Objective To explore the effects of permissive hypercapnia on postoperative cognitive function in elderly patients with diabetes mellitus.Methods Sixty elderly patients with diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation diabetes mellitus group(group DH)and the routine ven-tilation diabetes mellitus group(group DR),30 patients in each group.Another sixty elderly patients with non-diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation non-diabetes mellitus group(group NH)and the routine ventilation group(group NR),30 patients in each group.All patients in four groups were performed with tracheal intubation and mechanical ventilation after anesthesia induction.The respiratory parameters were adjusted to maintain PaCO2 in a range of 45-65 mmHg in groups DH and NH,and PaCO2 in a range of 35-45 mmHg in groups DR and NR.PETCO2 was recorded 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum.pH value and PaCO2 were recorded and arterial internal jugular vein bulbar oxygen difference(Da-jvO2)and cerebral oxygen extraction rate(CERO2)were calculated at the same time.The serum S100β protein concentration were detected before anesthesia induction and 3 days after operation.Montreal cognitive assessment(MoCA)scores and occurrence of postoperative cognitive dysfunction were recorded 1 day before operation,and 1 day,3 days and 7 days after operation.Results Compared with the baseline value 5 minutes before pneumoperitoneum,PETCO2 and PaCO2 were significantly increased,pH value,Da-jvO2 and CERO2 were significantly decreased 5,15,and 30 minutes after pneumoperitoneum in the four groups(P＜0.05).Compared with before anesthesia induction,the serum S100β protein concen-tration were significantly increased 3 days after operation in the four groups(P＜0.05).Compared with the last day before operation,MoCA scores were significantly decreased 1 day and 3 days after operation in the four groups(P＜0.05).Compared with group DR,PETCO2 was significantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneumoperitoneum,5,15,and 30 mi-nutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days af-ter operation,MoCA scores were significantly increased 1 day and 3 days after operation,the incidence rate of POCD was significantly decreased in group DH(P＜0.05).Compared with group NR,PETCO2 was sig-nificantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days after operation,MoCA scores were significantly increased 1 day and 3 days af-ter operation,the incidence rate of POCD was significantly decreased in group NH(P＜0.05).Compared with group NH,Da-jvO2 and CERO2 were significantly increased 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly in-creased 3 days after operation,MoCA scores were significantly decreased 1 day and 3 days after operation in group DH(P＜0.05).Conclusion Permissive hypercapnia can improve the cerebral oxygen metabolism during operation,reduce postoperative serum S100β protein concentration and reduce the incidence rate of POCD in the elderly patients with diabetes mellitus.

Objective:To evaluate the effect of ischemic preconditioning combined with dexmedetomidine on lung injury induced by limb ischemia-reperfusion (I/R) in patients undergoing orthopedic surgery.Methods:Seventy-five patients of both sexes, aged 50-89 yr, with body mass index of <35 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective lower extremity surgery with tourniquet, were divided into 4 groups using a random number table method: control group (group C, n=17), ischemic preconditioning group (group IP, n=19), dexmedetomidine group (group D, n=19) and ischemic preconditioning combined with dexmedetomidine group (group IPD, n=20). The patients underwent three cycles of 5 min ischemia which was induced by a tourniquet placed on the upper extremity and inflated to 200 mmHg, followed by 5 min deflation at 24 h before surgery in group IP and group IPD.In D and IPD groups, dexmedetomidine was intravenously infused at a loading dose of 0.5 μg/kg over 15 min starting from the time point after the patients were in the supine position, followed by an infusion of 0.5 μg·kg -1·h -1 until the end of surgery, while the equal volume of normal saline was given instead in group C. Before using the the tourniquet (T 0), immediately after loosing the tourniquet (T 1) and at 24 h after surgery (T 2), mean arterial pressure and heart rate (HR) were recorded.Arterial blood samples were collected for blood gas analysis at T 0 and T 1, and pH value, arterial oxygen partial pressure (PaO 2), arterial carbon dioxide partial pressure (PaCO 2) and lactic acid concentration (Lac) were recorded.Alveolar-arterial oxygen partial pressure difference (P A-aDO 2), oxygenation index (OI) and respiratory index (RI) were calculated.The occurrence of acute lung injury (ALI) was recorded from T 1 to T 2.The serum concentrations of Clara cells secrete proteins 16 (CC16) and malonyldialdehyde (MDA) were determined by enzyme linked immunosorbent assay from T 1 to T 2. Results:Compared with group C, HR was significantly decreased and PaCO 2 was increased in D and IPD groups, PaO 2 and OI were increased and RI was decreased in IP and IPD groups, and CC16 and MDA concentrations were decreased ( P<0.05), and no significant change was found in the incidence of ALI in IP and D groups ( P>0.05). Compared with group IP or group D, no significant change was found in the parameters mentioned above in group IPD ( P>0.05). Conclusion:For the patients undergoing orthopedic surgery, both ischemic preconditioning and dexmedetomidine can reduce lung injury induced by limb I/R, but the effect of the combination is not enhanced significantly.

