251
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Devoogdt N, De Groef A. Physiotherapy management of breast cancer treatment-related sequelae. J Physiother 2024; 70:90-105. [PMID: 38519340 DOI: 10.1016/j.jphys.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/24/2024] Open
Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Vascular Surgery, Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium.
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium; Department of Rehabilitation Sciences, MOVANT Research Group, Antwerp University, Antwerp, Belgium
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252
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Baradwan S, Alshahrani MS, AlSghan R, Alyafi M, Elsayed RE, Abdel-Hakam FA, Moustafa AA, Hussien AE, Yahia OS, Shama AA, Magdy AA, Abdelhakim AM, Badran H. The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024; 309:1267-1280. [PMID: 38165441 DOI: 10.1007/s00404-023-07319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rasha Ezzat Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Faiza Ahmed Abdel-Hakam
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman Esmail Hussien
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Othman Saadeldien Yahia
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Abdelaziz Shama
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Ahmed Magdy
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Haitham Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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253
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Liao WC, Cheng YY, Hsu CK, Chiu YC, Chiu HY, Chang SC, Hu SH. Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial. Int J Nurs Stud 2024; 154:104765. [PMID: 38642473 DOI: 10.1016/j.ijnurstu.2024.104765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S) This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION ClinicalTrials.gov ID: NCT04535765.
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Affiliation(s)
- Wan-Chun Liao
- Department of Nursing, Cathay General Hospital, No. 280, Sec. 4, Ren Ai Road, Taipei City 106, Taiwan
| | - Yu-Yi Cheng
- Department of Nursing, Cathay General Hospital, No. 280, Sec. 4, Ren Ai Road, Taipei City 106, Taiwan
| | - Chieh-Kuan Hsu
- Department of Nursing, Cathay General Hospital, No. 280, Sec. 4, Ren Ai Road, Taipei City 106, Taiwan
| | - Yi-Chun Chiu
- Division of Urology, Department of Surgery, Taipei City Hospital, No. 87 Tongde Road, Taipei City 115, Taiwan; Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Taipei City 112, Taiwan.
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City 110, Taiwan
| | - Shih-Chang Chang
- Division of Colorectal Surgery, Department of Surgery, Cathay General Hospital, No. 280, Sec. 4, Ren Ai Road, Taipei City 106, Taiwan
| | - Sophia H Hu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Sec.2, Li-Nong Street, Taipei City 112, Taiwan.
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254
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Ashokkumar P, Kuppusamy SK, Chinnasamy R. Effects of melatonin on postoperative pain and sensory recovery following zygomaticomaxillary complex fractures - A randomized controlled trial. J Craniomaxillofac Surg 2024:S1010-5182(24)00137-9. [PMID: 38609755 DOI: 10.1016/j.jcms.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Posttraumatic and postsurgical sensory disturbance is a known complication of almost all zygomaticomaxillary (ZMC) complex fractures involving the infraorbital nerve, for which few treatments are effective. Our study used neurosensory assessments to evaluate the efficacy of melatonin on pain and nerve healing following ZMC surgery. Sixty-four randomly allocated ZMC fracture patients were prophylactically administered either oral melatonin or an identical placebo for 15 consecutive days. Pre- and postsurgical clinical parameters included subjective pain, numbness, and objective neurosensory function. Melatonin significantly reduced subjective pain perception in the early postoperative days, with a significant difference in VAS scores between the groups from postoperative day 3 (p = 0.048) until day 7 (p = 0.002). The VAS assessment of subjective numbness perception showed significantly lower self-perceived neurosensory disturbance for patients in the interventional group from the first month (p = 0.039) until the third month (p = 0.005). Objective neurosensory assessment using the pinprick test and two-point discrimination showed statistically significant improvement to almost normal sensation by the first month (p = 0.014) to fully normal sensation by the third month (p = 0.001). The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and improved sensory recovery.
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Affiliation(s)
- Pavithran Ashokkumar
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 9894339889, India.
| | - Santhosh Kumar Kuppusamy
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 9894339889, India.
| | - Ravindran Chinnasamy
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, 9894339889, India.
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255
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Mong ER, Kethireddy S, Staudt MD. Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes. World Neurosurg 2024:S1878-8750(24)00540-0. [PMID: 38561030 DOI: 10.1016/j.wneu.2024.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Spinal cord stimulators (SCSs) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. METHODS Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. RESULTS Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6 ± 12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n = 12), too high (n = 2), or incompletely within the epidural space (n = 2). The mean duration from initial implantation to revision surgery was 44.8 ± 47.5 months. The mean operative duration was 126.1 ± 26.9 minutes and all patients required a "skip" laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4 ± 7.3 months. Mean preoperative pain intensity was 7.9 ± 1.5 and at last follow-up was 3.6 ± 1.7 (P < 0.001). All but 1 patient continued to use their device in follow-up. CONCLUSIONS The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.
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Affiliation(s)
- Eric R Mong
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Saini Kethireddy
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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256
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Najafi Z, Moosavi Z, Baradaran Rahimi V, Hashemitabar G, Askari VR. Evaluation of Anti-Nociceptive, Anti-Inflammatory, and Anti-Fibrotic effects of noscapine against a rat model of Achilles tendinopathy. Int Immunopharmacol 2024; 130:111704. [PMID: 38382264 DOI: 10.1016/j.intimp.2024.111704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
During tendinopathy, prolonged inflammation results in fibrosis and the adherence of tendons to the adjacent tissues, causing discomfort and movement disorders. As a natural compound, noscapine has several anti-inflammatory and anti-fibrotic properties. Therefore, we aimed to investigate the effects of noscapine against a rat model of tendinopathy. We created a surgical rat model of Achilles tendon damage to emulate tendinopathy. Briefly, an incision was made on the Achilles tendon, and it was then sutured using an absorbable surgical thread. Immediately, the injured area was topically treated with the vehicle, noscapine (0.2, 0.6, and 1.8 mg/kg), or dexamethasone (0.1 mg/kg) as a positive control. During the 19-day follow-up period, animals were assessed for weight, behavior, pain, and motor coordination testing. On day 20th, the rats were sacrificed, and the tendon tissue was isolated for macroscopic scoring, microscopic (H&E, Masson's trichrome, Ki67, p53) analyses, and cytokine secretion levels. The levels of macroscopic parameters, including thermal hyperalgesia, mechanical and cold allodynia, deterioration of motor coordination, tendon adhesion score, and microscopic indices, namely histological adhesion, vascular prominence and angiogenesis, and Ki67 and p53 levels, as well as fibrotic and inflammatory biomarkers (IL-6, TNF-α, TGF-β, VEGF) were significantly increased in the vehicle group compared to the sham group (P < 0.05-0.001 for all cases). In contrast, the administration of noscapine (0.2, 0.6, and 1.8 mg/kg) attenuated the pain, fibrosis, and inflammatory indices in a dose-dependent manner compared to the vehicle group (P < 0.05-0.001). Histological research indicated that noscapine 0.6 and 1.8 mg/kg had the most remarkable healing effects. Interestingly, two higher doses of noscapine had impacts similar to those of the positive control group in both clinical and paraclinical assessments. Taken together, our findings suggested that noscapine could be a promising medicine for treating tendinopathies.
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Affiliation(s)
- Zohreh Najafi
- Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Moosavi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Gholamreza Hashemitabar
- Division of Biotechnology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Vahid Reza Askari
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
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257
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Paris D, Bier M, Nacher M. [A promising tool in evaluation of psychological pain?]. Encephale 2024:S0013-7006(24)00047-2. [PMID: 38556395 DOI: 10.1016/j.encep.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/14/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Denis Paris
- Clinique Saint-Martin, 83090 Ollioules, France.
| | - Matthieu Bier
- Centre hospitalier universitaire de la Martinique, 97200 Fort-de-France, France
| | - Matthieu Nacher
- Centre d'investigation clinique Antilles-Guyane (Inserm CIC 1424), centre hospitalier de Cayenne, 97300 Cayenne, Guyane française
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258
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Chen Y, Chen L, Ji T, Yu Y, Zhang T, Wang L. The purinergic receptor P2X3 promotes facial pain by activating neurons and cytokines in the trigeminal ganglion. Int Immunopharmacol 2024; 130:111801. [PMID: 38442578 DOI: 10.1016/j.intimp.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/18/2024] [Accepted: 03/02/2024] [Indexed: 03/07/2024]
Abstract
The mechanism underlying allodynia/hyperalgesia caused by dental pulpitis has remained enigmatic. This investigation endeavored to characterize the influence of the purinergic receptor P2X3 on pain caused by experimental pulpitis and the mechanism involved. An experimental model of irreversible pulpitis was produced by the drilling and exposure of the dental pulp of the left upper first and second molars in rats, followed by measuring nociceptive responses in the oral and maxillofacial regions. Subsequently, neuronal activity and the expression of P2X3 and pertinent cytokines in the trigeminal ganglion (TG) were meticulously examined and analyzed. Histological evidence corroborated that significant pulpitis was produced in this model, which led to a distinct escalation in nociceptive responses in rats. The activation of neurons, coupled with the upregulated expression of c-fos, P2X3, p-p38, TNF-α and IL-1β, was identified subsequent to the pulpitis surgery within the TG. The selective inhibition of P2X3 with A-317491 effectively restrained the abnormal allodynia/hyperalgesia following the pulpitis surgery and concurrently inhibited the upregulation of p-p38, TNF-α and IL-1β within the TG. These findings suggest that the P2X3 signaling pathway plays a pivotal role in instigating and perpetuating pain subsequent to the induction of pulpitis in rats, implicating its association with the p38 MAPK signaling pathway and inflammatory factors.
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Affiliation(s)
- Yangxi Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Emergency and General Dentistry, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Liangyu Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Tuo Ji
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Yuan Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Tiejun Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China
| | - Li Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China; Department of Anesthesiology, School and Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China.
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259
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Leviel F, Fourdrain A, Delatre F, De Dominicis F, Lefebvre T, Bar S, Alshatri HY, Lorne E, Georges O, Berna P, Dupont H, Meynier J, Abou-Arab O. S erratus anterior plane block alone, paravertebral block alone and their combination in video-assisted thoracoscopic surgery: the THORACOSOPIC double-blind, randomized trial. Eur J Cardiothorac Surg 2024; 65:ezae082. [PMID: 38548664 PMCID: PMC10990687 DOI: 10.1093/ejcts/ezae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Serratus anterior plane block (SAPB) and paravertebral block (PVB) are well known to reduce pain levels after video-assisted thoracoscopic surgery (VATS). However, the relative efficacies of each block and a combination of the 2 have not been fully characterized. The objective of the present study was to assess the efficacy of PVB alone, SAPB alone and the combination of PVB and SAPB with regard to the occurrence and intensity of pain after VATS. METHODS We conducted the THORACOSOPIC single-centre, double-blind, randomized trial in adult patients due to undergo elective VATS lung resection. The participants were randomized to PVB only, SAPB only and PVB + SAPB groups. The primary end-point was pain on coughing on admission to the postanaesthesia care unit. The secondary end-points were postoperative pain at rest and on coughing at other time points and the cumulative opioid consumption. Pain was scored on a visual analogue scale. RESULTS One-hundred and fifty-six patients (52 in each group) were included. On admission to the postanaesthesia care unit, the 3 groups did not differ significantly with regard to the pain on coughing: the visual analogue scale score was 3 (0-6), 4 (0-8) and 2 (0-6) in the PVB, SAPB and PVB + SAPB groups, respectively (P = 0.204). During postoperative care, the overall pain score was significantly lower in the SABP + PVP group at rest and on cough. CONCLUSIONS The combination of SABP + PVB could be beneficial for pain management in VATS in comparison to SABP or PVB alone.
