The relation between catastrophizing and facial responsiveness to pain

Pain catastrophizing has recently been suggested to have a social function based on a positive association observed with facial responsiveness to noxious stimulation. However, this assumption is based on studies applying nociceptive stimuli of fixed intensity, such that high catastrophizers not only displayed increased pain behavior but also rated the stimulation as being more painful. The aim of this study was to investigate the relation between catastrophizing and facial responsiveness while controlling for individual differences in pain sensitivity. The facial expression of pain was investigated in 44 young and pain-free individuals in response to painful and non-painful phasic heat stimuli. Painful temperatures were tailored to the individual sensitivity to produce moderate pain. Facial responses were videotaped and objectively examined using the Facial Action Coding System. We also assessed skin conductance activity as an autonomic indicator of pain-related responses. Catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). In accordance with previous findings, subjects scoring higher on pain catastrophizing required lower thermal intensities to induce a moderately painful sensation (r=-0.40, p=0.007). However, catastrophizing did not correlate with facial responsiveness to perceptually controlled painful stimulation (r=-0.02, p=0.88). Moreover, correlation analyses revealed no significant associations between catastrophizing and skin conductance responses. The present findings provide further support for the impact of pain catastophizing on pain sensitivity. However, our finding of no relation between catastrophizing and facial responsiveness when participants are experiencing comparable psychophysical pain intensities, challenges previous assumptions that high catastrophizers display amplified pain behavior; at least in young and pain-free individuals.     

补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的近、远期临床观察

目的探讨补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的临床疗效。方法选取2019年2月—2020年2月收治的46例发生面神经炎的患者为本研究对象,采用随机数字表法将其分为观察组和对照组各23例,对照组采用针灸拔罐联合甲钴胺穴位注射治疗,观察组在对照组基础上给予补阳还五汤治疗,比较2组患者治疗后近期、远期患部功能恢复情况及临床疗效。结果治疗前,2组患者的临床症状评分及面部神经功能等级评估结果差异均不显著(P>0.05);治疗后1个月(近期)及治疗后3个月(远期),观察组患者的临床症状评分均显著低于对照组(P<0.05)。治疗后(远期)观察组患者中Ⅰ级患者比例显著高于对照组(P<0.05),2组中Ⅱ级和Ⅲ级患者占比差异均不显著(P>0.05),观察组显效患者占比显著高于对照组(P<0.05)。2组治疗总有效率差异不显著。结论补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗可显著缓解患者面神经炎的近、远期临床症状,有效促进患者面部神经功能恢复,具有重要临床价值。     

透刺联合桃红四物汤对静止期瘀血性面瘫的临床研究

目的:观察透刺联合桃红四物汤对静止期瘀血性面瘫的临床疗效、肌电表现和面神经运动情况。方法:随机选取2016年2月至2017年2月在乌鲁木齐市中医医院门诊及住院部就诊的静止期瘀血性面瘫患者60例。通过抽取随机数字法分为观察组与对照组,每组30例,对照组在基础治疗的基础上加用桃红四物汤;观察组在对照组治疗方案基础上施予透刺疗法。采用House-Brackman分级量表评估面神经功能;应用肌电图机在患侧额肌、眼轮匝肌、上唇方肌和口轮匝肌,记录肌肉的肌电表现和测量运动诱发动作电位起始处的潜伏期和M波波幅。结果:1)治疗后干预组House-Brackman评分低于对照组(P0.05)。2)观察组痊愈率(66.67%)明显高于对照组(46.67%)(P0.05)。3)2组患者治疗前肌电表现以静息电位和去神经电位为主(P0.05);治疗后2组患者再生电位、减弱运动电位和正常电位产生较治疗前多(P0.05),观察组优于对照组(P0.05)。4)治疗后2组患者潜伏期均缩短(P0.05),而M波波幅增大(P0.05);观察组的改善情况面神经运动潜伏期和M波波幅均优于对照组(P0.05)。结论:透刺联合桃红四物汤能有效改善静止期瘀血性面瘫的症状,其机制可能与激活更多的再生电位、减弱运动电位和正常电位有关。     

Imaging of hemifacial spasm

Almost all primary hemifacial spasms are associated with one or more neurovascular conflicts, most often at the root exit zone in the immediate vicinity of the brainstem. Imaging has first to exclude a secondary hemifacial spasm and secondly to search for and characterize the responsible neurovascular conflict(s). Magnetic resonance imaging should include high-resolution anatomical hyper T2-weighted sequences and magnetic resonance angiography by using 1.5 or even better 3 Tesla magnets. The most frequent vascular compressions are from the anterior-inferior cerebellar artery, the posterior-inferior cerebellar artery and the vertebrobasilar artery; venous conflicts are very rare. Conflicts are often multiple; also, the same vessel may compress the facial nerve in two places. Also, conflicts may be aided by particular anatomical circumstances, including arterial dolichoectasia, posterior fossa with a small volume or bony malformations.     

