Nongenetic and genetic predictors of haemodynamic instability induced by propofol and opioids: A retrospective clinical study.

AIM: Propofol and opioids are commonly used in anaesthesia, but are highly susceptible to haemodynamic instability, thereby threatening the patient's surgical safety and prognosis. The purpose of this study was to investigate the predictors of haemodynamic instability and establish its predictive model. METHODS: A total of 150 Chinese patients undergoing thyroid or breast surgery participated in the study, with target-controlled infusion concentrations of propofol, opioids dosage, heart rate (HR), mean arterial pressure (MAP) and Narcotrend Index recorded at key points throughout the procedure. The Agena MassARRAY system was used to genotype candidate single nucleotide polymorphisms related to pharmacodynamics and pharmacokinetics of propofol and opioids. RESULTS: Among nongenetic factors, baseline HR (R = -.579, P < .001) and baseline MAP (R = -.725, P < .001) had a significant effect on the haemodynamic instability. Among genetic factors, the CT/CC genotype of GABRB1 rs4694846 (95% confidence interval [CI]: -11.309 to -3.155), AA/AG of OPRM1 rs1799971 (95%CI: 0.773 to 10.290), AA of CES2 rs8192925 (95%CI: 1.842 to 9.090) were associated with higher HR instability; the AA/GG genotype of NR1I2 rs6438550 (95%CI: 0.351 to 7.761), AA of BDNF rs2049046 (95%CI: -9.039 to -0.640) and GG of GABBR2 rs1167768 (95%CI: -10.146 to -1.740) were associated with higher MAP instability. The predictive models of HR and MAP fluctuations were developed, accounting for 45.0 and 59.2% of variations, respectively. CONCLUSION: We found that cardiovascular fundamentals and genetic variants of GABRB1, GABBR2, OPRM1, BDNF, CES2 and NR1I2 are associated with cardiovascular susceptibility, which can provide a reference for haemodynamic management in clinical anaesthesia.

[Application of tunica dartos flap coverage to tubularized incised plate urethroplasty].

OBJECTIVE: To investigate the application of tunica dartos flap coverage to the prevention of urinary fistula in tubularized incised plate (TIP) urethroplasty. METHODS: This study included 140 cases of hypospadias following TIP urethroplasty, aged 1.9-22 (mean 5.6) years. Of the total number, 85 cases of the distal type were treated by coverage of the neourethra with the longitudinal ventrolateral pedicled-dartos penile skin flap, while the other 55 cases of the proximal type with the pedicled-dartos flap of arteriae scrotales anteriories. RESULTS: Urethrocutaneous fistula occurred in 12 of the patients, including 7 cases of distal and 6 cases of proximal hypospadias. CONCLUSION: For distal hypospadias, the longitudinal ventrolateral pedicled-dartos penile skin flap can be used, while for proximal urethroplasty, the pedicled-dartos flap of arteriae scrotales anteriories can be applied in coverage of the neourethra, which can effectively reduce the incidence of fistula.

[Diagnosis and treatment of epididymal obstructive azoospermia by microsurgery].

OBJECTIVE: To investigate the diagnosis and treatment of epididymal obstructive azoospermia (OA) by microsurgery. METHODS: We performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy (LIVES). And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection (ICSI). After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy. RESULTS: Of the total number of patients, 53 (92.9%) were diagnosed with epididymal OA by scrotal exploration, 47 (82.5%) underwent microsurgery, and the other 10 (17.5%) received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases (22/47), natural pregnancy in 10.6% (5/47), and ICSI pregnancy in 18.5% (6/32). CONCLUSION: With the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.

Proteomics of ischemia/reperfusion injury in rat intestine with and without ischemic postconditioning.

