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Objective To investigate the effect of genetic factors on the occurrence of chronic post-thoracotomy pain syndrome ( PTPS) from the perspective of genetic polymorphisms. Methods Two hun-dred patients of both sexes, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 18-80 yr, scheduled for elective video-assisted thoracoscopic radical lung cancer surgery, were enrolled in this study. Blood samples were taken before operation for genotype analysis of 20 SNP loci, such as rs4073 and rs3774932, after DNA extraction. Postoperative multimodal analgesia was applied to maintain the visual an-alogue scale score ＜3. All the patients were followed up for 2-4 months after operation to record the occur-rence of PTPS. The patients were divided into 2 groups according to whether PTPS occurred: non-PTPS group (group N) and PTPS group (group P). Results The incidence of PTPS was 38. 7％ after surgery, and there were 114 patients in group N and 72 cases in group P . There was significant difference in A/T al-lele and genotype frequency at interleukin-8 rs4073 site and NF-κB1 rs3774932 site between the two groups (P＜0. 05). Conclusion Interleukin-8 and NF-kappa B1 genetic polymorphisms are associated with the occurrence of PTPS.
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Objective:To observe the effect of sciatic nerve pulsed radiofrequency (PRF) on the activation levels of microglia cells and astrocytes in spinal dorsal horn in the chronic constriction injury (CCI) rat models, and to explore the relationships between the analgesic mechanism of sciatic nerve PRF and the activation levels of microglia cells and astrocytes in the spinal dorsal horn.Methods:Forty male SD rats were randomly divided into CCI shamoperation+RPF sham group (SS group) , CCI sham-operation+RPF group (SP group) , CCI+RPF sham group (CS group) , CCI+RPF group (CP group) (n=10) .PRF was applied on the sciatic nerve on the 4th day after CCI operation for 120s, with a maximum temperature of 42℃.The mechanical withdrawal thresholds (MWT) and thermal paw withdrawal latencies (TWL) were measured to evaluate mechanical hyperalgesia and thermal hyperalgesia 1dbefore operation (D0) and 1, 3, 5, 7dafter operation (D1, D3, D5, D7) .Western blotting method was used to detect the protein expression levels of ionized calcium binding adapter molecule 1 (Iba-1) and glial fibrillary acidic protein (GFAP) in the ipsilateral spinal dorsal horn of L3-5after pain behavioral test (D7) .Results:Compared with SS group, the rats in CS group after CCI had the significant behavioral changes, such as hallux valgus, lameness, toe bending, and foot raising during walking;MWT and TWL were decreased significantly (P＜0.01) ;the expression levels of Iba-1and GFAP proteins in the ipsilateral spinal dorsal horn were increased significantly (P＜0.05) .Compared with CS group, the behavioral changes of the rats in CP group (D5, D7) such as hallux valgus, lameness, toe bending, and foot raising during walking were alleviated significantly;MWT and TWL were increased significantly (P＜0.01) ;the Iba-1protein expression level in spinal dorsal horn was downregulated significantly (P＜0.05) and the GFAP protein expression level did not change significantly (P＞0.05) .Conclusion:PRF on sciatic nerve can relieve the neuropathic pain (NP) of the CCI rat models;PRF on sciatic nerve can inhibit activation of the microglia cells in the spinal dorsal horn.The analgesic mechanism of PRF on sciatic nerve may be associated with the inhibition of the activation of microglia cells in the spinal dorsal horn.
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Comfort medical treatment has aroused the attention of all walks of life.Perioperative analgesia will be one of the important components.The analgesic guidelines of American Society of Anesthesiologists (ASA) and anesthesiology are all advocating multi mode analgesia.Transversus abdominis plane (TAP) block is considered to be one of the effective methods of multimode analgesia in the perioperative period.It can provide analgesia for surgical perioperative period,reduce the dosage of opioid after operation and the incidence of adverse reactions.We review the relevant factors on patient selection,anesthetic seletion and clinical efficacy for TAP block by reviewed relative literatures,aiming to provide new methods and ideas for clinical practice.TAP block opens new ideas for perioperative analgesia,and it is a new direction of multimode analgesia during perioperative period.
