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Abstract: Objective: To explore protective effects of electroacupuncture at “Nèiguān” (▪ PC 6) for preconditioning on myocardial ischemia-reperfusion injury (MIRI) and the mechanisms involved. Methods: Forty-eight male Wistar rats were randomly divided into a sham operation group (Group N), a MIRI group (Group M) and an electroacupuncture (EA) group (Group E). The MIRI model was established by ligating the left anterior descending artery (LAD) for 30 min followed by reperfusion for 120 min. Partition sutures were passed under LAD without ligation for rats in Group N. Rats in Group E were pretreated with electroacupuncture (EA) applied at bilateral “Nèiguān” (▪ PC 6) for 20 min once a day for 3 consecutive days before ischemia. The infarct size plus the area at risk was evaluated by 2,3,5-triphenyltetrazolium chloride staining, and serum isoenzyme of creatine kinase (CK-MB) and lactate dehydrogenase (LDH) levels were measured by biochemical methods. Myocardium morphological changes were observed under light microscopy. The mRNA expressions of myocardial δ and κ opioid receptors (DOR and KOR) were tested by real-time RT-PCR measurements. Results: The myocardial infarct size in Group E was more significantly decreased than that in Group M (P<0.05). The levels of CK-MB [(980 ± 92) U/L] and LDH [(2743 ± 124) U/L] in Group M were significantly higher than those in Group N [(312±41) U/L] and [(530 ± 56) U/L], respectively (both P<0.01). The levels of CK-MB [(572±70) U/L] and LDH [(1819±97) U/L] in Group E were significantly lower than those in Group M (both P<0.01). There were no significant differences in mRNA expressions of DOR and KOR between Group M and Group N (both P>0.05), but DOR expression in Group E was significantly higher than that either in Group M or in Group N (both P<0.01). No significant differences were found in KOR expression among the three groups (all P>0.05). Conclusion: Up-regulation of expression of δ opioid receptors may be involved in protective effects of EA at Nèiguān (▪ PC 6) for preconditioning on MIRI. [Copyright &y& Elsevier]

Objective: To explore an optimum method on postoperative recovery of general-anesthesia gynecological laparoscopic surgery., Methods: One hundred and twenty cases of gynecological laparoscopic surgery were randomly divided into three groups, 40 cases in each one. The sensitive points of bilateral Shenmen (TF4), Zigong (TF2), Wei (CO4), Dachang (CO7) and so on were selected in all three groups one night before the surgery. The sticking with magnetic beads was applied in the group A. The magnetic beads were in-pair stuck at front-back corresponding location of both ears in the group B. The same-appearance plaster was put at the corresponding acupoints in the group C. The intubation anesthesia was applied in all three groups and postoperative recovery of gynecological laparoscopic surgery was observed., Results: The postoperative visual analogue scale (VAS) was (1.77 +/- 1.65) in the group A and (1.80 +/- 1.96) in the group B, which was both lower than (2.62 +/- 1.46) in the group C (both P < 0.01). The occurrence rate of nausea and vomiting was 25.0% (9/36) in the group A and 20.0% (8/40) in the group B, which was both lower than 50.0% (19/38) in the group C (both P < 0.01). The recovery of borborygmus on postoperative 1st and 3rd day in the group A and B was faster than that in the group C (both P < 0.05), while time of fart and defecation in the group A and B was earlier than that in the group C (both P < 0.05). The score of state-trait anxiety inventory in the group A and B was lower than that in the group C (both P < 0.05), but the differences of each item between the group A and B were not obvious (both P > 0.05)., Conclusion: The auricular point sticking could support analgesia of general-anesthesia gynecological laparoscopic surgery, which could relieve anxiety mood, reduce occurrence of nausea and vomiting and improve function of stomach and intestine to benefit postoperative recovery. However, the effect of in-pair sticking of auricular point with magnetic beads at front-back acupoints was not obviously strengthened.

Objective: To explore the protective effects of electroacupuncture preconditioning at "Neiguan" (PC 6) on myocardial ischemia reperfusion injury (MIRI) and the mechanism., Methods: Forty-eight male Wistar rats were randomly divided into a sham operation group (group N), a MIRI group (group M) and an electroacupuncture group (group E). The MIRI model was generated by ligating the left anterior descending artery (LAD) for 30 min followed by reperfusion for 120 min. The partition sutures in group N were passed under the LAD without ligation. The rats in group E were pretreated with electroacupuncture applied at bilateral "Neiguan" (PC 6) for 20 min once a day on 3 consecutive days before ischemia. The area at risk and infarct size and the serum levels of CK-MB and LDH were measured. The morphological changes were observed by light microscopy. The mRNA expressions of delta and kappa opioid receptor (DOR and KOR) were determined by real-time RT-PCR., Results: The myocardial infarct size in group E was significant smaller than that in group M (P < 0.05). The contents of CK-MB and LDH were (980 +/- 92) U/L and (2 743 +/- 124) U/L in group M which were significant higher than (312 +/- 41) U/L and (530 +/- 56) U/L in group N (both P < 0.01) and (572 +/- 70) U/L and (1 819 +/- 97) U/L in group E (both P < 0.01). The mRNA expressions of DOR and KOR had no significant difference between group M and N (both P > 0.05), while the DOR expression in group E was significant higher than that in group M and N (both P < 0.01). There was no significant difference in KOR expression among three groups (all P > 0.05)., Conclusion: The cardiac protective effects of electroacupuncture preconditioning at "Neiguan" (PC 6) on MIRI may be mediated by increasing expression of delta opioid receptor in myocardium.

