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Objective:To evaluate the effect of surgery under propofol anesthesia during mid-pregnancy on the cognitive function and hippocampal histone deacetylase 2 (HDAC2)-cAMP response element-binding protein (CREB)-N-methyl-D-aspartate (NMDA) receptor 2B subunit (NR2B)-containing NMDA receptor (NR2B) signaling pathway in the offspring rats.Methods:Thirty healthy Sprague-Dawley rats at 14 days of gestation were divided into 3 groups ( n=10 each) using a random number table method: propofol anesthesia group (P group), surgery under propofol anesthesia group (S group) and control group (C group). In S group, propofol 20 mg/kg was injected via the caudal vein, and then propofol was continuously infused at a rate of 20 mg·kg -1·h -1 to maintain anesthesia for 4 h, and exploratory laparotomy was performed. Group P received no exploratory laparotomy and the other treatments were similar to those previously described in group S. The equal volume of normal saline was given instead in group C. The learning and memory of the offspring rats was assessed using Morris water maze test on postnatal day 30. The expression of HDAC2, phosphorylated CREB (p-CREB), NR2B, brain-derived neurotriphic factor (BDNF) and phosphorylated tyrosine kinase B (p-TrkB) in offspring′s hippocampi was evaluated by Western blot. Apoptosis in hippocampal neurons was detected by TUNEL staining. Results:Compared with group C, the escape latency was significantly prolonged, the frequency of crossing the original platform was decreased, the time spent in the second quadrant was shortened, the expression of HDAC2 was up-regulated, the expression of p-CREB, NR2B, BDNF and p-TrkB was down-regulated, and the apoptosis rate of the hippocampal neurons was increased in P and S groups ( P<0.05). Compared with P group, the escape latency was significantly prolonged, the frequency of crossing the original platform was decreased, the time spent in the second quadrant was shortened, the expression of HDAC2 was up-regulated, the expression of p-CREB, NR2B, BDNF and p-TrkB was down-regulated, and the apoptosis rate of the hippocampal neurons was increased in S group ( P<0.05). Conclusions:Surgery under propofol anesthesia during mid-pregnancy can decrease the cognitive function of offspring rats, and the mechanism is related to the regulation of HDAC2-CREB-NR2B signaling pathway and the promotion of apoptosis in hippocampal neurons.
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Objective:To evaluate the effectiveness and safety of coronavirus disease 2019 (COVID-19) vaccines for dialysis patients with chronic kidney disease.Methods:PubMed, Medline, Embase databases and CNKI, VIP, Wanfang databases were searched systematically. The deadline was April 25, 2022. The search terms included haemodialysis, peritoneal dialysis, vaccine, seroresponse, COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main outcome included the positive rate after vaccination, antibody titer, antibody changes during follow-up, infection rate of SARS-CoV-2, hospitalization rate and mortality.Results:A total of 154 195 patients were analyzed in 26 studies. The results of meta-analysis showed that the positive rate of serum IgG antibody in patients with chronic kidney disease was 48% after the first dose of vaccine, 89% and 96% after the second dose and third dose, respectively. After vaccination with COVID-19 vaccines, there was no significant difference in serum antibody and titer between hemodialysis patients and peritoneal dialysis patients. However, compared with the healthy control group, the antibody positive rate and antibody titer of dialysis patients after vaccination were lower (both P<0.05). In the follow-up, the antibody positive rate at the third month decreased by 12% compared with at the first month, at the sixth month decreased by 15% compared with at the third month, and at the sixth month decreased by 20% compared with at the first month. The serum antibody positive rate after the third dose of vaccine increased by 38% ( RR=1.38, 95% CI 1.12-1.70, P<0.001), and the antibody titer increased significantly ( SMD=1.46, 95% CI 0.31-2.61, P<0.001). Although the vaccines could not reduce the infection rate of SARS-CoV-2 in dialysis patients, it could significantly reduce the hospitalization rate and mortality after infection. Conclusions:After vaccination with COVID-19 vaccines, dialysis patients can produce strong serum antibodies, which can reduce the hospitalization rate and mortality after SARS-CoV-2 infection. However, the duration of antibody is short and the titer level is low, so it is necessary to timely vaccinate booster vaccine dose to obtain stronger immunogenicity.
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Objective To investigate the effects of dexmedetomidine on renal function in patients with hemorrhagic shock undergoing emergency surgery.Methods Sixty patients (27 males, 33 females) with hemorrhagic shock, aged 18-69 years, ASA physical status Ⅲ or Ⅳ, required emergency surgery under general anesthesia, were randomized into two groups (n=30 each): dexmedetomidine group (group D) and control group (group C).The patients in group D receiving a loading dose of dexmedetomidine (0.5 μg/kg within 10 min) after the induction of anesthesia followed by a continuous infusion rate of 0.4 μg·kg-1·h-1 till 30 min before the end of surgery, while those in group C received equal volume of normal saline.Venous blood were obtained immediately before beginning of surgery (T1), immediately after surgery (T2), 24 h after surgery (T3) and 72 h after surgery (T4) for detecting the concentrations of the serum creatinine (Scr) and blood urea nitrogen (BUN), the contents of neutrophil gelatinase-associated lipocalin (NGAL) and high mobility group box-1 (HMGB1).The range ability of the concentration of the serum Scr from T4 to T1 (ΔScr) and the content of the serum HMGB1 from T4 to T1 (ΔHMGB1) were also calculated and recorded.Hemodynamic index (including MAP, HR) and arterial blood gas results were recorded during surgery.Results Compared with T1, MAP, CVP and BE were increased, meanwhile, HR and Lac were decreased at T2, but there was no statistically significant difference between the two groups.No statistical difference was found in BUN at any time point between group D and group C.Compared with T1, Scr decreased in both groups at T2-T4.The ΔScr in group D was higher than that in group C at T4 (P＜0.05).The content of serum NGAL at T4 in group D was significantly dropped when compared with T1 (P＜0.01) and was lower than that in group C (P＜0.05).Compared with T1, the content of serum HMGB1 was significantly decreased in both groups at T2 (P＜0.05);the content of serum HMGB1 at T3 in group C was significantly increased and was higher than that in group D;the ΔHMGB1 in group C was higher than that in group D.Conclusion Hemorrhagic shock could induce acute kidney injury.Perioperative continuous infusion of dexmedetomidine facilitated renal function recovery after ischemia-reperfusion injury in patients with hemorrhagic shock through inhibiting the elevation of serum HMGB1.