疼痛患者脊髓脑脊液中强啡肽含量的分析

本文观察了疼痛患者脊髓脑脊液中强啡肽含量的变化。共收集３１例急性疼痛患者和１４例慢性疼痛患者的脊髓脑脊液,测定其中的强啡肽含量,与２７例无痛患者的结果进行比较,并结合被测者的性别、年龄、体重、血压、脉搏、体温等一般情况进行分析。结果表明,慢性痛患者脑脊液中强啡肽含量显著升高,而急性痛患者则略有降低。判别分析表明,急性痛患者的强啡肽含量及其他临床资料有明显的特点（判别准确率８２％）;慢性痛患者未见明显特征。作者认为,在更广泛地收集临床资料和检验结果的基础上,进一步研究不同病因的疼痛患者的临床特征,可能有助于对疼痛疾病进行鉴别诊断     

Prophylactic corticosteroid to prevent pain flare in bone metastases treated by radiotherapy

BackgroundThe aim of this study was to evaluate the effectiveness of prophylactic corticosteroids to prevent pain flare (PF) in bone metastases treated with radiotherapy performing a meta-analysis of randomized clinical trials (RCT).Materials and methodsRCTs were identified on Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through June 2020. We followed the PRISMA and MOOSE guidelines. A meta-analysis was performed to assess if corticosteroids reduce the PF, pain progression, and the mean of days with PF compared with the placebo. A p-value < 0.05 was considered significant.ResultsThree RCTs with a total of 713 patients treated were included. The corticosteroids reduced the occurrence of early PF 20.5% (51/248) versus 32% (80/250) placebo, OR = 0.55 (95% CI: 0.36–0.82, p = 0.002). The mean days of PF were reduced to 1.6 days (95% CI: 1.3–1.9, p = 0.0001). Prophylactic corticosteroids had more patients with no PF and no pain progression, OR = 1.63 (95% CI: 1.14–2.32, p = 0.007). No significant corticosteroids effect was observed for pain progression (p = ns) and late PF occurrence (p = ns).ConclusionProphylactic corticosteroids reduced the incidence of early PF, the days with PF, resulting in a superior rate of patients with no PF and no pain progression, but with no significant benefit for reducing pain progression or late PF occurrence.     

一次性根管治疗联合清胃散口服对牙髓炎的治疗效果及对疼痛程度影响

摘要 目的：探讨一次性根管治疗联合清胃散口服对牙髓炎的治疗效果及对疼痛程度影响。方法：选取我院2021年1月到2022年12月收治的120例牙髓炎患者，分为观察组与对照组，各60例。对照组患者应用一次性根管治疗，观察组患者应用一次性根管联合清胃散口服治疗，对比两组患者的临床治疗效果，治疗前后咀嚼功能与疼痛程度，白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP）相关炎症因子水平，并对比两组患者的菌斑指数（PLI），龈沟出血指数（SBI）、龈沟探诊深度（SPD）、牙龈指数（GI）相关牙周健康指标水平。结果：观察组总有效率为93.33%明显高于对照组总有效率80.00%（P<0.05）；两组患者治疗前咀嚼功能评分与视觉模拟量表（VAS）评分对比无差异（P＞0.05），治疗后咀嚼功能评分均升高，观察组较对照组高，VAS评分降低，观察组较对照组低（P＜0.05）；两组患者治疗前WBC、PCT、CRP水平对比无差异（P＞0.05），治疗后均降低，观察组较对照组低（P＜0.05）；两组患者治疗前GI、SPD、SBI、PLI水平对比无差异（P＞0.05），治疗后均降低，观察组较对照组低（P＜0.05）。结论：一次性根管治疗联合清胃散口服能够改善牙髓炎的临床疗效，提升患者咀嚼功能，减轻疼痛程度，降低机体炎症因子水平，同时能够进一步改善患者牙周健康程度，值得临床应用推广。     

