[Retrospective cohort study on application of acupuncture-aided anesthesia technique to patients undergoing thoracoscopic lobectomy].

OBJECTIVE: To compare the clinical effect of "initial scheme" and "improved scheme" of acupuncture-aided anesthesia for patients undergoing thoracoscopic lobectomy. METHODS: A retrospective analysis about 2 groups ("initial scheme" and "improved scheme") of patients (40 cases in each group) who underwent thoracoscopic lobectomy was conducted in the present paper. Patients of the "initial scheme" group received thoracoscopic operation with three incisions under acupuncture-aided anesthesia i.e., electroacupuncture (EA) stimulation of bilateral Hegu (LI4), Neiguan (PC6), Houxi (SI3) and Zhigou (SJ6), combined with Lidocaine and ropivacaine epidural anesthesia and propofol intravenous anesthesia from January of 2013 to December of 2017. Patients of the "improved scheme" group received thoracoscopic operation with single incision under acupuncture-aided anesthesia by EA, combined with ropivacaine paravertevinal block and lidocaine and remifentanil intravenous anesthesia from August 2018 to August 2021. The incidence of intraoperative deep breathing, resuscitation time, ambulatory rate on day after surgery and postoperative incision pain of the two schemes were compared. RESULTS: The incidence of intraoperative deep breathing and the degree of postoperative incision pain were significantly lower (P<0.05), the postoperative resuscitation time was obviously shorter (P<0.05), and the ambulatory rate on day after surgery was higher (P<0.05) in the "improved scheme" group than in the "initial scheme" group. CONCLUSION: The "improved scheme" is better than the "initial scheme" in stabilizing the patient's breathing during thoracoscopic lobectomy operation, shortening the resuscitation time, and ameliorating the postoperative recovery state and pain reaction, thus being a better technical solution in clinical practice.

Meranzin Hydrate Improves Depression-Like Behaviors and Hypomotility via Ghrelin and Neurocircuitry.

OBJECTIVE: To investigate whether meranzin hydrate (MH) can alleviate depression-like behavior and hypomotility similar to Chaihu Shugan Powder (CSP), and further explore the potential common mechanisms. METHODS: Totally 120 Spraque-Dawley rats were randomly divided into 5-8 groups including sham, vehicle, fluoxetine (20 mg/kg), mosapride (10 mg/kg), CSP (30 g/kg), MH (9.18 mg/kg), [D-Lys3]-GHRP-6 (Dlys, 0.5 mg/kg), and MH+Dlys groups by a random number table, 8 rats in each group. And 32 mice were randomly divided into wild-type, MH (18 mg/kg), growth hormone secretagogue receptor-knockout (GHSR-KO), and GHSR+MH groups, 8 mice in each group. The forced swimming test (FST), open field test (OFT), tail suspension test (TST), gastric emptying (GE) test, and intestinal transit (IT) test were used to assess antidepressant and prokinetic (AP) effects after drug single administration for 30 min with absorbable identification in rats and mice, respectively. The protein expression levels of brain-derived neurotrophic factor (BDNF) and phosphorylated mammalian target of rapamycin (p-mTOR) in the hippocampus of rats were evaluated by Western blot. The differences in functional brain changes were determined via 7.0 T functional magnetic resonance imaging-blood oxygen level-dependent (fMRI-BOLD). RESULTS: MH treatment improved depression-like behavior (FST, OFT) and hypomotility (GE, IT) in the acute forced swimming (FS) rats (all P<0.05), and the effects are similar to the parent formula CSP. The ghrelin antagonist [D-Lys3]-GHRP-6 inhibited the effect of MH on FST and GE (P<0.05). Similarly, MH treatment also alleviated depression-like behavior (FST, TST) in the wild-type mice, however, no effects were found in the GHSR KO mice. Additionally, administration of MH significantly stimulated BDNF and p-mTOR protein expressions in the hippocampus (both P<0.01), which were also prevented by [D-Lys3]-GHRP-6 (P<0.01). Besides, 3 main BOLD foci following acute FS rats implicated activity in hippocampus-thalamus-basal ganglia (HTB) circuits. The [D-Lys3]-GHRP-6 synchronously inhibited BOLD HTB foci. As expected, prokinetic mosapride only had effects on the thalamus and basal ganglia, but not on the hippocampus. Within the HTB, the hippocampus is implicated in depression and FD. CONCLUSIONS: MH accounts for part of AP effects of parent formula CSP in acute FS rats, mainly via ghrelin-related shared regulation coupled to BOLD signals in brain areas. This novel functionally connection of HTB following acute stress, treatment, and regulation highlights anti-depression unified theory.

