Grape seed-derived procyanidins decreases neuropathic pain and nerve regeneration by suppression of toll-like receptor 4-myeloid differentiation factor-88 signaling.

Background: Recent studies have shown that peripheral nerve regeneration process is closely related to neuropathic pain. Toll-like receptor 4 (TLR4) signaling was involved in different types of pain and nerve regeneration. TLR4 induced the recruitment of myeloid differentiation factor-88 adaptor protein (MyD88) and NF-κB-depended transcriptional process in sensory neurons and glial cells, which produced multiple cytokines and promoted the induction and persistence of pain. Our study aimed to investigate procyanidins's effect on pain and nerve regeneration via TLR4-Myd88 signaling. Methods: Spinal nerve ligation (SNL) model was established to measure the analgesic effect of procyanidins. Anatomical measurement of peripheral nerve regeneration was measured by microscopy and growth associated protein 43 (GAP43) staining. Western blotting and/or immunofluorescent staining were utilized to detect TLR4, myeloid differentiation factor-88 adaptor protein (MyD88), ionized calcium-binding adapter molecule 1 (IBA1) and nuclear factor kappa-B-p65 (NF-κB-p65) expression, as well as the activation of astrocyte and microglia. The antagonist of TLR4 (LPS-RS-Ultra, LRU) were intrathecally administrated to assess the behavioral effects of blocking TLR4 signaling on pain and nerve regeneration. Result: Procyanidins reduced mechanical allodynia, thermal hyperalgesia and significantly suppressed the number of nerve fibers regenerated and the degree of myelination in SNL model. Compared with sham group, TLR4, MyD88, IBA1 and phosphorylation of NF-κB-p65 were upregulated in SNL rats which were reversed by procyanidins administration. Additionally, procyanidins also suppressed activation of spinal astrocytes and glial cells. Conclusion: Suppression of TLR4-MyD88 signaling contributes to the alleviation of neuropathic pain and reduction of nerve regeneration by procyanidins.

Knowledge, attitudes, and practice toward postoperative cognitive dysfunction among anesthesiologists in China: a cross-sectional study.

BACKGROUND: To investigate the knowledge, attitudes, and practice (KAP) toward postoperative cognitive dysfunction (POCD) among anesthesiologists in China. METHODS: This cross-sectional study was conducted nationwide among Chinese anesthesiologists between December 2022 and January 2023. The demographic information and KAP scores of the respondents were collected using a web-based questionnaire. The mean KAP dimension scores ≥ 60% were considered good. RESULTS: This study enrolled 1032 anesthesiologists (51.2% male). The mean total scores of knowledge, positive attitude, and positive practice were 9.3 ± 1.2 (max 12), 34.8 ± 3.3 (max 40), and 30.6 ± 6.7 (max 40), respectively. The knowledge items with correctness scores < 60% were "the anesthetic drugs that tend to cause POCD" (23.3%) and "Treatment of POCD" (40.3%). Multivariable analysis showed that ≥ 40 years old, master's degree or above, intermediate professional title (i.e., attending physician), senior professional title (i.e., chief physician), and working in tertiary hospitals were independently associated with adequate knowledge. Multivariable analysis showed that the attitude scores, middle professional title, and ≥ 16 years of experience were independently associated with good practice. CONCLUSIONS: These results suggest that Chinese anesthesiologists have good knowledge, favorable attitudes, and good practice toward POCD. Still, some points remain to be improved (e.g., the drugs causing POCD and managing POCD) and should be emphasized in training and continuing education. TRIAL REGISTRATION: ChiCTR2200066749.

Ultrasound-Guided Modified Thoracolumbar Fascial Plane Block in Tianji Robot-Assisted Lumbar Internal Fixation: A Prospective, Randomized, and Non-Inferiority Study.

