ABSTRACT
STUDY OBJECTIVE: We compare nasal inhalation of isopropyl alcohol versus placebo in treating nausea among emergency department (ED) patients. METHODS: A convenience sample of adults with chief complaints of nausea or vomiting was enrolled in a randomized, double-blind, placebo-controlled trial conducted in an urban tertiary care ED. Patients were randomized to nasally inhaled isopropyl alcohol versus nasally inhaled normal saline solution. Patient nausea and pain were measured with previously published 11-point verbal numeric response scale scores; patient satisfaction was measured by a 5-point Likert scale. The primary outcome was reduction in nausea 10 minutes poststart. Secondary outcomes included patient satisfaction and pain reduction measured at 10 minutes poststart. RESULTS: Of 84 recruited patients, 80 (95.2%) completed the study. Thirty-seven (46.3%) received nasally inhaled isopropyl alcohol and 43 (53.8%) received nasally inhaled normal saline solution. At 10 minutes postintervention, median nausea verbal numeric response scale score was 3 in the isopropyl alcohol arm versus 6 in the placebo arm, for an effect size of 3 (95% confidence interval 2 to 4). Median satisfaction score was 4 in the isopropyl alcohol arm versus 2 in the placebo arm, for an effect size of 2 (95% confidence interval 2 to 2). There were no significant differences between the 2 arms in median pain verbal numeric response scale scores or subsequent receipt of rescue antiemetics. CONCLUSION: We found that nasally inhaled isopropyl alcohol achieves increased nausea relief compared with placebo during a 10-minute period.
Subject(s)
2-Propanol/therapeutic use , Antiemetics/therapeutic use , Emergency Service, Hospital , Nausea/drug therapy , 2-Propanol/administration & dosage , Administration, Intranasal , Adult , Antiemetics/administration & dosage , Double-Blind Method , Female , Humans , Male , Patient SatisfactionABSTRACT
PRIMARY OBJECTIVE: Brain structures and their white matter connections that may contribute to emotion processing and may be vulnerable to disruption by a traumatic brain injury (TBI) occurring in childhood have not been thoroughly explored. RESEARCH DESIGN AND METHODS: The current investigation examines the relationship between diffusion tensor imaging (DTI) metrics, including fractional anisotropy (FA) and apparent diffusion coefficient (ADC), and 3-month post-injury performance on a task of emotion prosody recognition and a control task of phonological discrimination in a group of 91 children who sustained either a moderate-to-severe TBI (n = 45) or orthopaedic injury (OI) (n = 46). MAIN OUTCOMES AND RESULTS: Brain-behaviour findings within OI participants confirmed relationships between several significant white matter tracts in emotional prosody performance (i.e. the cingulum bundle, genu of the corpus callosum, inferior longitudinal fasciculus (ILF) and the inferior fronto-occipital fasciculus (IFOF). The cingulum and genu were also related to phonological discrimination performance. The TBI group demonstrated few strong brain behaviour relationships, with significant findings emerging only in the cingulum bundle for Emotional Prosody and the genu for Phonological Processing. CONCLUSION: The lack of clear relationships in the TBI group is discussed in terms of the likely disruption to cortical networks secondary to significant brain injuries.
Subject(s)
Brain Injuries/psychology , Cognition Disorders/psychology , Diffusion Magnetic Resonance Imaging , Diffusion Tensor Imaging , Emotions , Musculoskeletal Diseases/psychology , Social Behavior , Adolescent , Anisotropy , Brain Injuries/complications , Brain Injuries/physiopathology , Brain Mapping , Child , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Facial Expression , Female , Humans , Image Processing, Computer-Assisted , Interpersonal Relations , Male , Musculoskeletal Diseases/complications , Musculoskeletal Diseases/physiopathology , Nerve Fibers, Myelinated , Neuropsychological Tests , Recognition, Psychology , Trauma Severity IndicesABSTRACT
Interleukin-17 (IL-17) is a cytokine recently shown to be elevated, along with interferon-γ (IFNγ) and tumor necrosis factor (TNFα), in degenerated and herniated intervertebral disc (IVD) tissues, suggesting a role for these cytokines in intervertebral disc disease. The objective of our study was to investigate the involvement of IL-17 and costimulants IFNγ and TNFα in intervertebral disc pathology. Cells were isolated from anulus fibrosus and nucleus pulposus tissues of patients undergoing surgery for intervertebral disc degeneration or scoliosis. The production of inflammatory mediators, nitric oxide (NOx), prostaglandin E2 (PGE2) and interleukin-6 (IL-6), as well as intercellular adhesion molecule (ICAM-1) expression, were quantified for cultured cells following exposure to IL-17, IFNγ, and TNFα. Intervertebral disc cells exposed to IL-17, IFNγ, or TNFα showed a remarkable increase in inflammatory mediator release and ICAM-1 expression (GLM and ANOVA, p < 0.05). Addition of IFNγ or TNFα to IL-17 demonstrated a synergistic increase in inflammatory mediator release, and a marked increase in ICAM-1 expression. These findings suggest that IVD cells not only respond with a catabolic phenotype to IL-17 and costimulants IFNγ and TNFα, but also express surface ligands with consequent potential to recruit additional lymphocytes and immune cells to the IVD microenvironment. IL-17 may be an important regulator of inflammation in the IVD pathologies.
