Prevention of Osteopenia Induced with a Gonadotropin-Releasing Hormone Agonist in Rats

We investigated the effects of conjugated estrogens as an add-back replacement drug, incadronate sodium as a bisphosphonate, and alfacalcidol as a vitamin D₃ analog on femoral bone mineral density (BMD) and bone mineral content (BMC) in female rats chronically treated with the gonadotropin-releasing hormone (GnRH) agonist leuprorelin acetate. The chemical castration of the rats by the administration of GnRH agonist for 16 weeks reduced the BMD values to 92.3%, 91.3%, and 93.3% of those of the normal control animals in the whole femur, metaphysis, and diaphysis of the femur, respectively. The BMC value was decreased to 91.0% of that of the normal control animals by the chronic GnRH agonist treatment. However, a simultaneous 8-week administration of conjugated estrogens, bisphosphonate, and vitamin D₃ analog markedly augmented the BMC values to 110.3%, 110.1%, and 114.4%, respectively, of those in the rats treated with the GnRH agonist alone. These findings indicate that antiosteoporotic agents could be useful for preventing induced osteopenia under the careful monitoring of biochemical markers of osteoblastic activity or bone resorption and BMD or BMC in patients undergoing GnRH treatment. Received: 8 December 1998 / Accepted: 10 February 1999     

Comparative evaluation of four different infusion rates of ropivacaine (2 mg/mL) for epidural labor analgesia

Background and Objectives. Previous studies have reported comparable efficacy for ropivacaine and bupivacaine when used for labor analgesia at concentrations of 2.5 mg/mL. In this multicenter study, we assessed ropivacaine at the commercially available concentration of 2 mg/mL (0.2%) for labor pain management. Methods. After Institutional Review Board approval and informed consent, 128 women at term were randomly assigned to receive ropivacaine at one of the four infusion rates via a lumbar epidural catheter. Analgesia was initiated with a 5-mL test dose, followed by injections of 5–15 mL of 2 mg/mL ropivacaine. The continuous infusion was then started at 4, 6, 8, or 10 mL/hour. Rescue analgesia was provided with 5-mL “top-up” injections as necessary to provide maternal comfort. Pain relief was assessed by using a visual analog pain scale (VAPS) and motor block was assessed by using a modified Bromage scale. Results. All infusion regimens effectively decreased VAPS, and most patients in all groups had minimal or no motor block at the end of the first stage of labor. Mean total number of the top-up injections required per patient were 3, 2, 1.5, and 1.4, respectively, in the 4, 6, 8, and 10-mL/hour groups (P < .05, 4 mL/hour vs. all other groups). Despite receiving more total bolus dosages, the 4-mL/hour group had less motor block in the lower extremities (P < .05). Apgar scores and neurological adaptive capacity scores were similar for all groups. Conclusions. The 2 mg/mL of ropivacaine produces satisfactory labor analgesia at epidural infusion rates of 4, 6, 8, and 10 mL/hour, provided supplemental bolus dosages are available. Clinically, a rate of 6 mL/hour may be the lowest effective rate that provides the best combination of pain relief, motor block, and rebolusing, although rates of 8 and 10 mL/hour produced similar results.     

Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study

Background:Patient with chronic nonspecific low back pain is weakened ligament, and prolotherapy is the effective treatment but their use remains controversial. These ligaments can be strengthened by platelet-rich plasma injection. We hypothesized that the effectiveness of platelet-rich plasma injection and prolotherapy may decrease pain and improved disability of patient with chronic low back painMethods:This study was a prospective, double-blind, randomized controlled trial and was conducted for 3 years for patient enroll and follow-up. Thirty-four patients with chronic nonspecific low back pain (duration of at least 3 months) refectory to conventional management were randomized to platelet-rich plasma injection and lidocaine injection. Patients were treated with weekly platelet-rich plasma or lidocaine injections at the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy with 15% glucose for 2 weeks and followed up 6 months. Visual analog scale, Oswestry Disability Index, and Roland–Morris Disability Questionnaire were evaluated at initial, 4 weeks, 3 months, and 6 months. Four patients did not complete this trial. Three were in the platelet-rich plasma injection and 1 was in the lidocaine injection.Results:The intensity of pain was significantly decreased in platelet-rich plasma injections at 6 months as compared lidocaine injections; between-group differences were 0.9 (95% confidence interval 0.10–1.75 [P = .027]). All participants were significantly decreased pain and disability index at 4 weeks, 3 months, and 6 months but there were no significant differences between groups except for visual analog scale at 6 months. The baseline parameters were no significant differences in both groups.Conclusions:In chronic nonspecific low back pain, the platelet-rich plasma injection in combination with prolotherapy is an effective intervention and either lidocaine or platelet-rich plasma injection significantly reduced disability. And injection at the lumbopelvic ligaments using the platelet-rich plasma and prolotherapy is also an effective treatment for pain.     

