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ABSTRACT: A multicenter population pharmacokinetics study of propofol was performed to establish a new population model.
Three thousand two hundred and fifty-nine blood samples of 220 participants were measured by HPLC-UV or HPLC-FLU or GC-MS. Target-controlled infusion after single bolus or continuous infusion was applied for propofol anesthesia. The samples were taken from 2 to 1500 min. The concentration-time profiles were analyzed by nonlinear mixed effect model (NONMEM) with first order estimation method. The inter-individual variability and the residual variability were described by exponential model and constant coefficient variation model. The stepwise modeling strategy using PsN was applied for covariate modeling. The criteria of forward addition and backward elimination were (α = 0.01 and α = 0.005, χ(2), df = 1). The final model was evaluated by bootstrap using PDx and visual predictive check using PsN. 500 bootstraps and 1000 simulation were run.
The propofol population model was described by 3-compartment model with inter-individual variability of CL, V(1), Q(2,) and Q(3) describing by exponential model. The inter-individual variability of V(2), V(3) were not included because it is reported that the parameter was near its boundary. The typical value of CL, V1, Q2, V2, Q3 and V3 were 1.28 L · min(-1), 10.1 × (age/44)-0.465 × (1 + 0.352 × sex) L, 0.819 L · min(-1), 36.0 L, 0.405 × (bodyweight/60)1.58 L · min(-1) and 272 L, respectively. Coefficients of inter-individual variability of CL, V1, Q2 and Q3 were 30.5%, 35.6%, 43.7% and 66.9%, respectively, and the coefficients of variation of HPLC-UV, GC-MS and HPLC-FLU were 13.3%, 16.9% and 24.2%, respectively. The bootstrap evaluation showed that the final model parameter estimates were within ± 3.39% compared with bootstrap median. The curves of observations percentiles were distributed within the corresponding 95 prediction percentiles by the visual predictive check.
The three-compartment model with first-order elimination could describe the pharmacokinetics of propofol fairly well. The involved fixed effects are age, body weight and sex. The population model was evaluated to be stable by bootstrap and visual predictive check.
Indian Journal of Pharmacology 05/2012; 44(3):393-7. · 0.27 Impact Factor
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ABSTRACT: Craniopharyngiomas are the commonest benign histological tumours to involve the hypothalamo-pituitary region in childhood. Cystic craniopharyngiomas occur in more than 90% of tumours. The optimal treatment of cystic craniopharyngioma remains controversial. Radical resection is the treatment of choice in patients with favourable tumour localization. When the tumour localization is unfavourable, a gross-total or partial resection followed by radiotherapy is the main treatment option in adults. However, it presents risk of morbidity especially for children. Intracystic bleomycin has been utilized to potentially delay the use of radiotherapy or radical resection to decrease morbidity.
To determine the benefits and harms of intracystic bleomycin versus other treatments for cystic craniopharyngiomas in children.
We searched the electronic databases of CENTRAL (The Cochrane Library 2010, Issue 4), MEDLINE/PubMed (from 1966 to Oct 2010), and EMBASE/Ovid (from 1980 to Oct 2010) with pre-specified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases.
Randomised controlled trials (RCTs) quasi-randomised trials or controlled clinical trials (CCTs) comparing intracystic bleomycin and other treatments for cystic craniopharyngiomas in children (from birth to 18 years).
Two review authors independently performed the data extraction and the 'Risk of bias' assessment. We used risk ratio (RR) for binary data and mean difference (MD) for continuous data. We planned that if one of the treatment groups experienced no events and there was only one study available for the outcome, we would use the Fischer's exact test.