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Affiliation(s)
- Florent Leviel
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Marseille University Hospital, Marseille, France
| | - Florian Delatre
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
| | | | - Thomas Lefebvre
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
| | - Stéphane Bar
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
| | - Hamza Yahia Alshatri
- Faculty of Medicine, Department of Anesthesia and Critical Care, University of Jeddah, Jeddah, Saudi Arabia
| | - Emmanuel Lorne
- Department of Anesthesia and Critical Care Medicine, Millénaire Clinic, Montpellier, France
| | - Olivier Georges
- Department of Thoracic Surgery, Amiens Hospital University, Amiens, France
| | - Pascal Berna
- Department of Thoracic Surgery, Victor Pauchet Clinic, Amiens, France
| | - Hervé Dupont
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
| | - Jonathan Meynier
- Department of Biostatistics, Amiens Hospital University, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesia and Critical Care, Amiens Hospital University, Amiens, France
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260
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Andrews C, Patel J, Silvers A, Perry LA. Honing in on optimal regional analgesia in thoracoscopic surgery. Eur J Cardiothorac Surg 2024; 65:ezae147. [PMID: 38579241 DOI: 10.1093/ejcts/ezae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- Cassandra Andrews
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia
| | - Jinesh Patel
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia
- Cardiac Anaesthesia Division, Victorian Heart Hospital, Melbourne, VIC, Australia
| | - Andrew Silvers
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia
- Cardiac Anaesthesia Division, Victorian Heart Hospital, Melbourne, VIC, Australia
- Victorian Cardiac Anaesthesia Research Laboratory, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - Luke A Perry
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, VIC, Australia
- Cardiac Anaesthesia Division, Victorian Heart Hospital, Melbourne, VIC, Australia
- Victorian Cardiac Anaesthesia Research Laboratory, Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
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261
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Piret EM, Milloy MJ, Voon P, Choi J, DeBeck K, Hayashi K, Kerr T. Denial of prescription pain medication among people who use drugs in Vancouver, Canada. Harm Reduct J 2024; 21:72. [PMID: 38549113 PMCID: PMC10979632 DOI: 10.1186/s12954-024-00956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/03/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND People who use drugs experience pain at two to three times the rate of the general population and yet continue to face substantial barriers to accessing appropriate and adequate treatment for pain. In light of the overdose crisis and revised opioid prescribing guidelines, we sought to identify factors associated with being denied pain medication and longitudinally investigate denial rates among people who use drugs. METHODS We used multivariable generalized estimating equations analyses to investigate factors associated with being denied pain medication among people who use drugs reporting pain in three prospective cohort studies in Vancouver, Canada. Analyses were restricted to study periods in which participants requested a prescription for pain from a healthcare provider. Descriptive statistics detail denial rates and actions taken by participants after being denied. RESULTS Among 1168 participants who requested a prescription for pain between December 2012 and March 2020, the median age was 47 years and 63.0% were male. Among 4,179 six-month observation periods, 907 (21.7%) included a report of being denied requested pain medication. In multivariable analyses, age was negatively associated with prescription denial (adjusted odds ratio [AOR] = 0.98, 95% confidence interval [CI]:0.97-0.99), while self-managing pain (AOR = 2.48, 95%CI:2.04-3.00), experiencing a non-fatal overdose (AOR = 1.51, 95%CI:1.22-1.88), engagement in opioid agonist therapy (AOR = 1.32, 95%CI:1.09-1.61), and daily use of heroin or other unregulated opioids (AOR = 1.32, 95%CI:1.05-1.66) were positively associated with being denied. Common actions taken (n = 895) after denial were accessing the unregulated drug supply (53.5%), doing nothing (30.6%), and going to a different doctor/emergency room (6.1%). The period following the introduction of new prescribing guidelines was not associated with a change in denial rates. CONCLUSIONS A substantial proportion of people who use drugs continue to be denied prescriptions for pain, with such denial associated with important substance use-related harms, including non-fatal overdose. Guidelines specific to the pharmaceutical management of pain among people who use drugs are needed.
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Affiliation(s)
- Evelyne Marie Piret
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - M-J Milloy
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Pauline Voon
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - JinCheol Choi
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
| | - Kora DeBeck
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Public Policy, Simon Fraser University, 515 West Hastings St, Vancouver, BC, V6B 5K3, Canada
| | - Kanna Hayashi
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Thomas Kerr
- British Columbia Centre On Substance Use, 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Division of Social Medicine, Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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262
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Benoit-Piau J, Gaudreault N, Vallerand R, Fortin S, Guptill C, Morin M. Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers. Psychol Sport Exerc 2024; 73:102632. [PMID: 38548004 DOI: 10.1016/j.psychsport.2024.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVES This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks. DESIGN Prospective cohort study. METHODS A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary. RESULTS A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (β = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season. CONCLUSIONS Findings of this study support the role of obsessive passion in the development of MDEs in dancers.
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Affiliation(s)
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada.
| | - Robert Vallerand
- Department of Psychology, Université du Québec à Montréal, Canada.
| | - Sylvie Fortin
- Department of Dance, Université du Québec à Montréal, Canada.
| | | | - Mélanie Morin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Canada.
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Hareni N, Ebrahimnia S, Rosengren BE, Karlsson MK. Recovery pattern after decompression of central lumbar spinal stenosis: a prospective observational cohort study. J Orthop Surg Res 2024; 19:200. [PMID: 38528550 DOI: 10.1186/s13018-024-04614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Detailed preoperative information is associated with superior outcomes. We aimed to describe the recovery pattern after decompression of central lumbar spinal stenosis (CLSS). METHODS 50 patients aged 51-85 years who underwent decompression without fusion due to CLSS were followed from before to after surgery (post-op day 1, 7, and 14). Back and leg pain were evaluated using the Numeric Rating Scale (NRS; 0 = no pain 0, 10 = worst pain) and quality of life using the EuroQol-5D index (0 = death, 1 = best), and EQ-5D-visual analogue scale (VAS; 0 = worst, 100 = best). RESULTS NRS leg pain was reduced from preoperative to first postoperative day by 5.2 (6.1, 4.3) (mean (95%CI)], and NRS back pain from postoperative day 1-7 by 0.6 (1.2, 0.03) and from day 7 to 14 by 0.7 (1.3, 0.2)]. In contrast, EQ-5D index increased from preoperative to first postoperative day by 0.09 (0.06, 0.13) and from day 1 to 7 by 0.05 (0.02,0.08), and EQ-5D VAS from preoperative to first postoperative day by 13.7 (9.1, 18.3) and from day 1 to 7 by 6.0 (2.0, 10.0). After two weeks, 51% of the patients had improved above the minimal clinically important difference (MCID) in back pain and 71% in leg pain. CONCLUSIONS Patients scheduled for decompression due to CLSS should be informed that improvement in leg pain and quality of life in general can be expected within one day of surgery, that quality of life improves a little further in the first postoperative week, and that back pain improves in the first 2 postoperative weeks. In most patients, decompression without fusion due to CLSS seems to achieve clinically relevant improvement within 2 weeks.
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Affiliation(s)
- Niyaz Hareni
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
- Department of Orthopaedics, Varberg Hospital, Träslövsvägen 68, 432 37, Varberg, Sweden.
| | - Soheil Ebrahimnia
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Departments of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Pires PGDS, Sarrazin SLF, Souza DJDAD, Mourão RHV, Massing LT, Nunes HAS, Barroso AS, Oliveira RBD. Antiedema and antinociceptive potential of the essential oil of Pectis elongata Kunt (Asteraceae) from the Brazilian Amazon. J Ethnopharmacol 2024; 322:117643. [PMID: 38135233 DOI: 10.1016/j.jep.2023.117643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pectis elongata, a herbaceous species that is known in northern Brazil as "cominho" or "limãozinho", is traditionally used in the region for the treatment of fevers, colds, hypotension, genitourinary and gastric disorders, and pain. AIM OF THE STUDY Determine the chemical composition and acute oral toxicity and evaluate whether Pectis elongata essential oil (PeEO) has antiedema and antinociceptive activity. MATERIALS AND METHODS The chemical composition was determined using gas chromatography coupled to mass spectrometry (GC/MS) and the degree of toxicity determined by the LD50. The antiedema and antinociceptive potential was evaluated via the λ-carrageenan-induced paw edema test and formalin test, respectively. RESULTS Citral (geranial and neral) was characterized as a major component of the PeEO, representing 89% of the total identified compounds. According to OECD criteria (2002), the EO was considered non-toxic since it presented LD50 values over 2000 mg kg-1. Its antiedema potential was observed at doses of 200 and 400 mg kg-1 (p ≤ 0.05). At a dose of 400 mg kg-1, PeEO also showed antinociceptive potential (p ≤ 0.05), both in the neurogenic phase and in the inflammatory phase. CONCLUSIONS PeEO, which is rich in citral, did not induce any characteristic signs of acute oral toxicity and was also efficient in reducing carrageenan-induced paw edema, in addition to presenting antinociceptive potential and acting on both central and peripheral pain. It is thus a promising candidate for the development of a new herbal medicine with anti-inflammatory and analgesic action.
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Affiliation(s)
| | - Sandra Layse Ferreira Sarrazin
- Programa de Pós-graduação Em Ciências da Saúde, Universidade Federal do Oeste do Pará, Santarém, CEP: 68035-110, Pará, Brazil.
| | | | - Rosa Helena Veras Mourão
- Programa de Pós-graduação Em Ciências da Saúde, Universidade Federal do Oeste do Pará, Santarém, CEP: 68035-110, Pará, Brazil.
| | | | - Herman Ascenção Silva Nunes
- Programa de Pós-graduação Em Ciências da Saúde, Universidade Federal do Oeste do Pará, Santarém, CEP: 68035-110, Pará, Brazil.
| | | | - Ricardo Bezerra de Oliveira
- Programa de Pós-graduação Em Ciências da Saúde, Universidade Federal do Oeste do Pará, Santarém, CEP: 68035-110, Pará, Brazil.
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Ocal R, Buldukoglu OC, Hasoglan MG, Korucuk M, Cekin Y, Ocal S. Migraine and gasdermin D: a new perspective on the inflammatory basis of migraine. Acta Neurol Belg 2024:10.1007/s13760-024-02523-y. [PMID: 38526645 DOI: 10.1007/s13760-024-02523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Migraine is a common and disabling primary headache disorder and inflammation is a proposed factor in the complex ethiology of the disease. Gasdermin D (GSDMD) is a membrane pore-forming protein acting through the caspase system. End result is cell death caused by leakage of intracellular components to extracellular space which also results in inflammation. Stemming from this knowledge, the potential role of GSDMD in migraine was investigated in this prospective study. This prospective study was conducted between September 2022 to April 2023. 47 patients with migraine were designated as the patient group, whereas 47 healthy volunteers were designated as the control group. Serum GSDMD levels of both groups were compared, with an additional comparison between migraine patients during symptom-free and attack periods. Migraine related characteristics of the patients were also included in the study. Median GSDMD levels of the patient and control group did not reveal a significant difference. Nausea, vomiting and severity of headache were found to be correlated with GSDMD levels in migraine patients. Patients with nausea revealed a higher GSDMD level compared to patients without nausea during both symptom-free and attack periods (p = 0.021 and p = 0.01, respectively). Nausea was correlated to higher GSDMD levels in the patient population during symptom-free period (p = 0.030). The severity of pain was positively correlated with GSDMD levels during the attack period (p < 0.001). Gasdermin family and GSDMD in particular are promising prospects for therapy in a wide spectrum of disorders. Gasdermin proteins are candidates to be the focus for future studies both related to pathogenesis and drug therapy in migraine and varying inflammatory-driven clinical pictures.
