Effects of glycopyrrolate and atropine for oral secretions and perioperative hemodynamics in children undergoing tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled trial.

Introduction: Glycopyrrolate is commonly researched as a preoperative medication or in conjunction with cholinesterase inhibitors to counteract the lingering muscarinic effects of non-depolarizing muscarinic agents. However, studies have yielded inconsistent results regarding the superiority of glycopyrrolate over other anti-cholinergic drugs, such as atropine, particularly its effect on heart rate, blood pressure (BP), and glandular secretions. This study aimed to evaluate the differences in perioperative oral secretions, hemodynamics, and recovery quality with glycopyrrolate versus those with atropine before anesthesia induction in children undergoing tonsillectomy and adenoidectomy. Methods: In this prospective, single-center, randomized, double-blind, controlled trial, a total of 103 children were randomly assigned to group A (n = 51, glycopyrrolate 0.005 mg/kg) or B (n = 52, atropine 0.01 mg/kg). The follow-up anesthetic induction and maintenance protocols were the same in both groups. Vital signs, duration of surgery, extubation time, degree of wetness around the vocal cords during tracheal intubation, weight of oral secretions, and perioperative complications were recorded. Results: No significant differences were observed in the degree of wetness around the vocal cords during tracheal intubation, as well as in the weight of oral secretions, duration of surgery, or extubation time, between the two groups. The intraoperative and postoperative heart rates were lower in group A than in group B (110.18 ± 10.58 vs. 114.94 ± 11.14, p = 0.028; 96.96 ± 10.81 vs. 103.38 ± 10.09, p = 0.002). The differences observed in the intraoperative and preoperative heart rates were lower in group A than in group B (23.84 ± 9.62 vs. 29.65 ± 8.75, p = 0.002). The differences observed in the postoperative and preoperative heart rates were lower in group A than in group B (10.63 ± 9.97 vs. 18.09 ± 9.39, p = 0.000). Conclusion: Glycopyrrolate showed a smoother change in heart rate than atropine during and after tonsillectomy and adenoidectomy, with no effect on BP or recovery quality, and did not increase oral secretions. The findings indicate that glycopyrrolate can serve as an alternative to atropine to prevent secretions in anesthesia induction for tonsillectomy and adenoidectomy in children. Trial registration: This study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200063578; Date of Registration: 12/09/2022).

CX3CL1/CX3CR1 regulates nerve injury-induced pain hypersensitivity through the ERK5 signaling pathway.

Peripheral nerve injury induces the cleavage of CX3CL1 from the membrane of neurons, where the soluble CX3CL1 subsequently plays an important role in the transmission of nociceptive signals between neurons and microglia. Here we investigated whether CX3CL1 regulates microglia activation through the phosphorylation of extracellular signal-regulated protein kinase 5 (ERK5) in the spinal cord of rats with spinal nerve ligation (SNL). ERK5 and microglia were activated in the spinal cord after SNL. The knockdown of ERK5 by intrathecal injection of antisense oligonucleotides suppressed the hyperalgesia and nuclear impact of nuclear factor-κB induced by SNL. The blockage of CX3CR1, the receptor of CX3CL1, significantly reduced the level of ERK5 activation following SNL. In addition, the antisense knockdown of ERK5 reversed the CX3CL1-induced hyperalgesia and spinal microglia activation. Our study suggests that CX3CL1/CX3CR1 regulates nerve injury-induced pain hypersensitivity through the ERK5 signaling pathway.

[Effect of dexmedetomidine in acute postoperative pain relief is independent of suppressing the hyperalgesia induced by remifentanil].

