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Response Letter to the Editor Regarding "Clinical Application of Different Doses of Hydromorphone Slow-Release Analgesia in Lumbar Fusion in Elderly Patients". 就 "不同剂量的氢吗啡酮缓释镇痛在老年腰椎融合术中的临床应用 "致编辑的回信。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-10 DOI: 10.1007/s40122-024-00663-w
Weibo Zhong, Xianwei Jin
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引用次数: 0
Peripheral Nerve Stimulation for Neuropathic Pain Management: A Narrative Review. 外周神经刺激治疗神经性疼痛:叙述性综述。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-28 DOI: 10.1007/s40122-024-00659-6
Zhangyan Mao, Jing Lv, Yan Sun, Jiwei Shen, Yafen Gao, Shujun Sun, Dong Yang

This narrative review examines the therapeutic efficacy of peripheral nerve stimulation (PNS) in the treatment of neuropathic pain (NP), a type of pain arising from lesions or diseases of the somatosensory system with a global prevalence ranging from 6.90% to 10.00%. Traditional pharmacological interventions often fall short for many persons, highlighting the need for alternative treatments such as PNS, which has demonstrated significant promise with minimal side effects. The review summarizes the effectiveness of PNS in various NP conditions, including trigeminal neuralgia and postherpetic neuralgia, and underscores the need for further research to refine treatment approaches. The mechanism of PNS is discussed, involving the activation of non-nociceptive Aβ fibers and modulation of neurotransmitters, and offering pain relief through both peripheral and central pathways. Despite the proven efficacy of PNS, challenges remain, including the need for randomized controlled trials and the optimization of stimulation parameters. The review concludes that PNS is a promising treatment modality for NP, warranting additional high-quality trials to solidify its role in clinical practice.

神经病理性疼痛是一种由躯体感觉系统病变或疾病引起的疼痛,全球发病率为 6.90% 到 10.00%。传统的药物干预对许多人来说往往效果不佳,这就凸显了对替代疗法的需求,例如 PNS,它已被证明前景广阔且副作用极小。综述总结了 PNS 对各种 NP 病症(包括三叉神经痛和带状疱疹后神经痛)的疗效,并强调了进一步研究以完善治疗方法的必要性。文章讨论了 PNS 的机制,包括激活非痛觉 Aβ 纤维和调节神经递质,以及通过外周和中枢途径缓解疼痛。尽管 PNS 的疗效已得到证实,但挑战依然存在,包括需要进行随机对照试验和优化刺激参数。综述认为,PNS 是一种很有前景的 NP 治疗方式,需要进行更多高质量的试验,以巩固其在临床实践中的作用。
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引用次数: 0
Unaltered Responses of Distal Motor Neurons to Non-Targeted Thoracic Spinal Cord Stimulation in Chronic Pain Patients. 慢性疼痛患者远端运动神经元对非靶向胸椎脊髓刺激的反应未发生改变
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-18 DOI: 10.1007/s40122-024-00670-x
Carolyn Riera, Daniela Souza de Oliveira, Matthias Borutta, Martin Regensburger, Yining Zhao, Steffen Brenner, Alessandro Del Vecchio, Thomas M Kinfe

Introduction: Spinal cord stimulation (SCS) represents an established interventional pain therapeutic; however, the SCS effects of SCS waveforms on motor neuron recruitment of the lower limbs of chronic pain patients remain largely unknown.

Methods: We investigated these effects by performing isometric ankle-dorsal flexions at varying force levels under four SCS conditions: SCS Off (1 week), burst SCS (40 Hz), SCS Off (acute), and tonic SCS (130 Hz). Muscle activity was recorded via high-density surface electromyography (64-electrode grid) on the tibialis anterior muscle. Motor unit action (MUs) potentials were analyzed for recruitment and de-recruitment thresholds, discharge rate, inter-spike interval, and common synaptic input.

