祛痛生肌痔疮膏联合中药坐浴对痔疮手术后创面愈合及疼痛程度的影响

目的:探究祛痛生肌痔疮膏(院内制剂)联合中药坐浴对痔疮手术后创面愈合及疼痛程度的影响。方法:选取2020年2月-2021年2月佳木斯市肛肠医院的144例痔疮手术后患者,按照随机数字表法分为中药坐浴组和联合治疗组,每组72例。中药坐浴组术后中药坐浴治疗,联合治疗组中药坐浴治疗联合祛痛生肌痔疮膏治疗。比较两组肉芽组织生成评分,使用酶联免疫吸附法检测两组血浆5-羟色胺(5-HT)、血清β-内啡肽水平并进行比较,比较两组疼痛视觉模拟评分法(VAS)评分、创面渗出评分比较,比较两组水肿情况评分,记录两组不良反应发生率及治疗效果。结果:联合治疗组术后3、7 d肉芽组织生成评分、创面渗出评分、水肿情况评分均高于中药坐浴组(P<0.05)。联合治疗组术后1、2 d血浆5-HT水平均低于中药坐浴组,血清β-内啡肽水平均高于中药坐浴组(P<0.05)。联合治疗组术后3、5、7 d的VAS评分均低于中药坐浴组(P<0.05)。联合治疗组总有效率为90.28%,显著高于中药坐浴组的77.78%(P<0.05)。联合治疗组治疗过程中不良反应发生率高于中药坐浴组,但差异无统计学意义(P>0.05)。结论:使用祛痛生肌痔疮膏联合中药坐浴对痔疮手术后治疗,能促进创面愈合,降低肿痛,创面愈合作用明显,有效减轻痔疮术后疼痛。

三生祛痛方外敷缓解胃癌疼痛的应用研究

51例胃癌住院患者按随机表法分为观察组和对照组,对照组按医嘱给予曲马多镇痛并进行健康指导,观察组则给予三生祛痛方外敷,并由经过专门训练的资深护士完成。观察组患者血压、脉率及患者对护理工作的满意度明显优于对照组,P<0.05,差异有统计学意义;但两组患者镇痛效果及镇痛后疼痛评分比较,差异不显著(P>0.05)三生祛痛方外敷操作简单易行、成本低、镇痛效果好、无不良反应,能够满足患者对整体护理的需求。

定痛生肌散治疗肛门术后284例体会

定痛生肌散治疗肛门术后２８４例体会史敏儿（兰溪市人民医院痔疮科邮编３２１１００）我科１９８５年２月至１９８８年１０月用定痛生肌散治疗２４８例肛门术后病人，取得满意效果，现介绍如下。２４８例中，男性８５例，女性１６３例，年龄２个月至７９岁不等。单纯性结...

Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome

AIM： To investigate the role of endogenous pain modulatory mechanisms in the central sensitization implicated by the visceral hypersensitivity demonstrated in patients with irritable bowel syndrome （IBS）. Dysfunction of modulatory mechanisms would be expected to also result in changes of somatic sensory function. METHODS： Endogenous pain modulatory mechanisms were assessed using heterotopic stimulation and somatic and visceral sensory testing in IBS. Pain intensities （visual analogue scale, VAS 0-100） during suprathreshold rectal distension with a barostat, cold pressor stimulation of the foot and during both stimuli simultaneously （heterotopic stimulation） were recorded in 40 female patients with IBS and 20 female healthy controls. RESULTS： Rectal hypersensitivity （defined by 95% Cl of controls） was seen in 21 （53%）, somatic hypersensitivity in 22 （55%） and both rectal and somatic hypersensitivity in 14 of these IBS patients. Heterotopic stimulation decreased rectal pain intensity by 6 （-11 to -1） in controls, but increased rectal pain by 2 （-3 to ＋6） in all IBS patients （P 〈 0.05） and by 8 （-2 to ＋19） in IBS patients with somatic and visceral hypersensitivity （P 〈 0.02）. CONCLUSION： A majority of IBS patients had abnormal endogenous pain modulation and somatic hypersensitivity as evidence of central sensitization.

