ObjectiveTo investigate the effect of sevoflurane preconditioning on heme oxygenase-1 (HO-1) expression in lung tissues during one lung ventilation (OLV) in rats.MethodsTwenty-four male SD rats weighing 220-250 g were randomly divided into 4 groups ( n =6 each):control group (group C) ; two lung ventilation group (group T); OLV group (group O) and sevoflurane preconditioning+ OLV group (group SO).The animals were anesthetized with intraperitoneal pentobarbital sodium 40 mg/kg.In group T,the animals were tracheal intubated and bilateral lungs were ventilated for 1 h (VT 10 ml/kg,RR 60 bpt/min,I∶E 1∶2) and PETCO2 was maintained at 35-50 mm Hg.In groups O and SO,the animals were tracheal intubated and OLV was performed for 1 h (VT 5 ml/kg,RR 80 bpt/min,I:E 1:2) and PETCO2 was maintained at 35-50 mm Hg.In group SO,2.4％sevoflurane was inhaled for 30 min before OLV and then washed out by inhalation of oxygen for 15 min.The left lung tissues were removed in groups C and T,and the bilateral lung tissues were removed in groups.O and SO for microscopic examination and determination of wet/dry lung weight ratio (W/D ratio) and expression of HO-1 (by Western blot).Results Compared with group C,W/D ratio was significantly increased and the expression of HO-1 was up-regulated in left lung tissues in group T and in bilateral lung tissues in groups O and SO ( P ＜0.05).Compared with group T,W/D ratio was significantly increased and the expression of HO-1 was up-regulated in bilateral lung tissues in group O and in right lung tissues in group SO ( P ＜ 0.05).Compared with group O,W/D ratio was significantly decreased,the expression of HO-1 was up-regulated (P ＜ 0.05) and the pathological changes were reduced in bilateral lung tissues in group SO.ConclusionThe mechanism by which sevoflurane preconditioning reduces OLV-induced lung injury is related to up-regulation of HO-1 expression.

Objective To compare the effects of flurbiprofen axetil and fentanyl of postoperative analgesia on T-lymphocytes subtypes in patients undergoing esophagectomy.Methods Forty patients undergoing esophagectomy were randomly divided into two groups(20 cases each):group C (group fentanyl) was given fentanyl 20μg/kg plus tropisetron 5 mg diluted to 100 ml via PCIA after surgery,group F (group flurbiprofen-fentanyl) was administrated flurbiprofen axetil 50 mg at 30 min before the end of surgery,fentanyl 10μg/kg and flurbiprofen axetil 100 mg plus tropisetron 5 mg diluted 100 ml was administrated via PCIA after surgery.The PCIA rate was 2 ml/h,bolus 0.5ml,lock time 15 min.The VAS score was recorded at 12,24,48 h after surgery.Blood samples 2 ml were obtained from peripheral vein for determination of CD3+,CD4+,CD8+ and CD4+/CD8+ at 30 min before surgery(T0),24 h(T1)and 72 h(T2)after surgery.Results Patients in two groups did not show any significant difference in the VAS scores(P＞0.05).At T1 CD3+,CD4+ T-lymphoeytes were significantly lower than those at T0 in two groups(P＜0.05).At T2,CD3+,CD4+ T-lymphocytes in group F were significantly higher than those in group C(P＜0.05).In group C,CD3+,CD4+ T-lymphocytes at T2 were significantly decreased than those at T0(P＜0.05).CD8+ T-lymphocytes Was no significantly changed in two groups and at each time point determined (P＞0.05).Conclusion Postoperative analgesia by using flurbiprofen axetil and fentanyl can diminish the using dose of postoperative opioid drug,and it can'improve patient's cellular immune function.

