Mechanism of action of N7-methylguanosine in hepatocellular carcinoma / 临床肝胆病杂志

N7-methylguanosine （m7G） is one of the most popular RNA modifications at present and has attracted wide attention from researchers in China and globally. By influencing the metabolism of various RNA molecules （including messenger RNA， ribosomal RNA， microRNA， and transfer RNA）， m7G modification actively participates in many biological processes such as cell proliferation， differentiation， and apoptosis. More and more evidence has shown that m7G plays a key role in the development of cancer， and abnormal m7G levels are closely associated with the development and progression of cancer by regulating the expression of multiple oncogenes and tumor suppressor genes. Hepatocellular carcinoma is the most common gastrointestinal tumor in China， and current treatment methods tend to have an unsatisfactory therapeutic effect. At present， the potential molecular mechanism of m7G modification in hepatocellular carcinoma remains unclear. This article reviews the potential mechanism of action of m7G modification in hepatocellular carcinoma and the m7G-related diagnosis and treatment strategies.

Therapeutic effects of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy / 中华心血管病杂志

Objective: To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). Methods: This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (n=102) and ASA group (n=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Results: Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (P<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(P<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (P<0.001), NYHA classification was also remarkably improved (P<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),P=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (P=0.231). Survival free of HCM-related mortality was similar between the two groups (P=0.397). Conclusions: Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.

Experience of Finland children's whole-course health care service and management and its enlightenment / 上海预防医学

Finland is acknowledged as an international leader in the children's health care by the World Health Organization, especially in the formulation and planning of children's health care policies. In the article, we introduces Finnish service mode and management experience in the whole-process medical care for children, including successful operation of hierarchical diagnosis and treatment, key role of public health nurses in the whole-process management, significant influence of social and family environment on the healthy development of children, and integration of children's health and welfare services through multi-sectoral cooperation. We make some suggestions and recommendations for the construction of children's health service capacity in China in strengthening the laws and policies in the children's health, improving the network construction and three-level connection of maternal and child health care system, taking the construction of pediatric integrated health care system as the breakthrough point to further promote hierarchical diagnosis and treatment, improving the multi-sectoral cooperation mechanism, and maximizing the influence of information technology and family.

Melatonin receptor agonist neu-pll improves insulin resistance in T2DM rats / 中国药理学通报

Aim To study the effect of melatonin receptor agonist Neu-pl 1 on IR in T2DM rats and to predict its possible mechanism. Methods Long-term high-fat feeding plus low-dose streptozotocin (STZ, 30 mg • kg"1, IP) were used to induce an animal model of type 2 diabetes in female rats. After 4 weeks of intragastric administration, liver tissue was sacrificed. Hie mRNA expression levels of Sirtl, Nrf-1/2 and ERRa in rats were determined by RT-PCR. The relative expressions of PGC-la and Mfn2 were determined by Western blot. Rat INS was measured and HOME-IR and ISI were calculated. The liver ATP content and ATPase activity were measured. Results Compared with normal group, T2DM rats developed IR, PGC-la, Mfn2 protein expression increased, Sirtl and other mRNA expression decreased significantly, ERRa mRNA expression increased, ATP content decreased significantly, and ATPase activity decreased. Compared with model group, the Neu-pll low-dose group reduced INS in T2DM rats, improved IR in T2DM rats, up-regulated rat liver protein and mRNA expression, down-regulated ERRa mRNA expression, and increased rat liver ATP content and ATPase activity. Conclusions The melatonin receptor agonist Neu-pl 1 may improve IR by regulating the mitochondrial bal-ance-related factors in liver of T2DM rats and maintaining normal mitochondrial function.

