[Quality of psychomotility recovery after propofol sedation for painless gastroscopy and colonoscopy]

OBJECTIVE

To study the effect of propofol used for painless gastroscopy and colonoscopy on psychomotility recovery.

METHODS

One hundred adult patients undergoing painless gastroscopy and colonoscopy were recruited, aged 18-72 years, with American Society of Anesthesiologist (ASA) physical status Ⅰ-Ⅱ. According to age, the patients were divided into youth group (20-39 years old, 27 cases), middle age group (40-54 years old, 37 cases), and elder group (55-64 years old, 36 cases). Propofol was continuously infused according to the patients' condition to mantain the bispectal index (BIS) score 55-64. All the patients received psychomotility assesment 30 min before the operations when the discharge criteria were met including number cancellation test, number connection test and board test. The heart rate, blood pressure, saturation of pulse oximetry, electrocardiograph and BIS were monitored during the operation. The operating time, recovery time, total volume of propofol and discharge time were recorded. If the results obtained were inferior to those before operation, a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels.

RESULTS

All the patients completed the first and second assessments, and 25 patients had taken the third assessment. There was no statistically significant difference in the results of psychomotility assessment when the patients met the discharge standard. Furthermore, the results were analyzed by grouping with age, and there was no statistical difference in the test results of the youth and middle age groups compared with the preoperative group, among which, the efficiency of the number cancellation test was significantly better than that before operation in the youth group (P < 0.05). However, in the elderly patients the number cancellation efficiency, number connection test and board test were significantly inferior to that before operation (P < 0.05). There was no significant difference in the accuracy of number cancellation compared with that before operation. The patients who needed the third test in the elder group were significantly more than in the other groups (P < 0.05). Compared with the preoperative results, there was no statistical difference in the test results of those who completed the third test.

CONCLUSION

The psychomotility function of the patients who underwent painless gastroscopy and colonoscopy was recovered when they met discharge criteria. The elderly patients had a prolonged recovery period.

[To strengthen the basic and translational research of mesenchymal stem cell-based therapy for refractory wounds]

In recent years, the application of cell-based therapy in the field of refractory wound repair has shown broad prospects, among which the mesenchymal stem cell is the most concerned and widely studied cell type. Despite the rapid development of clinical translational research, the therapeutic effect of cell-based therapy is not consistent, and most clinical trials have not achieved the desired results. Further studies have found that heterogeneity is an important issue that restricts the further development of cell-based therapy and urgently needs to be studied. Based on the research progress of mesenchymal stem cells, in the review, we discuss the current status and challenges of cell-based therapy strategies for refractory wounds.

[Risk factors associated with delirium for patients with hip fracture under the orthogeriatric unit mode]

Objective: To explore postoperative delirium (POD)risk factors for geriatric patients who suffered hip fracture under the care of orthogeriatric unit mode. Methods: Patients aged 65 years or older, who were admitted to the orthogeriatric unit in Beijing Jishuitan Hospital from April to October 2017 for hip fracture surgery, were eligible for this prospective cohort study. After univariable analysis, significant risk factors associated with POD were further evaluated with multivariable analysis, to establish independent risk factors associated with POD. Results: A total of 203 patients with an average age of 80(65-96)years were enrolled in the study. The overall incidence of POD was 9.4%(19/203)in which hyperactive and hypoactive type accounting for 84.2%(16/19)and 15.8%(3/19), respectively. Significant difference was found between POD and non-POD groups in patients' age (P=0.003), albumin(P=0.006), TSH(P=0.018), PaCO(2) level(P=0.003), visual analogue scale (VAS )both at rest (P=0.013)and movement(P=0.010) on post-operative day 1.The further Logistic stepwise regression analysis showed that significant differences existed between groups in age(P=0.027), albumin(P=0.003), PaCO(2)(P=0.014)and VAS at rest(P=0.002). Conclusion: The independent risk factors of POD in geriatric patients undergoing hip fracture under the orthogeriatric unit mode include patients' age, pre-operative albumin as well as PaCO(2) level and post-operative VAS at rest.

