Nonsteroidal anti-inflammatory drugs before endoscopic ultrasound guided tissue acquisition to reduce the incidence of post procedural pancreatitis

Endoscopic ultrasound(EUS)with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and auto-immune pancreatitis or to analyze cyst fluid.The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis,which is likely induced by the same pathophysiological mechanisms as after en-doscopic retrograde cholangiopancreatography(ERCP).According to the current European Society of Gastrointestinal Endoscopy guideline,nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate.A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition(TA)is harm-less in healthy adults.Since it is associated with low costs and,most important,may prevent a dreadsome complication,we strongly recommend the adminis-tration of 100 mg diclofenac rectally prior to EUS-TA.We will explain this recom-mendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.

Role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis:a meta-analysis

BACKGROUND: The role of prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) for reduction of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is debated. We performed a meta-analysis of all published randomized controlled trials to evaluate the efficacy of NSAIDs in the prevention of post-ERCP pancreatitis. DATA SOURCES: Searches were conducted in the databases PubMed, EMBASE and the Cochrane Library. Six randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. Data were extracted by two independent observers according to predetermined criteria. RESULTS: The risk of pancreatitis was lower in the NSAID group than in the placebo, group (OR: 0.46, 95% CI: 0.32 to 0.65, P < 0.0001). Two hours after ERCP, prophylactic administration of NSAIDs was associated with a lower serum amylase level (WMD: -91.09,95% CI: -149.78 to -32.40, P=0.002), but there was no difference in mean 24-hour serum amylase values (WMD: -379.00, 95% CI: -805.75 to 47.76, P=0.08). No deaths or NSAID-related complications were noted. CONCLUSIONS: Prophylactic administration of NSAIDs can reduce the incidence of post-ERCP pancreatitis; this administration in patients undergoing ERCP is recommended. Further randomized controlled trials are required before its introduction into routine care.

Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis:A meta-analysis

AIM:To investigate the effect of nonsteroidal antiinflammatory drugs(NSAIDs)on the incidence of postendoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).METHODS:Two independent reviewers searched pub Med(1966 to October 2013),Embase(1984 to October2013)and the Cochrane Central Register of Controlled Trials(CENTRAL;Issue 4,2013)for relevant randomized controlled trials(RCTs)studying the effectiveness of prophylactic NSAID administration in the prevention of PEP.Using the Cochrane Collaboration Handbook,meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis.RESULTS:Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP,with 971 patients in the NSAID group and 912patients in the placebo group.Sixty-nine out of 971(7.11%)patients developed PEP in the NSAID group in comparison to 143 out of 912(15.68%)patients in the placebo group.The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43(95%CI:0.33-0.56),which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group(p<0.0001).Subgroup analysis was performed and revealed that the presence(NSAID group)or absence(placebo group)of NSAIDs had no significant effect on the development of moderate to severe pancreatitis(RR=0.79,95%CI:0.52-1.18).Moreover,the administration of NSAIDs as a rectal suppository(RR=0.35,95%CI:0.26-0.48;p<0.0001)was more effective than oral administration(RR=0.97,95%CI:0.53-1.80)or through infusion(RR=0.43,95%CI:0.12-1.54).CONCLUSION:NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis.

Interaction between Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs and/or low-dose aspirin use: Old question new insights

Previous reports clearly demonstrated that Helicobacter pylori(H.pylori)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer disease.Today,the presence of H.pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications.Whether NSAID intake in the presence of H.pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate.Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years.In addition,the interaction between H.pylori infection and low-dose ASA remains even more controversial.In real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors.These huge variety of possible combinations greatly hinder the decision making process of physicians.

Split-dose or hybrid nonsteroidal anti-inflammatory drugs and Nacetylcysteine therapy for prevention of post-retrograde cholangiopancreatography pancreatitis

BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.

Gastric body diaphragm-like stricture as a rare complication of nonsteroidal anti-inflammatory drugs

Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely reported, gastric body diaphragm-like stricture has not been reported. We describe the first case of gastric body diaphragm-like stricture due to NSAIDs in a 44-year-old male patient who was successfully treated by an endoscopic approach to avoid complicated surgery. This case highlights new insight into the disadvantages of NSAIDs and provides new data for future clinical studies.

