目的 观察超声引导下改良胸骨旁阻滞在纵隔占位正中开胸手术中临床应用效果.方法 择期行正中开胸手术患者60例,随机数字表法分为I组(对照组)和Ⅱ组(胸骨旁阻滞组)各30例.入室后,I组第三及第五肋软骨左右侧各给予0.9％生理盐水10 ml;Ⅱ组同I组位置各点给予0.375％罗哌卡因10ml.全凭静脉诱导后插入气管导管,术中静脉麻醉维持;比较两组患者入室时静息状态下(T0)、气管插管时(T1)、切皮时(T2)、拔管前(T3)心率及平均动脉压变化.两组均在术毕连接静脉自控镇痛泵.分别记录两组患者拔管后即刻及拔管后2、6、12、24、48 h Ramsay评分和NRS评分,镇痛泵首次PCA时间、术后有效PCA次数、口服镇痛药补救人次及麻醉相关并发症的发生率.结果 Ⅱ组患者T2、T3心率血压变化小于I组,拔管后即刻、拔管后2 h及拔管后6 h的NRS评分,拔管后即刻Ramsay评分显著小于I组;首次PCA时间长于I组,且术后PCA次数、补救次数均少于I组,差异均有统计学意义(P<0.05);两组患者麻醉并发症发生率比较,差异无统计学意义(P>0.05).结论 全身麻醉中复合应用改良胸骨旁阻滞有良好的围术期镇痛效果,有一定的临床应用价值.

目的 探讨全面质量管理结合递进教学在麻醉专业超声引导臂丛神经阻滞教学实践中的应用和效果.方法 选取2018-09/2019-10期间进入我院麻醉科接受住院医师规范化培训学员(简称"住培学员")48人,拟行B超引导下的臂丛神经阻滞学习,随机分为试验组(A组)和传统教学组(C组),每组24人.由武汉大学人民医院麻醉科超声质量控制小组拟定"B超引导下神经阻滞实施流程和质量管理",所有学员统一完成所有理论学习课程,A组住培学员严格按照质量管理办法分层递进通过模拟操作考核,C组住倍学员则通过传统的带教,比较2组住倍学员在B超引导下臂丛神经阻滞的操作成功率及并发症发生率,以及住倍学员自我评价和带教老师满意度评估.结果 全面质量管理结合递进教学组住培学员的臂丛神经阻滞操作成功率显著提高,操作时间显著缩短,并发症明显降低(P<0.05),住培学员以及带教老师的满意度均明显高于A组(P<0.05).结论 全面质量管理结合递进教学方法指导下的麻醉住院医师规范化培训模式可进一步保证住培学员操作的规范性和同质化,加深住倍学员对超声引导下臂丛神经阻滞的理解和运用,树立了住倍学员操作的信心,提高了培训效果及麻醉相关操作的安全性,值得在麻醉专业住院医师规范化培训中进一步推广.

目的:总结肺移植围术期麻醉管理经验,探讨围术期麻醉管理对肺移植结局的影响.方法:回顾性分析2016年12月-2020年12月武汉大学人民医院19例肺移植患者临床资料.结果:19例肺移植患者ASA分级Ⅳ～V级,心脏彩超检查提示肺动脉收缩压＞70mmHg6例,50～70mmHg5例,30～50mmHg5例.双肺移植12例,左单肺移植4例,右单肺移植3例.其中9例患者在体外膜肺氧合(ECMO)辅助下完成肺移植手术(2例为术前已经使用ECMO桥接治疗,术中继续ECMO辅助维持).围术期死亡6例,死因分别为:多器官功能衰竭3例;肺移植术后移植物失功、呼吸衰竭1例;术中心跳骤停1例;术后急性心肌梗死,患者家属放弃治疗要求出院1例;余13例均顺利出院.结论:肺移植是治疗终末期肺病的有效方法,心肺联合功能差的老年患者,围术期死亡风险明显增大,术前积极调整重要脏器功能,重视基础疾病的治疗,术中精细管理,正确及时使用ECMO辅助,可能改善肺移植患者的预后,降低围术期死亡率.