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Affiliation(s)
- Ruhsen Ocal
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey.
| | | | | | - Meltem Korucuk
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yesim Cekin
- Department of Medical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Serkan Ocal
- Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
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266
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Shekari Z, Sadeghian Afarani R, Fatorehchy S, Bakhshi E, Shahshahani S, Mousavi E. Relationship Between Postural Asymmetry, Balance, and Pain in Children With Spastic Cerebral Palsy. Pediatr Neurol 2024; 155:84-90. [PMID: 38608553 DOI: 10.1016/j.pediatrneurol.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Primary symptoms of cerebral palsy (CP), such as spasm and weakness, can lead to secondary musculoskeletal problems. Exploring the interplay and impact of secondary symptoms is essential in CP management. METHODS A total of 56 children (32 males and 24 females) aged eight to 12 years in level I to III of Gross Motor Function Classification System (GMFCS) completed The Pediatric Balance Scale and Wong-Baker Faces Scale and the Posture and Postural Ability Scale. Relationships between the three groups were examined using the Kruskal-Wallis test, Tukey test, gamma coefficient, De Somers D, phi coefficient, Cramér V, and one-way analysis of variance. RESULTS There was a significant correlation between balance and postural asymmetry (P < 0.001), and no significant difference in balance was there between the severe and moderate asymmetry groups (P = 0.759) and between the mild asymmetry and no asymmetry groups (P = 0.374). Furthermore, there was a significant relationship between postural asymmetry and each of the variables of pain (P < 0.001) and gross motor function (P = 0.002). Although a meaningful correlation was identified between balance and gross motor function (P < 0.001), the relationship between postural asymmetry and balance in GMFCS levels was not found (P = 0.052, P = 0.052, P = 0.233). Conversely, no significant relationship was detected between pain and gross motor function (P = 0.072). SIGNIFICANCE Postural asymmetry negatively impacts balance and correlates with pain intensity. Addressing postural problems can contribute to pain management and improved balance.
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Affiliation(s)
- Zahra Shekari
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Sadeghian Afarani
- Masters' Student, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Saeid Fatorehchy
- Assistant Professor, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Enayatollah Bakhshi
- Professor, Department of Biostatistics and Epidemiology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Soheila Shahshahani
- Associate Professor, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elahe Mousavi
- Masters Degree, Faculty of Rehabilitation Sciences, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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267
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van der Heijden PAHH, Bongers MY, Veersema S, Dieleman JP, Geomini PMAJ. The impact of embedment of the side arms of 52 mg levonorgestrel-intrauterine device on bleeding and pain: A prospective cohort study. J Gynecol Obstet Hum Reprod 2024; 53:102777. [PMID: 38531476 DOI: 10.1016/j.jogoh.2024.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/17/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The purpose of this study was to analyse the impact of embedment of side arms of the levonorgestrel 52 mg intrauterine device (LNG-IUD) in the myometrium (assessed by three-dimensional transvaginal ultrasound (3D-TVUS)) on uterine bleeding and pain. MATERIALS AND METHODS We performed a prospective cohort study in a large Dutch teaching hospital between February 2015 and December 2016. Participants over 18 years of age who selected a LNG-IUD for contraception or because of heavy menstrual bleeding were eligible for inclusion. Six weeks after insertion, a 3D-TVUS was performed to diagnose embedment of the side arms. At that moment participants filled in questionnaires about their bleeding pattern and pelvic pain. Menstruation patterns 'no bleeding', 'regular menstruation', 'sometimes a day of spotting (maximum once a week)' were classified as favourable bleeding pattern. Menstruation patterns 'heavy menstrual bleeding', 'several days a week bleeding days', 'several days a week spotting days', 'continuously spotting', and 'completely irregular cycle' were classified as unfavourable bleeding pattern. Univariate and multivariate logistic regression analysis was used to calculate odds ratios (OR) and 95 %-confidence intervals (CI). The multivariate analysis included endometrial thickness, reason for insertion and parity. The analysis of pelvic pain additionally included previous insertion. RESULTS A total of 220 participants were evaluated for the study of whom 176 returned the questionnaires. Embedment of the side arms was observed in 43 of the 176 responding participants (24.4 %). Favourable bleeding pattern was reported by 25/43 (58.1 %) participants with embedment and 53/133 (39.8 %) participants without embedment (ORadj 1.8, 95 % CI 0.9-3.9). Pelvic pain was reported by 4/43 (9.3 %) participants with embedment and 24/133 (18.1 %) participants without embedment (ORadj 0.3; CI 0.1-1.2). CONCLUSIONS The present study suggests that embedment of the side arms of the LNG-IUD in the myometrium assessed by 3D-TVUS is not associated with a unfavourable bleeding pattern nor pelvic pain six weeks after insertion. From this point of view, we do not recommend to perform standard 3D-TVUS for the purpose of excluding or demonstrating embedment.
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Affiliation(s)
- P A H H van der Heijden
- Department of Obstetrics and Gynaecology, Anna Hospital in Geldrop, Bogardeind 2, 5664 EH Geldrop, The Netherlands; Department of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, The Netherlands.
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, The Netherlands; Grow, Research School of Oncology and Reproduction, Maastricht University Medical Center in Maastricht, P. Debyelaan 25, 6229 HX, The Netherlands
| | - S Veersema
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - J P Dieleman
- Department of Science, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, The Netherlands
| | - P M A J Geomini
- Department of Obstetrics and Gynaecology, Máxima Medical Center in Veldhoven, de Run 4600, 5504 DB Veldhoven, The Netherlands
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Bittar CK, Perucci IF, Signorini DN, Mascarenhas MB, Silvestre OF, Cliquet A. CLINICAL AND FUNCTIONAL EVALUATION OF WRISTS AND HANDS OF SPINAL CORD INJURED PATIENTS. Acta Ortop Bras 2024; 32:e264175. [PMID: 38532869 PMCID: PMC10962066 DOI: 10.1590/1413-785220243201e264175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/22/2022] [Indexed: 03/28/2024]
Abstract
Introduction The inability of the spinal cord to propagate sensory and motor stimuli as a result of the disruption of the nerve tracts is called spinal cord injury. Objective This study analyzes clinically and radiologically the hands and wrists of spinal cord injured patients, evaluating their motor and sensitive functionality, in order to determine if these patients are more likely to develop degenerative alterations. Methods 14 patients (8 paraplegics and 6 tetraplegics) were evaluated, undergoing anamnesis and clinical examination - a scale of muscular strength (MRC - Medical Research Council) and the amplitude measurement of the movement with a manual goniometer (ROM), were used for objective evaluation - and x-ray exams. The results were compared with pre-existing data from other studies. Results When asked, only one of the 14 observed patients complained about constant wrist pain, described as level 3 (weak to moderate), based on the visual analog scale (VAS). The motor evaluation, MRC and ROM divided the group of patients into two subgroups: paraplegic and tetraplegic patients. The x-ray analysis showed, based on Kellgren and Lawrence classification, that all exam images fit grades 1 or 2 of osteoarthritis and osteoarthrosis. Conclusion In conclusion, spinal cord injured patients showed none or minimal clinical and radiological signs of osteoarthritis on hands or wrists. Overall, the hands and wrists of spinal cord-injured patients behave similarly to noninjured patients. Level of Evidence III; Retrospective Comparative Study.
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Affiliation(s)
- Cíntia Kelly Bittar
- Pontifícia Universidade Católica de Campinas, School of Medical Sciences, Campinas, SP, Brazil
| | | | - Danillo Nagel Signorini
- Pontifícia Universidade Católica de Campinas, School of Medical Sciences, Campinas, SP, Brazil
| | - Mariana Buratti Mascarenhas
- Universidade Estadual de Campinas, Department of Orthopedics, Rheumatology and Traumatology, Campinas, SP, Brazil
| | - Orcizo Francisco Silvestre
- Universidade Estadual de Campinas, Department of Orthopedics, Rheumatology and Traumatology, Campinas, SP, Brazil
| | - Alberto Cliquet
- Universidade Estadual de Campinas, Department of Orthopedics, Rheumatology and Traumatology, Campinas, SP, Brazil
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Poelchow F, Codde J, Kendell R, Edgar DW, Wood FM. A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes. Burns 2024:S0305-4179(24)00105-0. [PMID: 38614897 DOI: 10.1016/j.burns.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. METHODS This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. RESULTS Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 - 4.5 vs control group - Md = 1.5, IQR 0.6 - 3.8, z = -0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. CONCLUSION Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.
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Affiliation(s)
- Fiona Poelchow
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jim Codde
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rosemary Kendell
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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Panayi AC, Heyland DK, Stoppe C, Jeschke MG, Didzun O, Matar D, Tapking C, Palackic A, Bliesener B, Harhaus L, Knoedler S, Haug V, Bigdeli AK, Kneser U, Orgill DP, Hundeshagen G. The long-term intercorrelation between post-burn pain, anxiety, and depression: a post hoc analysis of the "RE-ENERGIZE" double-blind, randomized, multicenter placebo-controlled trial. Crit Care 2024; 28:95. [PMID: 38519972 PMCID: PMC10958907 DOI: 10.1186/s13054-024-04873-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Despite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise. METHODS RE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression. RESULTS A total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression. CONCLUSIONS Analyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.
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Affiliation(s)
- Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Christian Stoppe
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany
| | - Marc G Jeschke
- Hamilton Health Sciences Research, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Oliver Didzun
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Dany Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Björn Bliesener
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Amir K Bigdeli
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women'S Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen/Rhine, Germany.
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Bosio A, Ferretti S, Alessandria E, Vitiello F, Vercelli E, Campobasso D, Micai L, Gozzo C, Bertello G, Guarino GG, Alice C, Bisconti A, Fop F, Gontero P. Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial. World J Urol 2024; 42:186. [PMID: 38517489 PMCID: PMC10959803 DOI: 10.1007/s00345-024-04879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/10/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE To compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS Patients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). PRIMARY ENDPOINT to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline. RESULTS 93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ. CONCLUSIONS Patients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.
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Affiliation(s)
- Andrea Bosio
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy.
- Department of Surgical Sciences, University of Turin, Turin, Italy.
| | - Stefania Ferretti
- Department of Urology, AOU University Hospital, Parma, Italy
- Department of Urology, AOU University Hospital, Modena, Italy
| | - Eugenio Alessandria
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Federico Vitiello
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Eugenia Vercelli
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | - Luca Micai
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Claudia Gozzo
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Glauco Bertello
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | | | - Claudia Alice
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Alessandro Bisconti
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Fabrizio Fop
- Department of Nephrology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
| | - Paolo Gontero
- Department of Urology, AOU Città della Salute e della Scienza, Molinette University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
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272
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Tuna HI, Hakbilen S, Yilmaz S, Unver G. Determining the Effect of Telehealth Intervention for Lupus Patients on Pain, Happiness, and Life Activities: A Randomized Controlled Study. Pain Manag Nurs 2024:S1524-9042(24)00015-8. [PMID: 38519350 DOI: 10.1016/j.pmn.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE This study aims to determine the effect of a telehealth intervention for SLE patients on pain, happiness, and life activities. METHODS The study was conducted as a randomized controlled study. The sample of the study consisted of a total of 73 participants, including the experimental group (n = 37) and the control group (n = 36). Random number generation using Excel was used to determine how subjects were randomly assigned to treatment and control groups. Numerical Rating Scale, Oxford Happiness Scale Short Form, and Life Activities Scale were used to collect data. In addition to their routine treatments, participants in the experimental group received telehealth intervention once a week for 12 weeks, each intervention lasting 15 to 20 minutes. No application was made to the control group during the intervention. Scales were applied to both groups at the beginning of the study, in the 6th week, and in the 12th week. RESULTS Pain scores of the experimental group were lower at the 6th and 12th weeks compared to the beginning. While there was no difference in pain comparison between the groups at the 6th and 12th weeks, the pain score of the experimental group at the 12th week was significantly lower than the control group. It was determined that the happiness scale scores in the experimental group were higher at the 6th and 12th weeks compared to the beginning. At the end of the 12th week, the happiness score of the experimental group was higher than the control group. It was determined that the life activities scores in the experimental group were higher at the 6th and 12th weeks compared to the beginning. CONCLUSION It has been determined that telehealth application has a positive effect on the pain, happiness, and life activities of SLE participants. We suggest that future research should be conducted to improve the body image of SLE participants.
