Objective To evaluate the effects of inhalation sevoflurane in the early ischemia and reperfusion on pulmonary inflammatory response in patients undergoing cardiac surgery with extracorporeal circulation (ECC). Methods Forty patients with rheumatic heart disease scheduled for elective valve replacement were randomly assigned into 2 groups (20 patients in each group): control group and sevoflurane group. In sevoflurane group, 2% sevoflurane was inhaled for 15 min before and after the ascending aorta was blocked, and also before and after the ascending aorta was opened. Paitents in control group didn′t inhale sevoflurane. Time was defined as the followings: after anesthesia and before skin incision (T0), immediately before ECC (T1), immediately after ECC (T2), 2 h after ECC (T3), 6 h after ECC (T4) and 24 h after ECC (T5). At T0, T2, T3, T5, the radial artery blood was obtained to detect the levels of plasma tumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and soluble intercellular adhesion molecule-1(sICAM-1). At T1, T2, the pulmonary artery and pulmonary vein blood was obtained to detect the neutrophil count and calculate the differences between the vein and artery. At T0, T2, T3, T4, T5, the arterial blood gas was detected and differences of alveoli-arterial oxygen pres [P(A- a)O2], oxygenation index (OI), static compliance (Cst) were calculated. Results The levels of plasma TNF-α, IL-8 and sICAM-1 were higher at T2, T3, T5 than those at T0 in two groups (P<0.05). The levels of plasma TNF-α, IL-8 and sICAM-1 were decreased in sevoflurane group at T2 and T3, compared with those in control group (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were higher at T2 than those at T0 in two groups (P<0.05). The neutrophil counts of pulmonary artery, pulmonary vein and the differences between the vein and artery were decreased in sevoflurane group at T2 compared with those of control group (P<0.05). The level of P(A- a)O2 was higher at T2, T3, T4 and T5 than that at T0 in two groups (P<0.05). The level of OI was decreased at T2, T3, T4 and T5 compared with that at T0 in two groups (P<0.05). The level of Cst was decreased at T2, T3 and T4 compared with that at T0 in two groups (P<0.05). The level of P(A-a)O2 was decreased in sevoflurane group at T2, T3 and T4 compared with that in control group (P<0.05). The levels of OI and Cst were higher in sevoflurane group at T2, T3 and T4 compared with those in control group (P<0.05). Conclusions Severe pulmonary inflammation often occurs during cardiac surgery with ECC, and it can be relieved by inhalation of sevoflurane in the early ischemia and reperfusion.

Objective To investigate the effects of post-propofol anesthesia on cognitive function and hippocampus proteome expressions in aged rats.Methods Thirty healthy male Wistar rats aged 20 months were randomly divided into control group(n =15) and propofol group(n =15).The control group was injected with normal saline of 6 ml/kg intraperitoneally and propofol was injected intraperitoneally with propofol 60 mg/kg.The rats in both groups underwent Step-down Test to assess cognitive function at the first day and at the seventh day after the termination of drug administration.Five rats were decapitated randomly each time after the two step-down tests and their hippocampi were removed for two-dimensional gel electrophoresis and mass spectrometric analysis.Results In the step-down test,aged rats in the propofol group showed significantly learning impairment and decreased memory abilities at the 1st day after propofol anesthesia as compared with those in the control group.In learning phase of the 1st day,the latency of the propofol group is (29.5 ± 7.6)s as compared with(19.7 ± 7.0)s of the control group,while the error time is 3.6±1.2 vs.1.6 ±0.8 in the propofol group vs the control group,and the total time of electric shock is(65.2 t 10.6)s vs.(42.7 ± 10.3)s in the propofol group vs the control group(all P＜0.01).The latency of the memory phase in the propofol group is also decreased as compared with that in the control group(31.4±14.3)s vs.(111.2± 23.7) s,(P＜0.01).On the 7th day after anesthesia,there was no significant difference between the two groups.There were 17 differentially expressed proteins on the 1st day after propofol anesthesia,6 of them were up-regulated and 11 proteins were down-regulated (P ＜ 0.05).On the 7th day,there were 10 differentially expressed proteins,and the expression of 5 proteins was down-regulated (P ＜ 0.01).Conclusions Aging rats receiving propofol anesthesia show cognitive function decline,but do not show a long-term decline.The mechanism may be related to the different expressions of hippocampal proteins.