OBJECTIVE: To explore the effect of dexmedetomidine in acute postoperative pain and remifentanil-induced hyperalgesia. METHODS: From January 2011 to June 2012, 120 patients scheduled for elective abdominal surgery under general anesthesia were included in this study. All patients received intravenous remifentanil infusion during operation, and dexmedetomidine was given after anesthesia induction. The postoperative mechanical pain threshold, pain visual analog scale (VAS) score, morphine consumption, and score of sedation (Ramsay) was recorded. RESULTS: Relatively large-dose intraoperative remifentanil resulted in lower mechanical pain threshold and higher dose of postoperative morphine consumption. Dexmedetomidine reduced postoperative morphine consumption significantly, and increased Ramsay scores, but had no effect on mechanical hyperalgesia. CONCLUSION: Dexmedetomidine can alleviate the acute postoperative pain effectively, but the effect is not dependent on inhibiting remifentanil-induced hyperalgesia.

[Role of the CX3CR1/ERK5 pathway in spinal microglia for the development of neuropathic pain].

OBJECTIVE: To explore the role of spinal microglial CX3CR1/ERK5 pathway in the development of neuropathic pain. METHODS: The model of spinal nerve ligation (SNL) was established by ligating the L5 spinal nerve with 6-0 silk thread in male Sprague Dawley rats. The expression of activated ERK5 (p-ERK5) was examined by immunohistochemistry test. To detect the role of ERK5 in neuropathic pain, PWT and PWL were measured after an intrathecal knockdown of ERK5. For determining the regulating effect of CX3CL1/CX3CR1 on the activity of microglial ERK5, CX3CR1 was blocked by an intrathecal injection of anti-rat CX3CR1 antibody and the activity of spinal ERK5 tested. Then whether an intrathecal knockdown of ERK5 could reverse the effect of CX3CL1 on pain hypersensitivity and microglia activation was investigated. RESULTS: ERK5 was activated in spinal microglia after SNL compared to the sham group (61.75 ± 11.52 vs 2.2 ± 0.12; 58.01 ± 10.45 vs 1.1 ± 0.11) . The knockdown of ERK5 by an intrathecal injection of antisense oligonucleotides suppressed the mechanical (15.42 ± 3.46 vs 22.73 ± 3.21g; 13.63 ± 2.88 vs. 21.42 ± 4.12g) and thermal hyperalgesia (13.48 ± 2.01) vs (18.05 ± 3.71) s; (11.6 ± 2.33) vs (17.73 ± 1.42) s induced by nerve injury. The blockage of CX3CR1, a receptor of CX3CL1, significantly reduced the level of ERK5 activation following SNL (30.12 ± 8.60) vs (58.25 ± 11.5); (49.5 ± 12.12) vs (35.51 ± 3.74) (P < 0.05). In addition, the antisense knockdown of ERK5 reversed the CX3CL1-induced hyperalgesia and spinal microglia activation. CONCLUSIONS: CX3CL1/CX3CR1 regulates nerve injury-induced pain hypersensitivity through ERK5.

[Combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia in the treatment of postoperative intractable atelectasis].

OBJECTIVE: To explore the efficacy and safety of combined inflating lung and insufflating calf pulmonary surfactant under general anesthesia for treating postoperative intractable atelectasis. METHODS: From August 2006 to January 2013, 15 patients with obstinate postoperative atelectasis receiving pressure control lung expansion were enrolled. The bronchial cannula was intubated into the affected side to assist the expanding of the lung, and the calf pulmonary surfactant was insufflated selectively. The chest auscultation and computed tomography (CT) scan was performed at 1 d and 5 d after the procedure respectively, to evaluation the effect. The airway pressure, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2) were recorded before the treatment, during the treatment and after the treatment.Monitoring arterial blood gas before and after treatment. RESULTS: After the expansion of the lung and insufflation of calf pulmonary surfactants, the iconographic scan showed that collapsed alveolar was reinflated in 12 (80.0%) patients at 1 d after the treatment and in 14 patients(93.3%) at 5 d after the procedure.There were not notable vital sign change and complications during the treatment.At after the treatment, 1, 3, 5 and 7 d after the treatment, PaO2 was higher (P < 0.05), and there were not significantly difference in the PaCO2 and pH (P > 0.05) . CONCLUSION: Combined pressure control lung expansion with selectively insufflating calf pulmonary surfactant under general anesthesia may be an effective therapy for postoperative intractable atelectasis.

[Improvement of method to produce septic shock model of rats].

