球后阻滞是眼科手术中常见的麻醉方式之一,若操作不当,可造成严重并发症,包括局部麻醉药物的毒性反应等.现报告1例26岁诊断为"视网膜脱离"拟行眼底手术的女性患者,在球后阻滞10 min后,患者出现心率增快、血压升高后下降、吞咽困难、声音嘶哑、呼吸困难及SpO2下降,伴随对侧眼球运动障碍,全身肌力下降等临床表现.及时给予生命支持等对症处理后,患者上述临床表现好转,并随后在全身麻醉下完成手术.

OBJECTIVES:To evaluate the effect of anesthetic drugs on the expression of circadian gene Clock and Bmal1 in the brain of New Zealand rabbits, and to explore their change pattern. METHODS:A total of 90 New Zealand rabbits were randomly divided into 5 groups (n=18 in each group): A normal saline group (1 mL/h saline, group S), a propofol group [600 µg/(kg·min-1) propofol, 1 mL/h, group P], a 10% lipid group (1 mL/h lipid, group F), a dexmedetomidine group [1 µg/(kg·min-1) dexmedetomidine, 1 mL/h, group D), a sevoflurane (SEV) group (2.5% SEV, SEV group). Inhaled and intravenous anesthetic drugs were stopped after 24 h. Experimental animals were killed at 0, 24, and 72 h after anesthesia, and their brain tissues were isolated. Western blotting was performed to measure the Clock and Bmal1 protein expression in the brain of rabbits. RESULTS:At 0 and 24 h after anesthesia, compared with the group S, the levels of Clock and Bmal1 proteins were decreased significantly in the group P, the group D, and the group SEV (all P<0.05). At 72 h after anesthesia, compared with the group S, the levels of Clock and Bmal1 proteins showed no significant changes in the group P, the group D, and the SEV group (all P>0.05). Compared with the group S, the levels of Clock and Bmal1 proteins at all time points showed no significant changes in the group F (all P>0.05). CONCLUSIONS:Anesthetic SEV, propofol, and dexmedetomidine can inhibit the expression of clock gene Clock and Bmal1 protein in the brain fissues of the New Zealand rabbits, and the suppression effect continues for at least 24 h after anesthesia, whereas the suppression decreases significantly at 72 h after anesthesia.

Ethnopharmacological relevance: Scutellaria baicalensis georgi is one of the most widely studied TCMs; its effects in ALI have been studied in a large number of experiments, and the efficacy of volatile oil from TCM remains to be studied. Aim: The volatile component of Scutellaria baicalensis georgi was selected to act on the key target of acute lung injury and was preliminarily studied for its specific molecular mechanism. Methods: The volatile active substances of Scutellaria baicalensis georgi were extracted by GC–MS, and the active ingredients related with the occurrence and development of acute lung injury were searched and matched by the TCMSP database. The pharmacologic data and analysis platform of TCM were used to retrieve and screen for the volatile active components and the possible therapeutic targets of Scutellaria baicalensis georgi. In addition, acute lung injury was searched in the disease target database to identify the corresponding disease target proteins, thereby establishing a protein–protein interaction network. Finally, the effects of wogonin on the apoptotic and inflammatory factors in the acute lung injury cell model were analyzed experimentally. Results: We identified 100 candidate targets and successfully constructed a complex target network. The targets identified by the above gene enrichment analysis played important roles in the autoimmune disease cell cycle apoptosis and related signaling pathways. The KEGG pathway analysis showed that most of the target genes were involved in the inflammatory response regulation of the TRP, PI3K-Akt, and IL-17 signaling pathways. The participation of wogonin in the specific regulatory pathways of PI3K-Akt signaling and IL-17 signaling was verified through experiments. In the lung-injured cell model, the results showed that wogonin inhibited the apoptosis of injured lung cells by inhibiting the expression of BAD gene and the activation of cleaved caspase-3 gene while increasing Bcl-2 expression. In addition, wogonin inhibited the expression of the abovementioned inflammatory factors and further inhibited the inflammatory response in the lung injury cells. Conclusion: The results of pharmacological network analysis can predict and explain the regulation mechanism of multi-target and multi-pathway of TCM components. This study identified the potential target and important pathway of wogonin in regulating acute lung injury. At the same time, the accuracy of network pharmacological prediction is also preliminarily verified by molecular biology experiment.

