Editorial


Background: Pain is one of the main protests of inflammatory diseases, hence, understanding the mechanisms which involved in the induction and persistence of pain is essential. Microglia is a contributing factor in the onset and maintenance of inflammation. Increased microglial   activation increases the level of central pro-inflammatory cytokines and the development of central sensitization following inflammation. The aim of this study was evaluate the relation of spinal microglia activity with pain related behaviors during Complete Freund’s adjuvant (CFA)-induced inflammation.

Materials and Methods: Inflammation caused by subcutaneous injection of Complete Freund’s adjuvant (CFA) in a single dose to the animals right hind paw. The edema and hyperalgesia caused by inflammation, respectively are measured by Plethysmometer and Radiant Heat, on days 0,7,14 and 21. Spinal Iba-1 protein expression was detected by Western blotting. Minocycline hydrochloride (Sigma, U.S.A) was administered i.p. at a dose of 40mg/kg daily.

Results: Our study findings indicated that CFA injection to right hindpaw of rats increased paw volume and hyperalgesia significantly during different stages of study, while Minocycline treatment significantly reduced paw volume and hyperalgesia. CFA injection into the right hindpaw of the rat increases the expression of molecules Ionized calcium binding adaptor molecule -1 (Iba-1) on different days of study, while Minocycline administration reduced spinal Iba-1 expression significantly compared to the CFA group.

Conclusion: The results of this study indicated the significant roles of microglia activation in deterioration of pain related behaviors during different stages of CFA-induced inflammation. The steady injection of Minocycline (as a microglia inhibitor) could reduce the inflammatory symptoms.

Original Articles


Microglia are involve in pain related behaviors during the acute and chronic phase of arthritis inflammation

Behzad Nasseri, Vida Nazemian, Homa Manaheji, Jalal Zaringhalam

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 137-145
https://doi.org/10.22037/jcma.v1i4.13557

Abstract

Background: Pain is one of the main protests of inflammatory diseases, hence, understanding the mechanisms which involved in the induction and persistence of pain is essential. Microglia is a contributing factor in the onset and maintenance of inflammation. Increased microglial   activation increases the level of central pro-inflammatory cytokines and the development of central sensitization following inflammation. The aim of this study was evaluate the relation of spinal microglia activity with pain related behaviors during Complete Freund’s adjuvant (CFA)-induced inflammation.

Materials and Methods: Inflammation caused by subcutaneous injection of Complete Freund’s adjuvant (CFA) in a single dose to the animals right hind paw. The edema and hyperalgesia caused by inflammation, respectively are measured by Plethysmometer and Radiant Heat, on days 0,7,14 and 21. Spinal Iba-1 protein expression was detected by Western blotting. Minocycline hydrochloride (Sigma, U.S.A) was administered i.p. at a dose of 40mg/kg daily.

Results: Our study findings indicated that CFA injection to right hindpaw of rats increased paw volume and hyperalgesia significantly during different stages of study, while Minocycline treatment significantly reduced paw volume and hyperalgesia. CFA injection into the right hindpaw of the rat increases the expression of molecules Ionized calcium binding adaptor molecule -1 (Iba-1) on different days of study, while Minocycline administration reduced spinal Iba-1 expression significantly compared to the CFA group.

Conclusion: The results of this study indicated the significant roles of microglia activation in deterioration of pain related behaviors during different stages of CFA-induced inflammation. The steady injection of Minocycline (as a microglia inhibitor) could reduce the inflammatory symptoms.

Keywords: Inflammation, pain, microglia, minocycline

c.559 T>C as The Most Common Mutation of Factor XIII Deficiency in Iranian Patients is not Restricted to Southeast Iran

Akbar Dorgalaleh, Shadi Tabibian, Bijan Varmaghani, Gholam Hossein Tamaddon, Hasan Boustani

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 154-157
https://doi.org/10.22037/jcma.v1i4.13508

Background: Iran has a large group of patients with severe congenital factor XIII deficiency (FXIIID) and Trp187Arg mutation that is most disease causing mutation of FXIII in the world is only observed in southeast of Iran with 352 patients with FXIIID. 743 patients with FXIIID was observed in 17 provinces of Iran but Tehran city with more than 12 million population has no any registered patient with FXIIID. Here we described first case with severe congenital FXIIID in Tehran Province with underline FXIII mutation.

Methods: A neonate with prolonged umbilical cord bleeding was referred to hemophilia center. Patient was screened by routine coagulation tests and by clot solubility test. After observation of normal routine tests and abnormal clot solubility patient was underwent a full sequencing of FXIII-A gene. For confirmation of detected mutation in FXIII-A gene, exon 4 was amplified by PCR and cleaved by Eco130I restriction enzyme.

Results: We found first case with severe congenital FXIIID in Tehran Province with Trp187Arg mutation in exon 4 of FXIII-A gene. Patient’s parents were heterozygote for this mutation.

