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Aydın H, Şimşek T, Demiraran Y. Effects of Inadvertent Perioperative Hypothermia on Metabolic and Inflammatory Mediators. Turk J Anaesthesiol Reanim 2019; 47:448-455. [PMID: 31828241 DOI: 10.5152/tjar.2019.94715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/23/2019] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of the present study was to investigate the effects of perioperative undesirable hypothermia on inflammatory (interleukin (IL)-8, IL-10, IL-18, IL-23 and pentraxin (PTX)-3) and metabolic responses (cortisol and insulin) and recovery time. Methods A total of 60 patients between the ages of 18 and 65 years who were in the lumbar stabilisation operation were included in the study. In this prospective, randomised controlled study, two groups were constituted as with warmed (Group N) and not warmed (Group C) patients before and during the operation. Diuresis, blood loss, body temperature and side effects were recorded with IL-8, IL-10, IL-18, IL-23, PTX-3, cortisol and insulin levels. Results Perioperative diuresis was significantly higher in Group C. Aldrete score was significantly higher in Group N with less shivering and vomiting in the postoperative period. IL-10, PTX-3 and cortisol levels were found to be significantly higher in Group C in the first postoperative hour. PTX-3 and cortisol were found to be significantly higher in Group C after 24 h of the operation. Insulin was significantly higher in Group N. In 72 h, IL-8 in Group N and cortisol level in Group C were significantly higher. Conclusion Positive effects of heating the patients in the perioperative period on haemorrhage, diuresis, complications and recovery time were observed in our study. In addition, maintenance of normothermia appeared to modulate the biomarkers that indicate the inflammatory and metabolic responses.
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Affiliation(s)
- Halide Aydın
- Clinic of Anaesthesiology and Reanimation, Van Training and Research Hospital, Van, Turkey
| | - Tuncer Şimşek
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Yavuz Demiraran
- Deparment of Anaesthesiology and Reanimation, Medipol University School of Medicine, İstanbul, Turkey
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Kellermann S, Janssen C, Münch F, Koch A, Schneider-Stock R, Cesnjevar RA, Rüffer A. Deep hypothermic circulatory arrest or tepid regional cerebral perfusion: impact on haemodynamics and myocardial integrity in a randomized experimental trial. Interact Cardiovasc Thorac Surg 2018; 26:667-672. [PMID: 29272381 DOI: 10.1093/icvts/ivx393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/18/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Organ protective management during aortic arch surgery comprises deep hypothermic (18°C) circulatory arrest (DHCA), or moderate hypothermia (28°C/ 'tepid') with regional cerebral perfusion (TRCP). The aim of this experimental study was to evaluate the effect of distinct organ protective management on hemodynamic performance and myocardial integrity. METHODS Ten male piglets were randomized to group DHCA (n = 5) or TRCP (n = 5) group and operated on cardiopulmonary bypass (CPB) with 60 min of aortic cross-clamping. Blood gas analysis was performed throughout the experiment. Haemodynamic assessment was performed using a thermodilution technique before and after CPB. Myocardial biopsies were taken 2 h after CPB and evaluated using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling assay and western blot analysis. RESULTS At reperfusion, levels of central venous saturation were significantly higher (P = 0.016) and levels of lactate significantly lower (P = 0.029) in the DHCA group. After CPB, thermodilution measurements revealed higher stroke volume and lower peripheral resistance in the TRCP group (P = 0.012 and 0.037). At the end of the experiment, no significant differences regarding laboratory and haemodynamic parameters were evident. All specimens showed enrichment of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling-positive cells exclusively at the left ventricular subendocardium with no difference between groups and equal concentrations of cyclo-oxygenase-2. CONCLUSIONS TRCP is associated with decreased peripheral resistance and higher stroke volume immediately after CPB. However, this beneficial effect is contrasted by signs of lower body hypoperfusion, which is expressed by lower central venous saturations and higher lactate levels. Distinct strategies of organ protection did not seem to affect apoptotic/necrotic and inflammatory changes in the left ventricular myocardium.
