Objective To investigate the effect of propofol on the activation of NF-?B and the expression of Bcl-2 and Caspase-3 gene in cerebral cortex after transient focal cerebral ischemia-reperfusion (I/R) and the possible mechanism. Methods Ninety healthy male Wistar rats aged 3-4 months weighing 250-300g were randomly divided into 3 groups (n=30 each) : group Ⅰ sham operation; group Ⅱ I/R and group Ⅲ propofol + I/R. The animals were anesthetized with intraperitoneal chloral hydrate 300 mg?kg-1. Left common, internal and external carotid arteries (CCA, ICA, ECA) were exposed. Middle cerebral artery occlusion (MCAO) was produced by inserting a nylon thread, 0.26-0.28 mm in diameter and 4.0 cm in length into ICA and advancing it cranially until resistance was felt. After 2 h MCAO the nylon thread was withdrawn to allow reperfusion. In propofol group propofol 100 mg?kg-1 was given IP 10 min before MCAO. The animals were decapitated at 2, 3, 6, 12, 24 and 72 h of reperfusion (n=5 at each time point in each group) . Their brains were immediately removed for determination of translocation of NF-?B in the neurons (by immuno-histochemistry) and expression of NF-?B in cerebral cortex (by Western blotting). The expression of Bcl-2 mRNA and Caspase-3 mRNA in cerebral cortex was determined by in situ hybridization. Neurological deficit was scored and microscopic examination of ischemic cerebral cortex was performed at 24 h of reperfusion. Results In I/R group (Ⅱ) NF-?B was significantly translocated from cytoplasm into the nucleus of the neurons in the ischemic cerebral cortex during 2-24 h of reperfusion while in non-ischemic cortex NF-?B was confined to the cytoplasm. The expression of NF-?B, Bcl-2 mRNA and Caspase-3 mRNA was significantly higher in ischemic cortex than in non-ischemic cortex. Neurologic deficit scores were higher in I/R group than in sham-operation group. Microscopic examination showed congestion and edema of ischemic cerebral cortex and degeneration and necrosis of the neurons in I/R group. In group Ⅲ propofol pretreatment significantly inhibited the translocation of NF-?B, decreased expression of NF-?B and Caspase-3 mRNA and increased Bcl-2 mRNA expression as compared with I/R group (Ⅱ) . Neurologic dificit and histologic damage induced by I/R were significantly ameliorated by propofol pretreatment. Conclusion Propofol pretreatment can inhibit apoptosis of neurons induced by I/R by inhibiting the activation of NF-B, up-regulating Bcl-2 gene and down-regulating Caspase-3 gene.

Objective To investigate the analgesic effect of adenosine A1 receptor agonist R( - )-N6-(2-phenylisopropyl)-adenosine (R-PIA) administered into the brainstem medial pontine reticular formation (mPRF) and the underlying mechanism. Methods Sixty male SD rats aged 8-10 weeks weighing 250-300 g were used in this study. The animals were anesthetized with intraperitoneal 10% chloral hydrate 300 mg?kg-1 .A 24-gauge stainless steel cannula was inserted into mPRF on one side using a stereotaxic apparatus. One week after operation the animals were randomly divided into 12 groups ( n=5 each) : groupⅠcontrol; groupⅡR-PIA 0.5?g; groupⅢR-PIA 1.0?g; groupⅣR-PIA 2.0?g; groupⅤtheophylline (an adenosine receptor antagonist) 5.0?g; groupⅥ8-cyclopentyl-1 ,3-dipropylxanthine (DPCPX, an adenosine A, receptor antagonist) 1.0?g; groupⅦglibenclamide (an ATP-sensitive K+ channel blocker) 5.0?g; groupⅧ4-aminopyridine (4-AP, a voltage dependent K+-channel blocker) 5.0?g; groupⅨtheophylline 5.0?g + R-PIA 2.0?g; groupⅩDPCPX 1.0?g + R-PIA 2.0?g; groupⅪglibenclamide 5.0?g + R-PIA 2.0?g and groupⅫ4-AP 5.0?g + R-PIA 2.0?g. All the drugs were injected into mPRF in 0.3?l of normal saline. In groupⅨ-ⅫR-PIA 2.0?g was administered 15 min after pretreatment with theophylline, DPCPX, glibenclamide or 4-AP. Analgesia was determined using the tailflick latency (TFL) (the time between the onset of the radiant heat stimulus and voluntary tail withdrawal) at 5, 15, 30, 45, 60 and 90 min after R-PIA injection into mPRF. The pain threshold was expressed as percentage of the maximal possible effect ( MPE) : MPE = (TFL after drug - baseline TFL)/( 10.0 -baseline TFL)?100% .Results R-PIA 0.5-2.0?g injected into mPRF produced significant analgesia in a dose-dependent manner. Pretreatment with theophylline or DPCPX completely reversed the analgesic effect of R-PIA while pretreatment with glibenclamide or 4-AP only partially reversed the analgesic effect of R-PIA.Conclusion R-PIA administered into mPRF produces analgesia through activation of both ATP-sensitive and voltage-dependent K+ -channel in mPRF.