Characteristics and clinical outcome of nonsteroidal anti-inflammatory drug-induced acute hepato-nephrotoxicity among Chinese patients

AIM:To determine the clinicopathological characteristics of nonsteroidal anti-inflammatory drug(NSAID)-induced acute hepato-nephrotoxicity among Chinese patients.METHODS:We conducted a retrospective chart review of patients using the International Classification of Diseases,Ninth Revision diagnosis code for acute kidney injury(AKI)(584.5 or 584.9)and for acute liver injury(ALI)(570.0 or 573.3)from January 2004 to December 2013.Medical records were reviewed to confirm the diagnosis of AKI and ALI and to quantify NSAID administration.RESULTS:Seven of 59 patients(11.8%)were identified with acute hepato-nephrotoxicity induced by NSAIDs.Five patients(71.4%)received over the recommended NSAIDs dose.Compared with NSAIDsassociated mere AKI,the risk factors of NSAIDsinduced acute hepato-nephrotoxicity are age older than 60 years(57.1%),a high prevalence of alcohol use(71.4%)and positive hepatitis B virus(HBV)markers(85.7%).Compared with NSAIDs-associated mere ALI,the risk factors of NSAIDs-induced acute hepatonephrotoxicity are age older than 60 years(57.1%),increased extracellular volume depletion(71.4%),and renin-angiotensin-aldosterone system(RAAS)inhibitor combined use(57.1%).Acute interstitial nephritis and acute tubulointerstitial disease were apparent in three out of six(42.9%)kidney biopsy patients,respectively.Acute hepatitis was found in four out of six(66.7%)liver biopsy patients.Overall complete recovery occurred in four patients within a mean of 118.25±55.42 d.CONCLUSION:The injury typically occurred after an overdose of NSAIDs.The risk factors include age older than 60 years,alcohol use,positive HBV markers,extracellular volume depletion and RAAS inhibitor combined use.

Inhibitory effect of fluvastatin on ileal ulcer formation in rats induced by nonsteroidal antiinflammatory drug

AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs)cause gastrointestinal damage as one of their side effects in humans and experimental animals. Lipid peroxidation plays an important role in NSAID-induced ulceration. The aim of this study was to investigate the inhibitory effect of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)reductase inhibitors on the ulceration in small intestines of rats.METHODS: The effects of three HMG-CoA reductase inhibitors, fluvastatin, pravastatin and atorvastatin on ileal ulcer formation in 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT)-treated rats were examined. Antioxidative activity of the inhibitors was measured by a redox-linked colorimetric method.RESULTS: Fluvastatin, which was reported to have antioxidative activity, repressed the ileal ulcer formation in rats treated with BFMeT an NSAIDs. However, the other HMG-CoA reductase inhibitors (pravastatin and atorvastatin)did not repress the ileal ulcer formation. Among these HMG-CoA reductase inhibitors, fluvastatin showed a significantly stronger reducing power than the others(pravastatin, atorvastatin).CONCLUSION: Fluvastatin having the antioxidaitive activity suppresses ulcer formation in rats induced by NSAIDs.

Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

瞄准：由于高剂量的 acetaminophen 和 nonsteroidal 的摄取评估尖锐胃的损害的内视镜、组织病理学说的方面关于一些的反煽动性的药(NSAID ) 冒因素和耐心的特征的风险。方法：学习组由与高剂量止痛剂摄取进入紧急情况部门的 50 个病人组成(组我) 与自杀目的。三十个病人与或没有消化不良(组 II ) 的温和抱怨作为控制组被选择。学习组根据类型的使用和止痛剂的数字被成层。内视镜的调查结果根据 Lanza 分数(LS ) 被评估，表示根据基于尖锐腐蚀胃炎的组织病理学说的调查结果的一个得分系统的胃与十二指肠的损坏和活体检视的严厉。结果：胃与十二指肠的损坏是显著地在组更严重我与组 II 相比(P 【 0.01 ) 。LS 在组 Ia 和 Ib 是类似的。然而， LS 在与另外的病人相比摄取了多重 NSAID (组 Ic ) 的病人是显著地更高的(P 【 0.01 ) 。LS 被相关变老(P 【 0.01 ) 并且摄取的药的全部的数量(P 【 0.05 ) 在里面组我；但是它没与 Helicobacter pylori (H pylori ) 被相关暴露的感染或持续时间(P 】 0.05 ) 。活体检视分数(BS ) 在组是更高的我比组 II (P 【 0.01 ) ，并且在组 Ib 更高比组 Ia (P 【 0.05 ) 。结论：组织病理学说的损坏在与摄取仅仅 acetaminophen 的那些相比摄取病人的 NSAID 之中是更严重的，在在这些组之间的内视镜的调查结果没有有效差量。在在这些组之间的 LS 没有有效差量。意义的这缺乏以高剂量的 acetaminophen 的胃的效果是显著的。

