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In this era of crisis and controversy surrounding opioid therapy, we must remember that cancer patients entrust us with supporting them through what might be the most difficult, and oftentimes final, period of their life. The factors that affect the benefits and risks of opioid use in cancer patients and the non-cancer population are quite different. In fact, opioid-associated deaths are 10 times less likely in the former than the latter population, suggesting that a reluctance to initiate opioids in cancer patients can risk under treatment of complex pain. In this review, we outline the considerations and evidence-based practices required to manage the clinical situations that challenge the judicious use of opioids in patients with cancer. A comprehensive review that enable us to better understand and quantify the root causes of variability in pain control, as well as risks of opioid misuse or abuse, would arm healthcare providers with the tools they need to implement multi-modal approaches to treatment planning.BACKGROUND Breathing exercises can improve the symptoms of patients with gastroesophageal reflux disease (GERD), but their specific effect and function are disputed. To evaluate and conduct a meta-analysis on the effect of breathing exercises on patients with GERD. METHODS A literature search for randomized controlled trials (RCTs) and prospective studies on the effects of employing breathing exercises on patients with GERD was conducted of all major online English databases (PubMed, Embase, the Cochrane library, CENTRAL, Web of Science, AMED, and CINAHL). After the systematic review of all the studies according to inclusion and exclusion criteria, we analyzed the extracted data through meta-analysis by using RevMan 5.3 software. RESULTS This thesis analyzes 7 studies (including three RCTs), which together involved 194 patients and 16 healthy volunteers. The primary outcomes of these studies included GERD symptoms, esophageal manometry, esophageal pH monitoring, laryngoscopic findings, and acid suppression usage. The results of meta-analysis indicate that breathing exercises can improve pressure generated by the lower oesophageal sphincter (LES), and a statistically significant difference was observed. The possible mechanism behind this is the enhancement of the anti-regurgitation barrier [especially crural diaphragm (CD) tension]. CONCLUSIONS To some extent, breathing exercises can relieve the symptoms of patients with GERD.BACKGROUND Type 2 diabetes mellitus (T2DM) is a major cause of death with an increasing incidence at an epidemic rate. The existing treatments for T2DM lack long-term effective blood glucose control. In this study, the effects of miR-21 antagomir on T2DM and the related mechanism were investigated using streptozotocin (STZ)-induced T2DM rats. METHODS 30 T2DM rats were randomly divided into 3 groups (n=10) T2DM group, T2DM rats with miR-21 antagomir group, T2DM rats with NC antagomir group. The expression of miR-21 in rats was detected by qRT-PCR. blood glucose, triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-Cho), insulin, adiponectin, ITT and GTT were detected. The expression of TIMP3 in si-TIMP3 rats and the expression of TIMP3 in T2DM rats with miR-21 antagomir and si-TIMP3 was detected by Western blotting. RESULTS We found that miR-21 antagomir reduced blood glucose concentration in T2DM rats. 2-APV MiR21 antagomir improved lipid metabolic disorder by decreasing the levelsld be used as an effective therapeutic strategy and the underlying mechanism was revealed.Antipsychotics with a prominent anti-serotoninergic profile have risks of obsessive-compulsive symptoms (OCS). These types of OCS are remain mostly intractable to existing treatments because of the dilemma between the antipsychotic effects and the OCS adverse effects, both of which brought by serotoninergic-blocking profile. This state forced us to seek non-serotonergic system pharmaceuticals. Memantine, as a glutamatergic drug, is the adjunctive agent most consistently showing an effective impact in primary OCD, however its benefit in antipsychotics-associated OCS has not been reported. Herein, we presented a case of a 34-year-old male schizophrenia patient who experienced antipsychotics-associated OCS which could not be relieved by routine managements. He had fallen into dilemma of either aggravated OCS or poorly controlled schizophrenia. Eventually his condition got significant relief by individualized utilization of antipsychotics to control psychosis and by memantine to deal with his OCS. This is the first case to report the benefit of memantine in SGAs-associated OCS. It suggests that memantine is a worth considering approach, especially when the OCS are resistant to routine managements. Moreover, this case would be helpful for clinicians to know the etiology of SGAs-associated OCS, as indicated by the interesting changes after every adjustment of antipsychotics in the whole therapeutic course.BACKGROUND In this study, we evaluated the outcome of interlaminar epidural steroid injection (ESI) in patients with chronic pain induced by moderate or severe lumbar central spinal stenosis (LCSS), and compared the effects of interlaminar ESI according to the severity of LCSS. METHODS Sixty patients with chronic lower extremity pain due to LCSS were included and received interlaminar ESI. Two patients were lost to follow-up. On the basis of sagittal lumbar magnetic resonance imaging findings, 30 patients had moderate LCSS (group A) and 28 patients had severe LCSS (group B). Pain intensity was evaluated using a numeric rating scale (NRS) before treatment and at 1, 2, and 3 months after treatment. RESULTS In all the recruited patients, pain intensity was significantly lower at each evaluation time point compared to that before treatment. Intragroup analysis revealed that patients in each group showed a significant decrease in pain intensity at 1, 2, and 3 months after treatment. However, at 3 months after treatment, only 9 patients (30.0%) in group A and 5 patients (17.9%) in group B reported successful pain relief (pain relief of ≥50%). Pain intensity was significantly lower in group A than in group B at each evaluation time point. CONCLUSIONS Interlaminar ESI might be effective for alleviating pain induced by moderate or severe LCSS, but its effectiveness appears to be limited. Patients with severe LCSS showed worse treatment outcome compared to patients with moderate LCSS.
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