Comparison of the effect between electroacupuncture and NSAIDs on pain memory based on cAMP/PKA/CREB pathway in anterior cingulate gyrus / 中国针灸

OBJECTIVE@#To observe the direct intervention effects of electroacupuncture (EA) and non-steroid anti-inflammatory drugs (NSAIDs) on pain memory, and to explore their effects on cAMP/PKA/cAMP pathway in anterior cingulate gyrus (ACC).@*METHODS@#Fifty clean healthy male SD rats were randomly divided into a control group, a model group, an indomethacin group, an EA group and a sham EA group, 10 rats in each group. Except the control group, the pain memory model was established in the remaining four groups by twice injection of carrageenan at foot; 0.1 mL of 2%λ-carrageenan was subcutaneously injected at the left foot of rats; 14 days later, when the pain threshold of rats of each group returned to the basic level, the second injection was performed with the same procedure. The rats in the EA group were treated with EA at bilateral "Zusanli" (ST 36) for 30 min; the rats in the indomethacin group was treated with indomethacin intragastric administration with the dose of 3 mg/kg; the rats in the sham EA group was treated with EA without electricity at the point 0.3 mm forward "Zusanli" (ST 36) with the depth of 2 mm for 30 min; the rats in the control group was not given any invention. All the above interventions were performed 5 h, 1 d, 2 d and 3 d after the second injection of 2% λ-carrageenan. The left-side paw withdrawal thresholds (PWT) were observed before the first injection, 4 h, 3 d, 5 d after the first injection, before the second injection and 4 h, 1 d, 2 d, 3 d after the second injection. Three days after the second injection, the number of positive cells of cAMP, p-PKA, p-CREB and the number of positive cells of protein co-expression in the right ACC brain area were detected by immunofluorescence, and the relative protein expression of p-PKA and p-CREB were detected by Western blot.@*RESULTS@#Compared with the control group, the PWTs in the model group decreased significantly 4 h, 3 d and 5 d after the first injection and 1 d, 2 d and 3 d after the second injection (<0.05); compared with the control group, the positive expression of cAMP, p-PKA and p-CREB in the right ACC brain area in the model group increased significantly (<0.05), and the number of positive cells of the co-expression of cAMP/p-PKA and p-PKA/p-CREB also increased significantly (<0.05). Compared with the model group, indomethacin group and sham EA group, the PWTs in the EA group were increased significantly 1 d, 2 d and 3 d after the second injection (<0.05); compared with the model group, indomethacin group and sham EA group, the positive expression of p-PKA and p-CREB in the right ACC brain area in the EA group decreased significantly (<0.05), and the number of positive cells of co-expression of cAMP/p-PKA and p-PKA/p-CREB was decreased significantly (<0.05). Compared with the model group and sham EA group, the positive expression of cAMP in the right ACC brain area was decreased in the EA group (<0.05).@*CONCLUSION@#EA have a direct intervention effect on pain memory, which have significant advantage over NSAIDs in the treatment of chronic pain. The advantage effect of EA on pain memory may be related to the inhibition of cAMP/PKA/CREB pathway in ACC area.

Advance in drug treatment of autoimmune diseases / 中国药理学通报

Autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, etc.) are diseases characterized by local or systemic abnormal inflammatory immune response. At present, the treatment drugs of autoimmune diseases mainly include nonsteroid anti-inflammatory drugs, steroid anti-inflammatory drugs and disease modifying anti-rheumatic drugs (chemical medicine, natural medicine and biological agents), etc. With the pathological mechanism of autoimmune diseases to be clarified deeply and the discovery of new drug targets, new biological agents targeting cytokines and cell surface molecules have been developed rapidly. In recent years, multiple small molecule drugs targeting Janus kinase/ signal transducers and activators of transcription signaling pathway have been developed and applied in clinic. Soft regulation of inflammatory immune response drugs are the drugs with anti-inflammatory and immunomodulatory effects, as well as less adverse reactions. To develop this type of drug will be a new strategy and one of the main directions for the treatment of autoimmune diseases. The research progress of medicines to treat autoimmune diseases has been reviewed in this paper.

