To Research the Effects of Storage Time on Autotransfusion based on Erythrocyte Oxygen-Carrying Capacity and Oxidative Damage Characteristics.

Autotransfusion refers to a blood transfusion method in which the blood or blood components of the patient are collected under certain conditions, returned to himself when the patient needs surgery or emergency after a series of storing and processing. Although autotransfusion can avoid blood-borne diseases and adverse reactions related to allogeneic blood transfusion, a series of structural and functional changes of erythrocytes will occur during extension of storage time, thus affecting the efficacy of clinical blood transfusion. Our research was aimed to explore the change of erythrocyte oxygen-carrying capacity in different storage time, such as effective oxygen uptake (Q), P50, 2,3-DPG, Na+-K+-ATPase, to detect membrane potential, the change of Ca2+, and reactive oxygen species (ROS) change of erythrocytes. At the same time, Western blot was used to detect the expression of Mitofusin 1 (Mfn1) and Mitofusin 2 (Mfn2) proteins on the cytomembrane, from the perspective of oxidative stress to explore the function change of erythrocytes after different storage time. This study is expected to provide experimental data for further clarifying the functional status of erythrocytes with different preservation time in patients with autotransfusion, achieving accurate infusion of erythrocytes and improving the therapeutic effect of autologous blood transfusion, which has important clinical application value.

Expert consensus on the diagnosis and treatment of myofascial pain syndrome.

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points and fascial constrictions. At present, domestic and foreign scholars have not reached a consensus on the etiology and pathogenesis of MPS. Due to the lack of specific laboratory indicators and imaging evidence, there is no unified diagnostic criteria for MPS, making it easy to confuse with other diseases. The Chinese Association for the Study of Pain organized domestic experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of MPS. This article reviews relevant domestic and foreign literature on the definition, epidemiology, pathogenesis, clinical manifestation, diagnostic criteria and treatments of MPS. The consensus is intended to normalize the diagnosis and treatment of MPS and be used by first-line doctors, including pain physicians to manage patients with MPS.

Clinical efficacy of ultrasound-guided pulsed radiofrequency combined with ganglion impar block for treatment of perineal pain.

BACKGROUND: Ganglion impar block alone or pulsed radiofrequency alone are effective options for treating perineal pain. However, ganglion impar block combined with pulsed radiofrequency (GIB-PRF) for treating perineal pain is rare and the puncture is usually performed with X-ray or computed tomography guidance. AIM: To evaluate the safety and clinical efficacy of real-time ultrasound-guided GIB-PRF in treating perineal pain. METHODS: Thirty patients with perineal pain were included and were treated by GIB-PRF guided by real-time ultrasound imaging between January 2015 and December 2016. Complications were recorded to observe the safety of the ultrasound-guided GIB-PRF procedure, and visual analogue scale (VAS) scores at 24 h before and after treatment and 1, 3, and 6 mo later were analyzed to evaluate clinical efficacy. RESULTS: Ultrasound-guided GIB-PRF was performed successfully in all patients, and no complications occurred. Compared with pretreatment scores, the VAS scores were significantly lower (P < 0.05) at the four time points after treatment. The VAS scores at 1 and 3 mo were slightly lower than those at 24 h (P > 0.05) and were significantly lower at 6 mo after treatment (P < 0.05). There was a tendency toward lower VAS scores at 6 mo after treatment compared with those at 1 and 3 mo (P > 0.05). CONCLUSION: Ultrasound-guided GIB-PRF was a safe and effective way to treat perineal pain. The 6-mo short-term clinical efficacy was favorable, but the long-term outcomes need future study.

Exploration on the effect of predeposit autotransfusion on bone marrow hematopoiesis after femoral shaft fracture.