Objective: To explore the use of extracorporeal membrane oxygenation(ECMO) during lung transplantation anesthesia, and summarize the experience. Methods: From December 2016 to December 2020, the clinical data of 19 patients with lung transplantation using ECMO during anesthesia in Renmin Hospital of Wuhan University were retrospectively analyzed. Results: Among the 19 patients, the main diagnosis were chronic obstructive pulmonary diseases in 5 cases, idiopathic pulmonary fibrosis in 6 cases, bronchiectasis in 2 cases, pneumoconiosis in 4 cases, Kartagener syndrome in 1 case, and COVID-19 with advanced pulmonary fibrosis in 1 case. A total of 9 patients used ECMO to complete the operation. ECMO was used in 2 cases before anesthesia and 7 cases received ECMO treatment after anesthesia. Among them, 5 cases were veno-venous (V-V) ECMO and 4 cases were veno-arterial (V-A) ECMO. During operation, V-A ECMO was changed to veno-artery-vein (V-A-V) ECMO in 1 case, another case used V-V plus V-A ECMO. After operation, 4 cases removed ECMO successfully and returned to the intensive care unit, and 5 cases took ECMO back to the intensive care unit. Among them, 4 cases removed ECMO successfully and 1 case failed due to multiple infections. Among the 10 patients who did not receive ECMO, 1 patient had cardiac arrest during the operation. Conclusion: ECMO is an important auxiliary tool in lung transplantation. Accurate evaluation of patients' cardiopulmonary function and use of ECMO, according to their oxygenation and circulatory status, can provide effective support for lung transplantation anesthesia. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.

Objective The outbreak of coronavirus disease 2019 (COVID-19) has considerably burdened the healthcare system in the Hubei Province, the most severely affected region in China. The aim of our study was to assess the psychological effects of COVID-19 epidemic on the healthcare workers in Hubei. Methods A total of 2737 healthcare workers were sampled using a two-dimensional code shared online between Mar 4 and Mar 9, 2020. The questionnaires consisted of three elements: baseline characteristics, Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). The primary outcome variables were PQSI, anxiety and depression scores of non-medical staff, non-frontline medical staff and frontline medical staff. Binary logistical regression analyses were used to compare between respondents with and without sleep disturbance. Results About 61.6% of the respondents reported sleep problems, 22.6% experienced anxiety, and 35% exhibited depressive symptoms. The prevalence of sleep disorders was higher among the frontline healthcare workers compared to the non-frontline and non-medical staff, while anxiety and depression were prevalent in the entire cohort. Logistic regression analysis identified medical occupation, family burden, bereavement, anxiety, and depression as significantly predictive of poor sleep quality. Conclusions Frontline medical staff are more vulnerable to sleep disturbances. Psychosocial interventions are needed to help allied healthcare personnel to better respond to COVID-19 and future outbreaks.

Purpose Patients with diabetes are vulnerable to myocardial I/R (ischaemia/reperfusion) injury, but are not responsive to IPO (ischaemic post-conditioning). We hypothesized that decreased cardiac Adiponectin (APN) is responsible for the loss of diabetic heart sensitivity to IPO cardioprotecton. Methods Diabetic rats were subjected to I/R injury (30 min of LAD occlusion followed by 120 min of reperfusion). Myocardial infarct area was determined by TTC staining. Cardiac function was monitored by a microcatheter. ANP, 15-F2t-isoprostane, nitrotyrosine and MDA were measured by assay kits. Levels of p-Akt, total-Akt and GAPDH were determined by Western Blot. Results Diabetic rats subjected to myocardial IR exhibited severe myocardial infarction and oxidative stress injury, lower APN in the plasma and cardiac p-Akt expression ( P <0.05). IPO significantly attenuated myocardial injury and up-regulated plasma APN content and cardiac p-Akt expression in non-diabetic rats but not in diabetic rats. Linear correlation analysis showed that the expression of adiponectin was positively correlated with p-Akt and negatively correlated with myocardial infarction area ( P <0.01). Conclusion Protective effect of IPO was tightly correlated with the expression of adiponectin, exacerbation of I/R injury and ineffectiveness of IPO was partially due to the decline of adiponectin and inactivation of Akt in diabetes mellitus.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused great public concern worldwide due to its high rates of infectivity and pathogenicity. The Chinese government responded in a timely manner, alleviated the dilemma, achieved a huge victory and lockdown has now been lifted in Wuhan. However, the outbreak has occurred in more than 200 other countries. Globally, as of 9:56 am CEST on 19 May 2020, there have been 4,696,849 confirmed cases of COVID-19, including 315,131 deaths, reported to Word Health Organization (WHO). The spread of COVID-19 overwhelmed the healthcare systems of many countries and even crashed the fragile healthcare systems of some. Although the situation in each country is different, health workers play a critical role in the fight against COVID-19. In this review, we highlight the status of health worker infections in China and other countries, especially the causes of infection in China and the standardised protocol to protect health workers from the perspective of an anaesthesiologist, in the hope of providing references to reduce medical infections and contain the COVID-19 epidemic.

