Treatment For Relief Research Articles

An alternative source of medicines: pharmaceutical utilization of animal-derived metabolites

Abstract Throughout history, various human civilizations have used raw materials obtained from the body parts, metabolic byproducts, or non-animal components of animals as medical resources for the treatment of numerous diseases and relief of symptoms. Protein structures, including hormones and enzymes, as well as various animal-derived metabolites including polysaccharides, lipids, and vitamins, have been used for the development of raw drugs. These chemicals include widely used substances including heparin, melatonin, collagen, glucosamine, chondroitin, bile acids, and coenzyme Q10. Additionally, they include materials such as snake, spider, and amphibian poisons, which are now undergoing therapeutic development. This review presents examples of animal-derived pharmaceutical raw materials that are being used as drugs and have potential in drug development research. Detailed descriptions of the chemical structures, original sources and effects of these raw materials are included. In general, the production method that was previously carried out by using animal organisms has been replaced by the utilization of recombinant technologies. The use of animals as a resource in the drug development process is expected to remain an interesting topic and further research in this area is expected. Nevertheless, it is essential not to disregard the suggestions against utilizing animals in pharmaceutical production, particularly in cases where alternative sources are accessible.

Bridging Gaps in Migraine Management: A Comprehensive Review of Conventional Treatments, Natural Supplements, Complementary Therapies, and Lifestyle Modifications

Background: Migraine, a complex neurological condition, poses significant challenges for both sufferers and healthcare providers. While prescription medications play a vital role in managing migraine attacks, the quest for natural, non-pharmacological alternatives has garnered increasing interest. This review explores the efficacy and safety of natural supplements as treatments for migraine relief, comparing them with conventional prescription medications. Methods: The review delves into herbal supplements, clinical studies on natural remedies, aromatherapy, dietary influences, and lifestyle modifications in the context of migraine management in several databases. Results: The findings shed light on the potential of natural supplements as complementary or alternative approaches to traditional migraine therapies, offering insights into a holistic and personalized treatment paradigm for migraine sufferers. Conclusions: Natural supplements have gained attention as potential treatments for migraine relief, often perceived as safer alternatives to conventional medications.

Simultaneous bilateral avascular necrosis of the humerus and femur in long COVID-19: a case report

Background. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted the widespread use of corticosteroids as a treatment strategy, particularly in cases of severe pneumonia and cytokine storm. While this therapy has saved countless lives, its side effects have also been well-documented, including the development of avascular necrosis. Case presentation. This case report presents a rare instance of simultaneous bilateral avascular necrosis (AVN) affecting both the humeral and femoral heads in a 49-year-old male patient recovering from severe COVID-19. The patient was treated with high-dose corticosteroids, receiving 1250 mg of prednisolone over five days during hospitalization for COVID-19 pneumonia. Six months after discharge, he developed persistent hip pain, which was later diagnosed as AVN in both femoral heads. During hyperbaric oxygen therapy, the patient reported new shoulder pain, and MRI confirmed stage III AVN in both humeral heads. The patient’s pain was managed with bilateral suprascapular nerve radiofrequency ablation and bilateral Pericapsular Nerve Group (PENG) blocks, which provided significant relief. Conclusions. This case emphasizes the potential for corticosteroid-induced AVN, even months after treatment, and underscores the need for long-term monitoring of patients receiving corticosteroids for COVID-19. The involvement of four major joints highlights the severe musculoskeletal complications that can arise, supporting the importance of early diagnosis and timely intervention for pain relief.

Gender Differences in Stress Reduction: How the Five Senses Forest Therapy Enhances Well-Being in University Students

Forest therapy is known to promote physical and mental well-being, but its specific impact on physiological and psychological recovery in university students, particularly across genders, remains underexplored. This study examined the effects of a five-hour forest therapy session involving sensory-based activities on 48 students (30 males and 18 females). The key outcomes measured included pulse rate, heart rate variability (HRV), and mood states. Significant reductions in pulse rate and anxiety were observed, with females showing greater physiological and emotional recovery. These findings suggest that forest therapy may serve as an effective intervention for stress relief, particularly for females, and highlight the potential of sensory-based therapies in promoting student well-being.

