Effect of dual-acupoint and single-acupoint electric stimulation on postoperative outcomes in elderly patients subjected to gastrointestinal surgery: study protocol for a randomized controlled trial.

BACKGROUND: Transcutaneous electric acupoint stimulation (TEAS) has shown benefits when used peri-operatively. However, the role of numbers of areas with acupoint stimulation is still unclear. Therefore, we report the protocol of a randomized controlled trial of using TEAS in elderly patients subjected to gastrointestinal surgery, and comparing dual-acupoint and single-acupoint stimulation. METHODS/DESIGN: A multicenter, randomized, controlled, three-arm design, large-scale trial is currently undergoing in four hospitals in China. Three hundred and forty-five participants are randomly assigned to three groups in a 1:1:1 ratio, receiving dual-acupoint TEAS, single-acupoint TEAS, and no stimulation, respectively. The primary outcome is incidence of pulmonary complications at 30 days after surgery. The secondary outcomes include the incidence of pulmonary complications at 3 days after surgery; the all-cause mortality within 30 days and 1 year after surgery; admission to the intensive care unit (ICU) and length of ICU stay within 30 days after surgery; the length of postoperative hospital stay; and medical costs during hospitalization after surgery. DISCUSSION: The result of this trial (which will be available in September 2019) will confirm whether TEAS before and during anesthesia could alleviate the postoperative pulmonary complications after gastrointestinal surgery in elderly patients, and whether dual-acupoint stimulation is more effective than single-acupoint stimulation. TRIALS REGISTRATIONS: ClinicalTrials.gov, ID: NCT03230045 . Registered on 10 July 2017.

[Effect of assisted anesthesia of auricular point magnetic sticking on postoperative recovery of gynecological surgery].

OBJECTIVE: To explore an optimum method on postoperative recovery of general-anesthesia gynecological laparoscopic surgery. METHODS: One hundred and twenty cases of gynecological laparoscopic surgery were randomly divided into three groups, 40 cases in each one. The sensitive points of bilateral Shenmen (TF4), Zigong (TF2), Wei (CO4), Dachang (CO7) and so on were selected in all three groups one night before the surgery. The sticking with magnetic beads was applied in the group A. The magnetic beads were in-pair stuck at front-back corresponding location of both ears in the group B. The same-appearance plaster was put at the corresponding acupoints in the group C. The intubation anesthesia was applied in all three groups and postoperative recovery of gynecological laparoscopic surgery was observed. RESULTS: The postoperative visual analogue scale (VAS) was (1.77 +/- 1.65) in the group A and (1.80 +/- 1.96) in the group B, which was both lower than (2.62 +/- 1.46) in the group C (both P < 0.01). The occurrence rate of nausea and vomiting was 25.0% (9/36) in the group A and 20.0% (8/40) in the group B, which was both lower than 50.0% (19/38) in the group C (both P < 0.01). The recovery of borborygmus on postoperative 1st and 3rd day in the group A and B was faster than that in the group C (both P < 0.05), while time of fart and defecation in the group A and B was earlier than that in the group C (both P < 0.05). The score of state-trait anxiety inventory in the group A and B was lower than that in the group C (both P < 0.05), but the differences of each item between the group A and B were not obvious (both P > 0.05). CONCLUSION: The auricular point sticking could support analgesia of general-anesthesia gynecological laparoscopic surgery, which could relieve anxiety mood, reduce occurrence of nausea and vomiting and improve function of stomach and intestine to benefit postoperative recovery. However, the effect of in-pair sticking of auricular point with magnetic beads at front-back acupoints was not obviously strengthened.

[Effects of electroacupuncture preconditioning at "Neiguan" (PC 6) on gene expression of myocardial opioid receptors in rats with myocardial ischemia-reperfusion injury].

OBJECTIVE: To explore the protective effects of electroacupuncture preconditioning at "Neiguan" (PC 6) on myocardial ischemia reperfusion injury (MIRI) and the mechanism. METHODS: Forty-eight male Wistar rats were randomly divided into a sham operation group (group N), a MIRI group (group M) and an electroacupuncture group (group E). The MIRI model was generated by ligating the left anterior descending artery (LAD) for 30 min followed by reperfusion for 120 min. The partition sutures in group N were passed under the LAD without ligation. The rats in group E were pretreated with electroacupuncture applied at bilateral "Neiguan" (PC 6) for 20 min once a day on 3 consecutive days before ischemia. The area at risk and infarct size and the serum levels of CK-MB and LDH were measured. The morphological changes were observed by light microscopy. The mRNA expressions of delta and kappa opioid receptor (DOR and KOR) were determined by real-time RT-PCR. RESULTS: The myocardial infarct size in group E was significant smaller than that in group M (P < 0.05). The contents of CK-MB and LDH were (980 +/- 92) U/L and (2 743 +/- 124) U/L in group M which were significant higher than (312 +/- 41) U/L and (530 +/- 56) U/L in group N (both P < 0.01) and (572 +/- 70) U/L and (1 819 +/- 97) U/L in group E (both P < 0.01). The mRNA expressions of DOR and KOR had no significant difference between group M and N (both P > 0.05), while the DOR expression in group E was significant higher than that in group M and N (both P < 0.01). There was no significant difference in KOR expression among three groups (all P > 0.05). CONCLUSION: The cardiac protective effects of electroacupuncture preconditioning at "Neiguan" (PC 6) on MIRI may be mediated by increasing expression of delta opioid receptor in myocardium.