OBJECTIVE: By observing the changes in the number and activity of CD34+ cells in bone marrow after predeposit autotransfusion (PAT) to patients with femoral shaft fracture (FSF), to evaluate the effects of PAT on hematopoietic function and hematopoietic stem cells in bone marrow. METHODS: Selected FSF patients were randomly divided into 2 groups: the control group (patients did not receive blood transfusion after surgery) and PAT group (patients received PAT after surgery). The content of RBC and Plt in blood samples were counted by blood routine. The cell cycle and proportion of CD34+ myelinated cells in blood samples was analyzed by flow cytometry. The telomere DNA length of hematopoietic stem cells (HSCs) in the control groups and PAT group at postoperation 24 was analyzed by southern blot. RESULTS: The content of RBC and Plt in postoperation 6h and 24h in the control group was evidently higher compared to that in PAT group, while Hb content in control group was significantly lower compared to that in PAT group. The proportion of CD34+ myelinated cells in post-transfusion 6h and postoperation 24h in PAT group was evidently higher compared to that in the control group. In PAT group, S phase at postoperation 24h was significantly larger compared to that at post-transfusion 6h. The telomere DNA length of HSCs in PAT group was longer than that in the control group. CONCLUSION: PAT can increase the number of HSC, while does not cause the abnormal aging of HSCs. PAT is suitable for postoperative blood transfusion of patients with FSF.

Effect and mechanism of inhibition of PI3K/Akt/mTOR signal pathway on chronic neuropathic pain and spinal microglia in a rat model of chronic constriction injury.

OBJECTIVE: To explore the effects of inhibition of PI3K/Akt/mTOR signal pathway on chronic neuropathic pain (CNP) and spinal microglia in a rat model of chronic constriction injury (CCI). METHODS: Male SD rats were assigned into control, sham, CCI, wortmannin, dimethyl sulfoxide (DMSO) and wortmannin-positive control groups. Paw withdrawal mechanical threshold (PWMT) and thermal withdrawal latency (TWL) were recorded. qRT-PCR and Western blotting were used to detect PI3K, Akt and mTOR expressions and their phosphorylation. OX-4 expression was detected by immunohistochemistry and glial fibrillary acidic protein (GFAP) and nerve growth factor (NGF) expressions by immunofluorescence. RESULTS: PWMT and TWL decreased in the CCI group than in the sham group on the 7th and 14th day after operation. Compared with the control and sham groups, the CCI group showed increased PI3K, Akt and mTOR mRNA expressions and elevated PI3K, p-Akt, p-mTOR and P70S6K protein expressions. More OX-42-positive cells and higher integrated optical density (IOD) of GFAP and NGF were found in the CCI group than the sham group at the 14th day after operation. Compared with the DMSO group, the wortmannin group had higher PWMT and TWL, decreased PI3K, Akt and mTOR mRNA expressions and reduced PI3K, p-Akt, p-mTOR and P70S6K protein expressions. Less OX-42-positive cells and lower IOD of GFAP and NGF were found in the wortmannin group than the DMSO group 14th day after operation. CONCLUSION: Inhibition of PI3K/Akt/mTOR signal pathway may alleviate CNP and reduce microglia and GFAP and NGF expressions in marrow in a rat model of CCI.

Effect of preemptive ketamine administration on postoperative visceral pain after gynecological laparoscopic surgery.

The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. Group 3 was intravenously injected with preincisional ketamine (0.3 mg/kg) and local infiltration with 20 mL ropivacaine (4 mg/mL) at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale (VAS) scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively (P<0.05 and P<0.01, respectively). At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1 (P<0.01). Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.

[Influence of inhaled anesthesia on bispectral index of elderly patients with cognitive decline].

