Cardioand neuroprotection with volatile anesthetics in cardiac surgery

The researcher's opinions about myocardial and brain anesthetic preconditioning efficiency are yet contradictive. In addition, the anesthetic neuroprotection phenomenon is poorly investigated. In this study the authors attempted to evaluate the efficiency of myocardial and central nervous system (CNS) protection by using a modified method of volatile induction and maintenance of anesthesia (VIMA) based on pulse-like sevoflurane dosing that excludes propofol usage. Ninety CABG patients aged 45-75 years were included in the study group (VIMA) and underwent volatile induction with sevoflurane and anesthetic preconditioning (2 MAC) for 10 min before aortic cross-clamping, with ataralgesia used during CPB. The control group patients (TIVA) received propofol and fentanyl, no inhalation anesthetics were applied. Preoperative concentrations of NTpro-BNP were comparable. There was no significant rise of NTpro-BNP concentration in the VIMA group during the postoperative period. In the TIVA group NTpro-BNP concentrations were 3.8 and 4.8 times as much as the baseline values at 24 and 48 postoperative hours respectively (р<0.05). 17 patients in the VIMA group needed dopamine infusion during 24 postoperative hours, this number was 1.7 times less than that in the TIVA group (23 patients) (р<0.05). VIMA patients had 2-fold lower troponin T concentration in 24 hours after surgery (р<0.01). Significant differences in protein S100B concentrations were observed only during the postoperative period. No significant differences in cognitive functions of the patients from both groups were identified before surgery. On postoperative day 2 MMSE scale count was significantly lower in TIVA patients (20.843.73) in comparison with VI-MA patients (23.364.34) (р<0.05). Thus, the modified VIMA technique with sevoflurane has a greater neuroprotective potential during CABG with CPB and provides better preservation of myocardium structural integrity and cardiac performance than fentanyl/4propofol-based TIVA would do.

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Functional dynamics of myocardial injury biomarkers production during acute isoprenaline treatment in rats

Medicinski podmladak ◽

10.5937/mp72-31512 ◽

2021 ◽

Vol 72 (2) ◽

pp. 11-18

Author(s):

Nina Gatarić ◽

Ana Ilić ◽

Dušan Todorović ◽

Slavica Mutavdžin ◽

Jovana Jakovljević-Uzelac ◽

...

Keyword(s):

Experimental Model ◽

Myocardial Injury ◽

Saline Solution ◽

Troponin T ◽

Significant Rise ◽

Control Group ◽

Activity Levels ◽

St Segment Elevation ◽

Therapeutic Modalities ◽

Male Wistar Rats

Introduction: Isoprenaline or isoproterenol (1-(3,4-dihydroxyphenyl)-2-isopropylaminoethanolhydrochloride; ISO), a synthetic b-adrenergic agonist, can be used to establish myocardial ischemia, cardiotoxicity, necrosis and/or an experimental model of infarction in rats. Aim: Determination of the dynamics of myocardial injury biomarkers production of aspartate transaminase (AST), lactate dehydrogenase (LDH), creatine kinase (CK), and high-sensitive troponin T (hsTnT), with changes on electrocardiogram (ECG) parameters during the subcutaneous aplication of ISO in male Wistar rats. Material and methods: All animals (n = 23) were divided into two groups: control group (n = 11) treated with a saline solution, during two consecutive days (0,2 ml/kg b.m. daily, sc); and the ISO group (n = 12) treated with isoprenaline, during two consecutive days (85 mg/kg b.m. daily, sc). Blood was drawn from the rat tail vein in both groups, in order to determine serum activity levels of myocardial injury biomarkers, and an ECG (n = 6) was registered prior to the application, as well as 48h following the first dose of of saline solution or isoprenaline. Results: In comparison to the control group, in which no significant enzyme activities elevation (p > 0.05) nor ECG changes were registered, ISO group presented a significant rise of two clinically significant biomarkers of acute myocardial injury/myocardial infarction (AMI), CK (p = 0.05) and hsTnT (p < 0.01), as well as an ST segment elevation, with a patognomonic ECG change. Conclusion: Obtained results support previous studies, proving that isoprenaline represents an adequate experimental model for myocardial injury/AMI induction, and a "golden standard" for evaluating potential cardioprotective effects of pharmacological and non-pharmacological therapeutic modalities, with the ultimate goal of lowering the degree of lesions and improving post-infarction myocardium function.

