Objective To explore effect of different withdrawal time of dexmedetomidine (DEX) on the quality of general anesthesia recovery.Methods Eighty patients of ASA Ⅰ or Ⅱ undergoing lymph surgery were randomly assigned to four groups (n =20).Groups D1,D2 and D3 received DEX 0.5 μg/kg as bolus before induction,continued with 0.5 μg/(kg · h) by infusion until one hour,30 min before the end of operation and the end of operation,respectively.Group C received equal volume of normal saline.Mean artery pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were observed during and after operation.Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time,observer's assessment of alertness/sedation score (OAA/S),restlessness score (RS),and visual analogue scales (VAS) were observed after operation.Results For MAP and HR in Groups D2 and D3,there were no statistically significant difference during extubation compared to those at preoperation,but at the same time point,they were lower than those in group C (P ＜ 0.05).For groups C and D1,MAP and HR at extubation and 5 min after extubation were higher than those at preoperation (P ＜0.05).Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time in group D3 were significantly longer than those in Group C (P ＜ 0.05),while there were no statistically significantly difference between groups D1,D2,and group C.OAA/S in group D3 was significantly lower than that in group C (P ＜ 0.05) at extubation.Incidence of restlessness,VAS,and cases given analgesic 2 hours after operation in groups D2 and D3 were significantly lower than those in groups C and D1.Compared to those in group C,dosages of propofol and remifentanil in groups D2 and D3 were significantly lower.Conclusions Dexmedetomidine administered of 0.5 μg/kg before induction,continued with infusion of 0.5 μg/(kg · h) until 30 min before the end of operation,may improve emergence,without influencing the awakening time of patients,and prolong the duration time of analgesia which comfort the patients.

Objective To compare shikani optical stylet and Mc coy laryngoscope on elder patients with intratracheal intubation anesthesia.Methods 112 cases of elder patients with intratracheal intubation anesthesia were enrolled as study objects, all patients were divided into shikani optical stylet group (52 cases), Mc coy laryngoscope group (60 cases) according to different intubation way. Then detect the hemodynamic parameters, stress-related indicators, EEG relevant indicators of the two groups.Results One time success rate and total success rate in Shikani visual laryngoscope group was higher than Mc Coy visual laryngoscope group, while many times intubation rate was lower (P < 0.05); T1, T2 MAP, HR levels were lower in Shikani optical stylet group than Mc Coy laryngoscope group patients (P < 0.05); Plasma levels of epinephrine, norepinephrine, and glucose on T1, T2 in Shikani optical stylet group was lower than that in Mc Coy laryngoscope group (P < 0.05); T1, T2 BIS, ECoG grading, αβ% values in Shikani optical stylet group was lower than that in Mc coy laryngoscope group (P < 0.05).Conclusions Elderly patients with intratracheal intubation anesthesia received shikani optical stylet can enhance the success rate of intubation and effectively stabilize patients circulatory system, reduce excessive physical stress caused by various system dysfunction, which shows positive significance.

Objective To probe the etiology and management of restenosis after artificially grafting bypass for chronic ischemia of the lower extremities. Methods In this study 52 cases suffering from postoperative restenosis and obliteration were compared with 32 cases whose artificial grafts remain patent during the same postoperative follow-up period of 3～62 months.Possible risk factors that lead to restenosis were evaluated.Resuits FIB(4.48±1.68)g/L,CRP(9.5±2.6)mg/L and LDL(4.5±1.7)mmol/L were significantly higher in the restenosis group than FIB(3.50±0.72)g/L,CRP(4.0±3.2)mg/L and LDL(2.8±0.9)mmol/L in the patent group(P＜0.01).There were no significant difference between HDL(1.02±0.32)mmol/L in the restenosis group and HDL(1.12±0.28)mmol/L in the patent group (P＞0.05).Reoperation in these 52 cases found severe intima hyperplasia and secondary thrombosis within anastomosis in 42 cases and the remaining 10 cases were found with artificial vessel primary thrombosis.After reoperation,artificial graft remain patent in 28 cases,limb amputation was performed in 10 cases,the grafted bypass were removed due to infection in 3 cases. Five patients died postoperatively.Conclusion The main reason for restenosis after artificially grafting bypass is intima hyperplasia in vascular anastomosis.Higher levels of FIB,CRP and LDL maybe the major high risk factors that lead to intima hyperplasia and artificial graft obliteration.

