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Objective To determine the 50％ minimum effective concentration (EC50) of ropivacaine for postoperative analgesia after shoulder arthroscopy under general anesthesia combined with interscalene brachial plexus block.Methods Patients undergoing selective shoulder arthroscopy were included in this study.There were 9 males and 13 females,BMI 18-28 kg/m2,falling into ASA physical status Ⅰ or Ⅱ.The interscalene brachial plexus block was achieved under the guidance of ultrasound and nerve stimulator at the level of C6.The upper trunk of interscalene brachial plexus was blocked with 5 ml ropivacaine.The concentration of ropivacaine intially was 0.5 ％ and then depended on the response of the previous patient's postoperative NRS scale.The target ropivacaine concentration was determined by up and down sequential method.The ratio of two consecutive ropiva caine was 1.2.Two termination conditions were,firstly,to achieve seven negative-positive up-anddown deflections required to calculate EC50,and secondly,to deriminate if 7 were positive outcomes using 5 ml of 0.1 ％ ropivacaine or 7 were negative outcomes using 5 ml of 1 ％ ropivaciane.EC50 and 95％CI of ropivacaine was calculated using the formula of Dixon-Massey sequential method.The incidence of hemidiaphragmatic paresis was evaluated.Pre-and post-operative pulmonary function was compared using paired t test.Results The EC50 of ropivacaine was 0.21％ (95 ％CI 0.18％-0.25 ％).The incidence of hemidiaphragmatic paresis was 9 cases(40.90％).Postoperative FVC and FEV1/FVC was significantly decreased than preoperative,but FEV1 (P =0.116) was not.Conclusion For patients undergoing shoulder arthroscopy under general anesthesia and interscalene brachial plexus block,the minimum effective concentration of ropivacaine for analgesia of EC50 is 0.21％,95％ CI 0.18％-0.25％.
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<p><b>OBJECTIVE</b>To observe effects of on hepatocarcinoma (HCC) cell vasculogenic mimicry (VM) and explore the molecular mechanism by which inhibits HCC metastasis and invasion.</p><p><b>METHODS</b>Forty male SD rats were randomly divided into 4 groups for gastric lavage of normal saline or high, moderate or low doses of (twice daily) for 4 consecutive days. The sera were collected from the rats for treatment of cultured human HCC HepG2 cells. VM formation in the cells was detected using an image acquisition and analysis system 24 h after incubation of the cells with the sera and with the RhoA/ROCK inhibitor Y-27632(P). The expression levels of RhoA and ROCK1 in the cells were detected using Western blotting, and the contents of VE-cadherin and PI3K in the culture supernatant were determined using ELISA.</p><p><b>RESULTS</b>Treatment with the sera from -treated rats significantly inhibited formation of VM in HepG2 cells, and the diameters of VM formed were significantly greater than those in the positive control group ( < 0.01). Y-27632 completely inhibited the formation of VM in HepG2 cells ( < 0.01). Treatments with and Y-27632 both inhibited the expression of RhoA and ROCK1 ( < 0.05) and significantly lowered the contents of VE-cadherin and PI3K in the culture supernatant ( < 0.05).</p><p><b>CONCLUSIONS</b> can inhibit the formation of VM in HCC cells possibly by inhibiting the RhoA/ROCK pathways and the expressions of VE-cadherin and PI3K.</p>
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AIM To study the effects of Biejiajian Pills (Colla Carapacis Trionycis,Asini Corii Colla,Nidus Vespae,etc.) on NF-κB,p65,p50 and IκB in NF-κB signaling pathway and target gene expression in HSC-T6 cells of rats.METHODS HSC-T6 cells were cultured with Biejiajian Pills drug serum for 24 hours,the expressions of p65,p50,VEGF and TIMP-1 mRNA were determined by qPCR;the expression of p65 was measured by immunofluorescence;the expressions of IκBα,IκBβ and α-SMA were determined by Western blot.RESULTS The Biejiajian Pills middle-,high-dose and positive control groups showed significantly lower expressions of p65,VEGF and TIMP-1 mRNA as compared with the blank control group and negative control group,the expressions of p50 mRNA among various groups showed no significant differences.But immunofluorescence showed that the expression of p65 in cytoplasm was decreased.Meanwhile,Biejiajian Pills showed significantly higher IκBα protein expression and obvious down-regulation of α-SMA expression in a dose-dependent manner,but had no significant influence on the expression of IκBβ.CONCLUSION Biejiajian Pills' therapeutic effects on hepatic fibrosis may be related to influencing NF-κB signaling pathway and inhibiting the expression of down-stream target gene.
