• 【性类固醇增强肠肝细胞中的胰岛素受体和葡萄糖氧化。】 复制标题 收藏 收藏
    DOI:10.1016/j.cca.2008.09.011 复制DOI
    作者列表:Parthasarathy C,Renuka VN,Balasubramanian K
    BACKGROUND & AIMS: BACKGROUND:The present study was designed to assess the effect of sex steroids (testosterone and 17beta-estradiol) on insulin receptor expression, insulin binding and glucose oxidation in human liver cell line. METHODS:Non-malignant Chang liver cells were treated with different concentrations of testosterone and 17beta-estradiol dissolved in serum free medium for 24 h to identify the effective dose of both steroids for further studies. Cells with 70-80% confluency were challenged with testosterone (0.1 micromol/l), 17beta-estradiol (0.1 micromol/l) and their combination along with insulin as a positive control for 24 h. After the treatment period, insulin receptor mRNA expression, cell surface insulin binding and (14)C-glucose oxidation were assessed. RESULTS:Both testosterone and 17beta-estradiol significantly increased the insulin receptor mRNA expression, cell surface insulin binding and (14)C-glucose oxidation compared to basal, but the increase was not at par with the effect of insulin. Compared to individual effects of testosterone and 17beta-estradiol, their combination significantly increased the glucose oxidation similar to that of insulin. CONCLUSION:It is concluded from the present study that testosterone and 17beta-estradiol can directly enhance insulin receptor mRNA expression, insulin binding and glucose oxidation in Chang liver cells and thereby glucose metabolism.
    背景与目标: 背景:本研究旨在评估性类固醇(睾丸激素和17β-雌二醇)对人肝细胞系中胰岛素受体表达,胰岛素结合和葡萄糖氧化的影响。
    方法:用不同浓度的睾丸激素和17β-雌二醇溶解于无血清培养基中的非恶性昌肝细胞24 h,以鉴定两种类固醇的有效剂量,以供进一步研究。将70-80%汇合的细胞用睾丸激素(0.1 micromol / l),17beta-雌二醇(0.1 micromol / l)及其组合以及胰岛素作为阳性对照攻击24小时。治疗期后,评估胰岛素受体mRNA表达,细胞表面胰岛素结合和(14)C-葡萄糖氧化。
    结果:与基础相比,睾丸激素和17β-雌二醇均显着增加了胰岛素受体mRNA的表达,细胞表面胰岛素结合和(14)C-葡萄糖氧化,但与胰岛素的作用不相称。与睾丸激素和17β-雌二醇的个体作用相比,它们的组合显着增加了类似于胰岛素的葡萄糖氧化作用。
    结论:本研究得出的结论是,睾丸激素和17β-雌二醇可以直接增强昌肝细胞中胰岛素受体mRNA的表达,胰岛素结合和葡萄糖氧化,从而促进葡萄糖代谢。
  • 【硬膜外穿刺修补后硬膜穿刺后头痛与患者随后的慢性腰背痛相关:一项先导研究。】 复制标题 收藏 收藏
    DOI:10.1007/s11916-020-0834-5 复制DOI
    作者列表:Urits I,Cai V,Aner M,Simopoulos T,Orhurhu V,Nagda J,Viswanath O,Kaye AD,Hess PE,Gill J
    BACKGROUND & AIMS: PURPOSE OF REVIEW:Post dural puncture headache (PDPH) is a relatively common complication which may occur in the setting of inadvertent dural puncture (DP) during labor epidural analgesia and during intentional DP during spinal anesthetic placement or diagnostic lumbar puncture. Few publications have established the long-term safety of an epidural blood patch (EBP) for the treatment of a PDPH. RECENT FINDINGS:The aim of this pilot study was to examine the association of chronic low back pain (LBP) in patients who experienced a PDPH following labor analgesia and were treated with an EBP. A total of 146 patients were contacted and completed a survey questionnaire via telephone. The EBP group was found to be more likely to have chronic LBP (percentage difference 20% [95% CI 6-33%], RR 2.6 [95% CI 1.3-5.2]) and also LBP < 6 (percentage difference 24% [95% CI 9- 37%], RR 2.3 [95% CI 1.3-4.1]). There were no significant differences in the severity and descriptive qualities of pain between the EBP and non-EBP groups. Our findings suggest that PDPH treated with an EBP is associated with an increased prevalence of subsequent low back pain in parturients. The findings of this pilot study should spur further prospective research into identifying potential associations between DP, EBP, and chronic low back pain.
