Extracellular cyclophilin A may be a potential target to protect against myocardial reperfusion injury

Myocardial reperfusion injury is increasingly recognized as an inflammatory process, characterized by neutrophil recruitment and subsequently excessive release of pro-inflammatory factors. Recently, the extracellular cyclophilin A (CypA) has been showed to play an important role in initiation and development of inflammation by chemo trafficking of leukocytes into inflamed tissues, eliciting massive release of pro-inflammatory cytokines, and inducing production of matrix metalloproteinases. Also, the agents targeting CypA have been demonstrated to promise anti-inflammatory effects in the different experimental models of inflammatory diseases including acute lung injury, rheumatoid arthritis, and atherosclerosis. Therefore, we hypothesize that the extracellular CypA may in some way implicated in the pathogenesis of reperfusion-induced inflammatory process, and the specific inhibitors of the extracellular CypA can provide a protection against the myocardial reperfusion injury.

The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway

This prospective self-controlled study was designed to evaluate the influences of head flexion on airway seal, quality of ventilation, and orogastric tube placement through the ProSeal laryngeal mask airway (ProSeal LMA) in 80 anaesthetised, paralysed adult patients. After the ProSeal LMA was inserted and the cuff pressure was set at 5.9 kPa, ventilation quality, airway seal pressure, fibreoptic positions of the cuff and the drainage tube, orogastric tube placement and efficacy of intermittent positive pressure ventilation (IPPV) were assessed in two randomly selected positions: neutral and flexed position. When compared to the neutral head position, the head flexed significantly improved the airway seal pressure and the quality of ventilation of the ProSeal LMA (p < 0.05). Fibreoptic scores of the cuff position did not correlate with either the ability to obtain excellent or adequate ventilation through the ProSeal LMA or the ability to generate an airway seal pressure of >or= 2 kPa. Orogastric tube placement via the drainage tube was successful on the first attempt in all patients in the neutral position compared with seven failures following three attempts in the flexed position (p < 0.05). There were no significant differences between the two head positions in the volume of air required to obtain an intracuff pressure of 5.9 kPa, fibreoptic score of the drainage tube position, and expiratory tidal volume and peak inspiratory pressure during IPPV (p > 0.05). In conclusion, head flexion improves airway seal and ventilation quality of the ProSeal LMA. However, placement of an orogastric tube via the drainage tube is impaired in the flexed position compared to the neutral position. Fibreoptic scoring of the ProSeal cuff position is not an accurate test to assess the airway seal and ventilation function.