A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

Pain and Radiographic Changes in Adult Scoliosis Patients Using a Scoliosis Activity Suit: Case-Controlled 10-Year Follow-Up Results

Scoliosis in adult patients is known to increase across the lifespan and increases the chance of chronic pain in later adulthood. Non-surgical scoliosis treatment options for adults are not widely recommended, largely due to lack of research in this area. Pain management options for adults are focused primarily on treating scoliosis-related pain, and not necessarily the scoliosis itself, such as epidural injections, prescription pain medications, and general physical therapy. Recent studies reporting non-surgical, scoliosis-specific treatment methods in adults are encouraging, but their study designs limit extrapolation. The current study reports the self-reported pain and radiographic outcomes in adult patients wearing a scoliosis activity suit for at least 10 years. A total of 22 patient charts that fulfilled the inclusion criteria were selected for review. Cobb angle radiographic measurements and self-rated quadruple numerical pain rating scale (QVAS) at baseline and 10-year follow-up were used as the outcomes. Cobb angle measurements were compared at baseline and 10 years and subdivided according to scoliosis curve pattern. At 10 years, 68% of patients had improvements in their Cobb angle > 5˚, with an overall average of approximately 9˚. Significant differences were also observed in the 10-year Cobb angle measurements when compared to the predicted 10-year Cobb angles based on the established rate of linear progression in adults. A statistically significant change was also observed in the 10-year QVAS scores. These results suggest a potential role of the scoliosis activity suit for improving Cobb angles in adults and reducing scoliosis-related pain.

抑制P38MAPK信号通路表达减轻大鼠神经病理性疼痛的机制

目的探究抑制P38丝裂原活化蛋白激酶(P38MAPK)信号通路表达减轻大鼠神经病理性疼痛的机制。方法选取60只雄性无特定病原体(SPF)级大鼠(体质量200~220 g,3月龄左右),随机抽取10只作为假手术组,其余大鼠建立大鼠慢性压迫性损伤(CCI)模型。将成模大鼠[造模成功率为80%(40/50)]随机分为模型组、P38MAPK抑制剂组,造模后第6天分别鞘内注射生理盐水、P38MAPK抑制剂,2次/d,连续5 d。术后1、7、11 d测定各组大鼠机械性痛阈、运动功能评分。术后第11天处死大鼠,采用免疫组化法测定大鼠背根神经节P38MAPK、环氧合酶-2(COX-2)蛋白表达。计量资料采用重复测量方差分析。结果假手术组大鼠机械性痛阈变化不明显;模型组大鼠第7天开始痛阈水平降低,至第11天降至最低;P38MAPK抑制剂组第7天痛阈水平降低,第11天升高(P<0.05),且高于模型组(P<0.05);模型组与P38MAPK抑制剂组在第7天出现明显运动功能障碍,第11天模型组运动功能障碍程度增加,第11天P38MAPK抑制剂组运动功能障碍程度减轻(P<0.05),且运动功能评分低于模型组(P<0.05);假手术组P38MAPK免疫阳性细胞表达<P38MAPK抑制剂组<模型组[(7.35±0.63)%比(25.36±1.85)%比(60.23±2.17)%](P<0.05);假手术组COX-2蛋白阳性细胞表达<P38MAPK抑制剂组<模型组[(5.21±2.23)%比(15.14±2.01)%比(33.43±3.02)%](P<0.05)。结论P38MAPK信号通路与神经病理性疼痛发生有关,抑制P38MAPK信号通路表达可减轻大鼠神经病理性疼痛。

强化胰岛素治疗对急性心肌梗死患者的预后影响

目的系统评价强化胰岛素治疗应用于急性心肌梗死患者的临床疗效和安全性,为改善预后提供参考。方法对Cochrane、Embase、PubMed、中国知网、万方数据知识服务平台、中文科技期刊数据库、CBM数据库自建库至2022年10月的相关文献进行系统检索,以确定比较强化胰岛素治疗和普通胰岛素治疗对急性心肌梗死患者的临床预后影响的随机对照试验。提取每项研究的数据和特征,采用RevMan 5.4软件进行荟萃分析。结果最终纳入8篇文献,共包含726例患者,其中强化胰岛素治疗组372例、普通胰岛素治疗组354例。对各组数据进行荟萃分析显示,强化胰岛素治疗组主要心血管不良事件发生率(RR=0.53,95%CI=0.44~0.64,P<0.001)、全因死亡率(RR=0.51,95%CI=0.33~0.78,P=0.002)、治疗7 d超敏C反应蛋白(WMD=-2.00,95%CI=-2.17~-1.83,P<0.001)均显著低于普通胰岛素治疗组,治疗30 d左心室射血分数(WMD=3.94,95%CI=2.45~5.43,P<0.001)、低血糖事件发生率(RR=2.96,95%CI=1.12~7.83,P=0.030)均显著高于普通胰岛素治疗组,两组经皮冠状动脉介入治疗术后无复流事件差异无统计学意义(RR=0.39,95%CI=0.14~1.13,P=0.080)。结论强化胰岛素治疗可能与急性心肌梗死患者的临床获益相关,但需要更多研究来证实。

