Objective To investigate the effect of ondansetron on the analgesic efficacy of tramadol for postoperative patient-controlled intravenous analgesia (PCIA). Methods Forty ASA I - II patients aged 22-74 years, weighing 40-90 kg scheduled for radical mastectomy were randomly allocated to one of two groups : control group ( n = 20) and ondansetron group ( n = 20) . The patients were premedicated with intramuscular atropine 0.01 mg?kg-1 and diazepam 0.2 mg?kg-1. Anesthesia was induced with midazolam 0.1-0.2 mg (total dose was limited to 15 mg), fentanyl 2.4?g?kg-1 , propofol 1.5-2.0 mg?kg-1 and vecuronium 0.12-0.15 mg?kg-1 . The patients were mechanically ventilated after tracheal intubation (VT 8-10 ml?kg-1 , RR 13 bpm). Anesthesia was maintained with enflurane inhalation and continuous infusion of vecuronium. The patients were attached to a PCIA pump after operation and received PCIA with 1 % tramadol (background infusion 2 ml?h-1 , bolus dose 2 ml, lockout interval 10min) in both groups. In ondansetron group the patients received ondansetron 6 mg iv during operation and a loading dose of tramadol 1 mg?kg-1 and ondansetron 2 mg after operation before PCIA. Pain score (VAS 0-10), sedation score (0-3), tramadol consumption and the incidence of nausea and vomiting were recorded at 4, 8, 12 and 24 h after operation. Results There was no significant difference in pain and sedation scores and the incidence of vomiting between the two groups. Significantly more tramadol was consumed at 4, 8 and 12 h after operation in the ondansetron group as compared with control group (P

Objective To evaluate the efficacy of nalmefene in preventing sufentanil-induced cough during induction of general anesthesia.Methods One hundred American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes,aged 21-62 yr,weighing 45-82 kg,undergoing elective laparoscopic cholecystectomy under general anesthesia,were divided into 2 groups (n =50 each) using a random number table:nalmefene group (group N) and control group (group C).Nalmefene 0.25 μg/kg was injected intravenously at 2 min before anesthesia induction in group N,and the equal volume of normal saline was given instead in group C.Anesthesia was induced with target-controlled infusion of propofol,and sufentanil 0.5 μg/kg was injected over 5 s when bispectral index value reached 55.The number of patients who developed cough within 2 min after sufentanil injection and severity of cough were observed.Other iv anesthetics were given for induction after the end of observation.Results The incidence of sufentanil-induced cough was 8％ in group N and 48％ in group C.Compared with group C,the incidence and severity of cough were significantly decreased in group N (P＜0.05).Conclusion Nalmefene 0.25 μg/kg injected at 2 min before induction of anesthesia can effectively decrease the development of sufentanil-induced cough during induction of general anesthesia.

ObjectiveTo compare the roles of Toll-like receptor-4 (TLR-4) in the acute lung injury (ALI) induced by lipopolysaccharide (LPS) and by hemorrhagic shock and resuscitation (HSR) and LPS (twohit) in mice.MethodsTwo types of mice were used in this study:free wild type mice (C3H/HeN) and TLR4 gene mutation type ( C3H/HeJ).Each type of mice was randomly divided into 2 groups ( n ＝ 18):group sham operation+ LPS (group S/LPS) and group HSR + LPS (group HSR/LPS).Hemorrhagic shock was induced by blood withdrawal until MAP was reduced to 35-45 ram Hg and maintained for 60 min (first hit).The animals were then resuscitated by infusion of shed blood and lactated Ringer' s solution.LPS 30 tμg/kg was instilled into trachea at 24 h after HSR (second hit).Arterial blood gas analysis was performed and the animals were then sacrificed by exsanguination at 0,3 and 6 h after LPS(T,,T2,T3 ).The lungs were removed.W/D lung weight ratio and MPO activity,IL-6 and 1L-10 contents in the lung tissue were determined.The changing rate of the abovementioned variables at T2,T3 based on the values at T1 were calculated.ResultsIn C3H/HeN animals the changing rate of PaO2 was significantly lower while the changing rate of W/D ratio,MPO activity and IL-6,IL-10 contents in the lung tissue were significantly higher in HSR/LPS group than in S/LPS group at T2.3.But in C3H/HeJ animals the above-mentioned variables were changed at T2.ConclusionThe role of TLR-4 in the two-hit-induced ALI is stronger than that in the LPS-induced ALI in mice.

