ObjectiveTo investigate the clinical effect,suitable dose,and its safety of dezocine combined with propofol used in painless artificial abortion.MethodsWith a completely randomized double blind method,200 cases of ASA Ⅰ or Ⅱ early intrauterine pregnancy patients were divided into A,B,C,and D four groups ( n =50).Each patient in A,B,and C groups was infused dezocine in 0.10,0.15,and 0.20 mg/Kg,respectively.D group was administrated with intravenous fentanyl 1.5 μ g/kg,then 3min later,slowly intravenous injection of 1％ of propofol.MAP,HR,RR,and SpO2 were recorded at the before anesthesia induction (T0 ),loss of eyelash reflex time (T1 ),recovery time (T2),and recovery 10 -min time (T3 ).Meanwhile,the parameters including the anesthesia induction time,anesthesia recovery time,directional force recovery time,induction dosage and total dosage of propofol,and the intraoperative and postoperative analgesic efficacy and adverse reaction were compared among different groups.Results For the A and D groups,MAP,HR,RR,and SpO2 at the T1 were all lower than that at the T0 ( P ＜0.05).For the B group,MAP and HR at the T1 were lower than that at the T0 ( P ＜ 0.05).The anesthesia recovery time and orientation recovery time in the B and C groups were significantly shorter than A and D groups ( P ＜ 0.05 ),and significantly statistical difference was found between A and D groups,no statistical difference between B and C groups ( P ＞ 0.05).The propofol induction dosage and total dosage were different among groups ( groups C ＜ B ＜ D ＜ A) with a statistical significance ( P ＜ 0.05 ).The intraoperarive analgesia effect,postoperative pain score grading,and intraoperative body dynamic reaction rates in the B and C groups were significantly different from the A and D groups ( P ＜ 0.05 ),and no statistical significance was found between B and C groups ( P ＞ 0.05 ).The respiratory inhibition,postoperative nausea,vomiting and other adverse reaction rates in the B and C groups were significantly lower than those in A and D groups ( P ＜ 0.05),and those parameters in B group were lower than C group.ConclusionsDezocine combined with propofol is definitely effective and very safe in painless induced abortion with very less respiratory inhibition,nausea,vomiting,and other adverse reactions; and their optimal dosage is 0.15 mg/kg.

Objective To investigate the clinical application of remifentanil in awake state for removal of tumors in functional brain area. Methods Twenty-four patients with tumors in functional brain area were divided into two groups by random digits table with 12 cases each:control group and remifentanil group. Infiltration anesthesia was used in all patients with 0.2% ropivacaine. Remifentanil was injected intravenously with micropump in 0.05-0.10 μg/ (kg·min) in remifentanil group and 0.9% sodium chloride was instead of remifentanil in control group. Patients remained awake during surgery in both groups. The hemodynamic changes and complications during operation were monitored. The satisfaction for surgical procedure was evaluated. Results The patients in two groups could be completed in awake state with surgery;mean artery pressure, heart rate in remifentanil group during opening or closing skull or intracranial period were significantly higher than those in control group(P< 0.05). There were no conspicuous complication in two groups such as respiratory depression, nausea, vomitting and dysphoria. The satisfaction score in remifentanil group[(3.3 ?0.6) scores] was higher than that in control group[(2.4 ?0.5) scores],there was significant difference between two groups (P<0.05). Conclusion Awake brain tumor surgery could be completed in rational use of remifentanil on the base of good local anesthesia, and hemodynamics are stable and the patients are well tolerated.

Objective To study the protective effects of propofol pretreatment on ischemia-reperfusion injury in rabbit heart. Methods Forty New Zealand white rabbits (40 male, weighting 2. 5 ± 0. 36kg) were randomly assigned to 4 groups, including sham operation group, ischemia reperfusion (IR)group, IR + ischemia preconditioning (IP) group and IR + Propofol preconditioning (PP) group (n =10 each). The myocardial ischemia-reperfusion model of rabbits was established by coronary artery ligation.The levels of high energy phosphates (ATP, ADP and AMP) in myocardial tissue were measured by HPLC.The activities of serum lactate dehydrogenase (LDH), serum creatine kinase-MB (CK-MB) superoxide dismutase (SOD) and malondiadehyd (MDA) in myocardial tissue were assayed. Results The content of ATP, ADP, AMP, and the activity of SOD in PP group and IP group were higher than that of IR group, and the content of LDH, MDA and CK-MB in injured myocardial tissue in PP group and IP group were obviously lower than that of IR group (P ＜0. 05, P ＜0. 01). No difference was found in PP group and IP group(P＞0. 05). Conclusion Propofol preconditioning as well as ischemia preconditioning protected the myocardial tissues from the ischemia-reperfusion injury by improving the myocardial energy metabolism, the debasement of the oxyradical level and the antagonism the reaction of lipid peroxides.

