Objective To observe the effect of propofol of dento-anaesth dosage on prevention of emergence ngitatian(EA). Methods Forty ASA Ⅰ-Ⅱ patients, aged 32-56 years old and undergoing elective laparoscopic cholecystectomy, were randomly divided into two groups, propofol group (group P, 20 cases) and control group (group C, 20 cases). Anesthesia was induced intravenously with 0.1 mg/kg midaxolam, 1.0 mg/kg propofol, 2 μg/kg fentanyl and 0.15 mg/kg vecuronium. Anesthesia was maintained by intravenous and inhalation combined anesthesia. Vecuronium was discontinued about 15 min before the end of sur gery. After entered the postoperative care unit, patients in group P received propofol (0.5 mg/kg) and those in group C were administrated with normal saline (0.05 ml/kg). Time to recovery of spontaneously breathing, duration of opening eyes on verbal command, extubation time were recorded. Incidence of EA in both groups was calculated. Results Time to recovery of spontaneously breathing, duration of opening eyes on verbal com-mand and extubatian time in group P [(15.6±4.5), (18.2±6.5), (22.6±5.5) min, respectively] were sig-nificantly longer than those in group C[(13.2±5.4), (15.7±6.2), (18.4±6.8) min, respectively ]. In-cidence of EA in group P(5% ) was significantly less than that in group C(30%). Conclusion The propofol of dento-anaesth dosage can obviously decrease the incidence of EA in patients undergoing elective laporo-scopic cholecystectomy.

Objective To analyze the clinical effect of treating adjacent multi-vertebral tuberculosis by anterior radical debridement, titanium mesh bone fusion and internal fixation. Methods Twenty-four patients with adjacent multi-vertebral tuberculosis were treated by anterior radical debridement, titanium mesh bone fusion and internal fixation from April 2002 to May 2004. There were different types of tuberculosis symptoms in all the cases, including local pain and preoperative kyphosis deformity, and paraplegia in 6 cases. The preoperative kyphosis angle was 27.5??3.5?. After intensive anti-tuberculosis medication for 2 to 4 weeks before operation, 24 patients were reconstructed with Ti-Mesh filled with autograft rib and anterior internal fixation. After operation, the anti-tuberculosis medication was continued for one year. Results All the patients were followed up for 1.5 to 2.5 years postoperatively, with the average of 1.9 years. Their focus was eliminated completely, all the wounds healed in the first stage. The postoperative kyphosis angle was 5??2.5?. The average subsidence of Ti-Mesh was (3.5?0.5) mm at 8th weeks postoperation and the loss angle of kyphosis correction was 4.1??1.0? at lastest follow-up. Ti-Mesh began to fuse 3 to 6 months after operation. No looseness and dislocation were found during follow-up period. 6 patients with paraplegia recovered completely after 6 months, and kyphosis was rectified. ESR of these patients reduced a month after operation and reached to normal level after 6 months. Conclusion Anterior radical debridement, titanium mesh bone fusion and internal fixation show good results in treatment of adjacent multi-vertebral tuberculosis. The large bone deficit in the spine after debridement can be successfully reconstructed and kyphosis can be rectified. As the result of a better stability of the spine, secondary paraplegia can be avoided, and there is no need for iliac bone harvest, so without any relative complications.

Objective To explore multi-causes and therapy of massive hemothorax after thoracic operation.Methods Sixty-six patients suffered from massive hemothorax after thoracic operation.All of them were executed conservative treatments for postoperative hemothorax.The noneffeetive cases were executed re-exploration.The relationship of area of residual cavity,fluctuation of intrapleural pressure and volume of hemothorax were analyzed between lobectomy in 30 eases and wedge,segmental or no excision of lung in 24 cases in 24 h postoperation.Results Thirty-two of 66 cases being executed conservative treatments were suteessful,2 cases were dead,while 32 cases were executed re-exploration,and 29 of them were cured.but 1 case of them dead,and 2 cases suffered from bronchial fistula,who were cured by thoracoplasty.The operations of wedge,segmental or no excision of lung in 24 cases were compared with lobectomy in 30 cases.It Was proved that the former had the smaller area of residual cavity,the lower intrapleural pressure.and the less volume of hemothorax(P＜0.05).Conclusions The multiplicity analysis of massive hemothorax after thoracic operation are flucmafion of intrapleural pressure after operation,intracavitary suction with negative pressure,rise of pressure in microcirculation at wound,abnormality of blood coagulation function and so on.It can reduce complications that proper therapy is timely performed,and even avoid of re-exploration.

