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Gul B, Anwar R, Saleem M, Ahmad M, Ullah MI, Kamran S. Attenuation of CFA-induced arthritis through regulation of inflammatory cytokines and antioxidant mechanisms by Solanum nigrum L. leaves extracts. Inflammopharmacology 2023; 31:3281-3301. [PMID: 37864683 DOI: 10.1007/s10787-023-01357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/25/2023] [Indexed: 10/23/2023]
Abstract
Solanum nigrum L. is a popular traditional medicine for various inflammatory conditions including rheumatism and joint pain. The current study aimed to evaluate the anti-arthritic mechanism of Solanum nigrum L. Four extracts were prepared using n-hexane, methanol, chloroform, and water. The anti-nociceptive and anti-inflammatory activity was carried out with 100, 200, and 300 mg/kg body wt. PO of each extract by the hot plate and carrageenan-induced paw oedema methods, respectively. The anti-arthritic study was performed with chloroform and aqueous extracts (300 mg/kg) in complete Freund's adjuvant (CFA)-induced arthritis. Paw size (mm), ankle joint diameter (mm), and latency time (sec) were recorded on day 0 and every 4th day till 28 days. The hematological, inflammatory, and oxidative biomarkers were estimated. Results showed that significant analgesia (p < 0.05) and reduction in paw inflammation were achieved with all extracts. The highest percent inhibition in Carrageenan-induced inflammation was achieved with 300 mg/kg of chloroform (72.19%) and aqueous (71.30%) extracts, respectively. In the CFA model, both extracts showed a significant reduction in paw size and ankle joint diameter (p < 0.05). The RT-qPCR analysis revealed the upregulation of interleukin-4 and interleukin-10, and down-expression of interleukin-1β, interleukin-6, tumor necrosis factor-α, cycloxygenase-2, nuclear factor-κB, prostaglandin E synthase 2, and interferon-γ. A significant increase in superoxide dismutase, catalase, and glutathione levels was observed. Hence, it is concluded that Solanum nigrum L. leaf extracts regulate the expression of inflammatory markers and improve oxidative stress resulting in the attenuation of CFA-induced arthritis.
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Affiliation(s)
- Bazgha Gul
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Rukhsana Anwar
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
| | - Mohammad Saleem
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Mobasher Ahmad
- Gulab Devi Institute of Pharmacy, Gulab Devi Hospital, Lahore, Pakistan
| | - Muhammad Ihsan Ullah
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Shahzad Kamran
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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Yamanashi T, Sullivan EJ, Comp KR, Nishizawa Y, Akers CC, Chang G, Modukuri M, Tran T, Anderson ZEEM, Marra PS, Crutchley KJ, Wahba NE, Iwata M, Karam MD, Noiseux NO, Cho HR, Shinozaki G. Anti-inflammatory medication use associated with reduced delirium risk and all-cause mortality: A retrospective cohort study. J Psychosom Res 2023; 168:111212. [PMID: 36963165 DOI: 10.1016/j.jpsychores.2023.111212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To investigate the relationship between history of anti-inflammatory medication use and delirium risk, as well as long-term mortality. METHODS In this retrospective cohort study, subjects recruited between January 2016 and March 2020 were analyzed. Information about anti-inflammatory medication use history including aspirin, NSAIDs, glucosamine, and other anti-inflammatory drugs, was collected. Logistic regression analysis investigated the relationship between anti-inflammatory medications and delirium. Log-rank analysis and cox proportional hazards model investigated the relationship between anti-inflammatory medications and one-year mortality. RESULTS The data from 1274 subjects were analyzed. The prevalence of delirium was significantly lower in subjects with NSAIDs usage (23.0%) than in those without NSAIDs usage (35.0%) (p < 0.001). Logistic regression analysis controlling for age, sex, dementia status, and hospitalization department showed that the risk of delirium tended to be reduced by a history of NSAIDs use (OR, 0.76 [95% CI, 0.55 to 1.03]). The one-year mortality in the subjects with NSAIDs (survival rate, 0.879 [95% CI, 0.845 to 0.906]) was significantly higher than in the subjects without NSAIDs (survival rate, 0.776 [95% CI, 0.746 to 0.803]) (p < 0.001). A history of NSAIDs use associated with the decreased risk of one-year mortality even after adjustment for age, sex, Charlson Comorbidity Index, delirium status, and hospitalization department (HR, 0.70 [95% CI, 0.51 to 0.96]). CONCLUSION This study suggested that NSAIDs usage was associated with decreased delirium prevalence and lower one-year mortality. The potential benefit of NSAIDs on delirium risk and mortality were shown.
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Affiliation(s)
- Takehiko Yamanashi
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America; Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago, Tottori, Japan
| | - Eleanor J Sullivan
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Katie R Comp
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Yoshitaka Nishizawa
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; Osaka Medical and Pharmaceutical University Faculty of Medicine, Department of Neuropsychiatry, Takatsuki, Osaka, Japan
| | - Cade C Akers
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Gloria Chang
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Manisha Modukuri
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Tammy Tran
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Zoe-Ella E M Anderson
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Pedro S Marra
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Kaitlyn J Crutchley
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Nadia E Wahba
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America
| | - Masaaki Iwata
- Tottori University Faculty of Medicine, Department of Neuropsychiatry, Yonago, Tottori, Japan
| | - Matthew D Karam
- University of Iowa Carver College of Medicine, Department of Orthopedic Surgery, Iowa City, IA, United States of America
| | - Nicolas O Noiseux
- University of Iowa Carver College of Medicine, Department of Orthopedic Surgery, Iowa City, IA, United States of America
| | - Hyunkeun R Cho
- University of Iowa College of Public Health, Department of Biostatistics, Iowa City, IA, United States of America
| | - Gen Shinozaki
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, United States of America; University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, IA, United States of America.
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Xiao MZ, Liu CX, Zhou LG, Yang Y, Wang Y. Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: A review. Medicine (Baltimore) 2023; 102:e32991. [PMID: 36827061 PMCID: PMC11309669 DOI: 10.1097/md.0000000000032991] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
Postoperative delirium (POD) is an acute cognitive dysfunction that is mainly characterized by memory impairment and disturbances in consciousness. POD can prolong the hospital stay and increase the 1-month mortality rate of patients. The overall incidence of POD is approximately 23%, and its prevalence can go up to 50% in high-risk surgeries. Neuroinflammation is an important pathogenic mechanism of POD that mediates microglial activation and leads to synaptic remodeling. Neuroinflammation, as an indispensable pathogenesis of POD, can occur due to a variety of factors, including aseptic inflammation caused by surgery, effects of anesthetic drugs, disruption of the blood-brain barrier, and epigenetics. Understanding these factors and avoiding the occurrence of risk factors may help prevent POD in time. This review provides a brief overview of POD and neuroinflammation and summarizes various factors affecting POD development mediated by neuroinflammation, which may serve as future targets for the prevention and treatment of POD.