Conclusion: Trp187Arg mutation of FXIII-A is the most common mutation in Iranian patients with FXIIID and is not restricted to southeast of Iran.

Keywords: Factor XIII deficiency, Trp187Arg mutation, Tehran Province

The Effect of Lidocaine Infusion during General Anesthesia on Neutrophil-Lymphocyte-Ratio in Breast Cancer Patients Candidate for Mastectomy; a Clinical Trial

Elham Memary, Alireza Mirkheshti, Mahshid Ghasemi, Mehrdad Taheri, Ali Arhami Dolatabadi, Atiye Kaboudvand

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 146-153
https://doi.org/10.22037/jcma.v1i4.13519

Introduction: Considering the anti-inflammatory role of intravenous (IV) lidocaine, its analgesic properties, and its ability to reduce the need for opioids during and after surgery, in this study we decided to evaluate the effect of IV lidocaine infusion on levels of inflammatory factors based on neutrophil to lymphocyte ratio (NLR) in breast cancer surgery candidates.

Methods: The present study is a randomized clinical trial. All the patients with ASA: I, II breast cancer, who were candidates of mastectomy elective surgery were included. The patients were allocated to 2 groups of IV lidocaine and normal saline based on a random numbers table. After inducing anesthesia similarly for all the patients, using 0.02 mg/kg midazolam, 2-4 µg/kg fentanyl, 1-2 mg/kg propofol and 0.5 mg/kg atracurium, either 1.5 mg/kg/hr IV lidocaine or the same volume of normal saline was infused intravenously. Glasgow prognostic score and NLR were calculated before and 6, 24, and 48 hours and 14 days after surgery.

Results: A total of 63 women suffering from breast cancer, with the mean age of 49.25 ± 9.32 years, were included, and allocated to lidocaine and control groups using simple randomization. There was no statistically significant difference between the 2 groups regarding mean age (p = 0.591), incision size (p = 1.000), and duration of surgery (p = 0.752). Using mixture model regression analysis and after adjusting the effect of baseline variables, a significant difference was detected between the groups regarding NLR during the follow-up period (p = 0.006).

Conclusion: Based on the findings of the present study, it seems that NLR changes were smaller in breast cancer patients, who had received lidocaine infusion during surgery, compared to the control group.

Purification of Human Serum Albumin by Ion Exchange Chromatography

Nima Padashi, Mehdi Arjmand, Samira Rajaei, Ali Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 158-162
https://doi.org/10.22037/jcma.v1i4.13565

Introduction: Albumin, one of the most important plasma proteins, has a difficult process of synthesis and production. We compared two different methods for albumin purification: Carboxymethyl cellulose (CM cellulose) resin exchange and Diethylaminoethyl cellulose (DEAE cellulose) resin exchange in order to determine which resin could be more beneficial.

Materials and methods: two ion exchange resins were used DEAE cellulose resin and CM cellulose resin. All resins were recruited according to the standard preparation protocol. The final results were analyzed using SDS-PAGE technique.

Results: in DEAE Cellulose resin, nearly more than 75% of the purified protein was albumin; while, in CM cellulose resin, more than 90% was albumin.

Conclusion: albumin purification using CM cellulose resin is much more efficacious compared to DEAE cellulose resin. Though significant laboratory findings were demonstrated in this study, clinical studies are needed to confirm clinical outcomes.

 

Real-time RT-PCR Detection of HCN4 and ADAM8 genes in ventilator-associated pneumonia patients Hospitalized in intensive care unit

Hamidreza Jamaati, Naghmeh Bahrami, Masoum Abniki, Payam Tabarsi, Behrooz Farzanegan, Atosa Doroudinia, Abdolreza Mohamadnia

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 163-167
https://doi.org/10.22037/jcma.v1i4.13372

Introduction

Ventilator-associated pneumonia (VAP)  is One of the most serious and  prevalence of  complication  among patients in the intensive care unit nosocomial infections, which are often recognized after detecting symptoms. To date, there has been no proper clinical and diagnostic marker for early detection of this disease. In this study, two HCN4 and ADAM8 genes in patients with VAP were assessed to be used as a biomarker to recognize and distinguish the disease.  

 

Methodology

This study was done in Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences,Tehran,Iran since 2015-2016 and was case /control study . current study was administered by using peripheral blood samples, including 30 patients with VAP and 30 Healthy person. First, the peripheral blood samples were taken and then RNA was extracted and then synthesis CDNA. Finally, the evaluation of genes was performed by Realtime PCR method.   

Findings

In peripheral blood samples, patients individuals , 10 out of 30 cases had positive HCN4 markers. Among the healthy individuals, 6 out of 30 cases had positive HCN4  biomarkers.

 Moreover, in ADAM8 marker patients individuals, 13 out of 30 cases had positive ADAM8 marker and 8 out of 30 healthy individuals had positive ADAM8 biomarkers.

