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Objective:To investigate the clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement.Methods:The clinical data of 50 older adult patients who underwent artificial femoral head replacement in Zhuji Third People's Hospital between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into a control group ( n = 22) and a combined anesthesia group ( n = 28) according to different anesthesia methods. The control group was subjected to epidural anesthesia with bupivacaine. The combined anesthesia group underwent combined spinal and epidural anesthesia with isobaric bupivacaine. The excellent and good rate of anesthesia as well as heart rate and mean arterial pressure measured before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery were compared between the two groups. Time to anesthesia onset and time to block completion were recorded in each group. Results:The excellent and good rate of clinical efficacy in the combined anesthesia group was significantly higher than that in the control group [85.71% (24/28) vs. 59.09% (13/22), χ2 = 4.54, P < 0.05]. There were no significant differences in heart rate and mean arterial pressure between the two groups before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery ( t = 0.83, 0.60, 1.13, 1.21; 0.98, 0.60, 0.85, 0.88, P > 0.05). The time to anesthesia onset and the time to block completion in the combined anesthesia group were shorter than those in the control group ( t = 4.99, 2.29, both P < 0.05). Conclusion:Combined spinal and epidural anesthesia with isobaric bupivacaine can increase the excellent and good rate of anesthesia effects and has no obvious effect on hemodynamics in patients undergoing artificial femoral head replacement. Combined spinal and epidural anesthesia takes a shorter time to anesthesia onset and a shorter time to block completion than spinal or epidural anesthesia.
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Objective:To verify the accuracy and feasibility of radioactive 125I seed implantation assisted by an optical navigation system and a 3D-printing non-coplanar template in the treatment of recurrent head and neck cancers. Methods:A total of 12 patients with recurrent head and neck cancer treated with radioactive 125I seed implantation assisted by an optical navigation system and 3D-printing non-coplanar template were enrolled from Dec 2018 to Dec 2019.The pre-plan and post-implant implantation needle number and implanted seed number were recorded.Meanwhile, their dosimetric parameters were compared, including D90, minimum peripheral dose (MPD), V100, V150, V200, conformity index (CI), external index (EI), and the homogeneity index (HI) of the target volume. Results:The median lesion volume was 31.5 cm 3, the median number of seeds was 61.5, and the median prescription dose was 130 Gy.The means of the pre-plan D90, MPD, V100, V150 and V200 were 134.2, 64.6, 93.3, 75.3 and 39.3 Gy, respectively, while those of post-implant D90, MPD, V100, V150, and V200 were 146.7, 68.94, 97.47, 80.40 and 48.30 Gy, respectively, with no statistically significant difference ( P>0.05). Meanwhile, there was no statistically significant difference between the pre-plan and post-implantation needle number, implanted seed number, CI, HI, and EI ( P>0.05). In terms of postoperative dose quality assessment, eight cases were rated excellent (66.6%) and four cases were rated good (33.3%). Conclusions:Radioactive 125I seed implantation assisted by an optical navigation system and 3D-printing non-coplanar template can be accurately performed in the treatment of recurrent head and neck cancer, with good consistency between pre-plan and post-implant dosimetric parameters and thus of prospective potential in clinical application.
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Objective@#To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis, and to verify the accuracy of 3D-printing non-coplanar template (3D-PNCT) combined with CT-guided 125I seed implantation for the treatment of spinal metastasis.@*Methods@#The treatment plans of 7 patients with spinal metastasis (9 lesions) from 2016 to 2018 receiving 3D-PNCT in combination with CT-guided 125I seed implantation were retrospectively analyzed. The dosimetric parameters including homogeneity index (HI), conformal index (CI), external index (EI), dose of 90% target volume(D90), mPD, volume percent of 100%, 150%, and 200% prescribed dose V100、V150、V200 and D2cm3 of spinal cord were compared before and after operation. The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation.@*Results@#The HI, EI and CI, D90, mPD, V100, V150, V200 and D2cm3 of spinal cord did not significantly differ before and after the plan (all P>0.05). Five were evaluated as excellent and 4 were assessed as good.@*Conclusion@#The postoperative dosimetric parameters of 3D-PNCT combined with CT guided 125I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters. The postoperative plans are evaluated as excellent or good, suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.
