Objective To evaluate the efficacy of ketamine in preventing postpartum depression in patients undergoing cesarean section.Methods One hundred and twenty ASA physical status Ⅰ patieuts,aged 18-38 yr,with body mass index ＜35 kg/m2,scheduled for elective cesarean section,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ketamine group (group K).Postoperative analgesia was performed with sufentanil 100 μg in 100 ml of normal saline,and sufentanil was infused at 2 ml/h (bolus dose 5 μg,lockout interval 15 min) in both groups.In group K,ketamine 4 mg/kg was added to analgesic pump.VAS score was maintained＜3.Before surgery and at 1,3,5 and 42 days after surgery,depressive symptoms were measured using the Edinburgh Postpartum Depression Survey (EPDS),and postpartum depression was defined as EPDS score ≥ 13.Postpartum depression and ketamine-related complications occurred within 3 days after surgery in group K were recorded.Results Compared with group C,EPDS scores were significantly decreased at 1,3 and 5 days after surgery,and the incidence of postpartum depression was decreased in group K.Ketamine-related complications were not found in group K.Conclusion Ketamine (infused starting from the end of operation,lasting for 48 h,total amount 4 mg/kg) for postoperative analgesia can prevent postpartum depression to some extent in patients undergoing cesarean section.

Objectives To investigate the effect of electric vagal stimulation on the gene expression of injured myocardium from ischemia/reperfusion rat model and explore the involved molecular mechanism.Methods Twenty Sprague Dawley male rats were randomly selected and divided into 2 groups evenly:ischemia/reperfusion group (I/R group),and vagus nerve stimulation group (STM group).The left anterior descending coronary artery (LAD) was ligated and subjected to 30 min of myocardial ischemia followed by 2 h of reperfusion.In addition,10 min before reperfusion,left cervical vagus nerve of STM group was subjected to electronic stimulation at 5 V,2 ms and 1 Hz for 20 min.After 120 min of reperfusion,every group was randomly divided into two parts.One part that myocardium was collected from left ventricle was applied to determine the area of myocardial infarction.The RNA isolated from another part of the ischemic myocardium collected from left ventricle was hybridized to get gene expression profiles and the quality of hybridized RNA from both I/R and STM group was assessed and analyzed.GeneSpring software was applied to screen out the genes,which show significant difference between groups I/R and STM.Real-time polymerase chain reaction (RT-PCR) was applied to analyze the expression of important genes.Results (1)The area of myocardial infarction of STM (25.5 ± 3.9) ％ was significant reduced relative to L/R group (45.5 ± 4.8) ％ (P ＜ 0.05).(2)The expression levels of 186 genes were changed significantly,and analyzed by Gene ontology (GO) software,there were 3 kinds of genes were affected.The upregulated genes were reported to show protective effect on myocardium.The downregulated gene was relative to inflammation.(3)The RT-PCR result confirmed the genechip assay.Conclusions Electric vagal stimulation can reduce myocardial I/R injury in rats.Significant change of the gene expression was detected between groups I/R and STM.The results suggest that activation of cholinergic anti-inflammatory pathway be involved in the mechanism.

Objective To evaluate the effect of electric vagal stimulation on myocardial ischemia-reperfu-sion (I/R) injury in rats.Methods Forty-five male Sprague-Dawley rats,aged 4-5 months,weighing 180-220 g,were randomly divided into 3 groups (n =15 each):sham operation group (S group),I/R group,electric vagal stimulation group (EVS group).Myocardial I/R was induced by occlusion of left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion in I/R and EVS groups.In group EVS,the left cervical vagus nerve trank was stimulated for 30 min with continuous electric pulses (5 V,2 ms,10 Hz) starting from 10 min before reperfusion until 10 min of reperfusion.The animals were sacrificed at the end of 120 min reperfusion and the hearts were removed for determination of the infarct size,TNF-α and IL-6 contents and myeloperoxidase (MPO) activity in myocardial tissues.Results Compared with group S,the infarct size was significantly enlarged,and TNF-α and IL-6 contents and MPO activity were increased in I/R and EVS groups (P ＜ 0.05).The infarct size was significantly smaller,TNF-α and IL-6 contents and MPO activity were lower in EVS group than in I/R group (P ＜ 0.05).Conclusion Electric vagal stimulation can reduce myocardial I/R injury in rats and activation of cholinergic anti-inflammatory pathway is involved in the mechanism.