The nociceptive and anti-nociceptive effects of bee venom injection and therapy: A double-edged sword

Bee venom injection as a therapy, like many other complementary and alternative medicine approaches, has been used for thousands of years to attempt to alleviate a range of diseases including arthritis. More recently, additional theraupeutic goals have been added to the list of diseases making this a critical time to evaluate the evidence for the beneficial and adverse effects of bee venom injection. Although reports of pain reduction (analgesic and antinociceptive) and anti-inflammatory effects of bee venom injection are accumulating in the literature, it is common knowledge that bee venom stings are painful and produce inflammation. In addition, a significant number of studies have been performed in the past decade highlighting that injection of bee venom and components of bee venom produce significant signs of pain or nociception, inflammation and many effects at multiple levels of immediate, acute and prolonged pain processes. This report reviews the extensive new data regarding the deleterious effects of bee venom injection in people and animals, our current understanding of the responsible underlying mechanisms and critical venom components, and provides a critical evaluation of reports of the beneficial effects of bee venom injection in people and animals and the proposed underlying mechanisms. Although further studies are required to make firm conclusions, therapeutic bee venom injection may be beneficial for some patients, but may also be harmful. This report highlights key patterns of results, critical shortcomings, and essential areas requiring further study.     

Robotic-Assisted Shoulder Rehabilitation Therapy Effectively Improved Poststroke Hemiplegic Shoulder Pain: A Randomized Controlled Trial

ObjectiveThe purpose of this study was to investigate the therapeutic effects of a newly developed shoulder robot on poststroke hemiplegic shoulder pain.DesignProspective, single-blind randomized controlled trial.SettingInpatient department of a tertiary university hospital.ParticipantsHemiplegic shoulder pain patients (N=38) were consecutively recruited and randomly assigned to an intervention or control group.InterventionsA newly developed robot was designed to perform joint mobilization and stretching exercises with patients lying in the supine position. Conventional physical therapy directed at both improving upper extremity mechanics and reducing neurologic injury was performed twice per day in both groups. In the intervention group, additional robotic-assisted shoulder rehabilitation therapy was administered for 30 minutes per day, 5 times per week for 4 weeks.Main Outcome MeasuresThe visual analog scale was the primary outcome, and the pain-free passive range of motion of the shoulder joint, the Korean version of the Shoulder Disability Questionnaire, and ultrasonographic grades were the secondary outcomes. The outcomes were evaluated at baseline (T0), postintervention (T1), and a 4-week follow-up (T2).ResultsSignificant time and group interaction effects were found on the visual analog scale, in the abduction passive range of motion, and on the Shoulder Disability Questionnaire (F_2,33=16.384, P=.002; F_2,33=10.609, P=.012; F_2,33=32.650, P=.008, respectively). Significantly higher improvements in these outcome measures were observed in the intervention group than in the control group at T1 after post hoc analysis (P<0.05, all). These improvements were sustained at T2 when the intervention group was compared with the control group (P<.05, all).ConclusionsA prototype shoulder rehabilitation robot as an adjuvant therapy improves hemiplegic shoulder pain and self-reported shoulder-related disability.     

Prospective randomized,double-blinded,placebo-controlled trial of preoperative etoricoxib for pain relief in uterine fractional curettage under paracervical block

Objective

To evaluate the analgesic efficacy of preoperative etoricoxib combined with paracervical nerve block in patients who underwent uterine fractional curettage.

Study design

This double-blinded, randomized, placebo-controlled trial included 80 women who underwent uterine fractional curettage under paracervical block. Forty women were randomly assigned to etoricoxib 120 mg and 40 women to the placebo. The main outcome measure was the intensity of pain measured using the visual analog pain score during and after the procedure. Student's t-tests, Mann–Whitney U-test, and Chi-squared test were used for statistical analysis.

Results

The intensity of pain during operative procedure in the etoricoxib group was lower than in the placebo group (median visual analog pain scores (interquartile range) 48 (43–64) vs. 61 (51–72), P = 0.001) The amount of postoperative acetaminophen used in the etoricoxib group was also lower than in the placebo group (2.2 ± 1.7 vs. 3.2 ± 1.7 tablets, P = 0.011). We found no significant adverse effects in this study.

Conclusion

The preoperative administration of 120 mg oral etoricoxib can slightly reduce pain during fractional curettage under paracervical block. However, the degree of pain reduction by this treatment has no clinical importance.     