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Objective To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis,and to verify the accuracy of 3D-printing non-coplanar template (3D-PNCT)combined with CT-guided 125I seed implantation for the treatment of spinal metastasis.Methods The treatment plans of 7 patients with spinal metastasis (9 lesions) from 2016 to 2018 receiving 3D-PNCT in combination with CT-guided 125I seed implantation were retrospectively analyzed.The dosimetric parameters including homogeneity index (HI),conformal index (CI),external index (EI),dose of 90％ target volume (Dg0),mPD,volume percent of 100％,150％,and 200％ prescribed dose V100、V150、V200 and D2cm3 of spinal cord were compared before and after operation.The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation.Results The HI,EI and CI,Dg0,mPD,V100,V150,V200 and D2cm3 of spinal cord did not significantly differ before and after the plan (all P＞0.05).Five were evaluated as excellent and 4 were assessed as good.Conclusion The postoperative dosimetric parameters of 3D-PNCT combined with CT guided 125I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters.The postoperative plans are evaluated as excellent or good,suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.
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Objective To evaluate the clinical efficacy and safety of CT-guided 125 I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125 I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation (D90) was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12. 2 months. The 5-year local progression-free survival rate was 26. 6％.The 5-year overall survival rate was 15. 5％. Univariate analysis demonstrated that age,pathological type,implantation site,lesion volume,D90 and short-term efficacy were correlated with local control,and KPS score,lesion volume ,D90,and short-term efficacy were associated with survival (all P<0. 05). Multivariate analysis revealed that pathological type,lesion volume ,D90 and short-term efficacy were independent factors related to local control (P= 0. 000, 0. 002,0. 003 and 0. 014).In terms of the adverse events,skin/ mucosal ulceration was observed in 25. 7％ and pain occurred in 13. 9％ of all patients. No correlation was noted between the adverse events and dose.Conclusions CT-guided radioactive 125 I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma,small lesion volume and high dose (D90) indicate excellent local control.
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Objective To investigate the utilization rate of gold fiducial markers and reasons for abandonment of gold fiducial markers in the CyberKnife VSI System, and to provide reference data for implantation of gold fiducial markers and radiotherapy planning. Methods From March to August,2017,a total of 47 patients had gold fiducial markers implanted or pasted. In those patients, 42 patients had gold fiducial markers implanted,including 32 receiving computed tomography(CT)-guided 3D-printing coplanar template assisted implantation, 1 receiving CT-guided 3D-printing non-coplanar template assisted implantation,1 receiving CT-guided implantation,and 8 receiving ultrasound-guided implantation. A total of 44 patients received the CyberKnife treatment, including 2 patients who failed to use gold fiducial markers and were treated with spine tracking instead and 3 patients missing the treatment for other reasons. The numbers of utilized and abandoned gold fiducial markers were recorded for calculation of the utilization and abandonment rates. The reasons for abandonment of gold fiducial markers were analyzed and classified. Results A total of 134 gold fiducial markers were implanted into or pasted to the 44 patients.In all the gold fiducial markers, 111 were utilized and 23 abandoned, yielding a utilization rate of 82.8% and an abandonment rate of 17.2%.The reasons for abandonment of gold fiducial markers included large rigidity error(26.1%), unqualified implanted fold fiducial markers(17.4%), displacement of gold fiducial markers(26.1%), and others(30.4%). Conclusions Compared with the CT-guided or ultrasound-guided implantation of gold fiducial markers, the CT-guided 3D-printing coplanar or non-coplanar template assisted implantation of gold fiducial markers requires only two puncture needles for each implantation and implants two gold fiducial markers by a single needle,which reduces the number of puncture needles,risk of puncture-induced injury,and incidence of complications after implantation. Not all the gold fiducial markers implanted by a variety of ways will be utilized. Some gold fiducial markers will be abandoned for different reasons,which should be taken into account during implantation of gold fiducial markers.
