Objective We generated an experimental canine model of heterogeneous emphysema.The dogs subsequently underwent unilateral bronchoscopic lung volume reduction(BLVR).Observing the postoperative condition of ventilation/perfusion,blood gas analysis,respiratory dynamics,hemodynamic measurement,HRCT and radiologic outcomes,compared with the preoperative level,the correlative mechanism and the effects of BLVR were analyzed.Methods There were 15 healthy dogs that were treated samely with localized papain instillations under bronchoscopic guidance to generate heterogeneous emphysema.The right dorsal lobe was selected as the target area.All dogs were divided into 3 groups randomly.Group A was control group;Group B and Group C received BLVR 6 weeks later while group A was raised as the same way.Group B underwent endobronchial valve insertion(EVI);Group C underwent bronchial blocking with albumin gel.Measurements were made in each animal at 3 time points:prior to papain exposure(base-line),after establishment of emphysema(6 weeks later),6 weeks after BLVR.Data included blood gas analysis(PaO2,PaCO2),respiratory dynamics(respiratory peak pressure,lung compliance),hemodynamic measurement(pulmonary artery pressure,pulmonary capillary vessel wedge pressure),nuclear ventilation/perfusion scan(CTS,CTS/PIX).Dogs were euthanized at 6-week time point followed by autopsy.The data was statistically managed and compared.Results After development of emphysema,all dogs exhibitted aggravation in PaO2,PaCO2,PAP and lung compliance(P0.05).Through ventilation/perfusion scan,CTS/PIX of the target areas reduced(P

Objective To examine the dyllamic changes in excitatory and inhibitory amino acid neurotransmitter release in the spinal cord in a rat model of incisional pain.Methods Twelve healthy adult male SD rats weighing 250-300g were anesthetized with intraperitoneal chloral hydrate 300 mg/kg.A loop microdialysis catheter was implanted into the subarachnoid space via the atlanto-occipital membrane and advanced for 8.5 cm candad until lumbar region.The animals were randomly divided into 2 groups(n=6 each): control group(C) and incisional pain group(I).Incisional pain was produced by the plantar incision in the tight hindpaw under 1.2% isoflurane in group I while group C received only anesthesia with 1.2% isoflurane.The microdialysis samples were collected before incision(To,baseline)at 3 h,1 d,2 d and 3 d after incision(T1-4) for determination of amino acid using HPLC.The pain behavior was assessed and scored (O=no pain,2=severe pain) at the above time paints.Results In group I the aspartate and glutamate concentrations in the microdialysis samples were significantly increased at 3 h after incision(T1) as compared with the baseline value at To and returned to the baseline level at l d(T2);the glyeine and r-amino butyric acid concentrations were signifieantly increased at ld (T2)and returned to the baseline level at 2 d(T3).The cumulated pain scores were significantly increased at 3 h,1 d and 2 d after incision and returned to baseline level at 3 d (T4) in group I.Conclusion The increased release of excitatory amino acid neurotransmitter in the early phase after incision may be involved in hyperalgesia while the increased release of inhibitory amino acid neurotransmitter in the later phase may be involved in the pain relief.

Objective To evaluate the neurotransmitter mechanism and protective efficiency of three methods of isoflurane intervention on global cerebral ischemia, and to seek an effective method to improve cerebral ischemia damage. Methods Adult male Sprague-Dawley rats were randomly divided into sham operation group, control groups, preconditioning groups, protective groups and resuscitation groups. The rats of the last four groups were further divided into 10, 15 and 20min ischemia subgroups. The model of global cerebral ischemia and reperfusion was reproduced in waking rats 2 days before ischemia. The microdialysis samples were collected and BIS was recorded after reperfusion. The recovery of right reflection was observed after ischemia and the motor function was observed. All viable and apoptotic neurons were counted and the percentage of apoptotic neurons was calculated. The results showed that glutamate concentration in the hippocampus of protective groups was significantly lower compared with preconditioning group and resuscitation group. Results With ischemia fasting 10 and 15min (P

effect-site concentration. The cutoff points of BIS index, AEPI and effect-site concentration for implicit memory were 47, 28 and 2.3 ?g ? ml-1 respectively.Conclusion Implicit memory exists in unconscious patients when there is no noxious stimulation. Implicit memory disappears at level 1 of OAA / S score. Implicit memory score correlates well with BIS index, AEPI. The BIS index, AEPI and effect-site concentration are good predictors of implicit memory during target-controlled infusion of propofol.

