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Objective:To systematically compare the efficacy of different drugs in alleviating remifentanil-induced hyperalgesia.Methods:Databases such as PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data and CBM were searched using computers from inception to May 2020.The randomized controlled trials comparing the efficacy of different intervention measures for alleviating remifentanil-induced hyperalgesia were searched.After independently identifying the literature, the two reviewers conducted data extraction and evaluated the bias of the included studies, and Stata 14.0, ADDIS 1.16.5 and R4.0.2 softwares were used to analyze the data.Results:Thirty randomized controlled trials were included in our study.Compared with placebo, 3 out of 6 drugs could alleviate remifentanil-induced hyperalgesia, and the probability order for the effect was as follows: butorphanol with MD value (95% CI)-1.50 (-2.80, -0.24), dexmedetomidine with MD value (95% CI)-1.20 (-2.40, -0.09) and ketamine with MD value (95% CI) -0.88 (-1.60, -0.16). After sensitivity analysis, the efficacy of butorphanol remained to be verified.Two drugs could decrease the dosage of opioids within 24 h after operation, and the probability order for the effect was as follows: dexmedetomidine with MD value (95% CI) -14.00 (-28.00, -0.19) and ketamine with MD value (95% CI) -9.20 (-18.00, -0.08). One drug could decrease the incidence of postoperative nausea and vomiting within 24 h after operation: dexmedetomidine with RR value (95%CI) 0.28 (0.16, 0.22). Conclusion:The results of network meta-analyses show that dexmedetomidine has the best efficacy in alleviating remifentanil-induced hyperalgesia.
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Objective:To understand the effect of a new tracheal tube fixation device in the "double fixation" of oral tracheal intubation for critically ill patients in adult emergency department.Methods:A retrospective analysis of patients with oral tracheal intubation admitted to our EICU from January 2016 to June 2017 was performed using traditional tape and inch band fixation as a control group; the experience of treatment from July 2017 to December 2018 for patients with oral tracheal intubation, the new double-fixation method of tracheal tube fixation device was used as the observation group. The degree of displacement, oral cleanliness, facial skin allergies and injuries, and comfort of the two groups of patients was compared.Results:The rate of tracheal displacement in the experimental group was mildly 11.2% (11/98), moderately 5.1% (5/98), and the control group was mildly 24.2% (15/62), moderately 14.5% (9/62) and severe 6.5% (4/62). The incidence of facial skin allergy and skin damage was 6.1% (6/98), 0, and the control group was 24.2% (15/62), 11.3% (7/62), the difference was statistically significant ( Z value was -4.021, χ2 value was 24.48, P<0.05). The comfort score of the test group was (1.05±1.01) points, which was significantly higher than (2.10±1.71) points of the control group ( t value was 4.920, P<0.01). Conclusions:The new type of tracheal tube fixation device "dual fixation" for critically ill patients with mechanical ventilation through oral endotracheal intubation is visually beautiful, and has good firmness and comfort. It can effectively reduce the occurrence of adverse events and has good application value.
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ObjectiveTo investigate whether Xiayuxue decoction exerts an anti-liver fibrosis effect by inhibiting glial cell line-derived neurotrophic factor (GDNF). MethodsA total of 24 C57BL/6 mice were randomly divided into control group, model group, and Xiayuxue decoction group. The mice in the model group and the Xiayuxue decoction group were given intraperitoneal injection of 10% CCl4, and those in the Xiayuxue decoction group were given 0.4678 g/kg Xiayuxue decoction by gavage since week 4. The liver function parameters alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured, and liver histopathology was observed. Immunohistochemistry was used to measure the protein expression of alpha-smooth muscle actin (α-SMA) and GDNF. GFP-Col-HSC and human primary hepatic stellate cells (HSCs) were treated with GDNF (10 ng/ml), and HSC activation was measured. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group, the model group had significant increases in the levels of ALT and AST, and compared with the model group, the Xiayuxue decoction group had significant reductions in the levels of ALT and AST (all P＜0.01). Liver histopathology showed that the model group had marked inflammatory cell infiltration and formation of fibrous septa by proliferated collagen fibers, and the Xiayuxue decoction group had loose fibrous septa and alleviated inflammatory cell infiltration. Immunohistochemistry showed that compared with the control group, the model group had significant increases in the expression of α-SMA and GDNF (both P＜0.01), which were observed in fibrous septa, and compared with the model group, the Xiayuxue decoction group had significant reductions in the expression of α-SMA and GDNF (both P＜0.05). Western blotting showed that the control group had relatively low expression of GDNF in liver tissue, the formation of liver fibrosis at week 6 of CCl4 modeling, and an around 10-fold increase in the expression of GDNF, and the Xiayuxue decoction group had significantly inhibited protein expression of GDNF (P＜0.01); there were significant increases in the expression of α-SMA and collagen type I α1 (Col1) in mice with liver fibrosis, with significant reductions in α-SMA and Col1 after treatment with Xiayuxue decoction (all P＜0.01). The in vitro experiment showed that GDNF induced the significant increases in the protein expression of α-SMA and Col1 in HSCs, which was significantly inhibited by Xiayuxue decoction (all P＜0.01). ConclusionThe expression of GDNF is significantly upregulated in the formation of liver fibrosis. GDNF can induce HSC activation, and Xiayuxue decoction can exert an anti-liver fibrosis effect by inhibiting GDNF.
