Journal of Anesthesia and Perioperative Medicine最新文献

{"title":"A Mouse Model for Chronic Cerebral Hypoperfusion-induced Cognitive Dysfunction","authors":"L. Jun, Zuo Zhi-yi","doi":"10.24015/JAPM.2017.0015","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0015","url":null,"abstract":"Background: Chronic cerebral hypoperfusion potentially contributes to the initiation and progression of vascular dementia (VD). Bilateral common carotid artery occlusion (two-vessel occlusion) is the most commonly used animal model to replicate this pathological condition but with high mortality and severe histological cerebral damage. Unilateral common carotid artery occlusion (one-vessel occlusion) was introduced to simulate clinical conditions. Our study was designed to further characterize this model.Methods: In this study, eight-week old CD-1 mice were subjected to left common carotid artery occlusion (LCCAO). Two weeks after the occlusion, their learning and memory were assessed by Barnes maze and fear conditioning. Histo-morphological changes were evaluated by Hematoxylin-Eosin staining. Neuronal and axonal degenerative changes were examined by amino-cupric sliver staining.Results: LCCAO increased the time to find the target box in the Barnes maze test during the 4-day training sessions and one day after the training sessions compared with sham group mice. There was no difference in context-related or tone-related freezing behavior between these two groups. No significant histological neuronal cell damage or degeneration was observed in brain sections of hippocampus and corpus callosum in these two groups.Conclusions: Our results suggest that LCCAO can be used to mimic the vascular dementia.  Citation:  Jun Li, Zhi-Yi Zuo. A mouse model for chronic cerebral hypoperfusion-induced cognitive dysfunction. J Anesth Perioper Med 2017; 4: 60-66. doi:10.24015/JAPM.2017.0015This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"4 1","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2017-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80067690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Effect of Emulsified Isoflurane Preconditioning on Cardiac Toxicity Induced by Bupivacaine in Rats","authors":"Cansheng Gong, Xiaojia Wang, Jin Liu, D. Liao, Ru-rong Wang, Han Huang, Cheng Zhou","doi":"10.24015/japm.2017.0014","DOIUrl":"https://doi.org/10.24015/japm.2017.0014","url":null,"abstract":"Background: Lipid emulsion has been identified as a potent rescuing agent for cardiac arrest caused by local anesthetic overdose. In this animal study, we investigated whether prophylactic infusion of emulsified isoflurane, a mixture of lipid emulsion and isoflurane, could increase the tolerability for bupivacaine-induced cardiac toxicity.Methods: Rats were randomly assigned to receive one of the following treatments: saline, 30% Intralipid, 4% Emulsified Isoflurane (4% EISO), 2% EISO, 0.5% propofol, 0.25% propofol, inhaled isoflurane plus 30% Intralipid, or inhaled isoflurane plus saline, for 15 minutes. Then 0.75% bupivacaine was infused at the rate of 8 ml/kg/min (n=10 in each group). The time needed to induce cardiac arrest was recorded and the bupivacaine dose was calculated. Another set of rats were intubated for mechanical ventilation and catheterized for invasive arterial pressure monitoring while receiving one of the following sedative pretreatments for 15 minutes: 4% EISO, 0.5% propofol, inhaled isoflurane plus saline, or inhaled isoflurane plus 30% Intralipid (n=10 in each group). Then bupivacaine was infused at the rate of 8 ml/kg/min for 120 seconds (sublethal dose). The hemodynamic parameters were recorded till circulation fully recovered.Results: Pretreatment with 4% EISO significantly increased the dose of bupivacaine required to induce cardiac arrest (68.69±7.57 mg/kg vs. 26.61±5.13 mg/kg for saline, P<0.01). Prophylactic infusion of Intralipid alone also increased the bupivacaine tolerability (51.41±9.68 mg/kg, P<0.05 vs. saline), but less efficient than 4% EISO (P<0.05 vs. 4% EISO). Pretreatments with 4% EISO provided best preservation of hemodynamic parameters in the face of circulatory fluctuation caused by sublethal dose of bupivacaine.Conclusions: The 4% emulsified isoflurane preconditioning significantly increases the threshold of bupivacaine-induced cardiac arrest in rats and prevents circulatory instability caused by sublethal dose of bupivacaine. Our results implicate the potential application of emulsified isoflurane as an adjuvant agent in local anesthesia.  