Objective To investigate the effects of ulinastatin on pro- and anti-inflammatory cytokines and respiratory index during open heart surgery under CPB. Methods Twenty ASA Ⅱ- Ⅲ patients of either sex (9 males, 11 females) scheduled for elective valve replacement under CPB were randomly divided into two groups of 10 each : control group (C) and ulinastatin group (W) . Patients with hepato-renal dysfunction or taking glucocorticoid were excluded. The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.1 mg?kg-1 , fentanyl 10?g?kg-1 and vecuronium 0.1mg?kg-1 . After tracheal intubation anesthesia was maintained with midazolam and fentanyl. The patients were mechanically ventilated. VT was set at 8-12 ml?kg-1 , RR 10-12 bpm and I: E 1:2. PETCO2 was maintained at 35-45 mg. In ulinastatin group, the patients received ulinastatin 12 000 U?kg-1 of which half was given i.v. before CPB and half was added to the priming fluid, while group C received normal saline instead of ulinastatin. Blood samples were taken from radial artery for determination of plasma TNF-?, IL-6, and IL-10 concentrations and blood gas analysis before operation (T1 ) , 30 min after initiation of CPB (T2), 1 h (T3 ) , 4 h (T4 ) and 24 h (T5 ) after CPB. Respiratouy index (PA-aDO2/ PaO2) was calculated at T1-5 .Results There were no significant differences in sex, age, weight, height, duration of CPB, and aortic cross-clamping time between the two groups. In group C the plasma levels of TNF-?, IL-6 and IL-10 were significantly higher than the baseline values (T1 ) during and after CPB (P

Objective To investigate the changes of plasma cytokines and myocardial enzymes in different doses of fentanyl in patients undergoing valve replacement under cardiopulmonary bypass (CPB) and evaluate its anti-inflammatory and myocardial protective effects.Methods Thirty ASAⅡ-Ⅲ patients undergoing elective valve replacement under CPB were studied. We excluded patients having infection, abnormal immunological function of receiving steroid or immune- modulatory drugs. The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. Anesthesia was induced with midazolam modulate 0.1 mg ?kg-1 , fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with continuous infusion of fentanyl and intermittent i.v. boluses of midazolam and vecuronium. The total dose of fentanyl amounted to 30, 60 and 100 ?g?kg-1 (group 1, 2 and 3, n = 10) and was infused before CPB was started. MAP, CVP, HR, ECG, SpO2, PETCO2 and naso-pharyngeal and rectal temperature were continuously monitored during operation. Blood samples were taken before anesthesia (T1 ,baseline) , before CPB (T2 ) , 30 min and 2 h after release of aortic cross-clamping (T3 , T4 ) and 24 h after operation (T5 ) for determination of plasma levels of TNF-?, IL-6, IL-10 and creatine kinase (CK) and CK-MB activity.Results The three groups were comparable with respect to age, body weight, aortic cross-clamping time, CPB time and duration of operation. The plasma levels of TNF-?, IL-6, IL-10, CK and CK-MB activities were significantly increased after CPB compared to baseline (T1) (P

Objective To investigate the protective effects of ulinastatin on myocardial reperfusion injury during cardiopulmonary bypass(CPB) in patients underwent valve replacement. Methods 26 ASA Ⅱ-Ⅲ patients scheduled for valve replacement were randomly divided into control group (group C) and ulinastatin group ( group W), each group containing 13 patients. In group W, the patients received ulinastatin 12000U?kg -1 , half dose of which was given before CPB, and the other half was added into the primary solution. Plasma levels of CK,CK-MB and cTnI were measured before operation(T 1), 20 min after starting CPB(T 2), 30 min after declamping aorta (T 3), and 4h(T 4) and 24h(T 5) after operation. Results The plasma level of CK, CK-MB and cTnI increased significantly at T 3, T 4 and T 5 in the both groups compared with T 1(P

