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Objective:To observe the influence of NOD-like receptor thermal protein domain associated protein 6 (NLRP6) on hepatic ischemia-reperfusion injury (IRI), and elucidate the related mechanism.Methods:Thirty C57BL/6 mice with body weight of (18.80±1.99) g, were divided randomly into 5 groups, with 6 mice in each group: the mice that experienced only exploratory laparotomy were Sham group; that only underwent an operation to establish a hepatic IRI model were IRI group; that were treated with tail intravenous injection of clodronate (Clo) liposomes before the establishment of hepatic IRI model were Clo group; that received tail intravenous injection of clodronate liposomes and transfusion of bone marrow derived macrophages (BMDM) before the operation were Clo+ BMDM group; that received preoperative tail intravenous injection of clodronate liposomes and transfusion of BMDM with NLRP6 knockdown were Clo+ NLRP6-knockdown group. Real time quantitative polymerase chain reaction analysis (RT-PCR) and Western blot were performed to analyze the expressions of pyroptosis related proteins and factors. Simulate a hypoxia/reoxygenation (H/R) model in vitro, and set up experimental groups: lipopolysaccharide (LPS) + adenosine triphosphate (ATP), LPS+ ATP+ NLRP6-knockdown, H/R, and H/R+ NLRP6-knockdown. The changes of expressions of pyroptosis related proteins and factors were detected by RT-PCR and Western blot. Expression of NF-κB in vivo and in vitro was measured.Results:Compared with those in Sham group, protein expressions of NLRP6, NLRP3, Caspase-1, gasdermin D (GSDMD), IL-1β and IL-18 were remarkably increased in IRI group, but the levels of these proteins were dramatically decreased in Clo group with the exhaustion of macrophages in comparison with in IRI group, which were significantly different statistically (all P<0.05). The levels of these proteins were enhanced again in Clo+ BMDM group with the reconstruction of macrophages in contrast to those in Clo group, while the enhancements were more obvious in Clo+ NLRP6-knockdown group comparing to those in Clo+ BMDM group, with significant differences (all P<0.05). In vitro, pyroptosis rate for LPS+ ATP group was (16.39±1.06)%, which was lower than (27.34±2.79)% for LPS+ ATP+ NLRP6-knockdown group, with a statistical significance ( P<0.05). Meanwhile, pyroptosis rate for H/R group was (20.59±5.66)%, also much more reduced than (37.76±2.00)% for H/R+ NLRP6-knockdown group ( P<0.05). Expressions of NLRP3, Caspase-1, GSDMD, IL-1β, IL-18 and NF-κB p65 in LPS+ ATP+ NLRP6-knockdown group were more elevated than in LPS+ ATP group, and these indices were also more enhanced in H/R+ NLRP6-knockdown group than which in H/R group. Compared to the Sham group, expression of NF-κB p65 significantly increased in IRI group, which was reversed in Clo group, but enhanced again in Clo+ BMDM group and reached a peak in Clo+ NLRP6-knockdown group. Conclusions:Macrophage plays a critical role in immune response to hepatic IRI, wherein NLRP6 functions specifically. NLRP6 acts to suppress inflammation during hepatic IRI through regulating macrophage pyroptosis via inhibiting NF-κB.
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The concept of enhanced recovery after surgery (ERAS) has attracted more and more attention so far, but there are different opinions on it. ERAS philosophy covers many fields, in which anesthesiology plays an irreplaceable role by virtue of its professional advantages. Based on ERAS philosophy, anesthesiologists will provide guidance on preoperative assessment, preoperative prehabilitation, intraoperative fluid management, analgesia, temperature management, and postoperative rehabilitation to improve patient comfort and satisfaction.
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As the rapid development of minimally invasive techniques, anesthesia, and enhanced recovery after surgery (ERAS), anorectal day surgery receiving more and more attention by improving efficiency of medical care while reducing cost and hospitalized infection. However, day surgery also faces the challenge of completing the whole process from patient admission to discharge within 24 hours. Therefore, establishing a reasonable and detailed day surgery process is the cornerstone to guarantee safe medical practice and patients satisfaction. National Clinical Research Center for Geriatric Disorders (Xiangya), together with China Ambulatory Surgery Alliance formulates the clinical practice guideline for anorectal day surgery 2019 edition. Here we make some interpretations of the guidelines on the detailed process of anorectal day surgery, including indication, preoperative examination, preoperative risk evaluation, health education, assessment of day surgery anesthesia and before leaving postanesthesia care unit (PACU), postoperative management, assessment of discharge and follow-up, for the convenience of various medical centers.