Objective To observe the effect of patient-controlled intravenous analgesia (PCIA)with dezocine combined with sufentanil on inflammatory response and pain after laparoscopic hepatectomy for hepatocellular carcinoma.Methods Sixty patients (43 males,17 females,aged 18-60 years,ASA grade Ⅰ or Ⅱ) scheduled for laparoscopic hepatectomy for hepatocellular carcinoma were divided into sufentanil group (group S) and dezocine+sufentanil group (group DS) according to the random number table,n=30 each.Patients in group S were given 100 ml normal saline containing sufentanil 2.0 μg/kg and tropisetron 5 mg.Patients in group DS were given 100 ml normal saline containing sufentanil 2.0 μg/kg,dezocine 0.5 mg/kg and tropisetron 5 mg.VAS scores and numeric sedation scale (NSS) scores were recorded at 4,24,48 h after operation and patients' satisfaction scores were recorded at 48 h after operation.The levels of serum tumor necrosis factor-α (TNF-α),interleukin-2 (IL-2),interleukin-6 (IL-6) in blood samples harvested before induction of anesthesia and 0,4,24 and 48 h after operation were measured by ELISA.The times of efficient injection and incidence of adverse effect within 48 h after operation were recored.Results Compared with group S,the VAS scores in group DS were decreased significantly while the satisfaction of patients to analgesia were increased significantly at 4,24,48 h after operation (P<0.05).There were no obvious differences in NSS scores between two groups.Compared with before induction of anesthesia,the concentrations of TNF-α and IL-6 were increased significantly while the concentrations of IL-2 was decreased significantly in both groups at 4,24,48 h after operation (P<0.05).Compared with group S,the concentrations of TNF-α and IL-6 were decreased significantly while the concentrations of IL-2 was increased significantly in group DS at 24,48 h after operation (P<0.05).The times of efficient injection in group DS were less than that in group S significantly within 48 h after operation [(2.0±0.7) times vs.(7.2±1.3) times] (P<0.05).There were no obvious differences in adverse effects between two groups.Conclusion PCIA with dezocine 0.5 mg/kg combined with sufentanil 2.0 μg/kg can alleviate the inflammatory response to some extent in patients after laparoscopic hepatectomy for hepatocellular carcinoma,and it can offer a safe and effective analgesic effect.

Objective To evaluate the effects of penehyclidine hydrochloride on the oxidative stress and cell apoptosis during endotoxin-induced acute lung injury (ALI) in neonatal rats.Methods Forty 7-day-old Wistar rats weighing 12-18 g were randomly divided into 3 groups (n=10 each) using a random number table: penehyclidine hydrochloride group (group PHC), acute lung injury (group AKI) and normal saline group (group NS).The ALI model was induced with intraperitoneal endotoxin 5.0 mg/kg in groups PHC and ALI.In group PHC, penehyclidine hydrochloride 2.0 mg/kg was injected intraperitoneally at 1 h before ALI respectively, while the equal volume of normal saline was administered in groups NS and ALI.At 4 h after endotoxin injection,the rsts were sacrificed.The lungs were collected to determine the wet/dry (W/D) lung weight ratio.The expression of SOD was detected by xanthine oxidase method.The expression of MDA was detected by sulfuretted barbitone method.Levels of cytochrome C (Cyt-C) and Caspase-3 were determined with immunohistochemical method (IHC), and cell apoptosis (by TUNEL).Apoptotic index was calculated.Results Compared with group NS, the W/D ratio and the contents of MDA were significantly increased, the contents of SOD were significantly decreased in groups ALI and PHC (P＜0.05).Compared with group ALI, the W/D ratio and the contents of MDA were significantly decreased, the contents of SOD were significantly increased in group PHC (P＜0.05).Compared with group NS, the contents of Cyt-C, Caspase-3, and apoptotic index were significantly increased in groups ALI and PHC (P＜0.05).Compared with group ALI, the contents of Cyt-C, Caspase-3, and apoptotic index were significantly decreased in group PHC (P＜0.05).Conclusion Penehyclidine hydrochloride ameliorates endotoxin-induced ALI by inhibiting oxidative stress and cell apoptosis in neonatal rats.

Objective To investigate the effect of fructose-1,6-diphosphate (FDP) pretreatment on myocardial connexin43 (Cx43) in a rat model of acute myocardial ischemia.Methods Thirty-six male 8-12 week old SD rata weighing 220-280 g were randomly divided into 3 groups (n=12 each):group Ⅰ sham operation (group S);group Ⅱ ischemia(group Ⅰ)and group Ⅲ FDP+ischemia(group F).The animals were anesthetized with intraperitoneal 10%chloral hydrate 40 mg/100 g,tracheostomized and mechanically ventilated.Acute myocardial ischemia was induced by occlusion of left anterior descending coronary artery for 30 min.Myocardial ischemia was;verified by elevation of S-T segment on ECG.In group F FDP 100 mg/kg was injected iv at 10 min before ischemia.Arrhythmia was recorded within 30 min after occlusion and the severity of arrbythmia was aggesged.The hearts were removed after 30 min myocardial ischemia.The Left ventricle area (LVA),myocardial infarct area (IA) and area at risk (AAR) were measured and AAR/LVA and IA/AAR ratios were calculated.The expression of myocardial Cx43 protein was determined by immuno-histochemestry and analysis of mean optical density.Results The severity of arrhythmia was significantly higher in group F and I than in gropu S.while lower in group F than in group I(P<0.05).The IA,IA/AAR ratio was significantly lower in group F than in group I.The myocardial Cx43 protein expression was down-regulated in group I and F as compared with group S.and was significantly lower in group I than in group F.Conclusion FDP pretreatment can protect myocardium against acute ischemia by up-regulation of myocardial Cx43 expression.