Antidepression and Prokinetic Effects of Paeoniflorin on Rats in the Forced Swimming Test via Polypharmacology.

Paeoniflorin, an organic compound extracted from the roots of the white peony (Paeonia lactiflora) plant, has previously been shown to exert antidepression and prokinetic effects. The traditional Chinese prescription Si-Ni-San, of which paeoniflorin is a constituent, is often used in treating depression and functional gastrointestinal disorders. The effectiveness of Si-Ni-San has been shown to be less effective in a paeoniflorin-deleted form. The present study further investigates whether paeoniflorin alone is as effective as herbal prescriptions in which the compound is a constituent, specifically any antidepressive and prokinetic effect on rats subjected to a forced swimming test (FST). The FST was used to establish the depression model. Sprague-Dawley rats were administrated with 10 mg/kg paeoniflorin by gastrogavage three times before the behavioral test and gastrointestinal motility tests, respectively. In antidepression studies, fluoxetine was used as the positive control. In order to determine the effect of paeoniflorin on the gastrointestinal movement, mosapride was used as the positive control. Plasma and hippocampus monoamine, hypothalamic-pituitary-adrenal axis, plasma brain-derived neurotrophic factor (BDNF), superoxide dismutase (SOD), methane dicarboxylic aldehyde (MDA), ghrelin, motilin, and hippocampus nitric oxide (NO) were assessed using an enzyme-linked immunosorbent assay (ELISA). Gastrointestinal (GI) motility was measured in vivo and in vitro. Rats subjected to FST showed decreased gastric emptying and intestinal transit in vivo, decreased plasma and hippocampus 5-hydroxytryptamine, norepinephrine, dopamine, ghrelin, motilin, and reduced plasma BDNF and SOD as well as increased plasma and hippocampus corticotropin-releasing hormone, adrenocorticotropic hormone, corticosterone, plasma MDA, and hippocampus NO. Paeoniflorin reversed these symptoms in a similar manner to fluoxetine and mosapride, respectively. In vitro, paeoniflorin can stimulate the jejunal contract of healthy rats dose-dependently. The results suggest that paeoniflorin can simultaneously exert antidepression and prokinetic effects via polypharmacology.

[Effect of electroacupuncture pretreatment on differential expression profiles of myocardial long non-coding RNA and mRNA in mice with myocardial ischemia-reperfusion injury].

OBJECTIVE: To observe the effect of electroacupuncture (EA) pretreatment at "Neiguan" (PC6) on expression profiles of myocardial long non-coding RNAs (LncRNAs) and mRNAs in myocardial ischemia-reperfusion injury (MIRI) mice, so as to explore its mechanisms underlying prevention of MIRI via regulating LncRNA expression. METHODS: C57BL/6 mice were randomly divided into sham, model, and EA groups (n=4 in each group). The MIRI model was established by occlusion of the anterior descending branch (ADB) of the left coronary artery for 30 min, followed by reperfusion for 24 h. In the sham group, the ADB was only threaded beneath the artery without ligation. EA was applied to bilateral PC6 for 30 min prior to ischemia induction. Surgery was performed within 30 min at the end of EA stimulation. The expression profiles of differentially expressed LncRNAs and mRNAs in the left ventricular myocardium were analyzed by using LncRNA microarray. RESULTS: There was a significant diffe-rence in the expression pattern of LncRNAs and mRNAs among the sham, model and EA groups. A total of 1 693 LncRNAs and 2 858 mRNAs between the model and sham groups, and 3 859 LncRNAs and 1 343 mRNAs between the EA and model groups were identified to be differentially expressed candidates. According to Venn intersection analysis, LncRNAs with opposite regulative orientations in the model and EA groups were screened and defined as EA-related LncRNAs. LncRNA-mRNA co-expression analysis and Gene Ontology enrichment analysis of the EA-related LncRNAs predicted their roles to regulating post-traumatic stress and repairing of myocardial cells. Meanwhile, the proteins' function encoded by EA-related mRNAs mainly involved post-traumatic stress and inflammatory regulation. CONCLUSION: EA pretreatment at PC6 acupoint can produce extensive regulation on myocardial LncRNAs and mRNAs in MIRI mice, suggesting an involvement of LncRNAs in EA pretreatment induced improvement of MIRI. These results may provide direction and molecular basis for subsequent in-depth studies to reveal the underlying mechanisms of EA pretreatment for MIRI.