Results: In this prospective study, we included nine patients (five females; four males; mean age 59 years) with chronic pain treated with thoracic (Th7-Th8) epidural spinal stimulation. A total of 97 MUs were found for 15% maximal voluntary torque (MVT) and 83 for 30%MVT, an average of 10.8 ± 3.7 for 15%MVT and 10.4 ± 3.5 for 30%MVT. While a few subject-specific variations were observed, our study suggests that the different SCS frequencies applied do not significantly influence motor unit discharge characteristics in the TA muscle among the participants (p values at 15%MVT were 0.586 (Chi2 = 1.933), 0.737 (Chi2 = 1.267), 0.706 (Chi2 = 1.4) and 0.586 (Chi2 = 1.933), respectively. The p values of the Friedman test at 30%MVT were 0.896 (Chi2 = 0.6), 0.583 (Chi2 = 1.95), 0.896 (Chi2 = 0.6) and 0.256 (Chi2 = 4.05). No significant difference was found for the different stimulation types for the delta (0-5 Hz), alpha (5-12 Hz), and beta (15-30 Hz) bands at both force levels.

Conclusions: In summary, we did not observe any changes in motor unit oscillatory activity at any low and high bandwidths, indicating that SCS using different waveforms (tonic/burst) does not significantly influence motor neuron recruitment for non-motor individuals with chronic pain.

简介:脊髓刺激(SCS)是一种成熟的介入性疼痛治疗方法;然而,SCS 波形对慢性疼痛患者下肢运动神经元募集的影响在很大程度上仍然未知:我们通过在四种 SCS 条件下以不同的力量水平进行踝关节背侧等长屈伸来研究这些影响:SCS关闭(1周)、爆发性SCS(40赫兹)、SCS关闭(急性)和强直性SCS(130赫兹)。通过胫骨前肌的高密度表面肌电图(64 个电极网格)记录肌肉活动。对运动单位动作(MUs)电位的募集和去募集阈值、放电率、棘间期和共同突触输入进行了分析:在这项前瞻性研究中,我们纳入了九名接受胸椎(Th7-Th8)硬膜外脊柱刺激治疗的慢性疼痛患者(五名女性;四名男性;平均年龄 59 岁)。15% 最大自主转矩 (MVT) 和 30% 最大自主转矩 (MVT) 的 MU 分别为 97 和 83,15% 最大自主转矩 (MVT) 和 30% 最大自主转矩 (MVT) 的平均值分别为 10.8 ± 3.7 和 10.4 ± 3.5。虽然观察到了一些特定受试者的差异,但我们的研究表明,不同的 SCS 频率并不会显著影响受试者 TA 肌肉的运动单元放电特征(15%MVT 的 p 值分别为 0.586(Chi2 = 1.933)、0.737(Chi2 = 1.267)、0.706(Chi2 = 1.4)和 0.586(Chi2 = 1.933)。在 30%MVT 时,Friedman 检验的 p 值分别为 0.896(Chi2 = 0.6)、0.583(Chi2 = 1.95)、0.896(Chi2 = 0.6)和 0.256(Chi2 = 4.05)。在两种力量水平下,δ(0-5赫兹)、α(5-12赫兹)和β(15-30赫兹)波段的不同刺激类型没有发现明显差异:总之,我们在任何低带宽和高带宽下都没有观察到运动单元振荡活动的任何变化,这表明使用不同波形(强直/爆发)的 SCS 不会显著影响非运动型慢性疼痛患者的运动神经元募集。
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引用次数: 0
Abdominal Pain in Inflammatory Bowel Disease-Epidemiology, Pathophysiology, and Management: A Narrative Review. 炎症性肠病中的腹痛--流行病学、病理生理学和治疗:叙述性综述。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-28 DOI: 10.1007/s40122-024-00672-9
Wei-Wei Tan, Zi-Xuan Liu, Xiao-Yan Liu, Wei-Bing Zhang, Lie Zheng, Ya-Li Zhang, Yan-Cheng Dai

Abdominal pain is a major symptom of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, and has a significant impact on patients' quality of life. Given the evolving understanding of IBD pathology and management strategies, there is an urgent need to review the recent research findings. In this review, we have analyzed the epidemiology, pathophysiology, and management of abdominal pain in IBD over the past decade. We draw on the current literature and highlight emerging trends, challenges, and advances in this field. By synthesizing key findings, this review provides insights into the complex interplay between abdominal pain, disease progression, and therapeutic interventions for IBD.

