Effects of double vs triple injection on block dynamics for ultrasound-guided intertruncal approach to the supraclavicular brachial plexus block in patients undergoing upper limb arteriovenous access surgery: study protocol for a double-blinded, randomized controlled trial.

BACKGROUND: Ultrasound-guided intertruncal approach (IA) has been proposed to be an alternative and promising approach to the supraclavicular block (SCB), in which double injection (DI) of local anesthetics (LA) is sequentially administered between intertruncal planes. We would like to apply a refined injection technique, named triple injection (TI) technique, based on the 3 separate compartments visualized by ultrasound. The aim of this study is to compare the percentage of patients with complete sensory blockade at 20 min of DI vs TI technique, when they are applied in patients undergoing upper limb arteriovenous access surgery. METHODS: This study is a prospective parallel-group randomized controlled trial. A total of 86 end-stage renal disease patients will be randomly allocated to receive IA-SCB using either DI or TI technique with identical LA (0.5% ropivacaine 24 mL). The primary outcome is the percentage of patients with complete sensory blockade of all 4 terminal nerves (median, ulnar, radial, and musculocutaneous nerves) of the brachial plexus measured at 20 min after injection. The secondary outcomes will consist of the sensory or motor blockade of all individual nerves, onset times, performance time, diaphragmatic paralysis, surgical anesthesia, and adverse events. DISCUSSION: It is expected that ultrasound-guided IA-SCB with the TI technique results in better block dynamic in patients undergoing upper limb arteriovenous access surgery. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100045075 .

Randomized controlled trial of an alternative drainage strategy vs routine chest tube insertion for postoperative pain after thoracoscopic wedge resection.

BACKGROUND: Thoracoscopic surgery has greatly alleviated the postoperative pain of patients, but postsurgical acute and chronic pain still exists and needs to be addressed. Indwelling drainage tubes are one of the leading causes of postoperative pain after thoracic surgery. Therefore, the aim of this study was to explore the effects of alternative drainage on acute and chronic pain after video-assisted thoracoscopic surgery (VATS). METHODS: Ninety-two patients undergoing lung wedge resection were selected and randomly assigned to the conventional chest tube (CT) group and the 7-Fr central venous catheter (VC) group. Next, the numeric rating scale (NRS) and pain DETECT questionnaire were applied to evaluate the level and characteristics of postoperative pain. RESULTS: NRS scores of the VC group during hospitalization were significantly lower than those of the CT group 6 h after surgery, at postoperative day 1, at postoperative day 2, and at the moment of drainage tube removal. Moreover, the number of postoperative salvage analgesics (such as nonsteroidal anti-inflammatory drugs [(NSAIDs]) and postoperative hospitalization days were notably reduced in the VC group compared with the CT group. However, no significant difference was observed in terms of NRS pain scores between the two groups of patients during the follow-up for chronic pain at 3 months and 6 months. CONCLUSION: In conclusion, a drainage strategy using a 7-Fr central VC can effectively relieve perioperative pain in selected patients undergoing VATS wedge resection, and this may promote the rapid recovery of such patients after surgery. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03230019. Registered July 23, 2017.

Identifying circRNA-miRNA interaction based on multi-biological interaction fusion.

CircRNA is a new type of non-coding RNA with a closed loop structure. More and more biological experiments show that circRNA plays important roles in many diseases by regulating the target genes of miRNA. Therefore, correct identification of the potential interaction between circRNA and miRNA not only helps to understand the mechanism of the disease, but also contributes to the diagnosis, treatment, and prognosis of the disease. In this study, we propose a model (IIMCCMA) by using network embedding and matrix completion to predict the potential interaction of circRNA-miRNA. Firstly, the corresponding adjacency matrix is constructed based on the experimentally verified circRNA-miRNA interaction, circRNA-cancer interaction, and miRNA-cancer interaction. Then, the Gaussian kernel function and the cosine function are used to calculate the circRNA Gaussian interaction profile kernel similarity, circRNA functional similarity, miRNA Gaussian interaction profile kernel similarity, and miRNA functional similarity. In order to reduce the influence of noise and redundant information in known interactions, this model uses network embedding to extract the potential feature vectors of circRNA and miRNA, respectively. Finally, an improved inductive matrix completion algorithm based on the feature vectors of circRNA and miRNA is used to identify potential interactions between circRNAs and miRNAs. The 10-fold cross-validation experiment is utilized to prove the predictive ability of the IIMCCMA. The experimental results show that the AUC value and AUPR value of the IIMCCMA model are higher than other state-of-the-art algorithms. In addition, case studies show that the IIMCCMA model can correctly identify the potential interactions between circRNAs and miRNAs.

