Objective To investigate the effect of propofol(Pro)regulating macrophage polari-zation on airway inflammatory response and Toll-like receptor 4-NOD-like receptor protein 3(TLR4-NLRP3)pathway in mice with bronchial asthma(BA).Methods Forty BA model mice were ran-domly divided into BA group,low-dose Pro(Pro-L)group,high-dose Pro(Pro-H)group,and Pro-H+lipopolysaccharide(LPS)group,with 10 mice in each group.Additionally,10 normal mice were included as control group.Lung function indicators[peak expiratory flow(PEF)and ventilation vol-ume(VE)],eosinophil(EOS),lymphocyte(LYM)and neutrophil(NEU)counts in bronchoalve-olar lavage fluid,and interleukin(IL)-4,IL-10,IL-5 and IL-13 levels were measured in each group;flow cytometry was used to detect M1 and M2 macrophage levels and the proportions of T helper(Th)1 and Th 2 cells in peripheral blood;the enzyme-linked immunosorbent assay(ELISA)was used to detect serum interferon-γ(IFN-γ)and immunoglobulin E(IgE)levels;the hematoxylin-e-osin(HE)staining was used to observe the pathological morphology of lung tissues;the Western blot was used to detect the protein expression of cleaved caspase-3,TLR4,NLRP3 and Caspase-1 in lung tissues.Results Compared with the control group,mice in the BA group showed significant lung tissue damage,decreased PEF,VE,IL-10 and M1 macrophage levels,Th1 cell proportion,and IFN-γ level,and significant increased EOS,LYM,NEU counts,IL-4,IL-5,IL-13 and M2 macrophage levels,Th2 cell proportion,IgE,cleaved caspase-3,TLR4,NLRP3,and Caspase-1 protein expression levels(P＜0.05).Compared with the BA group,mice in the Pro-L and Pro-H groups showed significant lung tissue damage,increased PEF,VE,IL-10 and M1 macrophage lev-els,Th1 cell proportion,and IFN-γ level,and significant decreased EOS,LYM,NEU counts,IL-4,IL-5,IL-13 and M2 macrophage levels,Th2 cell proportion,IgE,cleaved caspase-3,TLR4,NLRP3,and Caspase-1 protein expression levels(P＜0.05).LPS significantly attenuated the im-provement effect of Pro in BA mice(P＜0.05).Conclusion Pro may regulate macrophage polari-zation and immune response in BA mice by inhibiting the TLR4-NLRP3 signaling pathway,reducing the degree of inflammatory response,and improving lung tissue morphology and lung function.

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

Objective To evaluate the reliability and validity of the Chinese version of the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)in patients with maintenance hemodialysis(MHD).Methods The general information and medical history of 84 MHD patients were collected,and the Mini-Mental State Exam(MMSE),Montreal Cognitive Assessment Scale(MoCA),and RBANS were conducted.The reliability of the scale was assessed by Cronbach α and split-half reliability.The structure and convergent validity of the scale were assessed by confirmatory factor analysis,and the RBANS scores'correlation to MoCA and MMSE scores was analyzed by Spearman correlation analysis.The predictive value of the RBANS total score on cognitive impairment(CI)was analyzed by receiver operating characteristic(ROC)curve.Results The Cronbach's alpha coefficient of the RBANS total scale was 0.896,split-half reliability was 0.911,and reliability for the five dimensions of the RBANS ranged from 0.618 to 0.791.Confirmatory factor analysis indicated that the overall fit of the five-dimensional model of the RBANS scale was acceptable(χ2/df=1.587,root mean square error of approximation=0.084,comparative fit index=0.967,incremental fit index=0.968,Tucker-Lewis index=0.947,goodness of fit index=0.891).The average variance extracted(AVE)for the five dimensions of the RBANS ranged from 0.525 to 0.863,while the composite reliability(CR)ranged from 0.733 to 0.926,indicating good convergent validity of the scale.Furthermore,Spearman correlation analysis revealed that the total RBANS score was negatively correlated to the age of MHD patients and positively correlated to years of education,as well as the total scores of MMSE and MoCA(all P<0.01).The ROC curve analysis indicated that the area under the curve(AUC)for the total RBANS score in predicting CI was 0.891(P<0.01),suggesting a high predictive value.Conclusion The Chinese version of RBANS has good reliability and validity in MHD patients,and can be used as a measure of cognitive function in MHD patients.

