[Propofol suppresses migration and invasion of breast cancer MDA-MB-231 cells by down-regulating H19].

OBJECTIVE: To explore the effect of propofol on H19 expression, migration and invasion of human breast cancer MDA-MB-231 cells in vitro. METHODS: MDA-MB-231 cells were randomly divided into 5 groups for treatment with basal medium, DMSO, or propofol at concentrations of 25, 50, and 100 µmol/L. H19 expression of the treated cells was assessed with RT-PCR, and the changes of cell motility, migration and invasion were evaluated with wound-healing assay and Transwell assays. RESULTS: Treatment of the cells with 25, 50, and 100 µmol/L propofol for 24 h down-regulated H19 by 17.83%, 37.50% and 63.67% (P<0.05), and suppressed cell motility by 13.46%, 36.54% and 46.17% (P<0.05), cell migration by 27.93%, 57.90% and 76.51% (P<0.05), and cell invasion by 25.72%, 53.32% and 81.43% (P<0.05), respectively. CONCLUSION: Propofol-induced cell migration and invasion suppression are partially mediated by down-regulating H19 in MDA-MB-231 cells in vitro.

[Propofol suppresses invasion of human lung cancer A549 cells by down-regulating aquaporin-3 and matrix metalloproteinase-9].

OBJECTIVE: To investigate the effect of propofol on cell invasion and expressions of aquaporin-3 (APQ-3) and matrix metalloproteinase-9 (MMP-9) in human lung adenocarcinoma cancer A549 cells. METHOD: A549 cells were treated with propofol at the concentrations of 25, 50, and 100 µmol/L for 12 or 24 h. RT-PCR was used to detect the effect of propofol on AQP-3 mRNA level in A549 cells, and the effects of propofol treatments for 24 h on AQP-3 and MMP-9 protein expression and the invasive ability of A549 cells were assessed with Western blotting and Transwell assay, respectively. RESULTS: Compared with the control cells, the cells treated with 25, 50, and 100 µmol/L propofol showed a obvious inhibition of AQP-3 mRNA expression, with inhibition rates ranging from 0.19 to 0.65 in cells with a 12-h treatment and from 0.13 to 0.41 in cells treated for 24 h; 100 µmol/L propofol treatment for 24 h produced the strongest inhibitory effect (0.13∓0.035, P<0.05). AQP-3 protein expression in cells treated with 25, 50, and 100 µmol/L propofol for 24 h (0.91∓0.009, 0.60∓0.020, and 0.57∓0.006, respectively) and MMP-9 protein expression in cells treated with 50 and 100 µmol/L propofol for 24 h (0.65∓0.006 and 0.46∓0.021, respectively) were significantly lower than those in the control cells (P<0.05). Treatment with 25, 50, and 100 µmol/L propofol for 24 significantly lowered the number of invading cells (122.55∓17.20, 96.33∓5.82, and 74.33∓2.85, respectively) compared with the control group (199.33∓23.88, P<0.05). CONCLUSION: Treatment with 50 and 100 µmol/L propofol inhibits cell invasion by down-regulating the expression of AQP-3 and MMP-9 in A549 cells.

Lutein protects against ischemia/reperfusion injury in rat skeletal muscle by modulating oxidative stress and inflammation.

BACKGROUND: Lutein is an antioxidant compound with potential biological effects. The present study investigated the protective role of Lutein against I/R injury in skeletal muscle. METHODS: Animals were divided into three groups. Group I - sham operated; Group II- IR injury- Hind limb ischemia was induced by clamping the common femoral artery and vein. After 4 h of ischemia, the clamp was removed and the animals underwent 2 h of reperfusion. Group III-Lutein + IR injury- Rats with Lutein treatment received intraperitoneal injection 1 h before reperfusion. The skeletal tissues were analyzed for oxidative stress parameters (reactive oxygen species, protein carbonylation and sulfhydryls, lipid peroxidation). Antioxidant status was determined by evaluating Nrf-2 levels and antioxidant enzyme activities. The inflammatory mechanism was determined through NF-κB and COX-2 expressions. Pro-inflammatory cytokines were determined by ELISA. RESULTS: The results showed that Lutein treatment significantly decreased the oxidative stress by reducing reactive oxygen species, protein carbonylation and sulphydryls, lipid peroxidation. Further, the levels of Nrf-2 and antioxidant status was significantly declined during IR injury compared to sham operated rats. Lutein treatment reduced the oxidative stress by enhancing Nrf-2 levels and antioxidant status. Skeletal IR injury enhanced the inflammatory signaling by up regulating NF-κB, COX-2 and various pro-inflammatory cytokines. NF-κB, COX-2 expressions were down regulated by Lutein treatment. CONCLUSION: The study shows that Lutein protects against skeletal IR injury by down regulating oxidative stress and inflammatory mechanisms.

