Effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation.

BACKGROUND: Postoperative neurocognitive dysfunction induced by anesthetics, particularly in elderly patients with impaired oxygenation, is a common complication of surgery and is eliciting increased interest in clinical practice. To investigate the effects of anesthetics on neurocognition, we compared the effects of propofol versus sevoflurane on cerebral oxygenation and cognitive outcome in patients with impaired cerebral oxygenation undergoing general anesthesia. METHODS: Sixty-three patients with impaired cerebral oxygenation (jugular venous bulb oxygen saturation [SjvO2] <50%) or cerebral blood flow/cerebral metabolic rate of oxygen ([CBF/CMRO2] ≤15%) undergoing elective abdominal surgery were randomly allocated into propofol group (group P) or sevoflurane group (group S). The clinical parameters and jugular venous bulb blood gas analysis were monitored throughout the surgical procedure. Cognitive function was assessed with the mini-mental state examination and Montreal Cognitive Assessment at day 1 and day 7 following surgery. S100ß protein in plasma was measured using enzyme-linked immunosorbent assay. RESULTS: The SjvO2 increased during anesthesia induction and surgery when compared to baseline but had no significant difference between group P and group S. When compared to baseline, the CBF/CMRO2 was increased only at the end of surgery and extubation in group P; however, the CBF/CMRO2 in group S was increased during anesthesia induction at 1 hour, 2 hours, end of surgery, and extubation. Furthermore, the CBF/CMRO2 in group S was significantly higher than that in group P during anesthesia induction at 1 hour, 2 hours, and end of surgery. S100ß protein did not significantly change at extubation and 1 day after surgery in both groups when compared to baseline. There was no significant difference in mini-mental state examination and Montreal Cognitive Assessment scores between group P and group S at all time points. CONCLUSION: Sevoflurane showed similar effects in postoperative neurocognitive function as propofol but could improve cerebral oxygenation in patients with impaired cerebral oxygenation.

[Effect of PTD-mFoxp3 fusion protein on graft-versus-host disease after allogeneic bone marrow transplantation].

This study was aimed to investigate the effect of PTD-mFoxp3 fusion protein on graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation. The 10-weeks-old C57BL/6 mice as recipients were randomly divided into three groups (A,B and C), 10 mice were in each group. The mice on day of transplantation as on day 0 received total body irradiation (TBI) 6.0 Gy, then the bone marrow cells (BMC) from BALB/c mice were injected through tail vein within 4-6 hours. At 2 days before transplantation and 0, 1, 3, 5, 7, 9 and 13 days after transplantation, mice in group A were injected with saline, mice in group B were injected with mFoxp3 protein and mice in group C were injected with PTD-mFoxp3 fusion protein. Symptoms of GVHD, survival time and histopathological changes were observed. The establishment of mixed chimerism was determined by flow cytometry in day 60, and IL-2 and IFN-γ expression profiles in the recipient peripheral blood were assessed by ELISA. The results showed that the mean survival time of recipients in group A,B and C was (32.95 ± 5.48) , (38.00 ± 5.45) and (55.30 ± 3.15) respectively. Graft rejection was observed in the liver and small intestine specimens of group A and group B. The serum levels of IL-2 and IFN-γ significantly decreased in the recipients of group C, as compared with the other groups. The flow cytometry analysis revealed that the survival recipient mice developed high chimerism levels, the percentages of donor cells in group A,B and C were (79.46 ± 1.80) %, (79.13 ± 2.23) % and (85.92 ± 2.82) % respectively. It is concluded that PTD-mFoxp3 fusion protein can reduce the incidence and mortality of GVHD after allogeneic bone marrow transplantation.

[Adult to adult living donor liver transplantation for decompensated end stage liver disease].

OBJECTIVE: To summarize the clinical experience and some principal surgical techniques of adult to adult living donor liver transplantation (ALDLT). METHODS: The clinical data of 9 patients receiving ALDLT from September 2000 to September 2004 in liver transplantation center in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The left lobe (segments II, III, IV, including the middle hepatic veins) was transplanted in 3 patients, and the right lobe (segments V, VI, VII, VIII, not including the middle hepatic veins) was transplanted in 6 patients. RESULTS: There was no operative death in donors. The median operative time was (6.2+/-1.4) hours. The blood loss ranged from 300 to 1,200 ml. Postoperative complications included biliary fistula (1 donor) and wound fat liquefaction (1 donor). They were followed up for 6-12 months, and no long term complications were found. In recipients, the operating time ranged from 5 to 11 hours. The blood loss ranged from 800 to 7,000 ml. Modified outflow reconstruction method, microvascular reconstruction of the hepatic artery and duct to duct biliary reconstruction were performed in recipients. The median cold ischemic time of the grafts was (1.9+/-0.5) hours. The mean non hepatic stage of recipients was (98+/-26) minutes. Graft/recipient weight ratio (GRWR) was (1.20+/-0.26)%. One recipient presented postoperative complication of biliary fistula. One recipient died of serious infection 1 month postoperatively. The other 8 recipients enjoyed longterm survival. CONCLUSION: The procedure of ALDLT is an effective method in the treatment of decompensated end stage liver disease, and it is relatively safe for the donor. Reconstruction of vessels is the key surgical technique in the operative procedure.

