Objective:To investigate the neuroprotective effect and possible mechanism on rats with low dose Lipopoly -saccharide ( LPS) preconditioning after spinal cord injury.Methods:120 female SD rats were randomly divided into the empty virus (EV) group,LPS+empty virus (LPS+EV) group,Nrf2 interference virus (NIV) group,LPS+Nrf2 interference virus (LPS+NIV) group.The model of traumatic spinal cord injury ( TSCI) was established by the modified Allen′s method,motor function of the rat hind limb was assessed by the Basso Beattie and Bresnahan (BBB) score at 1,3,7,14 and 28 d after the operation.The injured spinal cord tissue samples were harvested at each time ,and the pathological changes of rat spinal cord were observed by HE staining ,the Nissl body and neuron survival index were observed by Nissl staining ,the expressions of Nrf2 and GCLC protein level were detected by immunohis-tochemical staining and Western blot.Results:The rat BBB score of LPS+EV group increased significantly than EV group at 7,14,28 d after operation ( P<0.05 ,P<0.01 );The NIV group between LPS+NIV group have no statistical significance at each time.As compared with EV group:the Nrf2 protein of LPS+EV group was expression increased significantly and Nissl staining showed that the neurons survival index was increased at 1,3 and 7 d(P<0.05,P<0.01);The GCLC protein of LPS+EV group was expression increased significantly at 1-14 d( P<0.05 );HE staining showed that the injured spinal cord pathological changes of LPS +EV group was obviously improved.Conclusion:Low dose lipopolysaccharide preconditioning can accelerate the nerve function recovery on rats with traumatic spinal cord injury ,the mechanism may be regulated by activating the Nrf 2 antioxidant stress pathway.

Objective:To investigate the efficacy and safety of dexmedetomidine and dexamethasone in inhibiting opioid-induced cough (OIC) during general anesthesia induction in patients with gynecological tumors.Methods:A total of 180 patients who were scheduled for elective gynecological tumor surgery under general anesthesia in Shanxi Provincial Cancer Hospital from March to November 2019 were selected. They were randomly divided into blank control group, dexmedetomidine group and dexamethasone group according to the random number table method, each group had 60 cases. Firstly, all patients had a 10-minute rest (T 0) after they entered the operate room. Treatment before general anesthesia induction:dexmedetomidine group was pumped dexmedetomidine 0.5 μg/kg (diluted to 10 ml with 0.9% NaCl injection) using an electronic infusion pump; dexamethasone group was injected intravenously dexamethasone 10 mg; blank control group was pumped with 10 ml 0.9% NaCl injection. The pumping was finished within 5 minutes, and the end time of pumping was denoted as T 1. Induction of general anesthesia was performed 5 minutes after the end of pumping: firstly, sufentanil was given intravenously at 0.3 μg/kg, and the injection was finished within 5 seconds (T 2). Two minutes after sufentanil injection (T 3), cis-atracurium 0.3 mg/kg and propofol medium/long-chain injection 2 mg/kg were sequentially injected. Then preoxygenation, endotracheal intubation and mechanical ventilation were implemented in turn. One minute after intubation was recorded as T 4. The incidence and severity of cough in patients within T 2-T 3 of each group were recorded, as well as the incidence of tachycardia, bradycardia, hypertension, hypotension, respiratory depression and myotonia during T 1-T 4. Results:The incidence of OIC in the dexmedetomidine group (10.0%, 6/60) and dexamethasone group (8.3%, 5/60) was lower than that in the blank control group (33.3%, 20/60), and the difference among the three groups was statistically significant ( χ2 = 16.445, P < 0.01), while there was no significant difference in the incidence of OIC between the dexmedetomidine group and the dexamethasone group ( P > 0.05). The incidence of sinus bradycardia in the dexmedetomidine group (16.3%, 10/60) was higher than that in the blank control group (0, 0/60) and dexamethasone group (8.4%, 1/60), and the difference was statistically significant ( P < 0.05). Respiratory depression and myotonia did not occur in the three groups. Conclusions:Pretreatment with dexmedetomidine or intravenous dexamethasone before anesthesia induction can effectively reduce the incidence of OIC in patients with gynecological tumors, and there is no significant difference between the effects of the two drugs. The incidence of sinus bradycardia increases significantly after dexmedetomidine infusion.