Clinical analysis of 11 cases of pregnancy with ovarian cancer / 中国实用妇科与产科杂志

OBJECTIVE: To analyze the clinical features,diagnosis and treatment plan and clinical outcomes of pregnancy with ovarian cancer.METHODS: Retrospectively analyze the clinical data of 11 pregnant women with ovarian cancer admitted to five hospitals in Dalian from October 2005 to December 2018.RESULTS: The incidence of pregnancy with ovarian cancer was 0.05‰（11/241 770).Among 11 cases of pregnancy with ovarian cancer,7 cases were primary malignant ovarian tumors,of which there was one case without staging during operation,5 cases of stageⅠ,and 1 case of stage ⅢC.The except stage Ⅲ C patient gave up pregnancy,while the other 6 patients chose to terminate pregnancy on the premise of ensuring the survival of the fetus.Four cases were ovarian metastatic tumors,of which 3 were surgically treated,and all4 patients required to retain the fetus and abandon the treatment for malignant tumors.There were 9 neonates,including 4 premature infants,of whom,1 case died 5 minutes after birth and the remaining 8 neonates were healthy.CONCLUSION: The pregnancy with ovarian cancer lacks typical clinical symptoms;the combination of multiple auxiliary examinations is of great significance in the diagnosis of diseases.Diagnosis and staging can be determined according to the intraoperative and postoperative pathological results.We should be alert to metastatic tumors.The individualized treatment plan of the disease should be based on the pregnancy status,the type of tumor pathology and the stage of the tumor,the wishes of the patient and the family.

Genome editing for the treatment of tumorigenic viral infections and virus-related carcinomas / 医学前沿

Viral infections cause at least 10%-15% of all human carcinomas. Over the last century, the elucidation of viral oncogenic roles in many cancer types has provided fundamental knowledge on carcinogenetic mechanisms and established a basis for the early intervention of virus-related cancers. Meanwhile, rapidly evolving genome-editing techniques targeting viral DNA/RNA have emerged as novel therapeutic strategies for treating virus-related carcinogenesis and have begun showing promising results. This review discusses the recent advances of genome-editing tools for treating tumorigenic viruses and their corresponding cancers, the challenges that must be overcome before clinically applying such genome-editing technologies, and more importantly, the potential solutions to these challenges.

Introduction of Applications for AQoL Instruments / 中国卫生经济

It made a brief introduction to a series of AQo (assessment of quality of life) instruments,which was consisted of the developments,features,utility tariffs and applications about AQoL-4D,AQoL-6D,AQoL-7D and AQoL-8D,so as to provide basic support for health economic evaluations,especially for health utility measurements and cost-utility analysis in China.

Effects of ginsenoside RH2 on neovascularization of rats with middle cere-bral artery occlusion / 中国病理生理杂志

AIM:To investigate the effects of ginsenoside RH 2(GS-RH2 )on neovascularization of rats with middle cerebral artery occlusion(MCAO)and its potential mechanisms.METHODS:SPF Sprague-Dawley rats were ran-domly divided into sham operation(sham)group,MCAO model(MCAO)group and GS-RH2 group,with 18 rats in each group.After surgery,the general condition and neurological function score of the rats were assessed.At the 1st day,3rd day and 7th day after intervention,the microvessel density(MVD),the content of malondialdehyde(MDA)and the activ-ity of superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were examined.The protein expression of kelch-like ECH-associated protein 1(Keap1),nuclear factor E2-related factor 2(Nrf2)and heme oxygenase-1(HO-1)was de-termined by Western blot.RESULTS:Compared with sham group ,the rats in MCAO group showed significant neurobe-havioral obstacles and ischemic brain infarction with higher neurological function score ,while treatment with GS-RH2 sig-nificantly improved behavioral impairment and reduced the infarction volume with lower neurological function score.The MVD score in GS-RH2 group was increased as the animal survival time prolonged ,while the MVD score in MCAO group was decreased.After intervention for 7 d,the MVD score in GS-RH2 group was significantly higher than that in MCAO group(P<0.05).Compared with sham group,the content of MDA was increased and the activities of SOD and GSH-Px were decreased in MCAO group at each time point.After intervention for 7 d,the MDA content was decreased and the SOD and GSH-Px activities were increased in GS-RH2 group compared with MCAO group.After intervention for 7 d,the protein expression of Nrf2 and HO-1 was increased,while the protein expression of Keap1 was decreased in GS-RH2 group com-pared with MCAO group(P<0.05).CONCLUSION:Ginsenoside RH2 promotes neovascularization of MCAO model rats.The mechanism may be related to the activation of Keap 1/Nrf2 signaling pathway ,promotion of the antioxidant enzyme activity and inhibition of oxidative stress.