Objective To explore the incidence,features and outcomes of in-hospital sudden cardiac death (SCD) in order to determine the predictors of survival. Methods The clinical data of 69 patients with cardiac arrest hospitalized from January 2008 through December 2010 were retrospectively analyzed.Information on genders,age,types of arrhythmia was collected and further analyzed to determine these factors associated with the occurrence and outcomes of in-hospital cardiac arrest. Results The overall incidence of SCD was 47.3 / 100 000 per year and 17.4％ of them.survived at discharge.The occurrence rate was higher in male than that in female (66.7％ vs.33.3％,P ＜0.01 ),whereas difference in gender did not affect the discharge rate ( P ＞ 0.05 ). Survivors from in-hospital cardiac arrest were significantly younger than non-survivors (man:62.57 ± 12.83 years vs.75.56 ± 10.55 years; women:60.36 ± 13.24years vs.69.53 ± 11.72 years,P ＜ O.01 ).From 62 ECG records of SCD patients,the incidence of nonshockable rhythms was higher than that of shockable rhythms.Compare to the non-shockable rhythms,the shockable rhythms brought a higher rate of restoration of spontaneous circulation (ROSC) (54.5％ vs.24.5％,P ＜0.05),whereas survival rates at discharge between two groups were not statistically different ( 18.2％ vs.18.4％,P ＞ 0.05 ).Conclusions Non-shockable rhythms were more common in patients suffering from in-hospital cardiac arrest.Although defibrillation treatment contributed benefit to ROSC among patients with ventricular fibrillation or pulseless ventricular tachycardia,high-quality CPR and post-cardiac arrest care may play a more critical role in the outcomes of in-hospital sudden cardiac death.

Objective To investigate the influence of systematic nursing intervention on the quality of life of patients with radical cystectomy and bricker operation.Methods 67 patients with radical cystectomy and bricker operation were randomly divided into control group ( n = 33) and observation group ( n = 34).Control group was routinely cared, while the observation group was cared with systematic nursing intervention by the nurse in charge of work.Then all the patients were surveyed with the core questionnaire of quality of life of cancer patients (QLQ-C30) in 6 months after the operation.Results The scores of global health status, physical function, role function,emotional function,cognitive function and social function of the observation group (64.8 ± 8.7,80.1 ±9.2,67.5 ± 10.1,82.1 ± 11.5,84.6 ± 14.2,66.4 ± 12.5 ) were higher than those of the control group ( 53.3 ±9.4,68.3 ± 8.8,56.5 ± 10.3,68.3 ± 12.2,67.1 ± 10.5,55.3 ± 12.3 ), respectively.The scores of fatigue, nausea and vomiting, insomnia, and appetite loss of the observation group (34.6 ± 8.9,19.4 ± 6.9,27.7 ± 7.6,25.7± 8.4) were lower than those of the control group (44.4 ± 10.3,30.5 ± 7.6,39.8 ± 7.8,34.8 ± 10.1 ), respectively.And the difference was significant (P ＜ 0.05 ).Conclusion The systematic intervention can enhance patients' psychological, physical, and social adaptability, and improve patients' self-care skills and quality of life.

