Animals ; Bone Neoplasms ; Bone and Bones ; Humans ; Models, Animal ; Neoplasms ; Pain

OBJECTIVETo observe the intervention of electroacupuncture (EA) with different current frequencies and treatment frequencies on pain thresholt in rats with bone-cancer pain, so as to optimize treatment parameters of EA against bone cancer pain; and by measuring gene expression of opioid receptor and precursor in different tissues to preliminarily explore the possible mechanism of EA against bone cancer pain.

METHODSNinety healthy female SD rats were randomly divided into a control group, a model group, EA groups (6 subgroups according to different frequencies) and a sham EA group, ten rats in each one. Rats in the control group were injected with 10 µL of amicrobic phosphate buffer solution (PBS) into tibial cavity; rats in the remaining groups were injected with Walker 256 cancer cells to establish model of bone-cancer pain. No treatment was given to rats in the control group and model group; rats in the EA groups were treated with EA at bilateral "Housanli" (ST 36) and "Genduan" with 3 different current frequencies (2 Hz, 100 Hz and 2 Hz/100 Hz), once a day and once every other day, 30 min per treatment (1mA for 15 min, 2 mA for 15 min); rats in the sham EA group were treated with identical acupoints as the EA group, but the acupoints were needled subcutaneously and EA was connected with power off. All the treatment was given for 14 days. Dynamic plantar aesthesiometer was applied to measure the paw withdrawal thresholds (PWTs) of the affected side before the model establishment, 6d, 8d, 10d, 12d, 14d, 16d, 18d, and 20d after model establishment. The mRNA expressions of µ-opioid receptor (MOR), κ-opioid receptor (KOR), δ-opioid receptor (DOR), proopiomelanocortin (POMC) and prodynorphin (PDYN) in dorsal root ganglion (DRG) and lumbar spinal cord dorsal horn (SCDH) of L4-L6 of the affected side were detected by PCR method.

RESULTSThere were no differences in PWTs among all groups before model establishment (P>0. 05). Each time point after model establishment, PWTs in model group were obviously lower than those in the control group (all P<0. 01). Compared with the model group, PWTs in each EA subgroup were all increased (all P<0.05), but the differences at different time points were not significant among EA subgroups (P>0.05). The mRNA expressions of MOR, KOR, POMC, and PDYN in L4-L6 DRG in the 2 Hz/100 Hz II group were significantly higher than those in model group (P<0. 05, P<0. 01), while the mRNA expressions of MOR, KOR, DOR, POMC and PDYN in SCDH were not different compared with the model group (P>0. 05).

CONCLUSIONEA treatment has obvious analgesic effect on bone-cancer pain, however, its effect is not related with current frequency and treating frequency. EA against bone-cancer pain may be related with increasing the mRNA expression of some peripheral opioid receptors and precursor.

Acupuncture Analgesia ; instrumentation ; methods ; Acupuncture Points ; Animals ; Bone Neoplasms ; complications ; Electroacupuncture ; instrumentation ; methods ; Enkephalins ; metabolism ; Female ; Ganglia, Spinal ; metabolism ; Humans ; Pain ; etiology ; genetics ; metabolism ; Pain Management ; instrumentation ; methods ; Protein Precursors ; metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, Opioid ; genetics ; metabolism

Objective To study the diagnostic accuracy of bedside lung ultrasound examination in chronic obstructive pulmonary disease (COPD) and cardiac pulmonary edema.Methods A prospective pilot and single-blind trial was conducted.A total of 89 patients with respiratory failure admitted to the Department of Critical Care Medicine of Anhui Provincial Hospital from September 2012 to September 2013 were enrolled.There were 32 patients with COPD,31 patients with cardiac pulmonary edema,8 patients with interstitial lung disease,12 with lung infection,and 6 patients with other diseases.Another group of 30 patients without respiratory disease were enrolled as the control group.Bedside lung ultrasound examinations were performed in all patients within 24 hours,and chest radiograph was performed at the same time.The signs to be revealed were the A lines or horizontal lines arising from the pleural line,and the comet-tail artifact (B lines) arising from the lung wall interface.Results Of 89 patients,33 patients were shown a mean of 2.94 ± 1.87 A lines per case with the bedside lung ultrasound,and 38 patients with a mean of 3.27 ± 1.72 B lines per patient.1.94 ± 0.96 A lines a case and 1.74 ± 0.82 B lines a case in control group.There were significant difference between the test group and control group (Aline:t=3.835,P=0.000; B line:t=6.540,P=0.000).Among 32 cases with COPD,28 patients had a positive result of A line with a coincidence rate of 81.2％.In the 31 patients with cardiac pulmonary edema,25 patients presented B line,with a coincidence rate of 80.6％.The A lines or horizontal lines arising from the pleural line showed a sensitivity of 81.30％ and a specificity of 87.70％ with a positive predictive value (PPV) 78.80％ and a negative predictive value (NPV) 89.30％ of in the diagnosis of COPD,and the B lines showed a sensitivity of 80.60％ and a specificity of 77.60％ with a PPV of 65.80％ and a NPV of 88.20％ in the diagnosis of cardiac pulmonary edema.However,X-ray examination showed a sensitivity of 65.50％,a specificity of 86.00％,a PPV of 72.40％ and a NPV of 81.70％ in the diagnosis of COPD,and it showed a sensitivity of 74.20％,a specificity of 69.00％,a PPV of 56.10％ and a NPV of 83.30％ in the diagnosis of cardiac pulmonary edema.Bedside ultrasound was highly consistent with X-ray in diagnosis of COPD [area under receiver operating characteristic curve (AUC):0.833 vs.0.816,P＞0.05],but Kappa value of ultrasound technology A line in the diagnosis of COPD was greater than the value of X-ray imaging techniques (0.685 vs.0.527).There was little diagnostic value of ultrasound A line in cardiac pulmonary edema (AUC was 0.305),while the B line was superior to X-ray (AUC:0.888 vs.0.747,P＜0.001),and had a higher Kappa value than the value of X-ray imaging techniques (0.553 vs.0.481) in cardiac pulmonary edema.Conclusions We conclude that bedside ultrasound is cost-effective,easy for repeated examination,and suitable for differential diagnosis of lung diseases.It might be useful in screening for COPD and cardiac pulmonary edema.

