Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.

OBJECTIVE: To evaluate the effect and safety of fish oil supplementation in critically ill patients. METHODS: Cochrane library, Cochrane Register of Controlled Trials, MEDLINE, EMbase, CNKI and Wanfang Data were searched for eligible literatures. The methodological quality of the included studies was evaluated and the data was analyzed by Revman5.0 software. RESULTS: Eleven high-quality randomized controlled trials were included. The quality of the eleven studies was evaluated according to Jadad scale, of which one scored four points, one scored five points, one scored six points, the others all scored seven points. The result of meta-analysis indicated that fish oil supplementation could reduce the length of stay in ICU and the time of ventilation(P < 0.00001), but it had no effect on mortality or the incidence of nosocomial infections. CONCLUSION: It is demonstrated that fish oil supplementation is effective and safe for critically ill patients. High-quality large-scale multiple-centered RCTs are required to confirm this finding.

OBJECTIVE: To evaluate the pharmacodynamics of recombined human glucagon-like peptide-1 (GLP-1) after multiple dose subcutaneous injection with or without oral dimethyl diguanidine in Chinese type 2 diabetic patients. METHODS: Twenty-four Chinese type 2 diabetic patients were divided into three groups randomly to receive multiple dose of GLP-1 with or without oral dimethyl diguanidine. Plasma samples were collected after injection. The concentrations of glucose and insulin were determined, and the variation of glucose and insulin was analyzed. RESULTS: There was a significant reduction of blood glucose level compared with base line within 2 h after injection of GLP-1. The reduction magnitudes in the three groups were in the following sequence: GLP-10.2 mg + dimethyl diguanidine > GLP-10.2 mg > GLP-10.1 mg. There was a rise of insulin in contrast with base line within 10 - 30 min after injection of GLP-1. CONCLUSION: There are a rise of blood insulin and a reduction of blood glucose after injection of GLP-1 in Chinese type 2 diabetic patients.

OBJECTIVETo evaluate the efficacy and safety of acupuncture-moxibustion combined with modified Mojie tablet (see text) in the prevention of the recurrence of endometriosis (EMS) after laparoscopic surgery.

METHODSAfter laparoscopic surgery, 120 cases of EMS were randomized into an acupuncture-moxibustion group, a western medication group, a Chinese medication group and a combined therapy of acupuncture-moxibustion and Chinese medication group (combined therapy group), 30 cases in each one. In the acupuncture-moxibustion group, acupuncture was applied at Xuehai (SP 10), Sanyinjiao (SP 6) and Guanyuan (CV 4); the isolated moxibustion with ginger was used at Guanyuan (CV 4), once a day, twice a week. In the western medication group, gestrinone was prescribed for oral administration, 2.5 mg, once a day, twice a week. In the Chinese medication group, the self-prepared Mojie tablet were prescribed for oral administration. In the combined therapy group, acupuncture, moxibustion and modified Mojie tablet for oral administration were used in combination. The therapeutic methods were same as the acupuncture-moxibustion group and the Chinese medication group. Totally, the treatment of 3 months was required. Separately, before treatment, after treatment, in 3 months after treatment and in 6 months after treatment, EHP-5 score (endometriosis health profile-5), the abdominal/vaginal ultrasound examination, serum CA125 detection and safety index (ALT detection) were compared in patients among 4 groups.

RESULTSIn 3 and 6 months after treatment, the positive rates of EHP-5 score were 0% (0/30) in the combined therapy group and 0% (0/30) in the acupuncture-moxibuston group, which were all lower significantly than 13.3% (4/30) in the western medication group (both P < 0.05). In follow-up stage of 6 months after treatment, there was no recurrence case in abdominal lviginal ultrasound examination in the combined therapy group, which was lower than 13.3% (4/30) in the western medication group (P < 0.05); the serum CA125 detection in the combined therapy group did not find any abnormal case, which was lower than 16.7% (5/30) in the western medication group (P < 0.05). At the end of treatment session and in the follow-up stage of 3 months after treatment, the abnormal rate of ALT were 20.0% (6/30) and 13.3% (4/30) in the western medication group, which were higher than those in any of the rest groups (P < 0.05). In the follow-up stage of 6 months after treatment, there were 3 abnormal cases of ALT in the western medication group, but which was not different significantly as compared with the rest groups (P > 0.05).

