Metabolomics and Mass Spectrometry Studies (1)
Traditional Chinese Medicine Analysis (1)
Chromatography in Natural Products (1)
Medicinal Plant Pharmacodynamics Research (1)
Sanwu Huangqin Decoction (SHD), a classic prescription for nourishing yin and clearing heat, is commonly used to treat febrile diseases, erythromelalgia, autoimmune liver diseases, and skin diseases. However, research on the quality standard of SHD is still in its infancy and has focused mainly on single Chinese herbs, with few systematic studies. Currently, traditional Chinese medicine decoctions, as a complex polydisperse system, have attracted widespread attention. It is necessary to establish an integrated and rapid identification strategy for evaluating and controlling the quality of multiphase of SHD. The ingredients in the three phases of SHD were first isolated via the centrifugation‒dialysis technique, and an method was established via ultrahigh-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC‒Q-TOF‒MS) for discrimination. The identification results and multivariate statistical analysis revealed that the SHD and three phases were clearly clustered, whereas the composition difference between the nanophase state and SHD was the smallest. Moreover, 34 significantly common differential markers were screened out by variable importance for projection (VIP) > 1 and P < 0.05 to construct the orthogonal partial least squares-discriminant analysis (OPLS-DA) regression prediction model. Furthermore, a strategy for potential effective phase identification and quality evaluation index was established based on the absolute quantitative analysis of the 13 characteristic ingredients via ultrahigh-performance liquid chromatography triple quadrupole mass spectrometry (UHPLC-QQQ-MS). The comprehensive strategy of qualitative analysis combined with absolute quantitative analysis may be an effective tool for the identification and discrimination of SHD and the potential effective phase state. These findings could provide a significative reference for further revealing the material basis and determining the quality control indicators of SHD.
Cold hypersensitivity in the hands and feet is a common clinical symptom in Asian women. Currently, treatment of cold hypersensitivity in the hands and feet is still limited to traditional Chinese medicine, mainly herbal medicine. However, many patients with cold hypersensitivity in the hands and feet in China are not satisfied with the therapeutic effect of herbal medicine, and took medication for a longer time. Chemical lumbar sympathectomy is widely used in the treatment of plantar hyperhidrosis, diabetic foot, recalcitrant erythromelalgia, and other diseases. This study was conducted to evaluate the short-term as well as long-term efficacy, complications, and patient satisfaction of chemical lumbar sympathectomy during treatment cold hypersensitivity in the hands and feet. A retrospective, observational study. Department of Anesthesiology and Pain Medicine, Jiaxing, China. A retrospective study of 72 patients with cold hypersensitivity in the hands and feet who received chemical lumbar sympathectomy treatment in our hospital from January 2015 to October 2018 was conducted. The heart rate, non-invasive blood pressure, oxygen saturation, visual analog scale, perfusion index, and plantar temperature were monitored and recorded in before treatment (T1) and after treatment (T2) groups. The patients were followed up on day 1, at week 1, 1 month, 3 months, 6 months, one year, and 2 years after operation for satisfaction, complications, and recurrence. There were no significant differences in heart rate, non-invasive blood pressure, and oxygen saturation between T1 and T2 groups (P > 0.05). Perfusion index and plantar temperature in T2 group were remarkably higher than T1 group, and the difference was statistically significant (P < 0.01). The visual analog scale score of the T2 group was significantly reduced (P < 0.01). Of all the patients who underwent chemical lumbar sympathectomy, the postoperative therapeutic effect was effective in 63 cases (87.5%) and ineffective in 9 cases (12.5%). Among the effective patients, the postoperative curative effect was shown to be excellent in 47 cases and improved in 16 cases. According to the follow-up results at day 1, 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after operation, the satisfaction rate was 87.5%, 87.5%, 81.9%, 61.1%, 52.7%, 41.6%, and 34.7%, respectively. There were no serious complications observed and 23 patients relapsed after two years. Multivariate logistic regression analysis results showed that the effect of visual analog scale (OR = 7.312, 95% CI: 1.598 - 33.646, P = 0.011) and plantar temperature (OR = 0.470, 95% CI: 0.288 - 0.766, P = 0.002) on therapeutic effect showed has statistical significance; the effect of gender (OR = 0.654, 95% CI: 0.134 - 3.181, P = 0.599), age (OR = 0.975, 95% CI: 0.916 - 1.039, P = 0.441), perfusion index (OR = 0.710, 95% CI: 0.367 - 1.375, P = 0.310), and disease course (OR = 1.019, 95% CI: 0.997 - 1.042, P = 0.088) on therapeutic effect showed no statistical significance. The effect of gender (OR = 0.451, 95% CI 0.131 - 1.554, P = 0.207), age (OR = 0.961, 95% CI 0.912 - 1.013, P = 0.141), and course of disease (OR = 1.006, 95% CI 0.997 - 1.015, P = 0.203) on postoperative recurrence showed no statistical significance. The nonrandomized, single-center, small sample size, retrospective design is a major limitation of this study. Chemical lumbar sympathectomy is a valid treatment option for cold hypersensitivity in hands and feet, and computed tomography-guided percutaneous puncture chemical lumbar sympathectomy has the advantages of high success rate, less invasion, less complications, and repeatablity.
In children, erythromelalgia is a rare but difficult to manage condition that results in bilateral episodic pain and redness in distal extremities. It is heat intolerant and relieved by cooling. Management of erythromelalgia is difficult and requires a complex multidisciplinary approach. We present a case of successful treatment of erythromelalgia with short-term spinal cord stimulation in a 12-year-old girl. The patient had severe burning pain, having undergone trials of multiple medical therapies before presenting to our department. Dual-lead spinal cord stimulator electrodes were successfully implanted without complication, leading to excellent pain control, now 8 months postimplant. This case spurs interest for future research in neuromodulation as part of the multimodal regimen to treat pediatric erythromelalgia.