Clinical Efficacy of Pulsed Radiofrequency Combined with Intravenous Lidocaine Infusion in the Treatment of Subacute Herpes Zoster Neuralgia.

Objective: Under the guidance of a digital subtraction angiography (DSA) machine, via fluoroscopic imaging techniques, patients diagnosed with herpes zoster neuralgia at the subacute stage, where self-reported pain lasts between 30 and 90 days, were treated with nerve pulsed radiofrequency surgery combined with intravenous lidocaine infusion or saline infusion as control. This study explores the clinical efficacy, safety, and clinical value of the combined treatment compared with nerve pulsed radiofrequency surgery alone. Methods: In this study, 72 patients diagnosed with herpes zoster neuralgia at the subacute stage were randomly divided into two groups with matched gender, age, and clinical symptoms. Both groups received pulsed radiofrequency surgery for the affected nerve segments under DSA fluoroscopy. Five days after the operation, 0.9% saline was administered daily for five consecutive days (50 ml per day, intravenous infusion) to group A (n = 36), and lidocaine was administered daily for five consecutive days (3 mg per kg per day, intravenous infusion) to group B (n = 36). Patients with poor pain control during the treatment were given 10 mg morphine tablets for pain relief to reach visual analog scale (VAS) ≤4 points. Data of the following categories were collected: VAS score, self-rating anxiety scale (SAS) score, depression self-rating scale (SDS) score, Pittsburgh sleep quality score (PSQI), 45 body area rating scale score, skin temperature measurement using infrared thermography, analgesic drug use before and after treatment at six different time points: before surgery (T 0), one day after surgery (T 1), three days after surgery (T 2), five days after surgery (T 3), one month after surgery (T 4), and two months after surgery (T 5). Blood was collected from all patients in the morning before surgery and right after the last intravenous infusion of lidocaine at T 3. Serum inflammatory indexes including white blood cell count, lymphocyte count, neutrophils count, erythrocyte sedimentation rate count, C-reactive protein (CRP) level, calcitonin gene-related peptide (CGRP) level, and interleukin-6(IL-6) level were determined. Lastly, the incidence of complications and adverse reactions throughout the study was recorded. Results: In total, 64 out of 72 patients completed the whole study. Two patients met the exclusion criteria in group A, one patient refused to participate, and one was lost to follow-up. Two patients met the exclusion criteria in group B, and two were lost to follow-up. Three patients in group B experienced vomiting during lidocaine treatment. The adverse symptom was relieved after symptomatic treatment. No patients in the two groups had severe complications such as hematoma at the puncture site, pneumothorax, and nerve injury. Compared with before treatment, the mean of VAS score, SAS score, SDS score, PSQI score, and skin temperature of both groups at each time point after interventional surgery were all significantly reduced. Furthermore, at each time point after surgery, the above indicators of group B patients were significantly lower than those of group A patients. After treatment, the consumption of analgesics in both groups was significantly lower than before treatment. Compared with group A, the consumption of analgesics was also significantly lower in group B. In addition, serum inflammatory indexes at the T 3 time point of the two groups of patients were lower than T 0. Among them, the erythrocyte sedimentation rate, CRP level, CGRP level, and interleukin-6 level of group B were significantly lower than those of group A. The incidence of postherpetic neuralgia (PHN) in group B patients (6.25%) was also lower than that in group A patients (25%). Conclusion: DSA-guided nerve pulse radiofrequency surgery combined with intravenous lidocaine infusion can effectively relieve pain in patients diagnosed with herpes zoster nerves at the subacute stage, reduce the number of analgesic drugs used in patients, reduce postherpetic neuralgia incidence rate, and improve sleep and quality of life.

Effect of Shock Wave on Vascular Lesions in Diabetic Rats.

BACKGROUND: Diabetes is one of the most common diseases in today's society. Diabetes can cause multiple vascular lesions in the body, renal insufficiency, blindness, and so on. However, the evidence concerning the role of extracorporeal shock wave therapy in diabetic vascular disease is insufficient. OBJECTIVES: Observation of the effect of shock wave on vascular lesions in diabetic rats. STUDY DESIGN: This study used an experimental design. SETTING: The research took place in the laboratory research center at The Third Military Medical University. METHODS: Eighteen healthy adult male Sprague Dawley rats were randomly divided into 3 groups: normal control group (group A), diabetic group (group B), and diabetes + shock wave treatment group (group C). Groups B and C were established by intraperitoneal injection of streptozotocin 60 mg/kg to demonstrate a diabetic rat model. Shock wave treatment was performed on the left lower extremity femoral artery in group C for 1 week (T1), 2 weeks (T2), 3 weeks (T3), and 4 weeks (T4) while the other 2 groups were reared normally. At the end of T4 shock wave treatment, the femoral arteries of each group were observed under an electron microscope. The expression of vascular endothelial growth factors (VEGF), endothelial nitric oxide synthase (eNOS), and angiotensin type 1 (AT1) were measured by western blot, and the changes of VEGF expression were detected by real-time polymerase chain reaction. RESULTS: The VEGF and eNOS in group C were higher than those in group B (P < 0.05). The AT1 of the rats in the B and C groups was significantly higher than that in the A group (P < 0.05), but the C group was significantly lower than the B group (P < 0.05). After shock wave therapy, the surface of vascular endothelium in group C was flatter and smoother than that in group B, and the endothelial basement membrane and foot process were relatively tight. LIMITATIONS: Potential mechanisms that underlie the relationship between vascular dysfunction and diabetic neuropathy pain were not examined in this study. CONCLUSIONS: Shock wave may promote the formation of new blood vessels and improve vasomotor function by upregulating VEGF, eNOS, and downregulation of AT1 in diabetic rats and improve the damage of blood glucose to blood vessels to some extent. KEY WORDS: Shock wave, diabetic rats, vascular dysfunction, neovascularization.

Effects of transection of cervical sympathetic trunk on cognitive function of traumatic brain injury rats.

Objective: To observe the effects of transection of cervical sympathetic trunk (TCST) on the cognitive function of traumatic brain injury (TBI) rats and the potential mechanisms. Methods: A total of 288 adult male SD rats were divided into 3 groups using a random number table: TBI group (n=96), TBI + TCST group (n=96) and Sham group (n=96). The water maze test was performed before TBI (T0) and at day 1 (T1), day 2 (T2), day 3 (T3), 1 week (T4), 2 weeks (T5), 6 weeks (T6) and 12 weeks (T7) after TBI. The levels of α1-adrenergic receptors (α1-ARs), α2-adrenergic receptors (α2-ARs), toll-like receptor 4 (TLR-4) and P38 in hippocampi were detected by real-time PCR. Hippocampal P38 expression was assayed by Western blot. The expressions of interleukin-6 (IL-6), tumor necrosis factor (TNF-α) and brain-derived neurotrophic factor (BDNF) were examined by immunohistochemistry. Noradrenaline (NE) expression in plasma was evaluated by ELISA. The respiratory control ratio (RCR) of brain mitochondria was detected using a Clark oxygen electrode. Results: TCST effectively improved the cognitive function of TBI rats. TCST significantly inhibited sympathetic activity in the rats and effectively inhibited inflammatory responses. The expression of BDNF at T1-T6 in TBI+TCST group was higher than that in TBI group (P<0.05). Furthermore, P38 expression was inhibited more effectively in TBI+TCST group (P<0.05), than in TBI group (P<0.05), and the RCR of the brain was significantly higher in TBI+TCST group than in TBI group (P<0.05). Conclusions: TCST can enhance cognitive function in TBI rats by inhibiting sympathetic activity, reducing inflammatory responses and brain edema, upregulating BDNF and improving brain mitochondrial function.

Effects of extracorporeal shock waves on neuralgia in diabetic rats.

OBJECTIVE: The aim of this study was to observe the effects of extracorporeal shock waves (ECSWs) on neuralgia in diabetic rats. MATERIALS AND METHODS: Diabetic neuralgia model was established in rats via injection of streptozotocin. The rats were divided into diabetic neuralgia group (Group A, n=6) and ECSW treatment group (Group B, n=6). Another six rats were taken as control group (Group C, n=6). The mechanical withdrawal threshold (MWT) and thermal withdrawal latencies (TWLs) were measured at specific points throughout the experiment, and the sciatic nerve was bluntly severed under anesthesia after the last measurement. The protein expressions of Sphk1 and TNF-α were detected by Western blot, and the mRNA expressions of Sphk1 and TNF-α were detected by reverse transcription PCR. The structure of the sciatic nerve was observed by electron microscopy. RESULTS: Compared with Group C, MWT and TWLs were decreased significantly in Groups A and B (P< 0.05). The protein expressions of TNF-α and Sphk1 in Groups A and B were both significantly higher than those in Group C (P<0.05), with higher expression in Group A than in Group B (P<0.05). The mRNA expressions of TNF-α and Sphk1 were similar. Electron microscopy showed the intact structure of the myelin sheaths of the sciatic nerve fibers in Group C, whereas the structure of the nerve fibers was damaged, with a large number of vacuoles in the myelin sheath in Group A. In Group B, the vacuoles were occasionally formed on the sciatic nerve myelin sheath, with more compact and tidy layer arrangement compared with Group A. CONCLUSION: ECSWs can relieve neuralgia in diabetic rats. Sphk1 and TNF-α may be involved in the occurrence and development of diabetic peripheral neuralgia.

