Effects of Pilates Exercise Programs in People With Chronic Low Back Pain: A Systematic Review

The Pilates method has recently become a fast-growing popular way of exercise recommended for healthy individuals and those engaged in rehabilitation. Several published studies have examined the effects of Pilates method in people with chronic low back pain (LBP).The objective of this study is to describe and provide an extensive overview of the scientific literature comparing the effectiveness of the Pilates method on pain and disability in patients with chronic nonspecific LBP. The study is based on the data from the following sources: MEDLINE-NLM, MEDLINE-EBSCO, Scopus Elsevier, Cochrane, DOAJ, SciELO, and PLOSONE.Original articles and systematic reviews of adults with chronic nonspecific LBP that evaluated pain and/or disability were included in this study; studies in which the primary treatment was based on Pilates method exercises compared with no treatment, minimal intervention, other types of intervention, or other types of exercises.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. The literature search included 7 electronic databases and the reference list of relevant systematic reviews and original articles to July 2014. Two independent investigators conducted the literature search and performed the synthesis as follows: Study Design; Sample (n); Disability measure; Intervention; and Main results.The searches identified a total of 128 articles. From these, 29 were considered eligible and were included in the analysis. The items were stratified as follows: Pilates method versus other kind of exercises (n = 6 trials) and Pilates method versus no treatment group or minimal intervention for short-term pain (n = 9 trials); the therapeutic effect of the Pilates method in randomized cohorts (n = 5); and analysis of reviews (n = 9).We found that there is a dearth of studies that clearly demonstrates the efficacy of a specific Pilates exercise program over another in the treatment of chronic pain. However, the consensus in the field suggests that Pilates method is more effective than minimal physical exercise intervention in reducing pain. These conclusions need to be supported by other proper investigations.     

Smartphone apps for the self-management of low back pain: A systematic review

Guidelines for low back pain (LBP) often recommend the use of self-management such as unsupervised exercise, booklets, and online education. Another potentially useful way for patients to self-manage LBP is by using smartphone applications (apps). However, to date, there has been no rigorous evaluation of LBP apps and no guidance for consumers on how to select high-quality, evidence-based apps. This chapter reviews smartphone apps for the self-management of LBP and evaluates their content quality and whether they recommend evidence-based interventions.This chapter shows that generally app developers are selecting interventions that are endorsed by guidelines, although their quality is low. There are many apps available for the self-management of LBP, but their effectiveness in improving patient outcomes has not been rigorously assessed. App developers need to work closely with healthcare professionals, researchers, and patients to ensure app content is accurate, evidence based, and engaging.     

The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain: A protocol for systematic review and/or meta-analysis

Background:Low back pain (LBP) is a common symptom that affects almost 80% of the global population. LBP manifests as diverse pathologies and has different causes. The focus of this paper is nonspecific chronic low back pain (NSCLBP) wherein the pain lasts for more than 12 weeks, and for which there is no definite cause. Although there are various treatment options for NSCLBP, including medication and exercise, each option has its own limitations. Although electroacupuncture (EA) has been known to have useful analgesic effects on chronic LBP, there is no systematic review (SR) on EA in the literature. Therefore, this study aims to systematically review and validate the effectiveness and safety of EA for NSCLBP.Methods:We will search for randomized controlled trials on the use of EA for NSCLBP in multiple electronic databases, manual searches, and contacting authors. We will screen and select studies according to the predefined criteria and extract the data needed for this SR. The primary outcome will be the pain index (Visual Analog Scale and Numeric Rating Scale), and the secondary outcomes will be the functional status (Roland-Morris Disability Questionnaire), patient-centered outcomes, and adverse events. We will perform a meta-analysis using Review Manager software (Version 5.3; Copenhagen; The Nordic Cochrane Center, The Cochrane Collaboration, 2014) and assess the risk of bias using Cochrane Collaboration “risk of bias” tools and the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation.Results:Our SR will investigate the effectiveness and safety of EA on NSCLBP.Conclusion:Our SR will support the published clinical evidence of the usage of EA for NSCLBP to assess the effectiveness and safety of EA.Trial registration number:INPLASY; INPLASY2020120039     