[Effects of magnetic auricular point-sticking on adjuvant anesthesia and postoperative recovery of body function].

OBJECTIVE: To prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function. METHODS: Ninety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed. RESULTS: As compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05). CONCLUSION: The magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

[Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion].

OBJECTIVE: To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion. METHODS: Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups (n=20). Neuromuscular blockade was monitored using train-of-four (TOF) stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch (T1) < or = 5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index (RI), and the time interval from termination of infusion cisatracurium to recovery of TOF ratio (TOFR) to 0.9. RESULTS: With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group (P<0.05), and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups (P>0.05). CONCLUSION: During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.

Early administration of propofol protects against endotoxin-induced acute lung injury in rats by inhibiting the TGF-beta1-Smad2 dependent pathway.

OBJECTIVE: To assess the effects of propofol treatments at different time points on acute lung injury and on the expression of transforming growth factor (TGF)-beta1 and the downstream target of TGF-beta1, Smad 2, in the lung tissues in the endotoxic rats. METHODS: Seventy-six Wistar rats were randomly assigned to five groups: control group (saline only), endotoxemic group [lipopolysaccharide (LPS) 8 mg kg(-1), i.v.], and three propofol-treated groups. For the propofol-treated groups, propofol (5 mg kg(-1), i.v. bolus) was administered either 1 h before LPS, simultaneously with LPS, and 1 h after LPS, and all were followed by infusion of 10 mg kg(-1) h(-1) of propofol for 5 h after LPS. Lung tissues were sampled to measure myeloperoxidase activity and expression of TGF-beta1 and Smad2 and to assess pulmonary microvascular permeability and histopathological changes. RESULTS: The hemodynamics, arterial blood gases, 5 h survival rate, pulmonary microvascular permeability, and acute lung injury scores were significantly better, and expression of TGF-beta1 and Smad2 and myeloperoxidase activity in lung tissues was significantly lower in the pretreatment and simultaneous treatment groups compared to the endotoxemic group. However, there were no significant differences in all observed variables between the endotoxemic and postreatment groups. Except for TGF-beta1 expression in lung tissues, the other observed variables were also not significantly different between the pretreatment and simultaneous treatment groups. CONCLUSIONS: In the endotoxic rat model, pretreatment and simultaneous treatment with propofol provided protection against acute lung injury by inhibiting the TGF-beta1-Smad2 dependent pathway.

Effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock and infection.

BACKGROUND: To investigate the effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock (HS) followed by mimicked infection. METHODS: Sixty Sprague-Dawley rats were randomly assigned to one of the five groups (n = 12 per group) to receive the following treatments: (1) control group (group C), surgery, no hemorrhage, and no resuscitation; (2) no fluid resuscitation group; (3) lactated Ringer's solution group; (4) 7.5% hypertonic saline (HTS) group; and (5) hydroxyethyl starch group (group HES). All experimental groups were subjected to three phases: phase I entailed massive hemorrhage with a mean arterial pressure of 35 mm Hg to 40 mm Hg for 60 minutes by tail amputation and followed by mimicked infection by intratracheal administration of lipopolysaccharide 2 mg/kg. The animals in each group were then partially resuscitated with the fluid assigned to the group. Phase II of 60 minutes commenced at tail ligation, involved hemostasis, and return of all the blood initially shed. Phase III was an observation phase with no any further treatment and lasted for 3.5 hours. The survival rate at the end of the phase III was recorded. After phase III, arterial blood gases were recorded. The wet to dry lung weight ratio, pulmonary microvascular permeability, the expression of transforming growth factor (TGF)-beta1, and Smad2 were determined. The lung histology was also assessed. RESULTS: HES and HTS solutions were more effective than no fluid resuscitation and lactated Ringer's solution in reducing the detrimental effects of HS and infection on the lungs, as seen by the significantly lower pulmonary microvascular permeability and wet to dry lung weight ratio, the improved arterial blood gases and lower levels of TGF-beta1and Smad2 expression in lung tissues. These beneficial effects were most pronounced in the group HES. CONCLUSIONS: This study demonstrated that resuscitation with HTS and especially with HES could reduce lung tissue damage and pulmonary edema after severe uncontrolled HS. The TGF-beta1/Smad2 signaling pathway might play a key role in regulation of pulmonary permeability and formation of pulmonary edema in a rat model of uncontrolled HS and infection.