[Adult-to-adult living donor liver transplantation for decompensated end-stage liver diseases].

OBJECTIVE: To summarize our clinical experience in adult-to-adult living donor liver transplantation (ALDLT). METHODS: Clinical data of 12 patients with ALDLT performed in our center from September 2000 to June 2005 were analyzed, retrospectively. RESULTS: Left lobe (segments II, III, IV, including the middle hepatic veins) transplantation was performed in 3 patients and right lobe (segments V, VI, VII, VIII, with or without the middle hepatic veins) transplantation was performed in 9 patients. Donors: There were no operative deaths. The median operative time was 6.20+/-1.40 hours and their blood loss ranged from 300 ml to 1200 ml. Postoperative complications included biliary fistula (1 donor) and wound fat liquefaction (1 donor). During a 6-12 months follow-up, no long-term complications were found. Recipients: The operating time ranged from 5 to 11 hours and their blood loss ranged from 800 to 7000 ml. Modified outflow reconstruction, microvascular reconstruction of the hepatic artery and duct-to-duct biliary reconstruction were done during the recipient operations. The median cold ischemia time was 1.90+/-0.50 hours. The median anhepatic phase of recipients was 1.63+/-0.43 hours. Graft/recipient weight ratio (GRWR) was (1.20+/-0.26)%. One recipient presented a postoperative complication of biliary fistula and another recipient died 1 month after the operation from serious infection. The other 11 recipients had long-term survivals. CONCLUSION: ALDLT is an effective treatment for decompensated end-stage liver disease patients and is relatively safe for the donors.

[Expressions of aquaporin-1 on peritonea in hepatic cirrhotic rats with ascites].

OBJECTIVE: To investigate the changes of aquaporin (AQP-1) expressions on peritonea in liver cirrhotic rats with ascites, and to study the correlation between AQP-1 expressions and ascites form. METHODS: 32 healthy Sprague-Dawley (SD) rats were divided into two groups randomly, 20 rats were used to produce liver cirrhotic models induced with phenobarbitol sodium and CCl(4). The distribution and protein expressions of AQP-1 on the rats' peritonea were measured with immunohistochemistry assay, and the expressions of APQ-1 mRNA were tested with relative GAPDH quantitative RT-PCR. RESULTS: (1) The expressions of AQP-1 were mainly on the endothelial cells of capillary vessels and venules on the rats' peritonea, and also on mesothelial cells. (2) There was no statistically significant difference between the expressions of AQP-1 protein and mRNA in the two groups on the early stage of liver cirrhosis. (3) Downregulations of the expressions of AQP-1 protein and mRNA were observed in B group on the advanced cirrhotic stage. CONCLUSION: Expressions of AQP-1 were downregulated on the peritonea of rats with decompensated liver cirrhosis, which may play a role in the formation of ascites. The changes of AQP-1 Expressions on peritoneal mesothelial cells which were fewer than those on the endothelial cells may be few relations to ascites form.

Inhibitory effects of docetaxel on expression of VEGF, bFGF and MMPs of LS174T cell.

AIM: To study the effects of non-cytotoxic concentrations of docetaxel on some important angiogenic factors of LS174T Cells. METHODS: The non-cytotoxic concentration of docetaxel and the activity of gelatinase were determined with MTT and gelatin zymography respectively, the expression of VEGF(vascular endothelial growth factor), bFGF (basic fibroblast growth factor), MMP (matrix metalloproteinase) 2 and MMP 9 was investigated with RT-PCR and Western blot. RESULTS: The maximum non-cytotoxic concentration of docetaxel on LS174T Cells was 1.0 ng/ml. Compared with the solvent control group, 0.1, 0.5, 1.0 ng/ml of docetaxel could downregulate the expression of VEGF, bFGF, MMP 2 and MMP 9 and suppress the activity of gelatinase. CONCLUSION: Our study suggests that the non-cytotoxic concentrations of docetaxel have strong antiangiogenic activity on LS174T Cells, which suggests docetaxel may be a promising antiangiogenic agent.

[Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis].

OBJECTIVE: Using Markov model Monte Carlo simulation to conduct a cost-effectiveness analysis of screening Helicobacter pylori (H. pylori) infection to prevent gastric cancer. METHODS: The Markov model was developed based on the natural course from H. pylori infection to gastric cancer. Two strategies were compared: (1) screening for H. pylori and treatment for those with positive tests, and (2) without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base-case analysis and estimate the confidence interval of cost-effectiveness ratios. The probability sensitivity analysis was used to estimate the cost-effectiveness in multiple uncertainty factors. RESULTS: Assuming H. pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6% cases of gastric cancer. Cost-effectiveness were 10,405 Yuan (95% CI: 4,238 - 27,727 Yuan) per GC prevented, 64 Yuan (95% CI: 31 - 97 Yuan) per QALY saved and 1,374 Yuan (95% CI: 352 - 86,624 Yuan) per life year saved. CONCLUSION: Screening and treatment for H. pylori infection in population was potentially effective in the prevention of gastric cancer, and screening in high incidence area of gastric cancer would be more effective and economic.