Laparoscopic cholecystectomy (LC) patients showed mild to moderate pain, non steroidal anti-inflammatory drugs (NSAIDS), opioids and antiepileptic drugs are used in routine treatment of postoperative pain in clinic. Although these drugs worked quickly, their adverse effects, such as drowsiness, post-operative nausea and vomiting (PONV), constipation and respiratory inhibition can lead to delayed discharge. Therefore, many researchers study the replacement treatment of postoperative pain. Pain after LC can be divided into superficial incision pain, deep visceral pain and shoulder referred pain. The species of drug are local anesthetics, steroid, tramadol and dexmedetomidine. There are 3 main types intraperitoneal administration time: before the establishment of pneumoperitoneum, at the time of pneumoperitoneum and immediately after removal of the gallbladder. Intraperitoneal administration is often applied to the fossa of gallbladder, liver diaphragm, liver and diaphragm gap or the sites near the hepatoduodenal ligament. The main methods of intraperitoneal administration are instillation, infiltration, spraying and flushing. Based on many studies, it is beneficial to use intraperitoneal administration in terms of pain reduction in the early stage after LC. The use of intraperitoneal administration could reduce the amount of analgesic and mitigate the associated complications.

Objective To investigate the effects of lung lavage on respiratory function of experimental silicosis.Methods Thirty rats were randomly divided into three group: A, B and C. An intratracheal injection of 50 mg silica in 1 ml of sterile saline was given in group A and B, and in group C the same amount of normal saline was injected into trachea following the anesthesia with ether. Fifteen days later, the animals were anesthetized with an intraperitoneal injection of pentobarbital sodium 30 mg/kg. After endotracheal intubation through a trachotomy, three animals were connected in parallel to a pressure controlled ventilator. The respiratory frequency was set at 28 bpm with a 50% inspiration time, and 100% oxygen was used as the inspiratory gas. Throughout the experiment, the peak inspiratory pressure (PIP) was fixed at 2.45 kPa (25 cm H 2O) and the end expiratory pressure (PEEP) at 0.69 kPa (7.0 cm H 2O). Group A and C was lavaged 10 times respectively and group B was lavaged 20 times. Arterial blood gases, tidal volume, pressure volume and lung lavage fluid constituents were assessed. Results Arterial partial pressure of oxygen (PaO 2 ) in group C was higher than that in group A and B before lavage, increased significantly in group A and decreased significantly in group B and C after lavage, but arterial partial pressure of carbon dioxide (PaCO 2 ) rose gradually in group B and C . The vary amount of PaO 2 and PaCO 2 of group C was more significant than of group B. Tidal volume in group C was higher than that in group A and B before lavage, decreased significantly after lavage in group B and C. There were significant differences among three groups in pressure volume ratio. Protein concentrations in lung lavage fluid of group A and B were much higher than of group C, but phospholipid concentrations in lung lavage fluid had no different.Conclusions Lung lavage can improve respiratory function of early experimental silicosis. Unsuitable lavage may cause respiratory dysfunction.

Objective To investigate the protective effect of desflurane on the brain against ischemia-reperfusion (I/R) injury and the underlying mechanism. Methods Ninety-six male Wistar rats weighing 250-300 g were randomly divided into 4 groups (n = 24 each) : group A sham operation; group B I/R; group C desflurane + I/R and group D 5-HD + desflurane + I/R. I/R was induced by occlusion of bilateral common carotid arteries combined with controlled hypotension for 10 min. In C group 1 MAC desflurane (5.9% ) was inhaled for 60 min before I/R. In group D 5-HD 5 mg?kg-1 was given i.v. before desflurane inhalation. The animals recovered from anesthesia at 30 min of reperfusion. The neurological behavior was evaluated by the clambering test, the overhanging test, the inclined plane test and the beam balance test. Animals were killed at 6, 24 and 48 h ( n = 8 each) of reperfusion in each group and the brains were removed for microscopic examination of area CA1 of hippocampus for the number of normal pyramidal neurons surviving I/R. Results Neurological behavior was greatly compromised by I/R at 6, 24 and 48 h of reperfusion. The animals behaved significantly better at 6,24 and 48h in C group but only at 6 h in D group than in B group. The number of normal pyramidal neurons in CA1 of hippocampus was significantly decreased by I/R at 6, 24 and 48 h of reperfusion. The number was significantly larger at 6, 24 and 48 h in C group but only at 6h in D group than in B group. Conclusion Desflurane preconditioning has protective effect on the brain against I/R injury. Activation of KATP channel is involved in the mechanism.

