Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predic...Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predict the miRNA targets of Erxian decoction for the treatment of postmenopausal osteoporosis,and the results were validated by clinical trials.Methods:In this study,we identified possible targets of Erxian decoction in osteoporosis by means of network pharmacological analysis and bioinformatic prediction.Fifteen cases of postmenopausal osteoporosis with kidney Yin and Yang deficiency(In traditional Chinese medicine,kidney Yin nourishes and moistens the tissues of the internal organs of the body,while kidney Yang promotes and warms the tissues of the internal organs of the body.)were treated with Erxian decoction for four weeks,and serum bone metabolism indices(P1NP,osteocalcin,andβ-CTX)and miRNA-335-5p expression were measured before and after treatment.Results:The constructed miRNA postmenopausal osteoporosis related gene network of the effective compound of the Erxian decoction has 296 points and 981 edges.The 39 postmenopausal osteoporosis related genes regulated by miRNA-335-5p were enriched in ossification,while the signaling pathways were enriched in rheumatoid arthritis,the Toll signaling pathway,the HIF-1 signaling pathway,and the MAPK signaling pathway.After taking Erxian decoction,the expression of the serum bone formation index(P1NP,osteocalcin)and miRNA-335-5p gene expression levels increased significantly.The alterations in P1NP and osteocalcin were correlated with the changes in miRNA-335-5p.Conclusion:Circulating miRNA-335-5p may serve as an important target of Erxian decoction in the treatment of postmenopausal women.The effect of Erxian decoction on bone formation is significant,but the underlying mechanism requires further investigation.展开更多
Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encount...Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.展开更多
Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used admin...Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China.Thus,in this randomized,double-blinded study,we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension.Methods:In a tertiary women’s hospital in Nanjing,China,102 women were allocated with computer derived randomized number to receive prophylactic 8 mg norepinephrine(group N;n=52)or 100 mg phenylephrine(group P;n=50)immediately post-spinal anesthesia,followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80%of the baseline.Our primary outcome was standardized maternal cardiac output(CO)reading from spinal anesthesia until delivery analyzed by a two-step method.Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes.Maternal side effects and neonatal outcomes were collected as well.Results:Compared to group P,women in groupNhad a higherCO(standardizedCO5.8±0.9 vs.5.3±1.0 L/min,t=2.37,P=0.02)and stroke volume(SV,standardized SV 73.6±17.2 vs.60.0±13.3 mL,t=4.52,P<0.001),and a lower total peripheral resistance(875±174 vs.996±182 dyne·s/cm5,t=3.44,P<0.001).Furthermore,the incidence of bradycardia was lower in group N than in group P(2%vs.14%,P=0.023),along with an overall higher standardized heart rate(78.8±11.6 vs.75.0±7.3 beats/min,P=0.049).Other hemodynamics,as well as maternal side effects and neonatal outcomes,were similar in two groups(P>0.05).Conclusions:Compared to equivalent phenylephrine,intermittent bolus norepinephrine provides a greater CO for management of maternal hypotension during elective cesarean section with spinal anesthesia;however,no obvious maternal or neonatal clinical advantages were observed for norepinephrine.展开更多
基金supported by Suzhou Special Project for Diagnosis and Treatment Technology of Clinical Key Diseases(No.LCZX202127)。
文摘Background:miRNAs are closely related to bone metabolism.Studies have shown that Erxian decoction can improve bone metabolism,possibly achieving this regulatory effect through miRNA targets.Netinfer was used to predict the miRNA targets of Erxian decoction for the treatment of postmenopausal osteoporosis,and the results were validated by clinical trials.Methods:In this study,we identified possible targets of Erxian decoction in osteoporosis by means of network pharmacological analysis and bioinformatic prediction.Fifteen cases of postmenopausal osteoporosis with kidney Yin and Yang deficiency(In traditional Chinese medicine,kidney Yin nourishes and moistens the tissues of the internal organs of the body,while kidney Yang promotes and warms the tissues of the internal organs of the body.)were treated with Erxian decoction for four weeks,and serum bone metabolism indices(P1NP,osteocalcin,andβ-CTX)and miRNA-335-5p expression were measured before and after treatment.Results:The constructed miRNA postmenopausal osteoporosis related gene network of the effective compound of the Erxian decoction has 296 points and 981 edges.The 39 postmenopausal osteoporosis related genes regulated by miRNA-335-5p were enriched in ossification,while the signaling pathways were enriched in rheumatoid arthritis,the Toll signaling pathway,the HIF-1 signaling pathway,and the MAPK signaling pathway.After taking Erxian decoction,the expression of the serum bone formation index(P1NP,osteocalcin)and miRNA-335-5p gene expression levels increased significantly.The alterations in P1NP and osteocalcin were correlated with the changes in miRNA-335-5p.Conclusion:Circulating miRNA-335-5p may serve as an important target of Erxian decoction in the treatment of postmenopausal women.The effect of Erxian decoction on bone formation is significant,but the underlying mechanism requires further investigation.
基金supported by the grants from the National Natural Scientific Foundation of China(No.81500944)the Nanjing Municipal Health Bureau General Project(No.YKK14127).
文摘Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.
文摘Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China.Thus,in this randomized,double-blinded study,we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension.Methods:In a tertiary women’s hospital in Nanjing,China,102 women were allocated with computer derived randomized number to receive prophylactic 8 mg norepinephrine(group N;n=52)or 100 mg phenylephrine(group P;n=50)immediately post-spinal anesthesia,followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80%of the baseline.Our primary outcome was standardized maternal cardiac output(CO)reading from spinal anesthesia until delivery analyzed by a two-step method.Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes.Maternal side effects and neonatal outcomes were collected as well.Results:Compared to group P,women in groupNhad a higherCO(standardizedCO5.8±0.9 vs.5.3±1.0 L/min,t=2.37,P=0.02)and stroke volume(SV,standardized SV 73.6±17.2 vs.60.0±13.3 mL,t=4.52,P<0.001),and a lower total peripheral resistance(875±174 vs.996±182 dyne·s/cm5,t=3.44,P<0.001).Furthermore,the incidence of bradycardia was lower in group N than in group P(2%vs.14%,P=0.023),along with an overall higher standardized heart rate(78.8±11.6 vs.75.0±7.3 beats/min,P=0.049).Other hemodynamics,as well as maternal side effects and neonatal outcomes,were similar in two groups(P>0.05).Conclusions:Compared to equivalent phenylephrine,intermittent bolus norepinephrine provides a greater CO for management of maternal hypotension during elective cesarean section with spinal anesthesia;however,no obvious maternal or neonatal clinical advantages were observed for norepinephrine.