Research concerning the effect of analgesics on fracture healing / 中华创伤骨科杂志

Analgesics are widely used in fracture patients before and after operation.The analgesics frequently used include non-steroidal anti-inflammatory drugs,as well as central nerve and local medications.Recently,researches report that some analgesics may inhibit fracture healing,which has attracted much attention from orthopedic surgeons.However,there are researchers who hold opposite opinions.Accordingly,this paper reviews the progress in research concerning the effect of analgesics on fracture healing.

The Prescription Pattern of Acetaminophen and Non-Steroidal Anti-Inflammatory Drugs in Patients with Liver Cirrhosis

Analgesics, known to be hepatotoxic drugs, are frequently prescribed to patients with liver cirrhosis who are prone to drug-induced liver injury. No guidelines are available regarding the prescription of analgesics in these patients. Therefore, we aimed to evaluate the prescription pattern of most frequently used analgesics in patients with cirrhosis. We assessed the prescription pattern of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with liver cirrhosis registered in Health Insurance Review Assessment Service database between January 1, 2012 and December 31, 2012. A total of 125,505 patients with liver cirrhosis were registered from January 1, 2012 to December 31, 2012. Of that group, 50,798 (40.5%) patients claimed reimbursement for at least one prescription for acetaminophen or NSAIDs during the one year follow-up period. Overall, NSAIDs (82.7%) were more prescribed than acetaminophen (64.5%). NSAIDs were more prescribed than acetaminophen even in decompensated cirrhosis compared with compensated cirrhosis (71.5% vs. 68.8%, P value < 0.001). There was a marked difference in prescription preference between acetaminophen and NSAIDs among physicians. Internists more frequently prescribed acetaminophen than NSAIDs compared to other physicians (50.9% vs. 76.2%, P < 0.001). Gastroenterologists more frequently prescribed acetaminophen over NSAIDs compared to other internists (80.9% vs. 51.2%, P < 0.001). Analgesics were prescribed in 40.5% of patients with cirrhosis. NSAIDs were more frequently prescribed although they should be avoided. The prescription pattern of analgesics were different significantly among physicians in patients with liver cirrhosis. The harmful effects of NSAIDs in patients with cirrhosis should be reminded to all physicians prescribing analgesics.

Conhecimento e atitudes de fisioterapeutas sobre fármacos anti-inflamatórios não esteroides / Physical therapists understanding and attitudes toward non-steroid anti-inflammatory drugs

JUSTIFICATIVA E OBJETIVOS: No Brasil, estudos sobre o conhecimento de fisioterapeutas sobre a utilização dos fármacos anti-inflamatórios não esteroides (AINES) são raros ou mesmo inexistentes. O objetivo deste estudo foi investigar o conhecimento dos fisioterapeutas no município de Fortaleza sobre o seu uso. MÉTODO: Utilizou-se um questionário com 18 perguntas estruturadas, englobando aspectos demográficos, conhecimento atual, prática atual e a posição do profissional quanto ao uso das AINES. RESULTADOS: Foram avaliados 119 profissionais, destes, 84,9% cursaram a disciplina de Farmacologia. Os resultados indicam a necessidade de maior educação em relação à legislação corrente sobre a prescrição de fármacos, já que 47,8% afirmam aconselhar, 3,3% prescrever e 21% recomendar o uso de AINES, atos não permitidos para esses profissionais. CONCLUSÃO: Identificou-se fragilidade no conhecimento do profissional fisioterapeuta acerca da utilização do uso dos AINES, ressaltando-se a não identificação de reações adversas, interações farmacológicas e o conhecimento sobre a legislação.

BACKGROUND AND OBJECTIVES: There are few, if any, Brazilian studies on physical therapists' understanding of the use of non-steroid anti-inflammatory drugs (NSAIDs). This study aimed at investigating the understanding of its use by physical therapists of the city of Fortaleza. METHOD: The study consisted of a questionnaire with 18 structured questions, encompassing demographic aspects, current understanding, current practice and professionals' position about the use of NSAIDs. RESULTS: We have evaluated 119 professionals, of whom 84.9% attended the discipline of Pharmacology. Results indicate the need for further education with regard to current legislation about drug prescription, since 47.8% stated advising, 3.3% prescribing and 21% recommending the use of NSAIDs, which is not allowed for these professionals. CONCLUSION: There is poor understanding of physical therapists with regard to the use of NSAIDs, especially the non identification of adverse reactions, drug interactions and knowledge of the legislation.