Laser‐Based Closed‐Loop Controlled Heat Treatment for Residual Stress Relief of Additively Manufactured AlSi10Mg Components

In laser powder bed fusion of metals small melt pools with extremely short solidification times and steep temperature gradients to the surrounding material exist due to the layer‐wise and selective melting process with small areas of energy input compared to the cooler, solid ambient material. This causes high thermally induced residual stresses (RS), which can lead to the immediate rejection of the component due to critical part deformation and inhomogeneous mechanical properties under load. To prevent this, furnace‐based stress relief heat treatments are commonly applied before cutting‐off the part from the built platform. In this study a novel closed‐loop controlled laser‐based heat treatment using temperature feedback through inline pyrometer measurement is investigated, enabling a fast and highly efficient postprocess stress relief. Therefore, a laser beam is guided by a scanner optics in a meandering pattern over the top surface of AlSi10Mg cantilever specimens. It enables a decrease of near‐surface RS from 158 to 5 N mm−2, resulting in a reduction of displacement by over 90% at material affecting depths up to 3 mm and area rates of 8 to 163 mm2 s−1.

Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis

ObjectiveThis study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients. MethodsWe performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots. ResultsSixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy’s efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted. ConclusionsCold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain. Implications for clinical practiceIncorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.

Use of Palliative Site-Directed Ablation in Pediatric Oncology: A Retrospective Study From the Pediatric Surgical Oncology Research Collaborative.

Children with end-stage solid tumors would benefit from established nonsurgical options for palliative site-directed local control with the intent of improving quality of life (QOL) and extending survival. We investigated the practice and tolerability of palliative ablation strategies in patients with pediatric solid tumors. Children and young adults with solid tumors ineligible for surgical site-directed control were treated with palliative ablative strategies between 2010 and 2020 at five institutions participating in the Pediatric Surgical Oncology Research Collaborative. Demographic, histologic, and clinical data were retrospectively evaluated, and assessment of patient reasons for choosing ablative strategies was qualitatively assessed. A total of 69 patients underwent 89 ablative procedures for 132 lesions. More than 10 histologies were represented, the most common of which were Ewing sarcoma (n=15 patients), osteosarcoma (n=13 patients), and rhabdomyosarcoma (n=9 patients). Ablation techniques included cryoablation (n=9 procedures/16 lesions), radiofrequency ablation (RFA) (n=4 procedures/5 lesions), microwave ablation (MWA) (n=5 procedures/12 lesions), and stereotactic body radiotherapy (SBRT) (n=68 procedures/99 lesions). Grade 3 or higher adverse events (AEs) included pain requiring IV medication in cryoablation (three out of 12 procedures), RFA (one out of four procedures), and MWA (two out of five procedures), bleeding in MWA (two out of five procedures), and skin burns requiring surgical intervention in SBRT (one out of 68 procedures). Patients were generally hospitalized after percutaneous ablation (19 out of 21 cryoablation, RFA, and MWA procedures) but the hospital stay was short (mean/SD 1±4 days). Only four patients who were already hospitalized experienced hospitalization extension due to undergoing an ablative procedure. The primary reason for pursuing ablative measures could be broadly categorized into four groups: treatment of unresectable disease either due to surgical inaccessibility or metastasis (n=31), symptom relief, either pain or mass effect (n=25), specific patient QOL concerns unrelated to pain or life prolongation (n=5), and physiologic instability for otherwise resectable disease (n=4). All patients undergoing treatment for symptom relief received SBRT. In this cohort of patients undergoing palliative treatment of incurable or unresectable pediatric solid tumors, ablation strategies were well tolerated. Further research is needed to determine patient reported outcomes after ablation strategies are pursued and patient and family satisfaction with the choice for ablative strategies. An understanding of institutional availability and ability to employ these strategies would also be informative.

Flexible and Stretchable Li Ion Battery Using Origami Scale Structure for Untethered Soft Robot

