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Cao SJ, Zhang Y, Zhang YX, Zhao W, Pan LH, Sun XD, Jia Z, Ouyang W, Ye QS, Zhang FX, Guo YQ, Ai YQ, Zhao BJ, Yu JB, Liu ZH, Yin N, Li XY, Ma JH, Li HJ, Wang MR, Sessler DI, Ma D, Wang DX. Long-term survival in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: follow-up of a multicentre randomised trial. Br J Anaesth 2023; 131:266-275. [PMID: 37474242 DOI: 10.1016/j.bja.2023.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Experimental evidence indicates that i.v. anaesthesia might reduce cancer recurrence compared with volatile anaesthesia, but clinical information is observational only. We therefore tested the primary hypothesis that propofol-based anaesthesia improves survival over 3 or more years after potentially curative major cancer surgery. METHODS This was a long-term follow-up of a multicentre randomised trial in 14 tertiary hospitals in China. We enrolled 1228 patients aged 65-90 yr who were scheduled for major cancer surgery. They were randomised to either propofol-based i.v. anaesthesia or to sevoflurane-based inhalational anaesthesia. The primary endpoint was overall survival after surgery. Secondary endpoints included recurrence-free and event-free survival. RESULTS Amongst subjects randomised, 1195 (mean age 72 yr; 773 [65%] male) were included in the modified intention-to-treat analysis. At the end of follow-up (median 43 months), there were 188 deaths amongst 598 patients (31%) assigned to propofol-based anaesthesia compared with 175 deaths amongst 597 patients (29%) assigned to sevoflurane-based anaesthesia; adjusted hazard ratio 1.02; 95% confidence interval (CI): 0.83-1.26; P=0.834. Recurrence-free survival was 223/598 (37%) in patients given propofol anaesthesia vs 206/597 (35%) given sevoflurane anaesthesia; adjusted hazard ratio 1.07; 95% CI: 0.89-1.30; P=0.465. Event-free survival was 294/598 (49%) in patients given propofol anaesthesia vs 274/597 (46%) given sevoflurane anaesthesia; adjusted hazard ratio 1.09; 95% CI 0.93 to 1.29; P=0.298. CONCLUSIONS Long-term survival after major cancer surgery was similar with i.v. and volatile anaesthesia. Propofol-based iv. anaesthesia should not be used for cancer surgery with the expectation that it will improve overall or cancer-specific survival. CLINICAL TRIAL REGISTRATIONS ChiCTR-IPR-15006209; NCT02660411.
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Affiliation(s)
- Shuang-Jie Cao
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Yue Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science & Technology Medical Center, Shenzhen, China
| | - Yu-Xiu Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Wei Zhao
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ling-Hui Pan
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xu-De Sun
- Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China
| | - Zhen Jia
- Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing-Shan Ye
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Fang-Xiang Zhang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yong-Qing Guo
- Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yan-Qiu Ai
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bin-Jiang Zhao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jian-Bo Yu
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Zhi-Heng Liu
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China
| | - Ning Yin
- Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Hui-Juan Li
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Mei-Rong Wang
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Daniel I Sessler
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Anesthesiology Institute, OH, USA
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; National Clinical Research Center for Child Health, Hangzhou, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
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Cao SJ, Zhang Y, Zhang YX, Zhao W, Pan LH, Sun XD, Jia Z, Ouyang W, Ye QS, Zhang FX, Guo YQ, Ai YQ, Zhao BJ, Yu JB, Liu ZH, Yin N, Li XY, Ma JH, Li HJ, Wang MR, Sessler DI, Ma D, Wang DX. Delirium in older patients given propofol or sevoflurane anaesthesia for major cancer surgery: a multicentre randomised trial. Br J Anaesth 2023; 131:253-265. [PMID: 37474241 DOI: 10.1016/j.bja.2023.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Delirium is a common and disturbing postoperative complication that might be ameliorated by propofol-based anaesthesia. We therefore tested the primary hypothesis that there is less delirium after propofol-based than after sevoflurane-based anaesthesia within 7 days of major cancer surgery. METHODS This multicentre randomised trial was conducted in 14 tertiary care hospitals in China. Patients aged 65-90 yr undergoing major cancer surgery were randomised to either propofol-based anaesthesia or to sevoflurane-based anaesthesia. The primary endpoint was the incidence of delirium within 7 postoperative days. RESULTS A total of 1228 subjects were enrolled and randomised, with 1195 subjects included in the modified intention-to-treat analysis (mean age 71 yr; 422 [35%] women); one subject died before delirium assessment. Delirium occurred in 8.4% (50/597) of subjects given propofol-based anaesthesia vs 12.4% (74/597) of subjects given sevoflurane-based anaesthesia (relative risk 0.68 [95% confidence interval {CI}: 0.48-0.95]; P=0.023; adjusted relative risk 0.59 [95% CI: 0.39-0.90]; P=0.014). Delirium reduction mainly occurred on the first day after surgery, with a prevalence of 5.4% (32/597) with propofol anaesthesia vs 10.7% (64/597) with sevoflurane anaesthesia (relative risk 0.50 [95% CI: 0.33-0.75]; P=0.001). Secondary endpoints, including ICU admission, postoperative duration of hospitalisation, major complications within 30 days, cognitive function at 30 days and 3 yr, and safety outcomes, did not differ significantly between groups. CONCLUSIONS Delirium was a third less common after propofol than sevoflurane anaesthesia in older patients having major cancer surgery. Clinicians might therefore reasonably select propofol-based anaesthesia in patients at high risk of postoperative delirium. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR-IPR-15006209) and ClinicalTrials.gov (NCT02662257).