Balloon dilation of epidermolysis bullosa-related esophageal strictures: A report of two cases

Epidermolysis bullosa (EB) is a very rare inherited disease featured with skin blistering resulting from minor trauma. Sometimes the esophageal mucosa could also be involved, which leads to esophageal strictures. Here we report two cases of EB-related esophageal strictures who were successfully treated with esophageal balloon dilations. The two cases with EB had severe dysphagia. Clinical examination showed signs of malnutrition, skin blisters and loss of toenails due to EB. They underwent careful fluoroscopic balloon dilation with 10- and 16-mm-sized balloon catheters, respectively. They could ingest soft and some solid foods after the procedure and maintained during the 20 months and 16 months follow-up periods.

Nutritional support therapy in complicated intra-abdominal infection / 中华消化外科杂志

Complicated intra-abdominal infections (cIAIs) are common clinical conditions but difficult to manage in abdominal surgical practice.Since usually combined with gastrointestinal dysfunction,nutritional support therapy plays a key role in the long-term treatment.Early enteral nutrition could maintain intestinal barrier function,regulate immune function,and reduce gut permeability and bacterial translocation.Enteral combined with supplement parenteral nutrition could provide full-energy support to improve negative nitrogen balance and physiological function.Underlying pathophysiological changes should be understood,and appropriate mode of nutritional support should be chose carefully during disease course which can reduce incidence of complications and improve patients' prognoses.

HPLC determination of the content and dissolution of isophenylcyclopentylamine hydrochloride capsules / 国际药学研究杂志

Objective To establish a method for the determination of the content and dissolution of isophenylcyclopentyl?amine hydrochloride capsules. Methods The HPLC analysis was performed on a Diamonsil C18 column(150 mm×4.6 mm,5μm). A mixture of 0.02 mol/L KH2PO4 solution containing 0.1%triethylamine with pH adjusted to 3.0 by phosphoric acid-methanol-acetonitrile (30:35:35)was used as the mobile phase with the flow rate at 1.0 ml/min. The detection wavelength was 224 nm. Dissolution was de?termined by the basket method,using the 500 ml of 0.1 mol/L hydrochloric acid solution,pH 4.5 acetic acid buffer,water and pH 6.8 phosphoric acid buffer as dissolution media under the 50,75 and 100 r/min rotation speeds to select the dissolution condition. Re?sults This method had high specificity. The linear range for the quantitative determination was 20.74-155.58 μg/ml(r=1.0000), and the average recovery was 100.1%. The linear range for the determination of dissolution was 2.08-24.90μg/ml(r=0.9998),with the average recovery of 98.9%. The method of dissolution tests was established:0.1 mol/L hydrochloric acid solution was used as disso?lution medium and rotation speed was 50 r/min. The determined content and dissolution of three batches of capsules fulfilled the re?quirements. Conclusion The method is simple,accurate and reproducible for the determination of the content and dissolution of iso?phenylcyclopentylamine hydrochloride capsules.