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Objective To compare the dose distributions of postoperative plans with preoperative plans for 3D printing guide plate assist radioactive seeds implantations, explore the effects of the technology for seeds implantations in dosimetry level. Methods From January 2016 to December 2016, a total of 42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations in in Peking University Third Hospital, and included in the retrospective study. The prescribed dose was 110 -160 Gy. All patients carried out preoperative planning design, individual guide plate production, and compared the dose distribution of postoperative plan with preoperative plan. Dose parameters include D90 , mPD, V100 , V150 , V200 , CI, EI and HI. Statistical method was paired t-test. Results A total of 423D printing individual templates were produced. The mean GTV volume of all patients was 28. 6 cm3 , and mean D90 of postoperative target area ( GTV) was 142. 6 Gy. For postoperative plans, the mean D90 , mPD, V100 , V150, V200 was 142. 6 Gy, 77. 3 Gy, 92. 48％, 68. 40％and 42. 98％, respectively, and 144. 5 Gy, 70. 2 Gy, 91. 45％, 63. 12％ and 34. 74％, respectively, in preoperative plans. Except mPD, V150, V200(t= -2. 166, -2. 863, -4. 778, P<0. 05), there was no significant difference between the two groups. Conclusions 3D printing guide plate could provide good accuracy for positioning and direction. For local recurrent malignant tumor of head and neck, the actual dose distributions in postoperative validations were close to the expectations of preoperative plans which mean the improvement of accuracy in treatment.
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Objective To investigate the feasibility of 3D-printing coplanar coordinate template (3D-PCT) for guiding 125I radioactive seed implantation in the treatment of pelvic wall recurrence of cervical cancer on ensuring the accuracy of dose.Methods From Oct 2016 to Dec 2017 in Peking University Third Hospital,totally 10 patients with pelvic wall recurrent cervical cancer after radiotherapy were treated with 125I radioactive seed implantation assisted by 3D-PCT.The median age was 53.5 years old (37-71 years old).KPS score of the cohort were more than 70.All patients had received pelvic radiation therapy previously.The median volume of the lesion was 31.9 cm3 (3.5-58.0 cm3).The prescription dose was 120-180 Gy.The activity of seeds was 0.55-0.67 mCi(1 Ci =3.7 × 1010Bq),while the number of seeds was 12-81 (median 50) on preoperative plan.Radioactive seeds implantation was performed under 3D-PCT guidance according to the preoperative plan.The actual number of implanted seeds was 53 (10-82).Dosimetry parameters of preoperative plan and postoperative plan including D90,D100,V100,V150,V200,external index (EI),conformal index (CI),heterogeneity index (HI),and organat-risk doses of D2 cm3,D1 cm3 and D0.1 cm3 were compared using the nonparametric test.Results The seed number of postoperative plan was more than that of preoperative plan (Z =-2.255,P ＜ 0.05),but all of the dosimetric parameters showed no significant difference (P ＞ 0.05).D2 cm3 and D1 cm3 of rectum for postoperative plan were lower than that of preoperative plan (Z =-2.100,-2.240,P ＜ 0.05),while other dose parameters of normal tisssues showed no statistically significant difference (P ＞ 0.05).Conclusions Assisted by 3D-PCT for 125I radioactive seed implantation in pelvic wall recurrence of cervical cancer,the actual postoperative dose could meet the requirement of the preoperatie plan through the intraoperative optimization of dose.3D-PCT could ensure the precise of delivered dose of 125I radioactive seed implantation.
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Objective To compare the dose distribution of postoperative plans with preoperative plans of 3D-printing template (coplanar and non-coplanar) assisted and CT-guided 125I seed implantation for the treatment of soft tissue sarcoma,and to explore the accuracy of treatment at dosimetry level.Methods From December 2015 to July 2017,19 patients with soft tissue sarcoma (a total of 25 lesions)were treated with 3D printing template assisted and CT-guided 125I seed implantation in Peking University Third Hospital.All patients underwent preoperative assessment,CT simulation orientation,preoperative planning,3D-template printing,3D-template reduction,needle and seed implantation,postoperative dosimetry assessment,postoperative care and follow-up.The preoperative and postoperative dosimetric parameters were conpared.Ten cases of soft tissue sarcoma in superficial trunk or limbs were screened.Preoperative planning of coplanar template and non-coplanar template were designed respectively.The dosimetric parameters of preoperative planning guided of two templates were compared.Results Twentyfive 3D-printing templates were designed and constructed,and 25 lesions were totalled.There was no statistical difference between preoperative and postoperative dosimetric parameters.There was no statistical difference of the preoperative plan's dosimetric parameters between coplanar and non-coplanar in soft tissue sarcoma of superficial trunk/limbs.Conclusions The validation of actual dose distribution in postoperative plans assisted by 3D-printing template in 125I seed implantation showed that most of parameters could meet the expectation of preoperative plans,which indicated the improvement in accuracy for this new modality.For soft tissue sarcoma located in the superficial trunk/limbs,it was recommended to select the 3D-printing coplanar template firstly.
