Objective To investigate the clinical efficacy of CT-guided pulsed radiofrequency combined with continuous nerve block in the treatment of refractory postherpetic neuralgia(PHN).Methods A total of 208 patients with refractory PHN,who were admitted to the Hengshui Municipal People's Hospital of China between January 2021 and January 2023,were selected as the subjects of study.Using random number table method,the patients were divided into combination group and control group,with 104 patients in each group.The patients of control group received CT-guided pulsed radiofrequency therapy,and the patients of combination group received additional continuous nerve block therapy on the basis of the treatment of control group.The pain degree at different time point,clinical effective rate,number of analgesia remedy times,quality of sleep,and the levels of serum high mobility group box 1(HMGB1),interleukin-1 β(IL-1β)and interleukin-10(IL-10)were compared between the two groups.Results During the follow-up period,4 patients were lost in touch.Finally,103 patients were included in the combination group and 101 patients were included in the control group.The total treatment response rate in the combination group was 89.32％,which was significantly higher than 78.22％in the control group(P＜0.05).There were statistically significant differences in visual analogue scale(V AS)scores and Athens insomnia scale(AIS)scores including the time effect,inter-group effect and time-group interaction effect,between the two groups(P＜0.05).The postoperative one-week,2-week,4-week VAS scores and AIS scores in the combination group were remarkably lower than those in the control group(P＜0.05).The number of analgesia remedy times in the combination group was smaller than that in the control group,and the used dosage of tramadol in the combination group was lower than that in the control group(P＜0.05).Four weeks after treatment,the serum levels of HMGB1,IL-1β and IL-10 in the combination group were lower than those in the control group(P＜0.05).Conclusion For the treatment of refractory PHN,CT-guided pulsed radiofrequency combined with continuous nerve block can effectively alleviate neural inflammatory damage,and improve pain symptoms and sleep quality,besides,its analgesic effect and clinical efficacy are superior to CT-guided pulsed radiofrequency alone.(J Intervent Radiol,2024,33:264-268)

Objective To explore the effects of prucalopride(PRUC)on the intestinal function during the perioperative period of robot-assisted laparoscopic radical cystectomy(RARC)and urinary diversion.Methods A total of 75 patients undertaking RARC with urinary diversion(orthotopic neobladder or ileal bladder)in Nanjing Drum Hospital during Jan.and Dec.2021 were divided into PRUC group(n=28)and control group(n=47)according to whether they took PRUC or not.Postoperative intestinal ventilation time and defecation time,drainage tube retention time,tolerance time for first intake of semi-flow food,postoperative hospital stay,and incidence of complications were observed and recorded in the two groups.Postoperative C-reactive protein(CRP)and neutrophil/lymphocyte ratio(NLR)were compared.Results The PRUC group had shorter intestinal ventilation time and defecation time[(47.14±16.31)h vs.(74.04±35.33)h,P＜0.01;(86.14±30.47)h vs.(123.57±79.12)h,P=0.02],smaller change of ΔCRP and ΔNLR[(79.99±29.71)mg/L vs.(127.75±56.98)mg/L;(9.24±6.43)vs.(16.11±9.90),P＜0.01].All complications were minor,the incidence of intestinal obstruction in PRUC group tended to decrease within 90 days after operation(P=0.38),and there was no significant difference in other complications between the two groups(P＞0.05).Conclusion The perioperative use of PRUC in RARC with urinary diversion is safe and effective,which can promote the recovery of intestinal function after operation.

