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Dong Y, Wang M, Li W, Zhao K, Cui X, Yang Y, Geng X, Pu Y, Hu Z, Fang C, Lv G, Liu S, Chen X. Effect of dexmedetomidine infusion on postoperative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial. Anaesth Crit Care Pain Med 2024; 43:101358. [PMID: 38365169 DOI: 10.1016/j.accpm.2024.101358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Most women with breast cancer are prone to postoperative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep structures. METHODS A monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg-1 infusion 15 min before induction, then infused at 0.4 μg kg-1 h-1 until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of postoperative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA). RESULTS There were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (p = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on postoperative first day (p = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on postoperative first (p < 0.001) and third (p < 0.001) days. CONCLUSION Intra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR2300070136).
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Affiliation(s)
- Yushan Dong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Maosan Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Wenzhan Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Kai Zhao
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Xiaojie Cui
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yanming Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xingyu Geng
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yutian Pu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ziwei Hu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Can Fang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Gaochao Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Su Liu
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiuxia Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
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Li H, Li J, Hao C, Luan H, Zhang X, Zhao Z. Effects of anesthetic depth on perioperative T lymphocyte subsets in patients undergoing laparoscopic colorectal cancer surgery: a prospective, parallel-controlled randomized trial. BMC Anesthesiol 2023; 23:165. [PMID: 37189020 DOI: 10.1186/s12871-023-02129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND During the perioperative period, the surgical stress response induced by surgical trauma tends to cause a decrease in peripheral lymphocytes. Anesthetics could reduce the stress response during surgery and prevent sympathetic nerve overexcitation. The goal of this study was to investigate how BIS-guided anesthetic depth affected peripheral T lymphocytes in patients undergoing laparoscopic colorectal cancer surgery. METHODS A total of 60 patients having elective laparoscopic colorectal cancer surgery were randomly assigned and analyzed (n = 30 for deep general anesthesia, BIS 35, n = 30 for light general anesthesia, BIS 55). Blood samples were collected immediately before anesthesia induction and immediately after operation, 24 h and 5 days postoperatively. The CD4+/CD8 + ratio, T lymphocyte subsets (including CD3 + T cells, CD4 + T cells, and CD8 + T cells), and natural killer (NK) cells were analyzed by flow cytometry. Serum interleukin-6 (IL-6), interferon -ɣ (IFN-ɣ), and vascular endothelial growth factor-α (VEGF-α) were also measured. RESULTS The CD4+/CD8 + ratio decreased 24 h after surgery in two groups, but the reduction did not differ between the two groups (P > 0.05). The concentration of IL-6 and the numerical rating scale (NRS) score in the BIS 55 group were significantly higher than that in the BIS 35 group 24 h after surgery (P = 0.001). There were no intergroup differences in CD3 + T cells, CD4 + T cells, CD8 + T cells, NK cells, VEGF-α, or the IFN-ɣ. Statistical analyses showed no differences between the two groups in the incidence of fever and surgical site infection during hospitalization. CONCLUSIONS Despite the fact that patients in deep general anesthesia group had low levels of the IL-6 24 h after surgery, the deep general anesthesia was not associated to a positive effect on patients' peripheral T lymphocytes during colorectal cancer surgery. We found no evidence that peripheral T lymphocyte subsets and natural killer cells were affected by the targeting a BIS of either 55 or 35 in patients undergoing laparoscopic colorectal cancer surgery in this trial. TRIAL REGISTRATION ChiCTR2200056624 ( www.chictr.org.cn ).
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Affiliation(s)
- Han Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Jiachi Li
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Conghui Hao
- Jinzhou Medical University, No.40 Songpo Road, Jinzhou, Jinzhou, 121010, China
| | - Hengfei Luan
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Xiaobao Zhang
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China
| | - Zhibin Zhao
- Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang, Lianyungang, 222000, China.
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Guerrero Orriach JL, Quesada Muñoz G. Clevidipine and COVID 19: From Hypertension to Inflammatory Response. J Inflamm Res 2022; 15:2383-2386. [PMID: 35444451 PMCID: PMC9013712 DOI: 10.2147/jir.s350822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
Globally, more than 4 million have died from COVID-19, World Health Organization (WHO) to declare COVID-19 a pandemic. The COVID 19 pathology, produced by SARS-COV2, a virus from the coronavirus family, emerged at the end of 2019. The majority of cases usually have a mild or moderate form, characterized by fever, cough, intense asthenia and multiple symptoms derived from the initial replicative effect and subsequent hyperimmune effect. Severe cases present with Acute Respiratory Distress Syndrome (ARDS), due to pneumonia with bilateral involvement, which lead to hospital admission of patients and the need for admission to intensive care units (ICU) of approximately 10‒20%. According to the different series; the mortality of the condition once the patient is admitted to the ICU is close to 35‒45%. Currently, more than 4 million people have died in the world due to this pathology. The volume of infections generated the declaration by the World Health Organization (WHO) of the pandemic situation. Factors associated with a higher risk of progression into severe disease include age and comorbidities, especially systemic arterial hypertension due to its high incidence in the general population. Clevidipine can be rapidly and effectively adjusted to the clinical status of the patient, since it can be withdrawn and its effects reversed in just a few minutes, and contains high concentrations of lipids, and it could reduce the inflammatory response induced by SARS-COV2, which is key to progression into severe disease. However, its application in pro-inflammatory settings has not yet been explored, although it must play a key role in inflammation as a scavenger molecule.