[Research on Acupuncture in Regulating the Inflammatory Reaction in Anti-ischemia-reperfusion Injury].

The inflammatory response during ischemia-reperfusion is one of principal reasons for secondary organ injury. Therefore, the inhibition of inflammation has become a research hot spot. The current research showed that acupuncture can not only directly inhibit the infiltration of inflammatory cells and regulate the expression of inflammatory cytokines, but is also involved in the overall regulation of the inflammatory signaling pathway and inhibition of the inflammatory response, thereby effectively improving ischemia-reperfusion injury. Here, we review research on the mechanism of acupuncture in ischemia-reperfusion injury via regulation of the inflammatory response.

[Electroacupuncture Intervention Combined with Anesthetics for Analgesia and Post-surgical Gastrointestinal Recovery in Pneumectomy Patients].

OBJECTIVE: To observe the effect of electroacupuncture (EA) stimulation of bilateral Taichong (LR 3), Yan-glingquan (GB 34), Waiguan (TE 5) and Chize (LU 5) on pain and post-surgical gastrointestinal reactions in patients undergoing pneumectomy. METHODS: Sixty patients with pneumectomy were randomly divided into EA group (30 cases) and control group (30 cases). For patients of the EA group, EA stimulation (2 Hz, 3 - 5 mA) was applied to bilateral LR 3, GB 34, TE 5 and LU 5 once every 12 h in the following two days after the surgery. For patients of the control group, the filiform needles were just adhered to the abovementioned acupoints without electrical stimulation. In addition, patients of both groups were treated first with lower dose of anesthetics including Fentanyl (250 µg) + Flurbiprofen axetil (25 mg) + normal saline (i. v., 2 mL/h), and Sauteralgyl (muscular injection if necessary). The visual analogue scale (VAS) was used for measuring the patients' pain reaction at 24(th) h and 48(th) h after surgery. The contents of plasma ß-endorphine (EP) and leu-enkephalin were assayed by ELISA, the times of vomiting and nausea, and the time of postoperative exhaust and defecation were recorded. RESULTS: Compared with the control group, the VAS score at 48 h after surgery, and the dosage of the supplemented Sauteralgyl were evidently lower, and the time of both exhaust and defecation after surgery was significantly earlier, and the degree of nausea after surgery was obviously milder in patients of the EA group (P<0.05, P<0.01). Compared with 0 h post-operation, the ß-endorphin and leu-enkephalin levels were significantly increased in the EA group (P<0.01). No significant difference was found between the control and EA groups in the vomiting rating (P>0.05). CONCLUSION: EA intervention combined with anesthetics is effective in reducing the dosage of the supplemented Sauteralgyl and the degree of postoperative nausea, and in improving postoperative gastrointestinal functional recovery in patients undergoing pneumectomy.

[Post-operative management for 86 cases of heart valve replacement surgery patients undergoing transcutaneous electrical acupoint stimulation combined with general anesthesia].

