Objective To investigate the effects of three different effect-site concentration (Ce) of sufentanil given by TCI on the minimum alveolar concentration of sevoflurane for blunting adrenergic responses to skin incision(MAC_(BAR))in patients undergoing abdominal surgery.Methods Eighty ASAⅠ orⅡ patients,aged 20-60 yr,body mass index<30 kg/m~2,undergoing elective abdominal surgery,were randomly divided into 4 groups(n=20 each):control group(group so)and 3 sufentanil groups(group S_1,S_2,S_3).The patients were unpremedicated.Anesthesia was induced with TCI of propofol(target plasma concentration 3.5 μg/ml)and TCI of remifentanil(Ce 4 ng/ml).nacheal intubation was facilitated with rocuronium 0.6 mg/kg after the patients lost consciousness.The patients were mechanically ventilated.And then propofol and remifentanil were immediately stopped and anesthesia was maintained with inhalation of sevoflurane and a mixture of nitrous oxide and oxygen,fresh gas flow set at 10 L/min maintaining for at least 20 min.In group S_0,sufentanil was not given after intubation.In group S_1,S_2 and S_3,TCI of sufentamil was started after intubation at Ce of 0.12,0.18 and 0.24 ng/ml respectively.In group S_0,S_1,S_2 and S_3,sevoflurane inhalation was started with the initial end-tidal concentration of 3.0%,1.8%,1.3% and 1.1% respectively.The patients'response to skin incision was described as positive if MAP or HR increased by≥25%,or negative(MAP or HR increased by<25%).If the response was positive,the end-tidal concentration of sevoflurane for the next patient was increased by 1.2 times,while if negative,decreased by 1.2 times.The sevoflurane MAC_(BAR) was determined by up-and-down sequential trial.Results Compared with group S_0,the MAC_(BAR) of sevotlurane was significantly decreased in group S_1,S_2 and S_3(P<0.05).Compared with group S_1,the MACB_(BAR) of sevoflurane was significantly decreased in group S_2 and S_3(P<0.05).No significant difference was found in the MACB_(BAR) of sevoflurane between group S_2 and S_3 (P<0.05).Conclusion TCI of sufentanil at Ce of 0.12,0.18 and 0.24 ng/ml can significantly reduce MAC_(BAR) of sevoflurane and enhance the inhibitory effect of sevoflurane on stress response in a concentration-dependent manner.

This article sorted out research results of traditional Chinese herbal medicine at home and abroad, cleared up confirmed traditional Chinese herbal medicine with estrogen activity, analyzed the function classifications, and reviewed relevant clinical research progress. It also discussed the concept and connoation of traditional Chinese herbal medicine with estrogen activity, and proposed that the research on traditional Chinese herbal medicine with estrogen activity should clarify whether “bidirectional effect” establishes and the preconditions and requirements of the establishment, with a purpose to solve the security problems about hormone dependency caused by TCM therapy. Meanwhile, the problems about quick-screening experiments, standard establishment, and the transformation of experimental achievements to clinical application are waiting to be solved.

Objective To summarize the clinical and electroencephalography(EEG) characteristics of benign epilepsy with centro-temporal spikes (BECTS) in children.Methods The clinical manifestations,EEG findings,response to drug treatment and prognosis of 35 children with BECTS from Jul.2003 to Dec.2008 in the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.Results In the 35 cases,the age of onset was 2.5 to 14.0 years old,and the peak age of onset was 6-10 years old(62.9%).Twenty-two cases mainly presented partial seizures:hemifacial convulsions,sialorrhea,sounds,limb tonic-clonic seizures,and secondary generalized seizures.Thirteen cases were only describled generalized tonic-clonic seizures.Seizures were closely related to sleep and almost occurred shortly after falling asleep or before waking up.There were 26 cases who displayed convulsion during sleeping,including noon break.The EEG features showed numerous or single spikes on one side or both sides in the central and temporal areas under the background of normal activity in interictal period.The release frequency of abnormal wave was significantly increased after falling asleep,so the EEG monitoring during sleep could improve the positive rate of BECTS.Monotherapy with low-dose anti-epileptic drug could obtain good efficacy.Twenty-five cases stopped seizures within 3 months after therapy.Thirty-three cases hadn't get seizure since drug therapy at the age of 16 years old.So far,12 cases had been stopped medicine.Conclusions BECTS mostly begins at school-aged children,which displays partial seizures or secondary generalized seizures.The seizures are closely related to sleep.EEG monitoring during sleep which shows numerous or single spikes on the centrotemporal area has crucial diagnostic value to BECTS.There is a positive response to monotherapy with low-dose anti-epileptic drug and generally the prognosis is good.

