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1.
IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.  相似文献   
2.
Although methadone is effective in the management of acute pain, the complexity of its absorption-distribution-metabolism-excretion profile limits its use as an opioid of choice for perioperative analgesia. Because deuteration is known to improve the pharmacokinetic, pharmacodynamic and toxicological properties of some drugs, here we characterized the single dose pharmacokinetic properties and post-operative analgesic efficacy of d9-methadone.The pharmacokinetic profiles of d9-methadone and methadone administered intravenously to CD-1 male mice revealed that deuteration leads to a 5.7- and 4.4-fold increase in the area under the time-concentration curve and maximum concentration in plasma, respectively, as well as reduction in clearance (0.9 ± 0.3 L/h/kg vs 4.7 ± 0.8 L/h/kg). The lower brain-to-plasma ratio of d9-methadone compared to that of methadone (0.35 ± 0.12 vs 2.05 ± 0.62) suggested that deuteration decreases the transfer of the drug across the blood-brain barrier. The estimated LD50 value for a single intravenous dose of d9-methadone was 2.1-fold higher than that for methadone. Moreover, d9-methadone outperformed methadone in the efficacy against postoperative pain by primarily activating peripheral opioid receptors. Collectively, these data suggest that the replacement of three hydrogen atoms in three methyl groups of methadone altered its pharmacokinetic properties, improved safety, and enhanced its analgesic efficacy.  相似文献   
3.
《Drug discovery today》2022,27(3):808-821
Tyrosine kinases are enzymes that can transfer a phosphate group from ATP to a specific protein tyrosine, serine or threonine residue within a cell, operating as a switch that can turn ‘on’ and ‘off’ causing different physiological alterations in the body. Mutated kinases have been shown to display an equilibrium shift toward the activated state. Types I–III have been studied intensively leading to drugs like imatinib (type II), cobimetinib (type III), among others. It is the same scenario for types V–VII; however, there is a lacuna in information regarding type IV inhibitors, although recently some advances have surfaced. This review aims to accumulate the knowledge gained so far about type IV inhibitors.  相似文献   
4.
The COVID-19 pandemic caused by the SARS-CoV-2 virus has significantly disrupted and burdened the diagnostic workup and delivery of care, including transfusion, to cancer patients across the globe. Furthermore, cancer patients suffering from solid tumors or hematologic malignancies were more prone to the infection and had higher morbidity and mortality than the rest of the population. Major signaling pathways have been identified at the intersection of SARS-CoV-2 and cancer cells, often leading to tumor progression or alteration of the tumor response to therapy. The reactivation of oncogenic viruses has also been alluded to in the context and following COVID-19. Paradoxically, certain tumors responded better following the profound infection-induced immune modulation. Unveiling the mechanisms of the virus-tumor cell interactions will lead to a better understanding of the pathophysiology of both cancer progression and virus propagation. It would be challenging to monitor, through the different cancer registries, retrospectively, the response of patients who have been previously exposed to the virus in contrast to those who have not contracted the infection.  相似文献   
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6.
BackgroundFindings on the usefulness of massage therapy (MT) in postoperative pain management are often inconsistent among studies.ObjectivesThis study’s aim is to conduct a meta-analysis of randomized controlled trials (RCT) to clarify the effects of massage therapy in the treatment of postoperative pain.MethodsThree databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95 % confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I2. Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry.ResultsThe analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, −1.32; 95 % CI, −2.01 to −0.63; p = 0.0002; I2 = 98.67 %). A similar significant effect was found for both short (immediate assessment) and long terms (assessment performed 4–6 weeks after the MT). Remarkably, we found neither the duration per session nor the dose had an impact on the effect of MT and there seemed to be no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery.LimitationsPublication bias is possible due to the inclusion of studies in English only. Additionally, the included studies were extremely heterogeneous. Double-blind research on MT is difficult to implement, and none of the included studies is double-blind. There was some heterogeneity and publication bias in the included studies. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias.ConclusionsMT is effective in reducing postoperative pain in both short and long terms.  相似文献   
7.
廖文佳  何懿  孙尔维  李漓 《护理学报》2022,29(21):61-66
目的 比较3种神经病理性疼痛筛查量表在中轴型脊柱关节炎患者中的信度、效度和适用性。方法 采用painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表对186例中轴型脊柱关节炎患者进行调查,评价量表的信度和效度。结果 painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表的Cronbach α系数分别为0.807,0.697和0.623, Guttman分半系数分别为0.846、0.691和0.701。painDETECT问卷共提取2个公因子,累计方差贡献率55.171%。神经病理性疼痛4问卷共提取4个公因子,累计方差贡献率66.627%。利兹神经病理性症状和体征评估疼痛量表共提取2个公因子,累计方差贡献率50.836%。3种量表评估结果一致性Kappa值和相关性r值均大于0.500。患者对3种量表首选率分别为71.5%、3.2%和14.0%。结论 painDETECT问卷信度和效度良好,首选率最高。其余2种量表信度尚可,效度良好。3种量表一致性与相关性较强。  相似文献   
8.
目的:比较高聚焦超声睫状体成形术(UCP)和睫状体冷冻术治疗难治性青光眼的疗效。方法:回顾性研究。收集2017-01/2020-12本院收治的难治性青光眼患者45例81眼,依据患者治疗方法不同分为睫状体冷冻术组22例40眼,高聚焦超声睫状体成形术组23例41眼。观察两组患者术前,术后1d,1wk,1、3mo眼压变化情况,采用疼痛数字等级评定量表(NRS)评估眼球疼痛程度,比较两组患者手术效果和并发症发生情况。结果:高聚焦超声睫状体成形术组手术总有效率明显高于睫状体冷冻术组(P<0.05),两组患者术后1d,1wk,1、3mo眼压和眼球疼痛程度均低于术前(均P<0.05),两组间患者术后各时间点眼压和眼球疼痛程度比较均有差异(均P<0.05)。高聚焦超声睫状体成形术组患者结膜充血、角膜水肿、前房炎性渗出、反应性高眼压和前房积血并发症发生率低于睫状体冷冻术组(P<0.05)。结论:高聚焦超声睫状体成形术治疗难治性青光眼疗效明确,在降低患者眼压、减少眼球疼痛和并发症发生方面较睫状体冷冻术有明显优势。  相似文献   
9.
[目的]观察电针对完全弗氏佐剂(complete Freund‘s adjuvant,CFA)诱导的慢性炎性痛模型大鼠机械痛阈(paw withdrawal threshold,PWTs)、焦虑行为,以及双侧海马角1(Cornu Ammonis 1,CA1)、海马角3(Cornu Ammonis 3,CA3)、齿状回(Dentate Gyrus,DG)中神经肽Y(neuropeptide Y,NPY)、小清蛋白(parvalbumin,PV)、生长抑制素(somatostatin,SOM)、谷氨酸脱羧酶65/67(glutamic acid decarboxylase 65/67,GAD65/67)及原癌基因蛋白(cellular protooncogene Fos,c-Fos)表达的影响,探讨其可能机制。 [方法] 将32只健康雄性SD大鼠随机分为空白对照组、模型对照组、电针治疗组和假电针治疗组,每组8只,并对空白对照组以外的其他3组足底注射CFA,建立大鼠慢性炎性痛模型。于造模后26 d分别对电针治疗组和假电针治疗组进行电针和假电针干预,并观察各组大鼠的PWTs及高架O迷宫(elevated zero maze,EZM)中的焦虑行为。用免疫荧光法检测CA1、CA3和DG区NPY、PV、SOM、GAD65/67及c-Fos的阳性细胞表达。[结果] 造模后1 d,模型对照组、电针治疗组和假电针治疗组的PWTs显著降低,并在整个实验过程中显著低于空白对照组(P<0.01);在电针治疗第3天,电针治疗组大鼠的PWTs相较模型对照组和假电针治疗组显著升高(P<0.01)。在EZM中,与空白对照组比较,模型对照组大鼠的开放臂运动距离、开放臂停留时间和开放臂进入次数显著减低(P<0.01),电针干预后可改善上述指标,而假电针无作用(P>0.05)。与空白对照组比较,模型对照组双侧CA1、CA3、DG区NPY阳性细胞表达增多(P<0.01,P<0.01,P<0.05),c-Fos阳性细胞表达减少(P<0.01,P<0.05,P<0.01);电针干预后,电针治疗组大鼠双侧CA1、DG区、患侧CA3区NPY阳性细胞表达较模型对照组减少(P<0.01),假电针无此作用(P>0.05)。双侧CA1、CA3和DG区,四组大鼠PV、SOM以及双侧CA1、CA3区GAD65/67阳性细胞表达或阳性面积差异均无统计学意义(P>0.05)。 [结论] 电针干预能改善CFA大鼠的疼痛及其相关焦虑行为,该作用可能与增加大鼠海马CA1、CA3和DG区NPY的阳性细胞表达有关。  相似文献   
10.
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