Effect of Preemptive Ketamine Administration on Postoperative Visceral Pain after Gynecological Laparoscopic Surgery

The pain following gynecological laparoscopic surgery is less intense than that following open surgery; however, patients often experience visceral pain after the former surgery. The aim of this study was to determine the effects of preemptive ketamine on visceral pain in patients undergoing gynecological laparoscopic surgery. Ninety patients undergoing gynecological laparoscopic surgery were randomly assigned to one of three groups. Group 1 received placebo. Group 2 was intravenously injected with preincisional saline and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. Group 3 was intravenously injected with preincisional ketamine（0.3 mg/kg） and local infiltration with 20 m L ropivacaine（4 mg/m L） at the end of surgery. A standard anesthetic was used for all patients, and meperidine was used for postoperative analgesia. The visual analogue scale（VAS） scores for incisional and visceral pain at 2, 6, 12, and 24 h, cumulative analgesic consumption and time until first analgesic medication request, and adverse effects were recorded postoperatively. The VAS scores of visceral pain in group 3 were significantly lower than those in group 2 and group 1 at 2 h and 6 h postoperatively（P〈0.05 and P〈0.01, respectively）. At 2 h and 6 h, the VAS scores of incisional pain did not differ significantly between groups 2 and 3, but they were significantly lower than those in group 1（P〈0.01）. Groups 1 and 2 did not show any differences in visceral pain scores at 2 h and 6 h postoperatively. Moreover, the three groups showed no statistically significant differences in visceral and incisional pain scores at 12 h and 24 h postoperatively. The consumption of analgesics was significantly greater in group 1 than in groups 2 and 3, and the time to first request for analgesics was significantly longer in groups 2 and 3 than in group 1, with no statistically significant difference between groups 2 and 3. However, the three groups showed no significant difference in the incidence of shoulder pain or adverse effects. Preemptive ketamine may reduce visceral pain in patients undergoing gynecological laparoscopic surgery.

Mechanism of Huanglian Detoxification Soup Relieving Postherpetic Neuralgia by Enhancing IL-2 Levels in Rats

[Objectives]To explore the mechanism of Huanglian detoxification soup improving pain behavior by affecting serum IL-2 levels in postherpetic neuralgia(post herpes neuralgia,PHN)model rats.[Methods]20 PHN rats were randomly divided into model group(PHN group)and detoxification decoction group(n=10).In the group,10%Huanglian detoxification soup(0.4 mL/0.1 kg)was given once in the morning and evening for 14 d.The PHN group was filled with an equal volume of 0.9%sodium chloride solution.Tail vein serum inflammatory factor interleukin-2(IL-2),IL-βand IL-6 levels were measured using ELISA kits at 7 and 21 d.[Results]IL-2 increased at 14 and 21 d in IL group,while IL-βand IL-6 decreased compared with the PHN group(P<0.05).[Conclusions]Huanglian detoxification soup may raise IL-2 levels after VZV infection to promote the differentiation of cells of the immune system,so as to relieve the pain caused by IL-βand IL-6 inflammatory factors.

Changes of proinflammatory, fluid balance, vascular permeability and oxidative stress in patients with secretory otitis media

Objective: To investigate the changes of proinflammatory, fluid balance, vascular permeability and oxidative stress in patients with secretory otitis media. Methods: A total of 42 patients with secretory otitis media treated in our hospital from September 2016 to January 2018 were selected as the observation group and 42 healthy people as the control group. The levels of proinflammatory effect [including transforming growth factor beta 1 (TGF-β1), transforming growth factor-beta 2 (TGF-β2)], fluid balance [including aquaporin-1 (AQP-1) and aquaporin-4 (AQP-4)], vascular permeability [including hyaluronic acid (HA), fibronectin (Fn) and platelet activating factor (PAF)] and oxidative stress-related indexes [including malondialdehyde (MDA) and superoxide dismutase (SOD)] were observed and compared between the two groups. Results: The levels of AQP-1, AQP-4 and Fn in the observation group were significantly lower than those in the control group. The expression levels were (4.52±0.39) g/L, (23.06±7.21) g/L and (120.59±13.07) mg/L, respectively. The levels of TGF-β1, TGF-β2, HA, PAF, MDA and SOD were significantly higher than those of the control group and the expression levels were (11.99±4.23) 毺g/L, (4.22±1.66) 毺g/L, (70.54±6.99) 毺g/L, (123.83±20.58) ng/mL, (6.30±0.44) nmol/mL and (15.85±0.78) NU/mL, respectively. The difference was statistically significant. Conclusions: Inflammatory reaction occurs in patients with otitis media with secretory otitis media. It is easy to break the liquid balance in the middle ear cavity and to increase vascular permeability and oxidative stress. The relevant indicators should be strengthened in clinical practice, so as to provide evidence for early diagnosis and treatment of the disease.

