Articles: function.
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To compare the safety profiles of low and high-dose tramadol, short-acting hydrocodone, and short-acting oxycodone therapies among chronic noncancer pain individuals. ⋯ Low-dose oxycodone had a higher risk of opioid-related adverse outcomes compared with low-dose tramadol and hydrocodone. This should be interpreted in conjunction with the benefits of pain control and functioning associated with oxycodone use in future research.
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Irritable bowel syndrome is a functional gastrointestinal disorder characterized by chronic visceral pain with complex etiology and difficult treatment. Accumulated evidence has confirmed that the sensitization of the central nervous system plays an important role in the development of visceral pain, whereas the exact mechanisms of action of the neural pathways remain largely unknown. In this study, a distinct neural circuit was identified from the paraventricular hypothalamic (PVH) to the ventral of lateral septal (LSV) region. ⋯ The PVH-LSV CaMKIIα + projection pathway was further confirmed by experiments containing a viral tracer. Optogenetic inhibition of PVH CaMKIIα + inputs to LSV CaMKIIα-positive neurons suppressed visceral pain, whereas selective activation of the PVH-LSV CaMKIIα + projection evoked visceral pain. These findings suggest the critical role of the PVH-LSV CaMKIIα + circuit in regulating visceral pain.
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Humeral shaft fractures represent about 3% of all fractures. While there are several treatment options for this type of fractures, there is no evidence in literature showing which is the best one. This study aims at analysing the outcomes for patients with humeral shaft fractures treated with Locking Compression Plate (LCP) fixation in our hospital and comparing them with the outcome for patients conservatively treated (according to data from Pubmed),in order to determine the best treatment option. ⋯ After taking into account both the conservative and the surgical treatment, for humeral shaft fractures we suggest the operative treatment, because the patient's function of the upper limb recovers quickly in the immediate postoperative period and the incidence of malunions may be avoided.
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Observational Study
Implementation and function of interdisciplinary rounds: An observational multisite hospital study from project ACHIEVE.
Interdisciplinary rounds (IDR) are increasingly employed by hospitals; however, there is no formal definition, structure, or framework. ⋯ Hospitals varied significantly in IDR implementation. 51.9% included the "core" team (i.e., a physician, nurse, pharmacist, and case manager/social worker), though all included a case manager or social worker. Most (81.5%) occurred before noon. Content chiefly focused on medical care (74.1 to 92.6%) with patient responsibilities and preferences being less frequently discussed (25.9 to 40.7%). Bivariate analyses revealed that afternoon rounds were more likely to include dischargeȐrelated topics, such as patient/caregiver preferences (100% vs. 27.3%, p = .003) and follow-up needs (100% vs. 36.4%, p = .010).When IDR occurred at bedside, financial resources were more often assessed (100% vs. 34.8%, p = .015) and patient's ability to obtain medication was more often anticipated (75% vs. 21.7%, p = .031).
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Revista médica de Chile · Mar 2023
[Putative mechanisms of action of electronvulsive therapy in affective disorders, a review].
The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. ⋯ In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.