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Affiliation(s)
- Shuang-Jie Cao
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Yue Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Clinical Research Institute, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, Guangdong, China
| | - Yu-Xiu Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Wei Zhao
- Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ling-Hui Pan
- Department of Anesthesiology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xu-De Sun
- Department of Anesthesiology, Tangdu Hospital, Air Force Medical University (Fourth Military Medical University), Xi'an, Shaanxi, China
| | - Zhen Jia
- Department of Anesthesiology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing-Shan Ye
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Fang-Xiang Zhang
- Department of Anesthesiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Yong-Qing Guo
- Department of Anesthesiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Yan-Qiu Ai
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bin-Jiang Zhao
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jian-Bo Yu
- Department of Anesthesiology and Critical Care Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Zhi-Heng Liu
- Department of Anesthesiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, Guangdong, China
| | - Ning Yin
- Department of Anesthesiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China; Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Hui-Juan Li
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Mei-Rong Wang
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Daqing Ma
- Division of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK; The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Dong-Xin Wang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China; Outcomes Research Consortium, Cleveland, OH, USA.
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Wang TJ, Wu ZY, Yang CH, Cao L, Wang ZZ, Cao ZY, Yu MY, Zhao MR, Zhang CF, Liu WJ, Zhao BJ, Shang XQ, Feng Y, Wang H, Deng LL, Xiao BG, Guo HY, Xiao W. Multiple Mechanistic Models Reveal the Neuroprotective Effects of Diterpene Ginkgolides against Astrocyte-Mediated Demyelination via the PAF-PAFR Pathway. Am J Chin Med 2022; 50:1565-1597. [PMID: 35902245 DOI: 10.1142/s0192415x22500665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Currently, therapies for ischemic stroke are limited. Ginkgolides, unique Folium Ginkgo components, have potential benefits for ischemic stroke patients, but there is little evidence that ginkgolides improve neurological function in these patients. Clinical studies have confirmed the neurological improvement efficacy of diterpene ginkgolides meglumine injection (DGMI), an extract of Ginkgo biloba containing ginkgolides A (GA), B (GB), and K (GK), in ischemic stroke patients. In the present study, we performed transcriptome analyses using RNA-seq and explored the potential mechanism of ginkgolides in seven in vitro cell models that mimic pathological stroke processes. Transcriptome analyses revealed that the ginkgolides had potential antiplatelet properties and neuroprotective activities in the nervous system. Specifically, human umbilical vein endothelial cells (HUVEC-T1 cells) showed the strongest response to DGMI and U251 human glioma cells ranked next. The results of pathway enrichment analysis via gene set enrichment analysis (GSEA) showed that the neuroprotective activities of DGMI and its monomers in the U251 cell model were related to their regulation of the sphingolipid and neurotrophin signaling pathways. We next verified these in vitro findings in an in vivo cuprizone (CPZ, bis(cyclohexanone)oxaldihydrazone)-induced model. GB and GK protected against demyelination in the corpus callosum (CC) and promoted oligodendrocyte regeneration in CPZ-fed mice. Moreover, GB and GK antagonized platelet-activating factor (PAF) receptor (PAFR) expression in astrocytes, inhibited PAF-induced inflammatory responses, and promoted brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) secretion, supporting remyelination. These findings are critical for developing therapies that promote remyelination and prevent stroke progression.