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Objective To investigate the current situation of perioperative pain treatment and management using questionnaire survey.Methods A questionnaire was designed by ourselves and sent to anesthesiologists in each hospital all over China via the WeChat platform within 1 month.The system automatically recorded the situation of questionnaires.Results A total of 8 447 anesthesiologists involved in the investigation,the number of valid questionnaires retrieved was 6 778,anesthesiologists in the survey came from 847 hospitals in China,distributing across China 31 provinces and cities,and there were 526 tertiary hospitals (62.1％) and 321 hospitals under tertiary grade (37.9％).Among the medication for perioperative analgesia (not including medication for anesthesia),the following analgesics (applied alone or in combination) were used by anesthesiologists,and the application rate was as follows:opioids 79.74％,nonsteroidal anti-inflammatory drugs 53.78％,paracetamol 25.76％,local analgesics for analgesia (for nerve blockade) 25.44％,other drugs (such as ketamine,gabapentin) 12.39％;combination of two or more drugs 63.65％.Six hundred forty-nine hospitals (76.6％) carried out therapy with analgesic pump after operation,and the constituent ratio of hospitals using patient-controlled analgesia (PCA) pump was 43.8％.Four hundred seventy-five hospitals (56.1％) established Acute Pain Service (APS),the organizing rate of APS was significantly higher in tertiary hospitals than in hospitals under tertiary grade (P＜ 0.01),and the majority of APS personnel was anesthesiologists (72.4％).Conclusion Multimodal analgesia and PCA technique are not widely adopted and the requirement for non-steroidal anti-inflammatory drugs and nerve blockade is lower in perioperative pain treatment in China;analgesic pump is widely used after operation,but the application rate of PCA technique is not high;APS establishment is relatively weak in pain management and anesthesiologists play a leading role in APS.
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Objective To investigate the effect of different dose of dexmedetomidine for pre-venting the visceral traction reaction during caesarean section under spinal anesthesia.Methods Two hundred ASA physical status Ⅰ-Ⅱ patients,full-term primiparas scheduled for elective cesarean sec-tion were enrolled in this randomized,placebo-controlled study.Patients were randomly allocated to receive dexmedetomidine in four groups:group C (0.9% normal saline),group D1(dexmedetomidine 0.6 μg/kg),group D2(dexmedetomidine 0.8 μg/kg),group D3 (dexmedetomidine 1.0 μg/kg),50 cases in each group.Two minutes after cutting umbilical,groups D1,D2,D3 received an intravenous infusion single-dose of 0.6,0.8,1.0 μg/kg dexmedetomidine respectively for 10 minutes.Group C was injected the same dose of saline.Maternal blood pressure (BP),heart rate (HR),Ramsay scores,visceral traction reaction conditions were recorded at three points:before iv (T0 ),10 min af-ter iv (T1 )and abdominal exploration (T2 ).Results As for the inhibition of visceral traction pain, groups D2 and D3 were obviously better than groups D1 and C,and there was no statistically signifi-cant difference between groups D2 and D3 at T2 (P <0.05 ).The effects of slowing down heart rate and increasing blood pressure were weaker in group D2 than that in group D3 at T2 .Ramsay scores were higher in groups D2 and D3 than in groups D1 and C (P <0.05),and there was no significant difference between groups D2 and D3 at T2 .Conclusion Administration of dexmedetomidine 0.8 μg/kg could alleviate the visceral traction reaction and had little effect on maternal hemodynamics.
