OBJECTIVE:To explore the mechanisms of dorsal root ganglia and spinal microglia cascade cross in electroacupuncture(EA)analgesia in the treatment of lumbar disc herniation.METHODS:A rat model of lumbar disc herniation...OBJECTIVE:To explore the mechanisms of dorsal root ganglia and spinal microglia cascade cross in electroacupuncture(EA)analgesia in the treatment of lumbar disc herniation.METHODS:A rat model of lumbar disc herniation(LDH)was established,EA was administered at Huantiao(GB30)acupoint 30 min once a day,for 3 d.Before and after modeling,and after EA,mechanical allodynia thresholds were detected.Hyperpolarization-activated cyclic nucleotide-gated 2(HCN2)in dorsal root ganglia was detected by quantitative polymerase chain reaction(qPCR)and Western blot.C-X3-C motif chemokine ligand 1(CX3CL1)and activity of microglia in spinal cord was observed separately via qPCR and immunofluorescence staining.RESULTS:The mechanical allodynia threshold of the right planta of model rats was significantly reduced(P<0.01),EA increased the mechanical pain threshold of rats(P<0.01),and decreased HCN2 mRNA,and protein expression,reduced the expression of CX3CL1 and the activation of microglia.ZD7288(a blocker of HCN channel)reduced the analgesic effect of EA from 1.83±0.84 to 0.74±0.20(P<0.05),and the expression of CX3CL1 in the spinal cord decreased from 0.52±0.11 to 0.15±0.05(P<0.01).CONCLUSION:EA analgesia on the radicular pain of LDH is definite.EA reduced the expression of HCN2 channel in the dorsal root ganglion,thereby decreasing the noxious stimulation entered to microglia in spinal dorsal horn.Our work supports EA is an effective treatment for radicular pain of LDH.展开更多
BACKGROUND A radicular groove is an anatomic malformation that usually initiates at the central fossa,extending along the root at varying lengths and depths and predisposes the involved tooth to a severe periodontal d...BACKGROUND A radicular groove is an anatomic malformation that usually initiates at the central fossa,extending along the root at varying lengths and depths and predisposes the involved tooth to a severe periodontal defect.Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions.They are a serious challenge for doctors to diagnose and treat.CASE SUMMARY In this report,we described a patient with a maxillary lateral incisor with a deep palatogingival groove with two roots,which led to complex combined periodontal-endodontic lesions.Suggested treatment modalities included curettage of the affected tissues,elimination of the groove by grinding and/or sealing with a variety of filling materials,and surgical procedures.In this case,a combination of endodontic therapy,intentional replantation,and root resection were used,which resulted in periodontal/periradicular healing after 12 mo.CONCLUSION Intentional replantation and root resection offer a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves,especially for two-rooted teeth.展开更多
BACKGROUND A palatal radicular groove is an unusual developmental deformity of the tooth,which may serve as a channel linking the periodontal and periapical inflammation,and yet no literature could be obtained analyzi...BACKGROUND A palatal radicular groove is an unusual developmental deformity of the tooth,which may serve as a channel linking the periodontal and periapical inflammation,and yet no literature could be obtained analyzing microbiota within the palatal radicular grooves.CASE SUMMARY Four patients diagnosed with palatal radicular groove and concomitant periodontal-endodontic deformity in permanent maxillary lateral incisors were enrolled in this work.Twelve bacterial samples from 4 patients were collected from different parts of the palatal radicular groove during intentional replantation surgery.Illumina sequencing was performed to analyze the taxonomical composition and microbiome structure inside the palatal grooves,and 1162 operational taxonomic units were obtained.The phyla of Firmicutes and Proteobacteria predominated in most of the samples.An unknown genus from the Bacillaceae family,Lactococcus,and Porphyromonas were the most abundant genera identified.There was no difference in the microbiota richness and diversity in three sections of the groove.CONCLUSION The unique ecological niches inside the palatal grooves harbored bacterial communities that shared some component features of both the endodontic and periodontal infections.The existence of palatal groove may play an interaction bridge between the root apex and tooth cervix and thus impair the outcome of traditional therapeutic methods such as root canal treatment and periodontal management.展开更多
Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptom...Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.展开更多
The purpose of this study was to evaluate the antibacterial activity of a modified self-etching primer incorporating chitosan and whether this modification affected the bond strength to radicular dentin.A modified sel...The purpose of this study was to evaluate the antibacterial activity of a modified self-etching primer incorporating chitosan and whether this modification affected the bond strength to radicular dentin.A modified self-etching primer was prepared by adding chitosan solutions at 0.03%,0.06%,0.12% and 0.25%（W/W） to RealSeal selfetching primer.RealSeal primer without chitosan was used as the control.The antibacterial activity of the modified self-etching primer was evaluated using the direct contact test against Enterococcus faecalis.The bonding ability of the RealSeal system to radicular dentin was evaluated using the push-out bond strength test.The modes of failure were examined under a stereomicroscope.Data were analyzed using analysis of variance（ANOVA） and Tukey’s test,with a P-value 〈 0.05 indicating statistical significance.The results showed that the antibacterial properties of the freshly prepared and aged modified self-etching primer incorporating chitosan exhibited potent antibacterial effect against Enterococcus faecalis compared with the unmodified primer.The RealSeal system with the aged modified self-etching primer incorporating chitosan showed no significant differences in the bond strength as compared with the control（P = 0.99）.The findings suggest that modified self-etching primer incorporating chitosan is a promising antibacterial primer which does not adversely affect the bond strength of the RealSeal system to radicular dentin.展开更多
BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on th...BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.展开更多
The coronal-radicular amputation or radicular hemisection is defined as the sectioning fragments coronal-radicular of the lower molar with clinical damage followed endodontic treatment and pros-thetics rehabilitation....The coronal-radicular amputation or radicular hemisection is defined as the sectioning fragments coronal-radicular of the lower molar with clinical damage followed endodontic treatment and pros-thetics rehabilitation. This clinical treatment is viable in presence of the radicular decay or furca damage. This is a report case of radicular hemisection of lower molar with decay and bone loss that compromise distal root. The objective was elimination of distal root and conserved mesial root with endodontic and prosthetics treatment.展开更多
Background Although three-dimensional MRI （3D-MRI） of short T1 inversion recovery turbo spin-echo （STIR TSE） has showed superior to two-dimensional MRI （2D-MRI） in showing the spinal cord and lumbar nerve roots,...Background Although three-dimensional MRI （3D-MRI） of short T1 inversion recovery turbo spin-echo （STIR TSE） has showed superior to two-dimensional MRI （2D-MRI） in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo （STIR LONG TE） was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation （LDH） adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults. Methods Twelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5,S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated. Results The definite rate of radicular vein （DRRV） of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, $1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, $1,45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association （JOA） was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 （P=0.010） between the score of JOA and that of radicular vein. Conclusion The 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.展开更多
Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection ...Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection is a novel technique for the treatment of nerve pain due to entrapment. The use of hydrodissection for the treatment of deep gluteal syndrome has not been reported. Methods: A case report involved a 42-year-old female presenting with deep gluteal syndrome. Case report: We report, with patient consent, an ultrasound-guided superior gluteal nerve hydrodissection method used for treating the deep gluteal syndrome. A previously healthy 42-year-old female patient sought medical attention due to persistent left gluteal pain. Trials of joint injections, physiotherapy, and epidural blocks were unsuccessful. Hydrodissection under ultrasound-guidance allowed separation of the fascial plane in areas with significant neural innervation. We targeted the superior gluteal nerve with hydrodissection offering the patient immediate and persistent relief from her symptoms. Conclusion: Ultrasound-guided hydrodissection of the superior gluteal nerve offers an effective and novel diagnostic and treatment option for deep gluteal syndrome.展开更多
基金Supported by Inheritance and Innovation in TCM“Hundred-Thousand-Ten Thousand”Talent Project(Qinhuang Project)(No.F119090038)the National Natural Science Foundation of China(Based on the Cascade Reaction of Microglia-Astrocyte research exosomal mi RNA mechanisms of the inhibitory transition from acute to chronic pain of LDH by electroacupuncture,No.82074529)Scientific Research Projects of Traditional Chinese Medicine Bureau of Guangdong Province(Based on the cAMP-PKA-HCN2 pathway the mechanism of electro-acupuncture to prevent the development of pain in lumbar disc herniation,No.20211254)
文摘OBJECTIVE:To explore the mechanisms of dorsal root ganglia and spinal microglia cascade cross in electroacupuncture(EA)analgesia in the treatment of lumbar disc herniation.METHODS:A rat model of lumbar disc herniation(LDH)was established,EA was administered at Huantiao(GB30)acupoint 30 min once a day,for 3 d.Before and after modeling,and after EA,mechanical allodynia thresholds were detected.Hyperpolarization-activated cyclic nucleotide-gated 2(HCN2)in dorsal root ganglia was detected by quantitative polymerase chain reaction(qPCR)and Western blot.C-X3-C motif chemokine ligand 1(CX3CL1)and activity of microglia in spinal cord was observed separately via qPCR and immunofluorescence staining.RESULTS:The mechanical allodynia threshold of the right planta of model rats was significantly reduced(P<0.01),EA increased the mechanical pain threshold of rats(P<0.01),and decreased HCN2 mRNA,and protein expression,reduced the expression of CX3CL1 and the activation of microglia.ZD7288(a blocker of HCN channel)reduced the analgesic effect of EA from 1.83±0.84 to 0.74±0.20(P<0.05),and the expression of CX3CL1 in the spinal cord decreased from 0.52±0.11 to 0.15±0.05(P<0.01).CONCLUSION:EA analgesia on the radicular pain of LDH is definite.EA reduced the expression of HCN2 channel in the dorsal root ganglion,thereby decreasing the noxious stimulation entered to microglia in spinal dorsal horn.Our work supports EA is an effective treatment for radicular pain of LDH.
