Objective To investigate the utility of anesthesia depth monitoring of BIS during general anesthesia without tracheal intubation.Methods Sixty patients underwent surgery with local anesthesia were randomly divided into three groups of Ⅰ ,Ⅱand Ⅲ,who were sedated with propofol by TCI propofol 1.0,1.5,2.0μg/ml,respectively.HR,MAP,SpO2 BIS and MOAA/S score were recorded at l0min before operation(T0) .during local anesthesia ( T1) , at 30min after incision (T2) , at 60min after incision (T3) , and the end of operation (T4).Results BIS values declined with the decrease of MOAA/S.MOAA/S score was lower in group Ⅲ than that in group Ⅰ (all P < 0.05).Respiratory depression was seen in 3 cases in group Ⅲ.The difference of MAP had statistical significance between level 3 and level 2 of MOAA/S in group Ⅱ and group Ⅲ (P < 0.05).Conclusion Propofol 1.0 ～ 1.5 μg/ml given by TCI could produce optimal depth of sedation with less side effects in surgery during local anesthesia.

ObjectiveTo investigate the risk factors for airway management after tracheal extubation in old patients. Methods280 patients underwent general anesthesia were enrolled in the study. The procedure of anesthesia induction and maintenance were in the routine method. The patients were with tracheal extubation under clinical standards after operation. Dyspnea was recorded after tracheal extubation. They were divided into dyspnea group and general group. Twelve perioperative variables, ten variables in operation and six post-operative variables of two groups were compared respectively. ResultsThe incidence of dyspnea after tracheal extubation was 8.6％. Analysis identified that obesity( BMI ≥25kg/m2 ), preoperative lung disease and without postoperative neostigmine were the significant risk factors for dyspnea. ConclusionBMI≥25kg/m2 ,preoperative lung disease and without antagonist muscular relaxant were the main risk factors for dyspnea after tracheal extubation in old patients.

Objective To evaluate the effects of deliberated hypotension combined with acute hypervolemic hemodilution (AHH) on safety,operation time, blood loss,postoperative hemoglobin (Hb) and hematocrit (Hct) of the patients undergoing endoscopic nose surgery.Methods Twenty ASA grade I to II patients undergoing selective endoscopic nose surgery were divided randomly into two groups: control group (n=10) and hypotensive group (n=10). All patients received general anesthesia. In the hypotensive group, AHH was accomplished with infusion of HAES and lactated Ringer's solution after endotracheal intubation and before operation. Deliberated hypotension was induced and maintained with nitroprusside 0 5～3 0?g?kg -1 ?min -1 iv. Operation time, intraoperative blood loss, postoperative hemoglobin (Hb) and hematocrit (Hct) and hemodynamics during operation were recorded and compared between the both groups.Results Operation time was about 44% shorter in the hypotensive group than that in the control group. Blood loss was significantly lower in the hypotensive group than that in the control group (P

Objective To evaluated the effect of the regional cooperative rescue model implemented on the length of time from first medical contact (FMC) to balloon dilation (B),economic expense and prognosis in patients with acute coronary syndrome (ACS).Methods Patients with ACS (including ST-segment elevation and non-ST-segment elevation) selected from other hospitals within 24 hours after onset were treated with emergency percutaneous coronary intervention.Patients were divided into two groups, regional cooperative rescue group and control group without the regional cooperative rescue model approved.The lengths of FMC-to-B time and Door-to-B time (from arrival at emergency department or OPD to balloon dilation),time required for patients referred to our hospital,cardiac function,averaged hospital costs,average hospital stay,percentage of medication used and a major adverse cardiac event (MACE) were analyzed.Results Mean FMC-to-B time,Door-to-B time,referral time and time consumed to obtain informed consent were significantly shorter [(106±33) min,(31 ±8) min,(62 ±18,8 ±3) min] vs.[(231 ±35) min,(109 ±26) min,(98 ±31) min,(28 ±11) min,respectively] by implementing the regional cooperative rescue compared with control group,and LVEF was increased,and LVED was deceased inregional cooperative rescue group.The mean costs [(44 123.0 ±3 427.0) yuan vs.(51 587.0 ±5 621.0)] yuan,days of hospital stay [(8.7 ±4.1) vs.(13.2 ±6.4)] and percentage of medication used were significantly decreased in the regional cooperative rescue group.The incidence of MACE inregional cooperative rescue group was 6.2％,whereas the incidence in control group was 16.8％.Conclusions The regional cooperative rescue model can improve the prognosis and decrease the FMC-to-B time,the rate of MACE and financial burden in patients with ACS.

