Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/Subacute Herpetic Neuralgia: A Retrospective Study

OBJECTIVES

This retrospective study aimed to investigate the effectiveness and safety of early combined therapy with CT-guided paravertebral nerve (PVN), pulsed radiofrequency (PRF), and subcutaneous block on acute/subacute herpes zoster (HZ).

METHODS

A total of 98 medical records were analyzed. All patients underwent CT-guided PRF on PVN immediately followed by a single subcutaneous block with lidocaine and dexamethasone in acute/subacute phase. The therapy efficacy was evaluated by pain numeric rating scale (NRS) and effective rate, which was defined as a percent of cases with a reduction in pain NRS>50% at day 1, week 2, 4, 12, and 24 after the procedure. The incidences of medication reduction and postherpetic neuralgia (PHN) were also retrieved. Further comparison was conducted between acute group (disease duration<30 days from HZ onset) and subacute group (30 day

RESULTS

Early combined therapy indicated an immediate and sustained improvement in pain NRS as compared with before treatment ( P <0.0001), with effective rates of 74%, 79%, 80%, 76%, and 79% at day 1, week 2, 4, 12, and 24 after procedure, respectively. At the end of follow-up, the proportion of patients with a reduction of >50% in prior medications amounted to 83% and the incidence of clinically meaningful PHN decreased to 23%. The clinical efficacy was more profound in acute group than in subacute group at every time points ( P <0.05). No severe complications occurred.

DISCUSSION

Our data revealed surprising levels of pain relief by combination therapies of PRF and subcutaneous block targeting different sites of pain pathway, thus suggesting a valuable treatment option for acute/subacute herpetic neuralgia.

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MESH Headings

• Humans
• Retrospective Studies
• Pulsed Radiofrequency Treatment/methods
• Neuralgia/complications
• Neuralgia, Postherpetic/therapy
• Herpes Zoster/complications
• Herpes Zoster/therapy

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Grants Collapse

Affiliation(s)

Wei Zhang Departments of Day Surgery
Bin Yu Departments of Day Surgery
Zipu Jia Departments of Day Surgery
Chunmei Zhao Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
Fang Luo Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China

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[Verification of the peanut vitamin C synthesis-related gene AhPMM and its role in stress resistance]

Vitamin C plays an important role in plant antioxidation, photosynthesis, growth and development, and metabolism. In this study, a gene AhPMM, which is involved in vitamin C synthesis and responds significantly to low temperature, NaCl, polyethylene glycol (PEG) and abscisic acid (ABA) treatments, was cloned from peanut. An AhPMM overexpression vector was constructed, and transferred to a peanut variety Junanxiaohong using the pollen tube injection method. PCR test on the T3 generation transgenic peanut plants showed a transgenics positive rate of 42.3%. HPLC was used to determine the content of reducing vitamin C (AsA) and total vitamin C in the leaves of transgenic plants. The results showed that the content of AsA in some lines increased significantly, up to 1.90 times higher than that of the control, and the total vitamin content increased by up to 1.63 times compared to that of the control. NaCl and ABA tolerance tests were carried out on transgenic seeds. The results showed that the salt tolerance of transgenic seeds was significantly enhanced and the sensitivity to ABA was weakened compared to that of the non-transgenic control. Moreover, the salt tolerance of the transgenic plants was also significantly enhanced compared to that of the non-transgenic control. The above results showed that AhPMM gene not only increased the vitamin C content of peanut, but also increased the salt tolerance of transgenic peanut seeds and plants. This study may provide a genetic source for the molecular breeding of peanut for enhanced salt tolerance.

PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial

BACKGROUND

Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN.

METHODS

The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis.

RESULTS

A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons).

CONCLUSIONS

Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.

Knowledge mapping and global trends of drug hypersensitivity from 2013 to 2023: A bibliometric analysis

BACKGROUND

Drug hypersensitivity is a major global public health issue with a significant increase in prevalence in populations. Here, we provide a deep insight into the frontier hotspot and future direction in the field of drug hypersensitivity.

METHODS

A knowledge map is portrayed based on publications related to drug hypersensitivity from Web of Science Core Collection using CiteSpace. Co-occurrence relationships of countries, institutes, authors, journals, references, and keywords are constructed. According to the co-occurrence relationships, hotspots and future trends are overviewed.

RESULTS

The United States ranked first in the world and China with the second highest publications was the only developing country. Torres, Mayorga, and Blanca were highly productive authors. Harvard University was the institution with the most research publications. Keywords co-occurrence analysis suggested applications in emerging causes, potential mechanisms, and clinical diagnosis as the research hotspots and development frontiers.

CONCLUSION

Research on drug hypersensitivity is in a rapid development stage and an emerging trend in reports of anaphylaxis to polyethylene glycols is identified. Developing algorithms for understanding the standardization process of culprit drugs, clinical manifestations, and diagnostic methods will be the focus of future direction. In addition, a better understanding of the mechanisms to culprit drugs with immunological precise phenotypic definitions and high-throughput platforms is needed.

Application of deep learning in radiation therapy for cancer

In recent years, with the development of artificial intelligence, deep learning has been gradually applied to clinical treatment and research. It has also found its way into the applications in radiotherapy, a crucial method for cancer treatment. This study summarizes the commonly used and latest deep learning algorithms (including transformer, and diffusion models), introduces the workflow of different radiotherapy, and illustrates the application of different algorithms in different radiotherapy modules, as well as the defects and challenges of deep learning in the field of radiotherapy, so as to provide some help for the development of automatic radiotherapy for cancer.

Reasons why women are more likely to develop primary biliary cholangitis

Primary biliary cholangitis (PBC) is a chronic autoimmune disease of biliary stasis in which immune factors cause the gradual destruction of small bile ducts, biliary stasis, and eventually the development of liver fibrosis, cirrhosis, and even liver failure. One of the main characteristics of PBC is that it primarily affects middle-aged women, but the precise cause is still unknown. This article analyzes the unique causes and mechanisms of the female predominance of PBC and summarizes the potential causes.The female domination of PBC is reported to be primarily caused by sex hormones, environmental circumstances, and epigenetic changes, each of which has a different subtle impact on patients' gender disparities.

Pre-emptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): a prospective randomized controlled trial

BACKGROUND

Postoperative pain after laminoplasty and laminectomy occurs partially from local trauma of the paraspinal tissue. Finding a multimodal analgesic cocktail to enhance the duration and effect of local infiltration analgesia is crucial. Because of the rapid onset and long duration of action of betamethasone, the authors hypothesized that, a pre-emptive multimodal infiltration regimen of betamethasone and ropivacaine reduces pain scores and opioid demand, and improves patient satisfaction following laminoplasty and laminectomy.

MATERIALS AND METHODS

This prospective, randomized, open-label, blinded endpoint study was conducted between 1 September 2021 and 3 June 2022, and included patients between the ages of 18 and 64 scheduled for elective laminoplasty or laminectomy under general anesthesia, with American Society of Anesthesiologists classification I/II. One hundred sixteen patients were randomly assigned to either the BR (Betamethasone-Ropivacaine) group or the R (Ropivacaine) group in a 1:1 ratio. Each group received pre-emptive infiltration of a total of 10 ml study solution into each level. Every 30 ml of study solution composed of 0.5 ml of betamethasone plus 14.5 ml of saline and 15 ml of 1% ropivacaine for the BR group, and 15 ml of 1% ropivacaine added to 15 ml of saline for the R group. Infiltration of epidural space and intrathecal space were avoided and the spinous process, transverse process, facet joints, and lamina were injected, along with paravertebral muscles and subcutaneous tissue. Cumulative 48 h postoperative butorphanol consumption via PCA (Patient-controlled analgesia) was the primary outcome. Intention-to-treat (ITT) principle was used for primary analysis.

RESULTS

Baseline characteristics were identical in both groups ( P >0.05). The cumulative 48 h postoperative butorphanol consumption via PCA was 3.0±1.4 mg in the BR group ( n =58), and 7.1±1.2 mg in the R group ( n =58) ( P <0.001). Overall cumulative opioid demand was lower at different time intervals in the BR group ( P <0.001), along with the estimated median time of first analgesia demand via PCA (3.3 h in the BR group and 1.6 h in the R group). The visual analog scale (VAS) score at movement and rest were also significantly lower until 3 months and 6 weeks, respectively. No side effects or adverse events associated with the intervention were observed in this study.

CONCLUSIONS

Pre-emptive analgesia with betamethasone and ropivacaine provides better postoperative pain management following laminoplasty and laminectomy, compared to ropivacaine alone. This is an effective technique worthy of further evaluation.

Co-treatment with Oral Duloxetine and Intraarticular Injection of Corticosteroid plus Hyaluronic Acid Reduces Pain in the Treatment of Knee Osteoarthritis

BACKGROUND

Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of co-treatment with oral duloxetine and intraarticular (IA) injection of hyaluronic acid (HA) and corticosteroid (CS) in patients with knee OA.