In recent years, technology of soft robotics has emerged as an important issue for the robot industry. Compared to conventional industrial metallic robots in controlled environments, soft robots are highly expandable in responding to non-standardized environments. Due to these characteristics, it is expected to be used not only in daily life, but also in specific applications such as treatment of disease and disaster relief. The development of a structure that is free to deformation with energy source is also essential to improve the technology. Among several energy sources, Lithium ion batteries (LIBs) are the prime choices for these applications due to light weight, high energy density and long cycle life. The integration of flexible structure and LIBs is very important to reduce the waste of space and weight of soft robots for versatility and portability. However, there are many difficulties due to the absence of batteries with high reliability under deformation. LIBs usually have little flexibility due to the high stack cells and stiff nature of cell components. It is required to have a new design of LIBs. Geometrically designed structures incorporating bioinspiration are promising solutions for integrating components of soft robots. In this study, we propose a novel geometric structure for stretchable devices, created by folding well-defined two-dimensional patterns with cutouts to produce an extremely stretchable structure with superior reliability and bi-axial deformability. The structure is designed to mimic the hinge of a snakeskin so that its unit cells do not interfere with each mutual movement enabling stable deformations without mechanical damage. In addition, to maximize areal density and stretchability, the optimal shape of unit is determined. The unit-based geometric structure is applied to a stretchable Li-ion battery and constructed of hexagonal pouch cells and parallelogram interconnections. In situ electrochemical characterization confirms that the performance of the battery is maintained under dynamic deformation with a stretching ratio of 90% and a 10-mm-radius bending curvature, guaranteeing a long-lasting cycle life. To confirm the mechanical reliability of the scale battery, the strain distribution at the flexible hinge is obtained by FEA(Finite element analysis). The strain is mainly localized in the folding parts of the interconnection, and it is found that the unit cell experiences on deformation during the unfolding process. This is the main reason that the electrochemical performance is maintained during the mechanical deformation of the scale battery. Finally, the geometrically designed structure-based battery is applied to movable robots, crawling and slithering, with dynamic bi-axial deformations and can be pivotal role in the development of flexible electronics including human-friendly wearable electronics and soft robots.

A “people-like-me” approach to predict individual recovery following lumbar microdiscectomy and physical therapy for lumbar radiculopathy

BACKGROUND CONTEXTLumbar microdiscectomy is an effective treatment for short-term pain relief and improvements in disability in patients with lumbar radiculopathy, however, many patients experience residual pain and long-term disability. The 'people like me' approach seeks to enhance personalized prognosis and treatment effectiveness, utilizing historical data from similar patients to forecast individual outcomes. PURPOSEThe primary objective was to develop and test the ‘people-like-me’ approach for leg pain intensity and disability at 12-month follow-up after lumbar microdiscectomy and postoperative physical therapy. The secondary objective was to verify the clinical utility of the prediction tool via case vignettes. STUDY DESIGN/SETTINGA 12-month prospective cohort study. PATIENT SAMPLEPatients (N=618, mean age: 44.7) with lumbar radiculopathy who undergo a lumbar microdiscectomy and postoperative physical therapy. OUTCOME MEASURESLeg pain intensity (Visual Analogue Scale) and disability (Roland-Morris Disability Questionnaire) were measured at 12-months following surgery. METHODSPredictors were selected from data collected in routine practice before and 3-months after lumbar microdiscectomy. Predictive mean matching was used to select matches. Predictions were developed using preoperative data alone or combined with 3-month postoperative data. The prediction performance was evaluated for bias (difference between predicted and actual outcomes), coverage (proportion of actual outcomes within prediction intervals), and precision (accuracy of predictions) using leave-one-out cross-validation. RESULTSOverall, the 'people-like-me' approach using preoperative data showed accurate coverage and minimal average bias. However, precision based on preoperative data alone was limited. Incorporating 3-month postoperative data alongside preoperative predictors significantly enhanced prognostic precision for both leg pain and disability. Including postoperative data, leg pain prediction accuracy improved by 43% and disability by 23% compared to the sample mean. Adjusted R2 values improved from 0.04 to 0.21 for leg pain, and from 0.07 to 0.34 for disability, enhancing model precision. The effectiveness of this method was highlighted in two case vignettes, illustrating its application in similar patient scenarios. CONCLUSIONThe ‘people-like-me’ approach generated an accurate prognosis of 12-months outcomes following lumbar discectomy and physical therapy. Scheduling a 3-month postoperative follow-up to evaluate the course, and refine therapy plans and expectations for patients undergoing lumbar microdiscectomy would be recommended to assist clinicians and patients in more personalized healthcare planning and expectation setting.

Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis.

Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial. We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA). A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method. The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency. This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations. CRD42024524657.

