Reply to O. Corli et al and M. Lucchesi et al

As with the letter from Corli and Ribeiro, the Data Supplement from our article provides readers further points for discussion on the relevant issue of clinically meaningful pain reduction

Il modello di sorveglianza ECAD_O –Epidemiologia Clinico-Assistenziale del Dolore in Ospedale: il contributo degli infermieri

Introduzione e obiettivi. Il dolore è un sintomo molto presente tra i pazienti ospedalizzati. Garantire un adeguato controllo è un diritto di ciascun paziente e pertanto un proposito da perseguire da parte del personale clinico-infermieristico. Il programma di sorveglianza ECAD_O si è proposto di esaminare, in un campione di ospedali, le terapie farmacologiche utilizzate per il controllo del dolore e rilevare la percezione dello staff assistenziale sul livello di controllo garantito. Metodi. Indagine trasversale multicentrica (48 ospedali) e multidisciplinare (118 infermieri, 109 clinici, 123 farmacisti), condotta in 6 giorni indice sui pazienti che in ospedale ricevono una terapia antalgica. Per ciascun paziente sono state raccolte informazioni epidemiologiche, cliniche e terapeutiche ed è stata effettuata, da parte dello staff assistenziale (clinico o infermiere), una valutazione sui motivi di eventuale non controllo del dolore. Risultati. All’indagine hanno partecipato 164 reparti (61 chirurgie, 46 medicine, 28 oncologie, 22 ortopedie, 7 altro) e sono stati osservati 3854 pazienti in trattamento con analgesici, corrispondenti al 20.9% dei pazienti degenti. Il tipo di dolore trattato era diversificato a seconda dei reparti di degenza. La maggior parte dei pazienti (84.3%) ha ricevuto una terapia antalgica (TA) ad orari fissi. I farmaci oppioidi sono stati utilizzati nel 64.7% dei pazienti con TA ad orari fissi e nel 27.1% di quelli con terapia solo al bisogno. Per 516 pazienti la terapia somministrata, secondo lo staff, non controlla il dolore in maniera adeguata. Nonostante questa valutazione 288 pazienti non ricevono alcun farmaco aggiuntivo (rescue therapy) o perché non prescritto (180 pazienti) o, anche se prescritto, non somministrato (108 pazienti). Conclusioni. Il programma ECAD_O ha permesso la costituzione di una rete multidisciplinare di ricerca, in cui il ruolo dell’infermiere è stato di fondamentale importanza. Il dolore, sintomo comune a molti pazienti e a molte aree assistenziali, risulta ancora poco considerato e non adeguatamente controllato. Una valutazione mirata e prospettica dei pazienti “non controllati” rimane una priorità assistenziale permanente, rispetto alla quale gli studi come questo rappresentano una prima fase ed un input importante

VASCULAR KATP CHANNELS REDUCE SEVERE MUSCLE O2-DELIVERY TO O2-UTILIZATION MISMATCH DURING CONTRACTIONS IN CHRONIC HEART FAILURE RATS

