Association between Mir-17-92 gene promoter polymorphisms and depression in a Chinese population.

BACKGROUND: Depression is a common chronic debilitating disease with a heavy social burden. single nucleotide polymorphisms (SNPs) can affect the function of microRNAs (miRNAs), which is in turn associated with neurological diseases. However, the association between SNPs located in the promoter region of miR-17-92 and the risk of depression remains unclear. Therefore, we investigated the association between rs982873, rs9588884 and rs1813389 polymorphisms in the promoter region of miR-17-92 and the incidence of depression in a Chinese population. METHODS: we used GWAS (Genome-wide association study) and NCBI (National Center for Biotechnology Information) to screen three SNPs in the miR-17-92 cluster binding sites. A case-control study (including 555 cases and 541 controls) was conducted to investigate the relationship between the SNPs and risk of depression in different regions of China. The gene sequencing ii was used to genotype the collected blood samples. RESULTS: the following genotypes were significantly associated with a reduced risk of depression: rs982873 TC (TC vs. TT: OR = 0.72, 95% CI, 0.54-0.96, P = 0.024; TC/CC vs. TT: OR = 0.74, 95% Cl, 0.56-0.96, P = 0.025); CG genotype of rs9588884 (CG vs. CC: OR = 0.74, 95% CI, 0.55-0.98, P = 0.033; CG/GG vs. CC: OR = 0.75, 95% Cl, 0.57-0.98, P = 0.036); and AG genotype of rs1813389 (AG vs. AA: OR = 0.75, 95% CI, 0.57-1.00, P = 0.049; AG/GG vs. AA: OR = 0.76, 95% Cl, 0.59-1.00, P = 0.047). Stratified analysis showed that there was no significant correlation between the three SNPS and variables such as family history of suicidal tendency (P > 0.05). CONCLUSIONS: our findings suggest that rs982873, rs9588884, and rs1813389 polymorphisms may be associated with protective factors for depression.

The effect of different nerve block strategies on the quality of post-operative recovery in breast cancer patients: A randomized controlled study.

OBJECTIVE: To compare the effects of three types of ultrasound-guided nerve blocks on post-operative recovery quality in patients undergoing modified radical mastectomy for unilateral breast cancer. METHODS: In this randomized double-blinded trial (chictr.org.cn, ChiCTR2200059428), 150 female patients were equally assigned to S group (serratus anterior plane block, SAPB) group, P group (paravertebral block, PVB) or ST group (serratus anterior combined with transverse thoracic muscle plane blocks, SA-TTMPB). The primary outcome was QoR-15 at five time points after surgery. Secondary outcomes were pain scores, time of first rescue analgesic and chronic pain incidence at 3 months. RESULTS: The QoR-15 total score of S group at 24 h, 48 h, 72 h and 7 days post-surgery was significantly lower in groups P and ST, while there was no significant difference between groups P and ST (S vs. P vs. ST, 100.29 ± 6.20 vs. 108.51 ± 7.46 vs. 106.46 ± 6.95; 105.59 ± 6.18 vs. 113.06 ± 7.44 vs. 111.22 ± 6.56; 112.51 ± 6.32 vs. 119.88 ± 6.44 vs. 117.62 ± 6.09; 123.00 ± 5.78 vs. 128.86 ± 5.96 vs. 126.92 ± 5.72, p < 0.05). The dynamic and rest NRS scores at 6 and 12 h post-surgery were significantly higher in group S than in groups P and ST. CONCLUSION: Serratus anterior plane block combined with transverse thoracic muscle plane block and paravertebral block both have better effects than serratus anterior plane block alone in improving patients' early post-operative recovery quality, and also have an advantage in improving early post-operative pain. CLINICAL TRIAL REGISTRATION: chictr.org.cn (ChiCTR2200059428). DATE OF REGISTRATION: 29 April 2022. SIGNIFICANCE: Serratus anterior combined with transverse thoracic muscle plane block may be a safer, easier, and equally effective nerve block strategy than paravertebral block in patients undergoing modified radical mastectomy for unilateral breast cancer.

Opioids Prescribing Among Patients with Zoster-Related Pain in Real-Life: A Retrospective, Cohort Study Based on the Clinical Database.