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Pro-oxidant effects of a high α-tocopherol dose on kidney antioxidant biomarkers and histopathological aspects

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000512 ◽

2017 ◽

Vol 87 (3-4) ◽

pp. 179-190

Author(s):

Amel Kanane ◽

Fayrouz Rouaki ◽

Mohamed Brahim Errahmani ◽

Abdenour Laraba ◽

Hayet Mesbah ◽

...

Keyword(s):

Sunflower Oil ◽

Antioxidant Status ◽

Basal Diet ◽

Inflammatory Cells ◽

Significant Rise ◽

Control Group ◽

Histopathological Changes ◽

Group 5 ◽

Oxidant Effect ◽

Higher Doses

Abstract. The aim of this study is to evaluate the effect of α-tocopherol supplementation at two doses (600 and 1200 mg × kg–1) on kidney antioxidant status and the histopathological changes in Wistar rats after 12 weeks of exposure at different diets. Forty rats has been divided into 4 groups of 10 rats each, the control group received basal diet with 5 % fresh sunflower oil (FSO), the second group: 5 % oxidized sunflower oil (OSO), the third group: 5 % OSO supplemented with 600 mg × kg–1 α-tocopherol and the fourth group: 5 % OSO supplemented with 1200 mg × kg–1 α-tocopherol. In OSO groups, the results showed highly significant increases of LPO (from 31.3 ± 0.9 to 53.8 ± 1.2 nmol of MDA formed/min/mg protein, p < 0.0001) with a significant decrease (p < = 0.001) of the antioxidant enzymatic activities (CAT, SOD, GPX, GR and G6PDH), body weight (339 ± 9 to 290 ± 3 g) and α-tocopherol levels (13.6 ± 0.6 to 6.5 ± 0.4 μg/mg protein). In OSO groups with 600 mg × kg–1 α-tocopherol, an antioxidant effect was found, reflected by a return of the parameters to values similar to those of the control group. However, higher doses of α-tocopherol (1200 mg × kg–1) induced a depletion of antioxidant status, α-tocopherol levels (6.0 ± 0.3 μg/mg protein, p < 0.001) and a very highly significant rise (p < 0.0001) of LPO content (54.86 ± 0.01 nmol of MDA formed/min/mg protein). The kidney tissues also showed changes in glomerular, severe inflammatory cells infiltration, and formation of novel vessels. So, we can conclude that the oxidative stress is attenuated by a moderate administration of 600 mg × kg–1 α-tocopherol, while a pro-oxidant effect occurs at 1200 mg × kg–1 α-tocopherol.

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Systemic Thrombin Generation and Activity Resistant to Low Molecular Weight Heparin Administered Prior to Streptokinase in Patients with Acute Myocardial Infarction

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655907 ◽

1997 ◽

Vol 77 (01) ◽

pp. 057-061 ◽

Cited By ~ 7

Author(s):