Objective To compare the kidney injury in diabetic patients undergoing liver cancer resection performed under different methods of anesthesia.Methods Sixty diabetic patients of both sexes,aged 40-64 yr,weighing 48-75 kg,of ASA physical shatus Ⅱ or Ⅲ (liver function Child-Pugh grade A),scheduled for elective liver cancer resection,were randomly divided into 2 groups (n =30 each) using a random number table:total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S).In group S,8％ sevoflurane was inhaled (FGF 8 L/min),and sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously after the patients lost consciousness.In group P,propofol 1-2 mg/kg,sufentanil 0.4 μg/kg and cisatracurium besylate 0.2 mg/kg were injected intravenously.The patients were tracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 2 ％-3 ％ sevoflurane (FGF 2 L/min) in group S,or with iv infusion of propofol 0.5-0.8 mg· kg-1 · h-1 in group P,and with iv sufentanil 10 μg and cisatracurium 0.1 mg/kg when needed in both groups.BIS value was maintained at 40-60 and PET CO2 at 35-45 mmHg during operation.Before induction of anesthesia,at the end of operation,and at 24 and 72 h after operation,blood samples were collected from the central vein for determination of the levels of serum creatinine,blood urea nitrogen,serum cystatin C and 24 h.urinary microalbuminuria.Results Compared with group S,the levels of serum cystatin C at 24 and 72 h after operation and 24 h urinary microalbuminuria were significantly increased,and no significant changes were found in the levels of serum creatinine and blood urea nitrogen at each time point in group P.Conclusion The kidney injury is reduced in the diabetic patients undergoing liver cancer resection performed under combined intravenous-inhalational anesthesia with sevoflurane as compared with that under total intravenous anesthesia with propofol.

Objective To evaluate the effects of sulforaphane preconditioning on cognitive dysfunction induced by sevoflurane anesthesia in aged rats.Methods Thirty Sprague-Dawley rats,aged 22 months,weighing 380-560 g,were randomly divided into 3 groups (n =10 each) using a random number table:control group,sevoflurane group (Sev group),and sulforaphane group (Sul group).In group Sul,sulforaphane25 mg/kg was administered by oral gavage once a day for 7 consecutive days,while the equal volume of distilled water was given instead of sulforaphane in Sev and C groups.Groups Sev and Sul inhaled 3％ sevoflurane in oxygen (2.5 L/min) and group C inhaled air (100 min/d) for 5 consecutive days starting from the end of gavage.At 24 h after sevoflurane inhalation,cognitive function was detected using Morris water maze and open field tests.The escape latency,frequency of crossing the original platform,the number of crossing the grid,the number of standing on the back legs and the time the animals spent in the central square were recorded.Results Compared with group C,the frequency of crossing the original platform,the number of crossing the grid,and the number of standing on the back legs were significantly reduced,the time the animals spent in the central square and escape latency on 1st day were prolonged and no significant changes were found in the escape latency on 2nd-4th days in group Sev.Compared with group Sev,the frequency of crossing the original platform,the number of crossing the grid,and the number of standing on the back legs were significantly increased,and the time the animals spent in the central square and escape latency on 1st day were shortened.Conclusion Sulforaphane preconditioning can improve the cognitive dysfunction induced by sevoflurane anesthesia in aged rats.