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Affiliation(s)
- Tuan-Jie Wang
- Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu 210023, P. R. China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Zi-Yin Wu
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Chun-Hua Yang
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Liang Cao
- Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu 210023, P. R. China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Zhen-Zhong Wang
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Ze-Yu Cao
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Ming-Yang Yu
- Key Laboratory of Standardization of Chinese Medicines, Ministry of Education Institute of Chinese Materia Medica of Shanghai, University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Meng-Ru Zhao
- Key Laboratory of Standardization of Chinese Medicines, Ministry of Education Institute of Chinese Materia Medica of Shanghai, University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Chen-Feng Zhang
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Wen-Jun Liu
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Bin-Jiang Zhao
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
| | - Xue-Qi Shang
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Yu Feng
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Hui Wang
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Li-Li Deng
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Bao-Guo Xiao
- Department of Neurology and National Research Center for Aging and Medicine Huashan Hospital, Fudan University, Shanghai, P. R. China
| | - Hong-Yan Guo
- National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, P. R. China
- CapitalBio Corporation, Beijing 102206, P. R. China
| | - Wei Xiao
- Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, Jiangsu 210023, P. R. China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang, Jiangsu 222001, P. R. China
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Du YT, Li YW, Zhao BJ, Guo XY, Feng Y, Zuo MZ, Fu C, Zhou WJ, Li HJ, Liu YF, Cheng T, Mu DL, Zeng Y, Liu PF, Li Y, An HY, Zhu SN, Li XY, Li HJ, Wu YF, Wang DX, Sessler DI. Long-term Survival after Combined Epidural-General Anesthesia or General Anesthesia Alone: Follow-up of a Randomized Trial. Anesthesiology 2021; 135:233-245. [PMID: 34195784 DOI: 10.1097/aln.0000000000003835] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Experimental and observational research suggests that combined epidural-general anesthesia may improve long-term survival after cancer surgery by reducing anesthetic and opioid consumption and by blunting surgery-related inflammation. This study therefore tested the primary hypothesis that combined epidural-general anesthesia improves long-term survival in elderly patients. METHODS This article presents a long-term follow-up of patients enrolled in a previous trial conducted at five hospitals. Patients aged 60 to 90 yr and scheduled for major noncardiac thoracic and abdominal surgeries were randomly assigned to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia alone with postoperative intravenous analgesia. The primary outcome was overall postoperative survival. Secondary outcomes included cancer-specific, recurrence-free, and event-free survival. RESULTS Among 1,802 patients who were enrolled and randomized in the underlying trial, 1,712 were included in the long-term analysis; 92% had surgery for cancer. The median follow-up duration was 66 months (interquartile range, 61 to 80). Among patients assigned to combined epidural-general anesthesia, 355 of 853 (42%) died compared with 326 of 859 (38%) deaths in patients assigned to general anesthesia alone: adjusted hazard ratio, 1.07; 95% CI, 0.92 to 1.24; P = 0.408. Cancer-specific survival was similar with combined epidural-general anesthesia (327 of 853 [38%]) and general anesthesia alone (292 of 859 [34%]): adjusted hazard ratio, 1.09; 95% CI, 0.93 to 1.28; P = 0.290. Recurrence-free survival was 401 of 853 [47%] for patients who had combined epidural-general anesthesia versus 389 of 859 [45%] with general anesthesia alone: adjusted hazard ratio, 0.97; 95% CI, 0.84 to 1.12; P = 0.692. Event-free survival was 466 of 853 [55%] in patients who had combined epidural-general anesthesia versus 450 of 859 [52%] for general anesthesia alone: adjusted hazard ratio, 0.99; 95% CI, 0.86 to 1.12; P = 0.815. CONCLUSIONS In elderly patients having major thoracic and abdominal surgery, combined epidural-general anesthesia with epidural analgesia did not improve overall or cancer-specific long-term mortality. Nor did epidural analgesia improve recurrence-free survival. Either approach can therefore reasonably be selected based on patient and clinician preference. EDITOR’S PERSPECTIVE