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Objective To investigate the therapeutic effect of Taohong Siwu decoction on a mouse model of carbon tetrachloride (CCl 4 )-induced liver fibrosis and its mechanism of action. Methods A total of 24 male C57BL/6 mice were randomly divided into normal group, model group, and Taohong Siwu decoction group, with 8 mice in each group. The mice in the model group and the Taohong Siwu decoction group were given intraperitoneal injection of 10% CCl 4 , and Taohong Siwu decoction was given by gavage since week 3 for 4 consecutive weeks. Liver function [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] was measured, and liver pathomorphology was observed. Real-time PCR was used to measure the mRNA expression of α-smooth muscle actin (α-SMA), hyaluronic acid synthase-2 (HAS-2), and collagen type Ⅰ(Col1), and Western blotting was used to measure the protein expression of α-SMA, Col1, and HAS-2. Primary hepatic stellate cells (HSCs) were isolated, and HAS-2 was silenced by siRNA to observe its influence on HSC activation. The t -test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK or least significant difference t -test was used for further comparison between two groups. Results Compared with the normal group, the model group had significant increases in serum liver function parameters (ALT, AST) and the Taohong Siwu decoction group had significant reductions in the serum levels of ALT and AST (all P < 0.01). Pathological staining showed that the model group had marked inflammatory cell infiltration and formation of fibrous septa by proliferated collagen fibers, and the Taohong Siwu decoction group had loose fibrous septa and alleviated inflammatory cell infiltration. Compared with the model group, the Taohong Siwu decoction group had significant reductions in the mRNA and protein expression of α-SMA and Col1(all P < 0.001). Compared with the normal group, the model group had a significant increase in the mRNA expression level of HAS-2 in liver tissue ( t =6.14, P < 0.05), and compared with the model group, the Taohong Siwu decoction group had a significant reduction in the protein expression level of HAS-2 (0.29±0.10 vs 1.00±0.12, t =70.73, P < 0.001). After HAS-2 was silenced by siRNA, the Si HAS-2+transforming growth factor β (TGFβ) group (treated with TGFβ) had significant reductions in the mRNA expression levels of α-SMA and Col-Ⅰ compared with the NC+TGFβ group ( P < 0.01). Conclusion Taohong Siwu decoction exerts a marked therapeutic effect on CCl 4 -induced liver fibrosis in mice by inhibiting HAS-2.
