Role of hippocampal p75 neurotrophin receptor in postoperative cognitive dysfunction of aged mice / 中风与神经疾病杂志

@#Objective　To investigate the role of the p75 neurotrophic receptor (p75 NTR) in the cognitive impairment induced by laparotomy surgery of aged mice,and to explore the possible mechanism.Methods　Thirty eighteen-month-old male mice were equally randomized into three groups (n=10):control group,surgery group,surgery+TAT group.Open field test was performed 5 days after the surgery to record the exploration distance and the time in the center.Fear-conditioned training was performed 6 days after the surgery,and fear-conditioned test was performed 7 days after the surgery to record the freezing time.The hippocampus was harvested immediately after the behavioral test.Western blot was applied to detect the levels of p75NTR,BDNF,PSD95,TrkB and pCREB in the hippocampus,immunofluorescence was applied to detect the number of caspase-3 positive cells in the hippocampus,and Golgi staining was applied to observe the changes of dendritic spines in hippocampal CA-1 region.Results　In the open field test,the total distance and the time in the center had no significant difference among the three groups (P>0.05).In the fear conditioning test,compared with control group,the percentage of the contextual conditional freezing time decreased significantly in surgery group (P<0.05),and the expressions of BDNF，PSD95，TrkB and pCREB and the number of dendritic spines in CA-1 were significantly decreased (P<0.05),the expression of p75NTR and the number of caspase-3 positive cells were increased significantly in the surgery group (P<0.05).Compared with the surgery group,the percentage of the contextual conditional freezing time increased significantly in surgery+TAT group,and the expressions of BDNF,PSD95,TrkB,and pCREB and the number of dendritic spines in CA-1 were significantly increased,the number of caspase-3 positive cells were decreased significantly in the surgery+TAT group (P<0.05).Conclusion　Hippocampal p75 NTR plays a key role in the pathophysiology of POCD.

Changes of serum C-X-C motif ligand 13 concentration in senior patients undergoing total hip replacement / 临床麻醉学杂志

Objective To investigate the changes of serum C-X-C motif ligand 13 (CXCL13) concentration in senior patients undergoing total hip replacement and its role in post-operative dys-function(POCD).Methods Eighty consecutive senior patients aged 65-80 years with BMI 18.4-27.3 kg/m2,ASA physical status Ⅱ or Ⅲ,were recruited and scheduled to undergo hip joint replacement operation.Neuropsychological test was performed 1-5 d after operation and patients were divided into POCD group and non-POCD group.Serum C reactive protein (CPR),procalcitonin (PCT),IL-6, TNF-α,CXCL13 concentration were detected 1 d before and 1,2,3,4,5 d after operation. Results A total of 21 (26%)patients developed POCD 1-5 d after operation (recruited in POCD group),and the other 59 patients were recruited in non-POCD group.Compared with the time point of 1 d before operation,serum CRP,PCT,IL-6,TNF-αand CXCL13 concentration were higher 1-5 d after operation in all patients (P<0.05).The concentrationsof these factors were higher in patients from POCD group than in those from non-POCD group 1-5 d after operation (P < 0.05). Conclusion The CXCL13 concentration insenior patients undergoing total hip replacement who devel-oped POCD were higher than in those who did not developed POCD.Whether it is correlated with POCD remains further study.

Impact of different hemoglobin on postoperative cognitive functions in female patients undergoing laparo- scopic surgery / 实用医学杂志