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Affiliation(s)
- Jose Luis Guerrero Orriach
- Institute of Biomedical Research in Malaga, Malaga, Spain
- Department of Anesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
- Correspondence: Jose Luis Guerrero Orriach, Institute of Biomedical Research in Malaga, Malaga, Spain, Email
| | - Guillermo Quesada Muñoz
- Institute of Biomedical Research in Malaga, Malaga, Spain
- Department of Anesthesiology, Virgen de la Victoria University Hospital, Malaga, Spain
- Department of Pharmacology and Pediatrics, School of Medicine, University of Malaga, Malaga, Spain
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Wang G, Yu Y, Wang Y. Effects of propofol on neuroblastoma cells via the HOTAIRM1/miR-519a-3p axis. Transl Neurosci 2022; 13:57-69. [PMID: 35350655 PMCID: PMC8919833 DOI: 10.1515/tnsci-2022-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 12/25/2022] Open
Abstract
Background Propofol, an intravenous sedative-hypnotic agent, is demonstrated to have antioxidant properties. The purpose of this study is to investigate the functional roles of propofol in neuroblastoma cells. Methods The proliferation and apoptosis were assessed by 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazol-3-ium bromide (MTT), EdU, and flow cytometry assays, respectively. The protein expression level was quantified by western blot assay. Inflammation and oxidative stress were determined by measuring the release of inflammatory factors, along with intracellular reactive oxygen species (ROS), lactate dehydrogenase (LDH), malondialdehyde (MDA), and superoxide dismutase (SOD) levels. The real-time quantitative polymerase chain reaction (RT-qPCR) was conducted to assess the expression levels of HOXA transcript antisense RNA, myeloid-specific 1 (HOTAIRM1), and miR-519a-3p in cells. The interaction relationship between HOTAIRM1 and miR-519a-3p was confirmed by dual-luciferase reporter, RNA immunoprecipitation (RIP), and RNA pull-down assays. Results Treatment with MPP+ has been observed to induce apoptosis, oxidative stress, and inflammation in neuroblastoma cells, which were abolished by propofol or silencing of HOTAIRM1. Importantly, the increase of HOTAIRM1 and the decrease of miR-519a-3p caused by MPP+ were reversed by propofol in neuroblastoma cells. In addition, miR-519a-3p was a target of HOTAIRM1, and inhibition of miR-519a-3p abolished HOTAIRM1 silencing-induced effects on neuroblastoma cells. Moreover, functional experiments revealed that propofol might weaken MPP+-induced apoptosis, oxidative stress, and inflammation by regulating the HOTAIRM1/miR-519a-3p axis. Conclusion Propofol inhibited oxidative stress and inflammation in MPP+-induced neuroblastoma cells by targeting the HOTAIRM1/miR-519a-3p axis, implying the potential protective function of propofol against oxidative damage.
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Affiliation(s)
- Guan Wang
- Department of Anesthesiology, The Second Hospital of Dalian Medical University , No. 467 Zhongshan Road, Shahekou District , Dalian , Liaoning , China
| | - Yao Yu
- Department of Anesthesiology, The Second Hospital of Dalian Medical University , No. 467 Zhongshan Road, Shahekou District , Dalian , Liaoning , China
| | - Yang Wang
- Department of Anesthesiology, The Second Hospital of Dalian Medical University , No. 467 Zhongshan Road, Shahekou District , Dalian , Liaoning , China
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Liu T, Song J, Zhou Q, Chu S, Liu Y, Zhao X, Ma Z, Xia T, Gu X. The role of 5-HT 7R in the memory impairment of mice induced by long-term isoflurane anesthesia. Neurobiol Learn Mem 2022; 188:107584. [PMID: 35032676 DOI: 10.1016/j.nlm.2022.107584] [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: 05/20/2021] [Revised: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
General anesthesia is widely utilized in the clinic for surgical and diagnostic procedures. However, growing evidence suggests that anesthetic exposure may affect cognitive function negatively. Unfortunately, little is known about the underlying mechanisms and efficient prevention and therapeutic strategies for the anesthesia-induced cognitive dysfunction. 5-HT7R, a serotonin receptor family member, is functionally associated with learning and memory. It has recently become a potential therapeutic target in various neurological diseases as its ligands have a wide range of neuropharmacological effects. However, it remains unknown the role of 5-HT7R in the long-term isoflurane anesthesia-induced memory impairment and whether prior activation or blockade of 5-HT7R before anesthesia has modulating effects on this memory impairment. In this study, 5-HT7R selective agonist LP-211 and 5-HT7R selective antagonist SB-269970 were pretreated intraperitoneally to mice before anesthesia; their effects on the cognitive performance of mice were assessed using fear conditioning test and novel object recognition test. Furthermore, the transcriptional level of 5-HT7R in the hippocampus was detected using qRT-PCR, and proteomics was conducted to probe the underlying mechanisms. As a result, long-term exposure to isoflurane anesthesia caused memory impairment and an increase in hippocampal 5-HT7R mRNA expression, which could be attenuated by SB-269970 pretreatment but not LP-211pretreatment. According to the proteomics results, the antiamnestic effect of SB-269970 pretreatment was probably attributed to its action on the gene expression of Slc6a11, Itpka, Arf3, Srcin1, and Epb41l2, and synapse organization in the hippocampus. In conclusion, 5-HT7R is involved in the memory impairment induced by long-term isoflurane anesthesia, and the prior blockade of 5-HT7R with SB-269970 protects the memory impairment. This finding may help to improve the understanding of the long-term isoflurane anesthesia-induced memory impairment and to construct potential preventive and therapeutic strategies for the adverse effects after long-term isoflurane exposure.
