Chronic pain management - multidisciplinary approach

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An evidence-based resource for pain relief

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Increased nausea and dizziness when using tramadol for post-operative patient-controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine

Thirty-eight ASA I-III patients undergoing lower abdominal operations were randomly allocated to receive either morphine (group M, patient-controlled analgesia bolus = 1 mg of morphine) or tramadol (group T, patient-controlled analgesia bolus = 10 mg of tramadol) for post-operative patient-controlled analgesia (PCA) after receiving morphine intraoperatively. There were no between-group differences in the pain, sedation or vomit scores. The nausea scores were significantly higher in group T in the initial 20 h and between 32 and 36 h (P < 0.01, 0-4 and 8-12 h; P < 0.05, 4-8, 12-16, 16-20 and 32-36 h). The incidence of dizziness was also significantly higher in group T (68.4% vs. 31.6%, group T vs. group M, P < 0.05). There was no difference in the overall satisfaction. We conclude that the use of tramadol, compared with morphine, for post-operative PCA after intraoperative loading with morphine is associated with more nausea and dizziness, but with similar sedation, quality of analgesia and patient satisfaction.published_or_final_versio

Recent advances in opioid therapy

Recent advances in opioid therapy regarding routes of delivery, long-acting preparations, and sequential trials are described. Specifically, the advantages and disadvantages of transdermal therapeutic system fentanyl, transmucosal fentanyl citrate, Kapanol (sustained-release morphine) and individual variability in the responses to different opioids are discussed in detail. Pain and the fear of pain are perhaps the greatest source of suffering. It is common sense to accept that many diseases still cannot be cured, yet the accompanying suffering real. Hence relief is very important. Very few medications surpass opioids in terms of their therapeutic efficacy, ease of application, and lack of organic toxicity. The question is not whether opioids are effective but how to use them rationally. Many patients fail to have adequate analgesia, simply because doctors under-prescribe opioids as a result of lack of knowledge about their optimal usage.published_or_final_versio

Cancer pain managment: experience of 702 consecutive cases in a teaching hospital in Hong Kong

Effective pain control is essential in the management of patients with cancer. We present here our experience in the management of 702 patients with cancer pain by the Pain Management Team, Department of Anaesthesiology, Queen Mary Hospital. Patients were discharged from the Pain Management Team with a visual analogue scale of pain (VAS) less than 3 in 87.7% of cases, and more than 90% of patients had improved appetite and sleep on discharge. These promising results were achieved through an emphasis on comfort and function, close liaison among clinicians from different specialties, and a variety of analgesic modalities. Oral drugs remained the mainstay of treatment, supplemented by alternative routes of drug administration such as subcutaneous, intravenous and transdermal delivery. Main side effects observed included nausea (16%) and constipation (8%). Neural blockade, including coeliac plexus blockade, and intercostal nerve blockade, and administration of opioids via subarachnoid or epidural routes were also employed in selected patients.published_or_final_versio

Characteristics of Heavy Particulate Matter Pollution Events Over Hong Kong and Their Relationships With Vertical Wind Profiles Using High-Time-Resolution Doppler Lidar Measurements

This is the final version. Available from American Geophysical Union (AGU) via the DOI in this record. Previous studies have reported boundary layer features related to air pollution. However, few studies have comprehensively evaluated the characteristics and mechanisms of vertical wind in the formation and evolution of heavy particulate matter pollution episodes (EP) in Hong Kong. In this study, we analyzed the vertical characteristics of heavy particulate matter (PM) pollutions over Hong Kong and their relationships with vertical wind profiles using high-time-resolution Doppler lidar measurements and hourly meteorological and air quality observations. We identified nine EPs and show that the events were closely coupled to various vertical wind profiles in the planetary boundary layer (PBL). Our analysis suggests that strong vertical wind speed with wind shear at certain heights in the PBL had a positive correlation with surface PM during most superregional transboundary EPs. The maximum transport height extends from the surface to about 2.0 km or even higher; these transport heights differed among superregional and regional transboundary EPs. At peak surface pollution concentrations during the nine EPs, the surface PM10 had a significant negative correlation with PBL heights/mixing layer heights, while the averaged wind shear in the PBL was significantly positively correlated. These EPs with different mixing layer heights were mainly driven by different vertical wind shear conditions under various weather systems related to surface high pressure, cold fronts, dust storms, and typhoons. This work provides scientific evidence that surface PM pollutions were closely related to the characteristics of vertical profiles during the transboundary air pollutions.Chinese University of Hong Kong ‐ University of Exeter Joint Centre for Environmental Sustainability and Resilience (ENSURE)The Chinese University of Hong Kon