Objective To investigate the protective effect of ulinastatin on erythrocyte in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) .Methods Twenty NYHA class Ⅱ-Ⅲ patients (10 male, 10 female) aged 16-66 yr undergoing elective valve replacement under CPB were randomly divided into two groups: ulinastatin group (U, n = 10) and control group (C, n = 10) . Patients with hepato-renal disease, hyperlipoproteinemia, respiratory dysfunction, blood diseases or pulmonary hypertension were excluded. The patients were premedicated with intramuscular morphine 0.08 mg ? kg-1 and scopolamine 0.006 mg?kg-1 . Anesthesia was induced with midazolam 0.1 mg?kg-1 , fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with intravenous midazolam and fentanyl. In group U the patients received ulinastatin 12000 U?kg-1 , of which half was given i.v. before CPB and the other half was added to the priming solution. In control group the patients received normal saline instead of ulinastatin. Blood samples were taken from radial artery before operation (T1), 15 min after initiation of CPB (T2), 15 min (T3) and 30 min (T4) after aortic declamping and 24 h after operation (T5) , for determination of plasma and erythrocyte MDA (P-MDA, E-MDA) levels and erythrocyte SOD (E-SOD) , Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase activities.Results The levels of P-MDA and E-MDA were significantly increased at T2_5 in group C but only at T3 and T4 in group U compared to the baseline at T1 . The levels of P-MDA and E-MDA at T2-5 were significantly higher in group C than in group U. The E-SOD, Na+ -K+ -ATPase and Ca2+ -Mg2+ -ATPase activities significantly increased at T2 compared to baseline at T1 , then gradually decreased in both groups. They were significantly higher at T3-5 in group U than in group C. Conclusion Ulinastatin can alleviate erythrocyte lipid peroxidation and protect erythrocyte during CPB.

Objective To investigate the role of Clara cells in lung ischemia-reperfusion (I/R) injury in rabbits.Methods Twenty-four healthy 10-12 month old rabbits of either sex weighing 1.5-2.0 kg were randomly divided into 3 groups ( n = 8 each) ; group A sham operation (group S) ; group B lung I/R and group C Clara cell elimination+ lung I/R. The animals were anesthetized with iv pentobarbital 30 mg/kg , tracheostomized and mechanically ventilated. In group B and C lung I/R was induced by clamping the left hilum of lung for 60 min followed by 120 min repeffusion. In group C Clara ceils were eliminated by ventilating the lungs with 89.28 mg/m2 naphthalin vapor for 12 h before lung I/R. The animals were killed by iv KCI at the end of 120 min reperfusion after lung isehemia. The left lung was immediately removed for microscopic examination, determination of W/D lung weight ratio and serum TNF-α level and MDA content. The percentage of neutrophi] in bronchoalveolar lavage fluid (BALF) was detected as index of lung injury. The expression of Clara cell secreting protein (CCSP) in the lung was detected by immuno-histoebemistry to indicate the number and distribution of Clara cells in the lung.Results Microscopic examination showed that there were severe leukocyte infiltration in alveolar spaces, alveolar edema and destroyed alveolar structure in group B and C. The serum TNF-u leve],W/D ratio and MDA content in the left lung and neutrophil percentage and WBC counts in BALF were significantly higher in group C than in group B. Conclusion Clara cells can protect the lungs against I/R injury through inhibiting inflammatory responses.

OBJECTIVE:To investigate the affordability of essential medicines in public health and medical institutions of Shanghai Qingpu district after the implementation of the national essential medicines,and provide the basis for subsequent formula-tion and improvement of relevant policies. METHODS:Based on the WHO/HAI standardized approach,a survey on the affordabili-ty of 30 essential medicines was conducted in public health and medical institutions of Shanghai Qingpu district in aspects of equip-ping staffing,drug availability and the relativity in different levels of public health and institutions for investigation and evaluation. RESULTS:The equipping rate of 30 essential medicines in Shanghai Qingpu District varied from 53.33%-86.67%,while the date of original drugs varied from 16.67%-53.33%,the equipping rate in secondary and tertiary hospitals was high. The availability of 30 essential medicines with Approved Drug Names in secondary and tertiary hospitals (77.78%) was generally higher than that in community health service center(63.00%),while the availability of original drugs was relatively low. The essential medicines with more than 50% relativity in community health service center and tertiary hospitals were only 6 kinds of drugs. CONCLUSIONS:The equipping rate and availability of essential medicines in primary health and medical institutions are lower than that of second-ary and tertiary hospitals in Qingpu district,as well as the relativity. It is suggested to further improve equipping policy for essential medicines from the relativity to improve match rate of production place;while further study and improvement for generic drugs from bioequivalence to improve its bioequivalence with original drugs and ensure clinical efficacy.