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Affiliation(s)
- Tiantian Liu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Jia Song
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Qingyun Zhou
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Shuaishuai Chu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Yujia Liu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xin Zhao
- Nanjing Stomatology Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
| | - Tianjiao Xia
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Jiangsu Key Laboratory of Molecular Medicine, Nanjing University, Nanjing, Jiangsu Province, China.
| | - Xiaoping Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
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Cho HB, Kim MG, Park SY, Song S, Jang YS, Park S, Lee HK, Yoo JH, Chung JW, Kim SH. The influence of propofol-based total intravenous anesthesia on postoperative outcomes in end-stage renal disease patients: A retrospective observation study. PLoS One 2021; 16:e0254014. [PMID: 34292982 PMCID: PMC8297880 DOI: 10.1371/journal.pone.0254014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background To determine whether the anesthetic method of propofol total intravenous anesthesia (TIVA) is associated with postoperative outcome in ESRD patients, we evaluated the incidence of postoperative major adverse cardiac events (MACE), comparing propofol TIVA versus anesthesia with volatile anesthesia in ESRD patients. Methods Retrospectively, we identified cases with ESRD patients who underwent surgery under general anesthesia. Patients were divided into those who received only volatile anesthesia (volatile group) and those who received only propofol TIVA (TIVA group). The incidence of MACE and potential confounding variables were compared separately in a univariate logistic model and subsequently by multivariate logistic regression. Results Among the 2576 cases in ESRD patients, 1374 were in the TIVA group and 1202 were in the volatile group. The multivariate analysis included 12 factors, including the anesthesia method, of which five factors were significant. Factors that were associated with a significantly lower MACE risk included preoperative chloride concentration (OR: 0.96; 95% CI, 0.92–0.99), baseline SBP (OR: 0.98; 95% CI, 0.98–0.99), and propofol TIVA (OR: 0.37; 95% CI, 0.22–0.60). Conclusions We inferred that the anesthetic method associated with the postoperative outcome in patients with ESRD.
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Affiliation(s)
- Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
- * E-mail:
| | - Sanghoon Song
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Youn Sil Jang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Keun Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Ji Won Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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Ayıkgöz Y, Salih Aydın M, Kankılıç N, Temiz E. Nuclear factor erythroid 2-related factor 2 (Nrf2), tumor necrosis factor alpha protein (TNF-α), heme oxygenase-1 (HO-1) gene expressions during cardiopulmonary bypass. Gene 2021; 790:145690. [PMID: 33961973 DOI: 10.1016/j.gene.2021.145690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/14/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE During extracorporeal circulation, blood is in contact with nonendothelial surfaces. The increase in the amount of blood touching the non-endothelial surface increases the damage to the blood elements. This initiates and increases oxidative stress. Increased oxidative stress leads to the activation of antioxidant systems. These two systems work gradually in the process of Cardiopulmonary Bypass. This study aims to investigate the changes of TNF-α, Nrf2 and HO-1 gene expression in extracorporeal circulation. MATERIALS AND METHODS Fifteen patients who underwent open heart surgery were included in the study. Blood samples were taken preoperatively, during cardiopulmonary bypass (CPB) and 24 hours postoperatively. TNF-α, Nrf2 and HO-1 gene expressions in plasma samples were studied by using appropriate kits. Changes in gene expressions were compared. RESULTS TNF-α gene expression increased during CPB compared to preoperative levels (p <0.05). Similarly, Nrf-2 gene expression increased significantly during CPB (p <0.001) and decreased postoperatively (p <0.001). There was a significant increase in HO-1 gene expression during CPB (p <0.01). Postoperatively, this increase was found to decrease similar to Nrf2 (p <0.05). CONCLUSIONS According to the results, TNF-α, Nrf2, HO-1 gene expressions increase during CPB and these values decrease after the operation. This shows that oxidative stress and inflammatory processes start with CPB and antioxidant processes start similarly. With the termination of CPB, both processes are terminated. This has been demonstrated by gene expressions. Future studies will make it easier to understand these processes.
