[Experimental study on the effects of tumor necrosis factor-α monoclonal antibody on autophagy level in allergic rhinitis mice].

Objective: To observe the effect of tumor necrosis factor-α (TNF-α) monoclonal antibody on autophagy in allergic rhinitis (AR) mice. Methods: Thirty six weeks old BALB/c mice were randomly divided by random number table method into five groups: control group, model group (AR group), TNF-α antibody intervention group (AR+TNF-α group), autophagy inhibitor (3-methylindole, 3-NA) intervention group (AR+3-MA group), TNF-α antibody combined with autophagy inducer rapamycin (RAP) intervention group (AR+TNF-α+RAP group), with 6 mice in each group. AR model was established by conventional method, the corresponding reagent was administered before nasal cavity stimulation sensitization and during the whole experiment. Behavioral scores of mice were obtained, blood was collected from the eye socket, and mice in each group were sacrificed to collect nasal mucosa tissue samples. Pathological changes of nasal mucosa were observed by hematoxylin-eosin staining. Expression levels of inflammatory factor and IgE in serum were detected by enzyme-linked immunosorbent assay (ELISA). Expressions of autophagy related indicators microtubule-associated protein-1 light chain-3B (LC3B), Beclin-1, sequestosome1 (p62), autophagy-related 5 (ATG5), autophagy-related 7 (ATG7) were measured by Real-time PCR and Western blot. The aggregation of LC3B protein was observed by immunofluorescence. SPSS 19.0 software was used for statistical analysis. Results: Compared with the AR model group, symptoms of AR in AR+TNF-α group and AR+3-MA group were mild; the pathological changes of nasal mucosa were weak; the expression of IgE, TNF-α, interleukin 4 (IL-4), interferon-γ (IFN-γ) in serum significantly reduced (IgE: 666.19±78.35 (x±s) vs. 692.38±64.29 vs. 1 059.05±146.44, TNF-α: 112.06±12.95 vs. 113.17±15.43 vs. 161.22±17.96, IL-4: 54.05±7.14 vs. 58.26±5.67 vs. 79.95±6.33, IFN-γ: 28.58±4.51 vs. 30.67±2.60 vs. 39.83±3.31, all P<0.05), and the expression of LC3B Ⅱ/Ⅰ, Beclin-1, ATG5, ATG7 in nasal mucosa significantly decreased, the expression of p62 significantly elevated. After intervention with autophagy inducer RAP, the therapeutic effect of TNF-α monoclonal antibodies on AR was antagonized. Conclusion: TNF-α monoclonal antibody significantly improves nasal symptoms in AR mice by inhibiting autophagy levels.

The effect of dilution and prolonged injection time on dexamethasone-induced perineal pruritus.

Dexamethasone has been widely used before general anesthesia induction. However, previous studies have found that a pre-induction bolus dose of dexamethasone sometimes causes perineal pruritus. We hypothesized that an appropriate prolongation of the injection time might suppress dexamethasone-induced perineal pruritus. Four hundred patients requiring general anaesthesia were randomly allocated into four groups: group I receiving 2 ml dexamethasone (5 mg/ml); group II receiving 4 ml dexamethasone (2.5mg/ml); group III receiving 10 ml dexamethasone (1 mg/ml); and group IV receiving 20 ml dexamethasone (0.5 mg/ml). Dexamethasone was diluted with 0.9% sodium chloride. The injection time of dexamethasone was 5s in groups I, II and III; while the injection time of dexamethasone was 30s in group IV. Occurrence of perineal pruritus was significantly reduced in Group IV (0% vs 38%, 32% and 12% in Groups I, II and III, respectively, p < 0.05). The incidence was higher in females than in males (p < 0.05). The duration of perineal pruritus was longer in females than in males in groups I, II and III (p < 0.05). We conclude that the dilution of dexamethasone to 0.5 mg/ml with 0.9% sodium chloride combined with prolonged injection time to 30 s eliminates dexamethasone-induced perineal pruritus.

Immunological effects of laparoscopic and open cholecystectomy.

