Pain is a common symptom in patients with terminal cancer and is the main factor that affects their quality of life. Morphine is commonly used for the treatment of acute and chronic pain, but the long-time application of morphine results in morphine tolerance and hyperalgesia, which restrict the clinical applications of the anesthetic. In this review, pertinent studies on morphine over recent years were summarized and analyzed, and the mechanism of morphine tolerance and hyperalgesia were discussed, specifically on the function of calcitonin gene-related peptide (CGRP) in clinical practice. The authors analyzed the relationship between the plastic changes in the nervous system and chronic morphine application in terms of CGRP up-regulation based on its molecular biology charac-teristics and distribution, the relationship between CGRP and chronic application of morphine, and between CGRP and hyperalgesia. The effect of CGRP up-regulation on the nociceptive system and the relationship between CGRP up-regulation and the formation of hy-peralgesia were also analyzed. We discussed the sensitized effect of CGRP up-regulation on the nociceptive system, which promotes morphine tolerance and hyperalgesia. This study provides a framework for treating morphine tolerance and can be used as a guide for further research on the topic.

Fibrosarcoma ; diagnosis ; Humans ; Infant

Objective To investigate the changes in the expression of calcitonin gene-related peptide (CGRP), substance P (SP) and brain-derived neurotrophic factor (BDNF) in dorsal root ganglion (DRG) and the effect of electroacupuncture (EA) on morphine tolerance in rats with chronic inflammatory pain (CIP) and morphine tolerance. Methods Twenty-five 8-month-old male SD rats weighing 230-250 g in which intrathecal (IT)catheters were successfully implanted without complications were randomly divided into 5 groups ( n = 5 each):groupA CIP + normal saline (NS) 10 μl IT twice a day for 7 consecutive days; group B CIP + morphine 10 μg/kg ( 10 μl) IT twice for the first day only; group C CIP + morphine 10 μg/kg ( 10 μl) IT twice a day for 7 consecutive days; group D CIP + EA (intensity 2 mA, frequency 2 Hz, wave length 0.6 ms) + morphine 10 μ g/kg (10 μl) IT twice a day for7 consecutive days; group E CIP + EA (intensity 2 mA, frequency 15 Hz,wave length 0.4 ms) + morphine 10μg/kg (10 μl) IT twice a day for7 consecutive days. CIP was induced by injecting complete Freund's adjuvant (CFA) into the ankle joint of the left hindlimb. IT morphine or NS was started on the 4th day after induction of CIP. EA of Yanglingquan and Zusanli lasting 30 min was performed once a day after first IT administration of morphine for 7 days. Paw withdrawal latency (PWL) to a thermal nociceptive stimulus was measured before induction of CIP, 1 day before (baseline) and at day 1-7 after administration (T0-8) . The animals were sacrificed after the last PWL measurement. The DRGs of the lumbar segment (L4-6) were removed for determination of CGRP, SP and BDNF mRNA expression using RT-PCR. Results PWL was significantly shorter at T1 than at T0 in all groups, and at T3-8 than at T2 in group B-E, while longer at T2 than at T1 in group B-E ( P ＜0.05). PWL was significantly longer in group B-E and CGRP, SP and BDNF mRNA expression higher in group C than in group A ( P ＜ 0.05). PWL was significantly longer in group C-E than in group B ( P ＜ 0.05). PWL was significantly longer and CGRP, SP and BDNF mRNA expression lower in group D and E than in group C ( P ＜0.05). PWL was significantly lower and CGRP, SP and BDNF mRNA expression higher in group E than in group D ( P ＜ 0.05). Conclusion Up-regulation of the expression of CGRP, SP and BDNF mRNA in DRG is involved in the devepopment of morphine tolerance. EA can inhibit the devepopment of morphine tolerance by inhibiting the expression of CGRP2 SP and BDNF mRNA.

