Objective:There are a variety of minimally invasive interventional treatments for trigeminal neuralgia,and the efficacy evaluation is different.The preferred treatment scheme is still controversial.This study aims to investigate the differences in treatment effects between patients with primary trigeminal neuralgia(PTN)treated with percutaneous balloon compression(PBC)for the first intervention and patients with pain recurrence after radiofrequency thermocoagulation(RT)who then received PBC for PTN,and to offer clinicians and patients more scientifically grounded and precise treatment alternatives. Methods:We retrospectively analyzed 103 patients with PTN admitted to the Department of Pain Management of the Second Affiliated Hospital of Guangxi Medical University from January 2020 to December 2021,including 49 patients who received PBC for the first time(PBC group)and 54 patients who received PBC for pain recurrence after RT(RT+PBC group).General information,preoperative pain score,intraoperative oval foramen morphology,oval foramen area,balloon volume,duration of compression,and postoperative pain scores and pain recurrence at each time point on day 1(T1),day 7(T2),day 14(T3),1 month(T4),3 months(T5),and 1 year(T6)were collected and recorded for both groups.The differences in treatment effect,complications and recurrence between the 2 groups were compared,and the related influencing factors were analyzed. Results:The differences of general information,preoperative pain scores,foramen ovale morphology,foramen ovale area,T1 to T3 pain scores between the 2 groups were not statistically different(all P>0.05).The balloon filling volume in the PBC group was smaller than that in the RT+PBC group,the pain scores at T4 to T6 and pain recurrence were better than those in the RT+PBC group(all P<0.05).Pain recurrence was positively correlated with pain scores of T2 to T6(r=0.306,0.482,0.831,0.876,0.887,respectively;all P<0.01). Conclusion:The choice of PBC for the first intervention in PTN patients is superior to the choice of PBC after pain recurrence after RT treatment in terms of treatment outcome and pain recurrence.

Objective To investigate the clinical efficacy of arthroscopic debridement combined with platelet rich plasma(PRP)in treatment of supraspinatus calcified tendinitis.Methods 23 patients in the experimental group were treated with shoulder arthroscopic calcification clearing with PRP injection,while 23 patients in the control group were treated with simple arthroscopic clearing,and the curative effects were observed and compared.Results All the patients were followed up effectively.Of the 23 cases in the experimental group,5 cases were treated with rotator cuff repair(3 cases were diagnosed rotator cuff tear before operation,2 cases were diagnosed with large calcification,and rotator cuff repair was performed after cleaning),and 3 cases were treated with rotator cuff repair(2 cases were diagnosed with rotator cuff tear before operation,1 case was diagnosed with large calcification,and rotator cuff repair was performed after cleaning).The visual analogue scale(VAS)of the two groups one month after surgery was significantly lower than that before surgery,and the American Association of Shoulder and Elbow Surgeons(ASES)score of the two groups one month after surgery was significantly higher than that before surgery,with statistical significance(P＜0.05).The VAS of the experimental group was significantly lower than that of the control group one month after surgery,and the ASES score was significantly higher than that of the control group one month after surgery,with statistically significant differences(t =-5.52,t = 8.73,P = 0.001).Conclusion Arthroscopic debridement combined with PRP is an effective and minimally invasive method for the treatment of supraspinatus calcified tendinitis.The calcium salt can be removed as much as possible under arthroscopy,and the scope of rotator cuff injury can be accurately evaluated.For the obvious rotator cuff injury with large damage,the rotator cuff repair with thread anchor nail can be performed.At the same time,combined with PRP,it can accelerate the repair of rotator cuff injury,relieve pain,and accelerate the functional recovery of shoulder joint.

Objective:To investigate the influences of morphological characteristics of skull base ovale foramen in the puncture difficulty of percutaneous balloon compression (PBC), surgical efficacy and postoperative complications in patients with idiopathic trigeminal neuralgia (ITN).Methods:One hundred and twenty-seven patients with ITN, admitted to our hospital from January 2020 to January 2021, were collected. Dyna-CT three-dimensional imaging of the oval foramen at the skull base and PBC treatment were performed on the included patients, and the morphological data of the oval foramen were measured. Numeric Rating Scale (NRS) was used to assess pain degrees before and after surgery. The differences of cross-sectional area and exposure Angle, puncture difficulty and time, NRS scores before and after surgery and incidence of complications were compared in patients with ovale foramen at different forms. The correlations of puncture time with puncture difficulty and cross-sectional area of ovale foramen in skull base were analyzed.Results:The foramen ovale in skull base of 127 patients included standard oval shape ( n=82), almond shape ( n=9), narrow and long shape ( n=13), fissure shape ( n=8) and irregular shape ( n=15). Different morphological characteristics of the skull base ovale foramen could lead to significant differences in the difficulty of puncture, exposure angle, cross-sectional area and puncture time ( P<0.05). Puncture time was positively correlated with puncture difficulty and cross-sectional area ( r=0.359, P<0.001; r=0.280, P=0.007). The patients with skull base ovale foramen of different forms showed no significant differences in the differences of NRS scores before and after PBC and occurrence of postoperative complications ( P>0.05). Conclusion:Dyna-CT three-dimensional imaging can visually display the morphological characteristics of the oval foramen at the skull base; this technique can be used to guide the puncture of the oval foramen and effectively evaluate the difficulty of puncture in PBC, but it does not affect the postoperative pain improvement and complication incidences.

Objective To investigate the effects of the number of harvested lymph nodes in neoadjuvant chemoradiotherapy (nCRT) combined with surgery on prognosis of middle-low rectal cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 373 patients with middle-low rectal cancer who underwent nCRT combined with surgery in the Fujian Medical University Union Hospital from January 2009 to December 2013 were collected.There were 241 males and 132 females,aged from 26 to 81 years,with the age of (55 ± 11) years.Observation indicators:(1) treatment situations;(2) follow-up and survival;(3)influencing factors for the number of harvested lymph nodes;(4) prognostic analysis of the different number of harvested lymph nodes as cut-off for grouping;(5) stratified analysis.Follow-up using telephone interview and outpatient examination was performed to detect postoperative survival of patients once every three months within postoperative 2 years and once every 6 months during the postoperative third year up to March 2016.The endpoint of follow-up was tumor recurrence,retastasis or death.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was done using the independent sample t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was done using the Kruska1-Wallis H test.Count data was described as absolute numbers.Univariate and multivariate analyses were done by the multiple linear regression model.Survival rate was calculated by the Kaplan-Meier method,and Logrank test was used for survival analysis.Results (l) Treatment situations:373 patients underwent nCRT combined with surgery,including 329 combined with sphincter-sparing rectal resection and 44 combined with abdominoperineal rectal resection.The number of harvested lymph nodes was 12 ± 6 in 373 patients.There were 185 patients with the number of harvested lymph nodes ＜ 12 and 188 with the number of harvested lymph nodes ≥ 12.(2) Follow-up and survival:373 patients were followed up for 5-77 months,with a median follow-up time of 43 months.During the follow-up,the 1-,3-,5-year disease-free survival rates were respectively 90.4％,76.3％,and 67.5％ in the 373 patients.(3) Influencing factors for the number of harvested lymph nodes:univariate analysis showed that distance between the tumor and anal verge,tumor diameter,tumor pathological N staging,and regression grade of rectal cancer were associated factors for the number of harvested lymph nodes (t =3.156,2.992,x2=8.183,10.839,P＜0.05).Multivariate analysis showed that distance between the tumor and anal verge,regression grade of rectal cancer,and tumor pathological N staging were independent factors for the number of harvested lymph nodes (t=3.308,2.690,2.584,95％ confidence interval:0.808-3.180,0.446-2.873,0.332-2.448,P＜0.05).(4) Prognostic analysis of the different number of harvested lymph nodes as cut-off for grouping:with the number of harvested lymph nodes of 6,7,8,9,10,11,12,13,14,15,and 16 as cut-off for grouping,there was no significant difference in the 3-year disease-free survival rate,cumulative local recurrence rate,and cumulative distant metastasis rate between ＜6 group and ≥6 group,between ＜7 group and ≥7 group,between＜8 group and ≥8 group,between ＜9 group and ≥9 group,between ＜10 group and ≥ 10 group,between ＜11 group and ≥ll group,between ＜12 group and ≥12 group,between ＜13 group and ≥13 group,between ＜ 14 group and ≥ 14 group,between ＜ 15 group and ≥ 15 group,between ＜ 16 group and ≥ 16 group,respectively (P＞0.05).(5) Stratified analysis:with the number of harvested lymph nodes of 7,8,9,and 10 as cut-off for grouping in 45 of 373 patients with Ⅱ-Ⅲ regression grade of rectal cancer and negative lymph nodes (NO staging),there was no significant difference in the 3-year disease-free survival rate between ＜7 group and ≥ 7group,between ＜8 group and ≥8 group,between ＜9 group and ≥9 group,between＜10 group and ≥ 10 group,respetively (x2 =3.946,5.346,6.375,4.297,P＜0.05).Conclusions The number of lymph nodes as 12 is not the independent factor for prognosis of patients with middle-low rectal cancer after nCRT combined with surgery.The number of harvested lymph nodes as 7 to 10 is the important factor for evaluating the prognosis of middle-low rectal cancer patients with Ⅱ-Ⅲ regression grade of rectal cancer and negative lymph nodes after nCRT combined with surgery.

Objective To investigate the effects of different degrees of autophagy on the apop-tosis of GABAergic neurons in spinal dorsal horn of postherpetic neuralgia model mice. Methods Forty-eight Kunming mice,approximately 6-8 weeks of age and weighing 18-22 g,were randomly divided into four groups by a random digital generator of SPSS 19.0:resinotoxin+autoph-agy induction group (group PHN+Rapa),resinotoxin group (group PHN),resinotoxin+autophagy inhibitor group (group PHN+3-MA)and blank control group (group C),12 mice in each group. Group C was given no treatment,and the other groups were given intraperitoneal injection of 0.2 μg/g resiniferatoxin (RTX)to prepare PHN model.After successful model establishment,group PHN+Rapa was given Rapamycin (1 μg·kg-1·d-1),physiological saline was given to group PHN, group PHN+3-MA was given 2 μg·kg-1·d-1autophagy inhibitor 3-MA.The intraperitoneal injection was continued for 14 day.The mechanical withdrawal threshold (MWT)and the latent period of thermal withdrawal latency (TWL)were detected and the mice were killed after stability. The segments of L4-6spinal cord were extracted and the relative expressions of bcl-2,Bax and autoph-agy-associated protein LC3 were detected by western blot.Detection of the number of apoptotic cells in the spinal cord by fluorescence Tunel.The number of GABA intermediate neurons in the dorsal horn of the spinal cord was labeled by immunofluorescence.Results Compared with group C,the rel-ative expression level of Bax protein increased significantly,the LC3-II/I ratio and the number of ap-optotic cells increased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in spinal dorsal horn were significantly reduced in other groups (P<0.05).Compared with group PHN,the LC3-II/I ratio and the relative expression level of Bax protein,the number of apoptotic cells increased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in the spinal dorsal horn were significantly decreased of group PHN+Rapa (P<0.05).Compared with group PHN,the relative expression level of LC3-II/I ratio and Bax protein, the number of apoptotic cells decreased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in spinal dorsal horn increased significantly of group PHN+3-MA,(P<0.05).Conclusion Over activation of autophagy may be one of the mechanisms leading to the ap-optosis of GABA neurons in the dorsal horn of the spinal cord in postherpetic neuralgia.

Objective To evaluate the role of autophagy in the spinal cord in the maintenance of postherpetic neuralgia (PHN) in mice.Methods Forty-eight SPF Kunming mice,aged 6-8 weeks,weighing 18-22 g,were divided into 4 groups (n=12 each) using a random number table:normal control group (group C),group PHN,PHN plus autophagy inducer rapamycin group (group PHN+R) and PHN plus autophagy inhibitor 3-methyladenine (3-MA) group (group PHN+3-MA).PHN model was established by intraperitoneal injection of resiniferotoxin 0.2 μg/g.In PHN+R and PHN+3-MA groups,rapamycin 1 μg/g and 3-MA 2 μg/g were intraperitoneally injected once a day for 14 consecutive days starting from 7 days after resiniferotoxin injection.The equal volume of normal saline was given instead in group PHN.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured on 1st,3rd,6th,9th,12th and 14th days of administration of autophagy regulator (before administration).The animals were sacrificed after the last measurement of pain threshold,and the spinal cord was removed for examination of the ultrastructure and for determination of the expression of microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ),LC3 Ⅰ,Beclin-1 and P62 by Western blot.The ratio of LC3 Ⅱ to LC3 Ⅰ expression (LC3 Ⅱ /Ⅰ) was calculated.Results Compared with group C,the MWT was significantly decreased,TWL was prolonged,LC3 Ⅱ/Ⅰ was increased,Beelin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN.Compared with group PHN,the MWT was significantly decreased,TWL,was prolonged,LC3 Ⅱ/Ⅰ was increased,Beclin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN+R,and the MWT was significantly increased,TWL was shortened,LC3 Ⅱ/Ⅰ was decreased,Beclin-1 expression was down-regulated,P62 expression was up-regulated (P＜0.05),and the number of autophagosomes was decreased under electron microscope in group PHN+3-MA.Conclusion The maintenance mechanism of PHN may be related to the excessive activation of autophagy in the spinal cord of mice.

