Perioperative blood management strategies for elderly orthopedic patients / 中国输血杂志

With the arrival of an aging society, the number of orthopedic geriatric patient who require surgical treatment is also rapidly increasing. Elderly patients have decreased hematopoietic function, and perioperative blood management is difficult and challenging. This article aims to elaborate on the perioperative blood management strategies for orthopedic geriatric patients, including the diagnosis and treatment of preoperative anemia, specific measures to reduce perioperative blood loss, and blood transfusion strategies.

Safety and effectiveness of Perioperative Transfusion Trigger Score on perioperative allogeneic RBC transfusions in surgical patients / 中国输血杂志

【Objective】 To evaluate the safety and effectiveness of Perioperative Transfusion Trigger Score (POTTS) in guiding surgical patients blood transfusion intraoperatively and postoperatively. 【Methods】 A total of 900 patients(perioperative Hb 60~100 g/L) from December 2017 to March 2021 were collected, including 251 males and 649 females, with ASA grading Ⅰ~Ⅳ, and randomly divided into experimental group and controls. In the experimental group, the allogeneic RBC transfusion trigger(Hb threshold) and transfusion units in anemia patients was determined by POTTS. While those in the controls were decided by physicians according to current guidelines concerning transfusion. The proportion and units of allogeneic RBC transfusion, the incidence of postoperative complications, the mortality of hospitalization and discharge for 4 weeks, Hb value, healing of surgical incision, ICU admission rate and ICU length of stay, length of hospitalization, etc were recorded. 【Results】 The proportion of allogeneic RBC transfusion in the experimental group(35.3%)were less than the controls(42.2%)(P<0.05). The units of allogeneic RBC transfused, incidence of postoperative complications and mortality in hospital and 4 weeks after surgery, healing of surgical incision (grade A/ grade B/ grade C), the Hb level 24 h after surgery and at discharge, the ICU admission rate and ICU length of stay, length of hospitalization were not significantly different between the groups. 【Conclusion】 The peri-operative allogeneic red blood cells transfusion guided by POTTS can reduce the proportion of allogeneic RBC transfusion, and is safe and effective.

Cis-3-O-p-hydroxycinnamoyl Ursolic Acid Induced ROS-Dependent p53-Mediated Mitochondrial Apoptosis in Oral Cancer Cells

Cis-3-O-p-hydroxycinnamoyl ursolic acid (HCUA), a triterpenoid compound, was purified from Elaeagnus oldhamii Maxim. This traditional medicinal plant has been used for treating rheumatoid arthritis and lung disorders as well as for its anti-inflammation and anticancer activities. This study aimed to investigate the anti-proliferative and apoptotic-inducing activities of HCUA in oral cancer cells. HCUA exhibited anti-proliferative activity in oral cancer cell lines (Ca9-22 and SAS cells), but not in normal oral fibroblasts. The inhibitory concentration of HCUA that resulted in 50% viability was 24.0 µM and 17.8 µM for Ca9-22 and SAS cells, respectively. Moreover, HCUA increased the number of cells in the sub-G1 arrest phase and apoptosis in a concentration-dependent manner in both oral cancer cell lines, but not in normal oral fibroblasts. Importantly, HCUA induced p53-mediated transcriptional regulation of pro-apoptotic proteins (Bax, Bak, Bim, Noxa, and PUMA), which are associated with mitochondrial apoptosis in oral cancer cells via the loss of mitochondrial membrane potential. HCUA triggered the production of intracellular reactive oxygen species (ROS) that was ascertained to be involved in HCUA-induced apoptosis by the ROS inhibitors YCG063 and N-acetyl-L-cysteine. As a result, HCUA had potential antitumor activity to oral cancer cells through eliciting ROS-dependent and p53-mediated mitochondrial apoptosis. Overall, HCUA could be applicable for the development of anticancer agents against human oral cancer.