姿势微笑位口唇对称参考平面的数字化构建及初步应用验证

目的: 探索数字化技术构建姿势微笑(posed smile)位口唇对称参考平面(symmetry reference plane, SRP)的方法,实现姿势微笑位口唇SRP的自动化构建,并评价其初步应用效果。方法: 收集18名研究对象的三维面部和牙列数据,基于赋权普氏分析(weighted Procrustes analysis,WPA)算法和区域迭代最近点(iterative closest point,ICP)算法,分别构建每位受试者WPA算法和初学者ICP算法的姿势微笑位口唇SRP作为实验组,以专家定义的“真值平面(truth plane,TP)”作为对照组,比较WPA算法和初学者ICP算法确定的SRP与TP间的角度差异。将姿势微笑位下WPA算法自动获得的口唇SRP应用于前牙美学修复的数字化设计,进行临床初步应用评价。结果: 18名受试者姿势微笑位下WPA算法建立的口唇SRP与TP角度差异为1.78°±1.24°,初学者ICP算法建立的口唇SRP与TP角度差异为7.41°±4.31°,二者差异有统计学意义(P<0.05)。在前牙美学设计时,参照姿势微笑位下WPA算法自动获得的口唇SRP进行前牙修复体美学设计,受试者评分为(8.48±0.57)分;常规数字化方案按照原有牙列对称平面进行修复体设计,受试者评分为(5.20±1.31)分,二者差异有统计学意义(P<0.01)。结论: WPA算法自动构建的姿势微笑位口唇SRP较初学者ICP算法更准确,与“真值平面”非常相近,可以为口腔美学分析和设计提供重要参考,参照WPA算法自动构建的口唇SRP进行前牙修复体设计,能有效促进医患交流,提高患者对修复效果的满意度。     

A review of upper limb injuries in bear maul victims: Consistent pattern and inverse relation in severity with facial and scalp injuries

Purpose

Bear maul injuries are the most common wild animal inflicted injuries in India. More than 300 bear maul injuries report to our hospital per year.

Teaching facial fracture repair: A novel method of surgical skills training using three-dimensional biomodels

BACKGROUND:

The facial fracture biomodel is a three-dimensional physical prototype of an actual facial fracture. The biomodel can be used as a novel teaching tool to facilitate technical skills training in fracture reduction and fixation, but more importantly, can help develop diagnostic and management competence.

OBJECTIVE:

To introduce the ‘facial fracture biomodel’ as a teaching aid, and to provide preliminary evidence of its effectiveness in teaching residents the principles of panfacial fracture repair.

METHODS:

Computer three-dimensional image processing and rapid prototyping were used to generate an accurate physical model of a panfacial fracture, mounted in a silicon ‘soft tissue’ base. Senior plastic surgery residents in their third, fourth and fifth years of training across Canada were invited to participate in a workshop using this biomodel to simulate panfacial fracture repair. A short didactic presentation outlining the ‘patient’s’ clinical and radiological findings, and key principles of fracture repair, was given by a consultant plastic surgeon before the exercise. The residents completed a pre- and postbiomodel questionnaire soliciting information regarding background, diagnosis and management, and feedback.

RESULTS:

A total of 29 residents completed both pre- and postbiomodel questionnaires. Statistically significant results were found in the following areas: diagnosis of all fracture patterns (P=8.2×10⁻⁷ [t test]), choice of incisions for adequate exposure (P=0.04 [t test]) and identifying sequence of repair (P=0.019 [χ² test]). Subjective evaluation of workshop effectiveness revealed a statistically significant increase in ‘comfort level’ only among third year trainees. Overall, positive feedback was reported among all participants.

CONCLUSIONS:

Biomodelling is a promising ancillary teaching aid that can assist in teaching residents technical skills, as well as how to assess and plan surgical repair.     

Bloom syndrome does not always present with sun-sensitive facial erythema

Bloom syndrome is an autosomal recessive condition characterized by severe pre- and postnatal growth deficiency, immunodeficiency, an increased risk for malignancies, craniofacial dysmorphisms, and “typical” erythematous sun-sensitive skin lesions of the face. This facial rash has a butterfly-shaped distribution around the nose and is usually observed for the first time during the early years of life. Though reported as being a main feature of Bloom syndrome, there seems to be phenotypic variability regarding this facial skin rash among patients. It has been previously reported that in some individuals with Bloom syndrome these sun-sensitive lesions are less prominent or even absent. In this report we describe a 36 year old woman with short stature, microcephaly, several dysmorphisms, congenital hypothyroidism and premature ovarian failure. She was diagnosed with nasopharyngeal carcinoma at 36 years of age, only a few months after her consultation at the department of Clinical Genetics. Whole Exome Sequencing demonstrated that she had Bloom syndrome caused by a compound heterozygous mutation in BLM (c.2207_2212delinsTAGATTC; p.(Tyr736Leufs*5) and c.3681del; p.(Lys1227Asnfs*52)). She did not have facial sun-sensitive erythematous rash during childhood nor adulthood. We conclude that Bloom syndrome does not always present with erythematous sun-sensitive skin lesions of the face. We would like to underline that phenotypic variation regarding this “hallmark” feature of Bloom syndrome exists. Being aware of this might prevent a delay in diagnosing this rare short-stature syndrome and, subsequently, its potential clinical implications.