Aims . Ischemic postconditioning (IPO) has a strong protective effect against intestinal ischemia-reperfusion (IIR) injury that is partly related to autophagy. However, the precise mechanisms involved are unknown. Methods . C57BL/6J mice were subjected to unilateral IIR with or without IPO. After 45 min ischemia and 120 min reperfusion, intestinal tissues and blood were collected for examination. HE staining and Chiu’s score were used to evaluate pathologic injury. We test markers of intestinal barrier function and oxidative stress. Finally, we used WB to detect the expression of key proteins of autophagy and the Akt/GSK-3 β /Nrf2 pathway. Results . IPO significantly attenuated IIR injury. Expression levels of LC3 II/I, Beclin-1, and p62 were altered during IIR, indicating that IPO enhanced autophagy. IPO also activated Akt, inhibited GSK-3 β , induced Nrf2 nuclear translocation, and upregulated HO-1 and NQO1 expression, thus providing protective effects against IIR injury by suppressing oxidative stress. Consistently, the beneficial effects of IPO were abolished by pretreatment with 3-methyladenine, SC66, and brusatol, potent inhibitors of autophagy, Akt, and Nrf2, respectively. Conclusion . Our study indicates that IPO can ameliorate IIR injury by evoking autophagy, activating Akt, inactivating GSK-3 β , and activating Nrf2. These findings may provide novel insights for the alleviation of IIR injury.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused great public concern worldwide due to its high rates of infectivity and pathogenicity. The Chinese government responded in a timely manner, alleviated the dilemma, achieved a huge victory and lockdown has now been lifted in Wuhan. However, the outbreak has occurred in more than 200 other countries. Globally, as of 9:56 am CEST on 19 May 2020, there have been 4,696,849 confirmed cases of COVID-19, including 315,131 deaths, reported to Word Health Organization (WHO). The spread of COVID-19 overwhelmed the healthcare systems of many countries and even crashed the fragile healthcare systems of some. Although the situation in each country is different, health workers play a critical role in the fight against COVID-19. In this review, we highlight the status of health worker infections in China and other countries, especially the causes of infection in China and the standardised protocol to protect health workers from the perspective of an anaesthesiologist, in the hope of providing references to reduce medical infections and contain the COVID-19 epidemic.

Background and objectives: Dexmedetomidine has demonstrated protective effects against lung injury in vitro. Here, we investigated whether dexmedetomidine preconditioning protected against lung injury in hemorrhagic shock rats. Methods: Male Sprague-Dawley rats were randomly divided into four groups (n = 8): control group, hemorrhagic shock group, 5 ug.kg(-1) dexmedetomidine (DEX1) group, and 10 ug.kg(-1) dexmedetomidine (DEX2) group. Saline or dexmedetomidine were administered over 20 min. 30 min after injection, hemorrhage was initiated in the hemorrhagic shock, DEX1 and DEX2 group. Four hours after resuscitation, protein and cellular content in bronchoalveolar lavage fluid, and the lung histopathology were measured. The malondialdehyde, superoxide dismutase, Bcl-2, Bax and caspase-3 were also tested in the lung tissue. Results: Compare with hemorrhagic shock group, 5 ug.kg(-1) dexmedetomidine pretreatment reduced the apoptosis (2.25 +/- 0.24 vs. 4.12 +/- 0.42%, p < 0.05), histological score (1.06 +/- 0.12 vs. 1.68 +/- 0.15, p < 0.05) and protein (1.92 +/- 0.38 vs. 3.95 +/- 0.42 mg.mL(-1), p < 0.05) and WBC (0.42 +/- 0.11 vs. 0.92 +/- 0.13 x 10(9)/L, p < 0.05) in bronchoalveolar lavage fluid. Which is correlated with increased superoxide dismutase activity (8.35 +/- 0.68 vs. 4.73 +/- 0.44 U.m(-1) protein, p < 0.05) and decreased malondialdehyde (2.18 +/- 0.19 vs. 3.28 +/- 0.27 nmoL.m(-1) protein, p < 0.05). Dexmedetomidine preconditioning also increased the Bcl-2 level (0.55 +/- 0.04 vs. 0.34 +/- 0.05, p < 0.05) and decreased the level of Bax (0.46 +/- 0.03 vs. 0.68 +/- 0.04, p < 0.05), caspase-3 (0.49 +/- 0.03 vs. 0.69 +/- 0.04, p < 0.05). However, we did not observe any difference between the DEX1 and DEX2 groups for these (p > 0.05). Conclusion: Dexmedetomidine preconditioning has a protective effect against lung injury caused by hemorrhagic shock in rats. The potential mechanisms involved are the inhibition of cell death and improvement of antioxidation. But did not show a dose-dependent effect. (C) 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.

