Objective:To evaluate the effect of perioperative transcutaneous electrical acupoint stimulation (TEAS) on postoperative cellular immune function in the patients undergoing posterior spinal internal fixation.Methods:Ninety patients, aged 40-70 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective posterior spinal internal fixation in our hospital, were divided into 2 groups ( n=45 each) using a computer-generated table of random numbers: routine group and experiment group.Total intravenous anesthesia was used in routine group, while total intravenous anesthesia combined with TEAS was applied in experiment group.In experiment group, bilateral Zusanli and Sanyinjiao acupoints were stimulated with 2/15 Hz disperse-dense waves at the intensity that could be tolerated by patients at 30 min before induction of anesthesia, maintaining with 2/100 Hz disperse-dense waves from the end of induction until the end of operation at the same stimulation intensity before induction.Bilateral Neiguan and Taichong acupoints were stimulated for 30 min each time with 2/15Hz disperse-dense waves once a day at 1st-4th days after operation.In routine group, the electrodes were connected at the same time period, but no stimulation was given.Venous blood samples were collected before induction of anesthesia, at 1 h after surgery, and on 1st, 3rd, and 5th days after surgery, and the percentage of CD3 + , CD4 + , CD8 + T lymphocytes, CD4 + /CD8 + ratio, WBC count and percentage of neutrophils (NE%) were determined by flow cytometry, and the consumption of intraoperative anesthetics, use of postoperative analgesics, nausea and vomiting, dizziness, infection and length of hospital stay were recorded. Results:Compared with routine group, the total consumption and consumption index of remifentanil were significantly decreased, the percentage of CD3 + T lymphocytes was increased on 3rd and 5th postoperative days, the NE% was decreased on 1st postoperative day, and the incidence of dizziness was decreased ( P<0.05), and no significant change was found in the other indicators in experiment group ( P>0.05). Conclusions:Perioperative TEAS can improve postoperative cellular immune function and has a certain potential value in preventing postoperative infection in the patients undergoing posterior spinal internal fixation.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

Objective:To evaluate the accuracy of ultrasound-measured airway indicators in predicting difficult laryngoscopy.Methods:A total of 104 American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-70 yr, undergoing elective operation under general anesthesia, were selected.The airway was evaluated before induction of anesthesia, body mass index (BMI), neck circumference, mouth opening, thyromental distance and modified Mallampati classification were recorded, and mandibular condylar mobility, distance from skin to under surface of tongue, hyomental distance and distance from skin to epiglottis were measured by ultrasound.Anesthesia induction was performed after the end of measurement, and direct laryngoscopy was performed after mask pressure ventilation.Cormack-Lehane (CL) grade was recorded, and difficult laryngoscopy was defined as CL grade≥2b.The patients were divided into non-difficult laryngoscopy group (group NDL) and difficult laryngoscopy group (group DL) according to the view obtainable during laryngoscopy.The factors of which P values less than 0.05 would enter the logistic regression analysis.The accuracy of each index in predicting difficult laryngoscopy was evaluated using the area under the receiver operating characteristic curve (AUC) and 95% confidence interval (CI). The critical value was determined according to Youden index, and the sensitivity and specificity were calculated. Results:Compared with NDL group, BMI, depth of epiglottis and the incidence of modified Mallampti≥grade Ⅲ were significantly increased, and the mouth opening and thyromental distance were decreased in goup DL ( P<0.05). The AUC (95%CI) of modified Mallampti classification and the depth of epiglottis for difficult laryngoscopy prediction were 0.728 (0.619-0.836) and 0.833 (0.743-0.924), respectively.When the critical value of depth of epiglottis was 2.125 cm, the sensitivity and specificity of predicting difficult laryngoscopy were 65.71% and 89.86%, respectively. Conclusion:Ultrasound-measured depth of epiglottis can accurately predict the difficult laryngoscopy.

Objective To investigate the effects about Tetramethyl -pyrazine (TMP)to Bad, Caspases-1 protein relating with JNK signal transduction pathways on cultured rat hippocampal neurons after anoxia-reoxygenation. Methods Rat hippocampal neurons were cultured in vitro and observed respectively on 7 ~ 9 days. Neurons were exposed to TMP in three different concentration (60,200,800 μg/mL) and JNK inhibitors (10 μmol/L). Control/normal groups were set in each experiment, except for the normal group. After 1 hour of treatment, the rat hippocampal neurons were placed in an incubator with 90%N2 + 10% CO2 for 2 hours to induce anoxia. Then, the rat hippocampal neurons were placed in an incubator with 5% CO2+95%air to establish reoxygenation. Bad, Caspases-1 protein were examined by Western Blot. Results After neurons with 60,200, 800 μg/mL TMP and 10 μmol/L JNK inhibitors on damage induced by anoxia-reoxygenation , the Bad , Caspases-1 protein are lower than the control group. But the 200 μg/mL group is better than 60 800 μg/mL groups. Conclusions Through the JNK signal transduction pathways, the Caspases-1, Bad protein expressions are lower than the control group. So TMP has obvious inhibitory action to rat hippocampal neuronal damage induced by anoxia-reoxygenation.

