inhibitor LY294002 group (group OA+LY). Normal saline was administra-ted in group C and group I. Orexin A 1. 5 mmol∕L was given in group OA. Orexin A 1. 5 mmol∕L (dissolved in dimethyl sulfoxide) was given in group OA+D. Orexin A 1. 5 mmol∕L and LY29400210 mmol∕L were given in group OA+LY. Group C only inhaled pure oxygen for 2 h (oxygen flow rate 2 L∕min), all the rest groups inhaled 1. 4％ isoflurane for 2 h, and the corresponding drug 2 μl was injected into the lateral cere-bral ventricle according to the concentration mentioned above at 15 min before the end of anesthesia. Twelve mice were randomly selected from each group and trained for contextual fear conditioning test, and then fear memory retrieval was conducted at 24 h after training. The rest 8 mice in each group were sacrificed at 2 h after the end of anesthesia and their brains were removed for determination of the expression of PI3K, Akt and phosphor-Akt (p-Akt) protein by Western blot. Results Compared with group C, the freezing time was significantly shortened, the expression of PI3K, Akt and p-Akt was down-regulated, and p-Akt∕Akt ratio was decreased in group I (P<0. 05). Compared with group I, the freezing time was significantly pro-longed, the expression of PI3K, Akt and p-Akt was up-regulated, and p-Akt∕Akt ratio was increased in group OA (P<0. 05). There was no significant difference in each parameter mentioned above between group OA and group OA+D (P>0. 05). Compared with group OA+D, the freezing time was significantly short-ened, the expression of PI3K, Akt and p-Akt was down-regulated, and p-Akt∕Akt ratio was decreased in group OA+LY (P<0. 05). Conclusion Hippocampal PI3K∕Akt signaling pathway is involved in exoge-nous orexin A-induced improvement of isoflurane anesthesia-caused decline in memory function of mice.

Efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy / 中华麻醉学杂志

Objective To evaluate the efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy.Methods A total of 140 patients,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were enrolled and randomly assigned to ropivacaine group (group R)and routine analgesia group (group C).Three-port laparoscopic procedure was carried out.Before inserting trocars,incision infiltration was performed with ropivacaine with a total volume of 16 ml,6 ml for epigastric port,6 ml for umbilical port and 4 ml for working port.The equal volume of normal saline was given instead of ropivacaine in group C.Parecoxib 40 mg was intravenously injected before surgery in both groups or after surgery as rescue analgesic when necessary.The requirement for rescue analgesia was recorded within 24 and 48 h after surgery.The visual analogue scale (VAS) scores at rest and during activity were recorded at 2,4,6,8,12,18,24 and 48 h after surgery,and the area under curve (AUC) of VAS scores was calculated in each time point after surgery.The development of no pain at rest was recorded at 24 h after surgery.Parents'satisfaction with analgesia was assessed and scored at 24 and 48 h after surgery.Wound healing was evaluated and scored at 48 h after surgery,and the development of poor wound healing was recorded.The development of chronic pain and VAS scores were recorded at day 90 after surgery.Results There were 130 patients who completed the study,with 66 cases in group R and 64 cases in group C.Compared with group C,the AUC of VAS scores at rest in 0-8 h and 0-24 h periods after surgery was significantly decreased,the AUC of VAS scores at rest in 0-6 h,0-8 h,0-12 h,0-24 and 0-48 h periods after surgery was decreased,the requirement for rescue analgesia was reduced at 24 h after surgery,satisfaction scores were increased (P＜0.05),and no significant change was found in the rate of no pain at rest after surgery,wound healing score,incidence of poor wound healing,incidence of chronic pain at day 90 after surgery or VAS score at day 90 after surgery in group R (P＞0.05).Conclusion Incision infiltration with ropivacaine before incision can effectively alleviate acute pain within 48 h after laparoscopic cholecystectomy with a higher safety and exerts no effect on chronic pain after surgery.

Four awareness of clinical lean management / 中华烧伤杂志

Along with changes of medical model, hospitals need to provide best outcome with lowest cost and best patient′s experience rather than merely medical treatments. It is the cultivation of lean awareness to the doctors that could acquire such outcome. The healthcare lean awareness can be summarized as responsibility awareness, digitalized awareness, detail awareness, and outstanding awareness. Through the cultivation of lean awareness, humanism can immerse into the doctors′practice, which is conducive to train for the great masters of the medicine.

