Computed Tomography-Guided Percutaneous Stylomastoid Foramen Puncture and Radiofrequency Thermocoagulation for Treatment of Hemifacial Spasm via Mandibular Angle Approach.

BACKGROUND: Hemifacial spasm (HFS) is characterized by progressive, paroxysmal, and involuntary convulsions on one side of the face. We have conducted in-depth exploration on the puncture approach through the mandibular angle, which is an important supplement to the first 2 approaches (i.e., premastoid approach and the postmastoid approach), especially for patients who cannot find a suitable way before and after the mastoid process. OBJECTIVES: To investigate the effect of computed tomography (CT)-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through the stylomastoid foramen in treating HFS. STUDY DESIGN: A retrospective, observational study. SETTING: Pain Department, Jiaxing and Hangzhou, China. METHODS: A total of 89 patients with HFS who underwent CT-guided RFT in the Pain Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and the Pain Department of Jiaxing First Hospital, from June 2020 to June 2022, were retrospectively analyzed, including 29 men and 60 women, aged 34~88 (59.8 ± 11.1). They were divided into 3 groups: anterior mastoid approach group (Group A, n = 38), posterior mastoid approach group (Group P, n = 26), and mandibular angle approach group (Group M, n = 25), according to the different puncture approaches. Puncture time, minimum stimulating current triggering facial muscle twitches, temperature at the end of RFT and duration time of RFT at this temperature, and total treatment time, as well as degree of facial paralysis and complications one-day postoperation, were compared among the 3 groups. RESULTS: The puncture times (mean ± SD) of Group A, Group P, and Group M were (30.63 ± 4.88), (31.35 ± 5.89), and (35.08 ± 5.76), respectively, and the differences were statistically significant (P = 0.006). The puncture time of Group M was longer than that of Groups A and P (P < 0.05). The minimum stimulating current triggering facial muscle twitches in the 3 groups were (0.49 ± 0.16), (0.43 ± 0.14), and (0.28 ± 0.09), respectively, with a statistically significant difference (P = 0.000). The minimum stimulation current in Group M was less than that in Groups A and P (P < 0.05). The temperature at the end of RFT of the 3 groups was (78.29 ± 7.91), (76.54 ± 8.10), and (66.60 ± 8.00), respectively, and the differences were statistically significant (P < 0.001). The temperature of Group M was lower than Groups A and P (P < 0.05). There were no significant differences among the 3 groups in the total operation time or the degree of facial paralysis one-day postoperation (P > 0.05). No hematoma, infection, hearing impairment, or other complications were reported in any patients. LIMITATIONS: The nonrandomized nature, small sample size, and retrospective design are limitations of this study. CONCLUSIONS: CT-guided RFT through the stylomastoid foramen is an effective treatment of HFS. Compared to the poster and anterior mastoid approaches, the mandibular angle approach was found to be more effective in terms of reduced minimum stimulating current and reduced-end RFT temperature, which means fewer potential complications to the patient postsurgery. KEY WORDS: Hemifacial spasm, radiofrequency thermocoagulation, stylomastoid foramen, CT-guided.

Multispectral versus texture features from ZiYuan-3 for recognizing on deciduous tree species with cloud and SVM models.

Tree species recognition accuracy greatly affects forest remote sensing mapping and forestry resource monitoring. The multispectral and texture features of the remote sensing images from the ZiYuan-3 (ZY-3) satellite at two phenological phases of autumn and winter (September 29th and December 7th) were selected for constructing and optimizing sensitive spectral indices and texture indices. Multidimensional cloud model and support vector machine (SVM) model were constructed by the screened spectral and texture indices for remote sensing recognition of Quercus acutissima (Q. acutissima) and Robinia pseudoacacia (R. pseudoacacia) on Mount Tai. The results showed that, the correlation intensities of the constructed spectral indices with tree species were preferable in winter than in autumn. The spectral indices constructed by band 4 showed the superior correlation compared with other bands, both in the autumn and winter time phases. The optimal sensitive texture indices for both phases were mean, homogeneity and contrast for Q. acutissima, and contrast, dissimilarity and second moment for R. pseudoacacia. Spectral features were found to have a higher recognition accuracy than textural features for recognizing on both Q. acutissima and R. pseudoacacia, and winter showing superior recognition accuracy than autumn, especially for Q. acutissima. The recognition accuracy of the multidimensional cloud model (89.98%) does not show a superior advantage over the one-dimensional cloud model (90.57%). The highest recognition accuracy derived from a three-dimensional SVM was 84.86%, which was lower than the cloud model (89.98%) in the same dimension. This study is expected to provide technical support for the precise recognition and forestry management on Mount Tai.

p53/MicroRNA-34 axis in cancer and beyond.

