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Open Journal of Medical Imaging 2013年第1期3卷 12-16页

作者： Sei Fuku Masahiro Yoshimura Katsunori Miyata Nishiyama Junji Department of Anesthesiology Shiga University of Medical Science Hospital Otsu Japan Department of Psychosomatics Shiga University of Medical Science Hospital Otsu Japan pain Management Clinic Department of Anesthesiology Shiga University of Medical Science Hospital Otsu Japan

Anterior cingulated cortex (ACC) is involved in “the state in which patients do not care much about pain despite its presence” which is a goal of psychosomatic treatment. To investigate the absolute concentration of N-acetylaspartate (NAA) in the anterior cingulated cortex (ACC) as predictors of patients that may benefit from cognitive behavioural therapy in the treatment of chronic pain. Proton magnetic resonance spectroscopy (1H-MRS) was performed with a 1.5 T MR system on a voxel in the bilateral ACC in 85 chronic pain patients and 20 age-matched normal control subjects. Eighteen out of 24 (75.0%) patients whose NAA concentration decreased significantly in the ACC, respectively, compared to the mean NAA concentration of the normal control subjects, needed cognitive behavioural therapy. Our results suggest that decreased NAA concentration in the ACC is associated with the necessity of cognitive behavioural therapy. 1H-MRS may serve as a useful non-invasive tool for evaluating chronic pain patients.

关键词： Magnetic Resonance Spectroscopy chronic pain Anterior Cingulated Cortex N-Acetylaspartate

Cytokine profiles in patients receiving antioxidant therapy within the ANTICIPATE trial

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World Journal of Gastroenterology 2013年第25期19卷 4001-4006页

作者： Nehal Shah Ajith K Siriwardena Hepato-Pancreato-Biliary Surgery unit Manchester Royal Infirmary

AIM: To measure a broad profile of pro-and anti-inflammatory cytokines in patients with clinically proven chronic pancreatitis (CP) taking either antioxidant therapy or placebo as part of the larger ANTICIPATE study. METHODS: Patients with chronic pancreatitis were recruited to the ANTICIPATE study following informed consent and were randomised to intervention with either antox version 1.2-based antioxidant therapy or placebo. After a separate ethics committee amendment a subgroup of 7 patients from either arm of the study were selected for additional analysis of cytokines. Cytokines were measured at baseline and after 6 mo of either antox therapy or placebo by biochip array and enzyme-linked immunosorbent assay. RESULTS: Antioxidant therapy and placebo groups were well-matched in terms of age, gender, aetiology of CP, opiate use and disease duration. Baseline antioxidant levels were similar in patients allocated to the antioxidant group as compared to the group al- located to placebo. After 6 mo of antioxidant therapythere was significant elevation in vitamin C levels in the intervention group: 17.6 μg/mL (12.8-29.3 μg/mL) compared to 4.8 μg/mL (1.6-9.1 μg/mL) in placebo (P pain, circulating cytokine levels are low suggesting that pain in this disease is not simply a manifestation of inflammation.

关键词： chronic pancreatitis Antioxidant therapy Cytokine

chronic pain Management after Necrotizing Soft Tissue Infection (NSTI): A Case Report

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Case Reports in Clinical Medicine 2024年第9期13卷 382-390页

作者： Kinyungu Njoroge Vivian Matubia Ngugi Kinyungu School of Medicine and Surgery Kenya Methodist University Meru Kenya Basset Medical Center NY St Georges University School of Medicine True Blue Grenada ITAV pain Management Donald and Barbara Zucker School of Medicine at Hofstra/Northwell New York USA

Background: Necrotizing soft tissue infections (NSTIs) are potentially life threatening medical emergencies associated with devastating and rapidly spreading destruction of soft tissues. Atypical presentations and delayed early diagnosis can be significant challenges in managing NSTIs. The infectious process can start at any part of the body with rapid progression leading to limb amputation and high mortality rate. We present a case of a patient with NSTI, the sequelae and management of the chronic pain that developed. Aim: This case report looks to shed light on the importance of a plan for management of subacute and chronic pain in treating patients who present with Necrotizing soft tissue infection. Case presentation: A 53-year-old female who presented with septicemia and was subsequently admitted and treated for NSTI in 2014 resulting in amputation of her distal foot, toe digits, and now with ongoing chronic wound of the lower extremities along with chronic pain. Conclusion: chronic pain as part of the sequelae of Necrotizing soft tissue infections needs to be anticipated by the health care management team in order to optimize patient care post operatively.

