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ObjectiveSome studies reported that α7nAChR is closely related to the cognitive function. However, the elderly patients have become a high-risk group of postoperative cognitive dysfunction. The aim of this study was to explore the effect of sevoflurane inhalation on the cognitive function and the quantity of alpha 7nicotinic acetycholine receptors in the hippocampus of elderly model rats.MethodsAdult male Sprague-Dawley rats (N=72) were given subcutaneous injection of D-galactose on the neck for 6 weeks to establish elderly models. The model rats were divided into 4 groups randomly: control group (group Con, n=18) with 6h exposure carrier gas (2L/min Air+2L/min O2); Sevoflurane group (group Sev, n=18) with 6 h exposure to 3.2% sevoflurane through carrier gas. Sev+α7nAChR antagonist group (group Sev+M) injected with methyllycaconitine, after 24 h inhaled of 3.2% sevoflurane and carrier gas for 6 h. Sev+α7nAChR agonist group (group Sev+P, n=18) injected with PNU-282987, after 24 h inhaled of 3.2% sevoflurane and carrier gas for 6 h. Morris water maze experiments were conducted on 6 rats in each group 2 h, 1 week and 4 weeks after treatments, respectively. Every cycle after the behavioral test, the hippocampi were taken out. RT-qPCR method was used to detect α7nAChR mRNA expression. Western blotting was used to detect α7nAChR proteins expression.ResultsBehavioral test: compared with Con group at 2 h after awakening, indicators of working memory and spatial probe test in Sev group and Sev+M group decreased significantly (P0.05). RT-qPCR: compared with Con group at 2 h and 1 w after awakening, the expression of alpha 7nAChR mRNA in the other groups was down-regulated, while at 4 w it was up-regulated (P<0.05).Western blot: protein expression of alpha 7nAChR was down-regulated in the 2 h, 1 w Sev group and the Sev+M group after awakening, and up-regulated in the 4 w group after awakening (P<0.05).ConclusionInhalation of 3.2% sevoflurane for 6 h can cause 7nAChR metabolic disturbance in hippocampus of aging model rats and lead to a short-term (1 w) decline in learning and memory ability of the rats, but this effect is reversible. The PNU-282987 agonist can alleviate the temporary decrease of learning and memory caused by sevoflurane.
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Objective To evaluate the changes in the expression of hippocampal α7 nicotinic ace-tylcholine receptor (α7nAChR) , acetylcholinesterase ( AChE) and choline acetyltransferase ( ChAT) after sevoflurane anesthesia in neonatal rats. Methods Seventy-two healthy Sprague-Dawley rats of both sexes, aged 7 days, weighing 25-40 g, were divided into 3 groups ( n=24 each) using a random number table method: control group ( group C) , air and oxygen group ( group A∕O) and sevoflurane group ( group S) . Rats were exposed to carrier gas ( air 1 L∕min plus oxygen 1 L∕min) for 2 h in group A∕O. Rats were ex-posed to 3. 4％ sevoflurane in carrier gas for 2 h in group S. Eight rats in each group were selected at 2 h, 1 week and 4 weeks after the end of inhalation, and sacrificed, brains were removed and hippocampal tis-sues were obtained for determination of α7nAChR, AChE and ChAT protein and mRNA by Western blot and real-time polymerase chain reaction, respectively. Results Compared with group A∕O, the expression of α7nAChR mRNA was significantly down-regulated at each time point after the end of inhalation, and the expression of TnAChR was down-regulated at 2 h after the end of inhalation and up-regulated at 1 week after the end of inhalation, the expression of AChE mRNA was up-regulated at 2 h after the end of inhalation and down-regulated at 4 weeks after the end of inhalation, the expression of AChE was down-regulated at 4 weeks after the end of inhalation, the expression of ChAT mRNA was up-regulated at 2 h after the end of in-halation, and the expression of ChAT was down-regulated at each time point after the end of inhalation in group S ( P<0. 05) . Conclusion The expression of hippocampal α7nAChR is down-regulated at first and then up-regulated after sevoflurane anesthesia, the expression of ChAT and AchE in the later period is down-regulated, the tendency of protein expression mentioned above is different from that of its mRNA ex-pression, suggesting that sevoflurane may affect the protein expression through other pathways.