OBJECTIVES

This study aimed to test the hypothesis that an IA injection of CS+HA combined with duloxetine could achieve pain management superior to that of an IA injection of CS+HA alone in patients experiencing knee OA related pain.

STUDY DESIGN

This study adopted a prospective, randomized, open-label blind endpoint study design.

SETTING

The investigation was performed at Beijing Tiantan Hospital Affiliated with the Capital Medical University from October 2019 to December 2021. The study plan was approved by the Ethics Committee of Beijing Tiantan Hospital (KY 2019-086-02).

METHODS

A total of 150 patients were randomly allocated to receive either duloxetine combined with an IA injection (n = 75) or a single IA injection alone (n = 75). All patients were followed for 24 weeks. The primary outcome was the change in the weekly 24 hours average mean pain scores, and the secondary outcomes included the proportion of patients with >= 30% or >= 50% pain reduction, Brief Pain Inventory (BPI) items, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Patient Global Impression Improvement (PGI-I) ratings, hospital anxiety and depression scale (HADS) scores and adverse events (AEs)..

RESULTS

Patients in the experimental group had significantly greater improvement in the change of weekly mean of the 24 hours average pain scores, BPI pain severity ratings (P < 0.001) and WOMAC scores (P < 0.001) at the study endpoint. A significantly greater percentage of patients in the experimental group rated PGI-I of <= 2 (P = 0.021) and >= 50% pain reduction (P = 0.029) at 24 weeks. There was no difference in the proportion of patients with <= 30% pain reduction, the HADS scores or frequency of AEs between the 2 groups.

LIMITATIONS

The effectiveness and safety were examined only up to 24 weeks after treatment, and we did not perform a long-term follow-up as most previous studies have. Optimum dosage of duloxetine, as well as different molecular-weight HA, should be investigated in future studies.

CONCLUSION

Patients receiving co-treatment with oral duloxetine and IA (HA+CS) injections experienced considerable improvement in pain and knee function compared to those who received an IA injection alone.

A Remineralizing and Antibacterial Coating for Arresting Caries

Dental caries is a dynamic disease induced by the unbalance between demineralization of dental hard tissues caused by biofilm and remineralization of them; however, although various effective remineralization methods have been well documented, it is a challenge to reestablish the balance by enhancing remineralization alone while ignoring the antibacterial therapy. Therefore, the integration of remineralizing and antibacterial technologies offers a promising strategy to halt natural caries progression in clinical practice. Here, the conception of interrupting dental caries (IDC) was proposed based on the development of dual-functional coating with remineralizing and antibacterial properties. In this study, bovine serum albumin (BSA) loaded octenidine (OCT) successfully to form a BSA-OCT composite. Subsequently, through fast amyloid-like aggregation, the phase-transited BSA-OCT (PTB-OCT) coating can be covered on teeth, resin composite, or sealant surfaces in 30 min by a simple smearing process. The PTB-OCT coating showed satisfactory effects in promoting the remineralization of demineralized enamel and dentin in vitro. Moreover, this coating also exerted significant acid-resistance stability and anti-biofilm properties. Equally importantly, this coating exhibited promising abilities in reducing the microleakage between the tooth and resin composite in vitro and preventing primary and secondary caries in vivo. In conclusion, this novel dual-functional PTB-OCT coating could reestablish the balance between demineralization and remineralization in the process of caries, thereby potentially preventing or arresting caries.

Safety and Efficacy Analysis of Patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC) Treated with SHR-1316 Plus Chemotherapy and Sequential Chest Radiotherapy as First-Line Therapy from a Phase II Trial

PURPOSE/OBJECTIVE(S)

CAPSTONE-1, a phase 3 trial, showed that SHR-1316 (PD-L1 antibody) combined with standard first-line chemotherapy could prolong overall survival (OS) in patients (pts) with ES-SCLC. The CREST trial reported consolidative thoracic radiotherapy (TRT) of 30 Gy in 10 fractions provided a 10% 2-year OS benefit and more intensive TRT should be investigated in ES-SCLC. In the era of immunotherapy, the role of TRT also needs further exploration. Therefore, we designed this clinical trial to investigate the efficacy and safety of SHR-1316 plus first-line chemotherapy followed by TRT combined with SHR-1316.

MATERIALS/METHODS

Key inclusion criteria were pts aged 18-75 years, with previously untreated histologically or cytologically confirmed ES-SCLC, and an ECOG performance status of 0-1. Eligible pts would receive 4∼6 cycles of SHR-1316 (20mg/kg, D1, q3w) combined with EP/EC (etoposide, 100mg/m2, D1-5, q3w and cisplatin, 75mg/m², D1-3, q3w or carboplatin, AUC = 5, D1, q3w), followed by SHR-1316 combined with TRT (≥3 Gy*10 f or ≥2 Gy*25 f, involved-field irradiation), and then the maintenance therapy with SHR-1316 until disease progression or intolerable adverse events (AEs). The main endpoints included ORR, PFS and safety.

RESULTS

From October 2020 to January 2023, 33 pts received SHR-1316 and sequential consolidative TRT. Among them, 19 pts received high-dose TRT (>3 Gy*10 f or ≥2 Gy*25 f) and 14 pts received low-dose TRT (≤3 Gy*10 f or<2 Gy*25 f). The median age was 62 (range: 38-73). Most pts were male (28, 84.8%), former smokers (22, 66.7%) with an ECOG performance status 1 (32, 97%). Ten (30.3%) pts were diagnosed with brain metastasis and 10 (30.3%) pts had liver metastasis at baseline. At the data cutoff date, 9 pts remained on treatment, the average number of treatment cycles was 9.2. 33 pts had at least one 1 post-treatment tumor assessment. The confirmed ORR and DCR were 90.9% (30/33) and 100% (33/33) in all pts, were 89.5% (17/19) and 100% (19/19) in high-dose TRT group, and were 92.9% (13/14) and 100% (14/14) in low-dose TRT group. The median PFS was 10.2(CI: 5.8∼14.7) months in all pts, was 7 (CI: 3.8∼10.2) months in high-dose TRT group and 10.4 (CI: 8.4∼12.3) months in low-dose TRT group. AEs occurred in 27 (81.8%) pts and grade 3 or 4 AEs occurred in 20 (60.6%) pts. The most common grade 3 or 4 AEs included neutropenia (15, 45.5%), leukopenia (8, 24.2%), lymphocytopenia (5, 15.2%), pneumonia (3, 9.1%), anemia (3, 9.1%) and thrombocytopenia (2, 6.1%).

CONCLUSION

SHR-1316 plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. There is no significant difference between high-dose and low-dose TRT groups in terms of safety and efficacy according to current data.

Mitigation of Dosimetric Uncertainty in MRI-Based Proton Planning Using Spot-Scanning Proton Arc (SPArc) Technique

PURPOSE/OBJECTIVE(S)

MRI-based synthetic CT (SCT) images created using generative adversarial network (GAN) have been demonstrated to be feasible for intensity-modulated proton therapy (IMPT) planning. However, dose calculation accuracy can be uncertain in some regions within/near the target of head and neck patients due to the local CT number estimation error or sharp dose fall-off. This study investigated the feasibility of using the SPArc technique to mitigate such dosimetric uncertainty.

MATERIALS/METHODS

A GAN using a 3D U-net as the generator and a 6-layer 3D convolutional neural network as the discriminator was trained with T1-weighted MR-CT image pairs from 162 nasopharyngeal carcinoma patients (14 for validation). The generator was used to generate SCT images from MR images for 7 test patients. For each test patient, the CT image was used to create a SPArc plan and an IMPT plan with the same clinical objectives. The SPArc plans (control point frequency sampling, arc trajectory, etc.) were optimized using a previously developed iterative approach. The dose distributions of both SPArc plans and IMPT plans were re-calculated on the SCT images and compared to the one calculated on the CT images. The dosimetric uncertainty was quantified using the gamma index.

RESULTS

The 2%/2mm and 3%/3mm passing rates for SPArc plans were (96.9¡À2.7) % and (98.6¡À1.5) %, while the passing rates for IMPT plans were (94.0¡À3.9) % and (96.4+2.9) %. A significant reduction in dosimetric uncertainty was identified for SPArc plans (p ¡Ü0.021). Table 1 shows the passing rates for the 7 test individuals.

CONCLUSION

SPArc can mitigate the uncertainty of dose calculation in MRI-based proton planning. Further research needs to validate these findings on a larger patient cohort. The study paves the road map for using MRI for SPArc planning.

