-
Computational and Structural... 2023Stroke is the leading cause of death and disability worldwide, with a growing number of incidences in developing countries. However, there are currently few medical...
Stroke is the leading cause of death and disability worldwide, with a growing number of incidences in developing countries. However, there are currently few medical therapies for this disease. Emerged as an effective drug discovery strategy, drug repurposing which owns lower cost and shorter time, is able to identify new indications from existing drugs. In this study, we aimed at identifying potential drug candidates for stroke computationally repurposing approved drugs from Drugbank database. We first developed a drug-target network of approved drugs, employed network-based approach to repurpose these drugs, and altogether identified 185 drug candidates for stroke. To validate the prediction accuracy of our network-based approach, we next systematically searched for previous literature, and found 68 out of 185 drug candidates (36.8 %) exerted therapeutic effects on stroke. We further selected several potential drug candidates with confirmed neuroprotective effects for testing their anti-stroke activity. Six drugs, including cinnarizine, orphenadrine, phenelzine, ketotifen, diclofenac and omeprazole, have exhibited good activity on oxygen-glucose deprivation/reoxygenation (OGD/R) induced BV2 cells. Finally, we showcased the anti-stroke mechanism of actions of cinnarizine and phenelzine western blot and Olink inflammation panel. Experimental results revealed that they both played anti-stroke effects in the OGD/R induced BV2 cells inhibiting the expressions of IL-6 and COX-2. In summary, this study provides efficient network-based methodologies for identification of drug candidates toward stroke.
PubMed: 37206617
DOI: 10.1016/j.csbj.2023.04.018 -
The Journal of the American Academy of... Sep 2023Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative pain control for spine surgery has relied on opioids. However, opioid use is associated with adverse effects such as dependence, respiratory depression, and altered cognition. Our study aimed to determine whether an opioid-sparing multimodal analgesia regimen (ketorolac, orphenadrine, and gabapentin) could be a viable alternative to diminish opioid use compared with a standard opioid-based regimen in Hispanic patients undergoing posterior lumbar spinal fusion.
METHODS
This was a randomized controlled trial of Hispanic patients scheduled to undergo elective posterior spinal fusion. Inclusion criteria included age 30 to 85 years, Hispanic ethnicity, lumbar stenosis between L1 and S1, elective posterior spinal fusion with instrumentation, American Society of Anesthesiologists Score <2, and consent to participate in the study. Patients were randomized into two groups, an experimental multimodal analgesia and control (opioid-based) treatment groups, and outcomes such as morphine milligram equivalents used, visual analog scale score, and length of hospital stay were compared between the groups.
RESULTS
The MMA experimental group used significantly lower amounts of opioid (measured with morphine milligram equivalent) than the opioid-based group during the 12-hour and 24-hour postoperative periods ( P -value = 0.023 and P -value = 0.033, respectively). No statistically significant difference was observed in opioid use in the 48-hour postoperative period between both groups ( P -value = 0.066). The MMA group had significantly lower VAS scores reported at the 12-hour, 24-hour, and 48-hour postoperative periods compared with the opioid-based group ( P -values = 0.016, 0.020, and 0.020, respectively). No difference was observed in the length of hospital stay between groups ( P -value = 0.169).
DISCUSSION
Implementing an MMA protocol in Hispanic patients undergoing posterior lumbar fusion resulted in decreased overall opioid use and decreased pain intensity compared with the opioid-based group. MMA is an effective alternative for pain control in patients who want to avoid opioid use.
CLINICAL TRIAL REGISTRATION
Identifier: NCT05413902.
Topics: Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Analgesia; Analgesics, Opioid; Hispanic or Latino; Morphine Derivatives; Pain, Postoperative; Spinal Fusion
PubMed: 37192425
DOI: 10.5435/JAAOS-D-22-00878 -
Angewandte Chemie (International Ed. in... Jul 2023Advancing the development of perfecting the use of polar organometallics in bio-inspired solvents, we report on the effective generation in batch of organosodium...
