bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of de novo lipogenesis targets androgen receptor signaling in castration-resistant prostate cancer
Authors: Zadra Giorgia , Ribeiro Caroline F. , Chetta Paolo , Ho Yeung , Cacciatore Stefano , Gao Xueliang , Syamala Sudeepa , Bango Clyde , Photopoulos Cornelia , Huang Ying , Tyekucheva Svitlana , Bastos Debora C. , Tchaicha Jeremy , Lawney Brian , Uo Takuma , D’Anello Laura , Csibi Alfredo , Kalekar Radha , Larimer Benjamin , Ellis Leigh , Butler Lisa M. , Morrissey Colm , McGovern Karen , Palombella Vito J. , Kutok Jeffery L. , Mahmood Umar , Bosari Silvano , Adams Julian , Peluso Stephane , Dehm Scott M. , Plymate Stephen R. , Loda Massimo
Published: December 2018

A hallmark of prostate cancer progression is dysregulation of lipid metabolism via overexpression of fatty acid synthase (FASN), a key enzyme in de novo fatty acid synthesis. Metastatic castration-resistant prostate cancer (mCRPC) develops resistance to inhibitors of androgen receptor (AR) signaling through a variety of mechanisms, including the emergence of the constitutively active AR variant V7 (AR-V7). Here, we developed an FASN inhibitor (IPI-9119) and demonstrated that selective FASN inhibition antagonizes CRPC growth through metabolic reprogramming and results in reduced protein expression and transcriptional activity of both full-length AR (AR-FL) and AR-V7. Activation of the reticulum endoplasmic stress response resulting in reduced protein synthesis was involved in IPI-9119–mediated inhibition of the AR pathway. In vivo, IPI-9119 reduced growth of AR-V7–driven CRPC xenografts and human mCRPC-derived organoids and enhanced the efficacy of enzalutamide in CRPC cells. In human mCRPC, both FASN and AR-FL were detected in 87% of metastases. AR-V7 was found in 39% of bone metastases and consistently coexpressed with FASN. In patients treated with enzalutamide and/or abiraterone FASN/AR-V7 double-positive metastases were found in 77% of cases. These findings provide a compelling rationale for the use of FASN inhibitors in mCRPCs, including those overexpressing AR-V7.
PARL deficiency in mouse causes Complex III defects, coenzyme Q depletion, and Leigh-like syndrome
Authors: Spinazzi Marco , Radaelli Enrico , Horré Katrien , Arranz Amaia M. , Gounko Natalia V. , Agostinis Patrizia , Maia Teresa Mendes , Impens Francis , Morais Vanessa Alexandra , Lopez-Lluch Guillermo , Serneels Lutgarde , Navas Placido , De Strooper Bart
Published: December 2018

The mitochondrial intramembrane rhomboid protease PARL has been implicated in diverse functions in vitro, but its physiological role in vivo remains unclear. Here we show that
Parl
ablation in mouse causes a necrotizing encephalomyelopathy similar to Leigh syndrome, a mitochondrial disease characterized by disrupted energy production. Mice with conditional PARL deficiency in the nervous system, but not in muscle, develop a similar phenotype as germline
Parl
KOs, demonstrating the vital role of PARL in neurological homeostasis. Genetic modification of two major PARL substrates, PINK1 and PGAM5, do not modify this severe neurological phenotype.
Parl

−
/
−

brain mitochondria are affected by progressive ultrastructural changes and by defects in Complex III (CIII) activity, coenzyme Q (CoQ) biosynthesis, and mitochondrial calcium metabolism. PARL is necessary for the stable expression of TTC19, which is required for CIII activity, and of COQ4, which is essential in CoQ biosynthesis. Thus, PARL plays a previously overlooked constitutive role in the maintenance of the respiratory chain in the nervous system, and its deficiency causes progressive mitochondrial dysfunction and structural abnormalities leading to neuronal necrosis and Leigh-like syndrome.
Photodecomposition of methylene blue over Dy3+ impregnated MAO TiO2 films
Authors: Zhang Y. , Chen Y. , Liu X. , Zhao Y. W.
Published: December 2018

TiO2 films were formed in phosphate-based electrolyte on pure titanium by micro-arc oxidation (MAO) technology. After that, they were impregnated with Dy3+-containing electrolyte to produce TiO2:Dy3+ composite films. Effects of the duty cycle, impregnation time and concentration on physical and chemical properties of TiO2 and TiO2:Dy3+ composite films were investigated by scanning electron microscopy (SEM), X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS). A UV-VIS spectrophotometer was used to study photocatalytic properties of both films. XPS results revealed that Ti 2p spin-orbit components of the TiO2:Dy3+ composite film are shifted towards higher binding energy, with respect to the TiO2 film, suggesting that some of the Dy3+ ions are incorporated into TiO2 lattice. The TiO2:Dy3+ composite films showed an obvious enhanced photocatalytic activity than that of the TiO2 film under UV-irradiation.
Anti-diabetic effect of S-adenosylmethionine and α-glycerophosphocholine in KK-Ay mice
Authors: Izu Hanae , Okuda Mayumi , Shibata Sachi , Fujii Tsutomu , Matsubara Kiminori
Published: December 2018