Objective: To prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function., Methods: Ninety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed., Results: As compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05)., Conclusion: The magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

Objective: To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion., Methods: Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups (n=20). Neuromuscular blockade was monitored using train-of-four (TOF) stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch (T1) < or = 5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index (RI), and the time interval from termination of infusion cisatracurium to recovery of TOF ratio (TOFR) to 0.9., Results: With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group (P<0.05), and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups (P>0.05)., Conclusion: During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.

Objective: To investigate the effects of different fluid resuscitation regimes on lung injury and expression of pulmonary aquaporin 1 (AQP1) and AQP5 in rats with uncontrolled hemorrhagic shock., Methods: Sixty Sprague-Dawley (SD) rats were randomly assigned to the following five groups: control group (C group), no fluid resuscitation group (NF group), lactated Ringer's solution group (LRS group), 7.5%NaCl group (HS group) and hydroxyethyl starch group (hydroxyethyl starch 130/0.4, HES group). A four-phased uncontrolled hemorrhagic shock model was reproduced. Uncontrolled hemorrhagic shock phase began with blood withdrawal extended over 15 minutes, in which animals were subjected to massive hemorrhage [mean arterial pressure (MAP)=40 mm Hg (1 mm Hg=0.133 kPa)] for 60 minutes and followed by intratracheal lipopolysaccharide 2 mg/kg and continuous bleeding with amputation of the tail. Then, animals were partially resuscitated with LRS of 3 times the volume of shed blood (LRS group), followed by a bolus dose of 4 ml/kg body weight of 7.5%NaCl (HS), or hydroxyethyl starch (a volume equal to that of the shed blood), respectively, during different fluid resuscitation regimes. After that, comprehensive resuscitation phase of 60 minutes began with hemostasis, and transfusion of all the shed blood plus same amount of normal saline. Observation phase was continued for 3.5 hours. At the end the experiment, the lung tissue was sampled to measure wet-to-dry lung weight ratio (W/D), and the expression of AQP1 and AQP5 were determined with immunohistochemistry. The paraffin-embedded lungs were stained with hematoxylin and eosin for pathological analysis., Results: When compared with NF and LRS groups, the lung W/D ratio was significantly decreased, and the shock induced decreased expression of AQP1 and AQP5 in lung tissue were attenuated in HES group, but these beneficial effects were blunted in the HS group., Conclusion: Uncontrolled hemorrhagic shock may induce lung injury and pulmonary edema as well as down regulation of the expression of AQP1 and AQP5 in rats. Resuscitation with hypertonic fluids, especially with HES, can reduce lung damage and pulmonary edema in this kind of shock. The cause may be due in part to maintenance of the expression of AQP1 and/or AQP5 in the lung. Pulmonary AQP1 and AQP5 play an important role in fluid transportation.

Objective: To investigate the changes in pulmonary transforming growth factor-beta1 (TGF-beta1)/smad2 signaling pathway in pulmonary injury as a result of hemorrhagic shock followed by lipopolysaccharide challenge., Methods: Twenty-four Sprague-Dawley (SD) rats were randomly assigned to the following two groups: sham operation group (sham group, surgery, no hemorrhage and no resuscitation), and two-hit model group (HS group), each n=12. Three-phased uncontrolled hemorrhagic shock model was reproduced in rats. Hemorrhagic shock phase I began with blood withdrawal over 15 minutes, i.e. animals were subjected to massive hemorrhage [mean arterial pressure (MAP)=35-40 mm Hg (1 mm Hg=0.133 kPa) for 60 minutes], followed by intratracheal lipopolysaccharide 2 mg/kg (two-hit model). Ninety minutes after blood shedding, resuscitation phase II of 60 minutes began with hemostasis, return of all the blood initially shed, plus fluids. Observation phase III was 210 minutes. After phase III, blood gas analysis with carotid artery blood was performed. Lung tissue was sampled to measure values of wet-to-dry lung weight (W/D) ratio and pulmonary microvascular permeability. Immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR) were used to assess the expression of TGF-beta1 protein and mRNA, and the protein content of the smad2 was determined by Western blotting., Results: Compared with sham group, MAP was significantly lowered after 60 minutes in phase I, and lactic acid content was increased significantly, while partial pressure of oxygen in artery (PaO2), blood pH, HCO(-)3, arterial oxygen saturation (SaO2) and negative base excess (BE) showed a significant decrease in HS group. Concomitantly, values of pulmonary microvascular permeability and W/D ratio were significantly increased in HS group (all P<0.01). In sham group, weak TGF-beta1 staining was detected in the alveolar epithelial cells. However, intense positive immunostaining for TGF-beta1 was observed in alveolar epithelial cells, pulmonary interstitial inflammatory cell as well as macrophage cells of alveolar space of the HS group. Lung tissue in HS group demonstrated a marked increase in TGF-beta1 mRNA and smad2 protein expression in the lung tissue compared with those of sham group (all P<0.01)., Conclusion: The expression of TGF-beta1/smad2 signaling pathway may play an important role in regulation of pulmonary permeability and development of pulmonary edema in acute lung injury induced by uncontrolled hemorrhagic shock followed by lipopolysaccharide challenge.

