Spinal cord stimulation reduces cardiac pain through microglial deactivation in rats with chronic myocardial ischemia.

Angina pectoris is cardiac pain that is a common clinical symptom often resulting from myocardial ischemia. Spinal cord stimulation (SCS) is effective in treating refractory angina pectoris, but its underlying mechanisms have not been fully elucidated. The spinal dorsal horn is the first region of the central nervous system that receives nociceptive information; it is also the target of SCS. In the spinal cord, glial (astrocytes and microglia) activation is involved in the initiation and persistence of chronic pain. Thus, the present study investigated the possible cardiac pain­relieving effects of SCS on spinal dorsal horn glia in chronic myocardial ischemia (CMI). CMI was established by left anterior descending artery ligation surgery, which induced significant spontaneous/ongoing cardiac pain behaviors, as measured using the open field test in rats. SCS effectively improved such behaviors as shown by open field and conditioned place preference tests in CMI model rats. SCS suppressed CMI­induced spinal dorsal horn microglial activation, with downregulation of ionized calcium­binding adaptor protein­1 expression. Moreover, SCS inhibited CMI­induced spinal expression of phosphorylated­p38 MAPK, which was specifically colocalized with the spinal dorsal horn microglia rather than astrocytes and neurons. Furthermore, SCS could depress spinal neuroinflammation by suppressing CMI­induced IL­1ß and TNF­α release. Intrathecal administration of minocycline, a microglial inhibitor, alleviated the cardiac pain behaviors in CMI model rats. In addition, the injection of fractalkine (microglia­activating factor) partially reversed the SCS­produced analgesic effects on CMI­induced cardiac pain. These results indicated that the therapeutic mechanism of SCS on CMI may occur partially through the inhibition of spinal microglial p38 MAPK pathway activation. The present study identified a novel mechanism underlying the SCS­produced analgesic effects on chronic cardiac pain.

Author Correction: Levels of Faecal Calprotectin and Magnetic Resonance Enterocolonography Correlate with Severity of Small Bowel Crohn's Disease: A Retrospective Cohort Study.

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Levels of Faecal Calprotectin and Magnetic Resonance Enterocolonography Correlate with Severity of Small Bowel Crohn's Disease: A Retrospective Cohort Study.

Few studies have evaluated the usefulness of fecal calprotectin (FC) or magnetic resonance enterography (MRE) in diagnosing active Crohn's disease (CD) of the small bowel. In the study, we investigated the reliability of FC and MRE in assessing the activity of ileal CD and further explored the relationship between levels of FC and MRE scores. A total of 221 patients were diagnosed with ileal or ileo-colitis CD in our department between July 2012 and October 2016. The global magnetic resonance index of activity (MaRIA) correlated with the simple endoscopic score for CD (SES-CD) (r = 0.527, P = 0.005). When analysed segment-by-segment, a significant correlation was still observed (r = 0.590, P < 0.001). The SES-CD correlated closest with FC (r = 0.503), followed by CRP (r = 0.461), ESR (0.377) and the CDAI (r = 0.320). In receiver operating characteristic (ROC) analyses, the FC cut-off value of mucosal healing was 213.1 µg/g, with 76.1% sensitivity and 66.7% specificity. As for MaRIA, a cut-off value of 6.8 for each segment provided a sensitivity of 100% and a specificity of 79.2%. No agreement between MaRIA and FC levels was found. In conclusion, a combination of FC levels and MaRIA could be effective in monitoring mucosal activity in patients with small bowel CD.

[Identification characters of leaf morphological and venation pattern of Houttuynia cordata with its confused herb Gymnotheca chinensis].

OBJECTIVE: To study the identification characters of Houttuynia cordata and its confused herb Gymnotheca chinensis and establish an identification method. METHODS: LMVP (leaf morphological-venation pattern for identification Chinese herbs), and QAERM (quantitatively analyze and evaluate reliability for the method of identification Chinese herbs) were applied for the study. RESULTS: Both venations were brochidodromous-acrodromous and arising from the mid-petiole or the upper section of petiole. The main characteristic of the leaf of Houttuynia cordata: surface with small gray-white stoma protuberances; Ligulate process of stipule-petiole sheath were clear; Primary veins 7 or 5; The innermost pair of primary vein closed up the top of the sinus at blade base or above sinus, and the section of closed vein was straight; Emitted a smell of fish when fresh leaf was kneaded into pieces. The main feature of the leaf of Gymnotheca chinensis: no small gray-white stoma protuberances; Ligulate process of stipule-petiole sheath were not clear; Primary veins 5; The innermost pair of primary vein closed into the sinus at blade base, and the section of closed vein was slightly curve; No smell of fish. With the mentioned key differences, the both plants could be successfully identified from each other. The accuracy of identification results (AC) was 100%, the repeatability of identification results: agreement rate for observation (ARO) was 100% and Kappa value was 1.00. CONCLUSION: The established method is simple, rapid, economic and reliable.