BACKGROUND: Recently, lithium was reported shown neuroprotective effect against apoptosis induced by a variety of insults in vitro and in vitro,but the precise mechanisms underlying its neuroprotective effect remain unknown.OBJECTIVE: To observe the effect of lithium chloride on neuronal apoptosis and the expression of P53 or nuclear factor kappa B (NF-κB) protein in the CA1 region of the hippocampus after global ischemia in gerbils.DESIGN: A randomized controlled experimental research.SETTING: Department of Anatomy of Nanjing Medical University.MATERIALS: Fifty-four healthy male gerbils weighing 50-70 g, clearing grade, were purchased from Experimental Animal Center of Zhejiang Province.METHODS: Totally 54 gerbils were randomly divided into three groups namely: sham-operation group (SH group), ischemia-reperfusion group (IR group) and lithium chloride group (LI group), with 18 in each group. SH group, IR group and LI group were further divided into 3 subgroups respectively (SH1d, SH3d, SH7d; IR1d, IR3d, IR7d; LI1d, LI3d, LI7d), according to the time of reperfusion, with 6 gerbils in each. Gerbils in LI group were injected intraperitoneally with lithium chloride 3 mEq /kg, once a day for 7consecutive days before operation. Normal saline was used instead of lithium in SH group and IR group as vehicle control. Forebrain ischemia was induced at 24 hours after the last injection of lithium chloride. After gerbils being anesthetized, the bilateral common carotid arteries were blocked with micro aneurysm clips for 5 minutes, and the micro aneurysm clips were removed and the cerebral blood flow restored. Sham-operation animals were underwent the same operation except occlusion of bilateral common carotid arteries. Gerbils in each group were killed at every time points.4 μm coronal sections at 1.7-4.0 mm visual cross were cut at the level of the dorsal hippocampus. The apoptosis cells were assayed with in situ Cell Death Detection Kit, and assay of positive cell in cell apoptosis, P53 and positive NF-κB was performed with immunohistochemistry staining. The total number of TUNEL positive cells, P53 or NF-κB positive cells per image (area of 1 mm2) was counted.MAIN OUTCOME MEASURES: Neuronal apoptosis and expression of P53 or NF-κB protein in the CA1 region after cerebral ischemic reperfusion.apoptosis cell in cerebral hippocampus CA1 region: No TUNEL positive cells were detected in SH group, a large majority of TUNEL positive cells were detected in the CA1 region in IR group on the 3rd day after reperfusion [(552.0±145.5, 142.4±103.5) pcs/mm2, t= 5.623, P ＜ 0.01], and TUNEL positive cells declined on the 7th day after reperfusion. The numbers of TUNEL positive cells in the CA1 region of LI3d, LI7d group were significantly lower than those of IR3d, IR7d group [(408.0±119.8, 156.0±108.2) pcs/mm2,CA1 region: In IR group, the expression of P53 protein was increased on the 1st, 3rd and 7th day after reperfusion compared with that in SH group and cerebral hippocampus CA1 region: No NF-κB protein was expressed in SH group. In IR group, the expression of NF-κB protein was increased on the 1st day after reperfusion (78.5±25.2)/mm2, significantly increased on the 3rd day after reperfusion (176.5±35.5)/mm2 and on the 7th day after reperfusion, the expression of NF-κB protein disappeared. There were no significant statistical difference between LI group and IR group on the 1st day after reperfusion. The expression of NF-κB protein in LI group was significantly lower than that in IR group on the 3rd day after reperfusion [(64.5±30.8)/mm2,t=5.824, P ＜ 0.01].CONCLUSION: Lithium chloride can significantly suppress neuronal apoptosis after global ischemia in gerbils. The down-regulation of expression of P53 or NF-κB protein is one of the mechanisms of the neuroprotective effect by lithium chloride.

