Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppressi...Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppression is the most common adverse effect following IP administration.Despite this trend,the specific risk factors contributing to IP-related myelosuppression remain unclear.Methods:This study conducted a retrospective analysis of lung adenocarcinoma(LUAD)patients with LM who received IP treatment at the Second Affiliated Hospital of Nanchang University from April 2017 to April 2024.Risk factors for myelosuppression were identified through univariate and multivariate logistic regression analyses.Non-linear relationships and determined the inflection points were subsequently determined using smooth curve fitting and threshold effect analysis.Results:A total of 95 patients were identified,among whom 64(68.42%)experienced myelosuppression,with 43(45.26%)cases classified as severe myelosuppression.Leukopenia emerged as the most prevalent form of myelosuppression.Age was established as an independent risk factor for both myelosuppression and its severe form.A nonlinear relationship between age and severe myelosuppression was observed.The risk of developing severe myelosuppression increased significantly with age,beyond the turning point of 58 years old(OR 1.28,95%CI 1.08–1.52;p 0.0042).Conclusions:Advanced age is=associated with the occurrence of myelosuppression and severe myelosuppression.The probability of developing severe myelosuppression increases significantly in individuals aged 58 years or older.展开更多
Objective: Postoperative pain (POP) following abdominal surgery can vary from a few hours to several days. This acute, unrelieved pain can become chronic, requiring patients to take analgesics on an almost daily basis...Objective: Postoperative pain (POP) following abdominal surgery can vary from a few hours to several days. This acute, unrelieved pain can become chronic, requiring patients to take analgesics on an almost daily basis for comfort. Analgesia using general opioids has many side effects and intrathecal morphine is a good alternative. This study was conducted to evaluate the efficacy of intrathecal morphine (ITM) versus conventional analgesia in the management of postoperative pain in colectomy performed by laparoscopic surgery. Methods: Cohort study conducted at the Hôpital Nord in Marseille, from 01 January to 31 July 2021 in patients aged at least 18 years undergoing anaesthesia for scheduled colectomy by laparoscopic surgery. The primary endpoint was postoperative pain intensity and the secondary endpoints were morphine consumption, treatment side effects and length of hospital stay. Statistical analysis was performed using XLSTAT software. Results: We included 193 patients: 131 in the control group (conventional analgesia) and 62 in the ITM group. We observed: a significant decrease in pain (assessed by numerical scale) in favour of the ITM group in the post-anaesthetic care room, i.e. 3 (±4) vs 1 (±2), p 0 and H2: 2 (±2) vs. 1 (±2);p Conclusion: These results suggest that intrathecal morphine (ITM) in laparoscopic colectomy provides effective postoperative analgesia with low morphine consumption, and a reduction in morphine side-effects compared with conventional analgesia.展开更多
Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erec...Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erector spinae plane block (ESP) in outpatient abdominal wall surgery. Methodology: Thirty-six patients were randomized into two groups. The ESP group (n = 23) benefited from the ESP block with bupivacaine 5% (20 ml) followed by spinal anesthesia with bupivacaine (7.5 mg) and sufenta (2.5 µg). The Ram group (n = 13) benefited from spinal anesthesia with bupivacaine (7.5 mg), sufenta (2.5 µg) and morphine (100 µg). The primary endpoint was whether or not to return home on the day of surgery. The secondary endpoint was the pain score by the visual analog scale (VAS) in the post-intervention monitoring room (SSPI). After 2 hours (H2) and one day (D1) after surgery, the morphine consumption in the immediate postoperative period (mg) and the undesirable effects. Results: Inguinal hernia surgery predominated (n = 30). No difference in age (45.05 vs 50.7;p = 0.4), ASA score (1.43 vs 1.53;p = 0.57). All patients (n = 36) returned home on the day of surgery. No difference in postoperative pain in SSPI (p = 0.6), 2 hours after surgery (p = 0.40) and the day after surgery (p = 0.6). Postoperative morphine consumption was identical (0.9 mg vs 0.2 mg, p = 0.2). There were 2 urinary retentions in the Ram group. Conclusion: The erector spinae plane block and intrathecal morphine are well tolerated and perfectly compatible with the requirements of outpatient abdominal wall surgery.展开更多
Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inad...Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inadequacies which have stimulated the search for an alternative technique which can be effective, such as microdose intrathecal spinal analgesia that can be recommended in limited resources environment. Aim: This work aims to contribute to the improvement of anesthetic techniques for incomplete abortion by MVA. Methodology: We conducted a prospective comparative study, type single blind non-inferiority randomized trial with an analytical aim. The study counted 2 parts: 1) Descriptive observational component (KET): Ketamine narcosis. 2) Experimental component, single-blind non-inferiority randomized clinical trial (RAS) microdose intrathecal spinal analgesia. Three hundred and twenty expected cases per randomized arms. Excel Software 2022, SPSS, Open Epi, and XL-SAT were used for data encoding and analysis. Results: A total of 322 cases were retained and analyzed: 1) 161 cases per randomized arm, the majority age group was between 18 - 50 years in the 2 groups and there was no correlation between the two. Protocols with the sociodemographic characteristics studied, ASA class, type of intervention, history of MVA, variation in heart rate, temperature, appearance of hypotension, cost of the anesthetic procedure and admission to intensive care. 2) Effectiveness of the RAS protocol: Judged easier by anesthetists at 99.38% compared to 93.79% for KET with significant difference (p = 0.0104), allows them to be more mobile during the procedure at 98.76 % against 68.32% with significant difference (p < 0.0001) and the overall assessment was in favor of the RAS protocol at a rate of 32.92% against 5.58% for the anesthetists, 90.68% for the patients and 100% for gynecologists who find it excellent compared to the KET protocol with significant difference (p < 0.0001). 3) Weaknesses of the KET protocol: unconsciousness in all patients during the procedure and provides more tachypnea (17.39%) compared to the RAS protocol with difference p = 0.0008, moderate hemorrhages (55.28%), severe (9.94%) with p = 0.0006, higher material cost with p = 0.0018, occurrence of vomiting (10.56%), delay in waking up (22.36%), post-MVA pain (21.74%), and a slight change in the modified Aldrete score at the 30th min post-MVA (70.19%) compared to RAS (81.61%) p = 0.0002. 4) No patient died during the study period in both protocols. Conclusion: Intrathecal spinal analgesia microdosed with bupivacaine 0.1% and Fentanyl 50 µg/cc according to the process used in this study, has proven its effectiveness compared to Ketamine narcosis, currently recommended and not different in terms of effectiveness from other anesthetic techniques recommended for MVA indicated for incomplete abortion and can therefore be recommended as the anesthetic practice of choice in this area in a resource-limited setting.展开更多