Complementary and alternative therapies for low back pain

The support for the principles of evidence-based medicine has increased within the field of complementary and alternative medicine (CAM). The objective of this chapter is to determine the effectiveness of CAM therapies compared to placebo, no intervention, or other interventions for acute/subacute and chronic non-specific low back pain (LBP). Results from Cochrane reviews on acupuncture, botanical medicine, massage, neuroreflexotherapy, and spinal manipulation have been used. The results showed that acupuncture is more effective than no treatment or sham treatment for chronic LBP but that there are no differences in effectiveness compared with other conventional therapies. Specific botanical medicines can be effective for acute episodes of chronic non-specific LBP in terms of short-term improvement in pain and functional status; long-term efficacy was not assessed. Massage seems more beneficial than sham treatment for chronic non-specific LBP but effectiveness compared with other conventional therapies is inconclusive. Neuroreflexotherapy appears to be more effective than sham treatment or standard care for chronic non-specific LBP. Spinal manipulation was more effective than sham manipulation or ineffective therapies, and equally effective as other conventional therapies. In summary, the results on CAM therapies for (acute episodes of) chronic LBP are promising but more evidence on the relative cost-effectiveness compared to conventional treatments is needed.     

Plasma level of lipopolysaccharide-binding protein is indicative of acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation

Acute graft-versus-host disease (aGVHD) is the major cause of non-relapse mortality following allogeneic hematopoietic stem cell transplantation. To date, there are no consensus specific plasma biomarkers for aGVHD. We recently identified several candidates differentially expressed in aGVHD patients. Here, we have validated one such candidate: lipopolysaccharide-binding protein (LBP). We detected plasma LBP level by ELISA in 73 patients and performed correlation analysis with the progression and severity of aGVHD. We found that plasma LBP level increased during the period of aGVHD and decreased markedly as aGVHD was resolved. LBP level in patients with moderate aGVHD (25-50 % skin rash area of grade 1 and grade 2) was higher than in patients with no, little (skin rash area <25 % of grade 1), or severe aGVHD (grade 3-4). Higher LBP level indicated higher probability of aGVHD. Multivariate analysis showed that LBP level above 15000 ng/ml was significantly associated with an increased risk of aGVHD (HR 2.43; 95 % CI 1.29-4.58; P = 0.006). If LBP level exceeded 15000 ng/ml at d7 and d14 after HSCT, the subsequent probability of aGVHD increased markedly, especially at the time point of d14. There was no correlation between LBP level and the site of aGVHD. In conclusion, our study demonstrated that an elevated LBP level of >15000 ng/ml may serve as a biomarker for the prediction and monitoring of aGVHD.     

Prognosis and quality of life in patients with acute low back pain: insights from a comprehensive inception cohort study

OBJECTIVE: To investigate the respective contribution of various biologic and psychosocial factors, especially initial health-related quality of life (HRQOL), in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL. METHODS: For 3 months, we assessed 113 patients consulting for nonspecific acute LBP of <72 hours duration at inclusion and treated with acetaminophen. Endpoints included pain, disability assessed by the Roland Disability Questionnaire, and HRQOL assessed by the Short Form 36 health survey (SF-36). RESULTS: Seventy-three percent of patients recovered within 2 weeks and 5% of patients developed chronic LBP. Prior low back surgery, higher initial disability questionnaire score, lower SF-36 score, and temporary compensation status were independently associated with delayed recovery. The impact of the acute LBP episode on HRQOL was brief and moderate, except for patients with comorbidity, psychiatric disorders, those of foreign origin, unemployed, or with job dissatisfaction. The impact of compensation status, sick leave, and bed rest was more profound and lasting. CONCLUSIONS: This study highlights the large contribution of work-related factors, but also initial HRQOL, to the prognosis of LBP. It also suggests that LBP impairs HRQOL mainly through compensation and inappropriate medical care, and that, in turn, impaired HRQOL favors the condition becoming chronic. These findings have implications for future research into the management of LBP.     