Dennis W T Nilsen ◽

Lasse Gøransson ◽

Alf-Inge Larsen ◽

Øyvind Hetland ◽

Peter Kierulf

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Molecular Weight ◽

Body Weight ◽

Low Molecular Weight Heparin ◽

Troponin T ◽

Bleeding Complications ◽

Control Group ◽

Low Molecular Weight ◽

Creatine Kinase Mb

SummaryOne hundred patients were included in a randomized open trial to assess the systemic factor Xa (FXa) and thrombin inhibitory effect as well as the safety profile of low molecular weight heparin (LMWH) given subcutaneously in conjunction with streptokinase (SK) in patients with acute myocardial infarction (MI). The treatment was initiated prior to SK, followed by repeated injections every 12 h for 7 days, using a dose of 150 anti-Xa units per kg body weight. The control group received unfractionated heparin (UFH) 12,500 IU subcutaneously every 12 h for 7 days, initiated 4 h after start of SK infusion. All patients received acetylsalicylic acid (ASA) initiated prior to SK.Serial blood samples were collected prior to and during the first 24 h after initiation of SK infusion for determination of prothrombin fragment 1+2 (Fl+2), thrombin-antithrombin III (TAT) complexes, fibrinopeptide A (FPA) and cardiac enzymes. Bleeding complications and adverse events were carefully accounted for.Infarct characteristics, as judged by creatine kinase MB isoenzyme (CK-MB) and cardiac troponin T (cTnT), were similar in both groups of patients.A comparable transient increase in Fl+2, TAT and FPA was noted irrespective of heparin regimen. Increased anti-Xa activity in patients given LMWH prior to thrombolytic treatment had no impact on indices of systemic thrombin activation.The incidence of major bleedings was significantly higher in patients receiving LMWH as compared to patients receiving UFH. However, the occurrence of bleedings was modified after reduction of the initial LMWH dose to 100 anti-Xa units per kg body weight.In conclusion, systemic FXa- and thrombin activity following SK-infusion in patients with acute MI was uninfluenced by conjunctive LMWH treatment.

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Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

The Heart Surgery Forum ◽

10.1532/hsf.1367 ◽

2015 ◽

Vol 18 (4) ◽

pp. 171 ◽

Cited By ~ 1

Author(s):

Tolga Demir ◽

Mehmet Umit Ergenoglu ◽

Hale Bolgi Demir ◽

Nursen Tanrikulu ◽

Mazlum Sahin ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Myocardial Protection ◽

Troponin T ◽

Artery Bypass ◽

Control Group ◽

Study Group ◽

Cabg Surgery ◽

Anti Inflammatory ◽

Pump Coronary Artery Bypass

Background: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). Methods: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. Results: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). Conclusions: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.

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Optimization of postoperative management of patients undergoing functional endoscopic sinus surgery

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-1-26 ◽

2018 ◽

pp. 26-31

Author(s):

Sergey Bezshapochny ◽

Andrey Loburets ◽

Valery Loburets

Keyword(s):

Nasal Cavity ◽

Postoperative Period ◽

Sodium Hyaluronate ◽

Sinus Surgery ◽

Control Group ◽

Nasal Breathing ◽

Traditional Therapy ◽

Significant Difference ◽

Water Salt ◽

Experimental Group

Topicality: The result of surgical treatment depends largely on the chosen method of management of the postoperative period, the main purpose of which is to reduce the effects of surgical trauma. Despite the wide variety of drugs for local and systemic use, the question of pharmacotherapy of the operated sinus remains open to this day. The main properties that a modern drug should possess are safety and high clinical efficacy. Aim: to study the clinical efficacy of topical application of a complex preparation based on a saline solution containing sodium hyaluronate and dexpanthenol in patients with chronic sinusitis after functional endoscopic sinus surgery (FESS). Materials and Methods: Clinical and laboratory studies were conducted on 47 patients with chronic rhinosinusitis who underwent surgery using the FESS technique. Patients were divided into 2 groups according to the principle of the postoperative period. Patients of research group (n=21), except for traditional therapy, was used locally NASOMER (a preparation based on a water-salt solution containing sodium hyaluronate and dexpanthenol); to the control group (n=26) patients entered, in the postoperative period received traditional therapy. Traditional therapy included a toilet of the nasal cavity, the use of short-course topical decongestants, irrigation of the nasal cavity with water-salt solutions. Criteria of clinical effectiveness: data of endoscopy of the nasal cavity, rhinomanometry, activity of the mucociliary transport system. The effectiveness of functional research methods in the postoperative period was determined on the 7th and 14th day of treatment. Results: On the 3rd day of the study, an increase in the swelling of the nasal cavity was observed in patients of both clinical groups, correlated with difficulty in nasal breathing. On the 7th day, a decrease in edema was observed in patients of both groups, but in the experimental group, the index of nasal breathing, according to rhinomanometry, was significantly (p<0.05) different from the control group, and was respectively 1.54±0.14 and 2.04±0.19 kPa/l*s. On the 14th day of the study, no significant difference was observed between these indicators. When studying the activity of the ciliated epithelium of the mucous membrane of the nasal cavity, it was proved that patients of the experimental group on day 7 after surgery showed a statistically significant difference in this indicator compared to the control group (17.8±1.0 and 22.7±2.1 min. respectively). Conclusions: The use of NASOMER after surgical intervention in patients with chronic rhinosinusitis contributes to more effective treatment compared with traditional therapy, as evidenced by the rapid recovery of the main functional parameters according to active posterior rhinomanometry and mucociliary clearance. Based on the results of the studies performed, the use of NASOMER for pharmacotherapy in the postoperative period is recommended for patients who have undergone rhinosurgical interventions with the aim of reducing the period of postoperative rehabilitation as an effective anti-inflammatory and wound-healing agent.

