ABSTRACT
Background@#and Objective: With the advancement of cancer treatments and increased life expectancy, managing breakthrough cancer pain (BTcP) is essential to improve the quality of life for cancer patients. This study aimed to compare the major rapid onset opioids in Korea based on their characteristics and costs to determine the best option for each patient. @*Methods@#Based on sales information from IQVIA-MIDAS, sublingual fentanyl tablet (SLF), fentanyl buccal tablet (FBT), and oral transmucosal fentanyl citrate (OTFC) were selected as the top three drugs for the treatment of BTcP in Korea, considering them the most comparable drugs. The cost and cost-pain relief ratio of the drugs for short-term (1 month) and long-term (1 year) treatment were compared and the ease of administration based on various factors, including pharmacokinetics, onset of action, and administration procedures were evaluated. @*Results@#SLF was evaluated as the best overall in terms of rapid onset of action, ease of administration, and drug cost and also had the highest market share. SLF had the lowest cost pain relief ratio for both the initial and supplemental treatment for the 1-month pain intensity difference 15 (PID15) ratio. However, for the 1-month PID30 ratio, SLF was not superior to OTFC or FBT. The longer the breakthrough cancer pain duration, the more cost-effective the other rapid onset opioids. @*Conclusion@#The rapid onset opioids that fit the patient’s breakthrough cancer pain pattern have the best cost-effectiveness.
ABSTRACT
OBJECTIVE: Compared to elderly men, elderly women have substantially reduced performance of postural balance and greater risk of falls. To investigate the effect of age and sex on electromyographic (EMG) reaction time of tibialis anterior muscle contraction. METHOD: Fifty-nine elderly subjects and 29 young subjects participated in this study. Subjects were instructed to dorsiflex the ankle of the dominant leg as forcefully and quickly as possible in response to audible beeps. EMG activity was recorded over the tibialis anterior muscle and delays in initiation and termination of EMG signal were measured by two examiners. Mean and intrasubject variability of each delay were used as outcome measures. RESULTS: Both the intra-examiner and inter-examiner reliability of delay variables were above 0.97. Delays in initiation and termination of muscle contraction, as well as their intrasubject variability, were significantly greater in the elderly (p<0.01). However, there were no sex differences or interaction in all outcome measures. CONCLUSION: These results demonstrate that the EMG reaction time and their variability increase in the elderly population with no sex difference.
Subject(s)
Aged , Animals , Female , Humans , Male , Ankle , Electromyography , Leg , Muscle Contraction , Muscles , Oxazoles , Postural Balance , Reaction Time , Sex CharacteristicsABSTRACT
STUDY DESIGN: Lumbar disc degeneration and segmental instability of the lumbar spine are causes of low back pain. Disc degeneration causes specific changes of the intervertebral disc, and could affect anatomic variations of end plate and vetebral body. However, the exact relationship between degenerative changes of the intervertebral disc and segmental motion characteristics is not known. It is known that radial tears of the annulus fibrosus initiate or accompany degenerative process of nucleus pulposus and the motion segment. It is hypothesis of this study that the existence of radial tear in the annulus fibrosis affects 3 dimension motion characteristics of motion segment. For the purpose, the degree of intervertebral disc degeneration is newly classified by existence of radial tear. Then, the resulting biomechanical motions are investigated. OBJECTIVES: To investigate effects of disc degeneration by the classification on kinematic motions of the motion segment from human lumbar spine and to suggest a quantified method to determine spinal instability in vivo. MATERIALS AND METHODS: A total of 60 spinal motion segments from human lumbar spine was used for this study. To measure 3 dimensioal motion of the motion segments, Vicon system(Oxford, England) with 3 cameras reflective markers and VAX station was used. 6 kinds of pure moments(flexion, extension, right and left axial rotation, and right and left lateral bending) were applied to the motion segments using dead weight for each loading step. At the end of test(maximum loading), motion segments were frozen for anatomical study. For making clear the degree of the degeneration of the disc, a new classification based on MRI results was used: Grade 1 is a normal young disc without tear; Grade 2 is a normal aging disc without radial tear; Grade 3 is a degenerative disc with radial tear; and Grade 4 is a severely degenerative disc with radial tear and other degeneration such as showing decreased disc height. RESULTS: The upper lumbar specimens with radial tears has increased flexion motions as compared to the normal group. Also, the right and left axial rotation in radial tear group increased as compared to the normal group. However, there were no statistical differences in other motions. For the lower lumbar specimens, there were no significant differences in measured motions in all directions between the normal and radial tear groups CONCLUSIONS: These results suggests that the segmental motions are affected by radial tear in the intervertebral disc. Thus, the radial tear in the annulus fibrosus of lumbar intervertebral disc could cause the instability of lumbar spine. Further research is required to determine the relationship between other structural changes and biomechanical characteristics, and future studies should include in vivo investigations to correlate these findings to patients'symptoms.