OBJECTIVE: To investigate the feasibility of method improved for developing septic shock rats model. METHODS: Studies were performed on 60 adult male Sprague-Dawley rats. They were randomized into sham group and standard CLP (J Group) group (n = 20), A (n = 10), B (n = 10), C (n = 10) group and J group was further to two subgroups (n = 10) J1 and J2 group. The ligated distance of A, B and C group were 20%, 30%, 50% of the cecum respectively. Standard CLP procedures were made in J group as described previously. Sham group just sham operated. MAP was monitored continuously in A, B, C and J1 groups for 5h, and the MAP dropped to 70% of the baseline was defined as septic shock, MAP was monitored for more than 10 hours until it reached 70% of baseline or lower in the J2 group. The white blood cell count, endotoxin and histopathological changes in lung and renal tissue were observed in each groups. RESULTS: At 5h after operation, there is no change of MAP in sham, J1, A and B groups, but it dropped to 70% of the baseline [(73 ± 10) mmHg] in C group. Compared with sham group, the level of endotoxin [(17 ± 5) vs (456 ± 28) vs (596 ± 29) vs (982 ± 11) vs (209 ± 40) pg/ml] and white cell count [(6.3 ± 3.7) vs (4.6 ± 1.4) vs (3.7 ± 1.2) vs (3.3 ± 2.6) vs (4.2 ± 1.2)×10(9)/L] was significantly higher and lower respectively in A, B, C and J1 groups. Obvious pulmonary and nephridia tissue edema, inflammatory cell infiltration was observed in C group, but the inflammatory cell infiltration was not found in A, B and J1 groups, The manifestations of J2 group rats is similar with C group. CONCLUSIONS: The rat model produced by ligating 50% cecum can reproduce the pathophysiology of septic shock, and the time needed to prepare septic shock was significantly shorter. The improved model has application value for septic shock study.

[Influence of P2Y12 receptor inhibitor on pain threshold and spinal p38MAPK in rat bone cancer pain model].

OBJECTIVE: To investigate the role of P2Y12 receptor in rat bone cancer pain model and its influence on p38MAPK (Mitogen-activated protein kinase). METHOD: A total of forty female SD rats, weighting 200 - 250 g, were randomly divided into 5 groups (n = 8): normal group (group N), sham group (group S), vehicle group (group DA), cancer group (group A), and analgesia group (group MA). Rats in group N were untreated, rats in group S were injected with Hank's solution 10 µl into the left tibial metaphysis; rats in group DA, group A and group MA were injected with Walker 256 cancer cells (10 µl, 2×107 cells/ml) into the left tibial metaphysic to establish the model of bone cancer pain. Catheterization was simultaneously made in four groups between L3 and L4 vertebra except group N. Saline (0.9%, 15 µl) was injected in group S and group A, DMSO (5%, 15 µl) was injected in group DA, and MRS2395 (400 pmol/µl, 15 µl) was injected in group MA on day 9 to 12 post-inoculation. Mechanical withdrawal thresholds were measured on left hind paw before and every 10 min after intrathecal injection. Rats were euthanized after measuring mechanical withdrawal threshold at day 12 post-inoculation. L4-6 sections of spinal cord were collected to determine the expression of p-p38MAPK by immunohistochemistry and immunofluorescent. RESULT: Compared to that in group N (36.1 g ± 4.0 g) and group S (38.9 g ± 5.2 g), mechanical withdrawal thresholds in group MA (19.8 g ± 5.0 g) were decreased on day 9 post-inoculation (P < 0.01), and the expression of p-p38MAPK in spinal cord was increased on day 12 (P < 0.01). Compared to that in group DA (17.7 g ± 3.0 g) and group A (19.1 g ± 2.5 g), mechanical withdrawal threshold in group MA was obviously increased after intrathecal injection, peaked at (26.5 g ± 4.7 g) (P < 0.05); compared with group DA (number 43.4 ± 3.8, IOD 569 ± 27) and group A(number 45.0 ± 2.6, IOD 594 ± 22), the expression level of p-p38MAPK in spinal cord in group MA at day 12 was significantly decreased (number 20.9 ± 2.2, IOD 246 ± 25) (P < 0.01); Mechanical withdrawal threshold in group MA was still lower than group N and group S, while the expression of p-p38MAPK was higher than group N (number 9.9 ± 2.4, IOD 82 ± 28) and group S (number 10.9 ± 2.2, IOD 109 ± 25) (P < 0.01). Immunofluorescent showed that p-p38MAPK was colocalized with microglia in spinal dorsal horn, but not with neurons and astrocytes. CONCLUSIONS: These results demonstrate rat bone cancer pain could partially relieved after intrathecal injection of P2Y12 receptor inhibitor MRS2395 through inhibiting the phosphorylation of p38MAPK in spinal dorsal horn.

Patient Preferences for Rescue Medications in the Treatment of Breakthrough Cancer Pain.

OBJECTIVE: The discrete choice experiment (DCE) is conducted in this study to discuss Chinese cancer patients' risk-benefit preferences for rescue medications (RD) and their willingness to pay (WTP) in the treatment of breakthrough cancer pain (BTcP). METHOD: Through literature reviews, specialist consultation, and patient surveys, this work finally included five attributes in the DCE questionnaire, i.e., the remission time of breakthrough pain, adverse reactions of the digestive system, adverse reactions of the neuropsychiatric system, administration routes, and drug costs (estimating patients' WTP). The alternative-specific conditional logit model is used to analyze patients' preferences and WTP for each attribute and its level and to assess the sociodemographic impact and clinical characteristics. RESULTS: A total of 134 effective questionnaires were collected from January, 1 to April, 5 in 2022. Results show that the five attributes all have a significant impact on cancer patients' choice of "rescue medications" (P<0.05). Among these attributes, the remission time after drug administration (10.0; 95%CI 8.5-11.5) is the most important concern for patients, followed by adverse reactions of the digestive system (8.5; 95%CI 7.0-10.0), adverse reactions of the neuropsychiatric system (2.9; 95%CI 1.4-4.3), and administration routes (0.9; 95%CI 0-1.8). The respondents are willing to spend 1182 yuan (95%CI 605-1720 yuan) per month for "rescue medications" to take effect within 15 minutes and spend 1002 yuan (95%CI 605-1760 yuan) per month on reducing the incidence of drug-induced adverse reactions in the digestive system to 5%. CONCLUSION: For Chinese cancer patients, especially those with moderate/severe cancer pain, the priority is to relieve the BTcP more rapidly and reduce adverse drug reactions more effectively. This study indicates these patients' expectations for the quick control of breakthrough pain and their emphasis on the reduction of adverse reactions. These findings are useful for doctors, who are encouraged to communicate with cancer patients about how to better alleviate the BTcP.

[Effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperatively intractable atelectasis in hypo-analgesia and muscle relaxation].

OBJECTIVE: To investigate the effect of bronchial intubation for constant-pressure expanding ipsilateral lung on postoperative intractable atelectasis. METHODS: For this prospective study, we recruited 18 patients with pulmonary atelectasis who could not been relieved by bronchoscopic suctioning, closed thoracic drainage, backslap, blowing hall and other routine treatments for over a week. After bronchial intubation, ipsilateral lung was expanded with a constant pressure. And the therapeutic effect was evaluated by chest radiographic examination and auscultation at the following day. RESULTS: Collapsed lung tissue were examined in 15 patients (83.3%) after the first treatment and in 2 patients (11.1%) after twice inflation. And another case failed even after three times treatment. During the procedure, the vital signs of all patients were stable and no complication occurred. CONCLUSION: Constant-pressure expanding of ipsilateral lung during bronchial intubation is a safe and effective treatment for postoperative intractable atelectasis.

[Therapeutic feasibility of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block in palmar hyperhidrosis under the guidance of computed tomograph].

