Fascial tissues have been overlooked in the past, and there are only few studies on the thoracolumbar fascia and its treatment methods. The present study aimed to investigate the effectiveness and safety of ultrasound-guided bilateral L3-4 thoracolumbar fascia injection in treating postoperative low back pain. A prospective pilot study was conducted at a university hospital. Twenty-six patients with postoperative low back pain resistant to conservative therapies and US-guided bilateral L3-4 medial branch block (MBB) were included as participants. They were treated with US-guided L3-4 mid-thoracolumbar fascia injection. Using real-time fluoroscopy, we monitored the contrast medium’s diffusion range and double-checked the needle tips’ positions throughout the procedures. The pain numeric rating scales (NRS), lumbar anteflexion range of motion (ROM), and Oswestry disability index (ODI) were assessed through telephone interviews one, four, and twelve weeks after the procedures. All data were processed by SPSS software version 23.0 (IBM Corp., New York). Compared with NRS at baseline, pain scores decreased throughout the observation period. Lumbar anteflexion range of motion of US-guided bilateral L3-4 mid-thoracolumbar fascia injection continuously improved during the first, fourth, and twelfth week. No intravascular injections or neurologic injuries were observed. The US-guided bilateral L3-4 mid-thoracolumbar fascia injection facilitated a uniform dispersion of the medication, akin to the gentle spread of a goose feather, between the erector spinalis and quadratus lumborum muscles across the affected lumbar vertebrae. This technique demonstrated substantial clinical effectiveness in patients who were unresponsive to standard US-guided MBB.

Objective: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy and it is currently intractable We compared the efficacy of transcutaneous electrical acupoint stimulation (TEAS) against non-TEAS groups and investigated the variables that predict effective relief of upper extremity pain in cancer survivors with CIPN. Methods: We retrospectively collected data of cancer survivors who developed CIPN between May 2017 to March 2022. All eligible CIPN patients were divided into TEAS group (received TEAS) and non-TEAS group (did not receive TEAS) in our department. A 1:1 ratio propensity score matching (PSM) was used to balance the baseline features. The change of numerical rating scale (NRS), Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), and sympathetic skin response (SSR) parameters are all assessed after treatment. The procedure was considered a clinically effective relief if the patients' NRS scores were reduced by 50% or more, and overall patients with effective relief were all counted after treatment. Furthermore, a multivariable logistic regression model was utilized to evaluate the predictors of effective relief following CIPN treatment. Results: : A total of 102 cancer survivors with CIPN were analyzed after PSM (51 in each group). The change of NRS, SF-MPQ-2, SSR latency and SSR amplitude in TEAS group were significantly higher than those in non-TEAS group at 3 weeks after therapy (all P< 0.01). In addition, the effective relief rate was significantly higher in TEAS group than in non-TEAS group (P=0.026). Multivariate logistic regression on the total study cohort showed that TEAS group (OR 2.783, P = 0.025) and the baseline SSR amplitude of the upper extremity < 1265 mu V (OR 12.191, P = 0.000) were independent predictive factors for the clinical efficacy. Conclusions: : TEAS significantly decreased the severity of CIPN. TEAS group and baseline SSR amplitude of the upper extremity < 1265 mu V were the independent predictive factors for the clinical efficacy after treatment.

Objective: This study aimed to explore the effects of fluid hydration status on ultrasound muscle measurement in hemodialysis (HD) patients. Methods: Ultrasound muscle examination of the right rectus femoris and bioelectrical impedance analysis measurement of the right lower limb were performed in HD patients at the periods of predialysis and postdialysis. The correlations between the changes in the corresponding ultrasound and bioelectrical impedance analysis variables were analyzed. Results: A total of 50 patients on maintenance HD were included, with mean age of 52.6 +/- 13.5 years. Patients were 40% female (n=20), and average dialysis duration was 2.62 +/- 2.42 years. Compared to predialysis, the measurements of cross-sectional area, muscle thickness, echo intensity (EI), and their percentage changes all decreased significantly after the HD procedure (P<.05). The change in EI and its percentage change were significantly correlated with changes in total body water, intracellular water, and extracellular water (P<.05). Conclusions: The HD session may have significant effects on ultrasound muscle measurement. Both the indicators of muscle quantity (cross-sectional area and muscle thickness) and quality (EI) significantly decreased after HD, which may contribute to the change in fluid hydration status and the change in fluid composition.

