OBJECTIVE: To evaluate the effect of general anesthesia on postoperative melatonin secretion in 4-to 6-year-old children with snoring. METHODS: Twenty children with snoring aged 4-6 years of either gender (ASA grade Ⅰ and Ⅱ) were selected for adenoidectomy.Before, during and 3 days after the operation, salivary melatonin levels of the children were measured at 11 selected time points (T1-T11).The illumination intensity and body temperature of the children were recorded at each time point of measurement.The sleep time of the children in 3 days after the operation was recorded, and postoperative pain scores (FLACC) and Riker and Rehabilitation Quality Rating Scale-15(QoR-15) scores were assessed.Sleep Apnea Life Quality Evaluation Questionnaire (OSA-18) was used to evaluate postoperative recovery of the children at 28 days after the operation.The incidence of major adverse events of the children during hospitalization was recorded. RESULTS: No significant difference was found in baseline salivary melatonin level among the 20 children before the operation.Salivary melatonin level at 7 am after the operation (T8) was significantly lowered as compared with that before the surgery (T4)( CONCLUSIONS In preschool children with snoring, general anesthesia affects but does not inhibit melatonin secretion on the first night after surgery, and minor surgeries under general anesthesia in the morning do not cause significant changes in melatonin secretion to cause disturbance of the circadian rhythm in these children.
Anesthesia, General/adverse effects* ; Bodily Secretions ; Child ; Child, Preschool ; Circadian Rhythm ; Humans ; Melatonin ; Snoring

Objective:To determine the dose-effect relationship of nalbuphine preventing injection pain of medium plus long chain triglyceride propofol in pediatric patients undergoing gastroenteroscopy.Methods:Pediatric patients, aged 3-8 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective gastroenteroscopy, were enrolled in the study.The doses of nalbuphine were determined by up-down sequential allocation, nalbuphine 0.2 mg/kg was injected intravenously in the first child, and 5 min later medium plus long chain triglyceride propofol 2.5 mg/kg was given intravenously.Ambesh 4-point method was used to evaluate the injection pain of propofol.When the prevention of injection pain was ineffective, the dose of nalbuphine was increased in the next patient, otherwise the dose was reduced, and the difference between the two successive doses was 0.01 mg/kg.This process was repeated until the 7th turning point occurred.The ED 50 and ED 95 of nalbuphine and 95% confidence interval (CI) preventing injection pain of propofol were calculated by Probit regression. Results:The ED 50 and ED 95 (95% CI) of nalbuphine preventing medium plus long chain triglyceride propofol injection pain were 1.57 (1.50-1.62) and 1.71 (1.64-2.05) mg/kg, respectively. Conclusion:The ED 50 and ED 95 of nalbuphine preventing injection pain of medium plus long chain triglyceride propofol are 1.57 and 1.71 mg/kg, respectively, in pediatric patients undergoing gastroenteroscopy.

Objective:To evaluate the efficacy of auricular acupoint pressure therapy combined with intranasal dexmedetomidine for transthoracic echocardiography in pediatric patients.Methods:A total of 117 pediatric patients with congenital heart disease, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, aged 3-36 months, weighing 5-20 kg, scheduled for elective transthoracic echocardiography under outpatient sedation, were selected.Transthoracic echocardiography was performed under sedation using intranasally administered dexmedetomidine or using auricular acupoint pressure therapy combined with intranasal dexmedetomidine.The interval between the two sedation methods was at least 1 week.Intranasal dexmedetomidine: Dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.Intranasal dexmedetomidine combined with auricular acupoint pressure: auricular acupressure with Wang Bu Liu Xing (semen vaccariae) seeds was used at the auricular acupoints.After each acupoint was rubbed for about 1 min, dexmedetomidine 3 μg/kg was administered to both nostrils via a nebulizer, with 1/2 dose in each nostril.After the examination, auricular acupoint pressure therapy was continued at home, and pressing-rubbing at the acupoints was manipulated for 3 times daily, one of which was performed at 30 min before going to bed, for 3 consecutive days.When the University of Michigan Sedation Scale score≥2 and body movement score ≥2 within 30 min after giving dexmedetomidine, sedation was considered to be successful.The onset time of sedation, examination time, waiting time, recovery time and the success of sedation were recorded.The incidence of adverse reactions such as bradycardia, hypotension, hypertension, hypoxemia, nausea and vomiting, respiratory depression, restlessness, hyperactivity, action imbalances and allergic reaction were recorded within 24 h after administration of dexmedetomidine.Time to recovery and improvement of sleep quality at night were recorded.Results:Compared with intranasal dexmedetomidine, the successful rate of sedation and incidence of improvement of sleep quality at night were significantly increased ( P<0.05), and no significant change was found in adverse reactions using intranasal dexmedetomidine combined with auricular acupoint pressure ( P>0.05). Conclusion:Intranasal dexmedetomidine combined with auricular acupoint pressure therapy can increase the successful rate of sedation and improve the sleep quality at night in pediatric patients undergoing transthoracic echocardiography when compared to intranasal dexmedetomidine.