Advancing the development of perfecting the use of polar organometallics in bio-inspired solvents, we report on the effective generation in batch of organosodium compounds, by the oxidative addition of a C-Cl bond to sodium, a halogen/sodium exchange, or by direct sodiation, when using sodium bricks or neopentylsodium in hexane as sodium sources. C(sp )-, C(sp )-, and C(sp)-hybridized alkyl and (hetero)aryl sodiated species have been chemoselectively trapped (in competition with protonolysis), with a variety of electrophiles when working "on water", or in biodegradable choline chloride/urea or L-proline/glycerol eutectic mixtures, under hydrous conditions and at room temperature. Additional benefits include a very short reaction time (20 s), a wide substrate scope, and good to excellent yields (up to 98 %) of the desired adducts. The practicality of the proposed protocol was demonstrated by setting up a sodium-mediated multigram-scale synthesis of the anticholinergic drug orphenadrine.
PubMed: 37166367
DOI: 10.1002/anie.202304720 -
Journal of Fluorescence Sep 2023The interaction of orphenadrine hydrochloride (ORD) with the model protein, bovine serum albumin (BSA), was investigated using a variety of spectroscopic techniques such...
The interaction of orphenadrine hydrochloride (ORD) with the model protein, bovine serum albumin (BSA), was investigated using a variety of spectroscopic techniques such as steady-state fluorescence, ultraviolet-visible, Fourier transform infrared, 3-D spectroscopy, and electrochemical methods under physiological conditions. Stern-Volmer plots were used to calculate fluorescence quenching at various temperatures. The findings point to a static quenching mechanism between ORD and BSA. At various reaction times, the binding sites (n) and binding constants (K) of ORD to BSA were recorded. Thermodynamic parameters ∆H, ∆S and ∆G between ORD and BSA were calculated and reported. The average binding distance (r) between the donor (BSA) and acceptor (ORD) molecules was predicted using Förster's theory. Three-dimensional fluorescence spectra, Fourier transform infrared spectra, and synchronous fluorescence studies all supported the alternations in protein structure following the interaction with ORD. A displacement study using site probes such as warfarin, ibuprofen, and digitoxin confirmed ORD binding at Sudlow's site I of BSA. The effect of common metal ions such as Cu, Ni, Ca, Co, and Zn on binding constant values was investigated and reported.
Topics: Serum Albumin, Bovine; Orphenadrine; Spectrometry, Fluorescence; Spectrophotometry, Ultraviolet; Binding Sites; Thermodynamics; Protein Binding; Circular Dichroism
PubMed: 36976401
DOI: 10.1007/s10895-023-03199-y -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023Acute pain syndromes caused by discogenic lumbosacral radiculopathy and lumboischialgia are not uncommon in clinical practice and characterized by a high risk of...
[The use of a fixed combination of diclofenac and orphenadrine in the treatment of acute pain syndrome in patients with discogenic lumbosacral radiculopathy and lumboischialgia].
Acute pain syndromes caused by discogenic lumbosacral radiculopathy and lumboischialgia are not uncommon in clinical practice and characterized by a high risk of becoming chronic. The pathogenetic aspects, features of the clinical picture, existing approaches to conservative treatment of these conditions are analyzed in this paper. Data on the efficacy and safety of a fixed combination of diclofenac and orphenadrine (Neodolpasse) use in the treatment of vertebrogenic pain syndromes based on the NEODOLEX study results are presented, and the authors' own clinical observations are given. Possible reasons for the high efficacy of Neodolpasse in patients with discogenic radiculopathies and nonspecific back and neck pain are discussed.
Topics: Humans; Diclofenac; Radiculopathy; Orphenadrine; Acute Pain; Back Pain
PubMed: 36946408
DOI: 10.17116/jnevro2023123031122 -
PloS One 2023Mixtures ('cocktails') of various analgesics are more effective in controlling post-operative pain because of potential synergetic effects. Few studies have investigated...
BACKGROUND
Mixtures ('cocktails') of various analgesics are more effective in controlling post-operative pain because of potential synergetic effects. Few studies have investigated such effects in large combinations of analgesics and no studies have determined the probabilities of effectiveness.
METHODS
We used one-hot encoding of the categorical variables reported pain levels and the administered cocktails (from a total of eight analgesics) and then applied an unsupervised neural network and then the unsupervised DBSCAN algorithm to detect clusters of cocktails. We used Bayesian statistics to classify the effectiveness of these cocktails.