Alexander J. Fees1, Clark T. Holdsworth1, Scott K. Ferguson1, Trenton D. Colburn1, David C. Poole1,2, & Timothy I. Musch1,2 1Department of Anatomy and Physiology, 2Department of Kinesiology, Kansas State University, Manhattan, KS, 66506, USA The vascular ATP-sensitive K+ (KATP) channel is a regulator of skeletal muscle microvascular O2 pressure (PO2mv; set by the O2-delivery to O2-utilization ratio) during contractions. Inadequate tissue PO2mv during exercise in chronic heart failure (CHF) constrains exercise capacity and may be exaggerated by KATP channel inhibition. PURPOSE: We tested the hypotheses that 1) KATP channel inhibition via glibenclamide (GLI), often prescribed for hyperglycemic CHF patients, would augment the PO2mv undershoot, increase the time to reach the steady-state PO2mv and decrease the mean PO2mv during contractions of the spinotrapezius muscle in CHF rats and 2) these effects would be reversed by the administration of pinacidil (PIN, KATP channel activator). METHODS: Muscle PO2mv was measured via the phosphorescence quenching technique during 180s of 1-Hz twitch contractions (~6 V) under control, GLI (5 mg/kg), and PIN (5 mg/kg) conditions in 16 male Sprague-Dawley rats with CHF induced via myocardial infarction (left main coronary artery ligation). RESULTS: GLI augmented the PO2mv undershoot (control: 2.3 ± 0.4, GLI: 4.1 ± 0.5 mmHg, p\u3c0.05) and time-to-reach contracting steady state (control: 66.1 ± 10.2, GLI: 93.6 ± 7.8 s, p\u3c0.05), and reduced baseline (control: 28.3 ± 0.9, GLI: 24.8 ± 1.0 mmHg, p\u3c0.05) and mean PO2mv (control: 20.6 ± 0.6, GLI: 17.6 ± 0.3 mmHg, p\u3c0.05). PIN reversed these effects of GLI (p\u3c0.05 for all) indicating that the primary effects of GLI were KATP channel specific. CONCLUSIONS: KATP channels protect against severe mismatch of muscle O2-delivery to O2-utilization during contractions in CHF rats. These data suggest that sulphonylurea therapy (e.g. GLI) poses an additional constraint to muscle O2 delivery in CHF patients and may further compromise physical activity; a contributing factor to morbidity and mortality

USE OF SIT-TO- STAND WORKSTATIONS: IMPACT ON PHYSICAL ACTIVITY

Shiann Wickham, Catherine Patrick, Larissa Boyd, Melissa Powers University of Central Oklahoma, Edmond, Oklahoma Prolonged sitting affects daily total physical activity. Standing in order to break long periods of sitting may be beneficial to an individual’s health. PURPOSE: The purpose of this pilot study was to determine whether physical activity would change when using a sit-to-stand workstation in a workplace environment. METHOD: Volunteers from the faculty of the University of Central Oklahoma included apparently healthy male and female adults (N = 11, M = 39.09± 10.445 years). Participants were asked to use sit-to-stand workstations for a minimum of three hours per workday. The International Physical Activity Questionnaire (IPAQ) was used to measure self-reported daily physical activity. RESULTS: Dependent t-tests were used to analyze changes in self-reported physical activity over 5 months. Non-significant (p\u3e.05), meaningful improvements were seen in METmin/wk for walking (d=.19), total physical activity (d=.14), moderate activity (d=.01), and vigorous activity (d=.02). Total minutes of sit time per week (d=.25) and average daily minutes sitting (d=.25) decreased (p\u3e.05). CONCLUSION: Sit-to-stand workstations do provide an increase in daily physical activity levels. Although the results were non-significant, they do indicate a small decrease in time spent sitting along with small improvements in walking and total physical activity. Decreasing employee sitting time can increase the amount of physical activity achieved throughout the day. Future research should evaluate the use of sit-to-stand workstations in a larger, more diverse group of employees. See supplemental content for graphics

Schematic procedure Gene Expression and Genome CNA.

<p>Identification of up regulated genes with copy number gains and down regulated genes with copy number losses is showed.</p

Hazard ratio G3*vs G3.

<p>Hazard ratio G3*vs G3.</p

Heat maps for evaluation of our gene signatures in comparison with other gene signatures.

<p>III: combination of gene expression - genome CNA, and miRNA analysis, V: a down-sized gene signature (4 genes), Sotiriou et al. 97-gene signature, Ivshina et al. 18-gene signature and Ivshina et al. 6-gene signature. Classification performances were showed for: cross-validation (CV), and training on G1*–G3* - testing on G1–G3 (TT).</p

G1 vs. G3 classification performances (mRNA and miRNA): sensitivity, cross-validation.

1<p>standard deviation.</p

Hazard ratio G1*vs G1.

<p>Hazard ratio G1*vs G1.</p