The Impact of Histologies On Clinical Outcomes of Spinal Metastases Treated With Stereotactic Body Radiotherapy.

Background With the life expectance prolonging, more cancer patients occurred spinal metastases. To evaluate the impact of histologies on outcomes of spinal metastases treated with stereotactic body radiotherapy (SBRT) and identify the correlated prognostic factors. Methods The authors retrospectively reviewed the records of all patients who underwent SBRT with no prior radiation for spinal metastases between October 2015 and October 2020 at Sun Yat-sen University Cancer Center. Propensity score matching (PSM) was applied to balance the distribution of related baseline characteristics. The endpoints included overall survival (OS), local control (LC), pain relief, and time to pain relief. Results A total of 202 consecutive patients with 345 spinal metastases were treated with a median follow-up time of 16.02 months (range, 0.73–57.90 months). The 1- and 2-year OS rates were 57% and 50%, respectively. The median survival was 35.63 months. A higher Karnofsky Performance Scale (KPS) score at consult predicted for better OS (P = 0.020). The presence of pain at enrollment assessed by the Brief Pain Inventory (BPI) predicted for worse OS (P = 0.038). The 1-year LC rate was 92.0%. The pain relief rate was 76.30% (103/135 patients). Younger age was identified to be prognostic for better pain relief (P = 0.037). In the univariate and multivariate analysis, no variable was independently associated with time to pain relief. As for toxicity, no Grade ≥ 3 toxicity was observed. Conclusions SBRT is feasible and appears to be an effective treatment paradigm for patients with spinal metastases, with limited accepted toxicities.

Percutaneous Closure of Patent Foramen Ovale under TEE Guidance in Cryptogenic Stroke and Migraine

Background. To investigate safety and clinical efficacy of percutaneous closure of PFO under TEE guidance in patients with cryptogenic stroke (CS) and migraine, combined PFO and large right-to-left shunt（RLS）. Methods. From January 2018 to June 2021 in our hospital, 128 patients were treated by percutaneous PFO occlusion under TEE guidance in CS and migraine. Effective occlusion rate, complications, cerebral ischemia events, migraine relief, and hospitalization costs were analyzed. Postoperative follow-up were conducted. Results. All the 128 patients were successful in percutaneous PFO occlusion. The average operation time was 20~32 (25.6±4.2) min, the average hospitalization time was 2~3(2.8±0.4) d. There were 122 patients without RLS and 6 patients with medium residual RLS, with the sealing efficiency of 95.31% by TTE and right heart contrast echocardiography. 30 patients with migraine underwent percutaneous PFO occlusion, 24 patients relief after operation, with a relief rate of 80.0%. Postoperative follow-up was conducted for 1-36（28.8±3.6）months, and no follow-up was lost. 98 cases of CS with PFO underwent percutaneous blockade were followed up without cerebral embolism recurrence, 26 of 30 patients with migraine received significant remission of migraine, with remission rate of 86.66%. There were no serious adverse events. Conclusions. For patients with CS and migraine, combined PFO and large RLS, percutaneous PFO occlusion under the guidance of TEE has fewer complications and is safe and effective. It can prevent the recurrence of CS and treat migraine.

The Impact of Histologies on Clinical Outcomes of Spinal Metastases Treated with Stereotactic Body Radiotherapy

Purpose To evaluate the impact of histologies on outcomes of spinal metastases treated with stereotactic body radiotherapy (SBRT) and identify the correlated prognostic factors. Methods The authors retrospectively reviewed the records of all patients who underwent SBRT with no prior radiation for spinal metastases between October 2015 and October 2020 at Sun Yat-sen University Cancer Center. Propensity score matching (PSM) was applied to balance the distribution of related baseline characteristics. The endpoints included overall survival (OS), local control (LC), pain relief, and time to pain relief. Results A total of 202 consecutive patients with 345 spinal metastases were treated with a median follow-up time of 16.02 months (range, 0.73–57.90 months). The 1- and 2-year OS rates were 57% and 50%, respectively. The median survival was 35.63 months. A higher Karnofsky Performance Scale (KPS) score at consult predicted for better OS (P = 0.020). The presence of pain at enrollment assessed by the Brief Pain Inventory (BPI) predicted for worse OS (P = 0.038). The 1-year LC rate was 92.0%. The pain relief rate was 76.30% (103/135 patients). Younger age was identified to be prognostic for better pain relief (P = 0.037). In the univariate and multivariate analysis, no variable was independently associated with time to pain relief. As for toxicity, no Grade ≥ 3 toxicity was observed. Conclusions SBRT is feasible and appears to be an effective treatment paradigm for patients with spinal metastases, with limited accepted toxicities.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

