Objective To evaluate the effect of recombinant human erythropoietin (rHuEPO) on brain injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-five patients with chronic valvular heart disease,aged 36-62 yr,weighing 42-92 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with New York Heart Association of Ⅱ or Ⅲ,undergoing cardiac valve replacement with CPB,were randomly divided into 3 groups (n =15 each) using a random number table:control group (group C),and different doses of rHuEPO groups (EPO1 group,EPO2 group).In EPO1 and EPO2 groups,rHuEPO 40 and 80 IU/kg were injected intravenously before anesthesia induction,respectively.Before anesthesia induction (T0,baseline value),immediately after endotracheal intubation (T1),immediately after aortic cannulation (T2),immediately after cannulation of superior and inferior vena cava (T3),immediately after the beginning of CPB (T4),when each index was decreased to the minimal value during CPB (T5),after rewarming to 36.5 ℃ (T6),immediately after termination of CPB (T7),and at 1 h after termination of CPB (T8),regional cerebral oxygen saturation (rSO2),tissue hemoglobin index (THI),and changes in concentrations of oxyhemoglobin (△ O2Hb),deoxyhemoglobin (△ HHb) and total hemoglobin (△ cHb) in bilateral frontal lobes were recorded.The patients whose minimal rSO2 ≤ 50％ and decrease in minimal rSO2 ≥ 20％ of the baseline value (△rSO2) were recorded.At T0,T8 and 2 h after termination of CPB (T9),venous blood samples were taken for determination of serum concentrations of S100 protein and neuron-specific enolase (NSE) by ELISA.At 1 day before surgery and 8 days after surgery,the patient's cognitive function was assessed using Mini-Mental State Examination,the Digit Span subtest of the Wechsler Adult Intelligence Scale-Revised (WAIS-R),the Digit Symbol subtest of the WAIS-R,the Trailing Making Test (Part A)and the Stroop Color Word Interference Test,while depression and anxiety were assessed by Zung Self-Rating Depression Scale and Zung Self-Rating Anxiety Scale,respectively.The occurrence of postoperative cognitive dysfunction was recorded.Results There was no significant difference among the three groups in bilateral rSO2 and △ cHb,incidence of bilateral rSO2 ≤ 50％ and postoperative cognitive dysfunction,Zung Self-Rating Depression Scale score,and Zung Self-Rating anxiety Scale score at each time point (P＞0.05).Compared with group C,the incidence of left △ rSO2 ≥ 20％ was significantly decreased,the right △ O2 Hb was increased at T6,8,the serum NSE concentrations were decreased at T9,the serum S100 protein concentrations were decreased at T8,and the number of the Digit Symbol subtest of the WAIS-R completed was increased in group EPO1,and right THI was significantly decreased at T2,T3,T5,T7 and T8,right △ HHb was increased at T2 and T3,and the completion time of Stroop color word interference test B was shortened at 8 days after surgery in group EPO2 (P＜0.05 or 0.01).Compared with group EPO1,the incidence of left △rSO2 ≥ 20％ was significantly increased,the right THI was decreased at T2-4 and T6-8,and the left △ O2 Hb at T6-7 and right △ O2 Hb at T8 were decreased in group EPO2 (P＜0.05).Conclusion rHuEPO 40 IU/kg injected intravenously before induction of anesthesia can mitigate brain injury in the patients undergoing cardiac valve replacement with CPB.

OBJECTIVETo investigate the effect of propofol on the expression of thrombospondin-1 (THBS-1) mRNA and protein in purified newborn rat cortical astrocytes in vitro.

METHODSAstrocytes were isolated from newborn rat cortex and grown in culture before exposure to propofol at 3, 10, 30, 100 or 300 µmol/L for 6 h, 12, or 24 h. The mRNA level of THBS-1 was detected by RT-PCR, and the protein level of THBS-1 was detected by immunofluorescence cytochemistry and Western blotting.

RESULTSPropofol exposure caused significantly upregulated THBS-1 level in cultured astrocytes (P<0.05) to a level about 1.3 times higher than that in control cells. The mRNA and protein levels of THBS-1 in cultured rat cortical astrocytes were upregulated by exposures to 10, 30 and 100 µmol/L propofol (P<0.01). High expression of THBS-1 mRNA and protein was detected in the cells with exposures for different durations (P<0.05), especially in the 12 h group (P<0.01).

CONCLUSIONPropofol at clinically relevant concentrations can modulate the level of THBS-1 secreted by astrocytes of rat cerebral cortex in vitro.

