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.

Curative efficacy and safety of Kangfuxin liquid in treating patients of upper gastrointestinal hemorrhage caused by non-steroid drugs treated with somatostatin / 中国免疫学杂志

Objective:To investigate the curative efficacy and safety of Kangfuxin liquid in treating patients of upper gastrointestinal hemorrhage caused by non-steroid drugs treated with somatostatin.Methods:90 patients with upper gastrointestinal hemorrhage caused by non-steroid drugs meeting the inclusion criteria were collected as observational objects to be randomly divided into the control group and the observation group with 45 cases in each group.Besides conventional treatments,the control group was given somatostatin,while the observation group was given Kangfuxin liquid in combination with somatostatin.Then,the curative efficiency,hemostatic time,recurrent bleeding rate,levels of serum inflammatory factors and adverse reactions were observed and compared.Results:Assessment of curative efficacy showed that the total therapeutic efficiency ratio in the observation group was statistically higher than that in the control group(95.6％ vs 82.2％,P＜0.05).In comparison with the control group,the hemostatic time in the observation group was statistically shorter[(1.4±0.5)d vs (2.6±0.7)d,P＜0.05],while the recurrent bleeding rate in the two groups was statistically same(4.4％ vs 11.1％,P＞0.05).As to inflammatory factors,the observation group had statistically lower levels of serum TNF-α and IL-6 than those in the control group [(5.46±0.93)ng/L vs (8.37± 1.08)ng/L,(19.37±3.43)ng/L vs (38.22±8.14)ng/L,both P＜0.05].During the treatment,there was no case of severe adverse reactions.And the incidences of adverse reactions in the observation group and the control group were statistically same (22.2％ vs 15.6％,P＞0.05).Conclusion:Besides treatment of somatostatin,adjuvant therapy of Kangfuxin liquid has well application effect in patients of upper gastrointestinal hemorrhage caused by non-steroid drugs.And it can significantly increase curative efficacy,shorten hemostatic time,alleviate inflammatory reaction with minor adverse reactions.

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.

Principales aspectos clínicos y epidemiológicos en pacientes con dermopatías por medicamentos / Main clinical and epidemiological aspects in patient with dermopathies due to drugs

Se realizó un estudio descriptivo y transversal de los 51 pacientes con dermopatías por medicamentos, ingresados en el Servicio de Dermatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero del 2011 hasta diciembre del 2012, para determinar las características clínicas y epidemiológicas de ellos. A tal fin se analizaron las variables: edad, sexo, cuadro clínico, fármacos ingeridos y vía de administración, persona que indicó el medicamento, entre otras. Las erupciones cutáneas por medicamentos se presentaron en una amplia variedad clínica, con predominio del eritema multiforme menor, el tratamiento fue indicado por facultativos en la mayoría de los casos, y entre los grupos de fármacos consumidos con más frecuencia figuraron los antimicrobianos y los analgésicos antiinflamatorios no esteroideos.

A descriptive, cross sectional and prospective study of the 51 patients with dermopathies due to drugs, admitted to the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January, 2011 to December, 2012, to determine the clinical and epidemiological characteristics of them. For this purpose, the variables age, sex, clinical pattern, ingested drugs and administration route, person who indicated the drug, among others, were analyzed. The skin eruptions due to drugs were presented in a wide clinical variety, with prevalence of the minor multiform erythema, the treatment was indicated by doctors in most of the cases, and among the groups of consumed drugs with more frequency there were the antimicrobians and the non steroids analgesic anti-inflammatory drugs.

Concentration of Non-Steroidal Anti-Inflammatory Drugs in the Pelvic Floor Muscles: An Experimental Comparative Rat Model

PURPOSE: The aim of this study is to explore non-steroid anti-inflammation drugs (NSAIDs) potency for pelvic floor muscle pain by measuring local concentration in a rat model. MATERIALS AND METHODS: We used nine NSAIDs, including nabumetone, naproxen, ibuprofen, meloxicam, piroxicam, diclofenac potassium, etodolac, indomethacin, and sulindac, and 9 groups of female Wister rats. Each group of rats was fed with one kind of NSAID (2 mg/mL) for three consecutive days. Thereafter, one mL of blood and one gram of pelvic floor muscle were taken to measure drug pharmacokinetics, including partition coefficient, lipophilicity, elimination of half-life (T1/2) and muscle/plasma converting ratio (Css, muscle/Css, plasma). RESULTS: Diclofenac potassium had the lowest T1/2 and the highest mean Css, muscle/Css, plasma (1.9 hours and 0.85+/-0.53, respectively). The mean Css, muscle/Css, plasma of sulindac, naproxen and ibuprofen were lower than other experimental NSAIDs. CONCLUSION: Diclofenac potassium had the highest disposition in pelvic floor muscle in a rat model. The finding implies that diclofenac potassium might be the choice for pain relief in pelvic muscle.