OBJECTIVE: To investigate the influence of inhaled anesthesia on bispectral index (BIS) of elderly patients with cognitive decline at loss of consciousness and regain of consciousness, and on deepening of sedation. METHODS: The patients aged more than 65 years undergoing elective operations from January 2012 to September 2012 were recruited, then 60 cognitive intact patients and 60 cognitive decline patients were screened by mini-mental state examinations. Inhaled anesthesia was administered using sevoflurane. BIS's of the two groups at loss of consciousness and regain of consciousness, and during end-tidal concentration of sevoflurane (CETSev) changing from 0.7% to 2.8% were recorded. The data were compared with independent-samples t test and repeated-measures general linear model of ANOVA. RESULTS: In the study, 117 patients finshed the investigation, The BIS's of the cognitive decline group at loss of consciousness were significantly higher than those of the cognitive intact group (P<0.01). There were no significant differences at regain of consciousness between the two groups (P>0.05). The BIS's of the cognitive decline group during CETSev changing from 0.7% to 2.8% were significantly lower than those of the cognitive intact group (P<0.05). The BIS's of the cognitive decline group at CETSev 0.7%, 1.05%, 1.4% and 1.75% were significantly lower than those of the cognitive intact group (P<0.05), but there were no significant differences at CETSev 2.1%, 2.45% and 2.8% between the two groups (P>0.05). CONCLUSION: During inhaled anesthesia, the BIS of the elderly patients with cognitive decline at loss of consciousness is higher than that of the patients with cognitive intact, The BIS of elderly patients with cognitive decline on deepening of anesthesia is lower than that of the patients with cognitive intact, especially during light anesthesia, and its mechanisms may attribute to cognitive decline related neurodegeneration and neurotransmitter system dysfunction.

Use of ultrasound to facilitate femoral nerve block with stimulating catheter.

BACKGROUND: The adjunction of ultrasound to nerve stimulation has been proven to improve single-injection peripheral nerve block quality. However, few reports have been published determining whether ultrasound can facilitate continuous nerve blocks. In this study, we tested the hypothesis that the addition of ultrasound to nerve stimulation facilitates femoral nerve blocks with a stimulating catheter. METHODS: In this prospective randomized study, patients receiving continuous femoral nerve blocks for total knee replacement were randomly assigned to either the ultrasound guidance combined with stimulating catheter group (USNS group; n = 60) or the stimulating catheter alone group (NS group; n = 60). The primary end point was the procedure time (defined as the time from first needle contact with the skin until correct catheter placement). The numbers of needle passes and catheter insertions, onset and quality of femoral nerve blocks, postoperative pain score, and early knee function were also recorded. RESULTS: The procedure time was significantly less in the USNS group than in the NS group (9.0 (6.0 - 22.8) minutes vs. 13.5 (6.0 - 35.9) minutes, P = 0.024). The numbers of needle passes and catheter insertions were also significantly less in the USNS group. A greater complete block rate was achieved at 30 minutes in the USNS group (63.3% vs. 38.3%; P = 0.010). The postoperative pain score, the number of patients who required bolus local anesthetic and intravenous patient-controlled analgesia, and knee flexion on the second postoperative day were not significantly different between the two groups of patients. CONCLUSIONS: Ultrasound-assisted placement of a stimulating catheter for femoral nerve blocks decreases the time necessary to perform the block compared with just the nerve-stimulating technique. In addition, a more complete blockade is achieved using the ultrasound-assisted technique.

[Anesthesia for cesarean section in pregnancy complicated with severe scoliosis: a case report].

Scoliosis refers to a complex three-dimensional spine deformity. Onset of scoliosis can occur in an infantile, juvenile, adolescent, or adult period. Severe scoliosis not only affects the appearance of the patient, but also impairs the functions of circulation and respiratory systems. Significant changes of the cardiopulmonary function can occur during pregnancy. In this report, general anesthesia was needed for emergent cesarean section of the puerperant complicated with severe scoliosis. The puerperant had already suffered type II respiratory failure preoperatively. There might be managements of difficult airway, depression with circulation and respiration of the neonate, and the risk for inhibition of the uterine contraction and awareness. Facing the challenges, the anesthesiologists must work out a detail anesthesia plan quickly, and make sure the safety of the puerperant and the neonate.

A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol.

BACKGROUND: Early studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration. METHODS: Eighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mg x kg(-1) x h(-1) tramadol with no naloxone (group I, n = 20), 0.05 microg x kg(-1) x h(-1) naloxone (group II, n = 20), 0.1 microg x kg(-1) x h(-1) naloxone (group III, n = 20) and 0.2 microg x kg(-1) x h(-1) naloxone (group IV, n = 20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6, 12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers. RESULTS: Seventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P < 0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P < 0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P < 0.01). CONCLUSION: A small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.

Two-stage analysis of pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese patients.

