INTRODUCTION:There are a number of options for the symptomatic treatment of peripheral neuropathy, but the overall treatment outcomes remain unsatisfactory. METHODS:A total of 60 patients with refractory diabetic neuropathy were randomly assigned to two groups. Patients in Group A were treated with computed tomography (CT)-guided sympathetic neurolysis with alcohol, and patients in Group B were treated with a combined therapy of CT-guided catheterization to achieve continuous lumbar block for 4 weeks followed by neurolysis with alcohol administered via the catheter. The outcomes of these two treatment strategies were then analyzed in terms of pain relief, blood flow in the lower limb microcirculation, plasma levels of inflammatory mediators, and complications. RESULTS:The visual analog scale (VAS) pain scores of all patients after treatment decreased significantly at the different evaluation time points compared with pre-treatment values, with the intergroup analysis revealing that the VAS scores were lower in Group B patients than in Group A patients at all post-treatment time points. Skin temperature, capillary filling time, and blood oxygen saturation level were significantly improved in all patients at the 1- and 7-day post-treatment assessment compared to pre-treatment values, but patients in Group B showed a greater improvement. The plasma levels of inflammatory mediators were lower in all patients at the 7-day post-treatment assessment compared to pre-treatment values, with those of patients in Group B being statistically significantly lower than those of patients in Group A. CONCLUSION:Combined treatment with continuous lumbar sympathetic block followed by neurolysis with alcohol provided more benefit in all assessed outcomes than sympathetic alcohol neurolysis alone. The results show that the procedures were associated with satisfactory safety outcomes and sustained analgesic effects, thereby providing clinical evidence supporting the use of this novel treatment for patients with painful diabetic neuropathy.

Background:Intervertebral disc degeneration (IDD) is a widespread issue associated with chronic lumbar pain and disability. This study aimed to identify lactate metabolism-related genes in IDD and elucidate their mechanistic roles in disease progression. Methods:IDD datasets were analyzed using R packages GEOquery, sva, and limma for data retrieval, batch correction, and normalization. Differential gene expression analysis identified significant genes between IDD and control groups, from which lactate metabolism-related differentially expressed genes (LMRDEGs) were derived. Relationships among the LMRDEGs were assessed using Spearman's correlation analysis, and functional enrichment was conducted using ClusterProfiler. Gene set enrichment analysis identified biological processes associated with IDD. Diagnostic models were assessed using receiver operating characteristic (ROC) curve. Immune cell infiltration and correlations with core genes were analyzed via the CIBERSORT algorithm. Regulatory networks were constructed, and reverse transcription quantitative polymerase chain reaction (RT-qPCR) was employed to validate the expression of hub LMRDEGs in IDD. Results:A total of 1325 differentially expressed genes were identified, yielding seven LMRDEGs: TGFβ2, GSR, MB, MMP2, SLC16A7, PER2, and STAT3, which are enriched in blood circulation regulation and hypoxic response, as well as pathways like AGE-RAGE signaling in diabetic complications. ROC analysis indicated potential hub genes (MMP2, MB, TGFβ2, and PER2), while immune infiltration analysis uncovered significant variations in immune cell distribution. RT-qPCR confirmed MMP2, MB, and SLC16A7 as molecular indicators reflecting lactate metabolism abnormalities in IDD. Conclusion:This study clarifies how lactate metabolism contributes to IDD through molecular mechanisms and its interplay with immunological features, providing a theoretical basis for understanding the early pathogenesis of IDD.

Objective To investigate the clinical effect of anterior and posterior approach combined low temperature plasma radiofrequency on the treatment of cervical disc herniation（CDH）. Methods From February 2020 to October 2022, 98 patients with CDH admitted to Beijing Anzhen Hospital, Capital Medical University were selected. Patients were divided into observation group and control group according to the random number table method, with 49 cases in each group. The observation group was treated with anterior and posterior approach combined low temperature plasma radiofrequency, and the control group was treated with anterior approach low temperature plasma radiofrequency. The clinical effect, pain visual analogue scale（VAS） score, neck disablity index scale（NDI） score, cervical mobility before and after operation were compared between the two groups, and postoperative complications of patients were recorded. Results There was no significant difference in total efficacy rate between the two groups（P=0.957）. The scores of VAS and NDI in both groups 1 month after operation were lower than those before treatment, and those in the observation group were lower than those in the control group [（1.0±0.6） vs（1.2±0.7）,（10.8±1.6） vs（13.1±1.4）]（t=40.189, 55.395, both P＜0.001）. Cervical mobility of left rotation, right rotation, forward flexion and backward extension in both groups were greater than those before operation, and cervical mobility of left rotation, right rotation and forward flexion in the observation group were greater than those in the control group（all P＜0.05）. One patient in each group had nausea after operation, which alleviated after symptomatic treatment. Conclusion Anterior and posterior approach combined low temperature plasma radiofrequency in the treatment of CDH is superior to anterior approach low temperature plasma radiofrequency therapy in improving symptom and cervical mobility of patients, with good security.