OBJECTIVE: To explore the therapeutic feasibility of percutaneous puncture and neurolytic thoracic sympathetic nerve block under the guidance of computed tomograph (CT). METHODS: From September 2009 to August 2010, 23 cases with primary palmar hyperhidrosis underwent percutaneous puncture and neurolytic thoracic sympathetic nerve block at our hospital. The puncture of thoracic sympathetic nerve was guided by CT through the gap of T3-4. The screen showed the direction of needle and the location of needle tip at the upper joint of costal head beside T3 body and outside of costal pleura. A mixed injection of 1% lidocaine and 30% iohexol was administered. On CT, lidocaine was found to cover the area where the thoracic sympathetic nerve was located. And after several minutes, the patient's palms turned warm and dry from cool and wet without the onset of Horner's syndrome. Then 2.5 ml of absolute alcohol was injected to block the thoracic sympathetic nerve. RESULTS: CT could guide the needle to the right position. And the injectate spreaded to the site of thoracic sympathetic nerve. At 5 min after anesthetic injection, the palmar temperature raised an average of 2.86°C and the amplitude of pulse rose over 55%. Palmar hyperhidrosis was cured in 19 patients by one attempt and 4 patients required a second block with absolute alcohol. No complication occurred and there were 2 patients with tendency of recurrence during a follow-up period of 8 - 18 months. CONCLUSION: The CT-guided therapy of percutaneous puncture and chemical neurolysis of thoracic sympathetic nerve block is both feasible and efficacious for palmar hyperhidrosis.

Central deficiency of norepinephrine synthesis and norepinephrinergic neurotransmission contributes to seizure-induced respiratory arrest.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of mortality in patients with intractable epilepsy. However, the pathogenesis of SUDEP seems to be poorly understood. Our previous findings showed that the incidence of seizure-induced respiratory arrest (S-IRA) was markedly reduced by atomoxetine in a murine SUDEP model. Because the central norepinephrine α-1 receptor (NEα-1R) plays a vital role in regulating respiratory function, we hypothesized that the suppression of S-IRA by atomoxetine was mediated by NE/NEα-1R interactions that can be reversed by NEα-1R antagonism. We examined whether atomoxetine-mediated suppression of S-IRA evoked by either acoustic stimulation or pentylenetetrazole (PTZ) in DBA/1 mice can be reversed by intraperitoneal (IP) and intracerebroventricular (ICV) administration of prazosin, a selective antagonist of NEα-1R. The content and activity of tyrosine hydroxylase (TH), a rate-limiting enzyme for NE synthesis, in the lower brainstem was measured by ELISA. Electroencephalograms (EEG) were obtained from using the PTZ-evoked SUDEP model. In our models, atomoxetine-mediated suppression of S-IRA evoked by either acoustic stimulation or PTZ was significantly reversed by low doses of IP and ICV prazosin. Neither repetitive acoustic stimulation nor S-IRA reduced TH levels in lower brainstem. However, the enzyme activity of TH levels in lower brainstem was significantly increased by mechanical ventilation with DBA/1 mice, which makes the dying DBA/1 mice suffering from S-IRA and SUDEP recover. EEG data showed that although the protective effect of atomoxetine was reversed by prazosin, neither drug suppressed EEG activity. These data suggest that deficient synthesis of NE and norepinephrinergic neurotransmission contributed to S-IRA and that the NEα-1R is a potential therapeutic target for the prevention of SUDEP.

[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.

Elevated serum soluble Fas ligand is a promising marker of testicular toxicity induced by epirubicin in rats.

To investigate the role of the Fas/Fas ligand (Fas/FasL) system in testicular toxicity induced by epirubicin (Epi) and to correlate the system with the serum levels of soluble Fas and Fas ligand (sFas/sFasL), epirubicin was intraperitoneally administered to male Sprague-Dawley male rats at doses of 1.2mg/kg once a week for 10 weeks, and genital organ weights and histopathology were examined. Fas and FasL expression in rat testis were examined by immunohistochemistry. Apoptosis was assessed by TUNEL assay. Expression levels of Fas and FasL were analyzed by RT-PCR and Western blotting. Serum sFas/sFasL levels were determined by ELISA. The results show that the testicular toxicity of Epi involved germ cell apoptosis. Fas and FasL protein expression levels were markedly increased in Epi-treated rat testes, as was expression of sFasL. In particular, increasing serum sFasL levels were positively correlated with elevated expression levels of FasL and sFasL in the testes of Epi-treated rats, revealing serum sFasL to be a promising marker of testicular toxicity after cytotoxic chemotherapy.

