Objective To evaluate the effects of dexmedetomidine on inflammatory responses in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅱ or Ⅲ patients of both sexes,aged 45-64 yr,weighing 50-80 kg,scheduled for elective cardiac valve replacement with CPB,were equally and randomly divided into 2 groups using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of midazolam,sufentanil,etomidate and rocuronium.The patients were endotracheally intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after induction,followed by continuous infusion at 0.05 μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Anesthesia was maintained with inhalation of sevoflurane,iv infusion of sufentanil and intermittent iv boluses of rocuronium.Before induction (T0),at 10 min after termination of CPB (T1),at the end of operation (T2),and at 6 and 24 h after operation (T3,4),the jugular bulb venous blood samples were taken for determination of serum concentrations of tumor necrosis factor-apha (TNF-α),interleukin-6 (IL-6),S100β protein and neuron-specific enolase (NSE).Results Compared with group C,the serum TNF-α concentrations at T1 4,IL-6 concentrations at T24,S100β protein concentration at T3,4 and NSE concentration at T1,2 were significantly decreased in group D (P ＜ 0.05).Conclusion Dexmedetomidine infused at 0.05 μg· kg-1 · h-1 after a loading dose of 1 tg/kg can reduce inflammatory responses,thus reducing cerebral injury in patients undcrgoing cardiac valve replacement with CPB.

Objective To evaluate the effects of Shenmai injection on intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-60 yr,with body mass index of 18-25 kg/m2,scheduled for elective thoracic surgery,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and Shenmai injection group (group SM).Anesthesia was induced with midazolam,sufentanil,rocuronium,and etomidate.Starting from the end of induction of anesthesia until the time point immediately before one-lung ventilation,Shenmai injection 0.6 ml/kg (in 250 ml normal saline) was infused intravenously in SM group,and the equal volume of normal saline was given instead in C group.Immediately before one-lung ventilation,at 10 and 60 min of one-lung ventilation and at 10 min of two-lung ventilation,arterial and venous blood samples were collected for blood gas analysis and PaO2 was recorded.Intrapulmonary shunt (Qs/Qt) and alveolar-arterial oxygen pressure difference (P(A-a)DO2) were calculated.Results Compared with group C,PaO2 was significantly increased at 10 and 60 min of one-lung ventilation,and Qs/Qt and P(A-a)DO2 were decreased in group SM.Conclusion Shenmai injection 0.6 ml/kg infused intravenously before one-lung ventilation can reduce the intrapulmonary shunt during one-lung ventilation in patients undergoing thoracic surgery.

Objective To evaluate the effect of creatine phosphate on the myocardial injury induced by lung ischemia-reperfusion (I/R) in rats.Methods Twenty-four male Sprague-Dawley rats,aged 8-10 weeks,weighing 250-350 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group S),I/R group,and I/R+creatine phosphate group (group CP).Lung I/R was induced by clamping the left hilum of lung for 0.5 h with a non-invasive microvascular clip followed by mechanical ventilation and 2.0 h of reperfusion.Creatine phosphate 6.6 mg · kg-1 · min-1 were infused intravenously at 30 min before ischemia in group CP,while the equal volume of normal saline was administered in group I/R.At 2.0 h of reperfusion,blood samples were obtained from the right ventricle for determination of the serum concentration of cardiac troponin I (cTnI).Myocardial specimens were obtained from the apex for microscopic examination and for determination of the levels of myocardial superoxide dismutase (SOD),malondialdehyde (MDA),and myeloperoxidase (MPO).Results Compared with group S,the serum cTnI concentrations,MDA content,and MPO activity were significantly increased,and the SOD activity was significantly decreased in I/R and CP groups (P＜0.05).Compared with group I/R,the serum cTnI concentrations,MDA content,and MPO activity were significantly decreased,and the SOD activity was significantly increased in group CP (P＜0.05).Myocardial injury was significantly attenuated in group CP as compared with group I/R.Conclusion Creatine phosphate can attenuate the myocardial injury induced by lung I/R in rats,and the mechanism is related to decrease in damage caused by lipid peroxidation.