A retrospective analysis of debridement in the treatment of chronic injury of lactating nipples

Treatment strategies for nipple injury are mainly based on aetiology. However, some damaged nipples do not heal after the aetiology was corrected. This study retrospectively analyses the effect of debridement for treating chronic injury of lactating nipples. The medical records on nipple injury management in the authors’ department from December 2015 to January 2020 were retrospectively analysed. A total of 167 patients were enrolled and grouped based on the presence or absence of nipple debridement. The difference in the healing effect, pain relief rate and recurrence rate of nipple injury between the two groups after 1 week was examined. The cure rate of nipple injury in the intervention group (54.3%) was significantly higher than in the control group (26.7%). In addition, the complete pain relief rate in the intervention group (48.1%) was significantly higher than in the control group (23.3%). However, the recurrence rates between the two groups (36.4% (16/44) vs. 34.8% (8/23)) had no statistically significant differences. For patients with no improvement after correction of the aetiology of the in the nipple damage, debridement can improve the healing environment of nipple breakage and thus relieve nipple pain.

Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

Background The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. Methods A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. Results A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868–2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952–3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. Conclusions Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.

Frequency of Headaches in Macromastia Patients and Relief After Reduction Mammoplasty

Background Several studies have reported that neck, back, and shoulder pain can be reduced after macromastia. However, only 1 study has specifically investigated the relation between macromastia and headaches. Objectives This study aimed to determine the frequency of headaches in patients with macromastia by examining a sample from our clinic and to determine whether the patients experienced headache relief following breast reduction surgery. Methods One hundred patients, out of 456 patients who met the criteria, were contacted by telephone and administered a questionnaire. Statistical analysis was performed with SPSS version 17.0. Normal distribution of the variables was examined by histograms and Kolmogorov-Smirnov tests. Pearson’s chi-square and Fisher’s exact tests were used to compare groups. The Mann-Whitney U test was used to evaluate nonparametric variables between the patients who has 1500 grams or less breast tissue removed and the patients more than 1500 grams breast tissue removed. Results The incidence of headaches in patients with macromastia was found to be 29%. Among the patients with headaches, 65.52% reported relief after surgery. The relief rate for headaches was found to be associated with the amount of tissue removed. Conclusions The incidence of headaches increased in patients with macromastia compared with the general population, and patients reported headache relief after surgery. In addition, as the amount of tissue removal increased, the relief rate for headaches after surgery also increased. Although additional studies are essential, preoperative headaches should be evaluated in breast reduction patients, and the removal of larger amounts of breast tissue should be considered among patients who report headaches. Level of Evidence: 4

Wrist-ankle acupuncture has a positive effect on cancer pain: a meta-analysis

Background Wrist-ankle acupuncture (WAA) as a kind of micro acupuncture therapy has been used to management cancer pain, however, the effects of WAA on cancer pain were controversial in the current studies. Therefore, the purpose of this meta-analysis was to critically evaluate the effect of wrist-ankle acupuncture (WAA) on cancer pain. Methods Seven digital databases were searched from the inception of databases to July 2020, including CNKI, Wanfang, VIP, CBM, Cochrane Library, PubMed and Embase. Randomized controlled trials conforming to the inclusion and exclusion criteria were screened and extracted; the risk of bias was evaluated using the Cochrane Collaboration criteria. The primary outcome indicators included pain relief rate and pain score, and the secondary outcome was adverse reaction incidence. All analyses were performed with Review Manager 5.3. Results A total of 13 studies with 1005 cancer patients (intervention group: 568, control group: 437) were included in this meta-analysis. The results demonstrated that the pain relief rate of experimental group (WAA / WAA + drug intervention) was better than that of control group (analgesic drug intervention), and the difference was statistically significant [RR = 1.31, 95%CI: 1.15 ~ 1.49, P < 0.01]. Conclusions WAA has certain effect on cancer pain, and the effect of WAA combined with pharmacological intervention is better than that of drug therapy alone.