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Affiliation(s)
- Halil Ibrahim Tuna
- Nursing Department, Konya-Aksehir Kadir Yallagoz Health School, Selcuk University, Konya, Turkey.
| | - Selda Hakbilen
- Faculty of Medicine, Department of Rheumatology, Selcuk University, Konya, Turkey; Faculity of Medicine, Rheumatology Department, Selcuk University, Konya, Turkey
| | - Sema Yilmaz
- Faculity of Medicine, Rheumatology Department, Selcuk University, Konya, Turkey
| | - Gamze Unver
- Nursing Department, Kütahya University of Health Sciences, Kütahya, Turkey
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273
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Ivanova D, Newell D, Field J, Bishop FL. The development of working alliance in early stages of care from the perspective of patients attending a chiropractic teaching clinic. Chiropr Man Therap 2024; 32:10. [PMID: 38515190 PMCID: PMC10958961 DOI: 10.1186/s12998-023-00527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. METHODS Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. RESULTS The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. CONCLUSIONS Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations.
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Affiliation(s)
- Dima Ivanova
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK.
| | - Dave Newell
- AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, UK
| | | | - Felicity L Bishop
- School of Psychology, University of Southampton, University Road, Southampton, Hampshire, SO17 1BJ, UK
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274
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Seidler N, Terlep O, Ramanujam V. Peripheral nerve blocks for through-knee amputation in a patient on extracorporeal membrane oxygenation. BMJ Case Rep 2024; 17:e259987. [PMID: 38508595 PMCID: PMC10952935 DOI: 10.1136/bcr-2024-259987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
A woman in her 40s with an ischaemic right lower limb, who was on extracorporeal membrane oxygenation (ECMO) following cardiopulmonary failure secondary to bilateral alveolar haemorrhage, was scheduled for through-knee amputation. She was under mechanical ventilation and continuous intravenous medications. Considering her significant comorbidities, peripheral nerve blocks were chosen for anaesthesia. Ultrasound-guided traditional nerve blockade techniques of the femoral and sciatic nerves were not possible because of the presence of an ECMO cannula, altered anatomy following previous surgery on the same side and inability to turn the patient to a lateral position. An ultrasound-guided trans fascia iliaca for femoral and anterior approach for sciatic were rather used to accomplish the nerve blockades. Surgery completed without any complications and with reduced postoperative outcomes such as opioid consumption, other morbidities and mortality. This report is unique as the literature on peripheral nerve block approaches for lower limb amputations in ECMO patients is sparse.
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Affiliation(s)
- Nicholas Seidler
- Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Olivia Terlep
- Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Vendhan Ramanujam
- Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
- Anesthesiology, Lifespan Physician Group Services, Providence, Rhode Island, USA
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275
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Zhu B, Ba H, Kong L, Fu Y, Ren J, Zhu Q, Fang M. The effects of manual therapy in pain and safety of patients with knee osteoarthritis: a systematic review and meta-analysis. Syst Rev 2024; 13:91. [PMID: 38504373 PMCID: PMC10949788 DOI: 10.1186/s13643-024-02467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/21/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Manual therapy (MT) is frequently used in combination with management of osteoarthritis of the knee, but there is no consensus on the exact efficacy of this treatment strategy. The purpose of this systematic review and meta-analysis was to evaluate the pain relief and safety of MT for treatment of knee osteoarthritis (KOA). METHODS Randomized controlled trials evaluating MT in patients with KOA in major English and Chinese journals were searched in the following databases: Wanfang, China Science and Technology Journal Database (VIP database), China National Knowledge Infrastructure (CNKI), PubMed, Embase, Web of Science, and the Cochrane Library databases through June 2023. The methodological quality and quality of evidence of the included studies were assessed using Cochrane's risk-of-bias 2 (ROB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Data analysis was performed using Stata version 15.0 software. After use of Galbraith plots to exclude studies that could lead to heterogeneity, random effects models were used to analyze the remaining data and test the consistency of the findings. We used meta-regression to assess the effect of treatment period, patient age, and sex ratio on outcomes. Funnel plots and Egger's test were used to evaluate publication bias. Sensitivity analyses were used to determine the reliability of the results. RESULTS A total of 25 studies, with 2376 participants, were included in this review. The overall methodological quality of the included studies was limited. Our findings suggest that MT has a positive impact on pain relief outcomes in KOA patients. The meta-analysis showed that MT was superior to usual care (SMD = 2.04, 95% CI 0.94, 3.14, I 2 = 96.3%; low evidence quality) and exercise (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%; low evidence quality) for reducing pain. In terms of improvement in visual analogue scale (VAS) scores, MT treatment beyond 4 weeks (SMD = 1.56, 95% CI 0.41, 2.71, I 2 = 96.3%) may be superior to treatments less than or equal to 4 weeks (SMD = 1.24, 95% CI 0.56, 1.95, I 2 = 94.7%). No serious adverse events associated with MT were reported. CONCLUSIONS MT may be effective at reducing pain in patients with KOA and may be more effective after a 4-week treatment period. Compared with usual care and exercise therapy, MT may be superior at reducing KOA pain in the short term (9 weeks), but its long-term efficacy requires careful consideration of evidence-based outcomes. MT appears to be safe for KOA patients, though clinicians should inform patients of the potential risk of MT-related adverse events.
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Affiliation(s)
- Bowen Zhu
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - He Ba
- Department of Integrative Oncology, Shanghai Cancer Center, Qingdao Institute, Fudan University, Qingdao, China
| | - Lingjun Kong
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangyang Fu
- Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Ren
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qingguang Zhu
- Department of Traditional Chinese Massage, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Traditional Chinese Medicine and Massage, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Traditional Chinese Medicine and Massage, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
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276
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van Walraven SM, Witte LC, Prinsze F, Wiersum-Osselton JC, Bank I. Pain is what hurts: An exploration of perception and management of pain in peripheral blood stem cell donors. Transfus Apher Sci 2024:103908. [PMID: 38519381 DOI: 10.1016/j.transci.2024.103908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Pain is a side effect of Granulocyte-Colony Stimulating Factor (G-CSF) administration. This prospective study investigates various aspects including pain perception occurring in Peripheral Blood Stem Cell (PBSC) donors. MATERIALS AND METHODS Related and unrelated PBSC donors were prospectively studied. Donors recorded pain symptoms during the four-day period of G-CSF administration using the McGill Pain Questionnaire, a Visual Analog Scale and a pain diary. RESULTS There were 208 donors included, 102 (49%) related and 106 (51%) unrelated donors. Ninety-two percent of all reported the occurrence of pain. Moderate or severe pain was reported by 52%. No differences were found between related and unrelated donors. Pain occurred more often in females (p = 0.035). Relatively young donors (age 16-30 years) more frequently showed to have pain in comparison to older donors (>50 years) (p = 0.006). Musculoskeletal pain was most frequently distributed in the gluteal and lower back region (65-71%). Irrespective of the pain location, pain was most often described as nagging, annoying, however tolerable. Donors experiencing pain most on days of G-CSF administration, most frequently occurring during relaxation or at night. Sleep-mode was often affected. The use of paracetamol (acetaminophen) was sufficient for all but one donor. CONCLUSION This is the first study to describe different aspects of pain associated with G-CSF administration in donors. Although the observed pain was tolerable, it should never be neglected. Knowledge derived from this study is of use for staff members involved in donor information and care management.
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Affiliation(s)
| | - Leon C Witte
- Sanquin Blood Supply Foundation QRM Dept, the Netherlands
| | - Femmeke Prinsze
- Sanquin Research, Department for Donor Studies, Amsterdam, the Netherlands
| | - Johanna C Wiersum-Osselton
- Sanquin Blood Supply Foundation QRM Dept, the Netherlands; Transfusion and Transplantation Reactions in Patients (TRIP), National Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Ivan Bank
- Sanquin Blood Supply Foundation, Department for Transfusion Medicine, Amsterdam, the Netherlands.
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277
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Defaye M, Bradaia A, Abdullah NS, Agosti F, Iftinca M, Delanne-Cuménal M, Soubeyre V, Svendsen K, Gill G, Ozmaeian A, Gheziel N, Martin J, Poulen G, Lonjon N, Vachiery-Lahaye F, Bauchet L, Basso L, Bourinet E, Chiu IM, Altier C. Induction of antiviral interferon-stimulated genes by neuronal STING promotes the resolution of pain in mice. J Clin Invest 2024; 134:e176474. [PMID: 38690737 PMCID: PMC11060736 DOI: 10.1172/jci176474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/12/2024] [Indexed: 05/03/2024] Open
Abstract
Inflammation and pain are intertwined responses to injury, infection, or chronic diseases. While acute inflammation is essential in determining pain resolution and opioid analgesia, maladaptive processes occurring during resolution can lead to the transition to chronic pain. Here we found that inflammation activates the cytosolic DNA-sensing protein stimulator of IFN genes (STING) in dorsal root ganglion nociceptors. Neuronal activation of STING promotes signaling through TANK-binding kinase 1 (TBK1) and triggers an IFN-β response that mediates pain resolution. Notably, we found that mice expressing a nociceptor-specific gain-of-function mutation in STING exhibited an IFN gene signature that reduced nociceptor excitability and inflammatory hyperalgesia through a KChIP1-Kv4.3 regulation. Our findings reveal a role of IFN-regulated genes and KChIP1 downstream of STING in the resolution of inflammatory pain.
