Placebo Analgesia: Clinical considerations

Pain is the predominant symptom that prompts patients to seek medical advice and treatment from physiotherapists. Various treatment modalities such as heat and cold, electrical stimulation (Cheing and Hui-Chan, 1999), ultrasound, manipulative techniques, massage and laser treatment have been demonstrated in varying degrees to be clinically effective for managing pain of different pathologies. However, all these treatments could be assumed to have some placebo elements (French, 1994).

From a research design perspective, the presence of placebo response is undesirable and must be controlled as it complicates the demonstration of ‘real' treatment effect. From a clinical perspective, it is intriguing to note that the condition of patients in the placebo control groups did improve considerably in many of these validation studies, although in the majority the improvement was not so marked as in the treatment groups. Conspicuously, some neuro-physiological and psychological aspects of the placebo effects may have clinical use in enhancing the effect of pain treatments and their outcomes.

Unfortunately, although placebo response has been a subject of continuing interest among some physiotherapy researchers and clinicians, information about placebo analgesia and its clinical utility is seldom discussed. The purpose of this paper is to provide clinicians with an overview of the construct and research related to placebo analgesia as well as a discussion of the potential clinical use of certain components of placebo analgesia to enhance pain rehabilitation outcomes in physiotherapy practice.     

Prostate cancer detection upon transrectal ultrasound-guided biopsy in relation to digital rectal examination and prostate-specific antigen level: what to expect in the Chinese population?

We investigated the prostate cancer detection rates upon transrectal ultrasound (TRUS)-guided biopsy in relation to digital rectal examination (DRE) and prostate-specific antigen (PSA), and risk factors of prostate cancer detection in the Chinese population. Data from all consecutive Chinese men who underwent first TRUS-guided prostate biopsy from year 2000 to 2013 was retrieved from our database. The prostate cancer detection rates with reference to DRE finding and PSA level of < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ were investigated. Multivariate logistic regression analyses were performed to investigate for potential risk factors of prostate cancer detection. A total of 2606 Chinese men were included. In patients with normal DRE, the cancer detection rates were 8.6%, 13.4%, 21.8%, 41.7% and 85.2% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ respectively. In patients with abnormal DRE, the cancer detection rates were 12.4%, 30.2%, 52.7%, 80.6% and 96.4% in patients with PSA < 4, 4–10, 10.1–20, 20.1–50 and > 50 ng ml⁻¹ respectively. Older age, smaller prostate volume, larger number of biopsy cores, presence of abnormal DRE finding and higher PSA level were associated with increased risk of prostate cancer detection upon multivariate logistic regression analyses (P < 0.001). Chinese men appeared to have lower prostate cancer detection rates when compared to the Western population. Taking the different risk factors into account, an individualized approach to the decision of TRUS-guided biopsy can be adopted.     

Mental Well‐Being Mediates the Relationship between Perceived Stress and Perceived Health

The association between stress and health has been well researched in the past; however, comparatively few mediators have been tested to understand the underlying mechanism. With increasing awareness on mental well‐being, this study evaluated the relationship between perceived stress and perceived health and examined mental well‐being as a mediator. Two‐hundred undergraduates aged 21 to 26 years completed the English Perceived Stress Scale, Health Status Questionnaire and Asian Mental Well‐Being Scale that assess perceived stress, perceived health and mental well‐being, respectively. Factor analysis and structural equation modelling on the Perceived Stress Scale replicated the reported two‐factor structure after excluding an insignificant item. Linear multiple regression analyses indicated that perceived stress was negatively associated with perceived health. Results showed that mental well‐being partially mediated the relationship between perceived stress and perceived health, although it is acknowledged that this association could be bidirectional. Findings from the present study suggest that future research could focus on reducing stress and improving mental well‐being to alleviate the effect of stress on health. Copyright © 2013 John Wiley & Sons, Ltd.     