A Delphi study investigating consensus among expert physiotherapists in relation to the management of low back pain

Objectives: Low back pain (LBP) affects a large proportion of the adult population, with over 90% of people expected to experience symptoms associated with it. LBP is one of the most common conditions managed by primary health care practitioners, and physiotherapists are the largest professional group responsible for its management. Clinical guidelines exist for the management of LBP and are based on the best available evidence. However, there is currently no consensus on the actual physiotherapy management of this condition. Methods: A three‐round Delphi study was conducted among expert physiotherapists (n = 34). A focus group was initially convened to review the key questions, developed following a review of the literature. An expert panel then produced their responses, which were ranked in subsequent rounds, using a five‐point Likert scale, until a predetermined point of consensus was reached. Results: The results of this study indicated that it is possible to establish consensus among expert clinicians in relation to the management of LBP, with consensus reached on 64 (67.3%) of the 95 responses identified. The results also showed that, in general, physiotherapy management within the location studied conformed to current LBP evidence‐based clinical guidelines. In addition, the expert panel identified the importance of a biopsychosocial approach to LBP management. Conclusions: Although the study identified that consensus existed in relation to many aspects of physiotherapy management of LBP, it was also noted that confusion existed in relation to several key areas of practice, highlighting the need for further work. Copyright © 2008 John Wiley & Sons, Ltd.     

Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis

Objective

To determine the effectiveness of self‐management for nonspecific low back pain (LBP).

Methods

We performed a systematic review searching the Medline, Embase, CINAHL, PsycINFO, LILACS, PEDro, AMED, SPORTDiscus, and Cochrane databases from earliest record to April 2011. Randomized controlled trials evaluating self‐management for nonspecific LBP and assessing pain and disability were included. The PEDro scale was used to assess the methodologic quality of included trials. Data were pooled where studies were sufficiently homogenous. Analyses were conducted separately for short‐ (less than 6 months after randomization) and long‐term (at least 12 months after randomization) followup. Six criteria for self‐management were used to assess the content of the intervention.

Results

The search identified 2,325 titles, of which 13 original trials were included. Moderate‐quality evidence showed that self‐management is effective for improving pain and disability for people with LBP. The weighted mean difference at short‐term followup for pain was ?3.2 points on a 0–100 scale (95% confidence interval [95% CI] ?5.1, ?1.3) and for disability was ?2.3 points (95% CI ?3.7, ?1.0). The long‐term effects were ?4.8 (95% CI ?7.1, ?2.5) for pain and ?2.1 (95% CI ?3.6, ?0.6) for disability.

Conclusion

There is moderate‐quality evidence that self‐management has small effects on pain and disability in people with LBP. These results challenge the endorsement of self‐management in treatment guidelines.

     

洛铂腔内灌注治疗恶性胸腹腔积液的临床观察及安全性研究

目的探讨洛铂（LBP）、顺铂（DDP）腔内分别灌注治疗恶性胸腹腔积液的近期临床疗效及临床安全性。方法对41例恶性胸腹腔积液患者,在尽可能放尽胸腹腔内积液以后,腔内分别注入洛铂50mg／m2,或者顺铂60mg／m2,均为每3周1个周期,1周期后评价近期疗效、生活质量以及毒副反应,并对疗效进行分析。结果41例患者均可进行客观疗效评价及安全性评价,全组患者中完全缓解（CR）5例,病情稳定（SD）27例,疾病进展（PD）9例,疾病控制率（DCR）为78．05％;顺铂一线治疗组疗效：CR2例,SD13例,PD3例,DCR83．33％;洛铂二线治疗组疗效：CR3例,SD11例,PD2例,DCR87．50％;顺铂二线治疗组疗效：CR0例,SD3例,PD4例,DCR42．86％。顺铂一线与洛铂二线治疗间疗效无统计学差异（P〉0．05）,但明显优于顺铂二线治疗,统计学差异显著（P〈0．05）,并且结果与患者生活质量改变相似。三组患者中,恶心、呕吐等消化道反应不明显,但患者乏力明显直接影响患者的生活质量;三组患者白细胞、血小板减少等骨髓抑制反应相当,以Ⅰ-Ⅱ度反应为主,Ⅲ-Ⅳ度反应不明显,三组间比较无统计学差异（P〉0．05）。结论洛铂和顺铂腔内灌注均可以较好的控制恶性胸腹腔积液,既往应用顺铂治疗的患者采用洛铂治疗也具有较好的有效率;洛铂腔内治疗可显著减轻患者的临床症状,改善患者生活质量,临床安全性较好,未增加化疗药物的不良反应发生率。     

Lipopolysaccharide-binding protein (LBP) and markers of acute-phase response in patients with multiple organ dysfunction syndrome (MODS) following open heart surgery

Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. Plasma levels of procalcitonin (PCT), c-reactive protein (CRP), interleukin-6 (IL-6), and LBP were measured in the first four postoperative days in 12 adult male patients with the signs of SIRS and two or more organ dysfunctions after myocardial revascularization (MODS-group), and 12 patients without organ insufficiencies (SIRS-group). There were no significant differences regarding age, weight, height, preoperative NYHA-classification, preoperative LVEDP, or the number of anastomosis. Patients with MODS had a significantly longer operation time, duration of ischemia, and duration of extracorporeal circulation. None of the patients in the SIRS group died, whereas in the MODS group, 4 patients died due to septic multiorgan failure. Plasma PCT and IL-6 concentrations were significantly elevated in all MODS patients. CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.     

脂多糖/脂多糖结合蛋白复合物的初步构建

目的采用温孵法构建脂多糖/脂多糖结合蛋白(LPS/LBP)复合物,研究LPS炎症信号通路。方法将LPS与LBP按15︰1、10︰1、5︰1的比例混匀。把LPS/LBP混合物、LBP(浓度分别为200μg/ml、100μg/ml和50μg/ml)、LPS(浓度分别为100μg/ml、50μg/ml)过夜孵育。将孵育后的LPS/LBP混合物、LBP、LPS行凝胶电泳,经考马斯亮蓝染色后将各染色条带切取,行蛋白回收,并测定内毒素。结果凝胶电泳后,LPS/LBP复合物、LBP泳道于相对分子质量52×10~3处可见考马斯亮兰染色的条带。样本中LBP浓度越高、条带染色越浓,LPS泳道对应于相对分子质量52×10~3处无染色条带出现。各浓度比例的LPS/LBP复合物电泳后凝胶条带回收物中均能检测出内毒素。10︰1 LPS/LBP复合物组、15︰1 LPS/LBP复合物组复合物内毒素浓度显著高于5︰1 LPS/LBP复合物组内毒素浓度(P0.05)。10︰1 LPS/LBP复合物组与15︰1 LPS/LBP复合物组内毒素浓度无统计学差异(P0.1)。各浓度LBP组均未检出内毒素,各LPS组内毒素检测也为阴性。结论 LPS︰LBP为10︰1是较为合理的构建LPS/LBP复合物的比例,通过温孵及凝胶电泳可获得纯度较高的LPS/LBP复合物。     

Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study

OBJECTIVE: Low back pain (LBP) is the most frequently reported musculoskeletal problem in older adults, but its impact on health status is not well understood. Our objective was to determine whether LBP and concurrent leg pain are associated with health-related quality of life (HRQOL) and function in a cohort of older adults, and to examine care-seeking behaviors related to LBP. METHODS: This was a population-based, cross-sectional survey study of 522 community-dwelling men and women (67.4%) ages >/=62 living in 4 retirement communities in Maryland and northern Virginia. LBP status in the past year was categorized as no pain in the low back or leg, LBP only, and LBP with leg pain. HRQOL and function were measured with the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: A total of 26.8% of the sample reported LBP only and 21.3% reported LBP plus leg pain. Participants with LBP and LBP plus leg pain had lower scores in all SF-36 domains, reflecting worse HRQOL (P < 0.0001). LBP and LBP plus leg pain were associated with 2-fold greater odds of falling and increased difficulty lifting grocery bags, walking several blocks, and bathing. LBP plus leg pain was associated with difficulty in social interactions (odds ratio 10.63, 95% confidence interval 3.57-31.60). Less than half sought care for LBP and those who did had poorer health status and greater pain burden. CONCLUSION: LBP is common among older adults and strongly associated with reduced HRQOL and function. These findings argue strongly for both identifying cases of LBP by health care practitioners and pursuing effective treatments for LBP given the potential consequences.     