Citation:  Can-Sheng Gong, Xiao-Jia Wang, Jin Liu, Da-Qing Liao, Ru-Rong Wang, Han Huang, et al. Protective effect of emulsified isoflurane preconditioning on cardiac toxicity induced by bupivacaine in rats. J Anesth Perioper Med 2017; 4: 199-204. doi:10.24015/JAPM.2017.0014This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"39 1","pages":"199-204"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87992707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagal Nerve Stimulation: A Potentially Useful Adjuvant to Treatment of Sepsis","authors":"Guizhen Yang, F. Xue, Chao Sun, X. Liao, Jian-hua Liu","doi":"10.24015/JAPM.2017.0012","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0012","url":null,"abstract":"Aim of review: The hyper-inflammatory response is the classical pathogenesis of sepsis course. It has been shown that efferent vagal nerve stimulation (VNS) can regulate inflammatory response through a combination of acetylcholine and special α7 nicotinic acetylcholine receptor expressed on macrophages, which is defined as the cholinergic anti-inflammatory pathway (CAP). Furthermore, therapeutic methods related to CAP have been studied on lots of pathologic conditions, such as sepsis, ischemia/reperfusion injury, pancreatitis and hemorrhagic shock, etc. The aim of this review is to provide the evidence that VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response.Methods: We searched literatures published in the Pubmed with keywords \"inflammation\", \"sepsis\" and \"vagal nerve stimulation (VNS)\" from January, 1986 to November, 2016, analyzed them and then assessed the evidence as to whether VNS may be an effective adjuvant for treatment of sepsis. In this review, the evidence regarding the role of hyper-inflammatory response in the pathogenesis of sepsis and inflammatory regulation of CAP will first be described. Then, the possible beneficial effects of VNS on inflammatory response of sepsis by modulating CAP will be provided.Recent findings: Sepsis is complex interactions between infecting microorganism and host's immune, inflammatory, and coagulation systems. The beneficial effects provided by CAP activation have been demonstrated on lots of pathologic conditions related to inflammation. Furthermore, VNS has been shown to promote the gastrointestinal motility and provide protection of intestinal barrier, reducing organ injury. In addition, VNS has been effectively used for treatment of some diseases in clinical practice.Summary: There is limited number of effective therapies available for septic patients. Because the CAP plays an important role in the regulation of inflammatory response, we consider that with the standard intensive care therapy, VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response. If efficiency of this new intervention is proved by clinical experiments, it may represent an exciting opportunity to develop novel therapeutics recovering unregulated inflammatory response in septic patients. Citation:  Gui-Zhen Yang, Fu-Shan Xue, Chao Sun, Xu Liao, Jian-Hua Liu. Vagal nerve stimulation: a potential useful adjuvant to treatment of sepsis. J Anesth Perioper Med 2017; x: x-x. doi: 10.24015/JAPM.2017.0012This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85152106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thymosin α1-Based Immunomodulatory Therapy for Sepsis: A Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials","authors":"Wan-Jie Gu, X. Gu, Zhengliang Ma","doi":"10.24015/japm.2017.0017","DOIUrl":"https://doi.org/10.24015/japm.2017.0017","url":null,"abstract":"Background: Preclinical studies suggest that thymosin α1 has immunoregulatory and anti-inflammatory properties in various septic models. However, whether these effects will transform into improved outcomes in humans with sepsis remains unclear. We performed a meta-analysis to define the role of thymosin α1-based immunomodulatory therapy in sepsis.Methods: We searched Medline and Embase to identify randomized controlled trials that assessed the effect of thymosin α1-based immunomodulatory therapy compared with standard care for adults with sepsis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) using a random-effects model. The primary outcome was 28-day mortality.Results: Nine articles with 10 trials involving 1425 patients were included. Compared with standard care, thymosin α1-based immunomodulatory therapy was associated with a significant 31% relative risk reduction of 28-day mortality (RR 0.69, 95% CI 0.60-0.80, P<0.001), with no statistical heterogeneity (I2=0%). The benefit was confirmed by trial sequential analysis and was consistent across all subgroup analyses. For secondary