Propofol vs Sevoflurane anaesthesia on postoperative cognitive dysfunction in the elderly. A randomized controlled trial.

BACKGROUND: Postoperative cognitive dysfunction is a topic of special importance in the geriatric surgical population which primarily resolves within the short term postoperative period, but it can become a long term disorder with significant impact on patient's quality of life. This study was designed to compare the short and long term postoperative cognitive function after propofol and sevoflurane anaesthesia in the elderly and to evaluate the role of the inflammatory process. METHODS: Patients, aged 60-74, scheduled for a non-cardiac operation of more than two-hour duration were enrolled in this prospective randomized controlled trial and allocated into two groups in order to receive propofol or sevoflurane anaesthesia. Postoperative early cognitive function was assessed by means of the Mini Mental State Examination test (MMSE) 48 hours postoperatively. Late cognitive function was evaluated by means of 10 psychometric tests, 9 months postoperatively. The role of inflammation was estimated by the incidence of SIRS and the levels of the inflammatory markers. RESULTS: Statistical significant decrease was observed in the postoperative MMSE values in the sevoflurane group. Nine months postoperatively, there was a decline in test performance in the same group and an increase in postoperative values of inflammatory markers in both groups, which turned non-significant in their between comparison (except CRP). CONCLUSION: According to the neuropsychological test evaluation of cognition, there is a negative influence of sevoflurane anaesthesia on the early and late postoperative state. As far as the inflammatory markers are concerned, they don't relate to the patient's cognitive status.

An ancestral molecular response to nanomaterial particulates.

The varied transcriptomic response to nanoparticles has hampered the understanding of the mechanism of action. Here, by performing a meta-analysis of a large collection of transcriptomics data from various engineered nanoparticle exposure studies, we identify common patterns of gene regulation that impact the transcriptomic response. Analysis identifies deregulation of immune functions as a prominent response across different exposure studies. Looking at the promoter regions of these genes, a set of binding sites for zinc finger transcription factors C2H2, involved in cell stress responses, protein misfolding and chromatin remodelling and immunomodulation, is identified. The model can be used to explain the outcomes of mechanism of action and is observed across a range of species indicating this is a conserved part of the innate immune system.