Objective To investigate the effect of Shenfu injection (SFI) on hypoxia and reoxygenation (H/R)-induced apoptosis and the expression of Bcl-2 and Caspase-3 in cultured neonatal rat cardiomyocytes and to explore the possible molecular protective mechanisms of SFI from hypoxia and reoxygenation injury in cardiacmy-ocytes in vitro. Method The experiment was performed in Research Center for Cardiovascular Regenerative Medicine, Cardiovascular Institute and Fuwai Hospital in Beijing. Ventricular myocytes from the hearts of neonatal Sprague-Dawley rats (1- to 2-day old) were cultured. The model of hypoxia and reoxygenation injury was devel-oped in primary cultured neonatal rat cardiacmyocytes. The cultured cells were randomly divided into four groups: (1) Control group (Con group), without any treatment; (2) Hypoxia and Reoxygenation group (H/R group),4 h hypoxia followed by 16 h reoxygenation; (3) Low-dose SFI group (L-SFI group),cardiacmyocytes were pretreated with a low dose (50 μL/mL) of SFI for 30 min followed by H/R; (4) High-dose SFI group (H-SFI group),car-diacmyocytes were pretreated with a high dose (100 μL/mL) of SFI for 30 min followed by H/R. Apoptosis was quantified by fluoreacence-activated cell sorter (FACS) analysis after staining with Fluorescein isothiocyanate (FITC)-labled Annexin-V (Annexin V-FITC) and propidine iodide (PI). The expressions of Bcl-2 and Caspase-3 were detected by ECL-Western blot analysis. All data are expressed as mean±S.E.M. One-way analysis of vari-ance (ANOVA) was performed followed by Student-Newman-Keul test using SSPS 11.5 software. A p value less than 0.05 were considered as statistically significant. Results The results of FACS analysis indicated that the rate of different apoptotic process in cardiomyocytes was significantly increased after H/R, while after SFI treatment the occurrence of cell apoptosis induced by H/R was decreased significantly. The results of ECL-Western blot analysis showed that cells' exposure to H/R induced proteolytic cleavage of caspases,as revealed by the appearance of the characteristic fragment at 17 000 of Caspase-3 and this proteolytic activation was nearly completed with difference concentration SFI incubation. The anti-apoptotic protein Bcl-2 in cardiomyocytes was decreased after H/R insult and was increased in cells with SFI pretreatment. Conclusions SFI has protective effects on cardiacmyocytes a-gainst apoptosis that could be induced by H/R injury, the mechanisms of which probably involve the inhibition of down-regulation of Bcl-2 protein level and sequential activation of Caspase-3.

Objective To evaluate the role of p38MAPK signaling pathway in the up-regulation of heme oxygenase-1 (HO-1) expression during hemorrhagic shock and resuscitation (HSR)-induced acute lung injury (ALI) in mice. Methods Thirty-two C3H/HeN (wild-type) mice, aged 10-12 weeks, weighing 20-25 g, were randomly divided into 4 groups (n = 8 each): sham operation group (group S); group HSR; FR167653 (a p38MAPK inhibitor) group (group FR) and FR167653 + HSR group (group FR + HSR). HSR was induced according to the methods described by Ayala et al. MAP was reduced to 35-45 mm Hg and maintained for 60 min.Then the animals were resuscitated with transfusion of the shed blood and lactated Ringer's solution equivalent to the volume of shed blood. FR167653 5 mg/kg was injected intravenosly in group FR. FR167653 5 mg/kg was injected intravenously 30 min before blood-letting in group FR + HSR. The animals were sacrificed by exsanguination at 6 h after resuscitation. The lungs were immediately removed for microscopic examination. The W/D lung weight ratio was calculated and the levels of myeloperoxidase (MPO), IL-10, IL-6 and HO-1 and activated p38MAPK were determined (by ELISA).Results Compared with group S, the pathological score, W/D ratio, the levels of MPO, IL-10, IL-6 and HO-1 and the level of activated p38MAPK were significantly increased in group HSR, the pathological score, W/D ratio and the level of HO-1 were significantly increased in group HSR + FR ( P ＜ 0.01) .Compared with group HSR, the pathological score, W/D ratio, the levels of MPO, IL-10, IL-6 and HO-1 and activated p38MAPK were significantly decreased in group HSR + FR ( P ＜ 0.01 ). Conclusion p38MAPK signaling pathway mediates the up-regulation of HO-1 expression during HSR-induced ALI in mice.