关键词： Necrotizing Soft Tissue Infections (NSTIs) chronic pain Sequelae

Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia

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World Journal of Gastroenterology 2013年第17期19卷 2668-2675页

作者： Edoardo Savarino Marina Corbo Pietro Dulbecco Lorenzo Gemignani Elisa Giambruno Luca Mastracci Federica Grillo Vincenzo Savarino Gastroenterology unit Department of Surgical Oncological and Gastroenterological Sciences University of Padua Gastroenterology unit Department of Internal Medicine University of Genoa Department of Anatomic Pathology University of Genoa

AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME ex

关键词： Narrow-band imaging Magnification Gastric intestinal metaplasia Light blue crest Gastric cancer Endoscopy Precancerous conditions Gastric biopsy

AMPK activation by peri-sciatic nerve administration of ozone attenuates CCl-induced neuropathic pain in rats

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Journal of Molecular Cell Biology 2017年第2期9卷 132-143页

作者： Lijuan Lu Cailong Pan Lu Chen Liang Hu Chaoyu Wang Yuan Han Yanjing Yang Zhixiang Cheng Wen-Tao Liu Department of pain Affiliated Drum Tower Hospital of Medical School of Nanjing University Nanjing 210008 China Jiangsu Key Laboratory of Neurodegeneration Department of Pharmacology Nanjing Medical University Nanjing 210029 China State Key Laboratory of Natural Medicines China Pharmaceutical University Nanjing 210009 China Jiangsu Key Laboratory of Oral Diseases Nanjing Medical University Nanjing 210029 China Department of pain Management & Cancer Biotherapy Center The Second Affiliated Hospital of Nanjing Medicat University Nanjing 210029 China

Neuropathic pain is a debilitating clinical condition with few efficacious treatments, warranting development of novel therapeu- tics. Ozone is widely used as an alternative therapy for many different pain conditions, with exact mechanisms still elusive. In this study, we found that a single peri-sciatic nerve injection of ozone decreased mechanical aUodynia and thermal hyperalgesia, and normalized the phosphorylation of protein kinase C y, N-methyI-D-aspartate receptor, and extracellular signal-regulated kinase in a chronic constriction injury （CCI） model in rat sciatic nerve. Meanwhile, ozone significantly suppressed CCI-induced activation of spinal microgUa. More importantly, the anti-nociceptive effect of ozone depended on the activation of 5＇-adenosine monophosphate （AMP）-activated protein kinase （AMPK）, which was proved by the fact that the phosphorylated AMPK level increased during the ozone therapy and AMPK antagonist abolished the effect of ozone in vivo and in vitro. In addition, direct injection of AMPK agonist could replicate the anti-nociceptive effect of ozone in CCI rats. In conclusion, our observations indicate that peri-sciatic nerve injection of ozone activates AMPK to attenuate CCI-induced neuropathic pain.

关键词： AMPK ozone therapy neuropathic pain

chronic inflammation deteriorates structure and function of collagen fibril in rat temporomandibular joint disc

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International Journal of Oral Science 2019年第1期11卷 42-49页

作者： Shengjie Cui Yu Fu Yan Liu Xiaoxing Kou Jieni Zhang Yehua Gan Yanheng Zhou Xuedong Wang Department of Orthodontics Peking University School and Hospital of Stomatology Center for Craniofacial Stem Cell Research and Regeneration Peking University School and Hospital of Stomatology Center for Temporomandibular Disorders and Orofacial pain Peking University School and Hospital of Stomatology

Collagen is the building component of temporomandibular joint(TMJ) discs and is often affected by inflammation in temporomandibular disorders. The macromechanical properties of collagen are deteriorated by chronic inflammation. However,the mechanism by which inflammation influences disc function remains unknown. The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified. Seven-week-old female Sprague–Dawley rats were randomly divided into two groups. chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant, and samples were harvested after 5 weeks. Picrosirius staining revealed multiple colours under polarized light, which represented alternative collagen bundles in inflamed discs. Using atomic force microscopy scanning, the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs. Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres, and oversized collagen fibrils were observed in inflamed discs. Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm^(-1)/amide II area ratio of collagen in different regions. The peak positions of amide I and amide II bands were altered in inflamed discs,indicating collagen unfolding. Our results suggest that sustained inflammation deteriorates collagen structures, resulting in the deterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.

关键词： temporomandibular joint(TMJ female Sprague-Dawley

Upregulation of cystathionine β-synthetase in arcuate nucleus produces pain hypersensitivity via PKC-mediated phosphorylation of GluN2B in rats with chronic pancreatitis

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Upregulation of cystathionine β-synthetase in arcuate nucle...

Risk factors and pain status due to diabetic neuropathy in chronic long-term diabetic patients in a Chinese urban population

中国生理学会消化与营养专业委员会成立大会暨第一届学术会议

作者： Hang Zheng Hongyan Zhu Xiaoyu Zhang Meng Wang Ying Xiao 徐广银 Xinghong Jiang Key Laboratory of pain Basic Research and Clinical Therapy Department of Neurohiology & Physiology Medical College Institute of Neuroscience Soochow University 苏州大学神经科学研究所

Hydrogen sulfide(HS)contributes to visceral hyperalgesia in primary sensory neurons but its role in central nerve system remains largely *** study was to investigate the roles and underlying mechanisms of HS and its endogenous synthesizing enzymes in arcuate nucleus(ARC)in the pancreatic hyperalgesia in rats with chronic pancreatitis(CP).CP was induced in male adult rats by intraductal injection of trinitrobenzene sulfonic acid(TNBS).Abdominal hyperalgesia was assessed by referred somatic behaviors to mechanical stimulation of rat *** blot analysis was performed to detect protein *** microinjection of O-(Carboxymcthyl)hydroxylaminc hemihydrochloride(AOAA)an inhibitor of cystathionineβ-synthetase(CBS)significantly attenuated abdominal pain in CP rats in a dose-dependent *** of CBS in ARC was markedly uprcgulated while the expression of cystathionine-γ-lyase was not allcred4 weeks after TNBS *** the expression of total GluN2B was not altered TNBS injection greatly enhanced the phosphorylation level of GluN2B in ARC in CP rats when compared with age and sex-matched control *** also significantly increased expression of protein kinase Cy(PKCγ)in *** of AOAAinto ARC reversed the upregulation of p-GluN2B and PKCγin ARC in CP *** the specific PKC inhibitor chelerythrine significantly suppressed p-GluN2B expressionand attenuated abdominal hyperalgesia of CP *** together our data suggest that upregulation of CBS leads to an activation of GluN2B which is likely mediated by PKCγin ARC thus playing an important role in generation of pain hypersensitivity of chronic pancreatitis.

关键词： Arcuate nucleus chronic pancreatitis Abdominal pain Hydrogen sulfide NMDA receptor Protein kinase C

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Chinese Medical Journal 2012年第23期125卷 4190-4196页

作者： JI Na ZHANG Nan REN Zhan-jie JIA Ke-bao WANG Li NI Jia-xiang MA Jun Department of pain Management Xuanwu Hospital Capital MedicaJ University Beijing 100053 China Department of Endocrinology Xuanwu Hospital Capital MedicaJ University Beijing 100053 China Department of Anesthesiology Xuanwu Hospital Capital MedicaJ University Beijing 100053 China Department of Urology Second Affiiated Hospital Zhejiang University School of Medicine Hangzhou Zhejiang 310009 China

Background With economic growth and urbanization there have been significant changes in the life style and diet of urban residents in large cities of China, which is experiencing a rapid increase in the prevalence of diabetes. While high prevalence of diabetes has been reported, little is known of the long-term effects of diabetes in such a large population. The aim of this study was to estimate the morbidity rate of diabetic peripheral neuropathy （DPN） in a Chinese urban diabetic population with more than 10 years＇ disease duration, and evaluate the relevant risk factors. The clinical manifestation of DPN and pain status was also assessed. Methods Five hundred and sixty-five diabetes patients were recruited into the study. Symptoms and examination helped diagnose neuropathy. The clinical manifestation of DPN was assessed with a visual analog pain score （VAS）. Diabetic complication status was determined from medical records. Serum lipids and lipoproteins, glycosylated hemoglobin （HbAlc）, and the urinary albumin excretion rate were measured. Results The morbidity rate of DPN was 46.6%. HbAlc, hyperlipidemia, and retinopathy were significantly associated with neuropathy, and these risk factors were correlated with other diabetic micro and/or macrovascular complications. The average VAS pain score of the DPN patients was 4.12＋2.07. Severe and moderate pain was experienced by 11.4% and 40.5% respectively of DPN patients. About 3.7% of diabetic subjects had lower limb ulcer or amputation. Conclusions The morbidity rate of DPN for diabetic patients with 〉10 years duration is very high compared to the range reported for other populations in the world. The risk factors for DPN include HbAlc, hyperlipidemia, and retinopathy. In long-standing diabetic patients, DPN was not associated with diabetic duration, and half of the DPN patients experienced considerable daily suffering.

关键词： Diabetic neuropathy risk factors pain status urban Chinese population

pain and Radiographic Changes in Adult Scoliosis Patients Using a Scoliosis Activity Suit: Case-Controlled 10-Year Follow-Up Results

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Open Journal of Therapy and Rehabilitation 2023年第4期11卷 158-170页

作者： Mark W. Morningstar Natural Wellness & pain Relief Center Grand Blanc USA

Scoliosis in adult patients is known to increase across the lifespan and increases the chance of chronic pain in later adulthood. Non-surgical scoliosis treatment options for adults are not widely recommended, largely due to lack of research in this area. pain management options for adults are focused primarily on treating scoliosis-related pain, and not necessarily the scoliosis itself, such as epidural injections, prescription pain medications, and general physical therapy. Recent studies reporting non-surgical, scoliosis-specific treatment methods in adults are encouraging, but their study designs limit extrapolation. The current study reports the self-reported pain and radiographic outcomes in adult patients wearing a scoliosis activity suit for at least 10 years. A total of 22 patient charts that fulfilled the inclusion criteria were selected for review. Cobb angle radiographic measurements and self-rated quadruple numerical pain rating scale (QVAS) at baseline and 10-year follow-up were used as the outcomes. Cobb angle measurements were compared at baseline and 10 years and subdivided according to scoliosis curve pattern. At 10 years, 68% of patients had improvements in their Cobb angle > 5˚, with an overall average of approximately 9˚. Significant differences were also observed in the 10-year Cobb angle measurements when compared to the predicted 10-year Cobb angles based on the established rate of linear progression in adults. A statistically significant change was also observed in the 10-year QVAS scores. These results suggest a potential role of the scoliosis activity suit for improving Cobb angles in adults and reducing scoliosis-related pain.

关键词： Chiropractic pain Rehabilitation Scoliosis Spine