Investigation of birth state and disease spectrum in 1,434 hospitalized neonates / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the birth state of neonates and the disease spectrum of hospitalized neonates from a primary hospital, and compare with the national data of the same period.</p><p><b>METHODS</b>A retrospective investigation was carried out in 1,434 neonates born or hospitalized in this hospital from January 2005 to December 2005.</p><p><b>RESULTS</b>During the investigation period, there were 1,100 neonates born in the department of obstetrics. The incidence of premature birth was 2.3%. The caesarean birth accounted for 54.2%, significantly higher than the national average (49.2%, p<0.01). The neonatal mortality was 0.2%. The incidences of antepartum hemorrhage, threatened abortion, and pregnancy infection in preterm infant' s mothers were significantly higher than those in full-term infant' s mothers. A total of 344 neonates were admitted to the department of pediatrics during the investigation period. Preterm infants accounted for 38.0% which was higher than the national average (26.2%; p<0.01). Beside preterm infants, asphyxia, respiratory distress syndrome (RDS), sepsis and intracranial hemorrhage were shown to have a significantly higher proportion than the national averages. The mortality of hospitalized neonates was 0.9%.</p><p><b>CONCLUSIONS</b>The higher cesarean section rate should be controlled in our hospital. Prenatal health care and fetal monitoring should be strengthened to decrease the incidence of premature birth, RDS, sepsis and intracranial hemorrhage, thus reducing the mortality of neonates.</p>

Dose-effect dependence of ketamine in inducing the expression of heat shock protein 70 in the hippocampus of rats of different ages / 中国组织工程研究

BACKGROUND: It is proved that protein of heat shock protein 70 family has protective effects on cells. Ketamine can cause psychiatric symptoms such as illusion and delirium in patients, which can damage neurons of the limbic system in rats. The expression of heat shock protein 70 can be detected in the damaged neurons with immunohistochemical staining.OBJECTIVE: To observe the expression of heat shock protein 70 induced by ketamine in the hippocampus of rats of different ages and probe into the damaging effect on nerves.DESIGN: Randomized controlled trial.SETTING: Department of Anesthesiology and Critical Care Medicine,Huaxi Hospital of Sichuan University.MATERIALS: The experiment was conducted in the laboratory of the Department of Anesthesiology and Critical Care Medicine, Huaxi Hospital of Sichuan University, from January to May 2001. Totally 70 SD rats,weighing 25 to 285 g, of either gender and clean grade, were recruited.Thirty-five adult SD rats were randomly divided into control group and ketamine groups of 20.0, 40.0, 60.0, 80.0, 100.0 and 120.0 mg/kg with 5 rats in each group. The rats in each group were injected intraperitoneally with normal saline and 20.0, 40.0, 60.0, 80.0, 100.0 and 120.0 mg/kg of ketamine, respectively. Another 35 rats aged 0-10, 11-20, 21-30, 31-45,46-60, 61-90 and 91-120 days, 5 rats in each age stage, were given intraperitoneal injection of 80.0 mg/kg ketamine. After 24-hour survival time, the animals were put to death and their brains were removed. 5 μm-thick coronal sections of the hippocampus were cut on a vibratome. The expression of heat shock protein 70 was detected in the hippocampus of rats of different ages with immunohistochemical staining.MAIN OUTCOME MEASURES: Positive cellular percentage, density and grayscale of heat shock protein 70 in the rats' hippocampus.of different doses of ketamine on the expression of heat shock protein in rat hippocampus: In control group, the cellular density of heat shock protein 70 expression induced by 20.0, 40.0, 60.0, 80.0, 100.0 and 120.0 mg/kg of ketaminewas0, 8.12±1.82, 27.07±5.98, 45.35±5.84, 78.51±7.34,74.16±8.17 and 60.84±6.27, respectively. It indicated that when ketamine was under 80.0 mg/kg, the cellular density of heat shock protein 70 in creased significantly with the dose increase (P ＜ 0.01). When ketamine was over 80.0 mg/kg, the cellular density significantly decreased with the dose tamine in the hippocampus of rats of different ages: The density of positive nerve cells of heat shock protein 70 in young rats aged under 20 days was 0; the density of young rats aged 21-30 days, 31-45 days, 46-60 days and 61-90 days was 34.17±6.18, 55.42±4.80, 78.51±7.34 and 83.16±11.10,respectively. Compared with that of the first age group, with the increased age, the density of positive cells of heat shock protein 70 was significantly increased (P ＜ 0.01); it was 83.16±11.10 and 85.83±9.33 in the hippocampus of rats aged 61-90 days and 91-120 days, re spectively (P ＞ 0.05).CONCLUSION: Ketamine can induce the expression of heat shock protein 70 in the hippocampus of rats, indicating that neurons of the hippocampus may be damaged; with the increase of dose, its damaging effect is enhanced.The damage of ketamine is greater in adult rats than in young rats.