We could not identify any studies in which the only difference between the treatment groups was the use of intracystic bleomycin. We did identify a RCT comparing intracystic bleomycin with intracystic (32)P (n = 7 children). The trial had a high risk of bias. Survival could not be evaluated. There was no evidence of a significant difference in cyst reduction (MD = -0.15, 95% confidence interval (CI) -0.69 to 0.39, P= 0.59), neurological status (Fisher's exact P = 0.429), 3rd nerve paralysis (Fischer's exact P = 1.00), fever (RR = 2.92, 95% CI 0.73 to 11.70, P = 0.13) and total adverse effects (RR = 1.75, 95% CI 0.68 to 4.53, P = 0.25 ) between the treatment groups. There was a significant difference in favour of the (32)P group for the occurrence of headache and vomiting (Fischer's exact P = 0.029 for both outcomes).
Since no RCTs, quasi-randomised trials or CCTs in which only the use of intracystic bleomycin differed between the treatment groups in the treatment of cystic craniopharyngiomas in children, no definitive conclusions could be made about the effects of intracystic bleomycin in these patients. Only one low-power RCT comparing intracystic bleomycin with intracystic (32)P treatment was available, but no definitive conclusions can be made about the effectiveness of these agents in children with cystic craniopharyngiomas. Based on the currently available evidence, we are not able to give recommendations for the use of intracystic bleomycin in the treatment of cystic craniopharyngiomas in children. High quality RCTs are needed.
Cochrane database of systematic reviews (Online) 01/2012; 4:CD008890. · 5.72 Impact Factor
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ABSTRACT: To investigate the clinical features and perioperational managements of craniophayngiomas located in posterior fossa.
Nine patients with craniopharyngioma situated in posterior fossa were included in the study. The clinical manifestations, neuroimage features, operational treatment, and perioperational managments were retrospectively analyzed. RESULTS; All tumors associated with big or huge volume, arised from sellar/suprasellar region and extended into posterior fossa. Tumors showed cystic lesions in 2 cases and cystic-solid lesions in 7 cases. Headache was the most common symptoms (6/9), followed by cranial nerve deficit (4/9) and endocrine dysfunction(3/9). The supra- and infra-tentorial approaches were the optimal approaches for removal these tumors (7/9). Cranial nerves deficit was the most common complication in perioperative period. No perioperational death occured, most of the patients showed good recovery during the fellow-up period.
Craniophayngiomas in posterior fossa shows different clinical manifestations, radiological features, surgical complications to the tumor in sellar/suprasellar region.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 09/2011; 42(5):730-2, 744.
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ABSTRACT: To compare the effects of gabapentin on high-voltage-activated calcium (HVA) current in dorsal root ganglion (DRG) neurons in normal and nerve-injured rats and understand the reasons of their differences.
Pathogen-free male SD rats (weight 180 - 220 mg) aged 4 - 6 weeks were used. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg. L(5) spinal nerve was ligated between DRG and sciatic nerve and cut distal to the ligature. The animals were decapitated at Day 14 post-operation. L(5) (SNL-L(5) group) and L(4) DRGs (SNL-L(4) group) were respectively isolated and the ganglionic neurons enzymatically dissociated. The control group of rats was not operated. The lumbar DRG neurons of normal rats were treated similarly. The HVA-Ca(2+) current was recorded by the technique of whole cell patch clamp.
Compared with the SNL-L(4) group [(16.0 ± 1.9)%, (26.9 ± 2.0)%, (27.4 ± 2.3)%] and the control group, gabapentin inhibited the peak calcium current highlier at 10, 100 and 300 µmol/L in the SNL-L(5) group [(18.5 ± 1.7)%, (32.0 ± 2.6)%, (32.7 ± 2.8)%] (P < 0.05). The steady-state inactivation curves shifted to more hyperpolarized potentials in the SNL-L(5) group. The N-type relative contribution to the gabapentin-sensitive HVA-Ca(2+) current was markedly elevated in the SNL-L(5) group compared with that in other two groups (P < 0.05).
Gabapentin enhances the inhibition of HVA-Ca(2+) current in injured DRG neurons following spinal nerve ligation in rats. The alteration in the activation of electrophysiological properties and the increase of N-type relative contribution to the total HVA-Ca(2+) current may be involved in the mechanism.
Zhonghua yi xue za zhi 06/2011; 91(24):1713-7.
