Traditional Chinese medicine for foot pain in a patient with complex regional pain syndrome: A case report

BACKGROUND Complex regional pain syndrome(CRPS)is characterized by pain as well as sensory,motor,and sudomotor disorders.Generally,it is classified into two types CRPS-I and CRPS-II.There is no single diagnostic test or treatment approach for CRPS,and a multidisciplinary approach is gaining attention to improve patients’symptoms and their quality of life.CASE SUMMARY A 35-year-old woman with an unremarkable medical history sought treatment for CRPS at a hospital of Korean medicine.During her first visit,she was wheelchairbound due to severe pain in her left lower extremity.She had edema and discoloration of the left foot.She was treated with a combination of traditional Chinese medicine(TCM)approaches,including acupuncture,moxibustion,pharmacopuncture,and herbal decoction,for approximately 20 sessions.The foot and ankle outcome score(FAOS)and visual analog scale(VAS)score for pain were evaluated,along with general signs and functions.Her symptoms,signs,FAOS,and VAS scores improved after treatment,with a significant 7-degree decrease in the VAS score and a 62-point increase in the FAOS score.Additionally,the foot swelling and discoloration gradually resolved.During the phone follow-up,5 mo after the last visit,additional improvements in outcomes were observed.CONCLUSION Combined TCM treatment may be a reasonable and safe option for alleviating symptoms and improving function in patients with CRPS.

Impact of adolescent complex regional pain syndrome on the psychopathology of young men ahead of military service: A retrospective cohort analysis of Korean conscription data

Background: The relationship between physical and psychopathological features in complex regional pain syndrome(CRPS) has been a subject of constant interest, but no data are available in adolescents. Therefore, we aimed to identify the factors associated with psychopathology in adolescents with CRPS ahead of military service.Methods: We retrospectively reviewed all conscription examinees who had completed a Military Personality Inventory(MPI) during a period between February 2013 and December 2016. A total of 63 persons with a history of CRPS(19-years of age for all) were enrolled. Basic demographic and pain-related data were analyzed to examine their association with MPI results. The mean FGR score as well as the 8 subdomain scores were compared between those with pain duration at <15 months(n=30) vs. ≥15 months(n=33). Binary MPI results(normal-abnormal) were also compared between the two groups.Results: In multivariate analysis, abnormal MPI was associated with pain duration, with an odds ratio(OR) at 1.05 for every 1-month increase [95% confidence interval(CI) 1.02–1.08;P=0.002]. Subjects with pain duration at ≥15 months have lower faking good response score(P<0.001 vs. those with pain duration at <15 months), and higher abnormal MPI result rate, faking bad response, inconsistency, anxiety, depression, somatization, paranoid, personality disorder cluster A, and personality disorder cluster B scores(P<0.05). Pain duration was significantly associated with the MPI variables.Conclusions: Pain duration is associated with psychopathology in adolescents with CRPS. Psychopathologic features increased as the disease duration increased. A comprehensive understanding of time-dependent psychopathological factors could support the planning of multimodal approaches for managing adolescent CRPS.

State Support of Russian Agro-industrial Complex at the Federal and Regional Levels on Entering the Global Market

The main subject of the report consists in showing positive course of Russian agriculture over the last years-entering the global market. That＇s why it is essential to make following steps to support manufactures aiming them more actively at export： to develop export operations; to develop actively agro-industrial complex perspectives for entering the WTO; to ensure the food safety of agro-industrial complex while exporting the products; in the context of globalization Russian regions are entering more actively the global market as the relatively independent subjects of international economical relationships. The food safety of Russia-such condition of the state economy, when food independence of the country is provided, provision; physical and economic utility of food products is guaranteed by the state and corresponds to requirements of the legislation of the Russian Federation in safety and quality. Participation in the WTO gives to the country set of advantages in the decision food independence. In the world, the country and in region management of efficiency agriculture with a view of advancement to food safety, should be coordinated necessarily with food independence. State support of the Russian agro-industrial complex on the federal and regional levels when entering into the world market-is a factor of the formation of a new geopolitical status of Russia in the world arena, it is the new selection mechanism of the development of globalization processes in favor of the active participation of the agro-industrial complex of Russia in the world economy.

