[Efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation]

Objective: To assess the efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation. Methods: A total of 89 patients with primary trigeminal neuralgia in Nanjing Drum Tower Clinical College of Xuzhou Medical University from July 2021 to July 2022 were prospectively included, and were divided into experimental group (n=45, modified Hartel approach: selecting 2.0 cm lateral to and 1.0 cm below angulus oris as insertion point) and control group (n=44, traditional Hartel approach: selecting 2.5 cm lateral to the angulus oris as insertion point) according to the random number table method. There were 19 males and 26 females in the experimental group, and aged (67.6±8.8) years. Meanwhile, there were 19 males and 25 females in the control group, and aged (64.8±11.7) years. All the patients were treated by CT-guided radiofrequency thermocoagulation. The success rate of one-time puncture, number of punctures, the time of puncture, operation time, numerical rating scale (NRS) scores and complications were recorded and compared between the two groups. Results: The success rate of one-time puncture in experimental group was 64.4% (29/45), which was higher than that in control group 31.8% (14/44) (P<0.05). The number of punctures [M (Q₁, Q₃)], the time of puncture [M (Q₁, Q₃)] and operation time in the experimental group were 1 (1, 2), 218 (206, 378) s, (19.9±2.7) min, which were less than those of control group [2 (1, 3), 390 (231, 598) s, (27.0±3.9) min] (all P<0.05). The NRS scores [M (Q₁, Q₃)] of 1 day, 1 month and 3 months after surgery in the experimental group were 1 (1, 2), 1 (0, 2) and 1(0, 1), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). The NRS scores [M (Q₁, Q₃)] of 1 day, 1 month and 3 months after surgery in the control group were 1 (1, 2), 1 (0, 2) and 1 (0, 2), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). There was no statistically significant difference in the incidence of nausea and vomiting, facial numbness, and decreased masticatory muscle strength between the two groups (all P>0.05) In the experimental group, two patients had puncture needles into the oral cavity, with timely detection and replacement of puncture needles, and no infection occurred. There was no cerebrospinal fluid leakage and decreased corneal reflex in both groups. Conclusion: The modified Hartel approach can significantly improve the success rate of one-time puncture via foramen ovale, reduce the operation time and the incidence of postoperative facial swelling, which is a safe and effective puncture method.

Relationships of Low Serum Levels of Interleukin-10 With Poststroke Anxiety and Cognitive Impairment in Patients With Clinical Acute Stroke

BACKGROUND AND PURPOSE

The relationships among interleukin (IL)-10 levels, anxiety, and cognitive status after stroke remain controversial. We aimed to determine the associations of serum IL-10 levels with poststroke anxiety (PSA) and poststroke cognitive impairment (PSCI).

METHODS

We recruited 350 patients with stroke, of whom only 151 completed a 1-month follow-up assessment. The Mini Mental State Examination (MMSE) and Hamilton Anxiety Scale (HAMA) were used to assess the cognitive status and anxiety, respectively. Serum IL-10 levels were measured within 24 hours of admission.

RESULTS

IL-10 levels were significantly lower in the PSA group than in the non-PSA group, and they were negatively associated with HAMA scores (r=-0.371, p<0.001). After adjusting for all potential confounders, IL-10 levels remained an independent predictor of PSA (odds ratio=0.471, 95% confidence interval=0.237-0.936, p=0.032). IL-10 levels were strongly correlated with behavior during interviews, psychic anxiety, and somatic anxiety. Patients without PSCI had higher IL-10 levels were higher in non-PSCI patients than in PSCI patients, and they were positively associated with MMSE scores in the bivariate correlation analysis (r=0.169, p=0.038), and also with memory capacity, naming ability, and copying capacity. However, IL-10 did not predict PSCI in the univariable or multivariable logistic regression.

CONCLUSIONS

Low IL-10 levels were associated with increased risks of PSA and PSCI at a 1-month follow-up after stroke. Serum IL-10 levels may therefore be helpful in predicting PSA.

[Application of 3D-printed navigation plate in pulsed radiofrequency therapy of dorsal root ganglion in thoracic postherpetic neuralgia]

Objective: To evaluate the accuracy, efficacy and safety of 3D-printed personalized navigation template in the treatment of thoracic postherpetic neuralgia (PHN) with dorsal root ganglion pulsed radiofrequency (DRG-PRF). Methods: A total of 63 patients with thoracic PHN from March 2019 to December 2020 in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled and randomly divided into study group (n=31) and control group (n=32) by random number table method. The study group received DRG-PRF treatment assisted by 3D-printed navigation template, while the control group received DRG-PRF treatment guided by conventional CT. The one-time success rate of puncture, the incidence of puncture times ≥3, the number of punctures, puncture time, visual analogue scale (VAS) score and surgical complications between the two groups were compared. Results: The one-time success rate of puncture in study group was 84.9% (79/93), which was higher than that of control group [30.2% (29/96)] (P<0.001). The incidence of puncture times ≥3, the number of punctures, puncture time in study group were 4.3% (4/93), 1 (1, 1) and 2.9 (2.8, 3.0) min, respectively, which were lower than that of the control group [21.9% (21/96), 2(1, 3), 9.0 (4.5, 12.9) min, respectively] (all P<0.01). No difference was found in VAS score at each time point before and after surgery between the two groups (all P>0.05). There was one case of pleura puncture in the control group, but no other complications such as straying into vertebral canal, hematoma, spinal cord injury, limb movement disorder, infection were found in the two groups. Conclusions: 3D-printed personalized navigation template is an effective method to guide DRG-PRF for the treatment of thoracic postherpetic neuralgia. It can significantly improve the surgical efficiency of DRG-PRF, but has no significant effect on the surgical efficacy.

