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Hirudotherapy attenuates arthritic pain in patients with various chronic pain syndromes: A retrospective analysis

Journal of Integrative Medicine 2020年第5期18卷 425-433页

作者： Johannes Loeser Brigitte Layer Christopher Plata Klaus-Maria Perrar Tim Hucho Rebecca Kulbida department of Anaesthesiology and Intensive care Medicine University Clinic of CologneKoeln 50937Germany Department of Palliative Care University Clinic of CologneKoeln 50937Germany

Objective: Osteoarthritis is a degenerative disease that affects synovial joints. Micro-injuries of articular structures initiate inflammatory processes, leading to persistent pain. Due to various risk factors,osteoarthritis is often diagnosed in multimorbid patients. This makes pain management one of the key challenges, with a consistent need for new therapeutic strategies. Hence, complementary and integrative methods such as hirudotherapy have become increasingly important, even though their mechanisms of action are not entirely understood.Methods: We retrospectively analyzed the longitudinal effect of a single leech application on osteoarthritic joints in a heterogenic cohort of 24 cases with various chronic pain syndromes. We assessed articular pain intensity ratings and movability of the treated joint after one-time leeching for up to 12 months.We further investigated the effect of hirudotherapy on the systemic pain status and multimodal treatment strategies of the patients.Results: There was a significant reduction in pain intensity ratings at the joint of leech application for up to 12 months after treatment. The improvements in pain intensities were independent of the form of osteoarthritis treated. In addition, we saw a considerable enhancement in local movability of the treated joint. Hirudotherapy did not seem to influence the systemic pain status as well as the previously established individualized multimodal treatment model of the patients.Conclusion: Leeching as an adjuvant therapy has a great potential especially in terms of safety and longterm outcome.

关键词： Hirudotherapy Medicinal leeching Chronic pain syndromes Pain management Osteoarthritis

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Management of parenteral nutrition in critically ill patients

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World Journal of Critical care Medicine 2017年第1期6卷 13-20页

作者： Paolo Cotogni department of Anesthesia and Intensive care Pain Management and Palliative Care S. Giovanni Battista Hospital University of Turin

Artificial nutrition(AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition(PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider:(1) an appropriate blood glucose control;(2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones;(3) the adoption of insertion and care bundles for central venous access devices; and(4) the implementation of a policy of targeting "near zero" catheter-related bloodstream infections. Adopting all these strategies, the goal of "near zero" PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

关键词： Enteral nutrition Intensive care Nutritional support Vascular access Artificial nutrition

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Prediabetes in children and adolescents:A ticking bomb!

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World Journal of Clinical Pediatrics 2024年第2期13卷 11-15页

作者： Anju Gupta Nitin Choudhary Nishkarsh Gupta department of Anesthesiology Pain Medicine and Critical CareAll India Institute of Medical ScienceNew Delhi 110076India department of Onco-Anesthesiology and palliative Medicine All India Institute of Medical ScienceNew Delhi 110029India

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade.It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus.The incidence of prediabetes in adolescents ranges from 4%-23%which is alarmingly high and requires active intervention from the system.We have discussed early identification of high-risk patients,prompt screening and active intervention to manage this growing problem.

关键词： Prediabetes Children Adolescents Glucose metabolism Complications

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奈妥匹坦帕洛诺司琼预防化疗引起的恶心呕吐:从临床试验到日常临床实践

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中国实用医药 2024年第1期19卷 159-174页

作者： Matti Aapro Karin Jordan Florian Scotté Luigi Celio Meinolf Karthaus Eric Roeland Genolier Cancer Centre Clinique de GenolierGenolierSwitzerland department Haematology Oncology and Palliative CareErnst von Bergmann Klinikum PotsdamPotsdamGermany department of Medicine V HematologyOncology and RheumatologyUniversity Hospital HeidelbergHeidelbergGermany Interdisciplinary Cancer Course department Gustave Roussy Cancer InstituteVillejuifFrance Medical Oncology Unit ASST del GardaDesenzano del Garda(BS)Italy department of Hematology Oncology and Palliative CareKlinikum NeuperlachMunichGermany department of Hematology Oncology and Palliative CareKlinikum HarlachingMunichGermany Oregon Health and Sciences University Knight Cancer InstitutePortlandORUSA

化疗引起的恶心呕吐(CINV)是众多抗癌药物治疗中常见的不良事件,不仅会对患者生活质量带来负面影响,还有可能影响化疗效果。目前,指南建议的止吐方案可以预防大部分癌症患者的CINV。但临床医师并不能始终遵循指南建议,患者也常常难以坚... 详细信息

化疗引起的恶心呕吐(CINV)是众多抗癌药物治疗中常见的不良事件,不仅会对患者生活质量带来负面影响,还有可能影响化疗效果。目前,指南建议的止吐方案可以预防大部分癌症患者的CINV。但临床医师并不能始终遵循指南建议,患者也常常难以坚持医师处方的治疗。因此需要采取一些提高指南依从性的方法。奈妥匹坦帕洛诺司琼(NEPA)是首个也是唯一一个固定剂量复方止吐药,由奈妥匹坦(口服)/福奈妥匹坦(静脉给药)与帕洛诺司琼(PALO)组成。NEPA可以联合地塞米松组成三联止吐方案,这是用于高致吐性化疗(HEC)患者和部分中致吐性化疗(MEC)患者预防CINV的推荐方案。因此,NEPA止吐治疗操作简单便捷,可能有助于提高指南依从性。本综述对CINV进行了概括,评价了在临床试验和真实实践中积累的NEPA止吐效果及安全性方面的证据,同时也评价了在关键临床试验之外的环境下,即日常临床环境中使用NEPA进行止吐的初步证据。此外,本文还评述了化疗期间使用NEPA控制恶心症状和提高患者生活质量,这是癌症患者管理中面临的两个大挑战。

关键词：奈妥匹坦帕洛诺司琼化疗引起的恶心呕吐 NK1受体拮抗剂 5-羟色胺-3受体拮抗剂生活质量止吐方案

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The prevalence,associated factors,and impact of urinary incontinence in pregnant and postpartum women in Nanjing,China:A cross-sectional study

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Asian Journal of Urology 2023年第3期10卷 337-343页

作者： Xiaowei Yang Lynn Sayer Sam Bassett Sue Woodward King’s College London Department of Florence Nightingale Faculty of NursingMidwifery and Palliative CareLondonUnited Kingdom Nanjing Vocational Health College Department of Clinical Teaching and ResearchNanjingChina

Objective:Urinary incontinence(UI)is highly prevalent in antenatal and postnatal women while the prevalence of UI varied largely from 3.84%to 38.65%.This study was to assess the prevalence of UI,the associated factors,and the impact of UI on daily life in pregnant and postpartum women in Nanjing,China.Methods:The prevalence of UI and the impact of UI on life were assessed by the validated Chinese version of International Consultation on Incontinence Questionnaire-urinary incontinence-short form and the validated Chinese version of urinary incontinence quality of life.The associated factors were estimated by using logistic regression analysis.Results:UI affected 37.80%of pregnant women and 16.41%of postpartum women of the study population.Among the pregnant participants,the prevalence rates of stress UI,urge UI,and mixed UI were 25.77%,4.47%,and 7.10%,respectively.Among the postpartum women,the prevalence rates of stress UI,urge UI,and mixed UI were 11.15%,1.92%,and 2.69%,respectively.In both pregnant women and postpartum women,vaginal delivery had significantly increased the odds of reporting UI(p=0.007,p=0.003,respectively).The impact of UI on daily life was significantly greater in postpartum women compared to pregnant women especially in social embarrassment(p=0.000).Conclusion:The prevalence rates of UI were high in pregnant women in Nanjing,China.Vaginal delivery significantly increased odds of reporting UI.UI has a great impact on pregnant and postpartum women’s life,especially in social embarrassment.

关键词： Postpartum women Pregnant women Prevalence Risk factor Urinary incontinence

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Neural Blockade for Cancer Pain

Neural Blockade for Cancer Pain

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2016中国医师协会疼痛医师专业委员会年会

作者： Toyoshi Hosokawa department of Pain Management ＆ palliative care Medicine Kyoto Prefectural University of Medicine

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Current status of nitrous oxide use in pediatric patients

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World Journal of Clinical Pediatrics 2022年第2期11卷 93-104页

作者： Nishkarsh Gupta Anju Gupta R M Vishnu Narayanan department of Onco-Anesthesiology and palliative Medicine AIIMSNew Delhi 110029DelhiIndia department of Anesthesiology Pain Medicine and Critical CareAIIMSNew Delhi 110029DelhiIndia

Nitrous oxide is one of the most commonly used inhalational anesthetic agents used in practice.It is a cost-effective,pleasant,safe,and versatile anesthetic agent with many desirable properties like good quality analgesia,decreased awareness,accelerated induction and recovery from anesthesia,and reduced utilization of other expensive inhalational agents with potential cost savings.The use of nitrous oxide has been questioned by a lot of studies and case reports perceiving its adverse systemic,hematological,immune,and neurologic adverse effects.However,the literature in the recent past has tried to resolve the controversies related to its use.The concerns over an increase in cardiovascular complications and mortality following nitrous oxide use have been negated by recent data.However,its use in certain vulnerable populations like children with cobalamin and folate deficiency or defects in their metabolic pathways remains a cause of concern for its toxic effects.In this narrative review,we aim to discuss the pharmacological properties of nitrous oxide,the potential advantages and drawbacks of the use of nitrous oxide in children,address the neurodevelopmental and other systemic effects,and throw light on the evidence regarding the safety of nitrous oxide use and its current role in pediatric procedural sedation and anesthesia practice.The literature related to its use in the pediatric population for painful procedures and surgeries has been summarized.

关键词： Child Nitrous oxide Vitamin B12 Vulnerable populations Anesthesiology Anesthetics Folic acid Metabolic networks and pathways

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Hospital without dyspnea： rationale and design of a multidisciplinary intervention

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Journal of Geriatric Cardiology 2016年第7期13卷 625-631页

作者： Lourdes Vicent Juan Manuel Nunez Olarte Luis Puente-Maestu Esther Artajona Francisco Fernandez-Aviles Manuel Martinez-Selles department of Cardiology Gregorio Maranon General Hospital Madrid Spain Department of Palliative Care Gregorio Maranon General Hospital Madrid Spain department of Respirology Gregorio Maranon General Hospital Madrid Spain European University of Madrid Madrid Spain Complutense University of Madrid Madrid Spain

呼吸困难是普通、停用的症状呼吸并且心疾病，它在发生正在成长。在医院承认期间，呼吸急促下面诊断、下面对待，尽管有为控制症状可得到的治疗。我们开发了指导到医药职员在处理呼吸困难支持这些药理学和非药理学工具的应用程序的定制... 详细信息

呼吸困难是普通、停用的症状呼吸并且心疾病，它在发生正在成长。在医院承认期间，呼吸急促下面诊断、下面对待，尽管有为控制症状可得到的治疗。我们开发了指导到医药职员在处理呼吸困难支持这些药理学和非药理学工具的应用程序的定制的实现策略。主要目的是不收到呼吸困难的足够的消除的病人的率到减少。这是四阶段的伪试验性的研究。干预在将在心病学和呼吸的药部门被教的二次教学谈话在于。内容将被辩解的照顾专家准备，基于为呼吸困难和病人需要的管理的可得到的工具。在就医的病人的呼吸困难的代表性的研究将在干预前后被执行在诊所由于变化在呼吸困难紧张查明改进。最后阶段为根据我们的经验基于的呼吸困难管理在一致协议的创造在于。这研究的结果被期望价值大并且在不久的将来可以改变临床的实践并且支持一变化为呼吸困难照顾更好。

关键词：长期的肺的疾病呼吸困难心失败辩解的照顾

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Ultrasound: A promising tool for contemporary airway management

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World Journal of Clinical Cases 2015年第11期3卷 926-929页

作者： Rakesh Garg Anju Gupta department of Anaesthesiology Pain and Palliative Care Dr BRAIRCH All India Institute of Medical Sciences department of Anaesthesiology Maulana Azad Medical College

Airway evaluation and its management remainsan ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound(US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents(clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords(children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.

关键词： Airway Ultrasound Evaluation Difficult Management

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社区专业姑息治疗团队对患者临终时住院、急诊以及选择在医院内死亡的影响：一项汇总分析

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英国医学杂志中文版 2015年第10期18卷 587-593页

作者： Hsien Seow associate professor Kevin Brazil professor of palliative care Jonathan Sussman associate professor Jose Pereira head of division of paUiative medicine Denise Marshall associate professor Peter C Austin professor Amna Husain associate professor Jagadish Rangrej senior biostattsttctan Lsa Barbera associate professor 饶洁于世英 department of Oncology McMaster University HamiltonOntario LSV 5C2 Canada School of Nursing and Midwifery Queen's University BelfastBelfast UK Division of palliative care Faculty of Medicine University ofOttawa Ottawa Ontario Canada department of Family Medicine McMaster UniversityHamilton Ontario Canada Institute for Health Policy Management and Evaluation DallaLana School of Public Health University of Toronto TorontoOntario Canada department of Family and Community Medicine University ofToronto Toronto Ontario Canada institute for Clinical Evaluative Sciences Toronto OntarioCanada department of Radiation Oncology Institute of Health PolicyManagement and Evaluation University of Toronto TorontoOntario Canada 华中科技大学同济医学院附属同济医院

目的汇总11个开展家庭医疗服务的专业姑息治疗团队效应。设计进行一项回顾性队列研究的汇总分析。地点加拿大，安大略省。参与者3109名在2009-2011年接受专业姑息治疗团队医疗服务的患者（暴露组）及3109名在此期间接受常规医疗服务的... 详细信息

目的汇总11个开展家庭医疗服务的专业姑息治疗团队效应。设计进行一项回顾性队列研究的汇总分析。地点加拿大，安大略省。参与者3109名在2009-2011年接受专业姑息治疗团队医疗服务的患者（暴露组）及3109名在此期间接受常规医疗服务的患者（非暴露组）。干预措施虽然这些姑息治疗团队所在地区和规模不同，但包含了相同的核心团队成员和角色分配，即能够为患者在其家中提供综合姑息治疗的姑息治疗专科医师、护士和家庭医生，团队任务包括全天候的管理症状、给予医疗信息和治疗措施以及协调服务。主要结局测量指标患者（a）在死亡前最后2周在医院度过；（b）死亡前最后2周有过急诊；（c）在医院内死亡。结果暴露组和非暴露组中癌症患者约占80％，且78％患者接受临终家庭医疗护理服务的平均时间相同。在所有姑息治疗团队中，暴露组中分别有970（31．2％）和896（28．9％）名患者在生命最后2周住院治疗和有急诊经历，而在非暴露组，分别为1219（39．3％）和1070（34．5％）名患者（P〈0．001）。暴露组与非暴露组患者在生命终期住院和经历急诊的汇总相对危险度分别为0．68[95％可信区间（CI，0．61～0．76）]和0．77[95％CI（0．69～0．86）]。与非暴露组相比，暴露组患者选择院内死亡的更少[503（16．2％）比887（28．6％），P〈0．01]，且在医院内濒死的汇总相对危险度为0．46（0．40-0．52）。结论尽管社区专业姑息治疗团队的组成和地区不同，但均能有效降低患者临终时急诊及选择在医院内死亡比例。

关键词：社区生命死亡医院急诊组对专家治疗

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