Human umbilical cord mesenchymal stem cells(hUC-MSCs)are a promising candidate for spinal cord injury(SCI)repair owing to their advantages of low immunogenicity and easy accessibility over other MSC sources.However,mo...Human umbilical cord mesenchymal stem cells(hUC-MSCs)are a promising candidate for spinal cord injury(SCI)repair owing to their advantages of low immunogenicity and easy accessibility over other MSC sources.However,modest clinical efficacy hampered the progression of these cells to clinical translation.This discrepancy may be due to many variables,such as cell source,timing of implantation,route of administration,and relevant efficacious cell dose,which are critical factors that affect the efficacy of treatment of patients with SCI.Previously,we have evaluated the safety and efficacy of 4×10^(6) hUC-MSCs/kg in the treatment of subacute SCI by intrathecal implantation in rat models.To search for a more accurate dose range for clinical translation,we compared the effects of three different doses of hUC-MSCs-low(0.25×10^(6) cells/kg),medium(1×10^(6) cells/kg)and high(4×10^(6) cells/kg)-on subacute SCI repair through an elaborate combination of behavioral analyses,anatomical analyses,magnetic resonance imaging-diffusion tensor imaging(MRI-DTI),biotinylated dextran amine(BDA)tracing,electrophysiology,and quantification of mRNA levels of ion channels and neurotransmitter receptors.Our study demonstrated that the medium dose,but not the low dose,is as efficient as the high dose in producing the desired therapeutic outcomes.Furthermore,partial restoration of theγ-aminobutyric acid type A(GABAA)receptor expression by the effective doses indicates that GABAA receptors are possible candidates for therapeutic targeting of dormant relay pathways in injured spinal cord.Overall,this study revealed that intrathecal implantation of 1×10^(6) hUC-MSCs/kg is an alternative approach for treating subacute SCI.展开更多
Previous studies have confirmed the relationship between iron-dependent ferroptosis and a peripheral nerve injury-induced neuropathic pain model.However,the role of fe rroptosis in inflammatory pain remains inconclusi...Previous studies have confirmed the relationship between iron-dependent ferroptosis and a peripheral nerve injury-induced neuropathic pain model.However,the role of fe rroptosis in inflammatory pain remains inconclusive.Therefore,we aimed to explore whether ferroptosis in the spinal cord and do rsal root ganglion contributes to complete Freund's adjuvant(CFA)-induced painful behaviors in rats.Our results revealed that various biochemical and morphological changes were associated with ferroptosis in the spinal cord and dorsal root ganglion tissues of CFA rats.These changes included iron overload,enhanced lipid peroxidation,disorders of anti-acyl-coenzyme A synthetase long-chain family member 4 and glutathione peroxidase 4 levels,and abnormal morphological changes in mitochondria.Intrathecal treatment of liproxstatin-1(a ferroptosis inhibitor)reve rsed these ferroptosis-related changes and alleviated mechanical and thermal hype rsensitivities in CFA rats.Our study demonstrated the occurrence of fe rroptosis in the spinal cord and do rsal root ganglion tissues in a rodent model of inflammatory pain and indicated that intrathecal administration of fe rroptosis inhibitors,such as liproxstatin-1,is a potential therapeutic strategy for treating inflammatory pain.展开更多
BACKGROUND： Injection of glutamate （Glu） in normal animals can cause neuronal c-Fos expression; however, whether Glu can induce spinal neuronal c-Fos expression in pain models is unclear. OBJECTIVE： To examine the...BACKGROUND： Injection of glutamate （Glu） in normal animals can cause neuronal c-Fos expression; however, whether Glu can induce spinal neuronal c-Fos expression in pain models is unclear. OBJECTIVE： To examine the effects of intraplantar and intrathecal injection of Glu on c-Fos expression in the L5 spinal cord dorsal horn Ⅰ/Ⅱ and Ⅲ/Ⅳ layers after spinal nerve ligation, and to study the effects of the N-methyI-D-aspartic acid （NMDA） receptor antagonist, D-2-amino-5-phosphonopentanoate （D-AP5）, and a selective group I mGluR antagonist, 7-hydroyiminocyclo propan[a]chromen-lacarboxylic acid ethyl ester （cpccoEt）. DESIGN, TIME AND SETTING： A randomized, controlled animal study was performed at the Department of Pharmacology, Oral Anatomy, and Neurobiology, Osaka University Graduate School of Dentistry, from December 2005 to December 2006. MATERIALS： Glu （5 μmol）, D-AP5 （50 nmot） and cpccoEt （250 nmol） were provided by Wako Pure Chemical Industries, Osaka, Japan, and diluted in saline （50 μL）. The pH of all solutions was adjusted to 7.4. METHODS： Twelve rats were randomly divided into sham operation （n = 6） and spinal nerve ligation （SNL; n = 6） groups for behavioral assessments of neuropathic pain after ligation surgery of the left L5-6 nerve segment. Another 60 rats were randomly divided into sham operation, SNL, saline-intraplantar, saline-intrathecal, Glu-intraplantar, Glu-intrathecal, D-AP5-intrathecal, Glu-D-AP5-intrathecal, cpccoEt-intrathecal, and Glu-cpccoEt-intrathecal groups, with 6 rats in each group. All groups except sham operation group received a similar SNL. On day 14, rats received a 50-μL injection of saline, Glu, D-AP5, and/or cpccoEt into the left intraplantar or intrathecal L5-4 segments. MAIN OUTCOME MEASURES： The number of c-Fos positive neurons in both Ⅰ/Ⅱ and Ⅲ/Ⅳ spinal layers at L6 was observed using immunohistochemistry 2 hours after administration. RESULTS： （1） SNL increased the level of c-Fos expression in two sides of the spinal cord, particularly on Ⅲ/Ⅳ spinal layers of the ligated side. （2） Intraplantar or intrathecal administration of saline significantly increased the c-Fos labeled neurons in Ⅰ/Ⅱ spinal layers of the ligated side, compared with SNL alone （P 〈 0.01）. （3） Intraplantar Glu （5 μmol） increased the number of c-Fos positive neurons in Ⅰ/Ⅱ spinal layers compared with intraplantar saline （P〈 0.01）. （4） The number of c-Fos neurons in Ⅰ/Ⅱ spinal layers on both the ipsilateral and contralateral side after intraplantar Glu was lower than intrathecal Glu （P〈 0.01）, with a 3-fold higher induction by intrathecal Glu. （5） Co-administration of D-AP5 or cpccoEt reduced the effects of intrathecal Glu （P 〈 0.01）. CONCLUSION： Intrathecal Glu increases c-Fos expression more than intraplantar Glu. Antagonists of NMDA and group I mGluRs block this effect.展开更多
BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may ben...BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.展开更多