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Affiliation(s)
- Yusuf Ayıkgöz
- Department of Cardiovascular Surgery, Medical Faculty, Harran University, Şanlıurfa, Turkey
| | - Mehmet Salih Aydın
- Department of Cardiovascular Surgery, Medical Faculty, Harran University, Şanlıurfa, Turkey
| | - Nazım Kankılıç
- Department of Cardiovascular Surgery, Medical Faculty, Harran University, Şanlıurfa, Turkey.
| | - Ebru Temiz
- Medical Promotion and Marketing Program, Health Services Vocational School, Harran University, Department of Biochemistry, Medical Faculty, Harran University, Şanlıurfa, Turkey
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Oh TK, Song IA. Total Intravenous Anesthesia was Associated With Better Survival Outcomes After Coronary Artery Bypass Grafting: A Retrospective Cohort Study With 3-Year Follow-Up in South Korea. J Cardiothorac Vasc Anesth 2020; 34:3250-3256. [PMID: 32762879 DOI: 10.1053/j.jvca.2020.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The authors aimed to investigate if the anesthetic technique was associated with 3-year all-cause mortality after isolated coronary artery bypass grafting (CABG). DESIGN Population-based cohort study. SETTING Cohort data obtained from the National Health Insurance Service database in South Korea. PARTICIPANTS All adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2015. EXPOSURES The authors divided the cohort into the following 2 groups: the total intravenous anesthesia group using propofol (TIVA group) and the volatile anesthesia group. MEASUREMENTS AND MAIN RESULTS The primary study endpoint was 3-year all-cause mortality. The authors enrolled 10,440 patients from 91 hospitals; among them, 3,967 patients were in the TIVA group and 6,473 were in the volatile anesthesia group. After propensity score matching, the authors included 5,656 patients (2,828 patients per group) in the final analysis. The 3-year all-cause mortality rates in the TIVA and volatile anesthesia groups were 15.3% (434/2,828) and 18.3% (518/2,828), respectively. The risk of 3-year all-cause mortality was 16% lower in the TIVA group than in the volatile anesthesia group (hazard ratio: 0.84, 95% confidence interval: 0.75-0.94; p = 0.002). Similar results were observed for 30-day, 90-day, and 1-year all-cause mortality after CABG. CONCLUSION Compared with volatile anesthesia, propofol-based TIVA was associated with decreased 3-year all-cause mortality in patients undergoing CABG. This was the first study to suggest that TIVA might be associated with an increase in survival at 3-year follow-up after CABG, and further studies are needed to confirm the optimal anesthetic choice for CABG.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Pan S, Chen Y, Zhang X, Xie Y. The JAK2/STAT3 pathway is involved in dexmedetomidine-induced myocardial protection in rats undergoing cardiopulmonary bypass. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:483. [PMID: 32395527 PMCID: PMC7210156 DOI: 10.21037/atm.2020.03.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Many studies have reported that dexmedetomidine protects organs from ischemia/reperfusion-induced injury. However, the mechanism of this protective effect remains inconclusive. Methods Rats were randomly divided into 6 groups (n=8). Rats in the sham group were not subjected to cardiopulmonary bypass (CPB) while rats in the other groups underwent CPB for 2 h. Groups L and H received a low and a high dose of dexmedetomidine, respectively. Rats in group AG490 received 10 mg/kg of the Janus kinase 2 (JAK2) inhibitor, AG490, 30 min before anesthesia. Plasma levels of the inflammatory cytokines, interleukin (IL)-6 and IL-10, were measured by enzyme-linked immunosorbent (ELISA), and the apoptosis rate of myocardial cells, the expression of JAK2 and signal transducer and activator of transcription (STAT)3 mRNA, and the protein expression of JAK2, STAT3, pJAK2, pSTAT3, and caspase-3 were analyzed in myocardial tissues by real-time quantitative polymerase chain reaction (qRT-PCR), western blotting, and immunohistochemistry. Results We observed that, in both group L and group H, the level of IL-6 decreased (P<0.05), and the apoptosis rate of myocardial cells were reduced (P<0.05) compared to those in the CPB group. Moreover, qRT-PCR results revealed that dexmedetomidine administration reduced the expression of JAK2 and STAT3 mRNA (P<0.05); pJAK2 and pSTAT3 (P<0.05) protein levels were also reduced as assessed by western blotting and immunohistochemistry (P<0.05). Conclusions Dexmedetomidine treatment reduced CPB-related myocardial injury by inhibiting inflammatory reactions and myocardial apoptosis, and can be a potential therapy in CPB-related surgery.
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Affiliation(s)
- Sining Pan
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yanhua Chen
- Department of Anesthesiology of Cardiovascular Institute, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xu Zhang
- Department of Anesthesiology, the Second Affiliated Hospital of Guilin Medical University, Guilin 541199, China
| | - Yubo Xie
- Department of Anesthesiology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Irwin MG, Chung CKE, Ip KY, Wiles MD. Influence of propofol-based total intravenous anaesthesia on peri-operative outcome measures: a narrative review. Anaesthesia 2020; 75 Suppl 1:e90-e100. [PMID: 31903578 DOI: 10.1111/anae.14905] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Propofol-based total intravenous anaesthesia is well known for its smooth, clear-headed recovery and anti-emetic properties, but there are also many lesser known beneficial properties that can potentially influence surgical outcome. We will discuss the anti-oxidant, anti-inflammatory and immunomodulatory effects of propofol and their roles in pain, organ protection and immunity. We will also discuss the use of propofol in cancer surgery, neurosurgery and older patients.