肠道菌群及代谢物在神经认知恢复延迟中作用的研究进展

随着手术和全身麻醉患者数的增加,神经认知恢复延迟的发生率也相应增加,这对患者的生活质量产生了严重影响。微生物-脑-肠轴作为中枢神经系统与肠神经系统的双向通道,越来越引起人们的关注。肠道微生物及其代谢产物不仅在维持肠道内环境稳定方面起着至关重要的作用,而且与神经认知恢复延迟密切相关。目前,对神经认知恢复延迟的治疗尚没有确切的方法,明确肠道菌群及其代谢产物与神经认知恢复延迟的关系可为该疾病的治疗和诊断提供思路和参考。因此,该文针对肠道微生物及其代谢物,分析研究神经认知恢复延迟可能发生和发展的过程。通过深入了解肠道微生物与神经认知恢复延迟的关联,探索其潜在的机制,并为寻找预防和治疗神经认知恢复延迟的方法提供参考。

RVM致炎细胞因子上调导致5-HT释放参与调控慢性术后疼痛

【目的】探讨延髓头端腹内侧部(RVM)内致炎细胞因子肿瘤坏死因子α(TNFα)和白介素-1β(IL-1β)释放增多导致5-羟色胺(5-HT)向脊髓释放增多在慢性术后疼痛(CPSP)模型中的作用。【方法】按照随机方式将SD大鼠进行如下分组:对照组、皮肤/肌肉切开和牵拉(SMIR)(1d,7d)组、SMIR+RVM内注射TNFα或IL-1β中和性抗体组、SMIR+RVM内注射TNFα或IL-1β组、SMIR+RVM内注射溶剂组,用up-down方法测量大鼠50%机械刺激撤足阈值,免疫组化检测RVM内TNFα或IL-1β表达情况,酶联免疫吸附测定法(ELISA)方法观察RVM及脊髓背角内5-HT含量的变化。【结果】SMIR可引起大鼠机械痛敏,表现为50%机械刺激撤足阈值下降,持续至少3周。SMIR后,RVM内神经元和星形胶质细胞中的TNFα和IL-1β表达上调。TNFα或IL-1β中和抗体(每天一次行SMIR术前30 min给予,共4次))微量注射入RVM可阻断SMIR引起的50%机械刺激撤足阈值下降,并可降低RVM及脊髓背角5-HT的含量。正常动物RVM内注射TNFα和IL-1β也可导致50%机械刺激撤足阈值下降,且引起RVM及脊髓内5-HT含量增加。【结论】RVM中致炎细胞因子增多可能通过引起5-HT释放增多参与调控SMIR后慢性术后疼痛的发生发展。

术前电针干预对腹部手术后患者胃肠功能影响的Meta分析

目的采用Meta分析方法评价术前电针干预对腹部手术后胃肠功能恢复的影响。方法系统检索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学数据库(CBM)、中国知网(CNKI)、万方(WanFang)和维普(VIP)数据库,检索时间为建库至2024年3月。检索所有关于电针促进术后胃肠功能恢复的随机对照试验(RCT),由2名研究人员独立筛选文献、提取数据,使用Cochrane Risk of Bias工具对纳入研究进行质量评价,并采用RevMan5.3软件进行Meta分析。结果共纳入12篇RCTs,共计773例患者,其中术前电针组421例,对照组352例。Meta分析结果显示,与对照组比较,术前电针组术后首次肛门排气时间(SMD=-0.56,95%CI-0.84~-0.28,P<0.001)、术后首次排便时间(MD=-6.40 h,95%CI-9.27~-3.53 h,P<0.001)、术后肠鸣音恢复时间(MD=-8.45 h,95%CI-10.37~-6.52 h,P<0.001)、术后首次进食时间(MD=-16.88 h,95%CI-23.92~-9.83 h,P<0.001)均明显缩短、术后恶心呕吐(PONV)发生率明显降低(RR=0.75,95%CI 0.57~0.98,P=0.04)、术后住院时间明显缩短(MD=-0.78 d,95%CI-1.38~-0.19 d,P=0.010)。结论手术前电针干预可有效促进手术患者术后排气、排便、肠鸣音恢复,缩短术后禁食禁饮时间,减少PONV的发生率,缩短住院时间,在促进术后胃肠功能恢复方面具有良好的临床价值。

益生菌治疗轻度认知障碍和阿尔茨海默病患者的有效性及安全性

目的探讨益生菌增补治疗轻度认知障碍(MCI)和阿尔茨海默病(AD)患者的有效性及安全性。方法检索PubMed、Cochrane Library、Web of Science、Embase、中国生物医学文献数据库、知网、维普及万方数据库,搜集所有关于益生菌增补治疗AD及MCI患者有效性及安全性的研究,时间从建库至2022年12月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行meta分析。结果共纳入10个研究,716例患者。meta分析结果显示:益生菌组在提高简易智力状态检查量表(MMSE)积分(MD=1.23,95%CI 0.18~2.27,P=0.02)方面优于对照组,差异有统计学意义;两组不良反应发生率差异无统计学意义(OR=0.63,95%CI 0.25~1.63,P=0.34)。结论益生菌增补治疗在改善MCI和AD患者认知功能效果方面具有积极作用,且具有良好的安全性。

冠脉介入治疗联合抗阻训练对冠心病心绞痛患者心肺功能及运动耐力的影响

目的:探讨冠心病心绞痛(CHDAP)患者采用冠脉介入治疗联合抗阻训练对心肺功能及运动耐力的影响。方法:选取2021年3月—2022年10月锡林郭勒盟中心医院收治的共计94例CHDAP患者,以随机数字表法分成研究组(n=47)与对照组(n=47)。对照组给予冠脉介入治疗联合常规康复训练,研究组给予冠脉介入治疗联合抗阻训练。比较两组心肺功能、心绞痛发作情况、运动耐力及不良事件。结果:干预后,两组峰值分钟通气量(VEpeak)、峰值摄氧量(VO_(2)peak)、峰值脉氧饱和度(SpO_(2)peak)及氧脉搏(O_(2)pulse)均较干预前提高,研究组较对照组均更高,差异均有统计学意义(P<0.05)。干预后,两组心绞痛发作次数较干预前均减少,持续时间均缩短,研究组发作次数较对照组少,持续时间短,差异均有统计学意义(P<0.05)。干预后,两组6分钟步行试验(6MWT)、代谢当量(METs)均优于干预前,研究组较对照组均更优,差异均有统计学意义(P<0.05)。研究组主要不良心血管事件(MACE)发生率(6.38%)较对照组(21.28%)低,差异有统计学意义(P<0.05)。结论:冠脉介入治疗联合抗阻训练应用于CHDAP患者中,能够改善心肺功能,缓解心绞痛发作情况,提高运动耐力,降低MACE发生率。

Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

筋膜内热针技术在膝关节软组织疼痛治疗中的应用

目的分析筋膜内热针技术在膝关节软组织疼痛治疗中的应用价值。方法选取2022年1月至2023年8月浏阳市妇幼保健院麻醉科收治的膝关节软组织疼痛患者51例,随机分组,治疗组(26例)患者给予筋膜内热针技术,对照组(25例)患者给予非筋膜内热针技术。评定两组治疗总有效率;比较两组治疗前后炎症递质水平;比较两组治疗前后膝关节功能、关节功能障碍;比较两组治疗前后的疼痛评分;比较两组治疗后生活质量评分;比较两组复发率。结果治疗总有效率:治疗组与对照组分别为88.46%(23例)与60.00%(15例),差异有统计学意义(P<0.05)。治疗前,两组炎症递质水平、膝关节功能、关节功能障碍、疼痛评分比较,差异无统计学意义(P>0.05);治疗后,治疗组炎症递质水平、膝关节功能、关节功能障碍、疼痛评分低于对照组,差异有统计学意义(P<0.05)。治疗组治疗后生活质量评分高于对照组,差异有统计学意义(P<0.05)。治疗组复发率低于对照组,差异有统计学意义(P<0.05)。结论对膝关节软组织疼痛患者治疗中应用筋膜内热针技术,可获得理想的治疗效果,能改善患者的炎症水平与机体疼痛情况,提高关节功能与生活质量,利于降低疾病复发率。

