New Strategies For Management Research Articles

Extracorporeal Life Support in Multiple Trauma Patients with Refractory Cardiopulmonary Failure: Predictors of Procedural Suitability and Success Rate

Background: Major trauma is a leading cause of death, particularly amongst young patients. New strategies in management are needed to improve the poor outcome of severe trauma. We report our initial experience with extracorporeal life support (ECLS) as a rescue therapy in severe multiple trauma patients with refractory cardiopulmonary failure. Objectives: The purpose of this study was to identify the pre-ECLS patient characteristics predicting appropriateness ECLS treatment. Methods: From December 2008 to May 2013, 420 multiple trauma patients were treated at our tertiary level referral trauma center. Our ECLS team was alerted on 35 and applied ECLS in 20 adult trauma patients. In 16 patients with cardiopulmonary failure with refractory shock, we adopted a veno-arterial ECLS; in 4 patients with isolated refractory acute respiratory failure, we used venovenous ECLS. Results: ECLS was initiated at a mean of 324.15 ± 197.8 (110 - 950) min from initial trauma. In 4 patients, ECLS treatment failed due to an incapability to maintain adequate ECLS flow and patient perfusion. In the other 16 patients efficiently supported by ECLS, the Cardiac Index, mean arterial pressure, lactate concentration, PaO2, PaCO2, and pH showed significant improvement with normal values reached at 3.2 ± 1.5 hours. Seven (43.7%) patients in the ECLS-Success Group donated organs, 2 patients (22.2%) died due to septic multi organ failure (MOF), and 7 (77.7%) patients were discharged from the hospital. ECLS was suitable and successful in patients with a significantly lower injury severity score, lower blood lactate level, lower number of blood units given, and significantly higher pH and Hb. Conclusions: From our data, ECLS seems to be a valuable option to resuscitate severe trauma patients when conventional therapies are insufficient: it is safe, feasible and effective in providing hemodynamic support and blood gas exchange. Our data permitted us to identify strong predictors of ECLS non-suitability and success in multiple trauma patients; these might be helpful in deciding whether ECLS should be used or not. Future improvements in materials and techniques are expected to make ECLS even easier and safer to manage, leading to a further extension of its use in disastrously injured patients

Distinct properties of proteases and nucleases in the gut, salivary gland and saliva of southern green stink bug, Nezara viridula.

Stink bugs negatively impact numerous plant species of agricultural and horticultural importance. While efforts to develop effective control measures are underway, the unique digestive physiology of these pests presents a significant hurdle for either protein- or nucleotide-based management options. Here we report the comparative biochemical and proteomic characterization of proteases and nucleases from the gut, salivary gland and saliva of the southern green stink bug, Nezara viridula. The pH optimum for protease activity was acidic (5 to 6) in the gut with the primary proteases being cysteine proteases, and alkaline (8 to 9) in the saliva and salivary gland with the primary proteases being serine proteases. The serine proteases in saliva differ biochemically from trypsin and chymotrypsin, and the cathepsins in the gut and saliva showed distinct properties in inhibitor assays. Nuclease activity (DNase, RNase, dsRNase) was concentrated in the salivary gland and saliva with negligible activity in the gut. The most abundant proteins of the gut (530) and salivary gland (631) identified by proteomic analysis included four gut proteases along with eight proteases and one nuclease from the salivary gland. Understanding of N. viridula digestive physiology will facilitate the design of new strategies for management of this significant pest.

What makes the symptom free for the cancer patient in oldest old without treatment? Case Reports in a Long term care facility