    背景与目标: 审查目的:硬脑膜穿刺后头痛(PDPH)是一种相对常见的并发症,可能发生在分娩硬膜外镇痛期间的无意硬脑膜穿刺(DP)的情况下,以及在麻醉药放置或诊断性腰椎穿刺期间的故意DP发生期间。很少有出版物确定硬膜外补血片(EBP)用于治疗PDPH的长期安全性。
    最近的调查结果:这项初步研究的目的是检查分娩镇痛后经历PDPH并接受EBP治疗的患者的慢性下背痛(LBP)的相关性。总共联系了146名患者,并通过电话填写了调查问卷。发现EBP组更有可能患有慢性LBP(百分比差异20%[95%CI 6-33%],RR 2.6 [95%CI 1.3-5.2])以及LBP <6(百分比差异24%[ 95%CI 9- 37%],RR 2.3 [95%CI 1.3-4.1]。在EBP组和非EBP组之间,疼痛的严重程度和描述质量没有显着差异。我们的发现表明,用EBP治疗的PDPH与产妇随后发生的下背部疼痛的患病率增加有关。这项前瞻性研究的结果将刺激进一步的前瞻性研究,以发现DP,EBP和慢性下腰痛之间的潜在关联。
  • 【脊柱前路融合治疗青少年脊柱侧弯后使用硬膜外导管控制术后疼痛。】 复制标题 收藏 收藏
    DOI:10.1097/00007632-200106010-00024 复制DOI
    作者列表:Lowry KJ,Tobias J,Kittle D,Burd T,Gaines RW
    BACKGROUND & AIMS: STUDY DESIGN:A prospective review of patients undergoing epidural catheter placement after anterior spinal fusion and instrumentation for adolescent scoliosis was performed. Data were collected using visual analog pain scores reflecting the patients' perception of their pain control. OBJECTIVES:To present the authors' technique for epidural catheter placement and dosing protocol, and to demonstrate the results from postoperative pain control after anterior spinal instrumented fusion for 10 consecutive patients. SUMMARY OF BACKGROUND DATA:The literature regarding the benefits of epidural catheters after spinal surgery is contradictory, even with controlled studies comparing epidural catheters with intravenous morphine patient-controlled anesthesia. The authors believe that this lack of consensus stems from varied epidural dosing protocols and techniques in catheter placement, which they have witnessed anecdotally at their own institution. This prompted the authors to develop and refine a standardized dosing and catheter placement protocol for pain control after spinal surgery. METHODS:Epidural catheters were placed intraoperatively before wound closure, then removed on postoperative Day 5. Dosing consisted of fentanyl (1 microg/kg) and hydromorphone (5 microg/kg) diluted in preservative-free saline (0.2 mL/kg). After surgery, dosing consisted of 0.1% ropivacaine and hydromorphone (10 microg/ml) continuously infused at 0.2 mL/kg/hour. Postoperative pain control was assessed on each postoperative day using a visual analog pain scale with choices ranging from 0 to 10. RESULTS:The arithmetic mean of the median pain scores after surgery was 2.1. The mean of the maximum pain scores for the 5 days was 4.1. Three patients required an epidural bolus and a 20% increase in the epidural infusion rate. One patient was judged to be excessively sleepy, so the epidural infusion rate was decreased by 20%. Pruritus requiring diphenhydramine developed in three patients. No other adverse effects related to epidural analgesia were noted. No catheters were accidentally pulled out or disconnected. CONCLUSION:By following the dosing protocol described, epidural catheters can be used safely and effectively to control postoperative pain after anterior instrumentation and spinal fusion for adolescent scoliosis.
    背景与目标: 研究设计:对前路脊柱融合术和青春期脊柱侧弯器械置入硬膜外导管的患者进行了前瞻性评价。使用视觉模拟疼痛评分收集数据,以反映患者对疼痛控制的感知。
    目的:介绍作者的硬膜外导管置入和给药方案技术,并演示连续10例患者经前路脊柱器械融合后术后疼痛控制的结果。
    背景资料摘要:即使有比较硬膜外导管与静脉内吗啡患者自控麻醉的对照研究,有关脊柱外科手术后硬膜外导管益处的文献也相矛盾。作者认为,缺乏共识的原因在于导管置入过程中的各种硬膜外给药方案和技术,他们在自己的机构中轶事见证了这一点。这促使作者开发和完善用于脊柱手术后疼痛控制的标准化剂量和导管放置方案。
    方法:在伤口闭合前术中放置硬膜外导管,然后在术后第5天取下。剂量由在无防腐剂盐水(0.2 mL / kg)中稀释的芬太尼(1 microg / kg)和氢吗啡酮(5 microg / kg)组成。手术后,剂量为0.1%罗哌卡因和氢吗啡酮(10微克/毫升),以0.2毫升/千克/小时的速度连续注入。在术后的每一天,使用视觉模拟疼痛量表(范围从0到10)评估术后疼痛的控制情况。
    结果:手术后中位疼痛评分的算术平均值为2.1。 5天的最大疼痛评分平均值为4.1。三名患者需要硬膜外推注,硬膜外输注率增加20%。一名患者被判定为过度困倦,因此硬膜外输注率降低了20%。三名患者出现需要苯海拉明的瘙痒症。没有发现与硬膜外镇痛有关的其他不良反应。没有意外拔出或断开导管。
    结论:按照所描述的给药方案,硬膜外导管可安全有效地控制青少年前路脊柱侧弯前路器械和脊柱融合术后的术后疼痛。
  • 【椎旁和鞘内与胸腔硬膜外联合镇痛用于开胸术后的疼痛缓解。】 复制标题 收藏 收藏
    DOI:10.1093/bja/aes394 复制DOI
    作者列表:Dango S,Harris S,Offner K,Hennings E,Priebe HJ,Buerkle H,Passlick B,Loop T