Self-reported and physiological stress indicators and the moderating role of the Dark Tetrad in violent and non-violent gaming

Playing non-violent video games has been shown to reduce perceived levels of stress (Pallavicini et al., 2021). Does this effect also apply to violent game content? As findings suggest a particular preference for such games among people with certain personality traits, such as the Dark Tetrad (i.e., Machiavellianism, everyday sadism, subclinical psychopathy, and narcissism; e.g., Bonfá-Araujo et al., 2022; Greitemeyer, 2015; Greitemeyer & Sagioglou, 2017) do these traits influence the stress they feel? In the present lab experiment, potential stress-reducing effects of violent and non-violent video games were compared to a control condition (solving a jigsaw puzzle). Cortisol levels, heart rate variability (HRV), and self-reported stress levels were assessed before, during, and after gameplay. Irrespective of game condition, playing video game passages decreased cortisol levels, a typical indicator of stress. In addition, playing violent games led to a significant decrease in certain HRV indicators (i.e., ratio of low frequency power to high-frequency power), thus providing additional support for stress relief. In contrast, trying to solve a jigsaw puzzle did not result in stress reduction. Most results involving the Dark Tetrad traits showed null findings. However, participants with greater Dark Tetrad expressions experienced more relaxation after violent gameplay while showing greater stress reaction after trying to solve a jigsaw puzzle. The present results indicate that playing violent or non-violent video games can lead to physiological relaxation—an important finding for future research on the potential of video games for stress relief interventions.

Fractional Flow Reserve and Instantaneous Wave-Free Ratio as Predictors of the Placebo-Controlled Response to Percutaneous Coronary Intervention in Stable Coronary Artery Disease.

The Placebo-controlled Trial of Percutaneous Coronary Intervention for the Relief of Stable Angina (ORBITA-2) provided evidence for the role of percutaneous coronary intervention (PCI) for angina relief in stable coronary artery disease (CAD). Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are often used to guide PCI, however their ability to predict placebo-controlled angina improvement is unknown. Participants with angina, ischemia, and stable CAD were enrolled and antianginal medications were stopped. Participants reported angina episodes daily for 2 weeks using the ORBITA-app. At the research angiogram, FFR and iFR were measured. After sedation and auditory isolation, participants were randomized to PCI or placebo, before entering a 12-week blinded follow-up phase with daily angina reporting. The ability of FFR and iFR, analyzed as continuous variables, to predict the placebo-controlled effect of PCI, was tested using Bayesian proportional odds modelling. Invasive physiology data were available in 279 patients (140 PCI and 139 placebo). The median (IQR) age was 65 years (59.0 to 70.5) and 223 (79.9%) were male. Median FFR was 0.60 (0.46 to 0.73) and median iFR was 0.76 (0.50 to 0.86). The lower the FFR or iFR, the greater the placebo-controlled improvement with PCI across all endpoints. There was strong evidence that a patient with an FFR at the lower quartile would have a greater placebo-controlled improvement in angina symptom score with PCI than a patient at the upper quartile (FFR 0.46 vs. 0.73: OR 2.01, 95% CrI 1.79 to 2.26, Pr(Interaction)>99.9%). Similarly, there was strong evidence that a patient with an iFR at the lower quartile would have a greater placebo controlled improvement in angina symptom score with PCI than a patient with an iFR at the upper quartile (iFR 0.50 vs. 0.86: OR 2.13, 95% CrI 1.87 to 2.45, Pr(Interaction) >99.9%). The relationship between benefit and physiology was seen in both Rose angina and Rose nonangina. Physiological stenosis severity, as measured by FFR and iFR, predicts placebo-controlled angina relief from PCI. Invasive coronary physiology can be used to target PCI to those patients who are most likely to experience benefit.

Revolutionizing nurse well-being: Virtual reality as a stress relief intervention.

This article describes an 8-week pilot project implementing virtual reality (VR) technology as a stress relief intervention for nurses at a rural hospital. It highlights how VR allowed nurses to temporarily disconnect from their stressful work environment and experience calming virtual scenarios during break times.

Interpretation of a clinical practice guideline on the management of chronic pain associated with temporomandibular joint disorders

Temporomandibular disorders (TMD) are a heterogeneous group of diseases that affect the temporomandibular joint, chewing muscle system, dental occlusion, and even various structures throughout the body, with significant characteristics of biological-psychological-social pattern. TMD related chronic pain, as the most important clinical symptom, can result in negative emotions seriously affecting patients' quality of life and physical and mental health. Although a variety of therapies have been previously reported to treat TMD related chronic pain, there is a lack of widely recognized therapies. Professor Jason W Busse (from Michael G DeGroote National Pain Centre, McMaster University, Hamilton ON, Canada) took the lead and collaborated with multiple internationally renowned schools/hospitals of stomatology to develop an international consensus on the management of chronic pain associated with TMD, a clinical practice guideline, which took two years and was published in December 15th, 2023 in a global top journal of clinical research The British Medical Journal. This clinical practice guideline explored the comparative effectiveness of available therapies for chronic pain associated with TMD, conditionally recommended the specific intervention for different treatment or pain relief, proposed a comprehensive, agreed, and standardized clinical practice guideline. This present article describes the methodology and key elements of the clinical practice guideline to help clinicians fully understand and appropriately apply this guidance, which could provide the references for clinical practice of TMD associated chronic pain in China.

