Objective To investigate the effect of adenoviral-mediated interleukin-10 (IL-10) gene transfection on systemic inflammatory responses in a rat model of ventilator-induced lung injury. Methods Thirty adult male SD rats weighing 200-220 g were randomly divided into 5 groups (n=6 each): group Ⅰ control (group C); group Ⅱ adenovirus without IL-IO gene + 2 h mechanical ventilation (MV) (group B, ); group II1 adenoviruswithout IL-IO gene + 4 h MV (group B_2); group Ⅳ adenovirus with IL-10 gene + 2 h MV (group A_1) and group Ⅴ adenovirus with IL-10 gene + 4 h MV (group A_2). In group Ⅱ-Ⅴ the animals were mechanically ventilated (airway pressure = 25 cm H_2 O) and adenovirus was injected into right ventricle at 48 h before MV. Blood samples were taken from abdominal aorta at the end of 2 h or 4 h MV for determination of serum IL-8 and IL-10 concentrations. The animals were then killed. The pulmonary specimens were obtained for examination of ultrastructure with light and electron microscope. Results Mechanical ventilation significantly increased serum IL-8 and IL-IO concentrations in a duration-dependent manner in group Ⅱ-Ⅴ as compared with group C. Trans-pulmonary administration of adenoviraI-mediated interleukin-10 gene significantly decreased serum IL-8 concentration and increased serum IL-10 concentration and reduced ventilator-induced lung injury alter MV in group A_1 and A_2 as compared with group B_1 and B_2. Conclusion Adenoviml-madiated IL-10 gene transfection can attenuate the systemic inflammatory response and reduce ventilator-induced lung injury.

Objective To investigate the effects about Tetramethyl -pyrazine (TMP)to Bad, Caspases-1 protein relating with JNK signal transduction pathways on cultured rat hippocampal neurons after anoxia-reoxygenation. Methods Rat hippocampal neurons were cultured in vitro and observed respectively on 7 ~ 9 days. Neurons were exposed to TMP in three different concentration (60,200,800 μg/mL) and JNK inhibitors (10 μmol/L). Control/normal groups were set in each experiment, except for the normal group. After 1 hour of treatment, the rat hippocampal neurons were placed in an incubator with 90%N2 + 10% CO2 for 2 hours to induce anoxia. Then, the rat hippocampal neurons were placed in an incubator with 5% CO2+95%air to establish reoxygenation. Bad, Caspases-1 protein were examined by Western Blot. Results After neurons with 60,200, 800 μg/mL TMP and 10 μmol/L JNK inhibitors on damage induced by anoxia-reoxygenation , the Bad , Caspases-1 protein are lower than the control group. But the 200 μg/mL group is better than 60 800 μg/mL groups. Conclusions Through the JNK signal transduction pathways, the Caspases-1, Bad protein expressions are lower than the control group. So TMP has obvious inhibitory action to rat hippocampal neuronal damage induced by anoxia-reoxygenation.

ObjectiveTo investigate the effect of tertamethylpyrazine on perioperative humoral immune function in patients required for autologous blood transfusion.MethodsSixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-75 kg undergoing elective spinal surgery were randomly divided into 2 groups ( n =30 each):test group and control group.In test group,tertamethylpyrazine 2 mg/kg was infused intravenously over 5 min at 30 min before the autologous blood was collected.Tertamethylpyrazine was added to the heparinized saline and washing saline at the same time (25 mg per 500 ml) until the final concentration reached 0.005 ％.Tertamethylpyrazine was not given in control group.Venous blood samples were taken before anesthesia induction (T0) and at 1 h after operation (T1),and on day 1 and 5 after operation (T2.3) for measurement of serum IgG and IgM concentrations by ELISA.The operation time,intraoperative blood loss and amount of salvaged blood reinfused were recorded.ResultsThere was no significant difference in the operation time,intraoperative blood loss and amount of salvaged blood reinfused between the two groups (P ＞ 0.05).Compared with the baseline value at T0,serum IgG and IgM concentrations were significantly decreased at T1-3 in control group and the serum IgG concentration was significantly decreased at T1.2 in test group ( P ＜ 0.05 or 0.01 ).The serum IgG concentration at T2.3 and serum IgM concentration at T1-3 were significantly higher in test group than in control group ( P ＜ 0.05 or 0.01 ).ConclusionTertamethylpyrazine can reduce humoral immunosuppression to some extent and improve the balance of humoral immunity in patients required for autologous blood transfusion.