基于调枢通胃理论针灸治疗老年性便秘经验撷菁

便秘属于临床常见疾病之一,若不对病情实施积极有效的控制,可能增加心脑血管疾病发生风险,尤其是老年性便秘患者,其心脑血管疾病风险更高,便秘可在一定程度上威胁患者生命。针灸是中医外治法之一,亦是临床上用以治疗便秘的重要手段,具有显著的疗效,且有操作简便、无毒副作用以及治疗费用较低等优势。“调枢通胃”是近年来中医学者基于脾胃学说综合当代医学经验所提出的一种新型中医理论,主要用于指导脾胃疾病治疗,突出中医理论的整体观念。此文为基于调枢通胃学说的针灸治疗老年性便秘的经验撷菁,以期为针灸应用于老年性便秘的治疗提供理论依据。

带状疱疹后神经痛发生的治疗相关因素分析及其XGBoost临床预测模型的构建

目的分析影响带状疱疹后神经痛(PHN)发生的危险因素,特别是治疗相关因素,择优选择机器学习算法构建PHN临床预测模型。方法选取2023年5月至10月于西京医院疼痛医学中心门诊就诊的434名带状疱疹患者的病历资料。收集人口学因素、疱疹相关因素、治疗相关因素及合并疾病等指标。在患者病程满3个月后,根据疼痛VAS判断是否发生PHN,分为PHN组(n=197)和非PHN组(n=237)。使用单因素分析、logistic回归挑选变量,随后使用LASSO回归对挑选出的因素进行筛选和降维,选择最终纳入模型的变量。比较传统logistic回归模型和XGBoost、SVM两种机器学习模型的区分性能,选择最佳算法构建模型并进行验证和评价。结果研究通过LASSO回归筛选发现神经节段、年龄、急性期VAS、疱疹面积、神经阻滞治疗开始时间和疼痛性质是PHN发生的独立影响因素。logistic回归、XGBoost模型和SVM模型在训练集的ROC-AUC均值分别为0.82、0.95、0.77,在验证集的均值分别为0.81、0.81、0.76,提示XGBoost模型的预测性能最佳。使用XGBoost建模,训练集、验证集的ROC-AUC均值及95%CI分别为0.94(0.92~0.97)、0.86(0.79~0.94),提示模型区分度较好。Hosmer-Lemeshow拟合优度检验P>0.05,校准曲线比较接近理想曲线,说明模型预测性能良好。决策分析曲线显示模型具有良好的临床净收益。结论神经受累节段和神经阻滞治疗开始时间这两个治疗相关因素是PHN发生的重要独立影响因素。采用神经节段、年龄、急性期VAS、疱疹面积、神经阻滞治疗开始时间、疼痛性质六个变量构建的XGBoost临床预测模型性能优良,具有较好的区分度和校准度;对于早期甄别PHN高危患者,及时进行针对性治疗具有重要临床意义。

