Breakthrough pain in oncology: a longitudinal study.

Abstract CONTEXT: Existing studies on breakthrough pain (BP) have reported different prevalence rates because of different settings, populations, and assessment methods. These studies have used cross-sectional designs, and the relationship of BP with analgesic treatment has not been evaluated. OBJECTIVES: The aim of this study was to longitudinally assess BP in cancer patients admitted to oncology units. METHODS: A consecutive sample of patients admitted to oncology centers was selected. At admission (T0), three months after admission (T3), and six months after admission (T6), data on background pain and BP were recorded. BP was assessed in terms of its intensity, duration, number of episodes, onset with movement, spontaneous relief after stopping activity, limitation of physical activity, and effectiveness of analgesics. RESULTS: Three hundred two patients completed the study. At T0, T3, and T6, 39%, 38%, and 33% patients, respectively, had continuous pain (P=0.294). Pain intensity significantly decreased (P=0.004 and 0.027 at T3 and T6, respectively). Most patients had BP at T0 (87.1%), T3 (80.9%), and T6 (73.2%), and there was a significant decrease in the prevalence of BP over time (P=0.016). Of 149 patients with BP, pain on movement was recorded in 43.6%, 43.4%, and 32.4% at T0, T3, and T6, respectively (P=0.228). Pain spontaneously decreased or ceased when stopping physical activity in 66%, 56%, and 62% at T0, T3, and T6, respectively (P=0.537). Pain on movement strongly limited physical activity in most patients. CONCLUSION: These data expand current information about BP and underline the need for a longitudinal assessment of a phenomenon that is invariably dependent on stage of disease, patient, and therapeutic factors

Prediction of rehabilitation induced motor recovery after stroke using a multi-dimensional and multi-modal approach

Background: Stroke is a debilitating disease affecting millions of people worldwide. Despite the survival rate has significantly increased over the years, many stroke survivors are left with severe impairments impacting their quality of life. Rehabilitation programs have proved to be successful in improving the recovery process. However, a reliable model of sensorimotor recovery and a clear identification of predictive markers of rehabilitation-induced recovery are still needed. This article introduces the cross-modality protocols designed to investigate the rehabilitation treatment’s effect in a group of stroke survivors. Methods/design: A total of 75 stroke patients, admitted at the IRCCS San Camillo rehabilitation Hospital in Venice (Italy), will be included in this study. Here, we describe the rehabilitation programs, clinical, neuropsychological, and physiological/imaging [including electroencephalography (EEG), transcranial magnetic stimulation (TMS), and magnetic resonance imaging (MRI) techniques] protocols set up for this study. Blood collection for the characterization of predictive biological biomarkers will also be taken. Measures derived from data acquired will be used as candidate predictors of motor recovery. Discussion/summary: The integration of cutting-edge physiological and imaging techniques, with clinical and cognitive assessment, dose of rehabilitation and biological variables will provide a unique opportunity to define a predictive model of recovery in stroke patients. Taken together, the data acquired in this project will help to define a model of rehabilitation induced sensorimotor recovery, with the final aim of developing personalized treatments promoting the greatest chance of recovery of the compromised functions

Production of subject-verb agreement, tense, mood, and negation in Italian agrammatic aphasia