Objective To compare the diagnostic efficacy of the V/Q scan and CT pulmonary angiography (CTPA) for the detection of acute pulmonary embolism (PE) in elderly patients.Methods Fortyfour patients (age ≥60 years old) with suspected acute PE underwent V/Q scan and CTPA.The diagnosis of PE by V/Q scan was based on the criteria of prospective investigation of PE diagnosis (PIOPED) Ⅱ and the prospective investigative study of acute PE diagnosis (PISA-PED).The final diagnosis was made clinically.The sensitivities,specificities and accuracies of PIOPED Ⅱ,PISA-PED,CTPA and Wills score were calculated and compared using x2 and Fisher's exact tests.Kappa analysis was used to analyze the diagnostic accordance rate of PIOPED Ⅱ and PISA-PED.Results The sensitivities of PIOPED Ⅱ,PISA-PED and CTPA in the diagnosis of PE were 70.00％ (14/20),84.62％ (22/26) and 65.22％ (15/23),respectively (x2 =0.069-1.545,all P＞0.05).The sensitivity of Wills score was significantly lower (23.08％,3/13).The specificity of CTPA (93.75％,15/16) was significantly higher than those of PIOPED lⅡ and PISAPED (80.00％,12/15 and 61.11％,11/18,both P＜0.05).The accuracies of PIOPED Ⅱ,PISA-PED and CTPA were 74.29％ (26/35),75.00％ (33/44) and 76.92％ (30/39),respectively (x2 =0.005-0.070,all P＞0.05).The accuracy of Wills score was significantly lower (52.17％,12/23).The diagnostic accordance rate of PIOPED Ⅱ and PISA-PED criteria was 77.14％(27/35),Kappa=0.547,P＜0.05.Conclusion V/Q scan and CTPA have no significant difference for the diagnosis of PE in the elderly patients.

Objective To investigate the expression of Fas antigen (Fas) and ligand (FasL), placental growth factor (PlGF) in placenta of pregnant women with pre-eclampsia. Methods Expressions of Fas, FasL and PlGF of placenta were determined by immunohistological streptavidin-peroxidase-biotin (SP) method and compared between normal late pregnancy (24 cases) and mild pre-eclampsia (24 cases) and severe pre-eclampsia (24 cases) groups. Results Different expression of levels Fas, FasL and PlGF were observed in the trophoblasts of most placentae. Positive immunostain of Fas, FasL and PlGF was mainly located in the cytoplasm and membrane of syncytiotrophoblast. FasL and PlGF expressions (63?4, 81?6 and 42?6, 65?6) were significantly less (P

Objective:To investigate the effects of chronic exposure to low concentration sevoflurance on hippocampus in SD fetal rats.Methods:Totally sixty female SD rats at clean grade weighing 240-260 g were randomly divided into four groups , the control group and sevoflurane groups (n=15).The three experimental groups were respectively treated with 30 mg· L-1(parts permillion1 × 10 -6), 100 mg· L-1 and 300 mg· L-1 sevoflurane with 6-hour inhalation, qd for 2 weeks, while the control group breathed fresh air with the same volume .After mating conception , the rats inhaled the same concentration sevoflurane or air till scarification on the 19 th day.Half of brain in the fetal rats was withdrawn to prepare the paraffin specimens , and immunohistochemistry was used to detect the apoptosis in hippocampal CA 1 region associated with protein Bcl-2 and Bax.The hippocampus was stripped from the other half of brain and 10%homogenate was prepared, and the activity level of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) were detected.Results:Bcl-2 in hippocampus CA1 region in 300 mg· L-1 group was lower than that in the control group , while Bax was higher than that in the control group (P<0.05);SOD was lower in 300mg· L-1 group than that in the control group , and MDA was higher than that in control group (P <0.05) .The other two sevoflurane groups had no differences when compared with the con-trol group (P >0.05).Conclusion:Low concentration inhalation of sevoflurane above 300mg· L-1 can enhance the cell apoptosis in hippocampus through increasing the oxidative stress reaction in embryonic brain of SD rat resulting in excessive MDA and reduced SOD.

