Objective Chemotherapy-induced neuropathy (CIN) significantly impacts cancer patients, leading to functional disability, diminished quality of life, and increased healthcare costs amid the ongoing opioid crisis. Auricular point acupressure (APA), a non-invasive and non-pharmacological alternative, has shown potential for alleviating the pain, numbness, and tingling associated with CIN. This study aims to assess the efficacy of APA for CIN symptoms and physical function and to examine the mechanisms underlying APA’s effects on CIN. Methods This is a three-arm randomized controlled clinical trial protocol. Patients aged 18 and older who are experiencing CIN are randomly assigned to one of the three groups: an APA group (in-person APA; mAPA), a sham control group (virtual APA; vAPA), and a wait-list usual care control group (UC). During the four-week program, participants in the mAPA receive an in-person APA treatment and training; the sham control participants (vAPA) receive a self-guided smartphone APA application with APA demonstration videos; and the UC participants will continue with the usual care and be re-randomized into one of the APA groups. The primary outcomes are changes in CIN symptoms and physical function. Secondary outcomes include evaluating pain sensory thresholds, motor and cognitive functioning, inflammatory signaling, brain connectivity, opioid use, and quality of life. The outcomes are measured at baseline, program completion (4 weeks), and at monthly follow-up for 3 months post-intervention. Discussion This study will provide evidence supporting the potential viability of APA as an intervention for CIN. Trial registration ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.
The liver depends on a dual blood supply from the hepatic artery and the portal vein. The normal liver receives 70% portal flow and 30% hepatic arterial flow, with most arterial blood feeding the biliary tree. As cirrhosis robs the liver of its regenerative capacity, the portal flow decreases and intrahepatic portosystemic shunting increases with a variable increase in arterial flow across arterioportal shunts. This compensation mechanism attempts to reperfuse remaining sinusoids. Transjugular intrahepatic portosystemic shunts (TIPS) or surgical portosystemic shunts may acutely diminish portal perfusion further, leading to hepatic failure. Small-diameter TIPS or surgical shunts reduce the incidence of complications by preserving nutritive portal flow. Although the inverse relationship of arterial and portal flow is physiologically valid, there is individual variation in the ability to substitute one blood supply for another. This variability may result from anatomic or functional factors influencing the flow across arterioportal shunts. Hepatic perfusion curves derived from enhanced imaging studies can subtype cirrhotic patients into favorable versus unfavorable perfusion patterns. Patients with high arterial flow to the liver or patients with retained portal-type flow curves have better survival and morbidity compared with those patients with unfavorable flow manifest by diminished arterial-type curves on hepatic perfusion analysis.
Coronary artery aneurysms (CAAs) are relatively rare with an incidence varying from 1.4% to 5.3% of patients undergoing coronary angiography. Studies suggest that management of CAA can be guided by the absence or presence of significant coronary artery stenosis, with most concluding that CAA associated with stenosis of ≥70% should be managed surgically or with percutaneous intervention. However, given the paucity of cases described in the literature and lack of randomised control trials, no consensus exists on the natural history, prognosis or management of CAAs without significant concomitant stenosis. We present a case of medically managed atherosclerotic CAA without significant stenosis that was found to no longer be present on coronary angiography performed 11 years after initial diagnosis.
Peripheral vascular disease refers to any pathology that affects the blood vessels outside the brain or heart. Peripheral vascular disease is usually the result of atherosclerosis of the blood vessels resulting in insufficient tissue perfusion. Arteries are more commonly subject to atherosclerotic disease as compared to veins. Peripheral vascular disease is normally a chronic process, but it may present in an acute manner when thrombi, emboli, or acute trauma occur which can affect perfusion. Thromboses often occur in the lower extremities more frequently than in the upper extremities and may result from atherosclerotic plaques [1]. Emboli tend to carry higher morbidity because the extremity has not had time to develop collateral circulation. Whether caused by embolus or thrombus, occlusion results in both proximal and distal thrombus formation due to flow stagnation. Ultimately, this can result in tissue ischemia and necrosis.
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