Objective: To investigate whether CD137 induces primary vascular muscle cells (VSMCs) phenotype transformation through activating nuclear factor of activated T-cells 1(NFATc1) signaling. Methods: VSMCs were obtained from aorta of C57BL/6J mice (8 weeks, male) through tissue-piece inoculating. Cells were divided into control group, CD137 agonist group (treated with CD137L recombinant protein) and anti-CD137 group (treated with anti-CD137 antibody). In si-RNA transfection assay, cells were divided into si-control group and si-NFATc1 group which were transfected with control or si-NFATc1 sequence respectively. The levels of NFATc1 and other phenotype related protein such as α-smooth muscle actin (α-SMA), smooth muscle myosin heavy chain (SM-MHC), vimentin were detected by Q-PCR and Western blot. Nuclear protein expression and activity of NFATc1 were detected by immunofluorescence and Western blot. Transwell assay was performed to measure the migration of VSMCs. Results: According to Western blot, the expression of NFATc1 and vimentin was significantly upregulated (5.07±0.36 vs. 1.00±0.00, P<0.05; 3.23±0.27 vs. 1.00±0.00, P<0.05) while α-SMA and SM-MHC expressions was significantly downregulated (0.73±0.15 vs. 1.00±0.00, P<0.05; 0.45±0.05 vs. 1.00±0.00, P<0.05) in CD137 agonist group compare to control group. Compared with CD137 agonist group, the expression of NFATc1 and vimentin was significantly downregulated (1.56±0.27 vs. 5.07±0.36, P<0.05; 1.21±0.17 vs. 3.23±0.27, P<0.05), but the levels of α-SMA and SM-MHC were significantly upregulated (2.01±0.43 vs. 0.73±0.15, P<0.05; 2.85 ±0.32 vs. 0.45±0.05, P<0.05) in anti-CD137 group. Compared with si-con group, the expression of SM-MHC and α-SMA was significantly upregulated while the expression of vimentin was significantly downregulated in si-NFATc1 group. Transwell assay results demonstrated that migration cell numbers was significantly higher in CD137L group compared with control group(3.85±0.31 vs. 1.00±0.00, P<0.05), this effect was significantly attenuated by inhibiting NFATc1. Conclusion CD137 could induce VSMC phenotype transformation through activating NFATc1 signaling.

Objective: To investigate whether CD137 signaling promoted the formation of atherosclerotic plaque calcification by inhibiting the fusion of autophagosome and lysosome. Methods: (1) In vivo, CD137 agonist antibody and anti-CD137 antibody were used to stimulate and inhibit the CD137 signaling, respectively. Fifteen Apo E^-/- mice were randomly divided into three groups: control group (intraperitoneal injection of IgG2b 200 µg) , CD137 agonist group (intraperitoneal injection of CD137 agonist antibody 200 µg) , anti-CD137 group (pretreatment with 200 µg anti-CD137 antibody for 24 hours, then injection of CD137 agonist antibody) . (2) In vitro, primary culture of mouse aortic VSMCs obtained through adherence methods for tissues explants. The cells was divided into three groups: control group, agonist-CD137 group (CD137 agonist antibody 10 μg/ml) , and anti-CD137 group (pretreatment with 10 μg/ml anti-CD137 antibody for 60 minutes, then incubated with 10 μg/ml CD137 agonist antibody) . Von kossa staining was used to detect the calcification in the cell and plaque. Immunohistochemical staining was used to observe the expression of LC3B, Beclin 1 and p62 which are associated with autophagy. The levels of autophagy related protein (LC3) , Beclin 1, p62, and the expression of Runx2 and bone morphogenetic protein 2, which is associated with osteogenic differentiation in the VSMCs, were determined by Western blot. The autophagy flow of each group was detected by fluorescence microscopy. The autophagy was observed by transmission electron microscope in vivo and in vitro. Results: (1) In vivo, the calcified plaque area in CD137 agonist group was significantly larger than that in the control group (3.01%±0.45% vs. 0.27%±0.06%, P<0.01) , and calcified plaque area in anti-CD137 group was significantly smaller compared with that in the CD137 agonist group (1.23%±0.39% vs. 3.01%±0.45%, P<0.05) . Immunohistochemical staining showed that the expression of early autophagy marker protein LC3B and Beclin 1 were significantly upregulated in CD137 agonist group and anti-CD137 group than in control group, and the highest expression was observed in CD137 agonist group (P<0.05) . The expression of advanced autophagy marker protein p62 