Objective:To compare the efficacy of HES 130/0.4 and acetate Ringer′s solution (A-HES) and HES 130/0.4 and normal saline (NS-HES) for volume therapy in the patients undergoing non-cardiac surgery with general anesthesia.Methods:Two hundred and fifty American Society of Anesthesiologist physical status Ⅰ or Ⅱ patients of both sexes, aged 18-64 yr, with body mass index of 18-32 kg/m 2, undergoing noncardiac surgery with general anesthesia, were divided into group A-HES and group NS-HES using the stratified block randomization technique.A-HES and NS-HES 15 ml/kg were intravenously infused over 1 h immediately after induction of anesthesia in A-HES and NS-HES groups, respectively.Mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP) were recorded before and after infusion, and the maximum changing rate of MAP and HR and the maximum change in CVP were calculated.The pH value, BE and HCO 3- were recorded before infusion and at 15 min after the end of infusion, and Hb, Hct, electrolytes, blood glucose, blood biochemical parameters and parameters of coagulation function were measured.The occurrence of abnormal blood biochemical parameters, blood glucose, and parameters of coagulation function, intraoperative requirement for vasoactive drugs, occurrence of HES-related adverse events, and intraoperative fluid intake and output were recorded. Results:A total of 251 cases were actually enrolled in this study, with 125 cases in group A-HES, and 126 cases in group NS-HES.Compared with group NS-HES, no significant change was found in the maximum changing rate of MAP and HR and the maximum change in CVP ( P>0.05) in group A-HES, and non-inferiority analysis showed that group A-HES was not inferior to group NS-HES.Compared with group NS-HES, the concentrations of BE and HCO 3-, K + , Ca 2+ and Mg 2+ were significantly increased, the concentrations of Na + and Cl - were decreased, the PT was shortened, the incidence of abnormal PT was decreased at 15 min after the end of infusion ( P< 0.05), and no significant change was found in the other parameters mentioned above in group A-HES ( P>0.05). Conclusion:The volume expanding effect of A-HES and its effect on liver and kidney function are not significantly different from those of NS-HES, however, A-HES has certain advantages in maintaining acid-base balance, electrolyte stability and coagulation function.

Objective To investigate the changes in the expression of keratin genes in renal tissues during renal ischemia-reperfusion (I/R) injury in mice.Methods Six wild type male C57/B6 mice,aged 50 days,weighing 20-30 g,were divided into 2 groups (n=3 each) using a random number table:sham operation group (Sham group) and I/R group.Right renal arteries and veins were clamped for 1 h followed by reperfusion,and the left kidneys were removed to establish the model of renal I/R injury.At 24 h of reperfusion,blood samples were collected from the left ventricle for determination of serum creatinine and urea nitrogen concentrations by colorimetric method.The right kidney specimens were obtained for pathologic examination and for determination of the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA (by quantitative real-time polymerase chain reaction [qRT-PCR]) and keratin genes (by Affemetrixc DNA microarray).The differentially expressed genes identified were further confirmed by qRT-PCR.Results Compared with Sham group,the serum creatinine and urea nitrogen concentrations were significantly increased,the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA was up-regulated (P＜0.05),and the damage to the renal tubules was aggravated in I/R group.The results of microarray analysis showed that only keratin 20 gene (the expresion was up-regulated) was the differentially expressed gene (P＜0.05),and the results measured by qRT-PCR were consistent with those measured by Affemetrixc DNA microarray.Conclusion Keratin 20 gene expression in renal tissues is up-regulated during renal I/R injury in mice,and the change may be involved in the endogenous protective mechanism during renal I/R injury.

Objective To evaluate ketamine-induced cerebral protection in mice with traumatic brain injury (TBI) by magnetic resonance imaging (MRI).Methods Thirty-two pathogen-free healthy male C57BL/6 mice,aged 8 weeks,weighing 26-30 g,were divided into 4 groups using a random number table:control group (group C,n=7),ketanine group (group K,n=7),TBI group (n=9) and TBI plus ketamine group (group TBI+K,n =9).TBI was produced with a pneumatically driven controlled cortical impact device.Ketamine 150 mg/kg was intraperitoneally injected at l h after operation in TBI+K and K groups,while the equal volume of normal saline was given instead in TBI and C groups.Open field test was conducted at 24 h,72 h and 7 days after operation.The animals in TBI and TBI+K groups were scanned by T1-weighted MRI at 6,24 and 72 h after operation,the animals in C and K groups were scanned by MRI at 24 h after operation,and the development of cerebral edema was observed.Results MRI scan showed no cerebral edema in C and K groups,and different degrees of cerebral edema were found in TBI and TBI+K groups.Compared with group C,the locomotor distance was significantly shortened at 24 and 72 h after operation in group TBI (P＜0.05).Compared with group TBI,the size of cerebral edema was significantly decreased,and the locomotor distance was prolonged at 24 and 72 h after operation in group TBI+K (P＜0.05 or 0.01).Conclusion MRI method further clarifies that ketamine can produce cerebral protection to some extent in mice with TBI.