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ABSTRACT: To establish the craniopharyngioma cell line with primary culture which might provide experiment background and evidence for future eternal tumor cell line establishment.
Thirty six surgical specimens were collected from patients with craniopharyngiomas definited by iconography and pathology examinations in West China Hospital, Sichuan University, including twenty one adamantine epitheliomas and fifteen squamous papillary tumors. The tumor cell was treated through primary cukture, purification, passage, freezing, resuscitation, and identified by keratin 7 staining through SP method. The growth curve and double time were detected through trypan blue dye cell count and MTT assay. The growth of the tumor cells treated with growth hormone (GH) and Tamoxifen was also observed.
Thirty six primary cultures were done, 29 of which were successful and subculture was achieved in 80.6% of all primary cultures. These cell lines were from squamous epithelium by keratin 7 antibody identification, with three days of double time. Proloferative effect of GH was most prevalent at 100 ng/mL, while tamoxifen suppressed cell growth.
The finite craniopharyngioma cell lines were obtained through primary culture.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 05/2011; 42(3):417-21.
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ABSTRACT: We aim to analyze clinical features of patients with craniocerebral trauma after 2008 Sichuan earthquake in China.
Medical records of patients with craniocerebral trauma admitted to Department of Neurosurgery in West China Hospital within 30 days after earthquake were retrospectively analyzed. Demographic data, clinical diagnosis, treatment, and prognosis were reviewed. Patients' data from peripheral hospitals were also analyzed.
Two hundred forty-two patients with craniocerebral injuries were included in the study. The male to female ratio was 1.3:1, and more than half of the patients were between 20 and 60 years. Majority of patients suffered from mild to moderate injuries (88.4%). Scalp wound was the leading type, followed by skull fractures and brain contusion and laceration. Fifty patients (20.7%) underwent craniotomy. Overall mortality was 5.4% (n = 13). In survivors, 186 patients had good outcome (Glasgow Outcome Scale score ≥4, 76.9%). Staphylococcus aureus (n = 74, 44.6%), Aerobacter cloacae (n = 37, 22.3%), and Staphylococcus epidermidis (n = 33, 19.9%) were most frequently isolated bacteria in wound smear. Over 85% (n=6) of patients with infectious wound (n=7) obtained delayed first stage healing. Mortality of patients in local hospitals ranged from 3.8% to 8.9%.
Most patients admitted to tertiary hospitals are mildly or moderately injured. Cooperation among different departments is critical to shorten delay in emergency room. First stage wound healing or delayed first stage healing can be achieved in most patients after treatment. More than 76% of seismic injury patients in a tertiary medical center have good outcome.
The Journal of trauma 01/2011; 70(6):E108-12. · 2.48 Impact Factor
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ABSTRACT: In order to successfully develop the effective population pharmacokinetic model to predict the concentration of propofol administrated intravenously, the data including the concentrations across both distribution and elimination phases from five hospitals were analyzed using nonlinear mixed effect model (NONMEM). Three-compartment pharmacokinetic model was applied while the exponential model was used to describe the inter-individual variability and constant coefficient model to the intra-individual variability, accordingly. Covariate effect including the body weight on the parameter CL, V1, Q2, V2, Q3 and V3 were investigated. The performance of final model was assessed by Bootstrapping, goodness-of-fit and visual predictive checking (VPC). The context-sensitive half-times and the infusion rates necessary to maintain the concentration of 1 microg x mL(-1) were simulated to six subpopulations. The results were as follows: the typical value of CL, V1, Q2, V2, Q3 and V3 were 0.965 x (1 + 0.401 x VESS) x (BW/59)(0.578) L x min(-1), 13.4 x (AGE/45)(-0.317) L, 0.659 x (1 + GENDER x 0.385) L x min(-1), 28.8 L, 0.575 x (1 + GENDER x 0.367) x (1 - 0.369 x VESS) L x min(-1) and 196 L respectively. Coefficients of the inter-individual variability of CL, V1, Q2, V2, Q3 and V3 were 29.2%, 46.9%, 35.2%, 40.4%, 67.0% and 49.9% respectively, and the coefficients of residual variability were 24.7%, 16.1% and 22.5%, the final model indicated a positive influence of a body weight on CL, and also that a negative correlation of age with V1. Q2 and Q3 in males were higher than those in females at 38.5% and 36.7%. The CL and Q3 were 40.1% increased and 36.9% decreased in arterial samples compared to those in venous samples. The determination coefficient of observations (DV)-individual predicted value (IPRED) by the final model was 0.91 which could predict the propofol concentration fairly well. The stability and the predictive performance were accepted by Bootstrapping, the goodness-of-fit and VPC. The context-sensitive half-times and infusion rates necessary to maintain the concentration of 1 microg x mL(-1) were different obviously among the 6 sub-populations obviously. The three-compartment model with first-order elimination could describe the pharmacokinetics of propofol fairly well. The involved fixed effects are age, body weight, gender and sampling site. The simulations in 6 subpopulations were available in clinical anesthesia. The propofol anesthesia monitor care could be improved by individualization of pharmacokinetic parameter estimated from the final model.