Objective:To evaluate the effects of stellate ganglion block (SGB) on the activation of M1 microglia during cerebral ischemia-reperfusion (I/R) in rats.Methods:Fifty-four SPF healthy male Sprague-Dawley rats, aged 8-10 weeks, weighing 240-270 g, were divided into 3 groups ( n=18 each) using a random number table method: sham operation group (group Sham), cerebral I/R group (group IR) and SGB group.Blood vessels were only exposed, without occlusion in group Sham.Cerebral I/R was induced by occlusion of the middle cerebral artery for 90 min followed by reperfusion in group IR.Cervical sympathetic trunk transaction was performed to induce left SGB immediately after onset of reperfusion in group SGB.Blood samples were collected from the apex of the heart at 6, 12 and 24 h of reperfusion for determination of the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β in the serum (using enzyme-linked immunosorbent assay). The animals were sacrificed after the neurological function was evaluated at 24 of reperfusion, and brain tissues were removed for microscopic examination of the pathological changes in cortex, for determination of percentage of cerebral infarct size (by TTC staining), for assessment of cell apoptosis and apoptosis rate in cortex (by TUNEL), and for determination of the expression of microglial biomarker Iba-1 and activated M1 microglia biomarker CD68 (by Western blot). Results:Compared with group Sham, the neurological function score, percentage cerebral infarct size, apoptosis rate in cortex, concentrations of TNF-α, IL-6 and IL-1β in the serum, and the expression of Iba-1 and CD68 were significantly increased in IR and SGB groups ( P<0.05). Compared with group IR, the neurological function score, percentage cerebral infarct size, apoptosis rate in cortex, concentrations of TNF-α, IL-6 and IL-1β in the serum, and the expression of Iba-1 and CD68 were significantly decreased in group SGB ( P<0.05), and the pathological changes of brain tissues were significantly attenuated in group SGB. Conclusion:The mechanism by which SGB reduces cerebral I/R injury is related to inhibiting activation of M1 microglia in rats.

Objective Summarize the experiences of treating after-operation ventricular electrical storm (VES) with extra-corporeal membrane oxygenation (ECMO) .Methods Examine the clinical data of seven cases of treating after-operation VES with ECMO from January 2013 to April 2014 and analyze the basic pre-operation conditions of the patients ,diagnoses ,causes of VES ,ai-ding processes with ECMO ,and prognoses .Results Seven patients all were successfully separated from the machine after the treat -ment ,one patient infected seriously after being separated from the machine ,having multiple organ failure one week later and dis-charged voluntarily ;one patient having cerebral hemorrhage two days later after being separated from the machine and discharged voluntarily ;the remaining five patients cured and discharged with no complications .Conclusion ECMO can provide effective circu-lar support to patients suffering VES after heart operation ,maintaining coronary blood supply ,avoiding further myocardial damage , stabilizing electrolytes and the internal environment ,and gain time for restoration of heart rhythm and treatment according to the causes and triggers .

BACKGROUND: Studies have shown that propofol enables a reduction in the number of adult rat mesenchymal stem cells, while the cell differentiation is also significantly inhibited. OBJECTIVE: To explore whether liver X receptors (LXRs) can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells. METHODS: Fifteen healthy C57/BL6 mice were randomized into three groups, 5 of which served as blank control group (intraperitoneally treated with normal saline), 5 as propofol treatment group (intraperitoneally treated with 60 mg/kg propofol), and 5 as propofol + LXRs agonist treatment group (intraperitoneally injected with 10 μL/g LXRs at the 1st day, and then injected with 60 mg/kg propofol at the 2nd day). The mice in the three groups were killed at 1-3 hours after treatment to isolate and culture bone marrow mesenchymal stem cells. Cell counting kit-8 and cloneformation assay were used to evaluate the abilities of cell proliferation and self-renewal; induced differentiation experiments in vitro were used to evaluate the differentiation ability of cells into adipocytes, osteoblasts and chondrocytes; real-time quantitative PCR was used to detect the expression of differentiation related molecules andNotch signal. RESULTS AND CONCLUSION: In the propofol-treated mice, cell viability and clone forming ability as well as adipogenic, osteogenic and chondrogenic differentiation of cells decreased significantly compared with the blank control group (P <0.05), while LXR agonists could reverse these effects significantly (P < 0.05). Notch signal expressions showed no difference among three groups prior to induced differentiation. The expression levels differentiation related molecules downregulated significantly after propofol treatment (P < 0.05), but upregulated significantly after treatment with LXR agonists (P < 0.05). Notch signaling inhibitor treatment could significantly inhibit the multi-directional differentiation of bone marrow mesenchymal stem cells in the three groups. All these findings indicate that activated LXRs can reverse the inhibitory effects of propofol on bone marrow mesenchymal stem cells.

In recent years, more and more studies have shown that myeloid-derived suppressor cells (MDSCs) participate in the development and progression of various chronic liver diseases including chronic viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, autoimmune liver diseases, and liver cancer. As a type of cells derived from bone marrow progenitor cells and immature myeloid cells, MDSCs play an important role in the development, progression, and repair of liver diseases by regulating inflammatory response and the differentiation and function of immune cells. This article reviews the research advances in the association between MDSCs and various liver diseases, in order to provide new thoughts for the clinical diagnosis, prognosis, and treatment of chronic liver diseases.