    BACKGROUND & AIMS: BACKGROUND:Although thoracic epidural analgesia (TEA) is considered the gold standard for post-thoracotomy pain relief, thoracic paravertebral block (PVB) and intrathecal opioid (ITO) administration have also been shown to be efficacious. We hypothesized that the combination of PVB and ITO provides analgesia comparable with that of TEA. METHODS:After local ethics committee approval, 84 consecutive patients undergoing open thoracic procedures were randomized to the TEA (ropivacaine 0.2%+sufentanil) or the PVB (ropivacaine 0.5%)+ITO (sufentanil+morphine) group. The primary endpoints were pain intensities at rest and during coughing/movement at 1, 2, 4, 8, 12, 24, 48, and 72 h after operation assessed by visual analogue scale (VAS) score. Data were analysed by multivariate analysis (anova; P<0.05). RESULTS:Patient and surgical characteristics were comparable between the groups. The mean and maximal VAS scores were lower in the TEA (n=43) than in the PVB+ITO group (n=37) at several time points at rest (P<0.026) and during coughing/movement (P<0.021). However, in the PVB+ITO group, the mean VAS scores never exceeded 1.9 and 3.5 at rest and during coughing/movement, respectively; and the maximal differences between the groups (TEA vs PVB+ITO) in the maximal VAS scores were only 1.2 (3.4 vs 4.6) at rest, and 1.3 (4.4 vs 5.7) during coughing/movement. CONCLUSIONS:Although VAS scores were statistically lower in the TEA compared with the PVB+ITO group at some observation points, the differences were small and of questionable clinical relevance. Thus, combined PVB and ITO can be considered a satisfactory alternative to TEA for post-thoracotomy pain relief. ClinicalTrials.gov number. NCT00493909.
    背景与目标: 背景:尽管胸膜硬膜外镇痛(TEA)被认为是开胸术后疼痛缓解的金标准,但是胸椎旁椎体阻滞(PVB)和鞘内阿片类药物(ITO)的给药也已被证明是有效的。我们假设PVB和ITO的组合可提供与TEA相当的镇痛效果。
    方法:经当地伦理委员会批准,将84例接受开胸手术的患者随机分为TEA(罗哌卡因0.2%舒芬太尼)或PVB(罗哌卡因0.5%)ITO(舒芬太尼吗啡)组。主要目的是通过视觉模拟量表(VAS)评分评估术后1、2、4、8、12、24、48和72小时休息和咳嗽/运动过程中的疼痛强度。通过多变量分析对数据进行分析(方差分析; P <0.05)。
    结果:两组患者的病情和手术特点均具有可比性。在休息(P <0.026)和咳嗽/运动(P <0.021)的几个时间点,TEA(n = 43)的平均和最大VAS评分低于PVB ITO组(n = 37)。然而,在PVB ITO组中,静息时和咳嗽/运动时,VAS的平均得分分别从未超过1.9和3.5。两组之间(TEA与PVB ITO)的最大VAS评分差异在静止时仅为1.2(3.4 vs 4.6),在咳嗽/运动时仅为1.3(4.4 vs 5.7)。
    结论:尽管在某些观察点上,TEA的VAS评分在统计学上低于PVB ITO组,但差异很小且临床相关性值得怀疑。因此,开胸手术后疼痛缓解时,PVB和ITO的组合可被视为TEA的令人满意的替代品。 ClinicalTrials.gov号。 NCT00493909。
  • 【腰椎屈曲对硬膜外阻滞程度的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.rapm.2007.04.010 复制DOI
    作者列表:Kim JT,Lee JH,Yoon SZ,Lim YJ,Bahk JH,Kim CS,Jeon Y
    BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:This study examined the effect of lumbar flexion on the extent of the epidural block during lumbar epidural anesthesia. METHODS:The epidural catheter was introduced at the L3-4 interspace with the patient in the lateral decubitus position with the surgical side down. After administering a test drug (3 mL of 2% lidocaine and 15 mug of epinephrine), the patients were randomly allocated to 1 of 2 groups: Group F (n = 16, lumbar spine flexed) and Group N (n = 17, lumbar spine in the neutral position). In both groups, 2% lidocaine (16 mL) mixed with sodium bicarbonate (2 mL) was administered through the epidural catheter while the patient maintained the lateral decubitus position with the lumbar spine either flexed or in the neutral position. All the patients maintained their respective positions for 5 minutes and were subsequently turned to the supine position. The pinprick block level and the degree of motor blockade were assessed every 10 minutes for 60 minutes after administering the local anesthetics. A 2-dermatomal difference in uppermost block between groups was determined to be clinically significant. RESULTS:The median difference between groups in the uppermost pinprick block level was only 1.5 dermatomes and it did not satisfy our criteria for clinical significance. There were no significant differences between the 2 groups in the lowermost pinprick block level and the degree of motor block. CONCLUSIONS:Lumbar flexion has no clinically relevant effect on sensory spread during epidural anesthesia.
