Peripheral nerve injury often results in neuropathic pain and triggers nerve repair processes. Whilst controllable physical injury models are now well-established, existing thermal injury models remain exploratory and exhibit poor controllability. In clinical practice, radiofrequency ablation (RFA) systems are frequently employed to induce thermal injury to tissues and nerves. RFA is a therapeutic modality that has been demonstrated to effectively block pain transmission by inducing thermal damage to nerves. The extent of the ablation can be modified by adjusting specific parameters, as well as the degree of numbness and motor dysfunction in the affected nerve distribution area. This study used a monopolar radiofrequency system to create a stable, controllable nerve injury model in the sciatic nerve of mice by applying 75°C for 30 s. A significant increase in mechanical withdrawal threshold (MWT) was observed from days 7-14 post-surgery, with recovery occurring by day 28. This research addresses the current gap in RFA nerve injury models, replicates the nerve damage observed clinically after RFA procedures, and provides a methodological framework for subsequent studies on RFA-induced nerve injury.

BACKGROUND:Postherpetic neuralgia (PHN) is a challenging and persistent neuropathic pain condition that is often unresponsive to standard pharmacological treatments. Minimally invasive interventional therapies for PHN have been increasingly adopted in clinical practice. In recent years, low-temperature plasma ablation (LTPA) has demonstrated potential advantages and promising applications for managing chronic neuropathic pain. However, few studies have explored the use of LTPA in treating PHN. OBJECTIVES:To evaluate the effectiveness and safety of LTPA in treating PHN, with a focus on differences in outcomes among patients with varying durations of the disease. STUDY DESIGN:Retrospective cohort study. SETTING:Department of Pain Management, Xuanwu Hospital, Capital Medical University. METHODS:A retrospective analysis was conducted on 109 PHN patients treated with LTPA in our department from January 2023 to March 2024. Patients were categorized into 2 groups based on the duration of their disease: Group A (disease duration < 3 months) and Group B (disease duration >= 3 months). Pre-treatment pain levels were assessed using a Numeric Rating Scale (NRS), as were pain levels at one month and 3 months after treatment. Sleep quality was measured using the Medical Outcomes Study Sleep Scale (MOS-SS). Treatment efficacy was evaluated by comparing pre- and post-treatment data, with a reduction of at least 50% in NRS scores at 3 months after treatment considered the criterion for treatment success. The effective rates between the 2 groups were compared. Adverse events were recorded to assess the safety of the procedure. RESULTS:At all follow-up time points, NRS scores in both groups were significantly lower than pre-treatment scores (P < 0.05). At one and 3 months after treatment, Group A had significantly lower NRS scores (2.85 ± 1.89 and 2.74 ± 2.08) than did Group B (3.77 ± 1.91 and 3.71 ± 2.03, respectively; P < 0.05). The treatment success rate at 3 months after the treatment was significantly higher in Group A (78.72%) than in Group B (59.68%; P < 0.05). Both groups showed significant improvements from the pre-treatment MOS-SS sleep scores (in sleep disturbance [SLPD], sleep adequacy [SLPA], sleep quality [SLPQ], and comprehensive sleep disorder index [9-items]) at the one-month and 3-month follow-up points (P < 0.05), with no significant differences between the 2 groups at any time point after treatment. No severe adverse events were reported in either group during treatment or follow-up. LIMITATIONS:The single-center setting, relatively small number of patients, short duration of the review of medical records, and retrospective nature of the study. CONCLUSIONS:LTPA offers effective and sustained pain relief and sleep quality improvements for PHN patients and has a favorable safety profile.