Relation of postoperative serum S100A12 levels to delirium and cognitive dysfunction occurring after hip fracture surgery in elderly patients.

OBJECTIVE: Brain injury is implicated in pathogenesis of postoperative delirium (POD) and cognitive dysfunction (POCD). S100A12 is involved in inflammatory process and is recently known as a biomarker for brain injury. Herein, we clarified whether serum S100A12 levels are related to POD and POCD after hip fracture surgery in elderly patients. MATERIALS AND METHODS: In this prospective, observational study, we gauged S100A12 levels in preoperative and postoperative serum from 186 patients and serum from 186 controls. Patients were categorized according to the presence of POD and POCD. RESULTS: Postoperative, but not preoperative serum S100A12 levels were significantly higher in patients than in controls. There was a positive and independent correlation between postoperative C-reactive protein and S100A12 levels (t = 8.797, p < 0.001). Postoperative S10012 levels and age were independently associated with the risk of developing POD (S100A12 levels: odds ratio [OR] = 1.166, 95% confidence interval [CI] = 1.045-2.087, p = 0.001; age: OR = 1.243, 95% CI = 1.073-1.419, p = 0.012) and POCD (S100A12: OR = 1.157, 95% CI = 1.030-1.986, p = 0.003; age: OR = 1.228, 95% CI = 1.054-1.387, p = 0.014). In terms of area under receiver operating characteristic curve, postoperative S100A12 levels had a higher predictive ability than age and their combination dramatically exceeded that of each one alone. CONCLUSIONS: Postoperative elevated serum S100A12 levels have a strong relation to inflammation and are associated independently with the development of POD and POCD, substantializing serum S100A12 as a potential biomarker for predicting POD and POCD in elderly patients undergoing hip fracture surgery.

[Effect of a novel analgesic disposable urinary catheter in prevention of restlessness caused by catheter-related bladder discomfort in general anesthesia patients in recovery period].

OBJECTIVE: To investigate the effect of a novel analgesic disposable urinary catheter invented by the authors in prevention of restlessness caused by catheter-related bladder discomfort (CRBD) in general anesthesia patients in anesthesia recovery period. METHODS: Two hundred patients, who underwent general anesthesia for general surgical operation, were divided randomly into 2 equal groups: observation group, undergoing insertion of F16 novel analgesic disposable Foley urinary catheter after inducement of general anesthesia, and control group undergoing insertion of conventional F16 Foley urinary catheter after induction of anesthesia. The rate of restlessness caused by CBRD and the rate of catheter pulling-off were compared. RESULTS: The CRBD rate of the observation group was 9%, significantly lower than that of the control group (61%, P < 0.01), the rate of CRBD-caused restlessness of the observation group was 0, significantly lower then that of the control group (23%, P < 0.001). The extent of CRBD of the observation group was significantly lighter than that of the control group. CONCLUSION: The catheter inserting after the induction of anesthesia is an element related to the restlessness in anesthesia recovery period and other serious postoperative complications. The novel analgesic disposable urinary catheter effectively prevents CRBD-caused restlessness in general anesthesia patients in the anesthesia recovery period.

[Selective percutaneous dorsal root ganglion radiofrequency thermocoagulation guided by CT scanning in treatment of post-herpetic neuralgia].