Complex regional pain syndrome type 1 (CRPS-1) is prevalent after trauma, with intractable pain being the most prominent clinical symptom. The impact of sympathetic block on CRPS is unclear. The goal of this study was to explore the characteristics that predict successful symptom relief with lumbar sympathetic block (LSB) in patients with lower extremity CRPS-1. The study was designed as a prospective cohort study. Ninety-eight patients diagnosed with lower extremity CRPS-1 between March 2021 and March 2022 were enrolled as participants. All of the patients received two LSB treatments within a month. Sympthetic skin response (SSR) and numeric rating scale (NRS) were recorded before and after LSB treatment. The procedure was judged as a clinically positive response if the patients a 50

目的:观察改良超声引导下腰椎脊神经后内侧支阻滞在治疗腰背痛临床实践中的可行性和有效性.方法:选取拟行腰椎脊神经后内侧支阻滞(medial branch block,MBB)的腰背痛病人64例.对所有病人行超声引导下腰椎L3-L5脊神经后内侧支阻滞,按照L4+L5脊神经后内侧支阻滞不同的阻滞技术,分为常规两针两点组(TT组)和改良一针两点组(OT组),每组32例.记录每例病人单侧操作需要时间,治疗前、治疗后1小时和治疗后2周的视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评分;以治疗后2周VAS评分下降50％和ODI评分下降40％为治疗有效,计算单次治疗有效率,并记录治疗过程中和治疗后病人的不良反应.结果:所有病人均顺利完成超声引导下腰椎L3-L5脊神经后内侧支阻滞,OT组阻滞时间快于TT组(P<0.05),两组病人单次治疗后1小时和治疗后2周VAS评分和ODI评分均显著下降(P<0.05),OT组在治疗后1小时和2周VAS评分和ODI评分均低于TT组(P<0.05).OT组和TT组病人单次治疗有效率分别为75％和47％(P<0.05).OT组病人治疗期间和治疗后无明显不良反应,TT组2例病人在穿刺L5脊神经后内侧支阻滞过程中出现下肢神经刺激症状.结论:改良"一针两点法"有效解决了目前超声引导下L5脊神经后内侧支阻滞实践操作中存在的困难,短期内可显著改善腰背痛病人VAS评分和ODI评分,但还需大样本和长期随访研究进一步验证临床有效性和安全性.

Background Neuropathic pain is the most common clinical sign of complex regional pain syndrome (CRPS). Currently, lumbar sympathetic block (LSB) is commonly utilized in lower extremity CRPS that has failed to respond to medication therapy and physical therapy, but its effectiveness is unknown. The tourniquet ischemia test (IT) can distinguish between two types of CRPS: IT-positive CRPS and IT-negative CRPS. Objective The aim of the study was to investigate whether LSB improves pain scores in patients with lower extremity CRPS-1 and to screen factors to predict its efficacy. Study Design Prospective clinical observational study. Setting Pain management center. Subjects Forty-three patients diagnosed with lower extremity CRPS-1 using the Budapest criteria were included as participants. Methods Forty-three CRPS-1 patients were treated with LSB therapy, and all of them underwent a tourniquet ischemia test (IT) before undergoing LSB therapy. LSB therapy was performed using a combination of ultrasonography and fluoroscopy. Then, numeric rating scale (NRS) scores and the symptom relief rates of patients were evaluated at 1, 4, and 12 weeks. Finally, peripheral blood inflammatory cytokine samples were collected before and after the LSB treatment. Results At 4 weeks after the treatment, the total effective symptom relief rate of LSB on CRPS-1 was 25.6% (11/43), with 52.6% (10/19) of IT(+) patients and 4.2% (1/24) of IT(-) patients. There was a significant difference between the IT(-) and IT(+) groups (P = 0.001). The multivariate binary logistic regression analysis revealed that the response to the tourniquet IT was the only significant independent predictor of sympathetic block success (p = 0.007). Conclusion Tourniquet IT is a simple, safe and effective test to distinguish patients with lower extremity CRPS-1. The response to the tourniquet IT is a reliable predictor of LSB effectiveness in lower extremity CRPS-1 patients.

