Efficacy of ganglion impar block combined with pudendal nerve pulsed radiofrequency for pudendal neuralgia management-a randomized clinical trial.

BACKGROUND: Pudendal neuralgia is a chronic and debilitating condition. Its prevalence ranges from 5 to 26%. Currently, therapeutic approaches to treat pudendal neuralgia include patient education, medication management, psychological and physical therapy, and procedural interventions, such as nerve block, trigger point injections, and surgery. Drug therapy has a limited effect on pain relief. A pudendal nerve block may cause a significant decrease in pain scores for a short time; however, its efficacy significantly decreases over time. In contrast, pudendal nerve pulsed radiofrequency can provide pain relief for 3 months, and ganglion impar block has been widely used for treating chronic perineal pain and chronic coccygodynia. This study aimed to determine the efficacy and safety of monotherapy (pudendal nerve pulsed radiofrequency) and combination therapy (pudendal nerve pulsed radiofrequency plus ganglion impar block) in patients with pudendal neuralgia. METHODS: This randomized, controlled clinical trial will include 84 patients with pudendal neuralgia who failed to respond to drug or physical therapy. Patients will be randomly assigned into one of the two groups: mono or combined treatment groups. The primary outcome will be a change in pain intensity measured using the visual analog scale. The secondary outcomes will include a Self-Rating Anxiety Scale score, Self-Rating Depression Scale score, the use of oral analgesics, the Medical Outcomes Study Health Survey Short Form-36 Item score, and the occurrence of adverse effects. The study results will be analyzed using intention-to-treat and per-protocol analyses. Primary and secondary outcomes will be evaluated between the mono and combined treatment groups. Subgroup analyses will be conducted based on the initial ailment, age, and baseline pain intensity. The safety of the treatment will be assessed by monitoring adverse events, which will be compared between the two groups. DISCUSSION: This study protocol describes a randomized, controlled clinical trial to determine the efficacy and safety of mono and combination therapies in patients with pudendal neuralgia. The study results will provide valuable information on the potential benefits of this combination therapy and contribute to the development of more effective and safer treatments for patients with pudendal neuralgia. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2200061800).

A colorimetric/electrochemical sensor based on coral-like CuCo2O4@AuNPs composites for sensitive dopamine detection.

As a central neurotransmitter, DA (dopamine) plays a vital part in human metabolism, and its accurate detection is of great significance in disease diagnosis. In this work, we used Cu/Co bimetallic metal-organic frameworks (MOFs) as templates and gold nanoparticles (AuNPs) to construct novel nanocomposite coral-like CuCo2O4@AuNPs with strong peroxidase activity and electrochemical response. The coral-like CuCo2O4@AuNPs showed excellent peroxidase activity, and the Km value was as low as 0.358 mM. In the presence of H2O2, the colorless substrate 3,3',5,5', -tetramethylbenzidine (TMB) can be catalytically oxidized into a blue product. Simultaneously, coral-like CuCo2O4@AuNPs, as an electroactive substance, possess strong electrocatalytic activity, which enhances the electron-transfer rate and promotes excellent current response. In the presence of DA, coral-like CuCo2O4@AuNPs can catalyze the oxidation of DA to dopaquinone, which further enhances the electrochemical signal. In addition, DA captures hydroxyl radicals and inhibits the oxidation of TMB, resulting in an obvious color change (blue turns colorless) and realizing colorimetric detection with the naked eye. On this basis, we successfully established a dual-mode colorimetric/electrochemical sensor using coral-like CuCo2O4@AuNP nanocomposites as a dual-signal probe. Combining colorimetric and electrochemical detection, the sensor achieved a wide linear range (0-1 mM) and a low detection limit (0.07 µM) for DA concentration. It was also successfully used for the detection of DA in human serum and urine with good results. In summary, this work provides an intuitive, economical, sensitive, and promising platform for DA detection.

A Homogeneous Colorimetric Strategy Based on Rose-like CuS@Prussian Blue/Pt for Detection of Dopamine.

The development of effective methods for dopamine detection is critical. In this study, a homogeneous colorimetric strategy for the detection of dopamine based on a copper sulfide and Prussian blue/platinum (CuS@PB/Pt) composite was developed. A rose-like CuS@PB/Pt composite was synthesized for the first time, and it was discovered that when hydrogen peroxide was present, the 3,3',5,5'-tetramethylbenzidine (TMB) changed from colorless into blue-oxidized TMB. The CuS@PB/Pt composite was characterized with a scanning electron microscope (SEM), an energy dispersive spectrometer (EDS), and an X-ray photoelectron spectrometer (XPS). Moreover, the catalytic activity of the CuS@PB/Pt composite was inhibited by the binding of dopamine to the composite. The color change of TMB can be evaluated by the UV spectrum and a portable smartphone detection device. The developed colorimetric sensor can be used to quantitatively analyze dopamine between 1 and 60 µM with a detection limit of 0.28 µM. Furthermore, the sensor showed good long-term stability and good performance in human serum samples. Compared with other reported methods, this strategy can be performed rapidly (16 min) and has the advantage of smartphone visual detection. The portable smartphone detection device is portable and user-friendly, providing convenient colorimetric analysis for serum. This colorimetric strategy also has considerable potential for the development of in vitro diagnosis methods in combination with other test strips.

[Response of Water Quality in Small Reservoirs to Landscape Composition, Landscape Configuration, and Reservoir Characteristics in the Upper Reaches of the Yangtze River During Dry Season].

Small reservoirs in the Yangtze River are large in quantity and widely distributed, which have important ecological and economic benefits. It is of great significance to explore the response law of small reservoir water quality to environmental variables for improving reservoir water quality. Based on the measured water quality data of 36 small reservoirs in the upper reaches of the Yangtze River, combined with the measured water quality data, using correlation analysis, redundancy analysis, and other research methods, we divided the environmental variables into three categories:landscape configuration index, landscape composition index, and reservoir characteristic index, and explored their impact on the change in water quality index. The research results showed that:① farms were the main source of NO3--N, TN, and TP, and residential land was the main source of TP. Paddy, forest land, and wasteland had positive effects on the retention and purification of N and P in reservoirs. ② The LPI of farms was significantly positively correlated with the concentrations of TN and NO3--N in the reservoir, and the paddy and forest were significantly negatively correlated with the concentrations of NO3--N and TN in the reservoir. The PD of farms was positively correlated with TP. The LPI was negatively correlated with TP content. ③ The correlation between average reservoir depth and reservoir water quality was the strongest. Reservoir capacity, reservoir average depth, and reservoir LSI had significant positive effects on water quality improvement. ④ Among the environmental variables of the reservoir, landscape configuration index had the highest explanatory rate (24%), followed by that of the reservoir characteristics index (11%) and landscape composition index (9%). Watershed factors were the key factors (55%), and internal factors (19%) also had a significant influence on reservoir water quality. The research results can provide a theoretical basis for controlling water quality degradation of small reservoirs by managing and optimizing the landscape characteristics of reservoirs.

Biological redox cycling amplification in a self-powered photoelectrochemical sensor based on TiO2/CdIn2S4/ g-C3N4-WO3 photoanode for sensitive detection of Hg2.

A photoelectrochemical (PEC) sensor is proposed with a TiO2/CdIn2S4 co-sensitive structure and a g-C3N4-WO3 heterojunction as the photoanode to form a self-powered system. The photogenerated hole-induced biological redox cycle of TiO2/CdIn2S4/g-C3N4-WO3 composites is used as a signal amplification strategy for Hg2+ detection. In the test solution, ascorbic acid is first oxidized by the photogenerated hole of the TiO2/CdIn2S4/g-C3N4-WO3 photoanode, which triggers the ascorbic acid－glutathione cycle to achieve signal amplification and increase the photocurrent. However, in the presence of Hg2+, glutathione forms a complex with Hg2+, which destroys the biological cycle and leads to a decreased of photocurrent, thus achieving detection of Hg2+. Under optimal conditions, the proposed PEC sensor has a wider range (from 0.1 pM to 100 nM), and lower limit of Hg2+ detection (0.44 fM) than most other Hg2+ detection methods. In addition, the developed PEC sensor can be used to detect of real samples.