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Affiliation(s)
- M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C K E Chung
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Ip
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - M D Wiles
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Alhayyan A, McSorley S, Roxburgh C, Kearns R, Horgan P, McMillan D. The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surg Open Sci 2020; 2:1-21. [PMID: 32754703 PMCID: PMC7391900 DOI: 10.1016/j.sopen.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. METHODS This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. RESULTS Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12-24 and 24-72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein (P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. CONCLUSION There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.
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Affiliation(s)
- Aliah Alhayyan
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Stephen McSorley
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Campbell Roxburgh
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Department of Anaesthetics, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Paul Horgan
- Institute of Cancer Sciences, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Donald McMillan
- Institute of Cancer Sciences, Department of Surgery, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
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Sbrana S, Nunziata A, Storti S, Haxhiademi D, Mazzone A, Leone M, Solinas M, Del Sarto P. Differential modulatory effects of Propofol and Sevoflurane anesthesia on blood monocyte HLA-DR and CD163 expression during and after cardiac surgery with cardiopulmonary bypass: a preliminary randomized flow cytometry study. Perfusion 2019; 35:48-56. [PMID: 31151363 DOI: 10.1177/0267659119848295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The increase of the anti-inflammatory CD163highHLA-DRlow blood monocyte subset is one of the mechanisms dampening inflammation during cardiac surgery with cardiopulmonary bypass. We evaluated the effect of two different anesthetic protocols, intravenous Propofol infusion or Sevoflurane-gas administration, on the perioperative frequency of this subset. METHODS Blood from patients (Propofol = 11, Sevoflurane = 13) undergoing minimally invasive mitral valve surgery was drawn preoperatively (T1), before declamping (T2), at 6 (T3), 24 (T4), 48 (T5), and 72 hours (T6) after declamping. C-reactive protein, haptoglobin, and lactate dehydrogenase were measured. A hemolytic index, as C-reactive protein/haptoglobin ratio, was introduced. Monocyte expression of HLA-DR, CD163, and the CD163highHLA-DRlow subset fraction was quantified by flow cytometry. Baseline-referred variations of plasmatic and cellular data at T2 were normalized for clamping times. Subsequent time-point variations were normalized for the final cardiopulmonary bypass times. RESULTS Variations of hemolytic index and lactate dehydrogenase were higher with Propofol at T3 (p = 0.004 and p = 0.02, respectively) when compared with Sevoflurane. At T2, the down-modulation of CD163 was higher with Propofol (p = 0.005). Starting from T3, the up-regulatory trend of CD163 was basically higher with Propofol, although not significantly. Propofol induced higher increments of HLA-DR low fractions, at T2 (p = 0.04) and, to a lesser extent, at T4 (p = 0.06). Starting from T3, the CD163highHLA-DRlow subset variations were higher with Propofol, especially at T4 and T6. CONCLUSION Propofol seems to induce a higher postoperative fraction of the CD163highHLA-DRlow monocyte subset. This could represent either a compensatory mechanism dampening the higher inflammatory condition observed with Propofol at T2 or a consequence of a higher postoperative Propofol-induced hemolysis.
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Affiliation(s)
- Silverio Sbrana
- Flow Cytometry Laboratory, CNR Institute of Clinical Physiology, Ospedale del Cuore, Massa, Italy
| | - Anna Nunziata
- Department of Anesthesiology and Intensive Care, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Simona Storti
- Unit of Laboratory Medicine, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Dorela Haxhiademi
- Department of Anesthesiology and Intensive Care, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Annamaria Mazzone
- Adult Cardiology Department, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Maria Leone
- Perfusion Unit, Cardiothoracic Department, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Marco Solinas
- Adult Cardiac Surgery Department, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Paolo Del Sarto
- Department of Anesthesiology and Intensive Care, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio, Massa, Italy
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Effects of propofol on the inflammatory response during robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled study. Sci Rep 2019; 9:5242. [PMID: 30918320 PMCID: PMC6437140 DOI: 10.1038/s41598-019-41708-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALRP) is a minimally invasive procedure; however, some amount of surgical trauma that can trigger systemic inflammation remains. Moreover, pneumoperitoneum during RALRP induces ischemia–reperfusion injury (IRI). Propofol, an anesthetic, is known to have anti-inflammatory and antioxidant properties. In the present study, we compared the effects of propofol with those of desflurane on inflammation and IRI during RALRP via measurements of different biomarkers and evaluation of perioperative renal function. Fifty patients were randomized to receive either desflurane (n = 25) or propofol (n = 25) with remifentanil during RALRP. Serum levels of interleukin (IL)-6 (IL-6), tumor necrosis factor alpha, C-reactive protein, and nitric oxide were measured 10 min after anesthesia induction (T1), 100 min after carbon dioxide (CO2) insufflation (T2), and 10 min after CO2 deflation (T3). Perioperative urine outputs and the serum creatinine level at 24 h after surgery were also recorded. We found that IL-6 levels at T2 and T3 were higher than those at T1 in both groups, although the increases were significant attenuated only in the propofol group. The other parameters showed no differences among the three time points in both groups. The intraoperative urine output was significantly higher in the propofol group than in the desflurane group, while the creatinine level showed no significant changes in either group. Our findings suggest that propofol can not only attenuate the inflammatory response during and after pneumoperitoneum in patients undergoing RALRP but also prevent oliguria during pneumoperitoneum.