研究生一年级学生运动等级与其健康状况的相关性

目的:调查研究生一年级学生的体育锻炼和健康状况,并分析其相关性。方法:调查于2005-09/10完成。选取西南大学和重庆大学2005级研究生一年级学生作为调查对象,共发放问卷190份,男90份,女100份。进行问卷调查,当场收回问卷。问卷内容:①自测健康评定量表:由48个条目构成,1～17为自测生理健康评定子量表(170～0分),19～34为自测心理健康子量表(150～0分),35～47为自测社会健康子量表(120～0分),分数越高代表越健康。②体育活动等级量表:主要调查调查对象上1个月参加体育锻炼的运动量,运动量=强度×时间×频率,强度与频率从1～5等级分别计1～5分,时间从1～5等级分别计0～4分,故运动量最高分为100分,最低分为0分。结果:有效回收176份问卷进入结果分析。①不同性别调查对象在运动等级上的分布情况:研究生一年级男女新生的运动量水平都偏低(男生:31.80±23.19,女生:15.57±15.39),且性别对运动量有显著的主效应(P<0.01),女生在运动量上的得分显著偏低。②调查对象健康状况各维度与运动量的相关性:运动量与总体健康、生理健康、心理健康和社会健康都存在显著相关性(r=0.150～0.238,P<0.05～0.01),生理健康对运动量有显著的预测作用(P<0.05)。③不同运动量等级调查对象的健康量表得分:运动等级对生理健康有显著的主效应(P<0.01),随着运动量的增加,研究生一年级学生的生理健康水平不断提高。结论:研究生一年级学生的体育锻炼运动量与健康水平存在着明显的正相关,随着运动量的增加,生理健康、心理健康及社会健康水平均不断增加。     

Structuring a safer donor-replacement program

BACKGROUND: Replacement donors are more likely than volunteer donors to have positive or abnormal tests for transfusion-transmissible disease. In an effort to increase the donor pool, workers sought to identify a safer replacement-donor subgroup that may be acceptable for routine donations. STUDY DESIGN AND METHODS: In a retrospective review and cohort study, the replacement-donor effect was separated from the new- donor effect. The relative effect the replacement donor has on the risk of transfusion-transmissible diseases, donor retention, and frequency of returning donations was then quantified by comparison against the effect of repeat volunteer donors. RESULTS: The replacement donor had 3.1 times the risk and 0.72 times the donor retention rate and made 0.81 times as many returning donations as the repeat volunteer donor. The figures for the new-donor effect were similar. The two risks were additive, making a new replacement donor particularly hazardous. If replacement donations only from repeat replacement donors were considered, the donor risk and the number of donations per returning donor were made comparable to those for the general (combined) volunteer donor. CONCLUSION: The negative effect of the replacement donor is similar in magnitude to that of the new volunteer donor. A replacement-donation program targeting repeat replacement donors has an acceptable risk profile and may be a valuable adjunct to the collection of blood from general volunteer donors.     

The Role of Serotonin (5-HT) in Behavioral Control: Findings from Animal Research and Clinical Implications

The neurotransmitters serotonin and dopamine both have a critical role in the underlying neurobiology of different behaviors. With focus on the interplay between dopamine and serotonin, it has been proposed that dopamine biases behavior towards habitual responding, and with serotonin offsetting this phenomenon and directing the balance toward more flexible, goal-directed responding. The present focus paper stands in close relationship to the publication by Worbe et al. (2015), which deals with the effects of acute tryptophan depletion, a neurodietary physiological method to decrease central nervous serotonin synthesis in humans for a short period of time, on the balance between hypothetical goal-directed and habitual systems. In that research, acute tryptophan depletion challenge administration and a following short-term reduction in central nervous serotonin synthesis were associated with a shift of behavioral performance towards habitual responding, providing further evidence that central nervous serotonin function modulates the balance between goal-directed and stimulus-response habitual systems of behavioral control. In the present focus paper, we discuss the findings by Worbe and colleagues in light of animal experiments as well as clinical implications and discuss potential future avenues for related research.     