CONCLUSIONAcupuncture and moxibustion combined with modified Mojie tablet effectively prevent from the recurrence of EMS after laparoscopic surgery and improve the life quality of the patients. This combined therapy brings less damage on the liver as compared with the western medication of gestrinone and indicates its definite efficacy and safety.

Acupuncture Therapy ; Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Endometriosis ; drug therapy ; prevention & control ; surgery ; Female ; Humans ; Laparoscopy ; Middle Aged ; Secondary Prevention ; Young Adult

Purpose:To explore the effects of stem cell factor(SCF) in combination with erythropoietin (EPO) on erythropoiesis in patients with anemia associated with non-Hodgkin's lymphoma (NHL). Methods:Bone marrow (BM) mononuclear cells (MNC) from NHL patients and normal simples were cultured for 7 consecutives days in the presence or absence of SCF, EPO, and SCF+EPO in liquid medium. Erythropoiesis was analyzed by calculating the fraction of recovered erythroid cells and by flow cytometry. Results:Cultures stimulated with SCF+EPO contained a marked increased fractions of recovered erythroid cells compared to cells cultured in EPO alone in NHL simples (P

Aim To investigate the effect of selective cyclooxygenase-2 inhibitor, NS-398, on cell apoptosis in leukemia cell line K562 cells and its underlying mechanism. Methods Apoptotic cell percentage was examined by flow cytometry(FCM). The protein expression of Bcl-2 and Caspase-3 was detected by Western blot, and the activity of Caspase-3 was checked by FCM. Results NS-398 induced the cell apoptosis in K562 cells in a dose-dependent manner. After NS-398 treatment, the expression of Bcl-2 protein was downregulated, whereas the expression of Caspase-3 protein was upregulated. Moreover,the activity of Caspase-3 was increased in a dose-dependent way after NS-398 treatment. Conclusion Selective cyclooxygenase-2 inhibitor,NS-398,significantly induced apoptosis in K562 cells. The underlying mechanism might be related to the downregulation of Bcl-2 and the activation of Caspase-3.

Objective To compare the effects of sedation induced with propofol and midazolam on anterior pituitary hormone in mechanically ventilated patients with traumatic brain injury.Methods Eighty-four patients with acute traumatic brain injury,aged 20-60 yr,weighing 50-70 kg,undergoing mechanical ventilation during sedation induced with propofol or midazolam,were randomly divided into 2 groups ( n =42 each):propofol group (group P) and midasolam group (group M).Ramsay sedation score was maintained at 2-4.In group P,propofol was continuously infused at the initial infusion rate of 1.5-6.0 mg·kg-1 ·h-1 and propofol 50 mg was injected intravenously to increase the depth of sedation when needed.In group M,midazolam was continuously infused at the initial infusion rate of 0.10-0.35 mg· kg-1· h-1 and midazolam 7.5 mg was injected intravenously to increase the depth of sedation when needed.The patients were ventilated for 70-120 h.Glasgow Coma Scale scores were assessed before sedation and Glasgow Outcome Scale scores were assessed 4 weeks after admission to the intensive care unit.Venous blood samples were collected at 24 and 72 h of sedation and 4 weeks after admission to the intensive care unit for determination of the levels of serum cortisol,thyroid-stimulating hormone,prolactin,and growth hormone by ELLSA.Results Compared with group M,the levels of serum cortisol and growth hormone were significantly decreased and the level of thyroid-stimulating hormone was significantly increased at 24 and 72 h of sedation in group P ( P ＜ 0.05 or 0.01 ),and the parameters mentioned above were in the normal range.There was no significant difference in the serum prolactin level and outcome between the two groups (P ＞ 0.05).Conclusion The effects of sedation induced with propofol and midazolam on anterior pituitary hormone are comparable in mechanically ventilated patients with traumatic brain injury.