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Objective:To evaluate the role of hypoxia-inducible factor-1α (HIF-1α) in hydrogen-induced inhibition of lipopolysaccharide (LPS)-induced inflammatory responses in mouse macrophages.Methods:The mouse RAW264.7 macrophages cultured in vitro were divided into 4 groups ( n=24 each) according to the random number table method: control group (C group), LPS group (L group), hydrogen-rich solution plus LPS group (H+ L group), and hydrogen-rich solution plus LPS plus HIF-1α inhibitor 2-methoxyestradiol (2ME2) group (H+ L+ M group). LPS 1 μg/ml was added, and the cells were incubated for 6 h in group L. In group L+ H, LPS was added first, the medium was changed to 0.6 mmol/L hydrogen-rich solution, and cells were incubated for 6 h. In group H+ L+ M, 2ME2 10 μmol/L was given first, cells were then incubated for 30 min, LPS and hydrogen-rich solution were added, and cells were incubated for 6 h. Western blot was used to determine the expression of HIF-1α, Beclin-1, Bcl-2/E1B-19 kDa interacting protein 3 (BNIP3) and LC3.Enzyme-linked immunosorbent assay was used to detect the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-1β in the supernatant.The number of autophagosomes was observed using a transmission electron microscope. Results:Compared with group C, the concentrations of TNF-α, IL-6 and IL-1β in the supernatant were significantly increased, the expression of HIF-1α, Beclinl and BNIP3 in macrophages was up-regulated, the ratio of LC3Ⅱ/LC3Ⅰ was increased, and the number of autophagosomes was increased in group L ( P<0.05). Compared with group L, the concentrations of TNF-α, IL-6 and IL-1β were significantly decreased, the expression of HIF-1α, Beclin-1 and BNIP3 in macrophages was up-regulated, LC3Ⅱ/LC3Ⅰ ratio was increased, and the number of autophagosomes was increased in group H+ L ( P<0.05). Compared with group H+ L, the concentrations of TNF-α, IL-6 and IL-1β in the supernatant were significantly decreased, the expression of HIF-1α, Beclin-1, and BNIP3 in macrophages was down-regulated, and the ratio of LC3Ⅱ/LC3Ⅰ was decreased, and the number of autophagosomes was decreased in group H+ L+ M ( P<0.05). Conclusion:HIF-1α-mediated activation of autophagy is involved in the process of hydrogen-induced inhibition of LPS-induced inflammatory responses in mouse macrophages.
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Objective@#To investigate the incidence of neck and shoulder pain among dentists in several hospitals in Tianjin, China and the main factors for the onset of neck and shoulder pain, and to provide ideas for reducing the incidence rate of neck and shoulder pain in dentists.@*Methods@#In December 2018, a total of 140 dentists from General Hospital of Tianjin Medical University, The Second Hospital of Tianjin Medical University, and Tianjin Stomatological Hospital were selected as respondents. A self-designed questionnaire was used to investigate the incidence rate of neck and shoulder pain among the dentists and related influencing factors. A total of 140 questionnaires were distributed, among which 129 (96.9%) were usable questionnaires. The questionnaire contained the questions on personal information and conditions of neck and shoulder pain. The continuous data were expressed as Mean±SD, and the categorical data were expressed as percentage (%) . The multivariate logistic regression analysis was used to investigate influencing factors.@*Results@#Among the 129 respondents, 120 (93.02%) had neck and shoulder pain. The prevalence rates of neck pain alone, shoulder pain alone, and neck and shoulder pain were 34.9% (45/129) , 31.8% (41/129) , and 26.3% (34/129) , respectively. Certain factors, such as age, sex, exercise, working time, bad sitting posture, inappropriate seat, and engagement in periodontology or orthodontics, had a linear relationship with the incidence rate of neck and shoulder pain among the respondents (P<0.05) .@*Conclusion@#There is a high incidence rate of neck and shoulder pain among the dentists in some hospitals in Tianjin. Dentists should be encouraged to control the number of consultations, adjust the sitting posture during work, arrange working hours reasonably, and strengthen physical exercise, so as to reduce the incidence rate of neck and shoulder pain.
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Objective To evaluate the effect of application of pulsed radiofrequency to dorsal root ganglia on activation of spinal astrocytes in a rat model of neuropathic pain (NP).Methods Eighty male Sprague-Dawley rats,aged 6-8 weeks,weighing 200-250 g,were divided into 4 groups (n=20 each) using a random number table method:sham operation group (group Sham),group NP,pulsed radiofrequency group (PRF group) and sham pulsed radiofrequency group (group SPRF).NP was induced by chronic constriction injury (CCI).The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before CCI and 1,7,14 and 21 days after CCI.Four rats were sacrificed at 1 day before CCI and 14 and 21 days after CCI,and the L4.6 segments of the spinal cord were harvested to detect the expression of glial fibrillary acidic protein (GFAP) and interleukin-1beta (IL-1β) by Western blot.Results Compared with group Sham,the MWT was significantly decreased and the TWL was shortened at each time point after CCI,and the expression of GFAP and IL-1β was up-regulated at 14 and 21 days after CCI in NP,PRF and SPRF groups (P＜0.05).Compared with group NP,the MWT was significantly increased and the TWL was prolonged at 14 and 21 days after CCI (P＜0.05),and the expression of GFAP and IL-1β was down-regulated at 14 and 21 days after CCI in group PRF (P＜0.05),and no significant change was found in the parameters mentioned above in group SPRF (P＞0.05).Conclusion The mechanism by which pulsed radiofrequency reduces NP is probably related to inhibiting spinal astrocyte activation in rats.
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Objective To compare the efficacy of adriamycin chemo-ganglionectomy and radiofre-quency thermocoagulation ( RFT ) of semilunar ganglion in treating craniofacial postherpetic neuralgia ( PHN) . Methods A total of 95 patients with PHN in the areas innervated by maxillary and mandibular divisions of trigeminal nerve, aged 55-90 yr, with the course of disease 6 months-3 yr, were divided into 2 groups using a random number table method: adriamycin chemo-ganglionectomy group ( ADM group, n=48) and RFT group ( n=47) . Hartel anterior approach to puncture was performed via the foramen ovale un-der the guidance of CT in two groups. In group ADM, 0. 5％ adriamycin 2. 5 mg ( 0. 5 ml) was injected via the foramen ovale, and RFT of gasserian ganglion was performed in group RFT. Visual Analog Scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) scores were evaluated before and after treatment. The rate of effective treatment was calculated, and treatment-related complications were recor-ded. Results Compared with group RFT, no significant change was found in VAS or SF-MPQ scores be-fore treatment, VAS and SF-MPQ scores were increased and the rate of effective treatment was decreased at 1 and 7 days after treatment, VAS and SF-MPQ scores were decreased and the rate of effective treatment was increased at 6 and 12 months after treatment, the incidence of facial numbness, hypoesthesia, masti-catory muscle weakness and weakened corneal reflex was decreased in group ADM ( P<0. 05) . Conclusion Compared with semilunar ganglion RFT, the long-term efficacy of adriamycin chemo-ganglionectomy of semilunar ganglion in treating craniofacial PHN is enhanced, and the safety is higher.
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Objective To evaluate the clinical value of adriamycin injection via the foramen ovale and around peripheral trigeminal branches under the guidance of X-ray for treatment of primary trigeminal neuralgia by comparison with the three-dimensional computed tomography (CT).Methods A total of 91 patients with primary trigeminal neuralgia of both sexes,aged 33-76 yr,with the course of disease 6 months-24 yr,with visual analogue scale score of 6-9,were divided into 2 groups using a random number table:X-ray group (n =43) and CT group (n =48).Hartel anterior approach was used to puncture the foramen ovale in 2 groups.One point five percent adriamycin 0.2,0.3 and 0.5 ml were injected via the supraorbital foramen,infraorbital foramen and oval foramen.When pain relief was poor (visual analogue scalc scorc≥ 4) within 1 yr after treatment,oxcarbazepine and adjuncts (tramadol,flupentixol and melitracen tablets,etc.) were taken orally.The requirement for oxcarbazepine and adjuncts was recorded during 1 day-1 week,1 week-1 month,1-3 months,3-6 months and 6 months-1 yr after treatment periods.The operation time,the nuinber of puncture,and developinent and recurrence of complications during treatment and within 1 yr after treatment were recorded.Results Compared with CT group,the number of puncture and incidence of facial hematoma during treatment were significantly increased (P ＜ 0.05 or 0.01),and no significant change was found in the operation time,requirement for oxcarbazepine and adjuncts,incidence of dizziness,nausea and vomiting during treatment,or the incidence and recurrence rate of masticatory muscle weakness and facial numbness after treatment in X-ray group (P＞0.05).Conclusion Compared with the three dimensional CT,X-ray provides similar efficacy and safety when used to guide adriamycin injection via the foramen ovale and around peripheral trigeminal branches for treatment of primary trigeminal neuralgia,showing that X-ray guidance has significant clinical value.
