Objective The effect of the emulsion in which propofol is formulated on blood coagulation is still controversial. The aim of this study was to investigate the effect of intravenous propofol infusion on platelet aggregation and blood coagulation.Methods Forty-one ASA I or II patients of both sexes (22 male, 19 female) aged 24-56 yr weighing 46-75 kg scheduled for elective upper abdominal surgery were enrolled in this study. The patients were premedicated with intramuscular atropine 0.5 mg and phenobarbital 0.1 g. Anesthesia was induced with fentanyl 4 ?g?kg-1 , and propofol 2 mg?kg-1 . Tracheal intubation was facilitated with vecuronium 0.15 mg? kg-1 . The patients were mechanically ventilated (VT 8-12 ml?kg-1 , RR 12 bpm). Anesthesia was maintained with TCI of propofol and intermittent IV boluses of fentanyl and vecuronium. Propofol was infused with a TCI system ' Diprifusor' . The target effect site concentration was set at 4 ?g ? ml-1 . Platelet aggregation and intracellular calcium ion concentration [Ca2+ ]i were measured and thromb-elastography (TEG) and coagulation function tests (APTT, TT, PT, FIB) were performed before induction (T0, baseline), at 30, 60, and 120 rain after induction (T1 , T2 , T3) . Results (1) The maximum platelet aggregation rate was significantly decreased at T1,3 as compared to the baseline (T0) ( P

Nuclear factor-E2-related factor 2(Nrf2)is a member of C′n′C transcription factor family.It is an important transcrip-tion factor for regulation of cellular redox status and can be seen in all kinds of tissues .Recent studies have demonstrated that rapid deg-radation of Nrf2 after gene-induced antioxidative stress is as important as transcription and activation of Nrf 2 and the nuclear export of Nrf2 is a prerequisite for rapid degradation of Nrf2 in the cytosol.This review focuses on the mechanism of nuclear export of Nrf 2.

0.05) but the score after training was higher than before(P

ObjectiveTo investigate the changes in the expression of transforming growth factor beta-1 (TGF-β1) during differentiation of pulmonary microvascular endothelial ceils (PMVECs) into smooth muscle cells in rats with hepato-pulmonary syndrome (HPS).MethodsPrimary PMVECs were harvested from healthy adult SD rats of both sexes aged 3-4 months and inoculated in low-glucose DMEM culture medium (1(6/cm2 ) and randomly divided into 2 groups ( n =24 dishes each):control group ( group C) and HPS group.HPS was produced by chronic ligation of common bile duct.In group C serum obtained from normal rats was added to PMVECs,while in HPS group serum obtained from rats with HPS was added.The final concentration of serum was 10％.After being incubated for 24,48 and 72 h,the expression of SM-MHC,SM-α-actin and calponin protein and TGF-β1 mRNA and protein in PMVECs was determined by RT-PCR and Western blot analysis.ResultsThe expression of SMMHC,SM-α-actin and calponin protein.was positive in HPS group whereas the expression of SM-α-actin and calponin protein was negative and the expression of SM-MHC protein was barely detectable in group C.The expression of SM-MHC,TGF-β1 mRNA and protein was significantly higher in HPS group than in group C.The expression of SM-MHC,SM-α-actin and calponin protein and TGF-β1 mRNA and protein was increasing with duration of incubation from T1 to T3 in group HPS.ConclusionTGF-β1 plays an important role in the myogenic differentiation of PMVECs in rats with HPS.

Objective To investigate the effect of the serum obtained from rat with hepatopuimonary syndrome (HPS) on Akt mRNA and protein expression in rat pulmonary microvascular endotheliai cells (PMVECs) and the role of Akt signaling pathway in the proliferation of PMVECs in the HPS. Methods Healthy 3-4-month-old SD rats of both sexes were used in this study. HPS was produced by chronic ligation of common bile duct according to the method described by Fallon. liver cirrhosis and pulmonary microvascular proliferation were verified by microscopic examination of the liver and lung tissue 2 weeks after bile duct ligation. Serum was obtained from blood taken from aorta of HPS rats. Primary PMVECs were cultured and randomly divided into 2 groups: control group and HPS group. In HPS group serum was added to cultured PMVECs (final concentration was 10%) and incubated. Akt mRNA and protein expression was determined at 24, 48 and 72 h of incubation by RT-PCR and Western blot. The proliferation of PMVECs was detected by MTT and ~3H-TdR. Results The proliferation of PMVECs was significantly enhanced and the expression of Akt mRNA and protein was significantly increased in HPS group as compared with control group. Conclusion The Akt signaling pathway might play an important role in proliferation of PMVECs in the HPS.

High fidelity human patient simulator has become more and more important in clinical medical practice education.Medical circle has more and more realized that non-technical skill (NTS) is closely associated with the improvement of medical quality.This paper attempted to carry out a preliminary discussion on theory and practice of applying NTS in simulation training of critical care medicine based on their own teaching experiences.