Objective To evaluate the effect of morphine on the proliferation and migration of human hepatocellular carcinoma (HCC) cells in an in vitro experiment.Methods The experiment was performed in 2 parts.Experiment Ⅰ Human HCC cells were inoculated in 6-well plates at a density of 2×105 cells/well (2 ml/well) and divided into 6 groups (n=12 each) using a random number table:control group (C group) and 10,25,50,100 and 200 ng/ml morphine groups (M1-M5 groups).Morphine at the final concentration of 10,25,50,100 and 200 ng/ml was added in M1-M5 groups,respectively.The equal volume of phosphate buffer solution was added in group C.The cells were cultured or incubated for 48 h.The expression of μ1-opioid receptor (MOR1) mRNA was measured by real-time polymerase chain reaction.The expression of MOR1 was detected by Western blot in C and M4 groups.Experiment Ⅱ Human HCC cells were inoculated in 96-well plates (1×103 cells/well) or in Transwell chambers(200 μl) and divided into 2 groups (n=9 each) using a random number table:control group (C group) and morphine group (M group).Morphine was added at the final concentration of 100 ng/ml in group M,and the equal volume of phosphate buffer solution (final volume 100 μl/well) was added in group C.The cells were cultured or incubated for 7 days.The cell proliferation was detected by methyl thiazolyl tetrazolium assay at 1-7 days of incubation or culture.The cell migration was determined by Transwell chamber assay at 30 h of incubation or culture.Results Experiment Ⅰ Compared with group C,the expression of MOR1 mRNA was significantly up-regulated in M1-M5 groups,and the expression of MOR1 was significantly up-regulated in group M4 (P<0.01).Compared with group M4,the expression of MOR1 mRNA was significantly down-regulated in M1-M3 and M5 groups (P<0.01).Experiment Ⅱ Compared with group C,the cell proliferation was significantly enhanced on 4th-7th days of incubation,and the number of cells passing through Transwell chambers was increased in group M (P<0.05 or 0.01).The cell proliferation was gradually enhanced on 4th-7th days of incubation in group M (P<0.05).Conclusion Morphine can promote the proliferation and migration of human HCC cells,and the mechanism is related to up-regulation of MOR1 expression in an in vitro experiment.

Objective:To explore the effect of propofol on the tPA release of hippocampal neurons in developing mice ,so as to investigate whether exogenous tPA could reverse the propofol‐induced neurotoxicity on developing neurons .Methods : The hippocampal neurons of developing mice cultured in vitro were divided into 4 groups(n= 20 each):control group(group C) , propofol group(group Pro) ,group tPA and propofol plus tPA group(group Pro+ tPA) .There was no specific treatment in group C .In group Pro ,propofol was added to the culture media with the final concentration of 5 ,10 ,30 μmol/L ,respectively , and the cells were then incubated for 1 h ,2 h ,3 h ,6 h ,respectively .In group tPA ,tPA was added to the culture media with the final concentration of 1 μmol/L ,and the cells were then incubated for 6 h .In group Pro+ tPA ,both propofol and tPA were added to the culture with the final concentration of 10μmol/L and 1μmol/L ,respectively ,and the cells were then incubated for 6 h .The neuron apoptosis rate and the expression level of actived‐caspase‐3 protein were detected in each group .Results:Compared with that in group C ,the apoptosis rate and the expression level of actived‐caspase‐3 protein in group Pro significantly increased (P< 0 .05) .The tPA level in group Pro was significantly higher than that in group C (P< 0 .05) . Compared with that in group Pro ,the apoptosis rate and the expression level of actived‐caspase‐3 protein in group Pro+ tPA significantly decreased (P< 0 .05) .Conclusions :Propofol induces neurotoxicity on hippocampal neurons of developing mice cultured in vitro by inhibiting neuronal tPA release .And exogenous tPA could partially reverse propofol‐induced neurotoxicity .