outcomes, thymosin α1-based immunomodulatory therapy was associated with shorter length of intensive care unit (ICU) stay and duration of mechanical ventilation, increased T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and decreased inflammatory mediators (tumor necrosis factor-α, interleukin-1β, and interleukin-6).Conclusions: Thymosin α1-based immunomodulatory therapy decreases 28-day mortality in patients with sepsis. The benefit might be attributed to its immunomodulatory and anti-inflammatory effects. However, caution should be used to translate these findings to clinical practice, because current evidence is potentially subject to bias. Hence, high-quality and adequately powered trials are still warranted.  Citation: Wan-Jie Gu, Xiao-Ping Gu, Zheng-Liang Ma. Thymosin α1-based immunomodulatory therapy for sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0017This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87620121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine Alleviates Presurgical Anxiety-Induced Persistent Postsurgical Pain via Decreasing the Expression of Glucocorticoid Receptor","authors":"Lu Li, Zuoxia Zhang, Zhi-Yu Yin, Cui’e Lu, Yishan Lei, Rao Sun, Yue Liu, Zhengliang Ma, X. Gu","doi":"10.24015/JAPM.2017.0013","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0013","url":null,"abstract":"Background: Preoperative anxiety can worsen postsurgical pain. Glucocorticoids play an important role in psychological anxiety and pain, but the effect of glucocorticoid receptor (GR) on persurgical anxiety-induced persistent postsurgical pain remains unknown.Methods: Adult male Sprague Dawley rats were randomly divided into 10 groups: control group, SPS group, incision group, 'SPS-plus-incision' group, saline group, metyrapone group, Dexmedetomidine group 1 (10 μg/kg), Dexmedetomidine group 2 (20 μg/kg), Dexmedetomidine group 3 (40 μg/kg) and Dexmedetomidine + Corticosterone group. Single-prolonged stress (SPS) was used to induce anxiety behaviors. Intraperitoneal injection of saline and dexmedetomidine was performed at 24 h after SPS and 0.5 h before incision. Intraperitoneal injection of metyrapone (25 mg/kg) was performed at 1h before SPS. Paw withdrawal mechanical threshold (PWMT) was tested at 24 h before SPS and on 1, 4, 7, 14, 21, and 28 days after incision. Corticosterone levels were determined using ELISA. The expression of GR was determined using Western blot.Results: The 'SPS-plus-incision' group decreased PWMT compared with control group and incision group from 1 to 28 days (P<0.05). SPS combined with incision increased plasma corticosterone levels compared with control group (P<0.05). A time-dependent increase in GR was also observed in 'SPS-plus-incision' group (P<0.05). Metyrapone significantly blunted the SPS-induced persistent postsurgical pain (P<0.05). Intraperitoneal administration of dexmedetomidine inhibits SPS-induced persistent pain compared with group saline (P<0.05). The expression of GR decreased after the intraperitoneal administration of dexmedetomidine (P<0.05). Pretreatment with corticosterone blocked this effect.Conclusions: Glucocorticoids contributed to presurgical anxiety-induced persistent postsurgical pain. Dexmedetomidine that decreased the expression of GR alleviated anxiety-induced persistent pain. These results indicated that dexmedetomidine may be an effective agent for preventing presurgical anxiety-induced persistent postoperative pain.  Citation: Lu Li, Zuo-Xia Zhang, Zhi-Yu Yin, Cui-E Lu, Yi-Shan Lei, Rao Sun, et al. Dexmedetomidine alleviates presurgical anxiety-induced persistent postsurgical pain via decreasing the expression of glucocorticoid receptor. J Anesth Perioper Med 2017; x: x-x. doi:10.24015/JAPM.2017.0013This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"421 1","pages":"8-16"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86844596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperpolarization-Activated Cyclic Nucleotide-Gated Channel Blocker ZD7288 Prevents Sevoflurane-Induced Hyperactivity in a Novel Mice Behavioral Model","authors":"P. Liang, Xueying Huang, Fengshan Li, Han Huang, Jingxuan Qiu, D. Liao, Jin Liu, Cheng Zhou","doi":"10.24015/JAPM.2017.0011","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0011","url":null,"abstract":"Background: Besides effect of general anesthesia, sevoflurane also induces hyperactivity during induction and recovery, especially in young children. Lack of satisfied animal model impedes the investigation of causes of the hyperactivity as well as its prevention. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker might produce sedative effect. This study developed a novel mice model of hyperactive behaviors and further explored effects of HCN channel blocker on sevoflurane-induced hyperactivity.  Methods: C57BL/6 mice were used in the present study. Maximal speed, mean speed, total movement distance and resting percentage of mice were quantitatively measured by behavioral tracking software. Age-dependence of this model was also analyzed. HCN channel blocker ZD7288 at doses of 6.25 and 12.5 μg/kg were intraperitoneal injected to prevent sevoflurane-induced hyperactivity. Results: In the behavioral model, sevoflurane could induce significant hyperactivity in mice under 1% sevoflurane inhalation and in recovery period, characterized as increased movement speed and total distance. The sevoflurane-induced hyperactivity was more significant in young mice than adult (P<0.01). Pre-administration of ZD7288 could significantly prevent sevoflurane-induced hyperactivity. Conclusions: The mice behavioral model developed in this study could characterize sevoflurane-induced hyperactivity in induction and recovery period as well as age-dependence. In addition, by this animal model, HCN channel blocker ZD7288 could prevent sevoflurane-induced hyperactivity. Thus, HCN channel might be the underlying therapeutic target for sevoflurane-induced agitation in general anesthesia.   Citation: Peng Liang, Xu-Bin Huang, Feng-Shan Li, Han Huang, Jing-Xuan Qiu, Da-Qing Liao, et al. Hyperpolarization-activated cyclic nucleotide-gated channel blocker ZD7288 prevents sevoflurane-induced hyperactivity in a novel mice behavioral model. J Anesth Perioper Med 2017; 4: 205-12. doi: 10.24015/JAPM.2017.0011This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"24 1","pages":"205-212"},"PeriodicalIF":0.0,"publicationDate":"2017-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72994551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem Cells for the Treatment of Neuropathic Pain","authors":"Xie Fang, Yue Yun, Guan Yun, Wang Yun","doi":"10.24015/JAPM.2017.0009","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0009","url":null,"abstract":"Aim of review: Neuropathic pain induced by injury to the somatosensory system is a great clinical problem. Despite multiple therapeutic strategies, the medical community still faces a challenge to treat neuropathic pain in a complete and definitive way, since the pathogenesis of this hypersensitive state is very complex. Stem cell transplantation may be an important approach for the treatment of neuropathic pain. This article aimed to review important and illustrative results from recent stem cell studies under various neuropathic pain conditions and to interpret their clinical implications for stem cell transplantation.Method: We reviewed recent articles and literatures about stem cells for the treatment of neuropathic pain, in order to identify the types of stem cells, delivery approaches and the advances of stem cells for the treatment of peripheral nerve injury induced neuropathic pain, painful diabetic peripheral neuropathy and spinal cord injury (SCI) induced chronic pain.Recent findings: Recently, the successful use of stem cell for the treatment of a diverse spectrum of diseases in animals has attracted more attentions from pain scientists. Accumulating evidence has shown that stem cell transplantation has a therapeutic effect on neuropathic pain. Stem cell transplantation can effectively relieve neuropathic pain under different pathological conditions. However, it is interesting to point out that peripheral neuropathic pain seems to be more responsive to stem cell therapy than SCI-induced chronic pain. Moreover, stem cell treatment does not always exert positive results in SCI-induced chronic pain (e.g. aggravating pain above the lesion spinal cord segment).Summary: The analgesic effect of stem cells depends on the capacity to offer a multipotent cellular source for replacing injured neural cells and delivering trophic factors to lesion sites. Stem cell researches should focus on both experimental and clinical studies of neuropathic pain in the future. Citation: Fang Xie, Yun Yue, Yun Guan. Stem cells for the treatment of neuropathic pain. J Anesth Perioper Med 2017; 4: 186-94. doi: 10.24015/JAPM.2017.0009This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"24 1","pages":"186-194"},"PeriodicalIF":0.0,"publicationDate":"2017-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88503804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficulties in Understanding Postoperative Cognitive Dysfunction","authors":"Anqi