Objective To determine the effect of of thoracic epidural block on arterial oxygenation and intrapulmonary shunt during one-lung ventilation(OLV).Methods Twenty-four ASA class I - Ⅱ patients undergoing prolonged periods of OLV during elective general thoracic surgery were divided into two groups: general anesthesia group(GA)(n=12) and general anesthesia + epidural block group(GE, n = 12). The patients were premedicated with only scopolamine 0.3mg. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein under local anesthesia. Epidural block was performed at T7-8or T8-9 and a catheter was inserted and advanced in the epidural space cranially for 3.5-4 cm. General anesthesia was induced with propofol l.5mg?kg-1, fentanyl 3?g?kg-1 and vecuronium 0.1 mg?kg-1. Right or left-sided double-lumen endobronchial tube was placed blindly and the correct position was determined by a combination of unilateral clamping and unclamping and auscultation of the lungs. In GA group anesthesia was maintained with continuous infusion of propofol (150-200 ?g?kg-1?min-1 ) and intermittent IV boluses of fentanyl and vecuronium. BIS was maintained at 45-50. In GE group anesthesia was maintained with infusion of propofol(80 - 120 ?g?kg-1?min-1 ) and epidural block (a loading dose of 0.5% ropivacaine 7-9ml followed by epidural infusion of 0.5% ropivacaine 3-5 ml?h-1) .The patients were mechanically ventilated. VT = 8-10 ml?kg-1, FiO2 = 1, I: R = 1:1.5 and respiratory rate was adjusted to maintain PET CO2 at 35-45 mm Hg. During OLV the above parameters were maintained. ECG, HR, MAP, MPAP, CVP, continuous cardiac output, BIS and TOP were continuously monitored during operation. Blood samples were taken from radial artery and S-G catheter for blood gas analysis at following intervals: (1) during spontaneous breathing when the patients was a wake (baseline); (2) when the patient was placed in lateral position and the two lungs were being ventilated for 30 min(TLV 30 I) ; (3) 5,15, 30 and 60 minduring the course of OLV; (4) the two lungs were ventilated again for 30 min (TLV 30II) andQs/Qt was calculated. Results Venous admixture increased significantly after induction of anesthesia and during mechanical ventilation and increased further during OLV as compared with the baseline(P

Objective To compare the effects of isoflurane and propofol on arterial oxygenation and intrapulmonary shunt during one-lung ventilation (OLV) when combined with continuous thoracic epidural block. Methods Twenty-four ASA Ⅰ -Ⅱ patients with normal ventilatory function undergoing elective thoracic surgery were enrolled in this study. Patients with abnormal cardiac, liver or kidney function were excluded. The patients were premedicated with scopolamine 0. 3mg I. M. .Epidural block was performed at T7-8 or T8-9 . An epidural catheter was placed and its position confirmed by epidural 1% lidocaine 5 ml. General anesthesia was induced with propofol l.5mg?kg-1, fentanyl 3?g?kg-1 and vecuronium 0.lmg?kg-1 . Double-lumen catheter was inserted and its correct position was confirmed by a combination of unilateral lung ventilation and auscultation in both supine and lateral position. The patients were mechanically ventilated. Tidal volume was set at 8-10 ml?kg-1, FiO2 = 1, I:E=1:1.5, RR=10-12bpm and PETCO2 was maintained between 35-45 mm Hg. The parameters remained unchanged during one-lung ventilation. The patients were assigned to one of two groups : propofol group and isoflurane group. Anesthesia was maintained with propofol infusion in propofol group and isoflurane inhalation in isoflurane group and BIS was maintained at 45-55. A bolus of 0.5 % ropivacaine 7-9ml was given epidurally followed by 0.5% ropivacaine infusion at a rate of 3-5ml?h-1 in both groups during maintenance of anesthesia. Besides ECG, BP and BIS, continuous cardiac output(CCO Baxter) was monitored during operation. Blood samples were taken from radial artery and pulmonary artery simultaneously before anesthesia when patients were lying supine and breathing spontaneously (T0 ), in lateral position when both lungs were ventilated (T1 ), at 5,15, 30, 60 min of one-lung ventilation(T2-5 ) and when both lungs were ventilated again for 30min(T6) for blood gas analysis. Qs/Qt was calculated.Results (1) The two groups were comparable with respect to demographic data. Propofol infusion was maintained at 4-6 mg?kg-1?h-1 in propofol group and end-tidal isoflurane was maintained between 0.3%-0.5% in isoflurane group. (2) Venous admixture increased significantly at T1 and further increased after T2 and reached its peak at T3(31.1% ?4.2%) in propofol group and at T4 (33.5% ? 7.8% ) in isoflurane group. Shunt fraction was significantly lower in propofol at T4-5 than that in isoflurane group. (3) PaO2 decreased significantly during OLV in both groups, but there was no significant difference in PaO2 between the two groups. Conclusions When combined with thoracic epidural block, intravenous propofol infusion exerts less effect on intrapulmonary shunt than isoflurane inhalation during OLV but there was no significant difference in arterial oxygenation between the two groups.