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<p><b>BACKGROUND</b>Due to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin (Hb) level between 7 and 10 g/dl. As a result, the trigger point of blood transfusion may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future.</p><p><b>METHODS</b>From June 2013 to June 2014, patients were randomly divided into the experimental group (Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group) and the control group (control group). The between-group differences in the patients' demography and baseline information, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell (RBC) transfusion standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed.</p><p><b>RESULTS</b>During the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of (34.8 ± 14.6) years. 50 underwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline information. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transfusion-related complications and mortality. Only the POTTS-E group on the 1 st postoperative day Hb was lower than group control, P < 0.05. POTTS-E group was totally (100%) conformed to the requirements of the transfusion guideline to RBC infusion, which was higher than that of the control group (81.25%), P < 0.01.There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates of allogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group (84.3%, 84.3%, and 96.8%) P < 0.05 or P < 0.01. Per capita consumption of intraoperative allogeneic RBC, total allogeneic RBC and total RBC were 0 (0, 3.0), 2.0 (0, 4.0), and 3.1 (0.81, 6.0) in POTTS-E groups were all lower than those of control group (4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]), P < 0.05 or P < 0.001.</p><p><b>CONCLUSIONS</b>Peri-operative Transfusion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is safe; Compared with doctor experience-based subjective assessment, the scoring scheme was closer to patient physiological needs for transfusion and more reasonable; Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value for carrying out multicenter and large sample clinical researches.</p>
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Adolescent , Adult , Female , Humans , Male , Young Adult , Emergency Medical Services , Transfusion ReactionABSTRACT
OBJECTIVE@#To explore the effect of a reforming leukocyte depletion filter (LDF-1) on the functional and pathologic changes of canine kidney during cardiopulmonary bypass (CPB).@*METHODS@#Twelve Mongolian dogs were randomly allocated into a control group (no LDF-1, n = 6) or a leukocyte-depleted filter group (LDF-1 placed in venous line, n = 6). CPB of the dogs anestheitized with sodium pentobarbitone at 25 mg/kg was set up. After 10 min of CPB, aorta was clamped and St. Thomas cardioplegic solution at 20 mg/kg was immediately injected into the root of aorta. The aortic cross-clamp was released and CPB was closed at 70 min. Dogs were observed for 2 h after weaning from CPB. LDF-1 was opened at 2 min and stoped at 7 min during initially running CPB in the LDF-1 group. Circulating leukocytes, plasma L-selectin, and plasma IL-8 were respectively counted before CPB, at 10 minutes, 40 min, and 75 min during CPB, the end of CPB, and 2 h after CPB. The urine analysis and renal pathology, which were obtained before CPB and 2 h after CPB, were observed.@*RESULTS@#The number of leukocytes significantly decreased by 55% - 68% in the LDF-1 group compared with the baseline during CPB. The value at 10 min of CPB in the LDF-1 group was lower than that in the control group (P < 0.05). Plasma levels of L-selectin and IL-8 obviously increased in the 2 groups compared with the baseline during CPB, but both levels at 2 h after CPB in the LDF-1 group were lower than those in the control group (P <0. 05). No statistic difference was found in plasma levels of urea and creatinine, but hematuria was observed in the 2 groups at 2 hours after CPB. The pathologic changes of kidney, which was mainly renal tubule swelling accompanied partly with vacuolar degeneration, were similar under the light microscope in the 2 groups at 2 h after CPB. Obvious glomerular damage was not found.@*CONCLUSION@#LDF-1 can effectively decrease leukocyte counts and the inflammatory reaction, but it can not bring about excellent protective effect on kidney during CPB when used alone. Attention to should be paid the renal protection in the postoperative CPB.