Ni, Wei-hua Yu","doi":"10.24015/JAPM.2017.0010","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0010","url":null,"abstract":"Aim of review: Firstly brought up by Bedford in 1955, postoperative cognitive dysfunction (POCD) has been given increasing attention due to the increase of the elderly population. Although many researches have been conducted on POCD, the understanding of this clinical syndrome is still limited. There are currently many disputes regarding almost every aspects of POCD, even the term itself has not been included in the MeSH Database. This review aims to discuss the major disputes about POCD that hinder research consistency and provide possible perspectives for future research.Method: Recent articles and literatures about POCD were searched and reviewed. First, basic knowledge of POCD, including characteristics and incidence, risk factors, mechanisms, prevention and intervention are introduced. Second, the major obstacles of investigating POCD are discussed. Then two major problems are proposed: 1) Does the POCD in patients really start postoperatively? 2) Is POCD only related to old age? Finally, the never-ending argument regarding the role of anesthesia on POCD is discussed.Recent findings: Recent researches regarding POCD focused on the surgery-related neuroinflammation mechanism, and efforts have been made to find some biomarkers of POCD. In terms of POCD, there are many fundamental concepts and in urgent need of consensus. First, unifying the terms used among studies will benefit the communication of knowledge. Second, questions like whether POCD should be defined as a general cognitive decline that include other forms such as postoperative delirium, or they should be considered as separate unique illnesses, and whether or not young patients should be included when POCD is discussed, need to be answered. Only after answering these questions, will the study of POCD be less disputable. Third but not the least, efforts should be made trying to make \"golden-standard\" in regard of the testing methods of POCD both clinically and pre-clinically.Summary: Although lots of researches have been conducted on POCD, the understanding of this clinical syndrome is still very limited. There are currently many disputes regarding almost every aspect of POCD. It's time for clinicians and scholars to strike some fundamental consensus for the better investigation of POCD. How to find a way to increase the rigor of experimental design is an important question that still seeks answers. Citation:  Ni An, Wei-Feng Yu. Difficulties in understanding postoperative cognitive dysfunction. J Anesth Perioper Med 2017; 4: 87-94. doi: 10.24015/JAPM.2017.0010This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"19 1","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2017-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87291163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endothelial Derived Neuregulin-1 may be Important for Cardioprotection Induced by Ischemic Preconditioning","authors":"Guizhen Yang, F. Xue, Chao Sun, X. Liao, Jian-hua Liu","doi":"10.24015/JAPM.2017.0008","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0008","url":null,"abstract":"Aim of review: The underlying mechanisms of ischemic preconditioning (IPC) have been studied for many years, but have not been elucidated completely. The available literatures indicate that endothelial derived neuregulin-1 (NRG-1) is involved in myocardial ischemia/reperfusion injury (IRI) and protects cardiomyocytes against H2O2-induced apoptosis by regulating endoplasmic reticulum stress (ERS). The aim of this review is to provide the evidence that endothelial derived NRG-1 maybe a crucial biomolecule mediating powerful cardioprotection by IPC.Methods: According to the available literatures, this review will first discuss the factors attributable to cardioprotection of IPC and then provide an overview of the cellular and molecular mechanisms of endothelial derived NRG-1 maybe involved in IPC induced cardioprotection.Recent findings: Multiple factors are attributable to cardioprotection induced by IPC. It has been shown that anoxia preconditioning in vitro can not provide cardioprotection as much as the IPC in vivo. During myocardial ischemic conditioning, endothelial cells may play several roles: a “receptor” for blood-borne conditioning moieties, a sensor for hypoxic stress and a paracrine organ. The NRG-1 produced by endothelial cells has been proved to protect against myocardial IRI through a PI3K/Akt pathway. Furthermore, unbalanced endoplasmic reticulum