Conclusion

Genes HCN4 and ADAM8  assessment with Real Time-PCR  in this study can be used as promising markers in early detection of VAP disease. More extensive studies on larger sample sizes may yield higher sensitivity for these molecular markers.

Comparison between Infusion Pumps: Fentanyl/Ketamine and Fentanyl/Paracetamol in Pain control Following Tight and Leg Surgeries

Behnam Mahmoodiyeh, Mohamad Khalili, Maryam Panahi, Esmaeel Moshiri, Sayed Mehran Marashian, Alireza Jahangirifard

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 168-174
https://doi.org/10.22037/jcma.v1i4.13321

Background: Adjuvants such as ketamine, promethazine and paracetamol could bring up patients satisfaction and control harmful effects of opioids besides lessening their needed doses, as seen by fentanyl/paracetamol and fentanyl/ketamine combination before. The current study headed to compare paracetamol and ketamine in addition to fentanyl applied by infusion pumps in order to pain relief following major surgery.

Methods: Through a double blinded randomized clinical trial, patients between18 and 65 with elective surgery for tight or leg fractures with ASA Class 1 and 2 referring to a university hospital in Arak, a town in central region of Iran, were recruited and used infusion pump for their postoperative pain control. The participants were divided into cases and controls regarding using ketamine/fentanyl (KF) or paracetamol/fentanyl (PF) infusion pumps.

Results: The mean pain score was totally 3.87 with higher value in KF (5.06) and lower in PF (4.5) immediately after finishing surgery and getting conscious when started using infusion pump. There was no statistical difference between the groups in this regard. Concerning the side effects of the applied medications, blood pressure and heart rate had no differences comparing the groups.

Conclusion: This study showed that paracetamol used in infusion pump can be brilliant in pain control after major surgeries like what done in lower extremities and joint replacement while lessens opioid use. Although paracetamol was more effective than ketamine in the current trial, more qualified studies at bigger size and in other fields of surgery beside orthopedic ones would be useful to support the effects if applicable.

Keywords: Infusion pump, Ketamine, Paracetamol, Fentanyl, Postoperative pain

Brief Communications


Heparin- induced thrombocytopenia (HIT): a case report of CABG patient

Alireza Jahangirifard, Majid Golestani Eraghi, Mohammad Ali Saghafi

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 175-179
https://doi.org/10.22037/jcma.v1i4.13467

Heparin- induced thrombocytopenia (HIT) is an antibody mediated adverse effect of heparin therapy which is classified into two subtypes, HITI which is non-immune, spontaneously reversible thrombocytopenia and; HITII which is an autoimmune-mediated adverse effect of heparin therapy. In this case report, we described a 65-year old male patient with HITII after coronary artery bypass grafting.

Key words: Heparin- induced thrombocytopenia, Heparin- induced thrombosis, coronary artery bypass grafting.

Review


The effect of volatile anesthetics on myocardial ischemia/reperfusion: a review and meta-analysis

Neda Aram, Alireza Abadi, Zahra Nouri, Ali Dabbagh

Journal of Cellular & Molecular Anesthesia, Vol. 1 No. 4 (2016), 26 August 2016 , Page 180-188
https://doi.org/10.22037/jcma.v1i4.13347

Introduction: ischemia-reperfusion injury is one of the most important cellular mechanisms involved in myocardial injury; there is a possible protective role for volatile agents on myocardial cells against ischemia-reperfusion injury through inhibition of Ca2+ overload; in this review, the effects of volatile agents on myocardial ischemia-reperfusion were assessed using a meta- analysis methodology.

Materials and methods: from 2007 to 2012, using the following keywords, ischemia reperfusion, volatile agent, volatile anesthetic, preconditioning, myocardial, protection, Sevoflurane, Isoflurane, Desflurane. To select more related studies, the search was made narrower using "ischemia reperfusion" and "volatile agent" to yield in 38 articles which could be entered into study calculations, directly or indirectly, with one of the following indicators: odds ratio, standardized mean reference, relative risk and effect size.

Results: after final screening, 20 articles remaining as related to "the effects of volatile agents on myocardial ischemia/reperfusion". The study demonstrated significant decrease in myocardial ischemic region related to "exposure to volatile agents" (p < 0.01); also, there was not a statistically significant difference between the coverage areas of confidence intervals of 3 different drug doses: 1 MAC; 1.5 MAC and 2 MAC (p value>0.05); at the same time, there was no statistically significant difference regarding the protective effects of volatile anesthetic gases on ischemic outcome (p value>0.05).

Discussion: this study demonstrated that all volatile anesthetics could lead to attenuation of myocardial infarct size; though there is no difference between different doses of volatile agents regarding their protective effects and the protective effects of volatile anesthetics are not different regarding their the main genes involved in cardioprotection

Key words: volatile, ischemia reperfusion, ischemia reperfusion