Objective To investigate the effects of flurbiprofen pretreatment on the permeability of bloodbrain barrier in a rat model of global cerbral ischemia-reperfusion (I/R) injury. Methods Forty-five male SD rats weighing 300-350 g were randomly divided into 3 groups (n = 15 each): sham operation group (group S); global cerebral I/R group (group I/R); flurbiprofen 10 mg/kg + global cerebral I/R group (group F). Global cerebral ischemia was induced by 20 min occlusion of bilateral common carotid arteries combined with hypotension (MAP maintained at 35-45 mm Hg). In group F, flurbiprofen 10 mg/kg was injected iv at 15 min before ischemia. Evans blue 3 ml/kg was injectcd iv at 24 h of reperfusion, then the rats were sacrificed and their brains were immediately removed for determination of the apoptosis rate, brain water content, Evans blue content, TNF-α, IL-1β and IL-10 content, and microscopic examination. Results The apoptosis rate, brain water content, Evans blue content, and TNF-α, IL-1β and IL-10 content were significantly higher in group I/R and F than in group S (P ＜ 0.05 or 0.01).The apoptosis rate, brain water content, and Evans blue content and TNF-α and IL-1β content were significantly lower, while IL-10 content was higher in group F than in group I/R (P ＜ 0.01). Global cerbral I/R-induced changes were significantly attenuated in group F. Conclusion Pretreatment with flurbiprofen can protect bloodbrain barrier against cerebral I/R injury by inhibition of the inflammatory reaction.

Objective To evaluate the role of Phosphatidylinositol 3-kinase/protein-serine-threonine kinases (PI3K/Akt) signaling pathway in reduction of hypoxia-reoxygenation (H/R)-induced injury to cardiomyocytes by propofol postconditioning in rats.Methods Primary cardiomyocytes were obtained from neonatal rats aged 1-3 days and cultured in DMEM culture medium.The cells were seeded in 96-well plates (density 1 × 105/ml,200 μl/well) or 6-well plates (density 5 × 105/ml,2 ml/well) and randomly assigned into 4 groups (n =24 each):control group (C group),H/R group,H/R + propofol group (H/R + P group) and H/R + propofol + wortmannin (a specific PI3K inhibitor) group (H/R + P + W group).The cells were routinely cultured for 6 h in group C.The cells were exposed to 2 h hypoxia followed by 4 h reoxygenation.Propofol with the final concentration of 50 μmol/L was added to the culture medium at the end of hypoxia in group H/R + P.Wortmannin (final concentration 100 nmol/L) and propofol (final concentration 50 μmol/L) was added to the culture medium at the end of hypoxia in group H/R + P + W.At the end of reoxygenation,the cell viability was measured by MTT assay,the lactic dehydrogenase (LDH) activity was detected in the culture medium,the cell apoptosis was assessed by flow cytometry,and the expression of phosphorylated Akt (p-Akt),Bcl-2 and Bax in cardiomyocytes were determined by Western blot.The apoptotic rate and Bcl-2/Bax ratio were calculated.Results Compared with C group,the cellviability was significantly decreased,the LDH activity and apoptotic rate were increased,p-Akt and Bax expression was up-regulated and Bcl-2 expression was down-regulated in H/R group (P ＜ 0.05).Compared with H/R group,the cell viability and Bcl-2/Bax ratio were significantly increased,the LDH activity and apoptotic rate were decreased,p-Akt and Bcl-2 expression was up-regulated and Bax expression was down-regulated in H/R + P group (P ＜ 0.05).Compared with H/R + P group,the cell viability and Bcl-2/Bax ratio were significantly decreased,the LDH activity and apoptotic rate were increased and p-Akt and Bel-2 expression was down-regulated in H/R +P + W group (P ＜ 0.05).Conclusion The mechanism by which propfol postconditioning attenuates H/R-induced injury to cardiomyocytes is related to the activation of PI3K/Akt signaling pathway.

Objective To investigate the risk factors for early postoperative cognitive function in the patients with peritoneal surface malignancies after cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy(CRS-HIPEC).Methods Fifty-one patients(21 men and 30 women), ranged from 25 to 65 years,42-80 kg,ASA Ⅰ-Ⅲ,undergoing CRS-HIPEC under combined intrave-nous-inhalational anesthesia,were studied.Patients were assigned into postoperative cognitive dys-function (POCD)group or non-POCD group according to their performances of visual verbal learning test,concept shifting task,letter-digit coding test and stroop color-word test 1 day before operation and 7 days after operation.Years of education,medical history,duration of operation,intraoperative blood loss,frequency of cardiovascular events,amount of fluid infused per hour and VAS scores were recorded.Venous blood samples were taken at five time points:before surgery(T0 ),30 minutes after the beginning of the procedure(T1 ),30 minutes after the beginning of HIPEC(T2 ),at the end of the surgery(T3 )and 24 hours after the surgery(T4 ),to determine the concentration of serum amyloid A (SAA).pH,PaCO 2, Hb,blood glucose were recorded at T0-T2.Then the data was statistically analyzed.Results According to the diagnostic criteria,twenty patients developed POCD 20 (39.2%). There were significant differences between POCD and non-POCD groups on age,gender, pre-operative complications and the origin of tumor(P <0.05).The concentration of SAA increased from T2 and reached the peak at T4 ,and SAA concentration for patients in POCD group was higher than that for patients in non-POCD group(P <0.05).Compared with non-POCD group,the levels of blood glucose were significantly increased in POCD group at T2 (P <0.05).Conclusion CRS-HIPEC resul-ted in exaggerated and prolonged inflammatory response.Advanced age,female,diabetes,hyperten-sion,peritoneal carcinomatosis from ovarian cancer and endometrial cancer are associated with early POCD in the patients undergoing CRS-HIPEC.