OBJECTIVETo explore the risk factors and clinical features of delayed anastomotic fistula (DAF) following sphincter-preserving operation for rectal cancer.

METHODSClinical data of 1 594 patients with rectal cancer undergoing sphincter-preserving operation in our department from January 2008 to May 2015 based on the prospective database of Dpartment of Colorectal Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. Sixty patients(3.8%) developed anastomotic fistula. Forty-one patients (2.6%) developed early anastomotic fistula (EAF) within 30 days after surgery while 19(1.2%) were DAF that occurred beyond 30 days. Univariate analyses were performed to compare the clinical features between EAF and DAF group.

RESULTSDAF was diagnosed at a median time of 194(30-327) days after anastomosis. As compared to EAF group, DAF group had lower tumor site [(6.1±2.3) cm vs. (7.8±2.8) cm, P=0.023], lower anastomosis site [(3.6±1.8) cm vs. (4.8±1.6) cm, P=0.008], higher ratio of patients receiving neoadjuvant chemoradiotherapy (84.2% vs. 34.1%, P=0.000), and receiving preventive stoma (73.7% vs. 14.6%, P=0.000). According to ISREC grading system for anastomotic fistula, DAF patients were grade A and B, while EAF cases were grade B and C(P=0.000). During the first hospital stay for anastomosis, DAF group did not have abdominal pain, general malaise, drainage abnormalities, peritonitis but 8 cases(42.1%) had fever more than 38centi-degree. In EAF group, 29 patients(70.7%) had abdominal pain and general malaise, and 29(70.7%) had drainage abnormalities. General or circumscribed peritonitis were developed in 25(61.0%) EAF patients, and fever occurred in 39(95.1%) EAF cases. There were 13(68.4%) cases with sinus or fistula formation and 9(47.4%) with rectovaginal fistula in DAF group, in contrast to 5 (12.2%) and 5 (12.2%) in EAF group respectively. In DAF group, 5 (26.3%) patients received follow-up due to stoma (no closure), 5 (26.3%) received bedside surgical drainage, while 9(47.4%) patients underwent operation, including diverting stoma in 3 patients, Hartmann procedure in 1 case, intersphincteric resection, coloanal anastomosis plus ileostomy in 1case because of pelvic fibrosis and stenosis of neorectum after radiotherapy, mucosal advancement flap repair with a cellular matrix interposition in 3 rectovaginal fistula cases, incision of sinus via the anus in 1 case. During a median follow-up of 28 months, 14(73.7%) DAF patients were cured.

CONCLUSIONSIt is advisable to be cautious that patients with lower site of tumor and anastomosis, neoadjuvant chemoradiotherapy and preventive stoma are at risk of DAF. DAF is clinically silent and most patients can be cured by effective surgical treatment.

Anal Canal ; Anastomosis, Surgical ; Anastomotic Leak ; diagnosis ; pathology ; Colostomy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; Length of Stay ; Neoadjuvant Therapy ; Organ Sparing Treatments ; Postoperative Complications ; diagnosis ; Rectal Neoplasms ; surgery ; Rectovaginal Fistula ; Rectum ; surgery ; Retrospective Studies ; Risk Factors ; Surgical Flaps ; Surgical Stomas ; Treatment Outcome

Objective By analyzing the clinical symptoms, heart rate ( HR) , arterial oxygen saturation ( SaO2 ) and the number of white blood cells (WBC), we aimed to explore the implication of the above-mentioned indexes for early warning of high altitude pulmonary edema ( HAPE) .Methods Based on the Lake Louise Self-assessmeat Scoring System ( LLSS) and the scoring of respiratory symptoms, 628 subjects were divided into three groups: group A ( the healthy;score<3),group B(acute mountain sickness, AMS; score>3 and excluding HAPE),and group C (HAPE).Moreover, we analyzed the incidence of some clinical symptoms, HR and SaO2 , as well as the WBC number of some subjects in the three groups.Results The incidence of respiratory symptoms and WBC number were significantly increased in group C compared with group B(P<0.05).In addition,unlike group A and B, the mean HR in group C rose gradually in the first 3 days and was markedly increased at the third day(F=6.37,P<0.05).The mean SaO2in group C was remarkably lower than in group A and B in the first 3 days(F=8.21,F=8.77,F=9.58,P<0.01).Conclusion Those who enter high altitude for the first time with notable respiratory symptoms, WBC increase, HR maladaptation and decrease in SaO2 (>30%) have high risk of HAPE.It is of special importance to detect HAPE earlier at high altitude.

Objective To observe the effects of PCIA with oxycodone after laparoscopic surger-y.Methods Forty ASA Ⅰ or Ⅱ patients aged 20-60 years undergoing laparoscopic surgery were as-signed to two groups randomly (n=20 per group):oxycodone group (group A)and fentanyl group (group B).Patients in group A received oxycodone (0.03 mg/kg)and patients in group B received fentanyl (2 μg/kg)at the end of surgery.The PCIA pump was turned on when the patients entered the PACU.The PCIA pump was set up with a 4 ml bolus dose,a 1 5 min lockout interval and a back-ground infusion at the rate of 2 ml/h.Numerical rating scale (NRS)was assessed for the patients in moving,in rest and visceral pain at 3,6,12,24 and 48 h after administration,and the adverse reactions were recorded.Results NRS scores of the rest and visceral pain were significantly lower in group A than in group B at each time point(P <0.05).NRS score of the movement were significantly lower in group A than in group B at 3,6 and 12 h after surgery (P <0.05).There was no significant difference in the incidences of nausea,vomiting,dizziness and respiratory depression between the two groups. Conclusion PCIA with oxycodone can safely and effectively inhibit pain after laparoscopic surgery. The effect of oxycodone for controlling the visceral pain was better than that of fentanyl.

OBJECTIVETo explore predictive factors associated with pathologic complete response (pCR) after neoadjuvant chemoradiotherapy for rectal cancer.

METHODSClinicopathological data of 163 patients with locally advanced rectal cancer who were treated with neoadjuvant chemoradiotherapy followed by radical surgical resection from January 2007 to May 2013 were analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were performed to analyze associated factors of pCR, including age, gender, body mass index (BMI), diabetes, anemia, tumor diameter, distance of the tumor from the anal verge, circumferential extent of the tumor, tumor pathological types, tumor differentiation, pre-chemoradiotherapy T stage, pre-chemoradiotherapy N stage, pre-chemoradiotherapy CEA level, pre-chemoradiotherapy CA199 level, per-operation CEA level, pre-operation CA199 level, radiation dose, chemotherapy modality, time interval from completion of chemoradiotherapy to surgery, etc.

RESULTSTwenty-nine patients(17.8%) achieved pCR after neoadjuvant chemoradiotherapy for rectal cancer. Univariate analysis showed circumferential extent of tumor(≥1/2 cycle)(P=0.018), tumor pathological types(adenocarcinoma)(P=0.036), tumor differentiation (moderate or high)(P=0.021) and pre-chemoradiotherapy CEA level(≤2.5 μg/L)(P=0.007) were significantly correlated with pCR after neoadjuvant chemoradiotherapy for rectal cancer. Logistic regression revealed that circumferential extent of tumor (≥1/2 cycle)(OR=2.901, P=0.020) and pre-chemoradiotherapy CEA level (≤2.5 μg/L)(OR=2.775, P=0.022) were independent predictive factors of pCR after neoadjuvant chemoradiotherapy for rectal cancer.

CONCLUSIONPatients with circumferential extent of tumor ≤1/2 and pre-chemoradiotherapy CEA level ≤2.5 μg/L are more likely to achieve pCR after neoadjuvant chemoradiotherapy for rectal cancer, and these two indices can be used to predict pCR after neoadjuvant chemoradiotherapy for rectal cancer.

Adult ; Aged ; Chemoradiotherapy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Rectal Neoplasms ; therapy ; Retrospective Studies ; Treatment Outcome