Transplantation of fetal ventral mesencephalic (VM) tissue shows great promise as an experimental therapy for patients with Parkinson's disease. However, cell survival in brain tissue grafts is poor, with survival rates of only 5-15%. We have utilized a combination of the caspase inhibitor bocaspartyl (OMe)-fluoromethylketone (BOC-ASP-CH2F) and glial cell line-derived neurotrophic factor (GDNF) to enhance survival of grafted dopamine neurons. The VM tissue was dissected from embryonic day 13-15 rat fetuses, incubated in different doses of BOC-ASP-CH2F and GDNF, and transplanted to the anterior chamber of the eye of adult rats. Growth of the tissue was assessed through the translucent cornea. Doses of 50 and 100 micromolar of the general caspase inhibitor appeared to have detrimental effects on mesencephalic tissue, while 20 micromolar had beneficial effects on overall transplant growth. A combination of the caspase inhibitor and GDNF appeared to have more prominent effects on cell survival as well as dopaminergic fiber density than either agent by itself. The transplants doubled in size when they were treated with a combination of BOC-ASP-CH2F and GDNF, and cell death markers were significantly reduced at both 48 h and 4-6 days postgrafting. This is, to our knowledge, the first combined approach using apoptotic blockers with trophic factors, and demonstrates a viable strategy for protection of developing neurons, since several different aspects of graft function may be addressed simultaneously.

PURPOSE:Thoracic nerve root (TNR) block is performed primarily under computed tomography or X-ray fluoroscopy but is associated with radiation exposure. Ultrasound requires no radiation and distinguishes vessels, nerves, pleura, and other tissues. Few reports of ultrasound-guided TNR (US-TNR) block have been described, and the puncture end point has not been clearly defined. Herein, we evaluated the feasibility of US-TNR block using the midpoint of the inferior articular process (IAP) and parietal pleura (PP) as the puncture end point.PATIENTS AND METHODS:A prospective series of 10 patients with Herpes Zoster-associated pain underwent US-TNR-guided block performed using an in-plane technique with the midpoint of thoracic IAP and PP as the puncture end points of ultrasonography. The US-TNR block procedure was performed with ultrasound as the primary imaging tool followed by fluoroscopic confirmation.RESULTS:In all patients, the needle tips were visible at the lateral margin of the pedicle in the anteroposterior view and at the extraforaminal zone in the lateral view. The TNR and dorsal root ganglion (DRG) were delineated in all 10 patients. Furthermore, 2 mL of radiopaque agent could delineate the epidural space in 8 patients and the thoracic paravertebral (TPV) space in the other 2 patients. All patients developed numbness along the corresponding dermatome 30 min after injection of local anesthetics. The numeric rating scale (NRS) score at baseline, and at two- and four-week follow-ups were 6.50 ± 1.35, 3.50 ± 0.85 (vs NRS at baseline, P < 0.01), and 4.00 ± 0.82 (vs NRS at baseline, P < 0.01), respectively.CONCLUSION:This study demonstrated the feasibility of US-TNR block using the in-plane technique with the midpoint of thoracic IAP and PP as the puncture end point to effectively block the TNR and DRG. This technique is an accurate clinical application of TPV nerve block and provides a potential therapeutic option for the treatment of neuropathic pain.

Background Patients on hemodialysis often suffer from reduced muscle strength and exercise capacity due to the decreased quantity and quality of muscle. Cumulative studies showed ultrasound echo intensity (EI) had great potential in evaluating muscle quality. The objective of this study was to evaluate the relationship between EI of skeletal muscle and physical function of patients on maintenance hemodialysis. Methods Cross-sectional area (CSA) and mean EI of the right rectus femoris were measured by ultrasound to evaluate the quantity and quality of the muscle, respectively. Physical function was measured by handgrip strength (HGS), gait speed, sit-to-stand 60 s (STS-60) test, and instrumental activities of daily living (IADL) scale. Results A total of 107 patients on hemodialysis were included, with women accounting for 37.3% ( n = 40), and a mean age of 53.53 ± 12.52 years. Among the patients on hemodialysis, EI was moderately and negatively correlated with HGS ( r = − 0.467, P < 0.001), gait speed ( r = − 0.285, P = 0.003), and STS-60 ( r = − 0.313, P = 0.001). Multiple regression analyses adjusted for CSA showed that the enhanced EI of patients on hemodialysis remained associated with worse HGS (β = − 0.207, P = 0.047), lower gait speed (β = − 0.002, P = 0.001), less STS-60 (β = − 0.136, P = 0.049), and a higher likelihood of dependency in IADL (Odds Ratio: 1.070, 95% CI: [1.033–1.111], P = 0.001). Conclusions In patients on hemodialysis, enhanced EI in the skeletal muscle measured via ultrasound was correlated with poor physical performance. The combined muscle quality and muscle quantity evaluation provide more information for assessing the level of physical function of the patients.