Yao xue xue bao = Acta pharmaceutica Sinica 12/2010; 45(12):1550-8.
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ABSTRACT: Giant schwannomas concomitantly involving the intracranial and nasal cavities are rare. We report a 22-year-old male patient with a giant schwannoma involving the frontal skull base and extending into the nasal cavity. The patient had a 2-year history of nasal obstruction that was originally misdiagnosed as nasal polyps. A CT scan and an MRI revealed a large cranionasal tumor. Surgery was performed using a coronal incision with a bilateral frontal skull base extradural approach. The tumor originated from the anterior skull base and the dura and nasal mucosa were intact. Histopathology was consistent with a schwannoma. Schwannoma should be listed as part of the differential diagnosis of a cranionasal tumor and the surgical approach should be carefully selected to achieve total resection.
Journal of Clinical Neuroscience 04/2010; 17(4):520-2. · 1.25 Impact Factor
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Journal of neurosurgical anesthesiology 09/2009; 22(1):81-2. · 2.41 Impact Factor
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ABSTRACT: To investigate the expression of three acid-sensing ion channel (ASIC) subtypes termed as ASIC1b, ASIC2a, and ASIC3 in the neurons of trapezoid body and lateral paragigantocellular nucleus of rat brainstem, and the effects of intermittent hypoxia on their expression.
The intermittent hypoxic rat model was established, of which the blood gas analysis was tested after 12 days. The immunohistochemistry SABC method was performed to test the expression of ASIC1b, ASIC2a, and ASIC3 in neurons of trapezoid body and lateral paragigantocellular nucleus in the control (O2) and intermittent hypoxic (IH) groups of rats.
The ASIC1b-, ASIC2a- and ASIC3-positive immunoreactive neurons all could be observed in the nucleus of trapezoid body and lateral paragigantocellular nucleus. The intermittent hypoxia group, the numerical density of ASIC1b-positive immunoreactive neurons (cell/mm3) decreased in the nucleus of trapezoid body (P<0.05), but did not significantly change in the lateral paragigantocellular nucleus (P>0.05), the grey level did not significantly change in both the nucleus of trapezoid body and lateral paragigantocellular nucleus (P>0.05); the numerical density of ASIC2a-positive immunoreactive neurons (cell/mm3) did not significantly change in the nucleus of trapezoid body and lateral paragigantocellular nucleus (P>0.05), the grey level in the nucleus of trapezoid body increased (P<0.05) while it did not significantly change in the lateral paragigantocellular nucleus (P>0.05); the numerical density of ASIC3-positive immunoreactive neurons (cell/mm3) decreased in the lateral paragigantocellular nucleus (P<0.05), but it did not significantly change in the nucleus of trapezoid body (P>0.05), the grey level did not significantly change in the nucleus of trapezoid body and lateral paragigantocellular nucleus (P>0.05).