Comparison of the Efficacy and Safety of Bone-filling Mesh Container and Simple Percutaneous Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures.

BACKGROUND: Bone cement leakage in patients with vertebral fracture limits the use of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP). Finding a method to reduce bone cement leakage is clinically rather important. OBJECTIVE: To compare the efficacy and safety of bone-filling mesh containers (BFMCS) and simple percutaneous balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures. STUDY DESIGN: A randomized controlled clinical study discussing the effect of 3 methods in the treatment of vertebral fractures. METHODS: From October 2014 to August 2015, 80 patients with single osteoporotic vertebral compression fractures were admitted in our hospital, including 31 men and 49 women with an average age of 76.2 years (range, 63-82 years). Patients were divided into a percutaneous balloon kyphoplasty group (Group A) and a PVP with dilated balloon placement group (Group B), with 40 cases in each group. The visual analog scale (VAS), Oswestry disability index (ODI), height of the vertebral body and Cobb's angle of the injured vertebrae were observed before operation and at 1 day, 1 month, and 6 months after the operation. Bone cement leakage and postoperative complications were also observed. RESULTS: Operations were successfully completed in all 80 patients without pulmonary embolism and without spinal cord or nerve root injury. The operation time was (32.6 ± 6.1) minutes in Group A and (31.8 ± 5.8) minutes in Group B. Operation time did not significantly differ between the 2 groups (P > 0.05). Both groups differed significantly when comparing the results with those measured before treatment. In Group A, the ODIs before operation and at 1 day, 1 month, and 6 months after the operation were 84.125 ± 8.821, 29.300 ± 8.951, 16.175 ± 6.748, and 11.400 ± 6.164, respectively, and those in Group B were 84.300 ± 8.768, 29.200 ± 9.121, 15.975 ± 6.811, and 11.575 ± 6.460, respectively. Cobb's angle values in Group A before and after treatment were (19.225 ± 5.881)° and (13.900 ± 3.720)°, respectively, and those in Group B were (19.275 ± 6.210)° and (14.225 ± 4.016)°, respectively. CONCLUSION: Both bone-filling mesh bag and simple percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures can relieve pain effectively and correct the Cobb angle. The bone-filling mesh container can effectively prevent bone cement leakage and reduce the incidence of bone cement leakage. LIMITATIONS: The study has limitations due to the small number of cases and short period of follow-up time. Further studies are needed to determine whether the mesh bag can limit the distribution of bone cement within the vertebral body. KEY WORDS: Bone-filling mesh container, kyphoplasty, osteoporosis, vertebral compression fracture.

Stellate ganglion block promotes recovery of Bell's palsy in patients with diabetes mellitus.

CONCLUSION: Stellate ganglion block (SGB) is effective for treatment of Bell's palsy in patients with diabetes mellitus. BACKGROUND: Corticosteroids are widely used for treatment of Bell's palsy in patients with diabetes mellitus but may induce complications like hyperglycemia, which calls for an alternative therapy. This study aimed to ascertain the effect of SGB on Bell's palsy in patients with diabetes mellitus. METHODS: This randomized and single-blinded clinical trial involved 96 diabetic patients with Bell's palsy that were randomly divided into a control group (n = 48) and a treatment group (SGB group, n = 48). The House-Brackmann scale and facial disability index (FDI, including FDIP and FDIS) were observed before treatment and at 1 and 3 months after treatment for assessment of the outcome. RESULTS: No statistically significant difference was found between the two groups before treatment as regards the House-Brackmann scale and FDI. There was a statistically significant difference in FDIP score in the two groups after treatment in comparison with before treatment. The FDIS score showed a statistical difference between the two groups after treatment.