Effects of sevoflurane exposure during different stages of pregnancy on the brain development of rat offspring.

OBJECTIVE: This study explored the effects of sevoflurane exposure during different stages of pregnancy on the brain development of offspring. METHODS: Thirty-six pregnant SD rats were randomly divided into 4 groups: control, sevoflurane exposure in early (S1) pregnancy, sevoflurane exposure in middle (S2) pregnancy, and sevoflurane exposure in late (S3) pregnancy. After natural birth, the learning and memory capacity of offspring rats was analyzed using the Morris water maze experiment. The hippocampi of offspring rats were collected. The levels of interleukin (IL)-1ß, IL-6, and tumor necrosis factor (TNF)-α in the hippocampus were measured by ELISA. Additionally, the Nissl bodies in the hippocampus were analyzed using Nissl staining. Immunohistochemistry was used to examine the expression of BDNF and CPEB2 in the hippocampus of offspring. Proteins related to the NR4A1/NF-κB pathway were analyzed using western blotting. RESULTS: The memory and learning capacity of offspring rats was significantly reduced in the S1 and S2 groups compared to the control group (p < 0.05), while there was no obvious difference between the control and S3 groups (p > 0.05). The level of IL-1ß was significantly increased (p < 0.05) in the S1 group compared with the control group. Sevoflurane anesthesia received in early and middle pregnancy could significantly affect the formation of Nissl bodies in the hippocampi of offspring rats. In addition, the expression of BDNF and CPEB2 in the hippocampi of offspring rats was greatly decreased in the S1 group compared with the control group (p < 0.05). The expression of NR4A1 in the hippocampi of rat offspring was significantly decreased in the S1 and S2 groups compared with the control group (p < 0.05). The expression of proteins related to the NF-κB pathway was increased in the S1 group compared to the control group (p < 0.05). CONCLUSIONS: The neurotoxic effect of maternal sevoflurane anesthesia on the brain development of offspring is higher when the exposure occurs in early pregnancy than in late pregnancy, and its mechanism might involve the NR4A1/NF-κB pathway to increase the secretion of inflammatory cytokines.

The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients.

Postlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

Impact of epidural analgesia on quality of life and pain in advanced cancer patients.

Patients with advanced cancer often experience chronic postoperative pain and poor quality of life. The objective of this study was to determine if epidural self-controlled analgesia reduced the incidence of chronic pain and improved the quality of life when compared with intravenous self-controlled analgesia. A total of 50 patients diagnosed with advanced cancer who received analgesia treatment were randomly divided into two groups, epidural self-controlled analgesia group (EA group, n = 26) and intravenous self-controlled analgesia group (IA group, n = 24). Visual analog scale (VAS) and Karnofsky score were used to assess the pain and the quality of life, respectively. A multifunction monitor was used to continuously record the physical signs of patients after treatment. The physical signs, such as heart failure, respiration, pulse, blood pressure, and oxygen saturation, in the two groups were better after analgesia treatment. Meanwhile, the respiration and oxygen saturation in the EA group were significantly improved compared with that of the IA group (p < .05). The VAS in the EA group was significantly lower than that in the IA group (p < .05), and the Karnofsky score in the EA group was significantly higher than that in the IA group (p < .05). Moreover, patients treated with EA felt more satisfied and experienced fewer complications than those with IA (p < .05). The epidural self-controlled analgesia may greatly improve the quality of life and relieve the pain in patients with advanced cancer.

[Influence of various ventilation manier on rat's lung and the expression of lung endotoxin receptor CD14 mRNA].

OBJECTIVE: To observe the influence of mechanical ventilation (MV) on rat's lung and the expression changes of lung endotoxin receptor CD14 mRNA. METHODS: Forty-eight male SD rats weighing 330-360 g were randomly divided into 4 groups (n = 12 each): group R received no mechanical ventilation, group P received small MV (VT = 6 ml/kg, PEEP = 8 mm Hg), group M received conventional MV (VT = 12 ml/kg, PEEP = 0 mm Hg), and group N received large tidal volume mechanical ventilation (VT = 40 ml/kg, PEEP = 0 mm Hg). The animals were anesthetized with intraperitoneal pentobarbital 100 mg x kg(-1), tracheotomized and mechanically ventilated (I:E = 1:1, FiO2 = 21%). The respiratory rate (RR) of MV was adjusted to maintain the end-tidal carbon dioxide in the rang of 35-45 mm Hg throughout the procedure. Right carotid artery and left femoral vein were cannulated for BP monitoring and fluid and drug administration. 6 rats in each group were injected 50 mg/kg Evans Blue (EB). The experiment was culminated in 3 hours, then the rats were killed by exsanguination via arteria carotis interna. Morphologic change scores of the rats' lungs, wet/dry weight ratio of lung tissue (W/D), bronchial lavage fluid (BALF) inflammatory cell population, and permeability of vessel wall were evaluated. The concentration of TNF-alpha and MIP-2 in the plasma were determined by enzyme immunoassay method (ELISA). The expressions of lung tissue endotoxin receptor CD14 were detected by RT-PCR, macrophage CD14 in BALF was also detected by immunohistochemistry. RESULTS: pulmonary pathomorphology scores: there were no alteration in R group and P group, but it were slightly increased in M group, there was significantly elevated in N group as compare to M group (F = 8.0, P = 0.000). Pulmonary tissue wet/dry weight ratio (W/D): Compare with R group, There was no statistically significant difference in P group and M group; the elevation in N group (t = 4.103, P = 0.02), EB: Compare with R group, There was no statistically significant difference in P group and M group; the obviously elevation in N group (t = 36.634, P = 0.000). WBC in BALF: Compare with R group, there was no change in P group, the elevation in M group (t = 4.272, P = 0.02), there was significantly elevated in N group (F = 26.68, P = 0.000). TNF-alpha had no manifest variation in 4 groups. MIP-2: compare with R group (31.5 +/- 2.4), There was no statistically significant difference in P group (35.4 +/- 5.3), the elevation in M group (44.7 +/- 6.9, t = 7.85, P = 0.04), there was significantly elevated in N group (167.7 +/- 11.8, t = 27.779, P = 0.000). The expressions of macrophage CD14 protein in BALF and lung tissue CD14 mRNA were fundamentally coincident in R group and P group; the expressions of CD14 mRNA were elevated, but the expressions of CD14 protein were no change in M group; the expressions of CD14 in N group manifestly elevated (P = 0.000). CONCLUSIONS: Conventional MV induces minor injury in rat's lung and can up regulate the expression of CD14 mRNA in the lung, but not up regulate the expression of CD14 protein; large tidal volume MV induces injury of rat's lung and evidently up regulates CD14 expression in the lung. Protective MV can avoid the above mentioned variations in rat's lung.