Spinal cord stimulation (SCS) has emerged as a promising modality for managing zoster-associated pain (ZAP). This study aimed to evaluate the efficacy and safety of short-term spinal cord stimulation (SCS) for treating ZAP during the subacute phase. Records of patients undergoing transforaminal epidural injection (TFEI), pulsed radiofrequency (PRF), and short-term SCS were retrospectively reviewed. A 1:2:2 propensity-score matching was performed. The primary endpoint was Numeric Rating Scale (NRS) pain scores at 3 months after rash onset. Secondary endpoints included postherpetic neuralgia (PHN) incidence, Hospital Anxiety and Depression (HADS) scores, Pittsburgh Sleep Quality Index (PSQI) scores, quality-adjusted life years (QALY) scores, and adverse events. At 3 months post-rash onset, mean NRS pain score was 1.59 ± 1.18 in SCS cohort, which was lower than that of 4.80 ± 1.41 in TFEI cohort and 4.54 ± 1.40 in PRF cohort, with the difference exceeding the prespecified minimal clinically important difference of three points (p < 0.001). PHN occurred in 8.9

INTRODUCTION:Evaluation of ultrasound (US)-guided disc block used to diagnose discogenic pain, as described in case reports. The study aimed to ascertain the noninferiority of US-guided lumbar disc block to conventional discography in the diagnosis of discogenic low back pain (DLBP). MATERIAL AND METHODS:The reports of 418 patients undergoing lumbar fusion for DLBP were stratified into a US group receiving US-guided lumbar disc block and a control group receiving fluoroscopy (FL)-assistant discography via a propensity-score matched method in a 1 : 1 ratio. The primary endpoint was the confirmatory rate defined as the rate of clinical success following surgery measured by a numerical pain rating scale score ≤ 2 and an Oswestry Disability Index score ≤ 15 at the 1-month follow-up point. Secondary outcomes included needle insertions until contrast given, procedure time, radiation dosages and adverse events. RESULTS:The confirmatory rates for disc block and discography were 71.8% and 73.2% (difference = -1.3%, 95% confidence interval [CI]: -9.9%, 7.2%, P = 0.353). The lower bound of 95% CI did not cross the noninferiority margin of 10%. There were fewer needle insertions (median 2, IQR: 1-3 vs. 5, IQR: 4-6, P < 0.001), shorter procedure times (8.94 ± 2.28 vs. 16.13 ± 3.39 min, P < 0.001) and lower radiation dosage (1689.56 ± 898.54 vs. 8293.50 ± 1039.09 μGy m2 , P < 0.001) in the US group than the control group. No serious adverse events were observed. CONCLUSIONS:US-guided lumbar disc block was not inferior to conventional discography as a diagnostic modality in the evaluation of DLBP being considered for surgery. Given that the sonographic method provided advantages in terms of facilitation of needle insertion, reduced procedure time, and attenuated radiation exposure, it might be an alternative option for surgery decision making.

Aim:To assess whether ultrasound (US)-guided intercostal nerve blocks (ICNBs) provide non-inferior efficacy in the management of acute zoster pain (ZAP) and potential prophylaxis for post-herpetic neuralgia as compared to conventional thoracic paravertebral blocks (TPVBs). Material and methods:A total of 192 patients with ZAP were reviewed. Their records were stratified into two cohorts: those who underwent US-guided TPVBs (TPVB cohort) and those who received US-guided ICNBs (ICNB cohort). The ICNB cohort was matched using a propensity score method in a 1:1 ratio. The primary endpoint was non-inferiority of Herpes zoster (HZ)-related illness burden within 30 days (HZ-BOI30) post-procedure. Secondary outcomes included procedure time, rescue analgesic use, post-herpetic neuralgia occurrence, health-related quality of life, and adverse events. Results:Mean score of HZ-BOI30 was 87.92 ± 21.84 and 85.64 ± 17.01 in the TPVB and ICNB cohorts, respectively, with a mean difference of 2.28 (95% confidence interval (CI): -5.68, 10.24). Non-inferiority was met, as the 95% CI for the absolute difference in HZ-BOI30 fell within the predefined non-inferiority margin of 15 points. Comparable improvements in post-herpetic neuralgia incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed in both cohorts across all follow-up time points (all p >0.05). In contrast, the ICNB approach was associated with shorter procedure times (p <0.001) and reduced discomfort and pain during needle insertion (p <0.001). There were no complications, including pneumothorax, nerve injury, or intravascular injection in either study cohort. Conclusions:US-guided ICNBs were non-inferior to TPVBs in alleviating ZAP and preventing post-herpetic neuralgia, while also demonstrating a favorable safety profile. These findings suggest that the ICNB technique might be a promising alternative for managing ZAP.