经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果分析

目的：探究经皮椎弓根空心螺钉微创椎体间融合治疗腰椎间盘突出的临床效果及安全性。方法：病例来源于我院2009 年12 月~2013 年12 月收治的确诊为腰椎间盘突出症的病患174 例,依据随机数字表法将其均分为观察组与对照组,每组87 例。其 中,观察组施行Quadrant微创通道经皮椎弓根空心螺钉椎间融合术,对照组施行经后入路开放性椎间融合术。评估和比较两组病 患术前和随访结束时的视觉模拟评分系统(VAS)疼痛评分与Oswestry 功能障碍指数(ODI)的变化及术后并发症的发生情况。结 果：观察组治疗前、出院时及随访一年时的VAS 评分与ODI指数与对照组比较差异均不显著(P>0.05)。观察组手术切口长度、术 后住院时间及术中出血量均明显优于对照组(P<0.01),而其手术所需时间明显长于对照组(P<0.01)。对照组患者术后出现20 例神 经根损伤(22.99%),3 例椎间隙感染(3.45%),其并发症总发生率为(26.44%),而观察组患者术后仅出现3 例神经根损伤,发生率为 3.45%,显著低于对照组(P<0.01)。结论：经皮椎弓根空心螺钉微创椎体间融合治疗的临床效果肯定,能减少对病患的创伤,控制术 后并发症的发生,具有较高的临床应用价值。     

Can novel methods be useful for pain assessment of castrated piglets?

Given that surgical castration is a painful practice performed on millions of pigs every year, a need to identify novel reliable pain assessment tools exists in order to test anaesthetic and analgesic protocols that may reduce related pain. Two treatments were considered: handling (H) and surgical castration (C). Physiological (cortisol, lactate, glycaemia, rectal and eye temperature) and behavioural variables (latency to move after treatment and alterations in posture and walking) were analysed. Cortisol showed the greatest level in C piglets within 20 min after the surgical procedure and a positive correlation with glucose concentration. Eye temperature was higher in C piglets, and the same difference was detected for rectal temperature 3 h after castration. Behavioural parameters revealed that C piglets had longer latency to move and a higher percentage of them showed alterations in posture and walking. Results of this study showed that, in castrated piglets behavioural and physiological alterations occur mainly in the first 3 h from treatment. Latency to move, alterations in posture and walking, and eye temperature appear to give additional and useful information in piglet pain assessment. However, differently from the behavioural parameters considered, eye temperature involves several manipulations of the animals and a long process to acquire the data.     

Divergence in Endothelin-1- and Bradykinin-Activated Store-Operated Calcium Entry in Afferent Sensory Neurons

Endothelin-1 (ET-1) and bradykinin (BK) are endogenous peptides that signal through Gαq/11-protein coupled receptors (GPCRs) to produce nociceptor sensitization and pain. Both peptides activate phospholipase C to stimulate Ca²⁺ accumulation, diacylglycerol production, and protein kinase C activation and are rapidly desensitized via a G-protein receptor kinase 2-dependent mechanism. However, ET-1 produces a greater response and longer lasting nocifensive behavior than BK in multiple models, indicating a potentially divergent signaling mechanism in primary afferent sensory neurons. Using cultured sensory neurons, we demonstrate significant differences in both Ca²⁺ influx and Ca²⁺ release from intracellular stores following ET-1 and BK treatments. As intracellular store depletion may contribute to the regulation of other signaling cascades downstream of GPCRs, we concentrated our investigation on store-operated Ca²⁺ channels. Using pharmacological approaches, we identified transient receptor potential canonical channel 3 (TRPC3) as a dominant contributor to Ca²⁺ influx subsequent to ET-1 treatment. On the other hand, BK treatment stimulated Orai1 activation, with only minor input from TRPC3. Taken together, data presented here suggest that ET-1 signaling targets TRPC3, generating a prolonged Ca²⁺ signal that perpetuates nocifensive responses. In contrast, Orai1 dominates as the downstream target of BK receptor activation and results in transient intracellular Ca²⁺ increases and abridged nocifensive responses.     