电针对术后认知功能障碍模型大鼠炎症反应和铁死亡影响的研究

背景术后认知功能障碍(POCD)是增加患者术后发病率和死亡率的重要原因之一。炎症反应和铁死亡是POCD发生的重要机制假说,而电针改善POCD患者学习和记忆功能机制尚不明确。目的观察电针对老年POCD大鼠学习记忆及炎性细胞因子和海马神经元铁死亡的影响,探讨电针改善POCD的作用机制。方法2022年1月—2023年2月选取18~20月龄SD大鼠72只,按照随机数字表法分为3组:对照组(n=24)、模型组(n=24)和电针组(n=24)。根据术后3、7 d两个观察时间点将每组大鼠分为2个亚组(对照组术后3 d亚组、对照组术后7 d亚组,模型组术后3 d亚组、模型组术后7 d亚组,电针组术后3 d亚组、电针组术后7 d亚组),每组12只。采用剖腹探查手术建立POCD模型,选取电针组大鼠百会穴和内关穴进行电针刺激。采用Morris水迷宫装置检测大鼠行为学表现,酶联免疫吸附试验检测血清、海马中白介素(IL)6、IL-10、肿瘤坏死因子α(TNF-α)的水平,海马组织脂质过氧化物(LPO)、Fe^(2+),免疫印迹法检测海马酰基辅酶A合成酶长链家族成员4(ACSL4)、铁蛋白重链1(FTH1)、血磷脂酰胆碱酰基转移酶3(LPCAT3)蛋白表达水平。采用透射电镜观察海马区神经细胞超微结构。结果术后3、7 d大鼠组别与时间对大鼠术前认知功能训练逃避潜伏期均不存在交互作用(P_(交互)>0.05),训练时间对逃避潜伏期主效应均显著(P_(时间)<0.05),组别对逃避潜伏期主效应均不显著(P_(组间)>0.05)。模型组术后3 d亚组逃避潜伏期高于对照组术后3 d亚组、电针组术后3 d亚组,穿越平台次数、目标象限停留时间低于对照组术后3 d亚组、电针组术后3 d亚组,电针组术后3 d亚组穿越平台次数低于对照组术后3 d亚组(P<0.05)。模型组术后7 d亚组逃避潜伏期高于对照组术后7 d亚组、电针组术后7 d亚组,穿越平台次数低于对照组术后7 d亚组,目标象限停留时间低于对照组术后7 d亚组、电针组术后7 d亚组(P<0.05)。模型组术后3 d亚组血清IL-6、TNF-α高于对照组术后3 d亚组、电针组术后3 d亚组,电针组术后3 d亚组TNF-α高于对照组术后3 d亚组,IL-10高于对照组术后3 d亚组、模型组术后3 d亚组(P<0.05)。模型组术后7 d亚组血清IL-6高于对照组术后7 d亚组,TNF-α高于对照组术后7 d亚组、电针组术后7 d亚组,电针组术后7 d亚组IL-10高于对照组术后7 d亚组、模型组术后7 d亚组(P<0.05)。模型组术后3 d亚组海马IL-6、TNF-α高于对照组术后3 d亚组、电针组术后3 d亚组,电针组术后3 d亚组IL-6、TNF-α高于对照组术后3 d亚组,IL-10高于对照组术后3 d亚组、模型组术后3 d亚组(P<0.05)。模型组术后7 d亚组海马IL-6、TNF-α高于对照组术后7 d亚组、电针组术后7 d亚组,电针组术后7 d亚组IL-10高于对照组术后7 d亚组、模型组术后7 d亚组(P<0.05)。模型组术后3 d亚组Fe^(2+)、LPO、ACSL4、LPCAT3高于对照组术后3 d亚组、电针组术后3 d亚组,电针组术后3 d亚组高于对照组术后3 d亚组,模型组术后3 d亚组FTH1低于对照组术后3 d亚组、电针组术后3 d亚组,电针组术后3 d亚组低于对照组术后3 d亚组(P<0.05)。模型组术后7 d亚组Fe^(2+)、LPO、ACSL4、LPCAT3高于对照组术后7 d亚组、电针组术后7 d亚组,FTH1低于术后7 d亚组、电针组术后7 d亚组(P<0.05)。模型组术后3、7 d亚组海马组织视野内细胞核双核膜结构清晰,核周隙未见明显增宽,形态不规则,表面凹凸不平;核内染色质浓缩边集;胞质内少量线粒体膜破裂,膜结构消失;部分内质网明显扩张;并可见部分髓鞘断裂,排列紊乱;电针组术后3、7 d亚组较模型组明显改善。结论炎性细胞因子失衡和神经元铁死亡可能是POCD发生的重要病因机制;电针能够改善POCD老年大鼠的学习记忆能力,其发挥脑保护作用机制可能与其调控全身和中枢炎性细胞因子水平以及神经元细胞铁死亡途径有关。

运动神经损伤早期脊髓Calpain-2的上调促进IL-6的异常表达

【目的】探讨L5前根切除损伤运动神经的慢性痛模型中早期脊髓内钙依赖性蛋白水解酶Calpain-2(CALP2)介导白细胞介素-6(IL-6)异常表达的病理生理。【方法】采用免疫荧光组织化学和蛋白免疫印迹法,观察L5-VRT后L5背根、脊髓内CALP2的表达改变以及术前预处理calpain抑制剂MDL28170对脊髓内L5-VRT诱导的IL-6异常表达的影响,同时观察单纯给予外源性CALP2(rat recombinant calpain-2,rr-CALP2)对正常大鼠脊髓内IL-6表达的影响。【结果】(1)L5-VRT诱导邻近L5背根以及脊髓背角和前角内钙依赖性蛋白酶CALP2表达升高;(2)通过术前预处理calpain抑制剂MDL28170(25 mg/kg)部分阻断L5-VRT诱导的双侧脊髓IL-6异常表达;(3)在正常大鼠单侧L5背根表面给予rr-CALP2可直接诱导双侧脊髓IL-6蛋白水平升高。【结论】运动神经损伤早期可能首先通过损伤处CALP2的激活,诱导脊髓IL-6异常表达,参与慢性痛的产生。

Management of lumbar zygapophysial (facet) joint pain

AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.