This study aimed to investigate the clinical value of radiofrequency ablation (RFA) of the sinuvertebral nerve (SVN) in the treatment of discogenic low back pain (DLBP) following lumbar interbody fusion. A total of 12 patients who underwent RFA of the SVN for DLBP after lumbar interbody fusion at the Pain Department of Xuanwu Hospital of Capital Medical University from February 2023 to August 2023 were included in this retrospective study. In total, 12 patients with DLBP were included. The preoperative visual analog scale (VAS) score was 7.00(6.00, 7.75), while the postoperative VAS score at 1 day, 1 month, and 3 months was 1.00 (1.00, 1.00). This represented a statistically significant improvement compared to the preoperative period (all p = 0.002). The preoperative Pittsburgh Sleep Quality Index (PSQI) score was 14.42 ± 1.83, and the postoperative PSQI scores at 1 month and 3 months were 4.75 ± 1.06 and 2.17 ± 1.11, respectively (all p < 0.001). RFA of the SVN provides satisfactory short-term clinical results in patients with DLBP following lumbar interbody fusion. It appears to be an effective treatment for patients with DLBP who have poor outcomes after open lumbar spine surgery.

Background:This study aimed to examine the efficacy and safety of ultrasound (US)-guided superior cervical ganglion (SCG) block in conjunction with standard triptan in the management of migraine attacks. Methods:In total, 243 subjects who received an adjunctive US-guided SCG block alongside triptan for a migraine attack were enrolled as the SCG cohort. A 1:1 propensity score based on baseline covariates was used to match 243 cases who received triptan alone as the control. The primary endpoints were pain relief and freedom from pain within 24 h after the procedure. Secondary outcomes included headache relief and freedom from pain within 2 h, monthly migraine days (MMDs), Migraine Disability Assessment (MIDAS) scores, Migraine-Specific Quality of Life questionnaire (MSQ) scores, and adverse events. Results:The rates of pain relief and freedom from pain at 24 h after the block were increased in the SCG cases compared to the controls {73.3% vs. 49.4%, with mean difference [MD] of 23.9% [95% confidence interval (CI): 15.5%-29.0%] and 64.2% vs. 37.4%, with MD = 26.7% [95% CI: 18.2%-31.3%], respectively}. Superiority was met, as the 95% CI fell within the superiority margin of 15%. Higher rates of pain relief and freedom from pain at 2 h following the procedure were reported in the SCG cohort (both p < 0.001). At the 1-month follow-up, the SCG cohort had a greater improvement in MMDs (p < 0.01), MIDAS scores (p = 0.040), and MSQ scores (p = 0.036). There were no severe adverse events in the SCG group. Conclusions:US-guided SCG block with triptan was superior to triptan alone in achieving headache remission during a migraine attack for up to 24 h, resulting in reduced migraine days and improved functional ability and life quality at the 1-month follow-up.

Background Cervical spine disorders are becoming increasingly common, particularly among sedentary populations. The accurate segmentation of cervical vertebrae is critical for diagnostic and research applications. Traditional segmentation methods are limited in terms of precision and applicability across imaging modalities. The aim of this study is to develop and evaluate a fully automatic segmentation method and a user-friendly tool for detecting cervical vertebral body using a combined neural network model based on the YOLOv11 and U-Net3 + models.Method A dataset of X-ray and magnetic resonance imaging (MRI) images was collected, enhanced, and annotated to include 2136 X-ray images and 2184 MRI images. The proposed YOLO-UNet ensemble model was trained and compared with four other groups of image extraction models, including YOLOv11, DeepLabV3+, U-Net3 + for direct image segmentation, and the YOLO-DeepLab network. The evaluation metrics included the Dice coefficient, Hausdorff distance, intersection over union, positive predictive value, and sensitivity.Results The YOLO-UNet model combined the advantages of the YOLO and U-Net models and demonstrated excellent vertebral body segmentation capabilities on both X-ray and MRI datasets, which were closer to the ground truth images. Compared with other models, it achieved greater accuracy and a more accurate depiction of the vertebral body shape, demonstrated better versatility, and exhibited superior performance across all evaluation indicators.Conclusion The YOLO-UNet network model provided a robust and versatile solution for cervical vertebral body segmentation, demonstrating excellent accuracy and adaptability across imaging modalities on both X-ray and MRI datasets. The accompanying user-friendly tool enhanced usability, making it accessible to both clinical and research users. In this study, the challenge of large-scale medical annotation tasks was addressed, thereby reducing project costs and supporting advancements in medical information technology and clinical research.

Phantom limb pain (PLP), defined as neuropathic pain perceived in the missing portion of an amputated limb, represents a common and refractory condition significantly impairing patient rehabilitation and quality of life. Its pathogenesis is multifactorial, involving complex interactions between peripheral mechanisms (e.g., neuroma formation, ectopic discharges), central nervous system reorganization (including cortical remapping and spinal cord sensitization), and psychological components. Patients frequently present with heterogeneous pain descriptors, such as burning, shooting, or cramping sensations, which often coexist with residual limb pain, complicating clinical assessment. Despite the availability of diverse therapeutic interventions-ranging from pharmacotherapy (e.g., gabapentinoids, antidepressants, NMDA receptor antagonists) and physical modalities (e.g., transcranial magnetic stimulation, mirror therapy) to interventional procedures (e.g., nerve blocks, neuromodulation) and psychological approaches-treatment outcomes remain variable, and standardized clinical guidelines are lacking. This consensus, formulated by a panel of Chinese pain specialists, systematically reviews contemporary evidence on the epidemiology, pathophysiology, diagnosis, and management of PLP. It aims to establish practical, evidence-based recommendations to guide the standardized diagnosis and stratified treatment of PLP, thereby optimizing therapeutic efficacy and improving functional outcomes for affected individuals.

Pain-related behavioral research in animals is profoundly influenced by a constellation of interacting factors. This study explored the effect of device color and sex on exploratory and anxiety-related behavior of C57BL/6 mice in the von Frey test. Mice in 4 groups based on device color (red vs clear) and sex (male and female), behavioral observations were made during a 15 min adaptation period following the mice's entry into the test device, and mechanical pain thresholds were assessed using the von Frey test before and after inducing neuropathic pain through spared nerve injury surgery. Results showed mice in the red device exhibited significantly reduced exploratory and anxiety-related behavior, entered a resting state more rapidly and stabilized across the three 5 min periods compared to those in the clear one. On the 7th and 14th day after surgery, the mechanical pain threshold decreased in all groups. However, there were no significant differences between male and female. Device color could affect behavioral responses in the adaptation of von Frey test, and red device potentially improves test efficiency by reducing the necessary adaptation period. These findings emphasize the importance of considering environmental factors in pain research with von Frey test, and the red device can simulate red visible light environments that facilitate faster behavioral stabilization, which enhances the experiment efficiency and respects rodent nocturnal habits.

To evaluate the therapeutic efficacy of mesenchymal stem cells (MSCs) overexpressing miR-216a-5p delivered via a thermosensitive hydrogel in a rat model of spinal cord injury (SCI). A thermosensitive hydrogel was engineered to encapsulate MSCs overexpressing miR-216a-5p (MSC-miR-216a-5p). The hydrogel-cell construct was characterized for its physical properties and transplanted into rats with contusion SCI. Functional recovery was assessed using the Basso, Beattie, and Bresnahan (BBB) locomotor scale, mechanical withdrawal threshold (MWT), and thermal withdrawal latency (TWL). Inflammatory responses were evaluated by measuring pro-inflammatory cytokine levels. The engineered hydrogel demonstrated suitable mechanical properties, temperature-dependent swelling, and controlled degradation behavior. Rats treated with hydrogel-encapsulated MSC-miR-216a-5p showed significantly improved functional recovery, evidenced by higher BBB, MWT, and TWL scores than control groups. The treatment effectively modulated the inflammatory response by reducing pro-inflammatory cytokine levels. Mechanistic studies identified GPBP1 as a direct target of miR-216a-5p, mediating the observed neuroprotective and anti-inflammatory effects. The combination of miR-216a-5p-overexpressing MSCs with a thermosensitive hydrogel delivery system represents a promising therapeutic strategy for SCI treatment. This approach promotes functional recovery and modulates inflammatory responses through GPBP1 targeting, offering potential for clinical translation in SCI therapy.