OBJECTIVE: To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia. METHODS: From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass (heart valve replacement surgery without intubation) were recruited in the present summary. Post-operative managements in the Intensive Care Unit (ICU) were administrated with strict hemodynamic monitoring for volume infusion, routine administration of vasoactive drugs (including dopamine and nitroglycerin), oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. RESULTS: All the 86 patients under TEAS + general anesthesia and cardiopulmonary bypass and without intubation experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases (9.30%), the average stay duration in ICU was (28.6 +/- 6.2) hours, and the average draining volume of the interpleural space was (291 +/- 73)mL. The cardia insufficiency was found in 5 cases (5.81%), hypoxia occurred in 8 cases (9.30%), nausea in 8 cases (9.30%), vomiting 5 cases (5.81%) and post-operative gastrointestinal distension 13 cases (15.12%), mild renal insufficiency 3 cases (3.49%), fever (> 38.5 degrees C) 1 case(1. 16%) and severe post-operative pain 7 cases (8.14%). CONCLUSION: TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary bypass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

Thulium laser vaporesection versus standard transurethral resection of the prostate: a randomized trial with transpulmonary thermodilution hemodynamic monitoring.

OBJECTIVES: To characterize the hemodynamics comparing thulium laser vaporesection of the prostate with traditional transurethral resection of the prostate. METHODS: A total of 80 consecutive patients with benign prostatic hyperplasia were randomly assigned into the thulium laser vaporesection of the prostate group or transurethral resection of the prostate group. Transpulmonary thermodilution hemodynamic monitoring was used before and 1 h after surgery to assess patient hemodynamics. Acute complications and treatment efficiency were evaluated after surgery. RESULTS: There were no statistical differences in age, prostate volume, anticoagulants and International Prostate Symptom Score between the two groups. The postoperative Stroke Volume Index was significantly higher in the thulium laser vaporesection of the prostate group (P = 0.007). The extravascular lung water and intrathoracic blood volume indices differed significantly pre- and postoperatively, and were similar in both groups. Decreases in serum sodium and hemoglobin concentrations after surgery were lower in the thulium laser vaporesection of the prostate group (P < 0.01). Acute complications, and improvements in International Prostate Symptom Score and maximum urinary flow rates, were similar in both groups. CONCLUSIONS: Transpulmonary thermodilution hemodynamic monitoring provides additional safety measures during surgical procedures. Thulium laser vaporesection of the prostate is associated with fewer hemodynamic changes and provides similar efficacy to transurethral resection of the prostate. Thus, it can be considered a safe and effective procedure.

[Application of neoadjuvant hormonal therapy in (125)I permanent seed implantation for prostate cancer].

OBJECTIVE: To explore the therapeutic response and toxicity of neoadjuvant hormonal therapy in (125)I permanent seed implantation for prostate cancer and validate the clinical efficacy of neoadjuvant hormonal therapy. METHODS: A total of 165 patients with T1c-T3b prostate cancer received transperineal ultrasound-guided (125)I permanent seed implantation and neo-adjuvant hormonal therapy (NHT). Their median age was 79 years (range: 65 - 88). They were randomized into 2 groups: group A (n = 90, 3-month NHT before (125)I permanent seed implantation for prostate cancer 0 and group B (n = 75, (125)I permanent seed implantation). The prostate surface antigen (PSA) response rate, the change of prostate volume and the toxicities of urinary system and sexual function were observed. RESULTS: The median PSA decreased to 0.38 (0.01 - 6.56) µg/L from 26.50 (3.56 - 150.00) µg/L after a 3-month neoadjuvant hormonal therapy and the median prostate volume dropped from 29.33 (23.62 - 65.21) ml from 46.38 (19.28 - 128.10) ml during a follow-up period of 24 months. After brachytherapy, the PSA level was maintained at a relatively low level (median number of 0.62 µg/L and 2.56 µg/L in groups A and B respectively). And 6 and 9 patients suffered from acute urinary retention after brachytherapy in groups A and B respectively. CONCLUSION: Neoadjuvant hormonal therapy can reduce the volume of prostate before brachytherapy and serum PSA in a short time. The toxicities of urinary system, gastrointestinal tract and sexual function should be examined by further randomized control studies. A long-term observation is needed for the PSA-free survival rate.

Effect of Tongxie Yaofang Granule in treating diarrhea-predominate irritable bowel syndrome.