Spinal cord injury （SCI） is an unexpected event that is both devastating and debilitating, resulting in not just motor and sensory loss, but also autonomic dysfunction of the bladder, bowel and sexual organs. Curren...Spinal cord injury （SCI） is an unexpected event that is both devastating and debilitating, resulting in not just motor and sensory loss, but also autonomic dysfunction of the bladder, bowel and sexual organs. Currently, there are no treatments available to improve outcome follow- ing SCI, leaving individuals with permanent and lifelong physical disability. Worldwide it is estimated that more than 500,000 people sustain a SCI each year, with average lifetime cost of paraplegia and quadriplegia estimated at $5 million and $9.5 million respectively. We therefore urgently need effective therapies to improve quality of life following SCI, and this requires a greater understanding of how cell and axonal injury develops after the traumatic event.展开更多
Animal experiments have confirmed that mesenchymal stem cells can inhibit motor neuron apoptosis and inflammatory factor expression and increase neurotrophic factor expression. Therefore, mesenchymal stem cells have b...Animal experiments have confirmed that mesenchymal stem cells can inhibit motor neuron apoptosis and inflammatory factor expression and increase neurotrophic factor expression. Therefore, mesenchymal stem cells have been shown to exhibit prospects in the treatment of amyotrophic lateral sclerosis. However, the safety of their clinical application needs to be validated. To investigate the safety of intrathecal injection of Wharton's jelly-derived mesenchymal stem cells in amyotrophic lateral sclerosis therapy, 43 patients(16 females and 27 males, mean age of 57.3 years) received an average dose of 0.42 × 106 cells/kg through intrathecal administration at the cervical, thoracic or lumbar region depending on the clinical symptoms. There was a 2 month interval between two injections. The adverse events occurring during a 6-month treatment period were evaluated. No adverse events occurred. Headache occurred in one case only after first injection of stem cells. This suggests that intrathecal injection of Wharton's Jelly-derived mesenchymal stem cells is well tolerated in patients with amyotrophic lateral sclerosis. This study was approved by the Bioethical Committee of School of Medicine, University of Warmia and Mazury in Olsztyn, Poland(approval No. 36/2014 and approval No. 8/2016). This study was registered with the ClinicalTrials.gov(identifier: NCT02881476)on August 29, 2016.展开更多
Objective:To compare effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on the prevention of post-spinal anesthesia shivering and adverse events in hip fracture repair patients.Methods:In ...Objective:To compare effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on the prevention of post-spinal anesthesia shivering and adverse events in hip fracture repair patients.Methods:In a randomized,double-blind trial,132 patients with American Society of Anesthesiology(ASA)ⅠandⅡspinal anesthesia who needed hip fracture surgery were enrolled.Patients were stratified into 4 intervention groups based on a randomized block pattern:meperidine,tramadol,magnesium sulfate,and dexmedetomidine.Hemodynamic parameters including blood pressure,heart rate,and oxygen saturation,as well as the severity of shivering,core body temperature,Ramsay sedation score,adverse events,meperidine consumption were recorded and compared.Results:There was no statistically significant difference in the normal hemodynamic parameters,temperature,duration of surgery,meperidine consumption,and adverse events such as dizziness,hypotension,nausea,and bradycardia among groups(P>0.05).Compared to other groups,severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery.The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery(P=0.020).Conclusion:Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering.Overall,these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia,based on anesthesiologists’discretion and patients’general conditions.Clinical registration:The study was approved by the Research and Ethics Committee at the Valiasr Hospital(Arak,Iran)with the clinical trial code of IRCT20141209020258N153.展开更多
BACKGROUND Glioblastoma(GBM)is one of the most common and aggressive primary malignant brain tumors with severe symptoms and a poor prognosis.Leptomeningeal dissemination(LMD)is a serious complication of GBM that ofte...BACKGROUND Glioblastoma(GBM)is one of the most common and aggressive primary malignant brain tumors with severe symptoms and a poor prognosis.Leptomeningeal dissemination(LMD)is a serious complication of GBM that often results in dire outcomes.There is currently no effective treatment.AIM To estimate the clinical outcomes of combination therapy in GBM patients with LMD METHODS A retrospective analysis was conducted using data collected from GBM patients diagnosed with LMD from January 2012 to December 2019 at our institution.All these patients had received at least one cycle of a combination therapy consisting of intrathecal methotrexate(MTX)and systemic chemotherapy.Clinical and pathological data were analyzed to explore the outcome of GBM patients with LMD and to determine the most effective treatment.RESULTS Twenty-six patients were enrolled in this study.The median time from GBM diagnosis to LMD development was 9.3 mo(range:2-59 mo).The median overall survival of LMD patients from diagnosis to after receiving systemic chemotherapy in combination with intrathecal MTX was 10.5 mo(range:2-59 mo).In the Cox univariate analysis,gross resection of tumor(P=0.022),Karnofsky performance status(KPS)>60(P=0.002),and Ommaya reservoir implant(P<0.001)were correlated with survival.Multivariate analysis showed that KPS>60(P=0.037)and Ommaya reservoir implant(P=0.014)were positive factors correlated with survival.Myelotoxicity and gastrointestinal reactions were the common toxicities of this combination therapy.According to Common Terminology Criteria of Adverse Events 4.03,most of the patients presented with toxicity less than grade 3.CONCLUSION Intrathecal MTX administration combined with systemic chemotherapy is a potentially effective treatment for patients with GBM and LMD,with mild treatment-related side effects.展开更多
The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we p...The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.展开更多
AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper...AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and 2014.All patients had received peri-articular infiltration as per the hospital protocol.Data for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was collected.The data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical variables.RESULTS Twenty-two patients in ITM group and 32 patients in FNB group were analyzed.Median pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) postoperatively.Also,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the hospital.No respiratory depression in either group was noticed.CONCLUSION The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postoperatively compared to FNB group.展开更多
AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion.METHODS: We recognized 13 patients who underwent ...AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion.METHODS: We recognized 13 patients who underwent intrathecal narcotic pump(ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation(TP + ICT) for chronic pancreatitis(CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control(using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up. RESULTS: All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5(on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus(DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT. CONCLUSION: ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.展开更多