目的 探讨线粒体动力相关蛋白1(Drp1)在大鼠术后认知功能障碍中的作用.方法 采用随机数表法将64只健康清洁级成年雄性SD大鼠分为生理盐水对照组(C组)、Drp1选择性抑制剂Mdivi-1腹腔注射组(M组)、手术组(O组)和Mdivi-1腹腔注射+手术组(MO组).M组和MO组腹腔注射Mdivi-1(50 mg/kg)0.5 mL,C组和O组腹腔注射0.5 mL生理盐水.分别于术前、术后第1日和术后第3日进行水迷宫测试,观察大鼠的游泳距离和逃避潜伏期.术后24 h处死大鼠,取海马组织,检测其中三磷酸腺苷(ATP)含量,用透射电镜观察线粒体分裂情况,用蛋白免疫印迹法检查线粒体电子传递链复合物I和V的表达.结果 与C组比较,O组线粒体过度分裂,线粒体电子传递链复合物I和V水平下降,ATP含量减少,O组术后第1日和第3日逃避潜伏期及游泳距离延长(P均<0.05).与O组比较,MO组线粒体分裂减少,线粒体电子传递链复合物I和V水平升高,ATP含量增多;O组术后第1日和第3日逃避潜伏期及游泳距离缩短(P均<0.05).结论 线粒体Drp1介导的线粒体过度分裂参与了术后认知功能障碍的发生过程.

目的 评价骨髓Sca-1间充质干细胞对肺移植后急性肺损伤中的影响.方法 成年SD大鼠24只,体质量250～300 g,采用随机数字表法分为3组.C组:空白对照组(n=8只),不做任何处理,仅做空白对照;M组(n=8只):模型组,SD大鼠行自体左肺原位移植术;B组(n=8只):模型+骨髓Sca-1间充质干细胞,SD大鼠行自体左肺原位移植术后,经尾静脉注射骨髓Sca-1间充质干细胞.术后48 h抽取大鼠动脉血,行动脉血气分析,然后处死大鼠,取肺部组织标本,进行含水率和病理学检测.采用ELISA法检测肺组织中H2O2、MDA、IL-6以及TNF-α水平,采用Western blot方法检测肺组织中Ⅱ型肺泡上皮细胞标志物SPB和气道黏膜上皮细胞标志物CC10的表达水平.结果 与C组比较,M组大鼠动脉血中氧分压降低,肺组织出血、充血严重,炎性细胞浸润增多,肺水肿严重.肺组织中H2O2、MDA、IL-6以及TNF-α浓度升高(P<0.05);Ⅱ型肺泡上皮细胞标志物SPB和气道黏膜上皮细胞标志物CC10的表达水平降低.与M组比较,B组大鼠动脉血中氧分压升高,肺组织出血、充血减轻,炎性细胞浸润减少,肺水肿减轻.肺组织中H2O2、MDA、IL-6以及TNF-α浓度降低(P<0.05);Ⅱ型肺泡上皮细胞标志物SPB和气道黏膜上皮细胞标志物CC10的表达水平升高.结论 骨髓Sca-1间充质干细胞可通过抑制炎性反应及氧化损伤、修复损伤的上皮细胞,改善肺功能,减轻肺移植后急性肺损伤.

