Objective To investigate the effect of astragalus membranaceus on the ultrastructure of small intestinal epithelial cells in rabbits with hemorrhagic shock. Methods Twenty-four New Zealand white rabbits of both sexes weighing 2-3 kg were randomly divided into 3 equal groups : (A) control group received normal saline iv ( n = 8); (B) group HI received astragalus membranaceus 20 mg? kg-1 iv ( n = 8); ( C) group H2 received astragalus membranaceus 10 mg?kg-1 iv ( n = 8 ). Animal model of hemorrhagic shock-resuscitation was established according to Wigger's. A strip of small intestine, 10 cm in length was taken from distal end of ileum for electron microscopic examination. The two-dimensional structural parameters and three-dimensional structural parameters of mitochondria were calculated. Results (1) Morphological changes of small intestine : in group H1 epithelial cells were orderly arranged, with relatively normal mitochondria and intestinal villi were slender and orderly; in group H2 the nuclei in epithelial cells were dwindled, the intestinal villi were thin and short and unorderly arranged with slightly swelled mitochondria and blurring ridges. Endoplasmatic reticulum was dilated; in group C the gaps between epithelial cells widened. There were a lot of apoptotic cells. Microvilli were thin and short and swelled. Mitochondria were swelled with broken ridges. Endoplasmatic reticulum was severely dilated. (2) Structural parameters of mitochondria : in group C there were least mitochondria and the swelling of mitochondria was severe; in group H1 there were plenty of mitochondria and the swelling was slightest; in group H2 the changes in mitochondria were between group C and H1. Conclusion Astragalus membranaceus can protect small intestine from ischemia/reperfusion injury in a dose-dependent manner.

0.05), but pretreatment with yohimbine 10 ug significantly reduced the antinociceptive effect of tramadol ( 10ug) at 35 min and 40 min and the nociception score increased by 56% and 41 % respectively ( P 0.05). Scatchard analysis of the saturation isotherms showed that H-yohimbine was bound to a single binding site with a Kd value of 1.79 nM. The competition curve of tramadol was sigmoidal with a Ki value of 34.14 uM and an IC50 value of 68.25 uM. Tramadol was 19 000-fold less potent for binding to a2-adrenoceptor of the spinal cord as compared to H-yahimbine. Conclusion Intrathecal tramadol produces time-dependent antinociception. Tramadol has very low affinity with a2-adrenoceptor of the spinal cord. A part of its intrathecal antinociceptive effect was related to indirect a2-adrenoceptor effect of the spinal cord.

Objective To evaluate the perioperative monitoring of adult patients with hepatic encephalopathy under orthotopic liver transplatation (OLT).Methods Combined intravenous and inhalational general anesthesia was used for 18 patients with hepatic encephalopathy from October 2003 to August 2004. Rapid-sequence induction was performed. Propofol, 1 to 1.5 mg/kg, and fentanyl, 4 ?g/kg, were used. Norcuron, 0.1 mg/kg, was added to facilitate tracheal intubation. All patients were subjected to piggyback liver transplantation. Hemodynamics, respiratory, blood gas, blood biochemistry, coagulation function, body temperature, liver and kidney functions, urine output, and bleeding output were monitored during operation. According to the situations of patients, platelet, cryoprecipitate, fibrinogen, coagulation factors and ulinastatin were administrated.Results Eighteen patients tolerated the operation. Only 4 patients died of multiple organ dysfunction syndrome after operation. The survival rate reached was up to 77.8 %. The main blood gas change during perioperative phase was metabolic acidosis and hyposodium, hypokaleamia, hypocalcium. The main hemodynamics change during operation was that HR was increased significantly, and CO was higher than normal value before operation, and CO, CVP, SPAP and DPAP decreased significantly in anhepatic stage. Compared with those before operation, ALT, AST, BUN and Cr were increased significantly in neohepatic stage.Conclusions It is very important to pay more attention to these patients with hepatic encephalopathy during different stages of OLT. Drugs not affecting the function of liver and kidney should be selected. Benzodiazepine should be avoided. Supplementation of coagulation factors, CRBC and electrolyte was necessary. The key point is to protect renal function, maintain enough urine output and treat brain edema.