Acupuncture at Back-Shu point improves insomnia by reducing inflammation and inhibiting the ERK/NF-κB signaling pathway

BACKGROUND Insomnia is a disease where individuals cannot maintain a steady and stable sleep state or fail to fall asleep.Western medicine mainly uses sedatives and hypnotic drugs to treat insomnia,and long-term use is prone to drug resistance and other adverse reactions.Acupuncture has a good curative effect and unique advantages in the treatment of insomnia.AIM To explore the molecular mechanism of acupuncture at Back-Shu point for the treatment of insomnia.METHODS We first prepared a rat model of insomnia,and then carried out acupuncture for 7 consecutive days.After treatment,the sleep time and general behavior of the rats were determined.The Morris water maze test was used to assess the learning ability and spatial memory ability of the rats.The expression levels of inflammatory cytokines in serum and the hippocampus were detected by ELISA.qRTPCR was used to detect the mRNA expression changes in the ERK/NF-κB signaling pathway.Western blot and immunohistochemistry were carried out to evaluate the protein expression levels of RAF-1,MEK-2,ERK1/2 and NF-κB.RESULTS Acupuncture can prolong sleep duration,and improve mental state,activity,diet volume,learning ability and spatial memory.In addition,acupuncture increased the release of 1L-1β,1L-6 and TNF-αin serum and the hippocampus and inhibited the mRNA and protein expression of the ERK/NF-κB signaling pathway.CONCLUSION These findings suggest that acupuncture at Back-Shu point can inhibit the ERK/NF-κB signaling pathway and treat insomnia by increasing the release of inflammatory cytokines in the hippocampus.

Transarterial chemoembolization combined with radiofrequency ablation in the treatment of hepatocellular carcinomas larger than 5 cm

Aim:This meta-analysis was designed to compare the effectiveness of the combination of transarterial chemoembolization(TACE)and radiofrequency ablation(RFA)vs.that of TACE alone in hepatocellular carcinoma(HCC)tumors larger than 5 cm.Methods:PUBMED,CNKI,and CBM were searched for all related randomized controlled trials(RCTs)up until October 22,2018.Eleven studies were identified that compared TACE with RFAvs.TACE alone for HCC treatment.Tumor response rate,the proportion of patients with either complete or partial shrinkage of tumors,and survival rate were the major evaluation indices.Results:Meta-analysis data revealed that TACE with RFA showed significantly better tumor response rate(risk ratio(RR)=1.452,95%confidence interval(CI):1.308-1.610,P<0.001)and 1-year overall survival rate(RR=1.412,95%CI:1.249-1.596,P<0.001)than that of TACE alone treatment.Conclusion:The data of our study indicates that TACE combined with RFA in the treatment of HCC larger than 5 cm is an effective comprehensive interventional therapy.

Increased mitochondrial fission drives the reprogramming of fatty acid metabolism in hepatocellular carcinoma cells through suppression of Sirtuin 1

Background:Mitochondria are dynamic organelles that constantly change their morphology through fission and fusion processes.Recently,abnormally increased mitochondrial fission has been observed in several types of can-cer.However,the functional roles of increased mitochondrial fission in lipid metabolism reprogramming in cancer cells remain unclear.This study aimed to explore the role of increased mitochondrial fission in lipid metabolism in hepa-tocellular carcinoma(HCC)cells.Methods:Lipid metabolism was determined by evaluating the changes in the expressions of core lipid metabolic enzymes and intracellular lipid content.The rate of fatty acid oxidation was evaluated by[PH]-labelled oleic acid.The mito-chondrial morphology in HCC cells was evaluated by fluorescent staining.The expression of protein was determined by real-time PCR,imnmunohistochemistry and Western blotting.Results:Activation of mitochondrial fission significantly promoted de novo fatty acid synthesis in HCC cells through upregulating the expression of lipogenic genes fatty acid synthase(FASN),acetyl-CoA carboxylasel(ACCI),and elonga-tion of very long chain fatty acid protein 6(ELOVL6),while suppressed fatty acid oxidation by downregulating carnitine palmitoyl transferase 1A(CPTIA)and acyl-CoA oxidase 1(ACOX1).Consistently,suppressed mitochondrial fission exhibited the opposite effects.Moreover,in vitro and in vivo studies revealed that mitochondrial fission-induced lipid metabolism reprogramming significantly promoted the proliferation and metastasis of HCC cells.Mechanistically,mito-chondrial fission increased the acetylation level of sterol regulatory element-binding protein 1(SREBPI)and peroxisome proliferator-activated receptor coaC-tivator 1 alpha(PGC-1a)by suppressing nicotinamide adenine dinucleotide(NAD+)/Sirtuin 1(SIRTI)signaling.The elevated SREBP1 then upregulated the expression of FASN,ACC1 and ELOVL6 in HCC cells,while PGC-1c/PPARa sup-pressed the expression of CPTIA and ACOXL Conclusions:Increased mitochondrial fission plays a crucial role in the repro-gramming of lipid metabolism in HCC cells,which provides strong evidence for the use of this process as a drug target in the treatment of this malignancy.