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Li YW, Li HJ, Li HJ, Zhao BJ, Guo XY, Feng Y, Zuo MZ, Yu YP, Kong H, Zhao Y, Huang D, Deng CM, Hu XY, Liu PF, Li Y, An HY, Zhang HY, Wang MR, Wu YF, Wang DX, Sessler DI. Delirium in Older Patients after Combined Epidural-General Anesthesia or General Anesthesia for Major Surgery: A Randomized Trial. Anesthesiology 2021; 135:218-232. [PMID: 34195765 DOI: 10.1097/aln.0000000000003834] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Delirium is a common and serious postoperative complication, especially in the elderly. Epidural anesthesia may reduce delirium by improving analgesia, reducing opioid consumption, and blunting stress response to surgery. This trial therefore tested the hypothesis that combined epidural-general anesthesia reduces the incidence of postoperative delirium in elderly patients recovering from major noncardiac surgery. METHODS Patients aged 60 to 90 yr scheduled for major noncardiac thoracic or abdominal surgeries expected to last 2 h or more were enrolled. Participants were randomized 1:1 to either combined epidural-general anesthesia with postoperative epidural analgesia or general anesthesia with postoperative intravenous analgesia. The primary outcome was the incidence of delirium, which was assessed with the Confusion Assessment Method for the Intensive Care Unit twice daily during the initial 7 postoperative days. RESULTS Between November 2011 and May 2015, 1,802 patients were randomized to combined epidural-general anesthesia (n = 901) or general anesthesia alone (n = 901). Among these, 1,720 patients (mean age, 70 yr; 35% women) completed the study and were included in the intention-to-treat analysis. Delirium was significantly less common in the combined epidural-general anesthesia group (15 [1.8%] of 857 patients) than in the general anesthesia group (43 [5.0%] of 863 patients; relative risk, 0.351; 95% CI, 0.197 to 0.627; P < 0.001; number needed to treat 31). Intraoperative hypotension (systolic blood pressure less than 80 mmHg) was more common in patients assigned to epidural anesthesia (421 [49%] vs. 288 [33%]; relative risk, 1.47, 95% CI, 1.31 to 1.65; P < 0.001), and more epidural patients were given vasopressors (495 [58%] vs. 387 [45%]; relative risk, 1.29; 95% CI, 1.17 to 1.41; P < 0.001). CONCLUSIONS Older patients randomized to combined epidural-general anesthesia for major thoracic and abdominal surgeries had one third as much delirium but 50% more hypotension. Clinicians should consider combining epidural and general anesthesia in patients at risk of postoperative delirium, and avoiding the combination in patients at risk of hypotension. EDITOR’S PERSPECTIVE
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Hu Y, Dong WX, Xu JZ, Yuan ZS, Sun XY, Zhu BK, Lai OJ, Chen XG, Zhao BJ. [Biomechanical study of different kinds of internal fixation for the typeⅠ Hangman fracture, type Ⅱ odontoid fracture and the C(2/3) disc injury: a finite-element analysis]. Zhonghua Yi Xue Za Zhi 2018; 98:2489-2495. [PMID: 30139001 DOI: 10.3760/cma.j.issn.0376-2491.2018.31.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: To analyze the biomechanical stability of four kinds of internal fixation for the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture and the C(2/3) disc injury by finite element (FE) analysis. Methods: Thin-section spiral computed tomography (0.5 mm) was performed on C(1) to C(3) region of cervical vertebra in healthy male volunteers.A three-dimensional hexahedral FE model of upper cervical spine was established by software (Mimics, GEOMAGICS, Pro/E and Ansys). Then the weakening of the strength of grid was performed to simulate the FE model of the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture and the C(2/3) disc injury (FE/Fracture), the four internal fixation models: anterior cervical plate+ odontoid screw+ cage (FE/ACP+ OS+ cage), affixing rods from pedicle screws in C(2) to lateral mass screws in C(3)+ odontoid screw + cage (FE/C(2)PS+ C(3)LMS+ OS+ cage), affixing rods from pedicle screws in C(1) to pedicle screws in C(2) and lateral mass screws in C(3) (FE/C(1)PS+ C(2)PS+ C(3)LMS), anterior odontoid screw plate fixation system (FE/AOSP) were simulated on the FE/Fracture model.Flexion, extension, lateral bending and axial rotation were imposed on the FE/Intact, FE/Fracture and the four fixation models respectively. Results: The intact model of upper cervical spine (C(1)-C(3)) was established successfully, consisting of 259 641 nodes and 403 674 units.There was no significant difference among the FE/ACP+ OS+ cage, the FE/ C(2)PS+ C(3)LMS+ OS+ cage and the FE/AOSP of ROMC(1/2).During flexion, extension, left axial rotation and right axial rotation of ROMC(2)-C(3), the FE/AOSP decreased 70.7%, 74.4%, 38.9%, 41.1% respectively compared with the FE/C(1)PS+ C(2)PS+ C(3)LMS.The ROMC(2)-C(3) during flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation in the FE/AOSP decreased for 82.2%, 82.8%, 73.2%, 64.8%, 72.2%, 81.5% respectively when compared with those in FE/ACP+ OS+ cage.The ROMC(2)-C(3) during flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation in the FE/AOSP decreased 88.2%, 81.2%, 47.6%, 41.2%, 38.9%, 39.0% respectively when compared with those in FE/C(2)PS+ C(3)LMS+ OS+ cage.The stress concentrated on the connection between plate and screw in the FE/ACP+ OS+ cage, the FE/C(2)PS+ C(3)LMS+ OS+ cage and the FE/C(1)PS+ C(2)PS+ C(3)LMS, while it distributed evenly in the FE/AOSP. Conclusion: Anterior odontoid screw plate fixation system can be used to treat the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture, and the C(2/3) disc injury and can reserve the function of atlanto-axial joint.