The ASIC1b, ASIC2a, and ASIC3 exist in the neurons of trapezoid body and lateral paragigantocellular nucleus in the rat brainstem under normal condition, and their expressions in the two nuclei are different to intermittent hypoxia, which means that the roles of subtype of ASICs in different area may be different in the respiratory effects induced by hypoxia.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 07/2009; 40(4):662-6.
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ABSTRACT: The effect of recombinant human erythropoietin (rhEPO) on neuropathic pain remains unclear. This study aimed to determine the effects of preemptive administration of rhEPO on the behavioural changes and neuroinflammatory responses in a rat model of neuropathic pain.
Fifty rats were randomly allocated into five groups, sham-operation treated with saline and L5 spinal nerve transection treated with different doses of rhEPO (0 [saline], 1000, 3000, or 5000 U x kg(-1), respectively). The rats were intraperitoneally treated from 1 day before surgery to post-surgery day 7. The mechanical (paw pressure thresholds, PPT) and thermal thresholds (paw withdrawal latencies, PWL) were measured on post-surgery days 1, 3, and 7. The contralateral brain was obtained on post-surgery day 7 to determine the expressions of tumour necrosis factor (TNF-alpha), interleukin (IL)-1beta, IL-6, L-10, and nuclear factor-kappa B (NF-kappaB) activity.
There were significant decreases in PPT and PWL after L5 spinal nerve transection (P < 0.001). Compared with the saline group, the rhEPO 3000 and 5000 U x kg(-1) groups resulted in significant increases in PPT and PWL (P < 0.001) and reduced the cerebral expressions of TNF-alpha, IL-1beta, IL-6, and NF-kappaB activity associated with the increase in IL-10 (rhEPO3000 group, P < 0.05, and rhEPO5000 group, P < 0.001, respectively). Administration of rhEPO 1000 U x kg(-1) had no significant effects on these variables.
Preemptive rhEPO dose-dependently attenuated the mechanical and thermal hyperalgesia in L5 spinal nerve transection rats, which correlated with the decreased cerebral expressions of TNF-alpha, IL-1beta, and IL-6 via downregulating NF-kappaB activity and the increased expression of IL-10.
Canadian Anaesthetists? Society Journal 06/2009; 56(8):597-603. · 2.31 Impact Factor
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ABSTRACT: The experiments were carried out to test whether acid-sensing ion channel 1a and 3 (ASIC1a and ASIC3) were expressed on the primarily cultured type I cells of rat carotid bodies (CBs) and whether the expression of the channels was affected by acid stimulation. The Sprague-Dawley rats of either sex (50-100 g) were used. The CBs were isolated and primarily cultured. The immunofluorescent technique was used to detect the expression of tyrosine hydroxylase (TH), a specific marker of type I cells, in order to identify the type of the cultured cells. The double-label immunofluorescent technique was used to detect the expression of ASIC1a and ASIC3 on the TH-positive type I cells. To detect the influence of acid stimulation on the expressions of ASIC1a and ASIC3, each batch of primarily cultured cells were randomly divided into pH7.3 group (control group), pH6.8 group and pH6.2 group (n=9 in each group). The cells in above three groups were treated with pH7.3, pH6.8 and pH6.2 mediums for 24 h, respectively, and then the mRNA expressions of ASIC1a and ASIC3 in type I cells were detected by semi-quantitative RT-PCR technique. The results showed that more than 93% of the primarily cultured CB cells were TH-positive, indicating that most of the cultured cells were type I cells. Furthermore, all TH-positive cells expressed ASIC1a or ASIC3. After the cells were treated with acid stimulation, the amount of ASIC1a mRNA did not change significantly (P>0.05 vs control group); the amount of ASIC3 mRNA had no significant change in pH6.8 group compared with that in control group, but decreased significantly in pH6.2 group (P<0.01 vs control group, P<0.05 vs pH6.8 group). It is concluded that acid stimulation down-regulates the level of ASIC3 mRNA, but has no effect on the level of ASIC1a mRNA.