Different techniques reveal the difference of community structure and function of fungi from root and rhizosphere of Salvia miltiorrhiza Bunge

Fungi have essential functions in plant health and performance. However, the plant-associated functions of many cultured fungi have not been established in detail. Here, the fungal species diversity in Salvia miltiorrhiza roots and rhizosphere was assessed for the first time using culturomics and high-throughput sequencing. We present a comprehensive functional metagenomic analysis of these fungi and verified activity of cellulase and chitinase predicted in the metagenomic analysis. We first collected and cultured fungi from the root and rhizosphere of S. miltiorrhiza. We found 92 species across 37 families and five phyla, with Ascomycota being dominant. Many rDNA internal transcribed spacer sequences could not be assigned to lower taxonomic levels. There were 19 genera of endophytic fungi and 37 genera of rhizosphere fungi. The culturomics approach had lower taxonomic diversity than high-throughput sequencing, but some fungi were only found in cultures. Structural analyses indicated that the dominant species differed in cultured and non-cultured samples at other levels, apart from the phylum level. Functional analysis mapped 223 carbohydrate enzyme families and 393 pathways in the CAZy and KEGG databases, respectively. The most abundant families were glycoside hydrolases and those involved in carbohydrate metabolism. As predicted by metagenomics, we experimentally verified cellulase and chitinase activity for 29 and 74 fungi, respectively. We provide the first evidence of biomass recycling by fungi that are associated with plants. Culturing is essential to reveal the hidden microbial community and critical functions in plant-microbe interactions.

Single-Cell and Spatial Transcriptomics Revealing the Role of IDO1 in HPV+ Cervical Cancer Tumor Immune Microenvironment and Its Implications in Radiotherapy and Immunotherapy

PURPOSE/OBJECTIVE(S)

Persistent infection of human papillomavirus (HPV) is one major etiology of cervical cancer (CC). By now, anti-PD-1 immunotherapy is approved for advanced CC patients, but the response rate was just about 10-20%, tumor immune microenvironment (TIME) might be one factor that affect the efficacy. The indoleamine 2,3-dioxygenase (IDO), a metabolic immune checkpoint, is recently shown to have a correlation-ship with HPV carcinogenesis in CC, with unknown mechanism. This study, using the single cell transcriptomic single-cell sequencing and spatial transcription sequencing analysis/immunologic technology, aimed to exam the role of IDO1 expression in HPV+ CC TIME and explore the changes after radiotherapy.

MATERIALS/METHODS

Newly diagnosed advanced HPV- CC and HPV+ CC patients were tested for the tumor and tumor immune microenvironment (TIME) heterogeneity and their changes after fractionated radiation therapy. Tumor tissues were collected, single cell suspension was made for Single-cell RNA sequencing (SCRNAseq) using the 10 × Genomics, while frozen tissue was embedded for spatial transcriptome sequencing (STRNAseq). Seurat 4.0 was used to cluster and annotate cell clusters and map SCRNAseq data to the STRNAseq data. The specific characters of cell clusters were computed by Gene Set Enrichment Analysis (GSEA). SPOTLight and CellChat were used to analyze cell location and interaction respectively.

RESULTS

A total of 28631 cells were clustered into 31 cell subsets in HPV- CC and HPV+ CC tissues, including baseline (Pre HPV- CC and Pre HPV+ CC) and 3-week after radiotherapy (Post 3w HPV- CC and Post 3w HPV+CC). There were 10431 epithelial cells (Epi) in all these 4 tumor tissues, with heterogenous IDO1 expression, including IDO1-high Epi, IDO1-low Epi, and IDO1-neg Epi. Interestingly, more than 99% of Epi in Pre HPV- CC tissues were IDO1-neg cells, while more than 99% in Pre HPV+ CC tissue were IDO1-high. Furthermore, the proportion of IDO1-high Epi in Pre HPV+ CC patient dropped to 16.7% after radiotherapy, while the proportion of IDO1-low Epi rase to 63.3%. Using GSEA, the characters of IDO1-high Epi group was shown to have positive regulation of leukocyte chemotaxis and negative regulation of cell adhesion and differentiation. IDO1-high Epi cells also had the hallmark of interferon gamma response. These cells could mainly receive regulative information of interferon gamma pathway from exhausted CD8 T cells, which could affect the apoptosis of tumor cells.

CONCLUSION

This study comprehensively analyzed the immune suppressive role of IDO1-high Epi cells in HPV+ CC TIME at the single-cell transcriptional scale and explored their functional characters in CC radiotherapy. This would be able to provide more evidence to combine with radiotherapy and immunotherapy to improve patients' prognosis.

Radiation-Induced Nasopharyngeal Necrosis in Locally-Recurrent Nasopharyngeal Carcinoma Patients after Re-Radiotherapy

PURPOSE/OBJECTIVE(S)

Re-radiotherapy (re-RT) is the main treatment for locally recurrent nasopharyngeal carcinoma (lrNPC) patients, and commonly led to radiation-induced nasopharyngeal (NP) necrosis, which was lethal but rare study has focused on it. The aim of this study was to evaluate the cause and impact of radiation-induced NP necrosis in lrNPC patients who received re-RT.

MATERIALS/METHODS

Totally 252 lrNPC patients who received re-RT between January 2013 and December 2020 were retrospectively collected. The inclusion criteria were as follows: (1) no NP necrosis before re-RT; (2) complete medical records, including treatment, clinical and dosimetric information; (3) conventional fractionated radiotherapy. All patients received intensity-modulated radiotherapy ± chemotherapy. Radiation-induced NP necrosis was diagnosed by magnetic resonance imaging and/or electronic nasopharyngoscopy. Dosimetric factors of the planning target volume of primary tumor (PTVp) were extracted from the dose-volume histogram (DVH), which was rescaled to an equivalent dose of 2 Gy per fraction (EQD 2 Gy) using a linear quadratic model. Logistic regression was used to identify the independent prognostic factors for generating the nomogram.

RESULTS

With a median follow-up of 44.63 months (inter-quartile range [IQR], 27.70 - 69.20 months), 47.6% of patients (120/252) occurred radiation-induced NP necrosis, which mostly happened within 1 year post re-RT (median [IQR], 5.83 [3.37 - 11.57] months). The 3-year overall survival was 83.0% vs 39.7% (P<0.001) in lrNPC patients with or without radiation-induced NP necrosis. Except for the fractionated dose, other dosimetric factors of PTVp were not significantly different between two groups, including D98 (dose to 98% of PTVp), D50, D2 and homogeneity index (Table 1). Furthermore, multivariate analysis showed that continuous variable age (HR [95% CI]: 1.04 [1.02 - 1.07], P = 0.003) and tumor volume (HR [95% CI]: 1.02 [1.01 - 1.03], P<0.001), and fractionated dose > 2.22 Gy (HR [95% CI]: 2.36 [1.32 - 4.21], P = 0.004) were independent factors in predicting radiation-induced NP necrosis, which yielded a C-index of 0.742 (95% CI, 0.682 - 0.803) for OS in the nomogram.

CONCLUSION

The incidence of radiation-induced NP necrosis was high in lrNPC patients who received re-RT. Patients with older age, larger tumor volume or receiving fractionated dose over 2.22 Gy were more easily to suffer NP necrosis, which need to explore novel treatment strategies to improve patients' survivals.

[Long-term quality of life in patients with BrownⅡ maxillary defect repaired by different methods]

Objective: To analyze the long-term quality of life of patients with Brown Ⅱ maxillary defect repaired by tissue flap or prosthesis. Methods: Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term (>5 years) quality of life using the fourth edition of the University of Washington quality of life questionnaire (UW-QOL). Mann Whitney U test was used to examine the differences between two groups. Results: In this study, 4 cases were lost to follow-up, 9 died, and a total of 46 valid questionnaires were collected, including 24 males and 22 females, aged 19-86 years. There were 26 cases of class Ⅱb/c and 20 cases of class Ⅱd. Tissue flap reconstruction was performed in 29 cases (tissue flap group) and prosthesis restoration in 17 cases (prosthesis group). The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group (Z=-2.787, P=0.005), but the scores of entertainment, swallowing, speech and emotion QOL in the former group were respectively lower than those in the latter group (Z=-3.185, -2.091, -2.556 and -1.996, respectively, all P values<0.05). In patients with Brown Ⅱb/c defect, the prosthesis repair could improve the chewing QOL score (Z=-2.830, P=0.005), but no statistically significant differences in other QOL scores between two groups. In patients with Brown Ⅱd defect, the tissue flap reconstruction could improve the scores of pain, entertainment, swallowing and speech QOL (Z=-2.741, -2.517, -2.320 and -2.843, respectively, all P values<0.05), and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group (Z=-2.276, P=0.023). Conclusion: For postoperative long-term quality of life, both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with Brown Ⅱb/c defect, and patients with Brown Ⅱd defect repaired by tissue flap reconstruction have better speech and swallowing functions. Tissue flap reconstruction may bring more entertainment and emotional benefits.

[Clinical characteristics of patients with rheumatic diseases and abnormal liver function]

Objective: To investigate the clinical characteristics of patients with rheumatic diseases and abnormal liver function, as well as determine the proportion and severity of liver function abnormalities. Methods: Cross-sectional study. Data were collected from patients registered in the Chinese Rheumatism Date Center from 2011 to 2021. The rheumatic diseases analyzed in this study were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Sjogren syndrome (SS), ankylosing spondylitis (AS), and gout. Patient data, including demographic characteristics [ such as age, sex, body mass index,(BMI), and smoking history], liver function test results [including alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase(ALP), and total bilirubin], and use of anti-rheumatic immune drugs and liver-protective drugs, were collected and compared between groups with normal and abnormal liver functions. In addition, the proportions of abnormal liver function were compared between sex and age groups. Results: A total of 116 308 patients were included in this study, including 49 659 with RA, 17 597 with SLE, 9 039 with SS, 11 321 with AS, and 28 692 with gout. The lowest proportion of liver function abnormalities was observed in patients with RA[11.02% (5 470/49 659)], followed by those with SS[17.97% (1 624/9 039)] and AS [18.22% (2 063/11 321) ], whereas patients with SLE [21.14% (3 720/17 597) ] and gout [28.73% (8 242/28 692)] exhibited the highest proportion of these abnormalities. Elevated ALT, mostly classified as grade 1, was the most commonly noted liver function abnormality, whereas elevated ALP was the least common. Some patients who took liver-protective drugs had normal liver function, with the lowest percentage observed in patients with gout [7.45% (36/483) ] and ranging from 21.7% to 30.34% in patients with RA, SLE, SS, and AS. The proportion of liver function abnormalities was higher in males than in females for all disease types [RA: 13.8%(1 368/9 906) vs. 10.3%(4 102/39 753); SLE: 33.6% (479/1 424) vs. 20.0% (3 241/16 173); SS: 25.4%(111/437) vs. 17.6%(1 513/8 602); AS: 20.1%(1 629/8 119) vs. 13.6% (434/3 202); and gout: 29.3% (8 033/27 394) vs. 16.1% (209/1 298)]. In RA, SLE, and AS, the proportions of liver function abnormalities were similar across all age groups. In SS, the proportion of liver function abnormalities increased with age [<40 years: 14.9%(294/1 979); 40-59 years: 18.1%(858/4 741); ≥60 years: 20.4%(472/2 319)], whereas a reversal of this trend was observed in gout [<40 years: 34.9%(4 294/12 320); 40-59 years: 25.5%(2 905/11 398);≥60 years: 21.0%(1 042/4 971)]. Conclusions: The proportions of combined liver function abnormalities in patients with rheumatologic diseases were high, and the utilization rates of liver-protective drugs were low. It is necessary to pay more attention to monitoring patients' liver function, timely administer liver-protective drugs, and optimize liver-protective regimens during the treatment of rheumatic diseases.

Characterization of global research trends and prospects on sudden coronary death: A literature visualization analysis

Background

Sudden coronary death is a major global public health issue that has a significant impact on both individuals and society. Nowadays, scholars are active in sudden coronary death all over the world. However, no relevant bibliometric studies have been published. Here, we aim to gain a better understanding the current state of research and to explore potential new research directions through bibliometric analysis.

Methods

Articles and reviews on sudden coronary death from 2012 to 2023 were retrieved from the Web of Science Core Collection (WoSCC). The topic search was conducted using the following keywords: ((("sudden cardiac death" OR "sudden death") AND (coronary OR "myocardial infarction")) OR "sudden coronary death"). Knowledge maps of authors, countries, institutions, journals, keywords, and citations were conducted by CiteSpace. Publication dynamics, hotspots, and frontiers were analyzed independently by authors.

Results

A total of 2914 articles were identified from January 1, 2012 to June 20, 2023. The USA (n = 972) contributed the greatest absolute productivity and UK (centrality = 0.13) built a robust global collaboration. Harvard University was the institution with the highest number of publications (n = 143). Huikuri HV and Junttila MJ were the most published authors who devoted to searching for biomarkers of sudden coronary death. American Journal of Cardiology was the journal with the most publications, and Circulation was the most cited journal. Left ventricular ejection fraction, society, inflammation, and fractional flow reserve became novel burst words that lasted until 2023. Research on etiology and pathology, role of early risk factors in risk stratification, potential predictive biomarkers and novel measurement methods for the prevention and management of sudden coronary death were identified as the research hotspots and frontiers.

Conclusion

Our knowledge and understanding of sudden coronary death have significantly improved. Ongoing efforts should focus on the various etiologies and pathologies of sudden coronary death. Furthermore, a novel sudden coronary death risk model, large-scale population studies, and the rational use of multiple indicators to individualize the assessment of sudden coronary death and other risk factors are other emerging research trends.

[Characterization of metabotropic glutamate receptor 7 and 8 in rat superior cervical ganglion and their changes following chronic intermittent hypoxia]

OBJECTIVE

To investigate the expression and localization of metabotropic glutamate receptors 7 and 8 (mGluR7/8) in rat superior cervical ganglion (SCG) and their changes in response to chronic intermittent hypoxia (CIH).

METHODS

We detected the expressions of mGluR7 and mGluR8 in the SCG of 8-week-old male SD rats using immunohistochemistry and characterized their distribution with immunofluorescence staining. The expression of mGluR7 and mGluR8 in the cytoplasm and nucleus was detected using Western blotting. A 6-week CIH rat model was established by exposure to intermittent hypoxia (6% oxygen for 30 s followed by normoxia for 4 min) for 8 h daily, and the changes in systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured. The effect of CIH on expression levels of mGluR7 and mGluR8 in the SCG was analyzed using Western blotting.

RESULTS

Positive expressions of mGluR7 and mGluR8 were detected in rat SCG. mGluR7 was distributed in the neurons and small fluorescent (SIF) cells with positive staining in both the cytoplasm and nuclei, but not expressed in satellite glial cells (SGCs), nerve fibers or blood vessels; mGluR8 was localized in the cytoplasm of neurons and SIF cells, but not expressed in SGCs, nerve fibers, or blood vessels. Western blotting of the nuclear and cytoplasmic fractions of rat SCG further confirmed that mGluR7 was expressed in both the cytoplasm and the nucleus, while mGluR8 exists only in the cytoplasm. Exposure to CIH significantly increased systolic blood pressure, diastolic blood pressure and mean arterial pressure of the rats (all P < 0.001) and augmented the protein expressions of mGluR7 and mGluR8 in the SCG (P < 0.05).

CONCLUSION

mGluR7 and mGluR8 are present in rat SCG but with different localization patterns. CIH increases blood pressure of rats and enhanced protein expressions of mGluR7 and mGluR8 in rat SCG.

Effectiveness and safety of high-voltage pulsed radiofrequency to treat patients with primary trigeminal neuralgia: a multicenter, randomized, double-blind, controlled study

BACKGROUND

Trigeminal neuralgia (TN) is a debilitating pain disorder that still lacks an ideal treatment option. Pulsed radiofrequency (PRF), especially with high output voltage, is a novel and minimally invasive technique. PRF is regarded a promising treatment option for TN patients who respond poorly to medical treatment; however, the available evidence still lacks high quality randomized controlled trials (RCTs). Our study aimed to evaluate the long-term (1 year and 2 years) effects and safety of high-voltage PRF in primary TN patients and provide stronger evidence for TN treatment options.

METHODS

We performed a multicenter, double-blind, RCT in adults (aged 18-75 years) with primary TN who responded poorly to drug therapy or were unable to tolerate the side effects of drug. Eligible participants were randomly assigned (1:1) to receive either high voltage PRF or nerve block with steroid and local anesthetic drugs. The primary endpoint was the 1-year response rate. This trial has been registered in the clinicaltrials.gov website (registration number: NCT03131466).

RESULTS

One hundred and sixty-two patients were screened for enrollment between April 28th,2017 and September1st, 2019, among whom, 28 were excluded. One hundred and thirty-four participants were randomly assigned to either receive high voltage PRF (n = 67) or nerve block (n = 67). The proportion of patients with a positive response at 1-year after the procedure in the PRF group was significantly higher than that in the nerve block group in the intention-to-treat population (73.1% vs. 32.8%, p < 0.001). There was no difference between groups in the incidence of adverse events.

CONCLUSIONS

Our findings support that high voltage PRF could be a preferred interventional choice prior to receiving more invasive surgical treatment or neuro-destructive treatment for TN patients who have poor responses to medical treatment.

TRIAL REGISTRATION

Our study has been registered at ClinicalTrials.gov (trial registration number: NCT03131466).