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Chen CY, Tsai YF, Huang WJ, Chang SH, Hwang TL. Propofol inhibits endogenous formyl peptide-induced neutrophil activation and alleviates lung injury. Free Radic Biol Med 2018; 129:372-382. [PMID: 30312762 DOI: 10.1016/j.freeradbiomed.2018.09.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 02/06/2023]
Abstract
Critically ill patients have a high risk of sepsis. Various studies have demonstrated that propofol has anti-inflammatory effects that may benefit critically ill patients who require anesthesia. However, the mechanism and therapeutic effect remain incompletely understood. Our previous data suggest that propofol can act as a formyl peptide receptor 1 (FPR1) antagonist. Here, we hypothesize that propofol mitigates sepsis-induced acute lung injury (ALI) by inhibiting mitochondria-derived N-formyl peptide-mediated neutrophil activation. Oxidative stress caused by activated neutrophils is involved in the pathogenesis of ALI. In human neutrophils, propofol competitively reduced the release of superoxide and associated reactive oxygen species induced by fMMYALF, a human mitochondria-derived N-formyl peptide, suggesting that propofol effectively suppresses neutrophilic oxidative stress. In addition, propofol significantly inhibited fMMYALF-induced elastase release, chemotaxis, calcium mobilization, and phosphorylation of protein kinase B and mitogen-activated protein kinases. These results indicate that propofol suppresses neutrophil activation by blocking the interaction between endogenous N-formyl peptide and its receptor, FPR1, thus inhibiting downstream signaling. Furthermore, propofol alleviated alveolar wall disruption, edematous changes, and neutrophil infiltration in lipopolysaccharide-induced ALI in mice. Noticeably, propofol improved the survival of sepsis mice. This study indicates that the anti-neutrophil effects of propofol may benefit critically ill septic patients.
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Affiliation(s)
- Chun-Yu Chen
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Yung-Fong Tsai
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wei-Ju Huang
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shih-Hsin Chang
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Tsong-Long Hwang
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; Chinese Herbal Medicine Research Team, Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan; Research Center for Chinese Herbal Medicine, Research Center for Food and Cosmetic Safety, and Graduate Institute of Health Industry Technology, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan; Department of Chemical Engineering, Ming Chi University of Technology, New Taipei City 243, Taiwan.
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Wang D, Lou X, Jiang XM, Yang C, Liu XL, Zhang N. Quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in rat model of cardiopulmonary resuscitation through modulating Bmi‑1 expression. Mol Med Rep 2018; 18:610-616. [PMID: 29749525 DOI: 10.3892/mmr.2018.8994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/24/2018] [Indexed: 11/06/2022] Open
Abstract
With extensive pharmacological actions, quercetin has anti‑oxidant, free radical scavenging, anti‑tumor, anti‑inflammatory, anti‑bacterial and anti‑viral activity. Quercetin also reduces blood glucose and reduces high blood pressure, and has immunoregulation and cardiovascular protection functions. Additionally, it has been reported that it can reduce depression. The current study evaluated whether quercetin protects against inflammation, matrix metalloproteinase‑2 (MMP‑2) activation and apoptosis induction in a rat model of cardiopulmonary resuscitation (CPR), and whether Bmi‑1 expression was involved in the effects. In CPR model rats, treatment with quercetin significantly recovered left ventricular ejection fraction, left ventricular fractional shortening, ejection fraction (%), and left ventricle weight/body weight. Treatment with quercetin significantly inhibited ROS generation, inflammation and MMP‑2 protein expression in the rat model CPR. Finally, quercetin significantly suppressed caspase‑3 activity and activated Bmi‑1 protein expression in the rat model of CPR. The results demonstrated that quercetin protects against inflammation, MMP‑2 activation and apoptosis induction in a rat model of CPR, and that this may be mediated by modulating Bmi‑1 expression.
