Objective To investigate the role of cyclooxygenases (COXs) in the up-regulation of the expression of P2X3 receptors in the dorsal root ganglion (DRG) in rats with neuropsthic pain. Methods Twenty-four male SD rats, weighing 250-280 g, were randomly divided into 4 groups ( n = 6 each): sham operation group (group S), chronic constrictive injury (CCI) group, COX-1 inhibitor ibuprofen group (group Ⅰ), and COX-2 inhibitor celecoxib group (group C). Neuropathic pain was induced by CCI. The animals were anesthetized with intraperitoneal 10% chloral hydrate 300-500 mg/kg. CCI was produced by placing 4 ligatures on the left sciatic nerve at 1 mm intervals. In group S, the left sciatic nerve was only exposed but not ligated. In groups Ⅰ and C, ibuprofen 40 mg·kg-1 ·d-1 and celecoxib 30 mg·kg-1 ·d-1 were given through a gastric tube into the stomach at day 3-14 after operation respectively. Paw withdrawal latency (PWL) and paw withdrawal threshold (PWT) were measured before operation (baseline), and at 3, 5, 7, 10 and 14 days after operation. Then the rats were sacrificed and their L()-6 DRGs were removed to detect the expression of P2X3 mRNA and protein. Results Compared with group S, PWL was significantly shortened, PWT decreased, and P2X3 mRNA and protein expression up-regulated in group CCI ( P ＜ 0.05＝. Compared with group CCI, PWL was significantly prolonged, PWT increased, and P2X3 mRNA and protein expression down-regulated in groups Ⅰ and C (P ＜0.05＝. Compared with group Ⅰ, PWL was significantly prolonged, PWT increased, and P2X3 mRNA and protein expression up-regulated in group C ( P ＜0.05＝. Conclusion COXs are involved in the up-regulation of the expression of P2X3 receptors in the DRG in rats with neuropathic pain, and the effect of COX-1 is stronger than that of COX-2.

Objective To evaluate the effect of fast-track TKA upon the recovery time and degree of satisfaction of the patients.Methods 208 patients with primary osteoarthritis between 2013 and March 2015 were randomly divided into 2 groups.In fast-track TKA group was established in peri-operative analgesia,blood management,postoperative anticoagulation,surgical skill and mitigation of perioperative stress.In TKA group,conventional surgical management mode was followed.Identical discharge standards were established for patients in 2 groups to evaluate the recovery time.The patients' degree of satisfaction at postoperative 2 weeks was assessed by numerical rating scale (NRS).The degree of satisfaction about acquisition of preoperative information,degree of satisfaction about postoperative analgesia and postoperative function were statistically compared between 2 groups.Postoperative complication,blood transfusion rate,infectious events within postoperative 3 months,thrombosis-related events,re-operation and death were recorded.Results In fast-track TKA group,the mean discharge time was (2.3±1.2) d,significantly shorter compared with (4.7±5.1) d in TKA group.The mean NRS score in fast-track TKA group was 9.8±0.5 and 9.1±1.4 in TKA group.In fast-track TKA group,the mean scores of the degree of satisfaction about acquisition of preoperative information,degree of satisfaction about postoperative analgesia and postoperative function were 27.7±7.3,9.8± 1.7 and 9.6± 1.3,significantly higher than 15.5±10.1,9.2±2.2 and 8.7±1.8 in the TKA group.In fast-track TKA group,postoperative blood transfusion rate was 3.9％,considerably lower than 11.4％ in TKA group.Conclusion Fast-track TKA can shorten the length of hospital stay,not increase the mortality rate and postoperative complication,accelerate the recovery of daily activity and effectively enhance the degree of satisfaction of the patients.

Objective To investigate the effects of maternal behaviors in the rats with neuropathic pain (NP) on emotions of offspring rats and the relationship with DNA methylation in the amygdala.Methods Forty-eight healthy adult Sprague-Dawley rats (24 males and 24 females),weighing 200-250 g,were used in the study.Twelve female and 12 male rats were randomly selected,and NP was induced by chronic constriction injury (CCI).Each female rat was mated with one male rat at 10 days after CCI.Fortyeight F1 generation rats of maternal rats with NP were randomly divided into 2 groups (n =24 each) using a random number table:NP1 group and NP2 group.Forty-eight F1 generation rats of normal maternal rats were randomly divided into 2 groups (n=24 each) using a random number table:S1 group and S2 group.The F1 generation rats were cross-fed immediately after birth between group NP2 and group S2,and fed by their own mother rats in NP1 and S1 groups.All the offspring rats were fed to 21 days after birth by the maternal rats selected,and separately fed to 30 days after birth,and then subjected to behavioral testing.Retrieving and licking pups were recorded after delivery in maternal rats to evaluate the maternal behaviors.The mechanical and thermal paw withdrawal thresholds were measured in the offspring rats.Elevated plus maze and open field tests were conducted to detect anxiety and depression behaviors in the offspring rats.At 1 day after completion of behavioral testing,the expression of DNA methyltransferase 1 (DNMT1) and DNA methyltransferase 3a and 3b in the amygdala was detected by Western blot analysis.Results Compared with S1 or S2 groups,the latency to lick pups,latency to retrieve pups,and total retrieval time were significantly prolonged,and the total time spent licking pups was significantly shortened in NP1 group or NP2 group (P＜0.05 or 0.01).There was no significant difference in the mechanical and thermal paw withdrawal thresholds in the offspring rats between the four groups (P＞0.05).Compared with group S1,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Compared with group NP2,the ratios of time spent in the open arm to the closed arm and of time spent in the central square to the peripheral square were significantly decreased,DNMT1 expression in the amygdala was significantly up-regulated,and the total DNA methylation was increased in the offspring rats in S2 and NP1 groups (P＜0.05).Conclusion Decreased maternal behaviors in the rats with NP results in negative emotions including anxiety and depression in the offspring rats,and the mechanism is related to increased DNA methylation in the amygdala of the offspring rats.

Objective To investigate the effects of different degrees of neuromuscular blockade (NMB) induced by rocuronium on facial nerve evoked-electromyographic (EEMG) monitoring in patients undergoing resection of acoustic neuroma.Methods Thirty-five ASA Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index ≤30 kg/m2,scheduled for elective resection of acoustic neuroma under general anesthesia,were included in the study.Anesthesia was induced with midazolam,fentanyl and propofol.The patients were mechanically ventilated after tracheal intubation.Facial nerve EEMG monitoring and peripheral NMB monitoring were performed simultaneously during operation.Facial nerve EEMG was monitored using the Epoch XP2000 multichannel electrophysiological nerve monitoring system (Axon Co.,USA),facial nerve was stimulated and evoked potential of orbicularis oculi was recorded during operation.Peripheral NMB degrees were monitored with TOF-Watch SX monitor (Organon Co.Holland).After rocuronium 0.6 mg/kg was injected intravenously,the facial nerve EEMG responses were monitored when the degree of NMB (T1) was at 100％,75％,50％,25％ and 0 of the control height.The amplitude and latency of EEMG were recorded.The amplitude reservation ratio (the ratio of the amplitude of EEMG monitored to the baseline value) was calculated.Linear correlation of the amplitude reservation ratio or latency of EEMG with the degree of NMB was analyzed.Results No EEMG response was elicited when the degree of NMB was 100％ in 6 patients.The lirear regression equation of the interaction between the degree of NMB (X) and the amplitude reservation ratio (Y) was Y =1 - 0.787 X,the coefficient of determination was 0.898 ( P ＜ 0.05) and the correlation coefficient was - 0.947 ( P ＜ 0.05).The correlation coefficient between the latency of EEMG and the degree of NMB was 0.328 ( P ＜ 0.05).Conclusion When the degree of NMB is maintained at 25 ％-50％,facial nerve EEMG can be monitored effectively and body movement can be avoided during resection of acoustic neuroma.

Objective To test the effectiveness of an integrated intervention to improve control and management of type 2 diabetic patients.Methods The study was designed as a randomized and multi-center clinic trial for 24 weeks.150 overweight patients from 2 companies and one hospital in Shanghai were recruited.The principal objective of the project was to compare the effectiveness of a structured diabetes management program consisting of 200 kcal breakfast as a meal replacement with low glycemic index (GI),scheduled blood glucose monitoring(6 times per week),low GI diet consulting,monitoring and medical check up and nutritional education (diet consulting,health education on nutrition and healthy lifestyle) in overweight individuals with type 2 diabetes.Results At 12th week,the level of fasting blood glucose(FBG) in both groups decreased by 16.5% and 10.6%,and at 24th week,the FBG also decreased by 25.0% in intervention group,but in control group FGB increased 2.8% (P＜0.01).Meanwhile,there were 8.2% and 11.1% reductions in HbA1C respectively at 12th week and at 24th week in intervention group,while the values were increased slightly in control group(P＜0.01).Compared with control group,waist circumference,hip circumference,and blood pressure were significantly reduced after treatment for 24 weeks in intervention group (P＜0.01).Conclusions Integrated intervention is an effective approach in managing FBG,HbA1C blood pressure,and weight control in overweight diabetic patients.

Gastroesophageal reflux disease （GERD） is a frequently and commonly occurring disease in clinic. In recent decades， with the development in pathophysiology and drug researches， modern medicine has achieved remarkable progress and results in diagnosis and treatment. However， the treatments for non-erosive reflux disease， refractory gastroesophageal reflux disease， proton pump inhibitor resistance， overlap of disease symptoms， and extraesophageal symptoms are limited and ineffective. Traditional Chinese medicine （TCM） was widely used in clinical practice， which has been proved effective in relieving symptoms and improving the quality of life. Sponsored by China Association of Chinese Medicine （CACM） and undertaken by the Spleen and Stomach Disease Branch of CACM， "the 12^th Youth Salon of Clinical Predominance Disease Series （GERD）" invited 18 authoritative digestive experts of TCM and western medicine to discuss "the difficulties of clinical diagnosis and treatment of GERD and TCM advantages". The focus issues such as modern medical diagnosis and treatment achievements and contributions， improvement and maintenance of symptoms， response to overlapping disease symptoms， reduction and withdrawal of acid suppressors， and treatment of extra-esophageal symptoms were discussed in depth. TCM and western medicine exchanged and complemented each other's strengths， combing the difficulties of modern medical diagnosis and treatment， which clarified the positioning and advantages of TCM and provided guidance for clinical and scientific research.