[ ABSTRACT] AIM:To investigate the role of protease activated receptor-2 ( PAR-2 ) in the process of tryptase mediated IEC-6 cell injury.METHODS:The rat intestinal epithelial cell line IEC-6 was treated with tryptase at different concentrations (1 μg/L, 10 μg/L, 100μg/L and 1 000μg/L) in the presence or absence of PAR-2 antagonist FSLLRY-NH2 for 12 h respectively.The cell survival rate was detected by MTT assay.The protein levels of PAR-2 and cleaved-caspase 3 were determined by Western blotting.The LDH activity was also measured.RESULTS:Compared with control group, the cell survival rates were significantly decreased in 100 μg/L and 1 000 μg/L tryptase treated groups, the LDH activities were significantly increased in 10 μg/L to 1 000 μg/L tryptase treated groups, and the protein levels of PAR-2 and cleaved caspase 3 were significantly increased in 100μg/L and 1 000μg/L tryptase treated groups (P<0.05).Com-pared with 1 000 μg/L tryptase treated group, the LDH activity and cleaved caspase 3 protein level were dramatically de-creased while the survival rate was significantly increased in the presence of PAR-2 antagonist FSLLRY-NH2 (P<0.05). CONCLUSION:Tryptase induces IEC-6 cell injury in a dose-dependent manner by activating PAR-2.

Objective To systematically evaluate the effectiveness and safety of glucoside tripterygium total (GTT) combined with antihistamine medicine for chronic idiopathic urticaria (CIU). Methods All randomized or semi-randomized controlled trials (RCTs or semi-RCTs) of GTT in treating CIU were collected from CNKI, VIP, WanFang Data, CBM, Embase, PubMed and Cochrane Library clinical controlled trials database. After two researchers conducted screening and data extraction independently, the quality of the included literature research was evaluated according to the risk of bias tool described in the Cochrane Handbook version 5.1.0, and then RevMan 5.3 was used to undertake Meta analysis. Results A total of 21 articles about RCTs and semi-RCTs were obtained, including 2194 patients. Meta analysis indicated that GTT combined with antihistamine medicine treatment showed higher effective rates compared with the control group [RR=1.33, 95%CI (1.26, 1.40), P<0.000 01], with obviously lower recurrence rate [RR=0.45, 95%CI (0.33, 0.62), P<0.000 01]. There was no statistical significance in adverse reactions. Conclusion GTT combined with antihistamine medicine for CIU has definite efficacy, and is relatively safe. Whether apply GTT combined with antihistamine medicine for CIU should be verified through randomized controlled trial with large-scale samples, multiple centers and high quality.

Objective To observe the therapeutic effect of electroacupuncture combined with rehabilitation exercises on swallowing function and cerebral perfusion in dysphagic stroke patients.Methods Sixty-two stroke pa- tients with dysphagia were randomly divided into a treatment group(n=32)and a control group(n=30).The treat- ment group received electroacupunture,rehabilitation exercise and conventional medical treatment,while the control group received only rehabilitation exercise and conventional medical treatment.They were treated once a day,6 times a week for 4 weeks.Water drinking test,stethocatharsis scores and swallowing fluorography were used to assess the swallowing function before and after treatment.Single photon emission computed tomography(SPECT)was also em- ployed to observe the status of cerebral perfusion before and after treatment.Results It was shown that the swallo- wing function and cerebral perfusion in the treatment group were significantly better than the control group after treat- ment.The effective rate in the treatment group was 96.88% while that of the control group was 66.67%.Conclu- sion Electroacupuncture combined with rehabilitation exercises is effective in treating the dysphagic stroke patients, and can significantly improve the brain perfusion of these patients.

Objective To investigate the effects of transcutaneous electrical acupoint stimulation (TEAS) on early postoperative lung function in patients undergoing video-assisted thoracoscopic pneumonectomy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients whose preoperative forced expiratory volume in 1 second (FEV1) ＞ 1.5 L,scheduled for elective video-assisted thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group C),Lieque (LU7)-Quchi (LI11)-Neiguan (PC6)-Hegu (LI4) group (group S1),and Xinshu (BL1S)-Feishu (BL13)-PC6-LI4 group (group S2).TEAS was applied to the corresponding acupoints on the operated side for 30 min once a day starting from 30 min before induction of anesthesia until the end of surgery,and on 1 st and 2nd days after surgery in S1 and S2 groups.The frequency was 2/100 Hz,the intensity was the maximum current that could be tolerated,and the intensity was about 6-18 mA for LU7,LI11,PC6 and LI4,or about 20-35 mA for BL15 and BLI3.Patient-controlled intravenous analgesia was performed to maintain the score for the intensity of pain ＜ 4.Before and after surgery,forced vital capacity (FVC) and FEV1 were measured after the chest tube was withdrawn and the changing rate was calculated.Results FEV1 and FVC were significantly lower after surgery than before surgery in all the groups (P ＜ 0.05).There was no significant difference in FEV1 and FVC before and after surgery and the changing rate between the three groups (P ＞ 0.05).Conelusion TEAS (applied during surgery and within 2 days after surgery,30 min/d,2/100 Hz) provides no obvious improvement in early postoperative lung function for the patients undergoing video-assisted thoracoscopic pneumonectomy.