Interpretation of Diagnostic Criteria for Kala-azar / 中国血吸虫病防治杂志

Kala-azar was once transmitted in the northern area of the Yangtze River in China,including 16 provinces(cities or autonomous regions). Through the great continuing prevention and control effort,this disease has been effectively controlled in the most of endemic areas. However,because the epidemic factors of the disease are complex,this disease still transmits or sporadically occurs in the western part of China,including 60 counties of Xinjiang,Gansu,Sichuan,Inner Mongolia,Shanxi, and Shaanxi provinces(autonomous regions). Following the Management Measures for Health Criteria,the Diagnostic Criteria for Kala-azar(WS 258-2006)was compiled by the ex-Ministry of Health of the People's Republic of China and it was issued in April 7,2006 and implemented in December 1,2006. The Criteria consists of six parts,including the application range,terms and definitions,diagnostic principle,diagnostic standard,and differential diagnosis. Two informative appendices(epidemiolo-gy and differential diagnosis)and two normative appendices(immune-detection and etiological examination)are attached. The Criteria provides the technical reference for diagnosis of kala-azar in medical institutions and disease control institutions. Com-bined with the current epidemic situation of kala-azar in China,this paper interprets the main contents of the Diagnostic Criteria for Kala-azar(WS 258-2006),so as to promote its learning and implementing.

Very Long-term Outcomes and Predictors of Percutaneous Coronary Intervention with Drug-eluting Stents Versus Coronary Artery Bypass Grafting for Patients with Unprotected Left Main Coronary Artery Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.</p><p><b>METHODS</b>All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.</p><p><b>RESULTS</b>Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3-8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.</p><p><b>CONCLUSIONS</b>During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group.</p>

Variations of basic glomerular filtration function in experimental rabbits with partial unilateral ureteral ;obstruction / 实用医学杂志

Objective To investigate the variations of glomerular function in rabbits with partial unilateral ureteral obstruction (PUUO). Methods Thirty healty adult Japanese White Rabbits were randomly divided into the control group (6 rabbits) and the obstruction group (24 rabbits). The right PUUO model was established according to Cheng′s method. According to the PUUO duration, they were eaqually divided into four subgroups:the 7 day PUUO group, the 14 d PUUO group, the 28 d PUUO group and the 56 d PUUO group. The dynamic renal imaging was performed on all rabbits, and the glomerular filtration rate (GFR) was also calculated. The correlation between the renal function and PUUO duration was analyzed , and functional variations in the healthy kidneys were observed. Results (1)To the control group, no significant difference in the renal function was found between the left and the right kidneys (t = -0.145, P = 0.894). However, to the PUUO group, the right renal GFRs were significantly lower than the left renal GFRs (P 0.05), (3)No significant differences were found in the left renal GFRs among the five groups. Conclusions The function of PUUO kidneys is characterized by an obvious decrease in the early stage, followed with a steady state. The basic function of the opposite healthy kidney does not present the compensation phenomenon.

Effect of enteral nutrition tolerance assessment form in early postoperative enteral nutrition support of patients with gastric cancer / 现代临床护理

Objective To investigate the effect of enteral nutrition tolerance assessment form on the early enteral nutrition tolerance in patients with gastric cancer after operation. Methods According to the admission sequence, 108 patients with gastric cancer were divided into the control group and the experiment group with 54 cases in each group. Enteral nutrition was used in the control group, while enteral nutrition tolerance assessment form was used to evaulate and care patients in experiment group. Finally, the two groups were compared in the anal exhaust time and the rate of complications. Result Anal exhaust in the experiment group was significantly earlier than that in the control group and the rate of complications was significantly smaller than that of the control group (P < 0.05). Conclusions The enteral nutrition tolerance assessment form for systemic evaluation and intervention is effective in improvement of the patients′tolerance to enteral nutrition in early postoperative enteral nutrition support to patients with gastric cancer. It can promote the recovery of patients.