Objective To discuss the advantage of hispectral index(BIS) monitoring used in gastrointestinal endoscopy,and to observe elinical effects of target-controlled infusion(TCI) propofol combined with remifentanyl in elderly patients.Methods 120 patients aged from 65 to 78 with ASA physical status Ⅰ ～ Ⅱ were randomly divided into two groups,i,e.Group A (propofol with fentanyl ),Group B ( TCI propofol and remifentanyl with BIS).The amount of propofol was adjusted by consciousness and hemodynamics in Group A,while by BIS value in Group B.BIS was controlled at 55 ～60.The total amount of propofol and the time of wake-up,the incidence of complicatiors in each group were recorded.Results Compared with Group A,the changes of MAP and HR at T1 and T2 were smaller in Group B(P ＜ 0.05 ) ; Compared with Group A,the total amount of propofol and the time of wake-up were less in Group B ( P ＜ 0.05 ) ;Compared with Group A,the incidence of intraoperative respiratory depression and bradycardia were increased in Group B( P ＜ 0.05 ),there were no differences in the rest between the two groups.Conclusion Under BIS monitoring,TCl propofol and remifentanyl in elderly patients undewent gastrointestinal endoscopy may reduce propofol,and reach rapid recovery from anesthesia,but it needs additional management of respiration and circulation.

ObjectiveTo observe the changes of HR,MAP,BIS and Narcotrend induced by different doses of propofol in elderly patients. MethodsOne hundred elder patients(60 ～ 85 years old), AS A class Ⅰ or Ⅱ, scheduled for selective surgeries,were divided equally into 5 different doses of propofol( constant intravenous injection for 1min) groups of 0.5mg/kg( Ⅰ ) ,0. 75mg/kg( Ⅱ ) ,1.0mg/kg(Ⅲ) ,1.25mg/kg( Ⅳ)and 1.5mg/kg(Ⅴ). HR,MAP,BIS and Narcotrend were monitored before propofol injection and at 1 and 5 min after propofol injection. ResultsHR of 5 group s as similar. At 1 min after pmpofol injection, MAP decreased remarkably compared with at before in all 5 groups( t =2. 17,2.84,2.49,5.63,7.10, all p ＜ 0.05 ), which in group Ⅳ and Ⅴ decreased significantly compared with at in group Ⅰ, Ⅱ and Ⅲ(t =4.67,2.77,2.45,5.49,4.57,2. 18,all P＜0.05).At 1 min after propofol injection,BIS and NI values decreased compared with at before in all 5 groups(t =7.74,11.74,28.18,30.34,45.28, 6. 65,10.52,17.27,26.28,30. 14,allP ＜0.05) ,which in groupⅢ, Ⅳ and Ⅴ were significantly lower than those in group Ⅰ and Ⅱ (t =12.59,11.08,16.72,15.12,17.67,15.64,allP＜0.05).Dose of propofol was negatively correlated with BIS and NI value ( r =-0. 898/0. 930, P ＜ 0.01 ). ConclusionPropofol 1.0mg/kg constant injection should meet the sedation and hypnosis demand of general anesthesia in elderly patients and could not inhibit circulatory system; Bispectral Index and Narcotrend could accuratly monitor depth of anesthesia in elderly patients.

Objective To discuss the effects of sevoflurane on perioperative hemodynamics and serum cardiac troponin I(cTnI) in patients undergoing abdominal surgery,and offer the reference for selecting anesthetic in clinic.Methods Forty patients with ASA Ⅱ—Ⅲ,undergoing radical gastrectomy were randomly allocated into sevoflurane group(group S) and propofol group(group P),with each 20 patients.Systemic blood pressure(SBP),diastolic blood pressure(DBP),heart reat(HR) and saturation of oxygen(SPO2) were monitored as routine.The concerntration of cTnI was examined at pre-anesthesia(T1),post-induction(T2),beginning of operation(T3),end of operation(T4),the first day post-operation(T5) and the third day post-operation(T6) with radioimmunoassay.Results SBP,DBP and HR in group P at post-induction were significantly lower than those in group S(P

0.05).Significant differences were observed in analgesia grade between two groups.Visual analogue scores(VAS) in different postoperative time points(4,8,12,24 and 48h) were lower in experiment group than those in control group(P0.05).Conclusion Flurbiprofen axeti1 has preemptive analgesia effects with the chosen dosage regimen in patients undergoing thoracotomy and doesn't increase side effects.But the preemptive analgesia can't improve postoperative respiratory function.

