Effect of Blood Transfusion on Short- and Long-Term Outcomes in Oral Squamous Cell Carcinoma Patients Undergoing Free Flap Reconstruction.

Purpose: To analyze the short- and long-term effect of perioperative blood transfusion (PBT) in patients undergoing surgical treatment for oral squamous cell carcinoma (SCC). Methods: Patients undergoing free flap reconstruction were retrospectively enrolled and divided into two groups based on the implementation of PBT. Flap revision, surgical site infection (SSI), flap failure, overall survival (OS), and disease-specific survival (DSS) were compared between the two groups. Results: In 170 patients with PBT, 10 (5.9%) flaps required exploration revision, SSI occurred in 18 (10.6%) patients, and flap necrosis was noted in 6 (3.5%) patients. These rates were comparable to those in patients without PBT. The two groups had similar DSS rates, but the 5-year OS rates were 49 and 59% in patients with PBT and without PBT, respectively. This difference was significant. Patients with 4 units of PBT had OS rates comparable to those of patients with >4 units of PBT. A Cox model confirmed the fact that the decrease in OS was independent of PBT. Conclusion: In patients with free flap reconstruction for oral SCC, PBT did not increase the short-term complication rate or cancer-linked mortality. However, it was related to an elevated overall risk of death.

Protection of ripasudil, a Rho kinase inhibitor, in lipopolysaccharides-induced acute pneumonia in mice.

Pneumonia is a major cause of morbidity and mortality of infectious diseases, especially in children. Ripasudil (K-115), a selective ROCK inhibitor, is a promising emerging drug against glaucoma, and reported to have anti-inflammatory activity. However, the anti-inflammatory effect of ripasudil still remains unclear in pneumonia. The goal of this study is to investigate the role and the underlying mechanism of ripasudil in pneumonia. BALB/c mice were used to establish an acute pneumonia model of mice by injection of lipopolysaccharide (LPS) intraperitoneally. Ripasudil (0.5 mg, 1 mg, 2 mg) was administrated 1 h before the induction of LPS. The histoligical change of lung tissue was evaluated by hematoxylin-eosin staining and lung wet/dry ratio. Inflammatory cytokines secretion, oxidant-antioxidant factors levels were measured. Cell apoptosis was examined using TNUEL assay. Western blot and qRT-PCR was used to determine gene expressions. Results showed that ripasudil significantly attenuated LPS-induced histological changes, reduced the production of pro-inflammatory cytokines, and alleviated LPS-induced oxidative stress in mice. LPS-induced cell apoptosis and associated protein expression changes were attenuated by ripasudil. Besides, ripasudil reduced the expression of RhoA, and decreased the activity of RhoA/ROCK signaling. Finally, the level of RhoA and eNOS from pneumonia patients exhibited negatively correlated, whereas the level of RhoA was higher while eNOS level was lower than that in the healthy control. The results of the present study indicate that ripasudil attenuate LPS-induced pneumonia in BALB/c mice by ameliorating inflammation, oxidative stress and apoptosis through inhibiting RhoA/ROCK signaling pathway. Ripasudil might be a novel and effective drug for the treatment of pneumonia.

Effect of curcumin on expressions of NF-κBp65, TNF-α and IL-8 in placental tissue of premature birth of infected mice.

OBJECTIVE: To observe the effect of curcumin on expressions of nuclear transcription factor-kappa Bp65 (NF-κBp65), TNF-α and IL-8 in placental tissue of premature birth of infected mice induced by lipopolysaccharide (LPS). METHODS: A total of 60 C57BL/6 mice pregnant with 15 d were collected and randomly divided into control group, model group, treatment group and preventative group. LPS was repeatedly injected in abdominal cavity to construct infected premature birth model, while mice of control group were given with 100 mg/kg of vitamin C through abdominal cavity injection and mice of treatment group and preventative group were given curcumin of 100 mg/kg through abdominal cavity injection after modeling operation and before 1 d of modeling operation, respectively. A total of 5 mice of four groups respectively were executed by cervical dislocation after 6 h, 12 h and 24 h after constructing model. Placental tissues were collected and the immunohistochemical method SABC of immunologic tissue was used to detect the expression of NF-κBp65, TNF-α and IL-8 and peripheral blood of executed mice after 24 h was collected to detect the concentrations of IL-8, malondialdehyde (MDA) and superoxide dismutase (SOD), meanwhile live birth rate of four groups was contrasted. RESULTS: Staining intensity of NF-κBp65, TNF-α and IL-8 in placental tissue of treatment group and preventative group was significantly higher than control group but lower than model group (P < 0.05). Level of serum IL-8 and MDA of control group was significantly lower than the other three groups (P < 0.05) and level of blood of SOD in model group was significantly lower than control group (P < 0.05). Levels of serum IL-8 and MDA of treatment group and preventative group were significantly lower than model group (P < 0.05) while level of SOD was significantly higher than model group (P < 0.05). Live birth rate of treatment group and preventative group was significantly higher than model group (P < 0.05). CONCLUSIONS: Curcumin can effectively prevent the active pathway of NF-κB in pregnant tissue of premature birth of infected mice, reduce the expression of TNF-α and IL-8 and relieve the damage of lipid peroxide of oxidative stress of LPS on mother-fetus and further to achieve the objective of preventing and curing premature birth induced with infection.

[Short and mid-term effectiveness of paravertebral adriamycin injection under CT guidance on intractable postherpetic neuralgia].