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Early small hepatocellular carcinoma (SHCC) can be cured by surgery and interventional operation to improve the survival rate of paitents,so the accurate diagnosis of SHCC is of great significance.Presently,the dynamic contrast-enhanced MR scan could only obtain single arterial phase imaging by single breath hold,and it had breathing motion artifact because of the long scanning time.The early arterial transient enhancement of SHCC was easy to be misdiagnosed.The CAIPIRINHA-Dixon-TWIST-VIBE (CDT-VIBE) sequence couldobtain high-quality multiple arterial phases images and hepatic arterial dominant (HAD) images in short-time scanning.And it could not only detect small focal lesions which were difficult to find by other imaging examination,but also find the start enhanced difference between lesions which were relevant to lesions property and blood supplement.The CDT-VIBE has a high clinical value in diagnosis and treatment of SHCC.The research progresses of CDT-VIBE in diagnosis of SHCC was reviewed in this article.
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Objective To evaluate the efficacy and influencing factors analysis of doxorubicin treatment for herpes zoster neuralgia postherpetic neuralgia (PHN).Methods From January 2010 to January 2014 in the Second Hospital of Tianjin Medical University,209 cases of herpes zoster neural-gia patients (94 males,1 1 5 females,aged 45-86 years)received doxorubicin non-vascular interven-tional treatment,using visual analogue scale (visual analogue scale,VAS score)to evaluate curative effect,then recorded the related factors of patients (gender,age,location,duration,and degree of pain,whether to have hypoimmunity disease,early antiviral treatment,the presence of hyperalgesia, and outbreak pain,drug concentration,guiding method,the recent curative effect).Using single-fac-tor analysis of variance procedure and multiple factors of logistic regression analysis.Results The to-tal effective rate was 82.76% (1 73/209)after one month,the total effective rate was 86.12% (180/209)after twelve months.Single factor analysis showed that age≤65 years,duration of diseases<3 months,severe pain(VAS≥ 7 )or with low immunity disease was significantly associated with the curative effect of treatment of PHN (P <0.05).Multi-factor analysis showed that with low immunity diseases such as malignant tumor (OR =1.418,95%CI 1.347-8.563),the course of the disease more than 3 months (OR = 2.408,95% CI 3.325-18.643 ) were independent prognostic factors of influencing curative effects.Conclusion With low immunity diseases such as malignant tumor and the duration of more than 3 months,curative effect of doxorubicin non-vascular interventional treatment may be poor,patients should be treated as early as possible.
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Objective To evaluate the efficacy of lumbar discectomy,radiofrequency ablation and annuloplusty performed with Disc-FX system under the guidance of C-arm in treatment of discogenic low back pain.Methods Twenty-eight patients with discogenic low back pain,with VAS score greater than 7,aged 27-73 yr,underwent lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system under the guidance of C-arm.The patients were followed up for 2 months after surgery and pain was assessed using VAS score.VAS scores were recorded before surgery,and at 7 and 14 days and 1 and 2 months after surgery.The effective analgesia was recorded according to VAS scores.The therapeutic effect was evaluated according to Macnab standard 2 months after surgery.Results VAS scores were significantly lower at each time point after surgery than before surgery (P ＜ 0.05).The rate of effective analgesia was 93 % at 2 months after surgery.The excellent and good rate of the therapeutic effect evaluated was 93 %.One female patient developed injury to lumbar venous plexus,and no patients developed infection of intervertebral disk,nerve root injury or spinal cord injury.Conclusion The excellent and good rate is 93 % when lumbar discectomy,radiofrequency ablation and annuloplusty performed using Disc-FX system is used for treatment of discogenic low back pain under the guidance of C-arm,with fewer side effects.
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ObjectiveTo investigate the effects of paravertebral injection of doxorubicin on pain behavior and ultrastructure of dorsal root ganglion ( DRG ) neurons in rats with neuropathic pain.MethodsOne hundred male SD rats,aged 3 months,weighing 200-250 g,were studied.The spared nerve injury (SNI) model was established by ligation and separation of tibial and common fibular nerves.The rats were randomly divided into 5 groups ( n =20 each):SNI group and different concentrations of doxorubicin groups (groups A1,A2,A3,A4 ).The animals were anesthetized with intrapetitaneal 10％ chioral hydrate 0.3 ml/100 g.The L4,6 intervertebral foramina was exposed.Normal saline and 0.25％,0.50％,0.75％ and 1.00％ doxorubicin 5 μl were injected into the intervertebral foramina in groups SNI,A1,A2,A3,and A4 respectively.The paw withdrawal latency to the radiant heat stimulation (PWL) and paw withdrawal duration to acetone (PWD) were measured before administration and on day 1-28 after administration.Three rats were chosen in each group on day 28 after administration and DRG were removed to observe the ultrastructure of large and small neurons with electron microscope.ResultsCompared with group SNI,PWL was significantly prolonged and PWD was significantly shortened in groups A1,A2,A3,A4 in a concentration manner ( P ＜ 0.05).Nucleus condensation,mitochondrial swelling,increased lysosomes,chromatin condensation,fibrosis of intercellular substances,and cell necrosis were observed in small neurons.Mitochondrial swelling and increased fibers wcre observed in large neurons and most of large neurons survived.ConclusionParavertebral injection of doxorubicin can reduce neuropathic pain and result in damage to large and small DRG neurons,and small neurons in the DRG are more susceptible and vulnerable to doxorubicin than large neurons in rats.