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Objective To evaluate the effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation response in patients undergoing Han-uvulopharyngoplasty (H-UPPP).Methods Eighty-four patients,aged 28-48 yr,weighing 91-108 kg,scheduled for elective H-UPPP,requiring tracheal intubation under general anesthesia,were equally and randomly divided into 2 groups:compound lidocaine cream group (group L) and control group (group C).The compound lidocaine cream 2-3 g were coated on the tracheal tube cuff and exterior before induction of anesthesia in group L,while the paraffin oil was coated in group C.Mean arterial pressure (MAP),HR and pulse oxygen saturation were recorded before induction of anesthesia,at the end of infusion of anesthetics,during extubation and 5 min after extubation (T1-4).Blood samples were taken from the forearm veins on the noninfusion side at T1-4 for detection of plasma adrenergic and norepinephrine concentrations.Cardiovascular events during extubation were recorded.Results Compared with group C,MAP and HR were significantly decreased at T3,4,the incidences of hypotension and tachycardia were decreased,the plasma adrenergic and norepinephrine concentrations were significantly decreased at T2-4 in group L (P ＜ 0.05).Conclusion Topical anesthesia with compound lidocaine cream coated on the tracheal tube can effectively reduce the extubation response in the patients undergoing H-UPPP.
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Objective To observe the effects of combined penebyclidine hydrochloride-ketamine-propofoi intravenous anesthesia with local anesthesia in transcatheter occlusion of congenital heart diseases (CHD).Methods Eighty-six patients suffered in CHD scheduled for transcatheter Amplatzer occlusio were divided randomly and averagely into two groups with 43 cases each.Group A received combined ketamine--propofol ina'avenous anesthesia with local anesthesia. Group B received combined hydrochloride-ketamine-propofol intavenous anesthesia with local anesthesia.Results The rate of upper airway obstruction of child patient that was caused by increased oral secretion in group B (4.7%) was significantly lower than that in group A(14.0%) (P ＜ 0.05 ).The upper airway obsa-uction was removed by aspirating sputum and oxygen therapy in group A,while removed "by decreasing anesthetic depth in group B.The rate of arrhythmia in operation,the time of operation and wake-up time were not significantly different between two groups [37.2%,(2.65±1.85)h,(45.4±15.2)min in group A,but 34.9%,(2.58±1.74)h,(50.2±17.3)rain in group B (P＞0.05)].Conclusion The combined penehyclidine hydrochloride-ketamine-propofol intravenous anesthesia with local anesthesia is feasible and safe in transcatheter occlusion of congenital heart diseases.
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Objective To investigate the effects of combined epidural block with inhalation - intravenous general anesthesia (GE) on stress response in thepatients for laparoscopic radical colonectomy. Methods Twenty-eight ASA I-II patients scheduled for laparoscopic radical colonectomy were randomly divided into group GE and inhalation-intravenous general anesthesia group(group G) with 14 cases each. In group GE, epidural blocks were operated before induction, MAP,ECG ,HR,SpO2 and PETCO2 were observed and recorded at such point-time: pre-pneumoperitoneum and 1,2,3 h after pneumoperitoneum. Arterial blood-gas analysis ,noradrenaline(NE) and adrenaline(E) were also measured at the same time; Group G was the same as group GE except for no epidural block and extra fentanyl. Results The level of stress response hormones(NE and E) of post- pneumoperitoneum 1,2,3 h were increased VS those of pre-pneumoperitoneum in both groups, and group G was significant (P
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AIM: To analyze the polymorphic expression of UDP-glucuronosyltransferase UGT1A gene locus in human colorectal epithelium. METHODS: Colorectal tissue samples were obtained from 40 patients with colorectal cancer and 20 normal controls. The levels of UGT1A transcriptions were detected by RT-PCR, exon-1 specific RT-PCR. UGT1A proteins were measured by Western blotting analysis. RESULTS: (1) UGT1A mRNA expression was found to be significantly down-regulated in colorectal cancer tissue as compared with the surrounding healthy tissues (P