Six-week-old male KK-Ay mice received drinking water with S-adenosylmethionine (SAM), α-glycerophosphocholine (GPC), or SAM+GPC for 10 weeks. The serum glucose of SAM+GPC at 15 weeks old, total cholesterol of GPC at 12 weeks old, and triglyceride of GPC at 15 weeks old and of SAM at 16 weeks old were reduced. SAM+GPC reduced serum leptin and food intake.

Abbreviations: SAM: S-adenosylmethionine; GPC: α-glycerophosphocholine
3D Digital Image Correlation for vibration measurement on rolling tire: procedure development and comparison with Laser Doppler Vibrometer
Authors: Galeazzi S. , Chiariotti P. , Martarelli M. , Tomasini E. P.
Published: December 2018

Noise generated from rolling tire is strictly related to vibrations caused by the impacts of tread blocks on the road surface. Performing vibration measurements on rolling tires is a quite complex task and non-contact methods should be exploited. Laser Doppler Vibrometer (LDV) is the technique that has been mainly used so far, but it has some disadvantages, among which the measurement duration represents the main issue. Digital Image Correlation (DIC) could represent an appealing alternative for this kind of measurement. Recent developments in Digital Image Correlation combined with the modern fast cameras could represent an innovative instrument for vibration measurement at high frequency (up to about 1000 Hz depending on rolling speed). This paper analyses the possibility of using 3D DIC for vibration measurement on rolling tire by a direct comparison with LDV. The advantages and disadvantages of both the techniques are highlighted along the paper by analysing data of an impact test (static case) and a rolling measurement.
Catalysis in biodiesel production—a review
Authors: Thangaraj Baskar , Solomon Pravin Raj , Muniyandi Bagavathi , Ranganathan Srinivasan , Lin Lin
Published: December 2018

Catalysts play a significant role in transesterification of vegetable oils. Currently, chemical and biological catalysts are being investigated, and both have their inherent merits and demerits. In large-scale applications, these catalysts are expected to be cost effective and environmentally friendly. If the catalyst is homogeneous in its physical form it is more effective than is the heterogeneous catalyst, but its separation from the mixture is a major issue. Some of the heterogeneous catalysts suffer leaching in harsh reaction conditions. Of late, nanocatalysts that demonstrate high efficiency are being studed. Nanoparticles are used in biological catalysts as solid carriers for lipase immobilization. Lipase immobilized on magnetic nanoparticles has proved to be a versatile biocatalyst for biodiesel production. This article reviews the role of various catalytic systems commonly used in the transesterification reaction of oils in biodiesel generation.
Impact of tricuspid annular size reduction on right ventricular function, geometry and strain†
Authors: Malinowski Marcin , Jaźwiec Tomasz , Goehler Matthew , Bush Jared , Quay Nathan , Ferguson Haley , Rausch Manuel K , Timek Tomasz A
Published: December 2018

OBJECTIVES

Restrictive tricuspid annuloplasty is a clinically accepted approach to treat functional tricuspid regurgitation. We set out to investigate the effect of varying degrees of tricuspid annular reduction on the right ventricular (RV) function, geometry and strain.

METHODS

Eight, healthy sheep (45 ± 4 kg) had 6 sonomicrometry crystals implanted around the tricuspid annulus and 20 onto the epicardium of the right ventricle defining 3 free wall regions: basal, mid and lower. A polypropylene annuloplasty suture was placed around the tricuspid annulus and externalized to an epicardial tourniquet. Simultaneous echocardiographic, haemodynamic and sonomicrometry data were acquired at baseline and during 5 consecutive annular reduction steps (TAR 1–5) with successive (5–7 mm) suture cinching. RV free wall circumferential, longitudinal and areal cardiac and interventional strains, RV radius of curvature (ROC), cross-sectional area and tricuspid annular dimensions were calculated from 3-dimensional crystal coordinates.