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Objective To analyze the qualified rate of the fiducial markers during 3D-printing co-planar template assisted CT-guided implantation in stereotactic body radiation therapy by CyberKnife,and to explore the cause of the unavailable markers in order to provide the reference for the fiducial implantation,treatment planning and radiotherapy delivery.Methods From March to December 2017,a total of 52 cases were planned to stereotactic body radiation therapy(SBRT) using CyberKnife by fiducial tracking,and the fiducial markers were implanted based on CT-guided 3D-printing co-planar template,including 22 in lung,12 in liver,5 in mediastinal lymph node,8 in retroperitoneal lymph node,3 in pancreas,each in celiac and pelvic lymph nodes,respectively.Except 7 cases not fit for CyberKnife treatment,45 cases finished the treatment of CyberKnife,but there were 3 cases changed to spine tracking due to unqualified fiducial markers.The number of fiducial markers used and the qualified rate of fiducial markers were analyzed,and the cause of unqualified fiducial markers was studied.Results A total of 131 fiducial markers were impanted into 42 cases who finally received the treatment of CyberKnife by fiducial tracking,including 85 fiducial markers qualified (64.89％) and 46 fiducial markers unqualified (35.11％).The main causes of the unqualified fiducial markers varied,including outrange of rigidity error(26.08％),fiducial markers unavailable(41.31％),and other (32.61％).Conclusions The 3D-printing co-planar template assisted CT-guided implantation could reduce the number of puncture needles used,help to decrease the risk of puncture and trauma and the incidence of complications after the fiducial markers implantation.However,the fiducial markers implanted by this way would be abandoned by a variety of causes and should be taken into account before the fiducial markers implantation.
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Objective To investigate the accuracy of 3D-printing non-coplanar template (3D-PNCT) assisted 125I seed implantation with CT guidance in the pelvic recurrent cervical between the preplan and post-plan dosimetric parameters.Methods Nine patients with pelvic recurrent cervical cancer received 125I seed implantation under CT guidance assisted with 3D-PNCT.A pre-plan based brachytherapy treatment planning system (B-TPS) assisted with 3D-PNCT for seed needle depth,direction and angle was designed.The dosimetry parameters including homogeneity index (HI),dose of 90％ target volume (Dg0),mPD,volume percent of 100％,150％ and 200％ prescribed dose V100,V150 and V200 and organ at risk between the pre-plan and post-plan were compared.Results Total seeds number was 675 (median 44,25-114) according to pre-plan,and 669 (median 47,25-113) seeds were implanted actually.138 needles need implant according to preplan,and 132 needles was implanted actually.The median angle deviation was 1.99 ° ± 2.94°(0 °-13 °).There was no significant difference of HI,EI and CI between perand post-plan.The differences of D90,MPD,V100,V150 and V200 between pre-and post-plan were not significant.Conclusions The confidence of pre-plan and post-plan for 3D-PNCT assisted 125I seed implantation in the pelvic recurrent cervical cancer could be accurately performed under CT guidance.