Objective:To compare the efficacy of midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomi...Objective:To compare the efficacy of midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists classⅠorⅡ,who needed knee arthroplasty.Patients were stratified into three intervention groups,including the midazolam group,the fentanyl group,and the magnesium sulfate group,and the patients were administered with midazolam,fentanyl,and magnesium sulfate,respectively.Hemodynamic parameters,sensory and motor block,and pain score(Visual Analogue Scale)were measured and compared among the three groups.Results:A total of 105 patients were included in this study with 35 patients in each group.There was no statistically significant difference in terms of oxygen saturation,mean blood pressure,duration of surgery,and postoperative complications,including nausea,vomiting,bradycardia,dizziness,and hypotension,as well as the time of opioid administration among the three groups(P>0.05).Statistically significant differences were found in terms of heart rate at 15,30,45,60,75,and 105 min after beginning of operation among the three groups,which was lower in the midazolam group(P<0.05).The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia,sensory block to T8 or higher and sensory block to T12 and L1(P<0.05).Besides,the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3(P=0.001).No significant difference was noted in pain scores among the three groups(P>0.05).Conclusion:Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher,the onset of motor block and sensory block after spinal anesthesia,and time to achieve sensory block to T12 and L1,and the pain scores were not significantly different among the groups.Thus,midazolam can be highly underlined,if a shorter onset of sensory and motor blocks is targeted.[Funded by the research deputy of Arak University of Medical Sciences(No.99258);fa.irct.ir number,IRCT20141209020258N164].展开更多
Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 fem...Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.展开更多
To evaluate the effect of intrathecal administration of glycine on the minimum alveolar concentration （MAC） of isoflurane in rats. Methods Intrathecal catheters were implanted in 40 adult male rats anesthetized wit...To evaluate the effect of intrathecal administration of glycine on the minimum alveolar concentration （MAC） of isoflurane in rats. Methods Intrathecal catheters were implanted in 40 adult male rats anesthetized with isoflurane. Baseline MAC of isoflurane was measured during the infusion of artificial cerebrospinal fluid （CSF） alone. Subsequently, 10, 40, 80, 160, and 300 mmol/L of glycine dissolved in artificial CSF were infused for two hours at the same rate as under control conditions, and MAC for isoflurane was re-determined. Results Intrathecal administration of glycine produced a significant, dose-dependent decrease in MAC for isoflurane （up to -65.2% ± 16. 2% ）. Conclusions Intrathecal administration of glycine decreases anesthetic requirement. This result supports the idea that glycine receptors may be important to the immobilizing effect of anesthetics that enhance glycine receptor function such as isoflurane.展开更多
Multiple sclerosis （MS） is a chronic inflammatory disease of the central nervous system （CNS）. Essential charac- teristics are demyelination, inflammation and neurode- generation. This process affects the white an...Multiple sclerosis （MS） is a chronic inflammatory disease of the central nervous system （CNS）. Essential charac- teristics are demyelination, inflammation and neurode- generation. This process affects the white and grey matter in the CNS. MS patients experience various progression subtypes in association with the cerebral or spinal, acute inflammatory or glial sclerotic lesions （Mtiller, 2009）. Most patients end up in a progressive, smouldering, chronic inflammatory process （MUller, 2009）. Current predominantly used 1.5 respectively 3 Tesla MRI with Gadolinium~ application visualize the various old and acute lesions. They serve as a biological marker in com- bination with standardised assessment of brain atrophy, black holes, etc. However, MRI with a stronger magnetic 7 Tesla field with better sensitivity gave hints on an on- going, acute inflammatory, smouldering process even with Gadolinium~ enhancing acute lesions in the brain and the spinal cord in progressive, so-called relapse free MS patients （Mtiller, 2009; Sinnecker et al., 2012）. Ad- ditionally, progress of MS is determined with subjective standardised clinical ratings （Sinnecker et al., 2012）. Both methods are used for the evaluation of the efficacy of relapse rate reducing drugs. These compounds, i.e., in- terferons, teriflunamide, glatiramer acetate, fingolimod, fumarate or monoclonal antibodies, preponderantly weaken the malfunction of the peripheral immune system in relapse remitting MS patients. These MS drugs share one common disadvantage. They do not stop progression or improve MS within a framework of a regenerative process. They do not enable reversal of symptoms, for in- stance functional deficits or spasticity （Mtiller, 2009）.展开更多
BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbid...BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.展开更多
基金funded by the National Natural Science Foundation of China(grant number 82360629,awarded to ZZM)the Jiangxi Provincial Health Department Project(grant number 202410026,awarded to ZZM,202510363,awarded to HYQ).
文摘Background:Non-small cell lung cancer(NSCLC)patients with leptomeningeal metastasis(LM)have a very poor prognosis.Intrathecal pemetrexed(IP)has shown moderate efficacy in treating patients with NSCLC-LM.Myelosuppression is the most common adverse effect following IP administration.Despite this trend,the specific risk factors contributing to IP-related myelosuppression remain unclear.Methods:This study conducted a retrospective analysis of lung adenocarcinoma(LUAD)patients with LM who received IP treatment at the Second Affiliated Hospital of Nanchang University from April 2017 to April 2024.Risk factors for myelosuppression were identified through univariate and multivariate logistic regression analyses.Non-linear relationships and determined the inflection points were subsequently determined using smooth curve fitting and threshold effect analysis.Results:A total of 95 patients were identified,among whom 64(68.42%)experienced myelosuppression,with 43(45.26%)cases classified as severe myelosuppression.Leukopenia emerged as the most prevalent form of myelosuppression.Age was established as an independent risk factor for both myelosuppression and its severe form.A nonlinear relationship between age and severe myelosuppression was observed.The risk of developing severe myelosuppression increased significantly with age,beyond the turning point of 58 years old(OR 1.28,95%CI 1.08–1.52;p 0.0042).Conclusions:Advanced age is=associated with the occurrence of myelosuppression and severe myelosuppression.The probability of developing severe myelosuppression increases significantly in individuals aged 58 years or older.