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Affiliation(s)
- M. Z. Xiao
- Department of Anesthesiology, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - C. X. Liu
- Department of Anesthesiology, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - L. G. Zhou
- Department of Anatomy, Hengyang Medical College of University of South China, Hengyang, China
| | - Y. Yang
- Department of Anesthesiology, The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Y. Wang
- Department of Anesthesiology, The Second Affiliated Hospital of University of South China, Hengyang, China
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Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome. Anesthesiology 2022; 136:843-860. [PMID: 35180291 DOI: 10.1097/aln.0000000000004141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nonsteroidal anti-inflammatory drugs are among the most commonly administered drugs in the perioperative period due to their prominent role in pain management. However, they potentially have perioperative consequences due to immune-modulating effects through the inhibition of prostanoid synthesis, thereby affecting the levels of various cytokines. These effects may have a direct impact on the postoperative outcome of patients since the immune system aims to restore homeostasis and plays an indispensable role in regeneration and repair. By affecting the immune response, consequences can be expected on various organ systems. This narrative review aims to highlight these potential immune system-related consequences, which include systemic inflammatory response syndrome, acute respiratory distress syndrome, immediate and persistent postoperative pain, effects on oncological and neurologic outcome, and wound, anastomotic, and bone healing.
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Liu L, Zhang X, Wang C, Wu X, Long B. Hypercholesterolemia aggravates sevoflurane-induced cognitive impairment in aged rats by inducing neurological inflammation and apoptosis. J Biochem Mol Toxicol 2022; 36:e23009. [PMID: 35174938 DOI: 10.1002/jbt.23009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
We aimed to explore the effects of hypercholesterolemia on sevoflurane-induced cognitive impairment in aged rats and the underlying mechanism(s). Aged rats were administrated with high-fat diet, sevoflurane, or both. Thereafter, the plasma levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were evaluated. The Morris water maze task was performed to evaluate the spatial learning and memory ability of rats. Moreover, Nissl and Evans blue staining were conducted to test nerve damage and detect the blood-brain barrier permeability, respectively. The percentage of apoptotic cells was evaluated by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The messenger RNA expression of inflammatory factors and protein expression of microglial activation markers and apoptosis-related proteins were tested by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, or western blot analysis, respectively. High-fat diet induced high levels of TC, TG, and LDL but decreased levels of HDL. However, sevoflurane had no effects on these levels. In contrast, sevoflurane significantly induced the impairment of learning and memory, nerve damage, neuroinflammatory damage, and neuronal apoptosis. Hypercholesterolemia exacerbated the sevoflurane-induced impairment in aged rats. These results suggested that hypercholesterolemia aggravates sevoflurane-induced cognitive impairment in aged rats, possibly by inducing neurological inflammation and apoptosis.
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Affiliation(s)
- Lidan Liu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Zhang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Cong Wang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiuying Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bo Long
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Ge X, Pan Y, Jin D, Wang Y, Ge S. Effect of perioperative use of parecoxib on chronic post-surgical pain in elderly patients after hepatectomy: a prospective randomized controlled study. BMC Pharmacol Toxicol 2021; 22:35. [PMID: 34130753 PMCID: PMC8207796 DOI: 10.1186/s40360-021-00501-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/13/2021] [Indexed: 01/01/2023] Open
Abstract
Background Chronic post-surgical pain (CPSP) has a negative impact on the recovery, quality of life, and physical functioning of elderly patients. This study aimed to test the superiority of parecoxib vs. placebo in preventing chronic post-hepatectomy pain in elderly patients under combined general-epidural anesthesia. Methods A total of 105 elderly patients undergoing hepatectomy under combined general-epidural anesthesia were randomized into the parecoxib or placebo group. The primary outcome was the proportion of patients with CPSP 3 months postoperatively. The secondary outcomes included the Short-Form McGill Pain Questionnaire score in CPSP-positive responders, acute pain intensity, postoperative analgesic demand, inflammatory markers change, and postoperative complications within 28 days. Results The parecoxib group provided a non-significant absolute 9.1% reduction in the rate of CPSP compared to the placebo group (P = 0.34). The average chronic pain visual analog scale in the parecoxib group was lower than that in the placebo group (P = 0.04). Significantly less moderate-to-severe acute pain at rest (P = 0.04) and with coughing (P < 0.001), less patient-controlled epidural analgesia (PCEA) consumption (P = 0.01), and less rescue analgesia (P < 0.001) were observed in the parecoxib group compared to the placebo group. Furthermore, no between-group difference was observed in inflammatory markers (P > 0.05) and postoperative complications (P = 0.65). Conclusions Parecoxib reduced the prevalence of CPSP in elderly patients after hepatectomy under combined general-epidural anesthesia from 44.4 to 35.3% with no statistical significance. Moreover, significantly alleviated CPSP intensity and improved acute pain management were observed. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (URL: http://www.chictr.org.cn/edit.aspx?pid=56961&htm=4) on August 3, 2020 (ChiCTR-2,000,035,198). Supplementary Information The online version contains supplementary material available at 10.1186/s40360-021-00501-1.