    背景与目标: 背景与目的:本研究探讨了腰部硬膜外麻醉期间腰椎屈曲对硬膜外阻滞程度的影响。
    方法:将硬膜外导管插入L3-4间隙,患者置于侧卧位,手术侧朝下。服用试验药物(3 mL 2%利多卡因和15杯肾上腺素)后,将患者随机分为2组中的1组:F组(n = 16,腰椎屈曲)和N组(n = 17,腰椎)脊柱在中立位置)。在两组中,通过硬膜外导管给予2%利多卡因(16 mL)和碳酸氢钠(2 mL)混合,同时患者保持侧卧位,腰椎弯曲或处于中立位置。所有患者保持各自姿势5分钟,随后转为仰卧姿势。局部麻醉后60分钟,每10分钟评估一次针刺阻滞水平和运动阻滞程度。两组之间最上层阻滞的2层皮肤差异被确定为具有临床意义。
    结果:最高针刺阻滞水平组之间的中位数差异仅为1.5皮肤切开,不符合我们的临床意义标准。最低的针刺阻滞水平和运动阻滞程度在两组之间没有显着差异。
    结论:腰椎屈曲对硬膜外麻醉过程中的感觉扩散没有临床相关影响。
  • 【在1孔经椎间孔硬膜外注射类固醇激素注射中,Quincke针和Whitacre针在血管内摄取风险方面的比较:随机试验1376例。】 复制标题 收藏 收藏
    DOI:10.1213/ANE.0b013e3182a6d1bd 复制DOI
    作者列表:Shin J,Kim YC,Lee SC,Kim JH
    BACKGROUND & AIMS: BACKGROUND:Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. METHODS:This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated. RESULTS:There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection. CONCLUSIONS:To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.
    背景与目标: 背景:经椎间孔硬膜外注射类固醇激素(TFESI)是一种有效的疼痛治疗方法。 TFESI的大多数并发症是次要的和短暂的。但是,存在严重并发症的风险,例如神经损伤,脊髓梗塞或截瘫。一些风险与直接伤害血管或类固醇的血管内注射有关。我们前瞻性地检验了在TFESI期间Whitacre针的血管内注射速率低于Quincke针的血管内注射速率的假设。
    方法:这项研究是在S1级进行的1376个TFESI的随机试验。我们收集了年龄,性别,身高,体重,侧卧(左右),腰s部脊柱手术史,适当停用抗凝药物的间隔史以及潜在疾病的数据。在S1 TFESI期间,研究了contrast骨内接触,血液抽吸试验和使用造影剂对血管内注射进行实时荧光检查。
    结果:在年龄,性别,身高,体重,高血压,糖尿病,侧卧,腰s部脊柱手术史或适当停用抗凝药物的历史方面,血管内注射率无显着差异。血管内注射与抽血试验(P <0.001),针尖类型(P = 0.002),s骨内接触(P <0.001)和医师(P <0.05)显着相关。使用Quincke针和s骨内接触可增加血管内注射的速度。
    结论:为减少血管内注射的风险,使用不带intra骨内接触的Whitacre针可能是一种更安全,更有效的方法。
  • 【从头开始恶性视神经胶质瘤,最初对类固醇有临床反应。】 复制标题 收藏 收藏
    DOI:10.3109/01658107.2012.658594 复制DOI
    作者列表:Kang JJ,Hou JH,Bui KM,Michals E,Valyi-Nagy T,Koshy M,Munson T,Charbel FT,Villano JL,Moss HE
    BACKGROUND & AIMS: :Malignant optic nerve glioma (MONG) is a rare but uniformly fatal disease that remains poorly understood. We describe a notable case of this rare disease occurring in the optic chiasm. Normal brain imaging and normal ophthalmic examination two years prior to diagnosis provide evidence for de novo genesis of MONG in our patient. Early response to steroids highlights the degree to which MONG can initially mimic inflammatory optic neuropathies and chiasmal syndromes. Our case also demonstrates a poor outcome with MONG even with current advanced therapy for glioblastoma including radiotherapy plus concomitant and adjuvant temozolomide (the EORTC/NCIC regimen) and bevacizumab.