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Affiliation(s)
- Stephanie Kellermann
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carina Janssen
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Münch
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Adrian Koch
- Experimental Tumorpathology, Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Regine Schneider-Stock
- Experimental Tumorpathology, Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Anton Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - André Rüffer
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Wang Y, Zhang A, Lu S, Pan X, Jia D, Yu W, Jiang Y, Li X, Wang X, Zhang J, Hou L, Sun Y. Adenosine 5'-monophosphate-induced hypothermia inhibits the activation of ERK1/2, JNK, p38 and NF-κB in endotoxemic rats. Int Immunopharmacol 2014; 23:205-10. [PMID: 25218163 DOI: 10.1016/j.intimp.2014.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Abstract
Many studies have shown that LPS mainly activates four signal transduction pathways to induce inflammation, namely the p38, ERK1/2, JNK and IKK/NF-κB pathways. Studies have demonstrated that 5'-AMP-induced hypothermia (AIH) exhibits high anti-inflammatory capabilities. In this study, we explore that how AIH inhibits the inflammatory response. Wistar rats were divided into five groups: a control group, an LPS group, a 5'-AMP pre-treatment group, a 5'-AMP post-treatment group and a 5'-AMP group. For each group, plasma and lung were collected from the rats at 6h and 12h after LPS injection. ELISA assays were used to detect plasma levels of CD14, CRP and MCP-1. Inflammatory pathway activation and TLR4 expression were assayed separately by Western blot analysis and immunohistochemistry. Our results showed that rats treated with AIH either before or after an LPS-challenge had a significant decrease in plasma levels of CD14, CRP and TLR4 compared with rats that received LPS only. Western blot analysis showed that AIH inhibited the activation of extracellular signal-regulated kinases (ERK) 1/2, p38, c-Jun N-terminal kinase (JNK) and NF-κB in inflammatory rats. Our study concluded that AIH attenuated LPS-induced inflammation mainly by inhibiting activation on the ERK1/2, p38, JNK and NF-κB signaling pathways.
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Affiliation(s)
- Yunlong Wang
- Gout Laboratory, The Affiliated Hospital of Medical College Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases, 16 Jiangsu Road, Qingdao, China
| | - Aihua Zhang
- Department of Biochemistry, Medical College, Qingdao University, Qingdao, Shandong, China
| | - Shulai Lu
- Stomatological Department, Qingdao Municipal Hospital, Qingdao, China
| | - Xinting Pan
- ICU, The Affiliated Hospital of Medical College, 16 Jiangsu Road, Qingdao, China
| | - Dongmei Jia
- Pathology Department, Qingdao Municipal Hospital, Qingdao, China
| | - Wenjuan Yu
- Pathology Department, The Affiliated Hospital of Medical College Qingdao University, China
| | - Yanxia Jiang
- Pathology Department, The Affiliated Hospital of Medical College Qingdao University, China
| | - Xinde Li
- Gout Laboratory, The Affiliated Hospital of Medical College Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases, 16 Jiangsu Road, Qingdao, China
| | - Xuefeng Wang
- Gout Laboratory, The Affiliated Hospital of Medical College Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases, 16 Jiangsu Road, Qingdao, China
| | - Jidong Zhang
- Department of Cardiology, The Affiliated Hospital of Medical College Qingdao University, 16 Jiangsu Road, Qingdao, China
| | - Lin Hou
- Department of Biochemistry, Medical College, Qingdao University, Qingdao, Shandong, China.
| | - Yunbo Sun
- ICU, The Affiliated Hospital of Medical College, 16 Jiangsu Road, Qingdao, China.