Background: Oldest old cancer patients without treatment in our long-term-care facility, where laughter therapy is used, lived happily and longer with neither any major complaint nor individual symptoms. We would like to report on these cases. Methods and Findings: 1 A 97 year female, with hepatocellular carcinoma, symptom free, expired by stroke. A CT showed that the tumor had grown double in size compared with its size two years ago. Tumor markers were extremely high. 2 A 79 year male with severe dementia gradually lost weight within 7 months although he had a good appetite. Abdominal ECHO and CT proved a cystic malignant tumor in the liver with cholelithiasis without symptom. High CA19-9 was noticed. He had no weight gain for four months although his appetite was the same as before. 3 An 86 year female with a long standing schizophrenia had a malignant lymphoma of the stomach confirmed by biopsy 3 yrs 3 m ago. She had severe anemia and needed several blood transfusions. Her anemia improved after the transfusions. She had a cheerful character after she suffered from herpes zoster. 4 A 95 year female, who had a right lung partial lobectomy at her 68 yr against cancer, showed left side lung mass for 4 years but was symptom-free. After 4 years, the tumor mass maintained its size but pleural effusion and thickness were seen by CT. Her high CEA suggested carcinoma of left lung. In all cases, families preferred conservative management only as patients may not have fully understood their own physical situation. They lived happily in this facility, where laughter therapy was applied. Limitation occurs because of case reports. Epidemiologic surveys nationwide are requested. Conclusion: There were four reported untreated cases of symptom-free cancer oldest old patients. All cases had a good appetite, cheerful, with or without dementia, and lived for an average of 2 and half years. Psychologic effects may have contributed to the symptom-free feature of the tumor. We treated several other symptom-free cancer survivors who lived happily in this facility. A further understanding of the mechanism behind this rare phenomenon may provide new strategies for management of cancer. Similarly, research on the effect of deciding on the treatment is, likewise, warranted.

Time to define a new strategy for management of hepatocellular carcinoma in thalassaemia?

Time to define a new strategy for management of hepatocellular carcinoma in thalassaemia?

A new strategy for difficult airway management with visual needle cricothyroidotomy: a manikin study

BackgroundConventional needle cricothyroidotomy uses blind manipulation. We investigated the feasibility and efficiency of a new visually guided needle cricothyroidotomy technique. MethodsA 0.9-mm microimaging fiber was delivered into a 14G needle to develop a visual puncture system. 10 inexperienced physicians were randomly assigned to perform 10 repeated needle cricothyroidotomy in each group with both conventional method and visual puncture in a manikin. Tracheal lumen puncture time and number of procedure-related complications were recorded. ResultsUnder visual guidance, the needle successfully reached the tracheal lumen. The anatomy of the upper and lower airways was acquired by further advancing the microimaging fiber into the tracheal lumen of the visual group. The tracheal lumen puncture time was significantly less in the visual group than in the conventional group (3.85 ± 1.54 vs. 9.84 ± 1.08 seconds, P < .001). Damage to the posterior tracheal wall was not observed in the visual group; however, 21% of manikins in the conventional group had procedure-related complications. ConclusionsOur results demonstrate that visual needle cricothyroidotomy is feasible, and may lead to a decrease in procedure time and procedure-related complications compared to the conventional procedure. In addition, this strategy may also provide useful information for diagnostic purposes; therefore, visual needle cricothyroidotomy may be a new strategy for the management of difficult airways in future care.

Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

BackgroundCommon peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer.MethodWe retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer.ResultsPatients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength.ConclusionThe results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

Amniotic fluid embolism: pathophysiology and new strategies for management.

The registry program of amniotic fluid embolism (AFE) in Japan started in 2003. More than 400 hundred clinical diagnosed amniotic fluid embolism has been accumulated. Those data showed that there were two etiologies of AFE: the fetal materials create physical obstructions in the maternal microvessels in various organs, such as the lung; and (ii) the liquids cause an anaphylactoid reaction that leads to pulmonary vasospasm and activation of platelets, white blood cells and/or complements. The clinical findings showed that AFE was characterized mainly by cardiopulmonary collapse, the other involves the presence of disseminated intravascular coagulation (DIC) and atonic bleeding. Zinc coproporphyrin-1, sialyl Tn antigen (STN), complement C3, C4 and interleukin-8 have been used as serum markers of AFE. The levels of zinc coproporphyrin-1 and STN were increased in cardiopulmonary collapse type AFE, and a marked reduction of C3 and C4 was observed in DIC type AFE. At the primary medical institution, initial treatments for shock airway management, vascular management, fluid replacement, administration of anti-DIC therapy such as antithrombin, and administration of fresh frozen plasma should be provided. C1 esterase inhibitor activity in AFE cases was significantly lower than those of normal pregnant women. C1 esterase inhibitor may be a promising candidate of treatment of AFE.

