Objective To study the clinical value of combined detection of serum interleukin(IL)-8 ,tumor necrosis factor(TNF)-α,alvedar cell surface antigen Ⅱ(KL-6) and surface protein D(SP-D) in the diagnosis of idiopathic pulmonary fibrosis(IPF) .Meth-ods Seventy three patients with IPF were selected as the research subjects ,other 73 patients with bacterial pneumonia were taken as the bacterial pneumonia group .The levels of serum IL-8 ,TNF-α,KL-6 and SP-D were detected by enzyme-linked immunosorbent assay (ELISA) .The serum levels of IL-8 ,TNF-α,KL-6 and SP-D were compared between the IPF group and bacterial pneumonia group .The sensitivity and specificity of IPF detection were compared between the 4-index combined detection and single item de-tection .Results The levels of IL-8 ,TNF-α,KL-6 and SP-D in the IPF group were significantly higher than those in the bacterial pneumonia group (P<0 .05) .The positive rate of single detection of four indexes in the IPF group was significantly higher than that in the bacterial pneumonia group (P<0 .05) .The sensitivity and specificity of the 4-index combined detection for diagnosing IPF were 90 .4% and 93 .2% respectively ,which were significantly higher than the those of single index detection (P<0 .05) .Con-clusion The combined detection of IL-8 ,TNF-α,KL-6 and SP-D has better sensitivity and specificity in IPF diagnosis compared with single detection of IL-8 ,TNF-α,KL-6 and SP-D .

Objective To observe the effects of different anesthetic solutions on postoperative cognitive function and serum S100β protein levels.Methods A prospective randomized controlled trial was conducted. Ninety patients necessary to perform off-pump coronary artery bypass grafting (op-CABG) in Tianjin Chest Hospital from November 2013 to July 2014 were enrolled. They were divided into three groups by random number table: P1, P2 and P3 groups, 30 cases in each group. The anesthesia was maintained with propofol by target-controlled infusion (TCI) in all the patients in the three groups, and the respective dosages were < 2.0μg/mL, 2.0 - 3.0μg/mL and > 3.0 - 4.0μg/mL. The operation time, anesthesia time, dosages of propofol and the incidence of postoperative cognitive dysfunction (POCD) were compared among the three groups. At the following times: before induction of anesthesia (T0), completion of anesthesia induction (T1), after tracheal intubation (T2), skin incision (T3), 1 hour after operation (T4), 2 hours after operation (T5) and the end of operation (T6), the narcotrend index (NTI) and hemodynamic levels were observed; the serum S100β protein levels were measured at the following times: before induction of anesthesia (Ta), 2 hours after operation (Tb), the end of operation (Tc), postoperative 6 hours (Td) and postoperative 24 hours (Te).Results There were no significant differences in operation times and anesthesia times among three groups (allP > 0.05); dosages of propofol in P2 and P3 groups were obviously higher than those of P1 group (mg: 1 746.3±43.9, 2 332.7±42.8 vs. 968.5±35.6, bothP < 0.05), and the incidences of POCD in P2 and P3 groups were lower than that in P1 group (10.00%, 6.67% vs. 33.33%, bothP < 0.05). With the extension of anesthesia time, the level of NTI was gradually declined in each group, in P3 group, it was occasionally increased at T6, and beginning from time point T1 afterwards, the NTI levels were lower than those of P1 and P2 groups at all the time points (allP < 0.05); the mean arterial pressure (MAP) in the three groups had a tendency of firstly going down and then increasing, and the inflection point being at T2, in P1 group, the elevation of MAP level persisted to T4, and it began to decline at T5, while in P2 and P3 groups, the levels started to decline at T4; the heart rate (HR) in three groups showed a tendency of firstly going up and then declining, and the inflection point being at T3; until T6, in P3 group, MAP and HR were all lower than those of P1 and P2 groups, the differences being statistically significant [MAP (mmHg, 1 mmHg = 0.133 kPa): 74.9±8.3 vs. 85.3±11.2, 84.2±10.1;HR (bpm): 74.1±4.2 vs. 80.9±8.1, 78.7±7.9, allP < 0.05]. The serum S100β protein levels of three groups at Tb began to be obviously higher than those at Ta, and reached the peak points at Tc, then the levels started to decline until Td, and the levels at Te was approximately close to those of Ta, but the serum S100β protein levels in P2 and P3 groups were lower than that in P1 group, the differences being statistically significant (mg/L: 1.05±0.22, 1.04±0.21 vs. 1.33±0.22, bothP < 0.05).Conclusion Application of propofol by TCI 2.0 - 3.0μg/mL for maintenance of anesthesia can achieve the satisfactory depth of anesthesia, and it not only can reduce the effects on hemodynamics, but also can decrease the serum S100β protein level and the incidence of POCD.

