[Effect of wrist-ankle acupuncture on the expression of glutamate and NMDA receptor of the spinal dorsal horn in rats with neuropathic pain].

OBJECTIVE: To observe the effect of wrist-ankle acupuncture (WA) stimulation at "R4"- "R5" - "R6" on the expression of glutamate (Glu) and phosphorylated protein NMDAR1(p-NMDAR1) of the spinal dorsal horn in spared nerve injury (SNI) rats, so as to explore its mechanism underlying improvement of SNI. METHODS: A total of 36 SD rats were randomly divi-ded into sham operation, model and WA groups, with 12 rats in each group. The SNI procedure comprised an axotomy and ligation of the tibial and common peroneal nerves leaving the sural nerve intact. Rats of the WA group were treated by acupuncture at "R4"-"R5"-"R6" points from the 5th day to the 14th day after modeling. The mechanical pain thresholds were measured before and 5, 10 and 14 d after SNI, respectively. The cold allodynia was dectected by Acetone solution dropped onto the lateral plantar surface of the paw. Glu content and p-NMDAR1 expression of spinal dorsal horn were detected by 1H-MRS, ELISA and immunohistochemistry Methods. RESULTS: Compared with the sham operation group, the mechanical pain threshold of the model group was significantly decreased (P<0.01), the duration of cold stimulation foot contraction was increased (P<0.01), and the Glu content and p-NMDAR1 expression in the spinal dorsal horn were significantly increased (P<0.05, P<0.01). After WA intervention, the mechanical pain threshold was significantly increased (P<0.01), the duration of cold stimulation was significantly shortened (P<0.01), and Glu content and p-NMDAR1 protein expression of spinal dorsal horn were decreased significantly (P<0.05, P<0.01) in the WA group compared with the model group. CONCLUSION: WA can reduce pain sensitivity in rats with neuropathic pain, possibly by inhibiting the expression of Glu and p-NMDAR1 in the spinal dorsal horn.

[Clinical significance of D-dimer activity in thrombosis of patients with return of spontaneous circulation after cardiopulmonary resuscitation].

OBJECTIVE: To investigate the clinical significance of D-dimer contents in peripheral blood for monitoring the efficacy of thrombolytic therapy in patients with return of spontaneous circulation (ROSC) of cardiopulmonary resuscitation (CPR) cardiopulmonary resuscitation after cardiac arrest. METHODS: Forty-seven patients with sudden cardiac arrest received CPR according to 2005 American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC). At the early stage of ROSC, those patients underwent head and breast CT scan if they were in a state of unconsciousness and had unstable vital signs. If intracranial hemorrhage, dissection of aorta and pneumothorax were rule out, and those patients who maintained blood circulation for over 24 hours were included. The expression of D-dimer contents in peripheral blood was determined at 0, 1, 2, 4, 8, 12 h after CPR in all patients. And the patients were randomly divided into control and experiment groups. Prior to thrombolysis, the patients whose D-dimer more than 512 µg/L were classified as Group A (n = 17); those whose D-dimer below 512 µg/L Group B (n = 14); and the remaining control group whose family members refused thrombolytic therapy Group C (n = 16). The general data, Glasgow coma scale, survival rate and the change of D-dimer in peripheral blood were analyzed. RESULTS: In Group A, D-dimer level began to increase significantly at CPR 1 hour. It peaked at CPR 2 hours then decreased gradually. The final survival rate was 67%. The survival rate and GCS were higher than those of Groups B and C. In Group B, the D-dimer concentrations began to increase gradually at CPR1 hour, peaked at CPR 12 hours and then decreased. The survival rate and GCS was lower than those of Group A and similar to those of Group C. Group C was control group with no thrombolysis. CONCLUSION: For those ROSC patients with D-dimer concentrations significantly higher than usual, the pathogenesis of cardiac arrest may be concerned with thromboembolism, thrombosis in circulatory system and hyperviscosity. After an initiation of thrombolytic therapy, blocked blood vessels are recanalized, blood circulation improves and the cause of cardiac arrest is removed. Thus their survival rate becomes better. For those with D-dimer concentrations no higher than usual, the cause of cardiac arrest is not concerned with thromboembolism, thrombolytic therapy can not improve the patient outcome. And the final survival rate remains unchanged. The significance of thrombolytic therapy is none.