Indomethacin suppresses growth of colon cancer via inhibition of angiogenesis in vivo

AIM: It has been reported that regular consumption of nonsteroidal anti-inflammatory drugs like indomethacin decreases the incidence and mortality rate of a number of gastrointestinal cancers. We aimed to explore the efficacy and possible mechanisms of indomethacin on tumor growth and tumor angiogenesis of human colon cancer xenografts in nude mice. METHODS: MTT (thiazolyl blue) assay was used to assess the effect of indomethacin on cultured human colorectal cancer cell line HCT116. HCT116 cells were inoculated subcutaneously into BALB/c-nu/nu mice. After oral administration of indomethacin, 3 mg/kg·d for 4 wk, animals were sacrificed by cervical dislocation. Immunohistochemical staining was employed to determine the microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression in tumor tissues. RESULTS: Indomethacin, a non-selective COX inhibitor, significantly decreased the viability of HCT116 cells in a dose-dependent manner (P<0.05) with 50% inhibition at approximately 318.2±12.7 μmol/L Growth of HCT116 cell tumor was significantly suppressed by indomethacin. The tumor volume was significantly decreased in the treated group (458.89±32.07 mm3) compared to the control group (828.21±31.59 mm3) (P<0.05). The MVD of the treated group (19.50±5.32) was markedly decreased compared to the control group (37.40±4.93) (P<0.001). The VEGF expression of the treated group (1.19±0.17) was obviously reduced as compared to the control group (1.90±0.48) (P<0.01). The decrease in MVD was positively correlated with the decrease of VEGF expression (rs = 0.714, P<0.05). We did not see gastrointestinal complications in the treated group and no differences were noted in the body weight of the mice between the two groups throughout the study CONCLUSION: Indomethacin can significantly decrease the viability of cultured HCT116 cells and retard human colorectal HCT116 cell tumor growth via inhibiting tumor angiogenesis, which might be through reduction of VEGF expression.

Health-related quality of life in gastroesophageal reflux patients with noncardiac chest pain: Emphasis on the role of psychological distress

AIM To investigate the effects of depression and anxiety on health-related quality of life(QoL)in gastroesophageal reflux disease(GERD)patients and those suffering from cardiac(CCP)and noncardiac(NCCP)chest pain in Wuhan,China.METHODS In this cross-sectional study,a total of 358 consecutive patients with GERD were enrolled in Wuhan,China,of which 176 subjects had complaints of chest pain.Those with chest pain underwent coronary angiography and were divided into a CCP group(52 cases)and NCCP group(124 cases).Validated GERD questionnaires were completed,and the 36-item Short-Form Health Survey and Hospital Anxiety/Depression Scale were used for evaluation of Qo L and psychological symptoms,respectively.RESULTS There were similar ratios and levels of depression and anxiety in GERD with NCCP and CCP.However,the QoL was obviously lower in GERD with CCP than NCCP(48.34±17.68 vs 60.21±20.27,P<0.01).In the GERD-NCCP group,rather than the GERD-CCP group,the physical and mental QoL were much poorer in subjects with depression and/or anxiety than those without anxiety or depression.Anxiety and depression had strong negative correlations with both physical and mental health in GERD-NCCP(all P<0.01),but only a weak relationship with mental components of QoL in GERD-CCP.CONCLUSION High levels of anxiety and depression may be more related to the poorer QoL in GERD patients with NCCP than those with CCP.This highlights the importance of evaluation and management of psychological impact for improving QoL in GERD-NCCP patients.

Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

Effect of NCPB and VSPL on pain and quality of life in chronic pancreatitis patients

AIM: To compare the effects of neurolytic celiac plexus block (NCPB) and videothoracoscopic splanchnicectomy (VSPL) on pain and quality of life of chronic pancreatitis (CP) patients.METHODS: Forty-eight small duct CP patients were treated invasively with NCPB (n = 30) or VSPL (n = 18) in two non-randomized, prospective, case-controlled protocols due to chronic pain syndrome, and compared to a control group who were treated conservatively (n = 32). Visual analog scales were used to assess pain and opioid consumption rate was evaluated. In addition, the quality of life was measured using QLQ C-30 for NCPB and FACIT for VSPL.Although both questionnaires covered similar problems,they could not be compared directly one with another.Therefore, the studies were compared by meta-analysis methodology.RESULTS: Both procedures resulted in a significant positive effect on pain of CP patients. Opioids were withdrawn totally in 47.0% of NCPB and 36.4% of VSPL patients,and reduced in 53.0% and 45.4% of the respective patient groups. No reduction in opioid usage was observed in the control group. In addition, fatigue and emotional well-being showed improvements. Finally, NCPB demonstrated stronger positive effects on social support, which might possibly be attributed to earlier presentation of patients treated with NCPB.CONCLUSION: Both invasive pain treatment methods are effective in CP patients with chronic pain.