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Affiliation(s)
- Y Hu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo 315040, China
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Wang H, Zhao BJ, Yan RZ, Wang C, Luo CC, Hu M. [Evaluation of biocompatibility of Ti-6Al-4V scaffolds fabricated by electron beam melting]. Zhonghua Kou Qiang Yi Xue Za Zhi 2018; 51:667-672. [PMID: 27806759 DOI: 10.3760/cma.j.issn.1002-0098.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the biocompatibility of Ti-6Al-4V scaffolds fabricated by electron beam melting(EBM). Methods: Bone marrow mesenchymal stem cells(BMSC) co-cultured with Ti-6Al-4V specimens fabricated with EBM was prepared as experimental group and the regular cells culture was employed as control. The biocompatibility was detected using CCK-8 and cytoskeleton staining. The osteogenic differentiation ability was assessed using mineralization nodule formation. A 24 mm defect was created on the right mandibular body in 12 beagles. The mandibular defects were repaired with Ti-6Al-4V scaffolds mesh fabricated by EBM. General observation, CT and histology examination was carried out to evaluated the biocompatibility of Ti-6Al-4V scaffolds in vivo. Results: CCK-8 result showed the A values of the two groups had no significant difference(P >0.05). There was no significant difference between the two groups (P>0.05). Cytoskeletal staining showed that cells were fully stretched out and grew well on T-i6Al-4V specimen. The actin fibers were arranged in parallel and stained uniformly with fluorescent. After osteogenic culture, the quantity of the nodule formation of the experimental group and control group were 5.7±0.7 and 5.1 ± 0.6, respectively(P>0.05). All animals had tolerated the surgery and healed well. CT examination showed that Ti-6Al-4V scaffolds mesh had good retention with surrounding bone and the continuity of mandible was restored. Histological examination showed that no inflammation reaction or toxity was caused in the soft tissue surrounding the scaffolds and in the liver and kidney after implantation. Ti-6Al-4V scaffolds had good retention with surrounding bone. Conclusions: Ti-6Al-4V fabricated with electron beam melting has good biocompatibility.
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Affiliation(s)
- H Wang
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - B J Zhao
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - R Z Yan
- Department of Stomatology, Hospital of Jiangxi Provincial Armed Police Corps, Nanchang 330001, China
| | - C Wang
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - C C Luo
- Department of Radiology, General Hospital of Chinese PLA, Beijing 100853, China
| | - M Hu
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
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Zhang Y, Li HJ, Wang DX, Jia HQ, Sun XD, Pan LH, Ye QS, Ouyang W, Jia Z, Zhang FX, Guo YQ, Ai YQ, Zhao BJ, Yang XD, Zhang QG, Yin N, Tan HY, Liu ZH, Yu JB, Ma D. Impact of inhalational versus intravenous anaesthesia on early delirium and long-term survival in elderly patients after cancer surgery: study protocol of a multicentre, open-label, and randomised controlled trial. BMJ Open 2017; 7:e018607. [PMID: 29187413 PMCID: PMC5719291 DOI: 10.1136/bmjopen-2017-018607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Elderly patients who have solid organ cancer often receive surgery. Some of them may develop delirium after surgery and delirium development is associated with worse outcomes. Furthermore, despite all of the advances in medical care, the long-term survival in cancer patients is far from optimal. Evidences suggest that choice of anaesthetics during surgery, that is, either inhalational or intravenous anaesthetics, may influence outcomes. However, the impact of general anaesthesia type on the occurrence of postoperative delirium is inconclusive. Although retrospective studies suggest that propofol-based intravenous anaesthesia was associated with longer survival after cancer surgery when compared with inhalational anaesthesia, prospective studies as such are still lacking. The purposes of this randomised controlled trial are to test the hypotheses that when compared with sevoflurane-based inhalational anaesthesia, propofol-based intravenous anaesthesia may reduce the incidence of early delirium and prolong long-term survival in elderly patients after major cancer surgery. METHODS AND ANALYSIS This is a multicentre, open-label, randomised controlled trial with two parallel arms. 1200 elderly patients (≥65 years but <90 years) who are scheduled to undergo major cancer surgery (with predicted duration ≥2 hours) are randomised to receive either sevoflurane-based inhalational anaesthesia or propofol-based intravenous anaesthesia. Other anaesthetics and supplemental drugs including sedatives, opioids and muscle relaxants are administered in both arms according to routine practice. The primary early outcome is the incidence of 7-day delirium after surgery and the primary long-term outcome is the duration of 3-year survival after surgery. ETHICS AND DISSEMINATION The study protocol has been approved by the Clinical Research Ethics Committees of Peking University First Hospital (2015[869]) and all participating centres. The results of early and long-term outcomes will be analysed and reported separately. TRIAL REGISTRATION NUMBER ChiCTR-IPR-15006209; NCT02662257; NCT02660411.