Objective: To investigate the effects of propofol on the changes in actin cytoskeleton and permeability of cultured human umbilical vascular endothelial cells (HUVECs) monolayer induced by lipopolysaccharide (LPS)., Methods: HUVECs were randomly assigned to one of the following seven groups: no additives (negative control), LPS alone (1 mg/L and 10 mg/L), propofol alone (4 mg/L), introlipid alone, LPS (10 mg/L ) combination with propofol (4 mg/L) and LPS (10 mg/L ) together with introlipid (4 mg/L). Changes in filtration coefficients (Kf) and osmotic reflection coefficients (sigma) were measured, and changes in filamentous actin (F-actin) measured by F-actin fluorometry, and expression of nitrotyrosine analyzed by immunocytochemistry were observed in cultured HUVECs., Results: Compared with the control group, the LPS alone group Kf values were significantly increased and the sigma values decreased,the F-actin content was decreased and the expression of nitrotyrosine was increased (all P<0.01), especially in the high dose LPS alone group. The co-treatment of propofol and LPS significantly reduced levels of LPS-enhanced nitrotyrosine protein, and significantly attenuated the changes in Kf and sigma values (all P<0.01), while introlipid group had no such beneficial effects., Conclusion: Propofol rather than introlipid, significantly inhibit LPS-induced increase in permeability of HUVECs and alterations in F-actin organization. The scavenging actions of propofol on peroxynitrite may be helpful to attenuate endothelial barrier dysfunction as shown in our current study.

Objective: To study on regulative action of scalp acupuncture on oxidative stress reaction at operation stage., Methods: Fifty two cases selected for radical operation of intestinal cancer were randomly divided into a scalp acupuncture plus general anesthesia (scalp acupuncture group) and a simple general anesthesia group (general anesthesia group), 26 cases in each group. The scalp acupuncture group were treated first with scalp acupuncture for 20 min, followed by general anesthesia, with scalp acupuncture lasted till the end of operation. The general anesthesia group were treated only with simple intratracheal anesthesia. Effects of scalp acupuncture on malondialdehyde (MDA) level and superoxide dismutase (SOD) activity at the operation stage were observed., Results: After operation, MDA levels decreased significantly (P < 0.05) in the two groups, but with no difference between the two groups in the different values of MDA before and after treatment (P > 0.05); there was no significant change in SOD before and after treatment in the scalp acupuncture group, and significantly decreased in the general anesthesia group (P < 0.05). There was a significant difference between the two groups in the different value of SOD before and after the operation (P < 0.05)., Conclusion: Scalp acupuncture can inhibit the decrease of SOD activity, reducing oxidative stress reaction at operation stage.

Objective: To observe analgesic effect of acupuncture anesthesia., Methods: Sixty-nine cases undergoing rectal cancer surgery were randomly divided into 3 groups, group I, II and III, 23 cases in each group. Both Zusanli (ST 36) and Sanyinjiao (SP 6) were selected for acupuncture anesthesia. Group I received general anesthesia after acupuncture induction, group II received acupuncture after general anesthesia, and group II received only general anesthesia. Minimum alveolar concentration (MAC) before and after operation was recorded., Results: MAC was (1.35 +/- 0.19) vol% in the group I, (1.49 +/- 0.22) vol% in the group II and (1.64 +/- 0.27) vol% in the group III. Acupuncture before and after general anesthesia could decrease respectively by about 0.29% and 0.15% of MAC in rectal cancer surgery undergoing general anesthesia, with a very significant difference (P < 0.01) or a significant difference (P < 0.05) among the 3 groups., Conclusion: Acupuncture anesthesia has a certain adjuvant action for anesthesia and analgesia, and acupuncture before general anesthesia has a better action.