title: Ulinastatin as a neuroprotective and anti-inflammatory agent in infant piglets model undergoing surgery on hypothermic low-flow cardiopulmonary bypass.
abstract: OBJECTIVE
  Infants are potentially more susceptible to brain injury mediated via cell death attributed to cardiopulmonary bypass (CPB) especially with prolonged hypothermic low flow (HLF). We hypothesized that a human urinary protease inhibitor (ulinastatin), by its anti-inflammatory effect, would reduce central nervous system (CNS) injury during HLF.
  
  
  METHODS
  Fifteen general-type infant piglets were randomized to ulinastatin group (group U, n = 5), control group (group C, n = 5), and sham operation group (group S, n = 5). Routine CPB was established after median thoracotomy in group U and C under anesthesia. When the temperature of infant piglets dropped down to 25 °C, low-flow CPB (50 ml·kg(-1) ·min(-1) ) was instituted. After 120 min of aortic cross-clamping and 20- to 30-min rewarming, the aortic cross-clamp was removed and finally the piglet was weaned from CPB. Five thousand units per killogram of ulinastatin and equivalently normal saline were, respectively, given at the beginning of and at aortic declamping in group U and group C. group S just received sham median thoracotomy. Venous blood samples were taken immediately after anesthesia induction in all three groups, 5- and 120-min post CPB in both group U and C, respectively; plasma markers of inflammation and CNS injury were compared. Pathology results of hippocampus were observed by light microscopy.
  
  
  RESULTS
  Statistically significant differences between group C and U were noted in the expression of inflammatory markers such as IL-10, TNF-α and neuron-specific enolase at 120-min post CPB. Brain injuries were observed in both groups (index cases and controls) and were milder in group U.
  
  
  CONCLUSIONS
  In our study, HLF CPB on infant piglets resulted in brain injury, and ulinastatin might reduce the extent of such injury.
authors: Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors: Xiaocou
authors: X
authors: Wang
authors: Qinghua
authors: Q
authors: Xue
authors: Fuxia
authors: F
authors: Yan
authors: Lihuan
authors: L
authors: Li
authors: Jinping
authors: J
authors: Liu
authors: Shoujun
authors: S
authors: Li
authors: Shengshou
authors: S
authors: Hu
mesh_terms: D000758:Anesthesia; D000818:Animals; D000831:Animals, Newborn; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D001784:Blood Gas Analysis; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002493:Central Nervous System Diseases / Q000097:blood; D016207:Cytokines / Q000097:blood; D005260:Female; D006023:Glycoproteins / Q000627:therapeutic use*; D006439:Hemodynamics / Q000502:physiology; D006624:Hippocampus / Q000473:pathology; D006979:Hyperthermia, Induced; D008297:Male; D018696:Neuroprotective Agents; D011183:Postoperative Complications / Q000473:pathology; D013552:Swine; D014361:Trypsin Inhibitors / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D016207:Cytokines; D006023:Glycoproteins; D018696:Neuroprotective Agents; D014361:Trypsin Inhibitors; C028665:urinastatin