Explorations in disciplines development at a research hospital / 中华医院管理杂志

Aiming at building research disciplines,Xijing hospital has initially achieved a strategic transformation into a hospital with research disciplines,with such measures as scientific layout of disciplines,making of advantageous disciplines with overseas benchmarks,encouragement of potential disciplines with advantageous disciplines,promotion of medical innovation with innovative ideas,and upgrading clinical service quality with technical innovation.

Efficacy and safety of oxycodone hydrochloride injection for postoperative analgesia in patients undergoing operation under general anesthesia: a prospective, randomized, blind, multicenter, positive-controlled,clinical trial / 中华麻醉学杂志

Objective To evaluate the efficacy and safety of oxycodone hydrochloride injection for postoperative analgesia in patients undergoing the operation under general anesthesia in a prospective,randomized,blind,multicenter,positive-controlled,clinical trial.Methods Two hundred and forty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 40-95 kg,scheduled for elective abdominal operation or orthopedic surgeries under general anesthesia,were randomly divided into 2 groups (n =120 each):morphine sulfate injection group (group M) and oxycodone hydrochloride injection group (group O).Morphine or oxycodone 1 mg was injected intravenously when the patients complained of pain after tracheal extubation or removal of the laryngeal mask,and administration was repeated if necessary until VAS≤40 mm.Then patient-controlled intravenous analgesia (PCIA) (100 ml,0.5 mg/ml) with morphine or oxycodone was used for postoperative analgesia (lasting for 48 h).The PCIA pump was set up with a 1 ml bolus dose,a 5 min lockout interval and background infusion at a rate of 0.5 mg/h.Pain at rest and during movement was assessed using VAS score at 3,24 and 48 h after administration,and non-inferiority test was performed.Total morphine or oxycodone consumption,requirement for rescue analgesic,the number of unsuccessfully delivered dose,the number of attempts,and the level of patient' s satisfaction were recorded within 48 h after operation.The adverse events were recorded and laboratory examinations (blood and urine routine test,blood biochemical examination) were performed within 72 h after administration.Results There was no significant difference in the VAS scores at rest and during movement at different time points,requirement for rescue analgesic,the number of unsuccessfully delivered doses and attempts,level of patient' s satisfaction,total morphine or oxycodone consumption,and adverse events between the two groups (P ＞ 0.05).No serious adverse event occurred in the two groups.The most common adverse event was nausea,followed by vomiting.There was no significant difference in the incidences and degree of nausea and vomiting between the two groups (P ＞ 0.05).The incidences of nausea and vomiting in patients underwent orthopedic surgeries were significantly lower in group O than in group M (P ＜ 0.05).The other adverse events were fewer and abnormal laboratory examinations were rare in the two groups.95％ confidence interval of the difference between the mean VAS scores at rest and during movement at each time point was within 15 mm (boundary values of non-inferiority testing) in the two groups.Conclusion PCIA with oxycodone hydrochloride injection is safe and effective in reducing pain after moderate or major operation,and the analgesic efficacy is similar to that of morphine sulfate injection,however,the development of nausea and vomiting is reduced when PCIA with oxycodone hydrochloride injection is used for orthopedic surgeries as compared with that when morphine sulfate injection is used and the ratio between the analgesic efficacy of the two drugs is close to 1∶1.

Effects of electroacupuncture pretreatment on expression of phosphorylated signal transducer and activator of transcription 3 in cortical neurons in a rat model of focal cerebral ischemia/reperfusion injury / 中华麻醉学杂志