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Application of Nasomer in surgical treatment of patients with polyposis rhinosinusitis

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2018-2-39 ◽

2018 ◽

pp. 39-42

Author(s):

Vladimir Bereznyuk ◽

Alexander Chernokur ◽

Oleg Gospod

Keyword(s):

Nasal Cavity ◽

Postoperative Period ◽

Paranasal Sinuses ◽

Standard Treatment ◽

Surgical Intervention ◽

Sodium Hyaluronate ◽

Main Group ◽

Control Group ◽

Nasal Breathing ◽

Minimal Invasiveness

Relevance: Modern endonasal surgery allows to remove polyps from all affected paranasal sinuses, following the principles of minimal invasiveness. Minimal traumatic of surgical intervention gives the best results, accompanied by less progression of the disease. Minimal invasiveness of surgical intervention and its obligatory combination with postoperative medical treatment are common practice in many countries. One of the drugs that actively effect the restoration of the mucous membrane of the nasal cavity and paranasal sinuses in the early postoperative period is Nazomer, which includes sodium hyaluronate and dexpanthenol in saline solution. The purpose of the study is to investigate the effectiveness of the drug Nazomer in patients with polyposis rhinosinusitis after endoscopic polyposynosotomy. Results and discussion: The main group consisted of 30 patients with polyposis rhinosinusitis, who were prescribed Nasomer in addition to standard treatment in the postoperative period. The control group included 30 patients who underwent standard treatment in the postoperative period. As criteria for clinical efficacy, data from endoscopic examination of the nasal cavity and indicators of anterior rhinomatometry, measured by the «Optimus» device, were selected. In the main group, the index of nasal breathing according to rhinomatometry was better than the results of patients in the control group on the 3rd and 5th day of the postoperative period by 26% and 24%, respectively. Conclusion: The use of the drug Nazomer in the postoperative period in patients with polyposis rhinosinusitis contributes to more active restoration of respiratory function of the nasal cavity compared with the control group, according to rhinomatometry, up to 26%. Based on the results obtained, the drug Nazomer is an effective anti-inflammatory and regenerative agent in the postoperative period in patients with polyposis rhinosinusitis.

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Postoperative Anesthesia Of Elderly And Senile Patients With Total Joint Replacement Of The Lower Extremities

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume02issue09-16 ◽

2020 ◽

Vol 2 (09) ◽

pp. 75-81

Author(s):

Gaziev Z.T. ◽

Avakov V.E. ◽

Shorustamov M.T. ◽

Bektemirova N.T.

Keyword(s):

Epidural Analgesia ◽

Postoperative Period ◽

Joint Replacement ◽

Total Joint Replacement ◽

Lower Extremities ◽

Multimodal Analgesia ◽

Control Group ◽

Patient Controlled Analgesia ◽

Physical Status ◽

Traumatic Injuries

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

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Effects of Rapamycin Combined with Low Dose Prednisone in Patients with Chronic Immune Thrombocytopenia

Clinical and Developmental Immunology ◽

10.1155/2013/548085 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 15

Author(s):

Jiaming Li ◽

Zhaoyue Wang ◽

Lan Dai ◽

Lijuan Cao ◽

Jian Su ◽

...