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Affiliation(s)
- Xiaodong Ge
- Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Yan Pan
- Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Danfeng Jin
- Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Ying Wang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Shengjin Ge
- Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
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Liu G, Ma Y, Chen Y, Zhuang Y, Yang Y, Tian X. Effects of parecoxib after pancreaticoduodenectomy: A single center randomized controlled trial. Int J Surg 2021; 90:105962. [PMID: 33932589 DOI: 10.1016/j.ijsu.2021.105962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/07/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parecoxib, a selective cyclooxygenase-2 inhibitor, is a potential alternative analgesic to reduce opioid consumption after Pancreaticoduodenectomy (PD). Further, the safety and efficacy of long-term use of parecoxib for patients after PD remain a major concern. MATERIALS AND METHODS In this single-center, randomized clinical trial, 134 patients undergoing open PD were randomized into the parecoxib group (group P) and control group (group C) at a 1:1 ratio. Besides a routine patient-controlled epidural analgesia (PCEA) until 3 days postoperatively for both groups, patients in group P (n = 68) received parecoxib (40 mg, intravenously, Q 12 h) for the first 5 postoperative days and were encouraged to receive opioid analgesics to control severe pain as needed. Patients in group C (n = 66) received on-demand opioid analgesics (pethidine or morphine) postoperatively. The primary outcomes included the effectiveness of parecoxib in controlling pain (measured using the visual analog scale (VAS)) and reduction of opioid use (measured as accumulated doses). Secondary outcomes included the postoperative recovery process, rate of postoperative complications, and the anti-inflammatory effect of parecoxib. RESULTS The VAS scores were not significantly different between the two groups. The number of doses of opioids for patients in group P (3.2 ± 0.3 doses) was significantly lower than in group C (8.5 ± 0.4 doses) (p = 0.0007). The incidence of opioid-related side effects was significantly lower in group P than in group C (p = 0.001). There were no significant differences in postoperative complications or readmission rates between the two groups. The postoperative time to first pass flatus, time to first mobilization out of bed, and time of removal of nasogastric tube in group P were significantly shorter than those in group C (P < 0.05). The postoperative serum IL-6 levels of patients in group P were significantly lower than those in group C at each time point (P < 0.05). CONCLUSIONS Parecoxib effectively controls pain after PD. Prophylactic analgesia using parecoxib for up to 5 days after PD is safe, feasible, and can provide the same optimal pain control as opioids without adverse effects.
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Affiliation(s)
- Guangnian Liu
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Yongsu Ma
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Yiran Chen
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Yan Zhuang
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Yinmo Yang
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
| | - Xiaodong Tian
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China.
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Jin Z, Hu J, Ma D. Postoperative delirium: perioperative assessment, risk reduction, and management. Br J Anaesth 2020; 125:492-504. [DOI: 10.1016/j.bja.2020.06.063] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
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Liu X, Ma Y, Ouyang R, Zeng Z, Zhan Z, Lu H, Cui Y, Dai Z, Luo L, He C, Li H, Zong D, Chen Y. The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome. J Neuroinflammation 2020; 17:229. [PMID: 32738920 PMCID: PMC7395983 DOI: 10.1186/s12974-020-01905-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS), a state of sleep disorder, is characterized by repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Previous studies have revealed that intermittent hypoxia (IH) conditions in OSAS patients elicited neuron injury (especially in the hippocampus and cortex), leading to cognitive dysfunction, a significant and extraordinary complication of OSAS patients. The repeated courses of airway collapse and obstruction in OSAS patients resulted in apnea and arousal during sleep, leading to IH and excessive daytime sleepiness (EDS) and subsequently contributing to the development of inflammation. IH-mediated inflammation could further trigger various types of cognitive dysfunction. Many researchers have found that, besides continuous positive airway pressure (CPAP) treatment and surgery, anti-inflammatory substances might alleviate IH-induced neurocognitive dysfunction. Clarifying the role of inflammation in IH-mediated cognitive impairment is crucial for potentially valuable therapies and future research in the related domain. The objective of this article was to critically review the relationship between inflammation and cognitive deficits in OSAS.
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Affiliation(s)
- Xiangming Liu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yiming Ma
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zihang Zeng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zijie Zhan
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Huanhuan Lu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yanan Cui
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zhongshang Dai
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Lijuan Luo
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Chenjie He
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Herui Li
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Dandan Zong
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
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Zhang X, Lyu Y, Wang D. S100β as a potential biomarker of incident delirium: a systematic review and meta-analysis. Minerva Anestesiol 2020; 86:853-860. [DOI: 10.23736/s0375-9393.20.14100-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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11
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Luo A, Yan J, Tang X, Zhao Y, Zhou B, Li S. Postoperative cognitive dysfunction in the aged: the collision of neuroinflammaging with perioperative neuroinflammation. Inflammopharmacology 2019; 27:27-37. [PMID: 30607668 DOI: 10.1007/s10787-018-00559-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/26/2018] [Indexed: 12/25/2022]
Abstract
The aging population is burgeoning globally and this trend presents great challenges to the current healthcare system as the growing number of aged individuals receives procedures of surgery and anesthesia. Postoperative cognitive dysfunction (POCD) is a severe postoperative neurological sequela. Advanced age is considered as an independent risk factor of POCD. Mounting evidence have shown that neuroinflammation plays an essential role in POCD. However, it remains debatable why this complication occurs highly in the aged individuals. As known, aging itself is the major common high-risk factor for age-associated disorders including diabetes, cardiovascular disease, cancer, and neurodegenerative diseases. Chronic low-grade neuroinflammation (dubbed neuroinflammaging in the present paper) is a hallmark alternation and contributes to age-related cognitive decline in the normal aging. Interestingly, several lines of findings show that the neuroinflammatory pathogenesis of POCD is age-dependent. It suggests that age-related changes, especially the neuroinflammaging, are possibly associated with the postoperative cognitive impairment. Understanding the role of neuroinflammaging in POCD is crucial to elucidate the mechanism of POCD and develop strategies to prevent or treat POCD. Here the focus of this review is on the potential role of neuroinflammaging in the mechanism of POCD. Lastly, we briefly review promising interventions for this neurological sequela.
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Affiliation(s)
- AiLin Luo
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Jing Yan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - XiaoLe Tang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - YiLin Zhao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - BiYun Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - ShiYong Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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12
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Huang S, Hu H, Cai YH, Hua F. Effect of parecoxib in the treatment of postoperative cognitive dysfunction: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e13812. [PMID: 30608392 PMCID: PMC6344118 DOI: 10.1097/md.0000000000013812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Parecoxib is a selective cyclooxygenase (COX)-2 inhibitor widely used as an analgesia technique in perioperative period for its potent anti-inflammatory and analgesic effects. However, litter is known about its effect on postoperative cognitive dysfunction (POCD). The purpose of this meta-analysis of randomized controlled trials (RCTs) was to evaluate the effect of parecoxib in the treatment of postoperative cognitive dysfunction. METHODS We searched PubMed, Cochrane Library and Embase databases for relevant studies up to October 2017. We selected fixed-effect model for analysis of data heterogeneity. Statistical analyses were performed by using Review Manager Version 5.3 for Windows. RESULTS Four RCTs with 904 patients that underwent surgical operations were included. The meta-analysis demonstrated parecoxib could significantly decrease the incidence of POCD on postoperative day 1, day 3, day 5, and day 7 when compared with control treatment; IL-6 and S100β concentrations were lower up to postoperative day 2. The consumption of morphine, fentanyl and tramadol in parecoxib groups were lower than control groups. CONCLUSION Our meta-analysis suggested that the administration of Parecoxib was effective in treating early POCD within 7 days and reducing IL-6 and S100β concentrations within 2 days after operations. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.