目的 探索一种针对基层医院的腰椎旁神经阻滞教学培训模式.方法 选取2017年9月至2020年6月于首都医科大学附属北京安贞医院接受腰椎旁神经阻滞技术培训的112名来自基层医院的培训学员为研究对象,腰椎旁神经阻滞技术培训班的培训时长为1周,培训内容包括理论知识教学、模拟操作和临床实践3个部分.教学结束后,对培训学员进行腰椎旁神经阻滞技术的理论知识和临床实践考核,使用调查问卷的形式调查培训学员对教学的满意度[①您认为收益最大的培训内容,包括理论知识教学、模拟操作和临床实践;②您对培训模式是否满意(其中满分为10分,很满意为＞9分;基本满意为6～8分;不满意为＜6分);③您是否有信心独立开展腰椎旁神经阻滞技术,包括是、否、不确定].分别于培训后1、2年,对培训学员进行回访,调查培训学员独立开展腰椎旁神经阻滞技术1～100例、101～200例、201～300例、＞300例的情况.结果 教学结束后,所有培训学员均通过了理论知识考核和临床实践考核,培训学员的理论知识成绩为(80.1±11.8)分,临床实践成绩为(80.3±12.4)分.教学结束后,48名(42.9%)学员认为受益最大的培训内容为理论知识教学,106名(94.7%)的学员对培训模式满意,93名(83.0%)的学员有信心独立开展腰椎旁神经阻滞技术.培训后1、2年,均有109名(97.3%)学员开展了腰椎旁神经阻滞技术,且与培训后1年比较,学员培训后2年腰椎旁神经阻滞技术201～300例、＞300例的开展率均显著升高(P＜0.05).结论 本中心开展的腰椎旁神经阻滞教学培训模式的学员满意度较高,该培训模式可显著提升学员的理论知识和临床实践操作能力,从而使学员完成培训后可顺利于基层医院开展腰椎旁神经阻滞技术.

疼痛会影响病人身心功能、干扰日常生活、降低家庭和社会劳动能力、增加医疗负担和罹患精神类疾病(焦虑、抑郁等)的风险,从而降低生活质量,对家庭、医疗系统和社会都是一种沉重的负担.痛经是年轻女性最常见的疼痛疾病,是指行经前或行经期出现下腹坠、胀痛、伴有腰酸或其他不适,重症者伴有四肢发冷、寒战、恶心、呕吐、晕厥等症状.有 50％～80％的育龄妇女月经期有轻微痛经症状,有 10％～20％的妇女月经期痛经症状严重以致影响其工作、生活与学习 [1].如果能找到无创非药物治疗痛经的方法,将是广大痛经女性的福音.

Objective To investigate the correlation between Preptin and bone mineral density（BMD） in type 2 diabetes induced osteoporosis. Methods Eighty-eight patients with type 2 diabetes were included. They were divided into three groups according to T value of BMD: normal bone mass group（T-value greater than-1.0, N group）, osteopenia group（T-value less than-1.0 and greater than-2.5, R group）, and osteoporosis group（T-value less than-2.5, OP group）. The general clinical data, clinical laboratory data, BMD, plasma leptin, connective tissue growth factor（CTGF）, and bone specific alkaline phosphatase（BAP） levels among the three groups were compared. Pearson correlation analysis was used to study the correlation between BMD and general data, clinical laboratory data, and bone metabolism related indicators. SPSS 19.0 statistical software was used to draw the correlation curve between leptin, CTGF, and BAP. Results There were significant differences in weight and BMI among the three groups（P＜0.05）. There were significant differences in BMD and bone metabolism related indexes among the three groups. With the decrease of BMD, the levels of leptin, CTGF, and BAP among the three groups decreased gradually, with significant differences（P＜0.05）. BMD of L2-L4 was positively correlated with Preptin, ALP-B, and CTGF, and Preptin was positively correlated with ALP-B and CTGF（P＜0.05）. Conclusion Preptin plays an important role in the occurrence and development of type 2 diabetes induced osteoporosis by regulating the levels of CTGF and BAP. Preptin is expected to become a new target for the treatment of type 2 diabetes induced osteoporosis.