Purpose: The aim of this study was to analysis of the opioid use of opioid native zoster-related pain (ZRP) patients to evaluate the impact of opioid use on pain control and quality of life improvement based on the clinical database. Patients and Methods: We conducted a retrospective cohort study to identify opioid native patients who were hospitalized in the pain department between May 1, 2020, and May 1, 2021. The primary outcomes were persistent opioid use after discharge, visual analogue scale (VAS) at the admission, VAS remission rate during hospitalization, VAS score and quality of life at follow-up. Then, we assessed patient-level risk factors for persistent opioid use after the discharge. Results: A total of 350 patients met the inclusion criteria. Of those patients, 255 (72.9%) were administered with opioid during hospitalization, and 95 (27.1%) patients were not. Opioid prescription during hospitalization was independently associated with increased odds of persistent use after the discharge (adjusted odds ratio, 20.74; 95% CI, 4.504-95.474; P < 0.01). In the two groups, the VAS score at admission and the VAS score at follow-up were different. In the group with opioids during hospitalization, the persistent opioid use after discharge was more common (38% vs 2.1%) compared to patients without opioids, and VAS remission rate during hospitalization was less, restrictions on daily life, work or housework, and social activities were more common, and mood, diet and sleep were worse, respectively. Conclusion: Opioids prescription during hospitalization might increase the risk of chronic opioid use in opioid native ZRP patients, and it has limited benefits in pain control and quality of life improvement. Even though PHN was painful and intractable, the use of opioids should also be more cautious, and strict follow-up, management in this population.

Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials.

BACKGROUND: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA. METHODS: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects. RESULTS: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%). CONCLUSION: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries. REGISTRATION: PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

Interventions for zoster-associated pain: A retrospective study based on the clinical database.

Background: Herpes zoster (HZ)-associated pain can lead to severe pain and reduced quality of life. Exploring effective treatment and the risk factors of zoster-associated pain has become important. Methods: Interventions including nerve block, radiofrequency, and thermocoagulation were used for zoster-associated pain. The data of 131 patients with HZ and 230 patients with postherpetic neuralgia (PHN) were collected at baseline, 2 weeks, 3, 6, and 12 months after the intervention. Visual analog scale (VAS) and Brief Pain Inventory (BPI) scores at different time points were analyzed by two-way repeated measures ANOVA with Group as the between-subject variable (different pain durations and areas), Time as the within-subject variable (baseline, 2 weeks, 3 months, 6 months, and 12 months), and Group × Time as the two-way interaction. Besides, the effective rate, adverse effects, and medication were also recorded. The risk factors of PHN were analyzed by logistic regression. Results: A total of 25 (19.08%) patients with HZ continued to have pain in the initially affected area after 3 months. The VAS scores and the BPI quality of life scores of patients with HZ-associated pain were significantly reduced from baseline to 2 weeks, 3, 6, and 12 months after the interventions. There was no significant difference in VAS and BPI scores in different pain areas and pain durations. No significant Group × Time interaction was observed. Age, diabetes mellitus, and immune-related diseases were risk factors of PHN. Conclusion: Interventions could significantly improve the pain degree and life quality of patients with zoster-associated pain, and the positive effect of intervention did not change with pain duration and area. Advanced age, diabetes, and immune-related diseases are risk factors of PHN.

Effect and safety of extracorporeal shockwave therapy for postherpetic neuralgia: A randomized single-blind clinical study.

Objective: To evaluate the efficacy and safety of extracorporeal shockwave therapy (ESWT) for postherpetic neuralgia. Design: Randomized single-blind clinical study. Patients: Patients with postherpetic neuralgia. Methods: Patients were randomly divided into the control group and the ESWT group. The control group received conventional treatment while the ESWT group received conventional treatment and ESWT. The primary outcome is pain degree as assessed by the numeric rating scale (NRS), and secondary outcomes include brief pain inventory (BPI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). Data were collected at baseline and at weeks 1, 4, and 12. Linear mixed-effects models were applied to repeated measurement data. Results: The scores on the NRS, BPI, SAS, SDS, and PSQI decreased over time in both groups. The NRS and SDS scores of the ESWT group were statistically lower than the control group. There was no time × group interaction in the mixed model analysis. Baseline age was correlated with NRS scores and BPI scores, and invasive treatment was related to PSQI scores, with no interaction effect for baseline confounders observed. No adverse events were observed during the process of this trial. Conclusion: Extracorporeal shockwave therapy combined with conventional treatment could relieve pain and improve the psychological state in patients with postherpetic neuralgia without serious adverse effects.