Cancer is serious endangers human life. After a long period of research and accumulation, people's understanding of cancer and the corresponding treatment methods are constantly developing. p53 is an important tumor suppressor gene. With the more in-depth understanding of the structure and function of p53, the more importance of this tumor suppressor gene is realized in the process of inhibiting tumor formation. MicroRNAs (miRNAs) are important regulatory molecules with a length of about 22nucleotides (nt), which belong to non-coding RNA and play an important role in the occurrence and development of tumors. miR-34 is currently considered to be a master regulator of tumor suppression. The positive feedback regulatory network formed by p53 and miR-34 can inhibit the growth and metastasis of tumor cells and inhibit tumor stem cells. This review focuses on the latest progress of p53/miR-34 regulatory network, and discusses its application in tumor diagnosis and treatment.

Clinical Observation of CT-Guided Intervertebral Foramen Puncture and Radiofrequency Thermocoagulation for the Treatment of Refractory PHN in the Superior Thoracic Segment.

BACKGROUND: Post-herpetic neuralgia (PHN) is a typical neuropathic pain. Conventional oral analgesics and nerve block therapy can only obtain temporary analgesia in many cases. This study summarized the clinical effect of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation through the superior margin of costotransverse joint for the treatment of refractory PHN in the superior thoracic segment. OBJECTIVES: To observe the efficacy of CT-Guided intervertebral foramen puncture and radiofrequency thermocoagulation (RFT) treatment of refractory PHN in the T1 ~ T3 spinal innervation area. STUDY DESIGN: A retrospective, observational study. SETTING: Pain department, Jiaxing and Hangzhou, China. METHODS: Thirty-six patients with intractable superior thoracic PHN were admitted to the Pain Department. After the positioning image of CT was taken by prone, the upper thoracic segment was scanned in axial position with the layer thickness of 3 mm of spinal model.The puncture path was designed by selecting the slice of the foramen and costotransverse joint from the obtained images. The needle was inserted to the corresponding foramen. After confirmation by high and low frequency current stimulation tests, the RFT was performed at 90°C for 180s. A numeric rating scale (NRS) for pain was recorded before surgery, 2 hours, 1 week, 4 weeks and 8 weeks after surgery and the mental state was assessed with the SF-36 clinical questionnaire before surgery, 4 weeks and 8 weeks after surgery. RESULTS: Following RFT intervention the measured pain NRS significantly decreased after 2 hours, 1 week, 4 weeks and 8 weeks (P < 0.01). SF-36 scores in all categories increased 4 and 8 weeks after the operation (P < 0.01). No serious adverse effects were reported during the study period and no hypoxemia was found under intraoperative nasal catheter oxygen inhalation. LIMITATIONS: Limitations of this study include the small sample size, and nonrandomized retrospective design. CONCLUSION: CT-Guided intervertebral foramen puncture and RFT through the superior margin of the costotransverse joint can effectively improve refractory PHN in the superior thoracic segment with good safety.

Spatiotemporal distribution characteristics, causes, and prevention advice of fatal geohazards in Jiangxi Province, China.

Fatal geohazards result in severe losses of life and property worldwide, thus urging many large-scale studies of such geohazards. Further research on hotspots prone to fatal geohazard identified in national-scale studies is critical for government geohazard prevention. It has been pointed out that more detailed small-scale (sub-national) studies are essential for the hotspots (e.g., Jiangxi Province) identified in national-scale studies. However, there are only a few small-scale studies of hotspots and earlier studies have rarely delved into a thorough and detailed analysis of hotspots. In addition, previous studies of fatal geohazards have failed to offer specific geohazard prevention advice, significant for geohazard control policies. To bridge these gaps, this study took advantage of the Jiangxi Inventory of Fatal Geohazards (JIFGH) and employed spatial analysis and the geographical detector to analyze the spatiotemporal characteristics and causes and present prevention advice on fatal geohazards in Jiangxi Province. The study also analyzes the importance of provincial-scale (first-level administrative scale) studies for hotspots identified in national-scale studies. JIFGH includes 386 non-seismically triggered fatal geohazards that caused a total of 979 fatalities in the 1960-2020 period. The temporal trend of fatal geohazards in Jiangxi Province is mainly affected by rainfall and the government geohazard prevention measures. The causes of most fatal geohazards in Jiangxi Province include (i) slope-cutting activities in house construction projects that create steep slopes prone to failure, which threaten the vulnerable residents and buildings nearby and (ii) rainfall that triggers failures of cut slopes. This study not only proposes geohazard prevention advice for Jiangxi Province and tectonically stable areas but also analyzes the significance of provincial-scale studies of hotspots identified in national-scale studies. Therefore, this study contributes to the prevention of fatal geohazards in Jiangxi Province and tectonically stable areas, while also providing an essential reference for other studies of fatal geohazards.

Use of transcutaneous electrical acupoint stimulation in pulmonary surgery for patients with tuberculosis.

Objective: This study aimed to analyze the effects of transcutaneous electrical acupoint stimulation (TEAS) on the immune function in patients with pulmonary tuberculosis (PT) and the inflammatory response following one-lung ventilation surgery by comparing the levels of inflammatory mediators, such as tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and interleukin 8 (IL-8); T lymphocyte subsets, including CD3+, CD4+, CD8+, and CD4+/CD8+ cells; and natural killer cells (NK cells). Methods: We randomly divided 62 patients who underwent general anesthesia for thoracotomy into two groups: TEAS and sham TEAS. Patients in the TEAS group underwent bilateral acupoint electrical stimulation at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints from 30 min before anesthesia induction until the end of surgery. TEAS was continuously maintained throughout the procedure with a dilatational wave at 2/100 Hz. Those in the sham TEAS group underwent the same management but without stimulation, and the anesthesia induction and maintenance methods were the same in both groups. Venous blood was drawn to monitor inflammatory mediators and lymphocyte subsets before anesthesia induction and 5 days after the surgery. Results: There was no statistical difference in the general conditions between the two groups (P > 0.05). Before anesthesia induction, the levels of inflammatory factors (IL-6, IL-8, and TNF-α), lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and NK cells did not statistically differ between the two groups (P > 0.05). Compared to the sham TEAS group, the levels of IL-6, IL-8, TNF-α, and CD8+ were lower in the TEAS group, while those of CD3+, CD4+, CD4+/CD8+, and NK cells were higher; however, only the change in TNF-α was significant (P < 0.05). Conclusion: TEAS at the Hou-Xi, Zhi-Gou, Nei-Guan, and He-Gu acupoints at 2 Hz/100 Hz can reduce the inflammatory response during one-lung ventilation but has no significant effect on the immune function in patients with tuberculosis.

Driving factors and decoupling trend analysis between agricultural CO2 emissions and economic development in China based on LMDI and Tapio decoupling.

Based on mathematical models, in-depth analysis about the interrelationship between agricultural CO2 emission and economic development has increasingly become a hotly debated topic. By applying two mathematical models including logarithmic mean divisia index (LMDI) and Tapio decoupling, this work aims to study the driving factor and decoupling trend for Chinese agricultural CO2 emission from 1996 to 2020. Firstly, the intergovernmental panel on climate change (IPCC) method is selected to estimate the agricultural CO2 emission from 1996 to 2020, and the LMDI model is adopted to decompose the driving factors of agricultural CO2 emission into four agricultural factors including economic development, carbon emission intensity, structure, and labor effect. Then, the Tapio decoupling model is applied to analyze the decoupling state and development trend between the development of agricultural economy and CO2 emission. Finally, this paper puts forward some policies to formulate a feasible agricultural CO2 emission reduction strategy. The main research conclusions are summarized as follows: 1) During the period from 1996 to 2020, China's agricultural CO2 emission showed two stages, a rapid growth stage (1996-2015) and a rapid decline stage (2016-2020). 2) Agricultural economic development is the first driving factor for the increase of agricultural CO2 emission, while agricultural labor factor and agricultural production efficiency factor play two key inhibitory roles. 3) From 1996 to 2020, on the whole, China's agricultural sector CO2 emission and economic development showed a weak decoupling (WD) state. The decoupling states corresponding to each time period are strong negative decoupling (SND) (1996-2000), expansive negative decoupling (END) (2001-2005), WD (2006-2015) and strong decoupling (SD) (2016-2020), respectively.

