BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverage...BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.展开更多
Endoscopic ultrasound(EUS)with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and auto-immune pancreatitis or to analyze cyst fluid.The most common ...Endoscopic ultrasound(EUS)with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and auto-immune pancreatitis or to analyze cyst fluid.The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis,which is likely induced by the same pathophysiological mechanisms as after en-doscopic retrograde cholangiopancreatography(ERCP).According to the current European Society of Gastrointestinal Endoscopy guideline,nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate.A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition(TA)is harm-less in healthy adults.Since it is associated with low costs and,most important,may prevent a dreadsome complication,we strongly recommend the adminis-tration of 100 mg diclofenac rectally prior to EUS-TA.We will explain this recom-mendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.展开更多
Objective:To explore the efficacy of auricular acupuncture combined with transcutaneous electrical nerve stimulation(TENS)and nonsteroidal anti-inflammatory drugs(NSAIDs)in alleviating postpartum uterine pain.Methods:...Objective:To explore the efficacy of auricular acupuncture combined with transcutaneous electrical nerve stimulation(TENS)and nonsteroidal anti-inflammatory drugs(NSAIDs)in alleviating postpartum uterine pain.Methods:A total of 501 postpartum women with uterine pain were randomly divided into an experimental group(n=250)and a control group(n=251).The control group received oral NSAIDs(such as ibuprofen sustained-release capsules,diclofenac sodium suppositories,etc.),while the experimental group received auricular acupuncture and TENS in addition to the NSAIDs.The clinical efficacy,pain intensity,and vaginal bleeding volume of the two groups were observed.Results:The total effective rate in the experimental group(93.20%)was significantly higher than that in the control group(73.20%)(P<0.001).The NRS scores in the experimental group were lower than those in the control group after the intervention,and the bleeding volume within 24 h and 48 h after the intervention was also less than that in the control group,with significant differences(all P<0.001).Conclusion:Auricular acupuncture combined with TENS and NSAIDs for the treatment of postpartum uterine pain is safe and effective,can significantly reduce pain and vaginal bleeding,and is worthy of clinical promotion.展开更多
BACKGROUND: The role of prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) for reduction of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is debated. We performed a meta-analysis of ...BACKGROUND: The role of prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) for reduction of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is debated. We performed a meta-analysis of all published randomized controlled trials to evaluate the efficacy of NSAIDs in the prevention of post-ERCP pancreatitis. DATA SOURCES: Searches were conducted in the databases PubMed, EMBASE and the Cochrane Library. Six randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. Data were extracted by two independent observers according to predetermined criteria. RESULTS: The risk of pancreatitis was lower in the NSAID group than in the placebo, group (OR: 0.46, 95% CI: 0.32 to 0.65, P < 0.0001). Two hours after ERCP, prophylactic administration of NSAIDs was associated with a lower serum amylase level (WMD: -91.09,95% CI: -149.78 to -32.40, P=0.002), but there was no difference in mean 24-hour serum amylase values (WMD: -379.00, 95% CI: -805.75 to 47.76, P=0.08). No deaths or NSAID-related complications were noted. CONCLUSIONS: Prophylactic administration of NSAIDs can reduce the incidence of post-ERCP pancreatitis; this administration in patients undergoing ERCP is recommended. Further randomized controlled trials are required before its introduction into routine care.展开更多
AIM: To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: Two independent reviewers sea...AIM: To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: Two independent reviewers searched Pub Med (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis. RESULTS: Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54). CONCLUSION: NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
Previous reports clearly demonstrated that Helicobacter pylori(H.pylori)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the devel...Previous reports clearly demonstrated that Helicobacter pylori(H.pylori)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer disease.Today,the presence of H.pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications.Whether NSAID intake in the presence of H.pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate.Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years.In addition,the interaction between H.pylori infection and low-dose ASA remains even more controversial.In real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors.These huge variety of possible combinations greatly hinder the decision making process of physicians.展开更多
Inflammatory myofibroblastic tumor(IMT) occurring at retroperitoneal sites has rarely been reported.We report the case of a previously well 14-year-old girl with no history of abdominal disease whose past medical hist...Inflammatory myofibroblastic tumor(IMT) occurring at retroperitoneal sites has rarely been reported.We report the case of a previously well 14-year-old girl with no history of abdominal disease whose past medical history and family tumor history were unremarkable.She complained of intermittent abdominal pain for one month.An abdominal mass was found on physical examination and abdominal contrast-enhanced computed tomography(CT) showed a hypodense soft mass,the size and location of which suggested a well delineated retroperitoneal tumor surrounding the superior mesenteric vessels measuring 3.3 cm × 4.5 cm × 4.5 cm with enlarged lymph nodes.The patient underwent an exploratory laparotomy followed by biopsy and was subsequently diagnosed with retroperitoneal IMT.She was successfully treated with postoperative chemotherapy and oral diclofenac sodium.Following completion of therapy the mass was no longer palpable and no longer visible on CT scanning.The use of methotrexate and cisplatin for aggressive myofibroblastic tumors is also reviewed.展开更多
AIM: To determine the clinicopathological characteristics of nonsteroidal anti-inflammatory drug (NSAID)-induced acute hepato-nephrotoxicity among Chinese patients.
BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have...BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.展开更多
AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs)cause gastrointestinal damage as one of their side effects in humans and experimental animals. Lipid peroxidation plays an important role in NSAID-induced ulceration. ...AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs)cause gastrointestinal damage as one of their side effects in humans and experimental animals. Lipid peroxidation plays an important role in NSAID-induced ulceration. The aim of this study was to investigate the inhibitory effect of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)reductase inhibitors on the ulceration in small intestines of rats.METHODS: The effects of three HMG-CoA reductase inhibitors, fluvastatin, pravastatin and atorvastatin on ileal ulcer formation in 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT)-treated rats were examined. Antioxidative activity of the inhibitors was measured by a redox-linked colorimetric method.RESULTS: Fluvastatin, which was reported to have antioxidative activity, repressed the ileal ulcer formation in rats treated with BFMeT an NSAIDs. However, the other HMG-CoA reductase inhibitors (pravastatin and atorvastatin)did not repress the ileal ulcer formation. Among these HMG-CoA reductase inhibitors, fluvastatin showed a significantly stronger reducing power than the others(pravastatin, atorvastatin).CONCLUSION: Fluvastatin having the antioxidaitive activity suppresses ulcer formation in rats induced by NSAIDs.展开更多
Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely repor...Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely reported, gastric body diaphragm-like stricture has not been reported. We describe the first case of gastric body diaphragm-like stricture due to NSAIDs in a 44-year-old male patient who was successfully treated by an endoscopic approach to avoid complicated surgery. This case highlights new insight into the disadvantages of NSAIDs and provides new data for future clinical studies.展开更多
AIM： To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs （NSAIDs） with respect to some risk factors and pat...AIM： To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs （NSAIDs） with respect to some risk factors and patient characteristics. METHODS： The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion （group Ⅰ ） with suicidal intent. Thirty patients with or without mild complaints of dyspepsia （group Ⅱ） were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score （LS）, expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis. RESULTS： Gastroduodenal damage was significantly more severe in group Ⅰ compared to group Ⅱ （P 〈 0.01）. The LS was similar in both groups Ⅰ a and Ⅰb. However LS was significantly higher in patients who had ingested multiple NSAIDs （group Ⅰ c） compared to other patients （P 〈 0.01）. The LS was correlated to age （P 〈 0.01） and total amount of drug ingested （P 〈 0.05） in group Ⅰ ; but it was not correlated with Helicobacter pylori （H pylori） infection or duration of exposure （P 〉 0.05）. The biopsy score （BS） was higher in group Ⅰ than group Ⅱ （P 〈 0.01）, and higher in group Ⅰb than group Ⅰa （P 〈 0.05）. CONCLUSION： The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of highdose acetaminophen.展开更多
BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the compa...BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),one of the most common chronic metabolic diseases,is also one of the most significant risk factors for cardiovascular disease(CVD)and chronic kidney disease(CKD).AIM To conduc...BACKGROUND Type 2 diabetes mellitus(T2DM),one of the most common chronic metabolic diseases,is also one of the most significant risk factors for cardiovascular disease(CVD)and chronic kidney disease(CKD).AIM To conduct a systematic review and network meta-analysis of cardiovascular(CV)and renal benefits of glucagon-like peptide-1 receptor agonists(GLP-1RA),sodium-glucose cotransporter-2 inhibitors(SGLT2i),and nonsteroidal mineralocorticoid receptor antagonists(nsMRA)in T2DM patients.METHODS We searched four databases-PubMed,EMBASE,Cochrane Library,and Web of Science-for publications from inception to March 6,2025.Total 500 participants were enrolled and had an intervention period of at least one year(or 52 weeks).Eligible studies included adult patients with T2DM and interventions with a placebo or another GLP-1RA,SGLT2i,or nsMRA.Data were standardized using Stata 17.0 software.The quality of evidence was assessed using the CINeMA and GRADE approaches.RESULTS Total 14970 articles were retrieved,of which 25 high-quality studies were included for the systematic review and network meta-analysis,covering 189797 patients and three drug classes(14 drugs).Network meta-analysis revealed low heterogeneity,thus ensuring reliable results.Meta-regression analysis indicated that baseline factors,such as comorbidities and blood glucose levels,did not affect our results.Overall,all included drugs demonstrated significant CV and renal benefits compared with the placebo.nsMRA showed the best efficacy in reducing the incidence of major adverse CV events and myocardial infarction.SGLT2i were most effective in reducing all-cause mortality,CV mortality,and the incidence of renal outcomes.GLP-1RA showed the greatest benefits in reducing the incidence of stroke.SC-semaglutide had the most significant effect on reducing major adverse CV events,oral semaglutide was most effective in reducing all-cause mortality and CV mortality,empagliflozin had the strongest effect in reducing composite renal outcomes and renal replacement therapy,canagliflozin was most effective in slowing the progression of proteinuria,and dapagliflozin showed the most significant reduction in end-stage renal disease.CONCLUSION T2DM,as one of the most common chronic metabolic diseases,is also one of the most significant risk factors for CVD and CKD.GLP-1RA,SGLT2i,and nsMRAs have emerged as novel therapeutic agents to comprehensively manage T2DM-related CVD and CKD.We conducted a network meta-analysis to compare the efficacy and safety of GLP-1RAs,SGLT2i,and nsMRA in patients with T2DM.展开更多
Urinary tract infections(UTIs)are among the most frequent causes for antibiotic prescription and;therefore,alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance.T...Urinary tract infections(UTIs)are among the most frequent causes for antibiotic prescription and;therefore,alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance.To evaluate the efficacy of nonsteroidal antiinflammatory drugs(NSAIDS)for the treatment of uncomplicated lower UTIs in women,this study implemented a meta-analytic approach to evaluate the results of available randomized clinical studies from online databases.A total of four trials involving 1144 patients with uncomplicated lower UTIs were included in the final evaluation.Results showed that symptom resolution at Day 3-4 in the NSAIDs group was significantly lower than that in the antibiotics group[pooled odds ratio(OR)=0.41,95%confidence interval(CI):0.23-0.74,P<0.05].However,there was no significant difference between the NSAIDs and antibiotics groups in symptom resolution at Day 7(pooled OR=0.43,95%CI:0.17-1.06,P=0.07),secondary antibiotic treatment rate at Day 28-30(pooled OR=1.15,95%CI:0.16-7.98,P=0.89)and adverse events rate(pooled OR=1.09,95%CI:0.61-1.96,P=0.77).Therefore,this metaanalysis suggests that,although inferior to antibiotics in fast symptom resolution,symptomatic treatment with NSAIDs can be considered as an alternative treatment option for uncomplicated lower UTIs in women.However,given the low number of randomized controlled trials that met inclusion criteria in this meta-analysis,efficacy of NSAIDs for treatment of uncomplicated lower UTIs should be further evaluated in more comprehensive clinical studies.展开更多
Dihydrofolate reductase (DHFR) is an enzyme that catalyzes the reduction of dihydrofolate (DHF) to tetrahydrofolate (THF). Chemotherapy drugs such as methotrexate help to slow the progression of cancer by limiting the...Dihydrofolate reductase (DHFR) is an enzyme that catalyzes the reduction of dihydrofolate (DHF) to tetrahydrofolate (THF). Chemotherapy drugs such as methotrexate help to slow the progression of cancer by limiting the ability of dividing cells to make nucleotides by competitively inhibiting DHFR. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been previously reported to exhibit competitive inhibition of DHFR, in addition to their primary action on cyclooxygenase enzymes. This interaction interferes with the enzymatic reduction of dihydrofolate to tetrahydrofolate, thereby impeding the folate metabolism pathway essential for nucleotide synthesis and cell proliferation. This activity stems from their structural resemblance to the p-aminobenzoyl-l-glutamate (pABG) moiety of folate, a substrate of DHFR. It has been established that NSAIDs containing a salicylate group (which has structural similarities to pABG), such as diflunisal, exhibit stronger DHFR-binding activity. In this study, we synthesized salicylate derivatives of naproxen with the aim of exploring their potential as inhibitors of DHFR. The interactions between these derivatives and human DHFR were characterized using a combination of biochemical, biophysical, and structural methods. Through polyacrylamide gel electrophoresis (PAGE) analysis, enzymatic assays, and quantitative ELISA, we investigated the binding affinity and inhibitory potency of the synthesized salicylate derivatives towards DHFR. The findings of this study suggest the potential of salicylate derivatives of naproxen as promising candidates for the inhibition of DHFR, thereby offering novel therapeutic opportunities for modulating the inflammatory process through multiple pathways. Further optimization of these derivatives could lead to the development of more efficacious dual-targeted analogs with enhanced therapeutic benefits.展开更多
文摘BACKGROUND Thiocolchicoside(TCC),a muscle relaxant with anti-inflammatory properties,is often used alongside nonsteroidal anti-inflammatory drugs(NSAIDs)to treat musculoskeletal pain.This synergistic approach leverages the complementary mechanisms of action,providing more effective relief for conditions such as arthritis,muscle spasms,and soft tissue injuries.AIM To evaluate the comparative efficacy of the combination therapy of TCC and NSAIDs vs NSAID monotherapy in pain management.METHODS A systematic search of PubMed and Google Scholar databases through October 2024 was performed to evaluate the effectiveness of combined TCC and NSAID therapy vs NSAIDs alone.A retrospective analysis of electronic medical records from India spanning 3 years(2020-2023)examined treatment patterns and focused on clinical outcomes including pain relief,functional improvement,and adverse effects.Key metrics for assessment included visual analog scale scores and hand-to-floor distance,with secondary outcomes assessing patient satisfaction and adverse event(AE)incidence.RESULTS A systematic literature search revealed seven studies,involving 1137 subjects,aligning with the eligibility criteria from a total of 833 hits.Combination therapy using parenteral TCC with NSAIDs significantly reduced pain intensity[standardised mean difference(SMD):-1.33,P<0.001]and enhanced functional improvement(SMD:-1.08,P<0.001)compared to NSAIDs alone.Patients on combination therapy are 6.7 times more likely to experience over 30%pain relief and 5.2 times more likely to achieve over 50%pain relief.Post surgery pain reduction and patient satisfaction were notably higher in the combination group[odds ratio(OR)=10.14,P<0.001].There were no significant differences in mild/moderate AE rates between the groups(OR=1.30,P=0.378).CONCLUSION Evidence indicates that multimodal therapy,including parenteral TCC with NSAIDs,provides quicker and effective pain relief,reduces muscle spasms,and improves hand-to-floor distance compared to using NSAIDs or TCC alone.
文摘Endoscopic ultrasound(EUS)with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and auto-immune pancreatitis or to analyze cyst fluid.The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis,which is likely induced by the same pathophysiological mechanisms as after en-doscopic retrograde cholangiopancreatography(ERCP).According to the current European Society of Gastrointestinal Endoscopy guideline,nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate.A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition(TA)is harm-less in healthy adults.Since it is associated with low costs and,most important,may prevent a dreadsome complication,we strongly recommend the adminis-tration of 100 mg diclofenac rectally prior to EUS-TA.We will explain this recom-mendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.
基金Shaanxi Provincial Key Research and Development Program(Project No.2024SF-YBXM-242)。
文摘Objective:To explore the efficacy of auricular acupuncture combined with transcutaneous electrical nerve stimulation(TENS)and nonsteroidal anti-inflammatory drugs(NSAIDs)in alleviating postpartum uterine pain.Methods:A total of 501 postpartum women with uterine pain were randomly divided into an experimental group(n=250)and a control group(n=251).The control group received oral NSAIDs(such as ibuprofen sustained-release capsules,diclofenac sodium suppositories,etc.),while the experimental group received auricular acupuncture and TENS in addition to the NSAIDs.The clinical efficacy,pain intensity,and vaginal bleeding volume of the two groups were observed.Results:The total effective rate in the experimental group(93.20%)was significantly higher than that in the control group(73.20%)(P<0.001).The NRS scores in the experimental group were lower than those in the control group after the intervention,and the bleeding volume within 24 h and 48 h after the intervention was also less than that in the control group,with significant differences(all P<0.001).Conclusion:Auricular acupuncture combined with TENS and NSAIDs for the treatment of postpartum uterine pain is safe and effective,can significantly reduce pain and vaginal bleeding,and is worthy of clinical promotion.
文摘BACKGROUND: The role of prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) for reduction of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) is debated. We performed a meta-analysis of all published randomized controlled trials to evaluate the efficacy of NSAIDs in the prevention of post-ERCP pancreatitis. DATA SOURCES: Searches were conducted in the databases PubMed, EMBASE and the Cochrane Library. Six randomized clinical trials that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. Data were extracted by two independent observers according to predetermined criteria. RESULTS: The risk of pancreatitis was lower in the NSAID group than in the placebo, group (OR: 0.46, 95% CI: 0.32 to 0.65, P < 0.0001). Two hours after ERCP, prophylactic administration of NSAIDs was associated with a lower serum amylase level (WMD: -91.09,95% CI: -149.78 to -32.40, P=0.002), but there was no difference in mean 24-hour serum amylase values (WMD: -379.00, 95% CI: -805.75 to 47.76, P=0.08). No deaths or NSAID-related complications were noted. CONCLUSIONS: Prophylactic administration of NSAIDs can reduce the incidence of post-ERCP pancreatitis; this administration in patients undergoing ERCP is recommended. Further randomized controlled trials are required before its introduction into routine care.
文摘AIM: To investigate the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: Two independent reviewers searched Pub Med (1966 to October 2013), Embase (1984 to October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 4, 2013) for relevant randomized controlled trials (RCTs) studying the effectiveness of prophylactic NSAID administration in the prevention of PEP. Using the Cochrane Collaboration Handbook, meta-analyses were conducted to evaluate the overall effect of NSAIDs in preventing the incidences of PEP and moderate to severe pancreatitis. RESULTS: Eight RCTs were identified from the literature search and included 1883 patients that underwent ERCP, with 971 patients in the NSAID group and 912 patients in the placebo group. Sixty-nine out of 971 (7.11%) patients developed PEP in the NSAID group in comparison to 143 out of 912 (15.68%) patients in the placebo group. The pooled RR of PEP incidence with prophylactic NSAID administration was 0.43 (95%CI: 0.33-0.56), which demonstrates that NSAID administration after ERCP significantly reduced the incidence of PEP when compared to the placebo group (P < 0.0001). Subgroup analysis was performed and revealed that the presence (NSAID group) or absence (placebo group) of NSAIDs had no significant effect on the development of moderate to severe pancreatitis (RR = 0.79, 95%CI: 0.52-1.18). Moreover, the administration of NSAIDs as a rectal suppository (RR = 0.35, 95%CI: 0.26-0.48; P < 0.0001) was more effective than oral administration (RR = 0.97, 95%CI: 0.53-1.80) or through infusion (RR = 0.43, 95%CI: 0.12-1.54). CONCLUSION: NSAIDs effectively reduce the incidence of PEP but not of moderate to severe pancreatitis. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘Previous reports clearly demonstrated that Helicobacter pylori(H.pylori)infection,nonsteroidal anti-inflammatory drugs(NSAID)or low dose aspirin(ASA)use significantly and independently increased the risk for the development of peptic ulcer disease.Today,the presence of H.pylori infection associated with low dose ASA and/or NSAID use in the same patient is becoming more frequent and therefore the potential interaction between these factors and the consequences of it has important implications.Whether NSAID intake in the presence of H.pylori infection may further increase the risk of peptic ulcer carried by the presence of only one risk factor is still a matter of debate.Studies on the interaction between the two risk factors yielded conflicting data and no consensus has been reached in the last years.In addition,the interaction between H.pylori infection and low-dose ASA remains even more controversial.In real clinical practice,we can find different clinical scenarios involving these three factors associated with the presence of different gastrointestinal and cardiovascular risk factors.These huge variety of possible combinations greatly hinder the decision making process of physicians.
文摘Inflammatory myofibroblastic tumor(IMT) occurring at retroperitoneal sites has rarely been reported.We report the case of a previously well 14-year-old girl with no history of abdominal disease whose past medical history and family tumor history were unremarkable.She complained of intermittent abdominal pain for one month.An abdominal mass was found on physical examination and abdominal contrast-enhanced computed tomography(CT) showed a hypodense soft mass,the size and location of which suggested a well delineated retroperitoneal tumor surrounding the superior mesenteric vessels measuring 3.3 cm × 4.5 cm × 4.5 cm with enlarged lymph nodes.The patient underwent an exploratory laparotomy followed by biopsy and was subsequently diagnosed with retroperitoneal IMT.She was successfully treated with postoperative chemotherapy and oral diclofenac sodium.Following completion of therapy the mass was no longer palpable and no longer visible on CT scanning.The use of methotrexate and cisplatin for aggressive myofibroblastic tumors is also reviewed.
基金Supported by National Natural Science Foundation of China,No.81200535China-Japan Friendship Hospital Youth Science and Technology Excellence Project,No.2014-QNYC-A-01
文摘AIM: To determine the clinicopathological characteristics of nonsteroidal anti-inflammatory drug (NSAID)-induced acute hepato-nephrotoxicity among Chinese patients.
文摘BACKGROUND Despite significant technical and training improvements, the incidence of postendoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP) has not significantly dropped. Although many studies have evaluated the efficacy of various agents, e.g. nonsteroidal anti-inflammatory drugs, octreotide,antioxidants, administered via various dosages, routes(oral, intrarectal or parenteral), and schedules(before or after the procedure), the results have been conflicting.AIM To evaluate efficacy of three pharmacologic prophylactic methods for prevention of PEP.METHODS In this prospective, single-center randomized trial, patients who underwent firsttime ERCP for choledocholithiasis were randomly assigned to three groups. The first group received 600 mg N-acetylcysteine 15 min prior to ERCP, and perrectum administration of 50 mg indomethacin both prior to and after completion of the ERCP. The second group was administered only the 50 mg indomethacin per-rectum both prior to and after the ERCP. The third group was administeredper-rectum 100 mg indomethacin only after the ERCP, representing the control group given the guideline-recommended regimen. The primary end-point was PEP prevention.RESULTS Among the total 211 patients evaluated during the study, 186 fulfilled the inclusion criteria and completed the protocol. The percentages of patients who developed PEP in each of the three groups were not significantly different(χ2 =2.793, P = 0.247). Among the acute PEP cases, for all groups, 14 patients developed mild pancreatitis(77.77%) and 4 moderate. No severe cases of PEP occurred, and in all PEP cases the resolution was favorable. No adverse events related to the medications(digestive hemorrhage, rectal irritation, or allergies)occurred.CONCLUSION The efficacies of split-dose indomethacin and combined administration(Nacetylcysteine with indomethacin) for preventing PEP were similar to that of the standard regimen.
基金Supported by Funds From the Yakult Bio-Science FoundationGrant-in Aid for Scientific Research from the Ministry of Education,Sports and Culture of Japan
文摘AIM: Nonsteroidal anti-inflammatory drugs (NSAIDs)cause gastrointestinal damage as one of their side effects in humans and experimental animals. Lipid peroxidation plays an important role in NSAID-induced ulceration. The aim of this study was to investigate the inhibitory effect of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)reductase inhibitors on the ulceration in small intestines of rats.METHODS: The effects of three HMG-CoA reductase inhibitors, fluvastatin, pravastatin and atorvastatin on ileal ulcer formation in 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT)-treated rats were examined. Antioxidative activity of the inhibitors was measured by a redox-linked colorimetric method.RESULTS: Fluvastatin, which was reported to have antioxidative activity, repressed the ileal ulcer formation in rats treated with BFMeT an NSAIDs. However, the other HMG-CoA reductase inhibitors (pravastatin and atorvastatin)did not repress the ileal ulcer formation. Among these HMG-CoA reductase inhibitors, fluvastatin showed a significantly stronger reducing power than the others(pravastatin, atorvastatin).CONCLUSION: Fluvastatin having the antioxidaitive activity suppresses ulcer formation in rats induced by NSAIDs.