EPIPAGE 2: a preterm birth cohort in France in 2011

BackgroundChildren born at low gestational ages face a range of risks and number of neonates surviving very preterm birth is increasing. We present the objectives and methods of a French national cohort of very and moderately preterm children, the EPIPAGE 2 study. It aims to examine short- and long-term outcomes of very preterm children and their determinants.Methods/DesignEligible participants for this prospective population-based study include all infants live born or stillborn and all terminations of pregnancy between 22 and 31 completed weeks of gestation in all the maternity units in 25 French regions. In addition, a sample of moderate preterm births, i.e. births and late terminations at 32–34 weeks, was included in the same regions. In all, 7804 babies (stillbirths and live births) and terminations of pregnancy out of 8400 eligible births in France in 2011 that were either very (22–31 weeks) or moderately preterm (32–34 weeks) were included. Data on pregnancy, delivery, and neonatal events were extracted from the obstetric and neonatal records. The follow-up will collect information at corrected ages of one and 2 years and at 5, 8, and 12 years of age. Of the 4467 children discharged alive from the hospital and eligible for follow-up, 155 (4%) families refused further follow-up and 22 died before one-year of age. Finally, 4290 were included in the follow-up.Eight additional projects investigating specific hypotheses among subsamples of the cohort by collecting specific data in addition to the core cohort data are being conducted to investigate 1) diagnosis of histologic chorioamnionitis, 2) early biomarkers of child health, 3) attitudes of care for extremely preterm infants, 4) painful procedures in neonatal intensive care units, 5) neonatal MRI cerebral abnormalities and their relation to executive functions, 6) associations between early gut colonization and early and late onset diseases, 7) impact of neonatal nutrition on child development, and 8) mother-infant attachment.DiscussionThis project seeks to provide new data on the prognosis and etiology of very preterm birth and to assess related medical practices. Accordingly, it should lead to the development of new strategies of management and prevention in high-risk babies.

Effect of NUCKS-1 Overexpression on Cytokine Profiling in Obese Women with Breast Cancer

Overweight and obesity are recognized as major drivers of cancers including breast cancer. Several cytokines, including interleukin-6 (IL-6), IL-10 and lipocalin 2 (LCN2), as well as dysregulated cell cycle proteins are implicated in breast carcinogenesis. The nuclear, casein kinase and cyclin-dependent kinase substrate-1 (NUCKS-1), is a nuclear DNA-binding protein that has been implicated in several human cancers, including breast cancer. The present study was conducted to evaluate NUCKS-1 mRNA expression in breast tissue from obese patients with and without breast cancer and lean controls. NUCKS-1 expression was correlated to cytokine profiles as prognostic and monitoring tools for breast cancer, providing a molecular basis for a causal link between obesity and risk. This study included 39 females with breast cancer (G III) that was furtherly subdivided into two subgroups according to cancer grading (G IIIa and G IIIb) and 10 control obese females (G II) in addition to 10 age-matched healthy lean controls (G I). NUCKS-1 expression was studied in breast tissue biopsies by means of real-time PCR (RT-PCR). Serum cytokine profiles were determined by immunoassay. Lipid profiles and glycemic status as well as anthropometric measures were also recorded for all participants. IL-6, IL-12 and LCN2 were significantly higher in control obese and breast cancer group than their relevant lean controls (p<0.05), while NUCKS-1 mRNA expression was significantly higher in the breast cancer group compared to the other groups (p<0.05). Significant higher levels of IL-6, IL-12, and LCN2 as well as NUCKS-1 mRNA levels were reported in G IIIb than G IIIa, and positively correlated with obesity markers in all obese patients. Evaluation of cytokine levels as well as related gene expression may provide a new tool for understanding interactions for three axes of carcinogenesis, innate immunity, inflammation and cell cycling, and hope for new strategies of management.

Nutritional Treatment: New Strategy for Management of Chronic Pelvic Pain

Chronic pelvic pain is a common condition in women of reproductive age and can be described as chronic nociceptive, inflammatory and neuropathic pain characterized by spontaneous pain or a response to various stimuli. Oxidative stress is a component of the inflammatory reaction associated with pain processes. Iron and NF-κB are well-known inducers of oxidative stress, and reactive oxygen species (ROS) are associated with chronic pelvic pain and play an important role in the regulation of genes expressing immunoregulators, cytokines, and other molecules. Chronic pelvic pain treatment is often unsatisfactory and limited to symptom control. However, dietary treatment with antioxidants can improve the function of the immune system and overcome free radical damage. Therefore, dietary supplementation is suggested as a means to treat some chronic medical conditions that respond poorly to medication. In summary, dietary treatment with antioxidants could be considered for new strategy for treatment of chronic pelvic pain and may be better tolerated by patients than current treatments.

Rapid Assessment of Tourism Impacts through Community Participation—A Pilot Study in Cuba for Projecting New Strategies of Management

The report of the Rapid Assessment of tourism impacts through community participation is presented, based on a pilot study in Cuba to project new strategies of management. The purpose of this study is to develop a methodology to identify how tourism affects social organization in communities, in order to consider different policy implications and management options, at the same time, to conduct comparative studies to monitor vulnerabilities and the effectiveness of social and health-promoting policies. This project brings together researchers and community representatives from Cardenas and Caibarien, two coastal communities in Cuba, to examine how the expansion of tourism in these communities directly and/or indirectly affects them. In relation to the general objective a conceptual framework is elaborated to explain pathways that link the impacts of tourism and the policies that influence them across their lifespan. A consensus is developed on indicators and research/measurement protocols based on a comprehensive review of existing evidence on these issues. A preliminary agreement is also promoted according to the policy implications and policy options of insights that can be gained regarding the impacts of tourism on local communities among policy-makers, researchers and community leaders.

DOE Released a New Strategy for Management and Disposal of Used Nuclear Fuel and High−level Radioactive Waste

米国では，ヤッカマウンテン処分場計画が破棄され，昨年１月にブルーリボン委員会が，同計画破棄後の使用済燃料や高レベル放射性廃棄物の新たな管理方策に関する検討報告書を公表した。その報告を受けた議会は，DOEに対し，報告書に盛り込まれた勧告を実現するための実施戦略を６カ月以内に取りまとめるよう求めた。DOEの実施戦略は，半年の遅れで今年１月11日に公表された。本報では，その概要を紹介するとともに，この１年間の関連する動きと，今後の新たなサイト選定に向けた展望についても解説を試みる。

Dezesseis anos do plano diretor de reforma do aparelho do Estado (PDRAE): introdução à análise crítica sobre o papel do Estado brasileiro contemporâneo - doi: 10.5102/rbpp.v2i2.1676

The present paper aims to establish brief analysis about the evolution of Social Organizations of Civil replacement assignments as part of the contemporary state. Th e reform of the Brazilian State has established itself as the measure found by the public in order to solve social problems, political and economic, symptoms of which broke out in the seventies, through the so-called endogenous crisis of the state. It should be noted also that democratic participation as the foundation of the State Apparatus Reform obstacle lies in the very contemporary notion of civil society, especially the Brazilian civil society, because of the inherent characteristics of the trajectory of their formation. It was necessary to devote special attention to the Brazilian context through multidisciplinary approach, establishing the academic dialogue between diff erent fi elds of knowledge such as law and political science. Th e document analysis as an empirical endeavor, it is also necessary to understand the phenomenon of regulatory conformed new strategy for management of the national state, under the promise of eff ective and backed by the Federal Constitution. When draft ing the Master Plan for Reform of the state apparatus (PDRAE), many of the arguments were directed to incipient form as the state administered both the economy and the provision of public services. It should be stressed also that the document that formalizes the administrative reorganization of the Brazilian State, PDRAE only indicated tasks to civil society through the creation of social organizations, regulated by law, without, however, allocate yourself obligations to assist in provision of public services historically a state responsibility.

Extracorporeal life support in patients with severe trauma: An advanced treatment strategy for refractory clinical settings

Major trauma is a leading cause of death, particularly among young patients. New strategies in management are needed to improve poor outcomes in cases of severe trauma. Extracorporeal life support (ECLS) has proven to be effective in acute cardiopulmonary failure of different causes, even when conventional therapies fail. We report our initial experience with ECLS as a rescue therapy in severely polytraumatized patients in a refractory clinical setting. This study identifies the pre-ECLS characteristics of patients to predict the appropriateness of ECLS treatment. From December 2008 to May 2012, 375 patients with polytrauma were treated in the Careggi Teaching Hospital, a tertiary-level referral trauma center. Our ECLS team was alerted on 30 patients and applied ECLS in 18 adult patients with trauma. We adopted venoarterial ECLS in 14 patients with cardiopulmonary failure with refractory shock and venovenous ECLS in 4 patients with isolated refractory acute respiratory failure. ECLS was initiated at a mean of 359.176±216.606 (145-950) minutes from trauma. In 4 patients, the ECLS treatment failed because of an incapability to maintain adequate ECLS flow and perfusion. In 14 patients, efficiently supported by ECLS, the cardiac index, mean arterial pressure, blood lactate concentration, arterial oxygen tension, arterial carbon dioxide tension, and pH showed significant improvement, with normal values reached at 3.5±1.5 hours. From our data, ECLS seems to be a valuable option to resuscitate patients with severe trauma when conventional therapies are insufficient. ECLS is safe, feasible, and effective in providing hemodynamic support and blood gas exchange.

