Translational perioperative and pain medicine最新文献

{"title":"Does Size Matter? The Rationale for Centralising Acute Stroke Care into a Smaller Number of Larger Units","authors":"R. Anthony","doi":"10.31480/2330-4871/096","DOIUrl":"https://doi.org/10.31480/2330-4871/096","url":null,"abstract":"The experience from London where services were reconfigured in 2010 from 32 hospitals providing acute stroke care to just eight showed that processes of care were much improved with less door to needle time, higher thrombolysis rates, quicker access to stroke units, better swallow screening for dysphagia etc., mortality fell significantly compared to the rest of England. Although there were increased costs initially with the need to provide higher levels of medical, nursing and therapy, cover in the eight hospitals by 30 days after admission costs fell. This was due to lower use of intensive care beds and shorter lengths of stay. Projecting costs forward to 10 years fell very significantly largely down to patients having lower levels of disability and requiring less formal and informal care [2-4]. Manchester that initially reconfigured services to less stroke units but only focussing on getting potentially thrombolysable patients to the comprehensive stroke centre failed to show similar benefits. However, when they changed the model to one similar to London where all patients with acute stroke were taken to the comprehensive stroke centres, the outcomes improved to match those in London [5]. The plan in England now is to reduce the number of acute hospitals treating stroke from the current 120 to about 80, of which about half will be offering intra-arterial clot retrieval, and the remaining ones offering all other acute care and providing drip and ship facilities for patients appropriate for thrombectomy.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43548988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BIX01294, a G9a inhibitor, alleviates nerve injury-induced pain hypersensitivities during both development and maintenance periods.","authors":"Lingli Liang, Jian-Yuan Zhao, Ticehurst Kathryn, A. Bekker, Y. Tao","doi":"10.31480/2330-4871/097","DOIUrl":"https://doi.org/10.31480/2330-4871/097","url":null,"abstract":"Genetic knockdown or knockout of the histone methytransferase G9a in the injured dorsal root ganglion (DRG) has been shown to alleviate neuropathic pain development. However, the application of genetic strategy in clinic is highly limited. The present study sought to examine the effect of intrathecal BIX01294, a specific G9a inhibitor, on the development and maintenance of pain hypersensitivities caused by unilateral L5 spinal nerve injury (SNL) or chronic constriction injury (CCI) to the sciatic nerve in rats. We found that intrathecal administration of BIX01294 reduced SNL- or CCI-induced mechanical allodynia, thermal hyperalgesia and cold allodynia not only in the development period but also in the maintenance period. These effects were dose-dependent. Intrathecal administration of BIX01294 also blocked the SNL-induced increase in the level of H3K9me2, a marker of G9a activity, and reversed SNL-induced downregulation of Oprm1 mRNA, Oprk1 mRNA, Oprd1 mRNA, Kcna2 mRNA, and Kcna4 mRNA, the downstream targets of G9a, in the ipsilateral L5 DRG. These findings further implicate that G9a as a potential target in the management of neuropathic pain.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 4 1","pages":"106-114"},"PeriodicalIF":0.0,"publicationDate":"2019-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45570358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report and Literature Review: Interventional Management of Erythromelalgia","authors":"G. Chinn, Zhonghui Guan","doi":"10.31480/2330-4871/094","DOIUrl":"https://doi.org/10.31480/2330-4871/094","url":null,"abstract":"Erythromelalgia is a rare and very difficult to treat pain syndrome that usually presents as severe bilateral burning pain in the extremities. Here we present a case of a 34-year-old female with erythromelalgia who we treated successfully with a lumbar epidural infusion of ropivacaine and fentanyl. The patient had complete relief shortly after the epidural infusion, and she remained stable with only minor pain two weeks and nine months later. With this case, we have reviewed the interventional treatments of erythromelalgia. We suggest epidural infusion as the first line interventional management, followed by sympathetic block. Spinal cord stimulation can be considered if other interventional managements fail.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 1","pages":"91 - 97"},"PeriodicalIF":0.0,"publicationDate":"2019-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46708260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Cord Stimulation for Failed Back Surgery Syndrome -- Patient Selection Considerations.","authors":"N. Palmer, Zhonghui Guan, N. Chai","doi":"10.31480/2330-4871/093","DOIUrl":"https://doi.org/10.31480/2330-4871/093","url":null,"abstract":"Background\u0000Failed back surgery syndrome (FBSS) refers to the condition where persistent pain is experienced by patients following back surgery. This condition is historically difficult to treat. Spinal cord stimulation (SCS) and its recent technical advances have opened the door to a promising treatment option for FBSS. However, critical appraisal of supporting and refuting data is necessary to identify the best patient population for this treatment modality.