Predictive Ability of the SYNergy Between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery Score II for Long-term Mortality in Patients with Three-vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention Treated with Second-generation Drug-eluting Stents / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery Score II (SS-II) can well predict 4-year mortality in patients with complex coronary artery disease (CAD), and guide decision-making between coronary artery bypass graft surgery and percutaneous coronary intervention (PCI). However, there is lack of data regarding the utility of the SS-II in patients with three-vessel CAD undergoing PCI treated with second-generation drug-eluting stents (DES). The purpose of the present study was to evaluate the ability of the SS-II to predict long-term mortality in patients with three-vessel CAD undergoing PCI with second-generation DES.</p><p><b>METHODS</b>Totally, 573 consecutive patients with de novo three-vessel CAD who underwent PCI with second-generation DES were retrospectively studied. According to the tertiles of the SS-II, the patients were divided into three groups: The lowest SS-II tertile (SS-II ≤20), intermediate SS-II tertile (SS-II of 21-31), and the highest SS-II tertile (SS-II ≥32). The survival curves of the different groups were estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression analyses were performed to evaluate the relationship between the SS-II and 5-year mortality. The performance of the SS-II with respect to predicting the rate of mortality was studied by calculating the area under the receiver operator characteristic (ROC) curve. The predictive ability of the SS-II for 5-year mortality was evaluated and compared with the SS alone.</p><p><b>RESULTS</b>The overall SS-II was 27.6 ± 9.0. Among patients in the lowest, intermediate and the highest SS-II tertiles, the 5-year rates of mortality were 1.6%, 3.2%, and 8.6%, respectively (P = 0.003); the cardiac mortality rates were 0.5%, 1.9%, and 5.2%, respectively (P = 0.014). By multivariable analysis, adjusting for the potential confounders, the SS-II was an independent predictor of 5-year mortality (hazard ratio: 2.45, 95% confidence interval: 1.38-4.36; P = 0.002). The SS-II demonstrated a higher predictive accuracy for 5-year mortality compared with the SS alone (the area under the ROC curve was 0.705 and 0.598, respectively).</p><p><b>CONCLUSION</b>The SS-II is an independent predictor of 5-year mortality in patients with three-vessel CAD undergoing PCI treated with second-generation DES, and demonstrates a superior predictive ability over the SS alone.</p>

Dynamic Changes of Peripheral Blood IL-6,HGF and Ang-2 in Patients with Acute Pancreatitis / 胃肠病学

Background:Excessive immune cell activation-inflammatory factor theory is one of the most important pathogenic mechanisms of acute pancreatitis(AP). As the release of inflammatory factors is associated with systemic inflammatory response syndrome,seeking of serum cytokine markers for severity assessment of AP is of great clinical importance. Aims:To determine the dynamic changes of interleukin-6(IL-6),hepatocyte growth factor(HGF),and angiopoietin-2(Ang-2) in peripheral blood of AP patients in the first week after admission,and investigate preliminarily the clinical significance of these markers in AP. Methods:Seventy-two AP patients were prospectively recruited from Apr. 2014 to Oct. 2014 at the First Affiliated Hospital of Soochow University and were assigned into three groups:mild AP(MAP,n = 54),moderately severe AP(MSAP,n = 12)and severe AP(SAP,n = 6)according to the Atlanta classification of AP-2012. Thirty healthy subjects were served as controls. Serum levels of IL-6,HGF and Ang-2 were determined by ELISA on the 1st,3rd and 7th day after admission. Results:In the first week after admission,serum levels of IL-6,HGF and Ang-2 were significantly higher in AP patients than in controls(P 0. 05). Conclusions:IL-6,HGF and Ang-2 might play important roles in the pathogenesis of AP,and being the promising serum markers for severity assessment and dynamic monitoring of AP.

