Objective To compare the effect of different methods of anesthesia on cerebral autoregulation in patients undergoing neurosurgery.Methods Sixty-nine ASA Ⅱ orⅢ patients with brain tumor, aged 23-62 yr, scheduled for neurosurgery under general anesthesia, were randomly divided into 3 groups ( n = 23 each) : propofol-remifentanil group (group PR), sevoflurane-remifentanil group (group SR) and propofol-sevoflurane-remifentanil group (group PSR) . Anesthesia was induced with target-controlled infusion (TCI) of propofol (target plasma concentration3 μg/ml, PR and PSR groups) or inhalation of 8% sevoflurane (group SR) and iv injection of remifentanil 1 mg/kg and atracurium 0.5 mg/kg. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 32-35 mm Hg. Anesthesia was maintained with TCI of propofol (target plasma concentration 2.0-3.5 μg/ml) in group PR, with inhalation of 1.5%-2.5% sevoflurane in group SR, with TCI of propofol (target plasma concentration 1.5-3.0 μg/ml) and inhalation of 1% sevoflurane in group PSR, and with TCI of remifentanil (target plasma concentration 2.0-4.5 ng/ml) and iv infusion of atracurium at 6 μg · kg-1 · min-1 in all groups. Auditory evoked potential index was maintained between 40-45. The middle cerebral artery time-average peak flow velocity was recorded before induction (baseline) , immediately after intubation, immediately before craniotomy and at the beginning of skin suture. The unilateral carotid artery was compressed for 7 s at the corresponding time points mentioned above. The transient hyperemic response ratio (THRR) was calculated to reflect cerebral autoregulation. Results Compared with the baseline value at T0, THRR was significantly increased at T2in group PR and decreased at T2,3 in group SR (P <0.05) ,while no significant change was found in THRR at T1-3in group PSR (P >0.05). The THRR was significantly lower in SR and PSR groups than in group PR, and higher in group PSR than in group SR ( P < 0.05). Conclusion Propofol-remifentanil anesthesia can improve cerebral autoregulation, sevoflurane-remifentanil anesthesia can reduce cerebral autoregulation, and propofol-sevofluraneremifentanil anesthesia exerts no effect on cerebral autoregulation in patients undergoing neurosurgery.

Objective To study the changes in the expression of GABA and its receptors in the dorsal horn of rat spinal cord induced by hind paw formalin injection. Methods Twelve healthy male SD rats weighing 300-325 g were randomly divided into two groups: (A) control group (n=6) and (B) peripheral inflammatory hyperalgesia group in which 5% formalin 50?l was injected subcutaneously into the plantar region of right hind paw to produce persistent pain(n=6). The animals were killed 24h after formalin injection. L_(4-6) segment of the spinal cord was removed. The number of GABA immuno-reactive cells was examined by immuno-cytochemistry technique and the exprpession of GABA_(A?3) and GABA_(B1) receptor mRNA in the spinal dorsal horn were determined by in situ hybridization. Results In control group(A), GABA immuno-reactive cells and GABA_(A?3) and GABA_(B1) receptor mRNA were observed throughout the lumbar spinal dorsal horn. The density of GABA immuno-reactive cells and GABA_(B1) receptor mRNA was highest in the superficial laminae Ⅰ-Ⅲ; while the GABA_(A?3) receptor mRNA was evenly distributed in the spinal dorsal horn. In group B, 24h after formalin injection there was a significant increase in the GABA immuno-reactive cells in the ipsilateral spinal dorsal horn. The expression of GABA_(A?3) and GABA_(B1) receptor mRNA were significantly increased in bilateral dorsal horn compared to group A. The three parameters were positively correlated and their locations in the spinal dorsal horn were not significantly different from those in group A. Conchusion GABA and its receptors may play an important role in nociceptive modulation.

