Objective To explore and evaluate the efficiency of the leucocyte depletion filter on eliminating tumor cells from blood, and its influence on the morphology and function of red blood cells. Methods Blood from operation field was collected, filtered, centrifuged and washed. Intestinal cancer cells (LOVO) and gastric cancer cells (SGC) were cultured in vitro and mixed with the collected blood. Blood contaminated with known number of tumor cells was then centrifuged and washed with cell retriever, and then the mixture was filtered with leucocyte depletion filter. The amount of residual tumor cells in filtered blood was counted after trypan blue staining before and after culturing. Unwashed and unfiltered blood containing tumor cells were used as control and were also cultured. The morphology and Na+-K+-ATPase activity of treated red blood cells was assessed. Results Tumor cells were detectable after only being washed with cell retriever and grew well after culturing for two weeks. No tumor cells were found after both washed with cell retriever and filtered with leucocyte depletion filter, and no tumor cell grew two weeks after culturing. No change was found in morphology and Na+-K+-ATPase activity of red blood cells after being washed and filtered. Conclusion Cell retriever is not able to eliminate tumor cells from blood completely. Further filtration with leucocyte depletion filter is capable of completely eliminating the residual tumor cells in blood. The morphology and Na+-K+-ATPase of red blood cells do not change after being washed with cell retriever and being filtered with leucocyte depletion filter.

ObjectiveTo evaluate the accuracy of cerebral state index (CSI) as an indicator of anesthesia depth in the induction of anesthesia with target-controlled infusion (TCI) with propofol and remifentanil patients.Methods Forty-four ASA Ⅰ or Ⅱ patients undergoing elective surgery were anesthetized with TCI with propofol and remifentanil.Anesthesia was induced with TCI with remifentanil and propofol.The target effect-site concentration of remifentanil was 4 ng/ml.The initial effect-site concentration of propofol was 1.5 μ g/ml and was increased by0.5 μ g/ml every 4 min,till 1 min after the level of observer’s assessment of alertness sedation (OAA/S) score was 0 score.Electric tetanic stimulation was given when the level of OAA/S score was 1 score.The CSI,mean arterial pressure (MAP),heart rate (HR),OAA/S score and the effect-site concentration of propofol were recorded.ResultsCSI values declined with the decrease of OAA/S score,CSI was 91 ±5,77 ±7,70 ±7,62 ±6,49 ± 12,36 ± 10 at OAA/S score with 5,4,3,2,1score.CSI values were statistically different between 0 score and 1 score,1 score and 2 scores,3 scores and 4 scores,4 scores and 5 scores of OAA/S score(P ＜0.05).The differences of MAP,HR had no statistical significance between two scores of OAA/S score (P ＞0.05).The Spearman rank correlation coefficients between CSI,MAP,HR and OAA/S score were 0.899,0.342,0.125,respectively.The prediction probabilities to differentiate different OAA/S score for CSI,MAP,and HR were 0.89 ± 0.05,0.62 ± 0.08,0.53 ±:0.11,respectively.There was linear regression relationship between CSI and the effect-site concentration of propofol (the coefficient of determination was 0.812,P ＜ 0.01 ).ConclusionDuring the induction of patients with TCI with propofol and remifentanil,the CSI is accurate as an indicator of awakening and different levels of consciousness after anesthesia,and can reliably predict the anesthesia depth.

Objective To evaluate the effect of pretreatment with butorphanol to prevent injection pain of rocuronium bromide.Methods One hundred and fifty ASA Ⅰ-Ⅱ grade patients,undergoing elective surgery were divided into 3 groups by random digits table with 50 cases each.Butorphanol group received butorphanol 2 mg,fentanyl group received fentanyl 100 μg,and control group received 0.9％sodium chloride when general anesthesia induced.Anesthesia was induced with propofol 2 mg/kg and the test drug was injected over 30 s,120 s after the test drug injection,1％ rocuronium bromide 0.6 mg/kg was injected.Nausea,vomiting,apnea and bucking were recorded after drugs injection.Results The rates of rocuronium bromide injection pain in fentanyl group[10％(5/50)]and butorphanol group[8％(4/50)]were significant lower than that in control group[82％(41/50)](P ＜ 0.01).None of the patients discovered nausea,vomiting,apnea and bucking in 3 groups.Conclusion Pretreatment with 2 mg butorphanol reduced the incidence of rocuronium bromide injection pain,furthermore,there is no untoward reaction such as nausea,vomiting,apnea and bucking.

