[Application of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block to Enhanced Recovery After Surgery in Patients Undergoing Laparoscopic Colorectal Cancer Resection: A Randomized Controlled Clinical Trial].

OBJECTIVE: To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane (TAP) block in the enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic colorectal cancer resection (LCCR). METHODS: A total of 101 patients undergoing LCCR were randomly divided into three groups: control (n＝34), TAP (n＝35) and TEAS＋TAP (n＝32). Conventional perioperative anesthesia management of the 3 groups was performed according to the ERAS guidelines. All the patients experienced patient controlled epidural analgesia (PCEA), and those of the TAP and TEAS＋TAP groups received TAP block by injection of 0.3% Roperca hydrochloride (15 mL) into the space between the internal oblique and the transverse abdominis after induction of anesthesia. For patients of the TEAS＋TAP group, TEAS (2 Hz/10 Hz, an endurable stimulation strength) was applied to bilateral Zusanli (ST 36) from 30 min before anesthesia to the end of the surgery. The blood glucose value and dosage of Remifentanil used were recorded. The pain severity was assessed at 4, 12, 24 and 48 h after surgery by using visual analogue scale (VAS). Moreover, postoperative anal exhaust time, postoperative oral feeding time, postoperative first ambulation time and postoperative hospital stay length were recorded. RESULTS: The total dosages of Remifentanil used during surgery, and the blood glucose levels were significantly lower in the TAP and TEAS＋TAP groups than in the control group (P<0.05), but had no significant differences between the TAP and TEAS＋TAP groups (P>0.05). The VAS scores of the TAP and TEAS＋TAP groups were considerably lower than those of the control group at 4, 12, 24 and 48 h after surgery (P<0.05, except 48 h of TAP group). Of the 34, 35 and 32 cases in the control, TAP and TEAS＋TAP groups, 5(14.7%), 3(8.6%) and 1(3.1%) on the 1st day post-surgery, and 2(5.9%), 0(0) and 0(0) on the 2nd day after surgery experienced nausea and vomiting. The postoperative anal exhaust time and postoperative oral feeding time were significantly earlier in both TAP and TEAS＋TAP groups than in the control group (P<0.05), and the exhaust time of the TEAS＋TAP group was even earlier than that of the TAP group (P<0.05). No significant differences were found among the 3 groups in the postoperative ambulation time and postoperative hospitalization time (P>0.05). CONCLUSION: TEAS combined with TAP block analgesia is superior to simple TAP block analgesia in relieving postoperative pain, shortening the recovery time of gastrointestinal function and promoting postoperative rehabilitation in patients undergoing LCCR.

[Tricaicium phosphate complex pre-loaded with bone morphogenetic protein-2 or platelet derived growth factor-BB for repairing critical-size cranial defects in SD rats].

OBJECTIVE: To observe the effect of a new biomaterial in promoting the bone regeneration for repairing critical-size cranial defects in SD rats. METHODS: Critical-size cranial defects were induced in 3-month-old male Sprague-Dawley rats and repaired with the implants of calcium phosphate from growth factor enhanced matrix 21 (CaPfromGEM21, control), CaPfromGEM21 preloaded with 10 ng bone morphogenetic protein-2 (BMP-2), CaPfromGEM21 preloaded with 100 ng BMP-2, CaPfromGEM21 preloaded with 0.3 µg platelet-derived growth factor-BB (PDGF-BB), or CaPfromGEM21 preloaded with 3 µg PDGF-BB. The defects were examined 6 weeks after the surgery with X-ray, micro-CT, HE staining and quantitative assessments. RESULTS: X-ray showed defect repair in all the groups. The fracture line became obscure, and the defects were almost fully repaired by the regenerated bone tissues in PDGF-BB group. Micro-CT demonstarted new bone formation in the defects. The new bone volume was significantly greater in PDGF-BB groups than in BMP-2 groups (P<0.05). HE staining revealed the presence of new bones in the defects and new vessels in and around the new bones without inflammatory cells. The new bone area fraction was significantly greater in 10 ng BMP-2 group and 0.3 µg PDGF-BB group than in the control group (P<0.05), and the new vessel density was similar in the all the 4 cytokine-preloaded groups and all significantly greater than that in the blank and CaPfromGEM21 control group (P<0.05). CONCLUSION: CaPfromGem21 combined with BMP-2 or PDGF-BB has good biocompatibility and can better promote bone regeneration for repairing bone defects.

