Objective To evaluate the effects of a single IV lidocaine bolus dose on the minimal alveolar concentration (MAC)of sevoflurane. Methods Patients (n=90), aged 25-65 years whose Anesthesiologists (ASA) classification wasⅠorⅡand underwent elective surgery on trunk under general anesthesia, were randomly divided into 3 groups with 30 cases in each group:high-dose lidocaine group (group H), low-dose lidocaine group (group L) and control group (group C). They were induced by sevoflurane inhalation, and ventilated by LMA (laryngeal mask airway). After a 15 minutes equilibration period with the above sevoflurane concentration , the medication to be studied (2%lidocaine 1.5 mg/kg for group H , 2%lidocaine 0.75 mg/kg for group L, 0.9%saline 5mL for group C) was administered for 3 minutes before the skin incision. The response to skin incision (movement versus no movement) was recorded in the first minute after skin incision. The MAC for sevoflu?rane was determined using the Dixon′s up and down method. Values of mean arterial pressure (MAP), heart rate (HR), and BIS were recorded at 1 minute and 5 minutes after being monitored (average values were noted as T0), immediately before the administration of medication (T1), immediately before the skin incision (T2) and 1 minute after the skin incision(T3). Results MAC in group H (2.00%± 0.17%) was lower than that in group C (2.22%± 0.18%) by approximately 0.22%,and which was lower than that of group L ( 2.21%± 0.14%) by approximately 0.21%(F=7.054,P<0.05). No significant differ?ence in the MAC of sevoflurane was noted between group L and group C. The values of HR, MAP and BIS all decreased at T 2 and increased at T3 in all 3 groups (all P<0.05). No significant difference in HR, MAP or BIS was observed between T0 and T1 in all three groups. The values of HR and BIS were lower in group H than those in group C and group L at T2 and T3. The values of MAP were lower in group L and group H than those in group C at T2 and T3. The value of MAP were lower in group H than that in group L at T2(all P<0.05). Conclusion A singleⅣ1.5 mg/kg lidocaine decreases MAC of sevoflurane, but the decreased amplitude (11%) does not reach expectation.

Objective To investigate the influence of gender on the enmcement of neuromuscular blocking effects of cisatracurium or rocuronium by sevoflurane. Methods Two hundred and forty ASA Ⅰ or Ⅱ patients, aged 20-60 yr, weighing 45-85 kg, scheduled for elective surgery under general anesthesia were assigned into 2 groups ( n = 120 each): cisatracurium group and rocuronium group. Each group were divided into 4 subgroups according to gender and anesthetics ( n = 30 each): female propofol group, male propofol group, female sevoflurane group and male sevoflurane group. Anesthesia was induced with midazolam, propofol and fentanyl. After loss of consciousness, the laryngeal mask was inserted and the patients were mechanically ventilated. Propofol groups received target-controlled infusion (TCI) of propofol (target plasma concentration 2-6 μg/ml), and sevoflurane groups inhalation of sevoflurane. Cisatracurium 0.15 mg/kg or rocuronium 0.6 mg/kg was injected intravenously 5 min after propofol infusion or after the end-tidal concentrion of sevoflurane was maintained at 1.71% (1 MAC) for 5 min. Neuromuscular block was assessed with accelerograph F (TOF-watch SX). Train-of-four (TOF) stimulation of ulnar nerve was used. The onset time, duration of peak effect and times for recovery of T1 to 25% and TOF ratio (TOFR) to 25% were recorded.Results Compared with propofol groups, the time for recovery of TOFR to 25 % for rocuronium, and the duration of peak effect and times for recovery of T1 to 25 % and TOFR to 25% for cisatracurium were significantly prolonged in female sevoflurane group, the onset time of rocuronium was significantly shortened, while the duration of peak effect and times for recovery of T1 to 25% and TOFR to 25% for rocuronium and cisatracurium were significantly prolonged in male sevoflurane group ( P ＜ 0.05 or 0.01 ). The times for recovery of T1 to 25% and TOFR to 25% for rocuronium and onset time of cisatracurium were significantly shorter in female than in male during sevoflurane anesthesia (P ＜ 0. 05 or 0.01 ). Conclusion The enhancement of rocuronium-induced neuromuscular block by sevoflurane is stronger in male than in female,but there is no gender variation in the enhancement of cisatracurium-induced neuromuscular block by sevoflurane.

