Glycemia-dependent nuclear factor κB activation contributes to mechanical allodynia in rats with chronic postischemia pain.

BACKGROUND: Ischemia-reperfusion injury causes chronic postischemia pain (CPIP), and rats with higher glycemia during ischemia-reperfusion injury exhibit increased allodynia. Glycemia-induced elevation of nuclear factor κB (NFκB) may contribute to increased allodynia. METHODS: Glycemia during a 3-h ischemia-reperfusion injury was manipulated by: normal feeding; or normal feeding with administration of insulin; dextrose; or insulin/dextrose. In these groups, NFκB was measured in ipsilateral hind paw muscle and spinal dorsal horn by enzyme-linked immunosorbent assay (ELISA), and SN50, an NFκB inhibitor, was administered to determine its differential antiallodynic effects depending on glycemia. RESULTS: CPIP fed/insulin rats (12.03 ± 4.9 g, N = 6) had less allodynia than fed, fed/insulin/dextrose, and fed/dextrose rats (6.29 ± 3.37 g, N = 7; 4.57 ± 3.03 g, N = 6; 2.95 ± 1.10 g, N = 9), respectively. Compared with fed rats (0.209 ± 0.022 AU, N = 7), NFκB in ipsilateral plantar muscles was significantly lower for fed/insulin rats, and significantly higher for fed/dextrose rats (0.152 ± 0.053 AU, N = 6; 0.240 ± 0.057 AU, N = 7, respectively). Furthermore, NFκB in the dorsal horn of fed, fed/insulin/dextrose, and fed/dextrose rats (0.293 ± 0.049 AU; 0.267 ± 0.037 AU; 0.315 ± 0.015 AU, respectively, N = 6 for each) was significantly higher than in fed/insulin animals (0.267 ± 0.037 AU, N = 6). The antiallodynic SN50 dose-response curves of CPIP rats in the fed/insulin/dextrose, fed/dextrose, and fed conditions exhibited a rightward shift compared with the fed/insulin group. The threshold SN50 dose of CPIP fed/dextrose, fed/insulin/dextrose, and fed rats (328.94 ± 92.4 ng, 77.80 ± 44.50 ng, and 24.89 ± 17.20 ng, respectively) was higher than that for fed/insulin rats (4.06 ± 7.04 ng). CONCLUSIONS: NFκB was activated in a glycemia-dependent manner in CPIP rats. Hypoglycemic rats were more sensitive to SN50 than rats with higher glycemia. The finding that SN50 reduces mechanical allodynia suggests that NFκB inhibitors might be useful for treating postischemia pain.

[Competency-based nursing training]. / L'approche par compétences dans la formation des infirmiers.

The application of the new nursing training reference framework requires the active participation of professionals in the field, notably with assessing students' skills during a work placement. The skills approach represents a paradigm shift for caregivers, one which requires reflection with regard to their activities, and the creation of tools suitable for constructive assessment. A task force within the Toulouse cancer unit has been created to reflect on and support the changes brought about by the reform.

Effects of glycemic regulation on chronic postischemia pain.

BACKGROUND: Ischemia-reperfusion (I/R) injuries consist of enhanced oxidative and inflammatory responses along with microvascular dysfunction after prolonged ischemia and reperfusion. Because I/R injuries induce chronic postischemia pain (CPIP) in laboratory animals, it is possible that surgical procedures using prolonged ischemia may result in chronic postoperative pain. Glycemic modulation during ischemia and reperfusion could affect pain after I/R injury because glucose triggers oxidative, inflammatory, and thrombotic reactions, whereas insulin has antioxidative, antiinflammatory, and vasodilatory properties. METHODS: One hundred ten rats underwent a 3-h period of ischemia followed by reperfusion to produce CPIP. Rats with CPIP had previously been divided into six groups with differing glycemic modulation paradigms: normal feeding; fasting; fasting with normal saline administration; fasting with dextrose administration; normal feeding with insulin administration; and normal feeding with insulin and dextrose administration. Blood glucose concentration was assessed during I/R in these separate groups of rats, and these rats were tested for mechanical and cold allodynia over the 21 days afterward (on days 2, 5, 7, 9, 12, and 21 after I/R injury). RESULTS: I/R injury in rats with normoglycemia or relative hyperglycemia (normal feeding and fasting with dextrose administration groups) led to significant mechanical and cold allodynia; conversely, relative hypoglycemia associated with insulin treatment or fasting (fasting, fasting with normal saline administration, and normal feeding with insulin administration groups) reduced allodynia induced by I/R injury. Importantly, insulin treatment did not reduce allodynia when administered to fed rats given dextrose (normal feeding with dextrose and insulin administration group). CONCLUSION: Study results suggest that glucose levels at the time of I/R injury significantly modulate postinjury pain thresholds in rats with CPIP. Strict glycemic control during I/R injury significantly reduces CPIP and, conversely, hyperglycemia significantly enhances it, which could have potential clinical applications especially in the surgical field.

