非甾体抗炎药在骨科手术超前镇痛中的临床应用研究

目的:研究非甾体抗炎药的超前镇痛在骨科手术中的效果。方法:按照入选标准和排除标准选取2014年1月至2014年6月收治入院行骨科手术的各类骨折患者。记录每名患者人口统计学资料,骨折类型和部位,手术和麻醉方式,镇痛治疗方案,术前和术后疼痛评分,心理评分,用药期间不良反应,患者满意度评分。结果:本研究共纳入241名行骨折手术患者,分为超前镇痛组(n=115)和对照组(n=126),超前镇痛组术前使用非甾体抗炎药(主要为帕瑞昔布、塞来昔布)进行镇痛,对照组术前不使用非甾体抗炎药镇痛,两组术前疼痛评分无显著性差异。超前镇痛组和对照组在术后6 h、12 h、48 h、72 h视觉疼痛评分(visual analogue scale,VAS)、不良反应发生率和满意度评分差别有统计学意义(P0.05)。超前镇痛组心理评分低于对照组,不良反应发生率少于对照组,满意度较高。结论:非甾体抗炎药超前镇痛运用于骨科手术中,能够有效缓解手术切口疼痛,减轻炎症反应,减少不良反应的发生,患者满意度高。     

Design and synthesis of thiourea derivatives with sulfur-containing heterocyclic scaffolds as potential tyrosinase inhibitors

Tyrosinase is a key enzyme during the production of melanins in plants and animals. A class of novel N-aryl-N′-substituted phenylthiourea derivatives (3a–i, 6a–k) were designed, synthesized and their inhibitory effects on the diphenolase activity of mushroom tyrosinase were evaluated. The results showed some 4,5,6,7-tetrahydro-2-[[(phenylamino)thioxomethyl]amino]-benzo[b]thiophene-3-carboxylic acid derivatives (3a–i) exhibited moderate inhibitory potency on diphenolase activity of tyrosinase. When the scaffold of 4,5,6,7-tetrahydrobenzo[b]thiophene-3-carboxylic acid was replaced with 2-(1,3,4-thiadiazol-2-yl)thio acetic acid, the inhibitory activity of compounds (6a–k) against tyrosinase was improved obviously; especially, the inhibitory activity of compound 6h (IC₅₀ = 6.13 μM) is significantly higher than kojic acid (IC₅₀ = 33.3 μM). Moreover, the analysis on inhibition mechanism revealed that compound 6h might plays the role as a noncompetitive inhibitor.     

Patients with chronic,but not episodic,migraine display altered activity of their neck extensor muscles

The current study aimed to investigate differences in activity of neck flexor and extensor muscles in women with migraine considering the chronicity of their condition. Thirty-one subjects with episodic migraine, 21 with chronic migraine and 31 healthy controls participated. Surface electromyography signals were recorded bilaterally from the sternocleidomastoid, anterior scalene, splenius capitis and upper trapezius muscles as subjects performed 5 stages of cranio-cervical flexion (CCF), representing a progressive increase in range of CCF motion. Comparison of normalized root-mean-square among groups was conducted with 3 × 5 ANCOVA with task level as the within-subject variable, group as the between-subject variable, and the presence of neck pain and disability as co-variates. The group with chronic migraine exhibited increased activity of their extensor muscles compared to the control and episodic migraine groups (splenius capitis: F = 3.149, P = 0.045; upper trapezius: F = 3.369, P = 0.041). No significant between-group differences were found for the superficial neck flexors (sternocleidomastoid: F = 1.161, P = 0.320; anterior scalene: F = 0.135, P = 0.874). In conclusion, women with chronic migraine exhibit increased activity of their superficial neck extensor muscles when acting as antagonists during low-load isometric CCF contractions in comparison to non-headache subjects.     

