To study the effect of oxygen carrying capacity on expressed changes of erythrocyte membrane protein in different storage times.

Erythrocyte membrane is crucial to maintain the stability of erythrocyte structure. The membrane protein on the surface of erythrocyte membrane enables erythrocyte to have plasticity and pass through the microcirculation without being blocked or destroyed. Decreased deformability of erythrocyte membrane protein will lead to a series of pathological and physiological changes such as tissue and organ ischemia and hypoxia. Therefore, this research collected 30 cases of healthy blood donors, and explored erythrocyte stored at different times relating indicators including effective oxygen uptake (Q), P50, 2,3-DPG, Na+-k+-ATP. Erythrocyte morphology was observed by electron microscopy. Western blot and immunofluorescence assay were used to detect membrane protein EPB41, S1P, GLTP, SPPL2A expression changes of erythrocyte. To explore the effective carry oxygen capacity of erythrocyte at different storage time resulting in the expression change of erythrocyte surface membrane protein.

Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy.

BACKGROUND: A high prevalence of postoperative complications is closely associated with a worse short- and long-term outcome. This current study aimed to investigate potential risk factors including albumin-to-fibrinogen ratio (AFR) for severe postoperative complications (SPCs) in surgical gastric cancer (GC) patients. METHODS: Elderly patients (≥65 years) with primary GC who underwent elective radical laparoscopic gastrectomy under general anesthesia were included. According to the Clavien-Dindo classification system, the severity of complications was assessed from Grade I to V and SPCs were defined as C-D Grade ≥ IIIa. The clinicopathological features, operative-associated characteristics, postoperative recovery and laboratory tests were compared between patients with or without SPCs. Receiver operating characteristic (ROC) curve analysis using Youden's Index was established for determining the predictive value and cut-off threshold of AFR for SPCs. Binary univariate and multivariate logistic regression models were used to assess factors influencing SPCs. RESULTS: A total of 365 elderly GC patients were finally included in the analysis, of which 52 (52/365, 14.2%) patients had developed SPCs within postoperative 30 days. Preoperative AFR level predicted SPCs in surgical GC patients with an AUC of 0.841, a sensitivity of 76.36% and a specificity of 80.77%, respectively (P < 0.001). The multivariate analysis revealed that a lower AFR level (OR: 1.94, 95% CI: 1.09-3.36, P = 0.017) and an older age (OR: 1.81, 95% CI: 1.06-3.04, P = 0.023) were two independent predictive factors for SPCs in surgical GC patients. CONCLUSIONS: Preoperative AFR level is a useful predictor for SPCs in elderly GC subjects after radical laparoscopic gastrectomy.

A Comparison of the Efficacy and Tolerability of the Treatments for Sciatica: A Network Meta-Analysis.

BACKGROUND: There remains a lack of a systematic summary of the efficacy and safety of various medicines for sciatica, and discrepancies among these exist. OBJECTIVE: The aim of this study is to comprehensively assess the efficacy of and tolerance to several medical options for the treatment of sciatica. METHODS: We performed a network meta-analysis and illustrated the results by the mean difference or odds ratio. The surface under the cumulative ranking curve (SUCRA) was used for indicating the preferable treatments. All data analyses and graphs were achieved via R 3.3.2 and Stata 13.0. RESULTS: The subcutaneous anti-tumor necrosis factor-α (anti-TNF-α) was superior to the epidural steroid + anesthetic in reducing lumbar pain in both acute + chronic sciatica patients and acute sciatica patients. The epidural steroid demonstrated a better ability regarding the Oswestry disability score (ODI) compared to the subcutaneous anti-TNF-α. In addition, for total pain relief, the use of nonsteroidal antiinflammatory drugs was inferior to the epidural steroid + anesthetic. The epidural anesthetic and epidural steroid + anesthetic both demonstrated superiority over the epidural steroid and intramuscular steroid. The intravenous anti-TNF-α ranked first in leg pain relief, while the subcutaneous anti-TNF-α ranked first in lumbar pain relief, and the epidural steroid ranked first in the ODI on the basis of SUCRA. In addition, their safety outcome (withdrawal) rankings were all medium to high. CONCLUSIONS: Intravenous and subcutaneous anti-TNF-α were identified as the optimal treatments for both acute + chronic sciatica patients and acute sciatica patients. In addition, the epidural steroid was also recommended as a good intervention due to its superiority in reducing ODI.

Insulin-Like Growth Factor-1, a Potential Predicative Biomarker for Postoperative Delirium Among Elderly Patients with Open Abdominal Surgery.