[The application of conscious sedation with a small dose of dexmedetomidine and sufentanil in elderly patients undergoing multiple intestinal polyps resection]

Objective: To explore the effectiveness and feasibility of conscious sedation with a low dose of dexmedetomidine and sufentanil during multiple intestinal polyps resection in elderly patients. Methods: Sixty elderly patients who underwent multiple intestinal polyps resection in Peking University Third Hospital from Janurary to May 2016 were randomly divided into dexmedetomidine group (D group, n=30) and propofol group (P group, n=30). There were 28 males and 32 females with a mean age of (70.4±4.5) years old (range: 65-80 years old). The patients in the dexmedetomidine group received a loading dose of 0.3 μg/kg followed by a continuous infusion of 0.2-0.4 μg·kg^-1·min^-1 of dexmedetomidine and sufentanil (0.1 μg/kg) respectively.The patients in the propofol group received sufentanil 0.1 μg/kg and propofol 1.5 mg/kg and followed by a continuous infusion of 3-6 mg·kg^-1·h^-1 of propofol.Blood pressure, heart rate, pulse oxygen saturation (SpO₂), respiratory rate and bispectral index (BIS) were recorded at the basic status and at the beginning of operation, 10 min, 20 min, 30 min after operation, the end of operation and departure.The observer's assessment of alertness/sedation (OAA/S) scores and the clinical responses were also recorded.A statistical analysis was performed. Results: All patients in the two groups were sedated compared with baseline.The BIS values of patients in group D at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 89.6(87.8-91.0), 79.4(78.0-80.0), 76.9(75.0-80.0), 76.0(73.0-79.0) and 75.6(70.0-79.0) respectively, and those values were all significantly lower than baseline value[96.4(95.0-98.0)], (Z=-4.645, -4.788, -4.787, -4.789, -4.789, P<0.05). The OAA/S score at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 4.5(4.0-5.0), 3.4(3.0-4.0), 3.0(3.0-3.0), 3.5(3.0-4.0) and 3.3(3.0-4.0) respectively, and were significantly lower than baseline score [4.8(5.0-5.0)] (Z=-2.828, -4.862, -5.031, -4.420, -4.710, P<0.05). The BIS value of patients in group P at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 54.7(50.0-59.3), 54.8(50.0-59.3), 50.7(47.8-56.8), 54.4(51.5-58.0) and 53.7(50.0-57.3) respectively, and were significantly lower than baseline value[95.8(95.0-96.3)] (Z=-4.786, -4.787, -4.788, -4.786, -4.786, P<0.05). The OAA/S score at beginning of the operation , 10 min, 20 min, 30 min after operation and the end of operation were 0.4(0.0-1.0), 0.4(0.0-1.0), 0.4(0.0-1.0), 0.4(0.0-1.0) and 0.4(0.0-1.0) respectively, and were significantly lower than baseline score[4.9(5.0-5.0)] (Z=-4.927, -4.901, -4.912, -4.912, -4.901, P<0.05). The sedation state of group D were lighter than group P. The BIS value and OAA/S score at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation in group D were higher than group P (P<0.05). The breath and circulation were more stable in group D. The mean arterial pressure, breath rate and SpO₂ at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation in group D were higher than group P (P<0.05). There was no oxygen desaturation , hypotension and drowsiness in group D and the incidence in group P were 30.0%, 33.3% and 13.3% respectively.The emergency time and duration of stay in the PACU (post anesthesia care unit) were (2.0±1.2) and (22.0±7.4) min in group D, and they were (4.9±2.4) and (35.8±11.6) min in group P (t=-5.839, t=-5.472, P<0.05). There was no difference in surgery time, patient satisfaction and acceptance rate of reexamination (t=-3.031, t=-7.322, t=2.069, P>0.05). Conclusion: Conscious sedation with dexmedetomidine and sufentanil is effective and feasible in elderly patients undergoing multiple intestinal polyps resection.

[Relationship between hemolymph phenol oxidase and melanization of oocysts of Plasmodium yoelii in Anopheles stephensi]

OBJECTIVE

To explore the relationship between the hemolymph phenol oxidase and melanization of oocysts.