文摘Increased risk due to nonsteroidal anti-inflammatory drugs (NSAIDs) therapy has been observed in patients. Although diaphragm-like stricture in the small bowel and colon induced by NSAIDs therapy has been rarely reported, gastric body diaphragm-like stricture has not been reported. We describe the first case of gastric body diaphragm-like stricture due to NSAIDs in a 44-year-old male patient who was successfully treated by an endoscopic approach to avoid complicated surgery. This case highlights new insight into the disadvantages of NSAIDs and provides new data for future clinical studies.
文摘AIM： To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs （NSAIDs） with respect to some risk factors and patient characteristics. METHODS： The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion （group Ⅰ ） with suicidal intent. Thirty patients with or without mild complaints of dyspepsia （group Ⅱ） were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score （LS）, expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis. RESULTS： Gastroduodenal damage was significantly more severe in group Ⅰ compared to group Ⅱ （P 〈 0.01）. The LS was similar in both groups Ⅰ a and Ⅰb. However LS was significantly higher in patients who had ingested multiple NSAIDs （group Ⅰ c） compared to other patients （P 〈 0.01）. The LS was correlated to age （P 〈 0.01） and total amount of drug ingested （P 〈 0.05） in group Ⅰ ; but it was not correlated with Helicobacter pylori （H pylori） infection or duration of exposure （P 〉 0.05）. The biopsy score （BS） was higher in group Ⅰ than group Ⅱ （P 〈 0.01）, and higher in group Ⅰb than group Ⅰa （P 〈 0.05）. CONCLUSION： The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of highdose acetaminophen.
基金Supported by National Natural Science Foundation of China,No.11772226 and No.81572154.
文摘BACKGROUND In the management of postoperative pain following total joint arthroplasty(TJA),the use of nonsteroidal anti-inflammatory drugs,including acetaminophen,plays a key role in alleviating pain.However,the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.AIM To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.METHODS PubMed,Embase and the Cochrane Library were comprehensively searched to identify cohort studies.The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials.PRISMA guidelines were followed.The effectiveness of the administration routes was compared based on visual analogue scale(VAS)scores at 24 and 48 h,total morphine usage within 24 h,and total duration of hospital stay.RESULTS The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups.The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h(P=0.76 and 0.08,respectively).The difference in total morphine use between the two groups was not significant(P=0.22).However,the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups(P=0.0005),showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.CONCLUSION After TJA surgery,intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia,Oral administration has become the preferred choice for mild cases due to its convenience and economy,providing a basis for clinical drug selection.
基金Supported by National Natural Science Foundation of China,No.82305205Young Elite Scientists Sponsorship Program by CACM,No.CACM-2023-QNRC2-A05+1 种基金the Safeguard Project of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,No.GAMHH9324001the Special Fund for Outstanding Young Scientific Talent Training of the Fundamental Research Business Expenses of the China Academy of Chinese Medical Sciences,No.ZZ18-YQ-011.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),one of the most common chronic metabolic diseases,is also one of the most significant risk factors for cardiovascular disease(CVD)and chronic kidney disease(CKD).AIM To conduct a systematic review and network meta-analysis of cardiovascular(CV)and renal benefits of glucagon-like peptide-1 receptor agonists(GLP-1RA),sodium-glucose cotransporter-2 inhibitors(SGLT2i),and nonsteroidal mineralocorticoid receptor antagonists(nsMRA)in T2DM patients.METHODS We searched four databases-PubMed,EMBASE,Cochrane Library,and Web of Science-for publications from inception to March 6,2025.Total 500 participants were enrolled and had an intervention period of at least one year(or 52 weeks).Eligible studies included adult patients with T2DM and interventions with a placebo or another GLP-1RA,SGLT2i,or nsMRA.Data were standardized using Stata 17.0 software.The quality of evidence was assessed using the CINeMA and GRADE approaches.RESULTS Total 14970 articles were retrieved,of which 25 high-quality studies were included for the systematic review and network meta-analysis,covering 189797 patients and three drug classes(14 drugs).Network meta-analysis revealed low heterogeneity,thus ensuring reliable results.Meta-regression analysis indicated that baseline factors,such as comorbidities and blood glucose levels,did not affect our results.Overall,all included drugs demonstrated significant CV and renal benefits compared with the placebo.nsMRA showed the best efficacy in reducing the incidence of major adverse CV events and myocardial infarction.SGLT2i were most effective in reducing all-cause mortality,CV mortality,and the incidence of renal outcomes.GLP-1RA showed the greatest benefits in reducing the incidence of stroke.SC-semaglutide had the most significant effect on reducing major adverse CV events,oral semaglutide was most effective in reducing all-cause mortality and CV mortality,empagliflozin had the strongest effect in reducing composite renal outcomes and renal replacement therapy,canagliflozin was most effective in slowing the progression of proteinuria,and dapagliflozin showed the most significant reduction in end-stage renal disease.CONCLUSION T2DM,as one of the most common chronic metabolic diseases,is also one of the most significant risk factors for CVD and CKD.GLP-1RA,SGLT2i,and nsMRAs have emerged as novel therapeutic agents to comprehensively manage T2DM-related CVD and CKD.We conducted a network meta-analysis to compare the efficacy and safety of GLP-1RAs,SGLT2i,and nsMRA in patients with T2DM.