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Affiliation(s)
- Manon Defaye
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amyaouch Bradaia
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nasser S. Abdullah
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francina Agosti
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mircea Iftinca
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mélissa Delanne-Cuménal
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa Soubeyre
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Kristofer Svendsen
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gurveer Gill
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
| | - Aye Ozmaeian
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Gheziel
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Jérémy Martin
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Gaetan Poulen
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Nicolas Lonjon
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Florence Vachiery-Lahaye
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Luc Bauchet
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
- Institute of Functional Genomics, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Lilian Basso
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Emmanuel Bourinet
- Institute of Functional Genomics, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Isaac M. Chiu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christophe Altier
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gérardin M, Rousselet M, Couec ML, Masseau A, Aquizerate A, Authier N, Deheul S, Roussin A, Micallef J, Djezzar S, Feuillet F, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. Substance use disorder of equimolar oxygen-nitrous oxide mixture in French sickle-cell patients: results of the PHEDRE study. Orphanet J Rare Dis 2024; 19:124. [PMID: 38500184 PMCID: PMC10949610 DOI: 10.1186/s13023-024-03133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In many countries, nitrous oxide is used in a gas mixture (EMONO) for short-term analgesia. Cases of addiction, with significant misuse, have been reported in hospitalized patients. Patients suffering from sickle cell disease (SCD) could represent a high-risk population for substance use disorder (SUD) due to their significant pain crisis and repeated use of EMONO. The objective of the PHEDRE study was to assess the prevalence of SUD for EMONO in French SCD patients. RESULTS A total of 993 patients were included. Among 339 EMONO consumers, only 38 (11%) had a SUD, with very few criteria, corresponding mainly to a mild SUD due to a use higher than expected (in quantity or duration) and relational tensions with the care teams. Almost all patients (99.7%) were looking for an analgesic effect, but 68% of patients were also looking for other effects. The independent risks factors associated with at least one SUD criterion were: the feeling of effects different from the expected therapeutic effects of EMONO, at least one hospitalization for vaso occlusive crisis in the past 12 months and the presence of a SUD for at least one other analgesic drug. CONCLUSIONS The use of EMONO was not problematic for the majority of patients. Manifestations of SUD that led to tensions with healthcare teams should alert and lead to an evaluation, to distinguish a true addiction from a pseudoaddiction which may be linked to an insufficient analgesic treatment related to an underestimation of pain in SCD patients. TRIAL REGISTRATION Clinical Trials, NCT02580565. Registered 16 October 2015, https://clinicaltrials.gov/.
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Affiliation(s)
- Marie Gérardin
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Morgane Rousselet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie-Laure Couec
- CHU Nantes, Service de Pédiatrie et d'Oncologie Pédiatrique, Nantes Université, Nantes, France
| | - Agathe Masseau
- CHU Nantes, Service de Médecine Interne, Nantes Université, Nantes, France
| | - Aurélie Aquizerate
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Clermont Auvergne Université, Clermont-Ferrand, France
| | - Sylvie Deheul
- CHU Lille, Service de Pharmacologie, Lille Université, Lille, France
| | - Anne Roussin
- CHU Toulouse, Service de Pharmacologie Médicale et Clinique, Toulouse Université, Toulouse, France
| | - Joelle Micallef
- APHM, Service de Pharmacologie Clinique, Hôpital de La Timone, Institut de Neurosciences Des Systèmes, Aix-Marseille Université, Marseille, France
| | - Samira Djezzar
- APHP Paris, Centre d'Evaluation et d'Information sur la Pharmacodependence-Addictovigilance de Paris, Hôpital Fernand Widal, APHP Paris, Paris, France
| | - Fanny Feuillet
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
- CHU Nantes, DRI, Plateforme de Méthodologie et Biostatistique, Nantes Université, Nantes, France
| | - Pascale Jolliet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France.
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France.
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Köse Tosunöz İ, Yurtseven Ş, Deniz Doğan S. Perceptions of Nurses Regarding Opioid Administration: A cross-sectional study. Pain Manag Nurs 2024:S1524-9042(24)00022-5. [PMID: 38503631 DOI: 10.1016/j.pmn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Opioids are important drugs used in pain management due to their strong analgesic effects. However, there is limited research on nurses' perceptions of administering opioids. PURPOSE This study aims to determine nurses' perceptions of administering opioids. DESIGN This study used a descriptive cross-sectional design. SETTINGS A university hospital located in the south of Turkey. METHODS A self-reporting survey was provided to a convenience sample of 190 nurses. The data were collected with the "Introductory Information Form," and the "Nurses' Perceptions on Opioid Medications Administration Questionnaire." Descriptive statistics were applied for data analysis. RESULTS The mean age of the nurses was 33.11 ± 7.82 and 86.3% were female. The majority of the nurses did not receive any training on opioid administration other than their undergraduate education. Among the nursing staff, 90.0% expressed the importance of having trust in the prescribing doctor for their comfort in administering opioids. Of the nurses, 30% were undecided about "Nurses associate opioids with drug abuse." and 78.9% disagreed with the statement "Nurses often associate giving opioids with helping patients to die." CONCLUSIONS The results of this study provided further insight into nurses' perceptions of administering opioids that potentially contribute to pain management. Nurses had information needs and some prejudices regarding opioid administration. Also, relying on the prescribing doctor was important, and problems with prescribing were an obstacle to pain control. CLINICAL IMPLICATIONS Determining the knowledge and needs of nurses regarding opioid administration and providing in-service training on this subject would positively affect their approach to opioids.
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Affiliation(s)
- İpek Köse Tosunöz
- Hatay Mustafa Kemal University, Faculty of Health Sciences, Nursing Department, Hatay, Turkey.
| | - Şeyma Yurtseven
- Çukurova University Balcalı Hospital Health Application and Research Center, Adana, Turkey
| | - Sevgi Deniz Doğan
- Isparta University of Applied Sciences, Uluborlu Selahattin Karasoy Vocational School, Health Services Department, Isparta, Turkey
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280
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Adams IG, Jayaweera R, Lewis J, Badawi N, Abdel-Latif ME, Paget S. Postoperative pain and pain management following selective dorsal rhizotomy. BMJ Paediatr Open 2024; 8:e002381. [PMID: 38490692 PMCID: PMC10946356 DOI: 10.1136/bmjpo-2023-002381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that reduces lower limb spasticity, performed in some children with spastic diplegic cerebral palsy. Effective pain management after SDR is essential for early rehabilitation. This study aimed to describe the anaesthetic and early pain management, pain and adverse events in children following SDR. METHODS This was a retrospective cohort study. Participants were all children who underwent SDR at a single Australian tertiary hospital between 2010 and 2020. Electronic medical records of all children identified were reviewed. Data collected included demographic and clinical data (pain scores, key clinical outcomes, adverse events and side effects) and medications used during anaesthesia and postoperative recovery. RESULTS 22 children (n=8, 36% female) had SDR. The mean (SD) age at surgery was 6 years and 6 months (1 year and 4 months). Common intraoperative medications used were remifentanil (100%), ketamine (95%), paracetamol (91%) and sevoflurane (86%). Postoperatively, all children were prescribed opioid nurse-controlled analgesia (morphine, 36%; fentanyl, 36%; and oxycodone, 18%) and concomitant ketamine infusion. Opioid doses were maximal on the day after surgery. The mean (SD) daily average pain score (Wong-Baker FACES scale) on the day after surgery was 1.4 (0.9), decreasing to 1.0 (0.5) on postoperative day 6 (POD6). Children first attended the physiotherapy gym on median day 7 (POD8, range 7-8). Most children experienced mild side effects or adverse events that were managed conservatively. Common side effects included constipation (n=19), nausea and vomiting (n=18), and pruritus (n=14). No patient required return to theatre, ICU admission or prolonged inpatient stay. CONCLUSIONS Most children achieve good pain management following SDR with opioid and ketamine infusions. Adverse events, while common, are typically mild and managed with medication or therapy. This information can be used as a baseline to improve postoperative care and to support families' understanding of SDR before surgery.
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Affiliation(s)
- Isabel G Adams
- Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Ramanie Jayaweera
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jennifer Lewis
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, University of Sydney, Cerebral Palsy Alliance, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mohamed E Abdel-Latif
- Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
- Neonatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Simon Paget
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
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281
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Jing Z, Han Y, Li Y, Zeng R, Wu J, Wang Y, Jiang P. Effect of subanesthetic dose of esketamine on postoperative pain in elderly patients undergoing laparoscopic gastrointestinal tumor Surgery:A prospective, double-blind, randomized controlled trial. Heliyon 2024; 10:e27593. [PMID: 38495154 PMCID: PMC10943442 DOI: 10.1016/j.heliyon.2024.e27593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Postoperative pain is prevalent and severe complication in elderly surgical patients. Multiple studies propose that a small dose of esketamine administered intraoperatively can alleviate postoperative pain and curtail opioid usage. We aimed to evaluate the impact of esketamine on postoperative acute pain among elderly patients with gastrointestinal tumors. Patients and methods This is a prospective, parallel-group, randomized controlled trial. Ninety patients aged 60 and above, undergoing resection of gastrointestinal tumors, were randomly assigned to two groups: esketamine group (Group S, a single dose of 0.25 mg/kg and 0.1 mg/kg/h infusion) and control group (Group C, saline). Visual Analogue Scale (VAS) pain scores were the primary outcome. Remifentanil consumption, instances of rescue analgesia, delirium, sleep quality, postoperative recovery quality, serum levels of inflammatory cytokines, and adverse events within 72 h post-surgery were secondary outcomes, respectively. Results Data of 87 of 99 eligible patients were analyzed. VAS scores at rest in Group S were lower than those in Group C at 6 h [1.2 (0.6, 1.6) vs 1.6 (1.0, 2.0), P = 0.003], 12 h [1.4 (1.0, 2.0) vs 2.0 (1.5, 2.0), P < 0.001], and 24 h [1.8 (1.3, 2.0) vs 2.2 (1.6, 2.6), P < 0.001] postoperatively. At 6 h post-surgery, VAS score during coughing was lower in Group S than Group C [2.0 (2.0, 2.3) vs 2.0 (2.0, 3.0), P = 0.009]. The instances of rescue analgesia were fewer in group S compared to group C (P = 0.007). Furthermore, the esketamine group showed improved sleep quality and QoR-15 score (P < 0.05) postoperatively. Conclusion Intravenous administration of esketamine as an adjunct to general anesthesia can decrease the intensity of pain for 24 h without additional adverse effects after laparoscopic gastrointestinal tumor surgery.
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Affiliation(s)
- Zhaojun Jing
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yu Han
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yi Li
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Rui Zeng
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jin Wu
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yiting Wang
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Peng Jiang
- Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
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282
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Antunes FTT, Huang S, Chen L, Zamponi GW. Effect of ABT-639 on Cav3.2 channel activity and its analgesic actions in mouse models of inflammatory and neuropathic pain. Eur J Pharmacol 2024; 967:176416. [PMID: 38342359 DOI: 10.1016/j.ejphar.2024.176416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/13/2024]
Abstract
Cav3.2 T-type calcium channels are important targets for pain relief in rodent models of inflammatory and neuropathic pain. Even though many T-type channel blockers have been tested in mice, only one molecule, ABT-639, has been tested in phase II clinical studies and did not produce analgesic effects over placebo. Here we examined the effects of ABT-639 on Cav3.2 channel activity in tsA-201 cells and dorsal root ganglion (DRG) neurons, in comparison with another established Cav3.2 inhibitor Z944. These experiments revealed that Z944 mediated ∼100-fold more potent inhibition of Cav3.2 currents than ABT-639, with the latter blocking channel activity by less than 15 percent when applied at a concentration of 30 μM. A slight increase in ABT-639 potency was observed at more depolarized holding potentials, suggesting that this compound may act preferentially on inactivated channels. We tested the effects of both compounds in the Complete Freund's Adjuvant (CFA) model of chronic inflammatory pain, and in partial sciatic nerve injury model of neuropathic pain in mice. In the neuropathic pain model, both Z944 and ABT-639 reversed mechanical hypersensitivity to similar degrees when delivered systemically, but remarkably, when delivered intrathecally, only Z944 was effective. In the CFA model, both compounds reversed thermal hyperalgesia upon systemic delivery, but only Z944 mediated pain relief upon intrathecal delivery, indicating that ABT-639 acts primarily at peripheral sites. ABT-639 lost its analgesic effects in CFA treated Cav3.2 null mice, indicating that these channels are essential for ABT-639-mediated pain relief despite its poor inhibition of Cav3.2 currents.