Moderate and severe reactions in blood donors

During the period April 1985 to March 1986, 217 blood donors were found to have moderate (syncopal) to severe (convulsive) reactions. This population was compared to 5630 randomly selected donors who did not have reactions. An examination of demographic, physical, and societal/emotional factors was conducted to determine if any were predictive of reactions in donors. The results of the research supported the hypothesis that first-time donors have a higher frequency of reactions (1.7%) than do repeat donors (0.19%). A review of the above predictive factors documented that, with regard to demographic factors, 1) the number of prior donations was inversely proportional to the risk of reaction; 2) the gender of the donor was not predictive; and 3) youth was a predictor of reactions. An analysis of the physical factors revealed that donors who reacted were of lower weight (mean, 153.7 lb) than those who did not (mean, 166.4 lb) and that systolic blood pressure was slightly lower in the group with reactions. Although the difference was significant (3 torr), it was not thought to be significant clinically. In a comparison of a group with systolic blood pressure ranging from 80 to 100 torr and a group with systolic blood pressure ranging from 120 to 140 torr, the first group had a 70-percent higher risk of reaction. Finally, with regard to the last category of societal or emotional factors, the research demonstrates 1) that the ingestion of caffeinated beverages was associated with a reduced risk of reactions; 2) that the food intake of donors who reacred was significantly different from that of those who had no reaction, but this difference was not thought to be clinically significant; and 3) that the duration between registration and the onset of phlebotomy was directly predictive of reaction status. The research indicates that first-time donor status and several specific demographic, physical, and societal or emotional factors are predictors of donor reactions.     

冻存复苏条件对髓性白血病细胞株生物学特性的影响

目的:采用不同方法对白血病HL60细胞株进行冻存和复苏,观察生物学特性改变,筛选最佳冻存复苏方案。方法:实验于2006-04/06在吉林医药学院临床检验实验室(国家三级标准)进行。①HL60细胞株由中国科学院上海生物细胞研究所提供。将欲冷冻保存的HL60细胞调整到良好的生长状态(对数生长期),随机数字表法分成4组,离心收集后在含体积分数为0.1小牛血清的RPMI-1640培养基中分别加入二甲基亚砜,使其终浓度依次为50,100,150,200g/L。冻存15d后,每组取1支冻存管复苏并接种于细胞培养板,培养12h后用锥虫蓝拒染法计算细胞复苏率。②选择冻存条件和冻存细胞密度相同的两支冻存管,按不同方法进行HL60细胞复苏。37℃水浴传统复苏法:立即将冻存管置于37℃水浴中,待融化后800r/min离心5min,吸去上清液,加入含体积分数为0.1小牛血清的RPMI-1640培养基,混匀后接种于细胞培养板,1mL/孔,9孔/组,置于体积分数为0.05的CO2培养箱37℃继续培养。40℃溶解后再37℃恒温改良复苏法:将冻存细胞于40℃水浴中迅速溶解,转入37℃水浴箱,融化后离心、加培养基等操作同传统复苏法。复苏细胞培养12h后采用锥虫蓝染色计算细胞存活率。③用无血清RPMI-1640培养基制备HL60细胞悬液,按3×107L-1密度接种于细胞培养板中,1mL/孔,然后分别加入体积分数为0.05,0.1,0.12,0.15,0.2的灭活小牛血清,每种血清浓度设置8个试验孔,并分别于培养12,24,36,48,60,72,84,96h后计数每孔细胞数量,并绘制细胞生长曲线。结果:①不同浓度二甲基亚砜冻存后HL60细胞复苏率的比较:二甲基亚砜200g/L组的细胞复苏率明显低于二甲基亚砜50,100,150g/L组[(64.6±2.8)%,(87.0±1.4)%,(86.4±2.1)%,(85.7±2.8)%;t=25.44,P<0.01],二甲基亚砜50,100,150g/L组间差异无显著性意义(t=0.82～1.44,P>0.05)。②不同复苏方法HL60细胞存活率的比较:与37℃水浴传统复苏法比较,40℃溶解后再37℃恒温改良复苏法的细胞存活率显著升高[(69.5±1.5)%,(87.4±1.8)%,t=23.24,P<0.01]。③RPMI-1640培养基不同血清含量对HL60细胞生长情况的影响:在体积分数为0.05的血清含量培养基中,HL60细胞基本不生长,且有逐渐死亡的趋势;在体积分数为0.1的血清含量培养基中,HL60细胞生长趋势明显,但生长速度相对较慢;在体积分数为0.12,0.15,0.2的血清含量培养基中,HL60细胞生长迅速,3种血清浓度间细胞生长趋势无明显差异。结论:以50g/L二甲基亚砜作为HL60细胞冻存保护剂、联合40℃溶解后再37℃恒温改良复苏法可使细胞保持最佳生物学特性,体积分数为0.12的血清含量为HL60细胞常规培养的最适浓度。     

