Blockade des Ganglion cervicale superius des Truncus sympathicus: Ursachen für Fehlblockaden

Zusammenfassung: Hintergrund: Für die transorale Blockade des Ganglion cervicale superius (GCS) wurden die Ausbreitungsmuster von 3 verschiedenen Volumina untersuchten. Ziele waren, ein ideales Volumen und Ursachen für Fehlblockaden zu finden. Material und Methode: Es wurden 40 konservierte Köpfe untersucht. In 35 injizierten wir das Kontrastmittel Jopamiro®. In 30Köpfe wurden linksseitig 1ml, rechtsseitig 2ml und in 5Köpfe 5ml injiziert, wobei rechts das Spatium parapharyngeum (SPP) und links das Spatium praevertebrale (SPV) erreicht wurden. Alle Köpfe wurden mittels CT, Schnittbilder sowie 3D-Rekonstruktion, untersucht. In 5Köpfe injizierten wir 2ml blau gefärbtes Wasser für eine anschließende Dissektion. Ergebnis: 1 und 2ml zeigten sehr ähnliche Ausbreitungsmuster. Das SPP wurde durch eine nach lateral geführte Stichrichtung oder, bei Abweichung nach medial, durch ein Zurückziehen der Nadel erreicht. Bei 2 Widerständen erreichten wir das SPV und somit nicht mehr das GCS. Mit 5ml erreichten wir zahlreiche andere Kopfregionen. Schlussfolgerung: Ein Volumen von 1ml scheint ausreichend. Die Stichtechnik muss streng eingehalten werden, sonst erhöht sich das Risiko einer Fehlapplikatio

Die Bedeutung der Fascia stylopharyngea bei intraoralen Blockadetechniken

Zusammenfassung: Hintergrund: Mittels transoraler Blockade des Ganglion cervicale superius des Truncus sympathicus kann bei Trigeminusneuralgien durch Ausbreitung eines Opioids bis zum N.mandibularis eine zusätzliche Schmerzreduktion erzielt werden. Das Vorhandensein der Fascia stylopharyngea senkt möglicherweise die Erfolgsrate. Durch genaue anatomische Untersuchung der Faszie wollen wir auf die Effektivität der zusätzlichen Opioidwirkung rückschließen. Material und Methode: 103 Kopfhälften wurden untersucht, die Faszie von lateral her aufgesucht. Dabei unterschieden wir 3 Gruppen: GruppeA repräsentierte vollständig ausgebildete Faszienblätter, Gruppe Bunvollständige Faszien und in GruppeC war die Faszie nicht ausgebildet. Ergebnis: Die Faszie war in 86 vollständig und in 13 Fällen unvollständig ausgebildet. Lediglich in 4 Fällen fehlte sie vollends. Schlussfolgerung: Die Faszie kann die Erfolgsquote der Schmerzreduktion bei Trigeminusneuralgie beeinflusse

Effect of phosphorus supply on root traits of two Brassica oleracea L. genotypes

BACKGROUND: Phosphorus (P) deficiency limits crop production worldwide. Crops differ in their ability to acquire and utilise the P available. The aim of this study was to determine root traits (root exudates, root system architecture (RSA), tissue-specific allocation of P, and gene expression in roots) that (a) play a role in P-use efficiency and (b) contribute to large shoot zinc (Zn) concentration in Brassica oleracea. RESULTS: Two B. oleracea accessions (var. sabellica C6, a kale, and var. italica F103, a broccoli) were grown in a hydroponic system or in a high-throughput-root phenotyping (HTRP) system where they received Low P (0.025 mM) or High P (0.25 mM) supply for 2weeks. In hydroponics, root and shoot P and Zn concentrations were measured, root exudates were profiled using both Fourier-Transform-Infrared spectroscopy and gas-chromatography-mass spectrometry and previously published RNAseq data from roots was re-examined. In HTRP experiments, RSA (main and lateral root number and lateral root length) was assessed and the tissue-specific distribution of P was determined using micro-particle-induced-X-ray emission. The C6 accession had greater root and shoot biomass than the F103 accession, but the latter had a larger shoot P concentration than the C6 accession, regardless of the P supply in the hydroponic system. The F103 accession had a larger shoot Zn concentration than the C6 accession in the High P treatment. Although the F103 accession had a larger number of lateral roots, which were also longer than in the C6 accession, the C6 accession released a larger quantity and number of polar compounds than the F103 accession. A larger number of P-responsive genes were found in the Low P treatment in roots of the F103 accession than in roots of the C6 accession. Expression of genes linked with "phosphate starvation" was up-regulated, while those linked with iron homeostasis were down-regulated in the Low P treatment. CONCLUSIONS: The results illustrate large within-species variability in root acclimatory responses to P supply in the composition of root exudates, RSA and gene expression, but not in P distribution in root cross sections, enabling P sufficiency in the two B. oleracea accessions studied

Efficacy and patient satisfaction with autoadjusting CPAP with variable expiratory pressure vs standard CPAP: a two-night randomized crossover trial

Expiratory pressure relief (C-Flex) technology monitors the patient’s airflow during expiration and reduces the pressure in response to the patient. Increased comfort levels associated with C-Flex therapy have potential to improve patient adherence to therapy. The purpose of this study was to assess the combination of autoadjusting CPAP (APAP) and C-Flex in terms of (1) treatment efficacy, and (2) patient preference when compared to standard CPAP. Fifteen patients who had previously undergone formal CPAP titration polysomnography were treated with either one night of the APAP with C-Flex or one night of conventional CPAP, in a crossover trial. Patient satisfaction levels were recorded using visual analog scales (VAS) on the morning after the study. Mean patient age was 50 ± 12 years, body mass index (BMI) was 36 ± 6 kg/m(2), baseline AHI was 53 ± 31 events/h, and CPAP Pressure was 11 ± 2 cm/H(2)O. APAP with C-Flex was as effective as CPAP, with no differences detected in sleep latency (17 ± 5 vs 12.3 ± 3 min, p = 0.4), or respiratory indices (AHI of 4.2 ± 2 vs 2.4 ± 0.7 events/h, p = 0.1). VAS scores (scale 0–10) indicated a trend towards increased patient satisfaction while using APAP with C-Flex (7.9 vs 7.2, p = 0.07). 10 patients expressed a preference for APAP with C-Flex (VAS, 0 to10) over standard CPAP (total positive score of 68, mean score of 4.8 ± 4.3). One patient expressed no preference. Four patients expressed a preference for CPAP (total positive score of 13, mean score of 0.9 ± 1.9) (APAP with C-Flex vs standard CPAP, p < 0.01 paired t test). APAP with C-Flex eliminates sleep disordered breathing as effectively as standard CPAP. Patients indicated a preference for APAP with C-Flex suggesting a possible advantage in terms of patient adherence for this mode of treatment

Collective and broken pair states of 65,67Ga

Excited states of 65Ga and 67Ga nuclei were populated through the 12C(58Ni,αp) and 12C(58Ni,3p) reactions, respectively, and investigated by in-beam γ-ray spectroscopic methods. The NORDBALL array equipped with a charged particle ball and 11 neutron detectors was used to detect the evaporated particles and γ rays. The level schemes of 65,67Ga were constructed on the basis of γγ-coincidence relations up to 8.6 and 10 MeV excitation energy, and Iπ=27/2 and 33/2+ spin and parity, respectively. The structure of 65,67Ga nuclei was described in the interacting boson-fermion plus broken pair model, including quasiproton, quasiproton-two-quasineutron, and three-quasiproton fermion configurations in the boson-fermion basis states. Most of the states were assigned to quasiparticle + phonon and three quasiparticle configurations on the basis of their electromagnetic decay properties

An open-label, 1-year extension study of the long-term safety and efficacy of once-daily OROS® hydromorphone in patients with chronic cancer pain

