Alkaloids ; Antineoplastic Agents, Phytogenic ; Chemical Phenomena ; Chemistry ; Harringtonines

Objective To study the effect of dexmedetomidine and midazolam on hemodynamics and sedation in patients with nasal intubation.Methods Forty patients whose ASA grade Ⅰ-Ⅱ and anticipated difficult airway were randomly divided into dexmedetomidine group(group D,20 cases)and midazolam group(group M,20 cases)according to the admission number.In group D,dexmedetomidine 1 μ g/kg were constant speed pumped in 10 minutes.In group M,midazolam 0.03 mg/kg were intravenous injected.Then nasal intubation were carried.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial blood pressure(MAP),heart rate(HR),pulse oxygen saturation(SpO2),Ramsay sedation score,rate-pressure product(RPP),tip perfusion index(TPI)were recorded and compared before anesthesia (T0),fiberoptic bronchoscope pass by later nostril(T1),to spy on epiglottis(T2),intubation succeed(T3),after intubation 1 minute(T4)and after intubation 3 minutes(T5).Airway score and postoperative visit were evaluated.Results SBP,DBP,MAP,HR,RPP in group M were significantly higher at T1-T3 than those at T0 (P＜0.05),and were significantly higher than those in group D at the same time(P＜ 0.05).There was no significant difference in group D(P ＞ 0.05).Ramsay sedation score and TPI at T1-T3 in group M were significantly lower than those at To(P ＜0.05).Ramsay sedation score and TPI at T1-T5 in group D were significantly higher than those at T0(P ＜ 0.05),and were significantly higher than those in group M at the same time(P ＜ 0.05).The rate of airway score 1 score and intubation satisfaction in group D were significantly higher than those in group M[100％(20/20)vs.30％(6/20),90％(18/20)vs.50％(10/20)](P＜ 0.05).The rate of throat ache in group D was significantly lower than that in group M[5％(1/20)vs.35％(7/20)](P ＜0.05).Conclusions For difficult airway patients with nasal intubation during dexmedetomidine infusion,hemodynamics is stable and sedation is satisfied.

Humans ; Traumatology

Aim To observe the neuroprotective effect of different doses of propofol on ischemic fetal rat brain.Methods Eighteen healthy pregnant SD rats were randomly allocated into the following six groups with three rats in each.Group S: sham operation group, Group IR: ischemia/reperfusion group, Group P1~P3: different doses of propofol groups, Group B: bicuculline group.In group S and group IR, 1 ml saline solution was administered via caudal vein.In group P1~P3, 10, 30, 50 mg·kg-1 of propofol was administered via caudal vein respectively.In group B, when 50 mg·kg-1 propfol was administered via caudal vein, 5 mg·kg-1 bicuculline was injected intraperitoneally at the same time.Bilateral uterine ovarian arteries were clamped for 11 mins to make intrauterine distress model of the fetal rats.The brains of fetal rats were removed after 3 days of reperfusion.Brain sections(5 μm thick) were mounted and stained with Hematoxylin and eosin(HE).The profile of the hippocampus CA1 was evaluated under a light microscope and neuronal Lesion-index(LI) was calculated.MDA content of fetal rat brain was detected by thiobarbituric acid reaction method to determine the lipid peroxidation degree of brain.Results LI was (7.2±0.9) and MDA was (3.86±0.20) μmol·g-1 in group S.LI was 71.9±2.8 and the content of MDA was (9.10±0.45) μmol·g-1 in group IR, which increased significantly compared with those in group S(P<0.01).LI was (40.8±2.6), (21.4±1.4), (20.1±1.3) and the content of MDA was (7.32±0.41), (5.65±0.27), (5.44±0.28) μmol·g-1 in propofol groups, which decreased significantly compared with those in group IR(P<0.05).LI and the content of MDA was (51.2±2.3), (7.54±0.31) μmol·g-1 in group B,respectively, reversing partly the neuroprotevtive effect of propofl.Conclusion Propofol could protect the neurons in hippocampus CA1 region of fetal rat against intrauterine distress by reducing the concentration of MDA in the brain.