Objective To investigate the effects of dexmedetomidine on serum inflammatory factor and oxidative stress response in septic rats.Methods Thirty healthy male SD rats,aged 10-14 weeks,weighing 250-300 g,were randomly divided into 3 groups( n =10 each): sham operation group (group S),sepsis group (group CLP) and sepsis + dexmedetomidine group (group CLP + D).Sepsis was induced by cecal ligation and puncture in groups CLP and CLP + D.Group CLP + D received intravenous infusion of dexmedetomidine at 10 μg· kg- 1 ·h- 1 from the end of operation until dead or 12 h after operation.Groups S and CLP received equal volume of normal saline at 1 ml·kg-1 ·h-1.Arterial blood samples were taken from 5 rats in each group before (basline) and at 1,6 and 12 h after operation for determination of serum IL-6,IL-10,SOD and MDA levels.The survival rate within 12 h after operation was recorded.Results Compared with group S,serum IL-6,IL-10 and MDA concentrations at 1,6 and 12 h after operation were increased,while serum SOD activity at 1,6 and 12 h after operation and survival rate were decreased in group CLP ( P ＜ 0.05 ).Compared with group CLP,serum IL-6 and MDA concentrations at 6 and 12 h after operation were decreased,while serum SOD activity at 12 h after operation and survival rate were increased in group CLP + D ( P ＜ 0.05 ).Conclusion Dexmedetomidine can increase the survival rate of septic rats by inhibiting inflammatory factor release and oxidative stress response.

ObjectiveTo evaluate the efficacy of preoperative oral pregabalin for attenuating postoperative pain after laparoscopic cholecystectomy.MethodsIn this prospective,randomized controlled double-blind study,sixty ASA Ⅰ or Ⅱ patients aged 19-72 yr weighing 46-86 kg undergoing laparoscopic cholecystectomy were randomly divided into 2 groups ( n =30 each):control group (group C) received placebo,and pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery.Anesthesia was induced with propofol,fentanyl and rocuronium and maintained with sevoflurane inhalation and intermittent iv boluses of fentanyl and rocuronium.The patients were intubated and mechanically ventilated.BIS value was maintained at 40-50 during operation.Static and dynamic VAS score,Ramsay score and consumption of morphine were recorded at 6,12,and 24 h after surgery.Side-effects including nausea,vomiting,headache and dizziness were also recorded.ResultsStatic and dynamic VAS scores and morphine consumption were significantly lower during the first 24 h after surgery while Ramsay scores were higher at 6 h after operation in group P than in group C.There was no significant difference in the incidence of side-effects between the 2 groups.No over-sedation occurred in group P.ConclusionPreoperative oral pregabalin 150 mg is safe and effective in reducing postoperative pain after laparoscopic cholecystectomy.

Objective To evaluate the relationship between extracelluar signal?regulated protein kinase 1∕2 (ERK1∕2) and signal transducer and activator of transcription 3 (STAT3) signaling pathways involving in cardioprotection induced by diazoxide postconditioning in rats. Methods Sixty adult male Sprague?Dawley rats, aged 3 months, weighing 240-260 g, were randomly divided into 5 groups ( n=12 each) using a random number table: sham operation group ( SH group ) , ischemia?reperfusion ( I∕R ) group, diazoxide postconditioning group ( D group ) , ERK1∕2 inhibitor U0126 group ( U group ) , and STAT3 inhibitor Stattic group ( St group) . Myocardial I∕R was produced by occlusion of anterior descending branch of the coronary artery followed by 120 min reperfusionIn I∕R and D groups, 0?4% dimethyl sulfoxide 1 ml and 7 mg∕kg diazoxide ( in 1 ml of 0?4% dimethyl sulfoxide) was injected through the femoral vein at the onset of reperfusionIn U and St groups, U0126 100 μg∕kg and Stattic 500 μg∕kg were injected through the femoral vein at 10 min before reperfusion, and the other procedures were similar to those previously described in group DAt 120 min of reperfusion, the rats were sacrificed, and myocardial specimens were obtained from the left ventricle for determination of myocardial infarct size, cell apoptosis, and ERK1, ERK2 and STAT3 mRNA expression ( real?time PCR), and phosphorylated ERK1∕2 ( p?ERK1∕2) and phosphorylated STAT3 (p?STAT3) (using Western blot). Apoptosis index (AI) was calculated. Results Compared with group S, the myocardial infarct size and AI were significantly increased, and the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was down?regulated in group I∕R. Compared with group I∕R, the myocardial infarct size and AI were significantly decreased, and the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was up?regulated in group D. Compared with group D, the myocardial infarct size and AI were significantly increased in U and S groups, the expression of ERK1, ERK2 and STAT3 mRNA, p?ERK1∕2 and p?STAT3 was down?regulated in group U, and the expression of STAT3 mRNA and p?STAT3 was down?regulated, and no significant change was found in ERK1 and ERK2 mRNA and p?ERK1∕2 expression in group S. Conclusion STAT3 signaling pathway is located downstream of ERK1∕2 signaling pathway in the mechanism by which diazoxide postconditioning reduces myocardial I∕R injury in rats.

