A critical overview of the current myofascial pain literature – October 2020

With this edition, we welcome Dr. Orlando Mayoral from Toledo, Spain as a new contributor to this quarterly myofascial literature review. Dr. Mayoral has been studying myofascial pain since the early 1990-ies. He translated the Travell and Simons Trigger Point Manuals into Spanish (Simons et al., 2004), and contributed to many scientific studies, case reports, book chapters, and books (Mayoral del Moral and Salvat Salvat, 2017). In the current review, we included several trigger point (TrP) prevalence studies as well as the usual high volume of dry needling (DN) studies. But of particular interest are the basic research studies that increasingly support multiple aspects of the integrated TrP hypothesis.     

Factors related to the incorrect use of inhalers by asthma patients

OBJECTIVE:

To evaluate inhaler technique in outpatients with asthma and to determine associations between the correctness of that technique and the level of asthma control.

METHODS:

This was a cross-sectional study involving patients > 14 years of age with physician-diagnosed asthma. The patients were recruited from the Asthma Outpatient Clinic of the Hospital de Clínicas de Porto Alegre, in the city of Porto Alegre, Brazil. The patients completed two questionnaires (a general questionnaire and an asthma control questionnaire based on the 2011 Global Initiative for Asthma guidelines), demonstrated their inhaler technique, and performed pulmonary function tests. Incorrect inhaler technique was defined as the incorrect execution of at least two of the predefined steps.

RESULTS:

We included 268 patients. Of those, 81 (30.2%) showed incorrect inhaler technique, which was associated with poor asthma control (p = 0.002). Logistic regression analysis identified the following factors associated with incorrect inhaler technique: being widowed (OR = 5.01; 95% CI, 1.74-14.41; p = 0.003); using metered dose inhalers (OR = 1.58; 95% CI, 1.35-1.85; p < 0.001); having a monthly family income < 3 times the minimum wage (OR = 2.67; 95% CI, 1.35-1.85; p = 0.008), and having > 2 comorbidities (OR = 3.80; 95% CI, 1.03-14.02; p = 0.045).

CONCLUSIONS:

In the sample studied, incorrect inhaler technique was associated with poor asthma control. Widowhood, use of metered dose inhalers, low socioeconomic level, and the presence of > 2 comorbidities were associated with incorrect inhaler technique.     

雷火灸联合玻璃酸钠滴眼液治疗糖尿病干眼症患者疗效观察

目的观察雷火灸联合玻璃酸钠滴眼液治疗糖尿病干眼症的效果。方法选取2018年4月～2019年6月我院糖尿病科住院的88例糖尿病性干眼症患者,根据就诊日期单双号,单盲法分成观察组和对照组,对照组在常规护理基础上仅使用玻璃酸钠滴眼液干预,观察组在对照组基础上加用眼部雷火灸。两组均以10 d为一疗程,分别在干预前、干预后1个月对比两组标准干眼症状评估(SPEED)问卷评分及泪膜破裂时间(BUT)差异。结果观察组总有效率为81.82%,对照组为40.91%,观察组总有效率高于对照组,差异有统计学意义(χ~2=15.529,P0.001);两组标准干眼症状评估(SPEED)问卷评分比较,观察组改善率明显优于对照组(P0.05);两组泪膜破裂时间延长比较,观察组改善值(3.95±0.47)s,对照组改善(1.95±1.04)s,观察组疗效明显优于对照组(t=4.356,P=0.002)。结论使用雷火灸联合玻璃酸钠滴眼液治疗糖尿病干眼症状效果优于单用玻璃酸钠滴眼液治疗。     

手术源性干眼患者临床干预措施疗效研究

目的 探析手术源性干眼患者实施临床干预措施的临床疗效。方法 选取2018年1月～2020年1月在我院治疗的106例手术源性干眼患者为观察对象,按照随机原则分成对照组与干预组,每组53例。对照组患者予以常规治疗,干预组患者在对照组基础上予以玻璃酸钠滴眼液治疗与临床干预措施,分析比较两组患者临床疗效、治疗前后干眼症状评分、基础泪液分泌量、泪膜破裂时间。结果 在临床疗效上,干预组总有效率为96.23%,对照组总有效率为83.02%,差异有统计学意义(P0.05)。两组治疗后干眼症状评分均较治疗前降低,且干预组评分低于对照组,差异有统计学意义(P0.05)。干预组基础泪液分泌量、泪膜破裂时间均明显优于对照组,差异有统计学意义(P0.05)。结论 手术源性干眼患者应用玻璃酸钠滴眼液治疗与临床干预措施的效果更加确切,能够有效减轻患者干眼症状,增强患者泪膜稳定性,值得临床推广应用。     

生物电阻抗法评估血液透析患者干体质量的效果分析

目的比较生物电阻抗法(BIA)和传统方法评估血液透析患者干体质量(DW)的效果。方法选择2011年1月至2013年6月于万全县中医院进行透析治疗的76例尿毒症患者作为研究对象,分别用生物电阻抗分析法和传统方法评估患者的干体质量,同时收集患者的详细临床资料,根据性别、BMI状态及病因进行分组,判定DW评估结果,并进行统计学分析。结果两种DW评估方法判定结果显示,BIA评估结果显著低于传统方法评估结果[(56.3±1.7)kg vs(60.7±1.4)kg,P<0.05];BIA评估不同性别、不同体质量状态及透析根本原因时的DW与传统方法相比均显著降低(P<0.05);计算DW差异显示女性DW差异性大于男性,有统计学意义[(2.15±0.23)kg vs(0.89±0.17)kg,t=58.303,P<0.05];不同BMI状态组患者间DW差异相比无统计学意义(P>0.05);糖尿病组DW差异与非糖尿病组DW差异相比有统计学意义[(2.35±0.28)kg vs(1.36±0.17)kg,t=47.281,P<0.05]。结论 BIA法和传统方法评估血液透析患者DW结果存在差异,受患者基本特征影响,临床进行DW评估时需综合考虑患者各种因素,以求精确评估患者DW。     

Dry weight evaluation in hemodialysis patients

Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume（RBV） and other judgments. Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure: normal blood pressure group (A group, n=43）, hypotension group (B group, n=35) and hypertension group (C group, n=35). The level of hemoglobin, serum albumin, dialysis adequacy were determined. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, ultrafiltration volume, relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients. Each of the patients was continuously monitored of the indicators above for 10-12 times. At the observing period, the inferior vena cava diameter (IVCD), brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured. Then according to the monitoring results, appropriate clinical interventions were given under on-line blood volume monitoring guidance. Results (1)The shape of RBV curve in group A showed double-exponential curve early, then down to the final linear decling ended during hemodialysis. (2)The RBV curve in group B was stable in the former two hours, then rapidly linear declined. RBV changes were significantly higher in group B than group A (P＜0.05), but when changes in RBV were plotted against ultrafiltration volume, there was no significant difference in the two groups. The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P＜0.05, coefficient of variation=0.28). (3)The RBV curve in group C slowly linear declined. At the end of dialysis, RBV changes were significantly lower in group C than group A (P＜0.05). (4)The IVCD values in three groups of patients before dialysis were greater than normal, significantly decreased after the dialysis (P＜0.05), but that in group B and group C were still greater than that in group A (P＜0.05). The BNP values were significantly greater in three groups before and after dialysis (P＜0.05), but after dialysis, the values decreased significantly than that before dialysis (P＜0.05). (5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis, the patients of group B controlled weight gain, and even cut dry weight, the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P＜0.05); When the patients of group C cut dry weight, increased ultrafiltration, the RBV change increased, the mean arterial pressure decreased significantly than before (P＜0.05). Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes, which provides important information for forecasting the symptomatic hypotension in hemodialysis. (2)IVCD and CTR have certain significance to the adjustment of dry weight, but the BNP has guiding significance to volume change. (3)On-line monitoring of RBV can effectively guide the adjustment of dry weight, reduction of symptomatic hypotension occruence, and controlling of refractory hypertension in hemodialysis.     