<p>Abstract</p> <p>Background</p> <p>Opioid analgesics have proven efficacy in the short-term management of chronic cancer pain, but data on their long-term use is more limited. OROS^®hydromorphone is a controlled-release formulation of oral hydromorphone that may be particularly well suited to long-term management of chronic cancer pain because it provides stable plasma concentrations and consistent analgesia with convenient once-daily dosing. The objective of this study (DO-118X) was to characterise the pain control achieved with long-term repeated dosing of OROS^®hydromorphone in patients with chronic cancer pain.</p> <p>Methods</p> <p>In this multicentre, phase III, open-label, single treatment, 1-year extension study, OROS^®hydromorphone was administered to 68 patients with moderate-to-severe chronic cancer pain, who had successfully completed a short-term equivalence study, and whose pain was controlled with a stable dose of medication (≥ 8 mg OROS^®hydromorphone or equivalent controlled-release morphine). Patients were started on the dose of OROS^®hydromorphone equivalent to the opioid dose on which they achieved dose-stable pain control in the equivalence study; dose adjustments were made as necessary and breakthrough pain medication was permitted. Efficacy was assessed with the Brief Pain Inventory (BPI) and patient and investigator global evaluations of treatment effectiveness. No formal statistical analysis was done.</p> <p>Results</p> <p>The mean (standard deviation) duration of exposure to study medication was 139 (129.9) days and the mean (standard deviation) average daily consumption of OROS^®hydromorphone was 43.7 (28.14) mg/day. All scores were maintained at a mild to moderate severity throughout the study; however, BPI scores for pain at its worst, pain at its least, pain on average, pain right now, and pain relief were slightly worsened at end point compared with baseline. Mean BPI pain interference with daily activities and patient and investigator global evaluation scores also remained generally stable. Treatment effectiveness was rated as fair to good throughout the study. The most frequently reported adverse events were nausea (n = 24, 35.3%), constipation (n = 22, 32.4%), and vomiting (n = 15, 22.1%).</p> <p>Conclusion</p> <p>The results of this extension study suggest that long-term repeated dosing with once-daily OROS^®hydromorphone can be beneficial in the continuing management of persistent, moderate-to-severe cancer pain.</p

Mycobacteria Attenuate Nociceptive Responses by Formyl Peptide Receptor Triggered Opioid Peptide Release from Neutrophils

In inflammation, pain is regulated by a balance of pro- and analgesic mediators. Analgesic mediators include opioid peptides which are secreted by neutrophils at the site of inflammation, leading to activation of opioid receptors on peripheral sensory neurons. In humans, local opioids and opioid peptides significantly downregulate postoperative as well as arthritic pain. In rats, inflammatory pain is induced by intraplantar injection of heat inactivated Mycobacterium butyricum, a component of complete Freund's adjuvant. We hypothesized that mycobacterially derived formyl peptide receptor (FPR) and/or toll like receptor (TLR) agonists could activate neutrophils, leading to opioid peptide release and inhibition of inflammatory pain. In complete Freund's adjuvant-induced inflammation, thermal and mechanical nociceptive thresholds of the paw were quantified (Hargreaves and Randall-Selitto methods, respectively). Withdrawal time to heat was decreased following systemic neutrophil depletion as well as local injection of opioid receptor antagonists or anti-opioid peptide (i.e. Met-enkephalin, β-endorphin) antibodies indicating an increase in pain. In vitro, opioid peptide release from human and rat neutrophils was measured by radioimmunoassay. Met-enkephalin release was triggered by Mycobacterium butyricum and formyl peptides but not by TLR-2 or TLR-4 agonists. Mycobacterium butyricum induced a rise in intracellular calcium as determined by FURA loading and calcium imaging. Opioid peptide release was blocked by intracellular calcium chelation as well as phosphoinositol-3-kinase inhibition. The FPR antagonists Boc-FLFLF and cyclosporine H reduced opioid peptide release in vitro and increased inflammatory pain in vivo while TLR 2/4 did not appear to be involved. In summary, mycobacteria activate FPR on neutrophils, resulting in tonic secretion of opioid peptides from neutrophils and in a decrease in inflammatory pain. Future therapeutic strategies may aim at selective FPR agonists to boost endogenous analgesia

Pain Management in Patients with Cancer: Focus on Opioid Analgesics

Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant analgesics. Weak opioids are used for mild-to-moderate pain as monotherapy or in a combination with nonopioids. For patients with moderate-to-severe pain, strong opioids are recommended as initial therapy rather than beginning treatment with weak opioids. Adjunctive therapy plays an important role in the treatment of cancer pain not fully responsive to opioids administered alone (ie, neuropathic, bone, and visceral colicky pain). Supportive drugs should be used wisely to prevent and treat opioids’ adverse effects. Understanding the pharmacokinetics, pharmacodynamics, interactions, and cautions with commonly used opioids can help determine appropriate opioid selection for individual cancer patients