Interleukin-6 Protein Expression Is More Important Than Interleukin-6 mRNA Levels in Assessing Surgical Invasiveness
Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan Journal of Surgical Research
(Impact Factor: 1.94).
10/2007; 142(1):53-8. DOI: 10.1016/j.jss.2006.09.037
Interleukin-6 (IL-6) protein has been recognized as a sensitive marker of surgical stress response. However, little is known about the clinical significance of IL-6 mRNA levels as a marker of surgical stress. This study aims to examine the role of IL-6 mRNA expression in comparing the tissue invasiveness of microendoscopic discectomy (MED) and open discectomy (OD).
Twenty-three consecutive patients were randomly selected to undergo either MED or OD. The total RNA was extracted from the peripheral whole blood of patients at pre-op and at 1, 2, 4, 8, 12 h post-op. The real-time reverse transcription polymerase chain reaction (RT-PCR) using the SYBR Green I fluorescence dye and the 2(-DeltaDeltaCt) method was adopted to measure the IL-6 gene expression.
The quantitative changes of IL-6 mRNA expression in MED and OD patients at different times post-op differed significantly, P = 0.04. Experimental results indicate that the changes in IL-6 mRNA expression in OD and MED groups varied significantly at 1 h, 12 h post-op, 10.26-fold versus 4.42-fold and 52.15-fold versus 26.78-fold increase, respectively. Although IL-6 mRNA expression demonstrated an earlier difference than protein levels at 1 h post-op, IL-6 mRNA levels were found to be significantly affected after surgical procedures. Furthermore, compared with our enzyme-linked immunosorbent assay data, no significant correlation existed between IL-6 mRNA and protein levels at any post-op time interval.
We conclude that IL-6 mRNA expression using RT-PCR to extract the total RNA from a patient's peripheral whole blood is more sensitive than protein levels but can be significantly affected by surgical procedures. The enzyme-linked immunosorbent assay data on IL-6 protein expression are more consistent and significant than IL-6 mRNA levels in comparing tissue invasiveness between MED and OD.
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ABSTRACT: Endothelial dysfunction is associated with cardiovascular diseases. The Ca2+ influx occurring via activation of plasmalemma Ca2+ channels was shown to be critical in signaling the increase in endothelial permeability in response to a variety of permeability-increasing mediators. It has been reported that angiotensin II (AngII) could induce Ca2+ signaling in some cells, and transient receptor potential canonical 1 (TRPC1) had an important role in this process. The objective of this study was to examine the mechanism of AngII-induced Ca2+ entry and vascular endothelial hyperpermeability. Human umbilical vein endothelial cells (HUVECs) exposed to AngII exhibited dose-dependent increase in [Ca2+]i and endothelial permeability. Quantitative real-time RT-PCR and Western blotting showed that the level of TRPC1 expression had increased significantly at 12h and at 24h after treatment of HUEVCs with AngII. The expression of p65 was suppressed using an RNAi strategy. The results showed that the NF-κB signaling pathway and type-1 receptor of AngII was involved in AngII-induced TRPC1 upregulation. Moreover, knockdown of TRPC1 and NF-κB expression attenuates AngII-induced [Ca2+]i and endothelial permeability. NF-κB and TRPC1 have critical roles in AngII-induced Ca2+ entry and endothelial permeability.
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ABSTRACT: A review of methods to optimize anesthesia and analgesia for minimally invasive spine procedures.
To provide information to surgeons and anesthesiologists of methods to provide optimal anesthesia and pain control for minimally invasive spine surgery with an emphasis on preoperative planning.
Postoperative pain management in patients undergoing minimally invasive spine surgery is a challenge for the perioperative anesthesiologist. In addition to the incisional pain, trauma to deeper tissues, such as ligaments, muscles, intervertebral discs, and periosteum are reasons for significant pain. The increasing number of minimally invasive surgeries and the need for improved and rapid return of the patient of functionality have brought the perioperative anesthesiologist and the surgeon closer.
We undertook a review of the literature currently available on anesthesia and analgesia for minimally invasive spine surgery with an emphasis on preoperative planning. A large number of reports of randomized controlled clinical trials with respect to perioperative anesthetic and postoperative pain management for minimally invasive spine surgery are reviewed and the applicability of some of the principles and protocols used for other types of minimally invasive surgical procedures are placed in the context of spine surgery.
It is important to understand and implement a multimodal analgesic therapy during a patient's preoperative visits. Perioperative multimodal analgesia with a fast-track anesthetic protocol is also important and provided in the manuscript. This protocol poses a challenge to the anesthesiologist with respect to neurophysiologic monitoring, which requires further study. The postoperative analgesic management should be a continuance of the multimodal analgesia provided before surgery. Some drugs are not appropriate for patients undergoing fusion surgery because of their effect on bone healing.
An optimal preoperative, perioperative, and postoperative anesthesia and analgesia protocol is important to best possible pain relief and rapid return to normal function. Communication between the anesthesiologist and spine surgeon is important to achieve a protocol with the best short- and long-term outcomes for the benefit of the patient.
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ABSTRACT: Neuropathic pain originating from spinal disc herniations is a very common problem. The majority of disc surgeries are performed to alleviate this pain once conservative measures and targeted injections have failed. Endoscopic spinal surgery is increasingly popular because it minimizes access trauma and hastens recovery from the intervention. This clinically oriented review evaluates controlled studies that investigate the clinical results and the complications of full-endoscopic lumbar and cervical procedures for symptomatic disc herniations in comparison to a microsurgical standard procedure. This review focuses exclusively on modern, full-endoscopic disc surgery irrespective of the specific access technique (e.g., interlaminar vs. transforaminal) and irrespective of the spinal region.
Comprehensive review of the literature.
To assess the clinical outcomes and complication rates of full-endoscopic disc surgery compared to the microsurgical standard procedures.
A PubMed and Embase search was performed, considering entries up to January 2013. All 504 results were screened and categorized. Only 4 randomized controlled trials (RCTs) and one controlled studies (CS) could finally be considered for evaluation. All 5 manuscripts were meticulously analyzed with regards to randomization mode, inclusion/exclusion criteria, clinical results, and complication rates.
Overall, the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return to work than the microsurgical techniques. There were no significant differences in the main clinical outcome criteria between the endoscopic and the microsurgical techniques in any of the trials. All 5 studies had fewer complications with the endoscopic technique and this was statistically significant in 2 of the studies. One study showed a lower rate of revision surgeries requiring arthrodesis with the endoscopic technique.
All 5 studies that could be considered originate from experienced investigators and all 4 RCTs came from one group. This limits the transferability of their results to surgeons less experienced in endoscopic disc surgery.
The studies show that full-endoscopic disc surgery can achieve the same clinical results in symptomatic cervical and lumbar disc herniations as the microsurgical standard techniques. This does not appear to come at the price of higher complication rates.
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