OBJECTIVE: To study the clinical effect of Tongxie Yaofang (TXYF) Granule in treating diarrhea-predominate irritable bowel syndrome (D-IBS) and its possible mechanism. METHODS: A total of 120 patients were assigned to two groups using stratified block randomization, 80 in the intervention group and 40 in the control group. To the intervention group the TXYF granule was given at one package each time, twice a day; the control group was treated with Miyarisan three times a day, two tablets each time. The course of treatment was 4 weeks for both groups. The total efficacy in them was compared, and data of scoring on stool (Bristol method), abdominal pain, abdominal distension, and mental condition were collected before treatment and 2 and 4 weeks after treatment. The activation of mast cells (MCs) of six patients chosen from each group was detected as well before and after treatment. RESULTS: No significant difference between the two groups in terms of the total efficacy or the scores of symptoms before and after treatment was found (P>0.05). The number of activated MCs was decreased in the intervention group after treatment, showing significant difference as compared with that before treatment as well as with that in the control group after treatment (P<0.01). CONCLUSIONS: TXYF is an effective preparation for the treatment of D-IBS. It can quickly lessen abdominal pain and distention, improve the property of stool, and improve mental tension and depression in patients. Its mechanism of action might be through the adjustment of MCs activation to decrease visceral hypersensitivity.

[Effects of acupuncture on the gastric motivity in patients with functional dyspepsia].

OBJECTIVE: To observe the effects of the acupuncture on the gastric motivity in patients with functional dyspepsia (FD). METHODS: Ninety FD patients were randomly divided into 3 groups: the treated group, the control groups, 1 and 2, 30 patients in each group. Patients in the treated group received acupuncture treatment, those in the control group 1 and group 2 orally took Cisapride and Marzulene-s granule respectively. Changes in scores of symptoms, electrogastrographic figure, gastric emptying time estimated by B-ultrasonic examination and plasma level of motilin in the 3 groups before and after treatment were observed. RESULTS: Symptoms were obviously improved in the treated and control group 1 after treatment, which were better than those in the control group 2 (P < 0.01). Gastro-electric frequency and rhythm in the treated group and control group 1 were improved more significantly than those in before treatment (P < 0.01). Gastric emptying time and plasma motilin improved in the treated group and the control group 1 after treatment, when compared with before treatment, the difference was significant respectively (P < 0.05). CONCLUSION: Acupuncture could significantly improve the gastric motivity of FD patients.

[The influence of combined supplementation of glutamine and recombinant human growth hormone on the protein metabolism in severely burned patients].

OBJECTIVE: To investigate the influence of combined supplementation of glutamine (Gln) and recombinant human growth hormone (rhGH) on the protein metabolism in severely burned patients. METHODS: Sixty severely burned patients were enrolled in the study and were randomly divided into control (C, n = 20) and Gln with rhGH (Gln + rhGH, n = 20) groups. The patients in C group received glycine as the placebo, while those in Gln group took Gln orally in dose of 0.5 g kg(-1) d(-1) during 1-14 postburn days (PBDs). For the patients in Gln + rhGH group rhGH was administered subcutaneously in dose of 0.2 U kg(-1) d(-1) in addition to glutamine in same dosage beginning on the 7 PBD for 7 days. The plasma Gln concentration in the 3 groups of patients was determined on the 1st, 7th and 14th PBD and the plasma albumin level was determined on 14th and 21st PBD. The wound healing rate of the patients within 30 PBSs and the total hospital stay days were recorded. RESULTS: The plasma Gln concentration in Gln + rhGH group of patients was evidently higher than that in C group after 7 PBD[(452.28 +/- 21.72) micromol/L vs(325.12 +/- 25.34) micromol/L, P < 0.05]. The plasma albumin level in Gln + rhGH group was obviously higher than that in C and Gln groups on the 21st PBD (P < 0.05). The wound healing rate in Gln + rhGH group was evidently higher than that in Gln and C groups on the 30th PBD (P < 0.05). The total hospital stay days in Gln + rhGH group were obviously less than that in C and Gln groups (P < 0.05 or 0.01). CONCLUSION: Combined administration of Gln and rhGH could be beneficial to the elevation of plasma Gln level in severely burned patients and the systemic protein synthesis was therefore enhanced and the wound healing rate was improved.