An Improved Monkey Model of Myocardial Ischemic Infarction for Cardiovascular Drug Development.

Non-human primate monkey model of myocardial ischemic infarction is precious for translational medicine research. Ligation of the left anterior descending (LAD) artery is a common procedure to induce myocardial ischemic infarction. However, the consistency of the myocardial infarction thus generated remains problematic. The present study was undertaken to critically evaluate the monkey model of myocardial ischemic infarction to develop a procedure for a consistent cross-study comparison. Forty male Rhesus monkeys were divided into 4 groups and subjected to LAD artery ligation at different levels along the artery. In addition, the major diagonal branch was selectively ligated parallel to the ligation site of the LAD artery according to the diagonal branch distribution. Analyses of MRI, echocardiography, cardiac hemodynamics, electrocardiography, histopathology, and cardiac injury biomarkers were undertaken to characterize the monkeys with myocardial infarction. Ligation at 40% of the total length of the artery, measured from the apex end, produced variable infarct areas with inconsistent functional alterations. Ligation at 60% or above coupled with selective ligation of diagonal branches produced a consistent myocardial infarction with uniform dysfunction. However, ligation at 70% caused a lethal threat. After a thorough analysis, it is concluded that ligation at 60% of the total length coupled with selective ligation of diagonal branches, enables standardization of the location of occlusion and the subsequent ischemic area, as well as avoids the influence of the diagonal branches, are ideal to produce a consistent monkey model of myocardial ischemic infarction.

The methylenetetrahydrofolate reductase 1298 A>C polymorphism is associated with an increased risk of inflammatory bowel disease: evidence from a meta-analysis.

OBJECTIVE: The association between genetic variants in methylenetetrahydrofolate reductase (MTHFR) and risk for inflammatory bowel disease (IBD) has been widely studied. However, the results are equivocal. In this meta-analysis, we aimed to determine the association between MTHFR polymorphisms and susceptibility to IBD. METHODS: We retrieved studies from the PubMed, Web of Science, Ovid, and China National Knowledge Infrastructure databases. Data were analyzed using STATA software; odds ratios (OR) and confidence intervals (CI) were calculated using fixed or random effects models. RESULTS: A marginally significant association of the MTHFR 677 C > T polymorphism and patients' IBD risk was observed in the overall analysis (OR = 1.11, 95% CI, 1.01-1.23), but not in the analysis of high-quality studies. However, for the MTHFR 1298 A > C polymorphism, a significant association was found between the MTHFR 1298 AC/CC genotypes and IBD risk in the overall analysis (OR = 1.26, 95% CI, 1.10-1.44), in the high-quality studies (OR = 1.20, 95% CI, 1.02-1.41), and in patients with ulcerative colitis (OR = 1.28, 95% CI, 1.10-1.48). CONCLUSIONS: Evidence from this meta-analysis indicates that the MTHFR 1298 A > C polymorphism may be responsible for susceptibility to IBD and ulcerative colitis.

A Meta-Analysis of 5-Hydroxytryptamine Receptor 1B Polymorphisms With Risk of Major Depressive Disorder and Suicidal Behavior.

