Association between pain and the frailty phenotype in older men: longitudinal results from the Concord Health and Ageing in Men Project (CHAMP)

Objectives to determine whether pain increases the risk of developing the frailty phenotype and whether frailty increases the risk of developing chronic or intrusive pain, using longitudinal data. Design/Setting longitudinal data from the Concord Health and Ageing in Men Project (CHAMP), a prospective population based cohort study. Participants a total of 1,705 men aged 70 years or older, living in an urban area of New South Wales, Australia. Measurements data on the presence of chronic pain (daily pain for at least 3 months), intrusive pain (pain causing moderate to severe interference with activities) and the criteria for the Cardiovascular Health Study (CHS) frailty phenotype were collected in three waves, from January 2005 to October 2013. Data on age, living arrangements, education, smoking status, alcohol consumption, body mass index, comorbidities, cognitive function, depressive symptoms and history of vertebral or hip fracture were also collected and included as covariates in the analyses. Results a total of 1,705 participants were included at baseline, of whom 1,332 provided data at the 2-year follow-up and 940 at the 5-year follow-up. Non-frail (robust and pre-frail) men who reported chronic pain were 1.60 (95% confidence interval (CI): 1.02–2.51, P = 0.039) times more likely to develop frailty at follow-up, compared to those with no pain. Intrusive pain did not significantly increase the risk of future frailty. Likewise, the frailty status was not associated with future chronic or intrusive pain in the adjusted analysis. Conclusions the presence of chronic pain increases the risk of developing the frailty phenotype in community-dwelling older men.NHMRC, The Ageing and Alzheimer's Institut

Ratios of involved nodes in early breast cancer

INTRODUCTION: The number of lymph nodes found to be involved in an axillary dissection is among the most powerful prognostic factors in breast cancer, but it is confounded by the number of lymph nodes that have been examined. We investigate an idea that has surfaced recently in the literature (since 1999), namely that the proportion of node-positive lymph nodes (or a function thereof) is a much better predictor of survival than the number of excised and node-positive lymph nodes, alone or together. METHODS: The data were abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results (SEER) program of women diagnosed with nonmetastatic T1–T2 primary breast carcinoma between 1988 and 1997, in whom axillary node dissection was performed. The end-point was death from breast cancer. Cox models based on different expressions of nodal involvement were compared using the Nagelkerke R(2 )index (R(2)(N)). Ratios were modeled as percentage and as log odds of involved nodes. Log odds were estimated in a way that avoids singularities (zero values) by using the empirical logistic transform. RESULTS: In node-negative cases both the number of nodes excised and the log odds were significant, with hazard ratios of 0.991 (95% confidence interval 0.986–0.997) and 1.150 (1.058–1.249), respectively, but without improving R(2)(N). In node-positive cases the hazard ratios were 1.003–1.088 for the number of involved nodes, 0.966–1.005 for the number of excised nodes, 1.015–1.017 for the percentage, and 1.344–1.381 for the log odds. R(2)(N )improved from 0.067 (no nodal covariate) to 0.102 (models based on counts only) and to 0.108 (models based on ratios). DISCUSSION: Ratios are simple optimal predictors, in that they provide at least the same prognostic value as the more traditional staging based on counting of involved nodes, without replacing them with a needlessly complicated alternative. They can be viewed as a per patient standardization in which the number of involved nodes is standardized to the number of nodes excised. In an extension to the study, ratios were validated in a comparison with categorized staging measures using blinded data from the San Jose–Monterey cancer registry. A ratio based prognostic index was also derived. It improved the Nottingham Prognostic Index without compromising on simplicity

Detecting Heart Rate from Virtual Reality Headset-Embedded Inertial Sensors: A Kinetic Energy Approach