Hemophagocytic lymphohistiocytosis (HLH)is a severe syndrome characterised by fever,splenomegaly,cytopenia,hyperferritinemia,hypertriglyceridemia and hypofibrinogennemia.HLH includes primary and secondary HLH.Secondary HLH can be encountered in.association with a variety of underlying condtions.Infectious triggers are most commonly due to viral infections,especially EBV infection.This review mainly introduces clinical characteration of several viral infections associated HLH.

Objective To investigate the effect of nicardipine on perioperative insulin sensitivity in patients with essential hypertension(EH). Methods Thirty-eight patients undergoing lobectomy continuously after induction of anesthesia in group N, while normal saline was infused in group C instead of nicardipine. Blood samples were taken immediately before induction of anesthesia(T_0), 2 h after skin incision(T_1) ,4 h after surgery(T_2) and 24 h after surgery(T_3). Blood glucose(BG) and plasma insulin (Ins) were measured. The Insulin sensitivity index (ISI) was calculated. Results Values of BG at T_2and T_3 in group C were higher than those at T_0 (P<0. 05). Value of Ins at T_2 in group C was higher than that at T_0 (P<0. 05),which at T_3 in group C was significantly higher than that at T_0 (P<0. 01). ISI at T_2 in group C was lower than that at T_0 (P<0. 05) ,which at T_3 in group C was lower significantly than that at T_0 (P<0. 01). Values of BG and Ins at T_3 in group N were higher than those at T_0 (P<0. 05), ISI at T_3 in group N was lower than that at T_0 (P<0. 05). Value of BG at T_2 was significantly lower in group N than that in group C(P<0. 05). Value of Ins at T_3 was significantly lower in group N than that in group C(P<0. 01). ISI at T_2 and T_3 in group N was min~(-1) infused continuously during and after lobectomy can increase significantly insulin sensitivity and improve postopertive insulin resistance state in EH patients.

Objective To evaluate the efficacy of Shikani laryngoscope-guided nasotracheal intubation in patients undergoing maxillofacial surgery. Methods One hundred ASA Ⅰ or Ⅱ patients with body mass index ＜25 kg/m2 , aged 18-64 yr, undergoing maxillofacial surgery under general anesthesia requiring nasotracheal intubation were included in this study. Fifty patients without anticipated difficult airway in preoperative assessment were randomly divided into 2 groups ( n = 25 each): Macintosh luyngoscope group ( group M ) and Shikani Optical Stylet (SOS) group (group S1 ). The other 50 patients with mouth opening ＜ 3 cm but without difficult ventilation by mask were randomly divided into 2 groups ( n = 25 each): fiberoptic bronchoscope group (group F) and SOS group (group S2 ). Tracheal intubation was performed under the guidance of laryngoscopes after induction of anesthesia, and then the patients were mechanically ventilated. The degree of glottis exposure and epistaxis was evaluated. The rate of successful intubation, rate of successful intubation at first attempt, intubation time and complications were recorded. Results Compared with group M, the rate of successful intubation, rate of successful intubation at first attempt, and degree of glottis exposure were significantly increased, the intubation time was significantly shortened, and the degree of epistaxis was significantly decreased ( P ＜ 0.05), but no significant change was found in the complications in group S1 ( P ＞ 0.05). Compared with group F, the intubation time was significantly shortened ( P ＜ 0.05), but no significant change was found in the rate of successful intubation, rate of successful intubation at first attempt and complications in group S2 ( P ＞ 0.05). Conclusion Shikani laryngoscope can expose glottis better and the rate of successful intubation at first attempt is higher, thus it is more suitable for nasotracheal intubation in patients undergoing maxillofacial surgery.

Objective To compare fentanyl and sufentanil in total intravenous anesthesia for liver resection. Methods 100 patients undergoing liver resection were randomly received either sufentanil (group S, n = 50) anesthesia or fentanyl (group C, n = 50). Hemodynamic variables, time to spontaneous eye opening and extubation were recorded. VAS-scale was used to assess postoperative pain. The incidence of nausea & vomiting, agitation and respiratory depression was recorded and compared. Results Patients in group S had a more stable hemodynamic variables, and the incidence of postoperative pain (VAS: group S 4. 2± 1.1, group C 6. 1 ± 1.2), agitation (group S 2 cases, group C 11 cases) and respiratory depression (group S 1 case, group C 5 cases)was lower. Conclusions Both sufentanil and fentanyl were safe and efficacious in total intravenous anesthesia for liver resection. Compared with fentanyl, Sufentanil had higher hemodynamic stability, and lower incidence of postoperative pain, respiratory depression and agitation.