Objective Isoflurane preconditioning has been shown to protect against cerebral ischemia-reperfusion(I/R)injury.The purpose of this study was to investigate if isoflurane inhalation during reperfusion hasany protective effects.Methods Fourty-two SD rats weighing 318-365 g were randomly divided into 3 groups:sham group(n=6),control group(n=18)and isoflurane group(n=18).Control group and isoflurane groupwere further divided into 10,15 and 20 rain ischernia subgroups(subgroup A,B,C,n=6).In isoflurane group1.4% isoflurane in air was inhaled immediately after reperfusion was started for 30 min.Two days before theexperiment the animals were anesthetized with intraperitoneal chloral hydrate 300 mg?kg~(-1).Microdialysis catheterwas inserter into right hippocampns using stereotactic technique and fixed.BIS microelectrodes were placed in thebrain.Vertebral arteries were permanendy occluded by electric coagulation.Bilateral common carotid arteries wereexposed and atranmatic sutures were placed around them.Globol cerebral ischemia was produced by tighteningcarotid sutures and maintained for 10,15 or 20 min(subgroup A,B,C).Cerebral iscbemia was confirmed by lossof righting reflex,dilated pupils,loss of light reflex,BIS=0 and isoelectric potential on EEG.Carotid sutureswere then released for reperfusion.Isoflurane inhalation was started right after the beginning of reperfusion andmaintained for 30 min.Neurologlc outcome was assessed by motor performance according to Combs(0-10,0=severe dysfunction,10=no dysfunction)at 24 h,48 h and 72 h of reperfusion.Microdialysis samples werecollected before during and 0-15,15-30,30-45 and 45-60 min after ischemia for determination of glutamateconcentration.Three days after ischemia the animals were sacrificed and brains were removed for microscopicexamination of hippocampns CA1 region.The number of apoptotic(TUNEL positive)neurons were counted and thepercentage(the number of TUNEL positive neurons/the total number of neurons)was calculated.Results Theglutamate content in hippocampus was significantly lower in isoflurane group than in control group duringreperfusion(P

Objective To investigate the influence of pulmonary microembolism of early stage on hemodynamics, respiratory function and blood coagulation in dogs. Methods Eight mongrel dogs (6 male, 2 female) weighing 15.5-16.5 kg were anesthetized with intravenous atropine 0.02 mg?kg-1 , propofol 2-3 mg?kg-1 and pancuronium 0.4 mg?kg-1 . The animals were intubated and mechanically ventilated with 100% O2. The ventilatory settings were as follows : VT 12 ml? kg-1 , RR 15 bpm and I: E = 1:2. Anesthesia was maintained with intravenous infusion of propofol at 200-300 ?g ? kg-1? min-1 and intermittent iv boluses of pancuronium. A 7.5 F Swan-Ganz catheter was placed via femoral vein for hemodynamic monitoring and injection of microemboli. 50 ml of blood was removed from artery and mixed with methylene blue. The clot was cut into small pieces 1-2 mm in diameter. After being washed with normal saline, 100 microemboli in normal saline 10 ml were rapidly injected into pulmonary artery via Swan-Ganz catheter. BP, HR, pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure(PAWP), arterial blood gases, airway pressure, lung compliance, D-dimer, tissue plasminogen activator (t-PA), protein C and S were measured and recorded before (T0 ) , immediately after (T, ) and 30 min (T2) , 60 min (T3 ) , 120 min (T4) after embolization. Two hours after embolization, chest was opened and lung tissue was obtained for microscopic examination. Results Both systolic and diastolic PAP, PAWP and pulmonary vascular resistance (PVR) were significantly increased immediately after embolization (T1 ), and then decreased to the baseline level (T0) at Ih after embolization (T3) . There were no significant changes in respiratory function. D-dimer was increased at 30 min after embolizatiion (T2 ) and decreased to the baseline level at T4 . Microscopic examination showed that the lung exhibited hemorrhage and consolidation with microemboli in arterioles. Conclusion Pulmonary microembolism induces pulmonary hypertension and change in D-dimer level in the early stage but respiratory function is not affected. It causes injury to the lung parenchyma.