BACKGROUND:Although the neuroprotective role of propofol has been identified recently, the regulatory mechanism associated with microRNAs (miRNAs/miRs) in neuronal cells remains to be poorly understood. We aimed to explore the regulatory mechanism of propofol in hypoxia-injured rat pheochromocytoma (PC-12) cells.METHODS:PC-12 cells were exposed to hypoxia, and cell viability and apoptosis were assessed by CCK-8 assay and flow cytometry assay/Western blot analysis, respectively. Effects of propofol on hypoxia-injured cells were measured, and the expression of miR-153 was determined by stem-loop RT-PCR. After that, whether propofol affected PC-12 cells under hypoxia via miR-153 was verified, and the downstream protein of miR-153 as well as the involved signaling cascade was finally explored.RESULTS:Hypoxia-induced decrease of cell viability and increase of apoptosis were attenuated by propofol. Then, we found hypoxia exposure up-regulated miR-153 expression, and the level of miR-153 was further elevated by propofol in hypoxia-injured PC-12 cells. Following experiments showed miR-153 inhibition reversed the effects of propofol on hypoxia-treated PC-12 cells. Afterwards, we found BTG3 expression was negatively regulated by miR-153 expression, and BTG3 overexpression inhibited the mTOR pathway and AMPK activation. Besides, hypoxia inhibited the mTOR pathway and AMPK, and these inhibitory effects could be attenuated by propofol.CONCLUSION:Propofol protected hypoxia-injured PC-12 cells through miR-153-mediataed down-regulation of BTG3. BTG3 could inhibit the mTOR pathway and AMPK activation.

带状疱疹 (herpes zoster, HZ) 是由水痘-带状疱疹病毒 (varicella zoster virus, VZV) 侵犯神经节及皮肤,以沿神经簇集分布疱疹及神经痛为主要临床表现的病毒性疾病.带状疱疹急性期的有效治疗能够减轻带状疱疹后神经痛 (post-herpetic neuralgia, PHN) 的发病程度,提高病人的生活质量.椎旁阻滞已应用于 HZ 疼痛及PHN.臭氧因具有强氧化性,可以阻断痛觉传导,改善微循环,减少局部炎症反应,已逐渐应用于治疗急性带状疱疹及PHN.我中心在治疗带状疱疹的前期临床观察中发现,椎旁神经阻滞的基础上,在皮损区局部进行阻滞,联合臭氧注射,能够对带状疱疹急性期疼痛症状明显的缓解作用,并且能够降低PHN的发病率及疼痛症状.因此我们设计了本研究评价臭氧联合神经阻滞干预带状疱疹急性期的疗效,并对其进行总结分析,以期找到有效的缓解带状疱疹疼痛症状的方法.现报道如下.

Objective To investigate the clinical effect of coblation combined with ozone injection in treatment of cervical intervertebral disc herniation.Methods Totally 40 cases of cervical disc herniation patients in Beijing Anzhen Hospital,Capital Medical University From January 2013 to January 2014 were enrolled and randomly divided into combined treatment group (20 cases) which received coblation combined with ozone injection and control group (20 cases) which received pure ozone injection.The treatment effect was evaluated,and the visual analogue scale (VAS) before treatment,1 and 7 days after treatment,1 month and 3 months after diacharge were compared between the two groups.Results The excellent rate in combined treatment group after treatment was 95.0％ (19/20),higher than that in control group [70.0％ (14/20)].The VAS scores before treatment,1 and 7 days after treatment,1 month and 3 months after discharge was (7.0 ± 1.2),(4.2 ± 1.5),(1.5 ± 0.9),(0.6 ± 0.7),(0.8 ± 0.6) scores in combined treatment group,respectively; it was (7.2 ± 1.5),(4.0 ± 0.8),(5.0 ± 1.2),(5.4 ± 1.2),(5.6 ± 1.0)scores in control group,respectively.Compared with that before treatment,the VAS was significantly decreased 7 days after treatment,1 and 3 months after discharge in combined treatment group; it also decreased 1 day after treatment in control group (P ＜ 0.05).Compared with that in control group,the VAS of combined treatment group was statistically lower 1 and 3 months after discharge (P ＜ 0.05).Conclusions Coblation combined with ozone injection in treatment of cervical intervertebral disc herniation may play a complementary role,the curative effect is obviously superior to the single ozone injection.

目的 探讨颈动脉内膜剥脱术(CEA)中脑电双频指数(BIS)和脑血流速度的相关性.方法 择期CEA患者35例,年龄54～80岁.采用经颅多普勒(TCD)监测和记录入室时(T1)、麻醉诱导后气管插管前(T2)、游离颈动脉10 min(T3)、阻断颈动脉5 min(T4)、放置颈动脉转流管5 min(T5)、开放颈动脉5 min(T6)及60 min(T7)时大脑左、右两侧脑血流峰值速度(Vp)、平均速度(Vm),以及相应时点的BIS值,分析相关性.结果 35例患者均采集BIS值,其中17例患者采集Vp、Vm.T2、T3、T4、T7时BIS与Vp、Vm呈显著正相关(P＜0.01);两侧Vp、Vm在T7时均呈显著正相关(r=0.542和r=0.649,P＜0.05).T2时CEA侧BIS值与Vm呈显著正相关(r=0.498,P＜0.05);T1时非CEA侧BIS值与Vp呈显著正相关(r=0.556,P＜0.05).T3、T4时CEA侧BIS值的变化与Vp的变化呈显著负相关(r=-0.584,P＜0.05),而非CEA侧无显著相关性.结论 在CEA中,CEA侧与非CEA侧之间,其BIS值的变化因受到麻醉和脑血流量变化的双重影响而不完全一致.BIS值可反映脑血流速度的变化,在入手术室(非CEA侧)和麻醉诱导(CEA侧)时它们的变化方向一致,而在阻断颈动脉早期(CEA侧)的变化方向相反.

Objective To observe the clinical efficacy of calcitonin combined with ozone for the treatment of osteoporosis-related back pain.Methods A total of 80 patients with osteoporosis were randomly divided into treatment group and control group.Patients in treatment group were treated with calcitonin combined with ozone.Patients in control group were just treated with calcitonin.After 12-week treatment,the alleviation of pain,the improvement of physical function,the changes of bone mineral density(BMD) and biochemical index,and adverse drug reactions were observed.Results The alleviation of pain and the improvement of physical function in treatment group were significantly different comparing to those in control group after 1-month treatment(P0.05).No significant difference in BMD and biochemical index was observed in both groups before and after the treatment(P0.05).Conclusion The efficacy of calcitonin combined with ozone for the treatment of osteoporosis-related back pain is similar to that of single use of calcitonin.But the analgesic efficacy and physical function can be significantly improved in a short time.

Objective To analyze the clinical efficacy of thoracic paravertebral nerve block with ozone in the treatment of postherpetic neuralgia. Methods Eighty-five patients suffered postherpetic neuralgia were divided into 4 groups: Group A (oral drugs + intramuscular injection of vitamin B12 + local nerve block of lesion area), Group B (oral drugs + intramuscular injection of compound trivitamin B + local nerve block of lesion area), Group C (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block + local nerve block of lesion area), Group D (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block with ozone + local nerve block of lesion area). Treatment outcomes were evaluated by Visual Analogue Scale (VAS), Quality of Sleep (QS), Self-Rating Depression Scale (SDS) and C-reactive protein (CRP) before treatment and 4 weeks after treatment. Results After treatment, VAS, QS and SDS scores of 4 groups were lower than that before treatment, and the differences were statistically significant (P < 0.05, for all). There were no significant changes in the level of CRP of group A, B, C before and after treatment (P > 0.05, for all), while a significant change in CRP was observed in patients of group D between before and after treatment (P < 0.05). The improvement of VAS, QS and SDS scores of group D was significantly better than other 3 groups (P < 0.05, for all). Conclusion Thoracic paravertebral nerve block combined with ozone is a quick and effective method for postherpetic neuralgia patients.