Impaired (morpho)syntactic production is the hallmark of agrammatic aphasia. Several hypotheses have been proposed to account for agrammatic production, which often make different predictions. The Distributed Morphology Hypothesis (DMH) (Wang et al., 2014) posits that categories involving inflectional alternations are impaired in agrammatism. The Tense Underspecification Hypothesis (TUH) (Wenzlaff & Clahsen, 2004, 2005) states that what is impaired (\u201cunderspecified\u201d) is tense; subject-verb agreement and mood are well-preserved. The Interpretable Features\u2019 Impairment Hypothesis (IFIH) (Fyndanis et al., 2012) predicts categories involving integration processes (e.g., tense, mood, negation) to be more impaired than categories that do not involve integration processes (e.g., agreement). The Tree Pruning Hypothesis (TPH) (Friedmann & Grodzinsky, 1997) states that the syntactic tree is pruned at a specific node, usually tense, with all nodes/categories above the pruning site deleted/inaccessible and all nodes below intact. To reliably test these accounts, one should test agrammatic speakers on a wide range of (morpho)syntactic phenomena/categories. In this study, we investigate the ability of Italian-speaking agrammatic individuals to produce subject-verb agreement, tense, mood, and sentential negation. A sentence completion task (SCT) tapping agreement and tense, a SCT assessing mood, and a constituent ordering task tapping negation were administered to eight native speakers of Italian with chronic agrammatic aphasia and eight controls. Results are presented in Table 1. The control group performed better than the aphasic group on all four conditions. Both groups showed similar patterns of performance, with better performance on agreement and tense than on mood. Negation was better preserved than agreement, tense, and mood in the aphasic group, but in the control group negation was not different from any other category. At the individual level, five agrammatic participants exhibited the same pattern of performance (agreement/tense/negation>mood). At the group level, the results of the agrammatic participants are not consistent with any of the hypotheses discussed here. Contrary to the TUH, participants performed better on tense than on mood. The DMH cannot explain the observed, selective impairment of categories involving inflectional alternations (tense/agreement>mood). Results do not support the TPH, as the higher the category in the syntactic hierarchy (Neg>T(future/past)>M) (Cinque, 1999; Zanuttini, 2001), the better the performance of agrammatic participants. Lastly, results are at odds with the IFIH, because negation (+integration processes) is better preserved than agreement (-integration processes). Analogous results are observed at the individual level. None of the available hypotheses can account for the patterns of performance of all the agrammatic participants. Their results, together with the production results of other agrammatic speakers in the literature, show that all possible patterns can be observed in agrammatism, and that a unitary account of the disorder is unlikely to succeed. We suggest that subject-specific characteristics (e.g., site/type/volume of brain damage, type/severity of language impairment, education, age) and language-specific properties of functional categories (e.g., syntactic hierarchy, interpretability/involvement of integration processes, frequency) may interact in determining the way in which (morpho)syntactic impairments manifest themselves across agrammatic speakers and languages

Genetic Modifiers of Cystic Fibrosis-Related Diabetes

Diabetes is a common age-dependent complication of cystic fibrosis (CF) that is strongly influenced by modifier genes. We conducted a genome-wide association study in 3,059 individuals with CF (644 with CF-related diabetes [CFRD]) and identified single nucleotide polymorphisms (SNPs) within and 5′ to the SLC26A9 gene that associated with CFRD (hazard ratio [HR] 1.38; P = 3.6 × 10−8). Replication was demonstrated in 694 individuals (124 with CFRD) (HR, 1.47; P = 0.007), with combined analysis significant at P = 9.8 × 10−10. SLC26A9 is an epithelial chloride/bicarbonate channel that can interact with the CF transmembrane regulator (CFTR), the protein mutated in CF. We also hypothesized that common SNPs associated with type 2 diabetes also might affect risk for CFRD. A previous association of CFRD with SNPs in TCF7L2 was replicated in this study (P = 0.004; combined analysis P = 3.8 × 10−6), and type 2 diabetes SNPs at or near CDKAL1, CDKN2A/B, and IGF2BP2 were associated with CFRD (P < 0.004). These five loci accounted for 8.3% of the phenotypic variance in CFRD onset and had a combined population-attributable risk of 68%. Diabetes is a highly prevalent complication of CF, for which susceptibility is determined in part by variants at SLC26A9 (which mediates processes proximate to the CF disease-causing gene) and at four susceptibility loci for type 2 diabetes in the general population

Electrophysiological Correlates of Strategic Monitoring in Event-Based and Time-Based Prospective Memory

Prospective memory (PM) is the ability to remember to accomplish an action when a particular event occurs (i.e., event-based PM), or at a specific time (i.e., time-based PM) while performing an ongoing activity. Strategic Monitoring is one of the basic cognitive functions supporting PM tasks, and involves two mechanisms: a retrieval mode, which consists of maintaining active the intention in memory; and target checking, engaged for verifying the presence of the PM cue in the environment. The present study is aimed at providing the first evidence of event-related potentials (ERPs) associated with time-based PM, and at examining differences and commonalities in the ERPs related to Strategic Monitoring mechanisms between event- and time-based PM tasks

