| Chapter one:detection of pain substances in male nutcracker syndrome patients with varicoceleObjective:a large number of clinical studies have reported that nutcracker syndrome is closely related to pelvic pain syndrome/pelvic congestion syndrome and gonadal vein congestion.Some studies have found that 86%of female pelvic congestion syndrome(OVS)is secondary to nutcracker syndrome,and the pain substances calcitonin gene-related peptide(CGRP)and substance P(SP)in this patient are significantly increased.The main manifestations of male nutcracker syndrome are lumbar and abdominal pain and testicular pain secondary to varicocele.There is no report on the expression of pain substances in this kind of patients.This part of the study starts from clinical samples to explore the expression of CGRP in serum of male nutcracker syndrome patients with secondary varicocele.Methods:40 patients with nutcracker syndrome and varicocele diagnosed by ultrasound and 40 normal controls were divided into experimental group and normal group.The patients who complained of varicocele pain were evaluated by pain digital score and quality of life impact score.Peripheral blood samples of each group were collected to extract serum,and commercial kits were purchased to detect the expression of CGRP in serum of experimental group and control group.Results:the average pain score of the experimental group was 5.6,the average quality of life score was 7.4,the average age was 28.6 years old,and the average age of the control group was 31.0 years old(no significant difference).There was significant difference in the expression of CGRP between the experimental group and the control group.The average CGRP of the experimental group was 94.3%±8 and 51.1%in the control group ± 27.1,P<0.001。Conclusion:male patients with pelvic urinary pain(nutcracker syndrome complicated with varicocele)have significantly higher levels of pain substance(CGRP),which indicates that varicocele congestion secondary to nutcracker syndrome can cause the release of pain substance,and eventually cause pelvic urinary pain.In the later stage,it is necessary to increase the sample size to study the correlation between pain degree and CGRP.Chapter two:Construction of male rat model of pelvic urinary pain(nutcracker syndrome method)Objective:To study the mechanism of pelvic pain conduction,we combined with the characteristics of clinical diseases,and established an animal model of nutcracker syndrome,which laid a foundation for the study of pain mechanism of pelvic pain syndrome/pelvic congestion syndrome related urogenital system.Methods:the model of nutcracker syndrome was constructed by the method of left renal vein hemiconstriction,and varicocele was used as the evaluation standard.The animal model of renal hypertension was constructed by narrowing renal artery with different internal diameter of silver clip.40 male SD rats with SPF grade were divided into five groups,each group was named as sham operation group,silver clamp group A(0.70 mm),silver clamp group B(0.80 mm),silver clip group C(0.90 mm),and traditional group(0.85 mm).Results:the results showed that the model of nutcracker syndrome was successfully constructed in different degrees.The experimental data of each group were as follows:1.the success rate of traditional group,silver clamp group A,silver clamp group B and silver clamp group C were 75.0%,77.8%,37.5%and 37.5 respectively.2.in the complications,two rats in the traditional group suffered from left renal vein rupture and hemorrhage due to the tight ligation line.One of them was caused by the ureter being punctured by mistake,which resulted in the ponding and abscess around the left kidney;There were no complications such as bleeding and perirenal sepsis in silver clamp group A.the diameter of silver clip was too large in group B and group C,and some silver clips fell off the left renal vein,which led to failure of modeling.Conclusion:the study group successfully constructed the male rat pelvic urinary system pain(nutcracker syndrome)model by silver clip narrowing left renal vein method.Compared with the traditional methods,the feasibility of silver clip method in pelvic urinary pain animal model was discussed.The successful construction of this model laid a foundation for the follow-up study of pain mechanism of pelvic urinary system pain,especially walnut clamp syndrome.Chapter 3:Construction of female rat model of pelvic urinary pain(nutcracker syndrome method)Objective:In clinic,female pelvic congestion syndrome is also called ovarian varicose syndrome.It has been reported that 86%of ovarian varicose syndrome is secondary to nutcracker syndrome.Therefore,it is more suitable for clinical research to construct the pelvic urinary pain model of ovarian varicose syndrome secondary to nutcracker syndrome.Based on the successful construction of male Nutcracker rat model of pelvic urogenital pain,we intend to use silk thread to semi ligate the left renal vein to construct female rat model of pelvic urogenital pain.Methods:Referring to the method of semi ligation of left renal vein in male rats,the female Nutcracker model was established,and the ovarian varicose vein was used as the model evaluation standard.Sixteen female SD rats of SPF grade were taken back and reared in the experimental Institute.One week later,the rats were randomly divided into two groups with 8 rats in each group:sham operation group and experimental group(0.85 mm).One month after modeling,the rats were killed to detect the degree of ovarian varicose veins and the expression of serum pain substances,SP and CGRP.Results:The Nutcracker model was successfully established in the experimental group,and the survival rate of the two groups was 75%.The average concentration of SP was 0.21 umol/L in the sham operation group and 0.32 umol/L in the experimental group;The average concentration of CGRP was 0.40 umol/L in the sham operation group and 0.58 umol/L in the experimental group.Conclusion:The same results in this part of the experiment established the animal model of pelvic urinary pain,verified that the left renal vein semi ligation(nutcracker syndrome)can also cause the release of pain substances,which laid the foundation for the follow-up study on the mechanism of pelvic urinary pain caused by female nutcracker syndrome.Chapter 4:The construction of animal model of pelvic pain induced by acetic acidObjective:To establish a chronic pelvic urinary pain model by using pelvic congestion secondary to nutcracker syndrome.In order to facilitate the experimental needs,the research group also constructed an acute pelvic urinary pain model to simulate the state of bladder irritation.Methods:Because the acute model of acetic acid is more simple and the nerve conduction mechanism of cat is closer to that of human,the research group used acetic acid intravesical instillation to build pelvic urinary pain model.The bilateral inferior abdominal nerves were separated,ligated and severed.The nerve filaments were torn into nerve filaments.The nerve filaments were put on the recording electrode.At the same time,the bladder was dilated with normal saline or 0.5%acetic acid(AA)through urethral catheter.The action potential release response of the afferent nerve of the inferior abdominal nerve was recorded when the bladder pressure changed,so as to understand the fiber composition of the pain conduction of the inferior abdominal nerve fibers.Results:Three adult cats(2 males and 1 female)were used for the pre experiment.The results showed that the nerve signal was recorded in all three cats,and the nerve signal was gradually enhanced with the increase of bladder pressure.At the same time,after acetic acid instillation of bladder,the signal intensity increased.It is suggested that the signal of inferior abdominal nerve is related to bladder pressure and irritable state.Conclusion:The subabdominal nerve conduction model of acetic acid bladder pain was successfully constructed,which laid a foundation for the study of nerve fiber composition of subabdominal nerve pain signal conduction.Chapter 5.The pain response of hypogastric nerve to bladderObjective:to establish a chronic pelvic urinary pain model by using pelvic congestion secondary to nutcracker syndrome.In order to facilitate the experimental needs,the research group also constructed an acute pelvic urinary pain model to simulate the state of bladder irritation.Methods:Because the acute model of acetic acid is more simple and the nerve conduction mechanism of cat is closer to that of human,the research group used acetic acid intravesical instillation to build pelvic urinary pain model.The bilateral inferior abdominal nerves were separated,ligated and severed.The nerve filaments were torn into nerve filaments.The nerve filaments were put on the recording electrode.At the same time,the bladder was dilated with normal saline or 0.5%acetic acid(AA)through urethral catheter.The action potential release response of the afferent nerve of the inferior abdominal nerve was recorded when the bladder pressure changed,so as to understand the fiber composition of the pain conduction of the inferior abdominal nerve fibers.Results:Three adult cats(2 males and 1 female)were used for the pre experiment.The results showed that the nerve signal was recorded in all three cats,and the nerve signal was gradually enhanced with the increase of bladder pressure.At the same time,after acetic acid instillation of bladder,the signal intensity increased.It is suggested that the signal of inferior abdominal nerve is related to bladder pressure and irritable state.Conclusion:The hypogastric nerve conduction model of acetic acid bladder pain was successfully constructed,which laid a foundation for the study of nerve fiber composition of subabdominal nerve pain signal conduction. |
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