Objective To explore the effects and mechanisms of bone marrow mesenchymal stem cells(BMSCs)in regulating microglial polarization on neuropathic pain in rats with sciatic nerve branch-selective injury(SNI).Methods Fifty SD rats were randomly divided into five groups with ten rats in each group;sham group(rats only exposed sciatic nerve without ligation),SNI group(SNI model was estab-lished),BMSCs group[rats were injected with BMSCs(1×106)through the sheath for 3 days after SNI modeling],BMSCs+sh-NC group[rats were intrathecally injected with BMSCs(1×106)and intrathecally injected with knock-down control(adenovirus 2.5×107 IU)for 3 days after SNI modeling],and BMSCs+sh-YY1 group[rats were intrathecally injected with BMSCs(1×106)and intrathecally injected with YY1 knockdown adenovirus(2.5×107 IU)for 3 days after SNI modeling].Neuropathic pain was assessed using paw withdrawal threshold(PWT)and paw withdrawal thermal latency(PWTL)following mechanical stimulation.Immunofluorescence was used to detect the expression of CD86,CD206,iNOS,and Arg1 in the rat spinal cord tissues.Western blotting was used to measure the expression of YY1 and KLF4 in spinal cord tissue.Results Compared with sham group,the values of PWTL and PWT in the SNI group significantly reduced(both P<0.05).In spinal cord tissue,the positive rates of iNOS and CD86 protein increased,whereas the positive rates of CD206 and Arg1 protein and the expression of YY1 and KLF4 decreased(all P<0.05).Compared with the SNI group,the values of PWTL and PWT in the BMSCs and BMSCs+sh-NC groups increased(all P<0.05),the positive rate of CD86 protein in the spinal cord decreased,whereas the positive rate of CD206 protein and the expression of YY1 and KLF4 increased(all P<0.05).Also,the positive rate of iNOS protein in the spinal cord tissue decreased and the positive rate of Arg1 increased in the BMSCs group(all P<0.05).Compared with the BMSCs and BMSCs+sh-NC groups,the PWTL and PWT values in the BMSCs+sh-YY1 group decreased(all P<0.05).The positivity rate of CD86 protein increased,the positivity rate of CD206 protein decreased,and the expression of YY1 and KLF4 decreased in the spinal cord tissue(all P<0.05).Conclusion Intrathecal injection of BMSCs promotes M2 polarization of microglia in the spinal cord and relieves neuropathic pain in rats with SNI,and its mechanism may be related to the upregulation of KLF4 expression mediated by YY1.

Objective To explore the strategy of percutaneous balloon compression under local anesthesia for the treatment of primary trigeminal neuralgia.Methods Sixty patients with primary trigeminal neuralgia who underwent percutaneous puncture balloon compres-sion surgery at the Third Affiliated Hospital of Jinzhou Medical University between August 2018 and August 2022 were randomly divided into three groups.Group A received 2％lidocaine(1 mL)before puncturing the foramen ovale and 0.5％lidocaine(0.5 mL)after punc-turing the skull,group B received 2％lidocaine(1 mL)before puncturing the foramen ovale and 0.25％lidocaine(0.5 mL)after entering the skull,and group C received 2％lidocaine(0.5 mL)externally and 0.25％lidocaine 0.5 mL upon intracranial injection.The pain and trigeminal-cardiac reflex as well as postoperative facial pain and numbness experienced by the patients were recorded.Results No statistically significant differences in the Visual Analogue Scale(VAS)scores among the groups were observed before surgical puncture.At the time before foramen ovale puncture,the VAS score and incidence of trigeminal-cardiac reflex in group C were significantly higher than those in groups A and B(P＜0.05).No statistically significant differences were observed among the three groups during balloon com-pression(P＞0.05).After 6 and 12 months of follow-up,no statistically significant differences were observed in the degree of facial pain and numbness among the three groups of patients(P＞0.05).Conclusion A sufficient volume(2％lidocaine,1 mL)of local anesthetic should be administered to ensure an analgesic effect and suppress adverse reflexes before puncturing the foramen ovale.During balloon compression,a low-concentration local anesthetic(0.25％lidocaine,0.5 mL)can also achieve analgesic effects and significantly suppress adverse reflexes.Notably,various local anesthesia methods have no long-term effects.

Objective To explore the effects and mechanisms of bone marrow mesenchymal stem cells(BMSCs)in regulating microglial polarization on neuropathic pain in rats with sciatic nerve branch-selective injury(SNI).Methods Fifty SD rats were randomly divided into five groups with ten rats in each group;sham group(rats only exposed sciatic nerve without ligation),SNI group(SNI model was estab-lished),BMSCs group[rats were injected with BMSCs(1×106)through the sheath for 3 days after SNI modeling],BMSCs+sh-NC group[rats were intrathecally injected with BMSCs(1×106)and intrathecally injected with knock-down control(adenovirus 2.5×107 IU)for 3 days after SNI modeling],and BMSCs+sh-YY1 group[rats were intrathecally injected with BMSCs(1×106)and intrathecally injected with YY1 knockdown adenovirus(2.5×107 IU)for 3 days after SNI modeling].Neuropathic pain was assessed using paw withdrawal threshold(PWT)and paw withdrawal thermal latency(PWTL)following mechanical stimulation.Immunofluorescence was used to detect the expression of CD86,CD206,iNOS,and Arg1 in the rat spinal cord tissues.Western blotting was used to measure the expression of YY1 and KLF4 in spinal cord tissue.Results Compared with sham group,the values of PWTL and PWT in the SNI group significantly reduced(both P<0.05).In spinal cord tissue,the positive rates of iNOS and CD86 protein increased,whereas the positive rates of CD206 and Arg1 protein and the expression of YY1 and KLF4 decreased(all P<0.05).Compared with the SNI group,the values of PWTL and PWT in the BMSCs and BMSCs+sh-NC groups increased(all P<0.05),the positive rate of CD86 protein in the spinal cord decreased,whereas the positive rate of CD206 protein and the expression of YY1 and KLF4 increased(all P<0.05).Also,the positive rate of iNOS protein in the spinal cord tissue decreased and the positive rate of Arg1 increased in the BMSCs group(all P<0.05).Compared with the BMSCs and BMSCs+sh-NC groups,the PWTL and PWT values in the BMSCs+sh-YY1 group decreased(all P<0.05).The positivity rate of CD86 protein increased,the positivity rate of CD206 protein decreased,and the expression of YY1 and KLF4 decreased in the spinal cord tissue(all P<0.05).Conclusion Intrathecal injection of BMSCs promotes M2 polarization of microglia in the spinal cord and relieves neuropathic pain in rats with SNI,and its mechanism may be related to the upregulation of KLF4 expression mediated by YY1.

Objective To explore the strategy of percutaneous balloon compression under local anesthesia for the treatment of primary trigeminal neuralgia.Methods Sixty patients with primary trigeminal neuralgia who underwent percutaneous puncture balloon compres-sion surgery at the Third Affiliated Hospital of Jinzhou Medical University between August 2018 and August 2022 were randomly divided into three groups.Group A received 2％lidocaine(1 mL)before puncturing the foramen ovale and 0.5％lidocaine(0.5 mL)after punc-turing the skull,group B received 2％lidocaine(1 mL)before puncturing the foramen ovale and 0.25％lidocaine(0.5 mL)after entering the skull,and group C received 2％lidocaine(0.5 mL)externally and 0.25％lidocaine 0.5 mL upon intracranial injection.The pain and trigeminal-cardiac reflex as well as postoperative facial pain and numbness experienced by the patients were recorded.Results No statistically significant differences in the Visual Analogue Scale(VAS)scores among the groups were observed before surgical puncture.At the time before foramen ovale puncture,the VAS score and incidence of trigeminal-cardiac reflex in group C were significantly higher than those in groups A and B(P＜0.05).No statistically significant differences were observed among the three groups during balloon com-pression(P＞0.05).After 6 and 12 months of follow-up,no statistically significant differences were observed in the degree of facial pain and numbness among the three groups of patients(P＞0.05).Conclusion A sufficient volume(2％lidocaine,1 mL)of local anesthetic should be administered to ensure an analgesic effect and suppress adverse reflexes before puncturing the foramen ovale.During balloon compression,a low-concentration local anesthetic(0.25％lidocaine,0.5 mL)can also achieve analgesic effects and significantly suppress adverse reflexes.Notably,various local anesthesia methods have no long-term effects.

Objective To investigate the treatment effect of flupirtine maleate on postherpetic trigeminal neuralgia and the subsequent effects on patient quality of life.Methods Forty patients with postherpetic trigeminal neuralgia were selected at our hospital from December 2015 to December 2016,and they were randomized and divided into a control group and an observation group.Patients in the control group were treated with gabapentin and oxycodone-acetaminophen,and the patients in the observation group were treated with flupirtine maleate on the basis of the control group.Visual analogue scale (VAS) scores,quality of life scores (SF-36 scale),and clinical effective rate were compared between the two groups before and after treatment.Results There was a significant decrease (P ＜ 0.05) in the VAS scores of the two groups after treatment when compared to those before treatment.The VAS score of the patients in the observation group was significantly lower than that of the patients in the control group (P ＜ 0.05).The scores for each dimension in the observation group were significantly higher than those in the control group (P ＜ 0.05).Conclusion When combined with the basic conventional treatment,flupirtine maleate can effectively improve the treatment effects in postherpetic trigeminal neuralgia and effectively relieve pain,thereby improving the quality of life.

Objective To evaluate the clinical effect of computed tomography?guided visceral nerve plexus ethanol neurolysis through post?curs of diaphragm approach in the treatment of patients with pancreatic cancer pain using,and study the safety and life quality improvement of patients . Methods A total of 58 patients suffered from pancreatic cancer pain,who were treated in the department of pain medicine of the First Hospital of China Medical University from October 2013 to December 2014,were recruited for the study. The patients were divided into two groups according to the willing of the patients and their families,group A(32 cases)was treated with Visceral Nerve Plexus ethanol Neurolysis,while group B(26 cas?es)was treated with oral opioid drugs. The analgesic effect,changes in the amount of opioid drugs,changes in the PSQI scores and the improvement of quality of life were evaluated before treatment and 1 day(T1),15 days(T15),30 days(T30),60 days(T60)after treatment. Record the adverse reactions in the course of treatment. Results All the patients of group A successfully received visceral nerve plexus ethanol neurolysis,the VAS scores,Karnofsky scores,and PSQI scores of all the observed time points(after the operation)were statistically different compared to those before treatment and group B. Statistically difference was also observed in quality of life between two groups(P<0.05). The amount of opioid drugs of group B was statistically increased than that of group A(P<0.01).The most common side effects in Group A were postural hypotension(6 cases),diar?rhea(2 cases),and intercostal neuralgia,while nausea(20 cases),constipation(11 cases)and dizziness(8 cases)were seen in the Group B. Con?clusion Visceral nerve plexus ethanol neurolysis through post?curs of diaphragm approach by the guide of CT is effective and safe for the patients with pancreatic cancer pain,and the complications were totally acceptable.