ObjectiveTo investigate the effects and mechanism of rosuvastatin on the expression of tissue factor in cultured human monocyte-macrophages cells which was induced by oxidized low density lipoprotein(ox-LDL).MethodsThe human monocyte-macrophages cells were divided into four groups:control group,ox-LDL group,Poly-inosine monophosphate (Poly Ⅰ) group,rosuvastatin group.The expression of LOX-1mRNA and TF mRNA was assayed by RT-PCR.The ELISA was performed to determine the protein concentration of TF.ResultsCompared with control group,the expression of LOX-1 mRNA and TF mRNA was increased in the ox-LDL group[ (3.25156±0.15772) vs (1±0) ; (2.522451±0.138967) vs (1±0) ],and it was in a concentration-dependent manner (P＜0.01).Compared with the expression of LOX-1 mRNA in the Poly-inosine monophosphate group and rosuvastatin group,TF mRNA were decreased in the ox-LDL group[ (2.95139±0.157253) vs(3.25156±0.15772) ; (2.877343±0.156558) vs(3.25156±0.15772) ; (1.811956±0.169699) vs (2.522451±0.138967) ; (1.687701±0.174647) vs (2.522451±0.138967)],and it was in a concentration-dependent manner(P＜0.05).Compared with control group,the expression of TF in the ox-LDL group was increased [(207.7233±1.154701) vs (184.8467±0.871799) ],and it was in a concentration-dependent manner (P＜0.01).Compared with the Poly-inosine monophosphate group and rosuvastatin group [(197.8733±1.505003) vs (207.7233±1.154701) ;(202.9567±2.722744)vs(207.7233±1.154701) ],the expression of TF in the ox-LDL group were decreased,and it was in a concentration-dependent manner (P＜0.05).ConclusionsLOX-1 may be responsible for the expression of TF in human monocyte-macrophages cells induced by ox-LDL.Rosuvastatin is able to down-regulate the expression of LOX-1mRNA in human monocyte-macrophages cells through oxLDL,and TF mRNA and TF expression can be reduced.

Objective To investigate the protective role of carbon monoxide releasing molecule-2 (CORM-2) in post-resuscitation myocardial dysfunction (PRMD) in rat models of cardiopulmonary resuscitation (CPR).Methods Cardiopulmonary resuscitation model was established after cardiac arrest induced by ventricular fibrillation.Male healthy Sprague-Dawley (SD) rats were randomly (random number) divided into 4 groups according to random number table:control group,CORM-2 group,inactive CORM-2 (iCORM-2) group and Sham group,in which the equal volume (1 mL) of 0.2％ DMSO,50 μmol/kg CORM-2,50 μmol/kg iCORM-2 and 0.2％ DMSO were respectively administered into the rats of these groups after resuscitation.The ejection fraction (EF) of left ventricle and myocardial performance index (MPI) were measured to detect the myocardial function by echocardiography at 12 hours after resuscitation.Mitochondrial respiration was assessed with Clark oxygen electrode at the same time.Western blot was used to determine the ratio of mitochondrial cytochrome c (cyt c) to cytoplasmic cyt c as well as caspase-3 level.Multiple comparisons were made by analysis of variance.Results Compared with the control group,higher EF and MPI,higher state Ⅲ respiration rate and respiratory control rate (RCR) of mitochondria,and decreased ratio of mitochondrial cytc/cytoplasmic cyt c and lower caspase-3 level were observed in the CORM-2 group (P ＜ 0.05).However,there were no significant differences in above biomarkers found between iCORM-2 group and control group (P ＞ 0.05).Conclusions The CO released from CORM-2 might improve mitochondrial respiration and PRMD by inhibition of myocardial apoptosis via a mitochondrial pathway.

Objective To investigate the effect of mild therapeutic hypothermia for different lengths of time on cerebral edema and hypoxia-inducible factor 1 α (HIF-1α),vascular endothelial growth factor (VEGF) expressions following intracerebral hemorrhage (ICH) so as to explore possible mechanism for better application of mild hypothermia.Methods ICH models were made in rats by stereotaxically injecting autologous artery blood into right caudate nucleus.Forty male Sprague-Dawley (SD) rats were randomly (random number) divided into 5 groups (n =8 each):sham-operated (sham),normothermic (NT),hypothermic-1 hour (MH1),hypothermic-2 hours (MH2),hypothermic-4 hours (MH3).Normothermic and sham-operated animals were kept at (37.0-± 0.2) ℃ of body temperature.Animals in the hypothermic groups received immediately and rapid cooling after ICH and kept at (33.0 ± 0.5) ℃ of body temperature for 1,2 and 4 hours respectively.Rats were sacrificed at 48 hours after cerebral hemorrhage.Then brain water content and BBB permeability were determined.Quantitative real-time PCR and Western blot were used to analyze the expression of HIF-1α and VEGF.Results The content of brain water,Evans blue concentration in brain,and the mRNA expression and protein levels of HIF-1α and VEGF were noticeably higher in NT group than those in sham group (P ＜0.01).There were statistically significant difference in the expression of HIF-lα mRNA and protein but little difference in other indicators between MH1 group and NT group.Compared with NT group,MH2 group and MH3 group brought about an improvement in BBB permeability and remarkable down-regulation of protein levels and expression of HIF-1 α and VEGF mRNA,whereas there were no statistically significant difference in expression of indicators between the two groups.Conclusions Mild therapeutic hypothermia induced rapidly and immediately after ICH could limit the development of brain edema in rats by down-regulating expression and protein levels of HIF-1 α mRNA,and in turn suppressing the evaluation of VEGF mRNA and protein expression.The brain edema was effectively reduced in animals treated with hypothermia for 2 hours' or 4 hours ' duration with little difference in magnitude of reduction in brain edema between these two modalities of hypothermia.

Objective To study the effectiveness and safety of therapeutic mild hypothermia in patients successfully resuscitated from cardiac arrest using a meta-analysis.Methods We searched the MEDLINE (1966-April 2012),OVID (1980 to April 2012),EMBASE (1980 to April 2012),Chinese bio-medical literature & retrieval system (CBM) (1978 to April 2012),Chinese medical current contents (CMCC) (1995 to April 2012),and Chinese medical academic conference (CMAC) (1994 to April 2012).Studies were included (1) the study design was a randomized controlled trial (RCT); (2) the study population included patients successfully resuscitated from cardiac arrest,and received either conventional post-resuscitation care with normothermia or mild hypothermia; (3) the study provided data about good neurologic outcome and survival till hospital discharge.Relative risk (RR) and 95％ corfidence interval (CI) were used to pool the effect.Results The study included four RCTs with a collected total of 417 patients successfully resuscitated from cardiac arrest.Compared to conventional post-resuscitation care with normothermia,patients in the hypothermia group were more likely to have good neurologic outcome (RR =1.43,95％ CI 1.14 ～ 1.80,P =0.002) and were more likely to survive till hospital discharge (RR =1.32,95％ CI 1.08 ～ 1.63,P =0.008).From all over the studies there was no significant difference in reported adverse events between the normothermia and hypothermia group (P ＞ 0.05).There did not exist heterogeneity and publication bias.Conclusions Therapeutic mild hypothermia improves neurologic outcome and survival in patients successfully resuscitated from cardiac arrest.

Objective To monitor the changes of resting energy expenditure in ventilated critically ill children,to compare the results of standard equations and indirect calorimetry (IC) in predicting energy expenditure,and to investigate the possible influence factors of the metabolic status of the critically ill children.Methods From September 2012 to September 2013,56 critically ill children on assisted ventilation and fitting the requirements of IC in pediatric intensive care unit of Shanghai Children's Medical Center were enrolled in this prospective study.IC measurements were performed using metabolic cart on day 1,4,7,10 after trachea intubation.General clinical data of these children were recorded.Results 130 IC measurements were performed in the 56 children.The measured resting energy expenditure (MREE) did not exhibit significant differences among day 1,4,7,and 10 (P =0.379).Although there were no significant differences between MREE and energy expenditure predicted with Schofield and WHO equations (P =0.917,P =0.995),the agreement was poor between the measured and predicted values (R2 =0.185,R2 =0.322).The metabolic status of the children on day 1 of ventilation was only correlated with age (P =0.000) and height (P =0.027),not with severity of underlying diseases or clinical outcomes.Conclusions MREE of IC method in ventilated critically ill children did not significantly change over time in this study.A poor agreement was observed between equationpredicted energy expenditure and MREE.IC measurement of resting energy expenditure is recommended for guiding individual nutritional support among critically ill children so as to improve clinical outcome.