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Affiliation(s)
- Song Huang
- Anesthesia Department, The Second Affiliated Hospital of Nanchang University, Min De Road
| | - Haijun Hu
- Anesthesia Department, The Second Affiliated Hospital of Nanchang University, Min De Road
| | - Yue-Hong Cai
- Ophthalmology Department, Jiangxi Provincial People's Hospital, Nanchang, PR China
| | - Fuzhou Hua
- Anesthesia Department, The Second Affiliated Hospital of Nanchang University, Min De Road
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13
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Alam A, Hana Z, Jin Z, Suen KC, Ma D. Surgery, neuroinflammation and cognitive impairment. EBioMedicine 2018; 37:547-556. [PMID: 30348620 PMCID: PMC6284418 DOI: 10.1016/j.ebiom.2018.10.021] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/01/2018] [Accepted: 10/09/2018] [Indexed: 12/25/2022] Open
Abstract
Trauma experienced during surgery can contribute to the development of a systemic inflammatory response that can cause multi-organ dysfunction or even failure. Post-surgical neuroinflammation is a documented phenomenon that results in synaptic impairment, neuronal dysfunction and death, and impaired neurogenesis. Various pro-inflammatory cytokines, such as TNFα, maintain a state of chronic neuroinflammation, manifesting as post-operative cognitive dysfunction and post-operative delirium. Furthermore, elderly patients with post-operative cognitive dysfunction or delirium are three times more likely to experience permanent cognitive impairment or dementia. We conducted a narrative review, considering evidence extracted from various databases including Pubmed, MEDLINE and EMBASE, as well as journals and book reference lists. We found that further pre-clinical and well-powered clinical studies are required to delineate the precise pathogenesis of post-operative delirium and cognitive dysfunction. Despite the burden of post-operative neurological sequelae, clinical studies investigating therapeutic agents, such as dexmedetomidine, ibuprofen and statins, have yielded conflicting results. In addition, evidence supporting novel therapeutic avenues, such as nicotinic and HMGB-1 targeting and remote ischaemic pre-conditioning, is limited and necessitates further investigation.
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Affiliation(s)
- Azeem Alam
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zac Hana
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zhaosheng Jin
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Ka Chun Suen
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Daqing Ma
- Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
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14
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Zhou ZJ, Tang J, Li WH, Tao WD. Preoperative intravenous flurbiprofen reduces postoperative pain and inflammatory cytokines in elderly patients after hip arthroplasty. Exp Ther Med 2018; 17:354-358. [PMID: 30651803 PMCID: PMC6307351 DOI: 10.3892/etm.2018.6911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/11/2018] [Indexed: 12/29/2022] Open
Abstract
Effect of flurbiprofen on the postoperative cognition and inflammatory cytokines in elderly patients after hip arthroplasty was investigated. Elderly patients undergoing replacement of total hip were randomly divided into three groups of equal size (n=60). A control group (control) received no treatment before or at the end of surgery. The other two groups, PRE and INTRA, received 50 mg flurbiprofen intravenously 15 min before the surgery and 30 min before the end of surgery, respectively. The pain score was evaluated by a visual analog scale (VAS) at the following time-points: 24 h before surgery (T0), and 3 h (T1), 12 h (T2) and 24 h (T3) after surgery. Peripheral venous blood was collected at T0, T1, T2 and T3. Cognitive function was assessed by mini-mental state examination (MMSE) at the time of T0, T1, T2 and T3. The serum concentration of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), IL-6, and Cox-2 were measured using enzyme linked immunosorbent assay (ELISA). The VAS scores and the release of pro-inflammatory cytokines in the PRE and INTRA groups were less than those in the control group at T1, T2 and T3. The MMSE scores in PRE and INTRA groups were significantly higher than those in the control group at T1, T2 and T3. The PRE group showed a lower VAS score, release of pro-inflammatory cytokines and higher MMSE scores at T1, T2 and T3 than the control and INTRA groups. Intravenous flurbiprofen administration reduces postoperative pain and flammatory response after hip arthroplasty. Moreover, flurbiprofen is more effective when given preoperatively than intraoperatively.
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Affiliation(s)
- Zhi-Jun Zhou
- The Second People's Hospital of Nantong, Nantong, Jiangsu 226002, P.R. China
| | - Jian Tang
- The Second People's Hospital of Nantong, Nantong, Jiangsu 226002, P.R. China
| | - Wei-Hua Li
- The Second People's Hospital of Nantong, Nantong, Jiangsu 226002, P.R. China
| | - Wei-Dong Tao
- The Second People's Hospital of Nantong, Nantong, Jiangsu 226002, P.R. China
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15
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Zhu Y, Yao R, Li Y, Wu C, Heng L, Zhou M, Yan L, Deng Y, Zhang Z, Ping L, Wu Y, Wang S, Wang L. Protective Effect of Celecoxib on Early Postoperative Cognitive Dysfunction in Geriatric Patients. Front Neurol 2018; 9:633. [PMID: 30131758 PMCID: PMC6090028 DOI: 10.3389/fneur.2018.00633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/13/2018] [Indexed: 12/20/2022] Open
Abstract
Objective: Inflammation plays a key role in the etiology and pathology of postoperative cognitive dysfunction (POCD). Cyclooxygenase (COX)-2 inhibitor celecoxib is used for the treatment of acute pain due to its potent anti-inflammatory and analgesic effects. Herein, we evaluated the effects of celecoxib on POCD in geriatric patients. Methods: A total of 178 geriatric patients undergoing total knee arthroplasty were randomly divided into two groups and treated with celecoxib (group C) or placebo (group P). The levels of perioperative plasma COX-2, IL-1β, IL-6, TNF-α, neuron-specific enolase, and S100β were detected in all patients. The pain intensity was measured by numerical rating scale (NRS). A battery of 9 neuropsychological tests was performed pre-operatively and 1 week, and 3 months postoperatively. Patients, whose postoperative performance declined by ≧1 standard deviation as compared to each preoperative test score on ≧2 tests, were classified as POCD. Results: A significant decrease in POCD incidence was found in group C as compared to group P on postoperative day 7 (12.3% vs. 34.1%; p < 0.05). POCD incidence did not differ between the two groups at the 3-month follow-up (8.8 vs. 9.7%). NRS scores at days 3 and 4 post-surgery were significantly lower in group C (p < 0.05). Patients in group C showed lower level of plasma COX-2, IL-1β, IL-6, TNF-α, and S100β as compared to group P postoperatively (p < 0.05). Conclusion: These results demonstrated that celecoxib can decrease early POCD incidence after total knee arthroplasty in geriatric patients, which might be mediated by suppressing inflammation and acute postoperative pain caused by surgical trauma. Registration: Chinese Clinical Trial Register, ChiCTR-IOR-16008168.