Objective To explore the impact of different hemoglobin on postoperative cognitive functions in female patients underwent laparoscopic surgery. Methods 215 female patients who were underwent laparoscopic total hysterectomy or laparoscopic myomectomy from January 2016 to December 2016 in our hospital were selected. The patients were divided into 3 groups according to their hemoglobin:Group N with normal hemoglobin ,Group A with hemoglobin concentration of 9 ~ 11 g/L ,and Group B with hemoglobin concentration of 6 ~ 9 g/L. Same anesthesia and recovery plan were performed in all patients. Basic and operative information were recorded. The score of MoCA on the day before surgry ,the day after surgry ,3 days after surgry and 30 days after surgry were recorded. Blood samples were collected on the day before surgry and the day after surgry for the determina-tion of serum S-100β protein and IL-6 concentrations. Results No significant difference was found in basic and operative information among three groups. The recovery time was much longer in Group B than that in Group N. No difference were found among three group in the score of MoCA on the day before surgry and 30 days after surgry ,while the score in the day after surgry and 3 days after surgry were lower in Group B com-pared with Group N. The incidence of POCD were higher in Group B compared with Group N. Compared with the day before surgry ,the concentration of serum S-100β protein and IL-6 were much higher. And compared with Group N ,the concentration of serum S-100β protein was higher in Group A and B in the day after surgry , while IL-6 was higher in Group B. The concentration of serum S-100βprotein and IL-6 were much higher in Group B compared with Group A in the day after surgry. Conclusion Female patients with hemoglobin concen-tration of 6 ~ 9 g/L are susceptible to POCD ,which might be contributed by operative central nerve system damage induced by excessive inflammation.

Effects of electroacupuncture on postoperative cognitive dysfunction and AngⅡ/AT1R in the hippocampus in aging rats induced by D-galactose / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) on postoperative cognitive dysfunction (POCD) and AngⅡ/AT1R in the hippocampus in D-galactose-induced aging rats which received hepalobectomy, and to explore the possible mechanism of EA on POCD.</p><p><b>METHODS</b>Eighty male Sprague-Dawley rats were randomly divided into a young control group (10 rats), a D-Galactose-induced aged (Da) group (10 rats), a Da+hepatolobectomy group (30 rats) and an EA group (30 rats). The rats in the Da+hepatolobectomy group and EA group were further randomly divided into a 1 d subgroup, 3 d subgroup and a 7 d subgroup, 10 rats in each subgroup. The rats in the EA group were treated with EA at "Baihui" (GV 20) and "Dazhui" (GV 14) with continuous wave (15 Hz in frequency and 1 mA in intensity), and rats in each subgroup were treated for 1 d, 3 d and 7 d, respectively. The rats in the remaining groups were treated with immobilization, once a day. The Y-maze was used to observe the behavior change of rats, and ELISA was applied to measure the level of hippocampal AngⅡ, and RT-PCR and immunohistochemistry method were performed to detect AT1R mRNA expressions and AT1R positive expression in the hippocampus.</p><p><b>RESULTS</b>The number of rat initiative avoidance in the Da group was significantly less than that in the young control group (<0.05), and the mRNA expression and positive percentage of AT1R in the hippocampus in the Da group were significantly higher than those in the young control group (both<0.01). Compared with the Da group, the number of rat initiative avoidance in each subgroup of Da+hepatolobectomy group and EA group were significantly reduced (all<0.01), and the expression of AngⅡ, AT1R mRNA and AT1R positive cells percentage in the hippocampus were significantly increased (<0.05,<0.01). The number of rat initiative avoidance in each subgroup of EA group was higher than that in the subgroup of Da+hepatolobectomy group (<0.05,<0.01); and the expression of AngⅡ, AT1R mRNA, and AT1R positive percentage in the EA group were significantly less than that in the Da+hepatolobectomy group (<0.05,<0.01).</p><p><b>CONCLUSIONS</b>EA at "Baihui" (GV 20) and "Dazhui" (GV 14) could improve POCD in D-galactose-induced aging rats which received hepalobectomy, and it is likely to be related with the inhibition of AngⅡ, AT1R positive expression and AT1R mRNA in the hippocampus.</p>

The effects of memantine on recovery, cognitive functions, and pain after propofol anesthesia / Efeitos da memantina sobre a recuperação, funções cognitivas e dor após a anestesia com propofol