Objective To study the influence of excisional biopsy on detection rate of sentinel lymph node biopsy through methylene blue in breast cancer.Methods A review of 76 patients with clinical stage T1-2N0M0 breast cancer who had a successful sentinel lymph node biopsy at the Affiliated Nanhai Hospital of Southern Medical University between July 2009 to July 2014 was analyzed.There were 37 patients received sentinel lymph node biopsy directly.And 39 patients received sentinel lymph node biopsy after a excisional biopsy to primary lesion.We compare the difference of detection rate of sentinel lymph node between the two groups.Results Seventy cases had been found sentinel lymph node successfully in a total of 76 patients and the detection rate is 92.1％.There were 34 cases had sentinel lymph node biopsy in successfully in group of excisional biopsy and the detection rate is 87.2％.There were 36 cases had sentinel lymph node biopsy in successfully in group of needle core biopsy and the detection rate is 97.3％.This difference,however,was not statistically significant between the two groups (P ＞ 0.05).Conclusions The influence of excisional biopsy on detection rate of sentinel lymph node biopsy through methylene blue in breast cancer is not significant.

Objective:To study the effect of intravenous injection with butorphanol at different time points on stress response, recovery time after drug withdrawal, emergence agitation and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy.Methods:A total of 90 lung cancer patients who underwent elective thoracoscopic lobectomy from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and randomly divided into three groups according to random number table, 30 cases in each group. Group A was set as a preemptive analgesia group, and 20 μg/kg butorphanol was injected intravenously at 15 min before anesthesia induction; group B was injected with 20 μg/kg butorphanol at 30 min before the end of operation; and the blank control group (group C) was given with the same volume of 0.9% NaCl injection at the same time points. The following data including blood glucose, cortisol, heart rate and mean arterial pressure (MAP), recovery time after skin suture and drug withdrawal, emergence agitation score and incidence rate of restlessness, postoperative pain visual analogue scale (VAS) were observed.Results:The level of blood glucose [(5.25±0.32), (5.17±0.58) mmol/L] and cortisol [(253.63±48.29), (222.17±35.73) ng/ml] in group A were lower than those in group B [(5.85±0.53), (5.52±0.48) mmol/L; (302.83±48.63), (274.87±47.93) ng/ml] and group C [(6.07±0.70), (5.68±0.52) mmol/L; (319.97±32.05), (295.57±46.83) ng/ml] immediately after skin suture and 6 h after the operation (all P < 0.05). There were no significant differences in MAP and heart rate at intubation among the three groups (all P > 0.05). The levels of MAP and heart rate in group A at intubation were higher than those before anesthesia induction (all P < 0.05); there were no statistical differences of the levels of MAP and heart rate at 30 min after one-lung ventilation and at extubation compared with those before anesthesia induction (all P > 0.05). In group B and group C, heart rate and MAP at intubation, 30 min after one-lung ventilation and extubation were higher than those before anesthesia induction (all P < 0.05). Among them, the recovery time after drug withdrawal in group B [(16.53±3.64) min] was longer than that in group A [(13.83±3.24) min] and group C [(12.47±3.35) min] (all P < 0.05), while there was no significant difference between group A and group C ( P > 0.05). In addition, in terms of emergence agitation score and agitation incidence, group A [(3.20±0.41) scores, 0 (0/30)] was lower than group B [(3.73±0.74) scores, 7% (2/30)] and group C [(4.00±0.79) scores, 10% (3/30)] (all P < 0.05). The pain VAS in group A [(3.10±0.61) scores, (3.27±0.52) scores] at 3 h and 12 h after operation were lower than those in group B [(3.53±0.86) scores, (3.70±0.53) scores] and group C [(4.00±0.83) scores, (4.10±0.71) scores] at the same time points (all P < 0.05). However, there was no significant difference in pain VAS among the three groups at 24 h and 48 h after operation (all P > 0.05). Conclusions:For lung cancer patients who underwent thoracoscopic lobectomy, preemptive analgesia with butorphanol not only can reduce the stress response and increase the stability of hemodynamics, but also can effectively reduce the incidence of postoperative pain and restlessness without prolonging the recovery time after stopping drug.

