We studied the effects of mu-opioid receptor (MOR) modulation on seizure responses to electroshock stimulation in C57BL/6J (B6) and DBA/2J (D2) mice of both sexes. Using a genetic approach, we show that B6 and D2 mice with a constitutive deletion of the MOR gene Oprm1 have a significantly reduced maximal electroconvulsive shock (ECS) seizure threshold. Using a pharmacological approach, we show that morphine treatment (25 mg pellet, s.c.) significantly reduces expression of maximal ECS seizures in both wild type strains, and conversely, that naltrexone treatment (1-10 mg/kg, s.c.) increases maximal ECS seizure susceptibility, more so in B6 mice than in D2. Unexpectedly, we observe that higher doses of naltrexone (100-500 mg/kg, i.p.) elicit generalized seizures, with D2 mice displaying significantly greater susceptibility than B6. Together, results suggest that decreasing MOR function increases ECS seizure susceptibility in mice, whereas increasing MOR function decreases ECS seizure susceptibility. The greater sensitivity of D2 mice to the direct proconvulsant effect of high dose naltrexone is consistent with the relative response of this strain to other chemoconvulsants and suggests that endogenous opioids play a role in mediating the previously reported robust difference in seizure susceptibility between D2 and B6 mice. On the other hand, our finding that naltrexone intensifies ECS seizures more in B6 mice than D2 underscores the complex nature of seizure susceptibility and the interaction between opioids and seizures. We conclude that further refinement of approaches to modulate neuronal signaling linked to the effect of the MOR on electroshock seizure responses may provide clues for development of new anti-epilepsy treatments.

2025-05-01·Journal of Stroke and Cerebrovascular Diseases

Predictors of perioperative stroke in patients with Ischemic-type moyamoya disease treated with surgical revascularization: A retrospective multicenter study

Article

作者: Jabre, Roland ; Jabbour, Pascal ; Rosenwasser, Robert H ; Matouk, Charles ; Ghorbani, Mohammad ; Ogilvy, Christopher S ; Sioutas, Georgios S ; Spiotta, Alejandro M ; Weinberg, Joshua ; Herial, Nabeel A ; Bekelis, Kimon ; Roy, Joanna M ; Thomas, Ajith J ; Du, Rose ; Howard, Brian M ; Porto, Guilherme ; Nimjee, Shahid M ; Atallah, Elias ; Tjoumakaris, Stavropoula I ; Saad, Hassan ; Grossberg, Jonathan A ; Amllay, Abdelaziz ; Naamani, Kareem El ; Abbas, Rawad ; Dmytriw, Adam A ; Piscopo, Anthony J ; Zetchi, Akli ; Munoz, Alfredo ; Gooch, Michael Reid ; Patel, Aman B ; Hanel, Ricardo A ; Musmar, Basel ; Lai, Rosalind ; Cortez, Gustavo M ; Burkhardt, Jan-Karl ; Abdalrazeq, Hammam ; Siddiqui, Adnan ; Chen, Ching-Jen ; Khorasanizadeh, Mirhojjat ; Salem, Mohamed M ; Hasan, David M ; Monteiro, Andre

INTRODUCTIONMoyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database.METHODSWe conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke.RESULTSA total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3 %) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (P = 0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5 % vs. 47.9 %, P = 0.005). Current smoking was also more common in the perioperative stroke group (55.8 % vs. 38.2 %, P = 0.04). Multivariate logistic regression identified hypertension (OR 2.32, 95 % CI 1.01 to 5.37, P = 0.04) and current smoking (OR 2.28, 95 % CI 1.04 to 4.97, P = 0.03) as significant independent predictors of perioperative stroke.CONCLUSIONHypertension and smoking were significant predictors of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. These findings emphasize the importance of managing risk factors in ischemic-type MMD. Further prospective studies are needed to validate these findings.

2025-05-01·Anesthesia & Analgesia

Is the Compassion of Anesthesiologists Associated With Postoperative Pain and Patient Experience? A Prospective Cohort Study

Article

作者: Solina, Alann R. ; Trzeciak, Stephen ; Rana, Dhaval D. ; Libraro, Nicholas J. ; Dibato, John E. ; Roberts, Brian W. ; Trivedi, Keyur C. ; Greeson, Jeffrey M. ; van Helmond, Noud ; Chin, Gabrielle R. ; Mitrev, Ludmil V.

BACKGROUND:Patient perception of physician compassion may be associated with improved health outcomes, yet it is unclear whether it is associated with postoperative pain reduction or improved patient experience metrics in same-day surgery patients. We hypothesized that higher anesthesiologist compassion during the preanesthesia interview, rated by patients, is associated with lower postoperative pain via the anxiety pathway in same-day surgery patients. We also performed exploratory correlation analysis to assess whether compassion was associated with less opioid consumption and improved patient experience in same-day surgery patients.METHODS:We conducted a single-center, prospective, observational cohort study in American Society of Anesthesiologists (ASA) physical status I to III patients scheduled to undergo same-day surgery with anesthesia. Compassion was scored using a validated 5-item tool. State anxiety (SA) and trait anxiety (TA) were measured using the State-Trait Anxiety Inventory. Pain scores were obtained using a 0 to 10 Likert scale. Daily opioid use was recorded. Patient experience was assessed using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) and the Surgical Care CAHPS. Mediation analysis was used to assess the association between compassion and pain scores via the anxiety pathway. Spearman correlation was performed to test for association between the compassion score and the secondary outcomes.RESULTS:A total of 147 subjects completed the study with a median age of 50 years and 81% female. Fifty percent underwent breast surgery, 35% abdominal surgery, and the rest underwent gynecological and urological surgeries. The median (Q1–Q3) postoperative pain scores on postoperative days 0 and 3 days later were 4 (1.5–6) and 3 (1–5), respectively.Mediation analysis results showed a same-day anxiety-mediated effect (95% confidence interval [CI]) of compassion on pain of −0.08 (−0.13 to −0.02), attributing to 9% of the total effect. On postoperative day 0, an increase in compassion was associated with a significant average drop in pain of between 0.02 and 0.13. In addition, higher compassion was correlated with better patient experience metrics (ρ= −0.53 [95% CI, −0.64 to −0.39]).CONCLUSIONS:The study results suggest that an anxiety-mediated pathway exists through which compassionate care may help improve the patient’s perception of postoperative pain on the day of surgery (before discharge from the hospital). Higher compassion was also associated with better patient experience metrics.

100 项与 Cooper Medical School of Rowan University 相关的药物交易

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100 项与 Cooper Medical School of Rowan University 相关的转化医学

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