Allopathic impact of some medicinal plants on Portulaca oleracea L. and Lepidium sativum L. seed germination: a study to find natural herbicide

Recently by expose the health requirement as primal needs of mankind and people interested to use of organic production, investigation to find out effective natural compounds to replace of synthetic materials is increasing [1, 2, and 3]. In this context, the use of plant extracts as natural materials is a new strategy for management of weeds. In present study the allelopathic effects of aqueous and hydro-alcoholic extracts of Ruta graveolens L., Artemisia sieberi Besser, Allium sativum L., Tribulus terrestris L. and Peganum harmala L. were evaluated on Portulaca oleracea L. and Lepidium sativum at plant germination stage (pre-emergence). Percentage, germination rate (GR) and mean days to germination (MDG) obtained in 1-day intervals for 12 days. The results showed that hydro-alcoholic were effective in prevention of seed germination in compare with aqueous extract. Aqueous extract of R. graveolens with (76%), A. sieberi (89.33%) and A. sativum (44%) showed preventive effect on L. sativum seeds germination in compared with control (100%). All aqueous extract had shown allopathic effect (64–73%) on P. oleracea in Compared with control (100%). Hydro alcoholic extract of plants had shown less than 40% germinated seed corresponding to both of evaluated plants. Generally both kinds of extracts cause to decrease (GR) and increase (MDG). In conclusion T.terrestres extracts is introduce as natural compound with high allopathic effect that can be used as herbicide. However other studies are necessary to fully understand the reasons by which some medicinal plants may affect as herbicide in order to commercial application.

Up-regulation of NOS expression, activity and no production in the spinal cord induced by acute myositis in rats

Glial cells have an important role in inflammatory processes, through the release of several mediators. In order to explore the involvement of glia in the nitric oxide(NO)-mediated nociception, the present study was undertaken to investigate the NO synthase (NOS) expression in the spinal cord during the process of acute myositis induced by carrageenan in rats. In addition, we will also evaluate the effect of fluorocitrate (FC), an inhibitor of glial metabolism, on NOS expression. Myositis was induced by the administration of 400μg of carrageenan (Cg) in the right gastrocnemius (GS) muscle of rats, with saline (150μL) as control. Immunohistochemical assays to evaluate nNOS expression were performed in the lumbar dorsal horn and central canal of spinal cord 2h after the myositis-induced. The activity of all NOS isoforms was detected by NADPH-d histochemistry staining. Intrathecal injection of fluorocitrate was used to examine potential spinal glial mediation in this model. The immunohistochemical data showed that carrageenan up-regulated nNOS expression 2h after acute myositis, as immunostaining to nNOS was significantly higher in animals injected with Cg when compared with controls groups. Fluorocitrate, a glial inhibitor, when administered by intrathecal route, was not able to decrease nNOS expression in rats with myositis. Regarding NADPH-d, we also observed and increase of NO positive cells after carrageenan injections when compared with control animals. Our results suggest that in the process of acute muscle inflammation occurs the release of NO, through the activation of positive NOS neurons in the dorsal horn and central canal of the spinal cord. Understanding the role of glial cells during myositis-induced nociception may lead to new strategies for management of muscle pain, one of the most frequent types of clinically relevant pain. Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Glial cells have an important role in inflammatory processes, through the release of several mediators. In order to explore the involvement of glia in the nitric oxide(NO)-mediated nociception, the present study was undertaken to investigate the NO synthase (NOS) expression in the spinal cord during the process of acute myositis induced by carrageenan in rats. In addition, we will also evaluate the effect of fluorocitrate (FC), an inhibitor of glial metabolism, on NOS expression. Myositis was induced by the administration of 400μg of carrageenan (Cg) in the right gastrocnemius (GS) muscle of rats, with saline (150μL) as control. Immunohistochemical assays to evaluate nNOS expression were performed in the lumbar dorsal horn and central canal of spinal cord 2h after the myositis-induced. The activity of all NOS isoforms was detected by NADPH-d histochemistry staining. Intrathecal injection of fluorocitrate was used to examine potential spinal glial mediation in this model. The immunohistochemical data showed that carrageenan up-regulated nNOS expression 2h after acute myositis, as immunostaining to nNOS was significantly higher in animals injected with Cg when compared with controls groups. Fluorocitrate, a glial inhibitor, when administered by intrathecal route, was not able to decrease nNOS expression in rats with myositis. Regarding NADPH-d, we also observed and increase of NO positive cells after carrageenan injections when compared with control animals. Our results suggest that in the process of acute muscle inflammation occurs the release of NO, through the activation of positive NOS neurons in the dorsal horn and central canal of the spinal cord. Understanding the role of glial cells during myositis-induced nociception may lead to new strategies for management of muscle pain, one of the most frequent types of clinically relevant pain. Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).

