Intracranial hypertension remains the key biomarker of severe traumatic brain injury for neurosurgery doctors. The monitoring of intracranial pressure (ICP) provides the technical support of precision and effective treatment strategy. In this article, the authors analyze the methodology, timing, function and development trend of ICP monitoring. The developing process of ICP monitoring contains the efforts of exploring a safe and precise technique to reflect the pressure in an injured brain. The modern ICP monitoring technology provides sufficient information flow for the management of craniocerebral trauma. Neurosurgeons could follow the information in the value and trends of ICP monitoring and implement it into decision making throughout the whole process of patient management. With the advanced data collecting and analyzing system the clinician can look into the waveform and parameter generalized by ICP value, and can interpret to the pathophysiological profiling in brain. ICP monitoring could exert efficacy not only in reflecting the mechanism of brain injury but also in the directing the clinical practice.

Objective To investigate the effects of different doses of penehyclidine hydrochloride on postoperative cognitive function in the elderly patients.Methods Ninety-three ASA Ⅰ or Ⅱ elderly patients,aged ≥65 yr,weighing 55-71 kg,were randomly divided into 3 groups (n =31 each):penehyclidine hydrochloride 0.010 mg/kg group (group A),penehyclidine hydrochloride 0.015 mg/kg group (group B) and atropine 0.010 mg/kg group (group C).Their preoperative Mini-Mental State examination (MMSE) scores were ＞ 27.At 30 min before anesthesia,groups A,B and C received intramuscular penehyclidine hydrochloride 0.010 mg/kg,penehyclidine hydrochloride 0.015 mg/kg and atropine 0.010 mg/kg,respectively.The cognitive function of the patients was assessed within 72 h after operation using MMSE.Diagnostic criterion of postoperative cognitive dysfunction (POCD) was defined as MMSE score ≤27.POCD and the degree were recorded within 72 h after operation.Results Compared with group A,postoperative cognitive function was significantly decreased at each time point after operation and the incidence of POCD was significantly increased in group B (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group C (P ＞ 0.05).Compared with group B,postoperative cognitive function was significantly enhanced at each time point after operation and the incidence of POCD was significantly decreased in group C (P ＜ 0.05).Conclusion Penehyclidine hydrochloride can depress postoperative cognitive function and the effect is related to the dose.

Objective To investigate the effects of dexmedetomidine preconditioning on ischemia-reperfusion(I/R) injury to isolated rat hearts.Methods Twenty-four male Wistar rats weighing 230-260 g were anesthetized with intraperitoneal 10％ chloral hydrate 400 mg/kg and heparin 500 IU/kg.Their hearts were excised and perfnsed in a Langendorff apparatus with K-H solution saturated with 95％O2-5％CO2 at 37 ℃.Twenty-four isolated rat hearts were randomly divided into 3 groups after 10 min of equilibration(n =8 each):group I/R,dexmedetomidine 0.23,2.30 ng/ml preconditioning group (groups D I,D Ⅱ ).In group I/R,the hearts were perfused continuously for another 30 min.In groups D Ⅰ and D Ⅱ,the hearts were perfused with K-H solution containing dexmedetomidine 0.23,2.30 ng/ml for 20 min followed by 10 min washout before ischemia.All hearts were subjected to 30 min of global ischemia followed by 120 min of reperfusion with K-H solution.The activities of creatine kinase(CK) and lactate dehydrogenase(LDH) in coronary effluent were measured at the end of 10 min equilibration(balance),and at 5,30,60 and 120 min of reperfusion.Myocardial tissues were obtained at the end of reperfusion for determination of the activity of SOD and the content of MDA.Results Compared with group I/R,the CK and LDH activities in coronary effluent and MDA content in myocardium were significantly decreased,the SOD activity was significantly increased in groups D I and D Ⅱ ( P ＜ 0.05).Compared with group D Ⅰ,the CK and LDH activities in coronary effluent and MDA content in myocardium were significantly decreased,the SOD activity was significantly in group DⅡ ( P ＜ 0.05).Conclusion Dexmedetomidine preconditioning can attenuate myocardial I/R injury in a concentration-dependent manner in rats.