Objective To investigate the changes in oxygenation and intrapulmonary shunt duringprolonged one-lung ventilation (OLV) and compare the effects of four different anesthetic techniques. MethodsForty ASAⅠ -Ⅱ patients (27 male, 13 female) aged 36-74 yr undergoing prolonged OLV during elective thoracicsurgery were randomly allocated to one of four groups: (1) isoflurane (GI, n = 10); (2) isoflurane + epidural(GIE, n =10); (3) propofol (GP, n = 10); (4) propofol + epidural (GPE, n = 10). Radial artery wascannulated and Swan-Ganz catheter was placed via right internal jugular vein before induction of general anesthesia.In group 2 and 4 an epidural catheter was inserted at T_(7-8) or T_(8-9) and advanced 3 .5-4.0 cm in the epidural spacecephalad. Epidural block was produced by a bolus of 0.5 % ropivacaine 7-9 ml followed by continuous infusion of0. 5 % ropivacaine at 3-5 ml?h~(-1). Anesthesia was induced with propofol 1 .0-1. 5 mg?kg~(-1), fentanyl 3?g?kg~(-1) andvecuronium 0. 1 mg?kg~(-1). A left-sided double-lumen tube was inserted and correct position was confirmed. Thepatients were mechenically ventilated. The ventilation collditions were FiO_2 = 100 %, V_T = 8-10 ml?kg~(-1), I: E =1: 5 and respiratory rate was adjusted to maintained P_(ET) CO_2 at 35-45 mm Hg during both two-lung ventilation(TLV) and OLV. Anesthesia was maintained with isoflurane inhalation in group 1 and 2 or continuous infusion ofpropofol in group 3 and 4 supplemented with intermittent i. v. boluses of fentanyl. MAP, HR, ECG, MPAP,CVP, continuous cardiac output (CCO), BIS and TOF were continuously monitored during anesthesia. BIS was maintained at 45-55. Arterial and pulmonary blood gases were analyzed before induction of anesthesia (T_1), 30min after TLV was started (T_2 ), and 5, 15, 30, 60, 120 and 180 min after OLV was started (T_(3-8)) and 30 minafter TLV was resumed (T_9 ). The Qs/Qt (shunt fraction) was calculated at T_(1-9) Results Qs/Qt was significantlyincreased after induction of general anesthesia and mechanical ventilation and increased further during OLVcompared with the baseline value (T_1) in all four groups. The calculated Qs/Qt values were highest at 15 min (T_4)or 30 min (T_5) of OLV and remained high for 30-60 min and then gradually decreasing. During OLV QS/Qt washigher in group 1 than in the other three groups (P0.05). Cardiac output was significantly higher in group 1 and 2 than thatin group 3 and 4 during OLV. Conclusion During prolonged OLV intrapulmonary shunt tends to decrease withincreasing oxygenation with time, regardless of anesthetic techniques employed. Isoflurane inhalation is associatedwith a signifficant increase in shunt fraction. Combined general and epidural anesthesia may induce greaterhemodynamic changes.