\u0000\u0000\u0000Methods\u0000In this systematic review, we review randomized controlled studies and cohort studies with matched controls to synthesize the data on the overall efficacy of spinal cord stimulation for FBSS. We further identify available data on outcome measurements based on working status, psychological status, smoking, sex, and race to provide insight on patient selection and identify needs for further research.\u0000\u0000\u0000Results\u0000The literature search identified 34 publications, of which 23 were excluded due to duplication and inclusion/ exclusion criteria, yielding a total of 11 publications for review. Seven out of eleven studies reviewed had sources of potential funding or affiliation bias. Three out of 4 studies with radiating leg pain relief as their primary outcome showed statistically significant improvement with SCS treatment, while 2 out of 5 studies with mixed radiating leg pain and axial back pain as the primary outcome showed statistically significant improvement with SCS. All randomized controlled trials that included functional status and quality of life outcome measures showed improvement after SCS, though scales utilized in each study varied. Six studies included work status as a patient descriptor with only three reporting inclusion of workers' compensation patients. There was limited data on the effect of psychological status, smoking, sex or race on SCS outcomes based on the studies reviewed.\u0000\u0000\u0000Conclusions\u0000Evidence for the efficacy of SCS in FBSS is accumulating, with most studies demonstrating its efficacy especially for those patients with leg pain as the predominant symptom. However, a significant weakness in the current data includes potential bias based on the funding source for most studies. Additionally, it is clear that SCS provides short-term benefit, yet there is no solid evidence that SCS provides any benefit beyond two years of implantation. Another major concern is the significant placebo effect, which makes the true therapeutic response difficult to judge. Further, it is increasingly important to focus future studies on refining patient populations to those that may best respond to both SCS therapy in general, as well as specific stimulation techniques.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 3 1","pages":"81-90"},"PeriodicalIF":0.0,"publicationDate":"2019-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43377834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Outcomes of Pediatric Hematopoietic Stem Cell Transplantation Recipients Requiring Intensive Care Unit Admission- A Single Center Experience","authors":"Royce Kwon, S. Koutsogiannaki, S. Staffa, Koichi Yuki","doi":"10.31480/2330-4871/092","DOIUrl":"https://doi.org/10.31480/2330-4871/092","url":null,"abstract":"Background: Although the outcome of pediatric hematopoietic stem cell transplantation (HSCT) has significantly improved, it remains to be associated with high mortality. Identifying patients at high risk of mortality may potentially help to triage clinical management. The primary objective of this study is to evaluate risk factors associated with mortality of patients who received HSCT and admitted to ICU using pediatric sequential organ failure assessment (pSOFA), one of pediatric severity scoring systems in intensive care unit (ICU). Methods: We performed retrospective review of electronic medical records of pediatric patients who received HSCT and were admitted to ICU in our institution between January 2010 and June 2018. Incidence of mortality was obtained, and risk factors associated with the mortality were examined using univariate and multivariable analyses. Results: The mortality rate of pediatric HSCT patients who were admitted to ICU as a whole was 27.9%. Patients were divided into three groups based on the number of HSCT required and timing of ICU admission. Patients who received first HSCT and admitted to ICU during the same hospital stay were the majority of the study population (Group A). d(pSOFA), which was defined as the difference between maximum pSOFA and admission pSOFA, greater than and equal to 7 best predicted mortality of Group A (the area under the ROC curve 0.850; 95% CI: 0.733–0.966). Univariate and multivariable analyses showed that an increase in neurologic and cardiovascular sub scores were independently associated with higher mortality (odds ratio (OR) 2.27; 95% CI: 1.32–3.93, and OR 2.69; 95% CI: 1.21–5.99, respectively). Discussion: In our single center study, pediatric HSCT patients who were admitted to ICU demonstrated a high mortality. Risk factor analysis demonstrated that patients with the progression of neurologic and cardiovascular injuries probed by pSOFA scoring system during their ICU stay were strongly associated with mortality.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 1","pages":"75 - 80"},"PeriodicalIF":0.0,"publicationDate":"2019-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45031486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and In-Hospital Management of Stroke","authors":"L. Yue, S. Tong, Yi-ping Ding, Shan-shan Diao, Liyan Tan, Xiu-ying Cai, Xuliang Zhuan, K. Yan","doi":"10.31480/2330-4871/091","DOIUrl":"https://doi.org/10.31480/2330-4871/091","url":null,"abstract":"Background: For acute ischemic stroke (AIS), intravenous thrombolysis (IVT) is an effective but time-dependent therapy. However, patients are usually too late for treatment, mainly because of preand in-hospital delays. Method: Papers were identified through the PubMed search, with keywords such as: ‘stroke’, ‘thrombolysis’, ‘management’, ‘prehospital delay’, ‘in-hospital delay’. Results: In pre-hospital stroke management, factors related to pre-hospital delays include demographic characteristics, social factors, clinical factors, behavioral factors, and cognitive factors. Great significance should be assigned to the implementation of stroke preparedness interventions, stroke assessment instruments, the use of emergency medical service (EMS), mobile stroke units (MSUs), and the Stroke Emergency Map. With regard to in-hospital stroke management, there are some tasks related to the inhospital delays, such as registering patients, waiting for the stroke team, CT availability, lab resources, and making a decision for thrombolytic therapy. With good communication between the EMS and the emergency department (ED), delays can be significantly reduced. Conclusions: With the streamlining of all aspects of prehospital and in-hospital thrombolysis processes and the increase of hospital experience, we can achieve a shorter onset-to-treatment time (OTT), and more patients may benefit from timely thrombolytic therapy.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46100675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus on the Sensory Nervous System in Pain Diagnosis and Treatment","authors":"Lu Zhenhe, G. Chongrong, Fu Zhijian, Gong Qingjuan, F. Bifa","doi":"10.31480/2330-4871/090","DOIUrl":"https://doi.org/10.31480/2330-4871/090","url":null,"abstract":"Pain affects many physiological functions, and the diagnosis and treatment of chronic pain are relatively complicated. A group of Chinese pain physicians engaged in the field of chronic pain for a long time recommended that evaluating the sensory nervous system based on clinical findings and looking for locations of pain generators, including the sensory nerve endings, the conductive pain pathways, and the brain, are conducive to accurate diagnosis and appropriate treatment targeted at the causes of pain.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42786348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperkalemia after Administration of Hypertonic Mannitol: Two Case Reports: Reply to Editor","authors":"Chen Hsuan-ling, Z. Bin, Y. Lan","doi":"10.31480/2330-4871/089","DOIUrl":"https://doi.org/10.31480/2330-4871/089","url":null,"abstract":"The preoperative examination showed that this patient’s D-dimer level was normal and the ultrasonography of lower extremity vein showed no deep vein thromboses (DVTs). The patient did not have the risk factor of PE like obesity or after surgery which causes hypercoagulability. Meanwhile when the hypotension and bradycardia occurred, the surgeon was separating the brain tissue, and the TEE did not find any direct and indirect evidences of potential pulmonary thromboses.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45279869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leriche Syndrome in the Setting of Coronary Artery Bypass Grafting","authors":"E. H. Roy, B. John, Tveter Kevin, R. Pavithra, P. Jeffrey, B. Matthew","doi":"10.31480/2330-4871/088","DOIUrl":"https://doi.org/10.31480/2330-4871/088","url":null,"abstract":"We present the case of a 60-year-old male with Leriche Syndrome discovered on cardiac catheterization in preparation for coronary artery bypass grafting. While the patient was in the operating room receiving sedation and preoxygenation, additional angiography was requested to determine the routes of collateralization to the lower extremities. Because no route could be established with existing angiographic images, the case was canceled before induction of anesthesia. It was later determined by further testing that collateral flow to the bilateral lower extremities was dependent on the bilateral internal mammary arteries. This patient was subject to increased morbidity due to the inability to determine collateral flow and appropriate grafting vessels prior to the scheduled operation, leading to delay in treatment. Leriche Syndrome, or aortoiliac occlusive disease, is a known, but infrequently encountered coexisting disease process in patients presenting for coronary artery bypass grafting (CABG) procedures. Recognizing the importance of its implications specific to CABG surgery can help to avoid major postoperative morbidity and mortality through proper evaluation and surgical consideration.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48402337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post Thoracic Surgery Pain Management: A Novel Regional Approach beyond Epidural Catheter?","authors":"David Li, Aubrey P Yao, Hong Liu","doi":"10.31480/2330-4871/087","DOIUrl":"https://doi.org/10.31480/2330-4871/087","url":null,"abstract":"Perioperative care of the thoracic surgery patient is often focused on lung isolation, management of hypoxemia, and avoidance of acute lung injury. In the context of these acute needs, postoperative analgesia frequently becomes an afterthought. However, poor postoperative pain control significantly delays a patient’s recovery, increases postoperative morbidity, and even leads to increased healthcare costs [1]. Excessive reliance on opioidbased analgesia can result in nausea, vomiting, ileus, respiratory depression and oversedation. Therefore, there is a significant need for improved postoperative analgesic regimens for thoracic surgery patients.","PeriodicalId":75245,"journal":{"name":"Translational perioperative and pain medicine","volume":"6 1","pages":"49 - 52"},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42507773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}