Objective To investigate the potential sedative effects of epidural anesthesia and its mechanism. Methods Fifty ASA Ⅰ -Ⅱ patients aged 20-55yr, scheduled for gynecological surgery were studied. Patients whose body weight exceeded 95 kg or was less than 45kg were excluded. Alcoholics and those addicted to sedative or opiates were also excluded. The patients were unpremedicated. Before anesthesia the patients' radial artery was cannulated for continuous BP monitoring and blood sampling. ECG, BIS and HRV were continuously monitored. Epidural puncture was performed at L1-2 . A catheter was inserted in epidural space for 3-4cm in a cephalad direction. The patients were randomly divided into 3 groups: epidural lidocaine group (group E, n = 15); intravenous lidocaine group (group Ⅰ , n = 15) and control group (group C, n =20). In group E the patients received an iv bolus of lidocaine 1.5mg?kg-1 followed by a lidocaine infusion at a rate of 30mg?kg-1?min-1 and an epidural bolus of normal saline 15 ml; in group C the patients received an epidural bolus of NS 15 ml only. The intravenous lidocaine infusion in group I was designed to mimic systemic absorption of lidocaine from epidural space. 20 min after epidural lidocaine or saline administration, a propofol infusion was started at a rate of 150ml/h until the patients lost consciousness, The amount of propofol infused was recorded. Blood samples were taken before propofol infusion for determination of plasma level of lidocaine. Results The amount of propofol infused when the patients lost consciousness was (1.22 ?0.25) mg?kg-1 in group E, (1.62 ?0.22) mg?kg-1 in group I and (1.85?0.41) mg?kg-1 in control group. The amount of propofol infused in group E was significantly less than that n group I and C ( P

[Objective]To explore the technique and effect of anterior cervical decompression for the treatment of the mixed type of ossification of posterior longitudinal ligament. [Methods]Data on 37 patients(24 males and 13 females,with mean age of 54.3 years) who underwent resection or floating of posterior longitudinal ligament were reviewed.The occupying rate of OPLL ranged 32%~85% with an average of 51.4%.The Japanese Orthopaedic Association(JOA) scores ranged 4 ~14 points with an average of 7.9 points before operation.[Results]The Mean follow-up duration was 16 months(range,6~36 months).The JOA scores were 10.3 and 11.1 at 3 and 12 months after surgery.The results were excellent in 72.7% and good in 78.8%.[Conclusion]The resection of the longitude ligament and floating in anterior cervical decompression is a safe and effective treatment for the mixed type of ossification of posterior longitudinal ligament.

Objective: To observe the efficacy of controlled hypotention with nicardipine and influences on endocrine system. Method: Twenty adult patient, ASA grade Ⅰ-Ⅱ, scheduled for bone tumour operation, were selected. After the operation begining, Nicar of 0.01-0.02mg/kg was given at central venous bolus, was infused at 1-4?g?kg?min~(-1). Result: Hemodynamics was very stable during controlled hypotension, regulating frequency of Niear dosage was 1.5?0.7 time/h, reaching time of aim blood pressure was 47?31s, BP recovery time from discontinuating Nicar intusion to pre-hypotention level was 40?11min and no hypertention rebound occurred after discontinuation of Nicar. Fifteen min following controlled hypotension, plasma catecholamine (CA) level increased (P0.05). During mass bleeding and subsequent malignant hypotension, serious arrhythmia and oliguria did not occur. Conclusion: Controlled hypotension with Niear is rapid, stable and easy without hypertension rebound. The influences of Nicar on plasma CA are only very obvious. Nicar has considerable protective effects on heart and kidney during mass bleeding.

Objective To evaluate the efficacies of different ventilatory pattern during one lung ventilation (OLV). Methods During OLV, all patients underwent two different ventilatory pattern, total volume (10ml/kg) without PEEP and half tidal volume (5ml/kg) with PEEP of 7cmH 2O. The arterial blood samples were collected for blood gases analysis immediately before one lung ventilation, 30min following two different OLV pattern and 30 min after resuming two lung ventilation. The airway pressure and hemodynamic parameters were monitored simutaneously. Results PaO 2 and PaCO 2 were higher during half tidal volume than during total tidal volume(P

