Massage therapy in outpatient pediatric chronic pain patients: do they facilitate significant reductions in levels of distress,pain, tension,discomfort, and mood alterations?

Background and objectives: This study was designed to look at the efficacy of adjuvant massage therapy in children and adolescents who presented to a chronic pediatric pain clinic for management. Methods: After Institutional Review Board approval and informed consent and assent was obtained, all pediatric patients who presented to the outpatient chronic pain clinic at Children’s Memorial Hospital from July 2006 to May 2007 were invited to participate in a study that offered massage therapy as an adjunct to conventional pain treatment. Patients (n = 80 sessions, 57 patients) were asked to rate their levels of distress, pain, tension, discomfort, and degree of upset mood on a scale of 1–5 (e.g. for distress 1 = very calm; 5 = very distressed) before and after massage therapy. Paired t‐tests were used to compare pre‐ and postmassage ratings and probability values were corrected for multiple comparisons using the Bonferroni procedure. Results: After massage therapy, patients reported highly significant improvement in their levels of distress, pain, tension, discomfort, and mood compared with their premassage ratings (all t‐values >6.1, ****P < 1 × 10^?8. To control for the possible effects of patients reporting improvements simply as a result of rating their symptoms, we collected control ratings before and after a comparable ‘no intervention’ time period in a subset of 25 patients. The ‘no intervention’ time period typically took place in the treatment room with the therapist present. Approximately 60% of the control ratings were obtained before the intervention and 40% were obtained after the massage therapy. None of the differences between the pre‐ and postratings associated with the ‘no intervention’ control time period were significant. In these same patients, the difference between the pre‐ and postmassage ratings were significant, all t‐values >3.8, **P < 0.001.     

Hepatoprotective effect of morin on ethanol-induced hepatotoxicity in rats

Morin is a flavonoid that exists in nature and is the major component of traditional medicinal herbs. Here we evaluated morin for its hepatoprotective effect against chronic ethanol-induced biochemical changes in male Wistar rats. Ethanol administration (7.9 g/kg bwt) for 60 days induced hepatic and renal damage by increasing oxidative stress and decreasing antioxidant levels. The status of lipid peroxidation (thiobarbituric reactive substances (TBARS) and hydroperoxides (HP)), antioxidant (vitamin C, vitamin E, GSH), serum hepatic markers (AST, ALT, ALP, GGT, bilirubin), and renal markers (urea, creatinine) were assessed as biochemical endpoints to determine the hepatic protective effect of morin. Oral administration of morin (100 mg/kg b.w) to alcohol-intoxicated rats for 30 days showed significant decreases in lipid peroxidation and restoration of antioxidant, hepatic, and renal markers to normal. Histopathologic observations of liver were also in correlation with biochemical parameters. The results indicate that morin might be beneficial in ameliorating alcohol-induced oxidative damage in rat liver.     

Metabolic activation of N-hydroxy-4-acetylaminobiphenyl by cultured human breast epithelial cell line MCF 10A

Metabolism and nucleic acid binding of the mammary gland carcinogenN-hydroxy-4-acetylaminobiphenyl (N-OH-AABP) was investigatedusing the human mammary epithelial cell line MCF 10A. Chromatographicanalysis of the ethyl acetate extract of the media from culturedMCF 1OA after 24 h exposure to N-OH-AABP revealed the formationof two metabolites, 4-aminobiphenyl (ABP) and 4-acetylamlnobi-phenyl (AABP). Incubation of [³H]N-OH-AABP with calf thymusDNA in the presence of the cytosols or microsomes revealed abinding of 0.21 and 2.36 nmol/mg DNA/mg protein respectively.In contrast to cytosol-mediated binding, the microsome-mediatedbinding of [³H]N-OH-AABP to DNA was inhibited by paraoxon. Furthermore,exogenous addition of non-labelled N-hydroxy-4-aminobiphenyl(N-OH-ABP) to the incubation mixture blocked the binding of[³H]N-OH-AABP to DNA, suggesting that the metabolic activationprocess involves inter-molecular transacetylation. Cytosolsfrom MCF 10A also catalyzed acetyl coenzyme A (AcCoA) dependentbinding of [³H]N-OH-ABP to DNA; the amount of binding was 0.51nmol/mg DNA/mg protein. HPLC of the DNA hydrolysate obtainedafter incubation of [³H]N-OH-AABP and [³H]N-OH-ABP with theMCF 10A microsomes and cytosols showed N-(deoxyguanosin-8-yl)-4-aminobiphenyl(dG-ABP) as the primary adduct, based on the mobility of theradioactive peak in comparison with the synthetic standard.³²P-postlabelllng of adducted DNA obtained on incubation withN-OH-ABP or N-OH-AABP showed similar adduct profiles, with themajor adduct corresponding with the bisphospho derivative ofdG-ABP and a minor adduct corresponding with N-(deoxyadenosin-8-yl)-4-aminobiphenyl(dA-ABP). Additionally, the cellular DNA isolated from MCF 10Afollowing exposure to N-OH-AABP also revealed a major spot correspondingwith the dG-ABP derivative. These results suggest that the mammarygland carcinogen N-OH-AABP is activated to reactive electrophilicspecies in the target human mammary tissues by acetyl transferase(s)enzyme systems.     