Objective To investigate the effects of aerosolized prostaglandin E1 (PGE1) inhalation on oxygenation and intrapulmonary shunt in acute lung injury (ALI) .Methods Eighteen healthy male pigs weighing 14-18 kg were anesthetized with intraperitoneal pentobarbital 50 mg?kg-1, intubated and mechanically ventilated (VT=10-15 ml?kg-1, RR= 16 bpm, FiO2=100%) . PaCO2 was maintained at 34-45 mm Hg. Anesthesia was maintained with intravenous infusion of ketamine-procaine-succinyl-choline. Swan-Ganz catheter was placed via right femoral vein. Right femoral artery was cannulated for BP monitoring and blood sampling. ALI was induced by intratracheal instillation of HCl (0.1 mol?L-1) until PaO2 was

0.05 ). Conclusions With low initial FGF addition of N2O does not affect the uptake of desflurane. The low-flow desflurane anesthesia is safe and economical.

Objective To evaluate the effects of prostaglandin E1 (PGE1 ) infused in the pulmonary artery of the ventilated lung on hemodynamics and pulmonary gas exchange during one-lung ventilation (OLV).Methods Experiments were performed on 12 healthy pigs of both sexes (6 males , 6 females) aged 3 months, weighing 14-17 kg. The animals were anesthetized with intramuscular ketamine 15-20 mg?kg-1 , diazepam 1.5-2.0 mg?kg-1 and atropine. The animals were mechanically ventilated after tracheal intubation (FiO2 = 0.7, VT = 12-15 ml?kg-1, RR=15bpm, I:E=l:2). PaCO2 was maintained at 35-45 mm Hg. Swan-Ganz catheter was positioned in the right pulmonary artery via the left femoral vein. The right femoral artery was cannulated for BP monitoring and blood sampling. Anesthesia was maintained with a mixture of ketamine 100 mg and succinylcholine 100 mg in 2% procaine 100 ml infused i.v. at a rate of 2-3 ml?kg-1?h-1. The animals were placed in right lateral position. The left chest was opened and OLV was established by clamping the left main bronchus. During OLV RR was increased from 15 to 20 bpm but the minute ventilation remained unchanged. The animals were randomly divided into 2 groups of six : group A and B. Group A received PGE1 infusion in the right pulmonary artery with an initial dose of 0.01 ?g?kg-1?min-1 which was gradually increased to 0.02, 0.04, 0.06, 0.08 and 0.1 ?g?kg-1?min-1 . Theinfusion of each dose was maintained for 20 min. In group B normal saline was infused instead of PGE1. MAP, HR, CVP, PCWP, CO, PaO2 PvO2 were recorded at each dose and at 20, 40, 60 min after PGE1 infusion was terminated. Qs/Qt, PVR and SVR were calculated.Results MPAP, PVR, SVR, peak inspiratory pressure (PIP) and Qs / Qt significantly increased while CO, Cdyn and PaO2 significantly decreased (P 0.05) and a significant decrease of MPAP and PVR ( P