was higher in the CD137 agonist group than in the anti-CD137 group (P<0.05) . (2) In vitro, the ratio of autophagy related protein LC3 Ⅱ/Ⅰ and p62 protein expression were significantly higher in CD137 agonist group and anti-CD137 group than in control group (P<0.01) , while the expression of p62 protein was significantly higher in CD137 agonist group than that in anti-CD137 group (P<0.05) . In the cell calcification inducing experiment, the expression of BMP-2 and Runx2 protein was significantly higher in CD137 agonist group than that in control group (P<0.01) , but the levels of BMP-2 and Runx2 protein were lower in anti-CD137 group than in CD137 agonist group (P<0.05) . Conclusion Our results indicate that activation of CD137 signaling can promote the formation of atherosclerotic plaque calcification by inhibiting the fusion of autophagosome and lysosome.

Objective: To investigate whether CD137-CD137L signaling can affect the autophagy of mouse vascular smooth muscle cells(VSMCs) through JNK signal pathway. Methods: Primary culture of C57BL/6J mouse thoracic aorta VSMCs was performed by tissue block adherence method. VSMCs between the third to fifth passages were isolated and cultured. VSMCs were divided into 4 groups: control group, CD137 agonist group, JNK inhibition group, and DMSO group. VSMCs in CD137 agonist group were treated with recombinant protein of CD137L (10 μg/ml), VSMCs in JNK inhibition group were treated with JNK inhibitor SP600125 (10 μmol/L) for 30 minutes followed by recombinant protein of CD137L (10 μg/ml) and DMSO group was treated with the same amount of DMSO in JNK inhibition group for 30 minutes, then added recombinant protein of CD137L (10 μg/ml). Western blot was used to detect the protein expression of p-JNK, LCⅡ and p62 in each group. Fluorescence microscopy was used to track the changes of autophagy in cells which was infected with adenovirus expressing tandem mRFP-GFP-LC3. Transmission electron microscope (TEM) was used to observe intracellular autophagosomes and autolysosomes. Results: (1) Compared with the control group, stimulating CD137-CD137L axis by recombinant protein of CD137L significantly upregulated the expression of p-JNK, LCⅡ and p62 (1.15±0.19 vs. 0.72±0.21, P<0.05;1.03±0.13 vs. 0.59±0.15, P<0.05, and 1.10±0.19 vs. 0.76±0.15, P<0.05). These effects could be reduced by JNK inhibitor (0.61±0.21 vs. 1.15±0.19, P<0.05;0.74±0.11 vs. 1.03±0.13, P<0.05, and 0.21±0.12 vs. 1.10±0.19, P<0.05). The expression of these proteins in DMSO group remained unchanged compared with CD137 agonist group (P>0.05). (2) Changes of autophagy in cells of various group: the number of total fluorescent spots and yellow fluorescent spots in CD137 agonist group was significantly increased compared to control group (total fluorescent spots:(93.00±14.11)/cell vs. (52.33±9.61)/cell, P<0.05, and (64.33±6.81)/cell vs. (25.67±3.51)/cell, P<0.05), moreover, the number of yellow fluorescent spots was higher than the red fluorescent spots fluorescent spots in CD137 agonist group. Compared with CD137 agonist group, pretreatment with JNK inhibitor significantly reduced the number of total fluorescent spots and yellow fluorescent spots ((53.00±3.17)/cell vs. (93.00±14.11)/cell, P<0.05,and (15.33±4.51)/cell vs. (64.33±6.81)/cell, P<0.05). The red fluorescent spots were higher than the yellow fluorescent spots in JNK inhibition group. The number of total fluorescent spots and yellow fluorescent spots in CD137 agonist group was not affected by pretreatment with DMSO (P>0.05). (3) The number of intracellular autophagosomes and autolysosomes was significantly higher in CD137 agonist group than in control group((17.67±6.03)/cell vs. (5.67±2.52)/cell, P<0.05), and the number of autophagosomes was higher than that of autolysosomes in CD137 agonist group((14.00±4.00)/cell vs. (3.67±2.08)/cell, P<0.05). The number of intracellular autophagosomes and autolysosomes was significantly lower in JNK inhibition group compared to CD137 agonist group((5.67±4.04)/cell vs. (17.67±6.03)/cell, P<0.05) and the number of autophagosomes was lower than that of autolysosomes in JNK inhibition group((1.33±1.53)/cell vs. (4.33±2.52)/cell, P<0.05). The number of intracellular autophagosomes and autolysosomes was similar between DMSO group and CD137 agonist group (P>0.05). Conclusion CD137-CD137L signal may influence autophagy of mouse VSMCs via JNK pathway.

Objective: To explore whether CD137-CD137L interaction could induce mouse vascular smooth muscle cells(VSMCs) calcification via P38 MAPK signaling. Methods: (1) Mouse VSMCs obtained from 8-week old male C57 mice were cultured by using method of tissue piece inoculation.The cells from 3 to 8 passage were divided into 4 groups: control group, agonist-CD137 group(recombinant CD137L protein), anti-P38 group(agonist-CD137 group+P38 inhibitor), single anti-P38 group(P38 inhibitor). The calcification was induced by adding a mixture of 10 mmol/L β-glycerophosphate+10^-8 mol/L dexamethasone+10^-7 mol/L insulin in the culture medium.Immunofluorescence was used to observe the changes of VSMCs markers(α-SMA and OPN).Real time-PCR was used to observe the mRNA expression of OPN and RUNX-2. Western blot was used to observe the protein expression of p-P38, OPN and RUNX-2. The level of cell calcification was observed by detecting alkaline phosphatase activity and calcium concentration. (2) The degeree of local calcium deposition was also tested on Von Kossa staining and Alizarin red staining methods in following 5 mouse VSMCs groups: control group, agonist-CD137 group(recombinant CD137L protein), anti-P38 group (agonist-CD137 group+P38 inhibitor), anti-CD137 group (agonist-CD137 group+CD137 inhibitor),agonist-P38 group(anti-CD137 group+P38 agonist). Results: (1) Compared with the control group, the fluorescence intensity of α-SMA was lower in the agonist-CD137 group(2.79±0.25 vs. 5.42±0.47,P<0.05), while the fluorescence intensity of OPN was higher(4.91±0.23 vs. 1.63±0.26, P<0.05). The fluorescence intensity of α-SMA was partly recovered after adding P38 inhibitor(4.48±0.27 vs. 2.79±0.25,P<0.05),but it was still lower than the control group (4.48±0.27 vs. 5.42±0.47, P<0.05),the fluorescence intensity of OPN decreased(2.66±0.15 vs. 4.91±0.23,P<0.05),but it was still higher than that in the control group (2.66±0.15 vs. 1.63±0.26,P<0.05).The fluorescence intensity of α-SMA and OPN(5.32±0.67 vs. 5.42±0.47,1.82±0.30 vs.1.63±0.26,both P>0.05) was similar between the control group and single anti-P38 group.(2) Compared with the control group, the protein level of p-P38(4.15±0.24 vs. 3.48±0.26, P<0.05), OPN(2.43±0.21 vs. 1.53±0.08, P<0.05), RUNX-2(3.20±0.23 vs. 1.13±0.10, P<0.05) was significantly increased in agonist-CD137 group,the above effects were blocked by adding specific P38 inhibitor SB203580(1.16±0.12 vs. 4.15±0.24, 0.50±0.02 vs. 2.43±0.21,and 1.74±0.14 vs. 3.20±0.23,all P<0.05);the protein level of p-P38(2.93±0.60 vs. 3.48±0.26,P>0.05),OPN (1.4±0.64 vs. 1.53±0.08,P>0.05),RUNX-2(1.26±0.26 vs.1.13±0.10, P>0.05) was similar between single anti-P38 group and the control group. (3) Compared with the control group, the mRNA level of OPN (1.51±0.34 vs. 1, P<0.05) and RUNX-2(2.67±0.19 vs. 1, P<0.05) was significantly upregulated in agonist-CD137 group, and these effects were blocked by adding specific P38 inhibitor SB203580(0.33±0.14 vs. 1 and 0.45±0.03 vs. 1,P<0.05);the mRNA level of OPN (1.05±0.09 vs. 1, P>0.05) and RUNX-2(1.18±0.10 vs. 1, P>0.05) was similar between the single anti-P38 group and the control group.(4) Compared with the control group,the ALP activity and calcium concentration(2.40±0.25 vs. 1.40±0.21,5.51±0.33 vs. 3.15±0.31,both P<0.05) were significantly increased in agonist-CD137 group,while the effects could be blocked by adding specific P38 inhibitor SB203580((1.99±0.07) king unit/gprot vs. (2.40±0.25) king unit/gprot, (3.74±0.20) mmol/gprot vs. (5.51±0.33) mmol/gprot, both P<0.05).The ALP activity and calcium concentration was similar between single anti-P38 group and the control group((1.60±0.25) king unit/gprot vs. (1.40±0.21)king unit/gprot, (2.66±0.28) mmol/gprot vs. (3.15±0.31) mmol/gprot, both P>0.05). (5) Compared with the control group,the calcification of VSMCs in the agonist-CD137 group was significantly increased,while the calcification in the anti-P38 group was significantly reduced.Compared with the agonist-CD137 group,the level of calcification in the anti-CD137 group was obviously increased,and the calcification in the agonist-P38 group was significantly higher than that in the anti-CD137 group and the control group. Conclusion These findings suggest that CD137-CD137L signaling may regulate VSMCs calcification via modulating P38 pathway.

Objective To investigate the effect and related mechanism of CD137 stimulation on aortic atherosclerotic plaque calcification in high fat diet fed ApoE-/-mice and on calcification of vascular smooth muscle cells (VSMCs).Methods (1) ApoE-/-mice fed with high fat diet were randomly divided into 3 groups:CD137 activated group (treated by 200 μg CD137 agonist i.p.once per week for 6 weeks,n =5);CD137 inhibited group (anti-CD137 group:200 μg anti-CD137 antibody + 200 μg CD137 agonist,i.p.,once per week for 6 weeks,n =5) and control group (n =5).Von kossa staining was used to observe the calcification of the aortic plaque and VSMCs.Immunohistochemistry was used to observe the expression of BMP-2 and Runx2 which are known mediators of osteogenic differentiation.(2) The mouse aortic VSMCs were obtained by Patch-attaching method.The calcium content was measured by Methylthymol Blue complexone method.The mRNA expressions of bone morphogenetic protein 2 (BMP-2) and Runx2 were measured by real-time fluorescent quantitative PCR (RT-PCR).The protein levels of BMP-2,Runx2 of the VSMCs were determined by Western blot.Results (1) In vivo,the plaque calcified area in ApoE-/-mice was significantly larger in CD137-agonist group than that in control group ((1.75 ± 0.33) × 104 μm2 vs.(0.23 ±0.07) × 104 μm2,P ＜0.01),and this effect was significantly reduced by cotreatment with CD137-antagonist ((0.83 ± 0.30) × 104 μm2 vs.(1.75 ± 0.33) × 104 μm2,P ＜ 0.05).The levels of BMP-2 and Runx2 were all significantly upregulated in CD137-agonist group than in control group (both P ＜ 0.01),again,this effect was blocked by cotreatment with CD137-antagonist (P ＜0.05).(2) Consistent with the in vivo results,VSMCs calcification was also more serious in CD137-agonist group than in control group,which could be significantly attenuated by eotreatment with CD137-antagonist.In VSMCs,calcium content level in CD137-agonist group was higher than in control group ((0.001 3 ± 0.000 2) mmol/mg protein vs.(0.000 7 ±0.000 1) mmol/mg protein,P ＜ 0.01),which could be significantly reduced by co-treatment with CD137-antagonist ((0.000 9 ± 0.000 2) mmol/mg protein vs.(0.001 3 ± 0.000 2) mmoL/mg protein,P ＜0.01).The mRNA and protein levels of BMP-2 and Runx2 were significantly upregulated in CD137-agonist group compared with the control group (P ＜ 0.05),which could be significantly down-regulated by cotreatment with CD-137 antagonist (P ＜ 0.05).Conclusion CD137 activation can promote vascular calcification in high fat diet fed ApoE-/-mice both in vivo and in vitro.

Objective To explore whether CD137-CD137L signaling can promote angiogenesis in atherosclerosis plaque via activating nuclear factor of activated T cells c1 (NFATc1).Methods Apolipoprotein E knock out mice were divided into the following groups:control group (n =5),CD137 activated group(n =5) and CD137 inhibited group (n =5).Immunohistochemistry was performed to detect the expression of CD31 in aortic plaque.Endothelial cells (bEnd.3) were purchased from ATCC and divided into the following groups:control group,IgG isotype control group,CD137 activated group and CD137 inhibited group.Western blot was used to determine total protein and nucleoprotein expression of NFATc1.The expression level of CD137 protein on the surface of endothelial cells was detected by flow cytometry (FCM) and CD137 protein of lysate of endothelial cells was detected by enzyme-linked immunosorbent assay (ELISA).Transwell assay was used to observe the migration ability of endothelial cells.Matrigel tube formation ability of endothelial cells were tested in the following groups:control group,CD137 activated group,silent NFATc1 + CD137 activated group,CD137 inhibited group,and over expressed NFATc1 + CD137 inhibited group.Results (1) In vivo,the expression level of CD31 was significantly higher in the aortic plaque of CD137 activated group than in control group(1 191 ± 187 vs.115 ± 30,P ＜ 0.05),while which was significantly downregulated in CD137 inhibited group (450 ± 92,P ＜ 0.05).(2) The level of nucleoprotein(3.07 ±0.03 vs.1.00 ±0.00,P ＜0.05) and total protein(2.18 ± 0.30 vs.1.00 ±0.00,P ＜0.05) of NFATc1 were significantly higher in CD137 activated group than in IgG isotype control group.The level of nucleoprotein(0.82 ±0.04) and total protein(0.84 ± 0.09) of NFATc1 were significantly lower in CD137 inhibited group than in CD137 activated group(both P ＜ 0.05).(3) FCM results showed that the fluorescence intensity of CD137 on the cell membrane was significantly higher in endothelial cells stimulated by TNF-α than in normal endothelial cells(5 163 ± 329 vs.1 660 ± 162,P ＜ 0.05).(4) ELISA examination showed that the level of CD137 protein was significantly higher in endothelial cells stimulated by TNF-α than in normal endothelial cells ((573.4 ± 23.7) pg/mg vs.(69.5 ± 16.7) pg/mg,P ＜ 0.05).(5) Migration cell number was remarkably higher in CD137 activated group than in IgG isotype control group(1.19 ±0.13 vs.1.00 ±0.00,P ＜0.05) and significantly lower in CD137 inhibited group(0.82 ± 0.06) than in control group (P ＜ 0.05).(6) Values of the formation of the tube length ((5.76 ± 0.18) mm vs.(4.21 ± 0.11) mm,P ＜ 0.05) and branch number (29.38 ± 1.28 vs.21.13 ± 0.96,P ＜0.05) were both significantly higher in CD137 activated group than in the control group.The formation of the tube length ((1.90 ±0.11)mm) and branch number(8.91 ±0.72) were significantly lower in silent NFATc1 + CD137 activated group than in the CD137 activated group (both P ＜ 0.05).The formation of the tube length ((1.28 ± 0.34) mm) and branch number (5.07 ± 0.35) were also significantly decreased in the CD137 inhibited group compared with the CD137 activated group (both P ＜ 0.05).Compared with the CD137 inhibited group,the formation of the tube length ((4.82 ± 0.09)mm) and branch number(24.44 ± 1.05) in the over expressed NFATc1 + CD137 inhibited group was increased (both P ＜ 0.05).Conclusion CD137 can promote the angiogenesis in atherosclerosis plaque by activating NFATc1.