Hepatocyte Lysosomal Membrane Stabilization by Olive Leaves against Chemically Induced Hepatocellular Neoplasia in Rats

Extensive efforts are exerted looking for safe and effective chemotherapy for hepatocellular carcinoma (HCC). Specific and sensitive early biomarkers for HCC still in query. Present work to study proteolytic activity and lysosomal membrane integrity by hepatocarcinogen, trichloroacetic acid (TCA), in Wistar rats against aqueous olive leaf extract (AOLE).TCA showed neoplastic changes as oval- or irregular-shaped hepatocytes and transformed, vesiculated, and binucleated liver cells. The nuclei were pleomorphic and hyperchromatic. These changes were considerably reduced by AOLE. The results added, probably for the first time, that TCA-induced HCC through disruption of hepatocellular proteolytic enzymes as upregulation of papain, free cathepsin-D and nonsignificant destabilization of lysosomal membrane integrity, a prerequisite for cancer invasion and metastasis. AOLE introduced a promising therapeutic value in liver cancer, mostly through elevating lysosomal membrane integrity. The study substantiated four main points: (1) the usefulness of proteolysis and lysosomalmembrane integrity in early prediction of HCC. (2) TCA carcinogenesis is possibly mediated by lysosomal membrane destabilization, through cathepsin-D disruption, which could be reversed by AOLE administration. (3) A new strategy for management of HCC, using dietary olive leaf system may be a helpful phytotherapeutic trend. (4) A prospective study on serum proteolytic enzyme activity may introduce novel diagnostic tools.

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Abstract PL05-04: From basic science to public health: The Canadian approach to oral leukoplakia

Dietary therapy: a new strategy for management of chronic pelvic pain

Chronic pelvic pain (CPP) can be identified as a chronic nociceptive, inflammatory and neuropathic pain characterised by spontaneous pain and an exaggerated response to painful and/or innocuous stimuli. This pain condition is extremely debilitating and usually difficult to treat. Currently, the main approaches to treatment include counselling supported by reassuring ultrasound scanning or psychotherapy, attempting to provide reassurance using laparoscopy to exclude serious pelvic pathology, hormonal therapy and neuroablative treatment to interrupt nerve pathways. Dietary supplementation has been suggested as a means to treat chronic medical illnesses that are poorly responsive to prescription drugs or in which therapeutic options are limited, costly or carry a high side-effect profile. A comprehensive search of the PubMed database was performed using the search terms 'chronic pelvic pain', 'oxidative stress', 'antioxidants' and 'dietary therapy'. The systematic review focuses on both randomised and non-randomised controlled trials from 2005 onwards, in which CPP was the end point. Given the complexity and not well-understood aetiology of CPP, its treatment is often unsatisfactory and limited to partial symptom relief. Dietary therapy with antioxidants improves function of the immune system and in fighting free radical damage. Agents with antioxidant activity are able to improve CPP without undesired effects and any important metabolic changes associated with hormonal suppression therapy. In conclusion, dietary therapy with antioxidants could be considered as a new effective strategy in the long term for CPP, and may be better accepted by patients. Further randomised trials with larger series and long-term follow-up to confirm these observations are needed.

Roles of microglia and purinoceptors in pain

There is a abundant evidence that both extracellular and intracellular ATP have an important role in pain signaling.The focus of attention is now on the possible roles and mechanism of ATP and its receptors in chronic pain states, particularly in neuropathic pain. After the body is stimulated, the activated microglia can over express P2X4R and other ATP receptors, resulting in the release of BDNF ,IL-1β ,TNF-α、IL-6、NO.Understanding the key roles of these ATP receptors may provide new strategies for management of chronic pain states. Key words: Microglia; ATPreeeptors; P2X4; Pain