Nef divisors for moduli spaces of complexes with compact support

In [BM14b], the first author and Macr\`i constructed a family of nef divisors on any moduli space of Bridgeland-stable objects on a smooth projective variety X. In this article, we extend this construction to the setting of any separated scheme Y of finite type over a field, where we consider moduli spaces of Bridgeland-stable objects on Y with compact support. We also show that the nef divisor is compatible with the polarising ample line bundle coming from the GIT construction of the moduli space in the special case when Y admits a tilting bundle and the stability condition arises from a \theta-stability condition for the endomorphism algebra. Our main tool generalises the work of Abramovich--Polishchuk [AP06] and Polishchuk [Pol07]: given a t-structure on the derived category D_c(Y) on Y of objects with compact support and a base scheme S, we construct a constant family of t-structures on a category of objects on YxS with compact support relative to S.Comment: 36 pages. In memory of Johan Louis Dupont. V2: updated following comments from the referee and from Joe Karmazyn who gave a counterexample to a false claim in version 1. To appear in Selecta Mat

L’emorroidectomia secondo Milligan-Morgan con bisturi ad ultrasuoni

Premessa: L’emorroidectomia secondo Milligan-Morgan rappre - senta tutt’oggi il trattamento di scelta per la patologia emorroidaria. Il dolore post-operatorio rimane comunque la complicanza più temu - ta dai pazienti e molteplici sono le ricerche rivolte a ridurne l’inten - sità. Scopo del presente lavoro è stato quello di valutare se nell’emor - roidectomia secondo Milligan-Morgan l’uso del bisturi ad ultrasuoni possa ridurre il dolore post-operatorio. Materiali e metodi: Trenta pazienti affetti da emorroidi di III e IV grado sono stati inclusi nello studio e suddivisi in due gruppi. Nel I gruppo l’emorroidectomia sec. Milligan-Morgan è stata praticata utilizzando strumenti convenzionali, nel II gruppo lo stesso interven - to è stato effettuato con il bisturi ad ultrasuoni. Sono stati valutati: la durata dell’intervento, il tempo di degenza, il tempo di apertura dell’alvo alle feci, i tempi di completa riepitelizzazione e di ritorno alle normali attività, le complicanze, il dolore e la quantità di anal - gesici somministrati. Risultati: Nei pazienti del II gruppo è stato osservato un minor tempo di riepitelizzazione delle ferite con ridotta estensione della necrosi e dell’infiltrato flogistico associato ad una riduzione del dolore post-operatorio e ad un minor consumo di analgesici. C o n c l u s i o n i: L’utilizzo del bisturi ad ultrasuoni nell’emorroi - dectomia sec. Milligan- Morgan, rispetto agli strumenti convenziona - li, riduce il dolore post-operatorio e consente un accorciamento dei tempi di guarigione con un precoce ritorno alle normali attività. Per tale motivo il suo utilizzo, nonostante, i più elevati costi, appare van - taggioso

A painless treatment undergoing Milligan-Morgan hemorrhoidectomy

Background: Postoperative pain associated with Milligan Morgan haemorrhoidectomy (MMIf) remains problematic. Most patients complaint a severe pain on defecation and in the 1st postoperative week because of secondary infection a fid sphincter spasm. We studied the effect of metronida zole, lactulose and glyceryl-trinitrate on pain after MMH. Method: Thirty patients were randomly assigned to two groups. The 1st received a treatment with oral laxative (lac- tulose 66,7%) metronidazole and a topical glyceryl-trinitrate ointment at 0,2% both pre and postoperative; the 2nd received a placebo at the same dosage. The amount of pain in the 1st week and at the time of two defecation, postoperative analgesic requirement ana time to return to normal activities were documented. Results: A significant differences in the score pain on 2nd and 3rd day and on the 1st two defecation were observed among group. Analgesic consumption was highest in the pla-cebo group. Conclusion: The treatment with lactulose, metronidazole and topic glyceryl-trinitrate in patients undergoing MMH, seems to reduce secondary pain and increase patients satisfaction and earlier return to work with improvement of cost and benefit