Objective To explore effects of sulfentanyl preconditioning on myocardial injury in scald in diabetic and non-diabetic rats.Methods Eighty SD rats (40 diabetic rats and 40 non-diabetic rats)were divided into eight groups (10 rats per each),including sham group(group NS,non-diabetic rats with sham burn),burned group(group NB,non-diabetic rats with third-degree burns over 30%total body surface area (TBSA)and lactated Ringer??s solution for resuscitation),sulfentanyl group (group NP,non-diabetic rats without given sulfentanyl before burning and lactated Ringer??s solution for resuscitation)and naloxone group(group NN,non-diabetic rats given naloxone before sulfentanyl group),Diabetes sham group(group DS,diabetic rats with sham burn),Diabetic rats burned group (group DB,diabetic rats given third-degree burns,over 30 percent of the total body surface area had been burned and given lactated Ringer??s solution for resuscitation),diabetic sulfentanyl group(group DP,diabetic rats given sulfentanyl before burning and given lactated Ringer??s solution for resuscita-tion)and diabetic naloxone group(group DN,diabetic rats given naloxone,after that treated as the sulfentanyl group).Results Compared to group NB,for the mice in group NP,the activity of plasma SOD increased significantly,TNF-α,cTnI and water content level in myocardium decreased signifi-cantly (P <0.05 );whereas TNF-α,cTnI and water content level in myocardium in group DB in-creased significantly (P <0.05);Compared to group DB,for the mice in group DP,the activity of plasma SOD increased significantly,MDA,TNF-α,cTnI and water content level in myocardium de-creased significantly (P <0.05).Conclusion Diabetes may deteriorate burn-induced myocardial injury in rats.Sulfentanyl pretreatment exhibits significant protective effects on burned-induced myocardial injury in severely burned diabetic rats via inhibiting lipid peroxidation and TNF-αexpression.

Objective To investigate the effect of ulinastatin on the postoperative immune function of effective T-lymphocytes (Teff cells) and regulatory T-lymphocytes (Treg cells) in the peripheral blood in patients undergoing laparoscopic operation.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,weighing 45-65 kg,scheduled for elective laparoscopic operation for infertility,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ulinastatin group (group U).At 15 min before induction of anesthesia,ulinastatin 200,000 U (in 100 ml of normal saline) was infused intravenously in group U,while the equal volume of normal saline was infused instead in group C.Anesthesia was induced with iv injection of fentanyl,propofol,and cisatracurium and maintained with iv infusion of propofol and sevoflurane.Before surgery (T0),at the end of surgery (T1) and on 1st and 3rd days after surgery (T2.3),venous blood samples were collected from the peripheral blood for determination of the expression of Teff cells (CD4 + CD25-) and Treg cells (CD4 + CD25+) and serum interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β) concentrations (by ILISA).Teff/Treg and IFN-γ/TGF-β ratios were calculated.Results Compared with the baseline value at T0,the expression of Treg cells was significantly up-regulated,and Teff/Treg ratio was decreased at T2 and T3 in group C,and the expression of Teff cells was up-regulated at T3 (P ＜ 0.05 or 0.01),while no significant difference was found in the expression of Treg cells and Teff/Treg ratio at T3 in group U (P ＞ 0.05).Compared with group C,the expression of Teff cells was significantly up-regulated at T3,the expression of Treg cells was down-regulated and Teff/Treg ratio was increased at T2 and T3,the concentration of serum TGF-β was decreased and IFN-γ/TGF-β ratio was increased at T2 and T3 in group U (P ＜ 0.05 or 0.01).No significant changes were found in the serum IFN-γ and TGF-β concentrations and IFN-γ/TGF-β ratio at each time point in the two groups (P ＞ 0.05).Conclusion Ulinastatin can enhance the immune function of Teff cells in the peripheral blood and decrease the immune function of Treg cells,thus maintaining the balance of the postoperative cellular immune function in patients undergoing laparoscopic operation.