ABSTRACT : Objective To explore the effect of ulinastatinon early postoperative cognitive function in elderly patients undergoing thoracic surgery. Methods Sixty patients aged 65‐75 years , scheduled for elective thoracic surgery were randomly allocated into aulinastatin group and a normal saline control group (n＝30) . In the ulinastatin group , ulinastatin was given intravenously before skin incision with the dose of 200 000 U , followed by continuous use for 3 days ,100 000 U／d. T he patients in the control group were given equal doses of normal saline at the same time points. T he blood from the bulb of the internal jugular vein was collected at 10 min (T0 ) before surgery and 1 h (T1 ) ,6 h (T2 ) ,24 h (T3 ) ,48 h (T4 ) and 72 h (T5 ) after surgery ,then the levels of S‐100β protein (S‐100β) and neuron specific enolization enzyme (NSE) in serum were determined. Montreal Cognitive Assessment scale (M oCA scale) was performed at 24 h before surgery ,72 h and 7 d after surgery ,and the incidence of early postoperative cognitive dysfunction (POCD ) was recorded. Results Compared with T 0 ,the levels of S‐100 beta [ (0.14 ± 0.03 ) μg／L vs. (4.89 ± 1.47) μg／L ,(0.14 ± 0.03 ) μg／L vs. (5.34 ± 1.33 ) μg／L ,(0.14 ± 0.03 ) μg／L vs. (5.92 ± 1.76 ) μg／L ,(0.14 ± 0.03 ) μg／L vs. (6.23 ± 2.0 ) μg／L ,(0.14 ± 0.03 ) μg／L vs. (6.89 ± 1.72) μg／L ,all P＜0.05] and NSE [(5.51 ± 2.40 ) μg／L vs. (15.33 ± 2.92 ) μg／L ,(5.51 ± 2.40) μg／L vs. (19.6 ± 3.49) μg／L ,(5.51 ± 2.40 ) μg／L vs. (22.30 ± 3.12 ) μg／L ,(5.51 ± 2.40 ) μg／L vs. (25.84 ± 4.03 ) μg／L ,(5.51 ± 2.40) μg／L vs. (28.63 ± 4.36 ) μg／L ,all P＜0.05 ] in the control group were increased from T1 to T5. Compared with T0 ,the levels of S‐100β [(0.13 ± 0.04 ) μg／L vs. (4.03 ± 1.32 ) μg／L , (0.13 ± 0.04 ) μg／L vs. (4.36 ± 1.54 ) μg／L ,(0.13 ± 0.04) μg／L vs. (4.74 ± 1.34) μg／L ,(0.13 ± 0.04 ) μg／L vs. (5.33 ± 1.66) μg／L ,(0.13 ± 0.04) μg／L vs. (5.82 ± 1.41) μg／L ,all P＜0.05] and NSE [ (6.12 ± 1.81 ) μg／L vs. (12.43 ± 2.22 ) μg／L ,(6.12 ± 1.81) μg／L vs. (17.15 ± 3.55 ) μg／L ,(6.12 ± 1.81 ) μg／L vs. (20.72 ± 4.02) μg／L ,(6.12 ± 1.81 ) μg／L vs. (23.13 ± 3.52 ) μg／L ,(6.12 ± 1.81 ) μg／L vs. (25.73 ± 3.75 ) μg／L , all P＜0.05] in the ulinastatingroup were higher from T 1 to T5. Compared with the control group ,the levels of S‐100β and NSE from T1 to T5 were lower ( P＜ 0.05 ) in the ulinastatin group. Compared with the control group ,the MoCA scale [(23.4 ± 1.2) score vs. (21.7 ± 1.4) score 72 h post surgery and (24.2 ± 1.1 ) score vs. (23.5 ± 1.3) score 7 d post surgery ,both P＜ 0.05 ] were higher ,w hile the incidence of POCD (13.3% vs. 36.7%, P＜0.05) was significantly lower in the ulinastatin group than those in the control group. Conclusions Preoperative administration of ulinastatin to elderly patients undergoing thoracotomy could alleviate brain damage and improve cognitive function ,there by decrease the incidence of early POCD.