Purpose: Previous association studies have investigated whether genetic polymorphisms in HTR1B influenced individuals' susceptibility to major depressive disorder (MDD), anti-depressant response (ADR) and suicidal behavior. However, equivocal evidence was obtained. In this meta-analysis, we aimed to examine the association of HTR1B polymorphisms with risk of MDD, ADR and suicidal behavior. Materials and Methods: Studies evaluating the association between HTR1B polymorphisms and risk of MDD, ADR and suicidal behavior were searched in Pubmed, Ovid Medline, web of science and China National Knowledge Infrastructure databases. Summary odds ratios (ORs), 95 % confidence intervals (CIs) and p-values were calculated using a fixed or random effects model. Results: Meta-analysis findings revealed a significantly increased risk of MDD with rs6296 GC and GC/CC genotypes (GC vs. GG: OR = 1.26, 95% CI, 1.07-1.48; GC/CC vs. GG: OR = 1.22, 95% CI, 1.04-1.43, respectively). Moreover, rs6298 CT genotype was significantly associated with an increased risk of suicidal behavior (CT vs. CC: OR = 1.48, 95% CI, 1.16-1.88). However, both rs6296 and rs130058 were not significant risk factors for lethal suicidal behavior. Conclusion: This meta-analysis identified that rs6296 and rs6298 in HTR1B may be significantly related to the risk of MDD and lethality of suicide attempts, respectively. Further studies are required to assess the markers in larger cohorts.

Blocking the Mineralocorticoid Receptor Improves Cognitive Impairment after Anesthesia/Splenectomy in Rats.

Recent mounting studies showed that neuroinflammation caused by surgery or anesthesia is closely related to postoperative cognitive dysfunction (POCD). This study investigated the effect of mineralocorticoid receptor (MR) on neuroinflammation and POCD. To detect the MR effect in an animal model, we randomly divided rats into control, anesthesia, and surgery groups. To determine whether the MR-specific blocker eplerenone (EPL) could improve cognitive dysfunction, we assigned other animals into the control, surgery and EPL treatment, and surgery groups. Cognitive function was detected using the Morris water maze. Serum cytokine levels were measured by ELISA, and the histopathological changes of hippocampal neurons were identified by hematoxylin/eosin and Nissl staining. Our research confirmed that anesthesia and surgical stimulation could lead to IL-1ß, IL-6, and TNF-α activation and hippocampal neuronal degeneration and pathological damage. MR was upregulated in the hippocampus under cognitive impairment condition. Additionally, EPL could alleviate inflammatory activation and neuronal damage by exerting neuroprotective effects. The preclinical model of sevoflurane anesthesia/splenectomy implied that MR expression is upregulated by regulating the neuroinflammation in the brain under POCD condition. Manipulating the MR expression by EPL could improve the inflammation activation and neuronal damage.

Development and validation of an oxidative phosphorylation-related gene signature in lung adenocarcinoma.

Aim: To develop an oxidative phosphorylation (OXPHOS)-related gene signature of lung adenocarcinoma (LUAD). Materials & methods: We split The Cancer Genome Atlas LUAD cohort into a training set and a test set; we used the least absolute shrinkage and selection operator Cox method to structure the OXPHOS-related prognostic signature in the training set and verified in the test set and GSE30219 dataset. Meanwhile, the diagnostic model was constructed using the logistic Cox method. Results: The signature consisted of seven genes (LDHA, CFTR, HSPD1, SNHG3, MAP1LC3C, COX6B2, and TWIST1). LUAD patients were divided into high- and low-risk groups, demonstrating good diagnostic and prognostic capabilities. Conclusion: We developed the first-ever OXPHOS-related signature with both prognostic predictive power and diagnostic efficacy.

Efficacy and safety of the extracorporeal shockwave therapy in patients with postherpetic neuralgia: study protocol of a randomized controlled trial.

BACKGROUND: Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor response to the currently available treatments. The main strategies for PHN management are medication and invasive interventional therapies; however, these approaches have many adverse effects, so it is important to find another effective and safe treatment for PHN. METHODS: A single-center, single-blind randomized clinical trial will evaluate 98 study participants randomized in a 1:1 ratio into control and experimental groups. The control group will receive conventional treatment including medication therapy and invasive interventional therapy. The experimental group will receive extracorporeal shockwave therapy (ESWT) in addition to conventional therapy. The primary outcome is pain intensity assessed on a visual analogue scale (VAS); the secondary outcomes are the following: quality of life assessed by the 36-Item Short-Form Health Survey (SF-36), psychological state for anxiety and depression measured by the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Assessors blinded to the randomization will collect data during the intervention period at baseline and weeks 1, 4, and 12. The plasma levels of tumor necrosis factor-α and interleukin-6 will be assessed before and after ESWT to explore the biochemical mechanisms of ESWT in the treatment of PHN. DISCUSSION: This randomized controlled trial will evaluate the effectiveness and safety of ESWT in patients with PHN and thus will provide clinical evidence for its use in the management of PHN and explore the potential biochemical mechanisms of this treatment. TRIAL REGISTRATION: www.ChiCTR.org.cn , identifier: ChiCTR1900025828. Registered on 10 September 2019.