    背景与目标: :恶性视神经胶质瘤(MONG)是一种罕见的但致命的疾病,至今知之甚少。我们描述了这种罕见疾病在视神经交叉症中发生的显着情况。诊断前两年的正常大脑成像和正常眼科检查为我们的患者重新发生MONG提供了证据。对类固醇的早期反应突显了MONG最初可模拟炎症性视神经病变和chiasmal综合征的程度。我们的病例还证明,即使采用目前针对胶质母细胞瘤的先进疗法(包括放疗,伴随和辅助的替莫唑胺(EORTC / NCIC方案)和贝伐单抗),MONG的预后也很差。
  • 【性别改变角色的鱼中的性腺类固醇会影响LHRH的视前细胞数。】 复制标题 收藏 收藏
    DOI:10.1002/neu.480220708 复制DOI
    作者列表:Grober MS,Jackson IM,Bass AH
    BACKGROUND & AIMS: :In diandric sex-reversing fishes, sexually active males and females (primary phase) regularly transform into an alternative reproductive morph, terminal-phase males, that are morphologically and behaviorally distinct. The transformation from primary to terminal phase is associated with a twofold increase in the number of luteinizing hormone-releasing hormone (LHRH) immunopositive cells in the forebrain preoptic area, a region involved in both the initial development and daily control of reproductive physiology and behavior. We now show that implants of 11-ketotestosterone induce increases in LHRH cell number in both primary phase sexes to the level observed in field-collected terminal phase males. Conversely, gonadal steroids had no effect on the number of LHRH preoptic cells in terminal phase males, suggesting that this is indeed a terminal stage in the development of this species. These results demonstrate that transition to the terminal phase by both sexes involves a parallel and convergent change in LHRH cell number, which utilizes an evolutionarily conserved mechanism of sexual differentiation: the inductive effects of gonadal steroid hormones.
    背景与目标: :在二向性逆转鱼中,有性活跃的雄性和雌性(初生阶段)通常会转变成另一种生殖形态,终末期的雄性,在形态和行为上都不同。从初级到终末期的转变与前脑视前区中促黄体生成素释放激素(LHRH)免疫阳性细胞数量的两倍增加有关,该区域参与生殖生理和行为的初步发展以及日常控制。我们现在显示,在两个主要阶段的性别中,植入11-酮睾酮的LHRH细胞数均增加至在实地收集的末期阶段的男性中观察到的水平。相反,性腺类固醇对终末期雄性LHRH前视细胞的数量没有影响,这表明这确实是该物种发育的最后阶段。这些结果表明,两性过渡到末期涉及LHRH细胞数量的平行和会聚变化,这利用了进化上保守的性别分化机制:性腺甾体激素的诱导作用。
  • 【热QST表型与腰椎硬膜外类固醇注射反应相关:一项初步研究。】 复制标题 收藏 收藏
    DOI:10.1093/pm/pnw364 复制DOI
    作者列表:Maher DP,Ding W,Singh S,Opalacz A,Fishman C,Houghton M,Ahmed S,Chen L,Mao J,Zhang Y
    BACKGROUND & AIMS: Objective:Response to lumbar epidural steroid injection in lumbar radicular pain varies. The purpose of this study is to characterize the changes in quantitative sensory testing (QST) phenotypes of subjects and compare the QST characteristics in patients who do respond to treatment of radicular pain with a lumbar epidural steroid injection (ESI). Design:Prospective, observational pilot study. Setting:Outpatient pain center. Methods:Twenty subjects with a lower extremity (LE) radicular pain who were scheduled to have an ESI were recruited. At the visit prior to and four weeks following an ESI, subjects underwent QST measurements of both the affected LE and the contralateral unaffected UE. Results:Following an ESI, nine subjects reported a greater than 30% reduction in radicular pain and 11 reported a less than 30% reduction in radicular pain. Subjects who had less than 30% pain reduction response (nonresponders) to an ESI had increased pre-injection warm sensation threshold (37.30 °C, SD = 2.51 vs 40.39, SD = 3.36, P = 0.03) and heat pain threshold (47.22 °C, SD = 1.38, vs 48.83 °C, SD = 2.10, P = 0.04). Further, the nonresponders also showed increased pre-injection warm sensation threshold as measured in the difference of warm sensation detection threshold difference in the affected limb and the unaffected arm (2.68 °C, SD = 2.92 vs 5.67 °C, SD = 3.22, P  = 0.045). Other QST parameters were not affected. Conclusions:The results show that the nonresponders to ESIs have increased detection threshold to heat pain and warm sensation, suggesting that a preexisting dysfunction in the C fibers in this group of subjects who can be detected by QST. Such altered QST characteristics may prognosticate the response to ESIs.