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Affiliation(s)
- Flavia Tasmin Techera Antunes
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, AB, T2N 4N1, Calgary, Canada
| | - Sun Huang
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, AB, T2N 4N1, Calgary, Canada
| | - Lina Chen
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, AB, T2N 4N1, Calgary, Canada
| | - Gerald W Zamponi
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, AB, T2N 4N1, Calgary, Canada.
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283
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Mahdi S, Stoner R, Wyatt J, De'Ath H, Perkins Z. Prevalence of chronic pain after severe lower limb injury (SLLI): A systematic review and meta-analysis. Injury 2024; 55:111495. [PMID: 38490051 DOI: 10.1016/j.injury.2024.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Globally, severe lower limb injuries (SLLIs) are the predominant cause of long-term injury related disability and poor functional outcomes. Chronic pain is a major source of this morbidity, but the magnitude of the contribution is not clearly understood. The aim of this systematic review and meta-analysis was to determine the prevalence of chronic pain following SLLIs in civilian and military patients. METHOD This systematic review was prospectively registered with The International Prospective Register of Systematic Reviews (PROSPERO) with study ID CRD42022313615. A systematic literature search (Medline, Embase, Ovid, and Web of Science) was performed to identify original studies that reported chronic pain outcomes for adults who underwent surgical treatment for SLLIs in a civilian or military setting. Risk of bias in included studies was assessed using the ROBINS-E tool, and quality assessment was reported at study level using the Newcastle-Ottawa Scale, and at outcome-level using the GRADE framework. Absolute (proportional) and relative (odds ratio) outcome measures were calculated and pooled using a random effects model. RESULTS Forty-three studies reporting the outcomes of 5601 patients were included. Estimated overall prevalence of pain was 63 % (CI 55-70 %). The prevalence of chronic pain in amputees (64 % (CI 55-73 %)) was similar to those who underwent limb salvage (56 % (CI 44-67 %)). The prevalence of chronic pain in civilian populations was 70 % (CI 63-77 %) compared to military populations (51 % (CI 35-66 %)). In amputees, the prevalence of residual limb pain was similar to phantom limb pain (OR 1.06 [0.64-1.78], p = 0.81, I2 = 92 %). CONCLUSION Most people who sustain a SLLI will suffer from chronic pain. Healthcare systems must continue to research interventions that can reduce the incidence and severity of long-term pain and ensure adequate resources are allocated for this common and debilitating complication.
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Affiliation(s)
- Shareef Mahdi
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Rebecca Stoner
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | | | - Henry De'Ath
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Zane Perkins
- Centre for Trauma Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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284
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Gandolfi M, Geroin C, Imbalzano G, Camozzi S, Menaspà Z, Tinazzi M, Alberto Artusi C. Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions. Clin Park Relat Disord 2024; 10:100240. [PMID: 38596537 PMCID: PMC11002662 DOI: 10.1016/j.prdoa.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Italy
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatric and Gynaecology, University of Verona, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
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285
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Almeida T, Monaco BA, Vasconcelos F, Piedade GS, Morell A, Ogobuiro I, Lepski GA, Furlanetti LL, Cordeiro KK, Benjamin C, Jagid JR, Cordeiro JG. Everything old is new again. revisiting hypophysectomy for the treatment of refractory cancer-related pain: a systematic review. Neurosurg Rev 2024; 47:111. [PMID: 38467866 DOI: 10.1007/s10143-024-02347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.
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Affiliation(s)
- Timoteo Almeida
- Department of Radiation Oncology, University of Miami, Miami, USA.
- Department of Neurosurgery, University of Miami, Miami, USA.
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil.
| | - Bernardo A Monaco
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Fernando Vasconcelos
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, USA
| | - Guilherme S Piedade
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Alexis Morell
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | | | | | | | | | - Carolina Benjamin
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Jonathan R Jagid
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Joacir G Cordeiro
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
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Shamsalinia A, Fotokian Z, Jannat Alipour Z, Zahedpasha Y, Mohammadkhah F. Effects of White Noise Sound on the Severity of Muscle Vaccination Pain in Children Under Two Years. Iran J Child Neurol 2024; 18:113-125. [PMID: 38617401 PMCID: PMC11015731 DOI: 10.22037/ijcn.v18i2.38746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/28/2023] [Indexed: 04/16/2024]
Abstract
Objectives Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old. Materials & Methods This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05). Results A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28). Conclusion This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, , Babol, Iran
| | - Zahra Fotokian
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, , Babol, Iran
| | - Zahra Jannat Alipour
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, , Babol, Iran
| | - Yadollah Zahedpasha
- Non-Communicable Pediatric Disease Research Center, Health Research Institute , Babol University of Medical Sciences; , Babol, Iran
| | - Fatemeh Mohammadkhah
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, , Babol, Iran
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287
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Tsetseri MN, Keene DJ, Silman AJ, Dakin SG. Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review. BMC Public Health 2024; 24:769. [PMID: 38475746 PMCID: PMC10935970 DOI: 10.1186/s12889-023-17542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Immigrants are exposed to numerous risk factors that may contribute to the development of chronic musculoskeletal pain. Recent political and environmental crises in North Africa and the Middle East have led to an increase in immigration to Europe that has challenged the healthcare system and especially the management of chronic conditions. OBJECTIVE The aims of this scoping review are to investigate the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants from North Africa and the Middle East in Europe during the last decade. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. DESIGN Online databases Medline, Embase, PubMed and Web of Science were used to identify epidemiological studies published from2012-2022 examining chronic pain in populations from North Africa and the Middle East with a migration background residing in Europe. RESULTS In total eleven studies were identified conducted in Norway (n = 3), Denmark (n = 3), Germany (n = 1), Austria (n = 1), Sweden (n = 1), and Switzerland (n = 1). Among the identified studies, eight studies were cross-sectional (n = 8), two were prospective cohort studies (n = 2) and one was a retrospective cohort study (n = 1). Data suggested that chronic pain is more prevalent, more widespread, and more severe in people with than without a migration background. Furthermore, immigrants who have resided in the destination country for a longer period experience a higher prevalence of chronic pain compared to those in the early phases of migration. The following factors were found to be associated with chronic pain in this population: female gender, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, immigration status, anxiety, depression, and post-traumatic stress disorder. CONCLUSION Several gaps in the literature were identified. Research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors. Prospective cohort studies with long follow-ups would aid in improving prevention and management of chronic pain in populations with a migration background. In particular, they should reflect actual immigration trajectories, account for immigration factors, and have valid comparison groups in the countries of origin, transit and destination.
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Affiliation(s)
- Maria-Nefeli Tsetseri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK.
| | - David J Keene
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, B4495, Headington, Oxford, OX3 7LD, UK
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288
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Mehok LE, Walsh KT, Miller MM, Anastas TM, Hirsh AT. Exercise and Dietary Recommendations for Women with Chronic Pain: What's Weight and Race Got To Do with It? J Pain 2024:104505. [PMID: 38484856 DOI: 10.1016/j.jpain.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 05/12/2024]
Abstract
Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N = 90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75, 244.72) = 6.19, P < .01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89) = 17.20, P < .01), strength (F(1,89) = 6.08, P = .02), and dietary recommendations (F(1,89) = 37.56, P < .01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89) = 4.92, P = .03) than Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning.
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Affiliation(s)
- Lauren E Mehok
- Behavioral Health Care Line, New Mexico Veterans Affairs Healthcare System, Albuquerque, New Mexico
| | - Kaitlyn T Walsh
- Department of Psychology, Indiana University Indianapolis (IUI), Indianapolis, Indiana
| | - Megan M Miller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tracy M Anastas
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis (IUI), Indianapolis, Indiana
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289
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Chen WT, Hsiao FJ, Coppola G, Wang SJ. Decoding pain through facial expressions: a study of patients with migraine. J Headache Pain 2024; 25:33. [PMID: 38462615 PMCID: PMC10926654 DOI: 10.1186/s10194-024-01742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The present study used the Facial Action Coding System (FACS) to analyse changes in facial activities in individuals with migraine during resting conditions to determine the potential of facial expressions to convey information about pain during headache episodes. METHODS Facial activity was recorded in calm and resting conditions by using a camera for both healthy controls (HC) and patients with episodic migraine (EM) and chronic migraine (CM). The FACS was employed to analyse the collected facial images, and intensity scores for each of the 20 action units (AUs) representing expressions were generated. The groups and headache pain conditions were then examined for each AU. RESULTS The study involved 304 participants, that is, 46 HCs, 174 patients with EM, and 84 patients with CM. Elevated headache pain levels were associated with increased lid tightener activity and reduced mouth stretch. In the CM group, moderate to severe headache attacks exhibited decreased activation in the mouth stretch, alongside increased activation in the lid tightener, nose wrinkle, and cheek raiser, compared to mild headache attacks (all corrected p < 0.05). Notably, lid tightener activation was positively correlated with the Numeric Rating Scale (NRS) level of headache (p = 0.012). Moreover, the lip corner depressor was identified to be indicative of emotional depression severity (p < 0.001). CONCLUSION Facial expressions, particularly lid tightener actions, served as inherent indicators of headache intensity in individuals with migraine, even during resting conditions. This indicates that the proposed approach holds promise for providing a subjective evaluation of headaches, offering the benefits of real-time assessment and convenience for patients with migraine.
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Affiliation(s)
- Wei-Ta Chen
- Brain Research Center, National Yang Ming Chiao Tung University, 155, Linong Street Sec 2, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Keelung Hospital, Ministry of Health and Welfare, Keelung, Taiwan
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang Ming Chiao Tung University, 155, Linong Street Sec 2, Taipei, 112, Taiwan.
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, 155, Linong Street Sec 2, Taipei, 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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290
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Comptour A, Figuier C, Pereira B, Chauvet P, Bourdel N, Canis M. Endometriosis: Age at diagnosis and the severity of the disease. J Gynecol Obstet Hum Reprod 2024; 53:102759. [PMID: 38467186 DOI: 10.1016/j.jogoh.2024.102759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Endometriosis is often described as a progressive disease beginning with menarche and menstrual bleeding. However, this is controversial, as the origin of the disease remains unknown. The objective of this study was to investigate the association between the severity of endometriosis and age at initial diagnosis. MATERIAL AND METHODS This prospective multicenter cohort study included 964 patients, newly and histologically diagnosed with endometriosis during laparoscopic treatment. The main outcome measures were diagnostic lesions with staging according to rAFS (revised American Fertility Society) scores, intensity of pain based on VAS (Visual Analog Scale) scores and quality of life from SF-36 questionnaire results. Age was treated as a categorical variable. Univariate and multivariable analyses (linear and multinomial ordinal) were conducted taking into account two by two multiple comparisons. The results were expressed with effect sizes and 95 % confidence intervals. MAIN FINDINGS No significant association between age and rAFS stage was found (p = 0.053). The percentage of patients with a deep nodule ≥ 2 cm was respectively 20 %, 25 %, 21 %, 18 % and 9 % for patients aged ≤ 25, 26-30, 31-35, 36-40 and >40 years respectively (p = 0.005). For dysmenorrhea, 64 %, 61 %, 54 %, 51 % and 32 % of patients aged ≤25, 26-30, 31-35, 36-40 and >40 years respectively reported a VAS score of ≥7 (p ≤ 0.001). CONCLUSION Prospective data obtained in patients newly diagnosed with endometriosis, revealed that the rAFS score is not related to patient age, and that the percentage of patients with a nodule ≥ 2 cm and severe dysmenorrhea did not increase with age. These percentages were significantly lower in patients aged > 40.