Objective To assess the influence of upper thoracic epidural anesthesia (TEA) on systemic oxygen supply-demand relationship during one-lung ventilation (OLV). Methods Twenty ASA Ⅰ-Ⅲ patients undergoing elective esophageal surgery were randomly divided into 2 groups : group Ⅰ general anesthesia (GI n = 10) and group Ⅱ combined general-epidural anesthesia (GIE n = 10). In both groups anesthesia was induced with propofol 1.5-2.0 mg?kg-1, fentanyl 3 ?g?kg-1 and vecuronium 0.1 mg?kg-1. The patients were intubated with double-lumen catheter. Correct positioning was verified by auscultation and fiberoptic bronchoscopy. Anesthesia was maintained with isoflurane (1.5-2.0% ) and intermittent i. v. boluses of fentanyl. BIS was maintained at 45-55 during operation. In GIE group epidural puncture was performed at T7-8 or T8-9. The catheter was advanced 3.5-4.0 ml in the epidural space cephalad. 0.5% ropivacaine was infused at 3-5 ml?h-1 during operation. Anesthetic block levels ranged from T2-4 to T10-12 . Radial artery was cannulated for BP monitoring and blood sampling and Swan-Ganz catheter was positioned in the pulmonary artery via right internal jugular vein. ECG, MAP, HR, CVP, continuous cardiac output index (CCI) and BIS were continuously monitored during anesthesia. Arterial and mixed venous blood samples were obtained before induction of anesthesia (T0 ), 30 min after intubation while two lungs were being ventilated (T1) at 15, 30, 60 and 120 min of OLV (T2-3) and 30 min after TLV was resumed (T6 ) . MAP, CVP, cardiac output index (CI) and arterial and mixed venous blood oxygen content were measured and oxygen supply (DO2) and consumption (VO2) were calculated at each time point. Results In GIE group MAP was significantly lower than that in GI group ( P 0.05). At 15, 30 and 60 min of OLV (T2-4) mixed venous oxygen saturation (SVO2 ) was significantly lower while VO2 significantly higher in group GIE than in group GI. Consequently DO2/ VO2 in group GIE was significantly lower than that in group GI. Conclusion Thoracic epidural anesthesia combined with general anesthesia increases oxygen consumption (VO2) and consequently decreases DO2/ VO2 during OLV.

Acupuncture Therapy ; Aged ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Parkinson Disease ; drug therapy ; therapy

Objective:To study the infertility patients' ethical attitude towards the artificial insemination technology,with the aim of its better service for them.Methods:A questionnaire of 220 infertility patients Results:There exists notable difference in infertility patients' attitude towards AIH and AID(P

Biomarkers ; blood ; Brain ; diagnostic imaging ; pathology ; Brain Edema ; etiology ; pathology ; Child ; Diagnosis, Differential ; Electroencephalography ; Guillain-Barre Syndrome ; complications ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging ; Male ; Posterior Leukoencephalopathy Syndrome ; complications ; diagnosis ; therapy ; Radiography

Objective To investigate the effect of ulinastatin (UTI) on the expression of brainderived neurotrophic factor ( BDNF ) and remyelination in mice with experimental autoimmune encephalomyelitis ( EAE).Methods Twenty-four C57BL/6 mice were randomly divided into UTI group (U),normal saline treated group (S) and normal control group (N,n = 8,respectively).Demyelinations in the spinal cord were observed by solochrome cyanin staining.The expression of BDNF,myelin basic protein (MBP),and 2',3 '-cyclic nucleotide 3'-phosphodiesterase (CNP) in brain tissue of each group were evaluated by Western blot.Results Average clinical scores in group U at the 12,13,14,22,23,31,33,34 and 35 days were 0,0.25,0.38,0.63,0.63,0.40,0.40,0.40 and 0.40 respectively.They were significantly lower than group S at the same time ( U= 16.00,15.00,14.50,7.50,0.00,14.50,14.50,12.00 and 14.50,all P ＜0.05).Solochrome cyanin staining showed that demyelination of spinal cord in group U was also significantly improved than group S.Expressions of BDNF ( 1.96 ± 0.29),MBP (2.67 ± 0.48 ) and CNP ( 1.75 ± 0.20) in group U were all significantly higher than group S ( There were 0.80 ± 0.15,1.36 ± 0.38 and 1.06 ± 0.18 respectively,all P ＜ 0.05).Conclusions UTI has protective effect on EAE.The possible mechanism is that it could promote remyelination,and protect oligodendrocytes and neurons in EAE model by increasing BDNF expression in brain.