Objective To evaluate the perioperative monitoring of adult patients with hepatic encephalopathy under orthotopic liver transplatation (OLT).Methods Combined intravenous and inhalational general anesthesia was used for 18 patients with hepatic encephalopathy from October 2003 to August 2004. Rapid-sequence induction was performed. Propofol, 1 to 1.5 mg/kg, and fentanyl, 4 ?g/kg, were used. Norcuron, 0.1 mg/kg, was added to facilitate tracheal intubation. All patients were subjected to piggyback liver transplantation. Hemodynamics, respiratory, blood gas, blood biochemistry, coagulation function, body temperature, liver and kidney functions, urine output, and bleeding output were monitored during operation. According to the situations of patients, platelet, cryoprecipitate, fibrinogen, coagulation factors and ulinastatin were administrated.Results Eighteen patients tolerated the operation. Only 4 patients died of multiple organ dysfunction syndrome after operation. The survival rate reached was up to 77.8 %. The main blood gas change during perioperative phase was metabolic acidosis and hyposodium, hypokaleamia, hypocalcium. The main hemodynamics change during operation was that HR was increased significantly, and CO was higher than normal value before operation, and CO, CVP, SPAP and DPAP decreased significantly in anhepatic stage. Compared with those before operation, ALT, AST, BUN and Cr were increased significantly in neohepatic stage.Conclusions It is very important to pay more attention to these patients with hepatic encephalopathy during different stages of OLT. Drugs not affecting the function of liver and kidney should be selected. Benzodiazepine should be avoided. Supplementation of coagulation factors, CRBC and electrolyte was necessary. The key point is to protect renal function, maintain enough urine output and treat brain edema.

Objective To investigate the protective effects of ulinastatin on the lungs in patients undergoing lung resection after chemotherapy for lung cancer.Methods Thirty ASA Ⅱ or Ⅲ patients with lung cancer(Ⅲ a)aged 54-71yr weighing 55-74 kg undergoing lung resection after chemotherapy were randomly divided into 2 groups(n=15 each):Ⅰ ulinastatin group received ulinastatin 10 000 U?kg~(-1) after induction of anesthesia and Ⅱ control group received normal saline instead of ulinastatin.The patients were premeditated with intramuscular pothidine 70 mg and scopolamine 0.3 mg or atropine 0.5 mg.Anesthesia was induced with midazolam 0.05 mg?kg~(-1),fentanyl 4 ?g?kg~(-1) propofol 0.5-1.0 mg?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with 1%-2% isoflurane inhalation and vecuronium infusion at 0.06-0.08 mg?kg~(-1)?h~(-1).Blood samples were taken after induction of anesthesia(T_1,baseline),at 40 and 90 rain of one-lung ventilation(T_2,T_3) for determination of serum IL-6,IL-8,IL-10 and TNF-? concentrations.Lung specimen was taken from the operated lung at 90 min of one-lung ventilation for microscopic examination with light and electron microscopo.Results Serum IL-6,IL-8,IL-10 and TNF-? concentrations were all significantly increased during one-lung ventilation as compared to the baseline values at T_1 in both groups.Serum IL-6,IL-8 and TNF-? concentrations were significantly lower while Serum IL-10 concentration was significantly higher in ulinastatin group than in control group during one-lung ventilation(P＜0.05).The histopathologic changes of lung tissue were significantly less in group utinastatin than in group control.Conclusion Ulinastatin can effectively protect the lung in patients with lung cancer after chemotherapy by reducing systemic inflammatory response.

Objective The aim of this study was to determine the effective concentration of epidural ropivacaine for analgesia in 50% of parturients (EC50) in the first stage of labor. Methods Thirty-three ASA Ⅰ -　Ⅱ nulliparous women with 2-3 cm cervical dilatation who requested epidural analgesia were enrolled in the study. Epidural catheter was placed at L3-4 and advanced for 3-4 cm in the epidural space in a cephalad direction. 20 ml of ropivacaine solution of which the EC50 was being tested was given through the catheter into epidural space. The EC50 was determined by up-and-down sequential experiment. The initial concentration of the epidural ropivacaine being tested was decided to be 0.15% . If effective the next parturient received ropivacaine of a lower concentration; if ineffective the concentration of ropivacaine was increased in the next parturient. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . Analgesia was assessed by VAS score (1-10) . If VAS score was less than 3 within 30 min of ropivacaine administration, analgesia was defined as effective.Results Among the 33 parturients enrolled, three were excluded from the study because of uncertain analgesic efficacy. The results showed that the EC50 of epidural ropivacaine for analgesia in the first stage of labor was 0.063% [95% confidence interval (CI) was 0.05972%-0.06688%] .Conclusion The EC50 epidural ropivacaine for analgesia in the first stage of labor is 0.063 % determined by sequential experiment method.