OBJECTIVE: To present the experience in a technique used to treat intractable postherpetic neuralgia (PHN)-percutaneous dorsal root ganglion (DGR) radiofrequency thermocoagulation guided by CT scanning. METHODS: Sixteen PHN patients underwent puncture of radiohealing needle into the superior 1/3 of the corresponding intervertebral foramen guided by CT. Electric stimulation test and impedance test were conducted to confirm the right spot. Radiofrequency heat coagulation therapy under the condition of 90 degrees C 90 s was performed for 3 cycles. Then mixture of betamethasone and lidocain was injected and the needle was pulled out. CT was conducted to observe if pneumothorax occurred. The patients were followed up for 2-16 months. RESULTS: Radiofrequency thermocoagulation was performed on 45 target dorsal root ganglia in 16 PHN patients with the effect of immediate disappearance of hyperalgesia. Remaining spontaneous pain was seen in 5 cases, however, with decreases of attack frequency and severity. The visual analogue pain scale score was decreased from 7-9 before the procedure to 2-3 after the procedure. No relapse was found during the follow-up. CONCLUSION: Selective percutaneous DRG radiofrequency thermocoagulation guided by CT scanning is effective in treatment of PHN.

Additive analgesic effect of dexmedetomidine and dezocine administered intrathecally in a mouse pain model.

BACKGROUND: It is known that dexmedetomidine can reduce opioid requirements and that there is a synergistic effect when dexmedetomidine and morphine (a full mu opioid receptor agonist) are administered together. However, it was unclear whether a synergistic or additive effect would be observed when dexmedetomidine was co-administered with a partial mu opioid receptor agonist. The present study was designed to elucidate such effects by intrathecally co-administering dexmedetomidine and dezocine, a partial mu receptor agonist, in a mouse pain model. METHODS: C57 mice (N = 165) were randomly divided into 19 groups. The tail flick test was adopted to measure the antinociceptive effects of the tested agents. The mice were divided into saline and drug groups to investigate the dose-dependent analgesic effects. Each drug was administered at fixed doses alone and in combination with one of three doses of a second drug. RESULTS: Dezocine (0.3125 - 1.25 µg) and dexmedetomidine (0.04 - 1 µg) both enhanced the tail withdrawal latency in dose-dependent fashions. Dexmedetomidine (0.04 - 1 µg) enhanced the analgesic effect of dezocine. Dezocine (0.3125 - 1.25 µg) enhanced the analgesic effect of dexmedetomidine. Compared with the individual drug effects, the combined effects of dezocine (0.625 µg) and dexmedetomidine (0.04 µg) were more potent 15 - 60 min after injection, but they remained similar to the sum of the effects of the two individual drugs. CONCLUSIONS: Dexmedetomidine and dezocine produce an additive analgesic effect on acute nociception when administered simultaneously.

Twin pregnancy with triple parathyroid adenoma: A case report and review of literature.

Primary hyperparathyroidism (PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.

Synovial fluid concentrations of cold-inducible RNA-binding protein are associated with severity in knee osteoarthritis.

BACKGROUND: Cold-inducible RNA-binding protein (CIRP) is a pro-inflammatory cytokine. We determined whether serum or synovial fluid concentrations are associated with severity in osteoarthritis (OA). METHODS: CIRP concentrations in serum and synovial fluid from 156 knee OA patients and serum from 156 controls were determined. The Kellgren and Lawrence (KL) grade, Lequesne index and Western Ontario McMaster University Osteoarthritis Index (WOMAC) pain score were used to assess radiographic, clinical severity and pain severity respectively. Their scores were dichotomized based on their median values. RESULTS: OA patients had similar serum CIRP concentrations compared to controls. In OA patients, CIRP concentrations in synovial fluid were dramatically higher compared to, but not correlated with paired serum samples. CIRP concentrations in synovial fluid were significantly correlated with synovial fluid or serum C-reactive protein, tumor necrosis factor- alpha and interleukin-6 concentrations, KL grade, Lequesne index and WOMAC pain score. Synovial fluid CIRP concentrations were independently related to the KL grade>2, Lequesne index >13 and WOMAC pain score>12. Under receiver operating characteristic curves, Synovial fluid CIRP concentrations significantly predicted them. CONCLUSIONS: Increased synovial fluid CIRP concentrations were closely associated with the severity, substantializing CIRP as a potential marker for synovial inflammation of OA.