Objective To investigate the relationship between noninvasive brachial artery blood pressure (B) and radial artery blood pressure (R) of the right arm.Methods Two hundred and ninetyfive patients with 149 males and age of (47 ± 16) years were studied.The height of patients was 163 ± 8 cm,and weight of patients was (61.2 ± 7.8) kg.The patients with peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were all excluded.Their B (with adult cuffs) and R (with infant cuffs) of the right arm were measured and analyzed after the patients under general anesthesia and stable hemodynamics.The relationships between B and R were analyzed by linear regression,the differences between B and R of each interval were compared using one-way ANOVA and then followed by SNK procedure.Results Right brachial artery blood pressure was significantly lower than radial artery blood pressure.The differences between the two varied from 13 to 18 mmHg in systolic BP (SBP),diastolic BP (DBP) and mean blood pressure (MAP).And linear regression was most applicable to describe their correlation [r=0.841 (SBP),0.808 (DBP),0.833 (MAP),all P＜0.01].Conclusions Radial artery blood pressure measured with infant cuffs can well reflect the variation of brachial artery blood pressure.

Objective To evaluate the effects of peritoneal jet ventilation on peritoneal oxygenation in pigs.Methods Twenty-four pigs of both sexes (12-16 weeks,35-45 kg) were randomly divided into 3 groups (n=8 each): sham operation group (group S) ; peritoneal regular frequency jet ventilation group (16 bpm)(group N) and peritoneal high-frequency jet ventilation group (150 bpm) (group H).Oral tracheal intubation was performed.The animals were mechanically ventilated (VT 8-12 ml/kg,RR 12-16 bpm,I:E 1.0:1.5,FiO2 100％) via airway.Endotracheal tubes were inserted into abdomen through the incisions in the left lower (for peritoneal jet ventilation) and right upper quadrant (for outlet of air).Arterial blood PaO2 and PaCO2 were measured before (baseline) and at 30,60,90,120,150,180,210 and 240 s of peritoneal jet ventilation.Peritoneal jet ventilation was started after the lungs being mechanically ventilated for 35 min.Peritoneal jet ventilation was terminated when SpO2 dropped to SpO2 ＜ 90 ％.The duration of safe apnea (DSA,from the moment of begging of peritoneal jet ventilation to the time when PaO2 ＜ 60 mm Hg).Results PaO2 was significandy higher and DSA longer in group H than in groups S and N.But there was no significant difference in PaCO2 among the 3 groups.Conclusion Peritoneal high-frequency jet ventilation can significantly enhance the efficiency of peritoneal oxygenation and prolong DSA,while peritoneal regular frequency jet ventilation has no effect on peritoneal oxygenation.

Objective To prospectively investigate the neurological complications(NC)after offpump coronary artery bypass grafting(OPCABG),including the kinds of NC and their mobility,risk factors.prevetion and treatment.Methods A total of 55 consecutive patients with undergoing OPCABG were evaluated from March to June 2006 at the Department of Cardiosurgery in Beijing Anzhen Hospital.Risk factors of NC were collected before operation.Nervous system physical examination,The NIH Stroke Scale(NIHSS)score evaluation,cognitive tests,imaging examination(MRI,MRA and f-MRI),anxious and depression scale were performed before and after OPCABG.NC and their kinds were identified after surgery.According to the presence or absence of NC after the operation,the patients were divided into two groups,and univariate analysis was used between the two groups.P＜0.05 was considered of statistically significant difference.Results (1)2 cases of ischemic stroke developed after surgery(2/55),but there no case of mortality.The risk factors were not statistically different between the two groups(P＞0.05):(2)For all the patients,cognitive evaluation was normal and unchanged before and after surgery(P＞0.05),including Mini-Mental State Examination(MMSE),Clinical dementia rating(CDR)and Global Deterioration Scale (GDS);(3)Except the 2 cases of stroke,the others were normal and had no change on MRI,MRA,and f-MRI(P＞0.05)before and after surgery;(4)7 patients with slight anxiety and one with sight depression before operation recovered completely after surerty without treatment.Both the Self-rating Anxiety Scale (SAS)and Self-rating Depression Scale(SDS)were normal and unchanged before and after surgery (P＞0.05).Conclusions 2 cases of ischemic stroke were found among 55 patients undergoing OPCABG (2/55)and there was no mortality.There was no obvious change of cognitive function,imaging finding,anxiety and depression before and after the operation(P＞0.05).OPCABG is relatively safe for nervous system,but more exploratory work andclinical data are needed.

