CT引导下经蝶腭穴芒针透刺蝶腭神经节治疗变应性鼻炎的临床观察*

目的观察CT引导下经蝶腭穴芒针透刺蝶腭神经节治疗变应性鼻炎的临床疗效。方法 将72例变应性鼻炎患者随机分为试验组和对照组，试验组采用CT引导下经蝶腭穴芒针透刺蝶腭神经节；对照组采用常规针刺蝶腭穴及常规穴位，疗程结束后评定临床疗效。结果 试验组的总有效率为94.44%，对照组的总有效率为77.78%，差异具有统计学意义。试验组的指标改善均优于对照组。结论 在CT引导下，采用芒针透刺蝶腭神经节治疗变应性鼻炎，其治疗方法颇具特色，提高了透刺蝶腭神经节的准确性及安全性，从而为非CT引导时透刺的角度与深度提供了一定的参考依据。     

Optical coherence tomography findings in patients with alcohol use disorder and their relationship with clinical parameters

Abstract

Purpose: In our study, we aimed to investigate the ganglion cell-inner plexiform layer thickness (GCIPL), retinal nerve fibre layer thickness (RNFL), mean macular volume (MMV), central macular thickness (CMT), mean macular thickness (MMT), and choroidal thickness (CT) values with optical coherence tomography (OCT) in patients who are diagnosed with alcohol use disorder (AUD).

Materials and methods: The study included 43 patients who were diagnosed with AUD, and 43 healthy controls. Detailed biomicroscopic examinations of all the participants, visual acuity, intraocular pressure, anterior and posterior segment examinations, and then, OCT measurements were carried out.

Results: Although the measured values for RNFL in the superior and temporal quadrant are within normal limits, they were slightly higher compared to those in the control group (p values 0.127 and 0.191 for superior quadrant and temporal quadrant, respectively). The CT measurements in all quadrants were higher than the control group; however, these measurements were not statistically significant (p?>?0.05). When the relation between clinical features and OCT findings of the patients were examined, it was determined that the ages of the patients were statistically significantly and inversely correlated with the temporal CT and also the nasal and temporal quadrants of RNFL.

Conclusions: Our study is the first study that examines the retinal GCIPL and CT with OCT in patients who are diagnosed with AUD. In our results, it was determined that there were no statistically significant differences between the participants in terms of OCT parameters. Further studies with larger sampling groups evaluating neurotransmission findings may provide wider results.     

Cardiac Denervation for Arrhythmia Treatment with Transesophageal Ultrasonic Strategy in Canine Models

Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself. Two weeks after the ablation, the QT and QTc of the experimental group decreased compared with those of the sham group and at baseline (both p values < 0.001). Histologic examination revealed that left SGs were destroyed. No major complications were observed. This approach may be further explored as a method for ganglia remodeling evaluation and as a strategy of ganglia modification for arrhythmia and for other diseases.     

阿克替苷通过激活血红素加氧酶-1抑制H_(2)O_(2)诱导的视网膜神经节细胞氧化损伤北大核心

目的研究阿克替苷对视网膜神经节细胞(RGC-5)的保护作用及其机制。方法将RGC-5细胞分为对照组、H_(2)O_(2)组、阿克替苷+H_(2)O_(2)组(1μmol·L^(-1)、10μmol·L^(-1)、30μmol·L^(-1)阿克替苷分别预处理细胞2 h),MTT法检测各组细胞活力;后续实验阿克替苷+H_(2)O_(2)组选择阿克替苷30μmol·L^(-1)作为治疗浓度,荧光探针H2DCF-DA检测活性氧(ROS)产生和罗丹明123检测线粒体膜电位,Western blot检测各组细胞中Bcl-2、Bcl-2/Bax、半胱氨酸蛋白酶-3(Caspase-3)蛋白表达。机制研究中首先用不同浓度阿克替苷单独处理RGC-5细胞24 h,Western blot检测血红素加氧酶-1(HO-1)蛋白表达水平,进一步锌原卟啉(ZnPP)预处理RGC-5细胞1 h,而后30μmol·L^(-1)阿克替苷单独预处理后与200μmol·L^(-1)H_(2)O_(2)共孵育24 h,通过MTT法测定细胞活力。结果与对照组相比,H_(2)O_(2)组中细胞活力明显降低(P<0.01)。与H_(2)O_(2)组相比,阿克替苷+H_(2)O_(2)组中10μmol·L^(-1)、30μmol·L^(-1)阿克替苷预处理可显著提高细胞活力(P<0.05、P<0.01)。与对照组相比,H_(2)O_(2)组RGC-5细胞ROS生成明显增加,线料体膜电位显著降低,同时Bcl-2/Bax比值降低和Caspase-3蛋白相对表达量增加(均为P<0.05)。与H_(2)O_(2)组相比,阿克替苷+H_(2)O_(2)组RGC-5细胞ROS生成减少,线粒体膜电位增加,Bcl-2/Bax比值提高,Caspase-3蛋白相对表达量减少(均为P<0.05)。与阿克替苷未处理组相比,阿克替苷剂量依赖性诱导HO-1蛋白的表达,与阿克替苷+H_(2)O_(2)组相比,加入ZnPP后细胞活力降低(P<0.01),说明HO-1抑制剂ZnPP降低了阿克替苷对H_(2)O_(2)损伤的抑制作用。结论阿克替苷能够通过上调HO-1表达抑制H_(2)O_(2)诱导的RGC-5氧化应激损伤。     

Unusual multiloculated serpiginous ganglion of the foot

Ganglions are cystic lesion more commonly seen around the wrist joint. Gangliomas of plantar aspect of the foot are rare. We have presented a case of an unusual serpiginous ganglioma of the plantar aspect of the foot. Less literature is available regarding plantar foot gangliomas. The treatment is challenging because of occurrence of the lesion at weight bearing zone. Available options for treatment includes conservative with splint, intralesional injection,arthroscopic excision and open excision.     

重组碱性成纤维细胞生长因子通过Notch1信号通路对糖尿病大鼠视网膜神经节细胞的保护作用

目的　探讨重组碱性成纤维细胞生长因子(recombinant basic fibroblast growth factor,rbFGF)通过Notch1信号通路对糖尿病大鼠视网膜神经节细胞(retinal ganglion cell，RGC)的保护作用。方法　雄性SD大鼠40只，随机分成对照组、糖尿病组、rbFGF组、rbFGF+DAPT组(DAPT为Notch1通路的特异性拮抗剂)，每组10只。后三组大鼠采用单次腹腔注射链脲佐菌素(streptozotocin,STZ) 诱导糖尿病模型。模型诱导成功后，rbFGF组给予rbFGF 10 μL(200 U)玻璃体内注射给药，rbFGF+DAPT组在给予rbFGF基础上加用DAPT(10 μmol·L^-1)。注射12周后，HE染色检测RGC密度，免疫组织化学染色检测神经元再生相关蛋白GAP-43、Notch1蛋白表达，Western blot检测GAP-43、Notch1蛋白及凋亡相关蛋白Caspase-3相对表达量。结果　与对照组RGC密度(433.49±6.02)个·mm^-2，GAP-43荧光强度(8.96±0.26)%、Notch1阳性率(45.04±0.46)%及Caspase-3 (27.91±0.63) %蛋白表达相比，糖尿病组RGC密度(328.35±6.43)mm^-2，Notch1荧光强度(31.66±0.40)%蛋白表达明显降低，GAP-43荧光强度(13.66±0.52)%、Caspase-3 (48.91±0.64)%蛋白表达明显增加(均为P<0.05)；而与糖尿病组相比，rbFGF组RGC密度(425.30±7.98)个·mm^-2，Notch1阳性率(41.76±0.62)% 及GAP-43荧光强度(33.05±0.37)%蛋白表达明显增加，Caspase-3 (28.86±0.71)%蛋白表达明显降低(均为P<0.05)；而rbFGF+DAPT组RGC密度(324.91±8.22)个·mm^-2，GAP-43荧光强度(14.27±0.64)%、Notch1阳性率(30.40±0.82)%及Caspase-3 (47.63±0.68)%蛋白表达均无明显变化(均为P>0.05)。结论　rbFGF可上调糖尿病状态下视网膜GAP-43蛋白表达，下调Caspase-3蛋白表达，进而提高RGC的存活，其机制可能与激活Notch1信号通路有关。     

Accuracy of Electrode Position in Sphenopalatine Ganglion Stimulation in Correlation With Clinical Efficacy

IntroductionSphenopalatine ganglion (SPG) stimulation is an efficient treatment for cluster headache. The target for the SPG microstimulator in the pterygopalatine fossa lies between the vidian canal and foramen rotundum, ideally two contacts should be placed in this area. However, placement according to the manufacturers recommendations is frequently not possible. It is not known whether a suboptimal electrode placement interferes with postoperative outcomes.Materials and MethodsSPG stimulation was performed in 13 patients between 2015 and 2018 in a single center. Lead location was determined by intraoperative computed tomography scan and correlated with the planned lead position as well as clinical data and stimulation parameters. Patients with a reduction of 50% or more in pain intensity or frequency were considered responsive.ResultsEleven patients (84.6%) responded to SPG stimulation with eight being frequency responders (61.5%). In seven cases, there were less than two electrodes between vidian canal and foramen rotundum, there was no significant correlation with negative stimulation results (p = 0.91). The mean distance of lead location between pre- and postoperative images did not correlate with clinical outcomes (p = 0.84) and was even bigger in responders (4.91 mm vs. 4.53 mm). The closest electrode contact to the vidian canal was in the stimulation area in all but one patient, regardless of its overall distance to canal. The distance of the closest electrode to the vidian canal was, however, not significantly correlated to the percentage of frequency (p = 0.68) or intensity reduction (p = 0.61).ConclusionThere was no significant correlation regarding aberrations of lead position from the planned position with clinical outcome. However, this study might be underpowered to detect such a correlation. The closest electrode contact to the vidian canal was in the stimulation area in all but one patient in the final programming. This indicates that, overall, the lead location does play a crucial role in SPG stimulation for cluster headache.