Objective To evaluate the effect of heme oxygenase-1 (HO-1) protein transduction on acute lung injury in septic rats.Methods Eighteen healthy male Sprague-Dawley rats,aged 7-9 weeks,weighing 210-260 g,were randomly allocated into 3 groups (n =6 each) using a random number table:sham operation group (group Sham),sepsis group (group Sep),and fusion protein PEP-1-HO-1 group (group HO).Sepsis was produced by cecal ligation and puncture (CLP).In group HO,PEP-1-HO-1 fusion protein 0.6 mg was injected via the left iliac vein at 1 h before CLP and 5 h after CLP.The equal volume of normal saline was given instead of PEP-1-HO-1 in Sham and Sep groups.At 12 h after CLP,blood samples were collected from the right common carotid artery for measurement of serum tumor necrosis factoralpha (TNF-α) and interleukin-6 (IL-6) concentrations.The rats were then sacrificed,and lungs were removed for microscopic examination and for determination of wet/dry lung weight ratio (W/D ratio) and malondialdehyde (MDA) content (by thiobarbituric acid colorimetric method).Results Compared with group Sham,the W/D ratio and MDA content were significantly increased,the serum TNF-α and IL-6 concentrations were significantly increased (P＜0.05),and the pathological changes were significantly aggravated in Sep and HO groups.Compared with group Sep,the W/D ratio and MDA content were significantly decreased,the serum TNF-α and IL-6 concentrations were significantly decreased (P＜0.05),and the pathological changes were significantly attenuated in group HO.Conclusion HO-1 protein transduction can attenuate acute lung injury in septic rats,and the mechanism is probably related to inhibition of lipid peroxidation in lung tissues and systemic inflammatory responses.

Objective To investigate the effect of mechanical ventilation on the pulmonary microvascular permeability in diabetic mice.Methods Sixty-four male C57/BL6 mice aged 10-12 months,weighing 20-25 g,were randomly assigned into 4 groups (n =16 each):control group (group C); mechanical ventilation group (group M); diabetes group (group D); diabetes mechanical ventilation group (group DM).Diabetes was induced by intraperitoneal streptozotocin 150 mg/kg (in citric acid buffer solution 0.1 mol/L) and confirmed by blood glucose level ＞ 16 mmol/L in groups D and DM,while the equal volume of citric acid buffer solution was given instead of streptozotocin in groups C and M.The animals were anesthetized with intraperitoneal pentobarbital 100 mg/kg and tracheostomized.The animals kept spontaneous breathing for 4 h in groups C and D,while the animals were mechanically ventilated for 4 h in groups M and DM.Eight mice from each group were randomly selected,arterial blood samples were obtained for blood gas analysis,and then the animals were sacrificed and the lung tissues were removed for determination of microscopic examination,W/D lung weight ratio and myeloperoxidase (MPO)activity.Four mice from each group were sacrificed and the pulmonary vascular permeability was determined.Four mice from each group were sacrificed and the primary pulmonary microvascular endothelial cells (PMVECs) were cultured in vitro and confirmed.The PMVEC permeability coefficient was measured using transendothelial [ 14 C ]BSA flux.Results Compared with group C,PaO2 was significantly decreased,and the MPO activity,pulmonary microvascular permeability and PMVECs permeability coefficient were significantly increased in groups M,D and DM,and W/D lung weight ratio was significantly increased in groups M and DM ( P ＜ 0.05).PaO2 was significantly lower,and W/D lung weight ratio,MPO activity,pulmonary microvascular permeability and PMVECs permeability coefficient were significantly higher in group DM than in group D ( P ＜ 0.05).Conclusion The mechanism by which mechanical ventilation induces lung injury may be related to the increase in the pulmonary microvascular permeability in diabetic mice.