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      The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy

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          Abstract

          The aim of this study was to explore the effect of electroacupuncture (EA) on immune function in patients undergoing supratentorial craniotomy. We also examined whether point specificity in EA was present. The study involved 29 patients undergoing craniotomy. The patients were divided into three groups: a control (C, n=10), an EA (A, n=9) and a sham acupoints group (S, n=10). Blood samples were collected at the following time points: before anesthesia (T0), 4 h after the induction of anesthesia (T1), 1 day post-surgery (T2) and 2 days post-surgery (T3) to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10), immunoglobulin M (IgM), IgA and IgG. Data were analyzed using SPSS 13.0 software. When comparing the levels of cytokines following surgery, we observed that the peripheral blood IL-8 levels in groups A and S were increased significantly compared with those of group C at 1 and 2 days after surgery. When comparing immunoglobulin levels after surgery, we established that the peripheral blood IgA levels in group C had decreased significantly compared to those of group A and group S 4 h after induction of anesthesia and 1 day after surgery. However, there was no significant difference between group A and group S. Compared with simple general anesthesia, acupuncture combined with anesthesia partially reduces immune suppression in the perioperative periods under the same conditions as the simple general anesthesia. Point specificity in EA was not present.

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          Point specificity in acupuncture

          The existence of point specificity in acupuncture is controversial, because many acupuncture studies using this principle to select control points have found that sham acupoints have similar effects to those of verum acupoints. Furthermore, the results of pain-related studies based on visual analogue scales have not supported the concept of point specificity. In contrast, hemodynamic, functional magnetic resonance imaging and neurophysiological studies evaluating the responses to stimulation of multiple points on the body surface have shown that point-specific actions are present. This review article focuses on clinical and laboratory studies supporting the existence of point specificity in acupuncture and also addresses studies that do not support this concept. Further research is needed to elucidate the point-specific actions of acupuncture.
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            Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses.

            We studied the relationship between the neuroendocrine and inflammatory responses to hip arthroplasty and functional recovery in 102 patients undergoing elective arthroplasty for osteoarthritis. Blood samples were collected for up to 7 days after surgery and analysed for concentrations of norepinephrine, epinephrine, cortisol, interleukin-6 and C-reactive protein. The primary outcome measures were milestones in hospital, times to walk 10 and 25 m, pain on discharge from hospital, and function 1 and 6 months after surgery. Walking distances in hospital were significantly delayed in patients with greater interleukin 6 and C-reactive protein concentrations, but few neuroendocrine measures had significant correlations with functional recovery in hospital. Multivariate analysis showed that the interleukin 6 concentration on day 1 was the unique predictor of time to walk 10 and 25 m, and that the day 2 concentration of C-reactive protein was the unique predictor of pain on discharge from hospital. No significant correlations were found between the inflammatory and neuroendocrine variables and recovery at 1 and 6 months. We conclude that the inflammatory response affects immediate functional recovery after hip arthroplasty.
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              Myocardial and lung injury after cardiopulmonary bypass: role of interleukin (IL)-10.

              Proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-8 play a key role in the inflammatory cascade after cardiopulmonary bypass (CPB) and may induce cardiac and lung dysfunction. Antiinflammatory cytokines such as IL-10 may also significantly limit these complications. Corticosteroid administration before CPB increases blood IL-10 levels and prevents proinflammatory cytokine release. This study examined the association of increased release of IL-10, stimulated by steroid pretreatment, with reduced myocardial and lung injury after CPB. Twenty patients undergoing coronary artery bypass grafting (CABG) received either preoperative steroid (n = 10, protocol group) or no steroid (n = 10, control group). Perioperative care was standardized, and all caregivers were blinded to treatment group. Seven intervals of blood samples were obtained and assayed for TNF-alpha, IL-6, IL-8, and IL-10. Various hemodynamic and pulmonary measurements were obtained perioperatively. Levels of MB isoenzyme creatine kinase (CK-MB) were also measured. In the protocol group, proinflammatory cytokines were significantly reduced while IL-10 levels were much higher after CPB. The protocol group had a lower alveolar-arterial oxygen gradient and higher ratio of arterial oxygen pressure to fraction of inspired oxygen after CPB. Creatine kinase (CK) and CK-MB were reduced in the patients treated with steroid. Correlations were found between plasma cytokines levels and cardiac index, and CK-MB. This study confirms that corticosteroids abolish proinflammatory cytokines release and increase blood IL-10 levels after CPB. Our findings demonstrate a greater release of IL-10 induced by steroid pretreatment, and better heart and lung protection after CPB.
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                Author and article information

                Journal
                Exp Ther Med
                Exp Ther Med
                ETM
                Experimental and Therapeutic Medicine
                D.A. Spandidos
                1792-0981
                1792-1015
                September 2013
                16 July 2013
                16 July 2013
                : 6
                : 3
                : 699-702
                Affiliations
                [1 ]Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, Beijing, P.R. China
                [2 ]Department of Anesthesiology, State Grid Beijing Electric Power Hospital, Beijing, P.R. China
                [3 ]Department of Anesthesiology and Pain Management, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
                Author notes
                Correspondence to: Dr Baoguo Wang, Department of Anesthesiology and Pain Management, Beijing Sanbo Brain Hospital, Capital Medical University, 50 Xiang Shan Yi-ke-song, Beijing 100093, P.R. China, E-mail: baoguo.wang@ 123456yahoo.cn
                Article
                etm-06-03-0699
                10.3892/etm.2013.1225
                3786813
                24137250
                0c6e1755-ace8-473e-9d73-29c55c39cd49
                Copyright © 2013, Spandidos Publications

                This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

                History
                : 14 December 2012
                : 01 March 2013
                Categories
                Articles

                Medicine
                electroacupuncture,supratentorial craniotomy,immune suppression
                Medicine
                electroacupuncture, supratentorial craniotomy, immune suppression

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