METHODS

Anopheles stephensi-Plasmodium yoelii system was used to determine the activity of monophenol oxidase (MPO) and o-diphenol oxidase (o-DPO) in the hemolymph collected from 4 groups of mosquitoes by polyacrylamide gel electrophoresis (PAGE) followed by density scanning. The 4 groups of mosquitoes were: non-blood-fed (N), normal-blood-fed (B), infected-blood-fed (I) and nitroquine-administrated (D), respectively.

RESULTS

No significant difference was found in the activities of MPO and o-DPO between groups N and B. The activities of MPO and o-DPO were not obviously modified in group I, but were significantly increased on day 10 and decreased on day 15 after blood feeding in the group D as compared with those in the groups N and B.

CONCLUSION

The alteration in the mosquito hemolymph PO activity coincided at each time point with the melanization of Plasmodium yoelii oocysts.

Comparative study of hepatocyte growth factor/scatter factor and keratinocyte growth factor effects on human keratinocytes

Hepatocyte growth factor/scatter factor (HGF/SF) and keratinocyte growth factor (KGF, also designated FGF-7) are paracrine growth factors secreted by mesenchymal cells and active on a variety of epithelial cell types. In this study, the biologic responses of keratinocytes to these paracrine growth factors were compared. Stimulation of mitogenesis, migration, plasminogen activator (PA) activity, and fibronectin production were examined using human foreskin keratinocytes cultured in serum-free MCDB 153 medium. Although the two factors stimulated a similar level of proliferation when cells were maintained for 5 d in 1.8 mM Ca++, the peak effect of KGF, observed at 10 ng/ml, was approximately threefold higher than that of HGF/SF when cells were in medium containing 0.15 mM Ca++. Both agents promoted the migration of cells in low-calcium medium (0.08 mM Ca++). However, the magnitude of the response was approximately twofold greater for HGF/SF at 10 ng/ml than KGF at the same concentration. None of the matrix proteins such as type I collagen, type IV collagen, laminin, or fibronectin either stimulated or suppressed HGF/SF- or KGF-stimulated keratinocyte migration. Both factors stimulated PA activity of the cell extracts, especially urokinase-type, with similar potencies. Promoted PA activity was maximal with the addition of 10 ng/ml of either factor. Neither factor increased the production of fibronectin under conditions in which transforming growth factor-beta 1 was active. These results indicate that HGF/SF and KGF, both recognized as paracrine growth factors, elicit distinctive patterns of response by keratinocytes, implying that they have different roles in epidermal physiology.

Co-administration of insulin-like growth factor (IGF)-I and IGF-binding protein-1 stimulates wound healing in animal models

The stimulatory effect of recombinant human insulin-like growth factor-I (rhIGF-I) and recombinant human insulin-like growth-factor-binding protein-1 (rhIGFBP-1) on wound healing was assessed using diabetic db/db mice and normal rabbits. Full-thickness wounds of 6 mm diameter were prepared on the backs of diabetic C57BL/KsJ db/db mice and on the inner sides of normal rabbit ears. Various concentrations of rhIGF-I and/or rhIGFBP-1 were applied locally to the open wounds of db/db mice once daily for 5 d and to the covered wounds of normal rabbits once after wounding. Sections of the wounds were evaluated histologically on the seventh or eighth day by measuring re-epithelialization (%), area of granulation tissue (mm2), and capillary numbers. Wound repair was accelerated by each of the treatments in descending order of rhIGF-I plus rhIGFBP-1, rhIGF-I, rhIGFBP-1, and vehicle alone. In db/db mice, the combination of 50 micrograms rhIGF-I and 165 micrograms rhIGFBP-1 (equimolar ratio) significantly stimulated granulation tissue formation (p < 0.01) and capillary numbers (p < 0.05). Doses of rhIGFBP-1 greater than 16.5 micrograms were required for significant acceleration of the healing stimulated by 50 micrograms of rhIGF-I. In normal rabbits, co-administration of 10 micrograms rhIGF-I and 33 micrograms rhIGFBP-1 (equimolar ratio) significantly stimulated all three wound-healing parameters (p < 0.01), with such stimulation being much greater than that induced by rhIGF-I alone. Interestingly, rhIGFBP-1 alone showed a mild stimulatory activity on wound healing in both models despite its lack of mitogenic activity in vitro. These results demonstrate that rhIGFBP-1 enhances the stimulatory activity of rhIGF-I on wound healing and suggest the clinical utility of the co-administration of rhIGF-I and rhIGFBP-1 for wound repair.