Objective:To investigate the effect of electroacupuncture (EA) at Ganshu (BL 18) and Shenshu (BL 23) on vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1)/CD31 around the cerebral infarction focus in middle cerebral artery occlusion (MCAO) rats and the possible mechanism, thus to provide a new strategy for the treatment of cerebral ischemic stroke by acupuncture. Methods:A total of 180 healthy male Sprague-Dawley (SD) rats were randomly divided into a sham operation group, a model group, an acupoint group and a non-acupoint group, 45 rats in each group. MCAO model was established using the modified line-embolus method in all rats except for those in the sham operation group; rats in the acupoint group were treated with EA at Ganshu (BL 18) and Shenshu (BL 23); rats in the non-acupoint group were treated with EA at the control points; rats in other 2 groups were only subjected to bundling without treatment. Ten rats in each group were randomly selected on the 3rd day, the 14th day and the 21st day after acupuncture stimulation to test the neurological function impairment. The expression levels of CD31 and VEGF were also detected. Results:Compared with the model group and non-acupoint group, the neurological function score of the acupoint group was decreased at each time point, and the differences were statistically significant (P<0.05,P<0.01). The expressions of VEGF and CD31 in each group were the lowest on the 3rd day, reached the peak on the 14th day and still remained at high level on the 21st day. And the differences among groups were statistically significant both on the 14th day and the 21st day (P<0.05,P<0.01). Compared with the model group and the non-acupoint group, the expressions of VEGF and CD31 in the acupoint group were increased, and the differences were statistically significant (allP<0.05). Conclusion: EA at Ganshu (BL 18) and Shenshu (BL 23) can significantly improve the neurological function score of MCAO model rats, and shows protective effect on cerebral ischemia. The protective mechanism may be related to the up-regulation of CD31 and VEGF expression around the cerebral infarction focus in the MCAO model rats and induction of angiogenesis.

Objective To compare the efficacy of different target concentrations of sufentanil target-controlled infusion used to supplement topical anesthesia for fiber-optic bronchoscopy (FOB)-assisted awake nasotracheal intubation in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty-five ASA physical status Ⅱ or Ⅲ patients with OSAS,aged 28-60 yr,with body mass index of 30-40 kg/m2,scheduled for elective surgery,were randomly assigned into 3 groups (n =15 each):control group (group C) and sufentanil with the target plasma concentration of 0.4 ng/ml (group S1) and 0.6 ng/ml groups (group S2).Naso-pharyngeal and laryngeal mucous membrane was sprayed with 2％ lidocaine mixed with 1％ ephedrine for topical anesthesia in both groups.In addition 1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.FOB-assisted awake nasotracheal intubation was performed after the target concentration was achieved.The degree of airway obstruction was scored during intubation.The highest values of MAP and HR,rate-pressure product ＞ 12 000,decreased respiratory rate and hyoxemia were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The changes in MAP and HR as percent of baseline values were calculated.Before topical anesthesia (T0),when target concentrations were reached (T1),and at 1 and 3 min after intubation (T2,3),blood samples were taken to determine the plasma concentrations of epinephrine (E),norepinephrine (NE) and cortisol.Results Compared with group C,the airway obstruction score was significantly decreased in group S1,the incidence of changes in MAP and HR ＞ 30％ of baseline values and rate-pressure product ＞ 12 000 was decreased,the plasma concentrations of E,NE and cortisol were decreased in S1 and S2 groups,and the incidence of the respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with group S1,the airway obstruction score were significantly decreased,and the incidence of respiratory rate was decreased and hypoxemia was increased in group S2 (P ＜ 0.05).Compared with the baseline value at T0,the plasma concentrations of E,NE and cortisol were significantly increased at T2,3 in group C,while decreased at T1 in S1 and S2 groups (P ＜ 0.05).Conclusion Compared with pure topical anesthesia,sufentanil with the target plasma concentration of 0.4 ng/ml does not induce respiratory depression,maintains hemodynamics stable,attenuates the stress responses and provides better intubation conditions when used to supplement topical anesthesia for FOB-assisted awake nasotracheal intubation in patients with OSAS.

Objective To investigate the effect of different doses of sufentanil combined with dexmedetomidine ( DEX) on hemodynamic and Narcotrend index ( NI) during pediatric anesthesia induction. Methods A total of 45 children with lower abdominal surgery were randomly divided into three groups evenly: sufentanil 0. 1 μg·kg-1+ DEX (S1 group),sufentanil 0. 2 μg·kg-1+DEX (S2 group),and sufentanil 0. 3μg·kg-1+DEX (S3 group). Patients in each group began with intubation at the peak point of administration. Blood pressure,heart rate,perfusion index (PI) and NI were detected at the baseline (t0), delivering DEX 0.5 μg·kg-1·h-1 and sufentanil intravenously for 5 min (t1),delivering sufentanil for 3 min (t2),time of intubation ( t3 ) ,1 min ( t4 ) ,and 5 min ( t5 ) after intubation. The application rate of atropine and propofol was recorded. Patient recovery time and adverse reactions were observed. Results Compared with basicline value at t0 time point, hemodynamic parameters and NI were decreased at t1 and t2 ,while PI was increased in both groups. At t3 ,t4 ,and t5 ,all of the indicators in S1 group were significantly different from those at t0 ,and also significantly different from those in S2 and S3 group. Six patients were treated with propofol in S1 group and four presented with agitation after operation,more than S2 and S3 groups. Three patients were treatment with atropine in S3 group. Conclusion Sufentanil (0. 2 μg·kg-1 ) combined with dexmedetomidine can be used to induce intubation for pediatric anesthesia with stable hemodynamic profile and low incidence of adverse effects.