Radiographic, Pain, and Functional Outcomes in an Adult Post-Fusion Patient Using a Scoliosis Activity Suit: Comparative Results after 8 Months

There are few conservative treatment options for adult patients with idiopathic scoliosis who are status post-fusion surgery. These typically include pharmacologic pain management, epidural injections, and generalized CAM treatments such as massage and chiropractic manipulation in the non-fused areas of the spine. The purpose of this study was to compare the post-treatment results in an adult post-fusion patient who wore a scoliosis activity suit for 8 months. Pain was evaluated using a quadruple visual analog scale (QVAS), while function was measured using an SRS-22r questionnaire. After 8 months of wearing the scoliosis activity suit, her pain scores improved, here SRS-22r improved, and a significant correction in radiographic Cobb angle was observed. This case report is the first to document a Cobb angle change in an adult patient wearing a scoliosis activity suit who is status post-fusion. Given that pain and dysfunction are primary reasons for scoliosis treatment in the adult population, more studies need to address the disparity between available treatments for adult scoliosis and the incidence of adult scoliosis, especially in the post-meno-pausal population. Future prospective studies should consider evaluating treatment effects of this suit using intent-to-treat methodology.

PERIPHERAL MECHANISMS AND MODULATION IN INFLAMMATORY PAIN

Recently there have been several major advances in our understanding of pathophysiological mechanisms in primary afferent nociceptors that may contribute to enhanced nociception (hyperalgesia) in response to injury, in a variety of clinical states. These include contributions of specific second messenger signaling pathways and ionic conductances. Important roles for specific second messenger systems in acute primary

Painful intervertebral disc degeneration and inflammation:from laboratory evidence to clinical interventions

Low back pain(LBP),as a leading cause of disability,is a common musculoskeletal disorder that results in major social and economic burdens.Recent research has identified inflammation and related signaling pathways as important factors in the onset and progression of disc degeneration,a significant contributor to LBP.Inflammatory mediators also play an indispensable role in discogenic LBP.The suppression of LBP is a primary goal of clinical practice but has not received enough attention in disc research studies.Here,an overview of the advances in inflammation-related pain in disc degeneration is provided,with a discussion on the role of inflammation in IVD degeneration and pain induction.Puncture models,mechanical models,and spontaneous models as the main animal models to study painful disc degeneration are discussed,and the underlying signaling pathways are summarized.Furthermore,potential drug candidates,either under laboratory investigation or undergoing clinical trials,to suppress discogenic LBP by eliminating inflammation are explored.We hope to attract more research interest to address inflammation and pain in IDD and contribute to promoting more translational research.

Genetic and Demographic Outcomes in a Population of Patients with Headache and Facial Pain

Background: Pharmacogenetics information about cytochrome p450 (CYP450) polymorphism in patients with headaches is limitedly reported. Similarly, the genetic factors linking various headache types and vascular disorders are poorly described. We aimed to characterize the genetic profile of a cohort of headache and facial pain subjects. Methods: Medical records of consecutive headache subjects that underwent PersonaGeneTM testing were reviewed. PersonaGeneTM panel assessed CYP450, apolipoprotein E (ApoE), methylene tetrahydrofolate reductase (MTHFR), Factor II, Factor V Leiden and Vitamin K epoxide reductase complex subunit 1 (VKORC1). Demographic information, headache diagnosis and genetic profiling were analyzed and compared with data obtained from the general population. Results: Out of 130 headache patients, 91.3% were Caucasian and 70.8% had migraine. Compared to the general Caucasian population, our Caucasian headache patients were significantly different for CYP3A4/A5 and CYP2D6 (p < 0.001) and comparable regarding CYP2C9 and CYPC19. Whereas MTHFR genotype was similar, ApoE and Factor V Leiden were different in headache patients (p = 0.001). Less headache patients showed intermediate sensitivity to warfarin (p = 0.009) based on VQORC1 genotyping. No differences were noticed between migraine and other headache type diagnoses for all the genetic tests. Conclusion: Distinctive profiles for CYP450, ApoE, Factor V Leiden and VQORC1 were observed in our Caucasian headache cohort. These results may impact headache subjects’ pharmacological treatment options and vascular risk ascertainment.