Continuation of low-dose aspirin combined with rabeprazole on healing of peptic ulcer bleeding / 中国基层医药

Objective To investigate the effect of low-dose aspirin combined with rabeprazole on the healing of peptic ulcer after hemostasis with aspirin-related peptic ulcer bleeding,and to explore the independent factors associated with ulcer healing failure.Methods A total of 138 patients with acute upper gastrointestinal hemorrhage in the Department of Gastroenterology of the Second Affiliated Hospital of Fujian Medical University from June 2016 to June 2018 were enrolled.The clinical data of 138 patients with upper gastrointestinal ulcer bleeding caused by aspirin were analyzed.The patients were randomly divided into two groups.Aspirin group (n =68) received aspirin 100 mg/d plus rabeprazole 80 mg/d,while the placebo group (n =70) received rabeprazole 80 mg/d plus placebo.The patients were treated for 8 weeks.Subjects with H.pylori infection were treated with standard quadruple therapy.Follow-up endoscopy was performed at the end of 8 weeks.The primary endpoint was the healing of peptic ulcers.Results The ulcer healing rate was 79.4％ (54/68) in the aspirin group and 84.3％ (59/70) in the placebo group.There was no statistically significant difference between the two groups (x2 =0.552,P ＞ 0.05).There were 5 cases of ulcer bleeding in aspirin group and placebo group.The rehaemorrhage rate was 7.4％ (5/68) and 7.1％ (5/70),respectively.There was no statistically significant difference between the two groups(x2 =0.002,P ＞ 0.05).Among the factors affecting the healing of aspirin-associated peptic ulcer,the healing rate was significantly associated with steroid use during treatment (x2 =6.135,P =0.041) and smoking status (x2 =5.616,P =0.018).Other factors,including age,hypertension,diabetes,alcohol history,history of previous ulcer bleeding,initial Helicobacter pylori status,and ulcer location did not affect ulcer healing.Conclusion After aspirin-associated peptic ulcer bleeding,continued low-dose aspirin plus rabeprazole did not affect the healing of peptic ulcers,and the use of steroids and smoking status are independent risk factors for ulcer healing.

Tratamiento acupuntural y medicamentoso en el alivio de la cervicalgia / Drug and acupuncture therapies in neck pain relieving

INTRODUCCIÓN: el dolor cervical es considerado como uno de los síntomas más relevantes del de espalda, con una incidencia del 10 % de la población adulta, lo cual influye en la calidad de vida de las personas. OBJETIVO: comparar la eficacia de la acupuntura y del tratamiento medicamentoso para el alivio de la cervicalgia no traumática. MÉTODOS: estudio comparativo, abierto y aleatorizado en 100 pacientes de ambos sexos mayores de 18 años, seleccionados aleatoriamente en el municipio Marianao. Se conformaron dos grupos de 50 pacientes cada uno; al grupo A se le aplicó tratamiento con acupuntura y al grupo B terapia con analgésicos y antiinflamatorios no esteroideos. La evaluación comparativa de los resultados se realizó por la prueba de Mc Gill modificada, al quinto día y al final del tratamiento. Para el análisis y el procesamiento de los datos se utilizó la prueba de chi cuadrado. RESULTADOS: no hubo diferencias significativas para el alivio del dolor a favor de alguno de los tratamientos aplicados, aunque los pacientes tratados con acupuntura refirieron la mejora del dolor cervical, además de un menor tiempo de tratamiento. CONCLUSIÓN: ambos tratamientos son igualmente eficaces para el alivio de la cervicalgia, pero el acupuntural deviene en una terapia electiva a considerar por la rapidez en el alivio del dolor.

INTRODUCTION: the high incidence of cervical pain at the consultations of health areas has motivated this study, which was carried out during year in patients with neck pain diagnosis. 10 % of the population suffers cervical pain in a specific moment of their lives; it represents an important factor for their professional lives. OBJECTIVE: to compare the acupuncture efficacy and the medical treatment for relieving non-traumatic neck pain. METHODS: a comparative, open and randomized study was conducted in 100 patients of both sexes older than 18 years. They were randomly selected in Marianao municipality. Two groups of 50 patients each were formed; group A had acupuncture treatment and group B therapy had analgesics and nonsteroidal antiinflammatory drugs. The result comparative evaluation was performed by Mc Gill modified test, on the fifth day and at the end of treatment. For data processing and analyzing, chi square test was used. RESULTS: there was no significant difference for pain relief in any of the treatments applied, although patients treated with acupuncture reported improvement neck pain, and a shorter treatment time. CONCLUSIONS: both treatments are equally effective for neck pain relief, but acupuncture therapy is an option to consider due to fast pain relief.