BACKGROUND:Percutaneous balloon compression (PBC) is a surgical intervention for trigeminal neuralgia. This study hypothesized that PBC under regional anesthesia (RA) could reduce intraoperative hemodynamic fluctuations and postoperative adverse effects with efficacy equivalent to general anesthesia (GA). METHODS:In this retrospective cohort study, 159 patients who underwent PBC for trigeminal neuralgia at Xuanwu Hospital Capital Medical University between January 2022 and June 2023 were divided into RA (n = 60) and GA (n = 99) groups. Comparative analysis included intraoperative hemodynamics, postoperative efficacy, and adverse reactions over 12-month follow-up. RESULTS:Compared with GA, RA resulted in more stable intraoperative hemodynamics and significantly reduced trigeminocardiac reflex risk (P < 0.01). Patients had shorter operative duration; had reduced medical expenses; and experienced lower extent and faster recovery of postoperative numbness, hypoesthesia, and bite force decrease (P < 0.05). The groups were similar regarding pain scale decrease, oral analgesic reduction, patient satisfaction, and specific adverse events over 1-year follow-up (P > 0.05). CONCLUSIONS:PBC under RA has efficacy similar to GA without the need for GA management and resuscitation. RA was associated with more stable intraoperative hemodynamics and lower trigeminocardiac reflex incidence; reduced perioperative risk; enabled intraoperative communication with conscious patients, allowing for real-time assessment and adjustment of balloon compression extent, so that adverse events such as numbness were milder with faster recovery; resulted in shorter operative duration; and reduced medical expenses. This study demonstrated the clinical advantages and broad application prospects of PBC under RA, benefiting more patients with trigeminal neuralgia in remote areas.

Percutaneous balloon compression (PBC) is recognized as a simple, safe, and effective intervention for trigeminal neuralgia (TN) and has been widely adopted in clinical practice across China. However, variations in its application exist among different regions. To standardize procedural protocols and enhance clinical outcomes, a multidisciplinary panel of Chinese experts from pain medicine and neurosurgery collaboratively developed this clinical expert consensus. The consensus formulation involved a systematic literature review of major databases, including Wanfang and PubMed, among others, and focusing on high-quality evidence such as systematic reviews, meta-analyses, randomized controlled trials, expert consensus statements, and clinical guidelines. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework and structured consensus conference methods, the panel held iterative discussions and conducted voting sessions to finalize the recommendations. This document summarizes key aspects of PBC, including relevant anatomy, mechanisms of action, indications, contraindications, detailed operative techniques, and efficacy evaluation. It aims to serve as a practical reference for clinicians to standardize and optimize the use of PBC in the treatment of trigeminal neuralgia.

Background:Percutaneous radiofrequency thermocoagulation is the foremost minimally invasive approach for treating primary trigeminal neuralgia. However, postoperative complications may arise, necessitating tailored clinical care to enhance patient compliance and mitigate surgical risks. Objective:This study aimed to explore the impact of comprehensive nursing intervention combined with percutaneous radiofrequency thermocoagulation on the management of primary trigeminal neuralgia in elderly patients. Design:A retrospective analysis was conducted. Setting:The study was conducted at the Department of Pain Management, Xuanwu Hospital of Capital Medical University. Participants:A total of 126 elderly patients diagnosed with primary trigeminal neuralgia underwent percutaneous radiofrequency thermocoagulation at our hospital between June 2019 and August 2022. They were enrolled as an observation cohort and randomly assigned to either the control group or the intervention group, with 63 patients in each. Intervention:The control group received standard nursing care, while the intervention group received comprehensive nursing interventions. Primary Outcome Measures:The study assessed (1) negative emotional changes, (2) postoperative status, (3) complications, and (4) quality of life. Results:After the nursing care, the intervention group exhibited significantly lower anxiety and depression scores compared to the control group (P < .05). Additionally, the intervention group had reduced length of hospital stay and pain scores, along with higher nursing satisfaction scores, relative to the control group (P < .05). There was a significant difference in the total complication rate between the two groups (P < .05), with the intervention group experiencing fewer complications. Moreover, the quality of life scores were significantly higher in the intervention group (P < .05). Conclusions:Comprehensive nursing intervention alongside percutaneous radiofrequency thermocoagulation in elderly patients with primary trigeminal neuralgia can decrease complication rates and enhance treatment confidence. These findings support the clinical adoption and dissemination of such interventions.