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Objective To compare the efficacy of CT-guided radiofrequency thermocoagulation (RFTC) treatment through the inside and outside of the foramen rotundum for primary trigeminal maxillary neuralgia.Methods Forty-eight patients of both sexes,aged 58-75 yr,suffering from primary trigeminal neuralgia the 2nd trigeminal branch pain,scheduled for elective CT-guided trigeminal RFTC,were divided into 2 groups (n =24 each) using a random number table:inside of foramen rotundum group and outside of foramen rotundum group.The needle was inserted until the lateral 1/3 of the foramen rotundum was reached under CT guidance in inside of foramen rotundum group or until the outside of the foramen rotundum was reached in outside of foramen rotundum group.High-temperature RFTC 95 ℃ was performed for 120 s,repeating for 2-3 cycles.The current sensory threshold at different frequencies was measured at 1 day before and after operation.Numeric rating scale score was performed at 1 day,30 days,1 yr and 2 yr after operation,effective RFTC treatment was defined as numeric rating scale score≤ 1,and the condition of postoperative effective RFTC treatment was recorded.The development of adverse reactions such as facial hematoma,corneal ulcer,injuring the other branch and cerebrovascular accidents was recorded.Results Compared with outside of foramen rotundum group,the current sensory threshold on the affected side at frequency of 2 000 Hz was significantly increased at 1 day after operation,the rate of effective RFTC treatment was increased 2 yr after operation (P＜0.05),and no significant change was found in the incidence of postoperative facial hematoma in inside of foramen rotundum group (P＞0.05).Conclusion The long-term curative effect of CT-guided RFTC treatment for primary trigeminal maxillary neuralgia through the inside of the foramen rotundum is better than that through the outside of foramen rotundum.
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Objective:To evaluate the efficacy and safety of oxycodone combined with dexmedetomidine in the postoperative analgesia in the patients underwent laparoscopic radical surgery of colon cancer.Methods:Sixty colon cancer patients underwent laparoscopic radical surgery and recevied patient-controlled intravenous analgesia after operation were randomly divided into control group and experiment group (n=30)using The "Envelope Method". The patients in control group were given 0.5 mg·kg-1 oxycodone,and the patients in experiment group were given 0.5 mg·kg-1 oxycodone and 2 μg·kg-1 dexmedetomidine.The parameters of analgesic pump in two groups were set as follows:the continuous perfusion rate was 1 mL·h-1 ,the single bolus was 1.5 mL,the lock-out time was 10 min,and the total volume was 100 mL.The VAS scores of pain at rest and activity pain of the patients in two groups were evaluated at exiting the post anesthesia care unit (T1 ),and at 6 h (T2 ),12 h (T3 ),24 h (T4 )and 48 h (T5 )after operation.The dose of analgesic drugs used,times of emergent rescue analgesia and anus exhaust time after operation of the patients in two groups were recorded;the postoperative adverse responses,vital signs and Ramsay scores of the patients in two groups were observed.Results:The VAS scores of activity pain at T2 -T5 and pain at rest at T2 -T4 of the patients in experiment group (P T2-T5 =0.000;P T2 =0.018,P T3 =0.001,P T4 =0.010)were lower than those in control group;the doses of analgesic drugs used and times of emergent rescue analgesia of the patients in experiment group were significantly lower than those in control group (P =0.000,P =0.029);the anus exhaust time after operation was significantly earlier than that in control group (P =0.030);the cases of nausea of the patients in experiment group were significantly lower than that in control group (P =0.023), and there were no significantly differences in the other various adverse effects of the patients between two groups (P >0.05).Conclusion: Oxycodone combined with dexmedetomidine is effective and safe for the postoperative analgesia after laparoscopic radical surgery of colon cancer.
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Objective To study multimodal analgesia in patients who underwent transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods 60 patients who underwent TACE for HCC from Aug.2016 to Nov.2016 were randomized into two groups:the multimodal analgesia group and the control group.The pain scores of these two groups of patient during the procedure and at different posttreatment time points,and the rates of adverse effect and pharmacoeconomic differences were recorded.Results When compared to the control group,the pain scores at 0 h,2 h,4 h,6 h,12 h after treatment in the multimodal analgesia group were significantly lower (P ＜ 0.05),and the satisfactory scores for the patients were significantly improved (96.6％ vs.66.7％).The multimodal group of patients also had significandy lower adverse effect rates of nausea and vomiting,and it was more cost-effective.Conclusions Patients who required multimodal analgesia had better pain relieve,patient satisfaction and less adverse reactions after TACE than patients in the control group.Multimodal analgesia was a safe,effective and economic way to control TACE pain and it was worth recommended in clinical practice.