Objective To compare the clinical value of nerve stimulator-versus ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery.Methods Forty patients,aged 18-60 yr,with body mass index of 18-30 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic surgery,were randomly assigned into 2 groups (n =20 each) using a random number table:nerve stimulator group (group S) and ultrasound group (group U).Epidural anesthesia was performed with 1.73 ％ carbonated lidocaine in both groups.0.2％ ropivacaine 5 ml/h was infused continuously after surgery to perform femoral nerve block for analgesia.VAS score at rest was assessed at 2,6,24 and 48 h after surgery.At 24 and 48 h after surgery,VAS scores during active and passive movement were assessed.The time for catheter placement near the femoral nerve and development of subcutaneous hematoma at the puncture site,local anesthetic intoxication and nausea and vomiting were recorded.The postoperative requirement for analgesics was also recorded.Results There was no significant difference in the VAS scores and puncture for femoral nerve block-and local anesthetics-related adverse events between the two groups.The time for catheter placement near the femoral nerve was 8.0 ± 1.4 and (6.7 ± 0.9) min in S and U groups,respectively,and the time was significantly longer in group S than in group U.No patients required rescue analgesic after surgery in both groups.Conclusion Nerve stimulator-guided continuous femoral nerve block provides higher clinical value than ultrasound-guided continuous femoral nerve block for analgesia after laparoscopic surgery and it is more suitable for clinical application.

Objective To investigate the changes in trafficking of GluRl-containing AMPA (GluR1-AMPA) receptor and GluR2-AMPA receptor from cytoplasm to cell membrane in the spinal cord dorsal horn in a rat model of incisional pain.Methods Thirty-two adult male SD rats aged 6-8 weeks weighing 280-300 g were randomly divided into 2 groups:control group (group C,n =8) and incisional pain group (group Ⅰ,n =24).An 1 cm long incision was made in the plautar surface of right hindpaw according to Brennan et al.in group Ⅰ.Cumulative pain score (CPS) and paw-withdrawal threshold to yon Frey stimuli (PWT) were measured at 3 h and day 1 and 3 afar incision ( T1,2,3 ).The animals were sacrificed after pain behavior assessment.Their lumbar segments of the spinal cord (L3-6) were removed.The expression of GluR1 and GluR2 in cell membrane and cytoplasm in spinal cord dorsal horn was determined by Western blot analysis.The co-expression of Stargazing with GluR1 and GluR2 in the spinal cord dorsal horn was examined by co-immuno-precipitation.Results The CPS was increased and PWT decreased; the GluR1 expression in cytoplasm was decreased while the expression of GluR1 in cell membrane and the co-expression of Stargazing with GluR1 were up-regulated in group Ⅰ as compared with group C.There was no significant change in the expression of GluR2 in cytoplasm and cell membrane and the co-expression of Stargazing with GluR2 in group Ⅰ as compared with group C.Conclusion GluR1-AMPA receptor transfers from cytoplasm to cell membrane but GluR2-AMPA receptor does not in rats with incisional pain.

Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.

Objective To enhance the understanding of hemophagocytic syndrome(HPS)by analyzing the clinical manifestations, diagnosis and therapy. Methods The clinical data of 12 patients with HPS were retrospectively collected in the People's Hospital of Jiangsu Province from 2000 to 2007. The relevant literature were reviewed. Results Twelve patients were diagnosed as secondary hemophagocytic syndrome most secondary to virus and bacteria infection. Some patients condition was associated with systemic lupus erythematosus or histiocytic necrotizing lympheadenitis. All of the 12 patients had high fever, abnormal liver function and showed a decrease in the number of blood cells in a short time. After antivirus and antibiotic treatment, 11 patients'condition were improved and 1 patient died. Conclusion Hemophagocytic syndrome is not a common clinical condition but with poor prognosis. When patient presents with fever without apparent reasons and pancytopenia, bone marrow examination should be done and sometimes repeated bone marrow examinations are needed. The diagnosis of secondary haemophagocytic syndrome needs multidisciplineary cooperation. Aggressive diagnostic procedures are needed to clarify the diagnosis and prompt treatments are warranted to improve prognosis.