Objective To evaluate the efficiency of dexmedetomidine combined with flurbipro-fen axetil preventing agitation and reducing extubation reaction after general anesthesia. Methods Eighty patients,ASA Ⅰ or Ⅱ,scheduled for selective oral and maxillofacial surgery were randomly divided into four groups,20 patients in each group.30 mins before end of the operation, patients intravenously received flurbiprofen axetil 50 mg (group F),dexmedetomidine 0.5 μg/kg (group D),dexmedetomidine 0.25 μg/kg plus flurbiprofen axetil 50 mg (group DF),normal saline (group C),respectively.MAP,HR were recorded before extubation (T0 ),extubation (T1 ),5 mins after extubation (T2 ).The recovery time,extubation time,Riker sedation-agitation score(RSAS)be-fore extubation and Ramsay sedation score 5 min after extubation were observed.Results Compared with T0 ,MAP,HR at T1 ,T2 in group C and group F were significantly increased (P <0.05 or P <0.01),MAP,HR at T1 ,T2 in group D and group DF were significantly lower than those in group C (P <0.01 ).The recovery time,extubation time in group D were significantly longer than those in group C,group F and group DF(P <0.05).Ramsay scores in group D was significantly higher than other groups(P <0.05).The incidence of agitation in group D and group DF were significantly lower than those in group C(P <0.05 or P <0.01).Conclusion Dexmedetomidine 0.25 μg/kg plus flurbi-profen axetil 50 mg can effectively prevent agitation and reduce extubation cardiovascular reaction dur-ing recovery period,without the disadvantage of prolonging the recovery and extubation time.

Objective To evaluate protective effects of dexmedetomidine combined with lung-protective ventilation on lungs in patients undergoing thoracic surgery.Methods Eighty patients with normal pulmonary function,aged 40-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with body mass index of 20-25 kg/m2,scheduled for elective right lobectomy for lung cancer performed via a thoracoscope,were divided into 4 groups (n =20 each) using a random number table:conventional ventilation group (group C),dexmedetomidine combined with conventional ventilation group (group DC),lung-protective ventilation group (group P) and dexmedetomidine combined with lung-protective ventilation group (group DP).In DC and DP groups,dexmedetomidine was intravenously infused as a loading dose of 0.5 μg/kg (over 10 min) starting from 10 min before anesthesia induction,followed by an infusion of 0.6 μg · kg 1 · h-1 until the end of surgery.In C and DC groups,the tidal volume was set at 9 ml/kg,positive end-expiratory pressure 0 cmH2O,fraction of inspired oxygen 100％,respiratory rate 10-12 breaths/min,inspiratory/expiratory ratio 1 ∶ 2,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg during both two-lung ventilation (TLV) and one-lung ventilation (OLV).In P and DP groups,the tidal volume was set at 6 ml/kg,positive end-expiratory pressure 5 cmH2O,fraction of inspired oxygen 70％,respiratory rate 14-16 breaths/min,i nspiratory/expiratory ratio 1 ∶ 2,and end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg during TLV and OLV.Airway peak pressure (Ppe~),airway plateau pressure (Pp~t),dynamic lung compliance and airway resistance (Raw) were monitored and recorded immediately before OLV (T1),at 30 min,1 h and 2 h of OLV (T2-4) and at 15 min after restoration of TLV (T5).Arterial blood samples were collected at 10 min before induction of anesthesia (T0) and T1-5 for blood gas analysis,and oxygenation index was calculated.At T0,T1,T3,T4 and 2 and 24 h after surgery (T6,7),blood samples were taken from the right internal jugular vein for determination of the concentrations of serum tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and high-mobility group box 1 protein (HMGB1) by enzyme-linked immunosorbent assay.Results Compared with group C,Raw was significantly decreased at T2-4 in group DC,Ppeak,Pplat and Raw were significantly decreased at T2-4 in P and DP groups,oxygenation index was significantly increased at T5 in DC and P groups,oxygenation index was significantly inereased at T2-5 in group DP,the concentrations of serum TNF-α and IL-6 were significantly decreased at T3,4 and T6,7 in P,DC and DP groups,and the concentrations of serum HMGB1 were significantly decreased at T6,7 in DC and DP groups (P＜0.05).Compared with group DC,Ppeak,Pplat and Raw were significantly decreased at T2-4,oxygenation index was increased at T3-5,and the concentrations of serum TNF-α and IL-6 were decreased at T3,4 and T6,7 in group DP (P＜0.05).Compared with group P,Raw was signifieantly decreased at T2-4,oxygenation index was increased at T2-5,and the concentrations of serum TNF-α and IL-6 were decreased at T3,4 and T6,7,and the concentrations of serum HMGB1 were decreased at T6,7 in group DP (P＜0.05).There was no significant difference in dynamic lung compliance at each time point among the four groups (P＞0.05).Conclusion The combination of dexmedetomidine and lung-proteetive ventilation provides protective effects on lungs and exterts better efficacy than either alone,and the mechanism may be related to inhibiting systemic inflammatory responses of patients undergoing thoracic surgery.