Propofol maintains Th17/Treg cell balance and reduces inflammation in rats with traumatic brain injury via the miR­145­3p/NFATc2/NF­κB axis.

Propofol is a commonly used intravenous anesthetic. The aim of the study was to examine the mechanism of propofol in traumatic brain injury (TBI) by regulating interleukin (IL)­17 activity and maintaining the Th17/Treg balance. A rat model with moderate TBI was established using the weight­drop method. Rats with TBI were regularly injected with propofol and their brain injuries were monitored. The peripheral blood of rats was collected to measure the Th17/Treg ratio. MicroRNA (miR)­145­3p expression was detected in the brain tissues of rats and antagomiR­145­3p was injected into the lateral ventricles of their brains to verify the effect of miR­145­3p on brain injury. The downstream target of miR­145­3p was predicted. The targeting relationship between miR­145­3p and nuclear factor of activated T cells c2 (NFATc2) was confirmed. NFATC2 expression and phosphorylation of NF­κB pathway­related proteins were measured. Propofol alleviated brain injury in rats with TBI and maintained the Th17/Treg balance. Propofol upregulated miR­145­3p expression in rat brains, while the inhibition of miR­145­3p reversed the effect of propofol on brain injury. A binding relationship was observed between miR­145­3p and NFATc2. Furthermore, propofol decreased the phosphorylation of p65 and IκBα, and inhibited activation of the NF­κB pathway in the brains of rats with TBI. In conclusion, propofol maintained Th17/Treg balance and reduced inflammation in the rats with TBI via the miR­145­3p/NFATc2/NF­κB axis.

Dexmedetomidine inhibits vasoconstriction via activation of endothelial nitric oxide synthase.

Despite the complex vascular effects of dexmedetomidine (DEX), its actions on human pulmonary resistance arteries remain unknown. The present study tested the hypothesis that DEX inhibits vascular tension in human pulmonary arteries through the endothelial nitric oxide synthase (eNOS) mediated production of nitric oxide (NO). Pulmonary artery segments were obtained from 62 patients who underwent lung resection. The direct effects of DEX on human pulmonary artery tension and changes in vascular tension were determined by isometric force measurements recorded on a myograph. Arterial contractions caused by increasing concentrations of serotonin with DEX in the presence or absence of L-NAME (endothelial nitric oxide synthase inhibitor), yohimbine (α2-adrenoceptor antagonist) and indomethacin (cyclooxygenase inhibitor) as antagonists were also measured. DEX had no effect on endothelium-intact pulmonary arteries, whereas at concentrations of 10(-8)~10(-6) mol/L, it elicited contractions in endothelium-denuded pulmonary arteries. DEX (0.3, 1, or 3×10(-9) mmol/L) inhibited serotonin-induced contraction in arteries with intact endothelium in a dose-dependent manner. L-NAME and yohimbine abolished DEX-induced inhibition, whereas indomethacin had no effect. No inhibitory effect was observed in endothelium-denuded pulmonary arteries. DEX-induced inhibition of vasoconstriction in human pulmonary arteries is mediated by NO production induced by the activation of endothelial α2-adrenoceptor and nitric oxide synthase.

[Effect of resveratrol on constrictions of human intrapulmonary arteries ex vivo].

OBJECTIVE: To determine the effect of resveratrol on constrictions of isolated human intrapulmonary arteries and its mechanisms. METHODS: Intrapulmonary arteries (1-1.5 mm in diameter) were dissected and cut into rings (1.8-2.0 mm in length) under microscope, and were then mounted in a Multi Myograph system. The rings were stimulated with 100 nmol/L U46619, 30 nmol/L endothelin-1, or 60 mmol/L KCl to produce sustained contraction of the intrapulmonary arteries, after which resveratrol was applied cumulatively. Endothelium denudation, L-NAME and indomethecin were used to investigate the effect of resveratrol on constrictions of the isolated arteries, suing DMSO as the control. RESULTS: Resveratrol induced concentration-dependent relaxations in endothelium-intact rings that contracted in response to stimulations with U46619, ET-1 and KCl, with pD2 of 3.82±0.20, 3.84±0.57, and 3.68±0.27, Emax of (99.58±0.83)%, 100%, and (99.65±0.98)%, respectively. Treatment of the arterial rings with the eNOS inhibitor L-NAME, but not with indomethecin or endothelium denudation, obviously affected the relaxant effects of resveratrol. CONCLUSION: Resveratrol can concentration-dependently produce relaxant effect on human intrapulmonary arteries independent of the endothelium possibly by promoting synthesis and release of NO.