[Effects of different fluid resuscitation regimes on lung injury and expression of pulmonary aquaporin 1 and aquaporin 5 in uncontrolled hemorrhagic shock in rats].

OBJECTIVE: To investigate the effects of different fluid resuscitation regimes on lung injury and expression of pulmonary aquaporin 1 (AQP1) and AQP5 in rats with uncontrolled hemorrhagic shock. METHODS: Sixty Sprague-Dawley (SD) rats were randomly assigned to the following five groups: control group (C group), no fluid resuscitation group (NF group), lactated Ringer's solution group (LRS group), 7.5%NaCl group (HS group) and hydroxyethyl starch group (hydroxyethyl starch 130/0.4, HES group). A four-phased uncontrolled hemorrhagic shock model was reproduced. Uncontrolled hemorrhagic shock phase began with blood withdrawal extended over 15 minutes, in which animals were subjected to massive hemorrhage [mean arterial pressure (MAP)=40 mm Hg (1 mm Hg=0.133 kPa)] for 60 minutes and followed by intratracheal lipopolysaccharide 2 mg/kg and continuous bleeding with amputation of the tail. Then, animals were partially resuscitated with LRS of 3 times the volume of shed blood (LRS group), followed by a bolus dose of 4 ml/kg body weight of 7.5%NaCl (HS), or hydroxyethyl starch (a volume equal to that of the shed blood), respectively, during different fluid resuscitation regimes. After that, comprehensive resuscitation phase of 60 minutes began with hemostasis, and transfusion of all the shed blood plus same amount of normal saline. Observation phase was continued for 3.5 hours. At the end the experiment, the lung tissue was sampled to measure wet-to-dry lung weight ratio (W/D), and the expression of AQP1 and AQP5 were determined with immunohistochemistry. The paraffin-embedded lungs were stained with hematoxylin and eosin for pathological analysis. RESULTS: When compared with NF and LRS groups, the lung W/D ratio was significantly decreased, and the shock induced decreased expression of AQP1 and AQP5 in lung tissue were attenuated in HES group, but these beneficial effects were blunted in the HS group. CONCLUSION: Uncontrolled hemorrhagic shock may induce lung injury and pulmonary edema as well as down regulation of the expression of AQP1 and AQP5 in rats. Resuscitation with hypertonic fluids, especially with HES, can reduce lung damage and pulmonary edema in this kind of shock. The cause may be due in part to maintenance of the expression of AQP1 and/or AQP5 in the lung. Pulmonary AQP1 and AQP5 play an important role in fluid transportation.

[Changes in pulmonary transforming growth factor-beta1/smad2 signaling pathway in a two-hit pulmonary injury as a result of uncontrolled hemorrhagic shock and lipopolysaccharide in rats].

OBJECTIVE: To investigate the changes in pulmonary transforming growth factor-beta1 (TGF-beta1)/smad2 signaling pathway in pulmonary injury as a result of hemorrhagic shock followed by lipopolysaccharide challenge. METHODS: Twenty-four Sprague-Dawley (SD) rats were randomly assigned to the following two groups: sham operation group (sham group, surgery, no hemorrhage and no resuscitation), and two-hit model group (HS group), each n=12. Three-phased uncontrolled hemorrhagic shock model was reproduced in rats. Hemorrhagic shock phase I began with blood withdrawal over 15 minutes, i.e. animals were subjected to massive hemorrhage [mean arterial pressure (MAP)=35-40 mm Hg (1 mm Hg=0.133 kPa) for 60 minutes], followed by intratracheal lipopolysaccharide 2 mg/kg (two-hit model). Ninety minutes after blood shedding, resuscitation phase II of 60 minutes began with hemostasis, return of all the blood initially shed, plus fluids. Observation phase III was 210 minutes. After phase III, blood gas analysis with carotid artery blood was performed. Lung tissue was sampled to measure values of wet-to-dry lung weight (W/D) ratio and pulmonary microvascular permeability. Immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to assess the expression of TGF-beta1 protein and mRNA, and the protein content of the smad2 was determined by Western blotting. RESULTS: Compared with sham group, MAP was significantly lowered after 60 minutes in phase I, and lactic acid content was increased significantly, while partial pressure of oxygen in artery (PaO2), blood pH, HCO(-)3, arterial oxygen saturation (SaO2) and negative base excess (BE) showed a significant decrease in HS group. Concomitantly, values of pulmonary microvascular permeability and W/D ratio were significantly increased in HS group (all P<0.01). In sham group, weak TGF-beta1 staining was detected in the alveolar epithelial cells. However, intense positive immunostaining for TGF-beta1 was observed in alveolar epithelial cells, pulmonary interstitial inflammatory cell as well as macrophage cells of alveolar space of the HS group. Lung tissue in HS group demonstrated a marked increase in TGF-beta1 mRNA and smad2 protein expression in the lung tissue compared with those of sham group (all P<0.01). CONCLUSION: The expression of TGF-beta1/smad2 signaling pathway may play an important role in regulation of pulmonary permeability and development of pulmonary edema in acute lung injury induced by uncontrolled hemorrhagic shock followed by lipopolysaccharide challenge.