Effectiveness of warm saline mouth bath in preventing alveolar osteitis: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the effectiveness of a warm saline mouth bath (WSMB) in preventing dry socket after tooth extractions.A systematic search for randomized controlled trials published until August 30, 2020, in seven databases was conducted: Cochrane, PubMed, Ovid Medline, Google Scholar, and OpenGrey databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry. The inclusion criteria were studies investigating the use of a warm saline mouth bath postoperatively in a population of participants who had a tooth extraction, compared to no mouth rinse at all/any other mouth rinse. The primary outcome assessed in the studies was the incidence of alveolar osteitis.Only eight randomized studies met all inclusion criteria and were selected for qualitative analysis. Six of the studies compared WSMB with antimicrobial rinses, and two studies compared WSMB with no-rinse. This review found no significant difference (P > 0.05) in the incidence of alveolar osteitis between WSMB and other antimicrobial rinses.Based on the results of this review, WSMB has potential in reducing post-operative complications such as alveolar osteitis following a routine or surgical extraction of teeth. However, more studies are needed to validate these findings, as most of the studies reviewed had a high level of bias.     

下腔静脉宽度及脑钠肽对稳定血液透析患者干体重的评估

目的 B型脑钠肽(BNP)及体表面积矫正后下腔静脉宽度(VCD)对稳定血液透析患者的干体重的评估.方法 检测58例维持性血液透析患者透析前后血浆BNP水平,同时应用彩色多普勒超声心动图测定透析前和透析后2 h的下腔静脉宽度,检测透析前、后心脏结构及功能变化,记录当次透析脱水量.透析前、透析后及健康对照组对上述指标进行比较.结果 58例稳定透析患者经透析脱水后血浆BNP水平(52.1±22.8)ng/L较透析前(156.5 ±18.2)ng/L显著下降,但仍较健康对照组(15.6 ±7.6)ng/L增高(P＜0.01).VCD值透析后(9.8 ±2.1)mm/m2较透析前(13.3 ±3.1)mm/m2显著下降但与健康对照组(9.1±1.1)mm/m2比较差异无统计学意义.应用超声影像学及临床指标,对透析后患者判断仍存在高血容量者8例,血浆BNP[(224.1±42.8)ng/L]及VCD[(12.8±2.1)mm/m2]显著增高,降低干体重后,BNP[(38.4±8.6)ng/L]及VCD[(9.7±1.4)mm/m2]值显著下降.结论 血浆BNP及VCD在一定程度上反映血液透析患者体内血容量的变化,是判断干体重有价值的参考指标.     

Preparation and characterisation of controlled release co-spray dried drug–polymer microparticles for inhalation 1: Influence of polymer concentration on physical and in vitro characteristics

A series of co-spray dried microparticles containing di-sodium cromoglycate (DSCG) and polyvinyl alcohol (PVA - 0%, 30%, 50%, 70% and 90% w/w, respectively), were prepared as potential controlled release (CR) viscous/gelling vehicles for drug delivery to the respiratory tract. The microparticles were characterised in terms of particle size, crystal structure, density, surface morphology, moisture sorption, surface energy and in vitro aerosolisation efficiency. The co-spray dried particles were amorphous in nature and had spherical geometry. High-resolution atomic force microscopy analysis of the surfaces of the DSCG/PVA suggested no significant differences in roughness between microparticles containing 30-90% w/w PVA (ANOVA, p<0.05), while no specific trend in either size or density was observed with respect to PVA concentration. In comparison, a linear decrease in the relative moisture sorption (R2=0.997) and concurrent increase in total surface free energy (R2=0.870) were observed as PVA concentration was increased. Furthermore a linear increase in the aerosolisation efficiency, measured by inertial impaction, was observed as PVA concentration was increased (R2=0.993). In addition, the increase in aerosolisation efficiency showed good correlation with equilibrium moisture content (R2=0.974) and surface energy measurement (R2=0.905). These relationships can be attributed to the complex interplay of particle forces at the contiguous interfaces in this particulate system.     

用日本血吸虫干卵建立体外肉芽肿反应模型

目的在体外建立一种与血吸虫感染宿主组织内病变相似的虫卵肉芽肿反应模型以便对该病变的形成机理作进一步研究。方法将日本血吸虫干卵悬液分别加于感染组、虫卵免疫组和正常对照组小鼠脾细胞培养物中，诱导这些脾细胞对虫卵的附着等反应，对影响反应强度的部分因素进行观察。结果感染组和免疫组的脾细胞反应均显著强于正常对照组者，感染组的反应较免疫组者更早出现且更显著。结论采用日本血吸虫干卵和感染鼠脾细胞在体外建立虫卵肉芽肿反应模型简便可行。