Neurolytic celiac plexus block reduces occurrence and duration of terminal delirium in patients with pancreatic cancer.

PURPOSE: WHO's three step ladder sometimes cannot provide adequate pain relief for pancreatic cancer. Some patients develop terminal delirium (TD). The aim of this study was to test if the addition of a celiac plexus block (CPB) to pharmacotherapy could reduce the incidence of TD. METHODS: Pancreatic cancer patients under the care of our palliative-care team were investigated with regard to the duration and occurrence of TD, pain scores [numerical rating score (NRS)] and daily opioid dose. Between August 2007 to September 2008, 17 patients received only pharmacotherapy (control group). Then, we modified our guideline for analgesia, performing CPB 7 days after the first intervention of our team. Between October 2008 to September 2009, 19 patients received CPB. RESULTS: The opioid doses in CPB group were significantly lower both at 10 days after the first intervention (3 days after CPB) (27 ± 11 vs. 66 ± 82 mg; p = 0.029) and 2 days before death (37 ± 25 vs. 124 ± 117 mg; p = 0.009). NRS in the CPB group were significantly lower both at 10 days after the first intervention (0 [0-2] vs. 3 [2-5], p < 0.0001) and 2 days before death (1 [0-2] vs. 3 [1-4.5], p = 0.018). The occurrence and duration of TD in CPB group were both reduced (42 vs. 94 %, p = 0.019; and 1.8 ± 2.9 vs. 10.4 ± 7.5 days, p = 0.0003). CONCLUSION: The duration and occurrence of TD and the pain severity were significantly less in pancreatic cancer patients who underwent neurolytic CPB.

Excitatory GABAergic activation of cortical dividing glial cells.

Adult neocortex contains dividing satellite glia population even though their characteristics and functions have still remained unknown. Nestin(+)/NG2(+) cells as major fraction of dividing glial cells express bicuculline-sensitive gamma-aminobutyric acid A (GABA(A)) receptors and receive GABAergic inputs. Due to their high [Cl(-)](i), GABAergic activation depolarized the cells and then induced Ca(2+) influx into them. To assess an effect of this GABAergic excitation, we looked for the expression of neurotrophic factors. Among them, we detected the expression of brain-derived neurotrophic factor (BDNF) on the cells. The level of BDNF expression was elevated after cortical ischemia, and this elevation was blocked by bumetanide, an inhibitor for NKCC1 that blocks the GABAergic depolarization. Furthermore, performing a modified adhesive removal test, we observed that the treatment of bumetanide significantly attenuated the recovery in somatosensory dysfunction. Our results may shed a light on satellite glia population in the cortex and imply their roles in the functional recovery after ischemic injuries.

Neural precursor cells from adult mouse cerebral cortex differentiate into both neurons and oligodendrocytes.

Recent findings concerning adult neurogenesis in two selected structures of the mammalian brain, the olfactory bulb and dentate gyrus of the hippocampus, present the possibility that this mechanism of neurogenesis applies for all brain regions, including the cerebral neocortex. In this way, a small number of potential neural precursor cells may exist in the cerebral neocortex, but they do not normally differentiate into cortical neurons in vivo. It has, however, been reported recently that cycling cells isolated from non-neurogenic areas of adult rat cerebral cortex could generate neurons in vitro. In this study, we analyzed the lineage potential of cycling cells from the adult mouse neocortex. For the dissection of the cerebral cortex from the adult mouse, which is significantly smaller than that of the adult rat, we have modified the previous dissection protocol developed for the rat neocortex. As a result, cycling cells from adult mouse neocortex gave rise to neurons and oligodendrocytes, but not to astrocytes, whereas when the previous dissection method was used, cycling cells gave rise to neurons, oligodendrocytes and astrocytes. This discrepancy might stem from slight contamination of the dissected mouse neocortical tissue in the previous protocol used for the dissection of rat neocortex by cells from the surrounding subependymal zone, where typical adult neural stem cells exist. The results presented here will contribute to our understanding of the nature of cycling cells in the adult mammalian neocortex, and for which future stem cell research will provide new possibilities for cell replacement therapy to be used in the treatment of neurodegenerative conditions.