Purpose: Ultrasound-guided modified thoracolumbar fascial plane block (MTLIP) has been reported effective for postoperative pain control following lumbar surgery. Although trauma of the Tianji robot-assisted lumbar internal fixation is reduced, the degree of pain cannot be ignored.MTLIP may improve operation efficiency and reduce puncture complications.This study aimed to explore whether MTLIP is not inferior to thoracolumbar fascial plane block (TLIP) in the treatment of lumbar internal fixation. Methods: This prospective double-blinded, non-inferiority randomized trial enrolled patients underwent Tianji robot-assisted lumbar internal fixation between April and August 2022 to either MTLIP or TLIP. The primary outcome was an effective dermatomal block area after 30 min. Secondary outcomes included the numeric rating scale (NRS) scores, nerve block operation time, puncture times, image clarity, patient satisfaction, intraoperative opioid consumption, complications/adverse reactions, and Oswestry Disability Index (ODI). Results: Sixty participants were randomized to MTLIP (n=30) and TLIP (n=30). The effective dermatomal block area 30 min after block was non-inferior in the MTLIP group (283.6 ± 62.6 cm2) compared with the TLIP group (261.4±53.2 cm2) (P=0.145; estimated mean difference: -22.17, 95% CI: -52.19, 7.85; smaller than the non-inferiority margin of 39.5). Compared with TLIP, MTLIP showed shorter operation time, smaller puncture times, and better target definition and satisfaction scores (all P<0.001). Sufentanil amount, remifentanil amount, PCIA sufentanil dosage, parecoxib amount, NRS scores (increased with time in the two groups but without inter-group differences), and complications were not significantly different between the two groups (all P>0.05). Conclusion: This non-inferiority trial supports the hypothesis that MTLIP yields a non-inferior effective dermatomal block area compared with TLIP for Tianji robot-assisted lumbar internal fixation. Clinical Trials Registration: Chinese Clinical Trial Registry (ChiCTR2200058687);.

Effects of four different positive airway pressures on right internal jugular vein catheterisation.

CONTEXT: The right internal jugular vein (RIJV) is often used for central venous catheterisation in patients undergoing major surgery. The efficacy of this route correlates with the diameter of the vein which can be influenced by airway pressure. OBJECTIVE: To investigate four positive airway pressures (PAPs) in mechanically ventilated patients and to determine the most suitable of these for RIJV catheterisation. DESIGN: Prospective, randomised, controlled study. SETTING: Two Chinese medical centres. PATIENTS: Two hundred and forty patients scheduled for gastrointestinal tract surgery under general anaesthesia (male-to-female ratio, 135 : 105; American Society of Anesthesiologists' physical status class, I-III; age range, 19-81 years); patients were excluded from the study if they had a history of haematological disease, external neck injury, RIJV catheterisation, severe cardiovascular disease, RIJV thrombosis, injection-site infection, pneumothorax and pulmonary bulla. INTERVENTIONS: They were randomised into four groups of 60, each to undergo RIJV catheterisation at a PAP of 0 (1 cmH2O = 0.098 kPa, group A); 15 (group B); 20 (group C); and 25 cmH2O (group D). MAIN OUTCOME MEASURES: Primary outcomes were central venous pressure (CVP) and RIJV cross-sectional area which were measured before and during PAP; the number of catheterisations completed in 30 s; the number of first pass punctures; heart rate and mean arterial pressure which were monitored continuously; and the incidence of complications which included local haematoma, pneumothorax and internal carotid artery (ICA) puncture. RESULTS: Two patients were excluded following ICA puncture, leaving 238 for analysis. In groups C and D, the CVP and the cross-sectional area of RIJV were significantly larger; the number completing catheterisation within 30 s and the number of first pass punctures increased significantly and was comparable between these two groups. Compared with groups A and B, the incidences of hypotension and bradycardia were significantly increased in groups C and D. The incidence of local haematoma was significantly increased in group D compared with other groups. RIJV catheterisation was completed successfully in all but two patients in group A. CONCLUSION: A PAP of 20 cmH2O seems most suitable for successful RIJV catheterisation in mechanically ventilated patients. It is associated with an increase in cross-sectional RIJV area and CVP, which facilitate cannulation, and results in fewer puncture-related complications. However, meticulous haemodynamic monitoring is needed to avoid hypotension and bradycardia.

Influence of systemic immune and cytokine responses during the acute phase of zoster on the development of postherpetic neuralgia.

Postherpetic neuralgia (PHN) is a severe sequela of herpes zoster (HZ). Until now, only age and pain severity were considered predisposing factors for the development of PHN. We evaluated 49 patients with acute phase HZ, 10 of whom developed PHN (Group A) and 39 of whom did not develop PHN (Group B). Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls (Group C). Numbers of serum CD3(+) (pan-T lymphocytes), CD4(+) (helper/inducer), and CD8(+) (suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group, but there were no statistical differences between Groups A and B. Interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, IL-8, and IL-10 were significantly elevated in Groups A and B relative to Group C. IL-6 was significantly higher in Group A than in Group B, and was significantly positively correlated with pain severity scored on a visual analog scale. Therefore, we suggest that the inflammatory response, especially that of IL-6, in the acute phase of HZ may be associated with hyperalgesia and the development of PHN.