Objective To investigate the peri operative changes and anesthetic management during orthotopic liver transplantation (OLT) Methods General anesthesia or general anesthesia combined with epidural anesthesia was applied During the anhepatic phase, extracorporeal veno venous bypass (EVVB) was established Hemodynamics, respiratory function, blood gas, biochemistry, blood coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored According to the different characteristics of the pre anheptic phase, anheptic phase and neoheptic phase during OLT, the corresponding anesthetic management was supplied Results Applying EVVB during the anheptic phase could keep hemodynamics stable, but in 15 min of the primary anheptic and neoheptic stages a transient circulatory instablity occurred,and the rapid blood volume expansion was required Through comprehensive management, there was no obvious acid base disturbance during the phases The hypocalcemia, hypokalemia and hyperglycemia occurred and thebody temperature changed greatly,to require timly corrective measures Certain coagulative disturbances occurred, to require the supplement of coagulation factors, proper hemostatic drugs and protamine for neutralizing heparin Intraoperatively, anti rejection drugs were required Peri operatively, the blood glucose levels were higher than normal Conclusions Utilizing EVVB during the anheptic phase can be helpful to maintain hemodynamics stable, prevent obvious acidosis and hyperkalemia The anesthetic management during the neoheptic phase should be required to correcte hypothermia, hypocalcemia, hypokalemia, hyperglycemia and disturbence of coagulation

Objective To observe the changes of systemic and pulmonary hemodynamics during veno-venous bypass in liver transplantation Methods During the anhepatic phase, extracorporeal veno-venous bypass (EVVB) was utilized in 20 patients undergoing live transplantation Systemic and pulmonary hemodynamics were monitored through Swan-Ganz catheter during whole procedures Results As compared with the preoperative values , MAP remained unchanged in normal range during perioperative period;CO,CI,LVSW and RVSW decreased significantly during anhepatic phase and increased markedly 15 min after hepatic reperfusion (P

Objective To evaluate the effect of lipo-alprostadil on lung injury in patients undergoing orthotopic liver transplantation.Methods Forty-eight ASA Ⅱ-Ⅳ patients of both sexes,aged 45-64 yr,weighing 45-70 kg,scheduled for elective orthotopic liver transplantation,were randomly assigned to one of 2 groups (n =24 each):control group (group C) and lipo-alprostadil group (group A).Anesthesia was induced with midazolam,propofol,fentanyl and vecuronium and maintained with sevoflurane,sufentanil and vecuronium.The patients were tracheal intubated and mechanically ventilated.Lipo-alprostadil 5 μg in 10 ml of normal saline was infused intravenously and slowly over 30 min before induction of anesthesia and at 1 h of neohepatic phase in group A.Lipoalprostadil was not administrated in group C.Peak inspiratory pressure (PIP),mean inspiratory pressure (Pmean),dynamic lung compliance (Cd),oxygenation index (OI),respiratory index (RI) and the concentrations of inflammatory cytokines in exhaled breath condensate (EBC) were recorded immediately before operation,at the end of operation,and at 24 h after operation.The occurrence of pulmonary complications was recorded within 7days after operation.Results Compared with group C,PIP,Pmean,RI,and TNF-α and IL-8 concentrations in EBC were significantly decreased,while Cd and OI were increased at the end of operation and 24 h after operation,and the incidence of acute lung injury and pulmonary infection were decreased within 7 days after operation (P ＜0.05),and no significant change in the other indexes was found in group A (P ＞ 0.05).Conclusion Lipo-alprostadil has protective effect on lung in patients undergoing orthotopic liver transplantation.

Objective To evaluate the effects of hypoxia/reoxygenation (H/R) on apoptosis and gap junction in isolated renal tubular epithelial cells of rats.Methods The renal tubular epithelial cells were seeded in 6-well plates at a density of 1 × 105 cells/ml and randomly divided into 2 groups (n =18 wells each) using a random number table:control group (group C) and H/R group.In group C,the cells were cultured in a regular incubator with 21％ oxygen at 37 ℃.In group H/R,the cells were incubated in an anaerobic chamber for 24 h and then returned to a regular incubator and incubated for 4 h.Hoechst33258 staining method and flow cytometry were used to detect the cell apoptosis.Gap junction function was determined by specific parachute assay.Gap function protein connexin 43(Cx43) expression was measured by Western blot.Results Compared with group C,the apoptosis rate was significantly increased and gap junction function and Cx43 expression were decreased in group H/R (P ＜ 0.05).Conclusion H/R promotes apoptosis in isolated renal tubular epithelial cells through destroying intercellular gap junction in rats.

