Adiponectin regulates thermal nociception in a mouse model of neuropathic pain.

BACKGROUND: Adiponectin, a cytokine secreted by adipocytes, plays an important role in regulating glucose and lipid metabolism. However, the role of adiponectin in pain conditions is largely unknown. This study aimed to identify the role and mechanism of adiponectin in nociceptive sensitivity under physiological and pathological states utilising adiponectin knockout (KO) mice. METHODS: Wild type (WT) and adiponectin KO mice were subjected to partial sciatic nerve ligation (pSNL) or sham operation. Pain-like behavioural tests, including thermal allodynia, hyperalgesia, and mechanical allodynia, were performed before and after pSNL from Day 3-21. Dorsal root ganglions (DRGs), lumbar spinal segments at L3-5, and somatosensory cortex were collected for protein measurement via western blotting and immunofluorescence staining. RESULTS: Compared with WT mice, KO mice had significantly lower (40-50%) paw withdrawal latency to innocuous and noxious stimuli before and after pSNL. In DRG neurones from KO mice, where adiponectin receptor (AdipoR) 2 is located, phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK) and heat-sensitive transient receptor potential cation channel subfamily V member 1 (TRPV1) were significantly higher (by two- to three-fold) than from WT mice. In spinal microglia and somatosensory cortical neurones, where AdipoR1 is mainly located, p-p38 MAPK and TRPV1 were also higher (by two- to three-fold) in KO compared with WT mice, and altered signalling of these molecules was exacerbated (1.2- to 1.3-fold) by pSNL. CONCLUSIONS: Our results show that adiponectin regulates thermal nociceptive sensitivity by inhibiting activation of DRG neurones, spinal microglia, and somatosensory cortical neurones in physiological and neuropathic pain states. This study has relevance for patients with adiponectin disorders, such as obesity and diabetes.

Effects of extended in-patient treatment training on outcome of post-stroke dysphagia.

OBJECTIVE: To investigate the effects of extended in-patient training on swallowing function of patients with post-stroke dysphagia. PATIENTS AND METHODS: 40 patients with post-stroke dysphagia treated between January 2013-December 2015 were randomly divided into the treatment group and the control group. During the hospitalization, patients in both groups underwent routine examinations, graded swallowing training, radio frequency electrotherapy, acupuncture, dietary guidance, body position and compensation training, etc. In addition, patients in the treatment group received training with ice stimulation. The swallowing functions and prevalence rate of adverse events of the two groups during the first three months after discharge from the hospital were compared. Twenty healthy people coming for a regular checkup during the same period were also included in this study. ELISA was used to compare the peripheral blood S100ß levels of the patients with post-stroke dysphagia and the healthy population. RESULTS: After 3-month follow-up, statistical analysis showed that 70.00% patients in the treatment group regained normal (excellent/very good) swallowing function, which was much higher than the normal rate of people in the control group (25%). The difference was statistically significant (χ2 = 8.12, p<0.05). Patients in the treatment had a lower prevalence rate of adverse events (e.g. aspiration, choking, aspiration pneumonia) (5.00%) lower than the control group (25.00%), and the difference was statistically significant (χ2 = 4.02, p<0.05). ELISA assay indicated that the peripheral blood S100ß levels in patients with dysphagia were significantly higher than the healthy population (p<0.05). But compared with the control group, patients in the treatment group patients had lower S100ß level after the treatment, and the difference was statistically significant (p<0.05). CONCLUSIONS: The extended ward training could significantly improve the swallowing function of patients with post-stroke dysphagia, restore their swallowing function, and reduce adverse events of swallowing. The operations were simple, safe and practical. The training is worthy of promotion.

Higher mortality in patients with right hemispheric intracerebral haemorrhage: INTERACT1 and 2.

