CONCLUSIONS:Ketamine was able to accomplish some preemptive analgesic effects of reducing postoperative morphine consumption and prolonging the time to first analgesic. Meanwhile, ketamine was as safe as physiological saline in side effects of nausea and vomiting.

ABSTRACT. Ketamine is a dissociative anesthetic agent that has been widely used in surgery and for relieving pain in chronic cancer patients. We applied ketamine to breast cancer cell line MDA-MB-231 to detect the effect of treatment and molecular mechanisms involved. We found that ketamine can upregulate the level of anti-apoptosis protein Bcl-2, which promotes breast cancer cell invasion and proliferation. Knockdown of Bcl-2 could inhibit the increase of Bcl-2 and reduce the invasion and proliferation caused by ketamine in human breast cancer cells. Our findings provide new insight into the effects of ketamine in cancer treatment; we suggest that ketamine, which has been widely used in cancer operations and for relieving pain in chronic cancer patients, may be not the best choice because it can worsen the cancer through promotion of anti-apoptosis.

Acute lung injury (ALI) is a common complication in patients with sepsis and is accompanied by high mortality. The present study aimed to investigate if the organic compound citrulline has a protective against lipopolysaccharide (LPS)-stimulated ALI and its potential mechanisms. ALI was induced in mice by intraperitoneal (i.p.) injection of LPS (10 mg/kg). Citrulline (1 g/kg/day) was administrated i.p. 7 days prior to LPS injection. Mouse lung vascular endothelial cells (MLVECs) were divided into five groups: Control, LPS, LPS + Cit, LPS + N-acetyl-L-cysteine (NAC) and LPS + Cit + ML385. Lung injury was determined by morphology changes. Apoptosis and pyroptosis were detected using western blot analysis and immunofluorescence. The present results indicated that citrulline can significantly attenuate ALI. Citrulline pretreatment decreased the expression of NOD-, LRR-and pyrin domain-containing protein 3 (NLRP3) inflammasome and decreased pyroptosis and apoptosis. Intervention with the total reactive oxygen species (ROS) scavenger N-acetyl-L-cysteine attenuated NLRP3 inflammasome-associated pyroptosis and apoptosis in LPS-treated MLVECs. Citrulline pretreatment inhibited pyroptotic cell death and apoptosis induced by LPS. Citrulline decreased accumulation of intracellular ROS and activated the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway. Furthermore, the Nrf2 inhibitor ML385 reversed ROS generation, NLRP3 inflammasome-mediated pyroptosis and apoptosis suppressed by citrulline. In summary, the present data demonstrated that citrulline may confer protection against ALI via inhibition of ROS/NLRP3 inflammasome-dependent pyroptosis and apoptosis via the Nrf2 signaling pathway.

Background: Epicardial radiofrequency ablation for atrial fibrillation under total video-assisted thoracoscopy causes severe cardiopulmonary disturbances and affects cerebral perfusion and oxygenation. The aim of the present study was to investigate the changes in regional cerebral oxygen saturation (rSO2) during the surgery and their correlations with hemodynamic or blood gas parameters. Methods: A total of 45 patients scheduled for selective totally thoracoscopic ablation for stand-alone atrial fibrillation were enrolled in this study. The rSO2 was monitored at baseline (T0), 15 min after anesthesia induction (T1), 15 min after one-lung ventilation (T2), after right pulmonary vein ablation (T3), after left pulmonary vein ablation (T4) and 15 min after two-lung ventilation (T5) using a near-infrared reflectance spectroscopy (NIRS)-based cerebral oximeter. A Swan-Ganz catheter was placed in the pulmonary artery to obtain hemodynamic parameters. Arterial blood gas was analyzed using an ABL 825 hemoximeter. Associations between changes in rSO2 (△rSO2) and hemodynamic or blood gas parameters were determined with univariate and multivariate linear regression analyses. Results: The rSO2 decreased greatly from baseline 65.3% to 57.5% at T3 (P < 0.001). Univariate analysis showed that △rSO2 correlated significantly with △pH (r = -0.371, P = 0.012), △PaCO2 (r = -0.276, P = 0.066), △PaO2/FiO2 (r = 0.332, P = 0.026), △HR (r = 0.27, P = 0.073), △CI (r = -0.228, P = 0.132) and △PVRI/SVRI (r = -0.216, P = 0.153). Multivariate linear regression analysis further showed that △rSO2 was only influenced by △PaO2/FiO2 (β = 0.026, P = 0.025). Conclusion: The rSO2 decreased significantly during the totally thoracoscopic ablation for atrial fibrillation. There was a correlation between rSO2 reduction and PaO2/FiO2 changes. Greater attention should be paid to cerebral oxygen desaturation during the surgery.