The Sweet Potato K+ Transporter IbHAK11 Regulates K+ Deficiency and High Salinity Stress Tolerance by Maintaining Positive Ion Homeostasis

The K⁺ transporter KT/HAK/KUP (K⁺ transporter/high-affinity K⁺/K⁺ uptake) family has a critical effect on K⁺ uptake and translocation in plants under different environmental conditions. However, the functional analysis of KT/HAK/KUP members in sweet potatoes is still limited. The present work reported the physiological activity of a new gene, IbHAK11, in the KT/HAK/KUP family in sweet potatoes. IbHAK11 expression increased significantly in the low K⁺-tolerant line compared with the low K⁺-sensitive line following treatment with low K⁺ concentrations. IbHAK11 upregulation promoted root growth in Arabidopsis under low K⁺ conditions. Under high saline stress, transgenic lines had superior growth and photosynthetic characteristics compared with the wild-type (WT). As for IbHAK11-overexpressing plants, activation of both the non-enzymatic and enzymatic reactive oxygen species (ROS) scavenging systems was observed. Therefore, IbHAK11-overexpressing plants had lower malondialdehyde (MDA) and ROS levels (including H₂O₂ and O^2-) compared with WT under salt-induced stress. We also found that under both low K⁺ and high salinity conditions, overexpression of IbHAK11 enhanced K⁺ translocation from the root to the shoot and decreased Na⁺ absorption in Arabidopsis. Consequently, IbHAK11 positively regulated K⁺ deficiency and high salinity stresses by regulating K⁺ translocation and Na⁺ uptake, thus maintaining K⁺/Na⁺ homeostasis in plants.

Predicting Drug Treatment Outcomes in Childrens with Tuberous Sclerosis Complex-Related Epilepsy: A Clinical Radiomics Study

BACKGROUND AND PURPOSE

Highly predictive markers of drug treatment outcomes of tuberous sclerosis complex-related epilepsy are a key unmet clinical need. The objective of this study was to identify meaningful clinical and radiomic predictors of outcomes of epilepsy drug treatment in patients with tuberous sclerosis complex.

MATERIALS AND METHODS

A total of 105 children with tuberous sclerosis complex-related epilepsy were enrolled in this retrospective study. The pretreatment baseline predictors that were used to predict drug treatment outcomes included patient demographic and clinical information, gene data, electroencephalogram data, and radiomic features that were extracted from pretreatment MR imaging scans. The Spearman correlation coefficient and least absolute shrinkage and selection operator were calculated to select the most relevant features for the drug treatment outcome to build a comprehensive model with radiomic and clinical features for clinical application.

RESULTS

Four MR imaging-based radiomic features and 5 key clinical features were selected to predict the drug treatment outcome. Good discriminative performances were achieved in testing cohorts (area under the curve = 0.85, accuracy = 80.0%, sensitivity = 0.75, and specificity = 0.83) for the epilepsy drug treatment outcome. The model of radiomic and clinical features resulted in favorable calibration curves in all cohorts.

CONCLUSIONS

Our results suggested that the radiomic and clinical features model may predict the epilepsy drug treatment outcome. Age of onset, infantile spasms, antiseizure medication numbers, epileptiform discharge in left parieto-occipital area of electroencephalography, and gene mutation type are the key clinical factors to predict the epilepsy drug treatment outcome. The texture and first-order statistic features are the most valuable radiomic features for predicting drug treatment outcomes.

[Research on the formulation and revision of standard limits for antimony,boron and vanadium in the "Standards for Drinking Water Quality (GB5749-2022)" in China]

China is rich in antimony, boron, and vanadium mineral resources, which have been detected in environmental water bodies and drinking water. During the revision process of the "Standards for Drinking Water Quality (GB5749-2006)", research and evaluation are focused on three indicators: antimony, boron and vanadium. Vanadium is added and the limit value of boron is adjusted. This study reviews and discusses the technical contents related to the revision of the antimony, boron and vanadium, including the environmental presence levels, exposure status, health effects, and the revision of the standard limits of these three indicators. Suggestions are also made for the implementation of this standard.

[Clinical analysis of combined immunotherapy in patients with malignant pleural mesothelioma]

Objective: To observe the present situation, efficacy and safety of immunotherapy in patients with malignant pleural mesothelioma (MPM). Methods: The data of 39 patients with MPM in two centers from 2016 to 2021 were collected and the efficacy and safety were evaluated. According to the application of immune checkpoint inhibitors (ICIs), these patients, whose median clinical follow-up amounting to 18.97 months, were divided into immunotherapy group (19 cases) and control group (20 cases). Kaplan-Meier method and Log-rank test were used for the survival analysis. Results: The objective response rate (ORR) and the disease control rate (DCR) in the immunotherapy group is 21.05% and 79.0% respectively, compared with 10.0% and 55.0% in the control group; and the difference was not statistically significant (P>0.05). The median overall survival (OS) in the immunotherapy group was significantly longer than that in the control group (14.53 months vs 7.07 months, P=0.015), but there was no significant difference in the median progression free survival (PFS) between two groups (4.80 months vs 2.03 months, P=0.062). Single factor survival analysis showed that the nature of pleural effusion, pathological subtype and the efficacy of immunotherapy were related to both PFS and OS of the patients with MPM (P<0.05). The incidence of adverse reactions in immunotherapy group was 89.5% (17 out of 19 cases), and the most common adverse event was hematological toxicity (9 cases), followed by nausea and vomiting (7 cases), fatigue (6 cases) and skin damage (6 cases). Five patients had immune checkpoint inhibitors (ICIs) related adverse reactions with grade 1-2. Conclusions: Patients with MPM have begun to receive immunotherapy in more than 2-line mainly combined chemotherapy in the real world, and the median treatment line is 2-line. Either combined with chemotherapy or anti-angiogenesis therapy, ICI inhibitors have significant efficacy, controllable adverse events and good clinical value.

Altered flexor carpi radialis motor axon excitability properties after cerebrovascular stroke

Background

Spinal motoneurons may become hyperexcitable after a stroke. Knowledge about motoneuron hyperexcitability remains clinically important as it may contribute to a number of phenomena including spasticity, flexion synergies, and abnormal limb postures. Hyperexcitability seems to occur more often in muscles that flex the wrist and fingers (forearm flexors) compared to other upper limb muscles. The cause of hyperexcitability remains uncertain but may involve plastic changes in motoneurons and their axons.

Aim

To characterize intrinsic membrane properties of flexor carpi radialis (FCR) motor axons after stroke using nerve excitability testing.

Methods

Nerve excitability testing using threshold tracking techniques was applied to characterize FCR motor axon properties in persons who suffered a first-time unilateral cortical/subcortical stroke 23 to 308  days earlier. The median nerve was stimulated at the elbow bilaterally in 16 male stroke subjects (51.4 ± 2.9 y) with compound muscle action potentials recorded from the FCR. Nineteen age-matched males (52.7 ± 2.4 y) were also tested to serve as controls.

Results

Axon parameters after stroke were consistent with bilateral hyperpolarization of the resting potential. Nonparetic and paretic side axons were modeled by a 2.6-fold increase in pump currents (IPumpNI) together with an increase (38%-33%) in internodal leak conductance (GLkI) and a decrease (23%-29%) in internodal H conductance (Ih) relative to control axons. A decrease (14%) in Na⁺ channel inactivation rate (Aah) was also needed to fit the paretic axon recovery cycle. "Fanning out" of threshold electrotonus and the resting I/V slope (stroke limbs combined) correlated with blood potassium [K⁺] (R = -0.61 to 0.62, p< 0.01) and disability (R = -0.58 to 0.55, p < 0.05), but not with spasticity, grip strength, or maximal FCR activity.

Conclusion

In contrast to our expectations, FCR axons were not hyperexcitable after stroke. Rather, FCR axons were found to be hyperpolarized bilaterally post stroke, and this was associated with disability and [K⁺]. Reduced FCR axon excitability may represent a kind of bilateral trans-synaptic homeostatic mechanism that acts to minimize motoneuron hyperexcitability.

[Current status of the method of collecting aqueous humor by anterior chamber paracentesis]

Anterior chamber paracentesis (ACP) is a commonly used ophthalmic technique with broad clinical applications. It plays an important role in the diagnosis of intraocular infections, vitreoretinal lymphoma, and other diseases. However, the current ACP methods used in clinical practice have some issues and potential risks. There is no unified standard for the procedural steps, environment, and perioperative management. Therefore, this article provides a systematic review of various methods and devices for ACP and briefly summarizes the current clinical ACP environment, perioperative management, and safety considerations. The aim of this review is to provide insights into the current status and future prospects of ACP, with the goal of optimizing the safety and efficacy of this technique.

Efficacy and safety of computed tomography-guided percutaneous balloon compression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia

Percutaneous balloon compression (PBC) of Gasserian ganglion has been popularly used to treat trigeminal neuralgia (TN), one of the most painful syndromes in human experience. Vertebrobasilar dolichoectasia (VBD) is a rare cause of TN and remains challenging to treat. To our knowledge, no study has reported the therapeutic outcome of PBC for VBD-related TN (VBD-TN). In this retrospective study, we collected and analyzed the medical records of all patients undergoing PBC procedure for VBD-TN under the guidance of CT plus three-dimensional reconstruction at the Pain Management Center of Beijing Tiantan Hospital from January 2017 to December 2022. All 23 patients (15 men and 8 women) had a substantial pain relief as modified Barrow Neurological Institute (BNI) I-IIIb immediately after procedure. The follow-up duration ranged from 2 to 63 months, and at the last follow-up visit, only 3 patients (13%) relapsed (BNI IV-V). The cumulative recurrence-free survival was 95%, 87%, and 74% within 1, 3, and 5 years, respectively. Patients' reported satisfactory rate was 100% as Likert scale 4-5 throughout the whole follow-up period, with no severe complications occurring. Our data revealed promising efficacy and safety of PBC procedure for treatment of VBD-TN, thus suggesting a valuable option for pain control in these rare cases of TN. However, there has been no supporting evidence that PBC treatment is a preferred option to other treatments.

Lidocaine aerosol sprayed on oral and/or nasal mucosa for the rescue of acute trigeminal neuralgia exacerbations: A retrospective study

INTRODUCTION

Acute trigeminal neuralgia exacerbation is a common reason for frequent emergency department visits, that often occurs while waiting for surgery, but evidence on effective drugs for acute trigeminal neuralgia is scant. Whether lidocaine aerosol could be a rescue option for the treatment of acute trigeminal neuralgia exacerbations is worth exploring. Positive predictors of the analgesic effects of lidocaine aerosol also warrant further investigation.

METHODS

This is a retrospective study with a total of 152 patients. We analyzed the efficacy of lidocaine aerosol for the treatment of acute trigeminal neuralgia exacerbations. A positive response was considered a decrease in the VAS score of at least 50% at 30 min of treatment. Multivariable logistic analyses were performed to identify predictive factors for lidocaine aerosol response.

RESULTS

In the group of 109 responders, the VAS score decreased from 8.3 ± 1.1 cm to 0.8 ± 1.0 cm at 15 min, and 1.7 ± 1.0 cm at 30 min. The effective rate at 15 min and 30 min were 77.6% and 70.4%, respectively. Multivariate logistic analyses showed the treatment may provide better clinical outcomes in V2 trigeminal neuralgia (OR 0.01, 95%Cl 0.001-0.15, p < 0.001), V3 trigeminal neuralgia (OR 0.02, 95%Cl 0.001-0.16, p = 0.001), and V2 + V3 trigeminal neuralgia (OR 0.01, 95%Cl 0.001-0.13, p < 0.001), patients who were taking carbamazepine or oxcarbazepine with a maximum dose (OR 6.15, 95%Cl 2.11-17.93, p = 0.001) were less likely to experience immediate pain relief.

CONCLUSION

Lidocaine aerosol sprayed on oral and/or nasal mucosa is beneficial for immediate pain relief in patients with acute trigeminal neuralgia exacerbations. It is expected to become a promising treatment option for patients with V2 and/or V3 trigeminal neuralgia.

Effectiveness, Safety and Predictors of Response to Ultrasound-Guided Stellate Ganglion Blockades for the Treatment of Patients with Chronic Migraine: a retrospective and observational study

BACKGROUND

Whether ultrasound-guided stellate ganglion block (SGB) is a valuable therapeutic option for the treatment of patients with chronic migraine (CM) is worth exploring. If SGB is proven to be effective for CM, the identification of potential predictors for the effectiveness of SGB warrants further investigation. This study aimed to investigate the effectiveness and safety of SGB in patients with CM, and to explore the predictive factors for its treatment effectiveness.

METHODS

This is a retrospective observational study. We retrospectively analyzed the effects of SGB for the treatment of patients with CM under ultrasound guidance, between January 2018 to June 2022. The follow-up time was approximately 1 month, 2 months and 3 months after the last SGBs. The response criterion was defined as a reduction in pain intensity of >50% measured using the most severe numerical rating scale (NRS) score compared to pre-treatment baseline, without an increase in the dose or the type of analgesic or anxiolytic/antidepressant medication, otherwise unresponsive to SGB. Univariable and multivariable analyses were performed to identify the predictive factors for SGB response.

RESULTS

97 patients were included in this study. SGB was effective in most of the CM patients, with an effective rate of 90.7%, 82.5% and 71.1% after 1-month, 2-month and 3-month of the last SGBs, respectively. At 3-month follow-up, 95.7% responsive patients benefited from repeated SGBs. In patients receiving repeated SGB treatments, the number of SGBs in responsive patients were significantly greater than those in patients with no response at 3-month follow-up (3.41±1.31 vs 2.68±0.67, P=0.02). Comorbid anxiety or depression was a negative predictor of SGB effectiveness at 3-month follow-up (B=-0.25, 95%CI -0.45--0.05, P=0.01). The overall adverse events rate associated with ultrasound-guided SGB was 9.3%. There were no serious complications; all adverse events were transient, with hoarseness being the most common adverse event.

CONCLUSIONS

Ultrasound-guided SGB was an effective and safe treatment for CM patients. The majority of responsive patients with CM benefited from repeated SGBs. CM patients who needed repeated SGBs may obtain good and sustained analgesic effect after receiving a greater number of SGBs. Patients without comorbidities such as anxiety or depression were more likely to benefit from SGB treatments.

Prediction of knee pain improvement over two years for knee osteoarthritis using a dynamic nomogram based on MRI-derived radiomics: a proof-of-concept study

OBJECTIVES

To develop and validate a nomogram to detect improved knee pain in osteoarthritis (OA) by integrating magnetic resonance imaging (MRI) radiomics signature of subchondral bone and clinical characteristics.

METHODS

Participants were selected from the Vitamin D Effects on Osteoarthritis (VIDEO) study. The primary outcome was 20% improvement of knee pain score over 2 years in participants administrated either vitamin D or placebo. Radiomics features of subchondral bone and clinical characteristics from 216 participants were extracted and analyzed. The participants were randomly split into the training and validation cohorts at a ratio of 8:2. Least absolute shrinkage and selection operator (LASSO) regression was used to select features and generate radiomics signatures. The optimal radiomics signature and clinical indicators were fitted into a nomogram using multivariable logistic regression model.

RESULTS

The nomogram showed favorable discrimination performance [AUC_training, 0.79 (95% CI: 0.72-0.79), AUC_validation, 0.83 (95% CI: 0.70-0.96)] as well as a good calibration. Additional contributing value of fusion radiomics signature to the nomogram was statistically significant (NRI, 0.23; IDI, 0.14, P < 0.001 in training cohort and NRI, 0.29; IDI, 0.18, P < 0.05 in validating cohort). Decision curve analysis confirmed the clinical usefulness of nomogram.

CONCLUSION

The radiomics-based nomogram comprising the MR radiomics signature and clinical variables achieves a favorable predictive efficacy and accuracy in differentiating improvement in knee pain among OA patients. This proof-of-concept study provides a promising way to predict clinically meaningful outcomes.

Analysis of factors that influence the occurrence of otitis media with effusion in pediatric patients with adenoid hypertrophy

Objective

Adenoid hypertrophy (AH) and otitis media with effusion (OME) are common pediatric otolaryngological diseases and often occur concurrently. The purpose of this study was to comprehensively analyze the factors that influence the occurrence of OME pediatric patients with AH.

Methods

Patients younger than 12 years with AH, who were hospitalized for treatment at Beijing Tsinghua Changgung Hospital in Beijing, China, between March 2018 and February 2022 were enrolled. The patients were divided into an AH group and an AH + OME group based on the presence of OME. The authors collected the following clinical data for univariable analysis: sex; age; body mass index (BMI); comorbid nasal congestion/rhinorrhea, recurrent tonsillitis, or allergic rhinitis (AR); adenoid and tonsil grade; tonsillar hypertrophy; food/drug allergy; history of adenoidectomy and congenital diseases; breastfeeding status; preterm birth; exposure to environmental tobacco smoke (ETS); family history of adenotonsillectomy, otitis media, and AR; main data of polysomnography and oropharyngeal conditional pathogen culture data of some patients. Univariate analysis was performed as a basis for logistic regression analysis.

Results

A total of 511 children (329 boys and 182 girls) were included, their mean age was 5.37 ± 2.10 years. Of them, 407 (79.6%) were in the AH group and 104 (20.4%) in the AH + OME group. Univariate analysis revealed statistically significant differences in age, BMI, adenoid grade, AR, breastfeeding status, and ETS exposure between the two groups. Multivariate stepwise logistic regression analysis showed that age, adenoid grade, AR, breastfeeding status, and ETS influenced the occurrence of OME in pediatric patients with AH. The risk of OME decreased with increasing age. High adenoid grade, ETS exposure, and comorbid AR were risk factors for OME in pediatric patients with AH, but breastfeeding was a protective factor. The final analytical results of the oropharyngeal conditional pathogen culture data showed that Streptococcus pneumoniae positivity was associated with OME in AH.

Conclusion

The pathogenesis of AH with OME is complex. Young age, high adenoid grade, ETS exposure, non-breastfed status, comorbid AR, and the presence of S. pneumoniae in the oropharynx are risk factors for OME in pediatric patients with AH.

