PURPOSE: Berberine is a type of isoquinoline alkaloid that has been used to treat various diseases. A neuroprotective effect of berberine against cerebral ischemia has been reported; however, the effects of berberine on apoptosis in relation to reactive astrogliosis and microglia activation under ischemic conditions have not yet been fully evaluated. In the present study, we investigated the effects of berberine on global ischemia-induced apoptosis, and focused on the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in the hippocampus using gerbils. METHODS: Gerbils received berberine orally once a day for 14 consecutive days, starting one day after surgery. In this study, a step-down avoidance task was used to assess short-term memory. Furthermore, we employed the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay to evaluate DNA fragmentation, immunohistochemistry to investigate glial fibriallary acidic protein, CD11b, and caspase-3, and western blot to assess PI3K, Akt, Bax, Bcl-2, and cytochrome c. RESULTS: Our results revealed that berberine treatment alleviated ischemia-induced short-term memory impairment. Treatment with berbeine also attenuated ischemia-induced apoptosis and inhibited reactive astrogliosis and microglia activation. Furthermore, berberine enhanced phospho-PI3K and phospho-Akt expression in the hippocampus of ischemic gerbils. CONCLUSIONS: Berberine exerted a neuroprotective effect against ischemic insult by inhibiting neuronal apoptosis via activation of the PI3K/Akt signaling pathway. The antiapoptotic effect of berberine was achieved through inhibition of reactive astrogliosis and microglia activation. Berberine may therefore serve as a therapeutic agent for stroke-induced neurourological problems.
Apoptosis* ; Berberine* ; Blotting, Western ; Brain Ischemia ; Caspase 3 ; Cytochromes c ; DNA Fragmentation ; Gerbillinae ; Hippocampus ; Immunohistochemistry ; Memory, Short-Term ; Microglia ; Neurons ; Neuroprotective Agents ; Phosphatidylinositol 3-Kinases ; Phosphotransferases*

BACKGROUND: Left ventricular ejection fraction (LVEF) is considered to be an index of LV function. However, LVEF in chronic mitral regurgitation (MR) is overestimated due to a "systolic unloading effect" into the left atrium and leads to underestimation of the degree of LV dysfunction preoperatively. The purpose of this study was to evaluate the exact degree of preoperative LV dysfunction by LVEF, according to the MR grade. METHODS: Transesophageal echocardiography (on transgastric short axis view) was performed to compare LVEF at the Pre- and Post-MVR periods, in 39 patients with chronic MR: group I, MR grade III (n = 16) and group II, MR grade IV (n = 23). RESULTS: LVEF at Pre- and Post-MVR were 63.8 +/- 6.1% and 54.8 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 9.0 +/- 3.5 by number (14.1 +/- 5.3% by ratio) in group I. LVEF at Pre- and Post-MVR were 68.1 +/- 7.2% and 51.7 +/- 6.0%, respectively, and the LVEF difference between Pre- and Post-MVR was 16.4 +/- 4.2 by number (24.0 +/- 5.2% by ratio) in group II. CONCLUSIONS: For the exact evaluation of preoperative LV function in patients with chronic MR, we have to subtract 9.0 by number (14.1% by ratio) from the preoperative LVEF in MR grade III and 16.4 by number (24.0% by ratio) from the preoperative LVEF in MR grade IV.
Axis, Cervical Vertebra ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Stroke Volume*

BACKGROUND: Continuous epidural block after surgery has been able to get better postoperative analgesic effect than intermittent intravenous (IV) opioids and to decrease the duration of mechanical ventilatory support, endotracheal intubation and ICU stay. The purpose of this study is to observe these effects of continuous epidural block after cardiac surgery. METHODS: 30 patients, undergoing cardiac surgery, were divided into 2 groups. Postoperative analgesia were performed by intermittent IV meperidine 25 mg in group 1 and by continuous epidural block with 1% mepivacaine 100 ml and morphine 4 mg in group 2. Both groups were supplemented, at the patient's request, by IV meperidine 25 mg as needed. Quality of pain relief, total number of IV meperidine and duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay were compared between 2 groups. RESULTS: Quality of pain relief and total number of IV meperidine were significantly lower in group 2 than group 1, each time interval. Duration of consciousness return, mechanical ventilatory support, endotracheal intubation, ICU stay and time interval between consciousness return & mechanical ventilatory support were significantly shorter in group 2 than group 1. CONCLUSIONS: Continuous epidural block, with 1% mepivacaine 100 ml and morphine 4 mg, for postoperative analgesia decreases the duration of intensive care compaered with intermittent IV meperidine 25 mg, after cardiac surgery.
Analgesia ; Analgesics, Opioid ; Consciousness ; Humans ; Critical Care* ; Intubation, Intratracheal ; Meperidine ; Mepivacaine ; Morphine ; Thoracic Surgery*

BACKGROUND: Steroid injections are commonly used in pain clinics to relieve pain and treat inflammation. In Korea, these steroid injections are well known as ‘ppyeojusa’, which means to inject into the bone in Korean. Some patients often have a negative perception of this treatment method due to inaccurate information about the treatment and side effects of steroids. The purpose of this study is to investigate patients’ perception and knowledge of ppyeojusa. METHODS: A questionnaire about ppyeojusa was completed by patients who visited one of the pain clinics in nine university hospitals, from August 1 to September 10, 2017. RESULTS: Three-hundred seventy-four patients completed the survey. Eighty-five percent of patients had had ppyeojusa, and 74% of the respondents had heard of ppyeojusa from the mass media, friends or relatives. Only 39% of the patients answered that this injection was safe without side effects if properly spaced. Of the patients surveyed, 21% responded that ppyeojusa are “injections into the bone”; while 15% responded that ppyeojusa are “terrible injections that melted ‘the bone if used a lot’”. Half of the patients did not know what the active constituent is in ppyeojusa. If steroid injections are advised by the pain specialists, 89% of the patients would consent. CONCLUSIONS: Most pain clinic patients have heard of ppyeojusa. Most patients obtained information about ppyeojusa from mass media, rather than their physicians. Therefore, it is likely that most patients have inaccurate knowledge.
Friends ; Hospitals, University ; Humans ; Inflammation ; Korea ; Mass Media ; Methods ; Pain Clinics ; Specialization ; Steroids ; Surveys and Questionnaires