The teaching methods in anesthesiology practice to traditional Chinese medicine students was discussed.Watching for the first step, then simulation and manipulation on patients should be abided by. Paying more attention to patients’ safety and avoiding any fault to patients should be emphasized . The one to one and hand by hand teaching method should also be used to train the students' clinic thought and practical ability.

Medical moral education is a most important component of clinical practice teaching.In the department of anesthesiology,the success of medical moral education depends on the participation and concerne of the head of this department,At the same time,we should ask the clinical practice teacher to train the medical students to take the patients as the center and dedicate themselves to the duty of their profession.

Objective To investigate the effect of tetramethylpyrazine pretreatment on the expression of cfos and heat shock protein (HSP70) during hypoxia-reoxygenation (H/R) in cultured fetal rat hippocampal neurons. Methods After the neurons were cultured and identified, they were randomly divided into 5 groups ( n = 24each): control group (group C), H/R group, and low, median and high concentration of tetramethylpyrazine pretreatment groups (group L, M and H). The neurons were exposed to 2 h of hypoxia followed by 24 h of reoxygenation. Tetramethylpyrazine was added with the final concentrations of 60, 200 and 800 μg/ml in group L, M and H respectively, and then the neurons were incubated for 1 h before H/R. The apoptosis rate, cell viability and expression of c-fos and HSP70 were detected. Results The cell viability was significantly lower, while the apoptosis rate was significantly higher in group A/R, L and H than in group C (P ＜0.01). The cell viability and HSP70expression were significantly higher, while the apoptosis rate and c-fos expression were significantly lower in group L, M and H than in group A/R, and in group M and H than in group L (P＜ 0.05). The cell viability and HSP70expression were significantly lower, while the apoptosis rate and c-fos expression were significantly higher in group H than in group M ( P ＜ 0.01 ).Conclusion The mechanism by which tetramethylpyrazine pretreatment inhibits the apoptosis in cultured fetal rat hippocampal neurons during H/R may be related to the dowm-regulation of c-fos expression and up-regulation of HSP70 expression.

Objective To investigate the effect of ulinastatin on the postoperative immune function of effective T-lymphocytes (Teff cells) and regulatory T-lymphocytes (Treg cells) in the peripheral blood in patients undergoing laparoscopic operation.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,weighing 45-65 kg,scheduled for elective laparoscopic operation for infertility,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ulinastatin group (group U).At 15 min before induction of anesthesia,ulinastatin 200,000 U (in 100 ml of normal saline) was infused intravenously in group U,while the equal volume of normal saline was infused instead in group C.Anesthesia was induced with iv injection of fentanyl,propofol,and cisatracurium and maintained with iv infusion of propofol and sevoflurane.Before surgery (T0),at the end of surgery (T1) and on 1st and 3rd days after surgery (T2.3),venous blood samples were collected from the peripheral blood for determination of the expression of Teff cells (CD4 + CD25-) and Treg cells (CD4 + CD25+) and serum interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β) concentrations (by ILISA).Teff/Treg and IFN-γ/TGF-β ratios were calculated.Results Compared with the baseline value at T0,the expression of Treg cells was significantly up-regulated,and Teff/Treg ratio was decreased at T2 and T3 in group C,and the expression of Teff cells was up-regulated at T3 (P ＜ 0.05 or 0.01),while no significant difference was found in the expression of Treg cells and Teff/Treg ratio at T3 in group U (P ＞ 0.05).Compared with group C,the expression of Teff cells was significantly up-regulated at T3,the expression of Treg cells was down-regulated and Teff/Treg ratio was increased at T2 and T3,the concentration of serum TGF-β was decreased and IFN-γ/TGF-β ratio was increased at T2 and T3 in group U (P ＜ 0.05 or 0.01).No significant changes were found in the serum IFN-γ and TGF-β concentrations and IFN-γ/TGF-β ratio at each time point in the two groups (P ＞ 0.05).Conclusion Ulinastatin can enhance the immune function of Teff cells in the peripheral blood and decrease the immune function of Treg cells,thus maintaining the balance of the postoperative cellular immune function in patients undergoing laparoscopic operation.