[Comparative study between electroacupuncture at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery].

OBJECTIVE: To compare the clinical effect between electroacupuncture (EA) at Neima point and Neiguan (PC 6) and epidural nerve block for preemptive analgesia in patients undergoing thoracic surgery. METHODS: Sixty patients with elective radical esophagectomy were randomly divided into a group A, a group B and a control group, 20 cases in each group. The patients in the group A were treated with injection of 20 mL 0.375% ropivacaine at epidural space 30 min before anesthesia induction, followed by normal anesthesia during operation; the patients in the group B were treated with 30 min EA at bilateral Neima point and Neiguan (PC 6) before anesthesia induction, followed by normal anesthesia during operation; the patients in the control group were treated with general anesthesia alone. Patient-controlled intravenous analgesia was applied for all the patients. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before acupuncture/epidural puncture (T0), skin incision (T1), extubation (T2) and 2 h after operation (T3); the dosage of anesthetics and extubation time were recorded; the plasma levels of ß-endorphin (ß-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) were measured at the following time points: T0, T3, 12 h after operation (T4), 24 h after operation (T5) and 48 h after operation (T6). Visual analogue scale (VAS) was used to evaluate the analgesic effect. RESULTS: The MAP at T1 and T2 in the group A was lower than that in group B and control group (P<0.05), and HR at T1 and T2 was lower than that in control group (P<0.05). The MAP and HR at T1 and T2 in the group B were lower than those in the control group (P<0.05). The dosage of remifentanil in the group A and group B was lower than that in the control group (P<0.05), and extubation time was earlier than that in the control group (P<0.05). The content of ß-EP at T4, T5 and T6 in the group B was higher than that in the group A and control group (P<0.05); the contents of 5-HT and PGE2 at T3, T4 and T5 in the group A and group B were lower than those in the control group (P<0.05). The VAS scores at T3, T4 and T5 in the group A and group were lower than those in the control group (P<0.05). CONCLUSION: The preemptive analgesia of EA at Neima point and Neiguan (PC 6) and epidural nerve block could both provide effective perioperative analgesia for thoracic surgery. The EA could better maintain intraoperative hemodynamics and has less physiological disturbance.

Sevoflurane modulates the cancer stem cell-like properties and mitochondrial membrane potential of glioma via Ca2+-dependent CaMKII/JNK cascade.

AIMS: Gliomas are responsible for the majority of deaths from primary brain tumours. Sevoflurane showed inhibition effects on the tumor progression in vitro. However, whether sevoflurane could affect the stemness of glioma stem cells (GSCs) and the potential molecular mechanism have not been well elucidated. MAIN METHODS: Effects of sevoflurane on cell viability, proliferation and invasion ability of glioma cells as well as tumor growth in vivo were assessed. Sphere formation assay was performed to evaluate the effect of sevoflurane on the stemness of GSCs. Effects of sevoflurane on mitochondrial function was evaluated by intracellular/mitochondrial reactive oxygen species (ROS) level and mitochondrial membrane potential. Expression levels of proliferation-related proteins, stemness markers and proteins in CaMKII/JNK cascade were measured by Western blot. KEY FINDINGS: Sevoflurane inhibited the viability, proliferation and invasion ability of glioma cells (U87MG and U373MG). Western blot showed that sevoflurane decreased the expression levels of proliferation and invasion-related proteins. Sphere formation ability of GSCs, expression levels of stemness markers and mitochondrial function were significantly suppressed by sevoflurane. Moreover, sevoflurane treatment significantly increased the Ca2+ concentration and stimulated phosphorylation of CaMKII, JNK and IRS1. Ca2+ chelator BAPTA-AM combined with sevoflurane synergistically inhibited colony forming ability and the expression levels of proliferation-related proteins and stemness markers. In addition, the in vivo study further confirmed that sevoflurane inhibited tumor growth via Ca2+-dependent CaMKII/JNK cascade. SIGNIFICANCE: The present study demonstrated that sevoflurane inhibited glioma tumorigenesis and modulated the cancer stem cell-like properties and mitochondrial membrane potential via activation of Ca2+-dependent CaMKII/JNK cascade.

[Clinical trial of electroacupuncture at Neimadian-point for cancer pain].