Objective To evaluate the effect of dexmedetomidine combined with continuous positive airway pressure (CPAP) on the oxidative stress and inflammatory responses during one-lung ventilation (OLV) in the elderly patients undergoing radical surgery for esophageal carcinoma.Methods One hundred and twenty ASA physical status Ⅱ or Ⅲ patients,aged 65-80 yr,with body mass index 18-25 kg/m2,scheduled for radical surgery for esophageal carcinoma,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C),dexmedetomidine group (group D),CPAP group (group P) and dexmedetomidine combined with CPAP group (group DP).After induction of anesthesia,the patients were endotracheally intubated and then mechanically ventilated.At the beginning of skin incision,OLV was performed instead.In D and DP groups,a loading dose of dexmedetomidine 0.3 μg/kg was infused starting from 10 min before incision,followed by infusion at a rate of 0.3 μg·kg-1 ·h-1 untill the chest was closed.CPAP 2 cmH2O was used on the non-ventilated side during OLV in P and DP groups.Immediately before incision,at 90 min of OLV,at the end of operation and on 1 day after operation,venous blood samples were obtained for determination of the serum malondialdehyde (MDA),interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations.The development of complications was recorded at 1 and 7 days after operation.Results Compared with group C,the incidence of hyoxemia during operation and pulmonary atelectasis and infection after operation was significantly decreased in the other three groups,the incidence of hyoxemia and pulmonary atelectasis and infection after operation was decreased,and the serum concentrations of MDA,IL-6 and TNF-α were decreased in group DP (P ＜ 0.05).Compared with D and P groups,the serum concentrations of MDA,IL-6 and TNF-α were significantly decreased,and the incidence of pulmonary atelectasis and infection after operation was decreased in group DP (P ＜ 0.05).The incidence of hyoxemia during operation was significantly lower in group DP than in group D (P ＜ 0.05).Conclusion Dexmedetomidine combined with CPAP can alleviate the oxidative stress and inflammatory responses more effectively and is more helpful in improving prognosis than either alone during OLV in elderly patients.

Objective To evaluate the efficacy of intermittent ventilation performed in lungs on the operated side for prevention of reexpansion pulmonary edema after pulmonary resection.Methods Forty patients of both sexes,aged 16-32 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective thoracoscope-assisted pulmonary resection,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and intermittent ventilation performed in lungs on the operated side group (group Ⅴ).After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy,one-lung ventilation was performed instead.One-lung ventilation was performed routinely in group C.In group Ⅴ,the lung on the operated side was ventilated intermittently for 30 s with the tidal volume set at 2 ml/kg and respiration rate at 20 bpm,the bronchial tube was then opened,and the process was repeated at 10 min intervals until the diseased tissues were removed.After resection of diseased tissues,the specimens of normal tissues around the area were obtained for determination of the expression of aquaporin 1 (AQP-1) and AQP-5 in lung tissues.The development of pulmonary atelectasis,hyoxemia and reexpansion pulmonary edema was recorded within 24 h after surgery.Results Compared with group C,AQP-1 and AQP-5 expression was significantly up-regulated,the incidence of atelectasis and reexpansion pulmonary edema was decreased within 24 h after surgery,while no significant change was found in the incidence of hyoxemia in group Ⅴ.Conclusion Intermittent ventilation performed in lungs on the operated side can effectively prevent the development of reexpansion pulmonary edema during one-lung ventilation in the patients undergoing pulmonary resection.

Objective To determine the optimum dose of dexmedetomidine through evaluating the effects of different doses of dexmedetomidine combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.Methods Sixty ASA physical status Ⅱ patients of both sexes,aged 18-60 yr,with body mass index 20-26kg/m2,Child-Pugh grade A,undergoing radical resection for stomach or colon cancer,were randomly assigned into 3 groups (n=20 each):propofol and remifentanil group (group Ⅰ),low-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅱ) and high-dose dexmedetomidine combined with propofol and remifentanil group (group Ⅲ).In Ⅱ and Ⅲ groups,dexmedetomidine was infused at a rate of 0.2 μg·kg-1 · h-1 and 0.4 μg·kg 1 · h-1,respectively,until 30 min before the end of surgery after a loading dose of dexmedetomidine 0.4 μg/kg and 0.8 μg/kg,respectively,was infused at 10 min before induction of anesthesia.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol (target plasma concentration 2-4 μg/ml),iv infusion of remifentanil 0.2 μμg·kg-1 · h-1 and intermittent iv boluses of rocuronium 0.15 mg/kg.BIS value was maintained at 40-60.Before dexmedetomidine infusion (T0),at 2 min before intubation (T1),at 1 min after intubation (T2),immediatay after zskin incision (T3),and at 30 min of surgery (T4),arterial blood samples were taken for measurement of concentrations of plasma norepinephrine (NE) and epinephrine (E).The emergence time,adverse cardiovascular events,and the development of nausea and vomiting and restlessness during recovery from anesthesia were recorded.Results Compared with group Ⅰ,the plasma concentration of propofol was significantly decreased,and the incidence of tachycardia and restlessness during recovery from anesthesia were significantly decreased in Ⅱ and Ⅲ groups,and the incidence of bradycardia during operation was significantly increased,and the incidence of hypertension during recovery from anesthesia was significantly decreased,and the emergence time was prolonged in group Ⅲ (P ＜ 0.05).Compared with group Ⅱ,the plasma concentration of propofol was significantly decreased,the incidence of bradycardia during operation was increased,and the emergence time was prolonged in group Ⅲ (P ＜0.05).The plasma NE and E concentrations were significantly higher at T2.3 in group Ⅰ,and were lower at T1-4 in Ⅰ and Ⅲ groups than those at T0 (P ＜ 0.05).Conclusion 0.4 μg/kg injected before induction of anesthesia followed by infusion at 0.2 μg·kg-1 · h-1 is the recommended optimum method for application of dexmedetomidine when combined with propofol and remifentanil for anesthesia during laparotomy in patients with mild liver dysfunction.

With the progress of science technology,the 3D technology has raised comprehensive attention for its application value in medical field,especially in the orthopedic field.It has been mainly used before complicated orthopedic surgeries,and several studies have focused on 3D duplicated materials used in the treatment of bone defect.However,there are seldom studies about the 3 D technology used during surgeries,such as whether it is possible to 3D print internal fixation materials of bone fracture (the materials have biodegradability and excellent biomechanical characteristics),which can not only promote the healing of fracture,but also reduce the pain of second surgery for the patient.This paper reviews and summarizes the exploration of foreign and domestic scholars about the application value of 3 D printing technology used in complicated bone fracture,and proposes a forecast to the developing trend of the technology used in future orthopedic surgeries.

Objective To determine the difference between target and measured concentration of remifentanil given by target-controlled infusion (TCI) and evaluate the performance of a new type Ⅰ TCI system for Chinese. Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 40-60 yr weighing 50-70 kg undergoing elective lung resection were randomly divided into 2 groups according to target remifentanil concentration: group Ⅰ 6 ng ? ml-1 and group Ⅱ 8 ng?ml-1. The patients were premedicated with intramuscular midazolam 0.05 mg?kg-1 and atropine 0.5 mg. Anesthesia was induced with remifentanil and propofol both given by TCI. The target concentration of propofol (effect-site concentration) was set at 3 ?g?ml-1 and remifentanil (plasma concentration) at 6 or 8 ng? ml-1. When the patients lost consciousness, vecuronium 0.1 mg?kg-1 was given i. v. to facilitate intubation. The patients were mechanically ventilated and PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent i. v. boluses of vecuronium. Target plasma concentration of remifentanil remained unchanged during anesthesia. BIS value was maintained at 45-55 by modifying target propofol concentration. Arterial blood samples were taken before and 5, 10, 20, 40, 60, 90 and 120 min after TCI remifentanil was started for determination of blood remifentanil concentration by high performance liquid chromatography.The performance error (PE) was determined for each measured blood remifentanil concentration. The performance in the population was determined by median absolute performance error (MDAPE), median performance error (MDPE) and the wobble (the median absolute deviation of each PE from the MDPE). Results The measured concentrations (Cm) of remifentanil were significantly lower than the target plasma concentration (Cp) at5, 10, 20 min of TCI in both groups ( P

Objective: To study the effect of intraarticular injection of crosslinked-chitosan in the treatment of knee osteoarthritis in rabbits. Methods: Thirty-two New Zealand white rabbits were randomly divided into 4 groups (groups A, B, C, and D; 8 rabbits in each group). The knee osteoarthritis models were prepared by anterior cruciate ligament transection in the left hind in groups A, B, and C. At 4 weeks after operation, the rabbits were received intraarticular injection of 0.6 mL crosslinked-chitosan in group A, 0.3 mL chitosan (once per 2 weeks, for twice) in group B, and 0.3 mL saline (once per 2 weeks, for twice) in group C. The rabbits in group D were treated with sham operation in the left hind, and received intraarticular injection of 0.3 mL saline (once per 2 weeks, for twice). At 8 weeks, the macroscopic observation, histological examination (HE staining, Safranin-fast green double staining, and Mankin score), scanning electron microscopy (SEM) observation, and immunohistochemical staining of collagen type Ⅱ were performed. Results: Macroscopic and SEM observations showed that the cartilage in group D was basically the same as normal and better than that in groups A and B, and the abrasion of cartilage in group C was the most serious. The histological observation results in groups A and B were slightly similar and better than those in group C, but not up to the structure of group D. The macroscopic score and Mankin score of groups B and C were significantly higher than those of group D ( P<0.05), and there was no significant difference between group A and group B ( P>0.05). Immunohistochemical staining results showed that the collagen type Ⅱ positive percentage of chondrocytes was significantly higher in group D than that in groups B and C, and no significant difference was found between group A and group B ( P>0.05). Conclusion: The crosslinked-chitosan can significantly improve the osteoarthritis of the rabbit knee, delay the pathological changes of osteoarthritis, and decrease the frequency of injection.

Objective To evaluate the optimized efficacy of thoracic paravertebral block (TPVB) combined with general anesthesia via the research on the postoperative cellular immune function in the patients undergoing radical resection for esophageal cancer.Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 45-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective radical resection for esophageal cancer,were divided into 2 groups (n =20 each) using a random number table:general anesthesia group (G group) and TPVB combined with general anesthesia group (TPVB+G group).In group TPVB+G,TPVB was performed at T4 and T6 on the operated side under ultrasound guidance with 0.5％ ropivacaine 15 ml before anesthesia induction.Anesthesia induction was started after the level of block was confirmed.Anesthesia was maintained with propofol given by target-controlled infusion at the target plasma concentration of 1-4 μg/ml,and bispectral index value was maintained at 40-50.Patient-controlled intravenous analgesia was performed after operation,and visual analog scale score was maintained ≤ 3.Before anesthesia induction,at the end of operation and at 24 and 48 h after operation,blood samples were collected from the central vein for determination of the levels of T lymphocyte subsets CD3+,CD4+ and CD8+ and CD4+/CD8+ ratio.Ricker Sedation-Agitation Scale scores were recorded at 10 min,20 min,30 min and 1 h after extubation and 6,24 and 48 h after operation.The consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia,the number of unsuccessfully delivered doses and the total number of attempts were also recorded.Results Compared with group G,Ricker Sedation-Agitation Scale scores were significantly decreased at 10 min after extubation,the consumption of intraoperative remifentanil,requirement for vasoactive agents during recovery from anesthesia and the number of unsuccessfully delivered doses were decreased,and the postoperative CD4+ level and CD4 +/CD8 + ratio were increased in group TPVB+G (P＜0.05).Conclusion TPVB combined with general anesthesia can improve the postoperative cellular immune function and is an optimal anesthesia regimen in the patients undergoing radical resection for esophageal cancer.