Objective To investigate the effects of electroacupuncture (EA) pretreatment on the expression of phosphorylated signal transducer and activator of transcription 3 (pSTAT3) in cortical neurons in a rat model of focal cerebral ischemia/reperfusion (I/R) injury.Methods Forty-five adult male Sprague-Dawley rats,weighing 280-320 g,were randomly divided into 3 groups (n =15 each):sham operation group,I/R group and EA pretreatment group.Focal cerebral ischemia was induced by middle cerebral artery occlusion for 120 min,followed by 24 h of reperfusion.EA of Baihui acupoint lasting 30 min was performed and then the model of focal cerebral I/R was established 24 h later in EA group.Neurological function was assessed and scored at 24 h of reperfusion.The rats were then sacrificed and brains removed for detection of the cerebral infarct volume and expression of pSTAT3 (Ser727) in cortical neurons in ischemic penumbra by immunofluorescence and Western blot.Results Compared with sham operation group,the neurological function score was decreased,the infarct volume was increased,and the expression of pSTAT3 (Ser727) was up-regulated in groups I/R and EA (P ＜ 0.05).Compared with I/R group,neurological function score was increased,the infarct volume was decreased,and the expression of pSTAT3 (Ser727) was up-regulated in group EA (P ＜ 0.05).Conclusion EA pretreatment reduces focal cerebral I/R injury through up-regulating pSTAT3 expression in cortical neurons in rats.

Relationship between emergence agitation during recovery from general anesthesia and postoperative cognitive dysfunction / 中华麻醉学杂志

Objective To evaluate the relationship between emergence agitation (EA) during recovery from general anesthesia and postoperative cognitive dysfunction (POCD).Methods Two hundred and eighty ASA Ⅰ or Ⅱ patients,aged 18-70 yr,weighing 52-80 kg,undergoing elective surgery,were included.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil,propofol and cisatracurium.EA was assessed at 15-40 min after extubation by using Post-operative Quality Recovery Scale and the cognitive function was assessed at day 1 before operation and days 1-7 after operation.Patients were divided into POCD or nonPOCD group according to the occurrence of POCD.The general data of patients,preoperative complications and types of surgery were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factor for incidence of POCD.Results The incidence of POCD was 40.7 ％.The results of logistic regression analysis showed that the dangerous degree of the risk factors for POCD in order from high to low were emergence agitation,duration of anesthesia and age.Conclusion EA during recovery from general anesthesia is an independent risk factor for POCD.

Preliminary exploration on the cultivation methods of postgraduates of anesthesiology / 中华医学教育探索杂志

This paper analyzed the cultivation of postgraduates of anesthesiology and the academic achievements in anesthesiology department from 2003 to 2010 in our hospital and explored the experiences in postgraduate cultivation.Cultivation of postgraduates of anesthesiology should focus on multidisciplinary integration,cross-discipline communication,extension of scientific thinking,enhancement of clinical skills so as to create the opportunity for clinical and research work.

Effects of preconditioning with repeated electroacupuncture at Shenshu acupoint on renal ischemia-reperfusion injury in rats / 中华麻醉学杂志

Objective To investigate the effects of preconditioning with repeated electroacupuncture (EA)at Shenshu acupoint on renal ischemia-reperfusion (I/R) injury in rats.Methods Fifty adult male Sprague-Dawley rats,weighing 260-320 g,were randomly divided into 4 groups:sham operation group (n =5),I/R group,pentobarbital sodium + I/R group (PB + I/R group) and repeated EA at Shenshu acupoint + I/R group (EA + I/R group).The model of renal I/R injury was established by occlusion of bilateral renal pedicles for 45 min followed by reperfusion.Pentobarbital sodium 30 mg/kg was injected intraperitoneally everyday for 5 consecutive days and I/R was induced 24 h after the last injection in PB + I/R group.The animals received EA at Shenshu acupiont 30min per day for 5 consecutive days under pentobarbital sodium anesthesia and I/R was induced 24 h after the last preconditioning in EA + I/R group.Blood samples were taken at 1,3 and 7 days after I/R to determine the levels of serum blood urea nitrogen (BUN) and creatinine (Cr).The animals were then sacrificed and the kidney was isolated.The histological changes of the kidney was scored.The apoptosis in renal tubular epithelial cells was measured using TUNEL at 3 days after I/R.Apoptosis index (AI) was calculated.The expression of proliferating cell nuclear antigen (PCNA),Bcl-2,Bax,Fas and FasL in renal tubular epithelial cells was measured by immuno-histochemistry at 3 days after I/R.Results Compared with group S,the levels of serum BUN and Cr,and histological score were significantly increased at 1,3 and 7 days after I/R in I/R and PB + I/R groups,and at 1 and 3 days after I/R in EA + I/R group,the expression of PCNA,Bcl-2,Bax,Fas and FasL was up-regulated in I/R,PB + I/R and EA + I/R groups,and Bax/Bcl-2 ratio was significantly increased in I/R and PB + I/R groups (P ＜0.05).Compared with I/R and PB + I/R groups,the levels of serum BUN and Cr,and histological score were significantly decreased at 3 and 7 days after I/R,AI and the expression of Bax,Fas and FasL were significantly decreased,and the expression of PCNA and Bcl-2 was up-regulated in EA + I/R group (P ＜ 0.05).Conclusion Preconditioning with repeated EA at Shenshu acupoint can attenuate the renal I/R injury in rats by promoting the proliferation of renal tubular epithelial cells and reducing the apoptosis in cells.