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Objective To investigate the acute side effect of 3D printing individual non-coplanar template for 125I seed implantation in head and neck recurrent/ metastatic carcinoma.Methods Between January 2016 and December 2016,42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations,and included in the study.The tumor volume ranged from 2.4 to 102.8 cm3 (median 28.6 cm3).The prescribed dose is 110-160 Gy,and the seeds activity were 0.34 to 0.70 mCi (1 Ci =3.7 × 1010 Bq).All patients carried out preoperative planning design,individual guide plate production,seed implantation,postoperative dose assessment,and followup.The side effects of skin,mucous membrane,blood and spinal cord were statistically analyzed.Results All patients were operated successfully.The follow-up time was 4-14 months (median 8.5 months).There were no adverse reactions at grade three or above.Three patients had grade one skin reaction.One patient experienced grade one mucosal reaction,two experienced grade two mucosal reactions.The skin response was correlated with the dose of the skin (x2 =7.067,P =0.032).No hematologic toxicity or radiation myelopathy was observed and no seed displacement was found.Conclusions 3D-printing guide plate can provide good accuracy for positioning and direction.For local recurrent malignant tumor of head and neck,there were no obvious adverse reactions and the operation was simple and the dosage was accurate.
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Objective Controversies remain as to the recovery time, recovery quality, and incidence of peri-recovery adverse reactions of the patient receiving general anesthesia with remifentanil and sufentanil.This study aimed to systematically assess the qual-ity of recovery from general anesthesia with remifentanil and sufentanil. Methods Randomized controlled trials ( RCTs) were re-trieved from The Cochrane Library, PubMed, MEDLINE, EMbase, Ovid, Springer, Web of Science, CNKI, CBM, VIP, and Wan-Fang Data.According to the modified Jadad quality scale, the literature retrieved was screened and subjected to quality evaluation and meta-analysis was performed on the included studies using the RevMan 5.1 software. Results Thirty-three RCTs involving 2175 pa-tients were finally included.The results of meta-analysis showed no significant differences between the remifentanil and sufentanil groups undergoing thyroid surgery either in the recovery time to spontaneous breathing ( T1) and eye-opening ( T2) and endortracheal extubation time ( T3 ) ( P >0.05 ) or in the incidence rate of postoperative nausea and vomiting (PONV) (P>0.05).T1, T2 and T3 were significantly shorter in the sufentanil than in the remifentanil group in other types of surgery (P<0.05).The patients with level-1 Ramsay score were remarkably more in the remifentanil than in the sufentanil group ( MD =13.67, 95% CI 2.67 -69.91 ) ( P <0.05), and the VAS scores were markedly higher in the former than in the latter group at 30 minutes (MD=3.37, 95% CI 3.28-3.46) and 1 hour after extubation (MD=2.53, 95% CI 2.43 -2.63) (P<0.05). Conclusion Compared with sufentanil, remifentanil provides a quicker recovery but a weaker analgesia effect and a higher rate of post-operative agitation.However, sufentanil produces a better pain relief and a higher quality of recovery after operation.
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(1.Department of Anesthesiology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiang-su, China;2.Department of Anesthesiology, General Hospital of Shenyang Military Region, PLA, Shenyang 110000, China) le-blind, 60 patients scheduled for OPCABG were randomly divided into 4 groups: control group( group C) and 3 dexmedetomidine group(group D1、D2、D2).Patients in each group received saline or dexmedetomidine 0.2μg/kg, 0.4μg/kg, 0.6μg/kg respectively. Hemodynamic variables such as HR、MAP、CVP、MPAP、PCWP、SVRI and PVRI were recorded after entering into the operationroom ( T0 ) , before the anesthesia induction( T1 ) , at 5 minutes after tracheal intubation ( T2 ) , during the sternotomy( T3 ) , at the end of an-astomosis of left anterior descending(T4), at the end of anastomosis of right coronary artery or 1eft circum flex coronary artery(T5) and after operation ( T6 ) .Body tempreture and urine volume were recorded during the operation.Total quantity of analgesics consumption and heart adverse reaction( bradyarrhythmia, tachycardia, hypotension, hypertension etc) were also recorded. Results At T2 -T6 , there was a significant decline in HR, MAP, SVRI, PVRI and CI in group D2 and group D3 compared with group C (P<0.05).SVRI and PVRI in group C and group D2 significantly increased at T3 -T6 compared with those at at T0(P<0.05).At T2 and T6, HR and MAP in group group D2 signicantly increased compared with group D3([57 ±6]times/min vs [52 ±4] times/min, [72 ±7]mmHg vs [63 ±5]mmHg;[72 ±5]times/min vs [55 ±6]times/min, [68 ±5]mmHg vs [63 ±5]mmHg)].At T4 -T6, significant difference was found in CI, SVRI and PVRI between group D2and group D3(P<0.05).In comparison to group C, hypertension, tachycardia in-cidence, noradrenaline amount and isosorbide mononitrate amount declined significant in group D2and group D3(P<0.05);hypoten-sion and bradycardia incidence increased significantly while isosorbide mononitrate amount reduced significantly(P <0.05). Conclusion In OPCABG, dexmedetomidine infused at 0.4μg/(kg· h) after a loading dose of 0.5μg/(kg· 10 min) is useful in maintaining stable hemodynamics which contributes to oxygen balance and reduces myocardium injury in patients.
