Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers

Background@#Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. @*Methods@#We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. @*Results@#A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. @*Conclusions@#Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers

Background@#Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other nonmechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers. @*Methods@#We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation. @*Results@#A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers. @*Conclusions@#Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Integrated perinatal management and prognosis of 32 neonates prenatally diagnosed with congenital diaphragmatic hernia / 中华围产医学杂志

Objective To investigate the integrated perinatal management and prognosis of prenatally diagnosed congenital diaphragmatic hernia (CDH).Methods Clinical data of 32 cases of neonatal CDH that were diagnosed and treated in the Third Affiliated Hospital of Zhengzhou University from June 2015 to June 2017 were collected and retrospectively analyzed.All cases were classified into mild,moderate and severe groups based on prenatal lung-to-head ratio (LHR),observed to expected LHR and observed to expected total fetal lung volume.The integrated perinatal management included prenatal management (prenatal diagnosis and consultation),intrapartum management (delivery) and postnatal management (postnatal diagnosis,neonatal treatment and surgical treatment).Neonatal outcomes were analyzed.Statistical analysis was performed using Chi-square test and t-test.Results All of the 32 cases were diagnosed by prenatal ultrasonography and assessed by MRI.There were 18 mild,nine moderate and five severe CDH cases,respectively.Left-sided and right-sided CDH were respectively found in 27 and five cases.Thirty neonates underwent surgery when the diagnosis had been confirmed after birth and the conditions were stable after comprehensive treatment.The total survival rate was 81％ (26/32).The neonatal survival rates of severe and mild groups were 1/5 and 18/18,respectively.The more severe the CDH,the lower the survival rate (x2=16.538,P＜0.001).Among the 18 neonates with mild CDH,five neonates underwent minimally invasive laparoscopic surgery had shorter fasting time,duration of postoperative antibiotic administration and hospital stay than those received open surgery (n=13)[(2.4±0.5) vs (4.6±1.2) d,t=-3.939;(7.6±1.2) vs (9.8±1.4) d,t=-3.144;(14.4±1.1) vs (19.7±2.8) d,t=-4.064;all P＜0.01].Neonates who were discharged alive received a three months to two years postoperative treatment and follow-up and one received a second operation due to recurrence and all recovered.Conclusions Prognosis of neonatal CDH are closely related to prenatal conditions.Integrated management is of great significance in CDH.

Family medical intervention model of senile dementia with behavioral and psychological symptoms / 上海交通大学学报（医学版）

Objective · To explore family medical intervention model of senile dementia with behavioral and psychological symptoms. Methods · Four streets of Changning District in Shanghai were randomly selected and subjects were enrolled according to the inclusion criteria, who were randomly divided into the intervention group (n=71) and control group (n=70). The intervention group received door-to-door service from psychiatric doctors, given drug treatment and psychological intervention. Subjects were evaluated by several scales, including Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Mini-Mental State of Examination (MMSE), Activity of Daily Living Scale (ADL), Quality of Life-Alzheimer's Disease (QOL-AD), and Generic Quality of Life Inventory-74 (GQOLI-74), at baseline and by the end of 6 months and 12 months. Results · ① There was no significant difference in the total scores and all factor scores of BEHAVE-AD between the two groups before intervention (P>0.05). Repeated measures analysis of variance revealed a significant main effect of time (P0.05). Repeated measures analysis of variance revealed a significant main effect of time (P<0.001). The between-group effect was significant in the scores of MMSE and QOL-AD (P<0.001). The interactive effect of time×group was significant in the scores of MMSE, ADL, QOL-AD, and GQOLI-74 (P<0.05). ④ Inter-group comparison of MMSE, ADL, QOL-AD, and GQOLI-74 scores indicated that by the end of 6 months, scores of MMSE of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). By the end of 12 months, scores of MMSE, ADL, QOL-AD, and GQOLI-74 of the intervention group were remarkably better than those of the control group and the differences were statistically significant (P<0.05). Conclusion · The family medical intervention model of door-to-door services from psychiatrists integrating multidisciplinary team is effective to attenuate the mental and behavioral symptoms of senile dementia patients, and can improve the quality of life of patients and caregivers. The effect of persistent implementation will be more remarkable.

A review of perioperative anaphylaxis at a Singapore tertiary hospital

<p><b>INTRODUCTION</b>Perioperative anaphylaxis is an anaesthetic emergency, but its incidence is not well described in the local literature. This retrospective study aims to look at a group of patients who had perioperative anaphylaxis in our institution.</p><p><b>METHODS</b>We conducted a retrospective review of electronic databases and clinical case sheets, and identified 34 patients who had possible perioperative anaphylaxis during anaesthesia in our institution between 1 January 2007 and 30 April 2012.</p><p><b>RESULTS</b>After reviewing clinical and biochemical data, we found that 16 out of 151,876 patients who underwent surgery had confirmed perioperative anaphylaxis, an incidence of 1:10,000. Neuromuscular blockers were identified as the most common causative agent for perioperative anaphylaxis. The offending agent could not be identified in seven patients.</p><p><b>CONCLUSION</b>To the best of our knowledge, this is the first study in Southeast Asia on the incidence of perioperative anaphylaxis. Having a preoperative history of allergy did not seem to predispose patients to the subsequent development of perioperative anaphylaxis.</p>

Delay aversion test between the male children with obsessive-compulsive disorder and ones with attention-deficit/hyperactivity disorder / 中国心理卫生杂志

Objective:To clarify the characteristics and differences between obsessive-compulsive disorder (OCD)and attention-deficit/hyperactivity disorder (ADHD)in male children.Methods:Forty boys with OCD and 40 boys with ADHD were selected from out-patient department,and 40 normal boys matched with age,gender and IQ were recruited as the controls.Patients'diagnosis was made according to the International Statistical Classifica-tion of Diseases and Related Health Problems,Tenth Revision (ICD-10).The choice delay tasks (CDT1 /2)were assessed respectively for the measurements of normal or high ecological validity of delay aversion.In CDT1 /2, waiting time and scores of the tasks were indicators reflecting the delay aversion.Results:The scores of CDTs were higher in children with OCD than in the controls [CDT1,(30.9 ±3.2)vs.(27.6 ±3.8);CDT2,(31.3 ±4.4)vs. (28.5 ±4.9);P <0.01].The scores of CDTs were lower in children with ADHD than in the controls [CDT1, [(25.0 ±4.3)vs.(27.6 ±3.8)];CDT2,[(26.2 ±4.6)vs.(28.5 ±4.9);P <0.001].Conclusion:The results in-dicate that the children with OCD have a trend to choose the task with longer waiting time and higher score,and the children with ADHD trend to choose the task with shorter waiting time and lower score.The results suggest that the pathogenesis of hyperactivity/impulse control may be different between OCD and ADHD in delay aversion.