Objective: To study the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty (TAPP) in inguinal hernia patients. Metholds: A retrospective analysis of 156 patients with inguinal hernia who underwent TAPP in Nanhai Hospital Affiliated to Southern Medical University from January 2016 to January 2017 was conducted, they were males, the average age was 50.84 years and the age range was from 33 to 62 years. Patients were divided into sacral nail group (n=120) and absorbable line group (n=36) according to the different methods of fixation of the iliac crest. Among them, the patients in the sacral nail group were fixed with iliac screws, and the patients in the absorbable line group were sutured with absorbable sutures. Pain visual analog scale (VAS) was used to compare the extent of postoperative pain in both groups. After the operation, through the outpatient review and telephone follow-up for 1 year, observed the recurrence of inguinal hernia in both groups. Measurement data were expressed as mean ± standard deviation (Mean±SD), t-test was used for comparison between groups; the Chi-square test was used to compare the count data between the two groups. Results: Among them, 19 patients with moderate pain after operation in the nail group had an incidence of 15.8%. Two patients with moderate pain in the absorbable line group had an incidence of 5.6%. The difference between the two groups was statistically significant (χ²=2.511, P=0.013). The pain VAS of the patients in the sacral nail group was (3.08±1.36), and the absorbable line group was (2.50±0.91), the difference between the two groups was statistically significant (t=2.973, P=0.001). All patients had no recurrence after outpatient review and telephone follow-up for 1 year. Conclusion In TAPP, the application of absorbable suture fixed patch can effectively reduce postoperative pain.

Objective:To investigate the effects of dexmedetomidine on perioperative coagulation function and inflammatory factors in patients with malignant ovarian tumors.Methods:A total of 60 patients undergoing cytoreductive surgery for malignant ovarian tumors from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and divided into the dexmedetomidine group and the control group according to the random number table method, 30 cases in each group. Patients in the dexmedetomidine group were pumped with dexmedetomidine 0.5 μg/kg 10 min before induction of anesthesia, and then the intravenous pump was maintained at a rate of 0.2-0.6 μg·kg -1·h -1 until 30 min before the completion of the operation pump injection. The control group was pumped with 0.9% NaCl solution of the same volume at the same time. Before induction of anesthesia (T 0), 2 h after administration (T 1), and 3 h after operation (T 2), the patients' venous blood was collected to detect platelet count (Plt), prothrombin time (PT), activated partial thrombin time (APTT), plasma fibrinogen (FIB), D-dimer; and levels of serum inflammatory factors interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were also detected. The operation time, intraoperative fluid infusion, amount of anesthetics, and total intraoperative blood loss were compared between the two groups. Results:Plt at T 1 and T 2 time were (154±28)×10 9/L, (138±27)×10 9/L of the dexmedetomidine group and (133±44)×10 9/L, (114±50)×10 9/L of the control group, which were lower than those of both groups at T 0 time [(182±46)×10 9/L, (184±55)×10 9/L], and the differences were statistically significant ( F values were 11.975, 16.058, all P < 0.05); and Plt at T 1 and T 2 time of the control group were lower than those of the dexmedetomidine group (all P < 0.05). FIB level at T 1 and T 2 time [(3.2±0.9) g/L, (3.3±0.9) g/L of the dexmedetomidine group; (3.7±0.6) g/L, (4.6±0.9) g/L of the control group] and D-dimer level at T 1 and T 2 time [(0.77±0.25) mg/L, (0.81±0.51) mg/L of the dexmedetomidine group; (0.96±0.31) mg/L, (1.15±0.56) mg/L of the control group] were higher than those of both groups at T 0 time [FIB: (3.0met) g/L, (2.8 met) g/L; D-dimer: (0.65rt T) mg/L, (0.63 rt T) mg/L], and