Propofol inhibits lipopolysaccharide-induced tumor necrosis factor-alpha expression and myocardial depression through decreasing the generation of superoxide anion in cardiomyocytes.

TNF-α has been shown to be a major factor responsible for myocardial depression in sepsis. The aim of this study was to investigate the effect of an anesthetic, propofol, on TNF-α expression in cardiomyocytes treated with LPS both in vivo and in vitro. In cultured cardiomyocytes, compared with control group, propofol significantly reduced protein expression of gp91phox and phosphorylation of extracellular regulated protein kinases 1/2 (ERK1/2) and p38 MAPK, which associates with reduced TNF-α production. In in vivo mice studies, propofol significantly improved myocardial depression and increased survival rate of mice after LPS treatment or during endotoxemia, which associates with reduced myocardial TNF-α production, gp91phox, ERK1/2, and p38 MAPK. It is concluded that propofol abrogates LPS-induced TNF-α production and alleviates cardiac depression through gp91phox/ERK1/2 or p38 MAPK signal pathway. These findings have great clinical importance in the application of propofol for patients enduring sepsis.

[Protective effects of penehyclidine hydrochloride against acute renal injury induced by hemorrhagic shock and lipopolysaccharides in rats].

OBJECTIVE: To investigate the effect of penehyclidine hydrochloride (PHC) in a rat model of renal injury induced by hemorrhagic shock and lipopolysaccharides (LPS). METHODS: Forty-five healthy Wistar rats were randomized into sham operated group, model group, and 3 penehyclidine hydrochloride (PHC) dose (1, 2 and 3 mg/kg) groups (PHC1, PHC2, and PHC3 groups, respectively). The arterial blood samples were collected to determine the concentrations of serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-1 (IL-1), urine creatinine (Cr) and blood urine nitrogen (BUN), and the renal tissues were collected to measure the expressions of ICAM-1 and nuclear factor-κB (NF-κB) and observe the pathological changes. RESULTS: TNF-α, IL-8, IL-1, Cr, BUN, ICAM-1 and NF-κB in the 3 PHC groups were significantly lower than those in the model group (P<0.05). TNF-α, IL-8, IL-1, Cr and BUN were significantly lower in PHC1 (P<0.05) than in the PHC2 and PHC3 groups, and ICAM-1 and NF-κB were similar between 3 PHC groups (P>0.05). Compared with the model group, the 3 PHC groups showed lessened pathological changes in the renal tubules. CONCLUSION: PHC has protective effects against renal injury induced by hemorrhagic-endotoxin shock in rats, and treatment with 1 mg/kg PHC produces the most significant protective effect.

[Prophylactic effect of acupuncture on nausea and vomiting after laparoscopic operation].

