Herpes zoster neuralgia(HZN)is a refractory neuropathic pain.Its incidence increases with age,along with higher prevalence of postherpetic neuralgia(PHN).The pain is severe and often lasts for months or even years,significantly impacting patients'work and life.How to reduce the pain level and prevent postherpetic neuralgia is the key to its treatment.However,conventional drug treatment often has adverse effects such as dizziness and drowsiness with low overall efficacy,which is not conducive to controlling and mitigating the pain.Botulinum toxin type A(BTX-A)is an exotoxin released by clostridium botulinum,which is simple to inject,and can effectively alleviate the pain level of PHN through mechanisms such as acting on synapses of neuromuscular junctions and inhibiting neuroinflammatory responses,thereby reducing the incidence of posterior neuralgia.This paper reviews the progress of BTX-A application in the diagnosis and treatment of PHN.

Herpes zoster neuralgia(HZN)is a refractory neuropathic pain.Its incidence increases with age,along with higher prevalence of postherpetic neuralgia(PHN).The pain is severe and often lasts for months or even years,significantly impacting patients'work and life.How to reduce the pain level and prevent postherpetic neuralgia is the key to its treatment.However,conventional drug treatment often has adverse effects such as dizziness and drowsiness with low overall efficacy,which is not conducive to controlling and mitigating the pain.Botulinum toxin type A(BTX-A)is an exotoxin released by clostridium botulinum,which is simple to inject,and can effectively alleviate the pain level of PHN through mechanisms such as acting on synapses of neuromuscular junctions and inhibiting neuroinflammatory responses,thereby reducing the incidence of posterior neuralgia.This paper reviews the progress of BTX-A application in the diagnosis and treatment of PHN.

Objective:To investigate the etiology, clinical manifestations, treatment methods, and prognosis of patients with iliopsoas muscle hematoma compressing the lumbar plexus.Methods:The clinical data of 11 cases of iliopsoas muscle hematoma oppressing the lumbar plexus nerve admitted to The Affiliated Hospital of Southwest Medical University between March 2014 and May 2018 were analyzed.Results:Eleven patients, consisting of 10 men and 1 woman, aged (36.36 ± 6.74) years were analyzed. Causes of iliopsoas muscle hematoma oppressing the lumbar plexus nerve included coagulation abnormality ( n = 8) and trauma ( n = 3). Iliopsoas muscle hematoma occurred on the left side in 7 cases and on the right side in 4 cases. Among them, 11 cases had bleeding in the middle area, 8 cases in the lower area, and 2 cases in the upper area. The involved lumbar plexus nerve included the femoral nerve ( n = 11), lateral femoral cutaneous nerve ( n = 6), and obturator nerve ( n = 2). Eleven cases underwent causative treatment ( n = 11). Three-month follow-up results showed that the hematomas were completely absorbed in 11 cases, and the bone and joint activities were normal. The sensory and motor functions were restored in 10 cases. The sensory function was restored, but the recovery of motor function was poor in 1 patient. All 11 cases returned to normal after 1 year. Conclusion:The main causes of iliopsoas muscle hematoma are coagulation dysfunction and trauma. The femoral nerve and lateral femoral cutaneous nerve in the lumbar plexus are easily affected, which can cause lower limb sensory and motor disorders. As for iliopsoas muscle hematoma caused by coagulation abnormality, coagulation factors should be supplemented to correct coagulation function. As for iliopsoas muscle hematoma caused by trauma, early surgical treatment should be performed to relieve nerve compression. Timely treatment of iliopsoas muscle hematoma can generally acquire a good prognosis.

Objective:To analyze the efficacy and safety of ultrasound-guided intercostal nerve pulse radiofrequency combined with nerve block in the treatment of post-herpetic neuralgia.Methods:The clinical data of 62 patients with post-herpetic neuralgia who received treatment in The Affiliated Hospital of Southwest Medical University from May 2017 to May 2021 were retrospectively analyzed. These patients underwent nerve block (NB group, n = 30) or pulsed radiofrequency plus nerve block (PRF + NB group, n = 32). Before and after treatment, The Numerical Rating Scale (NRS) score and Pittsburgh Sleep Quality Index (PSQI) score were compared between the two groups. After treatment, the occurrence of complications including pneumothorax, infection, and skin numbness was evaluated in each group. Results:Before treatment, there were no significant differences in NRS and PSQI scores between the two groups (all P > 0.05). Immediately, 1 week and 1 month after treatment, there was no significant difference in PSQI score between the two groups (all P > 0.05). At 3 and 6 months after treatment, the NRS score in the NB +PRF group was (1.71 ± 0.35) points and (1.68 ± 0.36) points, which were significantly lower than (2.72 ± 0.68) points and (3.26 ± 0.76) points in the NB group ( t = 54.40, 78.18, both P < 0.05). There were no treatment-related complications such as pneumothorax, infection, nerve numbness, or muscle weakness in the two groups. Conclusion:Ultrasound-guided pulsed radiofrequency combined with nerve block has a definite curative effect on post-herpetic neuralgia and is highly safe. The medium- and long-term efficacy of the combined therapy is superior to that of nerve block alone.

Objective:To systematically evaluate the effect of early ambulation on the rehabilitation of patients after hepatectomy.Methods:Computer was used to search randomized controlled trial (RCT) literature on the effect of early ambulation on the rehabilitation of patients after hepatectomy in Chinese and English databases, such as China National Knowledge Infrastructure (CNKI) , Wanfang Data, VIP, China Biology Medicine, Ovid, PubMed, Web of Science, Embase, Cochrane Library. The retrieval time was from the establishment of database to May 10, 2020. RevMan 5.3 software was used to conduct Meta-analysis on literature that met the inclusion criteria.Results:A total of 8 RCT articles were included, with a total sample size of 936 cases, including 474 cases in intervention group (early ambulation) and 462 cases in control group (routine activity care) . The results of the systematic review showed that compared with control group, intervention group shorted the first exhaust time [weighted mean difference ( WMD) =-21.01, 95% confidence interval ( CI) (-25.98, -16.04) , P<0.05]and first defecation time [ WMD=-31.97, 95% CI (-54.69, -9.25) , P<0.05]after surgery, decreased gastrointestinal discomfort [relative risk ( RR) =0.44, 95% CI (0.34, 0.56) , P<0.05]and complications [ RR=0.76, 95% CI (0.56, 1.02) , P<0.05]after surgery, and had earlier time to early ambulation [ WMD=-20.64, 95% CI (-21.71, -19.56) , P<0.05], the differences were statistically significant. Conclusions:It is safe and effective to implement early ambulation in patients after hepatectomy, which is beneficial to the recovery of gastrointestinal function of patients, reduces the occurrence of gastrointestinal discomfort and complications, and promotes the recovery of patients.

OBJECTIVETo compare the efficacy and adverse events of adjusted BACOD (bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone) regimen (continuous intravenous infusion) and conventional BACOD regimen (conventional intravenous drip) in the treatment of relapsed and refractory diffuse large B cell lymphoma (DLBCL).

METHODSRetrospective analysis of 63 cases of relapsed or refractory DLBCL patients was performed, 32 patients received conventional BACOD regimen and 31 patients received adjusted BACOD regimen.

RESULTSThe response rates for adjusted group and conventional group were 87.1%(27/31)and 62.5%(20/32), respectively, during a median follow-up of 14(7-84) months. The difference was statistically significant between the two groups (P=0.025). The main adverse events were myelosuppression, gastrointestinal adverse reactions were rarely serious, and there were no serious liver and kidney toxicity. The median overall survival (OS) was 33 months for adjusted group and 12 months for conventional group, there was statistical differences (P=0.019). The median progression free survival (PFS) was 11 months and 8 months for two groups, the difference was not statistically significant (P=0.095). 1-year survival rates were 68.8% for adjusted group and 44.3% for conventional group, there were no statistical differences (P=0.055). The expected 3- and 5-year survival rates of adjusted group were significantly higher than that of conventional group (47.1% vs 12.8%, P=0.002; 37.7% vs 8.5%, P=0.006, respectively).

CONCLUSIONCompared with the conventional BACOD regimen, the adjusted BCOAD regimen is effective and well tolerated in patients with relapsed or refractory DLBCL, the overall response rate and OS increased.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; Bleomycin ; Cyclophosphamide ; Dexamethasone ; Doxorubicin ; Female ; Humans ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Vincristine

Gray zone lymphoma (GZL) is a special type of B-cell lymphoma,it is rare in clinical and reported fewly.In order to strengthen the understanding of GZL and make it be more recognized by clinicians.This article reviewed the status and progress of GZL by cell morphology,immunohistochemistry,cytogenetics and molecular biology,and discuss the current diagnostic criteria and treatment strategies.