Objective:To analyze the stage‐specific differences in gene expression of mouse kidneys insulted by ischemia reper‐fusion(IR) injury .Methods:Mouse kidney tissues were collected at 4 h and 24 h after IR .Total RNA of control and IR kidneys were prepared for Microarray and real‐time fluorescence quantitative reverse transcription polymerase chain reaction(RT‐qPCR) analysis .Results:The number of differential expressed genes(DEGs) at 24 h after IR was larger than that at 4 h .The DEGs at 4 h were associated with metabolism and stress responses ,while the DEGs at 24 h were associated with inflammation and apop‐tosis .The numbers of up‐regulated genes at both 4 h and 24 h were larger than those of down‐regulated genes .Several down‐regulated ,up‐regulated ,or unchanged genes were confirmed by RT‐qPCR .Conclusions:Stage‐specific changes of gene expres‐sion occurres during IR injury .These DEGs at early or intermediate‐late stages of IR injury are tightly associated with their stage‐specific pathophysiological processes .

Objective To evaluate the efficacy and safety of oxycodone hydrochloride injection for postoperative analgesia in patients undergoing the operation under general anesthesia in a prospective,randomized,blind,multicenter,positive-controlled,clinical trial.Methods Two hundred and forty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,weighing 40-95 kg,scheduled for elective abdominal operation or orthopedic surgeries under general anesthesia,were randomly divided into 2 groups (n =120 each):morphine sulfate injection group (group M) and oxycodone hydrochloride injection group (group O).Morphine or oxycodone 1 mg was injected intravenously when the patients complained of pain after tracheal extubation or removal of the laryngeal mask,and administration was repeated if necessary until VAS≤40 mm.Then patient-controlled intravenous analgesia (PCIA) (100 ml,0.5 mg/ml) with morphine or oxycodone was used for postoperative analgesia (lasting for 48 h).The PCIA pump was set up with a 1 ml bolus dose,a 5 min lockout interval and background infusion at a rate of 0.5 mg/h.Pain at rest and during movement was assessed using VAS score at 3,24 and 48 h after administration,and non-inferiority test was performed.Total morphine or oxycodone consumption,requirement for rescue analgesic,the number of unsuccessfully delivered dose,the number of attempts,and the level of patient' s satisfaction were recorded within 48 h after operation.The adverse events were recorded and laboratory examinations (blood and urine routine test,blood biochemical examination) were performed within 72 h after administration.Results There was no significant difference in the VAS scores at rest and during movement at different time points,requirement for rescue analgesic,the number of unsuccessfully delivered doses and attempts,level of patient' s satisfaction,total morphine or oxycodone consumption,and adverse events between the two groups (P ＞ 0.05).No serious adverse event occurred in the two groups.The most common adverse event was nausea,followed by vomiting.There was no significant difference in the incidences and degree of nausea and vomiting between the two groups (P ＞ 0.05).The incidences of nausea and vomiting in patients underwent orthopedic surgeries were significantly lower in group O than in group M (P ＜ 0.05).The other adverse events were fewer and abnormal laboratory examinations were rare in the two groups.95％ confidence interval of the difference between the mean VAS scores at rest and during movement at each time point was within 15 mm (boundary values of non-inferiority testing) in the two groups.Conclusion PCIA with oxycodone hydrochloride injection is safe and effective in reducing pain after moderate or major operation,and the analgesic efficacy is similar to that of morphine sulfate injection,however,the development of nausea and vomiting is reduced when PCIA with oxycodone hydrochloride injection is used for orthopedic surgeries as compared with that when morphine sulfate injection is used and the ratio between the analgesic efficacy of the two drugs is close to 1∶1.

Objective To assess the efficacy of recoil of inflating syringe plunger in limiting laryngeal mask airway (LMA) cuff pressure.Methods Sixty ASA Ⅰ or Ⅱ patients aged 22-64 yr with body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were enrolled in this study.LMA Supreme (Laryngeal Mask Co.Singapore) size # 3 (for patients with body weight ≤50 kg) or # 4 (for patients with body weight ＞ 50 kg) was placed after induction of anesthesia.Correct position of LMA was confirmed by fiberoptic bronchoscopy.The LMA cuff was inflated to 60,80,100 and 120 cm H2O step by step using a 20 ml-syringe.The cuff pressure was measured with a monometer through a 3-way stopcock and maintained at each level for 10 seconds.The plunger was then allowed to recoil.The cuff pressure at the end of recoil (residual cuff pressure) was recorded.The patients were mechanically ventilated.The inspiratory pressure was limited to 30 cm H2 O.The airway pressure at which the air started to leak between LMA and larynx (leak pressure-Pleak) was recorded.Results The residual cuff pressure following the 4 inflating pressures was all ＜ 60 cm H2 O.The Pleak was ＞20 cm H2O.There was no significant difference in residual cuff pressure and Pleak between size # 3 and # 4.Conclusion Recoil of inflating syringe plunger can limit LMA pressure to safe level.