OBJECTIVE: To explore the prophylactic effect of acupuncture Neiguan (PC 6) on nausea and vomiting after laparoscopic operation. METHODS: One hundred patients with laparoscopic gastrointestinal operation were randomly divided into an acupuncture group and a control group, 50 patients in each group. The operation was carried out with the combined infusion and inhalation anesthesia. The patients in the acupuncture group were being punctured at bilateral Neiguan (PC 6) before anesthesia and during the operation. The needles were extracted after operation, and the acupoints were covered with opaque tape. In contrast, the patients in the control group only accepted tape covering without acupuncture. After operation, all patients were given the self-controlled intravenous analgesia, and followed up at 6 h, 12 h, 24 h, 48 h for recording the incidence rate of the nausea, retching and vomiting, then scoring with VAS. RESULTS: At 6 h, 12 h, 24 h, 48 h after operation, in the acupuncture group, the incidence rates of the nausea were 12.0%, 6.0%, 6.0% and 2.0%, and the incidence rates of the retching were 0, 0, 2.0% and 2.0%, respectively; in the control group, the incidence rates of the nausea were 28.0%, 20.0%, 12.0% and 2.0%, and the incidence rates of the retching were 2.0%, 6.0%, 2.0% and 0, respectively. At 6 h, 12 h after operation, the incidence rates of the nausea and retching in the acupuncture group were lower than those of the control group (P < 0.05, P < 0.001). The vomiting was not happened in both groups. There was no difference between the two groups according to the scoring with VAS. CONCLUSION: Acupuncturing at Neiguan (PC 6) can reduce the incidence rates of the patients' nausea and retching after laparoscopic operation, especially in 24 h.

[Ulinastatin attenuates lung injury in rats with hemorrhagic shock].

OBJECTIVE: To investigate the effects of ulinastatin on lung injury in hemorrhagic shock rats. METHODS: Twenty-four normal SD rats were randomly divided into 3 groups (n=8), namely the control group, hemorrhagic shock group (group H) and ulinastatin group (group U). In group H and group U, blood was drawn from the femoral artery over a period of 10 min until a mean arterial pressure of 40 mmHg was obtained. Controlled hypotension was then maintained at 40-/+5 mmHg for 60 min by blood drawing or infusion when necessary. All the blood drawn and an equivalent volume of Ringer lactate solution were subsequently infused for resuscitation. Four hours after the resuscitation, the activity of superoxidedismutase (SOD), content of malondialdehyde (MDA), expression of heme oxygenase-1 (HO-1), wet to dry weight ratio (W/D), and pathologic changes of the lung tissues were measured or observed. RESULTS: Compared with those in the control group, the content of MDA, expression of HO-1 and W/D increased significantly in both group H and group U (P<0.05); these indexes in group U were significantly lower than those in group H (P<0.05). The activity of SOD in group U was significantly lower than that in the control group (P<0.05) but higher than that in group H (P<0.05). Optical microscopy demonstrated milder inflammatory cell infiltration and interstitial edema in the lung tissues in group U than in group H. CONCLUSION: Ulinastatin can lower the content of MDA, W/D and the expression of HO-1, increase the activity of SOD, and reduce histological lung injury in rats with hemorrhagic shock.

[Protective effects of lidocaine against lung injury after hemorrhagic shock in rabbits].

OBJECTIVE: To study the protective effect of lidocaine against lung injury after hemorrhagic shock in rabbits. METHODS: Eighteen healthy rabbits were randomly divided into 3 groups (n=6), namely lidocaine group (group L), hemorrhagic shock group (group H) and control group (group C). Hemorrhagic shock model was established in rabbits in groups L and H, and the venous blood samples were collected for measurement of plasma malondialdehyde (MDA) and superoxidedismutase (SOD) before phlebotomy (T0), 2 h after hemorrhagic shock (T1) and 2 h after resuscitation (T2). Blood samples were also taken for measurement of MDA and SOD at the same time points in group C. The wet to dry weight ratio of the lung (W/D) was measured at T2. RESULTS: MDA level was significantly lower while SOD level significantly higher in group L than in group H (P<0.05). The W/D ratio in group L was reduced significantly as compared with that in group H (P<0.05). CONCLUSION: Lidocaine can remarkably alleviate lung injury after hemorrhagic shock by inhibiting MDA production and increasing SOD content.

[Low-dose ketamine combined with fentanyl for intravenous postoperative analgesia in elderly patients].