BACKGROUND: Intestinal ischemia/reperfusion (I/R) injury is a critical condition associated with high morbidity and mortality. Our previous study showed that ischemic postconditioning (IPo) protects the intestinal mucosa from I/R injury. However, the precise molecular mechanisms of this event remain poorly elucidated. The aim of this study was to investigate the differentially expressed proteins of intestinal mucosa after intestinal I/R with or without IPo, and to explore the potential mechanisms of intestinal I/R injury and the protective effect of IPo in relation to the differential proteins. MATERIALS AND METHODS: Intestinal I/R injury was established by occluding the superior mesenteric artery (SMA) for 60 min followed by 60 min reperfusion. The rats were randomly allocated into one of three groups based upon the intervention (n = 8); sham : sham surgical preparation including isolation of the SMA without occlusion was performed; injury: there was no intervention either before or after SMA occlusion; IPo: three cycles of 30 s reperfusion-30 s reocclusion were imposed immediately upon reperfusion. A comparative proteomics approach with two-dimensional gel electrophoresis was used to isolate proteins in intestinal mucosa, the expression of which were regulated by I/R injury post-treated with or without IPo. The differentially displayed proteins were identified through matrix-assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). RESULTS: Image analysis revealed that an average of 1300 protein spots were detected on each gel; 16 and 9 proteins showing more than 1.5-fold difference were identified between the Sham versus Injury group and injury group versus IPo group, respectively. The identified proteins were functionally involved in the cellular processes of energy metabolism, anti-oxidation, and anti-apoptosis. CONCLUSIONS: This study provided new clues for understanding the mechanisms of IPo against intestinal I/R injury.

[Effects of different fresh gas flow on pharmacodynamics of isoflurane during anesthesia induction].

OBJECTIVE: To investigate the effect of different fresh gas flows (FGFs) on the pharmacodynamics of isoflurane during anesthesia induction. METHODS: Sixty female ASA class I or II patients (aged from 18 to 49 years) scheduled for gynecologic laparoscopic surgery were randomly divided into groups I, II, and III (n=20). The FGFs for group I, II, and III was 1, 2 and 3 L/min, respectively, and each group was further divided into two equal subgroups according to the setting concentrations of isoflurane vaporizer (Co), which was 1% in groups I1, II1, and III1 and 2% in groups I2, II2, and III2. Isoflurane at different setting concentration was administered under different FGF in the patients after tracheal intubation following anesthesia induction. The systolic blood pressure (SBP), diastolic blood pressure (DBP), main arterial blood pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded before anesthesia induction and every 3 min after tracheal intubation. Patients given ephedrine and atropine were also recorded. The patients' consciousness during anesthesia were followed up and recorded. The inspiratory concentration (CIiso) and expiratory concentration (CEiso) of isoflurane in the airway were monitored and recorded every 3 min. The observation after intubation lasted for 18 min, during which stimulation of the patients was avoided, and the operation began after the observation. RESULTS: There was a close correlation between BIS and CIiso and between BIS and CEiso (r=-0.904 and -0.893, respectively). The incidence of hypotension was significantly different between groups III and I (P<0.01), and between the subgroups in groups II and I (P<0.05). No bradycardia occurred and no consciousness reported awareness during anesthesia. CONCLUSIONS: Between the completion of tracheal intubation and beginning of the surgery, 1% or 2% Co under a moderate FGF (1-3 L/min) may guarantee the patients' unconsciousness, but hypotension is less likely under a relatively low flow (1-2 L/min) than a higher flow (3 L/min). Higher FGF and Co result in faster induction of deep anesthesia and higher incidence of hypotension.

Effect of mifepristone on uterine receptivity in guinea pigs.

AIM: To determine the effect of a low-dose mifepristone regimen on endometrial receptivity in guinea pigs. METHODS: Histologic evaluation for endometrial staging and immunoreactivity of cytokines [leukemia inhibitory factor (LIF) and interleukin-6 (IL-6)] were preformed on fixed endometrial tissue, and relative abundance of endometrial estrogen (E), and progesterone (P) receptor mRNA were evaluated with semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) in which cyclophilin mRNA, a housekeeping gene product, was co-amplified as the reference standard. RESULTS: Mifepristone at 0.03 mg.kg-1 . d-1 induced a delay in endometrial maturation. The staining intensity of LIF and IL-6 decreased in treated guinea pigs. E and P receptor mRNA increased significantly and uterine stage delayed in treated guinea pigs. CONCLUSION: Mifepristone at 0.03 mg.kg-1 . d-1 delayed development of endometrium. This study provides further evidence that endometrial maturation can be altered without affecting ovarian ovulatory function.