Non-steroidal anti-inflammatory drugs in prevention of gastric cancer

包括 cyclooxygenase 的 Non-steroidal 反煽动性的药(NSAID ) 2 (COX-2 ) 选择禁止者，是为胃的癌症的 chemoprevention 的潜在的代理人。尽管许多问题仍然保持未答复例如治疗的最佳的剂量和持续时间，流行病学、试验性的研究证明了 NSAID 使用与胃的癌症的减少的风险被联系。为致癌作用上的 NSAID 的 suppress 或效果的可能的机制是在血管生成的上皮细胞和规定导致 apoptosis 的能力。艇长依赖者和艇长无关的小径在 NSAID 的生物活动有一个角色。NSAID 怎么阻止肿瘤的生长的知识将极大地为胃的癌症帮助更好的 chemopreventive 药和新奇治疗的设计。

Health Related Quality of Life among Osteoarthritis Patients: A Comparison of Traditional Non-Steroidal Anti-Inflammatory Drugs and Selective COX-2 Inhibitors in the United Arab Emirates Using the SF-36

Objectives: Osteoarthritis (OA) has a dramatic impact on patients’ health related quality of life (HRQoL). Chronic use of analgesics and anti-inflammatory medications for pain management may improve symptoms but on long term may affect HRQoL negatively. The objective of the present study was to compare the impact of two different classes of analgesics, traditional non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclo-oxygenase-2 (COX-2) inhibitors on HRQoL among osteoarthritis patients using the SF-36 questionnaire. Methods: Clinic based cross-sectional study conducted at Al-Qassimi Hospital, Sharjah, United Arab Emirates (UAE), over a period of six months. Ethical Approval was obtained from the ethics committee at Al-Qassimi Clinical Research Center. Total of 200 osteoarthritis patients fulfilling the inclusion and exclusion criteria were involved in the study. Patients’ demographics were collected from their medical records. The Medical Outcome Study Short-Form 36 (SF-36) questionnaire was used to measure patients’ HRQoL. SF-36 data were scored using health outcomes scoring software 4.5. Results: Mean age of the subjects was 62.19 ± 9.81 years with females constituting 151 (75.5%) of the patients. In general, females scored lower in most of the HRQoL domains compared to males and there was significant difference between the two groups in the mental health (p = 0.005) & mental component (p = 0.042) domains. Compared to selective COX-2 inhibitors, patients on NSAIDs scored higher on all domains of SF-36 except physical functioning. There was significant difference in mental health domain for patients treated with NSAIDs (p = 0.02). Celecoxib was only better than NSAIDs in osteoarthritis patients with more than one musculoskeletal disorders in the domain of bodily pain (p = 0.009). Conclusion: NSAIDs-treated patients did not differ significantly from celecoxib-treated patients in all domains of the SF-36 except for the mental health domain.

非甾体抗炎药修饰查尔酮衍生物的制备和表征

长期服用非甾体抗炎药会给患者带来严重的副作用,如胃肠道出血、心血管疾病等。受查尔酮生物活性多样性的启发,本文以非甾体抗炎药(阿司匹林、布洛芬、萘普生、甲灭酸、氟灭酸、依托度酸、吲哚美辛)和查尔酮为原料,EDCI为缩合剂,DMAP为催化剂,经酯化反应得到7种查尔酮衍生物,产物的收率为67%~86%。