[Effects of propofol on the changes in cytoskeleton and cellular permeability of human umbilical vascular endothelial cells monolayer induced by lipopolysaccharide].

OBJECTIVE: To investigate the effects of propofol on the changes in actin cytoskeleton and permeability of cultured human umbilical vascular endothelial cells (HUVECs) monolayer induced by lipopolysaccharide (LPS). METHODS: HUVECs were randomly assigned to one of the following seven groups: no additives (negative control), LPS alone (1 mg/L and 10 mg/L), propofol alone (4 mg/L), introlipid alone, LPS (10 mg/L ) combination with propofol (4 mg/L) and LPS (10 mg/L ) together with introlipid (4 mg/L). Changes in filtration coefficients (Kf) and osmotic reflection coefficients (sigma) were measured, and changes in filamentous actin (F-actin) measured by F-actin fluorometry, and expression of nitrotyrosine analyzed by immunocytochemistry were observed in cultured HUVECs. RESULTS: Compared with the control group, the LPS alone group Kf values were significantly increased and the sigma values decreased,the F-actin content was decreased and the expression of nitrotyrosine was increased (all P<0.01), especially in the high dose LPS alone group. The co-treatment of propofol and LPS significantly reduced levels of LPS-enhanced nitrotyrosine protein, and significantly attenuated the changes in Kf and sigma values (all P<0.01), while introlipid group had no such beneficial effects. CONCLUSION: Propofol rather than introlipid, significantly inhibit LPS-induced increase in permeability of HUVECs and alterations in F-actin organization. The scavenging actions of propofol on peroxynitrite may be helpful to attenuate endothelial barrier dysfunction as shown in our current study.

[Effects of scalp acupuncture on regulative ability of oxidative stress reaction at operation stage].

OBJECTIVE: To study on regulative action of scalp acupuncture on oxidative stress reaction at operation stage. METHODS: Fifty two cases selected for radical operation of intestinal cancer were randomly divided into a scalp acupuncture plus general anesthesia (scalp acupuncture group) and a simple general anesthesia group (general anesthesia group), 26 cases in each group. The scalp acupuncture group were treated first with scalp acupuncture for 20 min, followed by general anesthesia, with scalp acupuncture lasted till the end of operation. The general anesthesia group were treated only with simple intratracheal anesthesia. Effects of scalp acupuncture on malondialdehyde (MDA) level and superoxide dismutase (SOD) activity at the operation stage were observed. RESULTS: After operation, MDA levels decreased significantly (P < 0.05) in the two groups, but with no difference between the two groups in the different values of MDA before and after treatment (P > 0.05); there was no significant change in SOD before and after treatment in the scalp acupuncture group, and significantly decreased in the general anesthesia group (P < 0.05). There was a significant difference between the two groups in the different value of SOD before and after the operation (P < 0.05). CONCLUSION: Scalp acupuncture can inhibit the decrease of SOD activity, reducing oxidative stress reaction at operation stage.

[Role of acupuncture anesthesia in operation of rectal cancer].

OBJECTIVE: To observe analgesic effect of acupuncture anesthesia. METHODS: Sixty-nine cases undergoing rectal cancer surgery were randomly divided into 3 groups, group I, II and III, 23 cases in each group. Both Zusanli (ST 36) and Sanyinjiao (SP 6) were selected for acupuncture anesthesia. Group I received general anesthesia after acupuncture induction, group II received acupuncture after general anesthesia, and group II received only general anesthesia. Minimum alveolar concentration (MAC) before and after operation was recorded. RESULTS: MAC was (1.35 +/- 0.19) vol% in the group I, (1.49 +/- 0.22) vol% in the group II and (1.64 +/- 0.27) vol% in the group III. Acupuncture before and after general anesthesia could decrease respectively by about 0.29% and 0.15% of MAC in rectal cancer surgery undergoing general anesthesia, with a very significant difference (P < 0.01) or a significant difference (P < 0.05) among the 3 groups. CONCLUSION: Acupuncture anesthesia has a certain adjuvant action for anesthesia and analgesia, and acupuncture before general anesthesia has a better action.