BACKGROUND: Delirium is commonly observed among elderly surgical subjects during the postoperative period, and the incidence of postoperative delirium (POD) in elderly patients (≥65 years) ranges widely from 10% to 70%. This study aimed at investigating potential serum predicative factors for POD in elderly patients after open abdominal surgery. METHODS: 140 subjects scheduled to undergo elective gastrointestinal tumor resection via laparotomy from March, 2013 to May, 2015 were enrolled in this study. Participants enrolled were evaluated for delirium and delirium severity on preoperative day, postoperative days 2 and 3. Non-fasting blood samples were collected in the morning on the day before surgery for the detection of serum cytokines expressions by enzyme-linked immunesorbent assays (ELISA). RESULTS: A total of 140 patients were finally enrolled in this study and 36 of them occurred POD, with a POD incidence of 25.7%. In comparison with non-POD group, the serum levels of insulin-like growth factor-1 (IGF-1) demonstrated significantly decreased of patients in POD group (P<0.01). The receiver operating characteristic (ROC) curve analysis revealed that serum IGF-1 levels as potential predicative factor for POD with the area under the ROC curve (AUC) values of 0. 805, with 95 % confidence interval (CI) of 0.719-0.891 (P<0.001). Univariate and multivariate logistic regression analysis resulted in serum IGF-1 level as a non-invasive predicative factor for POD (OR=2.52, 95%CI: 1.19-5.43, P=0.019). CONCLUSION: Our results showed that serum IGF-1 level was a potential predicative biomarker for POD among patients undergoing elective gastrointestinal tumor resection via laparotomy.

Age and the neuromuscular blockading effects of cisatracurium.

PURPOSE: To investigate the influence of age on the neuromuscular blocking effect of cisatracurium. METHODS: 90 patients with ASA I and II were assigned to the following groups according to their age: adults, children, and infants. Each group was subdivided into three subgroups according to the first dose of cisatracurium. Patients were administrated at a first dose of cisatracurium randomly, and their responses to train-of-four (TOF) stimulation were observed. When the same degree of the first response (T1) continuously repeats three times, the percentage of T1 inhibition was recorded, and the curve of dose-effect relationship and ED95 were calculated. A second dose of cisatracurium was then administrated (total volume 100 µg/kg). The recovery phase in each patient was observed upon T1 reaching the maximum blocking effect (100%). RESULTS: Once the maximum blocking effect was reached, patients were intubated. There were 83 cases (92.2%) of patients with grade 1 and 7 (7.8%) patients with grade 2 intubating conditions. ED95 was 59.29, 55.88 and 45.39 µg/kg in adults, children, and infants, respectively. ED95 positively correlated with age. The clinical duration of neuromuscular blockade, effective action duration of neuromuscular blockade, and in vivo action duration of neuromuscular blockade in adults was longer than that in children (P<0.05), but shorter than in infants (P<0.05). However, there were no significant differences in the recovery index among groups (P>0.05). CONCLUSION: Age influences the neuromuscular blocking effects of cisatracurium to a certain extent.

Effect of Acute Normovolemic Hemodilution Combined with Controlled Low Central Venous Pressure on Blood Coagulation Function and Blood Loss in Patients Undergoing Resection of Liver Cancer Operation.

BACKGROUND/AIMS: This paper aims to investigate the effect of acute normovolemic hemodilution (ANH) used with controlled low central venous pressure (LCVP) technology on perioperative bleeding and coagulation in hepatocellular carcinoma operation patients. METHODOLOGY: A total of 60 cases undergoing hepatic resection operation were randomly divided into the control group, LCVP group (Group II), and ANH + LCVP group (Group III). The changes of hemodynamic indexes at different time points in each group were observed and recorded, along with the volume of allogenous blood transfusion and the number of patients undergoing allogenous blood transfusion. RESULTS: Compared with Group I (control), there was evident reduction of the bleeding volume, allogenic blood transfusion volume, and number of patients undergoing allogenic blood transfusion in Groups II and III. CONCLUSION: The application of ANH combined with LCVP in hepatic resection can evidently reduce intraoperative hemorrhages and homologous blood transfusions; moreover, it has no significant adverse effect on the coagulation function.

[Effects of volume-controlled ventilation and pressure-controlled volume- guaranteed mode during one-lung ventilation on circulation, pulmonary function and lung injury].

