Objective To investigate the effects of penehyclidine hydrochloride combined with ulinastatin on lung injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).Methods Sixty ASA Ⅱ or Ⅲ patients of both sexes,aged 33-64,weighing 47-81 kg,NYHA class Ⅱ or Ⅲ ,scheduled for cardiac valve replacement,were randomly divided into 4 groups(n = 15 each): control group(group C),ulinastatin group(group U),penehyclidine hydrochloride group(group P)and penehyclidine hydrochloride + ulinastatin group(group PU).Group U,P and PU received iv injection of ulinastatin 20 000 U/kg,penehyclidine hydrochloride 0.05 mg/kg and ulinastatin 20 000 U/kg + penehyclidine hydrochloride 0.05 mg/kg 30 min after the end of CPB,respectively,while group C received equal volume of normal saline.Then PEEP was increased to 8 cm H2O in all groups.Blood samples were taken at 30 min,3 and 6 h after the end of CPB and 12 and 24 h after operation for determination of PaO2 and serum concentrations of TNF-α,IL-6,IL-8 and IL-10.Airway peak pressure and airway plateau pressure were recorded at the corresponding time points.Oxygen index(OI)and pulmonary compliance(CL)were calculated.Lung injury was scored at 6 h after the end of CPB and 12 and 24 h after operation.Results OI and CL were significantly increased and lung injury score was significantly decreased in group U,P and PU compared with group C(P ＜ 0.05 or 0.01),and in group PU compared with group U and P (P ＜ 0.05).Serum concentrations of TNF-α,IL-6 and IL-8 were significantly lower and the serum IL-10 concentration was significantly higher in group U,P and PU than in group C(P ＜ 0.05 or 0.01),and in group PU than in group U and P(P ＜ 0.05).There was no significant difference in the indices mentioned above between group U and P(P ＞ 0.05).Conclusion Penehyclidine hydrochloride combined with ulinastatin can attenuate lung injury by inhibiting inflammatory response in patients undergoing cardiac valve replacement with CPB.

Objective To investigate the changes of plasma activated protein C(APC)in the pediatric leukemia patients with acute lung injury(ALI),and the relationship with the outcome.Methods During the study period(from Jan to Dec 2009),17 pediatric leukemia patients with ALI were selected.They were divided into neutropenic(n =10)and non-neutropenic(n =7)group.We collected the basic data including the age,gender,stage of chemotherapy,pediatric critical illness score,mechanical ventilation time,ICU time.The blood gas and plasma APC levels were detected on day 1 and day 4 of ALI onset.Results Compared with the non-neutropenic group,the neutropenic group had a significantly longer mechanical ventilation time [(16.60 ± 1 0.83)d vs(3.79 ± 4.08)d,P =0.009 6],lower PaO2 level on day l[(54.90 ± 17.05)mm Hg vs (92.70 ± 27.53)mm Hg,P =0.009 7],and lower APC level on day 4[(193.06 ± 63.19)pg/mlvs(286.28 ±25.12)pg/ml,P =0.007 7].Conclusion The APC generation is severely impaired in the neutropenic group,especially in those who died.The lower APC level is,the longer is the mechanical ventilation time,the worse is oxygenation,the poorer is the prognosis.APC replacement therapy may be promising in these patients.

Objective To investigate the effect of dexmedetomidine on the cerebral injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Forty ASA Ⅱ or Ⅲ patients of both sexes,aged 43-64 yr,scheduled for elective cardiac valve replacement,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was injected intravenously over 15 min before induction of anesthesia,followed by infusion at 0.2μg· kg-1 · h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Blood samples were obtained from the radial artery and jugular bulb for blood gas analysis before CPB,immediatelv after declamping of the ascending aorta,at the end of CPB and at 6 h after operation (T1-4).The arteriovenous blood O2 difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated.The plasma concentrations of S-100β and neuron-specific enolase (NSE) in the blood samples obtained from the jugular bulb were measured at T1-4 and 24 h after operation.Results Compared with group C,the jugular venous oxygen saturation was significantly increased and Da-jvO2 and CERO were decreased at T2,3,and the plasma concentrations of S100β and NSE were decreased at T2-4 in group D (P ＜ 0.05).Conclusion Dexmedetomidine can decrease the cerebral O2 metabolic rate and reduce the cerebral injury in patients undergoing cardiac valve replacement under CPB.