OBJECTIVE To investigate antibiotic resistance and the prevalence of serotype of Streptococcus pneumoniae in Wuhan.METHODS Totally 152 strains of S.pneumoniae were collected to test the MICs of various antibiotics by agar dilution method according to the approved standard of NCCLS.Serotyping of S.pneumoniae was performed by using quelling reaction.RESULTS Among 152 strains of S.pneumoniae,65(42.76%) strains were resistant to penicillin(MIC≥0.12mg/L).94.08%,50.66%,41.45% and 11.18% of S.pneumoniae were resistant against the first(cefalexin),second(cefaclor) and third(cefaxime and ceftriaxone) generation of cephalosporins respectively.The resistance rates to other antibiotic agents,such as erythromycin,tetracycline,trimethoprim/sulfamethoxazole and chloramphenicol,were 84.21%,88.82%,89.47% and 18.42%,respectively.Strains that were resistant to levofloxacin and moxifloxacin were found both for 1.32%.Twenty serotypes were involved in 152 strains. The prevalent serotypes were 19(25.66%),23(19.08%),6(13.82%),15(7.24%)and 14(4.61%).Eight strains were remained for unable to serotype.All penicillin-resistant S.pneumoniae was included in serotypes 6,19 and 23.CONCLUSIONS The antibiotic resistance of S.pneumoniae is serious in Wuhan.Most of them are multi-resistant strains.Except for fluoroquinolones,ceftriaxone and chloramphenicol, most antibiotic agents have lost there activities against S.pneumoniae.The prevalent serotypes,especially of the multi-resistant strains,were 19,23 and 6.Pneumococcal polyvalent vaccine can well cover these serotypes.

Objective To explore the application value of pulmonary artery monitoring program for intracranial and cervical artery angiography with dual-energy CT.Methods Sixty patients performed intracranial and cervical artery angiography with dual-energy CT were divided into two groups according to the random number table.Group A (optimization group,30 patients):the monitoring points were located in the main pulmonary artery,with threshold 150 HU,trigger delay time 8-9 s,pitch 0.9,and the iohexol (350 mg I/ml) 60-65 ml.Group B (conventional group,30 patients):the monitoring points were located in aortic arch,with threshold 100 HU,trigger delay time 5 s,and the iohexol (350 mg I/ml)60-70 ml.Patients with the body weight less than 75 kg were injected with the flow rate of 4.0 ml/s,and those weight greater than 75 kg or with body mass index (BMI) greater than 27 kg/m2 were 4.5 ml/s,following 40 ml saline solution with the same flow rate respectively.All images were transferred to Siemens Syngo workstation for further processing and analysis.The attenuation values were measured on axial images in the common carotid artery,internal and external carotid artery,vertebral and basilar artery,the horizontal segment of the middle cerebral artery,the subclavian vein of injection side,the proximal,middle and distal segment of jugular vein,the straight sinus and the superior sagittal sinus.Two experienced observers blinded independently evaluated the image quality of CTA,the impact of contrast material residues artifacts of subclavian vein of injected side and the affect of venous return factors on arterial image display.Images of volume rendering technique(VR),the maximum intensity projection (MIP),and curved planar reformation (CPR) were reconstructed using dual energy bone removal and Inspace and 3D software.The mean intraluminal attenuation of contrast material (HU),the volume of contrast material and the mean image quality scores were compared with t test between the two groups.Chi-square test was used to compare of image contrast agents residual artifacts,the absence segments of the root of the neck artery,and the degree of the jugular vein return in two groups.Results The mean CT values were 372-414 HU for each segment of artery showing no significant differences between two groups (P ＞ 0.05).In group A,the CT values of the jugular vein in proximal,middle,distal segment of the two sides were (95 ± 36),(95 ± 36),(131 ±58),(133 ± 57),(174 ± 68),and (180 ± 66) HU respectively.In group B,CT values were (135 ± 58),(137 ±59),(170 ±58),(181 ±58),(218 ±62),and (224 ±68) HU.The CT value of jugular venous in group A was significantly lower than that in group B (t =-3.30--2.54,P ＜ 0.05).Case numbers of contrast agent residual artifacts of injection side subclavian vein and the absence segments of root of the neck artery at the beginning in group A (5,11) were less than that in group B (12,24) (x2 =4.02,5.65,P ＜0.05).The degree of the jugular vein return in group A were lesser severely than that in group B (x2 =6.79,6.37,P ＜0.05).Below the level of carotid artery bifurcation:slight 5 patients,severe 1 patient in group A vs.slight 15 patients,severe 9 patients in group B.Above the level of carotid artery bifurcation:slight 9 patients,severe 6 patients in group A vs.slight 12 patients,severe 17 patients in group B.Image quality scores of group A (3.84 ± 0.40) was higher than that of group B (3.64 ± 0.63) (t =4.26,P ＜0.05).Conclusions Pulmonary Artery Monitoring combines with 60-65 ml contrast material optimization scheme for intracranial and cervical artery angiography with dual energy CT can significantly reduce the degree of jugular venous return and contrast material residues artifacts of subclavian vein of injected side.This technique is helpful to improve the work efficiency and image quality.