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Affiliation(s)
- Yue Zhang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hui-Juan Li
- Project Development and Project Management Department, Peking University Clinical Research Institute, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Hui-Qun Jia
- Department of Anesthesiology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xu-De Sun
- Department of Anesthesiology, Tang-Du Hospital Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ling-Hui Pan
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Qing-Shan Ye
- Department of Anesthesiology, Ningxia People’s Hospital, Yinchuan, Ningxia Hui Autonomous Region, China
| | - Wen Ouyang
- Department of Anesthesiology, The Third Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zhen Jia
- Department of Anesthesiology, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Fang-Xiang Zhang
- Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
| | - Yong-Qing Guo
- Department of Anesthesiology, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China
| | - Yan-Qiu Ai
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bin-Jiang Zhao
- Department of Anesthesiology, Beijing Shijitan Hospital, Beijing, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China
| | - Qin-Gong Zhang
- Department of Anesthesiology, Shanxi Provincial Cancer Hospital, Taiyuan, Shanxi, China
| | - Ning Yin
- Department of Anesthesiology, Southeast University Zhongda Hospital, Nanjing, Jiangsu, China
| | - Hong-Yu Tan
- Department of Anesthesiology, Peking University Cancer Hospital&Institute, Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education), Beijing, Beijing, China
| | - Zhi-Heng Liu
- Department of Anesthesiology, Shenzhen Second People’s Hospital, Shenzhen, Guangzhou, China
| | - Jian-Bo Yu
- Department of Anesthesiology, Tianjin Nankai Hospital, Tianjin, China
| | - Daqing Ma
- Department of Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care Section, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Zhao BJ, Wang H, Yan RZ, Wang C, Li RX, Hu M. [Comparison of surface characteristics and cytocompatibility of Ti-6Al-4V alloy fabricated with select laser melting and electron beam melting]. Zhonghua Kou Qiang Yi Xue Za Zhi 2016; 51:753-757. [PMID: 27978917 DOI: 10.3760/cma.j.issn.1002-0098.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the surface characteristics and cytocompatibility of Ti-6Al-4V alloy fabricated using select laser melting (SLM) and electron beam melting (EBM) technique. Methods: Ti-6Al-4V alloy specimens were fabricated with SLM and EBM. A wrought form of Ti-6Al-4V alloy was used as a control. Its properties were evaluated using component analysis, contact angle test, surface roughness, surface topography, cell ultrastructure, cell attachment and proliferation observation, metal ion precipitation examination. Results: The roughness of SLM and EBM specimens was suitable for cell attachment but not the best. The character of SLM and EBM specimens was hydrophobic (>65°). The surface topography of EBM and SLM specimens were similar, but were not the best type for cell attachment. The components of Ti-alloy oxide film were detected in all the specimens. The content of Ti, Al, V ions of EBM, SLM and wrought specimens were very low and did not affect the cell attachment and proliferation. The ultrastructure of cell was normal, and the cytomembrane was intact. The number of cells was similar to each other among the three kinds of specimens and increased obviously with the culture time. Conclusions: The results of the study suggested that EBM and SLM Ti-6Al-4V specimens possessed good surface characteristics. However, the surface modification are needed further.
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Affiliation(s)
- B J Zhao
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - H Wang
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - R Z Yan
- Department of Stomatology, Hospital of Jiangxi Provincial Armed Police Corps, Nanchang 330001, China
| | - C Wang
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - R X Li
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
| | - M Hu
- Department of Oral and Maxillofacial Surgery, General Hospital of Chinese PLA, Beijing 100853, China
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Zhao BJ, Wang ZZ, Luo HP, Guo JK, Ji HW, Wang J, Yang LY, Xiao W. [A multi-center, double-blind, placebo-controlled, randomized trial for effect of Longxue Tongluo capsule in treatment of patients of atherosclerotic thrombotic cerebral infarction with blood-stasis syndrome in convalescence]. Zhongguo Zhong Yao Za Zhi 2016; 41:3473-3477. [PMID: 28925134 DOI: 10.4268/cjcmm20161825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 06/07/2023]
Abstract
To evaluate the effectiveness and safety of Longxue Tongluo capsule on patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, a double-blind, randomized controlled, multi-center clinical trial was conducted. A total of 160 eligible patients were randomly divided into treatment group and control group, with 80 patients in each group, and all of them were orally given Troxerutin pill(three pills each time, three times daily). Longxue Tongluo capsule was applied in the treatment group, while placebo was applied in the control group(two capsules each time, three times daily) for 4 weeks. Main outcomes were measured by ITT analysis. The neurological function deficits scale showed a decrease of 5.17±2.60 in the treatment group, while 4.31±2.31 in the control group, with significant differences between the two groups(P<0.05); the reduction rate in the treatment group (37.2±15.8)% was significantly higher than that in the control group (29.9±15.3)%(P<0.05). In terms of the comprehensive curative effect by ITT, the effective rates in the treatment and control group were 31.6% and 13.5%, respectively(P<0.05). With respect to the efficacy of traditional Chinese medicine syndrome by ITT, the total effective rate of the treatment group was significantly higher than the control group 88.2% vs 68.9%, P<0.05. Three cases of adverse events occurred in this study, including 1 case of diarrhea in treatment group and 2 cases of skin itch and upper respiratory infection in control group. In conclusion, Longxue Tongluo capsule is effective and safe in the treatment of patients of atherosclerotic thrombotic cerebral infarction convalescence with blood-stasis syndrome, and can effectively alleviate the patients' nerve function defect degree and invalidism, with a good effect on blood stasis syndrome.