Objective To investigate the difference of neuromuscular blocking effect of cis-atracurium under sevoflurane anesthesia between the genders. Methods 30 ASA Ⅰ or Ⅱ patients aged from 18 to 45 years who scheduled for laparoscopic operation were divided into two groups, male group( M group, n = 15 ) and female group ( F group,n = 15). After induction of Anesthesia all cases were maintained with remifentanyl 3μg/L(TCI) and sevoflurane.After 40 minutes of stable end-tidal anaesthetic concentration, a total dose of cisatracurium 45 μg/kg was divided into 3 equal doses( 15μ g/kg each) ,which was administered accumulatively in each patient. The next dose was given when the effect of the previous dose had reached its peak ( T1 was no longer depressed in the height of 3 successive stimuli).Neuromuscular block was monitored using accelograph(TOF GUARD,Denmark). The onset time and maximum depression of T1 of the initial dose and 2 incremental doses were recorded. The cumulative dose-response curves of the two groups were established. The effective dose to obtain 50% and 95% neuromuscular block( ED5o and ED95 ,respectively) were calculated from individual dose-response curves. After the lastincrement of 15 μg/kg, the time for T1 to return to 25% ,50% ,75% and TOF ratio(T4/T1 )to 70% were recorded. The recovery index( RI)was also calculated.Results The mean ED5o and ED95(95% confidence interval)of cisatracurium of women were 22.2( 15.8 ～27.2)and 38.4 ( 32.1 ～ 54.4) μg/kg during sevoflurane (1.3MAC) anaesthesia, while the data of men were 25.6 ( 19.7 ～30.8) μg/kg and 42.8 ( 36.3 ～ 58.2 ) μg/kg, the difference between groups had no statistical significance ( P ＞0. 05). There was no significant difference in the TOF ratio ( T4/T1 ) to 70% and recovery index between the two groups( P ＞0.05 ). The onset time of F group was shorter than M group. The time for T1 to return to 25% ,50% and TOFR 0.7 was significantly longer in the F group than in the M group (P ＜ 0.05). Conclusion The neuromuscular blocking effect of cis-atracurium under 1.3MAC sevoflurane anesthesia remained no difference between genders. But the onset time of women was much faster. Furthermore the effect on the time for T1 to return to 25% ,50% and TOFR 0.7 were greater than men.

Objective To evaluate the effects of propofol,etomidate and midazolam on gap junction function in rats in vitro and in vivo.Methods Experiment Ⅰ NRK52E cells were seeded in 6-well plates with the density of 1.0 × 105/ml and randomly divided into 4 groups (n =6 wells each):control group (group C),propofol group (group P),etomidate group (group E) and midazolam group (group M).In group C,NRK52E cells were cultured in DMEM-F12 culture medium containing 10％ fetal bovine serum.In P,E and M groups,propofol,etomidate and midazolam (with the final concentrations of 15,8 and 4μmol/L,respectively) were added to the culture medium,respectively,and the cells were then incubated for 1 h.Parachute dye-coupling assay was used to measure the gap junction function in NRK52E cells.Experiment Ⅱ Twenty-four male Sprague-Dawley rats,aged 2 months,weighing 220-280 g,were randomly divided into 4 groups (n =6 each):propofol group (group P),etomidate group (group E),midazolam group (group M),and control group (group C).In P,E and M groups,propofol 100 mg/kg,etomidate 6 mg/kg and midazolam 5 mg/kg were injected intraperitoneally once a day for 3 consecutive days,respectively.The equal volume of normal saline was given instead in group C.The animals were sacrificed at 30 min after the last administration and the renal cortex was harvested to measure the gap junction function using tissue scrape and load assay.Results Compared with group C,the gap junction function was significantly decreased in P and E groups (P ＜ 0.05),and no significant change was found in the gap junction function in group M (P ＞ 0.05).Conclusion Propofol and etomidate significantly inhibit the gap junction function in NRK52E cells and renal tissues in rats,but midazolam produces no effect.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from anesthesia in the patients undergoing modified electroconvulsive therapy (MECT) with propofol anesthesia.Methods One hundred and ten patients of both sexes,aged 18-50 yr,weighing 45-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective MECT with general anesthesia,were randomly assigned into 2 groups (n =55 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was infused intravenously in a dose of 0.5 μg/kg (in normal saline 10 ml) over 10 min in group D,while normal saline 10 ml was infused intravenously over 10 min in group C.Propofol 1.5 mg/kg and succinylcholine 0.5 mg/kg were injected intravenously,and MECT was performed in the two groups.The emergence time was recorded.The development of cardiovascular events,nausea and vomiting,respiratory depression,headache,somnolence and agitation during recovery from anesthesia was recorded.Results Compared with group C,the incidence of nausea and vomiting,headache and agitation during recovery from anesthesia was significantly decreased (P＜0.05),and no significant changes were found in the emergence time,and incidence of hypertension,tachycardia,respiratory depression and somnolence during recovery from anesthesia in group D (P＞ 0.05).Conclusion Dexmedetomidine (intravenously infused in a dose of 0.5 μg/kg over 10 min before anesthesia) can raise the quality of recovery from anesthesia in the patients undergoing MECT with propofol anesthesia.