Objective To discuss the curative effect of pulsed radiofrequency combined with nerve block in treating refractory postherpetic neuralgia(PHN).Methods A total of 201 patients with PHN,who were admitted to the hospital to receive treatment between March 2020 and March 2023,were enrolled in this study.Using random number table method,the patients were divided into pulsed radiofrequency group,nerve block group and combination group,with 67 patients in each group.On the basis of routine medication,the patients of pulsed radiofrequency group received nerve pulsed radiofrequency treatment,the patients of nerve block group received nerve block therapy,while the patients of combination group received nerve block followed by nerve root pulsed radiofrequency.At the preoperative(T0),postoperative 7-day(AT7),30-day(AT30)and 90-day(AT90)time point,the short-form of McGill pain questionnaire(SF-MPQ),Pittsburgh Sleep Quality Index(PSQI),levels of pain mediators including β-endorphin,substance P,calcitonin gene-related peptide(CGRP),and levels of inflammatory factors including tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were determined.The adverse reactions were recorded.Results The postoperative AT7,AT30 and AT90 scores of PRI,VAS,PPI and PSQI,and levels of substance P,CGRP,TNF-α and IL-6 in combination group were lower than those in pulsed radiofrequency group and in nerve block group(all P＜0.05),while level of β-endorphin in combination group was higher than that in the other two groups(P＜0.05).No obvious adverse reactions were observed in all three groups.Conclusion For the treatment of patients with intractable PHN,the combination therapy of pulsed radiofrequency and nerve block is superior to single therapy in improving pain and sleep quality,which may be related to the regulation of the levels of pain mediators and inflammatory factors.

Objective To explore the effect of pulsed radiofrequency combined with nerve block on the score of short-form of McGill pain questionnaire(SF-MPQ)and the levels of serum substance P(SP)and interleukin(IL)-1β in patients with refractory postherpetic neuralgia(PHN).Methods A total of 219 patients with PHN,who were admitted to the Hengshui Municipal People's Hospital of China between April 2021 and April 2022,were collected as the objects of study.Using random number table method,the patients were divided into group A(n=73,receiving pulsed radiofrequency therapy),group B(n=73,receiving nerve block therapy),and group C(n=73,receiving pulsed radiofrequency combined with nerve block therapy).The SF-MPQ score,levels of serum SP and IL-1β,degree of anxiety and depression,and quality of life were compared between each other among the three groups.Results Among the 219 patients with PHN,6 patients were excluded from this study due to losing in touch or due to receiving other therapies,and finally group A had 71 patients,group B had 70 patients,and group C had 72 patients.At 7 d after treatment(AT7),30 d after treatment(AT30)and 90 d after treatment(AT90),in group C the scores of pain rating index(PRI),visual analogue scale(VAS)and present pain intensity(PPI)were obviously lower than those in group A and group B(P＜0.05),the levels of serum SP and IL-1β were strikingly lower than those in group A and group B(P＜0.05),and the scores of patient health questionnaire-9(PHQ9),generalized anxiety disorder 7-item(DAG7)and Generic Quality of Life Inventory 74(GQOL-74)were remarkably lower than those in group A and group B(P＜0.05).Conclusion Pulsed radiofrequency combined with nerve block can effectively reduce the pain degree and the serum SP and IL-1β levels,relieve the degree of anxiety and depression in patients with refractory PHN,which can improve the quality of life.

Objective:To analyze the prognostic factors for survival in elderly patients with glioma.Methods:We performed a retrospective analysis of prognostic factors for elderly patients with glioma,who were treated by the same attending doctor during June 2014 and June 2016,to investigate the correlations of the age,dimension of pathology,histological grade,extent of resection,adjuvant therapy,preoperative Karnofsky Performance Scale (KPS) score,postoperative KPS score,molecular markers [isocitrate dehydrogenase-1 (IDHH-1),O6-methylguanine DNA-transferase (MGMT),epidermal growth factor receptor (EGFR),Ki-67] with the prognosis.Results:A total of 45 patients were included in the study.The median overall survival (OS) was 11 months.The median progression-free survival (PFS) was 6 months.Univariate analysis revealed that the age,gender,dimension ofpathology,histological grade and preoperative KPS score had no significant correlation with survival (P＞0.05).The gross total resection,higher postoperative KPS score,adjuvant therapy,lower Ki-67 index were significantly correlated with survival.The expressions of MGMT and EGFR were significant factors for survival.High postoperative KPS score (P=0.019),adjuvant therapy (P=0.024),and the expression of MGMT (P=0.026) were independent predictors for increased median OS in a multivariate regression model.Conclusion:The extent of resection,adjuvant therapy,postoperative KPS score and molecular markers are the influential factors for survival.Larger prospective studies are needed to confirm these findings.

