The effect and safety assessment of monitoring ethanol concentration in exhaled breath combined with intelligent control of renal pelvic pressure on the absorption of perfusion fluid during flexible ureteroscopic lithotripsy.

PURPOSE: Previously, we designed a ureteral access sheath with the capability of renal pelvic pressure (RPP) measurement and a medical perfusion and aspiration platform, allowing for the intelligent control of RPP. However, the effect of different RPP levels on perfusion fluid absorption remains unclear. This randomized controlled trial aimed to investigate the effects of exhaled ethanol concentration monitoring and intelligent pressure control on perfusion fluid absorption during flexible ureteroscopic lithotripsy. METHODS: Eighty patients scheduled for flexible ureteroscopic lithotripsy were randomly divided into four groups. In groups A, B, and C, the RPPs were set at 0, - 5, and - 10 mmHg, respectively. Group D was regarded as the controls with unfixed RPP. Isotonic saline containing 1% ethanol was used as the irrigation fluid, with an average irrigation flow rate of 100 mL/min. The primary outcome of this study was the absorption of perfusion fluid that was calculated based on the exhaled ethanol concentration. The secondary outcomes included duration of operation and amounts of perfusion fluid used. Postoperative complications, pre- and postoperative renal function, infection markers, and blood gas analysis were also recorded for safety assessment. RESULTS: In all, 76 patients were involved in this study, whose demographic characteristics and preoperative conditions were comparable among groups. Under the same perfusion flow rate, the groups with fixed RPP exhibited reduced absorption of perfusion fluid, duration of operation, and perfusion volume. In particular, the lowest values were observed in group C (RPP = - 10 mmHg). In contrast to the unfixed RPP group, no considerable difference were observed in levels of BUN, Scr, WBC, CRP, and blood gas values among the fixed RPP groups. Moreover, postoperative complications showed no significant difference among groups. CONCLUSION: In flexible ureteroscopic lithotripsy, the groups with fixed RPP had less absorption of perfusion fluid and perfusion volume, shorter duration of surgery, and higher safety than the unfixed group.

[Protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer].

OBJECTIVE: To study the protective effect of dexmedetomidine against perioperative inflammation and on pulmonary function in patients undergoing radical resection of lung cancer. METHODS: From May, 2014 to May, 2016, 124 patients with lung cancer receiving radical surgeries were randomized into experimental group (n=62) and control group (n=62). The patients in the control group received a single anesthetic agent for anesthesia, and additional dexmedetomidine was given in the experimental group. The levels of serum interleukin-1ß (IL-1ß), IL-10, and tumor necrosis factor-alpha (TNF-α) were measured before the operation (T0), at 30 min (T1) and 60 min (T2) during one lung ventilation (OLV) and at the end of operation (T3). Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of malondialdehyde (MDA), myeloperoxidase (MPO) and xanthine oxidase (XOD), and the arterial oxygen partial pressure (PaO2), oxygenation index (OI), airway plateau pressure (APP) and airway resistance (AR) were also recorded. RESULTS: At the time points of T1 and T2, IL-1ß, IL-10, MDA, MPO, TNF-α, and XOD levels were significantly increased in both of the groups, but the levels of IL-1, IL-10, TNF-α and MDA were significantly lower and MPO and XOD levels significantly higher in the experimental group than in the control group (P<0.05). In both groups, PaO2 and OI decreased and APP and AR increased significantly at T1 and T2, but APP and AR were significantly lower and PaO2 and OI significantly higher in the experimental group than in the control group (P<0.05). CONCLUSION: Anesthesia with dexmedetomidine in lung cancer patients undergoing radical surgery can effectively reduce the inflammatory response of the lungs and protect the lung function of the patients.

[Role of vanilloid receptors in thermal hyperalgesia induced by intraplantar endothelin-1 administration].

OBJECTIVE: To assess the role of vanilloid receptor (VR) in thermal hyperalgesia induced by intraplantar endothelin-1 (ET-1) injection. METHODS: VR gene-knockout mice (KO group) and wild type C57BL/6J mice (WT group) in 3 subgroups were subjected to intraplantar administration of ET-1 at the doses of 3, 10, 30 and 100 pmol (dissolved in 10 microl of PBS, pH 7.4, n=6 in each group), respectively. The latency time of paw withdrawal (PWT) from heat irradiation stimulation was recorded before injection and 15, 30, 45 and 60 min after injection. RESULTS: ET-1 induced thermal hyperalgesia in both groups. The mice in WT group showed a more sharply shortened PWT than those in KO group. ET-1 decreased PWT as the dose administered increased in WT group, which was different from the responses of the KO mice. At the dose of 100 pmol of ET-1, no further decrement of latency time was observed in WT group, whereas such response occurred at 30 pmol in KO group. CONCLUSION: Intraplantar injection of ET-1 induces thermal hyperalgesia mediated partially by VR.