BACKGROUND AND OBJECTIVES:Dexmedetomidine has demonstrated protective effects against lung injury in vitro. Here, we investigated whether dexmedetomidine preconditioning protected against lung injury in hemorrhagic shock rats. METHODS:Male Sprague-Dawley rats were randomly divided into four groups (n=8): control group, hemorrhagic shock group, 5ug.kg-1 dexmedetomidine (DEX1) group, and 10ug.kg-1 dexmedetomidine (DEX2) group. Saline or dexmedetomidine were administered over 20min. 30min after injection, hemorrhage was initiated in the hemorrhagic shock, DEX1 and DEX2 group. Four hours after resuscitation, protein and cellular content in bronchoalveolar lavage fluid, and the lung histopathology were measured. The malondialdehyde, superoxide dismutase, Bcl-2, Bax and caspase-3 were also tested in the lung tissue. RESULTS:Compare with hemorrhagic shock group, 5ug.kg-1 dexmedetomidine pretreatment reduced the apoptosis (2.25±0.24 vs. 4.12±0.42%, p<0.05), histological score (1.06±0.12 vs. 1.68±0.15, p<0.05) and protein (1.92±0.38 vs. 3.95±0.42mg.mL-1, p<0.05) and WBC (0.42±0.11 vs. 0.92±0.13×109/L, p<0.05) in bronchoalveolar lavage fluid. Which is correlated with increased superoxide dismutase activity (8.35±0.68 vs. 4.73±0.44U.mg-1 protein, p<0.05) and decreased malondialdehyde (2.18±0.19 vs. 3.28±0.27nmoL.mg-1 protein, p<0.05). Dexmedetomidine preconditioning also increased the Bcl-2 level (0.55±0.04 vs. 0.34±0.05, p<0.05) and decreased the level of Bax (0.46±0.03 vs. 0.68±0.04, p<0.05), caspase-3 (0.49±0.03 vs. 0.69±0.04, p<0.05). However, we did not observe any difference between the DEX1 and DEX2 groups for these (p>0.05). CONCLUSION:Dexmedetomidine preconditioning has a protective effect against lung injury caused by hemorrhagic shock in rats. The potential mechanisms involved are the inhibition of cell death and improvement of antioxidation. But did not show a dose-dependent effect.

Objective:To investigate the protective effect of myocardial ischemic postconditioning (IPO) on acute lung injury induced by myocardial ischemia-reperfusion in rats.Methods:A total of 36 healthy male SD rats were randomly divided into 3 groups:sham operation group (S group),ischemia-reperfusion group (I/R group),ischemic postconditioning +-ischemia-reperfusion group (IPO group).The rats model of myocardial ischemia-reperfusion and ischemic postconditioning were adopted.Blood samples were collected by carotid artery after 2 h reperfusion,the lung tissue were collected after rats were sacrificed,pulmonary microvascular permeability and assessment of pulmonary edema were detected to evaluate the lung function.Lung tissue sections were taken for light microscopic observation.TNF-α,IL-1β and IL-10 content in the serum and lung were measured.Results:In comparison with that in S group,lung tissue injury in I/R group was more severe under light microscope (P＜0.05).The mean wet/dry weight ratio and permeation index of lung in I/R group were significantly higher than those in S group (P＜0.05).The expression of TNF-α and IL-1β in I/R group were significantly increaced than those in S group (P＜0.05),while the expression of IL-10 in I/R group was decreased than that in S group (P＜0.05).After myocardial IPO,the degree of lung tissue injury had been reduced as compared with that in I/R group(P＜0.05),the mean wet/dry weight ratio and permeation index of lung were remarkably lower than those in I/R group (P＜0.05).The expressions of TNF-α and IL-1β in IPO group were definitely decreased than those in I/R group (P＜0.05),while the expression of IL-10 was increased (P＜0.05).The changes of TNF-α,IL-1β and IL-10 in the serum were consistent with those expression in lung tissue.Conclusion:Rhythmic stimulation of ischemic postconditioning attenuates acute lung injury induced by myocardial ischemia-reperfusion.The protective mechanism may be related to the regulation of anti-inflammatory/proinflammatory balance.