Animals ; Astrocytes ; drug effects ; metabolism ; Cells, Cultured ; Cerebral Cortex ; cytology ; Propofol ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Thrombospondin 1 ; metabolism

Objective To investigate the effect of propofol on the expression of thrombospondin-1 (THBS-1) mRNA and protein in purified newborn rat cortical astrocytes in vitro. Methods Astrocytes were isolated from newborn rat cortex and grown in culture before exposure to propofol at 3, 10, 30, 100 or 300μmol/L for 6 h, 12, or 24 h. The mRNA level of THBS-1 was detected by RT-PCR, and the protein level of THBS-1 was detected by immunofluorescence cytochemistry and Western blotting. Results Propofol exposure caused significantly upregulated THBS-1 level in cultured astrocytess (P<0.05) to a level about 1.3 times higher than that in control cells. The mRNA and protein levels of THBS-1 in cultured rat cortical astrocytes were upregulated by exposures to 10, 30 and 100 μmol/L propofol (P<0.01). High expression of THBS-1 mRNA and protein was detected in the cells with exposures for different durations (P<0.05), especially in the 12 h group (P<0.01). Conclusion Propofol at clinically relevant concentrations can modulate the level of THBS-1 secreted by astrocytes of rat cerebral cortex in vitro.

Objective To investigate the effect of propofol on the expression of thrombospondin-1 (THBS-1) mRNA and protein in purified newborn rat cortical astrocytes in vitro. Methods Astrocytes were isolated from newborn rat cortex and grown in culture before exposure to propofol at 3, 10, 30, 100 or 300μmol/L for 6 h, 12, or 24 h. The mRNA level of THBS-1 was detected by RT-PCR, and the protein level of THBS-1 was detected by immunofluorescence cytochemistry and Western blotting. Results Propofol exposure caused significantly upregulated THBS-1 level in cultured astrocytess (P<0.05) to a level about 1.3 times higher than that in control cells. The mRNA and protein levels of THBS-1 in cultured rat cortical astrocytes were upregulated by exposures to 10, 30 and 100 μmol/L propofol (P<0.01). High expression of THBS-1 mRNA and protein was detected in the cells with exposures for different durations (P<0.05), especially in the 12 h group (P<0.01). Conclusion Propofol at clinically relevant concentrations can modulate the level of THBS-1 secreted by astrocytes of rat cerebral cortex in vitro.

Objective To investigate the effect of artifictal circadian rhythm of melatonin on the postoperative cellular immune function in patients undergoing gynecological operation Methods Eighteen ASA Ⅰ or Ⅱ patients,aged 25-50 yr,weighing 45-80 kg,scheduled for elective gynecological operation,were randomly divided into 3 groups (n =6 each):control group (group C),placebo control group (group P) and melatonin group (group M).In group M.melatonin 6 mg was given orally at 10 min before lights-out (21:00) on 1 day before operation,on the day of operation and on 1 day after operation,while placebo was given orally instead of melatonin in group P.The operation was performed under epidural anesthesia.Patient-controlled epidural analgesia with ropivacaine was used for postoperative analgesia.VAS score was maintained ＜ 5.Blood samples were collected from the peripheral vein at 1 day before operation (baseline),the end of operation and 1 day after operation to measure CD4+,CD8+ and CD3+ cell count by flow cytometry.The ratio of the number of CD4+ cells to the number of CD8+ cells was calculated.Results There were no significant differences in the number of CD4+,CD8+ and CD3 + cells and ratio of the number of CD4 + cells to the number of CD8 + cells between groups C,P and M (P ＞0.05).Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular immune function in patients undergoing gynecological operation.

Objective To locate the brain areas in which pain was induced by mechanical noxious stimulation by using functional magnetic resonance imaging.Methods Twenty healthy male volunteers,aged 20-40 yr,with body mass index of 18-25 kg/m2,were involved in this study.The volunteers were stimulated with 300 g von Frey filaments.Functional magnetic resonance imaging examinations were performed 1 week later.The monitoring data were collected during the scanning.The images were analyzed with SPM2 software.Results Bain areas in which pain was induced by mechanical noxious stimulation with 300 g yon Frey filaments were bilateral anterior cingulate gyrus,right contralateral insula and bilateral primary somatic sensory cortex.Conclusion The brain areas in which pain is induced by mechanical noxious stimulation include bilateral anterior cingulate gyrus,right contralateral insula and bilateral primary somatic sensory cortex.