Extracorporeal Shock Wave Therapy for the Treatment of Osteoarthritis: A Systematic Review and Meta-Analysis.

BACKGROUND: Osteoarthritis is the most common musculoskeletal disease. Extracorporeal shockwave therapy had shown an effect on osteoarthritis in both some animal experiments and clinical studies, but there was no systematic review to confirm the value of shockwave therapy in the treatment of all types of osteoarthritis and compare it with other traditional therapies (especially traditional Chinese medicine). METHOD: PubMed, Medline, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, WANFANG database, and VIP database were searched up to December 10, 2019, to identify randomized controlled trials comparing shockwave therapy and other treatments for osteoarthritis. Visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index were extracted and analyzed by RevMan and STATA software as outcomes of pain reduction and functional improvement. Adverse reactions were recorded to evaluate the safety of shockwave therapy. RESULTS: Shockwave therapy had significant improvement in both pain reduction and functional improvement compared with placebo, corticosteroid, hyaluronic acid, medication, and ultrasound (P < 0.05). In functional improvement, shockwave therapy showed statistical improvement compared with kinesiotherapy and moxibustion (P < 0.05) but not with acupotomy surgery (P = 0.24). A significant difference between shockwave therapy and platelet-rich plasma was observed in pain reduction (P < 0.05) but not in functional improvement (P = 0.89). Meanwhile, a statistical difference was found between shockwave therapy and fumigation in functional improvement (P < 0.05) but not in pain reduction (P = 0.26). Additionally, there was no statistically significant difference between shockwave therapy and manipulation in both pain reduction (P = 0.21) and functional improvement (P = 0.45). No serious adverse reaction occurred in all of studies. CONCLUSIONS: Extracorporeal shockwave therapy could be recommended in the treatment of osteoarthritis as a noninvasive therapy with safety and effectiveness, but the grade of recommendations needs to be discussed in a further study.

Spinal Cord is the Primary Site of Action for Skeletal Muscle Relaxation by Sevoflurane.

MINI: A modified selective anesthetics delivery rabbit model was used validated to a better preferential anesthesia than previous models. Furthermore, we found evidence that primarily the spinal cord mediated the skeletal muscle relaxation action of sevoflurane. STUDY DESIGN: A randomized, in vivo study was performed to explore the skeletal muscle relaxation action site of sevoflurane. OBJECTIVE: The aim of this study was to investigate the skeletal muscle relaxation action of sevoflurane by a modified selective anesthetics delivery rabbit model. SUMMARY OF BACKGROUND DATA: The action site and mechanisms of skeletal muscle relaxation caused by sevoflurane were unclear, so a modified selective anesthetics delivery model was used. METHODS: Sixteen male New Zealand White rabbits were randomly assigned to the sevoflurane or sham group. In situ measurement of train of four, maximum single twitch, and tetanic muscle force of left tibialis anterior muscle was repeatedly measured at three time points: at the beginning of lower torso bypass (baseline value), during preferential sevoflurane delivery to the brain (brain value), during preferential sevoflurane delivery to the spinal cord (spinal cord value). RESULTS: When 1.5MAC sevoflurane was administrated via the lungs, the arterial concentration and partial pressure of sevoflurane in the upper torso were 205.27 ±â€Š16.23 µg/mL and 29.16 ±â€Š1.05 mmHg, whereas in the lower torso bypass circulation were 10.39 ±â€Š4.50 µg/mL and 1.79 ±â€Š0.97 mmHg. Conversely, the arterial concentration and partial pressure of sevoflurane in the upper torso were 14.04 ±â€Š5.33 µg/mL and 2.25 ±â€Š0.84 mmHg, whereas those values were 199.38 ±â€Š11.61 µg/mLl and 29.20 ±â€Š1.08 mmHg in the lower torso, when 1.5MAC sevoflurane was delivered via an oxygenator. In sevoflurane group, maximum single twitch and tetanic muscle force were significantly reduced compared with baseline (single: P = 0.046; tetanic: P = 0.001) or brain values (single: P = 0.005; tetanic: P = 0.001), when spinal cord was selectively anesthetized. In the sham group, there were no significant differences among the three conditions compared. CONCLUSION: A modified selective anesthetics delivery rabbit model has been validated, which provided evidence that the spinal cord, not the brain, was the primary site mediating the skeletal muscle relaxation action of sevoflurane. LEVEL OF EVIDENCE: 5.