Sensory testing of the human gastrointestinal tract

The objective of this appraisal is to shed light on the various approaches to screen sensory information in the human gut. Understanding and characterization of sensory symptoms in gastrointestinal disorders is poor. Experimental methods allowing the investigator to control stimulus intensity and modality, as well as using validated methods for assessing sensory response have contributed to the understanding of pain mechanisms. Mechanical stimulation based on impedance planimetry allows direct recordings of luminal cross-sectional areas, and combined with ultrasound and magnetic resonance imaging, the contribution of different gut layers can be estimated. Electrical stimulation depolarizes free nerve endings non-selectively. Consequently, the stimulation paradigm （single, train, tetanic） influences the involved sensory nerves. Visual controlled electrical stimulation combines the probes with an endoscopic approach, which allows the investigator to inspect and obtain small biopsies from the stimulation site. Thermal stimulation （cold or warm） activates selectively mucosal receptors, and chemical substances such as acid and capsaicin （either alone or in combination） are used to evoke pain and sensitization. The possibility of multimodal （e.g. mechanical, electrical, thermal and chemical） stimulation in different gut segments has developed visceral pain research. The major advantage is involvement of distinctive receptors, various sensory nerves and different pain pathways mimicking clinical pain that favors investigation of central pain mechanisms involved in allodynia, hyperalgesia and referred pain. As impairment of descending control mechanisms partly underlies the pathogenesis in chronic pain, a cold pressor test that indirectly stimulates such control mechanisms can be added. Hence, the methods undoubtedly represent a major step forward in the future characterization and treatment of patients with various diseases of the gut, which provides knowledge to dinicians about the underlying symptoms and treatment of these patients.

Psychological controversies in gastroparesis: A systematic review

To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.METHODSA comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to identify literature addressing the relationship between gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of gastroparesis patients, a quantitative methodology, and at least one of the following: (1) evaluation of the prevalence of psychopathology; (2) an outcome measure of anxiety, depression, or quality of life; and (3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review.RESULTSPrevalence of psychopathology was evaluated by three studies (n = 378), which found that combined anxiety/depression was present in 24% of the gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies (n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with gastroparesis symptom severity was evident. Quality of life was included as an outcome measure in 11 studies (n = 2076), with gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for gastroparesis patients (n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations.CONCLUSIONGastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.

“愈疡散”对结肠癌化疗致口腔黏膜炎患者免疫功能及炎症细胞因子的影响研究——附30例临床资料

目的:观察自拟愈疡散对结肠癌化疗致口腔黏膜炎患者免疫功能及炎症细胞因子的影响。方法:60例结肠癌化疗后出现口腔黏膜炎的患者随机分为治疗组和对照组,每组30例。对照组予生理盐水漱口,治疗组在对照组治疗的基础上加用自拟愈疡散涂抹,2组疗程均为2周。观察并比较2组患者口腔黏膜炎愈合时间及治疗前后T淋巴细胞亚群比例和肿瘤坏死因子-α(TNF-α)、白细胞介素2(IL-2)水平变化情况。结果:治疗组口腔黏膜炎平均愈合时间明显短于对照组(P<0.05)。2组患者治疗后T淋巴细胞亚群CD3+比例、CD4+比例、CD4+/CD8+比值及IL-2水平均较治疗前明显升高(P<0.05),治疗组明显高于对照组(P<0.05);治疗组治疗后T淋巴细胞亚群CD8+比例、TNF-α水平较治疗前明显降低(P<0.05),且明显低于对照组(P<0.05);对照组治疗后TNF-α水平较治疗前明显降低(P<0.05)。结论:在生理盐水漱口的基础上加用自拟愈疡散涂抹治疗结肠癌化疗致口腔黏膜炎,可缩短口腔黏膜炎愈合时间,调节机体免疫功能,改善炎症细胞因子水平。

