NMDA(N-Methyl-D-Aspartate)receptor is a kind of ionotropic receptors, which have been widely localized in peripheral somatic tissues and visceral pain pathways. The activation or expression changes of peripheral NMDA receptor may play an important role in pain occurrence. Peripheral administration of NMDA receptor antagonist can alleviate or prevent pain and enhance the analgesic effect of opiate. This method of administration can reduce the side effect of central action induced by the drug. It will be an important research direction of pain management.

60yr, weighting 50-80kg undergoing general thoracic surgery (lung resection and esophagus cancer resection) were enrolled in this study. Their preoperative hepatic and renal function were normal (blood creatinine

Objective:To explore the clinical features of subtyp es of ADHD in DSM-Ⅳ.Method:126 children fulfilled ADHD criteria of D S M-Ⅳ were further divided into 3 subtypes:predominantly inattentive(PI,61 cases) , predominantly hyperactive-impulsive(HI,9 cases)and combined type(CT,56 cases).C om orbid mental disorders were compared among the three groups.Parents and teacher s of children in each group completed CBCL(child behavior checklist)and TRF(teach er's report form).CWISC(Wechsler intelligence scale for children,Chinese versio n )and attention tests were also applied in each group.Results:Childr e n in CT group had more conduct disorder,more externalizing,delinquent and aggres sive behaviors rating by parents and teachers,and more inattentive than children in PI group.School performance of children in PI group was better than that of the other two groups evaluated by teachers.Conclusion:ADHD CT subty pe had highest rate of comorbid conduct disorder.They have more externalizing b ehavior,more academic problems and more inattentive.This subtype may be the mos t impaired subtype.

Arthrogryposis multiplex congenita (AMC) is a rare disorder characterized by non-progressive,multiple contractures.In addition to affected extremities,patients may also present microstomia,decreased temporomandibular joint mobility.Although the etiology of AMC is unclear,any factor that decreases fetal movement is responsible for AMC.Thus,accurate diagnosis and classification are crucial to the appropriate treatment of AMC.The development of ultrasound technology has enabled prenatal diagnosis.Very early treatment is favorable,and multidisciplinary treatment is necessary to improve the function of AMC patients.Most patients require surgery to release contracture and reconstruct joints.However,perioperative care is challenging,and difficult airway is the first concern of anesthesiologists.Postoperative pulmonary complications are common and regional anesthesia is recommended for postoperative analgesia.This review on AMC is intended for anesthesiologists.Thus,we discuss the treatment and perioperative management of patients undergoing surgery,as well as the diagnosis and classification of AMC.

Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .ABSTRACT Objective:To find the correlation of wrist bone mineral density ( BMD ) to wrist synovitis and erosion , by comparing wrist BMD and ultrasonography .Methods: A number of 80 female RA pa-tients were examined by BMD measurement of the femoral neck , spine and non-dominant wrist using du-al-energy X-ray absorptiometry ( DXA ) .Synovitis of the wrist was examined by ultrasonography .The wrist joint ( radiocarpal joint , dorsal midline , and carpoulnar joint ) was assessed in the same side of DXA, with transverse and longitudinal scans for USGS synovial hypertrophy and proliferation , tenosynovi-tis,tendinitis and bone erosion .Colour and power doppler ultrasonography ( PDUS) were used to sum the synovitis score .Results:We found:( 1 ) In the study , 80 female RA patients were enrolled , the mean age was 54.6 ±13.3 (27.0-80.0) years, the disease duration was 48 (12-116) months, and the body Mass Index was 23.0 ±4.0 (14.8-31.2) kg/m2 .The Wrist BMD ( g/cm2 ) in RA significantly reduced, compared with normal controls (0.297 ±0.121 vs.0.420 ±0.180,P<0.01).(2) The Wrist BMD (g/cm2) exceeded in early RA compared with the established RA (0.326 ±0.103 vs.0.285 ± 0 .132 ,P<0 .01 );the positive rate of severe osteoporosis in wrist was lower in early RA compared with the established RA(47.8%vs.64.9%, P<0.05); the positive rate of bone erosion in wrist by ultra-sound was lower in early RA compared with the established RA (39.1%vs.56.1%, P<0.01).(3) The wrist BMD ( g/cm2 ) in RA with high disease activity reduced compared with moderate and low disease activity (0.267 ±0.140 vs.0.280 ±0.126) and (0.267 ±0.140 vs.0.320 ±0.103) respec-tively , P<0 .05 ) .The percentages of positive ACPA in the high and moderate disease activity groups were significantly higher than those in the remission group (85% vs.81.8% and 92.6% vs.81.8%, respectively).DAS28ESR was correlated with wrist BMD (r=-0.288, P<0.01).(4) A significant positive correlation was found between wrist and spine /femur BMD ( r=0.634, P<0.01, r=0.795, P<0.01), and a negative correlation between wrist and disease duration and DAS 28ESR (r=-0.286, r=-0.301,P<0.01).There was a highly significant positive correlation between wrist BMD and femur BMD (r=0.95,P<0.05).(5) RA patients in wrist osteoporosis group had higher RF positive rate and ACPA rate than wrist osteopenia group (75.5%vs.55.6%,P<0.05,100% vs.83.3%, P<0.05). The patients of BMD osteoporosis group had higher DAS 28ESR compared with osteopenia group (5.3 ± 1.8 vs.3.7 ±1.5, P<0.01).The percentages of synovitis (61.5%vs.51.7%, P<0.05), tendeni-tis (14.3%vs.10.0%, P<0.05) and bone erosion (54.2%vs.46.2%, P<0.05) in wrist by ultra-sonography in osteoporosis group were higher than those of osteopenia group .(6) The wrist BMD in ne-gative bone erosion group by ultrasonography was lower than that in positive bone erosion group [ (0.333 ± 0.107) g/cm2 vs.(0.264 ±0.125) g/cm2, P<0.01], also the PDUS score was higher than positive bone erosion group (4.53 ±1.40 vs.2.55 ±2.66,P<0.01).Compared with negative bone erosion group, the patients in positive bone erosion group had longer disease duration (96.0 ±104.7) months vs.(66.2 ±78.0) months, P<0.05), higher percentage of RF (81.0% vs.53.8%,P<0.01), ACPA (92.7%vs.79.5%, P<0.05).and higher DAS28ESR (5.4 ±1.8 vs.4.2 ±2.0,P<0.05). The percentage of wrist synovitis in positive bone erosion group was higher (75.6% vs.30.8%,P<0.01) than that of negative bone erosion group , and moreover , the percentage of severe osteoporosis in the wrist was significantly higher (75.0%vs.46.4%, P<0.01).(7) A stepwise multivariate linear regression model was constructed to explore the relationship between the different clinical factors studied and a low wrist BMD.Statistically significant variables were age (P=0.001), disease duration (P=0.017), DAS28ESR (P=0.021), and ACPA (P=0.05).Conclusion:This study shows a highly sig-nificant correlation between hand BMD with disease duration and disease activity , and female RA patients with high titer of ACPA have lower wrist BMD .

Objective To evaluate the effects of vitamin C combined with low dose of gabapentin on neuropathic pain (NP) in rats.Methods Fifty male Sprague-Dawley rats,weighing 225-275 g,aged 6-7 weeks,were randomly assigned into 5 groups (n =10 each):sham operation group (group Sham),NP group,vitamin C group (group VitC),gabapentin group (group Gap),and vitamin C combined with gabapentin group (VitC + Gap group).NP was induced by chronic constrictive injury in the rats anesthetized with pentobarbital sodium.The sciatic nerve was exposed and 4 silk ligatures were placed on the sciatic nerve at 1 mm intervals.In VitC,Gap and VitC+ Gap groups,vitamin C 500 mg/kg,gabapentin 30 mg/kg,and vitamin C 500 mg/kg + gabapentin 30 mg/kg diluted in normal saline 1 ml were injected intraperitoneally,respectively,twice a day for 7 consecutive days starting from 7 days after NP.Normal saline 1 ml was given in Sham and NP groups.Before NP and at 3,7,and 14 days after NP,the paw withdrawal threshold to mechanical stimuli (PWMT) and paw withdrawal latency to thermal stimuli (PWTL) were measured.At 14 days after NP,the blood samples were drawn from the carotid arteries.The rats were then sacrificed and the spinal cord was removed for determination of concentrations of malondialdehyde (MDA) in serum (by using Thiobarbituric acid method) and Slc23a2 mRNA expression (by RTPCR).Results Compared with Sham group,PWMT and PWTL in left paws were significantly decreased in NP,VitC,Gap ard VitC + Gap groups,the concentrations of MDA in serum were increased and Slc23a2 mRNA expression was down-regulated in NP group,Slc23a2 mRNA expression was down-regulated in VitC and Gap groups,and no significant change in Slc23a2 mRNA expression was found in VitC + Gap group.Compared with NP group,PWMT and PWTL in left paws were significantly increased,the concentrations of MDA in serum were decreased,and Slc23a2 mRNA expression was up-regulated in VitC + Gap group,the concentrations of MDA in serum were decreased in VitC group,and no significant changes were found in PWMT and PWTL in left paws in VitC and Gap groups.There were no significant differences in PWMT and PWTL in fight paws at each time point between the five groups.Conclusion Vitamin C combined with low dose of gabapentin can relieve NP effectively,and up-regulation of Slc23a2 mRNA expression,increased trafficking of vitamin C to neurons and inhibition of oxidative stress may be involved in the mechanism.

