微血管减压与经皮穿刺球囊压迫治疗原发性三叉神经痛的临床观察

目的:对比微血管减压(MVD)和经皮穿刺球囊压迫(PBC)治疗原发性三叉神经痛(PTN)的疗效。方法:选择2010年5月至2013年11月在我院接受治疗的PTN患者124例进行研究,根据数字法随机分成MVD组及PBC组各62例,两组分别行对应手术,随访18个月,对比两组手术相关指标、疗效以及术后并发症。结果:MVD组的手术时间与术中出血量,以及住院时间和住院费用均分别大于PBC组(均P0.05)。MVD组治疗后完全无痛的比例显著高于PBC组,轻度复发的比例显著低于PBC组(均P0.05)。MVD组的麻木及总并发症发生率均分别显著低于PBC组(均P0.05)。结论:MVD术式与PBC术式在治疗PTN时均具有较好的疗效,MVD术后无痛和并发症情况较好,而PBC创伤较小,较适合高龄体弱而无法耐受较大手术者,临床治疗时应合理地选用相关术式。     

DEEP球囊介入治疗糖尿病足的临床疗效评估

目的:评估Deep球囊扩张膝关节以下动脉及支架置入治疗糖尿病足的临床疗效及其安全性.方法:选择2007年8月～2011年8月我院收治的96例糖尿病足患者并将其随机分成A、B两组,A组(74例)使用deep球囊扩张膝关节以下细小动脉甚至足背动脉,合并股动脉狭窄者植入支架;B组(22例)单纯给以抗凝、扩血管、溶栓及相关治疗.分别观察记录和比较治疗前、后及术后1周、1、3、6、10个月患者下肢及足部皮肤颜色、温度、静息痛、足背动脉搏动、间歇性跛行、溃疡愈合情况.结果:(1)糖尿病足的血管病变多为膝关节下的动脉,包括胫前、胫后、腓动脉以及以下分支,常累及双侧数支动脉,呈阶段性分布;(2)A、B组的有效率分别为88.32％和48.63％,A组显著高于B组(P＜0.05);(3)溃疡愈合情况:0-2期A组:100％愈合,B组83.72％;3-4期A组56.25％愈合,B组18.46％,对于溃疡治疗的有效率A组显著高于B组(P＜0.05).结论:Deep球囊扩张糖尿病足膝关节以下动脉联合动脉支架术治疗糖尿病足与保守治疗相比,效果明显,可恢复下肢动脉血供,明显消除和缓解静息痛、间歇性跛行,促进溃疡的愈合.降低截肢的几率.改善生活质量.     

球囊霉目一新种：长孢球囊霉

从福建厦门市郊芒果园、南靖县鳞苞锥和广西玉林市郊巨尾按根区采集的土样中分离到一个球囊霉属的新种——长孢球囊霉。本文描述了该种的形态特征及生态环境。     

三叉神经痛的临床治疗进展

三叉神经痛是一种常见的面部疼痛性疾病,目前对其病因的认识并不明确。普遍认为压迫可导致三叉神经痛,致病原因包括血管因素和非血管因素,其次创伤也可导致三叉神经痛,常见于口腔外科手术后。三叉神经痛的治疗方法较多,首选药物治疗,包括全身用药和局部用药,药物治疗初期效果明显,但很难治愈三叉神经痛,而且需要长期服药,副作用较大,当药物治疗无效或者患者难以耐受其副作用时,可采用外科疗法进行辅助治疗。三叉神经痛的外科疗法主要包括无创的微血管减压术及有创的射频热凝术、球囊压迫术和甘油毁损术。近年来采用放射外科对三叉神经痛进行治疗,取得了确切效果。此外,还有一些关于其他治疗方法的文献报道,均有一定效果。本文对三叉神经痛病因的认识及临床治疗进展作一回顾性综述。     

家族性三叉神经痛

三叉神经痛是一种临床常见疾病,典型的三叉神经痛主要表现为阵发性、闪电样的疼痛发作,疼痛剧烈,常无法忍受,呈电灼、针刺、撕裂样,每次发作持续时间数秒至数分钟不等。疼痛多发生于单侧,常有扳机点表现,其多表现为散发,而家族性三叉神经痛报道罕见,至今世界范围内报道仅50余个家系,其临床表现及发病特点与散发性三叉神经痛存在明显差别,尽管散发三叉神经痛患者的病因为责任血管压迫三叉神经REZ区已被普遍接受,但关于家族性三叉神经痛的病因是否为血管压迫存在争议,其遗传模式也没有达成一致的意见,文章复习了相关文献,并通过对这些文献进行分析综合,结合我们治疗三叉神经痛的经验,对其病因、发病机制、诊断和治疗原则、遗传模式等作了系统综述。     