Objective To determine the median effective target plasma concentration (EC50) of remifentanil inhibiting responses to skull-pin placement when combined with propofol in the female patients undergoing neurosurgery.Methods Sixteen female patients,aged 20-60 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective neurosurgery under general anesthesia,were enrolled in this study.Anesthesia was induced with propofol and remifentanil given by target-controlled infusion and iv rocuronium 0.6 mg/kg.The target plasma concentration (Cp) of remifentanil and propofol was set at 5 ng/ml and 3 μg/ml,respectively.At 3 min after tracheal intubation,the target Cp of remifentanil was adjusted and set at 5 ng/ml in the first patient.The skull-pin was placed after the target effect-site and plasma concentrations were balanced.The Cp increased/decreased by 20％ each time in the next patient depending on whether or not the response to skull-pin placement was positive.The ratio between the two successive concentrations was 1.2.The response to skull-pin placement was defined as positive when heart rate and/or mean arterial pressure increased by 20％ of the baseline value within 1 min after placement.The EC50 and 95％ confidence interval of remifentanil required to inhibit responses to skull-pin placement were calculated when combined with propofol.Results The EC50 (95％ confidence interval) of remifentanil required to inhibit responses to skull-pin placement was 3.74 (3.43-4.09) ng/ml when combined with propofol.Conclusion When combined with propofol,the EC50 of remifentanil inhibiting responses to skull-pin placement is 3.74 ng/ml in the female patients undergoing neurosurgery.

Objective To observe the safety and efficacy of different concentration of remifen-tanil TCI combined with dexmedetomidine for awake nasal intubation in cervical spine surgery patients and explore the clinical suitable concentrations for remifentanil TCI.Methods Sixty cervical spine surgery patients undergoing selective surgery under general anaesthesia (male 40 cases,female 20 ca-ses,aged 18-68 years,ASA Ⅰ or Ⅱ)were randomly divided into three groups according to TCI con-centration of remifentanil.The plasma concentration of remifentanil TCI of group A,B,C were 1.5 ng/ml,2.0 ng/ml,2.5 ng/ml respectively,which combined with dexmedetomidine 1 μg/kg.The value of MAP,HR,SpO2 ,RR were recorded when patients entering the operating room(T1 ), before intubation(T2 ),immediately after tracheal tube passing through nasopharynx(T3 ),immedi-ately after tracheal intubation(T4 ),immediately after tracheal tube cuff inflated(T5 )and 1min after intubation(T6 ).The success rate of first intubation were recorded.The incidence of cough,limb movement,respiratory depression,awareness and other adverse reactions during intubation were re-corded.Results In group A,MAP and HR at T3-T5 were significantly higher than those at T1 (P <0.05);SpO2 at T4-T6 and RR at T3-T6 were significantly lower than those at T1 (P <0.05)in group C.In group A,the incidence of cough and limb movements were significantly higher than those in group B,C(P <0.05).In group C,the incidence of respiratory depression was significantly higher than that in group A,B(P <0.05).Conclusion TCI concentration 2.0 ng/ml for remifentanil com-bined with dexmedetomidine can effectively inhibit the stress response to intubation with little respira-tory depression and can be widely used for awake nasal intubation in cervical spine surgery patients.

Objective To evaluate the patient-controlled paravertebral block (PCPB) in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in patients.Methods Forty-one ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 50-64 yr,with body mass index of 20-25 kg/m2,of TNM staging Ⅰ or Ⅱ,undergoing radical resection of pulmonary carcinoma performed via video-assisted thoracoscope,were randomly divided into 2 groups using a random number table:PCIA group (n =21) and PCPB group (n =20).PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.In PCPB group,the patients received paravertebral injection of 0.2％ ropivocaine 5 ml at T5 level on the affected side under ultrasound guidance at the end of operation,and then received PCPB.PCPB solution contained 0.75％ ropivacaine 67 ml in 250 ml of normal saline,and the pump was set up to deliver a 5 ml bolus dose,with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤ 3,and analgesia lasted until 50 h after operation.Before induction of anesthesia (baseline),at end of operation,and at 1,3 and 5 days after operation,peripheral venous blood samples were collected to determine the levels of regulatory T cells,natural killer cells and natural killer T cells (by flow cytometry) and plasma concentrations of interleukin-10 and transforming growth factor-β (by ELISA).Results Compared with group PCIA,the level of regulatory T cells was significantly decreased,the levels of natural killer cells and natural killer T cells were increased,and the plasma concentrations of interleukin-10 and transforming growth factor-β were decreased at 1 and 3 days after operation,and no significant change was found in the rate of cellular immune function decline after operation in group PCPB.Conclusion PCPB provides no significant difference clinically in optimizing the cellular immune function when used after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope in the patients.

Objective To investigate the effects of phosphocreatine postconditioning on cerebral ischemia-reperfusion(IR)injury in rats.Methods Thirty-six SD rats were randomly divided into three groups:groups Sham,IR (treated with normal saline)and PCr.IR was induced by intraluminal middle cerebral artery occlusion (MCAO).All treatments were given intravenously at the begining of reperfusion.Twenty-four hours after the reperfusion, neurological deficit score and magnetic resonance scan were performed.serum concentrations of malonaldehyde and 4-hydroxynonenal,cere-bral infarct volume and destruction of cerebral cortex were estimated.Neuronal apoptosis was further assessed by immunohistochemistry and immunofluorescent staining of caspase-3 and NeuN. Results Compared with group IR,phosphocreatine significantly decreased neurological deficit score, infarct volume,malonaldehyde and 4-hydroxynonenal levels(P < 0.05 ).Cortex structure was more complete,as well as neuronal apoptotic index was smaller in group PCr (P <0.05).Conclusion PCr can reduce cerebral infarct volume,thereby promote neurofunctional recovery.The mechanism of Pcr is related to reduced oxidative stress and inhibitted apopotosis during IR.