Objective To evaluate the role of signal transducer and activator of transcription 3 (STAT3) signal transduction pathway in diazoxide cardioplegic solution-induced reduction of ischemia-reperfusion (I/R) injury in isolated rat hearts.Methods Sixty adult male Sprague-Dawley rats,aged 2-3 months,weighing 240-260 g,were used in this study.Their hearts were excised and perfused in a Langendorff apparatus and then randomly divided into 5 groups (n=12 each):control group (group C),group I/R,cardioplegic solution group (group P),diazoxide cardioplegic solution group (group DZX),and STAT3 signal transduction pathway blocker Stattic group (group Stattic).The hearts were continuously perfused for 90 min after 15 min of equilibration in group C.Perfusion was stopped after 15 min of equilibration and restored 30 min later in I/R,P,DZX and Stattic groups.In P and DZX groups,the hearts were perfused with the cardioplegic solution containing 0.4％ dimethyl sulfoxide and 50μmol/L diazoxide,respectively,before perfusion was stopped.In group Stattic,the hearts were perfused with 10μmol/L Stattic for 5 min before perfusion with diazoxide.At 60 min of reperfusion,the hearts were sliced and stained for determination of myocardial infarct size (IS) as a percentage of area at risk (AAR) (IS/AAR),cell apoptosis and expression of phosphorylated STAT3 (p-STAT3) protein (by Western blot) and STAT3 mRNA (using RT-PCR).Apoptotic index (AI) was calculated.Results Compared with group C,the IS/AAR and AI were significantly increased in the other four groups,the expression of p-STAT3 and STAT3 mRNA was down-regulated in I/R and Stattic groups,and the expression of p-STAT3 was down-regulated and STAT3 mRNA was up-regulated in P and DZX groups (P ＜ 0.05).Compared with group I/R,the IS/AAR and AI were significantly decreased,and the expression of p-STAT3 and STAT3 mRNA was up-regulated in P and DZX groups (P ＜ 0.05),and no significant changes were found in the parameters mentioned above in Stattic group (P ＞ 0.05).The IS/AAR and AI were significantly lower,and the expression of p-STAT3 and STAT3 mRNA was higher in DZX group than in P group (P ＜ 0.05).Conclusion STAT3 signal transduction pathway is involved in diazoxide cardioplegic solution-induced reduction of I/R injury in isolated rat hearts.

Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane for sedation in patients.Methods ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,undergoing elective lower abdominal surgery performed under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (D1,D2 and D3 groups).In D1,D2 and D3 groups,the loading dose of dexmedetomidine 0.4,0.6 and 0.8 μg/ kg was intravenously infused over 15 min,respectively,adverse cardiovascular events were then recorded,followed by infusion at 0.4,0.6 and 0.8 μg· kg-1 · h-1 via a pump,respectively,while in group C,the equal volume of 0.9 ％ normal saline was given instead of dexmedetomidine.Sevoflurane administration was begun after completion of infusion of the loading dose.Up-and-down sequential allocation was used to determine the MAC.The initial end-tidal concentration of sevoflurane was set at 0.8％,0.7％,0.6％ and 0.5％ in C,D1,D2 and D3 groups,respectively,and maintained at this level for 15 min.Each time the concentration of sevoflurane increased/decreased in the next patient depending on whether or not the patients correctly followed the verbal command to open his eyes.The ratio between the two consecutive concentrations was 0.9.The middle point between the positive response and negative response served as a crossover pair.After at least 7 independent crossover pairs were observed in each group,the experiment was stopped.The MAC and 95 ％ confidence interval of sevoflurane were calculated.Results The incidence of adverse cardiovascular events was significantly higher in D3 group than in D1 and D2 groups (P ＜ 0.05).In C,D1,D2 and D3 groups,the MAC (95％ confidence interval) of sevoflurane was 0.68％ (0.64％-0.74％),0.50％ (0.47％-0.52％),0.36％ (0.32％-0.41％) and 0.28％(0.26％-0.31％),respectively.The MAC-awake of sevoflurane was significantly lower in D1-3 groups than in group C,in D2 and D3 groups than in group D1,and in D3 group than in group D2 (P ＜ 0.05).Conclusion Dexmedetomidine 0.6μg/kg can significantly decrease the MAC of sevoflurane for sedation,induces no side effects and is the optimum dose in patients.

