Zhonghui Guan's research while affiliated with UCSF University of California, San Francisco and other places
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Publications (31)
Background
Improper opioid prescription after surgery is a well-documented iatrogenic contributor to the current opioid epidemic in North America. In fact, opioids are known to be overprescribed to liver transplant patients, and liver transplant patients with high doses or prolonged postsurgical opioid use have higher risks of graft failure and dea...
This cohort study examines the extent of mismatched opioid prescribing between hospitalization and discharge after otolaryngology–head and neck surgery.
Although postsurgical overprescription has been well-studied, postsurgical opioid underprescription remains largely overlooked. This retrospective cohort study was to investigate the extent of discharge opioid overprescription and underprescription in patients after neurological surgeries. Six thousand nine hundred forty-nine adult opioid-naive pat...
Background:
Although postoperative opioid overprescription has been well-studied, little is known about opioid underprescription. This study aims to determine the extent of improper discharge opioid prescription in patients undergoing general surgery procedures.
Study design:
This retrospective cohort study investigated opioid-naïve adult patien...
Background:
As the opioid epidemic accelerates in the United States, numerous sociodemographic factors have been implicated its development and are, furthermore, a driving factor of the disparities in postoperative pain management. Recent studies have suggested potential associations between the influence of race and ethnicity on pain perception b...
BACKGROUND CONTEXT
Although studies have explored acute opioid use within 30 days after surgery and chronic opioid use longer than 90 days after surgery, the impact of opioid use within the subacute phase of 31-90 days after surgery has not been studied. However, this subacute postoperative period has been identified as a potential predictor of chr...
Chronic pain remains a public health problem and contributes to the ongoing opioid epidemic. Current pain management therapies still leave many patients with poorly controlled pain, thus new or improved treatments are desperately needed. One major challenge in pain research is the translation of preclinical findings into effective clinical practice...
Background
The Centers for Disease Control and Prevention’s (CDC) March 2016 opioid prescribing guideline did not include prescribing recommendations for surgical pain. Although opioid over-prescription for surgical patients has been well-documented, the potential effects of the CDC guideline on providers’ opioid prescribing practices for surgical...
Hypothalamic orexin (hypocretin) neurons play crucial roles in arousal control. Their involvement in anesthesia and analgesia remains to be better understood. In order to enhance our view on the neuroanatomy, we systematically mapped the projections of orexin neurons with confocal microscope and light sheet microscope. We specifically expressed opt...
Background:
Because it is traditionally difficult and time-consuming to identify the foramen ovale (FO) with fluoroscopy, we recently developed the H-figure method to acquire fluoroscopic view of FO with shorter procedure time and less radiation. However, the impact of such an H-figure approach on the clinical outcomes of trigeminal ganglion radio...
Microgliosis is a hallmark of many neurological diseases, including Alzheimer’s disease, stroke, seizure, traumatic brain and spinal cord injuries, and peripheral and optic nerve injuries. Recent studies have shown that the newly self-renewed microglia have specific neurological functions. However, the mechanism of adult microglia proliferation rem...
Human MYCN is an oncogene amplified in neuroblastoma and many other tumors. Both human MYCN and mouse Mycn genes are important in embryonic brain development, but their functions in adult healthy nerve system are completely unknown. Here, with Mycn-eGFP mice and quantitative RT-PCR, we found that Mycn was expressed in specific brain regions of youn...
Molecular and cellular interactions among spinal dorsal horn neurons and microglia, the resident macrophages of the central nervous system, contribute to the induction and maintenance of neuropathic pain after peripheral nerve injury. Emerging evidence also demonstrates that reciprocal interactions between macrophages and nociceptive sensory neuron...
Ion channels play a pivotal role in anesthesia, including general and regional anesthesia. Two main classes of general anesthetics (GAs) are inhalational anesthetics, such as isoflurane, sevoflurane, and nitrous oxide; injectable anesthetics, such as propofol, etomidate, and ketamine. Besides hypnotic agents, muscle relaxants for immobility and opi...
Background and objectives
Access through the foramen ovale (FO) is essential in performing trigeminal ganglion injection, glycerol rhizolysis, balloon compression, and radiofrequency thermocoagulation (RFT) to treat idiopathic trigeminal neuralgia (ITN). However, identification of the FO under fluoroscopy can be difficult and time-consuming, and th...
Paralleling the activation of dorsal horn microglia after peripheral nerve injury is a significant expansion and proliferation of macrophages around injured sensory neurons in dorsal root ganglia (DRG). Here we demonstrate a critical contribution of DRG macrophages, but not those at the nerve injury site, to both the initiation and maintenance of t...
Erythromelalgia is a rare and very difficult to treat pain syndrome that usually presents as severe bilateral burning pain in the extremities. Here we present a case of a 34-year-old female with erythromelalgia who we treated successfully with a lumbar epidural infusion of ropivacaine and fentanyl. The patient had complete relief shortly after the...
Significance
Although millions of procedures are performed under general anesthesia every year, we do not fully understand the mechanisms underlying anesthesia. Orexin neurons in the hypothalamus form one of the centers in the central nervous system involved in sleep–wake control. The orexin system has also been implicated in anesthesia. In this st...