A preferential delivery method to investigate direct neuromuscular blockade effect of inhaled anesthetics on skeletal muscle.

Inhaled anesthetics can enhance the effect of neuromuscular blocker, but whether inhaled anesthetics such as sevoflurane have a direct effect on skeletal muscle contractility is unknown. Selectively blocking skeletal muscle may prevent the interference effect of central nervous system. So we decided to evaluate a local application of neuromuscular blocker (NMB) atracurium to prevent the general effect on skeletal muscle. In part 1, sevoflurane (a inhaled anesthetic) minimum alveolar concentrations (MAC) of 1.0, 1.5 and 2.0 would be applied in succession. Neuromuscular function was assessed at each MAC. In part 2, patients are randomized into four groups: group1 (propofol+NMB, sevoflurane 0 MAC), and groups 2 to 4 (NMB+sevoflurane 1.0, 1.5 and 2.0 MAC respectively). In group 1, patients were anesthetized by propofol, then 0.01mg/kg atracurium was injected into the tested arm intravenously after the arterial blood flow was blocked using a tourniquet. For the other 3 groups, patients inhaled 1.0 MAC, 1.5 MAC, or 2.0 MAC of sevoflurane. Then 0.01mg/kg atracurium was injected. Neuromuscular function was recorded for the 4 groups. Neuromuscular function was assessed by acceleromyography measurement of evoked responses to train-of four (TOF) stimuli (2Hz for 2s applied every 12s) at the adductor pollicis using a TOF-Guard™ neuromuscular transmission monitor. If proven, our hypothesis would demonstrate the inhaled anesthetics have no direct effect on contractility but only by increasing the skeletal muscle sensitivity to NMB.

[The Effect of Emulsified Sevofluran on Muscular Relaxation through Selective Blockage of Peripheral Nerves].

OBJECTIVES: To identify the site that emulsified sevoflurane influences in the nerve system. METHODS: Thirty-six healthy New Zealand rabbits were randomly and equally divided into low concentration emulsified sevoflurane group [4 mL/(kg·h)], medium concentration [6 mL/(kg·h)]group, high concentration group[10 mL/(kg·h)]and intralipid control group. Emulsified sevoflurane was infused through arterial to selectively block peripheral nerves, neuro-muscular junctions and muscle fibers. The anterior tibial muscle resting tensions and muscle contraction forces were compared before and after the infusions. RESULTS: Significant differences of blood sevoflurane pressure between femoral veins and internal jugular veins appeared in rabbits in all the groups ( P<0.05). No significant changes in the resting tension of anterior tibia muscles were found in terms of single contractions and tetanic forces with the low and medium levels of infusion of sevoflurane compared to the base values. High level of infusion of sevoflurane resulted in decreased single contraction forces and tetanic forces of anterior tibia muscles ( P<0.05). CONCLUSIONS: A rabbit model with selective blockage of peripheral nerves was established. Peripheral nerves are not the primary site which low and medium levels of emulsified sevoflurane influence skeletal muscle relaxations.

[Emulsified Sevoflurane Selectively Blocking Spinal Cord and Brain in Rabbit Model].