RESULTS

TAR 1–5 resulted in 19 ± 15%, 35 ± 15%, 51 ± 15%, 60 ± 15% and 68 ± 13% tricuspid annular area reduction, respectively. TAR 1 and 2 had minimal influence on the RV function, RV-ROC and strains. TAR 4 and 5 decreased RV-ROC in basal and mid-regions, but reduced the RV cross-sectional area change (from 19 ± 4% at baseline to 14 ± 3% and 13 ± 2%, respectively, P < 0.001) and circumferential and areal strains. TAR 3 significantly decreased free wall RV-ROC from 44.0 ± 1.5 to 42.6 ± 2.4 mm P < 0.001 at the RV base but maintained the regional ventricular function and strains.

CONCLUSIONS

In healthy ovine hearts, a tricuspid annular area reduction of ∼50% provides optimal conditions for reducing RV-ROC while maintaining regional RV function and strain patterns.
The Treatment of Inflammatory Bowel Disease in Patients With a History of Malignancy
Authors: Lin Steven C , Goldowsky Alex , Papamichael Konstantinos , Cheifetz Adam S
Published: December 2018

As patients with inflammatory bowel disease (IBD) are living longer and our medical armamentarium expands, gastroenterologists are more frequently faced with treatment decisions about patients with IBD who also have a history of malignancy. This review aims to summarize the current literature on IBD, the inherent risk of developing gastrointestinal and extra-intestinal malignancies, and the risk of malignancies associated with available biologic and immunomodulatory therapies and to discuss the overall treatment strategy for a patient with a history of malignancy.
High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease
Authors: Barnes Edward L , Long Millie D , Kappelman Michael D , Martin Christopher F , Sandler Robert S
Published: December 2018

Background

High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one’s care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn’s disease or ulcerative colitis.

Methods

We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity.

Results

Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29–0.36) and depression (aOR, 0.33; 95% CI, 0.29–0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20–2.45).

Conclusions

In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.
Changing Connotations and the Evolution of the Effect of Wording: Labeling Asylum Seekers in a Political Campaign
Authors: Janky Béla
Published: December 2018

This paper investigates the moderating role of public discourse in the effects of labeling asylum seekers (as “immigrants” vs. “refugees”) on attitudes toward asylum policy. The study relies on a series of survey experiments conducted in Hungary, in a period when asylum policy suddenly became a highly salient issue there. Originally, respondents were much more solidaristic toward “refugees” than “immigrants,” but the public discussion on asylum policy suppressed this wording effect—mainly by contaminating the concept of “refugee.” By using data on news reports and respondents’ media use, the analysis also looks at the roots of these changes. In particular, it presents evidence on the moderating role of converging connotations of different labels on the effect of wording.
Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America
Authors: Gulayin Pablo Elías , Irazola Vilma , Gutierrez Laura , Elorriaga Natalia , Lanas Fernando , Mores Nora , Ponzo Jaqueline , Calandrelli Matías , Poggio Rosana , Rubinstein Adolfo , Bardach Ariel
Published: December 2018

Background

Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk.

Methods

CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR.

Results

A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers.

Conclusions

A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.
The paradox of inequality: income inequality and belief in meritocracy go hand in hand
Authors: Mijs Jonathan J B
Published: December 2018

Inequality is on the rise: gains have been concentrated with a small elite, while most have seen their fortunes stagnate or fall. Despite what scholars and journalists consider a worrying trend, there is no evidence of growing popular concern about inequality. In fact, research suggests that citizens in unequal societies are less concerned than those in more egalitarian societies. How to make sense of this paradox? I argue that citizens’ consent to inequality is explained by their growing conviction that societal success is reflective of a meritocratic process. Drawing on 25 years of International Social Survey Program data, I show that rising inequality is legitimated by the popular belief that the income gap is meritocratically deserved: the more unequal a society, the more likely its citizens are to explain success in meritocratic terms, and the less important they deem nonmeritocratic factors such as a person’s family wealth and connections.
Randomization procedures for multicomponent behavioral intervention factorial trials in the multiphase optimization strategy framework: challenges and recommendations
Authors: Gallis John A , Bennett Gary G , Steinberg Dori M , Askew Sandy , Turner Elizabeth L
Published: December 2018

Appropriate implementation and rigorous reporting of randomization procedures is vital in factorial trials for ensuring the efficiency and validity of the results.
Applying the Flipped Classroom Model to Psychomotor Skill Acquisition in Nursing
Authors: Dinndorf-Hogenson Georgia Ann , Hoover Carrie , Berndt Jodi Lisbeth , Tollefson Bethany , Peterson Jennifer , Laudenbach Nichole
Published: December 2018

This descriptive study aimed to examine baccalaureate student psychomotor skill performance when given different methods of pre-skill lab preparation materials in a flipped classroom environment. Students utilized either a narrated video demonstration of the skill or a skill instruction sheet with photographic images as lab preparation materials. Psychomotor skill performance of insulin pen administration was evaluated. Results suggest the type of preparation methods used with the flipped classroom pedagogy does not significantly affect student performance on psychomotor skill acquisition.
Interventions Addressing Neurodevelopmental Delay in Young Children Infected With and Exposed to HIV: A Scoping Review
Authors: Strehlau Renate , van Aswegen Tamryn , Potterton Joanne
Published: December 2018

Background:

Neurodevelopmental delays have been documented in children living with and infected by the human immunodeficiency virus (HIV). Early childhood stimulation programs can positively impact neurodevelopmental outcomes and have a far-reaching effect beyond childhood.

Objective:

To conduct a scoping review mapping evidence describing interventions aimed at mitigating or preventing neurodevelopmental delays resulting from exposure to or infection with HIV in preschool children.

Methods:

Electronic databases of PubMed, PsycINFO, CINAHL Plus, Google Scholar, and the Cochrane Library, reference lists of identified articles, and gray literature were searched. Title and abstract and full-text reviews were conducted independently by 2 reviewers. Study location, design, sample size, age of cohort, child's HIV serostatus, antiretroviral treatment availability for children or caregivers, neurodevelopmental assessment tool used, and details of the intervention and comparison groups were documented.

Results:

Ten studies meeting predetermined inclusion and exclusion criteria were identified. Six studies focused on training provided to the child's caregiver of which one offered an intervention focused specifically on stimulating child development through a home-based stimulation program. Four studies provided a child-directed intervention. Interventions ranged in duration from 10 days to 15 months. Intensity of the intervention varied from 3 times per day to biweekly. Interventions were aimed at children in the neonatal period throughout the preschool years.

Conclusion:

Many children are at risk of poor neurodevelopmental outcomes due to HIV infection. Few studies investigating interventions aimed at addressing this problem were identified. Further research into effective interventions aimed at improving childhood neurodevelopmental outcomes in the context of HIV is required.
Multidisciplinary Care Models in HIV/AIDS Care: A Wholistic Approach
Authors: Pullen Sara D.
Published: December 2018

This clinical conversation discusses the importance of a wholistic approach to HIV/AIDS care, with physical therapy as a critical part of the care team.
Chronic Pain Mitigation and Opioid Weaning at a Multidisciplinary AIDS Clinic: A Case Report
Authors: Pullen Sara
Published: December 2018

Background and Purpose:

Chronic pain has emerged as a treatment priority among people living with HIV (PLHIV). Recent studies indicate the use of physical therapy (PT) for chronic pain mitigation among PLHIV; however, there is a paucity of literature regarding PT as part of multidisciplinary collaboration to address the intersection of HIV, chronic pain, and opioid use.

Case Description:

This case report examined the effect of a 24-session PT intervention aimed at decreasing chronic pain and opioid weaning for a 64-year-old patient at a multidisciplinary AIDS clinic in Atlanta, Georgia. The PT intervention focused on pain mitigation, using pain relief techniques such as a home TENS (transcutaneous electrical nerve stimulation) unit, home stretching regimen, and diaphragmatic breathing techniques. In addition, the physical therapist communicated regularly with the patient's primary HIV provider regarding patient progress.

Outcomes:

After the intervention, outcomes included decreased pain from 10/10 to 0/10, independent pain management, and increased independence in functional activities. In addition, the patient decreased opioid usage from 15 to 2.5 mg hydrocodone, an 83.3% decrease.

Discussion:

In a complex chronic pain case with a patient on chronic opioid therapy, multidisciplinary communication is key in successful management. To truly address opiate weaning in the context of pain management, physical therapists' expertise in pain management should ideally be complemented by close communication with the patient's primary medical provider. This allows for open dialogue and acknowledges the importance of various specialty areas committed to a joint effort not of simply opioid weaning but of patient-centered, multidisciplinary chronic pain control.
Can We Avoid Implant-selection Errors in Total Joint Arthroplasty?
Authors: Ast Michael P. , Mayman David J. , Bostrom Mathias P. , Gonzalez Della Valle Alejandro , Haas Steven B.
Published: December 2018

Background

Implant selection in the operating room is a manual process. This manual process combined with complex compatibility rules and inconsistent implant labeling may lead to implant-selection errors. These might be reduced using an automated process; however, little is known about the efficacy of available automated error-reduction systems in the operating room.

Questions/purposes

(1) How often do implant-selection errors occur at a high-volume institution? (2) What types of implant-selection errors are most common?

Methods

We retrospectively evaluated our implant log database of 22,847 primary THAs and TKAs to identify selection errors. There were 10,689 THAs and 12,167 TKAs included during the study period from 2012 to 2017; there were no exclusions and we had no missing data in this study. The system provided an output of errors identified, and these errors were then manually confirmed by reviewing implant logs for each case found in the medical records. Only those errors that were identified by the system were manually confirmed. During this time period all errors for all procedures were captured and presented as a proportion. Errors identified by the software were manually confirmed. We then categorized each mismatch to further delineate the nature of these events.

Results

One hundred sixty-nine errors were identified by the software system just before implantation, representing 0.74 of the 22,847 procedures performed. In 15 procedures, the wrong side was selected. Twenty-five procedures had a femoral head selected that did not match the acetabular liner. In one procedure, the femoral head taper differed from the femoral stem taper. There were 46 procedures in which there was a size mismatch between the acetabular shell and the liner. The most common error in TKA that occurred in 46 procedures was a mismatch between the tibia polyethylene insert and the tibial tray. There were 13 procedures in which the tibial insert was not matched to the femoral component according to the manufacturer’s guidelines. Selection errors were identified before implantation in all procedures.

Conclusions

Despite an automated verification process, 0.74% of the arthroplasties performed had an implant-selection error that was identified by the software verification. The prevalence of incorrect/mismatched hip and knee prostheses is unknown but almost certainly underreported. Future studies should investigate the prevalence of these errors in a multicenter evaluation with varying volumes across the involved sites. Based on our results, institutions and management should consider an automated verification process rather than a manual process to help decrease implant-selection errors in the operating room.

Level of Evidence

Level IV, therapeutic study.
Middle Eastern Rhinoplasty: Update
Authors: Rohrich Rod J. , Mohan Raja
Published: December 2018

Middle Eastern rhinoplasty requires especially precise preoperative planning to achieve a successful result. Among all aesthetic surgery procedures, there is a higher demand for rhinoplasty among Middle Eastern cultures. The key is to maintain the ethnicity of the patients while meeting their goals. In this brief overview, common features in Middle Eastern patients and Middle Eastern rhinoplasty techniques in men and women are highlighted.
Patient Perspectives on Dialogue and Shared Decision Making
Authors: Dauer Lawrence T.
Published: December 2018

The fear of radiation on the part of patients and/or clinical staff can hamper adequate shared medical decision making. Typically, one-sided medical radiation risk communication methods with limited effectiveness are employed, such as paternalistic, risk numerology, and quality “assurance” approaches. More study is needed to determine patient preferences and potential fears associated with medical imaging radiation, and the results can provide insights for such discussions. Worry about the potential risks associated with medical imaging radiation has been shown to be substantial in the US population. The level of concern differs by sex, race/ethnicity, education, nationality, and overall health, suggesting that more care and individualized communication and discussion methods need to be employed by clinical staff. The opportunities for improved dialogue with patients (and parents of patients) and the public in general are plentiful.
Computed Tomography Technology—and Dose—in the 21st Century
Authors: McCollough Cynthia H.
Published: December 2018

In the last decade or so, a number of disruptive technological advances have taken place in x-ray computed tomography, making possible new clinical applications. Changes in scanner design have included the use of two x-ray sources and two detectors or the use of large detector arrays that provide 16 cm of longitudinal coverage in one gantry rotation. These advances have allowed images of the entire heart to be acquired in just one heartbeat, lowering the effective dose from cardiac computed tomography from ~15 mSv to <1 mSv. Dual-energy computed tomography is now in widespread clinical use, enabling the assessment of material composition and concentration, as well as a range of new clinical applications. An emerging technology known as photon-counting detector computed tomography directly measures the energies of detected photons and is capable of simultaneously acquiring more than two energy data sets. Photon-counting detector computed tomography also provides advantages such as the ability to reject electronic noise, better iodine contrast-to-noise for a given dose, and spatial resolution as fine as 150 μm. Optimized x-ray tube potential selection has allowed reduction in radiation and contrast doses. Finally, wide adoption of iterative reconstruction and noise-reduction techniques has occurred. In all, body computed tomography doses have fallen dramatically, for example, by over a factor of 3 from the early 1980s. All of these advances increase the medical benefit and decrease the potential radiation risk associated with computed tomography. However, care must be taken to ensure that doses are not lowered to the level at which the clinical task is compromised.
The IASP classification of chronic pain for ICD-11: applicability in primary care
Authors: Smith Blair H. , Fors Egil A. , Korwisi Beatrice , Barke Antonia , Cameron Paul , Colvin Lesley , Richardson Cara , Rief Winfried , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

The International Classification of Diseases, 11th Revision (ICD-11), proposes, for the first time, a coding system for chronic pain. This system contains 1 code for “chronic primary pain,” where chronic pain is the disease, and 6 codes for chronic secondary pain syndromes, where pain developed in the context of another disease. This provides the opportunity for routine, standardised coding of chronic pain throughout all health care systems. In primary care, this will confer many important, novel advantages over current or absent coding systems. Chronic pain will be recognized as a centrally important condition in primary care. The capacity to measure incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address chronic pain in primary care. Finally, opportunities to match evidence-based treatment pathways to distinct chronic pain subtypes will be enhanced.
The IASP classification of chronic pain for ICD-11: chronic neuropathic pain
Authors: Scholz Joachim , Finnerup Nanna B. , Attal Nadine , Aziz Qasim , Baron Ralf , Bennett Michael I. , Benoliel Rafael , Cohen Milton , Cruccu Giorgio , Davis Karen D. , Evers Stefan , First Michael , Giamberardino Maria Adele , Hansson Per , Kaasa Stein , Korwisi Beatrice , Kosek Eva , Lavand'homme Patricia , Nicholas Michael , Nurmikko Turo , Perrot Serge , Raja Srinivasa N. , Rice Andrew S.C. , Rowbotham Michael C. , Schug Stephan , Simpson David M. , Smith Blair H. , Svensson Peter , Vlaeyen Johan W.S. , Wang Shuu-Jiun , Barke Antonia , Rief Winfried , Treede Rolf-Detlef ,   Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG)
Published: December 2018

The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary task force of pain specialists. Here, we present the case for a reclassification of nervous system lesions or diseases associated with persistent or recurrent pain for ≥3 months. The new classification lists the most common conditions of peripheral neuropathic pain: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy. Conditions of central neuropathic pain include pain caused by spinal cord or brain injury, poststroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are captured in residual categories of ICD-11. Conditions of chronic neuropathic pain are either insufficiently defined or missing in the current version of the ICD, despite their prevalence and clinical importance. We provide the short definitions of diagnostic entities for which we submitted more detailed content models to the WHO. Definitions and content models were established in collaboration with the Classification Committee of the IASP's Neuropathic Pain Special Interest Group (NeuPSIG). Up to 10% of the general population experience neuropathic pain. The majority of these patients do not receive satisfactory relief with existing treatments. A precise classification of chronic neuropathic pain in ICD-11 is necessary to document this public health need and the therapeutic challenges related to chronic neuropathic pain.
Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)
Authors: Treede Rolf-Detlef , Rief Winfried , Barke Antonia , Aziz Qasim , Bennett Michael I. , Benoliel Rafael , Cohen Milton , Evers Stefan , Finnerup Nanna B. , First Michael B. , Giamberardino Maria Adele , Kaasa Stein , Korwisi Beatrice , Kosek Eva , Lavand'homme Patricia , Nicholas Michael , Perrot Serge , Scholz Joachim , Schug Stephan , Smith Blair H. , Svensson Peter , Vlaeyen Johan W.S. , Wang Shuu-Jiun
Published: December 2018

Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup “chronic primary pain.” In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as “chronic secondary pain” where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.
The IASP classification of chronic pain for ICD-11: chronic primary pain
Authors: Nicholas Michael , Vlaeyen Johan W.S. , Rief Winfried , Barke Antonia , Aziz Qasim , Benoliel Rafael , Cohen Milton , Evers Stefan , Giamberardino Maria Adele , Goebel Andreas , Korwisi Beatrice , Perrot Serge , Svensson Peter , Wang Shuu-Jiun , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

This article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called “chronic secondary pain” where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.
The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain
Authors: Nugraha Boya , Gutenbrunner Christoph , Barke Antonia , Karst Matthias , Schiller Jörg , Schäfer Peter , Falter Silke , Korwisi Beatrice , Rief Winfried , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

Physical, mental, and social well-being are part of the concept of health according to the World Health Organization, in addition to the absence of disease and infirmity. Therefore, for a full description of a person's health status, the International Classification of Functioning, Disability and Health (ICF) was launched in 2001 to complement the existing International Classification of Diseases (ICD). The 11th version of the ICD (ICD-11) is based on so-called content models, which have 13 main parameters. One of them is functioning properties (FPs) that, according to the WHO, consist of the activities and participation components of the ICF. Recently, chronic pain codes were added to the 11th edition of the ICD, and hence, a specific set of FPs for chronic pain is required as a link to the ICF. In addition, pain is one of the 7 dimensions of the generic set of the ICF, which applies to any person. Thus, assessment and management of pain are also important for the implementation of the ICF in general. This article describes the current consensus proposal by the International Association for the Study of Pain (IASP) and the International Society of Physical and Rehabilitation Medicine (ISPRM) for a specific set of FPs of chronic pain, which will have to be empirically validated in a next step. The combined use of ICD-11 and ICF is expected to improve research reports on chronic pain by a more precise and adequate coding, as well as patient management through better diagnostic classification.
Impact on Clinical Performance of Required Participation in a Student-Run Pro Bono Clinic
Authors: Gilles Jodi , Bishop Mark , McGehee William , Lulofs-MacPherson Kevin , Dunleavy Kim
Published: December 2018

Background and Purpose.

Early opportunities for students to develop clinical skills and professional attributes are important to maximize clinical learning. Student-run pro bono clinics have the potential to provide early contextual exposure. This article describes the impact of required compared to voluntary participation in a student-run pro bono clinic on clinical performance during the first full-time internship.

Method/Model Description and Evaluation.

Students in the University of Florida Doctor of Physical Therapy program were assigned to one of four service learning groups including a pro bono clinic. While attendance at the clinic was encouraged for all students, only the assigned group was required to attend twice a semester. A retrospective analysis of student performance on the Clinical Performance Instrument (CPI) for the first internship was conducted. Clinician CPI ratings were categorized as beginner or intermediate and above. Median scores for safety, professional practice, and practice management items for those students who were required to attend the clinic were compared to students from the other service learning groups who did not attend or attended voluntarily using Chi-square analysis.

Outcomes.

At midterm, a higher proportion of the required pro bono group were rated as intermediate or above by clinical instructors for safety, all professional practice items except professional development, and all patient management items except diagnosis/prognosis, education, and consideration of financial resources. Differences were present at the final evaluation for safety, professional behavior, cultural competence, clinical reasoning, and examination.

Discussion and Conclusion.

Positive outcomes were present for students involved in the pro bono clinic, illustrating the potential benefits of required pro bono clinic experiences early in a professional curriculum for accelerating clinical performance.
Calcinosis Cutis of the Vulva: A Review
Authors: Wang Qing , Heller Debra S.
Published: December 2018

Idiopathic calcinosis cutis (CC) is an uncommon skin condition. Although it has been reported many times in the scrotum, it is exceedingly rare in the vulva. Most reports of vulvar CC are in children. Vulvar CC may be thought clinically to be inclusion cysts. Other causes of calcinosis such as autoimmune disease or alterations in serum calcium levels, potentially associated with malignancy, must be considered before considering a case as idiopathic.
Haptoglobin 2 Allele is Associated With Histologic Response to Vitamin E in Subjects With Nonalcoholic Steatohepatitis
Authors: Banini Bubu A. , Cazanave Sophie C. , Yates Katherine P. , Asgharpour Amon , Vincent Robert , Mirshahi Faridoddin , Le Peter , Contos Melissa J. , Tonascia James , Chalasani Naga P. , Kowdley Kris V. , McCullough Arthur J. , Behling Cynthia A. , Schwimmer Jeffrey B. , Lavine Joel E. , Sanyal Arun J.
Published: December 2018

Background:

Haptoglobin (Hp) genotype has been linked to oxidative stress and cardiovascular outcomes in response to vitamin E (VitE) among patients with diabetes mellitus. Its effect on histologic response to VitE in nonalcoholic steatohepatitis (NASH) is unknown.

Goals:

Our objective was to determine if Hp genotype associates with response to VitE in patients with NASH.

Study:

A post hoc analysis of 228 patients receiving VitE or placebo in 2 clinical trials was performed. Regression analysis was used to assess the effect of VitE versus placebo, by Hp genotype (1-1, 2-1, or 2-2), on histologic features and laboratory markers of nonalcoholic fatty liver disease, comparing baseline to end of treatment values. An interaction term was included in the regression models to assess differential treatment effect across Hp genotype.

Results:

Hp 2-2 patients treated with VitE versus placebo showed significant histologic improvement (51% vs. 20%; OR=4.2; P=0.006), resolution of steatohepatitis (44% vs. 12%; OR=6.2; P=0.009), decrease in nonalcoholic fatty liver disease Activity Score (NAS) (−2.2 vs. −0.6; P=0.001), and decrease in liver enzymes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase. Hp 2-1 patients on VitE versus placebo showed improved resolution of steatohepatitis, NAS and liver enzymes. Hp 1-1 patients showed no significant improvement in histology or liver enzymes. VitE had no effect on fibrosis stage in any group. Regression analysis showed incremental benefit of having Hp 2-2 or 2-1 versus 1-1 for all liver enzyme.