Objective:To explore the relationship between respiratory mechanics and right heart function during ARDS mechanical ventilation through the establishment of Beagle dogs acute respiratory distress syndrome (ARDS) animal model and the application of different levels of mechanical ventilation, which will provide theoretical basis for right heart protective ventilation strategy of ARDS.Methods:Beagle dogs were anesthetized successfully and then pulmonary artery floating catheter, esophageal manometric catheter and femoral artery catheter were inserted. Under the pressure control mode, the driving pressure was fixed. After adjustment, PEEP gradually increased from 2 cmH 2O to 14 cmH 2O. The changes of respiratory mechanics, hemodynamics and right heart function were observed. ARDS model was established by injecting oleic acid into central vein, and mechanical ventilation with the same parameters was given after the model was established successfully. In contrast to itself, the changes of respiratory mechanics, hemodynamics and right heart function indexes of experimental dogs before and after modeling were analyzed. In the group, the indexes of different PEEP were compared by ANOVA, and then compared by Student-Newman-Keuls. The difference was statistically significant at a P value <0.05. Results:Before modeling, the peak airway pressure (P peak) and plateau pressure (P plat) increased with the increase of PEEP ( F=232.733,196.33, P<0.05). However, P trans-I, P trans-E, C stat and Vt decreased significantly ( F=4.524, 6.499, 64.803, 2.31, P<0.05). The area of change of right ventricle (FAC) became smaller ( F=3.09, P<0.05); SV first increased and then decreased ( F=3.24, P<0.05), and CVP and MPAP increased ( F=19.07,14.81, P<0.05). There was no significant difference in TAPSE, MAP, HR and SpO 2 ( P>0.05). After modeling, as PEEP increased, P peak, P plat, P ES-I and P ES-E increased significantly ( F=24.829, 41.95, 9.78, 87.86, P<0.05). Vt, P trans-I, P trans-E, C stat and Vt first increased and then decreased ( F=2.91, 4.29, 5.84, 48.890, P<0.05). TAPSE and SV first increased and then decreased ( F=6.22,6.54, P<0.05). CVP and MPAP increased ( F=5.23, 19.24, P<0.05). MAP increased first and then decreased ( F=5.02, P<0.05). SpO 2 increased ( F=2.77, P<0.05). FAC and HR had no statistical significance ( P>0.05). Conclusions:Trans pulmonary pressure and lung compliance can reflect the effectiveness of ARDS lung recruitment, and have good synergy; with the increase of PEEP, the right ventricular systolic function TAPSE is first affected, and SV compensatory increase, but with the increase of PEEP, TAPSE and SV decrease; pulmonary blood flow distribution is more important in improving alveolar oxygenation. Therefore, real-time monitoring of trans pulmonary pressure, TAPSE and intrapulmonary blood flow should be performed in ARDS treatment.

