Objective:To evaluate the effect of Mongolian medicine Eerdun Wurile on postoperative cognitive function in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty elderly patients of either gender, aged ≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with body mass index≤28 kg/m 2, with preoperative Mini-Mental State Examination (MMSE) score ≥27 points, undergoing thoracoscopic lobectomy under general anesthesia, were divided into 2 groups ( n=30 each) using the random number table method: control group (group C) and Eerdun Wurile group (group E). Eerdun Wurile 15 capsules per day were taken for 7 consecutive days starting from 3 days before surgery in group E, and placebo was given instead in group C. The peripheral venous blood samples were collected before medication at 3 days before surgery (T 1) and 24 and 72 h after surgery (T 2, 3) for determination of the concentrations of serum brain-derived neurotrophic factor (BDNF), interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and Tau proteins by enzyme-linked immunosorbent assay. The patients′ cognitive function was assessed by MMSE at T 1 and 5 days after surgery (T 4), and the occurrence of cognitive decline (MMSE score < 27) was recorded. Results:Compared with group C, the serum BDNF concentration was significantly increased at T 2 and T 3, and the concentrations of IL-1β, TNF-α and Tau protein were decreased, the MMSE score was increased at T 4, and the incidence of cognitive decline was decreased in group E ( P<0.05). Conclusions:Mongolian medicine Eerdun Wurile can improve postoperative cognitive function in elderly patients undergoing thoracoscopic surgery, and the mechanism may be related to reduction of systemic inflammatory responses and promotion of nerve cell repair and regeneration.

Objective:To evaluate the effects of propofol, dexmedetomidine and ketamine on oncentrations of β-amyloid peptide (Aβ) and tau in cerebrospinal fluid (CSF) of sleep-deprived rats.Methods:Forty SPF healthy male Sprague-Dawley rats, aged 3-4 months, weighing 230-280 g, were divided into 5 groups ( n=8 each) using a random number table method: control group (group C), sleep deprivation group (SD), propofol group (group P), dexmedetomidine group (group D) and ketamine group (group K). The sleep deprivation was induced using the improved multi-platform sleep deprivation model.Propofol 100 mg/kg, dexmedetomidine 100 mg/kg and ketamine 80 mg/kg were intraperitoneally injected at 72 h of sleep deprivation to maintain anesthesia for 3 h in P, D and K groups, respectively.Group C entered the large platform for 72 h free activity.The CSF was collected at 3 h of anesthesia for measurement of concentrations of Aβ and tau protein by enzyme-linked immunosorbent assay. Results:The concentrations of Aβ and tau protein in CSF were significantly higher in SD, P, K and D groups than in group C ( P<0.05). Compared with group SD, the concentrations of Aβ and tau protein in CSF were significantly increased in P and K groups, and the concentrations of Aβ and tau protein in CSF were significantly decreased in group D ( P<0.05). Conclusion:Dexmedetomidine can decrease the the concentrations of Aβ and tau protein in CSF of sleep deprived rats, while propofol and ketamine lead to the opposite effect.

Objective To evaluate the effect of ABO blood group factor on anticoagulation with aspirin.Methods Seventy-three patients of both sexes,aged 45-70 yr,who did not take aspirin recently,were divided into 4 groups according to the blood group:blood group A group (group A,n=18),blood group B group (group B,n=20),blood group AB group (group AB,n=15),and blood group O group (group O,n =20).Aspirin 100 mg/d was taken orally for 2 weeks.Fasting blood samples were taken from the peripheral vein before administration (T1) and at 2 weeks after administration (T2) for measurement of activated partial thromboplastin time (APTT),thrombin time (TT),prothrombin time (PT),fibrinogen (Fib),platelet count (Plt) and platelet aggregation rate.Results There was no significant difference in Plt at T1,2 or platelet aggregation rate at T1 among the four groups (P＞0.05).Compared with A,B and AB groups,PT,APTT and TT were significantly prolonged and Fib was decreased at T1,and platelet aggregation rate was decreased at T2 in group O (P＜0.05).Compared with the baseline at T1,no significant change was found in PT,APTF,TT,Fib or Plt at T2 (P＞0.05),and platelet aggregation rate was significantly decreased at T2 in the four groups (P＜0.05).Conclusion ABO blood group factor is related to the individual variation in anticoagulation with aspirin,patients of A,B and AB blood group have the same sensitivity to anticoagulation with aspirin,and patients of O blood group are more sensitive to anticoagulation with aspirin.