[Effect of assisted anesthesia of auricular point magnetic sticking on postoperative recovery of gynecological surgery].

OBJECTIVE: To explore an optimum method on postoperative recovery of general-anesthesia gynecological laparoscopic surgery. METHODS: One hundred and twenty cases of gynecological laparoscopic surgery were randomly divided into three groups, 40 cases in each one. The sensitive points of bilateral Shenmen (TF4), Zigong (TF2), Wei (CO4), Dachang (CO7) and so on were selected in all three groups one night before the surgery. The sticking with magnetic beads was applied in the group A. The magnetic beads were in-pair stuck at front-back corresponding location of both ears in the group B. The same-appearance plaster was put at the corresponding acupoints in the group C. The intubation anesthesia was applied in all three groups and postoperative recovery of gynecological laparoscopic surgery was observed. RESULTS: The postoperative visual analogue scale (VAS) was (1.77 +/- 1.65) in the group A and (1.80 +/- 1.96) in the group B, which was both lower than (2.62 +/- 1.46) in the group C (both P < 0.01). The occurrence rate of nausea and vomiting was 25.0% (9/36) in the group A and 20.0% (8/40) in the group B, which was both lower than 50.0% (19/38) in the group C (both P < 0.01). The recovery of borborygmus on postoperative 1st and 3rd day in the group A and B was faster than that in the group C (both P < 0.05), while time of fart and defecation in the group A and B was earlier than that in the group C (both P < 0.05). The score of state-trait anxiety inventory in the group A and B was lower than that in the group C (both P < 0.05), but the differences of each item between the group A and B were not obvious (both P > 0.05). CONCLUSION: The auricular point sticking could support analgesia of general-anesthesia gynecological laparoscopic surgery, which could relieve anxiety mood, reduce occurrence of nausea and vomiting and improve function of stomach and intestine to benefit postoperative recovery. However, the effect of in-pair sticking of auricular point with magnetic beads at front-back acupoints was not obviously strengthened.

Rosiglitazone enhances 5-fluorouracil-induced cell growth inhibition in hepatocellular carcinoma cell line Hep3B.

BACKGROUND AND OBJECTIVE: Rosiglitazone is a peroxisome proliferators-activated receptor gamma (PPARgamma) ligand, which inhibits tumor growth by activating PPARgamma signaling pathways. Fluorouracil (5-FU) is one of the commonly used chemotherapeutic drugs. However, patients develop drug resistance of 5-FU over time. The aim of this study was to investigate whether rosiglitazone can enhance 5-FU-induced cell growth inhibition and to explore its potential mechanisms. METHODS: Cell viability was measured using MTT assay. Protein expression levels were detected by Western blot analysis. Small interference RNA was utilized to knockout PPARgamma and PTEN in Hep3B cells. RESULTS: After 48 h of treatment with 10, 20, and 40 µmol/L rosiglitazone, the viability of Hep3B cells was (78.0 ± 2.7)%, (37.3 ± 8.1)%, and (19.8 ± 2.2)%, respectively (compared with control group, P values were all < 0.001). After 48 h of treatment with 10 µmol/L 5-FU, the viability of Hep3B cells was about (82.6 ± 3.9)%. When cells were treated with 10 µmol/L 5-FU in combination with either 10, 20 or 40 µmol/L rosiglitazone, the cell viability was (51.6 ± 5.4)%, (14.8 ± 4.2)%, and (8.5 ± 0.9)%, with corresponding q value of 1.36, 1.23, and 1.19, respectively. These data suggested that the two drugs had synergic effect in inhibiting Hep3B cell growth, which was further confirmed in an in vivo mice model. Subsequent investigations showed that rosiglitazone activated PPARgamma signaling pathways and increased the expression of PTEN. CONCLUSIONS: Rosiglitazone enhances 5-FU-induced cell growth inhibition of Hep3B cells.

[Effect of sevoflurane versus propofol-remifentanil anesthesia on neuromuscular blockade by continuous cisatracurium infusion].