目的:探讨抑制CD36过表达在糖尿病大鼠心肌缺血/再灌注损伤中的作用和机制.方法:成年雄性健康大鼠,体重210-240 g.大鼠糖尿病模型采取腹腔注射1％链脲佐菌素60mg/kg制备.大鼠冠状动脉左前降支分结扎30 min后再灌注2h来制备心肌缺血/再灌注模型.正常大鼠和造模成功的糖尿病大鼠被分为3组(n=16):非糖尿病心肌缺血/再灌注组(IR组)、糖尿病心肌缺血/再灌注组(DIR组),CD36的抑制剂SSO处理的糖尿病心肌缺血/再灌注组(DIRS组).再灌注结束,获取心肌组织和血样本.Western Blot法检测心肌CD36表达,TTC法检测心肌梗死面积,HE染色观察心肌组织病理变化,检测血糖,血清中胰岛素、甘油三酯(TGs)和游离脂肪酸(FFAs).检测血清15-F2t-isoprostane、LDH、CK-MB及BNP.结果:DIR组的心肌CD36表达明显高于IR组而低于DIRS组(P＜0.05),DIRS组的心肌缺血面积和梗死面积均减少(P＜0.05);DIR和DIRS组糖尿病大鼠的胰岛素、TGs和FFAs的浓度均高于非糖尿病大鼠IR组(P＜0.05),SSO处理的大鼠血清中胰岛素、TGs和FFAs的浓度均有不同程度下降(P＜0.05).DIR组的15-F2t-isoprostane、LDH、CK-MB和BNP浓度均高于IR组(P＜0.05),而经SSO处理后,DIRS组这些指标的浓度均有所下降(P＜0.05).结论:SSO部分抑制CD36过表达,减轻了糖尿病大鼠心肌缺血/再灌注损伤.

Objective:To evaluate the efficacy and safety of different single loading doses of dexmedetomidine (DEX) on early emergence agitation (EA) for patients with obstructive sleep apnea hypopnea syndrome (OSAHS) after uvulopalatopharyngoplasty (UPPp) sugery.Methods:Ninety patients aged 30-60 years with moderate-severe OSAHS undergoing selective UPPP sugery under general anesthesia were randomly divided into three groups as follows:control group (group A),low dose dexmedetomidine group (group B) and high dose dexmedetomidine group (group C).Before anesthesia induction,patients in group C and group B received pumping injection of DEX at a single loading dose of 0.4 μg/kg or 0.8 μg/kg in 20 min.HR,SpO2 and NIBP were monitored in all patients in the operation room and PACU.The Riker Sedation-Agitation Scale (SAS),Visual Analogue Scale(VAS) and Ramsay Sedation Score(RSS) were also recorded in PACU for every 10 min.Results:There was a significant difference in SAS and VAS among the three groups at the time of extubation (To) (P＜0.05),the difference in RSS between group A and group C was statistically significant (P＜0.05),the SAS in group B at To,T1,T2,and T3 were lower than those in group A (P＜0.05).Compared with group A,the SAS were decreased at all the other timepoints except T6 in group C (P＜0.05).The VAS in group A were significantly higher from T2to T6 than that in To (P＜0.05),while the VAS in group A at T1 were definitely lower than that in group A,the RSS in group C were significantly higher from T2 to T6 than that at To (P＜0.05).Conclusion:DEX can effectively prevent the incidence of early emergence agitation in patients undergoing UPPP surgery in a dose dependent manner.

Ischemic stroke is a common disease ,which leads to ischemia and hypoxia of the brain tissue ,thus producing neurological deficits .To restore the blood supply as soon as possible to the ischemic area is essential to the recovery of neu -rological function after ischemia .Despite having been studied for decades , there is still no particularly good treatment strategy.IL-4 is a pleiotropic cytokine ,which can promote the angiogenesis after stroke by regulating microglial cells /macro-phages ,mediating macrophages to form vascular mimicry channels and inhibiting autophagy ,so as to restore the blood flow of the infarcted area,reduce the area of cerebral infarction ,reconstruct the neural structure ,and restore the nerve functions to different degrees .