Objective To investigate the effects of desflurane on the delayed rectifier potassium current (Ik ) in acutely dissociated rat parietal cortical neurons. Methods Wistar rats between 10- and 14-day old of both sexes were used. The parietal cortical neurons were acutely dissociated enzymatically. The extracellular fluid saturated with 0.3,0.6 and 0.9 mmol/L desflurane was added to the culture dish, then the effects of different concentrations of desflurane on Ik were investigated by using the whole-cell patch-clamp technique in acutely dissociated rat parietal cortical neurons. Results IK was inhibited by desflurane in a concentration-dependent manner ( P ＜0.01). The V1/2 of the activation and inactivation curves and the slop factor had no change after giving 0.6 mmol/L desflurane (P ＞ 0.05). Conclusion Desflurane inhibits delayed rectifier potassium channels of parietal cortical neurons of rats in a concentration-dependent manner, and has no effect on the activation and inactivation of delayed rectifier potassium channels, indicating that the change in the excitability of the channel is not involved in the mechanism of inhibitory effect of desflurane, and the other reasons may be involved in the mechanism.

Objective To investigate the antimicrobial resistance in the clinical strains isolated from Tongji Hospital to the antimicrobial agents commonly used in 2012.Methods Antimicrobial susceptibility was tested by Kirby-Bauer method.The minimum inhibitory concentration (MIC) of penicillin and ceftriaxone for Streptococcus pneumoniae and vancomycin for Staphylococcus spp.were determined by E-test.All data were analyzed by WHONET 5.6 software.Results A total of 8 191 strains were isolated in 2012,including gram-positive bacteria (2 815,34.4%)and gram-negative bacteria (5 376,65.6%). The top five pathogenic bacteria isolated from outpatients were Escheria coli,Pseudomonas aeruginosa,coagulase-negative Staphylococcus (CNS),Klebsiella spp.and Staphylococcus aureus.For the isolates from non-ICU inpatients,the top five were E.coli,S.aureus,Acinetobacter spp.,Klebsiella spp.and P.aeruginosa.For those isolated from ICU patients,the top five were Acinetobacter spp.,S.aureus,P.aeruginosa,Enterococcus spp.and E.coli.The prevalence of MRSA and MRCNS was 58.1% and 64.3%,respectively.Seventeen strains of vancomycin resistant Enterococcus were identified, including 13 strains of E.faecium with VanA and 4 strains of E.gallinarum with VanA and VanC.The percentage of antimicrobial resistance in E.faecium was significantly higher than that in E.faecalis (P<0.05).A total of 94 strains of carbapenem-resistant Enterobacteriaceae were detected.The prevalence of penicillin-non-susceptible S.pneumoniae in children was much higher than that in adults. The prevalence of carbapenem-resistant P.aerugonosa and Acinetobacter spp. was 28.1% and 56.2% respectively.Beta-lactamase was produced in 41.8% of the H.influenzae and 98.6% of the M. catarrhalis isolates. Conclusions The prevalence of multidrug resistant strains has been increasing, especially vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae.