ABSTRACT
Objective:To investigate the effect of lappaconitine (LA) on neuropathic pain (NPP) mediated by retrograde transport of purinergic P2X3 receptor (P2X3R) in dorsal root ganglion (DRG) neurons of rats with chronic constriction injury (CCI) of the sciatic nerve.Methods:Seventy-two male healthy SD rats were selected to construct the NPP model following CCI of the sciatic nerve by ligating the right sciatic nerve. according to the random number table method. The rats were divided into CCI group, CCI+LA group and normal control group according to the random number table method, with 24 rats in each group. In normal control group, the right sciatic nerve was exposed without ligation. In CCI+LA group, the rats were given 2 g/L LA (ie, 4 mg/kg intravenously for once a day for one day only) after the same treatment as CCI group. Other two groups were injected with the identical amount of normal saline in the same way. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were evaluated before injury and at 2, 6, 12 and 24 hours after injury to evaluate the symptoms of neuralgia caused by nerve injury. The proximal and distal nerve fragments were collected in the three groups at 2, 6, 12 and 24 hours after injury. Western blotting was applied to analyze the expression of P2X3R at 2, 6, 12 and 24 hours after injury and the expression of neurotrophic factor (NGF) and tyrosine kinase receptor A (TrkA) at 24 hours after injury to evaluate the effect of LA on P2X3R, NGF and TrkA.Results:There were insignificant differences in MWT and TWL among all groups before injury (all P>0.05). Compared with normal control group, MWT and TWL were significantly decreased in CCI group and CCI+LA group at 2, 6, 12 and 24 hours after injury (all P<0.05 or 0.01). There were insignificant differences in MWT and TWL between CCI group and CCI+LA group at 2 and 6 hours after injury (all P>0.05), while MWT and TWL were significantly higher in CCI+LA group than those in CCI group at 12 and 24 hours after injury (all P<0.05 or 0.01). In the proximal sciatic nerve segment, Western blotting showed similar levels of P2X3R among all groups at 2, 6, 12 and 24 hours after injury (all P>0.05). In the distal sciatic nerve segment, Western blotting showed higher expression of P2X3R in CCI group than that in normal control group at 2, 6, 12, 24 hours after injury (all P<0.01), higher expression of P2X3R in CCI+LA group than that in normal control group at 2, 6 and 12 hours after injury (all P<0.05), similar expression of P2X3R expression between CCI+LA group and normal control group at 24 hours after injury ( P>0.05), similar expression of P2X3R between CCI group and CCI+LA group at 2 and 6 hours after injury (all P>0.05), and lower expression of P2X3R in CCI+LA group than that in CCI group at 12 and 24 hours after injury ( P<0.05 or 0.01). In the proximal and distal nerve fragments, the expression of NGF was lower in normal control group than that in CCI group and CCI+LA group ( P<0.05 or 0.01), but was similar between CCI group and CCI+LA group at 24 hours after injury ( P>0.05). In the proximal and distal nerve fragments, there were insignificant differences in the expression of TrkA among all groups at 24 hours after injury (all P>0.05). Conclusion:Early LA treatment after injury can alleviate mechanical and thermal hyperalgesia in NPP rats, which may be related to the reduction of P2X3R retrograde transport in DRG neuron axonal.
ABSTRACT
Objective:To explore the effect of perioperative whole-course closed-loop temperature management system for prevention of hypothermia in elderly patients with femoral neck fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 120 elderly patients with femoral neck fracture admitted to Chengdu First People's Hospital from January 2020 to December 2020. There were 48 males and 72 females, aged 60-79 years［（68.3±5.0）years］. All patients underwent total hip arthroplasty. Heat warming with the whole-course closed-loop temperature management system was applied in 40 patients（closed-loop group）, with the medical heating mattress in 40 patients（heat preservation group）, and with the quilt in 40 patients（control group）. The core body temperature of the three groups was recorded 8 minutes after wearing the temperature sensor（T0）, immediately after induction of anesthesia（T1）, 30 minutes after induction of anesthesia（T2）, 60 minutes after induction of anesthesia（T3）, at the end of surgery（T4）, and 20 minutes after entering the postanesthesia care unit（PACU）（T5）. The thrombin time（TT）, prothrombin time（PT）and activated partial thromboplastin time（APTT）were compared among groups before operation and at T4. The incidence of intraoperative hypothermia, incidence of shivering during PACU, incidence of surgical site infection, extubation time（from the day of drug withdrawal to the time of tracheal tube removal）, length of hospital stay（from the day of operation to the time of discharge）and adverse reactions related to the devices were compared among groups.Results:There was no statistically significant difference in core body temperature among three groups at T0（ P>0.05）. The core body temperature in closed-loop group［（36.61±0.28）℃］was higher than that in heat preservation group［（36.45±0.28）℃］and control group［（36.44±0.27）℃］at T1（ P<0.05）, but no statistically significant difference was found in core body temperature between heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group［（36.46±0.28）℃,（36.40±0.30）℃,（36.45±0.37）℃,（36.50±0.27）℃］was higher than that in heat preservation group［（36.32±0.31）℃,（36.24±0.26）℃,（36.28±0.30）℃,（36.24±0.31）℃］and control group［（36.12±0.30）℃,（35.98±0.28）℃,（35.73±0.31）℃,（35.81±0.32）℃］at T2-T5（ P<0.05）, and a higher temperature was found in heat preservation group than control group（ P<0.05）. The core body temperature in closed-loop group was increased at T1 compared to that at T0（ P<0.05）, while there was no statistical difference at T0 and T1 in heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group showed no significant difference at T2-T5 and T0（ P>0.05）, while the core temperature in heat preservation group and control group was decreased at T2-T5 compared to that at T0（ P<0.05）. The core body temperature in closed-loop group was within the set target temperature range. There was no statistically significant difference in TT, PT and APTT among the three groups before operation（ P>0.05）. At T4, the levels of TT, PT and APTT in closed-loop group［（18.9±1.7）seconds,（11.9±0.7）seconds,（35.5±3.3）seconds］and heat preservation group［（18.8±1.7）seconds,（11.6±0.8）seconds,（32.8±2.7）seconds］were shorter than those in control group［（20.9±1.3）seconds,（13.0±0.8）seconds,（35.7±3.4）seconds］（ P<0.05）. At T4, the levels of APTT in closed-loop group and heat preservation group were longer than those before operation（ P<0.05）. At T4, the levels of TT, PT and APTT in control group were longer than those before operation（ P<0.05）. There was no significant difference in the incidence of intraoperative hypothermia or shivering during PACU between closed-loop group［18%（7/40）, 3%（1/40）］and heat preservation group［33%（13/40）, 8%（3/40）］（ P>0.05）, which were lower than those in control group［75%（30/40）, 33%（13/40）］（ P<0.05）. There was no significant difference in the extubation time between closed-loop group［（12.5±3.6）minutes］and heat preservation group［（13.2±3.9）minutes］（ P>0.05）, which was shorter than that in control group［（16.6±4.0）minutes］（ P<0.05）. The incidence of surgical site infection and length of hospital stay were statistically insignificant among the three groups（ P>0.05）. No adverse reactions such as allergic reaction or pressure ulcers occurred in the three groups. Conclusion:For the elderly patients with femoral neck fracture, the perioperative whole-course closed-loop temperature management system can effectively maintain the core body temperature, improve coagulation function, prevent hypothermia, reduce shivering and shorten the extubation time, without increasing the risk of other adverse events, so the system can be safely used in clinical practice.
ABSTRACT
Objective@#To investigate the effects of metformin combined with clomiphene on endocrine index, vascular endothelial function, pregnancy rate and ovulation rate in infertile women with polycystic ovary syndrome(PCOS).@*Methods@#From January 2018 to January 2019, 60 cases of PCOS with infertility treated in Zhuji People's Hospital were studied.According to the random number table, they were divided into control group and study group, with 30 cases in each group.The control group was treated with clomiphene, while the study group was treated with metformin and clomiphene.The levels of endocrine indicators including follicle stimulating hormone (FSH), luteinizing hormone (LH), pituitary prolactin (PRL), testosterone (T) and estradiol (E2) were compared between the two groups before and after treatment.The levels of fasting insulin (FIN), fasting plasma glucose (FPG) and insulin resistance index (HOM-IR) were compared between the two groups before and after treatment.The pregnancy rate, ovulation rate and abortion rate were observed and compared between the two groups after treatment.@*Results@#In the comparison of endocrine indicators, the levels of LH, PRL, T, E2, FIN and FPG in the control group[(8.84±1.13)IU/L, (18.57±2.13)μg/L, (2.75±0.54)nmol/L, (62.49±5.73)ng/L, (16.55±7.84)IU/mL, (5.16±0.74)mmol/L] were improved after treatment compared with before treatment[(16.32±1.26)IU/L, (20.48±3.29)μg/L, (3.88±0.64)nmol/L, (59.13±4.95)ng/L, (21.33±5.32)IU/mL, (5.67±0.81)mmol/L; t=24.207, 2.669, 7.391, 2.431, 2.763, 2.546, P=0.000, 0.005, 0.000, 0.009, 0.004, 0.007], while the levels of FSH and HOM-IR were not significantly improved after treatment[(5.32±1.53)IU/L, (3.19±1.41)] compared with before treatment[(5.44±1.69)IU/L, (3.64±2.15); t=0.288, 0.959, P=0.387, 0.171]. The levels of LH, PRL, T, E2, FIN, FPG and HOM-IR in the study group[(6.25±1.47)IU/L, (16.24±2.16)μg/L, (3.79±0.83)nmol/L, (68.82±4.67)ng/L, (12.69±6.24)IU/mL, (4.63±0.71)mmol/L, (2.55±1.43)] were significantly improved after treatment compared with before treatment (t=24.576, 5.437, 9.277, 6.779, 5.479, 5.621, 2.018, P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000, 0.020), and the decrease of FSH was not significant after treatment[(5.17±1.55)IU/L, (5.21±1.54)IU/L]. After treatment, the levels of LH, PRL, T, FIN, FPG and HOM-IR in the study group decreased significantly, while the level of E2 increased significantly compared with those in the control group[(6.25±1.47)IU/L, (16.24±2.16)ug/L; t=7.651, 4.207, P=0.000, 0.000]. After treatment, CIMT in both two groups[(0.075±0.018)mm, (0.067±0.016)mm]was lower than before treatment[(0.088±0.028)mm, (0.088±0.022)mm], and the improvement in the study group was better than the control group(t=1.819, P=0.037). The body mass index (BMI) and endometrial thickness of the two groups were decreased after treatment[(24.53±3.11)kg/m2, (23.15±3.17)kg/m2, (9.46±0.72)mm, (8.89±0.67)mm] compared with before treatment[(26.91±4.02)kg/m2, (27.03±3.85)kg/m2, (12.03±0.45)mm, (11.92±0.53)mm], and the improvement degree of the study group was significantly better than that of the control group(t=1.702, 3.174, P=0.047, 0.001). As to clinical outcomes, the ovulation rate and pregnancy rate of the study group (50.00%, 76.67%) were higher than those of the control group (20.00%, 50.00%)(χ2=5.034, χ2=4.593, all P<0.05), and the abortion rate of the study group (3.33%) was lower than that of the control group (13.33%), but there was no statistically significant difference (χ2=1.964, P>0.05).@*Conclusion@#Metformin combined with clomiphene can effectively improve the level of endocrine indicators, regulate insulin resistance, improve BMI, reduce endometrial thickness, correct hyperandrogenic status, effectively promote ovulation, improve pregnancy rate and achieve obvious therapeutic effect in PCOS patients with infertility.