ObjectiveTo investigate the effect of tertamethylpyrazine on perioperative humoral immune function in patients required for autologous blood transfusion.MethodsSixty ASA Ⅰ or Ⅱ patients aged 20-60 yr weighing 50-75 kg undergoing elective spinal surgery were randomly divided into 2 groups ( n =30 each):test group and control group.In test group,tertamethylpyrazine 2 mg/kg was infused intravenously over 5 min at 30 min before the autologous blood was collected.Tertamethylpyrazine was added to the heparinized saline and washing saline at the same time (25 mg per 500 ml) until the final concentration reached 0.005 ％.Tertamethylpyrazine was not given in control group.Venous blood samples were taken before anesthesia induction (T0) and at 1 h after operation (T1),and on day 1 and 5 after operation (T2.3) for measurement of serum IgG and IgM concentrations by ELISA.The operation time,intraoperative blood loss and amount of salvaged blood reinfused were recorded.ResultsThere was no significant difference in the operation time,intraoperative blood loss and amount of salvaged blood reinfused between the two groups (P ＞ 0.05).Compared with the baseline value at T0,serum IgG and IgM concentrations were significantly decreased at T1-3 in control group and the serum IgG concentration was significantly decreased at T1.2 in test group ( P ＜ 0.05 or 0.01 ).The serum IgG concentration at T2.3 and serum IgM concentration at T1-3 were significantly higher in test group than in control group ( P ＜ 0.05 or 0.01 ).ConclusionTertamethylpyrazine can reduce humoral immunosuppression to some extent and improve the balance of humoral immunity in patients required for autologous blood transfusion.

Objective To investigate the effect of tetramethylpyrazine pretreatment on the expression of cfos and heat shock protein (HSP70) during hypoxia-reoxygenation (H/R) in cultured fetal rat hippocampal neurons. Methods After the neurons were cultured and identified, they were randomly divided into 5 groups ( n = 24each): control group (group C), H/R group, and low, median and high concentration of tetramethylpyrazine pretreatment groups (group L, M and H). The neurons were exposed to 2 h of hypoxia followed by 24 h of reoxygenation. Tetramethylpyrazine was added with the final concentrations of 60, 200 and 800 μg/ml in group L, M and H respectively, and then the neurons were incubated for 1 h before H/R. The apoptosis rate, cell viability and expression of c-fos and HSP70 were detected. Results The cell viability was significantly lower, while the apoptosis rate was significantly higher in group A/R, L and H than in group C (P ＜0.01). The cell viability and HSP70expression were significantly higher, while the apoptosis rate and c-fos expression were significantly lower in group L, M and H than in group A/R, and in group M and H than in group L (P＜ 0.05). The cell viability and HSP70expression were significantly lower, while the apoptosis rate and c-fos expression were significantly higher in group H than in group M ( P ＜ 0.01 ).Conclusion The mechanism by which tetramethylpyrazine pretreatment inhibits the apoptosis in cultured fetal rat hippocampal neurons during H/R may be related to the dowm-regulation of c-fos expression and up-regulation of HSP70 expression.

Objective To investigate the effect of adenoviral-mediated interleukin-10 (IL-10) gene transfection on systemic inflammatory responses in a rat model of ventilator-induced lung injury. Methods Thirty adult male SD rats weighing 200-220 g were randomly divided into 5 groups (n=6 each): group Ⅰ control (group C); group Ⅱ adenovirus without IL-IO gene + 2 h mechanical ventilation (MV) (group B, ); group II1 adenoviruswithout IL-IO gene + 4 h MV (group B_2); group Ⅳ adenovirus with IL-10 gene + 2 h MV (group A_1) and group Ⅴ adenovirus with IL-10 gene + 4 h MV (group A_2). In group Ⅱ-Ⅴ the animals were mechanically ventilated (airway pressure = 25 cm H_2 O) and adenovirus was injected into right ventricle at 48 h before MV. Blood samples were taken from abdominal aorta at the end of 2 h or 4 h MV for determination of serum IL-8 and IL-10 concentrations. The animals were then killed. The pulmonary specimens were obtained for examination of ultrastructure with light and electron microscope. Results Mechanical ventilation significantly increased serum IL-8 and IL-IO concentrations in a duration-dependent manner in group Ⅱ-Ⅴ as compared with group C. Trans-pulmonary administration of adenoviraI-mediated interleukin-10 gene significantly decreased serum IL-8 concentration and increased serum IL-10 concentration and reduced ventilator-induced lung injury alter MV in group A_1 and A_2 as compared with group B_1 and B_2. Conclusion Adenoviml-madiated IL-10 gene transfection can attenuate the systemic inflammatory response and reduce ventilator-induced lung injury.

The teaching methods in anesthesiology practice to traditional Chinese medicine students was discussed.Watching for the first step, then simulation and manipulation on patients should be abided by. Paying more attention to patients’ safety and avoiding any fault to patients should be emphasized . The one to one and hand by hand teaching method should also be used to train the students' clinic thought and practical ability.