Objective To determine perioperative changes of tumor necrosis factor alpha (TNF ?),superoxide dismutase(SOD),lipid peroxides(LPO) and creatine kinase MB (CK MB) in patients undergoing cardiopulmonary bypass (CPB) Methods Thirteen patients undergoing heart valves surgery were studied Blood samples were taken from artery and coronary sinus for measurement of plasma TNF ? and LPO concentrations, and plasma SOD and CK MB activities prior to CPB, 5min,30min after aorta declamping, at the end of operation, 6h and 18h after surgery respectively Blood gas analysis was done at various intervals and alveolar arterial oxygen gradient (P A a DO 2) was calculated The net myocardial release of TNF ? (coronary sinus plasma level minus arterial level) was recorded Results Arterial and coronary sinus TNF? levels increased significantly following aortic declamping as compared with those before CPB and were kept at the higher level till the end of operation (P

Objective To assess the influences of cardiopulmonary bypass (CPB) on energy matabolism and the effect of nicardipine pretreatment. Methods Sixteen patients with valvlar heart disease undergoing valve replacement were chosen and randomly allocated into control group (group C, n=8) and nicardipine pretreatment group (group N,n=8). In group N, nicardipine 0.5?g?kg -1?min -1 was continuously infused after induction of anesthesia and terminated before CPB. The total dose given was 0.5mg?kg -1. If the total dose was not reached before CPB, the rest dose was given immediately after the beginning of CPB. Arterial and coronary sinus blood samples were taken immediately before CPB,at 5,30min after the aortic declamping , the end of operation, 6 and 18h after operation.Blood lactate and glucose concentrations were measured. Blood gas was checked simultaneously. Then myocardial lactate extraction rate (LER) and myocardial glucose extraction rate(GER) and myocardial oxygen extraction index(MOEI) were calculated. Results In group C GER and LER decreased signficantly after aortic declamping as compared with those before CPB (P

Objective To evaluate the changes of pulmonary gas exchange and intrapulmonary shunt during orthotopic liver transplantation (OLT) Methods Eleven ASA Ⅲ Ⅳ patients (male 8, female 3) with end stage liver diseases were studied Age ranged from 17 67 yr Anesthesia was induced with midazolam 0 1 mg?kg -1 , fentanyl 5?g?kg -1 and pipecuronium 0 1 mg?kg -1 and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium combined with epidural anesthesia (T 8 9 ) The patients were mechanically ventilated with 100% O 2 during operation After induction of anesthesia Swan Ganz catheter was inserted via right internal jugular or subclavian vein Cardiac output (CO),mixed venous oxygen saturation and core venous temperature were continuously monitored with continuous cardiac output monitor (Baxter,Vigilance) ECG, CVP, SpO 2 and P ET CO 2 were also continuously monitored during operation Radial artery was cannulated for continuous direct blood pressure monitoring Arterial and mixed venous blood samples were taken at the beginning of operation, 120 min during preanhepatic stage, 30 and 60 min during anhepatic stage, 5 and 60 min during neohepatic stage and at the end of operation Alveolar arterial oxygen partial pressure difference (A aDO 2) , intrapulmonary shunt (Qs/Qt) , oxygen delivery index (DO 2I) and oxygen consumption (VO 2 I ) were calculated During operation body temperature was maintained above 35 5℃ Veno venous bypass (VVB) was performed during anhepatic stage Results At the beginning of operation, when FiO 2 was 100%, PaO 2 was only (376?141) mmHg, A aDO 2 and Qs/Qt were all higher than normal values There were no significant changes in all parameters 120 min during preanhepatic stage as compared with those at the beginning of operation PaO 2 increased and A aDO 2 and VO 2I decreased significantly during anhepatic stage Qs/Qt, A aDO 2 and PaCO 2 increased and PaO 2 decreased significantly, but there were no significant changes in cardiac index, DO 2I and VO 2I during early neohepatic stage Cardiac index, DO 2I and VO 2I increased at 60 min during neohepatic stage and at the end of operation Conclusions There are severe changes of pulmonary gas exchange during OLT