Sheng li xue bao: [Acta physiologica Sinica] 02/2009; 61(1):43-8.
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ABSTRACT: Morphology, immunocytochemistry, growth curve assay, and flow cytometry were used to investigate the effects of all-trans retinoic acid (RA) on cell proliferation, cell cycle progression and differentiation of the astrocytoma cell line SHG-44 from glioblastoma multiforme (World Health Organization grade IV). The differentially expressed genes from RA-treated and normal SHG-44 were identified by cDNA microarray after the cell line SHG-44 was treated with 10muM RA for 3 days. Validation of some differentially expressed genes was performed by Northern Blot analysis. The expression of glial fibrillary acidic protein (GFAP) was markedly increased in RA-treated SHG-44 cells. Other changes included a short shuttle shape, small nucleus, decreased karyoplasm proportion, the formation of increased thin cytoplasmic processes, reduced cell growth and a 15% increase in G0/G1 phase cell populations. In addition, 42 known genes were identified with altered expression in our cDNA microarray. There was stable down-regulation of MDM2 and UGB as well as overexpression of SOD2, CSTB, and G3BP when RA-treated SHG-44 was compared with normal SHG-44. RA simultaneously suppressed the proliferation of SHG-44 cells significantly as well as induced differentiation and altered gene expression.
Journal of Clinical Neuroscience 01/2009; 16(2):285-94. · 1.25 Impact Factor
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ABSTRACT: To investigate the effect of conjugated trienoic fatty acids on the growth inhibition, apoptosis in rat glioblastoma cells and to elucidate its mechanism of activity.
Rat glioblastoma cells were tested in vitro cytotoxicity, colony formation inhibition, Brdu incorporation after treatment with TCLA. Its effect of apoptosis induction was detected through Hoechst 33342 staining, cell cycle analysis. The expressions of ADPRTL1, CYP1A1 and PPAR-gamma genes were detected through RT-PCR.
After TCLA treatment, the proliferation of C6 cells were inhibited (40 micrommol/L, 72 h, viability 56.71% +/- 0.98%), this action acted as dose-time-dependent relations; colony formation decreased significantly (40 micrommol/L, 0) and BrdU labeling index of cancer cells decreased (63.1% +/- 1.0% vs 95.6 % +/- 1.4%); apoptotic cells increased; By FCM analysis, the apoptotic indices increased, the cells increased in G0/G1 phase, decreased in S phase, which have signigicant difference; RT-RCR showed that TCLA signigicantly increased the level of ADPRTL1, CYP1A1, and PPAR-gamma mRNA expression.
The findings in this experimental study suggested that TCLA has potent cytotoxicity and induction apoptosis in human and rat glioblastoma cells, its mechanism of activity might be associated with the inhibition of DNA synthesis, cell cycle arrest, up-regulation the expression of apoptosis related genes ADPRTL, CYP1A1, PPAR-gamma.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 08/2008; 39(4):570-4.
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ABSTRACT: To explore an effective microsurgical approach to the treatment of cranionasal tumors.
A retrospective review of 18 micro-neurosurgical patients with cranionasal tumors (June 2005 to June 2007) was undertaken.
All of the 18 patients were treated with subfrontal approaches in combination with transnasal endoscopy. Tumors were resected in the stage-one operations (14 were totally resected and 4 were subtotally resected). The anterior skull bases were reconstructed. Transient CSF rhinorrhea was found in two cases. All of the patients experienced good recoveries, with no operative death. The follow up after 5 to 29 months revealed that only four patients had tumor recurrence. Three patients lost in the follow up.
Subfrontal microsurgical operation combined with transnasal endoscopy is an effective approach to the treatment of cranionasal tumors. It enables high total resection rate and has low complications.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 06/2008; 39(3):489-91.
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ABSTRACT: A prospective controlled study was designed to observe the pharmacodynamics of rocuronium in cholestatic patients with or without hepatocellular injury.