El dolor: los opioides: los anti-inflamatorios no esteroideos y los canabinoides / Pain: opioids: nonsteroidal antiinflammatory drugs and cannabinoids

Aquí exponemos un modelo que explica por qué, en el sistema nervioso central, los anti-inflamatorios no esteroideos, para ejercer su acción analgésica, deben interactuar con los opioides endógenos y los canabinoides endógenos. La sustancia gris del acueducto de Silvio es una estructura clave del llamado "sistema descendente de control nociceptivo". La activación de este sistema disminuye el flujo de mensajes nociceptivos hacia la corteza cerebral y, por lo tanto, el dolor. En la sustancia gris el ácido araquidónico es el elemento donde los opioides endógenos, los analgésicos opioides y los no-opioides (anti-inflamatorios no esteroideos) convergen para inducir analgesia. Las enzimas degradantes de los endocanabinoides son el punto donde estos y los analgésicos no-opioides convergen para inducir analgesia. Parece ventajoso el hecho de que los analgésicos que se compran libremente en la farmacia pueden aprovechar para su acción los mecanismos endógenos que todos nosotros poseemos

Here we present a model that explains why, in the central nervous system, the nonsteroidal antiinflammatory drugs, in order to induce analgesia, must interact with the endogenous opioids and the endocannabinoids. The periaqueductal gray matter is a key structure in the socalled "descending pain control system". Activations of this system diminishes the flow of nociceptive signals towards the cerebral cortex and, therefore, pain perception. In the periaqueductal gray matter, arachidonic acid is the elements where endogenous opioids analgesics and nonopioid analgesics converge to induce analgasia. The endocannabinoid metabolizing enzyme are the point at which endocannabinoids and nonsteroidal antinflammatory drugs converge to induce analgesia. There seems to be some advantage in that analgesics that can be bought over the counter can use for their action some endogenous mechanisms that we all possess

The role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis:a meta analysis / 中国综合临床

Objective To evaluate the efficacy of NSAIDs in the prevention and alleviation of postERCP pancreatitis and to provide theoretical basis for clinical practice and enhance the improvement of clinical studies on post-ERCP pancreatitis medication.Methods We performed extensive literature search from computerized databases MEDLINE(Jan.1966-Jan.2011),EMBASE(Jan.1966-Jan.2011) and the Cochrane Central Register of Controlled Trials(Issue 1,2011) using the key wordsendoscopic retrograde cholangiopancreatography or ERCP, NSAIDs or nonsteroidal anti-inflammatory drugs, pancreatitis,indomethacin anddiclofenac.The following primary outcomes were assessed:(1) Incidence of PEP;(2)Mortality of PEP;(3) Adverse events.Pooled odds ratio and 95％ confidence interval were computed using Revman version 4.3.2 from Cochrane.org web.Results Five multinational RCTs were included in our metaanalysis.There were in total 1119 patients involved in this meta-analysis,including 561 individuals in the treatment group and 558 participants in the placebo group.Among the patients in the treatment group,265 were treated by diclofenac and 296 were treated by indomethacin.The placebo group had same duration and dose of treatment with the treatment group.The prevalence of post-ERCP pancreatitis was significantly lower in the treatment group than in the placebo group(6.60％ vs.13.26％ ; OR =0.45 ; P ＜ 0.001).The pooled odds ratio for NSAIDs with mild PEP was 0.48(95 ％ CI:0.31-0.76 ; P =0.002) and the pooled odds ratio for NSAIDs with moderate to severe PEP was 0.44(P =0.08).Conclusion Based on the findings from the present systematic review of 5 RCTs,NSAIDs are effective and well tolerated in the prevention of PEP.

Cancer Pain Management-Nonopoid Analgesics

Cancer pain patients have various diagnosis, stage of disease, response to pain, and treatments and individualized treatment methods are thus needed. Use of Nonopioid analgesics is the first step treatment (according to WHO ladder) for mild to moderate pain, and may be useful for second or third step treatments when combined with weak or strong opioids to reduce side effects of opioids and to create synergy between the two drugs. Acetaminophen and nonsteroidal antiinflammatory drugs(NSAIDs) are also nonopioid analgesics. NSAIDs have a ceiling effect, along with antipyretic, analgesic and antiinflammatory effects, while not producing physical and psychological dependence. Adverse effects of NSAIDs include gastrointestinal hemorrhage, coagulopathy, and deterioration of renal function.