An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong : a preliminary study

Author name used in this publication: Joanne W. Y. Chung2006-2007 > Academic research: refereed > Publication in refereed journalAuthor’s OriginalPublishe

Pharmacokinetics and safety of ixazomib plus lenalidomide–dexamethasone in Asian patients with relapsed/refractory myeloma: a phase 1 study

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Cross‐scale intercomparison of climate change impacts simulated by regional and global hydrological models in eleven large river basins

Ideally, the results from models operating at different scales should agree in trend direction and magnitude of impacts under climate change. However, this implies that the sensitivity to climate variability and climate change is comparable for impact models designed for either scale. In this study, we compare hydrological changes simulated by 9 global and 9 regional hydrological models (HM) for 11 large river basins in all continents under reference and scenario conditions. The foci are on model validation runs, sensitivity of annual discharge to climate variability in the reference period, and sensitivity of the long-term average monthly seasonal dynamics to climate change. One major result is that the global models, mostly not calibrated against observations, often show a considerable bias in mean monthly discharge, whereas regional models show a better reproduction of reference conditions. However, the sensitivity of the two HM ensembles to climate variability is in general similar. The simulated climate change impacts in terms of long-term average monthly dynamics evaluated for HM ensemble medians and spreads show that the medians are to a certain extent comparable in some cases, but have distinct differences in other cases, and the spreads related to global models are mostly notably larger. Summarizing, this implies that global HMs are useful tools when looking at large-scale impacts of climate change and variability. Whenever impacts for a specific river basin or region are of interest, e.g. for complex water management applications, the regional-scale models calibrated and validated against observed discharge should be used

Heat-Induced Structural Changes Affect OVA-Antigen Processing and Reduce Allergic Response in Mouse Model of Food Allergy

BACKGROUND AND AIMS: The egg protein ovalbumin (OVA) belongs to six most frequent food allergens. We investigated how thermal processing influences its ability to induce allergic symptoms and immune responses in mouse model of food allergy. METHODOLOGY/PRINCIPAL FINDINGS: Effect of increased temperature (70°C and 95°C) on OVA secondary structure was characterized by circular dichroism and by the kinetics of pepsin digestion with subsequent HPLC. BALB/c mice were sensitized intraperitoneally and challenged with repeated gavages of OVA or OVA heated to 70°C (h-OVA). Levels of allergen-specific serum antibodies were determined by ELISA (IgA and IgGs) or by β-hexosaminidase release test (IgE). Specific activities of digestive enzymes were determined in brush border membrane vesicles of jejunal enterocytes. Cytokine production and changes in regulatory T cells in mesenteric lymph nodes and spleen were assessed by ELISA and FACS. Heating of OVA to 70°C caused mild irreversible changes in secondary structure compared to boiling to 95°C (b-OVA), but both OVA treatments led to markedly different digestion kinetics and Tregs induction ability in vitro, compared to native OVA. Heating of OVA significantly decreased clinical symptoms (allergic diarrhea) and immune allergic response on the level of IgE, IL-4, IL-5, IL-13. Furthermore, h-OVA induced lower activities of serum mast cell protease-1 and enterocyte brush border membrane alkaline phosphatase as compared to native OVA. On the other hand h-OVA stimulated higher IgG2a in sera and IFN-γ secretion by splenocytes. CONCLUSIONS: Minor irreversible changes in OVA secondary structure caused by thermal processing changes both its digestion and antigenic epitopes formation, which leads to activation of different T cell subpopulations, induces shift towards Th1 response and ultimately reduces its allergenicity