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Affiliation(s)
- Bin-Jiang Zhao
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang 222001, China
| | - Zhen-Zhong Wang
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang 222001, China
| | - Hui-Ping Luo
- Hubei Province Hospital of Traditional Chinese Medicine, Wuhan 430061, China
| | - Jia-Kui Guo
- The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjing 300150, China
| | - Hai-Wang Ji
- Shanxi Provincial People's Hospital, Xi'an 710068, China
| | - Jian Wang
- The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang 110032, China
| | - Lin-Yong Yang
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang 222001, China
| | - Wei Xiao
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang 222001, China
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Li YW, Li HJ, Li HJ, Feng Y, Yu Y, Guo XY, Li Y, Zhao BJ, Hu XY, Zuo MZ, Zhang HY, Wang MR, Ji P, Yan XY, Wu YF, Wang DX. Effects of two different anesthesia-analgesia methods on incidence of postoperative delirium in elderly patients undergoing major thoracic and abdominal surgery: study rationale and protocol for a multicenter randomized controlled trial. BMC Anesthesiol 2015; 15:144. [PMID: 26459347 PMCID: PMC4603291 DOI: 10.1186/s12871-015-0118-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/02/2015] [Indexed: 12/20/2022] Open
Abstract
Background Delirium is a common complication in elderly patients after surgery and associated with increased morbidity and mortality. Studies suggest that deep anesthesia and intense pain are important precipitating factors of postoperative delirium. Neuraxial block is frequently used in combination with general anesthesia for patients undergoing major thoracic and abdominal surgery. Compared with general anesthesia alone and postoperative intravenous analgesia, combined epidural-general anesthesia and postoperative epidural analgesia decreases the requirement of general anesthetics during surgery and provided better pain relief after surgery. However, whether combined epidural-general anesthesia plus epidural analgesia is superior to general anesthesia plus intravenous analgesia in decreasing the incidence of postoperative delirium remains unknown. Methods/design This is a multicenter, open-label, randomized, parallel-controlled clinical trial. One thousand eight hundred elderly patients (age range 60–90 years) who are scheduled to undergo major thoracic or abdominal surgery are randomized to receive either general anesthesia plus postoperative intravenous analgesia or combined epidural-general anesthesia plus postoperative epidural analgesia. The primary outcome is the 7-day incidence of postoperative delirium. Secondary outcomes include the duration of postoperative delirium, the intensity of pain during the first three days after surgery, the 30-day incidences of postoperative non-delirium complications, the length of stay in hospital after surgery and 30-day all-cause mortality. Discussion Results of the present study will provide information to guide clinical practice in choosing appropriate anesthesia-analgesia method for elderly patients undergoing major thoracic and abdominal surgery. Trial registration The study is registered on ClinicalTrials.gov NCT01661907 and Chinese Clinical Trial Registry ChiCTR-TRC-12002371.
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Affiliation(s)
- Ya-Wei Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Hui-Juan Li
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Huai-Jin Li
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yao Yu
- Department of Anesthesiology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yan Li
- Department of Anesthesiology, Peking University Third Hospital, No.49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Bin-Jiang Zhao
- Department of Anesthesiology, Beijing Shijitan Hospital, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Xiao-Yun Hu
- Department of Anesthesiology, Beijing Shijitan Hospital, No.10 Tieyi Road, Haidian District, Beijing, 100038, China
| | - Ming-Zhang Zuo
- Department of Anesthesiology, Beijing Hospital, No.1 Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Hong-Ye Zhang
- Department of Anesthesiology, Beijing Hospital, No.1 Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Mei-Rong Wang
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Ping Ji
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Xiao-Yan Yan
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yang-Feng Wu
- Peking University Clinical Research Institute, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Liu YJ, Xiao W, Wang ZZ, Zhao BJ, Zhou ZM, Jiang HZ, Jin Z, Wei SB, Wang Z, Wang DM, Xia QH, Lin J, Wang Q. [Effects and safety of varying doses of guizhi fuling capsule in patients with primary dysmenorrhea: a multi-center, randomized, double-blind, placebo-controlled clinical study]. Zhongguo Zhong Yao Za Zhi 2013; 38:2019-2022. [PMID: 24066604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
To evaluate the effects and safety of varying doses of Guizhi Fuling capsule on treating primary dysmenorrhea. From August 2010 to March 2011, 240 subjects (aged 18-30) with primary dysmenorrheal, were enrolled in 8 sites. They were randomized into Guizhi Fuling capsule high dose group, low dose group and placebo control group, 80 cases in each group. These patients were treated for three consecutive menstrual cycles, then were followed up in another three consecutive menstrual cycles. Visual analogue scales (VAS) was used to determine the pain intensity. During the treatment, the high-, low-dose and placebo groups efficiency on pain relief are 68.42%, 67.57% and 47.89% respectively. Guzhi Fuling (included high- and low- dose group) significantly relieves the pain compared to placebo. In follow-up, Guzhi Fuling groups are still superior to the placebo group (73.68%, 72.97% and 53.52%). During the treatment, pain duration reduces 57.88% in high dose group, while 46.17% in low dose group, and 30.40% in placebo group. In follow-up, pain lasting time decrease 67.93%, 53.56%, 47.46%, respectively. Guizhi Fuling significantly reduces the pain duration compared to placebo and high-dose is better than low-dose. The efficacy of Guzhi Fuling (high- and low-dose) displays certain dosage-effect relationship. Among these group, no serious adverse event was reported. Guizhi Fuling capsule at high or low dose significantly relieves the pain, improves symptoms, reduces the duration of pain, and has a better overall treatment effect and long-term treatment effect in patients with primary dysmenorrhea.