Objective:To identify the risk factors for weaning failure after mandibular distraction osteogenesis in the infants with Pierre Robin sequence.Methods:A retrospective cohort study was conducted to collect clinical records of infants with Pierre Robin sequence underwent mandibular distraction osteogenesis at Guangzhou Women and Children′s Medical Center from November 2016 to May 2019.The inclusion criteria consisted of the following: age <1 yr and no serious cardiopulmonary disease or serious airway malformation.The medical charts were reviewed for sex, age, weight, premature delivery, low birth weight, preoperative intubation, preoperative pulmonary infection, ventilator-associated pneumonia, as well as mechanical ventilation time and distraction length at first weaning.The infants were divided into 2 groups according to the outcome of ventilator weaning at first attempt: successful group and failure group.The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify weaning failure-related risk factors. Results:A total of 140 infants were included in this study, of which 9 cases developed failure of weaning at first attempt after operation, with the incidence of 6.4%.The results of logistic regression analysis showed that the distraction length and incidence of ventilator-associated pneumonia were independent risk factors for weaning failure after operation ( P<0.05). Conclusion:The length of distraction and ventilator-associated pneumonia are independent risk factors for weaning failure after mandibular distraction osteogenesis in the infants with Pierre Robin sequence.

Objective To analyze the anatomical characteristics of the upper airway in Pierre Robin sequence pediatric patients with difficult laryngoscopy using the computed tomography-based three-dimensional reconstruction.Methods Fifty pediatric patients of both sexes with Pierre Robin sequence,aged 10-101 days,weighing 2.0-6.3 kg,of American Society of Anesthesiologists physical status Ⅲ,scheduled for elective mandibular distraction osteogenesis under general anesthesia,were enrolled in this study.Cone beam CT scan was performed to obtain upper airway anatomy information during the natural sleep before operation.Images were imported into medical engineering software MIMICS 17.0 to reconstruct the three-dimensional images of the oral and maxillofacial bones and airways.The related anatomical parameters were measured,including the distance between the alveolar ridge of the upper central incisor and root of the epiglottis (D1),distance between the root of the epiglottis and midpoint of glottis (D2),distance between the bilateral lower edge of the mandible and midpoint of glottis (D3),distance between the alveolar ridge of the lower central incisor and the lower edge of the mandible (D4),length of the mandibular ramus (D5),length of the mandible body (D6),and length of the total mandible (D7),angle between lines D1 and D2 (angle 1),the angle between line D2 and the alveolar ridge of the upper central incisor to the midpoint of glottis (angle 2),the angle between lines D3 and D4 (angle 3),the angle of the point of the upper central incisor alveolar ridge to the trailing edge of the hard palate and then to the root of epiglottis (angle 4),the angle of bilateral mandible (angle 5),the angle of the point of gnathion to the two gonions (angle 6),the airway cross-sectional area at the tip of epiglottis,volume of oral cavity,volume of velopharyngeal cavity,and volume of glossopharyngeal cavity.Fiberoptic bronchoscope-guided endotracheal intubation was performed under topical anesthesia with lidocaine.Propofol,sufentanil and cis-atracurium were intravenously injected to induce anesthesia after successful intubation,and then the pediatric patients were sent to the operating room.Anesthesia was maintained by inhalation of sevoflurane.The exposure of glottis was observed with a laryngoscope.Pediatric patients were divided into difficult laryngoscopy group (group A) and non-difficult laryngoscopy group (group B) according to whether they presented with difficult laryngoscopy (Cormack-Lehane classification Ⅲ or Ⅳ).Results Compared with group B,the airway cross-sectional area at the tip of epiglottis and in the volume of velopharyngeal cavity were decreased (P＜0.05),and no significant change was found in D1,D2,D3,D4,D5,D6,D7,angle 1,angle 2,angle 3,angle 4,angle 5,angle 6,volume of oral cavity or volume of glossopharyngeal cavity in group A (P＞0.05).Conclusion The three-dimensional CT images of the upper airway show characteristic changes in Pierre Robin sequence pediatric patients with difficult laryngoscopy,and the main manifestations are the decrease in the airway section area and in the volume of the palatopharyngeal cavity at the tip of the epiglottis.

OBJECTIVETo investigate the protective effect of ulinastatin (UTI) on HK-2 cells during paraquat (PQ)-induced injury and its underlying mechanisms.

METHODSRoutinely cultured HK-2 cells were divided into blank control group, PQ group, UTI+PQ group and UTI group. Cell viability was determined by CCK-8 assay. The concentration of PQ in HK-2 cells were measured by high performance liquid chromatography (HPLC). The production of total reactive oxygen species (ROS) were detected by fluorescence microscopy. The activities of superoxide dismutase activity (SOD) and the content of malondialdehyde (MDA) in HK-2 cells were observed by chemical colorimetry. The levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTSPQ, even at a dose of 200 µM, could significant suppress the viability of HK-2 cells in a dose-dependent and time-dependent. UTI showed no significant inhibitory effect on the viability of HK-2 cells when given at a dose below 8 000 U/ml (P > 0.05). Compared with the PQ group, the UTI+PQ group had significantly increased the viability of HK-2 cells in a dose-dependent of UTI (P < 0.05). Compared with the PQ group on the same hour, the UTI+PQ group showed decreased in PQ concentration in HK-2 cells (P < 0.05 for all except 6 h). Compared with the blank control group, the PQ group had significantly decreased SOD activity and significantly increased ROS level and MDA content (P < 0.05). Compared with the PQ group, the UTI+PQ group had significantly increased SOD activity and significantly decreased ROS level and MDA content (P < 0.05). Compared with the blank control group, the PQ group had significantly increased IL-6 and TNF-α level (P < 0.05); Compared with the PQ group, the UTI+PQ group had significantly decreased IL-6 and TNF-α level (P < 0.05).

CONCLUSIONUTI significantly reduces the PQ-induced oxidative damage and inflammatory injury and its mechanism may be by reducing the accumulation of PQ in HK-2 cells.

Cell Line ; Cell Survival ; drug effects ; Glycoproteins ; pharmacology ; Humans ; Interleukin-6 ; metabolism ; Malondialdehyde ; metabolism ; Oxidative Stress ; Paraquat ; toxicity ; Reactive Oxygen Species ; metabolism ; Superoxide Dismutase ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

Objective To evaluate the effect of hyperbaric oxygen (HBO) treatment on the expression of nerve growth factor (NGF) in the spinal cord of rats with neuropathic pain (NP).Methods Thirty healthy male Sprague-Dawley rats,aged 8-10 weeks,weighing 270-300 g,were randomly divided into 5 groups (n =6 each) using a random number table:sham operation group (group S),group NP,pure oxygen group (group O),treatment with HBO at 2.5 atmosphere absolute group (group H2.5) and treatment with HBO at 3.0 atmosphere absolute group (group H3.0).The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg/kg.NP was induced by chronic constrictive injury.The left sciatic nerve was exposed and 4 loose ligatures were placed on the sciatic nerve at 1-mm intervals with 4-0 silk thread.HBO treatment was performed with the corresponding atmosphere absolute once a day for 7 consecutive days starting from 1 day after operation in H2.5 and H3.0 groups.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured on 3,5,7 and 14 days after operation.The animals were sacrificed after the last measurement of pain threshold,and the lumbar segments of the spinal cord were removed to detect the expression of NGF by immuno-histochemistry and Western blot analysis.Results Compared with group S,MWT was significantly decreased,TWL was shortened,and the expression of NGF was up-regulated at each time point after operation in NP and O groups.Compared with group NP,MWT was significantly increased,TWL was prolonged,and the expression of NGF was up-regulated at each time point after operation in H2.5 and H3.0 groups,and no significant change was found in MWT,TWL and expression of NGF in group O.Compared with group H2.5,the expression of NGF was significantly down-regulated,and no significant change was found in MWT and TWL in group H3.0.Conclusion The mechanism by which HBO treatment mitigates NP is related to up-regulation of the expression of NGF in the spinal cord of rats.