Origin of Particle Spins, Bosons and Fermions, Compounds of Zero Spin Particles, in Complex Spin Region

This paper shows： Bosons and Fermions maybe the compounds П of two zero spin particles which are spin-conjugates each other in complex region. There are two kinds of spin-conjugates of zero spin particle： real spin-conjugate （πReal,π） and imaginary spin-conjugate （πImaginary,π）. Using （πReal, π）, Bosons and Fermions of Antimatter ПR could be formed, and using （πImaginary,π）, Bosons and Fermions of Matter П1 could be formed.

High-intensity swimming alleviates nociception and neuroinflammation in a mouse model of chronic postischemia pain by activating the resolvin E1-chemerin receptor 23 axis in the spinal cord

Physical exe rcise effectively alleviates chronic pain associated with complex regional pain syndrome type-Ⅰ.However,the mechanism of exe rcise-induced analgesia has not been clarified.Recent studies have shown that the specialized pro-resolving lipid mediator resolvin E1 promotes relief of pathologic pain by binding to chemerin receptor 23 in the nervous system.However,whether the resolvin E1-chemerin receptor 23 axis is involved in exercise-induced analgesia in complex regional pain syndrome type-Ⅰ has not been demonstrated.In the present study,a mouse model of chronic post-ischemia pain was established to mimic complex regional pain syndrome type-Ⅰ and subjected to an intervention involving swimming at different intensities.Chronic pain was reduced only in mice that engaged in high-intensity swimming.The resolvin E1-chemerin receptor 23 axis was clearly downregulated in the spinal cord of mice with chronic pain,while high-intensity swimming restored expression of resolvin E1 and chemerin receptor 23.Finally,shRNA-mediated silencing of chemerin receptor 23in the spinal cord reve rsed the analgesic effect of high-intensity swimming exercise on chronic post-ischemic pain and the anti-inflammato ry pola rization of microglia in the dorsal horn of the spinal cord.These findings suggest that high-intensity swimming can decrease chronic pain via the endogenous resolvin E1-chemerin receptor 23 axis in the spinal cord.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Neuronal changes resulting in up-regulation of alpha-1 adrenoceptors after peripheral nerve injury

Under normal conditions, the sympathetic neurotransmitter noradrenaline inhibits the production and release of pro-inflammatory cytokines. However, after peripheral nerve and tissue injury, pro-inflammatory cytokines appear to induce the expression of the alphalA-adreno- ceptor subtype on immune cells and perhaps also on other cells in the injured tissue. In turn, noradrenaline may act on up-regulated alphal-adrenoceptors to increase the production of the pro-inflammatory cytokine interleukin-6. In addition, the release of inflammatory mediators and nerve growth factor from keratinocytes and other cells may augment the expression of alphal-adrenoceptors on peripheral nerve fibers. Consequently, nociceptive afferents acquire an abnormal excitability to adrenergic agents, and inflammatory processes build. These mechanisms could contribute to the development of sympathetically maintained pain in conditions such as post-herpetic neuralgia, cutaneous neuromas, amputation stump pain and complex regional pain syndrome.

Persistent Post-Operative Low Back Pain, True Radiculopathy and Pseudoradiculopathy: Retrospective Observational Study and Point of View of a Practicing Clinician

Purpose: Persistent Postoperative Low Back Pain (PLBP) is inordinately common, and has been attributed to various pre-operative and post-operative anatomical and mechanical factors in the spine. It may or may not be associated with sensory symptoms in the lower extremities—frequently termed “radiculopathy”—with or without Electromyographic (EMG) or imaging abnormalities. The present study aimed to look at these various symptoms in the lower extremities from a different angle and perspective and to clarify the distinction between true radiculopathy and pseudoradiculopathy;and determine their possible relationship with the outcome of surgery. Methods: Medical records of twenty-four patients with PLBP who were referred to the author for clinical and electrodiagnostic examinations several months after surgery were reviewed. Clinical symptomatology, with special reference to the presence or absence of sensory and motor deficits together with EMG findings, were reviewed and categorized into 4 groups: non radicular, true radiculopathy, pseudoradiculopathy, and peripheral neuropathy. Results: Lower Back Pain (LBP) in all patients persisted following successful and uncomplicated surgery. LBP in patients with true radiculopathy persisted but was less disabling when the neurologic deficits resolved partially or significantly. As expected, the neurologic deficits related to peripheral neuropathy, together with LBP, remained persistent. Conclusion: LBP and various sensory and motor symptoms in the lower extremities are 2 distinct entities, both clinically and pathophysiologically. These sensory and motor symptoms, together with the heightened activity of various pro-inflammatory cytokines and neurotrophins—setting aside the various anatomical and mechanical factors in the spine—can influence the outcome of surgery, favorably or unfavorably.