the differences were statistically significant (F values were 5.234, 46.121, 4.358, 11.091, all P < 0.05); FIB and D-dimer levels at T 1 and T 2 time of the control group were higher than those of the dexmedetomidine group (all P < 0.05). PT and APTT at T 2 time of the dexmedetomidine group were (12.7±0.5) s and (33.8±3.7) s, respectively, and the control group were (12.3±0.8) s, (31.8±2.4)s, respectively, which were shorter than those of both groups at T 0 time [PT: (13.0±0.3) s, (13.0±0.3) s; APTT: (35.7±2.0) s, (35.7±2.6) s], and the differences were statistically significant (all P < 0.05), and PT and APTT levels at T 2 time of the control group were shorter than those of the dexmedetomidine group (all P < 0.05). IL-6 level at T 1 and T 2 time [(73.3±2.8) pg/L, (84.7±3.8) pg/L of the dexmedetomidine group; (81.5±3.6) pg/L, (89.8±3.2) pg/L of the control group] and TNF-α level at T 1 and T 2 time [(27.4±4.4) ng/L, (32.9±3.7) ng/L of the dexmedetomidine group; (32.7±2.5) ng/L, (39.8±4.0) ng/L of the control group] were higher than those of both groups at T 0 time [IL-6: (65.9±2.9) pg/L, (65.0±1.8) pg/L; TNF-α: (15.4±3.1) ng/L, (16.6±2.6) ng/L)], and the differences were statistically significant ( F values were 264.650, 553.019, 162.447, and 438.225, respectively, all P < 0.05), and IL-6 and TNF-α levels at T 1 and T 2 time of the control group were higher than those of the dexmedetomidine group (all P < 0.05). There were no statistically significant differences in operation time, intraoperative fluid infusion, and intraoperative total blood loss between the two groups (all P > 0.05), but the intraoperative use of propofol and remifentanil of the control group was more than that of the dexmedetomidine group (all P < 0.05). Conclusion:Dexmedetomidine under general anesthesia for malignant ovarian patients undergoing surgery can effectively improve the perioperative coagulation function and reduce the level of inflammatory factors, thereby reducing the risk of postoperative thrombotic events.

Objective:To analyze the effect and clinical significance of continuous renal replacement therapy (CRRT) on severe acute pancreatitis complicated with different grades of intra-abdominal hypertension, and to determine whether the level of intra-abdominal pressure can be used as one of the indicators of CRRT in these patients.Methods:From September 2020 to September 2022, the clinical data of 66 patients with severe acute pancreatitis complicated by intra-abdominal pressure (IAP) ≥12 mmHg who were treated with CRRT and admitted to the EICU of Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. According to the level of IAP, they were divided into group A: 12 mmHg≤IAP < 15 mmHg, 22 cases; group B: 15 mmHg≤IAP≤20 mmHg, 23 cases and group C: IA P>20 mmHg, 21 cases. The general clinical data and IAP values before and after CRRT treatment, as well as the ΔIAP (difference of IAP before and after treatment) were recorded. The difference of IAP before and after treatment and the ΔIAP between group B and group C were compared by independent sample t test. The relationship between IAP before treatment and ?IAP was analyzed by spearman test. Results:There were no significant differences in gender, age, modified Marshall score, APACHE Ⅱ score, number of mechanical ventilation, and etiology among the three groups before treatment( P>0.05). After CRRT treatment, IAP of group A was no significantly changed before and after treatment ( P>0.05). IAP in groups B and C was significantly lower after treatment than before treatment ( P<0.05), and the ΔIAP of group C was significantly higher than that of group B ( P<0.05). There was a positive correlation between IAP before treatment and ?IAP in group B and Group C ( P<0.05). Conclusions:1．For patients with severe pancreatitis complicated with intra-abdominal hypertension, CRRT treatment can effectively reduce IAP when IAP≥15 mmHg, and the higher the IAP, the more obvious effect of CRRT treatment in controlling intra-abdominal pressure. 2. IAP≥15 mmHg can be used as one of the indicators for CRRT in SAP patients.