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Developing transcranial direct current stimulation as a treatment for phantom limb pain: from pilot mechanistic studies to large clinical studies. 开发经颅直流电刺激治疗幻肢痛:从试验性机理研究到大型临床研究。
Pub Date : 2024-04-16 Epub Date: 2024-05-23 DOI: 10.21801/ppcrj.2024.101.10
Xinyi Christine Zhang, Kevin Pacheco-Barrios, Felipe Fregni
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引用次数: 0
Enhancing Dissemination and Understanding in Clinical Research Protocols: Optimizing Visual Communication in a Phantom Limb Pain Clinical Trial. 加强临床研究协议的传播和理解:在幻肢痛临床试验中优化视觉交流。
Pub Date : 2024-04-16 Epub Date: 2024-05-23 DOI: 10.21801/ppcrj.2024.101.8
Xinyi Christine Zhang, Kevin Pacheco-Barrios, Felipe Fregni
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引用次数: 0
Physical Conditioning, Obesity and Fibromyalgia: Causal Relationship or Confounding? 身体调节、肥胖和纤维肌痛:因果关系还是混杂因素?
Pub Date : 2023-11-28 Epub Date: 2024-02-13 DOI: 10.21801/ppcrj.2023.93.2
Valton Costa, Anna Carolyna Gianlorenço, Marianna Daibes, Fernanda Queiroz, Guilherme Lacerda, Daniela Martinez-Magallanes, Lucas Camargo, Luana Gola Alves, Maria Fernanda Andrade, Mustafa Reha Dodurgali, Kevin Pacheco-Barrios, Felipe Fregni
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引用次数: 0
Editorial - Seeking Brain Homeostatic Compensatory Mechanisms for Pain Control. 社论-寻找控制疼痛的大脑稳态补偿机制。
Pub Date : 2023-09-03 DOI: 10.21801/ppcrj.2023.92.2
Kevin Pacheco-Barrios, Lucas M Marques, Mustafa Reha Dodurgali, Daniela Martinez-Magallanes, Sara P Barbosa, Marianna De Andrade, Jorge Ortega Márquez, Paulo S de Melo, Marcel Simis, Wolnei Caumo, Felipe Fregni
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引用次数: 0
Curcumin for Aromatase Inhibitor-Induced Joint Pain in Breast Cancer Survivors - The CurPain Trial: A Randomized, Double-Blind, Phase III, Multicenter Clinical Trial 姜黄素治疗癌症幸存者芳香化酶抑制剂诱导的关节疼痛-CurPain试验:一项随机、双盲、III期、多中心临床试验
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.10
Michael Apostolou, T. Méry, I. Aivasovsky, Milena Akamatsu, Marianna Daibes, Winifer Araujo, Maria Burgos, Victor Capellan, F. Cerulli, Vitor Costa, W. Fandino, Igor Farias, Vivian Gagliardi, Maria Gomez, David Guardamino, Andreina Guzman, Karla L. Loss, S. Mohamed, V. Montero, J. Obeso, Alicia Rosell, Jorge Sakon, Erik Simon, Rene Tovar, S. Afonseca, Katarzyna Kresse-Walczak
Introduction: Adjuvant treatment with aromatase inhibitors (AIs) is extremely important in hormone-positive breast cancer survivors, reducing the early recurrence of the disease. Arthralgia and musculoskeletal symptoms resulting from AIs-toxicity can be observed in approximately one-third of the treated patients and are the leading cause of AIs-treatment discontinuation. However, there is no sufficient standard treatment. Analgesic and anti-inflammatory effects of curcumin in chronic joint pain are reported. This study protocol will determine whether curcumin supplementation reduces joint pain in breast cancer survivors under AIs therapy. Methods: This study protocol is a phase III, randomized, blinded, placebo-controlled, multicentric, parallel arm design. The study population targets post-menopause women with stage I, luminal, unilateral, non-metastatic, receptor-positive breast cancer after breast-conserving surgery healed per primary intention. 160 participants will be enrolled. Daily curcumin supplementation (500 mg thrice daily) for twelve weeks is planned. Brief Pain Inventory-Worst Pain (Δ BPI-WP) will assess joint pain change after twelve weeks of follow-up as the primary outcome. Secondary outcomes include Quality of Life assessed by Functional Assessment of Cancer Therapy-Breast, further Brief Pain Inventory-Short Form items, Patient Health Questionnaire-8, and Quantitative Analgesic Questionnaire at six and twelve weeks. Discussion: We present a randomized clinical trial to provide scientific evidence that supports the efficacy of curcumin supplementation on joint pain alleviation, pain-relieving medication reduction, and AIs-treatment adherence improvement in a predefined breast cancer survivor population.
简介:芳香化酶抑制剂(AIs)辅助治疗对激素阳性的癌症幸存者非常重要,可以减少疾病的早期复发。在大约三分之一的接受治疗的患者中可以观察到由人工智能毒性引起的关节痛和肌肉骨骼症状,这是人工智能治疗中断的主要原因。然而,没有足够的标准治疗方法。报道了姜黄素对慢性关节疼痛的镇痛和抗炎作用。该研究方案将确定添加姜黄素是否能减轻接受人工智能治疗的癌症乳腺癌幸存者的关节疼痛。方法:本研究方案为III期、随机、盲法、安慰剂对照、多中心、平行臂设计。该研究人群的目标人群是绝经后女性,她们在按主要意图进行的乳房切除手术后,患有I期、管腔性、单侧、非味觉、受体阳性的乳腺癌症。将有160名参与者参加。计划在12周内每天补充姜黄素(每天三次,每次500 mg)。简要疼痛清单最严重疼痛(ΔBPI-WP)将评估随访12周后的关节疼痛变化,作为主要结果。次要结果包括通过癌症治疗功能评估-乳腺评估的生活质量、进一步的简短疼痛清单-简表项目、患者健康问卷-8和6周和12周的定量镇痛问卷。讨论:我们提出了一项随机临床试验,以提供科学证据,支持在预先确定的癌症幸存者群体中补充姜黄素对减轻关节疼痛、减少疼痛药物和改善AIs治疗依从性的疗效。
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引用次数: 0
XIV International Symposium of Neuromodulation: Conference Abstracts 第十四届国际神经调节研讨会:会议摘要
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.11
Sara Barbosa, Lucas Marques, International Symposium of Neuromodulation Scientific Team
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引用次数: 0
Effect of Occupational Therapy on Cognition in Patients with Mild Alzheimer’s Disease: A Systematized Literature Review 职业治疗对轻度阿尔茨海默病患者认知的影响:系统化文献综述
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.8
Leandra Ramin-Wright, N. Pacheco-Barrios, Sandra Zhong, Marion Stokvis-Blok, A. Barrios-Ruiz, Aala F Elhadi, Stefany Alfaro-Amez, Deborah Estrella, João P. G. Kasakewitch, Cecilia Plaza, Renata Medeiros, Nayara Rutes, Guilherme Areas
Introduction: Mild Alzheimer’s Disease (AD), the most prevalent form of dementia, substantially burdens patients and caregivers. With only symptomatic treatments currently available, the potential of Occupational Therapy (OT) in aiding mild AD patients is increasingly recognized. This review evaluates OT’s role in preserving cognitive function in mild AD. Methods: We used PubMed and HINARI platforms to explore the effect of OT on mild AD. Studies in English, with observational or clinical trial designs involving patients with AD, were included. Case studies and literature reviews were excluded. Two authors independently selected the study, with a third resolving disputes. Results: 43 studies were initially retrieved. Post-duplicate removal, 34 abstracts were screened, 21 were selected for full review, and five met the inclusion criteria. Of these, three reported positive results, and two reported adverse effects. Those with positive results are observational studies with a low risk of bias and one RCT with a high risk of bias. The two remaining RCTs with negative consequences showed a low risk of bias. Discussion: Our review suggests no benefit on cognition in mild AD from OT, although methodological variability led to inconsistent findings. Certain OT interventions, like Recollection-Based and Group Cognitive Therapy, showed promise in cognitive improvement for mild AD. Future research should include larger samples, extended interventions, and follow-up periods for a more comprehensive insight into OT’s effects on cognition in mild AD patients.
轻度阿尔茨海默病(AD)是最常见的痴呆症形式,给患者和护理人员带来了很大的负担。由于目前只有对症治疗,职业治疗(OT)在帮助轻度AD患者方面的潜力越来越被认识到。本综述评估了OT在轻度AD患者保持认知功能中的作用。方法:利用PubMed和HINARI平台探讨OT对轻度AD的影响。纳入了涉及AD患者的观察性或临床试验设计的英文研究。排除个案研究和文献综述。两位作者独立选择了这项研究,第三位作者解决了争议。结果:最初检索到43项研究。删除重复后,筛选了34篇摘要,其中21篇入选全文,5篇符合纳入标准。其中,3例报告了阳性结果,2例报告了不良反应。阳性结果为低偏倚风险的观察性研究和一项高偏倚风险的随机对照试验。其余两项具有负面结果的随机对照试验显示偏倚风险较低。讨论:我们的综述表明,尽管方法的差异导致结果不一致,但OT对轻度AD患者的认知没有益处。某些OT干预,如基于回忆和群体认知治疗,在轻度AD的认知改善方面显示出希望。未来的研究应该包括更大的样本、更长的干预和随访期,以更全面地了解OT对轻度AD患者认知能力的影响。
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引用次数: 0
Transcranial Direct Current Stimulation in Opioid Use Disorder: A Systematic Review of the Literature 经颅直流电刺激治疗阿片类药物使用障碍:文献综述
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.4
Victor Anculle-Arauco, Mohammed S Alnafisah, Karen Czischke L, Ángel L. Rodríguez Lockward, Murilo Simão Cenovicz, Nassima Allouche Colak, Alexandra Frealdo Dumont Alves, Emilia Kvasnicka, Rafael A F Barros, Juliana A M Couto Magalhães, Fernando Zanela da Silva Arêas, Rabia Islam, Beatrice Nyawira, Pedro Lança Gomes, Ana Victoria P. Vigano, Sorivel Sosa, Sara Pinto Barbosa, Flávia Regina Bueno
Introduction: Opioid use disorder burdens healthcare facilities and causes significant annual mortality and healthcare costs. Its current management focuses on biopsychosocial interactions; however, a high relapse rate prompts the search for new treatment strategies, such as Transcranial Direct Current stimulation. Methods: A systematic literature search of PubMed, MEDLINE, and clinicaltrials.gov databases was performed. The search terms reflected the conditions and treatment modalities of interest. Trials reporting transcranial direct current stimulation in opioid use disorders were eligible. The primary outcome was craving reduction, measured using different questionnaires. According to the PRISMA guidelines, three research members independently performed article selection and data extraction. Also, was performed Cochrane risk-of-bias tool for each article. Results: Seven articles were selected from the 16 eligible papers. In total, 233 patients were included in this study. All studies were conducted in Asian countries and included only male subjects, and the follow-up time was limited to less than six months. Most studies (6/7) reported a significant improvement in craving reduction in the active transcranial direct current stimulation group. Discussion: Most studies concluded that active transcranial stimulation significantly reduced craving scores; however, the studies had high variability in frequency, intensity, and stimulation site. The limited locations of the trials and small sample sizes represent a threat to the external validity of the studies, which emphasizes the need for further large multicenter randomized trials with adequate follow-up periods to test the efficacy of transcranial direct current stimulation in treating opioid use disorder.
阿片类药物使用障碍给医疗机构带来负担,并导致重大的年度死亡率和医疗费用。目前的管理侧重于生物-心理-社会互动;然而,高复发率促使寻求新的治疗策略,如经颅直流电刺激。方法:系统检索PubMed、MEDLINE和clinicaltrials.gov数据库的文献。搜索条件反映了感兴趣的条件和治疗方式。报道经颅直流电刺激治疗阿片类药物使用障碍的试验符合条件。主要结果是渴望减少,用不同的问卷来衡量。根据PRISMA指南,三名研究成员独立进行文章选择和数据提取。同时,对每篇文章进行Cochrane风险偏倚分析。结果:从16篇符合条件的论文中筛选出7篇。本研究共纳入233例患者。所有研究均在亚洲国家进行,仅包括男性受试者,随访时间限制在6个月以内。大多数研究(6/7)报告了主动经颅直流电刺激组在渴望减少方面的显著改善。讨论:大多数研究得出结论,主动经颅刺激显著降低渴望得分;然而,这些研究在频率、强度和刺激部位上有很大的可变性。有限的试验地点和小样本量对研究的外部有效性构成威胁,这强调需要进一步进行大型多中心随机试验,并进行足够的随访期,以测试经颅直流电刺激治疗阿片类药物使用障碍的疗效。
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引用次数: 0
Inflammasomes as a Prognostic Marker and Possible Therapeutic Target in Multiple Sclerosis: A Rapid Review of the Literature 炎症小体作为多发性硬化症的预后标志物和可能的治疗靶点:文献综述
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.7
Nury Tatiana Rincón Cuenca, Daniela Pereira Lamas, Rosa Fernández Hawa, Ketty Quezada, L. Garcia, Pamela Baez, Assma A. Althobaity, N. Dim
Introduction: Inflammasomes are multiprotein complexes innate to the immune system that, upon activation, initiate a chain reaction culminating in the production of cytokines IL-1 and IL-18. Recent studies have suggested a connection between inflammasome activation and neurological diseases such as multiple sclerosis (MS). In this review, we aimed to evaluate the role of inflammasomes as potential therapeutic agents and prognostic markers of MS. Methods: Through a database search, 156 articles were identified. Of these, we selected articles focusing on observational and interventional studies that either directly measured the expression of inflammasomes or the levels of cytokines or interleukin as outcomes. After applying a snowball sampling strategy, this review ultimately included nine studies. Results: Our search yielded nine studies published between 2010 and 2022—9 observational studies included case-control and cohort designs. All studies comprised adult populations, 20–72 years of age. All studies incorporated a control group. We selected studies that utilized surrogate measures to evaluate outcomes such as inflammasome expression of NLRP3 or similar genes and assess cytokine levels such as IL-1β, IL-18, IL-23, and TNF. Discussion: Overall, the revised studies suggest a possible role for inflammasomes components, including ASC and caspase-1, which have been evaluated as potential prognostic markers in MS. Therapeutic strategies have focused on the inhibition of NLRP3, which is one of the most prominent and studied inflammasomes, by IFN-β.
炎性小体是免疫系统固有的多蛋白复合物,一旦激活,就会引发连锁反应,最终产生细胞因子IL-1和IL-18。最近的研究表明,炎症小体激活与多发性硬化症(MS)等神经系统疾病之间存在联系。在这篇综述中,我们旨在评估炎症小体作为多发性硬化症潜在治疗剂和预后标志物的作用。方法:通过数据库检索,确定了156篇文章。其中,我们选择了关注观察性和干预性研究的文章,这些研究要么直接测量炎症小体的表达,要么测量细胞因子或白细胞介素的水平。在采用滚雪球抽样策略后,本综述最终纳入了9项研究。结果:我们检索了2010年至2022年间发表的9项研究,其中9项观察性研究包括病例对照和队列设计。所有的研究对象都是20-72岁的成年人。所有的研究都纳入了一个对照组。我们选择了使用替代方法来评估结果的研究,如炎性体NLRP3或类似基因的表达,并评估细胞因子水平,如IL-1β、IL-18、IL-23和TNF。讨论:总体而言,修订后的研究表明炎症小体成分(包括ASC和caspase-1)可能发挥作用,这些成分已被评估为ms的潜在预后标志物。治疗策略侧重于IFN-β抑制NLRP3,这是最突出的研究炎症小体之一。
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引用次数: 0
Pursuing Dementia in People Living with HIV: Prevalence and Associated Factors 在艾滋病毒感染者中寻找痴呆:患病率和相关因素
Pub Date : 2023-08-30 DOI: 10.21801/ppcrj.2023.92.3
Daniela Pereira Lamas, Simone Barros Tenore, David Salomao Lewi, Paulo Abrao Ferreira
Introduction: The human immunodeficiency virus (HIV) is the leading cause of neurocognitive impairment in people over 40. The development of highly active antiretroviral therapy (HAART), the comprehension of disease pathogenesis, and the constant search for better life quality in people living with HIV have led to the HIV disease chronic evolution. Hence, it has been common to observe chronic diseases such as HIV-associated neurocognitive disorder (HAND). Unfortunately, the practitioner’s unfamiliarity with HAND screening and treatment has contributed to poor patient care. Methods: We evaluated 134 patients living with HIV and performed two tracking tests, the Mini-mental, which evaluates cortical dementia, and the International HIV Dementia Scale, which evaluates subcortical dementia. Results: We observed dementia associated with HIV (HAD) in 29 patients (prevalence of 21.6%; CI 95%: 15.0 – 29.6). The independent factors related to HAD in this study, with statistical significance, were age (RPaj 1.05; CI 1.00 – 1.09; p=0.033), TCD4+ nadir (RPaj 0.998; CI 95% 0.996 – 0.999; p=0.03), and more than two years of detectable HIV viral load (RPaj 2.35; CI 95% 1.27 – 4.33; p=0.006). Discussion: The prevalence of dementia related to HIV in our study was similar to the Brazilian and International data. Early diagnosis and treatment are fundamental for preventing HAND development, especially in older patients.
人类免疫缺陷病毒(HIV)是导致40岁以上人群神经认知障碍的主要原因。高效抗逆转录病毒疗法(HAART)的发展,对疾病发病机制的理解,以及对HIV感染者更好生活质量的不断追求,导致HIV疾病的慢性演变。因此,hiv相关神经认知障碍(HAND)等慢性疾病的观察已经很普遍。不幸的是,医生对HAND筛查和治疗的不熟悉导致了对病人的不良护理。方法:我们评估了134名艾滋病毒感染者,并进行了两项跟踪测试,一项是评估皮质痴呆的Mini-mental测试,另一项是评估皮质下痴呆的国际HIV痴呆量表。结果:我们在29例患者中观察到与HIV (HAD)相关的痴呆(患病率21.6%;Ci 95%: 15.0 - 29.6)。本研究中与HAD相关的独立因素有:年龄(RPaj 1.05;Ci 1.00 - 1.09;p=0.033), TCD4+最低点(RPaj 0.998;Ci 95% 0.996 - 0.999;p=0.03),两年以上可检测到的HIV病毒载量(RPaj 2.35;Ci 95% 1.27 - 4.33;p = 0.006)。讨论:在我们的研究中,与HIV相关的痴呆患病率与巴西和国际数据相似。早期诊断和治疗是预防HAND发展的基础,特别是在老年患者中。
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Principles and practice of clinical research (2015)
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