Objective To investigate the effect of butylphthalide and sodium chloride injection postconditioning on focal cerebral ischemia-reperfusion (I/R) injury and endoplasmic reticulum stress in rats.Methods Thirty-six male SPF Sprague-Dawley rats,aged 2-3 months,weighing 260-280 g,were randomly divided into 3 groups (n =12 each):sham operation group (group S),focal cerebral I/R group (group I/R) and butylphthalide and sodium chloride injection postconditioning group (group Buty).The animals were anesthetized with intraperitoneal 10 ％ chloral hydrate 300 mg/kg.Focal cerebral I/R was induced by occluding right middle cerebral artery for 2 h followed by 24 h reperfusion in I/R and Buty groups.Butylphthalide and sodium chloride injection 2.5 mg/kg was injected via the tail vein immediately after onset of reperfusion in Buty group,while the equal volume of normal saline was injected in I/R group.Neurological deficits were assessed and scored at 24 h of reperfusion,and then the brain was isolated for detection of neuronal apoptosis (by TUNEL) and the expression of glucose-regulated protein 78 (GRP78) and caspase-12 in ischemic cerebral cortex (by immunohistochemistry) in brain tissues.Apoptosis index was calculated.Results Compared with group S,the neurological deficit scores and apoptosis index were significantly increased,and the expression of GRP78 and caspase-12 was up-regulated in I/R and Buty groups (P ＜ 0.05 or 0.01).Compared with group I/R,the neurological deficit scores and apoptosis index were significantly decreased,the expression of GRP78 was up-regulated,and the expression of caspase-12 was down-regulated in group Buty (P ＜ 0.05).Conclusion Butylphthalide and sodium chloride injection postconditioning can reduce focal cerebral I/R injury in rats,and inhibition of endoplasmic reticulum stressmediated cell apoptosis is involved in the mechanism.

Objective To compare the efficacy of suprainguinal approach and pubic tubercle approach to obturator nerve block (ONB) in patients undergoing transurethral resection of bladder tumor.Methods Sixty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 41-80 yr,with body mass index of 17.5-31.0 kg/m2,scheduled for elective transurethral resection of bladder tumor,were randomly divided into 2 groups (n =30 each) using a random number table:pubic tubercle approach group (group P) and suprainguinal approach group (group S).Nerve blocks were performed using a 100-mm insulated needle for ONB (21-gauge) under the guidance of a nerve stimulator.In group P,the insertion point of the needle was 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle.In S group,the insertion point of the needle was at the midpoint of the line drawn in the inguinal crease between the femoral artery and the inner border of the adductor longus tendon and the needle was advanced 3 cm cephalad in the major axis of thigh.The number of puncture eliciting contraction of adductor muscle,time taken to elicit contraction of adductor muscle starting from onset of puncture,depth of puncture,and highest visual analog scale (VAS) pain scores during application of the block were recorded.The myodynamia of adductor muscle was evaluated.The development of complications was also recorded.Results Compared with group P,the number of puncture,highest VAS scores,and myodynamia of adductor muscle at 4 and 6 min of blockade were significantly decreased,the time taken to elicit contraction of adductor muscle was shortened,and the success rate of puncture at first attempt was increased in group S (P ＜ 0.05 or 0.01).There was no significant difference in the incidence of puncture point bleedings between the two groups (P ＞ 0.05).Conclusion The suprainguinal approach for ONB offers more accurate location,faster onset,lighter degree of noxious stimulation and better safety than the pubic tubercle approach in patients undergoing transurethral resection of bladder tumor.