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Objective To evaluate the histologic changes of dorsal root ganglion (DRG) and pain threshold following implantation of iodine-125(125I) seeds in the lumbar intervertebral foramina in rats.Methods Thirtysix adult male SD rats aged 6 months weighing 220-250 g were randomly assigned into 3 groups (n =12 each):group sham operation (group A) and groups low and high radioactive 125I seeds (groups B and C).125I seeds of 0.4 and 0.8 mCi were implanted in L4,5 and L5,6 intervertebral foramina in groups B and C respectively.Paw withdrawal threshold to von Frey filament stimulation (MWT) and paw withdrawal latency to thermal nociceptive stimuli (TWL) were measured 2 days before (T1,baseline) and at 2,7,14,30 and 60 days after implantation (T2-6) in 6 animals in each group.The remaining 6 animals in each group were sacrificed at 14 and 60 days after 125I seeds implantation for microscopic examination of L5 DRG.Results MWT and TWL were significantly decreased after 125I seeds implantation at T4 compared with the baseline values at T1 in both groups,and returned to the baseline in group B and were significantly increased in group C at T6.The neurons were severely injured in DRG in groups B and C in a time-and dose-dependent manner.Conclusion Implantation of 125I seeds in intervertebral foramen can induce radiation resection of DRG.
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Objective To evaluate the efficacy of destruction of dorsal root ganglia with local doxorubicin injection guided by CT for postherpetic neuralgia involving thoracic back region. Methods One hundred and fifty patients suffering from postherpetic neuralgia in thoracic back region were randomly divided into 3 groups ( n = 50 each): group A oral medicine; B and C groups undergoing local injection under the guidance of C-arm and CT respectively + oral medicine. Three spinal segments severely affected by herpes virus were chosen for paravertebral puncture. 1% lidocaine 1 ml was injected at each segment as test dose. Fifteen minutes later doxorubicin 3.3 mg and betamethasone compound 4.7 mg were injected at each segment if no side-effect occurred. All 3 groups were given oral medicine according to the intensity of pain after local injection. The number of patients who exited from the study because of the side effects of oral medicine was recorded. VAS, sleep interference score (SIS) and a short form of McGill pain questionnaire (SF-MPQ) were used to evaluate the efficacy of the treatment the day before (baseline), 24 h, 1 week, 1, 3 and 6 months after local injection. The dosage of oxycodone extended-release tablets and gabapentin was recorded, and also the incidence of pneumothorax within 12 h after local injection. Results The exit rate, VAS, SIS and SF-MPQ scores, dosage of oxycodone extended-release tablet and gabapentin were significantly lower in B and C groups than in group A, but there was no significant difference between the 2 groups. The incidence of pneumothorax was 10% in group B but no pneumothorax developed in group C.Conclusion Destruction of dorsal root ganglia with local doxorubicin injection guided by CT is more effective for the treatment of postherpetic neuralgia.