Proxomed Tergumed用于椎间孔镜术后早期康复的临床效果分析

目的:探讨Proxomed Tergumed系统用于腰椎间盘突出症椎间孔镜术后早期康复的治疗效果。方法:按照纳入和排除标准,选择2016年6月至2017年6月在我科明确诊断为腰椎间盘突出症并进行腰椎间孔镜手术的63例患者进行回顾性分析。按照是否进行系统的Proxomed Tergumed脊柱功能训练,将其分为功能训练组实验组(28例)与对照组(35例)。比较两组患者在术前、术后1周、术后3月及术后6月的疼痛(VAS)、功能评分(ODI)、相关肌肉力量及术后并发症的发生情况。结果:两组患者术后的VAS评分及ODI评分均较术前明显降低(P0.05)。术后1周时,两组VAS评分及ODI评分比较差异无统计学意义(P0.05)。术后3月及6月,实验组VAS评分和ODI评分均显著低于对照组(P0.05)。术后6个月,实验组肌力恢复显著优于对照组(P0.05)。术后6月,实验组各肌肉群力量与术前相比均无显著差异(P0.05),而对照组肌肉群力量仍较术前显著降低(P0.05)。结论:Proxomed Tergumed系统在腰椎间盘突出症椎间孔镜术后的康复中可以有效的降低患者的术后疼痛,改善患者的腰椎功能,相对于传统的术后康复训练而言有其明显的优势,且并无显著的安全性差异。     

Novel monoamine oxidase inhibitors based on the privileged 2-imidazoline molecular framework

Series of structurally diverse 2-imidazoline derivatives have been synthesized by condensation of substituted aldehydes with ethylenediamine, Pd-catalyzed N-arylation of 2-imidazolines and by the formation of 1,2,4-oxadiazoles and benzoxazepines from 2-imidazoline-containing precursors. The 2-imidazoline derivatives were evaluated as potential inhibitors of human monoamine oxidase (MAO) A and B. Among the 2-imidazolines, good potency inhibitors were discovered with compound 9p (IC₅₀?=?0.012?µM) being the most potent MAO-B inhibitor, while compound 9d (IC₅₀?=?0.751?µM) was the most potent MAO-A inhibitor of the series. These potencies are in the same range as those of reference MAO inhibitors used in the clinic. Among 33 compounds evaluated, 13 exhibited IC₅₀ values in the submicromolar range for the inhibition of an MAO isoform. It is postulated that the imidazoline moieties of some of these inhibitors may be recognized by the imidazoline I₂-binding site of MAO. Good potency MAO inhibitors may be useful for the treatment of neuropsychiatric and neurodegenerative disorders such as depression and Parkinson’s disease, and future application for the treatment of prostate cancer, congestive heart failure and Alzheimer’s disease. In addition, high potency 2-imidazoline-derived MAO inhibitors may be used as potential probes for the imidazoline binding sites of the MAOs, as well as to determine alternative binding regions of imidazoline within the MAO active site.     

Escovopsioides nivea is a non-specific antagonistic symbiont of ant-fungal crops

Fungus-growing attine ants maintain a mutualistic relationship with basidiomycete fungi which they cultivate for food. In addition to the fungal partner, attine ant colonies harbor a myriad of microorganisms, including the genus Escovopsis, fungal parasites of the ant crops. Because Escovopsioides nivea is phylogenetically close to Escovopsis, previous studies assumed it has a negative interaction in the ant-fungus association. Here, we present an extended phylogeny of E. nivea based on new collections from different attine ant genera found in different localities. We also carried out co-culture experiments between E. nivea with different fungal cultivars. Our results suggest E. nivea is a symbiont of attine ant colonies, which inhibits the growth of fungal crops, supporting the hypothesis it is antagonistic to the system. However, the patterns of interaction between E. nivea and fungal crops differ from those shown by Escovopsis, suggesting a different evolution from that of the parasite.     

3D-QSAR study of microsomal prostaglandin E<Subscript>2</Subscript> synthase(mPGES-1) inhibitors

Microsomal prostaglandin E₂ synthase (mPGES-1) has been identified recently as a novel target for treating pain and inflammation. The aim of this study is to understand the binding affinities of reported inhibitors for mPGES-1 and further to design potential new mPGES-1 inhibitors. 3D-QSAR-CoMFA (comparative molecular field analysis) and CoMSIA (comparative molecular similarity indices analysis) - techniques were employed on a series of indole derivatives that act as selective mPGES-1 inhibitors. The lowest energy conformer of the most active compound obtained from systematic conformational search was used as a template for the alignment of 32 compounds. The models obtained were used to predict the activities of the test set of eight compounds, and the predicted values were in good agreement with the experimental results. The 3D-QSAR models derived from the training set of 24 compounds were all statistically significant (CoMFA; q ² = 0.89, r ² = 0.95, , and CoMSIA; q ² = 0.84, r ² = 0.93, , ). Contour plots generated for the CoMFA and CoMSIA models reveal useful clues for improving the activity of mPGES-1 inhibitors. In particular, substitutions of an electronegative fluorine atom or a bulky hydrophilic phenoxy group at the meta or para positions of the biphenyl rings might improve inhibitory activity. A plausible binding mode between the ligands and mPGES-1 is also proposed.     