Correlation of GGT with AFP and diagnostic value of GGT for hepatocellular carcinoma / 临床肝胆病杂志

Objective To analyze the correlation of gamma-glutamyl transpeptidase (GGT)level with alpha-fetoprotein (AFP)level and to re-evaluate the diagnostic value of GGT for hepatocellular carcinoma (HCC).Methods Four hundred and seventy-two patients with HCC or liver cirrhosis,who were hospitalized in China-Japan Friendship Hospital from January 2003 to June 2009,were included in the study.The correlation between GGT and AFP was analyzed by Spearman nonparametric test.The cut-off values for the two parameters were determined based on their receiver operating characteristics (ROC)curves,areas under the ROC curve (AUCs),sensitivity,and specifici-ty,and the diagnostic values were presented using their sensitivity,specificity,and correct index.Statistical analysis was performed using SPSS 17.0.Normally distributed continuous data were analyzed by independent-samples t test,while non-normally distributed continuous data were analyzed by Mann -Whitney U test.Categorical data were analyzed by Pearson chi -square test,continuity-corrected chi -square test,or Fisher’s exact test.Results Among 472 patients,224 were diagnosed with HCC,and 248 with liver cirrhosis.Compared with cirrhotic patients,HCC patients had a significantly higher GGT level (113 (58-254)U/L vs 38 (22-72)U/L,Z=-11.037,P<0.001)and a significantly higher AFP level (429.5 (15.7-1210.0)ng/ml vs 5.7 (3.4-18.2)ng/ml,Z=-10.157,P<0.001).A significant correlation was found between GGT and AFP (r=0.449,P<0.001).The AUC was 0.784 for GGT and 0.788 for AFP.The cut-off value was 60 U/L for GGT and 20 ng/ml for AFP.The sensitivity was 74.1%for GGT,71.8%for AFP,and 90.7%for a combina-tion of the two parameters,the specificity was 70.2%,77.6%,and 58.7%,respectively,and the correct index was 0.443,0.494,and 0.494,respectively.Conclusion GGT may be regarded as one biomarker for HCC,and its level is significantly correlated with AFP level. The diagnostic value of AFP may not be improved when used in combination with GGT.

Effect of electro-acupuncture stimulation of Ximen (PC4) and Neiguan (PC6) on remifentanil-induced breakthrough pain following thoracal esophagectomy / 华中科技大学学报（医学）（英德文版）

The clinical analgesic effect of electro-acupuncture (EA) stimulation (EAS) on breakthrough pain induced by remifentanil in patients undergoing radical thoracic esophagectomy, and the mechanisms were assessed. Sixty patients (ASAIII) scheduled for elective radical esophagectomy were randomized into three groups: group A (control) receiving a general anesthesia only; group B (sham) given EA needles at PC4 (Ximen) and PC6 (Neiguan) but no stimulation; and group C (EAS) electrically given EAS of the ipsilateral PC4 and PC6 throughout the surgery. The EAS consisting of a disperse-dense wave with a low frequency of 2 Hz and a high frequency of 20 Hz, was performed 30 min prior to induction of general anesthesia and continued through the surgery. At the emergence, sufentanil infusion was given for postoperative analgesia with loading dose of 7.5 μg, followed by a continuous infusion of 2.25 μg/h. The patient self-administration of sufentanil was 0.75 μg with a lockout of 15 min as needed. Additional breakthrough pain was treated with dezocine (5 mg) intravenously at the patient's request. Blood samples were collected before (T1), 2 h (T2), 24 h (T3), and 48 h (T4) after operation to measure the plasma β-EP, PGE2, and 5-HT. The operative time, the total dose of sufentanil and the dose of self-administration, and the rescue doses of dezocine were recorded. Visual Analogue Scale (VAS) scores at 2, 12, 24 and 48 h postoperatively and the incidence of apnea and severe hypotension were recorded. The results showed that the gender, age, weight, operative time and remifentanil consumption were comparable among 3 groups. Patients in EAS group had the lowest VAS scores postoperatively among the three groups (P0.05). No apnea or severe hypotension was observed in any group. It was concluded that intraoperative ipsilateral EAS at PC4 and PC6 provides effective postoperative analgesia for patients undergoing radical esophagectomy with remifentanil anesthesia and significantly decrease requirement for parental narcotics. The underlying mechanism may be related to stimulation of the release of endogenous β-EP and inhibition of inflammatory mediators (5-HT and PGE2).