Opioid-Sparing Effects of Flurbiprofen Axetil as an Adjuvant to Ropivacaine in Pre-Emptive Scalp Infiltration for Post-Craniotomy Pain: Study Protocol for a Multicenter, Randomized Controlled Trial

Background

Pain after craniotomy remains a poorly controlled problem that is mainly caused by the inflammatory reaction at the incision site. Nowadays, systemic opioids use, as first-line analgesics, is often limited because of adverse effects. Flurbiprofen axetil (FA) is a non-steroidal anti-inflammatory drug merged into emulsified lipid microspheres, which represent a strong affinity to inflammatory lesions. Local administration of flurbiprofen into a surgical wound has induced enhanced analgesic efficacy and few systemic or local adverse effects after oral surgery. However, the impact of local FA, as a non-opioid pharmacologic alternative, remains elusive on postoperative pain in craniotomy. In this study, we presume that pre-emptive infiltration of scalp with FA as an adjuvant to ropivacaine can lead to less sufentanil consumption postoperatively in patient controlled intravenous analgesia (PCIA) compared with ropivacaine alone.

Methods/Design

We design a multicenter, randomized controlled study that will enroll 216 subjects who are planned to receive supratentorial craniotomy. Patients will receive pre-emptive infiltration of scalp either with 50 mg FA and 0.5% ropivacaine, or with 0.5% ropivacaine alone. Primary outcome is total consumption of sufentanil with PCIA device at 48 h postoperatively.

Discussion

This is the first study attempting to explore the analgesic and safety profile of local FA as an adjuvant to ropivacaine for incisional pain in patients undergoing craniotomy. It will provide additional insights into the opioid-sparing analgesia pathways by local administration of NSAIDs for neurosurgery.

Association between Sarcopenia and Cognitive Trajectories among Middle-Aged and Older Adults in China: A Nationally Representative Cohort Study

OBJECTIVES

The relationship between sarcopenia and cognitive function has been extensively studied, but is usually explored at a single time point. We used repeatedly measured cognitive data to examine the relationship between sarcopenia and cognitive trajectories over time among middle-aged and older Chinese adults.

DESIGN

A nationally representative cohort study.

SETTING AND PARTICIPANTS

Data were from three waves (2011, 2013 and 2015) of the China Health and Retirement Longitudinal Study (CHARLS). A total of 8963 participants with complete baseline data (wave 1) and at least two cognitive function tests (waves 1-3) were enrolled in this study.

MEASUREMENTS

Sarcopenia was diagnosed at baseline (wave 1). The wave 1-3 data were used to analyze cognitive trajectories over time by constructing a latent class trajectory model (LCTM). Logistic regression model was used to analyze the association between sarcopenia and cognitive trajectories.

RESULTS

Among 8693 participants, we identified two trajectories of cognitive function development, including a persistent low trajectory (n= 4856, 55.86%) and a persistent high trajectory (n= 3837, 44.14%). Sarcopenia was associated with persistently low cognitive trajectory of global cognitive (OR: 1.248, 95%CI: 1.046-1.490) after adjustment for other covariates. This association was still observed when stratified by age, gender, educational level, marital status, social activity, smoking status and drinking status. Mediation analysis showed that body mass index (BMI) mediated efficacy accounting for 42.32% of the relationship.

CONCLUSIONS

Our study showed two trajectory groups of global cognitive function. Sarcopenia was associated with a persistent low trajectory over time and BMI mediated the relationship between sarcopenia and cognitive trajectories among middle-aged and older Chinese adults.

Pre-incisional infiltration with ropivacaine plus dexamethasone palmitate emulsion for postoperative pain in patients undergoing craniotomy: study protocol for a prospective, randomized controlled trial

BACKGROUND

Post-craniotomy pain is a common occurrence which is associated with poor outcomes. Pre-emptive scalp infiltration with dexamethasone and ropivacaine has been proven effective in previous studies but with limited clinical significance. Dexamethasone palmitate emulsion (D-PAL) is a pro-drug incorporating dexamethasone into lipid microspheres with greater anti-inflammatory activity and fewer side effects than free dexamethasone. However, its effects in post-craniotomy pain management remain unknown. This study hypothesizes that pre-emptive scalp infiltration with ropivacaine plus D-PAL emulsion can achieve superior analgesic effects to ropivacaine alone in adult patients undergoing craniotomy.

METHODS/DESIGN

This is a single center, randomized controlled trial enrolling 130 patients scheduled for supratentorial craniotomy, which is expected to last longer than 4 h. We compare the efficacy and safety for postoperative pain relief of ropivacaine plus D-PAL group and ropivacaine alone group following pre-emptive scalp infiltration. Primary outcome will be pain Numerical Rating Scale at 24 h postoperatively. Secondary outcomes will include further analgesia evaluations and drug-related complications within a follow-up period of 3 months.

DISCUSSION

This is the first randomized controlled trial aiming to assess the possible benefits or disadvantages of D-PAL emulsion for incisional pain in craniotomy. It may provide an alternative to optimize pain outcome for neurosurgical patients.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT04488315). Registered on 19 July 2020.

[Effects of insulin glargine at different times on organ oxidative stress in burned rats with delayed resuscitation]

Objective: To examine the antioxidant effect of low dosage insulin glargine intervention at different time in rats with delayed resuscitation after burn, in order to acquire a better time of antioxidant intervention during delayed resuscitation following burn injury. Methods: With 10 rats in each group, 50 male SD rats were assigned to sham injury group, delayed resuscitation group, immediate post-burn insulin glargine treatment group (immediate treatment group), 2 hours post-burn insulin glargine treatment group(2 h treatment group), and 6 hours post-burn insulin treatment group(6 h treatment group) with random number table. Each treatment group received subcutaneous injections of insulin glargine (1.0 U·kg^-1·d^-1) immediately, two hours and six hours after the burn, while the delayed resuscitation group received the same amount of normal saline six hours after the burn. To imitate delayed fluid resuscitation, the delayed resuscitation group and each therapy group were intraperitoneally injected with normal saline (40 ml/kg) 6 hours after injury. No medicine and fluid resuscitation was administered to the sham injury group. Rats in the sham injury group had their abdominal aortic blood, hearts, and kidney tissues collected immediately after injury, while rats in the other groups had their blood and tissues collected 24 hours later. To analyze the timing of antioxidant intervention, the activities of CuZn-superoxide dismutase (CuZn-SOD), catalase (CAT), glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), xanthine oxidase (XOD) and myeloperoxidase (MPO) in blood glucose and myocardial and renal tissues were measured by spectrophotometry. Results: Compared with the sham group, blood glucose levels in the delayed resuscitation group increased [(10.72±0.80) vs (6.57±0.82)mmol/L,P<0.001], while in the myocardium and kidney, the activities of CuZn-SOD, CAT, GSH-Px and T-AOC decreased (all P<0.05) and the activities of XOD and MPO increased (all P<0.05). Compared with the delayed resuscitation group, blood glucose decreased in the immediate, 2 h, and 6 h treatment groups (all P<0.05). In the immediate and 2 h treatment group, the activities of CuZn-SOD, CAT, GSH-Px and T-AOC in the myocardium and kidney increased(all P<0.05). In the 6 h treatment group, only the activities of GSH-Px in myocardium, CAT and GSH-Px in kidney increased (all P<0.05). Compared with the delayed resuscitation group, in the immediate treatment group, the activities of MPO and XOD in myocardial tissue and XOD in renal tissue decreased (all P<0.05). The activities of MPO and XOD in myocardial and renal tissues of the 2 h treatment group both decreased (all P<0.05). In the 6 h treatment group, the activities of MPO in myocardial tissue and XOD in renal tissue both decreased (all P<0.05). Compared with the immediate treatment group, the activity of GSH-Px in myocardial tissue increased (P<0.05), and the activities of CuZn-SOD, CAT, GSH-Px and T-AOC in renal tissue increased in the 2 h treatment group (all P<0.05). The activities of CuZn-SOD, CAT, GSH-Px and T-AOC in myocardium of 6 h treatment group decreased (all P<0.05). Compared with the immediate treatment group, the activities of XOD and MPO in myocardial tissue and XOD in renal tissue of the 2 h treatment group had no significant difference (all P>0.05), but the activity of MPO in renal tissue decreased (P<0.05). The activities of XOD and MPO in myocardial tissue of the 6 h treatment group increased (all P<0.05). Compared with the 2 h treatment group, the activities of CuZn-SOD, CAT and GSH-Px and T-AOC in myocardium and kidney tissues in the 6 h treatment group decreased (all P<0.05), while the activities of XOD and MPO in myocardium and kidney tissues increased [myocardium: (374±8) vs (290±19) U/g, (0.021 8±0.003 9) vs (0.010 7±0.002 4) U/g, kidney: (157±6) vs (128±9) U/g, (0.026 8±0.004 3) vs (0.013 4±0.003 1) U/g, all P<0.05]. Conclusions: The timing of the intervention is related to the antioxidant effect of insulin glargine during delayed burn resuscitation. The intervention immediately and 2 hours after burn could have a better antioxidant effect compared to the intervention at 6 hours after burn.