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Objective To evaluate the characteristics of quantitative monitoring of brain function during the perioperative period in elderly patients and its relationship with postoperative cognitive dysfunction (POCD).Methods Seventy ASA physical status Ⅰ or Ⅱ patients,aged ≥ 60 yr,scheduled for elective lumbar spine decompression and fusion surgery under general anesthesia,having an expected postoperative length of hospital stay ≥ 7 days,were enrolled in the study.The cognitive function was assessed by using Mini-Mental State Examination before operation and the results were normal.Fifty healthy elderly volunteers were chosen and served as control group.Cognitive function was assessed at l day before operation (D0) and 3 (D3) and 7 days after operation (D7).Z score was used to identify POCD.All the patients were then divided into POCD group or control group (group C) according to the results of diagnosis.Quantitative monitoring of brain function was carried out using a traction system,and the wavelet index (WLI),i_22 and i_20 were recorded.Results A total of 67 patients completed the study and were enrolled in the analysis,there were 9 cases in group C,and 58 cases in group POCD.The WLI was significantly decreased at D7,and no significant change was found in WLI at D3 as compared with the value at D0.The WLI was significantly lower at D7 than at D3.There was no significant difference in i_22 and i_20 between the three time points.Compared with group C,i_22 was significantly decreased at D0,and no significant change was found in i_22 at the other time points and in WLI at each time point in POCD group.Conclusion During quantitative monitoring of brain function during the perioperative period in the elderly patients,WLI is significantly decreased on 7th day postoperatively,and no significant change is found in i_20 and i_22,however,the pre-operative low i_22 value can predict the development of POCD.
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Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postoperative analgesia in patients undergoing inguinal hernia repair.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-79 yr,with body mass index ＜ 30 kg/m2,scheduled for elective unilateral inguinal hernia repair combined spinal-epidural anesthesia,were randomly divided into 2 groups (n =20 each):control group (group C) and ultrasound-guided TAP block group (group B).The ultrasound-guided TAP block was performed at the end of surgery and 20 ml of 0.375 ％ ropivacaine was injected in group B,while the equal volume of normal saline was given in group C.Tramadol was injected intravenously when VAS score ≥ 4 after surgery.VAS scores at rest and during activity were recorded at 4,6,24 and 48 h after surgery.The warm block plane on the blocked side was measured at 24 and 48 h after surgery.The overall satisfaction on analgesia was scored and the time when the patients passed the flatus was recorded.TAP block-related side effects were recorded.Results Four patients required tramadol in group C,while no patients required rescue analgesic in group B.Compared with group C,VAS scores were significantly decreased,the overall satisfaction scores were increased (P ＜ 0.05 or 0.01),and no significant change was found in the time when the patients passed the flatus in group B (P ＞ 0.05).The rate of warm plane block on the blocked side was 80％ at 24 h after surgery and there was not warm block plane in patients at 48 h after surgery in group B.There was not warm block plane in patients at 24 and 48 h after surgery in group C.TAP block-related side effects were not found in group B.Conclusion The efficacy of ultrasound-guided TAP block for postoperative analgesia is better in patients undergoing inguinal hernia repair and the safety is higher.
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Objective To investigate the effects of inhalation of different concentrations of sevoflurane on pulmonary inflammatory response in rats. Methods One hundred and twenty adult Wistar rats of both sexes weighing 200-250 g were randomly divided into 4 groups: Ⅰ control group breathing room air (group C, n = 12);Ⅱ oxygen group breathing 40% O2(group O, n = 36);Ⅲ and Ⅳ sevoflurane groups breathing 1.5% and 3.0% sevoflurane in 40% O2 respectively (group S1, S2, n = 36). Group Ⅱ was further divided into 3 subgroups according to the duration of 40% O2 inhalation 4 h, 8 h and 10 h. Group Ⅲ and Ⅳ were further divided into 3 subgroups ( n = 12 each) breathing sevoflurane for 4 h, 8 h and 8 h followed by 2 h O2 (40%) inhalation. The animals were sacrificed at the end of O2 or/and sevoflurane inhalation. Broncho-alveolar lavage was performed in 6 animals in each subgroup. The TNF-α concentration in broncho-alveolar lavage fluid was determined. The TNF-α mRNA expression and MPO activity in the lung tissue were measured in the other 6 animals in each subgroup. Results Inhalation of 1.5% or 3.0% sevoflurane for 4 or 8 h did not induce inflammatory response in the lung as compared with animals breathing room air or 40% O2 . Conclusion Exposure to sevoflurane does not induce pulmonary inflammatory response in rats breathing spontaneously.
