Neuropathic pain is frequently comorbidity with cognitive deficits. Neuralized1 (Neurl1)-mediated ubiquitination of CPEB3 in the hippocampus is critical in learning and memory. However, the role of Neurl1 in the cognitive impairment in neuropathic pain remains elusive. Herein, we found that lumbar 5 spinal nerve ligation (SNL) in male rat-induced neuropathic pain was followed by learning and memory deficits and LTP impairment in the hippocampus. The Neurl1 expression in the hippocampal CA1 was decreased after SNL. And this decrease paralleled the reduction of ubiquitinated-CPEB3 level and reduced production of GluA1 and GluA2. Overexpression of Neurl1 in the CA1 rescued cognitive deficits and LTP impairment, and reversed the reduction of ubiquitinated-CPEB3 level and the decrease of GluA1 and GluA2 production following SNL. Specific knockdown of Neurl1 or CPEB3 in bilateral hippocampal CA1 in naïve rats resulted in cognitive deficits and impairment of synaptic plasticity. The rescued cognitive function and synaptic plasticity by the treatment of overexpression of Neurl1 before SNL were counteracted by the knockdown of CPEB3 in the CA1. Collectively, the above results suggest that the downregulation of Neurl1 through reducing CPEB3 ubiquitination and, in turn, repressing GluA1 and GluA2 production and mediating synaptic plasticity impairment in hippocampal CA1 leads to the genesis of cognitive deficits in neuropathic pain.
Animals ; Male ; Neuralgia/metabolism* ; Rats ; Down-Regulation/physiology* ; Ubiquitination/physiology* ; Neuronal Plasticity/physiology* ; Rats, Sprague-Dawley ; CA1 Region, Hippocampal/metabolism* ; Cognitive Dysfunction/metabolism* ; RNA-Binding Proteins/metabolism* ; Receptors, AMPA/metabolism*

Objective:To investigate the efficacy and safety of naborphine versus dezocine in painless visual anesthetics induced abortion. Methods:A total of 120 patients who underwent painless visual anesthetics induced abortion in Zhongshan City People's Hospital and Zhongshan Shaxi Longdu Hospital, China during January to September in 2020. They were randomly assigned to receive intravenous naborphine hydrochloride injection (0.15 mg/kg, naborphine group) or dezocine injection (5 mg, dezocine group), followed by intravenous propofol (2 mg/kg). When the eyelash reflex disappeared, surgery was initiated. If there were body movements, 30-50 mg propofol was added as appropriate. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, and heart rate before anesthesia (T 0), at 3 minutes after the beginning of surgery (T 1), and during recovery (T 2) were compared between the two groups. The time to regain consciousness, postoperative visual analogue pain score, propofol dose, operative time, and adverse reactions were determined in each group. Results:There were slight, but not significant, differences in systolic blood pressure and heart rate between the two groups at T 0, T 1 and T2 (all P > 0.05). There were no significant differences in time to regain consciousness, postoperative visual analogue pain score, propofol dose and operative time between the two groups (all P > 0.05). The incidence of nausea and vertigo in the naborphine group was 8.3% (5/60) and 11.6% (7/60), respectively, which was significantly lower than that in the dezocine group [30.0% (18/60), 31.6% (19/60), χ2 = 9.09, 7.07, both P < 0.05). Conclusion:Naborphine combined with propofol for painless visual anesthetics induced abortion exhibits good anesthetic effects and safety, with fewer intraoperative and postoperative adverse reactions than dezocine combined with propofol.

Objective To evaluate the safety and efficiency of robot assisted surgery guided by damage control orthopaedics(DCO) in polytraumatised patients with pelvic ring injuries.Methods A retrospective review of the pelvic fracture database was performed.Twenty-six patients who had sustained a pelvic fracture from September 2012 to December 2015 were suitable for robot-assisted minimally invasive internal fixation.They were 17 men and 9 women,aged from 23 to 58 years (average,42.6 years).Their Injury Severity Score(ISS) ranged from 20 to 31 points (average,21.3 years).According to Tile classification,6 cases were type B2,3 type B3,9 type C2 and 8 type C3.Guided by DCO,the vital signs were stabilized by all means and the fractures treated by simple and temporary external fixation before the pelvic and other fractures were managed by the robot-assisted minimally invasive internal fixation.Demographics,times to operating room (TOR),time from acute stabilization to late definitive internal fixation (TAL),time for bone union,type of robot-assisted surgery for major fractures,length of stay (LOS),postoperative complications and mortality were recorded.The outcomes of the pelvis were evaluated at the final follow-up according to the Matta criteria.Results Of the 26 patients,robot-navigated percutaneous screwing was conducted with 23 sacroiliac screws in 19,with 9 ramus pubicus screws in 9,with 6 supraacetabular screws in 4,and with 4 both-column screws in 2 cases.TOR averaged 2.7 times,TAL 5.9 days,LOS at ICU 2.1 days,ICU admission rate 46.2％ (12 of 26),hospital LOS 7.3 days,and time for pelvic bone union 79.0 days.None patients had postoperative complications related to the pelvic fracture and no one died.According to the Matta criteria at the final follow-ups,8 cases were excellent,11 good,5 fair and 2 poor,yielding an excellent and good rate of 73.1％.Conclusion Robot-navigated minimally invasive surgery plus DCO is effective,time saving and safe treatment for polytraumatised patients with pelvic ring injuries.