Endothelin-1 acts as an autocrine growth factor for normal human keratinocytes

Endothelin-1 (ET-1) is an endothelium-derived 21 amino acid vasoconstrictor peptide possessing two intrachain disulfide bridges. Recently it has become evident that isoforms of ET (ET-1, -2, and -3) have a wide range of pharmacological effects in various tissues and act as autocrine/paracrine factors. We demonstrate here that ET-1 is secreted from normal human keratinocytes and may work as an autocrine growth factor through a specific receptor. In this study, human foreskin keratinocytes were cultured in serum-free MCDB 153 medium. Cell growth and [3H] thymidine incorporation in low and high Ca++ concentration media was stimulated by ET-1, -2, and -3 with similar potencies. The strongest response was observed at 10 nM ETs, whereas stimulatory activity was reduced at 100 nM. ETs suppressed keratinocyte differentiation as measured by reactivity with involucrin antibody. Plasminogen activator activity (mainly urokinase) in the medium was also stimulated by the addition of 10 nM ETs. ET-1-like immunoreactivity measured by radioimmunoassay was 1.4 fmol/day/10(6) cells in non-treated condition medium. Among the various cytokines, tumor necrosis factor-alpha (TNF-alpha), interleukin-1 alpha, and transforming growth factor-beta stimulated ET-1 secretion in a dose-dependent manner. The strongest response (ten-fold) was observed upon the addition of 10 ng/ml TNF-alpha. Scatchard plot analysis of [125I] ET-1 binding to keratinocytes revealed the presence of a single class of high affinity receptors (KD 50 pM, 9 x 10(3) sites/cell). Binding was competitively inhibited by the addition of unlabeled ET-1 and -2 with similar affinities and by ET-3 with weaker affinity. ET-1 mRNA expression in keratinocytes was detected by reverse transcription-polymerase chain reaction and was increased by treatment with 10 ng/ml TNF-alpha. These results suggest that ET-1 acts as an autocrine growth factor for keratinocytes through a specific receptor.

Stimulation of keratinocyte migration by growth factors

Migration of keratinocytes from the wound edge is thought to be one of the critical features of reepithelialization. A quantitative migration assay was carried out using normal human keratinocytes. Keratinocytes, seeded on 12 well plates, were grown in serum free, keratinocyte growth medium (KGM, Curabo Co) with 0.08 mM Ca2+. The medium was switched from KGM to keratinocyte basal medium (KBM) 6 h prior to the wounding. Half of the plate's confluent monolayer of keratinocytes was removed with razor blade, and the remaining keratinocytes were incubated in KBM for 16 hrs in the presence of indicated growth factors. After incubation, the cells were fixed and counted at 100 magnification. Migration was quantitated by counting the number of cells in ten successive 125-microns zones. Transforming growth factor alpha (TGF-alpha), acidic and basic fibroblast growth factor (aFGF, bFGF), keratinocyte growth factor (KGF), hepatocyte growth factor (HGF), and insulin-like growth factor-I (IGF-I) stimulated the migration of keratinocytes, while TGF-beta suppressed it.

A wound healing model using healing-impaired diabetic mice

A quantitative histological approach was employed to evaluate the effects of basic fibroblast growth factor (bFGF) in healing-impaired diabetic mice. The dorsal areas of female mutant diabetic mice, C57BL KsJ db/db (Jackson Lab.), were given two 6 mm-size full thickness wounds with a punch biopsy instrument. After application of bFGF, the wounds were left open. 8 days after wounding, the mice were sacrificed, and histological sections were evaluated using several histological parameters, such as the degree of wound closure, granulation tissue thickness, matrix density, and capillary numbers. Application of 5 micrograms of bFGF for 5 days induced significant responses by all of these dermal parameters when compared to those of non-treated db/db mice (p < 0.001). A minimum of 0.5 micrograms bFGF per day was required for a significant effect. Time-course experiments indicated that the granulation response in bFGF-treated mice peaked between 8 and 12 days and decreased after 12 days, while matrix density continued to increase until the 18th day.