Comparação entre a anestesia geral isolada ou associada à peridural no controle da dor pós-operatória após colecistectomia videolaparoscópica / Comparison between general anesthesia alone or associated to epidural anesthesia to control postoperative pain after videolaparoscopic cholecystectomy.

JUSTIFICATIVA E OBJETIVOS: O trauma cirúrgico envolvido na colecistectomia videolaparoscópica é sabidamente menor que o do método convencional aberto, entretanto as queixas de dor pós-operatória têm sido relatadas por vários autores. Dentre as técnicas analgésicas a anestesia peridural é eficiente na redução da dor pós-operatória no método convencional, mas raramente é utilizada como método complementar nas colecistectomias por via laparoscópica. O objetivo deste estudo foi avaliar a eficácia da anestesia peridural associada com anestesia geral para controle da dor pós-operatória em pacientes submetidos à colecistectomia videolaparoscópica. MÉTODO: Cinquenta e dois pacientes submetidos à colecistectomia videolaparoscópica foram divididos aleatoriamente em dois grupos. Um grupo recebeu anestesia geral e o outro recebeu anestesia geral associada à anestesia peridural. A avaliação da intensidade da dor foi feita com a escala numérica de dor na sala de recuperação pós-anestésica, nas primeiras 24 horas e após as 48 horas que sucederam a cirurgia. RESULTADOS: Em ambos os grupos a qualidade da analgesia pós-operatória foi similar nos momentos avaliados. O grupo que recebeu anestesia peridural associada à anestesia geral apresentou a vantagem de consumir menos anestésico inalatório, mas com maior ocorrência de retenção urinária. CONCLUSÃO: Os resultados do estudo não evidenciaram razão para a associação da anestesia geral com a peridural em colecistectomia videolaparoscópica, pois a analgesia pós-operatória foi semelhante, porém com mais riscos para o paciente.Descritores: Anestesia peridural, Anti-inflamatório não esteroide, Dor pós-operatória, Colecistectomia videolaparoscópica.

BACKGROUND AND OBJECTIVES: Surgical trauma of videolaparoscopic cholecystectomy is knowingly lower as compared to the conventional open method, however postoperative pain complaints have been reported by several authors. Among analgesic techniques, epidural anesthesia is efficient to decrease postoperative pain of the conventional method, but is seldom used as additional method for laparoscopic cholecystectomies. This study aimed at evaluating the effectiveness of epidural anesthesia associated to general anesthesia to control postoperative pain in patients submitted to videolaparoscopic cholecystectomies. METHOD: Participated in this study 52 patients submitted to videolaparoscopic cholecystectomy, who were randomly distributed in two groups. One group received general anesthesia and the other received general anesthesia associated to epidural anesthesia. Pain intensity was evaluated with the pain numeric scale at the post-anesthetic care unit, in the first 24 and 48 hours after surgery completion. RESULTS: Postoperative analgesia quality was similar for both groups in evaluated moments. The group receiving epidural anesthesia associated to general anesthesia had the advantage of consuming less inhalational anesthetics, but there has been more urinary retention. CONCLUSION: Study results have not evidenced a reason to associate general and epidural anesthesia for videolaparoscopic cholecystectomy because postoperative analgesia was similar, however with higher risks for patients.

Incidência de dor no pós-operatório de cirurgia plástica estética / Incidence of postoperative pain after aesthetic plastic surgery