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Affiliation(s)
- Yangzi Zhu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Rui Yao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Yan Li
- Department of Anesthesiology, Suzhou Xiangcheng People's Hospital, Suzhou, China
| | - Congyou Wu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Lei Heng
- Department of Anesthesiology, Xuzhou Tumor Hospital, Xuzhou, China
| | - Meiyan Zhou
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Li Yan
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yan Deng
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Zhe Zhang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Lei Ping
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
| | - Yuqing Wu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
| | - Shengtao Wang
- Department of Pain, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Liwei Wang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
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16
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Xiao JY, Xiong BR, Zhang W, Zhou WC, Yang H, Gao F, Xiang HB, Manyande A, Tian XB, Tian YK. PGE2-EP3 signaling exacerbates hippocampus-dependent cognitive impairment after laparotomy by reducing expression levels of hippocampal synaptic plasticity-related proteins in aged mice. CNS Neurosci Ther 2018; 24:917-929. [PMID: 29488342 DOI: 10.1111/cns.12832] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/24/2022] Open
Abstract
AIM Multifactors contribute to the development of postoperative cognitive dysfunction (POCD), of which the most important mechanism is neuroinflammation. Prostaglandin E2 (PGE2) is a key neuroinflammatory molecule and could modulate hippocampal synaptic transmission and plasticity. This study was designed to investigate whether PGE2 and its receptors signaling pathway were involved in the pathophysiology of POCD. METHODS Sixteen-month old male C57BL/6J mice were exposed to laparotomy. Cognitive function was evaluated by fear conditioning test. The levels of PGE2 and its 4 distinct receptors (EP1-4) were assessed by biochemical analysis. Pharmacological or genetic methods were further applied to investigate the role of the specific PGE2 receptors. RESULTS Here, we found that the transcription and translation level of the EP3 receptor in hippocampus increased remarkably, but not EP1, EP2, or EP4. Immunofluorescence results showed EP3 positive cells in the hippocampal CA1 region were mainly neurons. Furthermore, pharmacological blocking or genetic suppression of EP3 could alleviate surgery-induced hippocampus-dependent memory deficits and rescued the expression of plasticity-related proteins, including cAMP response element-binding protein (CREB), activity-regulated cytoskeletal-associated protein (Arc), and brain-derived neurotrophic factor (BDNF) in hippocampus. CONCLUSION This study showed that PGE2-EP3 signaling pathway was involved in the progression of POCD and identified EP3 receptor as a promising treatment target.
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Affiliation(s)
- Jing-Yu Xiao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bing-Rui Xiong
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen-Chang Zhou
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hui Yang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Gao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong-Bing Xiang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, UK
| | - Xue-Bi Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu-Ke Tian
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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17
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Safavynia SA, Goldstein PA. The Role of Neuroinflammation in Postoperative Cognitive Dysfunction: Moving From Hypothesis to Treatment. Front Psychiatry 2018; 9:752. [PMID: 30705643 PMCID: PMC6345198 DOI: 10.3389/fpsyt.2018.00752] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022] Open
Abstract
Postoperative cognitive dysfunction (POCD) is a common complication of the surgical experience and is common in the elderly and patients with preexisting neurocognitive disorders. Animal and human studies suggest that neuroinflammation from either surgery or anesthesia is a major contributor to the development of POCD. Moreover, a large and growing body of literature has focused on identifying potential risk factors for the development of POCD, as well as identifying candidate treatments based on the neuroinflammatory hypothesis. However, variability in animal models and clinical cohorts makes it difficult to interpret the results of such studies, and represents a barrier for the development of treatment options for POCD. Here, we present a broad topical review of the literature supporting the role of neuroinflammation in POCD. We provide an overview of the cellular and molecular mechanisms underlying the pathogenesis of POCD from pre-clinical and human studies. We offer a brief discussion of the ongoing debate on the root cause of POCD. We conclude with a list of current and hypothesized treatments for POCD, with a focus on recent and current human randomized clinical trials.
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Affiliation(s)
- Seyed A Safavynia
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States
| | - Peter A Goldstein
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States.,Department of Medicine, Weill Cornell Medical College, New York, NY, United States.,Neuroscience Graduate Program, Weill Cornell Medical College, New York, NY, United States
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18
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Mu DL, Zhang DZ, Wang DX, Wang G, Li CJ, Meng ZT, Li YW, Liu C, Li XY. Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery. Anesth Analg 2017; 124:1992-2000. [DOI: 10.1213/ane.0000000000002095] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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19
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Schreuder L, Eggen BJ, Biber K, Schoemaker RG, Laman JD, de Rooij SE. Pathophysiological and behavioral effects of systemic inflammation in aged and diseased rodents with relevance to delirium: A systematic review. Brain Behav Immun 2017; 62:362-381. [PMID: 28088641 DOI: 10.1016/j.bbi.2017.01.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/26/2016] [Accepted: 01/10/2017] [Indexed: 01/20/2023] Open
Abstract
Delirium is a frequent outcome for aged and demented patients that suffer a systemic inflammatory insult. Animal models that reconstruct these etiological processes have potential to provide a better understanding of the pathophysiology of delirium. Therefore, we systematically reviewed animal studies in which systemic inflammation was superimposed on aged or diseased animal models. In total, 77 studies were identified. Aged animals were challenged with a bacterial endotoxin in 29 studies, 25 studies superimposed surgery on aged animals, and in 6 studies a bacterial infection, Escherichia coli (E. coli), was used. Diseased animals were challenged with a bacterial endotoxin in 15 studies, two studies examined effects of the cytokine IL-1β, and one study used polyinosinic:polycytidilic acid (poly I:C). This systematic review analyzed the impact of systemic inflammation on the production of inflammatory and neurotoxic mediators in peripheral blood, cerebrospinal fluid (CSF), and on the central nervous system (CNS). Moreover, concomitant behavioral and cognitive symptoms were also evaluated. Finally, outcomes of behavioral and cognitive tests from animal studies were compared to features and symptoms present in delirious patients.
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Affiliation(s)
- Leroy Schreuder
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands.
| | - B J Eggen
- Department of Neuroscience, Section Medical Physiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Knut Biber
- Department of Neuroscience, Section Medical Physiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry and Psychotherapy, Section of Molecular Psychiatry, University of Freiburg, Freiburg, Germany.
| | - Regien G Schoemaker
- Department of Neurobiology, GELIFES, University of Groningen, Groningen, The Netherlands.
| | - Jon D Laman
- Department of Neuroscience, Section Medical Physiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands.
