Search

BACKGROUND: Prothymosin α (ProT), a polypeptide, attenuates inflammation and inhibits transforming growth factor (TGF)-β signaling in pulmonary tissues. We investigated the potential role of ProT in myocardial ischemia-reperfusion (MyoIR) injury using ProT cDNA transfer. METHODS: Serum ProT levels were investigated in cardiogenic shock patients with MyoIR (n = 9). In addition, the myocardium of Sprague-Dawley rats (n = 52) was subjected to 25 min of ischemia followed by an injection of adenoviral vectors (2 × 10(9) plaque-forming units) carrying ProT or the luciferase gene, 10 min before reperfusion. Echocardiography, serum ProT, and biochemical analyses of organ functions were performed before euthanasia, 14 days after treatment. Immunohistochemistry and immunoblotting of the myocardial tissue were also performed. RESULTS: Serum ProT levels were transiently elevated in the rats and patients early after MyoIR, which was reduced to baseline levels in control rats and patients. ProT gene transfer persistently mobilized ProT serum levels, reduced dilatation, attenuated fibrotic changes, and preserved the left ventricular ejection fraction after MyoIR. Tissue thrombospondin-1 level was abundant, and matrix metalloproteinase-2, collagen I, and collagen IV levels were decreased in the treatment group. While TGF-β protein level remained stable, ProT transduction mobilized Smad7, which counteracted TGF-β. ProT reduced tissue microRNA-223 expression, inhibited the associated interleukin-1β, and preserved RAS p21 protein activator 1 protein abundance. CONCLUSIONS: An increase in transient serum ProT levels could be a protective response in the acute stage of MyoIR. ProT gene transfer further preserved ventricular morphology and function through anti-inflammatory and anti-fibrotic effects in the subacute stage after injury.

Additional file 1: Supplementary table 1. Surgical procedures with different levels of expected pain [19]

Additional file 2: Supplementary table 2. Variance inflation factors (VIF) for the degree of multicollinearity among patient’s characteristic and surgical-related variables that associated with preoperative anticipated pain. ASA: American Society of Anesthesiologists. *A total of 27 groups of surgical procedures were classified into 5 levels, as lowest, low, moderate, high and highest expected pain [22]

Background: Partial hepatectomy (PH) is the standard surgical approach in removal of macroscopic liver parenchymal disease and transplantation of liver lobes is the ultimate therapy to cure the end-stage liver disease. Derangement of liver function or development of nonregenerative liver after massive hepatectomy or liver transplant carries extensively high postoperative mortality. Therefore, it is essential to develop perioperative management to improve the regeneration of remnant lobes and attenuate hepatic ischemia-reperfusion injury (IRI) during PH or transplantation. Since HMG-CoA reductase inhibitors (statins) have been shown to mediate pleiotropic cytoprotective effects during IRI and enhance vasculogenesis, this study investigated the effect of rosuvastatin in the regenerative process of liver following PH.Methods. Sprague-Dawley rats were randomly assigned to receive oral placebo or rosuvastatin (20 mg/kg/d) in chow for 2 weeks. The animals were anesthetized and 70% PH was performed. Liver mass and serum/tissue biochemistries were analyzed 7 days after PH. The regenerative liver tissues were biopsied and examined for liver proliferation index.Results. The liver growth ratio was significantly increased in rats treated with rosuvastatin (0.72uf0b10.10 vs 0.59uf0b10.09, P=0.02). Serum level of monocyte chemoattractant protein (MCP)-1 was reduced following rosuvastatin therapy. The expressions of pro-angiogenic factors (VEGFR-2 and hepatocyte growth factor) and hepatic proliferative index (interleukin-6 and PCNA) were significantly upregulated in liver remnant of rosuvastatin-treated rats. Furthermore, immunohistochemical analysis confirmed the increased tissue expression of PCNA+/Ki67+ hepatocytes in these animals.Conclusion. Treatment with rosuvastatin attenuated the systemic inflammatory reaction and enhanced the regenerative response in the remnant liver by enhancement of tissue angiogenesis and proliferation of hepatocytes. Our results suggest that perioperative use of statins may serve a pharmacologic therapeutic to improve hepatic regeneration, particularly in parenchymal liver diseases such as steatosis.

Background. Spinal cord ischemia (SCI) leads to variable degrees of neurological deficit in patients undergoing major cardiovascular surgery. The effect of intraoperative neuroprotection against SCI and the subsequent ischemia reperfusion injury is still limited. Since isoflurane is a commonly used anesthetic agent during major operation, and its neuroprotective and neurotoxicity effects have both been discussed, this study aimed to investigate the effect of isoflurane on the spinal cordu2019s functional recovery in a rat model of cord ischemia.Methods: Rats were randomly anesthetized by parenteral anesthetic (Zoletiluf0d2) and isoflurane (0 and 1.5 % v/v in oxygen). Cord ischemia was induced by cross-clamping of thoracic aorta at the level of T5, and cord perfusion was resumed after 25 min. The motor function was assessed independently up to 48 h after reperfusion. Spinal cords were harvested and analyzed for molecular and histological changes.Results: The locomotor rating scale was significantly reduced in rats that received isoflurane treatment during SCI at 12 to 48 h after reperfusion. Isoflurane enhanced the expression of heme oxygenase-1 and suppressed tissue levels of IL-6. However, the protein expressions of glial fibrillary acidic protein (GFAP), cleaved caspase-3 and Iba-1 were enhanced in the injured spinal cord. Increased apoptotic cells and presence of axonal damage were also observed in the histological sections.Conclusion: Our results demonstrate that administration of inhaled isoflurane in spinal cord ischemia reperfusion injury deteriorates the recovery of motor function. The neurotoxicity response is associated with neuronal apoptosis and degeneration. This study highlights the potential adverse effect of isoflurane on the functional recovery of ischemic spinal cord during major aortic surgery.

Background. Accidental awareness (AA) during general anesthesia can result in long term neuropsychiatric sequelae. The reported incidence of perioperative awareness ranged from 0.006% to 0.13%, and the critically ill patients received major surgeries carries increased risks of developing AA. Since the incidence of AA in the non-critically ill patients has not been previously reported, this study analyzed the incidence and the associated risk factors for the occurrence of AA in patients with ASA class I-III during ambulatory surgeries in a single institutional hospital.Methods: Postanesthesia visit records (from January 2009 to December 2014) were reviewed. Patients reported to have AA were interviewed by an experienced nurse anesthetist and medical records of all patients were reviewed by the staff anesthesiologists, according to the Michigan awareness instrument and the NAP5 severity. The Poisson regression model was used for simultaneous analysis of the incidence proportion and the potential risk factors of AA.Results: A total of 58,181 inpatients (ASA uf0a3III) received general anesthesia during the 5-year period, and 16 patients were identified as definite AA. Patients received endotracheal anesthesia carried significantly higher incidence of developing AA (P= 0.015). ASA class and genders were similar between patients with and without AA. Compared with the matched controls, longer surgical time and higher educational levels were associated with increased incidence of AA. Additionally, higher mortality rate was found in patients who developed AA (18.8% vs 8.4%, AA vs matched controls, P= 0.129).Conclusion: The overall incidence proportion of AA was 0.0275% in the non-critically ill patients received elective surgeries during general anesthesia. Endotracheal anesthesia, prolonged operation time and higher education levels were associated with increased risks for development of AA. The relationship between AA and postoperative mortality requires further investigation.