Objective:To evaluate the lung protection induced by goal-directed fluid therapy (GDFT) in the patients undergoing pulmonary lobectomy.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 35-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective pulmonary lobectomy with general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: control group (group C) and GDFT group (group G). In group C, mean arterial pressure was maintained at 65-90 mmHg, central venous pressure at 8-12 cmH 2O, and urine volume>0.5 ml·kg -1·h -1.In group G, GDFT was performed, maintaining cardiac index>2.5 L·min -1·m -2 and stroke volume variation ≤11%.Peak airway pressure and plateau airway pressure were recorded immediately after intubation (T 1), 30 min of one-lung ventilation (T 2), 1 h of one-lung ventilation (T 3) and at the end of the surgery (T 4). Blood samples were collected from the radial artery at T 1-4 and 24 h after operation (T 5) for blood gas analysis to determine the alveolar-arterial difference of oxygen tension (A-aDO 2). Broncho-alveolar lavage fluid (BALF) and blood samples from the internal jugular vein were collected at T 1 and T 4 to detect the concentrations of interleukin-6 (IL-6) and IL-10 in serum and BALF, and the ratio of IL-6 to IL-10 was calculated.Ultrasound was used to measure the inferior vena cava respiratory variations index at T 1, 4.The intraoperative total volume of fluid infused, amount of colloid solution infused, urine volume and blood loss were recorded, and the hospitalization time was also recorded. Results:Compared with group C, peak airway pressure and plateau airway pressure at T 2-4, A-aDO 2 at T 2-5, concentration of IL-6 in BALF at T 4 and IL-6/IL-10 ratio were significantly decreased, the total volume of fluid infused and urine volume were reduced, and the amount of colloid solution infused was increased in group G ( P<0.05). Conclusion:GDFT can improve the intraoperative respiratory dynamics, inhibit inflammatory responses in lung tissues and improve lung function in the patients undergoing pulmonary lobectomy.

Objective:To compare the effects of different acupoint compatibility on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 140 patients of both sexes, aged 18-64 yr, with body mass index of 18.5-24.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy under general anesthesia, were divided into 4 groups ( n=35 each) by a random number table method: general anesthesia group (group A), Hegu plus Neiguan group (group B), Hegu plus Neiguan plus Zusanli group (group C), and Hegu plus Neiguan plus Zusanli plus Sanyinjiao group (group D). Group B, group C and group D underwent percutaneous electrical stimulation of the corresponding acupoints from 30 min before induction of anesthesia to the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia were recorded.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at 24 h before surgery and 24, 48 and 72 h after surgery.The extubation time and postoperative length of hospital stay were recorded.Adverse events such as intraoperative hypertension, hypotension, bradycardia and tachycardia were recorded. Results:Compared with group A, the intraoperative consumption of propofol and remifentanil and postoperative requirement for rescue analgesia were significantly reduced, the extubation time and postoperative length of hospital stay were shortened, and PSQI was decreased at 24 and 48 h after surgery in B, C and D groups ( P<0.05). Compared with group B and group C, PSQI was significantly decreased at 24 and 48 h after surgery, and postoperative hospitalization time was shortened in group D ( P<0.05). There was no significant difference in the PSQI and incidence of intraoperative hypertension, hypotension, bradycardia and tachycardia among the four groups ( P>0.05). Conclusion:Combination of Hegu, Neiguan, Zusanli and Sanyinjiao has a better effect on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.

Objective:To evaluate the effect of inhaled aerosolized budesonide and salbutamol on lung function during one-lung ventilation (OLV) in rabbits.Methods:Thirty-two healthy male New Zealand white rabbits, aged 5-6 months, weighing 2.5-3.0 kg, were randomized into 4 groups ( n=8 each) using a random number table method: two-lung ventilation (TLV) group, OLV group, inhalation of aerosolized budesonide group (group B) and inhalation of aerosolized budesonide and salbutamol group (group B+ S). Bilateral lungs were ventilated for 3 h in group TLV, the left lung was ventilated for 2 h followed by 1-h TLV in OLV, B and B+ S groups, aerosolized budesonide 1 mg (diluted to 2 ml in normal saline) was inhaled before OLV in group B, and aerosolized salbutamol 0.15 mg/kg plus budesonide 0.5 mg was inhaled before OLV in group B+ S.The equal volume of aerosolized normal saline was delivered in TLV and OLV groups.Volume-controlled ventilation was used in all groups.Arterial blood samples were obtained for blood gas analysis before aerosol inhalation (T 0), 15 min and 1 h after aerosol inhalation (T 1, 2), and at the end of ventilation (T 3). Oxygenation index was calculated.Mixed venous blood samples were collected to determine the corresponding parameters.The pulmonary shunt (Qs/Qt) was calculated.Peak airway pressure (P peak), airway platform pressure (P plat), airway resistance (Raw), and lung compliance (C dyn) were continuously monitored and recorded at T 0-T 3. Results:Compared with group TLV, the concentration of lactic acid was significantly increased at T 2, 3, oxygenation index and C dyn were decreased at T 1-3, and Qs/Qt, Raw, P plat and P peak were increased in OLV, B and B+ S groups ( P<0.05). Compared with group OLV, the concentration of lactic acid was significantly decreased at T 2, 3, oxygenation index and C dyn were increased at T 1-3, and Qs/Qt, Raw, P plat and P peak were decreased in B and B+ S groups ( P<0.05). Compared with group BD, the C dyn was significantly increased at T 1-3, and Qs/Qt, Raw and P peak were decreased in group B+ S ( P<0.05). Conclusion:Inhaled aerosolized budesonide and salbutamol can effectively improve lung function during OLV in rabbits.

Objective: To evaluate the role of G protein-coupled receptor 30 (GPR30) in 17β estradiol-induced inhibition of ketamine-caused neuroapoptosis in the hippocampus of newborn rats and the relationship with phosphorylated extracellular signal-regulated kinase 1/2 (p-ERKl/2). Methods: Twenty-four clean-grade healthy male Sprague-Dawley rats, aged 7 days, weighing 11-18 g, were divided into 4 groups (n=6 each) using a random number table method: control group (group C), ketamine group (group K), 17β estradiol plus ketamine group (group EK), and GPR30 inhibitor G15 plus 17β estradiol plus ketamine group (group G15EK). Ketamine 75 mg/kg (diluted to 0.1 ml in normal saline) was intraperitoneally injected every 24 h for 3 consecutive days in group K. In group EK, 17β estradiol 600 μg/kg was subcutaneously injected and ketamine 75 mg/kg was intraperitoneally injected every 24 h for 3 consecutive days.G15 300 μg/kg and 17β estradiol 600 μg/kg were subcutaneously injected and ketamine 75 mg/kg was intraperitoneally injected every 24 h for 3 consecutive days in group G15EK.The equal volume of normal saline 0.1 ml was intraperitoneally injected instead in group C. The animals were sacrificed at 24 h after the last injection for determination of the expression of cleaved caspase-3, ERK1/2 and phosphorylated ERK1/2(p-ERK1/2) (by Western blot). Results: There was no significant difference in the expression of ERK1/2 in hippocampus among the four groups (P>0.05). Compared with group C, the expression of cleaved caspase-3 was significantly up-regulated, and the expression of p-ERK1/2 was down-regulated in K and G15EK groups (P<0.05). Compared with group K, the expression of cleaved caspase-3 was significantly down-regulated, and the expression of p-ERK1/2 was up-regulated in group EK (P<0.05). Compared with group EK, the expression of cleaved caspase-3 was significantly up-regulated, and the expression of p-ERK 1/2 was down-regulated in group G15EK (P<0.05). Conclusion GPR30 is involved in 17β estradiol-induced inhibition of ketamine-caused neuroapoptosis in the hippocampus of newborn rats, which is related to up-regulating the expression of p-ERKl/2.

Objective: To evaluate the effect of ixeris sonchifolia pretreatment on the expression of hypoxia-inducible factor-1α (HIF-1α) following myocardial injury induced by exhausting exercise in rats. Methods: Fifty-six healthy clean-grade male Wistar rats, weighing 200-220 g, were divided into 3 groups using a random number table method: control group (group C, n=8), exhausting exercise group (group E, n=24) and ixeris sonchifolia pretreatment group (group IS, n=24). In E and IS groups, the model of myocardial injury was established by exhausting swimming.In group IS, the rats were subjected to exhausting swimming after intraperitoneal ixeris sonehifolia 20 ml/kg.In E and IS groups, blood samples were taken from the inferior vena cava at 0, 6 and 24 h after exhaustion (T_1-3) for determination of serum cardiac troponin I (cTnI) concentrations by enzyme-linked immunosorbent assay.The animals were sacrificed after anesthesia, and myocardial specimens were obtained for determination of the cell apoptosis index (by TUNEL) and expression of HIF-1α, Bax and Bcl-2 (by immunohistochemistry), and Bax/Bcl-2 ratio was calculated.The area of myocardial injury was observed using HBFP assay. Results: Compared with group C, the area of myocardial injury, concentration of serum cTnl, Bax/Bcl-2 ratio and apoptosis index were significantly increased, and the expression of HIF-1α in myocardial tissues was up-regulated at each time point in E and IS groups (P<0.05). Compared with group E, the area of myocardial injury, concentration of serum cTnl, Bax/Bcl-2 ratio and apoptosis index were significantly decreased, and the expression of HIF-1α in myocardial tissues was down-regulated at each time point in group IS(P<0.05). Conclusion The mechanism by which ixeris sonchifolia pretreatment mitigates myocardial injury induced by exhausting exercise is related to inhibiting up-regulated expression of HIF-1α in myocardial tissues and reducing cell apoptosis in rats.

Objective To evaluate the effect of ixeris sonchifolia pretreatment on the expression of hypoxia-inducible factor-1α(HIF-1α)following myocardial injury induced by exhausting exercise in rats.Methods Fifty-six healthy clean-grade male Wistar rats,weighing 200-220 g,were divided into 3 groups using a random number table method: control group(group C,n＝8),exhausting exercise group(group E,n＝24)and ixeris sonchifolia pretreatment group(group IS,n＝24).In E and IS groups,the model of myocardial injury was established by exhausting swimming.In group IS,the rats were subjected to exhaust-ing swimming after intraperitoneal ixeris sonehifolia 20 ml/kg.In E and IS groups,blood samples were taken from the inferior vena cava at 0,6 and 24 h after exhaustion(T1-3)for determination of serum cardiac tro-ponin I(cTnI)concentrations by enzyme-linked immunosorbent assay.The animals were sacrificed after an-esthesia,and myocardial specimens were obtained for determination of the cell apoptosis index(by TUNEL)and expression of HIF-1α,Bax and Bcl-2(by immunohistochemistry),and Bax/Bcl-2 ratio was calculated.The area of myocardial injury was observed using HBFP assay.Results Compared with group C,the area of myocardial injury,concentration of serum cTnl,Bax/Bcl-2 ratio and apoptosis index were significantly in-creased,and the expression of HIF-1α in myocardial tissues was up-regulated at each time point in E and IS groups(P＜0.05).Compared with group E,the area of myocardial injury,concentration of serum cTnl,Bax/Bcl-2 ratio and apoptosis index were significantly decreased,and the expression of HIF-1α in myocardi-al tissues was down-regulated at each time point in group IS(P＜0.05).Conclusion The mechanism by which ixeris sonchifolia pretreatment mitigates myocardial injury induced by exhausting exercise is related to inhibiting up-regulated expression of HIF-1α in myocardial tissues and reducing cell apoptosis in rats.

Objective To evaluate the effect of 17βestradiol on propofol-induced long-term cogni-tive dysfunction in developing rats and the relationship with hippocampal glutamate ( Glu )∕γ-aminobutyric acid (GABA). Methods Sixty healthy male Sprague-Dawley rats, aged 7 days, weighing 11-18 g, were divided into 5 groups ( n=12 each) using a random number table method: dimethyl sulfoxide ( DM-SO) group, fat emulsion group (group F), 17β estradiol group (group E), propofol group (group P) and propofol plus 17β estradiol group ( group P+E) . 17β estradiol 600 μg∕kg was subcutaneously injected in group E, and the equal volume of DMSO was given instead in group DMSO. Propofol 75 mg∕kg was in-traperitoneally injected in group P, and the equal volume of fat emulsion was given instead in group F. 17βestradiol 600μg∕kg was subcutaneously injected and 30 min later propofol 75 mg∕kg was intraperitoneally in-jected in group P+E. Injection was performed once every 24 h for 7 consecutive days in each group. Morris water maze test was performed at 60 days of age. The rats were sacrificed after the end of Morris water maze test and hippocampi were removed for determination of Glu content ( by ultraviolet colorimetry method) andGABA content (using enzyme-linked immunosorbent assay) in hippocampal tissues. Glu∕GABA ratio was calculated. Results There was no significant difference in the escape latency, the number of crossing the original platform, percentage of time spent in target quadrant, Glu content or Glu∕GABA ratio between group DMSO, group F and group E (P>0. 05). There was no significant difference in GABA content a-mong the five groups ( P>0. 05) . Compared with group F, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, and the percentage of time spent in target quad-rant, Glu content and Glu∕GABA ratio were decreased in group P (P<0. 05). Compared with group P, the escape latency was significantly shortened, the number of crossing the original platform was increased, and the percentage of time spent in target quadrant, Glu content and Glu∕GABA ratio were increased in group P+E ( P<0. 05) . Conclusion 17β estradiol can improve propofol-induced long-term cognitive dysfunction and the mechanism may be related to maintaining hippocampal Glu∕GABA balance in developing rats.