Effect of Propofol on the Production of Inflammatory Cytokines by Human Polarized Macrophages.

Macrophages are key immune system cells involved in inflammatory processes. Classically activated (M1) macrophages are characterized by strong antimicrobicidal properties, whereas alternatively activated (M2) macrophages are involved in wound healing. Severe inflammation can induce postoperative complications during the perioperative period. Invasive surgical procedures induce polarization to M1 macrophages and associated complications. As perioperative management, it is an important strategy to regulate polarization and functions of macrophages during inflammatory processes. Although propofol has been found to exhibit anti-inflammatory activities in monocytes and macrophages, it is unclear whether propofol regulates the functions of M1 and M2 macrophages during inflammatory processes. This study therefore investigated the effects of propofol on human macrophage polarization. During M1 polarization, propofol suppressed the production of IL-6 and IL-1ß but did not affect TNF-α production. In contrast, propofol did not affect the gene expression of M2 markers, such as IL-10, TGF-ß, and CD206, during M2 polarization. Propofol was similar to the GABAA agonist muscimol in inducing nuclear translocation of nuclear factor-E2-related factor 2 (Nrf2) and inhibiting IL-6 and IL-1ß, but not TNF-α, production. Knockdown of Nrf2 using siRNA significantly reduced the effect of propofol on IL-6 and IL-1ß production. These results suggest that propofol prevents inflammatory responses during polarization of human M1 macrophages by suppressing the expression of IL-6 and IL-1ß through the GABAA receptor and the Nrf2-mediated signal transduction pathway.

Atypical gaze patterns in children and adults with autism spectrum disorders dissociated from developmental changes in gaze behaviour.

Eye tracking has been used to investigate gaze behaviours in individuals with autism spectrum disorder (ASD). However, traditional analysis has yet to find behavioural characteristics shared by both children and adults with ASD. To distinguish core ASD gaze behaviours from those that change with development, we examined temporo-spatial gaze patterns in children and adults with and without ASD while they viewed video clips. We summarized the gaze patterns of 104 participants using multidimensional scaling so that participants with similar gaze patterns would cluster together in a two-dimensional plane. Control participants clustered in the centre, reflecting a standard gaze behaviour, whereas participants with ASD were distributed around the periphery. Moreover, children and adults were separated on the plane, thereby showing a clear effect of development on gaze behaviours. Post hoc frame-by-frame analyses revealed the following findings: (i) both ASD groups shifted their gaze away from a speaker earlier than the control groups; (ii) both ASD groups showed a particular preference for letters; and (iii) typical infants preferred to watch the mouth rather than the eyes during speech, a preference that reversed with development. These results highlight the importance of taking the effect of development into account when addressing gaze behaviours characteristic of ASD.

Successful use of femoral nerve block with dexmedetomidine for fracture fixation of an intracapsular fracture of the femoral neck in a patient with severe aortic stenosis: a case report.

We described a case in which femoral nerve block (FNB) and lateral femoral cutaneous nerve block (LFCNB) with dexmedetomidine (DEX) was useful for open reduction and internal fixation (ORIF) of a femoral neck fracture in a patient with severe aortic stenosis. Cardiac surgery had been recommended but was declined by the patient. Thus, ORIF was selected because of the patient's concomitant severe aortic stenosis. The anesthesia method used was FNB plus LFCNB with DEX, which achieved adequate local anesthesia. DEX was used to avoid respiratory depression because this patient has pulmonary hypertension. This patient had been sedative up to the end of surgery. Total operating time was 51 min, and the patient's hemodynamics were stable throughout the perioperative period. There were no complications. In this case, anesthesia using a nerve block with DEX contributed to the safety of noncardiac surgery in a patient with severe cardiac disease under conservative treatment during the perioperative period.