    背景与目标: 目的:腰椎硬膜外注射类固醇激素对腰部神经根痛的反应各不相同。这项研究的目的是表征受试者的定量感觉测试(QST)表型的变化,并比较对腰椎硬膜外类固醇注射(ESI)对神经痛进行治疗有反应的患者的QST特征。
    设计:前瞻性观察性初步研究。
    地点:门诊疼痛中心。
    方法:招募了二十名计划进行ESI的下肢(LE)根神经痛的受试者。在ESI之前和之后的四个星期,对受试者进行了QST测量,对受影响的LE和对侧未受影响的UE进行了QST测量。
    结果:在进行ESI评估后,有9名受试者的放射痛减轻了30%以上,而11名的放射痛减轻了30%以下。对ESI的疼痛缓解反应少于30%(无反应)的受试者注射前的热感觉阈值(37.30°C,SD = 2.51 vs 40.39,SD = 3.36,P = 0.03)和热痛阈值升高(47.22°°) C,SD = 1.38,而48.83℃,SD = 2.10,P = 0.04。此外,无反应者还表现出增加的注射前温暖感觉阈值,这是通过患肢和未患肢的温暖感觉检测阈值差异的差异来衡量的(2.68°C,SD == 2.92 vs 5.67°C,SD == 3.22,P = 0.045)。其他QST参数不受影响。
    结论:结果表明,对ESI无反应的患者对热痛和热感觉的检测阈值增加,这表明可以通过QST检测到的该组受试者的C纤维中已存在功能障碍。这样改变的QST特性可以预示对ESI的响应。
  • 【性类固醇对肺泡上皮钠转运的性别特异性影响。】 复制标题 收藏 收藏
    DOI:10.1152/ajplung.00275.2016 复制DOI
    作者列表:Haase M,Laube M,Thome UH
    BACKGROUND & AIMS: :Alveolar fluid clearance mediates perinatal lung transition to air breathing in newborn infants, which is accomplished by epithelial Na+ channels (ENaC) and Na-K-ATPase. Male sex represents a major risk factor for developing respiratory distress, especially in preterm infants. We previously showed that male sex is associated with reduced epithelial Na+ transport, possibly contributing to the sexual dimorphism in newborn respiratory distress. This study aimed to determine sex-specific effects of sex steroids on epithelial Na+ transport. The effects of testosterone, 5α-dihydrotestosterone (DHT), estradiol, and progesterone on Na+ transport and Na+ channel expression were determined in fetal distal lung epithelial (FDLE) cells of male and female rat fetuses by Ussing chamber and mRNA expression analyses. DHT showed a minor effect only in male FDLE cells by decreasing epithelial Na+ transport. However, flutamide, an androgen receptor antagonist, did not abolish the gender imbalance, and testosterone lacked any effect on Na+ transport in male and female FDLE cells. In contrast, estradiol and progesterone increased Na+ transport and Na+ channel expression especially in females, and prevented the inhibiting effect of DHT in males. Estrogen receptor inhibition decreased Na+ channel expression and eliminated the sex differences. In conclusion, female sex steroids stimulate Na+ transport especially in females and prevent the inhibitory effect of DHT in males. The ineffectiveness of testosterone suggests that Na+ transport is largely unaffected by androgens. Thus, the higher responsiveness of female cells to female sex steroids explains the higher Na+ transport activity, possibly leading to a functional advantage in females.
    背景与目标: :肺泡液清除介导新生婴儿从围产期肺过渡到呼吸,这是通过上皮Na通道(ENaC)和Na-K-ATPase来实现的。男性是造成呼吸窘迫的主要危险因素,尤其是在早产儿。我们以前表明,男性与上皮Na转运减少有关,可能导致新生儿呼吸窘迫中的性二态性。这项研究旨在确定性类固醇对上皮Na转运的性别特异性作用。通过Ussing chamber和mRNA表达分析确定了雄性和雌性大鼠胎儿的胎儿远端肺上皮(FDLE)细胞中睾丸激素,5α-二氢睾丸激素(DHT),雌二醇和孕酮对Na转运和Na通道表达的影响。 DHT仅通过减少上皮Na转运在雄性FDLE细胞中显示出较小的作用。但是,氟他胺是一种雄激素受体拮抗剂,并没有消除性别不平衡,睾丸激素对男女FDLE细胞中的钠转运没有影响。相反,雌二醇和孕酮增加了Na转运和Na通道表达,尤其是在女性中,并且阻止了DHT对男性的抑制作用。抑制雌激素受体可降低Na通道表达并消除性别差异。总之,女性性类固醇刺激钠运输,尤其是在女性中,并阻止DHT在男性中的抑制作用。睾丸激素的无效性表明,Na转运在很大程度上不受雄激素的影响。因此,女性细胞对女性性类固醇的较高反应性说明了较高的Na转运活性,可能导致女性的功能优势。
  • 【使用硬膜外空间检测装置(EPI-DetectionTM)进行层间颈硬膜外注射的可行性。】 复制标题 收藏 收藏
    DOI:10.3390/jcm9082355 复制DOI
    作者列表:Kang J,Park SS,Kim CH,Kim EC,Kim HC,Jeon H,Kim KH,Shin DA
    BACKGROUND & AIMS: :Cervical epidural injection (CEI), which is widely used for the treatment of cervical radiculopathy, sometimes has been associated with post-operative complications. Recently, EPI-DetectionTM, which detects the negative pressure of the epidural space and notifies the proceduralist by flashing a light and producing a beeping sound, was introduced. We assumed that the newly developed device could be as safe and efficient as the conventional loss of resistance (LOR) method. Therefore, we aimed to evaluate the effectiveness of the EPI-DetectionTM and compare it to that of the conventional LOR method. We randomly assigned 57 patients to the LOR and EPI-Detection groups (29 and 28 patients, respectively). Subjects were treated with interlaminar CEI (ILCEI) using one of two methods. The measured parameters, i.e., operation time and radiation dose were lower in the EPI-DetectionTM group (4.6 ± 1.2 min vs. 6.9 ± 2.1 min; and 223.2 ± 206.7 mGy·cm2 vs. 380.3 ± 340.9 mGy·cm2, respectively; all p < 0.05) than in the LOR group. There were no complications noted in either group. Both the EPI-DetectionTM and LOR methods were safe and effective in detecting the epidural space, but the former was superior to the latter in terms of operation time and radiation exposure. The EPI-DetectionTM may help perform ILCEI safely.