Objective To evaluate the intraoperative opioid-sparing effect of different frequency transcutaneous electrical acupoint stimulation (TEAS) in the patients undergoing video-assisted thoracoscopic pneumonectomy.Methods Eighty patients,aged 40-64 yr,weighing 50-90 kg,of ASA physical status Ⅰ-Ⅲ,scheduled for elective thoracoscopic pneumonectomy under general anesthesia,were randomly divided into 4 groups (n =20 each) using a random number table:control group (group Con),stimulation on Lieque (LU7)-Quchi (LI11)-Neiguan (PC6)-Hegu (LI4) at 2/100 Hz group (group 2/100 Hz),stimulation on LU7-LI11-PC6-LI4 at 2 Hz group (group 2 Hz),and stimulation on LU7-LI1 1-PC6-LI4 at 100 Hz group (group 100 Hz).The patients in group Con had the electrodes applied,but received no stimulation.In 2/100 Hz,2 Hz and 100 Hz groups,the patients received 2/100,2 and 100 Hz TEAS on LU7-LI11-PC6-LI4 acupoints ipsilateral to the surgery site,respectively,starting from 30 min before induction of anesthesia until the end of surgery,and the intensity was the maximum current that could be tolerated.Anesthesia was induced with iv midazolam,propofol,sufentanil and cisatracurim,and maintained with target-controlled infusion of remifentanil and propofol,continuous infusion of cisatracurim,and iv boluses of sufentanil when necessary.The target plasma concentration of propofol was adjusted to maintain BIS value at 40-60 during operation.The initial target effect-site concentration of remifentanil was 1 ng/ml,and adjusted to 4 ng/ml at skin incision.The concentration of remifentanil and consumption of sufentanil were adjusted to maintain Analgesia Nociception Index (ANI) at 50-70.When the concentration of remifentanil was increased to 4 ng/ml,ANI was still less than 50,and then 0.1 μg/kg sufentanil was given.The duration of operation and intraoperative consumption of remifentanil and sufentanil (the consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1:10) were recorded.Results The intraoperative consumption of remifentanil was significantly reduced in 2/100 Hz group as compared with Con,2 Hz and 100 Hz groups.There was no significant difference in the intraoperative consumption of remifentanil between Con group,2 Hz group and 100 Hz group.Conclusion The use of 2/100 Hz but not 2 and 100 Hz TEAS on LU7-LI11-PC6-LI4 significantly reduces intraoperative opioid consumption in the patients undergoing video-assisted thoracoscopic pneumonectomy.

Objective To compare the intraoperative opioids-sparing effects of transcutaneous electrical acupoint stimulation (TEAS) of Lieque (LU7)-Quchi (LI11)-Neiguan (PC6)-Hegu (LI4) versus Xinshu (BL15)-Feishu (BL13)-PC6-LI4 in patients undergoing video-assisted thoracoscopic lobectomy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 34-83 yr,weighing 50-93 kg,scheduled for elective video-assisted thoracoscopic lobectomy,were randomly divided into 3 groups (n =20 each):control group (group C),LU7-LI11-PC6-LI4 group (group S1),and BL15-BL13-PC6-LI4 group (group S2).TEAS was applied to the corresponding acupoints on the operated side starting from 30 min before induction of anesthesia until the end of operation in S1 and S2 groups.The wave length was 0.6 ms when the frequency was 2 Hz,and the wave length was 0.2 ms when the frequency was 100 Hz.The intensity was the maximum current that could be tolerated,and the intensity was 6-18 mA for LU7,LI11,PC6 and LI4,or 20-35 mA for BL15 and BL13.Anesthesia was induced with iv injection of midazolam,propofol,sufentanil and cisatracurium and maintained with target-controlled infusion of remifentanil and propofol,iv infusion of cisatracurium,and iv boluses of sufentanil when necessary.The plasma concentration of propofol was adjusted to maintain BIS value at 40-60 during operation.The initial effect-site concentration of remifentanil was set at 1 ng/ml and then adjusted to 4 ng/ml at skin incision,and the concentration of remifentanil and consumption of sufentanil was adjusted to maintain Analgesia Nociception Index (ANI) value at 50-70.If the concentration of remifentanil was increased to 4 ng/ml,ANI value was still less than 50,and then sufentanil 0.1 μg/kg was injected intravenously.The time of operation and intraoperative consumption ofremifentanil and propofol were recorded.Results Compared with group C,the intraoperative consumption of remifentanil was significantly decreased in S1 and S2 groups (P ＜ 0.05).There was no significant difference in the intraoperative consumption of remifentanil between group S1 and group S2 (P ＞ 0.05).There was no significant difference in the time of operation and intraoperative consumption of propofol between the three groups (P ＞0.05).Conclusion TEAS of LU7-LI1 1-PC6-LI4 provides similar opioids-sparing effects during operation as TEAS of BL15-BL13-PC6-LI4 in patients undergoing video-assisted thoracoscopic lobectomy.