Some reports have shown that electroconvulsive shock therapy is effective for treating refractory neuropathic pain. However, its mechanism of action remains unknown. This study analyzes changes in protein expression in the brainstems of neuropathic pain model rats with or without electroconvulsive stimulation (ECS). A neuropathic pain model rat is produced by chronic constrictive injury (CCI) of the sciatic nerve. An ECS was administered to rodents once daily for 6 days after the CCI operation. After ECS, the latency to withdrawal from thermal stimulation was significantly increased. The expression of several proteins was changed after CCI. Ten proteins that increased after CCI then had decreased expression levels (close to control) after ECS, and 8 proteins that decreased after CCI then had increased expression levels (close to control) after ECS. In conclusion, ECS improved thermal hypersensitivity in a rat CCI model. Proteomic analysis showed that altered expression levels of proteins in the brainstem of CCI model rats returned to close to control levels after ECS, including many proteins associated with pain. This trend suggests an association of ECS with improved hypersensitivity, and these results may help elucidate the mechanism of this effect.Electroconvulsive shock therapy (ECT) has been used widely as an effective and established treatment for refractory depression and schizophrenia, although the mechanism of action of this treatment has not been clarified precisely. Many recent studies in the psychiatric field have suggested that the expression levels of the genes for various cerebral neurotransmitters would change after ECT. This change in gene expression might be a possible mechanism of action of ECT (2,24,35,40). Also, some reports have shown that ECT is effective for treating refractory neuropathic pain (5,16,22,36,37). However, ECT has not been performed as a general treatment for neuropathic pain because the evidence for its therapeutic effect is insufficient, owing to a lack of data from large-scale controlled trials. Side effects, such as amnesia and injury from ECT, make this option rather unpopular (1). The mechanism of action of ECT in treating neuropathic pain has not been examined sufficiently, and thus remains unclear. We have previously shown that electroconvulsive stimulation (ECS) improves symptoms in rats with neuropathic pain. In the same study we also demonstrated that neuropeptide Y (NPY) expression in the brain was altered (28). Brainstem tissue was selected for our studies because it contains important nuclei involved in descending inhibition and facilitation of nociceptive or pain transmission, as well as ascending pain transmission and integration with higher structures such as the limbic system. The brainstem nuclei involved in descending control or ascending integration include the rostral ventromedial medulla (RVM), the parabrachial nuclei, the dorsal reticular nuclei and the solitary tract nucleus (25). We undertook a comprehensive study to clarify

Background and Objective:Anesthesiologists need to be familiar with perioperative changes in blood volume (BV); however, there is no standard method for repeated evaluation of BV over a short interval of time. We evaluated BV in the operation room using repeatable estimation methods. Method: Eighty-five ASA physical status I-II patients scheduled to undergo endoscopic urosurgery using irrigation fluid under general anesthesia at Nippon Medical School Hospital were included in this study. Irrigation with 3% sorbitol in water was commenced after establishment of general anesthesia and volumetric fluid balance, which was defined as control water balance (WB). Hematocrit (Hct), colloid osmotic pressure (COP), total protein (TP) and albumin (Alb) were repeatedly determined before and during anesthesia. BV was calculated using Allen's formula and the changes in Hct, COP, TP and Alb. Main Outcome Measures: The main outcome was the accuracy of measuring changes in BV (∆BV) calculated using the four serum markers. WB and the estimated ∆BV calculated from Hct, COP, TP and Alb (∆BV-Hct, ∆BV-COP, ∆BV-TP, and ∆BV-Alb) were analysed using Pearson's correlation coefficient test and Bland-Altman analysis. Results: Sixty-five patients were excluded. In the remaining 20 patients, there was a significant correlation between WB and ∆BV-COP (R 2 = 0.72; P < 0.01), WB and ∆BV-TP (R 2 = 0.59; P < 0.01) and WB and ∆BV-Alb (R 2 = 0.57; P < 0.01), while there was no correlation between WB and ∆BV-Hct (R 2 = 0.06). Conclusion: ∆BV-COP, ∆BV-TP and ∆BV-Alb had correlation with WB. However, since COP can be measured repeatedly with simplified instruments under selected clinical circumstances, while TP and Alb cannot. COP is the most useful marker to measure ∆BV during perioperative period. Hct does not allow precise estimation of ∆BV.

Video-assisted thoracoscopic surgery (VATS) is less invasive than traditional open thoracotomy and improves patient outcomes. However, postoperative pain in such cases is unexpectedly severe.Effective postoperative analgesia is believed to reduce morbidity, accelerate recovery, and improve patient outcomes. Thoracic epidural anesthesia (TEA) has been commonly used for pain control after VATS. TEA is effective in achieving pain relief but has side effects, including urinary retention, postoperative nausea and vomiting, and hypotension. Because of these side effects, TEA has been questioned as the gold standard for pain management after VATS. In our institute, we performed thoracic paravertebral block (TPVB) as pain management for about 1,000 cases after VATS as an alternative technique to TEA and obtained good results. This article shows that TPVB is a safe and simple technique that can provide TEA-equivalent pain relief with fewer side effects than TEA. We therefore feel that TPVB is the ideal method for pain management after VATS.