    背景与目标: :硬膜外硬膜外注射(CEI),广泛用于治疗颈椎神经根病,有时与术后并发症相关。最近,引入了EPI-DetectionTM,该技术可检测硬膜外腔的负压并通过闪烁灯光并发出蜂鸣声来通知程序师。我们假设新开发的设备可以像传统的电阻损失(LOR)方法一样安全有效。因此,我们旨在评估EPI-DetectionTM的有效性,并将其与常规LOR方法的有效性进行比较。我们将57例患者随机分配至LOR和EPI检测组(分别为29例和28例)。使用两种方法之一对受试者进行层间CEI(ILCEI)治疗。 EPI-DetectionTM组的测量参数(即手术时间和放射剂量)较低(分别为4.6±1.2分钟和6.9±2.1分钟; 223.2±206.7 mGy·cm2和380.3±340.9 mGy·cm2;所有p <0.05)。两组均未发现并发症。 EPI-DetectionTM和LOR方法在检测硬膜外间隙方面都是安全有效的,但前者在手术时间和放射线照射方面要优于后者。 EPI-DetectionTM可以帮助安全地执行ILCEI。
  • 【中枢神经系统浅表铁皮病与腹侧胸膜硬膜外腔的脊柱内出血和腹侧脊髓CSF泄漏相关:病例报告。】 复制标题 收藏 收藏
    DOI:10.3171/2016.11.SPINE16488 复制DOI
    作者列表:Takai K,Komori T,Niimura M,Taniguchi M
    BACKGROUND & AIMS: :In most patients with superficial siderosis of the CNS, the exact source of bleeding remains unknown because of a lack of objective surgical data. The authors herein describe the case of a 58-year-old man with superficial siderosis of the CNS. The patient also had spinal CSF leakage due to a spinal dural defect. Repair surgery for the dural defect was performed using posterior laminoplasty with a transdural approach without spinal fixation. During repair surgery, the bleeding source was found to be the epidural vein around the defect. The intraoperative and histological results of the present case suggest that epidural veins exposed to CSF represent a chronic bleeding source in patients with superficial siderosis of the CNS complicated by CSF leakage. Dural repair surgery may result in discontinuation of the CSF leaks, resolution of the epidural CSF collection, and cessation of chronic epidural bleeding.
    背景与目标: :由于缺乏客观的手术数据,在大多数中枢神经系统浅表铁屑病患者中,确切的出血来源仍然未知。本文作者描述了一个58岁的中枢神经系统表皮异位症的病例。由于脊柱硬膜缺损,患者也有脊柱CSF漏出。使用后路椎板成形术和硬膜外方法经硬膜外固定术修复硬脑膜缺损。在修复手术期间,发现出血源是缺损周围的硬膜外静脉。本例的术中和组织学结果表明,暴露于CSF的硬膜外静脉代表了CNS浅表铁定病并发CSF渗漏的患者的慢性出血源。硬膜外修补手术可能会导致CSF泄漏中断,硬膜外CSF收集消退以及停止慢性硬膜外出血。
  • 【接受类固醇,免疫抑制剂和IFN-γ1b治疗的特发性肺纤维化患者的细胞因子调节。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Marinari S,De Iuliis V,Dadorante V,Colella S,Marino A,Nunziata A,Flati V,Caruso M,Pennelli A,De Benedetto F,Matera S,Capodifoglio S,Martinotti S,Caputi S,Toniato E
    BACKGROUND & AIMS: :Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease of unknown etiology and pathogenic mechanisms. From an etiopathogenic point of view, alveolar macrophages play a key role in accumulation of fibroblasts and deposition of collagen and extracellular matrix by releasing specific cytokines and inflammatory mediators. IPF seems to be also associated with circulating fibrocytes, which might be involved with an abnormal pulmonary vascular repair and remodeling. Based on its hypothesized pathologic mechanisms, anti-inflammatory, anti-fibrotic and immunosuppressive therapies are often used. For these reasons, Interferon-g (IFN-g) has been used to exploit its activity on macrophages and fibroblasts. The aim of this study was to investigate the response to corticosteroids and/or IFN-g 1b treatments based on pulmonary function tests and on inflammatory cytokine patterns of expression on bronchoalveolar lavage (BAL), at baseline and during and after the therapies. Unlike previous studies, we analyzed a period of therapy longer than 1 year. Our results demonstrated the effectiveness of IFN-γ in a group of IPF patients in whom the treatment was prolonged for over a year. These data suggest a positive role of IFN-γ; treatment in patients in the initial stage of the disease.