Spatiotemporal variation and driving factors of water quality in Yunnan-Guizhou plateau lakes, China.

The Yunnan-Guizhou Plateau (YGP) lakes are the typical plateau rift lakes and an important water source in southwest China. However, there is a scarcity of research on its spatiotemporal water quality variations and driving factors, especially on long-term scales. Herein, multiple water quality indicators for 11 natural lakes on the YGP were measured from 2005 to 2020. In this study, the effects of natural lake attributes, human activities, and meteorological conditions on water quality were also analyzed. The results showed that the water quality of the YGP lakes tended to degrade, and was divided into heavy, medium, and light pollution types. Total phosphorus (TP), total nitrogen (TN), permanganate index (CODMn), and biochemical oxygen demand (BOD5) increased by 14.69%, 14.44%, 22.61%, and 11.26%, respectively, from 2005 to 2020. Natural attributes of lakes and land use types were the main reasons for the spatial heterogeneity of water quality in YGP. In contrast, the temporal evolution of lake water quality was mainly related to human activities and climatic conditions. The smaller the water/ terrestrial area ratio, water storage capacity, and water depth, the easier the eutrophication and the worser the water quality of YGP lakes. Land degradation accelerated the deterioration of water quality in plateau lakes, while ecological land played an improving role. This study summarizes the water quality changes and influencing factors in YGP lakes over the past 15 years, which can provide a scientific database reference for water environment protection in YGP.

Role of Dexmedetomidine in Early POCD in Patients Undergoing Thoracic Surgery.

OBJECTIVE: To evaluate whether a low-dose perioperative infusion of Dex reduces early POCD. DESIGN: This study was a double-blind, randomized, placebo-controlled trial that randomly assigned patients to Dex or saline placebo infused during surgery and patient-controlled intravenous analgesia (PCIA) infusion. Patients were assessed for postoperative cognitive decline. Interventions. Dex was infused at a loading dose of 0.5 µg/kg intravenously (15 min after entering the operation room) followed by a continuous infusion at a rate of 0.5 µg/kg/h until one-lung ventilation or artificial pneumothorax ended. Patients in the Dex group received regular PCIA pump with additional dose of Dex (200 µg). RESULTS: In total, 126 patients were randomized, and 102 patients were involved in the result analysis. The incidence of POCD was 36.54% (19/52) in the Dex group and 32.00% (16/50) in the normal saline (NS) group, with no statistic difference. No significant difference was observed between the two groups in terms of Telephone Interview for Cognitive Status-Modified (TICS-m) scores at different times. However, the TICS-m score at 7 days after surgery was significantly lower than that at 30 days in 102 patients (32.93 ± 0.42 vs. 33.92 ± 0.47, P = 0.03). The visual analogue scale scores in the Dex group were significantly lower than those in the NS group 1 day postoperation at rest and activity (2.00 [1.00-3.00] vs. 3.00 [2.00-4.00], P < 0.01; 4.00 [3.00-5.00] vs. 5.00 [4.00-6.00], P < 0.05, respectively). Patients receiving Dex or NS had no statistical difference in activities of daily living (ADLs) scores at 7 and 30 days after surgery, but the ADL score at 30 days after surgery showed a significant reduction compared with that at 7 days (P < 0.01). Patients in the Dex group had a shorter hospital length of stay (15.26 ± 3.77 vs. 17.69 ± 5.09, P = 0.02) and less expenses (52458.71 ± 10649.30 vs. 57269.03 ± 9269.98, P = 0.04) than those in the NS group. CONCLUSIONS: Low-dose Dex in the perioperative period did not reduce the incidence of early POCD in thoracic surgery. However, it relieved postoperative pain, decreased the hospitalization expenses, and shortened the length of stay.

[Acupuncture combined with medication improves endocrine hormone levels and ovarian reserve function in poor ovarian response patients undergoing in vitro fertilization-embryo transplantation].

OBJECTIVE: To observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy. METHODS: A total of 100 volunteer POR women undergoing in vitro fertilization-embryo transplantation (IVF-ET) were recruited in the present study. On the 1st cycle of IVF-ET, these POR women received microstimulation of ovulation program (oral administration of Clomiphene, muscular injection of Menotrophin, Chorionic Gonadotrophin triggering, etc.). Before receiving the 2nd period of IVF-ET, these patients were equally and randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture and acupuncture+medication (combined treatment) groups according to the random number table. Patients of the medication group were asked to orally take Climen (1 tablet/d for 21 days) beginning from the 3rd day of the menstruation, which was repeated for 3 menstrual cycles. Patients of the acupuncture group received manual acupuncture stimulation of Guanyuan (CV4), and bilateral Taixi (KI3), Sanyinjiao (SP6) of and Tai-chong (LR3) from day 8 to 15 of menstruation (follicular phase), once daily for 3 menstrual cycles. On the 2nd day of menstruation of the 1st and 2nd IVF-ET cycle, the ovarian reserve function was detected, including measurement of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) contents by using radioimmunoassay, and serum anti-mullerian hormone (AMH) level by using ELISA, and the antral follicles count (AFC) of the ovaries by using a color Doppler ultrasonic diagnosis apparatus. At the end of ovulation induction, the assisted pregnancy indexes and outcomes were detected, including administration of dosage and days of gonadotropin (Gn), the diameter of dominant oocyte, level of E2 on the trigger day, the numbers of ultrasound-guided-retrieved oocyte and the cultivated high-quality embryo (grade 1 and 2). RESULTS: After the treatment, the contents of serum FSH, LH and E2 in the medication, acupuncture and combined treatment groups were significantly reduced (P<0.05), and the content of serum AMH and ovary AFC in the medication, acupuncture and combined treatment groups were obviously increased (P<0.05) in comparison with their own pre-treatment (P<0.05). Compared with the control group, the levels of FSH, LH and E2 contents were notably decreased, and the AMH content and AFC significantly increased in the medication, acupuncture and combined treatment groups (P<0.05). Comparison among the three treatment groups showed that the levels of FSH, LH and E2 were notably lower in the combined treatment group than in the acupuncture group (P<0.05), and the AFC was markedly more in the combined treatment group than in the acupuncture group (P<0.05), and LH content was also significantly lower in the combined treatment group than in the medication group (P<0.05). Regarding the pregnancy-assistant indexes and outcomes, the dosage of Gn in the combined treatment group and the number of Gn administration days in the acupuncture and combined treatment groups were significantly fewer (P<0.05), serum E2 levels on the trigger day in the medication, acupuncture and combined treatment groups, and the high-quality embryo number in the combined treatment group were considerably higher in comparison with their own levels of the 1st IVF-ET cycle in each group (P<0.05). Comparison among the three groups showed that the dosage and number of administration days of Gn in the combined treatment group were fewer than those in the medication group(P<0.05), and the dosage of Gn in the combined treatment group were significantly lower than that in the acupuncture group (P<0.05), E2 content of the combined treatment group was markedly higher than that of the medication and acupuncture groups (P<0.05). The high-quality embryo number in the combined treatment group was obviously larger than that of the medication group (P<0.05). No significant differences were found between the 2nd and 1st IVF-ET cycles in the number of the obtained oocyte, between the acupuncture and medication groups in the E2 content at the trigger day, and the numbers of Gn administration days and the high-quality embryo (P>0.05). CONCLUSION: Acupuncture combined with medication improves the level of endocrinal hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy.