Neuroimaging the pain network – Implications for treatment

In this chapter, we provide an overview of neuroimaging studies in chronic pain. We start with an introduction about the phenomenology of pain. In the following section, the application of functional and structural imaging techniques is shown in selected chronic pain syndromes (chronic back pain, fibromyalgia syndrome (FMS), phantom limb pain, and complex regional pain syndrome (CRPS)), and commonalities and peculiarities of imaging correlates across different types of chronic pain are discussed. We conclude this chapter with implications for treatments, with focus on behavioral interventions, sensory and motor trainings, and mirror and motor imagery trainings.     

Is stenting for atherosclerotic renal stenosis an effective technique?

IntroductionOne of the treatments for renal artery stenosis is endovascular intervention, but its effectiveness is controversial. The present study aims to analyze the experience of a working group in the endovascular treatment of selected patients with severe obstructive atherosclerotic lesions of the renal arteries, and to characterize early and late results.MethodsThis is a retrospective study of symptomatic patients with atherosclerotic renal artery stenosis who underwent endoluminal therapy between May 12, 1999 and March 12, 2015 at two institutions. Statistical analysis was performed using the PASW Statistics program.ResultsA total of 99 patients were treated, mean age 66 years and 76.8% male. The mean degree of stenosis measured by renal Doppler echocardiography was 83% and 64.6% were ostial lesions. Mean preoperative creatinine level was higher than the postoperative mean: 1.3 vs. 1.2 mg/dl (p=0.014). The number of antihypertensive drugs in the preoperative period was higher than in the postoperative period: 2.0 vs. 1.3 (p=0.001). The mean follow-up was 40 months (0-164). The mean peak systolic velocity over time in the postoperative period was 77 cm/s (40-250). The restenosis rate was 8%, and 30-day mortality was 0%.ConclusionsThe results demonstrated that the endovascular technique has a beneficial effect on blood pressure and renal function in selected patients, and is a safe technique associated with a high rate of technical success and few complications.     

疏血通对慢性阻塞性肺疾病合并肺动脉高压患者血清D-二聚体与呼吸功能的影响

【摘要】 目的 观察疏血通注射液对慢性阻塞性肺疾病（COPD）合并肺动脉高压患者血清D 二聚体（D D）的影响及呼吸功能改善作用。方法 将我院收治的80例COPD合并肺动脉高压患者随机分为观察组与对照组各40例，均给予吸氧、支气管舒张剂、糖皮质激素、抗生素、营养支持等常规治疗，观察组在此基础上给予疏血通注射液，两组均治疗21d。比较两组凝血功能，检测血气指标、肺动脉压、肺功能指标，评估呼吸系统评分，统计治疗过程中的不良反应。结果 观察组治疗21d后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）显著高于对照组（P＜005），纤维蛋白原（FIB）、D D显著低于对照组（P＜005）。观察组治疗21d后动脉血氧分压（Pa02）、用力呼气1s率（FEV1/FVC）分别为（7124±1284）mmHg、（5784±1043）%显著高于对照组的（6536±1177）mmHg、（5241±945）%（P＜005），动脉血二氧化碳分压（PaC02）、肺动脉收缩压分别为（4541±819）mmHg、（4016±720）mmHg显著低于对照组的（5002±901）mmHg、（4473±806）mmHg（P＜005）。结论 疏血通可以改善COPD合并肺动脉高压患者血液高凝状态，增加血氧含量，降低肺动脉高压，改善呼吸功能。     

从脾论治慢性肾脏病的生物学基础探讨

脾为后天之源,肾为先天之本,以后天滋先天,使从脾论治成为中医临床治疗慢性肾脏病(CKD)的经典方法。现代医学研究发现人体内最庞大的“器官”——肠道菌群与“脾”的功能非常密切。目前研究发现肠道菌群紊乱是加速CKD进展的重要环节,基于脾肾互根互用的中医原理,收集、整理肠道菌群与CKD代谢功能、免疫应答及肾脏损伤关联的文献,从肠道菌群与机体功能代谢和内环境稳态的角度进行探讨,认识到运用中医药可通过干预肠道菌群的丰度、结构和代谢功能,维持肠道微生态的平衡,从而达到调节肾脏代谢和免疫应答的作用,提出肠道菌群是从脾论治慢性肾脏病的重要生物学基础。     