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Affiliation(s)
- Aurélie Comptour
- INSERM, CIC 1405 CRECHE Unit, CHU Clermont-Ferrand, Department of Gynecological Surgery, Clermont-Ferrand, France
| | - Claire Figuier
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Biostatistics, Clermont-Ferrand, France
| | - Pauline Chauvet
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Nicolas Bourdel
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France
| | - Michel Canis
- CHU Clermont-Ferrand, Department of Gynecologic Surgery. CHU Estaing. 1 Place Lucie et Raymond Aubrac 63000 Clermont Ferrand France; Université Clermont Auvergne, EnCoV, Institut Pascal, UMR 6602 CNRS, SIGMA Clermont, F-63000 Clermont-Ferrand, France.
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291
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Bachour R, Sengmanivong N, Vidal F, Goumarre C, Lapègue F, Destombes L, Gandois HC, Gac YTL, Chantalat E, Capdet J, Blais D, Guenego A, Sans N, Bilfeld MF. Percutaneous cryoablation of abdominal wall endometriosis: An analysis of 38 patients. Diagn Interv Imaging 2024:S2211-5684(24)00045-7. [PMID: 38467523 DOI: 10.1016/j.diii.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy of percutaneous cryoablation in the treatment of abdominal wall endometriosis (AWE) nodules. MATERIALS AND METHODS Thirty-eight women treated for symptomatic AWE nodules with percutaneous cryoablation under ultrasound and computed tomography (CT) guidance between May 2020 and July 2023 were retrospectively included. Pain was estimated using visual analog scale (VAS) and assessed at baseline, three months, six months, and 12 months after percutaneous cryoablation. Baseline VAS score, volume of AWE nodule and magnetic resonance imaging (MRI) features of AWE nodules were compared to those obtained after percutaneous cryoablation. Major complications, if any, were noted. RESULTS Thirty-eight women with a median age of 35.5 years (interquartile range [IQR]: 32, 39; range: 24-48 years) and a total of 60 AWE nodules were treated. Percutaneous cryoablation was performed under local or regional anesthesia in 30 women (30/38; 79%). Significant decreases between initial median VAS score (7; IQR: 6, 8; range: 3-10) and median VAS score after treatment at three months (0; IQR: 0, 5; range; 0-8) (P < 0.001), six months (0; IQR: 0, 1; range; 0-10) (P < 0.001) and 12 months (0; IQR: 0, 2; range: 0-7) (P < 0.001) were observed. Percutaneous cryoablation resulted in effective pain relief in 31 out of 38 women (82%) at six months and 15 out of 18 women (83%) at 12 months. Contrast-enhanced MRI at six-month follow-up showed a significant decrease in the volume of AWE nodules and the absence of AWE nodule enhancement after treatment by comparison with baseline MRI (P < 0.001). No major complications were reported. CONCLUSION Percutaneous cryoablation is an effective, minimally invasive intervention for the treatment of AWE nodules that conveys minimal or no morbidity.
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Affiliation(s)
- Rafy Bachour
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France.
| | | | - Fabien Vidal
- Department of Gynecology, Clinique la Croix du Sud, 31130 Quint-Fonsegrives, France
| | - Céline Goumarre
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Franck Lapègue
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Louise Destombes
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | | | - Yann Tanguy Le Gac
- Department of Gynecology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
| | - Elodie Chantalat
- Department of Gynecology, CHU Toulouse-Rangueil Cedex 9, 31059 Toulouse, France
| | - Jérome Capdet
- Department of Gynecology Department, Clinique Rive Gauche, 31300 Toulouse, France
| | - Donatien Blais
- Department of Gynecology Department, Clinique Rive Gauche, 31300 Toulouse, France
| | - Adrien Guenego
- Department of Interventional Neuroradiology Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Nicolas Sans
- Department of Radiology, CHU Toulouse-Purpan Cedex 9, 31059 Toulouse, France
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292
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Zeng F, Wade A, Harbert K, Patel S, Holley JS, Dehghanpuor CK, Hopwood T, Marino S, Sophocleous A, Idris AI. Classical cannabinoid receptors as target in cancer-induced bone pain: a systematic review, meta-analysis and bioinformatics validation. Sci Rep 2024; 14:5782. [PMID: 38461339 PMCID: PMC10924854 DOI: 10.1038/s41598-024-56220-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/04/2024] [Indexed: 03/11/2024] Open
Abstract
To test the hypothesis that genetic and pharmacological modulation of the classical cannabinoid type 1 (CB1) and 2 (CB2) receptors attenuate cancer-induced bone pain, we searched Medline, Web of Science and Scopus for relevant skeletal and non-skeletal cancer studies from inception to July 28, 2022. We identified 29 animal and 35 human studies. In mice, a meta-analysis of pooled studies showed that treatment of osteolysis-bearing males with the endocannabinoids AEA and 2-AG (mean difference [MD] - 24.83, 95% confidence interval [95%CI] - 34.89, - 14.76, p < 0.00001) or the synthetic cannabinoid (CB) agonists ACPA, WIN55,212-2, CP55,940 (CB1/2-non-selective) and AM1241 (CB2-selective) (MD - 28.73, 95%CI - 45.43, - 12.02, p = 0.0008) are associated with significant reduction in paw withdrawal frequency. Consistently, the synthetic agonists AM1241 and JWH015 (CB2-selective) increased paw withdrawal threshold (MD 0.89, 95%CI 0.79, 0.99, p < 0.00001), and ACEA (CB1-selective), AM1241 and JWH015 (CB2-selective) reduced spontaneous flinches (MD - 4.85, 95%CI - 6.74, - 2.96, p < 0. 00001) in osteolysis-bearing male mice. In rats, significant increase in paw withdrawal threshold is associated with the administration of ACEA and WIN55,212-2 (CB1/2-non-selective), JWH015 and AM1241 (CB2-selective) in osteolysis-bearing females (MD 8.18, 95%CI 6.14, 10.21, p < 0.00001), and treatment with AM1241 (CB2-selective) increased paw withdrawal thermal latency in males (mean difference [MD]: 3.94, 95%CI 2.13, 5.75, p < 0.0001), confirming the analgesic capabilities of CB1/2 ligands in rodents. In human, treatment of cancer patients with medical cannabis (standardized MD - 0.19, 95%CI - 0.35, - 0.02, p = 0.03) and the plant-derived delta-9-THC (20 mg) (MD 3.29, CI 2.24, 4.33, p < 0.00001) or its synthetic derivative NIB (4 mg) (MD 2.55, 95%CI 1.58, 3.51, p < 0.00001) are associated with reduction in pain intensity. Bioinformatics validation of KEGG, GO and MPO pathway, function and process enrichment analysis of mouse, rat and human data revealed that CB1 and CB2 receptors are enriched in a cocktail of nociceptive and sensory perception, inflammatory, immune-modulatory, and cancer pathways. Thus, we cautiously conclude that pharmacological modulators of CB1/2 receptors show promise in the treatment of cancer-induced bone pain, however further assessment of their effects on bone pain in genetically engineered animal models and cancer patients is warranted.
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Affiliation(s)
- Feier Zeng
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Abbie Wade
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Kade Harbert
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Shrina Patel
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Joshua S Holley
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Cornelia K Dehghanpuor
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Thomas Hopwood
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
| | - Silvia Marino
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences (UAMS), BioMed II, 238-2, Little Rock, AR, USA
| | - Antonia Sophocleous
- Department of Life Sciences, School of Sciences, European University Cyprus, 6 Diogenes Street, 1516, Nicosia, Cyprus.
| | - Aymen I Idris
- Department of Oncology and Metabolism, University of Sheffield, Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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293
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Nogueira APA, Ferreira MC, Maia CDCR, Gonçalves BLL, Filho EM, Costa CP, Gavini G, Grazziotin-Soares R, Carvalho CN. Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial. Clin Oral Investig 2024; 28:205. [PMID: 38459266 DOI: 10.1007/s00784-024-05582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To assess the anesthetic efficacy of articaine with the needle-free/Comfort-in™ method compared to the conventional needle method. To assess pain during anesthesia application, onset of anesthesia and patient`s self-reported quality of life-related to oral health after the dental emergency appointment. MATERIALS AND METHODS This parallel, randomized clinical trial was conducted by a single operator/dentist in the state of Maranhao, northeast of Brazil. Included participants were adult dental patients with one molar (maxillary) or premolar (maxillary or mandibular) tooth diagnosed with symptomatic irreversible pulpitis. The primary outcome was the anesthetic efficacy, measured using a combination of electrical and cold pulp tests (cold + EPT) and the Numerical Rating Scale (NRS). Secondary outcomes were pain during anesthesia application, onset of anesthesia, and patient`s quality-of-life (measured with the OHIP-14). RESULTS 62 patients were randomized in the anesthesia needle-free group and Comfort-in group (34.26 ± 10.786 × 33.29 ± 8.399 years old, respectively). The group of patients in the Comfort-in group had 71.0% success. Patients from the Comfort-in group reported statistically lower pain during the anesthesia application than patients from the conventional group (2.13 ± 2.172 × 6.03 ± 3.146 NRS scores, respectively) as well as immediately after the anesthetic procedure. Patients self-reported negative impact in quality of life was similar between groups before (p > 0.05) and after (p > 0.05) the dental emergency. CONCLUSIONS Comfort-in™ had similar efficacy to the conventional needle method. CLINICAL RELEVANCE This trial showed that it is possible to anesthetize patients with tooth pulpits without using needles to provide comfort mainly to anxious patients.
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Affiliation(s)
- Amanda Palmeira Arruda Nogueira
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil
- Dentistry Postgraduate Program, Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão (UFMA), Av. dos Portugueses, 1996, São Luís, 65080-805, Brazil
| | - Meire Coelho Ferreira
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil
| | | | - Bruna Laís Lins Gonçalves
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil
| | - Etevaldo Maia Filho
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil
| | - Cyrene Piazera Costa
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil
| | - Giulio Gavini
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo (FOUSP), Av. Lineu Prestes, 2227, São Paulo, 05508-000, Brazil
| | - Renata Grazziotin-Soares
- Division of Endodontics, Dept. of Oral Biological and Medical Sciences, Faculty of Dentistry University of British Columbia UBC, Vancouver, Canada
| | - Ceci Nunes Carvalho
- Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil.
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294
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Yoshino R, Nakatsubo M, Ujiie N, Ito A, Yoshida N, Aoki N, Kitada M. Ectopic epipericardial fat necrosis: a case report. Surg Case Rep 2024; 10:54. [PMID: 38453823 PMCID: PMC10920577 DOI: 10.1186/s40792-024-01859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Epipericardial fat necrosis (EFN) is a rare disease in which local inflammation and necrosis occur in the adipose tissue surrounding the heart, particularly epicardial fat. Few cases of EFN in which surgical resection was performed have been reported. We report a case of EFN after surgical resection of a right extrapulmonary tumor, in which a malignant disease could not be excluded. CASE PRESENTATION A 75-year-old male patient presented with fever and chest pain. A contrast-enhanced computed tomography scan of the chest revealed a lesion, 53 × 48 mm in size, with mixed fatty density spanning the middle and lower lobes of the right lung. Thoracic magnetic resonance imaging (MRI) revealed a mass with mixed fat and soft tissue density in the same area; the lesion was contiguous with pericardial fatty tissue. The tumor was diagnosed as a liposarcoma or teratocarcinoma based on imaging results; however, the possibility of lung cancer could not be excluded. Finally, EFN was diagnosed based on the postoperative histopathological examination. The patient underwent surgical resection of the suspected right extrapulmonary tumor. The intraoperative findings revealed a mediastinal mass contiguous with pericardial fat located between the middle and lower lobes. Intraoperative pathological examination of the lesion was performed using a needle biopsy; however, no definitive diagnosis was made. The tumor may have invaded the middle lobe of the right lung, and partial resection of the right lower lobe was performed in addition to resection of the middle lobe of the right lung. The patient was followed up every 3 months without adjuvant therapy. No recurrence was reported at 1 year after surgery. CONCLUSION EFN should be considered in the differential diagnosis of an extrapulmonary tumor when continuity with the pericardial space is observed on MRI or other imaging studies. Surgical resection is useful in the diagnosis and treatment of EFNs. Preoperative three-dimensional reconstructive imaging and MRI should be used to identify vascular structures and confirm the continuity of the lesion with the surrounding tissues to ensure safe and rapid tumor removal.