Superficial cervical plexus block for vocal cord surgery in an awake pediatric patient

Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphonia and dysphagia in patients who have vocal cord paralysis. We report a case of a pediatric patient who underwent this procedure with minimal sedation and bilateral superficial cervical plexus blockade. The use of a regional technique provided analgesia while allowing the patient to phonate at the request of the surgeon. IMPLICATIONS: Medialization thyroplasty is a surgical procedure that decreases the incidence of dysphagia and dysphonia in patients with vocal cord paralysis. This procedure is best performed in a patient who maintains the ability to phonate. We report a case of medialization thyroplasty in a pediatric patient after bilateral superficial cervical plexus blocks with minimal sedation.     

32P-Postlabeling analysis of adducts generated by peroxidase-mediated binding of N-hydroxy-4-acetylaminobiphenyl to DNA

³²P-Postlabeling analysis of the bisphosphate derivatives wasconducted to characterize the DNA adducts generated from theperoxidase-mediated activation of N-hydroxy-4-acetylaminobiphenyl(N-OH-AABP). Autoradiography of the D1 chromatogram of the postlabeledDNA hydrolysate revealed a major adduct (adduct 1) that migratedat R_f 0.15. An adduct with similar chromatographic characteristicswas also obtained by postlabeling the products generated bychemical interaction of: (i) 2', 6'-dichloro-benzoyloxy-4-acetylaminobiphenylwith the 3'-monophosphate of deoxyguanosine, and (ii) N-acetoxy-4-acetylamino-biphenyl(N-OAc-AABP) with calf thymus DNA. The adduct derived from chemicalreaction exhibited the same mobilities on two-dimensional TLCas that obtained from the peroxidase-mediated DNA binding ofN-OH-AABP. Moreover, on HPLC analyses, these bisphosphate derivativesexhibited identical retention times, suggesting that structurallythey might be the same. Furthermore, adduct 1 was insensitiveto digestion with nuclease P1. In addition to adduct 1, anotherminor adduct (adduct 2) was also detected in the peroxidase-mediatedDNA binding of N-OH-AABP. The adduct 2 in D1 exhibited an R_fof 0.66. Adduct 2 was also observed in the DNA sample chemicallyinteracted with N-OAc-AABP. Both these adducts retained theacetyl moiety, which was confirmed by the presence of radioactivityin the hydrolysate of DNA derived by interaction with N-OAc-[¹⁴C-acetyl]AABP(labeled at the N-acetyl group). Based on proton NMR and MSanalyses of the 5'-phospho analogs of adducts 1 and 2, the structuresof these have been identified as 3-(deoxyguanosin-N²-yl)-4-acetylaminobiphenyl(dG-N2-AABP) and N-(deoxyguanosin-8-yl)-4-acetylaminobiphenyl(dG-C8-AABP). Analyses of the DNA samples obtained from humanuroepithelial cells following exposure to N-OH-AABP revealedprimarily the non-acetylated derivative N-(deoxyguanosin-8-yl)-4-aminobiphenyl(dG-C8-ABP) with trace amounts of dG-N2-AABP. These resultssuggest that in the target cells for 4-aminobiphenyl carcinogenesis,the prevalence of the peroxidase mediated activation reactionof N-OH-AABP is relatively minor compared to the acetyltransferasepathway.