Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups ( n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group ( group QG) and general anesthesia group ( group G) . In group QG, anteri-or quadratus lumborum block was performed with 0. 33％ ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side. Combined intravenous-inhalational anesthesia was applied, propofol 3-5μg∕ml and remifentanil 3-5 ng∕ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups. Patient-controlled intravenous analgesia with sufentanil 2μg∕kg was used for postoperative analgesia. The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval. Bruggrmann comfort scale ( BCS) scores were recorded at 1, 6, 12, 24 and 48 h after operation ( T1-5 ) . Tramadol was used for rescue analgesic after operation. The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients' satisfaction with postoperative analgesia were recorded. The emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were also recorded. The develop-ment of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4,5 , the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients' satisfaction with postoperative an-algesia was increased, and the emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were shortened in group QG (P<0. 05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma.

Objective To observe the protective effect of dexmedetomidine(Dex)at different doses com-bined with ulinastatin in lung resection patients with one lung ventilation. Methods 80 patients having undergone unilateral lung resection were divided into four groups randomly:control group(C group)and groups Dex 1-3,20 cases in each group.One lung ventilation(OLV)was used in all the groups during operation.The patients in groups Dex 1-3 were treated with 0.5,1.0,2.0 μg/kg combined with ulinastatin,and the C group with amount of normal sa-line instead.The comparisons were done among the four groups in terms of SOD,L-6,IL-10,serum malondialde-hyde(MDA)concentration at 5 min after endotracheal intubation(T0),30 min(T1),60 min(T2),120 min (T3)as well as the levels of FVC,FEVl and FEVl/FVC at 24 h,48 h and 72 h after surgery. Results In the groups C and Dex 1,SOD decreased at T1-4 and IL-6,MDA and IL-10 at T2-4 rose.SOD decreased at T2-4 in groups Dex 2-3 and MDA,IL-6 and IL-10 rose.Compared with group C,the levels of SOD and IL-10 at T2-4 in groups Dex 1-2 and at T1-4 in group Dex 3 rose. In groups Dex 1-3,postoperative FVC,FEVl and FEVl/FVC rose.Compared with group Dex 1 or 2 respectively,SOD and IL-10 at T2-4 in group Dex 3 significantly rose,but MDA and IL-6 significantly declined;FVC,FEVl and FEVl/FVC significantly rose 48 h and 72 h after surgery (P<0.05). Conclusion Dex combined with ulinastatin has a protective effect for patients with one lung ventila-tion after lung resection,with the best-suggested dose of 1.0 μg/kg.

Objective To observe the effect of acute normovolemic hemodilution(ANH)combined with enhanced recovery after surgery(ERAS)on immune function in patients undergoing hepatic lobectomy. Methods 80 patients were divided into two groups:ERAS group(group E),ANH combined with ERAS group(group AE). bleeding volume,blood transfusion,infused fluid volume,urine output during operation and clinical index after surgery were recorded. Exhaust and defecation time ,fluid intake time and hospitalization duration were also record-ed. Blood samples were obtained from the patients at 30 min before anesthesia induction(T1),immediately(T2), 24 h(T3),3 d(T4)and 7 d(T5)after the end of operation for determination of the expression of CD3+,CD4+, CD8+ on T cells and natural killer cell. Results In group E ,CD3+,CD4+ T-lymphocytes and NK cells at T2-3 decreased as compared with T0. Compared with group E ,no allogeneic blood transfusion cases were found and clinical index duration was shorter in group AE. CD3+,CD4+T-lymphocytes and NK cells at T2-3 increased in group AE as compared with those in Group E. The difference is significant (P < 0.05). Conclusion ANH combined with ERAS can decrease allogenic blood transfusion and increase post-operation immunologic function ,shorten the postoperative hospitalization time.