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Affiliation(s)
- Ryusei Yoshino
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan.
| | - Masaki Nakatsubo
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
| | - Nanami Ujiie
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
| | - Akane Ito
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
| | - Nana Yoshida
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
| | - Naoko Aoki
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
| | - Masahiro Kitada
- Department of Thoracic Surgery and Breast Surgery, Respiratory Center, Asahikawa Medical University Hospital, 2-1-1-1 Midorigaoka Higashi, Asahikawa-Shi, Hokkaido, 078-8510, Japan
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295
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Gormley J, Isak P, Gjertsen D, Bain JR. Peripheral nerve decompression for pain relief in the setting of previous obstetrical brachial plexus injury: a retrospective case series. Childs Nerv Syst 2024:10.1007/s00381-024-06348-1. [PMID: 38456921 DOI: 10.1007/s00381-024-06348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE In children with previous obstetrical brachial plexus injury (OBPI), upper extremity pain is present in 45 to 66% of patients. Recent literature reports this as musculoskeletal or neuropathic in nature. The purpose of the study is to demonstrate that peripheral nerve decompression, and neurolysis may be an effective treatment for patients with upper extremity pain in the context of previous OBPI. METHODS A retrospective chart review was performed on patients undergoing peripheral nerve decompression and neurolysis after OBPI by senior author. The primary outcome assessed was pain, and secondary outcome measure was range of motion of the wrist and elbow. Outcome measures were assessed preoperatively as well as at their subsequent follow-up. RESULTS Six patients were included, with a mean age of 14 years old at time of decompression. Three patients underwent median nerve, two patients underwent ulnar nerve, and one patient underwent posterior interosseous nerve decompression. There was a substantial improvement in pain post-operatively, demonstrated by reduction or resolution of subjective pain in all patients and resolution of Tinel's sign. There was a modest improvement in range of motion. CONCLUSION This study demonstrates an improvement in subjective pain and range of motion after decompression and neurolysis in small subset of OBPI patients. It generates the hypothesis that peripheral nerve compression is a source of pain that can be addressed in this population. Future research should focus on confirming this hypothesis and assessing treatment options on a larger scale.
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Affiliation(s)
- Jessica Gormley
- Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Pavlo Isak
- Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Deborah Gjertsen
- McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - James R Bain
- Division of Plastic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
- McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
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296
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Song HT, Zhang XH. The need for innovation in burn pain management. Burns 2024:S0305-4179(24)00079-2. [PMID: 38641501 DOI: 10.1016/j.burns.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/05/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Hai-Tao Song
- Department of Burns, The First Hospital of Jilin University, Changchun 130021, China.
| | - Xiu-Hang Zhang
- Department of Burns, The First Hospital of Jilin University, Changchun 130021, China.
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297
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Savaş EH, Semerci R, Sayın A, Dinçer B, Semiz B, Ürey H. A Biofeedback Based Virtual Reality Game for Pediatric Population (BioVirtualPed): A Feasibility Trial. Semin Oncol Nurs 2024:151615. [PMID: 38458882 DOI: 10.1016/j.soncn.2024.151615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This trial aims to assess the acceptability, feasibility, and safety of BioVirtualPed, a biofeedback-based virtual reality (VR) game designed to reduce pain, anxiety, and fear in children undergoing medical procedures. METHODS An Oculus Quest 2 headset was used in the VR experience, respiratory data was captured using an ADXL354 accelerometer, and these data were integrated into the game with ArdunioUno software. The sample of this study consisted of 15 pediatric oncology patients aged 6 to 12 years between July and August 2023. BioVirtualPed's acceptability, feasibility, and safety were evaluated through child and expert feedback, alongside metrics including the System Usability Scale, Wong-Baker Pain Rating Scale, Child Fear Scale, Child Anxiety Scale-Status, Satisfaction Scoring, and various feasibility and safety parameters. RESULTS Regarding the acceptability, the expert evaluation showed a mean score of 122.5 ± 3.53, indicating high usability for the system. All children provided positive feedback, and both children and their mothers reported high satisfaction with using BioVirtualPed. The BioVirtualPed was feasible for reducing children's pain, fear, and anxiety levels. All the children complied with the game, and no one withdrew from the trial. BioVirtualPed did not cause symptoms of dizziness, vomiting, or nausea in children and was found to be safe for children. CONCLUSION The findings showed that BioVirtualPed meets the following criteria: feasibility, user satisfaction, acceptability, and safety. It is a valuable tool to improve children's experience undergoing port catheter needle insertion procedures. IMPLICATION FOR NURSING PRACTICE Integration of VR interventions with BioVirtualPed into routine nursing care practices has the potential to effectively manage the pain, anxiety, and fear experienced by children undergoing medical procedures. The safety, feasibility, and acceptability results are promising for further research and integration into pediatric healthcare practice.
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Affiliation(s)
| | | | - Ata Sayın
- College of Engineering, Koc University, Istanbul, Türkiye
| | - Betül Dinçer
- College of Engineering, Koc University, Istanbul, Türkiye
| | - Beren Semiz
- College of Engineering, Koc University, Istanbul, Türkiye
| | - Hakan Ürey
- College of Engineering, Koc University, Istanbul, Türkiye
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298
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Waltz TB, Chao D, Prodoehl EK, Enders JD, Ehlers VL, Dharanikota BS, Dahms NM, Isaeva E, Hogan QH, Pan B, Stucky CL. Fabry disease Schwann cells release p11 to induce sensory neuron hyperactivity. JCI Insight 2024; 9:e172869. [PMID: 38646936 DOI: 10.1172/jci.insight.172869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
Patients with Fabry disease suffer from chronic debilitating pain and peripheral sensory neuropathy with minimal treatment options, but the cellular drivers of this pain are unknown. Here, we propose a mechanism we believe to be novel in which altered signaling between Schwann cells and sensory neurons underlies the peripheral sensory nerve dysfunction we observed in a genetic rat model of Fabry disease. Using in vivo and in vitro electrophysiological recordings, we demonstrated that Fabry rat sensory neurons exhibited pronounced hyperexcitability. Schwann cells probably contributed to this finding because application of mediators released from cultured Fabry Schwann cells induced spontaneous activity and hyperexcitability in naive sensory neurons. We examined putative algogenic mediators using proteomic analysis and found that Fabry Schwann cells released elevated levels of the protein p11 (S100A10), which induced sensory neuron hyperexcitability. Removal of p11 from Fabry Schwann cell media caused hyperpolarization of neuronal resting membrane potentials, indicating that p11 may contribute to the excessive neuronal excitability caused by Fabry Schwann cells. These findings demonstrate that sensory neurons from rats with Fabry disease exhibit hyperactivity caused in part by Schwann cell release of the protein p11.
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Affiliation(s)
| | | | | | | | | | | | - Nancy M Dahms
- Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Elena Isaeva
- Department of Cell Biology, Neurobiology & Anatomy
| | | | - Bin Pan
- Department of Anesthesiology; and
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299
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Tharwat S, Nassar MK. Musculoskeletal symptoms and their impact on health-related quality of life in chronic nonbacterial osteomyelitis patients. Pediatr Rheumatol Online J 2024; 22:34. [PMID: 38448884 PMCID: PMC10916259 DOI: 10.1186/s12969-024-00971-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Chronic non-bacterial osteomyelitis (CNO) is a rare, non-infection- related inflammatory disorder that affects children and teens. Clinical manifestations of CNO range widely from moderate, time-limited, monofocal inflammation of the bone to extreme multifocal or chronically active inflammation of the bone. OBJECTIVES The main aim of this study was to explore the correlation between musculoskeletal (MSK) symptoms and health-related quality of life (HRQoL) in patients with CNO. METHODS Children and adults with CNO and their parents were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical and therapeutic data, MSK discomfort form based on the Nordic MSK Questionnaire and HRQoL based on Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL rheumatology module. The inclusion criteria included diagnosis of CNO before the age of 18. Patients who had malignancies or any chronic rheumatic, MSK, neurological disease prior to CNO onset were excluded. RESULTS There was a total of 68 participants, mostly females (66.2%), with median age 14 years and median disease duration 4.75 years. The median number of bones affected by CNO was 5 and ranged from 1 to 24 bones. Among the studied patients, 45 patients (66.2%) had MSK manifestations at the last month. The most commonly affected part was ankle and feet (26.5%). Regarding HRQoL, patients with MSK manifestations had lower scores than did patients without in PedsQL-4 (p < 0.001) including domains of physical functioning (p < 0.001), emotional functioning (p = 0.033), social functioning (p < 0.001) and school functioning (p = 0.007) in addition to lower scores in PedsQL rheumatology module (p < 0.001) including domains of pain and hurt (p < 0.001), daily activities (p < 0.001), treatment (p = 0.035), worry (p = 0.001) and communication (p < 0.001). CONCLUSION MSK manifestations have a negative impact on HRQoL in CNO patients. So, early identification and treatment are highly recommended.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
- Mansoura University Hospital, El Gomhouria St, 35511, Mansoura, Dakahlia Governorate, Egypt.
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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300
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Romo-Miguel P, Ballesteros-Peña S. Ultrasound-guided puncture vs conventional technique for arterial blood gas analysis sampling in adults: A systematic review. Enferm Intensiva (Engl Ed) 2024:S2529-9840(23)00071-X. [PMID: 38453623 DOI: 10.1016/j.enfie.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 10/02/2023] [Indexed: 03/09/2024]
Abstract
AIM To compare the efficacy of conventional puncture versus ultrasound-guided puncture for arterial blood gas sampling in adults. METHOD A search protocol was developed and applied to three databases (Medline, Cochrane, and Dialnet). Clinical trials published between January 2013 and January 2023, in Spanish or English, were considered. Outcomes in terms of first-attempt success, number of attempts until success, time taken, self-reported iatrogenic pain, and patient or professional experience were collected. The risk of bias for each included study was assessed. RESULTS Five randomized clinical trials were selected, with sample sizes ranging from 50 to 238 adult patients treated in emergency settings. Three out of four studies showed higher first-attempt success rates when using ultrasound, and 2 out of 4 studies reported a decrease in iatrogenic pain. Discrepant findings were observed among the studies in terms of time taken and the number of attempts required for success. CONCLUSIONS Although current evidence is limited and the findings are heterogeneous, ultrasound-guided arterial puncture may have advantages over conventional puncture in terms of first-attempt success and in reducing iatrogenic pain.
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Affiliation(s)
- P Romo-Miguel
- Unidad de Cuidados Intensivos, Osakidetza, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - S Ballesteros-Peña
- Biobizkaia Health Research Institute, Barakaldo, Vizcaya, Spain; Dirección de Enfermería, Osakidetza, Hospital Santa Marina, Bilbao, Vizcaya, Spain; Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Spain.
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