可视化针刀辅助非甾体抗炎药治疗颈型颈椎病患者的应用研究

目的观察可视化针刀辅助非甾体抗炎药治疗颈型颈椎病的效果及安全性。方法本研究为随机对照试验,选取2022年1月至12月南阳医学高等专科学校第一附属医院收治的106例颈型颈椎病患者作为研究对象,采用随机数字表法分为常规组(53例)和针刀组(53例)。常规组男30例、女23例,年龄(35.44±5.17)岁,予以手法推拿辅助非甾体抗炎药治疗;针刀组男31例、女22例,年龄(36.15±5.22)岁,采用可视化针刀辅助非甾体抗炎药治疗。对比两组患者治疗前后的疼痛缓解情况、颈椎活动度改善情况、颈椎生理结构及功能改善情况、并发症发生情况。统计学方法采用t检验、χ^(2)检验。结果治疗1周、2周、4周后,针刀组的视觉模拟评分法(VAS)评分[(4.55±1.27)分、(3.24±0.38)分、(2.56±0.21)分]均低于常规组[(5.65±2.08)分、(4.41±1.09)分、(3.07±0.46)分],差异均有统计学意义(t=3.286、7.379、7.343,均P<0.05)。治疗后,针刀组的颈椎前屈活动度[(62.41±10.27)°]、后伸活动度[(60.45±10.24)°]、左右旋转活动度[(45.22±10.36)°]均高于常规组[(55.46±10.27)°、(54.33±10.25)°、(39.16±10.21)°],差异均有统计学意义(t=3.484、3.075、3.046,均P<0.05)。治疗后,针刀组的颈椎Cobb角[(18.24±4.41)°]、颈椎曲度[(7.63±2.25)°]、日本骨科协会评估治疗分数(JOA)[(23.36±5.41)分]均高于常规组[(15.45±4.36)°、(6.42±2.07)°、(20.18±5.22)分],差异均有统计学意义(t=3.275、2.881、3.080,均P<0.05)。针刀组治疗相关并发症发生率与常规组比较[11.32%(6/53)比7.55%(4/53)],差异无统计学意义(χ^(2)=0.832,P=0.362)。结论可视化针刀辅助非甾体抗炎药治疗颈型颈椎病能有效缓解患者疼痛,对促进颈椎活动度、生理结构及功能恢复均有积极意义,此疗法未明显增加相关并发症发生风险,安全性较高。

NSAIDs对钛片表面成骨细胞增殖及功能活性的影响

目的通过建立种植体表面成骨模型,研究新型与传统非甾体类抗炎药(nonsteroidal antiinflammatory drugs,NSAIDs)对钛片表面MG-63成骨细胞增殖、形态、粘附、活性和成骨相关基因表达的影响。方法将MG-63成骨细胞接种至大颗粒喷砂酸蚀(sand-blasted,largegrit,acid-etched,SLA)钛片表面,建立种植体表面与成骨细胞结合的模型。设置一氧化氮供体型氟比洛芬(NO-氟比洛芬)组、氟比洛芬组与无药物对照组。CCK-8检测细胞增殖能力,扫描电镜观察细胞形态,MTT检测细胞粘附能力,化学法检测碱性磷酸酶(ALP)活性,茜素红染色观察钙化结节,RT-qPCR检测各组成骨细胞ALP、OCN、Runx-2 mRNA表达情况。结果细胞增殖检测结果显示,不同药物浓度组间的细胞增殖数量有统计学差异(P<0.01);NO-氟比洛芬组和氟比洛芬组细胞增殖数量均高于无药物对照组,且NO-氟比洛芬组高于氟比洛芬组,差异均有统计学意义(P<0.01)。扫描电镜观察结果显示,NO-氟比洛芬组成骨细胞最先开始复层生长。细胞粘附检测结果显示,NO-氟比洛芬组细胞粘附数量低于氟比洛芬组和无药物对照组(P<0.01)。ALP活性检测结果显示,NO-氟比洛芬组和氟比洛芬组ALP活性低于无药物对照组(P<0.01)。茜素红染色结果显示,NO-氟比洛芬组及氟比洛芬组实验观察期内未观察到典型的红色深染钙化结节。RT-qPCR分析显示,NO-氟比洛芬组OCN mRNA和氟比洛芬组Runx-2 mRNA表达量高于无药物对照组,ALP mRNA表达量低于无药物对照组(P<0.01)。结论NO-氟比洛芬和氟比洛芬均有效促进钛片表面成骨细胞的增殖能力和部分成骨相关基因表达,NO-氟比洛芬的促进效果更为明显。