Objective To explore the neuroprotective mechanism of propofol by comparing the influence of propofol and isoflurane on inflammatory cytokines ( TNF-α、IL-1、ICAM-1 ) in patients with intracranial tumors. Methods One hundred and sixty-eight patients with intracranial neoplasm were randomly divided into two groups:the propofol ( Group P) and isoflurane (Group I),84 cases in each. Patients were given with propofol (3-6 μg·mL-1) by plasma target-controlled infusion or with continuously inhaled isoflurane ( 1%-2%) , respectively. The serum levels of TNF-α, IL-1 and ICAM-1 were detected before anesthesia and at 0,24,and 48 h after operation. Results The serum levels of TNF-α,IL-1 and ICAM-1 were significantly increased after operation as compared to baseline in both groups. The serum level of TNF-α was(69. 11±8. 95) and (76. 26±11.28) μg·mL-1,IL-1 was(21.57±3.19) and (29.58±4.38) ng·L-1,and ICAM-1 was (1.63±0.24)and (1.94±0.29) g·L-1 at 24 h post operation in Group P and Group I,respectively. These inflammatory cytokine levels were significantly higher in group I compared to group P at 24 and 48 h after operation (P<0. 05 or P<0. 01). Conclusion The target-controlled infusion of propofol brings about lower level of inflammatory reaction than isoflurane inhalation in patients with intracranial neoplasm,which may attribute to the mechanism of brain protection against injury.

Objective · To investigate the difference in myocardial strain of left ventricle between obstructive hypertrophy cardiomyopathy (HCM) and nonobstructive HCM. Methods · Cardiac magnetic resonance imaging (MRI) exam was performed on 48 sequential enrolled patients with HCM (18 with obstructive HCM, and 30 with nonobstructive HCM), whose left ventricular ejection fractions (LVEF) were over 50%. Twenty-five healthy volunteers were examined as normal controls. Global longitudinal strain (GLS), global radial strain (GRS), global circumferentialstrain (GCS), LVEF, left ventricular end diastolic volume (LVEDV), left ventricularmass (LVM), left ventricular end diastolic volume index (LVEDVI), and left ventricular mass index (LVMI) were collected and compared. Radial strain, circumferential strain and peak radial displacement were also measured in medial segment of left ventricle according to American Heart Association (AHA) 17-segment model. Results · ① LVEF of the patients with obstructive HCM was bigger than those of nonobstructive HCM patients and control group (P<0.05). LVM and LVMI of the HCM groups were bigger than those of control group (P<0.01). ② Left ventricle GLS, GRS, and GCS significantly decreased in the patients with nonobstructive HCM compared to those with obstructive HCM (P<0.05). The three parameters of two HCM groups were significantly lower than those of healthy volunteers (P<0.05). ③ Compared with obstructive HCM patients,the segmental parameters of left ventricule, the medial segment circumferential strain and radial strain of nonobstructive HCM patients significantly decreased (P<0.05), and the two parameters of both HCM groups were lower than those in healthy volunteers. Compared with obstructive HCM patients and healthy volunteers, peak radial displacement of left ventricule medial segment in nonobstructive HCM witnessed a significant decrease, while no significant difference was observed between obstructive HCM patients and healthy volunteers. Conclusion · In the LVEF preserved HCM patients, the myocardial strain of left ventricle in nonobstructive HCM patients decrease significantly than that in obstructive HCM patients, which may result in the different clinical outcomes intwo types of HCM patients. It is suggested that the myocardial strain is more sensitive than ejection fraction in the evaluation of myocardial performance of HCM patients.

Objective To analyze common postoperative complications after autologous liver transplantation in patients diagnosed with hepatic alveolar echinococcosis (HAE)from plateau area. Methods Clinical data of 6 patients with advanced HAE undergoing ex-situ or partially ex-situ hepatectomy combined with autologous liver transplantation were retrospectively analyzed. Clinical characteristics of postoperative complications were analyzed. Results Postoperative complications mainly included biliary tract complications (n=4),intra-abdominal hemorrhage (n=1 ),infection (n=3). Two cases presented with bile leakage complicated with intra-abdominal infection and died from infectious shock and multiple organ dysfunction syndrome. One patient had intra-abdominal hemorrhage and died from hemorrhagic shock and disseminated inravascular coagulation. Biliary tract complication and intra-abdominal hemorrhage were primary causes of mortality. Conclusions Biliary tract complication,intra-abdominal hemorrhage and infection are the main prognostic factors for HAE patients undergoing autologous liver transplantation.

Objective To investigate the effects of sevoflurane pretreatment on the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) and the mechanism of myocardial protection.Methods Twenty NYHA class Ⅱ or Ⅲ patients of both sexes,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n=10 each): sevoflurane group (group S) and control group (group C).The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam0.03-0.06 mg/kg,fentanyl 5-10μg/kg and pipecuronium 0.04-0.08 mg/kg.Sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly adjusted to 1.0％ and maintained at this level for 30 min in group S.Blood samples were taken from the central vein before skin incision,immediately after aortic clamping,immediately after aortic unclamping and at 30 min after aortic unclamping,at 2,6,12 and 24 h (T1-8) after operation for determination of the concentrations of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL) and interleukin-8 (IL-8),intercellular adhesion molecule-1 (ICAM-1),cardiac troponin I (cTnI) and activity of creatine kinase MB (CK-MB).The requirement for cardiovascular drugs was recorded after release of aortic cross clamp.Results Compared with group C,the plasma concentrations of TNF-α,IL-6 and IL-8 were significantly decreased at T3-8,the plasma concentrations of ICAM-1 and cTnl were significantly decreased at T4-8,the activity of plasma CK-MB was significantly decreased at T8,and the requirement for cardiovascular drugs was significantly reduced after release of aortic cross clamp in group S (P ＜0.05).Conclusion Sevoflurane pretreatment can inhibit the inflammatory response and provide myocardial protection to some extent in patients undergoing cardiac valve replacement with CPB.