Objective To observe the functional changes of T lymphocytes in the spleen of rats with bone cancer pain.Methods forty-one healthy female Sprague-Dawley rats were used in this study, and were divided into blank control, PBS and Walker-256 tumor groups.Bone cancer pain model was established by inoculation of Walker 256 cancer cells into the tibial cavity.The paw withdrawal threshold (PWT), paw withdrawal thermal latency (PWL), and spontaneous pain (SP) were all measured before modelling (as base) and at 4, 6, 8, 10, 12, 14, 16, 18, and 20 days after modelling. The function of T lymphocyte proliferation, and the content of T lymphocytes and their subgroups in the spleen were detected by cell counting kit-8 method and flow cytometry, respectively, on day 20 after modelling.Results Before modellng, there were no differences of PWT, PWL, and SP between the PBS and model groups.After modelling, the PWT and SP of model group were significantly decreased on day 4, and were always lower than that of PBS group during the experiment.Statistical analysis revealed that Walker-256 cancer cell inoculation in the tibia induced a significant decrease in PWL on day 8, 10 and 12 after modellng.Compared with the control group, T lymphocyte proliferation, content of T lymphocyte (CD3) and subgroups ( CD4 and CD8) in the PBS group were not significantly decreased.However, T lymphocyte proliferation and the content of CD3 lymphocytes in the model group were significantly lower than those in the blank control group and/or PBS group.Conclusions The bone cancer pain rat model may appear obvious mechanical allodynia and spontaneous pain.Its thermal pain hyperalgesiaonly occurred in the intermediate stage of bone cancer pain. The content of T lymphocytes and its subgroups, and the function of T lymphocyte proliferation are weakened to some extent in the bone cancer pain rat model.

[摘 要] 目的：探讨表皮生长因子受体（epidermal growth factor receptor，EGFR）基因突变与非小细胞肺癌（non-small cell lung cancer，NSCLC）伴脑转移患者预后的相关性，为改善NSCLC合并脑转移患者预后、指导个体化治疗提供临床依据。方法：回顾性分析福建省立医院2013年1月1日至2018年9月30日期间收治的88例NSCLC合并脑转移患者的临床资料，随访取得患者的死亡时间，随访截止日期为2019年10月31日。收集和分析的临床资料包括性别、年龄、吸烟史、病理类型、基因检测、治疗情况、无进展生存期（progression free survival，PFS）、总生存期（overall survival，OS）等。运用生存分析（Kaplan-Meier生存时间曲线）评价EGFR突变型患者的预后，以单因素分析（log-rank检验）预测影响EGFR-TKI治疗效果的因素。结果：88例NSCLC脑转移患者有57例为EGFR突变型，其中位PFS（MPFS）为13.0个月（95%CI：11.951~14.049），明显高于EGFR野生型患者（P=0.003），患者中位生存期（median survival time，MST）为29.0个月（95%CI：20.531~37.468），明显高于EGFR野生型（P=0.001）。EGFR突变型中，Exon19-del突变组患者较Exon21 L858R突变组患者OS有延长趋势（P=0.05），Exon19-del+Exon20T790M突变组患者OS较Exon21 L858R突变组有延长趋势（P=0.077）。结论：EGFR突变组较野生型组NSCLC脑转移患者预后相对好些，且携带19外显子单一缺失突变的患者预后最好。