At each cardiac beat, blood flowing through the arterial tree produces micro-movements that can be measured by positioning inertial sensors in contact with the body. The resulting signal is the ballistocardiogram (BCG). The study aims to demonstrate the feasibility to exploit inertial sensors embedded in a virtual reality (VR) headset to estimate heart rate (HR). Eight volunteers were enrolled. 1-minute head BCG signals were acquired in supine, sitting and standing position using the tri-axial accelerometer and gyroscope (fs=71[71;77] Hz) integrated in a Oculus Quest (Facebook) VR headset. Linear and rotational kinetic energies were computed and used to automatically detect cardiac beats. Inter-beat intervals were extracted and mean HR was computed. In addition, 1-lead ECG signal was acquired and used as a gold standard for HR measurement. The HR values computed from BCG in each posture were compared with the gold standard (Wilcoxon Signed Rank Test, p< 0.05). Correlation (r2) and Bland Altman analyses were also performed. Best results were obtained using the rotational kinetic energy derived by the gyroscope, obtaining HRs comparable to the gold standard in both supine and sitting postures, with high correlation, no bias, and acceptable limits of agreement. In standing posture, the balancing movements for body equilibrium maintenance contributed reducing HR estimate accuracy. This is the first study in which HR has been measured using kinetic energy computed from the head-BCG obtained with a commercial VR headset, providing important insights on the possibility to expand the use of inertial units to accurately and non-invasively monitor physiological parameters

Virtual reality for assessing visual quality and lighting perception: A systematic review

The achievement of a good visual environment is key to guaranteeing human satisfaction indoors. In this context, it is crucial to assess the visual environment through the measurement of human perception. However, the assessment of the visual environment through human perception is often complicated. Using real spaces or mock-ups is time consuming, costly, and does not allow the control of all possible variables (e.g., daylight). Photorealistic rendered images present several limitations, starting from the veracity of the visual stimulus presented to participants. Virtual Reality (VR) is emerging as a valid alternative for evaluating the perception of the indoor visual environment due to the ability to control selected variables, analyse cause-effect relationships, and save time and cost, especially for the evaluation of daylit spaces. The high level of immersion and the possibility of interaction provide an opportunity to study users' perceptions and behaviors. However, some aspects of light assessment in VR need further investigations, such as the comparability of the perception of light in real and virtual environments. This paper reviews the available literature on the topic, highlighting the advantages and disadvantages related to the use of VR for lighting research and design. Previous research is classified into 1) studies focused on the comparability between lighting conditions in VR and real environments; 2) studies about users’ perception and behavior with respect to lighting scenarios in VR; and 3) studies exploiting VR for lighting design. Hardware and software used in existing literature are further analyzed. This paper highlights that more studies are needed to define a common investigation protocol to make VR a valid investigation tool for lighting research studies aimed at evaluating visual quality and lighting perception

Kn-Ba: a novel serine protease isolated from Bitis arietans snake venom with fibrinogenolytic and kinin-releasing activities

Abstract Background Bitis arietans is a venomous snake found in sub-Saharan Africa and in parts of Morocco and Saudi Arabia. The envenomation is characterized by local and systemic reactions including pain, blistering, edema and tissue damage, besides hemostatic and cardiovascular disturbances, which can cause death or permanent disabilities in its victims. However, the action mechanisms that provoke these effects remain poorly understood, especially the activities of purified venom components. Therefore, in order to elucidate the molecular mechanisms that make the Bitis arietans venom so potent and harmful to human beings, this study reports the isolation and biochemical characterization of a snake venom serine protease (SVSP). Methods Solubilized venom was fractionated by molecular exclusion chromatography and the proteolytic activity was determined using fluorescent substrates. The peaks that showed serine protease activity were determined by blocking the proteolytic activity with site-directed inhibitors. In sequence, the fraction of interest was submitted to another cycle of molecular exclusion chromatography. The purified serine protease was identified by mass spectrometry and characterized biochemically and immunochemically. Results A serine protease of 33 kDa with fibrinogen-degrading and kinin-releasing activities was isolated, described, and designated herein as Kn-Ba. The experimental Butantan Institute antivenom produced against Bitis arietans venom inhibited the Kn-Ba activity. Conclusions The in vitro activities of Kn-Ba can be correlated with the capacity of the venom to provoke bleeding and clotting disorders as well as hypotension, which are common symptoms presented by envenomed victims. Obtaining satisfactory Kn-Ba inhibition through the experimental antivenom is important, given the WHO’s recommendation of immunotherapy in cases of human accidents with venomous snakes

A MULTICENTER, TRIPLE-BLIND STUDY TO EVALUATE GALACTOSAMINOGLUCURONOGLYCAN SULFATE VERSUS PLACEBO IN PATIENTS WITH FEMOROTIBIAL GONARTHRITIS

In the study were included 226 patients with Oa of the knee. After 1 year, the ecographic findings revealed that GAGS treated patients preserved articular cartilage thikness