Objective To investigate the effects of different doses of fentanyl on pain-activated brain areas as demonstrated by functional magnetic resonance imaging (fMRI) at 3.0 T.Methods Twenty healthy right-handed male volunteers aged 20-40 yr were randomly divided into 2 groups ( n =10 each); group F1 (fentanyl 1.0 μg/kg) and group F2 (fentanyl 1.5 μg/kg).Mechanical stimulation with von Frey filaments (vFFs,300 g) was delivered to left sole.The intensity of pain was assessed by VAS scores.fMRI was performed before and after fentanyl administration and the changes in the brain areas activated by pain were recorded.Results In group F1 ipsilateral (left) cingulate gyrus was activated after a bolus of fentanyl 1.0 μg/kg under stimulation with vFFs 300 g,while in group F2 bilateral cingulate gyrus and contralateral (right) insula were activated under vFFs stimulation after fentanyl 1.5 μg/kg.Conclusion Cingulate gyrus and insula may be the target brain areas of fentanyl analgesia.

Objective To investigate the effect of propofol on the high-voltage-activated calcium currents [ICa(HVA)] in rat hippocampal neurons. Methods Hippocampal neurons were prepared from Wistar rats and cultured. ICa(HVA) was recorded using whole-cell patch clamp technique. Different concentrations of propofol were added to the culture. The effect of propofol on ICa(HVA) Was evaluated. Results ICa(HVA) was inhibited by propofol in 300 μmol/L reduced peak ICa(HVA) by (24±6)%, (33 ±5) %, (36±7)% and(38±3)% respectively with a mean IC50 of 3.8 μmol/L and Hill coefficient of 0.35. Vmax was shifted from (4.0± 2.0) mV to (3.8 ± 1.6) mV. The V1/2 of inactivation curve was shifted from (- 32 ± 5) mV to (- 35 ± 4) mV and the slope factor was 31 ± 5 and 35 ± 6 before and after administration respectively. Conclusion Propofol produces significant inhibition of calcium currents in the central neurons which may partly explain the action of propofol on central nervous system.

Objective To assess the accuracy of cerebral oxygenation measured by near-infrared spectroscopy (NIRS) in predicting ischemic cerebral injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Seventeen patients undergoing cardiac valve replacement under CPB were enrolled in this study. During operation, NIRS was used to measure regional oxygen saturation (rScO2),tissue hemoglobin index ( THI ), changes in concentrations of oxyhemoglobin (△ O2 Hb ), deoxyhemoglobin (△ HHb) and total hemoglobin (△ cHb) of the frontal lobes. The parameters mentioned above and patients whose minimal rScO2 decreased to less than 50% were recorded after entering the operation room, immediately after tracheal intubation, aortic cannulation and superior and inferior vena cava cannula, at the beginning of CPB, at the lowest temperature during CPB, after rewarming to 36.5 ℃, immediately after termination of CPB, and at 1 h after termination of CPB. Blood samples were taken from right internal jugular vein immediately before anesthesia induction, before rewarming, after rewarming to 36.5 C, and at 1, 5 and 20 h after termination of CPB to detect plasma concentrations of S100 protein and neuron-specific enolase (NSE) by ELISA. The cognitive function of patients was assessed 1 day before surgery and 8 days after surgery, and postoperative cognitive dysfunction (POCD) was recorded. Results Nine patients presented with minimal rScO2 less than 50%. Among them,7 patients developed POCD. The plasma concentrations of S100 protein and NSE were significantly higher at 1 and 5 h after termination of CPB in patients whose minimal rScO2 decreased to ≤ 50% than in those whose rScO2 ＞50% .Conclusion Cerebral oxygenation measured by NIRS can accurately predict cerebral ischemic injury in patients undergoing cardiac valve replacement under CPB.

Objective To evaluate the effects of magnesium sulphate on the efficacy of postoperative patient-controlled intravenous analgesia (PCIA) with morphine. Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes aged 45-60 yr weighing 48-70 kg scheduled for elective upper abdominal surgery were randomly allocated into 2 groups ( n = 30 each) : morphine group (group M) and magnesium sulphate-morphine group (group MS) . If the VAS score=3, PCIA was started. Patients in group M received morphine in a 0.015 mg/kg bolus dose. Patients in group MS received morphine 0.015 mg/kg and magnesium sulphate 0.9 mg/kg. The consumption of analgesic drugs was recorded at 4, 8, 16, 24 and 48 h after 1st attempt. The gastrointestinal function recovery time was recorded. Venous blood samples were taken before anesthesia induction and at the end of operation and analgesia to determine the serum magnesium and calcium ion concentrations. Results Compared with group M, the consumption of analgesic drugs was significantly decreased, and the gastrointestinal function recovery time after operation was significantly shortened in group MS (P < 0.05). The serum magnesium ion concentration in both groups was significantly lower at the end of operation and analgesia than before anesthesia induction ( P < 0.05) . The serum magnesium ion concentration in group MS was significantly higher at the end of analgesia than at the end of operation ( P <0.05) .There was no significant difference in the serum calcium ion concentration between M and MS groups. Conclusion Magnesium sulphate can ameliorate the efficacy of postoperative PCIA with morphine.