Conclusions:

Hp 2 allele is associated with greater histologic and biological improvement in NASH with VitE treatment compared with the Hp 1 allele.
Pathogenesis and treatment of electrolyte problems post transplant
Authors: Kim Erin
Published: December 2018

Purpose of review

Electrolyte abnormalities posttransplant are common occurrences that can have significant short-term and long-term effects on graft outcome and patient quality of life. Understanding the pathophysiology of these electrolyte derangements can help guide management to optimize bone health and minimize cardiovascular disease. This review explores the pathogenesis of the most common postrenal transplant electrolytes abnormalities as well as current treatment options.

Recent findings

Clarifications of the role of FGF-23 has improved our understanding of posttransplant bone disease in addition to the known roles of hyperparathyroidism and vitamin D. The mechanisms of renal electrolyte wasting by immunosuppressive agents give insight into potential treatment options for hyperkalemia and hypomagnesemia.

Understanding the pathogenesis of the common electrolyte abnormalities found post renal transplant may lead to targeted treatment options that in turn may improve transplant complications. Further studies are required to evaluate the effects on long-term outcomes of renal allografts.
A Novel Mutation of Glucose Phosphate Isomerase (GPI) Causing Severe Neonatal Anemia Due to GPI Deficiency
Authors: Burger Nienke C.M. , van Wijk Richard , Bresters Dorine , Schell Eveline A.
Published: December 2018

Glucose-6-phosphate isomerase (GPI) deficiency is very rare, but one of the most common erythroenzymopathies, causing hereditary nonspherocytic hemolytic anemia. This case report describes the clinical features and the molecular etiology of a Dutch patient with GPI deficiency. She is the fifth patient with GPI deficiency identified to date in the Netherlands and was found to be compound heterozygous for the previously reported c.1615G>A p.(Asp539Asn) mutation and a novel c.271A>T p.(Asn91Tyr) variant.
Beliefs and Adherence Associated With Oral and Infusion Chelation Therapies in Jordanian Children and Adolescents With Thalassemia Major: A Comparative Study
Authors: Abu Shosha Ghada M.
Published: December 2018

The researcher assessed the beliefs and adherence associated with both oral deferasirox and deferoxamine infusion chelation therapies among Jordanian children with thalassemia major, and compared the adherence levels between the recipients of each. In this descriptive cross-sectional study, 120 participants were recruited from 3 major thalassemia treatment clinics in Jordan using convenience sampling. Data were collected through questionnaires on demographic- and disease-related information, the beliefs about medicines, and a medication adherence report scale. Most participants showed a high adherence to deferoxamine infusion and oral deferasirox (87.20% and 89.08%, respectively), and believed in the necessity of deferoxamine for maintaining health (89.34%). However, 41.32% of the participants had strong concerns about deferoxamine use. While most participants believed in the need for oral deferasirox (89.84%), about 40.7% had strong concerns about its use. An independent samplesttest showed no statistically significant difference in the adherence between the oral deferasirox and infusion deferoxamine recipients (t=1.048, DF=118,P=0.075). Jordanian children with thalassemia have positive beliefs and adherence to both oral and infusion chelation therapies. Health care providers should pay attention to patients’ beliefs and discuss the major concerns pertaining to iron chelation therapy with them to enhance the continuity of adherence therapy.
Speed and temporal adaptations during nonmotorized treadmill walking in Parkinson disease and nondisabled individuals
Authors: Penn I-Wen , Sung Wen-Hsu , Lin Pei-Hsin , Wang Jia-Chi , Chuang Eric , Chuang Tien-Yow , Kuo Chia-Yu
Published: December 2018

Few studies have explored the potential of gait analysis and training in nonmotorized treadmill (NMT) in Parkinson’s disease (PD) patients. We investigated (a) the walking strategy adopted by patients with PD on NMT and (b) how balance may influence spatiotemporal gait parameters. We enrolled 12 patients with PD of modified Hoehn and Yahr stage 2–3 and 13 nondisabled individuals as controls. All participants were evaluated using Tinetti’s performance oriented mobility assessment scale, freezing of gait questionnaire, modified falls efficacy scale, and the timed up and go test. They were asked to ambulate with comfortable and maximal speeds on the NMT. The gait parameters acquired on the NMT included walking speed, cadence (CAD), step length, and vertical ground reaction force, which were calculated for intragroup and intergroup comparisons. The PD group took on with higher contribution of CAD and less contribution of step length to increase walking speed as compared with control group. The postural stability is correlated significantly positively to the CAD at the setting of maximal speed in the PD group. Moreover, a significantly lower ratio of vertical ground reaction force/body weight was noted in the PD group during both comfortable and maximal walking speeds compared with the nondisabled controls. Our study outcomes clearly support the perceived benefits of NMT to differentiate spatiotemporal gait parameters between PD and controls. NMT may potentially be useful to evaluate the recovery of physical activities in PD receiving medications and/or rehabilitation.