腹痛是包括克罗恩病和溃疡性结肠炎在内的炎症性肠病(IBD)的主要症状,对患者的生活质量有很大影响。鉴于人们对 IBD 病理和治疗策略的认识在不断发展,因此迫切需要对近期的研究成果进行综述。在这篇综述中,我们分析了过去十年中 IBD 腹痛的流行病学、病理生理学和治疗方法。我们借鉴了当前的文献,并强调了这一领域新出现的趋势、挑战和进展。本综述通过对主要研究结果的归纳,深入探讨了腹痛、疾病进展和 IBD 治疗干预之间复杂的相互作用。
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引用次数: 0
The Impact of Different Regional Anesthesia Techniques on the Incidence of Chronic Post-surgical Pain in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Network Meta-analysis. 不同区域麻醉技术对视频辅助胸腔镜手术患者术后慢性疼痛发生率的影响:网络 Meta 分析
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-06 DOI: 10.1007/s40122-024-00648-9
Yue Zhao, Yaming Guo, Xue Pan, Xinyue Zhang, Fang Yu, Xuezhao Cao

Introduction: Chronic post-surgical pain (CPSP) remains a prevalent issue following video-assisted thoracic surgery (VATS), despite advancements in surgical techniques. Various regional anesthesia techniques, including thoracic paravertebral block (PVB), intercostal nerve block (ICNB), serratus anterior plane block (SAPB), erector spinae plane block (ESPB), and thoracic epidural anesthesia (TEA), have been employed in VATS procedures to mitigate this issue. This study aims to compare the efficacy of these analgesia methods in reducing the incidence of CPSP in VATS patients through a network meta-analysis.

Methods: A systematic search was conducted in PubMed, the Cochrane Library, and EMBASE for randomized controlled trials (RCTs) comparing the incidence of CPSP associated with PVB, ICNB, SAPB, ESPB, and TEA. The occurrence of CPSP was evaluated at both 2-3 months and 6 months post-surgery.

Results: Six RCTs, involving 652 patients, were included in the analysis of CPSP incidence at 2-3 months, while seven RCTs, involving 715 patients, were included for 6 months analysis. PVB, ICNB, or TEA reduced CPSP incidence compared with control group (without regional anesthesia techniques) at both 2-3 months and 6 months post-surgery. However, SAPB was found less effective in reducing CPSP incidence at 2-3 months post-VATS compared to PVB, ICNB, or TEA.

Conclusions: PVB, ICNB, and TEA exhibit significant effects on reducing CPSP incidence following VATS. Conversely, SAPB is not recommended for reducing CPSP incidence post-VATS. Nonetheless, considering the limitation of a small sample size in this network meta-analysis, additional RCTs are necessary to validate these conclusions and enhance the management of CPSP after VATS.

导言:尽管手术技术不断进步,但视频辅助胸腔镜手术(VATS)后的慢性术后疼痛(CPSP)仍是一个普遍问题。为缓解这一问题,VATS 手术中采用了多种区域麻醉技术,包括胸椎旁阻滞 (PVB)、肋间神经阻滞 (ICNB)、前锯肌平面阻滞 (SAPB)、竖脊肌平面阻滞 (ESPB) 和胸硬膜外麻醉 (TEA)。本研究旨在通过网络荟萃分析比较这些镇痛方法在降低 VATS 患者 CPSP 发生率方面的效果:方法: 在 PubMed、Cochrane 图书馆和 EMBASE 中进行了系统检索,以寻找比较与 PVB、ICNB、SAPB、ESPB 和 TEA 相关的 CPSP 发生率的随机对照试验 (RCT)。在手术后 2-3 个月和 6 个月对 CPSP 的发生率进行评估:有六项研究纳入了 2-3 个月的 CPSP 发生率分析,涉及 652 名患者;有七项研究纳入了 6 个月的 CPSP 发生率分析,涉及 715 名患者。与对照组(未采用区域麻醉技术)相比,PVB、ICNB 或 TEA 可降低术后 2-3 个月和 6 个月的 CPSP 发生率。然而,与 PVB、ICNB 或 TEA 相比,SAPB 在减少 VATS 术后 2-3 个月的 CPSP 发生率方面效果较差:结论:PVB、ICNB 和 TEA 对降低 VATS 术后 CPSP 发生率有显著效果。结论:PVB、ICNB 和 TEA 对降低 VATS 术后 CPSP 的发生率有明显效果,相反,不推荐使用 SAPB 来降低 VATS 术后 CPSP 的发生率。尽管如此,考虑到该网络荟萃分析样本量较小的局限性,有必要进行更多的 RCT 研究来验证这些结论,并加强对 VATS 术后 CPSP 的管理。
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引用次数: 0
Cerebral Artery Vasoconstriction After Galcanezumab Loading Dose for Migraine Prevention: A Case Report. Galcanezumab 加载剂量用于偏头痛预防后的脑动脉血管收缩:病例报告。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-04 DOI: 10.1007/s40122-024-00665-8
Thanin Asawavichienjinda, Nutchawan Jittapiromsak, Andrew Blumenfeld

Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies that target CGRP ligands or receptors, may cause a very rare side effect of reversible cerebral vasoconstriction syndrome (RCVS). This study is a case report of a patient who developed cerebral artery vasoconstriction documented on serial brain magnetic resonance angiography (MRA) scans without the typical manifestations of RCVS following galcanezumab loading dose. Case report: A 40-year-old female patient with high-frequency episodic migraine with visual aura on topiramate 100 mg/day developed transient numbness of the right upper and lower extremities and right face without headache and a normal neurological examination 10 min after a loading dose of galcanezumab, which resolved over the next 2 days. Magnetic resonance angiography brain imaging showed segmental arterial constriction of both middle cerebral arteries in the M1-2 segments and both posterior cerebral arteries in the P1-2 segments, which partial resolved in a subsequent study by the end of 6 months. There were no other supporting examination data, such as transcranial Doppler, which might provide additional information on the progression and improvement of the vasoconstriction. Her differential diagnosis included prolonged migraine sensory aura without headache, RCVS, or cerebral vasoconstriction secondary to the effect of an anti-CGRP monoclonal antibody. Further research needs to be conducted.

以 CGRP 配体或受体为靶点的抗降钙素基因相关肽(CGRP)单克隆抗体可能会导致一种非常罕见的副作用,即可逆性脑血管收缩综合征(RCVS)。本研究报告了一例患者的病例,该患者在服用 galcanezumab 负荷剂量后出现了脑动脉血管收缩,连续的脑磁共振血管造影(MRA)扫描记录显示其没有 RCVS 的典型表现。病例报告:一位 40 岁的女性患者,患有高频发作性偏头痛并伴有视觉先兆,服用托吡酯 100 毫克/天,在加载剂量 galcanezumab 10 分钟后出现短暂的右上下肢和右脸麻木,但无头痛,神经系统检查正常。磁共振血管成像脑成像显示,M1-2段的两侧大脑中动脉和P1-2段的两侧大脑后动脉出现节段性动脉收缩,在随后的研究中,6个月后部分收缩消失。没有其他辅助检查数据(如经颅多普勒)可以为血管收缩的进展和改善提供更多信息。她的鉴别诊断包括无头痛的长期偏头痛感觉先兆、RCVS或继发于抗CGRP单克隆抗体效应的脑血管收缩。还需要进一步研究。
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引用次数: 0
Clinical Efficacy of Auricular Vagus Nerve Stimulation in the Treatment of Chronic and Acute Pain: A Systematic Review and Meta-analysis. 耳廓迷走神经刺激在治疗慢性和急性疼痛中的临床疗效:系统综述和元分析》(A Systematic Review and Meta-analysis)。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-09 DOI: 10.1007/s40122-024-00657-8
Irina T Duff, Rudolf Likar, Christophe Perruchoud, Stefan Kampusch, Markus Köstenberger, Sabine Sator, Caroline Stremnitzer, Andreas Wolf, Stefan Neuwersch-Sommeregger, Alaa Abd-Elsayed
<p><strong>Introduction: </strong>Current guidelines for pain treatment recommend a personalized, multimodal and interdisciplinary approach as well as the use of a combination of drug and non-drug therapies. Risk factors for chronification should already be reduced in patients with acute pain, e.g., after surgery or trauma. Auricular vagus nerve stimulation (aVNS) could be an effective non-drug therapy in the multimodal treatment of chronic and acute pain. The aim of this systematic review and meta-analysis is to evaluate the clinical efficacy and safety of aVNS in treating chronic and acute pain conditions.</p><p><strong>Methods: </strong>A systematic literature search was performed regarding the application of auricular electrical stimulation in chronic and acute pain. Studies were classified according to their level of evidence (Jadad scale), scientific validity and risk of bias (RoB 2 tool) and analyzed regarding indication, method, stimulation parameters, duration of treatment and efficacy and safety. A meta-analysis on (randomized) controlled trials (using different comparators) was performed for chronic and acute pain conditions, respectively, including subgroup analysis for percutaneous (pVNS-needle electrodes) and transcutaneous (tVNS-surface electrodes) aVNS. The visual analog pain scale (VAS) was defined as primary efficacy endpoint.</p><p><strong>Results: </strong>A total of n = 1496 patients were treated with aVNS in 23 identified and analyzed studies in chronic pain, 12 studies in acute postoperative pain and 7 studies in experimental acute pain. Of these, seven studies for chronic pain and six studies for acute postoperative pain were included in the meta-analysis. In chronic pain conditions, including back pain, migraine and abdominal pain, a statistically significant reduction in VAS pain intensity for active compared to sham aVNS or control treatment with an effect size Hedges' g/mean difference of - 1.95 (95% confidence interval [CI]: - 3.94 to 0.04, p = 0.008) could be shown and a more favorable effect in pVNS compared to tVNS (- 5.40 [- 8.94; - 1.85] vs. - 1.00 [- 1.55; - 0.44]; p = 0.015). In acute pain conditions, single studies showed significant improvements with aVNS, e.g., in kidney donor surgery or tonsillectomy but, overall, a non-statistically significant reduction in VAS pain intensity for active compared to sham aVNS or control with - 0.70 [- 2.34; 0.93] (p = 0.15) could be observed in the meta-analysis. In acute pain results vary greatly between studies depending especially on co-medication and timepoints of assessment after surgery. A significant reduction in analgesics or opiate intake was documented in most studies evaluating this effect in chronic and acute pain. In 3 of the 12 randomized controlled trials in patients with chronic pain, a sustainable pain reduction over a period of up to 12 months was shown. Overall, aVNS was very well tolerated.</p><p><strong>Conclusion: </strong>This systematic review and me
导言:目前的疼痛治疗指南建议采用个性化、多模式和跨学科的方法,并综合使用药物和非药物疗法。对于急性疼痛患者,如手术或创伤后患者,应减少慢性化的风险因素。耳迷走神经刺激疗法(aVNS)是一种有效的非药物疗法,可用于慢性和急性疼痛的多模式治疗。本系统综述和荟萃分析旨在评估耳迷走神经刺激治疗慢性和急性疼痛的临床疗效和安全性:方法:对应用耳穴电刺激治疗慢性和急性疼痛的相关文献进行了系统性检索。根据证据级别(Jadad 量表)、科学有效性和偏倚风险(RoB 2 工具)对研究进行分类,并就适应症、方法、刺激参数、治疗持续时间以及疗效和安全性进行分析。针对慢性疼痛和急性疼痛分别进行了(随机)对照试验(使用不同的比较对象)的荟萃分析,包括经皮(pVNS-针电极)和经皮(tVNS-表面电极)aVNS 的亚组分析。视觉模拟疼痛量表(VAS)被定义为主要疗效终点:结果:在已确定和分析的 23 项慢性疼痛研究、12 项急性术后疼痛研究和 7 项实验性急性疼痛研究中,共有 n = 1496 名患者接受了 aVNS 治疗。其中,7 项慢性疼痛研究和 6 项急性术后疼痛研究被纳入荟萃分析。在慢性疼痛(包括背痛、偏头痛和腹痛)方面,与假的 aVNS 或对照治疗相比,积极的 aVNS 治疗可在统计学上显著降低 VAS 疼痛强度,其效应大小 Hedges' g/mean difference 为 - 1.95(95% 置信区间 [CI]:- 3.94 至 0.04,p = 0.008),与 tVNS 相比,pVNS 的效果更佳(- 5.40 [- 8.94; - 1.85] vs. - 1.00 [- 1.55; - 0.44];p = 0.015)。在急性疼痛方面,有单项研究显示 aVNS 有显著改善,例如在肾脏捐献手术或扁桃体切除术中,但总体而言,与假 aVNS 或对照组相比,主动 aVNS 在 VAS 疼痛强度方面有 - 0.70 [- 2.34; 0.93] (p = 0.15) 的无统计学意义的显著降低。在急性疼痛方面,不同研究的结果差异很大,尤其取决于术后的联合用药和评估时间点。在大多数评估慢性和急性疼痛疗效的研究中,镇痛剂或阿片类药物的摄入量都有明显减少。在 12 项针对慢性疼痛患者的随机对照试验中,有 3 项显示疼痛可在长达 12 个月的时间内持续减轻。总体而言,aVNS 的耐受性非常好:本系统综述和荟萃分析表明,对于特定的慢性和急性术后疼痛患者,aVNS 是一种有效、安全的非药物治疗方法。需要进一步开展研究,以确定模拟参数的影响,并找到最佳的标准化治疗方案,同时考虑生活质量结果参数和延长随访时间。更标准化的方法和统一的研究设计将提高结果的可比性和稳健性。
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引用次数: 0
Efficacy and Safety of Ciprofol Versus Propofol as Anesthetic for Patients Undergoing Painless Colonoscopy. 对接受无痛结肠镜检查的患者使用异丙酚与丙泊酚作为麻醉剂的有效性和安全性。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-14 DOI: 10.1007/s40122-024-00662-x
Ke Qiang He, Ting Ting Huang, Meng Yuan Tan, Chen Gao, Sheng Wang

Introduction: Ciprofol is a novel propofol analogue with a characteristic of hemodynamic stability. At present, there is a lack of research comparing the hemodynamic stability of ciprofol and propofol during painless colonoscopy. In this study, we aim to test the hypothesis that ciprofol is superior to propofol in terms of hemodynamic stability for sedation anesthesia in patients undergoing colonoscopy.

Methods: A total of 222 patients were randomized into two groups. Patients in group P (n = 112) and group C (n = 110) received propofol and ciprofol sedation, respectively. Noninvasive blood pressure were monitored starting from induction (T0) to the end of the procedure, at 2-min intervals (T1 to T10). Heart rate variability (HRV), pain injection, Modified Observer's Assessment of Alertness and Sedation (MOAA/S) score, body movement, doses of norepinephrine, modified Aldrete score, drug-related adverse reactions, and patient satisfaction and endoscopist satisfaction were recorded.

Results: In group C, fewer patients experienced a decrease in blood pressure with a higher HRV after induction sedation, the incidence of pain injection was reduced, the amount of norepinephrine dose was decreased, patient satisfaction was increased compared with group P (all P < 0.05). There were no significant differences in induction time, modified Aldrete score, alertness time, drug-related adverse reactions, and endoscopist satisfaction.

Conclusions: Our study indicated intravenous induction with ciprofol was superior, with regard to hemodynamic stability and reduced injection pain, than induction with propofol for anesthesia in patients undergoing painless colonoscopy.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2200061814).

简介异丙酚是一种新型的异丙酚类似物,具有血流动力学稳定的特点。目前,还缺乏对无痛结肠镜检查过程中丙泊酚和异丙酚的血流动力学稳定性进行比较的研究。在本研究中,我们旨在验证一个假设,即在对结肠镜检查患者进行镇静麻醉时,环丙酚在血流动力学稳定性方面优于异丙酚:共有 222 名患者被随机分为两组。P组(112人)和C组(110人)患者分别接受异丙酚和环丙酚镇静。从诱导(T0)开始到手术结束,每隔 2 分钟(T1 至 T10)监测一次无创血压。记录心率变异性(HRV)、疼痛注射、改良观察者警觉性和镇静评估(MOAA/S)评分、身体移动、去甲肾上腺素剂量、改良 Aldrete 评分、药物相关不良反应、患者满意度和内镜医师满意度:结果:与 P 组相比,C 组患者在诱导镇静后出现血压下降且心率变异较高的情况较少,注射疼痛发生率降低,去甲肾上腺素用量减少,患者满意度提高(均为 P 结论:C 组患者在诱导镇静后出现血压下降且心率变异较高的情况较少,注射疼痛发生率降低,去甲肾上腺素用量减少,患者满意度提高:我们的研究表明,在无痛结肠镜检查患者的麻醉中,使用环丙酚进行静脉诱导在血流动力学稳定性和减少注射疼痛方面优于使用异丙酚进行诱导:中国临床试验注册中心(ChiCTR2200061814)。
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引用次数: 0
Letter to the Editor Regarding: Time Trends in the Incidence of Spinal Pain in China, 1990 to 2019 and its Prediction to 2030: The Global Burden of Disease Study 2019. 致编辑的信1990-2019年中国脊柱疼痛发病率的时间趋势及2030年的预测:2019年全球疾病负担研究》。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-09-28 DOI: 10.1007/s40122-024-00660-z
Christopher S Han, Qiuzhe Chen, Christopher G Maher
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引用次数: 0
Real-World Experience of Erenumab in Patients with Migraine in Germany: The SPECTRE Study. 艾伦单抗在德国偏头痛患者中的实际应用经验:SPECTRE 研究。
IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-01 Epub Date: 2024-10-21 DOI: 10.1007/s40122-024-00658-7
Charly Gaul, Astrid Gendolla, Dagny Holle, Hartmut Göbel, Mirja Koch, Caroline Baufeld, Cordula Weiss

Introduction: To provide real-world insights into migraine patient population in Germany treated with erenumab, focusing on the prescription patterns and reasons for the initial dosage choice.

Methods: SPECTRE was an observational, non-interventional, multicenter, open-label, single-arm study in patients treated with erenumab according to approved local dose and guidelines. The study enrolled adult patients (n = 571; Germany: 105 sites) with migraine who had received erenumab for not more than 3 months before the start of the study.

Results: The mean (standard deviation) patient age was 45.0 (12.3) years, and most patients were female (89.0%), Caucasian (97.6%), and non-smokers (85.1%). The starting dose of erenumab was 70 mg in 68.5% of patients and 140 mg in 31.5%. The proportion of patients with 140 mg as the starting dose was the highest (43.5%) in those aged 30-40 years. The most common reason for starting a higher dose of erenumab 140 mg was severity of migraine (47.4%). During the observational period, the proportion of patients taking erenumab 140 mg increased to 64.6% (visit 5; V5) after 12 months. Due to attrition of patients towards the end of the study (V9: 90 participants), data at V9 must be interpreted with caution. At least one dose change was performed in 45.3% of patients (i.e., erenumab 70 to 140 mg or 140 to 70 mg), 21.2% of patients attempted at least once to discontinue treatment (i.e., period with erenumab discontinuation and no other antibody treatment for migraine prevention), and 15.3% discontinued erenumab treatment, mainly because of no or insufficient treatment response (13.5%). The mean time until the first omission attempt was 332.3 (range 37-633) days. Constipation (12.1%) was the most frequently reported adverse event, in line with the summary of product characteristics (SmPC) of erenumab.

Conclusion: Most patients with migraine were prescribed erenumab 70 mg as the starting dose. No new safety signals were observed for erenumab versus the previous trials.

内容简介目的:了解在德国接受艾伦单抗治疗的偏头痛患者的实际情况,重点关注处方模式和初始剂量选择的原因:SPECTRE是一项观察性、非干预性、多中心、开放标签、单臂研究,研究对象是根据当地批准的剂量和指南接受艾伦单抗治疗的患者。该研究招募了偏头痛成年患者(n = 571;德国:105个研究点),这些患者在研究开始前接受艾伦单抗治疗的时间不超过3个月:患者的平均年龄(标准差)为45.0(12.3)岁,大多数患者为女性(89.0%)、白种人(97.6%)和非吸烟者(85.1%)。68.5%的患者起始剂量为70毫克,31.5%的患者起始剂量为140毫克。起始剂量为 140 毫克的患者中,年龄在 30-40 岁之间的比例最高(43.5%)。开始服用较高剂量艾伦单抗140毫克的最常见原因是偏头痛严重(47.4%)。在观察期间,服用艾伦单抗140毫克的患者比例在12个月后增至64.6%(第5次就诊;V5)。由于患者在研究接近尾声时自然减员(V9:90 名参与者),因此必须谨慎解释 V9 的数据。45.3%的患者至少更换过一次剂量(即艾珠单抗从70毫克换到140毫克或从140毫克换到70毫克),21.2%的患者至少尝试过一次中断治疗(即停用艾珠单抗且未使用其他抗体治疗偏头痛),15.3%的患者中断了艾珠单抗治疗,主要原因是没有治疗反应或治疗反应不足(13.5%)。距首次尝试停药的平均时间为 332.3 天(37-633 天)。便秘(12.1%)是最常报告的不良事件,这与艾伦单抗的产品特性概要(SmPC)一致:结论:大多数偏头痛患者的起始剂量为艾伦单抗70毫克。与之前的试验相比,艾伦单抗未发现新的安全性信号。
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Pain and Therapy
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