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Affiliation(s)
- Dawei Wang
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaoqian Lou
- Department of Endocrinology, Second Department, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiao-Ming Jiang
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chenxi Yang
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, BC V6P 2G9, Canada
| | - Xiao-Liang Liu
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Nan Zhang
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Haines DD, Tosaki A. Role of Heme Oxygenases in Cardiovascular Syndromes and Co-morbidities. Curr Pharm Des 2018; 24:2322-2325. [PMID: 30051777 PMCID: PMC6225334 DOI: 10.2174/1381612824666180727110353] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/17/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
Abstract
Cardiovascular Diseases (CVD), are the leading cause of human mortality worldwide and the focus of the intensive investigation is to characterize their pathogenesis. This review examines contribution to CVD of heme oxygenases (HOs), heat shock protein enzymes, comprising 3 isoforms: HO-1 (inducible), HO-2 (constitutively expressed) and HO-3 (function presently undefined), which constitute a primary endogenous countermeasure to oxidative tissue damage. Their role as CVD countermeasures is considered in the context of atherosclerosis, consequences of which are the leading cause of CVD deaths and from which 5 major syndromes may develop, namely: coronary artery disease and stroke, peripheral artery disease, kidney disease, cardiopulmonary disease and cerebrovascular disease. Over 75% of CVD deaths result from Coronary artery disease and stroke, with the severity of these conditions correlating with a systemic increase of the endogenous antioxidant bilirubin, produced by HO degradation of heme. Peripheral artery disease, (PAD) resulting from constricted arteries of the extremities is a painful and disabling condition, the severity of which correlates with elevated serum HO. Whether this represents an adaptive response or the enzyme is a contributor to PAD, remains to be determined. CVD symptoms, particularly hypertension, damage the vasculature and filtering structures of the kidneys and may be ameliorated by HO inducers. Interestingly, constitutive renal expression of HO-2 indicates that the enzyme is vital for healthy kidney function. Right ventricular hypertrophy and increased vascular resistance in blood vessels of the lungs exhibit mutually reinforcing positive feedback to result in cardiopulmonary heart disease, with morbidity and mortality resulting from associated inflammation and may be decreased with HO-1 inducers. Cerebrovascular disease, a major CVD complication affecting brain vasculature, with resulting susceptibility to stroke, maybe potently ameliorated by HO-1 inducers. Conclusion: Each of the six major categories of CVD exhibit features of pathogenesis that hold potential as future therapeutic targets, for modulated heme oxygenase activity.
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Affiliation(s)
- David D. Haines
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
| | - Arpad Tosaki
- Department of Pharmacology, Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
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17
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Influence of the postoperative inflammatory response on cognitive decline in elderly patients undergoing on-pump cardiac surgery: a controlled, prospective observational study. BMC Anesthesiol 2017; 17:113. [PMID: 28851286 PMCID: PMC5576316 DOI: 10.1186/s12871-017-0408-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023] Open
Abstract
Background The role of non-infective inflammatory response (IR) in the aetiology of postoperative cognitive dysfunction (POCD) is still controversial. The aim of this controlled, prospective observational study was to assess the possible relationship between the grade of IR, defined by procalcitonin (PCT) changes, and development of POCD related to cardiac surgery. Methods Forty-two patients, who were ≥ 60 years of age and scheduled for elective cardiac surgery, were separated into the low inflammatory (LIR) and high inflammatory (HIR) response groups based on their PCT levels measured on the first postoperative day. A matched normative control group of 32 subjects was recruited from primary care practice. The PCT and C-reactive protein (CRP) levels were monitored daily during the first five postoperative days. The cognitive function and mood state were preoperatively tested with a set of five neurocognitive tests and two mood inventories and at the seventh postoperative day. The Reliable Change Index modified for practice (RCIp) using data from normative controls was applied to determine the significant decline in test performance. Results The LIR (n = 20) and HIR (n = 22) groups differed significantly in the PCT (p < 0.001) but not in the CRP time courses. The incidence of POCD at the first postoperative week was 35.7% in the cohort. The LIR and HIR groups did not vary in the RCIp Z scores of neurocognitive tests and frequencies of POCD (7 vs 8 cases, respectively, p > 0.05). Additionally, there was no difference in the mood states, anxiety levels and perioperative parameters known to influence the development of POCD. Conclusions In this study, the magnitude of the non-infective inflammatory response generated by on-pump cardiac surgery did not influence the development of POCD in the early postoperative period in elderly patients.
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Mohaghegh T, Yazdi B, Norouzi A, Fateh S, Modir H, Mohammadbeigi A. Effect of intravenous anesthesia with propofol versus isoflurane inhalation anesthesia in postoperative pain of inguinal herniotomy: a randomized clinical trial. Med Gas Res 2017; 7:86-92. [PMID: 28744360 PMCID: PMC5510298 DOI: 10.4103/2045-9912.208511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Postoperative pain is a common problem after inguinal herniotomy. We aimed to compare the intravenous anesthesia effects of propofol and isoflurane inhalation anesthesia on postoperative pain after inguinal herniotomy. In a randomized clinical trial, 102 eligible patients were selected based on inclusion and exclusion criteria and were randomly divided in two groups. In the first group, propofol was used for the maintenance of anesthesia, while isoflurane was used in the second group. The patient’s heart rate, systolic and diastolic blood pressure and oxygen saturation before, during and after surgery, recovery time and postoperative pain were measured immediately, 2, 4 and 6 hours after surgery and compared between two groups. T-test, and repeated measurement test were used for statistical analysis. No statistically significant differences were observed in heart rate, blood pressure and oxygen saturation levels between the two groups (P > 0.05). Propofol has higher effect in easing postoperative pain of patients than isoflurane, but no difference in postoperative complications, including chills, nausea and vomiting, occurs in both two groups. Propofol is effective in declining the postoperative pain of patients after anesthesia in comparison with isoflurane. Moreover, due to the antioxidant, anti-inflammatory and analgesic properties of propofol, it is preferred to isoflurane and the authors recommended it to be used.
