Objective To evaluate the advantages of sevoflurane inhalation anesthesia combined with lumbosacral plexus block for hip replacement in elderly patients. Methods Sixty patients of both se-xes, aged 65-85 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective unilateral hip replacement, were divided into 2 groups(n=30 each)using a random number table: total intravenous anesthesia group(TIVA group)and GasMan software-guided sevoflurane inhalation anesthesia combined with lumbosacral plexus block group(SEV-B group). After the laryngeal mask airway was inserted, the patients were mechanically ventilated in both groups. Heart rate and mean arterial pressure(MAP)were recorded before anesthesia(T0), immediate-ly after insertion of laryngeal mask airway(T1), immediately after skin incision(T2), immediately after intramedullary reaming(T3), immediately after prosthesis implanting(T4), at the end of surgery(T5) and at 5 min after removal of the laryngeal mask airway(T6). The end-tidal concentration of sevoflurane at T2-5was also recorded in group SEV-B. The time for removal of the laryngeal mask airway, duration of stay in post-anesthesia care unit and first ambulation time were recorded. The consumption of anesthetics used during patient-controlled intravenous analgesia(PCIA), effective pressing times of PCIA, requirement for rescue analgesic and adverse reactions were also recorded at 24 h after surgery. The patient′s cognitive func-tion was assessed using Mini-Mental State Examination at 1 day before surgery and 1 and 3 days after surger-y, and the occurrence of postoperative cognitive dysfunction was recorded. Results Compared with group TIVA, heart rate at T1-6and MAP at T2-6were significantly decreased, and MAP at T1was increased in group SEV-B, and the time for removal of the laryngeal mask airway, duration of stay in post-anesthesia care unit and first ambulation time were significantly shortened, the consumption of anesthetics used during PCIA, effective pressing times of PCIA, requirement for rescue analgesic and incidence of adverse reac-tions were reduced at 24 h after surgery, the Mini-Mental State Examination scores were increased at 1 day after surgery, and the incidence of postoperative cognitive dysfunction was decreased at 1 day after surgery in group SEV-B(P<005). Conclusion GasMan software-guided sevoflurane inhalation anesthesia com-bined with lumbosacral plexus block can provide more accurate anesthesia management for hip replacement and promote rapid rehabilitation after surgery in elderly patients.

Objective To evaluate the relationship between the pathomechanism of neuropathic pain (NP)-inducced depression and autophagy in the cortex of the frontal lobe in rats.Methods Forty healthy male Sprague-Dawley rats in which IT catheters were successfully placed,aged 8-10 weeks,weighing 200-220 g,were divided into 4 groups (n =10 each) using a random number table method:sham operation group (group S),group NP,NP plus dimethyl sulfoxide group (group ND) and NP plus autophagy inducer rapamycin group (group NR).The neuropathic pain model was established by ligation of the left fifth spinal nerve of anesthetized rats in NP,ND and NR groups.Rapamycin 0.1 μgwas intrathecally injected via the intrathecal catheter immediately after ligation of the spinal nerve and every day after ligation once a day for 21 consecutive days in group NR.The equal volume of dimethyl sulfoxide was intrathecally injected instead of rapamycin in group ND.The mechanical paw withdrawal threshold (MWT) was measured before ligation and at 1,3,7,10,14 and 21 days after ligation.The forced swimming test was performed at 3 days before ligation and 14 and 21 days after ligation.The rats were sacrificed after the last measurement of the behaviour testing,and the prefrontal cortex was removed for determination of the expression of microtubule-associated protein light chain 3 Ⅰ (LC3 Ⅰ) and LC3 Ⅱ,Beclin-1 and p62 (by Western blot).The ratio of LC3 Ⅱ/LC3 Ⅰ was calculated.Results Compared with group S,the MWT was significantly decreased after ligation,the time of immobility was prolonged,the expression of LC3 Ⅰ was down-regulated,the expression of LC3 Ⅱ,Beclin-1 and p62 was up-regulated,and the LC3 Ⅱ/LC3 Ⅰ ratio was increased in NP and ND groups (P＜0.05).Compared with group NP,the MWT was significantly increased after ligation,the time of immobility was shortened,the expression of LC3 [and p62 was down-regulated,the expression of LC3 Ⅱ and Beclin-1 was up-regulated,and the LC3 Ⅱ/LC3 Ⅰ ratio was increased in group NR (P＜0.05).Conclusion Enhanced autophagy in the cortex of the frontal lobe is involved in the endogenous antidepressant mechanism in rats with NP.

Objective : The purpose of this study was to investigate the effects of plasma exosome⁃derived miR⁃29b⁃3p in myocardial ischemia⁃reperfusion injury ( MIRI) rats on hypoxia/reoxygenation ( H/R) cardiomyocyte after sevoflurane (SEV) postconditioning through targeting IGF1 . Methods : The GEO database was used to screen differentially expressed miRNAs in MIRI , and cardiomyocytes were treated with H/R to construct a MIRI cell model. The expression of miR⁃29b⁃3p and IGF1 in the MIRI cell model post⁃treated with SEV was intervened , and then the survival rate of cardiomyocytes was detected by MTT , apoptosis was detected by flow cytometry , and inflammatory factors (IL⁃1β and TNF⁃α ) in cardiomyocytes in each group were detected by ELISA. Results : Compared with Normal group , the expression of miR⁃29b⁃3p in plasma exosomes of MIRI rats was enhanced (P < 0. 05) , and the target⁃binding relationship between miR⁃29b⁃3p and IGF1 was confirmed ( P < 0. 05) . After SEV post⁃treatment , the expression of miR⁃29b⁃3p in H/R⁃stimulated cardiomyocytes decreased , while the expression of IGF1 increased (both P < 0. 05) . Overexpression of miR⁃29b⁃3p in plasma exosomes could significantly inhibit the survival rate of H/R cells after SEV treatment , aggravate apoptosis and inflammatory response , while knockdown of miR⁃29b⁃3p showed a opposite effects (all P < 0. 05) . The rescue experimental data showed that overexpression of IGF1 could partially reverse the effects of overexpression of miR⁃29b⁃3p on H/R cell injury after SEV treatment ( all P <0. 05) . Conclusion Plasma exosome⁃derived miR⁃29b⁃3p promotes H/R cardiomyocyte injury after SEV treatment by targeting IGF1 .