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study.

PURPOSE: Despite adequate epidural analgesia, up to 97% of patients undergoing thoracotomy experience ipsilateral shoulder pain. In this setting, this study evaluated the safety and the efficacy of pre-emptive gabapentin. METHODS: A double-blind, placebo-controlled study was undertaken in 51 patients randomized into two groups. Two hours before surgery, 23 patients received gabapentin 1200 mg po (Group G), and 28 patients received placebo (Group P). Shoulder pain and postoperative pain, at the surgical site, were monitored every four hours for 24 hr, using a numerical rating scale. Subcutaneous hydromorphone was administered for rescue analgesia against shoulder pain. RESULTS: Forty-four patients complained of shoulder pain (prevalence of 86%). Demographic and surgical data were similar between the two groups. There were no significant differences in the total cumulative doses of hydromorphone administered at eight, 16, and 24 hr, nor were there differences in individual numerical rating scale scores for shoulder pain. The groups were similar with respect to the degree of pain at the surgical site. The frequency of side effects between groups at corresponding time intervals was also similar, with the exception of sedation. At four hours, the incidence of sedation scores > 1 was greater in Group G (21/23 patients), compared to Group P (18/28 patients; P = 0.025). In contrast, by 24 hr, 5/18 patients in Group P had sedation scores > 1, compared to 0/28 patients in Group G (P = 0.05). CONCLUSION: Pre-emptively administered gabapentin, 1200 mg, does not reduce the incidence, or the severity, of post-thoracotomy shoulder pain in patients receiving thoracic epidural analgesia.

Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type.

STUDY DESIGN: A retrospective study investigated the sagittal alignment in adolescent idiopathic scoliosis (AIS). OBJECTIVE: To evaluate the sagittal alignment of the spine and pelvis in adolescent idiopathic scoliosis on the basis of curve type. SUMMARY OF BACKGROUND DATA: The relation between the spine and pelvis highly influences the sagittal balance in adults. However, the sagittal alignment of the spine and pelvis in adolescent idiopathic scoliosis is poorly defined in the literature. METHODS: Five sagittal parameters were evaluated on lateral radiographs of 160 patients with adolescent idiopathic scoliosis: thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence. The patients were classified according to their coronal curve type. Analysis of variance was used to compare the parameters between the curve types, and Pearson coefficients were used to investigate the relation between all parameters (alpha = 0.05). RESULTS: The thoracic kyphosis was significantly lower for King I, II, and III curves than for lumbar curves. The lumbar lordosis was higher for lumbar curves, although not significantly. No significant change between the groups was observed for the sacral slope, pelvic tilt, or pelvic incidence. The pelvic incidence was significantly correlated with the lumbar lordosis, sacral slope, and pelvic tilt for all the groups. The lumbar lordosis was strongly related to the sacral slope in all cases, but not with the thoracic kyphosis, except in the case of thoracolumbar curves. CONCLUSIONS: Thoracic kyphosis depended mostly on the spinal deformity, whereas lumbar lordosis was influenced mainly by the pelvic configuration. The scoliotic curve type was not associated with a specific pattern of sagittal pelvic morphology and balance. The pelvic incidence found in this study was significantly higher than that reported in the literature for normal adolescents. The role of the pelvic incidence in the pathogenesis of adolescent idiopathic scoliosis needs to be explored in a longitudinal study involving patients with adolescent idiopathic scoliosis and normal adolescents.

Relation between the pelvis and the sagittal profile in adolescent idiopathic scoliosis: the influence of curve type.

Previous studies have shown a correlation between pelvic parameters and the lumbar lordosis in normal subjects and in scoliotic adults. This study investigates the relationship between pelvic and spinal geometries in the sagittal plane for adolescent idiopathic scoliosis (AIS) patients having various curve types. The study group was composed of 129 AIS patients classified according to their curve type: King I, King II, King III or lumbar curve. The SpineView software (Surgiview, France) was used to compute five parameters on sagittal x-rays: thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). The TK was significantly lower for King I, II and III curves as compared to the lumbar curves. The LL tended to be higher for patients having a major lumbar scoliotic (King I and lumbar) curve, although not significantly. No significant change between the groups was observed for the SS, PT and PI. The PI was significantly correlated to the LL, SS and PT for all groups. The SS was strongly related to the LL in all cases. However, no relationship was found between the TK and the LL in any group. This study showed that the TK mostly depends on the thoracic scoliotic curve and therefore on the shape and orientation of the vertebrae, which explains that many King I, II and III patients are hypokyphotic. Conversely, the LL is mainly influenced by the pelvic configuration. Since the pelvic parameters are similar for all groups, these parameters are not likely to be important in the development of a specific type of scoliotic curve.