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Abstract
OBJECTIVES Accidental hypothermia increases mortality and morbidity after hemorrhage, but controversial data are available on the effects of therapeutic hypothermia. Therefore, we tested the hypothesis whether moderate pretreatment hypothermia would beneficially influence organ dysfunction during long-term, porcine hemorrhage and resuscitation. DESIGN Prospective, controlled, randomized study. SETTING University animal research laboratory. SUBJECTS Twenty domestic pigs of either gender. INTERVENTIONS Using an extracorporeal heat exchanger, anesthetized and instrumented animals were maintained at 38°C, 35°C, or 32°C core temperature and underwent 4 hours of hemorrhage (removal of 40% of the blood volume and subsequent blood removal/retransfusion to maintain mean arterial pressure at 30 mm Hg). Resuscitation comprised of hydroxyethyl starch and norepinephrine infusion titrated to maintain mean arterial pressure at preshock values. MEASUREMENTS AND MAIN RESULTS Before, immediately at the end of, and 12 and 22 hours after hemorrhage, we measured systemic and regional hemodynamics (portal vein, hepatic and right kidney artery ultrasound flow probes) and oxygen transport, and nitric oxide and cytokine production. Hemostasis was assessed by rotation thromboelastometry. Postmortem biopsies were analyzed for histomorphology (hematoxylin and eosin staining) and markers of apoptosis (kidney Bcl-xL and caspase-3 expression). Hypothermia at 32°C attenuated the shock-related lactic acidosis but caused metabolic acidosis, most likely resulting from reduced carbohydrate oxidation. Although hypothermia did not further aggravate shock-related coagulopathy, it caused a transitory attenuation of kidney and liver dysfunction, which was ultimately associated with reduced histological damage and more pronounced apoptosis. CONCLUSIONS During long-term porcine hemorrhage and resuscitation, moderate pretreatment hypothermia was associated with a transitory attenuation of organ dysfunction and less severe histological tissue damage despite more pronounced metabolic acidosis. This effect is possibly due to a switch from necrotic to apoptotic cell death, ultimately resulting from reduced tissue energy deprivation during the shock phase.
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Changes in serum cytokine and cortisol levels in normothermic and hypothermic term neonates after perinatal asphyxia. Inflamm Res 2012; 62:81-7. [DOI: 10.1007/s00011-012-0554-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/11/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022] Open
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Han HS, Park J, Kim JH, Suk K. Molecular and cellular pathways as a target of therapeutic hypothermia: pharmacological aspect. Curr Neuropharmacol 2012; 10:80-7. [PMID: 22942881 PMCID: PMC3286850 DOI: 10.2174/157015912799362751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 08/08/2011] [Accepted: 09/08/2011] [Indexed: 11/22/2022] Open
Abstract
Induced therapeutic hypothermia is the one of the most effective tools against brain injury and inflammation. Even though its beneficial effects are well known, there are a lot of pitfalls to overcome, since the potential adverse effects of systemic hypothermia are still troublesome. Without the knowledge of the precise mechanisms of hypothermia, it will be difficult to tackle the application of hypothermia in clinical fields. Better understanding of the characteristics and modes of hypothermic actions may further extend the usage of hypothermia by developing novel drugs based on the hypothermic mechanisms or by combining hypothermia with other therapeutic modalities such as neuroprotective drugs. In this review, we describe the potential therapeutic targets for the development of new drugs, with a focus on signal pathways, gene expression, and structural changes of cells. Theapeutic hypothermia has been shown to attenuate neuroinflammation by reducing the production of reactive oxygen species and proinflammatory mediators in the central nervous system. Along with the mechanism-based drug targets, applications of therapeutic hypothermia in combination with drug treatment will also be discussed in this review.
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Affiliation(s)
- Hyung Soo Han
- Department of Physiology, Brain Science & Engineering Institute, Kyungpook National University School of Medicine, Daegu, 700-422, Korea
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Roman PEF, Grigore AM. Pro: hypothermic cardiopulmonary bypass should be used routinely. J Cardiothorac Vasc Anesth 2012; 26:945-8. [PMID: 22790158 DOI: 10.1053/j.jvca.2012.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Philip E F Roman
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Stocker CF, Shekerdemian LS, Horton SB, Lee KJ, Eyres R, D’Udekem Y, Brizard CP. The influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery: A randomized trial. J Thorac Cardiovasc Surg 2011; 142:174-80. [DOI: 10.1016/j.jtcvs.2011.01.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 10/22/2010] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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Anti-aging effect of rice wine in cultured human fibroblasts and keratinocytes. J Biosci Bioeng 2009; 107:266-71. [DOI: 10.1016/j.jbiosc.2008.11.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 11/03/2008] [Indexed: 12/27/2022]
