Medication and its Effect on Safe & Sound Protocol Therapy Outcomes in a Pediatric Population

Background and Hypothesis: The current study evaluated the effect of different medications on a child’s response to the Safe & Sound Protocol (SSP) therapy. Informed by the Polyvagal Theory and the evidenced relationship between state regulation and autonomic imbalance, the therapy aims to improve state dysregulation which can manifest in children as emotional reactivity, sensory processing issues, and auditory sensitivities. Prior studies have shown a reduction in auditory hypersensitivities after the SSP therapy plus evidence shows SSRIs and stimulants have a positive impact on hearing in the presence of background noise. We hypothesized that a) the SSP could improve treatment response in those taking neurotransmitter-altering medication due to synergistic effects or b) it could show reduce treatment response due to sensitivities already being managed by medication. Project Methods: Children in the study underwent a month of the SSP therapy with auditory processing standardized parent reports (Brain Body Center Sensory Scale) taken prior to treatment then approximately 1 week and 4 weeks after treatment. The data was then separated into different medication groups: stimulants (n=4), non-stimulant neurotransmitter altering medications (n=4), and other non-neurotransmitter altering medications (n=9) such as albuterol. Non-medication and medication group outcomes were then compared to identify significant differences between the groups using independent and paired samples t-tests. Results: The results from this study found a significant reduced response to the SSP in children taking non-stimulant neurotransmitter altering medications, which included both sertraline, a selective serotonin reuptake inhibitor, and guanfacine, an a2A-adrenergic agonist. In addition, the non-neurotransmitter altering medication group was the only medication group that showed significant improvement in hypersensitivities while each non-medication group improved in hypersensitivity and hyposensitivity. Potential Impact: Commonly-used guidelines for SSP are to maintain typical medication use during the intervention. This study, the first to systematically assess treatment response to the SSP by medication use, could inform how clinicians implement both SSP and medication treatments concurrently. However, these results are based on very small medication groups, therefore follow-up studies with larger samples are necessary to inform current clinical practices.

Efficacy of Electroacupuncture Therapy in Patients With Postherpetic Neuralgia: Study Protocol for a Multicentre, Randomized, Controlled, Assessor-Blinded Trial

Introduction: The efficacy of conventional treatments for treating postherpetic neuralgia (PHN) remains unsatisfactory. Thus, this multicentre, randomized controlled, assessor-blinded trial aims to investigate the efficacy and safety of electroacupuncture (EA) therapy in patients with PHN.Methods and Analysis: This multicentre randomized controlled trial will enroll 132 patients with PHN from 3 hospitals. All patients will be randomly assigned to either the EA combined with medication group or medication group through a computerized central randomization system in a 1:1 ratio. Outcome measures will be assessed before intervention, at 2, 4, 6 weeks after intervention and at the end of 8-week follow-up. Primary outcomes will be sensory thresholds and pain intensity. Secondary outcomes will include dosage of analgetic, quality of life, anxiety, and depression severity and sleep quality. All adverse effects will be assessed during the trial.Conclusions: This study will provide evidence to ascertain whether EA is effective and safe for treating PHN.Ethics and Dissemination: Ethics approval (No.ZSLL-KY-2017-025) has been obtained from the Ethics Committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University. Informed consent will be signed prior to subject enrolment. The results will be submitted to international peer-reviewed journals and presented at international conferences.Trial Registration Number: The study protocol has been registered in the clinicaltrials registry with the identification code NCT04594226.

Current diagnosis and treatment of acute pancreatitis in China: a real-world, multicenter study

Background Efficacy of pancreatic enzyme inhibitors in acute pancreatitis (AP) is unclear in China. Aims We aimed to present the current status of AP and evaluate the efficacy of pancreatic enzyme inhibitors in a larger population in China. Method A retrospective, cross-sectional, real-world, multicenter analysis of a large dataset of patients presenting with AP from four hospitals of China over a two-year period was performed. Data were collected from the existing clinical records and the patients were grouped into medication group (somatostatin or octreotide or somatostatin and octreotide) and no medication group. Pair wise propensity score matching was performed for comparing somatostatin, octreotide and somatostatin/octreotide. The end points were incidence of disease complications, organ failure, hospitalization duration, and recovery time taken (hours) for serum amylase/serum lipase to normalcy. Results A total of 3900 patients were recruited and 2775 patients were included for analysis. A total of 1100, 661, 676 and 338 patients received either somatostatin or octreotide or somatostatin and octreotide or no medication, respectively. The incidence of complications (7.6% vs 13.6%), organ failure (4.5% vs 7.4%), and the instances of entering ICU (9.3% vs 13.3%) were higher in unmedicated group. Complications at discharge (2.91 times), organ failure (2.53 times), and hospitalization stay were higher in octreotide-treated patients compared with somatostatin-treated patients. In comparison to the octreotide group, the serum amylase/lipase recovery time was shorter in the somatostatin group. Conclusion This real-world study suggested that the use of pancreatic enzyme inhibitors was positively associated with greater clinical efficacy in AP patients and somatostatin might be more effective than octreotide in real-world settings in China.

Effect of Continuous 0.5% Ganciclovir Eye Drop Treatment in Secondary Glaucoma Associated with Cytomegalovirus Anterior Uveitis

Purpose: The purpose of this study was to investigate the treatment outcomes of secondary glaucoma caused by cytomegalovirus (CMV)-anterior uveitis (AU) with continuous 0.5% ganciclovir eye drop. Study Design: Retrospective observational study. Place and Duration of Study: Department of Ophthalmology, Oita University Hospital, between January 2012 and December 2017. Methodology: Nineteen eyes of 19 patients with secondary glaucoma associated with CMV-AU diagnosed by a polymerase chain reaction analysis from human aqueous samples were enrolled. They were treated with continuous 4-times-daily topical 0.5% ganciclovir in addition to topical steroids and anti-glaucoma medications. We performed glaucoma surgery for patients with poorly medically controlled intraocular pressure (IOP). Results: Anterior chamber inflammation and IOP were controlled without systemic ganciclovir or glaucoma surgery during the follow-up period (mean: 59.2±27.0 months) in 9 (47%) eyes. Five (26%) eyes required systemic ganciclovir and ten (53%) eyes required glaucoma surgery. Patients were divided into two groups for the comparison: one group requiring glaucoma surgery and one treated with medication. The mean IOP and number of anti-glaucoma medications at the first visit were significantly higher in the surgery group than in the medication group. The mean number of IOP spikes per year (IOP >30 mmHg) was 1.4±0.9 in the surgery group and 0.4±0.5 in the medication group. The recurrence of anterior chamber inflammation was suppressed in both groups. The cumulative survival rate after glaucoma surgery was 80% at 12 months and 70% at 36 months. Conclusion: The anterior chamber inflammation and IOP were controlled with continuous 0.5% ganciclovir eye drop treatment in half of the patients with CNV-AU. A high IOP at the first visit and frequent IOP spikes were risk factors for additional glaucoma surgeries.Cytomegalovirus

Use of osteopathic manipulative treatment for low back pain patients with and without pain medication history

Context Low back pain is one of the most frequent diagnoses in primary care, and prescription pain medication is commonly used for management. Osteopathic physicians may use osteopathic manipulative treatment (OMT) as an additional tool to help alleviate pain. Objective To determine if nonpharmacological options can improve back pain with the use of OMT. Methods Two groups were studied: patients receiving OMT but not using prescribed pain medications (OMT-only group) and patients who received prescribed pain medication and began receiving OMT after three months of pharmacologic therapy (OMT + medication group). All patients were enrolled in the study for one year. The amount of time between treatments was determined by the physician performing the OMT and the patient’s pain improvement. The Keele STarT survey and Oswestry Disability Index tool were used at each appointment to assess the patient’s functionality and pain. Results Thirty-six patients enrolled in the study: 26 in the OMT-only group and 10 in the OMT + medication group. Each group reported improvement in low back pain (LBP) according to both scales used. The OMT-only group reported improvement according to the Keele STarT survey (30% relative decrease in the mean score) and the Oswestry Disability Index tool (18% relative decrease in disability index), while patients in the OMT + medication group also reported improvement according to the Keele STarT survey (29.5% relative decrease in the mean score) and the Oswestry Disability Index tool (18% relative decrease in disability index). A decrease in Cyclobenzaprine usage was also observed in the OMT + medication group. Conclusion Both groups showed significant decreases in overall pain, and this similar effect in each group may indicate a lack of need for medications when OMT is used. Additional research on efficacy of OMT in this patient population is needed with larger, multicenter, randomized trials.

Effect of Aspirin and Statins on Pulmonary Function and Inflammation in Patients with AECOPD

Background: The influence of coronary atherosclerosis and related treatment drugs on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) development requires in-depth study. The study investigated the effect of coronary artery calcification (CAC) and drugs for CAC on the development of AECOPD. Methods: This retrospective clinical study recruited subjects with AECOPD from May 2017 to May 2019. All subjects performed spirometry and coronary computed tomography (CT), and were divided into three groups according to whether coronary CT revealed CAC and whether they had received oral aspirin and statins: AECOPD group, AECOPD[Formula: see text]CAC nonmedication and AECOPD[Formula: see text]CAC medication. The t-test and nonparametric test were used for analyzing the lung function, arterial blood gas, routine blood and lipid between groups. Results: Compared with the AECOPD group, Lym% were significantly higher ([Formula: see text]) in both the AECOPD[Formula: see text]CAC nonmedication and the AECOPD[Formula: see text]CAC medication. The AECOPD[Formula: see text]CAC medication group also had significantly higher PaO2 ([Formula: see text]). WBC, Neu, and Neu% in the AECOPD[Formula: see text]CAC medication group were significantly lower ([Formula: see text]) compared to the AECOPD group. Conclusions: Aspirin and statins for the treatment of cardiovascular diseases may be linked to improving lung function, normalizing blood gas levels, and reducing inflammation in patients with AECOPD and CAC. Further, randomized controlled trials are needed to explore this topic.

Safety of radiofrequency ablation for reducing inflammatory cytokine levels and the left atrial diameter in patients with atrial fibrillation

Objective To investigate the safety of radiofrequency ablation for reducing inflammatory cytokines and the left atrial diameter in patients with atrial fibrillation (AF). Methods A total of 200 patients with AF who were admitted to our hospital from December 2015 to April 2017 were included in this prospective analysis. Fifty patients were treated with conventional AF medication alone (AF medication group) and 50 patients received radiofrequency ablation (RFA) on the basis of conventional medication (RFA group). Results After treatment, the AF medication group showed significantly higher levels of high-sensitivity C-reactive protein, interleukin-6, carboxyterminal propeptide of type-I procollagen, procollagen type III N-terminal propeptide, and matrix metallopeptidase-9 than the RFA group. The AF medication group had a significantly lower activated partial thromboplastin time, thrombin time, and prothrombin time than the RFA group. A significantly smaller left atrial diameter was observed in both groups after treatment, but this decrease was more pronounced in the RFA group than in the AF medication group. The total treatment efficacy rate was significantly lower in the AF medication group than in the RFA group. Conclusions For patients with AF, RFA leads to a lower incidence of inflammatory responses, faster recovery of cardiac function, and good safety.

An Effective and Simple Way to Establish Elastase-Induced Middle Carotid Artery Fusiform Aneurysms in Rabbits

Objective. Elastase-induced aneurysms in rabbits have been proposed as a preclinical tool for device development, but there is still much deficiency in those aneurismal models. So we need to explore the efficient and convenient animal models for the investigation of intracranial aneurysms. Then, we compared and analyzed three methods of elastase-induced carotid artery aneurysms in rabbits and aimed to find a simple, effective, and reproducible method for creating elastase-induced aneurysms. Methods. 42 standard feeding male adult Japanese white rabbits (3.05±0.65 kg) were randomly divided into 3 groups and treated with elastase ablation to create common carotid artery (RCCA) aneurysm models: Group A (root-RCCA medication group, n=12), Group B (mid-RCCA medication group, n=18), and Group C (ligated RCCA+medication group, n=12). For Group A, the origin of the RCCA was blocked by two temporary aneurysm clips, and the resulting 2 cm cavity was infused with elastase for 20 min, then the clip was removed and the RCCA was not ligated. For Group B, the middle part of RCCA was treated the same way as Group A and the RCCA was not ligated. For Group C, the middle part of RCCA was treated as Group B, but the distal RCCA was ligated. After the aneurysm models were created for 3 weeks, prior to sacrificing the animals, color Doppler ultrasound and angiography were performed for blood flow measurements inside the aneurysms. Histological analysis (such as SMA-α, CD31, CD34, CD68, collagen IV, and Ki67) and the other relevant indexes were compared between the ideal model’s aneurysmal tissues and the human intracranial aneurysm’s tissues to confirm whether we have successfully established elastase-induced aneurysm models. Results. Compared with human intracranial aneurysm specimens by the color Doppler ultrasound, angiography, and changes in the inner diameter of arteries, all three methods have successfully established the elastase-induced aneurysm models. Histology showed that biological responses were similar to both human cerebral aneurysms and previously published elastase-induced rabbit aneurysm models. Group A and Group B had the same morphology, but Group A had a higher mortality rate than Group B. Group B and Group C had different morphology. The aneurysm of Group C was more similar to human cerebral aneurysms but had a higher mortality rate than Group B. Group B was confirmed not only as an alternative method but also as a more safe and effective method for creating elastase-induced aneurysm models. Conclusion. Through analysis and comparison, the Group B is proven to be the simplest, reproducible, and most effective modeling method. The aneurysm model established by Group B can be used for basic research related to aneurysm mechanism. We have provided a new and effective method for basic research on aneurysm.