Objective To compare the efficacy of patient-controlled intravenous analgesia (PCIA),patient-controlled paravertebral block (PCPB) and patient-controlled epidural analgesia (PCEA) in patients after lobectomy performed via video-assisted thoracoscope (VAT).Methods Forty-eight ASA Ⅰ or Ⅱ patients,aged 50-64 yr,with a body mass index of 20-25 kg/m2,undergoing elective lobectomy via VAT,were randomly divided into 3 groups ( n =16 each):PCIA group,PCPB group and PCEA group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline,The PCA pump was set up with a 2 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.PCPB solution contained 0.75％ ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.The PCEA solution contained 0.75％ ropivacaine 50 ml and sufentanil 1 μg/kg in 250 ml of normal saline.The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤3.Peripberal venous blood samples were obtained before operation ( baseline),and at 24 and 48 h after operation for determination of the plasma cortisol concentration.The side effects were recorded.Results The plasma cortisol concentration and incidence of Somnolence were significantly lower in groups PCPB and PCEA than in group PCIA ( P ＜ 0.05 ).The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB ( P ＜ 0.05).Compared with the baseline value,the plasma cortisol concentrstion was significantly higher after operation in groups PCIA and PCPB ( P ＜ 0.05),while no significant change was found in group PCEA ( P ＞ 0.05).Conclusion Compared with PCIA,PCEA can inhibit the stress response,while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.

Objective To evaluate the effect of propofol on local field potential of prefrontal cortex in rats in order to investigate the reason why pmpefol leads to cognitive dysfunction.Methods Thirty healthy male SD rats weighing 190-230 g were randomly divided into 3 groups(n=10 each):intralipid group(group C),low dose propofol group(group P1)and high dose propofol group(group P2).In group C,P1 and P2,10% intralipid 0.01 ml·kg-1·min-1,pmpofol 0.1 mg·kg-1·min-1,and propofol 0.5 mg·kg-1·min-1 were infused iv through the caudal vein for 2h respectively.The modified Morris water-maze (MWM) test was performed twice a day for 5 consecutive days one day after administration.The escape latency,swimming time in platform quadrant,percentage of swimming distance in platform quadrant in the total swimming distance and the fLrst central point were recorded.Propofol 0.1 and 0.5 mg·kg-1·min-1 were infused iv in group P1 and P2 respectively 14 days after propfol administration.Local field potential of prefrontal cortex was recorded at 1-2 h of administration.Results Compared with group C and P1,the escape latency was prolonged,the swimming time in platform quadrant was shortened,and the percentage of swimming distance in platform quadrant in the total swimming distance and the first central point were signifieandy decreased in group P2(P<0.05).The complexity and power spectrum were significantly lower in group P2 than in group P1(P<0.05).Conclusion The high dose of propofol Can inhibit prefrontal cortex neuronal discharge activity to result in cognitive dysfunction.

Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P ＜ 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass (CPB).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group (group PA) or sevoflurane-based anesthesia group (group SA) , with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received targetcontrolled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5％-2.5％ sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction (T0), at the end of surgery (T1) , and at 6, 12 and 24 h after surgery (T2-4) , the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay.Results Compared with group SA, the plasma S-100β concentrations at T1,2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA.Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB.

Objective:To evaluate the effect of jugular vein bulb pressure (JVBP) on postoperative cognitive function in elderly patients undergoing valve replacement-coronary artery bypass grafting under cardiopulmonary bypass (CPB).Methods:Ninety-two patients of both sexes, aged 65-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, were selected.All the patients underwent right internal jugular vein catheterization to monitor central venous pressure (CVP) and retrograde catheterization to measure JVBP.JVBP was recorded immediately after anesthesia induction (T 11), 10 min after CPB (T 12) and at the end of operation (T 13). The patients were divided into 2 groups according to JVBP: JVBP<12 mmHg group (group L) and JVBP≥12 mmHg group (group H). At T 11-13 and on 1st and 2nd days after operation (T 14, 15), heart rate, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded, and blood samples from the jugular vein bulb were collected to determine the concentrations of S100β protein and matrix metalloproteinase-9 (MMP-9) in plasma and nerve specific enolase (NSE) in serum.Cognitive function was evaluated by Mini-Mental State Examination (MMSE) at 1 day before operation (T 21), 3 and 7 days after operation (T 22, 23) and 3 months after operation (T 24). Results:A total of 80 patients were included in this study, including 46 patients in group L and 34 patients in group H. Compared with those at T 11, CVP, JVBP, and concentrations of S100β protein and MMP-9 in plasma and NSE in serum were significantly increased at T 12 in group H, and CVP at T 13-15 and JVBP at T 12, 13 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 12-15 were significantly increased in two groups ( P<0.05). MMSE scores were significantly lower at T 22, 23 than at T 21 in the two groups ( P<0.05). Compared with group L, JVBP at T 12, 13, CVP at T 12-14 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 13 were significantly increased, concentrations of S100β prote in plasma were increased at T 12, MMSE scores were decreased at T 22-24, and the incidence of POCD was increased in group H ( P<0.05). JVBP was positively correlated with CVP, plasma S100β protein, MMP-9 concentration and serum NSE concentration, and the r values were 0.95, 0.56, 0.70 and 0.58, respectively ( P<0.05). Conclusion:Increased JVBP can decrease the postoperative cognitive function of elderly patients undergoing valve replacement-coronary artery bypass grafting under CPB, and the mechanism is related to blood-brain barrier damage.

Objective:To evaluate the effects of sevoflurane on right ventricular myocardial fibrosis caused by pulmonary arterial hypertension (PAH) in rats.Methods:Eighteen SPF healthy adult male Wistar rats, weighing 260-300 g, were divided into 3 groups ( n=6 each) by a random number table method: control group (group C), group PAH and PAH plus sevoflurane group (group PS). The PAH model was established by single intraperitoneal injection of monocrotaline 60 mg/kg in group PAH and group PS, while the equal volume of normal saline was intraperitoneally injected in group C. Sevoflurane 1.5 MAC was inhaled for 1 h starting from the end of injection, twice a week for 6 weeks in total, in group PS.Echocardiography was performed at the end of 6th week to measure right ventricular end-diastolic diameter (RVEDD), right ventricular anterior wall end-diastolic thickness (RVWTd), interventricular septal end-diastolic thickness (IVSTd), pulmonary artery inner diameter (PAID) and pulmonary valve orifice maximum peak velocity (PV). At the end of 6th week, the hearts were taken to measure the weight of right ventricle, interventricular septum and left ventricle, and Fulton′s index was calculated, and the tissue of the lower lobe of the right lung was taken, the outer diameter and inner diameter of the vascular wall were measured to calculate the vascular wall thickness index (WT), and total vascular area and lumen area were measured to calculate the vascular wall area index (WA) after HE staining.The myocardial tissue of the right ventricle was obtained to observe the degree of myocardial fibrosis (with a light microscope after Masson staining) and to detect the expression of TGF-β1 (after immunofluorescence staining) and expression of TGF-β1, phosphorylated Smad3 (p-SMad3) and Smad7 (by Western blot). Results:Compared with group C, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly increased, PV was decreased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was up-regulated, the expression of Smad7 was down-regulated( P<0.01), and myocardial fibrosis occurred in group PAH.Compared with group PAH, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly decreased, PV was increased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was down-regulated, the expression of Smad7 was up-regulated ( P<0.05 or 0.01), and myocardial fibrosis was significantly improved in group PS. Conclusion:Sevoflurane can improve the myocardial fibrosis in right ventricle induced by PAH in rats, and the mechanism may be related to inhibiting activation of TGF-β1/Smad3 signaling pathway.