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Han D, Zhao BT, Liu Y, Li JJ, Wu YG, Lan GC, Tan JH. Interactive effects of low temperature and roscovitine (ROS) on meiotic resumption and developmental potential of goat oocytes. Mol Reprod Dev 2008; 75:838-46. [PMID: 17926351 DOI: 10.1002/mrd.20823] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this article was to study the effects of low temperature and roscovitine (ROS) on meiotic resumption and developmental potential of goat oocytes. Goat oocytes were cultured at different temperatures in medium containing different concentrations of ROS, and at the end of culture, oocytes were either matured or processed for light/confocal microscopy. The matured oocytes were activated chemically or fertilized in vitro for embryo development. Meiotic arrest was successfully maintained for 24 hr with 0, 50, and 200 microM ROS at 5, 20, and 38.5 degrees C, respectively. Following chemical activation, morulae/blastocysts (M/B) rates similar to untreated oocytes were obtained in oocytes that had been inhibited for 24 hr at 5 degrees C without ROS (Protocol 5C) or at 20 degrees C with 50 microM ROS (Protocol 20C) or for 8 hr at 38.5 degrees C with 200 microM ROS (Protocol 8 hr), but no blastulation was observed after oocytes were inhibited at 38.5 degrees C with 200 microM ROS for 24 hr. Following fertilization, however, while M/B rates similar to controls were achieved in oocytes treated with protocols 5C and 20C, few oocytes inhibited with Protocol 8 hr developed into morulae, due to a high incidence of polyspermy. Changes in GV chromatin configuration were not observed after inhibition with Protocol 5C, but were apparent after inhibition with protocols 20C and 8 hr, leading to a precocious germinal vesicle breakdown (GVBD) during subsequent maturation. Cortical granule (CG) migration and the formation of microtubule organizing centers occurred during inhibition and were more obvious in the absence of ROS. Significantly more oocytes inhibited by protocols 5C and 20C than by Protocol 8 hr completed CG migration after maturation. In conclusion, goat oocytes were tolerant to chilling and culture at lower temperatures with less ROS was better than culture at higher temperatures with more ROS for oocyte GVBD inhibition.
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Affiliation(s)
- Dong Han
- College of Animal Science and Vet Medicine, Shandong Agricultural University, Tai-an City 271018, PR China
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Stålman A, Tsai JA, Wredmark T, Dungner E, Arner P, Felländer-Tsai L. Local inflammatory and metabolic response in the knee synovium after arthroscopy or arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2008; 24:579-84. [PMID: 18442691 DOI: 10.1016/j.arthro.2007.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to study local synovial metabolism and inflammation after arthroscopy and arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS Microdialysis in the synovial membrane was performed during 4 hours postoperatively in 20 patients undergoing a minor arthroscopy procedure (e.g., meniscus surgery and 10 patients undergoing ACL reconstruction with a quadruple hamstring graft). Contralateral thigh adipose tissue served as a reference. Lactate, glucose, glycerol, and prostaglandin E(2) (PGE(2)) were monitored. The ACL group received intra-articular morphine preoperatively, and a cooling and compression device was applied postoperatively according to local clinical routines. RESULTS The synovial lactate levels and the consumption of synovial glucose was increased postoperatively in the arthroscopy group compared to the reference adipose tissue. There were no significant differences regarding synovial levels of glycerol, lactate, or glucose compared to the reference tissue in the ACL group. PGE(2) levels were significantly lower in the ACL group compared to the arthroscopy group. CONCLUSIONS A major arthroscopic surgical procedure (ACL reconstruction) did not increase the local synovial metabolism or induce a detectable inflammatory response compared to a minor arthroscopic surgical procedure (e.g., meniscal surgery) in our clinical setting. Intra-articular injection of morphine and or the use of a combined cooling and compression device in the ACL group showed a modulation of the response in tissue chemistry as measured by synovial microdialysis. LEVEL OF EVIDENCE Level III, therapeutic case-control study.
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Affiliation(s)
- Anders Stålman
- Division of Orthopedics, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
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Simkova V, Baumgart K, Radermacher P, Barth E, Calzia E. Year in review 2006: Critical Care--Multiple organ failure, sepsis, and shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:221. [PMID: 17764584 PMCID: PMC2206506 DOI: 10.1186/cc5938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In 2006, Critical Care provided important and clinically relevant research data in the field of multiple organ failure, sepsis, and shock. This review summarizes the results of the experimental studies and clinical trials and discusses them in the context of the relevant scientific and clinical background.
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Affiliation(s)
- Vladislava Simkova
- Anesteziologicko-resuscitacni klinika, Fakultni nemocnice u sv, Anny, Pekarska 53, 656 00 Brno, Czech Republic
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