BACKGROUND AND PURPOSE: Controversy exists over the prognostic significance of the affected hemisphere in stroke. We aimed to determine the relationship between laterality of acute intracerebral haemorrhage (ICH) and poor clinical outcomes. METHODS: A subsidiary analysis of the INTERACT Pilot and INTERACT2 studies--randomised controlled trials of patients with spontaneous acute ICH with elevated systolic blood pressure (BP), randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Outcomes were the combined and separate end points of death and major disability (modified Rankin scale (mRS) scores of 3-6, 6 and 3-5, respectively) at 90 days. RESULTS: A total of 2708 patients had supratentorial/hemispheric ICH and information on mRS at 90 days. Patients with right hemispheric ICH (1327, 49%) had a higher risk of death at 90 days compared to those with left hemispheric ICH after adjustment for potential confounding variables (OR, 1.77 (95% CI 1.33 to 2.37)). There were no differences between patients with right and left hemispheric ICH regarding the combined end point of death or major disability or major disability in the multivariable-adjusted models (1.07 (0.89 to 1.29) and 0.85 (0.72 to 1.01), respectively). CONCLUSIONS: Right hemispheric lesion was associated with increased risk of death in patients with acute ICH. The laterality of the ICH does not appear to affect the level of disability in survivors. TRIAL REGISTRATION NUMBER: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.

Significance of perihematomal edema in acute intracerebral hemorrhage: the INTERACT trial.

BACKGROUND: Uncertainty surrounds the effects of cerebral edema on outcomes in intracerebral hemorrhage (ICH). METHODS: We used data from the INTERACT trial to determine the predictors and prognostic significance of "perihematomal" edema over 72 hours after ICH. INTERACT included 404 patients with CT-confirmed ICH and elevated systolic blood pressure (BP) (150-220 mm Hg) who had the capacity to commence BP lowering treatment within 6 hours of ICH. Baseline and repeat CT (24 and 72 hours) were performed using standardized techniques, with digital images analyzed centrally. Predictors of growth in edema were determined using generalized estimating equations, and its effects on clinical outcomes were estimated using a logistic regression model. RESULTS: Overall, 270 patients had 3 sequential CT scans available for analyses. At baseline, there was a highly significant correlation between hematoma and perihematomal edema volumes (r(2) = 0.45). Lower systolic BP and baseline hematoma volume were independently associated with absolute increase in perihematomal edema volume. History of hypertension, baseline hematoma volume, and earlier time from onset to CT were independently associated with relative increase in edema volume. Both absolute and relative increases in perihematomal edema growth were significantly associated with death or dependency at 90 days after adjustment for age, gender, and randomized treatment, but not when additionally adjusted for baseline hematoma volume. CONCLUSIONS: The degree of, and growth in, perihematomal edema are strongly related to the size of the underlying hematoma of acute intracerebral hemorrhage, and do not appear to have a major independent effect in determining the outcome from this condition.

A cost analysis of an introduction to clinical medicine course in a non-university teaching hospital.

PURPOSE: To determine the major direct costs associated with teaching the Introduction to Clinical Medicine (ICM) course at a non-university teaching hospital. METHOD: The major direct costs were calculated for ICM, a ten-week course taught at the Columbia Michael Reese Hospital and Medical Center, a non-university teaching hospital, to second-year students from the University of Illinois College of Medicine at Chicago. The major components of ICM are physical diagnosis, clinical pathology, and radiology, as well as some pediatrics; the bulk of the costs for these components is incurred for physician staff time. Physician time was reported by component coordinators, who also estimated preparation and teaching times. Physician cost per hour was chosen as that equivalent to assistant professors' salaries. Resident cost per hour was determined from the average resident salary at the hospital. Miscellaneous direct costs (of basic life-support certification, gift certificates, and standardized patients) were calculated from the receipts and bills submitted for payment. In the spring of 1995 the hospital conducted ICM for 26 students. RESULTS: The attending physicians worked a total of 736.5 hours, for a cost of $37,303. The residents worked a total of 314 hours, for a cost of $4,396. Miscellaneous costs totaled $2,019. The total of these major direct costs was $43,718, or $1,681 per student. CONCLUSION: These results can help medical educators and policymakers as they investigate innovative teaching methods and funding sources.

The nucleotide sequence of a major glutamine tRNA from rat liver.

A major glutamine tRNA from rat liver was purified. Post-labeling techniques showed its nucleotide sequence to be: pG-G-U-U-C-C-A-U-m(1)G-G-U-G-psi-A-A-D-Gm-G-D-D-A-G-C-A-C-U-C-U-G-G-A-Cm-U-C-U-G-A-A-psi-C-C-A-G-C-G-A-U-m(5)C-m(5)C-G-A-G-psi-psi-C-A-m(1)A-A-U-C-U-C-G-G-U-G-G-A-A-C-C-U-C-C-A(OH).Images