Effect of 6% hydroxyethyl starch 200/0.5 infusion before operation on postoperative immune function / 中华麻醉学杂志

Objective To investigate the effect of 6 % hydroxyethyl starch (HES) 200/0.5 infusion before operation on postoperative immne function in patients. Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 21-58 yr weighing 47-79 kg were randomly divided into 2 groups ( n = 20 each): 6% HES 200/0.5 group (group H) and compound sodium acetate group (group A). 6% HES 200/0.5 10 ml/kg or compound sodium acetate solution was infused intravenously over 15 min before anesthesia induction. Anesthesia was induced with iv injection of propofol, fentanyl and vecuronium and maintained with target-controlled infusion of propofol and infusion of remifentanil. Venous blood samples were collected before operation and at 1 h, 1 day and 3 days after operation to detect the serum concentrations of IL-6, IL-8, TNF-α, IL-2, IL-10, IgG, IgA andIgM. Results Serum concentrations of IL-6, IL-8, TNF-α, II-2 and IL-10 were significantly higher after operation in the two groups, and serum concentrations of IgA and IgG were significantly lower after operation in group A than those before operation ( P ＜ 0.05 or 0.01 ). Serum concentrations of IL-6, IL-8 and TNF-α were significantly lower, while serum concentrations of IL-2, IL-10, IgA and IgG were significantly higher after operation in group H than in group A ( P ＜0.05). Conclusion Preoperative infusion with 6% HES 200/0.5 can improve the immune function after operation in patients.

Role of N-myc downstream regulated genes 2 in attenuation of focal cerebral ischemic-reperfusin injury by sevoflurane preconditioning in rats / 中华麻醉学杂志

Objective To investigate the role of N-myc downstream regulated genes 2 (NDRG2) in attenuation of focal cerebral ischemic-reperfusin injury by sevoflurane preconditioning in rats.Methods Forty-eight healthy male SD rats weighing 280-320 g were randomly divided into 3 groups ( n =16 each):sham operation group (group S),ischemia-reperfusion injury group (group I/R) and sevoflurane preconditioning group (group Sev).Focal cerebral ischemia-reperfusion injury was induced by right middle cerebral artery occlusion (MCAO)for 120 min followed by 24 h reperfusion.In group Sev,2.0％ sevoflurane was inhaled 1 h once a day for 5 consecutive days at 24 h before MCAO.The neurologic function was evaluated at 24 h of reperfusion and than the rats were sacrificed,and the brain was removed for determination of infarct volume percentage,NDRG2 and activated Caspase-3 expression in ischemic penumbra by Western Blot and NDRG2 expression and location by immunohistochemistry.Results The infarct volume percentage,NDRG2 and activated Caspase-3 expression were higher,and neurologic function score was lower in groups I/R and Sev then in group S( P ＜ 0.05).The infarct volume percentage,NDRG2 and activated Caspase-3 expression were lower,and neurologic function score was higher in group Sev then in group I/R ( P ＜ 0.05).The intranuclear NDRG2 positive staining was decreased in group Sev than in group I/R.Conclusion Sevoflurane preconditioning can reduce focal cerebral ischemia-reperfusion injury by inhibiting the expression and activity of NDRG2 and apoptosis in rats.