The cyclic expansion and contraction characteristics of a loess slope and implications for slope stability.

Loess covers approximately 6.6% of China and forms thick extensive deposits in the northern and northwestern parts of the country. Natural erosional processes and human modification of thick loess deposits have produced abundant, potentially unstable steep slopes in this region. Slope deformation monitoring aimed at evaluating the mechanical behavior of a loess slope has shown a cyclic pattern of contraction and expansion. Such cyclic strain change on the slope materials can damage the loess and contribute to slope instability. The site showing this behavior is a 70-m high loess slope near Yan'an city in Shanxi Province, northwest China. A Ground-Based Synthetic Aperture Radar (GB-SAR) sensor and a displacement meter were used to monitor this cyclic deformation of the slope over a one-year period from September 2018 to August 2019. It is postulated that this cyclic behavior corresponds to thermal and moisture fluctuations, following energy conservation laws. To investigate the validity of this mechanism, physical models of soil temperature and moisture measured by hygrothermographs were used to simulate the observed cyclic deformations. We found good correlations between the models based on the proposed mechanism and the exhibited daily and annual cyclic contraction and expansion. The slope absorbed energy from the time of maximum contraction to the time of maximum expansion, and released energy from the time of maximum expansion to the time of maximum contraction. Recoverable cyclic deformations suggest stresses in the loess are within the elastic range, and non-recoverable cyclic deformations suggest damage of the loess material (breakage of bonds between soil grains), which could lead to instability. Based on these observations and the models, we developed a quantitative relationship between weather cycles and thermal deformation of the slope. Given the current climate change projections of temperature increases of up to 3.5 °C by 2100, the model estimates the loess slope to expand about 0.35 mm in average, which would be in addition to the current cyclic "breathing" behavior experienced by the slope.

Battlefield Acupuncture for Adult Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pain is a major public health problem, causing heavy social and economic burdens to patients and society while consuming tremendous medical resources at the same time. Thus, there is a critical need to find low-cost, efficacious, and therapeutic approaches to help manage pain. While acupuncture is increasingly recognized as a promising pain-relieving method, less is known about a specific form of auricular acupuncture known as Battlefield Acupuncture (BFA). The BFA technique involves the sequential placement of semi-permanent, single-use, French ASP[Formula: see text] golden needles to five specific acupoints in one or both ears, where they are left in place for 3-4 days or longer [Niemtzow, R.C., Battlefield acupuncture. Med. Acupunct. 19: 225-228, 2007]. The BFA needles (more accurately described as tiny conical darts) pierce the ear in designated locations in a particular order [Levy, C.E., N. Casler and D.B. FitzGerald. Battlefield acupuncture: an emerging method for easing pain. Am. J. Phys. Med. Rehabil. 97: e18-e19, 2018.]. (Figs. 4 and 5) It was developed by Dr. Richard C. Niemtzow in 2001, as a subgroup form of an auricular acupuncture technique based on the somatotopic arrangement of an inverted fetus pattern on the external ear [Romoli, M. Ear acupuncture: historical abstract-differences of ear cartography between the east and the west. Dtsch. Z. Akupunkt. 53: 24-33, 2010.]. Currently, BFA is widely used in the US military, but to our knowledge, there is no review which comprehensively synthesizes the current publications surrounding pain management. This review aims to investigate the effects and safety of BFA in adults with pain. Electronic databases were searched for randomized controlled trials (RCTs) published in English evaluating efficacy and safety of BFA in adults with pain, from database inception to September 6, 2019. The primary outcome was pain intensity change, and the secondary outcome was safety. Nine RCTs were included in this review, and five trials involving 344 participants were analyzed quantitatively. Compared with no intervention, usual care, sham BFA, and delayed BFA interventions, BFA had no significant improvement in the pain intensity felt by adults suffering from pain. Few adverse effects (AEs) were reported with BFA therapy, but they were mild and transitory. BFA is a safe, rapid, and easily learned acupuncture technique, mainly used in acute pain management, but no significant efficacy was found in adult individuals with pain, compared with the control groups. Given the poor methodological quality of the included studies, high-quality RCTs with rigorous evaluation methods are needed in the future.

A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest.

Bone marrow aspiration (BMA) through the iliac crest is potentially unsafe due to the vicinity of neurovascular structures in the greater sciatic notch. Our objective was to investigate the safety of a recently described BMA technique, specifically a trajectory from the posterior superior iliac spine (PSIS) to the anterior inferior iliac spine (AIIS). We conducted a chart review of 260 patients, analyzing three-dimensional reconstructed computed tomography images of the pelvis and sacrum to validate that this new approach offers a wide safety margin from the greater sciatic notch. Analysis of three-dimensional computed tomography scans demonstrated that the PSIS to AIIS trajectory never crossed the greater sciatic notch. The trajectory was noted to be at least one cm away from the greater sciatic notch in all measurements. The new trajectory entered the PSIS at 25.29 ± 4.34° (left side) and 24.93 ± 4.15° (right side) cephalad from the transverse plane, and 24.58 ± 4.99° (left side) and 24.56 ± 4.67° (right side) lateral from the mid-sagittal plane. The area of bone marrow encountered with the new approach was approximately 22.5 cm2. Utilizing the same CT scans, the trajectory from the traditional approach crossed the greater sciatic notch in all scans, highlighting the potential for violating the greater sciatic notch boundary and damaging important neurovascular structures. Statistically significant sex-related differences were identified in needle trajectory angles for both approaches. We conclude that based on this three-dimensional computed tomography study, a trajectory from the PSIS to the AIIS for BMA may offer a wide safety margin from the greater sciatic notch.

Integration of Spatial Probability and Size in Slope-Unit-Based Landslide Susceptibility Assessment: A Case Study.

Landslide spatial probability and size are two essential components of landslide susceptibility. However, in existing slope-unit-based landslide susceptibility assessment methods, landslide size has not been explicitly considered. This paper developed a novel slope-unit based approach for landslide susceptibility assessment that explicitly incorporates landslide size. This novel approach integrates the predicted occurrence probability (spatial probability) of landslides and predicted size (area) of potential landslides for a slope-unit to obtain a landslide susceptibility value for that slope-unit. The results of a case study showed that, from a quantitative point of view, integrating spatial probability and size in slope-unit-based landslide susceptibility assessment can bring remarkable increases of AUC (Area under the ROC curve) values. For slope-unit-based scenarios using the logistic regression method and the neural network method, the average increase of AUC brought by incorporating landslide size is up to 0.0627 and 0.0606, respectively. Slope-unit-based landslide susceptibility models incorporating landslide size had utilized the spatial extent information of historical landslides, which was dropped in models not incorporating landslide size, and therefore can make potential improvements. Nevertheless, additional case studies are still needed to further evaluate the applicability of the proposed approach.

Personalized needle modification for CT-guided percutaneous infrazygomatic radiofrequency ablation of the maxillary nerve through the foramen rotundum in order to treat V2 trigeminal neuralgia.

Background: The computed tomography (CT)-guided radiofrequency ablation (RFA) of the maxillary nerve (V2) via foramen rotundum (FR) approach has been reported to offer the highest rates of pain relief in V2 trigeminal neuralgia (TN). However, the access to FR may be obstructed by the greater wing of the sphenoid bone. Objectives: We report on an optimized CT-guided percutaneous infrazygomatic of maxillary nerve through the foramen rotundum (FR) to treat V2 trigeminal neuralgia (TN) using personalized RFA needles based on patient's individual CT-image parameters. Patients and methods: 176 patients with isolated V2 TN were included. If the entry of the percutaneous needle into the FR canal was blocked by the greater wing of the sphenoid bone, straight RFA needles was bent at the tip with an angle α (the angle between the straight line from the external opening of FR to the skin entry point and the long axis of the FR canal). The maxillary nerve RFA was performed after confirmation with electrophysiological tests. Pain relief in the V2 territory and TN recurrence rate were followed for up to 60 months. Results: Fifty-two patients (29.55%) required needle bending. The maxillary nerve thermal RFA resulted in analgesia in the V2 territory without affecting the V1 or V3 zone. TN recurrence rate at 6, 12, 24, 36, 48 and 60 months was 2.55%, 7.64%, 17.20%, 24.41%, 30.28% and 33.77%, respectively. Conclusion: The personalized needle modification technique for maxillary nerve RFA through FR is safe and effective to treat V2 TN.