Objective To investigate the effects of general anesthesia and hard epidural anesthesia on the incidence of postoperative cognitive dysfunction (POCD),serum S-100β and Aβ1-42 protein in elderly patients with transurethral resection of the prostate (TURP).Methods 120 cases of elderly male patients who wanted to implement TURP were enrolled in this study.From March 2014 to August 2016,60 patients underwent general anesthesia (general anesthesia group) and 60 patients underwent epidural anesthesia (hard epidural Group).The effects of two anesthesia methods on the cognitive function,serum S-100 β and Aβ1-42 protein were compared.Results There was no significant difference in mini-mental state examination (MMSE) score in preoperative,postoperative 12 h,postoperative 24 h,postoperative 72 h,and postoperative 1 week between hard epidural group and general anesthesia group (P ＞ 0.05).The MMSE scores at 12 h,24 h and 72 h after operation in both groups were significantly lower than those before operation in both groups (P ＜0.05).There was no significant difference in clock drawing task (CDT) score in preoperative,24 h after operation,72 h after operation and one week after operation (P ＞ 0.05).The CDT scores of both groups at 12 h,24 h,72 h after operation were significantly lower than those before operation (P ＜0.05).There was no significant difference in serum S-100β levels between the two groups at preoperative and 12 h,72 h after operation (P ＞0.05).Serum S-100β levels at 12 h and 72 h after surgery in both groups were significantly higher than those before surgery (P ＜ 0.05).There was no significant difference in preoperative and postoperative 12 h,postoperative between hard epidural group and general anesthesia group (P ＞ 0.05).Serum Aβ1-42 levels at preoperative,12 h and 72 h after operation in both groups were significantly lower than those before operation (P ＜ 0.05).There was not statistically significant in the incidence of POCD between hard epidural group [28.33 ％ (17/60)] and general anesthesia group [35％ (21/ 60)] (P ＞ 0.05).Conclusions There was no significant difference in the incidence of POCD between general anesthesia and hard epidural anesthesia group in elderly patients with TURP.The incidence of POCD in elderly patients was related to the decrease of serum S-100β and the decrease of Aβ1-42.

Postoperative delirium (POD) is one of the common complications of central nervous system after operation. Severe POD can even develop into dementia, which seriously reduces the quality of life. Neuroinflammation and sleep disorder play important roles in the pathogenesis of POD. Dexmedetomidine (DEX) is a commonly used anesthetic in clinic, which is often used in the sedation of ICU patients and clinical anesthesia. DEX can reduce perioperative inflammatory response, improve patient's sleep, and reduce the incidence of POD. In this paper, the effects of DEX on neuroinflammation and sleep are discussed in order to provide evidence for clinical prevention and treatment of POD.

Objective To investigate the effects of sevoflurane pretreatment on the myocardial injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty NYHA class Ⅱ or Ⅲ patients,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n =10 each):sevoflurane group (group S) and control group (group C).The patients were premeditated with intramuscular morphine and scopolamine.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.Anesthesia was maintained with intermittent iv boluses of midazolam,fentanyl and pipecuronium and in addition sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly increased to 1.0％ and maintained at the level for 5 min in group S.Blood samples were taken from the central vein before skin incision (T1),immediately after aortic clamping (T2 ),at 0 and 30 min after aortic unclamping (T3-4),and at 2,6,12 and 24 h after operation (T5-8) for determination of the concentration of serum cardiac troponin Ⅰ (cTnI) and activities of creatine kinase (CK) and creatine kinase isoenzyme-MB (CK-MB).Myocardial specimens were taken from right auricle before aortic clamping and at 10 min after aortic unclamping for electron microscopic examination.Results The concentration of serum cTnI and activities of CK and CK-MB were significantly increased at T4-8 in both groups ( P ＜ 0.05).The serum cTnI concentration at T4-8 and the activities of CK and CK-MB at T8 were significantly lower in group S than in group C ( P ＜0.05).Different degrees of mitochondrial swelling were observed after aortic unclamping in both groups,but the changes were milder in group S than in group C.Conclusion Sevoflurane pretreatment can attenuate the myocardial injury in patients undergoing cardiac valve replacement with CPB.