Objective To compare the phaimacodynamics and circulatory function of domestic and imported rocuronium. Methods This is a five center study of rocuronium. Two hundred and ten ASA Ⅰ or Ⅱ patients aged 18-65 yr undergoing elective surgery under general anesthesia were randomly divided into 2 groups (n = 105 each): domestic rocuronium group (group Ⅰ ) and imported rocuronium group (group Ⅱ ) . Anesthesia was induced and maintained with TCI of propofol (target plasma concentration = 3 mg/L) and remifentanil (target effect-site concentration = 2-4 μg/L) . Tracheal intubation was facilitated with intravenous rocuronium 0.6 mg/kg. The N-M function was assessed by accelerography (TOF-Watch(R) SX, Organon, Netherlands) using TOF stimulation of ulnar nerve. Onset time, clinical duration, 75% recovery time,recovery indexes, the extent of maximal NM blockade and intubation conditions (ease of laryngoscopy, position of vocal cords and airway reaction) were monitored and recorded. BP and HR were also recorded. Results There were no significant differences in the onset time, clinical duration, recovery indexes, the extent of maximal N-M blockade, the intubation conditions, BP, HR and adverse reactions between groups Ⅰ and Ⅱ ( P ＞ 0.05) . The 75% recovery time was significantly longer in group Ⅱ than in group Ⅰ (P ＜ 0.05＝. Conclusion The pharmacodynamics of domestic and imported rocuronium is comparable. The two drugs have no adverse effect on the circulatory function.

Objective To compare the plasma volume expanding effect of hydroxyethyl starch (HES)130/0.4 and electrolyte solution (E-HES) and HES 130/0.4 and normal saline (NS-HES) in patients undergoing noncardiac surgery under general anesthesia.Methods A multicenter,prospective,randomized,double-blind,controlled clinical trial was conducted.Two hundred and forty-two ASA Ⅰ or Ⅱ patients aged 18-64 yr with body mass index 18-29 kg/m2 undergoing noncardiac surgery were randomly divided into 2 groups: group E-HES and group NS-HES.E-HES and NS-HES 15 ml/kg was infused iv over 1 h immediately after induction of anesthesia in groups E-HES and NS-HES respectively.Arterial blood samples were taken before (baseline) and at 15 min after the end of HES infusion for blood gas analysis (pH value,BE,HCO3-,K+,Na+,Cl-,Mg2+ ) and measurement of Hb,Hct,blood chemistry (ALT,AST,Cr,BUN,Glu) and coagulation function.The electrolyte abnormality,requirement for vasopressor,treatment-related adverse effects (prolonged prothrombin time,activated partial thromboplastin time and hyperchloremia) and fluid balance were recorded.Results Of the 242 patients,122received E-HES and 120 received NS-HES.Ninety-one patients in group E-HES and 95 in group NS-HES completed the trial.The pH value,BE,HCO3 -,K+,and Mg2+ were significantly higher and Na+ and Cl- lower at 15 min after HES infusion was finished in group E-HES than in group NS-HES.BE,HCO3-,Na+,Mg2+,Hb and Hct were significantly decreased while Cl- was significantly increased in group NS-HES while Na+,Mg2+,Hb and Hct were significantly decreased and Cl- was increased in group E-HES at 15 min after HES infusion as compared with the baseline values before infusion.The incidence of clinical significant abnormality in plasma K+ and Cl- was significantly lower in group E-HES than in group NS-HES.There were no significant differences in Hb,Hct,urine output,amount of HES infused,vasopressor requirement,the incidence of clinically significant abnormality in blood chemistry and treatment-related adverse effects between the 2 groups.Conclusion E-HES and NS-HES have the same plasma volume expanding effect,but E-HES maintains better electrolyte and acid-base balance than NS-HES.