OBJECTIVES: To establish the rabbits model of selectively anesthetized brain and spinal cord and to explore the skeletal muscle relaxation sites of sevoflurane. METHODS: Sixteen adult male New Zealand white rabbits were randomly assigned to the experiment. The upper torso systemic circulation and the lower torso bypass circulation were independently established by the ligation of thoracic aorta at T12-L1 level. Sevoflurane was administered to the upper or lower torso through lungs or oxygenator to selectively anesthetized brain or spinal cord (mainly lumbar and sacro-coccygeal region). Sevoflurane concentration from end-tidal (represented the brain) and oxygenator outlet (represented the spinal cord) was measured by an anesthetic gas analyzer. The concentration and partial pressure of sevoflurane in carotid artery (represented the brain) and abdominal aorta (represented the spinal cord) were determined using a gas chromatograph with the two-stage headspace equilibration method. RESULTS: When 1.5 mininum alveolar concentration (MAC) sevoflurane was administrated via lungs, the concentration and partial pressure of sevoflurane in the carotid artery were significantly higher than those in the abdominal aorta (P<0.05), with the end-tidal sevoflurane concentration higher than that of oxygenator outlet ( P<0.05), which indicated sevoflurane concentration and partial pressure in brain were higher than those in spinal cord. When 1.5 MAC sevoflurane was delivered via oxygenator,the indicators were conversed ( P<0.05), which indicated sevoflurane concentration and partial pressure in spinal cord were higher than those in brain. CONCLUSIONS: Based on the unique blood supply to the spinal cord of New Zealand white rabbits, we successfully established selectively anesthetized brain and spinal cord rabbit models.

Sevoflurane enhances neuromuscular blockade by increasing the sensitivity of skeletal muscle to neuromuscular blockers.

The aim of this study was to investigate the effects of sevoflurane on skeletal muscle contractility. In the first part, twenty-two American Society of Anesthesiology (ASA I-II) female adult patients undergoing elective hysterectomy surgery inhaled sevoflurane 1.0, 1.5 and 2.0 minimum alveolar concentrations (MAC) in succession. Neuromuscular function was assessed at each dose. In the second part, forty-four ASA I-II female adult patients were randomized into four groups: group 1 (propofol + atracurium, sevoflurane 0 MAC), and groups 2 to 4 (atracurium + sevoflurane 1.0, 1.5 and 2.0 MAC, respectively). In group 1, patients were anesthetized by propofol. Then 0.01 mg/kg atracurium was injected into the tested arm intravenously after the arterial blood flow was blocked using a tourniquet. For the other 3 groups, patients inhaled 1.0 MAC, 1.5 MAC, or 2.0 MAC of sevoflurane. Then 0.01 mg/kg atracurium was injected. Neuromuscular function was recorded for the 4 groups. Neuromuscular function was assessed by acceleromyography measurement of evoked responses to train-of four (TOF) stimuli (2 Hz for 2 s applied every 12 s) at the adductor pollicis using a TOF-Guard(TM) neuromuscular transmission monitor. Amplitudes of first response (T1) in each TOF sequence and the ratios of fourth TOF response (T4) to the first were similar at 1.0 MAC, 1.5 MAC, and 2.0 MAC sevoflurane. Compared to baseline, there was no significant change in the TOF value after inhaling 1.0 MAC, 1.5 MAC, or 2.0 MAC sevoflurane. Compared to group 1, there was no significant difference in atracurium onset time (time to reach TOF ratio = 0.25) in group 2 ( 5.6 ± 1.8 min vs. 6.5 ± 1.7 min, P>0.05), or degree of adductor pollicis block (subject number with TOF ratio = 0, 5 vs. 2 subjects, p = 0.3). However, inhaling 1.5 or 2.0 MAC sevoflurane decreased atracurium onset time (4.6 ± 1.5 min and 4.0 ± 1.3 min vs. 6.5 ± 1.7 min, P<0.01 and P<0.001, respectively), and enhanced the block degree (9 and 10 vs. 2 subjects, P<0.001) compared with group 1. Sevoflurane has no direct effects on the adductor pollicis contractility, but increased the skeletal muscle sensitivity to atracurium.

Sealing of tracheoesophageal fistula using a Y stent through fiberoptic bronchoscope during general anesthesia under laryngeal mask airway.

A 64-yr-old man was admitted because of repeated pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula (15 mm) in the right posterior trachea 1 cm beyond the carina. Coated nickel-titanium shape memory alloy Y shaped stent was planned to seal this fistula under general anesthesia. We took advantage of laryngeal mask airway to insert the fiberoptic bronchoscope to guide the stent placement. Our method of sealing a large tracheoesophageal fistula with LMA under total intravenous anesthesia was successful.