Prevention of pancreatitis after endoscopic retrograde cholangiopancreatography with different methods:a Meta analysis / 中华消化外科杂志

Objective To evaluate the efficacy of different methods in preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods Databases including PubMed,EMBASE,Cochrane Library,Chinese Journal Full-text Database,China Biomedicine Database were searched with key words including endoscopic retrograde cholangiopancreatography,ERCP,post-ERCP pancreatitis,pancreatitis,pancreatic duct stent,non-steroid anti-inflammatory drugs,indometacin,diclofenac,protease inhibitors,nafamostat,ulinastatin,gabexate,somatostain,内镜逆行胰胆管造影,内镜逆行胰胆管造影术后胰腺炎,胰腺炎,胰管支架置入,非甾体类抗炎药,吲哚美辛,双氯芬酸,抑酶剂,萘莫司他,乌司他丁,加贝酯and生长抑素.Literatures published between January 2000 and January 2014 were searched.Randomized controlled studies on prevention of pancreatitis after ERCP which were enrolled in this study were analyzed by 2 independent reviewers.The quality of the literatures was evaluated.All data were analyzed using the RevMan 5.0 software.Data were expressed in odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the studies was analyzed using the I2 test.Results Twenty-seven literatures were enrolled in the study.There were 4 701 patients in the experimental group (including patients who were treated by pancreatic stent installation,non-steroidal antiinflammatory drugs,nafamostat,ulinastatin,gabexate,intravenous infusion of somatostain for more than 6 hours,intravenous infusion of somatostain for less than 6 hours,bolus injection of somatostain) and 3 592 patients in the control group (including patients treated without pancreatic duct installation or placebo).The results of Meta analysis showed that pancreatic stent installation,non-steroid anti-inflammatory drugs,nafamostat,intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could significantly decrease the incidence of pancreatitis after ERCP (OR =0.18,0.45,0.31,0.33,0.25,95％ CI:0.09-0.35,0.33-0.61,0.19-0.52,0.20-0.56,0.11-0.55,P ＜ 0.05).Conclusion Pancreatic stent installation,non-steroid anti-inflammatory drugs,nafamostat,intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could effectively prevent the incidence of pancreatitis after ERCP.

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.

Gastropatía reactiva: Frecuencia en biopsias endoscópicas evaluadas en la Universidad Nacional de Colombia / Reactive gastropathy: Frequency in endoscopic biopsies evaluated at the Universidad Nacional de Colombia

La gastropatía reactiva (GR) es producida principalmente por antiinflamatorios no esteroideos (AINEs) y reflujo biliar; puede presentarse aisladamente o coexistir con otros tipos de gastritis crónica (GC). Se revisaron 5.079 informes de estudios histopatológicos de biopsias gástricas de 4.254 pacientes, 825 en seguimiento con 2 a 7 estudios. La GR correspondió a 12,8% de los diagnósticos, las GC no atrófica (GCNA) y atrófica multifocal (GCAMF) correspondieron a 63,4% y 27,3% respectivamente. La infección por Helicobacter pylori se presentó en 61,6% de casos con GCNA, 51,5% con GCAMF, 18,5% con GR (p < 0.0001); en casos con coexistencia de GR+GCNA fue 43,9% y de 40,7% para GCAMF+GR. En pacientes en seguimiento aumentaron los diagnósticos de GR: 2 estudios con 22,2%, 3 estudios con 26,7% y 4-7 estudios con 28,8%; los hallazgos histológicos de GR en estos casos posiblemente son residuales, luego de la desaparición de los infiltrados inflamatorios por el tratamiento.

Reactive gastropathy (RG) is primarily produced by non-steroid antiinflammatory drugs (NSAIDs) and bile reflux. It can occur alone or coexist with other types of chronic gastritis (CG). 5,079 histopathological reports of gastric biopsies from 4,254 patients were reviewed: 825 of them had 2 to 7 follow-up studies. 12.8% of these patients were diagnosed with GR while 63.4% were diagnosed with chronic non-atrophic gastritis (CNAG) and 27.3% were diagnosed with chronic multifocal atrophic gastritis (CMAG). Helicobacter pylori infections were found in 61.6% of the cases with CNAG, 51.5% with CMAG, and in 18.5% of cases with GR only (p <0.0001). Among patients suffering from both RG and CNAG 43.9% had H. pylori infections. 40.7% of those suffering from both CMAG and RG were infected with H. pylori. During monitoring of patients RG diagnoses increased to 22.2% in the second study, 26.7% in the third study, and 28.8% in the fourth through seventh studies. Histological findings of RG in these cases are probably residual following disappearance of inflammatory infiltrates due to treatment.