Objective To evaluate the effect of hyperbaric oxygen (HBO) treatment on postoperative cognitive dysfunction (POCD) in rats.Methods Eighteen healthy male Sprague-Dawley rats,weighing 260-290 g,were anesthetized with intraperitoneal 10％ chloral hydrate 350 mg/kg.POCD was induced by injecting Aβ-40 2μl into the bilateral hippocampi by using a brain stereotaxic apparatus.The rats were randomly divided into 3 groups (n =6 each) using a random number table:normal sahne group (group NS),POCD group,and HBO treatment group(groupHBO).0.9％ normal saline 2 μl was injected into hippocampus in group NS.In group POCD,Aβ0 2 μl was injected into hippocampus.In group HBO,Aβ 2μl was injected into hippocampus,and then the rats received hyperbaric oxygen treatment lasting for 60 min once a day within 1-5 days after operation.Morris water maze test was performed on 7,14 and 21 days after operation in each group and the swimming distance and speed and escape latency were recorded.The animals were sacrificed after the end of test,the hippocampi were then removed to detect the activation of astrocytes (by immuno-histochemistry) and content of tumor necrosis factor-α (TNF-α) (by ELISA).Resets There were no significant differences in the parameters of behavior in Morris water maze test on 7 and 14 days after operation between the three groups.Compared with group NS,the swimming distance and escape latency were significantly prolonged,and the activation of astrocytes and TNF-α content were increased on 21 days after operation in group POCD,and the swimming distance and escape latency were significantly prolonged,the activation of astrocytes was increased,and no significant change was found in TNF-α content on 21 days after operation in group HBO.Compared with group POCD,the swimming distance and escape latency were significantly shortened,and the activation of astrocytes and TNF-α content were decreased in group HBO.There was no significant difference in the swimming speed at each time point among the three groups.Conclusion HBO treatment can alleviate POCD in rats,and the mechanism is related to inhibition of activation of astrocytes and inflammatory responses in hippocampi by HBO.

Objective To investigate the role of nuclear factor-kappa B (NF-κB)signaling pathway in propofol-induced suppression of up-regulation of inducible nitric oxide synthase (iNOS) gene expression in LPSstimulated RAW264.7 cells.Methods RAW264.7 cells were purchased from cell bank of Chinese Academy of Sciences and cultured in DMEM culture medium containing 10％ fetal bovine serum.The cells were seeded in 6 cm diameter dishes (3 ml/dish) or in 6-well plates (2 ml/well) with a density of 5 × 105/ml and randomly divided into 3 groups ( n =18): normal control group (group C),group LPS (group L)and group LPS + propofol (group LP).The cells were incubated with LPS 1 μg/ml in groups L and LP.Propofol 50μmol/L was added to the culture medium at 2 h before LPS in group LP.Cells were harvested at 30 min after being stimulated with LPS.Phosphorylation of IκB kinase(p-IKK) and NF-κB activity were detected by Western blot.The expression of iNOS mRNA was determined after 6 h exposure of the cells to LPS.Results LPS significantly up-regulated the expression of p-IKK and iNOS mRNA and increased NF-κB activity in group L as compared with group C.Propofol pretreatment significantly attenuated the effects of LPS on p-IKK,iNOS mRNA expression and NF-κB activity.Conclusion NF-κB signaling pathway is involved in the propofol-induced suppression of up-regulation of iNOS mRNA expression in LPS-stimulated RAW264.7 cells.

ObjectiveTo observe the effect of Gankang Ⅱ in reducing bilirubin level of patients with chronic hepatitis B,and discuss the mechanism.Methods124 cases hyperbilirubinemia patients with chronic hepatitis B were randomly divided into Gankang Ⅱ treatment group (the treatment group for short),and Yinzhihuang particles treatment group (the control group for short),with 62 eases in each group.The cure rate,recover rate of the treatment group and control group were observed,together with the changes of ALT,AST,GGT,and TBiL.Results①The cure rate was 80.6％,the recover rate was 19.4％ in the treatment group; the cure rate of was 62.9％ and the recover rate was 37.1％ in the control group; the cure rate of the treatment group was obviously higher than the control group.② There was no significant difference between the treatment group and the control group on TBiL,ALT,AST,and GGT before the treatment (P＞0.05).while after treated,TBiL (20.75±3.77) μmol/L,ALT (52.53± 12.23) U/L,AST (51.75 ±9.93) μmol/L,GGT (48.75 ±16.68) U/L of the treatment group were obviously lower than the TBiL(26.68 ±4.99)μmol/L,ALT(79.68± 1 1.92)U/L,AST (60.12 ± 8.12) μmol/L,GGT (58.97±15.47)U/L of control group.There was significant difference(P＜0.05～0.01).ConclusionThe effect of Gankang Ⅱ in reducing the bilirubin level of patients with chronic hepatitis B was sound.