433例非甾体抗炎药物不良反应报告分析

目的通过对非甾体抗炎药物(NSAIDs)致药品不良反应(ADRs)进行分析,了解NSAIDs致ADRs发生特点,为临床合理安全用药作参考。方法收集2022年10月1日至2023年9月30日,国家药品不良反应监测系统接收的济南市范围内的所有NSAIDs相关ADRs报告,共计535例;剔除药品等相关信息不详报告,最终433例纳入统计分析,对报告一般情况、性别和年龄、NSAIDs类别、ADR发生时间、给药途径以及ADRs累及系统/器官和临床表现等进行统计分析。结果NSAIDs所致ADRs患者中,一般报告379例;严重ADR报告54例,转归情况大部分为痊愈或好转;男女性别比为1∶1.23,多发生于≥60岁人群(66.7%);NSAIDs涉及乙酸类(24.2%)、丙酸类(22.2%)、甲酸类(21.5%)等十大类别:ADRs发生时间≤1天(264例,61.0%);给药途径以口服(256例,59.1%)和静脉(133例,30.7%)为主。433例ADRs报告中累及多个系统/器官,共计551例次,其中排名前3位分别为胃肠系统(310,56.3%)、皮肤及其附件(122,22.1%)和视觉障碍(25,8.7%);54例严重报告累及多个系统/器官共计76例次,主要累及皮肤及其附件系统(40,52.6%)、胃肠系统(14,18.4%)和泌尿系统(4,5.3%),临床表现主要以皮疹、瘙痒、呕吐等为主。结论NSAIDs在临床上使用广泛,会导致不同程度ADRs,临床中应合理用药,确保用药安全。

干眼症的药物治疗策略及研究进展

干眼症(DED)是一种复杂的多因素疾病,表现出不同的症状,这些症状可影响视觉功能,导致日常生活活动受限,工作效率降低,从而严重影响生活质量。本综述对目前临床上DED的治疗药物以及市场上正在开发的DED治疗策略进行总结,旨在对临床研究提供参考。

戊己丸对吲哚美辛诱导大鼠胃溃疡的保护作用研究

目的 研究戊己丸对吲哚美辛诱导的大鼠胃溃疡的保护作用,并初步探索其可能的作用机制。方法 36只SD大鼠随机分为正常组、模型组、阳性对照组(奥美拉唑,20 mg/kg)、戊己丸低、中、高(2.52、5.04、10.08 g/kg生药量)剂量组,每组6只。各组大鼠灌胃相应药物或0.5%羧甲基纤维素钠(Carboxymethyl Cellulose, CMC-Na)水溶液,1次/d,连续7 d,于末次给药1 h后,除正常组外,其余各组均给予吲哚美辛(60 mg/kg)灌胃造模;6 h后处死大鼠,收集血清和胃组织。通过改良Guth法计算胃溃疡指数和溃疡抑制率,染色观察比较各组大鼠胃组织病理学变化;使用试剂盒测定胃组织中丙二醛(Malonaldehyde, MDA)、超氧化物歧化酶(Superoxide Dismutase, SOD)和环氧合酶1(Cyclooxygenase-1,COX-1),血清中一氧化氮(Nitric Oxide, NO)、肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)和白细胞介素-10(Interleukin-10,IL-10)的含量;TUNEL染色法比较各组大鼠胃组织细胞凋亡情况;免疫组化法测定胃组织中环氧合酶2(Cyclooxygenase-2,COX-2)、NF-κB(p65)蛋白的表达水平。结果 与正常组相比,模型组大鼠胃组织黏膜层、黏膜下层、肌层及浆膜部分结构受损,胃溃疡指数和胃组织细胞凋亡百分比显著升高(P<0.01);MDA、TNF-α、IL-6水平显著升高(P<0.01),COX-1、NO、IL-10和SOD水平显著降低(P<0.01);COX-2和NF-κB(p65)蛋白表达显著升高(P<0.01);与模型组相比,各给药组均能改善胃组织损伤状况;戊己丸中、高剂量组和奥美拉唑组均能显著降低(P<0.01)胃溃疡指数和升高溃疡抑制率,升高COX-1、NO、IL-10水平,降低MDA、COX-2、TNF-α、IL-6和NF-κB(p65)水平,各给药组均明显降低大鼠胃组织细胞凋亡百分比,其中戊己丸中剂量组表现出良好的作用。结论 戊己丸对吲哚美辛诱导的大鼠胃溃疡有明显的保护作用,其作用机制可能与改善氧化应激抑制、炎症反应和减少细胞凋亡有关。