Integrity of the Actin Cytoskeleton of Host Macrophages is Essential for Leishmania donovani Infection

Visceral leishmaniasis is a vector-borne disease caused by an obligate intracellular protozoan parasite Leishmania donovani. The molecular mechanism involved in internalization of Leishmania is poorly understood. The entry of Leishmania involves interaction with the plasma membrane of host cells. We have previously demonstrated the requirement of host membrane cholesterol in the binding and internalization of L. donovani into macrophages. In the present work, we explored the role of the host actin cytoskeleton in leishmanial infection. We observed a dose-dependent reduction in the attachment of Leishmania promastigotes to host macrophages upon destabilization of the actin cytoskeleton by cytochalasin D. This is accompanied by a concomitant reduction in the intracellular amastigote load. We utilized a recently developed high resolution microscopy-based method to quantitate cellular F-actin content upon treatment with cytochalasin D. A striking feature of our results is that binding of Leishmania promastigotes and intracellular amastigote load show close correlation with cellular F-actin level. Importantly, the binding of Escherichia coli remained invariant upon actin destabilization of host cells, thereby implying specific involvement of the actin cytoskeleton in Leishmania infection. To the best of our knowledge, these novel results constitute the first comprehensive demonstration on the specific role of the host actin cytoskeleton in Leishmania infection. Our results could be significant in developing future therapeutic strategies to tackle leishmaniasis.     

CDKN2B expression and subcutaneous adipose tissue expandability: Possible influence of the 9p21 atherosclerosis locus

Risk alleles within a gene desert at the 9p21 locus constitute the most prevalent genetic determinant of cardiovascular disease. Previous research has demonstrated that 9p21 risk variants influence gene expression in vascular tissues, yet the biological mechanisms by which this would mediate atherosclerosis merits further investigation. To investigate possible influences of this locus on other tissues, we explored expression patterns of 9p21-regulated genes in a panel of multiple human tissues and found that the tumor suppressor CDKN2B was highly expressed in subcutaneous adipose tissue (SAT). CDKN2B expression was regulated by obesity status, and this effect was stronger in carriers of 9p21 risk alleles. Covariation between expression of CDKN2B and genes implemented in adipogenesis was consistent with an inhibitory effect of CDKN2B on SAT proliferation. Moreover, studies of postprandial triacylglycerol clearance indicated that CDKN2B is involved in down-regulation of SAT fatty acid trafficking. CDKN2B expression in SAT correlated with indicators of ectopic fat accumulation, including markers of hepatic steatosis. Among genes regulated by 9p21 risk variants, CDKN2B appears to play a significant role in the regulation of SAT expandability, which is a strong determinant of lipotoxicity and therefore might contribute to the development of atherosclerosis.     

N-type voltage-dependent Ca channel in non-excitable microglial cells in mice is involved in the pathophysiology of neuropathic pain

Peripheral nerve injury induces neuropathic pain which is characterized by tactile allodynia and thermal hyperalgesia. N-type voltage-dependent Ca²⁺ channel (VDCC) plays pivotal roles in the development of neuropathic pain, since mice lacking Ca_v2.2, the pore-forming subunit of N-type VDCC, show greatly reduced symptoms of both tactile allodynia and thermal hyperalgesia. Our study on gene expression profiles of the Ca_v2.2 knockout (KO) spinal cord after spinal nerve ligation (SNL)-injury revealed altered expression of genes known to be expressed in microglia, raising an odd idea that N-type VDCC may function in not only excitable (neurons) but also non-excitable (microglia) cells in neuropathic pain state. In the present study, we have tested this idea by using a transgenic mouse line, in which suppression of Ca_v2.2 expression can be achieved specifically in microglia/macrophage by the application of tamoxifen. We found SNL-operated transgenic mice exhibited greatly reduced signs of tactile allodynia, whereas the degree of thermal hyperalgesia was almost the same as that of control. Immunohistochemical analysis of the transgenic lumbar spinal cord revealed reduced accumulation of Iba1-positive cells (microglia/macrophage) around the injured neurons, indicating microglial N-type VDCC is important for accumulation of microglia at the lesion sites. Although the mechanism of its activation is not clear at present, activation of N-type VDCC expressed in non-excitable microglial cells contributes to the pathophysiology of neuropathic pain.