Are tall people at higher risk of low back pain surgery? A discussion on the results of a multipurpose cohort

Objective

To investigate whether height is associated with low back pain (LBP) and surgery, taking into account personal and socioeconomic risk factors in a general population.

Methods

In 2001, 13,680 participants of the Gazel cohort completed a self‐reported questionnaire on LBP and surgery interventions. Three groups were compared according to their body height: no LBP (reference group, participants who declared they never had LBP), LBP without surgery (participants who ever had LBP but without surgery), and back surgery (participants who ever had surgery for LBP). Adjusted variables were sex, age, educational level, marital status, height, and body mass index.

Results

Mean height was significantly higher in men in the back surgery group than in the reference group and the LBP group. The proportion of surgically‐treated LBP was higher for people whose height was ≥4th quartile (P < 0.0001). Being in the highest quartile for height was a stronger risk factor for surgery (adjusted odds ratio [OR_adj] = 2.01, 95% confidence interval [95% CI] 1.61–2.51) than for LBP without surgery (OR_adj = 1.29, 95% CI 1.18–1.40).

Conclusion

The results suggest that being tall is a predictor for back surgery.     

Does strengthening the abdominal muscles prevent low back pain--a randomized controlled trial.

OBJECTIVE: To investigate the effects of abdominal muscle strengthening exercise on low back pain (LBP) risk reduction. METHODS: We compared the effects of abdominal muscle strength (AMS) exercise and back education with back education only on 402 asymptomatic subjects with weak AMS. The primary outcome was the percentage of subjects with at least one episode of LBP at 24 months. A diary was used to monitor compliance. RESULTS: There were no statistically significant differences between experimental (E) and control (C) subjects at 24 months for LBP episodes (E: 34.7%, C: 30.4%; C-E = 4.2%, P2 = 0.481; 95% CI -16.1%, 7.6%). The LBP episodes were also not statistically significantly different at 6 months (E: 13.2%, C: 16.1%; C-E: 2.9%, P2 = 0.493; 95% CI -5.3%, 11.0%) or at 12 months (E: 24.8%, C: 23.6%; C-E = -1.2%, P2 = 0.818; 95% CI -11.6%, 9.2%). Adjusting the data for strata and baseline AMS did not alter the findings. Imputed results for LBP episodes at 6 months (C-E: 4.8%, P2 = 0.191; 95% CI -2.4%, 12.0%), 12 months (C-E: -1.0%, P2 = 0.821; 95% CI -9.5%, 7.6%), and 24 months (C-E: -3.3%, P2 = 0.483; 95% CI -12.6%, 5.9%) were also not statistically significantly different. CONCLUSION: Back education and abdominal exercise instructions are similar to back education alone. There were no group differences in LBP episodes, possibly due to noncompliance with the exercise program. While the estimated benefit of 2.9% at 6 months from the complete data and 4.8% from the imputed data were not statistically significant, a larger study or future metaanalyses may be needed to confirm whether there is a clinical benefit or whether these results should be considered a chance finding.     

A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity

BACKGROUND: The objective of this study was to determine the prevalence of lower back pain and associated leg pain/numbness in postmenopausal Caucasian women and the relationship of these symptoms to health status and function. METHODS: A convenience sample of 573 white women enrolled in the Observational Study of the Women's Health Initiative (WHI) in Pittsburgh completed a questionnaire on low back pain (LBP) and leg pain (LP) and its impact on their daily activity. For data analysis, this information was merged with that obtained under the standard WHI protocol. RESULTS: Almost half of the women (49%) reported having had LBP during the previous month: 8% had LBP only, while 41% had both LBP and LP. In 9% of women, the leg and back symptoms were alleviated by sitting. Among women with LBP during the previous month, those who also had leg pain were five times more likely to have had functional limitations, two to four times more likely to have consulted a clinician or taken medications, and more likely to have had prior spinal surgery or hospitalization than the women with no LP. Based on the Short Form-36, women with LBP/LP had significantly lower scores for physical function, physical role, and bodily pain than women with no LBP or with LBP alone. CONCLUSIONS: Low back pain that radiates into the hip, buttock, or leg is relatively common in postmenopausal Caucasian women living in the community and is associated with decreased physical health status and with physical limitations.     