    背景与目标: :特发性肺纤维化(IPF)是一种病因和致病机理未知的慢性肺部疾病。从致病性的观点来看,肺泡巨噬细胞通过释放特定的细胞因子和炎性介质,在成纤维细胞的积累以及胶原蛋白和细胞外基质的沉积中起关键作用。 IPF似乎也与循环纤维细胞有关,可能与异常的肺血管修复和重塑有关。基于其假设的病理机制,通常使用抗炎,抗纤维化和免疫抑制疗法。由于这些原因,干扰素-g(IFN-g)已被用来开发其对巨噬细胞和成纤维细胞的活性。这项研究的目的是基于基线,治疗期间和治疗后,根据肺功能测试和支气管肺泡灌洗(BAL)的炎症性细胞因子表达模式,研究对皮质类固醇和/或IFN-g 1b治疗的反应。与以前的研究不同,我们分析了治疗时间超过1年的情况。我们的结果证明了IFN-γ在一组IPF患者中的有效性,这些患者的治疗时间延长了一年以上。这些数据表明IFN-γ具有积极作用。疾病初期患者的治疗。
  • 14 [Epidural anesthesia]. 复制标题 收藏 收藏

    【[硬膜外麻醉]。】 复制标题 收藏 收藏
    DOI:10.1007/s00101-007-1181-1 复制DOI
    作者列表:Gerheuser F,Roth A
    BACKGROUND & AIMS: :In epidural anaesthesia, the anaesthetist injects one or more drugs into the epidural space bordering on the spinal dura mater to achieve a "central" and/or "neuraxial" block. It is one of the earliest techniques in anaesthesia, originally performed exclusively with local anaesthetic agents. Adding other drugs and combining epidural with general anaesthesia or adapting the technique to the needs of children has extended the list of indications. Continuous epidural analgesia is an important tool in postoperative pain management. More and more often, the increasing proportion of patients who have comorbidities or are permanently taking medication that modulates the clotting system demands that the anaesthesiologist balance the individual risks and benefits before inducing epidural anaesthesia.
    背景与目标: :在硬膜外麻醉中,麻醉师将一种或多种药物注入硬脊膜硬膜外腔,以达到“中央”和/或“神经轴”阻滞。它是麻醉中最早的技术之一,最初仅由局部麻醉剂执行。添加其他药物以及将硬膜外麻醉与全身麻醉相结合或使该技术适应儿童的需求已扩大了适应症的范围。连续硬膜外镇痛是术后疼痛管理的重要工具。合并症或永久性服用可调节凝血系统的药物的患者越来越多,这要求麻醉师在进行硬膜外麻醉之前平衡个体风险和获益。
  • 【儿科人群大的创伤性硬膜外硬膜外血肿的保守治疗。】 复制标题 收藏 收藏
    DOI:10.1159/000455925 复制DOI
    作者列表:Champagne PO,He KX,Mercier C,Weil AG,Crevier L
    BACKGROUND & AIMS: BACKGROUND/AIMS:Conservative management of traumatic epidural hematomas is being recognized as a safe alternative to surgical treatment in asymptomatic children. There is still debate about the maximal size of epidural hematoma that should be tolerated before deciding for surgery. METHODS:We report - through a retrospective cohort study from a single institution - a series of 16 conservatively managed traumatic epidural hematomas of more than 15 mm thickness. RESULTS:14 patients (88%) were successfully treated using conservative management. Two patients required surgery. These 2 patients had the only 2 documented high-velocity injury mechanisms. All patients had a Glasgow Outcome Scale of 5/5 on follow-up. CONCLUSION:Conservative management with close observation is a safe alternative even in this population of voluminous hematomas. Injury velocity may be a contributing factor for failure of conservative management in this population.
    背景与目标: 背景/目的:在无症状儿童中,保守治疗创伤性硬膜外血肿是一种安全的替代手术治疗方法。关于硬膜外血肿在决定手术前应耐受的最大尺寸仍存在争议。
    方法:我们通过一项来自单个机构的回顾性队列研究报告了一系列16例厚度超过15毫米的保守管理的硬膜外硬膜外血肿。
    结果:保守治疗成功治愈14例(88%)。两名患者需要手术。这2例患者仅有2例记录了高速损伤机制。随访时所有患者的格拉斯哥结局量表均为5/5。
    结论:即使在这种大量血肿的人群中,进行密切观察的保守治疗也是一种安全的选择。伤害速度可能是导致该人群保守治疗失败的一个因素。

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