OBJECTIVE:To observe the other effects of cimetidine in the decompensated stage of chronic cardiopulmonary disease. METHODS: 72 patients with uncompensated chronic cardiopulmonary disease were assigned into therapy group and control group (n=36). Both groups were given routine treatment. Therapy group were additionally treated with cimetidine intravenously for 48 h. The changes of respiration frequency, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), intake of staple food and electrolytes in blood serum of 2 groups before and after treatment were determined. RESULTS:In therapy group, the respiration frequency, the level of PaCO2 and disorder of electrolytes in blood serum were decreased and the level of PaO2 and intake of staple food were increased. Above items of therapy group were all different from that of control group (P

Objective To study the incidence,risk factors and prognosis of stroke-associated infection(SAI) in acute stroke patients.Methods 382 serial acute cerebral stroke patients were retrospectively surveyed.Results The incidence of SAI was 29.3% in all cases,mainly involved lower respiratory tract(63.0%) and urinary tract(28.4%).Escherichia coli,Coagulase negative staph and Streptococcus viridans were the main pathogenic organisms.Developments of SAI were closely related with aging,diabetes mellitus,the application of antimicrobial agents and invasive procedure.The mortality was 10.7%(12/112) in the cases with SAI,but 1.9%(5/270) in the cases without SAI.Conclusion SAI is caused by various factors in acute stroke patients.Controlling SAI can help to succeed in treating stroke.

BACKGROUND:Endothelial progenitor cells are recruited into local vascular injury under the injury-induced stimulation, and then differentiate into mature endothelial cells that are thereby involved in angiogenesis and endothelial repair. OBJECTIVE:To investigate whether endothelial progenitor cells can al eviate renal injury and improve renal function of ischemia/reperfusion injury (I/R) rats. METHODS:Peripheral blood samples extracted from Sprague-Dawley rats were used to isolate and culture endothelial progenitor cells using density gradient centrifugation. Twenty-two male Sprague-Dawley rats were randomized to three groups:I/R group, normal control group, and endothelial progenitor cells group. In the I/R and endothelial progenitor cells groups, the right kidney was removed and the renal artery and vein of the left kidney were occluded for 40 minutes to establish I/R models in the rats, and then endothelial progenitor cells (5×109/L, total y 1 mL) or solvent was transplanted via the artery of the left kidney into the left kidney. In the normal control group, the experimental procedure was same as that in the I/R group except for occlusion of the artery and vein of the left kidney. Renal and blood samples from three groups were col ected at day 1 after operation. Peripheral blood CD34 and vascular endoethelial growth factor receptor 2 expressions were determined using flow cytometry and immunofluorescence methods, serum creatinine and urea nitrogen were tested, and immunohistochemistry observation was used for CD34 observation. RESULTS AND CONCLUSION:Compared with the normal control group, serum creatinine and urea nitrogen levels were significantly increased, and tubulointerstitial CD34 expression was decreased in the I/R group (P<0.05). Endothelial progenitor cells treatment largely decreased the levels of serum creatinine and urea nitrogen, and increased CD34 expression (P<0.05). These findings indicate that transplantation of endothelial progenitor cells contributes to renal protection in I/R rats.

Objective To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS), and compare it with contrast-enhanced CT(CECT). Methods Eighty-one focal liver lesions were evaluated with CEUS and CECT, diagnostic value of two modalities were calculated, vaseularity manifestations of two modalities in arterial phase were compared. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were 96.6 %, 86.9 %, 94.9 %, 90.9 %, 93. 80%, respectively, and the diagnostic value of CECT were 98.3%, 82. 6%, 93.4%, 95.0%, 93.8%, respectively. Among all the metastasis, hypervascular manifestation lesions in arterial phase of CEUS and CECT were 72% (18/25) and 32% (8/25)( P <0.05). Conclusions The diagnostic value of CEUS and CECT in focal liver lesions are comparably satisfying,and there is no significant difference between them, the combination use of two modalities would improve the diagnosis performance. CEUS can show more hypervaseular metastasis than CECT in arterial phase.