?AlM: To analyze and study the changes of intraocular pressure ( lOP) , visual field and P-ERG on patients with big cup/disk (C/D) in 24h.
?METHODS: A total of 120 cases ( 240 eyes ) diagnosed with big C/D (C/D>0. 3) were divided into group A (C/D<0. 6, 67 cases, 114 eyes ) and group B ( C/D≥0. 6, 73 cases, 126 eyes). Forty cases (80 eyes) with small C/D (C/D≤0. 3) were chosen as control group. All cases underwent 24h lOP examination, vision examination of 30-2 SlTA - standard static threshold and pattern electroretinogram ( P-ERG) examination. The differences between the examination indexes of the three groups were analyzed.
?RESULTS:There was no significant statistical difference in the 24h average lOP (P>0. 05) among the three groups, while the amplitudes had significant statistical differences (P<0. 05). Compared with the control group, the lOP amplitudes of group B were obviously higher, and the difference was of statistical significance (P<0. 05). ln terms of static threshold visual fields, the mean deviations (MD) and pattern standard deviations (PSD) of the three groups had significant statistical differences ( P < 0. 05 ). Comparison between every two groups:compared with the control group, the MD and the PSD were significantly increased in group B, and the difference was of statistical significance (P<0. 05); while there was no significant statistical difference in group A (P>0. 05);Compared with group A, the MD and the PSD were significantly higher in group B, and the difference was of statistical significance (P<0. 05). ln terms of P-ERG examination, there was no significant statistical difference in P50’s latent periods among the three groups (P>0. 05), but there were significant statistical differences in amplitudes (P<0. 05). Comparison between every two groups: compared with the control group, the P50’s amplitude was significantly decreased in group B, and the difference was of statistical significance (P<0. 05), while there was no significant statistical difference in group A (P>0. 05); Compared with group A, the P50’s amplitude of group B was significantly lower, and the difference was of statistical significance (P<0. 05).
?CONCLUSlON: When the patients’ C/D is no less than 0. 6, there are obvious changes of 24h lOP, static threshold visual field and P-ERG’s P50 wave. For patients with big C/D, a single lOP examination is far from sufficient, so an in-depth visual function examination should be performed. Meanwhile, it’s feasible to regard C/D 0. 6 as a screening criterion for suspected glaucoma.

Objective To explore the expression of TLR2,4,7 mRNA on peripheral blood mono-nuclear cells (PBMCs) in patients with chronic cystic echinococcosis(CE) infection, and the level of serum IL-10. Methods The expression level of TLR2,4,7 mRNA on peripheral blood mononuclear were tested in 42 chronic CE cases and 28 normal controls (NC) by real-time fluorescent quantitative reverse transcription polymerase chain reaction (FQ-RT-PCR) method. GAPDH was selected as the internal control. The level of serum IL-10 was determined in ELISA. The subjects were determined by t test. The correlations between TLR2, TLR4, TLR7 and IL-10 were determined by differences of expression of TLR2, TLR4, TLR7 on PBMCs and serum IL-10 in two groups of study linear correlation test. Results The expressions of TLR2, TLR4,TLR7 mRNA in chronic CE group were higher than those of in NC group. Compared with the NC group, the expressions of TLR2, TLR4 and TLR7 mRNA increased more than 7.3-, 3.6-, 3.6-fold, respectively. In chronic CE group, TLR2, TLR4 and TLR7 mRNA expressions were 1.0729 ±0.4006, 5.0976 ±1.6682, 0. 6481 ±0. 2574, respectively. TLR2, TLR4 and TLR7 mRNA expressions were 0. 1468 ± 0.0435, 1.4067 ±0. 3279, 0. 1804 ±0. 0568 in NC group, respectively. Compared with NC group, the differences of TLR2 and TLR4 mRNA expression were significant (P = 0.0287, 0. 033), while the expression of TLR7 mRNA was not difference (P =0.0862). Moreover, in chronic CE group, the level of serum IL-10 was higher than that of in NC group. In chronic CE group and NC group, the level of serum IL-10 was (17.6770±1.6298) pg/ml, (9.4898 ±0.7049) pg/ml. Compared with NC group, there was significant difference in chronic group (P<0.01). Significant positive correlation between TLR2 and TLR4 was found in chronic CE group, r = 0. 1135, P =0.036. Others were not correlations. Conclusion In the development of chronic CE, TLR2 and TLR4 participate in this progression. As the receptors of antigen of cystic echinococcus, TLR2 and TLR4 can regulate the immune response through interacting with different antigens from cystic echinococcus. Meanwhile, under the participation of TLR2, TLR4 and increased serum IL-10, they will approach to Th2 immune reaction, which play an important role in chronic CE that can induce immune evasion.