Altered brain function in classical trigeminal neuralgia patients: ALFF, ReHo, and DC static- and dynamic-frequency study.

The present study aimed to clarify the brain function of classical trigeminal neuralgia (CTN) by analyzing 77 CTN patients and age- and gender-matched 73 healthy controls (HCs) based on three frequency bands of the static and dynamic amplitude of low-frequency fluctuation, regional homogeneity, and degree centrality (sALFF, sReHo, sDC, dALFF, dReHo, and dDC). Compared to HCs, the number of altered brain regions was different in three frequency bands, and the classical frequency band was most followed by slow-4 in CTN patients. Cerrelellum_8_L (sReHo), Cerrelellum_8_R (sDC), Calcarine_R (sDC), and Caudate_R (sDC) were found only in classical frequency band, while Precuneus_L (sALFF) and Frontal_Inf_Tri_L (sReHo) were found only in slow-4 frequency band. Except for the above six brain regions, the others overlapped in the classical and slow-4 frequency bands. CTN seriously affects the mental health of patients, and some different brain regions are correlated with clinical parameters. The static and dynamic indicators of brain function were complementary in CTN patients, and the changing brain regions showed frequency specificity. Compared to slow-5 frequency band, slow-4 is more consistent with the classical frequency band, which could be valuable in exploring the pathophysiology of CTN.

Altered trends of local brain function in classical trigeminal neuralgia patients after a single trigger pain.

OBJECTIVE: To investigate the altered trends of regional homogeneity (ReHo) based on time and frequency, and clarify the time-frequency characteristics of ReHo in 48 classical trigeminal neuralgia (CTN) patients after a single pain stimulate. METHODS: All patients underwent three times resting-state functional MRI (before stimulation (baseline), after stimulation within 5 s (triggering-5 s), and in the 30th min of stimulation (triggering-30 min)). The spontaneous brain activity was investigated by static ReHo (sReHo) in five different frequency bands and dynamic ReHo (dReHo) methods. RESULTS: In the five frequency bands, the number of brain regions which the sReHo value changed in classical frequency band were most, followed by slow 4 frequency band. The left superior occipital gyrus was only found in slow 2 frequency band and the left superior parietal gyrus was only found in slow 3 frequency band. The dReHo values were changed in midbrain, left thalamus, right putamen, and anterior cingulate cortex, which were all different from the brain regions that the sReHo value altered. There were four altered trends of the sReHo and dReHo, which dominated by decreased at triggering-5 s and increased at triggering-30 min. CONCLUSIONS: The duration of brain function changed was more than 30 min after a single pain stimulate, although the pain of CTN was transient. The localized functional homogeneity has time-frequency characteristic in CTN patients after a single pain stimulate, and the changed brain regions of the sReHo in five frequency bands and dReHo complemented to each other. Which provided a certain theoretical basis for exploring the pathophysiology of CTN.

Alteration of the cortical morphology in classical trigeminal neuralgia: voxel-, deformation-, and surface-based analysis.

OBJECTIVE: This study aimed to combine voxel-based morphometry, deformation-based morphometry, and surface-based morphometry to analyze gray matter volume and cortex shape in classical trigeminal neuralgia patients. METHODS: This study included 79 classical trigeminal neuralgia patients and age- and sex-matched 81 healthy controls. The aforementioned three methods were used to analyze brain structure in classical trigeminal neuralgia patients. Spearman correlation analysis was used to analyze the correlation of brain structure with the trigeminal nerve and clinical parameters. RESULTS: The bilateral trigeminal nerve was atrophied, and the ipsilateral trigeminal nerve volume was smaller than the contralateral volume in the classical trigeminal neuralgia. The gray matter volume of Temporal_Pole_Sup_R and Precentral_R was found to be decreased using voxel-based morphometry. The gray matter volume of Temporal_Pole_Sup_R had a positive correlation with disease duration and a negative correlation with the cross-section area of the compression point and the quality-of-life score in trigeminal neuralgia. The gray matter volume of Precentral_R was negatively correlated with the ipsilateral volume of the trigeminal nerve cisternal segment, cross-section area of compression point, and visual analogue scale. The gray matter volume of Temporal_Pole_Sup_L was found to be increased using deformation-based morphometry and had a negative correlation with the self-rating anxiety scale. The gyrification of the middle temporal gyrus_L increased and the Postcentral_L thickness decreased, as detected using surface-based morphometry. CONCLUSIONS: The gray matter volume and cortical morphology of pain-related brain regions were correlated with clinical and trigeminal nerve parameters. voxel-based morphometry, deformation-based morphometry, and surface-based morphometry complemented each other in analyzing the brain structures of patients with classical trigeminal neuralgia and provided a basis for studying the pathophysiology of classical trigeminal neuralgia.

Amplitude of low-frequency fluctuation after a single-trigger pain in patients with classical trigeminal neuralgia.

OBJECTIVE: This study aimed to explore the central mechanism of classical trigeminal neuralgia (CTN) by analyzing the static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low-frequency fluctuation (dALFF) in patients with CTN before and after a single-trigger pain. METHODS: This study included 48 patients (37 women and 11 men, age 55.65 ± 11.41 years) with CTN. All participants underwent 3D-T1WI and three times resting-state functional magnetic resonance imaging. The images were taken before stimulating the trigger zone (baseline), within 5 s after stimulating the trigger zone (triggering-5 s), and in the 30th minute after stimulating the trigger zone (triggering-30 min). The differences between the three measurements were analyzed using a repeated-measures analysis of variance. RESULTS: The sALFF values of the bilateral middle occipital gyrus and right cuneus gradually increased, and the values of the left posterior cingulum gyrus and bilateral superior frontal gyrus gradually decreased in triggering-5 s and triggering-30 min. The values of the right middle temporal gyrus and right thalamus decreased in triggering-5 s and subsequently increased in triggering-30 min. The sALFF values of the left superior temporal gyrus increased in triggering-5 s and then decreased in triggering-30 min. The dALFF values of the right fusiform gyrus, bilateral lingual gyrus, left middle temporal gyrus, and right cuneus gyrus gradually increased in both triggering-5 s and triggering-30 min. CONCLUSIONS: The sALFF and dALFF values changed differently in multiple brain regions in triggering-5 s and triggering-30 min of CTN patients after a single trigger of pain, and dALFF is complementary to sALFF. The results might help explore the therapeutic targets for relieving pain and improving the quality of life of patients with CTN.

Analyzing the risk factors of unilateral trigeminal neuralgia under neurovascular compression.

Background: This study aimed to explore the risk factors and potential causes of unilateral classical or idiopathic trigeminal neuralgia (C-ITN) by comparing patients and healthy controls (HCs) with neurovascular compression (NVC) using machine learning (ML). Methods: A total of 84 C-ITN patients and 78 age- and sex-matched HCs were enrolled. We assessed the trigeminal pons angle and identified the compressing vessels and their location and severity. Machine learning was employed to analyze the cisternal segment of the trigeminal nerve (CN V). Results: Among the C-ITN patients, 53 had NVC on the unaffected side, while 25 HCs exhibited bilateral NVC, and 24 HCs showed unilateral NVC. By comparing the cisternal segment of CN V between C-ITN patients on the affected side and HCs with NVC, we identified the side of NVC, the compressing vessel, and certain texture features as risk factors for C-ITN. Additionally, four texture features differed in the structure of the cisternal segment of CN V between C-ITN patients on the unaffected side and HCs with NVC. Conclusion: Our findings suggest that the side of NVC, the compressing vessel, and the microstructure of the cisternal segment of CN V are associated with the risk of C-ITN. Furthermore, microstructural changes observed in the cisternal segment of CN V on the unaffected side of C-ITN patients with NVC indicate possible indirect effects on the CN V to some extent.

Argatroban in Patients With Acute Ischemic Stroke With Early Neurological Deterioration: A Randomized Clinical Trial.

Importance: The effect of argatroban in patients with acute ischemic stroke (AIS) and early neurological deterioration (END) is unknown. Objective: To assess the efficacy of argatroban for END in AIS. Design, Setting, and Participants: This open-label, blinded-end point, randomized clinical trial was conducted from April 4, 2020, through July 31, 2022. The date of final follow-up was October 31, 2022. This was a multicenter trial. Eligible patients were adults with AIS who experienced END, which was defined as an increase of 2 or more points on the National Institutes of Health Stroke Scale within 48 hours from symptom onset. Patients who withdrew consent, experienced duplicate randomization, or were lost to follow-up were excluded from the study. Interventions: Patients were randomly assigned to the argatroban group and control group within 48 hours of symptom onset. Both groups received standard therapy based on guidelines, including oral mono or dual antiplatelet therapy. The argatroban group received intravenous argatroban for 7 days (continuous infusion at a dose of 60 mg per day for 2 days, followed by 20 mg per day for 5 days) in addition to standard therapy. Main Outcome and Measure: The primary end point was good functional outcome at 90 days, defined as a modified Rankin Scale score of 0 to 3. Results: A total of 628 patients (mean [SD] age, 65 [11.9] years; 400 male [63.7%]) were included in this study (argatroban group, 314 [50%] and control group, 314 [50%]). Of these, 18 withdrew consent, 1 had duplicate randomization, and 8 were lost to follow-up. A total of 601 patients with stroke were included in the intention-to-treat analysis. Finally, 564 patients were included in the per-protocol analysis as 6 participants in the argatroban group and 31 participants in the control group did not follow the complete protocol. The number of patients with good functional outcome at 90 days was 240 (80.5%) in the argatroban group and 222 (73.3%) in the control group (risk difference, 7.2%; 95% CI, 0.6%-14.0%; risk ratio, 1.10; 95% CI, 1.01-1.20; P = .04). The proportion of symptomatic intracranial hemorrhage was 3 of 317 (0.9%) in the argatroban group and 2 of 272 (0.7%) in the control group (P = .78). Conclusions and Relevance: Among patients with AIS with END, treatment with argatroban and antiplatelet therapy resulted in a better functional outcome at 90 days. This trial provided evidence to support the use of argatroban in reducing disability for patients with END. Trial Registration: ClinicalTrials.gov Identifier: NCT04275180.

Alteration of brain network centrality in CTN patients after a single triggering pain.

Objective: The central nervous system may also be involved in the pathogenesis of classical trigeminal neuralgia (CTN). The present study aimed to explore the characteristics of static degree centrality (sDC) and dynamic degree centrality (dDC) at multiple time points after a single triggering pain in CTN patients. Materials and methods: A total of 43 CTN patients underwent resting-state function magnetic resonance imaging (rs-fMRI) before triggering pain (baseline), within 5 s after triggering pain (triggering-5 s), and 30 min after triggering pain (triggering-30 min). Voxel-based degree centrality (DC) was used to assess the alteration of functional connection at different time points. Results: The sDC values of the right caudate nucleus, fusiform gyrus, middle temporal gyrus, middle frontal gyrus, and orbital part were decreased in triggering-5 s and increased in triggering-30 min. The sDC value of the bilateral superior frontal gyrus were increased in triggering-5 s and decreased in triggering-30 min. The dDC value of the right lingual gyrus was gradually increased in triggering-5 s and triggering-30 min. Conclusion: Both the sDC and dDC values were changed after triggering pain, and the brain regions were different between the two parameters, which supplemented each other. The brain regions which the sDC and dDC values were changing reflect the global brain function of CTN patients, and provides a basis for further exploration of the central mechanism of CTN.

Brain entropy changes in classical trigeminal neuralgia.

Background: Classical trigeminal neuralgia (CTN) is a common and severe chronic neuropathic facial pain disorder. The pathological mechanisms of CTN are not fully understood. Recent studies have shown that resting-state functional magnetic resonance imaging (rs-fMRI) could provide insights into the functional changes of CTN patients and the complexity of neural processes. However, the precise spatial pattern of complexity changes in CTN patients is still unclear. This study is designed to explore the spatial distribution of complexity alterations in CTN patients using brain entropy (BEN). Methods: A total of 85 CTN patients and 79 age- and sex-matched healthy controls (HCs) were enrolled in this study. All participants underwent rs-fMRI and neuropsychological evaluations. BEN changes were analyzed to observe the spatial distribution of CTN patient complexity, as well as the relationship between these changes and clinical variables. Sixteen different machine learning methods were employed to classify the CTN patients from the HCs, and the best-performing method was selected. Results: Compared with HCs, CTN patients exhibited increased BEN in the thalamus and brainstem, and decreased BEN in the inferior semilunar lobule. Further analyses revealed a low positive correlation between the average BEN values of the thalamus and neuropsychological assessments. Among the 16 machine learning methods, the Conditional Mutual Information Maximization-Random Forest (CMIM-RF) method yielded the highest area under the curve (AUC) of 0.801. Conclusions: Our study demonstrated that BEN changes in the thalamus and pons and inferior semilunar lobule were associated with CTN and machine learning methods could effectively classify CTN patients and HCs based on BEN changes. Our findings may provide new insights into the neuropathological mechanisms of CTN and have implications for the diagnosis and treatment of CTN.

Effect of Silica Fume on the Rheological Properties of Cement Paste with Ultra-Low Water Binder Ratio.

The effect of silica fume on the rheological properties of a cement-silica fume-high range water reducer-water mixture with ultra-low water binder ratio (CSHWM) was studied. The results indicate that the W/B ratio and silica fume content have different effects on the rheological parameters, including the yield stress, plastic viscosity, and hysteresis loop area. The shear-thickening influence of CSHWM decreased with the increased silica fume content. When the silica fume content increased from 0% to 35%, the mixture with W/B ratio of 0.19 and 0.23 changed from a dilatant fluid to a Newtonian fluid, and then to a pseudoplastic fluid. When the silica fume content was less than 15%, the yield stress was close to 0. With the increase of silica fume content, the yield stress increased rapidly. The plastic viscosity and hysteresis loop area decreased slightly with the addition of a small amount of silica fume, but increased significantly with the continuous increase of silica fume. Compared with the Bingham and modified Bingham models, the Herschel-Buckley model is more applicable for this CSHWM.

Radiomics analysis of unaffected side changes in classic trigeminal neuralgia.

OBJECTIVE: To investigate the subtle differences in the structure of the unaffected trigeminal nerve between patients with classic trigeminal neuralgia (CTN) and healthy controls (HCs) by means of radiomics, so as to further explore the etiological mechanism of trigeminal neuralgia (TN). METHODS: The imagine data of 95 CTN patients and 89 matched HCs were collected and retrospectively analyzed. They were assigned to four groups according to the presence or absence of neurovascular compression (NVC) of the unaffected trigeminal nerve (HCs with and without NVC; CTN patients with and without NVC on the unaffected side). All patients underwent magnetic resonance imaging (MRI) scans. Bilateral trigeminal cisternal segments were manually delineated, followed by feature extraction, dimensionality reduction, feature selection, model construction and model evaluation. RESULTS: Six weighted textural signatures (sphericity, maximum 2D diameter, skewness, robust mean absolute deviation, large dependence low gray level emphasis, and surface-to-volume ratio) were found in HCs with and without NVC, while 7 were found in CTN patients without NVC on the unaffected side and HCs without NVC. The Rad_score was statistically different between the two groups (P < 0.05). The AUC of the training set was consistent with that of the validation set. The calibration curves of the training and validation sets demonstrated the high accuracy of the model. CONCLUSIONS: NVC can alter trigeminal nerve structure and cause alterations in related characteristics; but NVC is not a necessary condition for the formation of CTN, and its incidence is also high in asymptomatic healthy people, and thus it is necessary to grade the severity of NVC. In addition, there are differences in the characteristics of the unaffected side between CTN patients and HCs, which may be due to congenital or secondary factors.

Risk Factors for Unilateral Trigeminal Neuralgia Based on Machine Learning.

Purpose: Neurovascular compression (NVC) is considered as the main factor leading to the classical trigeminal neuralgia (CTN), and a part of idiopathic TN (ITN) may be caused by NVC (ITN-nvc). This study aimed to explore the risk factors for unilateral CTN or ITN-nvc (UC-ITN), which have bilateral NVC, using machine learning (ML). Methods: A total of 89 patients with UC-ITN were recruited prospectively. According to whether there was NVC on the unaffected side, patients with UC-ITN were divided into two groups. All patients underwent a magnetic resonance imaging (MRI) scan. The bilateral cisternal segment of the trigeminal nerve was manually delineated, which avoided the offending vessel (Ofv), and the features were extracted. Dimensionality reduction, feature selection, model construction, and model evaluation were performed step-by-step. Results: Four textural features with greater weight were selected in patients with UC-ITN without NVC on the unaffected side. For UC-ITN patients with NVC on the unaffected side, six textural features with greater weight were selected. The textural features (rad_score) showed significant differences between the affected and unaffected sides (p < 0.05). The nomogram model had optimal diagnostic power, and the area under the curve (AUC) in the training and validation cohorts was 0.76 and 0.77, respectively. The Ofv and rad_score were the risk factors for UC-ITN according to nomogram. Conclusion: Besides NVC, the texture features of trigeminal-nerve cisternal segment and Ofv were also the risk factors for UC-ITN. These findings provided a basis for further exploration of the microscopic etiology of UC-ITN.

[Study on navigation path correction in neuro-navigation based on near infrared spectroscopy].

At present, navigation path deviation caused by brain shift is the main factor that affects the accuracy of neurosurgical navigation. A new method of near infrared spectroscopy (NIRS) based neurosurgical navigation is presented in the paper. The correlation between NIRS optical parameters and medical image is used and the gray information of navigation path is regarded as the priori knowledge, sample-points curvatures are calculated by Hermite interpolation and the Mean Hausdorff distance as measurement criterion is used to match feature segments, then the real-time correction model is established. The algorithm of the given model is simple and can realize the best match within the error, it provides an effective method for real-time navigation path correction.

Effectiveness associated with different therapies for senile osteoporosis: a network Meta-analysis.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney (CHMIK) on senile osteoporosis. METHODS: We searched for studies in English-language databases (PubMed, the Cochrane Library, and Web of Science) and Chinese-language databases (China National Knowledge Infrastructure, Wan Fang Data, VIP Chinese periodical service platform, and China Biology Medicine disc from their inception to September 2017. Randomized controlled trials comparing the effectiveness of Traditional Chinese Medicine therapies (alone or in combination) and conventional clinical medicine therapies among older adult patients with osteoporosis were identified. We conducted a network Meta-analysis with a Bayesian hierarchical random-effects model using RStudio software, Version 3.4.1. RESULTS: Forty-three randomized controlled trials assessing the differences between Traditional Chinese Medicine and conventional clinical medicine were identified, including 15 treatments and involving 3316 patients. The results of the network Meta-analysis indicated that alendronate (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.047-0.73) and calcium (OR = 0.18, 95% CI: 0.11-0.30) are significantly more effective if combined with oral CHMIK. CHMIK alone is significantly more effective than both alendronate (OR = 0.34, 95% CI: 0.10-1.0) and calcium (OR = 0.13, 95% CI: 0.056-0.28). Moreover, CHMIK + tuina + calcium is more effective than CHMIK + calcium + vitamin D + alendronate (OR = 18.0, 95% CI: 1.1-2.7e + 02). CONCLUSION: The present network Meta-analysis found that alendronate and calcium are more effective if combined with oral CHMIK and that oral CHMIK alone may be more effective than alendronate or calcium. Tuina may have an advantage over oral medicines. Oral CHMIK and calcitonin show the most potential for treating senile osteoporosis.

