Activation of innate immune mechanisms within the dorsal root ganglion and spinal dorsal horn has been shown to play a key role in the development of neuropathic pain including paclitaxel-related chemotherapy-induced peripheral neuropathy (CIPN). Here, we tested whether similar mechanisms are generalizable to oxaliplatin-induced CIPN. After a single intraperitoneal injection of 3 mg/kg oxaliplatin, mechanical withdrawal threshold and the expression of C-C chemokine ligand 2 (CCL2) and its receptor, CCR2, in the dorsal root ganglion were measured by behavioral testing and immunohistochemical staining, respectively. Mechanical responsiveness increased from the first day after oxaliplatin injection and persisted until day 15, the last day of this experiment. Immunohistochemical showed that the expression of CCL2/CCR2 started to increase by 4 hours after oxaliplatin treatment, was significantly increased at day 4, and then both signals became normalized by day 15. Cotreatment with intrathecal anti-CCL2 antibodies prevented the development of oxaliplatin-induced mechanical hyperresponsiveness, and transiently reversed established hyperalgesia when given 1 week after chemotherapy. This is the first study to demonstrate CCL2/CCR2 signaling in a model of oxaliplatin-related CIPN; and it further shows that blocking of this signal can attenuate the development of oxaliplatin-induced mechanical hyperalgesia. Activation of innate immune mechanisms may therefore be a generalized basis for CIPN irrespective of the specific class of agent.
BackgroundThe “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion.MethodsA total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated.ResultsSuccessful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a “Rusch” intubation stylet.ConclusionsThe “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients.Trial registrationInstitutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910)
BACKGROUND AND OBJECTIVESSeveral techniques are available to facilitate nasogastric (NG) tube insertion with or without using other instruments to guide the NG tube to the stomach. This study aimed to determine the success rate and time required for inserting NG tube by 2 non-instrumental methods of NG tube insertion and compare the findings with the common method of NG tube insertion.DESIGN AND SETTINGSA prospective randomized, controlled clinical trial carried out at Chang Gung Memorial Hospital in Taiwan.SUBJECTS AND METHODSA total of 150 patients were randomized into 3 groups: control group, neck flexion with lateral pressure group, and lifting of the larynx group. The number of attempted insertions, success rate, duration of insertion, and various complications were recorded.RESULTSBoth neck flexion with lateral pressure and lifting of the thyroid cartilage techniques had high success rates; however, the time required to insert the NG tube was shortest in the thyroid cartilage lifting group.CONCLUSIONNeck flexion with lateral pressure and lifting of the thyroid cartilage are convenient and reliable techniques for NG tube insertion without using any other instruments. Lifting of the thyroid cartilage had the highest success rate and was less time consuming than the other NG tube insertion techniques. Familiarization with the procedure influenced the success rate and the time required for insertion.
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