Empleo de antiinflamatorios no esteroideos (AINEs) como coadyuvante en el tratamiento de la enfermedad periodontal

Estudios previos han indicado que las drogas antiinflamatorias no esteroideas (AINEs) actúan en la modificación de la respuesta inflamatoria por parte del huésped. El propósito del presente trabajo es presentar una revisión bibliográfica relacionada con el empleo de los AINEs y su efectividad comprobada sobre la enfermedad periodontal. Se desarrollarán diversos aspectos dentro de los cuales se mencionarán la etiología y patogenia de la enfermedad periodontal, características de los AINEs, su clasificación, farmacocinética, farmacodinamia (haciendo énfasis en el mecanismo como antiinflamatorio), uso terapéutico, así como diferentes estudios experimentales sobre el uso de los mismos en animales y en pacientes con enfermedad periodontal.

This review presents information about nonsteroidal antiinflammatory drugs their clinical efficacy in the periodontal disease, doing emphasis on the indications, pharmaceutical preparations, classification and adverse effects which they can produce on the basis of scientific knowledge. This report describes the use of nonsteroidal antiinflammatory drugs as an adjunct to scaling and root planning in periodontal disease.

Survey on the clinical use of nonsteroidal antiinflammatory drugs in China / 中华消化杂志

Objective To acknowledge the present status of clinical use of nonsteroidal antiinflammatory drugs(NSAIDs) in China. Methods Five hundred and seventy-five valid questionnaires were collected from 50 hospitals in different areas of China including Shanghai, Beijing, Tianjin, Shenyang and Guangzhou. Results 54.7% of doctors used cyclooxygenase-2 (COX-2) selective inhibitors. The ratio of the doctors prescribing loxoprofen, diclofenac, meloxicam were 22.6%, 23.3%, 14.60%, respectively. The ratio of the doctors who prescribe uncoated routine-dose aspirin, uncoated low-dose aspirin, enteric-coated routine-dose aspirin, enteric-coated low-dose aspirin and others were 17.0%, 14.7%, 36.8%, 28.5% and 3.0%, respectively. The ratio of doctors who only "some-times" prescribed co-medicine to prevent gastrointestinal damages when they prescribed aspirin, conventional NSAID and COX-2 selective inhibitors were 41.10%, 40.70% and 45.1%, respectively, while the most commomly used co-medicine were H2 receptor antagonist (H2 RA) and proton pump inhibitor respectively. 37.1% of doctors examined H. pylori infection status, and 76.3% of doctors would eradicate H. pylori if positive. Conclusions The most commonly used conventional NSAID is diclofe-nac. The most commonly used formulation of aspirin is enteric-coated aspirin. Most doctors only "sometimes" prescribe co-medicine together with aspirin, conventional NSAID and COX-2 selective inhibitors to prevent gastrointestinal damages, and the most commonly used co-medicine is acid inhibitor. Only a few doctors examine H. pylori infection prior to the administration of NSAID.

Effect of aspirin and celecoxib on proliferation of breast cancer cell line MCF-7 / 吉林大学学报(医学版)

Objective To discuss and compare the anti-tumor effects of aspirin and celecoxib on breast cancer cell MCF-7 through investigating the effects of aspirin,celecoxib,and combined with anastrozole respectively on the growth of human breast cancer cell MCF-7.Methods The human breast cancer cell MCF-7 were treated with 2.5,5.0,and 10.0 mmol?L-1 aspirin and 30,60,and 120 ?mol?L-1 celecoxib for 24,48,and 72 h respectively,the MCF-7 without treatment with drug was used as negative control group,the MCF-7 treated by ADM was used as positive control group,the inhibitory effect was detected by MTT assay.Besides,the MCF-7 cells were treated by anastrozole(0.5 and 1.0 ?mol?L-1),anastrozole(0.5 and 1.0 ?mol?L-1)combined with aspirin(2.5,5.0,and 10.0 mmol?L-1)or celecoxib(30,60,and 120 ?mol?L-1)for 48 h,respectively,the inhibitory rate was detected by MTT assay.Results ① The inhibitory rate of the MCF-7 cell line treated with aspirin was reduced compared with controls,which was in time-dependent and dose-dependent manner(P

Nonsurgical Treatment of Osteoarthritis

Osteoarthritis (OA) is the most common cause of localized or generalized joint pain in adults. OA is a condition that represents a complex of interactive degradative and reparative processes in the cartilage and bone with secondary inflammatory changes, particularly in the synovium. Although there is no known cure for OA, the treatment designed for the individual patients can reduce pain, maintain joint mobility, and limit the functional impairment. Guidelines for the treatment of OA include patient education and physical and occupational therapy. Weight loss has been shown to slow the progression of disease and to relieve symptoms in obese patients with OA of the knee. While low-impact exercise is beneficial, the adverse effects of high-impact and high-intensity activitiesy on the aggravation of OA have been documented. Most drug therapies with drugs are targeted to specific symptomsatic response. It is certainly worthwhile to initiate a trial of acetaminophen, known to be beneficial in OA patients with mild to moderate pain, on the basis of the risk-to-benefit ratio and cost. However, previous studies suggest that nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a better efficacy. The COX-2-specific inhibitors appear to be better tolerated, with a lower incidence of GI side effects, than comparator nonselective NSAIDs. However, the potential cardiovascular thrombotic events of these medications are considerable in the patients with hypertension or coronary artery disease. Although a number of agents are on the horizon, including glucosamine, chondroitin, diacerein, S-Adenosyl-LMethionine, and hyaluronan, no agent has been shown to have a disease-modifying OA drug (DMOAD) effect at this time.