Objective To summarize the experience of the ventriculoperitoneal shunt in treating children with methylmalonic aciduria combined with hydrocephalus,and to assess the clinical value.Methods From September 2012 to May 2016,a total of 12 patients with methylmalonic aciduria combined with hydrocephalus in Peking University First Hospital were enrolled,including 7 boys and 5 girls.All the 12 patients underwent ventriculoperitoneal shunt.Drug therapy was performed after surgery.The clinical manifestations and imaging findings were used as the basis for adjusting the pressure of the diverter valve appropriately.The clinical condition of patients were evaluated retrospectively.The patients' clinical symptoms,signs,imaging materials,surgical complications and postoperative prognosis were analyzed.Results All the cases were followed up for 3 to 36 months,no death case and no serious postoperative complications of hydrocephalus occurred.Clinical symptoms of intracranial hypertension were relieved or disappeared.The head circumference progressive enlargement stopped.The anterior fontanelle tension decreased significantly.Setting-sun sign of eyes disappeared.One out of 4 cases with convulsion and epilepsy was relieved after the operation.Seven cases of poor vision or vision loss,postoperative visual acuity were improved though not recover to normal eyesight.One case of the children with hearing loss,postoperative hearing recovered.During the follow-up period,the head CT showed that the ventricle was narrowed significantly,interstitial brain edema improved obviously.Conclusion Ventriculoperitoneal shunt is a effective method for treating children with methylmalonic aciduria combined with hydrocephalus,which is beneficial for patients with these diseases.

OBJECTIVETo analyze the percutaneous kyphoplasty (PKP) data statistically to predict the bone cement volume (CV).

METHODSRetrospective analysis of 93 patients with 154 vertebrae of osteoporotic vertebra compressed fracture, who received PKP from January 2012 to December 2013 in Beijing Tian Tan Hospital, Capital Medical University. All procedures were bilateral and non-high-pressure polymethyl methacrylate injection. The balloon volume (BV), balloon peak pressure (Pmax), CV and the ratio of Pmax to BV (P/BV) were documented. The data was analyzed by correlation analysis and linear regression analysis to reveal the correlation between BV and CV.

RESULTSSeven vertebrae had bone cement leakage, no intraspinal leakage, no neuro-deficit. Visual analogue scale was 0-2 of all patients on 3 d postoperation. The data of 147 vertebrae without leakage: BV was 2.1-6.3 ml, Pmax was 130-359 psi, CV was 2.8-8.5 ml, and the ratio of Pmax to BV (P/BV) was 25-263 psi/ml. The data analysis showed there was no high correlation between BV and CV as one group (R<0.75). However if divided the data into three groups by the value of P/BV, group A (P/BV<100), group B (100≤P/BV<200), group C (P/BV≥200), there was high correlation and linear relationship between BV and CV in each group (R>0.75, P<0.01). CV was 0.9-1.1 times of BV in group A; CV was 1.4-1.6 times of BV in group B; and CV was 2.0-2.2 times of BV in group C.

CONCLUSIONCV is predictable by the BV and the ratio of Pmax to BV. It can reduce the rate of the leakage, and also can prevent the unsatisfactory results by insufficient bone cement volume.

Beijing ; Bone Cements ; Fractures, Compression ; surgery ; Humans ; Injections ; Kyphoplasty ; Pain Measurement ; Postoperative Period ; Pressure ; Retrospective Studies ; Spinal Fractures ; surgery

SUMMARY Hemophilia A is aninherited bleeding disorder, lack of coagulation factorⅧ( FⅧ) , and if combined with intracranial malignant tumor, the operation risk is very high. Department of Pediatric Sur-gery in Peking University First Hospital used coagulation factor replacement therapy, succeeded in the operation of 2 cases of intracranial malignant tumor with hemophilia A in children, with no abnormal bleeding events. The establishment of the multi subject cooperation group before operation, good preoper-ative preparation, enough alternative factors, and close postoperative monitoring, are the key to the suc-cessful treatment.