Objective To evaluate the efficacy of cardiac output ( CO ) and corrected flow time ( FTc) monitored by ultrasonic cardiac output monitor ( USCOM) in guiding volume therapy in patients un-dergoing laparoscopic colorectal surgery. Methods Eighty American Society of Anesthesiology physical sta-tus Ⅰ or Ⅱ patients, aged 18-60 yr, with body mass index of 18-25 kg∕m2 , undergoing laparoscopic colorectal surgery, were divided into 2 groups ( n=40 each) using a random number table method: control group ( group C ) and USCOM-guided fluid therapy group ( group U ) . Mean arterial pressure was main-tained at 60-100 mmHg, central venous pressure at 5-10 cmH2 O and urine volume>0. 5 ml·kg-1 ·h-1 u-sing conventional fluid therapy in group C. In group U, goal-directed fluid therapy was performed under the monitoring of USCOM, FTc was maintained at 326-400 ms and CO at 4. 2-5. 9 L∕min. The volume of crys-talloid and colloid solution, total volume of fluid infused, blood loss, urine volume and requirement for va-soactive agents during surgery and time of surgery were recorded. Blood samples were collected from the left radial artery for determination of the blood lactate concentration immediately after anesthesia induction, at the end of the operation and at 1 and 2 days after surgery. The time of passing the first flatus after surgery, adverse cardiovascular events ( hypertension, hypotension, cardiac insufficiency ) , pulmonary complica-tions ( pulmonary edema, pulmonary atelectasis) , and oliguria and anuria within 24 h after surgery, and length of hospital stay were recorded. Results Compared with group C, the volume of crystalloid, total volume of fluid infused and urine volume were significantly decreased during surgery, the volume of colloid solution was increased during surgery, the blood lactate concentration was decreased at the end of surgery, the incidence of postoperative cardiovascular and pulmonary complications was decreased, and the time of passing the first flatus after surgery and length of hospital stay were shortened in group U ( P<0. 05) . Con-clusion USCOM-monitored CO and FTc produces better efficacy in guiding volume therapy and is helpful for improving recovery in patients undergoing laparoscopic colorectal surgery.

A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group.Group D:topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF:intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic (FOB)-assisted awake nasotracheal intubation was performed.Mean arterial pressure (MAP),heart rate (HR),Pulse oxygen saturation (SpO2),Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris (T1),peep the epiglottis(T2),intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P ＜ 0.05 or P ＜ 0.01) than those of group MF while Ramsay sedation scores were obviously higher (P ＜ 0.05) than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D (n =21) were significantly higher than group MF (n =12) ; initial success rate of intubation in group D was obviously higher than that in group MF (70％,n =21 vs.47％,n =14).And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37％,n =11 vs.67％,n =20).Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.

Objective To evaluate the predictive values of ABCD,ABCD2 ,SPI-Ⅱ and ESSEN score models for the patients with high-risk transient ischemic attack (TIA)to develop to cerebral infarction in short and long term. Methods The ABCD, ABCD2 , SPI-Ⅱ and ESSEN scores of 235 cases of TIA patients were retrospectively analyzed.The incidence of cerebral infarction was followed up for 7 d and 1 year, and the receiver operating characteristic curve (ROC)was drawn to calculate the area under curve (AUC)to assess the accuracy of the score models,and compared with the original model and the relative risk (RR)value was calculated.Results The 7 d-incidence and 1 year-incidence of cerebral infarction in the 235 TIA patients were 9.36 % and 20.43%.The AUC of ABCD,ABCD2 ,SPI-Ⅱ and ESSEN models for 7 d were 0.70,0.74,0.67,and 0.62.The AUC of 1 year were 0.62,0.62,0.64,and 0.65.Compared with the orginal models,the RRs for 7 d of ABCD score model of the TIA patients in low,middle,and high risk groups were 0.09,0.92,and 0.72;the RRs of ABCD2 score model were 0.49,0.59,and 0.65;the RRs of SPI-Ⅱ score model were 0.58,0.87,and 0.55;the RRs of ESSEN score model were 0.11,0.18,and 0.55.Conclusion ABCD,ABCD2 ,SPI-Ⅱ and ESSEN score models can be used to assess the risk of cerebral infarction after TIA in Chinese population.The ABCD2 score model is of great value for short-term risk prediction,and the ESSEN score model is more value for long-term risk prediction.