Clinical analysis of 45 cases with subacute thyroiditis / 中国基层医药

Objective To investigate the clinical manifestations,etiology,diagnosis and treatment of subacute thyroiditis(SAT).Methods Retrospectively analyzed 45 patients with subacute thyroiditis.Results In the cases 45with subacute thyroiditis,generallymore women who were 30～50 years old accounted for 88%.The clinical symptoms is typical,mainly headache(99%)and thyroid pain and obvious local tenderness(100%).45 patients were significandy higher erythrocyte sedimentation rate;d-2 cases of FT3,FT4 increased significantly,and the level of thyroid stimulating hormone is reduced.All patients of non-steroidal glucocorticoid treatment were effective.Conclusion The vast majority of subacute thyroiditis with typical clinical manifestations,the therapy of non-steroidal class and adrenal corticosteroid therapy is effective.

Há uma associação entre anti-inflamatórios não-esteroides e nefropatia induzida por contraste? / Is there an association between non-steroidal anti-inflammatory drugs and contrast nephropathy? / ¿Hay una asociación entre antiinflamatorios no esteroides y nefropatía inducida por contraste?

FUNDAMENTO: A associação entre o uso de anti-inflamatórios não-esteroides (AINEs) e insuficiência renal aguda ou crônica é bem documentada, mas evidências sobre a associação entre AINEs e nefropatia induzida por contraste (NIC) não são encontradas na literatura. OBJETIVO: Avaliar uma possível associação entre AINEs e NIC. MÉTODOS: Em um estudo de coorte, através da entrevista clínica de pacientes que foram submetidos à cateterização cardíaca, analisamos o uso de AINEs e sua associação com desenvolvimento de NIC, através da alteração dos níveis de creatinina sérica ou taxa de filtração glomerular em 48 ou 72 horas. RESULTADOS: No período de julho de 2005 a julho de 2006, 236 pacientes foram incluídos no estudo, dos quais 29 foram posteriormente excluídos. A incidência de NIC foi 10,37 por cento (20 de 207) e 42 por cento dos pacientes estavam recebendo AINEs até o momento da avaliação. Não houve associação entre o uso de AINEs e o desenvolvimento de NIC com OR de 1,293; IC95 por cento (0,46-4,2). O estudo detectou fatores de risco conhecidos para o desenvolvimento de NIC, tais como diabete, com OR de 2,77; IC95 por cento (1,05-7,47) e insuficiência renal crônica com OR de 3,48; IC95 por cento (1,1-11,07) e também sugeriu uma ação protetora da hidratação com solução salina com OR de 0,166; IC95 por cento (0,03-0,92). CONCLUSÃO: Com base nos dados obtidos, concluímos que não houve associação entre NIC e uso prévio de AINEs, pelo menos com um OR > 2,85, o qual nossa amostra detectou.

BACKGROUND: The association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and acute or chronic renal failure is well documented, but evidence of such association between NSAIDs and Contrast-Induced Nephropathies (CIN) is not found in the indexed literature. OBJECTIVE: To evaluate the possible association between NSAIDs and CIN. METHODS: In a cohort study, through clinical interviews of patients that underwent cardiac catheterization, we analyzed the use of NSAIDs and its association with the development of CIN, through alterations in serum creatinine or glomerular filtration rate in 48 or 72 hours. RESULTS: From July 2005 to July 2006, 236 patients were enrolled in the study, of which 29 were later excluded. The incidence of CIN was 10.37 percent (20 of 207) and 42 percent of the patients were using NSAIDs until the moment of the evaluation. There was no association between the use of NSAIDs and the development of CIN with OR of 1.293 95 percent CI (0.46-4.2). The study detected known risk factors for the development of CIN, such as diabetes with OR of 2.77 95 percentCI (1.05-7.47) and chronic renal failure with OR 3.48 95 percentCI (1.1-11.07). A protective action of saline solution hydrationis also suggested, with OR of 0.166 95 percentCI (0.03-0.92). CONCLUSION: Based on the data obtained, we conclude that there was no association between CIN and previous use of NSAIDs, at least with an OR higher then 2.85, which our sample detected.