stress is one of the important mechanisms of IRI, and IPC has been demonstrated to protect myocardial IRI by regulating endoplasmic reticulum stress. In addition, NRG-1 may attenuate IRI by regulating cold inducible RNA-binding protein with its downstream endoplasmic reticulum stress related signaling pathways.Summary: Endothelial derived NRG-1 and its downstream signaling pathways are involved in multiple aspects of cardiac physiology and function, and can provide a significant protection against myocardial injury. The available evidence indicates that selective deletion of endothelial derived NRG-1 in vivo decreases the tolerance to IRI, as demonstrated by impaired recovery of post-ischemic myocardial contraction function. Thus, endothelial derived NRG-1 maybe a crucial biomolecule mediating powerful cardioprotection by IPC. If this new view is proved by basic and clinical experiments, a crucial biomolecule mediated cardioprotection induced by IPC would be revealed. Citation:  Gui-Zhen Yang, Fu-Shan Xue, Chao Sun, Xu Liao, Jian-Hua Liu. Endothelial derived neuregulin-1 may be important for cardioprotection induced by ischemic preconditioning. J Anesth Perioper Med 2017; 4: 225-30. doi: 10.24015/JAPM.2017.0008This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"3 1","pages":"225-230"},"PeriodicalIF":0.0,"publicationDate":"2017-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83590778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Application of Tranexamic Acid and Thrombelastography in Pediatric Epilepsy Surgery","authors":"Qingfang Duan, Wenya Fu, Wei Xiao, J. Qi, Guoguang Zhao, Y. Shan, Xiaotong Fan, Tianlong Wang","doi":"10.24015/JAPM.2017.0007","DOIUrl":"https://doi.org/10.24015/JAPM.2017.0007","url":null,"abstract":"Background: Pediatric patients undergoing epilepsy surgeries are under high risks of bleeding, hemodynamic instability and complications related to transfusions. This study aimed to investigate whether combined application of tranexamic acid (TXA) and thrombelastography (TEG) in pediatric epilepsy surgery can decrease blood loss, transfusion requirements and post-operation complications.Methods: Thirty-two pediatric patients undergoing elective epilepsy surgery were randomized into two groups. Group T (Group T=Group Treatment, n=16) was given a loading dose of 10 mg/kg TXA in 15 minutes and then maintained at the speed of 5 mg/kg/h, while Group C (Group C=Group Control, n=16) was given the same dosage of normal saline. TEG tests were performed at the beginning of surgery (T1), opening the dura mater (T2), closing the dura mater (T3) and the end of surgery (T4) in both groups. In Group T, transfusion decision was made according to TEG results; while in Group C, it was made by anesthetist's experience without knowing the TEG results. The volume of blood loss, blood transfusion, post-operative drainage and complications were recorded.Results: In Group T, intraoperative bleeding volume was significantly lower than Group C ([8.23±4.10] ml/kg vs [12.86±5.30] ml/kg, P=0.010]), and subsequently the ratio of transfusion of red blood cells (RBC) (18.75% vs 56.25%, P=0.026), fresh frozen plasma (FFP) (32.15% vs 43.75%, P=0.465) were significantly reduced. Maximal amplitude (MA) value of TEG at T3 (Group T=[61.11±4.58] mm vs Group C=[56.09±8.03] mm, P=0.038) and T4 (Group T=[60.31±6.23] mm vs Group C=[54.08±7.28] mm, P=0.014) in Group T were significantly higher than those in Group C. A significant difference existed between two groups in postoperative drainage volume in the first 24 hours (Group T=[4.19±1.55] ml/kg vs Group C=[5.83±2.07] ml/kg, P=0.017). Postoperative hospital stay was significantly shortened in Group T, compared to Group C ([7.9±2.1] days vs [10.8±3.8] days, P=0.014). No transfusion related complications occurred in both groups.Conclusions: Combined application of TXA and TEG in pediatric epilepsy surgery may decrease blood loss, reduce transfusion requirements. The risk of thromboembolism may not be increased. Citation: Qing-Fang Duan, Wen-Ya Fu, Wei Xiao, Jia-Jian Qi, Guo-Guang Zhao, Yong-Zhi Shan, et al. Combined application of tranexamic acid and thrombelastography in pediatric epilepsy surgery. J Anesth Perioper Med 2017; 4: 213-9. doi: 10.24015/JAPM.2017.0007This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.","PeriodicalId":15018,"journal":{"name":"Journal of Anesthesia and Perioperative Medicine","volume":"36 1","pages":"213-219"},"PeriodicalIF":0.0,"publicationDate":"2017-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75759752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}