This prospective, randomized, controlled study evaluated plasma levels of interleukin-18 (IL-18) and monocyte chemotactic protein-1 (MCP-l) in patients undergoing cholecystectomy. Forty patients were randomized to undergo laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). Plasma concentrations of IL-18 and MCP-1 were measured before anaesthesia (T(0)), before operation (T(1)), 30 min after the start of the operation (T(2)) and at the end of the operation (T(3)). Compared with T(0), the IL-18 concentration was significantly increased at T(2) and T(3) in both groups. In addition, the MCP-1 concentration was significantly increased at T(3) compared with T(0) in the LC group. Both the IL-18 and MCP-1 concentrations were significantly lower in the OC group than in the LC group at T(3). It is suggested that carbon dioxide pneumoperitoneum may cause immunodepression, that epidural anaesthesia can attenuate the stress response, and that IL-18 and MCP-1 are sensitive markers for evaluating the patient's immune function.

Effects of acute hypervolaemic haemodilution on the expression of plasma interferon-inducible protein-10 and bactericidal/permeability-increasing protein in patients undergoing total hip replacement.

This prospective, randomized controlled study evaluated the effects of acute hypervolaemic haemodilution (AHH) on the expression of plasma interferon-inducible protein-10 (IP-10) and bactericidal/permeability-increasing protein (BPI) in patients undergoing elective total hip replacement. Twenty patients were randomized to receive an infusion of either hydroxyethyl starch (HES group) or lactated Ringer's solution (LR group) immediately after anaesthesia. Plasma concentrations of IP-10 and BPI were measured before anaesthesia (baseline), at the start of surgery, 30 min after the start of surgery and at the end of surgery. Blood loss and the volume of blood transfused were significantly lower in the HES group compared with the LR group. Compared with baseline, IP-10 and BPI concentrations increased significantly in both groups 30 min after the start of surgery. The IP-10 concentrations were significantly lower and BPI concentrations significantly higher in the HES group compared with the LR group 30 min after the start of surgery and at the end of surgery. It is concluded that AHH with HES may be helpful in ameliorating immune function during total hip replacement and in reducing blood loss and the extent of blood transfusion.

Which has the least immunity depression during postoperative analgesia--morphine, tramadol, or tramadol with lornoxicam?

BACKGROUND: Analgesics are commonly used to provide pain relief after surgery. These drugs produce some extended depression of immunity. A prospective randomized controlled trial was designed to observe expressions of T-lymphocyte subsets (CD3(+), CD3(+)CD4(+) and CD3(+)CD8(+)), natural-killer cells (CD3(-)CD16(+)CD56(+)), and activated T-lymphocytes (CD3(+)CD25(+)) of patients undergoing gastric cancer surgeries and receiving patient-controlled intravenous analgesia (PCIA). METHODS: Forty-five patients undergoing elective gastric cancer surgeries under general anesthesia were randomly allocated into 3 groups. Group I received PCIA using morphine after surgery, group II using tramadol, and group III using tramadol with lornoxicam. The analgesic efficacy was evaluated by visual analog scale (VAS) and Bruggrmann comfort scale (BCS). Expressions of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were measured as percentages of total lymphocytes by flow cytometer at 5 time points. RESULTS: There was no significant difference in analgesic efficacy and the baselines of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) in all groups. Compared with the baseline, CD3(+)CD8(+) had no changes in all groups at any time point. Ninety minutes after incision, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were lower in all groups (P<0.05). 24 h after surgery, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) were lower in group I and group II (P<0.05); meanwhile CD3(+), CD3(+)CD4(+), and CD3(+)CD25(+) returned to the baseline but CD3(-)CD16(+)CD56(+) was still low (P<0.05) in group III. 48 h after surgery, CD3(+), CD3(+)CD4(+), CD3(-)CD16(+)CD56(+), and CD3(+)CD25(+) returned to the baseline in group II and group III, but not in group I (P<0.05). 72 h after surgery, CD3(+), CD3(+)CD4(+), CD3(+)CD4(+)/CD3(+)CD8(+) returned to the baseline, but CD3(+)CD25(+) and CD3(-)CD16(+)CD56(+) were still low in group I (P<0.05). CONCLUSION: PCIA using lornoxicam with tramadol has the same good analgesic efficacy and less immunity depression than PCIA using morphine or tramadol.