RESULTS
Of the 61 different cocktails administered to 750 patients, we found that four combinations of three to four analgesics were by far the most effective. All these cocktails contained Metamizole and Paracetamol; three contained Hydromorphone and two contained Diclofenac and one Diclofenac-Orphenadrine. The ML probability that these cocktails decreased pain levels ranged from 0.965 to 0.981. Choice of a most effective cocktail involves choosing the optimum in a 4-dimensional parameter space: maximum probability of efficacy, confidence interval about maximum probability, fraction of patients with increase in pain levels, relative number of patients with successful pain level decrease.
CONCLUSIONS
We observed that administering one analgesic or at most two is not effective. We found no statistical indicators that interactions between analgesics in the most effective cocktails decreased their effectiveness. Pairs of most effective cocktails differed by the addition of only one analgesic (Diclofenac-Orphenadrine for one pair and Hydromorphone for the other). We conclude that the listed cocktails are to be recommended.
Topics: Humans; Diclofenac; Orphenadrine; Artificial Intelligence; Hydromorphone; Bayes Theorem; Analgesics; Pain, Postoperative; Orthopedic Procedures
PubMed: 36730239
DOI: 10.1371/journal.pone.0280995 -
Journal of Alzheimer's Disease : JAD 2023Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders.
BACKGROUND
Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders.
OBJECTIVE
To investigate if the use of muscle relaxants is associated with the risk of Alzheimer's disease (AD).
METHODS
The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who received AD diagnosis in 2005-2011 were included as cases (the MEDALZ study). Each case was matched with four controls without AD by age, sex, and region of residence (N = 282,858). Data was extracted from Prescription register (1995-2012), Special Reimbursement register (1972-2012), and Hospital Discharge register (1972-2012). Drug use periods were modeled with PRE2DUP-method. Defined daily dose (DDD) was used to quantify the use. Analyses were conducted for any muscle relaxant use, and drug specific analyses were done for orphenadrine and tizanidine. A five-year lag window prior to the diagnosis was used, and results analyzed with conditional logistic regression.
RESULTS
The use of any muscle relaxant was associated with the risk of AD, aOR (95% CI) 1.04 (1.02-1.07). Stronger associations were observed with longer use (>366 days, aOR 1.12 (1.03-1.21)) than shorter use (1-365 days aOR, 1.04 (1.02-1.06)) compared to non-users. Dose-response was not observed. Tizanidine was not associated with AD, whereas cumulative exposure of orphenadrine (≥101 DDDs) was associated with the risk of AD, aOR 1.19 (1.07-1.32).
CONCLUSION
Muscle relaxant use was associated with the risk of AD and higher exposure to orphenadrine showed increased risk. Further studies on higher doses and longer durations of use are warranted.
Topics: Humans; Alzheimer Disease; Orphenadrine; Case-Control Studies; Risk Factors; Finland; Muscles
PubMed: 36641664
DOI: 10.3233/JAD-220409 -
Wiener Klinische Wochenschrift Feb 2023Postoperative intravenous diclofenac reduces patient opioid demand and is commonly used in surgical units. Orphenadrine is mainly used in combination with diclofenac for... (Randomized Controlled Trial)
Randomized Controlled Trial
Intravenous diclofenac and orphenadrine for the treatment of postoperative pain after remifentanil-based anesthesia : A double-blinded, randomized, placebo-controlled study.
BACKGROUND
Postoperative intravenous diclofenac reduces patient opioid demand and is commonly used in surgical units. Orphenadrine is mainly used in combination with diclofenac for musculoskeletal injuries and postoperative pain control. The objective of this study was to compare the analgesic efficacy of diclofenac-orphenadrine, diclofenac alone and saline.
METHODS
We performed a double-blind, randomized, placebo-controlled, parallel-group, single-center clinical study investigating the opioid-sparing effect of a combination of diclofenac and orphenadrine versus diclofenac alone versus isotonic saline solution. Initially 72 patients were included and received total intravenous anesthesia during cruciate ligament surgery. All patients were postoperatively treated with a patient-controlled analgesia (PCA) device containing hydromorphone. Pharmacological safety was assessed by laboratory parameters, vital signs, and delirium detection scores.
RESULTS
There was no significant difference between the groups in cumulative dose of PCA analgesics required after 24 h postsurgery, with 5.90 mg (SD ± 2.90 mg) in the placebo group, 5.73 mg (SD ± 4.75 mg) in the diclofenac group, and 4.13 mg (SD ± 2.57 mg) in the diclofenac-orphenadrine group. Furthermore, there was no significant difference between the groups in cumulative dose of PCA analgesics required 2 h postsurgery (n = 65). Mean dose of hydromorphone required after 2 h was 1.54 mg (SD ± 0.57 mg) in the placebo group, 1.56 mg (SD ± 1.19 mg) in the diclofenac-only group, and 1.37 mg (SD ± 0.78 mg) in the diclofenac-orphenadrine group. However, when comparing the diclofenac-orphenadrine group and the diclofenac group combined to placebo there was a significant reduction in PCA usage in the first 24 h postsurgery. In total, there were 25 adverse events reported, none of which were rated as severe.
CONCLUSION
Orphenadrine-diclofenac failed to significantly reduce postoperative opioid requirements. However, in an exploratory post hoc analysis the diclofenac-orphenadrine and the diclofenac group combined versus placebo showed a tendency to reduce opioid demand in postoperative pain control. Further research is required to determine the value of orphenadrine as an adjuvant in a multimodal approach for postoperative pain management.
Topics: Humans; Diclofenac; Orphenadrine; Remifentanil; Analgesics, Opioid; Hydromorphone; Pain, Postoperative; Analgesics; Anesthesia; Double-Blind Method; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 36576555
DOI: 10.1007/s00508-022-02131-x -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2022Evaluation of the effectiveness of a multimodal scheme of postoperative analgesia based on a fixed combination of orphenadrine and diclofenac against the background of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Evaluation of the effectiveness of a multimodal scheme of postoperative analgesia based on a fixed combination of orphenadrine and diclofenac against the background of patient-controlled analgesia with morphine in the early postoperative period in cardiac surgery patients.
MATERIAL AND METHODS
A prospective, randomized, comparative study evaluated two analgesic regimens. In 20 patients (group 1), «Neodolpasse» (a fixed combination of 30 mg Orphenadrine and 75 mg Diclofenac) was administered immediately after trachea extubation. The second injection was performed at VAS>50 mm not earlier than 12 hours after the first one. Patient-controlled analgesia (PCA) with morphine was started 2 hours after extubation, 20 patients of group 2 who were used PCA with Morphine as monotherapy. The intensity of pain taking into account the motor activity of patients was assessed a 100 mm visual-analog scale (VAS), as an additional objective criterion for the effectiveness of analgesia, the method of incentive spirometry was used.
RESULTS
A decrease in the severity of pain according to VAS from an average of 41 to 19 mm (=0.036) was achieved already by the 1st hour from the start of Neodolpasse infusion, and in 80% of patients this effect persisted for 24 hours. 2 patients (10%) needed the administration of the 2nd dose after 12 hours. The infusion of Morphine was started 2 hours after extubation, a significant decrease in pain intensity was noted only at 4th hour, a significant decrease in pain intensity was noted only by 4 hours, and significant differences in the severity of pain in the comparison groups persisted at almost all stages of the study. The analgesic effect of the combination of orphenadrine and diclofenac had a positive effect on the function of respiration system with an increase in MILC by 1.5 times from the beginning of the study. In group 2, the observed adverse effects were associated with the use of Morphine and depended on its dose. No adverse effects of Neodolpasse were noted. The total 24 hour consumption of Morphine at PCA averaged 22.6 mg, and in the Neodolpasse group - 9.35 mg (<0.001).
CONCLUSION
There were demonstrated high analgesic efficacy, safety and significant opioid-sparing effect of a fixed combination of orphenadrine and diclofenac in the early postoperative period of cardiac surgery patients.
Topics: Humans; Diclofenac; Analgesics, Opioid; Orphenadrine; Pain, Postoperative; Prospective Studies; Analgesics; Morphine; Postoperative Period; Cardiac Surgical Procedures
PubMed: 36279236
DOI: 10.17116/jnevro2022122101109