Objective To establish a rat model of bone cancer pain by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Methods Sixty female Wistar rots weighing 180-200 g were randomly divided into 4 groups (a=15each):groupⅠ normal control; group Ⅱsham operation; group Ⅲtumor cell inoculation + normal saline (NS) and group Ⅳtumor cell inoculation + flurbiprofen. NS 0.2 nd and flurbiprofen 10 mg/kg in 0.2 ml were injected IV at 2 h before determination of pain threshold on 14 and 17 d after inoculation oftumor cells in groupⅢand Ⅳ respectively. On day 0, 4, 7, 10, 14, 17 and 21 after inoculation pain threshold was measured after determination of body weight. X-ray examination of the tibia was performed on day 14 after inoculation. The animals were killed on day 21 after inoculation for microscopic examination of the inoculated tibia. Results The animals started losing weight and the threshold to yon Frey hair stimulation was decreased from dhy 10 after inoculation in group Ⅲand Ⅳ. X-ray examination showed destruction of bone and microscopic examination showed tumor growing in tibia. Flurbiprofen significantly decreased mechanical hyperalgesia in group Ⅳ. There was no significant difference in paw withdrawal latoney to radiant heat among the 4 groups. Conclusion A model of bone cancer pain can be made by inoculation of Walker 256 mammary gland carcinoma cells into tibia characterized by mechanical hyperalgesia.

Objective:To clarify whether the signal peptide of human nerve growth factor can mediate secretory expression of beta-endorphin and whether there is difference between the efficiency of signal peptides from human and mouse nerve growth factor.Methods: Two kinds of eukaryotic vectors containing human or mouse signal sequence-mediated secretory expression of beta-endorphin were constructed.The culture supernatant and cells were collected 48 h after NIH3T3 cells were transfected by the two kinds of vectors,and the cover slips with single-layer cells was prepared.The concentration of beta-endorphin in the culture was determined by radio-immunoassay.The total RNA was extracted from cells and mRNA from fusion genes was assayed by RT-PCR.Cells on cover slips were subjected to immunofluorescence staining.Results: RT-PCR showed that the fusion genes were expressed in NIH3T3 cells;the expression of beta-endorphin was mainly in the cytoplasm of NIH3T3 cells.The concentrations of beta-endorphin in the supernatants 48 h after transfection with pcDNA3.1-hEP and pcDNA3.1-mEP were(280.33?24.16) pg/ml and(191.04?7.96) pg/ml(P

Objective To investigate the anesthesia and perioperative blood management of patients with Marfan syndrome (MS) undergoing scoliosis surgery.Methods The clinical data of MS patients underwent scoliosis surgery from January 2013 to December 2015 in Peking Union Medical College Hospital were collected and compared with patients received the same surgery but without MS.Perioperative information and data on anesthesia and blood management were analyzed.Results Compared with control group,MS patients were found with more preoperative comorbidities with statistical significance,including eye disease,echocardiographic abnormalities,and ventilatory defects.MS patients had significantly more blood loss,more intraoperative and postoperative allogeneic and autologous blood transfusion.The operation time,anesthesia time,and length of postoperative hospital stay were all significantly longer in MS patients.Conclusions MS patients are common with multi-system involvement and comorbidities.Considering the high risk of perioperative bleeding,the anesthesia and blood management for MS patients undergoing scoliosis surgery should be with extra caution.Blood management should be applied and appropriate invasive monitoring methods should be considered when necessary.

AIM: To observe the effects of ketamine on preventing the increase of postoperative morphine requirement induced by fentanyl.METHODS: Sixty women undergoing total abdominal hysterectomy by spinal anaesthesia were assigned to 4 groups consisting of placebo(normal saline,C),fentanyl(3 bolus of 1 ?g/kg,at 15 min intervals,F),ketamine(infusion of 15 ?g?kg-1?min-1 ketamine from the skin incision until 20 min before the end of the surgery,K),ketamine and fentanyl(infusion of 15 ?g?kg-1?min-1 ketamine from the skin incision until 20 min before the end of the surgery plus 3 bolus of 1 ?g/kg fentanyl,at 15-min intervals,FK).The cumulative morphine consumption,pain score,and adverse effects(nausea, vomiting,hallucination,dizziness and itching) were recorded at 1,3,6,12,24,48 h postoperatively.RESULTS: There were no significant differences in age,weight,duration of surgery and the post-operative sensory block time.The cumulative morphine consumption in group F was significantly higher than those in group C at 3,6,12 h postoperatively(P