Objective:To evaluate the effect of ulinastatin on the postoperative pulmonary complications (PPCs) in the patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:Medical records from patients scheduled for elective OPCABG from September 2021 to August 2023 were retrospectively collected. The patients were divided into ulinastatin and control groups based on the intraoperative use of ulinastatin. Confounding factors were adjusted using propensity score matching and an extended Cox proportional hazards model. The primary outcome was the development of PPCs within 30 days after surgery, and secondary outcomes included length of stay in intensive care unit, length of hospital stay and occurrence of other adverse events.Results:A total of 1 532 patients were included in this cohort study, and 585 cases (38.2%) experienced PPCs. Compared with control group, the incidence of PPCs was significantly decreased (before matching: 42.7% vs. 35.2%, P=0.004; after matching: 42.2% vs. 35.6%, P=0.033), the incidence of acute kidney injury was decreased and no significant differences were found in the length of stay in intensive care unit, length of hospital stay and incidence of other adverse events in ulinastatin group ( P>0.05). In the extended Cox proportional hazard model before and after adjustment for confounding factors, the risk of PPCs was significantly reduced after the use of ulinastatin ( HR value before adjustment was 0.81, 95% confidence interval [ CI] 0.67-0.99, P=0.004; the HR value after adjustment was 0.79, 95% CI 0.65-0.96, P=0.022). The risk of PPCs was significantly decreased in patients aged >65 yr and at high risk of PPCs after using ulinastatin ( HR=0.667, 95% CI 0.542-0.821, P<0.001; hR value was 0.641, 95% CI 0.516-0.812, P<0.001). Conclusions:The intraoperative use of ulinastatin is helpful in decreasing the risk of PPCs in patients undergoing OPCABG.

Objective:To evaluate the effect of sevoflurane on Ca 2+ transporter expression in cardiomyocytes during right ventricular remodeling in rats with pulmonary arterial hypertension. Methods:Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 200-250 g, were divided into 4 groups ( n=6 each) by the random number table method: control group (CM group), sevoflurane group (CS group), monocrotaline group (M group) and sevoflurane + monocrotaline group (S group). Monocrotaline 60 mg/kg was intraperitoneally injected in group M and group S, and monocrotaline lysate was intraperitoneally injected in group CM. The rats in S and CS groups inhaled 2.5% sevoflurane for 1 h, twice a week, at an interval of 3 days starting from the first day after injection of monocrotaline. Pulmonary artery acceleration time and pulmonary artery ejection time were measured by transthoracic echocardiography at 6 weeks after monocrotaline injection. The chest was exposed under 3% sevoflurane anesthesia, the heart was perfused, and the pulmonary artery branch and right ventricular myocardial tissues were retained. The wall thickness of pulmonary arterioles and cross-section area of right ventricular cardiomyocytes were observed by HE staining. The expression of Ca 2+ transporter in right ventricular cardiomyocytes was detected by Western blot. Results:Compared with CM group, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly decreased, the cross-section area of right ventricular cardiomyocytes was increased, the wall thickness of pulmonary arteriole was increased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was up-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was down-regulated in M group ( P<0.01). Compared with group M, the ratio of pulmonary artery acceleration time to pulmonary artery ejection time was significantly increased, the cross-section area of right ventricular cardiomyocytes was decreased, the wall thickness of pulmonary arteriole was decreased, the expression of type 1 sodium-calcium exchange and inositol triphosphate receptor was down-regulated, and the expression of voltage-dependent L-type calcium channel α1C subunit, type 2 ryanodine receptor, sarcoplasmic reticulum calcium pump 2α and proteinphilin-2 was up-regulated in group S ( P<0.01). Conclusions:The mechanism by which sevoflurane improves right ventricular remodeling is related to regulating the expression of Ca 2+ transporter in cardiomyocytes of rats with pulmonary arterial hypertension.