Tall stature, overweight and the prevalence of low back pain in Chinese middle-aged women.

OBJECTIVES: First, to estimate the rate and characteristic of low back pain (LBP) among Hong Kong middle-aged women. Second, to explore the relationship between being overweight, having tall stature and LBP prevalence. DESIGN: A case-control study of Hong Kong community-based middle-aged women was conducted. SUBJECTS: The study subjects were either from the University Family Medicine Clinic or from a population-based cross-sectional study on health in middle-aged women conducted by the Department of Community and Family Medicine (based on a randomized sample of telephone numbers from the Hong Kong residential telephone directory in 1991). Among the 928 potential eligible subjects from both sources, a total of 182 cases and 235 controls participated in this study. MEASUREMENTS: Data were collected from personal interviews and anthropometric measurements. Participants were asked about exclusion criteria, the occurrence of LBP and demographics factors. The anthropometric measurements included measures of body height, body weight, waist and hip circumferences. RESULTS: Among the 182 cases who entered this study, 83 women (45.6%) had 1-<14 days of LBP, and 99 women (54.4%) had at least 14 days of LBP in the previous 12 months. Having tall stature and being overweight were found to have no association with LBP prevalence. Conversely, high waist-to-hip ratio (> or =0.8) was noted to be inversely associated with the risk of severe (at least 14 days) LBP (adjusted odds ratio=0.43, 95% confidence interval 0.26-0.70) even when controlling for other risk factors together, but not for the overall (at least one day) LBP. CONCLUSION: This case-control study found no association between excessive weight, tall stature and an increased risk of LBP prevalence in Hong Kong Chinese middle-aged women. Conversely, the results indicate that a high waist to hip ratio was associated with a lower risk of severe LBP. Prospective studies are needed to further evaluate the association between underweight/obesity, bone mass density and LBP.     

Kupffer cell activation by lipopolysaccharide in rats: role for lipopolysaccharide binding protein and toll-like receptor 4

Lipopolysaccharide (LPS) binding protein (LBP) is a key serum factor that mediates LPS activation of mononuclear cells. In the presence of LBP, 1/1,000 the concentration of LPS is sufficient to activate peripheral blood monocytes. Previous studies with Kupffer cells have shown a variable effect of serum on LPS activation of these cells and led to the conclusion that, unlike extrahepatic mononuclear cells, Kupffer cells do not respond to LPS in an LBP-dependent fashion. Because there are multiple components in serum other than LBP that might affect LPS activation, these reports with serum are difficult to interpret. To investigate the specific role of LBP in LPS activation of Kupffer cells, we produced a functional recombinant rat LBP using a baculovirus expression system, which we used to selectively examine the role of LBP's on Kupffer-cell function. Isolated Kupffer cells exposed to increasing concentrations of LPS (0, 1, 10 ng/mL) showed a dose-dependent increase in TNF-alpha production, which was augmented and accelerated by the presence of LBP. The effects of LBP on Kupffer cell activation by LPS are dependent on a functional Toll-like receptor 4 (Tlr 4) because Kupffer cells from C3H/HeJ mice failed to respond to LPS in the presence of LBP. LBP plays an important role in mediating Kupffer cell activation by LPS, and these effects are dependent on the presence of functioning Tlr 4.     

实验性酒精性肝病时脂多糖结合蛋白和脂多糖受体CD14的表达

目的观察大鼠酒精性肝病时脂多糖结合蛋白(lipopolysaccharide binding protein,LBP)和脂多糖受体CD14的表达及其在酒精性肝损害中的作用.方法随机将Wistar大鼠分为乙醇喂养组和葡萄糖喂养对照组,分剐在饮水中加入乙醇(剂量5-12 g@kg-1@d-1)和相同量的葡萄糖.两组大鼠分别于4周和8周测定其血浆中内毒揪素(LPS)浓度及血清中ALT变化,同时用RT-PCR测定肝组织中LBP和CD14 mRNA的表达,并在光镜和电镜下观察肝脏的形态学改变.结果乙醇喂养组4周和8周时大鼠血浆LPS浓度分别为(129±21)pg/ml和(187±35)Pg/m1,明显高于对照组的(48±9)pg/ml和(53±11)pg/ml(f值分别为11.2和11.6,P＜0.05);乙醇组大鼠血清ALT浓度为(112±15)U/L和(147±22)U/L,也明显高于对照组的(31±12)U/L和(33±9)U/L(t值分别为5.9和20.6,P＜0.05).乙醇组大鼠肝组织中LBP和CD14 mRNA的表达水平明显高于对照组(P＜0.05),其肝组织发生显著的病理变化,主要表现为脂肪变性、炎性细胞浸润及细胞坏死.对照组肝组织中LBP和CD14mRNA无明显表达,其病理变化也不明显.结论乙醇能诱导大鼠血中LPS浓度升高和肝缝织中LBP与CD14 mRNA的表达显著增强,增高的LBP和CD14 mRNA能增加肝脏对LPS的敏感性,可能造成肝脏损害.     

Etoricoxib reduced pain and disability and improved quality of life in patients with chronic low back pain: a 3 month, randomized, controlled trial

BACKGROUND: Chronic low back pain (LBP) is a growing health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat this condition, but have not demonstrated efficacy beyond 2 weeks, and no studies have shown that NSAIDs produce durable improvements in disability. METHODS: To evaluate the efficacy and durability of effect of etoricoxib for chronic LBP, a randomized, double blind, placebo-controlled trial was conducted at 46 centres. Three hundred and twenty-five patients with chronic LBP requiring treatment with an NSAID or paracetamol were randomized 1:1:1 to etoricoxib 60 mg (n=109), 90 mg (n=106), or placebo (n=110), daily for 3 months. Pre-specified endpoints over 3 months included LBP intensity scale (visual analog scale 0-100 mm) time-weighted average change from baseline, the Roland-Morris Disability Questionnaire (RMDQ), the LBP bothersomeness scale, patient and investigator global assessments, and measures of quality of life. RESULTS: Both etoricoxib groups experienced significant reductions in LBP intensity at 4 weeks versus placebo [-15.15 mm and -13.03 mm for 60 and 90 mg, respectively, probability (p)<0.001 for each], which was maintained over 3 months. Treatment resulted in significant improvement from baseline compared to placebo in RMDQ scores (etoricoxib 60 mg, -2.82 and 90 mg, -2.38, p<0.001 for each) over 12 weeks and most other efficacy endpoints. There were no significant differences between treatments in incidence of adverse events (AEs) or discontinuations due to AEs. CONCLUSION: Etoricoxib provided significant relief of symptoms and disability associated with chronic LBP detected at 1 week, confirmed at 4 weeks, and maintained over 3 months. Reductions in chronic LBP severity corresponded to improvements in physical functioning and quality of life. All treatments were generally well tolerated.     

Lack of Correlation between Nonspecific Nasal and Bronchial Reactivity in Allergic Rhinitis Subjects

A link between allergic rhinitis and asthma has long been suspected, allergic rhinitis being considered a precursor of asthma. The hypothesis is that if such a link exists, then nonspecific nasal and bronchial reactivity are already correlated in acute rhinitis patients. To test for this correlation, we compared nonspecific nasal and bronchial reactivity in two groups of rhinitis subjects: 37 rhinitis pollinosis patients tested during the pollen season and 35 rhinitis pollinosis patients tested outside the pollen season. We also assessed how smoking affects this link. In each subject, allergy, nonspecific nasal, and nonspecific bronchial reactivity were tested, and smoking was categorized. We found no correlation between nonspecific nasal and bronchial reactivity in the two nonasthmatic rhinitis groups. During active allergic inflammation (pollinosis season) no shift toward a stronger link between upper and lower airways can be found compared with the latent period (out of pollinosis season). Unexpectedly, among smokers we found a significant relationship between nonspecific nasal and bronchial reactivity. Thus, there is not yet sufficient evidence for a straightforward link between nasal and bronchial hyperreactivity in nonasthmatic pollinosis rhinitis subjects. The development of asthma seems to be crucial for this link. Accepted for publication: 30 November 1998