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Affiliation(s)
- Yu-Jie Liu
- Jiangsu Kanion Pharmaceutical Co., Ltd., Lianyungang 222001, China.
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Zhu XQ, Liu Y, Zhao BJ, Cheng JP. An old but simple and efficient method to elucidate the oxidation mechanism of NAD(P)H model 1-Aryl-1,4-dihydronicotinamides by cations 2-methyl-5-nitroisoquinolium, tropylium, and xanthylium in aqueous solution. J Org Chem 2001; 66:370-5. [PMID: 11429802 DOI: 10.1021/jo0009696] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cations 2-methyl-5-nitroisoquinolinium (IQ+), tropylium (T+), and xanthylium (Xn+) were treated by an NAD(P)H model 1-(p-substituted phenyl)-1.4-dihydronicotinamide series (1) in buffered aqueous solution to give the corresponding reduced products by accepting hydride. Effects of the 4-substituents of 1 on the reaction rates were investigated. Hammett's linear free energy relationship analysis on the three reactions of 1 provides the reaction constants of -0.48, -2.2, and -1.4 with IQ+, T+, and Xn+ as the hydride acceptors, respectively. Comparison of the present reactions with the reaction examples whose mechanisms are well-known, such as the reaction of 1 with a one-electron oxidant Fe(CN)6(-3), shows that the active site of 1 in the oxidation with IQ+ is at the 4-position on the dihydropyridine ring but that the active site of 1 in the oxidations with T+ and Xn+ is at the 1-position, which is in agreement with the results from the Brønsted-type linear analysis and the relation studies of the logarithm of the second-order rate constants with the oxidation potentials of the hydride donors. According to the dependence of the reaction mechanism on the active site of 1, a conclusion can be made that the reaction of 1 with IQ+ proceeds by direct one-step hydride transfer mechanism, but the reactions of 1 with T+ and Xn+ would take place via multistep hydride transfer mechanism initiated by one-electron transfer.
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Affiliation(s)
- X Q Zhu
- Department of Chemistry, Nankai University, Tianjin 300071, China.
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Zhu XQ, Zhao BJ, Cheng JP. Mechanisms of the oxidations of NAD(P)H model Hantzsch 1,4-dihydropyridines by nitric oxide and its donor N-methyl-N-nitrosotoluene-p-sulfonamide. J Org Chem 2000; 65:8158-63. [PMID: 11101368 DOI: 10.1021/jo000484h] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
4-Substituted derivatives of Hantzsch 1,4-dihydropyridine were treated by nitric oxide (NO) or its donor N-methyl-N-nitrosotoluene-p-sulfonamide (MNTS) to give the corresponding pyridine derivatives. When the 4-substituted group was methyl, ethyl, n-propyl, and aryl groups, it was preserved, but when the group was isopropyl or benzyl one, it was lost. 2,3-Dichloro-5, 6-dicyano-1,4-benzoquinone (DDQ) was used in place of NO and MNTS to react with the 4-substituted Hantzsch 1,4-dihydropyridines, no the corresponding 4-dealkyl Hantzsch pyridines were obtained from all the reactions. 1-Benzyl-1,4-dihydronicotinamide (BNAH), a close analogue of Hantzsch 1,4-dihydropyridine (HEH), was used instead of HEH to react with either of NO and MNTS, no reactions were observed for 3 days. Replacement of HEH by N-d-HEH and HEH-4,4-d(2) to react with NO, MNTS and DDQ gave the observed kinetic isotope effects of 3.1 and 1.4 for NO, 1.1 and 1.3 for MNTS, and 1.1 and 2.1 for DDQ, respectively. When p-dinitrobenzene, an electron-transfer inhibitor, was added into the title reaction systems, no remarkable inhibitory effect was observed. These results indicated that the oxidation of HEH by NO was initiated by hydrogen transfer from the N(1)-position to give the corresponding aminyl radical, which then underwent homolytic cleavage to become the final aromatized product (A). But the reaction of HEH with MNTS was initiated by nitrosation to give the corresponding N-nitroso compound, which was subsequently subjected to two steps of homolytic cleavage to afford the aromatized Hantzsch pyridine A.
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Affiliation(s)
- X Q Zhu
- Department of Chemistry, Nankai University, Tianjin 300071, China.
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