Comparison of Clinical Efficacy between Nonsteroidal Anti-inflammatory Drugs and Acetaminophen in Knee Osteoarthritis according to Ultrasonographic Findings / 대한류마티스학회지

OBJECTIVE: To compare the clinical efficacy between nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen in knee osteoarthritis according to ultrasonographic findings. METHODS: We administered 12 mg of NSAIDs (lornoxicam) plus misoprostol 300microgram or 1,950 mg of acetaminophen in 40 randomly selected patients who fulfilled the ACR criteria for knee osteoarthritis. The effectiveness of these drugs on osteoarthritis was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. In addition, we performed ultrasonography of the knee joints and assessed length of capsular distension, length of medial and lateral osteophyte, amount of joint effusion, and the presence of synovial proliferation. RESULTS: There were significant correlations between WOMAC score and length of capsular distension and length of medial/lateral osteophyte. At 6 weeks, both lornoxicam and acetaminophen-treated patients had significant lower levels of WOMAC score compared to the entry into the trial (p or =0.7 cm) or severe medial osteophyte (length of osteophytes > or =0.4 cm) showed better responses to lornoxicam than to acetaminophen in terms of the reduction of WOMAC score (p=0.008 for severe capsular distension, p=0.03 for severe medial osteophyte). However, in the subgroup with mild forms of capsular distension (<0.7 cm) or medial osteophytes (<0.4 cm), no difference was found in the reduction of WOMAC score 6 weeks after treatment with lornoxicam versus acetaminophen. CONCLUSIONS: Patients with osteoarthritis of the knee had significantly greater improvements in pain score over 6 weeks with lornoxicam than with acetaminophen, particularly in patients with severe forms of capsular distension and medial osteophyte on joint ultrasonography. Ultrasonography could be an useful tool to determine the usage of NSAIDs versus acetaminophen in knee osteoarthritis patients.

A Case of Segmental Ischemic Colitis Associated with Nonsteroidal Antiinflammatory Drugs / 대한류마티스학회지

Acute colonic ischemia is the most common form of gastrointestinal ischemia. The majority of cases of non-occlusive ischemic colitis are associated with severe congestive heart failure with low cardiac output, or disease states resulting in dehydration, or the splanchnic vasoconstrictive effect of some dedications. Reactive splanchnic vasoconstriction is responsible for nonocclusive ischemic colitis. The authors report a case of 37-year-old man, who had a history of 8-year gout and no evidence of heart disease or severe dehydration and developed segmental ischemic colitis during nonsteroidal antinflammatory drug treatment, which ultimitely progressed to transmural infacrction, therby undergone extended right hemicolectomy

The Effect of Preemptive Analgesia with Morphine, Ketorolac, Droperidol / 대한마취과학회지

BACKGROUND: Several reports have suggested that preoperative nociceptive block with opioids and nonsteroidal antiinflammatory drugs (NSAIDs) may reduce postoperative pain. This study evaluated the effects of preemptive analgesia, the analgesic efficacy and safety of intravenous opioids and NSAIDs during the first 48 hours after lower abdominal surgery. METHODS: The 40 patients were randomized to either preemptive group or postincisional group. All subjects received IV bolus of 2 mg of morphine followed by continuous IV mixture (morphine 30 mg + ketorolac 90 mg + droperidol 2 mg in 90 ml of normal saline) via Baxter 2-Day Infusor(R). Evaluations included supplementary analgesics, analgesic pain assessment (visual analogue scale, VAS), time of first analgesic request, patient comfort (comfort scale), and side effects. RESULTS: There were no differences in number of patient requiring supplemental analgesic (3/20 vs 5/20), the time of first analgesic request (42.2 hours vs 37.5 hours), pain scores measured at each time, and patient comfort between two groups. There were minor complications such as nausea and somnolence in both groups, but no patients needed any treatment. CONCLUSIONS: Preemptive or postincisional morphine-ketorolac-droperidol infusion was equally effective for postoperative analgesia after lower abdominal surgery with minor complications. Further evaluation may be needed to determine whether preemptive analgesia has any advantages over postincisional analgesia.