Smac和XIAP与卵巢癌细胞耐药及凋亡关系的研究

目的探讨Smac与卵巢癌耐药及凋亡机制。方法采用RT-PCR、Western blot方法分别从基因和蛋白水平检测卵巢癌细胞系SKOV3及其耐药细胞系SKOV3/DDP中Smac与XIAP的表达水平的差异。构建Smac真核表达载体pc DNA3.1(+)/EGFP+Smac。采用脂质体转染法将pc DNA3.1(+)/EGFP+Smac真核表达载体导入卵巢癌顺铂耐药细胞系SKOV3/DDP。运用Western blot法检测转染前后细胞内Smac与XIAP表达的变化,MTT法检测Smac表达增加后细胞生长抑制率,观察Smac基因对卵巢癌细胞凋亡的影响。结果 SKOV3、SKOV3/DDP细胞系中均表达Smac/DIABLO与XIAP,且SKOV3中Smac的相对含量高于SKOV3/DDP。SKOV3中XIAP的相对含量低于SKOV3/DDP。Western blot检测转染后耐药细胞Smac蛋白表达增加,XIAP表达无明显改变。MTT结果转染48 h与72 h后细胞生长抑制率出现明显增加,差异有统计学意义(P<0.01)。结论 Smac表达的上调对卵巢癌细胞XIAP表达无明显影响,但对肿瘤细胞生长有明显的抑制作用。提示Smac确实促进卵巢癌细胞凋亡,但其凋亡机制并不是促进XIAP降解,而是与XIAP相互结合抑制其与caspase结合,激活caspase进而起到促凋亡作用。     

低强度激光照射缓解正畸分牙期间疼痛的疗效评价

目的评价低强度激光用于缓解弹性正畸分牙期间疼痛的治疗效果。方法将需固定正畸前分牙患者60例随机分为激光照射组和安慰治疗组各30例,均使用弹性橡皮圈分牙120h。在弹性分牙圈放置2、6、24、72、120h后,激光照射组采用激光治疗机照射第一磨牙颊侧根尖部,沿颊侧根轴依次向上照射3点至牙颈部,照射时间30s／次;安慰治疗组按同样照射部位使用输出功率为零假激光照射;应用视觉模拟评分（visual analog scale,VAs）评估2组分牙疼痛强度,并分析低强度激光对分牙疼痛的影响。结果放置弹性分牙圈2、6、24、72h,激光照射组VAS评分值均低于安慰治疗组,差异有统计学意义（P〈O．01）。结论低强度激光照射可有效减轻正畸患者分牙期间的疼痛。     

TMPRSS4及Smac在胃癌侵袭和转移中的机制及临床意义的研究

目的:通过检测胃癌组织中TMPRSS4与Smac的表达情况,分析其在胃癌侵袭与转移中的机制,并探讨其在胃癌发生、发展过程中的作用与意义。方法:采用Western blot、RT-PCR及免疫组化的方法检测胃癌组织与正常胃组织的TMPRSS4与Smac的表达。用脂质体转染过表达TMPRSS4胃癌细胞,构建特异性TMPRSS4siRNA表达载体,通过Transwell侵袭实验与划痕愈合实验研究TM-PRSS4表达的胃癌细胞侵袭转移机制;采用脂质体介导转染胃癌细胞MKN-45,用丝裂霉素处理转染前后的胃癌细胞株MKN-45,观察MKN-45的凋亡情况。结果:TMPRSS4mRNA与蛋白在胃癌组织中的表达明显高于正常组织,且以中、高表达占多数,差异有统计学意义(P<0.01);TMPRSS4mRNA与蛋白的表达水平与TNM分期、淋巴结转移个数、肿瘤直径大小、浸润深度有关,差异均有统计学意义(P<0.05～0.01)。在正常胃组织中的Smac表达率明显高于胃癌组织,差异有统计学意义(P<0.01);胃癌细胞的浸润深度、淋巴结转移个数与Samc的表达相关,差异有统计学意义(P<0.05);肿瘤直径大小与TNM分期与Samc表达无明显相关,差异无统计学意义(P>0.05)。转染后的MKN-45对化疗药物的敏感性比转染前明显增强,差异有统计学意义(P<0.05)。随访后发现TMPRSS4与Samc和患者的预后及生存时间相关。结论:TMPRSS4与患者的预后相关,可为患者的预后判断提供一定的依据;Samc的过表达能提高化疗药物的敏感性,为判断临床药物治疗的疗效提供一定的依据。     

人胃癌组织中Smac和Livin的表达及其临床意义

目的 观察Smac和Livin在人胃癌组织中的表达.方法 应用免疫组织化学SP法检测79例胃癌组织中Smac和Livin表达,分析Smac和Livin表达和临床病理因素、预后及相互的关系.结果 Smac和Livin在胃癌组织的阳性表达率分别为68.4%和46.8%.Smac在低分化,Ⅲ、Ⅳ期和青年人胃癌患者中的表达明显降低(P＜0.05);Livin在低分化和Ⅲ、Ⅳ期胃癌患者中的表达明显升高(P＜0.05).Smae表达阳性患者(40.7%)和Livin表达阴性者(45.2%)的5年生存率明显高于Smac表达阴性者(16.0%)和Livin表达阳性者(18.9%,P＜0.05).Smac和Livin表达呈负相关(P＜0.01).结论 Smac和Livin表达可作为判断胃癌组织恶性程度和预后的辅助指标.