Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

Mass spectrometry and multivariate analysis to classify cervical intraepithelial neoplasia from blood plasma: an untargeted lipidomic study

Cervical cancer is still an important issue of public health since it is the fourth most frequent type of cancer in women worldwide. Much effort has been dedicated to combating this cancer, in particular by the early detection of cervical pre-cancerous lesions. For this purpose, this paper reports the use of mass spectrometry coupled with multivariate analysis as an untargeted lipidomic approach to classifying 76 blood plasma samples into negative for intraepithelial lesion or malignancy (NILM, n = 42) and squamous intraepithelial lesion (SIL, n = 34). The crude lipid extract was directly analyzed with mass spectrometry for untargeted lipidomics, followed by multivariate analysis based on the principal component analysis (PCA) and genetic algorithm (GA) with support vector machines (SVM), linear (LDA) and quadratic (QDA) discriminant analysis. PCA-SVM models outperformed LDA and QDA results, achieving sensitivity and specificity values of 80.0% and 83.3%, respectively. Five types of lipids contributing to the distinction between NILM and SIL classes were identified, including prostaglandins, phospholipids, and sphingolipids for the former condition and Tetranor-PGFM and hydroperoxide lipid for the latter. These findings highlight the potentiality of using mass spectrometry associated with chemometrics to discriminate between healthy women and those suffering from cervical pre-cancerous lesions

‘Writing Now’

This chapter considers the themes and forms that characterise women’s writing in the new millennium. Post-9/11, self-representation has become a particularly urgent task for Muslim writers such as Monica Ali and Leila Aboulela. A concern with refugees, asylum seekers, and modern forms of slavery becomes increasingly prominent, not only in fiction – for example, Fadia Faqir’s My Name is Salma (2007) and Monica Ali’s In the Kitchen (2009) – but also in the theatre: Kay Adshead’s The Bogus Woman (2000), Sonja Linden’s Crocodile Seeking Refuge (2005), Christine Bacon’s Rendition Monologues (2008), Rukhsana Ahmad and Oladipo Agboluaje’s Footprints in the Sand (2008), Natasha Walter's Motherland (2008), and Gbemisola Ikumelo’s Next Door (2010). The impact of global capitalism, consumerism, and branding are explored in novels such as Scarlett Thomas’ Popco (2004), Ali Smith’s Girl Meets Boy (2007), and Winterson’s The Stone Gods (2007). Ageing is another major theme. Long a pre-occupation of Doris Lessing, it features also in Liz Jensen’s War Crimes for the Home (2002) and Alison Fell’s Tricks of the Light (2003). Anxieties about climate change and environmental apocalypse are addressed through dystopia in Maggie Gee’s The Ice People (1998) and The Flood (2004), Jeanette Winterson’s The Stone Gods (2007), Sarah Hall’s The Carhullen Army (2007), and Liz Jensen’s The Rapture (2009). Following Suniti Namjoshi’s pioneeringly collaborative Building Babel (1996), the use of multimedia in Maya Chowdhry’s digital poetry, Kate Pullinger’s ‘networked’ wikinovel Flight Paths (2005-), and the ‘visual novel’ (an interactive fiction game), gives literature an entirely new shape

The Toxicogenomic Multiverse: Convergent Recruitment of Proteins Into Animal Venoms

Throughout evolution, numerous proteins have been convergently recruited into the venoms of various animals, including centipedes, cephalopods, cone snails, fish, insects (several independent venom systems), platypus, scorpions, shrews, spiders, toxicoferan reptiles (lizards and snakes), and sea anemones. The protein scaffolds utilized convergently have included AVIT/colipase/prokineticin, CAP, chitinase, cystatin, defensins, hyaluronidase, Kunitz, lectin, lipocalin, natriuretic peptide, peptidase S1, phospholipase A2, sphingomyelinase D, and SPRY. Many of these same venom protein types have also been convergently recruited for use in the hematophagous gland secretions of invertebrates (e.g., fleas, leeches, kissing bugs, mosquitoes, and ticks) and vertebrates (e.g., vampire bats). Here, we discuss a number of overarching structural, functional, and evolutionary generalities of the protein families from which these toxins have been frequently recruited and propose a revised and expanded working definition for venom. Given the large number of striking similarities between the protein compositions of conventional venoms and hematophagous secretions, we argue that the latter should also fall under the same definition