Effects of general anesthesia combined with thoracic paravertebral block on postoperative recovery after pulmonary lobectomy / 临床外科杂志

Objective To evaluate Effects of general anesthesia combined with thoracic paraver-tebral block(TPVB)on postoperative recovery after thoracoscopic pulmonary lobectomy. Methods Eighty patients were randomized into the general anesthesia group( G group)and general anesthesia combined TPVB group(GT group). Under the guidance of ultrasound,patients in the GT group received 20ml of 0. 5% ropivacaine for TPVB,and sevoflurane and propofol for combined anesthesia. Patients in the G group received sevoflurane,propofol and remifentanil for combined anesthesia. Extubation time,postoperative vis-ual analogue scale(VAS),quality of recovery(QoR)score,and adverse reaction were all recorded. Results Patients in the GT group had less extubation time and earlier ambulation time compared to the G group. Postoperatively,at the 1st,24th and 48th hour,patients in the G group had significantly higher VAS values both at rest and on movement than GT group(P < 0. 05). The opioid consumptions in GT group were lower than the G group(P < 0. 05). The QoR values of GT group at 24th and 48th hour[(152 ± 21)min and (175 ± 17)min]were significantly higher than the G group[(134 ± 25)min and(162 ± 20)min]respec-tively. There were significant differences in hospitalization expenses,the hospitalization stay and the inci-dence of complications between the two groups. Conclusion The ultrasound-guided paravertebral block can improve the quality of recovery in patients undergoing thoracoscopic pulmonary lobectomy.

Effect of ketamine on mitochondrial function of rat neurons subjected to anoxia / 中华麻醉学杂志

Objective To investigate the effect of ketamine on the mitochondrial function of rat neurons subjected to anoxia. Methods Primarily cultured rat hippocampal neurons were seeded in culture dishes (35 mm in diameter) at the density of 5×105-1×106 cells∕ml, and divided into 3 groups (n=11 each) using a random number table: control group, anoxia group and ketamine group. The neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min in anoxia group. In ketamine group, ketamine was added to the culture medium with the final concentration of 20 μmol∕L at 1 h before anoxia, and then the neurons were exposed to 90% N2 plus 10% CO2 50 ml∕min for 5 min. After the end of treatment in each group, the dead neurons were detected using trypan blue staining, the ATP content was determined by ATP bioluminescence assay, and mitochondrial membrane potential was measured by rhodamine 123 staining. Results Compared with control group, the mortality rate of hippocampal neurons was significantly in?creased, and the ATP content and mitochondrial membrane potential were significantly decreased in anoxia group and ketamine group ( P<0.05) . Compared with anoxia group, the mortality rate of hippocampal neu?rons was significantly decreased, and the ATP content and mitochondrial membrane potential were signifi?cantly increased in ketamine group (P<0.05). Conclusion The mechanism by which ketamine amelio?rates anoxia?induced damage to rat neurons is related to improved mitochondrial function.

Application of Combined General Anesthesia and Bilateral Thoracic Paravertebral Block by Ropivacaine in 20 Cases of Patients Undergoing Off-pump Coronary Artery Bypass Surgery / 医药导报

Objective To investigate the effectiveness of the combination of general anesthesia ( GA) and single-shot bilateral thoracic paravertebral block ( TPVB) by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery ( OPCAB) . Methods Forty patients with coronary heart disease scheduled for elective OPCAB surgery were randomly divided into two groups:general anesthesia group (group A, n=20) and general anesthesia combined with bilateral thoracic paravertebral block group (group B, n=20). The frequency of hemodynamic abnormalities and dosage of vasoactive drugs during the period of operation were recorded. Meanwhile, other reference data were recorded, such as the consumption of sufentanil during operation and postoperative analgesia, the time of endotracheal tube retention and intensive care unit ( ICU) stay. Results Two cases were excluded from the study in group B for failure block. Compared with group A, the frequency of hypertension and the amount of nicardipine was lower during operation in group B (P<0. 05), the consumption of sufentanil was less both during operation (P<0. 01) and postoperative analgesia (P<0. 05). Moreover, the time of tracheal tube retention and ICU stay were shorter in group B (P<0. 05). Conclusion The findings of this study indicate that GA combined with single-shot TPVB is superior to GA alone in improving haemodynamic stability in patients undergoing OPCAB surgery. The combination therapy can also reduce the use of opiates and shorten the time of recovery.

Effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section / 中国医师进修杂志

Objective To evaluate the effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section.Methods Four hundred parturients (ASA Ⅱ-Ⅱ) undergoing cesarean section were randomly allocated into 4 groups,including sufentanil group (group S,96 cases),sufentanil combined with flurbiprofen axetil group (group SK,99 cases),butorphanol group (group N,106 cases) and butorphanol combined with llurbiprofen axetil group (group NK,99 cases).All the parturients received the operation under epidural combined with spinal anesthesia,and received patient-controlled intravenous analgesia (PCIA) after cesarean section.Numerical rating scale (NRS) of postoperative rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and PCIA-related adverse events were recorded for 24 h after operation.Results All the parturients were finished this study.The age,body weight,gestational weeks and operative time in 4 groups had no significant difference (P ＞ 0.05).The NRS score of rest incisional pain was equivalent among the 4 groups (P ＞ 0.05).The NRS score of dynamic incisional pain after operative 13 h in group S was significantly lower than that in group N[(3.6 + 1.3) scores vs.(5.4 + 1.2) scores](P＜ 0.05).The NRS score of uterine contraction pain after operative 4,13 h in group N and group SK was lower than that in group S [(1.3 ± 1.0),(1.1 ± 0.9) scores vs.(2.5 ± 1.1) scores and (1.6 ± 1.0),(1.4 ± 0.9) scores vs.(2.9 ± 1.1) scores] (P ＜ 0.05).The RSS scores and incidence rate of dizziness were significantly higher in group N than those in group S (P ＜0.05).No abnormality of new-horn infant was recorded in 4 groups.Conclusion Sufentanil combined with nonsteroidal antiinflammatory drugs can perform effective and safe analgesia on postoperative incisional and uterine contraction pain after cesarean section.

The effect of Th17 cells on A(H1N1) influenza virus clearance / 中华传染病杂志

Objective To investigate the phenotype, frequency of Th17 cells and the association between Th17 cells and viral clearance in patients with H1N1 influenza A. Methods Three groups including 70 confirmed patients with H1N1 influenza A, 30 patients with seasonal influenza as well as 68 healthy subjects as controls were enrolled in this study. The percentages of Th1, Th2, Treg and Th17 lymphocytes in the peripheral blood were determined by intracellular staining and flow cytometry. The levels of interferon-γ (IFN-γ), transforming growth factor-beta (TGF-β),interleukin-6 (IL-6) in plasma and supernatant of the peripheral blood mononuclear cell (PBMC)culture were quantified by enzyme-linked immunosorbent assay (ELISA). Viral load in nasopharyngeal swabs was detected by real time quantitative reverse transcription-polymerase chain reaction (RTPCR). Data were analyzed by one way ANOVA and liner correlation analysis. Results The percentage of Th17 cells in H1N1 influenza A patients was (2. 740±0. 210)%, which the percentage of was significantly decreased compared to healthy subjects (3. 443 ±0. 154)% and seasonal influenza patients (3. 443±0. 277) % (F=4. 242, P＜0. 05); while the percentage of Thl, Th2 and Treg cells were not significantly different among these groups. Moreover, the TGF-β level in plasma of H1N1 influenza A patients was (10±8) ng/mL, which was significantly lower than healthy subjects (43 ±32 ) ng/mL and seasonal influenza patient ( 18 ± 10) ng/mL ( F= 17.72, P＜0.01 ). The TGF-β level in the supernatant of PBMC culture of H1N1 influenza A patients was (782 ± 736) pg/mL, which was significantly lower than healthy subjects (1462±315) pg/mL and seasonal influenza patients (1481 ±348) pg/mL (F=5. 730, P＜0.01). Additionally, the viral clearance period was inversely correlated with the percentage of Th17 cells (r=-0.38, P=0.02). Conclusions The proportion of Th17 cells in patients with H1N1 influenza A is significantly decreased, which is closely correlated with the level of TGF-β. This decrease may results in the delayed viral clearance.

Use of IFN-γ release assay in latent tuberculosis infection diagnosis in general and HTV-infected populations / 中华微生物学和免疫学杂志

Objective To assess the validity of a newly developed in-house ELISPOT IFN-γ release assay (IGRA) for the detection of latent tuberculosis infection among HIV infected individuals. Methods In-house ELISPOT assay were performed, together with a tuberculin skin test in 205 health controls and 110 HIV infected individuals , who had no signs of active tuberculosis at time of enrolment . Results Using the ELISPOT assay, positivity rates for the 205 health controls, 110 HIV infected individuals and 47 AIDS patients on highly active antiretrovial therapy (HAART) were 7. 3% , 24.5% , 29. 8% , respectively. These results indicated that the positive rates obtained from HIV infected individuals (include patient on HAART) was significantly higher than health controls( P ＜ 0.001). We found no significant correlation between the CD4 cell count and positivity of ELISPOT assay (P ＞0.05 ). The proportion of subjects with a positive response to ELISPOT assay were higher than the proportion of tuberculin skin test(TST) responders(P＜0.0001) in HIV infected individuals. Conclusion Our study indicates that IGRA using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals.