Objective:To evaluate myocardial microcirculation perfusion with myocardial contrast echocardiography (MCE) in patients with acute myocardial infarction after percutaneous coronary intervention (PCI), and to explore the prognostic value of different types of myocardial microcirculation perfusion.Methods:This is a prospective cohort study. Patients with acute myocardial infarction who underwent successful PCI in Nanfang Hospital of Southern Medical University and Kanghua Hospital of Dongguan City from October 2019 to June 2021 were selected. All the enrolled patients completed MCE examination within 72 hours after PCI. According to the examination results, the patients were divided into normal microcirculation perfusion group, delayed microcirculation perfusion group, and blocked microcirculation perfusion group. Adverse cardiovascular events including all-cause death, cardiovascular death, and angina re-hospitalization were followed up, and left ventricular ejection fraction (LVEF) review results were collected at six months to one year after surgery. Kaplan-Meier survival curve was used to investigate the difference in the incidence of adverse cardiovascular events in different myocardial perfusion groups, and Cox regression analysis was used to evaluate the effect of myocardial perfusion on adverse cardiovascular events.Results:A total of 113 patients with acute myocardial infarction were included, aged (56.3±11.5) years, with 88(78%) males. There were 31 cases in the normal microcirculation perfusion group, 43 cases in the delayed microcirculation perfusion group and 39 cases in the blocked microcirculation perfusion group. LVEF was reviewed in 49 patients, and LVEF in the delayed microcirculation perfusion group was significantly improved compared with baseline at follow-up ((63.3±1.2) % vs. (58.6±1.8) %, P=0.043), and there was no statistically significant difference between the other two groups (all P>0.05). The median follow-up time was 473 days, during follow-up period 30 adverse cardiovascular events occurred. Kaplan-Meier survival curve analysis showed that there was a statistically significant difference in the incidence of adverse cardiovascular events among the three groups ( Plog-rank=0.029). Cox regression analysis showed that abnormal microcirculation perfusion (defined as delayed and blocked microcirculation perfusion) was an independent predictor of adverse cardiovascular events in patients with acute myocardial infarction after PCI ( HR=1.90, 95% CI1.16-3.12, P=0.011). Conclusions:Microcirculatory perfusion decrease or lost is common in patients with acute myocardial infarction after PCI. Timely restoration of blood flow reconstruction can save heart function when microcirculatory perfusion decreases. Microcirculatory perfusion is a predictor of adverse cardiovascular events in patients with acute myocardial infarction, and patients with poor myocardial perfusion are more likely to experience adverse cardiovascular events.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

Objective To investigate the role of the renin-angiotensin system(RAS)in the pathogenesis of acute kidney injury(AKI)after laparoscopic radical nephrectomy(LRN)and the predictive value of RAS activation status for AKI.Methods Eighty-two patients undergoing LRN at the Third Medical Center of General Hospital of PLA from December,2023 to March,2024 were enrolled,including 57 with postoperative AKI and 25 without AKI according to KDIGO criteria.Blood and urine samples were collected from the patients before and at 24 h after the operation for analyzing the correlation of urinary aldosterone,plasma ACE2,Ang1-7,Nrf-2,and IL-10 levels with postoperative AKI.Univariate and multivariate logistic regression analyses and ROC curve were employed to identify the risk factors for postoperative AKI and their predictive value for AKI.Results Compared with those without postoperative AKI,the patients with AKI had significantly higher postoperative urinary aldosterone levels and lower plasma ACE 2,Ang 1-7,Nrf-2,and IL-10 levels(P<0.05).Postoperative urinary aldosterone level was positively correlated with AKI and negatively with estimated glomerular filtration rate(eGFR)(P<0.05);plasma levels of ACE 2,Nrf-2,and IL-10 were all negatively correlated with AKI and positively with eGFR.Urinary aldosterone was a risk factor and plasma ACE 2,Ang 1-7,Nrf-2 and IL-10 were protective factors for AKI,and among them urinary aldosterone was an independent risk factor(AUC=0.651)and plasma Nrf-2 was an independent protective factor(AUC=0.679).The unconventional RAS pathway indices had an AUC of 0.758,and aldosterone combined with the unconventional pathway indices had an AUC of 0.788 for predicting postoperative AKI.Conclusion Activation of the conventional RAS pathway and suppression of the unconventional pathway contribute to AKI following LRA possibly by affecting eGFR.Aldosterone combined with the unconventional pathway indicators can predict the occurrence of AKI after LRN.

OBJECTIVE: To investigate the effect of dexmedetomidine (DEX) on renal function after laparoscopic radical nephrectomy. METHODS: We reviewed the clinical data of 282 patients with renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy (LRN) in the Department of Urology, Third Medical Center of PLA General Hospital from November, 2020 and June, 2022.According to whether DEX was used during the operation, the patients were divided into DEX group and control group, and after propensity score matching, 99 patients were finally enrolled in each group.The incidence of acute kidney injuries were compared between the two groups.Serum creatinine (sCr) data within 3 months to 1 year after the operation were available in 51 patients, including 26 in DEX group and 25 in the control group, and the incidence of chronic kidney disease (CKD) was compared between the two groups. RESULTS: After propensity score matching and adjustment for significant covariates, there were no significant differences in postoperative levels of sCr, cystatin C (CysC), β2-microglobulin (β2-MG), hemoglobin (Hb), or C-reactive protein (CRP), extubation time, incidence of AKI, or length of hospital stay between the two groups (P>0.05).The intraoperative urine volume was significantly higher in DEX group than in the control group (P < 0.05).A significant correlation between AKI and CKD was noted in the patients (P < 0.05).The incidence of CKD did not differ significantly between the two groups (P>0.05). CONCLUSION DEX can not reduce the incidence of AKI or CKD after LRN.
Humans ; Dexmedetomidine ; Incidence ; Propensity Score ; Renal Insufficiency, Chronic/epidemiology* ; Kidney Neoplasms/surgery* ; Nephrectomy/adverse effects* ; Laparoscopy/adverse effects* ; Acute Kidney Injury/prevention & control* ; Retrospective Studies

BACKGROUND: Agmatine can enhance the analgesic effect of morphine,and antagonize the tolerant and dependent effect of morphine.OBJECTIVE: To observe the effects of injecting agmatine on the neuronal nitric oxide synthase (nNOS) in hippocampus of morphine withdrawal rats.DESIGN: A randomized controlled experimental study.SETTING: Department of Anesthesiology, the General Hospital of Chinese PLA.MATERIALS: All the experiments were carried out in the Department of anesthesiology, the General Hospital of Chinese PLA between April and July 2004. Eighteen healthy SD rats were randomly divided into saline control group (n=6), morphine group (n=6) and agmatine-treated group (n=6).METHODS: The rats in the saline control group were treated with subcutaneous injection of physiological saline (10 mg/kg), those in the morphine group were treated with 5-day preconditioning, subcutaneous injection of morphine of 10, 20, 30, 40 and 50 mg/kg respectively, twice a day, and those in the agmatine-treated group were treated with subcutaneous injection of agmatine (10 mg/kg) at 30 minutes before morphine was given, but at 6 hours later, before morphine was given for the last time, the rats in the morphine group and agmatine treated group were also given intraperitoneal injection of naloxone (5 mg/kg) to induce morphine withdrawal symptoms.The number of times of the morphine withdrawal symptoms (including physical signs of trembling like a wet dog, chewing, irrigating, drooling, diarrhoea, etc.) were recorded within 1 hour, and the reduction of body mass was calculated according to the different value of body mass before and after the withdrawal symptoms induced by naloxone. The rats were killed under anesthesia after praxiological detection, and then hippocampus was taken out and made into frozen sections, and the nNOS was detected with immunohistochemical staining. The CMIAS systemwas applied for imaging analysis, and the average value of the integral absorbance (A) values in 5visual sights for each section was taken as the integral A value of positive neuron.MAIN OUTCOME MEASURES: ① The detected results of morphine withdrawal symptoms in each group; ② The changes of the nNOS expressions in hippocampus of rats in each group.RESULTS: All the 18 rats were involved in the analysis of results. ① The detected results of morphine withdrawal symptoms in each group: The withdrawal symptoms of trembling like a wet dog, chewing, irrigating, drooling,diarrhoea and reduction of body mass in the agmatine treated group were all obviously lower than those in the morphine group [(2.0±1.3), (5.0±1.1);(0.3±0.4), (1.8±0.7); (3.2±1.2), (6.8±3.1); (0.2±0.4), (1.2±0.9); (2.7±2.1),(6.7±2.1); (6.0±3.0), (12.8±2.7) times, P ＜ 0.01], and close to those in the saline control group (P ＞ 0.05). ② The changes of the nNOS expressions in hippocampus of rats in each group: The positive neurons of nNOS in hippocampus mainly distributed in CA1 region, the cytoplasm was stained buffy, and the round nuclei were stained pale purple by haematine. The immunofluorescent A value of positive neuron in the agmatine-treated group was significantly decreased as compared with that in the morphine group (24.32±8.31, 50.82±15.13, P＜ 0.01), and almost the same as that in the saline control group (24.32±8.31, 15.24±1.88, P ＞ 0.05).CONCLUSION: Agmatine can inhibit the morphine withdrawal syndrome and decrease the expression of nNOS in hippocampus CA1 region of morphine-withdrawal rats. Hippocampal nitric oxide pathway takes part in the inhibitory effect of agmatine on morphine withdrawal syndrome.

AIM:To investigate the effects of propofol on potassium currents in pulmonary artery smooth muscle cells of normotensive and hypertensive rats. METHODS: The effects of propofol on potassium currents in smooth muscle cells derived from normotensive and hypertensive rats pulmonary arteries were observed by patch clamp technique (whole cell recording) after application of the drug in the bath. RESULTS: The potassium current-voltage curves (I-V curves) of smooth muscle cells derived from normotensive and pulmonary hypertensive rats pulmonary arteries were up-ward shifted by propofol (50, 100 ?mol/L). Compared with control group, within 5 minutes after application of the drug, the current amplitude could increase to (121?11)%, (113?5)% (P

0.05).Intracellular Ca2+ FI in rat ventricular myocytes induced by KCl was inhibited significantly in group B2 and B3 compared with that in group C(P

AIM: To compare the blocking effect of ropivacaine and bupivacaine on sodium channels of rat dosal root ganglia(DRG) using whole cell recording technique. METHODS: Rat DRG neurons were enzymatically isolated , tetrodotoxin-sensitive(TTX-s) and tetrodotoxin-resistant (TTX-r) sodium currents of DRG were recorded by whole cell recording.Drugs were given in bath solution.The concentrations of ropivacaine were 10,30,100, 1 000 ?mol?L~ -1 and bupivacaine were 10,30,100,300 ?mol?L~ -1 . The recording number in each dose group was six. RESULTS: CsCl in extracellular fluid and TEA in intracellular fluid were used to block the potassium channels. Sodium currents were recorded when the holding potential was - 70 mV and a serials of pulse with step 10 mV and duration 70 ms was given.TTX-s sodium channel was recorded in 80.1 % large DRG cells and TTX-r sodium channel was recorded in 92.4 % medium and small DRG cells,of which 56.3 % cells had no response to 1 ?mol?L~ -1 TTX. The half-maximal blocking concentrations of ropivacaine on TTX-r sodium channel was 65.7 ? 6.1 ?mol?L~ -1 , which was much lower than that on TTX-s sodium channel 246.8 ? 11.2 ?mol?L~ -1 (P 0.05 ). CONCLUSION: Ropivacaine preferentially blocks TTX-r sodium channel.Selective blocking of TTX-r and TTX-s sodium channel was one of the reasons of seperation of sensation and motion when it is used in epidural anesthesia.

AIM: To compare the effects of total intravenous anesthesia and balanced anesthesia on stress response on suspensive laryngoscope vocal cords surgery. METHODS: Thirty patients undergone microlaryngeal surgery were randomly divided into two groups(n=15). Analgesia and amnesia slow induction was used in all patiens with nosal incubation. During maintenance of anesthesia, propofol, remifentanil and scopolamine were used in total intravenous anesthesia group(group TIVA); fentanyl, scopolamine and isoflurane were used in balanced anesthesia group(group BAL). Record the data of each group,including base data, after induction, end of tracheal intubation,3 min after intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy, removing the trachea, MAP, HR of each time, the time of recovery. The blood concentrations of epinephrine (E), noradrenalin(NE),cortisol,IL-6 were measured at each time point of base data, end of tracheal intubation, setting the suspensive laryngosopy, 3 min after setting the suspensive laryngosopy. RESULTS: There is no significant difference of HR, MAP, blood concentration of E,NE, cortisol, IL-6 at end of tracheal intubation compared with base data. AT setting the suspensive laryngosopy,3 min after setting the suspensive laryngosopy, HR, MAP, blood concentrations of E, NE, cortisol, IL-6 in group BAL were all higher than that of base data,and were also higher than group TIVA at the same time. The recovery time of group TIVA was shorter than that of group BAL. CONCLUSION: Analgesia and amnesia slow induction with nosal intubaion and maintenance with remifentanil, propofol can inhibit sudden change of hemodynamics and stress response of intubation and setting the suspensive laryngoscope, with quicker recovery .It is an ideal anesthesia method for suspensive laryngoscope vocal cords surgery.

AIM: To observe and compare the effects of Ropivacaine and Bupivacaine on glutamate-evoked currents in cultured rat hippocampus neurons.METHODS: Rat hippocampal neurons were dissociated and cultured.Glutamate-evoked currents were recorded by whole cell patch clamp recording.Effects of Ropivacaine and Bupivacaine on glutamate-evoked currents were observed.Drugs were given by pressure ejection or applicated in the bath.RESULTS: Glutamate(100(mmol?L~(-1))) can activate inward currents in cultured rat hippocampus neurons and this currents could be locked by non-NMDA antagonists DNQX.At concentrations of 10,50,100(mmol?L~(-1)),both Bupivacaine and Ropivacaine could obviously decrease glutamate-evoked currents in cultured rat hippocampus neurons.At higher concentration of 50 and 100(mmol?L~(-1)),the reduced amplitude of glutamate-evoked currents by Ropivacaine was larger than that of by Bupivacaine(P