Objective: To construct a regulatory network involved in acute lung injury, so as to provide a new theoretical basis and research ideas for studying the relationship between inflammatory factors and immune proteins to collectively regulate the occurrence of acute lung injury. Method: By using Meta-analysis, GO, KEGG and other methods notarized and constructed the regulatory network pathways of cytokine cascade and lung injury induced by LPS. Results: The result of Meta-analysis showed that the correlation between CD14, TNF-alpha, IL-6 gene and acute lung injury was statistically significant. GO analysis and KEGG analysis showed that acute lung injury contained CD14, TNF-alpha, IL-6 and other involved factors in the induced process of LPS, these inflammatory factors and immune proteins jointly regulate the process of disease development. Conclusion: CD14 receptor is an important receptor involved in mediating LPS-activated cells, and is a high-affinity LPS receptor. LPS stimulates inflammatory effector cells to bind to LPS receptor- CD14 to activate intracellular signal cascade. Direct or indirect involvement of pathogenic factors enable cytokine caused by induction form a particularly complex network of cytokine regulatory pathways, of which the inflammatory factors TNF-alpha and IL-6 are simultaneously involved in LPS-mediated and CD14-mediated cytokine cascades. (C) 2019 Production and hosting by Elsevier B.V.

OBJECTIVE:To evaluate the change of sleep-wake rhythm after extracorporeal circulation (ECC) in New Zealand rabbits, and to explore the role of clock genes in sleep-wake rhythm disorder by ECC.
 Methods: A total of 54 New Zealand rabbits were randomly divided into 3 groups: a normal group (Group N), a sham group (Group S) and a model group (Group ECC). Electrocorticogram (ECOG), electroophthalmogram (EOG) and electromyogram (EMG) were respectively recorded by multipurpose EEG recorder, and the sleep-wake rhythm was also recorded. The mRNA and protein expressions of period1 (Per1) and cryptochrome1 (Cry1) were detected by semi-quantitative reverse transcriptase PCR (RT-PCR) and Western blot in pineal gland of rabbits. The differences between the 3 groups were compared.
 Results: 1) Compared with the Group N and Group S at 24, 48 h respectively, the total amount of sleep (TAS), light time, slow wave sleep (SWS) in the Group ECC at 24, 48 h were significantly reduced (all P<0.05), and the proportion of light sleep increased (all P<0.05), the proportion of SWS decreased (all P<0.05); 2) Compared with the Group N and Group S, the expression of Per1 mRNA in the Group ECC at 24, 48 h and Cry1 mRNA at 24 h significantly increased (all P<0.05); 3) Compared with the Group N and Group S, the expression of Per1 protein in the Group ECC at 48 h and Cry1 protein at 24 h significantly increased (all P<0.05); 4) In the Group ECC, the sleep-wake rhythm disorder and clock genes expression were ameliorated at 72 h after surgery.
 Conclusion: ECC can cause sleep-wake rhythm disorder in New Zealand rabbits, which may be related to the abnormal expression of Per1 and Cry1, and their transcription proteins.

Objective To discuss the influence and mechanism of Oxycodone on acute lung injury following one-lung ventilation in rats.Methods Thirty-two adult male Sprangue-Dawley rats were randomly divided into four groups: control group, model group, saline group and Oxycodone group, with 8 rats each group.Acute lung injury model was esteblished with deep intubation;the water content in lung tissue was determined through taking the upper lobe of left lung;HE was stained through taking the lower lobe of left lurg to abserve the pathological changes of lung tissue;inflammatory facotr, interleukine-6, interleukin-1β and tumor necrosis facotr-α were measured with anzyme linked immunosorbent assay.Results After HE staining, in control group, there was no obvious pathological change of lung tissue, occasionally there were inflammatory cells and exudates.In model group and saline group, there were a large number of inflammatory cell infiltration and alveolar exudates.Pulmonary interstitial was obviously hyperemia and hemorrhage.However, in Oxycodone Group, the pathological change of lung tissue were relieved significantly.Compared with control Group, in model Group and saline Group, the content of lung water increased significantly (P<0.05);lung tissue pathological score increased significantly (P<0.05);the content of IL-6,IL-1β and TNF-α in lung tissue increased significantly (P<0.05).Compared with model Group, in Oxycodone Group, the content of lung water decreased significantly (P<0.05);lung tissue pathological score decreased significantly (P<0.05);the content of IL-6,IL-1βand TNF-α in lung tissue decreased significantly (P<0.05).Conclusion Oxycodone can alleviate acute lung injury induced by OLV, and the mechanism may be in evolve inhibition of inflammatory reaction.