OBJECTIVE: To observe the clinical efficacy and safety of electroacupuncture (EA) at Neimadian-point for cancer pain. METHODS: A total of 140 cancer patients with pain were randomly divided into EA and control groups, with 70 cases in each group. The patients of the EA group received EA at Neimadian-point plus analgesia pump (all prepared with normal saline). The patients of the control group were treated by Sufentanil patient-controlled intravenous analgesia plus sham EA (without stimulation). The treatment was conducted once daily for two days at 8 o'clock every morning. Respectively, in 1 h before treatment (T0), 1 h (T1), 8 h (T2), 24 h (T3) after treatment of the first day, 1 h (T4), 8 h (T5), 24 h (T6) after treatment of the second day, the visual analogue scale (VAS) score of pain, and the plasma levels of norepinephrine, 5-HT, leucine enkephalin, ß-endorphin and dynorphin A1-13 were tested. The security level (1-4 grade) was assessed during the treatment. RESULTS: Compared with their own pre-treatment, in T1 to T6, the VAS scores, and the contents of plasma norepinephrine and 5-HT obviously decreased in both groups （P<0.05）, and the contents of leucine enkephalin, ß-endorphin and dynorphin A1-13 all increased (P<0.05) in the EA group. The analgesia effects were significantly higher in the EA group than in the control group in T1, T2, T4 and T5 (P<0.05,P<0.01). The therapeutic effect of EA at Neimadian-point was significantly superior to that of the Sufentanil in down-regulating plasma norepinephrine and 5-HT levels, and in up-regulating leucine enkephalin, ß-endorphin and dynorphin A1-13 levels (P<0.05,P<0.01). CONCLUSION: EA at Neimadian-point can effectively relieve the pain of cancer patients and improve their quality of daily life.

[Observation on electroacupuncture at neimadian (extra) and neiguan (PC 6) for analgesia after thoracic surgery].

OBJECTIVE: To observe the effectiveness and safety of electroacupuncture (EA) at Neimadian (Extra) and Neiguan (PC 6) for analgesia after thoracic surgery. METHODS: One hundred and twenty cases of thoracic surgery were randomly divided into an electroacupuncture (EA) group (60 cases) and a medication group (60 cases). EA was applied at Neimadian (Extra) and Neiguan (PC 6) for postoperation analgesia in the EA group, while patient-controlled intravenous analgesia (PCIA) was applied in the medication group. The score of visual analogue scale (VAS), analgesia effect, safety and beta-endorphin level after the treatment in both groups were compared. RESULTS: Compared with those before the treatment, the VAS scores in every time point after surgery were decreased (all P < 0.05), which were lower in the EA group (P < 0.01). The excellent and good rates were 96.7% (58/60) and 75.0% (45/60) seperately, the analgesia effect in the EA group (2 h after operation) was superior to that in the medication group (P < 0.01). The safety degree in EA group was higher to that in the medication group (P < 0.01). Compared with that before the treatment, the beta-endorphin level in two groups after treatment was both increased, which was higher in the EA group (P < 0.01). CONCLUSION: Electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) has better analgesia effect (2 h after operation) and safety than PICA on analgesia after thoracic surgery.

[Analgesic effect of acupuncture at Neimadian(Extra) in postoperation of abdominal surgery].

OBJECTIVE: To observe the analgesia effectiveness and safety of electroacupuncture at Neimadian(Extra) for postoperation of abdominal surgery. METHODS: One hundred and twenty patients with routine abdominal surgery were randomly divided into an acupuncture group and a medication group, 60 cases in each group. The acupuncture group was treated with electroacupuncture at Neimadian(Extra), which was located on the inside of lower leg, 7 cun above the internal malleolus and 0.5 cun from post edge of tibial. The medication group was treated with patient-controlled intravenous analgesia (PCIA) with Sufentanil. After the treatment, the Visual Analogue Scale (VAS), the security, the analgesic effect and beta-endorphin content were compared. RESULTS: The postoperative VAS score at 2, 4, 8, 16, 24 and 48 h in the acupuncture group was lower than those in the medication group (all P < 0.05). The analgesic effect at 2, 4, 16 and 24 h after surgery in the acupuncture group were superior to those in the medication group (P < 0.05, P < 0.01). The beta-endorphin content at 0, 8, 16 and 48 h after surgery in both groups were increased, and the acupuncture group was superior to the medication group (all P < 0.05). The security class after surgery in the acupuncture group was higher than that in the medication group (P < 0.05). CONCLUSION: The analgesic effect and safety of electroacupuncture at Neimadian(Extra) in postoperation of abdominal surgery are superior to those of the PCIA with Sufentanil.

[Clinical observation on analgesic effect of electroacupuncture at Neimadian after operation of extremities].

OBJECTIVE: To observe effectiveness and safety of electroacupuncture at Neimadian for analgesia in the extremities after orthopedic operation. METHODS: Two hundred cases enrolled were divided into two groups. The test group of 100 cases were treated with electroacupuncture at Neimadian and oral administration of placebo, and the control group of 100 cases with oral administration of tramadoli hydrochloride. RESULTS: The mean score for pain signs at all the time points before and after analgesic treatment in the test group had more decreases as compared with the control group (P < 0.001); and in the good rate after treatment, the test group was higher than the control group (P < 0.001, P < 0.05), and for safety, the test group was higher than the control group (P < 0.001). CONCLUSION: The analgesic effect and safety of electroacupuncture at Neimadian are superior to the routine analgesic after operation of the extremities.