Objective To investigate the prevalence of pulmonary fungal infection and drug resist-ance of the pathogenic fungi among children with severe diseases in pediatric intensive care unit(PICU). Methods From July 2013 to June 2017,the complete clinical data,results of fungal culture and drug sensi-tivity of bronchoalveolar lavage fluid in 112 critically ill children with pulmonary fungus infection of PICU hospitalization in our hospital were collected. Samples of peripheral venous blood were collected meantime, including blood routine examination,C reactive protein,G test and GM test. Results One hundred and twen-ty-six fungi were isolated from sputum samples in 112 critically ill children. Severe pulmonary infection (30. 36%,34/112) was the most common form of the primary diseases, the next were severe sepsis (16. 07%,18/112)and severe malnutrition(15. 18%,17/112). Classified based on age difference,the first one was ＜1 year old (43. 75%,49/112),the second one was 1 to 3 years old(29. 46%,33/112). The fun-gal strains were predominantly Candida albicans (61. 90%) and Candida tropicalis (16. 67%),among the infectious cases 14 were diagnosed as mixed infection. Two cases of 3 cryptococcal infectious children were HIV infection,another one was malignant tumor,Cryptococcus was cultured in both sputum,pleural effusion and cerebrospinal fluid. The drug resistance rate of fluconazol in 126 strains of fungi was 12. 70%,the rate of itraconazole was 7. 14%. Generally,the fungi cultured were with very low resistance to 5-fluorocytosine,vori-conazole and amphotericin B. However,the strains of Aspergillus fumigates,Candida kruse,Candida parapsi-losis and Cryptococcus were highly resistant to fluconazol and itraconazole,but with very low resistance to 5-fluorocytosine and amphotericin B. Conclusion Candida albicans is the main pathogenic fungus of pulmo-nary fungal infection among children in PICU,and we could choose voriconazole and amphotericin B as treat-ment of critically ill children with pulmonaty fungal infection.

Objective To evaluate the influence of hyperlipidemia factor on ephedrine-treated hy-potension in the patients undergoing epidural anesthesia. Methods Patients scheduled for elective hyster-ectomy with epidural anesthesia, were divided into normal blood lipid group and hyperlipidemia group ac-cording to the fasting blood lipid level. Epidural puncture was performed at L1,2after replacing the cumula-tive body fluid loss. The hypotensive response was defined as decrease in systolic pressure (SP)＜80% of the baseline value or SP＜90 mmHg. Effective pressor response was defined as increase in SP＞90% of the baseline value or SP＞100 mmHg.The initial dose of ephedrine was 0. 10 mg∕kg.Up-and-down sequential al-location was used to determine the dose of ephedrine. The difference between two successive doses was 0. 02 mg∕kg. Each time the dose increased∕decreased in the next patient according to whether SP increased or not. Probit analysis was used to determine the ED50, and 95% confidence interval (CI) of ephedrine in treating hypotension. Results A total of 114 patients were enrolled in this study, with 64 cases in normal blood lipid group and 50 cases in hyperlipidemia group. The rate of epidural anesthesia-induced hypotension was 22%(14 cases) in normal blood lipid group and 40%(20 cases) in hyperlipidemia group, and there was significant difference between two groups (P＜0. 05). The ED50(95% CI) of ephedrine in treating hypoten-sion was 0. 81 (0. 75-1. 03) mg∕kg and 1. 14 (1. 05-1. 31) mg∕kg in normal blood lipid group and hyper-lipidemia group, respectively, and there was significant difference between two groups ( P＜0. 05). Con-clusion Hyperlipidemia can not only be considered as a risk factor for epidural anesthesia-induced hypo-tension, but also markedly decease pressor responses to ephedrine for the female patients undergoing low epidural anesthesia.

Objective To explore the role and effectiveness of flexible fiberoptic brochoscopy ( FFB) in critically ill children with continuous invasive respiratory support. Methods From July 2014 to June 2017,135 critically ill children with severe pneumonia had received continuous invasive respiratory sup-port and undergone FFB in the pediatric intensive care unit( PICU) of our hospital. These patients were en-rolled into the therapy group. Another 104 severe pneumonia patients who had not received FFB were enrolled into the control group. Clinical characteristics of both groups were collected and compared. Results No sig-nificant differences were detected in patients′gender, age, PCIS, usage of antibiotics, and the levels of CRP and PCT assayed at the time of admission to PICU between the therapy group and control group(P>0. 05). The positive rate of bacteria culture of the bronchoscopic lavage was 78. 52％( 106 cases ) in the therapy group,and it was significantly higher than that in the control group(60. 58％,63 cases) (χ2 =5. 681,P <0. 005). For 106 cases in the therapy group,117 bacteria strains were identified,while there were 72 bacteria strains found in 63 cases with positive bacteria culture in the control group. Gram negative bacteria were the most common type,followed by Gram positive bacteria. The third most common pathogenic microbes were fungi,with a significantly higher frequency in the therapy group. No significant differences were found in PaO2 and oxygenation index between both groups before FFB. However,in a half hour after FFB,the PaO2 and oxygenation index significantly increased in the therapy group,and higher than those in the control group (P<0. 005). The levels of CRP and PCT assayed before and the first day after FFB were not significantly changed(P>0. 05). But the levels of CRP and PCT in the therapy group significantly decreased in the third day after FFB,and more than those in the control group. Furthermore,duration of invasive respiratory sup-port,and the stay of PICU were significantly shorter in the therapy group(P<0. 005). Conclusion FFB can play an important role in the collection of pathogenic microbes. It also achieves better results in the treatment of severe pneumonia for children in PICU. Therefore,it is worthwhile to be recommended as a safe and feasi-ble intervention in PICU.

Objective To evaluate the protective effects of methylprednisolone combined with dexmedetomidine of cardiac valve replacement in patients with brain cognitive function under cardiopulmonary bypass (CPB).Methods Sixty patients for heart valve replacement in Affiliated Hospital.Inner Mongolia Medical University were randomly divided into four groups (n =15 each):group A control,methylprednisolone group (group M),dexmedetomidine group (Group D) and methylprednisolone combined with dexmedetomidine group (group B).After the induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated.Methylprednisolone 20mg/kg was administered to the CPB circuit prime in group M.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μg/(kg · h) until the end of operation in group D.A loading dose of dexmedetomidine 1 μg/kg was pumped intravenously over 10 minutes after induction,followed by continuous infusion at 0.05μ g/(kg · h) until the end of operation and methylprednisolone 20mg/kg was also administered to the CPB circuit prime in group B.At the same time the equal volume of normal saline was given in group A.After induction (T1),CPB instantly (T2),CPB 30min (T3),l0min after CPB(T4),at the end of operation(T5),6h after CPB (T6),the jugular bulb venous blood samples were taken for testing the serum concentrations of interleukin-6 (IL-6),interleukin-10 (IL-10),S100βprotein and neuron-specific enolase (NSE) using the method of ELISA.Simplified mini-mental state examination (MMSE) is used to assess the cognitive function of patients in pre-operation and 2days,3days as well as 7days after operation.Results At T1-6,IL-6,S100 protein and NSE in group M,group D and group B were significantly lower than those in control group,IL-10 was higher than that in control group,and there was significant difference (P ＜ 0.05).In B group at all time points IL-6 、S100 protein and NSE were lower than those in other groups,IL-10 was higher than other groups,and there was significant differences (P ＜ 0.05).The incidence of postoperative cognitive dysfunction in group M,group D and group B was higher than that in control group,and the incidence of cognitive dysfunction in B group was lowest,and there were significant differences (P ＜ 0.05).Conclusion Methylprednisolone and dexmedetomidine can effectively reduce the concentration of IL-6,S100 protein and NSE in cardiopulmonary bypass,reduce brain injury and the incidence of postoperative cognitive dysfunction.The protective effect on cerebral injury is better when using dexmedetomidine combined with methylprednisolone under cardiopulmonary bypass (CPB).