Neuropathic pain is caused by dysfunction or primary injury of the somatosensory nervous system. Long noncoding RNAs (lncRNAs) play important roles in the development of neuropathic pain. However, the effects of lncRNA colon cancer associated transcript-1 (CCAT1) in neuropathic pain have not been reported. The model of bilateral sciatic nerve chronic constriction injuries (bCCI) is regarded as long-lasting mechanical hypersensitivity and cold allodynia, which is the representative symptom in the human subjects suffering from the neuropathic pain. In this study, we found that CCAT1 expression was decreased in the spinal dorsal horn, dorsal root ganglion (DRG), hippocampus, and anterior cingulate cortex (ACC) of rats with bCCI. The rats of bCCI presented the cold allodynia after the 14th day of postoperation. We furtherly showed that lncRNA CCAT1 decreased miR-155 expression and enhanced Serum and glucocorticoid regulated protein kinase 3 (SGK3) expression in the NGF-differentiated PC12 cell. We found that miR-155 expression was increased in the spinal dorsal horn, DRG, hippocampus, and ACC of rats with bCCI injuries. However, SGK3 expression was downregulated in the spinal dorsal horn, DRG, hippocampus, and ACC of rats with bCCI injuries. Moreover, lncRNA CCAT1 overexpression could alleviate the pain thresholds and inhibited expression of SGK3 could rescue this effect. In conclusion, these results suggested the crucial roles of CCAT1 and SGK3 in the neuropathic pain.

Objective To evaluate the effect of tranexamic acid on the risk of venous thrombosis after operation in patients undergoing revision total hip arthroplasty.Methods Fifty-six ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 35-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective revision total hip arthroplasty,were randomly divided into 2 groups (n =28 each):control group (group C) and tranexamic acid group (group T).After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After intubation,tranexamic acid 15 mg/kg was injected intravenously followed by infusion at a rate of 10 mg·kg-1 ·h-1 in group T,while the equal volume of normal saline was given instead of tranexamic acid in group C.Before operation,at the end of operation,and at 6 and 24 h after operation,venous blood samples were obtained for routine blood test and for determination of parameters of coagulation.The intraoperative blood loss and blood salvage,volume of drainage within 24 h after operation and transfusion of allogeneic blood were recorded.The development of venous thrombosis in the lower extremity was recorded with Doppler ultrasound on 7th day after operation.Results Compared with group C,the intraoperative blood loss and blood salvage,volume of drainage within 24 h after operation and transfusion of allogeneic blood were significantly reduced,and hemoglobin and hematocrit were increased at the end of operation and different time points after operation (P ＜ 0.05),and no significant changes were found in activated partial thromboplastin time,prothrombin time and fibrinogen in group T (P ＞ 0.05).The incidence of venous thrombosis in the lower extremity was 18％ and 14％ in C and T groups,respectively,and there was no significant difference between the two groups (P ＞ 0.05).Conclusion Tanexamic acid infused at a rate of 10 mg· kg-1 · h-1 after a loading dose of 15 mg/kg injected during operation dose not increase the risk of venous thrombosis after operation in patients undergoing revision total hip arthroplasty.

目的探讨顽固性心跳停止患者持续进行体外膜肺氧合法生命支持后,安装人工心室辅助循环装置(VAD)对患者预后及并发症的影响。方法 6例顽固性心跳停止患者于腹部安装MEDOS型的人工气动体外心脏泵,2例在体外循环下安装,4例在体外膜肺氧合下完成。在实施人工心室辅助循环装置前行挠动脉置管监测平均动脉压(MAP),并放置Swan-Ganz导管监测血流动力学变化。记录实施VAD前及实施后7、14 d的MAP、心脏指数(CI)、中心静脉压(CVP),并抽取静脉血检测尿素氮(BUN)及肌酐(Cr),比较前后血流动力学及肾功能变化。结果 6例中,4例存活,2例分别于1、2 d时死亡。4例存活患者在实施VAD后7、14 d时MAP、CI升至正常范围,CVP、BUN及Cr基本降至正常范围。结论顽固性心跳停止需长时间辅助循环或等待心脏移植的患者,人工血泵心室辅助循环取代体外膜肺氧合法是合适的选择。