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Affiliation(s)
- Taherh Mohaghegh
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Bijan Yazdi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Afsaneh Norouzi
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Shahin Fateh
- Department of surgery, Arak University of Medical Sciences, Arak, Iran
| | - Hesameddin Modir
- Department of Anesthesiology and Critical Care, Arak University of Medical Sciences, Arak, Iran
| | - Abolfazl Mohammadbeigi
- Neurology and Neurosciences Research Center, Qom University of Medical Sciences, Qom, Iran
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Salameh A, Dhein S, Dähnert I, Klein N. Neuroprotective Strategies during Cardiac Surgery with Cardiopulmonary Bypass. Int J Mol Sci 2016; 17:ijms17111945. [PMID: 27879647 PMCID: PMC5133939 DOI: 10.3390/ijms17111945] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/02/2016] [Accepted: 11/15/2016] [Indexed: 12/27/2022] Open
Abstract
Aortocoronary bypass or valve surgery usually require cardiac arrest using cardioplegic solutions. Although, in principle, in a number of cases beating heart surgery (so-called off-pump technique) is possible, aortic or valve surgery or correction of congenital heart diseases mostly require cardiopulmonary arrest. During this condition, the heart-lung machine also named cardiopulmonary bypass (CPB) has to take over the circulation. It is noteworthy that the invention of a machine bypassing the heart and lungs enabled complex cardiac operations, but possible negative effects of the CPB on other organs, especially the brain, cannot be neglected. Thus, neuroprotection during CPB is still a matter of great interest. In this review, we will describe the impact of CPB on the brain and focus on pharmacological and non-pharmacological strategies to protect the brain.
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Affiliation(s)
- Aida Salameh
- Clinic for Paediatric Cardiology Heart Centre, University of Leipzig, 04289 Leipzig, Germany.
| | - Stefan Dhein
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, University of Leipzig, 04107 Leipzig, Germany.
| | - Ingo Dähnert
- Clinic for Paediatric Cardiology Heart Centre, University of Leipzig, 04289 Leipzig, Germany.
| | - Norbert Klein
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, St. Georg Hospital, Academic Medical Centre, University of Leipzig, 04129 Leipzig, Germany.
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Chen Y, Jiang S, Wu Y. Effect of 2 different anesthesia methods on stress response in neurosurgical patients with hypertension or normal: A prospective clinical trial. Medicine (Baltimore) 2016; 95:e4769. [PMID: 27583931 PMCID: PMC5008615 DOI: 10.1097/md.0000000000004769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Hypertensive patients in neurosurgery are becoming more common, which increased the risk of surgical stress response. Meanwhile, the relationship between hypertension and anesthesia methods is unclear on the stress response. The purpose of this study is to compare the effect of different anesthesia methods on high-sensitivity C-reactive protein (Hs-CRP), blood glucose, and leucocyte levels in neurosurgical patients with hypertension or normal.Eighty neurosurgical patients were randomly divided into 4 groups (n = 20): balanced anesthesia group (A), balanced anesthesia with hypertension group (B), total intravenous anesthesia group (C), total intravenous anesthesia with hypertension group (D). The levels of Hs-CRP, blood glucose, leucocyte count, and neutrophil percentage and were detected at before anesthesia (T0), during anesthesia (T1), 2 hours post anesthesia (T2), 24 hours post anesthesia (T3).Patients with hypertension had higher Hs-CRP expression, blood glucose, and neutrophil percentage at time T0 than those of normal, but not leucocyte count. At time T3, patients with hypertension in D group had lower Hs-CRP expression than those in B group (P < 0.01). Patients with normal in C group had lower Hs-CRP expression (P < 0.01), blood glucose (P < 0.05), and leukocyte count (P < 0.05) than those in A group. Both hypertension history and anesthesia method had significant effects on the Hs-CRP expression, blood glucose, and leukocyte count.Total intravenous anesthesia decreases Hs-CRP expressions more efficiently than balanced anesthesia in neurosurgical patients with hypertension or normal. Moreover, total intravenous anesthesia can availably reduce the perioperative stress response by attenuating the increase of blood glucose and leukocyte count in normal tensive patients.
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Affiliation(s)
- Ying Chen
- Department of Anesthesiology, The first People's Hospital of Lianyungang
| | - Shan Jiang
- Lianyungang Branch of Traditional Chinese Medicine, Jiangsu Union Technical Institute, Lianyungang, China
| | - Yong Wu
- Department of Anesthesiology, The first People's Hospital of Lianyungang
- Correspondence: Yong Wu, Department of Anesthesiology, The first People's Hospital of Lianyungang, Lianyungang, China (e-mail: )
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Blann A. The rolling evolution of biomedical science as an essential tool in modern clinical practice. Br J Biomed Sci 2016; 73:1-3. [PMID: 27182669 DOI: 10.1080/09674845.2016.1150665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The British Journal of Biomedical Science is committed to publishing high-quality original research that represents a clear advance in the practice of biomedical science, and reviews that summarise recent advances in the field of biomedical science. The overall aim of the Journal is to provide a platform for the dissemination of new and innovative information on the diagnosis and management of disease that is valuable to the practicing laboratory scientist. The Editorial that follows describes the Journal and provides a perspective of its aims and objectives.
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Affiliation(s)
- Andrew Blann
- a The Institute of Biomedical Science , London , UK
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Blann A, Nation B. British Journal of Biomedical Science in 2015: what have we learned? Br J Biomed Sci 2016; 73:4-9. [DOI: 10.1080/09674845.2016.1154701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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