Effect of ketamine-midazolam on myocardial HSP 70 expression in septic shock in rat / 中华麻醉学杂志

Objective To evaluate the myocardial protection afforded by ketamine midazolam in its septic shock and its possible mechanism by studying the impact of ketamine midazolam on myocardial HSP 70 expression in LPS induced septic shock in rats Methods 112 healthy adults SD rats of both sexes, weighing 180 205g were randomly assigned to one of following groups:(Ⅰ)control group received normal saline ip (group NS); (Ⅱ) endotoxin group received LPS 20mg?kg -1 ip(group E); (Ⅲ) endotoxin midazolam group received midazolam 0 5mg?kg -1 20 min before LPS (group EM); (Ⅳ) endotoxin ketamine group received ketmine 80mg?kg -1 20 min before LPS (group EK); endotoxin ketamine midazolam group received ketmine 80mg?kg 1 and midazolam 0 5mg?kg -1 20 min before LPS (group EKM) One hour later half of the initial dose of ketamine and/or midazolam was given to reinforce their effect Heart was harvested 2h after LPS or when the rats died of LPS induced septic shock(pupil did not respond to light) for determination of HSP 70 expression using monoclone antibody immunocytochemistry The survival time of every rat was recorded Results The expression HSP 70 was higher in group E than that in group NS and was lower than that in group EK and EKM The survival rate of group EK and EKM was higher than that of group E and EM (P0 05) Conclusions Ketamine can enhance myocardial HSP 70 expression in septic shock This may be one of the mechanisms of its myocardial protection Joint use of ketamine midazolam dose not affect the myocardial protective effect of ketamine

Effects of haloperidol on the expression of HSP70 induced by ketamine in the rat hippocampus / 中华麻醉学杂志

Objective This experiment was designed to determine the effect of haloperidol on HSP70 induced by ketamine, and to explore the possibility of using haloperidol to prevent or treat the brain injury caused by ketamine.Methods 48 rats were divided into 8 groups, In group 1-3 different doses of haloperidol (1.0,5.0,10.0 mg/kg)were given 1h before the administration of ketamine. There were two control groups. In control group 1 normal saline was given twice with 1h interval between the two injections. In control group 2 ketamine 80.0 mg/kg was given 1h after the administration of normal saline.The volume of each injection was 3ml and intraabdominal injection was used as the route of administration.HSP70 mono-clone antibody immunocytochemistry was used to detect HSP70 expression in rat hippocampus, and MIAS-2000 photography analytic software to analyze HSP70 expression in hippocampus of the rat brain.Results Ketamine induced HSP70 expression in the rat brain. Pretreatment with haloperidol inhibited HSP70 expression induced by ketamine, and the inhibition was dose-dependent, but haloperidol given after the administration of ketamine could not decrease HSP70 expression.Conclusions Ketamine injures neurons of rat hippocampus and induces the expression of HSP70 and haloperidol pretreatment can prevent neuronal injury caused by ketamine, but haloperidol can not antagonize the injury caused by ketamine.