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Objective To systematically review the efficacy of pregabalin in patients with post-herpetic neuralgia.Methods A comprehensive search was undertaken to identify all randomized placebo-controlled trials of pregabalin in patients with post-herpetic neuralgia.Medline,Web of Science,Cochrane Library,Wanfang Database and CNKI were searched from January 1966 up to December 2008.The modified Jadad scale was used for quality assessment.Numerical rating scale ( NRS),effective analgesia rate and the incidence of adverse effects were taken as main outcomes.Meta-analysis was conducted using the Cochrane Collaboration Review Manager 4.2 software.Results A total of four studies involving 1024 patients were included in this meta-analysis.The modified Jadad scale scores for the 4 studies were ≥ 4.The NRS scores were significantly lower,while effective analgesia rate was higher in groups 150,300,600 mg/d than placebo-controlled group (P ＜ 0.05).There were no significant differences in NRS scores and effective analgesia rate between 150 mg/d and 300 mg/d groups.The NRS scores were significantly lower in 600 mg/d group than in 300 mg/d group,but there were no significant differences in effective analgesia rate between 600 mg/d and 300 mg/d groups.The most frequent adverse effects were dizziness,somnolence,peripheral edema,and headache.Most of the adverse effects were mild or moderate in intensity.The occurrence of adverse effects appeared to be dose-related.Conclusion Pregabalin is effective and safe in patients with post-herpetic neuralgia,but the efficacy of reducing pain is not a dose-dependent manner.
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Objective To investigate the efficacy of adriamycin injection around trigeminal ganglion via foramen ovale for treatment of trigeminal neuralgia under the guidance of X-ray and neurostimulator.Methods 0.5% adriamycin 0.5 ml was injected into foramen ovale under the guidance of X-ray and neurostimulator in 78 patients with primary trigeminal neuralgia.Correct location of needle tip wax confirmed by lidocaine injection.THe patients were followed up for 24 months after adriamycin injection.The rate of effectiveness,excellent/good rate,compile remission rate and recurence rate were calculated.The complications were observed.Results On the day of treatment,and at 7 days and 1,6,12,24 months after treatment,the complete remission rate was 21%,18%,51%,45%,43%,and 39%respectively,the excellent/good rate 42%,41%,68%,65%,62%,and 54%respectively,and the rate of effectiveness 76%,82%,92%,91%,78%,and 70%respectivdy.The recurrence rate was 3%,20%and 35%at 6,12 and 24 months after treatment respectively.Facial numbness developed in 17 patients and disappeared after 8-12 months.No severe complication occurred.Conclusion Adriamycin injection around trigeminal ganglion via foramen ovale under the guidance of X-ray and neuronstimulator for treatment of trigeminal neuralgia is effective and safe.
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Objective To investigate the effects of paravertebral injection of different concentrations of adriamycin on motor conduction function in rats. Methods Eighty healthy male Wistar rats weighing 250-300 gwere randomly divided into 4 groups (n = 20 each): 3 adriamycin groups receiving paravertebral injection of 0.3%, 0.5% and 1.0% adriamycin 10 μl respectively (group A1, A2, A3) and control group (group C)receiving equal volume of normal saline (NS) instead of adriamycin. The animals were anesthetized with intraperitoneal 3% pentobarbital 40 mg/kg. A right paramedian incision was made in the back from L3 to S1.L4,5,5,6 intervertebral foramina were exposed. 0.3%, 0.5% and 1.0% adriamycin and NS 10 pl were injected into the intervertebral foramina in group A1, A2, A3 and C respectively. Spinal motor evoked pontential (SMEP)was measured at 1, 2, 4 and 8 weeks (T1-4)after paravertebral injection. Results The latent period of SMEP was significantly prolonged and the amplitude decreased at T1-4 in group A3 as compared with group A1, A2 and C.Conclusion Paravertebral injection of 1.0% adriamycin can significantly depress motor conduction function.
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Objective To evaluate the capability of model for end-stage liver disease (MELD)combined with serum sodium (MELD- Na,MELDNa and MESO scores) in predicting the prognosis of patients with decompensated liver cirrhosis in 6 and 12 months.Methods One hundred and nineteen patients with decompensated liver cirrhosis and completed follow-up data were retrospectively studied.The MELD,MELD- Na,MELDNa and MESO scores were calculated according to the clinical data of each patient.Receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to measure the values of the four models in predicting the 6 and 12 months survival,and Z-test was used to compare their predictive values.Results MELD,MELD-Na,MELDNa and MESO scores were significantly different between patients who survived and those who died within 6 and 12 months follow-up.The AUC for the MELD- Na,MELDNa and MESO scores were all more than 0.8 in predicting 6 and 12 months survival.However the differences of the AUC between the MELD score and MELD-Na,MELDNa,MESO scores were not significant in predicting 6 and 12 months survival.Conclusion The model for MELD combined with serum sodium can accurately predict the prognosis of patients with decompensated liver cirrhosis in 6 and 12 months,while these scores are not superior to MELD score.