癌性疼痛的影响因素及治疗新理念

癌性疼痛是癌症治疗过程中最常见的并发症之一,在很大程度上影响着患者的生活质量和生命周期,有效管理患者的癌性疼痛已经成为癌症治疗亟待解决的难题。本研究总结了国内外文献资料,梳理了与癌性疼痛相关的影响因素及治疗策略,同时讨论了癌性疼痛治疗的新理念,以期为癌性疼痛患者的诊疗和护理策略的制订提供借鉴和参考。

玻璃酸钠联合非甾体抗炎药治疗膝骨关节炎的临床效果观察

目的探讨膝骨关节炎(KOA)给予玻璃酸钠+非甾体抗炎药治疗的效果。方法200例KOA患者,随机分为观察组和对照组,各100例。观察组采用玻璃酸钠+非甾体抗炎药治疗,对照组采用玻璃酸钠治疗。对比两组患者炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平、骨关节炎指数(WOMAC)、膝关节功能评分[膝关节功能评价表(Lysholm)]、膝关节损伤与骨关节炎结果评分(KOOS评分)。结果治疗后,观察组TNF-α(6.1±0.7)pg/ml、IL-6(2.2±0.2)ng/L、CRP(10.3±3.0)mg/L低于对照组的(7.3±1.0)pg/ml、(3.1±0.8)ng/L、(13.0±3.2)mg/L(P<0.05)。治疗后,观察组疼痛、僵硬、关节功能评分分别为(15.3±1.7)、(5.5±0.7)、(36.7±5.6)分,均较对照组的(21.3±2.1)、(8.0±1.0)、(60.3±7.8)分更低(P<0.05)。治疗后,观察组跛行、楼梯攀爬、下蹲、使用支撑物、疼痛、不稳定感、交锁感、肿胀度评分分别为(4.5±0.6)、(9.2±1.0)、(4.4±0.4)、(4.3±0.4)、(24.6±3.2)、(24.0±2.8)、(7.6±1.1)、(9.1±0.9)分,均较对照组的(3.1±0.4)、(7.2±0.8)、(3.1±0.3)、(3.1±0.3)、(20.6±2.8)、(20.7±2.6)、(3.3±1.5)、(7.6±0.8)分更高(P<0.05)。治疗后,观察组膝关节相关的生活质量、运动及娱乐能力、日常生活活动、症状、疼痛评分分别为(10.8±1.8)、(12.6±2.9)、(55.9±3.7)、(20.8±3.5)、(23.4±2.1)分,均较对照组的(8.8±1.6)、(9.7±2.4)、(49.2±4.5)、(15.1±3.2)、(19.5±2.7)分更高(P<0.05)。结论玻璃酸钠与非甾体抗炎药联合治疗KOA可有效改善患者的膝关节功能,价值较高。

非甾体抗炎药使用与心血管疾病风险因素关联的研究进展

非甾体抗炎药(Nonsteroidal Anti-Inflammatory Drugs,NSAIDs)是一类广泛用于治疗骨关节炎、类风湿关节炎及多种疼痛、发热等症状的药物。然而,临床研究已经指出NSAIDs的使用与心力衰竭、高血压、血栓等心血管疾病的发生存在关联。鉴于当前药物开发中缺乏新的镇痛药,对于NSAIDs的安全、科学使用成为医疗从业人员、患者和药品监管机构关注的焦点。本文重点概述了有关NSAIDs心血管安全性的现有证据以及相应的生理病理作用,对于NSAIDs引起不同心血管疾病的机制进行了分类总结,并归纳了针对非甾体抗炎药在心血管疾病方面潜在机制的研究。在当前情况下,安全、科学地使用NSAIDs对于维护患者的心血管健康至关重要,因此需要进一步深入研究和监测。