Interleukin-10 level is associated with post-stroke depression in acute ischaemic stroke patients

BACKGROUND

Interleukin-10 (IL-10) is a pathophysiological factor in acute ischaemic stroke (AIS) and is relevant to mood disorders after stroke. We evaluated the predictive value of IL-10 in patients with post-stroke depression (PSD).

METHODS

A total of 350 stroke patients were recruited at baseline, and 151 AIS patients were screened and completed a 1-month follow-up. Serum IL-10 levels were measured within 24 h of admission. We used the 17-item Hamilton Depression Scale (HAMD-17) to evaluate depression symptoms; PSD was defined as an HAMD score ≥ 7.

RESULTS

Fifty-one (33.8%) patients showed a more serious stroke degree, larger infarction volume, and poorer daily life activities and prognosis (P < 0.05) and were diagnosed with PSD at the 1-month follow-up. Their IL-10 level decreased significantly compared to the non-PSD group (P < 0.001). After adjusting for confounders, IL-10 could be used as an independent predictor for PSD with an adjusted odds ratio (OR) of 0.615 (95% CI 0.410-0.923, P = 0.019). In addition, the optimal cut-off value of IL-10 was 0.615 pg/mL based on an area under the receiver operating characteristic curve of 0.692 (95% CI 0.604-0.781, P < 0.001), demonstrating that IL-10 could predict the occurrence of PSD. Moreover, IL-10 was an indicator of stroke severity, living ability, and functional outcomes (P < 0.05).

LIMITATIONS

IL-10 was only measured upon admission; dynamic changes need to be further monitored. This was also a single-centre study with a relatively small sample.

CONCLUSIONS

Lower IL-10 levels may be used to predict PSD.

A cross-sectional survey on occupational stress and associated dyslipidemia among medical staff in tertiary public hospitals in Wenzhou, China

INTRODUCTION

Occupational stress is considered to be a harmful physical and emotional response to an individual's psychological and/or physiological state in the work environment and is highly prevalent among medical staff. However, few epidemiological studies have investigated occupational stress in medical staff. Our study aims to explore the characteristics of occupational stress and its relationship with dyslipidemia in Chinese medical staff at tertiary hospitals and establish the basis for future preventive strategies.

METHODS

A cross-sectional study was conducted in three tertiary public hospitals in Wenzhou City, Zhejiang Province, China. Data were collected using random sampling procedures to examine demographic characteristics and job-related data. The participants completed the Occupational Stress Inventory-Revised (OSI-R) questionnaires and serum lipids tests. Partial correlation analysis was conducted to explore the relationship between occupational stress and dyslipidemia.

RESULTS

A total of 1,176 medical staff responses to questionnaires were obtained. The occupational stress levels of medical staff were higher than those of normative populations, while their coping resources were lower. Most of the subscales of occupational stress demonstrated higher results for doctors and males than for nurses and females with crude analyses. Each subscale of OSI-R was found to be associated with a different type of blood lipid level.

CONCLUSIONS

The occupational stress level of medical staff in tertiary public hospitals in Wenzhou was high, and occupational stress may contribute to dyslipidemia. An investigation into occupational stress levels and their association with dyslipidemia in this population could draw more attention to medical staff in tertiary public hospitals.

Clinical activity changes in the neurology department of Wenzhou during the COVID-19 pandemic: an observational analysis

OBJECTIVE

To explore the activity changes in neurology clinical practice that have occurred in tertiary public hospitals during the COVID-19 pandemic.

METHODS

Outpatient and inpatient data from the neurology department were extracted from the electronic medical record system of three tertiary Grade A hospitals in Wenzhou. Data were analyzed across 5 months following the beginning of the pandemic (from January 13 to May 17) and compared with the same period in 2019. Data on reperfusion therapy for acute infarction stroke were extracted monthly from January to April.

RESULTS

The number of outpatients declined from 102,300 in 2019 to 75,154 in 2020 (26.54%), while the number of inpatients in the three tertiary Grade A hospitals decreased from 4641 to 3437 (25.94%). The latter trend showed a significant drop from the 3rd week to the 7th week. The number of patients in these hospitals decreased significantly, and a significant drop was seen in the neurology department. As usual, stroke was the most common disease observed; however, anxiety/depression and insomnia increased dramatically in the outpatient consultation department.