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Aim To investigate the antagonistic effect of resveratrol on neuropathic pain and its underlying mechanism. Methods Neuropathic pain was induced by ligation of L5 spinal nerve (SNL) in rats. 90 male Sprague-Dawley rats, fit with intrathecal catheters were divided randomly into six groups ( n = 15 ): naive group; sham group; SNL group; high dosage of res-veratrol group (300μg);middle dosage of resveratrol group ( 30μg ) and low dosage of resveratrol group (3μg). The naive group did not make any process. In sham group, the L5 spinal nerve was only exposed without ligation. Other groups received SNL. Different dosages of resveratrol dissolved in 10μL 100% DMSO were administered by intrathecal injections once a day for 4 days, starting on day 4 after SNL. Paw withdraw-al latency (PWL) was measured on day 1,3,5,7,9, 11,14 days after surgery separately. On day 7 after be-havioral testing, the lumbar segments of the spinal cord were removed to measure the level of SIRT1 and acety-lated-p65(Ac-p65) for western blot. The activation of NF-κB was determined through calculating the percent-age of NF-κB-immunofluorescence positive staining cells in this study. Results Compared with sham groups,the SNL group showed an obvious decrease(P< 0. 05) of PWL and SIRT1 after surgery,whereas Ac-p65 and actived NF-κB significantly increased ( P <0. 05) in the spinal cord. Administration with high and middle dosages of resveratrol markedly attenuated(P <0. 05) SNL-induced thermal hyperalgesia and down-regulation of SIRT1 and blocked (P < 0. 05) the SNL-induced up-regulation of Ac-p65 and actived NF-κB in the spinal cord. Conclusion Intrathecal resveratrol can inhibit the development of neuropathic pain and suppress the activation of NF-κB signaling in SNL rats . The analgesic effect of resveratrol is implemented partly via increasing the level of SIRT1 and deacetylat-ing p65.
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Objective To explore the effects of intrathecal injection of acetyltransferase p300 inhibitor Garcinolon on hyperalgesia in a rat model of L5 spinal nerve ligation and its underlying mechanism. Methods After lumber intrathecal catheters implanted,90 male Sprague-Dawley rats (40-50 d,weighing 180-220 g)were randomly divided into six groups (n=15 each):Naive group (group N),Sham operation group (group S),SNL group (group C)and three Garcinol treatment groups (group H:500μg/kg,group M:100μg/kg,group L:20μg/kg).Group N did not receive any operation in rats.In group S,the L5 spinal nerve was only exposed without ligation.Other four groups all received spinal nerve ligation (SNL).Group N,group S and group SNL were administrated intrathcelly with 100% DMSO (10 μl)within 3 to 6 days after SNL surgery.Other three groups were treated with Garcinol 500μg/kg (group H),100μg/kg (group M),20 μg/kg (group L)at the same points respectively.Behaviorally,thermal withdrawal latency (TWL) were measured at 1 day (T0 )before and on days 1(T1 ),3(T2 ),5(T3 ),7(T4 ),9(T5 ),11(T6 ),14(T7 )after surgery separately.On the 7th day after behavioral testing,the lumber segment of the spinal cord was removed to test the level of p300 and acetyl-p65 by western blot,while NF-κB was detected with immunofluorescence. Results Compared with group N,TWL was significantly shortened in group C,L,M and H,the levels of ace-tyl-p65 and p300 in group C,L,M and H were markedly increased,the expression of NF-κB in group C,L,M and H was markedly increased(P<0.05).Compared with group C,TWL was significantly prolonged in group M and group H,the levels of acetyl-p65 and p300 in group M and group H were dramatically decreased,the expression of NF-κB in group H was obviously decreased(P <0.05).Conclusion The acetyltransferase p300 inhibitor Garcinol imposes protective effect in SNL-induced neuropathic pain.Mechanisms are probably associ-ated with decreasing acetyl-p65 protein expression level in the NF-κB pathway.
