Transdermal fentanyl for cancer pain: Trial sequential analysis of 3406 patients from 35 randomized controlled trials.

OBJECTIVE: The aim of this study was to assess the effectiveness and safety of transdermal fentanyl for the treatment of moderate or severe cancer-related pain. MATERIALS AND METHODS: Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, and Chongqing Weipu and Wanfang Database were searched for relevant studies published prior to January 2015. Only randomized controlled trials on the use of the transdermal fentanyl patch for the treatment of cancer pain were selected. Two reviewers independently screened the studies and extracted data. The quality assessment of the studies included was based on the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). RevMan 5 (version 5.3) and Trial Sequential Analysis software (TSA, version 2.1, provided by Copenhagen Trial Unit, Denmark) were used for data analyses. RESULTS: A total of 35 studies involving 3406 participants met the inclusion criteria for this meta-analysis. There was no statistically significant difference with regard to the effectiveness of management for cancer pain between the use of transdermal fentanyl patch and oral morphine (risk ratio = 1.00, 95% confidence interval, 0.97-1.03, P > 0.05). TSA results demonstrated that the cumulative Z-score crossed its monitoring boundaries, and therefore, reliable conclusions had been drawn. Moreover compared with oral morphine, the use of transdermal fentanyl patch resulted in statistically significantly decreased incidence of constipation, nausea and vomiting, drowsiness, and urinary retention. There was a significantly greater incidence of skin irritation in patients who used a transdermal fentanyl patch (P < 0.05). CONCLUSIONS: The findings from this study demonstrate that use of transdermal fentanyl for the management of moderate or severe cancer pain had more advantages compared to oral morphine.

Midazolam prevents motor neuronal death from oxidative stress attack mediated by JNK-ERK pathway.

Midazolam is a sedative used by patients with mechanical ventilation. However, the potential clinical value is not fully explored. In this report, we made use of a neuroblastoma-spinal cord hybrid motor neuron-like cell line NSC34, and elucidated the potential role of Midazolam on these cells under the insult of oxidative stress. We found the protective effect of Midazolam on motor neurons against cytotoxicity induced by the combination of oligomycin A and rotenone (O/R) or phenylarsine oxide. The characteristics of apoptosis, such as the ratio of TUNEL+ cells or the expression level of cleaved Caspase-3, was decreased by 22 or 45% in the presence of Midazolam. Furthermore, this effect was correlated with the JNK-ERK signaling pathway. Either phosphorylation of ERK or JNK was positively or negatively modulated with the treatment of Midazolam in NSC34 cells attacked by reactive oxygen species. Meanwhile, inhibition or activation of the JNK-ERK pathway regulated the protective effect of Midazolam on NSC34 cells with oxidative stress insult. Collectively, this study elucidated a previously unidentified clinical effect of Midazolam, and put forward the great promise that Midazolam may be considered as a potential candidate to the treatment of motor neuron disease.

The Efficacy and Safety of Transcutaneous Acupoint Interferential Current Stimulation for Cancer Pain Patients With Opioid-Induced Constipation: A Prospective Randomized Controlled Study.

INTRODUCTION: Opioid-induced constipation (OIC) is a principal complication secondary to analgesic therapy for cancer pain patients who suffer moderate to severe pain. In this study, we observe the efficacy and safety of transcutaneous acupoint interferential current (IFC) stimulation in those patients with OIC. METHODS: A total of 198 patients were randomly allocated to the IFC group and control group in a 1:1 ratio. Finally, 98 patients in the IFC group received 14 sessions administered over 2 weeks, whereas 100 patients in the control group took lactulose orally during the same period. Observation items were documented at management stage and at follow-up stage according to Cleveland Constipation Scales (CCS), pain Numeric Rating Scales (NRS) and Patient Assessment of Constipation Quality of Life (PAC-QoL). RESULTS: The total curative effects of the IFC group and the control group were indistinguishable (76.5% vs 70.0%, P = .299). Regarding CCS and PAC-QoL scores, no significant difference was observed between the 2 groups during the management time and at the follow-up stage of week 3 ( P > .05, respectively), but groups were distinguished at the follow-up stage of week 4 ( P < .001 and P = .031, respectively). The pain NRS decreased significantly at management stage week 2 and follow-up stage week 3 and week 4 ( P = .013, P = .041, P = .011, respectively). CONCLUSIONS: Transcutaneous acupoint IFC therapy over acupoints of Tianshu (ST25) and Zhongwan (RN12) may improve constipation and quality of life in cancer patients receiving opiates; further studies are worthwhile.

Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty: A meta-analysis.

BACKGROUND: In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA. METHODS: We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis. The outcomes included visual analog scale (VAS) at 24, 48, and 72 hours, total morphine consumption at 24 hours, and the length of hospital stay. We assessed the pooled data using a random-effect model. RESULTS: Six studies were finally included in this meta-analysis. Our pooled data analysis demonstrated that liposomal bupivacaine was more effective than the traditional bupivacaine in terms of VAS at 24 hours (P  =  .018) and the length of hospital stay (P  =  .000). There was no significant difference in terms of the VAS at 48 and 72 hours and total morphine consumption at 24 hours (P >.05). CONCLUSION: Compared with the traditional bupivacaine, liposomal bupivacaine shows better pain control at 24 hours and reduces the length of hospital stay after THA. Its economic costs must be assessed in multimodal center randomized controlled trials when being recommended as a long-acting alternative analgesic agent for a THA patient.

[Localization of cAMP-response element binding protein target gene Staufen in mouse hippocampus by situ hybridization].

OBJECTIVE: To search for an appropriate animal model that is more closely related to human to study cAMP-response element binding protein target gene Staufen and to identify its location. METHODS: The phylogenetic tree was constructed with Staufen protein (STAUFEN) sequences of different species, and the most suitable animal model was selected by analyzing relativity among them. The Staufen fragments were amplified with reverse transcription-PCR and inserted into a vector and then the sub-clone was transformed into bacteria, selected, amplified, extracted and sequenced. Staufen probes were in vitro transcribed and hybridized in situ on the cryosections of the mouse brain. The cryosections were stained and observed. RESULTS: The clustering patterns of the phylogenetic tree indicated that the mouse and human Staufen1 had 99.7% protein sequences similarity. The mRNA of Staufen was located in CA1, CA2, CA3 and DG hippocampus regions shown by in situ hybridization. CONCLUSION: The mouse is a preferable animal model for research on Staufen transcription in hippocampus.

[Effect of cardiopulmonary bypass on the expression of survivin in neutrophils].

OBJECTIVE: To investigate the effects of cardiopulmonary bypass on neutrophils apoptosis and the expression of survivin. METHODS: Ten patients who scheduled for cardiac surgery under cardiopulmonary bypass were recruited as study group and 10 healthy volunteers as control. Blood samples were obtained before operation, at the end of surgery, and at 24 hours postoperatively. Neutrophils were isolated by density gradient centrifugation and its apoptosis were evaluated by fluorescent microscope and flow cytometry. The expression of survivin protein was examined by Western blotting analysis. Expression level of survivin mRNA was detected by RT-PCR. RESULTS: The apoptotic rate of neutrophils decreased significantly at the end of surgery (P < 0.01), and was still lower at 24 hours postoperatively than before operation (P < 0.05). The expression ratios of survivin protein and mRNA were increased at the end of surgery (P < 0.01), and decreased gently at 24 hours postoperatively but was still higher than before operation (P < 0.05). CONCLUSION: Cardiopulmonary bypass could inhibit neutrophils apoptosis and increase the expression of survivin. The decrease of neutrophils apoptosis was correlated with high expression of survivin.

[Investigation of the status of perioperative blood transfusion in grade III-A general hospitals in Zhejiang province].

OBJECTIVE: To investigate the situation of perioperative blood transfusion in Grade III-A hospitals in Zhejiang province, in order to provide statistics for improving appropriateness of blood transfusion. METHOD: The questionnaire was conducted in 9 Grade III-A hospitals in Zhejiang province according to "The Technical Criterion of Clinical Blood Transfusion". The data including total quantity, whole blood and component blood transfusion in 2007 were analyzed. RESULTS: Among 19 102 cases, the percentage of component blood transfusion was 99.3%, but 44.1% transfusion is conducted just according to doctors' experience without any medical indication, including 603 patients not re-examining the level of Hct or Hb in 72 h after operation. For the patients with complete transfusion record, the irrational rate of whole blood, RBC and platelet transfusion were 39.2%, 39.2%, 43.7%, the mainly reason was the relax demand on the transfusion indication. CONCLUSIONS: Although Grade III-A hospitals in Zhejiang did fairly well in perioperative blood component transfusion, there are still some seriously unreasonable phenomenons. Every medical organization should pay more attention to improve the quality of clinical blood transfusion.