To identify the role of spinal cyclooxygenase (COX)-1 in the development and maintenance of postoperative pain, we examined the changes of COX-1 protein expression in lumbar spinal cord by immunohistochemistry and Western blot technique in rat plantar incision model at different time points (pre-incision or 2 h, 4 h, 6 h,12 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision). We also studied the anti-allodynic effects of the COX inhibitors by intrathecal administration of non-selective COX inhibitors (ketorolac), selective COX-1 (SC-560) or COX-2 inhibitor (NS-398) immediately or 2 h, 24 h after incision. The mechanical allodynia was evaluated by using paw withdrawal threshold (PWT) response to mechanical stimulation on pre-incision, 2 h, 1 d, 2 d, 3 d, 5 d and 7 d after incision or 30 min after drug treatment. The result showed that COX-1 immunoreactive cells mainly focused in the superficial laminae of lumbar spinal dorsal horn and expression of spinal COX-1 protein increased after incision, peaked at 4 h (P＜0.01) and lasted for 12 h. Postoperative treatment with both SC-560 and ketorolac significantly alleviating the mechanical allodynia induced by skin incision, but NS-398 had no such effect. This study demonstrates that spinal COX-1 involves in the development and maintenance of postoperative hypersensitivity and intrathecal COX-1 inhibitor has anti-allodynic effect on incision pain in the rat.

Objective To explore the effects and feasibility of minimal local analgesic dose of hyperbaric levobupivacaine in elderly patients undergoing unilateral spinal anesthesia during lower limb orthopedic surgery.Methods Seven hundred and fifty-six elderly patients who scheduled lower limb orthopedic surgery were assigned to levobupivacaine group (383 patients) and bupivacaine group (373 patients) by random digits table method.Haemodynamic change were monitored before,during and after anesthesia.The level and duration of sensory and motor block in each group were evaluated.Results Compared with bupivacaine group,the sensory block and motor block onset time was significantly longer in levobupivacaine group [(5.9 ± 1.4) min vs.(4.2 ± 0.3) min,(11.7 ± 3.0) min vs.(9.1 ± 3.3) min] (P ＜0.05),but the motor block duration was shorter [(152.8 ± 17.5) min vs.(195.4 ± 18.7) min] (P ＜ 0.05).The scores of maximum motor block in levobupivacaine group was significantly lower than that in bupivacaine group[(1.1 ±0.3) min vs.(2.3 ±0.6) min](P＜ 0.05).There was no significant difference in peak sensory block and haemodynamic between two groups (P ＞ 0.05).Conclusions Although levobupivacaine may be less potent than bupivacaine,it may be preferred for elderly patients with lower limb surgery because of satisfactory spinal anesthesia,good hsemodynamic stability and fast motor block regression.

Objective To explore the sedative effects of a low dose of dexmedetomidine (DEX) during percutaneous kyphoplasty (PKP) in the elderly patients.Methods Forty elderly patients with ASA grade Ⅱ-Ⅲ grade who scheduled PKP were divided into DEX group and control group by random digits table method,each group 20 cases.DEX group received an infusion of 0.5 μg/kg for 10 min before the operation,then the infusion speed was adjusted to 0.2 μ g/ (kg·h).An equivalent volume of 0.9％ sodium chloride was administered in control group.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate (HR),and pulse oxygen saturation (SpO2) were recorded at the beginning of DEX infusion (T0),10 min(T1),30 min(T2),60 min(T3) after DEX infusion and the end of operation (T4),Ramsay scores was also recorded.Results HR,SBP,DBP in DEX group at T1-T3 was significantly lower than that T0 and the same time in control group [(65.6 ± 14.6),(63.4 ± 10.2),(66.7 ± 10.5) times/min vs.(81.4 ± 11.2) times/min and (75.3 ±6.9),(72.8 ± 11.4),(73.8 ±9.6) times/min; (127.5 ± 10.2),(125.4 ± 12.6),(122.4 ±7.8) mm Hg(1 mm Hg =0.133 kPa) vs.(152.5 ± 11.8) mm Hg and(145.1 ± 10.6),(137.2 ± 11.3),(142.6 ± 8.8) mm Hg; (73.7 ± 8.9),(70.3 ± 9.9),(70.3 ± 11.5) mm Hg vs.(90.5 ± 11.0) mm Hg and(86.2 ± 11.6),(82.6 ± 10.9),(78.8 ±8.7) mm Hg,P ＜0.05].The Ramsay scores in DEX group at T1-T3 were significantly higher than those T0 and the same time in control group [(3.6 ± 0.8),(4.2 ± 0.8),(3.7 ± 0.5) scores vs.(2.0 ± 0.0)scores and (1.7 ± 0.6),(1.9 ± 0.4),(1.6 ± 0.5) scores,P ＜ 0.05].HR,SBP,DBP in DEX group at T4 was significantly lower than that T0,HR in DEX group at T4 was significandy lower than that in control group,difference was statistically significant(P ＜ 0.05).Bradycardia and applications vasopressors did not occur in two groups.There was no significant difference in SpO2 between DEX group and control group(P＞ 0.05).Conclusion It is both feasible and safe that sedative effect of a small dose of DEX during PKP in the elderly patients.