Objective To investigate the influence of combined spinal-epidural anesthesia and general anesthesia on short-term cogni-tive function of elderly patients with lacunar infarction after surgery.Methods A total of 50 patients with lacunar infarction who underwent abdominal surgery in our hospital from June 2012 to December 2013 were selected as the research object,who were divided into spinal-epi-dural anesthesia group (combined group)and general anesthesia group (general group).The incidence of postoperative cognitive dysfunction of two groups were observed and compared.The mini-mental state examination(MMSE)and Montreal cognitive Assessment(MoCA)were used to evaluated the cognitive function before and postoperative 1 day.Results The probability of postoperative cognitive dysfunction (POCD)of combined group and the general group were 12% and 32%,respectively,and the POCD probability of combined group was lower than that of general group,the difference was significant(P <0.05).The MMSE score and MoCA score at postoperative 1 day of two groups were lower than those before anesthesia,the difference was significant(P <0.05).The MMSE score and MoCA score of combined group at postoperative 1 day were lower than that of general group,the difference was significant(P <0.05).Conclusion The anesthesia can cause a certain cognitive dysfunction for elderly patients with lacunar infarction,while the spinal-epidural anesthesia can reduce the incidence rate of POCD compared anesthesia.

Objective To observe the effect of dexmedetomidine on plasma SDF-1 level in in hepatic portal occlusion operation.Methods Fifty patients with live cancer undergoing elective partial hepatectomy were selected,no gender limitation,aged 42 to 71,body mass index(BMI) 18.5 ～ 26.0 kg/m2,ASA grade Ⅱ or Ⅲ.The patients were randomly divided into 2 groups(n=25):control group and dexmedetomidine group.The dexmedetomidine group was performed the pump injection of dexmedetomidine 1 μg/kg at 15 min before induction of anesthesia.After induction the rate was changed to 0.4μg · kg-1 · h-1 until 15 min before the end of operation;the control group adopted the same method for conducting continuous intraverous infusion of the same capaci ty of 0.9％ sodium chloride.The peripheral venous blood was collected in 2 groups at preoperative 1 h (T0),postoperative 1 h (T1),postoperative 1 d (T2),postoperative 3 d(T3).The plasma SDF-1 level was detected by using enzyme-linked immunosorbent assay(ELISA).Results There was no statistically significant difference in liver resection range,blood loss,first porta hepatis vessel occlusion time,anesthesia time and plasma SDF-1 level before surgery between the two groups (P＞0.05).Compared with pre-operation,plasma SDF-11evel at T1,T2,T3 time point was significantly increased (P＜0.05).The plasma SDF-1 level at T1,T2,T3 time point in the dexmedetomidine group was lower than that in the control group(P＜0.05).Conclusion SDF-1 expression is significantly increased during perioperative period in the patients with hepatic portal occlusion operation,and intraoperative continuous dexmedetomidine can significantly reduce the SDF-1 level,which inhibits the chemotaxis and accumulation of inflammatory ceils to some extent.

Objective To investigate the effect of dexmedetomidine on awareness during intraoperative Wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia .Methods 36 patients ,requiring intraoperative arousal test during posterior spinal surgery were randomly divided into the group D (DEX ,n= 18) and C (NS ,n= 18) .DEX 1 μg/kg followed by 0 .2 μg · kg -1 · h-1 and equal volume NS were infused respectively 10 min before anesthesia induction and maintenance of anesthe-sia in two groups .Hemodynamic parameters were monitored 5 min(T1) before anesthesia induction ,3 min(T2)after anesthesia in-duction ,at the beginning of wake-up test(T3) ,at the end of the test(T4) and 5 min(T5) after deepen anesthesia respectively . Meanwhile the wake-up time ,success rate of arousal ,incidence agitation and the dosage of nitroglycerin during wake-up were also recorded .Results Successive rate of arousal awakening time between two group had no statistically significance (P>0 .05) .less in-cidence of agitation was found in group D compared with group C ,the dosage of nitroglycerin used during wake-up in group D was less than that in group C(P<0 .05) .Conclusion Dexmedetomidine auxiliary propofol remifentanil anesthesia can effectively implement intraoperative wake up ,during the awakening the hemodynamic was more smoothly ,and it has lower incidence of adverse events .

Objective To investigate the clinical value of aprotinin blood anesthesia in the radical excision of esophageal carcinoma. Methods A total of 90 patients with esophageal carcinoma undergoing radical excision were divided into two groups according to using aprotinin or not. Patients in experiment group (group A, 40 patients) were injected with 1 112 EPU aprotinin followed by constant pumped infusion of 278 EPU/h until 2 h after operation. Patients in the control group (group B, 50 patients) were treated with constant pumped infusion of 0.9% saline. The venous blood was collected for blood routine examination, thromboelastography(TEG) and normal coagulable function test at the following time points: before induction, at 2 h and 4 h after the beginning of operation, at the end of operation and at 12 h after operation. The changes of TEG and normal coagulable state were monitored during the whole surgical process. The intraoperative volume of hemorrhage, perioperative transfusion rate and average volume of transfusion in the two groups were compared. Results The preoperative coagulable state in experiment group was kept relatively stable during the operation. Volume of intraoperative hemorrhage, perioperative transfusion rate and average volume of blood transfusion in experiment group were significantly lower than those in the control group. Conclusion Aprotinin blood anesthesia can stabilize the coagulable state, reduce the volumes and rates of hemorrhage and transfusion, and hence can find wide application in the radical excision of esophageal carcinoma.