Abstract Objectives: Postoperative cognitive dysfunction refers to the problems associated with thought and memory that are often experienced after major surgery. The aim of this study is to evaluate the effects of intraperitoneally administered memantine on recovery, cognitive functions, and pain after propofol anesthesia. Methods: The study was conducted in Gazi University Animal Research Laboratory, Ankara, Turkey in January 2012. Twenty-four adult female Wistar Albino rats weighing 170-270 g were educated for 300 s in the radial arm maze (RAM) over three days. Group P was administered 150 mg kg−1 of intraperitoneal (IP) propofol; Group M was given 1 mg kg−1 of IP memantine; and Group MP was given 1 mg kg−1 of IP memantine before being administered 150 mg kg−1 of IP propofol. The control group received only IP saline. RAM and hot plate values were obtained after recovery from the groups that received propofol anesthesia and 30 min after the administration of drugs in other two groups. Results: The duration of recovery for Group MP was significantly shorter than Group P (p < 0.001), and the number of entries and exits in the RAM by Group MP was significantly higher during the first hour when compared to Group P (p < 0.0001). Hot plate values, on the other hand, were found to be significantly increased in all groups when compared to the control values, aside from Group C (p < 0.0001). Conclusion: In this study, memantine provided shorter recovery times, better cognitive functions, and reduced postoperative pain. From this study, we find that memantine has beneficial effects on recovery, cognitive functions, and pain after propofol anesthesia.

Resumo Objetivos: A disfunção cognitiva no pós-operatório refere-se a problemas associados ao pensamento e à memória que são frequentemente manifestados após uma cirurgia de grande porte. O objetivo deste estudo foi avaliar os efeitos da memantina administrada por via intraperitoneal sobre a recuperação, as funções cognitivas e a dor após a anestesia com propofol. Métodos: O estudo foi feito no Laboratório de Pesquisa com Animais da Universidade de Gazi, Ankara, Turquia, em janeiro de 2012. Vinte e quatro ratos albinos do sexo feminino, adultos, da linhagem Wistar, com 170-270 g, foram treinados durante 300 segundos no labirinto radial de oito braços (LRB) durante três dias. O Grupo P recebeu 150 mg/kg−1 de propofol por via intraperitoneal (IP), o Grupo H recebeu 1 mg/kg−1 de memantina IP e o Grupo MP recebeu 1 mg/kg−1 de memantina IP antes da administração de 150 mg/kg−1 de propofol (IP). O grupo controle recebeu apenas solução salina IP. Os valores do LRB e da placa quente foram obtidos após a recuperação dos grupos que receberam propofol e 30 minutos após a administração dos fármacos nos outros dois grupos. Resultados: O tempo de recuperação do Grupo MP foi significativamente menor do que o do Grupo P (p < 0,001) e o número de entradas e saídas do LRB do Grupo MP foi significativamente maior durante a primeira hora, em comparação com o Grupo P (p < 0,0001). Os valores da placa quente, por outro lado, foram significativamente maiores em todos os grupos, em comparação com os valores do grupo controle, exceto pelo Grupo C (p < 0,0001). Conclusão: No presente estudo, memantina proporcionou tempos mais curtos de recuperação, funções cognitivas melhores e reduziu a dor no pós-operatório. A partir deste estudo, descobrimos que a memantina tem efeitos benéficos sobre a recuperação, as funções cognitivas e a dor após anestesia com propofol.

Perioperative time course of matrix metalloproteinase-9 (MMP-9), its tissue inhibitor TIMP-1 & S100B protein in carotid surgery.

Background & objectives: Ischaemic stroke is a life burdening disease for which carotid endarterectomy (CEA) is considered a gold standard intervention. Pro-inflammatory markers like matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) and S-100 Beta (S100B) may have a role in the early inflammation and cognitive decline following CEA. This study was aimed to describe the perioperative time courses and correlations between of MMP-9, TIMP-1 and S100B following CEA. Methods: Fifty four patients scheduled for CEA were enrolled. Blood samples were collected at four time points, T1: preoperative, T2: 60 min after cross-clamp release, T3: first postoperative morning, T4: third postoperative morning. Twenty atherosclerotic patients were included as controls. Plasma MMP-9, TIMP-1 and S100B levels were estimated by ELISA. Results: TIMP-1 was decreased significantly in the CEA group (P<0.01). Plasma MMP-9 was elevated and remained elevated from T1-4 in the CEA group (P<0.05) with a marked elevation in T3 compared to T1 (P<0.05). MMP-9/TIMP-1 was elevated in the CEA group and increased further by T2 and T3 (P<0.05). S100B was elevated on T2 and decreased on T3-4 compared to T1. Interpretation & conclusions: Our study provides information on the dynamic changes of MMP-9-TIMP-1 system and S100B in the perioperative period. Preoperative reduction of TIMP-1 might be predictive for shunt requirement but future studies are required for verification.