Objective To report the early surgical outcomes of treating elbow varus posteromedialrotational instability (EVPRI),a pattern of traumatic elbow instability which has been recently described but incompletely understood. MethodsFrom December 2009 to April 2011,11 male patients with an EVPRI pattern were surgically treated in our hospital.Their average age was 33.8(from 22 to 40) years.They had 4 left and 7 right elbows affected.All had tenderness at the medial and lateral sides of the elbow and varus angulation of the elbow without dislocation.Their preoperative stress view X-rays and CT scans showed widened humeroradial joint space and fracture of the anteromedial facet of the coronoid process.We confirmed the diagnosis by applying yarus,pronated and axial stresses onto the forearm to evoke elbow dislocation,under fluoroscopy after anesthesia.In the initial operative treatment,the coronoid was repaired with a plate and K-wires applied to the medial surface of the coronoid,and a hinged external fixator was applied at the lateral side without repairing the lateral collateral ligament.Early rehabilitation was encouraged. Results All were followed up for an average of 14.4 (from 6 to 26) months.Each obtained an excellent result according to the Mayo Elbow Performance Index and recovered excellent elbow function.The average flexion was 137.8° ± 4.4° (from 130°to 140°), average extension 5.6°±7.3° (from 0 to 20°), average range of extension-flexion 132.2°±9.7°(from 120° to 140°),average pronation 87.8°±6.7°(from 70° to 90°),average supination 88.9° ± 3.3° (from 80° to 90°),and average range of rotation 176.7° ± 10.0° (from 150° to 180°).No complications such as varus subluxation of the elbow,infection and arthrosis occurred in this group. Conclusions Since EVPRI is a distinct type of elbow fracture-dislocation that must be recognized and adequately treated to restore good elbow function,inadequate or conservative treatment may cause subluxation,arthrosis or a poor outcome.Surgical treatment can achieve an excellent early outcome and avoid severe complications.

Objective To describe a minimal invasional surgical procedure for the treatment of avulsion fracture of tibial intercondylar eminence. Methods From July 1999 to December 2000, 26 cases of avulsion fracture of tibial intercondylar eminence were treated. With the arthroscope, reduction and absorbable suture fixation of anterior cruciate ligament or the avulsion fracture were performed. Taking the advantage of ACL－ aimer, bone tunnels, through which the suture can be pulled out and tied outside the joint, could be accurately produced. Results Twenty-two patients were available for 2－ 17 months(mean 10.5 months) follow-up. Seventeen patients gained normal range of motion, 5 have limited flexion but exceeded 90 degrees. X－ ray demonstrated bone union in all the cases and anatomical reduction obtained in 21 cases. Conclusion Arthroscopically guided operation, gives less trauma, and is a simple and effective method for the avulsion fracture of the tibial intercondylar eminence.

Objective To improve the accuracy with magnetic resonance imaging (MRI) diagnosis of spontaneous intraocular hemorrhage. Design Retrospective case series. Participants 6 patients with spontaneous intraocular hemorrhage. Methods The image findings were retrospectively analyzed in 6 patients confirmed by surgery with or without pathology. All of them were examined with ultrasonography and 5 cases with color ultrasonography. MRI was performed in 6 cases,and enhanced MRI in 5 cases. Main Outcome Measures Configuration,signal intense,characteristics of enhancement signal and ultrasonograph. Results 1 case was crescent shape on MRI of spontaneous intraocular hemorrhage,2 cases were lenticular shape,3 cases were hump shape. 2 cases showed high signal intensity on T1WI,and low signal on T2WI. 2 cases showed high signal on both T1 and T2WI. 2 cases showed low signal on T1WI,and high signal intensity on T2WI. 2 cases presented a ring with hypointensity on T2WI. No enhancement was revealed within the lesions in 5 cases. Liner enhancement was showed in 2 cases; ring enhancement was showed in 1 case. 2 cases were corrected diagnosed by MRI,2 cases were misdiagnosed as melanoma,and 2 cases were misdiagnosed as tumor concomitant hemorrhage,and all cases were diagnosed as tumor with ultrasonography. With color Doppler imaging 4 cases were correctly diagnosed as hemorrhage based on without blood-flow signal,and 1 case was diagnosed as tumor. Conclusions The MRI signal characteristic of spontaneous ocular hemorrhage is variable,and the main feature is no enhancement within the lesion. MRI combined with ultrasonography can make the diagnosis more correctly.