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Objective To investigate the effects of inhalation of isoflurane (Iso) on pulmonary and systemic inflammatory response through the changes in the plasma and pulmonary levels of IL-1β and IL-10 in rats. Methods Thirty-two adult male Wistar rats were randomly divided into 4 groups (n=8 each): group control (group C), group Iso-4 h, group Iso-8 h and group R. Group C inhaled air only. Group Iso-4 h and Iso-8 h inhaled in 40% O2 + 1.5% Iso for 4 and 8 h respectively. Group R inhaled 40% O2 + 1.5% Iso for 8 h and then withdrew and only inhaled 40 % O2 for 2 h. Blood samples were taken from femoral artery for measurement of plasma concentrations of IL-1β and IL-10 by ELISA. Then the rots were sacrificed to collect bronchoalveolar lavage fluid (BALF) for measurement of IL-1β and IL-10 concentrations. The right lung tissues were obtained for determination of the expression of IL-1β mRNA and IL-10 mRNA by RT-PCR. Results The BALF concentration of IL-1β and IL-1β mRNA expression in lung tissues were significantly higher in group Iso-4 h, and the concentrations of plasma and BALF IL-1β and IL-10, and the expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly higher in group Iso-8 h than in group C (P<0.05), but there were no significant differences in the concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues between group R and group C (P>0.05). The plasma and BALF IL-10 concentrations and IL-10 mRNA expression in lung tissues were significantly higher in group Iso-8 h than in group Iso-4 h (P<0.05). The concentrations of plasma and BALF IL-1β and IL-10 and expression of IL-1β mRNA and IL-10 mRNA in lung tissues were significantly lower in group R than in group Iso-8 h (P<0.05). Conclusion Isollurane inhalation can induce transient pulmonary and systemic inflammatory response in rats.
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Objective:To examine the effects of different concentrations of Isoflurane on the level of surfactant protein A(SP-A) and the expression of SP-A mRNA in the lung of rats.Methods: Thirty-two male Wistar rats were randomly divided into 4 groups: control group received 40%(volume fraction) O_2 inhalation(40% O_2,n=8);0.7% isoflurane group(n=8),1.5% isoflurane group(n=8).They and 2.0% isoflurane group(n=8).They were treated with 40%O_2 with 0.7%,1.5% and 2.0% isoflurane respectively.In each group,the rats inhaled experimental gas for 8 hours,and then were put to death immediately.Morphological changes of type Ⅱ pneumocytes were observed by transmission electron microscopy.Surfactant protein content in broncho-alveolar lavage fluid(BALF) was measured with Western Blotting.The level of intracellular SP-A was examined with immunohistochemistry(IHC).To assess the relative levels of SP-A mRNA in lung tissue,reverse transcriptase-polymerase chain reaction(RT-PCR) was used with the co-amplification of the "housekeeping" gene GAPDH as internal control.Results: Morphological changes of type Ⅱ pneumocytes were distinct in 1.5% isoflurane and 2.0% isoflurane groups.Isoflurane,after three doses,significantly reduced the SP-A content in BALF.Control group,(437 112)?25 654;0.7%Isoflurane group,355 789?28 116;1.5%Isoflurane group,238 554?31 531;(2.0%) Isoflurane group,223 632?25 710(P