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Aim Toinvestigatetheantagonisticeffect of intrathecal injection of carbenoxolone (CBX ) on neuropathic pain and its underlying mechanism.Meth-ods SixtymaleSprague-Dawleyratswererandomly divided into five groups (n =12 ):group I received sham surgery then treated with saline;group Ⅱ re-ceived SNT then treated with saline;groupⅢreceived SNT then treated with 0. 05 μg CBX;group Ⅳ re-ceived SNT then treated with 0. 5 μg CBX;group Ⅴreceived SNT then treated with 5 μg CBX.Treatment was undertaken with 10 μl volume as a single intrathe-cal injection on postoperative day 10.Mechanical with-drawl thresholds were measured 1 d before operation, 1,3,5,7 and 10 d after surgery,1 h before intrathe-cal administration,and 1 ,2,4,6 h after intrathecal administration.Lumbar spinal cord was obtained 2 h after intrathecal administration to determine the expres-sions of GFAP by immunohistology and TNF-α,IL-1βby ELISA in bilateral spinal dorsal horns.Results Comparedwiththeshamgroup,thebilateralMWTin group Ⅱ ~Ⅴ was significantly decreased.Compared with the MWT 1 h before intrathecal administration on day 10,the values at 1 ,2,4,6 h after administration of group Ⅱ and Ⅲ had no marked difference.The ip-silateral MWT in groupⅣhad no significant difference at 1,2,4 h after administration,the contralateral MWT was significantly increased,whereas GFAP and TNF-α,IL-1βwas significantly decreased in the spinal cord .In group Ⅴthe bilateral MWT was significantly improved at 1 ,2,4 h after administration,whereas GFAP and TNF-α,IL-1βwere significantly decreased inthespinalcord.Conclusions IntrathecalCBXcan inhibit the development of bilateral MWT.The analge-sic effect of CBX is implemented partly via suppressing the actation of GFAP and the realease of TNF-α,IL-1βin the spinal doral horn.
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Objective Beta platelet-derived growth factor receptor ( PDGFR-β)-mediated signaling plays a key role in mor-phine tolerance , but its molecular mechanisms are not yet completely understood .The present study aims to investigate whether the ex-tracellular signal-regulated kinase ( ERK) and cyclic AMP response element binding protein ( REB) signaling pathways are involved in the development of PDGFR-βactivation-induced morphine tolerance in rats . Methods Thirty-six adult male SD rats were randomly divided into six groups of equal number:normal saline (20μL), morphine (15μg), morphine +imatinib (morphine 15μg +ima-tinib 10μg), morphine +PDGF-BB (morphine 15μg +PDGF-BB 10 ng), imatinib (10μg), and PDGF-BB (10 ng), all treated intrathecally at 20μL once daily for 7 consecutive days .Paw withdrawal latency ( PWL ) was measured 1 d before and 30 min after medication at 1, 3, 5, and 7 days, respectively, followed by calculation of the maximal possible effect of analgesia (MPE).On the 8th day, PWL was again obtained from all the rats at 30 min after intrathecal injection of morphine (15μg).Then, all the animals were sacrificed and the L4-5 segment of the spinal cord was isolated for determination of the expressions of ERK , phosphorylated ERK ( p-ERK) , CREB, and phosphorylated CREB ( p-CREB) by Western blot. Results At 5 and 7 days after medication, MPE was significant decreased in the morphine group ([52.90 ±8.20] and [15.12 ±3.80] %) and the morphine +PDGF-BB group ([43.51 ±5.42] and [14.81 ±3.60] %) as compared with (100.00 ± 0.00) %in both groups at 1 day (P<0.05), but had no significant changes in the morphine +imatinib group at 1, 3, 5, and 7 days.After intrathecal injection of morphine on the 8th day, MPE was (16.22 ±2.51) %in the morphine group, (15.22 ±3.50) %in the morphine +PDGF-BB group, and (35.21 ±4.51) %in the PDGF-BB group, all remarkably lower than (100.00 ±0.00) %in the control group (P<0.05).There were no significant differences in the expression levels of ERK and CREB among the six groups.The expressions of spinal p-ERK and p-CREB were markedly increased in the morphine , morphine +PDGF-BB, and PDGF-BB groups as compared with the control group (P<0.05), but significantly decreased in the morphine +imatinib group in compari-son with the morphine group, (P<0.05). Conclusion The PDGFR-βsignaling pathway plays an important role in the develop-ment of tolerance to morphine-induced analgesia and its underlying mechanisms may be associated with the activation of the ERK and CREB pathways .