Objective To observe whether ultrasound-guided stellate ganglion block (SGB) can effectively relieve migraine pain and improve the quality of migraine patients’ life. Methods 81 patients with migraines were enrolled in this study. The patients received SGB with 6 ml of 0.15% ropivacaine once every week for four times. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS) at baseline and three-months follow-up (Tm). The numerical rating scale (NRS) score at baseline, one day after treatment (Td) and Tm, the frequency of analgesic use in 3 months and the side effects were also recorded at the same time. Results The NRS score of migraine subjects decreased significantly from 7.0 (2.0) to 3.0 (1.0) at Td and 2.0 (2.0) at Tm (vs baseline, P < 0.01). The MIDAS total scores were 14.0 (10.5) at baseline and 7.0 (4.5) at Tm ( P < 0.001). During the three months, the frequency of analgesic consumption was decreased from 6.2 ± 2.8 to 1.9 ± 1.8. There were no serious side effects. Conclusions This study confirmed that ultrasound-guided SGB is an effective method to treat migraines. This technique can reduce pain and disability and then improve the quality of life of patients with migraines.

目的:截肢后疼痛是截肢术后病人常见的神经病理性疼痛,包括残肢痛、幻肢痛和幻肢觉.残端神经瘤形成是引起疼痛的重要外周发病机制,针对痛性神经瘤进行毁损治疗简单易行.旨在研究超声引导下残端神经瘤毁损治疗截肢后神经病理性疼痛病人的短期与长期疗效.方法:回顾分析2016年6月至2019年10月在上海市第六人民医院疼痛科就诊的截肢后残肢痛和/或幻肢痛的病人共53例,其中36例病人最终纳入分析.治疗前记录病人的年龄、性别、截肢位置、病程、残肢痛的疼痛数字评分法(numerical rating scale,NRS)评分、是否伴有幻肢痛.在末次治疗后随访至12个月,记录末次治疗后2周、6月和12月后残肢痛的NRS评分、残肢爆发痛发作次数、幻肢痛的变化,并观察治疗的并发症.结果:共36例病人,治疗后残肢痛NRS评分和幻肢痛均较治疗前缓解,爆发痛的发作次数降低.在术后2周时有效率86.1％,术后6月和12月时有效率均为77.8％.所有病人均无并发症发生.结论:对截肢后疼痛的病人,可以用超声技术寻找是否有残端神经瘤;射频消融和无水乙醇注射毁损痛性神经瘤能有效缓解截肢病人的残端疼痛和幻肢痛(随访12个月),且操作简单、安全、无辐射,适合临床应用.

Objective. The aim of the present study was to investigate the effectiveness and safety of a novel lateral in-plane approach for ultrasound-guided transforaminal cervical nerve root block (US-guided TF-CNRB) in the treatment of cervical radiculopathic pain. Design. The design of the present study consisted of an institutional, retrospective case series. Setting. The present study was conducted at a university hospital. Subjects. Thirty-two patients with cervical radiculopathy who were resistant to conservative therapies and regular US-guided CNRB were included as participants. Methods. The included patients were treated with US-guided TF-CNRB. During the treatments, using real-time fluoroscopy, we monitored the spreading patterns of a contrast medium and double confirmed the positions of needle tips. Pain numeric rating scales (NRS) and symptom relief grades were determined via telephone interviews at one, four, and 12 weeks after the procedures. Results. US-guided TF-CNRB was performed at the C5 level in six patients, the C6 level in 18 patients, and the C7 level in eight patients. Compared with NRS at baseline, pain scores decreased throughout the observation period. Symptom relief rates of US-guided TF-CNRB at one, four, and 12 weeks were 72%, 69%, and 63%, respectively. Venous blood was aspirated during the procedures in two patients, and the needle tips were corrected. No intravascular injections or neurologic injuries were observed. Conclusion. USguided TF-CNRB produced circumferential spreading around the involved cervical nerve root and showed significant clinical effectiveness in patients resistant to regular US-guided CNRB.