Objective To investigate the effects of post-operative analgesia with oxycodone or morphine for patients undergoing colon cancer radical surgery on platelet activation and cellular immunity.Methods Forty colon cancer patients scheduled for radical surgery, 23 males and 17 females, ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups (n=20 each): oxycodone group (group O) and morphine group (group M).Patient-controlled intravenous analgesia (PCIA) was used for post-operative analgesia.PCIA solution contained oxycodone 1 mg/kg and tropisetron 6 mg in 100 ml normal saline in group O or morphine 1 mg/kg and tropisetron 6 mg in 100 ml normal saline in group M.Blood samples were obtained from the patients at 5 min before anesthesia induction (T0), 4 h after surgery (T1), 24 h after surgery (T2) and 48 h after surgery (T3).The levels of glycoprotein (GP)Ⅱb/Ⅲa, P-selection (CD62P), natural killer (NK) cells, NKT cells, and natural Treg (nTreg) cells were detected.The platelet aggregation rate (PAR) was determined.Results Compared with T0, the levers of GPⅡb/Ⅲa, CD62P, PAR and nTreg cells were significantly higher at T1 in group O and at T1, T2 in group M (P<0.05).Compared with T0, the levels of NK and NKT cells were decreased significantly at T1 in group O and at T1-T3 in group M (P<0.05).The levels of GPⅡb/Ⅲa, CD62P, PAR and nTreg cells at T2 and T3 in group O were decreased significantly as compared with group M (P<0.05).The levels of NK cells, NKT cells at T2 and T3 in group O were significantly higher than those in group M.Conclusion Post-operative analgesia with oxycodone for patients undergoing colon cancer radical surgery exhibits a more significant effect of decreasing platelets activity and presents a less disturbance on cellular immunity as compared with morphine.

Objective To explore the effect of meditation training on postoperative pain, anxiety and reduce the incidence of constipation in patients with lower limb fracture. Methods The enrolled 106 patients with lower extremity fractures were randomly divided into the observation group and control group 53 cases respectively according to the odd even method. The control group was implemented with fracture surgery routine care, while the observation group was implemented with meditation training on the basis of the control group, the two groups were compared by postoperative pain score, anxiety, constipation, and satisfaction. Results Before intervention, the postoperative pain Visual Analogue Scale (VAS) scores and anxiety scores of the two groups were not significantly different (P>0.05). After intervention, the postoperative pain scores of observation group and control group were (2.06 ± 0.85) points and (4.15 ± 0.62) points respectively, the difference was statistically significant (t = 4.103, P <0.05). The anxiety scores of observation group and control group were (28.95 ± 3.83) points and (56.13 ± 3.52) points respectively, the difference was statistically significant (t= 2.353, P < 0.05). The first defecation time and the cases number of observation group patients were as follows:day 1st:20.75%(11/53), day 2nd: 52.83% (28/53), day 3rd: 18.87% (10/53), day 4th: 7.55% (4/53). While the data of the control group were day 1st: 1.89% (1/53), day 2nd: 26.42% (14/53), day 3rd 37.74% (20/53), day 4th:33.96%(18/53), the difference between the two groups was statistically significant (χ2=4.022-5.629, P<0.05). The satisfaction of observation group and control group patients were 94.34%(50/53), 77.36%(41/53) respectively, the difference was statistically significant (χ2=4.543, P < 0.05). Conclusions Meditation training can effectively reduce postoperative pain, reduce the incidence of anxiety and constipation, and improve the satisfaction of patients to nursing service, and promote the recovery of patients after surgery.

Objective To investigate the effects of sevoflurane and propofol on postoperative cognitive function after abdominal surgery for elderly patients with diabetes. Methods Seventy diabetic patients (aged 60~75 yr, ASAⅠorⅡ) underwent abdominal surgery and are included in the research. Diabetic patients were randomly divided into two groups (n=35): sevoflurane group(group DS) and propofol group (group DP). MMSE score, the attachment test, words memory test and Stroop color word test were carried and the results were recorded before operation (T1), postoperative 24 h (T2), 48 h (T3) and 1 w (T4). Results Compared with T1, patients′ MMSE score reduced at T2 and T3. Time spent in attachment test is longer at T2 and T3. Mistaken incidences in Stroop color words test 1, 2 and 3 are higher and time longer at T2. Time spent on Stroop color words test 2 and 3 is longer in T3. Words memory test reveals decline at T2 and T3, whose difference is statistically significant (P < 0.05). Cognitive dysfunction incidence in the two groups shows no statistical significance (P > 0.05). Conclusion Sevoflurane and propofol can result in postoperative cognitive dysfunction for elderly patients with diabetes within 48 h after abdominal surgery, there were no difference between the effects of them.

OBJECTIVETo observe the change of neuronal nitric oxide synthase (nNOS) expression in the spinal cord of diabetic rats with painful diabetic neuropathy.

METHODSSixty SD rats were randomized equally into painful diabetic neuropathy group (DM group) and control group. Painful diabetic neuropathy was induced by intraperitoneal injection with STZ (60 mg/kg) in DM group, and the rats in the control group received a solvent injection. Blood glucose levels were measured before and at 2, 7, 14, 21, and 28 days after STZ injection (T1-6 respectively). Responses to the mechanical stimulus were measured with von Frey filament, and 50% paw withdraw threshold (PWT) and body weight were recorded at T1 and T3-6. At T1 and T3-6, 6 rats from each group were sacrificed to examine the expression of nNOS in the lumbar segments of the spinal cord using Western blotting.