Objective To compare the efficacy of laryngeal mask of Supreme and i-gel for the airway management in patients undergoing elective lumbar vertebral surgery in prone position. Methods A total of 264 patients,ASA physical status Ⅰ or Ⅱ,scheduled for elective lumbar verte-bral surgery in prone position under general anesthesia were divided into two groups (n =132)using a random number table:laryngeal mask of Supreme group (group S)and laryngeal mask of i-gel group (group I).The laryngeal mask of Supreme or i-gel were respectively placed in group S and group I im-mediately after anesthesia induction according to manufacturers’specification.Volume-controlled ven-tilation was used to observe the ventilation quality.The number of laryngeal mask insertion,laryngeal mask insertion time and the ventilation quality in supine and prone position were recorded,as well as the airway seal pressure.The position of laryngeal mask was evaluated by fibero ptic examination in both supine and prone positions.The blood on the laryngeal mask was noted.Finally,the occurrence of laryngeal mask related complications was observed.Results One patient in group I was excluded due to the failure of laryngeal mask insertion after three attempts.No significant difference in type of laryngeal mask,insertion time,adjusted cases,peak airway pressure,and fiber optic examination in both supine and prone positions between two groups.Compared with group S,group I required signif-icantly more attempts of insertion (P < 0.01 ).Nevertherless,ventilation quality in prone position was improved and airway seal pressure in supine and prone position increased (P <0.01 or P <0.05) in group I.No significant difference was found in the occurrence of laryngeal mask related complica-tions.Conclusion In the airway management of patient undergoing elective lumbar vertebral surgery in prone position,laryngeal mask of i-gel is more difficult to be inserted but can maintain higher air-way seal pressure compared with laryngeal mask of Supreme.

Objective To establish the first national standard of Cystatin C.Methods The candidate standard was prepared from human recombinant Cystatin C,diluted and dispensed aseptically.Homogeneity and stability study were carried out on the automated biochemical analyzer.The target value was assigned by six laboratories using widely recognized immumoassay under strict conditions,and traceable to ERM-DA471.Commutabilities of the candidate standard and its saline dilutions were evaluated according to EP14-Evaluation of Matrix Effects.Excel 2007 was used to analyze the results.Results The preparation had good immunological activity and was proved to be homogeneous and stable (6 months sealed at 2-8 ℃,30 days sealed at room temperature and 37 ℃,30 days open-vial at 2-8 ℃).The assigned value of the preparation was (4.47 ± 0.25) mg/L (coverage factor k =2).The candidate standard and/or its saline dilutions have commutability on the 10 evaluated systems.Conclusion The preparation meets the requirements of national secondary standard and could be used in quality control and evaluation of Cystatin C assays in China.

Objective To investigate protective effects of dexmedetomidine on oxygen-glucose deprivation/reperfusion(OGD/R)-induced neuronal apoptosis.Methods SH-SY5Y cells were differentiated to neurons with ATRA and followed by TPA.According to the results of preliminary experiment, OGD/R modle was constructed by oxygen-glucose deprivation(OGD) for 12 h and reperfusion(R) for another 12 h.During the start of the OGD, neurons were immediately divided into six groups: group D0(0 μmol/L dexmedetomidine), group D1(0.1 μmol/L dexmedetomidine), group D2 (1 μmol/L dexmedetomidine), group D3 (10 μmol/L dexmedetomidine), group D4(100 μmol/L dexmedetomidine), group D5 (1 000 μmol/L dexmedetomidine).After reperfusion 12 h, the cell viability was evaluated by the method of MTT.The cellular apoptosis was observed by flow cytometry method.The protective effects of different concentration dexmedetomidine on OGD/R-induced neuronal apoptosis were investigated.Then in chosen the exact group having protective effects, endoplasmic reticulum stress specific protein mesencephalic astrocyte-derived neurotrophic factor (MANF) and pro-apoptotic protein Caspase-3 and CHOP were detected by Westernblot method.Results Compared with group D0, there was no difference on the cell viability and cellular apoptosis induced by OGD/R in groups D1 and D2, but a significant decrease and increase in groups D4 and D5 (P<0.01 or P<0.05).And only group D3 had a neuroprotective effect, significantly increased the cell viability and inhibited the apoptosis (P<0.01).Further studys found that group D3 significantly up-regulated ER stress specific protein MANF (P<0.01) and inhibited up-regulation of Caspase-3 and CHOP (P<0.01).Conclusion These data suggest that 10 μmol/L dexmedetomidine had neuroprotective effect on OGD/R-induced neuronal apoptosis and significantly increased cell viability.Our results also indicate that up-regulation of ER stress specific protein MANF and inhibition of CHOP and Caspase-3 by MANF are involved in the neuroprotective effects of Dexmedetomidine.