CONCLUSIONS

The results of our study revealed the effects of the COVID-19 pandemic in the clinical practice of neurology in Wenzhou during the outbreak. Understanding the pandemic's trends and impact on neurological patients and health systems will allow for better preparation of neurologists in the future.

Predictors of the Prevalence of Dyslipidemia and Influencing Factors for Young Health Examination Cohort: A Cross-Sectional Survey

Objectives: The objective of this study was to estimate the prevalence of dyslipidemia and associated influencing factors in young adults in the southeastern coastal area of China. Methods: This study adopted a cross-sectional survey and included 7,859 young people who underwent examinations at three hospitals in Wenzhou, Zhejiang Province, China. All subjects completed a questionnaire in the form of face-to-face interviews and underwent anthropometric measurements and biochemical tests. The continuous data are presented as the means ± standard deviations and were compared using Student's t-tests. The categorical variables are presented as proportions. The influencing factors associated with dyslipidemia were evaluated through a multivariate logistic regression. Results: The prevalence of dyslipidemia among young adults aged 18-45 years in the southeastern coast of China was high with 7.1, 15.0, 22.9, and 4.0% for high-total cholesterol (TC), high-triglyceride (TG), low-high-density lipoprotein cholesterol (HDL-C), and high-low-density lipoprotein cholesterol (LDL-C). Among those with dyslipidemia, a statistically significant difference in sex was observed, and all types of dyslipidemia were associated with smoking and alcohol consumption. However, those with high-TG, high-LDL, and low-HDL levels did not significantly differ in education level or occupation. The presence of dyslipidemia was significantly associated with increased age, the male sex (OR: 1.85, 95% CI: 1.39-2.21), smoking (OR: 2.02, 95% CI: 1.98-2.13), alcohol consumption (OR: 1.33, 95% CI: 1.16-1.63), overweight or obesity (OR: 2.01, 95% CI: 1.79-2.41), and intellectual work (OR: 1.36, 95% CI: 1.11-1.72). Conclusion: The prevalence of dyslipidemia among young adults aged 18-45 years in the southeastern coast of China was high. To prevent dyslipidemia at an early age, it is essential to conduct effective intervention programs targeting risk factors and to implement routine screening programs.

Serum interleukin-33 as a novel marker for long-term prognosis and recurrence in acute ischemic stroke patients

OBJECTIVES

Interleukin-33, a newly identified member of interleukin-1 family, had been confirmed to play a crucial role in regulating inflammatory responses in various disease. However, the exact role of interleukin-33 in the disease process of acute ischemic stroke still remains unclear. This study aims to demonstrate the relationship between interleukin-33 levels and long-term functional outcome as well as ischemic stroke recurrence.

METHODS

Three hundred and four first-ever acute ischemic stroke patients were recruited and basic information and history of all subjects taken within 72 hr on admission. The functional outcome was estimated by Barthel index. The multivariate logistic regression was used to analyze the prognosis, while the Cox proportional hazard model was applied to assess the recurrence risk.

RESULTS

Out of 304 subjects, 259 patients successfully completed scheduled two-year follow-up. We found that higher interleukin-33 levels correlated positively with better prognosis as compared with those with lower interleukin-33 levels who presented with poorer outcome (62.45 ± 20.50 ng/ml vs. 51.58 ± 19.16 ng/ml, p < .001). After adjustment of all confounders, interleukin-33 was associated with the one-year prognosis with an adjusted odds ratio of 0.956 (95% confidence interval, 0.937-0.976, p < .001). Furthermore, interleukin-33 levels were also closely related to recurrent ischemic stroke with an adjusted hazard ratio of 0.979 (95% confidence interval, 0.961-0.997, p = .025).

CONCLUSIONS

IL-33 can be used to predict the long-term outcomes and ischemic stroke recurrence in first-ever acute ischemic stroke patients.

[Clustering of vestibular direction-selective neurons in macaque parieto-insular vestibular cortex]

Neurons with direction-selectivity for vestibular stimuli are found in a number of cortical areas, and neurons in the ventral intraparietal area (VIP) and the dorsal subdivision of the medial superior temporal area (MSTd) of the macaque brain are clustered according to their direction preferences for vestibular signals. This raises the question where the clustering inherits from? Previous work has shown that VIP and MSTd most probably receive vestibular input from the parieto-insular vestibular cortex (PIVC), which processes vestibular signals at the earlier stage. Thus, PIVC is also supposed to show a clustered organization similar to that seen in VIP and MSTd. The present study was aimed to examine clustering properties of vestibular response in PIVC area. To address this issue, we compared the tuning of isolated single unit (SU) with the undifferentiated multiunit (MU) activity of several neighboring neurons recorded from the same microelectrode. When directional tuning was observed in MU activity, the direction preference generally agreed closely with that of a simultaneously recorded SU. These results suggest that PIVC neurons are indeed clustered according to preferred direction for both translational and rotational vestibular stimuli.