Objective To observe the effect of Rosuvastatin on the function of vascular endothelial and inflammatory response in patients with acute myocardial infarction ( AMI) after intervention. Methods Seventy-eight patients with AMI patients underwent coronary angiography and PCI treatment The patients were divided into the control group (38 patients) and the Rosuvastatin group (40 patients) after PCI treatment All patients were routinely used nitrates, low molecular weight heparin,aspirin,clopidogrel,the Rosuvastatin group were treated on the basis of conventional medication plus service Rosuvastatin 10 mg/time, once a day. Both groups were continuous medicated for 6 months. Cardiovascular events of all patients, the serum lipids, inflammation-related biomarkers and indicators of vascular endothelial function were followed up for 6 months after discharge. Results The cardiovascular events in the Rosuvastatin group (5. 0% ) was significantly lower than that of the control group (18.4%) after discharge within 6 months (χ2 = 4. 52, P < 0. 05). After 6 months of discharge, the serum lipids, the serum IL-6, hs-CRP,plasma ET-1 and ox-LDL of Rosuvastatin group ((2. 16 ±0. 54)mmol/L,(4. 16 ±0. 28)mmol/L,(6. 80 ± 2. 65) ng/L, (4. 02 ± 1. 58) mg/L, ( 62. 45 ± 9. 38) ng/L and 381. 65 ± 39. 73, respectively) was significantly lower than those of the control group ((2.47 ±0. 59) mmol/L, (5. 29 ±0. 31 )mmol/L, (9. 39 ±4. 17) ng/L, (5. 76 ± 1. 52)ng/L, (81. 75 ± 10. 23) ng/L and 485. 91 ±42. 68,respectively) (t =2. 423,16. 910,3. 291,4. 952,8. 691 and 11. 173 , respectively , P <0. 01 ). The serum NO of Rosuvastatin group ( ( 62. 17 ± 17. 69 ) μmol/L) was significantly higher than than that of the control group ( (48. 27 ±18. 35 ) μmol/L) (t = 3.406, P < 0.01 ) . The serious adverse events were not observed in the Rosuvastatin group. Conclusions Rosuvastatin reduces inflammatory reaction after PCI in patients with AMI, improves endothelial function, and reduces adverse reactions.

Objective To investigate the preventive effects of aspirin on liver metastases of colorectal cancer in mice and study the mechanisms.Methods Twenty BALB/c mice were divided into the control group and the experimental group according to the random number table with 10 mice in each group.Mice in the control group were fed with saline each day at a concentration of 0.2 mL/d for 60 days,while mice in the aspirin group were fed with aspirin each day at a concentration of 30 μg/(g · d) for 60 days.Then C26 colon cancer cells were injected into the spleen and then the spleen was cut to establish mice model of colon cancer liver metastasis.The C26 colon cancer cells were divided into 2 groups.C26 colon cancer cells in the control group remained untreated,and C26 colon cancer cells in the experimental group were treated with aspirin at a concentration of 10 mmol/L for 24 hours.The scratches and transwell assays were conducted to observe the effects of aspirin on the invasion and metastasis of C26 colon cancer cells.The expressions of epithelial-mesenchymal transition (EMT)-related genes were detected using RT-PCR and Western blot.All data were analyzed using the Student t test.The survival curve was drawn by Kaplan-Meier method,and the survival analysis was done by Log-rank test.Results The numbers and weights of hepatic metastatic tumors were 4.8 ± 1.9 and (504 ± 107) mg in the control group and 2.6 ± 1.6 and (362 ± 67) mg in the experimental group,with significant difference between the 2 groups (t =2.840,3.584,P ＜ 0.05).The 1-month survival rate was 80％ in the experimental group,which was significantly higher than 40％ of the control group (x2=4.418,P ＜ 0.05).The results of pathological examination showed that tumor cell heteromorphism was reduced by aspirin.The results of scratches experiment showed an obvious migration of C26 colon cancer cells in the control group at 24 hours later,while no C26 colon cancer cells migrated in the experimental group.The numbers of C26 colon cancer cells penetrated the Watrige were 253 ± 21 in the control group and 148 ± 13 in the experimental group,with significant difference between the 2 groups (t =5.101,P ＜0.05).The relative mRNA expression of the E-cadherin and the Vimentin were 0.002 ±0.001 and 1.005 ±0.286 in the control group and 0.005 ± 0.001 and 0.270 ± 0.168 in the experimental group,with significant difference between the 2 groups (t =-4.606,4.942,P ＜ 0.05).The relative protein expressions of the E-cadherin and the Vimentin were 0.473 ±0.179 and 0.787 ± 0.118 in the control group and 1.585 ± 0.410 and 0.280 ± 0.133 in the experimental group,with significant difference between the 2 groups (t =-5.542,6.355,P ＜ 0.05).Conclusion Aspirin inhibits liver metastasis of colon cancer and promote the survival ratio of mice.Aspirin can up-regulate the expression of E-cadherin and down-regulate the expression of Vimentin,which inhibits EMT and reduces the invasion and metastasis of tumor cells.