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Objective To explore the clinical features of spontaneous intracranial hypotension (SIH) headache. Methods Thirty-six cases with SIH headache who were admitted between August 2009 and September 2014 were retrospectively analyzed. Results Twenty-five (69.4%) of 36 cases were female, and 11 cases (30.6%) were male. The age of onset was (39.6 ± 11.9) years. All the cases had headache, among whom 91.7% (33/36) had typical postural headache. The common concomitant symptoms were nausea, vomiting and neck stiffness. The average cerebrospinal fluid (CSF) pressure was (45.3 ± 28.6) mmH2O (1 mmH2O=0.009 8 kPa) which in male was (67.4 ± 15.4) mmH2O , and in female was (37.3 ± 28.2) mmH2O, and there was significant difference (P<0.05). The content of CSF protein was (545.6 ± 377.1) mg/L and the level of IgG was (57.4 ± 41.1) mg/L. Seventeen cases showed abnormality on MRI scan, with diffuse pachymeningeal enhancement, subdural hematoma, hyperemia and swelling pituitary. Eleven cases (52.4%, 11/21) showed abnormal on EEG examination, with theta waves and epiletiform waves in bilateral cerebral hemisphere. All cases were cured after conservative treatment, 3 cases relapsed within 1 month and was cured again. Conclusions Typical postural headache, cerebrospinal fluid pressure less than 60 mmH2O, higher levels of CSF protein and IgG, diffuse pachymeningeal enhancement and hyperemia and swelling pituitary on MRI scan are the main features in SIH headache, and this disease has favorable prognosis.
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Objective To establish male rat models for fertility following liver transplantation. Methods Male Sprague-Dawley (SD) rats were used as the donors and recipients of liver transplantation. The donor liver was transplanted with two-cuff technique. Liver transplantation was performed in 15 male SD rats. At 3 weeks after liver transplantation, 5 rats were randomly sacrificed for detection of sperm deformity rate. The remaining male rats were mixed bred and mated with healthy female SD rats at a ratio of 1︰2. General conditions of the rats undergoing liver transplantation were recorded. Liver function parameters were detected after liver transplantation. Postoperative sperm deformity rate was observed. The pregnant status of female rats and health situation of their offsprings was monitored. Results All 15 rats (100%) underwent liver transplantation successfully. Nine rats (9/10) survived longer than 8 weeks. Liver function parameters were normal in male rats following liver transplantation. The sperm deformity rate was ranged from 0.5% to 1.3%. Ten male rats undergoing liver transplantation were mixed bred with female rats at a ratio of 1︰2 for 1 week. All female rats were successfully mated and delivered their offsprings after 3 weeks. The offsprings had no evident physiological deformity. Conclusions Male rat models for fertility are successfully established after liver transplantation, which serve as an animal model to evaluate the fertility performance in male patients undergoing liver transplantation.
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Objective:To study the effects of expansion of ropivacaine hydrochloride liquid on the postoperative analgesia,sedation, hemodynamic effects and adverse drug reactions of the patients underwent endoscopic thyroidectomy,and to explore its clinical effectiveness and safety. Methods:Forty patients who were to undergo endoscopic thyroidectomy via chest-breast approach were randomly assigned to saline solution group and expansion liquid of ropivacine hydrochloride group (ropivacaine group,n = 20).The mean arterial pressure (MAP )and heart rate (HR)were also evaluated at the following time points:preoperative evaluation (T0 ),before local anesthetic infiltration (T1 ),at the end of the operation (T2 );the blood loss,the operation time,the postoperative drainage,and the hospital duration of the patients in two groups were recorded; the nausea and vomiting,the respiratory depression,the toxicity response,the infection,and the recurrent laryngeal nerve injury during 24 h after operation were recorded.The postoperative pain scores were assessed at extubaltion (T3 ),30 min (T4 ),2 h (T5 ),6 h (T6 ),12 h (T7 )and 24 h (T8 )after extubation using Visual Analog Scale (VAS).The postoperative Ramsay scores were assessed at T3 and T4 .Results:There were no significant differences in MAP and HR at T0 and T1 of the patients between two groups (P >0.05).Compared with saline solution group,the MAP and HR at T2 and T3 of the patients in ropivacaine group were significantly decreased (P < 0.05).There were significant differences in the blood loss,the operation time, the postoperative drainage,and the hospital duration of the patients between two groups (P <0.05).The number of patients required postoperative analgesia and the number patients with nausea and vomiting in ropivacaine group were decreased compared with saline solution group (P <0.05).Compared with saline group,the VAS scores at T3 ,T4 ,T5 ,T6 ,T7 and T8 of the patients in ropivacaine group were significantly decreased (P <0.05);the Ramsay scores at T3 and T4 of the patients in ropivacaine group were also decreased significantly (P <0.05).Conclusion:Expansion liquid of ropivacaine hydrochloride can reduce the stress response during endoscopic thyroidectomy effectively and reduce the postoperative pain and injury induced by operation.