Objective To study the effects of ulinastatin on proinflammatory cytokine and oxygen free radicals during acute lung injury in rabbits. Methods Eighteen health New Zealand rabbits were randomly divided into 2 groups: oleic acid group(n=9) and ulinastatin group(n=9). The rabbits of oleic acid group were intravenously injected analytical pure oleic acid(0.12ml/kg) to set up a model of acute lung injury. The rabbits of ulinastatin group were intravenously injected ulinastatin 50000u/kg before injecting oleic acid and received intravenous infusion of ulinastatin 5000u?kg -1 ?h -1 after injecting oleic acid. Before injecting oleic acid and 1h, 2h, 3h and 4h after injecting oleic acid,venous blood samples were taken to determine the concentration of plasma IL-8, MDA and active oxygen,and arterial blood samples were also taken for gas analysis. Results The concentration of IL-8, MDA and active oxygen and PaCO 2 gradually increased,and PaO 2 gradually decreased after injecting oleic acid in the both groups of rabbits. The changes of the above indices in the oleic acid group were larger than those in the ulinastatin group, and the difference between the two groups was significant. Conclusion Ulinastatin inhibited the release of proinflammatory cytokine and reduced the production of oxygen free radicals during acute lung injury.

Objective It has been shown that ketamine can effectively suppress expression of cell adhesion molecules in vitro. The purpose of this study was to investigate the effect of ketamine on plasma adhesion molecules in vivo during cardiac valve replacement.Methods Twenty ASA Ⅲ-Ⅳ patients (7 males, 13 females) aged 23-65 yrs, weighing 31-77 kg undergoing cardiac valve replacement were randomly divided into two groups of 10 patients each : ketamine group received ketamine 2 mg?kg-1 i.v. before induction of anesthesia and at the start of CPB and control group received normal saline instead of ketamine. Blood samples were taken from radial artery for determination of plasma P-selectin, L-selectin, ICAM-1, IL-6 and cTnI concentrations before induction of anesthesia (T0 ,baseline) , 20 min after initiation of CPB (T1) , 30 min after aortic declamping (T2) 4 h and 24 h after CPB (T3, T4) . Results There was no significant difference between the two groups in age, weight, operation time, CPB time and aortic cross-clamping time. The concentrations of P-selectin, L-selectin, ICAM-1 and IL-6 at T1-4 and cTnI at T2-4 increased significantly compared to baseline (T0) in both groups ( P

Objective To investigate the effects of pretreatment with volatile anesthetics on myocardial apoptosis induced by myocardial ischemia-reperfusion. Methods Forty-eight healthy New Zealand white rabbits of both sexes weighing 3.2-3.5kg were anesthetized with intramuscular ketamine 70mg?kg-1. The animals were tracheotomized and intubated and mechanically ventilated. PaCO2 was maintained at 4-4.5kPa. Sternum was longitudinally splitted. Left anterior descending branch of coronary artery was exposed and mobilized and a fine rubber tube was placed around it for occlusion of the artery. The occlusion of the artery was confirmed by cynosis of the area of myocardium involved and ECG which showed elevation of S-T segment. The animals were randomly allocated to one of 6 groups of 8 animals in each group: sham-operation group (P) ; ischemia / preconditioning group (IP) ; and three groups pretreated with isoflurane (I), sevoflurane (S) and desflurane (D) . Each group except group P was subjected to 3h occlusion of left anterior descending artery followed by 3h reperfusion. Group I, S and D were pretreated with inhalation of 1.1% isoflurane, 2% sevoflurane or 6% desflurane for 30 min followed by 15 min washout. The heart was then removed after ischemia-reperfusion. Infarct size and ischemic area were determined by dual staining with triphenyltetrazolium chloride and Evan' s blue. DNA laddering in the border zone of myocardial ischemic area was revealed by agarose gel electrophoresis. Apoptosis index (A I ) was obtained by flow cytometry. Results The infarct size, expressed as the percentage of the ischemic area was (60.8?10.8)% in ischemia-reperfusion group and was greatly reduced in group IP (33.1 ?4.9)%, group I (39.0?5.9)%, group S (30.9 ?6.8)% and group D (32.2? 7.5)% (P