BACKGROUND:Prostacyclin (PGI2) and its analogs have been reported to prevent pressure overload-induced cardiac hypertrophy, and to reduce cardiac ischemia/reperfusion injury. However, clinical application of PGI2 is chalenging due to its short half-life (< 2 minutes). Thus, we have generated PGI2 expressing rat endothelial progenitor cel strains (PGI2-EPCs) that constitutively secrete prostacyclin.
OBJECTIVE:To investigate the protective effectof PGI2-EPCs against oxidative stress-induced cardiomyocyte injury.
METHODS:Cultured H9c2 celsin vitrowere assigned into four groups: H9c2 cels treated by H2O2for 4 hours. H9c2 cels were pretreated by conditioned medium (colected form EPCs and PGI2-EPCs or colected form EPCs and PGI2-EPCs mixed with native EPCs) before the addition of H2O2. PBS instead of conditioned mediums served as negative control. The paracrine effect of PGI2-EPCs onin vitro angiogenesis of native EPCs was evaluated. MTT and Hoechst 33342 assays were used to examine the protective effect of conditioned medium on H2O2-induced rat embryonic cardiomyocyte apoptosis and cel viability. Finaly, the effect of conditioned medium on the electric activities of adult cardiomyocyteswas measuredby whole-cel patch clamp techniques.
RESULTS AND CONCLUSION:When native EPCs mixed with conditioned medium of PGI2-EPCs, the total length of tubes was significantly longer compared with those mixed with CM of EPC. Rat embryonic cardiomyocytes pretreated with conditioned medium of PGI2-EPCs significantly reduced H2O2-induced apoptosis and preserved cel viability compared with pretreatment with EPC-conditioned medium and without pretreatment (P< 0.01). Pretreatment of rat adult cardiomyocyteswith conditioned medium of PGI2-EPCs abolished H2O2-induced early afterdepolarization and shortened H2O2-induced action potential duration prolongation (P< 0.01) towards baseline.Our findings indicate thatPGI2-EPCs protect against oxidative stress-induced cardiomyocyte injury through paracrine action.ThisStudy providesthe groundwork for an innovative cel therapy approach to treat ischemic heart disease.

Objective To study the efficacy of tourniquet to block the distal of radial styloid on success rate of radial artery catheterization.Methods One hundred and forty ASA Ⅰ-Ⅲ patients, aged 22-88 years,undergoing general anesthesia and requiring radial artery catheterization were in-cluded in this study and were randomly allocated into touch positioning group (group A)or tourni-quet-assisted group (group B).Radial artery catheterization was conducted after induction of general anesthesia in two groups.The invasive systolic blood pressure (ISBP ), invasive diastolic blood pressure(IDBP)and HR of patients were recorded in group B at 1 min before ischemia (T1 ),using pressure pulse blocking after 1 min (T2 ),2 min (T3 ),5 min (T4 )and the complete release of tour-niquet after 1 min (T5 ),5 min (T6 )and 10 min (T7 ).The first and total success rate of radial artery puncture,puncture times,puncture duration and complications were recorded.Results The radial ar-tery diameter was not statistically significant in group B between before and after blocking radial artery .ISBP at T2-T4 in group B was significantly higher than that at T1 (P <0.05).The first time puncture success rate and overall success rate in group B was significantly higher than that of group A,The number of puncture in group B was significantly less than that of group A,and puncture time was significantly shorter in group A (P <0.05).Conclusion Tourniquet-assisted radial artery cathe-terization could improve success rate,decrease puncture times and shorten puncture duration.

BACKGROUND:It has been confirmed that carboxymethylated chitosan has an promoting effect on Schwann cel proliferation and secretion, but its impact on the cyclic adenosine monophosphate-mediated protein kinase A signaling pathway in schwann cel stil needs further study. OBJECTIVE:To investigate the effect of carboxymethylated chitosan on cyclic adenosine monophosphate/ protein kinase A signaling pathway in rat schwann cels. METHODS:The Schwann cels of the second generation neonatal rats were obtained and seeded in 6-wel plate at a concentration of 1×109/L. These Schwann cels were cultured and divided into four groups. The Schwann cels in the control group were cultured by adding PBS. The Schwann cels in the experimental groups were cultured by adding 50, 100 and 200 mg/L of carboxymethyl chitosan solution, respectively. After 24 hours, the concentration of cyclic adenosine monophosphate, protein kinase A activity and cyclic adenosine monophosphate response element binding protein mRNA expression were detected. RESULTS AND CONCLUSION:Compared with the control group, carboxymethyl chitosan increased cyclic adenosine monophosphate concentrations, the activity of protein kinase A and cyclic adenosine monophosphate response element binding protein mRNA expression within the Schwann cels in a dose-dependent manner (P < 0.05). These results demonstrate that carboxymethyl chitosan can increase the concentration of cyclic adenosine monophosphate within the Schwann cels and promote protein kinase A activity, thereby activating cyclic adenosine monophosphate/protein kinase A signaling pathway.