FUNDAMENTO: La asociación entre el uso de antiinflamatorios no esteroides (AINEs) e insuficiencia renal aguda o crónica está bien documentada, pero evidencias sobre la asociación entre AINEs y nefropatía inducida por contraste (NIC) no son encontradas en la literatura. OBJETIVO: Evaluar una posible asociación entre AINEs y NIC. MÉTODOS: En un estudio de cohorte, a través de la entrevista clínica de pacientes que fueron sometidos a cateterismo cardíaco, analizamos el uso de AINEs y su asociación con desarrollo de NIC, a través de la alteración de los niveles de creatinina sérica o tasa de filtrado glomerular en 48 o 72 horas. RESULTADOS: En el período de julio de 2005 a julio de 2006, 236 pacientes fueron incluidos en el estudio, de los cuales 29 fueron posteriormente excluidos. La incidencia de NIC fue 10,37 por ciento (20 de 207) y 42 por ciento de los pacientes estaban recibiendo AINEs hasta el momento de la evaluación. No hubo asociación entre el uso de AINEs y el desarrollo de NIC con OR de 1,293; IC95 por ciento (0,46-4,2). El estudio detectó factores de riesgo conocidos para el desarrollo de NIC, tales como diabetes, con OR de 2,77; IC95 por ciento (1,05-7,47) e insuficiencia renal crónica con OR de 3,48; IC95 por ciento (1,1-11,07) y también sugirió una acción protectora de la hidratación con solución salina con OR de 0,166; IC95 por ciento (0,03-0,92). CONCLUSIÓN: Con base en los datos obtenidos, concluimos que no hubo asociación entre NIC y uso previo de AINEs, por lo menos con un OR > 2,85, el cual nuestra muestra detectó.

Acciones cardiovasculares del ibuprofeno / Ibuprofen cardiovascular actions

El ibuprofeno (IB) es un antiinflamatorio no esteroideo (AINE) de amplio uso por su alta efectividad y buen margen de seguridad. Sin embargo, poco se conoce de sus posibles acciones cardiovasculares. Algunas evidencias clínicas sugieren que este AINE pudiera tener efectos adversos sobre el sistema cardiovascular. El objetivo de esta investigación fue estudiar las posibles acciones colaterales del ibuprofeno sobre corazón y músculo liso vascular, tomando como patrón de comparación el ácido flufenámico (AF), fármaco con probada acción inotropo negativa. Se utilizó la técnica clásica de corazón de rata aislado y perfundido (Langendorff), registrando electrograma superficial y la fuerza de contracción. También se estudió el efecto sobre la contracción de aorta abdominal de rata inducida por KCl isotónico y por fenilefrina (10 µmol/L). En comparación con el AF (IC50=9,5 µmol/L), el IB tuvo un pobre efecto inotrópico negativo (IC20=30 µmol/L). A la concentración máxima utilizada (100 µmol/L), el IB fue menos efectivo que el AF en reducir el intervalo QT (25 ± 7 ms vs. 60 ± 15 ms; N ³ 5) y alargar el intervalo RR (60 ± 10 ms vs. 145 ± 20 ms; N ³ 5). Mientras que el AF no tuvo acción sobre la contracción aórtica inducida por KCl o por fenilefrina, el IB provocó una vasorrelajación de » 30 por ciento de la contracción aórtica inducida por KCl o por fenilefrina aunque solo a la concentración máxima (100 µmol/L). Estos resultados sugieren que las acciones cardiovasculares directas del IB son mínimas lo cual contribuye al buen margen de seguridad para su uso en clínica en pacientes sin enfermedad cardiovascular

Ibuprofen (IB) is a non steroidal anti-inflammatory drug (NSAID) widely used because of its high effectivity and good safety margin. However, little is known about its possible cardiovascular actions. Some evidences in clinics suggest that this NSAID could have adverse side effects on the cardiovascular system. The aim of this investigation was to study the possible side effects of IB on the heart and vascular smooth muscle, taking as a reference the flufenamic acid (FA) a drug with known negative inotropic action. We used the isolated perfused rat heart (Langendorff) and recorded the surface electrogram and the force of contraction. We also studied the effects of IB on the KCl- or fenilephrine- (10 µmol/L) induced contraction of rat abdominal aorta. Compared to FA (IC50 = 9.5 µmol/L), IB showed a small negative inotropic effect (IC20 = 30 µmol/L). At the maximal concentration used (100 µmol/L), IB was less effective than FA in reducing the QT interval (45 ± 10 ms vs. 60 ± 15 ms; N ³ 5) and prolonging the RR interval (60 ± 10 ms vs. 145 ± 20 ms; N ³ 5). While FA had no effect on the aortic contraction (KCl or fenilepinephrine), IB relaxed aortic contraction (KCl or fenilephrine) by » 30 percent but only at the highest concentration (100 µmol/L). The present results suggest that cardiovascular actions of IB are minimal contributing to its good safety margin when used in clinics in patients not suffering from cardiovascular diseases

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.