Objective To assess the effect of propofol on changes in plasma enzymes (CPK,LDH), lipid peroxides (MDA) and metabolites of arachidonic acid (TXB 2,6 keto PGF 1? ) after ischemia reperfusion of lower extremity.Methods 19 ASAⅠ Ⅱscheduled for bilateral total knee replacement were randomly allocated to one of the two groups: isoflurane group (group I,n=10) and propoful group(group P, n=9). The patients were premedicated with intramuscular pethidine 50mg and scopolamine 0.3mg 30min before operation. In isoflurane group anesthesia was induced with midazolam 0.15mg?kg -1 ,fentanyl 3?g?kg -1 and vecuronim 0.1mg?kg -1 and maintained with 0.8% isoflurane after tracheal intubation. In propofol group anesthesia was induced with propofol 2mg?kg -1 ,fentanyl 3?g?kg -1 and vecuronim 0.1mg?kg -1 and maintained with propofol infusion 8mg?kg -1 ?h -1 . In both groups general anesthesia was supplemented with epidural block performed at L 2 3 . Blood samples were taken from femoral vein before the tourniquet of right leg was inflated(0min) and 5,10,20min after replace of left leg for determination of plasma creatine phosphokinase(CPK),lactate dehydrogenase(LDH),MDA,TXB 2 and 6 keto PGF 1? levels.Results In group P CPK and LDH levels decreased significantly at 10,20min and MDA level at 5min(P

ve To investigate the mechanism of myocardial ischemia-reperfusion injury during cardiac surgery and the protective effect of low dose nicardipine. Methods Sixteen patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomized to one of the two groups: control group (group C, n = 8) and nicardipine group (group N, n = 8) . In group N low dose nicardipine (O.5?g?kg-1 ?min-1) was infused after induction of anesthesia until beginning of CPB, a total dose of 0.05 mg?kg-1 was given. All patients were premedicated with intramuscular morphine 0.1-0.2 mg?kg-1 and scopolamine 0.3 mg 30 min before surgery. Anesthesia was induced with midazolam 0.05-0.1 mg?kg-1, fentanyl 15-20 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with intermittent boluses of midazolam 0.05 mg? kg-1, fentanyl 10-30?g?kg-1 and pipecuronium 2 mg. After induction of anesthesia Swan-Ganz catheter was placed for hemodynamic monitoring. Moderate hypothermia (26℃-28℃) was maintained and Hct was diluted to 20%-24% during CPB. Hyperkalemic cardioplegia was used for myocardial protection. Arterial blood (a) and coronary sinus (cs) blood were taken simultaneously for determination of tumor necrosis factor a (TNF-a), superoxide dismutase (SOD), lipid peroxide (LPO), creative kinase(CK-MB) before CPB and at 5 and 30 min after release of aortic cross-clamp (RACC), at the end of operation (EO) and at 6h and 18h after operation. Myocardial net release of TNF-a (TNF-anr) and LPO (LPOnr) and net consumption of SOD (SODnc) were calculated. The number of defibrillation after RACC, weaning index from CPB and dopamine requirement after CPB were recorded simultaneously. Results In group C LPOa and LPOcs increased significantly after RACC until the end of operation as compared with the baseline (P

Objective To evaluate the diagnostic value of urine-based prostate cancer antigen 3 ( PCA3 ) score in detecting prostate cancer during initial prostatic biopsy .Methods Urine was collected after digital rectal examination ( DRE) ( three strokes per lobe ) from 248 men before prostate biopsy .The specimens were collected between January 2010 and December 2012.The expression of PCA3 mRNA and prostate specifc antigen (PSA) mRNA was determined by quanti-tative real time polymerase chain reaction ( qRT-PCR ) .PCA3 scores were calculated by PCA 3 mRNA/PSA mRNA × 1000 .The ability of the PCA3 score to predict the biopsy outcome was assessed with AUC-ROC analysis and compared with the serum PSA levels.Results The rate of positive prostate biopsy was 32.3%(80 patients with positive prostatic biopsy versus 168 patients with negative prostate biopsy ) .PCA3 scores were significantly higher in patients with positive biopsy than in those with negative biopsy results (P<0.001).The ROC curve analysis demonstrated that the area under the ROC curve (AUC) of serum total PSA (tPSA), PCA3 score and the duplex model combining tPSA and PCA 3 score was 0.620, 0.693 and 0.724, respectively.Further analysis of the diagnostic performance of PCA3 score revealed that at a cut-off of 90.2456, the sensitivity was 67.5%and the specificity was 61.9%for discriminating positive biopsy from negative biopsy. The duplex model combining tPSA and PCA 3 score represented a better approach than tPSA alone in PCa diagnosis by pros-tatic biopsy (P=0.011), but there was no statistically significant difference between tPSA and PCA 3 score (P=0.160). In addition , a comprehensive diagnostic model based on multiple risk factors of prostate cancer combined with PCA 3 score could further improve the predictive accuracy of prostate cancer .Conclusion PCA3 could be a good predictor of prostate cancer in initial prostate biopsy in Chinese population .The comprehensive diagnostic model can improve the diagnostic potency .Further large-scale multicenter studies in China are needed to confirm our findings .