BACKGROUND:Radiofrequency thermocoagulation (RFT) of the thoracic nerve root is commonly employed in treating medication-refractory thoracic post-herpetic neuralgia (PHN). However, RFT procedures' suboptimal pain relief and high occurrence of postoperative skin numbness present persistent challenges. Previous single-cohort research indicated that the low-temperature plasma coblation technique may potentially improve pain relief and reduce the incidence of skin numbness. Nevertheless, conclusive evidence favoring coblation over RFT is lacking.OBJECTIVES:To compare the clinical outcomes associated with coblation to those associated with RFT in the treatment of refractory PHN.STUDY DESIGN:Retrospective matched-cohort study.SETTING:Affiliated Hospital of Capital Medical University.METHODS:Sixty-eight PHN patients underwent coblation procedures between 2019 and 2020, and 312 patients underwent RFT between 2015 and 2020 in our department. A matched-cohort analysis was conducted based on the criteria of age, gender, weight, pain intensity, pain duration, side of pain, and affected thoracic dermatome. Pain relief was assessed using the numeric rating scale (NRS), the Medication Quantification Scale (MQS) Version III and the Neuropathic Pain Symptom Inventory (NPSI), which were employed to indicate pain intensity, medication burden, and comprehensive pain remission at 6, 12, and 24 months. Numbness degree scale scores and complications were recorded to assess safety.RESULTS:We successfully matched a cohort of 59 patients who underwent coblation and an equivalent number of patients who underwent RFT as a PHN treatment. At the follow-up time points, both groups' NRS, MQS, and NPSI scores exhibited significant decreases from the pre-operation scores (P < 0.05). The coblation group's NRS scores were significantly lower than the RFT group's at the sixth and the twenty-fourth months (P < 0.05). At 24 months, the MQS values in the coblation group were significantly lower than those in the RFT group (P < 0.05). Furthermore, the coblation group's total intensity scores on the NPSI were significantly lower than the RFT group's at the 12- and 24-month follow-ups (P < 0.05). At 6 months, the coblation group's temporary intensity scores on the NPSI were significantly lower than the RFT group's (P < 0.05). Notably, the occurrence of moderate or severe numbness in the coblation group was significantly lower than in the RFT group at 6 and 12 months (P < 0.05). No serious adverse effects were reported during the follow-up.LIMITATIONS:This analysis was a single-center retrospective study with a small sample size.CONCLUSION:In this matched cohort analysis, coblation achieved longer-term pain relief with a more minimal incidence rate of skin numbness than did RFT. Further randomized controlled trials should be conducted to solidify coblation's clinical superiority to RFT as a PHN treatment.