Objective To evaluate the effect of dexmedetomidine on the damage to intestinal mu-cous membrane of rats with obstructive jaundice. Methods Thirty pathogen-free healthy male Sprague-Dawley rats, aged 4-6 months, weighing 200-250 g, were divided into 3 groups(n=10 each)using a random number table: control group(group C), obstructive jaundice group(group OJ)and dexmedeto-midine group(group D). Obstructive jaundice was induced by double ligation of common bile duct in anes-thetized rats. In group D, dexmedetomidine was intraperitoneally injected in a loading dose of 100 μg∕kg at 3 days after establishment of the model, followed by intraperitoneal infusion of 50 μg·kg-1·h-1for 5 h. The equal volume of normal saline was given instead in C and OJ groups. At 5 h after administration of dexmedetomidine, blood samples were collected from the heart for determination of serum concentrations of diamine oxidase(DAO)and tumor necrosis factor-alpha(TNF-α)by enzyme-linked immunosorbent as-say. Then the rats were sacrificed and colon tissues were removed for microscopic examination of the patho-logical changes. Results Compared with group C, the serum DAO and TNF-α concentrations were signifi-cantly increased in OJ and D groups(P<0.05).Compared with group OJ, the serum DAO and TNF-α concentrations were significantly decreased in group D(P<0.05).The pathological changes were signifi-cantly attenuated in group D when compared with group OJ. Conclusion Dexmedetomidine can reduce the damage to intestinal mucous membrane of rats with obstructive jaundice.

Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,undergoing elective cardiac surgery with CPB,were divided into 2 groups (n =45 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).CPB was established routinely after anesthesia induction.Before induction (T0),immediately after aortic unclamping (T1),at 30 min after aortic unclamping (T2) and at 2 h after discontinuation of CPB (T3),blood samples were collected from the radial artery for determination of the plasma endotoxin,D-lactic acid,diamine oxidase (DAO) and intestinal fatty acid-binding protein (Ⅰ-FABP) concentrations (by enzyme-linked immunosorbent assay) and plasma interleukin-6 (IL-6),IL-8 and tumor necrosis factor-alpha (TNF-o) concentrations (using radio-immunity method).Results Compared with the baseline at T0,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly increased at T1-T3 in both groups (P＜0.05).Compared with group P,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly decreased at T1-T3 in group S (P＜0.05).Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia,sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB.

Objective To evaluate the effect of dexmedetomidine on liver injury in the rats with ob?structive jaundice. Methods Forty?five healthy male Sprague Dawley rats, weighing 250-300 g, aged 8-9 weeks, were divided into 3 groups ( n=15 each) using a random number table: sham operation group ( S group) , obstructive jaundice group ( OJ group) and dexmedetomidine group ( D group) . Obstructive jaun?dice was induced in rats by division and double ligation of the common bile duct in OJ and D groups. Dexmedetomidine 100 μg∕kg was injected intraperitoneally at 72 h after establishment of the model in group D. At 3, 5 and 24 h after administration, blood samples were collected from hearts for determination of the plasma alanine aminotransferase (ALT) and C?reactive protein (CRP) levels. After blood sampling at each time point, the specimens from the external right lobe of the liver were obtained for detection of the expres?sion of Toll?like receptor 4 ( TLR4) mRNA ( by real?time polymerase chain reaction) and TLR4 content ( by enzyme?linked immunosorbent assay) in liver tissues and for pathological examination of liver tissues ( with light microscope) . Results Compared with group S, the plasma ALT and CRP levels were significantly increased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly up?regulated, and TLR4 content in liver tissues was significantly increased in OJ and D groups ( P<0?05) . Compared with group OJ, the plasma ALT and CRP levels were significantly decreased at each time point after administration, and the expression of TLR4 mRNA in liver tissues was significantly down?regulated, and TLR4 content in liver tissues was significantly decreased in group D ( P<0?05) . The degree of damage to liver tissues was significantly attenuated in group D compared with group OJ, and was aggrava?ted in group D compared with group S. Conclusion Dexmedetomidine can reduce liver injury in the rats with obstructive jaundice.