BACKGROUND: Sufentanil is a suitable choice for target-controlled infusion (TCI) because of its shorter context-sensitive half-time. The current study was to estimate the pharmacokinetics of sufentanil TCI in Chinese patients using the two-stage analysis. METHODS: Twelve adult patients with American Society of Anesthesiologists (ASA) physical status I or II undergoing elective surgery under general anesthesia were included. Anesthesia was induced with propofol, rocuronium and sufentanil administered by TCI lasting for 30 minutes, with target effect-site concentration of sufentanil 4 or 6 ng/ml. Frequent arterial blood samples (1.5 ml) were taken during and up to 24 hours after sufentanil TCI. Before the end of surgery, another arterial blood sample (1.0 ml) was drawn for the blood-gas analysis. Plasma sufentanil concentrations were determined by liquid chromatography-tandem mass spectrometry (limit of quantitation was 5 pg/ml). The data were analyzed with the two-stage approach, linear regression and correlation analysis. RESULTS: The pharmacokinetics of sufentanil TCI were adequately described by a three-compartment model. The variables were derived as follows: the volume of central compartment (V(1)) was 5.4 L, volume of distribution at steady-state (Vdss) was 222.6 L, metabolic clearance (Cl(1)) was 0.84 L/min and elimination half-life (t(1/2Y)) was 389 minutes. Patients' age, gender and PaCO2 correlated significantly with the pharmacokinetic parameters. The Vdss, volume of slowly equilibrating compartment (V(3)) and t(1/2Y) increased, and rapid distribution clearance (Cl(2)) decreased with increasing patient age. Male patients had larger values of Vdss, volume of rapidly equilibrating compartment (V(2)) and V(3) than female patients. The Vdss and V(3) increased with higher PaCO2 values. There were no significant correlations between the pharmacokinetic variables and body weight, height, lean body mass, plasma albumin, sufentanil dose, duration of surgery, pH or base excess of blood (BE-B). CONCLUSIONS: The pharmacokinetics of sufentanil TCI in Chinese patients can be optimally described by a three-compartment model. The pharmacokinetic analysis technique may affect the pharmacokinetic parameters and correlations.

[Effect of 17beta-estradiol on myocardial inducible NOS and endothelial NOS activities after ischemia-reperfusion in rat heart model].

OBJECTIVE: To study the effect of 17beta-estradiol (E(2)) on myocardial inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) activities of ischemia-reperfusion myocardium in rat model. METHODS: 40 Langendorff perfused hearts isolated from bilateral ovariectomy (OVX) rat were randomly divided into four groups: control group (Group C), in which hearts were reperfused ex vivo for 15 minutes before ischemia in rat; ischemia-reperfusion control (Group I-R), in which modified St. Thomas II cardioplegic solution was perfused to perform the ischemia-reperfusion; dissolved control group (Group D), in which 0.1% dimethyl sulfoxide (DMSO) was dissolved in cardioplegic solution; E(2) group (Group E), in which 0.1% DMSO and 5 micromol of E(2) were dissolved in cardioplegic solution. Myocardial iNOS and eNOS activities were detected before and after reperfusion. Creatine phosphokinase (CPK), lactic dehydrogenase (LDH) and nitric oxide (NO) of coronary flow were measured, and heart function was evaluated to observe the effect of E(2) on myocardial ischemia-reperfusion injury (MIRI). RESULTS: Myocardial eNOS activity declined (P < 0.01) and iNOS activity increased after ischemia-reperfusion (8.87 +/- 3.74 nmol/min/g in Group C, 15.83 +/- 2.42 nmol/min/g in Group I-R, 17.60 +/- 5.21 nmol/min/g in Group E; P < 0.01), moreover, iNOS activity was much higher in Group E (25.85 +/- 5.21 nmol/min/g, P < 0.01). NO production was lower in Group I-R and Group D (P < 0.05), and higher in Group E (30.96 +/- 4.91 micromol/L in Group C, 33.16 +/- 5.57 micromol/L in Group E; P < 0.01). CPK and LDH were lower in Group E (P < 0.05). Recovery of heart function was better in Group E (P < 0.05). CONCLUSIONS: E(2) can relieve the injury of MIRI and promote heart function recovery by increasing iNOS activity and NO production.