Objective To explore the clinical features and diagnostic procedure of atypical asthma characteristic of chest pain.Methods The patients with unexplained chest pain were screened by lung function test and bronchial provocation test.The diagnosis of asthma was established by therapeutic test and exclusive procedure.The clinical manifestations were analyzed.Results In 56 cases of unexplained chest pain 20 cases were diagnosed as asthma.While all patients referred to clinic with chest pain as chief complaint，a majority of patients (11 cases，85%) showed obscure chest tightness，breath shortness and cough..Some cases reported the same trigger factors as asthma.Chest pain was relieved in all cases after regular antiasthma treatments.Conclusions Chest pain could be a specific presentation of asthma which may be misdiagnosed as other diseases.Bronchial provocation tests and antiasthma therapy should be considered to screen and diagnose this atypical asthma.
Objective To systematically evaluate effectiveness and safety of nerve block therapy for neck pain. Methods Databases including CENTRAL, PubMed, Ovid, ISI, EBSCO, CBM and CNKI were searched from the date of their establishment to November 2011, and relevant references were also retrieved manually to collect both domestic and abroad randomized controlled trials (RCTs) about nerve block therapy for neck pain. According to the inclusion and exclusion criteria, two researchers independently screened literature, extracted data, and assessed the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.0 software. Results A total of 10 studies involving 625 participants were included. The results of qualitative analysis showed that: a) The short-term effectiveness of the nerve block therapy group was markedly superior to the placebo group, the cognitive therapy group and the transcutaneous electric nerve stimulation (TENS) group; and b) The short-term effectiveness of the combined nerve block therapy was markedly superior to the single nerve block therapy. The results of meta-analysis demonstrated that: a) There was no significant difference between the greater occipital nerve (GON) block group and the C2/3 nerve block group in neither short-term (SMD=−0.13, 95%CI −0.58 to 0.32, P=0.58) nor medium-term effectiveness (SMD=−0.01, 95%CI −0.46 to 0.44, P=0.98); and b): There was no significant difference between the injection with steroids group and the injection without steroids group in both short-term (SMD=0.16, 95%CI −0.13 to 0.44, P=0.28) and long-term effectiveness (SMD=0.27, 95%CI −0.02 to 0.55, P=0.07). Conclusion Current evidence shows nerve block therapy for neck pain is safe and especially good in short-term effectiveness. The combined nerve block therapy is probably more effective, but the effectiveness is not obviously improved by injection with or without steroids, and by different block methods. Due to the limitation of quality, quantity and total sample size of the included studies, this conclusion still needs to be proved by conducting more high quality and large scale studies.
ObjectiveTo explore the effect of selective exercise training technique combined with ultrasound therapy on patellofemoral pain syndrome. MethodsPatients who met the research criteria were assigned into treatment group and control group randomly between July 2011 and August 2012. Each group had 28 patients. There were no significant differences in gender, age and body mass index between the two groups (P>0.05). Patients in the treatment group received selective exercise therapy and ultrasound therapy, while patients in the control group received normal exercise treatment and ultrasound therapy. Knee numerical pain rating scale (NPRS) and knee functional obstruction assessment were performed on all the patients before treatment and 5 days after treatment (on the 6th day) for comparison. ResultsBefore treatment, the score of NPRS in the treatment group and the control group was 4.7±0.8 and 4.8±0.9, respectively, with no significant difference (P>0.05). The score of functional obstruction assessment was 11.2±2.2 and 12.2±2.7 in the two groups without significant difference (P>0.05). Five days after treatment, the NPRS score decreased to 2.1±0.5 in the treatment group and 4.2±1.0 in the control group, and the knee functional obstruction assessment score decreased to 6.4±1.9 and 11.1±2.6, respectively. Both groups improved significantly in NPRS score and knee functional obstruction assessment score (P＜0.05), while the treatment group exhibited more improvement in the two scores than the control group (P＜0.05). ConclusionSelective exercise training is effective for improving the pain and function of patients with patellofemoral syndrome.
ObjectiveTo understand the cervical spine function, core stability and strength of fighter pilots, and to explore the difference of that between fighter pilots with and without neck pain.MethodsFrom October to December 2020, a double-blind design was used to test the cervical spine function, core stability and strength of fighter pilots of a certain part of the Air Force. At the same time, the area of deep cervical flexor and the thickness of transverse abdominis and multifidus muscles were measured. According to the presence or absence of neck pain in the last 3 months, they were divided into neck pain group and non-neck pain group. The cervical spine function, core stability and core strength, deep cervical flexor and transversus abdominis endurance of the two groups were compared and analyzed.ResultsA total of 38 pilots were included. There was no significant difference in age, body mass index, service life, flight time, total flight time and weekly flight time between the neck pain group and the non-neck pain group (P>0.05). There was no significant difference in cervical spine mobility between the two groups of pilots (P>0.05). The cervical flexor muscle strength [(15.5±4.9) vs. (12.1±3.0) N] and the ratio of cervical flexion/neck extension (0.6±0.1 vs. 0.5±0.1) in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of other superficial cervical muscles between the two groups (P>0.05). The average value of deep neck flexor endurance in the neck pain group [25.36 mm Hg(1 mm Hg=0.133 kPa)] better than the non-neck pain group group (17.11 mm Hg) (P=0.026). There was no significant difference in test values of transverse abdominis endurance between the two groups (P>0.05). The left hip internal rotator strength [(11.9±2.6) vs. (10.0±2.1) N] and the left hip external rotator strength [(13.7±2.2) vs. (11.9±2.0) N] in the non-neck pain group were higher than in the neck pain group (P<0.05). There was no significant difference in the muscle strength of the other hip joint muscles between the two groups (P>0.05). The thickness of the right transversus abdominis in the neck pain group [(1.1±0.3) vs. (0.8±0.3) cm] was higher than that in the non-neck pain group (P<0.05). There was no significant difference in the thickness of the left transversus abdominis, the cross-sectional area of deep cervical flexor muscle and the thickness of lumbar multifidus muscle between the two groups (P>0.05).ConclusionsFighter pilots with neck pain have superficial cervical flexor muscle strength and decreased left hip internal and external rotation muscle strength, and the superficial cervical flexor and extensor muscle strength is unbalanced. Strengthening the superficial cervical flexor muscle strength, improving the balance between the superficial cervical flexor and extensor muscles, and enhancing the hip internal and external rotator muscle strength may help prevent neck pain.
Objective To explore the pain after discharged in patients with radical total gastrectomy under painless ward management, and to analyze the causes of pain in order to guide the treatment strategy after discharge. Methods Retrospective analysis was performed on the pain data of 82 patients who underwent radical total gastrectomy in The First Affiliated Hospital of Air Force Military Medical University from December 2015 to April 2017, and the situation of pain was followed-up at 2 weeks, 1 month, 2 months, and 3 months after discharged. Results Mild pain occurred in 25 patients at the 2 weeks after discharged; mild pain occurred in 38 patients and moderate pain occurred in7 patients at the first month after discharged; mild pain occurred in 31 patients and moderate pain occurred in 4 patients at the second month after discharged; 19 patients had mild pain at the third month after discharged. There was no significant difference in pain scores between male patients and female patients, <60 years old patients and ≥60 years old patients, patients’ operative time<180 min and patients’ operative time ≥180 min, patients’ intraoperative blood loss<200 mL and patients’ intraoperative blood loss ≥200 mL at the all time points, including the second week, the first, the second, and the third month after discharge ( P>0.05). Conclusion Painless ward management can effectively control the degree of pain in discharged patients who underwent radical total gastrectomy.
ObjectiveTo explore the effect of dynamic neuromuscular stabilization technique for chronic non-specific low back pain. MethodsFrom July 2019 to June 2020, 60 patients with chronic non-specific low back pain who underwent rehabilitation at the outpatient clinic of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine were prospectively selected. All patients were divided into trial group and control group by random number table method. There were 30 cases in each group. The control group used rehabilitation education and core muscle strength training. The trial group used dynamic neuromuscular stabilization of chest and abdomen combined with breathing control training on the basis of the treatment plan of the control group. The Visual Analogue Scale (VAS) score, Oswestry Dability Index (ODI), abdominal pressure stability, xiphoid level thoracic mobility and axillary level thoracic mobility were compared between the two groups of patients. ResultsAll the 60 patients in this study completed the trial, and there was no recurrent case during treatment, after treatment or during follow-up. There was no statistically significant difference in age, gender, height, weight, body mass index, or course of disease between the two groups (P>0.05). Taking VAS score as the dependent variable, the result of generalized estimating equations showed that the difference in VAS score between the trial group and the control group was statistically significant (χ2=4.132, P=0.042), and the VAS scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=1618.814, P<0.001; χ2=1573.419, P<0.001); the between-group comparisons at different time points showed that the difference in VAS score between the two groups at 12 weeks of follow-up was statistically significant (P<0.001), and the remaining between-group differences were not statistically significant (P>0.05). Taking ODI score as the dependent variable, the result of generalized estimating equations showed that the difference in total ODI score between the two groups was statistically significant (χ2=11.063, P=0.001), and the ODI scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=524.694, P<0.001; χ2=717.236, P<0.001); the between-group comparisons at different time points showed that there were statistically significant differences between the two groups at 8 weeks of treatment and at 12 weeks of follow-up (P<0.001). After treatment, the improvement of stability value of abdominal pressure [(−4.93±8.14) vs. (−1.33±4.78) mm Hg (1 mm Hg=0.133 kPa)], the improvement of xiphoid level thoracic mobility [(1.87±0.62) vs. (1.52±0.70) cm] and the improvement of axillary level thoracic mobility [(1.78±0.62) vs. (0.92±0.45) cm] in the trial group were better than those in the control group (P<0.05).ConclusionThe dynamic neuromuscular stabilization technique can improve the dysfunction and relieve the symptoms of patients with chronic non-specific low back pain, and it is worthy of promotion.
Objective To explore the risk factors of chronic postoperative inguinal pain (CPIP) after transabdominal preperitoneal hernia repair (TAPP), establish and verify the risk prediction model, and then evaluate the prediction effectiveness of the model. Methods The clinical data of 362 patients who received TAPP surgery was retrospectively analyzed and divided into model group (n=300) and validation group (n=62). The risk factors of CPIP in the model group were screened by univariate analysis and multivariate logistic regression analysis, and the risk prediction model was established and tested. Results The incidence of CPIP at 6 months after operation was 27.9% (101/362). Univariate analysis showed that gender (χ2= 12.055, P=0.001), age (t=–4.566, P<0.01), preoperative pain (χ2=44.686, P<0.01) and early pain at 1 week after operation (χ2=150.795, P<0.01) were related to CPIP. Multivariate logistic regression analysis showed that gender, age, preoperative pain, early pain at 1 week after operation, and history of lower abdominal surgery were independent risk predictors of CPIP. The area under curve (AUC) of the receiver operating characteristic (ROC) of the risk prediction model was calculated to be 0.933 [95%CI (0.898, 0.967)], and the optimal cut-off value was 0.129, while corresponding specificity and sensitivity were 87.6% and 91.5% respectively. The prediction accuracy, specificity and sensitivity of the model were 91.9% (57/62), 90.7% and 94.7%, respectively when the validation group data were substituted into the prediction model. Conclusion Female, age≤64 years old, preoperative pain, early pain at 1 week after operation and without history of lower abdominal surgery are independent risk factors for the incidence of CPIP after TAPP, and the risk prediction model established on this basis has good predictive efficacy, which can further guide the clinical practice.
Objective To review the research progress on protease-activated receptor 2 (PAR-2) in the pathogenesis of osteoarthritis (OA). Methods The relevant literature about the mechanism of PAR-2 in the occurrence and development of OA in recent years was extensively reviewed and comprehensively analyzed. Results Abnormal activation of PAR-2 plays an important role in responses to occurrence and development of OA. Through regulating production and releasing of a variety of cytokines (such as inflammatory factors, metabolic factors, pain factors, etc.), the PAR-2 can involve in pathophysiological progression of OA articular cartilage, subchondral bone, and synovial membrane, as well as occurrence and transmission of pain. Conclusion PAR-2 participation in the development of OA has been confirmed. However, since PAR-2 is complicated and widespread, it is necessary to study the specific role of PAR-2 and the interaction between various signal pathways in the progression of OA, and to elucidate the potential pathophysiological mechanisms of PAR-2 participating in the process of OA, in the hope of exploring the new targets for the effective control of OA.
Nevus flammeus is a skin disease caused by congenital skin capillary malformation. In recent years, photodynamic therapy (PDT) has been proved to be effective and safe for this disease, but significant pain in the treatment process is the biggest obstacle to the implementation of this therapy. This article reviews the current pain management strategies in PDT. The current pain management methods include topical anesthesia, cold air analgesia, nerve block and others. Topical anesthesia has weak analgesic effect and short duration in PDT. Cold air analgesia is simple and feasible, but there is potential risk of affecting the treatment effect. The analgesic effect of nerve block is accurate, but the application scenario is limited. For nevus flammeus patients who need PDT, individualized analgesia should be selected according to the patient’s age and treatment scenario.
Diabetic neuropathic pain (DNP) is one of the most common and complex complications of diabetes. In recent years, studies have shown that gut microbiota can regulate inflammatory response, intestinal permeability, glucose metabolism, and fatty acid oxidation, synthesis, and energy consumption by regulating factors such as lipopolysaccharides, short chain fatty acids, bile acids, and branched chain amino acids, achieving the goal of treating DNP. This paper summarizes the relevant mechanisms of gut microbiota in the treatment of DNP, the relevant intervention measures of traditional Chinese and western medicine, in order to provide new ideas for clinical treatment of DNP.