Key Scientific Issues for Regional Sustainable Development in Northeast Asia

Within the context of global climate change, achieving sustainable development in Northeast Asia will require in-depth research into the key scientific issues from both theoretical and empirical perspectives. This paper assesses that the main issues to be addressed are：（i） researches on the structure, function and differentiation disciplines of the vast and complex regional resources-environment-socio-economic system that is Northeast Asia and on how the region can respond and evolve. （ii） Failing to find a mode for sustainable development is one of the most serious restrictive factors to development in Northeast Asia. （iii） Development of cross-border regional socio-economic models for sustainable development is essential. And （iv） the strategies above require cross-border technical support platforms to guarantee a consistent approach to regional sustainability in Northeast Asia.

Eco-Sensitivity Assessment and Protection Policy in a Complex Geomorphic Region in China

Eco-sensitivity evaluation is the basis for land development and has practical significance to the establishment of environmentally-friendly economic and social development models. Compared to simple geomorphic regions, complex geomorphic regions are limited by a higher number of eco-sensitivity factors under a land exploitation context. Further still, these factors have complicated spatial characteristics and affect each other. Based on published data, we focused on the city of Qinzhou in Guangxi Zhuang Autonomous Region, China and developed an eco-sensitivity assessment system spanning land ecology, water ecology and plant ecology. A systematic comprehensive assessment of all watersheds was done using qualitative classification, spatial quantitative modeling, remote sensing and GIS technology. We were able to group Qinzhou’s 273 watersheds into three types： high sensitivity areas, medium sensitivity areas and low sensitivity areas. We propose a limit on land exploitation activities in high sensitivity areas and an ecological security network. The methods utilized here can help determine eco-sensitivity characteristics in complex geomorphic regions and with this knowledge governments wil be able to develop robust scientiifc policy to protect regional ecological security.

Painful scar neuropathy:principles of diagnosis and treatment

Nerve-tissue interactions are critical.Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical presentations.All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term“painful scar neuropathy”.The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis-associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy.The search retrieved twenty-one papers,twenty of which reported pain reduction or resolution with various techniques.There is no consensus on the best therapeutic approach to neuropathic pain due to scar tethering.Most authors report good or excellent results with different techniques,from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized tissue.The authors’classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type(perineural,or endoneural and perineural),pain type(due to traction or external trauma,pain at rest),and number of previous operations.Patients need to be informed that multiple procedures may be required,that outcomes may be partial,and that surgery can potentially worsen preoperative conditions.The review found no evidence for the best therapeutic approach to scar neuropathy,but there is consensus on a multidisciplinary approach.

A Comprehensive Security Regime in the Gulf Region: Prospects and Challenges

In international politics,regional initiatives to establish peace and security have been recognised as more appropriate and pragmatic in the present complex interconnected interdependent security scenario.Regional security regimes initiated and promoted both by regional and extra-regional powers for resolving,preventing and managing crises that had grown and nurtured in the regional landscape.Conceptually,comprehensive security regimes,the hybrid of both idealist and realist schools of thought of international relations,are preferably the unique one among all other security regimes.The best example of a comprehensive security regime is the Organisation for Security and Co-operation in Europe.Practically,the dynamic nature of Gulf regional security has become a matter of discourse to ponder upon whether the region is transforming itself on various fronts or whether regional security regimes should be explored to overcome the ongoing multiple security challenges on multidimensional aspects.Scholars have recognised Gulf security as a sub-regional security complex of a larger area which must be dealt with separately.Thus,using this conceptual framework the paper attempts to explore the feasibility of the establishment of a comprehensive security regime in the Gulf Region which can address all three levels of insecurity,regional,state and individual thereby transcend the state-centric approach to security and create security based on multi-sum principles and not on zero-sum calculations.