OBJECTIVE: To investigate the clinical efficacy of and complications arising from low-dose ketamine combined with fentanyl for intravenous postoperative analgesia in comparison with the exclusive use of fentanyl in elderly patients. METHODS: Eighty elderly patients were randomized into two equal groups following thoracoabdominal surgery, and received intravenous analgesia with the combination of 0.5 mg/ml ketamine, 5.0 microg/ml fentanyl and 50 microg/ml midazolam (KF group) and with 7.5 microg/ml fentanyl plus 50 microg/ml midazolam (FT group), respectively. The drugs used were diluted in 200 ml normal saline. For analgesic administration, a loading dose (2-4 ml) was given followed by a background infusion (2.5-3.5 ml), with patient-controlled bolus doses of 2.0-3.0 ml with lock-out time of 20 min via PCA pump (Automedical, Korea). The static pain score (VAS), sedation score, and incidences of nausea, vomiting, pruritus and hallucinations were recorded during the initial 48 h after the surgery. RESULTS: The total analgesic dosage and PCA dosage in the two groups were similar (P>0.05). With similar VAS in the two groups (P>0.05), the sedative effect in KF group was much better than that in FT group (P<0.05) during the initial 48 h postoperatively. The incidences of nausea, vomiting and itching were lower in KF group than in FT group (P<0.05), and no illusion was reported in two groups during the initial 48 h. CONCLUSION: For producing comparable postoperative analgesic effect, low-dose ketamine combined with fentanyl can markedly reduce fentanyl requirement in the elderly patients and lowers the incidences of nausea, vomiting and itching in comparison with the exclusive use of fentanyl.

[Patient-controlled intravenous analgesia with sufentanil and fentanyl after thoracotomy: a comparative study].

OBJECTIVE: To evaluate the clinical efficacy of sufentanil and fentanyl at equivalent dose for patient-controlled intravenous analgesia (PCIA) after thoracotomy. METHODS: Sixty ASA I-II patients (20-60 years of age) undergoing radical operation for lung or esophageal cancer were randomly divided into sufentanil intravenous analgesia group (group S, with sufentanil 1 microg/ml) and fentanyl intravenous analgesia group (group F, fentanyl 10 microg/ml). PCIA was administered with background infusion of 2.5 ml/h, bolus injection of 2.5 ml and lockout time of 15 min. The pain intensity according to visual analogue scale (VAS), cumulative analgesic consumption (CAC), sedative scores and side effects at 24 and 48 h after administration were recorded. SpO(2), respiratory rate (RR), blood pressure (BP) and ECG were continuously monitored. RESULTS: There were no significant differences in CAC between the two groups, but he VAS was lower in group S than in group F (P<0.05) and the sedative efficacy was superior in group S (P<0.05). The incidence of nausea and vomiting in group S was lower than that in group F (P<0.05). No significant differences were observed in SpO(2), RR, heart rate and mean arterial pressure between the two groups. CONCLUSION: PCIA with sufentanil provides better efficacy of analgesia and sedation with lower incidence of nausea and vomiting than with fentanyl in postoperative patients with thoracotomy.

[Changes of oxygen cost of breathing in children and adult during anesthesia and surgery].

OBJECTIVE: To investigate the changes of oxygen cost of breathing (OCB) in children and adult during general anesthesia and surgery. METHODS: This study included 12 elective surgical children and 12 adult patients receiving cerebral surgery. Mechanical ventilation was given during general anesthesia and surgery, and the indices of hemodynamics and respiratory function were measured at 5 min before induction, 1 min before the start of surgery, 30, 60, 120 and 180 min after the start of surgery and at the end of surgery, respectively. RESULTS: Mean arterial pressure (MAP) in the 2 groups did not undergo any conspicuous changes during general anesthesia and surgery (P>0.05), and the heart rate in child group was markedly faster than that in adult group during the whole course (P<0.01). Oxygen consumption (VO2) in 2 groups at 1 min before the start of surgery and 30 min after the start of surgery was significantly higher than that at 5 min before induction (P<0.01), and at these two time points after induction, child group had much higher VO2 (P<0.05) but evidently lower OCB (P<0.01) than in adult group, the latter index remained low till 60 and 120 min after the start of surgery (P<0.05). CONCLUSION: During anesthesia and surgery, VO2 in child group can be much greater than that in Adult group, while OCB markedly lower.