Objective To evaluate the effects of intravenous analgesia with dezocine combining sufentanil in hip and knee arthroplasty for elderly patients.Methods Ninety patients with ASA Ⅱ ～ Ⅲ and aged ≥ 65 years who were scheduled for hip and knee arthroplasty under CSEA and treated with intravenous analgesia post-operation were selected and divided into three group (20 cases):group Ⅰ (sufentanil 2.5μg/kg + droperidol 2.5 mg),group Ⅱ (sufentanil 2.0 μ g/kg + dezocine 10 mg + droperidol 2.5 mg) and group Ⅲ (intramuscular dezocine 10 mg and sufentanil 2.0 μ g/kg + droperidol 2.5 mg),which were diluted to be 100 ml by adding saline.VSA,Ramsay score as well as side effects were recorded at 6,12 and 24 h after operation.75 mg meperidine was administered intramuscularly as rescue medication when VAS was above 5.Results Compared with group Ⅰ and Ⅲ,group Ⅱ showed better outcomes regarding to the VAS and less side effects.Ramsay score 6 h after operation and the amount of patients who needed meperidine in group Ⅲ were higher than those in the other two groups (P ＜ 0.05).Conclusion Dezocine combining with sufentanil in elderly patients underwent low limb arthroplasty shows better postoperative analgesia effects with less side effects,and it's worth for clinical application.

AIM: To explore the effect of chronic enhanced external counterpulsation(EECP) on the protein expression in thoracic aorta endothelial cells in porcine with hypercholesteremia by proteomic techniques.METHODS: After performed EECP for 36 h on the hypercholesteremia porcines,the endothelial cells(ECs) were collected from the thoracic aorta and analyzed with proteomic techniques.RESULTS: Six kinds of protein were detected in ECs in the EECP group,but not in the hypercholesteremia control group.CONCLUSION: Chronic EECP may protect ECs against damage resulted from hypercholesteremia by regulating protein expression in artery ECs,subsequently improving cell adhesion and intracellular lipid metabolism and reducing ECs apoptosis.

Objective    To investigate the effect of pulmonary ultrasound on pulmonary complications in ultra-fast-track anesthesia for congenital heart disease surgery. Methods    In 2019, 60 patients with congenital heart diseases underwent ultra-fast-track anesthesia in Shenzhen Children's Hospital, including 34 males and 26 females with the age ranging from 1 month to 6 years. They were randomly divided into a normal group (group N, n=30) and a lung ultrasound optimization group (group L, n=30). Both groups were used the same anesthesia method and anesthetic compatibility. The group N was anesthetized by ultra-fast-track, the tracheal tube was removed after operation and then the patients were sent to the cardiac intensive care unit (CCU). After operation in the group L, according to the contrast of pre- and post-operational lung ultrasonic examination results, for the patients with fusion of B line, atelectasis and pulmonary bronchus inflating sign which caused the increase of lung ultrasound score (LUS), targeted optimization treatment was performed, including sputum suction in the tracheal tube, bronchoscopy alveolar lavage, manual lung inflation suction, ultrasound-guided lung recruitment and other optimization treatments, and then the patients were extubated after lung ultrasound assessment and sent to CCU. The occurrence of pulmonary complications, LUS, oxygenation index (OI), extubation time, etc were compared between the two groups. Results    Compared with the induction of anesthesia and 1 hour after extubation of the two groups, the incidence of pulmonary complications in the group L (18 patients, 60.0%) was lower than that in the group N (26 patients, 86.7%, χ2= 4.17, P=0.040) and the rate of patients with LUS score reduction was higher in the group L (15 patients, 50.0%) than that in the group N (7 patients, 23.3%, χ2=4.59, P=0.032). The correlation analysis between the LUS and OI value of all patients at each time point showed a good negative correlation (P<0.05). Extubation time in the group L was longer than that in the group N (18.70±5.42 min vs. 13.47±4.73 min, P=0.001). Conclusion    Ultra-fast-track anesthesia for congenital heart disease can be optimized by pulmonary ultrasound examination before extubation, which can significantly reduce postoperative pulmonary complications, improve postoperative lung imaging performance, and help patients recover after surgery, and has clinical application value.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.