文摘BACKGROUND A radicular groove is an anatomic malformation that usually initiates at the central fossa,extending along the root at varying lengths and depths and predisposes the involved tooth to a severe periodontal defect.Severe grooves that extend to the root apex often lead to complex combined periodontal-endodontic lesions.They are a serious challenge for doctors to diagnose and treat.CASE SUMMARY In this report,we described a patient with a maxillary lateral incisor with a deep palatogingival groove with two roots,which led to complex combined periodontal-endodontic lesions.Suggested treatment modalities included curettage of the affected tissues,elimination of the groove by grinding and/or sealing with a variety of filling materials,and surgical procedures.In this case,a combination of endodontic therapy,intentional replantation,and root resection were used,which resulted in periodontal/periradicular healing after 12 mo.CONCLUSION Intentional replantation and root resection offer a predictable procedure and should be considered a viable treatment modality for the management of palatogingival grooves,especially for two-rooted teeth.
基金Supported by National Natural Science Foundation of China,No.82001037the Research and Develop Program,West China Hospital of Stomatology,Sichuan University,No.RD-02-202007.
文摘BACKGROUND A palatal radicular groove is an unusual developmental deformity of the tooth,which may serve as a channel linking the periodontal and periapical inflammation,and yet no literature could be obtained analyzing microbiota within the palatal radicular grooves.CASE SUMMARY Four patients diagnosed with palatal radicular groove and concomitant periodontal-endodontic deformity in permanent maxillary lateral incisors were enrolled in this work.Twelve bacterial samples from 4 patients were collected from different parts of the palatal radicular groove during intentional replantation surgery.Illumina sequencing was performed to analyze the taxonomical composition and microbiome structure inside the palatal grooves,and 1162 operational taxonomic units were obtained.The phyla of Firmicutes and Proteobacteria predominated in most of the samples.An unknown genus from the Bacillaceae family,Lactococcus,and Porphyromonas were the most abundant genera identified.There was no difference in the microbiota richness and diversity in three sections of the groove.CONCLUSION The unique ecological niches inside the palatal grooves harbored bacterial communities that shared some component features of both the endodontic and periodontal infections.The existence of palatal groove may play an interaction bridge between the root apex and tooth cervix and thus impair the outcome of traditional therapeutic methods such as root canal treatment and periodontal management.
文摘Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.
文摘The purpose of this study was to evaluate the antibacterial activity of a modified self-etching primer incorporating chitosan and whether this modification affected the bond strength to radicular dentin.A modified self-etching primer was prepared by adding chitosan solutions at 0.03%,0.06%,0.12% and 0.25%（W/W） to RealSeal selfetching primer.RealSeal primer without chitosan was used as the control.The antibacterial activity of the modified self-etching primer was evaluated using the direct contact test against Enterococcus faecalis.The bonding ability of the RealSeal system to radicular dentin was evaluated using the push-out bond strength test.The modes of failure were examined under a stereomicroscope.Data were analyzed using analysis of variance（ANOVA） and Tukey’s test,with a P-value 〈 0.05 indicating statistical significance.The results showed that the antibacterial properties of the freshly prepared and aged modified self-etching primer incorporating chitosan exhibited potent antibacterial effect against Enterococcus faecalis compared with the unmodified primer.The RealSeal system with the aged modified self-etching primer incorporating chitosan showed no significant differences in the bond strength as compared with the control（P = 0.99）.The findings suggest that modified self-etching primer incorporating chitosan is a promising antibacterial primer which does not adversely affect the bond strength of the RealSeal system to radicular dentin.
基金Supported by the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022RC158.
文摘BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.
文摘The coronal-radicular amputation or radicular hemisection is defined as the sectioning fragments coronal-radicular of the lower molar with clinical damage followed endodontic treatment and pros-thetics rehabilitation. This clinical treatment is viable in presence of the radicular decay or furca damage. This is a report case of radicular hemisection of lower molar with decay and bone loss that compromise distal root. The objective was elimination of distal root and conserved mesial root with endodontic and prosthetics treatment.
文摘Background Although three-dimensional MRI （3D-MRI） of short T1 inversion recovery turbo spin-echo （STIR TSE） has showed superior to two-dimensional MRI （2D-MRI） in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo （STIR LONG TE） was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation （LDH） adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults. Methods Twelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5,S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated. Results The definite rate of radicular vein （DRRV） of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, $1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, $1,45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association （JOA） was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 （P=0.010） between the score of JOA and that of radicular vein. Conclusion The 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.
文摘Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection is a novel technique for the treatment of nerve pain due to entrapment. The use of hydrodissection for the treatment of deep gluteal syndrome has not been reported. Methods: A case report involved a 42-year-old female presenting with deep gluteal syndrome. Case report: We report, with patient consent, an ultrasound-guided superior gluteal nerve hydrodissection method used for treating the deep gluteal syndrome. A previously healthy 42-year-old female patient sought medical attention due to persistent left gluteal pain. Trials of joint injections, physiotherapy, and epidural blocks were unsuccessful. Hydrodissection under ultrasound-guidance allowed separation of the fascial plane in areas with significant neural innervation. We targeted the superior gluteal nerve with hydrodissection offering the patient immediate and persistent relief from her symptoms. Conclusion: Ultrasound-guided hydrodissection of the superior gluteal nerve offers an effective and novel diagnostic and treatment option for deep gluteal syndrome.