Objective:To evaluate the efficacy of ultrasound-guided peri-genicular nerve pulsed radiofrequency in the treatment of patients with knee osteoarthritis.Methods:Sixty-four patients, admitted to the Pain Department of the Sixth People's Hospital from June 2019 to February 2020, aged≥60 years old, both sexes, were included and randomly divided into pulsed radiofrequency group (group PRF) and never block group (group NB), 32 cases in each group. In group NB, each target nerve was given 2 ml of 2% lidocaine, for a total of 6 ml. In group PRF, pulse radiofrequency was performed on the basis of giving the same anesthetics to the target nerves as in group NB. The temperature of the radiofrequency electrode was set to 42 ℃, and the treatment time of each target nerve was 120 seconds × 3 times. All patients were received only one treatment. Visual analogue scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores and effective rate were recorded and compared before the treatment, 2, 4 and 12 weeks after the treatment.Results:No difference was found in general data between the two groups (all P>0.05). There were significant differences in VAS at different time points in the two groups ( F=139.84, P<0.001); and there was an interaction between time and group in VAS ( F=23.67, P<0.001). There were significant differences in WOMAC scores at different time points in the two groups ( F=1 857.79, P<0.001); and there was an interaction between time and group in WOMAC scores ( F=23.67, P<0.001). The effective rate was higher at 2, 4 and 12 weeks in group PRF than that in group NB respectively (65.6% vs. 31.3%, 37.5% vs. 3.1%, 25% vs. 0, all P<0.05). Conclusion:Ultrasound-guided peri-genicular nerve pulsed radiofrequency targeting the superior, inferior and inferior patellar branch of saphenous nerves can effectively and safely alleviate the symptoms in patients with knee osteoarthritis. Its effects are superior to the nerve block only.

OBJECTIVE:Postamputation pain (PAP) is a serious problem, and thus far, there is no perfect treatment strategy. Clinically, minimally invasive treatments for peripheral neuromas are simple and feasible. This study aimed to investigate the immediate and long-term effects of ultrasonography-guided radiofrequency ablation (RFA) on PAP.METHODS:Eighteen PAP subjects with painful peripheral neuromas were treated with ultrasonography-guided RFA.RESULTS:A total of 18 PAP subjects were included in the final analyses. Fourteen of the 17 subjects with residual limb pain (RLP) (82.4%) had successful outcomes. A successful outcome was noted in 9 of the 13 subjects with phantom limb pain (PLP) (69.2%). There were no significant associations between symptom relief and sex, age, or the duration of symptoms. There were no severe complications.CONCLUSIONS:Ultrasonography-guided RFA for painful stump neuromas can effectively relieve stump pain and PLP in amputees with PAP (follow-up time was 12 months). Ultrasonography-guided RFA is easy and safe and does not involve radiation exposure, making it very suitable for clinical applications.

Brain metastasis affects approximately 20%-30% of patients with triple-negative breast cancers (TNBCs). Even small metastatic lesions in the brain can trigger severe neurological impairments and result in extremely short survival time. Recently, active astrocytes were reported to be associated with brain metastases. However, how activated astrocytes regulate the behaviors of disseminated breast cancer cells in the brain remains unknown. In this study, human primary astrocytes were stimulated with IL-1β to form active astrocytes to study the cross-talk between stromal cells (astrocytes) and TNBC cells in brain metastases. Our results showed that active astrocytes significantly increase the malignancy of TNBC cells and prevent them from undergoing apoptosis caused by doxorubicin. We also found that the high level of IL-6 secreted by activated astrocytes was responsible for the drug resistance of breast cancer, which could be abolished by treatment of astrocytes with tamoxifen (TAM). The blockage of active astrocyte-derived IL-6 by a neutralizing antibody resulted in the attenuation of drug resistance, consequently enhancing the sensitivity of breast cancer cells to doxorubicin. Furthermore, the possible involved TAM-modulated drug resistance mechanism may be associated with a decrease in IL-6 expression in astrocytes and the downregulation of MAPK and JAK2/STAT3 signaling in cancer cells. Our data suggested that TAMs might reduce drug resistance through the IL-6/JAK2/STAT3 signaling pathway, providing a possible therapy to treat brain metastasis in TNBCs, as estrogen receptor inhibitors (TAMs, etc.) can cross the blood-brain barrier.