文摘Objective: Postoperative pain (POP) following abdominal surgery can vary from a few hours to several days. This acute, unrelieved pain can become chronic, requiring patients to take analgesics on an almost daily basis for comfort. Analgesia using general opioids has many side effects and intrathecal morphine is a good alternative. This study was conducted to evaluate the efficacy of intrathecal morphine (ITM) versus conventional analgesia in the management of postoperative pain in colectomy performed by laparoscopic surgery. Methods: Cohort study conducted at the Hôpital Nord in Marseille, from 01 January to 31 July 2021 in patients aged at least 18 years undergoing anaesthesia for scheduled colectomy by laparoscopic surgery. The primary endpoint was postoperative pain intensity and the secondary endpoints were morphine consumption, treatment side effects and length of hospital stay. Statistical analysis was performed using XLSTAT software. Results: We included 193 patients: 131 in the control group (conventional analgesia) and 62 in the ITM group. We observed: a significant decrease in pain (assessed by numerical scale) in favour of the ITM group in the post-anaesthetic care room, i.e. 3 (±4) vs 1 (±2), p 0 and H2: 2 (±2) vs. 1 (±2);p Conclusion: These results suggest that intrathecal morphine (ITM) in laparoscopic colectomy provides effective postoperative analgesia with low morphine consumption, and a reduction in morphine side-effects compared with conventional analgesia.
文摘Introduction: Ambulatory surgery requires effective analgesia with few side effects to allow a return home on the day of surgery. The aim of the study was to compare the efficacy of intrathecal morphine (Ram) and erector spinae plane block (ESP) in outpatient abdominal wall surgery. Methodology: Thirty-six patients were randomized into two groups. The ESP group (n = 23) benefited from the ESP block with bupivacaine 5% (20 ml) followed by spinal anesthesia with bupivacaine (7.5 mg) and sufenta (2.5 µg). The Ram group (n = 13) benefited from spinal anesthesia with bupivacaine (7.5 mg), sufenta (2.5 µg) and morphine (100 µg). The primary endpoint was whether or not to return home on the day of surgery. The secondary endpoint was the pain score by the visual analog scale (VAS) in the post-intervention monitoring room (SSPI). After 2 hours (H2) and one day (D1) after surgery, the morphine consumption in the immediate postoperative period (mg) and the undesirable effects. Results: Inguinal hernia surgery predominated (n = 30). No difference in age (45.05 vs 50.7;p = 0.4), ASA score (1.43 vs 1.53;p = 0.57). All patients (n = 36) returned home on the day of surgery. No difference in postoperative pain in SSPI (p = 0.6), 2 hours after surgery (p = 0.40) and the day after surgery (p = 0.6). Postoperative morphine consumption was identical (0.9 mg vs 0.2 mg, p = 0.2). There were 2 urinary retentions in the Ram group. Conclusion: The erector spinae plane block and intrathecal morphine are well tolerated and perfectly compatible with the requirements of outpatient abdominal wall surgery.
文摘Introduction: The current recommendations for manual vacuum aspiration (MVA) for incomplete abortion, although not different in terms of effectiveness of the anesthetic techniques of choice, have still shown some inadequacies which have stimulated the search for an alternative technique which can be effective, such as microdose intrathecal spinal analgesia that can be recommended in limited resources environment. Aim: This work aims to contribute to the improvement of anesthetic techniques for incomplete abortion by MVA. Methodology: We conducted a prospective comparative study, type single blind non-inferiority randomized trial with an analytical aim. The study counted 2 parts: 1) Descriptive observational component (KET): Ketamine narcosis. 2) Experimental component, single-blind non-inferiority randomized clinical trial (RAS) microdose intrathecal spinal analgesia. Three hundred and twenty expected cases per randomized arms. Excel Software 2022, SPSS, Open Epi, and XL-SAT were used for data encoding and analysis. Results: A total of 322 cases were retained and analyzed: 1) 161 cases per randomized arm, the majority age group was between 18 - 50 years in the 2 groups and there was no correlation between the two. Protocols with the sociodemographic characteristics studied, ASA class, type of intervention, history of MVA, variation in heart rate, temperature, appearance of hypotension, cost of the anesthetic procedure and admission to intensive care. 2) Effectiveness of the RAS protocol: Judged easier by anesthetists at 99.38% compared to 93.79% for KET with significant difference (p = 0.0104), allows them to be more mobile during the procedure at 98.76 % against 68.32% with significant difference (p < 0.0001) and the overall assessment was in favor of the RAS protocol at a rate of 32.92% against 5.58% for the anesthetists, 90.68% for the patients and 100% for gynecologists who find it excellent compared to the KET protocol with significant difference (p < 0.0001). 3) Weaknesses of the KET protocol: unconsciousness in all patients during the procedure and provides more tachypnea (17.39%) compared to the RAS protocol with difference p = 0.0008, moderate hemorrhages (55.28%), severe (9.94%) with p = 0.0006, higher material cost with p = 0.0018, occurrence of vomiting (10.56%), delay in waking up (22.36%), post-MVA pain (21.74%), and a slight change in the modified Aldrete score at the 30th min post-MVA (70.19%) compared to RAS (81.61%) p = 0.0002. 4) No patient died during the study period in both protocols. Conclusion: Intrathecal spinal analgesia microdosed with bupivacaine 0.1% and Fentanyl 50 µg/cc according to the process used in this study, has proven its effectiveness compared to Ketamine narcosis, currently recommended and not different in terms of effectiveness from other anesthetic techniques recommended for MVA indicated for incomplete abortion and can therefore be recommended as the anesthetic practice of choice in this area in a resource-limited setting.
基金supported by the National Key Research and Development Program of China,No.2017YFA0105401(to LMR)the National Natural Science Foundation of China,Nos.31671420 and 81602482(to MML)a grant from the Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases.