RESULTSThe level of blood glucose increased while the body weight decreased significantly after STZ injection in DM group (P<0.05). Comparing to those in the control group, PWT decreased while spinal nNOS expression increased significantly in DM group at T4-6 (P<0.05) showing an inverse correlation between them (P<0.01).

CONCLUSIONThe enhanced expression of spinal nNOS might be involved in the pathogenesis of painful diabetic neuropathy in rats.

Animals ; Blood Glucose ; Diabetes Mellitus, Experimental ; enzymology ; Diabetic Neuropathies ; enzymology ; Nitric Oxide Synthase Type I ; metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; enzymology

Objective To evaluate the effects of curcumin preconditioning on the activity of xanthine oxidase (XOD) during intestinal ischemia-reperfusion (I/R) in rats.Methods Thirty female Sprague-Dawley rats,aged 180-220 g,were randomly divided into 3 groups (n =10 each) using a random number table:sham operation group (S group),intestinal I/R group (I/R group),and curcumin preconditioning group (Cur group).Intestinal I/R was induced by clamping the superior mesenteric artery for 75 min followed by reperfusion.Curcumin 200 mg/kg was given everyday for 5 days before intestinal I/R in Cur group and the equal volume of normal saline was given instead of curcumin in S and I/R groups.The rats were sacrificed at 4 h of reperfusion and the intestinal specimens were obtained for microscopic examination of pathologic changes which were graded using Chiu scoring system and for determination of XOD activity,content of malondialdehyde (MDA),and superoxide dismutase (SOD) activity.Results Compared with S group,the Chiu score,activity of XOD and content of MDA were significantly increased,while the activity of SOD was decreased in I/R and Cur groups (P ＜ 0.05).Compared with I/R group,the Chiu score,activity of XOD and content of MDA were significantly decreased,and the activity of SOD was increased in Cur group (P ＜ 0.05).Conclusion Curcumin preconditioning can attenuate intestinal I/R injury in rats,which may be due to inhibition of XOD activity and decreased oxidative stress in intestinal tissues.

Objective To evaluate the effect of curcumin preconditioning on the activation of mast cells during intestinal ischemia/reperfusion (I/R) in rats.Methods Twenty-four female Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (S group),intestinal I/R group (I/R group),and curcumin preconditioning group (Cur group).Intestinal I/R was produced by occlusion of superior mesenteric artery (SMA) for 75 min followed by reperfusion.At 5 days before I/ R,curcumin 200 mg/kg (in 20 mg/ml normal saline) was given through a gastric tube in Cur group,while the equal volume of normal saline was given instead in S and I/R groups.All the rats were sacrificed at 4 h of reperfusion,and the intestinal specimens were obtained for microscopic examination and for determination of tryptase expression and β-hexosaminidase content.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,Chiu's score and β-hexosaminidase content were significantly increased,and the expression of tryptase was up-regulated in I/R and Cur groups.Compared with I/R group,Chiu' s score and β-hexosaminidase content were significantly decreased,and the expression of tryptase was down-regulated in Cur group.Conclusion The mechanism by which curcumin preconditioning attenuates intestinal I/R injury is related to inhibited activation of mast cells of rats.

Objective To discuss the distribution of TCM syndromes and clinical characteristics in adult viral pneumonia. Methods Retrospective analysis was carried out during 2009-2012 in 107 cases of adult viral pneumonia with virus antigen and serum virus IgM antibody positive detected with PCR, ELISA and IF method. The clinical symptoms, serology and TCM syndrome type distribution were analyzed. Results The average age of the patients with adult viral pneumonia was 34.78±11.4. The clinical symptoms were mainly fever, cough and sore throat, and defense phase symptoms such as headache and general aching were outstanding. TCM syndromes distribution accounted for 92.52%(99/107) of syndrome of wind-heat invading lung, syndrome of phlegm-heat congesting lung, syndrome of wind-heat with dampness, and syndrome of wind-cold to heat. Syndrome of wind-heat invading lung was commonly seen in disease course ≤7 d, and syndrome of phlegm-heat congesting lung in course >7 d. The viruses were mainly influenza A and B, parainfluenza virus. Among the 107 cases, 86 cases (80.37%) were infected with single virus. There were no significant difference among different pathogens in the distribution of type (P>0.05). Conclusion TCM syndrome distribution of adult viral pneumonia has some characteristics, and has correlation with disease course.