Keyword(s):

Immune Thrombocytopenia ◽

Low Dose ◽

Group Versus ◽

Treg Cells ◽

Significant Rise ◽

Control Group ◽

Foxp3 Mrna ◽

Experimental Group ◽

Dose Prednisone ◽

Chronic Immune Thrombocytopenia

We conducted this randomized trial to investigate the efficacy and safety of rapamycin treatment in adults with chronic immune thrombocytopenia (ITP). Eighty-eight patients were separated into the control (cyclosporine A plus prednisone) and experimental (rapamycin plus prednisone) groups. The CD4+CD25+CD127lowregulatory T (Treg) cells level, Foxp3 mRNA expression, and the relevant cytokines levels were measured before and after treatment. The overall response (OR) was similar in both groups (experimental group versus control group: 58% versus 62%,P=0.70). However, sustained response (SR) was more pronounced in the experimental group than in the control group (68% versus 39%,P<0.05). Both groups showed similar incidence of adverse events (7% versus 11%,P=0.51). As expected, the low pretreatment baseline level of Treg cells was seen in all patients (P<0.001); however, the experimental group experienced a significant rise in Treg cell level, and there was a strong correlation between the levels of Treg cells and TGF-beta after the treatment. In addition, the upregulation maintained a stable level during the follow-up phase. Thus, rapamycin plus low dose prednisone could provide a new promising option for therapy of ITP.

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Effects of Preservation Methods in the Composition of the Placental and Reflected Regions of the Human Amniotic Membrane

Cells Tissues Organs ◽

10.1159/000515448 ◽

2021 ◽

pp. 1-11

Author(s):

Jéssica Tereza Guedes de Oliveira Moraes ◽

Maíra Maftoum Costa ◽

Paula Cristina Santos Alves ◽

Luciana Barros Sant’Anna

Keyword(s):

Regenerative Medicine ◽

Amniotic Membrane ◽

Structural Integrity ◽

Storage Period ◽

Soluble Proteins ◽

Control Group ◽

Human Amniotic Membrane ◽

Glycerol Solution ◽

Preservation Methods ◽

Preservation Method

The human amniotic membrane (AM) is emerging as an interesting biomaterial for regenerative medicine due to its biological and mechanical proprieties. The beneficial effects of the AM are probably related to its bioactive factors produced by local cells and stored in the stromal matrix. However, the search for a preservation method capable of preserving AM properties remains a challenge. The aim of this study was to evaluate important features of 2 anatomical regions of the human AM (reflected and placental amnion) after different preservation methods. For this purpose, human placentas were harvested and processed for AM isolation and storage at 2 different conditions: room temperature for 18 h in DMEM (fresh AM) and −80°C in DMEM/glycerol solution for 30 days (cryopreserved AM). After the storage period, the structural integrity of the membrane was assessed by histological and Picrosirius polarization analysis, cellular viability analysis was performed using the MTT assay, and the soluble proteins were quantified with the Qubit Protein Assay Kit. Both preservation protocols reduced the cell viability, mainly in the placental amnion region of the AM, but preserved the morphology of epithelial and stromal layers, as well as the organization and distribution of collagen fibers. There was a reduction in soluble proteins only in fresh AM. Importantly, the cryopreserved AM group presented the same concentration as the control group. In conclusion, the cryopreservation using DMEM/glycerol was ideal for preserving the structural integrity and soluble protein content, indicating the feasibility of this method in preserving AM for its use in regenerative medicine.

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Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial

Clinical Rehabilitation ◽

10.1177/02692155211070945 ◽

2021 ◽

pp. 026921552110709

Author(s):

Telma Cristina Fontes Cerqueira ◽

Manoel Luiz de Cerqueira Neto ◽

Lucas de Assis Pereira Cacau ◽

Amaro Afrânio de Araújo Filho ◽

Géssica Uruga Oliveira ◽

...

Keyword(s):

Cardiac Surgery ◽

Electrical Stimulation ◽

Postoperative Period ◽

Intervention Group ◽

Neuromuscular Electrical Stimulation ◽

Functional Independence Measure ◽

Rectus Femoris ◽

Functional Independence ◽

Control Group ◽

Electromyographic Activity

Objective To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. Design A prospective, randomized controlled trial. Setting A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. Intervention The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. Main measures The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. Results Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked ( p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed ( p = 0.363), lactate levels ( p = 0.302), knee extensor strength ( p = 0.117), handgrip strength ( p = 0.882), global muscle strength ( p = 0.104), electromyographic activity ( p = 0.179) and Functional Independence Measure ( p = 0.059). Conclusions Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.

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