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BackgroundChildren with cyanotic heart disease develop secondary erythrocytosis and thrombocytopenia via unknown mechanisms. Mature erythrocyte microRNAs may reflect clinical pathologies and cell differentiation processes pre-enucleation. This study evaluated erythrocyte microRNAs in children with cyanotic heart disease.MethodsErythrocyte microRNAs from children with cyanotic and acyanotic heart disease and without cardiac disease were quantified with Ion PGM System (n=10 per group). Differential expression was confirmed by quantitative PCR (qPCR; n=20 per group).ResultsMir-486-3p, mir-486-5p, and mir-155-5p increased in patients with cyanotic heart disease compared with those without heart disease: fold differences (95% confidence interval): mir-486-3p: 1.92 (1.14–3.23), P=0.011; mir-486-5p: 2.27 (1.41–3.65), P<0.001; and mir-155-5p: 1.44 (1.03–2.03), P=0.028. Mir-486-5p was increased, and let-7e-5p and mir-1260a were decreased in patients with acyanotic heart disease compared with those without heart disease: mir-486-5p: 1.66 (1.03–2.66), P=0.035; let-7e-5p: 0.66 (0.44–0.99), P=0.049; and mir-1260a: 0.53 (0.29–0.99), P=0.045.ConclusionSeveral microRNA levels changed in children with cyanotic and acyanotic heart disease. Mir-486-3p and -5p are associated with hematopoietic differentiation. Mir-486-3p regulates the erythroid vs. megakaryocyte lineage fate decision. Mir-155 is a hypoxia-inducible microRNA, whose overexpression inhibits megakaryocyte differentiation. Erythrocyte microRNA expression changes may contribute to erythrocytosis and thrombocytopenia in children with cyanotic heart disease.

Published ahead of print September 15, 2014.

Halothane is still unique in its ability to inhibit platelet aggregation and to increase bleeding time in vivoat clinical concentrations, although sevoflurane inhibits platelet aggregation induced by weak agonists. Propofol itself, but not its fat emulsion, inhibits platelet aggregation and suppresses calcium mobilization. Extradural anaesthesia has been shown to prevent hypercoagulability during the perioperative period. Aprotinin reduces both blood loss and the incidence of blood transfusion during major orthopaedic and cardiac surgery.

Clonidine, an α2-adrenoceptor agonist, was introduced into clinical practice as an antihypertensive medication more than 25 years ago [1]. Apart from its use as an antihypertensive medication, clonidine has been used for many conditions ranging from a variety of psychiatric disorders to the management of children with delayed growth [2–6]. In veterinary practice, α2agonists have been used for several years in the practice of anesthesia. Experimental and clinical studies have progressed to the point where anesthesiologists are now focusing on the use of this class of agent for its analgesic and anesthetic effects. This renewed interest has coincided with the development and clinical introduction of superselective agonists such as dexmedetomidine.

We evaluated the usefulness of eptazocine hydrobromide as an adjuvant in patients receiving antipsychotics for long periods. Patients anesthetized with enflurane alone (enflurane group, n=11), were compared with those anesthetized with enflurane and eptazocine hydrobromide 1 mg·kg−1(eptazocine group, n=10). The mean daily dose of the antipsychotics, converted into the amount of chlorpromazine, was 345 mg in the eptazocine group and 366 mg in the enflurane group. The duration of antipsychotic medication was 14 years in the eptazocine group and 17 years in the enflurane group. The maintenance concentration of enflurane was 0.37% in the eptazocine group and 0.67% in the enflurane group, being significantly lower in the former group. The interval between the termination of operation and removal of the endotracheal tube was slightly shorter in the eptazocine group. The discriminant function of circulatory stability obtained from the measurement of systolic blood pressure and heart rate during anesthesia in the eptazocine group was 481, being significantly lower than 539 in the enflurane group. Both absolute and relative instabilities of systolic blood pressure and heart rate were slightly smaller in the eptazocine group. No side effects associated with eptazocine hydrobromide administration were observed. These results suggest the safety and usefulness of this analgesic in the anesthetic management of patients receiving long-term antipsychotic medication.

The alteration of monoamines and their metabolites in the brain during and after hemorrhagic shock in the conscious state was measured in rats. Blood pressure was maintained at 40–70 mmHg (5.3–9.3 kPa) for 60 min by withdrawing 8 ml of blood intermittently. The content of monoamines, as well as their metabolites, increased in various brain regions during hemorrhage, compared with the content in the control rats. Sixty min after the end of the bleeding period, almost no significant change in the contents of brain monoamines nor of their metabolites was observed. These results may indicate not only an increased release of monoamines from nerve terminals, but also an increased synthesis of them during hemorrhagic shock. Soon after the bleeding was stopped, the increased monoamine turnover rate returned to almost normal levels. (Mizobe T, Okuda C, Demura H et al.: Changes in brain monoamines and their metabolites during and after hemorrhagic shock in the rat. J Anesth 4: 116–122, 1990)

We present two cases of automatic hyperreflexia (AH) during labour in women with spinal cord damage, in whom AH developed before and after delivery. The AH was successfully controlled using epidural anaesthesia in Case #1, but failed in Case #2. The blood pressure was controlled with nicardipine. However, overdose of nicardipine produces vasodilatation and its side effects include headache, flushing and palpitation similar to AH1. Considering these effects, we recommend epidural anaesthesia to control AH, because epidural anaesthesia does not only reduce BP, but also blocks the noxious stimuli and relieves the symptoms of AH. Our experience suggests that the epidural catheter can be placed two to three weeks before the date of predicted childbirth, because the onset of labour in a patient with spinal cord damage is difficult to predict and can proceed very rapidly. Also, the epidural catheter is available after the delivery. We recommended the epidural catheter is maintained for 24–48 hr postpartum.

G protein-coupled receptors (GPCRs) have seven hydrophobic domains, which are thought to span the lipid bilayer as α helical transmembrane domains (TMDs). The tertiary structure of GPCRs has not been determined; however, molecular models of GPCRs have generally been based on bacteriorhodopsin, which is functionally unrelated to GPCRs but has a similar secondary structure. We sought to examine the validity of using bacteriorhodopsin as a scaffold for GPCR model building by experimentally determining the orientation of the TMDs of adrenergic receptors in the plasma membrane. In separate experiments, three sequential amino acid residues (Leu-310, Leu-311, Asn-312) in TMD VII of the β2adrenoreceptor were mutated to the amino acids found in the homologous domain of the α2adrenoreceptor (Phe, Phe, Phe). Exchange of Asn-312 and Leu-311 in the β2adrenoreceptor resulted in nonfunctional proteins, most likely due to incompatibility of the introduced bulky phenylalanine side chain with adjacent structural domains in the β2adrenoreceptor. This structural incompatibility was “repaired” by replacing the specific β2TMD sequence with an α2receptor sequence. TMD I and TMD II complemented the Asn-312 → Phe mutation, and TMD III and TMD VI complemented the Leu-311 → Phe mutation. These results indicate that TMDs I, II, III, and VI surround TMD VII in a counterclockwise orientation analogous to the orientation of TMDs in bacteriorhodopsin.