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20
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Zhu YZ, Yao R, Zhang Z, Xu H, Wang LW. Parecoxib prevents early postoperative cognitive dysfunction in elderly patients undergoing total knee arthroplasty: A double-blind, randomized clinical consort study. Medicine (Baltimore) 2016; 95:e4082. [PMID: 27428192 PMCID: PMC4956786 DOI: 10.1097/md.0000000000004082] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Trial design neuroinflammation and postoperative pain after surgery are increasingly reported in association with postoperative cognitive dysfunction (POCD). Parecoxib, a selective cyclooxygenase (COX)-2 inhibitor, is used for postoperative analgesia for its potent anti-inflammatory and analgesic effects. This study aimed to evaluate parecoxib's effects on POCD in elderly patients undergoing total knee arthroplasty. METHODS Around 134 elderly patients undergoing total knee arthroplasty were randomly divided into parecoxib (group P) and control (group C) groups, and treated with parecoxib sodium and saline, respectively, shortly after induction of general anesthesia and 12-h postsurgery, respectively. Perioperative plasma IL-1β, IL-6, TNF-α, and C-reactive protein (CRP) 1evels were measured. Postoperative pain was assessed following surgery. Neuropsychological tests were performed before surgery, and 1 week and 3 months postoperation. RESULTS POCD incidence in group P was significantly lower compared with that of group C at 1 week after surgery (16.7% vs 33.9%; P < 0.05); no significant difference was found between groups C and P at 3-month follow-up (9.7% vs 6.7%). Compared with group C values, visual analog pain scale (VAS) scores at 3, 6, and 12 hours after surgery were significantly lower in group P(P < 0.05). Plasma IL-1β, IL-6, and TNF-α levels were lower in group P than in group C after the operation (P < 0.05). No significant difference in the plasma CRP level was found between groups P and C. CONCLUSIONS Parecoxib sodium decreases POCD incidence after total knee arthroplasty in elderly patients and may explain how this drug suppresses inflammation and acute postoperative pain caused by surgical trauma.
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Affiliation(s)
- Yang-Zi Zhu
- Department of Anesthesiology, Xuzhou Central Hospital
| | - Rui Yao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University
| | - Zhe Zhang
- Department of Anesthesiology, Xuzhou Central Hospital
| | - Hui Xu
- Department of neurology, Xuzhou Central Hospital, Xuzhou, PR China
| | - Li-Wei Wang
- Department of Anesthesiology, Xuzhou Central Hospital
- Correspondence: Li-Wei Wang, Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, PR China (e-mail: )
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21
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GE YALI, LI XIAOBO, GAO JU, ZHANG XICHENG, FANG XIANGZHI, ZHOU LUOJING, JI WEI, LIN SHUNYAN. Beneficial effects of intravenous dexmedetomidine on cognitive function and cerebral injury following a carotid endarterectomy. Exp Ther Med 2016; 11:1128-1134. [PMID: 26998048 PMCID: PMC4774506 DOI: 10.3892/etm.2016.2978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/25/2015] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to investigate the effects of dexmedetomidine (DEX) on cognition following a carotid endarterectomy (CEA). In addition, the neuroprotective effects of DEX against ischemia-reperfusion injury during CEA were analyzed. Patients due to undergo elective CEA under general anesthesia were randomly assigned to either the DEX-treated group (group D; n=25) or the control group (group C; n=25). Patients in group D were treated with 0.3 µg/kg DEX pre-CEA, followed by 0.3 µg/kg/h DEX intraoperatively up to 30 min prior to the completion of surgery, and the patients in group C received an equal volume of normal saline. Cognitive function was assessed prior to CEA (T0), and at 24, 48, and 72 h, 7 days and 1 month post-surgery (T1-5, respectively), using the Mini-Mental State Examination (MMSE). Blood samples were drawn from the ipsilateral jugular bulb of all patients at 20 min prior to anesthesia (t0), and at 10 min following tracheal intubation, 15 min following clamping and unclamping of the carotid artery, and at 6 and 24 h postoperatively (t1-5, respectively). The protein expression levels of markers of cerebral ischemia and injury, namely S100 calcium-binding protein B (S100B) and neuron-specific enolase (NSE), and the concentration of the oxidative stress marker malondialdehyde (MDA), were analyzed. Patients in group D exhibited elevated MMSE scores at T2 and T3 post-CEA, as compared with group C. Furthermore, the protein expression level of S100B and the concentration of MDA in the jugular bulb of group D patients were markedly decreased compared with those in group C at t3-5 and t3, respectively. The results of the present study suggested that DEX was able to enhance the recovery of cognition following CEA, and this was associated with decreased cerebral damage and antioxidative effects.
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Affiliation(s)
- YA-LI GE
- Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - XIAOBO LI
- Department of Neurology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - JU GAO
- Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - XICHENG ZHANG
- Department of Vascular Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - XIANGZHI FANG
- Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - LUOJING ZHOU
- Department of Scientific Research, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - WEI JI
- Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
| | - SHUNYAN LIN
- Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu 225001, P.R. China
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22
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Yan BC, Jeon YH, Park JH, Kim IH, Cho JH, Ahn JH, Chen BH, Tae HJ, Lee JC, Ahn JY, Kim DW, Cho JH, Won MH, Hong S. Increased cyclooxygenase-2 and nuclear factor-κB/p65 expression in mouse hippocampi after systemic administration of tetanus toxin. Mol Med Rep 2015; 12:7837-44. [PMID: 26498481 PMCID: PMC4758276 DOI: 10.3892/mmr.2015.4490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/01/2015] [Indexed: 12/21/2022] Open
Abstract
Brain inflammation has a crucial role in various diseases of the central nervous system. The hippocampus in the mammalian brain exerts an important memory function, which is sensitive to various insults, including inflammation induced by exo/endotoxin stimuli. Tetanus toxin (TeT) is an exotoxin with the capacity for neuronal binding and internalization. The present study investigated changes in inflammatory mediators in the mouse hippocampus proper (CA1‑3 regions) and dentate gyrus (DG) after TeT treatment. The experimental mice were intraperitoneally injected with TeT at a low dosage (100 ng/kg), while the control mice were injected with the same volume of saline. At 6, 12 and 24 h after TeT treatment, changes in the hippocampal levels of inflammatory mediators cyclooxygenase‑2 (COX‑2) and nuclear factor kappa‑B (NF‑κB/p65) were assessed using immunohistochemical and western blot analysis. In the control group, moderate COX‑2 immunoreactivity was observed in the stratum pyramidal (SP) of the CA2‑3 region, while almost no expression was identified in the CA1 region and the DG. COX‑2 immunoreactivity was increased by TeT in the SP and granule cell layer (GCL) of the DG in a time‑dependent manner. At 24 h post‑treatment, COX‑2 immunoreactivity in the SP of the CA1 region and in the GCL of the DG was high, and COX‑2 immunoreactivity in the SP of the CA2/3 region was highest. Furthermore, the present study observed that NF‑κB/p65 immunoreactivity was obviously increased in the SP and GCL at 6, 12 and 24 h after TeT treatment. In conclusion, the present study demonstrated that systemic treatment with TeT significantly increased the expression of COX-2 and NF-κB/p65 in the mouse hippocampus, suggesting that increased COX‑2 and NF-κB/65 expression may be associated with inflammation in the brain induced by exotoxins.