A Comparison of Desflurane and Sevoflurane in the Recovery of Cognitive Function after General Anesthesia in Elderly Patients.

Background: The postoperative cognitive dysfunction (POCD) or psychomotor function disorder is known to be associated with the anesthetic agents, as well as the physiological changes resulting from the anesthesia. The known risk factors are old age, preexisting cerebral cardiac or vascular disease, alcohol abuse, intra and post-operative complications. Methods: 50 patients above 65 years of age falling into ASA Grade 1, 2 or 3 were categorized into 2 groups, one (Group A) wherein Sevoflurane was given as the anesthetic agent and the other (Group B) where Desflurane was administered. All had undergone physical and regular blood examination. MMSE score was taken for all patients for cognitive recognition before surgery and 1, 3, and 6 hours after surgery. Results: Of the 50 patients, the MMSE score was above 27 for all before surgery, while, post-surgery it was below 27 after I hour in 100% of the cases. After 3 hours, in the group A, the mean MMSE was above 27 while it was still below 27 in Group B while it was above 27 in both the Groups after 6 hours postsurgery. There was only 1 cases of POCD after 6 hours in Group A and none in Group B. The recovery time was faster in group B as compared to Group A. Conclusion: Desflurane was marginally a better anesthetic agent in terms or recovery to Sevoflurane and Sevoflurane was slightly better than the former when it came to cognitive recognition Therefore, we conclude that both the drugs are equally good anesthetic agents.

Influence of preemptive analgesia with Hydromorphone Hydrochloride on postoperative cognitive function and inflammation response in the elderly patients / 实用医学杂志

Objective To investigate the influence of preemptive analgesia with Hydr- omorphone Hy-drochloride on postoperative cognitive function and inflammation cytokines in the elderly patients. Methods Ninety ASA I orⅡ elder patients were randomly divided in control group (C)and Hydromorphone Hydrochloride group(H) with 45 cases each. Hydromorphone Hydrochloride 2 mg was injected iv before induction of anesthesia in group H. Observed plasma concentrations of the CRP、 TNF-α and IL-6 at different time. Cognitive function was assessed by minimental state examination. Results Plasma the CRP、 TNF-a and IL-6 concentrations were lower and MMSE scales were higher in group H than in group C. Conclusion Preemptive analgesia with Hy-dromorphone Hydrochloride 2 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.

A comparison of desflurane and sevoflurane in the recovery of cognitive function after general anesthesia in elderly patients.

Background: The postoperative cognitive dysfunction (POCD) or psychomotor function disorder is known to be associated with the anesthetic agents, as well as the physiological changes resulting from the anesthesia. The known risk factors are old age, preexisting cerebral cardiac or vascular disease, alcohol abuse, intra and post-operative complications. Methods: 50 patients above 65 years of age falling into ASA Grade 1, 2, or 3 were catagrzed into 2 groups, one (Group A) wherein sevoflurane was given as the anesthetic agent and the other (Group B) where desflurane was administered. All had undergone physical and regular blood examination. MMSE score was taken for all patients for cognitive recognition before surgery and 1, 3, and 6 hours after surgery. Results: Of the 50 patients, the MMSE score was above 27 for all before surgery, while, post-surgery it was below 27 after I hour in 100% of the cases. After 3 hours, in Group A, the mean MMSE was above 27 while it was still below 27 in Group B while it was above 27 in both the Groups after 6 hours post-surgery. There was only 1 cases of POCD after 6 hours in Group A and none in Group B. The recovery time was faster in Group B as compared to Group A. Conclusions: Desflurane was marginally a better anesthetic agent in terms or recovery to sevoflurane and sevoflurane was slightly better than the former when it came to cognitive recognition Therefore, we conclude that both the drugs are equally good anesthetic agents.