A survey of advanced medical students’ knowledge towards cancer pain management

Objective: The aim of the study was to investigate advanced medical students' knowledge towards cancer pain management, and understand the effect of specialisms and duration of oncology rotation on the advanced medical students' cognitive level towards cancer pain management. Methods: Randomly selected the respondents from a medical school in Wuhan, China. The educational background of the respondents should belong to one of these conditions: (1) clinical master degree candidate; (2) clinical doctor degree candidate; (3) the sixth or seventh year of clinical medicine for seven years. The respondents should also spend more than one year on internship. The self-developed questionnaire papers were distributed to respondents in the unit of dorms selected randomly and recovered them immediately after they're finished. The categori- cal data were expressed at the form of frequency (rate or constituent ratio). Chi-square test was required only as needed. Results: The survey was anonymous. We distributed 300 papers, recovered 300 papers and weeded out 8 invalid papers. Finally there were 292 valid papers, and the valid recovery rate was 97.3%. The 96.7% of oncological medical students and 47.6% non-oncological medical students relied on patients' description for cancer pain assessments; 90.0% of oncological medical students and 53.0% of non-oncological medical students prescribed strong opioid drugs firstly for patients suffering severe cancer pain; only 24.1% of non-oncological medical students recognized that pethidine was not safe and effective to treat cancer pain, which was much lower than oncological medical students (90.0%); 73.3% of oncological medical students and 28.9% of non-oncological medical students had the correct impression of drug addiction; 85.5% of non-oncological medi- cal students worried about the drug addiction, while 60.0% of oncological medical students worried about the strict control over opioid. In respect of the details of cancer pain management, only 66.7% of oncological medical students recognized that there was no upper limit of opioid prescribed clinically, and 16.3% of oncological medical students recognized that there was no psychological dependence if patients took opioid orally. The 69.8% of the students from no-less-than-two-week group relied on patients' description for cancer pain assessments, 76.7% prescribed strong opioid drugs firstly for patients suffer- ing severe cancer pain, 69.8% recognized that pethidine was not safe and effective to treat cancer pain, and 55.8% had the correct impression of drug addiction. All of the data were higher than that in no-rotation group and that in less-than-two-week group. The 51.2% of the students from no-less-than-two-week worried about drug addiction, which was the lowest of all. Conclusion: The cognitive level of advanced medical students towards cancer pain management is so low that it could not satisfy the clinical requirement, especially for the non-oncological medical students and the students spending little time on oncology rotation. Though the oncological medical students know something about cancer pain treatment, they know little about the details.

Trigger points and sensitized acupoints:same book,different covers?

Acupoints and trigger points in traditional Chinese medicine represent two different minimally invasive therapy systems-based,respectively,on traditional acupuncture and dry needles.Many studies argue that trigger points and traditional acupoints are conceptually similar because they generally have identical locations on the human body.However,whether trigger points contribute to the formation of the traditional acupuncture technique is controversial.Although many relevant studies have been conducted,this controversy continues to hinder the development of both disciplines.Recently,researchers of Chinese acupuncture have proposed the“acupoint sensitization”theory,which postulates that traditional acupoints may be sensitized by diseases,environments,and therapies.This turns them into a“sensitized state.”Recent studies suggest that trigger points and sensitized acupoints share similar biological properties.To clarify the above-mentioned confusion,we reviewed relevant studies on these two concepts and attempted to analyze their relationship.In this paper,we provide a general summary of acupoint sensitization theory and sensitized acupoints.We then compare trigger points with sensitized acupoints by categorizing their similarities and differences,including location and range,pathological morphology,pain perception,surface temperature effects,and bioelectrical properties.We believe that,because trigger points and sensitized acupoints have many shared properties,they might constitute“the same book with different covers.”

Ulnar variance related to biological and training characteristics, pain and handgrip strength in Portuguese skeletally immature male gymnasts

Purpose： This study was to investigate the association between ulnar variance（UV） and biological and training characteristics, handgrip, and wrist pain in a group of 23 Portuguese skeletally immature male gymnasts（aged 11.2 2.5 years）.Methods： Left and right UV was obtained using Hafner＇s procedure and skeletal age was determined by the TannereWhitehouse 3-method. A negative mean value for UV measures was observed（ 2.4 to 3.6 mm） without significant differences with increasing age-category（ p=0.09 to p=0.48）. Significant low correlations were observed between some UV parameters and stature, fat percentage, years of training, and left handgrip strength.Results： Ten gymnasts reported wrist pain with gradual onset and UV values were very similar between painless and painful wrists.Conclusion： The findings of this study do not directly support the thesis that gymnastics training and biological variables or wrist pain are associated with UV.

THE THIRD LUMBAR TRANSVERSE PROCESS SYNDROME TREATED BY ELECTROACUPUNCTURE AT HUATUOJIAJI POINTS

32 cases of the third lumbar transverse process syndrome were treated mainly byelectroacupuncture at Huatuojiaji points of the first and second lumbar vertebrae, andanother 30 cases of the syndrome by conventional acupuncture as the controls. The resultsshowed that treatment by electroacupuncture at Huatuojiaji points was superior inanalgesic effect and clinical total effective rate to that by conventional acupuncture. It isconsidered that the mechanism of treatment by electroacupuncture at Huatuojiaji pointsis related to the trunk of posterior ramus of the spinal nerve where the points are located.