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Objective To study the influence of sole massage on children’s analepsia from general anesthesia.Methods One hundred children in analepsia period were divided into the test group(50 cases)and the control group(50 cases).The routine nursing and monitoring during recovery stage were done in the control group.Based on the routine monitoring and nursing care as in the control group,the test group received sole massage for 10 minutes.The two groups were compared in terms of declining percentage of SpO2, rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores.Result The test group was significantly lower than the control one in all the indexes of the declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability,and post-analepsia dysphoria scores(all P<0.05).Conclusions Sole massage during children’s analepsia from general anesthesia is effective not only in lessening their declining percentage of SpO2,rate of nausea,blood pressure,heart-rate variability, and recovery dysphoria mark,but also easing their dysphoria,anxiety and fear.It may create a good condition for children to live through analepsia period successfully and safely.
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[Objective]To explore the roles of TIDC(tumor infiltrating dendritic cell)and TIL-T(tumor infiltrating T lymphocyte)in tumor immunity of EBV-associated gastric carcinoma(EBVaGC)and their clinical significance.[Methods]TIDC and TIL-T in EBVaGC(n=49)and EBVnGC(EBV-negative gastric carcinoma)(n=20)were detected by immunohistochemistry method and then their subtypes and their relationships with clinical and pathological factors were analyzed.[Results]Mild infiltration was detected in 29 of 49(59.2%)EBVaGCs and 18 of 20(90%)EBVnGCs,while marked infiltration of TIDC was detected in 20 of 49(40.8%)EBVaGCs and 2 of 20(10%)EBVnGCs.And the difference between the two groups was significant (P=0.013).The number of TIL-T in EBVaGC was hisher than that in EBVnGC(P=0.017),and most of them were CTLs.The number of TIL-T was positively correlated with that of TIDC(r=0.386,n=49,P=0.006).The degree of TIL-T infiltration in EBVaGC had negative relationship with the lymph node metastasis(P＜0.001),while TIDC had no relationship with the clinical features.[Conclusion]TIDC and TIL-T may play important roles in the tumor immunity of EBVaGC;TIDC may contribute to the TIL-T recruitment in EBVaGC.
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[Objective] Expressions of human epidermal growth factor receptor 2(HER-2),p53,estrogen receptor (ER),and progesterone receptor (PR) in tissues of breast invasive ductal carcinoma are not only applied to determine the therapeutic regimen,but they may also be related to the prognosis.We investigated the levels of these proteins among different clinical stages and the correlations.[Method] One hundred and thirty-eight tissues from cases with breast invasive ductal carcinoma were tested with immunohistochemistry.New scoring standards and rank test were applied.The indices were digitalized and semi-quantified.[Results] In the tissues from high clinical stage,the expression of HER2 was significantly increased,while expression of PR was markedly decreased.[Conclusion] Expression of HER2 and PR might be better markers for predicting clinical stages and prognosis.
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Objective To assess the risk factors for pneumonia in patients with acute stroke. Methods Three hundred and forty patients with acute stroke were studied, and risk factors for pneumonia such as demographics, history of hypertension, diabetes and smoking, initial blood pressure, body temperature, fasting plasma glucose level, C-reactive protein, National Institutes of Health Stroke Scale ( NIHSS) scores, degree of dysphagia and mechanical ventilation were evaluated. Besides, the correlation between incidence of pneumonia and pneumonia scores in patients with acute stroke was studied. Results Pneumonia was developed in 63 patients (18.5%). Logistic regression analysis revealed that age, gender, initial NIHSS scores, dysphagia and mechanical ventilation were independent predictors for pneumonia (P <0.05). The incidence of pneumonia gradually increased with the pneumonia scores. Conclusion The occurrence of pneumonia after acute stroke is associated with older age, male gender, high NIHSS scores, dysphagia and mechanical ventilation. The pneumonia scores can be adopted to identify the risks of pneumonia after acute stroke.