[Ropivacaine or its combination with fentanyl for postoperative patient-controlled epidural analgesia].

OBJECTIVE: To investigate the pain-relieving effects of ropivacaine or its combination with fentanyl in postoperative patient-controlled epidural analgesia. METHODS: Sixty patients (ASA class I to II) scheduled for elective upper abdominal surgery were randomly divided into 4 groups (15 in each group) to receive 2.0 mg/ml ropivacaine (group R), 1.25 mg/ml ropivacaine plus 1.0 microg/ml fentanyl (group RF1), 1.0 mg/ml ropivacaine plus 2.0 microg/ml fentanyl (group RF2), and 1.0 mg/ml ropivacaine plus 4.0 microg/ml fentanyl (group RF4) respectively for patient-controlled analgesia. The bolus injection was set at 3.0 ml, lockout interval at 20 min, and background epidural infusion at 5.0 ml/h. Before and at 0, 6, 12, 24 and 48 h after the surgeries, the data including mean arterial pressure (MAP), heart rate (HR), cumulative consumption volume (CCV) of analgesic solution and visual analog scale (VAS) scores were recorded, observed and the adverse effects such as vomiting, nausea, pruritus, as well as the time of first excretion of intestinal gas. RESULTS: Compared with group R, significantly smaller CCV occurred in groups RF2, RF4 (P<0.01), and RF1 (P<0.05) at each time points postoperatively. No significant differences were noted between the groups in VAS scores. CONCLUSION: The 4 preparations are comparable in terms of analgesic efficacy and adverse effects, but in groups RF2 and RF4, the smaller doses have sufficed the needs.

[Anesthetic management during resection of intratracheal tumor: report of 23 cases].

OBJECTIVE: To summarize our experience in anaesthetic management during the resection of intratracheal tumor. METHODS: A retrospective analysis of the anaesthetic management was conducted in 23 cases of intratracheal tumor resection. The anaesthetic methods were determined according to the location of tumor, the degree of tracheal obstruction and the surgical procedures. RESULTS: No severe complications occurred in relation to the anesthetic procedures. During the operation, the saturation of pulse oxygen (SpO(2)) transiently decreased to below 90 % in 5 cases (21.7 %) but recovered to normal level by aspiration of airway secretions and/or lung inflation. Seventeen patients (73.9 %) were extubated after the operation and returned to the ward safely, while another 6 (26.1 %) were sent to intensive care unit and extubated within 24 h. CONCLUSION: Case-specific anaesthetic plan is necessary before the operation, and it is crucial to maintain good ventilation without interfering with the surgical procedures during the operation.

Effect of patient-controlled epidural analgesia for pain relief after thymectomy in patients with myasthenia gravis.

OBJECTIVE: To evaluate the effect of patient-controlled epidural analgesia (PCEA) with ropivacaine or bupivacaine in relieving pain after thymectomy in patients with myasthenia gravis. METHODS: Twenty adult ASA I-II patients with myasthenia gravis were randomized to receive either 0.125% ropivacaine (Group R, n=10) or 0.125% bupivacaine (Group B, n=10) with a PCEA device after transsternal thymectomy. PCEA (continuous infusion at 1 ml/h, bolus dose of 4 ml and lockout time of 30 min) was implemented via an epidural catheter inserted in the T3-4 intervertebral space. The vital signs and visual analogue scale (VAS), together with cumulative consumption (CC) of ropivacaine or bupivacaine were recorded within 48 h postoperatively. RESULTS: The vital signs, including systolic and diastolic blood pressure, heart rate, SpO2, pH and PaCO2, did not show any significant differences between the 2 groups. The CC of the local anesthetic was significantly higher in group R than that in group B at 24 and 48 h postoperatively, but VAS were not significantly different between the 2 groups which was less than 4 in both groups. CONCLUSIONS: PCEA with low concentration of ropivacaine or bupivacaine may provide effective and safe analgesia after transsternal thymectomy.