JUSTIFICATIVA E OBJETIVOS: A cirurgia plástica estética tem como escopo melhorar algum aspecto físico que não agrada o paciente, sendo bastante realizadas a lipoaspiração e o implante de prótese de silicone nas mamas. Os objetivos deste estudo foram verificar a incidência da dor em cirurgia estética e identificar os analgésicos prescritos.MÉTODO: Pesquisa descritivo-exploratória, quantitativa, baseada em pesquisa documental de fonte primária, com análise quantitativa dos dados. Após os procedimentos ético-legais, foram analisados 408 prontuários de pacientes submetidas à cirurgia estética lipoaspiração, abdominoplastia, rinoplastia e prótese de mama, sendo analisado o conteúdo das anotações da equipe multiprofissional durante o período de internação hospitalar dos pacientes, a intensidade da dor e os analgésicos prescritos e usados pelos pacientes.RESULTADOS: A média de idade dos pacientes foi de 36 anos, sendo a maioria do sexo feminino. A maioria dos pacientes não relatou dor, e apenas 34% referiu ter sentido um ou mais episódios de dor, de leve ou moderada intensidade e apenas 16% relatou dor intensa. Apenas 0,5% pacientes não tinham nenhum analgésico prescrito pelo médico, para os demais 99,5% havia prescrição de um ou mais analgésicos, sendo que para 70% a prescrição era em regime de horário e de demanda, para 24% a prescrição dos analgésicos era exclusivamente em regime de horário e em apenas 6% a prescrição de analgésicos era unicamente, em regime de demanda. Foram identificados 11 analgésicos prescritos de horário, sendo a dipirona o mais frequente, seguida de cetorolaco e paracetamol e 11 analgésicos em regime de demanda, sendo a meperidina o mais frequente, seguida do tramadol e da morfina. CONCLUSÃO: A maioria dos pacientes não referiu dor no período pós-operatório imediato, porém 34% relataram dor de moderada intensidade, uma ou mais vezes no período de internação. Os analgésicos anti-inflamatórios não esteroides mais prescritos foram a dipirona e o cetorolaco, enquanto que os analgésicos opioides mais prescritos foram a meperidina e o tramadol.

BACKGROUND AND OBJECTIVES: Aesthetic plastic surgeries are intended to improve some physical aspect which is unpleasant for the patient being the most popular liposuction and silicone breast prosthesis implant. This study aimed at evaluating the incidence of pain after aesthetic surgeries and identifying prescribed analgesics.METHOD: Descriptive-exploratory and quantitative study based on primary source documents research, with quantitative data analysis. After ethical-legal procedures, 408 records of patients submitted to aesthetic liposuction, tummy tuck, rhinoplasty and breast prosthesis were analyzed by checking the content of notes of the multiprofessional team during patients' hospital stay, the intensity of pain and analgesics prescribed and used by patients. RESULTS: Mean age of patients was 36 years being most female patients. Most patients have not referred pain and only 34% have referred one or more mild or moderate pain episodes and only 16% have reported severe pain. Only 0.5% of patients had no analgesics prescribed by the physician. For the remaining 99.5% there was prescription of one or more analgesics, being that for 70% the prescription was by time and demand, for 24% analgesics prescription was exclusively by time and for just 6% analgesics prescription was only by demand. We have identified 11 analgesics prescribed by time, being dipirone the most frequent followed by ketorolak and paracetamol; 11 analgesics were prescribed by demand, being meperidine the most frequent, followed by tramadol and morphine. CONCLUSION: Most patients have not referred immediate postoperative pain, however 34% have referred one or more moderate pain episodes during hospital stay. Most widely prescribed non-steroid anti-inflammatory drugs were dipirone and ketorolak, while most widely prescribed opioid analgesics were meperidine and tramadol

Controle da dor pós-operatória em pacientes submetidas à cirurgia laparoscópica para tratamento da endometriose ou cirurgia plástica / Postoperative pain control in patients submitted to laparoscopic surgery to treat endometriosis or plastic surgery

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória é uma condição inerente à cirurgia, sendo habitualmente controlada com amplo espectro de fármacos, entretanto ainda é subtratada no Brasil e no restante do mundo. O objetivo desse estudo foi avaliar a incidência de dor aguda pós-operatória em pacientes submetidas à cirurgia de laparoscopia pélvica para diagnóstico e tratamento da endometriose e em pacientes submetidas à cirurgias plásticas estéticas ou reparadoras, bem como identificar as estratégias medicamentosas mais utilizadas no seu controle.MÉTODO: Foram estudadas 12 pacientes portadoras de endometriose submetidas à laparoscopia pélvica para diagnóstico e tratamento e 16 pacientes submetidas à cirurgia plástica, sendo coletados dados por meio de um formulário com informações sobre intensidade de dor, avaliada pela escala verbal numérica e a classe de medicamentos analgésicos utilizados durante a internação.RESULTADOS: Os resultados mostraram que 29% das pacientes não apresentaram dor no pós-operatório, porém 56% das pacientes submetidas à cirurgia plástica apresentaram dor de forte intensidade, enquanto que 50% das pacientes que se submeteram a laparoscopia para diagnóstico e tratamento da endometriose também apresentaram dor de forte intensidade. Cerca de 87% das pacientes submetidas à cirurgia plástica e 83% que se submeteram a laparoscopia para diagnóstico e tratamento da endometriose necessitaram de anti-inflamatório não esteroide, porém 81% das pacientes submetidas à cirurgia plástica usaram opioide fraco, versus 33% das pacientes que se submeteram a laparoscopia para diagnóstico e tratamento da endometriose.CONCLUSÃO: Os dados permitem concluir que a dor causada pelas cirurgias plásticas foi mais intensa que a induzida pela cirurgia laparoscópica devido à maior complexidade e duração das cirurgias plásticas, o que justifica o uso de maior quantidade de opioides fracos e fortes nessas pacientes.