Objective To investigate the effect of dexmedetomidine on the expression of hypoxia-inducible factor-1α (HIF-1α) during hypoxia/reoxygenation (H/R) in human renal tubular epithelial cells.Methods Human renal tubular epithelial cells (HK-2 cells) cultured in vitro were randomly divided into 4 groups (n =24 each) using a random number table:control group (group C),dexmedetomidine group (group DEX),H/R group and H/R+ dexmedetomidine group (group H/R + DEX).In group C,the cells were incubated for 28 h in an incubator filled with normoxia at 37 ℃.In group DEX,dexmedetomidine 0.1 nmol/L (final concentration) was added to the culture medium and the cells were incubated for 2 h,and then incubated for 28 h in an incubator filled with normoxia at 37 ℃.In group H/R,the cells were incubated in an anaerobic chamber for 24 h at 37 ℃,and then incubated for 4 h in an incubator filled with normoxia at 37 ℃.In group H/R + DEX,the cells were incubated for 2 h in the culture medium containing dexmedetomidine 0.1 nmol/L (final concentration),incubated in an anaerobic chamber for 24 h at 37 ℃,and then incubated for 4 h in an incubator filled with normoxia at 37 ℃.After treatment in each group,the cell viability was measured by MTT assay,cell apoptosis was measured using flow cytometry,the expression of HIF-1α mRNA was detected using RT-PCR,the expression of HIF-1α and activated caspase-3 protein was detected by Western blot,and the cell growth was observed.The apoptosis rate was calculated.Results Compared with group C,the cell viability was significantly decreased,the apoptosis rate was increased,and the expression of HIF-1α mRNA and protein and activated caspase-3 protein was up-regulated in H/.R and H/R + DEX groups,and no significant change was found in group DEX.Compared with group H/R,the cell viability was significantly increased,the apoptosis rate was decreased,the expression of HIF-1α mRNA and protein was up-regulated,the expression of activated caspase-3 protein was down-regulated,and the cell status was significantly improved in group H/R + DEX.Conclusion The mechanism by which dexmedetomidine attenuates H/ R-induced damage to human renal tubular epithelial cells may be related to up-regulated expression of HIF-1 α and inhibited cell apoptosis.

Objective To investigate the effect of L-carnitine on the apoptosis in Schwann cells induced by high glucose.Methods The cell line RSC96 cultured in vitro were seeded in 96-well plates at a density of 1.5 × 104/ml (200 μl/well) or in 6-well plates at a density of 2 × 105/ml (2 ml/well) and cultured for 24 h.The cells were randomly divided into 4 groups (n =24 each) using a random number table:normal control group (group C),high glucose group (group H),high glucose + L-carnitine group (group H + L),and mannitol osmotic control group (group M).The cells in group C were incubated in the plain culture medium containing normal glucose (5.6 mmol/L).The cells were incubated in the medium containing glucose 50 mmol/L in group H or in the medium containing glucose 50 mmol/L and L-carnitine 50 μmol/L (final concentration) in group H + L.The cells were incubated in the medium containing normal glucose (5.6 mtmol/L) and mannitol 44.4 mmol/L in group M.At 48 h of incubation,cell growth conditions were observed under inverted microscope,superoxide dismutase (SOD) activity was measured by xanthine oxidase method,malondialdehyde (MDA) content was measured by thiobarbituric acid test,cell viability was measured by MTT assay and cell apoptosis was measured by flow cytometry.The expression of activated caspase-3 and poly (ADP-ribose) polymerase-1 (PARP-1) protein was detected by Western blot.Results Compared with group C,the cell viability and SOD activity were significantly decreased,MDA content and apoptotic rate were increased,and the expression of activated caspase-3 and PARP-1 protein was up-regulated in H and H + L groups,and no significant changes were found in group M.Compared with group H,the cell viability and SOD activity were significantly increased,MDA content and apoptotic rate were decreased,and the expression of activated caspase-3 and PARP-1 protein was down-regulated in group H + L.Conclusion L-camitine can attenuate high glucose-induced apoptosis in Schwann cells by inhibiting oxidative stress responses and down-regulating the expression of activated caspase-3 and PARP-1.

Objective Comparing the effects of ultrasound with nerve stimulation guided obtu-rator nerve block(ONB)with simple nerve stimulation guided ONB for transurethral resection of blad-der tumor(TURBT),so as to realize the validity and advantages of ultrasound with nerve stimulation guided ONB.Methods Sixty ASA Ⅰ or Ⅱ,male or female,age 39-77 years old,BMI 1 9-30 kg/m2 patients undergoing elective TURBT were randomly divided into two groups,nerve stimulation group (group S)and ultrasound and nerve stimulation group (group US).Success rate of the first puncture, visual analog scale (VAS)pain score,insertion-adductor contraction interval (ICI),puncture times corresponding to ICI,adductor strength,incidence of complications and validity were observed during and after ONB.Results There was no significant difference of the general validity,adductor strength and complication incidence between the two groups.The success rate of the first puncture was signifi-cantly higher in group US than that in group S (P < 0.01).VAS pain score,ICI and puncture times were significantly lower in group US than those in group S (P < 0.05).Conclusion Compared with simple nerve stimulation guided ONB,ultrasound with nerve stimulation guidance showed less punc-ture time,more accurate positioning and more comfort.

Objective To determine the median effective concentration (EC50) of lidocaine for obturator nerve block (ONB) guided by a nerve stimulator in patients undergoing transurethral resection of bladder tumor (TURBT).Methods American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients with bladder tumor,scheduled for elective TURBT,required ONB according to the results of cystoscopy or CT examination performed before operation,with body mass index of 19-30 kg/m2,aged 18-64 yr,were enrolled in the study.ONB was performed with lidocaine using the suprainguinal approach under the guidance of a nerve stimulator.The concentration of lidocaine was determined by up-and-down sequential trial.The initial concentration of lidocaine was 1.5％,and the ratio between the two successive concentrations was 1.2.Successful ONB was considered to be positive response.The EC50 and 95％ confidence interval of lidocaine for ONB guided by a nerve stimulator was calculated.Results The EC50 of lidocaine was 0.57％,and the 95％ confidence interval was 0.55％-0.59％ when used for ONB guided by a nerve stimulator.Conclusion The EC50 of lidocaine is 0.57％ when used for ONB guided by a nerve stimulator in the patients undergoing TURBT.

Objective To investigate the effect of STH-2 cardioplegic solution containing levosimendan on ischemia-reperfusion (I/R) injury in isolated rat hearts. Methods Thirty-two male Wistar rats weighing 250-300 gwere anesthetized with intraperitoneal 3% pentobarbital 30 mg/kg. The hearts were rapidly excised and perfused with oxygenated (95% O2-5% CO2) K-H solution for 30 min in a Langendorff apparatus and then divided into 4groups (n = 8 each) according to the composition of cardioplegic solution: group Ⅰ control (group C) was perfused with STH-2 cardioplegic solution; group Ⅱ , Ⅲ and Ⅳ were peffused with STH-2 cardioplegic solution containing levosimendan 0.03 μmol/L (L1), 0.3 μmol/L (L2) and levosimendan 0.3 μmol/L + glibenclamide 10 μmol/L (L2+ G) respectively. The isolated hearts were first perfused with different cardioplegic solutions for 2 h and then with K-H solution for 30 min. The coronary effluent was collected before ischemia (baseline) and at 10, 20 and 30 min of reperfusion for measurement of creatine kinase (CK) and lactate dehydrogenase (LDH)activities. Myocardial specimens were obtained from apex at 30 min of reperfusion for determination of myocardial ATP and MDA contents and SOD activity. Results Perfusion with STH-2 cardioplegic solution significantly increased CK and LDH activities and MDA content, and significantly decreased SOD activity. Levosinendan 0.03or 0.3 μmol/L significantly attenuated the cardioplegia-induced increase in LDH,CK and SOD activities and MDA content. The protective effects of levosimendan on myocardium against I/R injury were reversed by glibenclamide to some extent. Conclusion Levosimendan can protect myocardium from I/R injury in a dose-dependent manner by opening KATP channel.