Effect of implanting fibrin sealant with ropivacaine on pain after laparoscopic cholecystectomy

AIM:To investigate the safety and efficacy of implant-ing fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic chole-cystectomy(LC).METHODS:Sixty patients(American Society of Anes-thesiologists physical status wasⅠorⅡand underwent LC)were randomly divided into three equal groups:group A(implantation of fibrin sealant in the gallbladder bed),group B(implantation of fibrin sealant carrying ropivacaine in the gallbladder bed),and group C(normal saline in the gallbladder bed).Postoperative pain was evaluated,and pain relief was assessed by visual analog scale(VAS)scoring.RESULTS:The findings showed that 81.7%of patients had visceral pain,50%experienced parietal,and 26.7% reported shoulder pain after LC.Visceral pain was significantly less in group B patients than in the other groups(P<0.05),and only one patient in this group experienced shoulder pain.The mean VAS score in group B patients was lower than that in the other groups.CONCLUSION:Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed.

Tagore＇s Gitanjali： Reunion With God Through Songs

Tagore reaches his lord through his songs which uplift him above the meanness end of life. Music ennobles him to a level of friendship with the Creator. Tagore＇s poems are suffused with wonder at the melodies spun by the lord. These entrance the entire universe. The poet wants to sign the same way but cannot. He has been made captive in the meshes of his music. The objective of the present study is to show how Tagore unites with God through songs. Methodology adopted in this study is the dynamic analysis of the poems. The intrinsic idea is the recurrent theme in his songs using me as an offering of worship O Lord, even if thou inflict pain on me in the process. Numerous bereavements in his life, from early youth to old age, agonized him throughout. But the more he suffered, the stronger grew his faith so he could write this song. The refrain, re-iterated from the beginning to the end, enhances the musicality. Thus it can be concluded when the poet perceived the world through songs, then he knew the world and he recognized it.

Chronic proctalgia and chronic pelvic pain syndromes:New etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing:A recently published large randomized,controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders.

Unbalance of the Physiological System May Cause Trouble —The Other Side of the Story from the Very Successful Drug, VIOXX

Selective cyclo-oxygenase-2 (CQX-2) inhibitor, VIOXX (rofecoxib), wasvoluntarily withdrawn worldwide from drugstores by its maker Merck & Co., Inc. on September 30,2004, for its potential lethal side effects of heart attack or stroke, The Merck' s decision wasbased on new, three-year data from a prospective, multi-center, randomized, placebo-controlled,double-blind clinical trial of VIOXX with an unrelated study, the APPROVe (Adenomatous PolypPrevention on VIOXX) trial. The trial has been enrolling 2 600 patients and comparing 156 weeks(three years) of treatment with VIOXX 25 mg to placebo since 2000.

NATIONAL SURVEY ON PREVALENCE OF CANCER PAIN

Objective. To collect nationwide basic data about cancer related pain. Methods. Sixty cancer patients in each province were randomly selected to participate in this survey. The subjects represented all stages of cancer, tumor sites, and different demographic characteristics. Two self- designed structured questionnaires including reasons, types of pain and pain management were used by patients and physicians respectively. Subjects were asked to report whether he/she had experienced any type of cancer related pain and filled out the equivalent questionnaire. The severity of pain was assessed by using“ visual analogue scale” . Original data input and analysis were using EPI- INFO software package. Results. The result showed that 61.6％ (958/1555) of patients had different types of cancer related pain. Majority of pain (85.1％ ) were caused by advanced cancer. The major reasons (64.4％ ) for poor management or impedimental factors of pain care are due to patient including over- concern on opioid analgesic addiction, reluctance to report pain or refused to use opioid analgesic until at times when pain is intolerable; 26.8％ belonged to physician’s reasons including fear to cause addiction on opioid and lack of knowledge about cancer pain management; 16.2％ are due to lack of different kinds of opioid analgesic for use and 16.1％ belonged to drug regulation. Conclusions. The results showed that majority of patients (61.6％ ) had different types of cancer related pain. In most of patients, cancer pain was relieved when they were treated. The major reason for under- treatment or impeded factors for effective relief of cancer pain was fear of opioid addiction by both medical professionals and patients.