文摘Human umbilical cord mesenchymal stem cells(hUC-MSCs)are a promising candidate for spinal cord injury(SCI)repair owing to their advantages of low immunogenicity and easy accessibility over other MSC sources.However,modest clinical efficacy hampered the progression of these cells to clinical translation.This discrepancy may be due to many variables,such as cell source,timing of implantation,route of administration,and relevant efficacious cell dose,which are critical factors that affect the efficacy of treatment of patients with SCI.Previously,we have evaluated the safety and efficacy of 4×10^(6) hUC-MSCs/kg in the treatment of subacute SCI by intrathecal implantation in rat models.To search for a more accurate dose range for clinical translation,we compared the effects of three different doses of hUC-MSCs-low(0.25×10^(6) cells/kg),medium(1×10^(6) cells/kg)and high(4×10^(6) cells/kg)-on subacute SCI repair through an elaborate combination of behavioral analyses,anatomical analyses,magnetic resonance imaging-diffusion tensor imaging(MRI-DTI),biotinylated dextran amine(BDA)tracing,electrophysiology,and quantification of mRNA levels of ion channels and neurotransmitter receptors.Our study demonstrated that the medium dose,but not the low dose,is as efficient as the high dose in producing the desired therapeutic outcomes.Furthermore,partial restoration of theγ-aminobutyric acid type A(GABAA)receptor expression by the effective doses indicates that GABAA receptors are possible candidates for therapeutic targeting of dormant relay pathways in injured spinal cord.Overall,this study revealed that intrathecal implantation of 1×10^(6) hUC-MSCs/kg is an alternative approach for treating subacute SCI.
基金supported by the Basic and Applied Basic Research Foundation of Guangdong Province,No.2021A1515220081(to XL)。
文摘Previous studies have confirmed the relationship between iron-dependent ferroptosis and a peripheral nerve injury-induced neuropathic pain model.However,the role of fe rroptosis in inflammatory pain remains inconclusive.Therefore,we aimed to explore whether ferroptosis in the spinal cord and do rsal root ganglion contributes to complete Freund's adjuvant(CFA)-induced painful behaviors in rats.Our results revealed that various biochemical and morphological changes were associated with ferroptosis in the spinal cord and dorsal root ganglion tissues of CFA rats.These changes included iron overload,enhanced lipid peroxidation,disorders of anti-acyl-coenzyme A synthetase long-chain family member 4 and glutathione peroxidase 4 levels,and abnormal morphological changes in mitochondria.Intrathecal treatment of liproxstatin-1(a ferroptosis inhibitor)reve rsed these ferroptosis-related changes and alleviated mechanical and thermal hype rsensitivities in CFA rats.Our study demonstrated the occurrence of fe rroptosis in the spinal cord and do rsal root ganglion tissues in a rodent model of inflammatory pain and indicated that intrathecal administration of fe rroptosis inhibitors,such as liproxstatin-1,is a potential therapeutic strategy for treating inflammatory pain.
基金the Scientific and Technological Research Project of Jiangxi Provincial Public Health Bureau,No.20071090
文摘BACKGROUND： Injection of glutamate （Glu） in normal animals can cause neuronal c-Fos expression; however, whether Glu can induce spinal neuronal c-Fos expression in pain models is unclear. OBJECTIVE： To examine the effects of intraplantar and intrathecal injection of Glu on c-Fos expression in the L5 spinal cord dorsal horn Ⅰ/Ⅱ and Ⅲ/Ⅳ layers after spinal nerve ligation, and to study the effects of the N-methyI-D-aspartic acid （NMDA） receptor antagonist, D-2-amino-5-phosphonopentanoate （D-AP5）, and a selective group I mGluR antagonist, 7-hydroyiminocyclo propan[a]chromen-lacarboxylic acid ethyl ester （cpccoEt）. DESIGN, TIME AND SETTING： A randomized, controlled animal study was performed at the Department of Pharmacology, Oral Anatomy, and Neurobiology, Osaka University Graduate School of Dentistry, from December 2005 to December 2006. MATERIALS： Glu （5 μmol）, D-AP5 （50 nmot） and cpccoEt （250 nmol） were provided by Wako Pure Chemical Industries, Osaka, Japan, and diluted in saline （50 μL）. The pH of all solutions was adjusted to 7.4. METHODS： Twelve rats were randomly divided into sham operation （n = 6） and spinal nerve ligation （SNL; n = 6） groups for behavioral assessments of neuropathic pain after ligation surgery of the left L5-6 nerve segment. Another 60 rats were randomly divided into sham operation, SNL, saline-intraplantar, saline-intrathecal, Glu-intraplantar, Glu-intrathecal, D-AP5-intrathecal, Glu-D-AP5-intrathecal, cpccoEt-intrathecal, and Glu-cpccoEt-intrathecal groups, with 6 rats in each group. All groups except sham operation group received a similar SNL. On day 14, rats received a 50-μL injection of saline, Glu, D-AP5, and/or cpccoEt into the left intraplantar or intrathecal L5-4 segments. MAIN OUTCOME MEASURES： The number of c-Fos positive neurons in both Ⅰ/Ⅱ and Ⅲ/Ⅳ spinal layers at L6 was observed using immunohistochemistry 2 hours after administration. RESULTS： （1） SNL increased the level of c-Fos expression in two sides of the spinal cord, particularly on Ⅲ/Ⅳ spinal layers of the ligated side. （2） Intraplantar or intrathecal administration of saline significantly increased the c-Fos labeled neurons in Ⅰ/Ⅱ spinal layers of the ligated side, compared with SNL alone （P 〈 0.01）. （3） Intraplantar Glu （5 μmol） increased the number of c-Fos positive neurons in Ⅰ/Ⅱ spinal layers compared with intraplantar saline （P〈 0.01）. （4） The number of c-Fos neurons in Ⅰ/Ⅱ spinal layers on both the ipsilateral and contralateral side after intraplantar Glu was lower than intrathecal Glu （P〈 0.01）, with a 3-fold higher induction by intrathecal Glu. （5） Co-administration of D-AP5 or cpccoEt reduced the effects of intrathecal Glu （P 〈 0.01）. CONCLUSION： Intrathecal Glu increases c-Fos expression more than intraplantar Glu. Antagonists of NMDA and group I mGluRs block this effect.
基金Supported by National Natural Science Foundation of China,No.81891004Tianjin Natural Science Foundation of China,No.21JCQNJC01140.
文摘BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.
基金supported by the Neil Sachse Foundation,Australia,a philanthropic organisation supporting research into spinal cord injury
文摘Spinal cord injury （SCI） is an unexpected event that is both devastating and debilitating, resulting in not just motor and sensory loss, but also autonomic dysfunction of the bladder, bowel and sexual organs. Currently, there are no treatments available to improve outcome follow- ing SCI, leaving individuals with permanent and lifelong physical disability. Worldwide it is estimated that more than 500,000 people sustain a SCI each year, with average lifetime cost of paraplegia and quadriplegia estimated at $5 million and $9.5 million respectively. We therefore urgently need effective therapies to improve quality of life following SCI, and this requires a greater understanding of how cell and axonal injury develops after the traumatic event.
基金supported by Instytut Terapii Komórkowych w Olsztynie(Cell Therapies Institute,FamiCord Group)in Olsztyn(to MB,SM,and TS)
文摘Animal experiments have confirmed that mesenchymal stem cells can inhibit motor neuron apoptosis and inflammatory factor expression and increase neurotrophic factor expression. Therefore, mesenchymal stem cells have been shown to exhibit prospects in the treatment of amyotrophic lateral sclerosis. However, the safety of their clinical application needs to be validated. To investigate the safety of intrathecal injection of Wharton's jelly-derived mesenchymal stem cells in amyotrophic lateral sclerosis therapy, 43 patients(16 females and 27 males, mean age of 57.3 years) received an average dose of 0.42 × 106 cells/kg through intrathecal administration at the cervical, thoracic or lumbar region depending on the clinical symptoms. There was a 2 month interval between two injections. The adverse events occurring during a 6-month treatment period were evaluated. No adverse events occurred. Headache occurred in one case only after first injection of stem cells. This suggests that intrathecal injection of Wharton's Jelly-derived mesenchymal stem cells is well tolerated in patients with amyotrophic lateral sclerosis. This study was approved by the Bioethical Committee of School of Medicine, University of Warmia and Mazury in Olsztyn, Poland(approval No. 36/2014 and approval No. 8/2016). This study was registered with the ClinicalTrials.gov(identifier: NCT02881476)on August 29, 2016.
文摘Objective:To compare effect of intrathecal meperidine,tramadol,magnesium sulfate,and dexmedetomidine on the prevention of post-spinal anesthesia shivering and adverse events in hip fracture repair patients.Methods:In a randomized,double-blind trial,132 patients with American Society of Anesthesiology(ASA)ⅠandⅡspinal anesthesia who needed hip fracture surgery were enrolled.Patients were stratified into 4 intervention groups based on a randomized block pattern:meperidine,tramadol,magnesium sulfate,and dexmedetomidine.Hemodynamic parameters including blood pressure,heart rate,and oxygen saturation,as well as the severity of shivering,core body temperature,Ramsay sedation score,adverse events,meperidine consumption were recorded and compared.Results:There was no statistically significant difference in the normal hemodynamic parameters,temperature,duration of surgery,meperidine consumption,and adverse events such as dizziness,hypotension,nausea,and bradycardia among groups(P>0.05).Compared to other groups,severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery.The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery(P=0.020).Conclusion:Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering.Overall,these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia,based on anesthesiologists’discretion and patients’general conditions.Clinical registration:The study was approved by the Research and Ethics Committee at the Valiasr Hospital(Arak,Iran)with the clinical trial code of IRCT20141209020258N153.
基金Supported by Special Research Project of Capital Health Development 2016,No.2020-2-2048.
文摘BACKGROUND Glioblastoma(GBM)is one of the most common and aggressive primary malignant brain tumors with severe symptoms and a poor prognosis.Leptomeningeal dissemination(LMD)is a serious complication of GBM that often results in dire outcomes.There is currently no effective treatment.AIM To estimate the clinical outcomes of combination therapy in GBM patients with LMD METHODS A retrospective analysis was conducted using data collected from GBM patients diagnosed with LMD from January 2012 to December 2019 at our institution.All these patients had received at least one cycle of a combination therapy consisting of intrathecal methotrexate(MTX)and systemic chemotherapy.Clinical and pathological data were analyzed to explore the outcome of GBM patients with LMD and to determine the most effective treatment.RESULTS Twenty-six patients were enrolled in this study.The median time from GBM diagnosis to LMD development was 9.3 mo(range:2-59 mo).The median overall survival of LMD patients from diagnosis to after receiving systemic chemotherapy in combination with intrathecal MTX was 10.5 mo(range:2-59 mo).In the Cox univariate analysis,gross resection of tumor(P=0.022),Karnofsky performance status(KPS)>60(P=0.002),and Ommaya reservoir implant(P<0.001)were correlated with survival.Multivariate analysis showed that KPS>60(P=0.037)and Ommaya reservoir implant(P=0.014)were positive factors correlated with survival.Myelotoxicity and gastrointestinal reactions were the common toxicities of this combination therapy.According to Common Terminology Criteria of Adverse Events 4.03,most of the patients presented with toxicity less than grade 3.CONCLUSION Intrathecal MTX administration combined with systemic chemotherapy is a potentially effective treatment for patients with GBM and LMD,with mild treatment-related side effects.
文摘The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.
文摘AIM To compare the efficacy of intrathecal morphine and single shot femoral nerve block for patients undergoing primary total knee arthroplasty.METHODS Data was extracted from electronic medical records and case-paper record files of patients who underwent unilateral primary total knee arthroplasty under spinal anesthesia using bupivacaine 12.5 mg with intrathecal morphine(ITM) 0.2 mg and under general anesthesia(GA) with single shot femoral nerve block(FNB) using 20 m L 0.5% bupivacaine at our hospital in 2013 and 2014.All patients had received peri-articular infiltration as per the hospital protocol.Data for gender,age,weight,American Society of Anesthesiologists status,total surgical time,postoperative pain score using visual analogue scale(VAS) from 1 to 10 at 6 h,12 h and 24 h postoperatively,24 h opioid consumption,use of oral multimodal analgesia,postoperative high dependency unit(HDU) admission and the time to discharge from the hospital was collected.The data was analyzed using Mann-Whitney U test for continuous variables and Fischer's exact-t-test for categorical variables.RESULTS Twenty-two patients in ITM group and 32 patients in FNB group were analyzed.Median pain scores using VAS in ITM group were significantly lower at 6 h(0.0 vs 2.0,P<0.001),12 h(0.0 vs 2.0,P<0.001) and 24 h(0.0 vs 2.0,P<0.001) postoperatively.Also,postoperative morphine consumption in ITM group was significantly lower(P<0.001).However,median of nonsteroid anti-inflammatory drug unit requirement in 24 h postoperatively was statistically significant higher in ITM compared to FNB group(2.0 vs 1.0,P=0.025).The difference in postoperative paracetamol consumption in 24 h was not statistically significant(P=0.147).There was no significant difference in the postoperative HDU admission or time to discharge from the hospital.No respiratory depression in either group was noticed.CONCLUSION The ITM group patients had much lower pain scores and morphine requirement in the first 24 hour postoperatively compared to FNB group.
文摘AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump infusion.METHODS: We recognized 13 patients who underwent intrathecal narcotic pump(ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation(TP + ICT) for chronic pancreatitis(CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control(using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up. RESULTS: All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5(on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus(DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT. CONCLUSION: ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.
基金funded by the research deputy of Arak University of Medical Sciences(No.99258).
文摘Objective:To compare the efficacy of midazolam,fentanyl,and magnesium sulfate as adjuvants to intrathecal bupivacaine on both block characteristics and postoperative analgesia in knee arthroplasty.Methods:This randomized double-blind clinical trial recruited spinal anesthesia patients of the American Society of Anesthesiologists classⅠorⅡ,who needed knee arthroplasty.Patients were stratified into three intervention groups,including the midazolam group,the fentanyl group,and the magnesium sulfate group,and the patients were administered with midazolam,fentanyl,and magnesium sulfate,respectively.Hemodynamic parameters,sensory and motor block,and pain score(Visual Analogue Scale)were measured and compared among the three groups.Results:A total of 105 patients were included in this study with 35 patients in each group.There was no statistically significant difference in terms of oxygen saturation,mean blood pressure,duration of surgery,and postoperative complications,including nausea,vomiting,bradycardia,dizziness,and hypotension,as well as the time of opioid administration among the three groups(P>0.05).Statistically significant differences were found in terms of heart rate at 15,30,45,60,75,and 105 min after beginning of operation among the three groups,which was lower in the midazolam group(P<0.05).The midazolam group showed a shorter time to achieve sensory block after spinal anesthesia,sensory block to T8 or higher and sensory block to T12 and L1(P<0.05).Besides,the three groups showed significantly differences in terms of onset of motor block after spinal anesthesia and time to achieve motor block to T8 or higher or Bromage score 3(P=0.001).No significant difference was noted in pain scores among the three groups(P>0.05).Conclusion:Midazolam resulted in a shorter time to achieve sensory and motor block to T8 or higher,the onset of motor block and sensory block after spinal anesthesia,and time to achieve sensory block to T12 and L1,and the pain scores were not significantly different among the groups.Thus,midazolam can be highly underlined,if a shorter onset of sensory and motor blocks is targeted.[Funded by the research deputy of Arak University of Medical Sciences(No.99258);fa.irct.ir number,IRCT20141209020258N164].
基金supported in part by the University of California Davis Health Department of Anesthesiology and Pain MedicineNIH grant UL1 TR001860 of the University of California Davis Health。
文摘Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.
文摘To evaluate the effect of intrathecal administration of glycine on the minimum alveolar concentration （MAC） of isoflurane in rats. Methods Intrathecal catheters were implanted in 40 adult male rats anesthetized with isoflurane. Baseline MAC of isoflurane was measured during the infusion of artificial cerebrospinal fluid （CSF） alone. Subsequently, 10, 40, 80, 160, and 300 mmol/L of glycine dissolved in artificial CSF were infused for two hours at the same rate as under control conditions, and MAC for isoflurane was re-determined. Results Intrathecal administration of glycine produced a significant, dose-dependent decrease in MAC for isoflurane （up to -65.2% ± 16. 2% ）. Conclusions Intrathecal administration of glycine decreases anesthetic requirement. This result supports the idea that glycine receptors may be important to the immobilizing effect of anesthetics that enhance glycine receptor function such as isoflurane.
文摘Multiple sclerosis （MS） is a chronic inflammatory disease of the central nervous system （CNS）. Essential charac- teristics are demyelination, inflammation and neurode- generation. This process affects the white and grey matter in the CNS. MS patients experience various progression subtypes in association with the cerebral or spinal, acute inflammatory or glial sclerotic lesions （Mtiller, 2009）. Most patients end up in a progressive, smouldering, chronic inflammatory process （MUller, 2009）. Current predominantly used 1.5 respectively 3 Tesla MRI with Gadolinium~ application visualize the various old and acute lesions. They serve as a biological marker in com- bination with standardised assessment of brain atrophy, black holes, etc. However, MRI with a stronger magnetic 7 Tesla field with better sensitivity gave hints on an on- going, acute inflammatory, smouldering process even with Gadolinium~ enhancing acute lesions in the brain and the spinal cord in progressive, so-called relapse free MS patients （Mtiller, 2009; Sinnecker et al., 2012）. Ad- ditionally, progress of MS is determined with subjective standardised clinical ratings （Sinnecker et al., 2012）. Both methods are used for the evaluation of the efficacy of relapse rate reducing drugs. These compounds, i.e., in- terferons, teriflunamide, glatiramer acetate, fingolimod, fumarate or monoclonal antibodies, preponderantly weaken the malfunction of the peripheral immune system in relapse remitting MS patients. These MS drugs share one common disadvantage. They do not stop progression or improve MS within a framework of a regenerative process. They do not enable reversal of symptoms, for in- stance functional deficits or spasticity （Mtiller, 2009）.
基金Supported by the DoD-CDRMP,No.W81XWH-14-SCIRP-CTA.
文摘BACKGROUND Severe spasticity may negatively impact functionality and quality of life after spinal cord injury(SCI).Intrathecal baclofen treatment(IBT)is effectively used to manage severe spasticity and reduce comorbidities.However,long-term IBT may have a negative effect on bone mineral content(BMC),bone mineral density(BMD)and body composition(such as percentage fat mass and lean body mass).We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.CASE SUMMARY A 46-year old Caucasian male Veteran(case)with a 21 year history of complete tetraplegia(complete C6 SCI)was implanted with IBT for 20 years.The case was matched to two participants with different time since injuries[2(match 1)and 13(match 2)years]without IBT.Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software.Total and leg body composition assessments were also conducted for the three participants.Potential effect of long-term IBT was demonstrated by changes in BMD,consistent with bone demineralization,at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs.The case showed 113%lower BMD at the distal femur,and 78.1%lower at the proximal tibia compared to match 1,moreover the case showed 45%lower BMD at the distal femur,and no observed changes at the proximal tibia compared to match 2.The case had 27.1%and 16.5%greater leg%fat mass compared to match 1 and match 2,respectively.Furthermore,the case had 17.4%and 11.8%lower%leg lean mass compared to match 1 and match 2,respectively.CONCLUSION Long-term IBT may impact bone health and body composition parameters in persons with complete SCI.It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures,cardiovascular diseases,and metabolic disorders in this population.