Although microglia have been implicated in nerve injury-induced neuropathic pain, the manner by which injured sensory neurons engage microglia remains unclear. We found that peripheral nerve injury induced de novo expression of colony-stimulating factor 1 (CSF1) in injured sensory neurons. CSF1 was transported to the spinal cord, where it targeted...
Decreased spinal cord GABAergic inhibition is a major contributor to the persistent neuropathic pain that can follow peripheral nerve injury. Recently, we reported that restoring spinal cord GABAergic signaling by intraspinal transplantation of cortical precursors of GABAergic interneurons from the embryonic medial ganglionic eminence (MGE) can rev...
There is continuing controversy relating to the primary afferent neurotransmitter that conveys itch signals to the spinal cord. Here, we investigated the DRG and spinal cord expression of the putative primary afferent-derived "itch" neurotransmitter, gastrin-releasing peptide (GRP). Using ISH, qPCR, and immunohistochemistry, we conclude that GRP is...
Citations
... Thus, we next asked, if PSAM 4 -GlyR-mediated silencing of sensory afferents can treat mechanical allodynia associated with neuropathic pain. We chose the tibial spared nerve injury model (tSNI) and measured the mechanical withdrawal thresholds of mice (39), that had previously received i.t. AAV-mCherry or AAV-mCherry-T-PSAM 4 -GlyR (Fig. 4I). ...
... The distinct functionality of OCT1 across different populations can have profound implications for clinical outcomes. For instance, morphine has been observed to exhibit stronger efficacy in East Asian populations, requiring significantly lower doses compared to Europeans (Konstantatos et al., 2012;Letchuman et al., 2023). Further investigation is needed to examine the impact of polymorphisms in morphine metabolizing enzymes and transporters. ...
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... Third, this type of contact needs to be confirmed further in tissue sections/co-culture of neurons/glial cell and immune cells by using EM and immuno-EM as described in a few previous studies (175,176). Once enough anatomical/morphological evidence of nerve-immune cell interaction has been obtained, further molecular/physiological/ functional studies should be conducted to reveal the molecular mechanism of this type of local neuroimmune interaction (20,(177)(178)(179). ...
... Data was then deseasonalized according to monthly seasonal coefficients (specially for each molecule) calculated from 2010 to 2019. Then analyses were performed-for each molecule of interestusing a long-term Interrupted Series Analysis (ITSA) model using the Stata command ITSA (19) with the deseasonalized number of boxes per 1,000 inhabitants as the outcome (20)(21)(22). The data before the 1st lockdown (from 2015 to March 2020) was used to modelized the counterfactual evolution after in order to test changes in trends of medication delivery. ...
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... 106 In addition to this, orexin is associated with a variety of functions, including feeding and energy regulation, neuroendocrine regulation, and regulation of pain. [107][108][109] Early on, the discovery that orexin deficiency could cause episodic sleeping sickness in several mammals, including mice, rats, dogs, and humans, caught the attention of scientists. [110][111][112] Researchers have been shown to improve sleep in insomnia patients by inhibiting dual orexin receptors, findings that reinforce the importance of the orexin system in regulating sleep/wakefulness. ...
... Patients in all studies were from China. 17 studies compared puncture approaches (15, 18,35,38,40,[42][43][44][45][46][49][50][51][52][53][54][55], and 10 studies compared guidance techniques (6,33,34,36,37,39,41,47,48,56). The mean Jadad score of the four RCTs was 5.75. ...
... We also evaluated the specific TF enrichment for both DAM and DIM subpopulations ( Figure 3H and Supplementary Figure 9A). In contrast to what we described for homeostatic microglia, the DAM nuclei showed high association with MYC and ATF6, both of which have been previously described as important factors in microglia activation 28,29 . Additionally, increased involvement of RFX TFs appeared to be characteristic of the Intermediate.DAM and DIMs. ...
... The SCZ is genetically different from the other neurogenic niches (Kim et al. 2017), which may explain why this region is primarily involved in the production of oligodendrocyte precursors that help preserve oligodendrocyte renewal and myelination in the corpus callosum (Morrison et al. 2020). A recent report suggests this region is regulated by the Mycn gene, an oncogene amplified in brain tumors (Chen and Guan 2022), which may have important implications for tumorigenesis or as a therapeutic target against brain tumors. ...
... Although DRG neurons are primarily damaged in many neuropathic pain conditions, their involvement in infant resistance remained unclear. Through comprehensive gene expression analysis, we found that several key factors for neuropathic pain, including PACAP, cathepsin S, and nNOS [24,[30][31][32][33], were differentially regulated in the adult and infant DRGs after nerve injury. Furthermore, bioinformatics analysis revealed that a group of differentially regulated genes was closely related to immunological and inflammation responses, which are an important cellular basis for neuropathic pain [8]. ...
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... The inconsistency (I 2 ) over 75% (considerable heterogeneity according the Cochrane Handbook for Systematic Reviews of Interventions) found in every acute and subacute pain summary measure of the review confirms the previous considerations. 4 Its high level of statistical heterogeneity is considered a prohibitive feature when considering performing a meta-analysis in many systematic review protocols and raises many concerns about the conclusions of the review announced by the authors. That statistical heterogeneity must dictate how the results are understood and reflects the aforementioned clinical heterogeneity. ...
Reference: Perioperative Use of Gabapentinoids: Comment