Sixty patients undergoing abdominal surgery were allocated into three groups: group I had 20 cholestatic patients with hepatocellular injury; group II had 20 cholestatic patients without hepatocellular injury, and group III (control group) had 20 patients without hepatic disease. Anesthetized with propofol and fentanyl, all patients received rocuronium 0.6 mg/kg for initial dose followed by intermittent repeated administration of rocuronium 0.15 mg/kg. The twitch high of adductor pollicis muscle was monitored by acceleromyography. The onset time of the initial dose, the duration time of the initial and the repeated doses, and the recovery index were observed.
The onset and the duration time of the initial dose had no significant difference among the three groups (P<0.05). After administration of the 5th dose, the duration time of the repeated doses was significantly prolonged than that of the 2nd dose in group I (31+/-8 versus 22+/-4 min) and group II (28+/-5 versus 21+/-4 min) (P<0.05), but not in group III (P>0.05). The recovery index of rocuronium was longer in group I (48+/-13 min) and group II (46+/-9 min) than that in group III (24+/-5 min) (P<0.05).
Cholestatic patients experience prolonged duration time and longer recovery index after repeated use of rocuronium, despite normal onset time after the initial dose.
Journal of pharmacy & pharmaceutical sciences: a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques 02/2008; 11(3):15-21. · 1.65 Impact Factor
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ABSTRACT: Scalp infiltration with epinephrine-containing lidocaine solution can elicit significant hypotension before craniotomy under general anesthesia. A prospective randomized controlled study was designed to observe whether a lighter depth of general anesthesia could prevent the unintentional hypotension induced by the epinephrine scalp infiltration during neurosurgery or not. Fifty patients undergoing scheduled neurosurgery involving craniotomy were randomly allocated into 2 groups. After anesthesia induction, anesthesia was maintained with propofol 2 mug/mL and rimifentanil 2 ng/mL by target-controlled infusion in group 1, and propofol 4 microg/mL and rimifentanil 4 ng/mL in group 2 (control group), respectively. All the patients received epinephrine scalp infiltration with 1% lidocaine 16 mL containing epinephrine 5 microg/mL. Mean arterial pressure (MAP) and heart rate were recorded at 30-second interval from the baseline to 5 minutes after the beginning of local infiltration. Bispectral index readings indicated group 1 had the lighter general anesthesia than group 2 (P<0.05). MAP was higher (P<0.05) and heart rate was lower (P<0.05) at 1.5 minutes time point in group 1 than group 2. The mean percentage of maximal decrease in MAP was group 1 (13%) <group 2 (24%) (P<0.05). The mean percentage of maximal increase in MAP was group 1 (10%)> group 2 (4%) without significant difference (P>0.05). The results implied that keeping a lighter general anesthesia caused less decrease in arterial blood pressure and was a relative effective method to prevent hypotension episode induced by epinephrine scalp infiltration.
Journal of Neurosurgical Anesthesiology 10/2007; 19(4):263-7. · 2.23 Impact Factor
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ABSTRACT: To study the cardioprotective effects of recombinant human erythropoietin (rhEPO) on heart with ischemia-reperfusion (I-R) injury and the possible mechanism.
156 SD rats, except 36 in the sham operation group, underwent ligation of the left descending coronary artery for 30 minutes and then reperfusion for 3 hours. 108 rats were randomly divided into 3 equal groups IR + rhEPO group (Group C, intraperitoneally injected with rhEPO 5000 U/kg 24 h before IR insult), IR group (Group B), and sham-operation group (Group A). By the end of reperfusion blood sample were collected by cardiac puncture to detect the plasma content of MB isoenzyme of creatine kinase (CK-MB). Before ischemia, after ischemia, and 30, 60, 120, and 180 min after reperfusion the hearts of 6 rats from each group were killed respectively with their hearts taken out. Another 12 rats were randomly divided into Groups B and C as described above to undergo IR insult, and underwent re-ligation, intravenous injection of Evans blue and pathological examination to observe the area of infarct size. Another 18 rats were divided into 3 equal groups: Groups A, B, and C as described above, and then underwent electron microscopy to observe the ultrastructure of the myocardium. Furthermore, another 18 rats were divided into 3 equal groups: Groups A, B, and C as described above to undergo pathological examination of the heart and neutrophil infiltration. Tumor necrosis-alpha (TNF-alpha) and interleukin-6 (IL-6) concentrations of left ventricle were analyzed by ELISA 1 h and 2 h after reperfusion respectively; and nuclear factor-kappa B (NF-kappaB) and activator protein-1 (AP-1) levels were detected by electrophoretic mobility shift assay.