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Objective To evaluate the effects of edaravone on postoperative delirium in aged patients following total hip -re-placement surgery . Methods Two hundred and forty-six patients undergoing unilateral hip replacement surgery were randomly divided into edaravone group and control group .Patients in the edaravone group were intravenous injected with edaravone 30 mg before anesthesia induction, whereas patients in the control group received the same volume of saline solution .On preoperative day 1 and postoperative day 1, confusion assessment was applied to evaluate the consciousness of patients .The length of hospital stay , incidence of myocardial infarc-tion, stroke, pulmonary embolism, pneumonia and transfusion volume were also recorded .Also, the levels of plasma malondialdehyde ( MDA) superoxide dismutase ( SOD) , neuron-specific enolase ( NSE) and S100βprotein ( S100β) were measured on the preoperative and postoperative day 1. Results There was no difference in the length of hospital stay , the incidence of perioperative acute pulmonary embolism, myocardial infarction and stroke (P>0.05).POD was significantly lower in the edaravone group than the control group (P0.05).On the postoperative day 1, plasma levels of MDA and NSE were significantly lower in the edaravone group than the control group (P<0.05). Conclusion Edar-avone can reduce the incidence of POD in aged patients following total hip-replacement surgery .
ABSTRACT
Objective Lipocalin-2(LCN2) can promote the M1 approach of microglia.The study was to explore the effect of activated microglia induced by LCN 2 on depression pathogenesis in rats and its mechanism . Methods According to the chronic stress depression model created by Willner , 40 adult male SD rats were divided into 4 groups(n=10): normal control group;UCMS group;UCMS+LCN2 siRNA group;LCN2 siRNA control group .A series of stress stimulation was given on UCMS group and UCMS +LCN2 siRNA group for 21 days to create depression model .At 7 days after the stress stimulation , the rats in UCMS+LCN2 siRNA group and LCN2 siRNA control group were anaesthetized by 0.4mg intraperitoneal injection of 10% chloral hydrate , followed by intrathecal injection of LCN2 siRNA(0.015 μL/g, 3 times a week) to the rats till the end of the stress (21 days).At the same time, the same volume of isotonic saline was given to normal control group and UCMS group .The weight of rats was measured every week and the sucrose preference and the forced swimming test were applied to measure behavior of the rats after the experiment .The hippocampus of the rats were extracted and immunofluorescence and western blot were applied to detect the expressions of microglia specific markers:LCN2 and the Iba. Results At 3 week, the weight of rats in UCMS+LCN2siRNA group was higher than that of UCMS group ([262.82 ±0.01]g vs [179.98 ±0.08]g, P<0.05).The weight of rats in normal control group and LCN2 SiRNA control group increased significantly higher than the other two groups (P<0.05).The sucrose preference values of normal control group (0.82 ±0.01),UCMS+LCN2 siRNA group(0.81 ±0.01) and LCN2 siRNA control group(0.82 ±0.01) were higher than that of UCMS group (0.25 ±0.04) (P<0.05).The fixed time of the forced swimming test of UCMS+LCN2siRNA group decreased significantly compared with UCMS group ([4.64 ±0.8]s vs [23.11 ±2.63]s, P<0.05).The LCN2 expression of UCMS group was significantly greater than the other groups (P<0.05).The Iba1 expression in the hippocampus of the UCMS group increased significantly compared with other groups . Conclusion LCN2 is associated with the pathogenesis of de-pression induced by chronic stress reaction and is mechanism may be related to the activation of microglia in the central nervous system of rats.