ObjectiveTo assess the degree of pain in elderly patients with mechanical ventilation in ICU using critical-care pain observation tool(CPOT) and to choose the correct sedative and analgesic method.Methods 110 elderly patients in ICU after neurosurgery were divided into three assessment stages,every stage had two record points and total six points (T1-T6):the first stage (intubation and unconsciousness,T1-T2),the second stage (intubation and consciousness,T3T4 ) and the third stage(extubation and consciousness,T5-T6 ).Among them T1,T3and T5were nonnocuity assessment points of every stage,while T2,T4 and T6 were nocuity assessment points of every stage.The assessment time was one minute at every point.After recorded at every point in second and third stages,patients were asked to use the pain intensity descriptive scale (PIDS) themselves.CPOT,heart rate and mean arterial pressure (MAP) from T1 to T6 were recorded as well as PIDS from T3 to T6 in second and third stages.Results In the three stages,CPOT〔(26.8 vs.0.54,3.36 vs.1.20,2.78 vs.0.68) scores〕,HR〔(95 vs.85,94 vs.82,94 vs.84)beat/min〕 and MAP〔(95 vs.85,95 vs.87,94 vs.87)mm Hg〕 at T2,T4and T6 were higher than T1 (t=-42.89,-55.95,-55.38),T3 (t =- 5.52,- 11.33,- 11.78) and T5 ( t =- 5.54,- 9.95,- 11.33 ) ( P＜ 0.05 ).The PIDS at T4 and T6were higher than at T3and T5in the second and third stages 〔(2.52 vs.1.69,2.12 vs.1.44)scores〕 (P＜0.05).The correlation coefficient between CPOT and PIDS at T3 and T4 in the second stage were 0.49 and 0.58,respectively (P＜0.05),and between CPOT and PIDS at T5 and T6 were 0.52 and 0.59 in the third stage,respectively (P ＜ 0.05),and they both reached moderate correlation.ConclusionsCPOT may be an effective way to assess the degree of pain in elderly patients with mechanical ventilation at present.

Objective To compare the effect of sevoflurane and propofol on cerebral metabolism in patients undergoing intracranial aneurysm clipping.Methods Sixty-eight ASA Ⅱ or Ⅲ patients aged 22-62 yr weighing 52-81 kg with Hunt-Hess Ⅱ or Ⅲ undergoing intracranial aneurysm clipping were randomly divided into 2 groups( n =34 each): group propofol(group P) and group sevoflurane (group S).Anesthesia was induced with target-controlled infusion(TCI) of propofol (target plasma concretration 2.0 μg/ml,group P) or inhalation of 8％sevoflurane (group S) and iv injection of remifentanil 0.8 mg/kg and atracurium 0.5 mg/kg.Anesthesia was maintained with TCI of propofol(target plasma concretration 1.5 μg/ml,group P) or inhalation of 2％ sevoflurane (group S) and TCI of remifentanil (target plasma concretration 2.0-3.5 ng/ml) and infusion of atracurium (4μg· kg- 1 · min- 1 ).Samples of dialysate in brain were collected at 5 min before temporary arterial occlusion (T0 ),5 min (T1),10 min (T2 ),15 min (T3) of temporary arterial occlusion,and 10 min (T4),20 min (T5),40 min (T6 ) after cerebral aneurysm clipping for determination of glucose,lactate and pyruvate concentrations.Lactate/pyruvate(L/P) ratio was calculated.Results Compared with group P,the concentrations of glucose,lactate and pyruvate were significantly increased at T1 -06,and L/P ratio was decreased at T2-T4 in group S( P ＜ 0.05).The glucose concentration was significantly lower,and lactate concentration higher at T1 -T6,pyruvate concentration was lower at T1 -T4,and higher at T5 and T6,and L/P ratio was higher at T1 -T5 in both groups than that at T0 ( P ＜0.05).The concentrations of glucose and pyruvate were higher and L/P ratio was lower at T4-T6,and lactate concentration was lower at T5,T6 in both groups than that at T3 ( P ＜ 0.05).Conclusion Compared with propofol,sevoflurane can better improve cerebral metabolites in patients undergoing intracranial aneurysm clipping.

Acute Disease ; Adult ; Female ; Herbicides ; poisoning ; Humans ; Inflammation ; therapy ; Male ; Paraquat ; poisoning ; Poisoning ; therapy ; Retrospective Studies ; Survival Rate ; Young Adult