壳聚糖的纳米化及其生物学效应

目的:综合分析壳聚糖纳米微粒的制备方法、研究进展及其生物学效应资料来源:应用计算机检索PUBMED 1998-01/2006-12有关壳聚糖纳米化方面的文献,检索词“Chitosan;nanoparticles”,同时计算机检索超星数字图书库2000-01/2006-12期间的相关文献,检索词为“壳聚糖”。资料选择:对资料进行初审,并查看每篇文献后的引文。选择针对性强的文章。同一领域的选择近期或权威杂志的文章。资料提炼:共收集到259篇相关文献,其中34篇符合纳入标准,排除25篇。符合纳入标准的34篇文献中,26篇涉及壳聚糖纳米粒的制备,8篇涉及纳米化后产生的生物学效应。资料综合:壳聚糖作为一类带正电的多糖,其性质不活泼,不与体液和体内组织产生免疫反应,并具有很好的生物相容性和生物可降解性。目前壳聚糖纳米化主要采用离子交联法、沉淀法、共价交联法、乳化溶剂扩散挥发法、自组装法等方法。纳米化后具有增加药物的吸收作用、增加药物的靶向性和降低药物副作用、增强药物的缓释作用及提高药物稳定性的生物学效应。结论:壳聚糖纳米粒的研究已成为当前生物医学领域的热点。纳米化后的壳聚糖在缓控释给药系统中具有广阔的应用前途,但其溶解性能有待于进一步提高。     

N-乙酰半胱氨酸对脑死亡状态巴马小型猪肾脏结构、功能与核转录因子κB表达的影响

目的：观察核转录因子κB活性抑制剂N-乙酰半胱氨酸对脑死亡状态下巴马小型猪肾脏结构、功能与核转录因子κB mRNA其蛋白表达的影响，以期提高脑死亡供肾的肾移植效果。方法：实验于2003—08／2004—12在河南省实验动物中心及河南省病理学重点实验室完成。①实验分组及方法：将15只巴马小型猪按随机数字表法分为3组（n=5），即脑死亡组、N-乙酰半胱氨酸组及对照组。脑死亡组和N-乙酰半胱氨酸组均应用改进的缓慢间断颅内加压法建立脑死亡模型，脑死亡组不行药物干预；N-乙酰半胱氨酸组分别于初次确认脑死亡后1h，12h给予N-乙酰半胱氨酸。对照组动物麻醉后仅行开颅与开关腹手术。②实验评估：分别于首次判定脑死亡后3，6，12，18和24h检测动物血清中尿素氮、肌酐、白细胞介素1β、白细胞介素6、肿瘤坏死因子α水平。于脑死亡后3，6，12及24h开腹取相同部位肾组织，苏木精-伊红染色后观察肾组织结构变化，应用免疫组化染色观察核转录因子κB蛋白的表达水平，应用反转录-聚合酶链反应法检测核转录因子κB mRNA动态变化。结果：15只猪均进入结果分析。①自首次判定脑死亡后12h开始，脑死亡组和N-乙酰半胱氨酸组尿素氮和肌酐水平逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。②自首次判定脑死亡3h开始，脑死亡组及N-乙酰半胱氨酸组白细胞介素1β、白细胞介素6、肿瘤坏死因子α逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。③自脑死亡后3h开始，脑死亡组及N-乙酰半胱氨酸组肾组织NF-κB mRNA其蛋白表达水平逐渐升高（P〈0．05），相同时间点比较N-乙酰半胱氨酸组显著低于脑死亡组（P〈0．05）。④N-乙酰半胱氨酸组和脑死亡组动物脑死亡后12h可见肾脏结构变化，N-乙酰半胱氨酸组变化程度明显轻于脑死亡组。结论：N-乙酰半胱氨酸可能通过抑制核转录因子κB mRNA其蛋白的表达，减少炎症介质的释放，从而保护脑死亡状态下肾脏的功能及结构，提高脑死亡供肾肾移植效果。