Objective To evaluate the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of propofol given by target-controlled infusion (TCI) at loss of consciousness (LOC).Methods Eighty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index ≤25 kg/m2,scheduled for operations under general anesthesia,were randomly allocated to one of four groups(n=20 each): control group (group C) and dexmedetomidine 0.4 μg/kg group (group D1),dexmedetomidine 0.5 μg/kg group (group D2) and dexmedetomidine 0.6 μg/kg group (group D3).Dexmedetomidine 0.4,0.5 and 0.6 μg/kg were infused intravenously over 10 min in groups D1-3,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Propofol was then given by TCI and the EC50 was determined by up-and-down sequential trial.The target plasma concentration was set at 2.0μg/ml in the first patient in each group.The ratio of the target plasma concentration between the two consecutive patients was 1.1.Loss of response to eyelash stimulation and verbal command (2 times) was considered to be signs of LOC.The EC50 and 95％ confidence interval (CI) of propofol causing LOC were calculated.Complications such as bradycardia,hypotension and respiratory depression were recorded.Results The EC50 (95％ CI) of propofol causing LOC was 2.59 (2.51-2.67),2.09 (2.02-2.16),1.82 (1.70-1.95) and 1.60 (1.49-1.72) μg/ml in groups C and D1.3 respectively.The EC50 of propofol causing LOC was significantly lower in groups D1-3 than in group C.Dexmedetomidine significantly decreased the EC50 of propofol required for causing LOC in a dose-dependent manner in groups D1-3 (P ＜ 0.05).The incidences of bradycardia and hypotension were significantly lower in groups D1.3 than in group C (P ＜ 0.05).Compared with group D1,the incidence of bradycardia was increased in groups D2,3 and the incidence of hypotension was increased in group D3 (P ＜ 0.05),There was no significant difference in the incidences of bradycardia and hypotension between groups D2 and D3 (P ＞ 0.05).No patients developed respiratory depression.Conclusion The optimum dose for dexmedetomidine infused intravenously when combined with propofol given by TCI is 0.4 μg/kg and it can decrease the EC50 of propofol administered by TCI at LOC with no adverse reactions.

Objective To evaluate the role of signal transducer and activator of transcription 3 (STAT3) signaling pathway in the reduction of myocardial ischemia-reperfusion (I/R) injury by diazoxide postconditioning in rats.Methods Sixty adult male Sprague-Dawley rats,aged 3 months,weighing 240-260 g,were randomly divided into 5 groups (n =12 each):sham operation group (S group),I/R group,vehicle group (V group),diazoxide postconditioning group (D group),and STAT3 signaling pathway inhibitor Stattic group (St group).Myocardial I/R was produced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion.In V and D groups,0.4％ dimethyl sulfoxide and 7 mg/kg diazoxide (in 1 ml of 0.4％ dimethyl sulfoxide) were injected through the femoral vein at the onset of reperfnsion,respetively.In St group,Stattic was injected through the femoral vein 10 min before reperfusion,and the other procedures were the same as those in D group.The infarct size (IS) and myocardial apoptosis were detected by TTC staining and TUNEL,respectively.Apoptotic index (AI) was calculated.STAT3 mRNA expression in myocardial tissues was detected using RT-PCR.Western blot was used to detect the phosphorylation of STAT3.Results Compared with S group,the IS and AI were significantly increased and the expression of STAT3 mRNA and phosphorylation of STAT3 were decreased in I/R group (P ＜ 0.05).Compared with I/R group,the IS and AI were significantly decreased and the expression of STAT3 mRNA and phosphorylation of STAT3 were increased in D group (P ＜ 0.05).There was no significant difference in IS,AI,expression of STAT3 mRNA and phosphorylation of STAT3 between V group and St group (P ＞0.05).Compared with group D,the IS and AI were significantly increased and the expression of STAT3 mRNA and phosphorylation of STAT3 were decreased in St group (P ＜ 0.05).Conclusion STAT3 signaling pathway is involved in the reduction of myocardial I/R injury by diazoxide postconditioning in rats.

Objective To determine the relative and independent risk factors of survival in patients with non-hepatitis B and non-hepatitis C hepatocellular carcinoma (NBNC-HCC).Methods The clinical records of 109 patients who underwent surgical resection for NBNC-HCC at Tianjin Medical University Cancer Institute & Hospital between January 2010 and January 2013 were retrospectively analyzed.The risk factors influencing disease-free survival (DFS) and overall survival (OS) were used as primary outcome measures.Univariate analysis was conducted to determine the relative risk factor predicting prognosis of NBNC-HCC,and the Cox proportional hazards model was used to determine independent risk factors of DFS and OS.Results For the 109 NBNC-HCC patients,the 1-,2-,3-year overall survival rates were 90.8％,78.0％ and 65.1％,respectively.The compounding disease-free survival rates were 74.0％,63.3％ and 55.8％,respectively.Univariate analysis showed the AFP level,ascites,and TNM staging were the risk factors of OS (all P ＜ O.05).The AFP level,ascites,BCLC stage,TNM staging were related with DFS (all P ＜ 0.05).Multivariate analysis demonstrated AFP and ascites to be the independent risk factors of OS and DFS.Conclusions AFP and ascites were independent risk factors of OS and DFS.For the NBNC-HCC patients,a strong positive AFP with ascites indicated poor prognosis.