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Affiliation(s)
- Bing Chun Yan
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, Jiangsu 225001, P.R. China
| | - Yong Hwan Jeon
- Department of Radiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Joon Ha Park
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - In Hye Kim
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Jeong-Hwi Cho
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Ji Hyeon Ahn
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Bai Hui Chen
- Department of Physiology, College of Medicine, Hallym University, Chuncheon, Gangwon 200‑702, Republic of Korea
| | - Hyun-Jin Tae
- Department of Biomedical Science and Research Institute of Bioscience and Biotechnology, Hallym University, Chuncheon, Gangwon 200‑702, Republic of Korea
| | - Jae-Chul Lee
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Ji Yun Ahn
- Department of Emergency Medicine, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Gyeonggi 431‑796, Republic of Korea
| | - Dong Won Kim
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Jun Hwi Cho
- Department of Emergency Medicine, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Moo-Ho Won
- Department of Neurobiology, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
| | - Seongkweon Hong
- Department of Surgery, School of Medicine, Kangwon National University, Chuncheon, Gangwon 200‑701, Republic of Korea
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Shen H, Chen Y, Lu KZ, Chen J. Parecoxib for the prevention of shivering after general anesthesia. J Surg Res 2015; 197:139-44. [PMID: 25908099 DOI: 10.1016/j.jss.2015.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 01/26/2015] [Accepted: 03/10/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Shivering is the most common complication during the recovery period after general anesthesia, and there is no clear consensus about the best strategy for its prophylactic. The aim of the study was to evaluate the efficacy of parecoxib in prevention of postoperative shivering. METHODS Eighty patients with American Society of Anesthesiologists physical status I-II, who were scheduled for minor urological surgeries under general anesthesia, were randomly assigned to two groups (n = 40 in each group): group P received 40 mg of parecoxib by intravenous bolus injection and group S received the same volume of normal saline in the same way just after the induction of anesthesia. Hemodynamic parameters and body temperatures including tympanic and axillary temperature were monitored. The occurrence of shivering and pain intensity score were recorded during the recovery period. RESULTS Parecoxib significantly reduced the incidence and severity of shivering in comparison with the placebo. Postoperative shivering was observed in 22 patients in group S (55%), compared with nine in group P (22.5%) (P = 0.003). In addition, pain intensity scores were lower in group P during recovery period; consequently, less rescue analgesics were required in group P when compared with group S (P = 0.001). Regarding the body temperature, it was found that core temperature decreased but peripheral temperature increased significantly in both groups. There was no significant difference between groups in all time intervals. CONCLUSIONS Prophylactic administration of parecoxib produces dual effects on antishivering and postoperative analgesia. This implies that cyclooxygenase 2-prostaglandin E2 pathways may be involved in the regulation of shivering.
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Affiliation(s)
- Hong Shen
- Department of Radiology, Chongqing Fifth Hospital, Chongqing, PR China
| | - Yan Chen
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
| | - Kai-zhi Lu
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
| | - Jie Chen
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, PR China.
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Ma W, Wang K, Du J, Luan J, Lou G. Multi-dose parecoxib provides an immunoprotective effect by balancing T helper 1 (Th1), Th2, Th17 and regulatory T cytokines following laparoscopy in patients with cervical cancer. Mol Med Rep 2014; 11:2999-3008. [PMID: 25434365 DOI: 10.3892/mmr.2014.3003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 11/07/2014] [Indexed: 11/05/2022] Open
Abstract
Analgesic treatment with anti‑inflammatory drugs may aid the prevention of postoperative pain and the attenuation of the postoperative immune inflammatory response. The current study presents a randomized, double‑blind controlled study, which was performed to investigate the levels of Th1, Th2, Th17 and Treg cytokines, including interleukin (IL)‑2, interferon (IFN)‑γ, IL‑4, IL‑10, IL‑17, IL‑23 and transforming growth factor (TGF)‑β in the peripheral blood of patients with cervical cancer following laparoscopy. The effects of perioperative multi‑dose parecoxib on postoperative immune function was evaluated. A total of 80 patients with cervical cancer (stage IB/IIA, ASA I‑III, aged 18‑65 years) that were scheduled for laparoscopy were randomly assigned into either the parecoxib (I; n=40) or control (II; n=40) groups. Group I received 40 mg parecoxib 30 min prior to surgery and then every 12 h subsequent to surgery for 60 h, and group II received normal saline at the corresponding time points. Intravenous tramadol (100 mg) was prescribed for pain relief as required. The mRNA and protein expression levels of cytokines in the peripheral blood were detected by quantitative polymerase chain reaction and ELISA. Pain visual analog scales (VAS) and incidence, analgesic relief, adverse events and the length of hospital stay were recorded. It was demonstrated that the mRNA and protein levels of IL‑2, IFN‑γ and IL‑17 in the two groups were reduced subsequent to surgery, while mRNA and protein expression levels of IL‑4, IL‑10 and TGF‑β were enhanced. Administration of multi‑dose parecoxib may diminish the increase in postoperative IL‑2, IFN‑γ and IL‑17 levels, and suppress the excessive production of IL‑4, IL‑10 and TGF‑β. This effect is accompanied by lower VAS scores, pain incidence, postoperative nausea/vomiting and infections. In conclusion, perioperative multi‑dose parecoxib was able to alleviate postoperative pain and ameliorate surgery‑induced immune suppression by balancing Th1, Th2, Th17 and Treg cytokines following laparoscopy in patients with cervical cancer. The current study provides support to the hypothesis that parecoxib may be a more effective therapeutic strategy than the currently available options, for postoperative pain and immune function management of patients with cancer.