BACKGROUND AND OBJECTIVES: Postoperative pain is inherent to surgery being usually controlled with a wide spectrum of drugs; however it is still under-treated in Brazil and worldwide. This study aimed at evaluating the incidence of acute postoperative pain in patients submitted to pelvic laparoscopic surgery to diagnose and treat endometriosis and in patients submitted to aesthetic or reconstructive plastic surgeries, as well at identifying most popular drug strategies to treat it.METHOD: Participated in this study 12 patients submitted to pelvic laparoscopy to diagnose and treat endometriosis, and 16 patients submitted to plastic surgery. A form was used to collect data on pain intensity evaluated by the numeric verbal scale and the class of analgesics used during hospital stay.RESULTS: Results have shown that 29% of patients had no postoperative pain, however 56% of patients submitted to plastic surgery referred severe pain while 50% of patients submitted to laparoscopy for diagnosis and treatment of endometriosis had also severe pain. Approximately 87% of patients submitted to plastic surgery and 83% of patients submitted to laparoscopy for diagnosis and treatment of endometriosis needed non-steroid anti-inflammatory drugs. However 81% of patients submitted to plastic surgery needed weak opioids as compared to only 33% of patients submitted to laparoscopy for diagnosis and treatment of endometriosis.CONCLUSION: Data allow to conclude that pain after plastic surgeries was more severe than that induced by laparoscopic surgery due to higher complexity and longer duration of plastic surgeries, which justifies the wider use of weak and strong opioids in these patients

Influence of rofecoxib, a high selective cox-2 inhibitor,on articular cartilage of rats / 中国临床药理学与治疗学

AIM: To observe the influence of rofecoxib, a non steroidal anti inflammatory drug, administrated for a long term on the knee joints cartilage of rats. METHODS: An experimental model of osteoarthritis of left knee in the early stage was induced by cutting achilles tendon in rats, the right knee providing a control. The rats of one group were given rofecoxib orally, and the rats in another group were given saline as a control. After 100 days, the histopathology, ultrastructure, and histochemistry changes on the knee joints cartilage were monitored. RESULTS and CONCLUSION: Rofecoxib, administrated for 100 days, had no harmful influence on chondrocyte and collagen, and could increase proteoglycan of cartilage in some degree in rats.

The anti-tumor molecular mechanisms of non-steroid anti-inflammatory drugs / 中国药理学通报

This review introduced the anti-tumor effects of non-steroid anti-inflammatory drugs (NSAIDs) and summarized their possible molecular mechanisms according to recent abroad literatures and our research results. Some evidence showed that the anti-tumor mechanisms of NSAIDs were different in various tumors.NSAIDs decreased the biosynthesis of PGE_2 and regulated the expressions of downstream correlated genes and proteins through restraining abnormal expression of COX-2 in certain neoplasms,which resulted in the inhibition of tumor angiogenesis and proliferation as well as induced apoptosis. But in other cancer cells, NSAIDs, as activators of peroxisome proliferator-activated receptor ? (PPAR?), induced COX-2 expression, promoted the biosynthesis of cyclopentenone prostaglandins (cyPGs). cyPGs further induced tumor cell apoptosis with PPAR? dependently or PPAR? independently. Since their special mechanisms of anti-proliferation and pro-apoptosis, NSAIDs revealed significant synergistic effects with other anti-tumor treatments.