Objective To investigate the effect of fructose-1,6-diphosphate (FDP) pretreatment on myocardial connexin 43 (Cx43) in a rat model of acute myocardial ischemia.Methods Thirty-six male Sprague Dawley rats (aged 8-12 weeks and weighing 220-280 g) were randomly divided into three groups (n =12 each):sham operation group (group S),ischemia group (group Ⅰ) and FDP + ischemia group (group F).The animals were anesthetized with intraperitoneal injection of 10％ chloral hydrate 40 mg/100 g,then tracheostomized and mechanically ventilated.Acute myocardial ischemia was induced by occlusion of the left anterior descending coronary artery for 30 minutes.Myocardial ischemia was verified by elevation of the S-T segment on echocardiogram (EGG).In group F,FDP 100 mg/kg was injected intravenously 10 minutes before ischemia.The hearts were removed after 30 minutes of myocardial ischemia.The myocardial infarct size (IS) and area at risk (AAR) were measured and the IS/AAR ratio was calculated.The expression of myocardial Cx43 protein was determined by immunohistochemestry and analysis of mean optical density.Results The severities of arrhythmia were significantly higher in groups F and I than in group S,while lower in group F than in group Ⅰ (P＜ 0.05).The IS/AAR ratio was significantly lower in group F than in group Ⅰ.The myocardial Cx43 protein expression was down-regulated in group Ⅰ and group F as compared with group S,and was significantly lower in group Ⅰ than in group F.Conclusion FDP pretreatment can protect myocardium against acute ischemia by up-regulation of myocardial Cx43 expression.

Objective To evaluate the role of glycogen synthase kinase-3 beta (GSK-3β) in spinal cord ischemia/reperfusion (I/R) injury in rats.Methods Forty-eight male Sprague-Dawley rats,aged 3 months,weighing 250-300 g,were randomly divided into 3 groups (n =16 each) using a random number table:sham operation group (group S),group I/R and I/R+ GSK-3β inhibitor LiCl group (group LiCl).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg/kg.Spinal cord ischemia was induced by 45 min occlusion of the abdominal aorta followed by reperfusion.In I/R and LiCl groups,normal saline 5 ml and LiCl 15 mg/kg were injected,respectively,via the caudal vein at 30 min before ischemia.The animals were sacrificed at 48 h of reperfusion and the lumbar segment (L4-6) of spinal cords was removed for microscopic examination and for determination of neuronal apoptosis in the anterior horn of the spinal cord (by TUNEL),and the expression of interleukin-6 (IL-6),IL-8 and IL-10 was detected (by immunohistochemistry).The apoptosis rate was calculated.Results Compared with group S,the apoptosis rate was significantly increased,IL-6 and IL-8 expression was upregulated,and IL-10 expression was down-regulated in I/R and LiCl groups.Compared with group I/R,the apoptosis rate was significantly decreased,IL-6 and IL-8 expression was down-regulated,IL-10 expression was up regulated,and the pathological damage was attenuated in LiCl group.Conclusion Activated GSK-3β is involved in the development of spinal cord I/R injury possibly by promoting synthesis and release of inflammatory factors in rats.

Objective To evaluate the efficacy of high frequency two-lung ventilation (TLV) with low tidal volume assisted by CO2 pneumothorax for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.Methods Thirty patients of both sexes,aged 48-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic radical resection of esophagus cancer,were divided into 2 groups (n =15 each) using a random number table:onelung ventilation group (group O) and TLV group (group T).A left-sided double-lumen tube was inserted orally in group O,and a single-lumen tube was placed orally in group T.During thoracoscopic surgery,the left lung was ventilated,with tidal volume 8 ml/kg and respiratory rate 14 breaths/min in group O.In group T,artificial pneumothorax was induced by continuous CO2 insufflation with CO2 pressure at 10 mmHg,and bilateral lungs were ventilated,with tidal volume 5 ml/kg and respiratory rate 20 breaths/min.Mean arterial pressure and heart rate were recorded before induction of anesthesia,immediately after intubation (T1),at 10 min after intubation (T2),at 30 min after the start of thoracoscopic surgery (T3),immediately after the end of thoracoscopic surgery (T4) and at 30 min of TLV (T5).Arterial blood samples were collected for blood gas analysis at T2,T3,T4 and T5.The exposure of the surgical field and the number of lymph node dissection in the left recurrent laryngeal nerve chain were recorded during surgery.The emergence time,extubation time and time for recovery of consciousness were recorded.Results Arterial oxygen partial pressure was significantly lower at T3,4 than at T2 in the two groups,and arterial carbon dioxide partial pressure was significantly higher,and the pH value was lower at T3,4 than at T2 in group T (P＜0.05).Compared with group O,arterial carbon dioxide partial pressure was significantly increased,the pH value was decreased,and the number of lymph node dissection in the left recurrent laryngeal nerve chain was increased at T3,4 in group T (P＜0.05).There were no significant differences between the two groups in the good exposure of the surgical field,emergence time,extubation time and time for recovery of consciousness (P＞0.05).Conclusion High frequency TLV with low tidal volume when assisted by CO2 pneumothorax can serve as a feasible mode for airway management in patients undergoing thoracoscopic radical resection of esophagus cancer.