The ratio of infarct size to area at risk (IS%) of Group C was (28.0% +/- 1.3%), significantly lower than that of Group B [(43.3 +/- 2.5)%, P < 0.01]. The plasma CK-MB concentrations of Groups B and C were (2110 +/- 245) U/L and (1689 +/- 138) U/L respectively, both significantly higher than that of Group A [(933 +/- 88) U/L, both P < 0.01], however, the CK-MB level of Group C was significantly lower than that of Group B (P < 0.01). The pathological changes of Group C were remarkably milder than those of Group B. The semi-quantitative scale of Groups B and C were 3.65 +/- 0.51 and 2.37 +/- 0.49 respectively, both significantly higher than that of Group A (1.76 +/- 0.43), and the semi-quantitative scale of Groups C was significantly lower than that of Group B (P < 0.01). The degree of neutrophil infiltration of Group C was remarkably milder than that of Group B. In Group B there were 2 peaks of NF-kappaB expression: 30 min and 180 min after reperfusion, and the AP-1 expression increased 30 min after reperfusion and then gradually decreased. In Group C the expression levels of NF-kappaB and AP-1 increased 30 min after reperfusion in comparison with Group A, and then gradually decreased and were all significantly lower than those of Group B (all P < 0.01). The levels of TNF-alpha and IL-6 1 h after reperfusion of Groups B and C were all significantly higher than those of Group A (all P < 0.01) and the TNF-alpha and IL-6 of Group C were both significantly lower than those of Group B (both P < 0.01).
RhEPO pretreatment can elicit potent cardioprotection against I-R injury, which may due in part to the suppression of NF-kappaB and AP-1 activation and downregulation of the downstream proinflammatory cytokines.
Zhonghua yi xue za zhi 10/2007; 87(35):2463-7.
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Chinese medical journal 07/2007; 120(11):1027-8. · 0.86 Impact Factor
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ABSTRACT: To investigate the expression of minichromosome maintenance protein 6 (MCM6) in tissue sections of craniopharyngioma and observe its relation with the outcome of patients with craniopharyngiomas.
Prospective cohorts were composed of 32 adamantine epithelioma (AE) patients and 31 squamous papillary tumor (SP) patients. The average of follow-up phase was 84. 26 months, of 60 patients with craniopharyngioma, 20 suffered from recurrence and underwent operation again for removal of tumor, and the specimens of the tumors patients were collected. MCM6 as proliferative marker expression in the specimen sections was measured by immunohistochemical method (avidin-biotin-peroxidase); quantitatively, scoring for MCM6 protein variation was performed by TE2000-U inverted biological microscope and Image-Pro Plus professional image analysis software. Oncocyte proliferation potential was evaluated for inter-group comparison in three pair of groups, including AE/SP, recurrence/recurrence-free, and primary/relapse groups.
14 of 32 AE patients and 6 of 31 SP patients had recurrence during follow-up. MCM6 protein expression showed significant difference between AE/SP groups and between recurrence/recurrence-free groups (P < 0.05, two-tailed), but there was no statistically significant difference between primary and recurrent craniopharyngiomas.
The subtype and MCM6 protein expression in craniopharyngiomas are related to the prognosis of tumor and thus may be useful in predicting the risk of tumor relapse.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 02/2007; 38(1):64-7.