OBJECTIVE: To compare the effects of volume-controlled ventilation (VCV) and pressure-controlled volume-guaranteed (PCV-VG) mode during one-lung ventilation (OLV) on circulation, pulmonary function and lung injury. METHODS: 2012 February to 2013 March in Ningbo No2. Hospital cardiothoracic surgery, 30 patients aged 52 to 76 years (ASA grade II-III) undergoing elective thoracoscopic lobectomy were randomly divided into VCV group and PCV-VG group, with 15 cases in each group. After anesthesia induction and endotracheal intubation, endobronchial blocker was inserted to start OLV. Heart rate (HR), mean arterial pressure (MAP), measured tidal volume (TV), peak airway pressure (Ppeak), airway resistance (Raw), chest compliance (Cdyn) and the end-tidal carbon dioxide pressure (PetCO(2)) were recorded at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation. In the meanwhile, arterial blood gas analysis was conducted to measure indicators of pH, oxygen tension (PaO(2)) and carbon dioxide partial pressure (PaCO(2)). Blood was drawn before induction, 1 hour after OLV and 1 hour after the end of surgery, and the concentration of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: HR, MAP, TV, PetCO(2), pH and PaCO(2) in two groups at the time point of 15 minutes after turning to the lateral position, 15 minutes and 60 minutes after OLV, and 15 minutes after the resumption of two lung ventilation showed no significant difference (P > 0.05). At the point of 15 minutes after turning to the lateral position and 15 minutes after two lung ventilation, Ppeak and Cdyn of two groups were significantly different (P < 0.05) (Ppeak:16 ± 3 cmH(2)O, 16 ± 3 cmH(2)O for VCV group and 14 ± 2 cmH(2)O, 14 ± 2 cmH(2)O for PCV-VG group; Cdyn: 43.5 ± 5.9 ml/cmH(2)O, 43.8 ± 6.7 ml/cmH2O for VCV group and 49.7 ± 7.1 ml/cmH(2)O, 53.3 ± 9.6 ml/cmH(2)O for PCV-VG group). Compared with VCV group, PCV-VG group showed a lower Ppeak 15 minutes and 60 minutes after OLV [ (17 ± 2 cmH(2)O) vs (22 ± 4 cmH(2)O) and (18 ± 4 cmH(2)O) vs( 23 ± 3 cmH(2)O) with a higher Cdyn at the same point (38.6 ± 6.3 ml/cmH(2)O) vs (29.6 ± 3.2 ml/cmH(2)O) and 37.3 ± 6.0 ml/cmH(2)O) vs (30.3 ± 3.8 ml/cmH(2)O)] (P < 0.01). Compared with VCV group,IL-6 and TNF-α of PCV-VG group 1 hour after OLV and 1 hour after the end of surgery were significantly lower (P < 0.01) (IL-6: 52.32 ± 3.59 vs 62.65 ± 4.17 pg/ml and 63.57 ± 4.98 vs 82.38 ± 4.10 pg/ml; TNF-α: 3.23 ± 0.27 vs 4.19 ± 0.38 pg/ml and 4.01 ± 0.28 vs. 5.49 ± 0.31 pg/ml). CONCLUSION: During one-lung ventilation in thoracoscopic lobectomy, PCV-VG mode has a competitive advantage over VCV mode in terms of pulmonary function and lung protection.

Impact of allogenic and autologous transfusion on immune function in patients with tumors.

OBJECTIVE: To observe the effects of allogeneic and autologous transfusion on cellular immunity, humoral immunity and secretion of serum inflammatory factors and perforin during the perioperative period in patients with malignant tumors. METHODS: A total of 80 patients (age: 38-69 years; body weight: 40-78 kg; ASA I - II) receiving radical operation for gastro-intestinal cancer under general anesthesia were selected. All the patients were divided into four groups based on the methods of infusion and blood transfusion: blank control group (Group C), allogeneic transfusion group (group A), hemodiluted autotransfusion Group (Group H) and hemodiluted autotransfusion + allogenic transfusion Group (A+H group). Venous blood was collected when entering into the surgery room (T0), immediately after surgery (T1) and 24h (T2), 3d (T3) and 7d (T4) after surgery, respectively. Moreover, flow cytometry was applied to assess changes of peripheral blood T cell subpopulations and NK cells. Enzyme linked immunosorbent assays were performed to determine levels of IL-2, IL-10, TNF-α and perforin. Immune turbidimetry was employed to determine the changes in serum immunoglobulin. RESULTS: Both CD3+ and NK cells showed a decrease at T1 and T2 in each group, among which, in group A, CD3+ decreased significantly at T2 (P<0.05) compared with other groups, and CD3+ and NK cell reduced obviously only in group A at T3 and T4 (P<0.05). CD4+ cells and the ratio of D4+/CD8+ were decreased in groups A, C and A+H at T1 and T2 (P<0.05). No significant intra- and inter-group differences were observed in CD8+ of the four groups (P<0.05). IL-2 declined in group C at T1 and T2 (P<0.05) and showed a decrease in group A at each time point (P<0.05). Moreover, IL-2 decreased in group A + H only at T1. No significant difference was found in each group at T1 (P<0.05). More significant decrease in group C at T2, T3 and T4 compared with group A (P<0.05), and there were no significant differences among other groups (P>0.05). IL-10 increased at T1 and T2 in each group (P<0.05), in which it had an obvious increase in group A, and increase of IL-10 occurred only in group A at T3 and T4 (P<0.05). TNF-α level rose at T1 (P<0.05), no inter- and intra-group difference was found in perforin in all groups (P<0.05). Compared with the preoperation, both IgG and IgA level decreased at T1 in each group (P<0.05), and they declined only in Group A at T2 and T3 (P<0.05), and these parameters were back to the preoperative levels in other groups. No significant differences were observed between preoperative and postoperative IgG and IgA levels in each group at T4 (P>0.05). No obvious inter- and intra-group changes were found in IgM in the four groups (P>0.05). CONCLUSIONS: Allogeneic transfusion during the perioperative period could obviously decrease the number of T cell subpopulations and NK cells and the secretion of stimulating cytokines and increase the secretion of inhibiting cytokines in patients with malignant tumors, thus causing a Th1/Th2 imbalance and transient decreasing in the content of plasma immune globulin. Autologous transfusion has little impact and may even bring about some improvement of postoperative immune function in patients with tumors. Therefore, cancer patients should receive active autologous transfusion during the perioperative period in place of allogeneic transfusion.