The aim of the present study was to evaluate the safety and efficacy of various general anesthesia regimens during endoscopic variceal ligation (EVL) and endoscopic variceal sclerotherapy (EVS). A total of 123 patients with American Society of Anesthesiologists physical status III and IV, aged 40-70 years, undergoing general anesthesia for EVL and EVS were randomly divided into two groups: Sevoflurane anesthesia (group S; n=60) and propofol anesthesia (group P; n=60). Vital signs, particularly heart rate (HR) and mean arterial pressure (MAP), were monitored. The designated time points were as follows: 5 min before induction (T0), and 1, 5, 10, 15, 20, 25 and 30 min after intubation (T1, T2, T3, T4, T5, T6 and T7, respectively). Time intervals were recorded, including recovery time and extubation time. Following surgery, the observer recorded the Ramsay sedation scale (RSS) score and the visual analogue scale (VAS) score. Adverse reactions were noted. Results demonstrated that there were significant differences in MAP between the two groups at T2, T3, T5, T6 and T7 (P<0.05). There was a significant difference in HR between the two groups at T2, T3 and T4 (P<0.05). Recovery time and extubation time in group P were significantly longer than those in group S (P<0.05; 18.38±2.25 min vs. 14.57±1.04 min and 21.70±2.70 min vs. 15.83±0.88 min, respectively). The rate of ephedrine injected was 58.3% (35/60 patients) in group P vs. 28.3% (17/60 patients) in group S (P<0.05). There was a significant difference in the RSS score between the two groups 5 min after extubation (P<0.05). VRS scores demonstrated that anesthetists and patients were significantly more satisfied with the procedure in group S than in group P (P<0.01). In conclusion, the superiority and special clinical value of inhalational anesthesia has been demonstrated during EVL and EVS attributed to stable hemodynamics and high quality of anesthesia recovery in the present study.

Intestinal ischemia/reperfusion (IIR) is a common pathological event associated with intestinal injury and apoptosis with high mortality. Nuclear factor (NF)-E2-related factor-2 (Nrf2) is a key transcription factor that interacts with NF-κB and has a vital anti-inflammatory effect. However, whether Nrf2 has a role in IIR-induced apoptosis and the possible underlining mechanisms, such as modulation of the inflammation regulation pathway, have remained to be fully elucidated. In the present study, IIR was identified to cause significant intestinal injury and apoptosis, with high expression levels of inflammatory cytokines, as well as the apoptotic proteins B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax) and caspase-3, while simultaneously decreasing the protein levels of Bcl-2. The effect was more pronounced after pretreatment of the animals with all-trans retinoic acid or brusatol, potent inhibitors of Nrf2. t-Butylhydroquinone, an Nrf2 activator, significantly attenuated IIR-induced intestinal injury and apoptosis, with inhibition of the overexpression of the inflammatory cytokines, Bax and caspase-3 protein and partial restoration of Bcl-2 protein expression. Taken together, these results indicated that increased Nrf2 expression reduced IIR-induced intestinal apoptosis and that the protective function of Nrf2 may be based on its anti-inflammatory effects through the inhibition of the NF-κB pathway.

Objective:To evaluate the feasibility of ultrasound-guided peripheral arterial puncture combined with the outer guidewire arterial puncture,and to investigate its safety and prognosis.Methods:A total of 306 cases who need invasive arterial monitoring were randomly divided into three groups:Group A used the traditional puncturing method,Group B were guided by ultrasound,and Group C were guided by guidewire.The puncturing times and duration,first puncture successful rate,total successful rate,and complications were compared.All the failed cases (Group D) after pucturing received combined ultrasound and guidewire method,and the above results were recorded.Results:Group C showed the highest successful puncture rate and fewest pucturing time in the three groups(P＜0.05).The success rate of the first puncture and total puncture were significantly increased in D group as 77.8％ and 97.2％ respectively.Conclusion:Ultrasound technology combined with ultra guidewire arterial puncture can lead to higher success rate,and which is also one of remedy directly after radial artery puncture failure.

Objective To investigate the signs of color doppler ultrasonography in the diagnosis of radial head subluxation in children and evaluate the value of color doppler ultrasound in the diagnosis of radial head subluxation in children in the diagnosis of radial head subluxation.Methods Retrospectively analyse of color doppler ultrasound image of 42 children with radial head subluxation.The results were compared with X-ray and the color doppler ultrasonography of contralateral elbow.Results Annular ligament incarcerated in the humeroradial joint was observed on the color doppler ultrasonography clearly which can provide guidance for reset.The diagnostic coincidence rate was 100％.Conclusion Color doppler ultrasound has an important clinical value in the diagnosis of the radial head subluxation,which provided a safe and reliable method for the diagnosis of radial head subluxation.