PCI术前与术后主动脉内球囊反搏治疗急性心肌梗死合并心功能不全患者的疗效比较

目的:比较急性心肌梗死合并心功能不全患者冠状动脉介入(PCI)术前及术后植入主动脉内球囊反搏术(IABP)的效果及其安全性.方法:选择50例2010年1月至2011年6月在南京市第一医院CCU病房应用IABP治疗的急性心肌梗死患者,分为两组,A组为术前组,B组为术后组,各25例,观察并比较两组的即刻病情改善率、住院期间并发症及术后30天心功能、主要心血管事件(MACE)发生率.结果:A组IABP即刻病情改善显著高于B组(36％ vs.12％,P＜0.05).两组住院期间并发症的发生率均无统计学差异(P＞0.05).术后30天,A组LVEF显著低于B组(40.2± 7.7％vs.35.6±5.0％,P＜0.05).MACE事件,A组非致死性心肌梗死、再次PCI/CABG术及死亡发生率低于B组,其中A组死亡率显著低于B组,差异有统计学意义(58％vs.32％,P＜0.05).结论:PCI术前植入IABP对于急性心肌梗死合并心功能不全患者的疗效优于PCI术后植入,且不提高并发症的发生率.     

VA真菌球囊霉属种的简表

本文以简表形式介绍了VA真菌球囊霉属73个种的主要特征。简表首先根据孢子颜色将球囊霉属分成三组,每组内的种按孢子大小由小到大排列。在按一定程序观察孢子形态特征后,可利用本表初步查种。但本表不是检索表,也不是种的详述。因此,须经查对该种的详细描述及标本,图片后方可定种。     

原发性三叉神经痛和疱疹后三叉神经痛临床特征及射频热凝术后效果分析

摘要 目的：探讨原发性三叉神经痛（PTN）和疱疹后三叉神经痛（PHN）的临床特征,并比较经卵圆孔射频热凝术（RF-TC）治疗PTN和PHN的临床疗效。方法：随机选取2019年1月至2020年8月在我院治疗的三叉神经痛患者123例,其中原发性三叉神经痛90例,带状疱疹后神经痛33例。所有患者均通过RF-TC进行治疗,治疗后通过视觉模拟量表（VAS）、巴罗神经研究所疼痛强度量表对面部疼痛评分进行疼痛评估,通过巴罗神经研究所麻木评分进行麻木评定,通过健康问卷-9对患者抑郁情况进行评估,通过匹斯堡睡眠质量指数测量患者心理状态。结果：PTN患者发病年龄显著低于PHN患者（P<0.05）,而病程显著高于PHN患者（P<0.05）;PHN患者的眼支发生率高于PTN患者（39.39% vs 8.89%, P<0.05）。两组患者经RF-TC治疗前后VAS评分无显著差异（P>0.05）。PHN组从轻度到重度影响睡眠质量的比例显著高于PTN组（30.30% vs 10.00%, P<0.05）。PTN组患者治疗后中重度抑郁患者比例显著高于PHN组患者（21.11% vs 9.09%, P<0.05）。两组患者经RF-TC治疗后,临床治疗有效率、面麻木程度以及巴罗神经研究所疼痛强度量表评定的面部疼痛无显著差异（P>0.05）。结论：经卵圆孔射频热凝术治疗原发性三叉神经痛和带状疱疹后三叉神经痛是安全有效的,但治疗后疱疹后三叉神经痛失眠的发生率较高,而原发性三叉神经痛的抑郁发生率较高。     

导管接触性溶栓同期球囊扩张+支架治疗血栓性髂静脉压迫综合征的疗效

摘要 目的：为提高治疗效率,本研究对髂静脉压迫综合征合并下肢深静脉血栓患者的导管接触溶栓同期球囊扩张+支架治疗方案和分期治疗方案进行比较。方法：以65例髂静脉压迫综合征合并下肢深静脉血栓患者为研究对象,根据治疗方法分为研究组和对照组,研究组32例,进行导管接触溶栓同期球囊扩张+支架治疗,对照组33例,进行导管接触溶栓分期球囊扩张+支架治疗。以治疗前后患者大腿围、小腿围、血管通畅评分,手术指标（住院时间、住院次数、溶栓时间及穿刺次数）,并发症（血栓复发、出血以及肺栓塞）及深静脉血栓后遗症为指标,考察两组疗效。结果：两组患者大腿围、小腿围和静脉畅通评分在治疗前均无显著差异（P＞0.05）,经过治疗,两组大腿围、小腿围和静脉畅通评分均显著改善（P＜0.05）,但两组间各项指标无显著差异（P＞0.05）。研究组患者住院时间、住院次数、溶栓时间及穿刺次数均显著低于对照组（P＜0.05）。研究组血栓复发0例,对照组血栓复发4例,有显著差异（P＜0.05）;研究组出血1例,肺栓塞0例,对照组出血2例,肺栓塞0例,两组出血和肺栓塞情况比较,无显著差异（P＞0.05）。研究组PTS发生率为6.25 %,显著低于对照组的18.18 %（P＜0.05）。结论：导管接触溶栓同期球囊扩张+支架治疗方案对髂静脉压迫综合征合并下肢深静脉血栓有良好的疗效。     

球囊霉素相关土壤蛋白根际环境功能研究进展

球囊霉素(glomalin)是丛枝菌根真菌产生的一种含有金属离子的耐热糖蛋白, 能够改善土壤结构, 固定土壤中的重金属, 近期被更名为球囊霉素相关土壤蛋白(glomalin-related soil protein)。该文从球囊霉素的定义、性质与环境功能等方面对相关文献进行了综述, 认为目前对球囊霉素的共识仍停留在理论假设蛋白的程度上, 包括: 1)该蛋白可能是热激蛋白60 (HSP 60)的同系物; 2)该蛋白所携带的阳离子可能随着土壤性质的改变而不同。目前还没有清楚确切地定义球囊霉素的真实分子结构与理化性质。今后需从分子层面对球囊霉素予以深入研究。同时, 需要不断改进球囊霉素的提取和测定方法, 以便进一步探讨球囊霉素固定重金属离子的机理, 提高植物的重金属抗性。     

Fluorescence visualization of the neuropathic pain triad in trigeminal neuralgia

Trigeminal neuralgia (TN), an exemplary condition of neuropathic facial pain, seriously affects the physical and mental health of patients, becoming a major medical and social problem. So far, the mechanism of TN and its relation to neuronal activity remain unclear, largely limited by the spatial resolution of visualization methods. In the meanwhile, current therapeutic strategies targeting neurons have not achieved satisfactory outcome. Here, we investigate the neuropathic pain triad in TN by establishing an animal model of TN by chronic constriction injury of the unilateral infraorbital nerve (ION-CCI) and leveraging the single-cell resolution of confocal microscopy, including neuronal hyperexcitability, glial activation, and macrophage polarization. These results can broaden the understanding of TN pathogenesis from neurons to the neuropathic pain triad, and suggest that optical microscopy can provide new opportunities for understanding the complex pathogenesis of TN at single-cell resolution, potentially contributing to the identification of more precise therapeutic targets and the development of more effective treatment modalities.     

Five-and-a-half years' experience with percutaneous retrogasserian glycerol rhizotomy in treatment of trigeminal neuralgia

The results of treating trigeminal neuralgia with percutaneous retroganglionic glycerol rhizotomy in 319 patients from an overall series of 394 patients with 459 operations carried out over a period of 5 1/2 years are reported. Idiopathic trigeminal neuralgia was the diagnosis in 252 patients. 34 patients had trigeminal neuralgia associated with multiple sclerosis. The remaining 33 patients suffered from symptomatic trigeminal neuralgia or atypical facial pain. 230 patients (91.3%) with idiopathic trigeminal neuralgia and 30 patients (88.2%) with multiple sclerosis reported complete freedom from pain. In 12 patients (4.8%) of those with tic douloureux and in 1 patient (2.9%) with multiple sclerosis, pain was alleviated, and the patients required a reduced pharmacotherapy. 10 patients (3.9%) and 3 patients (8.8%) were considered to be treatment failures. The rate of recurrences within the first 2 years was 10.9 and 40.0%, respectively. In the long-term, the rate of recurrences in patients with tic douloureux was 36.9%. 144 patients (45.1%) noticed a hypesthesia. 132 patients (41.4%) had hypalgesia following the procedure, and there was a decrease of symptoms in the long-term observation in 20.0% of the patients. 59 patients (18.5%) developed dysesthesia postoperatively which regressed only to an inappreciable extent in the long-term course. In 16 patients (5.0%) exclusively with a preexisting organic lesion or who had received surgical pretreatment, there was a loss of corneal sensation. The investigation showed on the one hand the effectiveness of the method, but on the other hand also the possibility of marked sensory disorder in selected cases.     

Application of stereotactic principles to the treatment of trigeminal neuralgia.