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Subject To explore the features of the abnormalities of the sex chromatin and the sex chromosome of the patients with mental disorders. Methods The sex chromatin in the cells of buccal mucous membrane of the 2 784 patients with mental disorders were examined by using a blinding and random way. The chromosome karyotypes in peripheral blood were further examined in those whose measure showed abnormal. The comparison group consisted of 1 069 normal persons.Results Compaired with the control group,the average frequency of Y chromatin in the male patients [(28.0±6.6)%] and the average frequency of X chromatin in the female patients [(22.3±8.0)%] rose significantly ; the average frequency of X chromatin in the female patients of the schizophrenia subgroup and the affective disorder subgroup were higher than that of neurosis and psychogenic mental disorder subgroup. X chromatins of eight male patients were positive and the karyotypes of the abnormal X chromosome were 47,XXY in 3 cases and 47,XXY/46,XY in 5 cases, the rate of 47,XXY was 7.7 , it rose significantly to the control group. X chromatin of two female patients were negative and the karyotypes of the abnormal X chromosome was 45,X/46,XX, the rate of 45,X was 1.2 ; one female patient had double X chromatin and the karyotypes of the abnormal X chromosome was 47,XXX/46,XX,there is no abnormal sex chromatin and sex chromosome in the control group.Conclusions The higher rate of the sex chromatin might be closely associated with the tendency of heredity of mental disorders , and the rate of the lacking X chromosome in females and the increasing X chromosome in males rise in the patients with mental disorders.
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AIM:To investigate the expression of TLR2 and TLR4 in hepatocellular carcinoma(HCC),and to analyze their correlations to clinicopathologic features of HCC.METHODS:The protein and mRNA levels of TLR2 and TLR4 in HCC and para-tumor tissue were determined by immunohistochemistry and real-time fluorescence quantitative PCR(RFQ-PCR).RESULTS:The protein and mRNA levels of TLR2 and TLR4 in HCC were lower than those in para-tumor tissue(P
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Objective To compare the effect of midazolam and propofol on cytokine balance in patients undergoing cardiac valve replacement under CPB. Methods Twenty NYHA class Ⅱ - Ⅲ patients with rheumatic heart disease scheduled for elective cardiac valve replacement under CPB were randomly divided into 2 groups: midazolam group (M, n = 10) and propofol group (P, n = 10) . Patients with preoperative hepatic and renal dysfunction, coagulation defect and diabetes, primary hypertension and coronary artery disease were excluded. The patients were premedicated intramuscular morphine 0.1 mg?kg-1 and oral diazepam 0.1 mg?kg-1. Anesthesia was induced with midazolam 0.06-0.1 mg?kg-1 (group M) or propofol 1.0-1.5 mg?kg-1 (group P) and scopolamine 0.6 mg, fentanyl 4-10 ug?kg-1, vecuronium 0.1 mg?kg-1 and lidocaine 1.5 mg?kg-1, and maintained with intermittent iv boluses of midazolam 0.04-0.1 mg? kg-1 (group M) or propofol intravenous infusion at a rate of 3-5 mg?kg-1?h-1 supplemented with intermittent boluses of fentanyl and vecuronium. PETCO2 was maintained at 30-40 mm Hg during mechanical ventilation. BP, HR, ECG, CVP, PETCO2, SpO2 , nasal and rectal temperature were continuously monitored during operation. Blood samples were taken from artery before anesthesia (T1), at vena cava catheterization (T2), 30min after aortic cross-clamping (T3) and 10 min (T4), 1 h (T5), 2 h(T6), 4 h(T7) and 24 h(T8) after declamping of aorta for determination of Hct, IL-1, IL-8 and IL-10 by using ELISA. Results Plasma concentrations of IL-6, IL-8 and IL-10 were significantly increased at T4-7 as compared with the baseline value before anesthesia (T1) in both group. Plasma concentration of IL-8 in group P was significantly lower than that in group M at T7 ( P
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AIM:This study was to investigate the expression and significance of Bmi-1 in colorectal carcinoma (CRC),and to explore the effect of Bmi-1 on Ki67 expression in human CRC.METHODS:The samples from sixty CRC,thirty adenomas and twenty normal colorectal mucosal tissues were used in this study. The expression of Bmi-1 protein was detected by immunohistochemistry. The clinicopathological features and survival rate of patients were also analyzed.RESULTS:The overexpression of Bmi-1 was respectively 25.0%,6.7%and 0% in CRC and adenomas as well as normal colorectal mucosal tissues. The results showed that the expression of Bim-1 was significantly higher in CRC,compared with that in adenomas and normal colorectal mucosal tissues (P0.05). Kaplan-Meier survival analysis showed that the overexpression of Bmi-1 reduced significantly survival of CRC patients (P