BACKGROUND:Occipital neuralgia manifests as pain in the cutaneous distribution of occipital nerves, with the greater occipital nerve stemming from the C2 spinal nerve and the lesser occipital nerve originating from the C2 and C3 spinal nerves. While pulsed radiofrequency ablation of the C2 dorsal root ganglion (DRG) is an effective treatment for refractory occipital neuralgia, accessing the C2 DRG remains a clinical challenge even under fluoroscopic guidance. OBJECTIVE:We aimed to develop an ultrasonographic method for quickly and accurately accessing the C2 DRG. STUDY DESIGN:This is a prospective, observational cohort study. SETTING:Our study was conducted in the Department of Pain Management, Xuanwu Hospital, Capital Medical University, Beijing, China. METHODS:Unlike the C3-C8 foramina, which are ventral to the corresponding facet joints, the C2 foramen is positioned more posteriorly, dorsal to the C1-C2 atlantoaxial joint and longitudinally aligns with the cervical facet joints of C2-C3 and C3-C4. This unique anatomical feature allowed us to rapidly identify the C2 foramen in the sonographic longitudinal-axis view, what we call the "Stage-light Sign." Further exposure of the C2 DRG in the oblique-axis view we call the "Turtle Sign." The following procedural parameters were prospectively obtained: the time required to identify the C2 DRG target, the time needed to reach the target from the point of skin puncture, the number of puncture attempts required to reach the target, and the minimum sensory testing voltage to evoke paresthesia responses in the cutaneous occipital nerve distributions. Clinical outcomes were assessed by serial pain severity using the Numeric Rating Scale at baseline and up to 3 months post the C2 DRG pulsed radiofrequency ablation procedure. RESULTS:The correct placement of the needle tip was initially confirmed with fluoroscopy, with the injected contrast medium distributed along the C2 spinal nerve. Importantly, electrical sensory stimulation elicited paresthesia in the headache area in all patients, with the required voltage being 0.35 ± 0.02 V. Furthermore, treatment outcomes supported the correct needle tip position, as pulsed radiofrequency ablation treatment led to sustained pain reduction. It took 36.2 ± 2.2 seconds to obtain the final "TurtleSign" view of the C2 DRG. Once the target was identified, it required a single puncture attempt to reach it, with a duration of 36.3 ± 2.5 seconds from puncturing the skin to reaching the target. LIMITATION:We only followed patients for up to 3 months postprocedure. CONCLUSION:We have developed an ultrasonographic method to quickly and accurately access the C2 DRG, which has the potential to greatly facilitate treating the C2 DRG for managing occipital neuralgia.

Introduction Trigeminal neuralgia is a debilitating condition that can significantly impair the quality of life of affected individuals. Percutaneous balloon compression (PBC) has been established as an effective treatment for this condition. However, the use of general anesthesia during the procedure poses challenges to achieving the desired degree of nerve damage without causing excessive numbness. In this study, we aimed to evaluate the feasibility and efficacy of performing PBC under conscious sedation of local anesthesia. Methods We improved the surgical procedure for PBC by administering intraganglionic lidocaine 0.2% with fine needle aspiration to achieve conscious sedation. This allowed the operator to determine the degree of nerve damage in real time through the tactile test. We conducted a clinical observation of 87 patients who underwent PBC under conscious sedation of local anesthesia. We evaluated the intraoperative blood pressure and heart rate changes, postoperative facial pain relief, and occurrence of complications such as severe facial numbness, irreversible keratitis, vision loss, and masticatory muscle weakness. Results All 87 patients achieved immediate relief of facial pain after undergoing PBC under conscious sedation of local anesthesia. The intraoperative blood pressure and heart rate changes were <20% of the baseline value. No patient experienced severe facial numbness or developed irreversible keratitis, vision loss, or masticatory muscle weakness. Discussion Our findings suggest that PBC under wide-awake local anesthesia is a safe and effective treatment for trigeminal neuralgia. The use of conscious sedation of local anesthesia during the procedure allows the operator to achieve the desired degree of nerve damage without causing excessive numbness. This can lead to long-term pain relief and improved quality of life for patients with trigeminal neuralgia.

BACKGROUND:Ultrasound (US)-guided injections for chronic pain has multiple advantages over traditional radiologic method. The study was performed to exam the clinical outcomes of lumbar transforaminal epidural injection (LTFEI) between US and fluoroscopy (FL) guidance for lumbar radiculopathy (LRP). METHODS:A total of 164 patients with LRP were randomly assigned into US and FL group to receive LTFEI in a 1:1 ratio. Pain relief and functional disability were assessed by numeric rating scale (NRS) and Modified Oswestry Disability Questionnaire (MODQ) scores before treatment, 1 month and 3 months post-intervention. Contrast spread pattern, fluoroscopic image number and complications were also recorded. The primary outcome was accurate rate of contrast dispersing into lumbar epidural space, and non-inferiority margin was predefined at -15 %. RESULTS:The accuracy of LTFEI was 90.2 % and 91.5 % in US and FL group, and the lower limit of the 95 %CI of mean difference between two modalities (-4.9 % (95 %CI: -12.8 %, 3.1 %)) was above the non-inferiority margin. Procedure time in US group (531.90 ± 67.12 s) was shorter than FL group (904.20 ± 120.20 s) (p < 0.05), while radiation dosage in the US group was lower than in the FL group (3047.20 ± 569.53 vs. 8807.50 ± 1039.10 μGy m2, p < 0.001). Both groups didn't differ in pain reduction (F = 1.050, p = 0.306) and functional improvement (F = 0.103, p = 0.749) during follow-up period. No severe complications occurred in both groups. CONCLUSIONS:US-guided LTFEI confirmed by FL was not inferior to conventional FL method in terms of accurate rate of lumbar epidural contrast dispersion. Effective pain relief and functional ability improvement were comparable between two modalities, and US technique had advantages of less radiation exposure and possible facilitation of avoiding critical vessels around intervertebral foramen.

