Adipose-derived Mesenchymal Stem Cells Improve Both Spontaneous Pain and Allodynia in a Rat Neuropathic Pain Model

Purpose：Several studies investigated the efficacy of transplanting adipose-derived mesenchymal stem cells（ADMSCs）in the treatment of neuropathic pain in animals. However, these studies evaluated the effects of ADMSCs transplantation by assessing the mechanical allodynia but not spontaneous pain. Here, we verify whether ADMSCs transplantation improves spontaneous pain in a rat model of neuropathic pain. Methods：ADMSCs were isolated from rat adipose tissue and cultured. Chronic constriction injury（CCI） model rats were created by surgical maneuver. A total of 20 F344 rats underwent surgery and were divided into 2 groups, the ADMSCs group and the control group. One week after CCI surgery, ADMSCs were transplanted into the epineurium of the damaged nerve. The effects of ADMSCs transplantation were evaluated by the number of spontaneous pain-related behaviors and the degree of mechanical allodynia. The degree of mechanical allodynia was assessed with the von-Frey filament test. Results：No rats died during the experiments and all CCI model rats were established successfully. ADMSCs transplantation improved mechanical allodynia on and after 7-day post-transplantation and spontaneous pain on and after 21-day post-transplantation with the statistically significant differences. These improvement effects were observed until 6-week post-transplantation in mechanical allodynia and 5-week post-transplantation in spontaneous pain. Conclusion：ADMSCs transplantation improved not only mechanical allodynia but also spontaneous pain. ADMSCs transplantation may be an effective treatment for neuropathic pain in clinical practice

ロボット支援下前立腺全摘除術の麻酔管理：600例の経験から

ロボット支援下前立腺全摘除術（RARP）は恥骨後式前立腺全摘除術に比べ低侵襲で，当施設でも一般的な手術となり，既に700例近いRARPの麻酔管理を経験してきた．RARPを当施設で開始するにあたっては，泌尿器科医と手術室看護師，臨床工学士と共に，必要な情報収集と様々な準備を行い，幾度とシミュレーションを実施してきた結果，これまでに深刻な合併症を経験していない．しかしながら，RARPでは，良好な術野確保のため，高度な頭低位，気腹などの特殊な状況に患者が曝されるため，麻酔管理中は最新の注意を払う必要がある．RARPの安全性を確保するために，今後も経験を重ねて，RARPの麻酔管理の質を向上し行かなければならない．Robot associated radical prostatectomy（RARP）is less invasive than open radical retropubic prostatectomy. RARP has become popular in our facility. We have already experienced near 700 cases about anesthetic management of RARP. Before starting RARP in our facility, we have obtained many required knowledges, prepared many things and done its simulations together with urologists, nurses and clinical engineers. Fortunately, until now, we have never experienced serious problems during its peri-operative management. To obtain superior surgical field during RARP, there are many special situations, such as head-down tilt and pneumoperitoneum, to patients. So that, we should pay careful attention about anesthetic management of RARP and further improve anesthetic management of RARP to increase safety based on our experiences