辛开苦降法治疗慢性肾小球肾炎初探

辛开苦降法为中医临床常用治法。本文通过探析辛开苦降法的源流和内涵,总结辛开苦降法在慢性肾小球肾炎治疗中的临床应用。辛开苦降法以苦辛之药配伍应用,具有燮理阴阳、平调寒热、调运气机、清利湿热、清化瘀热之功。慢性肾小球肾炎以本虚标实、虚实夹杂为病机特点,以机体阴阳失衡、肺脾肾三脏亏虚为本,以气机不调与湿热、瘀血阻滞为标。辛开苦降法可调补肺脾肾三脏之虚平燮阴阳,又可调运气机以清湿热、化瘀热,颇合慢性肾小球肾炎的病机特点。辛开苦降法在慢性肾脏病中的应用,为慢性肾小球肾炎的临床治疗提供了新的思路与方法,最后附典型病案1则加以说明。     

Cancer Drug Dosing in Chronic Kidney Disease and Dialysis

1. Download : Download high-res image (399KB)
2. Download : Download full-size image

     

基于健康信念模式的护理干预在慢性牙周炎患者种植修复治疗中的应用

目的探讨基于健康信念模式(HBM)的护理干预在慢性牙周炎患者种植修复治疗中的应用效果。方法选取2018年6月至2019年5月我院行种植修复治疗的慢性牙周炎患者72例,随机平均分为两组。对照组采用常规护理及健康教育,观察组在此基础上行基于HBM的护理干预,比较两组的牙科焦虑、畏惧程度,种植体周围PLI、 SBI、 PD。结果干预后,观察组的DAS、 DFS评分低于对照组(P <0.05);干预后6个月,观察组种植体周围PLI、 SBI及PD均优于对照组(P <0.05)。结论基于HBM的护理干预能降低慢性牙周炎患者种植修复的焦虑和畏惧水平,显著改善临床疗效,促进种植体周围健康,值得临床推广。     

Disability,kinesiophobia, perceived stress,and pain are not associated with trunk muscle strength or aerobic capacity in chronic nonspecific low back pain

ObjectivesTo investigate to which extent disability, psychological and pain-related factors are associated with the outcomes of an isometric trunk muscle strength test and a cardiopulmonary exercise test in persons with chronic nonspecific low back pain (CNSLBP).DesignCross-sectional study.SettingREVAL Rehabilitation Research Center (Hasselt, Belgium).ParticipantsPersons with CNSLBP.Main outcome measuresQuestionnaires concerning disability, patient specific functioning, kinesiophobia, perceived stress, pain intensity, and central sensitization were recorded. Outcomes of an isometric trunk strength test (maximum back and abdominal torque) and cardiopulmonary exercise test (VO₂max) were assessed. Multivariate linear regression models determined factors explaining outcome variance.ResultsData of 101 persons (39 males, mean age: 44.2y (SD = 9.6)) was assessed. Neither disability, nor psychological, nor pain-related factors were associated with the assessments. Variance in back muscle strength (R² = 0.44, F = p < 0.01), abdominal muscle strength (R² = 0.68, F = p < 0.01), and aerobic capacity (R² = 0.76, F = p < 0.01) could only be explained through the included demographics covariates (age, gender, weight).ConclusionThis study highlighted the lack of biopsychosocial factors in explaining variance in outcomes of abdominal and back strength, and aerobic capacity in persons with CNSLBP with characteristics as depicted in the current sample. This information supports the valid interpretation of the outcomes of these assessments.     

Autoimmune disease in CMML-the chicken or the egg?

Chronic myelomonocytic leukemia (CMML) is a clonal disorder that is associated with a wide range of systemic inflammatory and autoimmune diseases (SIADs). Approximately 20% of patients with CMML will have an associated SIAD and recognizing this association is critical to the evaluation, prognostication and management of patients with CMML. In this paper, we review the evidence supporting a causative link between these two entities as well as the direction of this relationship. We argue that the data favors CMML as the antecedent and causative disease state with a few notable exceptions. Better understanding of this relationship aids clinicians in the education of their patients and in determining the optimal management approach at the bedside. It is important to recognize opportunities to harmonize the treatments of these disease processes, which may enhance the effectiveness of treatment while reducing the burden of adverse effects from redundant therapies.