Objective To investigate the analgesic effect and adverse reactions of patient-controlled intravenous analgesia (PCIA) in breast cancer patients with radical mastectomy.Methods A total of 210 breast cancer patients who underwent radical mastectomy was randomly divided into two groups,experimental (group A) and control (group B) groups (n =105 cases per group).Patients in group A was used PCIA for 48 hours analgesia,while group B weas applied routine intramuscular injections of pethidine.Visual analogue score (VAS) at 4,8,12,24,and 48 hours after operation were recorded.Pulse,respiration,and blood pressure were monitored and side effects e.g.existed skin itching,nausea,vomiting,and respiratory repression were observed.Results The VAS of group A patients on 4,8,12,24,and 48 hours were2.02 ± 1.47,1.73 ± 1.38,1.68 ± 0.91,1.44 ± 0.65,and 1.21 ± 0.61,respectively;and the VAS of group B patients were 6.95 ± 1.96,6.42 ± 1.57,5.63 ± 1.66,4.99 ± 1.62,and 3.72 ± 1.46,respectively.The VAS was significantly lower in group A patients than in group B (P ＜ 0.05).The incidence of skin itching,nausea,vomiting,and respiratory repression was also distinctly decreased in group A than in group B (P ＜0.05).The overall satisfaction of patients in group A (96.2％) was remarkably higher than in group B (67.6％) (P ＜0.01).Conclusions Patient-controlled intravenous analgesia pump can more effectively alleviate the degree of pain,reduce the incidence of skin itching,nausea,vomiting and respiratory repression,improve the satisfactory degree for analgesia in breast cancer patients with radical mastectomy compared to traditional intramuscular way.

Objective To investigate the diagnostic correlation and sensitivity of amplitude integrated electroencephalogram (aEEG),brainstem auditory evoked potential (BAEP) and cranial magnetic resonance imaging (MRI) for acute bilirubin encephalopathy (ABE) in the newborn.Method Term and near-term neonates (gestational age ≥ 35 weeks) with hyperbilirubinemia (the level of bilirubin over than 95th percentile) of high and intermediate risk group admitted in the neonatal ward of Guangxi Maternal and Child Health Care Hospital from Jan 2014 to Dec 2015 were recruited retrospectively.The infants were assigned to ABE group and non-ABE group according to the diagnostic criteria of ABE.The clinical data of the newborns were collected and the diagnostic correlation between clinical diagnosis and aEEG,BAEP and cranial MRI were analyzed.The receiver operating characteristic (ROC) curve was adopted to assess the diagnostic efficiency of the peak level of serum bilirubin,aEEG,BAEP and cranial MRI on the early diagnosis of ABE.Result A total of 152 newborns with hyperbilirubinemia were recruited,including 33 cases in the ABE group and 119 cases in non-ABE group.(1) The results of aEEG and MRI were marginally positively correlated with clinical diagnosis of ABE (aEEG:r =0.487,P ＜ 0.001;MRI:r =0.220,P=0.018),while the results of BAEP were closely related to the clinical diagnosis of ABE (r =0.593,P ＜ 0.001);(2) The results of BAEP and MRI on the diagnosis of ABE were positively correlated with those of aEEG (BAEP:r =0.424,P ＜ 0.001;MRI:r =0.307,P ＜ 0.001).(3) The area under the ROC curves for predicting the onset of ABE were 0.899 for the peak level of serum bilirubin,0.767 for BAEP,0.738 for aEEG and 0.590 for MRI.Conclusion There was the correlation on the diagnosis of ABE among the methods of aEEG,BAEP and MRI.The combined diagnosis of the three methods could play a complementary role.The aEEG contributed to the early diagnosis of ABE with high sensitivity.