带状疱疹后神经痛(postherpetic neuralgia,PHN)一般是指急性带状疱疹(acute herpes zoster,AHZ)疼痛持续1个月以上的神经病理性疼痛[1].成人AHZ发展成PHN的比例可高达10％～50％[2],PHN相关的疼痛症状通常分为三大类:持续性自发性疼痛;阵发性枪击样、电击样疼痛;机械性痛觉超敏和机械性痛觉过敏[3].

BackgroundCervical transforaminal epidural steroid injection (CTFESI) is used to provide pain relief and restore function in patients with cervical radiculopathy. Traditionally, it is performed under the guidance of fluoroscopy or computed tomography. Here, we introduce a novel technique - ultrasound-guided CTFESI - with which operators can easily distinguish the close soft tissue (nerve, vessels) around the cervical foramina to avoid intravascular injection during the procedure.ObjectiveTo present the immediate and long-term effectiveness of ultrasound-guided CTFESI in patients with cervical radiculopathy in an academic pain-management center with prospective clinic experiments.MethodsFifteen patients with cervical radiculopathy who were resistant to conservative therapies and ultrasound-guided selective cervical spinal nerve-root injections, were treated with ultrasound-guided CTFESI. During the injection procedures, the needle tips were reconfirmed by real-time fluoroscopy. Pain numeric rating-scale and neck-disability-index scores were assessed from onset to six months after the procedures.ResultsDuring the procedures, based on real-time fluoroscopic confirmation, the injection solution outlined the spinal nerve root and spread into the epidural space in most cases (14 of 15). All patients reported pain relief within 10 minutes after the injection. The majority of patients (eleven of 15) experienced pain relief and neck-disability index-score improvement throughout the 6-month study period. No patient experienced any complication.ConclusionWe suggest that ultrasound-guided CTFESI is an effective, safe, and simple procedure free of radiation or magnetization and provides sustained pain relief in patients with cervical radiculopathy who have failed previous conservation therapies.

The stellate ganglion block (SGB) can lead to vasodilation of the head and neck. However, controversy remains concerning the changes in extracerebral blood flow. The objective of this study is to assess the effects of SGB on the blood flow to the neck.

Nerve damage often leads to nervous system dysfunction and neuropathic pain. The serine-threonine kinases receptor-interacting protein 1 (RIP1) and 3 (RIP3) are associated with inflammation and cell necrosis. This study aimed to explore the role of RIP1 and RIP3 in sciatic nerve chronic constriction injury (CCI) in mice. On a total of thirty mice, sciatic nerve CCI was performed. The paw withdrawal threshold was measured using Von Frey filaments. The mRNA expression and protein levels of inflammatory factors RIP1 and RIP3 in the dorsal root ganglion (DRG), spinal cord (SC) and hippocampus (HIP) were also determined. We found that paw withdrawal threshold was significantly reduced from the second day after the operation, and the levels of tumour necrosis factor-α and interferon-γ in DRG, SC and HIP were significantly increased on the eighth and 14th days in CCI mice. Furthermore, the downstream signalling molecules of RIP1 and RIP3, GTPase dynamin-related protein-1, NLR family pyrin domain containing-3 (NLRP3) and nuclear factor κB-p65 were upregulated. Increased protein levels of programmed cell death protein 1, which indicate cell death of peripheral and central nervous tissue, were induced by CCI of the sciatic nerve. Overall, this study showed that RIP1 and RIP3 were highly expressed in DRG, SC and HIP of the sciatic nerve in CCI mice and may be involved in chronic neuroinflammation and neuronecrosis.