Objective To compare the diagnostic values of 18F-FDG and 18F-FLT PET/CT in patients with suspicious recurrence of glioma after multimodal treatment.Methods A total of 20 patients (13 males,7 females;age range:12-73 years) with glioma who underwent 18F-FDG and 18F-FLT PET/CT due to abnormal enhancement on MRI from January 2012 to June 2015 were enrolled in this retrospective study.According to the pathological or follow-up results,patients were divided into therapy-related benign changes (TRBC) group and recurrent glioma group,the later was subdivided into initial low-grade glioma (LGG) group and initial high-grade glioma(HGG) group.T/NT ratios of 18F-FDG and 18F-FLT between HGG (LGG) group and TRBC group were compared using one-way analysis of variance and the least significant difference t test.ROC curve analysis was conducted to calculate the differential diagnostic efficiency of 18F-FDG and 18F-FLT between TRBC and recurrent glioma.Results A total of 14 patients were proved as recurrent glioma and 6 patients as TRBC.The mean 18F-FDG T/NT ratios of HGG group,LGG group and TRBC group were 2.31±0.86,1.32±0.86 and 1.32±0.64,respectively.The 18F-FDG T/NT ratio of the HGG group was significantly higher than that of the TRBC group(F=3.671,t=-2.471,P＜0.05).The mean 18F-FLT T/NT ratios of HGG group,LGG group and TRBC group were 8.94±3.14,7.18±3.29 and 1.92±1.20,respectively (F=13.301,t values:-5.150 and-2.360,both P＜0.05).The optimal T/NT cutoff values for 18 F-FDG and 18F-FLT PET/CT were 1.62 and 4.58,respectively.The sensitivity,specificity and accuracy of detecting recurrent glioma with optimal T/NT cutoff value were 11/14,5/6 and 16/20 for 18F-FDG PET/CT,and those for 18F-FLT PET/CT were 13/14,6/6 and 19/20,respectively.No significant difference was observed between the diagnostic efficiencies of the two imaging modalities (x2 values:1.167,1.091 and 2.057;all P＞0.05).Conclusion There were no statistical significances between 18F-FDG and 18F-FLT PET/CT on the differential diagnosis of glioma recurrence.

Objective:To analyze the imaging features of hepatic metastases in gastrointestinal stromal tumors (GIST) on 18F-fluorodexyglucose (FDG) PET/CT in order to improve the accuracy of diagnosis. Methods:Clinical and imaging data of 33 patients (18 males, 15 females, age 34-70 years) with hepatic metastases in GIST who underwent PET/CT examination between May 2013 and July 2019 in Fujian Cancer Hospital were analyzed retrospectively. All patients underwent 18F-FDG PET/CT early imaging, and nine of them underwent delayed imaging. Visual analysis was performed on the PET/CT images by comparing FDG uptake of hepatic lesions and liver background, and all lesions were classified as significant hypermetabolism, slightly higher metabolism and equal or lower metabolism. Maximum standardized uptake value (SUV max) of primary GIST lesions and hepatic metastases were calculated and compared, and the relationship between them was analyzed. Wilcoxon rank sum test and Spearman rank correlation analysis were used to analyze the data. Results:Among 33 GIST patients, 9 patients had solitary hepatic metastasis, and 24 patients had multiple hepatic metastases (104 lesions). The diameter of metastases was 0.8-14.6(2.2(1.5, 3.9)) cm, and SUV max was 1.4-21.5(3.6(2.4, 5.7)). Of the 104 hepatic metastases, 94.2%(98/104) lesions had clear boundaries, 65.4%(68/104) lesions had uniform density (2 lesions with cystic density), 34.6%(36/104) lesions had uneven density in which hemorrhage, cystic change or necrosis could be found. On visual analysis of PET images, 38.5%(40/104) lesions were with significant hypermetabolism, 26.0%(27/104) were with slightly higher metabolism and 35.6%(37/104) were with equal or lower metabolism. In 24 patients with multiple hepatic metastases, 79.2%(19/24) showed different metabolic levels synchronously. Among 67 hypermetabolic metastases, 34.3%(23/67) were with homogeneous metabolism, of which 13 lesions with diameter<2.0 cm; 65.7%(44/67) were with heterogeneous metabolism, of which 36 lesions with diameter≥2.0 cm. There was a moderate correlation of SUV max between GIST primary tumors and hepatic metastases ( n=15; 9.2(6.8, 14.5) vs 3.8(2.1, 6.0), rs=0.556, P<0.01). The difference of SUV max between GIST primary tumors and hepatic metastases was statistically significant ( z=-5.098, P<0.01). In delayed imaging, 13/15 hepatic metastases with equal or lower metabolism changed to slightly higher metabolism. Conclusions:Hepatic metastases in GIST on 18F-FDG PET/CT imaging usually have clear boundary, and often associate with cystic degeneration, hemorrhage or necrosis. The metabolic patterns of hepatic metastases in GIST are varied. Delayed PET/CT imaging is helpful for the diagnosis of hypometabolic hepatic metastases in GIST.

Objective To compare the anesthetic effect of fentanyl and sufentanil in vocal cord tumors excision in elderly patients.Methods Sixty elderly patients from the First Hospital of Shanxi Medical University scheduled for elective excision of vocal cord tumors were randomly divided into fentanyl group (group F) and sufentanil group(group SF) according to the random number table method, and each group had 30 cases. The dose was determined by its efficiency ratio of analgesic (10:1) followed by anesthesia induction with compound etomidate and cisatracurium. Besides, injection remifentanil and propofol with pump was used for anesthesia maintenance during the operation. Haemodynamics indicators of group F and group SF were recorded at different time point, including before (T0), after induction of anesthesia (T1), immediately after intubation (T2), during the resection of tumor (T3), before extubation (T4) and after extubation (T5). Time to resuscitation, time to extubation, the cooperation at extubation, the sedation scores of 10 minutes after extubation (according to Ramsay sedation level score), and the complications of anesthesia were recorded respectively. Results In the group SF, T0pressure: (135±6) mmHg / (82±6) mmHg (1 mmHg = 0.133 kPa), heart rate:(80±7)/min;in the group F,T0pressure:(129±7)mmHg/(79±6)mmHg,heart rate:(80±7)/min.In the group SF,T1pressure:(102±5)mmHg/(61±4)mmHg,heart rate:(64±4)/min;in the group F,T1pressure:(100±6) mmHg / (61±4) mmHg, heart rate: (61±3) /min. T3heart rate: (89±5) /min (group SF), (92±5) /min (group F). Compared with T0, the pressure and heart rate of T1were decreased in both groups, and the heart rate of T3was increased (P < 0.05). The time to resuscitation and time to extubation in the group F was shorter than that in the group SF[(5.5±1.8)min vs.(10.4±3.1)min,(8.6±2.4)min vs.(15.4±2.6)min,both P<0.05].Ramsay score in the group F was lower than that in the group SF[(2.4±0.3) scores vs. (3.2±0.5) scores, P<0.05]. There were no significant differences in the cooperation at extubation, incidence rate of vomiting and nausea between the two groups (all P > 0.05). Intraoperative awareness and postoperative irritability were not found in both groups.Conclusions The equivalent dose of fentanyl and sufentanil induction are safe and effective for elderly patients with excision of vocal cord tumors. The patients can get more rapid revival and higher revival quality after fentanyl induction.

Objective:To investigate the optimal dose of dexmedetomidine combined with propofol for anesthesia in patients undergoing modified electroconvulsive therapy (MECT).Methods:One hundred and sixty patients of both sexes, aged 20-60 yr, weighing 45-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective MECT, were allocated into 4 groups ( n=40 each) by a random number table method: different doses of dexmedetomidine combined with propofol group (D 1, D 2 and D 3 groups) and routine anesthesia group (group C). Dexmedetomidine 0.2, 0.4 and 0.6 μg/kg were intravenously injected in D 1, D 2 and D 3 groups, respectively, the equal volume of normal saline was given instead in group C, and propofol 1.0 mg/kg and succinylcholine 0.5 mg/kg were intravenously injected in turn 10 min later.Venous blood samples were collected before giving dexmedetomidine (T 0) and at 1 min after the end of MECT (T 1) for determination of the plasma epinephrine (E) and norepinephrine (NE) concentrations.Propofol consumption, occurrence of cardiovascular events, duration of epilespsy and energy suppression index were recorded. Results:Compared with group C, the plasma E and NE concentrations were significantly decreased at T 4, and the propofol consumption was reduced in D 1, D 2 and D 3 groups ( P<0.05). Compared with group D 2, the plasma E and NE concentrations were significantly increased at T 1 in group D 1 and decreased at T 1 in group D 3 ( P<0.05). The incidence of adverse cardiovascular events was significantly increased in group D 3 than in the other 3 groups ( P<0.05). There was no significant difference in duration of epilespsy or energy suppfession index among the 4 groups( P>0.05). Conclusion:The optimal dose of dexmedetomidine combined with propofol 1.0 mg/kg is 0.4 μg/kg when used for anesthesia in the patients undergoing MECT.

Objective:To investigate the values of two-dimensional and three-dimensional echocardiographic parameters in predicting pulmonary vascular resistance (PVR) in chronic pulmonary thromboembolic pulmonary hypertension (CTEPH).Methods:A total of 141 patients diagnosed with CTEPH in China-Japan Friendship Hospital from November 2015 to December 2022 were included. Two-dimensional echocardiographic indicators reflecting PVR were constructed according to the calculation formula of PVR: echocardiographic estimated systolic pulmonary artery pressure (sPAP Echo)/left ventricular end-diastolic diameter (LVIDd), echocardiographic estimated mean pulmonary artery pressure (mPAP Echo)/LVIDd. sPAP Echo/left ventricular end-diastolic volume (LVEDV), sPAP Echo/left ventricular cardiac output (LVCO) were measured by three-dimensional echocardiography. The correlations between two-dimensional and three-dimensional echocardiographic ratios and invasive PVR were then analyzed using the Spearman correlation method. Using receiver operating characteristic curve analysis, cut-off values for the ratios were generated to identify patients with PVR>1 000 dyn·s -1·cm -5. Pre- and postoperative hemodynamics and echocardiographic data were analyzed, as well as the correlation between the reduction rate of the echocardiographic index and PVR in 54 patients who underwent pulmonary endarterectomy (PEA). Results:sPAP Echo/LVIDd, sPAP Echo/LVEDV and sPAP Echo/LVCO were moderately correlated with PVR( rs=0.62, 0.52, 0.63, both P<0.001). The ratio of sPAP Echo to LVEDV, when greater than or equal to 1.41, had a sensitivity of 0.800 and a specificity of 0.930 for determining PVR >1 000 dyn·s -1·cm -5 (AUC=0.860, P<0.001). Similarly, the ratio of sPAP Echo to LVIDd, when greater than or equal to 2.14, had a sensitivity of 0.647 and a specificity of 0.861 for determining PVR >1000 dyn·s -1·cm -5 (AUC=0.830, P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd significantly decreased after PEA (both P<0.001). The sPAP Echo/LVIDd and mPAP Echo/LVIDd reduction rate (ΔsPAP Echo/LVIDd and ΔmPAP Echo/LVIDd) were significantly correlated with PVR reduction rate (ΔPVR), respectively ( rs=0.61, 0.63, both P<0.05). Conclusions:Two-dimensional ratio sPAP Echo/LVIDd and three-dimensional ratio sPAP Echo/LVEDV can be used to noninvasively estimate PVR in CTEPH patients. The conventional ratio sPAP Echo/LVIDd is convenient and reproducibly suitable for monitoring the improvement of PVR before and after treatment, and its ratio of 2.14 can predict the significant increase of PVR in CTEPH patients (>1 000 dyn·s -1·cm -5).

Objective: To evaluate the value of ¹⁸F-FDG PET-CT in predicting the malignant potential of Gastrointestinal Stromal Tumors (GIST). Methods: The clinical and pathological features of 31 patients with GIST confirmed by surgery or biopsy were retrospectively analyzed. The malignant potential of GIST before treatment was assessed by ¹⁸F-FDG PET-CT. The GIST risk classification was graded according to the Standard revised by the National Institutes of Health (NIH) in 2008. The relationship between the maximal standard uptake value (SUVmax) and GIST risk classification, tumor diameter, Ki-67 index, and mitotic count were analyzed respectively. The cut-off level of SUVmax for the diagnosis of malignant GIST was calculated from the Receiver Operating Characteristic (ROC) curve. Results: Among the 31 cases of GIST patients, 14 cases were gastric primary (stomach group) and 17 cases were nongastric primary (outside stomach group). The SUVmax, tumor diameter, Ki-67 index and mitotic count of the 31 patients were 8.21±4.68, (7.82±5.12)cm, (10.03±11.07)% and (12.29±10.55)/50 HPF, respectively. SUVmax was significantly correlated with GIST risk classification (r=0.727, P<0.01), but not with tumor diameter, Ki-67 index and mitotic count (r=0.348, r=0.284, r=0.290, P=0.055, P=0.121, P=0.114). The SUVmax, tumor diameter, Ki-67 index and mitotic count in the stomach group were 4.36±2.36, (6.08±4.31)cm, (3.43±3.03)% and (5.71±2.20)/50 HPF, respectively. SUVmax was significantly correlated with tumor diameter, GIST risk classification and Ki-67 index (r=0.682, r=0.868, r=0.732, P<0.01) but not with mitotic count (r=0.510, P=0.063). The SUVmax of the GIST in the gastric group and the outside gastric group were 4.36±2.36 and 10.68±5.50, respectively. The difference was statistically significant (P=0.001). The SUVmax in the malignant group of GIST (middle or high risk grade) was 8.90±4.89, which was significantly higher than 2.22±0.86 in the benign group (low or very low risk grade). The difference was statistically significant between the two group (P<0.01). ROC curve analysis showed that a SUVmax cut-off of 3.75 was the most sensitive for predicting malignant GIST. When the area under the curve of 0.969, the sensitivity was 84.6% and the specificity was 100%. Conclusions The SUVmax was strongly correlated with the GIST risk category and also with the tumor diameter and Ki-67 index in the gastric primary GIST, so it can be used as an effective indicator in predicting malignant potential of GIST before treatment.