[Dexmedetomidine inhibits 5-HT-induced intrapulmonary artery vasoconstriction].

OBJECTIVE: To investigate the effect of dexmedetomidine on 5-HT-induced constrictions of isolated human intrapulmonary arteries and explore the mechanisms. METHODS: Lung tissue was obtained from patients undergoing surgery for lung carcinoma. Intrapulmonary arteries were dissected and cut into rings, which were mounted in a Multi Myograph system to determine the effect of dexmedetomidine (0.3-3 nmol/L) on 5-HT-induced vasoconstrictions. The influences of the endothelium removal and various drugs including L-NAME, yohimbine and indomethacin were tested on the effects of dexmedetomidine. RESULTS: Dexmedetomidine (0.1-100 nmol/L) did not obviously affect the resting tension of endothelium-intact human intrapulmonary arteries. 5-HT induced concentration-dependent contraction in endothelium-intact intrapulmonary arteries [pD2: 6.11∓0.05, Emax: (102.10∓1.96)%]. In the rings with intact endothelium, dexmedetomidine (0.3-3 nmol/L) significantly attenuated the Emax and pD2 of 5-HT-induced vasoconstriction [pD2: 5.94∓0.03, Emax: (79.96∓1.31)%]. 5-HT also induced concentration-dependent contraction in endothelium-denuded intrapulmonary arteries [pD2: 6.10∓0.07, Emax: (107.40∓3.20)%]. Dexmedetomidine produced no significant effects on the rings with denuded endothelium. The effects of dexmedetomidine on 5-HT-induced vasoconstriction was suppressed by L-NAME and yohimbine, but not by indomethacin. CONCLUSION: Dexmedetomidine can inhibit 5-HT-induced vasoconstriction of isolated human intrapulmonary arteries probably through α2-adrenergic acceptor and NO released from the endothelium.

Effects of parecoxib on morphine analgesia after gynecology tumor operation: a randomized trial of parecoxib used in postsurgical pain management.

BACKGROUND: The analgesic efficacy of parecoxib in postsurgical pain management has been confirmed in minimally invasive surgery. However, little is known about its effects used in combination with opioids and about its potential for opioid-sparing effects in complex operations. This study was performed to investigate the influence of parecoxib on morphine analgesia after gynecological tumor surgery. METHODS: Eighty patients undergoing gynecological tumor resection were randomized to receive either intravenous parecoxib at a dose of 40 mg (Group P, n = 40) followed by 40 mg every 12 h for 48 h or saline as a control (Group C, n = 40) 30 min before induction of anesthesia, followed by saline at the same time points after the operation. All patients had access to patient-controlled analgesia with intravenous morphine. Patients were assessed with respect to pain score (visual analog scale from 0-10), cumulative morphine requirement, satisfaction score, and side effects at 2, 6, 12, 24, and 48 h after surgery. RESULTS: A total of 79 patients were evaluated. The cumulative dose of morphine administered at each time point was lower in Group P than in Group C (P < 0.05), at 2 h (3.81 ± 0.35 versus 4.13 ± 0.45; P = 0.01), 6 h (16.20 ± 1.49 versus 19.60 ± 0.35; P < 0.001), 12 h (26.29 ± 2.75 versus 32.49 ± 2.42; P < 0.001), 24 h (41.72 ± 2.70 versus 49.97 ± 4.53; P < 0.001), and 48 h (60.06 ± 4.00 versus 65.68 ± 3.23; P < 0.001). Compared with Group C, Group P had significantly lower visual analog scale scores at rest and with movement, respectively, at 2 h (4.2, P < 0.001 and 5.0, P < 0.001), 6 h (3.6, P < 0.001 and 4.5, P < 0.001), 12 h (3.0, P = 0.017 and 4.0, P < 0.001), 24 h (2.1, P < 0.001 and 3.4, P < 0.001), and 48 h (1.8, P < 0.001 and 2.6, P < 0.001). The satisfaction score was higher in Group P than in Group C (8.6 ± 0.3 versus 6.8 ± 0.7, P < 0.001). There were no significant differences in side effects between the two groups (P > 0.05). CONCLUSIONS: The use of parecoxib with patient-controlled analgesic morphine in postoperative analgesia resulted in comprehensive enhancement of the analgesic efficacy, reducing the opioid requirement and increasing patient satisfaction after gynecological tumor surgery.