Effect of electro-acupuncture stimulation of Ximen (PC4) and Neiguan (PC6) on remifentanil-induced breakthrough pain following thoracal esophagectomy / 华中科技大学学报（医学）（英德文版）

The clinical analgesic effect of electro-acupuncture (EA) stimulation (EAS) on breakthrough pain induced by remifentanil in patients undergoing radical thoracic esophagectomy, and the mechanisms were assessed. Sixty patients (ASAIII) scheduled for elective radical esophagectomy were randomized into three groups: group A (control) receiving a general anesthesia only; group B (sham) given EA needles at PC4 (Ximen) and PC6 (Neiguan) but no stimulation; and group C (EAS) electrically given EAS of the ipsilateral PC4 and PC6 throughout the surgery. The EAS consisting of a disperse-dense wave with a low frequency of 2 Hz and a high frequency of 20 Hz, was performed 30 min prior to induction of general anesthesia and continued through the surgery. At the emergence, sufentanil infusion was given for postoperative analgesia with loading dose of 7.5 μg, followed by a continuous infusion of 2.25 μg/h. The patient self-administration of sufentanil was 0.75 μg with a lockout of 15 min as needed. Additional breakthrough pain was treated with dezocine (5 mg) intravenously at the patient's request. Blood samples were collected before (T1), 2 h (T2), 24 h (T3), and 48 h (T4) after operation to measure the plasma β-EP, PGE2, and 5-HT. The operative time, the total dose of sufentanil and the dose of self-administration, and the rescue doses of dezocine were recorded. Visual Analogue Scale (VAS) scores at 2, 12, 24 and 48 h postoperatively and the incidence of apnea and severe hypotension were recorded. The results showed that the gender, age, weight, operative time and remifentanil consumption were comparable among 3 groups. Patients in EAS group had the lowest VAS scores postoperatively among the three groups (P<0.05). The total dose of sufentanil was 115±6.0 μg in EAS group, significantly lower than that in control (134.3±5.9 μg) and sham (133.5±7.0 μg) groups. Similarly, the rescue dose of dezocine was the least in EAS group (P<0.05) among the three groups. Plasma β-EP levels in EAS group at T3 (176.90±45.73) and T4 (162.96±35.00 pg/mL) were significantly higher than those in control (132.33±36.75 and 128.79±41.24 pg/mL) and sham (136.56±45.80 and 129.85±36.14 pg/mL) groups, P<0.05 for all. EAS could decrease the release of PGE2. Plasma PGE2 levels in EAS group at T2 and T3 (41±5 and 40±5 pg/mL respectively) were significantly lower than those in control (64±5 and 62±7 pg/mL) and sham (66±6 and 62±6 pg/mL) groups. Plasma 5-HT levels in EAS group at T2 (133.66±40.85) and T3 (154.66±52.49 ng/mL) were significantly lower than those in control (168.33±56.94 and 225.28±82.03) and sham (164.54±47.53 and 217.74±76.45 ng/mL) groups. For intra-group comparison, plasma 5-HT and PGE2 levels in control and sham groups at T2 and T3, and β-EP in EAS group at T3 and T4 were significantly higher than those at T1 (P<0.05); PGE2 and 5-HT levels in EAS group showed no significant difference among the different time points (P>0.05). No apnea or severe hypotension was observed in any group. It was concluded that intraoperative ipsilateral EAS at PC4 and PC6 provides effective postoperative analgesia for patients undergoing radical esophagectomy with remifentanil anesthesia and significantly decrease requirement for parental narcotics. The underlying mechanism may be related to stimulation of the release of endogenous β-EP and inhibition of inflammatory mediators (5-HT and PGE2).