Objective To evaluate the anesthetic efficacy of etomidate target-controlled infusion (TCI) in combination with remifentanil in patients undergoing gynecological laparoscopy.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 25-56 yr,with body mass index 18-27 kg/m2,undergoing elective gynecological lapa-roscopy,were equally and randomly divided into 2 groups:propofol TCI combined with remifentanil group (group PR) and etomidate TCI combined with remifentanil group (group ER).Anesthesia was induced with iv injection ofmidazolam 0.1 mg/kg,fentanyl 4 μg/kg and cisatracurium 0.15 mg/kg in both groups,and with TCI of propofolwith the target effect-site concentration (Ce) of 2.5 μg/ml in group PR or with TCI of etomidate (Ce 0.8 μg/ml) ingroup ER.The patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained withTCI of propofol (Ce 2.0-2.5 μg/ml) in group PR or with etomidate (Ce 0.5-0.7 μg/ml) in group ER,and with ivinfusion of remifentanil 0.1-0.2 μg· kg-1 · min-1 and intermittent iv boluses of cisatracurium 5 mg.BIS value was maintained at 40-60.Before anesthesia (baseline,T0),at the end of operation (T1),and at 24 and 48 h after operation (T2-3),venous blood samples were collected for determination of serum cortisol and aldosterone concentrations by radioimmunoassay.The emergence time,extubation time and requirement for vasoactive agents during operation were recorded.The development of injection pain and muscle twitch during induction of anesthesia,intraoperative awareness,and post-operative agitation,nausea and vomiting were also recorded.Results Compared with the baseline value at T0,the serum cortisol concentration was significantly decreased at T1 in group ER (P ＜0.05),while no significant change was found in serum aldosterone concentrations at each time point in the two groups (P ＞ 0.05).Compared with group PR,the requirement for vasoactive agents and incidence of injection pain were significantly decreased,and the incidence of muscle twitch was increased (P ＜ 0.05),and no significant change was found in the emergence time,extubation time,and incidences of post-operative agitation,nausea and vomiting in group ER (P ＞ 0.05).Conclusion Compared with propofol TCI in combination with remifentanil,etomidate TCI combined with remifentanil is helpful in maintaining the hemodynamics stable and exerts transient inhibition of adrenocortical function with less injection pain in patients undergoing gynecological laparoscopy.

Objective To evaluate the feasibility of induction with sevoflurane-midaaolam-remifentanil for tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.Methods Twenty-two ASA Ⅰ-Ⅲ patients with huge mediastinal tumor,aged 22-64 yr,weighing 48-76 kg,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midaaolam 0.03 mg/kg and inhalation of 8％ sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 8％,followed by decrement of 2％ every 30 s until 4％.When the eyelash reflex disappeared,remifentani1 2 μ g/kg was injected slowly over I min and sevoflurane inhalation was stopped 30 s later.The patients were mechanically ventilated after tracheal intubation.MAP and HR were recorded before induction and immediately before and 1 min after inlubation.The time of disappearance of eyelash reflex was recorded.The inlubation condition was evaluated using VibyMogensen score.Results The time period from sevoflurane inhalation to disappearance of eyelash reflex was(110 ± 14)s.The success rate of tracheal intubation at the first attempt was 86％.The position of the glottis was higher in 2 patients,and tracheal intubation was successfully performed under the guide of fiberoptic bronchoscope.The satisfactory intubation conditions were found in 86％ of cases.Compared with that before anesthesia induclion,MAP and HR were significantly decreased immediately after intubation and at 1 min after intubation(P ＜ 0.05).SpO2 ＞ 95％ in all patients.BIS was maintained at 45-55 during the period(before intubation until 1 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifenlail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.

Objective To evaluate the feasibility of induction with sevoflurane-midazolam-remifentail for tracheal intubation without muscle relaxants in neck brake patients.Methods Forty ASA Ⅰ or Ⅱ patients with cervical spine fracture with dislocation,aged 13-68 yr,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and inhalation of 5%sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 5%,followed by decrement of 1% every 30 s until 3%.When the eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 45s and 30 s later sevoflurane inhalation was stopped.The patients were mechanically ventilated after tracheal intubation.The time of disappearance of eyelash reflex was recorded.The intubation condition was evaluated using VibyMogensen score.Results All patients were successfully intubated at the first attempt.The time period from sevoflurane inhalation to disappearance of eyslash reflex was(69 ± 4)s.Coughing occurred in 3 cases during intubation.The satisfactory intubation conditions were found in 100% of cases.SpO2 ＞ 95% in all patients.BlS was maintained at 45-55 during the period(before intubation until 3 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifentail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in neck brake patients.

Objective To study the expression of prepro-orexin mRNA in circadian rhythms and sleep-deprived rats.Methods Sleep was deprived with “rotation cylinder” in rats. RT-PCR was used to determine the change of prepro-orexin mRNA expression in cortex and hypothalamus of circadian rhythms and sleep-deprived rats.Results There was a significant changes of prepro-orexin mRNA expression with circadian rhythms in hypothalamus of rats. But there was no significant change in cortex. More prepro-orexin mRNA expression was found in hypothalamus than in cortex of rats. The expression of prepro-orexin mRNA in hypothalamus and in cortex of rats was not effected by short times of sleep deprivation. However the expression was raised by a 8-hour sleep deprivation.Conclusions There should be a close relationship between orexin and sleep. The control of sleep may be dependent on regulation of orexin in hypothalamus.