Ribonucleotide reductase M2 subunit expression and prognostic value in nasopharyngeal carcinoma.

The ribonucleotide reductase M2 subunit (RRM2) modulates the enzymatic activity of ribonucleotide reductase, and is involved in tumor progression. Recently, high levels of RRM2 expression were reported to correlate with poor survival outcomes in patients with colorectal and bladder cancer. However, changes in RRM2 expression in nasopharyngeal carcinoma (NPC), and its effect on the prognosis of this disease remain unknown. The aim of the present study was to analyze the expression of RRM2 in NPC cell lines, and to identify whether RRM2 may serve as a biomarker with which to assess the prognosis of NPC. The present study found that RRM2 expression was higher in NPC cell lines and tissue samples than in noncancerous nasopharyngeal epithelial cell lines and noncancerous tissues, as shown by reverse transcription-quantitative polymerase chain reaction analysis, western blotting and immunohistochemistry staining. Kaplan-Meier survival analysis demonstrated that patients with higher RRM2 expression levels had poorer disease-free survival outcomes than those with lower expression levels of RRM2. Univariate analysis showed that a lower survival rate was significantly associated with high RRM2 expression levels [hazard ratio (HR), 6.424; 95% confidence interval (CI), 2.381-17.333; P<0.001]. Multivariate analysis indicated that RRM2 expression is an independent prognostic factor for patients with NPC (HR, 3.461; 95 % CI, 1.204-9.949; P=0.021). Overexpression of RRM2 led to increased cell proliferation, colony formation, migration and invasion in vivo. These results suggest that high levels of RRM2 expression may be a useful predictor for survival in patients with NPC and may serve as a novel prognostic indicator for these individuals.

[The long-term curative effect of microwave therapy of radiotherapeutical choanal atresia under nasal endoscope].

OBJECTIVE: In order to observe the long-term curative effect of microwave to treat the choanal atresia after radiotherapy under nasal endoscope. METHOD: Twenty-one cases of choanal atresia after radiotherapy were treated by microwave under nasal endoscope. RESULT: Following-up more than 3 years after operation, all the 21 cases were cured(100%) with no relapse. CONCLUSION: This method is simple with mild damage to normal tissues, clear operation visual field, less postoperation pain, stadle long-term therapeutical effect and good way to treat choanal atresia in NPC after radiotherapy.

[Endoscopic extralaryngeal approach subtotal arytenoidectomy in the treatment of bilateral vocal cord paralysis].

OBJECTIVE: To evaluate endoscopic extralaryngeal approach subtotal arytenoidectomy for the treatment of bilateral vocal cord paralysis. METHOD: Thirteen cases of bilateral median vocal cord paralysis was operated by endoscopic extralaryngeal approach unilateral subtotal arytenoidectomy. All of them had tracheostomy before. The airway was modified about 5-6 mm via endoscopic in operating. The airway was evaluated by fibro laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. RESULT: All cases were followed-up 6-36 months. The function of airway successfully restored, and the voice quality was kept satisfactory. All patients were decannulated after 8 to 15 days within the mean time 11.5 days post-operation. There were no granulation and no aspiration at the surgical site post operateally. CONCLUSION: The operation of extralaryngeal approach unilateral subtotal arytenoidectomy in endoscopy is a better restoration of airway with satisfying voice and without aspiration after operation. The procedure is simple, reliable and efficient for treatment of patients with bilateral median vocal cord paralysis.