Cannabis, pain, and sleep: lessons from therapeutic clinical trials of Sativex, a cannabis-based medicine

Cannabis sativa L. has been utilized for treatment of pain and sleep disorders since ancient times. This review examines modern studies on effects of Delta9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on sleep. It goes on to report new information on the effects on sleep in the context of medical treatment of neuropathic pain and symptoms of multiple sclerosis, employing standardized oromucosal cannabis-based medicines containing primarily THC, CBD, or a 1 : 1 combination of the two (Sativex). Sleep-laboratory results indicate a mild activating effect of CBD, and slight residual sedation with THC-predominant extracts. Experience to date with Sativex in numerous Phase I-III studies in 2000 subjects with 1000 patient years of exposure demonstrate marked improvement in subjective sleep parameters in patients with a wide variety of pain conditions including multiple sclerosis, peripheral neuropathic pain, intractable cancer pain, and rheumatoid arthritis, with an acceptable adverse event profile. No tolerance to the benefit of Sativex on pain or sleep, nor need for dosage increases have been noted in safety extension studies of up to four years, wherein 40-50% of subjects attained good or very good sleep quality, a key source of disability in chronic pain syndromes that may contribute to patients' quality of life.     

术前超声引导下腰方肌阻滞联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响

摘要 目的：探讨术前超声引导下腰方肌阻滞（QLB）联合全身麻醉对肾移植患者术后血清应激反应和疼痛相关指标的影响。方法：选择我院2019年9月~2021年8月期间收治的行肾移植手术的患者82例作为观察对象。根据随机数字表法分为A组和B组,分别为41例。A组给予全身麻醉,B组给予术前超声引导下QLB联合全身麻醉,对比两组静息视觉疼痛模拟（VAS）评分、自控静脉镇痛中的舒芬太尼使用量、有效按压次数,对比两组术后血清应激反应和疼痛相关指标变化,对比两组不良反应发生情况。结果：B组术后6 h、12 h、24 h、48 h静息VAS评分低于A组（P<0.05）。B组自控静脉镇痛中的舒芬太尼使用量少于A组,有效按压次数少于A组（P<0.05）。B组拔管后、术后24 h血糖（Glu）、皮质醇（Cor）低于A组（P<0.05）。两组术后24 h P物质（SP）、前列腺素E₂（PGE₂）及5-羟色胺（5-HT）均升高,但B组低于A组（P<0.05）。两组的不良反应发生率对比无差异（P<0.05）。结论：术前超声引导下QLB联合全身麻醉用于肾移植手术患者,可有效减轻疼痛和应激反应,减少自控静脉镇痛中的舒芬太尼使用量、有效按压次数,且不增加不良反应发生率。     

超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质PGE2、SP和认知功能及睡眠质量的影响

摘要 目的：观察超声引导下髂筋膜神经阻滞联合全麻对老年股骨近端骨折患者术后血清疼痛介质前列腺素E₂（PGE₂）、P物质（SP）和认知功能及睡眠质量的影响。方法：选取2018年8月~2021年9月期间我院收治的择期行手术治疗的老年股骨近端骨折患者80例,根据随机数字表法分为对照组（40例,常规全麻方案）和观察组（40例,超声引导下髂筋膜神经阻滞联合全麻方案）,对比两组麻醉效果、血流动力学、疼痛情况、认知功能和睡眠质量,观察不同模式麻醉下的安全性。结果：观察组的苏醒及拔管时间均短于对照组,丙泊酚使用量少于对照组（P<0.05）。两组置入喉罩时（T1）~术毕时（T3）心率（HR）先升高后下降,平均动脉压（MAP）先下降后升高（P<0.05）;观察组T1~T3时点HR低于对照组,MAP高于对照组（P<0.05）。两组术后24 h血清PGE₂、SP水平和视觉疼痛模拟量表（VAS）评分均升高,但观察组低于对照组（P<0.05）。两组术后1 d、2 d、3 d 蒙特利尔认知评估量表（MoCA）评分较术前先下降后升高（P<0.05）;观察组术后2 d、3 d MoCA评分高于对照组（P<0.05）。两组术后1 d、2 d、3 d匹兹堡睡眠质量评估量表（PSQI）评分较术前先升高后下降（P<0.05）;观察组术后1 d、2 d、3 d PSQI评分低于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：老年股骨近端骨折患者术中选用超声引导下髂筋膜神经阻滞联合全麻,镇痛效果显著,可稳定机体血流动力学,减少对认知功能和睡眠质量的影响,且安全性良好。