Objective To investigate the changes in expression of vanilloid receptor subtype 1 (VR1) in dorsal root ganglion (DRG) and effect of electroacupuncture (EA)on morphine tolerance in rats with inflammatory pain (IP) and morphine tolerance. Methods Thirty 8 month old male SD rats in which intrathecal (IT) catheters were successfully implanted without complication were randomly divided into 6 groups ( n = 5 each): group A IP + normal saline (NS) 10 μl IT twice a day × 7 days;group B intact rats + morphine 10 μg/kg(10 μl )IT twice a day × 7 days;group C IP + morphine 10 μg/kg(10 μl) IT once;group DIP + morphine 10μg/kg(10 μl) IT twice a day × 7 days;group E and F IP + EA (frequency 2/15 Hz) + morphine 10μg/kg(10 μl) IT twice a day × 7 days. IP was induced by injecting complete Freund's adjuvant (CFA) into the anlle joint of the left hindlimb. IT morphine or NS was started on the 4th day after induction of IP. EA of Yanglingquan and Zusanli lasting 30 min was performed once a day after first IT administration of morphine for 7 days. Paw withdrawal latency (PWL) to a thermal nociceptive stimulus was measured before induction of IP (baseline), at 1 day before and 1-7days of consecutive IT administration. The animals were sacrificed after last PWL measurement. The DRGs of the lumbar segment (L4-6) were removed for determination of VR1 expression in total and membrane protein using Western blot analysis. Results There was no significant difference in the baseline PWL measured before induction of IP among the 6 groups. Morphine tolerance developed in group B and D but did not develop in group E and F.The expression of VR1 in total and membrane protein of DRG was highest in group D and was significantly lower in group E than in group F. Conclusion VR1 in DRG is involved in the development of morphine tolerance. EA can inhibit morphine tolerance by down-regulating the expression of VR1.

Objective To evaluate spiral CT features and differential diagnosis of cystadenocarcinoma in the hepatic biliary duct.Methods CT findings of cystadenocarcinoma in the hepatic biliary duct proved by pathology in 4 cases were retrospectively analysed with review literatures.Results Biliary cystadenocarcinoma appeared as unilocular or multilocular cystic tumor,the cystic wall was irregular with mural nodules and satellite leisons,and the distal biliary duct was dilated.Conclusion Spiral CT is efficient method in diagnosis of cystadenocarcinoma in the hepatic biliary duct.

Objective To investigate the effect of electroacupuncture (EA) on the activity of extracellular signal-regulated kinase 1/2 (ERK1/2) in the spinal dorsal horn during morphine tolerance in rats.Methods Twenty-five healthy male Sprague-Dawley rats in which intrathecal (IT) catheters were successfully implanted with-out complications were randomly divided into 5 groups (n =5 each):group normal saline (NS) 10 μl IT twice a day × 7 days; group M morphine 10μg (10 μl) IT twice a day × 7 days; group MO morphine 10 μg + missense oligonucleotide (ODN) 10μg (10 μl) twice a day × 7 days; group AO morphine 10 μg + antisense ODN 10 μg (10μl) twice a day×7 days; group EA morphine 10 μg (10μl) twice a day×7 days + EA (frequency 2 Hz,wave length 1 ms,intensity 3 mA).EA of Yanglingquan and Zusanli lasting for 30 min was performed after first IT administration of morphine once a day for 7 days.Mechanical pain threshold (MPT) was measured before IT administration and at day 2,4,6 of IT administration and 1 day after the end of IT administration.The animals were sacrificed after the last MPT measurement,and L3-5 segments of the spinal cord were isolated to detect the expression of ERK1/2 and phosphor-ERK1/2 (p-ERK1/2) in the spinal dorsal horn by Western blot analysis.Results Morphine tolerance developed in groups M,MO and AO,and was lightest in group EA.Compared with group NS,the expression of p-ERK1/2 was significantly up-regulated in groups M and MO,the expression of ERK1/2 was down-regulated in group AO (P ＜ 0.05),and no significant change was found in the indexes mentioned above in group EA (P ＞ 0.05).Compared with groups M and MO,the expression of p-ERK1/2 and ERK1/2 was significantly down-regulated in group AO,and the expression of p-ERK1/2 was down-regulated in group EA (P ＜0.05).Compared with group AO,the expression of p-ERK1/2 and ERK1/2 was significantly up-regulated in group EA (P ＜ 0.05).Conclusion EA can inhibit chronic morphine tolerance-induced increased activity of ERK1/2 in the spinal dorsal horn and alleviate the development of morphine tolerance in rats.