Duty, Diligence and Disasters: Detailing Everyday Practices of Malawian Civil Servants in the Climate Crisis

African civil servants are often portrayed as lacking capacity, deeply entangled in patronage networks, embroiled in all kinds of corruption and largely indifferent to their jobs and the plight of their fellow citizens. Perceptions of Malawian civil servants have been no exception to this stereotype and find fertile ground in numerous recent governance scandals, including the misuse of COVID-19 funds. In this paper, I suggest that this overarching focus on failure has obscured and trivialised important dimensions of civil servants’ work that are central to how they perform their duties. Drawing on 18 months of ethnographic fieldwork with civil servants working with the Department of Disaster Management Affairs in relief interventions after Cyclone Idai (2019) and Cyclone Freddy (2023), I detail the ways in which they understood their professional responsibilities and their efforts to balance different (moral) obligations they experienced in relation to their job. Taking seriously my interlocutors’ suggestion that one needs ‘a special heart’ in their line of work, I argue that they draw on a sense of duty to fulfil their duties. This becomes more visible during times of emergency response and disasters but is always present. I ultimately suggest that shifting the focus from failure to civil servants’ sense of duty allows for a more nuanced understanding of the Malawi state.

Uncaria Rhynchophylla and hirsuteine as TRPV1 agonists inducing channel desensitization

Ethnopharmacological relevanceUncaria rhynchophylla (UR) is recognized for its therapeutic applications in treating hypertension and inflammation. However, the specific molecular mechanisms how UR and its bioactive constituents modulate inflammatory pathways remain unknown. This study investigates the effects of UR extract and its constituent, hirsuteine (HST), on TRPV1 channel modulation which is related to hypertension and inflammation. Materials and methodsElectrophysiological recordings and calcium imaging experiments were conducted to assess TRPV1 activation by UR extract and HST in HEK293T cells and sensory neurons. ResultsUR extract and HST activated TRPV1 in HEK293T cells, with repeated applications causing channel desensitization. HST application on TRPV1-positive sensory neurons significantly reduced electrical activity compared to capsaicin. ConclusionThis study demonstrated UR extract and HST are a novel TRPV1 agonists inducing channel desensitization and a potent agent for treatment of TRPV1 dependent pain relief.

Osteoarthritis: An Update on Diagnosis & Management.

Osteoarthritis (OA) is the most prevalent joint condition. It is a progressively degenerating disease that involves the entire joint, including the articular cartilage, subchondral bone, ligaments, capsule, synovial fluid, and periarticular muscles. Physicians understand that osteoarthritis is diagnosed late during the illness, which may be too late for patients to receive significant benefits from medications that change their condition. The goals of OA therapy are to preserve function while minimizing pain and stiffness. This article focuses on the current and potential treatments for osteoarthritis and various diagnostic methodologies for this disease. In the coming years, despite having numerous treatments for symptomatic relief, the treatment plan should be more specialized because everyone might experience improved outcomes.

Cellular responses following ex vivo lung exposure to the nerve agent VX – Potential for additional treatment targets?

Following inhalation exposure to organophosphorus nerve agents, symptoms rapidly develop and severe respiratory symptoms, such as bronchorrhea and bronchoconstriction are the leading causes of lethality. Nerve agent-induced lung injury is little investigated and the standard treatment for symptomatic relief targets the enzyme acetylcholinesterase and muscarinic acetylcholine and GABAergic receptors. In the present study, cellular responses in lung tissue during the acute (40 min) and extended phase (24 h) following severe exposure to the nerve agent VX have been investigated using an ex vivo rat precision-cut lung slice model including electrostimulation to induce a cholinergic response. Changes in protein amount, cell viability, together with, inflammatory and oxidative stress markers have been determined in both the lung tissue and incubation medium.During the acute phase, VX caused significantly increased airway contraction and decreased airway relaxation. Five micromolar of VX did not affect the sample protein levels and cell viability in lung tissue. Among seven markers of cellular responses investigated in the lung tissue, increased levels of heme oxygenase-1 and matrix metalloproteinase-9 together with decreased levels of glutathione in the incubation medium were observed in the acute phase following VX-exposure compared to electrostimulation only. No difference in cellular response was observed following VX-exposure for 24 h compared to the air control. In comparison, LPS-exposure resulted in time-dependent changes in all markers of inflammation and oxidative response.In conclusion, the present study demonstrated VX-specific patterns of oxidative responses in the lung, as well as, signs of inflammatory response and remodelling of extracellular matrix. These potential mechanisms of tissue injury should be further investigated for their potential as additional therapeutic targets during the acute phase of intoxication.