Objective: To investigate the effect of different concentrations of dextrose transfusion on cerebral glucose metabolism in pediatric neurosurgical operations. Methods: Sixty anesthetized children undergoing selective cerebral tumor resection were randomly divided into three groups: Ringer lactate solution group (A, n = 20), 2.5% dextrose lactated Ringer's solution group(B, n = 20), 1% dextrose lactated Ringer's solution group (C, n = 20). All the hemodynamic data were recorded during anesthesia. The values of blood glucose and lactic acid were collected before intubation(T_a), 2 hours after opening cerebral dura mater (T_b) and the end of operation (T_c). The catheters for microdialysis were punctured into normal brain tissue. The contents of glucose and lactic acid were determined in the collected intercellular fluid by biochemical analysis instruments at T_A and T_B respectively. Results: There were no differences in heart rate(HR), mean arterial pressure(MAP) and arterial oxygen saturation (SpO_2) among three groups(P > 0.05). There were no differences in blood glucose at T_a between three groups(P > 0.05). The values of blood glucose at T_b and T_c were B group＞C group＞A group(P < 0.05). The values of blood glucose were higher at T_b and T_c than that of T_a in three groups(P < 0.05). There were no differences in blood lactic acid among three groups(P > 0.05). There were no significant differences in values of glucose and lactic acid in the collected intercellular fluid among three groups(P > 0.05). Conclusion: Transfusion of Ringer lactate solution or low concentration dextrose solution will increase blood glucose in pediatric neurosurgical operations, but still in the normal range, which has a little influence on blood lactic acid, glucose and lactic acid in brain intercellular fluid. It is a safe choice during neurosurgical operation.

Adult ; Humans ; Male ; Occupational Health Services ; Physical Examination

OBJECTIVE: To review the progress on cell-penetrating peptides(CPPs). METHODS: Based on the original researches in recent years, the structure properties, classification, internalization mechanism, application and novel research orientation of CPPs were introduced in the present paper. RESULTS: Cell-penetrating peptides(CPPs) consisted of 30 or less amino acids. CPPs, generally categorized as amphipathic or cationic depending on their sequences, are increasingly drawing attention as a non-invasive delivery technology for macromolecules. Delivery of a diverse set of cargoes has been attempted using different types of CPPs in vitroand in vivo. Additionally, the relative lack of toxicity and cell specificity has enabled its widespread use in preclinical models. This paper reviewed the studies on the structure properties, classification, internalization mechanism, application and novel research orientation of CPPs. CONCLUSION: Although the internalization mechanism of CPPs will be studied deeply, CPPs, as a novel drug delivery tool, has promising application for the delivery of diverse drugs and cargoes.

Objective To compare the effects of sedation induced with propofol and midazolam on anterior pituitary hormone in mechanically ventilated patients with traumatic brain injury.Methods Eighty-four patients with acute traumatic brain injury,aged 20-60 yr,weighing 50-70 kg,undergoing mechanical ventilation during sedation induced with propofol or midazolam,were randomly divided into 2 groups ( n =42 each):propofol group (group P) and midasolam group (group M).Ramsay sedation score was maintained at 2-4.In group P,propofol was continuously infused at the initial infusion rate of 1.5-6.0 mg·kg-1 ·h-1 and propofol 50 mg was injected intravenously to increase the depth of sedation when needed.In group M,midazolam was continuously infused at the initial infusion rate of 0.10-0.35 mg· kg-1· h-1 and midazolam 7.5 mg was injected intravenously to increase the depth of sedation when needed.The patients were ventilated for 70-120 h.Glasgow Coma Scale scores were assessed before sedation and Glasgow Outcome Scale scores were assessed 4 weeks after admission to the intensive care unit.Venous blood samples were collected at 24 and 72 h of sedation and 4 weeks after admission to the intensive care unit for determination of the levels of serum cortisol,thyroid-stimulating hormone,prolactin,and growth hormone by ELLSA.Results Compared with group M,the levels of serum cortisol and growth hormone were significantly decreased and the level of thyroid-stimulating hormone was significantly increased at 24 and 72 h of sedation in group P ( P ＜ 0.05 or 0.01 ),and the parameters mentioned above were in the normal range.There was no significant difference in the serum prolactin level and outcome between the two groups (P ＞ 0.05).Conclusion The effects of sedation induced with propofol and midazolam on anterior pituitary hormone are comparable in mechanically ventilated patients with traumatic brain injury.