OBJECTIVE: To determine the short and mid-term effect of paravertebral adriamycin injection under CT guidance on intractable postherpetic neuralgia (PHN). METHODS: From January 2010 to May 2012, 68 patients with intractable PHN receiving paravertebral adriamycin injection under CT guidance were enrolled. The outcome included the Quality of Life Score (QLS), Visual Analogue Score (VAS) (average, the worst and the least VAS), pain relief rate at the time before and after the injection, and 1 year after discharge. RESULTS: Lower VAS was observed after the injection than that before the injection [(3.5 ± 1.5) vs (7.9 ± 1.3) on average; (2.1 ± 0.9) vs (6.5 ± 1.7) at least and (4.5 ± 1.4) vs (9.2 ± 1.1) at worst, P<0.05]. Lower VAS at 1 year after discharge was found than that before the injection [(2.2 ± 1.8) vs (7.9 ± 1.3) on average; (1.5 ± 0.8) vs (6.5 ± 1.7) at least; (3.2 ± 1.6) vs (9.2 ± 1.1) at worst ] and that after the injection [(3.5 ± 1.5) vs (2.2 ± 1.8) on average; (1.5 ± 0.8) vs (2.1 ± 0.9) at least and (3.2 ± 1.6) vs (4.5 ± 1.4) at worst, P<0.05]. The pain relief rate after the injection was (68 ± 23)%. The pain relief rate at 1 year after discharge (81 ± 22)% was higher than that at discharge (68 ± 23)% (P<0.05). The quality of life evaluation index scale after the injection (daily life, diet, general activities, sleep, work and social activities) was significantly improved than that before the injection [(10.1 ± 2.2) vs (14.2 ± 1.9), P<0.05]. The quality of life evaluation index scale at 1 year after discharge was significantly improved than that before the injection [(7.0 ± 2.1) vs (14.2 ± 1.9)] and that after the injection [(7.0 ± 2.1) vs (10.1 ± 2.2), P<0.05]. No complication was observed when the patients were discharged and 1 year after discharge. CONCLUSION: Paravertebral adriamycin injection under CT guidance for intractable PHN can effectively relieve the patient's pain, improve the quality of sleep and life without obvious complications. It is safe and effective for intractable PHN.

[Effect of pre-amputation pain block on the spinal and anterior cingulated cortex NMDA receptor activation in amputated rats].

OBJECTIVE: To investigate the effect of pre-amputation pain block on the N-methyl-D-aspartate receptor activation in the central nervous system of amputated rats, and the association between pre-amputation pain block and chronic amputation-related pain. METHODS: Thirty-six adult male SD rats were randomly assigned to an NA group (n=12), a PA group (n=12) and a PAB group (n=12). Group NA was intraplantarly injected saline l00 µL while group PA and group PAB were intraplantarly injected complete Freund adjuvant (CFA) 100 µL. The sciatic nerve of group NA and group PA were freed from surrounding tissue, and that of group PAB was blocked by bupivacaine under pentobarbital sodium anesthesia 5 days after the injection. Thermal withdrawal latency (TWL) was measured before and after the injection. All rats were amputated at the scheduled survival time. The expression of N-methyl-D-aspartate receptor (NR2B) was measured by immunohistochemistry in L4-6 of the spinal cord and the anterior cingulated cortex 7 days after the amputation procedure. RESULTS: The TWL after intraplantar administration of CFA in group PA and group PAB decreased significantly compared with the baseline value (P<0.05), while the saline treated control group remained unchanged. Besides the basic value, the TWL of group PA was shorter than that of group NA at the above-mentioned time-points (P<0.05). Compared with the basic value and group NA, the TWL of group PAB after the block increased significantly (P<0.05). Compared with group NA and group PAB, group PA had a remarkably high expression of NR2B (P<0.05), while there was no difference between group PA and group PAB. CONCLUSION: Pre-amputation pain may activate N-methyl-D-aspartate receptor of the central nervous system, which may lead acute postoperative pain to chronic pain. It is necessary to treat pre-amputation pain.

Effect of cyclosporine on the pharmacokinetics of aliskiren in healthy subjects.

To explore the clinical relevance of inhibition of multidrug resistance transporter 1 and organic anion transporting polypeptide transporter, a drug-drug interaction study was conducted using aliskiren and cyclosporine. This was an open-label, single-sequence, parallel-group, single-dose study in healthy subjects. Subjects (n = 14) first received aliskiren 75 mg orally (period 1), followed by aliskiren 75 mg + cyclosporine 200 mg (period 2) after a 7-day washout period, and aliskiren 75 mg + cyclosporine 600 mg (period 3) after a 14-day washout period. Safety and pharmacokinetics were analyzed during each period. The primary objective was to characterize pharmacokinetics of aliskiren (single-dose and combination with cyclosporine). The increases in area under the time-concentration curve from time 0 to infinity and maximum concentration associated with cyclosporine 200 mg or 600 mg were 4- to 5-fold and 2.5-fold, respectively. Mean half-life increased from 25 to 45 hours. Based on comparison to literature, a single-dose of aliskiren 75 mg did not alter the pharmacokinetics of cyclosporine. Aliskiren 75 mg was well tolerated. Combination with cyclosporine increased the number of adverse events, mainly hot flush and gastrointestinal symptoms, with no serious adverse events. Two adverse events led to withdrawal (ligament rupture, not suspected to be study-drug related; and vomiting, suspected to be study-drug related). Laboratory parameters, vital signs, and electrocardiographs showed no time- or treatment-related changes. As cyclosporine significantly altered the pharmacokinetics of aliskiren in humans, its use with aliskiren is not recommended.