Objective To analyze the categories of co-existed nervous system anomalies in children with meningomyelocele in order to consummate the treating strategy for meningomyelocele.Methods Sixty-nine children who had complete clinical data diagnosed as meningomyelocele in Department of Pediatric Surgery,Peking University First Hospital from Jan.2005 to Jun.2013,were retrospectively analyzed.Preoperative spinal MRI was routinely performed.Ultrasonagraphy,CT,MRI or combination of the 2 measures were adopted to evaluate the brain.Microscopically excision of the sac,exploration of the spinal canal,brisement of the tethered cord and meningomyelocele repair were routine operation procedures.Other lesions detected during operation were treated accordingly.MRI findings and intraoperative findings were also compared.Results Preoperative spinal MRI found 59 cases of cone bit,24 cases of syringomyelia,20 cases of mild syringomyelus,14 cases of diastematomyelia,6 cases of intraspinal cyst,6 cases of intraspinal lipoma.Nineteen cases of hydrocephalus were diagnosed by iconography,among which 5 cases complicated with caudal herniation of cerebellar tonsils.Seventeen cases of diastematomyelia,8 cases of intraspinal lipoma,6 cases of intraspinal cyst were detected and treated during operation.Three cases of intraspinal lipoma and 3 cases of osseous diastematomyelia were ignored by preoperative MRI reports.Two cases of intraspinal epidermoid cyst were misdiagnosed as general cyst.One case of teratoma who was not found on MRI was detected by operation and resected.Syringomyelus or syringomyelia was found in all the children complicated with hydrocephalus.Sixty-one cases(88.4％) among the 69 cases complicated with other nervous system anomalies.All of patients were followed up for 4-71 months,averaged 23.8 months.All of patients had no new symptom.Conclusions Children with meningomyelocele often complicate with multiple nervous system anomalies.Preoperative brain and entire spinal iconography,together with thorough intraoperative exploration,are very important so as to avoid omission the co-existed lesions during operation.

Objective To evaluate the influence of simple subtalar arthrodesis to the motion and degeneration of midfoot.Methods Data of 37 patients (27 males,10 females) with an average age of 42.6 years who had undergone subtalar joint fusion from January 1996 to August 2011 were retrospectively analyzed.The MOS item short form health survey (SF-36),American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score were used.Midfoot sagittal and coronal motion were measured on ankle radiographs of maximum plantar flexion and dorsiflexion.On sagittal plane,the Meary angle was measured and the bilateral tarsometatarsal joints mobility was compared.On coronal plane,tibio-plantar angles (TPA) on 30 degrees varus slope and 30 degrees valgus slope were respectively measured on the anterio-posterior ankle X-ray films to observe the changes of midfoot activities.Besides,single photon emission computed tomography/computed tomography (SPECT/CT) of bilateral foot and ankle was taken to estimate the degeneration of midfoot joint.Results All the 37 patients were followed-up,with mean follow-up period of 9.2 years.The average SF-36 scores was increased from 34.26± 11.02 points preoperatively to 77.59± 12.57 points postoperatively.The average AOFAS midfoot scores were 86.14± 16.79 points preoperatively and 86.43± 16.70 points postoperatively without any statistical significant difference.On sagittal plane,medial tarsometatarsal joints mobility was limited by 20％.According to coronal plane of varus slope,the average TPA of healthy side and operated side were 61.32° and 64.91°,respectively,so the varus mobility of operated side was limited by 12.5％.While standing on the valgus slope,the average TPA of both sides were 76.54° and 82.28°,which indicated that valgus mobility of operated side was reduced by 42.6％.35.1％ patients of talonavicular joint,56.8％ patients of calcaneocuboid joint,and 27.0％ patients of metatarsal cuboid joint were found mild joint degeneration on SPECT/CT images without any clinical symptoms.Conclusion Subtalar arthrodesis can affect midfoot with less limit of sagittal mobility and more limit of coronal movement.And the lateral joints degeneration is more likely to happen for their compensatory activity.