基金This work was supported by the Young and Middle-age High-end Medical Reserve Personnel Training Plan Foundation of Chongqing Health Committee,China(grant number 2018GDRC002).
文摘Urinary tract infections(UTIs)are among the most frequent causes for antibiotic prescription and;therefore,alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance.To evaluate the efficacy of nonsteroidal antiinflammatory drugs(NSAIDS)for the treatment of uncomplicated lower UTIs in women,this study implemented a meta-analytic approach to evaluate the results of available randomized clinical studies from online databases.A total of four trials involving 1144 patients with uncomplicated lower UTIs were included in the final evaluation.Results showed that symptom resolution at Day 3-4 in the NSAIDs group was significantly lower than that in the antibiotics group[pooled odds ratio(OR)=0.41,95%confidence interval(CI):0.23-0.74,P<0.05].However,there was no significant difference between the NSAIDs and antibiotics groups in symptom resolution at Day 7(pooled OR=0.43,95%CI:0.17-1.06,P=0.07),secondary antibiotic treatment rate at Day 28-30(pooled OR=1.15,95%CI:0.16-7.98,P=0.89)and adverse events rate(pooled OR=1.09,95%CI:0.61-1.96,P=0.77).Therefore,this metaanalysis suggests that,although inferior to antibiotics in fast symptom resolution,symptomatic treatment with NSAIDs can be considered as an alternative treatment option for uncomplicated lower UTIs in women.However,given the low number of randomized controlled trials that met inclusion criteria in this meta-analysis,efficacy of NSAIDs for treatment of uncomplicated lower UTIs should be further evaluated in more comprehensive clinical studies.
文摘Dihydrofolate reductase (DHFR) is an enzyme that catalyzes the reduction of dihydrofolate (DHF) to tetrahydrofolate (THF). Chemotherapy drugs such as methotrexate help to slow the progression of cancer by limiting the ability of dividing cells to make nucleotides by competitively inhibiting DHFR. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been previously reported to exhibit competitive inhibition of DHFR, in addition to their primary action on cyclooxygenase enzymes. This interaction interferes with the enzymatic reduction of dihydrofolate to tetrahydrofolate, thereby impeding the folate metabolism pathway essential for nucleotide synthesis and cell proliferation. This activity stems from their structural resemblance to the p-aminobenzoyl-l-glutamate (pABG) moiety of folate, a substrate of DHFR. It has been established that NSAIDs containing a salicylate group (which has structural similarities to pABG), such as diflunisal, exhibit stronger DHFR-binding activity. In this study, we synthesized salicylate derivatives of naproxen with the aim of exploring their potential as inhibitors of DHFR. The interactions between these derivatives and human DHFR were characterized using a combination of biochemical, biophysical, and structural methods. Through polyacrylamide gel electrophoresis (PAGE) analysis, enzymatic assays, and quantitative ELISA, we investigated the binding affinity and inhibitory potency of the synthesized salicylate derivatives towards DHFR. The findings of this study suggest the potential of salicylate derivatives of naproxen as promising candidates for the inhibition of DHFR, thereby offering novel therapeutic opportunities for modulating the inflammatory process through multiple pathways. Further optimization of these derivatives could lead to the development of more efficacious dual-targeted analogs with enhanced therapeutic benefits.