High mechanical Q-factor measurement of Si using a 3D cantilever support

Thermal noise in test mass substrates and coatings is a significant noise contribution in the detection band of current and proposed future gravitational wave detectors. Substrate thermal noise can be reduced by using high mechanical Q-factor materials and cooling the test mass mirrors. Silicon is a promising potential candidate for the next generation detector test masses. The low thermal expansion and high thermal conductivity of silicon allow efficient cryogenic operation, and a significant increase in the amount of optical power that can be used in the detectors by decreasing thermal deformation and aberration. Mechanical stress, damage, poor surface quality or contamination can result in increased loss and thermal noise. Therefore, the characterization of mechanical loss in silicon test masses is necessary. In this project, we developed a technique to measure high Q-factor mechanical modes. We used finite element modeling to optimize the design of the test mass support structure to minimize the loss coupling from the support structure over a wide frequency range. Mechanical Q-factors of the order of 10⁷ were achieved for several modes of a 10 cm diam. × 3 cm cylindrical silicon test mass with such a support at room temperature.

In silico and in vivo analysis of TIPE1 expression in diffuse large B cell lymphoma

TIPE1 is a gene in the TNFAIP8 family involved in immune regulation and tumorigenesis. Although previous studies demonstrated that TIPE1 might play different roles in different tumors, its expression and role in lymphoma are unclear. Here we observed TIPE1 expression in diffuse large B cell lymphoma (DLBCL). Two microarrays containing 96 tumor tissue specimens were obtained from the Affiliated Hospital of Nantong University biobank. All specimens came from patients with a clear pathological diagnosis of lymphoma, lymphadenitis, breast cancer, or bladder cancer, and we performed immunohistochemical experiments on these tissue specimens. GEPIA and TIMER platforms were used for bioinformatic analyses. We found higher TIPE1 expression in tumor tissues from patients with lymphoma compared with those with lymphadenitis, breast cancer, or bladder cancer. The GEPIA and TIMER analyses revealed that TIPE1 was upregulated in DLBCL tissues but not in invasive breast carcinoma, urothelial bladder carcinoma, or liver hepatocellular carcinoma tissues. TIPE1 expression was irrelevant for pathological stage, overall survival, or DLBCL immune infiltration levels. However, TIPE1 expression was correlated with MKI67 expression in DLBCL. Overall, TIPE1’s high expression levels in DLBCL may contribute to tumor growth in DLBCL.

[Gray matter morphological changes in children with cleft palate speech disorder]

Objective: To analyze the morphological changes of gray matter in clefts lip and palate (CLP) children using voxel-based morphometric (VBM) and surface-based morphometric (SBM) methods. So as to provide a reference for the neural mechanism of cleft palate speech disorder (CPSD) in CLP population. Methods: A total of 29 CLP children with CPSD who were admitted to Department of Oral & Maxillofacial Plastic & Tramuma Surgery, Capital Medical University School of Stomatology from January 2017 to January 2022 were selected (CLP group), including 9 males and 20 females, aged (9.6±3.2) years (5-17 years old). During the same period, 33 healthy children (healthy control group) were recruited in Beijing Children's Hospital, including 9 males and 24 females, aged (9.6±2.4) years (5-16 years). Results: There were no significant differences in age and gender between the healthy control group and the CLP group (t=-0.07, P=0.944; χ²=0.11, P=0.745). Compared with the healthy control group, the left inferior temporal gyrus, right inferior parietal angular gyrus, and left upper cerebellar gray matter volume in the CLP group were significantly decreased (P<0.05), and the volume of the right medial superior frontal gyrus was significantly increased (P<0.05). The left inferior frontal gyrus insula and the right insula cortical thickness of the subjects in the CLP group were significantly thinner [family-wise error rate (FWER) correction, P=0.035]. The right hemisphere cingulate gyrus isthmus sulcus index increased in the CLP group (FWER correction, P=0.040). Conclusions: CLP children with speech disorder have multiple language-related brain regions with reduced gray matter (GM) volume, decreased cortical thickness, and increased gyrificaition index. The abnormal changes in GM morphology in these brain regions may be related to the characteristics of cleft palate speech disorder in the CLP population.

JS07.5.A 18F-fluciclovine PET and multi-parametric MRI to distinguish pseudoprogression from tumor progression in post-treatment glioblastoma

Background

Differentiation of tumor progression (TP) from pseudoprogression (PsP) is a major unmet need in glioblastoma (GBM). 18F-Fluciclovine is a synthetic amino acid PET radiotracer with higher uptake in tumor tissue vs. areas of treatment-related change. We aimed to assess the combined value of 18F-Fluciclovine PET and multi-parametric MRI for differentiating PsP from TP.

Material and Methods

We enrolled 30 patients with GBM with a new or enlarging contrast-enhancing lesion on MRI after chemoradiotherapy who were planned for surgical resection of the lesion. Patients underwent pre-operative 18F-Fluciclovine PET and multi-parametric MRI. Following surgery, the relative percentages of viable tumor and therapy-related changes observed on histopathology were quantified. Patients were categorized as TP if viable tumor represented ≥ 50% of the specimen, mixed TP if &lt; 50% and &gt; 10%, and PsP if ≤ 10%. SUVmax, SUVpeak, and 50% threshold SUVmean were calculated and normalized to contralateral brain, pituitary gland, and superior sagittal sinus (SSS). The least absolute shrinkage and selection operator (LASSO) was used to determine the variables most predictive of tumor percentage. The strength of association between the primary outcome and selected variables was assessed by Pearson’s or Point-biserial correlation.

Results

18 patients with TP, 4 with mixed TP-PsP, and 8 with PsP were included. There was a positive correlation between 50% threshold SUV mean measured from PET images acquired 50-60 minutes post-injection and rCBVmax by MRI and tumor percentage by histology (r= 0.56; p= 0.004 and r=0.50; p=0.012 respectively). 40-50 minutes SUVmax (OR=1.78 rpb=0.51) and rCBVmax (OR=1.64, rpb=0.48) were positively correlated with tumor TP/mixed TP group. Patients who demonstrated TP/mixed TP-PsP had significantly higher 40-50 minutes SUVmax compared to patients with histological PsP (6.71±2.03 vs 3.93±1.63; p=0.012). 40-50 minutes SUVmax cut-off of 4.46 provided 90% sensitivity and 80% specificity for differentiation of TP/mixed TP-PsP from PsP (AUC=0.88). Combining a 40-50 minutes SUVmax cut-off of 4.46 and an rCBVmax cut-off of 3.67 provided 100% sensitivity and 100% specificity for differentiating TP/mixed TP-PsP from PsP (AUC=1). Patients who demonstrated TP had a significantly higher 40-50 minutes SUVmax compared to patients with histological PsP (6.99±2.06 vs 3.93±1.63; p=0.008). A 40-50 minutes SUVmax cut-off of 4.66 provided 94% sensitivity and 80% specificity for differentiation of TP from PsP (AUC=0.89).

Conclusion

18F-Fluciclovine PET uptake is positively correlated with viable tumor quantification on histology and can accurately differentiate PsP from TP in patients with GBM. Further independent studies are required to cross-validate these promising early results.

Outcomes and Predictors of Response of Duloxetine for the Treatment of Persistent Idiopathic Dentoalveolar Pain: A Retrospective Multicenter Observational Study

Background

Duloxetine has been reported to significantly relieve the pain of persistent idiopathic dentoalveolar pain (PIDP); however, the number of studies available is scarce and no study has identified the predictors of response of duloxetine for the treatment of PIDP.

Objective

To report the efficacy, safety, and identification of positive predictors of duloxetine for PIDP patients through a retrospective multicenter observational study.

Methods

We retrospectively reviewed the clinical database of PIDP patients who were prescribed duloxetine at 3 hospitals between January 2018 and November 2021. Demographic and pain-related baseline data, efficacy of patients after 3 months of medication by visual analog scale (VAS) scores for pain and adverse events were extracted and analyzed. The predictors of pain-relieving effect of duloxetine were identified by logistic regression analysis.

Results

A total of 135 patients were included in this study. Side effects occurred immediately after taking duloxetine in 24 (17.8%) patients, and the treatment with duloxetine was discontinued on 13 of them because they could not tolerate the side effects. Other 11 (8.1%) patients gradually tolerated the side effects within 2 weeks. Ninety-four out of 122 (77.0%) patients obtained pain relief with VAS significantly decreased (p < 0.01) and the other 28 (23.0%) patients stopped taking the drug because of weak efficacy. Binary logistic regression analysis showed that short disease duration (OR = 1.017, 95% CI = 1.004–1.030, P = 0.012) was an independent predictor of the positive response of duloxetine.

Conclusion

This study confirmed that duloxetine can significantly improve chronic pain of PIDP patients, and the safety was tolerable. Patients with shorter disease duration had more benefit from duloxetine.

Limitations

This is a retrospective observational study. Long-term efficacy and safety of duloxetine in the treatment of PIDP patients were not evaluated.