The application of neuroanatomical and neurophysiological principles to the functional surgery of the trigeminal nerve is discussed. Particular attention has been directed toward correlating the three-dimensional anatomical features of the trigeminal nerve and the surrounding structures to the two-dimensional radiograph of this same region. In this regard, 20 trigeminal nerves, including the surrounding neurovascular structures from 10 cadaver sphenoid blocks, were examined. Measurements of the third, fourth and sixth cranial nerves in relation to the profile of the clivus were made from lateral radiographs of the sphenoid blocks. The position of the internal carotid artery in relation to these structures was also noted. These neurovascular relationships are of clinical importance when using the percutaneous thermocoagulation technique for the treatment of trigeminal neuralgia.     

Therapeutic protocol in the treatment of trigeminal neuralgia

The ideal treatment of trigeminal neuralgia is still an open question. A recent large series reporting the results from the three available percutaneous techniques has been reviewed. Fifty consecutive cases, treated from January 1984 to January 1985, are reported. Microcompression was performed as the first approach in all cases. The other techniques were adopted only in case of failure of microcompression.     

Effect of coenzyme Q10 on mitochondrial respiratory proteins in trigeminal neuralgia

Trigeminal neuralgia (TN) is the neuropathic pain. Mitochondrial dysfunction, increased oxidative stress, and inflammation demonstrated in chronic pain. Carbamazepine (CBZ) is the first-line drug for TN, however, it is still insufficient. Coenzyme Q10 (CoQ10) has been used as the additional supplement for pain therapy. Nonetheless, mitochondrial respiratory proteins, oxidative stress, and inflammation in TN, and the add-on effects of CoQ10 on those defects have never been investigated. CBZ-treated TN-patients, naïve TN-patients, and control subjects were included. CBZ-treated TN-patients were randomised into two subgroups, received either CoQ10 or placebo for 2 months. Pain levels were evaluated, and peripheral blood mononuclear cells were isolated to determine the oxidative stress, mitochondrial oxidative phosphorylation (OXPHOS), peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), and cytokines including TNF-α, IL-1β and IL-18 mRNA expression. Pain scales, oxidative stress, and OXPHOS levels were greater in naïve TN-patients than control, whereas the cytokine profiles were unchanged. Although pain scales were lower in CBZ-treated TN-patients than in naïve TN-patients, oxidative stress, OXPHOS, and cytokine expression profiles were not different. PGC-1α levels found to be increased in CBZ-treated TN patients when compared with the naïve group. CoQ10 supplement in CBZ-treated TN patients reduced pain scale and oxidative stress and increased antioxidants levels when compared with placebo group. However, OXPHOS, PGC-1α, and cytokines were not different between groups. These findings suggest that increased oxidative stress could be potentially involved in the pathogenesis of TN. CoQ10 supplements can reduce oxidative stress, leading to more effective pain reduction in TN patients being treated with CBZ.     

微血管减压术在三叉神经痛患者中的应用及预后分析

目的:分析微血管减压术在三叉神经痛患者中的应用及预后效果。方法:选取2015年8月至2016年7月我院收治的86例三叉神经痛患者,根据患者入院顺序分为观察组43例和对照组43例。对照组予以三叉神经节射频热凝治疗,观察组使用微血管减压术完成治疗。比较两组患者临床疗效,疼痛情况、睡眠情况,生存质量。结果:治疗后,观察组临床总有效率显著高于对照组[93.02%(40/43)比72.09%(31/43)](P0.05)。观察组的视觉模拟评分(VAS)、匹茨堡睡眠质量指数量表评分(PSQI)显著低于对照组[(3.35±0.31)分、(7.02±0.81)分比(5.68±0.57)分、(8.45±0.92)分](P0.05)。观察组的生存质量评分显著高于对照组[(83.43±8.22)分比(68.98±6.51)分](P0.05)。结论:在三叉神经痛患者中经微血管减压术治疗,能降低患者疼痛程度,提高睡眠质量和生存质量,有利于患者预后的改善。     

Problems with retrogasserian glycerol in the treatment of trigeminal neuralgia

Following glycerol injections for trigeminal neuralgia. H?kanson, Lunsford, Apfelbaum, Beck and Lobosky and Dieckmann, among others, report that few patients have sensory loss and dysesthesia and a high percentage have sustained gratifying relief. Such was not our experience or that of Laitinen, Price, Siegfried, or Takusagawa, among others. Our own disappointing results re initial failures to achieve relief, significant sensory loss including corneal anesthesia and some dysesthesias in 77 patients are described.