Effect of acute normovolemic hemodilution combined with controlled low central venous pressure on cerebral oxygen metabolism of patients with hepalobectomy.

BACKGROUND/AIMS: The effect of acute normovolemic hemodilution (ANH) combined with controlled low central venous pressure (LCVP) on the cerebral oxygen metabolism of patients with hepalobectomy. METHODOLOGY: Undergoing hepatic resection operation in 60 cases, were randomly divided into control group, LCVP group (Group II) and ANH + LCVP group (Group IIl). Before hemodilution (T1), decrease of CVP (T2) and increase of CVP (T3) and at the end of surgery (T4), the blood was sampled via the jugular vein bulb and radial artery for blood gas analysis. RESULTS: Compared with group I, the CaO2 of group II at T3 and T4 was increased; in group III, CaO2 and Da-jvO2 at T2 and T3 were decreased, CjvO2 at T2 decreased, and CaO2 and CjvO2 at T4 increased. Compared with group II, CaO2, CjvO2 and Da-jvO2 of group III at T2 and T3 were decreased. CERO2 of the three groups at T3 and T4 were all decreased (P<0.05 or 0.01). The jugular venous oxygen saturation (SjvO2) and VADL of the three groups at each time point were all within the normal range. CONCLUSION: The moderate ANH combined with LCVP had no adverse effect on the cerebral oxygen metabolism of the patients with the hepalobectomy.

Acute normovolemic hemodilution effects on perioperative coagulation in elderly patients undergoing hepatic carcinectomy.

BACKGROUND: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. MATERIALS AND METHODS: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (130/0.4) and Ringer's solution, respectively. Blood samples were drawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min after ANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. RESULTS: The perioperative blood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss was not significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANH group was significantly less than in control group (350.0±70.7) mL vs. (457.0±181.3) mL (p<0.01). Compared with the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measured after T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significant changes of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC and F1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressions in patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). CONCLUSIONS: ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection of liver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic blood transfusion.

Effects of glial cell line-derived neurotrophic factor intrathecal injection on spinal dorsal horn glial fibrillary acidic protein expression in a rat model of neuropathic pain.

Glial fibrillary acidic protein (GFAP) is a specific astrocytic marker in the central nervous system. Few studies on the effects of glial cell line-derived neurotrophic factor (GDNF) intrathecal injection on GFAP expression exist in the literature. The present study determined GFAP expression in rat spinal dorsal horn following a spinal nerve ligation (SNL). The effects of GDNF intrathecal injection on GFAP expression were examined to gather experimental evidence on the mechanisms underlying neuropathic pain. Following L5-6 SNL, male Sprague-Dawley rats were randomly divided into four groups: normal control, sham-operated, SNL, and GDNF. Each group was further divided into three subgroups (n = 10) according to the times of sacrifice: 3, 7, and 14 days after surgery. Compared with the normal control and the sham-operated groups, GFAP expression in the SNL group increased at day 3 after surgery and lasted until 14 days after. GFAP expression was significantly less in the GDNF group compared with the SNL group which lasted until 14 days after surgery, suggesting that rat spinal dorsal horn GFAP expression contributes to SNL-induced neuropathic pain. The mechanisms underlying GDNF alleviation of neuropathic pain were shown to be related to the GDNF inhibition of GFAP expression in the spinal dorsal horn.