OBJECTIVE: To compare the effects of sevoflurane and propofol-remifentanil anesthesia on neuromuscular blockade produced by continuous cisatracurium infusion. METHODS: Forty ASA I or II patients undergoing selective surgery were randomly divided into sevoflurane and propofol-remifentanil anesthesia groups (n=20). Neuromuscular blockade was monitored using train-of-four (TOF) stimulation by recording the contraction force of the adductor pollicis muscle with a muscle relaxation monitor. A bolus dose of cisatracurium of 0.15 mg/kg was administered to facilitate endotracheal intubation, followed by continuous infusion adjusted manually to maintain the first twitch (T1) < or = 5% of the control level. The following variables were recorded including the infusion rate, total amount of cisatracurium, spontaneous recovery index (RI), and the time interval from termination of infusion cisatracurium to recovery of TOF ratio (TOFR) to 0.9. RESULTS: With the maintenance of a 95%-99% neuromuscular blockade, the infusion rate was significantly lower in sevoflurane group than in propofol-remifentanil group (P<0.05), and stabilized in both groups after 120 min. No significant differences were found in RI or the time to TOFR of 0.9 between the two groups (P>0.05). CONCLUSION: During the maintenance of stable neuromuscular blockade by continuous cisatracurium infusion, both sevoflurane and propofol-remifentanil anesthesia can time-dependently enhance the effect of cisatracurium without producing significant differences in the recovery properties.

[Adjuvant effect of transcutaneous electrical acupoint stimulation in propofol-fentanyl anesthesia in partial mastectomy].

OBJECTIVE: To evaluate the adjuvant effect of transcutaneous electrical acupoint stimulation (TEAS) in propofol-fentanyl anesthesia in partial mastectomy. METHODS: Ninety patients undergoing partial mastectomy were randomly divided into 3 groups (n=30), namely group A with propofol-fentanyl anesthesia (PFVA), group B with PFVA and TEAS at Hegu-Laogong and Neiguan-WaiGuan acupoints, and group C with PFVA and TEAS at Hegu-Laogong, Neiguan-Waiguan, and bilateral Jianjing acupoints. The bispectral index (BIS), heart rate (HR), saturation of pulse oxygen (SpO2), blood pressure (BP), the reaction of patients to the incision and awakening quality were observed at different time points. Blood samples were obtained from the dorsal artery of the foot to determine the levels of adrenaline and beta-endorphin using the enzyme-linked immunosorbent assay before TEAS (entry into the OR in group A) and at 30 min after TEAS (30 min after entry into the OR in group A), 5 min after incision, end of the surgery and awakening. RESULTS: Thirty minutes after TEAS (or 30 min after entry into the OR in group A), BIS, BP and HR were all decreased significantly in groups B and C (P<0.05) but remained stable in group A (P>0.05). The plasma propofol concentration of groups B and C were significantly lower than that in group A, and group B had the highest plasma propofol concentration (P<0.05). The total dose of propofol in groups B and C were decreased by 19% and 27% in comparison with that in group A, respectively. Compared with the basal value, the content of beta-endorphin in groups B and C increased obviously 30 min after TEAS, being the highest in group C (P<0.05); the adrenaline level in groups B and C remained stable after TEAS (P>0.05). CONCLUSION: TEAS provides an adjuvant effect in propofol-fentanyl anesthesia and obviously enhances the analgesia effect.

[Experience of endovenous radiofrequency combined with TriVex in treatment of chronic venous insufficiency in lower extremity].

OBJECTIVE: To evaluate therapeutic results of endovenous radiofrequency in combination with TriVex in treatment of venous insufficiency in lower extremities. METHODS: One hundred and fifty patients with chronic venous insufficiency (150 limbs) were randomly assigned to Group A (75 limbs) and Group B (75 limbs). Patients in Group A were treated with long saphenous veins radiofrequency ablation procedures in combination with TriVex. Patients in Group B were treated with long saphenous veins traditional stripping operation in combination with TriVex. The postoperative pain, average hospital stay and short-term results in hospital were compared between the two groups. Self-assessment of the operation 4 weeks after, changes of CEAP classification, venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ) score were compared between the two groups. RESULTS: The operation time in Group A was (67 +/- 11) min, compared with (59 +/- 9) min in Group B (P > 0.05). Postoperative pain and average hospital stay in Group A were significantly lower than those in Group B (P < 0.05). The scores of self-assessment of the operation in Group A was higher than that in Group B 4 weeks after operation (P < 0.05). The change of CEAP classification, VCSS and quality of life were significant after operation in both groups. The VCSS of Group A decreased by 4.6 +/- 2.5 compared with 4.3 +/- 2.7 in Group B (P > 0.05). CONCLUSIONS: Endovenous radiofrequency combined with TriVex for treatment of venous insufficiency in lower extremity is available, effective and with less trauma and faster recovery. CEAP classification, VCSS and CIVIQ are useful tools for assessing outcomes after radiofrequency in these patients.