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Affiliation(s)
- Wenguang Ma
- Department of Gynecology, The Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Kun Wang
- Department of Anesthesiology, The Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Jongqiang Du
- Department of Anesthesiology, The First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - Junqi Luan
- Department of Gynecology, The First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - Ge Lou
- Department of Gynecology, The Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
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Prophylactic parecoxib reduces the incidence of shivering after general anaesthesia. Eur J Anaesthesiol 2014; 31:714-5. [PMID: 25335108 DOI: 10.1097/eja.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tian Y, Zhao P, Li L, Guo Y, Wang C, Jiang Q. Pre-emptive parecoxib and post-operative cognitive function in elderly patients. Int Psychogeriatr 2014; 27:1-8. [PMID: 25222148 DOI: 10.1017/s1041610214001951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABSTRACT Background: To investigate the effect of pre-emptive parecoxib sodium, given in addition to routine analgesic treatment, on post-operative cognitive function in elderly patients. Methods: Seventy elderly patients were included, who were 65-82 years of age, 48-75 kg of weight, and ASA grade I-II. Preoperative mini mental state examination (MMSE) score was ≥21 points. Patients were randomly divided into two groups: control group (group C) and parecoxib sodium group (group P). Before induction of general anesthesia, 40 mg of parecoxib sodium was injected intravenously in group P and the same volume of saline was injected in group C. Patient-controlled intravenous analgesia (PCIA) containing fentanyl and tramadol was used for post-operative pain control. A 3 ml blood sample was obtained from the peripheral vein one day before surgery, 1, 4, 24, and 72 h after surgery, and plasma cortisol, IL-6 and S100β concentrations were measured. Cognitive function was evaluated by measuring the MMSE score and a neurological test battery within 72 h after surgery. The occurrence of post-operative cognitive dysfunction (POCD), the dosage of fentanyl and tramadol used in PCIA, and the rate of additional fentanyl administration were recorded. Results: Compared to group C, post-operative plasma cortisol concentration decreased, the amount of fentanyl and tramadol used in PCIA was reduced, the rate of additional fentanyl administration decreased, and the rate of POCD was reduced in group P (P < 0.05). Conclusion: Pre-emptive analgesia with 40 mg of parecoxib sodium can reduce the incidence of POCD in elderly patients.
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Affiliation(s)
- Yue Tian
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
| | - Ping Zhao
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
| | - Lu Li
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
| | - Yao Guo
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
| | - Cong Wang
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
| | - Qian Jiang
- Department of Anaesthesiology,Shengjing Hospital of China Medical University,Shenyang,China
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Li RL, Zhang ZZ, Peng M, Wu Y, Zhang JJ, Wang CY, Wang YL. Postoperative impairment of cognitive function in old mice: a possible role for neuroinflammation mediated by HMGB1, S100B, and RAGE. J Surg Res 2013; 185:815-24. [DOI: 10.1016/j.jss.2013.06.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 06/05/2013] [Accepted: 06/20/2013] [Indexed: 01/01/2023]
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Peng L, Xu L, Ouyang W. Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One 2013; 8:e79624. [PMID: 24236147 PMCID: PMC3827367 DOI: 10.1371/journal.pone.0079624] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/03/2013] [Indexed: 12/23/2022] Open
Abstract
Background Postoperative cognitive dysfunction (POCD) is common following cardiac and non-cardiac surgery, but the pathogenic mechanisms remain unknown. Many studies suggest that an inflammatory response is a key contributor to POCD. The current meta-analysis shows that the levels of peripheral inflammatory markers are associated with POCD. Methods An online search was performed to identify peer-reviewed studies without language restriction that measured peripheral inflammatory markers of patients with and without POCD, using PubMed, ScienceDirect, SinoMed and the National Knowledge Infrastructure database. Extracted data were analyzed with STATA (version 12).The standardized mean difference (SMD) and the 95% confidence interval (95%CI) were calculated for each outcome using a random effect model. Tests of heterogeneity assessment of bias, and meta-regression were performed in the meta-analysis. Results A total of 13 studies that measured the concentrations of peripheral inflammatory markers were included. The current meta-analysis found significantly higher concentrations of S-100β(SMD[95%CI]) (1.377 [0.423, 2.331], p-value < 0.001, N [POCD/non-POCD] =178/391, 7 studies), and interleukin(IL)-6 (SMD[95%CI]) (1.614 [0.603,2.624], p-value < 0.001, N[POCD/non-POCD] = 91/99, 5 studies), but not of neuron specific enolase, interleukin-1β, or tumor necrosis factor-α , in POCD compared with patients without POCD. In meta-regression analyses, a significant positive association was found between the SMD and the preoperative interleukin-6 peripheral blood concentration in patients with POCD (Coef.= 0.0587, p-value=0.038, 5 studies). Conclusions This study shows that POCD is indeed correlated with the concentrations of peripheral inflammatory markers, particularly interleukin-6 and S-100β.
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Affiliation(s)
- Linying Peng
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Liwei Xu
- Department of Gastrointestinal Surgery, The First Xiangya Hospital of Central South University, Changsha, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China
- * E-mail:
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Li M, Yong-Zhe L, Ya-Qun M, Sheng-Suo Z, Li-Tao Z, Ning-Ling P. Ulinastatin alleviates neuroinflammation but fails to improve cognitive function in aged rats following partial hepatectomy. Neurochem Res 2013; 38:1070-7. [PMID: 23508312 DOI: 10.1007/s11064-013-1018-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/17/2013] [Accepted: 03/12/2013] [Indexed: 11/29/2022]
Abstract
Postoperative cognitive dysfunction (POCD) is very common complication of surgery in aged individuals. Accumulated evidence suggests that neuroinflammation may be the underlying cause of POCD. The aim of the present study was to investigate the effects of ulinastatin (UTI) on neuroinflammation and on learning and memory of aged rats after anesthesia and surgery. Our results showed that anesthetic isoflurane increased the hippocampal mRNA level of IL-1β, while surgery of partial hepatectomy increased the hippocampal mRNA levels of IL-1β, TNF-α, and IL-6 as well as impaired rats' spatial memory at day 7 post-surgery. UTI (10,000 U/kg, i.v.) decreased the anesthesia- and surgery-induced increases in mRNA levels of all three cytokines, but did not improve the rats' impaired working memory. In conclusion, moderate and temporary suppression of UTI-induced inflammatory cytokines in hippocampus is not sufficient to alleviate the impairment of working memory.
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Affiliation(s)
- Ma Li
- Department of Anesthesiology, Beijing Military General Hospital of the Chinese People's Liberation Army, Beijing 100700, China.
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