OBJECTIVE: To evaluate whether dexmedetomidine hydrochloride, an α2-adrenergic receptor agonist, can prevent oxidative damage to alveolar macrophages induced by H2O2. METHODS: We used methyl thiazolyl tetrazolium (MTT) colorimetry to test the effect of different concentrations and action time of H2O2 on the survival rate of alveolar macrophages, and then we chose the appropriate H2O2 concentration and action time to build NR8383 cell oxidative damage model. After pre-conditioning of 0.01, 0.10, and 1.00 μmol/L dexmedetomidine hydrochloride for 24 hours, MTT colorimetry was used to demonstrate the survival rate of NR8383 cells damaged by H2O2, and the release of lactate dehydrogenase (LDH) and TNF-α by H2O2-damaged NR8383 cells was detected by corresponding kit. RESULTS: At 50-300 μmol/L, H2O2 caused concentration-dependent oxidative damage in the alveolar macrophages, decreased the cell survival rate, and increased LDH and TNF-α release. At 0.01-1.00 μmol/L dexmedetomidine hydrochloride concentration-dependently protected NR8383 cells from oxidative damage induced by H2O2, significantly increased the cell survival rate, decreased LDH and TNF-α release, and this effect of dexmedetomidine hydrochloride was dose-dependent. Yohimbine, an α2 - adrenergic receptor antagonist, completely neutralized the protective effect of dexmedetomidine hydrochloride on NR8383 cells without affecting the oxidative damage of NR8383 cells. CONCLUSION Dexmedetomidine hydrochloride can prevent alveolar macrophages from oxidative damage induced by H2O2, which may play a protective role through α2 - adrenergic receptors.
Animals ; Cell Line ; Cell Survival ; Dexmedetomidine ; pharmacology ; Hydrogen Peroxide ; L-Lactate Dehydrogenase ; metabolism ; Macrophages, Alveolar ; drug effects ; Oxidative Stress ; Rats ; Receptors, Adrenergic, alpha-2 ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

Objective:To verify the revised method of cerium sulfate catalytic spectrophotometry for iodide index of "Standard Examination Methods for Drinking Water-Nonmetal Parameters" (GB/T 5750.5-2006).Methods:From July to September 2019, the Laboratory of Department for Endemic Disease Prevention and Control of Qinghai Institute for Disease Prevention and Control verified the revised method (determination of iodide in drinking water by cerium sulfate catalytic spectrophotometry) of cerium sulfate catalytic spectrophotometry (hereinafter referred to as original method) in "Standard Examination Methods for Drinking Water-Nonmetal Parameters" (GB/T 5750.5-2006). The revised method was verified according to the requirements of "Standard Examination Methods for Drinking Water-Water Analysis Quality Control" (GB/T 5750.3-2006), including standard curve, detection limit, precision, accuracy and actual sample determination.Results:The linear range of the revised method was 0 - 20.0 μg/L, the correlation coefficient was - 0.999 4 - 0.999 8, and the detection limit was 0.231 μg/L. The relative standard deviation ( RSD) of low, medium and high iodine water samples of 6 times detection ranged from 1.4% to 9.6%, and the recoveries of low and medium water samples ranged from 89.0% to 108.0%. The detection results of national first-class reference materials for iodine composition analysis in water were within the range of standard value ± uncertainty. There was no significant difference in the test of results of 12 tap water samples between the revised method and the original standard method ( t = - 0.075, P > 0.05). Conclusion:The revised method has a good linear relationship of standard curve, high precision and accuracy, and good reproducibility, is simple and easy to operate, and is suitable for promotion and application.