Early diagnosis of hepatocellular carcinoma(HCC)is still a great challenge in clinical practice.Tumor markers such as alpha-fetoprotein(AFP),liver enzymes,cytokines,and some special glycoproteins,though helpful,are not sensitive and specific enough for early diagnosis of HCC.The establishment of several interesting predictive diagnostic models on liver fi- brosis/cirrhosis suggests that mathematic predictive model,which is developed based on large sample size and follow-up study, might be of higher sensitivity,specificity and feasibility in clinical application.Here we suggest that more attention should be paid to this kind of multi-parameter predictive diagnostic models clinically,so as to improve the early diagnosis of HCC in a more economical and feasible way.

Complement system is an important constituent in immune system.Membrane attack complex (C5b-9)is the final ingredient in the complement activation.Recently,a few studies showed that C5b-9 deposition was found in the diabetics with chronic complications,indicating that complement activation might be involved in the pathogenesis of diabetic complications.Our aim is to summarize some newly published works and show a prelimimary work we did in this area.We hope that more attention should be paid to the role of autoimmune mechanism in diabetic complications.

Tumor cells obtain energy mainly by glycolysis to maintain growth and proliferation. It is related to the DNA mutations of mitochondria and anti-oncogene mutations. Inhibition of glycolysis can inhibit proliferation and kill tumor cells. The rate-limiting enzyme of glycolysis and hypoxia inducible factor may be the new targets for cancer therapy.

ObjectiveTo assess the degree of pain in elderly patients with mechanical ventilation in ICU using critical-care pain observation tool(CPOT) and to choose the correct sedative and analgesic method.Methods 110 elderly patients in ICU after neurosurgery were divided into three assessment stages,every stage had two record points and total six points (T1-T6):the first stage (intubation and unconsciousness,T1-T2),the second stage (intubation and consciousness,T3T4 ) and the third stage(extubation and consciousness,T5-T6 ).Among them T1,T3and T5were nonnocuity assessment points of every stage,while T2,T4 and T6 were nocuity assessment points of every stage.The assessment time was one minute at every point.After recorded at every point in second and third stages,patients were asked to use the pain intensity descriptive scale (PIDS) themselves.CPOT,heart rate and mean arterial pressure (MAP) from T1 to T6 were recorded as well as PIDS from T3 to T6 in second and third stages.Results In the three stages,CPOT〔(26.8 vs.0.54,3.36 vs.1.20,2.78 vs.0.68) scores〕,HR〔(95 vs.85,94 vs.82,94 vs.84)beat/min〕 and MAP〔(95 vs.85,95 vs.87,94 vs.87)mm Hg〕 at T2,T4and T6 were higher than T1 (t=-42.89,-55.95,-55.38),T3 (t =- 5.52,- 11.33,- 11.78) and T5 ( t =- 5.54,- 9.95,- 11.33 ) ( P＜ 0.05 ).The PIDS at T4 and T6were higher than at T3and T5in the second and third stages 〔(2.52 vs.1.69,2.12 vs.1.44)scores〕 (P＜0.05).The correlation coefficient between CPOT and PIDS at T3 and T4 in the second stage were 0.49 and 0.58,respectively (P＜0.05),and between CPOT and PIDS at T5 and T6 were 0.52 and 0.59 in the third stage,respectively (P ＜ 0.05),and they both reached moderate correlation.ConclusionsCPOT may be an effective way to assess the degree of pain in elderly patients with mechanical ventilation at present.