ABSTRACT
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive lethal malignancy, characterized by late diagnosis, aggressive growth, and therapy resistance, leading to a poor overall prognosis. Emerging evidence shows that the peripheral nerve is an important non-tumor component in the tumor microenvironment that regulates tumor growth and immune escape. The crosstalk between the neuronal system and PDAC has become a hot research topic that may provide novel mechanisms underlying tumor progression and further uncover promising therapeutic targets. In this review, we highlight the mechanisms of perineural invasion and the role of various types of tumor innervation in the progression of PDAC, summarize the potential signaling pathways modulating the neuronal-cancer interaction, and discuss the current and future therapeutic possibilities for this condition.
Subject(s)
Humans , Carcinoma, Pancreatic Ductal/pathology , Pancreatic Neoplasms/therapy , Signal Transduction , Peripheral Nerves/metabolism , Tumor MicroenvironmentABSTRACT
Metastatic cancer-induced bone pain is the most common pain complaint in patients with advanced cancer. Cancer-induced bone pain can significantly affect patients' quality of life and worsen their prognosis. This bone pain includes different types, such as background pain and breakthrough pain, and its underlying molecular mechanism is complex, including inflammatory pain and neuropathic pain, which may change with tumor progression. Current clinical treatments mainly comprise drug therapies, such as peripheral and central analgesics and osteoclast blocking, and non-drug therapies, such as radiotherapy, nerve damage, and neuromodulation. Thus, elucidating the molecular mechanism underlying bone cancer-induced pain is crucial for its optimal treatment. This study aims to review advances in the current understanding of the molecular mechanism and clinical treatment of metastatic cancer- induced bone pain.
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Objective:To investigate the effect of ultrasound-guided transversus abdominis plane block on intraoperative and postoper-ative analgesia in laparoscopic abdominal surgery.Methods:Sixty ASAⅠ-Ⅱpatients with abdominal tumor,undergoing laparoscopic/robotic surgery were randomly assigned into two groups:one group undergoing general anesthesia(G group)and the other undergo-ing general anesthesia combined with transversus abdominis plane block(G+T group).After induction of general anesthesia in the G+T group,the patients received transversus abdominis plane block with injection of 15 Ml of 0.25% ropivacaine on each side,guided by ultrasound.The operation time,resuscitation time,orientation recovery time,and the dosage of remifentanyl were recorded and com-pared.During surgery,the MAP and HR at different time points(5 min before,after surgical incision;30 min after the surgery begin-ning;surgery finished)between the two groups were recorded and compared.Additionally,the VAS scores at different postoperative time points were compared between the two groups.Results:Compared to the G group,the resuscitation time,orientation recovery time and the dosage of remifentanyl in the G+T group were significantly decreased(P<0.05).In G group,compared to the basic value, the MAP and HR at 5 min and 30 min after surgical incision were significantly increased(P<0.05);whereas in the G+T group,the MAP and HR remained stable at different time points(P>0.05).Moreover,compared to the G group,the VAS score in the G+T group was sig-nificantly lower at 2,6,and 12 hours postoperatively(P<0.05).Conclusions:General anesthesia combined with transversus abdominis plane block in patients undergoing laparoscopic abdominal surgery reduces the intraoperative and postoperative remifentanil con-sumption,improves the efficacy of perioperative analgesia,and enhances the patient's recovery after surgery.
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Objective:We aimed to investigate the effect of neo-adjuvant chemotherapy on postoperative cognitive dysfunction (POCD) in elderly patients who underwent one-lung ventilation (OLV) surgery. Methods:A total of 90 esophageal carcinoma patients aged 60 years old or older were included. These patients were scheduled for esophagectomy, including two or three-field lymphadenec-tomy, and were randomly divided into two groups based on the American Society of Anesthesiologists status (Ⅰ or Ⅱ) and the Tu-mor-Node-Metastasis (TNM) classification stage (ⅡorⅢ), as follows:the neo-adjuvant chemotherapy group (Group N:n=45) that re-ceived preoperative neo-adjuvant chemotherapy;and the control group (Group C:n=45) that did not receive chemotherapy. The neuro-psychological test was performed 1 d before and 7 d after surgery to evaluate the changes in cognitive function. The incidence of POCD was also determined via the Z-value method in the two groups. Results:A total of 44 patients in Group N and 41 patients in Group C completed the neuropsychological tests. No statistical differences were observed in the demographics, TNM stage, and the intra-and post-operative clinical data between the groups. POCD was observed in 21 of the patients in Group N (47.7%) and 11 of the patients in Group C (26.8%), and the differences were significant (χ2=3.949, P=0.047). Conclusion:Neo-adjuvant chemotherapy can aggravate the impairment of cognitive function in the elderly patients undergoing OLV surgery and can significantly increase the incidence of POCD.
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Objective To investigate the effects of sevoflurane wash-in during cardiopulmonary bypass (CPB) on myocardial injury in patients undergoing coronary artery bypass grafting(CABG).Methods Forty ASA Ⅱ or Ⅲ patients aged 50-64 yr,weighing 53-90 kg undergoing scheduled for CABG under CPB were randomly divided into 2 groups (n =20): control group (group C) and sevoflurane group(group S).Anesthesia was maintained with propofol 3-5 mg·kg-1 ·h-1 and sufentanil 0.5-1.0 μg·kg-1 ·h-1 in both groups.Sevoflurane 1％-2％ was washed into extracorporeal circuit during CPB in group S.Blood samples were taken from central vein after the induction of anesthesia (T0,baseline) and at 6,12 and 24 h (T1-3) after operation for determination of plasma cardiac troponin I(cTnI) concentration and creatine kinase-MB (CK-MB) activity.Myocardial specimens were obtained from right auricle before aortic cross-clamping and at the end of CPB for ultrastructure examination.The severity of mitochondria injury was assessment and scored (0 =normal,4 =impaired inner mitochondrial membrane integrity).Results CPB significantly increased plasma cTnI concentration at T1-3 as compared with the baseline values at T0 before CPB.Plasma cTnI concentration was significantly lower at T2 and T3 in group S than in group C.Mitochondrial injury index was significantly lower at the end of CPB in group S than in group C.There was no significant difference in plasma CK-MB activity between the 2 groups.Conclusion Wash-in of sevoflurane during CPB can attenuate myocardial injury in patients undergoing CABG.