Objective To investigate the variation in the position of conus medullaris in Chinese adult population in order to avoid hitting conus during spinal puncture. Methods Eight hundred patients suffering from back pain, aged 18-91 yr, were enrolled in this study. The position of conus medullaris was determined using Siemens 1.5 T magnetic resonance imaging system. According to the method described by Reimann, the vertebral body was used as mark of reference to the level of the end of conus. Results There were 190 patients in whom the position of the end of conus medullaris was lower than L1,2 . The incidence of the position of the end of conus medullaris lower than L1,2 was higher in patients 30-60 or older than in those under 30, and in those over the age of 60 than in those 30-60 (P ＜ 0.05). Conclusion Spinal puncture should be performed cautiously at L2,3. CT or MRI is recommended before operation for the patients to locate the position of conus medullaris and avoid injury to the spinal cord.

Objective To investigate the effect of norepinephrine infusion at 0.03-0.3 μg·kg-1 ·min-1 on renal function in patients undergoing kidney transplantation. Methods Thirty-two ASA Ⅲ or Ⅳ patients aged 22-64 yr weighing 44-88 kg undergoing kidney transplantation were studied. Dialysis was performed within 36 h before operation. Blood pressure was fairly stable. Combined spinal-epidural anesthesia (CSEA) was performed. Spinal anesthesia was performed at L2,3 interspace and hyperbaric 0.5% bupivacaine 10-15 mg was injected into the subarachnoid space. The upper level of sensory block measured by pin-prick reached T6. Epidural catheter was placed at T11,12 interspace and 1% ropivacaine was given intermittently. The patients were randomly allocated into preoperative baseline level (increase or decrease amplitude ＜ 10% of baseline level) by dopamine or norepinephrine infusion during operation. Venous blood samples and urine samples were obtained at the end of operation and 12 h after operation for determination of serum concentrations of cystatin C and β2-microglobulin and urine α1- and β2-microglobulin concentrations. Urine was collected and the volume was recorded. Meanwhile the consumption of furosemide administration during the 12 h after operation was recorded. Results The two groups were comparable with respect to age, M/F sex ratio, body weight, the volume of urine and fluid infused, and the consumption of furosemide. There was no significant difference in serum cystatin C and β2-microgiobulin and urine α1- and β2-microglobulin concentratious, urine volume and consumption of furosemide administration between the transplantation without adverse effect on kidney allograft function.

Objective To evaluate the effect of hypothermia on somatosensory evoked potentials (SSEPs). Methods Thirteen ASA Ⅱ or Ⅲ patients aged 23-51 yr weighing 45-82 kg scheduled for cardiac surgery were enrolled in this study. Bilateral median nerve SSEPs (N9, N13, N20) were recorded after induction.The MAP, peak latency and amplitude of N9, N13 and N20 were recorded when the target temperature (36, 35,34, 33 ℃ ) was reached during the cooling and rewarming periods. The neurological dysfunction was recorded after operation. Results The peak latency was prolonged and MAP was decreased with the decrease in the body temperature during the cooling period, the peak latency was shortened with the increase in the body temperature during the rewarming period ( P ＜ 0.05), but no significant change in the amplitudes was found ( P ＞ 0.05). The regression equation of the interaction between the peak latency and body temperature was YN9= -0.558X + 28.994(r=-0.673), YN13 =-1.121X+53.242 (r= -0.702) , YN20 = -1.458X+72.036(r= -0.702) during the cooling period (P ＜ 0.05), and YN9 = - 0.505X + 27.313 ( r = - 0.634), YN13 = - 0.905X + 46.249(r= -0.619), YN20 = - 1.142X + 61.668 (r= -0.600) during the rewarming period (P ＜0.05). No neurological dysfunction was found in all the patients. Conclusion Hypothermia can prolong the peak latency of SSEP and does not alter the SSEP amplitude.

Objective To study the CT manifestation of testicular endodermal sinus tumor in childhood.Methods Clinical and CT data in sixteen cases of testicular endodermal sinus tumor in children were retrospectively reviewed.Results The tumors appeared as solid masses on plain CT scan,the density of the tumor was homogeneous in 14 cases and heterogeneous in 2 cases.The masses were obviously heterogeneous enhancement after administration of contrast material in 12 cases.Serum ?-fetoprotein(AFP)level was elevated to more than 1000?g/L(normal:less than 20?g/L).Conclusion CT is a valuable in diagnosis of testicular endodermal sinus tumor in children.CT combined with serum AFP can improve the diagnosis of the disease.