Effect of dexmedetomidine combined with parecoxib on postoperative cognitive function in elderly patients re-ceived operation / 局解手术学杂志

patients received thoracic surgery. Methods Fifty patients underwent radical resection of pulmonary carcinoma were divided into DP group ( dexmedetomidine infusion by micro pumo and parecoxib 40 mg through intravenous injection) and DN group ( dexmedetomidine infusion by micro pumo and nomal saline 5mL through intravenous injection). The time for spontaneous breath,eye opening and extubation after the oper-ation were recorded. The mimi-mental state examination ( MMSE) was used to assess the cognitive function. The concentration of protein S100β and IL-6,TNF-α were determined at 1 d before operation and 1 h,24 h after the operation. Results The difference of time for spon-taneous breath,eye opening,extubation and preoperative values of MMSE between two groups were not statistically significant(P>0. 05). MMSE scores at 1 d,3 d and 5 d after operation in group DN were lower than those in group DP (P<0. 05). The values of S100β、IL-6、TNF-α at 1 h and 24 h after operation in group DN were higher than that in group DP (P< 0. 05). Conclusion Dexmedetomidine com-bined with parecoxib can decrease the incidence of postoperative cognitive dysfunction in elderly patients underwent thoracic surgery,and the mechanism of which may be related to the downregulation of serum inflammatory factors.

The Correlation Between the Elevation of IL-2 and IL-10 Levels Under Mild Hypothermia and Early Postoperative Cognitive Dysfunction in Elderly / 昆明医科大学学报

Objective To compare the effects of mild hypothermia or normothermia on inflammatory cytokines (IL-2 and IL-10) in elderly patients undergoing surgery for rectal cancer, and determine whether the elevation of IL-2 and IL-10 levels and early postoperative cognitive dysfunction has the relevant. Methods Forty ASA classification Ⅰ or Ⅱ patients aged 65-83 yr undergoing surgery for rectal cancer were randomly divided into 2 groups (n=20 each):normal body temperature group (GroupⅠ) and mild hypothermia group (GroupⅡ) . The venous blood samples were taken at 3 points which were at 1 h before anesthesia (T1), the end of operation (T2) and the 24h after operation (T3) to measure the levels of plasma IL-2 and IL-10. The cognitive function test (MMSE) were performed at one day before operation (N1), one day after operation (N2) and 3th days after operation (N3) . Results The level of plasma IL-2 was significantly lower in the GroupⅡthan that in the GroupⅠat T2 and T3 ( < 0.01), and those was significantly lower at T3 than that at T2 ( <0.01) . The level of plasma IL-10 was significantly higher in the GroupⅡat T3 than that at T1 and T2 ( <0.01) . To compare with N1, the score of both groups were decreased at N2 ( <0.05), and it was lower in GroupⅡthan that in GroupⅠ( <0.05), with a significant difference. The score of both groups were increased significantly at N3 (<0.05), and there was significant difference with N2 ( <0.05);Positive correlation was found between IL-2 at T2 and T3 and the score of MMSE in the GroupⅡat N2 ( =0.459, <0.01) ( =0.550, <0.01) . Conclusion Positive correlations were found between the elevation of IL-2 levels under mild hypothermia and the decline of postoperative early cognitive function in elderly undergoing rectal cancer surgery.

Postoperative Cognitive Dysfunction in Adult Patients: Risk Factor and Its Influence on Clinical Outcome / 中国康复理论与实践

@#Objective To investigate the influence of postoperative cognitive dysfunction (POCD) to clinical outcome in adult patients and the risk factor. Methods 122 patients after operation on chest were surveyed with Wechsler Adult Intelligence Scale-Revised China (WAIS-RC) within 3 d before operation and on the 7th day after operation. Their pulmonary functions were measured before discharged. Their time on bed, total time in hospital, time after operation in hospital, time in intensive care unit and spending for therapy were investigated. Results 45 patients were finally diagnosed as POCD (POCD group) 7 d after operation. Before operation, the age, the body weight index, the smoking index and the number of risk factor of angiosclerosis in the POCD group were all higher than those whose cognitive function were normal (normal group) (P<0.05). The sores of insight, count, digit scope, vocabulary, figure collocation, figure patch of WAIS-RC in POCD group were obviously lower than those in normal group (P<0.05). Every index of pulmonary function in POCD group was lower than those in normal group(P<0.05). The time keeping on bed, total time in hospital, time after operation in hospital, time in intensive care unit and spending for therapy in POCD group all exceeded those in normal group (P<0.05).Conclusion The adult patients with POCD may spend more time and money for therapy in hospital, and their pulmonary functions may be recovered poorly.