Objective To investigate the median effective dose(ED50)and 95％effective dose(ED95)of ciprofol in combination with butorphanol for painless gastroscopy in elderly patients.Meth-ods A total of 27 elderly patients with selective gastroscopy were conducted with intravenous induc-tion of 5 μg/kg butorphanol for at least 30 seconds,and 3 minutes later,they were administered intra-venously with ciprofol for at least 30 seconds;gastroscopy was performed when the eyelash reflex disap-peared or the Modified Observers Assessment of Alertness/Sedation(MOAA/S)score was less than one point.The initial dose of ciprofol was set as 0.2 mg/kg,and the modified sequential allocation method was used;if there was a positive response during the insertion of the gastroscope,the dose for the next patient would increase by one level,and vice versa,the dose would decrease by one level,with an adjacent dose concentration gradient of 0.05 mg/kg.A positive response to gastroscope inser-tion was defined as coughing,swallowing,or limb movements when the gastroscope entered the throat.The study was terminated after 7 reversals in ciprofol dose adjustments.ED50,ED95,and correspond-ing 95％confidence intervals(95％CI)of ciprofol combined with butorphanol for painless gastroscopy were calculated.Results When combined with butorphanol,the ED50 of ciprofol for painless gastrosco-py in elderly patients was 0.253 mg/kg(95％CI,0.219 to 0.290),and the ED95 was 0.328 mg/kg(95％CI,0.290 to 0.521).Conclusion When combined with butorphanol,the ED50 of ciprofol for painless gastroscopy in elderly patients is 0.253 mg/kg,and the ED95 is 0.328 mg/kg.

Objective To investigate the median effective dose(ED50)and 95％effective dose(ED95)of ciprofol in combination with butorphanol for painless gastroscopy in elderly patients.Meth-ods A total of 27 elderly patients with selective gastroscopy were conducted with intravenous induc-tion of 5 μg/kg butorphanol for at least 30 seconds,and 3 minutes later,they were administered intra-venously with ciprofol for at least 30 seconds;gastroscopy was performed when the eyelash reflex disap-peared or the Modified Observers Assessment of Alertness/Sedation(MOAA/S)score was less than one point.The initial dose of ciprofol was set as 0.2 mg/kg,and the modified sequential allocation method was used;if there was a positive response during the insertion of the gastroscope,the dose for the next patient would increase by one level,and vice versa,the dose would decrease by one level,with an adjacent dose concentration gradient of 0.05 mg/kg.A positive response to gastroscope inser-tion was defined as coughing,swallowing,or limb movements when the gastroscope entered the throat.The study was terminated after 7 reversals in ciprofol dose adjustments.ED50,ED95,and correspond-ing 95％confidence intervals(95％CI)of ciprofol combined with butorphanol for painless gastroscopy were calculated.Results When combined with butorphanol,the ED50 of ciprofol for painless gastrosco-py in elderly patients was 0.253 mg/kg(95％CI,0.219 to 0.290),and the ED95 was 0.328 mg/kg(95％CI,0.290 to 0.521).Conclusion When combined with butorphanol,the ED50 of ciprofol for painless gastroscopy in elderly patients is 0.253 mg/kg,and the ED95 is 0.328 mg/kg.

Objective To evaluate the efficacy of different doses of oxycodone for prevention of fen-tanyl-induced cough during induction of general anesthesia. Methods A total of 250 American Society of Anesthesiologists physical statusⅠor Ⅱ patients of both sexes, aged 22-62 yr, weighing 47-81 kg, un-dergoing elective surgery, were divided into 5 groups (n＝50 each) using a random number table method:different doses of oxycodone groups (O1-4groups) and control group (group C). Oxycodone 0. 025, 0. 050, 0. 075 and 0. 100 mg∕kg were intravenously injected in O1-4groups, respectively, while the equal volume of normal saline was given instead of oxycodone in group C. Five minutes later fentanyl 3 μg∕kg was intrave-nously injected within 5 s, and then 2 min later the other drugs were administered for induction. The occur-rence and severity of cough were observed within 2 min after fentanyl injection. The development of respira-tory depression and hypotension and severe bradycardia during induction of anesthesia were recorded within 5 min after oxycodone injection. Results The incidence of cough was significantly lower in O1-4groups than in group C (P＜0. 05). There was no significant difference in the incidence of cough among O1-4groups (P＞0. 05). No respiratory depression was found in C and O1-3groups. The incidence of respiratory depression was significantly higher in group O4than in C and O1-3groups (P＜0. 05). There were no significant differ-ences in the incidence of hypotension or severe bradycardia during induction of anesthesia among the five groups (P＞0. 05). Conclusion Oxycodone 0. 025 mg∕kg provides better efficacy in preventing fentanyl-induced cough during induction of general anesthesia.

Objective To investigate the efficacy and safety of preemptive one lung ventilation(OLV)combined with disconnection technique for lung collapse during OLV with bronchial blocker(BB)in thoracoscopic surgery.Methods 75 patients who were scheduled for elective left lung segment or lobectomy under thoracoscopy were randomly divided into preemptive OLV group(group A),disconnection technique group(group B)and preemptive OLV combined with disconnection technique(group C),25 cases in each group.The time of complete lung collapse,surgeon satisfaction,pre-thoracic preparation time,OLV time,operation time,and occurrence of hypoxemia[percutaneous arterial oxygen saturation(SpO2)<90%]within 20 minutes after the onset of OLV were recorded;The lung collapse score(LCS)at the moment of pleural cavity opening(T0),1 min(T1),5 min(T2),10 min(T3)and 20 min(T4)after pleural cavity opening were recorded.Results Compared with group A and B,the complete lung collapse time in Group C was significantly shortened,and the surgeon satisfaction was significantly improved,the differences were statistically significant(P<0.05).There was no statistical significance in the complete lung collapse time and surgeon satisfaction between group A and B,the differences were not statistically significant(P>0.05).Compared with group A,the LCS at T0 in group B was lower than that in group A,but significantly higher at T1,the differences were statistically significant(P<0.05).The LCS at T1,T2,T3 and T4 in group C were significantly higher than those in group A and group B,the differences were statistically significant(P<0.05).The value of SpO2 at T2 in group C was obviously lower than that in group A and group B,the difference was statistically significant(P<0.05).Conclusion Preemptive OLV combined with disconnection technique can improve the lung collapse of the non-ventilated lung during OLV with BB in thoracoscopic surgery,shorten complete lung collapse time,with higher surgeon satisfaction,and higher LCS score during OLV.However,SpO2 during OLV still needs to be monitored.