Functional and Radiological Outcome of Simultaneous Bilateral Total Knee Replacement in a Tertiary Care Centre : A Quasi-prospective Study.

Osteoarthritis (OA) is the most frequent joint disease with a prevalence of 5313 per 100,000 persons in India. OA of the knee is a major contributor to mobility impairment, particularly among women. In these patients, total knee replacement (TKR) is widely accepted as the gold standard treatment for pain relief and restoration of function. Now, patients have the option of undergoing either a simultaneous bilateral TKR or a staged TKR. The former has shown significant advantages such as shorter rehabilitation, cost efficacy and shorter hospital stay. This study aimed to assess the functional and radiological outcome of simultaneous bilateral TKR in a tertiary care centre. 30 adult patients above the age of 55 years with severe OA knee who underwent simultaneous bilateral TKR between 2022-2023 were included in this prospective study. Preoperatively, they were assessed with radiographs including full length scannograms. Mean Anatomical Axis, Mean Mechanical Axis and Mechanical Axis Deviation (Varus) were calculated based on the scannograms by a single observer. The same observer administered the oxford knee score (OKS) preoperatively to all patients. Regular clinical and radiological follow up was done. After 1 year follow up, the same observer administered the Oxford Knee Score (OKS) to the operated knee. With a female preponderance among the study subjects (56.7%), the majority of the cases in our cohort were characterised as Grade IV Kellgren-Lawrence radiological grade of Osteoarthritis (76.66%) and were found to have tricompartmental involvement (70%). The mean anatomical axis for the right and left lower limb were 4.56±5.17 and 9.68±1.72 respectively. The mean mechanical axis deviation (Varus) for the right and left lower limb were 31.6±15.1 and 52.0±13.9 respectively. Preoperatively, mean mechanical axis for the right and left lower limb were 9.95±4.31 and 14.2 ±0.67 respectively. Postoperatively, mechanical axis was restored to near-normal values (3-5 degrees). Significant improvement in mean OKS from a preoperative value of 18.30 ± 3.46 to postoperative value of 33.50 ± 5.32 was noted at 1 year. Treatment of severe bilateral OA knee with simultaneous single staged bilateral TKR ensures good functional outcome , early mobility with minimal complications.

Effect of transcutaneous electrical nerve stimulation therapy on condylar position and myofascial pain in patients with temporomandibular joint disorders-A pilot clinical trial.

Temporomandibular joint disorders (TMD) are a type of disorder that affects the temporomandibular joint, muscles, and nerves leading to persistent facial pain. Transcutaneous electrical nerve stimulation (TENS) therapy is an alternative treatment for pain relief in TMD patients. The aim of the study was to assess the condylar position changes and pain levels occurring in TMD patients after TENS therapy. According to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria, a total of seven patients with TMD were included in this study. Routine diagnostic investigations were taken for each patient along with joint vibration analysis (JVA), electromyography (EMG), and a cone beam computed tomography (CBCT) at rest position. Using the Dolphin software (version 11.95), the temporomandibular joint spaces were measured on the CBCT for the right and left sides individually for each patient. These patients were then subjected to TENS therapy, and an EMG reading was taken post-TENS therapy to evaluate the effect on muscle strain. A CBCT was taken after the TENS therapy to assess its effect on the condylar position. The statistical significance of the pre- and post-temporomandibular joint spaces and the EMG readings post-TENS therapy were assessed using paired t-tests, respectively. There was a change in the anterior, middle, and posterior dimensions observed radiographically, before and after TENS. However, the results were found to be statistically significant only in the anterior region on the right joint space (P = 0.03) and posterior region of the left joint space (P = 0.04). TENS therapy has been found to bring about a change in the condylar position and pain intensities by relieving inadvertent muscle activity in the temporomandibular region. Therefore, further studies with larger sample sizes and control are required to fully ascertain the role of inadvertent muscle activity on the TMJ.