High-quality mouse dorsal root ganglion (DRG) cryostat sections are crucial for proper immunochemistry staining and RNAscope studies in the research of inflammatory and neuropathic pain, itch, as well as other peripheral neurological conditions. However, it remains a challenge to consistently obtain high-quality, intact, and flat cryostat sections onto glass slides because of the tiny sample size of the DRG tissue. So far, there is no article describing an optimal protocol for DRG cryosectioning. This protocol presents a step-by-step method to resolve the frequently encountered difficulties associated with DRG cryosectioning. The presented article explains how to remove the surrounding liquid from the DRG tissue samples, place the DRG sections on the slide facing the same orientation, and flatten the sections on the glass slide without curving up. Although this protocol has been developed for cryosectioning the DRG samples, it can be applied for the cryosectioning of many other tissues with a small sample size.

BACKGROUND:Although chat generative pre-trained transformer (ChatGPT) has made several successful attempts in the medical field, most notably in answering medical questions in English, no studies have evaluated ChatGPT's performance in a Chinese context for a medical task.OBJECTIVE:The aim of this study was to evaluate ChatGPT's ability to understand medical knowledge in Chinese, as well as its potential to serve as an electronic health infrastructure for medical development, by evaluating its performance in medical examinations, records, and education.METHOD:The Chinese (CNMLE) and English (ENMLE) datasets of the China National Medical Licensing Examination and the Chinese dataset (NEEPM) of the China National Entrance Examination for Postgraduate Clinical Medicine Comprehensive Ability were used to evaluate the performance of ChatGPT (GPT-3.5 and GPT-4). We assessed answer accuracy, verbal fluency, and the classification of incorrect responses owing to hallucinations on multiple occasions. In addition, we tested ChatGPT's performance on discharge summaries and group learning in a Chinese context on a small scale.RESULTS:The accuracy of GPT-3.5 in CNMLE, ENMLE, and NEEPM was 56% (56/100), 76% (76/100), and 62% (62/100), respectively, compared to that of GPT-4, which was of 84% (84/100), 86% (86/100), and 82% (82/100). The verbal fluency of all the ChatGPT responses exceeded 95%. Among the GPT-3.5 incorrect responses, the proportions of open-domain hallucinations were 66 % (29/44), 54 % (14/24), and 63 % (24/38), whereas close-domain hallucinations accounted for 34 % (15/44), 46 % (14/24), and 37 % (14/38), respectively. By contrast, GPT-4 open-domain hallucinations accounted for 56% (9/16), 43% (6/14), and 83% (15/18), while close-domain hallucinations accounted for 44% (7/16), 57% (8/14), and 17% (3/18), respectively. In the discharge summary, ChatGPT demonstrated logical coherence, however GPT-3.5 could not fulfill the quality requirements, while GPT-4 met the qualification of 60% (6/10). In group learning, the verbal fluency and interaction satisfaction with ChatGPT were 100% (10/10).CONCLUSION:ChatGPT based on GPT-4 is at par with Chinese medical practitioners who passed the CNMLE and at the standard required for admission to clinical medical graduate programs in China. The GPT-4 shows promising potential for discharge summarization and group learning. Additionally, it shows high verbal fluency, resulting in a positive human-computer interaction experience. GPT-4 significantly improves multiple capabilities and reduces hallucinations compared to the previous GPT-3.5 model, with a particular leap forward in the Chinese comprehension capability of medical tasks. Artificial intelligence (AI) systems face the challenges of hallucinations, legal risks, and ethical issues. However, we discovered ChatGPT's potential to promote medical development as an electronic health infrastructure, paving the way for Medical AI to become necessary.